College of Nurses of Ontario v. Joan Abrahams, 2025 ONCNO 152776

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Susan Roger, RN Chairperson Todd Hillhouse Public Member Jeffrey Ko, RN Member Patricia Pilon Public Member Sherry Szucsko-Bedard, RN Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) DOUGLAS MONTGOMERY for ) College of Nurses of Ontario

• and - )

JOAN ABRAHAMS ) GRANT FERGUSON for Registration No. JI728048 ) Joan Abrahams

) ELYSE SUNSHINE ) Independent Legal Counsel

) Heard: NOVEMBER 20, 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 November 20, 2025.

The Allegations

The allegations against Joan Abrahams (the “Member”) as stated in the Notice of Hearing dated May 16, 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 Practical 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 in 2023 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 Practical 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 in 2023 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’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. Joan Abrahams (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse (“RPN”) on March 9, 2009.

2. The Member has been employed as an RPN at Shepherd Village Inc. in Scarborough, Ontario, since 2009.

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

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

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 helps nurses engage in activities that foster lifelong learning and helps nurses maintain and improve their professional competence. Participation in the QA Program is a professional requirement.

6. There are two parts to CNO’s QA Program: Part A - Knowledge Assessment and Part B - Practice Assessment.

The Member Failed to Participate in the 2023/2024 QA Program

7. On October 16, 2023, CNO advised the Member, via the Member’s CNO membership portal, that she had been selected to participate in the QA Program. The Member was given until November 24, 2023 to complete Part A - Knowledge Assessment activities. These activities consisted of reviewing learning modules and answering questions about the modules to ensure the Member’s understanding. CNO advised the Member that if she did not complete Part A, she may also be required to complete Part B activities.

8. The Member failed to complete the Part A activities by the deadline of November 24, 2023.

9. On December 5, 2023, CNO advised the Member, via the Member’s CNO membership portal, that since she had not completed the Part A activities by the deadline, she would also be required to complete Part B - Practice Assessment activities. Part B required the Member to submit a learning plan and complete a Code of Conduct practice activity. The Member was given a new deadline of January 9, 2024 to complete Parts A and B.

10. On January 3, 2024, CNO reminded the Member, via email, of the deadline to complete her QA Program activities. However, the Member failed to complete the activities by the deadline.

11. On January 24, 2024, CNO wrote to the Member via both SharePoint and email to provide a final opportunity to complete the QA Program activities, with a new deadline of February 22, 2024.

12. On January 30, 2024, CNO called the Member and left a voicemail, requesting the Member contact the QA Program Team by email or phone.

13. On January 31, 2024, CNO sent the Member a final notice reminding her of her outstanding QA Program activities via post mail.

14. The Member did not respond to any of CNO’s communications, nor did she complete any portion of her QA Program activities by the deadline of February 22, 2024.

15. If the Member were to testify, she would state that she had limited access to her email and voicemail due to departures out of the country due to family issues. She would testify she did not ignore the messages and emails left by the CNO out of malice or an intention not to cooperate with the CNO.

16. If the Member were to testify, she would accept that the messages as detailed above were sent on the dates and times above but would advise that she did not receive the messages until well after they were sent. She would testify that any ignoring of the messages was inadvertent on her part.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

17. 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 Quality Assurance assessment in 2023 and/or failed to complete all Quality Assurance assessment requirements in or around 2023 and/or 2024, as described in paragraphs 7 to 16 above.

18. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 2 of the Notice of Hearing, and in particular, that her conduct was unprofessional, as described in paragraphs 7 to 16 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 the Member’s conduct would be 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 is supported by paragraphs 7-17 in the Agreed Statement of Facts. The Member admitted that, after being selected for the QA Program and being required to complete Part A - Knowledge Assessment activities, she failed to complete the required components of the QA Program despite multiple attempts by the College to engage her participation. She acknowledged that she committed the acts of professional misconduct as alleged by repeatedly failing to cooperate with the QA Committee. Although the QA Committee provided several courtesy extensions to support her compliance, the Member still did not participate. Regulated professionals are expected to be responsive to their regulatory body, and the Member’s lack of engagement in the QA Program demonstrated a disregard for her professional responsibilities and requirements. The Panel found that the Member’s failure to comply with a mandatory requirement of a statutory committee of her regulator constituted a clear breach of her professional obligations, regardless of her intent.

Allegation #2 in the Notice of Hearing is supported by paragraphs 7-18 in the Agreed Statement of Facts. The Panel finds that the Member’s failure to comply with the QA Committee and to complete the QA Program requirements was relevant to the practice of nursing, because continuing competence is a requirement of the profession. This conduct would reasonably be regarded by members of the profession as unprofessional. The Member ignored formal requests from a statutory committee of the College, despite being given multiple opportunities to comply. Every nurse is responsible for participating in the mandatory QA Program to help ensure high standards of patient care. This repeated non-compliance calls into question the Member’s understanding of, and commitment to, the self-regulatory responsibilities inherent in nursing practice.

Penalty

College Counsel and the Member’s Counsel advised that a Joint Submission on Order (“JSO”) 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 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. 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. 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;

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) 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 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 aligns with the goals of penalty, including specific and general deterrence, remediation, rehabilitation, and protection of the public. Counsel emphasized that the purpose of penalty is not to punish the Member, but to safeguard the public and uphold confidence in both the nursing profession and its self-regulatory system.

The aggravating factors in this case were:

• The seriousness of the Member’s conduct, having received a direction from the College’s statutory committee and failing to respond; and

• The Member’s failure to recognize the seriousness and importance of her professional accountability.

The mitigating factors in this case were:

• The Member cooperated with the College and accepted responsibility to obtain a resolution; and

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

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. Agustin, 2025 114859 (ON CNO), CNO v. Lualkwane, 2024 140483 (ON CNO), CNO v. Davis, 2020 116470 (ON CNO), and CNO v. Rubinas, 2020 121144 (ON CNO).

Member’s Submissions on Penalty

Member’s Counsel agreed with the College’s submissions and stated that the Member accepts full responsibility for her actions. The Member accepts the penalty as proposed in the Joint Submission on Order. Member’s Counsel submitted that the penalty sends a strong message to other nurses regarding the importance of keeping their contact information current. The suspension is significant, and the Member has accepted it.

Counsel further submitted that the Member would benefit from meeting with a Regulatory Expert, completing the required education, and fulfilling her QA obligations so that she is current in her practice upon returning to the profession. Counsel noted that the cases presented to the Panel by College Counsel are consistent with the facts and proposed penalty in this matter.

Member’s Counsel submitted the following additional mitigating factors for the Panel to consider:

• The Member has been practicing for 14 years with no prior discipline;

• There were no patients involved or concerns with the Member’s care brought forward;

• The Member cooperated with the College, took accountability, gained insight and is remorseful; and

• The Member did not deliberately ignore the QA requests but rather, her contact information was not up to date.

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. This will deter other members of the profession from failing to respond to requests from the QA Committee and reinforces that the Discipline Committee treats non-compliance with College Committees seriously.

The proposed penalty provides for specific deterrence through the two-month suspension and the oral reprimand. This will deter the Member from engaging in similar conduct in the future and sends a strong signal that cooperation with the QA Committee is mandatory.

The proposed penalty provides for remediation and rehabilitation through:

• The two meetings with a Regulatory Expert which will help the Member gain greater insight into her conduct and her professional obligations; and

• The oral reprimand will inform the Member of the standards expected by both colleagues and the public.

Overall, the public is protected because the Member will be required to complete her outstanding QA Program requirements, which ensures that she continues to learn and uphold high standards of care.

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, Susan Roger, 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.