Canada’s medical watchdogs know more about bad doctors than they are telling you - Toronto Star

In late 2009, Ontario’s medical watchdog was considering yet another complaint against Dr. Ronald Bjorndahl Sorensen.

Before a meeting to discuss the matter, members of the complaints committee at the College of Physicians and Surgeons of Ontario (CPSO) exchanged notes about the Windsor urologist, who held medical licences in three American states.

Sorensen had what one committee member described as a “long and troubling history with us,” including “lots of complaints.”

“I would support a verbal caution at least,” another member replied, “but with the history and several previous cautions, is another verbal caution going to be enough?“

Several months earlier, a patient had complained to the college after seeing Sorensen at his Windsor clinic. She said he recommended urethral dilation to treat her frequent bladder infections. He said the procedure would allow him to examine and stretch her urethra and “was not painful.” He offered to do it that afternoon for a $50 fee.

Almost immediately, she said she felt “an excruciating pain that was unbearable.” She cried out, begging him to stop. She said he didn’t listen.

“I am emotionally distraught. I cannot stop thinking that he should have stopped, and he violated my rights,” she wrote in a letter to the college. “I do not want any other woman to go through what I did.”

Dr. Ronald Bjorndahl Sorensen had his medical licence revoked in California and restrictions imposed on his practice in Ontario and Washington state following a complaint by a patient who said the doctor subjected her to “excruciating pain” during a medical procedure. Tyler Brownbridge/The Windsor Star

The complaint against Sorensen, who declined to comment for this story, would result in restrictions on his practice in Ontario and Washington state and the revocation of his California medical licence.

Details about the number and nature of complaints against Sorensen have never been released by the CPSO. The information reported here came from the websites of American medical regulators and Sorensen’s case file in Washington, which was released for free through a public records request.

The Ontario college is keeping nearly all of it secret from you.

An 18-month investigation by the Toronto Star into doctor discipline reveals how regulators keep an ocean of patient-safety information hidden beneath what little they make public. This investigation wasn’t easy. Canada’s regulators don’t tell you everything about your doctors’ disciplinary records, and they stood in our way throughout.

Patients rely on medical regulators to protect them and the public interest. Across North America, the physician profiles posted on medical college and board websites play a vital role in that function. These public databases are a safeguard for patients, who can use them to confirm that their doctors hold valid medical licences — and find out if there are any red flags.

The Star has compiled a database of 159 physicians with disciplinary records who have held licences to practise in both Canada and the U.S. — but this is surely a fraction of the real number. Some medical regulators scrub discipline details from physician profiles five to 10 years after a sanction is imposed, and remove the profiles entirely when a doctor loses his licence. Some also refused to release additional information that may have allowed us to add more doctors to our database, citing confidentiality provisions.

Overall number of licences held by 159 disciplined doctors throughout their careers.

Average number of licences per doctor throughout their careers.

The greatest number of licences, active and inactive, held by a single doctor.

The greatest number of active licences held by a single doctor.

The true number of disciplined doctors who have practised on both sides of the border is anyone’s guess. North America’s 64 medical regulators oversee nearly a million active physicians. No single government agency, regulator or umbrella organization tracks cross-border physicians. An estimate provided by the Canadian Institute of Health Information based on changes to the mailing addresses of Canadian doctors suggests that hundreds relocate to the U.S. — and return to Canada — each year.

Physicians with disciplinary records represent a very small fraction of doctors in North America, but as shown in a 2016 study in the New England Journal of Medicine, a few bad doctors can cause significant damage.

Canadian and U.S. regulators have starkly different standards of transparency. Unlike in the U.S., where consumer legislation governs many medical boards and mandates openness, Canada’s doctors oversee themselves. One consequence of self-regulation, we found, is endemic secrecy.

This secrecy is baked into the bylaws, policies and culture of Canadian medical colleges, depriving patients of information about doctors who have been sanctioned by regulators for a range of offences, including sexual misconduct, improper prescribing, negligence and fraud.

