College of Nurses of Ontario v. Ian Salter, 2024 ONCNO 120504

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Michael Hogard, RPN Chairperson

Jean-Laurent Domingue, RN Member Sylvia Douglas Public Member

Carly Hourigan Public Member

Shannon Mantha, RN Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) ALYSHA SHORE for

) College of Nurses of Ontario

• and - )

IAN SALTER ) ANNA LICHTY for

Registration No. 0327924 ) Ian Salter

) CHRISTOPHER WIRTH

) Independent Legal Counsel

) Heard: April 2, 2024

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee (the “Panel”) of the College of Nurses of Ontario (the “College”) on April 2, 2024, via videoconference.

Publication Ban

College Counsel brought a motion pursuant to s.45(3) of the Health Professions Procedural Code of the Nursing Act, 1991, for an order preventing public disclosure and banning the publication or broadcasting of the names of the colleagues, or any information that could disclose their identities, referred to orally or in any documents presented at the Discipline hearing of Ian Salter.

The Panel considered the submissions of College Counsel and the Member’s Counsel and decided that there be an order preventing public disclosure and banning the publication or broadcasting of the names of the colleagues, or any information that could disclose their identities, referred to orally or in any documents presented at the Discipline hearing of Ian Salter.

The Allegations

College Counsel advised the Panel that the College was requesting leave to withdraw the allegations set out in paragraphs 1(c) and 2(c) in the Notice of Hearing dated February 6, 2024. The Panel granted this request. The remaining allegations against Ian Salter (the “Member”) are as follows:

IT IS ALLEGED THAT:

1. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(1) of Ontario Regulation 799/93, in that while employed as a Registered Nurse at Royal Ottawa Health Care Group – Brockville Mental Health Centre in Brockville, Ontario, you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as follows:

a. in 2016, you inappropriately touched the buttocks of Colleague [A] while she was checking medications by the nursing station;

b. on, about or around March 8, 2018, with respect to Colleague [B], you:

i. came up behind her unexpectedly and smacked her on the buttocks; and/or

ii. inappropriately grabbed her on the hips and told her she had a “bubble butt” or words to that effect;

c. [Withdrawn];

d. in or around May 2019, you interacted inappropriately with Colleague[C], including when you:

i. inappropriately touched her hands, shoulders, arms and/or waist;

ii. used both your hands and “grabbed” Colleague [C]’s hips from behind and, with your hands on her hips, moved past her and/or brushed up against her;

iii. referred to her using names such as “darling” and/or “sweetheart” or words to that effect;

iv. after Colleague [C] poured medications for you, you responded with “I love you”, or words to that effect; and/or

v. inappropriately stated, “I’d rather do round(s) with Colleague [C], she’s better to look at”, or words to that effect;

e. on, about or around July 7, 2021, you interacted inappropriately with Colleague [D] when you:

i. shoved or pushed Colleague [D] with your right hand; and/or

ii. pointed at your watch and stated, “move that little ass”, or words to that effect, as Colleague [D] walked past you in the hallway; and/or

2. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that while employed as a Registered Nurse at Royal Ottawa Health Care Group – Brockville Mental Health Centre in Brockville, Ontario, you engaged in conduct relevant to the practice of nursing that would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional, as follows:

a. in 2016, you inappropriately touched the buttocks of Colleague [A] while she was checking medications by the nursing station;

b. on, about or around March 8, 2018, with respect to Colleague [B], you:

i. came up behind her unexpectedly and smacked her on the buttocks; and/or

ii. inappropriately grabbed her on the hips and told her she had a “bubble butt” or words to that effect;

c. [Withdrawn];

d. in or around May 2019, you interacted inappropriately with Colleague [C], including when you:

i. inappropriately touched her hands, shoulders, arms and/or waist;

ii. used both your hands and “grabbed” Colleague [C]’s hips from behind and, with your hands on her hips, moved past her and/or brushed up against her;

iii. referred to her using names such as “darling” and/or “sweetheart” or words to that effect;

iv. after Colleague [C] poured medications for you, you responded with “I love you”, or words to that effect; and/or

v. inappropriately stated, “I’d rather do round(s) with Colleague [C], she’s better to look at”, or words to that effect; and/or

e. on, about or around July 7, 2021, you interacted inappropriately with Colleague [D] when you:

i. shoved or pushed Colleague [D] with your right hand; and/or

ii. pointed at your watch and stated, “move that little ass”, or words to that effect, as Colleague [D] walked past you in the hallway.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1(a), (b)(i), (b)(ii), (d)(i), (d)(ii), (d)(iii), (d)(iv), (d)(v), (e)(i), (e)(ii), 2(a), (b)(i), (b)(ii), (d)(i), (d)(ii), (d)(iii), (d)(iv), (d)(v), (e)(i) and (e)(ii) in the Notice of Hearing. The Panel received a written plea inquiry which was signed by the Member. The Panel also conducted an oral plea inquiry and was satisfied that the Member’s admissions were voluntary, informed and unequivocal.

