discipline summaries
mia had been managed and resolved prior to her
arrival in the emergency department, there were a
number of clinical aspects of her presentation that
were not addressed during her brief stay in the
emergency department such that she could be safely
discharged; and
• The well-being of the fetus was not adequately assessed during the patient’s emergency department
evaluation and the significantly elevated blood
pressure was unaddressed. No fetal heart rate was
recorded and no follow-up was arranged regarding
the dangerously high blood pressures.
On the basis of two complaints in 2008 and Dr.
Huebel’s history with the College (Caution-in-person
in 2004, Caution-in-writing in 2006), the College
commenced an investigation of Dr. Huebel’s emergency medicine practice.
In 2010, Dr. Huebel entered into an undertaking
with the College. That undertaking provided that Dr.
Huebel would be subject to supervision for a period
of six months, after which he would be reassessed by
the College.
In her report to the College, Dr. Q, assessor for the
College, noted that Dr. Huebel’s charting was illegible, that there was a consistent pattern of deficiencies in Dr. Huebel’s documentation of patient history, physical exam, working or provisional diagnosis
and reassessments prior to discharge, that significant
results for investigations and lab tests were not documented, and that Dr. Huebel’s use of consultants was
problematic as he relied on them to assume care of
his patients with no further management by him.
Commencing in 2013, Dr. Huebel has undertaken
significant remedial and educational efforts to expand
his knowledge base and improve his practice, which
included: becoming a member of the College of
Family Physicians of Canada, obtaining 198.3 CME
credits from January 2013 to October 2014, and he
applied for and was accepted into the Alternative
Route for Certification (ARC) program, which is a
practice eligible route to the CCFP Designation.
In the context of its investigation of Dr. Huebel’s
emergency medicine practice, the College retained
Dr. Y to review Dr. Huebel’s practice. Dr. Y found
Dr. Huebel’s clinical handling of the 14 patient
encounters he reviewed to be appropriate and that he
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met the standard of care expected by the profession
and did not expose any of his patients to harm or
injury. In March 2014, Dr. S, Chief of Dr. Huebel’s
Emergency Department, advised the College of improvements to Dr. Huebel’s clinical practice over the
past year.
In May 2014, Dr. Huebel entered into an undertaking with the College, pending this hearing. Pursuant to the undertaking, Dr. Huebel retained Dr. T,
Chief of Emergency Services, as a clinical supervisor.
To date, Dr. T has expressed no concerns about Dr.
Huebel’s care or treatment of patients. On January
13, 2015, Dr. Huebel signed an undertaking with the
College requiring him to continue supervision with
a clinical supervisor, continue in the ARC program,
and submit to two reassessments of his practice.
Reasons for Penalty
Counsel for the College and counsel for Dr. Huebel
made a joint submission as to an appropriate penalty
and costs order.
The Committee found that Dr. Huebel failed to
maintain the standard of practice of the profession in
his emergency department care of two patients. With
respect to Patient A, Dr. Huebel failed to consider a
diagnosis of aortic dissection on classic presentation
of difference in blood pressures and to order immediate investigations to rule out that diagnosis as a
possibility. Regarding Patient B, who was an insulindependent diabetic and seven months pregnant, Dr.
Huebel’s documentation was inadequate, there were
significant deficits in his assessment and management
of Patient B and also an inadequate assessment of the
well-being of the fetus.
The Committee considered the aggravating and
mitigating factors in this case. Miti