There is a lot patients don’t know about the doctors in our database: We found that 90 per cent of these physicians’ Canadian medical college profiles were missing discipline details that had been publicly disclosed in another province or state, while 69 per cent of their U.S. medical board profiles were missing this information. In Canada, 73 per cent of the profiles had no disciplinary history whatsoever, compared to 40 per cent in the U.S. — even though records exist in every case. The majority of the sanctions in our database were imposed after 2000.

Most regulators refused to discuss the holes we exposed, making it difficult to trace the root of the problem in every case. But in some instances, the answer is plain: Medical boards and colleges are aware of doctors’ disciplinary records, and they are withholding that information from you.

He was “drinking again with increasingly uncontrolled behaviour.”

In our investigation, we faced an uneven, illogical patchwork of policies guiding the public release of licensing and disciplinary details by medical regulators in all 50 U.S. states, 13 Canadian provinces and territories, and Washington, D.C.

In some of them, such as California, Washington, New Brunswick and Ontario, discipline decisions and full physician rosters were available online or provided quickly upon request.

This was not the case everywhere. In Quebec, it took several months — and a Freedom of Information request — before the college sent the Star a DVD containing 32 files with disciplinary decisions from 1988 to 2016. From nearly 20,000 pages of records, we logged 1,277 cases of discipline by the Quebec college to arrive at a list of names we could cross-reference with records from other medical regulators to see which physicians practised outside of the province.

“The College can not and will not provide a list of its members.”

But the college said it was “impossible” to provide the Star — and the public — with a list of its 20,606 active members because “Quebec no longer produces a directory of its members as the information changes daily.” Because of this, our search certainly missed doctors currently licensed in the province who were disciplined elsewhere.

The B.C. college also initially refused to provide a full physician roster, relenting only after we sent a formal letter explaining how we intended to use the data.

“What we’ll need from the Toronto Star is a formal letter with a detailed explanation on how it intends to use the data, and agreeing in writing to the terms, as set out in the policy. The letter should be signed by a representative of the Star with appropriate signing authority...”

We encountered another black hole in Northwest Territories, where we were told that privacy laws prohibit the release of any details about disciplinary decisions before 2010, other than the date of a hearing. According to a government spokesperson, only three doctors have ever been disciplined as a result of a complaint in Northwest Territories — in 1994, 2001 and 2007.

Star reporters narrowed down about 1,800 potential matches between physicians and their discipline records on both sides of the border by comparing birthdates, medical school credentials and other publicly available information. In many cases, regulators refused to provide this additional information.

We had to abandon two possible matches in P.E.I. because the college would not confirm the years the doctors had graduated medical school. A college spokesperson said this information is protected by provincial privacy rules, even though it is routinely posted on physicians’ profiles in other provinces.

The Quebec college refused to provide any information about when and where doctors graduated from medical school, “because this information is not public,” a spokesperson said.

In all, this secrecy forced us to abandon nearly 200 possible matches — more than the 159 we confirmed.

Success, we found, depended largely on the boards and colleges involved.

He’s been disciplined for fraud, “disgraceful” conduct and deadly prescribing offences.

Dr. Ronald Bjorndahl Sorensen’s discipline originated in Ontario, but the case might not have come to our attention without the transparency of the Medical Board of California.

The Ontario college’s public physician profiles are the only ones we found in Canada that include information about discipline imposed in other jurisdictions. It is arguably the most open medical regulator in the country.

But the CPSO, which is governed by provincial legislation but operates independently, is a fortress compared to California’s board — a semi-autonomous, state agency, whose website was named the best among U.S. medical boards in a 2016 review by Consumer Reports and the Informed Patient Institute.

The California board has lobbied successfully for legislative changes that allow it to post most discipline information on its profiles in perpetuity, including criminal convictions and malpractice settlements.

The information is updated, even after a doctor is no longer licensed in the state. Since 1998, the board has published information about discipline imposed in other jurisdictions.

“The mission of the board totally is consumer protection,” the board’s executive director, Kimberly Kirchmeyer, said in an interview.

“We want the individuals in California and in other states to be as informed as possible about the physician that they may be seeing,” she said. “Any information that’s public should be on that website.”

The Ontario college takes a different approach.

