On May 13, 2019, the Discipline Committee found that Dr. Allen Phillip Denys committed an act of professional misconduct in that: he failed to maintain the standard of practice of the profession in his care of patients; and he engaged in acts or omissions relevant to the practice of medicine that would be regarded by members as disgraceful, dishonourable or unprofessional by ordering pulmonary function testing without appropriate clinical indication in respect of which he and members of his family obtained a benefit, and by failing to comply with the Conflict of Interest Regulation by failing to submit forms to the College declaring his conflicts of interest until August 16, 2017.
FACTS
Dr. Denys is a 68-year-old respirologist practicing in Windsor, Ontario, who received his certificate of registration authorizing independent practice in 1977. At the relevant times, Dr. Denys practiced both sleep medicine and respirology.
BACKGROUND
On August 24, 2016, the College received information from a physician who had previously practiced under the supervision of Dr. Denys at the Windsor Sleep Disorders Clinic. The physician expressed concern that Dr. Denys routinely ordered pulmonary function tests without appropriate clinical indication for patients referred to the Windsor Sleep Disorders Clinic. On the basis of this information, the Inquiries, Complaints and Reports Committee of the College (the “ICRC”) approved the appointment of investigators under section 75(1)(a) of the Health Professions Procedural Code which is Schedule 2 to the Regulated Health Professions Act, 1991 (the “Code”) in order to conduct a broader investigation into Dr. Denys’ practice.
INVESTIGATION INTO DR. DENYS’ PRACTICE
Facilities in which Dr. Denys and his family members have or had an interest.
At the relevant times, Dr. Denys was the Quality Advisor and an interpreting physician at a sleep medicine clinic known as the Windsor Sleep Disorders Clinic. The Windsor Sleep Disorders Clinic is an Independent Health Facility, which is permitted pursuant to a license to bill facility fees to OHIP. Dr. Denys’ daughter was the sole shareholder of the corporation that held the license to operate this Independent Health Facility.
Dr. Denys is the Quality Advisor and the main interpreting physician at a pulmonary function lab known as Essex County Respiratory Services, an Independent Health Facility. Dr. Denys’ daughter is the sole shareholder of the corporation that holds the license to operate this Independent Health Facility.
Dr. Denys is also the Quality Advisor and the main interpreting physician for pulmonary function tests at a pulmonary function and diagnostic imaging facility known as Essex County Diagnostic Services, an Independent Health Facility. One of the daughters is the sole shareholder of the corporation that holds the license to operate this Independent Health Facility.
In addition, Dr. Denys’ brother is the sole shareholder of the corporation known as Denys Sleep Supplies and Services Inc., which is operated from the same location as the Windsor Sleep Disorders Clinic and which is described as a “Patient liaison to facilitate the purchase of sleep equipment and sleep supplies for treatment of sleep apnea”.
Failure to Maintain the Standard of Practice of the Profession
The College retained Dr. Raymond Gottschalk, a respirologist who practices both sleep medicine and respirology, to opine on Dr. Denys’ care and treatment of patients at the Windsor Sleep Disorders Clinic. Dr. Gottschalk conducted a review of 50 patient charts of patients from the Windsor Sleep Disorders Clinic, along with those patients’ OHIP data, and interviewed Dr. Denys on August 17, 2017. His report was received by the College on August 30, 2017.
Dr. Gottschalk noted that in almost every chart reviewed, patients were booked for a pulmonary function test immediately upon referral to the Windsor Sleep Disorders Clinic. Dr. Gottschalk opined that there was no clinical indication for such testing evident on the face of the referral nor had the patient been evaluated in person by Dr. Denys. In addition, although routine pulmonary function tests were booked on almost all patients, Dr. Gottschalk opined that the results of such testing were not addressed in the consultation reports to the referring physicians nor were abnormalities identified or treatments recommended.
