Dialogue Volume 14 Issue 2 2018 - Page 57

DISCIPLINE SUMMARIES • l  acked knowledge about the risks of polypharmacy and the risks of treating chronic pain with opioid analgesics; • demonstrated a lack of judgment by continuing to prescribe drug combinations with known risks of harm, by continuing to prescribe narcotics when it was obvious that the patient was unable to control her use and the medication was doing more ‘to’ her than ‘for’ her, and by continuing to provide the patient with large numbers of narcotics when he knew the patient was unable to prevent theft by her husband. It was found that Dr. Barnard failed to maintain the standard of practice of the profession in his care and treatment of the patient. On November 9, 2014, Dr. Barnard signed an undertaking to the College restricting him from prescribing any narcotics, controlled drugs, benzo- diazepines/other targeted substances and all other monitored drugs and narcotics preparations, with the exception of Tylenol with codeine #3 in limited amounts. Pre scribing Practices The College conducted a broader investigation into Dr. Barnard’s prescribing practices with respect to 25 patients. A family physician retained by the College concluded that Dr. Barnard’s care of 11 patients did not meet the standard of practice and that he dem- onstrated various degrees of a lack of knowledge, skill or judgment. He opined that in seven charts the care provided posed a potential risk of exposing patients to harm or injury and, of these seven, the risk of harm was particularly high with respect to four patients. The four cases in which it was concluded that the risk of exposing the patient to harm or injury was particularly high were those in which: • A patient was receiving frequent morphine in- jections as well as other narcotics while she was pregnant; • A patient who had severe migraine headaches was receiving frequent morphine injections as well as nasal butorphanol, the amounts of which were well in excess of recommended guidelines for non-can- cer pain; • A patient was receiving very frequent morphine injections for chronic pelvic pain, much in excess of recommended guidelines; and • A patient’s chart contained indications from anony- mous phone calls that he was selling his medication and a letter from the Children’s Aid Society express- ing concern of large amounts of narcotic medica- tion in a household with small children. It was found that Dr. Barnard failed to maintain the standard of practice of the profession in his care of 11 patients. Broader Patient Care On September 18, 2012, the College received in- formation regarding Dr. Barnard from the Ministry of Health and Long-Term Care (MOHLTC) as a result of a review of his medical records for services completed in 2009. The MOHLTC medical advi- sors identified clinical concerns with respect to Dr. Barnard’s patient care. The College retained a family physician to provide an opinion regarding the standard of care provided by Dr. Barnard to 37 patients. The family physician concluded that the standard of care was not met in any of the cases reviewed and that Dr. Barnard displayed a lack of knowledge and judgment in each case. She also opined that Dr. Barnard’s clini- cal practice and conduct exposed all but one of the patients whose care was reviewed to a risk of harm. The conclusions were based, in part, on the following concerns: • The administration of human chorionic gonadotro- pin (HCG) for weight loss in the management of obesity despite it being discredited and rejected by the medical community; • Numerous, significant examples of disjointed and episodic care with poor record keeping and judg- ment that impairs the provision of an adequate diagnosis and case management; Full decisions are available online at www.cpso.on.ca. Select Find a Doctor and enter the doctor’s name. ISSUE 2, 2018 DIALOGUE 57