In a display of its tougher stance on misconduct involving patient-doctor relationships, the discipline committee of the College of Physicians and Surgeons of Ontario has revoked the licence of a psychiatrist who entered into a romantic relationship with a patient he intends to marry.

Whereas similar conduct in previous cases was typically met with suspensions, the decision to strip Toronto doctor Nagi Ghabbour’s licence is likely a response to criticism that the committee was being too lenient in the past, critics say.

Ghabbour is only the second Ontario physician to lose his licence for beginning a relationship with a patient too soon after the end of the doctor-patient relationship.

“The very nature of the relationship, the profound vulnerability of this specific patient and Dr. Ghabbour’s lack of insight into the egregiousness of the misconduct led the committee to decide that revocation is the only suitable penalty to fully protect the public in the circumstances of this case,” a five-member panel of the discipline committee wrote in a decision released Tuesday.

“Sexual relationships with prior psychotherapeutic patients are likely never advisable, nor likely ever in the best interest of the patient. Public trust and protection must be the guiding principle for the profession to do no harm.”

Ghabbour, 55, will be eligible to reapply for his licence in one year, but will have to prove that he has learned from his misconduct, the panel said. His lawyer did not return the Star’s request for comment.

Ghabbour admitted at his discipline hearing in February to professional misconduct in that he began a relationship with Patient A, whose name is covered by a publication ban, about a month after he stopped being her psychiatrist.

The panel heard in February that the pair are living together — Patient A even attended the discipline hearing — and that they intend to marry.

The college had argued that Ghabbour’s licence should be revoked, but the doctor’s lawyer pushed for a nine- to 12-month suspension with a condition that Ghabbour receive therapy.

While admitting during the penalty phase of the hearing that dating a patient so soon after the end of their professional relationship was a serious boundary violation and a “huge lapse in judgment,” Ghabbour also testified: “I love her, I adore her, and I respect her.”

Ghabbour’s penalty hearing took place while the provincial government was looking to strengthen the law around sexual abuse and physician-patient relationships in the wake of a Star investigation into doctors still at work after being found guilty of sexually abusing their patients.

The government’s Bill 87 became law in May. It stipulates that a person is still considered a “patient” for one year after they stop seeing the physician. Therefore, any sexual activity within that year would lead to the mandatory revocation of a doctor’s licence. Colleges would also be permitted to extend the period beyond one year.

The bill was not yet law when Ghabbour’s conduct and hearing took place, but the college’s lawyer drew the panel’s attention to it while arguing for revocation. “It’s an indication of where our society is moving in Ontario with regards to this type of conduct,” Elisabeth Widner told the panel.

The discipline panel acknowledged a “shift in societal values” in its decision to revoke.

“The public expects and deserves professionalism and integrity from Ontario doctors and that the college will regulate the profession in the public interest,” the panel wrote. “The committee is very aware of the shift in societal values that is highlighted by the Ontario government’s amendments to the Regulated Health Professions Act (Bill 87).”

Medical malpractice lawyer Paul Harte, who was not involved with the case, said the panel’s decision sends a message that the type of conduct Ghabbour engaged in will not be tolerated, but that it is a message that should have been transmitted long ago.

“They seem to be responding both to the concerns expressed in the media and also concerns expressed by the Minister of Health,” he said.

Patient A had been experiencing stress at work as well as marital difficulties, and was seeing Ghabbour for anxiety and depression, the panel heard in February. Ghabbour provided prescriptions for antidepressants. He also documented suicidal ideation.

She eventually began displaying romantic feelings for him in sessions, which he testified he resisted. Ghabbour maintained he didn’t want to refer her to someone else because he felt she was lacking support in other areas of her life and he wanted to help her.

After one session, she hugged him, and at one point he noted in his charts that the patient was “idealizing him and is seeking a real/physical bond with him,” according to an agreed statement of facts filed at the hearing. He said he made attempts to make clear to her that he was her psychiatrist.

In one of their last sessions, Patient A kissed him on the mouth, Ghabbour testified. Within weeks of Patient A deciding she no longer wanted Ghabbour as her psychiatrist because of her personal feelings toward him, the two began to see each other socially, and the relationship soon became sexual, the panel heard.

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“Dr. Ghabbour testified that he was concerned about abandoning Patient A if he referred her for appropriate therapy once the transference was evident,” the panel wrote, referring to when Ghabbour became aware of Patient A’s feelings for him.

“It is atrocious that he chose to terminate treatment and made no attempt to transfer her to another psychiatrist, despite his conclusion that she was suffering from serious psychiatric conditions that included suicidal ideation. His misconduct in pursuit of his own needs has led, in the result, to many patients being abandoned.”

The first doctor to lose their licence for starting a personal relationship too soon after the end of the professional one was Mehdi Horri, whose licence was yanked in March, as a different panel of the discipline committee was still deliberating Ghabbour’s punishment.