Post by Mary on Dec 19, 2006 14:10:25 GMT -5
Dr. Michelle Tania Gaby Horonczyk
TORONTO
Allegation
It was alleged that Dr. Horonczyk committed professional misconduct, in that she engaged in conduct or an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Response to the Allegation
Dr. Horonczyk admitted to the allegation.
Evidence
An Agreed Statement of Facts established that Dr. Horonczyk has a practice in family medicine and that Mr. A became Dr. Horonczyk’s patient in or about June 2002. From approximately June 2002 to the end of December 2002, Dr. Horonczyk treated Mr. A at a clinic for, among other things, drug addiction or dependency. In approximately December 2002, Mr. A was arrested and incarcerated at a Detention Centre.
While incarcerated, Mr. A received methadone treatment from the Detention Centre physician. On or about December 23, 2002, Dr. Horonczyk wrote to the Detention Centre physician, identifying herself as “Mr. A’s regular methadone prescriber” and gave advice regarding appropriate doses.
Dr. Horonczyk wrote over 40 letters to Mr. A describing her feelings of attraction towards him, graphically detailing anticipated sexual acts between them, explicitly describing her sexual fantasies involving him and professing her love for him. These letters continued up until his release from the Detention Centre.
Mr. A was released from the Detention Centre on or about May 1, 2003. Following his release, he and Dr. Horonczyk commenced a physical sexual relationship. This sexual relationship continued until early 2004.
Dr. Horonczyk issued a methadone prescription to Mr. A dated April 28, 2003 for doses starting May 1, 2003 and ending May 4, 2003. She provided him with a further methadone prescription dated May 5, 2003 for one day. Dr. Horonczyk stated that this was a bridging prescription to avoid withdrawal.
After his release from the Detention Centre, Dr. Horonczyk arranged for the transfer of Mr. A’s methadone treatment from the clinic where he originally received methadone treatment from Dr. Horonczyk to the health centre where Dr. Horonczyk was then working. Mr. A did not receive his primary methadone treatment from Dr. Horonczyk at the health centre. Dr. Horonczyk provided episodic treatment to Mr. A on two occasions.
On January 10, 2004, Mr. A broke into Dr. Horonczyk’s apartment, assaulted and forcibly confined her, and repeatedly stabbed her live-in boyfriend when he arrived home. Mr. A was arrested and charged with numerous criminal offences including attempted murder, criminal negligence causing bodily harm, aggravated assault, assault with a weapon, break and enter, forcible confinement and uttering death threats.
In April 2005, Mr. A was convicted of a number of the charges, including aggravated assault, assault with a weapon, uttering death threats, breaking and entering, and forcible confinement. In June 2005, he was sentenced to five years in prison for these offences.
Finding
The Committee found that Dr. Horonczyk committed professional misconduct, in that she engaged in conduct or an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Reasons for Penalty
The Committee wishes to indicate to the public and the profession its extreme dismay and disappointment in the actions that brought Dr. Horonczyk to this hearing. The inappropriate behaviour in becoming involved in a sexual relationship with a very recently discharged patient and Dr. Horonczyk’s sexually explicit correspondence with Mr. A while he was incarcerated brings disrepute to the profession. The Committee is concerned with the lack of judgment displayed by Dr. Horonczyk as a newly licensed physician in entering into a sexual relationship with Mr. A, and after his release from prison when the doctor-patient relationship had supposedly been terminated, maneuvering the transfer of Mr. A’s records to the clinic in which she was working.
The Committee wishes to be satisfied about Dr. Horonczyk’s ability to resume practice at the end of her suspension. For this reason, a psychiatric evaluation was also ordered. This evaluation will protect the public and provide Dr. Horonczyk with the confidence to return to practice with a greater understanding of her role as a physician, and the balance of power between the doctor and patient.
Penalty
The Discipline Committee directed that:
* The Registrar suspend Dr. Horonczyk’s certificate of registration for a period of nine months, three months of which shall be suspended upon Dr. Horonczyk’s successful completion of the College’s Boundaries Course and the College’s Ethics Course, at her own expense.
* The Registrar impose the following terms, conditions and limitations on Dr. Horonczyk’s certificate of registration:
Dr. Horonczyk will have a practice monitor for a period of 18 months. The practice monitor must be another member of the College, approved by the College, and must meet with Dr. Horonczyk not less than once a month to review her records and discuss her care of patients and her professional behaviour, and must report to the College every three months, or sooner should he/she have any concerns about her professional behaviour or the care she is providing to patients;
Dr. Horonczyk may not prescribe methadone; and
Prior to Dr. Horonczyk’s return to practice, her treating psychiatrist shall provide a report to the College confirming Dr. Horonczyk’s readiness to return to practice.
the results of the proceeding to be included in the register.
At the completion of the hearing, Dr. Horonczyk waived her right to appeal.
