DISCIPLINE SUMMARIES
In the summer of 2014, Dr. Di Paola was invited to attend a meeting regarding Patient A’ s care at a hospital by virtue of Dr. Di Paola’ s close personal relationship with Patient A. This meeting was attended by Patient A’ s treating physician and by a Children’ s Aid Society social worker who had been involved with Patient A’ s family. At that meeting, Dr. Di Paola took a position with respect to Patient A’ s access to Patient A’ s child that was adverse to the position taken on this issue by Patient A’ s treating physician.
CAMH Policies and Privacy Education On December 10, 2012, Dr. Di Paola signed a letter of offer of appointment to the medical staff at CAMH. On April 17, 2013, Dr. Di Paola signed a letter of re-appointment to the medical staff at CAMH. Each letter provided that, by signing the letter, Dr. Di Paola confirmed that she was familiar with the Personal Health Information and Privacy Protection Act and was aware of, and agreed to honour, her obligations set out therein. Each letter also provided that acceptance of the appointment entailed Dr. Di Paola’ s agreement to govern herself in accordance with all CAMH Policies, which included a Privacy Policy. Dr. Di Paola completed CAMH’ s e-learning program on Privacy Fundamentals on April 26, 2012 and again on August 31, 2014. Dr. Di Paola was aware each time that she accessed the medical records of Patient A and Patient B that she was doing so without authority or consent.
CAMH Disciplinary Action The Medical Advisory Committee at CAMH, where Dr. Di Paola holds privileges and where the breaches of privacy occurred, took disciplinary action against Dr. Di Paola. The disciplinary action consisted of a two-week unpaid leave of absence; the completion of two courses addressing issues relating to professional boundaries and privacy and confidentiality; and the drafting of three letters of apology, one to Patient A, one to Patient B, and one to CAMH as an organization.
REASONS FOR PENALTY The Committee took into account a number of principles in assessing the proposed penalty. Paramount is the protection of the public. Also important is a desire to express the abhorrence of the profession for the member’ s behaviour, and to maintain public confidence in the profession and the College’ s ability to regulate the profession in the public interest. Deterrence both of the member and other physicians is also an important feature in a penalty. When possible, the penalty should also provide for rehabilitation of the member. The penalty should also be proportionate to the misconduct.
Dr. Di Paola accessed the confidential medical records of two people with whom she had a close personal connection. Dr. Di Paola improperly accessed the medical records of these two patients willfully for her own purposes, rather than for the wellbeing of the patients. Confidentiality is one of the fundamental pillars within medical education. Patients must feel that their personal medical information is handled in a confidential manner. Medical records contain information about their background, their experiences, their illnesses and their treatments, and may only be disclosed with the patients’ informed consent. Dr. Di Paola signed annual re-appointment forms at the hospital from July 2013 acknowledging her understanding of confidentiality and handling of clinical records. In spite of this, she acted deliberately and repeatedly to violate the confidentiality of the medical records of the two patients. The conduct of Dr. Di Paola was not a transient, impulsive act; rather, she gained unauthorized access to the patients’ medical records on 19 occasions, and accessed multiple records on some occasions, over a two year period. Dr. Di Paola’ s activity only stopped when the hospital changed its method of accessing health records. Accessing health records inappropriately is not a harmless activity. This was demonstrated in the victim impact statement provided by one of the patients. She felt“ extremely devastated,” humiliated, and helpless. Because she lacked the power to prevent these acts, this patient felt re-traumatized by the breach of confidentiality. She had always guarded her privacy, for example, by discussing confidential material with only one psychiatrist over an 18-year period. It is likely that this breach will affect her trust in the medical profession in the future and could affect her ability to receive optimal care.
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DIALOGUE ISSUE 4, 2017