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Roche, Susan Louise

CPSO#: 58615

MEMBER STATUS
Expired: Resigned from membership as of 10 Mar 2017
CURRENT OR PAST CPSO REGISTRATION CLASS
None as of 28 Jun 1989

Summary

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Former Name: No Former Name

Gender: Female

Languages Spoken: English

Education: Dalhousie University Faculty of Medicine, 1985

Practice Information

Primary Location of Practice
Practice Address Not Available

Specialties

Specialty Issued On Type
Psychiatry Effective:30 May 1989 RCPSC Specialist

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 01 Jul 1987
Transfer of class of registration to: Independent Practice Certificate Effective: 28 Jun 1989
Expired: Resigned from membership. Expiry: 10 Mar 2017

Previous Hearings

Committee: Discipline
Decision Date: 13 Mar 2017
Summary:

On March 13, 2017, the Discipline Committee found that Dr. Susan Louise Roche committed an act of professional misconduct in that: she has failed to maintain the standard of practice of the profession and in that she has engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional by failing to maintain appropriate boundaries with Patient A including employing Patient A as her personal nurse, discussing with Patient “A” moving to another province and offering Patient “A” tenancy; requiring Patient A and other patients to do errands for her; sharing private and confidential information pertaining to Patient A with others in group therapy without her consent; failing to transmit clinical information in a timely way following termination of care; and, in her inappropriate OHIP billing practices regarding Patient A. The Discipline Committee also found Dr. Roche is incompetent.

Dr. Roche is a psychiatrist who received her certificate of registration authorizing independent practice in Ontario on June 28, 1989. At the relevant time, Dr. Roche practised in Ottawa.

Disgraceful, Dishonourable and Unprofessional Conduct re Patient A

Patient A was a registered nurse who retired in or around October 2013 and was Dr. Roche’s patient for over 20 years. Dr. Roche treated her for clinical depression, weekly for individual therapy as well as weekly for group therapy.

In or around the summer of 2014, in the course of their private therapy, Dr. Roche asked Patient A if she would be interested in moving to British Columbia with her and being her tenant in a home she planned to buy there. All subsequent planning discussions took place during individual planning sessions. A couple months later, Dr. Roche hired Patient A in her professional capacity as a registered nurse to care for her during her recovery from abdominal surgery. Dr. Roche offered to pay Patient A $500 for nursing care for a one week period as well as gas money for travel to and from the Hospital and to post-operative appointments. Patient A stayed in Dr.Roche’s home following her surgery, to care for Dr. Roche for seven days in November 2014.While caring for in her home, Dr. Roche was agitated and difficult. She shouted at Patient A and used foul language and told Patient A that she was dissatisfied with her services.

Patient A attended in January 2015 at Dr. Roche’s office for their next scheduled therapy session. At that appointment, Dr. Roche became upset with her and told her she had changed her mind about moving to B.C. Also, Dr. Roche complained about her nursing services and stated
that she decided not to pay her any more money for the services she provided. Patient A attended a subsequent appointment in February in which Dr. Roche continued to be verbally aggressive. Patient A did not book a further appointment for individual therapy.

Following the February 2015 appointment, Dr. Roche left Patient A a voicemail advising her not to attend group therapy until she attended further individual therapy. Patient A learned later that Dr. Roche had advised the group that Patient A was absent because she had “regressed” and there was a parking issue. Patient A did not give Dr. Roche consent to discuss her departure from group therapy with the others.

Patient A terminated the doctor-patient relationship by sending Dr. Roche a registered letter of termination. Dr. Roche refused to accept delivery, and did not transfer her patient files until at least seven weeks after receiving a signed consent.

Disgraceful, Dishonourable and Unprofessional Conduct in respect of Other Patients

Dr. Roche requested other patients to do errands for her. Specifically, she asked a patient to retrieve her eye medication, and another patient frequently picked up groceries for her.

Failed to Maintain the Standard of Practice of the Profession and is Incompetent

The College retained a psychiatrist who opined with respect to Dr. Roche’s care and treatment of Patient A that:

- In hiring a patient she had worked with extensively, Dr. Roche did not meet the standard of practice as a physician. In not considering the aforementioned ways this could have affect the psychotherapeutic relationship, it also demonstrated a lack of skill and judgment as a
therapist. The risks of the employment relationship should have been easily foreseeable to Dr. Roche. In this case, it caused harm to the patient in that it led to the termination of what had been a 20 year long therapeutic relationship.
- Dr. Roche stated that there “is no pressure” for Ms. C. to accept her offer to be her nurse. As an experienced therapist, the expected standard would be for Dr. Roche to recognize that there is an inherent pressure which cannot be eliminated by attempting to convince the
patient otherwise.
- The offer of tenancy would be below the standard. If it had ultimately been entered into, the risk of harm, would be the same as what the employment situation led to, namely tension in the relationship and an ultimate severing.
- Asking patients to perform errands for her would be taking advantage of a therapist patient relationship for personal gain and would be considered unprofessional and below the standard of care. If somehow Dr. Roche did not consider these patient performing errands as
transgressions, then at best she would be showing poor judgment for not recognizing them as such.
- It is uncommon for a therapist to provide both individual psychotherapy and group psychotherapy for the same patient, though it does occur. In this scenario, there is a requirement for confidentiality around the material discussed during the patient’s individual therapy. Sharing information about co-patients during individual sessions and sharing information about one patient during a group session would constitute breaches of confidentiality contrary to the CPSO policy. As such, Dr. Roche falls below the standard of care.
- Dr. Roche was inappropriately billing for family therapy instead of individual or group therapy. There is a financial advantage to coding therapy sessions as family therapy.
- Dr. Roche’s documentation failed to maintain the standard of practice of the profession. There is little mention of the particular symptoms of major depressive disorder for which the patient was receiving treatment. It was difficult to ascertain the patient’s clinical status of any given time which is essential. There was no suicide risk assessment.

The psychiatric expert concluded that the most notable demonstrations of falling below the standard of care related to the lack of boundaries between Dr. Roche and certain patients.

The College retained a second psychiatric expert opinion who, like the first expert, opined that Dr. Roche did not meet the standard of practice and showed a lack of knowledge skill and judgment with respect to observing appropriate boundaries with her patient. The second expert also found Dr. Roche breached the standard of care by billing her individual sessions with Patient A as family sessions, at a higher rate than she was entitled.

Dr. Roche signed an Undertaking, Acknowledgment and Consent on February 17, 2017, in which she resigned from the College effective March 10, 2017 and agreed not to apply or re-apply for registration as a physician in the province of Ontario or any other jurisdiction after that
date.
On March 13, 2017, in light of Dr. Roche’s undertaking to resign and to not re-apply, the Committee ordered and directed on the matter of penalty and costs that:
- Dr. Roche appear before the panel to be reprimanded.
- Dr. Roche pay costs to the College in the amount of $5,500.00 within thirty (30) days of the date this Order becomes final.
 


Decision: Download Full Decision (PDF)
Hearing Date(s): March 13, 2017

Concerns

Source: Member
Active Date: March 10, 2017
Expiry Date:
Summary:
Summary of the Undertaking given by Dr. Susan Louise Roche to the College of Physicians and Surgeons of Ontario, effective March 10, 2017:

Dr. Roche was referred to the Discipline Committee on allegations of professional misconduct and incompetence. In the face of these allegations, Dr. Roche resigned from the College and has agreed never to apply or reapply for registration as a physician in Ontario or any other jurisdiction.
Download Full Document (PDF)