discipline summaries
the Discipline Committee. In 2007, he appeared
before a panel of the Committee and pleaded no contest to allegations that he displayed serious deficiencies in his medical record-keeping, and in prescribing
medication to a patient who was allergic to it. In addition to a reprimand and an order of costs, Dr. Nicol was ordered to practise under the supervision and
monitoring of a monitor, as well as to participate in
a program of professional education and mentoring.
He was also required to complete a Physician Review
Program (PREP) and abide by its recommendations,
and to take courses on medical record-keeping, and
medical ethics and informed consent. The 2007 decision of the Committee stated that Dr. Nicol would
be “deterred from further misconduct by the exigencies of this penalty”. The fact that Dr. Nicol was back
before the Committee admitting to similar allegations caused the Committee to be concerned that
specific deterrence had not been achieved.
The Committee recognized that the consideration
of an appropriate penalty involves balancing various
factors, with the protection of the public being the
key consideration. These factors include general and
specific deterrence, as well as the need to maintain
the confidence of the public in the profession’s ability
to self-regulate. The Committee was most concerned
to ensure that any penalty would have a specific
deterrent effect given the apparent lack of improvement in Dr. Nicol’s practice since 2007. The Committee was not satisfied that the penalty as originally
proposed would achieve specific deterrence. Although
the proposed penalty imposed certain restrictions on
Dr. Nicol’s practice, it otherwise provided for Dr. Nicol to practise without supervision after 12 months,
subject only to a re-assessment within three months.
The Committee expressed its concern about the possibility of recidivism given that the remediation that
was prepared for Dr. Nicol in 2007 did not achieve
its purpose, and that he appeared not to have learned
from the medical record-keeping course that he took.
The Committee indicated to counsel that it wanted
to see more monitoring after the re-assessment, to
ensure that the improvements to Dr. Nicol’s practice
that were noted in the Agreed Statements of Facts
Regarding Penalty continued.
In response to this, counsel added a term to the
proposed order, which provided for a further assess-
ment of Dr. Nicol’s practice after two years. In addition, College counsel advised the Committee that
the College now uses individualized education plans
(IEPs), that will measure Dr. Nicol’s progress in his
remediation.
The Committee recognized several mitigating factors. First, inadequacies in the previous monitoring
of Dr. Nicol may have given him the wrong impression that his remediation plan was working, and that
he was improving, when he was not. Second, since
January 2014, Dr. Nicol has displayed significant
improvements in his practice and record-keeping,
including the adoption of an electronic medical
record, which the Committee was advised has been
very helpful in dealing with Dr. Nicol’s medical
record-keeping. Also, by admitting to the allegation,
Dr. Nicol avoided the stress to witnesses, and the
cost and time expenditures that would be exacted by
a contested hearing.
The Committee was satisfied that Dr. Nicol’s
patients would be adequately protected by the
restrictions that are to be imposed on his practice.
Specific deterrence has been achieved through the
remediation plan that requires Dr. Nicol to practise
only under the supervision of a clinical preceptor
(whose recommendations must be followed) and
clinical supervisor, followed