Regulators generally prefer a remedial approach to practice concerns in the absence of deliberate misconduct. However, where even a skilled practitioner lacks the insight to practise safely, revocation can be justified.
In Doyle v Discipline Committee of the College of Physicians and Surgeons of Ontario, 2019 ONSC 3905, http://canlii.ca/t/j15sr the practitioner had been found to have crossed boundaries and exercised poor judgment. The practitioner was receiving ongoing therapy and had undertaken scores of educational courses since the current concerns arose. However, the discipline panel expressed concern about the feasibility of changing the practitioner’s behaviour: “given numerous chances at remediation with many years of psychotherapy, supervision, monitoring and practice restrictions. Despite this, he is still struggling with professionalism, boundary issues, and clinical care…” that put his patients at serious risk. The Court upheld that revocation was reasonable given this lack of insight.
On a side note, there was discussion as to what use could be made of the practitioner’s failure to testify. The Court said: “I should note that, in the civil context of this proceeding, there would be nothing objectionable had the Discipline Committee drawn an inference that Dr. Doyle’s failure to testify signified his view that his testimony would not be helpful to his case.” While the discipline tribunal did not make that inference, it was entitled to note that his lack of testimony prevented it from evaluating his level of insight from his own words.