discipline summaries
nectomies. The likely etiology of the epidural abscess was believed to be the epidural injection.
Reasons for Penalty The following facts were set out in an Agreed Statement of Facts for penalty and were accepted by the Committee:
1. Dr. James was cooperative with the Toronto Public Health investigation, as well as the look-back process.
2. The College retained Dr. EE, Medical Director of Infection Prevention and Control at an Ontario hospital, and associate professor of medicine at an Ontario university, to provide an opinion regarding Dr. James’ infection control procedures. Dr. EE conducted an inspection and observation of Dr. James in January 2013. Dr. EE had a few recommendations for further improvement but concluded:“ Dr. James meets the standard of practice of the profession with respect to infection control procedures. … Dr. James does not display a lack of knowledge, skill or judgment. … Dr. James’ clinical practice, behaviour or conduct do not expose or are likely to expose his patients to harm or injury.”
3. Dr. James retained Dr. GG, an expert in anesthesiology and chronic pain, to review the care and treatment that Dr. James provided to Patients A, B and C. Separate and apart from the issues of aseptic technique and infection control, Dr. GG was supportive of the care and treatment that Dr. James provided to Patients A, B and C and delivered expert reports outlining his opinions in that regard. Given the timing of the referrals to discipline of Patients D, E and F, Dr. James did not receive and provide to the College expert reports in respect of the care he provided to them.
4. On April 1, 2014, the Inquiries, Complaints and Reports Committee approved an appointment of investigators to conduct a broad investigation into Dr. James’ clinical practice in interventional pain management. The College retained Dr. JJ, FR- CPC, Anesthesiology, to review 25 patient charts, observe Dr. James in practice( performing 10 procedures) and conduct an interview. Three of the charts reviewed were Patient X, W and Z, revealed in the Toronto Public Health investigation as having contracted Staph aureus. In respect of each of the remaining 22 cases reviewed, and in respect of each of the 10 procedures observed, Dr. JJ concluded that Dr. James’ care and treatment met the standard of practice of the profession. Dr. James did not display any deficiencies in knowledge, skill or judgment, nor did his practice, behaviour or conduct expose or likely expose his patients to harm or injury. Dr. JJ concluded Dr. James to be a knowledgeable, skilled and competent physician, practising to a high standard.
5. On May 22, 2015, Dr. James completed a series of online infection control courses offered by Public Health Ontario.
6. Dr. James advised the College of his intention to perform procedures at a new clinic. Prior to the opening of that clinic, the Associate Director of Infection Prevention and Control at a hospital network in Ontario was sent by the College to review the clinic’ s physical layout, as well as its policies and procedures. The assessment report made some recommendations about changes to the premises( for example, cupboards should be changed from being wall-mounted to being on the floor, sinks should be wall-mounted, certain configuration changes to the rooms should be made.) These changes were made and the premises received a pass with conditions on July 15, 2015. The Premises Inspection Committee will conduct a further inspection-assessment within six months of the new clinic becoming operational to observe procedures and review record-keeping documentation.
7. On September 21, 2015, a College-approved assessor, the Medical Director of Infection Prevention and Control at Hamilton Health Sciences, attended for an unannounced inspection of Dr. James’ practice at the Rothbart Centre for Pain Care. The assessor reviewed the setting and observed Dr. James perform two procedures: an epidural
50
Dialogue Issue 1, 2017