College of Nurses of Ontario v. Liubov Alviano, 2025 ONCNO 114857

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Lalitha Poonasamy, Public Member Chairperson

Jeanette Lane, NP Member

Matthew Secord, RN Member

Sherry Szucsko-Bedard, RN Member

Shari Wilson Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) HAILEY BRUCKNER for ) College of Nurses of Ontario

• and - )

LIUBOV ALVIANO ) SINAT SAM for Registration No. 0400457 ) Liubov Alviano

) ELYSE SUNSHINE ) Independent Legal Counsel

) Heard: June 9, 2025 ) via videoconference

DECISION AND REASONS

This matter was heard by a panel of the Discipline Committee (the “Panel”) of the College of Nurses of Ontario (the “College”) on June 9, 2025. A Russian interpreter attended the hearing to assist the Member.

The Allegations

The allegation against Liubov Alviano (the “Member”) as stated in the Notice of Hearing dated April 14, 2025 is 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(37) of Ontario Regulation 799/93, in that while registered as a Registered Nurse, 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 of the profession as disgraceful, dishonourable or unprofessional, and, in particular, you failed to:

a. Comply with an Inquiry, Complaints, and Reports Committee decision, dated March 30, 2022, that ordered you to complete a Specified Continuing Education or Remediation Program and receive a caution.

Member’s Plea

The Member admitted to the allegation set out in paragraph 1(a) 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 admission was voluntary, informed and unequivocal.

Agreed Statement of Facts

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

THE MEMBER

1. Liubov Alviano (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse (“RN”) on December 31, 2003. She was administratively suspended for non-payment of fees from February 15, 2012 to March 27, 2012. She is currently entitled to practise nursing without restrictions.

PRIOR HISTORY

2. The Member has no prior disciplinary findings with CNO.

INCIDENT RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

3. On March 30, 2022, a panel of the Inquiries, Complaints and Reports Committee (“ICRC”) of CNO issued a decision (the “ICRC Order”) requiring the Member to complete a specified continuing education or remediation program (the “SCERP”). A copy of the ICRC Order is attached as Exhibit “A”.

4. The SCERP required the Member to:

a. Register for CPEP’s Probe: Ethics & Boundaries program (the “Probe Program”) and provide proof of registration to CNO’s Monitoring Team within three months of the ICRC Order;

b. Compete all aspects of the Probe Program, receive a grade of “unconditional pass” and provide CNO’s Monitoring Team with proof of the same within six months of the ICRC Order;

c. Attend one meeting with a regulatory expert to discuss the incidents investigated, the applicable nursing standards, and the insights and learning gained from practice reflection within three months of completing the Probe Program, and complete additional remedial training;

d. Pay the costs required to complete the terms of the SCERP.

5. The ICRC Order also required the Member to attend an oral caution before the ICRC.

6. The Member and her counsel were notified of the ICRC Order by letter dated May 10, 2022. This letter enclosed the ICRC’s reasons for decision and noted that the Member would receive further correspondence regarding the scheduling of the caution, which she would receive after completing the SCERP.

7. CNO sent the Member and her counsel a letter dated May 11, 2022, which provided instructions on how to comply with the SCERP. The letter stated the Member was required to provide proof of her registration in the Probe Program within three months of the date of the letter, by August 11, 2022.

8. The Member filed an application for judicial review of the ICRC’s decision. On June 10, 2022, CNO sent the Member’s counsel a letter confirming that the ICRC Order would not be in effect pending the outcome of the Member’s application for judicial review.

9. The Divisional Court dismissed the Member’s application for judicial review on September 30, 2022. She brought a motion for leave to appeal to the Court of Appeal, but never perfected her motion nor sought a stay of the ICRC Order. On May 1, 2023, her counsel on the appeal advised CNO she did not intend to proceed with her motion for leave to appeal. On July 31, 2024, the Court of Appeal for Ontario formally dismissed the motion for leave to appeal for delay.

10. Following the dismissal of her application for judicial review, CNO sent a letter to the Member’s counsel on October 3, 2022, advising that the ICRC Order was again in effect. The letter stated that the Member was required to provide proof of registration in the Probe Program within three months of the date of the letter, being January 3, 2023.

11. The Member did not provide proof of registration by January 3, 2023. On that day, CNO wrote to the Member’s counsel requesting proof of registration in the Probe Program. When the Member’s counsel did not respond, CNO followed up directly with the Member on January 18, 2023. The Member did not respond.

