College of Nurses of Ontario v. Matthew Elliott, 2023 ONCNO 149351

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: David Edwards, RPN Chairperson Tim Crowder Public Member Carly Gilchrist, RPN Member Sharon Moore, RN Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO (Megan Shortreed for College of Nurses of Ontario)

• and -

MATTHEW ELLIOTT Registration No. 10411422 (Chris Bryden for Matthew Elliott) (Patricia Harper, Independent Legal Counsel)

Heard: May 23, 2023

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee (the “Panel”) of the College of Nurses of Ontario (the “College”) on May 23, 2023, via videoconference.

Publication Ban

College Counsel brought a motion pursuant to s.45(3) of the Health Professions Procedural Code of the Nursing Act, 1991, for an order preventing public disclosure and banning publication or broadcasting of the names of the patients, or any information that could disclose the identities of the patients referred to orally or in any documents presented in the Discipline hearing of Matthew Elliott. Counsel for the Member confirmed that the Member consented to the Order requested.

The Panel considered the submissions of College Counsel and decided that there be an order preventing public disclosure and banning publication or broadcasting of the names of the patients, or any information that could disclose the identities of the patients referred to orally or in any documents presented in the Discipline hearing of Matthew Elliott.

The Allegations

College Counsel advised the Panel that the College was requesting leave to withdraw the allegation set out in paragraph 3 in the Notice of Hearing dated April 20, 2023 (hereinafter referred to as Notice of Hearing #1). The Panel granted this request. The remaining allegations against Matthew Elliott (the “Member”) in the Notice of Hearing #1 and the allegations against the Member as stated in the Notice of Hearing dated May 10, 2023 (hereinafter referred to as Notice of Hearing #2) are as follows:

Notice of Hearing #1

IT IS ALLEGED THAT:

1. 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(1) of Ontario Regulation 799/93, in that while working as a Registered Nurse at Niagara Health – St. Catharines Site in St. Catharines, Ontario (the “Facility”), you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as follows:

a. in, around or between September to November 2019, you failed to maintain the boundaries of the therapeutic nurse-client relationship in respect of Patient 1 when you engaged in a personal and/or sexual relationship with Patient 1 immediately before and/or while the patient was attending group therapy sessions co-facilitated by you;

b. in, around or between September to November 2019, you sexually abused Patient 1 by engaging in physical sexual relations and/or touching of a sexual nature and/or behaviour or remarks of a sexual nature with Patient 1 while the patient was attending group therapy sessions co-facilitated by you;

c. in, around or between October to November 2019, you failed to maintain the boundaries of the therapeutic nurse-client relationship in respect of Patient 2 when you engaged in a personal and/or sexual relationship with Patient 2 while the patient was attending group therapy sessions co-facilitated by you;

d. in, around or between October to November 2019, you sexually abused Patient 2 by engaging in physical sexual relations and/or touching of a sexual nature and/or behaviour or remarks of a sexual nature with Patient 2 while the patient was attending group therapy sessions co-facilitated by you; and/or

e. in or around the spring and summer of 2018, you failed to maintain the boundaries of the therapeutic nurse-client relationship in respect of Patients 3 and 4 when you engaged in a personal relationship with one or both of them while they were attending group therapy sessions co-facilitated by you; and/or

2. 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 while working as a Registered Nurse at the Facility, you sexually abused patients as follows:

a. in, around or between September to November 2019, you sexually abused Patient 1 by engaging in physical sexual relations and/or touching of a sexual nature and/or behaviour or remarks of a sexual nature with Patient 1 while the patient was attending group therapy sessions co-facilitated by you; and/or

b. in, around or between October to November 2019, you sexually abused Patient 2 by engaging in physical sexual relations and/or touching of a sexual nature and/or behaviour or remarks of a sexual nature with Patient 2 while the patient was attending group therapy sessions co-facilitated by you; and/or

3. [Withdrawn]; and/or

4. 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 you were employed as an Registered Nurse at the Facility, 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, as follows:

a. in, around or between September to November 2019, you failed to maintain the boundaries of the therapeutic nurse-client relationship in respect of Patient 1 when you engaged in a personal and/or sexual relationship with Patient 1 immediately before and/or while the patient was attending group therapy sessions co-facilitated by you;

b. in, around or between September to November 2019, you sexually abused Patient 1 by engaging in physical sexual relations and/or touching of a sexual nature and/or behaviour or remarks of a sexual nature with Patient 1 while the patient was attending group therapy sessions co-facilitated by you;

c. in, around or between September to November 2019 you practiced the profession while in a conflict of interest in that you provided health care to Patient 1 when you previously had a personal and/or sexual relationship with Patient 1;

d. in, around or between October to November 2019, you failed to maintain the boundaries of the therapeutic nurse-client relationship in respect of Patient 2 when you engaged in a personal and/or sexual relationship with Patient 2 while the patient was attending group therapy sessions co-facilitated by you;

e. in, around or between October to November 2019, you sexually abused Patient 2 by engaging in physical sexual relations and/or touching of a sexual nature and/or behaviour or remarks of a sexual nature with Patient 2 while the patient was attending group therapy sessions co-facilitated by you; and/or

f. in or around the spring and summer of 2018, you failed to maintain the boundaries of the therapeutic nurse-client relationship in respect of Patients 3 and 4 when you engaged in a personal relationship with one or both of them while they were attending group therapy sessions co-facilitated by you.

Notice of Hearing #2

IT IS ALLEGED THAT:

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 while working as a Registered Nurse at Niagara Health – St. Catharines Site in St. Catharines, Ontario, in, around or between April 2018 to March 2019, you sexually abused [Patient 3] by engaging in sexual intercourse with [Patient 3] while or immediately after the patient was attending group therapy sessions co-facilitated by you;

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(1) of Ontario Regulation 799/93, in that while working as a Registered Nurse at Niagara Health – St. Catharines Site in St. Catharines, Ontario, you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as follows:

a. in, around or between April 2018 to March 2019, you failed to maintain the boundaries of the therapeutic nurse-patient relationship in respect of [Patient 3] when you engaged in sexual intercourse with [Patient 3] while or immediately after the patient was attending group therapy sessions co-facilitated by you; and/or

b. in, around 2019, you failed to maintain the boundaries of the therapeutic nurse-patient relationship in respect of [Patient 5] when you added the patient as a friend on multiple social media platforms while the patient was attending group therapy sessions co-facilitated by you; and/or

3. 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 you were employed as an Registered Nurse at Niagara Health – St. Catharines Site in St. Catharines, 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, as follows:

a. in, around or between April 2018 to March 2019, you sexually abused [Patient 3] when you engaged in sexual intercourse with [Patient 3] while or immediately after the patient was attending group therapy sessions co-facilitated by you;

b. in, around or between April 2018 to March 2019, you failed to maintain the boundaries of the therapeutic nurse-patient relationship in respect of [Patient 3] when you engaged in sexual intercourse with [Patient 3] while or immediately after the patient was attending group therapy sessions co-facilitated by you; and/or

c. in, around 2019, you failed to maintain the boundaries of the therapeutic nurse-patient relationship in respect of [Patient 5] when you added the patient as a friend on multiple social media platforms while the patient was attending group therapy sessions co-facilitated by you.

