On March 8, 2018, the Discipline Committee found that Dr. Melvyn Lawrence Iscove committed an act of professional misconduct, in that has engaged in sexual abuse of patients, and in that he has engaged in an act or omission relevant to the practice of medicine that, having regard to all of the circumstances, would reasonably be regarded by members as disgraceful, dishonorable, or unprofessional.
Dr. Iscove is a psychiatrist who practises psycho-analysis in Toronto.
Dr. Iscove has a special interest in the treatment of patients with problems related to homosexuality, to which he applies the theories of Dr. Edmund Bergler; these theories treat homosexuality as a condition dating to infancy, which is amenable to therapy. Although Dr. Bergler’s theories and Dr. Iscove’s use of these theories in his practice are controversial, there was no allegation in this case that Dr. Iscove failed to maintain the standard of practice of the profession, and the Committee’s findings in this case are not related to any views that the members of the Committee may have with respect to Dr. Bergler’s teachings.
The case was about allegations of sexual abuse that arose from the complaints of two men, Patient A and Patient B, who had each been long-term patients of Dr. Iscove. In addition, it was alleged that Dr. Iscove engaged in disgraceful, dishonourable or unprofessional conduct in relation to boundary violations of a financial and social nature with Patient A and Patient B.
Patient A
Patient A first became a patient of Dr. Iscove when he was in his early twenties and continued to see Dr. Iscove as a patient for about eighteen years. He was referred to Dr. Iscove by a psychologist to whom he had presented with depression and anxiety associated with fears that he was gay. From the outset of treatment, he was introduced by Dr. Iscove to the concepts of Dr. Edmund Bergler. Patient A understood that homosexuality, according to Dr. Bergler, was a clinically curable condition through psychoanalytic treatment, with excellent chances of cure.
Patient A's appointments were initially two or sometimes three times per week, and at each appointment, he would discuss major events in his life, and feelings about other people and about Dr. Iscove. At almost every appointment, there were discussions about Patient A’s dreams and fantasies, including any fantasies that he might have had about Dr. Iscove. Even if Patient A did not spontaneously refer to fantasies about Dr. Iscove, Dr. Iscove would ask directly about fantasies specifically involving Dr. Iscove.
Patient A understood from Dr. Iscove that he was the only psychiatrist who was available to discuss and treat these fantasies and that Dr. Iscove was the only available source for this sort of help. Dr. Iscove also cautioned Patient A that he should not talk to other people about the therapy, because they would be unable to understand the basis for it.
During their doctor-patient relationship, Patient A admired Dr. Iscove and considered him as a father figure. He felt free to call him at any point and felt he could rely on Dr. Iscove's advice about almost every aspect of his life. However, Dr. Iscove's enquiries about his fantasies about Dr. Iscove made him feel uncomfortable, and talking about his sexual fantasies was associated with a lot of shame. Patient A at times felt pressure to respond in a way that he thought Dr. Iscove expected and would say what he thought Dr. Iscove wanted to hear.
On a date between the end of 2001 and the beginning of 2002, Dr. Iscove offered Patient A a hug at the end of an appointment. Patient A accepted and Dr. Iscove walked round his desk and they embraced. This recurred on two or three appointments, during which Dr. Iscove would ask "what are you thinking you want to do?" and subsequently said "you may touch me if you like." Patient A then touched Dr. Iscove's erect penis through Dr. Iscove's trousers. The sexual activity subsequently progressed to Dr. Iscove removing his penis from his trousers, then Patient A doing the same. This progressed on later occasions to mutual masturbation and oral sex. Patient A estimated that such activity occurred on between 10 and 20 occasions with oral sex occurring on one-third of the episodes. On one occasion only, Patient A remembered removing his clothes.
Patient A was uncertain about how and when the sexual activity ended. He believes it ended when he told Dr. Iscove that he did not want it to continue. Patient A continued to see Dr. Iscove as a patient after the sexual activity ended.
A number of interactions between Patient A and Dr. Iscove extended beyond the conventional physician-patient psycho-therapeutic relationship. One day Patient A awoke with pain and called Dr. Iscove, who took him to the hospital where Patient A had surgery. In addition, emails between Dr. Iscove and Patient A referred to other subjects, including:
- photographs of a trundle bed owned by Dr. Iscove, sent at a time when Patient A needed to buy a bed for his family member, although he did not recall receiving such a bed from Dr. Iscove.
