The College of Physicians and Surgeons (CPSO) expects that all of its member physicians will notify patients of any impending closure of their practices in a timely way. This enables the patients to make plans for alternate care and to obtain their medical records from their current physician. The CPSO also expects that its members will ensure that their patients know how to obtain their medical records on request. These expectations are clearly set out in its policy statement entitled Practice Management Considerations for Physicians Who Cease to Practise, Take an Extended Leave of Absence or Close Their Practice Due to Relocation.
In a recent decision of the CPSO Discipline Committee, a doctor was sanctioned for his failure to meet these expectations. The decision emphasizes that a medical professional’s duty to a patient comes first. The circumstances, in this case, show clearly that no matter how hard or difficult the situation is to the physician personally, this must play second fiddle to the patient’s needs.
A Clinic Closes With Little Guidance for Patients
A pediatrician purchased a building in order to establish a multi-service family medical clinic. He borrowed money to do so and to renovate the premises. He had tenants signed but they stopped paying rent. His lender grew impatient and locked him and his tenants out and started foreclosure proceedings. The doctor advised the CPSO.
The CPSO began receiving complaints from patients that they could not contact the doctor or obtain their children’s medical records. The local hospital also advised the CPSO that they had been receiving the same type of complaints from the doctor’s patients. When the CPSO contacted the doctor, he informed them that he was in the process of negotiating with his bank and expected to re-open soon.
On the subject of notice, the doctor advised that he had posted the closure on the clinic’s Facebook page. It was suggested to the doctor that he post a notice on the clinic door, update his telephone greeting and update any and all websites the clinic used. The doctor responded that he would consider these options should the need ever arise again. He emphasized that his patients would have all of his records anyway as he routinely reported to each family physician after each consultation.
Despite his efforts and ongoing promises over the next ten months to re-open the clinic, he never did. The doctor took up practice again but at another clinic. Throughout this ordeal, the doctor suggested that he was complying with patients’ requests for records by email, by fax and at the end through a document storage service. Each effort was sporadic and ever-changing or promised and then either not delivered or delivered late.
The CPSO received seven written complaints. Each of them expressed concern about the sudden clinic closure and the lack of notice to patients, as well as the lack of direction with respect to contact and record retrieval. In each case, despite the doctor being advised of the complaints and promising the records, they were provided much later, if at all.
Admission of Unprofessional Conduct
The doctor admitted the facts as set out in the complaints. He also then admitted that his conduct would be reasonably regarded by other members of his profession as being disgraceful, dishonourable or unprofessional.
Aggravating Factors at Play
Many of the doctor’s patients were children with serious and/or chronic medical conditions. The doctor’s cavalier approach to their care was concerning, as it caused unnecessary stress and difficulty for the patients and their families. It may have also put those children’s care at risk. These consequences were considered very serious by the CPSO. Patients had to make attempts to retrieve their records for up to a year before they were successful, if at all. Finally, although unrelated to the matter at hand, the doctor had been disciplined once before.
The doctor admitted the facts and his misconduct. He co-operated with the investigator although he often did not follow up with the recommendations. It is of note that his financial difficulties were specifically rejected as a mitigating factor to his conduct.
The doctor was given a two-month suspension, the imposition of terms, limitations and conditions on his certificate of registration, and a reprimand. The proposed terms, conditions and limitations included that the doctor:
- comply with the CSPO Policy #2-07, “Practice Management Considerations for Physicians Who Cease to Practise, Take an Extended Leave of Absence or Close Their Practice Due to Relocation”;
- complete and pass a PROBE Ethics & Boundaries Program within six months of the date of the Order;
- provide proof to the CSPO that he had contracted with a third-party provider to process patient medical record requests and for the next three years, provide proof to the CSPO every six months that the arrangement remained in good standing; and
- maintain a log of requests for medical records and provide it to the CSPO upon request.
Takeaways for Medical Professionals
The clear takeaway here is that nothing can come before a doctor’s duty to their patients. Closing a practice, even when done suddenly and without warning, must be done in a way that provides notice to patients at the earliest opportunity. Doctors must make every effort to communicate the news to patients via every channel available to them. Further, an arrangement must be made for the quick transfer of medical records in order to allow patients to obtain ongoing care as seamlessly as possible.
At Wise Health Law, we focus on health and administrative law, including appealing and seeking judicial review of disciplinary committees. Our lawyers are passionate about helping regulated health professionals and healthcare organizations understand and protect their legal rights and obligations. We will guide you through the process, help you understand potential risks and legal implications, and assist you with or skillfully represent you at the proceedings. To find out how we can assist, contact us online, or at 416-915-4234 for a consultation.