Winnipeg Free Press - PRINT EDITION

Give college's discretion to patients

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How can it be that a Manitoba doctor is in jail for a serious criminal offence, but his patients are kept blissfully ignorant of the fact?

The College of Physicians and Surgeons of Manitoba, the licensing body that regulates doctors expressly to protect you, the public, has been tireless in its support for Dr. George Korol, who has been to jail twice and has had his licence to practice revoked in the United States, subject to strict conditions in Manitoba and then twice suspended during college investigations.

But the abundance of tolerance the college has shown for Korol should lead us all to question where the weight of concern comes to rest on the balancing of a doctor's versus a patient's rights.

Korol was licenced by the college to practice in Manitoba within a year of his leaving jail after being convicted in California for arson, after lighting a fire at his mother-in-law's house. The California medical board revoked his licence when he got out of jail, stating he was unfit to practice. Initially, Korol's practice was strictly supervised in Manitoba. But subsequent to that, the college has imposed two interim suspensions. While on the latest suspension, Korol was jailed after conviction on domestic assault and weapons charges. He was released in October.

So this doctor is "out," so to speak, but the college won't tell anyone why. Only the suspensions were posted on the college's website. But, stripped bare of any explanation, the public and his patients were left to wonder what triggered the move.

The case reveals that the self-regulating regime, offered as the best way to keep doctors competent and accountable, gives short shrift to patients' rights to protect themselves, to make informed decisions about their care.

Korol's record would lead most people to question his stability. Up front, let's agree: You can't have lived a few years without acquiring a soft spot for people who live with mental illness. Life is unfair, and most people are sympathetic for those burdened by an invisible sickness that can thoroughly ruin a life.

Ann Landers is credited with saying, with one of every four people suffering some kind of mental imbalance: Look at your three closest friends; if they seem OK, then you're the one.

This recognition of the reach of mental illness is a relevant precursor to the controversy embroiling the Manitoba college. This is not about whether to give extraordinary support to those struggling with illness. It is about allowing patients to weigh their own risk, which they can't do when information is withheld out of a respect for a doctor's privacy.

A lot of the detail on Korol's criminal convictions and his struggle with mental illness is available publicly from court records -- but not from the college, the very soul of discretion.

And despite the fact that the "physician profiles" on the college website are supposed to post criminal convictions in the last 10 years, Korol's file is free of any notation.

The college says the recent conviction will appear soon. The American conviction is not there because it happened before compulsory reporting of a criminal record was included and because the new law doesn't cover convictions outside of Canada. That makes no sense to anyone I know.

Further, if the physician profile gives no hint on why a doctor's licence is suspended, a patient has no way of knowing if he should question the medical advice he was getting, whether he should get a second opinion. Or whether his doctor has been playing fast and loose with medical billings.

Some people have wide tolerance for transgression. Korol has garnered substantial support from past patients, as the comment board on the Winnipeg Free Press website attests.

This speaks to the point about the value of information and people's right to exercise their own informed decisions. To further illustrate it, here's a story. I've lived a mundane life but a colleague is full of colourful experiences and is a fount of introspection.

He told me that as a child, his parents took him and his siblings to a long-time friend and family doctor who was an incorrigible drunk, but whose medical care they swore by. It is dangerous to measure decisions of yesteryear against contemporary standards, but we both agreed that was remarkable tolerance on his parents' part.

The fact that some swear by Korol's care underscores the salient point about college responsibility, privilege and the public's right to know.

Their reticence to trust people with information is symptomatic of a professional culture rife with paternalism. It is why Canadians are denied good data on surgical outcomes for physicians and hospitals.

People who live with mental illnesses have every right to conduct their professional lives without interference, unless someone is put at risk.

And here my colleague served up additional insight. He could not, he said, trust a doctor whom he knew to suffer from schizophrenia, a psychosis that can impair judgment and trigger disturbing behaviours. He said all the schizophrenics he knows always go off their meds. I could only respond that I didn't know any schizophrenics, but maybe that is the difference between those I didn't know I know and those he does.

That should cast some light on this conversation about people's relative perception of risk.

As it is, the college denies people the right to make those judgments. The college is best suited to decide on a doctor's competence to treat, but only a patient can decide, in the end, if that care is right for them.

Republished from the Winnipeg Free Press print edition December 5, 2009 A20

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