College of Nurses of Ontario v. Angela Bianca, 2024 CanLII 145647

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Grace Fox, NP Chairperson

Erin Cowan, RN Member

Sandra Larmour Public Member

Lalitha Poonasamy Public Member

Susan Roger, RN Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) JEAN-CLAUDE KILLEY for ) College of Nurses of Ontario

• and - )

ANGELA BIANCA ) DANIEL LIBMAN for Registration No. 9814518 ) Angela Bianca ) PATRICIA HARPER ) Independent Legal Counsel

) Heard: December 13, 2024 ) via videoconference

DECISION AND REASONS

Publication Ban

By Order of the Discipline Panel dated December 13, 2024, pursuant to subsection s.45(3) of the Health Professions Procedural Code of the Nursing Act, 1991, no one shall publish or broadcast the names of the patients, or any information that could disclose their identities, referred to orally or in any documents presented at the Discipline hearing of Angela Bianca.

This matter was heard by a panel of the Discipline Committee (the “Panel”) of the College of Nurses of Ontario (the “College”) on December 13, 2024.

The Allegations

The allegations against Angela Bianca (the “Member”) as stated in the Notice of Hearing dated November 12, 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 you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, and in particular:

(a) on or about April 29, 2021, while employed by Toronto Public Health as a Communicable Disease Investigator, you provided inaccurate and/or misleading information about COVID-19 and/or COVID-19 vaccines to Patient 1, when you made the following and/or similar statements to Patient 1:

(i) they had the deadly variant;

(ii) despite having the deadly variant, they would be fine, as most healthy people are;

(iii) the media are overhyping COVID-19;

(iv) only the very elderly and people with lots of underlying health conditions are dying from COVID-19;

(v) masks are pointless in relation to COVID-19;

(vi) they should not rush to get the vaccine, because they already have antibodies from COVID-19 and/or we do not know what is in the vaccine and it could cause long term effects like cancer; and/or

(vii) vaccine makers are only trying to make money, and the reason that hydroxychloroquine is not widely used to treat COVID-19 is because it is inexpensive;

(b) on or about January 18, 2022, while attending at Halton Healthcare – Georgetown Hospital to provide care to Patient 2:

(i) you administered an infusion to Patient 2 of what purported to be Vitamin C, without an order or other authorization;

(ii) you failed to wear appropriate personal protective equipment while providing care to Patient 2, having regard to Patient 2’s status as positive for COVID-19;

(c) on or about February 1, 2022, while employed by the Region of Peel as an Immunizer, you provided inaccurate and/or misleading information about COVID-19 and/or COVID-19 vaccines to Patient 3, when you made the following and/or similar statements to Patient 3:

(i) you suggested to Patient 3 that the COVID-19 vaccine could harm their unborn child, including by asking “don’t you want to keep your baby?” or words to that effect, and by asking Patient 3’s child “you wouldn’t want anything bad to happen to your little brother or sister would you?” or words to that effect;

(ii) you told Patient 3 that they would not die from COVID-19;

(iii) you suggested to Patient 3 that the COVID-19 vaccine was of limited benefit by telling Patient 3’s child that she could still get COVID-19 and transmit it to her parent and her parent’s unborn child despite being vaccinated;

(d) in or around July 2021, you submitted a falsified document to the Region of Peel intending it to be accepted as evidence of your having received two COVID-19 vaccine doses outside of Ontario, when you had not received those vaccine doses;

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 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, and in particular:

(a) on or about April 29, 2021, while employed by Toronto Public Health as a Communicable Disease Investigator, you provided inaccurate and/or misleading information about COVID-19 and/or COVID-19 vaccines to Patient 1, when you made the following and/or similar statements to Patient 1:

(i) they had the deadly variant;

(ii) despite having the deadly variant, they would be fine, as most healthy people are;

(iii) the media are overhyping COVID-19;

(iv) only the very elderly and people with lots of underlying health conditions are dying from COVID-19;

(v) masks are pointless in relation to COVID-19;

(vi) they should not rush to get the vaccine, because they already have antibodies from COVID-19 and/or we do not know what is in the vaccine and it could cause long term effects like cancer; and/or

