College of Nurses of Ontario v. Liza Pomerleau, 2024 ONCNO 122854

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Lalitha Poonasamy, Public Member Chairperson

Jean-Laurent Domingue, RN Member Jane Hess, RN Member

Sandra Larmour Public Member

Kerrie Naylor, RPN Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) GLYNNIS HAWE for

) College of Nurses of Ontario

• and - )

LIZA POMERLEAU ) CARINA LENTSCH for

Registration No. JG690634 ) Liza Pomerleau

) CHRISTOPHER WIRTH

) Independent Legal Counsel

) Heard: April 29, 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 29, 2024, via videoconference.

The Allegations

The allegations against Liza Pomerleau (the “Member”) as stated in the Notice of Hearing dated January 3, 2024 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 Practical Nurse for the Haliburton, Kawartha, Pine Ridge District Health Unit, you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession in that:

a) On October 23, 2021, you knowingly arranged for and received a fake COVID-19 vaccine; and/or

b) On October 30, 2021, you asked a nursing colleague to pretend to administer the COVID-19 vaccine to you;

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 Practical Nurse for the Haliburton, Kawartha, Pine Ridge District Health Unit you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional in that:

a) On October 23, 2021, you knowingly arranged for and received a fake COVID-19 vaccine; and/or

b) On October 30, 2021, you asked a nursing colleague to pretend to administer the COVID-19 vaccine to you.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1(a), 1(b), 2(a) and 2(b) 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. Liza Pomerleau (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse (“RPN”) in the General Class on January 14, 2008 and is currently entitled to practice nursing in Ontario.

2. At the time relevant to the incidents, the Member was employed as an RPN by the Haliburton, Kawartha, Pine Ridge District Health Unit (the “Public Health Unit”) – Port Hope Office, in Port Hope, Ontario, and worked in a mobile COVID-19 mass immunization clinic. She resigned from her employment with the Unit on November 10, 2021.

3. The Member has no prior disciplinary history with CNO.

Background

4. In September 2021, the Public Health Unit instituted a mandatory COVID-19 vaccination policy, which required all staff to provide documentation proving “full immunization” against COVID-19 as defined by provincial and national public health guidelines, by November 1, 2021 (the “Policy”). The Policy permitted employees to seek a medical exemption.

5. On October 19, 2021, the Member submitted a written request for a medical exemption, due to her diagnosis of Von Willebrand disease (“VWD”), a lifelong bleeding disorder.

6. On October 22, 2021, the Unit’s Medical Officer of Health denied the Member’s request because she did not meet the Unit’s criteria for medical exemption from COVID-19 vaccination.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

7. On October 23, 2021, the Member worked as part of a five-person team administering COVID-19 vaccines at one of the Public Health Unit’s COVID-19 mass immunization clinics. As part of the team, one nurse was assigned the role of pre-loader and in charge of preparing the vaccine syringes and delivering them to the other nurses, who administered the vaccine to patients in the role of injector.

8. The Member was initially assigned to the role of nurse injector, while a colleague (“Colleague A”) was assigned to the role of pre-loader. At the outset of the shift, the Member asked Colleague A if they could switch roles. As a result, the Member served as the pre-loader and drew up vaccines that day, while Colleague A administered vaccines to patients.

9. At around 1:30 p.m. on October 23, 2021, the Member approached Colleague A and asked if Colleague A would vaccinate the Member. The Member filled up a syringe with saline solution instead of a dose of the COVID-19 vaccine and brought that syringe to Colleague A to administer to her. The Member did not disclose to Colleague A that the syringe did not, in fact, contain active COVID-19 vaccine ingredients. Colleague A then administered the injection to the Member.

10. On October 24, 2021, the Member emailed the Unit’s Director of Corporate Services to advise that she had decided to get vaccinated against COVID-19 in order to keep her employment. The Member attached a vaccine receipt indicating the Member had received a first dose of the COVID-19 vaccine on October 23, 2021.

11. On October 30, 2021, the Member informed another nursing colleague (“Colleague B”) that she had not actually received a real COVID-19 vaccine on October 23, 2021. The Member then asked Colleague B if she would be willing to pretend to administer the Member’s “second” vaccine dose by taking the Member to a private area and disposing of the vaccine dose without injecting the Member.

12. Colleague B sent the Member a text message later that day, refusing the Member’s request to pretend to vaccinate the Member. The Member responded, asking Colleague B not to tell anyone about the Member’s request. Colleague B reported her interactions with the Member to the Unit’s management.

