College of Nurses of Ontario v. Shuqing Hou, 2025 ONCNO 145953

Discipline Committee of the College of Nurses of Ontario

Panel: Sherry Szucsko-Bedard, RN (Chairperson) Kerrie Naylor, RPN (Member) Wendy Cheuk, RN (Member) Todd Hillhouse (Public Member) Lynda Carpenter (Public Member)

Between: College of Nurses of Ontario (Douglas Montgomery for College of Nurses of Ontario)

• and -

Shuqing Hou Registration No. 12512248, AJ770775 (Self-represented for Shuqing Hou) (Elyse Sunshine, Independent Legal Counsel)

Heard: July 10, 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 July 10, 2025.

The Allegations

The allegations against Shuqing Hou (the "Member") as stated in the Notice of Hearing dated May 30, 2025, are as follows:

IT IS ALLEGED THAT:

1. You have committed an act of professional misconduct as provided by subsection 51(1)(b.0.1) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, in that, while registered as a Registered Nurse with the College of Nurses, you failed to cooperate with the Quality Assurance Committee or any assessor appointed by that committee, and in particular, you failed to participate after being selected by the Quality Assurance Committee for Quality Assurance assessment and/or failed to complete all Quality Assurance assessment requirements in or around 2023 and/or 2024.

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 registered as a Registered Nurse with the College of Nurses, 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 you failed to participate after being selected by the Quality Assurance Committee for Quality Assurance assessment and/or failed to complete all Quality Assurance assessment requirements in or around 2023 and/or 2024.

Member's Plea

The Member admitted the allegations set out in paragraphs 1 and 2 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 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. Shuqing Hou (the "Member") initially registered with the College of Nurses of Ontario ("CNO") as a Registered Practical Nurse ("RPN") in the General class on September 8, 2010. The Member subsequently registered as a Registered Nurse ("RN") in the General class on July 30, 2012, and resigned her RPN certificate on November 13, 2012.

2. The Member has been employed at Baycrest Hospital in Toronto since 2012. The Member was also employed at the Lyndhurst Centre, a rehabilitation institute affiliated with the University Health Network, between 2012 and 2024.

PRIOR HISTORY

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

CNO'S QUALITY ASSURANCE PROGRAM

4. CNO is required by the Health Professions Procedural Code to establish a quality assurance program. CNO's Quality Assurance Committee ("QA Committee") is responsible for administering CNO's Quality Assurance Program (the "QA Program").

5. The QA Program is a process where nurses are required to reflect on their practice, identify gaps in their knowledge and take action to fill those gaps. Participation in the QA Program is a professional requirement, and nurses must declare they engage in QA Program activities every year when renewing their CNO membership.

6. Each year, CNO randomly selects nurses for Quality Assurance assessment ("QA Assessment"). QA Assessment may involve completion of a set of learning modules focused on the standards of practice and nursing accountability, submission of a learning plan to be reviewed by a CNO-trained Quality Assurance Peer Coach, and other activities.

7. Nurses selected for QA Assessment are informed of their selection by letter sent to their email on file with CNO. Members of CNO are required to ensure that their contact information on-file at CNO is correct and checked on a regular basis.

8. If a nurse chooses not to participate in QA Assessment, the QA Committee may refer the nurse to Inquires, Complaints and Reports Committee if it believes the lack of participation may amount to professional misconduct.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

The Member Failed to Participate in QA Assessment

9. On October 16, 2023, the Member was selected to participate in a mandatory QA Assessment. The Member was required to complete a 2023 Learning Plan, and Code of Conduct Practice Activity Practice Activity (the "QA Assessment activities"), and submit both to CNO by November 24, 2023.

10. The Member was informed of her selection for QA Assessment by a letter sent to her email address on-file with CNO on October 16, 2023.

11. The Member did not submit the QA Assessment activities by the deadline.

12. By letter dated December 7, 2023, the QA Committee provided the Member with a second opportunity to complete the QA Assessment activities by January 9, 2024.

13. The Member did not respond to the December 7, 2023, letter or complete the QA Assessment activities by the January 9, 2024, deadline.

14. By letter dated January 25, 2024, the QA Committee provided the Member with a third opportunity to complete the QA Assessment activities by February 22, 2024.

15. Each letter to the Member included a warning that failure to complete the QA Assessment activities could result in a referral to the Inquiries, Complaints and Reports Committee ("ICRC") and/or a direction to the Executive Director to impose terms, conditions, or limitations on the Member's certificate of registration.

16. A QA Program Team member also called the Member on January 30, 2024, at the phone number the Member provided to CNO. The QA Program Team member spoke directly with the Member. During the conversation, the Member agreed to check their inbox and complete the QA activities before the deadline.

17. The Member did not complete the QA Assessment activities by the February 22, 2024, deadline.

18. By letter dated February 23, 2024, the Member was informed that the QA Committee decided to refer the matter to the ICRC due to the Member's lack of participation in the QA Assessment.

19. All of the QA Program Team's attempts to communicate with the Member were via the e-mail and phone number that the Member had provided to CNO.

20. By letter dated April 9, 2024, sent via SharePoint and courier, the Member was provided with disclosure of the documents provided to the ICRC from the QA Committee. The Member was also given information about how to prepare a response to the investigation and advised to submit a written response by May 9, 2024.

