FACTS
Dr. Richard Nahas is a 46-year-old physician practicing medicine in Ottawa, Ontario. His practice focusses on chronic pain management. In 2001, he obtained his certificate of registration authorizing independent practice from the College and his specialization in family medicine.
A. Patient A
In the fall of 2016, Patient A sought treatment from Dr. Nahas for chronic low back pain. Patient A had three appointments at Dr. Nahas’ office. On Patient A’s last visit to Dr. Nahas’ office, Dr. Nahas treated Patient A by performing trigger point and peripheral nerve block injections, manual therapy, and placed an acupressure seed on Patient A’s ear.
B. Trigger Point Injections
In order to perform the injections, Dr. Nahas required access to Patient A’s exposed back. Prior to performing the trigger point injections, while Patient A was seated on the examination table with her back to Dr. Nahas, Dr. Nahas made efforts to access Patient A’s back by lifting the bottom of her shirt without adequate warning or explanation of what he was doing.
Although Dr. Nahas asked Patient A if she required his assistance to lift her shirt, he did not wait for her response before lifting the shirt himself. This conduct caused Patient A to feel upset and uncomfortable.
C. Manual Therapy
After administering the trigger point injections, Dr. Nahas performed manual therapy on Patient A. This included a manipulation of her left hip and sacroiliac joint, while she was lying supine on the examination table. Patient A was fully clothed during the manual therapy. The manual therapy involved Dr. Nahas placing one of his hands on the inner aspect of Patient A’s upper left thigh, an area he described to Patient A as being “a sensitive area”. Prior to performing the manual therapy, Dr. Nahas did not adequately explain to Patient A what the manual therapy would involve, including placing his hand on her inner upper thigh. This left Patient A confused and upset.
D. Acupressure Seed
After performing manual therapy, Dr. Nahas placed an acupressure seed on Patient A’s ear. In order to gain access to her ear, Dr. Nahas moved Patient A’s hair away from her ear, without adequate warning or explanation of what he was doing. This conduct made Patient A uncomfortable.
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FINDING
The Committee found that Dr. Nahas committed an act of professional misconduct under paragraph 1(1)33 of Ontario Regulation 856/93 made under the Medicine Act, 1991, in that he has engaged in an act or omission relevant to the practice of medicine that, having regarding to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
PENALTY AND COSTS ORDER
In its Order issued at the hearing, the Committee ordered with respect to penalty and
costs that:
- Dr. Nahas to attend before the panel to be reprimanded.
- The Registrar to suspend Dr. Nahas’ certificate of registration for a period of two (2) months, commencing from September 21, 2020 at 12:01 a.m.
- Registrar to place the following terms, conditions and limitations on Dr. Nahas’ certificate of registration effective immediately:
(i) Dr. Nahas shall comply with the College Policy “Closing a Medical Practice”.
(ii) Dr. Nahas will participate in the PROBE Ethics & Boundaries Program offered by the Centre for Personalized Education for Professionals, by receiving a passing evaluation or grade, without any condition or qualification. Dr. Nahas will complete the PROBE program within 6 months of the date of this Order, and will provide proof to the College of his completion, including proof of registration and attendance and participant assessment reports, within one (1) month of completing it.
- Dr. Nahas to pay costs to the College in the amount of $6,000 within 30 days of the date of the Order.