Dialogue Volume 14 Issue 1 2018 - Page 53

DISCIPLINE SUMMARIES DR. DAVID JAMES HILL PRACTICE LOCATION: Toronto AREA OF PRACTICE: General Practice HEARING INFORMATION: Allegations Denied; Contested Eight-Day Hearing On December 2, 2016, the Discipline Committee found that Dr. Hill committed acts of professional misconduct, in that he failed to maintain the stan- dard of practice of the profession, and he engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all the circum- stances, would reasonably be regarded by members as disgraceful, dishonourable, or unprofessional. The Committee also found that Dr. Hill’s charting and patient care reflect a lack of knowledge, skill and judgment to an extent that demonstrates Dr. Hill is incompetent. Dr. Hill, a physician with a solo office practice in Toronto, retired from active practice in 2015. FAILURE TO MAINTAIN THE STANDARD OF PRACTICE The finding that Dr. Hill failed to maintain the stan- dard of practice relates to his care of Patient A and 24 additional patients. Patient A Patient A, Dr. Hill’s former patient, complained to the College that Dr. Hill had missed a diagnosis of colon cancer. The Committee agreed with the evidence of the College’s expert, Dr. X, that Dr. Hill failed to maintain the standard of practice of the profession with respect to Patient A: 1. Although Dr. Hill saw Patient A on dozens of occasions, visits were devoted exclusively to treating episodic and chronic illness and mini- mal attention was paid to prevention of disease; 2. Dr. Hill’s notes with respect to Patient A were vague and repetitive with little documentation of physical findings or specifics with regard to his- tory, investigations, or treatment; 3. The cumulative patient profile (CPP) used by Dr. Hill was out of date and incomplete, with important data on family history missing; 4. D  r. Hill failed to document a proper family his- tory, which may have led to a screening colonos- copy; and 5. D  r. Hill failed to properly document or investi- gate Patient A’s abdominal pain in 2010, which may have led to a delay in the diagnosis of his cancer. Dr. X reviewed 25 additional, randomly selected patient charts and concluded that Dr. Hill failed to maintain the standard of practice in 24 of those cases. Many of the concerns identified by Dr. X were common among the care provided the patients. Dr. Y, an expert retained by Dr. Hill, agreed with a num- ber of the problems identified by Dr. X. The Com- mittee found that Dr. Hill failed to maintain the standard of practice for the 24 additional patients. The Committee’s reasons addressed the concerns by issue, with examples provided from the charts reviewed. Record Keeping The Committee found that Dr. Hill failed to main- tain the standard of practice of the profession in his record keeping. Based on the evidence of both Dr. X and Dr. Y, it was clear that Dr. Hill’s record keeping fell far below what is expected of a family physician. Dr. X found that Dr. Hill often failed to document a proper family history and did not record immu- nizations, laboratory reports, consultant reports or preventive care investigations on the CPP. Narra- tive notes lacked detail and contained diagnoses and inclusions unrelated to the reasons for assessment. There was a chronological discrepancy between narra- tive notes, laboratory reports and consultation notes. Dr. Y agreed that Dr. Hill’s charting fell below the standard of practice of the profession and described Dr. Hill’s documentation of patient records as “unac- ceptably brief.” Dr. Y agreed that “some of these deficiencies generate risk to the patient and potential for medical error.” The Committee also found that Dr. Hill failed to maintain the standard of practice of the profession Full decisions are available online at www.cpso.on.ca. Select Find a Doctor and enter the doctor’s name. ISSUE 1, 2018 DIALOGUE 53