Sixty-four medical regulators in Canada and the U.S. oversee nearly one million medical doctors. Their common mission is to protect the public. They each have their own policies, laws and languages that shape how this is done.

Some regulators say they have a full picture of the disciplinary, criminal and malpractice histories of these mobile doctors — everything they need to protect patients.

“The process is as seamless as it can be,” said Dan Faulkner, interim registrar of the College of Physicians and Surgeons of Ontario (CPSO).

But how much of that information is made public is another matter.

Dan Faulkner, interim registrar for the College of Physicians and Surgeons of Ontario, said a national registry is “a great policy idea,” but is not a priority. Anne-Marie Jackson/Toronto Star

“As a member of the public, I’d love to press a button and get all of this information available to me. But we have laws that are different in every province and jurisdiction,” Faulkner said. “We’ve made some very careful decisions about how we’re going to provide credible and relevant high-quality information to the public.”

A Toronto Star investigation reveals that Canadian medical watchdogs keep secret the vast majority of cross-border doctors’ disciplinary histories.

In January 2003, a Whatcom County prosecutor decided there was “insufficient evidence” to criminally charge McCallum with rape, court staff told the Star.

According to the Washington medical commission’s disciplinary records, McCallum was working on both sides of the U.S.-Canada border from 2001 until 2003, while he was under investigation by Bellingham police for rape.

The Star reached McCallum, 69, in Saskatoon, where he now lives. In an emailed statement, he said the medical commission’s hearing was “blatantly unfair, prejudicial, capricious and without due process.”

“That object was the Respondent’s penis,” the medical commission’s 2006 decision said. The commission revoked his medical licence.

The patient told the medical commission that McCallum asked her to remove her clothes, put on a gown, press the front of her shoulders against the exam table and brace herself. The patient’s belly hung over the side. She said that she felt McCallum’s legs touch the back of her thighs and shake as he placed an object into her vagina.

A chaperone was not present when the patient came back, the decision said.

Later that evening, he called her at home and asked her to return to the clinic “immediately” to have bacteria “scraped” out of her vagina, according to a 41-page disciplinary decision by the state health department’s Medical Quality Assurance Commission. He told her “the baby would be hurt” if she waited.

This is a 2001 image of Dr. Gary McCallum submitted as an exhibit at a disciplinary hearing of the Washington state health board.

McCallum, a Saskatchewan-trained general practitioner, had performed a pelvic exam on the patient earlier that day with a chaperone present, as per policy at the clinic, located 30 minutes south of the Peace Arch border with British Columbia.

In July 2001, a 7-months pregnant woman told staff at St. Joseph hospital in Bellingham, Wash., that Dr. Gary McCallum had sexually assaulted her in his office. A nurse administered a rape kit, and collected semen, according to the state medical commission’s records, which redacted the victim’s name.

“For every problem doctor who has come to the attention of regulators, there are probably a dozen who are causing similar levels of harm to patients who have not.”

The “few doctors who have significant disciplinary outcomes” provide the sharpest lens to see the cracks in the medical regulatory system that allow some physicians to leave their disciplinary histories behind as they travel from one jurisdiction to another, Bismark said.

The cases the Star has analyzed are only “the tip of the iceberg,” she said.

Dr. Marie Bismark, a physician and lawyer at the University of Melbourne, who is a leading researcher in the study of doctor discipline, called the Star’s database “unprecedented.”

He faked his death in New York. Now he’s practising in St. Catharines.

The Star has reached out to all of the doctors we identified to give them an opportunity to respond. We’ll share more of their stories here, and in the days and months ahead. Among them: a pediatrician working in St. Catharines, Ont., who surrendered his New York licence after the state medical board discovered he faked his own suicide by forging a death certificate; a licensed doctor working as a surgical assistant in Regina who lost his California licence after he was declared clinically brain damaged; and a family doctor in Markham who was jailed and stripped of his U.S. medical licences after being convicted of selling opioids to an undercover agent in Hawaii.