The college recently amended its bylaws to allow it to post more details about undertakings (agreements between doctors and the board), as well as criminal charges, convictions, and discipline imposed in other jurisdictions after Sept. 1, 2015.

Dan Faulkner, the college’s interim registrar, said the 2015 cut-off date was imposed because prior discipline details are “inherently prone to poor memories (and) no documentation.”

Dan Faulkner, the interim registrar of the College of Physicians and Surgeons of Ontario, said the college does not keep discipline records that took place before Sept. 1, 2015 because historical details are “inherently prone to poor memories (and) no documentation.” Anne-Marie Jackson/Toronto Star

“We felt that there would be the strong possibility of providing unreliable and inaccurate information,” he said, adding that the physician profiles are “not a complete spray of information.”

Differences in the public disclosure policies of medical regulators in the U.S. and Canada were emphasized repeatedly throughout our investigation, especially in the case of Sorensen.

The only sanction against Sorensen’s medical licences that was initially captured in the Star’s analysis was posted on the California board’s website, imposed in December 2011.

But this was the last domino in a series of sanctions that had begun in Ontario in 2010. That year, Sorensen signed a voluntary agreement with the Ontario college to stop practising female urethral dilation procedures, leading to the same restriction being imposed in Washington state, where he was also licensed.

But the California records didn’t explain what prompted these restrictions.

For that, we had to turn to a “sunshine” state.

Medical regulators imposed 490 disciplinary actions against 159 doctors in the Star's database.

disciplinary actions imposed in Canada.

disciplinary actions imposed in the United States.

disciplinary actions imposed internationally.

Many Canadian colleges say their privacy rules prevent them from releasing investigative reports and patient complaints that result in disciplinary action. That is not the case in Washington, where sunshine laws require administrative agencies to do their work in plain sight. The Washington Medical Commission was also among the few regulators in North America willing to discuss ongoing investigations.

The documents we obtained from Sorensen’s case file in Washington include dozens of pages of the Ontario college’s notes, sent by the CPSO in 2010, after the U.S. board learned of the restriction on Sorensen’s Ontario licence in an alert.

The Ontario records — which are unavailable to patients in Ontario — show that his female patient alleged that before Sorensen performed the procedure, he turned off lights and said, “Here, I will even set the mood.”

The patient wrote: “I remember feeling shocked and dumbfounded at that remark. I could not help but think that it was not appropriate or professional.”

Sorensen responded to the complaint seven months after it was filed. In a five-page letter, he said he did not remember the patient and refuted her allegations.

“Although she makes mention that I was ‘short’ with her, this has never been the case in any patient interaction over 27 years. Physicians, nurses and patients alike will attest to the fact that I am one of the most relaxed, patient and tolerant individuals practising medicine, and even in some of the most stressful circumstances, do not ‘lose my cool/relaxed/tolerant demeanour. I am not sure why this patient felt ‘threatened.’”

He said he told patients that “ ‘mood lighting’ will also help to relax them while they are waiting, instead of having the bright fluorescent lights in their eyes,” a lighting system that cost him “dearly to install, all aimed at making the patient more comfortable and relaxed … NOT FOR some type of inferred sexual gratification.”

In December 2009, a urologist who provided an independent opinion for the Ontario college concluded that Sorensen performed an inappropriate and out-of-date procedure, for which he appeared to have also billed OHIP, despite charging the patient out-of-pocket.

He did not believe Sorensen had been sexually inappropriate, but said, “Dr. Sorensen displayed a lack of (regard) for the welfare of this patient and has failed to recognize the trauma that this patient experienced ... I believe that the patient did suffer harm.”

Sorensen was not publicly disciplined in Ontario. Instead, he agreed to stop performing female urethral dilation.

Nova Scotia doctor found guilty of “negligence on more than one occasion” in N.Y.

Sorensen’s restriction remained until February 2012, when three medical inspectors — all doctors — recommended against referring the case to the college’s discipline committee. Instead, the doctors said Sorensen should receive a verbal caution.

Washington lifted Sorensen’s restriction in July 2012.

