DISCIPLINE COMMITTEE OF THE ROYAL COLLEGE OF DENTAL SURGEONS OF ONTARIO
Date: 2017-03-29
File No.: H150014, H160005
IN THE MATTER OF: A Hearing held pursuant to the provisions of the Health Professions Procedural Code which is Schedule 2 to the Regulated Health Professions Act, 1991, Statutes of Ontario, 1991, Chapter 18 (“Code”)
AND IN THE MATTER OF: the Dentistry Act and Ontario Regulation 853, Regulations of Ontario, 1993, as amended (“Dentistry Act Regulation”)
AND IN THE MATTER OF: the Statutory Powers Procedure Act, Revised Statutes of Ontario, 1990, Chapter S.22, as amended; 1993, Chapter 27; 1994, Chapter 27
BETWEEN:
Royal College of Dental Surgeons of Ontario
-and-
Dr. Helmut Ragnitz
PENALTY REASONS
PANEL MEMBERS:
Dr. Richard Bohay, Professional Member (Chair)
Dr. Nancy Di Santo, Professional Member
Dr. David Mock, Professional Member
Mr. Gregory Larsen, Public Member
Mr. Manohar Kanagamany, Public Member
APPEARANCES:
Ms. Marie Henein, for the College
Dr. Helmut Ragnitz, on his own behalf
Mr. Paul Le Vay, Independent Legal Counsel
Heard: February 23, 2017, in person
Decision Date: March 29, 2017
Release of Written Reasons: March 29, 2017
DECISION AND REASONS ON PENALTY
Introduction
On October 25 and 26, 2016, a panel of the Discipline Committee (the “Discipline Panel”) of the Royal College of Dental Surgeons of Ontario (the “College”) convened to hear allegations of professional misconduct made against Dr. Helmut Ragnitz (the “Member”). In a Decision and Reasons released February 7, 2017, the Discipline Panel found that the Member had committed acts of professional misconduct in respect of Allegations 1, 4, 5 and 6 as set out in Notice of Hearing H150014 (Exhibit 1B) which contained seven (7) allegations, and also found that he committed acts of professional misconduct in respect of all Allegations (i.e., 1-4) as set out in Notice of Hearing H160005 (Exhibit 2). The allegations and findings of professional misconduct are set out in detail in our February 7th Decision and Reasons. That detail will not be repeated here but our findings are summarized below.
The Panel reminded those present that it had made an order pursuant to subsection 45(3) of the Health Professions Procedural Code[1](the “Code”), banning publication of any patients’ names and identifying information at the outset of the hearing and that order continued to apply to penalty hearing.
Findings of Professional Misconduct
Exhibit 1A and B – Notice of Hearing H150014
The Panel found the Member guilty of professional misconduct in relation these four (4) allegations:[2]
1. He committed acts of professional misconduct as provided by s.51(1)(c) of the Code, in that, from September 29, 2014 onwards, he contravened a term, condition or limitation imposed on his certificate of registration relative to certain patients, contrary to paragraph 2 of Section 2 of the Dentistry Act Regulation.
He committed acts of professional misconduct as provided by s.51(1)(c) of the Code, in that, during the year(s) 2014 and 2015, he failed to abide by a written Undertaking/Agreement given by him to the College or to carry out an arrangement entered into with the College, contrary to paragraph 54 of Section 2 of the Dentistry Act Regulation.
He committed acts of professional misconduct as provided by s.51(1)(c) of the Code, in that, during the year(s) 2014 and 2015, he failed to take reasonable steps to ensure that any information provided by him or on his behalf to the College was accurate, contrary to paragraph 57 of Section 2 of the Dentistry Act Regulation.
He committed acts of professional misconduct as provided by s.51(1)(c) of the Code, in that, during the year(s) 2014 and 2015, he engaged in conduct or performed an act or acts that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable, unprofessional and unethical relative to the following patients, contrary to paragraph 59 of Section 2 of the Dentistry Act Regulation.
Exhibit 2 – Notice of Hearing H160005
The Panel found that the Member had engaged in professional misconduct as follows:
- He committed acts of professional misconduct as provided by s.51(1)(c) of the Health Professions Procedural Code, being Schedule 2 of the Regulated Health Professions Act, 1991, Statutes of Ontario, 1991, Chapter 18 in that, during the year 2014, he contravened a term, condition or limitation imposed on his certificate of registration relative to one of his patients, namely T, N., contrary to paragraph 2 of Section 2 of the Dentistry Act Regulation.
2. He committed acts of professional misconduct as provided by s.51(1)(c) of the Health Professions Procedural Code, being Schedule 2 of the Regulated Health Professions Act, 1991, Statutes of Ontario, 1991, Chapter 18 in that, during the year 2014, he failed to abide by a written Undertaking given by him to the College or to carry out an arrangement entered into with the College, contrary to paragraph 54 of Section 2 of the Dentistry Act Regulation.
3. He committed acts of professional misconduct as provided by s.51(1)(c) of the Health Professions Procedural Code, being Schedule 2 of the Regulated Health Professions Act, 1991, Statutes of Ontario, 1991, Chapter 18 in that, during the year 2015, he failed to reply appropriately or within a reasonable time to a written enquiry made by the College, contrary to paragraph 58 of Section 2 of the Dentistry Act Regulation.