13. On November 8, 2021, the Unit interviewed the Member regarding the information received from Colleague B. The Member denied any wrongdoing. She refused to be tested for Covid-19 antibodies when asked by the Unit whether she would do so.

14. On November 10, 2021, the Member resigned from her employment with the Unit. In the Member’s resignation letter, the Member denied any wrongdoing and asserted that Colleague B could not be believed. The Member claimed that Colleague B had made false allegations against her as a form of retaliation.

15. If the Member were to testify, she would say that she deeply and sincerely regrets her actions, which were motivated by her personal concerns about her own health status. In particular, the Member was fearful about potential unknown effects and safety of the COVID-19 vaccine on sufferers of VWD, like herself. The Member would further state that she is the mother of two young children, who were under the age of 10 at the time, and as she was the sole income earner for her family at the time she was also worried about losing her employment with the Health Unit and her ability to provide for her family.

16. The Member would further state that she had no objections to the COVID-19 vaccinations generally or about Public Health efforts during the COVID-19 pandemic, which she believes were important. Following her resignation from her employment with the Public Health Unit on November 10, 2021, the Member received valid COVID-19 vaccines from independent sources.

17. The Member sincerely apologizes to her colleagues, the Unit, the CNO and the profession for her conduct, which she admits was wrong. The Member would state that she has a deep sense of regret, shame and remorse for her conduct, which she feels are not at all reflective of her character or abilities as a nurse. The Member admits that her allegations against Colleague B were untrue.

CNO STANDARDS

Code of Conduct

18. CNO’s Code of Conduct is a standard of practice describing the accountabilities all nurses in Ontario 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.

19. Regarding the principle requiring nurses to maintain patients’ trust by providing safe and competent care, CNO’s Code of Conduct provides that nurses must seek and use the best available evidence to inform their practice, and nurses are required to use their knowledge, skill, and judgment when giving nursing care.

20. Regarding the principle requiring nurses to work respectfully with the health care team to meet clients’ needs, CNO’s Code of Conduct provides that nurses contribute to a safe organizational culture.

21. Regarding the principle requiring nurses to act with integrity to maintain patients’ trust, CNO’s Code of Conduct provides that nurses place their professional responsibilities ahead of their personal gain and are truthful in their professional practice.

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

23. 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

24. 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 pertaining to accountability, continuing competence, ethics, knowledge, knowledge application, leadership and relationships.

25. 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 actions such as ensuring their practice is consistent with CNO’s standards of practice and guidelines as well as legislation.

26. CNO’s Professional Standards provides, in relation to the ethics standard, that nurses are accountable for understanding, upholding, and promoting the values and beliefs described in CNO’s Ethics practice standard. Ethical nursing care means promoting values including, among other things, respectful truthfulness and acting with integrity, honesty, and professionalism in all dealings with client and other health care team members. Nurses demonstrate this standard by actions such as identifying personal values and ensuring that they do not conflict with professional practice, and creating environments that promote and support safe, effective, and ethical practice.

27. CNO’s Professional Standards 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. The leadership expectation is not limited to nurses in formal leadership positions and all nurses, regardless of their position, have opportunities for leadership. Nurses demonstrate this standard by actions such as role-modelling professional values, beliefs and attributes.

28. Attached as Exhibit “B” is a copy of CNO’s Professional Standards which was in force at the time of the incidents.

Ethics

29. CNO’s Ethics Standard describes ethical values that are important to the nursing profession in Ontario including patient well-being, patient choice, privacy and confidentiality, respect for life, maintaining commitments, truthfulness and fairness.

30. CNO’s Ethics Standard provides, in relation to maintaining commitments, that nurses have a commitment to the nursing profession and being a member of the profession brings with it the respect and trust of the public. To continue to deserve this respect, nurses have a duty to uphold the standards of the profession, conduct themselves in a manner that reflects well on the profession, and to participate in and promote the growth of the profession.

31. CNO’s Ethics Standard also provides, in relation to truthfulness, that truthfulness means speaking and acting without intending to deceive.

32. Attached as Exhibit “C” is a copy of CNO’s Ethics standard which was in force at the time of the incidents.

33. The Member admits and acknowledges that she contravened CNO’s Code of Conduct, Professional Standards and Ethics Standard.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

34. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 1 of the Notice of Hearing in that she contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as described in paragraphs 4 to 33 above.

35. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 2 of the Notice of Hearing, and in particular, that her conduct was dishonourable and unprofessional, as described in paragraphs 4 to 33 above.