Member’s Plea

The Member admitted the allegations set out in paragraphs 1(a), (b), (c), (d), (e), 2(a), (b) and 4(a), (b), (c), (d), (e) and (f) in Notice of Hearing #1 and paragraphs 1, 2(a), (b) and 3(a), (b), (c) in Notice of Hearing #2. 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 admission was 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 as amended reads, unedited, as follows:

THE MEMBER

1. Matthew Elliott (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse (“RN”) on April 1, 2010. His certificate of registration is currently suspended on an interim basis pursuant to an order of the Inquires, Complaints and Reports Committee (“ICRC”), dated December 1, 2022.

2. The Member was employed at Niagara Health – St. Catharines Site located in St. Catharines, Ontario (the “Facility”) from July 16, 2012 to January 30, 2020.

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

NOTICES OF HEARING

4. The Inquiries, Complaints and Reports Committee (“ICRC”) referred two sets of allegations against the Member:

a) On March 9, 2022, the ICRC referred allegations in respect of Patients 1, 2, 3 and 4, which are contained in a Notice of Hearing dated April 20, 2023 (“NOH #1”); and

b) On March 15, 2023, the ICRC referred allegations in respect of Patients 3 and 5, which are contained in a Notice of Hearing dated May 10, 2023 (“NOH #2”).

5. The Member admits the allegations contained in both Notices of Hearing, except for Allegation 3 in NOH #1, which is withdrawn.

THE FACILITY’S OUTPATIENT MENTAL HEALTH PROGRAM

6. At the material time, the Member worked primarily in the Facility’s Outpatient Mental Health Program, Monday to Friday, from 08:30 to 16:30 hours.

7. The Member facilitated group therapy for patients with mental health conditions. In the ordinary course, a patient would come to the Facility for an information session during which they would meet with a clinician individually for an assessment to determine the best group program to address the patient’s symptoms and needs. The patient would then be placed in the most suitable group.

8. The Facility’s group therapy programs range in length from six to nine weeks and have eight to ten participants. Typically, two staff members facilitate each group therapy session. In addition, up until 2018, the Member also engaged in 1:1 individual therapy with some patients.

THE NURSE-PATIENT RELATIONSHIPS

Patient 1

9. Patient 1 was 21 years old when she was admitted to the Facility in and around June through August of 2019. When she presented at the Emergency Department on June 14, 2019, Patient 1 displayed a number of borderline personality traits, with a likely diagnosis of bipolar disorder and Post Traumatic Stress Disorder (PTSD).

10. During this admission, Patient 1 was informed of the Mood Management Group Program (“MMGP”) and its potential therapeutic benefit.

11. Patient 1 attended an information session about the MMGP and underwent an initial assessment at the Facility on August 28, 2019. There were three or four clinicians present during the information session, including the Member.

12. Another clinician, Greg Climenhaga, individually assessed Patient 1. Mr. Climenhaga noted Patient 1’s diagnosis of bipolar disorder, borderline personality disorder and documented her experience with symptoms of anxiety, manic behaviours, excessive spending, highly sexualized behaviour, mood swings and suicidal ideation. Patient 1 also reported a history of sexual assaults in trusted relationships and experience of flashbacks caused by this trauma.

13. Patient 1 was placed in the MMGP that was co-facilitated by the Member and Terry Gregory, social worker.

14. The program ran from September 10, 2019 to October 22, 2019. Patient 1 attended all seven of the scheduled sessions.

Patient 2

15. Patient 2 was 25 years old at the time she presented at the Facility for a Mental Health and Addictions Adult Outpatient Assessment on September 24, 2019. She had diagnoses of Borderline Personality Disorder, Bipolar Disorder and Attention-Deficit Hyperactivity Disorder (ADHD).

16. Patient 2 first attended the Cognitive Behavioural Therapy (CBT) Mindfulness program in September 2019 and then the Dialectic Behaviour Therapy group program from November to December 2019. Both groups were co-facilitated by the Member and Mr. Gregory.

Patient 3

17. Patient 3 was approximately 22 years old at the relevant time.

18. Patient 3 has a diagnosis of Post-Traumatic Stress Disorder (PTSD) resulting from sexual abuse from a family member during her childhood until the age of 14. She has a self-reported tendency to be protective of the person in power or the abuser.

19. Patient 3 was referred to the MMGP in February 2018 and attended an information session on February 21, 2018. She attended the MMGP from March 13, 2018 to April 17, 2018. This was a six-week program co-facilitated by the Member and Mr. Gregory.

20. In addition, Patient 3 attended 1:1 therapy sessions with the Member for 30 minutes after the MMGP sessions.

21. Patient 3 also attended additional group therapy programs offered by the Facility, and co-facilitated by the Member, including:

a) Stepping into Mindfulness from May 17 to May 31, 2018;

b) Activity Days on October 24 and 31, 2018;

c) Managing Emotions/DBT Component Group from November 14, 2018 to January 23, 2019; and

d) Creative Group Therapy from February 2, 2019 to July 24, 2019 and August 7, 2019 to November 27, 2019.

Patient 4

22. Patient 4 was a patient of the Facility’s Outpatient Mental Health Unit for three years after an admission to the Emergency Department in 2016. She was approximately 21 years old at that time of the incidents.

23. Patient 4 attended several group therapy programs that were co-facilitated by the Member, including three groups in 2018. The last group she attended with the Member was in December 2019.

Patient 5

24. Patient 5 attended several group therapy sessions at the Facility in 2019. Two of those groups were co-facilitated by the Member.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Patient 1: Personal and Sexual Relationship, September 2019 to November 2019

25. After the first group session on September 10, 2019, Patient 1 saw the Member’s profile on the dating platform “Tinder,” but she was not certain if it was him. She swiped right and immediately matched with the Member. The Member started messaging Patient 1 through Tinder and added her on Snapchat, and messaged her through that application as well.

26. When Patient 1 attended the second group therapy session on or about September 16, 2019, she confirmed that the person she was communicating with on Tinder was the Member. After the session, Patient 1 texted the Member noting that she was a participant in the MMGP and described herself as the “one with [ ].”

27. The Member did not give Patient 1 any indication that he was prohibited from communicating with her outside of the MMGP and continued to message Patient 1 in a personal capacity, after he knew she was involved in the program.

28. On or around September 19, 2019 at around 20:00 hours, the Member and Patient 1 met in person at a Tim Hortons located between their respective homes. The Member shared with Patient 1 that he had two children. The conversation turned to sexual topics with each of them disclosing information about their previous experiences and preferences.

29. After their first in-person meeting, the Member continued to exchange text messages with Patient 1. In one message, the Member revealed to Patient 1 that he had masturbated while thinking about her and looking at her pictures.

30. The Member and Patient 1 met for a second time at Tim Hortons. The Member then drove Patient 1 to his house. The Member initially expressed some hesitation about pursuing a personal relationship given their nurse/patient relationship. Nevertheless, they had sexual intercourse that night at the Member’s home.

