Dialogue Volume 13 Issue 2 2017 - Page 65

discipline summaries to infection control procedures and maintenance of equipment in his practice. [His] care in relation to infection control as of March 12, 2015, displayed a lack of knowledge, care and judgment in that he was unaware of and/or did not implement basic office infection control processes and procedures that are readily available to all Ontario physicians through Public Health Ontario,” stated Dr. Z. “In my opinion, his deficit is severe as the breaches in infection control were numerous and place pa- tients at risk,” stated Dr. Z. “Dr. Ng’s practice, behaviour, and conduct in relation to infection control as of March 12, 2015, exposed his patients to harm and was likely to expose his patients to injury. Significant risks resulting from his practice, behav- iour and conduct include transmission of respiratory pathogens such as influenza, enteric pathogens such as C difficile and blood borne pathogens such as hepatitis B or C,” he continued. Dr. Ng wrote to the College on August 7, 2015, in response to the forensic document report as well as Dr. Z’s report. Dr. Ng maintained in his response that he had not altered Patient A’s chart, despite the forensic document report. Section 75(1) Investigation Based on Patient A’s letter of complaint and the Col- lege’s unannounced inspection of Dr. Ng’s clinic on February 27, 2015, the Inquiries, Complaints and Reports Committee approved the appointment of investigators to conduct a broader investigation into Dr. Ng’s practice on March 10, 2015. On March 3, 2015, the College notified Toronto Public Health that Dr. Ng was using unacceptable infection prevention and control practices while pro- viding patient care at his office. On March 6, 2015, an inspection by Toronto Public Health concluded that Dr. Ng failed to use adequate infection prevention and control practices. On the same day, Toronto Public Health gave a verbal order under section 13 of the Health Protec- tion and Promotion Act, requiring Dr. Ng to close his office until further notice. On March 11, 2015, Toronto Public Health served a written order requiring Dr. Ng to make improve- ments to his office, including disposing sharps in an approved sharps container; ensuring the premises is clean and in good repair at all times; ensuring there is an area that has a sink for cleaning and disinfecting instruments; and ensuring that single-use items are discarded safely after use. On March 23, 2015, Toronto Public Health re- inspected Dr. Ng’s practice and concluded that he made the necessary corrective infection prevention and control measures and reopened the premises for patient care. On July 2, 2015, the College conducted a re-in- spection of Dr. Ng’s office which revealed continuing infection control issues. The College retained Dr. Z to review Dr. Ng’s standard of care. Based on an office inspection, an observation of Dr. Ng’s practice, an interview with Dr. Ng, and a review of 26 patient charts as well as a review of five patient charts whose care she observed on June 8, 2015, Dr. Z stated that: • In 25 charts, Dr. Ng failed to properly maintain a CPP, medication record or immunization record. • In 16 charts, Dr. Ng failed to meet the standard in assessing, documenting, investigating and manag- ing patients with a thyroid nodule, microcytic anemia, low hemoglobin/hematocrit, ulcer pain, infected heel wound, ongoing albuminuria, diabe- tes, toothache and not referring patients for den- tal care, using non-evidence based treatments for prostatitis, H pylori titers, zoster infections, carpal tunnel syndrome, enuresis in a 2-year-old child, in having performed a laryngoscopy on a patient, and not having used a growth chart and not following the Ontario immunization schedule. • Dr. Ng failed to meet the standard of care in five out of five of the patients observed, including performing blood pressure assessment, assessing a patient’s complaint of fatigue and back pain, following up on an abnormal HbA1C, assessing a patient’s complaint of chest pain and shortness of breath, managing a patient’s oral pain. • Dr. Ng demonstrated a lack of knowledge/skill/ Full decisions are available online at www.cpso.on.ca. Select Doctor Search and enter the doctor’s name. Issue 2, 2017 Dialogue 65