If a patient searches for Sorensen on the Ontario college website, she will find no mention of the cautions, the 2010 undertaking, or any details of what led to those sanctions. There is also no mention of his U.S. discipline because it fell before the Sept. 1, 2015, cut-off date.

All the Ontario college will say about the incident is contained in a single, cryptic line indicating a change to his registration status from early 2010 to 2012. It states: “Transfer of class of certificate to: Restricted certificate.”

That’s more than patients are being told in Michigan, where Sorensen has been licensed since 2003. There, his online profile shows no trace of any disciplinary history.

Details of Sorensen’s case came from the Ontario college, but were uncovered by the Star through a request to the Washington regulator. At first, the Ontario college told the Star it was not the source of this information. A spokesperson said, the CPSO “does not share confidential investigation files or details about complainants with other jurisdictions.”

The spokesperson later said the college was upset that this information had been made public: “The College is troubled that the Star was apparently able to obtain information from the Washington commission which included patient identifiable information and has contacted the Washington commission to object to its conduct.”

“The College is now reviewing its practice in response to inquiries from other regulators to see if any additional measures are required or can be taken to ensure that confidential information is protected.”

Last November, the CPSO imposed a new sanction on Sorensen’s licence.

His profile states that he must practise under a supervisor who will review his patient charts “on the basis of areas of concern” identified in two medical inspectors’ reports. There are also conditions relating to GreenLight Laser Prostatectomy, a procedure to treat urinary blockages.

There is no further detail about the concerns.

The Star reached out to Sorensen by phone, letter and a visit to his office.

Sorensen’s Windsor clinic is housed in a squat, concrete building in a commercial area, not far from the airport. On a weekday morning in late March, about a dozen people filled the chairs in the waiting room. A receptionist accepted a hand-delivered letter and said Sorensen was “not prepared to talk about it.”

Sorensen, a urologist, runs a clinic in a commercial area in Windsor, not far from the airport. Rachel Mendleson/Toronto Star

Sorensen’s California profile has been updated to include this latest sanction. It is not disclosed on his profiles in Michigan or Washington.

In Michigan, the licensing department was informed about the action in Ontario in November 2017, and is “currently reviewing the case,” a spokesperson said.

A lawyer for the Washington Medical Commission, Rick Glein, said the board should have redacted patient information from Sorensen’s case file, but stood by its release to the Star.

In an email, Glein said the board had been informed about the latest action in Ontario, and that “the complaint had been authorized for investigation and possible disciplinary action.”

“Although the case does not appear to present any risk to Washington patients, it is likely the panel will decide to mirror the College of Ontario’s new restriction placed on Sorensen’s practice,” he said.

He also provided a case file number and instructions on how to file another public records request, but suggested waiting a few months until the investigation has progressed.

“I wouldn’t want to waste your time,” he said. “Right now, the file would be really slim.”

He’s been disciplined for fraud, “disgraceful” conduct and deadly prescribing offences.

WINDSOR—In a busy plaza, across the hall from the Real Canadian Superstore, a triptych of posters advertises the breadth of “wellness” services that once attracted thousands of patients to Dr. Thomas Joseph Barnard.

One image depicts a grey-haired Barnard performing anti-aging laser treatment under a banner that promises, “Prevention.”

A tryptic of posters in a busy Windsor plaza advertises the "wellness" services that once attracted thousands of patients to Dr. Thomas Joseph Barnard, who can be seen in the image of the far right, performing laser treatment. Rachel Mendleson/Toronto Star

That cheery facade fades inside Fresh Medical Spa, the vestiges of Barnard’s Windsor health-care empire. In the waiting area, above the display case featuring before-and-after photos, two signs outline the restrictions on Barnard’s Ontario medical licence: He “must not practise family medicine.” He “must not prescribe narcotic drugs.” He “may only provide certain aesthetic and cosmetic services and nutritional counselling.”

There is a lot the signs don’t say.

