Professional boundaries in a clinician-patient relationship
Mental Health Commissioner Kevin Allan today released a report finding a psychiatrist and a nurse in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failing to maintain professional boundaries with their patient.
A man was admitted to a public hospital for a five-day medical detoxification programme. After the man self-discharged the nurse and the psychiatrist visited him at home to assess his immediate risk of self harm and his mental state. During this risk assessment they discussed the man needing to sell his house due to a relationship break up.
The man and his ex-wife later sold their house to the psychiatrist, with the nurse in frequent contact with the man to progress the sale and purchase of the property.
The man said he felt manipulated and pressured into selling his house and believed staff acted unprofessionally when he was in a vulnerable situation.
Mr Allan said that professional boundaries must be managed well by health professionals and that in this case, they were not.
"This case has reinforced the importance of professional boundaries in a clinician-patient relationship and demonstrated how engaging in financial transactions with a patient can compromise the therapeutic relationship," Kevin Allan said.
He found that the psychiatrist and nurse did not provide the man with services that complied with legal, professional, ethical, and other relevant standards and, accordingly, that they breached the Code.
Mr Allan recommended that both the psychiatrist and nurse apologise to the man and complete relevant training. He recommended that the Medical Council consider whether a review of the psychiatrist’s competence is appropriate and that the Nursing Council do the same in regards to the nurse.
Mr Allan considered that the DHB where they worked could have provided better guidance to staff on professional boundaries and conflicts of interest. He recommended that it also apologise to the man, consider how its codes of conduct and relevant guidelines may be improved, provide relevant refresher training to staff, and share any changes with other DHBs.
In addition, he invited the Medical and Nursing Councils, and the New Zealand Medical Association, to consider reviewing their standards and guidelines, in light of this case, to give clearer guidance on the ethics of financial transactions between patients and providers.
The full report for HDC case 18HDC00178 is available on the HDC website.