The Star analyzed 490 discipline decisions by medical boards and colleges across North America for 159 doctors who've held licences in the U.S and Canada. Doctors may have been disciplined for more than one offence.

The range of offences captured in the Star’s database includes: incompetence, improper prescribing, sexual misconduct, substance abuse and fraud. Nearly all of the disciplined doctors we identified are male and more than half are Canadian-educated. In 45 cases, these are doctors — including Konasiewicz and Lemire — who have been disciplined in the U.S. and who currently hold an active Canadian licence. Thirty-four of 159 doctors we examined had criminal records: 13 of them were convicted in the United States and later kept or were granted a Canadian medical licence.

The Star’s analyses of these records show that almost half of the 159 doctors who were found guilty of professional misconduct in one place went on to commit a second violation that resulted in discipline. We found that 90 per cent of these doctors’ public profiles in Canada failed to report the breadth of sanctions taken against them.

The Star spent 18 months reviewing thousands of pages of doctors’ public disciplinary records to verify those who have been licensed to work on both sides of the Canada-U.S. border. We used these records, as well as interviews with physicians and regulators, to create the first comprehensive database that follows disciplined doctors — 159 of them — throughout their careers across state, provincial and country lines.

In July 2003, McCallum signed a settlement agreement with the victim in which he promised to pay her $60,000 on the condition she make no further claim against him. The agreement states there is no admission of fault, liability or legal responsibility on McCallum’s part. McCallum closed his Washington practice in 2005, the year the state’s health department brought its full charges against him, and returned to practise in British Columbia. Washington’s final order against McCallum followed a 10-day hearing after which he was found guilty of an extensive range of charges. These charges dealt with: improper prescribing; taking inappropriate Polaroid photos of a prepubescent female patient’s genitals after falsely telling her parents the images were for a clinical study; administering an expired, non-FDA approved flu vaccine he had stolen from a medical clinic in Surrey, B.C., to about 70 of his American patients; aiding and abetting unlicensed practice; and the sexual assault of the pregnant woman, referred to as “Patient One.” The decision, at a hearing presided over by a health law judge, noted the department provided “clear and convincing evidence” on the charges outlined above. It also noted that a specific felony provision in state law fit the “exact circumstances” of the sex assault in McCallum’s office, describing when “the perpetrator is a health care provider and the sexual intercourse occurs during an exam without the consent of the patient.” “The evidence from both the Whatcom County Medical Examiner and the DNA crime lab is critically important and entirely supports Patient One’s assertion that the Respondent had sexual intercourse with her,” the decision read. “The Respondent raped Patient One.” McCallum said in his email to the Star that he provided evidence from witnesses who testified that “not only was it impossible for the sexual assault to happen, but it did not happen.” He also denied taking Polaroid photos of the child. The 2006 decision called McCallum “serially dishonest,” and stated that he had “co-opted” a friend he had hired as a part-time nurse to support his story that the victim had taken a vial of his sperm from the clinic’s lab, which he was going to analyze for fertility issues. McCallum filed a petition for a judicial review of the Washington commission’s findings of fact, conclusions and final order, but a Whatcom County Superior Court judge denied his application in 2012. McCallum told the Star “any reasonable person” who reads the legal brief he submitted to the court “will understand why I was shocked at the lack at the hearing of what I would consider basic notions of fundamental fairness in terms of the admission and/or suppression of evidence.” The judge who rejected McCallum’s petition for review ruled there was “substantial evidence in the record” — including 6,843 pages of materials submitted by the health department in one document alone — to uphold the medical commission’s findings of fact, conclusions of law and final order, according to a copy of the decision obtained by the Star. McCallum abandoned a subsequent appeal.

Who they are The Star compiled and analyzed basic information from the profiles of 159 disciplined doctors who have held licences in Canada and the U.S. 57% obtained their medical degree from a Canadian university. 84% graduated medical school before 1990. 94% are men.

