Dialogue Volume 14 Issue 2 2018 - Page 66

DISCIPLINE SUMMARIES failure to respond to inquiries from the College within a reasonable time; and his communications with Pa- tient C regarding his complaint to the College and his request for Patient C to call the College and convey that he had no concerns with Dr. Fenton as a doctor. Investigation Regarding Patient D On February 19, 2016, the College received a com- plaint from a family member of Patient D expressing concern regarding the care provided by Dr. Fenton to Patient D. The College retained a family physician expert who opined as follows: • Dr. Fenton’s practice does not meet the standard for record keeping. This includes the lack of an up-to- date cumulative patient profile, lack of documenta- tion to demonstrate physical findings, differential diagnoses and well thought out treatment plans. His referral notes to specialists were incomplete; • Dr. Fenton’s practice does not meet the standard for the safe and effective use of opioids in the manage- ment of chronic non-cancer pain. He documented risk factors for addiction and adverse events (alcohol abuse, lorazepam abuse) and did not apply harm re- duction strategies such as tapering benzodiazepines, weekly prescribing, or referral to a pain specialist; • Dr. Fenton’s practice does not meet the standard of care for the safe and effective use of benzodiaz- epines in the management of anxiety and insomnia. This patient became dependent on lorazepam. She was falling, complaining of general malaise, dizzi- ness, and tremor. Medication adverse effects were never documented as a possible contributing factor to her progressive debility. The College expert further opined that Dr. Fenton’s care and treatment of Patient D displayed a lack of knowledge, skill and judgment as follows: • Lack of knowledge: Dr. Fenton knew Patient D had a history of alcohol abuse. He documented Patient D’s dependence and abuse of lorazepam. He con- tinued to prescribe as Patient D became older and frailer (21 Dec 2015- “needs more help now every 66 DIALOGUE ISSUE 2, 2018 2 weeks”), experiencing episodes of dizziness, poor balance, low appetite and multiple falls. There is no evidence that he has a comprehensive and organized approach to managing chronic non-malignant pain with resources other than controlled drugs. • Lack of skill: Dr. Fenton continued to prescribe opioids and benzodiazepines for Patient D without taking any extra precautions to manage the risk of potential abuse. He did not refer Patient D to a pain or addiction specialist. He did not reduce her prescribed doses in an attempt to safely wean her from these drugs. There is no evidence that he had a thoughtful approach to the overall health risk management of this frail elderly woman with multiple chronic conditions. • Lack of judgment: Dr. Fenton acceded to [Patient D’s] demands for stronger pain medication without establishing any safeguards against increasing de- pendence and adverse effects. He cautioned Patient D about drug and alcohol use but took no effective steps to treat these conditions or reduce harm from his part, which was the prescribing. Dr. Fenton put the responsibility for managing dependence and abuse of controlled drugs on to his patient, despite clear ongoing indications that Patient D was not taking the best self-care. The expert concluded that “it is reasonably fore- seeable that if Patient D’s prescribed medications and alcohol use continue, Patient D will experience serious adverse health outcomes from some kind of in home accident, a fall or an overdose.” Also, Dr. Fenton’s care is likely to expose other patients to harm or injury as well if it is conducted similarly to his care of Patient D. In order to investigate this complaint, the College requested Dr. Fenton’s medical records for Patient D on March 16, 2016. Subsequent requests from the College, including from the Chair of the Inquiries, Complaints and Resolutions Committee, were sent to Dr. Fenton on April 28 and May 16, 2016. No records were received in response to these written requests. On July 13, 2016, the College’s investiga- tor contacted Dr. Fenton by telephone and requested that he provide his medical records for Patient D.