DISCIPLINE SUMMARIES DR. MOHAN KRISHNAN RAJA PRACTICE LOCATION: St. Catharines AREA OF PRACTICE: Family Medicine (Methadone) HEARING INFORMATION: Contested Hearing; Joint Submission on Penalty On November 27, 2017, the Discipline Committee found that Dr. Raja committed an act of professional misconduct in that he engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reason- ably be regarded by members as disgraceful, dishon- ourable or unprofessional. The allegations arose from the conduct of Dr. Raja during a number of clinical appointments when Patient A saw Dr. Raja for methadone treatment. The Committee found that in at least two examinations of Patient A, Dr. Raja had her raise her shirt above her bra, lifted the left side of her bra, and exposed her left breast. He then listened to her heart sounds in four areas, which included touching the periphery of her left breast with his stethoscope and pushing aside her breast for optimal skin contact. There was no evidence that Dr. Raja made any comments of a sexual nature. The Committee found that while he did raise Patient A’s bra, there was no evidence that Dr. Raja touched her breast in a sexual manner. The Committee noted that there was no fondling, massaging of the breast, squeezing, or touching of the nipple. The Committee accepted that listening to the heart sounds in the four areas described by Dr. Raja was an acceptable focused cardiac examination. Examination of the heart in this manner with a stethoscope would involve placing the stethoscope close to the breast or at the periphery of the breast. In some cases, the breast would need to be pushed aside for optimal contact between the stetho- scope and skin. The Committee found there was no sexual character to the examination as performed in this fashion. While Dr. Raja may have touched her breast while carrying out the examination of her heart, such touching of the breast in this context did not constitute a violation of sexual integrity. Dr. Raja’s ap- proach appeared to have a mechanical quality, but was not of a sexual character. 74 DIALOGUE ISSUE 4, 2018 In making a finding of disgraceful, dishonourable and unprofessional conduct, the Committee considered that: • Dr. Raja failed to respect the privacy owed to his patient; • The unanticipated exposure of her breast on its own constituted a significant boundary violation; • Dr. Raja was inconsiderate when he exposed Patient A’s breast; • Dr. Raja did not understand or disregarded how his actions would make Patient A feel; • Dr. Raja’s explanation to Patient A of why he needed to repeatedly listen to her heart sounds was unclear or nonexistent; and • Patient A was a particularly vulnerable patient, which makes a lack of respect for her dignity and privacy more egregious. The nature of Dr. Raja’s misconduct was held to be an aggravating factor. The Committee commented that physicians need to have heightened awareness with regard to maintaining appropriate boundar- ies and need to show respect for modesty and body integrity. It is also necessary to provide sufficient explanation to patients to meaningfully communi- cate. Failure to do so results in patients’ confusion about the possible motive for certain actions and sets the stage for negative consequences. Both maintain- ing appropriate boundaries and meaningful com- munication are integral to a healthy patient-doctor relationship and are necessary to ensure that public and patient trust is not eroded. There were a number of mitigating factors which the Committee acknowledged. Dr. Raja completed the course on Understanding Boundaries and Man- aging the Doctor-Patient Relationship. Dr. Raja co- operated in coming to an agreement on penalty, thus shortening the penalty hearing. In addition, Dr. Raja has no prior discipline history with the College. ORDER The Committee ordered: a two-month suspension of Dr. Raja’s certificate of registration; a reprimand and payment to the College for the costs in the amount of $22,000. For complete details, please see the full decision at www.cpso.on.ca. Select Find a Doctor and enter the doctor’s name.