Dialogue Volume 14 Issue 2 2018 - Page 58

DISCIPLINE SUMMARIES • Certain use of “off label” prescribing and potential- ly harmful prescribing (including prescribing HCG as described above; potentially harmful prescribing of narcotics for non-cancer pain; prescribing ben- zodiazepines with narcotics; prescribing Methotrex- ate 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 pre- scribing some such medicines which he knew had no medical evidence for use, such as HCG; and • The use of excessive laboratory testing in the ab- sence 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 prac- tice 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 Bar- nard Wellness Centre in May 2012. Patient A had a history of testosterone levels having been document- ed 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 continu- ally 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 fo- cus in men’s health, including testosterone deficiency, 58 DIALOGUE ISSUE 2, 2018 to review Dr. Barnard’s care in regard to Patient A, who found that Dr. Barnard did not meet the stan- dard of practice of the profession in that he: • Displayed poor documentation and record keep- ing of his thought process and/or discussions with Patient A; • Failed to adequately counsel Patient A in the haz- ards 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 man- agement, 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 ”]Y[X[YH\\8&\]Y[[X\ L[\YK]Y[X[YH\\8&\œ]Y[[XX\H Lˈ\\\Z[]Y]Y[H\XXH[\[ L˂\\X]Y]Y[܈ۚXZ[B\ܚXY\XK[X[K[X[ۜ]KBZ[[X[ۜ[\\ۙH[X[ۜY[[š[X^H L\\YXܙ]Y[&\œ\[H\\ۙH][YܙH\ܚX[\\BۙH[X[ۜ˂HYH]Z[YH[Z[H\XX[]Y]H\HݚYYH\\]Y[[ˈH[Y]H\HݚYY]Y[™[[H[\وHٙ\[ۈ\YۈBXو[ ۛYH[Y[Y[[]\\8&\\H^Y[H\KXYX[KB]Y]\\([[ۜ]YHXو[[H]X[]H[]X[]Hو\[ܛX][ۈ]\[[\XܙY\[[[\\ܛX[Hو\\X[\\Y[