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Charges against a local doctor accused of voyeurism and sexual assault involving more than 50 people over three decades have reignited questions about the policies and legislation that are meant to protect patients.
Meanwhile, the medical clinic where Dr. Vincent Nadon worked has put up posters in all of its examination rooms advising patients that they can have another person present during a medical exam.
Nadon, 56, a physician with the University of Ottawa Health Services (UOHS) was charged with voyeurism in January after a patient complained that she was being filmed without her consent. Another 10 charges were laid in February. Last week, Ottawa police laid 43 additional charges of sexual assault and 40 counts of voyeurism for a total of 94 charges involving 51 victims.
Sen. Marilou McPhedran is a former human rights lawyer who has been on three provincial task forces that have reviewed legislation covering sexual abuse for 23 self-regulating health-care professions.
There has been a “crisis of confidence” in these regulatory bodies, especially the College of Physicians and Surgeons of Ontario, McPhedran says. In the course of her work over 25 years, she has heard from patients who have turned to police after getting an unsatisfactory response from the college.
“This is about public safety. We are all patients.”
It’s unknown if Nadon’s patients tried to report to the College of Physicans and Surgeons of Ontario before going to police, said McPhedran. But whether patients report their complaints to police or to the college, they still face hurdles. McPhedran would like to see patients have full status at hearings and trials. In both the college complaints system and the courts, patients can be witnesses and complainants, but they don’t have their own legal representation, she said.
“Their voices are stifled by the rules of procedure. In the arena in which they have to do battle, they have one hand tied behind their back.”
Health professionals and organizations are required by law to report suspected cases of patient sexual abuse to their regulatory colleges. The provincial fines recently doubled to $50,000 for an individual and $200,000 for an organization for failing to do so. But the province has never used that power, McPhedran said.
“While legislation places clear responsibility on institutions, institutions have never actually been fined.”
The executive director of the clinic where Nadon worked, Christopher Fisher, said the clinic reviewed its policies and procedures after the first patient complaint was made in January.
UOHS now has a bilingual, 11 x 17-inch poster prominently displayed on the wall of every exam room.
“One thing we did change was to be more explicit in our reminders to patients that they are always able to request the presence of a staff member, or trusted person they bring with them, during an encounter with any of our health professionals.”
As of Friday last week, UOHS had sent email notices to 2,085 people who had been patients in Nadon’s practice at the time of his arrest to inform them of the new charges and to provide contact information for the Ottawa police. The clinic did not have email addresses for another 150 patients, and sent them letters, said Fisher. These patients would have seen Nadon at least once in the past five years.
About 51,500 patients of the clinic, who were not Nadon’s patients but who may have seen him in various contexts, were also sent emails to inform them of the newest developments, Fisher said.
This is not every patient who has ever potentially come in contact with Nadon. The clinic’s data base has patient information dating back to 2001, but the clinic will not be contacting everyone who has ever been a patient since Dr. Nadon has been a provider, nor will it be contacting those who were once in his practice but have long since moved on, Fisher said.
The clinic has had extensive policies to protect patients from breaches of privacy and personal health information for many years, he said.
“We regularly review our policies and procedures and provide privacy and professional conduct training for all staff and providers on an ongoing basis. We also use a variety of means to actively monitor for breaches and have a robust reporting system to catch and disclose any breaches, should they occur.”
Claire Daigle, a former Nadon patient who was visiting another doctor at the Rideau Street clinic Thursday, said this was the first time she had seen a notice about having someone else present.
Daigle has been a patient for 23 years and has never had anyone else with her during an exam. She never saw a reason for it.
“He was always respectful to me,” she said. “I thought he was a very good doctor.”
Another of Nadon’s patients, who declined to be named, said she she “never felt uncomfortable with Dr. Nadon. … He was wonderful.”
Shae Greenfield, a spokesman for the college, said abuse of a patient by their doctor is a violation of a doctor’s ethical obligations, an abuse of their power and represents professional misconduct and the college vigorously investigates and prosecutes sexual abuse cases.
“Although allegations of this nature are rare, we take them very seriously — and take appropriate steps to investigate and protect patients.”
In its latest report, the task force recommended removing the responsibility of processing and adjudicating complaints from the college and creating a centralized regulatory body and an independent tribunal. That hasn’t happened.
