DISCIPLINE SUMMARIES certificate after one year, in the absence of a find- ing of sexual abuse, and that the possible date for an application for reinstatement by Dr. Marcin will be delayed by this newly imposed revocation. For complete details, please see the full decision at www.cpso.on.ca. Select Find a Doctor and enter the doctor’s name. DR. JAMES SCOTT BRADLEY MARTIN PRACTICE LOCATION: London AREA OF PRACTICE: Obstetrics/Gynecology HEARING INFORMATION: Admission; Agreed State- ment of Facts; Joint Submission on Penalty On September 25, 2018, the Discipline Committee found that Dr. Martin committed an act of profes- sional misconduct, in that he has failed to maintain the standard of practice of the profession. The Com- mittee also found that Dr. Martin is incompetent. During the relevant time period, Dr. Martin’s prac- tice was focused on transgender care and hormone replacement therapy. In 2016, staff in the Ministry of Health and Long- Term Care contacted the College with inquiries regarding Dr. Martin's prior approval application for a 14-year-old female-to-male transgender patient seeking sex reassignment surgery (a mastectomy), Patient A. As a result of the Ministry's inquiries, investigators were appointed. At the time the investigation began, Dr. Martin described his practice as focused on transgender care and hormone replacement therapy. He indicated that he saw approximately 30 patients a week, spending 15 hours a week in direct patient contact. Also in 2016, a relative complained to the Col- lege about Dr. Martin's treatment of Patient B, an adolescent male-to-female transgender patient. The complainant voiced concerns that Dr. Martin had prescribed hormone replacement therapy and was prepared to approve sex reassignment surgery with- out a mental health assessment. A pediatrician and adolescent medicine specialist was retained to review Dr. Martin's care of Patient A and Patient B. Among other things, as found by the specialist: 58 DIALOGUE ISSUE 1, 2019 • D r. Martin did not meet the standard of practice of the profession regarding care for adolescents with gender dysphoria in his care of Patient A and Patient B; • Dr. Martin prescribed cross-sex hormones to Patient A, who was then 13-years old, at the first visit. Cross-sex hormones have many side effects, including infertility, and more time is necessary to process this information so that adolescents can make an informed decision. Dr. Martin lacked judgment in this regard; • Dr. Martin prescribed cross-sex hormones to Patient B, who was then 16-years old, at the first visit. Although Patient B was 16 at the time of consultation, age alone is not a criterion for initia- tion of cross-sex hormones. Dr. Martin lacked judgment in this regard. The short length of the first consultation (described by Dr. Martin as 30 minutes), at which cross-sex hormones were prescribed, was also concerning, given the time required for an informed consent discussion to take place; • Dr. Martin lacked judgment regarding determina- tion of mental health needs and supports. The mental health portions of the patient charts were limited, and he did not specifically address com- mon mental health diagnoses that co-occur with gender dysphoria in adolescents, such as depres- sion and anxiety. There was no mental health assessment before initiating cross-sex hormones in either Patient A or Patient B; • Dr. Martin's conduct could expose patients to harm or injury, based on his prescribing cross-sex hormones to young patients at the first visit with minimal mental health history-taking and the lack of assurance that the patient has sought and is accessing appropriate mental health resources and supports. Prior History with the Discipline Committee In 2014, The Discipline Committee found that Dr. Martin failed to maintain the standard of practice of the profession in his fertility practice and directed the Registrar to suspend Dr. Martin’s certificate of registra- tion for a period of two months and restrict his practice to reproductive endocrinology and the interpretation of fertility-related ultrasound images, among other things.