Agreed Statement of Facts

College Counsel and the Member’s Counsel advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, which reads, unedited and without exhibits, as follows:

THE MEMBER

1. Ian Salter (the “Member”) initially registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse (“RPN”) on June 11, 2001. The Member was suspended for non-payment from April 14, 2005 until February 1, 2013 when he resigned his RPN certificate of registration. The Member registered with CNO as a Registered Nurse (“RN”) on November 26, 2003.

2. The Member was employed by the Royal Ottawa Health Care Group – Brockville Mental Health Centre (the “Facility”) located in Brockville, Ontario. The Member was employed at the Facility as a full-time nurse from December 28, 2003 until his termination on September 27, 2021.

PRIOR HISTORY

3. In August 2023, following receipt of a report regarding concerns about the Member’s practice, the Inquiries, Complaints and Reports Committee (“ICRC”) directed the Member to complete remedial activities and to attend before the ICRC to be cautioned with respect to the following standards: Code of Conduct, Medication and Documentation.

THE FACILITY

4. The Member worked on the Secure Treatment Unit (the “Unit”) at the Facility and typically worked night shifts.

5. The residents on the Unit were convicted of a crime and sentenced to treatment. The residents on the Unit were male and had mental health and/or addiction conditions.

6. Each resident had their own room similar to a jail cell. There were four pods on the Unit, each of which had mandated programming that the residents were required to complete, such as anger management. Staff on the unit included RNs, RPNs and provincial correctional officers.

7. During the relevant period, the Member worked on Unit 3 East – the Admissions and Stabilization area of the Unit. There were 25 beds plus four additional secure beds for residents who required a higher level of observation.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Colleague A

8. (“Colleague A”), RN, worked on the Unit from 2016 until February 2020.

9. In 2016, shortly after Colleague A started on the Unit, she was checking medications at the nursing station and the Member came up to her and touched her on the buttocks.

10. Colleague A described the contact as a “small gentle tap” rather than a “slap”.

11. Colleague A confronted the Member about the incident later in the shift and she did not have any further issues with him.

Colleague B

12. (“Colleague B”), RN, worked at the Facility since June 2017. Colleague B primarily worked day shifts but also worked night shifts on occasion. Colleague B and the Member rarely worked together.

13. On March 8, 2018, Colleague B and the Member were working. Around shift change, Colleague B was alone with the Member at the nursing station and she walked to the sink to empty her water bottle. Her back was to the Member, and he came up behind her and smacked her buttocks.

14. Colleague B did not say anything to the Member at the time or afterward. The incident occurred in Colleague B’s first year of nursing and she was afraid to report it because she did not want the Member to get into trouble. Colleague B did tell a colleague who reported the incident to management approximately four months later.

15. In addition, on another occasion around the time of the previous incident, the Member grabbed Colleague B’s hips and told her she had a “bubble butt” or words to that effect.

Colleague C

16. (“Colleague C”), RN, started working at the Facility in the spring of 2018 as a part-time employee.

17. In or around 2018/early 2019, there were situational circumstances where the Member made inappropriate gestures towards Colleague C, such as touching her hands, shoulders, and arms.

18. The Member also made inappropriate comments to Colleague C such as referring to her using names such as “darling” and “sweetheart” or words to that effect and after Colleague C poured medications for the Member, he responded with “I love you”, or words to that effect. Colleague C did not confront the Member until May 2019.

19. On May 10, 2019, Colleague C was pouring medications. The Member tried to squeeze through to help her with the count. He used both hands to pull her towards him and squished to get around her and and brushed up against her. The gesture was too close and uncomfortable for Colleague C.

20. Following this encounter, Colleague C told the Member directly that he was making her uncomfortable. At first, the Member said that he was from Newfoundland and using names such as “darling” and “sweetheart” were part of the culture. The Member subsequently approached Colleague C and was very apologetic. She accepted his apology.

21. Subsequently, on May 13, 2019, the Member made a comment about Colleague C’s appearance saying words to the effect of “I’d rather do rounds with [Colleague C], she’s better to look at”. The comment made Colleague C question the sincerity of the Member’s earlier apology. Colleague C decided to report his conduct to management and filed a complaint on June 3, 2019.

Facility Investigation

22. Following receipt of the report from Colleague C, the Facility conducted an investigation in which four other female colleagues came forward with similar experiences with the Member. Following the investigation, the Member received a 30-day unpaid suspension. The Member also completed a full day of training on Professional Boundaries.

23. The Member returned to work in February 2020 and was placed on a different area of the Unit during day shifts which have more direct managerial supervision. Residents on this area of the Unit were also more stable.

Colleague D

24. (“Colleague D”) worked as a recreational therapist at the Facility since January 2021. She worked with the Member after he was transferred to Unit 2 West in March/April 2021. Colleague D worked day shifts.

25. On July 7, 2021, the Member was standing in a hallway with Colleague D and another nurse. When Colleague D walked towards the Member, the Member pushed Colleague D with his right hand. The contact caught Colleague D off guard and caused her to lose her balance and step back.

26. According to Colleague D, there is a strict no-touch policy at the Facility given the nature of the residents.

27. About five minutes later, Colleague D was walking up the hallway towards the nursing station. The Member walked towards her and stated while pointing to his watch, “move that little ass”. Colleague D said, “excuse me?” in response. The Member repeated his statement while pointing to his watch. Colleague D did not respond to the Member and kept walking. The Member’s comments were made within hearing distance of a number of residents.

