News Release

Discipline Committee Decisions

Dr. Bernard Norman Barwin; Dr. Kenneth Buttoo; Dr. Hung-Tat Lo; Dr. Naeem Hafiz Muhammad; Dr. Michael Varenbut

Feb 28, 2013

The College of Physicians and Surgeons of Ontario (“the College”) released the results of its most recent disciplinary hearings. The College is the licensing and disciplinary body for physicians in Ontario. Hearings are held to review allegations of professional misconduct and incompetence, and are open to the public. The following are brief summaries of recent discipline hearing results. The Discipline Committee’s full decisions and reasons for decisions are posted on the College’s website as they become available. Full decisions are located by entering the doctor’s name in the Doctor Search section of the College’s website at All Doctors Search.

Dr. Bernard Norman Barwin, Ottawa. On January 31, 2013, the Disciplined Committee found that Dr. Barwin committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession. Dr. Barwin admitted the allegation.

Dr. Barwin is a general practitioner with additional training in obstetrics and gynaecology. He has practised in Ontario in artificial insemination, among other areas of medicine since 1973.

Patient A became pregnant in 2004 as a result of artificial insemination conducted by Dr. Barwin. Approximately three years later, Patient A found out, through DNA testing, that her child was not the product of the donor sperm she had instructed Dr. Barwin to use to inseminate her.

In or about late 2006/early 2007, Patient B went to Dr. Barwin with her sister, Patient C, who had agreed to act as Patient B's surrogate. Dr. Barwin was to artificially inseminate Patient C with the sperm of Patient B's husband. Patient C discovered, through DNA testing in 2008, that her child was not the biological child of Patient B's husband.

In or about 1985 and 1986, Patient D went to Dr. Barwin for the purpose of being artificially inseminated with her husband's sperm. In approximately 2011, Patient D discovered, through DNA testing, that her son was not her husband's biological child.

The errors in the inseminations of Patients A and C occurred after Dr. Barwin had been notified by the College of an error he made in his insemination of another patient, Patient E, in 1994. Patient E discovered, following the birth of her child in June, 1995, that the child was not the product of the donor sperm she had instructed Dr. Barwin to use to inseminate her. Dr. Barwin was notified of this error by the College of Physicians and Surgeons of Ontario and states that he took some steps to endeavour to ensure that no such errors would occur in his practice in the future.

Dr. Barwin and an expert review were unable to identify any evident errors in the conduct of the artificial inseminations or in Dr. Barwin's office policies and procedures regarding his artificial insemination practice. However, Dr. Barwin accepts that errors in his practice, which would fall below the standard of care, resulted in his failure to provide his patients with offspring from their intended biological fathers. These concerns do not involve any other areas of Dr. Barwin's medical practice.

The Discipline Committee ordered a public reprimand, and a two-month suspension of Dr. Barwin's certificate of registration. Dr. Barwin was further ordered to pay the College costs in the amount of $3,650.

Dr. Kenneth Buttoo, Ajax. On February 1, 2013, the Discipline Committee found that Dr. Buttoo committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession. Dr. Buttoo admitted to the allegation.

As a result of concerns regarding his practice, Dr. Buttoo executed an undertaking to the College on March 10, 2009, by which he agreed that he would engage in an assessment of his practice within one year. As a result of concerns that arose out of the subsequent practice assessment, the College proceeded with a section 75 investigation into Dr. Buttoo's practice and retained a medical inspector to review 20 patient charts, visit the site, interview Dr. Buttoo and observe five patient visits in February 2010. As set out in the inspector's report, Dr. Buttoo fell below the standard of practice of the profession in the areas of allergy management and respiratory management. In particular, in the care of multiple patients in 2009-2010, Dr. Buttoo: 

  • inappropriately ordered and/or recommended testing that was unnecessary and/or not indicated;
  • inappropriately failed to mention airways resistance findings in his interpretation of pulmonary function test results;
  • in circumstances in which Dr. Buttoo made a provisional diagnosis of asthma and then conducted testing which did not support the diagnosis, he inappropriately failed to address the provisional asthma diagnosis in his follow-up consultation letters to referring physicians and did not state that asthma had been ruled out;
  • inappropriately presented "hyper responsive airways" to referring physicians in terms that suggested it represented a final diagnosis of a patient's condition, when in fact no diagnosis had been reached on the basis of the testing conducted and the patient's symptoms remained undiagnosed;
  • inappropriately prescribed medications that were unnecessary and not indicated; and
  • utilized inappropriate sterilization techniques.

