Committee: Discipline
Decision Date: 08 Sep 2014
Summary:
On September 8, 2014, the Discipline Committee found that Dr. Reid committed an act of professional misconduct in that he has failed to maintain the standard of practice of the profession with respect to Patient A, and that he has 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. The Discipline Committee also found that Dr. Reid is incompetent. Dr. Reid admitted to the allegations.
Patient A first saw Dr. Reid in November 2011. Patient A had been prescribed opioids since 2009 through at least May 2011, initiated by another physician. There is no documented history of early dispensing of opioid medication for Patient A prior to the commencement of treatment by Dr. Reid. Dr. Reid began to treat Patient A, including by way of opioid prescribing. In June 2013, a pharmacist contacted the College to voice concerns regarding Dr. Reid’s prescribing practices in respect of Patient A. Records indicate that pharmacists had expressed concerns to Dr. Reid on more than one occasion that Patient A was filling prescriptions for opioids at multiple pharmacies and that early dispensing was often authorized by Dr. Reid.
There were approximately two dozen episodes of Patient A obtaining early releases or replacement prescriptions for what were described as “stolen” or “lost” opioid medications or opioid patches that were said to have fallen off between February 2012 and the end of July 2013.
Dr. Reid recognized and was aware of Patient A’s aberrant drug-related behaviours by at least the summer of 2012. Dr. Reid asserted that he took steps in response, but he failed to document having done so.
Dr. Reid failed to:
(a) seek to arrange with a local pharmacy to prescribe opioids to Patient A on the condition that they be dispensed to him in daily or weekly allotments, to reduce the risk of large amounts of medication being lost should events such as theft occur;
(b) require Patient A to undergo regular urine drug screens and pill counts to ensure that he was not overusing or selling the medications;
(c) require Patient A to enter into an opioid agreement that explicitly stated that no early releases or replacement of medications for lost or stolen medications or patches that had fallen off prematurely would be permitted;
(d) document measures to mitigate the possible diversion, misuse and/or abuse of opioids by Patient A through education, strict monitoring, and changes in prescribing patterns;
(e) document any re-evaluation to assess whether opioids were the most appropriate choice for Patient A under the circumstances;
(f) document any consideration of opioid rotation;
(g) document any exploration of psychological methods of pain control; or
(h) document any discussion with Patient A regarding initiation and titration of other non-opioid
analgesics.
Dr. Reid lacked judgment when, despite recognizing Patient A’s drug-aberrant behaviour, he repeatedly permitted numerous early repeats and provided replacement scripts, contrary to common practices of chronic pain practitioners for dealing with drug-aberrant behaviour in their patient populations. This exposed the patient to risk of harm.
After reporting to the College that he had discharged Patient A from his practice, Dr. Reid wrote a further prescription for Patient A during the evening of the day on which allegations had been referred to the Discipline Committee of the College regarding his conduct towards and care of Patient A. This further prescription authorized early release of medications for what was said to be a trip. When a pharmacist contacted Dr. Reid with concerns about the prescription, Dr. Reid validated the prescription.
Dr. Reid also violated appropriate professional boundaries with Patient A:
(a) On approximately five occasions in 2013, Dr. Reid accompanied Patient A to the pharmacy to assist him in obtaining medication.
(b) On one occasion when accompanying Patient A to the pharmacy, Dr. Reid withdrew money from an automated teller machine to pay for the medication, and paid for the medication for Patient A;
(c) On one occasion in September 2012 when Patient A stated that he was homeless, Dr. Reid drove Patient A to a City and took him to a place to stay;
(d) On one occasion in May 2012, Dr. Reid attended a meeting of a religious men’s club held during the evening with Patient A and then drove him home.
On January 7, 2014, the Inquiries, Complaints and Reports Committee made an interim order (the “Interim Order”) against Dr. Reid pending disposition of the allegations against him. The Interim Order, among other things, prohibited Dr. Reid from issuing new prescriptions or renewing existing prescriptions for Narcotic Drugs, Narcotic Preparations, Controlled Drugs, and Benzodiazepines/Other Targeted Substances, or All Other Monitored Drugs. It came into effect at 12:01 a.m. on January 9, 2014. Dr. Reid violated the Interim Order by way of two prescriptions dated January 9, 2014 which were faxed to pharmacies on the morning of January 9, 2014 .
