On September 27, 2018, the Discipline Committee found that Dr. William Andrew Roy committed an act of professional misconduct, in that he has 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.
Dr. Roy is a General Practitioner, practising in Toronto. He obtained his Independent Practice Certificate in 1971.
The College received information from the Narcotics Monitoring System (NMS) identifying Dr. Roy as having prescribed, in 2015, eight or more patients at least 650 oral morphine equivalents (OMEs) per day and issued at least one prescription exceeding 20,000 OMEs. This prescribing exceeds the recommended watchful dose of 200 OMEs per day as set out in The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (v 5.6, April 30, 2010). In total, 19 patients were flagged by the NMS.
The College retained an expert, a family physician certified by the College of Family Physicians of Canada, to review this matter. The expert concluded that Dr. Roy failed to meet the standard of practice of the profession in 13 of the 20 charts reviewed and noted that:
- the main areas of concern are his prescriptions for very high doses of opioids, often in combination with high doses of benzodiazepines, poor record keeping with respect to opioid prescribing, and lack of monitoring of patients with prescriptions for high doses of opioids.
- Dr. Roy displayed a lack of knowledge in 2 charts as evident in situations where he indicated that he prescribed two different long-acting opioids as one did not appear to be effective, and where a patient was currently using intravenous street drugs, but he felt that the patient would still require prescription opioids for his pain.
- Dr. Roy displayed a lack of skill in 5 charts as evident by his management of patients who demonstrated inappropriate behaviour or features of misuse.
- Dr. Roy displayed a lack of judgment in 10 of the charts reviewed, which was evident in the management of patients who were prescribed high doses of opioids and benzodiazepines without adequate monitoring for safety and effectiveness.
The expert concluded that in 7 of the 20 charts reviewed, Dr. Roy exposed patients to a potential risk of harm due to the extremely high doses of opioids that were prescribed in combination with high doses of benzodiazepines and by not monitoring the patients closely enough to ensure that they were taking the medications safely.
Disgraceful Dishonourable or Unprofessional Conduct
As a resolution, Dr. Roy entered into an undertaking with the College in June of 2017, requiring, among other things, that Dr. Roy practise under the guidance of a clinical supervisor acceptable to the College. If unable to obtain a clinical supervisor, Dr. Roy is required to cease to prescribe narcotic drugs, narcotic preparations, controlled drugs, benzodiazepines and other targeted substances, and all other monitored drugs.
Dr. Roy obtained a clinical supervisor on July 19, 2017. However, on August 29, 2017, due to a potential conflict of interest, Dr. Roy was notified that this clinical supervisor was no longer suitable. Dr. Roy was provided with fourteen days to obtain a new clinical supervisor.
Dr. Roy did not propose a suitable supervisor within the time limit set out in the undertaking. He was reminded on September 12, 2017, that, in accordance with the terms of the undertaking, he would have to cease prescribing by the end of the day, unless a supervisor was proposed and approved. Following a request by Dr. Roy’s counsel, an extension was provided until September 15, 2017.
Dr. Roy was unable to find a suitable clinical supervisor by the extended deadline. In accordance with the terms of the undertaking, and the terms, conditions and limitations on his certificate of registration effective September 19, 2017, Dr. Roy was required to cease prescribing narcotic drugs, narcotic preparations, controlled drugs, benzodiazepines and other targeted substances, and all other monitored drugs until such time as he has obtained a clinical supervisor acceptable to the College. This restriction appeared on the public register.
On October 13, 2017, another clinical supervisor was approved. On October 18, 2017, the clinical supervisor wrote to the College, noting that Dr. Roy had stated in their initial meeting earlier that day that he had continued to prescribe controlled substances during the period of time when he did not have a supervisor.
College Compliance Case Managers selected 13 patient names from Dr. Roy's prescribing log and obtained copies of the prescriptions and physician's notes from the corresponding charts. NMS data was obtained with respect to the 13 patients, which demonstrates that Dr. Roy continued to prescribe monitored drugs between the period of September 19, 2017 and October 18, 2017.
Disposition
On September 27, 2018, the Discipline Committee ordered and directed that:
- the Registrar suspend Dr. Roy’s certificate of registration for a period of three (3) months, commencing October 15, 2018.
- Dr. Roy participate in and successfully complete one-on-one individualized educational instruction in ethics with an instructor approved by the College, and provide proof thereof to the College within six (6) months of the date of this Order.
- Dr. Roy appear before the panel to be reprimanded.
- Dr. Roy pay to the College its costs of this proceeding in the amount of $10,180 within thirty (30) days from the date of this Order.
Terms and conditions imposed on certificate by: Member