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James, Stephen Rose

CPSO#: 92083

MEMBER STATUS
Active Member as of 15 Oct 2016
CURRENT OR PAST CPSO REGISTRATION CLASS
Restricted as of 10 Sep 2009

Summary

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Former Name: No Former Name

Gender: Male

Languages Spoken: English, Spanish

Education: Universidad Iberoamericana(UNIBE), 2001

Practice Information

Primary Location of Practice
9-6400 Millcreek Dr
Mississauga ON  L5N 3E7
Phone: (905) 288-1045
Fax: (905) 858-2144 Electoral District: 05

Additional Practice Location(s)

CPM
425-1200 Markham Road
Scarborough ON  M1H 2Y9
Canada
Phone: 4164387080
Fax: 416.438.7072
County: City of Toronto
Electoral District: 10

CPM
123 Edward Street, Unit #1118
Toronto ON  M5G 1E2
Canada
Phone: 4165937700
Fax: 416.593.7702
County: City of Toronto
Electoral District: 10

Apollo Cannnabis Clinic
240 Duncan Mill Road, Unit 201
North York ON  M3B 3S6
Canada
Phone: (416) 840-5991
Fax: (647) 729-4766
County: City of Toronto
Electoral District: 10

Apollo Cannabis Clinic
2352 Yonge Street, 2nd Floor
Toronto ON  M4P 2E6
Canada
Phone: (416) 840-5991
Fax: (647) 729-4766
County: City of Toronto
Electoral District: 10

National Cannabinoid Clinics
4125 Lawrence Avenue East, suite 20
Scarborough ON  M1E 2S2
Canada
Phone: 416-751-0090
Fax: 416-751-0995
County: City of Toronto
Electoral District: 10

National Cannbinoid Clinics
716 The Queensway South
Keswick ON  L4P 4C9
Canada
Phone: 905-535-2393
Fax: 416-751-0995
County: Regional Municipality of York
Electoral District: 05

Professional Corporation Information


Corporation Name: Stephen R. James Medicine Professional Corporation
Certificate of Authorization Status: Issued Date:  Mar 26 2010

Shareholders:
Dr. S. James ( CPSO# 92083 )

Business Address:
Suite 9
6400 Millcreek Drive
Mississauga ON  L5N 3E7
Phone Number: (905) 288-1045

Business Address:
Suite 425
1200 Markham Road
Scarborough ON  M1H 2Y9

Business Address:
Suite 1118
123 Edward Street
Toronto ON  M5G 1E2

Business Address:
Suite 201
240 Duncan Mill Road
Toronto ON  M3B 3S6

Business Address:
2nd Floor
2352 Yonge Street
Toronto ON  M4P 2E6

Business Address:
National Cannabinoid Clinics
Suite 20
4125 Lawrence Avenue East
Scarborough ON  M1E 2S2
Phone Number: (416) 751-0090

Business Address:
National Cannabinoid Clinics
716 The Queensway South
Keswick ON  L4P 4C9
Phone Number: (905) 535-2393

Specialties

Specialty Issued On Type
Anesthesiology Effective:10 Sep 2009 CPSO Recognized Specialist

Registration History

Action Issue Date
First certificate of registration issued: Restricted certificate Effective: 10 Sep 2009
Terms and conditions imposed on certificate by Registration Committee Effective: 10 Sep 2009
Expiry date attached to certificate of registration. Expiry Date: 09 Mar 2011
Terms and conditions amended by Registration Committee Effective: 22 Mar 2011
Terms and conditions amended by Registration Committee Effective: 17 Nov 2011
Terms and conditions amended by Registration Committee Effective: 17 May 2012
Expiry date removed from certificate of registration. Effective: 17 May 2012
Terms and conditions amended by member Effective: 08 Oct 2014
Terms and conditions amended by Registration Committee Effective: 14 Dec 2015
Suspension of registration imposed: Discipline Committee Effective: 15 Dec 2015
Suspension of registration removed Effective: 15 Oct 2016
Terms and conditions amended by member Effective: 10 May 2021

Practice Restrictions

Imposed By Effective Date Expiry Date Status
member Effective: 10 May 2021 Active
 (1 of 2)

