An Ontario review board has sharply rebuked the province's College of Physicians and Surgeons for not conducting a disciplinary hearing for a doctor who anonymously issued intimidating letters to colleagues at Toronto's Hospital for Sick Children.

In a decision released Nov. 21, Ontario's Health Professions Appeal and Review Board found the college should have considered disciplinary action against Dr. Gideon Koren for a series of poison pen letters he sent to doctors supporting Dr. Nancy Olivieri.

Koren issued the letters during a prolonged controversy at the hospital which erupted after Olivieri informed patients of possible risks to a drug she was testing, against the wishes of the drug's manufacturer, Apotex. Neither the hospital nor the University of Toronto where Olivieri is cross-appointed supported her in the affair.

One letter that Koren sent referred to those supporting Olivieri as a "group of pigs." Another letter sent to Dr. Peter Durie warned: "You cannot overestimate the contempt and mistrust we have towards you."

Koren initially denied writing the letters but later admitted he was the author when confronted with DNA evidence that matched saliva on the envelopes with his own.

The doctors who received the letters filed a complaint with the Ontario College of Physicians and Surgeons on Oct.1, 1999. In a ruling issued in January 2000, the college found that the letters were "an unprofessional form of communication," but refused to consider any disciplinary action.

However, in its ruling, the review board ordered the case to be sent back to the college for a full disciplinary hearing.

"The unprofessionalism and lack of judgement demonstrated by these anonymous letters over a medical dispute, and Dr. Koren's denial of having written them ... is, in the Board's view, very relevant to a consideration of the behaviour, integrity and judgement expected of medical professionals," the review board concluded.

The doctors who filed the initial complaint welcomed the review board's decision. "We see this ruling as a vindication for what we've been saying all along. We have not been adequately listened to, and I would expand that beyond the college and point fingers at the hospital as well," Durie said.