Dialogue Volume 14 Issue 2 2018 - Page 75

DISCIPLINE SUMMARIES DISGRACEFUL, DISHONOURABLE OR UNPROFESSIONAL CONDUCT Patient A was a retired registered nurse and was Dr. Roche’s patient for over 20 years. Dr. Roche treated her for clinical depression, weekly for individual therapy as well as weekly for group therapy. In or around the summer of 2014, in the course of their private therapy, Dr. Roche asked Patient A if she would be interested in moving to British Columbia with her and being her tenant in a home she planned to buy there. All subsequent planning discussions took place during individual therapy sessions. A couple of months later, Dr. Roche hired Patient A in her professional capacity as a registered nurse to care for her during her recovery from abdominal surgery. Dr. Roche offered to pay Patient A $500 for nursing care for a one week period as well as gas money for travel to and from the hospital and to post-operative appointments. Patient A stayed in Dr. Roche’s home following her surgery, to care for Dr. Roche for seven days in November 2014. While caring for in her home, Dr. Roche was agi- tated and difficult. She shouted at Patient A and used foul language and told Patient A that she was dissat- isfied with her services. Patient A attended in January 2015 at Dr. Roche’s office for their next scheduled therapy session. At that appointment, Dr. Roche became upset with her and told her she had changed her mind about mov- ing to B.C. Also, Dr. Roche complained about her nursing services and stated that she decided not to pay her any more money for the services she pro- vided. Patient A attended a subsequent appointment in February in which Dr. Roche continued to be verbally aggressive. Patient A did not book a further appointment for individual therapy. Following the February 2015 appointment, Dr. Roche left Patient A a voicemail, advising her not to attend group therapy until she attended further individual therapy. Patient A learned later that Dr. Roche had advised the group that Patient A was absent because she had “regressed.” Patient A did not give Dr. Roche consent to discuss her departure from group therapy with the others. Patient A terminated the doctor-patient relation- ship by sending Dr. Roche a registered letter of ter- mination. Dr. Roche refused to accept delivery, and did not transfer her patient files until at least seven weeks after receiving a signed consent. Dr. Roche asked other patients to do errands for her. Specifically, she asked a patient to retrieve her eye medication, and another patient frequently picked up groceries for her. FAILURE TO MAINTAIN THE STANDARD OF PRACTICE, INCOMPETENCE The College retained a psychiatrist who opined with respect to Dr. Roche’s care and treatment of Patient A that: • In hiring a patient she had worked with extensively, Dr. Roche did not meet the standard of practice as a physician. In not considering the ways this could have affect the psychotherapeutic relationship, it also demonstrated a lack of skill and judgment as a therapist. The risks of the employment relationship should have been easily foreseeable to Dr. Roche. In this case, it caused harm to the patient in that it led to the termination of what had been a 20-year therapeutic relationship. • Dr. Roche stated that there “is no pressure” for Pa- tient A to accept her offer to be her nurse. As an ex- perienced therapist, the expected standard would be for Dr. Roche to recognize that there is an inherent pressure which cannot be eliminated by attempting to convince the patient otherwise. • The offer of tenancy would be below the standard. If it had ultimately been entered into, the risk of harm would be the same as what the employment situation led to, namely, tension in the relationship and an ultimate severing. • Asking patients to perform errands for her would be taking advantage of a therapist-patient relation- ship for personal gain and would be considered unprofessional and below the standard of care. If somehow Dr. Roche did not consider patients per- forming errands as transgressions, then at best she would be showing poor judgment for not recogniz- ing them as such. • It is uncommon for a therapist to provide both individual psychotherapy and group psychotherapy for the same patient, though it does occur. In this scenario, there is a requirement for confidentiality around the material discussed during the patient’s individual therapy. Sharing information about ISSUE 2, 2018 DIALOGUE 75