Ontario case brought by prison inmate states expectations for doctor on patient confidentiality

To safeguard patient confidentiality, doctors are expected to refrain from talking loudly where others might hear and transfer to an examination room if discussing personal issues, a committee of the College of Physicians and Surgeons of Ontario has said.

In D.B. v M.K., 2021 CanLII 9 (ON HPARB), the applicant, an inmate at the Ottawa Carlton Detention Centre, alleged on behalf of himself and nine other inmates that the respondent, a primary physician who provides care to at least 500 inmates at the detention centre, made no effort to ensure that his appointments happened in private, made prescriptions which were not explained and which were not in the best interests of the patient and rushed his appointments.

On the other hand, the respondent claimed that he was providing the best care that he could under the circumstances, considering that the inmates in question were in the maximum-security unit, with examinations occurring in a designated room that was dysfunctional, not entirely enclosed and destroyed due to previous riotous act.

The respondent also submitted that he had already asked for the room to be repaired and that it was the policy of the Ministry of Correction Safety and Correctional Services that the correctional staff would have the discretion to decide whether patients could be moved from their cells, based on factors such as the nature of the patients’ convictions and the risk of danger to staff.

The Inquiries, Complaints and Reports Committee of the College of Physicians and Surgeons of Ontario decided to take no further action upon the applicant’s complaint but stated its expectation that a physician ensure patient confidentiality by not talking loudly where other people can hear. If a patient’s personal issues are being aired, a physician is expected to try to transfer the patient to an examination room. A physician is also expected to make every attempt to renovate or repair examination rooms so that there is adequate privacy in the room.

The committee noted that the applicant’s complaint generally criticized the care provided at the detention centre. The committee stressed that its role is to consider specific complaints, not systemic issues regarding how medical care is delivered in correctional facilities. Such issues may be brought up in other forums, the committee said.

Upon a request for review, the Health Professions Appeal and Review Board confirmed the committee’s decision to take no further action and to state the expectation. The board said that, even though the investigator failed to visit the detention centre as requested, the committee’s investigation was still adequate because it gathered the needed information for it to make an informed decision.

The board also said that the committee had reached a reasonable, transparent, intelligible and justified decision that dealt with the issues raised in the complaint.

On the issue of privacy, the committee found that the respondent did his best to ensure privacy despite the institutional limitations. The board found the committee’s stated expectation properly addressed the applicant’s privacy concerns. The committee’s decision was based on a coherent, rational and justified chain of analysis, the board said.

On the issue of the respondent’s prescription of medication, the committee agreed with the respondent’s explanation that he would explain the prescribed medication to patients and answer their questions, and that he relied on his own assessment and examination of patients when prescribing medication. The committee acknowledged the logistical challenge faced by the respondent, who is responsible for the care of many inmates who are not his regular patients and who have diverse medical needs. The board found the committee’s ruling upon this issue reasonable.

On the issue of rushed appointments, the committee said that it made sense for the respondent to prioritize medical needs and to act in an efficient manner, considering that he is the sole physician dealing with many patients. The board ruled that the committee’s reasoning here was also rational and coherent.