On August 29, 2016, the Discipline Committee of the College of Physicians and Surgeons of Ontario found that Dr. Jacques Henri Dubins committed an act of professional misconduct in that he has failed to maintain the standard of practice of the profession and in that he engaged in an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Dr. Dubins, a 72-year-old family physician with an interest in hypnotherapy, has had an independent practice in Toronto.
In March of 2013, the College received a complaint about Dr. Dubins from Patient A, a patient who had attended Dr. Dubins twice in early 2013 for hypnotherapy for smoking cessation.
Patient A complained that:
-Dr. Dubins’ office was dirty;
- During the appointment, Dr. Dubins asked unnecessary and inappropriate questions of a sexual nature that made him feel uncomfortable, such as whether he is gay or straight and whether he is sexually active;
- During the hypnotherapy session Dr. Dubins used graphic and offensive sexual images that caused Patient A to be very uncomfortable; and
- During the session, Dr. Dubins told Patient A to unbutton his pants, lower his fly and lower his pants.
On March 18, 2013, College investigators attended at Dr. Dubins’ office to inspect for cleanliness, where they found the following:
- 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 techniques. He explained that the purpose is to develop strong negative associations with the behaviour that the patient seeks to stop (such as smoking). For example, 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 discrete 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 unbutton or otherwise loosen their pants may – even if 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 cautioned 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 concerned” 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 “inappropriate”. 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 regarding the nature of his treatment of the patient and his failure to provide her with an adequate explanation prior to proceeding with the treatment.
PENALTY
On August 29, 2016, the Discipline Committee ordered and directed that:
- Dr. Dubins appear before the panel to be reprimanded; and
- Dr. Dubins pay to the College costs in the amount of $5,000 within 30 days of the date of this Order.
On August 29, 2016, Dr. Dubins executed an undertaking with the College to resign and never re-apply to practise medicine in Ontario or any other jurisdiction, effective August 29, 2016.