21. CNO's investigator spoke with the Member by phone on April 10, 2024, after the matter had been referred to the ICRC by the QA Committee. The Member informed CNO's investigator that she did not recall receiving the letters from the QA Committee, and that she did not check her e-mails often. The Member did recall receiving a phone call from someone at CNO but stated that the Member probably thought they were a scammer, and so the Member did not pay attention to the call.

22. The Member sent a follow-up e-mail to the investigator on April 30, 2024, confirming that the Member had received a call from CNO. The Member added that they thought the caller was a scammer and indicated a willingness to cooperate in the future.

23. In a further phone conversation with the investigator, the Member informed the investigator that she did not "want to do anything", and questioned the purpose of Quality Assurance, given her plans to retire.

24. Despite her knowledge of the requirement to complete mandatory QA activities and receipt of all the written communications from the QA Committee, the Member failed to take any action in response.

25. The Member acknowledges that she had a professional obligation to participate in and complete the QA Assessment activities and respond to communications from CNO, regardless of any personal circumstances. The Member accepts responsibility for her conduct and is committed to meeting her obligations going forward.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

26. 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 cooperate with the QA Committee or any assessor appointed by that Committee, and in particular she failed to participate after being selected by the QA Committee for QA Assessment in 2023 and failed to complete all QA Assessment requirements in 2023 and 2024, as described in paragraphs 4-25 above.

27. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 2 of the Notice of Hearing, and in particular her conduct was unprofessional, as described in paragraphs 4-25 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 paragraphs 1 and 2 of the Notice of Hearing. With respect to allegation #2, the Panel finds that the Member's conduct would reasonably be regarded by members of the profession to be unprofessional.

Reasons for Decision

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

Allegation #1 in the Notice of Hearing, relating to the failure to cooperate with the QA Committee, is supported by paragraphs 4 – 26 of the Agreed Statement of Facts. In October 2023, the Member was selected to participate in a mandatory QA Assessment. She was required to complete the specified QA Assessment activities by November 2023. Despite numerous opportunities to comply, and the Member's knowledge of the requirements, the Member failed to complete the QA Assessment activities. The Member admitted and the Panel finds that her failure to cooperate with the QA Committee constituted professional misconduct.

Allegation #2 in the Notice of Hearing, that the Member engaged in unprofessional conduct, is supported by paragraphs 4 – 25 and 27 of the Agreed Statement of Facts. The Member's conduct in failing to comply with the College's QA Committee was relevant to the practice of nursing and was unprofessional, since continued competence is a professional requirement. The Member's conduct demonstrated a serious and persistent disregard for her professional obligations. Complying with College committees, like the QA Committee, and completing QA Assessment activities is an important professional obligation, which the Member ignored.

Penalty

College Counsel and the Member 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 2 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 two meetings with a Regulatory Expert (the "Expert"), at the Member's own expense and within 6 months from the date that this Order become 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 Practice Reflection Worksheets, online learning modules and decision tools (where applicable):

1. Code of Conduct;

iv. 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;

v. 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;

vi. 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) The Member shall successfully complete Quality Assurance Program requirements by the dates and deadlines that will be communicated by the Quality Assurance Committee.

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

Submissions on Penalty

College Counsel made submissions that the proposed penalty meets the general principles of sanction and would protect the public and enhance public confidence. The suspension would deter other members of the profession from engaging in similar conduct. The elements of the proposed penalty would also specifically deter this Member from engaging in this kind of conduct again. Remediation and rehabilitation are provided through the terms, conditions and limitations on the Member's certificate of registration.

College Counsel noted that the Panel should consider the aggravating and mitigating factors in this case. The aggravating factor was the seriousness of the Member's conduct in failing to follow a direction from a statutory committee. This creates doubts about the Member's governability.

The mitigating factors are that the Member has no prior disciplinary history with the College, and the Member accepted accountability by admitting to the allegations and cooperating with the College, and entering into an Agreed Statement of Facts and Joint Submission on Order.

Counsel submitted the following cases to the Panel, which demonstrate that the proposed penalty falls within the range of similar cases from this Discipline Committee: CNO v. Rubinas, (Discipline Committee, 2020), CNO v. Agustin, (Discipline Committee, 2025, signed orders dated February 4, 2025 and June 12, 2025, with appended Notice of Hearing, Agreed Statement of Facts, and Joint Submission on Order) and CNO v. S. J Thomas, (Discipline Committee, 2025, signed order dated June 10, 2025, with appended Notice of Hearing, Agreed Statement of Facts, and Joint Submission on Order).

The Member did not make submissions on penalty but had previously commented that she intended to cooperate with the College, and that it was not her intention to be dishonest. She submitted that she was ill with COVID-19 which resulted in her not reviewing the communications from the College, and that she thought that the calls from the College were "scammer calls."

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 two-month suspension, which communicates to members of the profession that the College takes this type of conduct seriously and that members are required to comply with the requirements of the QA program.

The proposed penalty provides for specific deterrence through the two-month suspension and the oral reprimand, which the Panel believes will ensure that the Member does not engage in this kind of conduct in the future.

The proposed penalty provides for remediation and rehabilitation through the meetings with a Regulatory Expert, which will assist the Member to understand and meet her professional obligations for continuing competence moving forward.

Overall, the public is protected when nurses comply with their obligations for continuing competence and their professional responsibilities for quality assurance. Quality assurance is vital in nursing because it ensures patient safety, consistent and evidence-based care and professional accountability. It helps prevent errors, improves health outcomes, supports nurses in delivering safe care and builds patient trust in the healthcare system.

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, Sherry Szucsko-Bedard, RN sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.