Face of Nation : The remarks seemed out of place, but Emily Paine had been looking for a family doctor so long she tried not to think twice about it and knew she shouldn’t waste the opportunity.
Paine had been given a walk-in appointment with Dr. Craig Smith for a prescription renewal, but by the end of the meeting, he had offered to take her on as a patient.
Smith, she says, then likened the ensuing paperwork to marriage: If she saw another doctor, she remembers him telling her, it would be like cheating on him.
It felt strangely proprietary, she says now, “but you need a family doctor and someone’s offering to be your family doctor, so you jump on it.”
It was December 2018. For her next appointments with Smith, the doctor was always accompanied by another woman in the room. Then, when Paine called to reschedule a Pap test this April, she was told Smith was no longer working at the clinic.
Paine found out why by reading a news report online: Smith was before the Quebec College of Physicians’ disciplinary board for having used his smartphone to surreptitiously take pictures of two patients during exams.
At no point did Smith or the clinic, the Centre médical Santé Mont-Royal in Town of Mount Royal, tell Paine about the inquiry, which had begun roughly seven months before her first appointment.
“Did I not have the right to know?” Paine, 29, asked in a recent interview with the Montreal Gazette.
Paine’s appointments landed in a grey zone created by the way disciplinary complaints against physicians are handled in Quebec: the time that elapses between the doctor being cited for infractions and when the disciplinary action becomes public.
Her experience also raises questions about how patients are told of ongoing inquiries into their doctors and the lack of measures in place to inform them about possible misconduct.
“Maybe the doctor didn’t feel it was his responsibility, but at least someone should have stepped up and (told me),” Paine said.
“I feel like I was never given the chance to make an informed decision,” she added. “Someone could have at least said, ‘Here’s something that’s going on; you don’t need to believe it, but do you still want to proceed?’”
The Quebec College of Physicians’ syndic, similar to a prosecutor in a criminal case, first met with Smith and his lawyer at his offices in May 2018.
The syndic was investigating a complaint that Smith, a 45-year-old doctor with 16 years of experience, had taken a photo of a patient’s breasts the previous month.
The woman, in her 30s, had visited Smith for a blocked ear and warts on her toe. Smith told her she was due for an annual checkup and asked if she had a Pap test done recently.
When she told him she had, he asked about a breast examination. Since she hadn’t had one recently, she agreed to one. When she removed her shirt and bra, she believed she detected Smith — who said he received an urgent text message — take a picture of her with his smartphone.
The patient confronted Smith about it after the examination, then spoke with her husband at home and filed a complaint the next day with the College. She also went to the police.
During his meeting with the syndic the following month, Smith initially denied but later admitted to trying to take a picture of the woman’s breasts. He then also admitted to taking a photo of another patient’s vulva during a gynecological exam the previous week.
That meeting took place seven months before Paine first met with Smith, and a year before he was eventually sanctioned: On May 14, 2019, Smith was stripped of his licence for three years and ordered to pay a $7,500 fine to offset the cost of the therapeutic care the complainant has since needed.
The board ruled Smith took advantage of his patients’ trust to “satisfy a desire” and that taking a photo of the woman’s breasts while she was in a vulnerable position “constitutes an attack on her physical and mental integrity and a lack of human respect.”
The College’s syndic receives more than 2,000 investigation requests each year. Before anything is made public about patients’ complaints, the syndic will investigate the claim and come to one of three decisions:
- If the syndic judges the complaint is non-founded, it closes the case.
- If it judges it founded but deemed not worthy of disciplinary action, it recommends “non-disciplinary” measures for the doctor.
- In the most serious cases, it lodges an official complaint with the disciplinary council over the doctor’s misconduct and schedules public hearings.
Despite the months or years that can elapse, the disciplinary committee’s file on the complaint only becomes public on the first day of hearings.
Per the Professional Code of Quebec, the law that governs all professional orders in the province, the College must post a roll of upcoming disciplinary hearings at least 10 days before they begin. At that point, if patients were to search their doctor’s name on the College’s website or call the order directly, they could learn their doctor is facing disciplinary action and the nature of the complaint.
