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Martin, James Scott Bradley

CPSO#: 29320

MEMBER STATUS
Expired: Failure to Renew Membership as of 16 Aug 2018
CURRENT OR PAST CPSO REGISTRATION CLASS
None as of 20 May 2014

Summary

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Former Name: No Former Name

Gender: Male

Languages Spoken: English

Education: Schulich School of Medicine and Dentistr, 1976

Practice Information

Primary Location of Practice
Practice Address Not Available

Specialties

Specialty Issued On Type
Obstetrics and Gynecology Effective:30 Jun 1993 RCPSC Specialist

Postgraduate Training

Please note: This information may not be a complete record of postgraduate training.



Schulich School of Medicine and Dentistr, 01 Jul 1989 to 30 Jun 1990
Resident 1 - Obstetrics and Gynecology

Schulich School of Medicine and Dentistr, 01 Jul 1990 to 30 Jun 1991
Resident 2 - Obstetrics and Gynecology

Schulich School of Medicine and Dentistr, 01 Jul 1991 to 30 Jun 1992
Resident 3 - Obstetrics and Gynecology

Schulich School of Medicine and Dentistr, 01 Jul 1992 to 30 Jun 1993
Resident 4 - Obstetrics and Gynecology

Schulich School of Medicine and Dentistr, 01 Jul 1994 to 30 Jun 1995
CF - Obstetrics and Gynecology

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 23 Jun 1976
Transfer of class of registration to: Independent Practice Certificate Effective: 30 Jun 1977
Transfer of class of certificate to: Restricted certificate Effective: 20 May 2014
Terms and conditions imposed on certificate Effective: 20 May 2014
Suspension of registration imposed: Discipline Committee Effective: 01 Jul 2014
Suspension of registration removed Effective: 01 Sep 2014
Terms and conditions amended by Inquiries, Complaints and Repo Effective: 24 Aug 2017
Terms and conditions amended by Inquiries, Complaints and Repo Effective: 23 Sep 2017
Expired: Failure to Renew Membership Expiry: 16 Aug 2018

Previous Hearings

Committee: Discipline
Decision Date: 25 Sep 2018
Summary:

On September 25, 2018, the Discipline Committee found that Dr. James Scott Bradley Martin committed an act of professional misconduct, in that he has failed to maintain the standard of practice of the profession. The Committee also found that Dr. Martin is incompetent.

Dr. Martin is an obstetrician-gynecologist who received his certificate of registration authorizing independent practice in June 1977. Throughout the relevant time, Dr. Martin practised in London, Ontario.

Patient A

The College commenced investigation after being contacted in 2016 by staff in the Ministry of Health and Long-Term Care with inquiries regarding Dr. Martin's prior approval application for an adolescent female-to-male transgender patient (Patient A) seeking sex reassignment surgery (a mastectomy). 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 thirty patients a week, spending fifteen hours a week in direct patient contact.

The College retained an expert, a pediatrician and adolescent medicine specialist, to review Dr. Martin's care of Patient A. The expert’s report was received on July 11, 2017. The expert found, among other things, that:

- Dr. Martin did not meet the standard of practice of the profession regarding care for adolescents with gender dysphoria in his care of Patient A;
- Dr. Martin prescribed cross-sex hormones to Patient A, an adolescent, at their first visit. Gross-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 lacked judgment regarding determination of mental health needs and supports. The mental health portions of the patient chart were limited, and he did not specifically address common mental health diagnoses that co-occur with gender dysphoria in adolescents, such as depression and anxiety. There was no mental health assessment before initiating cross-sex hormones;
- Dr. Martin's conduct could expose patients to harm or injury, based on his prescribing cross-sex hormones to a young patient 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.

The expert provided an addendum to his report, in which he advised that his opinion had not been affected after reviewing a response submitted by Dr. Martin. Dr. Martin failed to maintain the standard of practice of the profession and was incompetent in his care of Patient A.

Patient B

In 2016, a relative complained to the College 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 without a mental health assessment.

