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.
Terms and conditions imposed on certificate by: Discipline Committee