Frank, Cathy Sheila (CPSO#: 71131)

Current Status: Suspended as of 26 Feb 2018

CPSO Registration Class: Restricted as of 19 Jan 2009

Indicates a concern or additional information

Summary

Former Name: No Former Name

Gender: Female

Languages Spoken: English

Education:McMaster University, 1997

Practice Information

Primary Location of Practice
Practice Address Not Available

Specialties

Specialty Issued On Type
Obstetrics and Gynecology Effective: 30 Jun 2002 RCPSC Specialist

Postgraduate Training

Please note: This information may not be a complete record of postgraduate training.

The University of Western Ontario, 01 Jul 1997 to 30 Jun 1998
PostGrad Yr 1 - Obstetrics and Gynecology

The University of Western Ontario, 01 Jul 1998 to 30 Jun 1999
PostGrad Yr 2 - Obstetrics and Gynecology

The University of Western Ontario, 01 Jul 1999 to 30 Jun 2000
PostGrad Yr 3 - Obstetrics and Gynecology

The University of Western Ontario, 01 Jul 2000 to 30 Jun 2001
PostGrad Yr 4 - Obstetrics and Gynecology

The University of Western Ontario, 01 Jul 2001 to 30 Jun 2002
PostGrad Yr 5 - Obstetrics and Gynecology

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 01 Jul 1997
Transfer of class of registration to: Independent Practice Certificate Effective: 30 Jun 2002
Transfer of class of certificate to: Restricted certificate Effective: 19 Jan 2009
Terms and conditions amended by Discipline Committee Effective: 26 Feb 2018
Terms and conditions amended by Discipline Committee Effective: 26 Feb 2018

Practice Restrictions

Registration Status: Suspended     Effective From: 26 Feb 2018


Imposed By Effective Date Expiry Date Status
Discipline Committee Effective: 27 Feb 2018 Active

Previous Hearings

Committee: Discipline
Decision Date: 26 Feb 2018
Summary:

On February 26, 2018, the Discipline Committee found that Dr. Cathy Frank committed an act of 
professional misconduct, in that she has failed to maintain the standard of practice of the profession. 
The Committee also found that Dr. Frank was incompetent in her professional care of 24 patients. 
 
Dr. Frank is an obstetrician and gynecologist who received her certificate of registration authorizing 
independent practice from the College of Physicians and Surgeons of Ontario (“the College”) in June 
2002. At the relevant time, she practised in St. Thomas and/or London.  
  
Between 2009 and 2012, more than 30 patients filed complaints with the College regarding their 
treatment by Dr. Frank. Investigations into the patient complaints revealed that Dr. Frank had failed to 
maintain the standard of practice of the profession in the care and treatment of patients and 
demonstrated a lack of knowledge amounting to incompetence in the following respects: 
 
  -  failing to adequately investigate causes of patients’ symptoms prior to deciding on surgical 
     management; 
  -  failing to obtain informed consent before performing surgeries or procedures; 
  -  failing to adequately document informed consent discussions and the manner in which she 
     conducted gynecological surgeries; 
  -  performing surgeries and procedures in a manner inconsistent with the standards of practice of 
     the profession; and 
  -  failing to adequately monitor and assess post-operative patients, including those exhibiting 
     symptoms of complications. 
                
Patient A  
 
Patient A was referred to Dr. Frank for heavy menstrual bleeding in 2003. Dr. Frank offered Patient A 
an ablation or a laparoscopically assisted vaginal hysterectomy ("LAVH"). Patient A initially chose an 
ablation but changed her mind to an LAVH. Dr. Frank performed the LAVH. 
 
Prior to proceeding with an LAVH, and in breach of the standard of practice, Dr. Frank failed to 
complete necessary investigations to diagnose dysfunctional uterine bleeding, such as ordering an 
ultrasound and blood work. Dr. Frank failed to record any discussion of any options other than ablation 
and LAVH or any discussion of specific risks of the surgical options in Patient A’s medical record, 
contrary to the standards of practice. Patient A does not recall any such discussion. 
       
Following the surgery, Dr. Frank failed to adequately address Patient A’s follow-up care needs, in 
breach of the standards of practice. She allowed Patient A to be discharged without an examination, 
despite a hemoglobin reading that had dropped significantly, and a description by the nurse of Patient 
A as being pale, bruised and diaphoretic. While documenting that this was due to the patient’s desire to 
leave, she did not document that this was against medical advice. Dr. Frank also failed to adequately 
document the assessments of Patient A upon her re-attendance twice to the hospital. Patient A was 
readmitted by her family physician on her third attendance and seen by a different gynecologist. 
Patient A ultimately was found to have internal bleeding with a large pelvic hematoma, bruising of her 
lower abdomen, and vault cellulitis, which were caused by the LAVH. 
 
