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The Execution: A doctor's battle against moral and institutional harassment

The Execution: A doctor's battle against moral and institutional harassment

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The Execution: A doctor's battle against moral and institutional harassment

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330 pagine
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Oct 24, 2018
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Since 2010, Albert Benhaim, a doctor, has been subjected to repeated attacks by the Quebec Health Insurance Board (RAMQ) and the College of Physicians of Quebec, which expelled him for life from its ranks in 2017. The reason?
Physimed, the clinic of which he is one of the shareholders, refused to provide, first to the RAMQ and then to the College of Physicians, a document of a strictly commercial nature that concerns neither the services provided by the public plan nor its medical practice. In this book, Dr. Benhaim - who in nearly 30 years of practice has never been the subject of a disciplinary complaint - recounts his long descent into hell, describing how the College of Physicians has not shied away from any unfair maneuver or abuse of power to professionally and morally execute him and break him financially. At the same time, he denounces the lack of oversight by professional orders on their syndics whose actions are held virtually unaccountable by anyone.

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Oct 24, 2018
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The Execution - Albert Benhaim

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Table Of Contents

Foreword

Chapter 1 – The Fake News

Chapter 2 – A Logical Vocation

Chapter 3 – Occupational Medicine

Chapter 4 – Physimed

Chapter 5 – The Tale Of A Permit

Chapter 6 – When the Competition Gets Involved

Chapter 7 – Leukemia

Chapter 8 – The Season of Subpoenas

Chapter 9 – At the College, We Don’t Like Doctors Who Make Money

Chapter 10 – The Vengeful Arm of the RAMQ

Chapter 11 – Lie, Lie. There Will Always Be a Trace

Chapter 12 – The Syndic and His Big, Dirty Boots

Chapter 13 – Objection!

Chapter 14 – Immediate Provisional Suspension

Chapter 15 – Moral and Institutional Harassment

Chapter 16 – Nicoud

Chapter 17 – Guilty! Of What?

Chapter 18 – Towards My Sanction

Chapter 19 – Permanent Removal: Capital Punishment

Chapter 20 – A Little Victory

Chapter 21 – Epilogue

Appendix 1: Glossary of organizations cited in the work.

Appendix 2: Index of persons whose names appear more than once in this book.

Acknowledgements

Postface

About The Author

To all victims of moral and institutional harassment who suffer in silence without understanding what is happening to them, so that they will know that they are not alone. And to all those who are helplessly witnessing this devastating phenomenon, so that they cease to be accomplices of the system and so that this book gives them the needed courage to report it.

FOREWORD

Wednesday, December 7, 2016 in an anonymous meeting room at the Hotel Dix, Sherbrooke Street, Montreal. I appear before the Disciplinary Council of the College of Physicians of Quebec to receive my sentence.

Three months earlier to the day, on September 7, the same Disciplinary Council found me guilty. Guilty of what, exactly? Negligence? No. The illegal practice of medicine? Not even. Sexual misconduct? Definitely not.

The College’s Disciplinary Council found me guilty of obstructing a syndic’s investigation. Why is that? Because the medical clinic of which I’m a shareholder refused to give the Quebec Health Insurance Board (RAMQ) and the College of Physicians a commercial document that doesn’t belong to me, is not part of the services insured by the RAMQ, and has nothing to do with the practice of medicine.

A little over a year earlier, on October 28, 2015, my license had been temporarily suspended on an immediate provisional basis by the Disciplinary Council for the same reason, without any active patient complaints, and with a clean disciplinary record.

On December 7, I find myself standing in an all-too-familiar makeshift courtroom, surrounded by an all-too-familiar cast of characters. The most familiar, unfortunately, is the College’s assistant syndic, Dr. Louis Prévost, who smiles at me with the perpetual smirk that he has glued to his face.

At the central table is Mrs. Caroline Champagne, president of the Disciplinary Council, who presided over my so-called trial and found me guilty of obstruction. Flanking her were Dr. Vania Jimenez and Dr. Pierre Marsolais, both members of the Disciplinary Council and both of whom practiced so much discretion throughout the previous hearing that I wondered if they were there for any other reason than to endorse the syndic’s accusations against me without blinking.

Also in the room are the syndic’s attorney, Mr. Anthony Battah, and my lawyer, Mr. Robert- Jean Chénier. He’s one of Quebec’s leading specialists in medical law and is rigorous, meticulous, and a devoted man.

