Previous Hearings
Committee: Discipline
Decision Date: 23 Apr 2018
Summary:
On April 23, 2018, the Discipline Committee found that Dr. George Williams Otto committed an
act of professional misconduct, in that he has engaged in conduct or an act or omission relevant
to the practice of medicine that, having regard to all of the circumstances, would reasonably be
regarded by members as unprofessional.
Dr. Otto received a certificate of independent practice in 1988. He practises family medicine in
Toronto. Dr. Otto failed to provide records in a timely manner when requested on behalf of
three patients.
Patient A
On April 13, 2016, a lawyer for Patient A sent a letter by fax to Dr. Otto's office, requesting
Patient A's complete client file and enclosing an executed authorization and direction. The fax
was received by Dr. Otto's office. Dr. Otto failed to respond to the request.
On August 15, 2016, Patient A's lawyer sent another letter to Dr. Otto's office by fax and
by regular mail. He repeated his request for Patient A's file and noted that time was of the
essence. The letter was received by Dr. Otto's office. Dr. Otto failed to respond to the
request.
On September 28, 2016, Patient A's lawyer contacted the College regarding Dr. Otto's
ongoing failure to provide Patient A's file as requested. The College investigator
requested Dr. Otto's response by letters dated October 3, 2016 and November 14, 2016.
On December 9, 2016, Dr. Otto submitted a letter of response to the College. In his letter,
Dr. Otto advised that he had provided the records to Patient A's counsel on October 1,
2016.
Patient B
On November 16, 2015, counsel for Patient B sent a letter by regular mail to Dr. Otto's
office, requesting Patient B's complete client file and enclosing an executed authorization and
direction. The letter was received by Dr. Otto's office. Dr. Otto failed to respond to the
request.
Counsel for Patient B sent two further letters to Dr. Otto's office by regular mail on January
18, 2016 and June 14, 2016, repeating his request for Patient B's file. Both letters were
received by Dr. Otto's office. The final letter stated in bold that the matter had become
urgent. Dr. Otto failed to respond to these requests.
On August 24, 2016, counsel for Patient B contacted the College regarding Dr. Otto's
ongoing failure to provide Patient B's file as requested. The College investigator requested
Dr. Otto's response by letters dated August 30, 2016 and October 25, 2016.
On December 9, 2016, Dr. Otto submitted a letter of response to the College. In his letter,
Dr. Otto advised that he had provided the records to Patient B's counsel on October 19,
2016.
Patient C
On January 4, 2017, the College received a letter from counsel for Patient C requesting
assistance in obtaining copies of her client’s records from Dr. Otto. As advised in her
letter, Patient C's counsel had sent four requests to Dr. Otto for Patient C's records by letters
dated February 12, March 12, April 14 and May 14, 2014. The final three request letters
included the following statement in bold font: "If you have not seen this patient, please
confirm in writing." Dr. Otto failed to respond to these requests.
In his response to the College, dated February 16, 2017, Dr. Otto stated that he had no record of
receiving the requests from Patient C's counsel and apologized if the letters were received and
missed by an administrative error. Dr. Otto also noted that Patient C's first name was spelled
inconsistently, in that a single letter in the middle of Patient C's first name was different in
counsel's letter and in the four request letters. Dr. Otto stated that he did have records
related to a patient with the name indicated on the request letters and would provide them
upon receipt of an executed consent form. Patient C's surname was spelled correctly
throughout, and her birthdate was included in the four request letters.
Relevant College History
Dr. Otto has been the subject of a number of prior investigations, cautions and disciplinary
decisions by the College.
In responding to the investigations regarding the complaints made on behalf of Patients A and
B, Dr. Otto advised the College investigator on December 8, 2016 that in order to prevent
similar oversights and delays, he has directed that all requests for patient records received
by his office be logged into a journal, that each week, he personally reviews the journal to
ensure requests have been attended to in a timely manner, and that if they are not, he
personally ensures his office staff immediately attends to the request. Dr. Otto indicated
that he is confident that the system now implemented at his office will assist in responding
to patient record requests in a timely and appropriate manner.
