Committee: Discipline
Decision Date: 09 Dec 2020
Summary:
On September 27, 2019, allegations of Dr. Young’s professional misconduct were referred to the Discipline Committee. The allegations included that Dr. Young engaged in disgraceful, dishonourable, or unprofessional conduct by, in part, misleading a College assessor; and failed to maintain the standard of practice of the profession in his documentation, infection control practices, and in his professionalism.
The matter was heard on December 9, 2020 by way of videoconference, in the presence of Dr. Young, counsel for the College and counsel for Dr. Young. On the basis of an Agreed Statement of Facts on Liability and Penalty, the Discipline Committee found that Dr. Young committed an act of professional misconduct in that he engaged in disgraceful, dishonourable, or unprofessional conduct and failed to maintain the standard of practice of the profession. The Committee reserved its decision on penalty.
On March 3, 2021, the Committee released its full reasons for decision, including its order on Penalty. The Committee ordered and directed:
• The Registrar to suspend Dr. Young’s certificate of registration for a period of three months, commencing on the day following release of the order.
• Dr. Young to attend before the panel to be reprimanded.
• The Registrar to impose terms, conditions and limitations on Dr. Young’s certificate of registration, including a requirement to take the PROBE course on ethics and professionalism; practice observation and reassessment
• Dr. Young to pay the College its costs of this proceeding in the amount of $6,000.
The decision is available for review on the College’s website.
Committee: Discipline
Decision Date: 29 Nov 2016
Summary:
On November 29, 2016, the Discipline Committee of the College of Physicians and Surgeons of Ontario found that Dr. James Wen Young committed an act of professional misconduct in that he has failed to maintain the standard of practice of the profession.
Dr. Young, an anesthesiologist practicing in Toronto, received his specialist qualification in anesthesiology in 2003. Dr. Young has had privileges at the Humber River Regional Hospital (the “Hospital”) since 2003 and currently practises full-time anaesthesiology there. During the relevant time period, Dr. Young worked at the Ontario Endoscopy Clinic one day per month as one of a group of anaesthesiologists from the Hospital.
Dr. Young entered a plea of no contest based on the following statement of uncontested facts:
HEPATITIS C OUTBREAK AT THE ONTARIO ENDOSCOPY CLINIC
On April 28, 2014 the College received a complaint from a patient that she had contracted Hepatitis C as a result of a gastroscopy performed at the Ontario Endoscopy Clinic. The patient had obtained this information after being advised by Toronto Public Health regarding a Hepatitis C outbreak at the Ontario Endoscopy Clinic.
The Toronto Public Health investigation found that five patients became infected with Hepatitis C during their procedures at the Ontario Endoscopy Clinic on March 15, 2013, a day when Dr. Young was working as one of two anaesthesiologists at the Ontario Endoscopy Clinic. Toronto Public Health concluded that the source patient, Patient A, was the fourth of 10 patients who had procedures in the same procedure room with the same endoscopist and the same anaesthesiologist (Dr. Young) on that day. All except one of the patients who had a procedure following Patient A acquired Hepatitis C. The investigation ruled out contamination of the endoscopes as a source of the contamination since a different scope had been used on each of the five patients that contracted Hepatitis C.
Toronto Public Health conducted a review of Dr. Young’s practice, including a direct interview and observation of his practice at the Ontario Endoscopy Clinic on August 16, 2013. Toronto Public Health also conducted a look-back of patients who had a procedure at the Ontario Endoscopy Clinic in the five years prior to the date of transmission and were cared for by Dr. Young. No additional newly Hepatitis C or HBV-infected individuals were found.
While observing that Dr. Young separated unused and used syringes on the anaesthesia cart, and observing that needles were not re-used and re-inserted into the medication bottle if more medication was required, Toronto Public Health noted that the literature supported the theory that Hepatitis C transmission occurs in health care settings as a result of mishandling of multi- dose injectable medications.
The use of multi-dose injectables, while common, presents greater risk when used in a high volume, rapid turnover environment.
Toronto Public Health concluded that it was possible that a multi-dose vial of medication, most likely lidocaine, became contaminated with blood from Patient A, and was used during the subsequent procedures on that day. It noted that lidocaine was the one vial used for all patient procedures that day, while the propofol vial would not have provided enough doses for all patient procedures subsequent to Patient A.
CLINICAL CARE ISSUES IDENTIFIED BY COLLEGE EXPERTS
The College retained two medical inspectors to conduct an investigation into Dr. Young’s practice. The College’s experts reviewed the charts of the patients who had been provided with anesthesia by Dr. Young during their procedures at the Ontario Endoscopy Clinic on the day in question, interviewed Dr. Young and observed his practice providing anaesthesia for endoscopy procedures at the Hospital.
The first College expert opined that:
- Dr. Young failed to properly review Patient A’s chart, including the pre-anesthesia questionnaire, to determine whether there were any anaesthesia associated risks;
- Dr. Young did not see that the patient had checked off “hepatitis” in the questionnaire and may have taken additional precautions based on this information;
- This failure created a significant risk to patient safety;
- Dr. Young should have been aware of the risks of using a multi-dose vial regardless of time or cost pressures that might have been in play at the Ontario Endoscopy Clinic level;
- Despite Dr. Young’s statement that he never re-enters a multi-dose vial with a used syringe, this is the most plausible explanation for the sequence of Hepatitis C cases that occurred on March 15, 2013;
- Dr. Young should have been aware of the importance of reviewing a patient’s medical history;
- Dr. Young’s care did display a lack of judgment, but did not display a lack of skill or knowledge;
- Despite the fact that he could not control what the Ontario Endoscopy Clinic ordered in terms of stack vial size, he could have exercised increased caution when using large multi-dose vials.
The first expert concluded that transmission of Hepatitis C likely occurred as a result of contamination of a multi-dose vial, likely of propofol, by Dr. Young. The expert concluded that the degree of deficit in this case was mild and that Dr. Young appeared to have learned from the experience at the Ontario Endoscopy Clinic and concluded that Dr. Young’s current clinical practice, behaviour or conduct does not expose and is not likely to expose patients to harm or injury.
The second College expert opined that the documentation in the anaesthetic record completed by Dr. Young for Patient A and the 6 patients who followed her was deficient and below standards of practice in one or more of the following areas:
- No pre-operative vitals (in two out of seven cases);
- No post-operative vitals or level of consciousness;
- No discharge orders;
- No pre-operative airway assessment.
The second expert opined that with respect to Patient A, the anaesthetic record was deficient in having no pre-operative blood glucose despite her history of diabetes and insulin use, no notation of the patient’s history of Hepatitis C, and no documentation of her history of chest pain.
The second expert concluded that Dr. Young did not meet standards of practice in that he was not aware that Patient A was Hepatitis C positive although the patient questionnaire indicated a history of Hepatitis C. There was an increased potential for harm in not being aware that the patient was Hepatitis C positive. Dr. Young did not meet the standards of practice regarding infection control procedures. It is extremely likely that the 5 patients were infected with Hepatitis C from contaminated intravenous medication administered by Dr. Young, In addition, there were poor infection control practices observed both in medication preparation (e.g., not cleaning the tops of vials before re-entering) as well as failure to change gloves frequently enough and disposal of contaminated syringes in a bio-medical waste bin.
The second College expert reported that Dr. Young displayed a lack of knowledge regarding appropriate infection control techniques with respect to multi-dose vials and that Dr. Young’s clinical practice exposed five patients to harm as they were infected with Hepatitis C.
On November 29, 2016, the Discipline Committee reserved its decision on penalty. On June 19, 2017, the Discipline Committee released its decision on penalty and ordered that:
- The Registrar suspend Dr. Young’s certificate of registration for a period of three (3) months commencing immediately.
- The Registrar impose the following terms, conditions and limitations on Dr. Young’s certificate of registration:
(i) Dr. Young shall take a course on infection control as approved by the College within six (6) months of the date of this Order and provide proof of completion of same to the College;
(ii) Dr. Young shall be subject to an assessment of his practice, including but not limited to an observation of his sterile technique, his preoperative process and his record keeping within six (6) months of his return to practice after the end of the suspension referred to above; and
(iii) Dr. Young shall be solely responsible for payment of all fees, costs charges and expenses, arising from the implementation of this order.
- Dr. Young appear before the panel to be reprimanded.
- Dr. Young pay costs to the College in the amount of $10,000.00 within sixty (60) days of the date of this order.