I find myself before this absolute puppet court in which the College of Physician’s syndic—as well as the syndics of all other professional orders of Quebec—is not accountable to anyone. When a syndic wants to destroy a member of his professional, he can become a steamroller that crushes everything in his path. He can cause much damage before he’s stopped—in the rare cases that he can be stopped at all.

So when I go to my hearing, my fate has already been sealed.

I feel like Joseph K., hero of Kafka’s The Trial, who was convicted of a crime without ever knowing what he was accused of.

I’ll always remember this hearing, its oppressive atmosphere, the absurdity of the wrongdoings I was found guilty of, my feelings of helplessness in the face of my omnipotent accuser, my sense of revolt that the assistant would demand my permanent removal from the College, which was a gross injustice. Though I’d anticipated all of this in advance, I was devastated all the same.

I can’t help but think that if I’d been accused of having sex with a patient—like some of my fellow doctors have done—I’d have gotten away with a temporary suspension for just a few months. A slap on the wrist!

On December 6, the day before this hearing, I learned that Dr. Alain Sirard had taken his own life in his office at the Sainte-Justine Hospital. For more than three and a half years, he’d also suffered harassment from the College and other institutions just for performing his duties. The syndic who was investigating his case was the same one who’s been attacking me for many years. It was also my lawyer, Mr. Chénier, who was representing Dr. Sirard. I am therefore fairly familiar with Dr. Sirard’s file, which is more complicated than mine and about which—out of respect for the lives destroyed in the wake of his suicide—I don’t want to elaborate.

However, what Dr. Sirard and I share with many other professionals in Quebec, and undoubtedly elsewhere, is the fact that we have been victims of moral and institutional harassment, a relatively new concept, but whose consequences can be devastating. Generally practiced by one or more individuals on behalf of one or more organizations, institutional harassment aims to humiliate and destroy a person, both professionally and personally, while protecting the harasser or the institution he represents.

Sometimes colleagues or friends who tell my story to their acquaintances are frequently told, Yes, but your doctor friend must have done something wrong. You don’t lose your practice just like that.

There’s no smoke without a fire, as they say. This is precisely part of the institutional harasser’s strategy: massive and repeated blows that destroy the reputation of the victim.

But why exactly did they come after me? After more than eight years of battling, things seem much clearer to me than when the first stab wounds were inflicted. They didn’t just attack me as a doctor; they came after me because I was the owner of one of Quebec’s largest medical clinics.

Led by leftwing ideologues, large sections of Quebec’s health system—the Ministry of Health, the RAMQ, and the College of Physicians, all of whom are abetted by complacent ministers— declared war on private and semi-private clinics. They’ve used all the resources of demagoguery to portray physician entrepreneurs as highwaymen who exploit their patients and seek only to get rich. Later, two of their most powerful institutions came together to harass me, intimidate me, and ruin my reputation with a sham, Soviet-style trial.

I’ve decided to fight back and won’t let formidable and merciless opponents crush me. It’s precisely because far too many people suffer from institutional and moral harassment in silence, isolated, and without help that I wrote this book.

I have a story to tell. A horror story. And a personal story, of course, but as I’ve just mentioned, it’s one that transcends the limits of my own person. In addition to the institutional and moral harassment that you will see unfolding in these pages, this book is also about a health system sick because of an incompetent, dishonest, and soulless bureaucracy. It’s a system that’s been made sick by a professional order that’s deviated from its mandate to protect the public in order to wage an ideological battle, using intimidation and lies to do so.

CHAPTER 1

THE FAKE NEWS

My story begins on Friday, July 30, 2010.

The long heatwave that had plagued Montreal had finally broken. It was a crisp 15 degrees, and at 7AM the sun rose over a cloudless sky. I was about to cycle 200 kilometers from Montreal to Stowe, Vermont, where my wife, Gail, and I owned a country home. I love Stowe, a picturesque ski town tucked away in the Green Mountains, and looked forward to every opportunity to visit and get away from it all.

The annual bike ride from Montreal to Stowe was usually one of the highlights of my summer. Every year, 15 of my friends and I rode the winding, country roads over the border and around Lake Champlain into the foothills of Northern Vermont. This year, the ride had special significance because I had been unable to complete last year’s due to poor health. I saw this day—the open air, the perfect blue sky, the sun shining down on the Montreal skyline—as a sort of rebirth. A second chance. I was happy to be here and to be alive.

