#1 The Case of Dr T: Relationships with Patients

Connect with Santa at srabi@rabilaw.ca. More information about her law firm can be found at rabilaw.ca

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Dental Disputes takes an in depth look at real patient complaints about their dental care. From communication breakdowns to total malpractice, we uncover these stories in order to help dentists avoid similar pitfalls. Join us as we discuss complaints taken from discipline hearings across Canada. Subscribe now and never miss a case. thank you so much for tuning in to the very first episode of our podcast dental disputes My name is kelsey and i'm one of the,hosts of the podcast and santa My co host is joining me today. We're so lucky to have you on Hello. So just a little bit about Santa. So she was my classmate in dental school and then you went on to do your law school and now dentists and lawyer. Yes. Now I'm working as a lawyer and I do part time dentistry. So I'm very exciting. So I'm so happy you're here, Santa, because for me, I have zero, law background. And in reading these cases, there was so much that I wasn't familiar with. And a lot of the laws that I didn't even really know about. So I'm happy that you'll be here to kind of present the case with me and explain some of the nuances that we might not be familiar with. Yeah, I'm happy to be here. And it's kind of exciting to combine the two. Finally, you know, and I don't know if you remember this case from dental school, but this was a case that was like, extremely, extremely popular. In the media, everyone was all the time talking about it, and I thought it would be a very good first case for us um, do you remember it? Yeah, for sure. Yeah, that was the hot topic at the time, for sure. So, like, all the details from this case are all available online, and they were also in the news. But Santa and I have decided to kind of keep the names private of both the dentist and of course of the patient and leave out some of the information just for the sake of privacy. So without further ado, I will be presenting the case of Dr. T. Dr. T is an oral surgeon in Ontario who had over 30. 30 years of experience. And at the time of this case, he was working in both his private practice and at a hospital in Ontario, as well as even being a professor in one of the schools and the patient in this case, we will refer to her as kit, of course, not her real name, but a little bit of background information about her. So, in 1993, she was actually in a motor vehicle accident. And as a result of this accident, she had lots of injuries to the right side of her face into her jaw. And she actually developed temporal mandibular joint dysfunction and was like just having so much pain. So she decided to go through multiple surgeries to try to correct both this pain as well as her appearance. one of the surgeries that she had done was actually a chin implant. But according to Kit's testimony, this chin implant was like not successful at all. And the chin implant had actually started to migrate up the right side of her face. So because of this, she was extremely dissatisfied with her appearance following the surgeries. And in one of her testimonies, she actually mentioned that she relocated from Ontario to Europe. And one of the major reasons for this relocation was to avoid hearing comments Kit's story and her changed appearance from her friends and family. So like very, very sad, extremely traumatic and caused her a lot of pain and discomfort, even years afterwards. So again, this accident was in 1993. But if we fast forward to the time of the case, it was in 2006. And at this time, Kit was living in Europe. And during this period, she was searching for different surgeons on the internet. who could possibly help her address the concerns about her appearance as well as the pain. And after doing some Google searching, she came across the name of the famous Dr. T. And she requested a referral letter from her family dentist in Europe to go see Dr. T in Ontario. So this is where it all begins. And on September of 2006, Dr. T and Kit met for a consultation at the hospital where he was working. And during this visit, it was just a regular consultation appointment where Dr. T requested all of Kit's previous dental, um, records and scans, so that he could kind of start with a treatment planning process to help alleviate this jaw pain and fix this chin implant. So, so far, very normal. And after two weeks, Kit returned back to see Dr. T. And at this visit, he kind of like performed a minor, minor surgical procedure where he removed a piece of bone that was in her lower left jaw and he just plucked it out with tweezers. And then that was that, and um, after those two visits, Kit returned back to Europe. eventually they start to email, and this is kind of where things start to turn. So Dr. T and Kit had sent some emails back and forth, and Dr. T was specifically requesting that he and Kit meet up, because he was attending a conference in, um, The country that Kit was living in in Europe. So he was just requesting that they meet up while he's there. So this meetup occurred on,;;;October 14th. And they went for a walk, had dinner, and went to go see the movie. And during the movie, apparently Dr. T had placed his hand on Kit's knee. And then they did some hand holding. went for some drinks and then one thing led to another and they ended up having sex in Dr. T's hotel room. So the first sexual encounter, October 14th of 2006. So following this visit, again, they continue to have like email conversations, text messages, phone calls, both professional and sexual in nature. And in the discipline hearing, they actually noted all