​                CPSO-HPARB Reconsideration Request
                                  and Introduction

                                                           by Susan McPherson August, 2019

                                 web site      Accountability in Health Care: ethics in aging
​                                  http://www.AccountabilityinHealthCare.homestead.com

For the purpose of this introduction and my Request to HPARB that follows, the College of Physicians and Surgeons of Ontario, known as the CPSO, is responsible for setting requirements for standards of practice and professionalism for doctors. The Health Professions Appeal and Review Board, known as the HPARB, closely related to the CPSO, is supposedly responsible for setting requirements for standards of practice and professionalism for doctors, and conducting complaint reviews of complaints that have gone through the CPSO’s complaint system, and also registration reviews of doctors. 

The text of a Reconsideration Request – names removed - that I wrote follows this introduction. I submitted it to HPARB (Health Professions Appeal and Review Board), on Aug 13, 2019. The Request I submitted was a result of their Decision of July 24, 2019 to take no further action on the College of Physicians and Surgeons (CPSO) Committee’s Decision of October 5, 2018. I had laid a Complaint in 2018 against a family doctor I had been going to. I have had difficulty gaining access to a doctor I could depend on, actually every since I came back to London. First one, then the next, treated me badly. It could be for different reasons, not always the same. But I am an older woman, alone here, and am virtually unknown, having graduated from Western but not had a career or relationships that might have granted me some credibility and status in the community. 

This family doctor who has been the subject of this complaint with the CPSO, and the Reconsideration Requestion, knew almost from the start that there had been some troubling incidents happen regarding the specialist I had gone to for an appointment in late 2016. The specialist did treat me unfairly, no matter what the final Decision is on the subject, my case with the HRTO (Human Rights Tribunal of Ontario). And when I asked questions of his staff, they turned on me, blaming me for being rude to them and telling me if I wanted health care with the specialist I would have to apologize, otherwise I would have to go to Toronto for treatment. I hadn’t been rude, and didn’t apologize. But it made no difference. The specialist wrote up a report of the appointment repeating what his girls in the office had told him. And then a couple of months later wrote up another one, so now there were two. Reports don’t simply disappear when they are written up for Health Records at the local hospital. So trying to find a reasonable, understanding, family doctor has been a nightmare, and Dr G, the subject of this Complaint to the CPSO, is part of that nightmare. Oh, yes, and soon after that I laid a complaint against the specialist who had treated me so badly, and his staff, and others, with the Human Rights Tribunal of Ontario (HRTO), in November 2017, a year after it happened.  

The situation with Dr G, the family doctor, has evolved, going through the steps, each no better than the last as far as receiving just attention and consideration of my experience with him. I submitted my complaint on June 27, 2017. First – not first but the first main decision on the matter - after a period of lengthy, time-consuming errors and time-wasting on the part of the caseworker/investigator assigned to the case, came the Decision by the CPSO’s Committee on October 5, 2018, which stated, in part:

“the Committee is satified that the Respondent provided excellent care in the circumstances. We commend him for the accuracy and level of detail with which he documented his care of the Complainant. Disposition: For the reasons set out above, the Committee takes no further action on this complaint” (ICRC [Inquiries, Complaints and Reports Committee] Decision, Oct 5, 2018, CPSO. Toronto). Notice how the CPSO emphasizes the “accuracy and level of detail” of his notes, documenting his care of me. That’s because the doctor has credibility and I apparently don’t, in their eyes, or if I do, then they are trying to destroy that.

Credibility has nothing to do with telling the truth. It has everything to do with being believed, or having people take your side whether or not you are believed, which is called loyalty. Instead of saying “loyalty,” say the reason you are supporting what a person does or says is “credibility” and you will be more likely to be believed, and so will the person to whom you may only be being blindly loyal. See Presumed Innocence in politics and health care, on my Blog, Sue’s Views on the News. Feb 6, 2018. http://suemcpherson.blogspot.ca/2018/02/presumed-innocence.html .

And since I didn’t have a career, I must either have been stupid or a drug addict, in the eyes of some, or perhaps they simply want people to believe that, and not that I was married to a man who didn’t want me to work and insisted that I stay home and had a family. Many of us knew little about the world back then. Some of us didn’t realize the harm that would do, staying home and taking care of the family to avoid family arguments.

After the CPSO ICRC (the Committee) handed down their Decision, I applied to the HPARB for a Review of the CPSO’s Decision. The CPSO was meant to submit all documents I had sent them and which passed between her and myself and the respondent, including one controversial one, submitted to me by the caseworker, Ms V, asking me to sign off on a Summary she had written of my original letter of complaint and return it by private mail (not CPSO envelope) to her. I didn’t as it did not accurately reflect what I saw as a good Summary, and I also thought that if I did, the brief description might be used against me, leaving out important parts. I di, however, waste much sffort in trying to rewrite her Summary, but ending up with a slightly shorter version of my original letter and her Summary combined, that I had been presssured into writing, unecessarily, and which she accepted. More about that later. 

Once the HPARB became involved, I received a phone call stating that the process had been expedited, receiving a package of information on Dec 24, 2018, which apparently was the same information the CPSO had used to make its Decision, now handed over to the HPARB so they could analyze it – and to me, so I could too, for the first time. I was denied it before, even though I wrote several letters to CPSO officials about it. And of course, it was not complete, and there were errors. And I did not have time to delve into it in great detail at the time. By this time I was dealing with problems with my respirologist and with the HRTO case over Dr A, the specialist, which had rescheduled their Summary Hearing for Dec 7, 2018, instead of Nov 7, leaving me little time to prepare for each of these events - the case conference with the HPARB on Feb 7, 2019, and the Review also by teleconference with them on April 3. A meeting I had had with my respirologist on Jan 7, 2019 didn’t go well and it was only a matter of time before I decided I could nnot have him as my respirologist any longer. None of this will make much sense to readers; however my point is there was a lot going on and a lack of information as well as obstacles were being placed in my way. 

By the time all that was over, I had received a Decision about the complaint I had made about the specialist to the HRTO (on March 5, 2019) to which I responded with a Request for Reconsideration on March 28. In due course, on July 24, 2019, the HPARB responded, on the matter of the Complaint I made against Dr G with the CPSO. I did also receive acknowledgment from the HRTO of the Request for Reconsideration that I had sent them. That HRTO case, against the specialist and his staff, is closely related to the CPSO complaint I made against the family doctor on June 27, 2017, who had sent away for all specialists’ reports on the first day and soon let me know that he believed him – what he had said in his reports of that appointment and about his female staff and others. There was no way this patient-doctor relationship could work out well.  

Returning to the Decision against Dr G, the HPARB Board wrote that the Committee (of the CPSO) had “investigated the Complaint and decided to take no further action” (Item 11, HPARB Decision, July 24, 2019).

It further stated, “Accordingly, the Board (HPARB) finds the Committee’s decision to take no action on this aspect of the Applicant’s complaint to be reasonable” (Item 38, HPARB Decision July 24, 2019. CanLII 67524). 

That is when I wrote the Reconsideration Request of the Decision made by HPARB and submitted it on August 13, 2019. 

The decision made by adjudicator Bonnie Goldberg, on Aug 19, 2019, on my Reconsideration Request from HPARB was as follows: 

“11. While the Applicant has provided the reasons as to why she believes the Board failed to properly consider adequacy of the investigation and the reasonableness of the decision, I
am not persuaded that the reasons advanced by the Applicant warrant reconsideration of the Board’s decision.
12. Accordingly, the Board’s decision of July 24, 2019 will not be reconsidered” (Items 11 and 12. Decision, Aug 19, 2019, HPARB, Toronto).

