discipline summaries an epidural steroid injection performed by Dr. James at the clinic. Toronto Public Health’ s view regarding the cause of these infections is that Dr. James was colonized with Staph aureus, and due to breaches in IPAC, transmission of Staph aureus occurred from Dr. James to his patients. The patients revealed in the Toronto Public Health investigation suffered serious complications. Parts of their disease courses are described here:
a) Patient T received lumbar injections from Dr. James commencing in 2012. Following her last injection in October 2012, Patient T was admitted to hospital, vomiting and incoherent. She was diagnosed with bacterial meningitis. b) Patient U received lumbar injections from Dr. James commencing in 2011. In October 2012, she received three lumbar / thoracic epidural injections. In late October or early November, Patient U began suffering from headaches, nausea, vomiting, confusion, blurred vision, tremors. In November, she notified the clinic that she was suffering persistent headaches. Shortly after, she was admitted to hospital and diagnosed with meningitis.
C) Patient V received lumbar injections from Dr. James commencing in 2010. Following a lumbar injection in July 2012, she developed fever and sought attention at the emergency department. She was discharged with negative blood and urine cultures. She subsequently sought treatment from her family physician complaining of pain, fever and difficulty urinating. She received additional injections from Dr. James on two occasions in August of 2012. In September 2012, she suffered a stroke and on investigation, it was discovered that many sites on her spine were infected with abscesses requiring hospitalization and the insertion of a PICC line. d) Patient W received lumbar injections from Dr. James in September and October 2012. Shortly after his injection in October 2012, Patient W experienced back pain and fever and went to the hospital, but an MRI revealed no abscesses. In November 2012 he was admitted to hospital with on going fever and increasing weakness. A lumbar epidural abscess was found and an emergency laminectomy was performed. e) Patient X received lumbar injections from Dr. James commencing in 2012. Following his last injection in November 2012, Patient X developed a fever and was hallucinating. He was admitted to hospital where he was diagnosed with an epidural abscess and Staph aureus infection requiring evacuation and spinal decompression. Patient X required further surgical intervention. f) Patient Z received lumbar injections from Dr. James commencing in 2012. After her third injection in September 2012, Patient Z experienced increasing back pain and developed a fever. She was admitted to hospital with two epidural abscesses and sepsis.
The College retained Dr. N, to provide an opinion regarding Dr. James’ infection control procedures. Dr. N was asked to opine on Dr. James’ practices prior to Toronto Public Health intervention largely on the basis of the information gathered by Toronto Public Health. In a report dated December 20, 2013, he opined, among other things, that Dr. James practices prior to their revision fell below the standard of infection control practice expected of a physician performing such procedures and concluded that these breaches were of a major nature and resulted in an uncommon serious outbreak. The College also received several public complaints from patients who suffered serious complications:
i) Regarding Patient A, Dr. James administered lumbar steroid injections in August, September and October, 2012. At the October appointment, Patient A states that she noticed that Dr. James did not wear sterile gloves or a mask; and stated that she did not have iodine put on her back like previous times; her procedure felt rushed.
She felt unwell soon after the October appointment. By November, Patient A felt extremely confused, weak, and lethargic, and had a fever. Patient A was admitted to hospital and found to have a Staph aureus infection. She was diagnosed with meningitis and an epidural abscess precisely
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Issue 1, 2017 Dialogue 47