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The CPSO has to be careful to make sure that its definition of sexual abuse is not outstripping the definition in the criminal system. In a recent case publicized in the Toronto Star a doctor was originally charged with sexual assault but pled guilty to assault only. If I was that doctor and was convicted of sexual assault at the college level I would appeal on this basis. If a court of law cannot convict then neither should the college .
Second all people including doctors have the right to presumption of innocence. If the publics right to protection can be met without removing a doctor from his practise then this should be the practise of the college in the preliminary phases of the investigation and prosecution.
We shouldn’t compare the burden of proof for professional discipline to that required for criminal prosecution: a finding by the college against a physician can obstruct his/her PRIVILEGE to practice, but a criminal conviction results in the loss of one’s RIGHT to freedom.
I agree with the notion that a physician should never use their position and power to take advantage of a patient sexually.
However I think there are some issues with the draft that may benefit from further consideration.
‘Physicians must never have any sexual involvement with patients’.
Here I think it’s very important to define what is meant by ‘patient’. In a small town, for instance, if a physician has a brief encounter with a ‘patient’ say for a cold at an urgent care clinic, does this preclude them from ever having a sexual relationship with that ‘patient’ at a later date even where no further doctor-patient interaction occurs?
‘There is an inherent power imbalance in the physician-patient relationship’.
I think this is an antiquated notion and although it may be mostly true of past generations, in the modern era I believe patients are more empowered than ever and one might even make the opposite argument i.e. that patients are in a position of power of doctors.
‘Any sexual involvement with patients is harmful, is considered sexual abuse, and is never acceptable.’
To call any sexual involvement with a patient sexual abuse in my view fails to make an important distinction. Sexual abuse to me implies coercion and battery. Although I agree that a doctor should never be involved sexually with a patient where a lasting and enduring doctor-patient relationship has been established, I believe in this era of patient empowerment it is possible for a patient to act autonomously and consent to a sexual act with a doctor. In such cases, I would call a breach on the part of the doctor sexual misconduct or sexual inappropriateness but not sexual abuse and I would accord it a lesser punishment.
I would reserve the term sexual abuse for instances where a doctor engages in a sexual act with a patient unexpectedly and against the patient’s will and I would accord such egregious behaviour the most severe of punishment.
the Toronto Star routinely, and on purpose, makes a mockery of the distinction between sexual abuse or assault in the criminal sense, and sexual abuse in a regulatory sense. The two offenses are completely different and have little to do with each other. Now the College is falling for this confusion of terms too.
The College basically and rightfully considers any sexual contact between a physician and a patient “sexual abuse”, even when the sexual contact was fully consensual between adults and without any force. While this is fine, sex between a patient and a doctor is not a criminal offense unless force is involved, the patient is not awake, aware, not an adult, etc.
So if the College finds a physician guilty of REGULATORY sexual abuse, it is under very special circumstances that the physician would be found also guilty of CRIMINAL sexual abuse or assault.
Please keep this distinction in mind when making new policies about reporting to the police about College sexual findings.
-The draft statement about `inherent power balance` appears misconstrued.In this era,patients are more empowered than ever.They change doctors,refuse treatment,indulge in behaviour against medical advice,do not bring Health cards&expect treatment,make threats&harrassment over nothing etc.
-I think the draft should be careful about using `sexual abuse`in a loose manner,which will not stand scrutiny in criminal system.The word connotes use of coersion or battery.Inappripriate comments or gestures,without any physical contact,ahould be considered a lesser offence,under professional misconduct,and should be given lesser punishment.
-I know a colleague,who was charged just for touching the shoulder(form of petting),but was able to defend himself,after going through lot of stress.
‘Any sexual involvement with patients is harmful, is considered sexual abuse, and is never acceptable.’
-I think,this statement is rather vague pertaing to various related complaints received by college,and as well overriding the related sexual assault/battery definition used by Criminal-Justice syetem&hence can`t stand its ground.
-Comments or gestures,misconstrued&complained under sexual-rtelated professional misconduct or inappropriate behaviour,should be considered as lesser degree&deserving of lesser treatment.
-I know a colleague,who was complained to the College,for touching the shoulder of a patient(mere pat on the back),for sexually inappropriate behr,was able to defend himself successfully,but only after going though lot of agony&stress.
Recently the College asked for our views on a proposed fee increase, doctors overwhelmingly said ‘no’, the Council/Executive still went ahead and now the Ontario Government is cutting back on the fees paid to us for our services.
So will the Executive/Council pay any attention to our comments regarding the very difficult matter of sexual issues regarding patients?
I doubt it.
Sexual contact in the fullest sense of the term between physicians and patients should be prohibited. Not because of the outmoded notion of power balance – introduced by extremist feminists – but because it interferes with the doctor’s objectivity – in a similar manner to the other issue regarding treating members of our own families for anything but minor conditions.
But we have to be extremely careful that we do not allow an overly broad definition of “sexual abuse” to be introduced.
And as others have pointed out we have to be very careful not to interfere with the possible development of a genuine romantic relationship as long as there has been a significant period of time between the termination of the doctor-patient relationship and the commencement of the personal romantic relationship.
To me, a time period of 2 years seems reasonable.
As a psychiatrist I would also add that the notion of a permanent life-time ban for psychiatrists and ex-patients is also quite extreme and unacceptable. It is also based upon a false notion of a post-therapy power imbalance. If during the treatment the psychiatrist came to know much more about the patient than the patient did about the psychiatrist, then the time interval would contribute to a lessening of so-called transference distortions, and if some years later a ‘real’ mutually-sharing post-therapy relationship did not develop, then I think whatever relationship did develop would not survive well.