Dr. Otto's previous involvement with the College includes the following:
- In November 2012, the Inquiries, Complaints and Reports Committee (the ICRC)
cautioned Dr. Otto in person and accepted his undertaking in resolution of an
investigation into issues regarding his practice, including his use of a physician
assistant and his inadequate record-keeping. Among other things, Dr. Otto
undertook to complete a medical record-keeping course.
- On May 1, 2013, the ICRC advised and cautioned Dr. Otto in two separate cases to
respond promptly and properly to requests for patient records. In one case, counsel
for the patient advised that he had written four letters to Dr. Otto requesting a copy
of the patient's records and had telephoned on numerous occasions. In the other case,
counsel for the patient advised that he had written three letters requesting records on
the patient's behalf and had called numerous times. In both cases, Dr. Otto advised
the College that he had since set up a binder to record patient record requests, which
he reviewed weekly.
- In a decision dated October 5, 2015, relating to his completion of Special Diet
Allowance forms, the Discipline Committee made findings of professional
misconduct. Dr. Otto admitted that his record-keeping did not meet the standard of
practice. The Committee administered a public reprimand, suspended Dr. Otto's
registration for two months, ordered he pay a $10,000 fine and imposed a number
of other terms. The Committee noted that Dr. Otto had since completed the medical
record-keeping course in accordance with his previous undertaking, and ordered that
he also complete an educational program in ethics.
Disposition
On April 23, 2018, the Committee ordered and directed that:
- the Registrar suspend Dr. Otto’s Certificate of Registration for period of 3 months, to
commence on May 7, 2018;
- the Registrar impose the following terms, conditions and limitations on Dr. Otto’s
Certificate of Registration:
Records Log
(a) Dr. Otto shall maintain a log of all requests for the release of Personal Health
Information (“PHI”), which shall include a copy of the requests received, the date such
requests were received, and the date of Dr. Otto’s response (the “Log”). Dr. Otto shall
also include a copy of the request and his response in the relevant patient’s clinical
record;
(b) Dr. Otto shall submit a copy of the Log to the College thirty (30), sixty (60) and ninety
(90) days following the date of this Order, and every two (2) months thereafter, for a
total period of twenty-four (24) months;
Education
(c) Dr. Otto shall complete a physician practice management course acceptable to the
College within six (6) months of the date of this Order;
Preceptorship
(d) Within thirty (30) days of the conclusion of the suspension of his Certificate of
Registration described above in paragraph 3, Dr. Otto shall retain, at his own expense, a
College-approved clinical supervisor or supervisors (the “Preceptor”) with respect to
effective office administration, and in particular the timely response to requests for PHI.
The Preceptor will sign an undertaking in the form attached as Schedule “A” to the
Order, dated April 23, 2018;
(e) Dr. Otto shall meet with the Preceptor a total of six (6) times over a period of twelve
(12) months (the “Preceptorship”): an initial meeting, then once after one (1) month,
once after a further two (2) months; and once every three (3) months thereafter until the
conclusion of the Preceptorship;
(f) The meetings shall include a review of the Log and related correspondence, including
the requests received, the responses by Dr. Otto and the associated records and patient
charts to ensure appropriate documentation. The Preceptor may conduct an additional
review of any records or documents deemed necessary for the purposes of the
Preceptorship. The Preceptor may also make inquiries of relevant individuals, including
staff or colleagues;
(g) Dr. Otto shall cooperate fully with the Preceptor and shall abide by the
recommendations of the Preceptor, including but not limited to, any recommended
practice improvements and professional development;
(h) The Preceptor shall submit quarterly reports to the College;
(i) If a person who has given an undertaking in Schedule “A” to this Order dated April 23,
2018 is unable or unwilling to continue to fulfill its provisions, Dr. Otto shall, within
twenty (20) days of receiving notice of same, obtain an executed undertaking in the
same form from a similarly qualified person who is acceptable to the College and ensure
that it is delivered to the College within that time;
(j) If Dr. Otto is unable to obtain a Preceptor in accordance with this Order, he shall cease
to practice until such time as he has obtained a Preceptor acceptable to the College;
