DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

Panel:

Marsha Taylor, RPN Chairperson

Ruth Kitson, RN Member

Marg Axelson, RN Member

Veronica Kerr Public Representative

Tom Clifford Public Representative

B E T W E E N:

COLLEGE OF NURSES OF ONTARIO

• and - JOSEPH D.M. GIGNAC #80-0862-5

) Michelle Fuerst ) for College of Nurses ) of Ontario ) Kelly Waddingham ) for Joseph D. Marcel Gignac

) Heard: June 8, 2000

)

DECISION AND REASONS

A panel of the Discipline Committee met on June 8, 2000, at the College of Nurses of Ontario (the “College”) at Toronto. Mr. Joseph D. Marcel Gignac (the “Member”) was present and was represented by counsel.

Notice of Hearing

Notice of Hearing

1. You have committed an act of professional misconduct as provided by subsection 51(1)(b.1) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c.32, as amended, in that during the period from April 1, 1998 to March 24, 1999 [ ], in the Province of Ontario, while you were in a psychotherapeutic relationship with a [client], you sexually abused [the Client], in that you:

(a) Hugged [the Client]; and/or,

(b) Kissed [the Client]; and/or,

(c) Fondled [the Client]’s body over [the Client’s] clothing.

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 during the period from April 1, 1998 to March 24, 1999 [ ], in the Province of 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 respect of your dealings with a psychotherapy client, [the Client], in that you

(a) Failed to maintain professional boundaries with the client; and/or

(b) Hugged [the Client]; and/or

(c) Kissed [the Client]; and/or

(d) Fondled the body of [the Client] over [the Client’s] clothing; and/or,

(e) Continued to see [the Client] for psychotherapy despite [the Client’s] emotional/romantic attachment to you; and/or

(f) Took [the Client] back as a client for psychotherapy after recognizing [the Client’s] emotional/romantic attachment to you.

The Member admitted to the allegations of professional misconduct in Allegations #1 and #2 as laid out in the Notice of Hearing.

Plea Inquiry

Plea Inquiry

The chair conducted a plea inquiry in order to ensure that the Member’s admission of professional misconduct as alleged was informed and voluntary. [ ] The Member’s responses confirmed to the panel that the Member’s admissions of professional misconduct were voluntary, informed and unequivocal.

Agreed Statement of Fact

Agreed Statement of Fact

An Agreed Statement of Fact was received [ ]. This document states as follows:

The Member

The Member

1. Mr. Gignac is a Registered Nurse. He received his nursing training [ ] in 1979. He has taken courses [ ] towards a diploma in Clinical Behavioral Sciences.

2. The Member has practised primarily in the mental health field. Between 1987 and 1996, he worked as an RN for [ ] Adult Mental Health Services [ ].

3. In 1996, the Member began working in independent private practice, providing mental health counseling for the clients of a health services organization [ ] (HSO) in [ ] Ontario. The Member received referrals for psychotherapeutic counseling from a group of five family physicians. He met with clients alone and did not work under the supervision of the referring physicians.

The Client

The Client

4. [The Client] was a [parent] suffering from an obsessive-compulsive disorder. [The Client] was referred to the Member by [the Client’s] family physician in October 1997 for psychotherapeutic counseling.

5. At the time of the referral, the Client was experiencing recurring intrusive thoughts, was crying daily and was having trouble eating. [The Client] had been recently started on anti- depressant medication.

The Nurse-Client Relationship

The Nurse-Client Relationship

6. The Client attended two sessions with the Member in October and November 1997. Beginning in January 1998, the Member began providing weekly counseling sessions to the Client.

Allegation 1: Sexual Abuse of a Client

Allegation 2: Disgraceful, Dishonourable and Unprofessional Conduct

Allegations of Misconduct

7. In the spring of 1998 the Client told the Member that [the Client] had feelings for him. The Member told [the Client] that if [the Client’s] feelings got in the way of the therapy, he would have to refer [the Client] to someone else. In or about June 1998, during a counseling session, the Client and the Member held hands and discussed having a relationship together. The session ended with kissing, hugging and fondling of the Client’s [body] over [the

Client’s] clothing.

8. At the next session, the Member told the Client that the events that had occurred should not have happened and that the situation could not continue. He and the Client agreed that they would carry on with the therapy.

9. During July and August 1998, the Client and the Member exchanged hugs and occasional kisses.

10. In September, the Member referred the Client to [a] Mood Disorder Clinic (the Clinic) [ ] because of his concerns about the Client’s dependency on and feelings for him. The Member had mentioned his concerns that the Client was becoming attached to him to the Client’s family physician.

11. Following [ ] assessment at the Clinic, the Client was given the choice of receiving counseling at the Clinic or returning to receive counseling from the Member. The Client chose to return to receive counseling from the Member. In November 1998, the Member agreed to continue counseling [the Client] as long as they stayed within the professional boundaries of the relationship.