 
 
 
Patient B  
 
Patient B saw Dr. Frank in 2007 on referral for cystocele and vaginal vault prolapses from a urologist. 
Dr. Frank offered a posterior repair and possible Nichol's sling. Dr. Frank's record failed to reflect any 
discussion of alternative options or of any specific risks for the patient in undergoing the procedures, 
in breach of the standards of practice. 
 
Dr. Frank attempted the surgical procedures, but was not able to complete all of the intended repairs so 
she discontinued the procedure. Patient B's prolapse returned and Dr. Frank then referred her to a 
urogynecologist for ongoing management. The College did not allege that Dr. Frank’s performance of 
the surgery or referral to a urogynecologist after the surgery failed to meet the standard of practice of 
the profession.  
 
Patient C  
 
Patient C was referred to Dr. Frank for dysmenorrhea. Dr. Frank obtained an ultrasound, which was 
unremarkable. Patient C was then booked for an LAVH, which Dr. Frank performed. Dr. Frank failed 
to adequately investigate the possible causes of menorrhagia and dysmenorrhea before booking Patient 
C for an LAVH. She did not record eliciting a history of pelvic pain, did not check TSH (though 
Patient C had known hypothyroidism on replacement), did not perform an endometrial biopsy or a pap 
test, and did not evaluate uterine size and mobility.  
 
Patient C’s tolerance for surgical risk from the LAVH was very low because her child was scheduled 
for surgery four days after her own surgery. Dr. Frank failed to record having discussed with Patient C 
any specific risks of the LAVH. It was Patient C’s recollection that Dr. Frank advised her that she 
would be well enough to accompany her child to surgery in four days and that the LAVH was a simple 
operation. 
 
Following the LAVH, Patient C experienced low blood pressure, requiring a fluid bolus, and a 
significant drop in hemoglobin. There is no evidence in the record that Patient C was assessed by a 
physician, but she was nonetheless discharged from hospital. Patient C returned to another hospital 
some days later and was ultimately diagnosed with a hematoma and underwent subsequent surgery. 
Dr. Frank's failure to monitor for, identify and treat Patient C's complication represents a failure to 
adequately follow up on her patient post-operatively in breach of the standard of practice. 
 
Patient D  
 
Dr. Frank managed Patient D's pregnancy after 32 weeks' gestation. According to Patient D, when she 
saw Dr. Frank at 34 weeks' gestation, she reported decreased fetal movement. Dr. Frank recorded that 
there was fetal movement, but there was no documentation in Dr. Frank's record about kick counting 
(to measure fetal movement) nor of advising the patient to go to hospital triage to have the baby 
assessed if there was decreased fetal movement. This lack of documentation breached the standard of 
practice.  
       
At 35 weeks, Patient D presented to the emergency department and found the fetus was deceased.  
Patient D was then booked for an induction of labour. Dr. Frank ordered 800 mcg of Misoprostol every 
four hours, which was an inappropriately high dose for induction of a term 35 week pregnancy and in 
breach of the standard of practice.  Dr. Frank also failed to obtain Patient D’s informed consent to her 
off-label use of Misoprostol in breach of the standard of practice.  
 
Patient E 
 
Patient E saw Dr. Frank in 2005 for pain associated with ovarian cysts and a family history of ovarian 
cancer. Dr. Frank conducted a laparoscopic right salpingo-oophorectomy and left ovarian resection.  
       
When Patient E was later reassessed by Dr. Frank post-operatively, Patient E was complaining of pain. 
An ultrasound was done and revealed a 9cm left adnexal mass. Dr. Frank recommended to Patient E 
that this mass be removed in its entirety by way of laparotomy.  Dr. Frank failed to document any 
other options for treatment or management offered to the patient and failed to document the specific 
risks of the laparotomy, in breach of the standards of practice.  
 
Patient F 
 
Patient F was referred to Dr. Frank by her family physician for irregular periods and consideration of 
an endometrial ablation. Dr. Frank saw Patient F in April 2009 and scheduled her for an endometrial 
ablation, which she performed in May. Dr. Frank failed to perform the required investigations (for 
example, blood work and ultrasound) to determine the cause of the irregular periods before proceeding 
with an endometrial ablation. 
 
