Dialogue Volume 11 Issue 2 2015 | Page 66

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