discipline summaries not in contact with the patient’ s skin. Listening to the front of the patient’ s chest, however, Dr. Peirovy’ s usual practice was to place his hand, holding the stethoscope, underneath the patient’ s clothes. The presence of overlying clothing restricted the space, such that he held the stethoscope differently, with the bell between his index and middle fingers and his other fingers extended. Auscultating the anterior aspect of a patient’ s chest Dr. Peirovy would typically listen on two or three locations on each lung, moving the stethoscope from place to place underneath the patient’ s clothing. For female patients wearing bras, he would place the stethoscope under the bra, directly on the patient’ s skin. He acknowledged that, as a result, the stethoscope, and his hand, would come in contact with the patient’ s breast, and possibly with the nipple. Dr. Peirovy stated that, in the walk-in clinic, he would usually not ask patients to remove any clothing. Although gowns were available in the clinic, he would generally not make use of them. Exceptions would occur if his initial examination detected more serious problems, indicating the need for a more thorough examination or, in the case of a full annual examination when the patient might be requested to disrobe. In this case, a gown would be provided for the patient. Dr. Peirovy explained that his practice in this regard was both on account of the limited time available in the walk-in setting, and also in the interests of the patient’ s privacy, as they were not required to undress. Dr. Peirovy testified also about his routine for examining the heart. He stated that, in auscultating the heart, he focused on the apex area as the best location for auscultating the mitral valve. He stated that the apex is typically located underneath the left breast. In female patients, there would be occasions where the apex was covered by the left breast, which might require him to displace the breast with his hand in order to properly auscultate the apex. With female patients, he would generally ask them to lift their clothing in order to make the apex accessible. His examination of the cardiovascular system would also include auscultating the lungs, particularly the lower lobes. Dr. Peirovy testified about his recollection of his encounters with the six complainants in these proceedings. He had no independent recollection of Ms. V, Ms. W or Ms. X. He could recall the other three, because in each case something out of the ordinary had occurred which caused him to remember these particular patients. Specifically, he recalled the argument involving Ms. U’ s boyfriend after he had examined her, the anxiety-related problems of Ms. Y and the difficulty in her examination on account of the malfunctioning of the examination table, and the alleged misunderstanding of Ms. Z which resulted in her breasts being exposed, in addition to his subsequently having asked her out on a date. Dr. Peirovy had reviewed his records for each of these patients. Dr. Peirovy testified that, in relation to each of these six complainants, he had examined them in a manner which was consistent with his usual routine. He stated that, in each case, he felt that his examinations were medically indicated and undertaken for a legitimate medical purpose. He denied any sexual interest in any of these patients, and he denied that his touching of them, during the course of his examinations, had been sexually motivated. Dr. Peirovy was, for the most part, clear and consistent in his testimony. The Committee observes that, in fact, there is considerable common ground between the accounts of the various complainants and Dr. Peirovy’ s own recollections of what happened or, in the cases for which he had no recollections, his assumptions about his actions based on his review of the records and his usual routine in examining such patients. Each of the complainants states that Dr. Peirovy touched their breasts during the course of medical examination of their lungs and / or heart; Dr. Peirovy acknowledges that, indeed, he may have done so. Five of the complainants state that Dr. Peirovy placed his hand, holding his stethoscope, underneath their clothes including their bras; Dr. Peirovy confirms that this is his usual practice. Ms. Z states that her breasts were fully exposed while Dr. Peirovy was examining her chest; Dr. Peirovy recalls that this was in fact the case. Ms. Z alleges that Dr. Peirovy asked her out on a date; Dr. Peirovy does not deny having done so,
Full decisions are available online at www. cpso. on. ca. Select Doctor Search and enter the doctor’ s name.
Issue 1, 2017 Dialogue 67