The Board of the HPARB isn’t required to give a reason why they will not reconsider a Request for Reconsideration, according to Practice guidelines. And although the Rules state that the Board will make corrections of errors and missing documents, none of the ones I mentioned in my Request for Reconsideration were acted upon. It only took adjudicator Bonnie Goldberg 6 days to examine my 19-page Request, and she was new to it, not being present for the Review – not being a member of the original panel of Board members.

In Rule 16.5 of the Rules for the HPARB, it states,

“The Board, on its own motion or at the request of a party to the proceeding, may reconsider any decision made by it and may confirm, amend, or revoke it. The Board may do so if it considers it advisable to do so.” (p. 30, Power to Reconsider a decision of the Board. Consolidated Rules of Practice and Procedure, HPARB and HSARB. http://www.hparb.on.ca/english/docs/directions/2013%20HPARB%20&%20HSARB%20-%20Consolidated%20Rules%20of%20Practice%20and%20Procedure%20-%20EN.pdf ).  

One may wonder why someone who was not part of the original Board was invited in to place judgement on me – on my Reconsideration Request. But there are other rules that cover that kind of situation, described in “Powers of the Board”. See General Rules, Rule 2, Application of rules; and Powers of the Board, 2.1 - 2.8. pp 7-8. Consolidated Rules of Practice and Procedure, HPARB and HSARB. http://www.hparb.on.ca/english/docs/directions/2013%20HPARB%20&%20HSARB%20-%20Consolidated%20Rules%20of%20Practice%20and%20Procedure%20-%20EN.pdf

Moreover, in the HPARB and HSARB Consolidated Rules of Practice and Procedure, under Corrections, it is stated,

“After rendering a decision or order, the Board may at any time correct a typographical error, an error of calculation, an error of omission, or any other similar error in its decision without prior notice to the parties. The Board shall notify the parties of its correction to the decision or order (16.4, p 30-31. Rule 16 – Decisions, Corrections, Consolidated Rules of Practice and Procedure, HPARB and HSARB. http://www.hparb.on.ca/english/docs/directions/2013%20HPARB%20&%20HSARB%20-%20Consolidated%20Rules%20of%20Practice%20and%20Procedure%20-%20EN.pdf
Yet in the Reconsideration Request sent to the HPARB, I included several instances of errors and omissions from material submitted to the CPSO, hence that also went to the HPARB from the caseworker/investigator. And that’s just the minor part of my Request. The legal aspect of it is about the idea of “error of law” based on the matter of Medical Records being seen as legal documents, even though there may be errors. 

My next step should be to appeal the case to Divisional Court, but this is another new area for me, and one that would take even more physical effort and energy that is sometimes lacking. The filing of documents and attending the court room sessions is not something I would look forward to or maybe not be able to do well enough, especially when it is obvious justice has not been done if anyone took the time to read what I have written. Why would they believe what I say, or what I show them, when the authorities in this situation have not done that yet themselves? I can write and explain all that happened, but they aren’t listening. And they don’t have to. There’s nothing or no one to make them, and nothing within themselves to enable that to happen. 

Following is the Reconsideration Request I made to the HPARB about the CPSO Decision on the case of McPherson v Dr G. 


To: HPARB Reconsideration request HPARB File # 18-CRV-0693  
Susan McPherson (Applicant) Dr G (Respondent)

Date: Aug 13, 2019

Submitted by email – letter by attachment

HPARB hparb@ontario.ca 
Mr K presiding  
Ms S Board member  
Mr T Board member  
Ms M HPARB caseworker  
SM counsel for Dr G

Subject: Reconsideration request, of Board Decision July 24/19 re S McPherson v Dr G HPARB File # 18-CRV-0693 CPSO File # 107085

From : Susan McPherson, Applicant s.a.mcpherson@sympatico.ca 

Reasons for Request

1. This Reconsideration request is being submitted to the Board as a result of its July 24, 2019 Decision on the Adequacy of the Investigation and Reasonableness of the Decision of the CPSO Committee’s Decision, dated Oct 5, 2018, in the case of Susan McPherson v Dr G. My purpose here has not been to reargue the case but to provide enough details to enable the Board to see that the Investigation of the CPSO’s Committee was not adequate, and the Decision the Committee made was not reasonable.

2. I understand the Board can correct certain errors and also omissions in the write-up of the Decision (Practice, Practice Direction: Reconsideration of Board Decisions. HPARB). There are also errors in the material used in the Committee’s Decision, which should not have happened, and I ask that the Board use their power seek a way to deal with the persons who did this. In summary, I am requesting a Reconsideration of the HPARB Decision due to the original errors, omissions, distortions and abuses of process made by the CPSO case workers, investigators and Committee that then got carried through to the HPARB’s investigation and decision, continuing the errors, omissions, distortions, and abuses of process to the extent that the investigation the Board made of the Committee’s investigation and decision was unreliable and unfair, and wrong. 

3. Among the abuses of process is the Summary sent to me by Ms V on July 20, 2017, that I did not sign but was required to construct one myself, which turned out quite long so I called it a Revised Letter of Complaint. Pieces of it were used in the Committee’s Decision and the Board’s. A lot of extra work, and unecessary, for everyone involved. 

4. My request also includes Exceptional Circumstances as a reason for a Reconsideration. The Board’s Decision of July 24, 2019 “breached . . . procedural fairness” by only looking at what they were handed; the Decision they made “was obtained through abuse of process” by their not seeking out essential information, and also by the CPSO’s employees and Committee members not doing so; and “made a material error of law or fact such that the Board would likely have reached a different decision” (Exceptional Circumstances considered. Practice Direction: Reconsideration of Board Decisions. HPARB). See Para 

5. An explanation of the above, see Para 4., of the error of law made by the Committee due to assumptions made about the Medical Record, and how it affected the Analysis and the Decision of the Committee to mistakenly express their approval of the presumed accuracy of Dr G’s records, form the last pages of this Request. Assessing evidence on the basis of a legal principle that was wrong in this case is, in part, why the wrong decision was made about Dr G and why it was perpetuated. If not considered to be an Exceptional Circumstance I am requesting this Error of Law be dealt with in a manner that will discover the truth of this case. See Paragraph 88 under Medical Record Falsehoods.

6. I have included other matters that are in need of reconsideration, such as Dr G’s attempt to treat a condition that he did not know much about. I can understand that he might not, and that is not a problem, ordinarily, but it is when he refuses to allow me to see a gynecologist, which is what he did, early on in our time together. 

7. Some of what happened falls under the heading abuse of process, even though I may have referred to it as a missing document, or an uneccessary Summary I was required to wrote, which now seems to have been either to delay me, or to waste the Committee’s time, because if she could, she would put all the materials together in a way that indicated the fault was mine. 

8. Although there is some overlap, the headings I have used in my argument and explanations why this Reconsideration should be done are: 

a) Adequacy of the Investigation see p.2, referring to the Committee being required to “seek to obtain the essential information relevant to making an informed decision regarding the issues raised in the complaint” (Item 19 p, 7) and “to consider whether the Committee conducted an adequate, but not exhaustive examination, and if, in view of the information in the Record, the Committee’s decision falls within a range of possible, acceptable outcomes and is reasonable” (Item 24, p. 9, HPARB Board Decision, July 24, 2019).

b) Reasonableness of the Decision starting p.7, although at times there is overlap between them. Reasonableness in this context means “whether the Committee’s decision can reasonably be supported by the information before it and can withstand a somewhat probing examination. In so doing, the Board considers whether the decision falls within a range of possible, acceptable outcomes that are defensible in respect of the facts and the law” (Item 29, p 10, HPARB Board Decision, July 24, 2019).

