DISCIPLINE SUMMARIES
Dr. Price provided details of his interactions with Patient A in response to the complaint. Some of these details were inconsistent with Patient A’ s descriptions of his appointments with Dr. Price, including Dr. Price’ s statement that Patient A refused, during an appointment, to consent to a physical examination. While Patient A denied ever having refused a medical examination by Dr. Price, the medical records provided by Dr. Price supported his version of events as set out in his response letter. A College investigator asked Dr. Price whether his chart entries were made contemporaneously to Patient A’ s visits or whether there were any changes, additions or deletions made to any of the chart entries following the date-time of Patient A’ s visits. Dr. Price wrote in response that“ All chart entries made regarding [ Patient A ]’ s visits were made at a time that was contemporaneous to the visits” and“ All entries were made on the dates indicated in [ Patient A ]’ s records, and at the same time as the other entries included under each date-entry.” Dr. Price claimed this was consistent with his“ regular charting practice.” The College retained a forensic examiner who concluded that multiple entries in Patient A’ s chart were written during different writing episodes from the remainder of the handwriting on that page. The College investigator sent the forensic report to Dr. Price in May 2015 and requested his comments. In his June 2015 response, Dr. Price did not dispute the forensic conclusions reached by the forensic expert. In his June 2015 response, Dr. Price advised the College, for the first time, of the following:( a) He frequently writes chart notes in different sittings and with different pens;( b) It is often the case that chart entries are not fully completed at the end of the appointment;
( c) It is his practice to make additions to his charts when doing dictations, performing chart audits, and during subsequent visits; d) He is sometimes unable to complete his charting until“ a couple weeks” after appointments or within a“ reasonable time period” thereafter;( e) He often brings his patient charts home to complete his charting;( f) Entries are made from different locations at different times;( g) He is present at the medical cannabis clinic only on Mondays and uses the rest of the week to complete chart entries; h) He cannot recall when he completed the entries in Patient A’ s chart;
( i) He may have backdated his notes in Patient A’ s chart;
( j) He may have written“ discussed pain Scale Score to be 20”, purporting to be written on the date in early April 2013, after he received the late April 2013 document;
( k) He would have written the phrase“— Secretary feels threatened by conversation”, purporting to be written in mid-April 2014, at a later time;
( l) He may have written the phrases“ 1yr”,“ no renewal”,“ Refusing exam” and“ May have to D / C licence if this continues”, purporting to be written on a date in mid-January 2014, weeks after mid-January 2014.
REASONS FOR PENALTY AND COSTS The joint penalty submission included a three-month suspension and a number of terms on Dr. Price’ s certificate of registration. The Committee considered the principles related to the determination of penalty and found that they were addressed in the joint submission. The Committee expressed its abhorrence of Dr. Price’ s behaviour by means of the three-month suspension and the reprimand. Protection of the public, specifically the protection of current and future patients, is achieved with the stipulation that mandates the use of an electronic medical record-keeping system. Dr. Price will be expected to comply with the College policy on Practice Management while on an extended leave, thus protecting his current patients. The public will be protected in the future by the College’ s monitoring of Dr. Price’ s compliance with unannounced inspections of his practice locations and by making inquiries of the Ontario Health Insurance Plan and other persons or institutions. The penalty will serve to maintain public confidence in the integrity and reputation of the profes-
Full decisions are available online at www. cpso. on. ca. Select Doctor Search and enter the doctor’ s name.
ISSUE 4, 2017 DIALOGUE 87