the places that the two had sex. So some of which included, but might not be limited to the faculty office, a hospital recovery room, private practice in Dr. T's car and in a relative's home. So, you know, at this point, it seems like they're definitely in like a sexual relationship. So all this time, Kit is always waiting for her major surgery, which was the removal of a chin implant. That was migrating up the side of her face. And finally, the surgery occurred in March of 2007 by Dr. T. So he removes the chin implant at the hospital. And allegedly, when Kit was in the recovery room, there was like a little bit of, Rubbing the leg after the surgery. Um, and then that was that the chin implant was out following that surgical visit. Kit attended Dr. T's office for multiple follow up visits, and he also had her do a sleep study. So their relationship actually continued on for quite some time. But apparently, around 2011, their relationship really started to go sour. and they actually had a final meeting that was in October of 2011. So again, this all began in 2006. Now we're fast forwarding to 2011. And they had a final meeting at Dr. T's, um, at the hosp at the hospital. With kit and actually her husband. So she had been married this whole time that she was in an affair with Dr. T. And during this final consultation visit, what was very strange was that kit had actually recorded the whole audio of the consultation visit with Dr. Her, her husband and Dr. T, but Dr. T was not aware of the voice recording. So during this consultation visit, apparently things got a little bit heated. The whole point of the consultation was to discuss what had kind of gone wrong during the surgery. Although the details of the surgery weren't in the discipline hearing. But I did get the impression that something just didn't go as planned So one of the I don't know if you remember the santa but like the main thing that was splashed across the news Was that during that consultation visit? Dr. T Whipped a skull across the room And it like smashed the wall and it was so violent, um, and he had lost his temper and that was in all the the news articles. Um, and the famous line that was presented was that Dr. T had thrown the plastic skull with such velocity that it flew across the exam room and caused her hair to be blown by the wind. Um, and it was thrown in such proximity that it scared her almost to the point of incontinence. Yeah. And I want to say like, this was an allegation. So, um, the RCDS, so I actually didn't find that he, any reasonable evidence that, that he did, did that. So it was one of the allegations. Right. It was all, it was all audio recorded. No comment on that. Yeah. So major, like one of the major pieces that I remember. Yeah. And then like, so pretty much after that meeting, um, Kit ultimately ended filing the complaint with the RCDSO against Dr. T. Again, and the allegations were sexual abuse. And she was arguing, you know, that he was her doctor and she was his patient and that they had sexual intercourse, um, as well as I believe, oral sex. At that time. So some of the things that were like, again, the evidence that was presented by kids legal team. They, of course, had all the text messages that audio recording, um, as well as like the weirdest evidence that I heard of was that she presented semen stained underpants. And apparently the semen on these underpants was Dr. T's, but these underpants were stored for seven years. So whether they were inadvertently stored or like stored on purpose, nobody knows again, but that was one of the pieces of evidence. So, so bizarre. And then I think, like, correct me if I'm wrong, but the major points that Dr. T had with his legal team, um, were that, you know, they were arguing that she wasn't a credible witness, that Kit was always changing her story, giving conflicting evidence, um, that she was omitting certain, like, emails, deleting others, presenting others, and they really were just arguing that she was out to get him in a multi million dollar lawsuit. And then the other arguments they had were that, like, Dr. T wasn't her, her, her dentist at the time that they had the, um, any intercourse, and that he couldn't have possibly been her dentist because she already had a family dentist. And I believe that, like, the college just said no to all those points. Is that right? Yeah. So I think, you know, I think you mentioned at the beginning is that he had a consultation or some sort of appointment with her, but there was no treatment plan, um, at that point. And one of the legal arguments at the disciplinary hearing was that he, there was no dentist patient relationship had formed at that point because the only, Time that we had certain evidence that they had slept together was that date that you mentioned so that was the time that we had certain evidence that there was, um, probable, You know, high chance that there was some sexual intercourse at that time. Um, so that was kind of the link where was there a dentist patient relationship with her at that point where we know for sure that an intercourse happened. And then I think the RCDSO said that those consultations were, you know, for, they, they did form a patient. Yeah. Yeah. Yeah. And then I think, um, the argument where they said, She was out to get him, so this was planned. She kept the undergarments. She recorded him, etc. And the RCDS didn't care about the intentions of the patients. It's irrelevant to whether, you know, the test to whether was there sexual abuse during this relationship or not. Yeah, that's a good point. And then I think, like, ultimately they found him to be guilty of sexual abuse. They found him that he committed, yeah, the, sexual