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
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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.