31. The personal and sexual relationship between Patient 1 and the Member continued until the end of November 2019.

32. Between September and November 2019, Patient 1 attended the Member’s house multiple times per week and they engaged in sexual intercourse on each occasion. In addition, on one or more occasions the Member and Patient 1 engaged in oral sex. Patient 1 would testify oral sex made her uncomfortable given her prior sexual trauma. If the Member were to testify, he would testify that he was not aware that Patient 1 felt this way about oral sex.

33. The subject matter of their conversations included:

a) the Member’s role as a nurse and what would happen if the relationship became known to other individuals. The Member told Patient 1 that after she was no longer his patient for three months, their relationship would be permitted.¹ The Member instructed Patient 1 not to tell anyone about their relationship; and

b) Details of the Member’s personal life including his address, the names of his children, his past drug use, that the Member was dealing with child visitation issues, the name of his ex-partner and the circumstances under which their marriage ended.

34. During their group therapy sessions, the Member pretended that he did not know Patient 1 personally and barely made eye contact with her.

35. In October 2019, Patient 1 was admitted to hospital after a suicide attempt. The Member was aware of Patient 1’s admission and the two spoke about her suicide attempt in the context of their personal relationship. If she were to testify, Patient 1 would say that when she was released from hospital, the Member looked at the cuts on her wrist and said something to the effect of “these are ridiculous, you didn’t even try to kill yourself”. If the Member were to testify, he would deny that he made such comment.

36. The in-person visits and text messaging between Patient 1 and the Member became less frequent and ultimately stopped altogether by the end of November 2019. The Member slowly stopped answering Patient 1’s messages. Patient 1 deleted the Member from Snapchat and shortly thereafter found out that the Member was in another relationship. Patient 1 filed a complaint with the Facility and the CNO shortly after discovering that the Member was in another relationship.

37. Patient 1 has had no further contact with the Member since November 2019.

38. On January 14, 2020, Patient 1 contacted the Facility’s Patient Relations department – initially anonymously via email – advising that she was involved in a sexual relationship with the Member and was concerned about whether the Member had taken advantage of other participants in the program.

39. Her complaint initiated an investigation by the Facility.

Patient 2: Personal and Sexual Relationship, October 2019 to November 2019

40. While attending group therapy sessions co-facilitated by the Member, Patient 2 asked the Member if he wanted to go out for drinks. He said no a number of times.

41. The Member knew that Patient 2 collected hockey cards based on information she had shared in group sessions.

42. In November 2019, the Member called Patient 2 to ask if she wanted to open hockey cards to which she responded, “hell yeah,” or words to similar effect. Patient 2 subsequently received from the Member a picture of a hockey card on her mobile device that said “hey”. Eventually, they set up a time to meet.

43. Patient 2 had not given her phone number to the Member. He obtained her contact information from the Facility.

44. The Member picked up Patient 2 in his car and they went to a Tim Hortons. The Member said something to the effect of “I’m freaking out right now” and repeatedly commented that he should not be with a patient. She asked the Member if he meets like this with other female patients. He said it was his first time.

45. When they got to Tim Hortons, they stayed in the Member’s car while Patient 2 opened hockey card packages. They did not stay long as Patient 2 had to get home before her boyfriend.

46. After this first meeting, Patient 2 and the Member texted and spoke on the phone. They next met in person at a bar called Chucks in Niagara Falls. Patient 2 was there with a friend and texted the Member. He said he would stop by. The Member met Patient 2 there around midnight. They left Chucks and went to the Member’s home.

47. Patient 2 and the Member had sexual intercourse twice that night at the Member’s home. The Member drove Patient 2 home the next morning.

48. Patient 2 and the Member may have had sex one additional time, though Patient 2 acknowledges that she is uncertain about this. She is certain that she went to the Member’s house two or three more times. She was often drinking on these occasions because she was nervous and therefore does not have a clear memory about these visits.

49. Phone records show five phone calls between Patient 2 and the Member between October 25 and October 30, 2019. These calls took place while Patient 2 was participating in the group therapy sessions co-facilitated by the Member.

50. On May 5, 2020, during an individual psychotherapy session with a Masters’ student under the supervision of a registered psychotherapist, Patient 2 disclosed information about her non-clinical interactions with the Member. Specifically, Patient 2 revealed that she had “slept with her ?counsellor (Matt?) who provided group therapy to her; he bought her hockey cards; he was reportedly fired from outpatient mental health Niagara Falls Hospital around November for unrelated reasons.”

Patients 3 and 4: Personal and/or Sexual Relationship, March 2018 to December 2019

51. Patient 3 and Patient 4 attended high school together.

52. In addition to attending the MMGP sessions in March 2018, Patient 3 also met with the Member for 1:1 therapy sessions in his office, immediately following the group sessions.

53. In one of the individual therapy sessions, Patient 3 shared with the Member that she was having difficulties being sexually intimate with her partner at that time. One of the comments made by the Member in response involved disclosing to Patient 3 that seeing someone being unfaithful was a turn-on for him.

54. During another individual therapy session, Patient 3 told the Member that she was having suicidal ideations. In response, the Member gave her his business card and wrote his personal cell phone number on the back. He told her to call him if she was ever in an emergency.

55. Patient 4 became aware of Patient 3 attending 1:1 therapy with the Member and joined them on one or two occasions.

56. The Member shared with both Patients 3 and 4 that he was going through a difficult time in his marriage. He disclosed that he was feeling unstable, in the process of breaking up with his spouse, and considering speaking to Mr. Climenhaga about being hospitalized.

57. The Member texted with both Patients 3 and 4 in a personal capacity outside of the professional therapeutic relationship.

58. The texts between the Member and Patient 4 were friendly and usually about logistics regarding meeting up in person. They also all exchanged Snapchats and this became their main platform of communication.

59. The texts and Snapchat exchanges between the Member and Patient 3 eventually became flirtatious in nature.

60. Patient 3 and Patient 4 met up with the Member on multiple occasions outside of group therapy. One time, they went for lunch to a restaurant called Kitchen in Ridgeway.

61. In April 2018, the Member advised Patient 4 via text message that he was in hospital. Patients 3 and 4 were worried about the Member and decided to visit him at St. Joseph’s Healthcare in Hamilton, Ontario. Patient 4 recalls visiting on one occasion. Patient 3 recalls visiting the Member twice and on one of these occasions, took a photograph of three of them together and posted it on Instagram. The photograph is dated April 22, 2018.

62. Patient 3’s mother saw this post on Instagram. She knew the Member was facilitating group therapy for her daughter at the Facility. She advised the Facility of the photograph and expressed concern about the personal relationship between her daughter and the Member.

63. In or around the same time, Mr. Climenhaga and other staff members requested a meeting with the Member’s manager to discuss concerns with the Member’s inappropriate disclosure of personal information to patients during group sessions.

64. The Member acknowledged the boundary breaches during the Facility’s investigation. The Member was required to complete further training on “Professional Care and Therapeutic Relationships” from June to August 2018. He was also restricted in his practice and no longer allowed to meet with current clients or facilitate groups on his own.

65. While completing this training, in the summer of 2018, the Member invited Patient 3 and Patient 4 to his home. He suggested that they follow him there after his shift ended following a group therapy session. The Member mentioned that he had cats and upon arrival at his home, Patient 4 went to go look for them. She was in the basement for approximately 15 minutes.

