How system helps shield bad doctors
College admits flaws in process
ROBERT CRIBB, RITA
DALY AND LAURIE MONSEBRAATEN
You've just been diagnosed with cancer. You're scheduled for surgery
in a few weeks by a doctor you hardly know.
In Ontario - and across Canada - provincial laws governing doctors
say you can't find out if your surgeon has been hauled before the
physicians' watchdog for complaints of malpractice, even for the exact
operation you're facing. You aren't told if the surgeon is under
investigation now, or has a spotless record.
The medical complaints system is cloaked in secrecy.
Since discipline procedures at the College of Physicians and Surgeons
of Ontario can take three years, some dangerous doctors continue
practising without patients knowing there may be a risk.
In the last six years, the college investigated 13,000 complaints
about doctors. Of those, 99 per cent were either dismissed outright or
handled internally and in secret.
We can learn nothing about them. The college, which says it is bound
by privacy provisions in the Regulated Health Professions Act, will not
reveal the names of the doctors involved, how many had complaints
against them, the nature of the complaints or how they were handled.
The only window into a doctor's competence, integrity and past
professional conduct is a public disciplinary hearing conducted by the
A Toronto Star investigation shows that since 1994, when new
legislation governing doctors came into effect, only 141 complaints have
reached this stage.
Of 13,000 complaints
lodged against doctors, 99 per cent were either dismissed or handled
in secret by the College of Physicians and Surgeons of Ontario
Data on those cases, compiled by The Star using the college's public
records, reveal a disciplinary system that typically hands out lenient
penalties, rarely revokes licences, can take years to render decisions
and puts doctors on higher legal footing than complainants.
The Star's data show that 111 doctors have been found guilty of
offences ranging from fraud, drugging and sexually assaulting patients
and missed diagnoses, some causing death. Of those, 34 received the
college's maximum penalty - licence revocation.
The majority of sanctions handed out were suspensions averaging less
than three months or reprimands, usually with some conditions, such as
cash fines, additional training or letters of apology.
Ontario's college took an average of three years to reach those
decisions - tied with Manitoba as the slowest medical disciplinary
system in Canada.
The overwhelming majority of Ontario's 20,480 practising doctors -
skilled professionals dedicated to meeting the highest standards of care
- has never been the subject of a college disciplinary hearing. They may
face a minor complaint or two over the years but for the most part their
records are clean.
But some physicians who have done great harm are allowed to continue
Dr. Kenneth Bradley, a former Milton chief surgeon, was twice was
found guilty of medical negligence involving patients who died. Still,
Bradley kept his licence and later moved to Virginia, where he was
implicated in another four deaths.
Dr. Stanley Dobrowolski, a London, Ont., psychiatrist, was
disciplined three times for sexually related offences. He is still
Dr. Anthony Laws, who practises in Oakville, falsified documents to
cover up his role in the death of a 14-year-old patient under his care.
People who feel they have been harmed by a physician can seek damages
through the courts. But the self-governing College of Physicians and
Surgeons of Ontario is the only authority that can suspend or revoke a
The Ontario Medical Association, which speaks for the province's
doctors, believes the college is doing an ``exemplary job'' of
protecting the public and guiding the profession.
Dr. Alex Schumacher, the OMA's immediate past president, says the low
discipline rate is a reflection of the province's high licensing
standards compared to other jurisdictions.
But the college itself acknowledges the system should be more open
and must resolve patient complaints more quickly.
`We have to act before
the public loses confidence.'
|- Dr. Rocco Gerace
President of the College of
Physicians and Surgeons of Ontario
``We have to act before the public loses confidence,'' says college
president Dr. Rocco Gerace.
And that means getting tougher on dangerous doctors, say some college
``Clearly there has been less than effective identification of those
(doctors) who have serious problems that need addressing,'' says Dr.
David Walker, dean of health sciences at Queen's University and co-chair
of the college's complaints committee.
Last year in Ontario, 21 doctors had their licences revoked or
During the same period, Michigan, with a similar number of
physicians, suspended or revoked the licences of 102 doctors. In
Massachusetts, another comparable jurisdiction, it was 45.
In Ontario and elsewhere, most doctors can keep practising while they
are being investigated. But in a growing number of states, information
about doctors under investigation is posted on Web sites for anyone to
Gerace doesn't think the American focus on discipline gets to the
heart of the matter.
``Their measure of success is their percentage of discipline
referrals. I would suggest to you that a discipline referral is a
``We have to balance the will of the public for revenge - an eye for
an eye and a tooth for a tooth - versus what's best for the public
interest, which is having doctors deliver better care. Do we need to
have a few examples out there? Just beat someone up?''
Gerace says that while U.S. jurisdictions rely solely on discipline,
Ontario has developed unique programs to assess and retrain doctors
whose skills are lacking.
The philosophy reflects the college's belief that most doctors who
have made clinical mistakes are anxious to improve and will become
better doctors through education rather than punishment.
But according to a recent government report about the discipline
process, there is no system in place to ensure this approach is actually
The government-commissioned report expressed concerns that the
quality assurance program ``may not be the appropriate response'' for
patient complaints about doctors.
And since the process is handled entirely behind closed doors,
there's no way patients or the public can judge whether their complaint
was handled adequately.