Patient G  
 
Patient G saw Dr. Frank in September 2006 for severe abdominal pain. The pain was somewhat, 
although not completely, cyclical, and thus should have been investigated as potentially chronic pelvic 
pain via a multidisciplinary approach. An ultrasound was done and was normal.  Dr. Frank offered the 
patient an LAVH. Dr. Frank failed to investigate and propose a cause of Patient G's pain before 
proceeding with an LAVH, in breach of the standard of practice. Dr. Frank's record failed to reflect 
having offered Patient G any non-surgical treatments. The LAVH was performed in November  2006, 
but did not resolve Patient G's pain. 
 
Patient H 
 
Dr. Frank, the on-call physician, attended to Patient H when she was admitted to hospital in labour in 
2008. During the second stage of labour, while pushing, a fetal bradycardia occurred. As a result, Dr. 
Frank performed a forceps delivery with midline episiotomy. Dr. Frank failed to document obtaining 
consent for either procedure and the patient states that no informed consent discussion took place.  
 
When Dr. Frank repaired the midline episiotomy, she failed to note a fourth degree laceration.  Patient 
H was required to return and undergo a primary repair of the fourth degree laceration procedure seven 
days later. Dr. Frank fell below the standard of practice by failing to identify the fourth degree tear at 
the time of her repair of the episiotomy immediately after delivery. 
 
 
 
 
 
Patient I  
 
Patient I saw Dr. Frank in 2009 for problems regarding menorrhagia and a prior laparotomy for a 
ruptured ovarian cyst that had become infected. Dr. Frank failed to complete necessary steps to 
identify the cause of Patient I’s symptoms before scheduling Patient I for an LAVH.  
 
Dr. Frank performed the LAVH. She documented in the operative report that Patient I's right ovary 
looked abnormal and that she removed it. This was Patient I's only ovary (as her other ovary had been 
previously removed in another surgery). The removal of Patient I's ovary was not discussed with 
Patient I before the surgery, nor with any family member during the surgery. Dr. Frank's failure to 
discuss the removal of the ovary with Patient I meant that Patient I had no opportunity to consent to a 
procedure that rendered her prematurely menopausal.  
 
Patient I only became aware that her ovary had been removed when she reviewed her medical records 
several years later. Dr. Frank failed to meet the standard of practice by failing to obtain informed 
consent for the removal of Patient I's ovary. 
 
Patient J 
 
Patient J saw Dr. Frank in April 2005 regarding an ultrasound that revealed a fibroid in her uterus. She 
was asymptomatic at that time and did not want any treatment. She saw Dr. Frank again in January 
2006 on referral from her family physician as her fibroid was increasing in size.  
 
In her reporting letter to the referring physician, Dr. Frank documented having discussed with Patient J 
the possibility of complications of an increasing fibroid including the remote possibility of cancer. She 
only documented discussing two options for treatment of the fibroid: embolization and an LAVH. Dr. 
Frank failed to document discussion of other non-invasive treatment options. Patient J proceeded with 
an LAVH due to her misunderstanding of the degree to which cancer was a risk and her lack of 
understanding of other treatment options. 
 
Patient K  
 
Patient K initially saw Dr. Frank in October 2003 for pain associated with fibroids. Dr. Frank 
performed a diagnostic laparoscopy in January 2004.  Patient K was later re-referred and seen by Dr. 
Frank in January 2007 for heavy menses and a large uterine fibroid. Dr. Frank's record reflects only 
having offered Patient K an LAVH to address the fibroid.  Dr. Frank’s medical record fails to reflect 
any discussion of non-surgical options or of any specific risks of an LAVH for Patient K, even though 
she had increased risk due to the fibroid and two previous caesarean sections, contrary to the standards 
of practice. Dr. Frank also failed to perform an investigative step necessary to rule out cancer, namely 
an endometrial biopsy in advance of the LAVH.  
       
Dr. Frank performed the LAVH in April 2007. She failed to adequately document the procedure in her 
operative note, as it did not clearly describe how the procedure was performed. 
 
Patient L  
 
Patient L was seen by Dr. Frank in March 2006, after having been referred for heavy, irregular 
bleeding. Dr. Frank failed to conduct required steps, which would have provided more information 
about Patient L’s treatment options, specifically, an endometrial biopsy, before proceeding with an 
LAVH.  Patient L was booked on the first visit for an LAVH. Dr. Frank performed the LAVH. Dr. 
Frank failed to adequately document the procedure in the operative note, as it does not clearly set out 
how the procedure was performed, in breach of the standard of practice. 
 
Patient M  
 
Patient M was seen by Dr. Frank in May 2006 for menorrhagia. Dr. Frank failed to take the 
appropriate investigative step of obtaining an endometrial biopsy before proceeding with an LAVH.   
 
