Dialogue Volume 13 Issue 2 2017 - Page 70

discipline summaries and oral progesterone such as Prometrium do have many of the benefits that Dr. Wojcicka is attributing to the compounded medications. d) Dr. Wojcicka does not appear to be letting patients know that so-called BHRT is available in the form of Estrogel and Prometrium. These are often covered by Drug Plans, whereas com- pounded therapy often is not. e) Dr. Wojcika does a lot of redundant testing in her practice. She does salivary levels which cost the patients money and then she does blood lev- els. Dr. Y was not sure why she is doing blood levels if she is doing salivary levels. She also does abdominal ultrasound as well as a pelvic ultra- sound and in many cases, this is not necessary. f ) Dr. Y saw no clear delineation of who is respon- sible for various conditions in patients. Dr. Y believes that investigations such as cholesterol testing, for example, should be left to the pa- tient’s family doctor. g) Dr. Y also agreed with Dr. Z’s statement that the first thing to be done is not an ultrasound, but physical examination. Dr. Y also agreed with Dr. Z’s statement that studies using Estrogel and oral progesterone are readily available. Studies using transdermal progesterone are few and far be- tween and this is not equivalent to choosing oral progesterone. Despite his concerns, Dr. Y concluded that he did not believe that Dr. Wojcicka’s patients had under- gone any harm. Section 37 Interim Order On February 2, 2015, after referring allegations of professional misconduct to the Discipline Commit- tee, the Inquiries Complaints and Reports Commit- tee directed the Registrar to impose terms, condi- tions and limitations on Dr. Wojcicka’s certificate of registration pursuant to s. 37 of the Health Profes- sions Procedural Code. The Order required that Dr. Wojcicka cease to provide care with regards to BHRT to patients. Reasons for Penalty In considering the jointly proposed penalty, the Com- mittee must consider the specific facts supporting the 70 Dialogue Issue 2, 2017 finding, any aggravating or mitigating factors, and the principles that underlie a suitable penalty. Penalty principles include: protection of the public from the member who committed the misconduct; specific and general deterrence; the maintenance of the public’s confidence in the medical profession and its ability to self-regulate in the public interest; and the extent to which rehabilitation of the member is possible. Aggravating factors Dr. Wojcicka committed an act of professional misconduct by failing to maintain the standard of practice of the profession. The misconduct included, but was not limited to: 1. Failing to do physical examinations; 2. Failing to document diagnoses; 3. Ordering tests without reasonable cause; 4. Ordering redundant testing; 5. Using forms of testing generally considered to be inaccurate; 6. Failing to document discussion of consent or actual consent; 7. Failing to offer alternative forms of treatment covered by drug plans; 8. Prescribing BHRT to patients with contraindica- tions such as smoking and vaginal bleeding not yet diagnosed; and 9. Failing to follow the College’s policy on Com- plementary/Alternative Medicine. Mitigating factors 1. D  r. Wojcicka acknowledged the concerns ex- pressed by the College and her own expert; 2. Dr. Wojcicka admitted to failing to maintain the standard of her practice in her BHRT and accepted responsibility for her actions, thus obvi- ating the need for a lengthy and costly hearing with expert witnesses. 3. The proposed penalty falls within the range of penalties in similar cases. The Committee is satisfied that the proposed pen- alty satisfies the requisite penalty principles in the following manner: Dr. Wojcicka’s prohibition from practising comple- mentary and alternative medicine and from consulting and/or treating patients with respect to BHRT as well