A Burlington optician is outraged after discovering a psychiatrist he'd never met wrote a critical two-page psychiatric evaluation about him without ever seeing or talking to him.
The optician, Jay Hakim, filed a complaint with the provincial medical regulator, which concluded the psychiatrist's conduct was appropriate.
Hakim appealed the regulator's decision; that appeal was held in a hearing downtown Hamilton on Wednesday.
The case raises "some very serious consequences for society" if it's allowed to stand, Hakim argued.
It also parallels issues raised in the United States over whether psychiatrists can ethically provide opinions on the mental health of presidential candidates they've never met.
In the U.S., psychiatrists are called to observe the Goldwater rule, refraining from diagnosing a person without meeting and examining that person as a patient.
The rule, adopted by the American Psychiatrists Association, was named for a presidential candidate many psychiatrists openly called unfit for office in the 1960s.
It's been in the news again lately at a time when psychiatrists have been tempted to label deficiencies they find in current presidential candidates, particularly Donald Trump.
Among the rationales touted in support of the Goldwater rule is that diagnosing someone from a distance can stigmatize that person and their family – and often turns out to be wrong.
Six years ago, Hakim became embroiled in a feud with fellow members on the executive council of the College of Opticians of Ontario, which regulates opticians.The outcome of that dispute is being hammered out in a separate legal case.
But through the legal filings in that case, Hakim learned that Joel Sadavoy – a prestigious Toronto psychiatrist specializing in geriatric care — had at the request of the opticians' college written a two-page psychiatric evaluation about Hakim without meeting him in person.
The psychiatrist's determinations were reached through reviewing some of Hakim's emails and documents sent by the college.
In addition to this appeal, Hakim has served Sadavoy with a notice of action on defamation over the diagnosis.
"He has a medical file on me; I've never met the man," Hakim said Wednesday.
'Unique issues that can be difficult to navigate'
Hakim takes issue with the evaluation being done at all, without his consent or knowledge.
He complained initially to the governing body for psychiatrists, the College of Physicians and Surgeons of Ontario.
The college has language about third-party reports, acknowledging that they "often give rise to unique issues that can be difficult to navigate."
The College's reasons for finding Sadavoy's conduct appropriate were not made public during Wednesday's appeal hearing before Health Professions Appeal and Review Board.
But at the hearing, Sadavoy's attorney, Marc Flisfeder, said the college had found the psychiatrist's actions hadn't crossed any lines, that there was no requirement for Sadavoy to obtain consent from Hakim for the evaluation because none of Hakim's personal medical records had been disclosed to the psychiatrist.
'Makes a mockery'
At the hearing, Hakim argued that the college's investigation didn't go far enough and its conclusion was unreasonable.
Marvin Ross, representing Hakim, argued that the practice of secretly commissioning psychiatric evaluations of third parties is "Stalinesque."
He called on the appeal review board to send the matter back to the college for further review.
"What Dr. Sadavoy wrote was defamatory and makes a mockery of psychiatric evaluations." Ross said. "It also has some very serious consequences for society if it is allowed to stand."
But Flisfeder argued the college had properly investigated and reasonably concluded that the psychiatrist was within his rights to deliver the opinion as a "possible diagnosis."
The college's investigation into the complaint, he said, "does not need to be perfect or exhaustive; it simply needs to be adequate."
Sadavoy did not appear in person at the hearing.
'…and the patient'
Near the end of Wednesday's hearing, one of the three non-medical, independent panelists noted to the parties that at the time the diagnosis was written, the policy of the College of Physicians and Surgeons of Ontario on undertaking a third-party report read:
"It is imperative that physicians discuss their role in the reports process … with the third party and the patient or examinee."
Asked by CBC News whether it has a Canadian equivalent to the Goldwater rule, the Canadian Psychiatric Association provided its ethical position statement on courtroom testimony, which states in part:
"Whenever possible, psychiatrists should testify ... as to the mental state of a particular person only if they have examined that person or made significant attempts to do so."
The statement goes on: "They may review records and critique a diagnosis but should not make a diagnosis without an examination of the person."
The review board didn't state a timeline for releasing its decision, which will be public.