First, we descended southward to Nuns’ Island and then crossed the river using the ice bridge adjacent to the Champlain Bridge. From there we went west to Sainte-Catherine and then to Saint-Jean-sur-Richelieu where we crossed the border into Vermont. Riding a bike gives you the chance to see things differently. There is so much you miss when driving in a car, windows closed, breathing air-conditioned air, watching the world zip by at 120 kilometers per hour. Landscapes have a different perspective on a bike, and not just because you travel less quickly. It gives you time to appreciate the details of nature—the flowers, the trees, the smell of fresh cut grass. You can feel the wind whipping in your face as you go up and down the gentle contours of the road. As I biked, I felt in perfect harmony with the environment around me, an integral part of it.

Though it wasn’t a race, we rode relatively quickly. Each of us pushed ourselves and helped each other out. I took my turn leading the pack and then ceded my position to another. When you ride in a peloton, the leader makes himself most vulnerable, fighting against wind resistance and pulling along the rest of the pack.

About halfway into our journey, we arrived at the border and each of us was stopped at the customs post at St.-Armand/Phillipsburg. When my turn came, the stern-faced border agent took my passport and asked if I was carrying any weapons. I was only wearing a pair of skintight bike shorts and a brightly colored cycling shirt that clung to my body from sweat. Even if I wanted to carry a weapon, there would be nowhere for me to hide one. How could I answer this sort of question with a straight face?

I looked from my skin-tight bicycling outfit to the border guard’s humorless face and bit my lip to keep from laughing. I replied as seriously as possible that I was not.

After we all cleared the border, we continued into American territory. Here the terrain becomes much more mountainous and breathtaking. Everywhere you look, you’re overwhelmed by scenes of dramatic mountains and brilliant flashes of green. The air becomes thinner just as the ride becomes its most demanding. I huffed fresh mountain air and pumped my legs up the steep climb through Smugglers Notch, a pass between the Mansfield and Spruce Mountains that led directly into the heart of Stowe.

•••

At 2:30 we glided into Stowe, exhausted and proud. I’d biked 200 kilometers in six-and-a-half hours. Not necessarily a monumental achievement, but respectable nonetheless. Last summer I’d felt absolutely incapable of completing such a journey. Considering the diagnosis I’d received, I didn’t think I’d be able to make the ride ever again.

I said goodbye to my friends and we all made plans for a dinner party later on that evening after our wives arrived in town.

At my cottage, I showered and rested on my balcony. The view of the mountains was nourishing. It set my mind free. I was approaching fifty and up until that point had lived a truly lucky life.

I had a fantastic wife, intelligent and strong; a marriage full of love and harmony; three wonderful children who made me so proud. I’d achieved all of my professional goals and was most proud of the medical clinic, which I’d founded in 1988. It was a thriving, state-of-the-art medical center that was considered a model in the Quebec healthcare community. We strived to offer the best services to our patients, and to do so in a smart and effective way. Recently we’d made considerable investments to our imaging and radiology clinic, providing it with sophisticated and cutting edge medical equipment, including an MRI machine and a CT scan. Just two years before that we’d digitized the entire clinic, making it completely paperless. By comparison, the rest of the Quebec healthcare system was in the Stone Age. I had every reason in the world to feel good about myself.

I was in this state of Zen when the phone rang startling me from my euphoria. It was my wife. She wanted to make sure that everything was okay and that I’d arrived at our home safely. However, despite her innocuous questions, I sensed something odd in her voice. It masked frustration. She was cutting her sentences short as if there was something she didn’t want to tell me.

So I asked her, Is everything okay? Not really. She sighed.

Did something happen? My first thought was about our kids.

"We made the front page of La Presse."

La Presse is one of Montreal’s largest French-language newspapers. It has more than 200,000 daily subscribers, and reaches many more readers online.

"What do you mean the front page? La Presse? I asked her what she was talking about. They released an article about us this morning. I only found out later in the day."

By us I gathered that my wife was talking about the clinic where she also worked as the head of finance, putting her accounting degree to good use.

It must have been a good article, I said, though I knew from her tone that it was not.

Not particularly. The article says that Physimed has been taking advantages of its patients by requesting $340 for the services of a family doctor.

That’s impossible! Where did they get such an idea?