Dr. Chinniah Krishnalingam
RICHMOND HILL
Allegation
It was alleged that Dr. Krishnalingam committed an act of professional misconduct, in that he engaged in conduct or an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Response to the Allegation
Dr. Krishnalingam entered a plea of no contest.
Evidence
An Agreed Statement of Facts established that during Patient A’s initial visit to Dr. Krishnalingam’s psychiatric practice, the doctor asked her questions regarding her sexual relationships with men. The questions made Patient A uncomfortable and were not necessary in order to address Patient A’s concerns.
Dr. Krishnalingam engaged in a brief hug with Patient A at the end of the second and third appointments.
During therapy sessions with Patient B, Dr. Krishnalingam held and caressed Patient B’s hands, which he intended as a supportive gesture. Dr. Krishnalingam acknowledged that holding Patient B’s hands made her feel uncomfortable and that it was unwarranted, unwanted and inappropriate.
At the end of her final appointment, Dr. Krishnalingam gave Patient B a brief hug.
Dr. Krishnalingam acknowledged that hugging Patient A and Patient B was unwanted, unwarranted and inappropriate.
Finding
Having regard to the uncontested facts, the Committee found that Dr. Krishnalingam committed professional misconduct, in that he engaged in conduct or an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Reasons for Penalty
Counsel for the College and counsel for Dr. Krishnalingam made a joint submission regarding penalty.
The Committee took into account, as mitigating factors, that Dr. Krishnalingam has no prior conviction at the College and, by entering a plea of no contest, Dr. Krishnalingam spared the complainants from having to testify and saved the costs of a longer hearing. The Committee noted that a longer suspension may have been appropriate, but for the fact that Dr. Krishnalingam voluntarily took a boundaries course after learning about the complaints.
The Committee concluded that the proposed penalty would adequately protect the public, uphold the honour and integrity of the profession and satisfy the principles of specific and general deterrence and rehabilitation of the member.
Penalty
The Discipline Committee directed that:
* The Registrar suspend Dr. Krishnalingam’s certificate of registration for a period of two months effective immediately.
* Dr. Krishnalingam appear before the panel to be reprimanded.
* Dr. Krishnalingam pay to the College costs in the amount of $4,750.
* The results of this proceeding to be included in the register.
At the completion of the hearing Dr. Krishnalingam waived his right to appeal and the reprimand was administered.
Dr. Young Min Lee
MARKHAM
On August 24, 2001, a panel of the Discipline Committee found that Dr. Young Min Lee has committed an act of professional misconduct, in that he sexually abused a patient.
On April 19, 2002, the Discipline Committee ordered that:
* Dr. Lee attend before it to be reprimanded and the fact of the reprimand be recorded on the register.
* The Registrar revoke Dr. Lee’s certificate of registration.
* Dr. Lee reimburse the College for funding for therapy and counselling provided to the patient;
* Dr. Lee post security acceptable to the College, as determined by the Registrar, to reimburse the College for the funding required under the program; and,
* Dr. Lee pay the costs of this hearing in the sum of $10,000.
Dr. Lee appealed the decision of the Discipline Committee to the Divisional Court, Superior Court of Justice. The Divisional Court allowed the appeal and ordered a new hearing before a different panel of the Discipline Committee and costs of the appeal to Dr. Lee in the amount of $7,500.
As a result, the College held a new hearing with a different panel. The following is a summary of that case.
Allegations
At the second hearing, it was alleged that Dr. Lee committed an act of professional misconduct, in that:
• he sexually abused a patient; and
• he committed an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded as disgraceful, dishonourable or unprofessional.
Response to the Allegations
Dr. Lee denied the allegations.
Evidence
Patient A
The allegations of sexual abuse and disgraceful, dishonourable or unprofessional conduct in this case arise from alleged conduct by Dr. Lee in relation to one patient, Patient A. Patient A was a patient of Dr. Lee from June 1994 until February 1996. She saw Dr. Lee for emotional and psychological care. During this process, she alleges that the sessions became more intimate with hugging becoming routine, an episode of sexual touching occurred during one visit and that, during two visits approximately three months apart, she performed fellatio on Dr. Lee at his instigation. She also alleges that he gave her an unsolicited gift on one occasion. She referred her children and her husband to see Dr. Lee before and during the interval between the alleged sexual events. She also saw a specialist, as well as a psychologist, during the time she saw Dr. Lee.
Dr. Lee
Dr. Lee testified that Patient A initiated the first hug. He testified that he did not see hugs as differing from handshakes, and it was in lieu of a handshake on departure. Dr. Lee testified that he was not concerned as to boundaries as he thought of the hugs as simply reassuring, and would participate if asked.
Dr. Lee denied that either of the incidents of alleged fellatio occurred.