(vii) vaccine makers are only trying to make money, and the reason that hydroxychloroquine is not widely used to treat COVID-19 is because it is inexpensive;

(b) on or about January 18, 2022, while attending at Halton Healthcare – Georgetown Hospital to provide care to Patient 2:

(i) you administered an infusion to Patient 2 of what purported to be Vitamin C, without an order or other authorization;

(ii) you failed to wear appropriate personal protective equipment while providing care to Patient 2, having regard to Patient 2’s status as positive for COVID-19;

(c) on or about February 1, 2022, while employed by the Region of Peel as an Immunizer, you provided inaccurate and/or misleading information about COVID-19 and/or COVID-19 vaccines to Patient 3, when you made the following and/or similar statements to Patient 3:

(i) you suggested to Patient 3 that the COVID-19 vaccine could harm their unborn child, including by asking “don’t you want to keep your baby?” or words to that effect, and by asking Patient 3’s child “you wouldn’t want anything bad to happen to your little brother or sister would you?” or words to that effect;

(ii) you told Patient 3 that they would not die from COVID-19;

(iii) you suggested to Patient 3 that the COVID-19 vaccine was of limited benefit by telling Patient 3’s child that she could still get COVID-19 and transmit it to her parent and her parent’s unborn child despite being vaccinated;

(d) in or around July 2021, you submitted a falsified document to the Region of Peel intending it to be accepted as evidence of your having received two COVID-19 vaccine doses outside of Ontario, when you had not received those vaccine doses.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1(a)(i), (ii), (iii), (iv), (v), (vi), (vii), 1(b)(i), (ii), 1(c)(i), (ii), (iii), 1(d), 2(a)(i), (ii), (iii), (iv), (v), (vi), (vii), 2(b)(i), (ii), 2(c)(i), (ii), (iii) and 2(d) 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, as follows:

THE MEMBER

1. Angela Bianca (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse (“RN”) on July 8, 1998. The Member was in the non-practising class from January 1, 2014, to August 28, 2017.

2. On March 9, 2022, the Inquiries, Complaints and Reports Committee imposed terms, conditions and limitations on the Member’s certificate of registration on an interim basis.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Providing inaccurate/misleading information while employed at TPH

3. On October 13, 2020, the Member started working for Toronto Public Health (“TPH”) as a Communicable Disease Investigator (“CDI”). The Member’s job duties included phoning patients who had reported a positive test result for the coronavirus SARS-CoV-2 (“COVID-19”) to TPH to ensure they were aware of their diagnosis, to advise them on matters relating to self-isolating, and to identify any contacts who may have been exposed to the virus.

4. The CDI position consisted of remote work with minimal supervision. CDIs were therefore expected to follow provided scripts, policies and protocols from TPH that reflected up-to-date evidence-based guidance.

5. On April 29, 2021, the Member spoke with Patient 1 by phone in her capacity as a CDI. Patient 1 had recently reported a positive COVID-19 test to TPH.

6. On April 30, 2021, Patient 1 submitted an emailed complaint about her call with the Member to TPH. The complaint said that while “[m]uch of the discussion was friendly and informative… there were some pieces of information I felt were not in line with TPH and CDC guidance.” The patient then categorized information given to her by the Member as “good information,” “questionable information but possibly correct,” “very questionable information,” and “alarming information.”

7. Below are relevant excerpts from Patient 1’s complaint describing what the Member told her:

• “I had the ‘deadly’ variant (her words) – so either the UK or Brazilian. She wanted to assure that even though I had the ‘bad one, [’] I was fine! As most healthy people are”

• “The media is overhyping COVID and only really old people and those with lots of underlying conditions are dying”

• “SARS CoV2 is so small that masks are pointless, it goes right through the fibers”

• “I should not rush to get the vaccine because I already have antibodies from COVID and we don’t know what’s in the vaccine, it could cause long term effects like cancer for all we know”

• “The vaccine makers are just trying to make money, and the reason hydroxychloroquine isn’t in wide use is because it’s so cheap to use… her friend’s wife used it when she got covid and came out quickly and fine”

8. These statements were inconsistent with TPH guidance and were inaccurate and/or misleading.

9. If the Member were to testify, she would state that she could not recall the exact conversation she had with Patient 1. However, the Member would acknowledge that the above statements, as reported in Patient 1’s complaint, are an accurate representation of what she told her.

