DISCIPLINE SUMMARIES
relationship and in circumstances where she has conducted a complete assessment.
The Inquiries, Complaints and Reports Committee( ICRC) cautioned Dr. Ruggles in writing regarding inappropriately prescribing narcotics and treating a person with whom she had a work-related association, including by prescribing narcotics to that individual. The ICRC noted that Dr. Ruggles’ prescription of narcotics and other medications to a person with whom she had a work-related association was clearly inappropriate; that this was an isolated event in Dr. Ruggles’ practice; and that Dr. Ruggles admitted to the indiscretion and agreed to appropriate remediation. The ICRC also required Dr. Ruggles to complete a boundaries course and a narcotics prescribing course, which she completed in 2012.
2013 College Investigation In May 2013, another individual with whom Dr. Ruggles had a work-related association(“ Individual 2”) called the College to advise that Dr. Ruggles had been prescribing narcotics to that individual.
The College commenced a s. 75( 1)( a) investigation and obtained pharmacy records, which demonstrated that Dr. Ruggles had written the following prescriptions for Individual 2:
July 6, 2011: Clonazepam 5mg, 180 tablets, with 2 repeats
Nov 3, 2011: Azithromycin( Zithromax) 500 mg po OD, then 250mg po 4 days
July 25, 2012: Macrobid, 100mg for 7 days Naproxen 500mg po tid, 80 tablets, with 1 repeat; Oxy IR 10mg, 60 tablets, with 1 repeat
Nov 20, 2012: Oxy IR 10mg, 60 tablets, with 1 repeat; Naproxen 500mg po tid no substitution, 80 tablets, 1 repeat
Dec 10, 2012: Tamiflu, 75mg, 5 day supply
In her response to this investigation, Dr. Ruggles admitted to treating Individual 2 and to providing these prescriptions to Individual 2 during their workrelated association.
Dr. Ruggles wrote the first prescription for Individual 2 within weeks of her June 14, 2011 response to the College’ s previous investigation. Dr. Ruggles wrote the additional prescriptions for Individual 2 both before and after she completed the boundaries and narcotics prescribing courses required by the College, and both before and after she received the ICRC decision cautioning her for this behaviour.
Expert Report The College retained an expert to review Dr. Ruggles’ care of patients in her office practice. The expert stated that the main issues of concern, ordering much larger amounts of narcotics than commonly prescribed, in particular, Oxycodone, Clonazepam, and Ativan, were found in three of the 24 charts reviewed and the related prescription analysis.
One of these three charts was that of Individual 2. The care Dr. Ruggles provided to Individual 2 did not meet the standard of practice. The expert noted:“ A large amount of narcotics and sedatives were prescribed … She did not show good judgment and her management of this patient fell below the standard of practice. The same can be said about the doctor’ s failure to recognize the conflict of interest and potential harm created by continuing to keep [ Individual 2 ] as a patient … Dr. Ruggles also failed to maintain proper boundaries in this relationship.”
With respect to a second patient, the expert stated:“ I find it concerning that the patient was seen only twice within one month and had two prescriptions for a total of 300 Oxy RI [ sic ] tabs, 200 Ativan tabs, and 180 Rivotril tabs. Based on the above information, I feel that in this case the standard of care was not met. The physician was not likely prescribing within her scope of practice and did not show good judgement.”
With respect to a third patient, the expert noted that the patient was given a prescription of 200 Percocets in March 2011, and 60 Percocets and 60 Toradol in June 2011. Thirty more Percocets were prescribed in November 2011. The expert concluded that this was overly generous prescribing and that Dr. Ruggles did not meet the standard of care as she prescribed an excessive amount of narcotics, putting the patient at risk.
The expert opined that Dr. Ruggles demonstrated a lack of knowledge and judgment in respect of these
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DIALOGUE ISSUE 1, 2018