What should the panel in the discipline case of Dr. Suganthan Kayilasanathan rely on more in coming to their decision: the documents filed as exhibits, or the testimony of the reluctant main witness?

That question will now form part of the deliberations for the five-member panel, which heard closing submissions Thursday in the case of the Toronto doctor who is accused of sexual abuse and of disgraceful, dishonourable and unprofessional misconduct. He denies the allegations.

The panel must decide whether the College of Physicians and Surgeons of Ontario has proven its case, namely that Kayilasanathan and the woman and main witness, known only as Patient A due to a publication ban, were engaged in a doctor-patient relationship when the two had sex in December 2010. Under Ontario law, it’s mandatory that doctors who have sex with a patient lose their licence.

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“We are all familiar with the expression ‘The documents don’t lie,’” said college lawyer Carolyn Silver in her closing submissions. “In this case, I submit that the college has proved its case through the physician’s own documents.”

As the basis of her argument that Kayilasanathan and Patient A were indeed in a doctor-patient relationship, Silver pointed out that the exhibits include “detailed” medical charts written by Kayilasanathan from two dates in December 2010 when the woman saw the physician for the purposes of getting doctor’s notes to avoid taking exams, along with the physician’s OHIP billings for those two visits.

A receipt from a Mississauga hotel was also entered as an exhibit at the discipline hearing, showing a room charged to Kayilasanathan’s credit card for one night during the week between those two visits to the doctor’s clinic — the same night the college argues the doctor and Patient A had sex.

“This is a very simple a case, a straightforward case,” Silver said, echoing what she had said in her opening statement when the discipline hearing began last November.

The case proved to be complex, however. Patient A did not show up to testify in November, and hired a lawyer in an effort to quash the summons compelling her to testify. The medical regulator countered that if she refused to attend, it would enforce the summons and have her arrested and brought to the college to testify.

(The woman never complained about Kayilasanathan to the college; the regulator found out after the woman told another doctor that she and Kayilasanathan had had sex. The other doctor was required by law to report it to the college.)

Patient A did eventually testify, last month, after her bid to quash the summons was dismissed by the discipline panel.

She testified that she and Kayilasanathan had been partying with a friend on a weekend in December 2010, and that Kayilasanathan had offered to write her a doctor’s note so she could get out of her exam the following Monday. She testified he wrote her a second note a week later to get out of yet another exam.

“I essentially used him to get a note,” she testified.

She also testified that the two had sex, but as defence lawyer Andrew Parley highlighted Thursday, she was unclear about the “sequence of events,” namely what came first, the doctor’s visit or the sexual encounter.

Contrary to Silver on the college side, Parley urged the panel to rely primarily on the testimony of the main witness, Patient A, to show that the woman and Kayilasanathan were not in fact engaged in a doctor-patient relationship.

“The important point is (Patient A) could not remember,” he said. “She remembered going to the clinic, remembered having sex, but couldn’t remember how they all fit together.”

Patient A did testify that she had sex with Kayilasanathan on the night in December 2010 put forward by the college, but Parley argued it was after she was shown a calendar by the college. Parley also argued that although Patient A went to the clinic to get a doctor’s note, no medical care was actually provided.

Patient A had actually testified that although the doctor made notes in the chart about her having a cough and chills and should continue taking medication, none of that was actually discussed during the visit. She emphasized the visit was solely for the purpose of getting the note to get out of her exam.

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“Our position is that does not rise to the level of a physician-patient relationship,” he said.

And going back to Patient A’s testimony that she had “used” Kayilasanathan to get a note, Parley said: “If anyone is abusing the relationship here, it is Patient A, asking her friend to do her a favour, putting her friend in jeopardy.”

The panel will render its decision at a later date.