Inquiry finds N.W.T. doctor who sterilized woman without consent engaged in unprofessional conduct

A Northwest Territories doctor has been sanctioned by a board of inquiry that found he engaged in "a clear instance of unprofessional conduct" by sterilizing a patient during surgery without written consent, and without a clinical reason to do so.

Dr. Andrew Kotaska is a former clinical director of obstetrics at Stanton Territorial Hospital in Yellowknife and a published expert in consent in obstetrics. He hasn't worked in the territory since April 2022. 

The board found that Kotaska removed the left fallopian tube of a 37-year-old patient during surgery in November 2019. The patient had consented, in writing, only to have her right fallopian tube and ovary removed. The patient filed a civil lawsuit against Kotaska and the Northwest Territories Health and Social Services Authority in April 2021. Both Kotaska and the health authority have filed statements of defence.

It's not clear when the official complaint was filed. A board of inquiry convened by the N.W.T.'s Department of Health and Social Services, which licenses doctors to work in the territory, held a virtual hearing on Feb. 10 and 11 and produced a written ruling. 

"Consent is a cornerstone of medical interventions," the board wrote. "Proceeding with a surgical removal of a part of a patient's body without their consent represents a significant lack of judgment in the practice of medicine, is conduct that brings the standing of the medical profession into disrepute," and violates the Canadian Medical Association's Code of Ethics and Professional Responsibilities.

In sanctioning Kotaska, the board agreed to suspend his medical licence for five months, a period considered already served since the N.W.T. Health and Social Services Authority did not renew his contract in April 2022. The authority declined to comment, citing privacy.

The board of inquiry — chaired by Dr. Ian MacNiven of Yellowknife and including Dr. Don Yee of Edmonton and Gillian Burles of Yellowknife as a public representative — investigated several aspects of a single complaint. 

Among its findings, the board noted that it was likely the patient did say she did not intend to have more children, however, there was no written evidence that she had consented to sterilization. 

The board also heard testimony from an anesthesiologist who was present during the surgery, and who reported Kotaska making the comment: "Let's see if I can find a reason to take the left tube." 

Kotaska admitted to making the comment, describing it as part of his clinical reasoning. The board found the comment was not made "maliciously" and did not represent unprofessional conduct. 

The complaint also alleged that Kotaska ignored comments from colleagues present during the surgery. The board found inconsistent evidence on this point, and found that this, too, was not unprofessional conduct. 

Kotaska 'capable of excellent decision making'

In addition to the five-month suspension, considered served, Kotaska was ordered to pay up to $20,000 in costs related to the hearing and investigation process, though the actual costs were expected to be higher. He was also ordered to complete an ethics course at his own expense. 

In issuing its sanction, the board considered Kotaska's long career and the fact this was a first offence. A letter signed by colleagues described Kotaska as "an accomplished, thoughtful surgeon who is capable of excellent decision making." 

Though Kotaska did not admit his conduct was unprofessional, according to the board, the board noted that he took responsibility for his actions and demonstrated "significant remorse." 

Kotaska "remains profoundly troubled and has acknowledged his failure of judgment," the board noted. Kotaska has not been able to find meaningful employment since the end of his contract, the report notes, and the incident has negatively affected his "health, well being and quality of life." 

The patient has also felt the fallout, the board noted in its decision, including "considerable negative effects on her well being, quality of life, her ability to choose to reproduce without medical assistance, and lack of trust in the medical system."

Kotaska declined to comment for this article, except to confirm that the conditions of the board have been fulfilled. 

Only 2nd complaint in 12 years to merit hearing

Complaint hearings regarding doctors are rare in the N.W.T.

Ravan Bedingfield, registrar of Northwest Territories Professional Licensing, said Kotaska's hearing was only the second complaint to merit a hearing in the last dozen years. 

The other case involved Dr. Lance Crook. 

On Nov. 1, 2021, a board of inquiry was convened to hear a complaint that he had an "inappropriate sexual relationship" with the mother of a minor male patient in his care. Crook was accused of accessing personal health records on or around Oct. 1 and Dec. 15, 2016, with no medical reason to do so.

At the time, the doctor was working in Hay River. 

Documents show the board accepted a joint sanction proposal that Crook have his licence suspended for nine months, undergo an assessment regarding his fitness to practice, and take a course on boundaries. The doctor's licence to work in the N.W.T. expired on March 31, 2018. 

An obscure process

Kotaska's virtual hearing was public, said Bedingfield. However, it was not advertised publicly, she said. 

The written document notes that the hearing was actually held in private, at the request of the patient. The board wrote that this request "warranted an exception to the presumption of openness," due to the "real and substantial risk of personal and confidential medical information being disclosed to the public."

The board noted that its decision document would subsequently be made public. "Such transparency is sufficient to ensure the protection of the public and to reassure the public that the medical profession is capable of self-governance." 

CBC News made several attempts to learn the status of the complaint. 

A query in March to the College and Physicians and Surgeons of Alberta, which manages N.W.T. complaints, received no response. A subsequent query more than two months later met with a response directing the inquiry to a staff member of the N.W.T. health department. 

A reporter was finally invited to view public documents related to the case 13 days after requesting access, and was not allowed to make a copy. 

According to Bedingfield, the government plans to update its website to provide summaries of complaint hearings. 

In the meantime, people who want to know whether such hearings are underway or when hearings are scheduled are invited to telephone her office at 867-767-9067, ext. 49051.

The process, Bedingfield said, is "something we are going to definitely flesh out."