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.
Concerns
Source:
Member
Active Date: February 20, 2020
Expiry Date:
Summary:
Summary of the Undertaking given by Dr. Solomon Marc Shapiro to the College of Physicians and Surgeons of Ontario, effective February 20, 2020:
Following a public complaint, a College investigation was conducted into Dr. Shapiro’s care of a patient in his psychiatry practice. As a result of the investigation:
Dr. Shapiro will practise under the guidance of a Clinical Supervisor acceptable to the College for six (6) months.
Dr. Shapiro will engage in professional education in maintaining boundaries and confidentiality.
Source:
Compliance and Monitoring Department
Active Date: January 14, 2020
Expiry Date:
Summary:
Caution-in-Person:
A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed. A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee. The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015 or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.
Download Full Document (PDF)
Source:
Compliance and Monitoring Department
Active Date: January 14, 2020
Expiry Date:
Summary:
Caution-in-Person:
A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed. A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee. The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015 or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.
Download Full Document (PDF)