Shapiro, Solomon Marc

Previous Hearings

Committee: Discipline
Decision Date: 08 Sep 2020
Summary:

On September 8, 2020, on the basis of an Agreed Statement of Facts on Liability, the 
Discipline Committee found that Dr. Shapiro committed an act of professional 
misconduct in that: he committed an act 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, 
dishonourable or unprofessional; and, in that he failed to maintain the standard of the 
profession. 
 
FACTS 
 
BACKGROUND 
 
Dr. Shapiro is a 61-year-old psychiatrist with a sub-specialty in child and adolescent 
 psychiatry who received his certificate of registration from the College of Physicians 
 and Surgeons of Ontario (the “College”) on August 7, 1987.  
  
 At the relevant time, Dr. Shapiro was in private practice at an office in Toronto, Ontario. 
  
 Between approximately May 26, 2014 and the end of June 2014, Dr. Shapiro provided 
 psychiatric treatment to Patient A. 
  
 FACTS  
  
 The College Received a Mandatory Report 
  
 On May 6, 2015, the College received a mandatory report from a Staff Psychiatrist at the 
 Centre for Addiction and Mental Health, (“CAMH”), who had assessed Patient A in the 
 CAMH Emergency Assessment Unit.  
  
 The College Subsequently Received a Public Complaint 
  
 On February 3, 2016, the College received a public complaint from Patient A, regarding 
 his former psychiatrist, Dr. Shapiro. At the time of the complaint, Patient A was 28 years 
 old. It was ultimately determined by the College that Patient A was the same patient 
 referred to in the May 6, 2015, mandatory report from a Staff Psychiatrist at CAMH.  
 DISGRACEFUL, DISHONOURABLE OR UNPROFESSIONAL CONDUCT 
 Patient A’s Psychotherapy with Dr. Shapiro 
  
 Patient A contacted Dr. Shapiro in approximately April or May 2014 asking for an 
 appointment. Dr. Shapiro telephoned Patient A late on a Friday evening and an 
 appointment was made for an initial assessment. Following an initial assessment 
 conducted on May 26 and 28, 2014, Patient A began seeing Dr. Shapiro for sessions 
 several times a week. Patient A was 26 years old at the time. The treatment included a 
 few one-on-one appointments but mainly consisted of having Patient A participate in 
 group sessions involving other patients of Dr. Shapiro. The group sessions sometimes 
 included psychiatry residents. Dr. Shapiro invited Patient A to attend group sessions 
 after the completion of the initial assessment. 
 As set out below, Dr. Shapiro’s overall behaviour and clinical approach made Patient A 
 feel uncomfortable, isolated and emotionally distraught. The CAMH psychiatrist who 
 made the May 2015 mandatory report to the College stated that this culminated in 
 Patient A’s admission to the CAMH Emergency Department. 
  
 At the initial assessment conducted by Dr. Shapiro, Patient A started crying.  Dr. Shapiro 
 directed Patient A to look him in the eyes. Patient A found this interaction very 
 uncomfortable as it was difficult to look into Dr. Shapiro’s eyes while crying. Patient A 
 was particularly vulnerable at this point in his life. He was experiencing anxiety. He 
 trusted that Dr. Shapiro would assist him with his difficulties and provide emotional 
 support. At the conclusion of the initial assessment, Dr. Shapiro diagnosed Patient A as 
 suffering from chronic post-traumatic stress disorder, and documented various 
 stressors, including anxiety and social isolation.  
  
 Patient A was disturbed by Dr. Shapiro’s clinical approach during group sessions which 
 included the use of terms such as “begging” and “commanding”. Patient A found this 
 confusing and unsettling. Patient A understood that he needed to “beg” or “command” 
 the attention of other group members or Dr Shapiro to Dr. Shapiro’s satisfaction, and 
 that if he did, Dr. Shapiro would provide positive reinforcement. Dr. Shapiro failed to 
 explain the rationale for this technique to Patient A, who was confused and disturbed by 
 this practice. Patient A felt that he did not have the opportunity to simply discuss his 
 concerns with Dr. Shapiro given that most of his sessions were with a group. 
 