“If the plane crashes, do you want the airline looking into it?” said Sheila Macdonald, a member of the task force.
Greenfield said the college has a specialized team of investigators that includes former police officers, lawyers and prosecutors who have training and experience in these matters, as well as an understanding of the unique factors related to sexual abuse in a medical setting.
“Given our extensive experience and expertise in in adjudicating these complex matters, we continue to believe that the college is best positioned to investigate and pursue appropriate action in these matters.”
Q: What are medical schools doing to screen students to prevent patient sexual abuse?
A: As students, physicians get a clear understanding of the boundaries between patients and physicians, says Geneviève Moineau, president of the Association of Faculties of Medicine of Canada.
When it comes to physical examinations, it is recommended that doctors have another person, such as a nurse, present in the room when examining opposite-gender patients. This is now deemed a best practice, although it is not always reality, she said.
Medical school candidates are screened for inappropriate behaviour through the process of in-person interviews, strong letters of recommendation and a police check for work in the vulnerable sector. “Unfortunately, there is no magic test. If that test existed, we would be the first to implement it,” Moineau said.
Q: How has Ontario law changed to protect patients?
A: Since 2016, the provincial government has enacted a number of initiatives into law, says David Jensen, a spokesman for the Ministry of Health and Long-Term Care.
The changes include expanding the list of acts that will result in the mandatory revocation of a health professional’s licence, including sexual touching that is not of a clinical nature and inappropriate to the service provided. The law also now prohibits sexual relations between a practitioner and a patient for a minimum of one year after the formal end of a patient-provider relationship.
As well, regulatory colleges may no longer allow a health professional to continue to practise on patients of a specific gender after an allegation or finding of sexual abuse. (In the past, after an allegation was made, a male practitioner may have been able to treat male patients and a female practitioner could treat female patients.)
The colleges have also been required to fund patient therapy and counselling from the moment a complaint of sexual abuse is made.
Q: What kinds of sexual abuse complaints can be made to the College of Physicians and Surgeons of Ontario?
A: There are four categories of complaints:
1. Privacy and respect (A doctor not providing the patient with enough privacy while they are putting on a gown or getting dressed after an examination, for example)
2. Inappropriate comments or gestures (Sexually suggestive remarks, asking the patient out on a date, or commenting on the patient’s attractiveness.)
3. Unnecessary or improper physical examinations (Subjecting a patient to more frequent breast, genital or pelvic examinations than would be considered medically necessary, or conducting a physical examination in a sexual rather than a medical way)
4. Sexual contact or assault (This could include anything from inappropriate touching to rape. It also includes any sexual contact between a doctor and patient that would otherwise be considered consensual.)
Q: How is a complaint to the college different from a complaint to police?
A: A police report is independent of a report to the college, says Staff Sgt. Alison Cookson of the Ottawa police.
If police receive a complaint about a criminal matter involving a doctor, the college is advised, but police do not release any details. Often, the college conducts a parallel but not joint investigation. Usually when the college learns of a police investigation, it suspends the doctor’s licence pending the outcome.
Of the four kinds of complaints that can be made to the college, only two kinds can lead to criminal changes: sexual contact or assault and unnecessary or improper examinations.
Q: What happens when a patient makes a complaint to the college?
A: If there is evidence that a doctor’s practice may pose a risk to patients, the college immediately takes action to protect the public. T6hat could result in a number of different steps, including suspending the doctor.
The complainant first speaks to the college’s intake co-ordinator, who has training in sexual abuse and a background in social work. If the patient decides to make a complaint, the matter is handed over to a college investigator.
Q: What can happen to a doctor?
A: The college’s inquiries, complaints and reports committee can suspend or restrict a doctor’s licence pending the completion of an investigation if the college believes that there is a risk of harm to the public.
If there is a disciplinary hearing, a lawyer is appointed to act as the prosecutor. The hearing is like a proceeding in a court of law. Evidence from the doctor and the patient is presented before a panel consisting of doctors and members of the public, similar to a jury. If the discipline hearing finds that the doctor has committed an act of professional misconduct or is incompetent, the doctor’s licence can be revoked or suspended or terms, conditions or limitations may be imposed.
jlaucius@postmedia.com
查看原文...
