discipline summaries
This matter was brought to the College’ s attention by a family member of Mr. X. The nature and extent of the relationship that existed between Dr. Vasovich and Mr. X between the end of their relationship in early 2005 and Mr. X’ s death is the subject of court proceedings. During this time, Dr. Vasovich was involved in Mr. X’ s care as outlined above. Mr. X lent Dr. Vasovich money, including 2 loans of $ 30,000 each in 2008. Other sums changed hands between Mr. X and Dr. Vasovich after 2008. Throughout her relationship with Mr. X, Dr. Vasovich issued prescriptions to Mr. X in circumstances that were not for minor conditions and did not constitute an emergency. Some of these prescriptions were repeats of prescriptions initiated by Mr. X’ s treating specialists.
The College policy on Treating Self and Family Members provides, among other things, that physicians should not treat their family members or other individuals in relation to whom the physician has personal or emotional involvement that may render the physician unable to exercise objective professional judgment in reaching diagnostic or therapeutic decisions(“ family or other close individuals”), except for minor conditions or in an emergency situation, and only when other qualified health professions are not readily available. Where it is necessary to treat family or other close individuals, physicians must transfer care to another qualified health professional as soon as is practical. By treating Mr. X in circumstances that did not constitute an emergency, and treating him when other health-care professionals were available, Dr. Vasovich contravened the College policy.
Reasons for Penalty The Committee received in evidence extensive volumes of material regarding the care provided by Dr. Vasovich to Mr. X. The Committee noted that Mr. X was being treated for a number of serious medical conditions, utilizing multiple medications. It was clear that Dr. Vasovich was treating a complex and potentially difficult patient, even though he was in a relationship with her. Dr. Vasovich’ s treatment of and prescribing for Mr. X clearly and grossly fell outside of the guidelines of the College’ s policy Treating Self and Family Members.
The College’ s policy outlines the guidelines that every physician in Ontario must follow in treating either themselves or their family members. It provides that“ physicians are not permitted to diagnose or treat either themselves or family members, except for minor conditions or in emergency situations, and then only when another physician is not readily available”. The Committee did recognize that Dr. Vasovich did not bill OHIP for her services, and thus received no direct financial gain through the medical care she provided to Mr. X. Furthermore, there was no evidence of ongoing provision of controlled or restricted substances to Mr. X. It was also recognized that much of Mr. X’ s care was directed by the multitude of specialists that he had seen on referral from Dr. Vasovich. At the same time the central role of the family physician / general practitioner, the role which Dr. Vasovich assumed in the management of the treatment of her patient, cannot be overemphasized in terms of its critical mandate in organizing, integrating and orchestrating patient care. Family physicians are in a unique and important position in the provision of care for their patients. They are the key medical providers to the patient due to their global perspective on their patients’ medical condition. They ultimately direct the care of their patients regardless of the number of consultants / specialists who may be involved. As a mitigating factor, the Committee does recognize that this was the first appearance by Dr. Vasovich before the Discipline Committee. There is no evidence that she treated other family members. The Committee believes that the penalty jointly proposed by the parties achieves both specific and general deterrence. It also reflects the profession’ s disapproval of the misconduct by Dr. Vasovich. Dr. Vasovich’ s care of Mr. X grossly and clearly fell outside of the policy established by the College in 2001. Physicians must recognize that treatment of themselves or family members is fraught with hazard given the unpredictability of medical conditions. Even“ simple” problems can at times and do become complex and the physician can then be placed in a compromised position, objectivity being lost, resulting in compromised decision-making and care. The Committee is aware that a four-month suspension is significant for treatment of a family member,
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Dialogue Issue 2, 2016