discipline summaries
• In some instances, Dr. Wojcicki has provided care to patients with established medical diagnoses and has not treated these patients in a manner consistent with standard medical practice.
In response to the College expert’ s report, Dr. Wojcicki retained Dr. Z, a practitioner of integrativecomplementary / alternative medicine, to provide an opinion with respect to his care and treatment of patients at the Vivian Medical Spa. Dr. Z opined that“ Dr. Wojcicki’ s care, as demonstrated in the chart review, did not meet the standard of care expected of the profession. Dr. Wojcicki demonstrates a lack of compliance and understanding of the CPSO’ s policy related to CAM Practice. He has displayed a lack of judgment in his care, and a failure to provide proper informed consent. His record-keeping is inadequate. Illustratively, Dr. Wojcicki demonstrated a lack of judgment in the prescribing of bio-identical estrogen replacement to a receptor positive breast cancer patient. The patient record does not contain any evidence of a consent discussion. Also of significant concern is the application of chelation therapy without fulsome assessment or proper informed consent, to a patient on whom he initiated intravenous chelation therapy by way of email correspondence.” Dr. Z stated that“ it is imperative that standard therapies be discussed and documented in the patient chart prior to initiation of any CAM modality, according to the CAM policy of the CPSO. This fact is not consistently demonstrated by Dr. Wojcicki, nor is there sufficient evidence of robust discussion / documentation of risks of therapies offered or denied. This would apply particularly to his management of dyslipidemia, and hormone deficiency syndromes,” he stated.
Hospital Practice The College commenced an investigation into Dr. Wojcicki’ s hospital based internal medicine practice. The College retained an independent expert, Dr. R, to opine on 25 patients charts. Dr. R stated that Dr. Wojcicki’ s care and documentation fell below the standard of practice of the profession in 16 out of 24 charts. Dr. R found four instances that demonstrated Dr. Wojcicki’ s lack of knowledge, including:
• In two cases, a full dose of enoxaparin was ordered in a patient with severe renal insufficiency;
• An incorrect dose of IV Zantac was prescribed; and
• The wrong dose of Digoxin was prescribed.
With respect to his lack of judgment, Dr. R found that Dr. Wojcicki:
• Did not address elevated troponin and creatinine levels in testing done in the E. R. for one patient;
• Did not acknowledge or treat pneumonia perceived on chest x-ray done in the E. R. for one patient;
• Ordered triple anticoagulation for a patient without sufficient evidence it was needed;
• Ordered medications a patient was taking at home without regard for E. R. clinical status;
• Ordered anticoagulant and laxatives in a patient with bloody diarrhea; and
• Did not consider that a follow-up appointment was needed for patient to receive biopsy results.
With respect to lack of skill, Dr. R stated:“ There was consistent criticism of inadequate consult notes and discharge summaries. I felt that the consult notes were very brief and did not reflect the consultation that would be expected from an internist. The discharge summaries generally did not provide a good picture of the events of the hospitalization.” Dr. R found that the following examples from the charts demonstrate that Dr. Wojcicki’ s practice, behaviour or conduct exposes or is likely to expose patients to harm or injury:
• Triple anticoagulant therapy based on diagnosis of Acute Coronary Syndrome, without firm evidence to support this diagnosis;
• Two cases of prescribing a full prophylactic dose of enoxaparin when creatinine levels were, respectively, 1479 and 379;
• Ordering prophylactic anticoagulation in patient having bloody diarrhea and ordering NSAID in same patient with history of esophagitis and preplyoric ulcerations; and
• Ordering a dose of Digoxin 0.625 mg instead of 0.0625 mg.
In response to Dr. R’ s opinion, Dr. Wojcicki provided an expert report by Dr. U dated July 16, 2015. In sum-
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Dialogue Issue 4, 2016