Dr. Frank discussed some other options with Patient M, but booked Patient M for an LAVH on the 
first visit. Dr. Frank failed to document discussion of risks specific to Patient M. Patient M does not 
recall having been advised of the risks associated with the procedure.  Patient M faced a specific risk 
of damage to her bladder because of her previous history.    
 
Dr. Frank performed the LAVH. Dr. Frank failed to adequately document the procedure in the 
operative note, as it does not clearly set out how the procedure was performed, in breach of the 
standard of practice.  
 
Patient O 
 
Patient O was referred to Dr. Frank for prenatal care and delivery of her fourth child. Following the 
delivery of her fourth child, Patient O saw Dr. Frank and discussed surgical sterilization. Dr. Frank 
offered her a tubal ligation, which was then performed. Dr. Frank's record does not reflect any 
discussion of alternative options or of any specific risks of the procedure, in breach of the standard of 
practice.  
 
Patient P  
 
Dr. Frank managed Patient P's pregnancy and attended for her delivery. Patient P was admitted for a 
post-dates induction in May 2006. After Patient P pushed for approximately one hour, Dr. Frank 
delivered the baby using forceps. Patient P experienced a third-degree tear of the perineum. Dr. Frank 
failed to record any discussion with Patient P of the indication for forceps, the risks and benefits of 
forceps, or the alternatives to forceps use, and Patient P does not recall any such discussion.  
 
Patient Q  
 
Patient Q saw Dr. Frank in October 2005 for heavy, painful periods. Dr. Frank ordered an ultrasound, 
which was found to be normal. Patient Q was subsequently booked for an LAVH. Dr. Frank failed to 
take the required step of obtaining an endometrial biopsy preoperatively. 
 
Dr. Frank failed to document discussion of risks specific to Patient Q, in particular the increased risk 
of bladder injury as a result of Patient Q’s prior caesarean sections.  Dr. Frank failed to document 
which medical management options were discussed and the advice given to Patient Q as to each of 
those options given Patient Q’s specific circumstances. It was Patient Q's understanding that Dr. Frank 
was recommending a hysterectomy for her. 
 
Dr. Frank failed to adequately document the procedure in her operative note, as it did not clearly 
describe how the procedure was performed. 
 
Patient R  
 
Patient R, in her first pregnancy, was seen by Dr. Frank for prenatal care. She was admitted to hospital 
in August 2005 for induction of labour. Patient R had a prolonged second stage of labour followed by 
a failed forceps delivery by Dr. Frank. Dr. Frank then planned for the patient to go for a caesarean 
section, which she carried out approximately three hours later when an OR became available. In view 
of Patient R's prolonged labour and the failed forceps delivery, Dr. Frank should have, but did not, 
order prophylactic antibiotics prior to the caesarean section. 
 
Following surgery, Patient R presented with an abnormal ECG and developed a fever, which continued 
for five days. Dr. Frank failed to appropriately document and coordinate Patient R's post-operative care 
and failed to ensure appropriate assessment of the patient.  Patient R was found to have an intra-
abdominal abscess which was drained by another physician seven days after the caesarian section.  
 
Patient S  
 
Patient S was seen by Dr. Frank in 2008 for heavy menstrual cycles. She was found to have multiple 
fibroids. She wished to avoid surgery and was given a prescription for an Evra patch. However, she 
later attended at hospital with abdominal pain, heavy flow and a palpable suprapubic mass. On the 
same day, she saw Dr. Frank who noted pain and bleeding. Dr. Frank ordered an ultrasound which 
found a large uterus with multiple fibroids. Dr. Frank booked Patient S for an LAVH. Dr. Frank failed 
to document the details of alternative treatment options that were discussed or the specific risks for 
Patient S, contrary to the standards of practice. 
 
The surgery was completed in December 2008. Dr. Frank’s operative note indicated that, following the 
introduction of the laparoscope, a small bowel puncture due to the trocar placement was identified. Dr. 
Frank obtained an intra-operative general surgery consultation and, on advice, proceeded to a 
laparotomy (abdominal approach). Given the size of the uterus and the presence of multiple fibroids, 
Dr. Frank should have used an abdominal rather than a laparoscopic approach. The manner in which 
Dr. Frank conducted the surgery therefore breached the standard of practice. 
 
