On March 4, 2019, on the basis of a Statement of Agreed and Uncontested Facts, and Admission and Plea Of No Contest On Liability, the Discipline Committee found that Dr. Mark J. Sager committed an act of professional misconduct, 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 and failed to maintain the standard of practice of the profession.
STATEMENT OF AGREED AND UNCONTESTED FACTS, AND ADMISSION AND PLEA OF NO CONTEST ON LIABILITY
1. Dr. Mark J. Sager is a 74-year-old general physician practicing in Toronto. Dr. Sager received his certificate of registration authorizing independent practice from the College of Physicians and Surgeons of Ontario (“the College”) on July 6, 1972. He has practiced general medicine since that time.
Communication and Conduct with Patient A
2. Patient A was a patient of Dr. Sager’s for over 30 years. During this period she was treated for two occurrences of breast cancer.
3. During gynecological examinations, Patient A would often cover herself with her hand or her gown out of shyness. On these occasions, in order to perform the examinations, Dr. Sager would move Patient A’s hand or gown out of the way. He did so without asking Patient A to move her hand or gown herself, and without asking if he could move her hand or providing her with an adequate explanation. This left Patient A feeling humiliated.
4. The gynecological examinations were otherwise not inappropriate.
5. In early 2017, Patient A was scheduled for s gynecological surgery. Given her cancer history, she was anxious about the procedure. Her specialist instructed her to insert misoprostol vaginally prior to the surgery.
6. Patient A had an appointment with Dr. Sager in January 2017, prior to the surgery. At this appointment, Patient A asked Dr. Sager to explain medical terms in a lab report. Dr. Sager shouted at Patient A to “come over here, just come over here”.
7. At the same appointment, Patient A asked Dr. Sager to clarify the instructions she had received regarding the insertion of misoprostol. Patient A was unfamiliar with the drug and had questions about the prescription, as the literature accompanying the prescription indicated it was used for stomach ulcers and did not mention gynecological uses.
8. When Patient A asked for clarification regarding the use of misoprostol vaginally, Dr. Sager flew into a rage and said, “fucking take the pills when a doctor told you”, “fucking do what you’re told” and that she was “fucking annoying” him. He told her to take the pills and “stick those up your pussy”.
9. Patient A told Dr. Sager she had a right to ask questions and that she was intelligent enough to understand. Dr. Sager responded by saying, “You’re not that intelligent.” Patient A repeated that she had a right to ask questions and get clarification, to which Dr. Sager responded, “Ask your goddamn questions.”
Communication with College Investigators
10. Patient A complained to the College in July 2017 regarding Dr. Sager’s conduct.
11. On August 11, 2017, College investigators attended unannounced at Dr. Sager’s office to deliver the complaint notification letter. Dr. Sager was informed of the complaint and given the opportunity to read the letter and comment. He was encouraged to contact the Canadian Medical Protective Association (CMPA) and was informed he was not obliged to speak with the investigators.
12. After briefly reviewing the complaint letter, Dr. Sager said the following to the investigators:
- He had treated Patient A for 25 years and she was a “nut case”. Dr. Sager stated several times that Patient A was mentally unwell and had depression and cancer;
- This was a “fairy tale”; it was “made up”; he didn’t “diddle” her; “diddling people” is not his gig;
- Asked if the incidents in the letter were before or after Patient A had her “breasts mutilated”; and
- Asked that investigators speak with Patient A to “trip her up” and find inconsistency in her story.
13. Dr. Sager has advised the College that when he made these statements to the College investigators, he believed he was being accused of having touched Patient A inappropriately, which he did not do.
Telephone Call to Patient A
14. In September 2017, Dr. Sager telephoned Patient A while she was at work and asked her to discuss her complaint to the College. Patient A said she could speak, but only for a moment as she was working on an urgent task.
15. During this telephone conversation, Dr. Sager asked what Patient A hoped to get out of the complaint. He told Patient A: he had not slept in a month; complained about his health problems; and told Patient A her complaint was causing him misery. During the call, Dr. Sager asked Patient A more than once to drop the complaint. He reminded Patient A that it was before Rosh Hashanah (the time for God’s forgiveness of sins) and suggested she should contact the College before Rosh Hashanah to withdraw her complaint.
16. Patient A told Dr. Sager several times during the call that she was at work and could not take a long, personal phone call, but Dr. Sager did not end the call and repeated his request that she drop her complaint. The phone call was difficult, awkward and emotional for Patient A. She felt manipulated by his reference to her religious faith. After the call she was shaken and embarrassed. Her employer was angry at the distraction of a long, personal call during work hours. At the end of the day, Patient A was fired from her job, which was her sole source of income.
Failure to Maintain the Standard of Practice of the Profession re: Record Keeping
17. During the investigation, the College obtained Dr. Sager’s chart for Patient A. In providing the chart, Dr. Sager acknowledged that his notes were not legible and provided a transcription of the chart entries.
18. The College retained Dr. Marcus Law to review Dr. Sager’s record keeping. Dr. Law noted that of the 11 patient encounters he reviewed, there was not a single encounter note which was legible. Further, all encounter notes were missing pertinent information that other health professionals would need in order to understand the patient’s health issues. He concluded that Dr. Sager’s medical record keeping did not meet the standard of practice of the profession.
19. Dr. Sager admits the facts specified above, with the exception of paragraphs 8 and 16. Dr. Sager admits that based on these facts, he engaged in professional misconduct by engaging in an act or omission that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional and failed to maintain the standard of practice.
20. Dr. Sager does not contest the facts set out in paragraphs 8 and 16. Dr. Sager does not contest that based on these facts, he engaged in professional misconduct by engaging in an act or omission that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
AGREED STATEMENT OF FACTS ON PENALTY
Relevant College History
In June 2013, the Inquiries, Complaints and Reports Committee of the College (“ICRC”) issued a decision requiring Dr. Mark Jerome Sager (“Dr. Sager”) to be cautioned and to complete a specified continuing education or remediation program in relation to his record keeping. Dr. Sager completed the University of Toronto Medical Record Keeping Course in October 2013.
Undertaking to The College
Dr. Mark Jerome Sager entered into an undertaking to the College on January 16, 2019, by which he agreed to resign his certificate of registration effective February 26, 2019. He also undertook not to apply or re-apply for registration as a physician in Ontario or any other jurisdiction.
DISPOSITION
The Discipline Committee ordered that:
- Dr. Sager appear before the panel to be reprimanded.
- Dr. Sager pay costs to the College in the amount of $6,000. 00 within thirty (30) days of the date of this Order.
Dr. Sager waived his right to an appeal under subsection 70(1) of the Code and the Committee administered a public reprimand.