66. While Patient 4 was in the basement looking for the cats, the Member asked Patient 3 if she wanted a tour of the house. If Patient 3 were to testify, she would state that while she was alone with the Member, he showed her pornography and exposed himself to her. If the Member were to testify, he would deny this.

67. When Patient 3 and Patient 4 left the Member’s home, Patient 4 took one of the Member’s cats home with her with the Member’s permission. The cat is still with Patient 4. She still occasionally communicates with the Member via Instagram direct messages regarding the cat’s well-being.

68. The Member admits that he initiated a sexual relationship with Patient 3. It escalated after the visit to his home.

69. For two weeks during the summer of 2018, Patient 3 was house sitting for a family in [ ]. She gave the Member the address and he drove from Niagara Falls to visit her. During the visit, they had sexual intercourse.

70. The Member and Patient 3 spent time together at the Member’s home on multiple occasions. According to Patient 3, they had sexual intercourse at his home in his bed on one or more occasions.

71. If the Member were to testify, he would say that he and Patient 3 only had sexual intercourse on one occasion in the summer of 2018 at the home she was house sitting in [ ].

72. Patient 3 continued to attend therapy groups throughout 2018 and into 2019, including the art therapy group co-facilitated by the Member. During this time, they continued to engage in a sexual relationship. The Member asked Patient 3 not to sit too close to him as he worried he could not control himself if she was too close to him during the sessions.

73. During their relationship, they spoke on numerous occasions about how it was problematic for them to have a sexual relationship while the Member was providing therapy to Patient 3. The Member told her to make sure she did not tell anyone. He would say things to the effect of, “You know this stays between you and me and obviously you won’t tell anyone.” Patient 3 understood that his comments were driven by the fact that he was her nurse and thus it was inappropriate for them to have a personal relationship, especially a sexual one.

74. The sexual relationship between the Member and Patient 3 ended in early 2019.

75. The Member remained on friendly terms with Patient 3, including initiating contact with her over Instagram and buying a piece of her art in October 2021.

Patient 5: Boundary Violation

76. While attending group therapy sessions co-facilitated by the Member, at the Member’s own initiative, he added Patient 5 on Snapchat, Facebook and TikTok.

77. They communicated relatively infrequently on these applications. At some point, Patient 5 and the Member made tentative plans to meet outside of group therapy, but that never materialized.

Reports and Complaint, Investigations and Interim Suspension

78. In February 2020, CNO received a report from the Facility advising that the Member had been terminated following its investigation into a complaint submitted to the Facility by Patient 1. In the same report, the Facility informed CNO about the boundary breaches it had identified in the spring/summer of 2018 with respect to Patients 3 and 4 as described above in paragraphs 63 to 65.

79. On May 28, 2020, CNO received a further report regarding the Member’s interactions with Patient 2. The report was submitted by a registered psychotherapist, based on information Patient 2 shared during the psychotherapy session on May 5, 2020.

80. CNO investigated the incidents involving Patients 1, 2, 3 and 4.

81. Patient 3 was contacted by a CNO Investigator in June 2020. A voice message was left for Patient 3 requesting a return call regarding a case, with no mention of the Member’s name. Patient 3 texted the Member something to the effect of, “I just got a call from CNO. What did you do? Call me. What happened?”

82. The Member replied, “People are saying things… nothing is true… but make sure you don’t tell them about us.” Patient 3 responded, “Matt – Nothing happened. I would not make you look bad” or words to that effect. Patient 3 felt defensive and protective of the Member. He reiterated to her not to tell CNO saying something to the effect of, “Make sure you don’t tell them.” The Member told her to call him after she spoke with the CNO investigator.

83. Patient 3 spoke with the CNO investigator and did not disclose that she had a sexual relationship with the Member in 2018. She then called the Member. He asked: “What did you say? What did they say?” Patient 3 said she made him look so good and mentioned that he had talked her out of her suicidal thoughts. The Member expressed how much that meant to him and how he did not realize he had such a good friend.

84. At the time of her interview with the CNO investigator in June 2020, Patient 3 untruthfully maintained that she had no further contact with the Member outside of group therapy after the Facility had concluded its investigation. She expressed her gratitude for the Member’s care, noting that he went “above and beyond” his duties to make sure that she was okay. Patient 3 stated that she felt awful that the Member was subject to an investigation by CNO.

85. In his response to the initial CNO investigation, the Member:

a) acknowledged engaging in a personal and sexual relationship with Patient 1 but asserted that it ended in the summer of 2019, before the nurse-patient relationship began;

b) disputed the authenticity of photographic and video evidence provided by Patient 1, suggesting that the time and location were inaccurate;

c) denied any personal or sexual relationship with Patient 2 at any time whatsoever; and

d) admitted that he crossed the therapeutic boundaries with Patients 3 and 4, to the limited extent he admitted a breach of the boundaries to the Facility in 2018. Specifically, he admitted that he texted with both patients and spoke on the phone with Patient 3. The Member acknowledged that Patients 3 and 4 visited him when he was in the hospital, to his surprise. He recalled that they both visited him twice. Prior to the second visit, Patient 3 texted him to see if it was ok for them to come and he advised them that it was fine. The Member attributed his lapse of judgment with respect to Patients 3 and 4 to the traumatic breakdown of his family and marriage.

86. Following CNO’s investigation, the ICRC referred allegations of professional misconduct to the Discipline Committee as set out in NOH #1.

87. Based on the information available to CNO at that time, the specified allegations of professional misconduct regarding the Member’s interactions with Patients 3 and 4 involved only breaches of the therapeutic nurse-patient relationship, and did not reference a sexual relationship or sexual abuse of Patient 3.

88. NOH #1 was accessible via CNO’s website and has been since shortly after the ICRC’s decision of March 9, 2022.

89. In the summer of 2022, Patient 3 attended a baby shower with Patient 4 at which time, Patient 4 alerted Patient 3 to NOH #1 on CNO’s website. Patient 3 reviewed it and learned for the first time that there were allegations that the Member had engaged in sexual relationships with other female patients.

90. Patient 3 decided to advise CNO about the sexual component of her relationship with the Member via an email complaint sent to CNO in August 2022.

91. Following a further investigation, it was confirmed that the Member did in fact have a sexual relationship with Patient 3 from the summer of 2018 to sometime in 2019, including during the period he was undergoing remedial training about professional boundaries at the Facility, and while he was providing nursing care to Patient 3.

92. The Member was provided with notice of CNO’s intention to suspend his certificate of registration on an interim basis by letter dated November 11, 2022.

93. In response, the Member admitted to the initial allegations referred to in NOH #1. He stated that he was deeply regretful and remorseful regarding the circumstances giving rise to the matters before the Discipline Committee and also regretful and remorseful that his admissions to those allegations came out at such a late juncture in the process.

94. A panel of the ICRC issued an interim order directing the Executive Director to suspend his certificate of registration on December 1, 2022.

95. If the Member were to testify, he would state that on March 23, 2018, his wife left their home, taking their two young children, pets and personal belongings with her. He had to obtain legal counsel and intervention in order to see his children. He was unable to see his young children, both under 5 years old, for several months.

