Roundup: How do Canada's physician colleges differ on handling sexual misconduct complaints?

Media outlets in Manitoba have been pounding hard on the College of Physicians and Surgeons of Manitoba, accusing the regulator of failing to act adequately to protect patients from sexual misconduct by doctors. The uproar stems from a complaint filed in 2018 by a patient against Dr. Arcel Bissonnette, who practised in Ste. Anne, a rural community about 40 minutes southeast of Winnipeg with a population of just over 2,100. In November 2020, police charged Dr. Bissonnette with six counts of sexual assault in connection with incidents alleged to have taken place from 2004 to 2014. About a year later, 16 more sexual assault were brought against Dr. Bissonnette for a total of 22 charges. The college barred Dr. Bissonnette from practice as soon as the charges were laid in 2020. The year before, in January 2019, it had placed restrictions on his practice, including a mandatory chaperone during breast and pelvic exams. But news outlets today are demanding to know two things: why was Dr. Bissonette allowed to continue practising after the 2018 complaint, and why did the college put a hold on his case when police started its own investigations? Read: College policies in the #MeToo era In light of this public uproar, the Medical Post reached out to regulators across the country, including Manitoba’s college, to ask about their policies for sexual misconduct complaints. Among other things, we learned that policies related to sexual misconduct complaints are not consistent across the country. We also learned that in some parts of the country—Saskatchewan is one example—a college can impose interim restrictions such as a mandated chaperone but doesn’t actually have the legislated authority to enforce them. In certain cases as well, college investigators have been asked by police to put their work on hold until the criminal case is concluded. To quote Brian Salte, associate registrar and senior legal at the College of Physicians and Surgeons of Saskatchewan, when it comes to college policies for sexual misconduct complaints: “This is not a quick question, nor it is susceptible to a simple answer.” Here’s what colleges across the country told us about their approach to sexual misconduct complaints: College of Physicians and Surgeons of Alberta “If a physician in Alberta is facing criminal charges, CPSA will open a complaint as per the Health Professions Act,” wrote Andrea Garland, acting director, communications, at the college. “Though an investigation may proceed, the investigated member may decline participation in the process until the criminal proceedings have concluded.” This policy is based on case law, added Garland, and is intended to ensure physicians’ participation in the college proceeding does not interfere with the criminal investigation or effectively force a physician to waive their “right to silence” with a pending criminal matter. Depending on the circumstances of the case, the college has the authority to place conditions on a doctor’s permit—such as a chaperone requirement—while criminal proceedings are ongoing. “And if deemed necessary in the interest of patient safety,” the college can suspend a physician from practice, said Garland. Read: Sexual misconduct with two patients plus fling and aborted baby with sister of third patient add up to zero licence for doctor College of Physicians and Surgeons of British Columbia “The college’s inquiry committee has the discretion to put an investigation into abeyance on certain conditions if there is a related criminal prosecution,” wrote the communications and public affairs department at the College of Physicians and Surgeons of British Columbia. The college may decide to do this “as it wants the best evidence available for an investigation, and the police file will not be released to the college during an ongoing criminal matter. The college complaint file remains open when the investigation is put into abeyance.” During this hold period, the college will monitor the criminal investigation and seek regular updates. It will also take “investigatory steps” such as offering updates and support for the complainant and ensuring witness statements are taken. The college may also decide to continue an investigation at any time before a parallel criminal investigation is completed. Whether or not it decides to defer an investigation, when a sexual misconduct complaint is filed the college requires interim measures such as chaperones and, in some cases, gender-based restrictions or even suspension of licensure. “The college’s investigations are trauma-informed,” wrote the CPSBC. “A complaint navigator trained in the area of sexual abuse and trauma is available as needed to guide and support complainants through the complaints process.” Read: Can you regulate racism out of medicine? Nova Scotia's medical regulator is working on it College of Physicians and Surgeons of Manitoba The college explained in a statement to media that its investigation chair or committee must view the suspension of a physician’s certificate as “necessary to protect the public from exposure to serious risk.” When there are unproven allegations and the strict criteria for suspension are not met, the college looks at other measures that can “reasonably be applied to ensure patient safety. This includes accepting undertakings not to practice or requiring attendants during patient encounters.” As for deferring its own investigation until police finishes theirs, the college said it defers to the “higher authority such as the police or the courts to minimize interference with their public protection role.” Doing this can also be helpful for patients, who could find it difficult to participate simultaneously in a college and police investigation, said the statement. Wendy Elias-Gagnon, communications officer at the college, said the CPSM reviews its processes continuously, “enhancing transparency, and raising awareness of our role in protecting the public.” The college has added a social worker as a public support advisor to its team to “communicate with and support complainants,” wrote Elias-Gagnon. “We also encourage feedback at the end of the complaints process and through this feedback, we are improving trauma-informed interactions.” Plans are also underway to update the college’s physician profile so inactive members appear on the registry, and to improve the “disciplinary actions” section on its website to make it easier for the public to find publications and other information. “This past year, we focused on making the complaints submission process more accessible to the public,” wrote Elias-Gagnon. “A new online tool for submitting complaints was launched, significantly increasing the number of complaints received.” Since the new tool went online, it’s become the main channel for receiving complaints, accounting for 80% of complaints submitted to the college. “Our processes are not what they used to be even three years ago,” wrote Elias-Gagnon. “We have increased transparency and public engagement.” College of Physicians and Surgeons of New Brunswick “The physician usually requests a deferral if there is a police investigation,” wrote Dr. Ed Schollenberg, registrar at the College of Physicians and Surgeons of New Brunswick. “We would always grant that, although it has not happened in quite a while.” Such requests tend to come as the criminal investigations get close to the hearing stage, said Dr. Schollenberg, adding that the college could at any point still decide to proceed with an investigation. College of Physicians and Surgeons of Ontario Shae Greenfield, senior communications advisor at the College of Physicians and Surgeons of Ontario, said the regulator does not have policy to defer investigation when police are also investigating. “Each investigation is considered on a case-by-case basis,” wrote Greenfield. “At the same time, CPSO investigators would always seek to cooperate with and support criminal investigations and would work to avoid interfering with the police in their investigation. The CPSO may also not receive evidence from the Crown uncovered as part of the police investigation until the conclusion of the criminal process.” When there’s evidence that patients may be at risk of harm, the college has the authority to apply interim restrictions—including suspension—on a physician’s licence. Read: Ontario directs regulator to register internationally trained nurses more quickly Collège des médecins du Québec In Quebec, the syndic's office does not wait for the police to complete an investigation before starting its own, wrote Leslie Labranche, who leads media relations at the college. “The two investigations may proceed simultaneously depending on the powers of each authority. According to the powers of investigation conferred upon him by the Professional Code, the syndic may obtain the information necessary for his investigation by the police,” added Labranche. In the course of the investigation, the syndic also has the power to file a motion to bar the physician in question from practice. The college can also obtain an undertaking from the physician to stop practising medicine while the investigation takes place, or to comply with restrictions such as a mandated chaperone during physical examinations. “The college has a zero tolerance policy for misconduct of a sexual nature,” wrote Labranche. “If the syndic collects the necessary evidence, he automatically files a complaint against the physician before the disciplinary council. These investigations are a priority for us because of our mission to protect the public.” College of Physicians and Surgeons of Saskatchewan Bryan Salte, associate registrar and senior legal counsel at the College of Physicians and Surgeons of Saskatchewan, said the regulator has no policy that specifically addresses how the college should proceed when there is a criminal investigation into the same complaint. “On occasion the College has conducted an independent investigation,” he wrote. “On occasion the College has deferred conducting an investigation until the outcome of a criminal investigation.” Salte pointed to at least one occasion when the college was ordered by a court to suspend its investigations while criminal proceedings were ongoing. “I am aware of similar orders made in other provinces,” wrote Salte. In deciding whether to conduct an independent investigation or await the outcome of the criminal investigation, the college considers a number of factors including the complainant’s willingness to participate at the same time in a college and criminal investigation, risk to the patient and whether these can be addressed with interim measures such as practice restrictions, whether police have resources to investigate that are not available to the college—and therefore be more likely to obtain all relevant information—as well as the risk of a college investigation interfering with a police investigation, and of the possibility for inconsistent outcomes from both proceedings. “That is by no means an exhaustive list,” added Salte. In Saskatchewan, the current legislation—the Medical Profession Act, 1981—allows the college to suspend a physician while there is an ongoing investigation but does not give it authority to impose restrictions such as a chaperone. “Saskatchewan courts have ruled that the power of suspension can only be used if no other measures are available to deal with the risk to patients/clients,” wrote Salte. “Consequently, while the college will often seek a physician’s agreement to interim measures that are less intrusive than a complete suspension, such as a chaperone being present for patient encounters, it has no authority to order such measures.” The College and other health regulatory bodies have requested amendments to health regulatory legislation to address this, and other, issues, added Salte. “We are unsure if that will occur,” he said. Read: Cardiologist strikes back with defamation suit against medical resident who accused him of sexual assault

Roundup: How do Canada's physician colleges differ on handling sexual misconduct complaints?

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