Meanwhile, the medical clinic where Dr. Vincent Nadon worked has put up posters in all of its examination rooms advising patients that they can have another person present during a medical exam.
Nadon, 56, a physician with the University of Ottawa Health Services (UOHS) was charged with voyeurism in January after a patient complained that she was being filmed without her consent. Another 10 charges were laid in February. Last week, Ottawa police laid 43 additional charges of sexual assault and 40 counts of voyeurism for a total of 94 charges involving 51 victims.
Sen. Marilou McPhedran is a former human rights lawyer who has been on three provincial task forces that have reviewed legislation covering sexual abuse for 23 self-regulating health-care professions.
There has been a “crisis of confidence” in these regulatory bodies, especially the College of Physicians and Surgeons of Ontario, McPhedran says. In the course of her work over 25 years, she has heard from patients who have turned to police after getting an unsatisfactory response from the college.
“This is about public safety. We are all patients.”
It’s unknown if Nadon’s patients tried to report to the College of Physicans and Surgeons of Ontario before going to police, said McPhedran. But whether patients report their complaints to police or to the college, they still face hurdles. McPhedran would like to see patients have full status at hearings and trials. In both the college complaints system and the courts, patients can be witnesses and complainants, but they don’t have their own legal representation, she said.
“Their voices are stifled by the rules of procedure. In the arena in which they have to do battle, they have one hand tied behind their back.”
Health professionals and organizations are required by law to report suspected cases of patient sexual abuse to their regulatory colleges. The provincial fines recently doubled to $50,000 for an individual and $200,000 for an organization for failing to do so. But the province has never used that power, McPhedran said.
“While legislation places clear responsibility on institutions, institutions have never actually been fined.”
The executive director of the clinic where Nadon worked, Christopher Fisher, said the clinic reviewed its policies and procedures after the first patient complaint was made in January.
UOHS now has a bilingual, 11 x 17-inch poster prominently displayed on the wall of every exam room.
“One thing we did change was to be more explicit in our reminders to patients that they are always able to request the presence of a staff member, or trusted person they bring with them, during an encounter with any of our health professionals.”
As of Friday last week, UOHS had sent email notices to 2,085 people who had been patients in Nadon’s practice at the time of his arrest to inform them of the new charges and to provide contact information for the Ottawa police. The clinic did not have email addresses for another 150 patients, and sent them letters, said Fisher. These patients would have seen Nadon at least once in the past five years.
About 51,500 patients of the clinic, who were not Nadon’s patients but who may have seen him in various contexts, were also sent emails to inform them of the newest developments, Fisher said.
This is not every patient who has ever potentially come in contact with Nadon. The clinic’s data base has patient information dating back to 2001, but the clinic will not be contacting everyone who has ever been a patient since Dr. Nadon has been a provider, nor will it be contacting those who were once in his practice but have long since moved on, Fisher said.
The clinic has had extensive policies to protect patients from breaches of privacy and personal health information for many years, he said.
“We regularly review our policies and procedures and provide privacy and professional conduct training for all staff and providers on an ongoing basis. We also use a variety of means to actively monitor for breaches and have a robust reporting system to catch and disclose any breaches, should they occur.”
Claire Daigle, a former Nadon patient who was visiting another doctor at the Rideau Street clinic Thursday, said this was the first time she had seen a notice about having someone else present.
Daigle has been a patient for 23 years and has never had anyone else with her during an exam. She never saw a reason for it.
“He was always respectful to me,” she said. “I thought he was a very good doctor.”
Another of Nadon’s patients, who declined to be named, said she she “never felt uncomfortable with Dr. Nadon. … He was wonderful.”
Shae Greenfield, a spokesman for the college, said abuse of a patient by their doctor is a violation of a doctor’s ethical obligations, an abuse of their power and represents professional misconduct and the college vigorously investigates and prosecutes sexual abuse cases.
“Although allegations of this nature are rare, we take them very seriously — and take appropriate steps to investigate and protect patients.”
In its latest report, the task force recommended removing the responsibility of processing and adjudicating complaints from the college and creating a centralized regulatory body and an independent tribunal. That hasn’t happened.