96. In April 2018, and as a result of major depression and suicidal ideation, the Member was admitted to the Facility for care and observation on the mental health unit, a unit where he had previously worked. He was subsequently transferred to Hamilton Health Sciences on a Form 3 where he remained for two weeks. In summary, the Member would testify that the incidents occurred during a very difficult time in his personal life.

CNO STANDARDS

97. At the relevant time, CNO’s Professional Standards provided that each nurse is accountable to the public and responsible for ensuring her or his practice and conduct meets legislative requirements and the standards of practice of the profession. A nurse demonstrates this standard by providing, facilitating, advocating and promoting the best possible care for patients.

98. Further, nurses are responsible for their actions and the consequences of those actions. They are also accountable for conducting themselves in ways that promote respect for the profession.

99. CNO’s Professional Standards further state that ethical nursing includes acting with integrity, honesty and professionalism in all dealings with the patient and other health care team members.

100. The Professional Standards also expressly reflect that patients are the central focus of the professional services that nurses provide. The goal of professional practice is to obtain the best possible outcome for patients, with no unnecessary exposure to risk of harm.

101. As identified in the Therapeutic Nurse-Client Standard (TNCR Standard), the relationship between nurse and patient is an unequal power relationship. The nurse has more authority and influence in the health care system, specialized knowledge, access to privileged information, and the ability to advocate for the patient. The appropriate use of power, in a caring manner, enables the nurse to partner with the patient to meet the patient’s needs. A misuse use of power is considered abuse.

102. The TNCR Standard defines a boundary in the nurse-patient relationship as “the point at which the relationship changes from professional and therapeutic to unprofessional and personal.” The TNCR Standard places the responsibility for establishing and maintaining the limits and boundaries in the therapeutic nurse-patient relationship on the nurse. The TNCR Standard provides that:

Crossing a boundary means that the care provider is misusing the power in the relationship to meet his/her personal needs, rather than the needs of the [patient], or behaving in an unprofessional manner with the [patient].

103. With respect to maintaining boundaries, a nurse demonstrates having met the TNCR Standard by actions such as:

• setting and maintaining the appropriate boundaries within the relationship, and helping [patients] understand when their requests are beyond the limits of the therapeutic relationship;

• developing and following a comprehensive care plan with the [patient] and health care team that aims to meet the [patient’s] needs;

• ensuring that any approach or activity that could be perceived as a boundary crossing is included in the care plan developed by the health care team;

• abstaining from disclosing personal information, unless it meets an articulated therapeutic need of the patient;

• continually clarifying her/his role in the therapeutic relationship, especially in situations in which the [patient] may become unclear about the boundaries and limits of the relationship; and

• ensuring that the nurse-[patient] relationship and nursing strategies are developed for the purpose of promoting the health and well-being of the patient and not to meet the needs of the nurse, especially when considering self-disclosure.

104. CNO’s TNCR Standard requires nurses to protect the patient from harm by ensuring that abuse is prevented or stopped and reported. With respect to protecting the patient from abuse, a nurse demonstrates having met the TNCR Standard by actions such as:

a) not entering a friendship, or a romantic, sexual or other personal relationship with a [patient] when a therapeutic relationship exists; and

b) not engaging in behaviours with a [patient] or making remarks that may reasonably be perceived by other nurses and/or others to be romantic, sexually suggestive, exploitive and/or sexually abusive (for example, spending extra time together outside of the [patient]’s care plan).

105. The TNCR Standard states that sexual abuse includes but is not limited to: consensual and non-consensual touching of a sexual nature or touching that may be perceived by the patient or others to be sexual; sexual intercourse or other forms of sexual contact with a patient; and non-physical sexual activity such as viewing pornographic websites with a patient.

106. As set out in section 1(6) of the Code, for the purposes of sexual abuse, an individual is considered to be a “patient” for one year from the date on which the individual ceased to be the member’s patient. This is reflected in the TNCR Standard which expressly notes that an individual is considered to be a patient while receiving care and for a period of one year following the end of the professional relationship.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

Admissions to Allegations in NOH #1

107. The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 1 (a), (c) and (e) and 4 (a), (c) and (e) of NOH #1, in that he failed to maintain the boundaries of a therapeutic nurse-client relationship in respect of Patients 1, 2, 3 and 4, when he engaged in personal and/or sexual relationships with the patients. His conduct breached the standard of practice of the profession and was disgraceful, dishonourable and unprofessional.

108. The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 1 (b) and (d), 2 (a) and (b), and 4 (b) and (d) of NOH #1, in that he sexually abused Patients 1 and 2 by having sexual intercourse with them while they were his patients. His conduct breached the standards of practice of the profession, constituted sexual abuse under s. 1(3)(a)(b) and (c) of the Code, and was disgraceful, dishonourable and unprofessional.

109. With leave of the Discipline Committee, CNO withdraws the allegation at paragraph 3 in NOH #1.

Admissions to Allegations in NOH #2

110. The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 1 and 3(a) of NOH #2, in that he sexually abused Patient 3 by having sexual intercourse with her while she was his patient. His conduct constituted sexual abuse under s. 1(3)(a)(b) and (c) of the Code, and was disgraceful, dishonourable and unprofessional.

111. The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 2(a) and (b) and 3(b) and (c) of NOH #2, in that he failed to maintain the boundaries of a therapeutic nurse-client relationship in respect of Patients 3 and 5, when he engaged in personal and/or sexual relationships with the patients. His conduct breached the standard of practice of the profession and was disgraceful, dishonourable and unprofessional.

Submissions on Liability by College Counsel

College Counsel submitted that the parties were jointly asking the Panel to make findings of professional misconduct on all of the allegations except for the allegation that had been withdrawn. College Counsel submitted that the parties were jointly seeking findings of breaches of the standards of practice. College Counsel submitted that the Member breached the standard by breaching the boundaries with respect to all five patients in the Notices of Hearing. College Counsel submitted that the Member breached the standards of practice by engaging in a sexual relationship with 3 of the 5 patients.

College Counsel submitted that the Member engaged in professional misconduct in the form of sexual abuse which is contrary to section 51(1)(b.1) of the Health Professions Procedural Code (the “Code”). College Counsel submitted that the Member had admitted to sexual abuse, including sexual intercourse with Patient 1, Patient 2 and Patient 3. College Counsel submitted that all 3 patients were in a patient-relationship with the Member at the relevant time that the Member had sexual intercourse with them. College Counsel submitted that this met the statutory definition of sexual abuse.

College Counsel submitted that both counsel were asking for findings of disgraceful, dishonourable and unprofessional conduct with respect to all of the Member’s conduct. College Counsel submitted that the conduct was unprofessional as it was an egregious breach of the standards and of the statutory prohibition of having sexual intercourse with a patient. College Counsel submitted that the Member breached the professional boundaries with 5 patients. College Counsel submitted that the Member’s conduct would be considered disgraceful and dishonourable by members of the profession. College Counsel submitted that members of the profession would reasonably regard this conduct as morally unfit for a nurse. College Counsel submitted that the Member’s conduct was repeated and ongoing conduct with 5 patients within a 2-year period. College Counsel submitted that the Panel had enough evidence of the professional and personal relationship of the Member with each patient and College Counsel submitted that the Panel must have regard to the frank acts of sexual abuse that are described in the Agreed Statement of Facts. College Counsel submitted that the Panel does not have facts in regard to the Member having a sexual relationship with Patient 4 and Patient 5, however, the Panel has facts in support of the admitted boundary violations with both patients.

