Dialogue Volume 13 Issue 4 2017 - Page 80

DISCIPLINE SUMMARIES 1, 2 and 3, was determined to be the source of the Hepatitis C virus outbreak. Patient 0’s Hepatitis C virus was genetically highly related to that of Patients 1, 2 and 3. Dr. Lucas acted as the anesthesiologist for the procedures on each of the four patients on the date in question, December 7, 2011. Toronto Public Health provided the College with its interim report of August 21, 2014 and final report of October 6, 2014, both of which concluded that Patients 1, 2 and 3 acquired Hepatitis C virus during their endoscopic procedures at DEC on December 7, 2011 and that Patient 0 was the source of the out- break. Toronto Public Health noted that Hepatitis C virus transmission has often been documented as being linked to mishandling of multi-dose injectable medi- cations. It concluded that it is possible that either a vial of propofol anesthetic or a vial of lidocaine (used to reduce the sting of the anesthetic) became con- taminated after being used on the source patient. Dr. Lucas administered propofol anesthetic and lidocaine to all four patients during the procedures in question on December 7, 2011. Dr. Lucas acknowledged it was his practice to reuse syringes containing fentanyl between patients, only changing the needle. Toronto Public Health concluded that the contamination of fentanyl leading to transmission to all three patients did not seem likely. College Investigation In written responses to the College investigation, Dr. Lucas admitted that it was not his practice to swab multi-dose vials before withdrawing medication. The propofol anesthetic and lidocaine used at DEC were contained in multi-dose vials. The College retained two experts in infection pre- vention and anesthesiology as Medical inspectors to assist in its investigation. The first expert opined in her report that: a) Dr. Lucas did not meet the standard of practice