Committee: Discipline
Decision Date: 06 Apr 2018
Summary:
On April 6, 2018, the Discipline Committee found that Dr. Michal Edmund Mrozek committed an act of professional misconduct, in that: he has failed to maintain the standard of practice of the profession; 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.
Dr. Mrozek is a psychiatrist practising in Toronto. He received his certificate of registration authorizing independent practice from the College of Physicians and Surgeons of Ontario in November 1972 and was certified as a specialist in psychiatry by the Royal College of Physicians and Surgeons of Canada in 1980. At the relevant times, Dr. Mrozek maintained an office practice in the community, as well as a practice seeing patients at a Hospital.
Failed to Maintain Standard of Practice
Patient A, a woman in her fifties, first saw Dr. Mrozek in 2007 at the Hospital. At that time, as far as Dr. Mrozek was aware, she had no prior psychiatric history. Thereafter, Dr. Mrozek saw Patient A as a patient from 2009 to
2013.
In May 2013, upon receipt of a complaint from a relative of Patient A about the care Dr. Mrozek provided to Patient A, the College retained a Medical Inspector to review Dr. Mrozek’s care and treatment of Patient A. The Medical Inspector concluded that Dr. Mrozek had fallen below the standard of practice in his care of Patient A in the following respects:
- Dr. Mrozek had failed to recognize or elicit the symptoms of psychosis, particularly hallucinations, delusions and lack of insight into illness by Patient A, and did not attend with adequate care to the opinions of colleagues and information provided by family members;
- Dr. Mrozek did not use accepted, standard diagnostic descriptors in his documentation regarding Patient A; and
- Dr. Mrozek used sub-therapeutic doses of anti-psychotic medication in a form that was unlikely to be taken and discontinued treatment in an individual who was likely to relapse.
The Committee found that Dr. Mrozek committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession with respect to his care of Patient A.
Disgraceful, Dishonourable or Unprofessional Conduct
Failed to Cooperate with College Investigation
On May 24, 2012, the Registrar of the College appointed investigators to investigate Dr. Mrozek’s practice. Dr.
Mrozek was notified of the investigation on May 29, 2012. The College retained a Medical Inspector to review a number of patient records obtained from the Hospital and, later, to review the care Dr. Mrozek provided to Patient A in relation to the complaint made by her relative in May 2013. In the course of the College investigation, the investigator attempted to schedule an interview between the Medical Inspector and Dr. Mrozek.
Subsection 76(3.1) of the Health Professions Procedural Code states: “A member shall cooperate fully with an
investigator.” The Committee found that it was not necessary to issue a summons to Dr. Mrozek to have him attend a meeting with the investigator and the Medical Inspector. The Committee found that Dr. Mrozek’s statutory duty “to cooperate fully” required him to attend a meeting with the investigator and the Medical Inspector, if requested, and respond to questions asked. Subsection 76(1.1) provides that, “An investigator may make reasonable inquiries of any person, including the member who is the subject of the investigation, on matters relevant to the investigation.” That subsection stands alone without any requirement for a summons. In the context of the section 76 as a whole, including, subsection 76(1.1), the duty to co-operate fully in subsection 76(3.1) must include a duty to respond to the “reasonable inquiries” of an investigator, without having to be summonsed.
Ultimately, Dr. Mrozek only participated in the interview when the investigator and Medical Inspector showed up at his office, 20 months after the first request for an interview was made.
The Committee found that Dr. Mrozek’s delay and attempt to frustrate and set parameters on the interview, in the facThe Committee found that Dr. Mrozek was willfully non-compliant with the investigator’s requests to schedule the interview with the Medical Inspector. Dr. Mrozek did not respond to all correspondence in a timely fashion, cancelled scheduled appointments and attempted to impose unreasonable conditions on the interview including: repeatedly objecting to the interview being recorded; insisting that his colleague attend although the investigator repeatedly reminded him that, because of issues of confidentiality, no third party, other than legal counsel, was permitted to attend the interview; and demanding the investigator not attend the interview.e of twelve reminders of his duty to co-operate, constituted a breach of the duty to fully co-operate with the investigator. The Committee emphasized that public protection requires members to co-operate fully with the College’s investigation, including making efforts to meet with an investigator promptly upon request, so that the College can determine on a timely basis whether there are any patient safety concerns. The Committee found that Dr. Mrozek failed to cooperate fully with the College investigation was not a mere error of judgment, rather, rose to the level of professional misconduct in that he 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, dishounorable or unprofessional.