(k) If Dr. Otto is required to cease practice as a result of paragraph (4)(j) above, this will
constitute a term, condition or limitation on his Certificate of Registration and that term,
condition or limitation will be included on the public register;
(l) Dr. Otto shall consent to the disclosure by his Preceptor to the College, and by the
College to his Preceptor, of all information the Preceptor or the College deems
necessary or desirable in order to fulfill the Preceptor’s undertaking and Dr. Otto’s
compliance with this Order;
Reassessment
(m) Within six (6) months of completing the Preceptorship required above, Dr. Otto shall
undergo a reassessment with regard to effective office administration by a College-
appointed Assessor;
(n) The reassessment may include (at the College’s discretion) a review of Dr. Otto’s Log
and related documentation; an interview with Dr. Otto, interviews with colleagues and
staff, and any other tools deemed necessary by the College;
(o) The results of this assessment shall be reported to the College;
(p) Dr. Otto shall abide by all recommendations with regard to practice management made
by the College-appointed Assessor;
(q) If Dr. Otto is of the view that any of the Assessor’s recommendations are unreasonable,
he shall have thirty (30) days following receipt of the recommendation within which to
provide the College with his submissions in this regard. Thereafter, the Inquiries,
Complaints and Reports Committee (the “ICRC”) will consider his submissions and
make a determination regarding whether or not the recommendations, or any of them,
are reasonable and if so, whether they, or any of them, constitute limitations or
restrictions on his practice, and that decision will be provided to Dr. Otto;
(r) Following the decision referenced in paragraph (4)(q) above, Dr. Otto shall abide by
those recommendations of the Assessor that the ICRC has determined are reasonable.
Other
(s) Dr. Otto shall inform the College of each and every location where he practices, in any
jurisdiction (his “Practice Location(s)”) within fifteen 15 days of this Order and shall
inform the College of any and all new Practice Locations within fifteen (15) days of
commencing practice at that location;
(t) Dr. Otto shall submit to, and not interfere with, unannounced inspections of his Practice
Location(s) and patient records for the purposes of monitoring and enforcing his
compliance with the terms of this Order;
(u) Dr. Otto shall consent to the College making appropriate enquiries of the Ontario Health
Insurance Plan and/or any person who or institution that may have relevant information,
in order for the College to monitor his compliance with this Order.
(v) Dr. Otto shall consent to the sharing of information among the Preceptor, the Assessor
and the College, as any of them deem necessary or desirable in order to fulfill their
respective obligations;
(w) Dr. Otto shall be responsible for any and all costs associated with implementing the
terms of this Order.
- Dr. Otto attend before the panel to be reprimanded;
- Dr. Otto pay costs to the College for one half-day hearing in the amount of $6,000 within
sixty (60) days from the date of this Order.
On May 4, 2018, Dr. Otto appealed the decision on penalty of the Discipline Committee to the
Ontario Superior Court of Justice (Divisional Court). Pursuant to s. 25(1) of the Statutory Powers
Procedure Act, the appeal operated as a stay of the decision pending the outcome of the appeal.
Therefore, the decision of the Discipline Committee was not in effect.
On January 28, 2019, the Divisional Court dismissed for delay Dr. Otto’s appeal.
Decision: Download Full Decision (PDF)
Hearing Date(s): April 23 ,2018
Committee: Discipline
Decision Date: 05 Oct 2015
Summary:
On October 5, 2015, the Discipline Committee found that Dr. Otto committed an act of
professional misconduct in that he has failed to maintain the standard of practice of the
profession; 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, dishonourable or unprofessional. Dr. Otto admitted to the allegations.
In March 2012, the Ministry of Health and Long Term Care (the “Ministry”) expressed concerns
to the College regarding Dr. Otto’s completion of special diet allowance (“SDA”) applications.
The Ministry reviewed 25 patient records which were selected based on claim submissions of an
assessment code and a code for completing an application for a SDA. The records submitted
were for families where all of the patients within the family were billed on the same service date.
Fifteen of the records were for patients eighteen and under. The Ministry’s review revealed that
of those fifteen records, thirteen records included the phrase ‘anceiform rash all over body’ and
also noted an opinion of lactose intolerance or milk allergy.
