A Hamilton physiotherapist who entered into an inappropriate relationship with a patient has been censured after an appeal to the High Court.

The Health Practitioners Disciplinary Tribunal heard evidence that Jeremy Nathan Spence gave a woman he was treating a full body massage while being treated for a calf injury and subsequently called and invited her out for coffee.

The patient accepted and later visited him at his house on three occasions.

The pair also exchanged hundreds of texts in less than three months including what the tribunal described as some "risqué banter" in which Spence took the lead for the most part.


After her second treatment the practitioner made contact and suggested meeting up for a coffee.

In her evidence the patient claimed she made clear from the outset that she was not interested in a romantic relationship but was open to a friendship.

The first issue between the two came at the patient's final treatment for her calf injury when Spence asked the woman to change into some shorts and proceeded to massage not just her leg but her back and shoulders, the patient claimed.

"I was a little bit concerned about why he was giving me a massage but it felt good and [the practitioner] said it would help to relieve the stress in my life," she said.

"I also thought there may be a link between the problems I was having with my legs and the massage he was giving, because he had mentioned something about me having a crooked spine. At one point during the massage he ran his hands down my sides, up under my arms and brushed my breasts. I am not sure if this was intentional or appropriate for the type of massage he was giving me. Looking back, I feel like I was in some sort of porn movie and I think the massage was inappropriate. I believe I was naive in letting the massage continue."

Spence denied there was anything unusual about the treatment and said she had told him she also had jaw, neck and shoulder pain and that the calf injury may have affected her knee and other parts of her leg.

He said the session was to complete therapy for her lower leg and assist with additional issues affecting her knee and back.

The tribunal accepted the treatment was appropriate.


It was after the final treatment that Spence again suggested coffee and she agreed.

From there they meet a number of times and exchanged numerous text messages.

The patient eventually came to the view the relationship was not healthy and almost three months after the final treatment sent Spence a text ending the relationship.

The tribunal accepted the patient did not appreciate the number of texts she was receiving or their contents, which she perceived to have romantic or sexual overtones.

The tribunal's impression of the communication was that it was very much two-way traffic and that there was nothing especially troubling about the exchanges.

While Spence maintained his intention was only for a friendship and that the texts were only banter, he acknowledged it was "unwise" to embark on a non-therapeutic relationship with a patient.

The tribunal found that for a practitioner to actively seek and embark upon a social relationship of the type involved in this case, was plainly a breach of his professional responsibilities.

But they concluded the breach was not serious enough to impose a disciplinary sanction.

However, the Professional Conduct Committee appealed the tribunal's decision on liability and the High Court found in the committee's favour.

The High Court ordered that Spence be censured and pay $2500 in costs.