Toronto doctor faces sanctions for helping poor

Last week, the Ontario College of Physicians and Surgeons (OCPS) met to determine the sanctions to be imposed against Toronto doctor Roland Wong. The inner-city community doctor, who had come to the attention of authorities for providing a high number of special diet allowance authorizations to welfare recipients, had been found guilty of professional misconduct by the College last December. At that time, the College ruled that Wong had not taken all the necessary steps to ensure that his patients qualified for the dietary benefit.

The OCPS is seeking a nine-month suspension of Wong’s license to practice medicine, a $35,000 fine and hearing (i.e., court) costs amounting to $4,460 per day. The College is also considering requiring Wong to submit to an appointed overseer of his work for one year after his suspension is over.

Dubbed the “Robin Hood Doctor” by many of his patients, Wong has declared in his own defense that his diagnoses and medical assistance to the poor were entirely consistent with his Hippocratic oath and the information provided to him by his patients. The case and Wong’s steadfast defense of his actions have highlighted the abysmal conditions of poverty inflicted on hundreds of thousands of Ontario residents and the provincial government’s ongoing austerity program directed against the working class.

Currently, a single person on social welfare in Ontario receives $591 per month. With low-rent districts charging an average of $400 per month for a room and monthly public transportation costs often amounting to $100, little money is left to buy nutritional food, let alone other basic essentials. About 900,000 people in Ontario today receive social welfare or disability benefits (disabled individuals can receive up to $930 per month). Not surprisingly, study after study shows that this social layer suffers the worst health-related outcomes in the province.

A little-advertised provision in social assistance regulations allows for doctors to authorize a “special dietary supplement,” which in some cases could amount to $250 per month, for recipients who exhibit a number of health conditions that include not only serious illnesses such as heart disease and diabetes but also allergies to certain foods, chronic constipation, osteoporosis, gum disease, bad teeth and other afflictions. In 2003, less than $6 million per year was dispensed by the Ontario government for the special dietary allowance.

When, in that same year, the Liberal government of former premier Dalton McGuinty succeeded the Conservatives (who had cut welfare rates by 22%), attacks on social assistance recipients continued. Increases in already substandard welfare payments were consistently pegged well below the annual inflation rate.

Anti-poverty activists did their best to publicize the little-known special dietary supplement. As the decade proceeded, tens of thousands more people were added to the social assistance rolls in the wake of the Great Recession of 2008. By 2009, claims had increased more than 10-fold in the province, climbing to $67 million. One hundred and sixty thousand people were now receiving the special dietary benefit, 16% of all those on social assistance at that time.

More than a million Ontario citizens are not registered with a family doctor. Many more who are find their physicians unfamiliar with the special dietary allowance provisions. Poor people from across Toronto and from other Ontario cities specifically sought out Dr. Wong for examinations.

In addition, to ensure that all those seeking the supplement could have access to a medical professional familiar with the program, anti-poverty activists organized special all-day clinics attended by Dr. Wong. Overall, between April 2006 and September 2009, Wong filed 34,360 dietary supplement claims for his patients. About half of those recommended “high value” amounts between $200 and $250 per month. The Toronto doctor’s 34,340 filings constituted 13% of all dietary assistance claims in the province over that period.

Alarmed by the fact that an increasing number of impoverished people were actually applying for and receiving the special dietary allowances, the Liberal government abruptly announced in 2010 that it would abolish the program. However, in the face of a significant backlash against this attack on the most vulnerable of citizens and an anti-discrimination ruling against the government at a Human Rights Tribunal, the Liberals in 2011 instead passed legislation revamping the program. These “reforms” considerably reduced the list of afflictions eligible for financial relief, forced all recipients to reapply for the program and threw previous recipients off the rolls.

At the same time, then right-wing Toronto city councilor Rob Ford (now mayor) filed a complaint against Wong with the College of Physicians. When Wong’s case was finally heard last winter, the College found that Wong had not maintained proper records of his examinations, had largely relied upon information provided by his patients and had not referred them for enough testing before issuing his diagnoses. The College found no evidence of lack of medical knowledge or skill. A police investigation found no evidence of fraud. The sanctions to be applied against Wong by the College are expected to be announced next month.

Doctors, nutritional specialists and social workers supported Wong at both the evidentiary and penalty phases of his hearing. Dr. Tomislav Svoboda, a community medicine specialist at St. Michael’s Hospital in Toronto, stated that Wong “should be commended for assisting thousands of the poorest members of our community” and that Wong’s actions were consistent with accepted and established medical standards.

Valerie Tarasuk, a professor of nutrition at the University of Toronto, testified that social assistance alone does not provide sufficient income for basic nutrition. “I think it’s very important to look at the context in which Dr. Wong made those decisions”, she said.

John Clarke from the Ontario Coalition Against Poverty stated that “One decent man stood up to ensure that people lacking the basic necessities of life could get nutrition and health, and to punish him would be to intimidate anyone else who might follow his example”.

Wong himself has said that his only regret is that “the government does not help the poor”. Outside the hearing, Wong told reporters that he was “angry because I’m not able to serve my patients. I’m angry because I have to come to this college to listen to things which should be obvious to the College of Physicians and Surgeons: that it’s important for poverty to be recognized”.