10. TPH investigated Patient 1’s complaint and suspended the Member for 10 days. At the start of the meeting where the Member was informed of the suspension, she is recorded by TPH as having said the following [sic throughout]:

• “This is not who I am. I don’t know how this conversation got out of hand how it did”

• “It was a learning experience”

• “I’m very embarrassed, it’s not who I am”

• “Spoken to hundreds of cases, if this was my regular practice, I would have had more complaints”

• “I got caught up with the misinformation”

• “Hard time for all of us, we’re all human”

• “It was very inappropriate and very unprofessional, I'm embarrassed”

11. If she were to testify, the Member would state that the above is an accurate reflection of her comments during the meeting with TPH.

12. After the meeting with TPH, the Member committed to completing a learning plan. She was moved to a new team and did not resume her prior duties as a CDI.

13. On September 1, 2021, the Member resigned her role with TPH without completing the learning plan.

Administering an infusion without authorization and appropriate PPE

14. On January 18, 2022, the family of Patient 2, a COVID-19-positive patient at Halton Healthcare – Georgetown Hospital, attended the hospital with a bag of yellow liquid they identified as containing Vitamin C. The family told Patient 2’s treatment providers that they wanted it administered to Patient 2 intravenously immediately.

15. The Member had supplied the bag of purported Vitamin C to the family.

16. Patient 2’s most responsible physician (the “MRP”) refused to administer the infusion. His record of the interaction with Patient 2’s family notes that he told them that there was a lack of evidence for Vitamin C infusions and that no one at the hospital would feel comfortable administering the substance from the bag, as it came from an unknown source and had no label to indicate its contents or dosage. However, Patient 2’s family were adamant that the infusion be administered and asked the MRP to escalate the situation to the nursing manager as well as the COO of the hospital.

17. The MRP showed the charge nurse then on duty (“Charge Nurse 1”), the bag of purported Vitamin C and asked her what he ought to do with it. Charge Nurse 1 explained that in order for nurses to infuse a medication, it would need to be labelled with a patient identifier, its contents, and dosage/infusion information, and there would need to be a physician’s order.

18. Over the next few hours, Patient 2’s family spoke with nursing staff and hospital management about the possibility of having a “private nurse” administer the infusion. Patient 2’s family indicated to Charge Nurse 1 that they wanted to do everything they could to keep their grandfather alive.

19. Patient 2’s family asked the Member to come to the hospital. The Member attended the hospital and spoke to Charge Nurse 1 at the nursing station. She stated that she was a private nurse hired for Patient 2. Charge Nurse 1 explained that hospital staff were still determining whether the medication could be administered.

20. The Member entered the patient’s room and spoke with Patient 2’s family. Patient 2’s daughter was on the phone with the hospital’s upper management about whether the infusion could be administered. Patient 2’s daughter came out of the room and told Charge Nurse 1 that “everything was a go”, and the phone was placed outside on a linen cart.

21. Based on this misrepresentation from Patient 2’s daughter, Charge Nurse 1 gave the bag of purported Vitamin C to the Member, as she did not hear otherwise and assumed the infusion was approved. The Member took the bag of Vitamin C into Patient 2’s room to administer it.

22. At this time, Charge Nurse 1 told the Member to wear proper personal protective equipment (“PPE”), and the Member agreed to do so. As indicated on a sign outside the patient’s door, appropriate PPE for this COVID-19-positive patient on high-flow oxygen would include an N95 mask, face shield, gown and gloves.

23. Charge Nurse 2 took over as charge nurse at 1930. At the start of his shift, Charge Nurse 1 informed Charge Nurse 2 of the Member’s presence.

24. Around 1940, Charge Nurse 2 entered the patient’s room and found the Member at Patient 2’s bedside. The Member had set up the bag of purported Vitamin C and was infusing it through Patient 2’s IV.

