Chronic lack of transparency Patients, critics question the way Manitoba’s physician watchdog handles cases of misconduct and discipline; efforts to shed light on oversight only lead to more questions By: Katrina Clarke Posted: 12:33 PM CDT Thursday, Apr. 6, 2023 Last Modified: 5:05 PM CDT Thursday, Apr. 6, 2023 Updates

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This article was published 06/04/2023 (910 days ago), so information in it may no longer be current.

At least five Winnipeg-area doctors have conditions on their medical licences limiting the treatment they can provide to female patients, a Free Press investigation reveals.

But why those conditions were put in place remains a mystery, raising more questions about patient safety and regulatory transparency in the province.

As part of an ongoing investigation into how the Manitoba physician watchdog handles cases of misconduct and discipline involving its members, the Free Press set out in February to find out how many of the province’s more than 3,000 physicians have licence restrictions.

The College of Physicians and Surgeons of Manitoba does not share the names of all doctors with conditions and there is no search function for such information on the college’s website.

Instead, the Free Press had to manually input names individually into the college’s online profile registry to determine if the physician has any restrictions, a process that took days to complete. It would take another full search to determine if any doctors have since had conditions imposed or removed.

The search revealed 31 physicians have “terms and conditions” on their licences. They range from bans on performing circumcisions to bans on prescribing opioids to notations that they are in a practice assessment program and not yet a fully registered doctor.

Some conditions are one sentence long, others go on for paragraphs. In one case, a longtime Brandon pediatrician is required to have another adult in the room during genital examinations.

Five doctors — Dr. Maged Ghebrial, Dr. Peiman Malek-Marzban, Dr. Marvin Slutchuk, Dr. Earl Minuk and Dr. David Ames — have gender-based conditions, meaning they need a chaperone when treating female patients or are otherwise restricted in what care they can offer female patients.

(The Free Press found a sixth doctor but the college later confirmed, once presented with the Free Press’s findings, the profile was out of date and the condition should have been removed in 2018.)

The effort to shed light on physician oversight has led to more questions, including when and why the specific conditions were put in place, and whether they are imposed in the interim while an investigation is ongoing. Asked these questions, a spokesperson said the college can’t comment on individual doctors, but said the conditions are in place to protect patients.

“Placing terms and conditions on a registrant’s practice and publicizing that information is in itself an important public protection measure,” college spokesperson Wendy Elias-Gagnon said.

Still, the college does not publicize when conditions are imposed, unless they’re part of a discipline decision.

Critics say these cases highlight secrecy surrounding doctor discipline. They say the self-regulating body is too focused on protecting doctors’ privacy and should do more to keep patients safe. Long-standing calls for the province to update legislation that governs the college, which could make it more transparent and accountable to the public, have gone unanswered.

Calls for transparency

Brandon Trask, an assistant professor of law at the University of Manitoba, says patients deserve to know more about serious allegations of misconduct their doctor may be facing, calling it a matter of “informed consent.”

“People need to have information, knowledge to be able to make informed choices about who they are receiving health care from,” Trask said.

“This all is at the forefront — or should be at the forefront — of patient rights.”

“People need to have information, knowledge to be able to make informed choices about who they are receiving health care from.”–Brandon Trask

Currently, details of misconduct are only revealed after the doctor in question is disciplined or censured — a process laid out in Manitoba’s Regulated Health Professions Act (RHPA), which governs the college.

Conditions, however, can be imposed in the interim while the college investigates the complaints, and in those cases, no information other than the condition itself is disclosed to the public on the doctor’s online profile. Discipline decisions are also not posted if a physician is appealing the matter.

Aside from Ames and Slutchuk — whose discipline decisions have been made public — it remains unclear if conditions imposed on other physicians are “interim” or part of discipline being appealed or if they exist for some other reason.

College registrar Dr. Anna Ziomek has previously said the college recognizes “some improvements can be made” to transparency within the RHPA but that would require change at the provincial level.

