On February 22, 2016, the Discipline Committee found that Dr. Herman Yip-Chi Ng committed an act of professional misconduct in that he failed to maintain the standard of practice of the profession; and that he engaged in 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 Discipline Committee also found that Dr. Ng is incompetent.
Patient A was Dr. Ng’s patient for approximately ten years. On February 13, 2015, the College received a Complaint Form from Patient A expressing concerns about how Dr. Ng conducted himself during an appointment on February 7, 2015. Patient A was also concerned that Dr. Ng failed to maintain adequate cleanliness in his office environment.
On February 27, 2015, the College conducted an unannounced inspection at Dr. Ng’s clinic which revealed significant cleanliness concerns, including:
- the disposing of used non-safety engineered syringes in a dirty sink;
- no clear delineation between soiled and clean areas;
- improper cleansing and disinfecting of instruments; and
- a dirty and cluttered examination/utility/consultation room.
On April 15, 2015, Dr. Ng provided the College with what he purported to be Patient A’s original patient chart.
The College investigator sent a letter to Dr. Ng on dated May 11, 2015 asking for Dr. Ng to confirm that he had not altered the chart in any way or made any changes to it, and that all entries were made on the dates shown on the chart.
Dr. Ng’s counsel sent a letter to the College on May 13, 2015 stating that Dr. Ng had not altered the chart in any way, and that all entries had been made contemporaneously.
The College retained a forensic document examiner to review Patient A’s chart. The forensic report confirmed that parts of Dr. Ng’s chart for Patient A had been substituted and backdated.
The College retained an expert, Dr. Z, to review Dr. Ng’s care for Patient A; Dr. Ng’s infection control procedures; and Dr. Ng’s maintenance of equipment in his practice.
Dr. Z’s review of Dr. Ng’s care of Patient A was based on Dr. Ng’s chart, which had been altered by Dr. Ng.
Dr. Z’s comments on Dr. Ng’s infection control procedures included the following: “Dr. Ng did not meet the standard of practice of the profession as of March 12, 2015 with respect to infection control procedures and maintenance of equipment in his practice. [His] care in relation to infection control as of March 12, 2015 displayed a lack of knowledge, care and judgment in that he was unaware of and/or did not implement basic office infection control processes and procedures that are readily available to all Ontario physicians through Public Health Ontario. In my opinion, his deficit is severe as the breaches in infection control were numerous and place patients at risk. Dr. Ng’s practice, behaviour, and conduct in relation to infection control as of March 12, 2015 exposed his patients to harm and was likely to expose his patients to injury. Significant risks resulting from his practice, behaviour and conduct include transmission of respiratory pathogens such as influenza, enteric pathogens such as C difficile and blood borne pathogens such as hepatitis B or C.” Dr. Ng wrote to the College on August 7, 2015 in response to the forensic document report as well as Dr. Z’s report. Dr. Ng maintained in his response that he had not altered Patient A’s chart, despite the forensic document report.
SECTION 75(1)(A) INVESTIGATION
Based on Patient A’s letter of complaint and the College’s unannounced inspection of Dr. Ng’s clinic on February 27, 2015, the Inquiries, Complaints and Reports approved the appointment of investigators to conduct a broader investigation into Dr. Ng’s practice under section 75(a) of the Health Professions Procedural Code on March 10, 2015.
On March 3, 2015, the College notified Toronto Public Health that Dr. Ng was using unacceptable infection prevention and control practices while providing patient care at his office.
On March 6, 2015, an inspection by Toronto Public Health concluded that Dr. Ng failed to use adequate infection prevention and control practices. On the same day, Toronto Public Health gave a verbal order under section 13 of the Health Protection and Promotion Act, requiring Dr. Ng to close his office until further notice
On March 11, 2015, Toronto Public Health served a written order requiring Dr. Ng to make improvements to his office, including disposing sharps in an approved sharps container; ensuring the premises is clean and in good repair at all times; ensuring there is an area that has a sink for cleaning and disinfecting instruments; and ensuring that single-use items are discarded safely after use.
On March 23, 2015, Toronto Public Health re-inspected Dr. Ng's practice and concluded that he made the necessary corrective infection prevention and control measures and reopened the premises for patient care.
On July 2, 2015, the College conducted a re-inspection of Dr. Ng’s office which revealed continuing infection control issues.
The College retained Dr. Z to review Dr. Ng’s standard of care. Based on an office inspection, an observation of Dr. Ng's practice, an interview with Dr. Ng, and a review of 26 patient charts as well as a review of five patient charts whose care she observed on June 8, 2015, Dr. Z stated that:
- In 25 charts, Dr. Ng failed to properly maintain a CPP, medication record or immunization record.
- In 16 charts, Dr. Ng failed to meet the standard in assessing, documenting, investigating and managing patients with a thyroid nodule, microcytic anemia, low hemoglobin/ hematocrit, ulcer pain, infected heel wound, ongoing albuminuria, diabetes, toothache and not referring patients for dental care, using non-evidence based treatments for
prostatitis, H-pyloris titers, zoster infections, carpal tunnel syndrome, enuresis in a 2 year old child, in having performed a laryngoscopy on a patient, and not having used a growth chart and not following the Ontario immunization schedule.
- Dr. Ng failed to meet the standard of care in 5 out of 5 of the patients observed, including performing blood pressure assessment, assessing a patient's complaint of fatigue and back pain, following up on an abnormal HgA1C, assessing a patient's complaint of chest pain and shortness of breath, managing a patient's oral pain.
- Dr. Ng demonstrates a lack of knowledge/skill/judgment in the areas of pap screening, use of glucometer, use of otoscope, H pylori screening, ordering diagnostic testings such as mammography, pelvic ultrasound, thyroid ultrasound and abdominal ultrasound, office emergency procedures, periodic screening, management of diabetes, chest pain assessment, use of Rourke or developmental record and Ontario immunization schedule.
- In 15 out of 23 charts, Dr. Ng's practice is likely to expose his patients to harm/injury.
- In 5 out of 5 patients observed, Dr. Ng's practice may expose his patients to harm/injury.
With respect to Dr. Ng's Infection Control Practice, Dr. Z opined as follows:
- Dr. Ng carried out improper reprocessing multi-use equipment and displayed a lack of knowledge of proper reprocessing process.
- Once hygiene product was available in his office after the Toronto Public Health investigation, he did not utilize it once during the patient observations on June 8, 2015; he did not manage sharps appropriately; he did not document hepatitis B status properly; he did not manage multi-dose vials properly; he did not have controls for refrigerated items; he did not understand or carry out syndromic surveillance.
“Dr. Ng's clinical practice created a definite risk of harm for patients who attended his office prior to February 27, 2015. The risk was one of transmission of respiratory, enteric and bloodborne pathogens, and transmission of multi-drug resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA).The nature of the harm ranged from possible acute infection to colonization with a risk of future infection. Depending on the pathogen, infection could have caused significant morbidity and even mortality. It is not possible to quantitate the probability of the harm…any patient may have been exposed to harm.”
The Discipline Committee ordered Dr. Ng to appear before the panel to be reprimanded.
The Discipline Committee ordered Dr. Ng to pay costs to the College in the amount of $4,460.00 within 30 days of the date of this Order.
On February 22, 2016, Dr. Ng resigned from the College and has agreed never to apply or reapply for registration as a physician in Ontario or any other jurisdiction.
