On July 28, 2020, on the basis of uncontested facts and a plea of no contest, the Discipline Committee found that Dr. Robert Barry Miller committed an act of professional misconduct under paragraph 1(1)33 of O. Reg. 856/93, 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.
Dr. Miller is a 67-year-old otolaryngologist who practices in Toronto, Ontario. He received his certificate of independent practice in Ontario in 2007.
Interaction with a health care professional
In January 2018, a patient of Dr. Miller’s attended a pharmacy with a prescription for hydrocodone syrup. That medication was not available at the pharmacy as it was on backorder. Accordingly, the pharmacist on duty contacted Dr. Miller by telephone to discuss alternatives available at the pharmacy. Dr. Miller, in speaking with the pharmacist, insisted that the medication prescribed must contain hydrocodone, a controlled substance.
The Pharmacist advised Dr. Miller that he must then supply a new written prescription for an alternative medication containing hydrocodone as prescriptions for controlled substances cannot be provided verbally over the phone. Dr. Miller expressed irritation and then attended the pharmacy in person. In the presence of the pharmacy technician, he called the pharmacist stupid multiple times, threatened that he would tell his patients not to come to that pharmacy, accused the pharmacist of withholding treatment to the patient, and then grabbed the pharmacist by the neck, pulled him close, and whispered in the pharmacist’s ear “you are stupid”.
Patient A
Patient A was referred by her family physician to Dr. Miller for a consultation regarding her ear drums, which had burst previously. She attended the consultation with another family member.
As explained by Patient A and the family member, Dr. Miller was short and curt in his assessment of Patient A. He then told Patient A to lie down on the table without explaining what was going to happen. Patient A told Dr. Miller that she was nervous and advised him that it did not instill confidence when he did not explain what he was going to do. Dr. Miller replied that “it does not instill confidence in me when you won’t lie down and stay still”. Patient A and her family member elected to leave, and Dr. Miller threw down his instrument and said, “then leave and continue to have problems with your ears”.
Dr. Miller’s consultation note to the referring physician stated in part:
…She became quite fearful, in fact she was crying in my office. [Family member] then stepped in, and enabled her to continue this “performance”. [Family member] said “do you want to go home” and the young lady said yes I do. They left. For a 20-year- old, in spite of being quite fearful, this type of behaviour is really unacceptable. As you know I am quite gentle and explained what I am doing at each step. However this hystrionic [sic] behaviour was only enabled by the [family member]…
FACTS ON PENALTY
In December 2011, the Inquiries, Complaints and Reports Committee of the College (the “ICRC”) considered a complaint that Dr. Miller was rude and abrupt in his communications when a patient questioned the cleanliness of a nasopharyngoscope.
The ICRC required Dr. Miller to participate in a Specified Continuing Education and Remediation Program consisting of a preceptorship in infection control and a reassessment. In June 2013, the ICRC considered a complaint that Dr. Miller was rude and abrupt in his communications during an examination of the complainant’s ear. The Committee noted that Dr. Miller had received prior complaints about communications and stated its expectation that physicians conduct themselves in a professional manner at all times and clearly explain all procedures to the patient.
In January 2016, the ICRC considered a complaint that Dr. Miller was rude and abrupt in his communications when performing an endoscopic procedure on the complainant.
The ICRC directed Dr. Miller to attend to be cautioned in person regarding his communications and his record-keeping. In addition, the ICRC required Dr. Miller to participate in a Specified Continuing Education and Remediation Program consisting of one-on-one instruction in Communications with Dawn Martin, clinical supervision focused on record-keeping, and a reassessment.
Since January 2016, the ICRC has considered three subsequent complaints about Dr. Miller’s communications, not including the incidents at issue in this proceeding.
DISPOSITION
In its order issued on July 28, 2020, the Committee ordered and directed:
- Dr. Miller to attend before the panel to be reprimanded.
- the Registrar to suspend Dr. Miller’s certificate of registration for a period of three (3) months, commencing on October 3, 2020 at 12:01 a.m.
- .the Registrar to place the following terms, conditions and limitations on Dr. Miller’s certificate of registration effective immediately:
(a) Dr. Miller shall comply with the College Policy “Closing a Medical Practice”;
(b) Dr. Miller shall successfully complete a one-on-one program acceptable to the College in anger management and impulse control. The program may include formal instruction, treatment/counselling, or a combination thereof, must include a written report to the College by the professional offering the program upon completion of the program, and must be completed within six (6) months from the date of this Order.
- Dr. Miller to pay costs to the College in the amount of $10,370.00 within ninety (90) days from the date of this Order.
Terms and conditions imposed on certificate by: Registration Committee
