On March 26, 2018, the Discipline Committee found that Dr. Robert Stewart Cameron committed an act of professional misconduct, in that he has failed to maintain the standard of practice of the profession.
Dr. Cameron is a 65-year-old general physician who received his certificate of registration authorizing independent practice in 1978. At the relevant time, Dr. Cameron practised at a walk-in clinic in Windsor, Ontario.
Information from the Narcotics Monitoring System
In July 2016, the College received information from the Ministry of Health and Long-Term Care’s Narcotics Monitoring System regarding Dr. Cameron’s prescribing of controlled drugs, including narcotics, from January 1, 2015 to December 31, 2015 (the “NMS data”). The NMS data indicated that Dr. Cameron had been identified as a physician who, in 2015, prescribed eight or more patients at least 650 oral morphine equivalents per day and issued at least one prescription exceeding 20,000 oral morphine equivalents.
Investigation of Dr. Cameron’s Practice
The College retained an expert, a family physician, to opine on Dr. Cameron’s prescribing of controlled drugs including narcotics. The expert reviewed 24 charts, the NMS data, and interviewed Dr. Cameron. At the request of the College, the expert provided an addendum report to the College, containing individual patient reports of the charts he reviewed. The expert opined that Dr. Cameron’s care of his patients fell below the standard of practice of the profession in 18 of 24 charts and that Dr. Cameron’s care in 16 of 24 charts placed his patients at a risk of harm.
In particular, the expert noted that:
- Dr. Cameron had a tendency to prescribe narcotics at doses well in excess of those recommended in the relevant clinical guidelines, for chronic pain, over many years, with few physical exams or other evaluations of the patient’s pain or function;
- Dr. Cameron demonstrated questionable and at times very poor judgment in continuing to prescribe large doses of narcotics to patients who had repeatedly demonstrated aberrant behaviour, often at appointments over a period of years, and was too accepting of patients often questionable explanations for lost, stolen or damaged narcotics;
- Dr. Cameron failed to regularly conduct opioid risk assessments, implement narcotics contracts and/or conduct urine drug screening to address repeated aberrant behaviour;
- In respect of at least six patients, Dr. Cameron failed to refer patients to specialists, including pain and/or addiction specialists, where indicated;
- In respect of at least seven patients, Dr. Cameron failed to react to information from third parties about potential opioid abuse or to follow the advice of consultants who suggested decreasing or discontinuing opioid medications;
- Dr. Cameron continued to prescribe high doses of narcotics to patients who may have sustained accidents or injuries due to these prescriptions;
- Dr. Cameron prescribed benzodiazepines to patients to whom he was also prescribing high doses of narcotics;
- In respect of at least four patients, Dr. Cameron regularly prescribed narcotics to patients also prescribed methadone for addiction without appropriate consultation with the methadone prescriber.
Undertaking
On March 9, 2018, Dr. Cameron has entered into an undertaking with the College, whereby he undertook to resign from the College, effective April 30, 2018 and not to apply or re-apply for registration as a physician to practise medicine in Ontario or any other jurisdiction after the effective date.
Disposition
The Discipline Committee ordered that:
- the Registrar impose the terms of the Inquiries, Complaints and Reports Committee’s Order dated June 27, 2017 made pursuant to section 25.4(1) of the Health Professions Procedural Code (the “Code”), which is Schedule 2 to the Regulated Health Professions Act, 1991 (attached as Appendix “B” to the Order) as terms, conditions and limitations on Dr. Cameron’s certificate of registration.
- Dr. Cameron attend before the panel to be reprimanded.
- Dr. Cameron pay costs to the College in the amount of $10,180.00 within 60 days of the date this Order becomes final.
Terms and conditions imposed on certificate by: Inquiries, Complaints and Reports Committee