Dialogue Volume 14 Issue 4 2018 - Page 73

DISCIPLINE SUMMARIES found that Dr. Proulx is incompetent. Dr. Proulx received his certificate of independent practice in 2003, and his specialist qualification in family medicine in 2006. Before July 2016, Dr. Proulx practised medicine in St. Catharines, Ontario. Dr. Proulx engaged in a scheme to divert narcotics from patients to himself, prescribing approximately 200 tabs of Oxycodone to two people (his neighbor, Ms. A, and her boyfriend) approximately every 16 days, and then buying most of the pills back from them. Despite prescribing to the neighbour between August 2013 and January 2016, Dr. Proulx only saw Ms. A clinically on two occasions, in February 2015 and January 2016. Dr. Proulx lied to the neighbour about the reason he needed the pills, telling her that he needed them to treat his lymphoma (which he does not have) but that his own physician would not prescribe narcotics to him. He told her that their arrangement was se- cret, illegal, and that she could face criminal charges if it was discovered. After learning of the College’s in- vestigation, Dr. Proulx again told her she would be in trouble, including that she could go to jail, and told her not to cooperate with the College’s investigation. In his response to the College, Dr. Proulx was untruthful about the nature of his arrangement with his neighbour. He also failed to cooperate with the College’s investigation by refusing to answer the investigator’s questions. The independent expert retained to review Dr. Proulx’s charts opined that there were systemic, broad-based deficiencies in his narcotics and benzo- diazepine prescribing practices that exposed patients to a risk of harm, both in terms of his medical record keeping and his clinical care. Most patients were prescribed opioids without an appropriate history, proper physical examination, or a full assessment of their pain and often when they were quite new to Dr. Proulx’s practice. Dr. Proulx typically prescribed high doses of opioids in very large quantities, without as- sessing patients’ potential for addiction or document- ing discussion regarding functional status, adverse effects, and risks of opioids before prescribing opioids to them. The actual indication for the opioids was not clear for several patients. There was no use of a formalized narcotic treatment agreement, and urine drug screens were performed extremely rarely. Several patients were obtaining excessively large quantities of opioids from Dr. Proulx that were not documented anywhere in their chart notes. For two patients to whom he had prescribed opioids, Dr. Proulx had no patient chart whatsoever, one of whom was the neighbour’s boyfriend with whom he had engaged in the pills for cash scheme. The College’s expert opined that Dr. Proulx did not meet the standard of practice of the profession in his care of Ms. A, in that: • Dr. Proulx provided medical care to Ms. A outside of an office setting, without adequate documentation; • Dr. Proulx’s care also failed to meet the standard of practice of the profession in terms of the require- ments for prescribing; • Dr. Proulx’s care displayed a severe and ongoing lack of judgment evidenced by his prescriptions of large quantities of a controlled substance to an acquaintance whom he had not adequately assessed. This was not a single lapse in judgment; and • Dr. Proulx’s conduct in this case was likely to ex- pose Ms. A to harm or injury, since she was at high risk for opioid misuse or overdose, given her past history of overdose and her current substance use. UNDERTAKING AND RESIGNATION On February 21, 2017, in a submission to the Inqui- ries, Complaints and Reports Committee in respect of its investigations, Dr. Proulx emphasized that he had permanently resigned his membership with the College, and that he has no intention of ever practis- ing medicine in Ontario, or any other jurisdiction. ORDER The Committee ordered the revocation of Dr. Proulx’s certificate of registration; a reprimand; and payment to the College for costs in the amount of $5,500.00. 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, counsel for Dr. Proulx indicated that Dr. Proulx waived his right to an appeal and the Committee administered the public reprimand in Dr. Proulx’s absence. ISSUE 4, 2018 DIALOGUE 73