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Licensed Practical Nurses
On January 25, 2021, the Professional Conduct Committee accepted Ms. Barkhouse’s application for consent revocation. A summary of the Committee’s decision will be available shortly.
Decisions and Outcomes
January 25, 2021
SUMMARY OF APPLICATION FOR CONSENT REVOCATION
On the 25th day of January, 2021, the Professional Conduct Committee of the Nova Scotia College of Nursing (“NSCN” or “College”) accepted an Application for Consent Revocation from Crystal Barkhouse, LPN, Registration # 13358. NSCN consented to the Application for Consent Revocation.
The Application was submitted in accordance with Section 106 of the Nursing Act.
Background and Overview
Crystal Barkhouse graduated from the Nova Scotia Community College – Kingstec Campus with a Diploma in Practical Nursing in 2016. She was first licenced to practise in Nova Scotia that same year.
She commenced employment as a Licensed Practical Nurse at an inpatient treatment centre in Nova Scotia in September 2017. She resigned her position at the treatment centre in October 2018.
Ms. Barkhouse does not have a prior discipline history with NSCN.
This matter came to NSCN’s attention upon receipt of a complaint from Ms. Barkhouse’s supervisor alleging that Ms. Barkhouse had a sexual relationship with a former client (“Client A”) of the inpatient treatment centre. The complaint also alleged that Ms. Barkhouse socialized outside of the workplace with another former client (“Client B”).
Details of Issues Before the College
Ms. Barkhouse was the primary LPN on Client A’s unit and frequently provided direct care to Client A during his two admissions at the treatment centre in 2018. As a result of providing care to Client A, Ms. Barkhouse was aware of Client A’s diagnoses and vulnerabilities, which were significant.
Following his initial discharge, Client A and Ms. Barkhouse began exchanging texts and engaging in phone conversations for non-therapeutic reasons.
During the course of Client A’s second admission, Client A began pursuing Ms. Barkhouse romantically. Ms. Barkhouse responded to Client A’s advances.
Prior to Client A’s second discharge, Ms. Barkhouse’s supervisor met with her to address concerns that she and Client A were spending an unusual amount of time together at the nursing station.
Client A’s second discharge was related to his physical health rather than a result of completing treatment. Upon discharge, it was recommended that Client A continue counselling and return for treatment after being medically cleared with respect to his physical health condition. Ms. Barkhouse was aware that Client A was discharged for physical health reasons and not because he had completed treatment.
Two days following Client A’s second discharge, Ms. Barkhouse entered into a sexual and intimate relationship with Client A. The relationship lasted for approximately 3 months.
Ms. Barkhouse initially denied the existence of a sexual relationship with Client A upon questioning by her employer.
On one occasion, Ms. Barkhouse attended her co-worker’s residence, where she socialized with Client A and Client B. On this occasion, Ms. Barkhouse had engaged in intercourse with Client A, and her co-worker, in a separate room, engaged in intercourse with Client B.
Following the termination of the sexual relationship, Ms. Barkhouse texted Client A a photograph of herself that was highly inappropriate given Client A’s diagnoses.
In her Application for Consent Revocation, Ms. Barkhouse admitted the following allegations:
- Ms. Barkhouse engaged in professional misconduct and/or conduct unbecoming in or about August 2018 to November 2018 in that she:
- engaged in an inappropriate and intimate sexual relationship with Client A, a recently discharged patient of the inpatient treatment centre for whom she had provided nursing services;
- failed to maintain appropriate professional boundaries by:
- meeting Client A socially outside of the workplace;
- exchanging texts with Client A for non-therapeutic reasons;
- socializing with Client B outside of the workplace.
Position of Parties
NSCN sought the revocation of Ms. Barkhouse’s registration and licence in this case. There were a number of aggravating factors including Client A’s vulnerability due to his diagnoses; Ms. Barkhouse’s awareness of his vulnerability; Ms. Barkhouse’s awareness that Client A’s second discharge was related to a physical health condition, rather than because he had completed treatment; and Ms. Barkhouse’s continued poor judgment following the end of the sexual relationship, as demonstrated by texting Client A a photo of herself that was highly inappropriate given Client A’s diagnoses.
NSCN views sexual misconduct with a client or a vulnerable former client as one of the most serious acts of professional misconduct in the nursing profession. NSCN requested that the Professional Conduct Committee strongly denounce such behaviour.
Ms. Barkhouse agreed to the revocation of her licence and registration in this case.
