Committee: Discipline
Decision Date: 21 Sep 2018
Summary:
On September 21, 2018, the Discipline Committee found that Dr. Suganthan Kayilasanathan committed an act of professional misconduct, in that he has engaged in the sexual abuse of a patient, and in that he has 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.
The allegations arose from alleged conduct by Dr. Kayilasanathan in relation to Ms A. Dr. Kayilasanathan and Ms A knew each other socially prior to Ms A being seen by Dr. Kayilasanathan on two occasions at a walk-in clinic one week apart. At both clinic visits, the medical record of Dr. Kayilasanathan established that he took a history and examined Ms A. At both clinical visits, Dr. Kayilasanathan provided Ms A with a medical note to excuse her from examinations. It was alleged that Dr. Kayilasanathan and Ms A engaged in sexual intercourse and oral sex on a single occasion between the two clinic visits when Dr. Kayilasanathan and Ms A were in a physician-patient relationship.
Sexual Abuse of a Patient
The Committee found that the allegation of sexual abuse was proven, that is, Dr. Kayilasanathan engaged in sexual relations with Ms A concurrent with a doctor-patient relationship.
The Committee found on the testimony of Ms A and a hotel manager and reservation information from the hotel that Dr. Kayilasanathan and Ms A engaged in sexual intercourse and oral sex at an Inn on a date between Ms A’s two clinic visits to Dr. Kayilasanathan.
The Committee found that Dr. Kayilasanathan established a doctor-patient relationship with Ms A on the date of the first clinic visit which continued through to the date of the second clinic visit based on the following:
- Dr. Kayilasanathan had a patient file for Ms A, which included on the date of the first clinic visit, a detailed description of a history, physical examination, diagnosis, and plan of management, and direction for a follow-up return to the clinic in one week or prn (as needed);
- Dr. Kayilasanathan’s patient file for Ms A for the follow-up appointment on the date of the second clinic visit also included a detailed description of the history, physical examination, and diagnosis, and plan of management. Given the plan of management noted in Ms A’s patient file, which included a return to the clinic in one week, the Committee found that a second visit was planned as a follow-up to the first visit, indicating a continuity of care. Accordingly, the Committee rejected the submission from Dr. Kayilasanathan’s counsel that a doctor-patient relationship, if there had been one, was terminated after each visit;
- Dr. Kayilasanathan billed OHIP for an intermediate assessment for each of the visits for specified services provided to Ms A.
- There was a notation on the clinic’s medical record for Ms A identifying Ms A as the patient.
- Dr. Kayilasanathan issued two medical notes to Ms A excusing her from her examinations. The Committee found that the provision of a medical note is part of providing medical care to a patient and constitutes a medical service. The medical certificate of the date of the second clinic visit states that Dr. Kayilasanathan saw Ms A on that date for medical reasons, indicates she is unable to attend exams due to illness/injury, that she will return if she is better and invites further inquiry of him if there are any questions or concerns. A medical note is similar conceptually to a prescription for medication; it is understood to be issued by a physician on the basis of his or her professional judgment after an assessment of a patient and to be relied on by the intended recipient. The recipients of medical notes, such as employers and organizations, including administrators in this case, are expected to respect the recommendations and directions made by a physician. This is an example of the special authority granted to physicians.
The Committee concluded that Dr. Kayilasanathan, by his actions in requesting Ms A to attend at his clinic, taking a history and conducting examinations, assessing Ms A as a patient and making a diagnosis and treatment plan, creating a medical record which included a plan for a return visit, billing OHIP and providing to Ms A medical notes excusing her because of illness from examinations, established a doctor-patient relationship with her on the date of the first clinic visit, which continued through to the follow-up appointment one week later on the date of the second clinic visit.
Disgraceful, Dishonourable or Unprofessional Conduct
The Committee also found that Dr. Kayilasanathan failed to maintain the appropriate boundary between physician and patient in having sexual relations with Ms A after he commenced a doctor-patient relationship and for that reason his conduct is disgraceful, dishonourable or unprofessional.
Immediate Interim Suspension
Given the Committee’s findings, the Committee made an immediate interim order suspending Dr. Kayilasanathan’s certificate of registration, pursuant to section 51(4.2) of the Health Professions Procedural Code (the Code), which is Schedule 2 to the Regulated Health Professions Act, 1991, until a penalty order is made under subsection 5 or 5.2 of the Code.
Disposition
On December 11, 2018, the Discipline Committee ordered that:
- The Registrar revoke Dr. Kayilasanathan’s certificate of registration effective immediately.
- Dr. Kayilasanathan appear before the panel to be reprimanded.
- Dr. Kayilasanathan pay to the College costs in the amount of $46,220 within 30 days of the date of this Order.
Appeal
On October 19, 2018, Dr. Kayilasanathan appealed the decision of the Discipline Committee to the Superior Court of Justice (Divisional Court). Pursuant to s.71.1 of the Code, the interim suspension of Dr. Kayilasanathan’s certificate of registration remained in effect despite the appeal. On July 4, 2019, the Divisional Court dismissed the appeal for written reasons released on July 18, 2019.
On July 31, 2019, Dr. Kayilasanathan filed a Notice of Motion for Leave to Appeal the decision of the Divisional Court to the Court of Appeal. The decision of the Discipline Committee remained in effect. On November 29, 2019, the Court of Appeal refused to grant Dr. Kayilasanathan leave to appeal with costs fixed at $1,000.00.
Decision: Download Full Decision (PDF)
Appeal: Appeal Dismissed
Appeal Decision Date: July 4, 2019
Hearing Date(s): Hearing Dates: November 6 , 7, 9, 2017; Motion Dates: Nov 20 - 21, 2017, February 28, March 2, March 22, 2018
Penalty hearing date: December 11, 2018