The Committee ordered and directed that:
• the Registrar suspend Dr. Reid’s certificate of registration for a period of three (3) months, to take effect at 12:01 a.m. on September 9, 2014.
• Dr. Reid appear before the panel to be reprimanded.
• the Registrar place the following terms, conditions and limitations on Dr. Reid’s certificate of registration:
(a) Dr. Reid shall participate in and successfully complete all components in the next available series of the Safe Opioid Prescribing program offered by University of Toronto, or an equivalent program acceptable to the College, and shall forthwith thereafter provide proof of completion thereof to the College.
(b) Dr. Reid shall participate in and successfully complete the next available course on “Understanding Boundaries in Managing the Risks Inherent in the Doctor-Patient Relationship” offered by Western University, or an equivalent program acceptable to the College, and shall forthwith thereafter provide proof of completion thereof to the College.
(c) Until Dr. Reid has delivered to the College an executed undertaking in the form attached to this Order as Schedule “A” (“Undertaking”) from a clinical supervisor who has been approved by the College (the “Clinical Supervisor(s)”), or if the Clinical Supervisor(s) resigns or cannot otherwise fulfill his or her Undertaking, Dr. Reid shall not issue new prescriptions or renew existing prescriptions for any of the following (hereinafter referred to as “Narcotics or Restricted Substances”):
(i) Narcotic Drugs (from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19);
(ii) Narcotic Preparations (from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19);
(iii) Controlled Drugs (from Schedule G of the Regulations under the Food and Drugs Act, S.C., 1985, c. F-27);
(iv) Benzodiazepines/Other Targeted Substances (from the Benzodiazepines and Other Targeted Substances Regulations made under the Controlled Drugs and Substances Act., S.C., 1996, c. 19); or (A summary of the above-named drugs [from Appendix I to the Compendium of Pharmaceuticals and Specialties] is attached hereto as Schedule "B"; and the current regulatory lists are attached hereto as Schedule "C") (v)All Other Monitored Drugs (as defined under the Narcotic Safety and Awareness Act, S.O. 2010, c. 22 as noted in Schedule "D") and as amended from time to time.
(d) While Dr. Reid is subject to the restriction regarding Narcotics or Restricted Substances set out above at paragraph 5(c), the following statement shall appear on the public register:
Dr. Reid shall not issue new prescriptions or renew existing prescriptions for any of the following (“Narcotics or Restricted Substances”):
(i) Narcotic Drugs (from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19);
(ii) Narcotic Preparations (from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19);
(iii) Controlled Drugs (from Schedule G of the Regulations under the Food and Drugs Act, S.C., 1985, c. F-27);
(iv) Benzodiazepines/Other Targeted Substances (from the Benzodiazepines and Other Targeted Substances Regulations made under the Controlled Drugs and Substances Act., S.C., 1996, c. 19); or
(v) All Other Monitored Drugs (as defined under the Narcotic Safety and Awareness Act, S.O. 2010, c. 22) and as amended from time to time.
(e) While Dr. Reid is subject to the restriction regarding Narcotics or Restricted Substances set out above at paragraph 5(c), Dr. Reid shall post a clearly visible sign in the waiting room of every location at which he practises in the form set out as Schedule "E". For further clarity, the sign shall state that "Dr. Reid shall not prescribe Narcotic Drugs, Narcotic Preparations, Benzodiazepines, Other Targeted Substances, Controlled Drugs and All Other Monitored Drugs.”
