DISCIPLINE SUMMARIES
• l acked knowledge about the risks of polypharmacy
and the risks of treating chronic pain with opioid
analgesics;
• demonstrated a lack of judgment by continuing to
prescribe drug combinations with known risks of
harm, by continuing to prescribe narcotics when it
was obvious that the patient was unable to control
her use and the medication was doing more ‘to’ her
than ‘for’ her, and by continuing to provide the
patient with large numbers of narcotics when he
knew the patient was unable to prevent theft by her
husband.
It was found that Dr. Barnard failed to maintain
the standard of practice of the profession in his care
and treatment of the patient.
On November 9, 2014, Dr. Barnard signed an
undertaking to the College restricting him from
prescribing any narcotics, controlled drugs, benzo-
diazepines/other targeted substances and all other
monitored drugs and narcotics preparations, with
the exception of Tylenol with codeine #3 in limited
amounts.
Pre scribing Practices
The College conducted a broader investigation into
Dr. Barnard’s prescribing practices with respect to 25
patients. A family physician retained by the College
concluded that Dr. Barnard’s care of 11 patients did
not meet the standard of practice and that he dem-
onstrated various degrees of a lack of knowledge,
skill or judgment. He opined that in seven charts
the care provided posed a potential risk of exposing
patients to harm or injury and, of these seven, the
risk of harm was particularly high with respect to
four patients.
The four cases in which it was concluded that the
risk of exposing the patient to harm or injury was
particularly high were those in which:
• A patient was receiving frequent morphine in-
jections as well as other narcotics while she was
pregnant;
• A patient who had severe migraine headaches was
receiving frequent morphine injections as well as
nasal butorphanol, the amounts of which were well
in excess of recommended guidelines for non-can-
cer pain;
• A patient was receiving very frequent morphine
injections for chronic pelvic pain, much in excess of
recommended guidelines; and
• A patient’s chart contained indications from anony-
mous phone calls that he was selling his medication
and a letter from the Children’s Aid Society express-
ing concern of large amounts of narcotic medica-
tion in a household with small children.
It was found that Dr. Barnard failed to maintain
the standard of practice of the profession in his care
of 11 patients.
Broader Patient Care
On September 18, 2012, the College received in-
formation regarding Dr. Barnard from the Ministry
of Health and Long-Term Care (MOHLTC) as a
result of a review of his medical records for services
completed in 2009. The MOHLTC medical advi-
sors identified clinical concerns with respect to Dr.
Barnard’s patient care.
The College retained a family physician to provide
an opinion regarding the standard of care provided
by Dr. Barnard to 37 patients. The family physician
concluded that the standard of care was not met
in any of the cases reviewed and that Dr. Barnard
displayed a lack of knowledge and judgment in
each case. She also opined that Dr. Barnard’s clini-
cal practice and conduct exposed all but one of the
patients whose care was reviewed to a risk of harm.
The conclusions were based, in part, on the following
concerns:
• The administration of human chorionic gonadotro-
pin (HCG) for weight loss in the management of
obesity despite it being discredited and rejected by
the medical community;
• Numerous, significant examples of disjointed and
episodic care with poor record keeping and judg-
ment that impairs the provision of an adequate
diagnosis and case management;
Full decisions are available online at www.cpso.on.ca.
Select Find a Doctor and enter the doctor’s name.
ISSUE 2, 2018 DIALOGUE
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