Dialogue Volume 14 Issue 2 2018 - Page 62

DISCIPLINE SUMMARIES ous blocks; • In several instances, Dr. Billing did not adjust his treatment based on new evidence when new findings or diagnostic results, such as imaging became available, and/or he failed to record any adjustments to treatment based on new findings or diagnostic results; and • When a patient notes a new area of pain, Dr. Bill- ing often performs nerve blocks without document- ing investigations to confirm the diagnosis. Due to their proximity to the epidural space, para- vertebral blocks (a block of the spinal nerve where local anesthetic is injected in the paravertebral space) must be done using appropriate sterile technique due to the rare, but potentially severe consequences of infection in this area, including epidural abscess and paralysis. “Sterile technique” means that everything used in the injection must be sterile, including the target area on the patient’s skin for the injection, which must be cleaned in a sterile fashion; the syringe, the needle, and the solution in the syringe; and the gloves, which must also be sterile. Dr. Billing’s technique in administering paraver- tebral blocks had the following deficiencies with respect to the sterile technique used: • He used only alcohol swabs to sterilize the general block area, not the stronger chlorhexidine spray. According to Dr. Billing, he began to use chlorhexi- dine spray when this issue was drawn to his atten- tion by an expert; • He administered injections to individual patients using the same needle that had already been used to perform occipital nerve blocks through the patients’ scalps. The scalp area is notoriously difficult to sterilize; • He did not appropriately maintain the sterility of his gloves, in that although he started with sterile gloves, while he was administering injections, he used gloves that had touched unsterilized areas of the patients, including their scalps. ORDER The Discipline Committee ordered: a two-month suspension of Dr. Billing’s certificate of registration; 62 DIALOGUE ISSUE 2, 2018 terms, conditions and limitations on Dr. Billing’s cer- tificate of registration; a reprimand and payment of $5,000 to the College for costs. The terms, conditions and limitations include a 12-month period of clinical supervision, with varying levels of supervision in response to the findings of the clinical supervisor; a reassessment three months after the period of clinical supervision ends; cooperation with unannounced inspections of his practice; and providing consent to the College to make inquiries of the Ontario Health Insurance Plan and/or any person or institution that may have relevant informa- tion, in order for the College to monitor and enforce his compliance with the terms of this Order;. For complete details of the Order, please see the full decision at www.cpso.on.ca. Select Find a Doctor and enter the doctor’s name. APPEAL On June 30, 2017, Dr. Billing appealed the pen- alty decision to the Ontario Superior Court of Justice (Divisional Court). On April 25, 2018, the Divisional Court dismissed the appeal with $10,000 in costs to the College. DR. PETER MICHAEL FENTON PRACTICE LOCATION: Toronto AREA OF PRACTICE: General Practice HEARING INFORMATION: Admission, Agreed Statement of Fact, Joint Submission on Penalty On March 20, 2017, the Discipline Committee found that Dr. Fenton committed an act of profes- sional misconduct in that he failed to maintain the standard of practice of the profession and he engaged in conduct or an act or omission relevant to the prac- tice of medicine that, having regard to all the circum- stances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional. The Discipline Committee also found that Dr. Fenton is incompetent. Dr. Fenton received his certificate of registration authorizing independent practice in Ontario in June