Using court records and public documents from medical regulators on both sides of the border, the Star has pieced together eight sanctions against Barnard in Ontario, Michigan and California that stretch back more than a decade. That’s eight times Barnard has been penalized for a range of offences, including improper prescribing, “signs of incompetence” and “failing to disclose” pending discipline on a licence application. It also includes a guilty finding in Ontario for fraud under the provincial Health Insurance Act, which was unknown to the College of Physicians and Surgeons of Ontario (CPSO) for almost a year, until March.

Barnard, a family doctor and former head of the Essex County Medical Society, is among the most disciplined physicians in the Star’s analysis of 159 cross-border doctors with sanctions in their records. He still holds licences in Ontario and Michigan.

Some details appear on the websites of medical regulators in Ontario, Michigan and California. But none of Barnard’s public profiles lists the full history the Star has compiled, highlighting the weaknesses in the North American regulatory system that prevent medical boards and colleges from receiving timely disciplinary details — and sharing that information with you.

Barnard did not respond to phone messages at the Fresh Medical Spa or a hand-delivered letter, which was accepted by a manager who said the doctor was in the office, but “not available.” After repeated attempts, a spa receptionist told the Star Barnard had “made it clear” he “is not going to be commenting.”

In the waiting area of Barnard's Fresh Medical Spa, two signs outline the restrictions on his Ontario medical licence, including that he “must not practise family medicine”; “must not prescribe narcotic drugs”; and “may only provide certain aesthetic and cosmetic services and nutritional counselling.” Rachel Mendleson/Toronto Star

Licensed in Ontario since 1980, Barnard first appeared before the college’s discipline committee on Nov. 28, 2006, following an investigation into how he charged patients for uninsured services and for giving some patients “gold member” cards, which they believed entitled them to preferential service, according to the decision by the Ontario college.

Barnard didn’t dispute the professional misconduct charges. In a decision reached that same day, Barnard was ordered to pay $2,500 and received a two-month suspension, one month of which was to be suspended if he complied with conditions.

Six days before the college hearing, Barnard applied for a licence in Michigan. The application, obtained through a freedom of information request to Michigan’s licensing department, included the question: “Have you ever had a federal or state health professional or controlled substance license revoked, suspended, or otherwise disciplined; been denied a license; or currently have disciplinary action pending against you?” Barnard’s answer: “No.”

In Michigan, Bernard’s lie went undiscovered for nearly a decade. The state granted him a licence in December 2006, eventually fining him $2,500 in July 2015 for “failure to notify” the regulator within 30 days.

Michigan learned of the 2006 Ontario suspension when it was examining another allegation against Barnard from the CPSO in 2014, said Pardeep Toor, spokesperson for the state licensing department. Toor did not provide detail about the allegation. (The Michigan action is not listed on Barnard’s Ontario profile, because the college does not post discipline imposed in other jurisdictions before Sept. 1, 2015.)

In 2010, Barnard was criminally charged for submitting fraudulent OHIP billings, a charge that would not be resolved for seven years.

Then, in the fall of 2012, the province’s chief coroner and the Ministry of Health and Long-Term Care contacted the CPSO over concerns about the standard of care Barnard was providing.

Over the next five years, experts retained by the college conducted seven reviews of Barnard’s practice. The findings, as the college observed, “were strikingly similar.”

In the case of a patient whose overdose death sparked the complaint from the coroner, one expert concluded in July 2013 that Barnard continued to prescribe drug combinations “with known risks of harm,” even after it became “obvious the patient was unable to control her use,” according to college records.

The coroner’s report said the cause of death was “multi-drug toxicity” from controlled substances Barnard prescribed to the patient.

In May 2015, a review of 37 patient files by another doctor found that Barnard “displayed a lack of knowledge and judgment in each case.”

That June, another investigation, which looked at Barnard’s treatment of 25 patients, found his care of 11 patients “did not meet the standard of practice and that he demonstrated various degrees of a lack of knowledge, skill or judgment.” Seven patient charts showed evidence of “a potential risk of exposing patients to harm or injury.”

California, where Barnard was licensed in 1990, took action in 2016, when the Ontario college issued a formal disciplinary charge and imposed an interim order, pending a hearing.