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 all the allegations as set out in paragraphs 33 to 35 of the Agreed Statement of Facts and, on the basis of those facts and admissions, make findings of professional misconduct with respect to the allegations in the Notice of Hearing. College Counsel submitted that the Panel has taken the Member’s plea, conducted a verbal plea inquiry, and received a written plea inquiry which confirmed that the plea was voluntary, informed, and made on the advice of experienced Counsel. College Counsel submitted that based on the Agreed Statement of Facts, which specifically describes the facts in relation to the allegations, the Panel has enough evidence to find that the Member committed professional misconduct as set out in all of the allegations in the Notice of Hearing.

College Counsel reviewed allegations #1(a), #1(b), #2(a) and #2(b) with the Panel. With regard to allegations #1(a) and #1(b), College Counsel submitted that this allegation is supported by the Agreed Statement of Facts, which contained evidence of the relevant College standards of the profession, as well as the Member’s admissions that those standards were breached.

With regard to allegations #2(a) and #2(b), College Counsel submitted that the parties agreed that the Member’s conduct is relevant to the practice of nursing and is unprofessional and dishonourable.

The Member’s conduct is relevant to the practice of nursing as it took place while she was employed as a Registered Practical Nurse (“RPN”) at the Haliburton, Kawartha, Pine Ridge District Health Unit (the “Public Health Unit”). She arranged to receive a fake COVID-19 vaccine for the purpose of meeting the Public Health Unit’s vaccination policy. College Counsel submitted that the Member’s conduct would not have been possible had she not been employed as an RPN at the Public Health Unit.

College Counsel submitted that having regard to all of the circumstances members of the profession would regard the Member’s conduct to be unprofessional and dishonourable. The Member’s conduct was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations. She knew or ought to have known that her conduct was unethical and put patients at risk. The Member’s conduct was dishonourable as it involved an element of moral failing and dishonesty. She was aware that her conduct was unprofessional, but she engaged in it despite this knowledge.

College Counsel submitted that the Panel should make findings of professional misconduct on all allegations.

The Member’s Counsel’s Submissions

The Member’s Counsel submitted that the Member made admissions to the allegations and agreed to proceed by way of an Agreed Statement of Facts. College Counsel submitted that the Member’s conduct was unprofessional and dishonourable.

The Member’s Counsel submitted that, in College Counsel’s submissions she claimed that the Member’s conduct placed patients at risk. The Member’s Counsel submitted that the Agreed Statement of Facts does not contain evidence to support this claim.

The Member’s Counsel submitted that she agreed with the other submissions made by College Counsel.

College Counsel’s Reply Submissions

College Counsel agreed that there was no evidence in the Agreed Statement of Facts that the Member’s conduct placed patients at risk.

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), 1(b), 2(a) and 2(b) of the Notice of Hearing. As to allegations #2(a) and #2(b), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be unprofessional and dishonourable.

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 4 to 10, 18, 20 to 22, 24 to 29 and 31 to 34 in the Agreed Statement of Facts. The Member admitted that on October 23, 2021 she arranged for and received a fake COVID-19 vaccine from Colleague A while employed at the Public Health Unit. The Member, who was responsible for pre-loading the COVID-19 vaccines, asked Colleague A to vaccinate her, filled up a syringe with saline solution instead of a dose of the COVID-19 vaccine and brought that syringe to Colleague A to administer to her without disclosing to Colleague A that the syringe did not contain active COVID-19 vaccine ingredients. The Member subsequently emailed the Public Health Unit’s Director of Corporate Services a copy of her vaccination certificate.

Allegation #1(b) in the Notice of Hearing is supported by paragraphs 4 to 6, 11 to 14, 18, 20 to 22, 24 to 29 and 31 to 34 in the Agreed Statement of Facts. The Member also admitted that on October 30, 2021, she asked another nurse Colleague B to pretend to administer her the second dose of a COVID-19 vaccine. Colleague B refused to pretend to administer the COVID-19 vaccine to the Member and reported the incident to management. When the Member was confronted by the Public Health Unit’s management about the incident, the Member denied any wrongdoing and claimed that Colleague B had made false allegations against her as a form of retaliation.

The Member contravened three of the six principles contained in the College’s Code of Conduct. In relation to the principle requiring that “Nurses work respectfully with colleagues to best meet patients’ needs”, the Code of Conduct provides that nurses contribute to a safe organizational culture. In relation to the principle requiring that “Nurses act with integrity to maintain patients’ trust”, the Code of Conduct provides that nurses place their professional responsibilities ahead of their personal gain and are truthful in their professional practice. In relation to the principle requiring that “Nurses maintain public confidence in the nursing profession”, the Code of Conduct provides that nurses are accountable for their own actions and decisions. The Panel finds that by arranging for and receiving a fake COVID-19 vaccine from Colleague A and asking Colleague B to pretend to administer the second dose to her while employed at the Public Health Unit, the Member contravened the College’s Code of Conduct. The Member’s conduct placed her personal gain, namely keeping her employment, before her professional responsibilities, which includes being truthful and accountable for one’s actions. Through this act of dishonesty, the Member jeopardized the safe organizational culture of her workplace.