He also denied the alleged episode of sexual touching as described by Patient A. Dr. Lee described an alternative scenario when Patient A was having a bad day due to the anniversary of her father’s death. He testified that he allowed her to hug him, and she collapsed over his body, making a moaning sound, not crying. As he supported her, she moved her hand from his shoulder to his back and lower part of body toward his groin area. He gently pushed her away. She took his hand and put it on her breast. He stated that he told her to stop and she did, saying, “I love you.” He stated that he ignored this episode as he thought it was caused by a “bad day.” There were no clinical notes concerning this episode in his charts and, under cross examination, he testified that he did not chart it. He stated that he no longer allowed hugs to occur after this episode.
Findings
Allegation of Sexual Abuse
The Committee found that the allegation of sexual abuse was not proved to the required standard.
In considering the evidence, the Committee was aware that the burden of proof rests with the College. This proof must be convincing and based upon clear and cogent evidence. The seriousness of the allegation is an element to be considered in determining where this balance lies.
The Committee believed that Patient A is of the belief that the events she described took place. She gave the preponderance of her testimony in a straightforward manner, but when questioned as to important details that appeared to be central to the story of the events, she became more vague and contradictory.
The Committee was of the opinion that this series of events lacked the ring of possibility. That she sent or continued to send her husband and children, including her daughter, as well as to see Dr. Lee alone in his office following the first alleged episode of fellatio, brought doubt to her story.
Allegation of disgraceful, dishonourable or unprofessional conduct
The Committee found that the allegations of disgraceful, dishonourable or unprofessional conduct was proved.
The Committee was not able to decide if the episode of sexual touching described differently by Patient A and Dr. Lee occurred in the way either described it. But, if the Committee were to believe that it occurred as described by Dr. Lee, then it would be absolutely expected that he would have dealt with it therapeutically and have made a chart notation of the event. To not deal with this issue is detrimental to the patient, and therefore unprofessional.
The Committee disagreed with Dr. Lee’s characterization of hugs as no different than handshakes or greetings in a psychotherapeutic relationship. As well, the conflicting testimony given at earlier hearings that it was also given on “compassionate grounds” would have the Committee believe that Dr. Lee was aware of its meaning beyond that of a purely disinterested greeting. This spoke to Dr. Lee’s lack of credulity in his testimony at this hearing.
Touch within the psychotherapeutic relationship always has meaning, and Dr. Lee knows, or should have known this, and to be unaware of this, or to attempt to pass it off as meaningless, is to the possible detriment of the patient and of the therapeutic relationship and, therefore, is unprofessional behaviour. The Committee is not making any statements on the appropriateness of hugs within the doctor–patient relationship, only that they be acknowledged, be understood as part of the transference-counter transference, and that they may well result in boundary issues that need to be clarified. None of this was done by Dr. Lee.
Reasons for Penalty
The Committee took into account as a key relevant factor the circumstances from the time the allegations came before this Committee. A hearing was held and a decision of sexual abuse was handed down on April 19, 2002, which resulted in the revocation of Dr. Lee’s certificate of registration. On August 26, 2003, the decision of the Discipline Committee was quashed on appeal to the Divisional Court and sent back for a new hearing. Dr. Lee did not become aware that his certificate of registration had to be reinstated until April 23, 2004, resulting in a two-year period where Dr. Lee was unable to practise.
Subsequently, as a condition of an adjournment leading to the evidentiary portion of the present hearing, Dr. Lee’s certificate of registration was subject to the conditions of having a female member of the College of Nurses of Ontario present when he examined female patients and the posting of an office sign concerning this restriction. Not knowing what the outcome of this hearing would be, Dr. Lee chose not to risk the difficulties and expense of recommencing his practice under the restrictions imposed. While this was Dr. Lee’s choice, it did result in a total period in excess of three years during which Dr. Lee did not practise.
Based on these unusual circumstances, the Committee was of the opinion that the suspension of the full period of the six-month suspension was justified. Dr. Lee is now entitled to practise without the requirement of having a female monitor present.
Penalty
The Discipline Committee directed that:
* The Registrar suspend Dr. Lee’s certificate of registration for a period of six months from the date of this order, the entire period of which shall be suspended.
* The following term, condition and limitation be imposed on Dr. Lee’s certificate of registration:
Dr. Lee must successfully complete the College’s course on boundary issues at his own expense within a period of six months of this order and that proof of successful completion be provided to the Registrar forthwith.
Dr. Lee is required to attend before the panel to be reprimanded.
* The results of this proceeding be included in the register.
At the completion of the hearing, Dr. Lee waived his right to appeal and the reprimand was administered.
Dr. Barbara Schogt
TORONTO
Allegation
It was alleged that Dr. Schogt committed an act of professional misconduct, in that she engaged in conduct or an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Response to the Allegation
Dr. Schogt admitted to the allegation.
Evidence
The Agreed Statement of Facts established that the patient was a psycho-therapy patient of Dr. Schogt’s from 1992 until 2001. In that period, the patient attended for regular appointments with Dr. Schogt, usually several times a week. In April 2001, Dr. Schogt and the patient terminated the physician-patient relationship.
