discipline summaries The fact of Dr. Noriega having failed to comply with conditions of a previous undertaking, put in place specifically for the purpose of protecting the public, seriously undermines the submission of his counsel that the goals of penalty can be addressed by a proposed penalty which would include conditions on Dr. Noriega’s certificate of registration. The Committee has no confidence whatsoever that Dr. Noriega would now abide by conditions and restrictions on his practice, when he failed to do so in what is described as a deliberate demonstration of flagrant disregard, on a previous occasion. The Committee is struck by the particularly abhorrent nature of the sexual impropriety committed by Dr. Noriega with Ms X. This was a teenager who, in many respects, was the epitome of vulnerability. She had developed what she believed to have been a trusting therapeutic relationship with Dr. Noriega over a period of approximately one year. Dr. Noriega took advantage of her sexually, in a most egregious fashion, masturbating her to orgasm under the guise of a medical examination. Ms X was seriously traumatized as a result. Dr. Noriega is a pediatrician who took advantage of his position of trust and authority, derived from a physician/patient relationship, to sexually victimize, in a most intrusive and offensive fashion, a vulnerable teenager. In the view of the Committee, this easily falls within the range of “the most serious” forms of professional misconduct. It is deserving of the most severe penalty. It is self-evident that the public must be protected from pediatricians who sexually abuse their adolescent patients. Misconduct of this nature is likely to cause serious harm. The patients affected are often severely traumatized, as was Ms X. Their families, the wider community, and the medical profession as a whole are also harmed through the erosion of public confidence and trust in the profession. This Committee has been presented with no evidence which would assist in understanding the origins of Dr. Noriega’s deviant behaviour. If, as suggested by his counsel, Dr. Noriega’s certificate of registration was suspended for a limited period of time, he would be free to return to practice without any necessity for the risk factors pertaining to potential recidivism, whatever they may be, having been addressed. It is a 46 Dialogue Issue 3, 2016 reasonable inference, accordingly, that he would remain at risk for future misconduct of this nature. The fact that there are no allegations of subsequent sexual misconduct against him in the past 11 years does not inspire confidence in the Committee that the risk to the public has been eliminated. The circumstances of this case would in fact suggest otherwise; Dr. Noriega has demonstrated a pattern of transgressions separated by a lengthy period of time, and his previous behaviour demonstrates a complete disregard of the terms of his undertaking. This indicates to the Committee that there is a continuing risk to the public. Maintenance of public confidence in the integrity of the profession is of crucial importance in a case of this nature. In the view of the Committee, a strong statement of denunciation is required in order to ensure that public confidence is preserved. The Committee considered Dr. Noriega’s personal circumstances as outlined by his counsel, and the letters of support from families of some of his patients, which were filed on his behalf. The Committee accepts that the revocation of Dr. Noriega’s certificate of registration will have very serious consequences for him. This is to be expected under the circumstances. Significant hardship could well result. This issue, however, is not a central concern of the Committee. The Committee is concerned with arriving at a just penalty which, in all the circumstances of the case, achieves the goals of public protection, maintenance of public confidence in the integrity of the profession, and specific and general deterrence. In summary, the Committee ordered the following: revocation of Dr. Noriega’s certificate of registration; a public reprimand; and payment to the College in the amount of $40,140 for hearing costs. Order For complete details of the Order, please see the full decision at www.cpso.on.ca . Select Doctor Search and enter the Doctor’s Name. On November 25, 2014, Dr. Noriega appealed the decision on finding of the Discipline Committee to the Superior Court of Justice (Divisional Court). On March 8, 2016, the Divisional Court dismissed Dr. Noriega’s appeal and ordered him to pay costs in the amount of $10,000 to the College.