On April 23, 2018, the Discipline Committee found that Dr. George Williams Otto committed an act of professional misconduct, in that he has engaged in conduct or 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 unprofessional.
Dr. Otto received a certificate of independent practice in 1988. He practises family medicine in Toronto. Dr. Otto failed to provide records in a timely manner when requested on behalf of three patients.
Patient A
On April 13, 2016, a lawyer for Patient A sent a letter by fax to Dr. Otto's office, requesting Patient A's complete client file and enclosing an executed authorization and direction. The fax was received by Dr. Otto's office. Dr. Otto failed to respond to the request.
On August 15, 2016, Patient A's lawyer sent another letter to Dr. Otto's office by fax and by regular mail. He repeated his request for Patient A's file and noted that time was of the essence. The letter was received by Dr. Otto's office. Dr. Otto failed to respond to the request.
On September 28, 2016, Patient A's lawyer contacted the College regarding Dr. Otto's ongoing failure to provide Patient A's file as requested. The College investigator requested Dr. Otto's response by letters dated October 3, 2016 and November 14, 2016.
On December 9, 2016, Dr. Otto submitted a letter of response to the College. In his letter, Dr. Otto advised that he had provided the records to Patient A's counsel on October 1, 2016.
Patient B
On November 16, 2015, counsel for Patient B sent a letter by regular mail to Dr. Otto's office, requesting Patient B's complete client file and enclosing an executed authorization and direction. The letter was received by Dr. Otto's office. Dr. Otto failed to respond to the request.
Counsel for Patient B sent two further letters to Dr. Otto's office by regular mail on January 18, 2016 and June 14, 2016, repeating his request for Patient B's file. Both letters were received by Dr. Otto's office. The final letter stated in bold that the matter had become urgent. Dr. Otto failed to respond to these requests.
On August 24, 2016, counsel for Patient B contacted the College regarding Dr. Otto's ongoing failure to provide Patient B's file as requested. The College investigator requested Dr. Otto's response by letters dated August 30, 2016 and October 25, 2016.
On December 9, 2016, Dr. Otto submitted a letter of response to the College. In his letter, Dr. Otto advised that he had provided the records to Patient B's counsel on October 19, 2016.
Patient C
On January 4, 2017, the College received a letter from counsel for Patient C requesting assistance in obtaining copies of her client’s records from Dr. Otto. As advised in her letter, Patient C's counsel had sent four requests to Dr. Otto for Patient C's records by letters dated February 12, March 12, April 14 and May 14, 2014. The final three request letters included the following statement in bold font: "If you have not seen this patient, please confirm in writing." Dr. Otto failed to respond to these requests.
In his response to the College, dated February 16, 2017, Dr. Otto stated that he had no record of receiving the requests from Patient C's counsel and apologized if the letters were received and missed by an administrative error. Dr. Otto also noted that Patient C's first name was spelled inconsistently, in that a single letter in the middle of Patient C's first name was different in counsel's letter and in the four request letters. Dr. Otto stated that he did have records related to a patient with the name indicated on the request letters and would provide them upon receipt of an executed consent form. Patient C's surname was spelled correctly throughout, and her birthdate was included in the four request letters.
Relevant College History
Dr. Otto has been the subject of a number of prior investigations, cautions and disciplinary decisions by the College.
In responding to the investigations regarding the complaints made on behalf of Patients A and B, Dr. Otto advised the College investigator on December 8, 2016 that in order to prevent similar oversights and delays, he has directed that all requests for patient records received by his office be logged into a journal, that each week, he personally reviews the journal to ensure requests have been attended to in a timely manner, and that if they are not, he personally ensures his office staff immediately attends to the request. Dr. Otto indicated that he is confident that the system now implemented at his office will assist in responding to patient record requests in a timely and appropriate manner.
Dr. Otto's previous involvement with the College includes the following:
- In November 2012, the Inquiries, Complaints and Reports Committee (the ICRC) cautioned Dr. Otto in person and accepted his undertaking in resolution of an investigation into issues regarding his practice, including his use of a physician assistant and his inadequate record-keeping. Among other things, Dr. Otto undertook to complete a medical record-keeping course.
-On May 1, 2013, the ICRC advised and cautioned Dr. Otto in two separate cases to respond promptly and properly to requests for patient records. In one case, counsel for the patient advised that he had written four letters to Dr. Otto requesting a copy of the patient's records and had telephoned on numerous occasions. In the other case, counsel for the patient advised that he had written three letters requesting records on the patient's behalf and had called numerous times. In both cases, Dr. Otto advised the College that he had since set up a binder to record patient record requests, which he reviewed weekly.
-In a decision dated October 5, 2015, relating to his completion of Special Diet Allowance forms, the Discipline Committee made findings of professional misconduct. Dr. Otto admitted that his record-keeping did not meet the standard of practice. The Committee administered a public reprimand, suspended Dr. Otto's registration for two months, ordered he pay a $10,000 fine and imposed a number of other terms. The Committee noted that Dr. Otto had since completed the medical record-keeping course in accordance with his previous undertaking, and ordered that he also complete an educational program in ethics.