28. If the Member were to testify, he would state that he said “get your ass in gear” to Colleague D, not “move that little ass”. Regardless, the Member admits and acknowledges that either comment was inappropriate and unprofessional.

29. The incidents between the Member and Colleague D were captured on video surveillance, without sound.

30. After a further complaint was received from Colleague D, the Member’s employment was terminated on September 27, 2021.

CNO STANDARDS

Code of Conduct

31. CNO’s Code of Conduct is a standard of practice describing the accountabilities all Ontario nurses have to the public. The Code of Conduct consists of six principles including:

• Nurses respect the dignity of patients and treat them as individuals;

• Nurses work together to promote patient well-being;

• Nurses maintain patients’ trust by providing safe and competent care;

• Nurses work respectfully with colleagues to best meet patients’ needs;

• Nurses act with integrity to maintain patients’ trust; and

• Nurses maintain public confidence in the nursing profession.

32. CNO’s Code of Conduct provides, in relation to the principle requiring nurses to work respectfully with colleagues to best meet patients’ needs, that:

• Nurses are professional with colleagues and treat them with respect, including on social media; and

• Nurses collaborate and communicate with colleagues in a clear, effective, professional and timely way.

33. CNO’s Code of Conduct further provides, in relation to the principle requiring nurses to maintain public confidence in the nursing profession, that nurses are accountable for their own actions and decisions.

34. Attached as Exhibit “A” is a copy of CNO’s Code of Conduct which was in force at the time of the incidents.

Professional Standards

35. CNO’s Professional Standards provides an overall framework for the practice of nursing and a link with other standards, guidelines and competencies developed by CNO. It includes seven broad standard statements and indicators that illustrate how the standard may be demonstrated pertaining to accountability, continuing competence, ethics, knowledge, knowledge application, leadership and relationships.

36. CNO’s Professional Standards provides, in relation to the accountability standard, that nurses are accountable to the public and responsible for ensuring their practice and conduct meets the legislative requirements and the standards of the profession. Nurses are responsible for their actions and the consequences of those actions as well as for conducting themselves in ways that promote respect for the profession. Nurses demonstrate this standard by ensuring their practice is consistent with CNO’s standards of practice and guidelines as well as legislation.

37. CNO’s Professional Standards further provides, in relation to the ethics standard, that ethical nursing includes acting with integrity, honesty and professionalism in all dealings with the patient and other health care team members.

38. CNO’s Professional Standards also provides, in relation to the leadership standard, that leadership requires self-knowledge (understanding one’s beliefs and values and being aware of how one’s behaviour affects others), respect, trust, integrity, shared vision, learning, participation, good communication techniques and the ability to be a change facilitator. Nurses demonstrate their leadership by role-modelling professional values, beliefs and attributes.

39. In addition, CNO’s Professional Standards provides, with respect to the relationship standard and professional relationships, that professional relationships are based on trust and respect, and result in improved patient care. Nurses demonstrate this standard by:

• role-modelling positive collegial relationships; and

• using a wide range of communication and interpersonal skills to effectively establish and maintain collegial relationships.

40. Attached as Exhibit “B” are copies of CNO’s Professional Standards that were in force at the time of the incidents and have since been retired.

41. With respect to Colleague A, the Member admits and acknowledges that he contravened CNO’s Professional Standards when he inappropriately touched the buttocks of Colleague A while she was checking medications by the nursing station.

42. Regarding Colleague B, the Member admits and acknowledges that he contravened CNO’s Professional Standards when he:

• came up behind Colleague B unexpectedly and smacked her on the buttocks; and

• inappropriately grabbed Colleague B on the hips and told her she had a “bubble butt” or words to that effect.

43. With respect to Colleague C, the Member admits and acknowledges that he contravened CNO’s Professional Standards and Code of Conduct when he:

• inappropriately touched Colleague C’s hands, shoulders, arms and waist;

• used both his hands and “grabbed” Colleague C’s hips from behind and, with his hands on her hips, moved past her and brushed up against her;

• referred to Colleague C using names such as “darling” and “sweetheart” or words to that effect;

• after Colleague C poured medications for him, he responded with “I love you”, or words to that effect; and

• inappropriately stated, “I’d rather do round(s) with Colleague C, she’s better to look at”, or words to that effect.

44. Regarding Colleague D, the Member admits and acknowledges that he contravened CNO’s Code of Conduct and Professional Standards when he:

• pushed Colleague D with his right hand; and

• pointed at his watch and stated, “move that little ass”, or words to that effect, as Colleague D walked past him in the hallway.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

45. The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 1(a), 1(b), 1(d) and 1(e) of the Notice of Hearing in that he contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as described in paragraphs 8 to 44 above.

46. The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 2(a), 2(b), 2(d) and 2(e) of the Notice of Hearing, and in particular his conduct was dishonourable and unprofessional, as described in paragraphs 8 to 44 above.

OTHER

47. With the leave of the Panel of the Discipline Committee, CNO withdraws the remaining allegations in the Notice of Hearing, which are as follows:

• Paragraph 1(c) of the Notice of Hearing; and

• Paragraph 2(c) of the Notice of Hearing.