Submissions on Liability by the Member’s Counsel

The Member’s Counsel submitted that the Member is ashamed and remorseful of his conduct and asked the Panel to accept the Member’s plea, Agreed Statement of Facts, and admissions of professional misconduct.

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(a), (b), (c), (d), and (e); #2(a), (b); #4(a), (b), (c), (d), (e) and (f) of the Notice of Hearing #1. As to allegations #4(a), (b), (c), (d), (e) and (f), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be disgraceful, dishonourable and unprofessional.

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; #2(a), (b) and #3(a), (b) and (c) of the Notice of Hearing #2. As to allegations #3(a), (b) and (c), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be disgraceful, dishonourable and 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 #1 and the Notice of Hearing #2.

Notice of Hearing #1

Allegations #1(a) and (b) in the Notice of Hearing #1 are supported by paragraphs 9-14, 25-39, 97-105, 107 and 108 in the Agreed Statement of Facts. Patient 1 was 21 years old at the time of the interactions with the Member. She was admitted to Niagara Health – St. Catharines Site (the “Facility”) around June to August 2019. Her diagnoses included Bipolar Disorder, Borderline Personality Disorder and Anxiety. Patient 1 demonstrated behaviours symptomatic of mania. As part of her treatment, she was to attend Mood Management Group Program (“MMGP”). The Member was a co-facilitator of this group. After the first group session on September 10, 2019, Patient 1 saw the Member’s profile on a dating platform. Patient 1 and the Member were matched. The Member started messaging Patient 1 and added her to Snapchat. The Member did not give Patient 1 any indication that he was prohibited from communicating with her in any personal capacity. The Member and Patient 1 met at a Tim Hortons. Topics of conversation included personal histories and topics of a sexual nature. There was a text exchange where the Member admitted that he had masturbated while he was thinking about Patient 1 while looking at a picture of her. Conversations between the Member and Patient 1 included the Member’s role as a nurse and what would happen if the relationship became known to other individuals. Patient 1 and the Member had a sexual relationship that continued until the end of November 2019.

Allegations #1(c) and #1(d) in the Notice of Hearing #1 are supported by paragraphs 15-16, 40-50, 97-105, 107 and 108 in the Agreed Statement of Facts. Patient 2 was 25 years old at the time of the interaction with the Member. She attended the Facility for a Mental Health and Addiction’s Adult Outpatient Assessment in September 2019. Patient 2 had diagnoses of Borderline Personality Disorder, Bipolar Disorder and Attention Deficit Hyperactivity Disorder. Patient 2 attended a Cognitive Behavioural Therapy program in September 2019, then a Dialectic Behaviour Therapy Group from November to December 2019. Both of these groups were co-facilitated by the Member. During one of these group sessions, Patient 2 asked the Member if he would like to go out for drinks. The Member declined Patient 2 a number of times. In November 2019, the Member obtained Patient 2’s phone number from the Facility. The Member picked up Patient 2 in his car and went to a Tim Hortons. After the first meeting the Member and Patient 2 exchanged text messages and met up at a local bar. The Member and Patient 2 engaged in a sexual relationship after this meeting. Phone records show five phone calls between Patient 2 and the Member between October 25 and October 30, 2019.

Allegation #1(e) in the Notice of Hearing #1 is supported by paragraphs 17-21, 51-75, 97-105 and 107 in the Agreed Statement of Facts. Patient 3 was approximately 22 years old at the time of the incident. She had a diagnosis of Post-Traumatic Stress Disorder (“PTSD”) and had a history of sexual abuse. Patient 3 attended the MMGP group from March to April 2018. Patient 4 was a patient of the Facility’s Outpatient Mental Health Unit for three years. She was 21 years old at the time of the incident. Patient 3 and Patient 4 attended high school together. Patient 3 attended the Member’s MMGP group as well as met with the Member for 1:1 therapy sessions in his office. During one of these sessions the Member provided Patient 3 with his cell phone number after she confided in him that she was experiencing suicidal ideations. The Member told Patient 3 to call him if she was ever in an emergency. Patient 4 joined the Member and Patient 3 for 1:1 therapy sessions on one or two occasions. The Member texted Patient 3 and Patient 4 in a personal capacity outside the professional therapeutic relationship. The text messages between Patient 3 and the Member eventually became flirtatious in nature. Patient 3 and Patient 4 met up with the Member on multiple occasions outside of group therapy. In April 2018, the Member advised Patient 4 that he was in hospital. Patient 3 and Patient 4 visited him during his admission into hospital. During this period, the Member’s conduct in group sessions was reported to his manager. The Member was required to complete further training on Professional Care and Therapeutic Relationships and the Member’s practice was restricted. While completing this training the Member invited Patient 3 and Patient 4 to his home. The Member also gave Patient 4 a cat.

The Member’s over all conduct with Patients 1, 2, 3 and 4 breached the College’s Professional Standards and the Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”). The College’s Professional Standards provides that each nurse is accountable to the public and responsible for ensuring their practice and conduct meets legislative requirements and the standards of the profession. Nurses are responsible for their actions and the consequences of those actions. Nurses are accountable for conducting themselves in ways that promote respect for the profession. Ethical nursing includes acting with integrity, honesty and professionalism in all dealings with the patient and other health care team members. The goal of any professional practice is to obtain the best possible outcome with no unnecessary exposure to risk of harm to the patient. As identified in the TNCR Standard, the relationship between the nurse and the patient is an unequal power relationship. The nurse has more authority and influence. The appropriate use of power, in a caring manner, enables the nurse to partner with the patient to meet the patient’s needs. A misuse of power in these circumstances is considered abuse. The TNCR Standard defines the boundary in the nurse-client relationship. The TNCR Standard places the responsibility for establishing and maintaining the limits and boundaries in the therapeutic nurse-client relationship on the nurse. Crossing a boundary means that the care provider is misusing the power in the relationship to meet their personal needs, rather than the needs of the patient, or behaving in an unprofessional manner with the patient. With respect to boundaries a nurse demonstrates having met the TNCR Standard by actions such as setting and maintaining appropriate boundaries, abstaining from disclosing personal information, unless it meets an articulated therapeutic need of the patient. A nurse also demonstrates the therapeutic nurse-client relationship by not entering a friendship, or a romantic, sexual or other personal relationship with a patient when a therapeutic relationship exists. The nurse is also not to engage in behaviours with a patient or remarks that may reasonably be perceived by other nurses and/or others to be romantic, sexually suggestive, exploitive and/or sexually abusive. The TNCR Standard states that sexual abuse includes but is not limited to consensual and non-consensual touching of a sexual nature or touching that may be perceived by others as sexual. This includes sexual intercourse or other forms of sexual contact. The Panel carefully reviewed the Member’s conduct as described above and determined that it was a clear breach of both the Professional Standards and the TNCR Standard.