12. CNO sent the Member and her counsel a letter dated March 3, 2023 regarding the Member’s apparent breach of the ICRC’s Order. The letter requested the Member provide proof of registration in the Probe Program by March 24, 2023. CNO did not receive a response to this letter.

13. On April 10, 2023, CNO sent a further letter to the Member and her counsel noting that proof of enrolment and proof of an “unconditional pass” in the Probe Program were still outstanding. The letter requested the Member provide the outstanding documents by May 1, 2023.

14. On May 1, 2023, the Member’s counsel sent CNO a letter requesting an extension for completing the SCERP. The letter stated that the Member intended to take “immediate steps” to comply with the ICRC Order, including registering in the Probe Program.

15. On May 3, 2023, CNO responded to the Member’s counsel and the Member stating that for CNO to consider the extension request, the Member would need to provide a proposed deadline for completing the SCERP. CNO asked for the proposed deadline to be provided by May 10, 2023. Neither the Member nor her counsel responded.

16. On May 15, 2023, CPEP informed CNO that the Member had registered in a session of the Probe Program scheduled for August 2023. However, on June 2, 2023, CPEP notified CNO that the Member had cancelled her enrolment.

17. On June 5, 2023, CNO wrote to the Member’s counsel noting the Member’s withdrawal and asking for an explanation, as proof of registration would be required for CNO to consider an extension for completion of the SCERP. CNO followed up a second time on June 19, 2023.

18. On June 19, 2023, the Member’s counsel reported to CNO his understanding that the Member did not intend to complete the Probe Program.

19. The Member did not complete the SCERP. Since the SCERP was not completed, the Member also never received her oral caution.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

20. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 1 of the Notice of Hearing, in that she failed to complete the SCERP and receive an oral caution pursuant to the decision of the ICRC dated March 30, 2022, and that her conduct would reasonably be regarded by members of the profession as dishonourable and unprofessional, as described in paragraphs 3 to 19, above.

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 paragraph 1(a) of the Notice of Hearing. The Panel finds 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 a finding of professional misconduct as alleged in the Notice of Hearing.

Allegation #1(a) in the Notice of Hearing is supported by paragraphs 3 - 20 in the Agreed Statement of Facts. In May 2011, the Member was notified of the ICRC Order requiring her to complete a SCERP as well as attend for an oral caution before the ICRC. The College made several attempts to contact the Member and/or her counsel requesting proof of registration in the Probe Program with no response until May 2023, when the Member requested an extension to complete the SCERP. The Member then registered in the Probe Program only to cancel her registration a couple of weeks later. The Member communicated to the College through her counsel that she did not intend to complete the Probe Program; accordingly, the Member did not complete the SCERP or receive her oral caution. The Member admits that she committed an act of professional misconduct when she failed to complete the SCERP and receive an oral caution as ordered by the ICRC.

The Panel finds that the Member’s conduct was relevant to the practice of nursing in that the Member failed to comply with an ICRC decision and that this conduct was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations. The Panel finds that the Member intentionally disregarded the ICRC Order.

The Panel also finds that the Member’s conduct was dishonourable because it included an element of moral failing. The Member chose not to comply with the ICRC Order: she registered for the Probe Program and then withdrew from it a couple of weeks later. The Member knew or ought to have known that her conduct was unacceptable and fell well below the standards of a professional.

Penalty

College Counsel and the Member’s Representative 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 from the date this Order becomes final until the later of:

a) Three months from the date the suspension commences; or

b) Such time as the Member completes the specified continuing education or remediation program (the “SCERP”), and appears before a panel of the Inquiries, Complaints and Reports Committee (the “ICRC”) to be cautioned with respect to CNO’s Professional Standards, Ethics, Code of Conduct and Social Media – Reflect Before You Post practice standards and educational tools, as required in the ICRC’s Decision and Reasons dated March 30, 2022 (the “ICRC Order”).

3. The suspension described in term 2 above shall continue to run without interruption as long as the Member remains in a practising class.

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

a) The Member shall complete the SCERP and appear before a panel of the ICRC to be cautioned with respect to CNO’s Professional Standards, Ethics, Code of Conduct and Social Media – Reflect Before You Post practice standards and educational tools, as required in the ICRC Order.

b) The Member will attend a minimum of 2 meetings with a Regulatory Expert (the “Expert”) to discuss the findings of professional misconduct made by this Panel against the Member 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; and

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.