Submissions on Liability

College Counsel’s Submissions

College Counsel asked the Panel to accept the Agreed Statement of Facts, as well as the Member’s admissions to the allegations in the Notice of Hearing except for allegations #1(c) and #2(c) as they were withdrawn, and that the Panel should make findings of professional misconduct for each allegation.

In regard to allegations #1(a), (b)(i), (b)(ii), (d)(i), (d)(ii), (d)(iii), (d)(iv), (d)(v), (e)(i), (e)(ii), College Counsel submitted that the Panel needed evidence of the professional standards that were breached to make a finding of professional misconduct. College Counsel submitted that the relevant professional standards in force at the time of the allegations are attached as exhibits to the Agreed Statement of Facts. Engaging in inappropriate and unwanted behaviour is a breach of the College’s Professional Standards and the College’s Code of Conduct. Such conduct is not what we would expect of nurses when they engage in collegial professional relationships.

To make a finding of professional misconduct in regard to allegations #2(a), (b)(i), (b)(ii), (d)(i), (d)(ii), (d)(iii), (d)(iv), (d)(v), (e)(i) and (e)(ii), College Counsel submitted that the Panel first needed to be satisfied that the conduct in question is relevant to the practice of nursing. College Counsel submitted that the Member’s conduct was relevant to the practice of nursing because it occurred while the Member was working as a nurse. College Counsel submitted that if the Panel was satisfied that the conduct was relevant to the practice of nursing, it then needed to be satisfied that the conduct would be considered by other members of the profession as unprofessional, dishonourable or disgraceful. College Counsel submitted that these terms are disjunctive and that the Panel does not need to specify whether it believes the Member’s conduct was unprofessional, dishonourable or disgraceful, nor does the Panel need expert evidence to make this determination. College Counsel submitted that the Member’s conduct was unprofessional and dishonourable. The Member’s conduct was unprofessional because it demonstrated a serious disregard for his professional obligations. The Member’s conduct was also dishonourable because he knew or ought to have known that his conduct fell well below what we would expect from nurses. College Counsel submitted that there was an element of moral failing to the Member’s conduct.

College Counsel submitted the following two cases to the Panel to demonstrate that other panels of the Discipline Committee made similar findings of professional misconduct for similar conduct:

CNO v. Sanidad (Discipline Committee, 2023): This case proceeded by way of an Agreed Statement of Facts. The case involved significant and repeated harassment by the member toward four colleagues. The allegations were significant to the extent that they consisted of repeated, unwanted and sexualized conduct by the member toward his colleagues. In this case, there was also a second allegation related to a privacy breach related to a patient. The panel found that the member’s conduct amounted to a breach of the College standards, and amounted to conduct that would be considered unprofessional, dishonourable and disgraceful.

College Counsel submitted that the nature of the conduct in the Sanidad case was more egregious than in the case before this Panel, and it is for this reason that the College is seeking only for a finding that the Member’s conduct was unprofessional and dishonourable.

CNO v. Crummey (Discipline Committee, 2020): This case proceeded by way of an Agreed Statement of Facts. The case involved inappropriate sexualized conduct by the member toward two colleagues. The panel found that the member’s conduct amounted to a breach of the College standards, and amounted to conduct that would be considered unprofessional, dishonourable and disgraceful.

College Counsel submitted that the nature of the comments and conduct in question in the Crummey case were more egregious than in the case before this Panel.

College Counsel submitted that the Panel should make findings on each of the allegations listed in the Notice of Hearing.

The Member’s Counsel’s Submissions

The Member’s Counsel submitted that she agreed with College Counsel’s submissions. The Member’s Counsel submitted that the cases referenced by College Counsel were more egregious than the Member’s conduct.

The Member’s Counsel submitted that throughout the investigation process, several letters from references were submitted on behalf of the Member by his colleagues. The Member’s Counsel read some excerpts of these letters which spoke very highly of the Member’s clinical and interpersonal skills. The Member’s Counsel submitted that these references do not diminish the Member’s alleged conduct.

College Counsel’s Reply

College Counsel reminded the Panel that excerpts of letters submitted by the Member’s Counsel referenced during the investigation process should not be considered evidence as they are not part of the Agreed Statement of Facts.

Decision

The College bears the onus of proving the allegations in accordance with the standard of proof, that being the balance of probabilities based upon clear, cogent and convincing evidence.

Having considered the evidence and the onus and standard of proof, the Panel finds that the Member committed acts of professional misconduct as alleged in paragraphs 1(a), (b)(i), (b)(ii), (d)(i), (d)(ii), (d)(iii), (d)(iv), (d)(v), (e)(i), (e)(ii), 2(a), (b)(i), (b)(ii), (d)(i), (d)(ii), (d)(iii), (d)(iv), (d)(v), (e)(i) and (e)(ii) of the Notice of Hearing. As to allegations #2(a), (b)(i), (b)(ii), (d)(i), (d)(ii), (d)(iii), (d)(iv), (d)(v), (e)(i) and (e)(ii), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be dishonourable and unprofessional.