Allegations #2(a) and (b) in the Notice of Hearing #1 are supported by paragraphs 9-16, 25-50, 97-105, 107 and 108 in the Agreed Statement of Facts. The Member admitted that he sexually abused Patient 1 and Patient 2 when he had sexual intercourse with them. Both patients were in a nurse-client relationship with the Member at the time that the Member had sexual intercourse with them. The Panel finds that the Member’s conduct meets the statutory definition of sexual abuse in s. 1(3)(a)(b) and (c) of the Code and therefore constitutes professional misconduct as set out in section 51(1)(b.1) of the Code.

Allegations #4(a), (b), (c), (d), (e) and (f) in the Notice of Hearing #1 are supported by paragraphs 9-23, 25-75, 107 and 108. The Panel finds that the Member’s conduct in engaging in a personal and/or sexual relationship with his patients was clearly relevant to the practice of nursing and was unprofessional as it demonstrated a serious and persistent disregard for his professional obligations as set out in the Professional Standards and the TNCR Standard. A nurse is expected to follow the standards of the profession and legislation while providing high quality of care.

The Panel also finds that the Member’s conduct was dishonourable. The Member, on repeated occasions, told Patient 1 not to disclose his sexual relationship with them to others. This behaviour demonstrates an element of dishonesty and deceit. Through the evidence provided in the Agreed Statement of Facts it was clear that the Member knew that his conduct was inappropriate. The Member was provided education by his employer on his boundary violations which involved two-month training on “Professional Care and Therapeutic Relationships”. The Member knew or ought to have known that his conduct was unacceptable and fell below the standards of the profession, yet he continued with that conduct.

Finally, the Panel finds that the Member’s conduct was disgraceful as it shames the Member and by extension, the profession. The Member demonstrated disgraceful conduct by repeatedly entering into sexual relationships with patients during a professional nurse-client relationship. These patients were very vulnerable. They suffered from serious mental health conditions and one of them had a prior history of sexual trauma. This conduct casts serious doubt on the Member’s moral fitness and inherent ability to discharge the higher obligations the public expects professionals to meet.

Notice of Hearing #2

Allegation #1 in the Notice of Hearing #2 is supported by paragraphs 17-21, 51-75 and 110 in the Agreed Statement of Facts. The Member admitted that he sexually abused Patient 3. Patient 3 met with the Member on multiple occasions outside of group therapy. After a visit to the Member’s home, Patient 3 had sexual intercourse with the Member. During the Member’s relationship with Patient 3, the Member told Patient 3 to make sure she did not tell anyone about that relationship. The sexual relationship between the Member and Patient 3 ended in early 2019. Engaging in a sexual relationship with a patient constitutes sexual abuse of the patient as defined in s. 1(3)(a)(b) and (c) of the Code and therefore constitutes professional misconduct as set out in section 51(1)(b.1) of the Code.

Allegation #2(a) in the Notice of Hearing is supported by paragraphs 17-21, 51-75 and 111 in the Agreed Statement of Facts. The Member admitted that he failed to maintain the boundaries of the therapeutic nurse-patient relationship when he engaged in sexual intercourse with Patient 3. The Member’s conduct breached the Professional Standards and the TNCR Standard.

The TNCR Standard defines the boundary in the nurse-client relationship. The nurse is not to engage in behaviours with a patient or remarks that may reasonably be perceived by other nurses and/or others to be romantic, sexually suggestive, exploitive and/or sexually abusive. The TNCR Standard states that sexual abuse includes but is not limited to consensual and non-consensual touching of a sexual nature or touching that may be perceived by others as sexual. This includes sexual intercourse or other forms of sexual contact. The TNCR Standard expressly notes that an individual is considered to be a patient while receiving care and for a period of one year following the end of a professional relationship. A nurse must refrain from entering into a sexual relationship during this time. The Member clearly breached these obligations.

Allegation #2(b) in the Notice of Hearing is supported by paragraphs 24, 76-77, 97-105 and 111 in the Agreed Statement of Facts. Patient 5 attended several group therapy sessions at the Facility in 2019. Two of those groups were co-facilitated by the Member. While attending group therapy sessions co-facilitated by the Member, the Member on his own initiative added Patient 5 on Snapchat, Facebook and TikTok. The Member and Patient 5 communicated relatively infrequently. At some point, Patient 5 and the Member made tentative plans to meet outside of group therapy, but it never materialized.

The Member’s conduct as described above breached the College’s Professional Standards and the TNCR Standard. The TNCR Standard identifies that the relationship between the nurse and the patient is an unequal power. The TNCR Standard places the responsibility for establishing and maintaining limits and boundaries in the therapeutic nurse-client relationship on the nurse. Crossing a boundary means that the care provider is misusing the power in the relationship to meet their personal needs, rather than the needs of the patient, or behaving in an unprofessional manner with the patient. With respect to boundaries, a nurse demonstrates having met the TNCR Standard by actions such as setting and maintaining appropriate boundaries, and abstaining from disclosing personal information, unless it meets an articulated therapeutic need of the patient. A nurse is also expected not to enter into a friendship or any other personal relationship with a patient when a therapeutic relationship exists. The Member failed to maintain these required standards in his interactions with Patients 3 and 5.

Allegations #3(a), (b) and (c) in the Notice of Hearing are supported by paragraphs 17-21, 24, 51-77, 110 and 111. The Panel finds that the Member’s conduct in engaging in a personal and/or sexual relationship with his patients was clearly relevant to the practice of nursing and was unprofessional as it demonstrated a serious and persistent disregard for his professional obligations as set out in the Professional Standards and the TNCR Standard. The Member failed to maintain boundaries in the therapeutic nurse-patient relationship. Adding a patient on to a personal social media platform causes a further power imbalance between the nurse and the patient and it is inconsistent with the requirements of the Professional Standards and the TNCR Standard.

The Panel also finds that the Member’s conduct was dishonourable. The Member admitted that he initiated a sexual relationship with Patient 3. When Patient 3 was house sitting, the Member visited, and they engaged in sexual intercourse. The Member and Patient 3 continued to engage in a sexual relationship while Patient 3 attended therapy groups throughout 2018 and into 2019. The Member and Patient 3 would speak about how their sexual relationship would be problematic for the Member. This behaviour demonstrates moral failing as the Member knew that his conduct fell well below the expectorations of the profession. The Member also admitted that he asked Patient 3 not to tell anyone about their relationship as it would be considered inappropriate. Despite this, the Member continued to have a sexual relationship with Patient 3. The Member’s conduct demonstrated to the Panel that the Member acted in a deceitful manner. Even though he knew his conduct was inappropriate, he continued to have sexual intercourse with Patient 3.

Finally, the Panel finds that the Member’s conduct was disgraceful as it shames the Member and by extension, the profession. The Member demonstrated disgraceful conduct by repeatedly engaging in sexual intercourse with Patient 3 during a professional nurse-patient relationship. Patient 3 was vulnerable, had serious mental health conditions and had previously suffered from sexual abuse. This conduct casts serious doubt on the Member’s moral fitness and inherent inability to discharge the higher obligations the public expects professionals to meet.