5. All documents delivered by the Member to CNO or the Expert will be delivered by verifiable method, the proof of which the Member will retain.

College Submissions on Penalty

College Counsel submitted that the Joint Submission on Order is the product of negotiations between the College, the Member and the Member’s Representative. The Panel must accept the Joint Submission on Order unless doing so would be contrary to the public interest or bring the administration of justice into disrepute.

The proposed penalty appropriately reflects the aggravating and mitigating factors in this case. It appropriately meets the goals of penalty and is consistent with prior decisions of the Discipline Committee.

The aggravating factors in this case were:

• The Member’s conduct was serious;

• The Member’s conduct showed persistent disregard for her professional obligations;

• The Member’s conduct was repeated as she was given many opportunities to complete the SCERP;

• The Member’s conduct was intentional, as she withdrew from enrolment in the Probe Program, and then had her Counsel advise the College she was not going to comply with the ICRC Order;

• The Member’s conduct demonstrates a serious disregard for the profession and undermines the College’s ability to self-regulate its members and uphold the public’s confidence.

The mitigating factors in this case were:

• The Member has taken responsibility for her actions and has cooperated with the College throughout this process by entering into an Agreed Statement of Facts and a Joint Submission on Order with the College; and

• The Member has no prior disciplinary history with the College.

College Counsel submitted that the proposed penalty will specifically deter the Member from repeating this conduct. The oral reprimand will signal to the Member disapproval of the conduct and the suspension will show that this kind of conduct is taken seriously and has serious consequences. The proposed penalty will also signal to other members of the profession that this kind of conduct is not acceptable and will be dealt with seriously. The proposed penalty also achieves the goals of rehabilitation, as the completion of the SCERP and the meetings with the Regulatory Expert will assist the Member to meet the standards and comply with the ICRC Order, and will provide the Member with an opportunity to learn and reflect. College Counsel also submitted that the proposed penalty is in the public interest as the Member would be suspended until she complies with the ICRC Order.

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

CNO v. Watson (Discipline Committee, 2023): In this case, the member attended the hearing and was found to have engaged in conduct that would reasonably be regarded by members of the profession as dishonourable and unprofessional by failing to complete a Remediation Program and not attending to receive an oral caution ordered by the ICRC. The penalty included an oral reprimand, a four-month suspension of the member’s certificate of registration and, in the event the member did not comply with the ICRC order within that four-month period, the suspension would continue until she complied. A minimum of two meetings with a Regulatory Expert was also ordered.

CNO v. Blasco (Discipline Committee, 2024): In this case the member did not attend the hearing and was found to have engaged in conduct that would reasonably be regarded by members of the profession to be dishonourable and unprofessional by failing to complete a Remediation Program and failing to attend to receive an oral caution ordered by the ICRC. The penalty included an oral reprimand, a four-month suspension of the member’s certificate of registration and, in the event the member did not comply with the ICRC order within that four-month period, the suspension would continue until she complied. A minimum of two meetings with a Regulatory Expert was also ordered.

Member Submissions on Penalty

Neither the Member’s representative nor the Member made any submissions on penalty.

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 suspension which will continue until the Member complies with the ICRC Order. The proposed penalty sends a message to members of the profession that this type of conduct is unacceptable and will not be tolerated. The proposed penalty communicates to members of the profession that they will face serious consequences for disregarding orders of the ICRC.

The proposed penalty provides for specific deterrence through the oral reprimand, which will allow the Panel to express their disapproval of the Member's conduct directly to her. The suspension of three months is significant and will deter the Member from engaging in this type of conduct again. The suspension will also not end until the Member complies with the ICRC Order, which will further deter her from noncompliance with an order of a College Committee in the future.

The proposed penalty provides for remediation and rehabilitation through the completion of the SCERP, which will address the deficiencies in the Member's practice and enable her to return to the profession with a renewed sense of her professional obligations. The terms, conditions and limitations placed on the Member’s certificate of registration, including a minimum of two meetings with a Regulatory Expert, will allow the Member to develop a greater understanding of how her actions are perceived and provide her with strategies to avoid this kind of conduct in the future.

Overall, the public is protected because the Member will be suspended from practice for three months or longer until she complies with the ICRC Order.

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 penalty is in line with the range of what has been ordered in previous similar cases.

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.