College expert reviewed the patient's care and provided a report on July 11, 2017. Among other things, the expert found that:

- Dr. Martin did not meet the standard of practice of the profession regarding care for adolescents with gender dysphoria in his care of Patient B;
- Dr. Martin prescribed cross-sex hormones to Patient B, an adolescent, at their first visit. Cross-sex hormones have many side effects, including infertility. More time is necessary to process the information regarding side effects so that adolescents can make an informed decision. Dr. Martin lacked judgment in this regard. The short length of the first consultation (described by Dr. Martin as thirty 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 determination of mental health needs and supports. The mental health portions of the patient chart were limited and the notes were similar from visit to visit. Dr. Martin did not specifically address common mental health diagnoses that co-occur with gender dysphoria in adolescents, such as depression and anxiety. There was no mental health assessment before initiating cross-sex hormones;
- Dr. Martin's conduct exposed patients to harm or injury, based primarily on Dr. Martin's initiation of cross-sex hormones at the first visit, as well as Dr. Martin's lack of understanding regarding the need to assess an adolescent patient's mental health.

Dr. Martin failed to maintain the standard of practice of the profession and was incompetent in his care of Patient B.

Dr. Martin’s Discipline History

On June 9, 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, among other things, to suspend his certificate of registration for a period of two months and restrict his practice to reproductive endocrinology and the interpretation of fertility-related ultrasound images. Dr. Martin admitted that he provided an excessive number of intrauterine insemination (“IUI”) treatment cycles in some cases, delaying patients from moving on to more effective treatment options. He also, among other things, failed to document important discussions regarding patients’ treatment options that he claimed took place, including about patients choosing to continue with IUI rather than try other interventions.

Dr. Martin’s Inquiries, Complaints and Reports Committee (the “ICRC”) History

On April 11, 2014, in response to a complaint from a patient, the ICRC cautioned Dr. Martin regarding improper OHIP billing and advised him regarding the adequacy of his record-keeping and documentation with patients who exceed six IUI procedures.

On August 15, 2014, in response to a complaint from a couple regarding infertility treatment as well as communications with Dr. Martin and his staff, the ICRC cautioned Dr. Martin to ensure that he responded promptly to communications from the College about complaints, and advised him regarding documentation, to ensure that he fully documents patient interactions.

On June 10, 2016, the ICRC considered investigations into three complaints from families of transgender patients. As a result, the ICRC required Dr. Martin to attend in person for cautions. The complaints also grounded a broader investigation into Dr. Martin’s hormone and transgender practice. The ICRC required Dr. Martin to complete a specified continuing education or remediation program (“SCERP”) regarding transgender care, including moderate clinical supervision and a reassessment.

Clinical Supervision

As required by the SCERP ordered by the ICRC in June 2016, Dr. Martin retained a clinical supervisor for transgender care. The Clinical Supervisor provided reports and identified areas for improvement with respect to Dr. Martin’s failure to adequately canvas and document mental health issues and history, and his practice of initiating hormone therapy during initial visits, sometimes before appropriate examinations (such as baseline blood testing) had been completed and acted upon. During the course of the clinical supervision, the Clinical Supervisor documented that Dr. Martin made improvements to these aspects of his practice. At the conclusion of the clinical supervision, the Clinical Supervisor stated that he had no major concerns, but continued to identify areas for improvement.

Dr. Martin’s Status Pending the Discipline Hearing

On August 22, 2017, the ICRC made an interim order, which required, among other things, that Dr. Martin refrain from providing transgender care to any new patients under the age of eighteen, and that he practise under clinical supervision in providing transgender care to existing patients under the age of eighteen. Dr. Martin subsequently advised the College that he had chosen not to obtain a clinical supervisor. Accordingly, as of September 23, 2017, under the terms of the order Dr. Martin was required to cease providing transgender care to patients under the age of eighteen.

As of August 16, 2018, Dr. Martin permitted his certificate of registration to expire.

Dr. Martin’s Undertaking

Dr. Martin has entered into an undertaking, by which, among other things, he has undertaken to resign his certificate of registration and not to apply or re-apply for registration as a physician to practise medicine in Ontario or any other jurisdiction.

Disposition

On September 25, 2018, the Discipline Committee ordered and directed that:

- Dr. Martin appear before the panel to be reprimanded.
- Dr. Martin pay to the College its costs of this proceeding in the amount of $6,000.00 within sixty (60) days from the date of this Order.