In addition, Dr. Gottschalk opined that there were other significant areas of concern with Dr. Denys’ sleep medicine practice, including that:
- There was no effective initial triage process to distinguish between severe patients and routine patients. All patients appeared to be treated with the same strategy without evaluating the severity of the condition for which they were referred;
- There was a failure to report unsafe drivers to the Ministry of Transportation or to recommend to patients that they not drive;
- The presenting complaint was not addressed in the consultation report provided by Dr. Denys to the referring physician;
- There was no effective triage following sleep studies, with the result that some patients with extremely severe sleep apnea experienced 6-9 month delays in getting treatment;
- The quality of the sleep study reports and consultation reports provided to the referring physician was poor, with nearly identical assessments and recommendations regardless of the issues or severity of concerns identified in the sleep study;
- In some cases there was no evidence that the patient had attended for a consultation with Dr. Denys following the sleep study, nor any evidence that attempts had been made to contact the patient or that the referring physician was advised that the patient did not attend for the consultation.
Dr. Gottschalk opined that Dr. Denys failed to meet the standard of practice of the profession in his care and treatment of patients in 45 of the 50 patient charts reviewed, that Dr. Denys demonstrated a lack of knowledge, skill and/or judgment in 44 of the 50 patient charts reviewed, and that Dr. Denys’ clinical practice exposed, or was likely to expose, patients to a risk of harm in 25 of the 50 patient charts reviewed.
Dr. Denys provided responses outlining the changes to his practice to address the concerns of Dr. Gottschalk. Dr. Gottschalk reviewed Dr. Denys’ responses, with reference to the specific patient charts, and delivered addendum reports dated November 24, 2017 and January 7, 2018.
Disgraceful, dishonourable and unprofessional conduct
As indicated in the reports of Dr. Gottschalk, Dr. Denys ordered pulmonary function tests without appropriate clinical indication. Dr. Denys’ daughters own the licenses of Essex County Respiratory Services and Essex County Diagnostic Services, the Independent Health Facilities where the pulmonary function tests were performed, and Dr. Denys is the main interpreting physician for pulmonary function tests at both facilities.
Referring patients for testing without appropriate clinical indication and from which he and his family members received a benefit constitutes disgraceful, dishonourable and unprofessional conduct. In addition, Dr. Denys failed to comply with conflict of interest requirements, which also constitutes disgraceful, dishonourable and unprofessional conduct.
Dr. Denys failed to inform the College of his conflicts of interest in respect of Windsor Sleep Disorders Clinic, Essex County Respiratory Services, Essex County Diagnostic Services and Denys Sleep Supplies and Services Inc. until he submitted the Conflict of Interest declaration forms on August 16, 2017.
INTERIM UNDERTAKING
On March 6, 2018, the ICRC directed that Dr. Denys enter into an Undertaking in lieu of imposing an Order pursuant to s. 25.4(1) of the Code (the “Section 25.4 Undertaking”). The Section 25.4 Undertaking provides that Dr. Denys must practice sleep medicine under the supervision of a Clinical Supervisor until the disposition of the allegations referred to the Discipline Committee.
FACTS ON PENALTY
On April 12, 2019, Dr. Denys entered into an Undertaking with the College in which he agreed to cease practicing sleep medicine in all jurisdictions and to never resume doing so.
DISPOSITION
On May 13, 2019, the Discipline Committee ordered and directed that:
- the Registrar suspend Dr. Denys’ certificate of registration for a period of four (4) months, commencing from May 14, 2019 at 12:01 a.m.
- the Registrar place the following terms, conditions and limitations on Dr. Denys’ certificate of registration:
- Dr. Denys will participate in and pass the PROBE Ethics & Boundaries Program offered by the Centre for Personalized Education for Professionals (CPEP), with a report or reports to be provided by CPEP to the College regarding Dr. Denys’ progress and compliance. Dr. Denys will complete this requirement within 6 months, or, if it is not possible to do so within 6 months, at the first available PROBE Ethics & Boundaries program for which Dr. Denys is eligible.
- Dr. Denys attend before the panel to be reprimanded.
- Dr. Denys to pay costs to the College in the amount of $6,000.00 within 30 days of the date of this Order.
Terms and conditions imposed on certificate by: Member