25. The Member identified herself to Charge Nurse 2. She was wearing a medical face mask and a protective visor, which was not adequate PPE.

26. Patient 2’s daughter told Charge Nurse 2 that the MRP had “approved the treatment”, which was untrue, and that according to the MRP, the medication only required a label before it could be infused. The Member had brought a label with her to the hospital which had since been placed on the bag. The label indicated that the bag contained Vitamin C as well as several other supplements.

27. Upon checking the patient’s record, Charge Nurse 2 saw the MRP’s note suggesting that the treatment had not been approved or ordered. Charge Nurse 2 spoke with the on-call physician, who informed him that the issue had been escalated to the hospital’s upper management.

28. Charge Nurse 2 then had a phone call with the hospital’s Chief Operating Officer (“COO”). With the phone on speaker, in the presence of the Member and Patient 2’s daughter, the COO confirmed that the hospital had not given permission for the infusion to be administered.

29. Charge Nurse 2 stopped the infusion. The Member then asked how to restart the infusion and tried to restart the pump. When Charge Nurse 2 left the room, Patient 2’s family was actively trying to resume the infusion.

30. Around 20 minutes later, the Member exited the room and reported that the infusion was finished and that she was leaving.

31. A physician’s order was required for this treatment under both hospital policy and the Public Hospitals Act, RSO 1990, c P.40. However, no such order existed.

32. If the Member were to testify, she would explain that she understood from Patient 2’s family that they had received approval from both the MRP and the hospital to complete the treatment. The Member would testify that she had every intention of leaving if the infusion was not approved. In the approximately one-hour period between the Member being given the Vitamin C bag by Charge Nurse 1 and being told the infusion was not approved by Charge Nurse 2, no one advised the Member that the infusion was not approved, nor did anyone tell the Member to stop. The Member acknowledges that she did not take any further steps to verify or confirm the existence of an order for this infusion, as she believed it was authorized based on her discussion with Charge Nurse 1.

Providing a falsified vaccine certificate to the Region of Peel

33. On January 10, 2022, the Member was hired by the Region of Peel (the “Region”) as an immunizer. A condition of her employment was being vaccinated against COVID-19.

34. The Member worked shifts as an immunizer on January 19, 20, 25, 26 and February 1, 2022.

35. On January 18, 2022, a day before her first shift as an immunizer, the Member called the Region’s COVID-19 vaccination call centre to ask about an alert on COVax of a person who the Member identified as her brother. COVax is a COVID-19 vaccine tracking and documentation system. The COVax alert indicated that the Member’s brother’s out-of-province COVID-19 vaccination certificate was not considered valid and the vaccine doses from that certificate should not be recognized.

36. The Member made several subsequent calls to the Region’s call centre about the issue with her brother’s certificate.

37. The Region identified the Member’s own COVax profile from the phone number she had provided in connection with the calls regarding her brother. Upon examining her profile, the Region discovered that the Member had submitted a similar out-of-province vaccine certificate as proof of vaccination on July 22, 2021. The Member had provided the certificate in her personal capacity as a resident of the Region before her employment with the Region began.

38. The out-of-province certificate claimed that the Member had received two doses of the COVID-19 vaccine in the United States at a pop-up vaccination clinic in Florida on May 10 and July 20, 2021. Further investigation by the Region revealed that the pharmacy identified on the out-of-province certificate did not have a record of having vaccinated the Member.

39. The Member had not been vaccinated at the pop-up clinic on May 10 and July 20, 2021. Instead, she had purchased the certificate from someone in Florida and submitted it to the Region to establish a false record of vaccination. The Member also bought a fake vaccination certificate for her mother.

40. The individual the Member phoned the Region’s call centre to discuss is not the Member’s brother, but rather someone she met in Florida who also bought a fake vaccine certificate and who subsequently asked for the Member’s assistance with resolving the “flag” on his COVax profile.

Providing inaccurate/misleading information about COVID-19 vaccinations while working as an immunizer

41. On February 1, 2022, the Member worked her last shift as an immunizer with the Region at a vaccination clinic located at the Save Max Sports Centre in Brampton.

