discipline summaries an epidural steroid injection performed by Dr . James at the clinic . Toronto Public Health ’ s view regarding the cause of these infections is that Dr . James was colonized with Staph aureus , and due to breaches in IPAC , transmission of Staph aureus occurred from Dr . James to his patients . The patients revealed in the Toronto Public Health investigation suffered serious complications . Parts of their disease courses are described here :
a ) Patient T received lumbar injections from Dr . James commencing in 2012 . Following her last injection in October 2012 , Patient T was admitted to hospital , vomiting and incoherent . She was diagnosed with bacterial meningitis . b ) Patient U received lumbar injections from Dr . James commencing in 2011 . In October 2012 , she received three lumbar / thoracic epidural injections . In late October or early November , Patient U began suffering from headaches , nausea , vomiting , confusion , blurred vision , tremors . In November , she notified the clinic that she was suffering persistent headaches . Shortly after , she was admitted to hospital and diagnosed with meningitis .
C ) Patient V received lumbar injections from Dr . James commencing in 2010 . Following a lumbar injection in July 2012 , she developed fever and sought attention at the emergency department . She was discharged with negative blood and urine cultures . She subsequently sought treatment from her family physician complaining of pain , fever and difficulty urinating . She received additional injections from Dr . James on two occasions in August of 2012 . In September 2012 , she suffered a stroke and on investigation , it was discovered that many sites on her spine were infected with abscesses requiring hospitalization and the insertion of a PICC line . d ) Patient W received lumbar injections from Dr . James in September and October 2012 . Shortly after his injection in October 2012 , Patient W experienced back pain and fever and went to the hospital , but an MRI revealed no abscesses . In November 2012 he was admitted to hospital with on going fever and increasing weakness . A lumbar epidural abscess was found and an emergency laminectomy was performed . e ) Patient X received lumbar injections from Dr . James commencing in 2012 . Following his last injection in November 2012 , Patient X developed a fever and was hallucinating . He was admitted to hospital where he was diagnosed with an epidural abscess and Staph aureus infection requiring evacuation and spinal decompression . Patient X required further surgical intervention . f ) Patient Z received lumbar injections from Dr . James commencing in 2012 . After her third injection in September 2012 , Patient Z experienced increasing back pain and developed a fever . She was admitted to hospital with two epidural abscesses and sepsis .
The College retained Dr . N , to provide an opinion regarding Dr . James ’ infection control procedures . Dr . N was asked to opine on Dr . James ’ practices prior to Toronto Public Health intervention largely on the basis of the information gathered by Toronto Public Health . In a report dated December 20 , 2013 , he opined , among other things , that Dr . James practices prior to their revision fell below the standard of infection control practice expected of a physician performing such procedures and concluded that these breaches were of a major nature and resulted in an uncommon serious outbreak . The College also received several public complaints from patients who suffered serious complications :
i ) Regarding Patient A , Dr . James administered lumbar steroid injections in August , September and October , 2012 . At the October appointment , Patient A states that she noticed that Dr . James did not wear sterile gloves or a mask ; and stated that she did not have iodine put on her back like previous times ; her procedure felt rushed .
She felt unwell soon after the October appointment . By November , Patient A felt extremely confused , weak , and lethargic , and had a fever . Patient A was admitted to hospital and found to have a Staph aureus infection . She was diagnosed with meningitis and an epidural abscess precisely
Full decisions are available online at www . cpso . on . ca . Select Doctor Search and enter the doctor ’ s name .
Issue 1 , 2017 Dialogue 47