But without the patient looking up their doctor by their own accord, there are few measures in place that would warn someone a doctor is under investigation by the College.
The Professional Code also establishes that the College only informs clinics or medical establishments once a doctor’s sanctions have been decided — in Smith’s case, roughly a year after the infractions.
According to the College, the code was modified a few years ago to try to reduce delays between when the complaint is filed and when the person is sanctioned. The effort helped reduce the time from an average of up to one year to approximately three months.
If the syndic judges the physician’s actions could endanger public safety, however, it can ask to have the doctor’s licence revoked on a provisional basis until the proceedings begin.
And when the citation is related to sexual misconduct, the clinic will be informed immediately if a doctor pleads guilty, instead of waiting for the sanctions to be decided.
Otherwise, the College will inform the doctor’s clinic or health facility after sanctioning. It is then obligated to post a notice about the decision in a local newspaper in the area where the doctor worked.
“However, we do not have jurisdiction over health facilities so we cannot know how they inform patients about the doctor,” a College spokesperson wrote when asked about its policy. “That being said, it must be remembered that since we live in a state of law, the doctor has the presumption of innocence until proven guilty.”
Paine believes someone at the clinic must have known the College was looking into Smith’s conduct, given that he had female colleagues in the room with him at all times during appointments.
When she was to have her Pap test done, she says, she was told it would need to be done by a nurse, and that Smith would meet with her afterward.
“They had multiple occasions to let me know what was going on,” Paine said. “There were three or four visits where someone could have said something, but no one did.”
During the disciplinary hearings, Smith said he took the decision to always have another woman in the room with him during breast or gynecological exams ever since May 2018, a month after the incidents. He also hired a medical scribe to be present during meetings with patients.
But the Santé Mont-Royal clinic denies having had any knowledge of the inquiry into Smith’s conduct until March 2019, when the first public hearings into the complaint were heard and he was found guilty of the infractions.
“SMR could not advise Dr. Smith’s patients because it did not know that Dr. Smith was under investigation for such conduct,” the clinic’s medical directors wrote in a statement.
The clinic “immediately ended its professional relationship” with Smith once it did find out, they added.
The directors said the clinic did know about the scribe, but was not aware of Smith’s decision to have another woman in the room during examinations, and “at no times was SMR ever advised of any constraints or restrictions placed on Dr. Smith’s right to practice.”
Learning of Smith’s misconduct, they added, “was very shocking and upsetting for his patients, colleagues and the staff at SMR.”
Smith declined to comment on this article through his lawyer. According to Santé Mont-Royal, he has moved his professional activities to Santé Family Médicine, a clinic in Côte-des-Neiges.
The clinic did not respond to the Montreal Gazette’s request for comment. A message on its answering machine says it is closed until further notice. An automatic email response from the clinic said Smith “has had to take a leave of absence.”
By the time Paine walked into her first appointment with Smith, she had been on a waiting list for a family doctor for nearly nine months.
She believes in the presumption of innocence and the right to be fairly judged for one’s actions, she says, but also believes patients should be allowed to know of pending disciplinary action as soon as possible.
If the clinic was aware of the inquiry, she’s adamant someone should have told her. And if it wasn’t aware, then she believes the College should be advising clinics at an earlier date, not only at the end of the disciplinary process.
Had she known about the investigation, she says, she would not have taken appointments with Smith.
She also believes he should not have been in a position to become her family doctor when he was aware he was likely facing a multi-year licence suspension.
As a result of Smith’s licence being revoked, Paine now needs to de-register as his patient. She fears how long it might take to find another family doctor if she ends up on the waiting list again.
“I think it puts people in Quebec in an unfair position,” Paine said. “You want so much to be treated, so much to have a doctor that, essentially, you end up grasping at straws and taking the first doctor that comes along.”
She paused before finishing her thought.
“You don’t think that anything may be wrong,” she said. “All you want is care.”