Look, I’m in the car. I have the newspaper with me. You can read the article when I arrive. Suddenly, I went from a state of bliss into a confused rage. Physimed is a good and honorable

business. No one who works there would ever do something to harm or take advantage of our patients. The article sounded ridiculous. Who would try to hurt us by writing a story like that? The whole thing left a bad taste in my mouth.

I’d asked my wife about reactions to the article around the clinic. What did the other doctors and staff members think? She said that they joked about it mostly. They found it absolutely ludicrous that anyone could make such baseless statements.

That’s what I thought too. Physimed illegally charging its patients? It was ridiculous.

Still, my mind was running around in circles. I was worried that the article would cause some kind of serious blowback. Here I was in Stowe, cut off from the outside world without even functioning internet. What was going to happen back in Montreal if this baseless accusation grew out of hand?

I needed to read the article. I stopped pacing, sat on the bed, and called my business partner, Gilles Racine.

Albert, he said. This makes no sense.

He picked up right away. The phone didn’t even have a chance to ring.

I didn’t want to call you while you were riding, said Gilles, because it’s an absolutely preposterous article. I don’t know how this journalist could even come up with such a story.

Gilles read me the entire article, written by a journalist named Anabelle Nicoud.

Under the headline, A Family Physician… for $340, she wrote that because of the shortage of family doctors in Quebec, Physimed had been charging its patients exorbitant fees just to be seen.

But everyone knows that a physician affiliated with Medicare¹ can’t charge both a patient and the Regie for the same service. All physicians who practiced and still practice at Physimed are affiliated with Medicare. This is a policy our clinic has always followed. It didn’t matter whether there was a physician shortage or not. It should also be noted that Physimed was accredited by the Minister of Health as a network clinic, which meant that patients could consult a physician free of charge, whether or not they were registered with a family physician at our clinic. If we set up a barrier to patient accessibility, financial or otherwise, we’d have had tons of complaints from our patients and our accreditation would long ago have been stripped away.

While Gilles read the article, I couldn’t help but think about Physimed’s reputation. What would all the people who cite Physimed as a model clinic think? Worse, I was, among other things, the Joint Chief of the Montreal Regional Department of General Medicine (DRMG), the department that advises the Montreal Health and Social Services Agency on healthcare strategies and implementation around the city. I was respected by and in constant contact with people who were involved in the healthcare sector in Montreal and all throughout Quebec. What would they think of me?

The journalist had not only written lies, but she’d given her article extra credibility by collecting quotes and comments to support her accusations from members of the RAMQ, the College of Physicians, the Ministry of Health, and from the President of the Federation of General Practitioners of Quebec (FMOQ), Dr. Louis Godin.

There was even a comment from the President of Quebec Physicians for the Public System (MQRP). This was a new organization that had called for free healthcare throughout Quebec, regardless of the long-term consequences, and had essentially declared war on private and semi-private clinics like mine.

Like most medical clinics in Quebec, Physimed was a semi-private clinic. This meant that consultations with physicians were covered by the public health insurance system. But several services—like MRIs, laboratory tests, and consultations with psychologists and physiotherapists—were not.

The $340 mentioned in the article had nothing to do with access to a doctor. The charge referred to laboratory tests conducted at our clinic. The journalist was at liberty to have her tests performed free of charge at any hospital or public community clinic (CLSC), which our receptionists always told our patients. However, the journalist chose consciously and willingly to have her tests performed at Physimed. She had to know that there would be fees.

After Gilles finished reading me the article, he told me that it was already having a negative impact. Paul Arcand, whose morning show on 98.5 FM is the most popular in Montreal, had mentioned it on the radio. While I was trying to wrap my head around these woes, Gilles interrupted.

I’m sorry, he said. Journalists and cameramen have invaded our clinic. I have to go. He hung up.

I stood there for several minutes in total silence, staring at the phone.

Here I was 200 kilometers away from the action. I was overwhelmed with a growing sense of helplessness and was starting to panic. Finally, Gilles called back.

He told me that he got the journalists and cameramen out of the clinic. But they’d just moved outside of the building and had managed to interview a few of our patients.

Gilles, I said. Do you want me to come back to Montreal now?

No, he said. He sounded tired. It’s Friday. There’s nothing you can do.

