When a doctor is caught breaking the rules in one province but then decides to practise in another, patients don't always get to see the physician's full disciplinary history, CBC News has found.
CBC has identified at least 15 doctors over the last 15 years who were disciplined in one province and now practise in another.
In 13 cases, the doctors' discipline history from the first province is not listed on their current college profile.
"I think that if somebody has been disciplined, the public should be able to access that," said Dr. Gail Robinson, a Toronto psychiatrist and expert in sex abuse of patients.
"When you're applying for a licence or when your licence is being renewed, you are supposed to declare whether you have lost your licence, whether you're under investigation for anything," she said.
Dr. James Bernard Hanley, a psychiatrist, gave up his medical licence in Newfoundland and Labrador in 2007 after acknowledging he had four sexual encounters with a patient he was treating. He then had his licence revoked in New Brunswick after the Newfoundland and Labrador decision.
In 2011, his licence was reinstated by an adjudication tribunal with the restriction that he not work in a private office practice. The tribunal wrote that it was satisfied "that there is independent, corroborating evidence that it is extremely unlikely that the misconduct will recur if the respondent is permitted to return to practice."
Hanley registered in Alberta in early 2014, where the college applied its own restrictions to his licence, including the requirement that he only see patients when another health professional is present in the clinic. As well, he was to work only in a multi-physician setting and restrict his practice to a maximum of 50 hours per week.
Hanley is currently working at the Canadian Forces Base in Cold Lake, Alta., and his current college profile doesn't mention that he held and lost his licence in two provinces, or why. It does mention his restrictions.
The College of Physicians and Surgeons in Alberta didn't specifically explain the lack of information on the college website about Hanley. But the college said it takes that information into consideration.
"Before deciding whether to issue a practice permit, the college will often seek additional details from the candidate and/or the regulatory body determining the discipline," said Kelly Eby, a spokeswoman for the college in an email to CBC News.
"We can't speak specifically to an individual physician's licensing process," wrote Eby. "I can't give you details about Dr. Hanley."
A spokesperson for the Defence Department confirmed he is still working with the military and confirmed Hanley declined our request for an interview.
"While his licence was revoked at one point in his long career, his licence to practise in Newfoundland was reinstated and he is currently licensed to practice in Alberta," said Jennifer Eckersley in an email. "Dr. Hanley was hired following a rigorous process to which all civilian clinicians employed by the CAF (Canadian Armed Forces) submit."
Physicians disciplined again in 2 cases
In two of the cases reviewed by CBC News, the physician was disciplined again in the province they moved to.
Dr. Ian Egbert DePass practised general surgery at Nova Scotia's Queens General Hospital from 1997 to June 2002. A medical colleague sent a letter of complaint in May 2002 to the Nova Scotia College of Physicians and Surgeons about "general quality of care" and "the wide scope of practice by Dr. DePass," specifically "the range of procedures he provided and his management of post-operative complications and his patient selection in view of his experience, skill and knowledge," according to the settlement agreement signed by DePass and the college. .
DePass moved to Ontario in late 2002, but the college in Nova Scotia charged him two years later. The college filed allegations of failing to exercise appropriate judgment by performing surgery as a solo surgeon, failing to demonstrate adequate skill and failing to demonstrate adequate skill or judgment in managing post-operative care for patients. He brought numerous procedural challenges to his Nova Scotia hearing, all of which were dismissed by the college.
He filed a notice of appeal in 2007, but in preparing the appeal, a settlement agreement was reached and DePass admitted the allegations. He consented to restrict his Nova Scotia licence to group practice and was reprimanded. He also paid costs to the college of $15,000, but his licence in Ontario, where he was registered since 1992, was not affected by the decision.
"When a disciplinary decision is rendered, the College of Physicians and Surgeons of Nova Scotia notifies stakeholders including all of the regulatory colleges," said an email from Pattie LaCroix, a spokeswoman for the Nova Scotia college, who declined to specifically discuss DePass.
Records could be pooled
An expert in sex abuse of patients said colleges could pool their discipline history information and make it available to the public.
"They could have a national database," said Marilou McPhedran, a lawyer and professor at the University of Winnipeg. "There's nothing stopping them from that, and why not? Why isn't that in place?"
"We are all patients," she said, "We move around and to move from jurisdiction to jurisdiction, we need consistency," she said. "We all need to be able to gather information, information for our health not limited to by the fact that we've crossed over a border from one province to another."
Restrictions on practice
DePass, now working as a surgeon in Ontario, was found by a College of Physicians and Surgeons of Ontario discipline committee in 2009 to have failed to "meet the standard of practice." The committee said he was "incompetent with respect to his management of abdominal surgery of three patients."
According to the college's summary of the decision, the committee found his care of three patients demonstrated that "he is unfit to continue to practise or that his practice should be restricted."
The committee ordered a reprimand and that he be limited to acting as a surgical assistant in a hospital setting, only practising when a certified surgeon approved by the college was present. A notice was to be placed in the operating room area with his restrictions listed. He was also ordered to co-operate with unannounced inspections of his practice and patient charts.
In 2012, the college found that DePass committed an act of professional misconduct, in that he "failed to maintain the standard of practice of the profession" for failing to properly manage five additional patients. In the case of one patient, he admitted he "failed to consider a more serious diagnosis in spite of documented clinical and laboratory evidence" in the post-operative management of a patient who eventually developed sepsis.
In the case of an 83-year-old patient who came to the emergency room with severe burning in her stomach, the committee found, among other issues, that he failed to order exams "quickly enough in the face of deterioration in a patient who may have a bowel perforation."
DePass is currently working as a surgical assistant at the Chatham-Kent Health Alliance (CKHA). CBC reached out to him at the operating room floor where he works, but he could not be reached.
"Chatham-Kent Health Alliance (CKHA) relies on a physician's licensure, as set by the [Ontario college], regarding physicians' scope of practice," wrote the health alliance's Dr. Ranjith Chandrasena, in part. "Dr. Ian DePass practises as a surgical assistant at CKHA, which is in keeping with the scope of practice set out for him by the [college]."
DePass's Nova Scotia discipline still does not appear on his current physician profile on the Ontario college's website, and the Ontario college would not answer specific questions about DePass's disciplinary history in Nova Scotia.
"The college's public register contains the information that we are permitted to make public about this particular doctor," said Kathryn Clarke, a college spokeswoman.
The College of Physicians and Surgeons of Ontario started a "multi-phase initiative" three years ago to make more information available to the public.The CPSO will post information about disciplinary findings by another medical regulatory or licensing authority made on or after September 1, 2015.