On one occasion, Patient A tried to get Dr. Shapiro’s attention in a group session by 
calling out Dr. Shapiro’s first name, “Solomon”, twice in a loud manner. Dr. Shapiro 
appeared to become irritated and made Patient A feel as if he could not participate at 
that time. Patient A broke down in tears in front of the group. 
 
Another technique used by Dr. Shapiro was called “Words”, a form of “mindful 
communication”. In this technique, Patient A was told to use words to describe his 
feelings. On at least one occasion when Patient A tried to express his feelings, Dr. 
Shapiro disagreed with the words Patient A used and with Patient A’s interpretation of 
his own feelings, leaving Patient A feeling unvalidated and embarrassed. 
 
Dr. Shapiro made some inappropriate comments to Patient A, that contributed to his 
confusion and distress. On one occasion,  Dr. Shapiro referred to “the spirit”, which 
Patient A took as a religious reference that made him uncomfortable. 
 
Dr. Shapiro hugged Patient A in his office, a hug that was not welcomed by Patient A. 
 
Festival Trip 
 
In the summer of 2014, Dr. Shapiro informed Patient A that he would be taking a one-
week vacation and that Patient A should make a plan for what he would be doing that 
week. Patient A became anxious at the thought of Dr. Shapiro’s absence as he had been 
attending sessions 4-5 days per week with Dr. Shapiro and felt very dependent.  
 
Towards the end of the week, Dr. Shapiro told Patient A that he was attending a festival 
north of Toronto, and suggested that it might be good for Patient A to attend. Dr. 
Shapiro told Patient A that, if he attended, they would not be spending time together at 
the festival and other attendees would not know that he was Dr. Shapiro’s patient. Dr. 
Shapiro told Patient A that if anyone asked, Patient A could be vague and say he knew 
Dr. Shapiro from Toronto. 
 
Patient A travelled alone to the festival.  
 
Patient A approached and interacted with Dr. Shapiro on numerous occasions at the 
festival. On a couple of occasions, Patient A approached Dr. Shapiro for counselling and 
support. On both occasions, Dr. Shapiro responded in a frustrated and impatient 
manner, resulting in Patient A doubting himself and feeling unworthy of being supported 
or helped. At one point, Dr. Shapiro criticized Patient A for swearing, stating that he (Dr 
Shapiro) was being undermined in his own efforts to stop swearing by the fact that 
Patient A was swearing. 
 
During the festival, Dr. Shapiro saw Patient A dancing with and kissing a woman. Dr. 
Shapiro made a comment to Patient A about this interaction. Patient A recalls the 
comment as being along the lines of, “oh that must have been terrible.” Dr. Shapiro 
recalls making a comment based on his concern about Patient A becoming involved 
with someone he had just met. Patient A was confused by Dr. Shapiro’s comment as his 
sexuality had never been in issue and he became worried about Dr. Shapiro’s 
boundaries and wondered if Dr. Shapiro was attracted to him.  
 
Patient A attended several workshops run by Dr. Shapiro at the festival. Patient A also 
attended a workshop on gender identity that Dr. Shapiro said might be good for him to 
attend. This again confused Patient A as his gender identity was not in issue. During the 
festival Patient A experienced a pattern of Dr. Shapiro withholding his attention from 
Patient A until Patient A behaved and communicated in a manner approved by Dr. 
Shapiro. Another workshop was devoted to hugging (i.e. how to navigate hugging, 
including when it is not wanted).  Dr. Shapiro hugged some participants in the 
workshop, but not Patient A, leaving Patient A feeling as if he had displeased Dr. 
Shapiro. 
 
