DISCIPLINE SUMMARIES
certificate after one year, in the absence of a find-
ing of sexual abuse, and that the possible date for an
application for reinstatement by Dr. Marcin will be
delayed by this newly imposed revocation.
For complete details, please see the full decision at
www.cpso.on.ca. Select Find a Doctor and enter the
doctor’s name.
DR. JAMES SCOTT BRADLEY MARTIN
PRACTICE LOCATION: London
AREA OF PRACTICE: Obstetrics/Gynecology
HEARING INFORMATION: Admission; Agreed State-
ment of Facts; Joint Submission on Penalty
On September 25, 2018, the Discipline Committee
found that Dr. Martin committed an act of profes-
sional misconduct, in that he has failed to maintain
the standard of practice of the profession. The Com-
mittee also found that Dr. Martin is incompetent.
During the relevant time period, Dr. Martin’s prac-
tice was focused on transgender care and hormone
replacement therapy.
In 2016, staff in the Ministry of Health and Long-
Term Care contacted the College with inquiries
regarding Dr. Martin's prior approval application
for a 14-year-old female-to-male transgender patient
seeking sex reassignment surgery (a mastectomy),
Patient A. As a result of the Ministry's inquiries,
investigators were appointed.
At the time the investigation began, Dr. Martin
described his practice as focused on transgender care
and hormone replacement therapy. He indicated that
he saw approximately 30 patients a week, spending
15 hours a week in direct patient contact.
Also in 2016, a relative complained to the Col-
lege about Dr. Martin's treatment of Patient B, an
adolescent male-to-female transgender patient. The
complainant voiced concerns that Dr. Martin had
prescribed hormone replacement therapy and was
prepared to approve sex reassignment surgery with-
out a mental health assessment.
A pediatrician and adolescent medicine specialist was
retained to review Dr. Martin's care of Patient A and
Patient B. Among other things, as found by the specialist:
58
DIALOGUE ISSUE 1, 2019
• D
r. Martin did not meet the standard of practice
of the profession regarding care for adolescents
with gender dysphoria in his care of Patient A and
Patient B;
• Dr. Martin prescribed cross-sex hormones to
Patient A, who was then 13-years old, at the first
visit. Cross-sex hormones have many side effects,
including infertility, and more time is necessary to
process this information so that adolescents can
make an informed decision. Dr. Martin lacked
judgment in this regard;
• Dr. Martin prescribed cross-sex hormones to
Patient B, who was then 16-years old, at the first
visit. Although Patient B was 16 at the time of
consultation, age alone is not a criterion for initia-
tion of cross-sex hormones. Dr. Martin lacked
judgment in this regard. The short length of the
first consultation (described by Dr. Martin as
30 minutes), at which cross-sex hormones were
prescribed, was also concerning, given the time
required for an informed consent discussion to
take place;
• Dr. Martin lacked judgment regarding determina-
tion of mental health needs and supports. The
mental health portions of the patient charts were
limited, and he did not specifically address com-
mon mental health diagnoses that co-occur with
gender dysphoria in adolescents, such as depres-
sion and anxiety. There was no mental health
assessment before initiating cross-sex hormones in
either Patient A or Patient B;
• Dr. Martin's conduct could expose patients to
harm or injury, based on his prescribing cross-sex
hormones to young patients at the first visit with
minimal mental health history-taking and the lack
of assurance that the patient has sought and is
accessing appropriate mental health resources and
supports.
Prior History with the Discipline Committee
In 2014, The Discipline Committee found that Dr.
Martin failed to maintain the standard of practice of
the profession in his fertility practice and directed the
Registrar to suspend Dr. Martin’s certificate of registra-
tion for a period of two months and restrict his practice
to reproductive endocrinology and the interpretation of
fertility-related ultrasound images, among other things.