As from May 10, 2021, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Stephen Rose James in accordance with an undertaking and consent given by Dr. James to the College of Physicians and Surgeons of Ontario:

UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT 
("Undertaking")

of

DR. STEPHEN ROSE JAMES
("Dr. James")

to 

COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
(the "College")

A.	PREAMBLE

(1)	In this Undertaking:

"Code" means the Health Professions Procedural Code, which is Schedule 2 to the Regulated Health Professions Act, 1991, S.O. 1991, c. 18, as amended; 

"Discipline Committee" means the Discipline Committee of the College; 

 "OHIP" means the Ontario Health Insurance Plan;

"Public Register" means the College's register that is available to the public.

(2)	I, Dr. James, certificate of registration number 92083, am a member of the College.  

(3)	I, Dr. James, acknowledge that the College conducted an investigation bearing File Number 1110669 (the "Investigation") into whether I engaged in professional misconduct and/or am incompetent in my pain management practice. In addition, I underwent remediation of my practice according to a Discipline Order dated December 15, 2015 and submitted to a reassessment. The reassessment report subsequently received by the College raised concerns about my pain management practice. 

B.	UNDERTAKING

(4)	I, Dr. James, undertake to abide by the provisions of this Undertaking, effective immediately.

(5)	Professional Education  

(a)	I, Dr. James, undertake to participate in and successfully complete the following professional education (the "Professional Education"):

(i)	Medical Record Keeping Workshop, University of Toronto;

(ii)	Canadian Interventional Pain Course; 

(iii)	Documentation: Principles of Medical Record Keeping e-learning module, CMPA;

(iv)	Review, reflection, and a written summary of the following policies and other self-study:
            
1.	Medical Records Documentation, College Policy;

2.	Practice Guidelines for Spinal Diagnostic and Treatment Procedures, Second Edition, Spine Intervention Society;

3.	Chronic Non-Cancer Pain, Centre for Effective Practice; and

(v)	Review of the Toronto Academic Pain Institute Resources. 

(b)	I, Dr. James, undertake to provide proof to the College of my successful completion of the Professional Education, including proof of registration and attendance and participant assessment reports, within one (1) month of completing it. I acknowledge that the College will determine, in its sole discretion, whether I have successfully completed the Professional Education.

(c)	I, Dr. James, undertake to complete this requirement within three (3) months or, if no satisfactory program is available by that time, at the first possible opportunity thereafter.

(d)	I, Dr. James, acknowledge that a report or reports may be provided to the College regarding my progress and compliance with the Professional Education.

(e)	I, Dr. James, acknowledge that if any of the programs listed above become unavailable, substitution requests will be reviewed by the College and the College will determine in its sole discretion whether substitution is appropriate.

(6)	Reassessment of Practice

(a)	I, Dr. James, undertake that, approximately six (6) months after the completion of the Professional Education set out in section (6) above, I will submit to a reassessment of my practice ("the Reassessment") by an assessor or assessors selected by the College (the "Assessor" or "Assessors").  I acknowledge that the Reassessment may include a chart review of a minimum of fifteen (15) charts, direct observation of my care, interviews with me, colleagues and co-workers, feedback from patients, and any other tools deemed necessary by the College.

(b)	I, Dr. James, undertake to co-operate fully with the Reassessment, conducted under the term of this Undertaking. 

(c)	I, Dr. James, acknowledge that the results of the Reassessment will be provided to me and reported to the College and the Reassessment may form the basis of further action by the College. 

(7)	Monitoring 

(a)	I, Dr. James, undertake to inform the College of each and every location at which I practise or have privileges, including, but not limited to, any hospitals, clinics, offices, and any Independent Health Facilities with which I am affiliated, in any jurisdiction (collectively my "Practice Location" or "Practice Locations"), within five (5) days of executing this Undertaking.  Going forward, I further undertake to inform the College of any and all new Practice Locations within five (5) days of commencing practice at that location.

(b)	I, Dr. James, give my irrevocable consent to the College to make appropriate enquiries of OHIP and/or any person who or institution that may have relevant information, in order for the College to monitor my compliance with the provisions of this Undertaking. 

