Dialogue Volume 14 Issue 2 2018 - Page 71

DISCIPLINE SUMMARIES 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. At the conclusion of the hearing, Dr. Ghumman waived his right to an appeal and the Committee administered the public reprimand. DR. JEFFREY RICE HOLMES MATHESON PRACTICE LOCATION: Ajax AREA OF PRACTICE: General Practice (Chronic Pain Management) HEARING INFORMATION: Admission, Agreed Statement of Facts; Contested Penalty On May 1, 2017, the Discipline Committee found that Dr. Matheson committed an act of professional misconduct in that he failed to maintain the standard of practice of the profession, and he engaged in an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable, or unprofessional. Dr. Matheson is a family physician practising in Ajax. Beginning in 2002, Dr. Matheson developed a specialty in chronic pain management. PRESCRIBING PRACTICES During the period from July 2013 to October 2014, the College received four telephone calls from four pharmacists raising concerns about Dr. Matheson’s prescribing practices. The College retained an expert to review Dr. Matheson’s opioid prescribing. The expert con- cluded that Dr. Matheson did not meet the expected standard of practice as outlined in the Canadian Guidelines for Opioids for Chronic Non-Cancer Pain either at the level of primary care physicians, or at a reasonably higher standard of physicians, like Dr. Matheson, holding themselves out as a specialist in the field. The expert’s concerns included that: • Dr. Matheson consistently demonstrated a lack of understanding of the expectations outlined in the Canadian Guidelines with respect to instituting opioid therapy, following up, changing from one opioid to another and the medical implications of high-dose opioids. • Dr. Matheson consistently demonstrated an almost cavalier approach to switching opioids, most often increasing the total daily morphine equivalent, by as much as 30% rather than allowing for incom- plete tolerance and decreasing by 30 – 50%, all the time with no documentation of discussion around the driving or fall risk. • Dr. Matheson’s greatest failure of judgment is perhaps his complete lack of adherence to and recognition of the fundamental importance of the Canadian Guidelines to an opioid practice. This shows a significant lack of judgment to the point of negligence causing harm. • Dr. Matheson’s prescribing of opioids and failure to follow any standards of care beyond opioid agree- ments is nothing short of reckless. There is a risk to both his patients’ health and that of the public at large. As a result of concerns raised by the College and its expert during the investigation, Dr. Matheson vol- untarily cea 6VB&W67&&r&6F72B6G&V@7V'7F6W2&6b#R##RG"FW66vVBf&FW&VFW'FrF6V6R&W67&&r&6F70B6G&VB7V'7F6W2UBbԄ5D$Tԕ4U0G"FW6v2VF6F&V7F"b&V֗6W2F@vW&R7V&V7BFFR7V7F76W76VB&VvR@FR6VvRW'7VBFFR&VwVFW'6W&f&&6VGW&W22FVfVBFR&VwVF&V֗6W2VW72FR6VvR( 76W>( FR&V֗6W0"76W2BvF6FF2FBr&6VGW&W2F&RW&f&VB6WFV&W"#BFR6Vv^( 2WBbФ7F&V֗6W27V7F&w&&V6VfV@F6RFBG"FW6( 2&V֗6W2v2FVFpgVFV662&Rf&RƖRBwwr7666VV7BfBF7F"BVFW"FRF7F.( 2Rक55TR"#DuTPs