Monday, 30 April 2012

DOCTORS WHO LOSE THEIR LICENCE TO PRACTICE


Some of the text has a white background. It is merely an anomaly in the printing.

Doctors can practice medicine only if they have a license. A doctor must meet certain standards and expectations to receive a license, however if he does not continue to meet these standards and expectations, his medical license can be suspended or revoked by his state's Board of Medicine and in Canada, his province’s College of Physicians and Surgeons.  The purpose is not to punish the physician, but to protect the public. The state/province grants the Boards and the Colleges the authority based on its responsibility to maintain public health and the welfare of patients.



In the U.S. the license to practice medicine is granted independently by each state. The degree "Doctor of Medicine" (M.D.) or "Doctor of Osteopathic Medicine" (D.O.) is granted by a college or university with an accredited medical school. Therefore, if a doctor loses his licence, loses his authorization to practice in that particular state, not his title or degree. I believe that the same would apply in Canada and other countries.

Ontario doctors lose their licence to practice for a variety of reasons which are generally — medical incompetence, sexually abusing a patient and OHIP (Ontario Hospital Insurance Plan) fraud.

In the United Sates, each state has its own rules for licensing doctors. The Federal Government has nothing to do with it. However, if a doctor loses his license to practice in one state, it is difficult for him to get a license to practice in another state.
 
Complaints against the doctor are investigated. Then the state board may decide to interview him. Some doctors have their privileges cut back. For example, they can no longer prescribe certain kinds of medicines. They lose hospital privileges. Others lose their licenses to practice but it depends entirely on the decisions of the Medical Boards in the state where they are practicing medicine. This also applies in Canada.

Recently the state Medical Quality Assurance Commission and the Department of Health suspended the license of Coupeville dermatologist Dr. Donald Russell Johnson for allegations of patient abandonment.

The 51-year-old Whidbey Island resident had his medical license suspended. The Medical Quality Assurance Commission's charges against Johnson recounted how he closed his medical offices in Coupeville and Anacortes on July 1,2011 leaving about 33,000 patients without medical records. The charges state that Johnson closed his clinic without telling his patients and did not make arrangements for patients or other health care providers to have access to the records, in violation of professional conduct guidelines. He did not respond to the Medical Commission's request for information. He also was in arrears on rent payments to a storage facility where he kept patient records which may explain why he couldn’t produce them.

The charges also detail the experience of a person described as “Patient A” who Johnson had been treating and prescribing medication. The patient made several emergency calls to his office and emergency numbers to discuss concerns about the medicine, but the calls weren't answered.

Obviously, Dr. Johnson is not the kind of doctor people should visit when they are in need of medical assistance.

I remember many years ago being hired to investigate the complaints filed against a doctor in Detroit. He was an obstetrician and conducted the deliveries of babies in his clinic. After one of the babies was born, he and his nurse left the mother on the operating table and went out to lunch. When they returned, they discovered that the mother had died from loss of blood. Needless to say, the doctor lost his licence and was also sent to prison.

Three years ago, Dr. Krishnarao Rednam was the lead partner in a group of eye clinics across greater St. Louis, Missouri.  Now he's working in the back of a church in one of the nation's poorest communities.

His previous medical practice ended after an audit of St. Louis Eye Clinic revealed Rednam, 61, was billing Medicare insurance for expensive drugs, but injecting cheaper, still-experimental drugs into his patients' eyes. He also would sometimes split a single-use vial among multiple patients, billing each of them for a full dose. He repeated the actions at least 284 times, overcharging patients and their insurance more than $600,000. As investigators closed in, Rednam destroyed records to cover up his wrongdoing.

After a felony conviction for obstructing a health care investigation in 2008, Missouri regulators gave him the harshest penalty allowed by state law: They revoked his license and said he couldn't reapply for seven years.

But different states' medical boards have different rules, and a discredited doctor can move to a place where that state government might still let him practice. So the disgraced  Rednam went to Illinois, where a felony conviction does not automatically trigger the suspension of a medical license.

He arrived there in June 2009 at Trinity United Methodist Outreach Center, which faces a junkyard where two pit bulls roam. His name is stenciled in black spray paint over a sign advertising “Affordable Healthcare."