Adequacy of the investigation of the Investigating Committee, CPSO

Inaccurate point made - with no source given

9. Under Analysis and Reasons, the Board summarizes what it received from me, including the recordings and oral submissions. But in itemizing them, the Board doesn’t say where the information came from, or provide details (dates) of the submissions received. I attempted to find the source of one item they mentioned, on page 6, because it did not sound like something I would say – or write, especially. It claimed that I said:
“the Respondent was nasty to her and appeared to be looking to end the physician-patient relationship and to blame it on her” (Analysis and Reasons, p 6. HPARB Decision. July 24, 2019). 

10. I wondered if someone was rephrasing what s/he read and wrote it in this way. If so, I do not appreciate having people do that, especially in a formal document. I see this as part of the inadequacy of the case, that liberties are taken in this manner. Dr G had made a nasty comment, but the way this phrase was worded it sounded as though I was saying he was this way essentially – nasty.  

11. I wouldn’t use that word to describe the kind of interactions we had. He wasn’t overtly nasty. He used a more subtle way of making me uncomfortable (such as asking me why I wouldn’t want to have the pelvic exam at a point when it had been overdiscussed and by May 10 there was no possibility that it would ever happen.) I didn’t see anything in any of my submissions or responses or application that used the word nasty, although I did describe his Attitude and behaviour in the small space on the application form as controlling, insensitive, defensive, and abusive. Farther along in the form I said more but not that he was nasty. 

12. Even abuse doesn’t always mean the abuser is nasty. Abuse can be done in ways the victim doesn’t always recognize it as abuse, such as the abuser attributing comments he says the victim said when she really didn’t, making her appear to be not just overly critical but outrageous in her accusations. Saying someone is nasty, when he is a Doctor, for instance, is really hard to believe, inplying direct abuse (or a patient who exagerrates), and no patient should stick around if she has a doctor who is nasty to her. 

13. In one place among my submissions, letters, application, and responses I did find a reference to my saying someone had been nasty to me, and the way that piece was written up by me, if not read carefully someone could have thought I was talking about Dr G. However, the person I was talking about was Dr A, who had been nasty to me, (despite not ordinarily being a nasty person) by writing reports that have had such a profoundly negative effect on my life. Following is what I wrote about being “nasty”:

14. Under the heading, “the Committee’s decision was not reasonable, April 2 notes [submission] for Apr 3 Review,” I wrote 
 [16] Dr G knew that something had happened between me and Dr A, just a few months earlier, and that the reports he wrote were not just disrespectful of me but nasty, written in support of his staff who were trying to trying to get me to back down. And he did say to me that he believed Dr A – what he wrote in the reports. The committee chose to not see it that way, that Dr A’s actions have had an effect on my being able to find and keep a family doctor” (2019 S McPherson. The committee’s decision was not reasonable. Apr 2 Notes for Apr 3 Review). 
15. It may have been in error that such a mistake was made, to think I was calling Dr G nasty. It’s about as bad a word as vile. More care needs to be taken to make sure the records are accurate.

16. Another misuse of a word in the Committee’s Decision is the use of the word “frequent,” instead of the term “recurrent” when speaking of the problem of infections of the urinary tract or bladder (1st paragraph, page 4, Decision, CPSO, Oct 5, 2018). Recurrent means something slightly different than frequent. Frequent generally means “often.” The term Recurrent UTIs is generally used to describe the condition. It is more common for women as they grow older to have this problem. I would appreciate having the correction made in the Committee’s Decision of Oct 5, 2018. The Board used the correct term in their Decision of July 24, 2019, and Dr G did also, in his Response to me on Sept 8, 2017. It was the Committee that got it wrong. 

missing - audio tape recordings 

17. In Item 16 of their July 24, 2019 Decision, in Part V, Analysis and Reasons, the HPARB Board names the items sent to them via their caseworkers, Ms B and Ms M, and by Ms V, case investigator for the CPSO to her counterparts at HPARB. Not among them are the short audio tape recordings that I sent, as well as other missing documents. I submitted the additional tape recordings of Dr G and myself once I realized the original recordings might be too long for the members to wade through. 

18. One recording was 1 minute 11 seconds long and vital to my complaint. Dr G is inappropriately asking me, “What are you so concerned about the examination?” Title of attachment was 2017 May 10 G-1min 11s, submitted in November 2018 to HPARB and again on Feb 22, 2019. This comment by him came in the weeks following his remark that he believed Dr A, not me, and discussions about the value of hormone replacement therapy for older women, regardless of the outcome of the pelvic examination he was referring to in his question to me. 

19. The second tape was 1 min 47 secs – an excerpt from the end of that last appointment on May 10 when he raised the abuse that occurred in relation to the specialist at the hospital and the false accusations the specialist wrote in his reports. Dr G must have been aware that I could be taping the appointment and so spoke these words so only I could hear them. I did react, as he was blaming me, although in my response I got my words mixed up. However, the existence of the tape suggests that something was said, and I responded to it. 2017 May 10 - 1 min 47 secs at end.

20. I again sent the two short tapes to HPARB on February 22, 2019, on a USB memory stick, to Ms B, HPARB caseworker, due to having become aware that the CPSO Committee probably had not listened to the entire longer versions. The HPARB Board, in their Decision of July 24, referred on p. 7, Item 17, to tapes of the May 5 and 10th appointments, as though they were the only tapes I sent. The Board did not identity them by length, only by the dates of the appointment. The 2 tapes I submitted that were less than 2 minutes in length were both of the May 10 appointment. I mentioned these at the Teleconference, as the two incidents were important for the CPSO and the Board to hear. The excerpts themselves are not new, as both would have been included in the longer tape of May 10. However, if the Committee was reluctant to listen to the entire tape (2017 May 5 G-20 min) they would have missed these parts of it. I have the location on the longer tape of the end of the May 10 appt, which I describe later in this request. Go to 14 min 40 secs on the longer tape (16.25 min long but with error in naming of it as being 20 min) where Dr G rasises the matter of what he saw as my abuse of Dr A and his staff, not the other way around.  

missing - Feb 22, 2019 submission by S McPherson to HPARB

21. I submitted some of these not knowing whether the Board had received them in an earlier submission, or in the bundle sent to them. My intention is not to repeat what I have already done but I feel it is necessary and the only way I can get things through – to keep trying.

22. From all appearances, this document plus attachments, didn’t get to the HPARB or used as evidence. A complete list of what I sent HPARB on Feb 22, 2018 follows, as stated in the cover letter that originally accompanied them. If HPARB did not receive them - the tapes as a matter of convenience so they would not have to listen to the entire length of it to find these 2 excerpts – one might assume the Committee did not listen to them either and so their investigation could not have been adequate on that basis. Just because something is before them doesn’t meana they have to read it. or listen to it, if its importance doesn’t jump out at them. 
Documents enclosed
1. 2017 July 20 Summary Letter by Ms V 2 pages
2. 2019 Feb 22 Notes on Summary Letter by S McPherson 2 pages 
3. 2019 Feb 22 Newly Revised Table of Contents 2 pages
4. 2019 Feb 22 Descriptions of audio recordings 1 page
5. USB Memory stick with 2 recordings 2017 May 10 G-1min 11s
2017 May 10 - 1 min 47 secs at end 

missing - Ms V’s Summary, July 20, 2017

23. One additional missing document that was important is the original Summary that Ms V sent to me, to have me sign and return. I refused to sign it and instead, tried to do what she wanted, but still ended up writing a revised letter of complaint similar to the original one I had written. The second letter is mentioned on page 1 of the CPSO Decision (File # 107085), as though I simply wrote it out of the blue, with no prompting on the part of the case worker, Ms V. I was not able to mention that sooner because I had no access to even a list of documents that had been sent to the ICRC at CPSO, let alone copies. I was not able to do anything about missing documents or the Committee lacking some of the information it needed to make a fair Decision, not until the bundle of documents were sent to the HPARB Board and copies were sent to me. 

missing - New, Revised Table of Contents

24. I created a New, Revised Table of Contents and submitted it on Feb 22, also, allowing it to become, apparently another missing document or one that the HPARB simply decided not to use. The Table of Contents by Ms V, included with the package sent by her to the HPARB Board was scant in information so I revised it, ending up with a New Revised Table of Contents which I submitted on Feb 22, 2018, after the Teleconference, although I had mentioned it at the Teleconference, to correct problems of omissions and lack of organization of unintelligible documents. I have not had any indication that the New Revised Table of contents, sent Feb 22, was received by the Board. 