Canada has a cold climate with a very long winter during which people remain mostly indoors, dress in heavy winter clothing including heavy coats, hats, scarves, gloves, which all contribute to a considerably greater personal distance than is the case in many warmer climates. Such distancing may have led some people to think that any form of physical contact including an arm around the shoulder, a hug, is automatically sexual – and to some sexual abuse, which of course is not true.
The CPSO should not be giving in to such nonsense.
On the positive side, most of the recent cases reported in ‘Dialogue’ do seem to have been quite clearly cases of abuse.
But the possibility that any complaint – however erroneous or malicious and untruthful – may still become public, as is being pushed by some, must be firmly resisted as not being in the best interests of the public – because of the very negative effect it will have on us doctors serving the public.
If the public wants to have good doctors – and I think we all believe it does – then it must be seen through the CPSO to encourage doctors, not threaten them.
I fully support a zero tolerance policy to sexual abuse. In cases where abuse is alleged by a patient against a physician the College should investigate as quickly as possible and if there is strong evidence to suspect the member is guilty I would propose suspension until the investigation is complete and it is determined whether or not the member is indeed guilty.
I would also support guidelines regarding the conduct of physicians and their staff outside the office, clinic, or hospital. Physicians should refrain from inappropriate comments about their patients, by example, a comment on this size of someones breasts or whether or not a female patient lacks pubic hair. This should extend to the staff as well. I was in a colleague’s office once and two female members of his staff starting to talk to me (while I was waiting to see him) about penis size and how one of the girls preferred a circumcised penis. I responded by saying that “I’m not getting into this discussion” and they immediately stopped. The College should consider taking a position on this kind of behaviour.
My concern is that some physicians may misinterpret this in terms of how they deal with the issue of empowerment, namely that empowerment is always a bad thing, and therefore should be eliminated. This has the paradoxical effect of more vulnerability to boundary violations when physicians relate to patients in the name of “equality” , e.g. going on a first-name basis, self-disclosure, or other ways of relaxing or “casual-izing” the traditional structure of the doctor-patient relationship. The challenge here is that such measures may initially lead to the immediate gratification of relaxation of tension and may therefore be experienced by patients as positive, whereas a more formal structure may be perceived as cold, distant or uncaring, especially by emotionally needy patients who are the most vulnerable to abuse. This initial gratification caused by relaxation of structure can lead to a slippery slope phenomenon. Some physicians who have engaged in sexual relationships with patients have attempted to rationalize this on the basis that they were relating to the patient as equals. These physicians have clearly neglected, denied or minimized the power which is endowed to them within the physician-patient relationship.
So, the message should be that we as physicians must accept and respect, not minimize, the power of the doctor-patient relationship in order to ensure that this power is used cautiously and wisely, to help our patients and not harm them.
There needs to be accountability to our governing authorities. Sexual abuse cannot just be handled internally but needs to be reported to police and handled by our legal system.
I see many admirable changes here but one concerns me.
It seems that the proposed discretionary minimum period before a reinstatement application can be made also applies to sexual abuse (not just sexual impropriety) and thereby greatly softens the College position and penalty in perception and reality!
This will not be viewed in a positive light by the MOHLTC, the general public, or many College members.
Please reconsider this proposal so it includes only sexual impropriety.
As [an investigator] I have some familiarity with the above captioned subject.
CPSO investigators ought to be trained in Sexual Assault investigations by the Ontario Police College (OPC) in Aylmer Ontario so that they are fully cognizant of the essential ingredients that constitute sexual assault as opposed to ‘sexual abuse’.
The issue of consent (and in the instance of medical treatment, informed consent) is at the epicentre of every CPSO investigation of ‘sexual abuse’ and is at the same centre in respect of criminal investigations of allegations of sexual assault.
Arguably physicians may be deemed to be persons of authority depending upon the nature of the physician/patient relationship, or contract if one prefers. Consent is vitiated whenever a complainant views the physician as a person of authority as opposed to simply someone they trust and depend on to do them no harm.
CPSO investigators ought to assume that every allegation of ‘sexual abuse’ or sexual impropriety they investigate is in reality, an allegation or allegations of sexual assault, and understand that he or she may become the first person to whom a complainant discloses sexual assault as described by the Criminal Code. The investigator who becomes the first recipient of the disclosure faces greater involvement when the police are notified than simply conduits of information; they may become key witnesses for the Crown should a criminal charge be brought against the subject physician.
I encourage your management directorate to inquire of the OPC as to special arrangements being made for your investigative personnel (if not already in place) to acquire the OPC’s specialized training in sexual assault investigations. Certification by the OPC for your personnel in this regard is bound to stand up to the rigors of any tribunal or court when the investigation – and not the complaint – is called into question.
All of which is respectfully submitted.
Thank you for providing me with the opportunity to provide feedback to this process.
My thoughts are the out line lacks teeth and power for the community and may not be implemented equitably to all communities in the Provence
Other thoughts around stigma in communities that would prevent an individual from coming forward combined with the the colleges limited relationship with communities is problematic
There is also a certain amount of privilege in the manner in which the college is soliciting feed back that will leave out vulnerable sections of our communities such as refugees, youth, and individuals who do not have English or French as their first language etc. as a result their voices may not be heard in this process.
College of Physicians and Surgeons of Alberta Response in PDF format.
Information and Privacy Commissioner of OntarioResponse in PDF format.
Professional Association of Residents of OntarioResponse in PDF format.
Response in PDF format.
Ontario Medical AssociationResponse in PDF format.