Dialogue Volume 14 Issue 2 2018 - Page 59

DISCIPLINE SUMMARIES • Demonstrated a lack of knowledge when he in- creased Patient C’s dose of thyroxine and added Cytomel without evidence of thyroid deficiency; • Demonstrated a lack of knowledge when he pre- scribed Flagyl to Patient C without indication; • Demonstrated a lack of knowledge in failing to identify the significance of Patient C’s rising erythrocyte sedimentation rate (ESR) (which with other symptoms was suggestive of an autoimmune disorder); and • Demonstrated poor judgment in failing to comply with College guidelines for record keeping, pre- scribing drugs and the use of alternative therapies. The College retained a second family physician with some knowledge of and interest in complemen- tary and alternative medicine to provide an opinion regarding Dr. Barnard’s care of Patients B and C, having regard to the College’s complementary/alter- native medicine policy. With regard to Patient B, the family physician opined that Dr. Barnard’s use of testosterone and vitamin injections was unconventional and not sup- ported by any scientific evidence of which he was aware. Dr. Barnard had failed to clearly indicate the diagnosis although he treated chronic pain syndrome with an associated neuropathy. Dr. Barnard did not document valid informed consent for his unconven- tional therapeutic interventions. With respect to Patient C: • Dr. Barnard’s care of Patient C’s inflammatory disorders falls within the realm of complementary medicine; • Dr. Barnard failed to provide an appropriate clini- cal assessment with regard to Patient C. He record- ed no clear working diagnosis or treatment plan; • Dr. Barnard failed to document a conventional diagnosis; • He did not record any evidence of informed con- sent having been obtained for the unconventional therapeutic interventions; • He failed to address the patient’s elevated ESR; and • Despite the poor assessment and review of Patient C, his care did not demonstrate a lack of knowl- edge or skills. However, Dr. Barnard showed poor judgment by failing to document more appropriate patient counselling regarding the unconventional therapies being utilized. It was found that Dr. Barnard failed to maintain the standard of practice of the profession in his care of Patients B and C. Investigations Regarding Patients D, E and F Patients D, E and F were a mother and her two chil- dren. They became Dr. Barnard’s patients in the fall/ winter of 2010/2011, and continued as his patients until November 2013. The College retained a family physician to review the standard of care provided by Dr. Barnard to Patients D, E and F. He concluded that Dr. Barnard did not meet the standard of practice of the profession in rela- tion to Patients D, E and F and that he demonstrated a lack of knowledge and skill. Examples include: • a lack of knowledge of appropriate testing and investigations for specific symptoms. Among other things, Dr. Barnard repeatedly ordered a broad spectrum of tests on Patients D, E and F without indication, including broad annual testing for Patient D, and ordered specific tests that were not inappropriate based on the patient’s age or lack of suitability as a screening tool; • a lack of knowledge in treating asthma in children with respect to Patients E and F: those patients received oral medications without any clear indica- tion for their use and without corresponding use of inhaled medications; • a lack of knowledge in the use of antibiotics, in- cluding prescribing incorrect doses and prescribing in cases where antibiotics are not indicated; • a lack of knowledge in prescribing with respect to dosage of Topamax; • a lack of knowledge of the treatment of anxiety for Patient D, and giving inappropriate treatment for the same; and • a lack of skill in the documentation of visits, in- cluding incomplete or absent charting of history, Full decisions are available online at www.cpso.on.ca. Select Find a Doctor and enter the doctor’s name. ISSUE 2, 2018 DIALOGUE 59