Canada's most populous province has long recognized the gravity of sexual misconduct by physicians. Two decades ago, Ontario passed laws mandating punishment for predatory doctors.
But the reforms needed reforming, officials eventually decided. And that led to a long process that hasn't left anyone completely satisfied.
The complications experienced in Canada may serve as a lesson for U.S. regulators. Several states are considering improvements in patient-safety laws after last year's Atlanta Journal-Constitution investigation of sexual misconduct by doctors.
The latest Canadian efforts also began with a series of newspaper reports, by the Toronto Star. In 2014, the Star reported on the minor penalties assessed against a doctor who placed his lips on a patient's breast.
Ontario law called for revoking the licenses of all doctors who engaged in sexual abuse.
But the law had several loopholes: among them, groping and other sexual touching.
The doctor featured in the Toronto article could have been charged with sexual assault if the incident had occurred outside the examining room, the newspaper said.
But because regulations didn't mention the word "breast," the offense wasn't considered severe enough to warrant revoking the doctor's license. He served only an eight-month suspension.
A government task force spent 20 months studying the matter before issuing its last fall.
The proposals endorsed last month by the provincial government include automatically revoking licenses for some sexual acts by doctors involving patients, increasing access to therapy and counseling for doctors' victims, and ensuring that patients can easily access "all relevant information" about a doctor's history of misconduct and disciplinary action.
If adopted, the proposals would be in contrast to physician discipline in the United States, where regulators focus on a doctor's health and his potential for rehabilitation, rather than on the victims.
Many U.S. medical boards also withhold details about a doctor's history of misconduct.
The Ontario task force's original report was initially kept secret because medical officials thought it might libel individual doctors. Finally, the government released a redacted version with endorsements of several of the task force's recommendations.
But patient advocates complained that the proposed remedies don't go far enough.
The government did not put forth the task force's central idea: creation of an independent tribunal, outside the medical profession, to judge sexual-abuse complaints against doctors.
"It is absolutely needed," said Gary Schoener, a Minnesota psychologist who deals with abusive doctors. He served on an previous task force that made recommendations in Ontario.
Canadian medical associations in each province have jurisdiction over physician discipline.
No government agency regulates doctors.
In the United States, state medical boards oversee licensing and discipline of doctors. Although they are government agencies, most boards consist mostly of physicians.
"What the Ontario problem illustrates is that the situation is complicated and requires continued scrutiny _ not just a follow-up eight years later," Schoener said.
The chairwoman of the task force, Marilou McPhedran, agreed that much more should have been done.
"A major element in the real story behind so little change in 25 years of review by three thorough inquiries is in the skewed flow of resources that leach the public system of meaningful accountability," she said.
Ontario puts more than $100 million a year into a defense fund for doctor malpractice.
But McPhedran, a lawyer and former dean at the University of Winnipeg, said: "No grants of any significant amount have been made to patients' organizations or advocacy groups that include patient safety from sexual abuse within their mandate."
It's impossible to judge which country has a more widespread problem with predatory doctors _ partly because disciplinary proceedings lack transparency in many U.S. states. And Canada has fewer than 10 percent as many practicing physicians as the United States.
In its review of public board orders from each state, the Journal-Constitution identified half a dozen doctors who were licensed in both countries and had been punished for sexual misconduct in the United States or in Canada, or both.
Among them was Anthony Theodore Deluco, who once was licensed in Ontario, Indiana and Michigan. He faced sanctions for groping, kissing and having sex with patients. In 2003, Ontario ordered him to treat female patients only when a chaperone was present, according to public records. But then he was accused of inappropriate sexual contact with two more patients, and Ontario revoked his license in 2005. Both Indiana and Michigan also took action against him.
Efforts to reach Deluco were unsuccessful. He apparently is no longer licensed to practice in either country.
