On September 1, 2023, the Ontario Physicians and Surgeons Discipline Tribunal (“OPSDT”) ordered an 18 month medical license suspension against a general surgeon, Dr. Biagio Iannantuono for taking advantage of his position at a hospital to arrange for a female ultrasound technician (“Ms. X”) to perform an intimate procedure on him in an inappropriate manner. 

The OPSDT found that Dr. Iannantuono effectively forced the female ultrasound technician to view and touch his penis several times.

Dr. Iannantuono had engaged in similar misconduct approximately 15 years earlier and had received a 1 month suspension.

FACTS

The evidence before the OPSDT included the following important facts:

• Dr. Iannantuono received his certificate of registration with the College of Physicians and Surgeons of Ontario (“CPSO”) in 1993. In 2022, he was practicing at a small community hospital, where Ms. X had been an ultrasound technician for six years.
• On January 19, 2022, the member attended a medical appointment with his family doctor with a complaint of testicular swelling/enlargement. His physician wrote a requisition for a testicular ultrasound. The requisition was not marked as urgent.
• Dr. Iannantuono asked his doctor to provide the requisition to him, contrary to usual practice. Typically, ultrasound requisitions were submitted directly to the hospital’s Diagnostic Imaging Department, and then ultrasounds were booked with a technician who happened to be available.
• On January 24, 2022, Dr. Iannantuono approached Ms. X at the hospital and asked her to do a scrotal ultrasound on him. He described it as a “sensitive exam” and gave her the ultrasound requisition from his family doctor.
• The member indicated that he was available any time that day. Ms. X agreed to accommodate Dr. Iannantuono as a courtesy, since he was a surgeon at the hospital.
• Ms. X directed Dr. Iannantuono to the examination room and attempted to give him instructions on removing his clothes and draping his body appropriately.
• Ms. X’s usual practice was to tell patients that she needs a minute to explain to them what they need to do. She would explain that she was going to leave the room and give them a chance to undress, and that they should remove their pants and underwear. She would also explain that she would be giving them two towels – one to drape over the thighs, and the other to bring the penis up and over the abdomen to keep it covered up and not exposed for the duration of the examination. She would then leave the room to give the patient privacy to prepare themselves.
• Ms. X did all of this to maintain appropriate boundaries and to preserve the clinical nature of the encounter.
• As Ms. X started to give these instructions to Dr. Iannantuono, he undid his pants. She told him to wait and said she would explain what he needed to do.
• Before she could complete her explanation, Dr. Iannantuono removed his bottoms. He was then naked from the waist down, with his penis exposed to her. This startled Ms. X.
• Ms. X asked Dr. Iannantuono to lie on the examination bed and to cover himself with the two towels. The member did not follow her instructions. Instead, he placed one towel over his thighs and the second up onto his abdomen, leaving his penis exposed. Ms. X took the second towel and used it to cover his penis herself.
• Ms. X was confused and upset by Dr. Iannantuono’s disregard for her instructions.
• As Ms. X was conducting the ultrasound, Dr. Iannantuono’s penis was exposed again. Seeing this, she tried to complete the examination as quickly as possible
• As she was completing the ultrasound, Dr. Iannantuono asked Ms. X if she would also scan him for inguinal hernias. Inguinal hernias occur in the groin area, in the areas on either side of the pubic bone.
• Dr. Iannantuono’s requisition form did not include inguinal imaging. However, because the medical issue for which Dr. Iannantuono was having the ultrasound can be related to hernias, and because it was a doctor asking her to do so, Ms. X agreed to expand the scope of the examination to scan an additional area.
• Ms. X slanted one of the towels over Dr. Iannantuono’s genitals to again cover them, and to gain access to his inguinal area for the purpose of scanning it. The doctor began to explain how hernias are palpated. He told Ms. X to palpate him, although that it is not the role of an ultrasound technician.
• Ms. X became very uncomfortable. Because of Dr. Iannantuono’s position as a senior surgeon in the hospital, she felt compelled to be cooperative and deferential.
• At his request, Ms. X tentatively poked Dr. Iannantuono’s inguinal region. The doctor pushed the towel out the way, which exposed his penis. He told her she was doing it wrong and that she had to use a different finger. He grabbed her hand, repositioned it, and pressed her fingers into his groin area. This caused her hand to make contact with his penis.
• Dr. Iannantuono then uncovered the other side of his groin. He told Ms. X to feel the difference between the two sides. Ms. X tentatively palpated his other side. She tried to do this in a way that avoided contact between her hand and his penis.
• The doctor again said her technique was wrong. He grabbed her hand, repositioned it, and pressed her fingers into his groin area. Once again this caused her hand to make contact with his penis.
• Dr. Iannantuono then had Ms. X do this process again on the original side, causing her to make contact with his penis for a third time.
• Ms. X finished the examination and stood up. Dr. Iannantuono also immediately stood up from the exam table, naked from the waist down. Leaving the draping towels behind him, he again exposed his penis to Ms. X.
• Throughout the examination, given Dr. Iannantuono’s position of authority as a physician at the hospital, Ms. X felt intimidated and unable to stop his inappropriate behaviour. Her interaction with Dr. Iannantuono made her deeply uncomfortable, and left her visibly shaken, upset and confused. She was tearful afterwards.

DECISION

Based on the evidence above, the OPSDT found that Dr. Iannantuono’s misconduct was very serious, involving:

• a boundary violation of the highest order, by exposing himself to a staff member and requiring her to touch his penis several times;
• abuse of his authority and disrespectful behaviour as a senior surgeon in a small community hospital;
• rejection of proper procedures in the arranging and carrying out of the ultrasound examination; and
• offensive and harmful conduct toward another health care professional.

The OPSDT accepted the proposed joint penalty of the parties which in addition to ordering an 18-month suspension, also imposed substantial obligation on the physician, including:

• individualized instruction in professionalism and ethics;
• therapy with a mental health professional approved by the CPSO;
• continuous observation by an approved practice monitor who must enter into a prescribed undertaking to the CPSO and will submit monthly logs in a prescribed form of the doctor’s encounters with patients;
• a prescribed posting and other notifications to ensure that all his patients know about the practice monitor requirement; and
• monitoring of the member’s compliance with the order.

Dr. Iannantuono was also ordered to pay costs of $6,000 to the CPSO.

Decision Date: September 1, 2023

Jurisdiction: Ontario Physicians and Surgeons Discipline Tribunal

Citation: College of Physicians and Surgeons of Ontario v. Iannantuono, 2023 ONPSDT 20 (CanLII)