Zero tolerance some of the time? Doctors, discipline and sexual abuse in Ontario.

Confirming College's commitment to the safety of the public by affirming the philosophy of Zero Tolerance of and in accordance with that philosophy, developing policies, procedures, practices, and education programmes that support it. (1) The purpose of the provisions of this Code with respect to abuse of patients by members is to encourage the reporting of such to provide funding for therapy and counselling for patients who have been sexually abused by members and, ultimately, to eradicate the abuse of patients by members. (2) Introduction In the early 1990s, many provincial regulatory Colleges governing the practice of medicine began to reexamine their response to doctors' abuse of patients. College investigations revealed that the abuse of patients did occur, and that it could not be explained as occasional or anomalous. In fact, the abuse of patients was well documented, although relatively little had been done to respond to the abuse or to protect patients. In the decade that followed, many of the regulatory Colleges commendably undertook specific initiatives to respond to physician often in the face of the outraged resistance of their members. (3) In 1991, the College of Physicians and Surgeons of Ontario (CPSO) established a Task Force on the exploitation of patients. (4) Alberta, British Columbia, Manitoba, Saskatchewan and Quebec each undertook studies of their own. (5) The study undertaken in Ontario demonstrated categorically that the response by the CPSO to patient complaints of abuse was experienced as re-abusing by the complainants. Penalties imposed by CPSO disciplinary committees were seen as inappropriately lenient, and as manifesting overarching identification with the accused physicians. Minimal penalties were rightly understood by the complainants, and those concerned about violence in all of its forms, as little more than a slap on the abuser's professional wrist. At the same time, when the discipline committee did respond seriously to physician abuse and imposed significant penalties on abusers, the Ontario courts regularly overturned the penalties, substituting less onerous ones and undermining the efforts of the CPSO to respond seriously to abuse. (6) In Ontario, the CPSO wrote reports, produced detailed policies and engaged in educational initiatives for both their professional members and for the public. The CPSO took important steps to increase the information available about abuse in the health care context and to open up the disciplinary process to public scrutiny. Policies, discussions and disciplinary decisions of CPSO committees were posted on its website, as were the disciplinary histories of individual doctors. The Province of Ontario and the CPSO demonstrated a commitment to eradicating physician abuse that has been unmatched elsewhere. Ontario undertook major legislative reform of the regulatory structure applicable to all health care professions, introducing legislative changes to the Regulated Health Professions Act (7) designed to implement zero tolerance of abuse and to impose license revocation as a mandatory penalty for the most serious cases of abuse. (8) Broad changes were made to the Act, introducing new provisions designed to address the exploitation of patients by health care professionals. (9) Recognition that abuse of patients is unprofessional and constitutes misconduct was not new. Prior legislation defined professional misconduct to include impropriety with a patient. However, the revised legislation included specific measures defining sexual abuse, imposing an obligation on all health care professionals to report abuse by other health care providers, (10) introducing specific penalties and restrictive reinstatement provisions, and listing specific forms of misconduct punishable by mandatory license revocation. …

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