Reasons for Decision

The Panel considered the Agreed Statement of Facts and the Member’s plea and finds that this evidence supports findings of professional misconduct as alleged in the Notice of Hearing.

Allegation #1(a) in the Notice of Hearing is supported by paragraphs 8 to 11, 35, 37 to 39, 41 and 45 in the Agreed Statement of Facts. The Member admitted that in 2016, he inappropriately touched the buttocks of Colleague [A] while she was checking medications by the nursing station. The Panel finds that this conduct is contrary to the College’s Professional Standards, and particularly the ethics standard, the leadership standard, and the relationship standard. In relation to the ethics standard, the College’s Professional Standards stipulate that ethical nursing includes acting with integrity, honesty and professionalism in all dealings with health care team members. In relation to the leadership standard, the College’s Professional Standards stipulate that, among other things, leadership requires respect, trust, and integrity. Nurses demonstrate their leadership by role-modelling professional values, beliefs and attributes. In relation to the relationship standard, the College’s Professional Standards stipulate that professional relationships are based on trust and respect, and result in improved patient care. Nurses demonstrate this standard by role-modelling positive collegial relationships. The Panel finds that by inappropriately touching the buttocks of Colleague [A] while she was checking medications by the nursing station, the Member disrespected Colleague [A], broke the trust between himself and Colleague [A], and thus contravened the College’s Professional Standards.

Allegations #1(b)(i) and (b)(ii) in the Notice of Hearing are supported by paragraphs 12 to 15, 35, 37 to 39, 42 and 45 in the Agreed Statement of Facts. The Member admitted that on, about or around March 8, 2018, he came up behind Colleague [B] unexpectedly and smacked her on the buttocks. The Member also admitted to inappropriately grabbing Colleague [B] on the hips and told her she had a “bubble butt” or words to that effect. The Panel finds that this conduct is contrary to the College’s Professional Standards, and particularly the ethics standard, the leadership standard, and the relationship standard. In relation to the ethics standard, the College’s Professional Standards stipulate that ethical nursing includes acting with integrity, honesty and professionalism in all dealings with health care team members. In relation to the leadership standard, the College’s Professional Standards stipulate that, among other things, leadership requires respect, trust, and integrity. Nurses demonstrate their leadership by role-modelling professional values, beliefs and attributes. In relation to the relationship standard, the College’s Professional Standards stipulate that professional relationships are based on trust and respect, and result in improved patient care. Nurses demonstrate this standard by role-modelling positive collegial relationships. The Panel finds that by smacking the buttocks of Colleague [B] and by commenting on her buttocks, the Member disrespected Colleague [B], broke the trust between himself and Colleague [B], and thus contravened the College’s Professional Standards.

Allegations #1(d)(i), (d)(ii), (d)(iii), (d)(iv) and (d)(v) in the Notice of Hearing are supported by paragraphs 16 to 21, 31 to 33, 35 to 39, 43 and 45 in the Agreed Statement of Facts. The Member admitted that in or around May 2019, he inappropriately touched the hands, shoulders, arms and/or waist of Colleague [C], used both hands and “grabbed” her hips from behind and, with his hands on her hips, moved past her and/or brushed up against her, referred to her using names such as “darling” and/or “sweetheart” or words to that effect, responded to her with “I love you”, or words to that effect, after she had poured medications for him, and inappropriately stated that “I’d rather do rounds with [Colleague C], she’s better to look at”, or words to that effect”. The Panel finds that this conduct is contrary to the College’s Code of Conduct.

The College’s Code of Conduct is a standard of practice describing the accountabilities all Ontario nurses have to the public. The Code of Conduct consists of six principles including “nurses work respectfully with colleagues to best meet patients’ needs”. To work respectfully with colleagues to best meet patients’ needs , the Code of Conduct provides that nurses are professional with colleagues and treat them with respect; and that nurses collaborate and communicate with colleagues in a clear, effective, professional and timely way. The Panel finds that by inappropriately touching the body of Colleague [C] and by inappropriately calling her by endearing names, the Member lacked the respect and professionalism required by the Code of Conduct, and thus breached the Code of Conduct.

The Panel also finds that the Member’s conduct was contrary to the College’s Professional Standards, and particularly the ethics standard, the leadership standard, and the relationship standard. In relation to the ethics standard, the College’s Professional Standards stipulate that ethical nursing includes acting with integrity, honesty and professionalism in all dealings with health care team members. In relation to the leadership standard, the College’s Professional Standards stipulate that, among other things, leadership requires respect, trust, and integrity. Nurses demonstrate their leadership by role-modelling professional values, beliefs and attributes. In relation to the relationship standard, the College’s Professional Standards stipulate that professional relationships are based on trust and respect, and result in improved patient care. Nurses demonstrate this standard by role-modelling positive collegial relationships. The Panel finds that by inappropriately touching the body of Colleague [C] and by inappropriately calling her by endearing names, the Member disrespected Colleague [C], broke the trust between himself and Colleague [C], and thus contravened the College’s Professional Standards.