(c)	I, Dr. James, acknowledge that I have executed the OHIP consent form, attached hereto as Appendix "A". 

C.	ACKNOWLEDGEMENT

(8)	I, Dr. James, acknowledge that all appendices attached to or referred to in this Undertaking form part of this Undertaking.

(9)	I, Dr. James, acknowledge and undertake that I shall be solely responsible for payment of all fees, costs, charges, expenses, etc. arising from the implementation of any of the provisions of this Undertaking. 

(10)	I, Dr. James, acknowledge that I have read and understand the provisions of this Undertaking and that I have obtained independent legal counsel in reviewing and executing this Undertaking, or have waived my right to do so.

(11)	I, Dr. James, acknowledge that the College will provide this Undertaking to any Chief of Staff, or a colleague with similar responsibilities, at any Practice Location ("Chief of Staff" or "Chiefs of Staff").

(12)	I, Dr. James, acknowledge that a breach by me of any provision of this Undertaking may constitute an act of professional misconduct and/or incompetence, and may result in a referral of specified allegations to the Discipline Committee of the College.

(13)	I, Dr. James, acknowledge that this Undertaking constitutes terms, conditions, and limitations on my certificate of registration for the purposes of section 23 of the Code. 

(14)	Public Register

(a)	I, Dr. James, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.

(b)	I, Dr. James, acknowledge that, in addition to this Undertaking being posted in accordance with section (14)(a) above, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:

A College investigation was conducted into whether Dr. James engaged in professional misconduct and/or is incompetent in his chronic pain management practice. In addition, Dr. James submitted to a reassessment of his practice according to an Order of the Discipline Committee. The reassessment report received by the College raised concerns about his standard of practice. As a result of the investigation and reassessment:

Dr. James will engage in professional education in medical record-keeping and interventional pain.

Dr. James's practice will be reassessed by an assessor selected by the College within 6 months of completion of the professional education.

(c)	I, Dr. James, acknowledge that this Undertaking remains in effect until the College determines its terms are satisfied.

D.	CONSENT

(15)	I, Dr. James, give my irrevocable consent to the College to provide the following information to any person who requires this information for the purposes of facilitating my completion of the Professional Education and to all Assessors:

(a)	any information the College has that led to the circumstances of my entering into this Undertaking;

(b)	any information arising from any investigation into, or assessment of, my practice; and 

(c)	any information arising from the monitoring of my compliance with this Undertaking.

(16)	I, Dr. James, give my irrevocable consent to the College to provide all Chiefs of Staff with any information the College has that led to the circumstances of my entering into this Undertaking and/or any information arising from the monitoring of my compliance with this Undertaking.

(17)	I, Dr. James, give my irrevocable consent to any persons who facilitate my completion of the Professional Education, and to all Chiefs of Staff and Assessors, to disclose to the College, and to one another, any of the following:

(a)	any information relevant to this Undertaking;

(b)	any information relevant to the Reassessment;

(c)	any information relevant for the purposes of monitoring my compliance with this Undertaking; and/or  

(d)	any information which comes to their attention in the course of providing the Professional Education and which they reasonably believe indicates a potential risk of harm to my patients.

(2 of 2)

As from 11:59 p.m., December 15, 2015, by order of the Discipline Committee of
            the College of Physicians and Surgeons of Ontario, the following terms,
            conditions and limitations are imposed on the certificate of registration held
            by Dr. Stephen Rose James:

                  a.    Dr. James be prohibited from holding the position of Medical
                        Director in any facility;
                  
                  b.    Dr. James shall perform all injections in the presence of a
                        regulated health professional who observes each injection and who
                        contemporaneously signs and dates the patient record confirming
                        he/she has observed the injection.  Dr. James shall provide the
                        College with a list of regulated health professionals with whom he
                        works and provide copies of their signatures within seven (7) days
                        of the date of this Order, and within fourteen (14) days of
                        employing any additional regulated health professional thereafter;
                  
                  c.    If Dr. James becomes aware that a patient developed an infection
                        following a procedure that he performed, Dr. James shall, within 7
                        days of date on which he became aware, report the infection to the
                        College;
                  
