DISCIPLINE SUMMARIES
ous blocks;
• In several instances, Dr. Billing did not adjust
his treatment based on new evidence when new
findings or diagnostic results, such as imaging
became available, and/or he failed to record any
adjustments to treatment based on new findings or
diagnostic results; and
• When a patient notes a new area of pain, Dr. Bill-
ing often performs nerve blocks without document-
ing investigations to confirm the diagnosis.
Due to their proximity to the epidural space, para-
vertebral blocks (a block of the spinal nerve where
local anesthetic is injected in the paravertebral space)
must be done using appropriate sterile technique due
to the rare, but potentially severe consequences of
infection in this area, including epidural abscess and
paralysis.
“Sterile technique” means that everything used in
the injection must be sterile, including the target area
on the patient’s skin for the injection, which must be
cleaned in a sterile fashion; the syringe, the needle,
and the solution in the syringe; and the gloves, which
must also be sterile.
Dr. Billing’s technique in administering paraver-
tebral blocks had the following deficiencies with
respect to the sterile technique used:
• He used only alcohol swabs to sterilize the general
block area, not the stronger chlorhexidine spray.
According to Dr. Billing, he began to use chlorhexi-
dine spray when this issue was drawn to his atten-
tion by an expert;
• He administered injections to individual patients
using the same needle that had already been used to
perform occipital nerve blocks through the patients’
scalps. The scalp area is notoriously difficult to
sterilize;
• He did not appropriately maintain the sterility of
his gloves, in that although he started with sterile
gloves, while he was administering injections, he
used gloves that had touched unsterilized areas of
the patients, including their scalps.
ORDER
The Discipline Committee ordered: a two-month
suspension of Dr. Billing’s certificate of registration;
62
DIALOGUE ISSUE 2, 2018
terms, conditions and limitations on Dr. Billing’s cer-
tificate of registration; a reprimand and payment of
$5,000 to the College for costs.
The terms, conditions and limitations include a
12-month period of clinical supervision, with varying
levels of supervision in response to the findings of the
clinical supervisor; a reassessment three months after
the period of clinical supervision ends; cooperation
with unannounced inspections of his practice; and
providing consent to the College to make inquiries
of the Ontario Health Insurance Plan and/or any
person or institution that may have relevant informa-
tion, in order for the College to monitor and enforce
his compliance with the terms of this Order;.
For complete details of the Order, please see the
full decision at www.cpso.on.ca. Select Find a Doctor
and enter the doctor’s name.
APPEAL
On June 30, 2017, Dr. Billing appealed the pen-
alty decision to the Ontario Superior Court of Justice
(Divisional Court). On April 25, 2018, the Divisional
Court dismissed the appeal with $10,000 in costs to the
College.
DR. PETER MICHAEL FENTON
PRACTICE LOCATION: Toronto
AREA OF PRACTICE: General Practice
HEARING INFORMATION: Admission, Agreed Statement of
Fact, Joint Submission on Penalty
On March 20, 2017, the Discipline Committee
found that Dr. Fenton committed an act of profes-
sional misconduct in that he failed to maintain the
standard of practice of the profession and he engaged
in conduct or an act or omission relevant to the prac-
tice of medicine that, having regard to all the circum-
stances, would reasonably be regarded by members
as disgraceful, dishonourable or unprofessional. The
Discipline Committee also found that Dr. Fenton is
incompetent.
Dr. Fenton received his certificate of registration
authorizing independent practice in Ontario in June