Dialogue Volume 13 Issue 4 2017 - Page 89

DISCIPLINE SUMMARIES • h  is failure to measure intraocular pressure in cer- tain age groups (under 40); • h  is failure to dilate pupils to look at the fundus/ posterior eye; and • h  is failure to use cycloplegia in children to obtain proper refraction. Dr. Wales’ deficiencies in his care and treatment of patients demonstrated a lack of knowledge, skill, and judgment of such a nature and to an extent that he is unfit to continue to practise or that his practice should be restricted. The Committee found that the deficiencies Dr. Wales displays are current. SUBMISSIONS ON PENALTY Counsel for the College submitted that the appropri- ate penalty order for Dr. Wales was revocation of his certificate of registration and a public reprimand. College counsel also sought an order that Dr. Wales pay costs to the College in the amount of $23,340. Counsel for Dr. Wales submitted that revocation of Dr. Wales’ certificate of registration was not warrant- ed. Instead, she proposed continuation of the same terms previously imposed on Dr. Wales’ certificate of registration under section 37 of the Code by the In- quiries, Complaints and Reports Committee (ICRC) on May 22, 2012. The terms imposed by the ICRC included an order that Dr. Wales cease practising medicine effective May 22, 2012 and that strict terms, conditions and limita- tions be imposed on his certificate of registration. Counsel for Dr. Wales does not oppose the repri- mand proposed by the College. However, counsel for Dr. Wales proposed a lower costs order in the amount of $18,360 to be paid by Dr. Wales to the College. REASONS FOR PENALTY The Committee considered the well-established principles relevant to the imposition of penalty in College disciplinary proceedings. The protection of the public is of paramount importance. Other principles include: maintaining the reputation and integrity of the profession and public confidence in the College’s ability to regulate the profession in the public interest; general deterrence as it applies to the membership as a whole; specific deterrence as it ap- plies to this particular member; and the potential for rehabilitation of the member. College counsel submitted that Dr. Wales has shown no insight into his substandard practices and that the Committee must take notice of the fact that he perceives his practice as having zero risk of harm. He testified he would not miss a case of intraocular hypertension using finger tonometry. He has pro- vided no evidence that he has taken any steps to ad- dress the concerns of the Committee. He showed no remorse and did not propose any remediation plan. College counsel submitted that Dr. Wales presented as adamant in his opinions and exhibited rigidity of thought in that he had trouble with views that were different to his own. In fact, Dr. Wales made the grandiose claim of being ahead of his time in his use of a technique that has not been the standard of practice for 50 years. College counsel argued that Dr. Wales poses a risk of harm to patients. The College expert testified that he had observed Dr. Wales performing applanation tonometry on one patient and Dr. Wales had deficits that were “dangerous”. The expert testified that Dr. Wales repeatedly performed the procedure on that patient, which risked corneal abrasion with each try, and resulted in the procedure taking much longer than needed. Given his reliance on finger tonometry, applanation tonometry was never routine for Dr. Wales and his failure to perform applanation tonom- etry properly presents risk to patients. Dr. Wales’ counsel argued that revocation is an overly harsh penalty for Dr. Wales, who has had an unblemished career until this time. In addition, counsel for Dr. Wales argued that revocation of Dr. Wales’ certificate of registration was not required to maintain public trust. She submitted that continu- ing the same terms, conditions and limitations as imposed by the ICRC under section 37 of the Code would ensure ongoing supervision and protect of the public. She stated that Dr. Wales is willing to reme- diate through direct supervision indefinitely. She ar- gued that converting the section 37 ICRC Order into an indeterminate order of the Discipline Committee would accomplish the same goals that the College was seeking with the order of revocation. She submit- ted that although the proposed order may be uncon- ventional, it accomplishes the goals of public protec- ISSUE 4, 2017 DIALOGUE 89