Committee: Discipline
Decision Date: 12 Apr 2016
Summary:
On April 12, 2016, the Discipline Committee of the College of Physicians and Surgeons of Ontario found that Dr. Howard Sheldon Einstoss committed an act of professional misconduct in that he engaged in sexual abuse of patients and in that he has engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonorable or unprofessional.
DR. EINSTOSS’ SEXUAL ABUSE OF PATIENT A
Patient A is a middle-aged woman who began seeing Dr. Einstoss as her sole family physician in her late 20s. Dr. Einstoss provided psychotherapy for her mental health issues and prescribed medications for her.
One December while she was his patient, Patient A had taken a Christmas gift to Dr. Einstoss, who responded by giving her a kiss. Eventually, during subsequent appointments, Dr. Einstoss started touching Patient A inappropriately, leading to sexual intercourse in his office.
Patient A testified that although she would attend Dr. Einstoss’ office for psychotherapy appointments, he never provided any therapy. Instead, Patient A would have sexual intercourse with Dr. Einstoss on the floor, using a sleeping bag he kept under his examination table. Patient A’s sexual encounters with Dr. Einstoss at his office occurred roughly every two to four weeks for about three to four years.
Patient A would usually arrive at Dr. Einstoss’ office at 4:30 or 5:00 p.m. She would stay in Dr. Einstoss’ office with him until about 7:00 p.m. After having sex, the two would sit on the sleeping bag and he would have “a couple of drinks” containing vodka. They would then both leave to go home.
Patient A testified that she would either call for an appointment or Dr. Einstoss would call her to tell her to come in to the office, if she wanted her medications. Patient A testified that if she didn’t go into the office and have sex with Dr. Einstoss, she wouldn’t get her medications.
Patient A recalled attending Dr. Einstoss’ office occasionally for medical appointments. During those instances, Dr. Einstoss would often tell her to come back after hours and they would have sex at that time. Patient A testified that Dr. Einstoss made her feel she couldn’t tell anyone about the sexual encounters and she felt she could do nothing to stop them.
Because of the sexual encounters, Patient A ultimately no longer felt comfortable seeing Dr. Einstoss as her doctor. When she called Dr. Einstoss’ office to request her medical records, she was told he had retired. She was never able to obtain her medical records.
DR. EINSTOSS’ SEXUAL ABUSE OF PATIENT B
Patient B saw Dr. Einstoss for mental health issues and substance abuse issues. Dr. Einstoss provided frequent psychotherapy sessions and prescribed medication for Patient B in her late teens and early 20s.
Patient B testified that, in 2009, she was heavily self-medicating on a daily basis and was worried she had damaged her liver. She therefore made an appointment to see Dr. Einstoss.
At her appointment, Dr. Einstoss examined Patient B and ordered blood work. When she went to the lab for the blood testing, Patient B was surprised to see that Dr. Einstoss had ordered testing for sexually-transmitted diseases (STDs). Patient B testified that she now believes that Dr. Einstoss “set her up to have sex with him” by ordering the STD testing that had not otherwise seemed medically necessary.
At her subsequent appointment, Patient B told Dr. Einstoss that she was still feeling unwell. However, Dr. Einstoss did not address her medical concerns; he instead told her about his problems with his medical practice and that he might be suspended. Dr. Einstoss asked her to write a favorable letter regarding his character to his lawyer, which she did, using the words he had given her.
At that same visit, Dr. Einstoss took Patient B’s hands and told her he would take care of her forever. Patient B testified that she and Dr. Einstoss then took a bus to a hotel, stopping to have a meal at a nearby restaurant, which she paid for. They had sex at the hotel. They then left the hotel together, each taking a cab home. Dr. Einstoss called her later that evening and told her that he loved her.
The next week, Patient B went to Dr. Einstoss’ office. She waited for him to finish seeing another patient, and again they left his office together to go to a hotel together by cab and again had sex.
Patient B’s credit card billings showed she had made charges on several occasions for hotel rooms, a meal at a restaurant, and several taxis. She testified that these charges for the dates indicated on the credit card statements all corresponded to times she had sex with Dr. Einstoss in various hotels. The dates for the credit card charges in her statement correspond to visit dates billed for Patient B to OHIP by Dr. Einstoss.
