A Mississauga doctor disciplined by the province’s medical regulatory body for sexually abusing as many as 13 women is back in practice with conditions forbidding him from treating female patients.

“Important notice: Dr. Maharajh may treat male patients only,” reads a sign posted at the front desk inside Mississauga’s MD Walk-in clinic, where Dr. Sastri Maharajh has been working since late 2012.

Maharajh, 53, admitted to either placing his mouth on or resting his cheek on the breasts of up to 13 female patients between 2005 and 2011. He was disciplined for sexual abuse under the Regulated Health Professions Act after a College of Physicians and Surgeons of Ontario discipline committee hearing last summer.

Months after Maharajh’s licence was reinstated in July following an eight-month suspension, the strength of the legislation, touted as a zero tolerance law since its inception more than two decades ago, is being called into question.

Only sexual intercourse, various forms of contact with the genitals, the anus and the mouth, and masturbation merit a mandatory revocation of a doctor’s licence. If a doctor performs another type of sexual act, the panel can also decide to either suspend or impose specified terms, conditions and limitations on their licence.

Health law expert Trudo Lemmens says that weakens the act.

“It would seem reasonable that mandatory sanctions are imposed in the context of medical interventions in which patients are in a particularly vulnerable situation, even when the sexual transgressions are less severe,” said Lemmens, a professor in the University of Toronto’s faculty of law and the Scholl chair in health law and policy.

A University of Toronto graduate, Maharajh, who specializes in family medicine, earned his medical licence in 1985. He worked out of a private practice before transferring to the walk-in clinic almost two years. Online reviews from former patients called Maharajh an excellent doctor; many expressed surprise at his recent disciplinary record.

The Star’s attempts to reach Maharajh at his home and clinic for comment were unsuccessful.

A female patient, whose identity is protected by a publication ban, lodged a complaint against Maharajh in July 2011 after the doctor cupped her nipple with his mouth during a breast examination, according to the discipline committee’s written decision. Maharajh later disclosed to the college similar incidents happened with 10 to 12 other women. No other complaints were filed with the college.

Peel Regional Police won’t say whether or not Maharajh is being investigated, but say his name has not appeared on an arrest report. College spokesperson Kathryn Clarke told the Star she couldn’t say whether it contacted the police about Maharajh specifically. The College is not mandated to.

Maharajh testified to the discipline committee he lost all thinking and control during the incident with the complainant, and was not conscious of what he was doing until after he had done it.

“The ‘next thing he knew,’ his mouth was on her nipple. He described himself as feeling dizzy, out of touch, having lost his higher thinking and his control; his actions were ‘semi-automatic’,” the decision says.

The doctor testified he was going through a difficult period with his wife and three children, was sometimes suicidal, suffered from obsessive compulsive disorder and was abusing alcohol during the six years.

Testifying on Maharajh’s behalf, the psychiatrist treating him — identified in the report only as Dr. B — said the incidents were not sexual in nature but a search for a familiar childhood comfort by a man who was breastfed until he was three years old.

“Dr. B explained that in placing his mouth on his patients’ breast, Dr. Maharajh was seeking the same sort of psychological nurturing that babies seek when they suckle at their mother’s breast,” the report said.

Though Dr. B said Maharajh “absolutely” accepts responsibility for his actions, the discipline committee disagreed.

“The Committee heard evidence from Dr. Maharajh about childhood challenges and family dynamic issues that led to his need for comfort, and about his personal life stressors that exacerbated his difficulties,” the report said.

“While the Committee is sensitive to these background facts, it viewed this testimony as offering excuse for his behaviour, rather than as an acceptance of responsibility for it.”

In addition to Maharajh’s practice being restricted to male patients only, the discipline committee said Maharajh has to continue therapy with a College-approved psychiatrist who will submit reports every six months, and reimburse the College for any counselling provided for up to six patients referred to in the report on the penalty hearing.

At the hearing, Maharajh opposed that his practice be restricted to male patients only, requesting any appointment with a female patient be monitored by another health professional. But the committee said he remained at great risk of reoffending because of his failure to take responsibilities for his activities and his lack of insight into his behaviour.

“Allowing him to continue to treat female patients while he is in the early stages of treatment for that would not adequately protect the public,” the decision said. “If he were to repeat his actions with another female patient, a chaperone may not be able to move quickly enough to stop him.”

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Carolyn Silver, senior legal council for the college, said there was no such thing as mandatory revocation prior to a groundbreaking 1991 Ontario Special Task Force on Sexual Abuse of Patients by Health Care Professionals, which shaped the current act. It is the law, not the College, that implemented varied penalties, she said.

“The legislation says there is zero tolerance for sexual abuse; a physician will be revoked for certain acts of sexual abuse. The legislature, not the college but the legislation, has made the decision what are those acts of sexual abuse.”

Though University of Toronto professor Lemmens believes that credible accountable regulatory bodies can function well, he said the penalties outlined in the act should be reviewed.

“Ensuring trust and protecting patients are key goals of professional regulations,” he said, “The ongoing concerns about how the college deals with some transgressions and professional violations suggest that these goals are not sufficiently met.”

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