According to California records, Ontario imposed the order — the third sanction Barnard faced — in February 2016, “based on signs of incompetence” and his “failure to maintain the standard of practice” in the care of three patients.” The order imposed restrictions on Barnard’s practice, including a prohibition on prescribing narcotics, and led the California board to file charges.

In September 2016, Barnard’s fourth sanction: an in-person caution from Ontario for a “delay in diagnosis of a lymphoma.” A patient at Barnard’s clinic had had an ultrasound in 2014 that showed “abnormally enlarged nodes,” but he made no attempt to contact the patient, the college decision states. A year later, the patient had developed “multiple lumps” which were “very widespread.”

While Barnard acknowledged not following up on the ultrasound results, the committee was not convinced “Dr. Barnard fully appreciates the repercussions of his error,” the decision states.

Barnard agreed to surrender his California licence in late 2016, his fifth sanction.

In January 2017, yet another action: Barnard signed an “undertaking” with the Ontario college in which he agreed, among other things, that he would no longer practise family medicine and no longer bill OHIP. (Undertakings are agreements between doctors and the college’s complaints committee.)

Barnard agreed to limit his practice to esthetics, cosmetics and nutritional counselling, which includes treatments such as Botox injections. These are the restrictions posted in his waiting rooms.

A month later, the college announced Barnard’s seventh penalty: His licence had been suspended for four months after he admitted to allegations stemming from the seven reviews over five years.

At the time, Barnard claimed to have a roster of more than 25,000 patients, the Windsor Star reported.

Barnard told the paper that he was shocked by his patient’s overdose death, which he blamed for creating a “witch hunt atmosphere.”

He said he would have loved to work another decade. “I’m retiring from family practice to avoid a $70,000 hearing that I would have to pay for,” he said, adding that he will miss treating “the many, many people I’ve been able to help.”

Barnard’s Ontario profile contains a more complete record of his discipline history than those posted by California and Michigan. However, until recently, it was missing at least one key detail it is mandated to make public — the latest sanction on our list.

Court records obtained by the Star show the 2010 criminal case against Barnard resolved last spring. After seven years, Barnard pleaded guilty on May 31, 2017, to fraud under the provincial Health Insurance Act — a lesser offence that does not result in a criminal record. He was fined $8,000, given two years of probation and ordered to pay $250,000 in restitution. The next day, four criminal charges of fraud over $5,000 were withdrawn at the request of the Crown.

In an email, a college spokesperson said that “as part of the annual renewal process, physicians are required to notify the CPSO of any criminal convictions that occurred since the previous year’s renewal. That process is about to commence for the previous year.”

In Michigan, Barnard’s profile does not list actions in Ontario or the fraud case. Toor said the regulator became aware of the Ontario college’s decision in February 2017 when it was issued, through the National Practitioner Data Bank, an American clearing house containing information on malpractice payments and disciplinary actions that is not available to the public.

He said there is an ongoing investigation and further actions are being considered.

He was “drinking again with increasingly uncontrolled behaviour.”

In the summer of 2000, Dr. Richard Cunningham’s drinking had gotten out of hand. It wasn’t the first time the doctor would struggle with his alcoholism, nor would it be the last.

The director of the Mississippi physicians health program, a sort of AA for doctors, called the state medical board to report Cunningham was “drinking again with increasingly uncontrolled behaviour.”

Dr. Richard Cunningham leaves court in January 2011 after pleading guilty to several charges, including uttering death threats. He was sentenced to 90 days in jail. Terrence McEachern/Northern News Service Ltd.

After attempting to stage an intervention, Dr. Gary Carr told the board: “It would be my professional opinion that the continued, unrestricted practice of medicine by Dr. Cunningham could pose an immediate threat to the public.”

Days later, Cunningham, a Newfoundland-educated doctor who had been practising family medicine in Lucedale, Miss., for almost a decade, was charged with professional misconduct.

Barely a month later the charges were dropped — or “placed in abeyance for an indefinite period of time” — because Cunningham had allowed his licence to lapse.

After leaving the state, Cunningham hopscotched across North America. He had his licence revoked in Alabama and was convicted of numerous alcohol-related offences in the Northwest Territories, where he went to jail for threatening to kill his wife.