Patient B testified that she continued to feel unwell during the time period of her second sexual encounter with Dr. Einstoss. She repeatedly called and went to Dr. Einstoss’ office to try to see him. On these occasions, Dr. Einstoss’ receptionist told her he was not available. Patient B tried contacting Dr. Einstoss at his office throughout the summer of 2009. Dr. Einstoss ignored and did not return her calls.
In October 2009, Dr. Einstoss called Patient B and apologized for hurting her. He asked if he could call her weekly, and she agreed. In late October 2009, Patient B met Dr. Einstoss again, and they had sex at a hotel. For approximately one year thereafter, Dr. Einstoss would meet Patient B at a hotel on a set day of the week and have sex. Patient B would pay for the hotel, and Dr. Einstoss would give her $100.00 towards the bill every other week. They occasionally had sex at Patient B’s home as well. When Patient B tried to obtain her medical records from Dr. Einstoss, she was told there was a $75.00 charge. When Patient B asked Dr. Einstoss to waive the charge, Dr. Einstoss told her that she didn’t need her chart. She was never able to obtain her medical records.
After Patient B made her complaint to the College, Dr. Einstoss repeatedly called her on the phone and yelled at her. Dr. Einstoss emailed Patient B and her child. He tried repeatedly to reach Patient B through various social media websites. Patient B last heard from Dr. Einstoss six months ago.
Patient B’s substance abuse issues relapsed. Patient B had difficulty finding a doctor and even seeking medical care because she did not trust that anyone would actually listen to her. She testified that she has an ongoing “incredible distrust” of others.
FINDINGS
The Committee found that Dr. Einstoss had a doctor-patient relationship with both Patient A and Patient B at the time of his sexual relationships with them. The Committee therefore found that Dr. Einstoss sexually abused both Patient A and Patient B.
The Committee found that Dr. Einstoss engaged in the following conduct that would reasonably be regarded by members as disgraceful, dishonourable, or unprofessional as follows:
With respect to Patient A:
1. Dr. Einstoss had diagnosed Patient A with having significant mental health and addictions issues. Patient A was, accordingly, a particularly vulnerable patient who was sexually abused by Dr. Einstoss.
2. Dr. Einstoss linked the prescribing of medications for Patient A to attending his office for sexual intercourse. Patient A testified that she would not receive the medications she needed if she did not have sex with Dr. Einstoss.
3. Dr. Einstoss billed OHIP for multiple psychotherapy sessions for Patient A in 2009. Patient A testified while she had received psychotherapy from Dr. Einstoss in the past, he had not provided psychotherapy at the visits billed for in 2009.
4. Dr. Einstoss disclosed personal information about himself and his family to Patient A, breaching professional boundaries.
With respect to Patient B:
1. Dr. Einstoss had diagnosed Patient B with significant mental health and addiction issues. He had provided medication and psychotherapy for mental health issues and substance abuse issues when she was in her late teens and early 20s. As a result of the sexual abuse by Dr. Einstoss, Patient B relapsed into substance abuse issues and it took her years to recover her sobriety. Patient B was clearly a vulnerable patient, exploited by Dr. Einstoss.
2. Dr. Einstoss failed to adequately address Patient B’s medical concerns. Her medical concerns were never addressed beyond ordering blood work and reviewing the results with her. The visits instead led to sexual abuse by Dr. Einstoss. Patient B had to ultimately seek care at a walk-in clinic because Dr. Einstoss eventually refused to see her. She was then sent to hospital and underwent a surgical procedure.
3. Dr. Einstoss sent Patient B for STD testing when this was not a legitimate medical concern of hers. He did not advise Patient B that he had included these tests on a requisition he gave her for blood work. Patient B was made aware of this by the technician at the lab she attended. The inclusion of these tests did not reflect Patient B’s concern nor was there any rationale for ordering these tests discussed with her at the time. The ordering of these tests was most likely self-serving on Dr. Einstoss’ part, given he subsequently had sexual intercourse with her.
4. Dr. Einstoss billed OHIP for psychotherapy sessions provided to Patient B in 2009. Patient B testified that, while she had received psychotherapy from Dr. Einstoss in the past, he had not provided psychotherapy at the visits billed for in 2009.
