Discipline Committee Decisions
Dr. Robert M. Carter; Dr. John K. Pariag; Dr. Eli Judah; Dr. Paul M. Porter
April 27, 2012
Dr. Robert M. Carter, London. On March 19, 2012, the Discipline Committee found that Dr. Carter committed an act of professional misconduct, in that he engaged in the sexual abuse of a patient, and has failed to maintain the standard of practice of the profession. Dr. Carter did not contest these allegations.
Conduct Regarding the Romantic and Sexual Relationship
Patient A became Dr. Carter's patient in June 2004. Over the course of the doctor-patient relationship, Patient A was treated for depression and anxiety and, on occasion, treatment included supportive psychotherapy. On February 11, 2008, at the end of a medical appointment, Dr. Carter hugged and kissed Patient A in his office. Starting on February 13, 2008, Dr. Carter and Patient A corresponded regularly and frequently via e-mail and instant text messages. The content of the e-mails was personal and sexual in nature. During this time, Dr. Carter began to visit Patient A at her house and they began a romantic relationship, which included kissing and hugging. On March 19, 2008, Dr. Carter and Patient A discussed that Dr. Carter could no longer be her family doctor as a result of their romantic relationship. A note in Patient A's medical record indicates that on this date Patient A was terminated as a patient. Shortly after March 19, 2008, Dr. Carter and Patient A began a sexual relationship, which included sexual intercourse. The sexual relationship lasted until November 2008. Patient A was vulnerable prior to and during the romantic and sexual relationship.
Conduct Regarding Clinical Care and Treatment
During the sexual relationship, Dr. Carter provided incidental treatment to Patient A while he was on call at the local hospital. On one of these occasions, Dr. Carter prescribed a significant number of repeats of her anti-depressant and anti-anxiety medications, totalling one full year of medication. Dr. Carter knew that Patient A did not have another family doctor throughout the course of their relationship. After Dr. Carter terminated the sexual relationship in November 2008, Patient A experienced severe anxiety and depression and expressed suicidal ideation. Without assessing Patient A, Dr. Carter made a verbal order to a pharmacy for a significant quantity of the controlled substance Ativan, with one repeat. The College's expert opined that the clinical care provided to Patient A by Dr. Carter fell below the standard of care.
The Discipline Committee ordered a public reprimand, and an 18-month suspension of Dr. Carter's certificate of registration. Dr. Carter was further ordered to attend with a psychiatrist or psychologist who is acceptable to the College, for as long as the treating therapist deems necessary, but for not less than one year. For a period of one year, Dr. Carter's treating therapist will provide quarterly reports attesting to Dr. Carter's attendance at these regularly scheduled meetings.
The Committee imposed as a term, condition and limitation on Dr. Carter's certificate of registration that he shall successfully complete an acceptable course in prescribing skills.
Dr. Carter is to reimburse the College for funding for therapy and counselling provided for the complainant under the program required under section 85.7 of the Code, and he is to pay costs to the College in the amount of $3,650.
Dr. John K. Pariag, Mississauga. On March 22, 2012, the Discipline Committee found that Dr. Pariag committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession. The Committee also found that Dr. Pariag is incompetent. Dr. Pariag admitted to the allegations of professional misconduct and incompetence, as follows:
Regarding a review of 35 patient charts from his surgical practice:
- improper placement of chest tubes in a CF patient;
- performing cholecystectomy in the presence of evidence that the common bile duct was not clear;
- failure to protect an anastomosis with a stoma where appropriate;
- improperly discharging three post-surgical patients with elevated white blood cell counts and fevers;
- unnecessary transfusion of one patient;
- questionable decision to perform a targeted bowel resection in a patient with rectal blood loss when the point of bleeding was unknown, and failure to investigate a possible foreign body as indicated by x-rays of the patient;
- incorrectly repairing a hernia, leading to recurrence;
- unnecessary removal of three healthy appendices;
- failure to obtain a right breast ultrasound despite a radiologist's suggestion in a cancer patient;
- failed to give DVT [deep vein thrombosis] prohylaxis perioperatively to a patient with known breast cancer;
- failure to properly control intraoperative bleeding;
- improperly performing surgery without first addressing the patient's elevated INR;
- perforating a patient's bowel while removing two 0.25 cm polyps;
- improperly ordering blood transfusion of a 12-year-old with a haemoglobin count of 108, which order was subsequently cancelled by another physician, and failure to investigate percutaneous pelvic abscess drainage before proceeding to perform a laparotomy on that patient;
- improperly performing an elective thyroidectomy without supervision when Dr. Pariag had never performed such a procedure at the hospital and had not reviewed thyroid surgery during his residency; and
- dissecting a patient's portal triad during surgery to correct a bowel obstruction, which error resulted in the patient's death due to hemorrhagic shock.