Later in 2001, after the physician-patient relationship was terminated, Dr. Schogt and the patient began an intimate relationship.
Since that time, Dr. Schogt and the patient have lived together as a family, along with the patient’s child, for whom they have both assumed parental responsibility.
At no time has the patient complained to the College about Dr. Schogt or their relationship. This matter came to the College’s attention by way of mandatory reports.
Finding
The Committee found that Dr. Schogt committed an act of professional misconduct, in that she engaged in conduct or an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Reasons for Penalty
Counsel for the College and counsel for Dr. Schogt made a joint submission regarding penalty.
The Committee accepted that the lengthy suspension proposed in this case is sufficient to satisfy the principles of specific and general deterrence as well as protection of the public.
The Committee wishes unequivocally to express its condemnation of Dr. Schogt’s misconduct. Sexual relationships with prior psychotherapy patients are totally unacceptable. Dr. Schogt knew, or ought to have known, the absolute prohibition against entering into such a relationship. As a psychiatrist, she should be even more aware of the necessity to maintain boundaries with vulnerable patients.
Penalty
The Discipline Committee directed that:
* The Registrar suspend Dr. Schogt’s certificate of registration for a period of nine months commencing immediately;
* The Registrar suspend Dr. Schogt’s certificate of registration for a further three months, to be suspended upon Dr. Schogt successfully completing College-approved courses in boundaries and ethics;
* Dr. Schogt attend before the panel to be reprimanded, with the fact of the reprimand to be recorded on the register; and;
* The results of this proceeding be included in the register.
At the completion of the hearing, Dr. Schogt waived her right to appeal and the reprimand was administered.
Dr. Sean Michael McHugh
TORONTO
Dr. Sean Michael McHugh made an application to the College of Physicians and Surgeons of Ontario for reinstatement of his certificate of registration. Dr. McHugh’s certificate was revoked in 2000 when he admitted to sexual abuse of a patient.
The College did not contest the application, subject to the imposition of specified terms and conditions.
Based on the evidence before the Committee, and all of the circumstances of this case, the Committee concluded that Dr. McHugh had satisfied the burden of demonstrating to the satisfaction of the Committee that he could safely be returned to the practice of medicine, subject to the imposition of specified terms, conditions and limitations on his certificate of registration, as proposed by the parties. The Committee concluded that the proposed terms and conditions provide a careful and safe framework for Dr. McHugh’s re-entry to practice in a supervised manner.
It is notable that the proposed terms, conditions and limitations were largely agreed upon by both the College and Dr. McHugh. From the Committee’s perspective, the terms and conditions provide safeguards to ensure that Dr. McHugh is appropriately supported, monitored and assessed in his practice, and treated for his condition. They also provide the Registrar with authority to intervene if any problems arise. The Committee concluded that these terms and conditions were appropriate in all the circumstances.
Order
The Committee therefore directed the Registrar to issue a certificate of registration to the applicant, Dr. McHugh, subject to the following terms, conditions and limitations:
* Dr. McHugh will limit his practice to clinical settings that are either team-based or in which other physicians also practice. In non-team based setting, there shall be either a physician or an administrative staff person in the same office setting while Dr. McHugh sees patients;
* Dr. McHugh will cause workplace monitor(s) acceptable to the College, in each setting in which he practices, to execute an undertaking, prior to commencing work in any such setting;
* At least once per month, Dr. McHugh shall see a psychiatrist who is acceptable to the College, for treatment as required. Dr. McHugh shall comply with all treatment recommendations of his psychiatrist;
* Dr. McHugh shall cause his treating psychiatrist to execute an undertaking, within 30 days of the date of the Order;
* If a person who has given an undertaking in the form of a Schedule to the Order is unable or unwilling to continue to fulfill its terms, Dr. McHugh shall, within 30 days, obtain an undertaking in the same form from a similarly qualified person who is acceptable to the College;
* If any of the reports of the workplace monitor(s) or psychiatrist are not delivered or are unsatisfactory to the College, the Registrar may suspend Dr. McHugh’s certificate of registration;
* Dr. McHugh shall undergo and successfully complete to the satisfaction of the College an assessment under the direction of the College in each of his practice settings within 12 months of his return to practice. The assessment will be at Dr. McHugh’s expense and may include, among other things, an observation component, consultation with his workplace monitor(s) and his treating psychiatrist, and a chart review. Dr. McHugh shall comply with any recommendations of the College that result from the assessment;
* In the event that Dr. McHugh is unsuccessful in the completion of the assessment or in complying with any recommendations that result from the assessment as determined by the College, the Registrar may suspend Dr. McHugh’s certificate of registration until he successfully completes the assessment or complies with the recommendations;
* • Dr. McHugh shall pay to the College $2,750 to satisfy an outstanding costs order. Such amount shall be paid within six months of the date of this Order; and;
* • Dr. McHugh shall not apply to vary any of the terms of this Order until at least two years have passed from the date of this Order.
