Sexual Abuse and duty to report
Scenario 8 - Sexualized comments
Barrie is a fourth-year nursing student observing a surgical case with Dr. West. One day, Barrie is observing Dr. West perform surgery. While the patient is under general sedation, Dr. West makes sexualized comments about the patient’s breasts and then fondles them. Barrie is disturbed by what he sees. He knows he should do something but isn’t sure how proceed.
Barrie decides to approach the preceptor he works with. He tells the preceptor, Andy, what he witnessed and asks Andy for advice on how to handle this situation.
Questions for discussion
- Are the actions of Dr. West considered a boundary violation or sexual abuse? Why or why not?
- Is Barrie obligated to report this? Why or why not?
- What professional or ethical dilemma does Barrie have with Dr. West?
- Do any legal/statutory obligations arise once Barrie tells Andy what he witnessed? Explain your answer
Key concepts this scenario illustrates:
- When you have a duty to report, and when you don’t
- Legal/statutory obligations versus professional and ethical obligations around reporting
Dr. West’s behaviour is unacceptable, unprofessional and a clear case of sexual abuse of a patient because he made sexualized comments and touched a patient in a sexual way. This is sexual abuse of a patient as defined by the Regulated Health Professions Act, 1991 (RHPA).
Nursing students are not members registered to practice under the RHPA and therefore not regulated by the CNO. Because of this, Barrie does not have a legal/duty to report the sexual abuse he wit¬nessed. However, he has witnessed a criminal act and this is a very serious matter. He is a student and is learning the principles of professionalism and altruism. He should report this to his superiors and seek guidance on how to report this situation, given the risk Dr. West presents to current and future patients. In addition, it would be wise for Barrie to review the guidelines and policies provided by his nursing school.
When Andy was informed by Barrie about Dr. West’s sexually abusing a patient while she was sedated, Andy is bound by the mandatory reporting obligations in the RHPA and in CNO’s policy on Mandatory Reporting. The RHPA requires that, “when a nurse has reasonable grounds, obtained in the course of practising the profession, to believe that another nurse or regulated health professional has sexually abused a patient, the nurse must file a report in writing with the Registrar of the College to which the alleged abuser belongs”. The Code indicates that the member has 30 days to file a report, though if there is a continued risk to patients the report should be filed immediately. The nurse reporting alleged sexual abuse is not required to have witnessed the abuse themselves. Instead, it requires that the nurse have reasonable grounds to suspect sexual abuse of the patient. Barrie’s account constitutes reasonable grounds to believe the abuse occurred. Andy is expected to report the incident. If he doesn’t report, Andy could face a fine of not more than $50,000.