Rednam's story was part of a series of investigations by the Post-Dispatch this year into how patients are kept in the dark about problems with their doctors and hospitals, and a disciplinary system that seems geared toward protecting doctors' livelihoods. Rednam's case is proof as to how a doctor can keep practicing medicine even after a felony conviction and a suspension of his licence to practice.
 
Although most states revoke a license after a felony conviction, it's unfortunately rarely permanent.

Medical boards don't release statistics on how many active licensees are convicted felons. A Post-Dispatch analysis of Missouri and Illinois records identifies at least eight felons who either regained their license or never lost it. They include doctors convicted of possession of child pornography, false imprisonment, dealing drugs, child endangerment, persistent drunken driving, mail fraud and leaving the scene of a fatal car crash.

Arthur Caplan, chairman of the medical ethics department at the University of Pennsylvania, believes a doctor who has any felony conviction has demonstrated a lack of integrity and credibility. That would certainly apply to doctors convicted of offences as listed in the previous paragraph.

An Ontario anesthesiologist involved in the botched liposuction surgery that led to the death of Krista Stryland has lost his licence. A disciplinary committee of the College of Physicians and Surgeons of Ontario ruled Wednesday that Dr. Bruce Liberman should have his licence revoked, effective immediately. Liberman will also have to face a public reprimand at a future date and pay the college $62,000 in hearing costs within six months.

In the 35-page decision, the five-member committee said Liberman abdicated responsibility for Stryland during the time she was in his care. Calling the case “one of the most serious or most egregious” it has seen, the committee said revoking Liberman’s licence is warranted because of his “serious and repeated acts of professional misconduct in his care of Ms Stryland, his profound lack of judgment, his incompetence, his dishonesty, and his lack of insight.” It said taking away Liberman’s licence — the college’s most severe penalty — is necessary “to maintain public confidence in the medical profession.”

In a  sweeping investigation  of doctors in the United States paid by leading pharmaceutical companies to promote their drugs, the nonprofit ProPublica has found that hundreds have been accused of professional misconduct, lacked credentials or have been disciplined by state boards. Some lost their jobs or their license to practice. Despite those sanctions, many were paid up to several hundred thousand dollars each to educate other physicians.

For sex abuse of a patient, there is a mandatory licence ban of five years in the Province of Ontario as stipulated by the Regulated Health Professions Act. There is no offence for which there is a permanent licence ban — though in at least one case, the College denied reinstatement and recommended a permanent revocation of the licence.

In the month of April 2012, a London, Ontario neurologist and board member of London Health Sciences Centre was charged with Internet luring and communicating for the purpose of paying for sexual services of a person under 18-years of age. Neurologist Dr. Harvey Christopher Hyson, 41, was arrested after an investigation that began in April. A spokesperson for London Health Sciences Centre said the hospital spoke to police and confirmed the person arrested was Dr. Hyson. "We are taking the necessary steps to ensure he is not practicing at LHSC pending further information," said Cathy Cuylle, hospital spokesperson. If he is found guilty, should he be permitted to practice medicine again?

Some critics believe that doctors found guilty of sex abuse should not be allowed to practice again. Lawyer, Marilou McPhedran, a long-time critic of the disciplinary committee process said, “Doctors do not have the right to earn their living by being doctors.” He is right. It is the same with respect to driving a car. People don’t automatically have a right to drive motor vehicles on public roads as it too is a privilege. Like doctors, their privileges can be suspended or revoked.

The dean of the Global College at the University of Winnipeg, McPhedran chaired the College of Physician’s groundbreaking task force that recommended zero tolerance principles for sex abuse in 1991; she also led a review of the implementation of the law 10 years later. As of 2009, McPhedran says her research continued to conclude that doctors who had their licences revoked for sexual abuse should not be allowed to be reinstated.

In cases where doctors do get their licences back (information on their prior offences can be found through a search on the College website), the panel can impose restrictions, including unscheduled checks, posting of information in the doctor’s office, allowing practice only in a team setting, or only treating male patients over the age of 18.

The latter was a condition for Dr. David Stuart Lambert, a Toronto GP (general practitioner) who had his licence revoked in 2002 for sexual abuse of patients. He was reinstated in 2009. But when the college sent two private investigators masquerading as female patients to check up on him, Lambert sexually abused one of them, touching her breast.

