discipline summaries
Interim Undertaking
Prior to the Discipline Committee hearing, Dr. Haines
entered into an undertaking in response to the College’s concern to protect the public. Further to the
undertaking, Dr. Haines was required, among other
things, to practise under the guidance of a clinical
supervisor acceptable to the College and to keep a
narcotics log.
Dr. Haines’ supervisor consistently indicated in his
monthly reports to the College that he has identified
no material deficiencies with respect to Dr. Haines’
standard of practice. After learning of the College’s investigation, Dr. Haines took steps at his own initiative
to update his medical knowledge and his prescribing
practices in respect of narcotics. In addition, throughout 2013, Dr. Haines completed several continuing
medical education programs, targeted at addressing
deficiencies identified by Dr. X specifically, as well as
reviewing family medicine issues generally. Following
an interview, Dr. X made a number of observations
about Dr. Haines’ generally heightened knowledge and
skill, and also highlighted the various improvements in
Dr. Haines’ practice.
Reasons for Penalty
The Committee accepted the joint submission, finding
that the penalty represented an appropriate sanction in
this matter.
The penalty proposed included: (i) a reprimand (ii) an
overall practice assessment with a focus upon the areas
of concern outlined in Dr. X’s reports approximately
12 months after the date of the Order, and (iii) a
process for managing the results of the practice assessment. In addition, costs in the amount of $4,460 for a
one-day hearing at a rate are to be paid to the College
by Dr. Haines.
It decided that through this penalty, general deterrence and upholding public confidence in the profession is achieved. The Committee highlighted the
seriousness with which the College views a failure to
maintain the standard of practice of the profession.
Notwithstanding the difficulties involved with the
management of chronic pain in complex patients, it
was clear to the Committee that Dr. Haines’ practice in 2013 fell below the standard of practice in a
number of ways. Of most concern was the prescription
of high dose opiates in combination with benzodi-
66
Dialogue Issue 2, 2015
azepines. Oxycodone toxicity was implicated in the
death of one of Dr. Haines’ patients. Dr. X’s report
highlighted his concern about ongoing prescriptions
for opiates and benzodiazepines in the face of patients
with proven substance abuse and concerns expressed
by other doctors. The Committee shared his concern.
Dr. X also noted shortcomings in the application of
current standards in cancer screening and the use of
current tools in management of abnormal cholesterol
testing.
The Committee was encouraged to see the comments of Dr. X in his report, in which he notes early
action by Dr. Haines to systematically taper opiate
doses and introduce practice tools such as the Brief
Pain Inventory, the Opiate Risk Score and more use
of urine drug testing. Dr. X commented in his report
that Dr. Haines has much improved his knowledge
and skill in treating chronic non-cancer pain and demonstrates a good knowledge base. Dr. Haines’ immediate action in addressing the shortcomings identified
in his practice was considered a significant mitigating
factor in respect of the penalty.
The Committee was of the view that Dr. Haines has
demonstrated insight by his immediate action and by
undertaking the remedial education outlined in the
Agreed Statement of Facts. This action was appropriate and responsive to the problems identified. The
Committee also considered this to be a mitigating
factor.
Throughout the discipline process, it was evide