DISCIPLINE SUMMARIES
• Certain use of “ off label ” prescribing and potentially harmful prescribing ( including prescribing HCG as described above ; potentially harmful prescribing of narcotics for non-cancer pain ; prescribing benzodiazepines with narcotics ; prescribing Methotrexate and Plaquenil without indication ; prescribing hormone replacement therapy without appropriate documentation and assessment ; prescribing high doses of vitamin D ; prescribing iron and high doses of vitamin B without indication );
• Failure to meet the standard in his documentation of consent for “ off label ” or potentially harmful prescribing , and other failures of documentation ;
• Lack of documentation of appropriate follow-up on test results ;
• Failure to document history , physical examination , diagnosis , and informed consent when prescribing complementary and alternative medicines , and prescribing some such medicines which he knew had no medical evidence for use , such as HCG ; and
• The use of excessive laboratory testing in the absence of clear documentation of medical need .
In December 2015 , the College requested updated patient records from Dr . Barnard for 10 patients whose care had been reviewed . It was found that Dr . Barnard ’ s care did not meet the standard of practice in any of the charts reviewed and that his care continued to display a lack of knowledge , skill and judgment . It was found that Dr . Barnard failed to maintain the standard of practice of the profession in his care of 37 patients as described above .
Investigation Regarding Patient A Patient A became Dr . Barnard ’ s patient in the Barnard Wellness Centre in May 2012 . Patient A had a history of testosterone levels having been documented as low by other physicians as recently as 2011 , but it was very high based on the initial bloodwork ordered by Dr . Barnard in May 2012 . Dr . Barnard treated Patient A , including continually prescribing testosterone injections from July 2012 until April 2013 , when Dr . Barnard severed the doctor-patient relationship . The College retained a family physician with a focus in men ’ s health , including testosterone deficiency , to review Dr . Barnard ’ s care in regard to Patient A , who found that Dr . Barnard did not meet the standard of practice of the profession in that he :
• Displayed poor documentation and record keeping of his thought process and / or discussions with Patient A ;
• Failed to adequately counsel Patient A in the hazards of continued steroid use ;
• Failed to try to have Patient A adhere to a more traditional protocol for testosterone replacement , with lower initial dosing and further titration based on serum testosterone levels and / or symptom management , and escalated the dosage of testosterone without monitoring hematocrit ; and
• Demonstrated poor judgment in embarking on an unorthodox treatment plan of high dosing with little monitoring that was not in the best long-term interests of the patient .
It was found that Dr . Barnard failed to maintain the standard of practice of the profession in his care of Patient A .
Investigation Regarding Patients B and C Patient B became Dr . Barnard ’ s patient in March 2012 and his wife , Patient C , became Dr . Barnard ’ s patient in February 2013 . Dr . Barnard terminated both patients from his practice in April 2013 . Dr . Barnard treated Patient B for chronic pain . He prescribed Lyrica , Cymbalta , Botox injections , vitamin injections and testosterone injections beginning in May 2012 . Dr . Barnard did not record Patient B ’ s serum testosterone levels before prescribing testosterone injections . The College retained a family physician to review the care provided by Dr . Barnard to Patients B and C . He opined that the care provided to both patients fell below the standard of the profession based on a lack of skill , knowledge and judgement and that Dr . Barnard ’ s care exposed them to harm . Specifically , he stated that Dr . Barnard :
• Demonstrated a lack of skill in the quality and quantity of his information gathering , in his record keeping and in his performance of proper physical assessments ;
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DIALOGUE ISSUE 2 , 2018