On August 15, 2017, the Discipline Committee found that Dr. Koffman committed an act of professional misconduct in that she 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.
Dr. Koffman is a family physician who received her certificate of registration authorizing independent practice in June of 2000 and has been providing episodic walk-in care and primary care at the Earl Bales Walk-in Clinic since 2011. Between January 2004 and December 2010, Dr. Koffman provided episodic walk-in care and primary care at the Bathurst Walk-in Clinic and Family practice.
Unwanted Rostering
The College received complaints from three patients about being rostered to Dr. Koffman’s practice without their knowledge and consent after they attended with Dr. Koffman at the Walk- In Clinics and she requested them to complete “Patient Enrolment and Consent to Release Personal Health Information” form:
- Patient A complained that when she first attended the Bathurst Walk-In Clinic, she indicated on the Clinic registration form the name of her family physician. When several months later Patient A visited the Clinic and was seen by Dr. Koffman, she was told by Dr. Koffman that in order to make a referral to a specialist, she had to complete “Patient Enrolment and Consent to Release Personal Health Information” form. Patient A was not informed that by completing the form she would change her family physician to Dr. Koffman. She had no intention to de-roster from her family physician’s practice when she completed the form.
- Patient B complained about being surprised and upset to find out that his care had been switched from his family doctor to Dr. Koffman after he completed the “Patient Enrolment and Consent to Release Personal Health Information” form when being treated by Dr. Koffman at the Earl Bales Walk-In Clinic. Patient B indicated in the clinic registration form that he had a “previous” family physician.
- Patient C received episodic care from physicians other than Dr. Koffman. When she attended the Bathurst Walk-In Clinic and was treated by Dr. Koffman, Dr. Koffman requested her to sign a Patient Enrollment Form. Patient C did not understand that in doing so she would be rostered to Dr. Koffman’s practice and found out that she was listed as Dr. Koffman’s patient several years later, when she contacted the Ministry of Health and Long Term Care. She indicated that it was stressful experience for her to have been rostered without her knowledge and the subsequent need to undo the rostering.
The College commenced an investigation of Dr. Koffman’s office practices, which revealed that Dr. Koffman engaged in inappropriate rostering with respect to an additional eleven (11) patients at the Bathurst Walk-In Clinic:
- Patient E signed the Patient Enrollment form when she attended the Clinic with her daughter Patient F who was an infant and was ill. Patient E was relatively new to Canada at the time she signed the form, and already had a family physician. Patient E does not recall whether the form was explained to her, stating that at that time she did not understand the health care system and that she was willing to sign any form that would help her daughter to get medical attention. When interviewed by the College, Patient E expressed confusion about why she would be asked to sign a Patient Enrollment Form when she already had a family physician.
- Patient F signed a Patient Enrollment Form at the Clinic for herself and her daughter, Patient G, while the remainder of the data in the form was completed by someone other than herself. At the time she signed the form, Patient E had a family physician and her daughter had a pediatrician. Patient F took her children to the Clinic when the children needed to be seen quickly or when it was off-hours for her children’s pediatrician. She indicated that had she known the purpose of the Patient Enrollment Form, she would not have signed it.
- Patient H does not recall any details related to completing the consent form for herself and her son, Patient I, at the Clinic. The only item on the consent form in her handwriting is her signature. At the time the form was signed, Patient H had a family physician and her son, Patient I, had a pediatrician. Patient H had no intention of switching family physicians or rostering with Dr. Koffman. Patients H and I only attended the Clinic when their family physician was unavailable.
- Patient J does not recall any details related to completing the consent form for herself and her son, Patient K, at the Clinic. The only item on the consent form in her handwriting is her signature. Patients J and K attended the Clinic when it was more convenient to do so and saw Dr. Koffman only twice. Patient K recalls being asked at the Clinic if she had intended to switch to another family physician when she had signed the consent form, but she replied that she had not intended to roster with any physician other than her existing family physician at the time. She was then provided with paperwork to de-roster from Dr. Koffman’s practice, which she completed.
- Patient L does not recall any details related to completing the consent form at the Clinic. The only item on the consent form in her handwriting is her signature. Patient L did not intend to switch doctors at the time the form was signed. She went to the Clinic on a few occasions, when her doctor wasn’t available or she needed something urgently.
- Patient M does not recognize the handwriting in the Patient Enrollment Form containing her information and Dr. Koffman’s signature. She does not recall completing the consent form at the Clinic. Patient M has had a family physician for over 20 years when the form was signed and had no intention of changing to another family physician. She attends the walk-in clinics only when it is convenient to do so and does not recall anybody at the Clinic ever asking her to switch family physicians.
- Patient N does not recall any details related to completing the consent form for herself and her son, Patient O, at the Clinic. The only item on the consent form in her handwriting is her signature. At the time the form was signed she has had a family physician for 4 years and her son, Patient O, had a pediatrician for 11 years. Patient N went to the Clinic only occasionally and had no intention of switching family physicians for her son or herself. Given that Patient O had special needs, patient N wanted continuity of care with her son’s pediatrician.
On August 15, 2017, the Committee ordered and directed on the matter of penalty and costs that:
- The Registrar suspend Dr. Koffman’s certificate of registration for a period of four (4) months commencing at 12:01 a.m. on September 1, 2017.
- the Registrar impose the following as a term, condition and limitation on Dr. Koffman’s certificate of registration:
i) At her own expense, Dr. Koffman shall participate in and successfully complete, within 4 months of the date of this Order, individualized instruction in medical ethics with an instructor approved by the College. The instructor shall provide a summative report to the College including his or her conclusion about whether the instruction was completed successfully by Dr. Koffman.
ii) At her own expense, Dr. Koffman shall participate in and successfully complete, within 4 months of the date of this Order, individualized instruction with respect to OHIP billing with an instructor approved by the College. The instructor shall provide a summative report to the College including his or her conclusion about whether the instruction was completed successfully by Dr. Koffman.
- Dr. Koffman attend before the panel to be reprimanded.
- Dr. Koffman pay costs to the College in the amount of $5,500.00 within thirty (30) days of the date this Order becomes final.
Terms and conditions imposed on certificate by: Discipline Committee
