When he put his lips on a patient’s breast, Dr. Sastri Maharajh did something that would have been treated as sexual assault if it had occurred outside his examination room.

But because the zero-tolerance policy used by the province’s medical watchdog doesn’t include the word “breast,” Maharajh was allowed to continue practising after an eight-month suspension of his licence.

Now the Mississauga family doctor can see patients, with a single caveat: they cannot be women.

The situation highlights a difficult ethical question for health-care experts across the country: when a doctor commits an offence so egregious that he is restricted from ever seeing female patients, should he be allowed to continue to see male ones?

A Star investigation found 21 doctors in the province currently have gender-specific restrictions on their practices. Of those, 20 were male doctors not permitted to see female patients without restrictions. One was a male doctor who had restrictions against seeing male patients.

“The single most important asset which a physician has is trust,” said Arthur Schafer, director of the University of Manitoba’s Centre for Professional and Applied Ethics. “Anything that a physician does that violates that bond of trust is potentially devastating for the practice of medicine.”

By restricting doctors from seeing female patients, the penalties focus narrowly on preventing the offence from reoccurring, without addressing wider issues of judgment and trustworthiness, said Paul Harte, a lawyer who represents patients in medical malpractice suits.

“I do not see how such a physician having breached the fundamental trust of patients on more than one occasion … can continue to practice,” Harte said.

Exposing your body and its most intimate secrets to your doctor is necessary in order to receive proper medical care, medical ethics experts say. If a man sees a poster stating that his doctor is not allowed to examine women, that confidence is shattered.

“The most important issue is patient safety,” Schafer said. “If a physician isn’t trustworthy enough to do an exam of a patient of a certain sex … are they trustworthy enough to be practising medicine at all? At least sometimes, the answer should be no.”

The College of Physicians and Surgeons of Ontario has a zero-tolerance policy for sexual abuse that applies to intercourse with patients, masturbation and certain types of sexual touching. By law, doctors found to have committed one of these acts must have their licences revoked. But because the policy doesn’t specifically mention breasts, Maharajh has kept his license, his practice and his male patients.

When determining the penalty for a doctor found guilty of sexual misconduct, the college considers many questions, said spokesperson Kathryn Clarke.

“Does the proposed penalty protect the public? Will it serve as a specific deterrent to the doctor, and a general deterrent to the profession? Is the proposed penalty a denunciation of the doctor’s conduct, and does it maintain the integrity of the profession?” Clarke wrote in an email.

Marilou McPhedran, a lawyer who chaired two provincial task forces on sexual abuse of patients, previously told the Star she doesn’t think the college has adequately explained its rationale for gender-based restrictions.

The issue was brought up at Queen’s Park this week, with opposition members accusing the Liberal government of turning a blind eye to sexual assault.

“Today we learned doctors can sexually assault women and return to practice,” said New Democrat MPP Peggy Sattler (London West).

“It’s one of those things that people would rather have a zero-tolerance approach to,” NDP Leader Andrea Horwath told reporters.

Health Minister Eric Hoskins has launched a review of the decades-old legislation governing the College of Physicians and Surgeons. Asked if cases like the one Sattler mentioned trouble him, Hoskins, himself a physician, replied: “They do.”

“I want to make sure the mechanism in place is as strong as it can be and needs to be,” he said.

Jeff Blackmer, an associate professor at the University of Ottawa and director of ethics at the Canadian Medical Association, says the implementation of gender-specific restrictions “is a really valid societal question.”

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“The college has to strike a balance between the protection of the public and the reintegration of physicians into practice,” Blackmer said. “I think, by and large, we do a pretty good job.”

“It’s a never-ending discussion within the profession on where to set those parameters. None of these systems are perfect.”