•••

When my wife arrived later on, we couldn’t bring ourselves to go to the dinner party. At 8:30 my friends called and asked where we were at. I forced myself to sound cheerful and told them that we were just about to leave to join them. But by the time we arrived at the party an hour later, there was no one left. We turned around and went back home.

What was supposed to be a weekend of fun with friends turned out to be two long days of uneasiness, anxiety, and stress. Two days that I spent with my head spinning. I reread the article again and again. Why did the journalist write this story? What were her motives? Who was trying to hurt us and why?

•••

Back at the clinic on Monday morning, the first thing that I did was find out more about this journalist. She had presented herself to the clinic as a patient and after she met with one of the clinic’s doctors, he’d prescribed laboratory tests that cost $340 if they were conducted here.

She had paid for the tests without complaining, which meant that this was worse than I thought.

She’d known that the amount she paid covered only laboratory expenses and did not in any way represent the cost of seeing a family doctor, as she claimed in her article. She had also mentioned in the article that in 2007 the RAMQ had investigated another clinic in our area that was charging patients for in-house laboratory tests and concluded that the practice was perfectly legal. She knew that she had been paying for laboratory services because she’d gotten a detailed bill that explained what she paid for; she knew that it was perfectly legal for us to bill for them; and yet she accused us of overcharging our patients. I was completely stunned.

Those around me were not as worried. They thought that the article was so misinformed and full of lies that it was not worth making a fuss about. They believed that the truth would come out and then it would all blow over.

Regardless, we still had to manage the situation in the short term. Since we’d done nothing wrong, I chose a strategy of open communication and transparency. After I researched the journalist, I wrote letters to the Minister of Health, the Secretary General of the College of Physicians, the President of the Health and Social Services Agency, and the President of FMOQ to denounce the false accusations and provide the correct facts.

I also wrote to the editor-in-chief of La Presse, André Pratte, asking him to publish the letter that I’d sent the Minister of Health in his Opinion section. However, he never acknowledged that he received my letter and, of course, my letter never appeared in print.

I called the President of the FMOQ, Dr. Louis Godin, to express my astonishment that he’d allowed himself to be quoted in Mrs. Nicoud’s article. Why would he give credibility to the nonsense that she’d written?

He apologized. He said that he didn’t know that it was our clinic that she’d been writing about. He knew about the clinic’s sterling reputation. He’d been trapped by the journalist, he said.

Albert, she asked what I thought about a network clinic that charged $340 to see a family doctor. I had no choice but to tell her that it didn’t make any sense. She never told me that she’d paid for laboratory tests. Otherwise, I would have had a completely different response.

After I got off the phone with Dr. Godin, I returned to the journalist’s administrative records to follow up on another hunch. Just as I suspected, the journalist didn’t live anywhere near the clinic. She lived on the east end of the city and worked in downtown Montreal. Physimed is located on the west end of the island. Usually, patients who visit our clinic live or work nearby. Why did the journalist take such a detour when there were plenty of medical clinics closer to where she lived and worked?

Something didn’t seem right.

Even though my colleagues thought that the media storm would soon settle down, I was not convinced. Who had sent this journalist to Physimed? Who wanted to hurt us by spreading lies about us on the front page of the newspaper? Something told me that the article was just the beginning. Whatever was happening, it would not stop there.

Since my earliest years, I have always followed my instincts, and my instincts have rarely failed me.

In this case, my instincts proved to be right.


¹ The Régie de l’Assurance Maladie du Québec, or RAMQ.

CHAPTER 2

A LOGICAL VOCATION

For as long as I can remember, I’ve always wanted to be a doctor. I was never like other students who floundered or second-guessed or had difficulty choosing a career. For me, my path had been set well before I’d reached adolescence. I have never really tried to explain the origin of this early sense of vocation, but no doubt it stems from the fact that I’ve always enjoyed helping people and have always been interested in science and biology. I also believe that I can trace my desire to become a doctor back to a brief time in my life when I was seized by an intense bout of spirituality and religious belief. Though the religious calling did not last, it had a profound effect.

I was born in Casablanca, in the eastern part of Morocco, into a Jewish family. Though my parents insisted that my brothers and me attend French missionary schools, they were not particularly religious. They did not force religion on my brothers or me. We only practiced the most basic rituals of Judaism at home.

However, when I was 11 I had a kind of revelation that pushed me to attend synagogue for the next four years. During that time I followed all of the Jewish traditions,

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