DISCIPLINE SUMMARIES
• Certain use of“ off label” prescribing and potentially harmful prescribing( including prescribing HCG as described above; potentially harmful prescribing of narcotics for non-cancer pain; prescribing benzodiazepines with narcotics; prescribing Methotrexate and Plaquenil without indication; prescribing hormone replacement therapy without appropriate documentation and assessment; prescribing high doses of vitamin D; prescribing iron and high doses of vitamin B without indication);
• Failure to meet the standard in his documentation of consent for“ off label” or potentially harmful prescribing, and other failures of documentation;
• Lack of documentation of appropriate follow-up on test results;
• Failure to document history, physical examination, diagnosis, and informed consent when prescribing complementary and alternative medicines, and prescribing some such medicines which he knew had no medical evidence for use, such as HCG; and
• The use of excessive laboratory testing in the absence of clear documentation of medical need.
In December 2015, the College requested updated patient records from Dr. Barnard for 10 patients whose care had been reviewed. It was found that Dr. Barnard’ s care did not meet the standard of practice in any of the charts reviewed and that his care continued to display a lack of knowledge, skill and judgment. It was found that Dr. Barnard failed to maintain the standard of practice of the profession in his care of 37 patients as described above.
Investigation Regarding Patient A Patient A became Dr. Barnard’ s patient in the Barnard Wellness Centre in May 2012. Patient A had a history of testosterone levels having been documented as low by other physicians as recently as 2011, but it was very high based on the initial bloodwork ordered by Dr. Barnard in May 2012. Dr. Barnard treated Patient A, including continually prescribing testosterone injections from July 2012 until April 2013, when Dr. Barnard severed the doctor-patient relationship. The College retained a family physician with a focus in men’ s health, including testosterone deficiency, to review Dr. Barnard’ s care in regard to Patient A, who found that Dr. Barnard did not meet the standard of practice of the profession in that he:
• Displayed poor documentation and record keeping of his thought process and / or discussions with Patient A;
• Failed to adequately counsel Patient A in the hazards of continued steroid use;
• Failed to try to have Patient A adhere to a more traditional protocol for testosterone replacement, with lower initial dosing and further titration based on serum testosterone levels and / or symptom management, and escalated the dosage of testosterone without monitoring hematocrit; and
• Demonstrated poor judgment in embarking on an unorthodox treatment plan of high dosing with little monitoring that was not in the best long-term interests of the patient.
It was found that Dr. Barnard failed to maintain the standard of practice of the profession in his care of Patient A.
Investigation Regarding Patients B and C Patient B became Dr. Barnard’ s patient in March 2012 and his wife, Patient C, became Dr. Barnard’ s patient in February 2013. Dr. Barnard terminated both patients from his practice in April 2013. Dr. Barnard treated Patient B for chronic pain. He prescribed Lyrica, Cymbalta, Botox injections, vitamin injections and testosterone injections beginning in May 2012. Dr. Barnard did not record Patient B’ s serum testosterone levels before prescribing testosterone injections. The College retained a family physician to review the care provided by Dr. Barnard to Patients B and C. He opined that the care provided to both patients fell below the standard of the profession based on a lack of skill, knowledge and judgement and that Dr. Barnard’ s care exposed them to harm. Specifically, he stated that Dr. Barnard:
• Demonstrated a lack of skill in the quality and quantity of his information gathering, in his record keeping and in his performance of proper physical assessments;
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DIALOGUE ISSUE 2, 2018