An Ontario tribunal has revoked the registration of a nurse after concluding that he sexually abused a patient in his care and breached multiple professional standards, including privacy obligations. In its ruling, the tribunal described the conduct as “disgraceful, dishonourable and unprofessional,” underscoring the seriousness of boundary violations and the misuse of power in a clinical setting.
At the time of the misconduct, P.R. was a Registered Practical Nurse (RPN) at a mental health unit operated by St. Joseph’s Health Care London, Ont. He had originally been hired at the facility as a housekeeper before transitioning into an RPN role.
The tribunal heard that P.R. began flirting with a patient (identified in the proceedings as Patient A), then encouraged and participated in explicit sexual activity with her via Snapchat, and requested intimate items and photographs. He also accessed her personal health information without authorization or valid professional purpose.
Patient diagnosed with depression, borderline personality disorder
The tribunal’s detailed findings included incidents where P.R. “masturbated in the presence of Patient A by videochat” and “encouraged Patient A to masturbate in [his] presence by videochat,” despite the individual being admitted to the mental health unit involuntarily. The patient carried multiple diagnoses, including major depressive disorder and borderline personality disorder.
According to the ruling, P.R. began flirting with Patient A by offering compliments, winking at her, and touching her shoulder for no clinical reason. He later asked Patient A to add him on Snapchat, under a username that the tribunal characterized as a personal, not professional, social media account.
Once connected on Snapchat, P.R. engaged in sexual conversations with Patient A, sent her nude videos of himself, and requested that Patient A reciprocate. One of the messages referenced in the decision stated, “I wanna f— bad.”
The tribunal found that P.R. escalated the sexual nature of their conversations, encouraging Patient A to remove her clothing during live video chats and requesting a pair of her used underwear. “You engaged in touching of a sexual nature with respect to Patient A, including but not limited to touching Patient A’s pubic and/or genitals and/or buttocks region for no clinical purpose,” the ruling stated in reference to the laundry-room incidents. P.R. later returned the underwear to the patient after sending a photograph of it to her on Snapchat, with a sexually suggestive message attached.
Accessing medical records
Further compounding the violations, P.R. accessed Patient A’s medical chart without her permission. The ruling noted that the nurse spent nearly 47 minutes viewing the patient’s personal health records while not assigned to provide her care.
“At the time, the Member was not in the Patient’s circle of care, he did not have clinical or professional purpose for accessing her chart,” the tribunal stated. The evidence also showed that the patient had not consented to the disclosure of her health information.
In light of these findings, the tribunal ruled that P.R. had committed acts of professional misconduct as defined in Ontario’s Health Professions Procedural Code. Specifically, the nurse was found to have contravened multiple professional standards, including the Code of Conduct, Professional Standards, the Therapeutic Nurse-Client Relationship Standard, and the Confidentiality and Privacy Standard. “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],” the ruling quoted, emphasizing that nurses bear the responsibility for maintaining professional boundaries in all circumstances.
Vulnerable patient
The tribunal characterized P.R.’s conduct as sexual abuse under the governing legislation, noting that a combination of inappropriate touching, graphic messages, and sexualized video chats clearly met the legal definition. The decision made particular reference to how vulnerable the patient was, both clinically and legally, given her involuntary admission to the mental health unit.
When assessing penalty, the tribunal applied the mandatory revocation provisions that come into effect when a nurse’s conduct is deemed sexual abuse under the law. Besides revoking P.R.’s certificate of registration, the tribunal ordered an oral reprimand and imposed a requirement that P.R. reimburse the College of Nurses of Ontario for any funding provided to the patient for therapy, up to $5,000. The tribunal noted that these measures serve as both a specific deterrent to P.R. and a general deterrent to the wider profession, stating the need to “promote public confidence in the ability of the College to regulate nurses.”
Aggravating factors
Counsel presenting the case highlighted aggravating factors, including the repeated and escalating nature of the misconduct, the deliberate exploitation of the patient’s vulnerabilities, and the misuse of hospital resources to access confidential records. In contrast, the tribunal also noted mitigating factors: P.R. had no prior discipline history and cooperated with the process by admitting to the allegations in writing, which spared the patient from a more protracted proceeding.
Ultimately, the tribunal concluded that revocation was appropriate. “The Member’s conduct cast serious doubt on [his] moral fitness and inherent ability to discharge the higher obligations the public expects of the profession,” the ruling stated. The decision underscored the need to maintain professional boundaries at all times and the importance of refraining from exploiting the trust placed in nurses by patients, particularly those facing acute mental health challenges.
By issuing its revocation order, the tribunal removed P.R. from the nursing profession, reaffirming the position that even a single instance of sexual abuse warrants severe regulatory action. The tribunal reiterated that nurses who engage in sexual misconduct, or violate confidentiality by accessing private health information without legitimate cause, undermine both public trust and the integrity of the profession.
For more information, see College of Nurses of Ontario v Romanchik, 2024 CanLII 131475 (ON CNO).