4. He committed an act or acts of professional misconduct as provided by s.51(1)(c) of the Health Professions Procedural Code, being Schedule 2 of the Regulated Health Professions Act, 1991, Statutes of Ontario, 1991, Chapter 18 in that, during the year 2014, he engaged in conduct or performed an act or acts that, having regard to all the circumstances, would be reasonably be regarded by members as disgraceful, dishonourable, unprofessional and unethical relative to one of your patients, namely T, N., contrary to paragraph 59 of Section 2 of the Dentistry Act Regulation.
Submissions of the College
Ms. Henein on behalf of the College submitted that revocation was the appropriate penalty as the Member was ungovernable. She pointed to the Member’s willful and deliberate breach of the undertaking he gave to the College. She referred to the fact that the Member had breached the undertaking the day after it was given and that it was breached with numerous patients over a lengthy period of time. Ms. Henein also highlighted evidence that Dr. Ragnitz had willfully misled the College investigator, claiming that he had only continued to provide the restricted prosthetics to patients with whom he had started the procedure before giving the undertaking when, in fact, 16 cases were started after the undertaking had been given. He continued the treatments after he knew that he was being investigated for breach of the undertaking and after he had been expressly warned by the investigator.
Ms. Henein submitted that this evidence demonstrated that the Member was not prepared to accept the jurisdiction of his regulator, the College. She took the panel through a brief (Exhibit 12) of decision of the Complaints Committee and the ICRC concerning Dr. Ragnitz which, she submitted, showed an escalating pattern of refusing to accept the College’s jurisdiction. Revocation was therefore required to fulfill the public protection mandate of the College.
Submissions of Dr. Ragnitz
Dr. Ragnitz attended and spoke on his own behalf. He said that he disagreed that he was ungovernable but added that this was not such a terrible thing given what was happening in the United States. He attempted to shift responsibility for his circumstances to patients and other practitioners. He attempted to minimize the seriousness of patient safety issues. With respect to past non-responsiveness to the College, he explained that he had not responded on certain occasions in the past because he gets his back up when he is accused of doing something that he did not do.
He provided the Panel with certain letters of support (Exhibits 13). Ms. Henein pointed out in reply that there was no indication that the authors of these letters had been told about the Panel’s findings.
Dr. Ragnitz also told the panel that he was “basically done with the College”.
Decision on Penalty
The Panel directs the Registrar to revoke the Member’s certificate of registration pursuant to section 51(2) of the Code.
Reasons for Penalty
The Panel was convinced by the evidence and by the submissions presented by the College that the Member is ungovernable.
The past decisions of the Complaints Committee and the ICRC about Dr. Ragnitz contained in Exhibit 12 demonstrate a prolonged and escalating level of failure by Dr. Ragnitz to recognize and accept the authority of the College.
Certain examples of concern to the Panel were as follows:
i) Complaint of PS: Exhibit 12, Tab 5, Page 2: “Dr. Ragnitz failed to respond to the College’s requests for all of S,P’s original patient records…” requiring the Committee to request the Registrar commence an investigation pursuant to s. 75(c) the Code. On Page 7: The Panel expressed concern that “Despite the complainant’s clear request for records and the complainant’s ongoing treatment needs, Dr. Ragnitz failed to provide either S,P or his new treating dentist with all the requested records.” Complaints Committee Panel met on five occasions between October 2007 and April 2009.
ii) Complain of MS: Exhibit 12, Tab 6, Page 5: “Additionally, the Panel is concerned that Dr. Ragnitz failed to provide S,M’s records to the College in a timely manner.” The Inquiries, Complaints and Reports Committee (ICRC) Panel met twice in 2011.
iii) Complaint of GM: Exhibit 12, Tab 7, Page 5: The ICRC Panel determined that in relation to a patient, Dr. Ragnitz failed to maintain the standards of practice for a prosthodontic specialist. The Member signed a voluntary Undertaking/Agreement to restrict his practice such that he would not initiate any implant placement or provide any prosthodontic treatment, including prosthetic treatment (crowns, bridges). Dr. Ragnitz signed the Undertaking/Agreement on 29 September 2014. The ICRC met twice in the fall of 2014.
iv) Complaint of GG: Exhibit 12, Tab 8, page 5: “…and the panel was also concerned that Dr. Ragnitz did not fully cooperate with the College’s investigation.” The ICRC Panel met twice in 2015.
v) Complaint of JAS: Exhibit 12, Tab 9, Page 4: “The Panel was extremely troubled by the events that unfolded in this matter. It was left with the impression that Dr. Ragnitz made little to no effort to comply with the many requests for records from his patient directly, from his patient’s legal counsel and finally from his governing body, the College.” “It also appeared that Dr. Ragnitz took a very lackadaisical approach to ensuring his contact information on file with the College was current and showed no signs of attempting to cooperate with the investigation.” “This degree of non-cooperation with a College investigation is unacceptable.” “The Panel was further troubled by Dr. Ragnitz’s eventual response to the College in that he provided misleading information.” On page 6 of the same decision, the Panel writes: “From that information the panel can see that Dr. Ragnitz exhibits a pattern of failing to comply with requests for records both from patients directly and from the College pursuant to an investigation. Although the importance of complying with this legislative requirement has been brought to Dr. Ragnitz’s attention on multiple occasions, the panel can see from the facts in this case that Dr. Ragnitz still does not appreciate this lesson.” The ICRC Panel met twice in 2015 and once in 2016.
