The Health and Disability Commissioner (HDC) findings were released in a report this week on the foreign nurse who worked for a contractor providing prison health services.
The registered nurse, who is not identified in the report outlining the decision, started work in 2017 for a mental health support service operating in the prison. She left the position in 2019 and returned to her home country, where she is currently registered and holds a practising certificate. Her New Zealand practising certificate has expired.
The inmate has been in prison since 2011 and is serving an indefinite term of preventive detention.
His care plan outlined that he had a childhood history of trauma, substance issues, and sex addiction, the report said.
By September 2020 the nurse had started telling the inmate that she loved him when he said it to her. She told him that she missed him.
“It also outlined that he was experiencing feelings of worthlessness, sleep issues, weight loss, poor concentration, and excessive guilt, which had improved since the initial referral, and that future sessions [with the nurse] would focus on reducing anxiety.”
The nurse’s sessions included cognitive behavioural therapy and mindfulness techniques.
In May 2020 the nurse asked to have her phone number shared with the inmate, and to be added to his call list. She no longer worked in New Zealand but said she was concerned after reading about the impact of COVID-19 in prisons.
Seeking contact was in line with her “spiritual” beliefs, but the ongoing contact was not intended to be therapeutic, the report said.
The prison service records calls made by inmates. Over the next five months a total of 47 calls were made between the pair.
The HDC report said the calls were “personal in nature”. There were 11 calls containing sexually explicit comments, primarily made by the inmate. However, both engaged “in personal discussions about their families, marriage, drug use, and their relationship”.
From the first call, the inmate spoke of loving the nurse, and over subsequent calls discussed getting married, and “yummy yoga” poses the nurse showed him during their therapy sessions. Her clinical notes make no mention of yoga being performed during appointments.
By September 2020 the nurse had started telling the inmate that she loved him when he said it to her. She told him that she missed him. The pair also shared letters.
Ultimately the inmate told a mental health clinician about the relationship, after he asked the clinician if there might be work available for the nurse as she planned to return to New Zealand “to be with him”, the report said.
The matter was “escalated” through the support service, to the Nursing Council, who referred it to the HDC, the report said.
The HDC findings noted the nurse had access to the inmate’s personal medical information, “including discussion of his past childhood sexual abuse and documentation of his mental wellbeing”.
Even though the therapeutic relationship had ended, an inherent power imbalance still existed between the pair, “where the [health care] provider is privy to extremely intimate details about a person’s life and the person’s mental health”.
Findings
The nurse was found to have breached the health and disabilities consumers’ rights code by initiating personal and often intimate contact after the end of the therapeutic relationship. She also breached the code because the ongoing power imbalance between the two was “exploitative” of her former patient. She was also found to have not followed the Nursing Council of New Zealand’s code of conduct and guidelines.
The report recommended the Nursing Council “consider the nurse’s fitness to practise” and whether any reviews of competence and/or conduct were required, if she returned to New Zealand.