42. While working at the clinic, the Member saw Patient 3. Patient 3 attended the site with her six-year-old daughter planning for them both to receive COVID-19 vaccinations. However, since they had both recently received flu shots, the site supervisor informed Patient 3 that her daughter was not eligible to receive a COVID-19 vaccination that day. Patient 3, however, was eligible for a booster shot and was directed to the Member’s vaccination station.

43. The Member spoke with Patient 3 and her daughter. After speaking with the Member, Patient 3 decided not to get her planned COVID-19 booster shot from the Member.

44. Later that day, Patient 3 used the Region’s online feedback form to make a complaint about her interaction with the Member. The complaint included the following:

• [The Member] asked my daughter if she had just gotten her shot, I explained that she wasn’t able to get it today because we had gotten our flu shots. She looked at me and asked why I was getting the vaccine, I explained that I spoke with the supervisor who reassured me that the vaccine was safe for me even though I had recently gotten my flu shot, and even though I was pregnant. Then she asked me who told me to get vaccinated, I said my doctor. She said “You can say no.” I explained that I was already vaccinated, and I was just here for my booster. She then asked me how far along I was, I said 15 weeks, and then she asked, “don’t you want to keep your baby?” I said of course! She then looked at my daughter and said, “you wouldn’t want anything bad to happen to your little brother or sister, would you?” She then told me to take this as a sign from God that I should not be getting this booster today. Then she told me that I am 20 years old (which I am not) and that I will not die from covid, and she looked at my daughter and told her that even if she’s vaccinated, she can still get covid and give it to mommy and the baby. There was no way I was getting my booster shot from this person. She held my arm (not tight or forcefully) and said “don’t tell anyone that I gave you this advice, don’t tell anyone that the nurse told you this.[”] Terrified I agreed not to tell anyone and thank[ed] her for her advice, she gave me back my health card and I left. I contacted my doctor immediately who assured me that the information that I was given by the nurse today was not accurate and that there are studies that show the opposite of what she said. It was a traumatic experience and I will not be going back there.

45. The Member’s statements to Patient 3 and her daughter about COVID-19 and COVID-19 vaccinations were inaccurate and/or misleading.

46. If the Member were to testify, she would state that she cannot recall exactly what she said during her conversation with Patient 3, but that Patient 3’s complaint is an accurate representation of what she told her and her daughter.

47. The Member resigned her position with the Region on February 11, 2022.

CNO STANDARDS OF PRACTICE

48. CNO publishes nursing standards to set out the expectations for the practice of nursing. CNO’s published standards inform nurses of their accountabilities and apply to all nurses regardless of their role, job description or area of practice.

Code of Conduct

49. The Code of Conduct articulates what Ontarians can expect of nurses in all practice settings. It aims to promote public confidence in the nursing profession through a principle-based accountability model.

50. Nurses have a commitment to the nursing profession. Being a member of CNO 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 by comporting themselves in a manner befitting their role. Nurses must behave in a way that reflects well on the membership and, importantly, must take accountability for their actions when their conduct falls below or contravenes an articulated standard. This is a critical element of self-regulation.

51. Members uphold this standard by, among other things, ensuring that their practice is evidence-based and free from personal bias. The Code of Conduct sets out the following expectations:

• Nurses do not impose their personal beliefs and biases on patients.

• Nurses use appropriate knowledge, skill and judgment when assessing the health needs of patients.

• Nurses use research and accurate sources of information to inform their practice.

Professional Standards

52. CNO’s Professional Standards provides that each nurse is accountable to the public and responsible for ensuring their conduct meets legislative requirements and the standards of practice of the profession. Nurses demonstrate this standard by role-modelling professional values, beliefs and attributes as well as maintaining and continually improving their knowledge and competency to practise. In particular, the Professional Standards directs nurses to base their clinical decision-making in evidence and to use research to inform their practice and professional services.

Ethics

53. Every nurse is expected to understand, uphold and promote the values and beliefs described in CNO’s Ethics practice standard. The Ethics standard provides that nurses have a commitment to the nursing profession. Professional status brings with it the respect and trust of the public. Maintaining the respect of the public requires, amongst other things, for nurses to conduct themselves in a manner that reflects well on the profession.

