Quebec doctor suspended for issuing fraudulent ‘open bar’ medical notes

A $20,000 fine rather than a suspension. That was the proposal put forward by Dr. Céline Léonard, found guilty of issuing false medical certificates. Dr. Michel Bichai, assistant syndic of the Collège des médecins du Québec, had instead requested a four-month suspension. The disciplinary board ultimately imposed a three-month suspension. In addition to this sanction, she was fined $5,000 for incomplete notes in a patient’s file. The Mont-Tremblant, Que, clinician will also have to pay disbursements, expert fees and the costs associated with publishing a notice in a local newspaper.The case dates back to the beginning of the pandemic. The patient in question, then a correctional officer, was working long shifts and had altercations with inmates. He reported being exhausted, anxious and suffering from insomnia. Of the seven medical certificates (or medical notes) found in his file, six were flagged as fraudulent. In two certificates, he concluded that notes had been issued or modified at the patient’s request, without any medical evaluation to justify them. Another went much further: valid for two years, it allowed the patient to take sick leave “as needed.” When questioned later by the trustee, Dr. Léonard admitted that “it was an ‘open bar,’ and you shouldn't issue an ‘open bar’ for two years.”At the disciplinary hearing, Dr. Léonard stated that she had engaged in some self-reflection. She said the guilty verdict had caused her anguish, anxiety and insomnia. She stated that she is now “more aware of the implications of her medical certificates.” She also affirmed that she has revised her record-keeping practices, now completing her files before leaving the clinic. Furthermore, she submitted several training certificates covering topics such as certificates, sick leave and ethical obligations.But when she addressed the actions in question, the doctor reiterated that she wanted to prevent the patient from taking extended leave by temporarily adapting his working conditions. She also believed that consultations by phone or videoconference during the pandemic constituted “a kind of trap.” Her lawyer, for his part, maintained that the clinician was seeking a solution in the face of the employer’s refusal to accommodate her and that the notes in question were indeed based on medical justification.Remorse that is difficult to perceiveHer testimony did not reassure Dr. Bichai. The deputy trustee criticized her for showing neither remorse nor regret towards the third parties involved and for attributing the consequences of the case primarily to her own experience. “She says she’s reflected on it, but on what?” he wondered. In his view, the risk of recidivism remains.The council was only slightly more lenient on this point. While the absence of remorse is not considered an aggravating factor, it refused to acknowledge Dr. Léonard’s repentance. Her explanations—wanting to avoid a prolonged work stoppage, preventing the patient from using their vacation time or dealing with the employer’s refusals—“cannot be considered an expression of remorse.” Above all, the council believed that she “did not demonstrate that she fully understood that she could not issue certificates at the request of a patient she hadn’t even assessed.”The training courses the general practitioner has completed are considered “a step in the right direction.” However, it was added, her demonstration of a willingness to concretely implement her ethical obligations “remains incomplete.” Council members therefore believed the risk of recidivism remained present regarding the issuance of false certificates. They consider the risk, however, to be low with regard to proper record keeping.The argument of the 1,100 patientsDr. Léonard also cited the very real consequences that a licence suspension would have on her practice. As the only doctor at her clinic, she serves approximately 1,100 patients and works with two assistants. She feared having to lay off her colleagues and losing them. Most importantly, no one would be able to take over her care, as her colleagues have retired.These arguments did not convince the council. Its members acknowledged that the local population and the clinic’s employees would suffer the repercussions of the sanction, but reiterated that protecting the public remained the priority. They also cited the Professions Tribunal, which, in a previous case, ruled that “the shortage of physicians cannot be used as a pretext to lower medical standards.”Why three months?In determining its sanction, the council nevertheless took into account Dr. Léonard’s lack of prior disciplinary record, a “significant mitigating factor.” Conversely, her more than 30 years of practice worked against her. Such experience “should have led her to understand that she cannot issue certificates out of complacency or fail to complete her file with appropriate notes,” wrote her peers, who considered it an “aggravating factor.”The council therefore rejected the $20,000 fine proposed by the doctor. “A period of suspension appears necessary,” particularly due to the risk of recidivism. However, it reduced the four-month suspension requested by the disciplinary board by one month, since Dr. Léonard did not “fabricate a false case,” unlike in some more serious cases. Three months thus seemed “appropriate.”This item was translated from French. It originally appeared in our sister publication in Quebec, Profession Santé.

Quebec doctor suspended for issuing fraudulent ‘open bar’ medical notes

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