Decision: Download Full Decision (PDF)
Hearing Date(s): September 25, 2018 1:00 p.m. start time

 

Committee: Discipline
Decision Date: 20 May 2014
Summary:

On May 20, 2014, the Discipline Committee found that Dr. James Scott Bradley Martin committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession. Dr. Martin admitted to the allegation.

The referral relates to a s.75 investigation and two complaints in relation to Dr. Martin's practice of fertility medicine at the Southern Ontario Fertility Technologies Inc. Clinic.
 
In relation to the s.75 investigation regarding the care of 28 patients, Dr. X, an independent expert retained by the College, had significant concerns regarding Dr. Martin's lack of judgment and his standard of care. Dr. X found an excessive number of intrauterine insemination (IUI) treatment cycles in some cases, which did not justify a prolonged delay in moving to more effective treatments, such as in vitro fertilization (IVF), or intracytoplasmic sperm injection. In addition, important discussions regarding patients' treatment options and decisions that Dr. Martin claimed took place - including regarding about moving to IVF and the patient(s) choosing to continue with IUI - were not documented in their charts.

In relation to Dr. Martin's care of Patient A between approximately 2001 and 2010, the complaint was triggered by Dr. Martin's decision to terminate Patient A's weekly counselling appointments for an eating disorder. Dr. Martin admitted that he is not specifically trained to counsel eating disorders and that he was outside of his scope in the 5 years he engaged in this counselling. He also admitted he erred in misrepresenting to Patient A the reason he stopped the counselling. In relation to Patient A's fertility treatment, Dr. Y, an independent expert retained by the College, opined that Dr. Martin failed to maintain the standard of care in his: medical charting; proceeding with IUI despite a degree of hyperstimulation dangerous to patient health; failing to adjust treatment to reduce the risk of severe hyperstimulation; and, repeatedly placing Patient A at extreme risk of multiple medical complications, including thrombosis, pulmonary emboli and stroke.

In relation to Dr. Martin's care of Patient B in August of 2009, Dr. Y concluded that Dr. Martin failed to maintain the standard of care in that: he lacked knowledge regarding the diagnosis and management of an ectopic pregnancy; the systems in place at the clinic which failed to maintain the standard in terms of the organization and management of Patient B's care between the clinic's health care providers; and, in the lack of adequate documentation and the poor communication among health professionals at the clinic that put Patient B's life at risk.

The Discipline Committee ordered and directed that:

Dr. Martin appear before the panel to be reprimanded;
the Registrar suspend Dr. Martin's Certificate of Registration for a period of two (2) months, to commence on July 1, 2014 and ending at 11:59 p.m. on September 1, 2014. 
the Registrar impose the following terms, conditions and limitations on Dr. Martin's Certificate of Registration:

a. Effective immediately, Dr. Martin shall cease accepting new patients in his practice of fertility medicine;

b. Effective immediately, Dr. Martin shall not counsel or advise patients regarding eating disorders or any other matter falling outside his permitted scope of practice;

c. Effective July 1, 2014, Dr. Martin shall restrict his practice exclusively to reproductive endocrinology and the interpretation of fertility-related ultrasound images;

d. Without in any way restricting the generality of the restriction set out in paragraph 4(c) above, effective July 1, 2014, Dr. Martin shall be prohibited from practising fertility medicine in any respect, including, without limitation, the following:

i. Fertility-related assessment and investigations, including the performance or interpretation of fertility-related hysterosalpingograms, fertility treatment or fertility-related cycle-monitoring;
ii. Artificial insemination;
iii. In vitro fertilitzation including oocyte retrievals and/or embryo transfers;
iv. Counseling or advising patients regarding fertility treatments, artificial insemination, or any other matter relating to fertility medicine; and
v. Decision making of any kind regarding the care and treatment of patients  undergoing fertility treatment, artificial insemination, in vitro fertilization or any other treatment or procedure associated with fertility medicine;

e. Within thirty (30) days of the date of this Order, Dr. Martin shall obtain a clinical supervisor acceptable to the College, who will supervise Dr. Martin's interpretation of fertility-related ultrasound images and who will sign an undertaking in the form attached hereto as Schedule "A" (the "Clinical Supervisor");