54. The Ethics standard identifies several behavioural directives for nurses to maintain an ethical practice, including respecting clients’ wishes even when those wishes are not the same as theirs, providing knowledgeable and client-centred care, and conducting themselves in ways that promote respect for the nursing profession.

Decisions About Procedures and Authority

55. CNO’s Decisions About Procedures and Authority practice standard outlines the expectations of nurses when determining if they have the authority to perform a procedure; whether it is appropriate for them to perform a particular procedure; and whether they are competent to perform it. It identifies four “standard statements”, one of which is “Authority: Nurses ensure that they have the appropriate authority before performing procedures”. The practice standard notes that nurses meet the standard by “knowing when specific direction for client care is required in the form of orders, directives, protocols or recommendations.”

ADMISSIONS OF PROFESSIONAL MISCONDUCT

56. The Member admits that her conduct breached CNO’s Code of Conduct, Professional Standards, Ethics and Decisions About Procedures and Authority standards of practice.

57. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 1(a) of the Notice of Hearing, in that she provided inaccurate and/or misleading information about COVID-19 and/or COVID-19 vaccines while employed by TPH as a CDI.

58. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 1(b)(i) of the Notice of Hearing, in that she administered an infusion without an order or other authorization, and as alleged paragraph 1(b)(ii), in that she failed to wear appropriate PPE while providing care to a COVID-19 positive patient.

59. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 1(c) of the Notice of Hearing, in that she provided inaccurate and/or misleading information about COVID-19 and/or COVID-19 vaccines while employed by the Region as an immunizer.

60. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 1(d) of the Notice of Hearing, in that she submitted a falsified document to the Region intending it to be accepted as evidence of her having received two COVID-19 vaccine doses outside of Ontario, when she had not received those vaccine doses.

61. The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 2(a), (b), (c) and (d) of the Notice of Hearing, and in particular, that her conduct was disgraceful, dishonourable and unprofessional.

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)(i), (ii), (iii), (iv), (v), (vi), (vii), 1(b)(i), (ii), 1(c)(i), (ii), (iii), 1(d), 2(a)(i), (ii), (iii), (iv), (v), (vi), (vii), 2(b)(i), (ii), 2(c)(i), (ii), (iii) and 2(d) of the Notice of Hearing. With respect to allegations #2(a)(i), (ii), (iii), (iv), (v), (vi), (vii), 2(b)(i), (ii), 2(c)(i), (ii), (iii) and 2(d), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be disgraceful, 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.

Allegations #1(a)(i), (ii), (iii), (iv), (v), (vi) and (vii) in the Notice of Hearing are supported by paragraphs 5 - 7, 56 and 57 in the Agreed Statement of Facts. The Panel found and the Member admitted that while employed at Toronto Public Health (“TPH”) as a Communicable Disease Investigator she committed an act of professional misconduct by contravening the standards of practice when she provided inaccurate and/or misleading information about COVID-19 and/or COVID-19 vaccines to Patient 1. The Member was expected to follow an evidence-based script, as well as policies and protocols provided by TPH, which she failed to do. This was particularly important as guidance relating to the management of COVID-19 was constantly evolving during this time. The Member breached the Code of Conduct, the Professional Standards, the Ethics Standard and the Decisions About Procedures and Authority Standard.

Allegations #1(b)(i) and (ii) in the Notice of Hearing are supported by paragraphs 14 - 32, 56 and 58 in the Agreed Statement of Facts. The Panel found and the Member admitted that she committed an act of professional misconduct by contravening the standards of practice when she attended at Halton Healthcare – Georgetown Hospital as a private nurse hired by Patient 2’s family and administered intravenously to Patient 2, an unlabelled medication without a physician’s order in a hospital where she was not employed. Additionally, she put herself and the public at risk by not wearing proper Personal Protective Equipment (“PPE”) while in close, sustained contact with a COVID-19 positive patient. The Member breached the Code of Conduct, the Professional Standards, the Ethics Standard, and the Decisions About Procedures and Authority Standard.