The Discipline Committee ordered a public reprimand, and directed that the Registrar impose the following terms, conditions and limitations on Dr. Buttoo's certificate of registration:

  1. For an indefinite period of time, Dr. Buttoo shall not prescribe inhaled corticosteroids and/or anticholinergic medication for a patient unless he or she has a diagnosis of asthma, and in any case Dr. Buttoo shall not prescribe such medication in cases in which the patient has had a negative methacholine challenge.
  2. While Dr. Buttoo is subject to the term, condition and limitation set out at paragraph (a), Dr. Buttoo shall maintain a log listing all patients to whom he has prescribed inhaled corticosteroids and/or anticholinergic medication, their OHIP number, the date on which he saw the patient, whether the patient has a diagnosis of asthma, whether a methacholine challenge has been conducted and, if so, whether the challenge was positive or negative. Dr. Buttoo shall maintain the original log and shall send a copy of the log to the College on a quarterly basis until completion of the re-assessment referred to below in paragraph (g), and thereafter shall produce the log at any time upon request of the College.
  3. For a period of at least 12 months, Dr. Buttoo shall practice only under the supervision of a clinical supervisor, who will meet with Dr. Buttoo on a monthly basis for the duration of the supervision, except that after three months of supervision, the frequency of meetings may be decreased to every two months if the clinical supervisor is of the view that this is appropriate and it has been pre-approved by the College.
  4. If the clinical supervisor is unwilling or unable to continue to fulfill the terms of supervision, within 20 days, a similarly qualified person must be obtained or Dr. Buttoo shall cease to practice until such time as he has obtained a clinical supervisor acceptable to the College. The fact that he has ceased to practice shall be a term, condition and limitation on his certificate of registration until that time.
  5. Dr. Buttoo shall abide by all recommendations of his clinical supervisor with respect to practice improvements and education.
  6. Dr. Buttoo shall consent to the disclosure by his clinical supervisor to the College, and by the College to his clinical supervisor, of all information deemed necessary or desirable in order to fulfill the terms of this Order.
  7. Approximately 12 months after the completion of the period of supervision, Dr. Buttoo shall undergo a re-assessment of his clinical practice by a College-appointed assessor. This re-assessment will include determining whether Dr. Buttoo meets the standard of practice of the profession and whether Dr. Buttoo is in compliance with this Order. The assessor(s) shall make recommendations regarding Dr. Buttoo's practice and shall report the results of the re-assessment to the College.
  8. Dr. Buttoo shall consent to the disclosure to the assessor(s) of all information deemed necessary or desirable in order to fulfill the terms of this Order.
  9. For an indefinite period of time, Dr. Buttoo shall inform the College of each and every location where he practices including, but not limited to hospitals, clinics, and offices, in any jurisdiction.
  10. For an indefinite period of time, Dr. Buttoo shall consent to the College making appropriate enquiries of the Ontario Health Insurance Plan and/or any person or institution that may have relevant information, in order for the College to monitor his compliance with this Order.
  11. For an indefinite period of time, Dr. Buttoo shall submit to, and not interfere with, unannounced inspections of his practice location(s) and patient records by a College representative for the purposes of monitoring his compliance with this Order.
  12. Dr. Buttoo shall be responsible for any and all costs associated with implementing the terms of this Order.

Dr. Buttoo was further ordered to pay the College costs in the amount of $3,650.

Dr. Hung-Tat Lo, Scarborough. On January 13, 2012, the Discipline Committee found that Dr. Lo committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession.

Record-keeping

Dr. Lo failed to maintain the standard of practice in record-keeping with respect to Patient A. The patient's record was largely illegible and most entries contained scant information. Changes to medications were made at the last three appointments without documented communication with Patient A's family doctor, who was managing the patient's medications on a more consistent basis. Risk assessments and their conclusions were not documented.

Dr. Lo also failed to maintain the standard of practice in record-keeping with respect to 14 of 15 patients. Patient records were largely illegible and transcriptions were required for review. The patient encounter entries were generally scant. Most charts did not have the initial history, diagnosis and treatment plan charted in any detail. There was a general lack of pertinent negative findings, and mental status exams and risk assessments were not documented.

Care and Treatment

Dr. Lo failed to maintain the standard of practice in his care and treatment of Patient A with respect to his collateral fact gathering and follow-up. Dr. Lo also failed to maintain the standard of practice in his care and treatment of two patients, in that he: 1) failed to adequately monitor the Lithium level of one patient and failed to make the necessary inquires that would have led to the disclosure of the patient's thyroid carcinoma; and 2) managed an alcoholic patient with out-dated treatment and inappropriate use of antabuse.

On February 7, 2013, the Committee ordered a public reprimand, and directed that the following terms, conditions and limitations be imposed on Dr. Lo’s certificate of registration:

  1. Dr. Lo shall undergo, at his own expense, a re-assessment of his practice within 12 months by an assessor acceptable to the College. The re-assessment shall include a review of Dr. Lo’s documentation and record-keeping, his appropriate prescription and monitoring of Lithium in clinical practice, his communications with family members and family physicians, and his identification and referral to specialists of patients in his care with comorbid alcoholism; and
  2. Dr. Lo shall abide by all recommendations provided by the assessor.