Allegations #1(e)(i) and (e)(ii) in the Notice of Hearing are supported by paragraphs 24 to 30, 31 to 33, 35, 37 to 39, 44 and 45 in the Agreed Statement of Facts. The Member admitted that on, about or around July 7, 2021, he shoved or pushed Colleague [D] with his right hand and pointed at his watch stating, “move that little ass”, or words to that effect, as Colleague [D] walked past him in the hallway. The Panel finds that this conduct is contrary to the College’s Code of Conduct.

The College’s Code of Conduct is a standard of practice describing the accountabilities all Ontario nurses have to the public. The Code of Conduct consists of six principles including “nurses work respectfully with colleagues to best meet patients’ needs”. To work respectfully with colleagues to best meet patients’ needs this, the Code of Conduct provides that nurses are professional with colleagues and treat them with respect and that nurses collaborate and communicate with colleagues in a clear, effective, professional and timely way. The Panel finds that by shoving or pushing Colleague [D] and by telling her to “move that little ass”, the Member lacked the respect and professionalism required by the Code of Conduct, and thus breached the Code of Conduct.

The Panel also finds that the Member’s conduct was contrary to the College’s Professional Standards, and particularly the ethics standard, the leadership standard, and the relationship standard. In relation to the ethics standard, the College’s Professional Standards stipulate that ethical nursing includes acting with integrity, honesty and professionalism in all dealings with health care team members. In relation to the leadership standard, the College’s Professional Standards stipulate that, among other things, leadership requires respect, trust, and integrity. Nurses demonstrate their leadership by role-modelling professional values, beliefs and attributes. In relation to the relationship standard, the College’s Professional Standards stipulate that professional relationships are based on trust and respect, and result in improved patient care. Nurses demonstrate this standard by role-modelling positive collegial relationships. The Panel finds that by shoving or pushing Colleague [D] and by telling her to “move that little ass”, the Member disrespected Colleague [D], broke the trust between himself and Colleague [D], and thus contravened the College’s Professional Standards.

Allegations #2(a), (b)(i), (b)(ii), (d)(i), (d)(ii), (d)(iii), (d)(iv), (d)(v), (e)(i) and (e)(ii) in the Notice of Hearing are supported by paragraphs 8 to 44 and 46 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct in inappropriately touching the body of his colleagues [A], [B], [C], [D], and commenting to some of them on their body in a sexualized or endearing way was relevant to the practice of nursing and was unprofessional as it demonstrated a serious and persistent disregard for his professional obligations in breaching the College’s Code of Conduct and the Professional Standards.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of dishonesty and deceit as the Member knew or ought to have known that his conduct was wrong. The Member’s conduct also contained an element of moral failing in that he repeated his conduct despite knowing what was expected of him. He had multiple formal and informal opportunities to learn about the unwanted nature of his conduct, the effects of his conduct on his colleagues, and to change his behaviour. The Panel also finds that the Member’s conduct brought shame on the profession to the extent that nurses, and particularly those new to the profession like in the case of Colleague [B], should not have to worry about coming to work to provide nursing care. The Member knew or ought to have known that his conduct was unacceptable and fell below the standards of a professional.

Penalty

College Counsel and the Member’s Counsel advised the Panel that a Joint Submission on Order had been agreed upon. The Joint Submission on Order requests that this Panel make an order as follows:

1. Requiring the Member to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.

2. Directing the Executive Director to suspend the Member’s certificate of registration for 3 months. This suspension shall take effect from the date that this Order becomes final and shall continue to run without interruption as long as the Member remains in a practicing class.

3. Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:

a) The Member will attend a minimum of 2 meetings with a Regulatory Expert (the “Expert”) at the Member’s own expense and within 6 months from the date that this Order becomes final, or within another timeframe approved by CNO. If the Expert determines that a greater number of sessions are required, the Expert will advise CNO regarding the total number of sessions that are required and the length of time required to complete the additional sessions, but in any event, all sessions shall be completed within 12 months from the date that this Order becomes final, or within another timeframe approved by CNO. To comply, the Member is required to ensure that:

i. The Expert has expertise in nursing regulation and has been approved by CNO in advance of the meetings;

ii. At least 5 days before the first meeting, or within another timeframe approved by the Expert, the Member provides the Expert with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following CNO publications and completes the associated Reflective Questionnaires, online learning modules and decision tools (where applicable):

1. Code of Conduct;

iv. At least 5 days before the first meeting, or within another timeframe approved by the Expert, the Member provides the Expert with a copy of the completed Reflective Questionnaires;

v. The subject of the sessions with the Expert will include:

1. the acts or omissions for which the Member was found to have committed professional misconduct,

2. the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,

3. strategies for preventing the misconduct from recurring,

4. the publications, questionnaires and modules set out above, and

5. the development of a learning plan in collaboration with the Expert;

vi. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards their report to CNO, in which the Expert will confirm:

1. the dates the Member attended the sessions,

2. that the Expert received the required documents from the Member,

3. that the Expert reviewed the required documents and subjects with the Member, and

4. the Expert’s assessment of the Member’s insight into the Member’s behaviour;

vii. If the Member does not comply with any one or more of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on the Member’s certificate of registration;

b) For a period of 12 months from the date the Member returns to the practice of nursing, the Member will notify the Member’s employers of the decision. To comply, the Member is required to:

i. Inform any employer of the decision prior to commencing or prior to resuming employment in any nursing position;

ii. Ensure that CNO is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;

iii. Provide the Member’s employer(s) with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. a copy of the Panel’s Decision and Reasons, once available;

iv. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to CNO, in which it will confirm:

1. that they received a copy of the required documents, and

2. that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

3. All documents delivered by the Member to CNO, the Expert or the employer(s) will be delivered by verifiable method, the proof of which the Member will retain.

