College of Nurses of Ontario v. Relia Mae Almonia, 2025 ONCNO 146440

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Sherry Szucsko-Bedard, RN Chairperson Doreen Bankole, RN Member Todd Hillhouse Public Member Shannon Mantha, RN Member Patricia Pilon Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) GLYNNIS HAWE for ) College of Nurses of Ontario

• and - )

RELIA MAE ALMONIA ) ANNA LICHTY for Registration No. 20266891 ) Relia Mae Almonia ) LONNY ROSEN ) Independent Legal Counsel

) Heard: August 5, 2025, ) via videoconference

DECISION AND REASONS

Publication Ban

By Order of the Discipline Panel dated August 5, 2025, pursuant to subsection s.45(3) of the Health Professions Procedural Code of the Nursing Act, 1991, no one shall disclose, publish or broadcast the name(s) of the patient(s), or any information that could disclose the identity(ies) of the patient(s), referred to orally or in any documents presented at the Discipline hearing of Relia Mae Almonia.

This matter was heard by a panel of the Discipline Committee (the “Panel”) of the College of Nurses of Ontario (the “College”) on August 5, 2025.

The Allegations

The allegations against Relia Mae Almonia (the “Member”) as stated in the Notice of Hearing dated June 24, 2025 are as follows:

IT IS ALLEGED THAT:

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

a. on or about February to March 2023, you:

i. failed to follow-up regarding concerns with the care of Patient A;

ii. shared Patient A’s health record and/or personal health information via social media chat without clinical purpose, the consent of Patient A, or other authorization; and/or

iii. participated in a social media chat which included discussion about how to influence the outcome of an employer investigation into Patient A’s care;

2. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that while employed as a Registered Nurse at Chartwell Pine Grove in Woodbridge, Ontario, 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 or about February to March 2023, you:

i. failed to follow-up regarding concerns with the care of Patient A;

ii. shared Patient A’s health record and/or personal health information via social media chat without clinical purpose, the consent of Patient A, or other authorization; and/or

iii. participated in a social media chat which included discussion about how to influence the outcome of an employer investigation into Patient A’s care.

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’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 mentioned therein, as follows:

THE MEMBER

1. Relia Mae Almonia (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse (“RN”) on May 4, 2020.

2. The Member was employed at Chartwell Pine Grove (the “Facility”) from May 10, 2019 until March 16, 2023.

PRIOR HISTORY

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

THE FACILITY

4. The Facility is a long-term care home located in Woodbridge, Ontario. The Facility consists of three units with approximately 30 patients on each unit. The Facility may have up to 96 patients at a time.

5. During the night shift, the Facility is staffed by one RN, one Registered Practical Nurse (“RPN”), and nine Personal Support Workers (“PSWs”). The RPN is responsible for patients on the first and second floors, while the RN, who is the charge nurse, is directly responsible for patients on the third floor as well as oversight of the other floors.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

The Member failed to follow-up regarding concerns with the care of Patient A

6. On February 24, 2023, Patient A complained to the Facility that she had been subject to neglect and abuse. Patient A reported that she was unable to pee the whole night, unable to breathe, and that she rung the call bell, but no one responded.

7. On the night of February 23 to 24, 2023, one of the Member’s PSW colleagues, Colleague A, witnessed Patient A in pain and crying. Colleague A reported this to the Member. If the Member were to testify, she would state that in response, she looked into Patient A’s room and the patient was sleeping. The Member also spoke with another PSW, Colleague B, who was assigned to Patient A’s care. The Member admits that in the circumstances, she ought to have followed-up directly with Patient A, including by conducting an assessment of Patient A, which she did not do.

8. Though the Member had not assessed Patient A, on February 24, 2023 at 6:36 a.m., the Member documented that Patient A was “crying and refusing AM care. Staff showed her that her brief needs to be changed for it is soaked but she said she didn’t pee.” If the Member were to testify, she would state that the contents of her documentation were relayed to her by Colleague B.

The Member inappropriately shared Patient A’s health record and/or personal health information via a social media chat, and participated in a social media chat which included discussion about how to influence the outcome of an employer investigation

9. After receipt of Patient A’s complaint, the Facility initiated an investigation.

10. During the Facility’s investigation, it came to the Facility’s attention that the Member was part of a group chat on Facebook Messenger along with multiple of her PSW colleagues, including Colleague B.