The B.C. College of Physicians and Surgeons did not publicly discipline McCallum. The Washington sanction never appeared on his public profile on the B.C. college’s website. After Washington revoked McCallum’s licence in 2006, a B.C. college spokesperson told the Star that the college had “entered into an agreement with Dr. McCallum whereby he was required to refrain from practising medicine in B.C.” The college allowed McCallum to keep his Canadian licence for seven more years, until he resigned in 2013. The Star could not verify whether McCallum practised in B.C., or elsewhere, during this period. The B.C. college denied our request to view a copy of its agreement with McCallum. This record, the spokesperson said, cannot be shared without McCallum’s “express consent.” The Star’s investigation To build the Star’s database, reporters collected physician rosters and discipline information from medical regulators in all 50 U.S. states, Washington, D.C., and 13 Canadian provinces and territories. We looked for every discipline record on one side of the border that matched the name of a doctor who held a licence on the other. The process took more than a year.

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Using publicly available information — birthdates, medical school graduation details and other records — we were able to verify the identities of 159 cross-border doctors with disciplinary records. In creating this database, we logged every disciplinary decision issued by regulators. We noted the start and end dates of every licence we found for each physician. Then we looked for patterns. The Star found: Canadian medical regulators keep more information secret from you than their U.S. counterparts. Since the 1990s, medical regulators across North America have been using the internet to build public trust by posting brief summaries of information about the physicians on their registries. These “profiles” allow members of the public to confirm their doctors hold valid medical licences and view any red flags related to discipline. In Canada, 90 per cent of physician profiles we analyzed were missing some disciplinary history that was made public in another jurisdiction; 73 per cent of the profiles showed no disciplinary history whatsoever, even though records exist in every case. In the U.S., 40 per cent of these doctors’ profiles had no information about their misconduct. More than 75 per cent of the discipline rulings that appear in the Star’s database — including the sanctions against McCallum, Konasiewicz and Lemire — were issued from the year 2000 onward. The Ontario college’s physician profiles are the only ones we found in Canada that include information about discipline imposed in other jurisdictions — but only on decisions imposed after Sept. 1, 2015. It takes years for Canadian regulators to respond to U.S. discipline. In the United States, when a doctor is found guilty of professional misconduct, an umbrella agency called the Federation of State Medical Boards (FSMB) adds this decision to its central repository — a “one-stop shop” for licensure and disciplinary information. Regulators around the world can access this information and submit disciplinary decisions from their jurisdictions. However, for physicians who hold licences in both the U.S. and Canada, our data shows Canadian regulators took an average of three years to impose discipline after a U.S. medical board verdict. U.S. boards acted on discipline imposed by Canadian regulators roughly two years after the fact. The FSMB also offers a “disciplinary alert service.” Only three Canadian regulators have signed up: Ontario and Alberta joined this program in 2015, B.C. signed up a year later. The honour system often doesn’t work. Regulators rely on doctors to be honest on licence applications. Although there are other ways for boards and colleges to find out about a doctor’s discipline history — such as through the FSMB or from another regulator — truthfulness is a cornerstone of the system. Yet more than a quarter of the doctors in our database were later found by regulators to have lied or “failed to disclose” their discipline history. Your doctor may have a criminal record Criminal convictions that prompt U.S. medical boards to revoke a doctor’s licence may not prompt equivalent punishment in Canada, the Star found. The Medical Board of California revoked Dr. Jacques Lemire’s licence in 2006 after he pleaded guilty to possessing child pornography. A judge at Lemire’s 2007 sentencing hearing accepted a psychiatric evaluation showing the children’s kidney specialist was not a pedophile. “There’s just no explanation for it,” U.S. federal prosecutor Anne Perry told the court. “These are not pictures of naked babies lying on blankets … These are damaging pictures that represent abuse to children. And here is a fine man, a fine doctor, somebody who’s done nothing wrong in his life, but he’s got a lot of these images on his computer.” A year after the U.S. government deported Lemire to Canada, Quebec’s physicians’ college granted him a licence. From 2010 to 2014, Lemire was permitted to practise only in Quebec “institutions,” and he spent three years at an old-age home for retired nuns. He was not explicitly restricted from treating children, and the institutions category includes child and youth protection centres. In 2014, the college limited Lemire’s licence to “administrative tasks without clinical duties,” meaning he is not to see patients. His public profile on the college’s website reflects this restriction, but provides no explanation for this decision. Lemire, who obtained his medical degree at University of Sherbrooke in 1977, told the Star he paid his debt to society and has worked hard to rehabilitate. Lemire worries if his record is exposed in Canada, “especially at my age, the opportunities won’t be there. “The fact that I’m doing administrative, I’m not working with patients. I think it shouldn’t be disclosed,” he said. “I’m not even close to any patient.” The Quebec college did not answer the Star’s question about why it didn’t explicitly bar Lemire from treating children. The Star found no evidence he practised pediatric medicine following his conviction. Lemire told the Star he disclosed his conviction to the Quebec college before it granted his licence.

