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