Penalty Submissions

College Counsel’s Submissions

College Counsel submitted that the Panel should accept the Joint Submission on Order and make an order in accordance with its terms. College Counsel submitted that the penalty included three elements: an oral reprimand, a 3-month suspension of the Member’s certificate of registration, and terms, limitations and conditions placed on the Member’s certificate of registration. These terms include a minimum of 2 meetings with a Regulatory Expert to review specific documents and standards, and 12 months of employer notification.

College Counsel submitted that the Joint Submission on Order is appropriate for three reasons: (1) it reflects the aggravating and mitigating factors of the case; (2) it meets the goals of penalty; and (3) it is consistent with prior decisions of the College’s Discipline Committee.

The aggravating factors in this case were:

• The seriousness of the Member’s conduct;

• The Member’s conduct was repeated over time and with various colleagues, even after being notified that his conduct was unwelcomed;

• The harm his conduct caused to his colleagues and the potential harm it could have caused to patients; and

• The Member’s conduct discredits the profession and constitutes a serious disregard for his professional obligations.

The mitigating factors in this case were:

• The Member has no prior discipline history with the College;

• The Member has taken accountability by entering into an Agreed Statement of Facts and a Joint Submission on Order with the College; and

• The Member cooperated with the College throughout the investigation process thereby eliminating the need for the College to hold a contested hearing and call numerous witnesses to testify.

The public is protected through the 3-month suspension of the Member’s certificate of registration and the 12-month period of employer notification.

The proposed penalty provides for general deterrence through the 3-month suspension of the Member’s certificate of registration, which makes a statement to the other members of the profession that such conduct is unacceptable and comes with serious consequences.

The proposed penalty provides for specific deterrence through the oral reprimand and the 3-month suspension of the Member’s certificate of registration.

The proposed penalty provides for remediation and rehabilitation through a minimum of 2 meetings with a Regulatory Expert and review of the College’s Code of Conduct to help the Member reflect and learn about his conduct.

College Counsel submitted the following cases to the Panel to demonstrate that the proposed penalty fell within the range of similar cases from this Discipline Committee:

CNO v. Sanidad (Discipline Committee, 2023): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The case involved significant and repeated harassment by the member toward four colleagues. The allegations were significant to the extent that they consisted of repeated, unwanted and sexualized conduct by the member toward his colleagues. In this case, there was also a second allegation related to a privacy breach related to a patient. The panel made findings of professional misconduct in that the member breached the College’s standards of practice and that his conduct was unprofessional, dishonourable and disgraceful. The penalty included an oral reprimand, a 6-month suspension of the member’s certificate of registration, a requirement to complete a mandatory course, a minimum of 2 meetings with a Regulatory Expert and 24 months of employer notification.

College Counsel submitted that the conduct in the Sanidad case constituted a different level of harassment when compared to the case before this Panel because of its ongoing and repeated nature. This is why the Joint Submission on Order in the case before this Panel provides for a shorter period of suspension and employer notification than in the Sanidad case.

CNO v. Crummey (Discipline Committee, 2020): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The case involved inappropriate sexualized conduct by the member toward two colleagues. The panel found that the member’s conduct amounted to a breach of the College standards, and amounted to conduct that would be considered unprofessional, dishonourable and disgraceful. The panel made findings of professional misconduct in that the member breached the College’s standards of practice and that his conduct was unprofessional, dishonourable and disgraceful. The penalty included an oral reprimand, a 5-month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert and 12 months of employer notification.

College Counsel submitted that they were requesting a shorter suspension in the case before this Panel than the one ordered in the Crummey case because the member in the latter engaged in more egregious acts of sexualized touching than the Member in the case before this Panel.

CNO v. Robichaud (Discipline Committee, 2016): This case initially proceeded in a contested manner, but concluded by way of an Agreed Statement of Facts and a Joint Submission on Order. The case involved inappropriate sexualized behaviour by the member toward three colleagues. The panel found that the member’s conduct amounted to a breach of the College standards, and amounted to conduct that would be considered unprofessional, dishonourable and disgraceful. The penalty included an oral reprimand, a 4-month suspension of the member’s certificate of registration, 2 meetings with a Nursing Expert and 12 months of employer notification.

College Counsel submitted that they are requesting a penalty almost identical to the penalty ordered in the Robichaud case, but that in the case before this Panel, the parties are requesting a suspension that is 1-month shorter.

College Counsel submitted that the Panel should accept the Joint Submission on Order because it meets the goals of penalty, it reflects the circumstances of the case, and it is consistent with the range of penalties ordered in prior decisions of the Discipline Committee. The Joint Submission on Order was negotiated between experienced counsel, and it satisfies the objectives of penalties.

