Ontario’s medical watchdog has been too easy on a doctor who ran a clinic where patients developed serious bacterial infections, a medical malpractice lawyer argues.

Dr. Peter Rothbart “needs to be held to account,” lawyer Paul Harte told a three-member panel of the Health Professions Appeal and Review Board on Tuesday.

Rothbart, an anesthesiologist, is the founder and former medical director of the Rothbart Centre for Pain Care, where about 20 patients developed serious, even disabling bacterial infections in 2012 because of poor infection control practices, said Harte.

One of those patients is Anne Levac, 69, of Fenelon Falls, whose story was detailed in a 2014 Star investigation of infection outbreaks at clinics. She developed a life-threatening infection in her spine after receiving an epidural steroid injection for back pain.

Eleven days after her appointment, she says she was rushed to an ER in excruciating pain. She was diagnosed with sepsis and spent 10 weeks in hospital after undergoing emergency surgery to treat an abscess in her spine.

She suffered permanent nerve damage and is now bladder and bowel incontinent, and requires a cane or scooter to get around.

Levac filed a complaint about Rothbart to the College of Physicians and Surgeons of Ontario, the medical profession’s regulator, two years ago, alleging the doctor was negligent in carrying out his responsibility to protect the public.

In response, the college last year decided Rothbart should be “orally cautioned.” This is a sanction that requires a doctor to attend a meeting at the college to receive advice or education.

Levac appealed the decision to the Health Professions Appeal and Review Board, arguing it was “unreasonable.”

Rothbart did not attend Tuesday’s appeal hearing, nor did he have a lawyer acting for him.

He did not return phone calls and emails from the Star. Rothbart previously said he was unaware there was an infection control problem at the clinic, and that he believed it was unavoidable. He noted the clinic passed an earlier inspection by the college, and said he believed the infection-control deficiencies identified at his clinic would be found in any community or hospital-based pain clinic.

“It is my opinion that this was a black swan event, a very rare event that nobody believed could happen,” he said previously.

Representing Levac, Harte told the board that Rothbart should be required to face a disciplinary hearing at the college, which could result in his medical licence being revoked.

Harte questioned why Rothbart still has a licence given that in 2003, the regulator considered him a serious enough threat to the public that it stripped him of most of his medical authority.

Restrictions placed on his practice prohibited him from working directly with patients. Specifically, he was told he could no longer assess, diagnose, treat, advise or prescribe to anyone.

While there is no explanation on the college’s public register for the practice restrictions, known as an “undertaking,” Rothbart told the Star in an earlier interview that he was sanctioned over concerns the college had about the way he prescribed opioids.

Harte called the undertaking “bizarre” and unlike any he has ever seen before. He said it’s apparent Rothbart “cut a deal” with the college that allowed him to hold onto his licence, a requirement for him to continue serving as medical director of the clinic.

“The reason it came about was because he was a medical director, making a ton of money running this huge pain management clinic. So he gave up his practice of medicine so he could continue to control his clinic,” Harte charged.

Had the college been tougher in dealing with Rothbart on the opioid issue back then, there’s a good chance there would have been no infection outbreak, Harte suggested.

“The risk of allowing such an individual to retain his licence becomes clear in a case like this. Arguably, he should have been referred to discipline in the first case, but certainly he should be referred to discipline in this case,” Harte said.

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Harte went on to suggest that the anesthesiologist had violated the practice restrictions on his licence by handing out to clinic patients an information sheet with medical advice, signed by “Peter Rothbart, MD.” It advised patients what to do, for example, if they experienced night chills or elevated blood sugars after receiving pain injections.

In a telephone interview from her home, Levac said her life has never been the same since she developed the infection. She now wears a catheter and a colostomy bag and rarely ventures out of her home.

Her energy is low, she said. Even though she wears a fentanyl patch, she said she has more pain now than when she first went to Rothbart’s clinic for pain relief.

Last year she was hospitalized for seven weeks for a bowel blockage and kidney failure. And two years before that, she was hospitalized with a bowel blockage.

“Basically, I am just sitting here, existing,” she said.

“He’s ruined all our lives,” she said, noting her children are constantly worried about her and she and her husband no longer trust doctors.

She’s still upset that no one from the clinic ever phoned her to explain what had happened. She said she only learned that there was an infection outbreak and that others had also been affected when she sent a freedom-of-information request to Toronto Public Health, asking for her medical files.

Rothbart was not the doctor who gave Levac an epidural steroid injection. That was anesthesiologist Dr. Stephen James, who last year had his licence suspended for 10 months. He was unknowingly colonized with Staphylococcus aureus bacteria when patients became infected.

But as medical director, Rothbart was responsible for ensuring appropriate infection control procedures were in place and followed, according to the college’s decision to caution him.

An investigation by Toronto Public Health found that Levac and other patients contracted infections because of “many dozens of deficiencies in basic infection prevention and control practices,” Harte said.

He went on to tell the board that he has heard Rothbart has stepped down from the clinic and may have plans to retire. The lawyer said the college should still deliver a tougher sanction to the doctor, to send a message to other doctors and ensure confidence in the health system.

The Health Professions Appeal and Review Board reserved its decision in the case.