Dialogue Volume 14 Issue 4 2018 - Page 53

DISCIPLINE SUMMARIES In June 2016, Patient A attended Dr. Choong with complaints of pain in her rectum due to constipa- tion. Given Patient A’s presentation, Dr. Choong offered to conduct a digital rectal examination, which the patient accepted. Dr. Choong directed Patient A to take off her pants and undergarments and failed to provide the patient with any draping. He then asked Patient A to bend forward and lean over the examining table, raising her rectum towards him. Dr. Choong’s positioning did not allow for adequate visual examination and he inadvertently inserted his finger in the patient’s vagina in a manner the patient experienced as force- ful. Patient A responded quickly stating, “Oh no, not there.” Dr. Choong then released his finger and proceeded to insert it in her rectum to perform a digital rectal exam. Given Patient A’s presentation and finding, Dr. Choong believed she had an anal fissure and pre- scribed an analgesic cream. An expert retained by the College concluded that a digital rectal exam was clinically indicated in the circumstances. However, the expert opined that Dr. Choong failed to maintain the standard of practice of the profession in this case, explaining that the standard of practice for a female digital rectal ex- amination is for the patient to be in the lithotomy position (on her back with legs open as for a pelvic examination) or lying on her left side. According to the expert, one would proceed in the lithotomy posi- tion, if the patient was being evaluated for possible pelvic complaints and a rectal examination was also required. If only a rectal examination is indicated based on the complaint, the left side lying position is standard. Given that Patient A was complaining specifically of rectal pain and she was constipated, a side lying examination was indicated. The expert further concluded that Dr. Choong’s digital rectal examination technique displayed a lack of judgment. Not only did he not employ the ap- propriate technique for female patients, he also failed to provide modesty draping, demonstrating a lack of judgment and a failure to maintain the standard of practice. The expert noted that the examination, which was “clumsily performed”, may have a lasting negative effect on the patient. On January 30, 2018, Dr. Choong entered into an undertaking with the College, wherein he agreed to resign from the College effective immediately and to not apply or re-apply for registration to practise medicine in Ontario or in any other jurisdiction. ORDER In light of this undertaking, and the assurance that the public would be protected, the Committee or- dered a reprimand. Dr. Choong was also ordered to pay costs to the College in the amount of $5,500. For complete details, 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. Choong waived his right of appeal and the Discipline Committee adminis- tered the reprimand. DR. PETER DIARMUID DAVISON PRACTICE LOCATION: Ottawa AREA OF PRACTICE: General Practice HEARING INFORMATION: Admission; Agreed Statement of Facts; Joint Submission on Penalty On May 1, 2018, the Discipline Committee found that Dr. Davison committed an act of professional misconduct, in that he engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all of the circumstances, would rea- sonably be regarded by members as unprofessional. Dr. Davison is a family physician practising in Ot- tawa. He received his certificate of registration autho- rizing independent practice in Ontario in 1975. PATIENT A Patient A, a man in his 90s, has been a patient of Dr. Davison since mid-1990s. In 2015, a general evaluation was conducted of Patient A in hospital by a geriatric nurse. The out- come of the evaluation was “suspected dementia” and “probable mixed mild dementia.” In July 2016, Dr. Davison was experiencing acute fi- nancial difficulties, both of a professional and personal nature, including with respect to paying office rent. ISSUE 4, 2018 DIALOGUE 53