The office of Health Minister Audrey Gordon did not respond to requests for comment. Gordon has long resisted critics’ calls for legislative change.

Paul Harte, a Toronto-based medical malpractice lawyer, says there are still steps the college should take, within the limitations of the RHPA, to better inform patients.

For one, the college should be more upfront with providing an up-to-date list of all doctors with conditions on their licences, Harte said, especially since that information is already public but the records are not easily accessible.

“To bury (conditions) in among 3,000 records, that may help an individual who wants to research one doctor, but it doesn’t help the public in terms of evaluating if the college is effective,” he said. “They want to obfuscate how many physicians have problems.”

Providing the date the condition came into effect is also information that should be public, he said.

“They want to obfuscate how many physicians have problems.”–Paul Harte

The college says it is open to change, including adding the date a condition was imposed.

“We regularly review the profile (system) and are open to making improvements that are of value to patients,” Elias-Gagnon, the CPSM spokesperson, said in a statement. She added that the online database “must include details such as education, training, primary practice location, current restrictions or conditions on their practice, and previous disciplinary action; it is not meant to be an in-depth archive.”

The database provides up-to-date information “for that day on any given day,” she said.

However, the Free Press discovered one profile that was out-of-date by five years.

Elias-Gagnon said Winnipeg-based Dr. Chamindra Labiyaratne, who had a temporary condition stating he required a chaperone when treating female patients, “satisfied the terms of his undertaking in 2018 and does not require a chaperone.”

This condition has since been removed from his profile.

Reached for comment, Labiyaratne said he was not able to speak to the matter at this time.

The fact that incorrect information appeared on the college’s website for several years indicates it is not routinely reviewing and updating public information, Harte said.

“It is critical that information on the website be accurate and up to date, particularly when it comes to allegations of sexual harassment or abuse. Inaccurate or outdated information can only undermine public confidence in the regulator,” he said.

Public signage required

Doctors are required to inform patients of chaperone conditions via signage placed in a “prominent location” in their office’s reception area and examination room, according to the college.

The Free Press visited the offices of the five Winnipeg-based physicians with gender-based conditions on their licences: Ghebrial, Malek-Marzban, Slutchuk, Minuk and Ames. All, with the exception of Slutchuk, had a sign posted at the front reception stating their name and their specific licence condition, such as requiring an attendant when treating female patients.

At Slutchuk’s office, which is shared with other physicians, a sign on a back wall states: “A chaperone must be present during female genital examinations by male doctors (and) patients may request the presence of a chaperone for breast examination.”

Slutchuk’s conditions do not require him to have a chaperone but state he cannot perform breast or pelvic exams on female patients, treat female patients for gynecologic or breast problems, or treat those who are pregnant. He is required to “advise” patients of these restrictions.

In an email, the clinic manager of Lakewood Medical Centre, Slutchuk’s place of employment, said patients are informed of his conditions through a sign in his exam room stating he “does not perform breast examinations and/or female genital examinations.”

“In that context, he cannot perform pelvic or breast examinations; treat gynecologic or breast problems; or treat pregnant patients,” clinic manager Monica Roa said.

“You have some potentially very vulnerable people … not even able to understand the signage.”–Brandon Trask

Roa said Slutchuk has many patients but fewer than 10 are women to whom he provides primary care. Roa said in addition to the signage, he advises patients of the range of conditions on his licence. Slutchuk has not received any complaints at the clinic since the conditions were imposed, she said.

Even when doctors are fully compliant with signage requirements, Trask, the law professor, says accessibility questions remain.

He notes that in the cases the Free Press flagged, signage was only in one language: English. This is despite Malek-Marzban’s college profile stating he speaks Turkish and Persian, and Slutchuk’s noting he speaks Yiddish.

“You have some potentially very vulnerable people … not even able to understand the signage,” Trask said.

Elias-Gagnon said the college only requires signage in English.

Signage doesn’t tell whole story

Neil McArthur, director of the Centre for Professional and Applied Ethics at the University of Manitoba, says clinics have an “ethical obligation” to directly inform patients of conditions when they book an appointment.

