B.C. Supreme Court judge worried by surgeon’s past professional problems

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A B.C. Supreme Court judge says the case of a surgeon who was allowed to practise in the province after complaints forced him to surrender his licence in Arizona raises troubling questions about the regulatory body overseeing the profession.

But the College of Physicians and Surgeons of British Columbia insists that some of the concerns date back 15 years and changes in 2009 mean the problems identified by the judge aren't applicable today.

Justice Elaine Adair said she was worried that a doctor was able to lie repeatedly about his past professional problems when applying for a licence from the college, according to a ruling this week in a defamation lawsuit involving the CBC and Dr. Fernando Casses.

Dr. Casses made headlines in 2009 when he faced new complaints from patients in Quesnel, B.C., after giving up his licence to practise in Arizona eight years earlier. In early 2001, he had signed a voluntary agreement with the state medical board that found "he fell below the standard of care which might have been harmful to the health of a patient."

In late 2000, before the Arizona board met, Dr. Casses applied for and received a temporary licence from the college to practise medicine in British Columbia so that he could start a short-term contract at a Port Alberni hospital.

In the CBC defamation case, Dr. Casses testified he learned of a review of one of his surgeries at a Phoenix-area hospital just two days after being interviewed by the registrar of the B.C. college for the temporary licence. He testified he didn't inform the college of the ongoing review right away because "he had no obligation to do so," the ruling stated.

After the Arizona medical board's decision to suspend his licence was posted to its website, the college accepted the doctor's contention that his problems in Arizona represented a "preliminary review," according to the judgment.

"Dr. Casses's conduct in relation to the B.C. application was consistent with that of someone with something to hide, and intent on hiding it," Justice Adair wrote.

"In my opinion, the circumstances in which Dr. Casses applied for and became licensed by the college raise very troubling questions."

From 2002 to 2009, in his annual questionnaire from the college, Dr. Casses answered no when asked whether he had previously faced disciplinary action from another licensing authority.

He later told Justice Adair that he answered no because he thought the college already knew about his problems in Arizona.

"Although Dr. Casses provided an excuse, he continues to give false answers on the college's annual questionnaires, implying that this is acceptable to the college," she wrote.

"In my opinion, this also raises troubling questions about the college's oversight."

During that period, Dr. Casses gained a full licence and began practising in Quesnel. By 2009, six patients from northern British Columbia had complained to the college about his care and three civil lawsuits were filed.

Dr. Casses, who is listed by the college as an active member in good standing, was unreachable Wednesday at the number listed on the college's website.

After the CBC stories went to air, his referrals dried up in Quesnel and he moved to the Lower Mainland, according to the ruling.

For the past two years, he has been working as a surgical assistant in Surrey, the decision stated.

When reached by The Globe and Mail after the complaints first surfaced, Dr. Casses issued a statement saying he had no outstanding complaints and that he told the college about the surrender in Arizona. He also denied allegations by patients that he didn't sufficiently inform them about the risks of surgery, while noting that his surgical complication rate was "well below the average for a general surgeon."

College spokeswoman Susan Prins said in an e-mailed statement on Wednesday that the judge's criticisms "have no impact on our current practices."

She wrote that when a new doctor applies for a licence in British Columbia, they are required to obtain certificates from all other jurisdictions in which they have practised that disclose their registration status and whether they have faced any investigations, disciplinary actions or restrictions.

"The college transitioned to a new governing statute in 2009," Ms. Prins wrote. "The judge made some comments about the college's processes dating back almost 15 years ago. We are confident that the college's current legislation, bylaws and processes are effectively providing oversight and governing the profession."

Justice Adair dismissed Dr. Casses's lawsuit, and ruled that the CBC and reporter Kathy Tomlinson, who now works for The Globe, acted "responsibly in developing and publishing" a web story and several news reports in 2009.

"The defamatory stings are no worse than the facts that have been proved at trial, and a more complete reporting of the facts would have been more damaging for Dr. Casses," she stated.