Committee: Discipline
Decision Date: 10 May 2019
Summary:
On May 10, 2019, on the basis of an Agreed Statement of Facts and Admission (Liability), the Discipline Committee found that Dr. Taniguchi committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession in his care of patients, and engaged in an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
AGREED STATEMENT OF FACTS AND ADMISSION (LIABILITY)
Dr. Taniguchi is 54 years old. He received his certificate of registration authorizing independent practice in 1991. He practices in Hamilton, Ontario in the area of palliative care. He previously also practiced in the area of long-term care medicine.
In addition to his clinical practice, Dr. Taniguchi is an Assistant Clinical Professor at McMaster University, and the Program Director of McMaster’s Family Medicine Palliative Care Residency Program. At the time of the events at issue, in addition to his clinical duties, Dr. Taniguchi had significant teaching, academic, and administrative responsibilities.
Failure to comply with SCERP
On July 15, 2016, the Quality Assurance Committee of the College of Physicians and Surgeons of Ontario (“the College”) required Dr. Taniguchi to participate in a specified continuing education or remediation program (“SCERP”) consisting of:
-a review and written summary of a College policy, and a section of the Practice Guide;
-a period of clinical supervision, in which Dr. Taniguchi was required to meet with a supervisor monthly for six months and review 10 charts at each meeting; and
-a reassessment of his practice.
Dr. Taniguchi was notified of the Committee’s decision on August 5, 2016. He was required to retain a clinical supervisor within 30 days of receiving the decision.
Dr. Taniguchi did not retain a clinical supervisor, or undergo a reassessment, pursuant to the SCERP. Dr. Taniguchi failed to respond to correspondence from the College on August 16, 2016, November 22, 2016 and January 2, 2017 with respect to his compliance with the SCERP. Dr. Taniguchi submitted the required written summary on June 23, 2017.
Breach of Order
On May 10, 2017, the QAC made an Order imposing terms, conditions, and limitations on Dr. Taniguchi’s certificate of registration. Under the Order, Dr. Taniguchi was required to obtain a clinical supervisor acceptable to the College within 14 days of the Order, and meet with the clinical supervisor monthly to review 10 long-term care patient charts. The Order was to remain in effect until May 9, 2018. If Dr. Taniguchi was unable to retain a clinical supervisor as required by the Order, he was required to cease practicing long-term care until such time as he had done so.
On May 25, 2017, Dr. Taniguchi proposed that Dr. David Chan be approved as his supervisor.
On May 31, 2017, the College confirmed that Dr. Chan was approved. On June 7, 2017, the College advised Dr. Taniguchi that it had received Dr. Chan’s executed undertaking, and that Dr. Taniguchi was permitted to return to practice.
Dr. Taniguchi had his first and only meeting with Dr. Chan on September 8, 2017:
-there were “no deficiencies identified” in Dr. Taniguchi’s charts; and
-“Dr. Taniguchi has made a lot of progress. His documentation is excellent and in my opinion meets the standard of documentation in a [long-term care] setting”.
Although Dr. Chan’s initial report was favorable, Dr. Taniguchi states that he felt overwhelmed. He failed to arrange follow-up meetings with Dr. Chan. Dr. Chan emailed Dr. Taniguchi twice after their first meeting to encourage Dr. Taniguchi to schedule their next meeting, but Dr. Taniguchi did not respond.
On January 26, 2018, Dr. Taniguchi was notified that he was in breach of the Order, and was advised to meet with Dr. Chan and review 40 charts with him by February 8, 2018 to bring himself back into compliance. Dr. Taniguchi failed to do so.
On February 12, 2018, Dr. Chan advised the College that he had not heard from Dr. Taniguchi, and withdrew as Dr. Taniguchi’s clinical supervisor. Dr. Taniguchi ceased practicing long-term care in February 2018.
Section 75 Investigation
In addition to making the Order described above, the QAC also disclosed to the ICRC Dr. Taniguchi’s name, as well as the allegations that he may have committed an act of professional misconduct, including but not limited to lack of governability, or that he may be incompetent or incapacitated. The Registrar appointed investigators to investigate whether Dr. Taniguchi, in his general medicine practice, including his long-term care and palliative care, had engaged in professional misconduct or was incompetent.
Dr. Taniguchi was notified of the investigation on July 13, 2017. The investigator asked Dr. Taniguchi to complete a Physician Practice Questionnaire and an Electronic Records Questionnaire, and return them to the College within 10 business days. Dr. Taniguchi did not respond. The investigator sent several further requests for Dr. Taniguchi’s completed questionnaires between October 2017 and February 2018, to which Dr. Taniguchi did not respond. The College did not receive Dr. Taniguchi’s completed questionnaires.
The College retained Dr. Benoit Robert to opine on Dr. Taniguchi’s care of 25 patients in both palliative care and long-term care practices.
On April 16, 2018, the investigator wrote to Dr. Taniguchi advising him that Dr. Robert had requested to interview Dr. Taniguchi for the purposes of preparing his opinion. Dr. Taniguchi did not respond to this letter, and did not attend for an interview with Dr. Robert.