(f) After Dr. Reid has delivered an executed Undertaking from an approved Clinical Supervisor(s) to the College as described above at paragraph 5(c), Dr. Reid shall issue new prescriptions or renew existing prescriptions for Narcotics or Restricted Substances only in accordance with the Remediation Program described below at subparagraphs 5(f)(i)-(vi), until the Remediation Program has been completed:
(i) Throughout the Remediation Program, Dr. Reid shall maintain an up-to-date log of all prescriptions issued or renewed for Narcotics or Restricted Substances, in a form approved by the College (“the Narcotics Log”).
(ii) In Phase One of the Remediation Program, Dr. Reid shall prescribe Narcotics or Restricted Substances to no more than twenty (20) patients, who will be selected in cooperation with and approved by the Clinical Supervisor(s). Dr. Reid shall submit an initial treatment plan for each patient to the Clinical Supervisor(s) for review and approval prior to prescribing Narcotics or Restricted Substances to the patient. Thereafter, Dr. Reid shall submit these patients’ charts including documentation of the prescriptions and the Narcotics Log to the Clinical Supervisor(s) for review and meet with the Clinical Supervisor(s) every two (2) weeks to discuss the care of these patients and any concerns that the Clinical Supervisor(s) may have.
(iii) If reports from the Clinical Supervisor(s) indicate that it is appropriate to do so and if approved by the College, after a minimum of three (3) months in Phase One of the Remediation Program, Dr. Reid may commence Phase Two of the Remediation Program, during which he shall prescribe Narcotics or Restricted Substances to no more than forty (40) patients, whose charts shall be reviewed at least once a month by his Clinical Supervisor(s) together with the Narcotics Log. During Phase Two of the Remediation Program, Dr. Reid shall meet with his Clinical Supervisor(s) once a month to discuss the care of these patients and any concerns that the Clinical Supervisor(s) may have.
(iv) If reports from the Clinical Supervisor(s) indicate that it is appropriate to do so and if approved by the College, after a minimum of three (3) months in Phase Two of the Remediation Program, Dr. Reid may commence Phase Three of the Remediation Program, which shall include monthly review by the Clinical Supervisor(s) of at least twenty (20) charts of patients to whom Dr. Reid prescribes Narcotics or Restricted Substances, to be randomly selected by the Clinical Supervisor(s), and monthly review of the Narcotics Log.
(v) If reports from the Clinical Supervisor(s) indicate that it is appropriate to do so and if approved by the College, after a minimum of six (6) months in Phase Three of the Remediation Program, Dr. Reid may complete the Remediation Program, but shall continue to maintain a Narcotics Log pending completion of the Assessment described at paragraph 5(g).
(vi) Throughout the Remediation Program, Dr. Reid shall cooperate with the Clinical Supervisor(s) and shall abide by the recommendations of his Clinical Supervisor(s), including with respect to patient care, practice management, and continuing education.
(g) Dr. Reid shall undergo an assessment by a College-appointed assessor(s) (the“ Assessor(s)”) approximately twelve (12) months after the conclusion of the Remediation Program, focusing on patients to whom Dr. Reid prescribes Narcotics or Restricted Substances (the “Assessment”). The Assessment may include, but need not be limited to, review of charts, interview(s), and observation. The Assessor(s) shall report the results of the Assessment to the College. Dr. Reid shall cooperate with the Assessment and shall abide by the recommendations of the Assessor(s).
(h) Dr. Reid shall consent to the sharing of information among the Assessor(s), Clinical Supervisor(s) and the College as any of them deem necessary or desirable in order to fulfill their respective obligations.
(i) Dr. Reid shall not post-date prescriptions for Narcotics or Restricted Substances.
(j) Dr. Reid shall cooperate with unannounced inspections of his practice and patient charts by the College for the purpose of monitoring and enforcing his compliance with the terms of this Order and shall consent to the College making appropriate enquiries of the Ontario Health Insurance Plan, Narcotics Monitoring System and/or Ontario Drug Benefit Program, and/or any person or institution who may have relevant information for this purpose.
(k) Dr. Reid shall be responsible for any and all costs associated with implementing the terms of this Order.
• Dr. Reid pay the College its costs of this proceeding in the amount of $4,460.00 within sixty (60) days of the date of this Order.