Dialogue Volume 13 Issue 3 2017 - Page 65

DISCIPLINE SUMMARIES referral to a gynecologist for contraception and a CT scan for chest and heart. Dr. Ramzy referred Ms. A to the cardiologist who was in the office the same day to manage her chest pain. Three days later, Ms. A returned to Pro Care Medi- cal Clinic, where she received care from Dr. Ramzy. Dr. Ramzy’s entry in Ms. A’s chart indicates that she attended that day for a CT scan for her chest, report- ing a chronic cough. On a date in September 2013, Ms. A attended Dr. Ramzy’s practice for a cardiac work report and a stress echo test. Dr. Ramzy’s entry reads: “she threatened me regarding her husband case, he died … 3 years ago, she wants money from me or she is going to complain to the College. She was told that nothing wrong in her husband case. I will not give her money if she wants to complain she can [sic].” Ms. A’s Complaints to the College In October 2013, Ms. A made two complaints to the College against Dr. Ramzy: one with respect to the care her late husband had received and one with respect to feeling “used” after Dr. Ramzy dated her for two months. The College obtained an independent opinion with respect to Dr. Ramzy’s care of Mr. B. The assessor found Dr. Ramzy to have met the standard of care. As such, the Inquiries, Complaints and Reports Committee took no further action with respect to Ms. A’s complaint about the care her husband re- ceived from Dr. Ramzy. Dr. Ramzy admitted that he committed an act of professional misconduct, in that he engaged in con- duct that, having regard to all of the circumstances, would reasonably be regarded by members as dis- graceful, dishonourable or unprofessional by plan- ning a social encounter during C’s medical appoint- ment and by treating Ms. A too soon, given their recent sexual relationship. REASONS FOR PENALTY The jointly proposed penalty consisted of a repri- mand, a three-month suspension of Dr. Ramzy’s cer- tificate of registration, and the term, condition and limitation on his certificate that he shall successfully complete a College-approved course on understand- ing boundaries. The proposed penalty also included the requirement that Dr. Ramzy pay the cost of a one-day hearing to the College within 30 days of the order. A penalty should express the profession’s abhor- rence of the physician’s behaviour and serve to main- tain the public’s confidence in the profession’s ability to self-regulate in the public interest. A penalty must send a strong message to the member himself, and to the membership at large, that such transgressions will not be tolerated by the College. The penalty must protect the public from such misconduct in the future. Finally, in as far as it is possible, the penalty should serve to help with the rehabilitation of the subject doctor. Physicians are called upon to provide professional services to trusting patients. By virtue of this fact, an inherent power imbalance exists in all doctor-patient interactions and relationships. The patient is the vul- nerable party. The physician is expected to maintain professional boundaries at all times. In addition to the expectation that these very basic tenets of medical practice are known to all registered physicians, the College publishes policies for all Ontario physicians to be very clear on their respon- sibilities. The Physician Treatment of Self, Family Members or Others Close to Them policy clearly states that “physicians must not provide treatment to a spouse, partner, or anyone else with whom they are sexually or romantically involved beyond the circum- stances of a minor condition or emergency, where no other qualified health-care professional is readily available.” Dr. Ramzy had a sexual relationship with Patient A which ended in August 2012. It is understandable that he provided emergent care to Patient A in the face of a cardiac problem in October of that year. In contrast to that first doctor-patient interaction which resulted in an urgent referral to a cardiologist, Dr. Ramzy admits, and his records show, that he went on to provide general care to Patient A in his family practice. He provided routine care including a flu shot, a gynecologic referral, and an assessment of an upper respiratory infection. The Committee is of the view that if Dr. Ramzy had initially maintained a clear doctor-patient boundary with Patient A when she returned to his office in July 2012, not for care for herself but for ISSUE 3, 2017 DIALOGUE 65