A Toronto plastic surgeon who may be filming patients in states of undress without their consent is being investigated by both the College of Physicians and Surgeons of Ontario and the province's privacy commissioner following a Marketplace investigation.
During a hidden camera investigation into the marketing practices associated with breast augmentation, a security camera was seen on the ceiling of a closed-door consultation room at the Toronto Cosmetic Surgery Institute, owned by Dr. Martin Jugenburg.
Two CBC producers went undercover, one posing as a potential patient and the other as a supportive friend to document the consultation process for the surgery.
At Jugenburg's clinic, the producer was asked by staff to remove her top in order to have photos taken of her breasts for her medical file, which is standard for most breast implant consultations.
But the security camera spotted in the corner of the room was unusual.
A security camera, located in the upper left-hand corner of this photo, is shown in the waiting room of the Toronto Cosmetic Surgery Institute. The same style of camera was spotted in one of the clinic's consult rooms by a CBC producer who was posing undercover as a patient wanting breast augmentation. (CBC)
When the Marketplace producer asked about the camera, a staff member responded that it was "for the doctor's record," saying the office had to document everything for "legal purposes."
Later, when the nurse entered the room, she said the camera was "just a security camera, basically."
"It's to protect you, too" she said. "And him. Like if someone ever said something happened and it didn't. Or stuff like that."
When asked if that has happened before, the nurse replied: "No, never."
Brian Beamish, the Information and Privacy Commissioner of Ontario, called the situation "unacceptable" and "intrusive," saying it was the first he had heard of a camera being used for surveillance in an examination room.
Physicians using cameras for surveillance rather than strictly clinical purposes is "unjustified and would likely be a breach of our privacy law," he said.
WATCH: Brian Beamish explains why the presence of cameras for surveillance is a concern
Beamish also noted that cameras for surveillance could impact the relationship between patients and health-care providers, suggesting patients may avoid seeking health care if they're uncomfortable being filmed.
During the consultation, the Marketplace producer asked if she could have photos of her breasts taken in a different room, away from the security cameras; staff said there were cameras "all around" the clinic.
"I think that's wrong," said Beamish. "[The patient] has not provided their informed, voluntary consent to have their images captured."
It's not unheard of to have cameras in doctors' offices under certain circumstances.
At the South East Toronto Family Health Team (SETFHT), a clinic in the city's east end that is associated with the University of Toronto, cameras are used as a teaching tool for medical residents. Their closed-circuit system allows new doctors to interact with patients one-on-one while their supervisors watch from another room.
Prior to the appointment, the SETFHT asks patients if they are willing to be on camera. Patients are given consent forms and signs are posted underneath the cameras to remind people they're being filmed. If patients prefer, they can choose not to be filmed at all.
This was not an option during Marketplace's visit to Jugenburg's clinic.
Toronto plastic surgeon Dr. Martin Jugenburg uses his social media accounts for what he calls educational purposes, showing before-and-afters as well as real in-surgery photos and videos. (Carlos Osorio/Toronto Star via Getty Images)
The surgeon — known online as Dr. 6ix — is well-known for posting videos of his operations on social media. He has more than 100,000 followers on his Instagram account, which notes that the content of his account is for educational purposes.
On any given day, his fans can follow along as he performs breast augmentations, tummy tucks or Brazilian butt lifts, among other surgeries. Those videos are filmed with a hand-held device, likely a smartphone or tablet.
Even though Jugenburg's staff told the Marketplace producer that "nothing gets posted to our social media unless you consent," Beamish said any recording could be problematic if a patient isn't asked for his or her explicit consent.
"First of all, [the patient] should have been notified immediately about the presence of a security camera, [she] should have been told whether that camera was on or off, and should have been asked for her explicit consent to have the camera on," he said.
Brian Beamish, the information and privacy commissioner of Ontario, called the issue of using cameras for security in medical settings 'intrusive.' (CBC)
Kerry Bowman, a bioethicist with the University of Toronto, agreed that patients need to know when they're being filmed and called the experience captured by Marketplace "creepy" and "very problematic."
He questioned whether staff would've even mentioned the presence of the security camera had the producer not pointed it out.
According to SETFHT staff, the clinic's cameras only offer a live feed of a consult room — the footage is not recorded and stored.
That also appears to be in contrast to the situation at Jugenburg's clinic, the Toronto Cosmetic Surgery Institute. When responding to Marketplace's initial investigation into his marketing practices, Jugenburg mentioned he "reviewed the entire consultation," which suggests the footage from the clinic's cameras is being saved.
Beamish said he has concerns about how those images are being stored.
"How long are they going to be stored for? Who's going to have access to them? How are they going to be used? How is that doctor's office ensuring that they're secure? That people aren't looking at those images who have no right to look at them?" he asked.
WATCH: Clinic staff says security camera in consult room is for 'the doctor's record'
Jugenburg did not respond when Marketplace posed similar questions to him by email. Instead, he said that "security cameras are present in the office for security purposes, with notice provided in our clinic, and appropriate protections put in place to preserve patient privacy and confidentiality."
The Marketplace producers did not see any notices indicating the presence of security cameras during their visit.
Marketplace was not able to confirm how long the cameras at Jugenburg's clinic have been in operation. But based on videos from his YouTube account, cameras appear to have been in his some of his waiting rooms, hallways and operation rooms since at least 2014.
Dr. Martin Jugenburg goes by the name Dr. 6ix on his social media channels, a reference to a popular nickname for the City of Toronto. (Carlos Osorio/Toronto Star via Getty Images)
Marketplace also spoke with a patient who had her breast implants explanted by Jugenburg last year. She said she doesn't recall seeing security cameras in the clinic and wasn't informed of any security cameras by clinic staff.
Beamish said he plans to follow up on what was captured byMarketplace's hidden camera with his own investigation. If his office finds the situation to be in violation of the province's health privacy laws, he said it would have the power to order Jugenburg to shut down the cameras and possibly delete the footage.
The College of Physicians and Surgeons of Ontario is also investigating the situation.
"If anyone has information about allegations that a physician may be surreptitiously recording patients, we would implore them to contact the College so that we can take steps to investigate and ensure that other patients are not at risk," the regulator said in a statement.
Jugenburg is facing a disciplinary hearing before the provincial college, which alleges he committed professional misconduct for advertising methods, including permitting a film crew into a surgical procedure without the patient's consent, making "improper" use of her images and posting "pre- and post-operative images of her on his social media accounts without her consent," along with "pressuring her to follow and contribute to his social media accounts."
In a previous response, Jugenburg told Marketplace those allegations are "denied and being defended."
A hearing date is set for July 2019.