Doctors in Canada who engage in improper behaviour with patients — everything from inappropriate comments and relationships to unwanted touching and sexual abuse — are frequently given a second chance to continue practising, a CBC investigation has found.
Over the last 15 years, at least 250 doctors have been disciplined across the country for a litany of patient boundary offences, according to a CBC News examination of discipline cases.
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Fewer than one-third lost their licence, and about half of the doctors continue to practise today.
In fact, CBC has identified 28 doctors who have been cited more than once for inappropriate behaviour with their patients. Five of them continue to practise.
Barb MacQuarrie, community director at the Centre for Research and Education on Violence against Women and Children at Western University, called the situation revealed by CBC's findings "unacceptable."
"They're tragic really, because there's a story behind each one of those, of an individual who's really been betrayed and injured by the conduct of the doctor," she said.
According to the disciplinary data, more than 380 patients were involved in inappropriate interactions with doctors.
Of the 250 doctors who were found to have behaved inappropriately with patients, 181 were general practitioners and 32 were psychiatrists.
The statistics come from an analysis of 15 years of published doctor discipline cases across the country. The process was made difficult by the lack of uniform reporting and transparency rules in the different jurisdictions and their respective regulatory bodies: the colleges of physicians and surgeons.
The governing body in Alberta, for instance, only publishes a summary of disciplinary findings going back five years. Manitoba's website only lists discipline cases going back 10 years. Ontario's information stretches back to the 1980s. The Yukon Medical Council said legislation restricted them from releasing all discipline information.
The analysis found a total of 934 formal discipline cases representing 817 physicians in 10 provinces and two territories. Offences ranged from faking credentials, ethical breaches and minor administrative issues to a lack of skill and poor quality of care.
In 250 cases, doctors were cited for inappropriate behaviour with patients, which included everything from criminal sexual assaults and physical touching to entering into personal relationships. Fewer than one-third had their licence revoked, while others were allowed to retire or resign rather than face disciplinary hearings.
Of the 250 physicians, 185 were allowed to keep practising medicine in Canada following fines, reprimands, re-education, restrictions or temporary licence suspensions. Three doctors are currently practising in other countries.
"Patients come to doctors because they trust them," said Dr. Gail Robinson, a psychiatrist and University of Toronto professor who has been involved in multiple task forces on sex abuse of patients in Ontario. "They come because they're worried. They're vulnerable."
She framed the current disciplinary system as "protectionism of the professions as opposed to being more concerned about the welfare of patients."
She's critical of decisions by the respective colleges of physicians and surgeons that allow a doctor to keep practising, especially in cases of repeat offenders. The status and power enjoyed by doctors can become "a barrier to holding doctors accountable for their behaviour."
"How many times do you have to show that you are either incompetent or you show poor judgment before they say, 'I don't think you should be a doctor?'" Robinson asked.
"If you have an abuse of power over a patient then you don't understand your basic professional obligations."
Regulatory bodies generally prohibit sexual or romantic relationships between doctors and patients, even when the physician believes there is consent from the patient.
In Ontario, for example, as in many other jurisdictions, a physician who becomes sexually involved with a patient is subject to a disciplinary action.
Not all colleges required to refer sex cases to police
Not all of Canada's medical colleges are required — or allowed under their province's Privacy Act — to refer disciplinary cases to police.
Manitoba's regulator said that it informs complainants that "they may make a report to police if they wish," while Saskatchewan says it provides patients information about how to do that.
The College of Physicians and Surgeons of Ontario started forwarding decisions to police last fall in cases where acts by doctors — including sexual abuse — are potentially criminal.
"I still believe myself and the other victims will never get justice at the college level," said Debra Dreise, who was abused by Toronto anesthesiologist Dr. George Doodnaught while under sedation in 2010.
Doodnaught was convicted of sexual assaults on 21 sedated patients, including Dreise, in November last year. He was sentenced to 10 years in prison, but he is currently appealing the convictions.
"Even after this man has been found guilty, he's been sentenced and now he is in jail, his licence is still only suspended, it hasn't been revoked, it hasn't been taken away," Dreise said. "We are going on now, almost six years. To me that's a disgrace."
"Revocation is a penalty that can be ordered after a hearing has made findings of professional misconduct or incompetence," Kathryn Clarke, senior communications co-ordinator at the College of Physicians and Surgeons of Ontario wrote in an email. "Dates will be scheduled after the appeal of his criminal convictions is determined."
The Federation of Medical Regulatory Authorities of Canada declined to be interviewed for this story, as did most individual regulatory authorities across the country.
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One who did, Ed Schollenberg, registrar with the College of Physicians and Surgeons of New Brunswick, said: "We have tended to have smaller and smaller number of serious matters.
"We publish every single one of the complaints in our newsletter," he added. "You don't necessarily have to have a trial or shoot them at sunrise to make the point.
"Our numbers have stayed very, very low," he said. "We think complaints should be preventable."
"It's our job to be curious and diligent, and if we have reasonable and probable cause to pursue a lead, we will," said Dr. Galt Wilson, senior deputy registrar with the British Columbia College of Physicians and Surgeons.
He explained that physicians are subject to progressive discipline like other professionals and organizations.
Discipline has to be "taken up a notch" in every repeat case of misconduct, Galt said, adding that the college's investigating committees will consider a doctor's past conduct in their decisions and that publicity is helpful in getting information to the public.
Dreise said she can't understand how colleges can justify giving doctors who act inappropriately with their patients a second chance.
"The colleges are very lenient and forgiving with that," she said. "No man, woman or child should ever go through an assault."
"Your licence should be taken away," she said. "You do not deserve the privilege of caring for people."
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The Federation of Medical Regulatory Authorities of Canada is the national voice of physician regulatory bodies across the country. While it declined a request for an interview, FMRAC surveyed its members on six questions and provided the results to CBC News.