25. The New Revised Table of Contents showed where the missing documents should have been, and by itemizing the Table of Contents it was more accurate in its labels. eg. My letter was not 48 pages long with attachments. My complaint contained a Letter of Complaint, as required, 4 pages long. I did include some attachments. Some pages were of articles I sent to Dr G about how older women might need Estrogen (this is for the Board of lawyers, if you don’t mind). And also one about tape recording doctors. 

missing – cover letter re 3 doctors Oct 2, 2017 and April 2, 2019 submission to HPARB

26. Another document missing from the bundle sent by the CPSO caseworker Ms V to the ICRC was the cover letter to the response I wrote, dated Oct 2, 2017, in which I asked about the 3 doctors who might be able to offer testimony on some of this. In her confirmation of receiving it she said she had only briefly looked at it. And she never did anything about that information, not even about contacting the gynecologist I went to afterward and asking for his expert opinion. Perhaps I was supposed to complete a form on him, but I wasn’t given one to send. In this respect, the investigation was inadequate.  

27. In spite of all this, the Board wrote in their Decision, ”Accordingly, the Board finds the Committee’s investigation to be adequate” (Item 28, p. 9. Adequacy of the Investigation, HPARB Decision, July 24, 2019). 

28. I mentioned this in a submission to the HPARB Board, much later, on April 2, 2019, that I sent to HPARB, and to Ms B and Ms M (caseworkers), only a day before the April 3 Review, as I had wanted this information to be given the members. See attachments (not included here but presumably delivered to the Board members and [counsel] S M by Ms M, as she claimed she would):
2019 Apr 2 Notes for April 3 review - See this attachment first - NB notes for Board & respondent  
2017 Oct 3 cover letter for my Response - missing document fr HPARB bundle (supplied by CV)

Dr G’s way of dealing with learning on the job

29. Having bladder or urinary tract infections is more of a problem as women grow older, and Estrogen is known to help keep the body’s hormones in balance. There are other reasons for such infections, such as a compromised immune system, not simply that the organs, such as the uterus (womb), for instance, might become less securely held in position. It would have been great then, and now, if the Committee investigating this problem, or investigating the investigation, could realize that even if I had had the internal exam done, it might not have shown anything problematic, and in fact, it didn’t, when I eventually had one done by a gynecologist. Nevertheless, after that I was placed on hormone therapy.

30. Among the duties of a physician, as stated in the CPSO, It states, “At all times physicians should:
 • be aware of deficiencies in knowledge or ability;
 • obtain help when needed; and 
 • ensure that their practice matches their level of competence (p 7, Principles of Practice and duties of Physicians. The Practice Guide MEDICAL PROFESSIONALISM AND COLLEGE POLICIES. http://www.cpso.on.ca/admin/CPSO/media/Documents/physician/polices-and-guidance/practice-guide/practice-guide.pdf retrieved Aug 7, 2019.

31. It would have been helpful had Dr G been able to admit he didn’t really know how to treat this painful condition. In fact, he didn’t acknowledge in his notes or Responses that I told him the condition at times was causing me substantial pain. But what’s important here is the fact that the Board members didn’t see his lack of knowledge as a problem (and his reluctance to admit it). Nor did the Committee members. They all seemed to go by the Medical Record - how it appeared to them, and what it said about me. 

meaning of “adequacy” of investigation 

32. When the Board raises the matter of the term Adequacy meaning not having to investigate everything before it, it means that it has to investigate enough so that justice is achieved – at least, the “essential information information relevant to making an informed decision regarding the issues raised in the complaint” it says on p. 7. Item 19, of the Decision, although elsewhere, for example in the letter I have before me from Ms B, dated March 8, 2019, regarding the Feb 22 submission I made, that my submission “will be given to the Board panel prior to the Review” (Copy of Letter from Ms B to [counsel] S M, March 8, 2019.)

abuse of Process - Required Summary for the Ms V and the Dr

33. Employees of CPSO have interfered in the continuity of the investigation by imposing the apparent necessity, acccording to Ms V, for instance, of there being first of all a Summary written by her, and then when that didn’t turn out well, an additional Summary, by me, which turned out to be not a summary but a Revised Letter of Complaint. The Revised Letter of Complaint/Summary is mentioned by the Board at the bottom of p. 3, after Item 8 of the Decision, repeating what I was obliged to write out for Ms V, although it appeared to be remarkably similar to the sections just above it in terms of content. Later, I realized that the Board had quoted from the original reasons I gave in the application form. To do both these letters was completely uneccessary. To complicate matters further, it turns out that the sections in Item 8 on p. 3 were from pieces of the Revised Letter of Complaint, with at least one word altered, to change its meaning. What’s more, the Board didn’t get a copy of the original Summary that Ms V wrote herself and sent to me to sign, on July 20, 2017, and neither did the Committee, resulting in another way the Committee’s Investigation was not adequate. And because it wasn’t, it affected the HPARB investigation. None of this was not an error. This appeared to have been done intentionally and led to an inadequate investigation. 

34. It’s not simply that this investigation was inadequate. It’s that there are problems with the process of dealing with Complaints and the ways the caseworkers, such as Ms V, have the freedom to manipulate the process and withhold information that leads to a waste of time for Committee members of the CPSO and for Board members of the HPARB (though not for the Doctor who is the subject of the Complaint). What might have been helpful, too, would have been to have someone on the Board likely to know a little about medicine and how the CPSO functions. Trying to explain to board members who may not understand from the point of view of a patient who unlike themselves, are being abused by the doctor, and trying to have them see when the College makes Policies for them to follow it may be difficult when their field of expertise is the Law.

Reasonableness of the ICRC Decision (Oct 5, 2018)

35. Previously, on April 2, 2019, I made a submission to the HPARB (missing document) which was confirmed by Ms M who said she was sending it to SM, counsel for the Respondents, and to the Board. There were 13 paragraphs in it related to the Reasonableness of the Committee’s Decision alone, if the Board would like to check on it to see what it contains.

end of May 10 appointment with Dr G  

36. Evidence of this interaction is on the 16 min recording of the May 10, 2017 appointment (see USB memory drive, starting at minute 14.40).” So, not seeing that anyone on the Committee or the Board listened to this lengthy tape, I made shorter versions of it, ending in a brief 1 min 11 second tape. If the Committee thought it was a sign of caring, or understanding, for a doctor to question me in this manner, asking Why not, when over and over my response had been no - No, to the doctor who had said to me he believed Dr A, No, to a procedure which put me at his mercy – which I could see he did not have towards me, not even offering anything in the way of precautions he would take, or who would be there, No to someone who didn’t even explain whether or not I could still be prescribed Estrogen if nothing was showing as being problematic in his pelvic examination. No, to someone whose priority was being able to do it rather than reflecting on why I might not want to and how else he could handle that situation.

