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Misbehaving Doctors Deserve Real Consequences

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The Ontario Medical Association is upset with the Ontario government, but not over money this time. They are concerned that the government is trying to tighten discipline procedures for misbehaving doctors and other health professionals.

For a change, I agree with the government. These new changes could result in discipline panels being made up of a majority of independent lay people rather than health professionals and create more greater transparency.

doctor fine
(Photo: Edward Olive - Fine Art Photographer via Getty Images)

The government has been pushed into this position by the Toronto Star which has published numerous exposés on doctors who have either gotten off or have had light sentences meted out. The Star has also done a number of editorials on the topic. While their emphasis has been on sexual abuse, I believe that all matters should be dealt with more severely.

Health professions are allowed to regulate themselves under the Regulated Health Professions Act, and Ontario has 26 such colleges. Each college is made up of members of that profession elected by their peers and a minority of public members appointed by the government to represent the interests of the public. Members of each profession discipline themselves when a member is accused of an infraction such as sexually abusing a patient, failing to meet the standards of the profession, and so on.

In 2012, the Canadian Medical Association Journal looked at the problems of self-regulation by doctors. The author, Roger Collier, said that "the problem with this collegial form of regulation, however, is that professions tend to be protective of their members. This is not really that surprising; individuals belonging to any group tend to be protective of their own kind."

His penalty was to engage in a process of self-learning and write and submit a 2,000-word report on what he had learned.

For a number of years, I was a public appointee to the College of Opticians of Ontario where I did sit on discipline panels and, in the past six months, I've represented two people who have appealed what we considered to be erroneous decisions by the College of Physicians and Surgeons of Ontario (CPSO) to the Health Professions Appeal and Review Board (HPARB).

The first case was reported on by the CBC. When I was on the Opticians Council, I became aware that the college had secretly hired a psychiatrist to provide them with an assessment of an elected member whom they did not like and I knew roughly what the report said, although I never saw it nor did I know the name of the doctor.

That individual and a second elected member of the college, both of whom were also elected by their peers to be on the executive, were removed from executive a few years later, and one of them was removed from his elected position on the council itself. This was analogous to the House of Commons removing a member of Parliament who had been elected by his constituents.

They are both suing the college and, thanks to disclosure, they received the name of the psychiatrist who conducted his assessment along with his report and the minutes of the meeting when this course of action was decided upon. The assessment was completed by the psychiatrist without ever seeing the person in question, and he based his diagnosis only from selected letters and emails that he was given. A complaint was filed with the CPSO, but they dismissed the complaint as they felt that it was suitable for a psychiatrist to determine that someone they had never met and who had never seen medical records for the person could diagnose them with a probable mental illness.

college of physicians and surgeons of ontario.
(Photo: Andrew Francis Wallace via Getty Images)

The matter was appealed based on numerous arguments, including the fact that a doctor cannot diagnose someone they have never seen. We just received the decision by HPARB signed on March 6 and received by me on March 7. The HPARB panel has ruled that CPSO must reconsider this case as they did not feel that the doctor should have been exonerated.

Aside from a seeming reluctance to find fellow professionals guilty, the other problem is exemplified by another case I helped with at HPARB. When a complaint is received, it is investigated by a college committee and either dismissed, referred to a discipline panel or some finding of guilt and a penalty are decided upon. Cases that don't go to the discipline committee for a trial -- but where a finding of guilt is found at the committee -- are often not reported on the doctor's public register.

In this second case, a mother from Richmond Hill was very concerned with the psychiatrist her son had at MacKenzie Health, also located in Richmond Hill. She managed to find another psychiatrist for her son and filed a complaint against the original doctor. The CPSO complaints committee did find that the doctor was deficient in nine areas of his treatment and his practice, including not having a clear diagnosis of what was wrong with his patient, making it difficult to determine appropriate treatment, excluding the family and illegible medical reports.

His penalty was to engage in a process of self-learning and write and submit a 2,000-word report on what he had learned. The finding of guilty will not appear on his public register for others to see, as his penalty was considered remedial and CPSO did not consider the doctor's deficiencies to be of a serious nature.

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

The mother was upset with this, as she considered that the deficiencies of the doctor were severe and he deserved more than to write a 2,000-word paper. She was also concerned because many staff at the hospital were aware that she had a dispute with the doctor and had filed a complaint. Because the results of her complaint are secret, no one will know that she was right and the doctor wrong, and she will be perceived by the staff as a troublemaker should she or her son require treatment at that hospital.

As I assisted her in her appeal, I do have all records pertaining to the case, including the decision by the CPSO committee and I argued her case at the HPARB panel. We are still waiting for the decision of HPARB on this case. Meanwhile, her son is doing significantly better with his new psychiatrist.

Another more egregious case, in my opinion, was that of a complaint filed against Toronto 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 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 practicing surgery and her medical license was suspended for two years.

krista stryland
(Photo: Steve Russel via Getty Images)

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

I suspect that the situation in the Richmond Hill mother's case above is not unique as the Bill before the legislature states that "the public register for members of health regulatory colleges will include more information, including: any specified continuing education or remedial programs required by a panel of the ICRC" See bullet point 4.

Once the government bill is passed, such remediation as required in the case of the Richmond Hill mother's doctor will have to be on the register, but unless the mother wins her appeal and this case is sent back to the CPSO, then this doctor will not have his finding appear on the register.

These changes being proposed are logical and should make for greater transparency. Health professionals need to be accountable to the public they serve and that accountability should be apparent. This is not the case now.

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