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