Notice

IN THE MATTER OF ​​ THE COLLEGE OF REGISTERED NURSES OF

BRITISH COLUMBIA (the “College”)  and  IN THE MATTER OF A HEARING PURSUANT TO SECTION 38 OF THE HEALTH PROFESSIONS ACT INTO THE CONDUCT OF JULIET WAL​​​​SH, R.N. REGISTRATION NO. 745491 (“Ms. Walsh” or the “Registrant”)

On April 8, 2010, the Panel made a finding in this matter pursuant to the Health Professions Act (the “Act”) as follows:

The Panel, after consideration of the evidence and arguments presented before it, finds that Ms. Walsh [the Registrant] has committed unprofession​​al conduct pursuant to Section 39(1)(c) and has incompetently pra​cticed as a Registered Nurse pursuant to Section 39(1)(d).  (the “April 8 Decision”)

The Panel made a publication order and advised that it would seek further submissions from the parties with respect to the appropriate remedy pursuant to Section 39(2) of the Act.  The parties agreed that the question of remedy could be resolved by way of written submissions.

The Panel subsequently received significant written submissions and correspondence from the parties with respect to Remedy.  These include, but are not limited to, submissions from Ms. Walsh, dated August 11 and October 6 and 30, 2011 and from the College, dated September 9 and October 13, 2011.  The Panel has considered all of these submissions and has taken them into account along with its previous findings and the evidence submitted by the parties through the course of the hearing in order to arrive at its conclusions with respect to Remedy.

Subsequent to the April 8 Decision, and at the suggestion of counsel for the College, Ms. Walsh agreed to undergo an assessment by a neuropsychologist (the “Neuropsychologist’s Report”) as well as a Competency Assessment & Enhancement for Nurses (“CAEN”) by an assessor at Kwantlen College (the “CAEN Assessment”).  These reports, dated December 16, 2010 and July 13, 2011, respectively, were provided to the Panel for its consideration along with the Parties’ submissions.  The Panel has carefully considered the content of these reports, however in order to respect Ms. Walsh’ privacy it will only refer to these reports to the extent necessary to explain its decision herein.

FINDINGS OF FACT

As noted, the Panel made a number of factual findings in the April 8 Decision and the Panel has taken these facts into account.  The Panel has received additional evidence from the Parties for the purpose of its remedial considerations and the findings based on this evidence are set out below.

The conclusions set out in Neuropsychologist’s Report and CAEN Assessment were not challenged by Ms. Walsh in any material way.  We also view the conclusions in these reports to be consistent with the evidence heard from the Parties.

Upon review of the Neuropsychologist’s Report, the Panel has concluded as follows:

1. Ms. Walsh’s ability to manage multiple task demands effectively and/or to recognize errors is limited;
2. Working in high traffic rapidly changing settings that require quick, independent decision making is likely to be challenging for Ms. Walsh; and,
3. Ms. Walsh’s difficulties are likely to be long-standing.

Upon review of the CAEN Assessment, the Panel has concluded that Ms. Walsh suffers from shortcomings (or “gaps” as described in the CAEN Assessment) in the following areas:

1. Professional Responsibilities;
2. General Nursing Knowledge;
3. Comprehensive Physical Assessment;
4. Psychomotor Skills; and,
5. Clinical Practice.

The Panel has also considered and accepted the evidence set out in the Affidavit of David McDonald with respect to the limits set out in the above reports and Ms. Walsh’s resulting inability to practice or teach nursing in any environment at this time.

The Panel was also advised through the submission process that, during the course of her interim suspension, Ms. Walsh has not renewed her registration with the College and so is currently not a member.

CONCLUSIONS BASED ON FINDINGS OF FACT

Based on these findings of fact, the Panel has come to the conclusion that Ms. Walsh is unable to safely practice nursing and presents a significant risk to the public.

The Panel has been persuaded, for the reasons set out above and in the College’s submissions, along with the events giving rise to the citation, that Ms. Walsh should not be eligible to engage in the practice of nursing.  As a result, having made the determinations pursuant to s. 39(1) of the Act in the April 8 Decision, the Panel has now determined pursuant to s. 39(2) that the interim suspension of Ms. Walsh’s registration should now be changed to a cancellation of the registration pursuant to s. 39(2)(e) of the Act, and the Panel so orders.

The Panel recognizes that Ms. Walsh’s registration has already lapsed as a result of her failure to maintain her registration.  However, given the seriousness of the events leading to the April 8 Decision and the Panel’s obligation to consider the risk to the public presented by these facts, the Panel wishes to provide its formal determination that cancellation of Ms. Walsh’s registration is the appropriate remedy in these circumstances.  For the same reasons, the Panel also orders pursuant to s. 39(8)(b) of the Act that Ms. Walsh is not eligible to apply for reinstatement of her registration until January 1, 2014.

The Panel has considered the College’s detailed proposal with respect to the appropriate remedies, as well as Ms. Walsh’s October 6, 2011 response to the College’s proposals.  The College has submitted that Ms. Walsh’s suspension should be confirmed and that the suspension should not be lifted, and re-registration not granted, until Ms. Walsh has successfully completed a significant number of steps.  The College has also proposed that the Panel retain jurisdiction to play an ongoing supervisory role in determining whether Ms. Walsh has satisfactorily completed these steps.

With respect to this latter proposal, the Panel is not inclined in these circumstances, particularly given its decision to impose a significant period of ineligibility, to retain jurisdiction to determine whether conditions for reinstatement have been met.  While the Act provides the Panel with the jurisdiction to determine whether any conditions should be placed on the registrant’s reinstatement and to determine whether these conditions have been met, it is the Panel’s view that in these circumstances it would be both more practical and appropriate for the College to retain and exercise its regulatory and enforcement role with respect to any conditions that may be appropriate should Ms. Walsh apply for reinstatement of her registration at some future date.

As noted in the College’s September 9, 2011 submissions, any application for registration is subject to s. 20 of the Act.  Section 20(2.1) provides the College with the jurisdiction to refuse to grant the registration, or to grant the registration with any limits or conditions it deems appropriate, in the case of an application by a registrant that has had her registration cancelled in British Columbia.

The Panel has considered the conditions for re-instatement proposed by the College.  If Ms. Walsh is able to satisfy the College that she is capable of safely engaging in the practice of nursing then the Panel views these conditions, as a minimum, to be sensible.  However, having formally cancelled Ms. Walsh’s registration pursuant to s. 39(2)(e), and imposing a significant period of ineligibility for registration, the Panel is content to allow the College to exercise its jurisdiction to impose any or all of these conditions (or others that it deems appropriate) pursuant to s. 20 of the Act, should Ms. Walsh apply for registration in the future.

To summarize, the Panel orders that:

1. Pursuant to s. 39(2)(e) of the Act, Ms. Walsh’s registration is cancelled;
2. Pursuant to s. 39(8)(b) of the Act, Ms. Walsh is ineligible for reinstatement of her registration until January 1, 2014, and after that time will be subject to any conditions or limitations that may be imposed by the College in exercise of its jurisdiction pursuant to s. 20 and the other relevant provisions of the Act and Bylaws; and,
3. Pursuant to s. 39.3(1)(e) of the Act, the Registrar of the College shall notify the public of this Order.

The College has not expressly sought costs in this matter and so the Panel makes no order pursuant to s. 39(5) of the Act.  In any event, the Panel is of the view that an order for costs would not be appropriate in these circumstances.

Pursuant to s. 39(3)(d) of the Act, the Panel notes that Ms. Walsh may appeal this decision to the Supreme Court of British Columbia, pursuant to s. 40 of the Act.