On August 14, 2019, on the basis of an Agreed Statement of Facts and Admission (Liability), the Discipline Committee found that Dr. Hyde committed an act of professional misconduct, in that he has failed to maintain the standard of practice of the profession, and has engaged in an act or omission relevant to the practice of medicine that, having regard to all circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Background
Dr. Hyde is 82 years old. Until July 9, 2019, he was a general practitioner in Ottawa, Ontario. He held a certificate of independent practice with the College of Physicians and Surgeons of Ontario since 1968.
Failure to Maintain the Standard of Practice of the Profession
The College retained an expert to provide an opinion with respect to Dr. Hyde’s care and treatment of patients. In his reports, the expert opined that:
a) Dr. Hyde failed to maintain the standard of practice with respect to his medical record-keeping in that:
i. His patient charts are not clearly written, are disorganized and often lack an easily identifiable patient record;
ii. He fails to maintain chronological SOAP notes or other clearly delineated summaries of patients’ investigations and medical condition(s), such as a Cumulative Patient Profile, and does not include pertinent positive or negative findings, rationale for ordering investigations or discussions with patients about the results;
iii. Dr. Hyde uses unprofessional language in his charts to describe his patients;
b) Dr. Hyde states that he practices “complex disease management” primarily involving Myalgic Encephalomyelitis and Chronic Fatigue Syndrome, which is outside the conventionally-recognized scope of general or primary care practice;
c) Dr. Hyde takes diagnostic approaches that are not supported or corroborated by conventional practice, and orders investigations the results of which are nonspecific and yield no discernible constructive findings;
d) Dr. Hyde failed to follow currently accepted guidelines for the detection of prostate cancer, including in ordering PSA testing;
e) Dr. Hyde lacked knowledge of opioid or benzodiazepine treatment contracts, despite prescribing long-term benzodiazepines to patients;
f) Dr. Hyde lacked knowledge as to whether or not his electronic correspondence and patient files are encrypted or stored in a secure fashion, despite the fact that he purported to conduct an extensive telemedicine practice from Italy for several months each year.
The College retained another expert to provide an opinion specifically with respect to Dr. Hyde’s psychotherapy practice. In his reports, the expert opined that:
a) Dr. Hyde failed to record what is required of a practitioner providing psychotherapy, such as a mental status exam, diagnosis, his psychotherapeutic treatment plans, his interventions and the patient’s response to treatment;
b) In one case, where Dr. Hyde billed OHIP for providing psychotherapy 49 times between 2006 and 2016, the expert found only one adequate psychotherapy note;
c) In five cases, the expert could find no evidence in the charts that Dr. Hyde performed any psychotherapy, despite Dr. Hyde’s numerous billings between 2005 and 2016.
d) In one case, Dr. Hyde prescribed addictive medications and opioids, including Dilaudid, quietapine, clonazepam, and hydromorphone, without documenting the patient’s progress, and how the psychotherapy he was providing was assisting the patient. He failed to properly monitor the patient for risk of addiction, overdose and suicide. This displayed a lack of judgement.
Dr. Hyde’s inappropriate care and treatment of his employee
Individual B was employed by Dr. Hyde. While Individual B was Dr. Hyde’s employee, Dr. Hyde:
a) prescribed medication to Individual B on six occasions, including a prescription for a tricyclic antidepressant; and
b) billed OHIP for providing treatment to Individual B on eight occasions, including for psychotherapy on seven of those occasions, between April 2009 and August 2010.
Despite prescribing to Individual B, and billing OHIP for treating Individual B, Dr. Hyde did not maintain a patient chart for Individual B.
Unprofessional communications, boundary violations, and conflict of interest Dr. Hyde is the founder of a charitable foundation. Dr. Hyde wrote newsletters for his charitable foundation, which he mailed to the patients in his medical practice.
In these newsletters, Dr. Hyde provided his personal opinions that the compensation of physicians in Canada is inadequate, complained about the College’s requirements of physicians, solicited patients to make donations to his charitable foundation, and disclosed inappropriate personal information about himself and of his patients.
Patient A was a patient of Dr. Hyde’s between approximately 2008 and 2014. In appointments with Patient A, Dr. Hyde disclosed his and other patients’ health information, questioned the competency of other physicians, and complained about physicians’ remuneration and about the College, including the College’s record-keeping requirements.
Block Fee for Uninsured Services
When Patient A first became a patient of Dr. Hyde’s, Dr. Hyde charged her $1,500, purportedly as a block fee for services that are not covered by OHIP. In doing so, Dr. Hyde failed to comply with the OHIP Schedule of Benefits, and the College’s policy on Block Fees and Uninsured Services by:
a) improperly charging Patient A a block fee charged to cover the constituent elements of one or more insured services;
b) failing to provide her with the alternative of paying for each service individually at the time that it was provided; and
c) failing to offer the block fee in writing indicating the services that were and were not covered by the block fee, and failed to provide her with a copy of the policy to ensure that she was fully informed of her payment options.
Delay in Responding to Request for Patient Chart and Inappropriate Fee
In September 2013, Patient A’s lawyer wrote to Dr. Hyde requesting a copy of her chart, which Patient A was required to produce for the purpose of motor vehicle litigation, enclosing a direction authorizing Dr. Hyde to release it to the lawyer.
Patient A did not obtain any portion of her chart from Dr. Hyde until July 2014, despite having made multiple requests for it both directly to Dr. Hyde and to his secretary, and despite attending at Dr. Hyde’s office numerous times specifically for this purpose.
In July 2014, Dr. Hyde’s assistant informed Patient A that her chart was available to be picked up, and that the fee would be $825. Dr. Hyde’s first invoice to Patient A, indicated that the $825 fee was for “medical-legal work”. When Patient A raised a concern with Dr. Hyde that his fee was excessive, and that she had not requested that he do any medical-legal work, he provided a revised invoice indicating that he had charged her $825 “to organize all patient data into a comprehensive chart and copy the entire file at the request of [Patient A]’s lawyer”, and that this had taken him four hours.
ADMISSION
Dr. Hyde admits the facts above, and admits that, based on these facts, he engaged in professional misconduct under:
a) paragraph 1(1)2 of Ontario Regulation 856/93 made under the Medicine Act, 1991, in that he failed to maintain the standard of practice of the profession; and
b) paragraph 1(1)33 of O Reg. 856/93, in that he engaged in acts or omissions relevant to the practice of medicine that would be regarded by members as disgraceful, dishonourable or unprofessional.
AGREED STATEMENT OF FACTS RELEVANT TO PENALTY
Dr. Hyde entered into an undertaking to the College on July 5, 2019, by which he agreed to resign from the College, and not to apply or re-apply for registration as a physician to practise medicine in Ontario or any other jurisdiction, effective July 9, 2019.
ORDER
The Discipline Committee ordered that:
- Dr. Hyde attend before the panel to be reprimanded
- Dr. Hyde pay costs to the College in the amount of $10,370.00 within thirty (30) days from the date of this Order.
Terms and conditions imposed on certificate by: Inquiries, Complaints and Reports Committee