“If the plane crashes, do you want the airline looking into it?” said Sheila Macdonald, a member of the task force.
Greenfield said the college has a specialized team of investigators that includes former police officers, lawyers and prosecutors who have training and experience in these matters, as well as an understanding of the unique factors related to sexual abuse in a medical setting.
“Given our extensive experience and expertise in in adjudicating these complex matters, we continue to believe that the college is best positioned to investigate and pursue appropriate action in these matters.”
•••
Q: What are medical schools doing to screen students to prevent patient sexual abuse?
A: As students, physicians get a clear understanding of the boundaries between patients and physicians, says Geneviève Moineau, president of the Association of Faculties of Medicine of Canada.
When it comes to physical examinations, it is recommended that doctors have another person, such as a nurse, present in the room when examining opposite-gender patients. This is now deemed a best practice, although it is not always reality, she said.
Medical school candidates are screened for inappropriate behaviour through the process of in-person interviews, strong letters of recommendation and a police check for work in the vulnerable sector. “Unfortunately, there is no magic test. If that test existed, we would be the first to implement it,” Moineau said.
Q: How has Ontario law changed to protect patients?
A: Since 2016, the provincial government has enacted a number of initiatives into law, says David Jensen, a spokesman for the Ministry of Health and Long-Term Care.
The changes include expanding the list of acts that will result in the mandatory revocation of a health professional’s licence, including sexual touching that is not of a clinical nature and inappropriate to the service provided. The law also now prohibits sexual relations between a practitioner and a patient for a minimum of one year after the formal end of a patient-provider relationship.
As well, regulatory colleges may no longer allow a health professional to continue to practise on patients of a specific gender after an allegation or finding of sexual abuse. (In the past, after an allegation was made, a male practitioner may have been able to treat male patients and a female practitioner could treat female patients.)
The colleges have also been required to fund patient therapy and counselling from the moment a complaint of sexual abuse is made.
Q: What kinds of sexual abuse complaints can be made to the College of Physicians and Surgeons of Ontario?
A: There are four categories of complaints:
1. Privacy and respect (A doctor not providing the patient with enough privacy while they are putting on a gown or getting dressed after an examination, for example)
2. Inappropriate comments or gestures (Sexually suggestive remarks, asking the patient out on a date, or commenting on the patient’s attractiveness.)
3. Unnecessary or improper physical examinations (Subjecting a patient to more frequent breast, genital or pelvic examinations than would be considered medically necessary, or conducting a physical examination in a sexual rather than a medical way)
4. Sexual contact or assault (This could include anything from inappropriate touching to rape. It also includes any sexual contact between a doctor and patient that would otherwise be considered consensual.)
Q: How is a complaint to the college different from a complaint to police?
A: A police report is independent of a report to the college, says Staff Sgt. Alison Cookson of the Ottawa police.
If police receive a complaint about a criminal matter involving a doctor, the college is advised, but police do not release any details. Often, the college conducts a parallel but not joint investigation. Usually when the college learns of a police investigation, it suspends the doctor’s licence pending the outcome.
Of the four kinds of complaints that can be made to the college, only two kinds can lead to criminal changes: sexual contact or assault and unnecessary or improper examinations.
Q: What happens when a patient makes a complaint to the college?
A: If there is evidence that a doctor’s practice may pose a risk to patients, the college immediately takes action to protect the public. T6hat could result in a number of different steps, including suspending the doctor.
The complainant first speaks to the college’s intake co-ordinator, who has training in sexual abuse and a background in social work. If the patient decides to make a complaint, the matter is handed over to a college investigator.
Q: What can happen to a doctor?
A: The college’s inquiries, complaints and reports committee can suspend or restrict a doctor’s licence pending the completion of an investigation if the college believes that there is a risk of harm to the public.
If there is a disciplinary hearing, a lawyer is appointed to act as the prosecutor. The hearing is like a proceeding in a court of law. Evidence from the doctor and the patient is presented before a panel consisting of doctors and members of the public, similar to a jury. If the discipline hearing finds that the doctor has committed an act of professional misconduct or is incompetent, the doctor’s licence can be revoked or suspended or terms, conditions or limitations may be imposed.
jlaucius@postmedia.com
查看原文...