Patient T  
 
Dr. Frank performed an LAVH on Patient T in 2007. During the surgery, Dr. Frank used a 
laparoscopic LigaSure device for a vaginal approach for cauterization of the uterosacral and cardinal 
ligaments.  The shaft length of the instrument may have increased the risk of injury to the patient 
which could have been avoided with a different approach or method, such that it amounted to a breach 
of the standard of practice. Patient T presented to the emergency department a few days following 
surgery with urinary incontinence, and also presented to Dr. Frank’s office. Dr. Frank ultimately 
facilitated Patient T being seen by further specialists and she was diagnosed with a ureterovaginal 
fistula, subsequently undergoing reparative surgery.  
 
 
 
 
Patient U  
 
Dr. Frank performed an LAVH on Patient U in 2010. During the surgery, Dr. Frank used a 
laparoscopic LigaSure device for a vaginal approach to divide the tissues up the broad ligament. The 
shaft length of the instrument may have increased the risk of injury to the patient which could have 
been avoided with a different approach or method, such that it amounted to a breach of the standard of 
practice.  Patient U experienced a ureteric vaginal fistula following surgery. 
 
Patient V  
 
Dr. Frank performed an LAVH on Patient V in 2009. During the surgery, Dr. Frank used a 
laparoscopic LigaSure device for a vaginal approach. The uterosacral and cardinal ligaments were 
cauterized and cut using the laparoscopic LigaSure device. The shaft length of the instrument may 
have increased the risk of injury to the patient which could have been avoided with a different 
approach or method, such that it amounted to a breach of the standard of practice.     
 
Following the surgery, Dr. Frank failed to address in a timely way Patient V’s post-operative 
complications, specifically what was eventually identified as a bowel perforation sustained during the 
surgery. Dr. Frank should have arranged for a general surgical consultation and a restricted diet earlier 
in light of Patient V’s symptoms of bloody bowel movements, abdominal distension, severe pain, and 
a suspicion of bowel perforation.   
 
Patient W 
 
Dr. Frank assumed the prenatal care of Patient W in April 2005.  Patient W attended at hospital and 
was seen by others on three occasions in October 2005.  Dr. Frank was then notified of Patient W’s re-
attendance at hospital, assessed her, and admitted her to hospital with a spontaneous rupture of 
membranes. An ultrasound showed a fetal heart rate of 133 and decreased amniotic fluid. Dr. Frank 
prescribed a 50 mcg dose of Misoprostol to augment labour.  
 
There was a non-reassuring difficulty in registering a fetal heart rate. Dr. Frank then performed an 
emergency caesarean section. The infant was delivered and could not be resuscitated. 
 
The use of Misoprostol for the induction of labour was not appropriate in this case and breached the 
standard of practice. Misoprostol can cause tetanic uterine contractions. Dr. Frank failed to obtain 
Patient W’s informed consent for an off-label use of Misoprostol.  
 
Immediately after the delivery, Dr. Frank performed a tubal ligation. Patient W did not consent to the 
tubal ligation. Dr. Frank failed to document any discussion with Patient W about a tubal ligation in her 
office records nor to document performance of the tubal ligation in her operative note in a timely 
manner, which breached the standard of practice. 
 
Patient X 
 
Patient X was seen by Dr. Frank in 2005 on referral for menorraghia. Patient X was booked for an 
LAVH on her first visit. Dr. Frank's medical records do not reflect any discussion of specific 
alternative options for Patient X, nor of any specific risks of the surgery, in breach of the standards of 
practice. Dr. Frank failed to conduct or document necessary investigative steps to ascertain the cause 
of the menorraghia prior to booking Patient X for an LAVH, specifically, Dr. Frank's record does not 
document any physical examination prior to recommending an LAVH, nor does Patient X recall Dr. 
Frank having conducted one. 
 
Patient BB 
 
Patient BB saw Dr. Frank in 2003 for menorrhagia, pelvic pain, and stress incontinence. Dr. Frank 
obtained an ultrasound, which was found to be normal. At a subsequent appointment, Dr. Frank 
scheduled Patient BB for an LAVH and a tension free transvaginal tape procedure, which she later 
conducted. Dr. Frank failed to document in Patient BB’s medical record any discussion of non-surgical 
options or of any specific risks related to the procedures.    
 
Patient DD 
 
Patient DD was seen by Dr. Frank in 2003 for menometrorrhagia. An ultrasound showed an ovarian 
cyst which was noted to be not simple. Dr. Frank booked Patient DD for an endometrial ablation and a 
diagnostic laparoscopy with possible ovarian cystectomy. Dr. Frank failed to document in Patient 
DD’s medical record any discussion of specific alternative options, or of specific risks related to these 
procedures. During the surgery, Patient DD’s uterus was perforated.  The College does not allege that 
Dr. Frank’s performance of the surgery failed to meet the standard of practice of the profession. 
 