Penalty

College Counsel and the Member’s Counsel advised the Panel that a Joint Submission on Order had been agreed upon. The Joint Submission on Order requests that this Panel make an order as follows:

1. Requiring the Member to appear before the Panel to be reprimanded within three months of the date that this Order becomes final.

2. Requiring the Member to reimburse the College for funding provided for Patient 1, Patient 2, and Patient 3, under the program required by s. 85.7 of the Health Professions Procedural Code, up to the amount of $5,000 for each patient, if Patient 1, Patient 2, and/or Patient 3 accesses the fund.

3. Directing the Executive Director to immediately revoke the Member’s certificate of registration.

Penalty Submissions

Submissions were made by College Counsel.

College Counsel submitted that the Panel has found that the Member sexually abused 3 patients in a manner which involved sexual intercourse with them.

Therefore, there is not a lot of deliberation for the Panel to conduct with respect to the penalty because two elements of the penalty are mandatory under the Statute. College Counsel submitted that the reprimand is mandatorily required by section 51(5)(1) of the Code when there is a finding of sexual abuse and that under section 51(5)(3) of the Code if a panel finds that a member has committed an act of professional misconduct by sexually abusing a patient the panel shall revoke the member’s certificate of registration if the sexual abuse consisted of or included among other things sexual intercourse. Therefore, the Panel must revoke the Member’s certificate of registration. College Counsel submitted that the third element of the Member reimbursing the College for funding provided for Patient 1, Patient 2 and Patient 3 under the program required under section 85.7 of the Code is a typical order made by panels in cases of sexual abuse. College Counsel submitted that patients are entitled to access funding for therapy and counselling as a result of sexual abuse by a member of any college and if they do so the college has the right to seek reimbursement under the Code.

College Counsel submitted that when a panel is crafting a sanction there is regard to the objectives of general deterrence - to deter the members of the profession at large from similar misconduct - and specific deterrence - to deter this Member from similar misconduct. College Counsel submitted that in a case where the Panel has a statutory requirement of revocation, remediation is not an applicable factor. College Counsel submitted that the overall objective is to protect the public and uphold the public's confidence in the profession of nursing.

The aggravating factors in this case were:

• In the course of two years the Member violated the boundaries of the therapeutic nurse-client relationship with 5 patients;

• The Member had a sexual relationship with 3 of these patients;

• The ages of 4 of the patients were between 21-25 years old;

• The patients were very young and at the time of the conduct the Member had 9 years of practice experience;

• All of the patients were extremely vulnerable mental health patients. Two of the young patients who had a sexual relationship with the Member had a history of sexual assault and childhood sexual abuse;

• The conduct occurred over a two-year period between 2018 and 2019;

• The Facility learned about the Member’s conduct with two patients and remedial action was taken requiring the Member to take training in maintaining professional boundaries. Despite his remedial training, the Member continued the conduct with the patients; and

• The Member was preying on young women in his therapy sessions to meet his sexual and personal needs without any regard for his patients’ needs.

The mitigating factors in this case were:

• The Member has admitted his professional misconduct and expressed his remorse; and

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

The proposed penalty provides for general deterrence through the revocation of the Member’s certification of registration, which sends a strong message to all members of the profession that any findings of sexual abuse have significant consequences.

The proposed penalty provides for specific deterrence through the oral reprimand and the revocation of the Member’s certificate of registration, which allows the Member to gain insight into his behaviour from members of the profession as well as members of the public and shows the Member that there are serious consequences to breaching professional boundaries and sexually abusing patients.

Overall, the public is protected as the Member’s certificate of registration has been revoked and he will no longer be practicing as a Registered Nurse.

Submissions were made by the Member’s Counsel.

The Member’s Counsel submitted that the Member is very remorseful and ashamed of his conduct.

Penalty Decision

The Panel accepts the Joint Submission on Order and accordingly orders:

1. The Member is required to appear before the Panel to be reprimanded within three months of the date that this Order becomes final.

2. The Member is required to reimburse the College for funding provided for Patient 1, Patient 2, and Patient 3, under the program required by s. 85.7 of the Health Professions Procedural Code, up to the amount of $5,000 for each patient, if Patient 1, Patient 2, and/or Patient 3 accesses the fund.

3. The Executive Director is directed to immediately revoke the Member’s certificate of registration.

Reasons for Penalty Decision

The Panel understands that the penalty ordered should protect the public and enhance public confidence in the ability of the College to regulate nurses. This is achieved through a penalty that addresses specific deterrence, general deterrence and, where appropriate, rehabilitation and remediation.

The Panel is cognizant of its statutory obligations under s.51(5)(3) to reprimand the Member and order the revocation of his certificate of registration in this case.

Even if it were not statutorily required to reprimand and revoke the Member, the Panel would have concluded that the penalty contemplated in the Joint Submission on Order, which includes a reprimand and revocation, as well as the requirement that the Member reimburse the College for funding as contemplated under s. 85.7 of the Health Professions Procedural Code, was appropriate in the circumstances of this case.

In that regard, the Panel also considered the penalty in light of the principle that joint submissions should not be interfered with lightly.

Even apart from this obligation, the Panel concluded that the proposed penalty is reasonable and in the public interest. The Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility.

The proposed penalty provides for general deterrence through the revocation of the Member’s certification of registration, which sends a strong message to all members of the profession that any findings of sexual abuse have significant consequences. The proposed penalty provides for specific deterrence through the oral reprimand and the revocation of the Member’s certificate of registration, which allows the Member to gain insight into his behaviour from members of the profession as well as members of the public and shows the Member that there are serious consequences to breaching professional boundaries and sexually abusing patients. Overall, the public is protected as the Member’s certificate of registration has been revoked and he will no longer be practicing as a Registered Nurse.

Remediation and rehabilitation are not necessary or appropriate in these circumstances given the revocation of the Member’s certificate of registration.

The Panel wanted to acknowledge that all nurses work with vulnerable patients. It is up to the nurse to ensure that the professional nurse-patient relationship remains therapeutic. At any time in the nurse-patient relationship a nurse has a certain element of power. The nurse must ensure that there is no abuse of power. In this case, the Member demonstrated a clear pattern. He sought out young, vulnerable patients, breached therapeutic boundaries by initiating conversations outside the professional relationship and engaged in a sexual relationship with 3 of them. Even after being provided with remedial educational activities on the nurse-patient relationship, the conduct continued. The Panel found the Member’s conduct to be heinous and intolerable. The Panel has determined that the Member cannot be governed and the best way to ensure that this conduct does not occur again is to agree with the Joint Submission on Order as the public must be protected.

Section 85.7 of the Code requires the College to establish a program to provide funding for therapy and counselling for persons alleging sexual abuse by a member. The College is entitled to recover money paid from this program for such therapy and counselling, from the Member. The Panel accepts as appropriate the parties’ Joint Submission on Order to require the member to reimburse the College in the amounts proposed.

I, David Edwards, 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.

Footnotes

1. 1This was false. Under s. 1(6) of the Code, “patient” for the purposes of sexual abuse includes an individual who was a member’s patient within one year from the date on which the individual ceased to be the member’s patient.