                  d.    Dr. James shall complete the next available medical record keeping
                        course approved by the College and provide proof of successful
                        completion within three (3) weeks thereof; 
                  
                  e.    Dr. James shall successfully complete individualized education in
                        communication, approved by the College at the instructor's earliest
                        availability and provide proof of successful completion within
                        three (3) weeks thereof.  The course will involve a series of
                        one-on-one sessions with a College-approved instructor (the
                        "Instructor"), incorporating principles of guided reflection,
                        tailored feedback, and other modalities customized to the specific
                        needs of Dr. James as assessed by the Instructor.  The Instructor
                        will make reports to the College regarding Dr. James' progress and
                        compliance; 
                  
                  f.    Dr. James shall successfully complete individualized instruction in
                        ethics approved by the College at the instructor's earliest
                        availability and provide proof of successful completion within
                        three (3) weeks thereof. The instruction will involve a series of
                        one-on-one sessions with a College-approved instructor (the
                        "Instructor"), incorporating principles of guided reflection,
                        tailored feedback, and other modalities customized to the specific
                        needs of Dr. James as assessed by the Instructor.  The Instructor
                        will make reports to the College regarding Dr. James' progress and
                        compliance; 
                  
                  g.    Dr. James shall retain a clinical supervisor, approved by the
                        College, who will sign an undertaking in the form attached hereto
                        as Schedule "A" (the "Supervisor") no later than 30 days prior to
                        Dr. James' return to practice after the suspension referred to in
                        paragraph 4 above.  Dr. James shall practice under the guidance of
                        the Supervisor for a period of period of twelve (12) months.  Dr.
                        James shall meet with the supervisor monthly to discuss any
                        concerns arising from patient care, including infection prevention,
                        control and treatment. 
                  
                  h.    Dr. James shall engage a preceptor acceptable to the College to
                        provide education in the indications and treatment for infection in
                        Interventional Pain Medicine for a minimum period of (4) four
                        hours.  The preceptorship shall be completed within (3) months of
                        Dr. James' return to practice after the end of the suspension
                        referred to in paragraph 4 above, and the preceptor shall confirm
                        such completion in writing to the College; 
                  
                  i.    Dr. James shall be subject to a reassessment of his practice
                        including an observation of his sterile technique, within six (6)
                        months of his return to practice after the end of the suspension
                        referred to in paragraph 4 above, and shall be subject to periodic
                        assessments (announced and/or unannounced) thereafter at the
                        discretion of the College, including a reassessment following the
                        completion of supervision described in paragraph g above.  Dr.
                        James shall abide by the recommendations of the assessors;
                  
                  j.    Dr. James shall cooperate with unannounced inspections of his
                        practice and patient records by a College representative for the
                        purposes of monitoring his compliance with the provisions of this
                        Order and his infection control practices; and
                  
                  k.    Dr. James shall be solely responsible for payment of all fees,
                        costs, charges, expenses, etc. arising from the implementation of
                        any of the provisions of this Order.
                  
                  
            As from December 14, 2015, the following is imposed as a term, condition and
            limitation on the certificate of registration held by Dr. Stephen Rose James,
            in accordance with an undertaking and consent given by Dr. James to the College
            of Physicians and Surgeons of Ontario:

                        UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
                                          ("Undertaking")
                  
                                                of
                  
                                    DR. STEPHEN ROSE JAMES 
                                          ("Dr. James")
                  
                                                to
                  
                        COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
                                          (the "College")
                                                                                     

            A.    UNDERTAKING

            (1)   I, Dr. James, undertake that, effective immediately, I will ensure that I
                  follow all the recommended and required infection control practices
                  (designated as "recommended" and "always" respectively) for the specified
                  procedures as set out in the attached Appendix "A". 

            (2)   I, Dr. James, acknowledge that this undertaking (including Appendix "A")
                  shall be provided to all assessors appointed by the College, and shall be
                  relied upon by the College, including when conducting compliance and
                  monitoring activities associated with the Order of the Discipline
                  Committee dated December 15, 2015. 

