Dialogue Volume 13 Issue 2 2017 - Page 69

discipline summaries Dr. ANNA MARIA WOJCICKA Practice Location: Mount Albert Area of Practice: : Internal Medicine; Radiation Oncology (Hormone Replacement Therapy) Hearing Information: Admission, Agreed Statement of Facts, Joint Submission on Penalty On February 17, 2016, the Discipline Committee found that Dr. Anna Maria Wojcicka committed an act of professional misconduct, in that she has failed to maintain the standard of practice of the profession. Dr. Wojcicka is a radiation oncology and internal medicine specialist who currently provides radiation oncology consultation services and practices general medicine in an office at 6165 Vivian Road in Mount Albert, Ontario. She also provides complex medi- cal rehabilitation care at Southlake Regional Health Centre in Newmarket, Ontario. The College initiated an investigation into Dr. Wojcicka’s Bioidentical Hormone Replacement Therapy (BHRT) practice in 2012 after the College received information about membership fees and ser- vices relating to the Vivian Medical Spa, also located at 6165 Vivian Road, Mount Albert, Ontario. The College retained an expert, Dr. Z, to provide an opinion on the care of 22 patients who were receiving BHRT from Dr. Wojcicka. On the basis of her chart reviews and an interview, Dr. Z concluded that Dr. Wojcicka’s care did not meet the standard of practice of the profession in all 22 cases in that she failed to meet some component of the College’s policy on Complementary/Alternative Medicine for each patient. In 14 of the 22 cases, Dr. Z also found that Dr. Wojcicka’s care demonstrated a lack of knowledge, skill and judgment and that her practice posed a risk of harm to patients. Dr. Z’s concerns with respect to Dr. Wojcicka’s BHRT practice included: a) 17 cases of prescription BHRT administered without performing a pelvic exam; b) three cases where BHRT was prescribed and no physical exam was documented in the chart; c) four cases of pelvic ultrasound being performed without reasonable cause; d) 1  5 charts where a conventional diagnosis is not listed; e) 17 charts where salivary or blood hormone lev- els are used to guide treatment; f ) one chart in which there is no documented dis- cussion or consent surrounding administration of BHRT; g) one chart in which a woman who has had a total hysterectomy received a Pap test; h) three charts in which BHRT is prescribed to a smoker over 40; one in a patient with history of migraine; one with undiagnosed vaginal bleed- ing; i) one chart in which a patient’s method of contra- ception is discontinued without proper counsel- ling; and j) one chart in which a patient’s diastolic blood pressure is read as over 100 and they are not directed to urgent care. In response to Dr. Z’s report, Dr. Wojcicka pro- vided her own rebuttal defending her care of the patients reviewed. Dr. Wojcicka also retained Dr. Y to provide an opinion with respect to her BHRT practice. Dr. Y reviewed the same 2 2 patient charts that were reviewed by Dr. Z and provided a report, dated July 8, 2015. The concerns noted in Dr. Y’s report included: a) Dr. Wojcicka seemed reluctant in some cases to do pelvic examinations and Pap smears. She also does not undertake endometrial biopsies and so this would necessitate referring to a gynecologist; b) she relies heavily on saliva levels and it is not generally agreed that this is accurate testing. Dr. Y expressed concern in this regard, particularly looking at progesterone levels in saliva when they do not appear to be the same in blood or tissue levels; c) the literature suggesting that compounded therapy using such things as BiEst and progester- one cream is not strong. The European literature shows that transdermal estrogen such as Estrogel Full decisions are available online at www.cpso.on.ca. Select Doctor Search and enter the doctor’s name. Issue 2, 2017 Dialogue 69