12. During the period from November 1998 to March 1999, the Member and the Client exchanged hugs and occasional kisses.

13. In March 1999, the Client told a friend about [the Client’s] relationship with the Member. The friend subsequently confronted the Member about his relationship with the Client. The

Member terminated his counseling sessions with the Client at this time.

14. The Member admits that his conduct amounts to professional misconduct as set out in allegation 1 of the Notice of Hearing in that he sexually abused the Client by hugging and kissing the Client and by fondling the Client’s body over [the Client’s] clothing.

15. The Member further admits that his conduct amounts to professional misconduct as set out in allegation 2 of the Notice of Hearing in that he engaged in conduct, relevant to the practice of nursing, that having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable and unprofessional in that he:

. failed to maintain professional boundaries with the Client;

. hugged, kissed and fondled the Client;

. continued to see the Client for psychotherapy despite [the Client’s] emotional/romantic attachment to him; and

. took the Client back as a client for psychotherapy after recognizing [the Client’s] emotional/romantic attachment to him.

The Member’s Conduct following Termination of the Nurse-Client Relationship

The Member’s Conduct following Termination of the Nurse-Client Relationship

16. Following the termination of the counseling sessions with the Client in March 1999, the Member voluntarily reported his conduct to the Client’s physician and the Director of the HSO.

17. In March 1999, the Member voluntarily removed himself from practice. He has not resumed practice at this time.

18. On March 25, 1999, through his legal counsel, the Member reported his conduct to the College of Nurses.

19. The Member sought assessment and obtained treatment [ ] in May 1999. He also sought [ ] assessment from [a health professional] who has dealt with cases of boundary violations by health care providers. [The assessor] found that the Member recognized his boundary transgression and clearly understood the gravity of the situation. [The assessor] recommended that the Member work in a practice setting where he receives regular supervision and mentoring for a period of two years.

Finding of Professional Misconduct

Finding of Professional Misconduct

The panel accepted the Agreed Statement of Fact as presented and found the Member, Mr. Gignac, had committed an act of professional misconduct in relation to Allegations #1 and #2.

The panel found that the Member engaged in unprofessional behavior by:

. failing to maintain professional boundaries with the Client:

. hug[ing], kiss[ing] and fondl[ing] the Client;

. continu[ing] to see the Client for psychotherapy despite [the Client’s] emotional/romantic

attachment to him; and

. [taking] the Client back as a client for psychotherapy after recognizing [the Client’s] emotional/romantic attachment to him.

The panel believes that the Member’s conduct was a violation of the trust that the public expects in the provision of client care and is especially serious in a psychotherapeutic relationship.

Joint Submission on Penalty

Joint Submission on Penalty

Counsel for the College tendered [ ] a Joint Submission on Penalty which provided that the Discipline panel should make an order in the following terms:

a) Directing the Executive Director to suspend the Member’s certificate of registration for a period of three months, to commence on the day the order becomes final;

b) Requiring the Member to appear before the panel of the Discipline Committee to be reprimanded, at a date to be arranged, but in any event within three months of the date the order becomes final; and

c) Directing the Executive Director to impose the following specified terms, conditions and limitations on the Member’s certificate of registration for a period of two years:

(i) That the Member restrict his practice to an area where he has immediate supervision by a member of the College or such other supervision as acceptable to the Director of Investigations and Hearings (the Director);

(ii) That the Member notify his employer(s) of the decision and reasons in this matter;

(iii) Requiring the Member to provide performance appraisals from his supervisor to the Director every six months.

Decision

Decision

After carefully considering the Joint Submission on Penalty , the panel found that it was fair and appropriate. It provided for the protection of the public, deterrence to the Member, deterrence to other members of the profession and rehabilitation for the Member. There were a number of mitigating circumstances. The Member had a long-standing, unblemished career in nursing, had voluntarily removed himself from the practice of nursing, voluntarily reported his transgressions to the College, and was forthright and cooperative, and had further voluntarily sought appropriate assessment and treatment.

The panel believes that the penalty sufficiently recognizes the seriousness of the acts of misconduct while taking into the account the mitigating factors in this case thus providing the right balance between specific deterrence to the Member and general deterrence to the members of the profession.

After the Member signed a waiver of the appeal, his counsel requested that the Member’s name not appear in the College Communiqué. The panel deliberated and denied this request following the

advice of independent legal counsel and consideration of sections 23 and 56 of the Health Professions Procedural Code.

At the conclusion of the hearing an oral reprimand was given.

I, Marsha Taylor, RPN, sign this decision and reasons for the decision as Chairperson of this Discipline panel and on behalf of the members of the Discipline panel as listed below:

, Chairperson Date

Marg Axelson, RN Ruth Kitson, RN

Veronica Kerr, Public Representative Tom Clifford, Public Representative