“By the time you’re in that room, what are you supposed to do, storm out?” he said. “No — you need advance notice.”

He sees signage alone as “totally insufficient.”

“A small sign on a wall… which is just often not noticed, I think it’s totally insufficient, especially in proportion to some of the accusations,” McArthur said.

“There’s an ethical obligation for these clinics to inform (patients) in a different way and for the college to require them to inform us in different way.”

“By the time you’re in that room, what are you supposed to do, storm out? No, you need advance notice.”–Neil McArthur

He speaks from experience.

McArthur said he didn’t initially notice signage at the office of his own former doctor and when he did, it wasn’t until he later Googled the person that he saw past media reporting on the doctor’s case and learned of the circumstances that led to conditions being imposed.

“I’m an adult male with a PhD and I didn’t figure out that this was a problem,” he said.

He doesn’t think the college should share unproven allegations, but if the condition is the result of a discipline decision, that information should be on the sign, he said.

And while the college says conditions are in place to keep patients safe, questions remain about the effectiveness of signage and chaperones in preventing potential harm.

The Free Press has reported on two cases where patients allege misconduct by doctors who had chaperone requirements in place.

Ste. Anne family physician Arcel Bissonnette was charged with six counts of sexual assault in 2020 — charges which have since been stayed — and 16 more in 2021, which are still before the courts. At least one former patient alleges Bissonnette sexually abused her after conditions were put in place in 2019.

Training, disclosure, conflict of interest are concerns about physicians

In June, Winnipeg family doctor Shamoon Hasham Din was stripped of his medical licence after the college found he breached conditions, including that he treated female patients without a chaperone. In December, a former patient filed a lawsuit alleging sexual abuse occurred during medical appointments when no chaperone was present.

Doctors watchdog ‘dropped the ball’: expert

Gaps remain

Nothing is known about why conditions are in place for longtime Brandon pediatrician Dr. Emmett Elves.

Elves is required to have an adult present when conducting genital examinations and must provide “a fulsome explanation to the patient and/or their parent/guardian as to the basis for performing such an examination.” It’s unclear how long the conditions have been in place.

He was previously censured — which amounts to a public warning — in 2014 for a case involving the death of one infant and an unnecessary liver transplant for another. There is no note of conditions accompanying the public censure.

Reached for comment, Elves’ medical receptionist provided a statement: “Taking care of his patients’ needs is his top priority at this time.”

Transparency gaps remain even in cases where discipline decisions are made public. College policy is to wipe such decisions from its website after 10 years.

In Slutchuk’s case, his discipline occurred decades ago and as such, the related decisions are nowhere to be found on the college’s website. A member of the public would need to search the internet to find information about why his licence was cancelled in 2003 and reinstated with conditions in 2007.

According to a 2003 college decision, Slutchuk was previously found to have engaged in sexual acts with a patient on-and-off between 1989 and 1998. Then in 2001, he was nude in a hot tub at an office party attended by co-workers who were also patients. This led to his licence being cancelled for four years.

In contrast, the details of the decision in Ames’ case are posted on the college’s online discipline page and on his profile.

The college suspended Ames’ licence last year for six months after the orthopedic surgeon was found guilty of professional misconduct for making inappropriate sexual comments to a female patient and texting a photo of a penis to the woman. Ames admitted he sent the photo but said it was not of his genitalia.

katrina.clarke@freepress.mb.ca

Katrina Clarke
Investigative reporter

Katrina Clarke is an investigative reporter at the Winnipeg Free Press. Katrina holds a bachelor’s degree in politics from Queen’s University and a master’s degree in journalism from Western University. She has worked at newspapers across Canada, including the National Post and the Toronto Star. She joined the Free Press in 2022. Read more about Katrina.

Every piece of reporting Katrina produces is reviewed by an editing team before it is posted online or published in print — part of the Free Press‘s tradition, since 1872, of producing reliable independent journalism. Read more about Free Press’s history and mandate, and learn how our newsroom operates.