Today, he works at a clinic in the southern Alberta town of Fort Macleod. Cunningham’s public physician profile on the Alberta college website has no record of his discipline.

In an interview, Cunningham said the public doesn’t have a right to know about his past.

“Patients should know as much as they can about their physician. But not whether or not I have a certain illness,” he said. “I’m not a threat to my patients.”

Cunningham called his repeated movement a “geographic cure” for his alcoholism and said as long as he hasn’t harmed his patients, he is fit to practise medicine.

“The fact that I have an addictive disease does not make me a danger,” Cunningham said. “It’s a relapsing disease ... not a moral or shameful issue,” he said. “A lot of people don’t see it that way obviously. They think it’s a matter of character.”

Cunningham says he has disclosed his alcoholism, his professional discipline and his criminal history to medical regulators each time he moved to a new province or state, and it’s up to the local medical college or board to decide whether he can practise.

“They looked into it, they made a decision. I was forthcoming with them,” he said. “They don’t let you go working if they think you’re a danger.”

In January, Cunningham withdrew from practice by agreement with the college. In March, conditions were imposed on his licence as part of the agreement for him to return to practice. He is restricted to practising a maximum of 40 hours per week and can work only in a multi-physician setting. A college spokesman said he cannot disclose the reason for the conditions and refused to provide further details on Cunningham’s case.

“If a physician has alcohol or drug problems, it’s like any health condition, we don’t disclose that,” college spokesman Steve Buick said. “But if we need to limit their practice, we do disclose the conditions or restrictions. Doctors usually agree to such conditions to avoid a sanction.”

Cunningham’s former supervisor, Carr, who blew the whistle on his drinking in Mississippi, said Cunningham’s case was unusual and that the system should have caught a serial offender like him.

“Typically, if we had a problem in Mississippi and the medical board became involved and took an action, you could write it on a rock that within the next six weeks these other boards would be issuing paperwork and reporting disciplinary action in their state as well,” Carr said in an interview.

“If you’re a physician in the U.S. and you have a problem with the (medical) board in one state, you’re going to have a problem in any state you go to,” he said.

But that didn’t happen for Cunningham.

Before he gave up his licence in Mississippi in 2000, Cunningham had already secured a licence in Alabama. In Alabama, Cunningham told the medical board that he had experienced problems with alcohol, checking “YES” beside a question on the medical license application form asking whether he had ever been “addicted to the use of alcohol or the use of controlled substances.” He was granted an unrestricted license.

Cunningham apparently practised medicine in Alabama without incident from 2000 to 2004, when, at the Bayfest Music Festival in Mobile, Cunningham was arrested for public intoxication.

“Dr. Cunningham had difficulty standing and communicating and was trying to get into a vehicle which was determined not to be his,” according to Alabama medical board records. This time he would lose his licence.

Cunningham missed a discipline hearing and the Alabama State board of medical examiners revoked his licence in August 2005.

Cunningham moved to the N.W.T. in November 2000, when the territory’s college granted him a licence. The college declined to comment on Cunningham’s case.

While Cunningham has no disciplinary record with the N.W.T. college, he has had repeated run-ins with the law. Between 2008 and 2011, he was criminally convicted for drunk driving, falsely declaring he possessed explosives at the airport and uttering a death threat.

According to media reports, Cunningham arrived at the Yellowknife airport in October 2009 intoxicated and refused to show his boarding pass when attempting to board. When a staff member asked him to identify his luggage so it could be removed from the plane, he said “I hope my bag blows up your plane,” according to the agreed statement of facts. He pleaded guilty and was fined $3,000.

In 2011, he was convicted of threatening to kill his wife and violating a restraining order. He was sentenced to 90 days in jail and served his time on weekends.

After a two-month stint at a rehab facility in Ontario, Cunningham moved to Alberta, where he was granted a licence in 2012. He says he started a mandatory monitoring program with the Alberta college that required him to blow into a breathalyzer daily.

When the monitoring ended in June 2017, he continued to blow daily on a voluntary basis. But within two months he had a relapse. In December, he says he fell off the wagon again.