abuse. So, which was, you know, huge because sexual, um, intercourse would be a revulsion of, of license, which is what happened in this case. Yeah, took away his license and they also made him pay three, almost 320, 000 in the span of a year. Yeah. And I wasn't aware that like, you know, when you're going through these legal battles that you actually have to pay. I always thought that our malpractice insurance covers that. But I guess if you're found guilty. You still have to, um, pay up some certain fees. So, I think, um, our malpractice insurance, the mandatory one at least, doesn't cover any RCDSO complaints. So nothing, none of that, that will all be out of pocket. Whatever, if you have a complaint with RCDSO, then it would be all out of pocket. Any malpractice in civil court, to this week. covered by your model practice insurance. If you're not disqualified for one reason or the other, um, sometimes some criminal acts are disqualified. So yeah, so this would be all out of pocket from the dentist. And sometimes you're ordered to pay certain fees to the college for cost or, the colleges regulatory bodies usually have the program for sexual abuse. Patients, um, to go through, and then they require that the dentist pay for that as well. So that's what, but the actual patient, the college can't award the patient money to them. So the patient doesn't actually get any financial gains from, uh, an RCDS. So complain or hearing, um, do you only get, uh, a penalty for that? Dentist, whether it's a suspension or revocation of license, or you take a course if it's one of the lower, um, lower risk cases. So yeah, so in this case, in the disciplinary hearing, the patient doesn't actually get money. They have to go to the civil. Courts, if they want to claim sexual assault, in by civil matters and, uh, and that's at a very different standard than the RCDSO because RCDSO is concerned more about whether did you abuse your patient, but, civil courts might be more concerned about whether there was legal consent or not. And, and sometimes. There is consent, even though it's considered sexual abuse in, um, in the professionalism matters and with our city. So this is super interesting. And I think this case actually did also go to civil court, but the details were like aren't aren't available to the public, as I know. Yeah, I mean, I mean, I can't, you know, we can't make any speculations, but it could have, and, uh, Outcome could have been different, who knows? Yeah, yeah, but, you know, it's a different standard in civil court, for sure. So, yeah, but, uh, very interesting case very. And I got also had a couple of questions that I also I wasn't too sure about. So I was wondering, can dentists practice on their spouses, family members and does common law count? Yeah, so I think dentistry is one of the very few, or if not the only profession who has an exception for spouses. So if you are, and spouses is by definition of, uh, legislation, which is if you're legally married in the, in Canada, um, then that would be your, your spouse. That's the only exception where you can work on someone where you have sexual relations with. You can also work on family members or friends, if obviously with friends, if there are no sexual relations, occurring between, can you work on common law, partners, and I'm assuming that there are sexual relations between you and the common law partner. And unfortunately, if, if it's not, if there is no legal marriage, then no. So common law partners would not have the same rights as married, couple and in Ontario, for a dentist to work on you. So if you. Live with someone for years and you are, um, common law. And, um, you, you've, you know, you break up for some reason or the other, you're definitely common law partner can come after you, whether it's vengeance or, or whatever reason to, to say this person worked on me, this dentist worked on me while we were not married. And that's huge because, you can get your license revoked for sure. Yeah, I did not know that. So very good to know. I'm sure the listeners might not have known that either. Um, the other question, that I had was what about an ex from from long, long ago? Yeah. So, um, what the test is basically is you ask is, is there a dentist patient relationship between you? And the person and is there and sexual relations, happening, during that time. So if, if the relationship where there was a reasonable, I would say reasonable time period between where it ended and when you start having the patient dentist relationship, um, then that would be, technically okay. And it's the same thing of whether you have a patient and then Um, you're no longer there a dentist and what's a lot of time period until you come, um, you can have sexual relations with them. My advice as a lawyer, I mean, there's no, like every case is different. Definitely. I'm not giving you legal advice, but my, my recommendation as a lawyer is always, these are not, uh, an area where you want to, To be in because, you do not want this to ever be on the RCDS. So as public records, whether you are in the right or not, and whether, because this is something you're risking your license or not. So it's not something to take lightly. Um, I would stay away from, from, trying to engage with. Patients sexually or to, work on people who have, you've had a history of sexual relations. Yeah. Sound advice. Very good advice. Yeah. Exactly. The other, group of people that we were wondering about was employees. Oh, yes. So this is, uh, happens more often than, than, uh, than people think. So a lot of dentists work on their employees, whether it's a filling their employee asks, them to do. So, you know, I, I think I have a cavity