discipline summaries
staff at the clinic in order to influence the nurses ’ responses to the College investigation ;
• Misrepresenting the purpose of the Interview Prep Document to the College ;
• Misstating the steps he took when learning of Patient A and Patient B ’ s complications caused by his inadequate infection prevention and control ( IPAC ) procedures ; and
• Failing to make himself available , and communicating inappropriately through his nursing staff , when Patient E suffered complications .
On October 8 , 2014 , after allegations had been referred to the Discipline Committee , Dr . James executed an undertaking with the College agreeing to cooperate with specific infection control guidelines provided to him and to submit to unannounced inspections by the College to ensure his infection control practices were acceptable . On about November 30 , 2012 , and December 10 , 2012 , the College received information from Toronto Public Health relating to a suspected meningitis outbreak connected to Dr . James at the clinic . On the basis of that information , the Inquiries , Complaints and Reports Committee ( ICRC ) commenced an investigation into Dr . James ’ practice .
Toronto Public Health Investigation In November 2012 , Toronto Public Health received information that three different patients were hospitalized with either Staph aureus or meningitis infections from epidural injections administered by Dr . James . As a result of these infections , Dr . L , Associate Medical Officer of Health for the City of Toronto Health Unit , and Ms M , Communicable Disease Manager , Toronto Public Health , attended Dr . James ’ clinic . At that time , Dr . L made a verbal order requiring that Dr . James not perform any procedures and that no one change or touch anything in Room 11 or use it in any way . ( Room 11 was Dr . James ’ procedure room . All of his non-X-ray guided procedures were performed in that room ; no other doctor used that room ). In December 2012 , Ms M re-attended at the clinic to continue the Toronto Public Health investigation . Dr . James was served with a written order to immediately cease performing any medical procedures that involve penetration of an instrument into a sterile site , and that he not enter Room 11 . As a result of their visits to the clinic , Toronto Public Health noted the following :
• The patient ’ s sterile field was not covered ;
• A non-sterile gauze was used after a procedure to wipe the ooze from the patient ’ s back ;
• Dr . James ’ gloves were too big ;
• Dr . James used a mask but the nose was not pinched ;
• Dr . James did not always allow the Betadine , the antiseptic used to wipe the patients ’ skin , to dry for long enough before he started a procedure ;
• After Dr . James used an alcohol-based hand rub ( ABHR ), and prior to donning sterile gloves , he touched many surfaces ;
• Dr . James opened sterile items onto a non-sterile field into a sterile container ; and
• Dr . James ’ wedding band was not removed during the procedure .
On December 7 , 2012 , at the request of Toronto Public Health , Public Health Ontario attended the clinic with a representative from Toronto Public Health to conduct a review of IPAC practices within the clinic . At that visit , Dr . James offered to provide a mock demonstration of a typical epidural procedure . The audit team observed the following issues that required immediate attention :
• Dr . James applied and removed his mask without performing hand hygiene ;
• Dr . James ’ hand hygiene ABHR lasted less than 5 seconds ;
• Dr . James stated that he does not wait for the skin prep to dry before inserting the needle ;
• Abundant supplies ( including unwrapped gauze pads ) stored on the counter are subject to contamination ; and
• Dr . James ’ mask was not adjusted at the bridge of his nose .
Based on the information obtained by Toronto Public Health , and a review of the literature regarding complications following epidural steroid injections , Toronto Public Health concluded that nine patients developed serious infections after receiving
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Dialogue Issue 1 , 2017