Getting it Right the First
Time:
Applying Research to Reduce
Recidivism
Presentation by:
Karen McGovern, RN, BScN, LLB
Manager, Hearings Program
College of Nurses of Ontario
This session will:
• Explore issues of recidivism in
regulatory discipline based on a
retrospective study of CNO Discipline
cases completed in the last five years;
• Consider study findings in the context
of current research regarding criminal
recidivism;
• Identify possible future directions for
regulators
College of Nurses of
Ontario
Retrospective Audit of Discipline
Cases from 1998 - 2003
The Complaints Process
Investigations & Hearings
Department receives letter of complaint
Member notified of complaint
Complaint investigated
Member responds to complaint
Case report forwarded to Complaint Committee
Complaints Committee makes a decision about the complaint
Option:
Case referred to
Discipline Committee
Option:
Case referred to
Executive Committee for
purposes of incapacity
Option: Committee may:
Take no action
Remind member
Give advice to member
Issue written caution
Issue oral caution
Refer to Quality Assurance
Frivolous and Vexatious
Complainant and member can request
review by Health Professions Board
For the purposes of the
audit:
• A recidivist is a licensee/member
who has a prior Discipline finding
• Does not include prior complaints
or reports where no action was
taken or where screening committee
took remedial approach (e.g. letter
of caution, reminder)
Summary of Recidivism in
Relation to Disciplined Members
Year
Total cases
with
discipline
outcomes
Number with
prior
discipline
action
Recidivism
Rate
1998
20
1
5%
1999
26
1
4%
2000
42
2
5%
2001
34
2
6%
2002
40
2
5%
Total
162
8 Average= 5%
Findings –
Rate of Recidivism
• Eight cases out of a total of 162
cases = 5%
• Criminal recidivism rate:
- in U.S. = 39-53%
- in Canada = 16.1%
Recidivism – Disciplined Members with Prior
Discipline Action
Case
Reference
Date
Disposition
Nature of Conduct
Case A
28/10/02
Suspension/reprimand
Failing to comply with
discipline order
10/11/98
Suspension/condition/
reprimand
Falsifying a record
14/06/93
Suspension/condition/
reprimand
Verbal abuse
01/01/80
Revoke
(member reinstated
26/01/81)
Poor interpersonal
communication
12/06/02
Suspension/condition/
reprimand
Misappropriating property
11/11/98
Suspension/condition/
reprimand
Collecting pay under false
pretences
Case B
Recidivism – Disciplined Members with Prior
Discipline Action
Case
Reference
Date
Disposition
Nature of Conduct
Case C
01/11/01
Revocation
Failure to comply with
discipline order
26/06/00
Suspension/condition
/reprimand
Failure to comply with College
undertaking/providing false info
to employer/public/colleagues
19/03/98
Letter of concern and
Meeting with Member
Poor interpersonal
communication/
administered unauthorized
treatments
25/03/97
Undertaking signed
Mental health issues
Verbal & emotional abuse
22/08/01
Suspension/condition
reprimand
23/01/91
Withdrawn
No info on file
01/05/78
Revocation
Reinstated 18/12/81
Case D
Recidivism – Disciplined Members with Prior
Discipline Action
Case
Reference
Date
Disposition
Nature of Conduct
Case E
22/02/00
Suspension/condition/reprimand
Theft of medications
11/09/90
Suspension/condition/reprimand
Conviction for theft
under $1000
22/03/82
Letter of caution
Theft
21/11/00
Reprimand
Breach of
confidentiality
17/09/90
Condition/reprimand
Unsatisfactory nursing
practice
03/11/99
Suspension/condition/reprimand
Boundary violation
03/04/98
Suspension/condition/reprimand
Conflict of interest
20/09/88
Take no action
Unsatisfactory nursing
practice
20/05/98
Suspension/condition/reprimand
Provided false
information to
employer/public/
colleague
11/09/95
Suspension/condition/reprimand
Verbal abuse
14/04/83
Reprimand
Conviction for
shoplifting
Case F
Case G
Case H
Findings – nature of
misconduct
• All recidivists were disciplined at some
point for matters involving conduct /
moral turpitude
• There were no recidivists who were
disciplined for practise/standards issues
alone
• In six of the eight cases, the
licensee/member’s subsequent
discipline finding was in relation to
conduct, not practice
Findings –matters similar to
previous discipline
• Half of cases involved matters
similar in nature to the prior
discipline.
• In these four cases, the subsequent
discipline finding was in relation
to conduct e.g. abusive behaviour,
theft/fraud/governance issues
Trends
• Conduct / moral turpitude, not
practice, is the basis for the
majority of cases in which
licensees/ members commit
repeated misconduct.
• Recidivists have problems with
acting morally and ethically, rather
than problems in respect of their
practice
Making the connection between
regulatory and criminal recidivism
• Moral turpitude basis for
behaviour
• Similar aims and methods used in
addressing conduct
• Sentencing principles of public
protection; deterrence, specific and
general; and rehabilitation
Criminal Recidivism
Research
• Since mid-1970’s, trend away
from rehabilitation and towards
punishment as best method to
reduce recidivism – “get tough on
crime”
• Belief that harsher punishment
will deter re-offending
Solicitor General, Canada (2002)
• Findings showed that harsher criminal
justice sanctions had no deterrent effect
on recidivism; in fact, punishment
produced a 3% increase in recidivism.
Consistent across gender, age and
ethnicity
• Imprisonment v. community sanctions
produced a higher recidivist rate.
• Longer jail sentences were associated
with higher recidivism rates
Implications
• Policies to reduce recidivism based on
“getting tough on crime” have no
empirical basis
• Imprisonment and other criminal justice
sanctions should be used for aims other
than reducing re-offending
• Alternative approaches to punishment
need to be explored and strengthened
Alternatives to punishment
•
•
•
•
Community service
Restitution
Monitoring/supervising/mentoring
Restorative justice options
Restorative justice
• Process whereby parties with a
stake in a specific offence resolve
collectively how to deal with the
aftermath of the offence and its
implications for the future
• Requires that offender admits
responsibility for the offence and
is based upon volunteer
participation
Types
• Victim offender mediation
• Family or community group
conferencing
• Peacemaking or Sentencing circles
Benefits
• Like Alternate Dispute Resolution,
involves the victim and stakeholders in
the outcome, increasing satisfaction in
the process
• Solicitor General study (1998) showed
a reduction in recidivism when
Restorative Justice was used compared
to usual justice sanctions: 5.3%
compared to 16.1%
Applications to the
Regulatory Arena?
• Restitution
• Mediated resolutions after findings
of misconduct are made
• Sentencing circles involving the
client, employer, public, the
regulator