He lost his licence again last year — making him the first doctor in Ontario to have his licence revoked twice. But from the health professional’s point of view, the members of a college are typically much harsher on their members than would be the police or another government agency. This would also apply to reinstatements as well. According to the College, there have been eight reinstatement applications since 2004. Five were granted and three were denied.

At a reinstatement hearing, the College’s counsel and the doctor’s lawyer can offer up witnesses, character references (from colleagues, friends and former patients) and experts to argue their case. Previous testimony and evidence from any criminal or civil trials are also included. Witnesses can include psychiatrists, neurologists and clinicians responsible for treating the doctor, as well as independent experts who have conducted risk assessments.

There is a flaw in the system with respect to using expert witnesses in sex offence cases. The College does not have a clear set of criteria for expert witnesses’ knowledge in cases of sexual abuse. The experts need to be qualified to say there is “virtually no possibility that the doctor (whose licence is suspended) is going to reoffend.” It is very difficult to make that kind of finding.

Sex-offending doctors and health professionals in the state of Illinois have been allowed to continue practicing on probation, virtually unmonitored, according to a  long-term investigation by the Chicago Tribune.

A Tribune reporter found that there were only three officials in the Illinois Department of Financial and Professional Regulation’s probation unit responsible for monitoring some 7,500 state-licensed individuals — spanning a variety of occupations, including health care and medicine — who have committed violations ranging from sexual misconduct to substance abuse.

Among that group, 1,098 are on probation — including 180 doctors and chiropractors — and none are routinely visited by a state official, the Tribune reports. In the case of health professionals, many continue to see patients and are left to self-monitor their own behavior. That is like telling your child to mark down on a piece of paper the number of times he steals a cookie from the cookie jar. The Tribune article began with a revealing anecdote:

State regulators waited nearly six years after Timothy Johnson was convicted of battery of a teenage patient to place the chiropractor on professional probation.

Dr. Johnson, who allegedly fondled the girl in his office, is now required to have a chaperone with him while treating female patients. But because no one verifies his self-reported activities, he could “take a drunk off the street” to serve in that role of supervising him. Since June 2009, he has received one visit from a probation official at his practice in Troy, New York. Johnson has admitted that the oversight is so lax, he doesn’t even know if he’s still on probation.

The same three state officials are also responsible for ensuring that the other 6,448 misbehaving professionals with revoked or suspended licenses do not practice illegally, including those whose licenses were revoked for sexual offenses. How they can do that is beyond reason.

Patients should be outraged if their medical board has allowed a doctor who is a convicted criminal to resume practicing, Caplan said. “Medical treatment depends on being able to trust your physician. You have to be able to share secrets, speak honestly, and talk about sensitive subjects.”

But doctors don't have to disclose their histories to patients. It's up to the patients to do their own research in news archives, county courthouses or government websites.
 
Illinois State Rep. Mary Flowers, D-Chicago, has sponsored legislation that would make doctors' criminal and malpractice records easily accessible. Flowers said doctors found guilty of felonies should be permanently stripped of their right to practice. "Can a bank robber go to work for a bank?" she asked. I also ask the following rhetorical question, “Can a child molester go to work at a day care?”

In cases where doctors in Ontario do get their licences back, there is information about their prior offences that can be found through a search on the College’s website. The courts and medical authorities that govern doctors treat doctors who rip of the public severely.

A doctor (Rednam) in the State of Missouri was sentenced to six months in prison and four months of home confinement, and fined $30,000. He agreed to repay $304,000 to Medicare and $65,000 to Medicare contractors. He and his four partners, who got a share of the overbilled money, agreed to repay $16,000 in patient co-pays, and the partners agreed to repay $252,000 although none of them was criminally responsible. The revocation of Rednam's Missouri license came up in July 2008, while he was in prison.

His attorney, Harvey Tettlebaum, conceded that the Missouri Board of Registration for the Healing Arts could revoke his client's license, but urged members to let him reapply for it at any time.

The board's president at the time, Dr. Jean Hausheer, also an ophthalmologist, called Rednam's actions "horrible, horrible" and said, “The potential for harm existed with what he did.” Board members criticized Rednam's care; Hausheer said she doubted that patients would know they were harmed and said no one could be sure what drugs were administered and when.

Tettlebaum repeatedly tried to portray his imprisoned client's crime as merely billing fraud, but he conceded, “It isn't clear if patients knew what drugs and dosages they got.” The board took a hard line at the hearing. One member noted that the board could ban Rednam for the maximum seven years “if we think he's a menace.” They did and that’s what the board did.