Patient EE 
 
Patient EE was referred to Dr. Frank in 2009 for post-menopausal bleeding, hot flashes, and atrophic 
vaginitis. Dr. Frank ordered an ultrasound and subsequently performed an endometrial biopsy.  Dr. 
Frank then carried out an LAVH with bilateral salpingo-oopherectomy (BSO) in January 2010. Dr. 
Frank failed to document having discussed the specific risks of the LAVH and BSO along with the 
risks of not having surgery, such as the risk of progression, spread, and mortality.  
 
The pathology from the LAVH and BSO showed that Patient EE had two types of cancer: a well 
differentiated endometrioid adenocarcinoma and an adult granulosa cell tumour.  Follow-up for these 
cancers should have included a pelvic exam every three to four months for the first two years and 
every six months for up to five years. Dr. Frank failed to advise Patient EE of the pathology findings 
and of the appropriate frequency of follow up required, in breach of the standard of practice, rather 
advising her to attend for follow up in one year’s time.  
 
Patient AAA  
 
Dr. Frank was the physician on-call at the hospital who managed Patient AAA when she was admitted 
to hospital in labour in 2006. After one hour of pushing, the fetal heart rate tracing showed variable 
decelerations. Dr. Frank decided to deliver the baby by forceps.  Dr. Frank failed to adequately assess 
and document the station and position of the fetal head before doing this. She then tried using forceps 
four times. She re-applied the forceps three times (including a change of forceps type). Each time, she 
noted that the forceps "slipped off." The trial of forceps lasted approximately half an hour. Dr. Frank 
failed to meet the standard of practice of the profession in her multiple uses of the forceps. Dr. Frank 
failed to document in the record having received informed consent to proceed with a trial of forceps.  
Patient AAA does not recall having provided informed consent.  
 
Dr. Frank moved to a caesarean section. However, and in breach of the standard of practice, Dr. Frank 
failed to appropriately arrange anaesthesia support before starting the trial of forceps, which then 
resulted in a delay of 48 minutes for anaesthesia to arrive.  Dr. Frank failed to adequately document 
how she performed the caesarean section. In particular, she failed to properly document the position of 
the baby at birth. She recorded the delivery as a "breech extraction" in her delivery summary, but did 
not make any reference to this in her operative note, stating there that it was in a vertex presentation.  
 
Patient AAA and her baby both experienced significant complications following the birth. The baby 
required resuscitation and transfer to another hospital.   
 
The Facts Regarding Penalty  
 
Prior Decisions 
 
 -  In 2009, the College's Complaints Committee issued a decision in which it required Dr. Frank to 
    attend to be cautioned. The concerns of the Complaints Committee related to Dr. Frank's 
    management of a twin pregnancy, including inadequate documentation and the failure to order 
    appropriate bloodwork and glucose testing. 
 -  In 2016, the College's Inquiries, Complaints and Reports Committee ("ICRC") issued a decision in 
    which it required Dr. Frank to attend to be cautioned. This decision was disposed of at the same 
    time as some of the complaints at issue in the discipline case. The ICRC's concerns related to Dr. 
    Frank's prenatal care of the patient in 2006 and, specifically, her failure to appropriately 
    manage/investigate the patient’s weight gain, hypertension and decreased fetal movement. 
     
