Scenario 7 - Legal versus professional and ethical obligations

Sam and Amy grew up together and have been friends for many years. They both decided to enter the health profession. Amy became a nurse practitioner and Sam became a doctor. They both work in the same clinic in their hometown and have many common patients.

After a few years practicing in the same clinic, Amy becomes aware of an ongoing personal relationship between Sam and a member of their small community. Sam is single and there aren’t many opportunities to click with someone, so Amy is happy for him. One day she sees a woman come in for an appointment with Sam. As the woman goes into the treatment room, the administrative assistant whispers to Amy, “That’s the new woman in Sam’s life”. Amy is concerned and thinks, Sam is dating a patient? He knows better than that… I thought.”

Questions for discussion

  1. Are the actions of Sam considered a boundary violation or sexual abuse? Why or why not?
  2. Is Amy obligated to report what she has learned? Why or why not? 

Key concepts this scenario illustrates:

  • Maintaining boundaries in a small town
  • When you have a duty to report, and when you don’t
  • Legal/statutory obligations versus professional and ethical obligations around reporting

 

The requirements regarding sexual abuse set out in the Regulated Health Professions Act, 1991 (RHPA) apply to all regulated health professionals in Ontario, including physicians. Sam’s actions are clear boundary violations and could qualify as sexual abuse if the personal relationship involves sexual comments, gestures or contact with the patient. Sam’s certificate of registration may be revoked because of his actions.

Amy became aware that Sam was involved in a personal relationship with his patient. If Amy has reasonable grounds that a sexual relation has occurred, she is required to report this to the College of Physicians and Surgeons of Ontario within 30 days or as soon as possible.


Scenario (continued)

Instead of reporting Sam to the College of Physicians and Surgeons of Ontario, Amy decides to confront her friend. Sam reacts poorly when Amy expresses her concerns over him dating a patient, and states, “What am I supposed to do? There aren’t many options in this small town. Am I supposed to die alone?” Amy understands his frustrations, but she is also aware of their professional and legal obligations to patients. She offers to take on his patient so that Sam can continue to see this woman without being in conflict with the RHPA. 

Questions for discussion

  1. Is Amy obligated to report the situation even though she spoke with Sam and they made an arrangement? Explain your answer. 
  2. If Amy takes over as clinician for the patient, is Sam is free to continue seeing her? Explain your answer

Amy has a professional and ethical duty to patients, but she decides to handle the situation on her own by confronting Sam. 

Amy’s decision to confront Sam instead of reporting him puts her in violation of the Regulated Health Professions Act, 1991, which requires a member to report “if the member has reasonable grounds, obtained in the course of practising the profession, to believe that another member of the same or a different College has sexually abused a patient.” If found guilty and convicted, Amy faces a fine of not more than $50,000. Also, Amy’s failure to report may result in an investigation and possibly discipline action by CNO. 

It was kind of her to offer to take on this patient so Sam can continue his relationship, but this doesn’t change that Sam had a concurrent treating and sexual relationship with a patient. The law is clear, the health care provider-patient relationship continues for a minimum of one year after the date when the individual ceases to be a patient, and what Sam is doing constitutes sexual abuse of a patient. 

In order to protect the patient, Amy is expected to report Sam’s actions to his professional regulatory college.