Finally, the board agreed that Rednam had a rare skill and that if he got his license back “it would be in the public interest to put him in a position where he could resume his good works.”

Citing that statement, Tettlebaum argued in court that the board had not justified a seven-year ban. An appellate court agreed, and the case was sent back to the board. Rednam and his attorney took it as another opportunity to plead for a second chance.
At a hearing on October 22, he tearfully read letters of support from family members, friends and patients. He admitted that he had brought dishonor to his extended family. Tettlebaum and Rednam spent an hour imploring the board to give the doctor a chance to reapply.

Tettlebaum said that not only was Rednam needed at Trinity Eye Clinic, but another group of clinics in Metro East was poised to hire him to treat needy diabetic patients. Tettlebaum insisted: “If you don't give him that chance, the public is not protected.”
But will the public really be protected from this doctor?

Tettlebaum told the board that Rednam saw patients at the eye clinic oince a week. Mike Adkins, 56, was having vision problems. After Adkins walked out from an hour-long exam, reporters asked him if he knew that Rednam had gone to prison. Adkins replied, “You're scaring the hell out of me. I would have liked to have been informed about that.” Rednam told reporters he had not disclosed his problems to any of his new patients. His excuse was, “No one has asked me about it.”

His office looks like any other doctor's office. A white coat hung from a coat rack. Business cards stacked on the front desk said, "Trinity Eye Clinic: We Care." A framed certificate on his wall recognized him for specialized training in ophthalmology. Board certification is the mark of a highly trained physician. But the American Board of Ophthalmology says he is not certified.

After an internal audit at Rednam's clinic revealed the dosing scam, his medical partners turned the case over to federal investigators. Rednam later admitted that he stayed in his office after business hours and destroyed patient files. Other employees told investigators they saw him leaving his office with bags of records.

The government ordered Rednam to tell his patients about the misdosing — or the FBI would do it for him. But the questionnaire sent by Rednam to 162 patients did not acknowledge any scam.

His letter told his patients they may have received one drug when they signed a consent form to get another. The letter asked patients "to assist in determining the effectiveness of the treatment" by filling out a simple questionnaire that asks about any changes in vision or side effects.

An alternative version of the letter sent to some patients suggested patients might have benefitted from Rednam's actions. It said that drugs might have been added to treatments to “enhance the effectiveness” and that doctors were “eager to determine” the results.

Gearline Holtgrave showed the letter she got in the mail to her daughter, who thought it was strange. Then she sought a lawyer's advice.

After news coverage of Rednam's arrest, Holtgrave sued the doctor for medical malpractice, blaming him for her loss of vision in her right eye. The case is scheduled to go to trial next year.

“Holtgrave is real angry, and I don't blame her,” said her attorney, Michael Stokes. He didn't think the questionnaire satisfied patient concerns, and no one ever called to explain the full story to her.

The fraud of switching and splitting drugs was motivated by greed, federal prosecutor Andrew Lay wrote in asking the court for 'serious punishment for Rednam.
But what really happens if a doctor wants his licence back?

The question has been a matter of debate for years, and while patients may not want to see an expelled doctor work in an office or operating room again, the College of Physicians and Surgeons in Ontario says the process of reinstatement is a rigid one.

That process is about to begin this month for two physicians, each of whom lost his licence some years ago for sexually abusing a patient.

In April, a five-day reinstatement hearing took place for Dr. Stephen Dawson, who lost his medical licence in May 2005. The family physician based in Barrie and Toronto — who previously came before a discipline committee for refusing to provide birth control pills and Viagra to unmarried people on religious grounds — was found guilty of professional misconduct by the College, for having oral sex with a woman he was treating with psychotherapy.

Later this month, Toronto pediatrician Dr. Jeffrey Seidman will also attend a reinstatement hearing. The former member of a sexual assault team at a Scarborough hospital had his licence revoked nine years ago after he sexually abused a 15-year-old patient, a girl he first saw when she was 12 to treat for depression and an eating disorder.

Each doctor will plead his case before a disciplinary committee that plays judge and jury which is made up of three members of the College and two members of the public. According to Lonny Rosen, a heath lawyer at the law firm of Rosen Sunshine LLP, the burden of proof falls squarely on the physician seeking reinstatement. He said that the doctors have to satisfy the panel that it’s in the public interest that he or she be reinstated.