            (3)   I, Dr. James, acknowledge that this entire Undertaking constitutes terms,
                  conditions, and limitations on my certificate of registration for the
                  purposes of section 23 of the Code. I understand that this Undertaking
                  shall be information on the College's Register that is available to the
                  public during the time period that the Undertaking remains in effect.




            Effective September 10, 2009:

            Dr. Stephen Rose James may practise medicine independently in Anaesthesia
            limited to Pain Management, only.



Previous Hearings

Committee: Discipline
Decision Date: 16 Nov 2015
Summary:

On November 16, 2015, the Discipline Committee found that Dr. Stephen Rose James committed an act of professional misconduct in that he failed to maintain the standard of practice of the profession and he engaged in conduct or 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 Committee also found Dr. James is incompetent.

Dr. James is an anaesthesiologist practising in pain management. His practice at the time relevant to these proceedings was at the Rothbart Centre for Pain Care (the “Clinic”).

Specifically, the findings of professional misconduct relate to his care and treatment, including his infection control practices, of: Patients A to F as well as the additional seven (Patients T to Z) identified by Toronto Public Health (TPH).

In addition, he engaged in disgraceful, dishonourable and unprofessional conduct including by:
-Providing an Interview Prep document to nursing staff at the Clinic in order to influence the nurses’ responses to the College investigation; 
-Misrepresenting the purpose of the Interview Prep Document to the College;
-Misstating the steps he took when learning of Patient A and Patient B’s complications caused by his inadequate Infection Prevention and Control (IPAC) procedures; and
-Failing to make himself available, and communicating inappropriately through his nursing staff, when Patient E suffered complications.

On October 8, 2014, after allegations had been referred to the Discipline Committee, Dr. James executed an undertaking with the College agreeing to co-operate with specific infection control guidelines provided to him and to submit to unannounced inspections by the College to ensure his infection control practices were acceptable.

On about November 30, 2012 and December 10, 2012, the College received information from TPH relating to a suspected meningitis outbreak connected to Dr. James at the Clinic. On the basis of that information, the Inquiries, Complaints and Reports Committee (ICRC) commenced an investigation into Dr. James’ practice.

Toronto Public Health Investigation
In November 2012, TPH received information that three different patients were hospitalized with either staph aureus or meningitis infections from epidural injections administered by Dr. James. As a result of these infections, Dr. L, Associate Medical Officer of Health for the City of Toronto Health Unit, and Ms M, Communicable Disease Manager, TPH, attended Dr. James’ clinic. At that time, Dr. L made a verbal order requiring that Dr. James not perform any procedures and that no one change or touch anything in Room 11 or use it in any way. (Room 11 was Dr. James’ procedure room. All of his non-X-ray guided procedures were performed in that room; no other doctor used that room). In December 2012, Ms M re-attended at the Clinic to continue the TPH investigation. Dr. James was served with a written order to immediately cease performing any medical procedures that involve penetration of an instrument into a sterile site, and that he not enter Room 11.

As a result of their visits to the Clinic, TPH noted the following:
-The patient’s sterile field was not covered;
-A non-sterile gauze was used after a procedure to wipe the ooze from the patient’s back;
-Dr. James’ gloves were too big;
-Dr. James used a mask but the nose was not pinched;
-Dr. James did not always allow the Betadine, the antiseptic used to wipe the patients’ skin, to dry for long enough before he started a procedure;
-After Dr. James used an alcohol-based hand rub (“ABHR”) (Purell), and prior to donning sterile gloves, he touched many surfaces
-Dr. James opened sterile items onto a non-sterile field into a sterile container; and
-Dr. James’ wedding band was not removed during the procedure.

On December 7, 2012, at the request of TPH, Public Health Ontario attended the Clinic with a representative from TPH to conduct a review of IPAC practices within the Clinic. At that visit, Dr. James offered to provide a mock demonstration of a typical epidural procedure. The audit team observed the following issues that required immediate attention:
-Dr. James applied and removed his mask without performing hand hygiene;
-Dr. James’ hand hygiene ABHR lasted less than 5 seconds;
-Dr. James stated that he does not wait for the skin prep to dry before inserting the needle;
-Abundant supplies (including unwrapped gauze pads) stored on the counter are subject to contamination; and
-Dr. James’ mask was not adjusted at the bridge of his nose.

