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Controversial Topic: Physician Misconduct Regulation


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The CBC has been broadcasting headlines around physician misconduct over the past few weeks.

 

In particular the the perceived lack of transparency around the process of disciplinary hearings, and the slow processing speed of the colleges has been under scrutiny.  Obviously each province has its own process so I don't want to make a blanket statement.    

 

But as a budding physician I find the topic really concerning. In particular the back of Dialogue in Ontario, I found a concerning number of physicians engage in inappropriate relationships with their patients.   

 

We may all remember this case, where the patient was unable to testify in front of the college for health reasons, and the allegations were eventually dropped.  Initially a license was suspended, another province appointed and then de-appointed this individual:

http://www.cbc.ca/news/canada/edmonton/dr-claudio-soares-cleared-of-sexual-misconduct-in-ontario-1.2943319

 

The physician in question is now a fully tenured professor at another Ontario medical school.  

 

Obviously allegations are allegations, and we as a society value the principle of innocent till proven guilty, but I find it frustrating that the case appears to have been dropped on a technicality.  The individual is now appointed to a high ranking position.  Overall it doesn't sit well with me. 

 

Anyone else have any thoughts around this? 

 

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The CPSO has it's share of flaws, but I think a zero tolerance policy on sexual misconduct is not one of them. I definitely support greater transparency around this and protections for patients, even if it as at the cost of physician privacy in this setting (i.e. bill 87). they should have appropriate resources for dealing with these complaints in a timely fashion.

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I mean, it seems like the other alternative in that case was to compel the patient who brought the complaint to testify - and I would suspect (though there is no way to know) that trauma is grounds upon which her physician recommended that the College excuse her.  If the College had sought a warrant to compel her to testify, the PR on that wouldn't have looked great either, nor would it be in the patient's best interest, so I'm not sure I'd qualify that as dismissing the case on a technicality.  If there was no other way to investigate the case, their hands were kind of tied, and it would be the same in a criminal court.

 

It's a horrific breach of trust - I support mandatory license revocation, which is in place.  The CPSO also often publishes the information from the disciplinary hearing in the medical register, so it's openly available when you look up that physician.

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Bill 87 is concerning though - for various reasons, and through no fault of my own other than having a health condition, the CPSO has a fair amount of my private health information.  I am also a patient and I have my own right to privacy.

 

Also, working with some patient populations, allegations and complaints aren't exactly unexpected.  I have no problem with the CPSO allowing the public to access substantiated complaints, but I do think that allegations and complaints that are not substantiated should not be made public.

 

Furthermore, it bothers me that the increased regulation of medical practice in Ontario is happening almost exclusively without any input by or consideration of the needs of physicians.

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Definitely agree with the majority of your comments about bill 87 and the situation in Ontario. 

 

For this case--I do think with regards to allegations and complaints, if it's a severe and substantial enough allegation that a physician has a restriction placed on license for sexual abuse (e.g. cannot care for patients of a specific gender/sex without supervision), the public deserves to know.

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Pretty sure the policy for the CPSO as of a few years ago was to report all allegations of sexual abuse to the police.

 

The college and the police serve different roles. The police/courts investigate for criminal behaviour. The college investigates for professional behaviour. They aren't necessarily the same.

 

For example, let's say an ER physician is found having sex with a patient in the ER. The patient is an adult who was presenting for a cut finger. The patient is completely alert and oriented and of sound mind. The sexual encounter was not coerced (I.e. have sex with me or I won't treat you). This scenario would be professional misconduct and the college would likely persecute it (license suspension/revoke, restrictions on practice etc). The police could also investigate at the colleges request but the justice system may find there was no alleged criminal behaviour as it was sex between consenting adults.

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Pretty sure the policy for the CPSO as of a few years ago was to report all allegations of sexual abuse to the police.

 

The college and the police serve different roles. The police/courts investigate for criminal behaviour. The college investigates for professional behaviour. They aren't necessarily the same.