Allegations #1(c)(i), (ii) and (iii) in the Notice of Hearing are supported by paragraphs 41 - 46, 56 and 59 in the Agreed Statement of Facts. The Panel found and the Member admitted that while employed by the Region of Peel as an immunizer at a COVID-19 vaccination clinic she committed an act of professional misconduct by contravening the standards of practice when she provided inaccurate and/or misleading information about COVID-19 and/or COVID-19 vaccines to Patient 3. The Member provided misleading information to Patient 3 who was pregnant and who attended the clinic with her six-year-old daughter, impressing upon them that the vaccine was harmful or even ineffective. This was a breach of the Code of Conduct, the Professional Standards, the Ethics Standard and the Decisions About Procedures and Authority Standard.

Allegation #1(d) in the Notice of Hearing is supported by paragraphs 33 - 40, 56 and 60 in the Agreed Statement of Facts. The Panel found and the Member admitted that she committed an act of professional misconduct by contravening the standards of practice when she submitted a falsified document to the Region of Peel as evidence that she had received two COVID-19 vaccine doses outside of Ontario when she had not received them in order to gain employment as a COVID-19 vaccinator. In doing so, the Member breached the Code of Conduct, the Professional Standards and the Ethics Standard.

With respect to allegations #1(a)(i), (ii), (iii), (iv), (v), (vi), (vii), #1(b)(i), (ii), #1(c)(i), (ii), (iii) and #1(d), the Member breached the Code of Conduct, the Professional Standards, the Ethics Standard, and the Decisions About Procedures and Authority Standard by failing to provide safe and competent care, failing to act with integrity in the patient’s best interest, failing to work respectfully with the health care team, and failing to maintain public confidence in the nursing profession by:

• sharing misleading and scientifically inaccurate information while working as a communicable disease investigator and as an immunizer;

• administering a substance without a prescription;

• neglecting to wear proper PPE in the presence of a COVID-19 positive patient; and,

• providing a falsified vaccination record to gain employment.

Allegations #2(a)(i), (ii), (iii), (iv), (v), (vi), (vii), #2(b)(i), (ii), #2(c)(i), (ii), (iii) and #2(d) in the Notice of Hearing are supported by paragraphs 3 - 47 and 61 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct in multiple incidents over a period of time in different practice settings was relevant to the practice of nursing.

It was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations in contravening the Code of Conduct, the Professional Standards, the Ethics Standard, and the Decisions About Procedures and Authority Standard. The Member provided her own opinion to influence the health of others rather than evidence-based practice. Moreover, the Member provided unlabelled medication to a patient without an order in a hospital where she was not employed.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of dishonesty and deceit as she provided false COVID-19 information to patients and acquired and submitted a falsified personal COVID-19 vaccination record. The Member knew or ought to have known that her conduct was unacceptable and fell well below the standards of a professional.

Finally, the Panel finds that the Member’s conduct was disgraceful as it shames the Member and by extension the profession. In particular, the Member’s conduct during her interaction with Patient 3 and her six-year-old child at a vaccination clinic casts serious doubt on the Member’s moral fitness and inherent ability to discharge the higher obligations the public expects professionals to meet.

Penalty

College Counsel and the Member’s Counsel advised that a Joint Submission on Order had been agreed upon and requested that the Panel make the following order:

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 6 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 of this Order. 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 of this Order. 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 Practice Reflection Worksheets, online learning modules and decision tools (where applicable):

1. Code of Conduct, and

2. Social Media: Reflect Before You Post webcast;

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 Practice Reflection Worksheets;

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.

College Submissions on Penalty

College Counsel made submissions on penalty which include the following:

The objectives of penalty orders are to achieve deterrence for the profession as a whole and for the Member, to protect the public, to facilitate the Member’s rehabilitation and remediation, and maintain public confidence in the College’s disciplinary processes. College Counsel submitted that the proposed order is appropriate and meets all of the objectives of penalty. College Counsel submitted that the proposed order protects the public and maintains public confidence in the profession’s ability to regulate itself.

College Counsel made submissions on the aggravating and mitigating circumstances in this case.