-a series of photographs of "Oriental" rugs, including comments from Dr. Iscove such as "Let me know if the colours suit your tastes" and "Does this sort of size and pattern suit your purposes? I would need to know the width of your space", sent at a time when Patient A needed a rug, although he did not receive one from Dr. Iscove.
- an e-mail in which Patient A asks about the availability of an apartment in another city owned by the Bergler Foundation, at which Patient A and a friend stayed for a weekend. This was arranged by Dr. Iscove in his role on the board of the foundation.
- a series of e-mails about operatic productions. In one of these e-mails Dr. Iscove invited Patient A and a friend to a working rehearsal of the opera as Dr. Iscove's guest as a President's Council member. Patient A attended the rehearsal, sitting with several other
guests of Dr. Iscove, including another psychiatrist. When Patient A expressed concern about disclosing that he was a patient of Dr. Iscove, Dr. Iscove suggested that he could lie about that fact.
With respect to the occasion on which Dr. Iscove drove Patient A to the hospital because he had an acute medical condition, the Committee did not want to suggest that there is anything wrong in coming to the aid of a patient requiring medical assistance. The Committee noted, however, that Dr. Iscove is a psychiatrist and this was not a psychiatric issue. The fact that Patient A chose to call Dr. Iscove when he had an acute physical condition and the fact that Dr. Iscove responded by driving Patient A to the hospital is reflective of the extent to which Patient A had come to rely on Dr. Iscove and that the boundaries within this doctor-patient relationship were significantly eroded.
The rental of the apartment in another city was claimed to be at a low rate which went to the Foundation rather than directly to Dr. Iscove; however, Dr. Iscove's position on the Foundation board placed him in a clear conflict of interest with respect to financial dealings of this nature and must be considered unprofessional.
The invitations to opera rehearsals not only violated social boundaries but placed Patient A in a position of dependency to Dr. Iscove and created the potential for violation of Patient A’s confidentiality, demonstrated by Dr. Iscove’s caution that not only should Patient A not disclose that he was a patient of Dr. Iscove, but that Dr. Iscove would deny the doctor-patient relationship if needed.
The Committee concluded that the e-mails regarding the trundle bed and the carpets must be viewed as offers to sell these items to Patient A. The fact that Patient A may not have actually purchased any of the items does not mean that this was not a boundary violation. Attempting to sell personal items to your patients is unprofessional.
The Committee found that Dr. Iscove engaged in conduct that would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional in that he:
- tried to sell Patient A personal items;
- invited Patient A to attend the opera as his guest;
- arranged for him to rent the Bergler Foundation’s apartment in another city.
Patient B
Patient B became a patient of Dr. Iscove in his late teenage years and saw Dr. Iscove as a patient for over 20 years. His parents had recommended that he see Dr. Iscove for his feelings of depression and anxiety. Patient B denied having any concerns about his own sexuality before seeing Dr. Iscove.
Throughout his therapy with Dr. Iscove, Patient B was encouraged to read material by Dr. Bergler and was aware that this was the basis for his treatment by Dr. Iscove. According to Patient B, Dr. Iscove raised the issue of Patient B’s feelings about homosexuality at every appointment, even though he did not think of himself as gay and had no physical relationships with other men.
Patient B developed a trusting relationship with Dr. Iscove. He relied on Dr. Iscove to make decisions for him and found Dr. Iscove to be helpful in advising him, for example, in avoiding self-destructive behavior with alcohol. Patient B also felt that Dr. Iscove was supportive and helpful in his desire to further his career. As a consequence, he wanted to impress Dr. Iscove and show himself to be a "good patient." Although he was reluctant to disclose details at first, he concluded that it was easier to respond to these requests from Dr. Iscove and fully engaged in analysis of his fantasies.
Dr. Iscove would ask at almost every appointment whether Patient B was having fantasies about Dr. Iscove himself. Patient B replied that he did have fantasies about Dr. Iscove and that these made Patient B feel uncomfortable. He expressed this discomfort to Dr. Iscove without taking any other action. He felt that he needed to continue to see Dr. Iscove because of an emotional dependence on Dr. Iscove as his therapist.
