In early April, the College of Physicians and Surgeons’ (CPSO) Discipline Committee
found that an obstetrician/gynecologist had committed an act of professional misconduct and also found him to be incompetent. The physician was suspended.
Events Leading to the Physician’s Resignation
In February 2013, the hospital in which the physician worked had been informed that a nurse had found a “powdery tablet” inside of a patient’s vagina. The substance looked like prostin/misoprostol (a medication used to induce uterine contractions and labour). There had been no orders for this medication in the patient’s chart. When questioned, the physician denied any knowledge of the substance. The substance was not retained for analysis.
In August 2015, the hospital was again informed that a nurse had found a similar substance when examining a different patient. This time, the substance was collected, but no analysis was done at the time. The physician again denied knowledge of the substance, denied that he had ever placed any medication in the patient’s vagina, and maintained that he had never done this before.
The hospital advised the physician that if they were to discover that he had placed medication used to induce labour inside of a patient, especially without that patient’s knowledge, that would be grounds for revocation of his privileges and potential battery charges.
Subsequent discussions with the patient in question confirmed that she had been unaware of the use of the medication and had not consented to its use.
The hospital held a department meeting in August 2015 where staff was reminded that hospital policy permitted the use of misoprostol only in certain limited circumstances and that using medication to induce labour in an office setting would likely result in revocation of hospital privileges.
In May 2016, a hospital incident report reflected that five of the physician’s patients had arrived in triage with rapid labours. One of the patients required an immediate c-section. The incident report noted that there had been a surge of patients with imminent deliveries on Saturday when there were less staff and resources available and that this pattern was not consistent with the practice of other department members.
Later that same summer, nurses were surprised at how quickly the labour of one of the physicians’ admitted patients had been progressing since she was giving birth to her first child. An internal examination of the patient discovered white pill fragments.
The patient confirmed that she had been unaware of any medication being placed in her vagina and had not consented to the use of any such medication. A chemical analysis of the medication, as well as the medication collected in 2015, revealed that it was misoprostol.
The Physician’s Resignation
In August 2016, the hospital convened a meeting in which the physician was asked about his prior denials about the powdery white substances previously found. The physician was informed that the hospital has tested the substances and had concluded it was misoprostol. The physician continued to deny any knowledge of this medication and also denied ever using it in his office.
The physician eventually admitted that he had been using the medication in his office for out-patient inductions. He defended this practice as safe and argued that his outcomes were better than most of his colleagues.
The hospital suspended the physician’s staff privileges.
Several days later, the physician emailed the hospital, noting that he had done “a great deal of soul searching” and could now see the seriousness of his actions. He expressed remorse and took responsibility for what had happened and noted that he would not fight the hospital’s decision but wanted six months to care for his current patients. He noted that if the hospital agreed to such a plan, he would immediately announce his retirement from hospital work (effective from six months of the date of the email), would stop accepting new patients, and would never artificially induce labour without a patient’s consent again.
The hospital informed the CPSO that the physician had decided to retire from his hospital practice after meeting with hospital staff to discuss serious concerns related to his practice.
The CPSO decided to conduct their own investigation.
The CPSO Investigation
The CPSO interviewed other physicians and nurses at the hospital, who all confirmed that they had been unaware of the physician’s practice of using misoprostol for office-based inductions.
An expert reviewed the physician’s charts and interviewed the physician and concluded that the physician’s actions fell below the standard of care in obstetrics since he had:
- Inserted an induction agent into patients;
- Where the patients displayed no indication that induction was needed;
- In an outpatient setting;
- Without the patient’s knowledge or consent.
The physician had confirmed that he had not informed the patients about this medication, had not discussed the risks of using it, had not obtained their consent, and had not documented this practice in his records. He admitted to engaging in this practice for many years.
Discipline Committee Findings
The Discipline Committee concluded that the physician had committed an act of professional misconduct since he had:
- Failed to maintain the standard of practice of the profession;
- Engaged in an act or omission relevant to the practice of medicine, which would reasonably be regarded by members as disgraceful, dishonourable, or unprofessional (having regard to all the circumstances).
The Committee also found the physician to be incompetent. The physician was suspended.
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