More about: Dr. Jacques Lemire He treated children for 23 years. Then he was convicted on possession of child porn.

In Ontario, the physicians’ college refused to discuss the case of Dr. Clement Ka-Chun Yeung — another convicted felon. Yeung, a family practitioner in Markham, served nearly a year in a Hawaii prison after pleading guilty in 2007 to two counts of prescribing controlled substances “outside the course of professional medical practice and not for a legitimate purpose.” In both instances, he sold Oxycodone to an undercover agent with the U.S. Drug Enforcement Administration. He lost his licences in Hawaii and California due to his convictions. Dr. Clement Ka-Chun Yeung, a family practitioner in Markham, Ont., was convicted of a felony in the U.S. in 2007 but was allowed to keep an unrestricted licence in Ontario until 2012. Anne-Marie Jackson/Toronto Star Unlike the other doctors in this story, Yeung’s U.S. discipline and criminal history is noted on his physician profile in Canada because it led to public discipline in Ontario. A decision posted to his Ontario profile states the college knew of his convictions in 2008 but allowed him to keep an unrestricted licence in the province until 2012. Yeung moved to Hong Kong in 2009 and “elected not to practice medicine in Ontario” until the college dealt with the case, according to the decision. In January 2012, the college suspended his licence for six months and ordered him to log all narcotics prescriptions as a result of his felony conviction. It is unclear when Yeung returned from Hong Kong. In January 2017, the college imposed a new condition that Yeung practise under a clinical supervisor for at least a year, his profile states. The college refused to tell the Star why these conditions were imposed. Yeung did not respond to multiple requests for comment. His clinic is in a strip mall on Kennedy Rd. He works six days a week, and offers services in Cantonese and Mandarin. On a recent morning, he refused to discuss his past with a reporter who approached him in the parking lot of his clinic. “I can’t talk to you,” he said, before driving away. One per cent of doctors The vast majority of doctors practising in North America live up to the high standards of their profession. The Canadian Medical Protective Association, which provides vigorous legal defence to doctors charged with medical negligence or regulatory misconduct, estimates that more than 75 per cent of complaints made to physician colleges are dismissed outright or dismissed with some concern. But the small minority of doctors who do have red flags on their public records can cause serious damage. A 2016 study in the New England Journal of Medicine found that just 1 per cent of doctors practising in the U.S. account for a third of all paid malpractice claims in the country. More than half of 66,426 claims paid in a recent 10-year period related to significant physical injury. Nearly 20,000 of those claims related to patient deaths. “Doctors are human,” Dr. Marie Bismark, the University of Melbourne researcher, said. “Things go wrong and there are errors in diagnosis that don’t mean someone is incompetent or unethical.” Bismark said her work tries to distinguish doctors who make human mistakes from those “who have serious or recurring lapses in professionalism and competence.” “I don’t think regulators are really good at distinguishing between those different groups of practitioners.”

How far back does our data go? 18 Number of records from the 1970s and 1980s. 96 Number of records from the 1990s. 195 Number of records from the 2000s. 178 Number of records from 2010-2017.