DISCIPLINE SUMMARIES
- Garbage cans in examination rooms and common
areas were filled with garbage;
- The radiator in the examination room was peeling
paint and the paint chips were lying on the floor
around it;
- Dr. Dubins’ office was cluttered with numerous
items including soft drink bottles covered in dust;
- Blinds in the examination room were stained and
dusty;
- Paint on the walls was peeling; and
- A plant pot at the front door was filled with dirt
and garbage; there was no plant.
In response, Dr. Dubins explained that he used
“Aversive Imagery” techniques in his hypnotherapy
practice, and that patients (including Patient A) are
informed of and consent to the use of these tech-
niques. He explained that the purpose is to develop
strong negative associations with the behaviour that
the patient seeks to stop (such as smoking). For ex-
ample, he stated, when he asked Patient A to imagine
a cigarette in “fishy-smelling vaginal discharge”, his
intention was to create a negative association with
the taste and smell of cigarettes to assist Patient A in
quitting smoking.
He also said he asked Patient A to undo his belt and
pants button and lower his fly approximately one inch
in order to make him more comfortable. He stated
that he has improved the cleanliness of his office.
The expert retained by the College concluded that
although the vast majority of Dr. Dubins’ care of
Patient A met the standard, he demonstrated a lack
of judgment in some areas: “The vast majority of the
aspects of care provided by Dr. Dubins, as far as I
am able to discern, and based on the information I
have, do meet the threshold of standard of clinical
practice. However, the reliance upon sexually themed
aversive imagery (extrapolated from questions related
to sexual orientation/identity) for simple and dis-
crete chemical-addiction hypnosis is in my opinion
excessive, not specifically required for positive clinical
effect and in a minority of cases could render the
treatment modality ineffective or even be potentially
harmful (i.e., triggering past traumatic memories/
emotions.)…Likewise, comments (particularly
during session) related to having a patient unbut-
ton or otherwise loosen their pants may – even if
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DIALOGUE ISSUE 4, 2017
solely intended for the purposes of increasing patient
comfort – cause anxiety and/or unease in a subset of
patients…[These] aspects of care … reflect a lack of
judgment on the practitioner’s part as opposed to a
lack of skill or knowledge.”
Prior History with the College
In January 1995, the Complaints Committee cau-
tioned Dr. Dubins in person in relation to a complaint
by a patient who complained that Dr. Dubins made
inappropriate comments and used inappropriate and
unnecessarily intimate images in his smoking cessation
therapy. The Committee stated that it was “very con-
cerned” about the use of extremely graphic and sexual
images during the smoking cessation therapy. It said
that his approach in his care of this patient was “inap-
propriate”. It also expressed concern that the patient
had not been advised in advance that sexual material
and extremely graphic images would be used during
the therapy. He was cautioned by the Committee re-
garding the nature of his treatment of the patient and
his failure to provide her with an adequate explanation
prior to proceeding with the treatment.
REASONS FOR PENALTY
The Committee determined that protection of the
public from further misconduct by this physician is
of the utmost importance in deciding the appropri-
ate penalty. The penalty must also provide specific
and general deterrence, communicate the profession’s
disapproval of the misconduct, and take into account
any aggravating and mitigating factors. It is vital to
maintain the public’s confidence in the College's
ability to self-govern in the public interest.
Dr. Dubins signed an undertaking that results
in his immediate resignation from the College. He
undertook to never re-apply to practise medicine in
Ontario or elsewhere. This will protect the public
from any further misconduct by him as a physician.
It will also serve to maintain public confidence in the
integrity and reputation of the medical profession,
and in its capacity for effective self-governance in the
public interest. The public must trust that the Col-
lege will act to ensure that no physician will misuse
his position of trust and authority to take advantage
of vulnerable patients.
The Committee accepts that such behaviour as that