by Written on behalf of Wise Health Law May 10, 2018 4 min read

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. If you are a regulated health professional facing a complaint, investigation, or disciplinary hearing at your College, contact the highly trusted and knowledgeable health lawyers at Wise Health Law. We will help you understand your rights, outline your options, highlight possible risks, guide you through the process, and skillfully represent you at all proceedings. Contact us online, or at 416-915-4234for a consultation.

Also in Blog

Cases to Watch: Marchi v. Nelson

by Mina Karabit September 22, 2020 3 min read

In August 2020, the Supreme Court heard and granted leave to appeal in Marchi v. Nelson, a case from the British Columbia Court of Appeal. The decision is one to watch as it will likely result in a renewed discussion of the distinction of policy versus operational decisions and their impacts on liability in tort law. The discussion will likely impact many of the anticipated post-COVID-19 lawsuits against public and government institutions.
Judicial Review: New Time Limits and a Helpful Primer

by Mina Karabit September 17, 2020 4 min read

In December 2019, Ontario’s Attorney General introduced Bill 161, the Smarter and Stronger Justice Act (the “Act”), which became law on July 8, 2020. The Act hopes to simplify a complex and outdated justice system by bringing changes to how legal aid services are delivered, how class actions are handled, and how court processes are administered.

Of note, the Act has amended the Judicial Review Procedures Act (JRPA) to establish new rules as to when an application for judicial review may be brought.

Any decisions made on or after July 8, 2020 are now subject to a 30-day limit for bringing an application for judicial review unless another Act provides otherwise. Courts, however, retain powers to extend the time for making an application for judicial review if satisfied that there are apparent grounds for relief and that no prejudice or hardship will be incurred by the delay. Before these amendments, the JRPA did not set out any time limits for bringing an application, but courts had powers to extend the time to bring an application if another Act prescribed the limit.

Recent Exemptions for Psychedelic Therapy in Canada

by Mina Karabit August 14, 2020 3 min read

In early August 2020, the Federal Minister of Health granted an exemption under the Controlled Drugs and Substances Act (CDSA) to four terminally ill Canadians to use psilocybin in their end of life care.

Psilocybin is one of the active ingredients/chemicals in “magic mushrooms,” the other is psilocin. Both psilocybin and psilocin are controlled substances under Schedule III of the CDSA. The sale, possession, production, etc. are prohibited unless authorized for clinical trial or research purposes under Part J of the Food and Drug Regulations. Both have been illegal in Canada since 1974. According to Health Canada, there are no approved therapeutic products containing psilocybin in Canada. However, the purified active ingredient, i.e. psilocybin, is being studied in supervised clinical settings for its potential to treat various conditions such as anxiety and depression.