The Member’s Counsel’s Submissions

The Member’s Counsel agreed with the aggravating and mitigating factors submitted by College Counsel. The Member’s Counsel also submitted the following cases to the Panel to demonstrate that the proposed penalty fell within the range of similar cases from this Discipline Committee:

CNO v. Deonarain (Discipline Committee, 2019): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. In this case, the member touched the breast and buttocks of a colleague without their consent. The panel made findings of professional misconduct and found that the member’s conduct was unprofessional, dishonourable and disgraceful. The penalty included an oral reprimand, a 3-month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert and 12 months of employer notification.

CNO v. Petsura (Discipline Committee, 2021): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. In this case, the member repeatedly sexually harassed three co-workers and, among other things, touched one co-worker's lower abdomen. The panel made findings of professional misconduct and found that the member’s conduct was unprofessional and dishonourable. The penalty included an oral reprimand, a 2-month suspension of the member’s certificate of registration, a minimum of 2 meetings with a Regulatory Expert and 12 months of employer notification.

Penalty Decision

The Panel accepts the Joint Submission on Order and accordingly orders:

1. The Member is required to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.

2. The Executive Director is directed to suspend the Member’s certificate of registration for 3 months. This suspension shall take effect from the date that this Order becomes final and shall continue to run without interruption as long as the Member remains in a practicing class.

3. The Executive Director is directed to impose the following terms, conditions and limitations on the Member’s certificate of registration:

a) The Member will attend a minimum of 2 meetings with a Regulatory Expert (the “Expert”) at the Member’s own expense and within 6 months from the date that this Order becomes final, or within another timeframe approved by CNO. If the Expert determines that a greater number of sessions are required, the Expert will advise CNO regarding the total number of sessions that are required and the length of time required to complete the additional sessions, but in any event, all sessions shall be completed within 12 months from the date that this Order becomes final, or within another timeframe approved by CNO. To comply, the Member is required to ensure that:

i. The Expert has expertise in nursing regulation and has been approved by CNO in advance of the meetings;

ii. At least 5 days before the first meeting, or within another timeframe approved by the Expert, the Member provides the Expert with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following CNO publications and completes the associated Reflective Questionnaires, online learning modules and decision tools (where applicable):

1. Code of Conduct;

iv. At least 5 days before the first meeting, or within another timeframe approved by the Expert, the Member provides the Expert with a copy of the completed Reflective Questionnaires;

v. The subject of the sessions with the Expert will include:

1. the acts or omissions for which the Member was found to have committed professional misconduct,

2. the potential consequences of the misconduct to the Member’s patients, colleagues, profession and self,

3. strategies for preventing the misconduct from recurring,

4. the publications, questionnaires and modules set out above, and

5. the development of a learning plan in collaboration with the Expert;

vi. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards their report to CNO, in which the Expert will confirm:

1. the dates the Member attended the sessions,

2. that the Expert received the required documents from the Member,

3. that the Expert reviewed the required documents and subjects with the Member, and

4. the Expert’s assessment of the Member’s insight into the Member’s behaviour;

vii. If the Member does not comply with any one or more of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on the Member’s certificate of registration;

b) For a period of 12 months from the date the Member returns to the practice of nursing, the Member will notify the Member’s employers of the decision. To comply, the Member is required to:

i. Inform any employer of the decision prior to commencing or prior to resuming employment in any nursing position;

ii. Ensure that CNO is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;

iii. Provide the Member’s employer(s) with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. a copy of the Panel’s Decision and Reasons, once available;

iv. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to CNO, in which it will confirm:

1. that they received a copy of the required documents, and

2. that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

3. All documents delivered by the Member to CNO, the Expert or the employer(s) will be delivered by verifiable method, the proof of which the Member will retain.

Reasons for Penalty Decision

The Panel understands that the penalty ordered should protect the public and enhance public confidence in the ability of the College to regulate nurses. This is achieved through a penalty that addresses specific deterrence, general deterrence and, where appropriate, rehabilitation and remediation. The Panel also considered the penalty in light of the principle that joint submissions should not be interfered with lightly.

The Panel concluded that the proposed penalty is reasonable and in the public interest. The Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility. The Panel finds that the penalty satisfies the principles of specific and general deterrence, rehabilitation and remediation, and public protection.

General deterrence is provided through the 3-month suspension of the Member’s certificate of registration, which makes a statement to the other members of the profession that such conduct is inacceptable and comes with serious consequences.

Specific deterrence is provided through the oral reprimand, which demonstrates to the Member that his conduct is perceived to be problematic by other members of the profession and by the public. The 3-month suspension of the Member’s certificate of registration also provides for specific deterrence, in that it will incentivize the Member to abstain from engaging in similar conduct in the future.

Remediation and rehabilitation is provided through a minimum of 2 meetings with a Regulatory Expert and review of the Code of Conduct to help the member reflect and learn about his conduct.

Overall, the public is protected through the 12 months of employer notification as it will ensure that the Member’s future employers can provide oversight and support regarding his conduct. As well, the public is protected through the cumulative effects of the provisions included within the proposed penalty.

The penalty is also in line with what has been ordered in previous cases in similar circumstances as demonstrated by the cases submitted and referred to by College Counsel.

I, Michael Hogard, RPN, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.