He said he is now back in a five-year mandatory monitoring program that includes psychiatric and addictions counselling. He returned to practice in March, Buick said.

“I’m quite open about the fact that I’m an alcoholic, but I’m in recovery,” he told the Star. “I had some guilt and things to be paid for, but I did that. It’s a consequence of what I’ve done when I’m drinking. I’ve accepted that. I’m monitored everyday.”

Cunningham’s public Alberta profile contains no mention of this monitoring.

He was found guilty of “negligence on more than one occasion.”

SYDNEY MINES, NS—In March, the Nova Scotia medical college notified the public that Dr. Eugene Ignacio had committed professional misconduct. He had used foul language and displayed disruptive behaviour toward a nurse, it said.

The college did not disclose that the Sydney Mines family doctor is not a first-time offender. In 2008, Ignacio surrendered his New York licence for failing to properly diagnose and treat an unconscious patient who was in urgent need of intensive care.

Ignacio’s discipline for “the manner in which he spoke to a nurse” is described in detail on the college’s website because it occurred in Nova Scotia. There is no mention of the New York incident, for which he was found guilty of “negligence on more than one occasion.”

Dr. Eugene Ignacio's office on Main St. in Sydney Mines, Cape Breton. Zane Woodford/Metro Halifax

Ignacio is one of more than 159 doctors identified by the Star in an 18-month investigation into cross-border discipline. The investigation shows that doctors who face discipline in one jurisdiction can often move to a new province or state and start again with a clean slate, highlighting a patchwork of laws and regulations that makes it difficult — and sometimes impossible — for patients to access their doctors complete discipline history.

In many cases, regulators know about doctors’ disciplinary histories but don’t share that information with patients.

Ignacio did not respond to repeated requests for comment, including detailed questions faxed and hand delivered to his clinic.

The Nova Scotia college confirmed it was aware Ignacio lost his medical licence in New York.

“The college does not publish findings of other organizations or other jurisdictions, but takes these decisions into consideration when assessing issues before it,” wrote college spokesperson Pattie Lacroix.

On July 9, 2003, a patient was rushed to the emergency room of the Claxton-Hepburn Hospital in Ogdensburg, N.Y. The patient had been discharged from the ER the previous day. He had a high fever, a racing pulse, a distended stomach, mottled skin and had been vomiting.

The doctor on call was Eugene Ignacio.

According to disciplinary documents posted on the New York medical board’s website, Ignacio “failed to meet accepted standards of medical care” when he pulled out the patient’s intubation tubes, which had been applied only 90 minutes earlier, and then failed to administer antibiotics and send the patient to the intensive care unit.

Ignacio also neglected to “obtain a timely consultation concerning (the patient’s) urgent condition” and “failed to adequately document” the patient’s progress, the New York documents say.

In January 2007, the New York board put Ignacio on probation for three years over the incident. In May 2008, he applied to have his probation lifted in exchange for surrendering his licence and agreeing to never reapply.

Ignacio has held a Nova Scotia licence ever since he graduated from Halifax’s Dalhousie University in 1985. It’s unclear when he returned to practise in Cape Breton.

“The college was fully aware of Dr. Ignacio’s disciplinary history in New York when considering Dr. Ignacio’s application for licence renewal in 2006. The college obtained and reviewed a copy of his file from the New York Medical Board. The college reviewed these materials to assess Dr. Ignacio’s suitability for ongoing licensure,” wrote college spokesperson Lacroix.

Ignacio had held an unblemished Nova Scotia record for 30 years. That was until last month, when the college posted its eight-page disciplinary finding on Ignacio’s “disruptive behaviour.”

A nurse had called Ignacio asking for instructions on a newly admitted patient. Ignacio refused, according to the report, and said: “Can you let me eat my God DAMN lunch” and “stop bothering me,” before slamming down the phone.

Ignacio later went to the hospital, “sought out the Nurse, pointed his finger in her face and screamed at her, ‘You’re a f-----’ bitch why don’t ya report that one,’” according the report.

Ignacio was reprimanded and ordered to enrol in a professional support program. He continues to practise in Cape Breton.

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