2024-08-10 Saturday Peaceful Freedom Rally

11:00am - 12 noon Markham and Lawrence

Nurse Sarah A. Choujounian’s ongoing disciplinary hearing 2024-08-07

Last week I expressed concerns about how Ms. Choujounian might hold up under cross exam, but I though she did well. Good demeanour, unflappable, questioned to clarify, made a few effective counter points and only rarely answered off topic. Instead of the constant confrontation I was expecting, there was general agreement. College of Nurses of Ontario (CNO) lawyer Meagan Shortreed, went over Ms. Choujounian’s background and the professional, ethical and legal standards for nursing. Ms Shortreed did claim that World Financial Group was a multi-level marketing company that an Ontario financial regulatory body started investigating in 2024. Ms Choujounian responded that she hadn’t been involved with WFG for a number of years. The background questions were mostly clarifying and didn’t add anything of importance to the record as far as I could tell.

As during her examination in chief Ms. Choujounian made it clear she agreed with and believes she followed all the required professional, ethical and legal standards - at least to the extent they were consistent and in the patients interest. One statement that may come back against Ms Choujounian was I thought I heard her agree that she had to communicate scientifically proven information to the public without explaining what she means by science. Both sides agreed at length and in great detail that patient is to be interpreted as “the public” in the context of the allegations against Ms Choujounian’s public statements. I guess this is important to nail down in a legal proceeding, but I didn’t think Ms. Shortreed added much to the record here either.

As when cross examining the defense’s expert witnesses, Ms Shortreed got into legal details as to how various health organizations derived their power from various statutes. I don’t think Ms Choujounian could be expected to know all these statutes and even asked what the word statute meant. This struck me as at best legal housekeeping.

CNO lawyer Ms Shortreed did not cross examine the truth of Ms Choujounian’s statements. Instead it appeared Ms Shortreed was outlining a legal theory that Ms Choujounian was part of the “health care system” and had an absolute duty to uphold the system which I find very concerning. I thought Ms Choujounian deflated this theory very effectively when Ms Choujounian pointed out she has a duty to warn if she thinks a doctor is making a mistake such as giving an incorrect dose of a medication. With all parties vehemently agreeing the patient is the public in this case, this ethical standard seems to cover exactly what Ms Choujounian was doing with her public statements on COVID-19. Ms Choujounian also had a good comeback when Ms Shortreed pointed out that many others were more qualified to comment on the pandemic. Ms. Choujounian agreed and said that’s why so many of the posts at issue are reposts of others she found more qualified than herself.

There were legal fireworks in the afternoon over Ms. Choujounian’s "gangster" post from 2023-06-08 where she stated Public Health, Government and the Elite are the real gangsters. This a rant and the tone is unfortunate. I would have found the contents shocking before the pandemic, but less so after the pandemic. Ms. Choujounian’s lawyer Mr. Boissonneau-Lehner objected because the post was not disclosed to the defense in advance under Health Professions Procedural Code 42.1 and was overruled because the panel sided with the CNO argument that there is wide latitude to introduce new evidence on cross. Mr. Boissonneau-Lehner shortly thereafter objected under the Collateral Fact Rule - 2018 Ontario Court of Appeal decision prevents a party from calling extrinsic contradictory evidence solely to undermine credibility to a collateral issue (i.e. not substantive). According to Mr. Boissonneau-Lehner, the Notice of Hearing sets out the substantive issues and Ms Choujounian’s opinion of Public Health is not substantive. The panel denied this objection too and ruled the issue was relevant. Questioning proceeded and Mr. Boissonneau-Lehner objected a third time for the record without asking for a ruling. To her credit Ms. Choujounian was pretty well composed throughout this questioning. Ms. Choujounian basically stated that Public Health got so many things wrong, with all the “best” “scientific” advice available to them, that it is either utter incompetence or bad faith which seems reasonable to me.

So far, I don’t think the College made any case ending points in cross, but it remains to be seen how Ms Shortreed will deal with the truth of Ms. Choujounian’s statements and pull all the threads together. I’m proud of Ms. Choujounian for standing up for our rights.

Upcoming:

Aug 13th Tamara Lich and Chris Barber’s trial resumes in Ottawa

Aug 16th expected to be fully devoted to Ms Choujounian’s cross examination. Contact HearingsAdministrationGroup@cnomail.org for the YouTube link. If anyone else also takes notes, I’d be interested in sharing the work and/or comparing notes.

Legal Disclaimers: I remain not a lawyer so please absolutely don’t rely on this as legal advice. Unfortunately the CNO does not permit recording the hearing so these comments are largely from notes/memory. Presumably there will be an official transcript available at cost if you require legally reliable information.