TORONTO
Allegation
It was alleged that Dr. Horonczyk committed professional misconduct, in that she engaged in conduct or an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Response to the Allegation
Dr. Horonczyk admitted to the allegation.
Evidence
An Agreed Statement of Facts established that Dr. Horonczyk has a practice in family medicine and that Mr. A became Dr. Horonczyk’s patient in or about June 2002. From approximately June 2002 to the end of December 2002, Dr. Horonczyk treated Mr. A at a clinic for, among other things, drug addiction or dependency. In approximately December 2002, Mr. A was arrested and incarcerated at a Detention Centre.
While incarcerated, Mr. A received methadone treatment from the Detention Centre physician. On or about December 23, 2002, Dr. Horonczyk wrote to the Detention Centre physician, identifying herself as “Mr. A’s regular methadone prescriber” and gave advice regarding appropriate doses.
Dr. Horonczyk wrote over 40 letters to Mr. A describing her feelings of attraction towards him, graphically detailing anticipated sexual acts between them, explicitly describing her sexual fantasies involving him and professing her love for him. These letters continued up until his release from the Detention Centre.
Mr. A was released from the Detention Centre on or about May 1, 2003. Following his release, he and Dr. Horonczyk commenced a physical sexual relationship. This sexual relationship continued until early 2004.
Dr. Horonczyk issued a methadone prescription to Mr. A dated April 28, 2003 for doses starting May 1, 2003 and ending May 4, 2003. She provided him with a further methadone prescription dated May 5, 2003 for one day. Dr. Horonczyk stated that this was a bridging prescription to avoid withdrawal.
After his release from the Detention Centre, Dr. Horonczyk arranged for the transfer of Mr. A’s methadone treatment from the clinic where he originally received methadone treatment from Dr. Horonczyk to the health centre where Dr. Horonczyk was then working. Mr. A did not receive his primary methadone treatment from Dr. Horonczyk at the health centre. Dr. Horonczyk provided episodic treatment to Mr. A on two occasions.
On January 10, 2004, Mr. A broke into Dr. Horonczyk’s apartment, assaulted and forcibly confined her, and repeatedly stabbed her live-in boyfriend when he arrived home. Mr. A was arrested and charged with numerous criminal offences including attempted murder, criminal negligence causing bodily harm, aggravated assault, assault with a weapon, break and enter, forcible confinement and uttering death threats.
In April 2005, Mr. A was convicted of a number of the charges, including aggravated assault, assault with a weapon, uttering death threats, breaking and entering, and forcible confinement. In June 2005, he was sentenced to five years in prison for these offences.
Finding
The Committee found that Dr. Horonczyk committed professional misconduct, in that she engaged in conduct or an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Reasons for Penalty
The Committee wishes to indicate to the public and the profession its extreme dismay and disappointment in the actions that brought Dr. Horonczyk to this hearing. The inappropriate behaviour in becoming involved in a sexual relationship with a very recently discharged patient and Dr. Horonczyk’s sexually explicit correspondence with Mr. A while he was incarcerated brings disrepute to the profession. The Committee is concerned with the lack of judgment displayed by Dr. Horonczyk as a newly licensed physician in entering into a sexual relationship with Mr. A, and after his release from prison when the doctor-patient relationship had supposedly been terminated, maneuvering the transfer of Mr. A’s records to the clinic in which she was working.
The Committee wishes to be satisfied about Dr. Horonczyk’s ability to resume practice at the end of her suspension. For this reason, a psychiatric evaluation was also ordered. This evaluation will protect the public and provide Dr. Horonczyk with the confidence to return to practice with a greater understanding of her role as a physician, and the balance of power between the doctor and patient.
Penalty
The Discipline Committee directed that:
* The Registrar suspend Dr. Horonczyk’s certificate of registration for a period of nine months, three months of which shall be suspended upon Dr. Horonczyk’s successful completion of the College’s Boundaries Course and the College’s Ethics Course, at her own expense.
* The Registrar impose the following terms, conditions and limitations on Dr. Horonczyk’s certificate of registration:
Dr. Horonczyk will have a practice monitor for a period of 18 months. The practice monitor must be another member of the College, approved by the College, and must meet with Dr. Horonczyk not less than once a month to review her records and discuss her care of patients and her professional behaviour, and must report to the College every three months, or sooner should he/she have any concerns about her professional behaviour or the care she is providing to patients;
Dr. Horonczyk may not prescribe methadone; and
Prior to Dr. Horonczyk’s return to practice, her treating psychiatrist shall provide a report to the College confirming Dr. Horonczyk’s readiness to return to practice.
the results of the proceeding to be included in the register.
At the completion of the hearing, Dr. Horonczyk waived her right to appeal.