Accessing Patients’ Personal Health Records without Consent or Authorization
In March 2012, the Chief of Staff at the Hospital where Dr. Mrozek saw patients appointed a supervisor in respect of Dr. Mrozek’s practice. In November 2012, in response to a concern raised by the supervisor that Dr. Mrozek was not employing the DSM multi-axial recording formats for his diagnosis, Dr. Mrozek wrote a letter describing 11 charts (12 entries) where other psychiatrists also don’t use the multi-axial recording format in the DSM. The Hospital conducted an audit to determine whether or not patient files referred to in Dr. Mrozek’s letter were accessed appropriately. According to the audit results, the charts listed in Dr. Mrozek’s letter of November 2012 were all accessed by someone using Dr. Mrozek’s credentials and there were other charts accessed beyond the ones that were listed in Dr. Mrozek’s letter, i.e., a total of 41 patient charts, involving 39 patients were accessed.
In response to the request from the Hospital’s General Counsel regarding the potential privacy breach with respect to patient records that he accessed, Dr. Mrozek wrote a letter in May 2013, wherein he confirmed that he accessed the above patient records for the sole purpose of reviewing the psychiatric diagnosis recording formats as employed by his Department of Psychiatry colleagues in their charting. He emphasized in his letter that he did not access the patient records for any improper or illicit purpose, but rather did so for solely educational and informational reasons, so as to assist him in preparing his response to the supervision report regarding his practice. In that letter, Dr. Mrozek also stated that he believes that obtaining prior authorization to access those of the records that were outside of his circle of care would have prevented unnecessary concerns.
Based on Dr. Mrozek’s statements in his correspondence of November 2012 and May 2013, the Committee found that he accessed records of patients outside his circle of care without obtaining prior consent or authorization and that the reason he accessed those records was to assist him in his dispute with the Hospital and not for education or research purposes. The Committee noted that although Dr. Mrozek did not access patient records for the purpose of investigating personal circumstances of the patients, it does not mean that
the privacy of the patients was not violated. As a physician, and in particular as a psychiatrist, Dr. Mrozek should have appreciated the confidential nature of the documents. The Committee found that Dr. Mrozek 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.
Disposition
On December 11, 2018, the Discipline Committee ordered that:
- The Registrar suspend Dr. Mrozek's certificate ofregistration for a period ofsix (6) months, commencing immediately.
- The Registrar impose the following terms, conditions and limitations on Dr. Mrozek's certificate of registration:
Education in the Identification and Diagnosis of Psychosis
o Within nine (9) months of the date of this Order, and at his own expense, Dr. Mrozek shall participate in and successfully complete an educational course approved by the College, which includes instruction in identifying and diagnosing psychosis. Dr. Mrozek will provide proof of successful completion within two (2) weeks of completing the course.
Clinical Supervision
o Prior to resuming practice following the suspension of his Certificate of Registration described above in paragraph 1, Dr. Mrozek shall retain , at his own expense, a College-approved clinical supervisor to review Dr. Mrozek's practice, who will sign an undertaking in the form attached hereto as Schedule "A" (the "Clinical Supervisor");
o For a period of six (6) months commencing on the date Dr. Mrozek resumes practice following the suspension of his Certificate of Registration described above in paragraph 1, Dr. Mrozek may practise only under the terms of the clinical supervision set out herein and in "Schedule "A";
o Clinical supervision of Dr. Mrozek 's practice shall contain the following elements: meeting with Dr. Mrozek on a monthly basis and reviewing a minimum of 20 (twenty), with chartsto be selected at the sole discretion ofthe Clinical Supervisor;
o the Clinical Supervisor will keep a log of all patient charts reviewed along with patient identifiers; and
o the Clinical Supervisor will provide reports to the College every two (2) months for the six (6) month period of clinical supervision, or more frequently if the Clinical Supervisor has concerns
about Dr. Mrozek's standard of practice or conduct.