37. If the Board has read through the original CPSO Decision and documents provided by CPSO caseworkers – and have not received all the submissions and documents intended for them, then the reasonableness of the CPSO Decision cannot be assumed, no more than the adequacy of the investigation can. The Board may well state (regarding adequacy of the investigation p. 7.) that their Decision depends on the information that is put in front of them. It removes any sense of responsibility any of the members might have to examine original documents and compare them to what is in the Decision of the Committee, for example. Reasonableness of the Decision (see p 10) depends on the ability of the Board to defend the CPSO’s decision based on what the CPSO Committee had in front of it (Item 29). But what that means is, if the Committee has not had enough of the right information in front of it, neither will the Board, because it just follows suit, using the same documents that the Committee has used. 

38. But while the question for the Board in Item 29 on p 10 of their HPARB Decision is “whether the Committee’s decision can reasonably be supported by the information before it and can withstand a somewhat probing examination,” it must also be asked whether the caseworkers and other employees at CPSO did their job properly and placed the information available to it (sent by the complainant, the Respondent, and any witnesses) before the Committee. 

39. I was not provided with a list of documents that were meant to go before the CPSO Committee, despite my requesting them, from the caseworker Ms V and others. She, or them, decided what information the CPSO Committee got to see, to the extent that it would be viewed as reasonable to them to not receive everything, based on the trust they had in their caseworkers and investigators, apparently. The same thing happened when it came to what was later sent to the Board of the HPARB. 

40. In fact, it didn’t even have to be the same information that got sent to the CPSO Committee as was later sent to the HPARB Board because hardly anyone would know what was sent to the CPSO Committee – only the accused, the lawyers for the accused, and the lawyers for the CPSO. The lawyers on the Board of the HPARB, and me, did not get sent those copies that went to the CPSO Committee, and did not even get a list of documents sent. We only got sent what Ms V sent to Ms B, claiming that was what was sent to the Committee. (But when it came time for Ms B to send submissions to the Board that I had sent to her, or Ms M to send them, it appears that my submissions may not have been passed on to the Board members, only to SM, lawyer for the accused.) Each time I submitted information for the Board, - Feb 22, 2019, and April 2, 2019, I received confirmation of it (something) having been received from me, and having been sent to SM. 

41. If only some of what is being sent to the caseworkers to be passed on to the Committee or the Board is getting passed on, and no list is provided, how can a complainant know whether the information was passed on unless the Decisions written up by the Committee and the Board reflect that seemingly missing information? It may be the Board’s Rule that what gets put in front of the Committee, or Board, is what the members use in making their decision, but how can that possibly lead to a reasonable decision being made by the Board, if some information is missing? When someone wrote, in good faith, presumably, that the question is “whether the Committee’s decision can reasonably be supported by the information before it and can withstand a somewhat probing examination” (Item 29, p. 10. HPARB, July 24, 2019), they probably didn’t realize that caseworkers would be making decisions of their own as to what gets looked at by the HPARB Board and what doesn’t. And where the term “probing examination” is mentioned, did the writer mean a probing examination of all that should have been placed in front of the Board, or only of what actually got placed in front of the Board? If important information has been left out, the Decision by the Board stands a lesser chance of being a reasonable one. Simply repeating the errors and omissions made by the Committee won’t do much good.

Falsifying and altering, and coercion by caseworkers and investigators

42. Another main issue concerns the items in boxes on p. 1 and 2 of the Committee’s Decision, in which they claim I am setting out my concerns. Starting with a) on page 1 with b) and c) on the next page, the Committee presumably quoted from my Complaint – or was it Ms V who sent in that distorted view of my Complaint, not using my original wording from my Complaint, made on June 27, 2017 but using fragments taken from the Revised Letter of Complaint/Summary that she told me I was required to complete? At least one word was changed completely, so that the meaning of the sentence was changed. 

43. In the version put on p. 1 of the Committee’s Decision and repeated on page 3 of the Board’s Decision, for my reasons for laying the complaint, one example of interference with my prepared text is as follows, from a) :

44. Most of the pieces that are printed in those Decisions, altered from the Revised Summary that I wrote at C Vale’s insistence, include this alteration:
“[The Respondent] said to me when a matter arose that involved ENT issues he believed [the physician’s] accusations, which I believed at the time was unprofessional of him” (Ms V?). 

45. Whoever wrote this, and I suspect Ms V did, changed the word that I used – “thought” – into the word ‘believed.’ The original sentence that I wrote, see following, came from the Revised letter of complaint that I wrote, on Aug 21, 2017, which arose from the insistence of Ms V that I submit a Summary. What I came up with was too long for a Summary, but she accepted it. But what got sent to the Committee, as being my original concerns, ended up being from the Revised letter of Complaint/Summary I was required to write for her. this is what I had written:

“At one point, early on, Dr G said to me, when a matter arose that involved ENT issues, that he believed Dr A’s accusations, which I thought at the time was unprofessional of him” (Susan McPherson).

46. The change from thought to believe changes the meaning of what I wrote. Dr G did behave unprofessionally. I didn’t just believe that he behaved unprofessionally. I thought about it. and he had. 

47. Once again, is it reasonable that the Board look at a Committee Decision when it was unknown where the information came from, or that I and what I thought was judged on the basis of someone else’s words and alterations? 

48. On the original Complaint Form, dated June 27, 2017, in response to the question 2 and the followup question, I filled in the boxes, as follows, after the questions:

F. Details of Complaint 
1. On a separate sheet, outline the details of your complaint. 
2. “Please summarize the details of your complaint by listing your areas of concern (care/behaviour, etc.)” 
  i. Attitude and behaviour: controlling, insensitive, defensive, abusive 
3. Why you are concerned about these areas?
He was controlling but I wanted to be involved in my healthcare. He was insensitive, trying to persuade me to agree to an invasive procedure that I was reluctant to have. He was abusive towards me at the last appointment, on May 10, 2017, then discharged me from his practice, making it increasingly difficult to get a new gp, or gain access to specialists. (See HPARB p. 7, HPARB bundle).

49. I decided to reproduce this part of the Application form because it was not mentioned in the Decision made by the Committee – probably because the information in it came from the Revised Letter of Complaint that came out of the Summary written for my case by caseworker Ms V which they may not even have known about. Even so, it was either Ms V or someone writing out the CPSO Decision who put their own touch on it, using the Revised Letter of Complaint, but leaving bits out and changing at least one word, with the effect of making it look as though these thoughts expressed in a), b) and c) on pages 1 and 2 of the Committee’s Decision were all mine. 

50. As I have stated, Ms V did not include her Summary letter of July 20, 2017 in the information sent to to the Committee. It was missing from the Table of Contents that she provided the CPSO Committee, and missing from the files she submitted to the HPARB, I would find out later. This missing document is vital to my case. I mentioned it in one of my submissions to the HPARB, after I got the bundle of documents, finally, that had been sent to the Committee by Ms V.  

51. This may all seem as though it belongs in the section Adequacy of the Investigation by the CPSO, but it is also relevant to consider when thinking about the Reasonableness of the Decision. If the Board accepts this introduction to my concerns in Para 36. above, as being written by me while not under coercion, then their impression of me would be influenced by that, just as it was by reading the Medical Record written by Dr G.  