The Member also contravened three of the standard statements contained in the College’s Professional Standards. In relation to the accountability standard statement, the Professional Standards provide that 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. In relation to the ethics standard statement, the Professional Standards provide that nurses are accountable for understanding, upholding, and promoting the values and beliefs described in the College’s Ethics practice standard, which includes respectfulness, truthfulness and acting with integrity, honesty and professionalism in all dealings with health care team members. In relation to the leadership standard statement, the Professional Standards provide that leadership requires, among other things, self-knowledge, respect, trust, and integrity, and that nurses demonstrate this standard by actions such as role-modelling professional values, beliefs and attributes. The Panel finds that by arranging for and receiving a fake COVID-19 vaccine from Colleague A and asking Colleague B to pretend to administer the second dose to her while employed at the Public Health Unit, the Member contravened the College’s Professional Standards. The Member’s conduct demonstrated a lack of professional accountability, and dishonesty towards herself, her colleagues and her employer.

The Member also contravened the College’s Ethics Standard, which provides, in relation to truthfulness, that truthfulness means speaking or acting without intending to deceive. The Panel finds that by arranging for and receiving a fake COVID-19 vaccine from Colleague A and asking Colleague B to pretend to administer the second dose to her while employed at the Public Health Unit, the Member acted with the intention to deceive.

Allegations #2(a) and #2(b) in the Notice of Hearing are supported by paragraphs 4 to 14, 18, 20 to 22, 24 to 29, 31 to 33 and 35 in the Agreed Statement of Facts. The Panel finds that by arranging for and receiving a fake COVID-19 vaccine from Colleague A and asking Colleague B to pretend to administer the second dose to her while employed as an RPN at the Public Health Unit, the Member’s conduct was clearly relevant to the practice of nursing. It was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations in breaching the College’s Code of Conduct, the Professional Standards and the Ethics Standard.

The Panel also finds that the Member’s conduct was dishonourable as it demonstrated an element of dishonesty and deceit. The purpose of the Member’s conduct was to obtain personal gain in the form of continued employment, by knowingly manufacturing lies to her colleagues and management.

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. 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. 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.

c) The Member shall not practice independently in the community for a period of 12 months from the date the Member returns to the practice of nursing.

4. 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 Panel is generally expected to accept the Joint Submission on Order unless it believes it is contrary to public interest or that it would bring the administration of justice into disrepute. 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 Member’s conduct was willful and intentional. When the Member was confronted, she was initially dishonest with her employer and levied an allegation against a colleague to avoid responsibility; and

• The Member’s conduct demonstrated a disregard for public health and safety.

The mitigating factors in this case were:

• The Member agreed to proceed by way of an Agreed Statement of Fact and a Joint Submission on Order;

• The Member took responsibility for her actions and offered sincere regret in the Agreed Statement of Facts;

• The Member remediated the misconduct in that she is now fully vaccinated; and

• The Member has no previous discipline history with the College.

College Counsel submitted that the Joint Submission on Order achieves the goals of penalty, including general deterrence, specific deterrence and rehabilitation and remediation, and that it ultimately ensures public safety.

General deterrence is achieved through the oral reprimand and the 3-month suspension of the Member’s certificate of registration. Both elements send a signal to other members of the profession that the Member’s conduct is not acceptable, and the College will take this conduct seriously.

Specific deterrence is achieved through the oral reprimand and the 3-month suspension of the Member’s certificate of registration. The oral reprimand allows the Member to understand how her conduct is perceived by other professionals and the public. The 3-month suspension of the Member’s certificate of registration and the subsequent 12-month restriction requiring her not to practice independently will deter the Member from engaging in similar conduct.

Rehabilitation and remediation are achieved through a minimum of two meetings with a Regulatory Expert, the subsequent 12-month period of employer notification and the 12-month restriction on the Member’s certificate of registration requiring her not to practice independently. These three elements provide support, guidance and supervision for the Member when she returns to the practice of nursing.