f. If a Clinical Supervisor who has given an undertaking in Schedule "A" to this Order is unable or unwilling to continue to fulfill its terms, Dr. Martin shall, within twenty (20) days of receiving notice of same, obtain an executed undertaking in the same form from a similarly qualified person who is acceptable to the College and ensure that it is delivered to the College within that time;

g. If Dr. Martin is unable to obtain a Clinical Supervisor in accordance with paragraphs 4(e) and 4(f) of this Order, he shall cease to interpret fertility-related ultrasounds until such time as he has done so, and the fact that he has ceased to practise shall be a term, condition and limitation on his Certificate of Registration until that time;

h. Dr. Martin shall abide by all recommendations of his Clinical Supervisor with respect to practice improvements and education;

i. Dr. Martin shall consent to the disclosure by his Clinical Supervisor to the College, and by the College to his Clinical Supervisor, of all information the Clinical Supervisor or the College deems necessary or desirable in order to fulfill the Clinical Supervisor's undertaking and to monitor Dr. Martin's compliance with this Order.

This shall include, without limitation, providing the Clinical Supervisor with any reports of any assessments of Dr. Martin's practice in the College's possession;

j. Effective December 31, 2014, Dr. Martin shall be prohibited from interpreting ultrasound images and shall restrict his practice exclusively to reproductive endocrinology;

k. For an indefinite period of time, Dr. Martin shall inform the College of each and every location where he practices including, but not limited to hospitals, clinics, and offices, in any jurisdiction (collectively, his "Practice Location(s)"), within fifteen (15) days of this Order, and shall inform the College of any and all new Practice Locations within 15 days of commencing practice at that location;

l. For an indefinite period of time, Dr. Martin shall submit to, and not interfere with, unannounced inspections of his Practice Location(s) and patient records by a College representative for the purposes of monitoring his compliance with this Order;

m. Dr. Martin shall, at his own expense, participate in and successfully complete an educational program satisfactory to the College in Ethics, with a report or reports to be provided to the College regarding Dr. Martin's progress and compliance. Dr. Martin shall complete this requirement by September 1, 2014 or, if no satisfactory program is available by that time, by the first possible opportunity thereafter;

n. Dr. Martin shall, at his own expense, participate in and successfully complete an educational program satisfactory to the College in medical record-keeping. Dr. Martin shall complete this requirement by September 1, 2014 or, if no satisfactory program is available by that time, by the first possible opportunity thereafter;

o. Dr. Martin shall consent to the monitoring of his OHIP billings and cooperate with inspections of his practice and patient charts by College representatives for the purpose of monitoring and enforcing his compliance with the terms of this Order; and

p. Dr. Martin shall be responsible for any and all costs associated with implementing the terms of this Order.

Dr. Martin pay to the College costs in the amount of $40,140, within 30 days of the date of this Order.


Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): May 20, 2014

Concerns

Source: Member
Active Date: September 24, 2018
Expiry Date:
Summary:
Summary of the Undertaking given by Dr. James Scott Bradley Martin to the College of Physicians and Surgeons of Ontario, effective September 24, 2018:

Dr. Martin was referred to the Discipline Committee on allegations of professional misconduct and incompetence. In the face of these allegations, Dr. Martin resigned from the College and has agreed never to apply or reapply for registration as a physician in Ontario or any other jurisdiction.
Download Full Document (PDF)

 

Source: Compliance and Monitoring Department
Active Date: June 10, 2016
Expiry Date:
Summary:
Specified Continuing Education and Remediation Program:

A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a Specified Continuing Education and Remediation Program (“SCERP”) is required by the College By-laws to be posted on the register, along with a note if the decision has been appealed. A SCERP is one of the dispositions that the College’s Inquiries, Complaints and Reports Committee may make in connection with a matter before it, and this disposition requires the member to complete an education and remediation program specified for the member. A note will also be posted when all the elements of the SCERP have been completed. The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015 or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.

See PDF for the summary of a decision made against this member in which the
disposition includes a SCERP:
Download Full Document (PDF)