Dr. Chinniah Krishnalingam
RICHMOND HILL
Allegation
It was alleged that Dr. Krishnalingam committed an act of professional misconduct, in that he engaged in conduct or an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Response to the Allegation
Dr. Krishnalingam entered a plea of no contest.
Evidence
An Agreed Statement of Facts established that during Patient A’s initial visit to Dr. Krishnalingam’s psychiatric practice, the doctor asked her questions regarding her sexual relationships with men. The questions made Patient A uncomfortable and were not necessary in order to address Patient A’s concerns.
Dr. Krishnalingam engaged in a brief hug with Patient A at the end of the second and third appointments.
During therapy sessions with Patient B, Dr. Krishnalingam held and caressed Patient B’s hands, which he intended as a supportive gesture. Dr. Krishnalingam acknowledged that holding Patient B’s hands made her feel uncomfortable and that it was unwarranted, unwanted and inappropriate.
At the end of her final appointment, Dr. Krishnalingam gave Patient B a brief hug.
Dr. Krishnalingam acknowledged that hugging Patient A and Patient B was unwanted, unwarranted and inappropriate.
Finding
Having regard to the uncontested facts, the Committee found that Dr. Krishnalingam committed professional misconduct, in that he engaged in conduct or an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Reasons for Penalty
Counsel for the College and counsel for Dr. Krishnalingam made a joint submission regarding penalty.
The Committee took into account, as mitigating factors, that Dr. Krishnalingam has no prior conviction at the College and, by entering a plea of no contest, Dr. Krishnalingam spared the complainants from having to testify and saved the costs of a longer hearing. The Committee noted that a longer suspension may have been appropriate, but for the fact that Dr. Krishnalingam voluntarily took a boundaries course after learning about the complaints.
The Committee concluded that the proposed penalty would adequately protect the public, uphold the honour and integrity of the profession and satisfy the principles of specific and general deterrence and rehabilitation of the member.
Penalty
The Discipline Committee directed that:
* The Registrar suspend Dr. Krishnalingam’s certificate of registration for a period of two months effective immediately.
* Dr. Krishnalingam appear before the panel to be reprimanded.
* Dr. Krishnalingam pay to the College costs in the amount of $4,750.
* The results of this proceeding to be included in the register.
At the completion of the hearing Dr. Krishnalingam waived his right to appeal and the reprimand was administered.
Dr. Young Min Lee
MARKHAM
On August 24, 2001, a panel of the Discipline Committee found that Dr. Young Min Lee has committed an act of professional misconduct, in that he sexually abused a patient.
On April 19, 2002, the Discipline Committee ordered that:
* Dr. Lee attend before it to be reprimanded and the fact of the reprimand be recorded on the register.
* The Registrar revoke Dr. Lee’s certificate of registration.
* Dr. Lee reimburse the College for funding for therapy and counselling provided to the patient;
* Dr. Lee post security acceptable to the College, as determined by the Registrar, to reimburse the College for the funding required under the program; and,
* Dr. Lee pay the costs of this hearing in the sum of $10,000.
Dr. Lee appealed the decision of the Discipline Committee to the Divisional Court, Superior Court of Justice. The Divisional Court allowed the appeal and ordered a new hearing before a different panel of the Discipline Committee and costs of the appeal to Dr. Lee in the amount of $7,500.
As a result, the College held a new hearing with a different panel. The following is a summary of that case.
Allegations
At the second hearing, it was alleged that Dr. Lee committed an act of professional misconduct, in that:
• he sexually abused a patient; and
• he committed an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded as disgraceful, dishonourable or unprofessional.
Response to the Allegations
Dr. Lee denied the allegations.
Evidence
Patient A
The allegations of sexual abuse and disgraceful, dishonourable or unprofessional conduct in this case arise from alleged conduct by Dr. Lee in relation to one patient, Patient A. Patient A was a patient of Dr. Lee from June 1994 until February 1996. She saw Dr. Lee for emotional and psychological care. During this process, she alleges that the sessions became more intimate with hugging becoming routine, an episode of sexual touching occurred during one visit and that, during two visits approximately three months apart, she performed fellatio on Dr. Lee at his instigation. She also alleges that he gave her an unsolicited gift on one occasion. She referred her children and her husband to see Dr. Lee before and during the interval between the alleged sexual events. She also saw a specialist, as well as a psychologist, during the time she saw Dr. Lee.
Dr. Lee
Dr. Lee testified that Patient A initiated the first hug. He testified that he did not see hugs as differing from handshakes, and it was in lieu of a handshake on departure. Dr. Lee testified that he was not concerned as to boundaries as he thought of the hugs as simply reassuring, and would participate if asked.
Dr. Lee denied that either of the incidents of alleged fellatio occurred.
