On August 10, 2018, the Discipline Committee found that Dr. Ayoob Mossanen committed an act of professional misconduct, in that he has 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, and in that he has contravened a term, condition or limitation on his certificate of registration.
Allegations referred by Notices of Hearing dated November 23, 2016, November 15, 2017, and March 20, 2018 were dealt with in one hearing.
Dr. Mossanen received his certificate of registration authorizing independent practice from the College in 1970; he holds RCPSC certification in neurology and practised at the Clinic in Toronto, until his resignation on October 26, 2017.
Patient A
In the fall of 2006, Patient A sustained injuries in a motor vehicle accident. Dr. Mossanen was retained by Patient A’s legal counsel to conduct an independent medical examination. Patient A attended Dr. Mossanen’s office in the fall of 2007. She reported headache, neck pain, mid and lower back pain and lower abdominal pain. Patient A was in her mid-30s.
After interviewing Patient A, Dr. Mossanen instructed her to remove her top and provided her with a gown. Patient A followed his instructions. Dr. Mossanen examined Patient A’s nervous system, cranial nerves, motor system, gait, neck, back, facet joints, shoulders, lower extremities, sacro-iliac joint and lower abdominal area. Dr. Mossanen’s examination included straight leg raising (including hip flexion), and bending each of Patient A’s knees toward the chest. In examining Patient A’s fundi, Dr. Mossanen placed his face very close to hers. She could feel his breath. Patient A recalls Dr. Mossanen touched her face.
Dr. Mossanen asked Patient A to remove her pants. Patient A was upset and cold and did not wish to remove her pants. As Patient A recalled, Dr. Mossanen assisted her in removing her pants during the course of the examination. Without an adequate explanation to Patient A, Dr. Mossanen manipulated Patient A’s legs as part of his examination. In doing so, he came close to Patient A’s symphysis pubis, causing her discomfort. Without an adequate explanation, Dr. Mossanen palpated Patient A’s lower abdomen, including near her symphysis pubis. To do so, Dr. Mossanen rolled down Patient A’s underwear exposing her lower abdomen and the upper part of her pubic area. Patient A became increasingly upset and uncomfortable, and was crying extensively. She found Dr. Mossanen sharp and impatient and did not understand why he was palpating her near her pelvic area, and why he was pushing and pulling on her legs, as part of his examination. She forced her legs shut.
Dr. Mossanen terminated the IME and advised Patient A he could not complete the examination. Dr. Mossanen failed to explain to Patient A the steps of his examination, failed to explain that he would be palpating a sensitive area of her anatomy, and failed to obtain Patient A’s informed consent, causing Patient A considerable distress. Dr. Mossanen failed to show adequate sensitivity and respect for Patient A’s comfort, which was unprofessional.
In November 2015, Patient A complained to the College regarding her experience with Dr. Mossanen.
Patient B
In the fall of 2016, Patient B sustained injuries in a motor vehicle accident. Dr. Mossanen was retained by Patient B’s legal counsel to provide an IME. Patient B attended Dr. Mossanen’s office in the summer of 2017. She reported neck pain, chest pain, interscapular, lower and whole back pain, right groin pain, post-nose fracture, vague cracking sensation in the toes without any pain, right and left upper extremity stiffness and intermittent tingling of the hands and feet. Patient B was in her mid-30s at the time.
Dr. Mossanen’s physical examination included investigation of Patient B’s nervous system (including cranial nerves, fundi and visual fields, and hearing), musculoskeletal, motor, and sensory systems as well as an examination of the left and right side of her groin. As part of the examination of Patient B’s cranial nerves, Dr. Mossanen examined Patient B’s eyes. This involved coming in very close to Patient B’s face, which made Patient B very uncomfortable. Dr. Mossanen failed to adequately explain the steps of his examination and the purpose of his examination, making Patient B uncomfortable. Further to Patient B’s complaint of right groin pain, without an adequate explanation to Patient B, Dr. Mossanen palpated Patient B’s right and left inguinal ligament. Without an adequate explanation to Patient B, the examination was performed with Patient B’s pubic hair and the top of her vulva exposed. In palpating the area, Dr. Mossanen incidentally touched the area of Patient B’s pubic bone. The examination caused Patient B considerable distress.
At the time of Patient B’s IME, Dr. Mossanen was required to have a College-approved practice monitor present during the entirety of the encounter. The practice monitor, a registered nurse, who observed Dr. Mossanen’s entire examination of Patient B, did not consider any touching inappropriate.
Dr. Mossanen failed to explain the steps of his examination, failed to explain that he would be palpating a sensitive area of Patient B’s anatomy, and failed to obtain her informed consent, causing Patient B considerable distress. Dr. Mossanen failed to show adequate sensitivity and respect for Patient B’s comfort which was unprofessional.
Breach of the Section 37 Order
On January 6, 2017, the Inquiries Complaints and Reports Committee made an Order prohibiting Dr. Mossanen from engaging in professional encounters with female patients of any age, unless the patient encounter took place in the presence of an approved practice monitor. Dr. Mossanen was required to ensure that the practice monitor remained in the examination room or consultation room and carefully observed all physical examinations. The terms of the Order required, among other things, that:
- Dr. Mossanen ensure that each patient scheduled for an appointment with him was directly notified, prior to the appointment, of the details of the practice restriction
- Dr. Mossanen ensure that each practice monitor maintain a patient log of all in-person professional encounters with female patients and that
-Dr. Mossanen ensure the practice monitor submit the original Log to the College on a monthly basis.
Dr. Mossanen contravened the terms, conditions and limitations on his certificate of registration by failing to notify several of his patients, including Patient B, that he was required to have a practice monitor present for all professional encounters with female patients, and by failing to ensure that all three College–approved practice monitors submitted their patient logs to the College on a monthly basis as required.
2018 Undertaking
On August 7, 2018, Dr. Mossanen entered into an Undertaking with the College, wherein he acknowledged that he resigned from the College and undertook not to apply or re-apply for registration as a physician to practise medicine in Ontario or any other jurisdiction.
Disposition
On August 10, 2018, the Discipline Committee ordered and directed that:
- Dr. Mossanen attend before the panel to be reprimanded.
- Dr. Mossanen pay costs to the College in the amount of $6,000.00 within thirty (30) days from the date this Order becomes final, or in accordance with a payment plan approved by the College.