Based on the information obtained by TPH, and a review of the literature regarding complications following epidural steroid injections, TPH concluded that nine (9) patients developed serious infections after receiving an epidural steroid injection performed by Dr. James at the Clinic. TPH’s view regarding the cause of these infections is that Dr. James was colonized with staph aureus, and due to breaches in IPAC, transmission of staph aureus occurred from Dr. James to his patients.

The patients revealed in the TPH investigation suffered serious complications. Parts of their disease courses are described here:
i. Regarding Patient T, she received lumbar injections from Dr. James commencing in 2012. Following her last injection in October 2012, Patient T was admitted to hospital, vomiting and incoherent. She was diagnosed with bacterial meningitis.
ii. Regarding Patient U, she received lumbar injections from Dr. James commencing in 2011. In October 2012, she received 3 lumbar/thoracic epidural injections. In late October or early November, Patient U began suffering from headaches, nausea, vomiting, confusion, blurred vision, tremors. In November, she notified the Clinic that she was suffering persistent headaches. Shortly after she was admitted to hospital and diagnosed with meningitis. 
iii. Regarding Patient V, she received lumbar injections from Dr. James commencing in 2010. Following a lumbar injection in July 2012, she developed fever and sought attention at the Emergency Department. She was discharged with negative blood and urine cultures. She subsequently sought treatment from her family physician complaining of pain, fever and difficulty urinating. She received additional injections from Dr. James on two occasions in August of 2012. In September 2012, she suffered a stroke and on investigation, it was discovered that many sites on her spine were infected with abscesses requiring hospitalization and the insertion of a PICC line.
iv. Regarding Patient W, he received lumbar injections from Dr. James in September and October 2012. Shortly after his injection in October 2012, Patient W experienced back pain and fever and went to the hospital, but an MRI revealed no abscesses. In November 2012 he was admitted to hospital with on-going fever and increasing weakness. A lumbar epidural abscess was found and an emergency laminectomy was performed.
v. Regarding Patient X, he received lumbar injections from Dr. James commencing in 2012. Following his last injection in November 2012, Patient X developed a fever and was hallucinating. He was admitted to hospital where he was diagnosed with an epidural abscess and staph aureus infection requiring evacuation and spinal decompression. Patient X required further surgical intervention.
vi. Regarding Patient Z, she received lumbar injections from Dr. James commencing in 2012. After her third injection in September 2012, Patient Z experienced increasing back paid and developed a fever. She was admitted to hospital with two epidural abscesses and sepsis.

The College retained Dr. N, to provide an opinion regarding Dr. James’ infection control procedures. Dr. N was asked to opine on Dr. James’ practices prior to TPH intervention largely on the basis of the information gathered by TPH. In a report dated December 20, 2013, he opined, among other things that Dr. James practices prior to their revision fell below the standard of infection control practice expected of a physician performing such procedures and concluded that these breaches were of a major nature and resulted in an uncommon serious outbreak.

The College also received several public complaints from patients who suffered serious complications:
i) Regarding Patient A, Dr. James administered lumbar steroid injections in August, September and October, 2012. At the October appointment, Patient A states that she noticed that Dr. James did not wear sterile gloves or a mask; and stated that she did not have iodine put on her back like previous times; her procedure felt rushed. She felt unwell soon after the October appointment. By November, Patient A felt extremely confused, weak, and lethargic, and had a fever. Patient A was admitted to hospital and found to have a staph aureus infection. She was diagnosed with meningitis and an epidural abscess precisely where the injection had taken place.

In addition, Dr. James made inaccurate statements to the College during their investigation about advising Patient A’s attending physician to obtain a neurological consultation.

ii) Regarding Patient B, her first consultation and treatment with Dr. James occurred in June 2012 to treat debilitating back pain. He proceeded to administer a lumbar steroid injection to Patient B that day and again in July and August 2012. In September 2012, Patient B was taken to the hospital with fever, confusion and lower back pain. Patient B spent several days in the emergency, and was ultimately admitted to as an in-patient. The working diagnosis in respect of Patient B was an epidural abscess secondary to direct skin infection from the epidural injections. It was confirmed that Patient B had a positive blood culture for staph aureus.

