Dialogue Volume 14 Issue 4 2018 - Page 76

DISCIPLINE SUMMARIES DR. IAN KENT SHIOZAKI PRACTICE LOCATION: Newboro AREA OF PRACTICE: General Practice HEARING INFORMATION: Admission; Agreed Statement of Facts; Joint Submission on Penalty On March 21, 2018, the Discipline Committee found that Dr. Shiozaki committed an act of profes- sional misconduct in that he failed to maintain the standard of practice of the profession, and engaged in disgraceful, dishonourable or unprofessional con- duct. It also found that he was incompetent in his prescribing and injecting of controlled substances, including narcotics. On October 22, 2015, the College received in- formation from a physician about the dosages of a stimulant prescribed by Dr. Shiozaki to a mutual pa- tient. On the basis of this and other information, the College began an investigation to obtain a broader view of Dr. Shiozaki’s general medicine practice, including his prescribing. In February 2016, the College received information from the Ministry of Health and Long-Term Care’s Narcotics Monitoring System (NMS) regarding Dr. Shiozaki’s prescribing of controlled drugs, including narcotics. The College retained a specialist in family medi- cine to provide an opinion on Dr. Shiozaki’s general medicine practice, including his prescribing. The expert physician identified significant concerns in Dr. Shiozaki’s care and treatment of his patients’ chronic non-cancer pain, particularly in the areas of (a) prescribing of controlled drugs, including narcot- ics, and (b) injecting of opioids, and associated stor- age and disposal of injectable opioids. The expert physician opined that Dr. Shiozaki failed to meet the standard of practice of the profession and that he demonstrated a lack of knowledge, skill and/ or judgment in his prescribing of controlled drugs, in- cluding narcotics, and, in some cases, his injecting of opioids and associated storage and disposal of inject- able opioids, in all 25 patient charts reviewed. In addition to the concerns identified about Dr. Shiozaki’s treatment of pain, the expert physician 76 DIALOGUE ISSUE 4, 2018 identified other concerns about Dr. Shiozaki’s general medicine practice in 11 of the 25 charts reviewed, including a failure to offer or document age-specific preventive screening and a failure to adequately treat and monitor certain conditions. Dr. Shiozaki provided the College with a report of a family medicine/emergency medicine special- ist, who noted in his report that Dr. Shiozaki has a challenging patient population and, as an isolated rural family physician in a small community, he has limited ancillary resources to assist him with the management of his patients. COLLEGE’S PAIN MEDICINE EXPERT The College retained a pain medicine expert to provide an opinion about whether certain injections performed by Dr. Shiozaki were of a nature that they could only be performed in a licensed out-of-hospital premises. The pain medicine expert reviewed five patient charts, and attended at Dr. Shiozaki’s office where he toured the clinic, reviewed equipment and inter- viewed Dr. Shiozaki as to the variety of injections that he performed. Dr. Shiozaki advised the pain medicine expert that he had not performed nerve block injections since the out-of-hospital premises (OHP) program was implemented. In his report, the pain medicine expert took issue with one of the injection procedures conducted by Dr. Shio- zaki and concluded that Dr. Shiozaki was performing nerve blocks in the form of SI joint injections – a Level 1 nerve block procedure under the OHP guidelines. Level 1 nerve block procedures may only be per- formed in authorized out-of-hospital premises. Dr. Shiozaki’s office was not an authorized out- of-hospital premises. Dr. Shiozaki applied to the College in 2010 to have his office authorized as an out-of-hospital premises because he was performing nerve blocks. He elected not to proceed with the ap- plication after learning what was required to obtain authorization to operate an out-of-hospital premises and advised a College investigator at that time that he was no longer performing nerve blocks. The pain medicine expert identified concerns with Dr. Shiozaki’s clinic’s preparedness for medical emergencies given that Dr. Shiozaki was performing Level 1 nerve block procedures, and opined that, in the five charts that he reviewed, Dr. Shiozaki’s procedural notes fell be-