Touching patients rarely necessary, expert testifies
Psychiatrists have strict boundaries which they must follow when dealing with patients under their care and they must strictly adhere to these boundaries, an expert in the field testified at Dr. Aubrey Levin’s sexual assault trial on Friday.
Dr. Peter Collins, associate professor at University of Toronto who also works privately in forensic psychiatry and clinical criminology, said there is rarely any occasion in which a doctor needs to have physical contact beyond a handshake or to test for blood pressure.
Touching a patient’s genitals to check for a sexually transmitted disease or sexual dysfunction, he said, is not part of a psychiatrist’s mandate and clearly unacceptable as it crosses boundaries.
“As a psychiatrist, I’m not going to physically examine a patient in a therapeutic relationship,” Collins told Crown prosecutor Bill Wister. “Exceptions are that I’ll take blood pressure, and explain why I’m doing it.”
The power imbalance between the doctor and patient in the therapeutic situation, always in favour of the doctor, is even more pronounced when the patient has previously been physically or sexually abused and when the patient is under court order to attend.
“Many of these people were subject to abuse as children and they do not know boundaries, so when doctors violate boundaries, it is a problem,” Collins said.
“Doctors have to explain everything they are doing, why they are doing it and get consent. There is a power imbalance in any therapeutic relationship. In therapy, the patient puts confidence and trust in the psychiatrist. The psychiatrist, in response, has to act in good faith. He can’t betray that trust.”
Levin, 73, is on trial for allegedly sexually assaulting 10 male patients — most of them seeing him as a result of a court order — between 1999 and 2010 at his office or an examination room at the Peter Lougheed Centre.
Several complainants have said Levin fondled their genitals without any valid explanation or explanation at all, and that he did not wash his hands first or wear protective gloves.
Collins also said sharing food with a patient or developing a friendly relationship is also crossing a boundary.
“You can be affable and friendly without being a friend,” said Collins. “You can treat a patient with respect without being their buddy.”
Levin was charged in March 2010 after a patient, who complained to his lawyer he was being sexually abused, used a Spy Watch video camera to record his last two sessions with Levin. The videos, played in court, show Levin fondling the complainant’s penis for nearly 15 minutes.
Under cross-examination, Collins agreed with defence lawyer Karen Molle that patients with borderline personality disorder are the most likely to be sexually abused, but also to make false sexual allegations.
Court has heard some of Levin’s patients were diagnosed with borderline personality disorder, although Collins did not specifically refer to anything about the Levin case.