He also denied the alleged episode of sexual touching as described by Patient A. Dr. Lee described an alternative scenario when Patient A was having a bad day due to the anniversary of her father’s death. He testified that he allowed her to hug him, and she collapsed over his body, making a moaning sound, not crying. As he supported her, she moved her hand from his shoulder to his back and lower part of body toward his groin area. He gently pushed her away. She took his hand and put it on her breast. He stated that he told her to stop and she did, saying, “I love you.” He stated that he ignored this episode as he thought it was caused by a “bad day.” There were no clinical notes concerning this episode in his charts and, under cross examination, he testified that he did not chart it. He stated that he no longer allowed hugs to occur after this episode.
Findings
Allegation of Sexual Abuse
The Committee found that the allegation of sexual abuse was not proved to the required standard.
In considering the evidence, the Committee was aware that the burden of proof rests with the College. This proof must be convincing and based upon clear and cogent evidence. The seriousness of the allegation is an element to be considered in determining where this balance lies.
The Committee believed that Patient A is of the belief that the events she described took place. She gave the preponderance of her testimony in a straightforward manner, but when questioned as to important details that appeared to be central to the story of the events, she became more vague and contradictory.
The Committee was of the opinion that this series of events lacked the ring of possibility. That she sent or continued to send her husband and children, including her daughter, as well as to see Dr. Lee alone in his office following the first alleged episode of fellatio, brought doubt to her story.
Allegation of disgraceful, dishonourable or unprofessional conduct
The Committee found that the allegations of disgraceful, dishonourable or unprofessional conduct was proved.
The Committee was not able to decide if the episode of sexual touching described differently by Patient A and Dr. Lee occurred in the way either described it. But, if the Committee were to believe that it occurred as described by Dr. Lee, then it would be absolutely expected that he would have dealt with it therapeutically and have made a chart notation of the event. To not deal with this issue is detrimental to the patient, and therefore unprofessional.
The Committee disagreed with Dr. Lee’s characterization of hugs as no different than handshakes or greetings in a psychotherapeutic relationship. As well, the conflicting testimony given at earlier hearings that it was also given on “compassionate grounds” would have the Committee believe that Dr. Lee was aware of its meaning beyond that of a purely disinterested greeting. This spoke to Dr. Lee’s lack of credulity in his testimony at this hearing.
Touch within the psychotherapeutic relationship always has meaning, and Dr. Lee knows, or should have known this, and to be unaware of this, or to attempt to pass it off as meaningless, is to the possible detriment of the patient and of the therapeutic relationship and, therefore, is unprofessional behaviour. The Committee is not making any statements on the appropriateness of hugs within the doctor–patient relationship, only that they be acknowledged, be understood as part of the transference-counter transference, and that they may well result in boundary issues that need to be clarified. None of this was done by Dr. Lee.
Reasons for Penalty
The Committee took into account as a key relevant factor the circumstances from the time the allegations came before this Committee. A hearing was held and a decision of sexual abuse was handed down on April 19, 2002, which resulted in the revocation of Dr. Lee’s certificate of registration. On August 26, 2003, the decision of the Discipline Committee was quashed on appeal to the Divisional Court and sent back for a new hearing. Dr. Lee did not become aware that his certificate of registration had to be reinstated until April 23, 2004, resulting in a two-year period where Dr. Lee was unable to practise.
Subsequently, as a condition of an adjournment leading to the evidentiary portion of the present hearing, Dr. Lee’s certificate of registration was subject to the conditions of having a female member of the College of Nurses of Ontario present when he examined female patients and the posting of an office sign concerning this restriction. Not knowing what the outcome of this hearing would be, Dr. Lee chose not to risk the difficulties and expense of recommencing his practice under the restrictions imposed. While this was Dr. Lee’s choice, it did result in a total period in excess of three years during which Dr. Lee did not practise.
Based on these unusual circumstances, the Committee was of the opinion that the suspension of the full period of the six-month suspension was justified. Dr. Lee is now entitled to practise without the requirement of having a female monitor present.
Penalty
The Discipline Committee directed that:
* The Registrar suspend Dr. Lee’s certificate of registration for a period of six months from the date of this order, the entire period of which shall be suspended.
* The following term, condition and limitation be imposed on Dr. Lee’s certificate of registration:
Dr. Lee must successfully complete the College’s course on boundary issues at his own expense within a period of six months of this order and that proof of successful completion be provided to the Registrar forthwith.
Dr. Lee is required to attend before the panel to be reprimanded.
* The results of this proceeding be included in the register.
At the completion of the hearing, Dr. Lee waived his right to appeal and the reprimand was administered.
Dr. Barbara Schogt
TORONTO
Allegation
It was alleged that Dr. Schogt committed an act of professional misconduct, in that she engaged in conduct or an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Response to the Allegation
Dr. Schogt admitted to the allegation.
Evidence
The Agreed Statement of Facts established that the patient was a psycho-therapy patient of Dr. Schogt’s from 1992 until 2001. In that period, the patient attended for regular appointments with Dr. Schogt, usually several times a week. In April 2001, Dr. Schogt and the patient terminated the physician-patient relationship.
