Dialogue Volume 13 Issue 4 2017 - Page 69

DISCIPLINE SUMMARIES DR. FRANCESCA ANNE DI PAOLA PRACTICE LOCATION: Toronto AREA OF PRACTICE: Family Medicine (Addiction Medicine) HEARING INFORMATION: Agreed Statement of Facts, Admission, Joint Submission on Penalty On October 27, 2016, the Discipline Committee found that Dr. Di Paola has committed an act of professional misconduct, in that she has engaged in conduct or an act or omission relevant to the p ractice of medicine that, having regard to all the circum- stances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, specifi- cally, by repeatedly accessing confidential and sensi- tive personal health information of Patients A and B without consent or legal authority, when she knew she had no authority to do so, and by acting in a conflict of interest in relation to Patient A’s care. Dr. Di Paola, a family physician, practises in the area of addiction medicine at the Centre for Addic- tion and Mental Health (CAMH) in Toronto. Dr. Di Paola had a close personal connection to Patients A and B. Both Patient A and Patient B accessed services at CAMH. Patient A was an in-patient at CAMH between April and May 2014. In February 2015, concerned about potential unauthorized access of his medical record by Dr. Di Paola, Patient B requested that a “lockbox” be imple- mented on his medical record at CAMH. A lockbox is a restriction on access to a patient’s medical record, imposed at the request of the patient. In Patient B’s case, he requested that access to his medical record be restricted to two specific physicians at CAMH. He also requested a list of all individuals who had ac- cessed his CAMH medical record at any time. On another date in February 2015, also concerned about potential unauthorized access of her medi- cal record by Dr. Di Paola, Patient A requested that a lockbox be implemented on her medical record at CAMH, on similar terms to those requested by Patient B. She also requested a list of all individuals who had accessed her CAMH medical record at any time. Dr. Di Paola's Access of Medical Records Pursuant to Patient A’s and Patient B’s requests, CAMH conducted an internal audit which revealed that Dr. Di Paola had accessed or attempted to ac- cess Patient A’s medical records on 10 separate dates between May 2012 and August 2014. The audit also revealed that Dr. Di Paola had accessed or attempted to access Patient B’s medical records on nine separate dates between May 2012 and September 2014. Dr. Di Paola did not have consent or any other le- gal authority to access the medical records of Patient A or Patient B on any occasion. In CAMH’s current database system, iCARE, which was implemented in May 2014, a physician must declare that he or she is in a treating relation- ship with the patient, and set out the nature of that relationship, in order to be granted permission to access a patient’s medical records. Dr. Di Paola at- tempted to access Patient A’s medical records through iCARE on a date in August 2014. She did not declare a treating relationship with Patient A, and so was not granted access to Patient A’s medical re- cords on that date. Dr. Di Paola attempted to access Patient B’s medical records through iCARE on a date in September 2014. She did not declare a treating relationship with Patient B and so was not granted access to Patient B’s medical records on that date. When Dr. Di Paola accessed Patient B’s medical re- cords through iCARE on a date in September 2014, she declared herself to be an “Attending Physician” in order to gain access. On that date, Dr. Di Paola was the attending physician on the unit where Patient B was a patient, but she did not have his consent or legal authority to access his medical records. Dr. Di Paola also accessed Patient B’s medical records through iCARE a few days later. On a later date in September 2014, Dr. Di Paola, having previously been the attending physician on Patient B’s unit, received an Inbox message sent to all of Patient B’s physicians at CAMH. Dr. Di Paola did not access Patient B’s medical records through iCARE on that date. The medical records of Patient A and Patient B accessed by Dr. Di Paola included personal health information of a very sensitive na- ture, namely information related to psychiatric and addictions issues. Patient A and Patient B expected that this information would be kept confidential. ISSUE 4, 2017 DIALOGUE 69