Undertakings 
 
 -  Dr. Frank has been the subject of a number of undertakings with the College as a result of prior 
    complaints, reports, and practice assessments. At the time of the hearing, Dr. Frank's practice was 
    restricted as a result of undertakings entered into in 2011 and 2014, as well as an interim 
    undertaking entered into in 2016 pending the current hearing, in lieu of an interim order. 
 -  On January 19, 2009, Dr. Frank provided an undertaking agreeing to undergo a practice 
    assessment and abide by recommendations of the assessor. She also agreed to complete the 
    College's Medical Record-Keeping course as well as the Society of Obstetricians and 
    Gynaecologists of Canada ("SOGC") ALARM course.  
 -  The 2009 Undertaking arose as a result of concerns regarding Dr. Frank's clinical care arising 
    from two public complaints. As a result of the two public complaints, the College initiated an 
    investigation into Dr. Frank's practice. The 2009 Undertaking was entered into in resolution of the 
    investigation. 
 -  On September 14, 2011, Dr. Frank agreed to an undertaking restricting her ability to practise 
    obstetrical and gynecological surgery. Under the 2011 Undertaking, Dr. Frank was not permitted 
    to practise gynecological or obstetrical surgery, unless as part of a remediation program. She also 
    could not apply for gynecological or obstetrical privileges, and was not permitted to practise as the 
    most responsible physician in respect of any gynecological or obstetrical patients in any hospital. 
    The 2009 Undertaking also remained in effect. 
 -  The 2011 Undertaking arose after St. Thomas-Elgin General Hospital said that it would be 
    conducting an external review into Dr. Frank's practice at the hospital. Dr. Frank subsequently 
    voluntarily resigned her staff appointment at the hospital and this was reported to the College. 
 -  On December 7, 2012, Dr. Frank signed a further undertaking. Under this undertaking, the 2011 
    Undertaking remained in effect, meaning that the restrictions on Dr. Frank's ability to practise 
    obstetrical and gynecological surgery continued. In addition, under the 2012 Undertaking, Dr. 
    Frank agreed to a two-year period of clinical supervision. She also agreed not to perform 
    ultrasound procedures without further training if the College deemed that her training and 
    certification were not appropriate. She further agreed to complete a program in medical ethics.  
 -  The 2012 Undertaking resulted from recommendations made by assessors under the 2009 
    Undertaking. 
 -  On October 21, 2014, Dr. Frank executed another undertaking, which replaced the 2009 and 2012 
    Undertakings. The 2011 Undertaking restricting Dr. Frank's scope of practice to exclude 
    obstetrical and gynecological surgery remained in effect. In addition, under the 2014 Undertaking, 
    Dr. Frank could not conduct ultrasound testing, interpret ultrasound images, or perform 
    ultrasound-guided procedures unless she completed remediation and reassessment. Dr. Frank also 
    agreed to ongoing clinical supervision. The undertaking included an Individualized Education 
    Plan to be completed by Dr. Frank.  
 -  The 2014 Undertaking arose as a result of the recommendations from a clinical supervisor retained 
    under the 2012 Undertaking. 
 -  On April 27, 2016, Dr. Frank provided an undertaking in lieu of an interim order pending the 
    disposition of the discipline case. Under this undertaking, Dr. Frank agreed to practise under a 
    clinical supervisor who would submit reports to the College at least once per quarter. The 
    restrictions on her scope of practice from the 2011 and 2014 Undertakings remained in effect.  
 
Practice Restrictions At the Date of the Hearing 
 
 -  Dr. Frank had existing practice restrictions at the time of the hearing as a result of her 
    undertakings to the College:  
   -  under the 2011 Undertaking, Dr. Frank was not permitted to: 
      -  practise in the area of gynecological or obstetrical surgery unless she as part of a 
         remediation program pre-approved by the College and supervised by a preceptor who was 
         to act as most responsible physician ("MRP") for all patients; 
      -  apply for gynecological or obstetrical surgery privileges at any hospital , orengage in the 
         practice of medicine as the MRP in respect of any obstetrical or gynecological patients, at 
         any hospital. 
   -  the terms of the 2014 Undertaking that were not completed remained in effect. Specifically: 
      -  while Dr. Frank could be the MRP performing ultrasounds on her own patients, she could 
         only do so under the supervision of her clinical supervisor. 
      -  while Dr. Frank could be the MRP performing ultrasound-guided procedures on her own 
         patients, she could only do so under the supervision of the clinical supervisor, meaning that  
         Dr. Frank's ultrasound-guided procedures could only be performed in the clinical 
         supervisor's clinic and where a reproductive endocrinologist and infertility specialist was to 
         always be available on the premises to intervene if required. Although Dr. Frank was 
         permitted to perform ultrasound-guided procedures in these circumstances, Dr. Frank had 
         ceased performing these procedures. 
      -  the clinical supervisor was required to select and review a minimum of fifteen charts per 
         month related to imaging, ultrasound-guided procedures and pelvic and pregnancy 
         ultrasounds and meet with Dr. Frank once every month. The clinical supervisor was also 
         required to provide quarterly reports to the College. 
   -  until final disposition of the Discipline Committee proceeding, Dr. Frank had been required to 
      practise under the guidance of a clinical supervisor with respect to all areas of her practice. The 
      clinical supervisor was to review at least fifteen of Dr. Frank's patient charts from all areas of 
      her practice once every month and meet with Dr. Frank once every month. The clinical 
      supervisor was also required to submit written reports to the College at least once a quarter. 
   -  the 2014 Undertaking required reassessment of Dr. Frank's practice following the required 
      remediation. In the process of agreeing to the 2016 Undertaking, Dr. Frank agreed to submit to 
      a reassessment of her practice by an assessor or assessors selected by the College, to take place 
      six months after she had returned to practise following the conclusion of the Discipline 
      Committee proceeding. 
   -  therefore, since 2011, Dr. Frank had been prohibited from performing any obstetrical or 
      gynecological surgeries. Since 2012, Dr. Frank's ability to perform ultrasounds and ultrasound-
      guided procedures had been restricted. Dr. Frank's practice as of the date of the hearing 
      consisted of reproductive endocrinology and infertility, office gynecology and early obstetrical 
      care.  
       