In addition, Dr. James made inaccurate statements to the College during their investigation about his interactions with the hospital.

Regarding both Patients A and B, the College retained Dr. O to provide an opinion in respect of the care and treatment provided by Dr. James. He opined:

In summary, it is my opinion that Dr. James has demonstrated a lack of knowledge, lack of judgment and lack of skill in providing care to [Patient B] and [Patient A]…. His non adherence to appropriate aseptic technique in the invasive procedures provided has led to significant complications and morbidity.

iii) Regarding Patient C, she was treated by Dr. James seven times between April and August 2012 for management of lower back pain. Dr. James administered epidural steroid injections to Patient C. In or around July 2012, Patient C started to experience increasing pain and decreasing stability on her feet. She reported these concerns to Dr. James, and on two occasions sought treatment at emergency. Patient C continued to see Dr. James throughout that summer. After the epidural injections failed to alleviate Patient C’s pain, Dr. James administered bilateral diagnostic lumbar facet blocks in July 2012. In August 2012, he performed a left rhizotomy on Patient C. At this appointment he provided Patient C with a note to take to her family doctor recommending a neurosurgery consult and recommending that her family physician request an MRI. He engaged in no further follow up with Patient C.

Patient C obtained was diagnosed with a serious spinal infection. A sensitive strain of staph aureus was recovered from the surgical specimen and the infection was believed to be the direct result of steroid injections.

Dr. O opined, among other things that, Dr. James failed to appreciate the patient’s progressive symptoms, failed to realize that the symptoms could be signs of an infection in a high risk patient. He also failed to adequately document the patients progressive symptoms, failed to correctly diagnosis/work up possible complications of treatments he provided, failed to adequately inquire about the patients ER visits and failed to organize appropriate timely work up of the patient’s symptoms.

iv) Regarding Patient D, she was seen by Dr. James for injections on a regular basis for treatment of chronic back pain commencing in 2010. In October 2011, Dr. James administered a lumbar epidural injection. Less than two weeks after receiving the epidural injection, Patient D began to experience symptoms of fever, increasing confusion, neck pain, nausea, vomiting and occipital headaches. She was admitted to hospital. The suspected etiology was an infection secondary to epidural injections received from Dr. James.

Patient D was readmitted to the hospital in November 2011 for a twelve day period. Her headache, nausea and vomiting continued. An MRI demonstrated an epidural fluid collection with a diagnosis of a likely enlarging epidural abscess. Patient D required extensive surgical laminectomies.

v) Regarding Patient E, Dr. James treated her for pain in her right elbow. In January 2012, Dr. James injected her elbow with cortisone and performed a caudal epidural injection the same day. Soon after the injection, Patient E’s right arm became painful and red. She began calling the Clinic to get an appointment with Dr. James so that he could look at her arm. Subsequently, Patient E attended at the clinic, and asked that someone look at her red and swollen elbow. After she waited for about an hour and a half, Dr. James saw her, told her it was likely nothing and gave her a prescription for antibiotics and told her to follow up in two weeks.

Patient E’s arm remained very painful, swollen and red. In March 2012, Dr. James immediately sent her to the Emergency Department. Patient E was found to have a post-injection abscess and a heavy growth of staph aureus and was referred for both orthopedic and plastic surgery consults.

Dr. O opined that it is below standard of care to not offer urgent follow up for a potential infection after a procedure, even if there is no fever.

vi) Regarding Patient F, in May 2012 he received a lumbar epidural injection for lower back pain from Dr. James. Less than two weeks later Patient F developed a high fever, delirium and increasing back pain while out of the country. Patient F was admitted to hospital in the United States, critically ill. He was found to have an epidural abscess and sepsis (staph aureus bacteremia), requiring ICU admission, intubation and neurosurgical evacuation together with hemi laminectomies. The likely etiology of the epidural abscess was believed to be the epidural injection.