52. Over time, Dr G must have been writing notes into my medical file on his computer, planning to finally get rid of me, blaming me for yelling and so on. It is necessary to hear the tape recording – the longer one of May 10. Headphones help, and turning up the volume and listening at line 14.40 of the 16.25 min tape, named as being a 20 minute tape recording. We discussed problems, about me wanting to be put on hormone therapy, for symptoms of pain and to stop bladder infections, and all he could do was express his concern from his own point of view, and wanted to know why I wouldn’t have the pelvic examination. That remark can be heard on the shorter tape of 1min 11 seconds. And that was not only unprofessional but inappropriate, to ask me that, having harped on it for two or more appointments, knowing it was unlikely I would give in. I considered how to get it done, but it just wasn’t going to happen. He was just bullying me by that time, probably enjoying seeing me so uncomfortable, me knowing he disapproved of me, knowing he could have started me on hormone therapy simply due to my age and being post menopausal, but didn’t. Women go on this medication for reasons other than having recurrent UTI’s, osteoporosis being one of them, and I already had ostopenia and was at risk. There are so many reasons to see Dr G not being as praiseworthy as the CPSO like to think or pretend.

Error of Law

53. Regarding Reasonableness of the Committee’s Decision, the Board wrote in Item 29 of its Decision of July 24, 2019, 

“the question for the board is . . . .whether the Committee’s decision can reasonably be supported by the information before it and can withstand a somewhat probing examination.”  

But when the information before it is false, that information has to be corrected first, by going back to the original documents. 

54. Regarding Adequacy of the investigation, the Board states in Item 19 that “an adequate investigation doesn’t need to be exhaustive. Rather, the Committee must seek to obtain the essential information relevant to making an informed decision regarding the issues raised in the complaint.”

The key words in that statement are “must seek to obtain.”  

55. Having stated in vague terms in Item 20, p. 7, what the Committee obtained from the applicant (eg letter and attachments – 48 pages, a second letter, audio recordings and her rebuttal to the Repondent’s response, the Board then does the same for the Respondent and on the following page ends with general “miscellaneous correspondence and telephone conversations.” But it also acquired falsifed documents, as noted in the discussion on Ms V’s misuse of the Revised Letter of Complaint. See Para 33. 2019 Aug 12 Reconsideration Request. And some documents and audio tape recordings that should have been in the bundle from the CPSO were missing. They should have been included among my submissions of February 22, 2019 and April 2, 2019.

56. If the Board did not seek out and examine these documents that I submitted to the CPSO, which would automatically go to the caseworker first to be processed, and if they didn’t listen to the short recordings on the USB stick, and take a look at the new Revised Table of Contents and the missing documents, or look at the wording on the original application form (see HPARB p 7 in bundle) and take it into consideration, then I question whether the investigation of my complaint was adequate, if adequate is the right word. I have had it used against me to suggest that half-way health care in some situations, for me, was adequate. Asking questions of the caseworker, instead of relying on her to do the right thing, would be one way for the Committee, or the Board, of seeking to obtain the essential information to make a fair Decision, through requesting all documents submitted by the complainant and then sending that Applicant a list of what they received, to doublecheck. 

57. In Item 33 the Board makes a point of saying that “a review of the Record did not yield any information to indicate that the Respondent was abusive and disrespectful and that the audio recordings appeared to indicate that the Respondent was professional and accommodating toward [the Applicant]” (Item 33, Reasonableness of the Decision, p. 11. HPARB Decision, July 24, 2019.

58. Item 34 of the Board’s Decision refers to my (the patient’s) letters and other submissions provided to the CPSO, as well as those made by the respondent, Dr G, noting that they were contemporaneous (added to the record at the same time they were happening), and saying,

“The Board notes that the College’s Policy #4-12 dealing with Medical Records states that: 
‘Medical Records are legal documents and may provide significant evidence in regulatory, civil, criminal, or administrative matters when the patient care provided by a physician is questioned’.”

59. However, medical records may well be thought of as legal documents but if they do not tell the truth, then their legality is in question. Surely they cannot be considered “legal documents” if they have been falsified or if they contain mistakes or incorrect information which has yet to be corrected. Assuming they tell the truth of the matter may be an assumption the CPSO and HPARB take for granted. The CPSO website has devoted a section on how to deal with such errors and inaccurate information, indicating that corrections must be made and the correct information recorded, as follows:

“Where it is necessary to modify medical records to ensure their accuracy, physicians should do so. Corrections must be made in such a manner as to ensure that the correct information is recorded (with the additions or changes dated and initialed) and the incorrect information is either severed from the record and stored separately, or maintained in the record but clearly labeled as being incorrect. Where the incorrect information is severed from the record, physicians must ensure that there is a notation in the record that allows for the incorrect information to be traced.43 Where incorrect information is maintained in the record, physicians must ensure that the information remains legible (for example, by striking through incorrect information with a single line).
PHIPA also stipulates that patients may request that corrections be made to their record if they show that it is incomplete or inaccurate.44 If the physician is not persuaded that a correction requested by a patient is warranted, the patient may require the physician to attach a statement of the patient’s disagreement to the medical record.45 The statement of disagreement would then become a part of the record” (Modifying Records. CPSO Policy Medical Records https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies Retr Aug 4, 2019). 

60. To assume the physician doesn’t make mistakes, or that he doesn’t distort or falsify the patient’s medical record depending on his own personal limitations, biases, and agenda, would be to misapply the meaning of the College’s statement that “medical records are legal documents” (see above) were it not for the disclaimer following it, the words “may provide significant evidence” that they may be considered legal documents (implied - not always), but probably not if they are incorrect. 

Incompatibility between Audio Recordings in the Medical Record, etc. and the Committee’s Decision (Ending the Physician-Patient Relationship)

61. Information in the medical record provided by Dr G about ending the physician-patient relationship in the audio recordings and in his written Responses to me during the CPSO Investigation are not consistent with what the CPSO Committee and/or the HPARB Board declare in their Decisions.

62. In the CPSO Decison of Oct 5, 2018, it is stated:

“In light of the above [3 other paragraphs], the Committee considers it reasonable that the Respondent concluded that there was insufficient trust and he had grounds to end the physician-patient relationship’. . . the Committee has no concerns in this regard.” (p 4.Analysis and Conclusions, CPSO Committee Decision Oct 5, 2018. )

63. However, in his official letter of discharge to me, dated May 10, 2017, mailed the same day of the last appointment, Dr G wrote,

“ . . . your yelling, aggressive, and argumentative behaviour constituted abuse towards myself in addition to your previous abusive behaviour towards myself at previous appointments. Such behaviour is not acceptable and I will be unable to continue care as your Family Physician, as such behaviour is not compatible with an ongoing physician-patient relationship.”

64. Again, in his Sept 8, 2017 response to my letters-with-details - part of my original Complaint to the CPSO, Dr G wrote about the last appointment, saying on p 3, 

“I was forced to discharge her from my Family Practice. I explained the logistics of her discharge from the practice, that I would be providing her with bridging prescriptions for the next months, and suggested she find another family physician. The explanation was brief due to Ms McPherson’s threatening behaviour. I discontinued the interaction and left the examination room, went to my office, and closed the door” (May 10, 2018).

[And I picked up my walker and left the building.] 

Audio Recordings of medical appointments

65. In his medical notes, written about me while I was sitting in his treatment room with him, Dr G described on May 10 how “the patient went from a raised, voice with interrupptions[sic] to screaming and yelling accusing the other doctors of abusing her, and that she had done nothing wrong” (second page of May 10 appt, p 95 (top right #) HPARB page #97 (bottom #), bundle (Dec 23, 2018). 

