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Why Health Professionals Need Independent Supervision

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Who protects the public when health professionals are either incompetent or engage in wrong doing?

In a number of earlier blog posts, I pointed out that medical treatment is not always ideal. For example, often those with schizophrenia get worse health care than others and die at a significantly earlier age.

In other blogs, I've written about psychiatrists not always following their own treatment guidelines, and of a man with schizophrenia being charged with criminal assault as the result of an incident in a hospital emergency room. In finding the man not guilty, the judge stated that hospital staff did not provide truthful testimony under oath. Aside from being sued along with the hospital, nothing happened to the nurse and social worker other than a lengthy suspension with pay.

In almost all jurisdictions, health professionals regulate themselves. Each health profession has its own regulatory body which ensures that those practising meet established standards, upgrade their skills, are investigated when the public complain and are disciplined if they are found at fault. In Ontario, under the Regulated Health Professions Act, each college has on it a small number of public members to represent the interests of the public but they are in a minority.

Roger Collier writing in the Canadian Medical Association Journal, pointed out that "Self-regulation is a basic tenet of all professions." But, he added, "the problem with this collegial form of regulation... is that professions tend to be protective of their members."

And that, in my own opinion, is a problem.

One well-publicized case in Ontario is that of family doctor Benhaz Yazdanfar and her Toronto Cosmetic Clinic. Dr. Yazdanfar was not a trained surgeon but she was performing cosmetic surgery and, when Waterloo physician and quack watchdog Dr. Terry Polevoy saw her ad soliciting surgical patients, he investigated and filed a complaint against her with the College of Physicians and Surgeons of Ontario. Polevoy argued that she was not trained as a surgeon and should not be performing cosmetic surgery.

The college investigated and ruled that she was qualified so Polevoy appealed that decision to the Health Professions Appeal and Review Board. During the 16 months it took the appeal board to meet and consider the case, one of Dr. Yazdanfar's patients, 32-year-old real estate agent Krista Stryland, died immediately after her liposuction procedure. The appeal board still upheld the College decision and dismissed Polevoy's complaint. However, because of Ms. Stryland's death, the college investigated and Dr. Yazdanfar was permanently banned from practising surgery and her medical license was suspended for two years.

Why did it take a death for the regulatory officials to realize that she was not properly trained?

Even more bizarre but without a death is the College of Opticians of Ontario. In 2007, Toronto's CITY TV journalist, 75-year-old Peter Silverman, went to an optical store to investigate complaints about the optician selling counterfeit frames when he was assaulted by that optician. That assault, which aired on Anderson Cooper's CNN show called Optician Gone Mad, is on YouTube. You would think that this sort of unprofessional behaviour would result in discipline action being taken against the optician in question by his regulatory college. After all, we do not expect that a health professional needs to be removed from their offices by a police SWAT team and then charged with assault as happened in this case.

The optician, Adam Plimmer, was referred to the College Discipline board in 2007 and he allegedly had a trial on September 24, 2013 according to the college website. But, there is no decision more than six years after that assault and, with a short suspension of his license in 2009 for what is described as administrative reasons, the optician's status is current and active. He is still practising.

But then, this College may be too busy as it is is presently mired in a $1.5-million libel action that was brought against it, the 2013 president David Milne, vice president Roque Fernandes, and the former registrar for defamation. Two members of the 2013 executive who were removed from the executive, Mr. Jay Hakim (who was also removed from council even though he was elected) and Mr. Chris Namvarazad, are suing. In their 22-page statement of claim, they allege that the vice president referred to them as Iranian terrorists and suggested that their Muslim or cultural backgrounds "made them dangerous."

It is also alleged that the registrar told an optician during a conference that Mr. Hakim was dangerous and harmful and that the president disclosed privileged information about them. That information stated that they had been escorted from the premises by security during an executive committee meeting and that staff were concerned for their safety because of aggressive outbursts by the plaintiffs.

Their claims have not yet been tested in a court of law and the College has not presented a statement of defence but they have filed a motion to have some sections of the claim dismissed and both parties will be in court in Hamilton, Ontario to argue their positions on March 17.

Then there is the College of Denturists of Ontario. After numerous allegations ranging from inappropriate business relations to inappropriate comments made about race, religion and sex, the government ordered an audit. In 2012, as the result of that audit, the Government took over the College and put in a supervisor. That College now has a new registrar as of June, 2013 who just happens to be the former registrar of the College of Opticians who is named in the libel action -- Abena Buahene

The Canadian Medical Association Journal (CMAJ) article points out that the privilege of professional autonomy and self regulations comes with a responsibility to keep your house in order. I'm not sure that is always the case in Ontario. In the U.K., the CMAJ article stated, there were so many medical scandals that came to light that U.K. doctors are no longer self regulating. Mary Dixon-Woods, a professor of medical sociology at the University of Leicester, is quoted saying:

Though sufficient to ensure that most doctors were 'good,' the collegial model adopted by the profession left it fatally vulnerable to the problem of 'bad apples': those unwilling, incapable or indifferent to delivering on their professional commitments and who betrayed the trust of both patients and peers.

It seems from my examples above that this may be the case with some colleges in Ontario and it may be time to re-evaluate the self regulatory model to better protect the public interest.

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