discipline summaries
in a therapeutic abortion practice was inspected by the Premises Inspection Committee( PIC) and received a“ fail”. Accordingly, Dr. Sim was prohibited from performing any“ procedures”( as defined in s. 44( 1) of the General Regulation O. Reg 114 / 94, made under the Medicine Act, 1991), including therapeutic abortions, at his clinic. Among the reasons cited in the report for the“ fail” was the clinic’ s non-compliance with infection control standards set by the Outof-Hospital Premises Standards. The PIC notified the Registrar of the College of its concerns. Following an investigation, the Inquiries, Complaints and Reports Committee( ICRC) agreed that Dr. Sim should undertake in writing to undergo a re-inspection of his practice, as well as a re-assessment regarding record keeping and documentation and an infection control inspection of his premises. Additionally, the ICRC counseled Dr. Sim to ensure he practised within his scope of practice. After receiving the results of the reassessment and the inspection, the ICRC commenced another investigation of Dr. Sim’ s practice. The College retained a medical inspector to investigate infection control issues in Dr. Sim’ s practice. She found that Dr. Sim did not meet the standard of practice in infection control practices and instrument reprocessing. Additionally, she found that Dr. Sim’ s infection control and reprocessing practices may put patients at significant risk for harm in terms of transmission of infectious microorganisms, including antibiotic-resistant organisms and blood-borne pathogens. The College retained another medical inspector to opine on Dr. Sim’ s obstetrical and gynecological practice. He found that Dr. Sim’ s practice did not meet the standard of care for the practice of the profession, and that Dr. Sim performed surgical procedures that should not be performed in an office setting. Dr. Sim’ s practice of medically induced therapeutic abortions was of harm and danger to the patients because he converted many of these into surgical abortions if they did not succeed initially. The medical inspector concluded that, for this reason, Dr. Sim should cease from performing medical or surgical therapeutic abortions in an office setting.
Reasons for Penalty The Committee considered that protection of the public was the paramount consideration in determining the appropriate penalty. The Committee found that, in light of the multiple ways in which Dr. Sim placed his patients at risk, he could not be permitted to continue to practise. The Committee accepted the joint submission on penalty, whereby Dr. Sim undertook to resign from the College and to never reapply to practise medicine in Ontario. Had Dr. Sim not agreed to resign, based on the facts before the Committee, a very strong case could have been made that his certificate of registration should be revoked. The Committee stated that it was appalled by the conduct of Dr. Sim. The facts established a pattern of glaring deficiencies in his practice, insensitivity to the interests of his patients, lack of knowledge in critical areas, and impaired judgment. The effect was to place his patients at serious risk of harm. Although the evidence before the Committee did not establish that any of Dr. Sim’ s patients suffered actual physical harm as a result of his treatment, the risk of harm was significant. In particular, the Committee considered the following:
• Dr. Sim fell below the standard of practice in both infection control and instrument reprocessing procedures. His hand hygiene was inadequate; the white coat which he wore while performing procedures was an infection control hazard; and his sterile gloves were ten years past expiry. He delegated instrument reprocessing to individuals in his office who were neither properly trained in this area nor aware of best practices. His instrument cleaning and sterilization were inadequate. Reprocessed instruments inspected were found to have visible rust and / or debris on them. This created another infection control hazard, to which Dr. Sim and his staff appeared to have been oblivious. The result of Dr. Sim’ s practice deficiencies in this area placed his patients at risk of exposure to blood-borne pathogens and antibiotic-resistant organisms.
• Dr. Sim’ s record keeping was totally inadequate. His notes were sketchy, disorganized, and hard to
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Dialogue Issue 2, 2016