Disposition
On April 23, 2018, the Committee ordered and directed that:
- the Registrar suspend Dr. Otto’s Certificate of Registration for period of 3 months, to commence on May 7, 2018;
- the Registrar impose the following terms, conditions and limitations on Dr. Otto’s Certificate of Registration:
Records Log
(a) Dr. Otto shall maintain a log of all requests for the release of Personal Health Information (“PHI”), which shall include a copy of the requests received, the date such requests were received, and the date of Dr. Otto’s response (the “Log”). Dr. Otto shall also include a copy of the request and his response in the relevant patient’s clinical record;
(b) Dr. Otto shall submit a copy of the Log to the College thirty (30), sixty (60) and ninety (90) days following the date of this Order, and every two (2) months thereafter, for a total period of twenty-four (24) months;
Education
(c) Dr. Otto shall complete a physician practice management course acceptable to the College within six (6) months of the date of this Order;
Preceptorship
(d) Within thirty (30) days of the conclusion of the suspension of his Certificate of Registration described above in paragraph 3, Dr. Otto shall retain, at his own expense, a College-approved clinical supervisor or supervisors (the “Preceptor”) with respect to effective office administration, and in particular the timely response to requests for PHI. The Preceptor will sign an undertaking in the form attached as Schedule “A” to the Order, dated April 23, 2018;
(e) Dr. Otto shall meet with the Preceptor a total of six (6) times over a period of twelve (12) months (the “Preceptorship”): an initial meeting, then once after one (1) month, once after a further two (2) months; and once every three (3) months thereafter until the conclusion of the Preceptorship;
(f) The meetings shall include a review of the Log and related correspondence, including the requests received, the responses by Dr. Otto and the associated records and patient charts to ensure appropriate documentation. The Preceptor may conduct an additional review of any records or documents deemed necessary for the purposes of the Preceptorship. The Preceptor may also make inquiries of relevant individuals, including staff or colleagues;
(g) Dr. Otto shall cooperate fully with the Preceptor and shall abide by the recommendations of the Preceptor, including but not limited to, any recommended practice improvements and professional development;
(h) The Preceptor shall submit quarterly reports to the College;
(i) If a person who has given an undertaking in Schedule “A” to this Order dated April 23,
2018 is unable or unwilling to continue to fulfill its provisions, Dr. Otto shall, within twenty (20) days of receiving notice of same, obtain an executed undertaking in the same form from a similarly qualified person who is acceptable to the College and ensure that it is delivered to the College within that time;
(j) If Dr. Otto is unable to obtain a Preceptor in accordance with this Order, he shall cease to practice until such time as he has obtained a Preceptor acceptable to the College;
(k) If Dr. Otto is required to cease practice as a result of paragraph (4)(j) above, this will constitute a term, condition or limitation on his Certificate of Registration and that term, condition or limitation will be included on the public register;
(l) Dr. Otto shall consent to the disclosure by his Preceptor to the College, and by the College to his Preceptor, of all information the Preceptor or the College deems necessary or desirable in order to fulfill the Preceptor’s undertaking and Dr. Otto’s
compliance with this Order;
Reassessment
(m) Within six (6) months of completing the Preceptorship required above, Dr. Otto shall undergo a reassessment with regard to effective office administration by a College- appointed Assessor;
(n) The reassessment may include (at the College’s discretion) a review of Dr. Otto’s Log and related documentation; an interview with Dr. Otto, interviews with colleagues and staff, and any other tools deemed necessary by the College;
(o) The results of this assessment shall be reported to the College;
(p) Dr. Otto shall abide by all recommendations with regard to practice management made by the College-appointed Assessor;
(q) If Dr. Otto is of the view that any of the Assessor’s recommendations are unreasonable,
he shall have thirty (30) days following receipt of the recommendation within which to provide the College with his submissions in this regard. Thereafter, the Inquiries, Complaints and Reports Committee (the “ICRC”) will consider his submissions and make a determination regarding whether or not the recommendations, or any of them, are reasonable and if so, whether they, or any of them, constitute limitations or restrictions on his practice, and that decision will be provided to Dr. Otto;
(r) Following the decision referenced in paragraph (4)(q) above, Dr. Otto shall abide by those recommendations of the Assessor that the ICRC has determined are reasonable.
Other
(s) Dr. Otto shall inform the College of each and every location where he practices, in any jurisdiction (his “Practice Location(s)”) within fifteen 15 days of this Order and shall inform the College of any and all new Practice Locations within fifteen (15) days of commencing practice at that location;
(t) Dr. Otto shall submit to, and not interfere with, unannounced inspections of Practice Location(s) and patient records for the purposes of monitoring and enforcing his compliance with the terms of this Order;
(u) Dr. Otto shall consent to the College making appropriate enquiries of the Ontario Health Insurance Plan and/or any person who or institution that may have relevant information, in order for the College to monitor his compliance with this Order.
(v) Dr. Otto shall consent to the sharing of information among the Preceptor, the Assessor and the College, as any of them deem necessary or d desirable in order to fulfill their respective obligations;
(w) Dr. Otto shall be responsible for any and all costs associated with implementing the terms of this Order.
- Dr. Otto attend before the panel to be reprimanded;
- Dr. Otto pay costs to the College for one half-day hearing in the amount of $6,000 within sixty (60) days from the date of this Order.
On May 4, 2018, Dr. Otto appealed the decision on penalty of the Discipline Committee to the Ontario Superior Court of Justice (Divisional Court). Pursuant to s. 25(1) of the Statutory Powers Procedure Act, the appeal operated as a stay of the decision pending the outcome of the appeal.
Therefore, the decision of the Discipline Committee was not in effect.
On January 28, 2019, the Divisional Court dismissed for delay Dr. Otto’s appeal.