Patients in dark over doctor discipline
Medical regulators governed by patchwork of policies that prevents access to records
WINDSOR— In late 2009, Ontario’s medical watchdog was considering yet another complaint against Dr. Ronald Bjorndahl Sorensen.
Before a meeting to discuss the matter, members of the complaints committee at the College of Physicians and Surgeons of Ontario (CPSO) exchanged notes about the Windsor urologist, who held medical licences in three American states.
Sorensen had what one committee member described as a “long and troubling history with us,” including “lots of complaints.”
“I would support a verbal caution at least,” another member replied, “but with the history and several previous cautions, is another verbal caution going to be enough?”
Several months earlier, a patient had complained to the college after seeing Sorensen at his Windsor clinic. She said he recommended urethral dilation to treat her frequent bladder infections. He said the procedure would allow him to examine and stretch her urethra and “was not painful.” He offered to do it that afternoon for a $50 fee.
Almost immediately, she said she felt “an excruciating pain that was unbearable.” She cried out, begging him to stop. She said he didn’t listen.
“I am emotionally distraught. I cannot stop thinking that he should have stopped, and he violated my rights,” she wrote in a letter to the college. “I do not want any other woman to go through what I did.”
The complaint against Sorensen, who declined to comment for this story, would result in restrictions on his practice in Ontario and Washington state and the revocation of his California medical licence.
Details about the number and nature of complaints against Sorensen have never been released by the CPSO. The information reported here came from the websites of American medical regulators and Sorensen’s case file in Washington, which was released for free through a public records request.
The Ontario college is keeping nearly all of it secret from you.
An 18-month investigation by the Toronto Star into doctor discipline reveals how regulators keep an ocean of patientsafety information hidden beneath what little they make public. This investigation wasn’t easy. Canada’s regulators don’t tell you everything about your doctors’ disciplinary records, and they stood in our way throughout.
Patients rely on medical regulators to protect them and the public interest. Across North America, the physician profiles posted on medical college and board websites play a vital role in that function. These public databases are a safeguard for patients, who can use them to confirm that their doctors hold valid medical licences — and find out if there are any red flags.
The Star has compiled a database of 159 physicians with disciplinary records who have held licences to practise in both Canada and the U.S. — but this is surely a fraction of the real number. Some medical regulators scrub discipline details from physician profiles five to 10 years after a sanction is imposed, and remove the profiles entirely when a doctor loses his licence. Some also refused to release additional information that may have allowed us to add more doctors to our database, citing confidentiality provisions.
The true number of disciplined doctors who have practised on both sides of the border is anyone’s guess. North America’s 64 medical regulators oversee nearly a million active physicians. No single government agency, regulator or umbrella organization tracks cross-border physicians. An estimate provided by the Canadian Institute for Health Information based on changes to the mailing addresses of Canadian doctors suggests that hundreds relocate to the U.S. — and return to Canada — each year.
Physicians with disciplinary records represent a very small fraction of doctors in North America, but as shown in a 2016 study in the New England Journal of Medicine, a few bad doctors can cause significant damage.
Canadian and U.S. regulators have starkly different standards of transparency. Unlike in the U.S., where consumer legislation governs many medical boards and mandates openness, Canada’s doctors oversee themselves. One consequence of self-regulation, we found, is endemic secrecy.
This secrecy is baked into the bylaws, policies and culture of Canadian medical colleges, depriving patients of information about doctors who have been sanctioned by regulators for a range of offences, including sexual misconduct, improper prescribing, negligence and fraud.
There is a lot patients don’t know about the doctors in our database: We found that 90 per cent of these physicians’ Canadian medical college profiles were missing discipline details that had been publicly disclosed in another province or state, while 69 per cent of their U.S. medical board profiles were missing this information. In Canada, 73 per cent of the profiles had no disciplinary history whatsoever, compared to 40 per cent in the U.S. — even though records exist in every case. The majority of the sanctions in our database were imposed after 2000.
Most regulators refused to discuss the holes we exposed, making it difficult to trace the root of the problem in every case. But in some instances, the answer is plain: Medical boards and colleges are aware of doctors’ disciplinary records, and they are withholding that information from you.
In our investigation, we faced an uneven, illogical patchwork of policies guiding the public release of licensing and disciplinary details by medical regulators in all 50 U.S. states, 13 Canadian provinces and territories, and Washington, D.C.
In some of them, such as California, Washington, New Brunswick and Ontario, discipline decisions and full physician rosters were available online or provided quickly upon request.
This was not the case everywhere. In Quebec, it took several months — and a Freedom of Information request — before the college sent the Star a DVD containing 32 files with disciplinary decisions from 1988 to 2016.
From nearly 20,000 pages of records, we logged 1,277 cases of discipline by the Quebec college to arrive at a list of names we could cross-reference with records from other medical regulators to see which physicians practised outside of the province.
But the college said it was "impossible" to provide the Star — and the public — with a list of its 20,606 active members because “Quebec no longer produces a directory of its members as the information changes daily.” Because of this, our search certainly missed doctors currently licensed in the province who were disciplined elsewhere.
The B.C. college also initially refused to provide a full physician roster, relenting only after we sent a formal letter explaining how we intended to use the data. We encountered another black hole in Northwest Territories, where we were told that privacy laws prohibit the release of any details about disciplinary decisions before 2010, other than the date of a hearing. According to a government spokesperson, only three doctors have ever been disciplined as a result of a complaint in Northwest Territories — in 1994, 2001 and 2007.
Star reporters narrowed down about 1,800 potential matches between physicians and their discipline records on both sides of the border by comparing birthdates, medical school credentials and other publicly available information. In many cases, regulators refused to provide this additional information.
We had to abandon two possible matches in P.E.I. because the college would not confirm the years the doctors had graduated medical school. A college spokesperson said this information is protected by provincial privacy rules, even though it is routinely posted on physicians’ profiles in other provinces.
The Quebec college refused to provide any information about when and where doctors gradu- ated from medical school, “because this information is not public,” a spokesperson said.
In all, this secrecy forced us to abandon nearly 200 possible matches — more than the 159 we confirmed.
Success, we found, depended largely on the boards and colleges involved.
Dr. Ronald Bjorndahl Sorensen’s discipline originated in Ontario, but the case might not have come to our attention without the transparency of the Medical Board of California.
The Ontario college’s public physician profiles are the only ones we found in Canada that include information about discipline imposed in other jurisdictions. It is arguably the most open medical regulator in the country.
But the CPSO, which is governed by provincial legislation but operates independently, is a fortress compared to California’s board — a semi-autonomous, state agency, whose website was named the best among U.S. medical boards in a 2016 review by Consumer Reports and the Informed Patient Institute.
The California board has lobbied successfully for legislative changes that allow it to post most discipline information on its profiles in perpetuity, including criminal convictions and malpractice settlements.
The information is updated, even after a doctor is no longer licensed in the state. Since 1998, the board has published information about discipline imposed in other jurisdictions.
“The mission of the board totally is consumer protection,” the board’s executive director, Kimberly Kirchmeyer, said in an interview.
“I do not want any other woman to go through what I did.” A PATIENT OF DR. SORENSEN’S WHO SUFFERED THROUGH A PAINFUL PROCEDURE