Dialogue Volume 14 Issue 3 2018 - Page 36

DISCIPLINE SUMMARIES In the summer of 2012, a pharmacist expressed concern about Dr. Garcia’s narcotic prescribing prac- tices to both Dr. Garcia and the physician who had supervised him at Wellington Medical Centre. In the late summer and fall of 2012, the supervis- ing physician reviewed the charts for most of the ap- proximately dozen patients to whom Dr. Garcia was prescribing narcotics or opioids at the Wellington Medical Centre, met with several of these patients, along with Dr. Garcia, and conducted an assessment of each patient’s pain and the appropriateness of the narcotics prescriptions given by Dr. Garcia. Follow- ing this process, several patients seen together by the supervising physician and Dr. Garcia were referred to a pain clinic, specialist or detoxification program. In May 2013, the supervising physician contacted the College to report his concerns about the medical care provided by Dr. Garcia. Following receipt of this information, the College began an investigation into Dr. Garcia’s practice. The College obtained medical records with respect to 36 patients. A review by a medical inspector retained by the College concluded that Dr. Garcia provided quality medical care to some patients and failed to maintain the standard of practice of the profession in his care of other patients. During the College investigation, Dr. Garcia stated that his practice had changed since 2012 and early 2013, and that he had tried to slow down how quickly he saw patients and communicate more ef- fectively with them. Dr. Garcia also said that he was “duped” by a couple of patients who were engaged in drug-seeking behaviour and that he was too trust- ing of patients who were seeking narcotics for pain medication. Dr. Garcia failed to maintain the standard of prac- tice of the profession with respect to 11 patients. The deficiencies noted included: • not obtaining an adequate history or doing a proper physical examination of a patient who com- plained of “chronic pain”; • in the case of several patients, not recording any physical examination and not recording details about the source or type of pain they experienced; 36 DIALOGUE ISSUE 3, 2018 • p  rescribing narcotics to pain patients without tak- ing a proper and full history and without doing any physical examination; • e  arly renewal of narcotic prescriptions without a notation in the chart to explain why the medication was renewed early; • r  egarding one patient who was given a typhoid immunization, Dr. Garcia made no notes of this appointment in the chart and no record was kept of the drug identification number or lot number for the vaccine given; and • i  n the case of one patient, Dr. Garcia’s charting was moderately below standard. Dr. Garcia’s typed note for a visit incorrectly indicated he gave the patient a typhoid shot, although his handwritten note cor- rectly indicated that he gave the patient an allergy shot on that date. The medical inspector expressed concern that Dr. Gar- cia’s general patient population was put at risk because of his willingness to prescribe narcotics and repeated inabil- ity to detect the misuse of opioid medication. DISGRACEFUL, DISHONOURABLE OR UNPROFESSIONAL CONDUCT (A CONTESTED HEARING) The Committee found that Dr. Garcia prescribed medications and provided a medical service to Ms. A, a woman who was not a patient and with whom he had a personal and romantic relationship. Dr. Garcia prescribed medications to Ms. A on three occasions. On one of those occasions, he prescribed an IUD and referred Ms. A to a gynecologist to perform the IUD insertion. There was no record of an assessment, including a history and physical examination, prior to providing any of the prescriptions. The Treat- ing Self and Family Members policy clearly states that physicians should not treat either themselves or family members, except for a minor condition or in an emergency situation and when another quali- fied health-care professional is not readily available. These conditions were not present on the occasions when Dr. Garcia chose to prescribe medications, an IUD and provide a medical service to Ms. A. As Ms.