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 outbreak . Toronto Public Health noted that Hepatitis C virus transmission has often been documented as being linked to mishandling of multi-dose injectable medications . 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 contaminated 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 prevention 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 , documentation 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 ; ii ) No pre-operative blood glucose despite the history of diabetes and oral hypoglycemic medication ; iii ) Incomplete medication list ; iv ) Incomplete pre-anesthetic assessment ; v ) Hypotension not treated on arrival and blood pressure not reassessed post-procedure to ensure it had returned to normal ; vi ) Re-using fentanyl syringes between patients . b ) Dr . Lucas displayed a lack of skill and a lack of knowledge regarding appropriate infection control practices in the setting of medication administration , including : i ) Not being aware of the risks involved in reusing syringes between patients . c ) Dr . Lucas ’ clinical practice exposed his patients to harm , including by : i ) Providing deep sedation without an appropriate pre-procedure assessment ; ii ) Reusing syringes between patients .
The first expert further opined : “ It is well-established that syringes are easily contaminated especially when injecting directly into a saline lock . It is clearly below standard of care for a physician to re-use syringes or needles between patients and to be unaware of risk to patients … Theoretically , the top of the vial could become contaminated as a result of poor hand hygiene after the intravenous insertion . The medication inside could possibly become contaminated if the top of the vial was not appropriately cleaned before re-entering . There is no evidence that vials were deliberately contaminated .” The second expert concluded that Dr . Lucas did not meet the standard of practice with respect to infection control procedures . Dr . Lucas reused syringes of fentanyl between patients , only changing the needle . This posed significant risk to his patients . Further , Dr . Lucas ’ care displayed a lack of skill and knowledge . Dr . Lucas should have been aware of the risks of reusing a syringe of medication between patients . This deficit was significant . Dr . Lucas has executed an undertaking never to engage in the practice of medicine again .
REASONS FOR PENALTY Counsel for the College and counsel for Dr . Lucas
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DIALOGUE ISSUE 4 , 2017