That secrecy is only lifted when complaints trigger disciplinary
In the past six years, the majority of those hearings - 77 out of 141
- concerned sexual misconduct, followed by cases involving patient
deaths (19), and psychological harm inflicted by doctors (10).
Other offences that went to disciplinary hearings included fraud,
physical injuries and faulty record keeping.
The focus on sex-related cases reflects the college's zero-tolerance
policy, adopted in 1994 following a provincial government task force
that estimated 10 per cent of Ontario doctors had sexually abused a
patient at some time.
The Star data show that 25 of the 61 doctors found guilty of
sex-related complaints had their licences revoked, 24 received
suspensions averaging 3* months, 10 received reprimands and two quit
Zero tolerance covers anything from inappropriate touching to
consensual intercourse to rape. The Ontario Medical Association is
currently challenging this policy before the courts as a Charter of
Rights and Freedoms issue.
The Star data shows that in at least four cases, physicians allowed
to continue practising went on to repeat the same offence.
Dobrowolski, the psychiatrist from London, Ont., is a prime example.
He has appeared before the college three times since 1994 on
complaints ranging from hugging, kissing, fondling and sexual
intercourse with patients.
At his second appearance, in 1996, the panel concluded Dobrowolski
demonstrated ``an extremely worrisome pattern of behaviour.''
Dobrowolski received a short suspension and two reprimands but never
lost his licence. He continues to treat patients in London.
``It (the disciplinary system) is such an unpleasant process from the
point of view of a physician that even just talking about it brings back
bad memories,'' he said, when contacted by The Star. ``You try and put
it behind you and get on with life.''
Many doctors see the college as an adversary that often dishes out
Of the 19 cases of death under physician care that reached the
disciplinary committee since 1994, no fault was found in five.
In the other 14 deaths since 1994, the college did lay blame on
substandard care. Three of the 14 doctors had their licences revoked,
while the rest were handed reprimands or given short licence
On Aug. 20, 1993, Tom and Patricia Bain buried their only son,
14-year-old Jonathan. At the time, the Mississauga couple were told his
death was caused by a viral infection.
The family contends that tests later revealed prescribed drugs caused
the teenager's death. They complained to the college that Oakville
physician Anthony Laws covered it up.
Throughout the process, Laws continued to practise with a clean
College documents show Laws first prescribed the drug Cylert, which
has been linked to liver problems, to treat Jonathan's Attention Deficit
Disorder (ADD) in 1992.
In July, 1993, the boy was admitted to hospital with severe liver
problems. He died after undergoing two liver transplants.
Following the teen's death, tissue tests revealed Cylert was the
cause of Jonathan's liver failure, according to the family.
The Bains complained to the college that Laws ``never told us of the
risk in advance, he never monitored our son when he was on the drug, he
never ordered blood tests despite the risks.''
The Bains are upset that Laws prescribed Ritalin, another ADD drug,
along with Cylert.
``He was experimenting with our son,'' Tom Bain told The Star.
But at the hearing, medical competence wasn't the focus. The panel
was more concerned about Laws' conduct after Jonathan's death, ruling
that he falsified letters to the Bains' family doctor and entries in
Jonathan's chart and failed to warn them about the risks of liver
``Our complaint was never dealt with because our complaint was never
for forgery, falsification or perjury,'' Bain says. ``It was for the
In June, 1999, Laws was found guilty of professional misconduct and
handed a six-month suspension, reduced to three for meeting conditions
such as seeking psychiatric treatment and upgrading his skills.
`He should have been
|- Tom Bain
referring to the family's complaint
about Dr. Anthony Laws
|`(Laws) felt the
disciplinary decision was fair and he didn't have any complaint
about the process.'
|- Tom Curry
``He should have been revoked,'' says Bain. ``The system failed us.''
Tom Curry, the Toronto lawyer representing Laws, said his client
``felt the disciplinary decision was fair and he didn't have any
complaint about the process.''
Like all complainants, the Bains had no official standing before the
college, acting merely as witnesses in the case.
College lawyers, much like crown attorneys, act on behalf of the
system, not the individual. Complainants cannot call witnesses or ask
If complainants want their own legal advice, they must pay for it
On the other side of the room, money is no object for doctors. The
Canadian Medical Protective Association (CMPA), which represents more
than 90 per cent of doctors in Ontario, picks up the tab for top legal
Doctors, in turn, are reimbursed with public money for most of the
insurance premiums they pay. This year, it is expected the province will
pay just under $70 million out of total malpractice premiums of about
``I've walked out of college hearings thinking physicians are
protected far more than they deserve,'' says Toronto lawyer Barry
Swadron, who has represented several clients in complaints against
``Doctors stick together. If a fight is involved, the odds against
the victim are astronomical.''
College president Gerace dismisses the claims of a power imbalance
between doctors and complainants, saying the system is designed to
protect the public interest.
``The analogy is the criminal system. If someone gets drunk and kills
my child, I want to be a party to that but I'm not. The prosecutor is
there to protect the public interest,'' he says.
``We're there to ensure that either a physician is found to be okay
or is found to be wanting and that the correct steps are taken.''
Investigative reporter Robert Cribb can be reached at: