DISCIPLINE SUMMARIES • U se of Demerol, a medication which has been removed from almost all hospital formularies and which has extremely limited indications; • U sage of antibiotics that was a significant variance from the norm; and • U se of mesh in a potentially contaminated field, which is contraindicated, reflecting a knowledge deficit or a cavalier attitude towards patient care. The College commenced a second investigation as a result of a complaint from Patient A, who had attended several times at the Cornwall Community Hospital in 2013 and 2014 and received surgery from Dr. Irwin in 2014 to detach a damaged bowel. Patient A developed abdominal pain following the surgery and later had to undergo further surgery performed by another physician. Patient A indicated that Dr. Irwin failed to properly communicate with her and her family about her care. The College’s expert opined that Dr. Irwin’s care of Patient A fell below the standard of practice of the profession and demonstrated a lack of knowledge and judgment. Specifically, the expert found: • D r. Irwin failed to adequately justify Patient A’s need for colon and ovarian surgery, and failed to sufficiently document that he had informed, dis- cussed, and ensured that the patient had a reason- able understanding of her care; • D r. Irwin demonstrated a lack of knowledge and judgment in failing to further investigate the pa- tient’s presenting complaint; • Dr. Irwin failed to adequately investigate the patient’s right ovarian cyst as a cause of her symptoms, includ- ing failing to seek an opinion from a gynaecologist; • D r. Irwin displayed inadequate judgment in resect- ing both of the patient’s ovaries, with no docu- mentation that the patient requested to have both ovaries removed; and • D r. Irwin’s clinical practice subjected the patient to colon and ovarian surgery that may not have been entirely necessary and that resulted in complica- tions and subsequent harm. The College began a third investigation after a physi- cian assessor expressed concerns about Dr. Irwin’s tech- nique during an out-of-hospital premises inspection at a 62 DIALOGUE ISSUE 4, 2018 clinic where Dr. Irwin practised. The College’s expert opined that Dr. Irwin failed to meet the standard of practice of the profession and demonstrated a lack of knowledge, skill, and judg- ment. In particular, the expert noted that: • Dr. Irwin failed to meet the standard in his docu- mentation, with incomplete charts, failure to follow any organized format, missing consult notes, du- plicative procedure notes which were significantly different, and missing documentation, as well as numerous grammatical errors; • Dr. Irwin lacked knowledge, skill and judgment in that he failed to keep up to date with current endo- scopic guidelines; and • Dr. Irwin’s lack of endoscopic proficiency may have placed patients at risk by missing pathology and increasing the risk of complications. The Committee noted that Dr. Irwin had breached an Inquiries, Complaints + Reports Committee (ICRC) Order restricting his practice by failing to advise the College about his “home practice” of visit- ing approximately 10 patients in their homes, when he was required to notify the College of the addresses of all his practice locations. The Committee also noted Dr. Irwin’s complaints history with the College, in- cluding two prior cautions and a specified continuing education or remediation program with respect to his consent process and documentation of that process, and two prior occasions on which the ICRC issued advice to Dr. Irwin regarding his documentation and patient care. ORDER The Committee ordered: a five-month suspension on Dr. Irwin’s certificate of registration; a reprimand and terms, conditions and limitations on Dr. Irwin’s certificate of registration. These include clinical supervision, a reassessment, restricting his practice to providing small surgical procedures requiring local anesthesia and surgical consultations. The Committee also ordered Dr. Irwin to pay costs of $10,180 to the College. For complete details, please see the full decision at www.cpso.on.ca. Select Find a Doctor and enter the doctor’s name.