After the gender identity workshop, Dr. Shapiro spoke with Patient A using inappropriate 
phrases along the lines of, “your sentences are not short enough”, and, “I’m a servant of 
God, use me.” The religious connotation disturbed Patient A, as did Dr. Shapiro’s 
 frustration and impatient tone of voice. Patient A tried to use the “begging” form of 
 communication to ask for help, saying “please help me”. Minutes later, Dr. Shapiro 
 walked away from Patient A. Patient A felt abandoned.  
  
 Patient A broke down crying uncontrollably. Patient A was given help by a member of 
 the festival’s Health and Safety team. Another festival attendee also came to help.  Dr. 
 Shapiro soon attended in the area where Patient A was being helped. The member of 
 the festival Health and Safety team and the other attendee left when Patient A had 
 settled down.  
  
 Later that same day, Dr. Shapiro requested that Patient A discuss with him in his vehicle 
 what had occurred. Patient A accepted Dr Shapiro’s invitation. Patient A told Dr. Shapiro 
 that he did not feel safe around him. Dr. Shapiro said, “We are climbing a mountain 
 together, and you’re just going to give up now?” Patient A got out of the car and walked 
 away.   
  
 Relationship after the Festival 
  
 Dr. Shapiro called Patient A within two days after he left the festival and encouraged 
 Patient A to come in for another appointment. Patient A told Dr. Shapiro that he still did 
 not feel safe around him. He finally agreed to see Dr. Shapiro but later changed his 
 mind.  
  
 Patient A did not attend any further appointments with Dr. Shapiro. 
  
 Summary – Disgraceful, Dishonourable or Unprofessional Conduct 
 
Dr. Shapiro engaged in disgraceful, dishonourable or unprofessional conduct towards 
Patient A, including by: 
 
   -  hugging Patient A  
   -  suggesting to Patient A that he attend a festival where Dr. Shapiro would be in 
      attendance; 
   -  suggesting to Patient A that he conceal the nature of their doctor-patient 
       relationship at the festival; 
    -  being frustrated and impatient with Patient A on occasion at the festival when 
       Patient A sought his help; 
    -  not responding adequately to Patient A’s distress at the festival; 
    -  criticizing Patient A for swearing based on Dr. Shapiro’s own desire to stop 
       swearing; 
    -  using imagery with religious overtones, and; 
    -  making comments that were unprofessional and misplaced. 
  
 FAILURE TO MAINTAIN THE STANDARD OF PRACTICE OF THE PROFESSION 
  
 Report of Dr. Taras Babiak 
  
 The College retained a Neuropathologist and Psychiatrist, Dr Taras Babiak, to provide an 
 independent opinion. On February 25, 2019, Dr. Babiak provided his report to the 
 College. In his report, Dr. Babiak opined as follows: 
 
1. Did the care Dr. Shapiro provided to the patient meet the standard of practice? 
 
“The care that Dr. Shapiro provided to the patient did not meet the standard of practice of 
the profession.  
 
As the patient’s Psychiatrist Dr. Shapiro failed to consider the patient’s fragilities and 
vulnerabilities in deciding what sort of experiences to implement for the patient, for the 
purpose being therapeutic, namely exposure to individual and group therapy. When the 
patient reached out to Dr. Shapiro for help in dealing with his emotional turmoil at the 
[festival], Dr. Shapiro kept pushing him away, injuring the patient further emotionally, 
motivated out of concern by Dr. Shapiro for the patient’s potential for “outing” the nature 
of the relationship to others. While Dr. Shapiro may have been concerned about 
confidentiality in this instance, I believe he was more concerned about his boundary 
crossing with the patient being revealed.  
 
With regard to boundary crossings, these occurred as well prior to the events of 
the…festival. There was his rather over-familiar and flippant response to the patient’s 
expression of admiration and idealization for him. There was late Friday night call to 
initiate contact with the patient, his inclusion of the patient to “sit in” in group, individual 
and couple sessions, after only a handful of sessions with him following his assessment - 
another series of serious boundary crossings. Offering the patient the choice of attending 
a festival where Dr. Shapiro would be present, as well and leading events, and then 
instructing the patient that he needed to keep the nature of their relationship to himself, 
was a very serious boundary crossing. While not sexual in nature, it is a violation of 
boundaries. It is a violation, in my opinion, because the patient was engaged by him in 
colluding with his Psychiatrist with what should not have occurred according to the 
Profession’s standards of conduct. While it is up to Physicians to maintain their 
professional obligations and conduct with respect to confidentiality, it is up to our 
patients to choose whether and whom they wish to reveal their relationship with a 
Physician to. It is not the Physician’s place to insist that patients protect their crossings 
or violations a boundary.” 
 
