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A leading Canadian expert in bariatric surgery pleaded no contest yesterday to accusations that he sexually abused female patients over nearly a decade, leading a disciplinary committee of the College of Physicians and Surgeons to revoke his medical licence effective immediately.

Jacobo Joffe, a Toronto surgeon who provided weight-loss operations to obese patients, engaged in concurrent and continuing sexual relationships with four patients, including a pair of twin sisters, taking "advantage of the patients' vulnerable position," according to Carolyn Silver, a lawyer representing the CPSO.

"I went to him to help me make my life better, to help me transform, and he destroyed my trust," said one of the patients, who attended the proceedings and can be identified only as Patient D.

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In a personal-impact statement read to the hearing by Ms. Silver, Patient D wrote that she went to Dr. Joffe at a time of "personal desperation" and "when my life began to get better he took advantage of my feelings of thankfulness toward him."

Dr. Joffe performed gastroplasty on Patient D in 1999, the hearing was told, and during follow-up visits engaged her in sexual intercourse and oral sex, sometimes at Scarborough Hospital, where Dr. Joffe had hospital privileges.

During a hearing recess, tears pooling along her dark lashes, Patient D said, "I thought I was the only one." Both she and Dr. Joffe were married when the abuse began, she said, and by the time it ended in 2006, so had her marriage.

The committee also heard that Dr. Joffe, 59, engaged the twin sisters, identified as Patients A and B, by complimenting them and telling them it was every man's dream to have sex with twins. Ms. Silver read uncontested allegations that he used illicit drugs with both patients and "engaged in various sexual acts with them, both separately and together," sometimes at his office.

Candidates for bariatric surgery, who generally have a body mass index over 40, are especially vulnerable to compliments from an authority figure such as a doctor, said David Macklin, director of Weightcare weight management clinics.

Obese patients often struggle with "false and negative thoughts," and a physician's role is to provide an antidote to those thoughts, he said. "Someone who is a trusted individual by the nature of their profession that would cross the line into such an activity is nothing less than a trauma."

In their impact statements, all of the patients wrote that they were seeking counselling to help cope with anxiety and depression resulting from their abuse.

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Dr. Joffe, despite arguments from his lawyer, David Porter, was ordered by the committee to pay $10,000 to each of the four victims toward their therapy and counselling.

Dr. Joffe did not attend his disciplinary hearing and Mr. Porter declined comment.

A woman who answered the phone at his North York home asked for privacy.

"It's a difficult situation," she said.

On a forum called obesityhelp.com, patients of Dr. Joffe posted reviews that were generally positive about his professionalism. They indicated that he was still performing surgery in recent months.

The CPSO placed a restriction on his licence in May of last year prohibiting him from engaging in professional encounters with females without the presence of a monitor.

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