with respect to infection control procedures, docu- mentation and preoperative assessment, including: i) No documentation of pre-procedure vitals, patient weight, NPO status, airway assessment, physical examination, or post-procedure vitals or level of consciousness; 80 DIALOGUE ISSUE 4, 2017 ii) N  o pre-operative blood glucose despite the his- tory of diabetes …Ή½Ι…°‘εΑ½±ε•΅₯Œ΅•‘₯„΄)Ρ₯½Έμ)₯₯€€%Ή½΅Α±•Ρ”΅•‘₯…Ρ₯½Έ±₯ΝΠμ)₯Ψ€%Ή½΅Α±•Ρ”ΑΙ”΅…Ή•ΝΡ‘•Ρ₯Œ…ΝΝ•ΝΝ΅•ΉΠμ)Ψ€€!εΑ½Ρ•ΉΝ₯½ΈΉ½ΠΡΙ•…Ρ•½Έ…ΙΙ₯Ω…°…Ή‰±½½)ΑΙ•ΝΝΥΙ”Ή½ΠΙ•…ΝΝ•ΝΝ•Α½ΝΠ΅ΑΙ½•‘ΥΙ”ΡΌ•ΉΝΥΙ”)₯Ё‘…Ι•ΡΥΙΉ•ΡΌΉ½Ι΅…°μ)Ω€€I”΅ΥΝ₯Ήœ™•ΉΡ…Ήε°ΝεΙ₯Ή•Μ‰•Ρέ••ΈΑ…Ρ₯•ΉΡΜΈ)ˆ€(ΘΈ1Ս…́‘₯ΝΑ±…啐„±…¬½˜Ν­₯±°…Ή„±…¬½˜)­Ή½έ±•‘”Ι•…Ι‘₯Ήœ…ΑΑΙ½ΑΙ₯…Ρ”₯Ή™•Ρ₯½Έ½ΉΡΙ½°)ΑΙ…Ρ₯•Μ₯ΈΡ‘”Ν•ΡΡ₯Ήœ½˜΅•‘₯…Ρ₯½Έ…‘΅₯Ή₯ΝΡΙ„΄)Ρ₯½Έ°₯Ή±Υ‘₯Ήœθ)€€8(½Π‰•₯Ήœ…έ…Ι”½˜Ρ‘”Ι₯ͭ́₯ΉΩ½±Ω•₯ΈΙ•ΥΝ₯Ήœ)ΝεΙ₯Ή•Μ‰•Ρέ••ΈΑ…Ρ₯•ΉΡΜΈ)Œ€€ΘΈ1Ս…ΟŠd±₯Ή₯…°ΑΙ…Ρ₯”•αΑ½Ν•‘₯́Α…Ρ₯•ΉΡ́Ѽ)‘…Ι΄°₯Ή±Υ‘₯Ήœ‰δθ)€€@(Ι½Ω₯‘₯Ήœ‘••ΐΝ•‘…Ρ₯½Έέ₯Ρ‘½ΥЁ…Έ…ΑΑΙ½ΑΙ₯…Ρ”)ΑΙ”΅ΑΙ½•‘ΥΙ”…ΝΝ•ΝΝ΅•ΉΠμ)₯€€I•ΥΝ₯ΉœΝεΙ₯Ή•Μ‰•Ρέ••ΈΑ…Ρ₯•ΉΡΜΈ)Q‘”™₯ΙΝЁ•αΑ•ΙЁ™ΥΙΡ‘•Θ½Α₯Ή•θƒŠq%Ё₯́ݕ±°΅•ΝΡ…ˆ΄)±₯Ν‘•Ρ‘…ЁΝεΙ₯Ή•Μ…Ι”•…Ν₯±δ½ΉΡ…΅₯Ή…Ρ••ΝΑ•₯…±±δ)έ‘•Έ₯Ή©•Ρ₯Ήœ‘₯Ι•Ρ±δ₯ΉΡΌ„Ν…±₯Ή”±½¬Έ%Ё₯́±•…Ι±δ)‰•±½άΝΡ…Ή‘…ɐ½˜…Ι”™½Θ„Α‘εΝ₯₯…ΈΡΌΙ”΅ΥΝ”Νδ΄)Ι₯Ή•Μ½ΘΉ••‘±•Μ‰•Ρέ••ΈΑ…Ρ₯•ΉΡ́…ΉΡΌ‰”ΥΉ…έ…Ι”)½˜Ι₯Ν¬ΡΌΑ…Ρ₯•ΉΡϊ™Q‘•½Ι•Ρ₯…±±δ°Ρ‘”Ρ½ΐ½˜Ρ‘”Ω₯…°)½Υ±‰•½΅”½ΉΡ…΅₯Ή…Ρ•…́„Ι•ΝձЁ½˜Α½½Θ‘…Ή)‘ε₯•Ή”…™Ρ•ΘΡ‘”₯ΉΡΙ…Ω•Ή½Ύ₯ΉΝ•ΙΡ₯½ΈΈQ‘”΅•‘₯„΄)Ρ₯½Έ₯ΉΝ₯‘”½Υ±Α½ΝΝ₯‰±δ‰•½΅”½ΉΡ…΅₯Ή…Ρ•₯˜)Ρ‘”Ρ½ΐ½˜Ρ‘”Ω₯…°έ…́Ή½Π…ΑΑΙ½ΑΙ₯…Ρ•±δ±•…Ή•‰”΄)™½Ι”Ι”΅•ΉΡ•Ι₯ΉœΈQ‘•Ι”₯́ΉΌ•Ω₯‘•Ή”Ρ‘…ЁΩ₯…±Μέ•Ι”)‘•±₯‰•Ι…Ρ•±δ½ΉΡ…΅₯Ή…Ρ•»Št)Q‘”Ν•½Ή•αΑ•ΙЁ½Ή±Υ‘•Ρ‘…ЁΘΈ1Ս…́‘₯)Ή½Π΅••ΠΡ‘”ΝΡ…Ή‘…ɐ½˜ΑΙ…Ρ₯”έ₯Ρ Ι•ΝΑ•ΠΡΌ)₯Ή™•Ρ₯½Έ½ΉΡΙ½°ΑΙ½•‘ΥΙ•ΜΈΘΈ1Ս…́ɕΥΝ•)ΝεΙ₯Ή•Μ½˜™•ΉΡ…Ήε°‰•Ρέ••ΈΑ…Ρ₯•ΉΡΜ°½Ή±δ‘…Ή₯Ήœ)Ρ‘”Ή••‘±”ΈQ‘₯́Α½Ν•Ν₯Ή₯™₯…ΉΠΙ₯Ν¬ΡΌ‘₯́Α…Ρ₯•ΉΡΜΈ)ΥΙΡ‘•Θ°ΘΈ1Ս…ΟŠd…Ι”‘₯ΝΑ±…啐„±…¬½˜Ν­₯±°…Ή)­Ή½έ±•‘”ΈΘΈ1Ս…́͑½Υ±‘…Ω”‰••Έ…έ…Ι”½˜)Ρ‘”Ι₯ͭ́½˜Ι•ΥΝ₯Ήœ„ΝεΙ₯Ή”½˜΅•‘₯…Ρ₯½Έ‰•Ρέ••Έ)Α…Ρ₯•ΉΡΜΈQ‘₯́‘•™₯₯Ё݅́Ν₯Ή₯™₯…ΉΠΈΘΈ1Ս…́‘…Μ)•α•ΥΡ•…ΈΥΉ‘•ΙΡ…­₯ΉœΉ•Ω•ΘΡΌ•Ή…”₯ΈΡ‘”ΑΙ…Œ΄)Ρ₯”½˜΅•‘₯₯Ή”……₯ΈΈ)IM=9L=HA91Qd) ½ΥΉΝ•°™½ΘΡ‘” ½±±•”…Ή½ΥΉΝ•°™½ΘΘΈ1Ս…Μ