Brenda Lee Rusnak Cassaday

Discipline Case Summary

Allegations

Facts

1. Brenda Lee Rusnak Cassaday (registered at the time as Brenda Rusnak) was at the time of the alleged incidents a duly registered physiotherapist working through the Brenda Rusnak
2. Physiotherapy Clinic, Toronto, Ontario.
3. From about April 2001 to May 2003, Ms. Rusnak permitted an employee, Mr. Saleh Elshamiy,* to provide physiotherapy services at the A. Long Term Care Facility (the“facility”).
4. Ms. Rusnak hired M., a registered physiotherapist, as Clinic Manager. Among other duties, M. was responsible for arranging for staffing of all nursing homes, filling in for absent staff and ensuring that staff were complying with clinic policy. In September 2000, when the then physiotherapist left the facility, M. was unable to find a replacement physiotherapist. In November 2000, she made arrangements for Mr. Elshamiy to obtain his supervised practice certificate and to provide services to the facility under her supervision.
5. After failing to successfully complete the Physiotherapy National Examination (PNE) in 2000, Mr. Elshamiy was no longer registered with the College after February 6, 2001. M. advised Ms. Rusnak that Mr. Elshamiy would continue to work, as a physiotherapy aide, under M.’s supervision.
6. On March 6, 2001, M. gave four weeks notice to Ms. Rusnak that she would be leaving her employ. For the remaining period of March 6-31, 2001, M. continued to supervise Mr. Elshamiy. As of March 31, 2001, Ms. Rusnak temporarily assumed the rule of supervising Mr. Elshamiy. Although many advertisements were placed, no other physiotherapist was found.
7. Ms. Rusnak acknowledged that she did not attend the facility often enough and did not respond sufficiently when she became aware that Mr. Elshamiy was doing evaluative procedures independently.
8. Regular clients at the facility believed that Mr. Elshamiy was a physiotherapist and did not recall being assessed or treated by Ms. Rusnak.
9. Regular staff of the facility, who would have seen Ms. Rusnak if she attended there, did not recall seeing her but did recall Mr. Elshamiy attending and conducting assessments and treatments on his own.
10. Mr. Elshamiy held himself out as a physiotherapist. Ms. Rusnak stated that she was not actually aware of this.
11. Ms. Rusnak ought to have known that Mr. Elshamiy was holding himself out as a physiotherapist, or done more to prevent it from happening. Ms. Rusnak did not ensure that others advised the facility that Mr. Elshamiy had lost his registration status. Ms. Rusnak contributed to this holding out by not monitoring and enforcing her name tag policy when she observed that Mr. Elshamiy was not wearing a name tag and by not wearing a name tag herself when she visited the facility. Ms. Rusnak should also have considered that Mr. Elshamiy’s practice of placing “B.Sc.P.T.” after his name in his charts could have been misleading.
12. Ms. Rusnak had contracted with the facility to provide a physiotherapist to visit on a regular basis; assessment and treatment by a physiotherapist for all residents as necessary; documentation as necessary; participation in clinical team planning, conferences, accreditation, and so on; communication with next of kin; and consultation with other nursing regarding rehabilitation, among other things. Mr. Elshamiy attended meetings and communicated with nursing.
13. Ms. Rusnak learned of the College investigation on May 13, 2003. On May 14, 2003, the facility copied certain charts without the knowledge of Ms. Rusnak. On May 15, 2003, Ms. Rusnak attended the facility and altered certain patient records that were relevant to the investigation, without appropriately indicating in the records that she was doing so or advising the facility’s management that she was doing so. The alterations included co-signing notes that were months and even years old, adding sheets that were not in the chart (Ms. Rusnak states these documents were in the file maintained elsewhere), rewriting some assessments done by Mr. Elshamiy in her own handwriting and affixing only her signature (the content of the re-written notes were not changed except for the signature lines). Ms. Rusnak did not advise the College when producing copies of these records on June 5, 2003, that they had been altered.
14. Patient records at the facility were brief and incomplete and indicated inconsistent supervision.
15. Ms. Rusnak advised the facility and the College on May 22, 2003 that Mr. Elshamiy did not work on his own but under her supervision at the facility. These statements were misleading.

Order on Penalty and Costs

1. Ms. Rusnak Cassaday’s certificate of registration be suspended for a period of two months.
2. It be a term, condition and limitation upon Ms. Rusnak Cassaday’s certificate of registration that during the period of her suspension she not engage in clinical practice or in the supervision of physiotherapists or physiotherapy students engaged in clinical practice.
3. Ms. Rusnak Cassaday pay $10,000 to the costs and expenses of investigating and prosecuting this matter, payable the month after the date of the order.

The Panel’s Reasons