On December 15, 2015, the Discipline Committee ordered and directed that:
- Dr. James appear before the panel to be reprimanded.
- the Registrar suspend Dr. James’ certificate of registration for a period of ten (10) months, effective immediately.
- the Registrar to impose the following terms, conditions and limitations on Dr. James’ certificate of registration:
a. Dr. James be prohibited from holding the position of Medical Director in any facility;
b. Dr. James shall perform all injections in the presence of a regulated health professional who observes each injection and who contemporaneously signs and dates the patient record confirming he/she has observed the injection. Dr. James shall provide the College with a list of regulated health professionals with whom he works and provide copies of their signatures within seven (7) days of the date of this Order, and within fourteen (14) days of employing any additional regulated health professional thereafter;
c. If Dr. James becomes aware that a patient developed an infection following a procedure that he performed, Dr. James shall, within 7 days of date on which he became aware, report the infection to the College; 
d. Dr. James shall complete the next available medical record keeping course approved by the College and provide proof of successful completion within three (3) weeks thereof;
e. Dr. James shall successfully complete individualized education in communication, approved by the College at the instructor’s earliest availability and provide proof of successful completion within three (3) weeks thereof. The course will involve a series of one-on-one sessions with a College-approved instructor (the “Instructor”), incorporating principles of guided reflection, tailored feedback, and other modalities customized to the specific needs of Dr. James as assessed by the Instructor. The Instructor will make reports to the College regarding Dr. James’ progress and compliance;
f. Dr. James shall successfully complete individualized instruction in ethics approved by the College at the instructor’s earliest availability and provide proof of successful completion within three (3) weeks thereof. The instruction will involve a series of one-on-one sessions with a College-approved instructor (the “Instructor”), incorporating principles of guided reflection, tailored feedback, and other modalities customized to the specific needs of Dr. James as assessed by the Instructor. The Instructor will make reports to the College regarding Dr. James’ progress and compliance;
g. Dr. James shall retain a clinical supervisor, approved by the College, who will sign an undertaking in the form attached hereto as Schedule “A” (the “Supervisor”) no later than 30 days prior to Dr. James’ return to practice after the suspension referred to in paragraph 4 above. Dr. James shall practice under the guidance of the Supervisor for a period of period of twelve (12) months. Dr. James shall meet with the supervisor monthly to discuss any concerns arising from patient care, including infection prevention, control and treatment.
h. Dr. James shall engage a preceptor acceptable to the College to provide education in the indications and treatment for infection in Interventional Pain Medicine for a minimum period of (4) four hours. The preceptorship shall be completed within (3) months of Dr. James’ return to practice after the end of the suspension referred to in paragraph 4 above, and the preceptor shall confirm such completion in writing to the College;

i. Dr. James shall be subject to a reassessment of his practice including an observation of his sterile technique, within six (6) months of his return to practice after the end of the suspension referred to in paragraph 4 above, and shall be subject to periodic assessments (announced and/or unannounced) thereafter at the discretion of the College, including a reassessment following the completion of supervision described in paragraph g above. Dr. James shall abide by the recommendations of the assessors;
j. Dr. James shall cooperate with unannounced inspections of his practice and patient records by a College representative for the purposes of monitoring his compliance with the provisions of this Order and his infection control practices; and
k. Dr. James shall be solely responsible for payment of all fees, costs, charges, expenses, etc. arising from the implementation of any of the provisions of this Order.
- Dr. James pay costs to the College in the amount of $4,460.00 within thirty (30) days of the date of this Order.


Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): November 16 and December 15, 2015

Concerns

Source: Member
Active Date: May 10, 2021
Expiry Date:
Summary:
Summary of the Undertaking given by Dr. Stephen Rose James to the College of Physicians and Surgeons of Ontario, effective May 10, 2021:

A College investigation was conducted into whether Dr. James engaged in professional misconduct and/or is incompetent in his chronic pain management practice. In addition, Dr. James submitted to a reassessment of his practice according to an Order of the Discipline Committee. The reassessment report received by the College raised concerns about his standard of practice. As a result of the investigation and reassessment:

Dr. James will engage in professional education in medical record-keeping and interventional pain.

Dr. James’s practice will be reassessed by an assessor selected by the College within 6 months of completion of the professional education.