Based on the information received from the Ministry, the College commenced an investigation.
In the course of its investigation, the College received billings for the 25 patients reviewed by the
Ministry.
The College retained the services of an expert, Dr. X, who opined that of the 24 charts she
reviewed, only three met the standard of care with respect to the completion of the SDA
application forms. In general, documentation and investigations to support the conditions
indicated in the SDA forms was lacking. It was also noted that many patients had frequent
assessments over a very short period of time, prior to the completion of the SDA forms, and that
many of the clinical entries for those repeat assessments were identical.
During the College’s investigation, in November 2012, Dr. Otto participated in a medical record-
keeping course and submitted proof of completion to the College.
In May 2014, Dr. X reviewed ten additional records of Dr. Otto and found that four of them did
not meet the standard of care of the profession in relation to his completion of SDA forms, in
that there was no documentation of the symptoms, investigations or treatment recommendations
to support the condition(s) reported on the SDA form. However, Dr. X noted improvement with
regards to Dr. Otto’s charting and patient assessments that were conducted to support the clinical
conditions indicated in the SDA and to satisfy the requirements of the Ministry when completing
the SDA forms, and that Dr. Otto provided sound rationale for supporting dietary and lifestyle
modifications for the management of hypercholesterolemia and hypertension for his patients and
for supporting the SDA claim for his patients.
The Discipline Committee ordered and directed that:
- Dr. Otto appear before the panel to be reprimanded.
- the Registrar suspend Dr. Otto’s certificate of registration for a period of two (2) months,
commencing at 12:01 a.m. on October 6, 2015.
-the Registrar place the following terms, conditions and limitations on Dr. Otto’s certificate of
registration:
(i) Dr. Otto shall participate in and successfully complete an educational program satisfactory
to the College in Ethics, with a report or reports to be provided to the College regarding Dr.
Otto’s progress and compliance. Dr. Otto shall complete this requirement by December 31,
2015 or, if no satisfactory program is available by that time, by the first possible opportunity
thereafter;
(ii) Dr. Otto shall not complete any Special Diet Allowance forms unless he has submitted the
Special Diet Allowance form, along with the corresponding patient chart, to a physician
approved by the College in its sole discretion (the “Monitor”), and that Monitor has reviewed,
approved and co-signed every Special Diet Allowance form prior to Dr. Otto providing this
form to his patient(s). The Monitor shall sign an undertaking to the College in the form
attached [to the Order] as Schedule “A”, will agree to maintain a log of all Special Diet
Allowance forms that have been approved and co-signed, and to report any irregularity to the
College;
(iii) Dr. Otto shall retain a copy of all Special Diet Allowance forms in the patient chart. Dr.
Otto shall also maintain a log of all Special Diet Allowance forms that he has completed
which he will submit to the College along with the corresponding patient chart upon request.
(iv) Dr. Otto shall inform the College of each and every location where he practises including,
but not limited to hospitals, clinics, and offices, in any jurisdiction (collectively, his “Practice
Location(s)”), within fifteen (15) days of this Order, and shall inform the College of any and
all new Practice Locations within fifteen (15) days of commencing practice at that location,
for the purposes of monitoring his compliance with this Order;
(v) Dr. Otto 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;
(vi) Dr. Otto shall consent to the monitoring of his OHIP billings and cooperate with
inspections of his practice and patient charts by the Monitor and College representatives for
the purpose of monitoring and enforcing his compliance with the terms of this Order.
Monitoring this Order shall include making inquiries of the Ministry of Community and
Social Services and/or the Ministry of Health and Long Term Care regarding Dr. Otto’s
completion of, and billing for, special diet allowance forms; and
(vii) Dr. Otto shall be responsible for any and all costs associated with implementing the
terms of this Order.
- Dr. Otto shall, within six (6) months, pay a fine to the Minister of Finance in the amount of
$10,000.00, and that Dr. Otto shall provide proof of this payment to the Registrar of the College.
- Dr. Otto pay to the College costs in the amount of $4,460, within sixty (60) days of the date of
this Order.
Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): October 5, 2015