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. Librado (Discipline Committee, 2014): In this case, the hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member worked as a Registered Nurse (“RN”), but was registered with the College as a Registered Practical Nurse (“RPN”). When employed as an RN, the member charted documents as an RN, despite not being qualified. The member also worked in two facilities at the same time. The member would arrange for a colleague to swipe her pass at one facility while she was paid by the other facility. The panel made findings of professional misconduct on all allegations, including a falsification of documentation and a breach of professional standards. The panel found that the member’s conduct was unprofessional, dishonourable and disgraceful. The panel accepted the Joint Submission on Order. The penalty included an oral reprimand, a 4-month suspension of the member’s certificate of registration, 3 meetings with a Nursing Expert, and a 12 months of employer notification.

College Counsel submitted that the aggravating and mitigating factors in the Librado case were very similar to the aggravating and mitigating factors in the case before this Panel. The member in the Librado case attempted to cover up her conduct, and she used another person to do so. College Counsel submitted that despite minor differences between the elements of penalty proposed in the case before this Panel and those included in the Librado case, there are similarities between the facts in the two cases.

CNO v. Charania (Discipline Committee, 2014): In this case, the hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member was found guilty of criminal charges, and she applied and was hired at a facility using a falsified resume and false references. The panel made findings on all allegations, including a breach of the professional standards, signing or issuing false or misleading documents, and that her conduct would be perceived as unprofessional, dishonourable and disgraceful. The panel accepted the Joint Submission on Order. The penalty included an oral reprimand, a 4-month suspension of the member’s certificate of registration, 2 meetings with a Nursing Expert and 24 months of employer notification.

College Counsel submitted that the penalty in the Charania case falls within a similar range of penalty as the one proposed in the case before this Panel.

CNO v. Olalere (Discipline Committee, 2022): In this case, the hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member provided false and misleading information to multiple employers, and claimed to have credentials that allowed her to have greater authority. The member also provided false names of references during her hiring process and provided false information to the College about her employment history. The panel made findings on all allegations, including a breach of standards, the falsification of records related to the member’s practice, and that the member’s conduct would be considered as being unprofessional and dishonourable. The panel accepted the Joint Submission on Order. The penalty included an oral reprimand, a 3-month suspension of the member’s certificate of registration, a minimum of 1 meeting with a Regulatory Expert and 18 months of employer notification.

College Counsel submitted that the aggravating and mitigating factors in the Olalere case are similar to the ones in the case before this Panel except for the prolonged nature of the conduct in the Olalere case. The members in both cases cooperated with the College and took full responsibility for their actions.

The Member’s Counsel’s Submissions

The Member’s Counsel submitted that the Panel should accept the Joint Submission on Order. The proposed penalty meets the goal of penalty and the College’s public protection mandate.

The mitigating factors in the case include:

• The Member ultimately took responsibility for her conduct, which led to the Agreed Statement of Facts and the Joint Submission on Order;

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

• There is a low probability that the Member would re-engage in the conduct as this was a time-limited issue characterized by the COVID-19 pandemic, new mRNA vaccines, and the Member’s fear related to the vaccine considering her chronic health concern;

• The Member took full responsibility. She recognizes that what she did was seriously wrong; and

• The Member has gained insight since the events, and she has remorse about her conduct.

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. 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. 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.

c) The Member shall not practice independently in the community for a period of 12 months from the date the Member returns to the practice of nursing.

4. 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. In making its finding, the Panel considered the aggravating and mitigating factors put forth by College Counsel and the Member’s Counsel. 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.

The proposed penalty provides for general deterrence through the oral reprimand and the 3-month suspension of the Member’s certificate of registration. Both elements send a signal to other members of the profession that the Member’s conduct is not acceptable, and the College will take this conduct seriously. The proposed penalty provides for specific deterrence through the oral reprimand and the 3-month suspension of the Member’s certificate of registration. The oral reprimand allows the Member to understand how her conduct is perceived by other professionals and the public. The 3-month suspension of the Member’s certificate of registration and the subsequent 12-month restriction on the Member’s certificate of registration requiring her not to practice independently will deter the Member from engaging in similar conduct. The proposed penalty provides for remediation and rehabilitation through a minimum of two meetings with a Regulatory Expert, the subsequent 12-month period of employer notification and the 12-month restriction on the Member’s certificate of registration requiring her not to practice independently. These three elements provide support, guidance and supervision for the Member when she returns to the practice of nursing.

Overall, the public is protected through the 12-month period of employer notification and the 12-month limitation on independent practice, which will allow for the Member’s employer to have an additional layer of oversight over her practice upon her return to nursing practice.

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

I, Lalitha Poonasamy, Public Member, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.

Chairperson