The aggravating factors in this case were:

• The Member’s conduct involved dishonesty in the most serious sense, as she intended to deceive the Region of Peel into believing she had been vaccinated when she had not been;

• The Member’s conduct in administering a substance without an order is itself an aggravating factor, as regulated health care providers are expected to remain within their scope of practice and respect the scope of others; and

• The Member’s communications regarding COVID-19 and the COVID-19 vaccine, and working as a vaccinator without being vaccinated, put the public at risk, which should be considered an aggravating factor.

The mitigating factors in this case were:

• The Member accepted responsibility and acknowledged that her conduct had been inappropriate within a short amount of time and entered into an Agreed Statement of Facts and a Joint Submission on Order with the College; and

• The Member’s admissions to the facts and allegations are an important mitigating factor as it avoided the need for a contested hearing which would be costly, lengthy, and distressing for the witnesses.

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. Petit (Discipline Committee, 2023): This hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. In this case, the member failed to wear PPE with a COVID-19 positive patient. The penalty included an oral reprimand, a 10-month suspension of the member’s certificate of registration, a minimum of 2 meetings with a Regulatory Expert, completion of an ethics course, 24 months of employer notification, 12 months of mentorship and 24 months of no independent practice in the community. While this case and the case before this Panel have some similarities, the penalty is comparable.

CNO v. Pomerleau (Discipline Committee, 2024): This hearing proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. In this case, the member knowingly arranged a fake vaccination certificate and asked colleagues to administer a falsified COVID-19 vaccine. The penalty included an oral reprimand, a 3-month suspension of the member’s certificate of registration, a minimum of 2 meetings with a Regulatory Expert, 12 months of employer notification and 12 months of no independent practice in the community. Again, the penalty in this case is comparable with the case before this Panel.

Member’s Submissions on Penalty

The Member’s Counsel indicated that they agreed with the College’s submissions.

The Member’s Counsel highlighted the mitigating circumstances in this case, and in particular, the Member’s admissions to the allegations and her early cooperation with the College’s investigation and disciplinary process. This demonstrates that the Member has taken responsibility for her actions.

The Member also has no prior disciplinary history and has been registered with the College since July 1998. The Member’s Counsel also noted that she has also been subject to an interim order since 2022, which has prevented her from seeking nursing employment.

Penalty Decision

The Panel accepted the Joint Submission on Order and made the order requested.

Reasons for Penalty Decision

There is a high threshold for departing from a Joint Submission on Order established by the Supreme Court of Canada in R. v. Anthony-Cook, 2016 SCC 43. Departing from a joint submission would require a finding that the proposed penalty would bring the administration of justice into disrepute or is otherwise contrary to the public interest.

The Panel concluded that the proposed penalty is not contrary to the public interest and does not bring the administration of justice into disrepute.

The Panel concluded that the proposed penalty is reasonable and in the public interest. It promotes public confidence in the ability of the College to regulate nurses.

The Panel finds that the proposed penalty satisfies the penalty goals of specific and general deterrence, rehabilitation and remediation, and public protection.

The proposed penalty provides for general deterrence through the 6-month suspension of the Member’s certificate of registration and the oral reprimand. This penalty demonstrates to the membership at large that this type of conduct will not be tolerated.

The proposed penalty provides for specific deterrence through the 6-month suspension of the Member’s certificate of registration, the oral reprimand, and the 12 months of employer notification. This penalty further demonstrates that the College takes cases of this nature very seriously and ensures there is transparency and protective measures in place while the Member engages in remediation and rehabilitation efforts.

The proposed penalty provides for remediation and rehabilitation through a minimum of 2 meetings with a Regulatory Expert and related preparatory work involved. This penalty allows the Member to learn from her misconduct, provides opportunity for reflection, and facilitates a return to ethical practice.

Overall, the public is protected because of the 12 months of employer notification which provides transparency and vigilance within the profession. The penalty demonstrates that the College takes this misconduct very seriously and also deters other members from engaging in similar conduct and maintains public trust in nurses.

The Panel acknowledges that the Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility, which is a mitigating factor.

The Panel reviewed the two cases provided by College Counsel and was satisfied that the proposed penalty fell within the reasonable range.

I, Grace Fox, NP, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.