Based on all of the above, both NSCN and Ms. Barkhouse agreed to the revocation of her registration and licence and agreed that the public interest was served by proceeding with an Application for Consent Revocation instead of a formal hearing.
Pursuant to section 103 of the Nursing Act, Ms. Barkhouse is not permitted to seek reinstatement of her registration and licence as a Licensed Practical Nurse in Nova Scotia for a period of at least two years following the date of the Professional Conduct Committee's decision.
In addition, Ms. Barkhouse agreed to pay $3,000 towards NSCN’s costs incurred in the investigation and processing of this matter.
The Application for Consent Revocation was presented to a panel of NSCN’s Professional Conduct Committee for consideration. The Committee heard submissions from legal counsel for NSCN and from Ms. Barkhouse who did not have counsel attending the meeting, although she did have the assistance of counsel prior to the meeting. In reaching its decision to approve the Application for Consent Revocation, the panel noted the objects of the College are to serve and protect the public interest in the practice of the profession, to preserve the integrity of the profession, and to maintain the public’s and registrants’ confidence in the ability of the College to regulate the profession. The panel considered various aggravating and mitigating factors, in particular, the following:
- Ms. Barkhouse was the primary LPN on the unit, frequently provided direct care to Client A and was fully aware of Client A’s condition and circumstances;
- Client A was extremely vulnerable and was being treated on an inpatient basis;
- Ms. Barkhouse was aware that when Client A was discharged after his second admission that he had not yet completed treatment related to that admission;
- Ms. Barkhouse exchanged personal text messages with Client A for non-therapeutic reasons following his second admission;
- Ms. Barkhouse commenced a sexual relationship only two days following Client A’s second discharge and maintained a romantic and sexual relationship with him for approximately two months;
- Ms. Barkhouse denied allegations of inappropriate behaviour involving Client A when confronted by her employer and she continued the behaviour after being confronted;
- Ms. Barkhouse sent an inappropriate and concerning text message and photograph to Client A a few weeks after the relationship ended;
- Ms. Barkhouse was concerned for her own interests and not for those of Client A;
- Ms. Barkhouse socialized with Client B;
- Ms. Barkhouse (and her co-worker) met with Client A and Client B outside of their place of employment in response to the clients sharing difficult information which the clients would see as a therapeutic relationship;
- Ms. Barkhouse was a relatively new licenced practical nurse and had no disciplinary history with the College;
- Ms. Barkhouse co-operated with the College throughout the complaint and investigation process and admitted to having a sexual relationship with Client A and to having a social relationship with Client B;
- Ms. Barkhouse acknowledged that she violated professional standards and admitted to sexual misconduct and/or conduct unbecoming;
- Ms. Barkhouse expressed remorse and regret;
- The Application for Consent Revocation fulfills the mandate of the College and avoids a lengthy and costly formal hearing.
Based on these considerations, the panel accepted that revocation of Ms. Barkhouse’s nursing licence and registration was appropriate, but that the mitigating circumstances should permit her to be able to apply for reinstatement of her license and registration after a period of two years. Any conditions or terms and conditions of registration and licensing will be address if and when Ms. Barkhouse applies for reinstatement of her license and registration in Nova Scotia.
Condition or restriction
February 25, 2020
Following an investigation of concerns regarding Crystal Barkhouse’s conduct, on February 25, 2020, the NSCN Complaints Committee imposed conditions/restrictions upon Ms. Barkhouse’s licence under the authority of Section 81 of the Nursing Act. The condition/restrictions will remain in effect until lifted, superseded or annulled by the Complaints Committee or the Professional Conduct Committee, as the case may be. The professional conduct process is ongoing. The conditions/restrictions are as follows:
- Ms. Barkhouse is restricted to practising nursing only as an employee within her current position with her current employer (that is, her employer as at the date of this Complaints Committee meeting and as previously approved by the College), at the discretion of, and in accordance with, any conditions and restrictions imposed by her employer;
- Ms. Barkhouse is restricted to working only when a Registered Nurse or another Licenced Practical Nurse is present for general supervision, monitoring and oversight of her nursing practice (i.e., there must be at least one other RN or LPN present in person on the unit at all times for supervisory purposes while she is working), and where that supervising person is aware of the restrictions upon her and the allegations upon which these restrictions are based; and
- Ms. Barkhouse is restricted from working with patients who are/can reasonably be determined to be “vulnerable”, with such determination to be made by the supervising staff person on duty at the relevant time who meets the criteria as above in subsection (b).