here. Can you take a set of bite wings on me? Or I have an emergency. I need antibiotics. Um, and then anything that you do for your employee, whether it's your prescribing a set of antibiotics or, or just seeing them for emergency or filling, is potentially you developing a patient, dentist relationship with them. And so all your actions to them, in the eyes of the RCDSO is that of how you view. Is how you interact with a patient, not with an employee, because it's a different standard to say that you harass an employee, you're more getting into the waters of perhaps maybe criminal or professionalism, but if you're harassing and sexually harassing your, your, your patient, then you are definitely going into, sexual abuse in, in terms of, are you going to lose your, your license or not? Especially if you're having, if you're having sexual, intercourse with them. So always, uh, a huge, uh, you know, warning with. Dentists who work on their employees and, and I know today's topic is about sexual relations, but it even goes with bullying. Um, you know, sometimes some employees will, be fired and they want to get back, on the dentists and they file a complaint that they were mean and they bullied them, et cetera. And, if the dentist was their patient, if the dentist was their dentist and they've treated them as a patient at one point, then that kind of takes our CDS. So a different path to see, are you pulling your patient? Not just your employee. So, and then it sounds like, yeah, there's a very recent case on our CDS. So website about a dentist Who had an, I think a hygienist who he took to, uh, I can, I think it was a conference and they didn't have sexual intercourse, but they were in the same room. There was some touching. They slept on the same bed. But he had seen this hygienist for, something. So he was her dentist. Um, whether it was very brief appointment or not, I don't know. And, and, so he had his license suspended for a period of time. Wow. Even yeah, crazy stuff out there. Yeah. Um, what's steps should we take? So if you're, if you're a dentist and you've got a patient and love strikes and relationship blossoms, what is the proper course of action to take so that these kinds of things do not happen? Yeah. So, I mean, um, the thing is love shouldn't blossom with your patients. I think that if it doesn't, it might be a little bit too late. It shouldn't. And my advice is always. Do not approach, anyone who, is your patients sexually. You should definitely, uh, dismiss a patient if, you know that there will be sexual relations and there should be sufficient time for that. a reasonable time period, between this discharge and, and in the start of the sexual relation. So I can't discharge you today. And then tomorrow, engage in sexual relations. Um, there has to be some reasonable period to say, yes, this person is no longer their dentist. Maybe, maybe them going to a different dentist and being treated regularly somewhere else. So it's not just on paper dismissing a patient, but there has to be an actual, real dismissal of patient and having another family, as much evidence as possible that this person has another family dentist that they're, they're seeing or any other dentist. But it's, it's, it's not, again, it's not something that you want the whole world to see and assess. Were you a patient of this dentist and were you not? Because it's, it's a serious offense with the RCDSO. Yeah, totally. What would like, so if you're writing a dismissal letter to a patient, what's an example, like what kind of wording would you put? And where is this, is this an actual physical letter that's mailed? Is it emailed or like, what, what would you do for these dismissal letters? So, dismissal. I, I think the R-C-D-S-O does have still, like a, a draft of a dismissal letter on their website. They might have it still. And, uh, there are reasons where you can dismiss patients. And we can maybe do another, topic on that one because there's quite a bit of reasons where, you know, it's, it's, it's a long thing of when can you dismiss patients and when can you not, if there is no longer patient trust or mutual understanding between the two, you can dismiss, uh, patients, if you feel that you cannot no longer serve this person or this patient, to the best of your abilities because of some reason or the other, you can dismiss your patient again. I think I'm saying it very general. it's very, uh, there are specific reasons where you can dismiss and not, and especially in emergency situations, you shouldn't. Um, but, it would be very, It's tricky for sure for if you, if you want to sleep with your patients and that's why you're dismissing, not something I would recommend doing. If a client came up to me and said, can you draft me a client, a letter to do that, I probably would steer them away from doing that than actually writing it for them. Yeah. And, uh, I think. Tricky situation. Yeah, let them go grab another dentist for for a few years and then you come back. No, thanks so much. I'm so happy that you, you know, you could be here and explain some of these things. There was tons of things I didn't know. Um, like especially with this, like the civil case and RCDSO complaints not getting money and having to pay for that out of pocket should it ever happen. And I hope that you guys enjoyed the episode and we can get together again, subscribe to our podcast and then we'll each week we'll go over a case and kind of have a nice discussion about this. And certainly if you guys have any questions or comments, make sure to send them our way and we will address them. Thank you everyone. Don't engage in sexual relations with patients. Final words of wisdom. Thank you.