DISCIPLINE SUMMARIES
the patient's knowledge, that would be grounds for
revocation of Dr. Shuen's privileges, and potentially
"battery" if the patient was unaware. Subsequent dis-
cussions with the patient confirmed that the patient
was unaware of and did not consent to any medica-
tion being placed in her vagina.
In May 2016, a hospital incident report reflected
that five of Dr. Shuen's patients arrived in triage with
rapid labours. One of the patients required an im-
mediate caesarean section. The incident report noted
that there was a surge of patients with imminent
deliveries on Saturday when less staff and resources
are around, that this type of activity is not consistent
with the practice of other members of the depart-
ment, and that due to multiple precipitous deliveries
arriving after being seen in a physician's office, ques-
tions are raised about whether induction measures
are being instituted in the office, which would fall
outside of best practices with respect to monitoring
for patients.
HOSPITAL INVESTIGATION
In summer 2016, one of Dr. Shuen’s patients was
admitted and the nurses were surprised about how
quickly her labour progressed given that this was her
first child. On internal examination of the patient,
the nurse found white pill fragments on her glove.
The hospital commenced an investigation. Disclo-
sure was made to the patient and it was confirmed
that the patient was unaware of and did not consent
to any medication being placed in her vagina. Dr.
Shuen never discussed this with her. A chemical
analysis conducted on the substances found in Dr.
Shuen's patients in 2015 and 2016 confirmed that
they were misoprostol.
On August 18, 2016, during a meeting with the
hospital authorities, Dr. Shuen was confronted about
his prior denials when he had been asked about
powdery white substances found in his patients. Dr.
Shuen was advised that the substances found in his
patients in 2015 and 2016 had been analysed and
were, in fact, misoprostol. At this meeting, Dr. Shuen
again denied any knowledge of these labour induc-
ing medications, and denied ever using them in his
office. After a lengthy discussion, including about the
potential for revocation of his privileges, Dr. Shuen
admitted that he had been using misoprostol in his
office for many years for out-patient inductions. Dr.
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DIALOGUE ISSUE 4, 2018
Shuen defended this practice as safe and asserted that
his outcomes were better than most of his colleagues.
Dr. Shuen’s active hospital staff privileges were sus-
pended on August 18, 2016.
On August 21, 2016, in his email to the hospital,
Dr. Shuen expressed remorse and took responsibil-
ity for what he had done. By letter dated August 22,
2016, Dr. Shuen resigned his privileges at the hospital.
COLLEGE INVESTIGATION
An expert retained by the College reviewed Dr.
Shuen’s seven hospital and corresponding office
charts and interviewed Dr. Shuen. The expert opined
that Dr. Shuen fell below the standard of care in his
practice of obstetrics by inserting an induction agent
into patients who had no indication for induction,
in an outpatient setting, without their knowledge or
consent. During his interview with the expert, Dr.
Shuen admitted, among other things, that he did not
inform patients, discuss the risks, or obtain patients'
consent before engaging in office-based inductions,
nor did he document this practice or keep records
documenting these patients' outcomes. This was
despite earlier suggestions by him, which were not
true, that the nurses at the hospital who had seen
his patients were aware of and had consented to this
practice. He admitted to engaging in this practice for
many years.
Dr. Shuen's practice was contrary to the hospital’s
practice and policies, and to the SOGC Guidelines for
Induction of Labour (2013 and updated in 2015).
PRIOR INAPPROPRIATE CONDUCT
In September 2012, the Chief of Obstetrics and
Gynecology spoke with Dr. Shuen about exceeding
his cap on deliveries. Dr. Shuen apologized, citing
financial pressure from his divorce. In January 2013,
the Chief of Obstetrics and Gynecology spoke to
Dr. Shuen about his inappropriate and intimidating
behaviour with patients and staff. He noted that Dr.
Shuen showed very little insight.
PRESCRIBING CONCERNS
Information was obtained from the Shoppers Drug
Mart Pharmacy located in Dr. Shuen's office build-
ing regarding medications ordered by Dr. Shuen for
"office use.” By letter dated May 15, 2017, Dr. Shuen
confirmed that he prescribed medications "for office