At some point in 2007, Patient B and Dr. Iscove began engaging in sexual activity; there were about 12 episodes of sexual contact. When Patient B started to believe that he was homosexual and discussed with Dr. Iscove his thoughts of beginning a homosexual affair with an unspecified male, Dr. Iscove persuaded him that a random partner was undesirable and made it known that he, himself, would be available. Patient B described Dr. Iscove coming around his desk to the patient's side and initiating mutual handling of each other's penis through their clothes. On subsequent occasions, the contact progressed to mutual oral sex with both parties ejaculating; on one or two occasions, they removed their shirts. On one visit, Patient B brought a condom with him, and asked Dr. Iscove to penetrate him anally, which Dr. Iscove did. The final three episodes occurred at Dr. Iscove's house, after Dr. Iscove suggested that they meet there.
After patient B ended the sexual activity with Dr. Iscove, there was a gap of several years in the doctor-patient relationship but Patient B went back again to Dr. Iscove with concerns about his response to the death of a family member.
During their physician-patient relationship, Patient B and Dr. Iscove exchanged emails, which related to activities of a non-sexual nature that extended beyond physician-patient relationship, including:
- e-mails regarding an apartment in another city owned by the Bergler Foundation and administered by Dr. Iscove, at which Patient B had stayed for a small amount of money.
- e-mails regarding the treatment of a medical condition at a time when Patient B’s family member was ill. These included complimentary medicine therapy for the medical condition, the removal of dental amalgams for ameliorating the condition, and referral of Patient B’s family member to an experimental treatment centre. According to Patient B, Dr. Iscove sold him an electromagnetic device for the treatment of his family member’s medical condition for $4000. Dr. Iscove also sold him a juicer.
- e-mails with photographs of Dr. Iscove's grandchild.
- e-mails from Patient B to Dr. Iscove detailing Patient B’s various experiences when on holiday, including details of sexual activities and fantasies.
The Committee found that Dr. Iscove engaged in boundary violations that members of the profession would find disgraceful, dishonourable or unprofessional, in that he:
- sold equipment to Patient B, for the use of Patient B's family member, in an area of medicine in which Dr. Iscove had no expertise;
- arranged for Patient B to rent the Bergler foundation’s apartment in another city; and
- sold a juicer to Patient B.
These boundary violations further eroded the appropriate professional boundaries in a doctor-patient relationship. Given the level of dependence that Patient B had on him, Dr. Iscove should not have engaged in any commercial transactions with Patient B.
Finding
On March 8, 2018, the Discipline Committee found that Dr. Iscove committed an act of professional misconduct in that:
-he has engaged in the sexual abuse of two patients: Patient A and Patient B; and
- he has engaged in conduct or 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. In particular:
- he sexually abused two patients;
- he sold equipment to Patient B for the use of Patient B’s family member in an area of medicine in which he had no expertise;
- he arranged for Patient B and Patient A to each rent the Bergler Foundation’s apartment in another city;
- he sold a juicer to Patient B;
- he tried to sell Patient A personal items; and
- he invited Patient A to attend a working rehearsal of the opera as his guest.
Immediate Interim Suspension
Given the Committee’s findings, the Committee made an immediate interim order suspending Dr. Iscove’s certificate of registration pursuant to subsection 51(4.2) of the Health Professions Procedural Code, until such time as the Committee makes a penalty order under subsection (5) or (5.2) of the Code.
Disposition
On October 5, 2018, the Discipline Committee ordered that:
- The Registrar revoke Dr. Iscove’s certificate of registration, effective immediately.
- Dr. Iscove reimburse the College for funding provided for patients under the program required under section 85.7 of the Code, by posting an irrevocable letter of credit or other security acceptable to the College, within thirty (30) days from the date of this Order, in the amount of $32,120.00.
- Dr. Iscove appear before the panel to be reprimanded.
- Dr. Iscove pay to the College its costs of this proceeding, in the amount of $91,620.00 within thirty (30) days from the date of this Order.
Terms and conditions imposed on certificate by: Member