discipline summaries in an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional. The Discipline Committee also found that Dr. Wojcicki is incompetent. After receiving information from an anonymous source and from a physician, the College began a Section 75( 1)( a) investigation into Dr. Wojcicki’ s practice. Dr. X, an independent expert, provided an opinion on Dr. Wojcicki’ s internal medicine practice and complementary and alternative medicine( CAM) practice based on his care of 25 patients. Dr. X concluded that Dr. Wojcicki’ s care did not meet the standard of practice of the profession in all of the 25 charts reviewed. In 24 of these charts, Dr. X also found that Dr. Wojcicki’ s care reflected a lack of knowledge, skill and judgment and that his clinical practice is likely to expose many of his patients to a risk of harm or injury. The details of Dr. X’ s concerns include:
• Dr. Wojcicki’ s documentation practices do not meet the standard of practice of the profession. For example, he does not appear to use a Cumulative Patient Profile or similar instrument to document patient’ s previous and current medical problems and treatment;
• Dr. Wojcicki makes a diagnosis without explaining his reasoning in the same chart note [ which ] is particularly problematic in light of the unconventional diagnoses( e. g., adult hormone deficiency syndrome) that [ he ] reaches;
• In many instances, Dr. Wojcicki makes a treatment recommendation without indicating clearly why he has chosen a particular course of action;
• In many instances, Dr. Wojcicki recommends that patients with atherosclerosis undergo chelation and“ plaque therapy” which consists of intravenous administration of phospholipids and other agents. This treatment is not considered standard and … if offered should be done so in the context of an approved research study or under the auspices of the CPSO’ s Complementary / Alternative Medicine policy;
• In several instances, not only with regard to plaque therapy and intravenous chelation, but also in regard to bioidentical hormone replacement therapy … Dr. Wojcicki’ s practice does not adhere to CPSO’ s
Complementary / Alternative Medicine policy;
• Dr. Wojcicki recommends that patients with testosterone levels below the reference range be treated with testosterone creams, even in older adults( e. g., patients over the age of 65) who do not have symptoms and signs strongly suggestive of testosterone deficiency, and even in those with a history of prostate disease;
• Dr. Wojcicki recommends that patients with“ adult hormone deficiency syndrome” or simply“ hormone deficiency” be treated with growth hormone [ and ] in some cases this diagnosis is reached even when IGF-1 is within the reference range … the standard of practice is such that the diagnosis would generally be made or confirmed by an endocrinologist [ and ] treatment should also generally occur under the supervision of an endocrinologist;
• In many instances, Dr. Wojcicki appears to have ordered tests that are not indicated given the clinical circumstances – e. g., C-peptide levels, FSH and LH levels in women who are obviously post-menopausal, estradiol and progesterone in men, co-enzyme Q10, Vitamin A, mercury, various tumour markers, etc. … the ordering of these tests reflects a lack of knowledge and judgment and is inconsistent with the standard of practice;
• In one instance, Dr. Wojcicki treated a patient with a history of estrogen receptor positive breast cancer with estrogen. Such treatment is contra-indicated and … should only be offered in extremely unusual circumstances with the approval of a patient’ s oncologist;
• Dr. Wojcicki treated post-menopausal women with estrogen. Because of the increased risk of cardiovascular disease, the standard of practice is that estrogen should only be used to treat severe menopausal symptoms, for a short period of time, and only after discussion of benefits and risks;
• In at least one instance, he treated a patient with newly diagnosed metastatic breast cancer with unconventional treatments without documenting a discussion regarding chemotherapy and without referring her to a medical oncologist; and
Full decisions are available online at www. cpso. on. ca. Select Doctor Search and enter the doctor’ s name.
Issue 4, 2016 Dialogue 75