discipline summaries
Aggravating factors Dr . James ’ poor antiseptic technique Dr . James ’ clinical care was brought to the attention of the College after Toronto Public Health suspected a meningitis outbreak . Toronto Public Health examined a total of 272 patients who received epidural injections from Dr . James between August and December 2012 . Nine patients were found to have serious infections . The College ’ s enquiry found six patients , two of whom overlapped with the Toronto Public Health enquiry . In total , 13 patients became infected . Toronto Public Health noted serious breaches of antiseptic technique during its visit to Dr . James ’ clinic , including : the patient ’ s sterile field was not covered ; Dr . James used a non-sterile gauze after a procedure ; Dr . James ’ gloves were too large ; he used a mask but its nose was not pinched ; he did not often allow the betadine antiseptic to dry ; he touched many surfaces after donning sterile gloves ; and he wore his wedding band throughout the procedure . Moreover , Dr . James did not wipe the multi-dose vials of local anesthetic with 70 % alcohol prior to accessing with a syringe . This was also not done with single use vials . This practice would put patients at increased risk of infection . Reviewers also found needles left in partially-used vials , a practice that should never be followed because air contaminants in the room could easily enter the vials . The Committee found that there were very serious breaches occurring over many months , and the consequences have been devastating . The breaches affected people ’ s lives permanently , physically and emotionally , with significant effects for patients and their families . Dr . James ’ breaches also undermined his patients ’ trust in the medical profession . Some patients have permanently lost the control of their bladders and bowels and cannot walk without canes or walkers . All of the impact statements strongly urged that action be taken so that this type of problem should never happen again . They expressed a sense of betrayal that their authors felt about the medical profession .
Lack of Self-Scrutiny and Response to Patients in Distress Over a relatively brief period of time , many of Dr . James ’ patients became seriously ill . Although Dr . James was made aware of some of the patients ’ complaints , he tended to dismiss them as involving an allergy to the preservative . Dr . James was often too busy to see the patient , and at times he became annoyed with patients requesting such follow up . Had he clinically assessed these patients himself , and noted the frequency of these infections , Dr . James might have alerted himself and others to the problem much sooner .
Communication with Patients One patient ( Patient E ) commented that when she finally saw Dr . James about the abscess in her elbow , he was stern with her and told her that he was annoyed . He lectured her on her abusive attitude to two of his nurses , and told her that this was not a walkin clinic . When he looked at her elbow , he thought mistakenly that it was a reaction to the preservative and suggested the use of cortisone cream .
Breach of Ethics The Committee was dismayed that Dr . James had sought to manipulate the nursing staff at his clinic into falsely describing his antiseptic technique when he knew he was under College investigation . In an effort to thwart the College , Dr . James attempted to influence how nurses would answer College investigators ’ questions by writing a false “ prep sheet .” The procedures described on the “ prep sheet ” did not correspond to the actual techniques Dr . James used . Furthermore , Dr . James was dishonest with the College investigators in describing what he did and the purpose of the “ prep sheet .” Importantly , Dr . James ’ medical records in several cases did not correspond with material written in hospital records when patients were referred .
Questionable Remorse Counsel for Dr . James submitted to the Committee that Dr . James felt devastated by these infections and their consequences . At times , Dr . James did attempt to phone some of his patients after they had been ill , but this was not a consistent practice . Several pa-
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Dialogue Issue 1 , 2017