Rally at Markham and Lawrence this Saturday from 11:00am - 12 noon

Please bring a freedom related sign, flag, flyers etc. if you have them.

I will be at or near Markham and Lawrence, ending up directly outside Healthy Planet in Cedarbrae Mall towards noon.

Raw Notes

10:10

Cross Exam

no university degree

2 year nursing diploma

RPN 2004

administrative suspension for a month for lack of payment of fees

2024-03-18 registration expired

Currently RPN General Class

Find a Nurse marked as exhibit 53

currently not a member, not entitled to practice

Nurses are a regulated health profession

regulated in the public interest

CNO to protect the public, Nursing Act, Regulated Health Professions Act

CNO charged with developing standards of practice, knowledge and skill, competence, professional ethics

CNO required to enhance relations with other members and other professions

Obligated to comply whether you agree or not? yes, but not if harmful to patients

Code of Conduct: Foreword: focus is to protect the public, Code is a standard of practice. Agreed applied to Sarah

Sarah Accountable to public not the CNO

If standards are not being followed by the College

Sarah agrees with values set out in Code of Conduct, patient centred, public confidence, public safety is top priority

Sarah accountable to CNO where they are doing the right thing

Sarah agrees with maintaining patients trust, principles 3.2, 3.4 legal scope of practice, 3.7 accurate sources of information

3.9 relevant laws, CNO standards

principle 4 work respectfully with colleagues to best meet patient needs and respectful of colleagues on social media

4.2 profession communication with colleagues

5 nurses act with integrity to maintain patients trust

5.7 nurses maintain integrity, do not use position to sell or promote products for personal gain

5.8 professional boundaries

patients - extends to the community as well, Sarah agrees

Each principle is supported by a set of statements

CNO's Professional Standards (2018)

- introduction, standards contribute to public protection, Sarah agrees the standards applied to her

- Guiding principles, clients are the central focus, clients ultimately make their own decisions, client may include the community agreed

Accountability Standards

- accountable to public agreed

- conduct to promote respect for the profession - agreed

Ethics Standards - agreed

- obligations to uphold values in ethics

- client well being, respecting client choice, sanctity and quality of life, truthfulness, fairness

- acting with integrity, honesty, professionalism...

Knowledge - agreed

- knowledge relevant to professional practice

- indicators evidence based rationale, informed and objective, informed about nursing and relation to healthcare delivery system, understand legislation and standards relevant to nursing

- knowing where and how to access learning resources, seek and review learning in nursing and related areas

Leadership - agreed

- promote best possible care

- self knowledge, understand how behaviour could affect others

- respect, trust, integrity, shared vision, learning, whether or not formal leadership

- indicators - roling modelling professional beliefs and attributes

CNO ethics standards (2019) - agreed

- a starting point

- behavioural directives are intended to help nurses work through ethical situations

- client definition, therapeutic, family, group, public

- ethical values: respect for life, truthfulness

Commitments to nursing profession - agreed

- respect and trust of public

- nurses have a duty to uphold the standards of the profession

Code of Conduct

- limit to scope of practise of RPN - agreed

- applies to social media - agreed

- Nursing Act sets out controlled acts

- RPN, not permitted to prescribe medication

- RPN, not permitted to communicate a diagnosis to a patient

- RPN, not permitted to sell or compound a medication

- RPN, not permitted to dispense medication

- RPN, not permitted to make decisions about treatment plans, regardless of personal views

- Sarah: RPN should highlight mistakes, critical thinking

11:38

reflect before you post - agreed

- professionalism and integrity at all times on social media

- posts should not reflect negatively on the nursing profession

- public trust in nursing profession

- relevant educational resources

- available to public

- used hashtags to make posts public by topic

position statement from INRC? on public communication

- use caution before posting

- different accounts for professional and personal posts

- protect integrity of profession

Nurses Supporting Public Health Measures (via Kristen Nagel)

- CNO expectations about evidence based health protection measures

- nurses are leaders - agreed

- public trust extends to social media - agreed

- statements have potential to impact health and safety - agreed

- professional accountabilities

- accurate sources of informations - agreed

- applies to COVID-19

- support patients and public to make informed decisions, including public health - agreed

- nurses have a professional responsability to role model professional integrity

- Sarah agrees with principle of following public health directives that keep patients and public safe (if they keep them safe)

- applies when communicating to public as a nurse - agreed

- nurses adhere to standards of practise when carrying out their professional responsibilities

- Nurses not to contradict available scientific evidence

- Sarah agrees has to communicate scientifically proven evidence (what about College communicating?)