Regarding patient A, who had surgeries for an intra-abdominal mass, later identified as a sarcoma:
- failed to adequately document a differential diagnosis, treatment plan, or informed consent discussions with Patient A; and,
- after the recurrence of the sarcoma, failed to solicit an opinion from the Regional Cancer Centre where the patient had been seen in the past, and improperly attempted to treat the sarcoma outside a multi-disciplinary care center.
The Discipline Committee’s penalty decision is pending.
Dr. Eli Judah, Toronto. On April 10, 2012, the Discipline Committee found that Dr. Judah committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession. The Committee also found that Dr. Judah is incompetent. Dr. Judah admitted to the allegations of professional misconduct and incompetence.
Dr. Judah is a general practitioner who, at the time of the events at issue, performed cosmetic surgery at his clinic. Dr. Judah completed three years of surgical training in a residency program, but does not have a Royal College certification in a surgical specialty. Dr. Judah admits to the following deficiencies identified in his cosmetic surgery practice:
- Dr. Judah failed to maintain the standard of practice of the profession in his care and treatment of 29 cosmetic surgical patients in the following ways:
Dr. Judah is incompetent in that his professional care of patients displayed a lack of knowledge, skill and judgment in the following ways:
- he failed to employ staff with appropriate training;
- he failed to administer IV sedation in the presence of a qualified anaesthesiologist;
- in respect of some of his patients, he failed to properly store harvested fat that he later injected;
- he excessively sedated patients during surgery; and
- he performed combined surgery on an unsuitable candidate.
- he used IV sedation in the absence of a qualified anaesthesiologist;
- he directed the use of IV sedation while also being responsible for performing the surgery;
- he lacks training in administering IV sedation; and
- he lacks knowledge and judgment in IV sedation.
The Discipline Committee ordered a public reprimand, and directed that the following terms, conditions and limitations on be imposed on Dr. Judah's certificate of registration:
- Dr. Judah shall be prohibited from administering parenteral sedation;
- With the exception of hair transplant procedures, Dr. Judah shall be prohibited from performing cosmetic surgical procedures;
- Dr. Judah's performance of hair transplant procedures shall be in accordance with any and all conditions and dispositions made by the Premises Inspection Committee of the College; and
- Dr. Judah shall cooperate with unannounced inspections of his practice and such other steps as the College may take for the purpose of monitoring and enforcing his compliance with the terms of the Order at his expense.
Dr. Judah was further ordered to pay costs to the College in the amount of $3,650.
Dr. Paul M. Porter, St. Catharines. On April 16, 2012, the Discipline Committee found that Dr. Porter committed an act of professional misconduct, in that he engaged in disgraceful, dishonourable, or unprofessional conduct. Dr. Porter admitted the allegation of professional misconduct.
Dr. Porter's certificate of registration was subject to an interim suspension between December 13, 2000 and November 29, 2002. This was in relation to a discipline proceeding in which Dr. Porter was later found to be incompetent and to have committed professional misconduct in respect of two patients with complex psychiatric issues, including dissociative identity disorder. Dr. Porter's practice was made subject to conditions, including retaining a practice monitor and clinical supervisor, and discontinuing treating dissociative identity disorder or borderline personality disorder patients for at least five years. Dr. Porter's certificate of registration continues to be subject to these conditions.
Dr. Porter's Failure to Maintain Boundaries with Patients A and B
Dr. Porter began treating Patient A in 1989. He diagnosed Patient A with dissociative identity disorder. Dr. Porter continued to treat Patient A until his certificate of registration was suspended, as described above.
While treating Patient A, Dr. Porter developed a close personal relationship with her and failed to maintain therapeutic boundaries. Dr. Porter was regarded by Patient A as being akin to a member of her family, and he and Patient A spent time at each other's homes and with each other's families. Dr. Porter also commenced treating Patient A's husband, Patient B. Both Patient A and Patient B felt highly dependent on Dr. Porter. The close personal relationship between Dr. Porter and Patients A and B continued during the time when Dr. Porter's certificate of registration was suspended, and Patient A also received counselling from Dr. Porter during that period.
While Dr. Porter's certificate of registration was suspended, Patients A and B began to provide significant sums of money to Dr. Porter which they maintain were loans. Dr. Porter maintains that the sums were gifts. The amounts included two drafts in the amounts of $4,900 and $8,000, and a cheque for $12,000. Patients A and B asked Dr. Porter for a number of years to return the money in question. Dr. Porter has returned between approximately $5,000 and $7,000. Dr. Porter has undertaken to the College to pay a total of $17,400 to Patient A.
The Discipline Committee ordered a public reprimand, a one-month suspension of Dr. Porter’s certificate of registration, and he is to pay the College its costs of this proceeding in the amount of $3,650.