o Dr. Mrozek shall abide by the recommendations of the Clinical Supervisor;
o If a Clinical Supervisor who has given an undertaking as set out in Schedule "A" to this Order is unable or unwilling to continue to fulfill its terms, Dr. Mrozek shall, within twenty (20) days of
receiving notice of same, obtain an executed undertaking in thesame form from a person who is acceptable to the College and ensure that it is delivered to the College within thattime;
o If Dr. Mrozek is unable to obtain a Clinical Supervisor in accordance with this Order, he shall cease to practise until such time as he has done so;
o Dr. Mrozek shall consent to the disclosure by his Clinical Supervisor to the College, and by the College to
his Clinical Supervisor, of all information the Clinical Supervisor or the College deems necessary or desirable in order to fulfill the Clinical Supervisor's undertaking and Dr. Mrozek' s compliance with this Order;
Re-Assessment
o Approximately twelve (12) months after the completion ofthe period ofsupervision as set out above, Dr. Mrozek shall undergo a re-assessment of his practice (the "Assessment") by a College- appointed assessor (the "Assessor(s)"). TheAssessor(s) shall report the results of the Assessment
to the College;
o The Assessment may include chart reviews , direct observation of Dr. Mrozek's care, interviews with
colleagues and co-workers, feedback from patients and any other tools deemed necessary by the College. Dr. Mrozek shall abide by all recommendations made by the Assessor(s), and the results of the
Assessment will be reported to the College and may form the basis of further action by the College;
o Dr.Mrozek shall consent to the disclosure to the Assessor(s) of there reports of the Clinical Supervisor
arising from the supervision, and shall consent to the sharing of all information between the Clinical Supervisor, the Assessor(s) and the College, as the College deems necessary or desirable;
o Other
o Dr. Mrozek shall comply with the College's Policy on Practice Management Considerations for Physicians Who Cease to Practise, Take an Extended Leave of Absence or Close Their Practice Due to Relocation in respect of his period of suspension, a copy of which forms Schedule "B" to this Order.
o Dr. Mrozek shall submit to, and not interfere with, unannounced inspections of his practice location(s) and to any other activity the College deems necessary in order to monitor his compliance with the provisions of this Order.
o Dr. Mrozek shall inform the College of each and every location where he practises, in any jurisdiction
(his "Practice Location(s)") within five (5) days of the date Dr. Mrozek resumes practice following the suspension of his Certificate of Registration described above in paragraph 1, and shall inform the College of any and all new Practice Locations within five (5) days of commencing practice at that location, until the report of the Assessment has been provided to the College.
o Dr. Mrozek 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.
o Dr. Mrozek shall be responsible for any and all costs associated with implementing the terms of this Order.
- Dr. Mrozek appear before the panel to be reprimanded.
- Dr.Mrozek pay costs to the College in the amount of$26,680 within 30 days of the date of this Order.
On December 19, 2018, Dr. Mrozek requested a variation of the stat date of the suspension. On December 20,
2018, the Discipline Committee ordered as follows:
- The Discipline Committee grants the variance sought and orders that the six-month suspension, instead of “commencing immediately,” shall commence on Friday, February 1, 2019 at 11:59 p.m.
- The Discipline Committee orders that the terms of the Interim Order of the Inquiries Complaints and Reports Committee, dated January 17, 2017, shall continue in effect until the commencement of the suspension on February 1, 2019 at 11:59 p.m.
Decision: Download Full Decision (PDF)
Hearing Date(s): Motion: January 3, 2017
Hearing Dates: July 17-19, 2017
Penalty hearing date: August 13, 2018