The fact that Dr. Ragnitz breached a voluntary Undertaking/Agreement with the College that was put in place because the ICRC Panel had determined that he had failed to maintain the standards of practice for a prosthodontic specialist is an extremely serious failing on the part of Dr. Ragnitz. His decision to disregard this Undertaking/Agreement clearly indicates that he placed his own interests above those of the patients to whom he provided treatment that he was prohibited from providing by the terms of the Undertaking/Agreement. His actions further demonstrate a complete lack of respect for the authority of the College and of its public protection role in the regulation of its members.
The fact that a total of 44 patients were listed as being treated during the time that the Undertaking/Agreement was in effect and that this treatment went on from September 2014 to February 2015, demonstrated to the Panel that the Member did not simply make an isolated mistake. Rather, it shows that he had a complete disregard and contempt for the agreement he had entered into voluntarily with the College.
Of the 44 patients he treated while the Undertaking/Agreement was in effect, 16 of them were patients for whom he initiated treatment after signing the Undertaking. Of grave concern to the Panel, was the fact that even after College Investigator Dr. Helene Goldberg informed Dr. Ragnitz that he was under investigation by the College on January 7, 2015, he still proceeded to initiate treatment for eight more patients after that date. Again, the Panel found this to be overwhelming evidence that Dr. Ragnitz was ungovernable by the College.
Dr. Ragnitz lied to Dr. Goldberg when, in January 2015 and February 2015, he was asked if he had initiated any new patient treatment while the Undertaking/Agreement was in effect. This is further evidence of Dr. Ragnitz contempt for the authority of the College and of its vital role in protecting the public.
During the Penalty phase of the hearing Dr. Ragnitz attempted to explain his situation by placing responsibility on patients and other practitioners, rather than on himself. He attempted to minimize the seriousness of his actions by suggesting that the treatment he was providing was not as dangerous as if he had used sedation. While Dr. Ragnitz did eventually send a letter, in 2015, apologizing to an ICRC Panel, he did not express any remorse or demonstrate any real insight, understanding and acceptance during the course of this hearing of the importance of the role performed by the College in regulating the dental profession in the public interest and of the ultimate authority of the College over him as a regulated health professional. In fact, the account contained in the ICRC Panel Decision and Reasons dated 4 May 2016 of Dr. Ragnitz’s continued non-responsiveness and lack of cooperation in respect of the investigation of the complaint of JAS, which took place after Dr. Ragnitz sent his letter of apology, led this Discipline Panel to put little weight on that letter. In addition, during the hearing, Dr. Ragnitz suggested that ungovernability may not be a bad thing. He minimized the findings of CC/ICRC Panels, suggesting the concerns were just financial concerns and that in some of the cases decided by the CC/ICRC Panels nothing had happened. He stated that he believed that the College was out to get him, that he was basically done with the College and that he really did not care anymore. Taken together, these comments indicate to the Panel that this Member has not accepted responsibility for his actions or that he has any interest in remediation or changing his ways or beliefs related to the authority of the College.
Finally, the Member referred to personal circumstances that, he suggested, influenced his decisions and actions. While the Panel can sympathize with any Member who runs into personal difficulty and hard times, such circumstances cannot exempt that member from the ultimate responsibility that he has to his patients and to the profession and the public. The panel did not hear or receive any evidence from the Member related to any mental or physical health diagnosis that should be weighed in considering the appropriate penalty. Dr. Ragnitz submitted three letters of reference (Exhibit 13). However, none of the letters addressed Dr. Ragnitz’s ability to be governed by the College and were therefore not accorded weight by the Panel.
Based on the evidence presented and after hearing the submissions of the parties, the Panel concluded that the Member is ungovernable. He did not demonstrate understanding of the seriousness of his actions and did not acknowledge the ultimate authority of the College and a member’s responsibility to cooperate with the College and place patient care above all else.
The decision to revoke a member’s certificate of registration is extremely serious and is not taken lightly by this Panel. The decision was reached, first and foremost, for reasons of public safety. The Panel did not believe that any remedial actions would have a positive influence on Dr. Ragnitz. This decision will serve to send a message to the profession that compliance with the College’s regulation is essential and will demonstrate to the public that they can have confidence in the self-regulation of the dental profession.
I, Dr. Richard Bohay, sign these Reasons for Decision as Chairperson of this Discipline Panel.
1Schedule 2 to the Regulated Health Professions Act, 1991, SO 1991, c 18.
2Three other allegations that set out in this Notice of Hearing were withdrawn at the request of College Counsel. They appeared as allegations 2, 3 and 7 respecting the use of a practice name and engaged in improper advertising, respectively.