Dialogue Volume 14 Issue 2 2018 - Page 65

DISCIPLINE SUMMARIES chart in that a complete list of medications being prescribed is not found in the record provided. It is unclear as to when or why hydrochlorothiazide ap- pears to have been added. There is no documented risk stratification. There is no assessment of possible end organ damage. The management of hyperten- sion and its risks as documented does not meet the standard of care as expected of a competent practi- tioner in family medicine and demonstrates a lack of skill and judgment in the management of this chronic disease; • The diagnosis and management of diabetes by Dr. Fenton does not follow the current guidelines of the Canadian Diabetic Association. Dr. Fenton appears from the chart to have made the diagnosis of diabetes based on a single laboratory reading of HbA1c equaling 0.065. There is no discussion of repeating this test on a different day as recommend- ed. Once diagnosed, appropriate treatment based on the information provided would begin with discussion of lifestyle management of weight loss, exercise, and dietary habits including referral to al- lied health professionals for education. This would be the expected standard of care. The only docu- mentation in this regard is “weight loss discussed” following the visit where metformin therapy was instituted; • There is mention in the chart provided of discus- sion of lipid management, however targets were not identified. Again, there is no evidence of risk strati- fication to guide treatment decisions as outlined in current guidelines. The patient appears to have been put on sub-therapeutic doses of atorvastatin and had Ezetrol added in 2012, with no follow-up to document response to treatment, or potential side effects until 2014. There is no discussion documented regarding maximizing the dose of the statin, or reasons why this would not be appropri- ate, before starting another class of medication which is considered standard of care by current guidelines. There is no discussion of lipid manage- ment following the lab work done in May 2014, which included a lipid profile and Dr. Fenton’s diagnosis of diabetes. In December 2015, the College’s investigator re- ceived a call from Patient B who described running into Dr. Fenton recently at a coffee shop in their neighbourhood. During that encounter, Dr. Fenton asked Patient B to call the College and drop the investigation regarding Dr. Fenton. Patient B asked the College investigator to contact Dr. Fenton and request that Dr. Fenton not approach him in the future if they see each other in the community. It was found that Dr. Fenton failed to maintain the standard of practice of the profession in his care and treatment of Patient B, as described above, including his failure to follow the College’s policy regarding Test Results Management. It was also found that Dr. Fenton engaged in con- duct that would reasonably be regarded by members as disgraceful, dishonourable or unprofessional in his failure to transfer Patient B’s medical chart in a timely manner; and his communications with Patient B regarding his complaint to the College and his request for Patient B to withdraw his complaint. Patient C In July 2015, the College received a complaint from Patient C’s lawyer who was representing Patient C with respect to an insurance claim and accident ben- efits arising out of a motor vehicle accident in 2010. Patient C was a patient of Dr. Fenton’s since ap- proximately 2009. Between August 2011 and July 2015, Patient C’s lawyer made several attempts to obtain Patient C’s medical chart from Dr. Fenton. Despite multiple requests from the College, the EMR and the paper charts were provided to Patient C’s lawyer for the first time in March 2017. In January 2016, Patient C had an appointment with Dr. Fenton. During that appointment, Dr. Fen- ton asked Patient C to contact the College and report that Patient C had no concerns with Dr. Fenton as a doctor. Dr. Fenton engaged in conduct that would reason- ably be regarded by members as disgraceful, dishon- ourable or unprofessional in his failure to transfer Patient C’s medical chart in a timely manner; his Full decisions are available online at www.cpso.on.ca. Select Find a Doctor and enter the doctor’s name. IS SUE 2, 2018 DIALOGUE 65