Dr. Lo was further ordered to pay to the College costs in the amount of $3,650.

Dr. Naeem Hafiz Muhammad, London. On February 14, 2013, the Discipline Committee found that Dr. Muhammad committed professional misconduct, in that he has engaged in the sexual abuse of a patient and engaged in disgraceful, dishonourable or unprofessional conduct.

Dr. Muhammad is a family physician and jointly owned two walk-in clinics. Ms. X was a part-time employee at the walk-in clinics. In addition, although Ms. X had her own family doctor, she attended Dr. Muhammad as a patient in the clinics for episodic, minor complaints on five occasions between December 2009 and July 2010 at the time she was working a shift. Dr. Muhammad did not deny that there was an ongoing doctor-patient relationship.

The Committee found that:

  • Ms. X was a patient of Dr. Muhammad from December 2009 to September 2010;
  • prior to September 2010, Dr. Muhammad engaged in conduct that was disgraceful, dishonourable or unprofessional conduct in his relationship with Ms. X by making inappropriate comments to and about her; and
  • on a date in September 2010, while Ms. X was working at Dr. Muhammad's clinic, Dr. Muhammad made inappropriate and sexual comments to her and engaged in sexual abuse of her, including by touching her lips, hugging and kissing her and that this constituted the sexual abuse of a patient.

A penalty hearing is yet to be scheduled.

Dr. Michael Varenbut, Richmond Hill. On February 19, 2013, the Discipline Committee found that Dr. Varenbut committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession. Dr. Varenbut admitted the allegation.

Dr. Varenbut is an addiction medicine specialist and is a co-founder of the Ontario Addiction Treatment Centres (OATC), the country's largest network of methadone clinics. OATC provides a range of harm reduction treatment modalities, including Methadone Maintenance Treatment ("MMT").

In 2005, Patient A sought help for her drug addiction from OATC. She received treatment from OATC clinics in Thunder Bay, Sudbury and Peterborough between 2005 and the spring of 2008. In mid-2006, Dr. Varenbut became the Most Responsible Physician with respect to her care.

Throughout her involvement with OATC, Patient A's attendance for her regular urine samples, supervised methadone doses and clinic appointments was sporadic. Clinic staff felt Patient A was challenging and demanding and that her non-compliance and the hostile conduct of her partner created more challenges than most patients within their clinic structure.

After travelling to southern Ontario for a medical procedure in the spring of 2008, Patient A stopped taking her methadone dose. In August of 2008, Patient A asked to re-start the methadone program at OATC. At the time she was using cocaine and other opiates, including by injection. Clinic staff told her she would have to leave urine samples twice a week and have blood work and an ECG done before she could see a doctor. Clinic staff indicated that these preconditions were now required for all patients seeking to be initiated on the program. Although Patient A provided 24 witnessed urine samples at the OATC clinic between August 2008 and March 2009, she didn't complete her blood work until early March of 2009 and did not obtain an ECG. She was not given an appointment with Dr. Varenbut, who viewed her failure to complete the other tests as demonstrating a lack of commitment to the program and thus was unwilling to waive the requirements.

In early 2009, Patient A stressed the importance of seeing a physician as she wanted to go on methadone and receive take-home doses for a vacation out of the country. In early April, 2009, after returning from her trip, she attended at the clinic to provide a urine sample and was advised by clinic staff that Dr. Varenbut was terminating her care and OATC would not provide her with methadone treatment.

Dr. Varenbut failed to maintain the standard of care with respect to Patient A by:

  1. failing to provide Patient A with a physician appointment within a reasonable time after she sought to be re-admitted to the MMT program in August 2008;
  2. failing to make a timely decision about whether or not to accept Patient A back into the MMT program; and
  3. unreasonably delaying Patient A's access to methadone treatment, of which she was in urgent need.

Dr. Varenbut intends to stop his methadone practice and has already started to transfer his MMT patients to other physicians. Since the time of Patient A's involvement with Dr. Varenbut and the OATC clinics, the following changes have been implemented at OATC:

  1. An Involuntary Discharge Policy which details the protocol to be followed when terminating a MMT patient has been implemented at all OATC clinics.
  2. The OATC has a "Best Practice Committee" comprised of five OATC physicians, a Clinical Case Manager, clinic nurses and other ad hoc members of the team. A dedicated subcommittee of the Best Practice Committee, the "Involuntary Discharge Committee", has been formed which collaborates on any decision to discharge a patient involuntarily from OATC.

In 2008, an assessment of Dr. Varenbut's MMT practice based on a review of his care of 15 patients was conducted for the College's Methadone Comittee. The Committee concluded that his care of these patients complied with the MMT Guidelines.

The Discipline Committee ordered a public reprimand and Dr. Varenbut is to pay to the College costs in the amount of $14,600.