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