5. Dr. Einstoss disclosed personal information to Patient B regarding himself and his family, breaching professional boundaries.
PENALTY AND COSTS
On April 12, 2016, the Discipline Committee ordered that:
-The Registrar revoke Dr. Einstoss’ certificate of registration effective immediately;
-Dr. Einstoss appear before the panel to be reprimanded on or before June 12, 2016;
-Dr. Einstoss reimburse the College for funding provided to patients under the program required under section 85.7 of the Code, by posting an irrevocable letter of credit or other security acceptable to the College, by September 6, 2016, in the amount of $32,120.00; and
-Dr. Einstoss pay costs to the College in the amount of $14,460.00, by June 12, 2016.
Committee: Discipline
Decision Date: 20 Jan 2011
Summary:
On January 20, 2011, the Discipline Committee found that Dr. Howard Sheldon Einstoss committed an act of professional misconduct in that he failed to maintain the standard of practice of the profession and that he has engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Dr. Einstoss did not meet the standard of practice of the profession in his care and treatment of patients and displayed a lack of clinical judgement. Significant deficiencies were found with respect to Dr. Einstoss' record-keeping and prescribing practices. Dr. Einstoss has responded to the above concerns by registering and successfully completing the College's Prescribing Skills course in October 2009 and Medical Record-Keeping course in July 2010. With respect to conduct, Dr. Einstoss displayed poor judgment and inclusion of inappropriate 'editorial additions' in patient charts.
The Discipline Committee ordered and directed that:
1. Dr. Einstoss appear before the panel to be reprimanded.
2. The Registrar impose the following specified terms, conditions and limitations on Dr. Einstoss' certificate of registration (for an indefinite period or for the specified periods of time set out herein):
(a) Dr. Einstoss may only practise in an out-patient walk-in clinic setting for two (2) half days per week, which may be increased to two (2) full days per week, conditional on the College's receipt of support, in writing, from specified individuals. At no time may he practise more than two (2) days per week.
(b) Within approximately six (6) months after the date on which Dr. Einstoss resumes practising, as set out in 2(a) above, he shall undergo a re-assessment of his clinical practice by a College-appointed assessor ("Assessor"). This assessment will be directed to determining whether Dr. Einstoss is in compliance with this Order and whether Dr. Einstoss' practice is below the standard of practice of the profession.The assessment by the Assessor will include, at minimum, a review of Dr. Einstoss' office charts, direct observation of his practice and interviews with staff and/or patients. Dr. Einstoss shall abide by all recommendations made by the Assessor.The Assessor shall report the results of this assessment to the College.
(c) Dr. Einstoss shall not issue prescriptions for any of the following substances as set out in the Regulations, as amended from time to time:
i. Narcotic Drugs from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19;
ii. Narcotic Preparations from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19;
iii. Controlled Drugs from Schedule G of the Regulations under the Food and Drugs Act, S.C., 1985, c. F-27; or
iv. Benzodiazepines/Other Targeted Substances from the Benzodiazepines and Other Targeted Substances Regulations made under the Controlled Drugs and Substances Act., S.C., 1996, c. 19.
A Summary of Narcotics, Narcotic Preparations, Controlled Drugs, and Benzodiazepines/Targeted Substances taken from Appendix I to the Compendium of Pharmaceuticals and Specialties (reviewed by Health Canada) is at Schedule "A" [to the Order] and Current Regulatory Lists are at Schedule "B" [to the Order].
(d) Dr. Einstoss shall post a clearly visible sign in every walk-in clinic where he is practicing in the form set out at Schedule "C" [to the Order]. For further clarity, this sign shall state as follows: "Dr. Howard Einstoss has relinquished his prescribing privileges with respect to Narcotic Drugs, Narcotic Preparations, Controlled Drugs and Benzodiazepines and/or Other Targeted Substances".
(e) Dr. Einstoss shall cooperate with unannounced inspections of his practice and patient charts by a College representative(s) for the purpose of monitoring and enforcing his compliance with the terms of this Order.
(f) Dr. Einstoss shall be responsible for any and all costs associated with implementing the terms of this Order.
3. Dr. Einstoss pay to the College costs in the amount of $3650.00 within 120 days of the date of this Order.