From the standpoint of documentation, however, his records lack documentation of the 
lion’s share of what contacts his patient and he had, and what he exposed his patient to. 
This clearly falls below the Profession's standard with respect to clinical documentation.” 
 
2. Did Dr. Shapiro’s care display any or all of the following:  
 
            lack of skill? 
 
“Yes, Dr. Shapiro’s care did displayed [sic] a lack of skill in that he displayed a lack of 
ability to: 
 
   (a) exercise patience and restraint in his expectations for progress and outcomes in 
      the treatment of patients with Post-Traumatic Stress Disorder. He addressed his 
      remedial efforts and intentions with regard to his therapeutic hubris in his letter of 
      response to the patient’s complaint and the Appendix. 
 
   (b) in the application of skills regulating his countertransference in response to 
      Patient A's idealization of him and his reaching out to him for support in a context 
      that the patient was unfamiliar with. Dr. Shapiro had set this problem up by 
      offering the patient the choice of attending the festival, after having “sit in” in 
      sessions with other patients. He first made him feel included, special and chosen, 
      and then he betrayed his trust, abandoned and pushed him away, making him feel 
      diminished and discardable. Dr. Shapiro was reacting instead of responding in a 
      considered manner, with the patient’s emotional well-being in mind.” 
 
lack of judgment? 
 
“Yes. Dr. Shapiro displayed a serious lack of judgment in the commission of boundary 
crossings with the patient in other patients’ sessions, in his boundary violation regarding 
his requiring the patient keep the nature of their relationship to himself at the festival to 
protect his Psychiatrist's duty of confidentiality. In so doing, he retraumatized and 
overburdened the patient. First, he retraumatized the him [sic] by effectively rejecting and 
abandoning the patient the way his father had. Second, he overburdened him the way his 
mother had by putting the obligation to look after his Psychiatrist’s duty to confidentially 
after having been rather loose with these boundaries in the clinical context. The patient, 
feeling that he had “fallen from grace”, fell into a turmoil with psychotic reaction, and 
ended up in hospital.” 
 
3. Does Dr. Shapiro’s clinical practice, behaviour or conduct expose or is likely to expose 
his patients to harm or injury? 
 
“No, I believe they no longer do at this point. Given the insight, admissions and 
acknowledgement of how he injured the patient and could pose risks to other vulnerable 
patients that Dr. Shapiro details in his response letter and the remediation efforts that he 
 lists…I cannot say he still poses a risk. He has done this in the identified areas of 
deficiency in his clinical work and documentation. This is encouraging, in particular with 
 regard to boundary issues, their importance and management, where Dr. Shapiro has 
 done course work and ongoing supervision. His continued work, consultation and 
 supervision which he described with regard to boundary issues are and will be crucial for 
 facilitating the transfer of knowledge and skills in considered clinical judgment and safe 
 clinical practice.”  
  
 PENALTY 

 The Committee ordered and directed: 

- Dr. Shapiro is to be reprimanded 

- Dr. Shapiro’s certificate of registration is to be suspended for a period of six (6) months, 
commencing from October 1, 2020 at 12:01 a.m. 

- The Registrar is to impose terms, conditions and limitations on Dr. Shapiro’s Certificate of 
Registration related to related to practice supervision and re-assessment 

- Dr. Shapiro is to pay costs to the College in the amount of $6,000 within 30 days of the date of 
the Order.

Decision: Download Full Decision (PDF)
Hearing Date(s): September 8, 2020 at 1:00 p.m.