discipline summaries
Aggravating factors Dr. James’ poor antiseptic technique Dr. James’ clinical care was brought to the attention of the College after Toronto Public Health suspected a meningitis outbreak. Toronto Public Health examined a total of 272 patients who received epidural injections from Dr. James between August and December 2012. Nine patients were found to have serious infections. The College’ s enquiry found six patients, two of whom overlapped with the Toronto Public Health enquiry. In total, 13 patients became infected. Toronto Public Health noted serious breaches of antiseptic technique during its visit to Dr. James’ clinic, including: the patient’ s sterile field was not covered; Dr. James used a non-sterile gauze after a procedure; Dr. James’ gloves were too large; he used a mask but its nose was not pinched; he did not often allow the betadine antiseptic to dry; he touched many surfaces after donning sterile gloves; and he wore his wedding band throughout the procedure. Moreover, Dr. James did not wipe the multi-dose vials of local anesthetic with 70 % alcohol prior to accessing with a syringe. This was also not done with single use vials. This practice would put patients at increased risk of infection. Reviewers also found needles left in partially-used vials, a practice that should never be followed because air contaminants in the room could easily enter the vials. The Committee found that there were very serious breaches occurring over many months, and the consequences have been devastating. The breaches affected people’ s lives permanently, physically and emotionally, with significant effects for patients and their families. Dr. James’ breaches also undermined his patients’ trust in the medical profession. Some patients have permanently lost the control of their bladders and bowels and cannot walk without canes or walkers. All of the impact statements strongly urged that action be taken so that this type of problem should never happen again. They expressed a sense of betrayal that their authors felt about the medical profession.
Lack of Self-Scrutiny and Response to Patients in Distress Over a relatively brief period of time, many of Dr. James’ patients became seriously ill. Although Dr. James was made aware of some of the patients’ complaints, he tended to dismiss them as involving an allergy to the preservative. Dr. James was often too busy to see the patient, and at times he became annoyed with patients requesting such follow up. Had he clinically assessed these patients himself, and noted the frequency of these infections, Dr. James might have alerted himself and others to the problem much sooner.
Communication with Patients One patient( Patient E) commented that when she finally saw Dr. James about the abscess in her elbow, he was stern with her and told her that he was annoyed. He lectured her on her abusive attitude to two of his nurses, and told her that this was not a walkin clinic. When he looked at her elbow, he thought mistakenly that it was a reaction to the preservative and suggested the use of cortisone cream.
Breach of Ethics The Committee was dismayed that Dr. James had sought to manipulate the nursing staff at his clinic into falsely describing his antiseptic technique when he knew he was under College investigation. In an effort to thwart the College, Dr. James attempted to influence how nurses would answer College investigators’ questions by writing a false“ prep sheet.” The procedures described on the“ prep sheet” did not correspond to the actual techniques Dr. James used. Furthermore, Dr. James was dishonest with the College investigators in describing what he did and the purpose of the“ prep sheet.” Importantly, Dr. James’ medical records in several cases did not correspond with material written in hospital records when patients were referred.
Questionable Remorse Counsel for Dr. James submitted to the Committee that Dr. James felt devastated by these infections and their consequences. At times, Dr. James did attempt to phone some of his patients after they had been ill, but this was not a consistent practice. Several pa-
52
Dialogue Issue 1, 2017