 

For example, let's say an ER physician is found having sex with a patient in the ER. The patient is an adult as was presenting for a cut finger. The patient is completely alert and oriented and of sound mind. That would be professional misconduct and the college would likely persecute it (license suspension/revoke, restrictions on practice etc). The police could also investigate at the colleges request but the justice system may find there was no alleged criminal behaviour as it was sex between consenting adults.

 

that is my understanding - no oversight organization is going to be able to override the law. Otherwise doctors could self govern to give themselves legal protections that others don't have (ha, immunity to murder as an extreme example). 

 

way too much power. 

 

the college is just involved in matters of professionalism which does (or is supposed to) exist on a higher standard than the law (as it cannot be less, and would have no point in being the same). 

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Ok so. Sexual misconduct (such as this psychiatrist) vs sexual abuse.

 

In the context of psychiatry what's the fine line here? 

And once no case could be made in front of the tribunal, what happened afterwards? I couldn't find anything about this Queen's professor on the CPSO website. 

 

He seems to have gotten full tenureship though. Opinions on this? 

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Frankly, the discomfort surrounding the psych doc obtaining a professorship in Alberta worries me.

 

I get that it "feels" unjust. But ultimately we're looking at an allegation that was made and never substantiated AFAIK. The man is innocent until proven guilty.

 

That is something that could happen to any one us. An allegation is not difficult to make and can be devastating to your career and personal life. And if you don't think it will happen to you so long as you behave correctly, remember that all it takes is one patient.

 

If the accusation is proven by the court or the college, then sure, make it public. Allegations however should be kept private.

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He has a restricted license according to the CPSO - some sort of supervised practice arrangement.  Unclear if that's related to this, or for another reason.

 

I'd see us in psychiatry as high risk - we work with really vulnerable people in very intimate, long-term psychotherapeutic relationships.  If you haven't worked through your own "stuff" in one way or another, you tend to start acting it out with your patients, especially when your own life gets stressful.

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I feel like the whole CPSO is kind of a black box. Difficult to know how they make their decisions

For example, I wonder if there as a process through which allegations get substantiated, even before they go to a review board.

I'd imagine they do things like request and review the physicians records, etc. before they decide the allegation is substantial enough to further pursue....

For instance, what if an allegation is made, and then records are reviewed which clearly state there was an RN chaperone present for xyz component of the physical exam, who then is contacted and independently verifies things, etc. in that case, might the allegation be thrown out before things like this progress to the point where licenses are restricted?

how do they decide which allegations to pursue vs. not? 

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I am no expert on the entire process - but I think the burden of evidence is lower than what people would call "proved" as in a court of law.

 

The college I think can and does make decisions based on the probability of things and the need to protect the public. In short the college is a lot more interested in protecting the profession than protecting one particular doctor. 

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The CBC has been broadcasting headlines around physician misconduct over the past few weeks.

 

In particular the the perceived lack of transparency around the process of disciplinary hearings, and the slow processing speed of the colleges has been under scrutiny.  Obviously each province has its own process so I don't want to make a blanket statement.    

 

But as a budding physician I find the topic really concerning. In particular the back of Dialogue in Ontario, I found a concerning number of physicians engage in inappropriate relationships with their patients.   

 

We may all remember this case, where the patient was unable to testify in front of the college for health reasons, and the allegations were eventually dropped.  Initially a license was suspended, another province appointed and then de-appointed this individual:

http://www.cbc.ca/news/canada/edmonton/dr-claudio-soares-cleared-of-sexual-misconduct-in-ontario-1.2943319

 

The physician in question is now a fully tenured professor at another Ontario medical school.  

 

Obviously allegations are allegations, and we as a society value the principle of innocent till proven guilty, but I find it frustrating that the case appears to have been dropped on a technicality.  The individual is now appointed to a high ranking position.  Overall it doesn't sit well with me. 

 

Anyone else have any thoughts around this? 