- Ontario Ministry of Health, Public Health Ontario - Sarah doesn't remember those contents

- Public Health Ontario COVID-19 healthcare resource

- COVID-19 vaccine resources, Vaccine Safey Resource page, OMH vaccine page, Canada Covid-19 vaccine page, Canada portal for health care professionals - Sarah had access

- nurse, registered practical nurse is a restricted title

- general public trusts nurses - agreed

- title nurse - public might not know the scope of expertise

Working outside the system

- using title implies part of healthcare delivery system - agreed

Dec 10 investigator appointed, Apr 1 Sarah got notice and 800 pages of disclosurei prior to referral to disciplinary committee

Objection

needs 10 days notice - within the hearing process, not the investigation process

13:39

will drop objection depending on how cross proceeds

2021-01-12 informed of investigation

2021-04-01 document disclosure, summary of incidents, summary of interviews

Sarah not sure why College initiated the investigation Registrar's report, Letter of report

relevant documents - initiated by many reports from many members of the public

2021-10-12 referral to discipline letter from College Appendix A set out 12 posts/speeches sent to discipline

several complaints were about Jan 6th complaint

did not include speech Jan 6th in Washington DC

Sarah effort to censor speech, College promoting a certain narrative, College will promote their view over all others

2020 Sarah raised concerns about conditions at Sienna home, for many reasons

Not being prosecuted for anything related to Sienna (quality of food, masking/gowning at Sienna)

Only portions of the posts are at issue: lockdowns not at issue, residents isolate not at issue, mental health issues of lockdowns not at issue

2 year nursing diploma from Humber College

pre grad clinical at Toronto Western Hospital

2004-06-01 temporary licence

2004-10-19 full licence

2005-04-14 registration suspended because she moved to Montréal

5-6 months at Toronto Western

No degree in nursing, medecine, pharmacist, etc

never worked as a public health nurse

Independent Scholar - self described, no diploma, no formal training

Principle work within limits of knowledge and scope of practice

Sarah agrees others more qualified - that's why she quoted others

World Financial Group - self employed, WFG regulatory concerns

- network marketing, tiered/pyramid recruitment

knowledge standard - Sarah had as much evidence as "Public Health", agrees to assume Ontario

Public Health Ontario part of health delivery system created by legislation

Public Health Ontario mandate - provide scientific and technical advice to government, promote health of Ontarians and reduce health inequities, promote best practices for infectious diseases, produce public health statistics, including infectious diseases, public health research, education and professional development for health professionals and government, provide laboratory service, infection control and occupational health and safety, research into respiratory illness transmission, take direction from Chief Medical Officer of Health, CMO authority to issue directives during an outbreak. agrees CMO has the power to make directives during an outbreak.

Science advisory table (SAT) - Sarah doesn't remember, assumes the government had advice on outbreak

SAT summarizing evidence - Sarah agrees

SAT available on Public Health website, but Sarah didn't feel need to access

Health Canada - mission, promote longevity, health

- authorize drugs, look at scientific evidence, weigh risks against benefit (at least used to)

Sarah not sure the organizations were following their mandates, good faith, no reason to doubt individually

Objection to "gangster" post from 2023-06-08

has to be relevant to issue, or credibility

needs to be disclosed Health Professions Procedural Code 42.1 admissible means not admitted as evidence may not restrict cross exam

approx 15:03

Objection overruled

Public Health, Government and the Elite are the real gangsters

Object

Collateral Fact Rule - 2018 ONCA decision prevent a party from calling extrinsic contradictory evidence solely to undermine credibility to a collateral issue (i.e. not substantive) Notice of Hearing sets out substantive issue and opinion of Public Health is not substantive. Sopinka's law of evidence in Canada, Section 20 of the Ontario Evidence Act

Shortreed issue is substantive: Ms Choujounians views on institutional players are relevant to respect for institutions and the pressures they were under in formulating a Public Health response

B-L allegations do not include Ms Choujounian's views on public health, does not impact whether statements were false or misleading, not her views on Public Health

Objection denied, issue is relevant

The are disguised as the establishment like the CNO, all the loaded ones who get millions killed. Bullies, corrupt government and regulatory bodies, Public Health is not acting in good faith, loaded refers to organizations in general, problem in general when Public Health with all their resources and knowledge couldn't get it right, Censorship of links for hearing, the hearing itself is censorship, big organizations are not getting in trouble for all the harm they caused.

B-L reiterated concern with line of questioning

Wanted to be noted as an advocate, wanted to use nursing title in advocacy

used nursing hashtags, introduced as chief nurse steward, was nurse and chief steward

Wanted to use nursing in advocacy to get more credibility

Leadership, nurses are leaders in the community, wanted to influence people and reach as many people as possible

Part of a call to action, unite nurses, educate the public and bring the ethics back into health care

16:32 adjourned

Full day for cross on 16th