66. That incident was caught on tape, as it happens, on the first, 16.25 minute tape sent to the CPSO by me on Aug 21, 2017 (Revised Letter of Complaint), labelled approximately as being 20 min long. Listening with ear buds, Dr G can be heard across the room from me, referring to me having said to him before about situations in the past where other specialists had concerns about my behaviour ( attachment 2017 May 10, 20 min. See min #14:40 for his reinvented interpretation. At the time, I was closer to the tape recorder, which meant that my voice was louder on the recording, but there was no screaming or yelling. I objected at the time to Dr G about those remarks of his, which were, in effect, placing blame on me for the problems that occurred with the specialist. The specialist had put those comments in not one but 2 reports of the same appointment, of November, 2016, which Dr G inadvertently sent away for after the first appointment we had, to gather information for my medical file. I believe Dr G made the decision then to use his knowledge of the accusations made against me by Dr A, including incorrect and exagerrated descriptions of my behavour in his medical notes, even as we were talking. 

67. I say this now because the CPSO Committee, in their Decision of Oct 5, 2018, wrote that “on the basis of the audio recording, the Committee finds that the Respondent was professional and accommodating towards the Complainant. It appears to the Committee that the recording supports the Respondent’s version of events” (P 4 Analysis and Conclusions. 5th paragraph, CPSO Committee Decision, Oct 5, 2018).

68. I query the Committee’s conclusion, above, about there being nothing of significance on the audio recordings. Just because the audio was not clear doesn’t mean Dr G was respectful of me. Elsewhere he claims that several appointments ended in conflict, but not providing details. I am saying that he makes it sound as though I was always the way he described, rather than certain issues, especially at that time about Dr A, and also about the pelvic exam, were sensitive issues for me. I wrote in the Revised Complaint Letter of Aug 21, 2017 saying, 

“I recorded the appointment of May 5, and although the actual words are not clear, it is easy to see that it was simply a discussion, with no antagonism or disputes involved. Hear the recording (May 5, 2017, audio recording, usb-flash-drive) . . . He was not always abusive, and I was not always dissatisfied with the treatment from him, as demonstrated at the May 5 appointment (May 5, 2017, audio recording, usb-flash-drive). But Dr G was not respectful in his general approach to my health problems or to me as a person. As far as the Dr A incident was concerned, Dr G did not consider the possibility that Dr A was protecting his secretary because she had been trying to cover up his mistakes as well as her own in their treatment towards me (Items c and d. 2017 Aug 21 revised complaint letter).

69. On reading that excerpt, from the Revised Letter of Complaint which the Committee most certainly had, I question why the Committee was unable to find evidence to think about that contradicted Dr G or his Medical Record stated, resulting in a Decision that would be slanted, if no one took the time to relay such information to the Committee – or in this case, to listen to the audio recordings. There appears to be no way for them to know that such contradictory evidence is there, and there is no one to point it out to them. 
70. Dr G, as reported in the HPARB Decision, had stated in his Response to the Complainant that the quality of the recordings was often poor. See p 4, HPARB Decision, July 24, 2019. Furthermore, counsel for the Respondent provided oral submissions at the HPARB Review, including the mention of the Committee having found “no information in the record or recordings provided by the Applicant to indicate that the Respondent behaved unprofessionally and the audio recordings of May 5 and 10 support this conclusion”. See p 7, Item 17, sentence 5. HPARB Decision, July 24, 2019.

71. Under the heading Reasonableness of the Decision, in Item 33 of the Board’s Decision, is written:
“the Committee concluded that . . . . the audio recordings appeared to indicate that the Respondent was “professional and accomodating toward [the Applicant]” (Reasonableness of the Decision, p. 11. Item 33. HPARB Decision, July 24, 2019).  

72. On the same page as the previous Item is Item 36, where it is written:
“In addition, the Board has reviewed the audio recordings provided by the Applicant and is unable to conclude from those recordings that the Respondent’s behaviour during those patient visits was anything other than appropriate. Accordingly, the Board finds the Committee’s Decision to take no further action regarding the allegations of unprofessional behaviour on the part of the Respondent to be reasonable” (Reasonableness of the Decision, p. 11. Item 36. HPARB Decision, July 24, 2019).

73. I request that the committee listen to the audio recordings, using headphones or ear buds and turning up the volume as necessary. In the audio recording labeled May 10 appt, 2017, 20 min (or the brief recordins of the same appointment, it is possible to catch enough to realize something (near the end in particular) was taking place, when Dr G attempted to provoke me. I believe that a godd doctor should have been able to find a way through this without resorting to those tactics. But if he had planned it from the start, because of his knowledge about Dr A, it was probably inevitable that the Physican-Patient relationship would end this way.  

Informed Decisions

74. In Item 29 of the Board’s Decision, is stated:
“the question for the Board is not whether it would arrive at the same decision as the Committee, but whether the Committee’s decision can reasonably be supported by the information before it and can withstand a a somewhat probing examination. In doing so, the Board considers whether the decision falls within a range of possible, acceptable outcomes that are defensible in respect of the facts and the law.” (Reasonableness of the Decision, p. 10. Item 29. HPARB Decision, July 24, 2019).  

75. Referring to the last words in the previous Item, #29, “the facts and the law, I question whether the Reasonableness of the Board was adequate, considering that it had assumed that that the materials before it – among them the two “20 min” tapes were the only recordings made available to them, while the short, under-2-min tapes were not mentioned, nor their subject matter, excerpts from the May 10 appt that I submitted on February 22, 2018 to the Board via Ms B, caseworker. 

76. The Board seemed to be taking for granted that everything I wrote in my Complaint was not true and everything Dr G wrote in his medical notes and later his Responses to be straightforward facts. The conclusion it came to, (see above in discussion in Para 71), was taken to be reasonable but only because they chose to believe Dr G and the medical Record. 

77. Not only the Reasonableness of the Committee’s Decision but also Adequacy of the Committee’s Investigation was thus affected by the missing audio tapes and documents, and by audio tapes that were not listened to carefully enough to get some meaning from – if they did have them. Referring to Item 19 of the HPARB Decision, it is clear that the Committee was meant to “seek to obtain the essential information” and not just expect the caseworkers to get the job done and deliver all it was meant to deliver. In that respect, an informed decision could not be made by the Committee (Item 19, p. 7. Adequacy of the Decision. HPARB Decision, July 24, 2019). And without that information, an informed Decision on either the Reasonableness of the Committee’s Decision or the Adequacy of its Investigation couldn’t be made by the HPARB Board.  

78. In Item 27 in the HPARB Decision, the Board offers a disclaimer, stating that no one told them so how they supposed to know: 
“The Board has not been directed to any essential information that the Committee failed to obtain, or information that had it been obtained might reasonably be expected to have affected the outcome of the Committee’s decision” (Item 27, p. 9. Adequacy of the Investigation, HPARB Decision, July 24, 2019). 

79. I tried to let them know, but there appears to be a time warp, due to the applicant (me) not knowing what the Committee received from Ms V, not until the HPARB Board sent out their bundle, nor knowing if they received the submissions dated Feb 22, 2019 (including the short audio recording and about the missing documents) and the April 2 submission. In this way, the Investigation by the Committee was inadequate, leading to an inadequate investigation by the Board. 

80. The Decision by the CPSO Committee had numerous failings, including not quoting from what I, myself, wrote, in my original Letter of Complaint, but quoting from the Revised Letter of Complaint, taking it as truth while misquoting from it – from the Summary concocted by Ms V. That Summary, dated July 20, 2017, which was missing not only from the HPARB bundle but presumably from the documents the CPSO received, were prepared by Ms V. 

81. Different interpretations of the case, by Dr G, the Committee, and the Board, and what the brief less-than-2-minute tape recordings indicated about the end of this patient-physician relationship, are not all compatible with the message from the CPSO’s Policy on Ending the Physician-Patient Relationship whereby the presumably one-sided abusive relationship between the doctor – Dr G – and the patient – me (with the abuse apparently directed from me to him) is a legitimate reason for the breakup of the Relationship. 

