Dialogue Volume 13 Issue 4 2017 - Page 72

DISCIPLINE SUMMARIES - Garbage cans in examination rooms and common areas were filled with garbage; - The radiator in the examination room was peeling paint and the paint chips were lying on the floor around it; - Dr. Dubins’ office was cluttered with numerous items including soft drink bottles covered in dust; - Blinds in the examination room were stained and dusty; - Paint on the walls was peeling; and - A plant pot at the front door was filled with dirt and garbage; there was no plant. In response, Dr. Dubins explained that he used “Aversive Imagery” techniques in his hypnotherapy practice, and that patients (including Patient A) are informed of and consent to the use of these tech- niques. He explained that the purpose is to develop strong negative associations with the behaviour that the patient seeks to stop (such as smoking). For ex- ample, he stated, when he asked Patient A to imagine a cigarette in “fishy-smelling vaginal discharge”, his intention was to create a negative association with the taste and smell of cigarettes to assist Patient A in quitting smoking. He also said he asked Patient A to undo his belt and pants button and lower his fly approximately one inch in order to make him more comfortable. He stated that he has improved the cleanliness of his office. The expert retained by the College concluded that although the vast majority of Dr. Dubins’ care of Patient A met the standard, he demonstrated a lack of judgment in some areas: “The vast majority of the aspects of care provided by Dr. Dubins, as far as I am able to discern, and based on the information I have, do meet the threshold of standard of clinical practice. However, the reliance upon sexually themed aversive imagery (extrapolated from questions related to sexual orientation/identity) for simple and dis- crete chemical-addiction hypnosis is in my opinion excessive, not specifically required for positive clinical effect and in a minority of cases could render the treatment modality ineffective or even be potentially harmful (i.e., triggering past traumatic memories/ emotions.)…Likewise, comments (particularly during session) related to having a patient unbut- ton or otherwise loosen their pants may – even if 72 DIALOGUE ISSUE 4, 2017 solely intended for the purposes of increasing patient comfort – cause anxiety and/or unease in a subset of patients…[These] aspects of care … reflect a lack of judgment on the practitioner’s part as opposed to a lack of skill or knowledge.” Prior History with the College In January 1995, the Complaints Committee cau- tioned Dr. Dubins in person in relation to a complaint by a patient who complained that Dr. Dubins made inappropriate comments and used inappropriate and unnecessarily intimate images in his smoking cessation therapy. The Committee stated that it was “very con- cerned” about the use of extremely graphic and sexual images during the smoking cessation therapy. It said that his approach in his care of this patient was “inap- propriate”. It also expressed concern that the patient had not been advised in advance that sexual material and extremely graphic images would be used during the therapy. He was cautioned by the Committee re- garding the nature of his treatment of the patient and his failure to provide her with an adequate explanation prior to proceeding with the treatment. REASONS FOR PENALTY The Committee determined that protection of the public from further misconduct by this physician is of the utmost importance in deciding the appropri- ate penalty. The penalty must also provide specific and general deterrence, communicate the profession’s disapproval of the misconduct, and take into account any aggravating and mitigating factors. It is vital to maintain the public’s confidence in the College's ability to self-govern in the public interest. Dr. Dubins signed an undertaking that results in his immediate resignation from the College. He undertook to never re-apply to practise medicine in Ontario or elsewhere. This will protect the public from any further misconduct by him as a physician. It will also serve to maintain public confidence in the integrity and reputation of the medical profession, and in its capacity for effective self-governance in the public interest. The public must trust that the Col- lege will act to ensure that no physician will misuse his position of trust and authority to take advantage of vulnerable patients. The Committee accepts that such behaviour as that