Monitoring Reports 
 
 -  The College received reports from Dr. Frank's clinical supervisors under her undertakings and, 
    most recently, under the 2014 and 2016 Undertakings. The recent reports received from Dr. 
    Frank's clinical supervisor were consistently positive. While Dr. Frank's most recent clinical 
    supervisor under the 2014 and 2016 Undertakings raised criticisms in individual cases, the number 
    of criticisms declined over time. He did not raise any significant practice concerns.  
 
Disposition 
 
On February 26, 2018, the Discipline Committee ordered and directed that: 
 
 -  the Registrar suspend Dr.  Frank's certificate of registration for twenty-four (24) months, to 
    commence at 12:01 a.m., February 27, 2018. 
     
 -  the Registrar impose  the  following terms,  conditions  and limitations  on Dr.   Frank's certificate 
    of registration: 
     
   -  Dr. Frank shall practise only in the areas of reproductive endocrinology and infertility, 
      office-based gynecology and early obstetrical care (i.e. before 20 weeks of pregnancy); 
   -  Upon returning to practice following the suspension of her certificate of registration, Dr. 
      Frank shall comply with any College policy regarding re-entering practice in existence at the 
      time of her resumption of practice. Without restricting the generality of the foregoing, any 
      program pursuant to the College policy regarding re•entering practice shall, at a minimum, 
      require that: 
      -  Dr. Frank initially perform ultrasound-guided procedures only in a clinic belonging to 
         a clinical supervisor and where a reproductive endocrinologist and infertility 
         specialist is/are always available on the premises to intervene if required; and, 
      -  Approximately six (6) months following Dr. Frank's return to practice, Dr. Frank 
         undergo a reassessment of her practice (the "Reassessment") by a College-appointed 
         assessor or assessors (the "Assessor(s)"). Dr. Frank shall cooperate fully with the 
         Reassessment, which may include a review of Dr. Frank's patient charts, direct 
        observation, interviews with staff and/or patients, and/or other tools deemed 
        necessary by the College. The results of the Reassessment shall be reported to the 
        College, and, if requested to do so by the College, Dr. Frank shall abide by the 
        recommendations of the Assessor(s). Any of those recommendations of the 
        Assessor(s) which are limitations and/or restrictions on Dr. Frank's practice and/or 
        which the Inquiries, Complaints and Reports Committee identifies as limitations 
        and/or restrictions on her practice shall be included on the public register as terms, 
        conditions, or limitations on her Certificate of Registration for the purposes of section   
        23  of   the   Health Professions Procedural Code, which is Schedule 2 to the Regulated 
        Health Professions Act, 1991, S.O. 1991, c. 18, as   amended; 
  -  Dr. Frank shall only practise in a group setting which has been approved by the College; 
  -  Dr. Frank shall consent to sharing of information among the Assessor(s), any of her Clinical 
     Supervisor(s), and the College as any of them deem necessary or desirable in order to fulfill 
     their respective obligations; 
  -  Dr. Frank shall consent to the College making appropriate enquiries of the Ontario Health 
     Insurance Plan and/or any person who or institution that may have relevant information, in 
     order for the College to monitor and enforce her compliance with the terms of this Order; 
  -  Dr. Frank shall submit to, and not interfere with, unannounced inspections of her Practice 
     Locations and patient charts by a College representative for the purposes of monitoring her 
     compliance with the terms of this Order; 
  -  Dr. Frank shall give her irrevocable consent to the College and to her Assessor(s) to make 
     enquiries of her patients regarding medical services provided by her in order to ensure that she 
     is documenting all information relevant to her practice in an accurate way; 
  -  Dr. Frank shall consent to the College providing   any Chief(s)  of  Staff or a colleague with 
     similar responsibilities at any location where she practises with any information the College 
     has that led to this Order and/or any information arising from the monitoring of her 
     compliance with this Order; and, 
  -  Dr. Frank shall be responsible for any and all costs associated with implementing the terms of 
     this Order. 
      
-  Dr. Frank attend before the panel to be reprimanded. 
           
-  Dr. Frank to pay to the College costs in the amount of $10,180.00, within thirty (30) days of 
   the date of this Order.

Decision: Download Full Decision (PDF)
Hearing Date(s): Motion for Adjournment: August 15, 2017 Hearing Dates: February 26 2018