Later in 2001, after the physician-patient relationship was terminated, Dr. Schogt and the patient began an intimate relationship.
Since that time, Dr. Schogt and the patient have lived together as a family, along with the patient’s child, for whom they have both assumed parental responsibility.
At no time has the patient complained to the College about Dr. Schogt or their relationship. This matter came to the College’s attention by way of mandatory reports.
Finding
The Committee found that Dr. Schogt committed an act of professional misconduct, in that she engaged in conduct or an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Reasons for Penalty
Counsel for the College and counsel for Dr. Schogt made a joint submission regarding penalty.
The Committee accepted that the lengthy suspension proposed in this case is sufficient to satisfy the principles of specific and general deterrence as well as protection of the public.
The Committee wishes unequivocally to express its condemnation of Dr. Schogt’s misconduct. Sexual relationships with prior psychotherapy patients are totally unacceptable. Dr. Schogt knew, or ought to have known, the absolute prohibition against entering into such a relationship. As a psychiatrist, she should be even more aware of the necessity to maintain boundaries with vulnerable patients.
Penalty
The Discipline Committee directed that:
* The Registrar suspend Dr. Schogt’s certificate of registration for a period of nine months commencing immediately;
* The Registrar suspend Dr. Schogt’s certificate of registration for a further three months, to be suspended upon Dr. Schogt successfully completing College-approved courses in boundaries and ethics;
* Dr. Schogt attend before the panel to be reprimanded, with the fact of the reprimand to be recorded on the register; and;
* The results of this proceeding be included in the register.
At the completion of the hearing, Dr. Schogt waived her right to appeal and the reprimand was administered.
Dr. Sean Michael McHugh
TORONTO
Dr. Sean Michael McHugh made an application to the College of Physicians and Surgeons of Ontario for reinstatement of his certificate of registration. Dr. McHugh’s certificate was revoked in 2000 when he admitted to sexual abuse of a patient.
The College did not contest the application, subject to the imposition of specified terms and conditions.
Based on the evidence before the Committee, and all of the circumstances of this case, the Committee concluded that Dr. McHugh had satisfied the burden of demonstrating to the satisfaction of the Committee that he could safely be returned to the practice of medicine, subject to the imposition of specified terms, conditions and limitations on his certificate of registration, as proposed by the parties. The Committee concluded that the proposed terms and conditions provide a careful and safe framework for Dr. McHugh’s re-entry to practice in a supervised manner.
It is notable that the proposed terms, conditions and limitations were largely agreed upon by both the College and Dr. McHugh. From the Committee’s perspective, the terms and conditions provide safeguards to ensure that Dr. McHugh is appropriately supported, monitored and assessed in his practice, and treated for his condition. They also provide the Registrar with authority to intervene if any problems arise. The Committee concluded that these terms and conditions were appropriate in all the circumstances.
Order
The Committee therefore directed the Registrar to issue a certificate of registration to the applicant, Dr. McHugh, subject to the following terms, conditions and limitations:
* Dr. McHugh will limit his practice to clinical settings that are either team-based or in which other physicians also practice. In non-team based setting, there shall be either a physician or an administrative staff person in the same office setting while Dr. McHugh sees patients;
* Dr. McHugh will cause workplace monitor(s) acceptable to the College, in each setting in which he practices, to execute an undertaking, prior to commencing work in any such setting;
* At least once per month, Dr. McHugh shall see a psychiatrist who is acceptable to the College, for treatment as required. Dr. McHugh shall comply with all treatment recommendations of his psychiatrist;
* Dr. McHugh shall cause his treating psychiatrist to execute an undertaking, within 30 days of the date of the Order;
* If a person who has given an undertaking in the form of a Schedule to the Order is unable or unwilling to continue to fulfill its terms, Dr. McHugh shall, within 30 days, obtain an undertaking in the same form from a similarly qualified person who is acceptable to the College;
* If any of the reports of the workplace monitor(s) or psychiatrist are not delivered or are unsatisfactory to the College, the Registrar may suspend Dr. McHugh’s certificate of registration;
* Dr. McHugh shall undergo and successfully complete to the satisfaction of the College an assessment under the direction of the College in each of his practice settings within 12 months of his return to practice. The assessment will be at Dr. McHugh’s expense and may include, among other things, an observation component, consultation with his workplace monitor(s) and his treating psychiatrist, and a chart review. Dr. McHugh shall comply with any recommendations of the College that result from the assessment;
* In the event that Dr. McHugh is unsuccessful in the completion of the assessment or in complying with any recommendations that result from the assessment as determined by the College, the Registrar may suspend Dr. McHugh’s certificate of registration until he successfully completes the assessment or complies with the recommendations;
* • Dr. McHugh shall pay to the College $2,750 to satisfy an outstanding costs order. Such amount shall be paid within six months of the date of this Order; and;
* • Dr. McHugh shall not apply to vary any of the terms of this Order until at least two years have passed from the date of this Order.