 

No disciplinary system is going to be perfect and we should expect some dismissals even in publicly suspicious circumstances. Without more details, it is very hard to say how this case should have been resolved, or whether the physician in question should be continuing to practice. I think physicians get away with far too much, but innocent until proven guilty should still be the standard.

 

That said, the CPSO is lacking some credibility with regards to its abuse investigation process and the general standards it holds pthahysicians to. The Dialogue cases are the best-case examples of what the CPSO does and even then the reports are far from reassuring. Cases obviously take too long to work through the system with insufficient interim protections in place for patients. Reports of decisions take an excessively long time to get published. Punishment appears to be reserved only for cases of painfully obvious misconduct, begging the question as to what evades correction that might not be as egregious. The CPSO is supposedly getting better about being proactive, but this mostly seems to be regarding competence, not conduct.

 

I know there is stiff opposition to further government oversight of physician conduct, but the whole notion of self-regulation is that we get autonomy in exchange for enforcing high standards among ourselves. If we're not ensuring those high standards, then we don't deserve the promised autonomy. I worry about the government going too far, but I can't dispute the need for improvement and we've had far too long to raise the bar without a push.

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Yeah.  If there's anything that's been drilled into me by pretty much every staff ever, it's "the College is not your friend and you should have as little contact with them as humanly possible."

 

same here - it is just stated over, and over, and over again. 

 

"the College is not your friend"

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same here - it is just stated over, and over, and over again.

 

"the College is not your friend"

I think the CPSO is regarded as the most aggressive/strict of all the provincial colleges.

 

College decisions can also be appealed to an actual court of law overseen by a judge.

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No idea.

 

yeah me neither - if I had to guess probably not very. Not to mention the sheer humiliation factor (ok least say you do get back your licence and that would the only reason I could see anyone trying to do this. Would anyone actually refer to you? Would any hospital actually want to go near you? Even if in family medicine it would be hard to get away from things. Plus I am sure the college would be "aggressive" in monitoring you forever - they don't like to lose)

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Frankly, the discomfort surrounding the psych doc obtaining a professorship in Alberta worries me.

 

I get that it "feels" unjust. But ultimately we're looking at an allegation that was made and never substantiated AFAIK. The man is innocent until proven guilty.

 

That is something that could happen to any one us. An allegation is not difficult to make and can be devastating to your career and personal life. And if you don't think it will happen to you so long as you behave correctly, remember that all it takes is one patient.

 

If the accusation is proven by the court or the college, then sure, make it public. Allegations however should be kept private.

Did you actually read the articles around it? I googled his name and went down a bit of a rabbit hole, and from what I can gather it was the CPSO that alerted the CPSA. Thereafter I don't know what happened in Alberta, but Soares then was on leave and  resigned. 

 

Allegations were taken seriously enough for the Ontario college to notify across the country, BEFORE the tribunal was scheduled years later.  

 

Suppose the tribunal should have been conducted much sooner to come to a conclusion one way or the other.  Someone posted on here that some articles say Soares was not cooperating with the investigations back then either.  

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Did you actually read the articles around it? I googled his name and went down a bit of a rabbit hole, and from what I can gather it was the CPSO that alerted the CPSA. Thereafter I don't know what happened in Alberta, but Soares then was on leave and resigned.

 

Allegations were taken seriously enough for the Ontario college to notify across the country, BEFORE the tribunal was scheduled years later.

 

Suppose the tribunal should have been conducted much sooner to come to a conclusion one way or the other. Someone posted on here that some articles say Soares was not cooperating with the investigations back then either.

I wonder how much of that is regular procedure for accusations of this nature? Anyways, the college taking action against an individual prior to proving their guilt is not an accurate marker of whether the physician in question is guilty given how low their threshold to action is.

 

I'm curious as to how he was not cooperating. To be fair, I would not be open to to speaking if I were being investigated unless it was absolutely necessary. Especially given how easily comments could be taken out of context or used against you. That could be construed as non-compliance when realistically it is the smart thing to do.

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