Can a doctor date a former patient?
Discipline panel debates whether psychiatrist can keep his licence
Should a psychiatrist who began dating his patient shortly after they stopped seeing each other professionally be allowed to keep his licence?
That’s the question before a discipline panel of the College of Physicians and Surgeons of Ontario, which must determine if Toronto doctor Nagi Ghabbour should become the first physician in the province to have his licence yanked for becoming romantically involved with a former patient too soon after the end of the doctor-patient relationship.
The penalty of revocation is “appropriate and necessary to protect the public and ensure that public trust in the profession is maintained and that public trust in the regulator is maintained,” college lawyer Elisabeth Widner told the five-member panel Wednesday.
Ghabbour’s case comes as the provincial government is looking to strengthen the law around sexual abuse and physicianpatient relationships in the wake of a Star investigation.
Under proposed legislation, known as Bill 87, announced last year, a person is still considered a “patient” for the purpose of the new rules for one year after they stop seeing the physician. Therefore, any sexual activity within that year would be considered sexual abuse and lead to the mandatory revocation of a doctor’s licence.
“It’s an indication of where our society is moving in Ontario with regards to this type of conduct,” Widner told the panel.
She pointed out that while Bill 87 has yet to become law, the panel still has the discretion now to revoke.
The college’s current policy on sex with former patients states that several factors should be considered, including the length and intensity of the professional relationship, the type of care involved and how much personal information has been confided to the doctor.
“When the physician-patient relationship involves a significant component of psychoanalysis or psychotherapy, sexual involvement with the patient is likely inappropriate at any time after termination,” says the policy.
Ghabbour has been practising for more than 20 years. Patient A (as she was called because of a publication ban) and Ghabbour have now been living together for over a year, and intend to marry, according to an agreed statement of facts.
She also attended Ghabbour’s twoday discipline hearing.
The college began investigating Ghabbour after Patient A’s family filed a complaint.
The psychiatrist pleaded guilty on Tuesday to conduct that would be regarded as disgraceful, dishonourable or unprofessional, in that he began a relationship with Patient A about a month after he stopped being her psychiatrist in 2015.
The woman had been experiencing stress at work as well as marital difficulties, and was seeing Ghabbour for anxiety and depression. Ghabbour provided prescriptions for antidepressants. He also documented suicidal ideation.
She began displaying romantic feelings for him in sessions in early 2015, which he testified he resisted. Ghabbour maintained he didn’t want to refer her to someone else because he felt she was lacking support in other areas of her life and he wanted to help her.
In one instance, she kissed him on the cheek and “referred to the kiss as one a daughter gives her father on Christmas,” according to the agreed statement of facts.
After another session, she hugged him, and at one point he noted in his charts that the patient was “idealizing him and is seeking a real/physical bond with him,” the agreed statement of facts says. He said he made attempts to make clear to her that he was her psychiatrist. Ghabbour also discussed the issue with colleagues.
In one of their last sessions, Patient A kissed him on the mouth, Ghabbour testified. Within weeks of Patient A deciding she no longer wanted Ghabbour as her psychiatrist because of her personal feelings toward him, the two began to see each other socially, and the relationship soon became sexual, the hearing heard.
While admitting that dating a pa- tient so soon after the end of their professional relationship was a serious boundary violation and a “huge lapse in judgment,” Ghabbour also testified: “I love her, I adore her and I respect her.”
Previous cases involving similar conduct that were presented to the panel included penalties within the range of nine to 12 months, but Widner urged the panel to increase the punishment due to “changing social norms.”
A revocation in this case would mean that Ghabbour can reapply for his licence in 12 months, but he would have to convince the panel that he is fit to practise.
“(Bill 87 is) an indication of where our society is moving in Ontario with regards to this type of conduct.” ELISABETH WIDNER LAWYER
Widner said this would allow the panel to make sure that Ghabbour has received proper therapy for his boundary violation with Patient A.
Ghabbour’s lawyer, Paul-Erik Veel, argued for a nine-to 12-month suspension along with a condition that Ghabbour seek therapy, saying it’s important to keep in mind that Ghabbour pleaded guilty, that this was an isolated incident for someone with no prior discipline history, and that Ghabbour has suffered from depression.
Forensic psychiatrist Dr. Julian Gojer also testified that Ghabbour is at a low risk to reoffend, but admitted on the stand that there would be “enormous work” involved in Ghabbour’s therapy because he now lives with Patient A.
“I do not disagree with the proposition that penalties can and should change over time, but they should be incremental and proportional,” Veel told the panel.