On 12 February 2019, the NSW Civil and Administrative Tribunal found an enrolled nurse, Mr Nelson, guilty of professional misconduct after commencing a sexual relationship with a mental health patient and ordered that he be disqualified from applying for re-registration for two years and imposed a prohibition order preventing him from providing health services for two years.
Mr Nelson, an enrolled nurse, commenced work in the mental health ward of Coffs Harbour Hospital (the Hospital) in 2014.
In October 2014, a patient was admitted to the Hospital in a suicidal state and remained an in-patient for over three months. During this time, Mr Nelson formed a personal relationship with the patient. Mr Nelson was 41 and the patient had recently turned 20.
On the day of her discharge from the Hospital on 23 January 2015, the patient and Mr Nelson became friends via Facebook and began communicating via Facebook Messenger and SMS. Shortly thereafter, Mr Nelson invited the patient to her house and over the following 11 or 12 days a sexual relationship developed.
The patient’s family became aware and informed the Hospital of the relationship. The manager of the Hospital instructed Mr Nelson not to have contact with the patient, but Mr Nelson denied the allegations and stated he had not had contact with the patient since her discharge.
In order to continue the relationship with the patient, on 28 January 2015, Mr Nelson asked a young man over whom he was in a position of authority to say he was the patient’s girlfriend, and that he had been using Mr Nelson’s Facebook to communicate with her. Mr Nelson then instructed the young man to became friends with the patient on his own Facebook account, and dictated various messages between the patient and the young man.
Mr Nelson persisted with this story until October 2018, including through an internal hospital investigation, Local Health District investigations, and the HCCC investigation process.
The Tribunal was satisfied the conduct amounted to professional misconduct by reason of its inherent seriousness. The apparently minor boundary violations such as those involving Facebook contact were considered serious because they were a part of a process that led to gross violations, through Mr Nelson’s pursuit of a social and sexual relationship with the patient. The sexual relationship was a violation of trust of a patently vulnerable young woman, and was an abuse of Mr Nelson’s professional position. While the period of the relationship itself was brief, it came to an end only because of the efforts of the patient’s family and the response of the Hospital.
Mr Nelson’s deception to maintain the relationship, and the abuse of his relationship with the patient and his position of authority with the young man to involve them in that deception, were of serious concern to the Tribunal:
“Mr Nelson coached and cajoled Patient A into lying to her family, with whom she was living, and in doing so deliberately cut her off from her main support network at a time of intense need for such support”.
The Tribunal also emphasised that more than once in the investigations, Mr Nelson invoked the patient’s status and history as a mental health in-patient in order to attempt to discredit her. The Tribunal concluded:
“Mr Nelson’s actions, both through the misconduct itself and in his contemporaneous and continued denials of it, acted to impeded Patient A’s recovery and were manifestly harmful to her.”
The Tribunal ordered that the practitioner be deregistered and prevented from re-registration for a further two years. This sanction was designed to provide specific and general deterrence, and to protect the public from Mr Nelson.
The Tribunal also imposed a prohibition order prohibiting him from providing health services for two years to “prevent the practitioner from working with vulnerable patients and aged care residents in roles such as AIN or personal care assistant until he has taken steps to remediate this risk”.
The Tribunal refused Mr Nelson’s application to have his name repressed, finding it is in the public interest that disciplinary proceedings and outcomes be publicly available. Although Mr Nelson had past and present challenges with substance abuse and mental health issues, this was not sufficient to objectively establish a heightened or specific risk of such severity as to justify subjugating the public interest in openness in order to suppress his name.