Dialogue Volume 13 Issue 3 2017 - Page 58

DISCIPLINE SUMMARIES The College retained another psychiatrist to pro- vide his opinion on the care and treatment Dr. Laws provided to Patient B. This expert opined that Dr. Laws did not demonstrate insight or acknowledge- ment with regards to the boundary issues, nor did he express any sense of responsibility with regards to his role in this doctor-patient relationship. Dr. Laws also did not provide an adequate explanation regarding his prescription of opiates to [Patient B], and did not mention the use of these drugs in subsequent reports to other physicians. REASONS FOR PENALTY The Committee considered that protection of the pub- lic from further misconduct by Dr. Laws to be of the utmost importance in this case. Mandatory revocation achieves this objective. It is also vital to maintain the public’s confidence in the College’s ability to self- regulate in the public interest. The penalty provides specific and general deterrence and communicates the profession’s disapproval of the misconduct. Aggravating Factors 1. D  r. Laws’ sexual abuse of Patient A occurred over a two year period. Patient A was younger, vulner- able, and in need of treatment by a physician. This clearly placed Dr. Laws in a position of authority and trust which he abused by seducing Patient A into an inappropriate personal relationship for the purposes of sexual exploitation. When a position of trust is found to have existed, this can be con- sidered an aggravating factor. The Committee felt strongly that a position of trust as well as a power imbalance existed in the relationship between Pa- tient A and Dr. Laws. Dr. Laws’ abuse of a vulner- able patient over the span of two years is a most disgraceful disregard of the fundamental principles of the profession. 2. Dr. Laws’ patients suffered because of his bound- ary violations. For example, Patient B became Dr. Laws’ tenant and employee, both of which are boundary violations in their own right. Dr. Laws even opened a joint bank account with Patient B into which Patient B’s social assistance payments were deposited. Dr. Laws also prescribed narcotic medication to Patient B without an adequate 58 DIALOGUE ISSUE 3, 2017 explanation while maintaining both the doctor-pa- tient and landlord-tenant relationship. In the same vein, Patient A told the College that “there isn’t really a clear boundary between friend and doctor and it’s always been kind of frustrating to me.” 3. Dr. Laws has not demonstrated an understanding or appreciation of how important boundaries are to the practice of medicine. The parameters of the doctor-patient relationship are at the core of the capacity to treat. Physicians are taught early in clinical training to provide care only according to the patient’s needs, not their own; to avoid harm to the patient; to respect the individual; and not to exploit the patient’s dependency on the physi- cian, while maintaining privacy and truthfulness. Trust, integrity, and a commitment to the patient’s well-being are essential to the provision of safety in the therapeutic environment. When he was first contacted by the College in 2009 and real- ized there were concerns about his conduct with Patient B, Dr. Laws ceased some of his boundary- violating behaviour. However, Dr. Laws continued to employ Patient B as recently as late 2012. 4. Dr. Laws displayed no insight into his behaviour. 5. Dr. Laws inverted the victimization phenomenon by claiming he was the victim. He accepted no responsibility of his role in the doctor-patient relationship. 6. Dr. Laws treated Patient A with stimulant medica- tions in high doses and on one occasion provided the patient with a cookie that had marijuana in it. After eating it, the patient developed paranoid psychotic symptoms, eventually being admitted to the hospital where he was treated for psychosis. This could have been related to the marijuana con- sumption, or a high dose of the stimulant medica- tion, or a combination of the two. The expert, on reviewing Patient A’s chart, felt the doses of stimu- lant medication exceeded the standard maximum. There was no regard for cardiovascular or psycho- sis risks related to these high doses. There is no evidence that Dr. Laws was monitoring these risks, and the use of an illicit drug, probably cannabis,