On March 27, 2019, on the basis of a Statement of Uncontested Facts on Liability, the Discipline Committee found that Dr. Noza committed an act of professional misconduct, in that he engaged in an act or omission relevant to the practice of medicine that, having regard to all circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
STATEMENT OF UNCONTESTED FACTS ON LIABILITY
Dr. Assefa Fersha Noza (“Dr. Noza”) is a sixty-two (62) year old physician, practising family medicine in Etobicoke, Ontario. Dr. Noza received his certificate of registration authorizing independent practice on December 6, 2001.
Dr. Noza is a member of the Humber River Family Health Team (“Humber River FHT”). At all relevant times, Dr. Noza practised at the Humber River FHT clinic site in Etobicoke.
Patient A was a patient of Dr. Noza between 2013 and 2016. In May 2016, Dr. Noza saw Patient A for a periodic health examination. At this appointment, Patient A underwent a blood test and a urine test.
Upon receiving Patient A’s blood and urine test results, Dr. Noza’s secretary called Patient A and told her that the doctor wanted to see her for a follow-up appointment.
Patient A saw Dr. Noza to discuss her results. Patient A’s urine culture was positive for Group B Beta Hemolytic Streptococcus. Dr. Noza discussed this with Patient A and asked her whether she had been experiencing any symptoms related to a urinary tract infection. Patient A told Dr. Noza that she did not have any problems. Dr. Noza told Patient A that if she did experience any issues she could return to see him. Patient A then left the clinic.
A short time later on the same day, Patient A remembered that she had been experiencing heavy vaginal bleeding for the past few days but she had forgotten to mention this to Dr. Noza. Patient A returned to Dr. Noza’s clinic and asked the secretary to see him again. The secretary placed Patient A into an examination room and Dr. Noza saw Patient A for a second time that day.
Patient A told Dr. Noza about her heavy vaginal bleeding. Dr. Noza told Patient A to lie down on the examination table.
Dr. Noza first palpated Patient A’s abdomen and asked whether she had any pain. Without adequately explaining, Dr. Noza then told Patient A to pull down her underwear. She was not offered a drape or gown. Dr. Noza put on a glove and conducted a vaginal examination.
Patient A was not expecting Dr. Noza to conduct a vaginal examination. Dr. Noza had never conducted a vaginal examination of Patient A. In the past, only Dr. Noza’s female staff had conducted Pap smears for Patient A.
Following the examination, Dr. Noza told Patient A to get dressed and return to see him if she had any continuing concerns.
Prior to conducting the vaginal examination, Dr. Noza failed to:
- Advise Patient A that he was going to conduct a vaginal exam;
- Explain to Patient A the reason for the exam and what the exam would involve;
- Obtain Patient A’s informed consent before proceeding;
- In accordance with his usual practice, ascertain whether Patient A wanted a chaperone present in the room; and
-Provide Patient A with proper draping or a gown.
As a result, Patient A felt confused and upset.
Dr. Noza did not make any notes in Patient A’s medical chart of her having returned to see him for a second time on the same day. He failed to document her concerns about vaginal bleeding and failed to document the physical and vaginal examination.
Dr. Noza does not contest the facts set out above, and does not contest, for the purposes of the College proceedings, that he engaged in professional misconduct, in that he engaged in 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
AGREED STATEMENT OF FACTS ON PENALTY
Undertaking in Lieu of the s. 25.4 Order
On April 30, 2018, Dr. Noza entered into an interim undertaking to the College in lieu of an Order under section 25.4 of the Health Professions Procedural Code, Schedule 2 to the Regulated Health Professions Act, S.O. 1991, C-18.
No concerns regarding Dr. Noza’s compliance with the interim undertaking have been identified by the College’s compliance monitor.
Dr. Noza’s March 27, 2019 Undertaking
Dr. Noza has entered into an undertaking to the College, effective March 27, 2019, by which he has agreed, among other things, that he will not conduct any breast, pelvic or rectal examination of any patient, of any age, in any jurisdiction, unless the examination takes place in the continuous presence and under the continuous observation of a monitor who is a regulated health professional acceptable to the College.
Prior History
On May 14, 2015, the Inquiries, Complaints and Reports Committee (the “ICRC”) issued a written caution to Dr. Noza with regard to professional communication. The ICRC also directed a Specified Continuing Education or Remediation Program (a “SCERP”) which required Dr. Noza to complete one-on-one instruction on communication, and engage in self-directed learning by writing a report reflecting on how he has changed his communication technique.
Dr. Noza has no prior history with the Discipline Committee.
AGREEMENT AS TO PENALTY
The parties agreed that the appropriate penalty in this matter is set out in the draft Order filed at the hearing.
DISPOSITION
The Discipline Committee Ordered that:
- The Registrar suspend Dr. Noza’s Certificate of Registration for a three (3) month period effective immediately.
- The Registrar impose the following terms, conditions and limitations on Dr. Noza’s Certificate of Registration:
- Dr. Noza shall comply with the College’s Policy #2-07, “Practice Management Considerations for Physicians Who Cease to Practice, Take an Extended Leave of Absence or Close Their Practice Due to Relocation”;
- Dr. Noza shall successfully complete the PROBE Ethics and Boundaries Course (“PROBE course”), at his own expense, within twelve (12) months of the date of this Order. Dr. Noza will agree to abide by the recommendations of the PROBE course and provide proof of completion to the College;
- Dr. Noza shall inform the College of each and every location where he practices, in any jurisdiction (“Practice Location(s)”) within five (5) days of commencing practice at that location;
- Dr. Noza shall be responsible for any and all fees, costs, and expenses, associated with implementing and fulfilling the terms of this Order; and
- Dr. Noza shall provide irrevocable consent to the College to make appropriate enquiries of OHIP and/or any person or institution that may have relevant information, in order for the College to monitor compliance with this Order.
- Dr. Noza appear before the panel to be reprimanded.
- Dr. Noza pay costs to the College in the in the amount of $6,000.00 within thirty (30) days.