DISCIPLINE SUMMARIES
and controlled substance prescribing, and do not meet the standard of care of the profession for a family physician as follows:
• Dr. Fenton’ s recorded histories are often nonexistent and lack detail to understand the patient’ s story. His documented physical examinations are either lacking entirely or insufficient for the complex chronic pain condition this patient reports. No investigations are done with respect to Patient A’ s physical pain or anxiety conditions. Impressions and management plans are not outlined regularly. Not all prescriptions given are recorded in the EMR. Rationale for the prescription of medications( choice of drug, dose or quantity), including many controlled substances, is not found in the medical record. CPP was not completed until after the patient was discharged from the practice;
• Dr. Fenton’ s prescribing of controlled substances including narcotics, benzodiazepines and stimulants is excessive and without documented justification;
• Prescription information from the NMS database and Dr. Fenton’ s chart calculate over 1000 morphine equivalents daily – well in excess of“ watchful dose” limits. There is a lack of evidence of application of recognized controlled substance prescribing guidelines. There is no adequate discussion of side effects, risks and alternative analgesic options. There are no clear treatment goals documented. There is no documented indication for either stimulant or sedative medication, or discussion about the use [ of ] both categories of medication being prescribed concurrently. There is no supporting documentation of underlying diagnoses to support the use of these medications. There is no supporting evidence of favourable clinical outcomes as a result of these treatments.
• Dr. Fenton appropriately advised Patient A that because of repeated breaches of their opiate treatment agreement, he would no longer continue to prescribe controlled substances for Patient A. This would be partially considered to be within the standard of care for termination of a physicianpatient relationship as per College policy, however the policy also indicates a copy of this letter should be sent by registered mail to the patient and a copy be in the patient record. There is no documentation in the chart or in the patient complaint that the patient received such a letter. In addition, in considering termination of the patient-physician relationship, there is no evidence that arrangement for any consultations with a pain clinic or alternate provider were made which would also be within the standard of care in family medicine. More importantly, there is no evidence of strategies to taper doses of her various medications or dispensing smaller quantities at one time,( which would have potentially mitigated some of the risk of her having been taking such high doses of narcotics and sedatives) prior to her dismissal.
It was found that Dr. Fenton is incompetent and failed to maintain the standard of practice in his care and treatment of Patient A, as described above, including his failure to follow the College’ s Ending the Physician-Patient Relationship policy.
Patient B In January 2015, the College received a complaint from Patient B who had been a patient of Dr. Fenton’ s from approximately July 2008 until November 2014. Patient B’ s medical history includes hypertension, hypercholesterolemia, diabetes and chronic pain. The College expert opined that Dr. Fenton’ s care of Patient B did not meet the standard of care including in his record keeping, his chronic disease management and his follow-up on abnormal test results and suggestions of consultants. Specifically, the expert noted the following deficiencies:
• There is evidence that medications are prescribed but not recorded within the EMR. A large gap exists in that there is no evidence of chronic disease management between the periods June 2013 to May 2014. There is evidence that abnormal test results and suggestions made by a consultant( in this case, the ER doctor) are not followed up;
• Dr. Fenton’ s treatment of [ Patient B’ s ] hypertension is not clear from the documentation found in the
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DIALOGUE ISSUE 2, 2018