With respect to Dr. Taniguchi’s palliative care practice, Dr. Robert opined:
-Dr. Taniguchi’s pattern of documentation was consistent with a physician who practiced “at a distance”. It was unclear from much of the documentation provided whether Dr. Taniguchi had direct contact with patients. Although Dr. Taniguchi was a consultant in a teaching setting, his charting pattern was suggestive of not being available on a consistent basis;
-Dr. Taniguchi’s documentation of encounters did not follow a “SOAP” format, or a problem-based approach. His notes contained minimal subjective and objective data, and his assessments and plans were cursory. There was limited evidence of physical examinations;
-Dr. Taniguchi demonstrated a significant lack of knowledge of appropriate documentation. The paucity of charting and documentation interfered with Dr. Robert’s ability to opine on Dr. Taniguchi’s knowledge with respect to palliative care. The lack of documentation also precluded an accurate assessment of Dr. Taniguchi’s skill; and
- Dr. Taniguchi was not readily available to assess patients in a timely fashion. While Dr.Taniguchi’s clinical practice was unlikely to expose patients to harm or injury, this was due to the rapid available backup by other qualified palliative care physicians on days on which Dr. Taniguchi is not available.
With respect to Dr. Taniguchi’s long-term care practice, Dr. Robert opined:
-It was not clear from Dr. Taniguchi’s documentation in 2015 and 2016 that he was performing admission physicals, nor was it clear that he was performing annual physicals. There were a number of occasions on which these physicals were not documented. Dr. Taniguchi’s extensive use of PRN orders in the order sets in some charts also suggested that his approach to those residents’ care was not personalized;
-There was a significant improvement in Dr. Taniguchi’s long-term care documentation after mid-2017, with respect to his use of SOAP notes, and the documentation of admission and annual exams, and care conferences;
-Dr. Taniguchi’s knowledge and skill were difficult to ascertain from his charts. However, there were instances in which Dr. Taniguchi’s charting suggested a lack of knowledge and/or skill. In one case, Dr. Taniguchi failed to follow through on a psychiatry note outlining the need for quarterly monitoring of the patient’s liver function tests. In another case, Dr. Taniguchi failed to address rising creatinine levels in an elderly patient who was prescribed Ramipril, and who later developed acute-on- chronic renal failure; and
-Dr. Taniguchi was not readily available to assess his patient load, and his lack of availability was concerning. His practice of attending on patients only every two weeks allowed for conditions to aggravate between visits. It also appeared that he was not available between visits. The use of email did not seem to expedite communication. It also was not clear that the email channels used were secure, and Dr. Taniguchi’s email correspondence at times comingled patients’ personal health information.
Section 25.4 Order
On November 8, 2018, the Inquiries, Complaints and Reports Committee made an Order under s.25.4 of the Health Professions Procedural Code (“s. 25.4 Order”), requiring, among other things, that Dr. Taniguchi practice under the guidance of a clinical supervisor.
On November 23, 2018, Dr. Anne Woods was approved as Dr. Taniguchi’s clinical supervisor. Since that time, Dr. Taniguchi has been fully cooperative with the College, and has been meeting with Dr. Woods on a regular basis to review patient charts from his palliative care practice pursuant to the s. 25.4 Order. Dr. Woods’s reports have been positive, and indicate that Dr. Taniguchi’s care has been appropriate.
As Dr. Woods has noted in her reports:
-“Once aware of the requirements for charting, Dr. Taniguchi's notes have met all requirements, have addressed concerns raised in the previous audit, and reflect a care that is exemplary. I have made only one recommendation: ‘Ensure the documented physical exam reflects all major concerns noted as issues that day.’”
-“Dr. Taniguchi’s notes consistently reflect a high quality of care, supervision, education, collegiality, and graciousness”; and
-“Dr. Taniguchi has the reputation in the wider palliative medicine community as being the doctor’s doctor, the one physicians would choose to have look after them. He is known for his unremitting respect for other physicians, his knowledge, and his hard work”.
ADMISSION
Dr. Taniguchi admits the facts above, and admits that, based on these facts, he engaged in professional misconduct under in that he failed to maintain the standard of practice of the profession; and engaged in acts or omissions relevant to the practice of medicine that would be regarded by members as disgraceful, dishonourable or unprofessional.
AGREED STATEMENT OF FACTS (PENALTY)
Dr. Taniguchi states that, between 2016 and 2018, he was feeling overwhelmed by his professional responsibilities, and was struggling to cope, and that this contributed to his failure to comply with the SCERP, and his failure to be responsive to the College.
In order to address the issues that contributed to his conduct in this case, Dr. Taniguchi is working to reorganize his workload. He has stepped down from some of his academic responsibilities, and has recently moved to a lower-volume clinical environment. Dr. Taniguchi has also seen a counsellor, to help him develop his stress management and coping skills.
On May 8, 2019, Dr. Taniguchi entered into an undertaking with the College by which he agreed to, among other things:
-practise under the guidance of a Clinical Supervisor acceptable to the College for 6 months;
-engage in professional education in professional responsibilities in post-graduate medical education, and medical ethics; and
-undergo a reassessment of his practice by an assessor selected by the College within 6 months of the end of the period of Clinical Supervision.
DISPOSITION
The Discipline Committee Ordered that:
-Dr. Taniguchi attend before the panel to be reprimanded.
-The Registrar suspend Dr. Taniguchi’s certificate of registration for a period of two (2)months.
-Dr. Taniguchi pay costs to the College in the amount of $6,000.00 within thirty (30) days from the date of this Order.