11. In the group chat, the Member and the other PSWs discussed being interviewed by the Facility about Patient A’s complaint. As part of this discussion, the Member encouraged her colleagues to not tell the Facility about a specific comment Colleague B claimed Patient A had made, which the Member had not included in her documentation. The Member stated in the group discussion: ““Don’t say about the devil thing. I didn’t report it. But next time it will happen again, I’ll include it on my documentation. I’ll just documented that she refused care and didn’t believe it’s her pee. That’s it. She was crying.” In response, Colleague B stated: “Okay I will say that”.

12. In response to a comment from another PSW, Colleague C, in which Colleague C told the others to stick to answering questions during their interviews, and not to volunteer other information, the Member responded: “True stick only on the questions”.

13. The Member’s participation in the Facebook group chat included the Member stating “I covered for you guys” in relation to the investigation. If the Member were to testify, the Member would state that she was referring to the fact that she had documented in Patient A’s chart what had been reported to her earlier by Colleague B, that Patient A was “crying and refusing AM care. Staff showed her that her brief needs to be changed for it is soaked but she said she didn’t pee.”

14. The Member also posted in the group chat a picture of an excerpt from Patient A’s chart reflecting her documentation of this statement.

CNO STANDARDS

Code of Conduct

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

• Nurses respect the dignity of patients and treat them as individuals;
• Nurses work together to promote patient well-being;
• Nurses maintain patients’ trust by providing safe and competent care;
• Nurses work respectfully with colleagues to best meet patients’ needs;
• Nurses act with integrity to maintain patients’ trust; and
• Nurses maintain public confidence in the nursing profession.

16. With respect to the principle requiring nurses to respect the dignity of patients and treat them as individuals, CNO’s Code of Conduct provides that nurses treat patients with care and compassion and take steps to maintain patients’ privacy.

17. With respect to the principle requiring nurses to work together to promote patient well-being, CNO’s Code of Conduct provides that nurses acknowledge patients’ right to express concerns, and respond by working with patients to resolve concerns.

18. Regarding the principle requiring nurses to work respectfully with colleagues to best meet patients’ needs, CNO’s Code of Conduct provides that nurses take action to stop unsafe, incompetent, unethical or unlawful practice, including any type of abuse.

19. Regarding the principle requiring nurses to act with integrity to maintain patients’ trust, CNO’s Code of Conduct provides that nurses protect the privacy and confidentiality of patients’ personal health information; nurses do not share patient information on social media; and nurses take prompt action to prevent and protect patients from harm.

20. Regarding the principle requiring nurses to maintain public confidence in the nursing profession, CNO’s Code of Conduct provides that nurses have a duty to report any error, behaviour, conduct or system issue that affects patient safety.

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

Professional Standards

22. 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.

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

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

Confidentiality and Privacy – Personal Health Information

25. CNO’s Confidentiality and Privacy - Personal Health Information Standard (“Privacy Standard”) largely incorporates the Personal Health Information Protection Act, 2004. The Privacy Standard provides that nurses have ethical and legal responsibilities to maintain the confidentiality and privacy of patient health information obtained while providing care. It requires that personal health information be kept confidential and secure. Nurses comply with the Privacy Standard by, among other acts: safeguarding the security of computerized, printed or electronically displayed or stored information against theft, loss, unauthorized access or use, disclosure, copying, modification, or disposal.

26. Attached as Exhibit “C” is a copy of CNO’s Privacy Standard that was in force at the time of the incidents.

27. The Member admits and acknowledges that in engaging in the conduct described above she breached CNO’s Code of Conduct, Professional Standards, and Privacy Standard.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

28. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 1(a)(i)(ii), and (iii) of the Notice of Hearing, in that she contravened a standard of practice of the profession or failed to meet the standard of practice of the profession, as described in paragraphs 4-27 above.

29. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 2(a)(i)(ii), and (ii) of the Notice of Hearing, in that she 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 dishonourable and unprofessional, as described in paragraphs 4-27 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. As to allegations #2(a)(i), (ii), and (iii) of the Notice of Hearing, the Panel finds that the Member engaged in conduct that would reasonably be regarded as 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)-(iii) in the Notice of Hearing are supported by paragraphs 4 - 28 in the Agreed Statement of Facts. The Member admitted to failing to follow up on patient care concerns brought to her attention while acting as charge nurse. Instead of conducting her own assessment, she relied solely on a colleague’s account. She also admitted to sharing patient information in a social media chat with no clinical purpose or proper authorization, and participating in social media chat discussions aimed at influencing her employer’s investigation.

This conduct clearly breached the College’s Code of Conduct, the Professional Standards, and the Privacy Standard, in that it fell well below the expectations, accountabilities and legislative requirements outlined within these standards. The Panel found that the Member’s failure to directly assess the patient, who was reportedly crying and in pain, and her inappropriate use of social media, constituted serious breaches of standards of practice. Her actions violated the profession’s standards and legislative requirements by neglecting patient care responsibilities and compromising patient confidentiality and privacy.

Allegations #2(a)(i)-(iii) in the Notice of Hearing is supported by paragraphs 4 - 29 in the Agreed Statement of Facts. The Member’s conduct occurred during her clinical work as an RN at the Facility, and therefore it is relevant to the practice of nursing. The Panel finds that the Member’s conduct in failing to follow-up on a patient care concern, sharing a patient’s personal health information within a social media chat, and participating in a social media chat to influence the Facility’s investigation was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations, in contravening the Code of Conduct, the Professional Standards, and the Privacy Standard.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of moral failing, and dishonesty and deceit through documenting in a misleading manner that suggested she had completed patient care when she had not, and by engaging in social media chat with the goal of influencing the outcome of the Facility’s investigation into a patient’s care complaint. 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 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 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 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 Practice Reflection Worksheets, online learning modules and decision tools (where applicable):

1. Code of Conduct, and
2. Confidentiality and Privacy – Personal Health Information;

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.

Penalty Submissions

College Counsel submitted that the proposed penalty is appropriate, is not intended to punish the Member, enhances the Colleges ability to self-regulate its members and meets the College’s goal of protecting the public. It also achieves specific deterrence, general deterrence, and provides an opportunity for the Member’s remediation and rehabilitation.

The aggravating factors in this case were:

• Patient A, who was under the Member’s care, was a long-term care resident who was extremely vulnerable;
• A breach of patient trust occurred by the Member sharing the patient’s personal health information in a social media chat for her own purposes and with no clinical purpose and without proper authorization; and,
• Failing to follow-up on a patient who was reportedly crying in pain could have resulted in potential harm to the patient.

The mitigating factors in this case were:

• The Member has no prior disciplinary history with the College;
• The Member cooperated with the College by entering into an Agreed Statement of Facts and a Joint Submission on Order; and
• The Member expressed serious remorse throughout the process in her dealings with the College.

Counsel submitted the following cases to the Panel which demonstrate that the proposed penalty falls within the range of penalties ordered in similar cases from this Discipline Committee: CNO v. Dacillo Cruz (Discipline Committee, 2023), and CNO v. Popo (Discipline Committee, 2020).

The Member’s Counsel agreed with the College’s submissions and submitted that the Member has shown insight into her conduct throughout the investigation and discipline process.

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 specific deterrence through the oral reprimand delivered by the Member’s peers and a member of the public to convey the impact of her misconduct on the nursing profession and the public. The two-month suspension of the Member’s certificate of registration will also deter the Member from engaging in this kind of misconduct again.

The proposed penalty provides for general deterrence through the two-month suspension of the Member’s certificate of registration, which will deter other members from engaging in similar conduct. The proposed penalty also conveys that the Panel takes breaches of numerous standards of practice and engaging in dishonourable and unprofessional conduct seriously and will impose a significant penalty as a result.

The proposed penalty provides for remediation and rehabilitation through meetings with a Regulatory Expert, which provides the Member with opportunity to reflect on her conduct and improve her practice moving forward.

Overall, the public is protected because of the 12-month employer notification period, which will provide day to day oversight into the Member’s return to nursing practice following her suspension, to prevent future misconduct.

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.