82. The Board quoted from the Respondent’s medical notes about the supposed behaviour of the patient, in Item 35, p 11, concluding in Item 36 of the HPARB Decision that the Respondent’s behaviour was not inappropriate, finding that “the Committee’s decision to take no further action regarding the allegations related to unprofessional behaviour on the part of the Respondent to be reasonable. The Board further finds that the Respondent appropriately terminated the physician-patient relationship with the Applicant in accordance with the College Policy #2-17 Ending the Physician-Patient Relationship”.

Termination of the physician-patient relationship

83. The CPSO Committee did not explain precisely the reason they accepted for the ending of the relationship, only stating that “there was insufficient trust and he had grounds to end the physician-patient relationship”(p. 4, Analysis and Conclusions, 4th Para. CPSO Decision, Oct 5, 2018). 

84. I am explaining this here, now, because under the heading of Reasonableness of the Decision made by the Committee, the Board questions “whether the Committee’s Decision can reasonably be supported by the information before it and can withstand a somewhat probing examination” (Item 29, p 10, HPARB Board Decision July 24, 2019).  

85. I suggest that the CPSO’s Decision on ending the physician-patient relationship cannot be supported by the information before it. And that means the HPARB’s cannot either, since both depend for the most part on the same information to make their Decision.  

86. In this situation, about the reason for ending the Physician-Patient Relationship, the Committee made assumptions and errors. According to the policy, abuse of the doctor by the patient is a reason why a physician-patient relationship might be ended, and trust is not mentioned. See Ending the Physician-Patient Relationship. CPSO Policy, reviewed and updated May 2017. https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Ending-the-Physician-Patient-Relationship

87. The Board, however, decided that what they read that Dr G wrote about my supposed behaviour, in the doctor’s Medical Record and in his Responses about my behaviour, was true, but did not take into consideration that he may have falsified these documents. 

Medical Record falsehoods

88. A Doctor’s notes can reflect falsehoods on purpose, such as when Dr G claimed he did not say to me that he believed Dr A, or when he claimed that I was rude towards him. One reason for not telling the truth could be to cover up the fact that right from the start he planned to write scathing notes about me and my supposed behaviour (see Item 35, Board’s Decision), while waiting for the right time to provoke me, to get me to react, and thus end the relationship on a bad note.  
89. If the Board does not consider that this kind of plan could be put into effect by a physician, then it is not considering such possibilities, that the idea that the Medical record created by Dr G could just as easily contain not only errors and omissions but reports of fake incidents throughout that were not recognized as such by the CPSO, due to the Committee’s false belief in the wrong legal principle – at least, in the wrong half of one. 

90. In ‘Error of Law v. Mixed Fact & Law: Crown’s Right to Appeal,’ it is stated:
“3. An assessment of the evidence based on a wrong legal principle is an error of law”  
(R. v. Bentley, 2015 BCCA 251 (CanLII) https://canliiconnects.org/en/summaries/37344 ) .

And within the CPSO it is stated:
 “Medical Records are legal documents and may provide significant evidence in regulatory, civil, criminal, or administrative matters when the patient care provided by a physician is questioned,” 
(Evidence of Care, Medical Records, Policies, CPSO. Approved November 2000, Updated May 2012. https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Medical-Records ).

91. If the CPSO Committee believes what is stated in Items 34 and 35 of the Board’s Decision, as has also been described in the records and Responses of the Respondent, and which includes a definition of Medical Records from the CPSO, they would have to acknowledge that the distortions, errors and omissions, and lack of attention to audio recordings would likely lead to an error of law, because the legal principle that Medical Records are legal documents (as stated by the CPSO Policy) only applies in certain situations, not if there are errors in it. 

92. The Medical Record of Dr G’s wasn’t altered. It hadn’t been changed after being written up. It was falsifed as he sat at his computer, being written contemporaneously as I sat there in the room, there for treatment, while he judged me and entered lies into his notes to protect Dr A, and to ensure he wouldn’t do his reputation harm by treating me.  

93. Finishing the excerpt from Para 90., ‘Error of Law v. Mixed Fact & Law: Crown’s Right to Appeal,’ in Item 4. it states:
“4. The trial judge’s failure to consider all of the evidence in relation to the ultimate issue of 
  guilt or innocence is an error of law. 

Further,” [it states] “the error must also be material to the verdict – in order to set aside an 
acquittal there must be a reasonable degree of certainty that the verdict would not 
necessarily have been the same had the error(s) not been made: R v Morin, [1988] 2 SCR 
345 at 374” (R. v. Bentley, 2015 BCCA 251 (CanLII)  
https://canliiconnects.org/en/summaries/37344 .

94. Disregarding the context in which that argument takes place, what is to be taken from Error of Law piece is that conditions have been placed on the Medical Record as legal document. Item 4, in Para 92, states that the judge [Committee, in this case] needs to consider all of the evidence, not just at what seems at first glance is the obvious conclusion. It must consider all the evidence, even the audio tapes that are difficult to hear, for some – and those documents that are missing but which were submitted. 

95. Further (see Para 92), there is a reasonable degree of certainty in this case involving Dr G and myself that had the Committee – and thus the Board – not been convinced that the Dr was not at fault – and that I was – they would have investigated the complaint with more vigour. Their eyes might have been more observant, and their ears more open to what they were listening to, and their brains more welcoming to the truth. 

96. The case of CR v ML, HPARB 2015, (CR being the wife of a patient who died) brings to light the issue of altering or falsifying a patient’s medical record. Addressing the CPSO, the applicant, CR, made an allegation that the Respondent falsified the patient’s medical record (see Para 27, CR v ML).

97. The Board, however, of the 2015 case, observed that the contemporaneous medical record was consistent with the Respondent’s response and included the patient’s vital signs as charted in Triage (see Para 29). Thus the Board decided that “the patient’s medical record provides a reliable indicator of the patient’s condition and there is no indication in the Record that the records were altered or falsified” (Para 30. C.R. v M.L., 2015 CanLII 39430 (ON HPARB) 2015-07-10 File number: 14-CRV-0313. <http://canlii.ca/t/gk1d6>).

98. The Committee commends Dr G for his accuracy, but how could they know that what he wrote in the medical record was accurate? Dr G’s medical record on me was not altered, it was falsified. It was misrepresented at the time it was being typed up by Dr G.

99. From this quote, the attitude of the Committee is clearly seen:
 “The Committee is satisfied that the Respondent provided excellent care in the circumstances. We commend him for the accuracy and level of detail with which he documented his care of the Complainant” (Analysis and Conclusions, p 5. Committee’s Decision, Oct 5, 2018). (Emphasis on “in the circumstances” is mine - Susan McPherson). At the same time the committee praises Dr G, they place blame on me, for being difficult. 

100. The legal principle, that the Medical Record is a valid legal document, is not always correct, and an assessment based on it could be an error of law. Taking for granted the accuracy of a medical record because the law has been interpreted to suggest that it is a legal document is an error of law. The Committee erred in its assumptions, and in ignoring all the evidence, such as the under-2-minute recordings of the May 10 appointment, or the longer 20 minute tape (actually 16.25 minutes long) in which it is possible to make out the words at the end, and the tone of the discussion between Dr G and myself, and more. The Committee erred in not seeking out the truth of the actions of the caseworker Ms V, whereby among other things, she manipulated me into writing a Revised Letter of Complaint/Summary which she then took pieces from which ended up in the Decision made by the Committee, and in the Decision made by the Board. 

Thank you,
Susan McPherson

s.a. mcpherson@sympatico.ca 

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