The College takes a similar position that “public safety is paramount,” said spokesperson Jill Hefley.


I got the following information from an article that was originally published in ‘Monday Magazine’ in which the article was written by Rob Wipond in 1998.
 
I will tell you the story of a pysiciatrist who worked out of the Eric Martin Pavilion psychiatric hospital in Victoria as that facility’s former chief of psychiatry between 1983 and 1989. He also had a private practice in Victoria between 1979 and 1991. His name is Dr. Frank Gordon Johnson.
 
As a psychiatrist, Dr. Johnson worked in Ontario but while there, his licence to practice in that province was permanently revoked in 1993 after it was determined that he drugged and repeatedly sexually assaulted two of his patients The Ontario College of Physicians and Surgeons had determined that Johnson was guilty of medical incompetence and sexual impropriety, and for this reason, the College declared him “unfit to continue in practice”.
 
Now what I find most disturbing is that when he then moved to Victoria, B.C, no one there chose to seriously consider his past as a psychiatrist in Ontario. If they had, surely he wouldn’t have been permitted to practice in B.C. or work as a psychiatrist at the Eric Martin Pavilion psychiatric hospital in Victoria as an employee let alone as its chief psychiatrist. If they were really concerned about his past indiscretions in Ontario  and still gave him a licence to practice in B.C., then the shame falls on the medical authorities in that province who turned a blind eye towards his past. 
 
Who in his right mind would hire a psychiatrist who was convicted of administrating drugs into two of his female patients that put them into a ‘zombie-like’ state so that he could repeatedly sexually abuse them?
 
Despite his horrendous past, this horrible man was granted a one-year renewable licence to practice as a psychiatrist in British Columbia by the B.C. College of Physicians and Surgeons, the physician-run organization with authority for licensing and maintaining professional standards. According to that College, they later said that Johnson was a member in good standing.
 
I think that there is something very grotesque about a decision like that. If the man was molesting small children as their psychiatrist, (which there was no evidence of that) would he still be licenced by that College? If he was, then the parents who would bring their small children into his office would not know of what possible risk he might have brought upon those children. I think once it has been determined that a doctor committed a sexual crime; he should never be permitted to practice medicine again.
 
It is most unfortunate that out-of-province disciplinary decisions are never put on a doctor’s publicly available record in British Columbia.  Regulations and standards are different from province to province so when a medical licence is revoked in one province, it doesn’t necessarily mean that the doctor will be refused a licnce to practice medicine in another province. I do know of one instance where a doctor lost his licence in Ontario and moved to Saskatchewan to practice medicine but later, the authorities there realized that they made a mistake and subsequently he was fired from the hospital that employed him in that province. If they had done due diligence and checked his credentials in Ontario, they wouldn’t have hired him to be a doctor in the hospital in the first place.
 
Most professional records regarding Johnson’s work in Victoria were confidential, and for this reason, the findings by the Ontario College of Physicians and Surgeons with respect to his sexual abuse allegations would be difficult for the pubic to read because they would be scattered through a variety of records–virtually none of which were available to the public. Further, if there were complaints lodged with the B.C. College, they would also not be considered as public information.
 
It would appear that permanent revocations are reserved for only the most extreme cases. It is beyond my understanding that such a College in B.C. would not consider drugging patients into zombie-like states so that they can be sexually abused by their doctor, be considered an extreme case of abuse worthy of permanent revocation of a licence to practice medicine in any form whatsoever. Ontario made his revocation permanent but B.C. didn’t which makes me suspicious of doctors in that province. How many of them are incompetent or sexually abusive to their patients and have been forgiven by the College of Physicians and Surgeons in that province?
 
I am afraid that our Colleges of Physicians and Surgeons in Canada are in need of revamping. They are supposed to protect the public more than the doctors they govern. Is their treatment of bad doctors any different than having your six-year-old child govern your four-year-old when the latter has his or her hand in the cookie jar?  Are the Americans doing any better?

1 comment:

Sari Crossman said...

This story contains an error. Dr. Harvey Christopher Hyson lives in London, ONTARIO in Canada. Though Canada is technically considered to be part of the United Kingdom, it is a separate country.