On February 1, 2013, the Discipline Committee found that Dr. Kenneth Buttoo committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession. Dr. Buttoo admitted to the allegation.
As a result of concerns regarding his practice, Dr. Buttoo executed an undertaking to the College on March 10, 2009, by which he agreed that he would engage in an assessment of his practice within one year. As a result of concerns that arose out of the subsequent practice assessment, the College proceeded with a section 75 investigation into Dr. Buttoo's practice and retained a medical inspector to review 20 patient charts, visit the site, interview Dr. Buttoo and observe five patient visits in February 2010. As set out in the inspector's report, Dr. Buttoo fell below the standard of practice of the profession in the areas of allergy management and respiratory management. In particular, in the care of multiple patients in 2009-2010, Dr. Buttoo:
inappropriately ordered and/or recommended testing that was unnecessary and/or not indicated;
inappropriately failed to mention airways resistance findings in his interpretation of pulmonary function test results;
in circumstances in which Dr. Buttoo made a provisional diagnosis of asthma and then conducted testing which did not support the diagnosis, he inappropriately failed to address the provisional asthma diagnosis in his follow-up consultation letters to referring physicians and did not state that asthma had been ruled out;
inappropriately presented "hyper responsive airways" to referring physicians in terms that suggested it represented a final diagnosis of a patient's condition, when in fact no diagnosis had been reached on the basis of the testing conducted and the patient's symptoms remained undiagnosed;
inappropriately prescribed medications that were unnecessary and not indicated; and utilized inappropriate sterilization techniques.
The Discipline Committee ordered and directed that:
the Registrar impose the following terms, conditions and limitations on Dr. Buttoo's Certificate of Registration:
(a) For an indefinite period of time, Dr. Buttoo shall not prescribe inhaled corticosteroids and/or anticholinergic medication for a patient unless he or she has a diagnosis of asthma, and in any case Dr. Buttoo shall not prescribe such medication in cases in which the patient has had a negative methacholine challenge.
(b) While Dr. Buttoo is subject to the term, condition and limitation set out at paragraph 3(a), Dr. Buttoo shall maintain a log (the "Log") listing all patients to whom he has prescribed inhaled corticosteroids and/or anticholinergic medication, their OHIP number, the date on which he saw the patient, whether the patient has a diagnosis of asthma, whether a methacholine challenge has been conducted, and, if so, whether the challenge was positive or negative. Dr. Buttoo shall maintain the original Log and shall send a copy of the Log to the College on a quarterly basis until completion of the re-assessment referred to below in paragraph 3(g), and thereafter shall produce the Log at any time upon request of the College.
(c) Dr. Buttoo shall, within thirty (30) days from the date of this Order, retain a College-approved clinical supervisor, who will sign an undertaking in the form attached hereto as Schedule "A" (the "Clinical Supervisor"). For a period of at least twelve (12) months commencing on the day the Clinical Supervisor is retained, Dr. Buttoo may practice only under the supervision of the Clinical Supervisor, who will meet with Dr. Buttoo on a monthly basis for the duration of the supervision, except that after three (3) months of supervision, the frequency of meetings may be decreased to every two months if the Clinical Supervisor is of the view that this is appropriate and it has been pre-approved by the College.
(d) For the duration of the clinical supervision required by paragraph 3(c), Dr. Buttoo shall, within twenty (20) days of receiving notice that his Clinical Supervisor is unwilling or unable to continue to fulfill the terms of his or her undertaking attached hereto as Schedule "A", obtain an executed undertaking from a similarly qualified person who is acceptable to the College and ensure that it is delivered to the College within that time. If Dr. Buttoo is unable to obtain a Clinical Supervisor on the terms set out under paragraphs 3(c) and 3(d) to this Order, he shall cease to practice until such time as he has obtained a Clinical Supervisor acceptable to the College, and the fact that he has ceased to practice shall be a term, condition and limitation on his Certificate of Registration until that time.
(e) Dr. Buttoo shall abide by all recommendations of his Clinical Supervisor with respect to practice improvements and education.
(f) Dr. Buttoo 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. Buttoo's compliance with the Order. This shall include, without limitation, providing the Clinical Supervisor with the reports of any assessments of Dr. Buttoo's practice in the College's possession.
(g) Approximately twelve (12) months after the completion of the period of supervision required by paragraph 3(c), Dr. Buttoo shall undergo a re-assessment of his clinical practice by a College-appointed assessor (the "Assessor(s)"). This re-assessment will include determining whether Dr. Buttoo meets the standard of practice of the profession and whether Dr. Buttoo is in compliance with this Order. The Assessor(s) shall make recommendations regarding Dr. Buttoo's practice and shall report the results of the re-assessment to the College.
(h) Dr. Buttoo shall consent to the disclosure to the Assessor(s) of the reports of the Clinical Supervisor arising from the supervision, and shall consent to the sharing of all information among the Clinical Supervisor, the Assessor(s) and the College, as any of them deem necessary or desirable in order to fulfill their respective obligations.
(i) For an indefinite period of time, Dr. Buttoo 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.
(j) For an indefinite period of time, Dr. Buttoo shall consent to the College making appropriate enquiries of the Ontario Health Insurance Plan and/or any person or institution who may have relevant information, in order for the College to monitor his compliance with this Order.
(k) For an indefinite period of time, Dr. Buttoo 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.
(l) Dr. Buttoo shall be responsible for any and all costs associated with implementing the terms of this Order.
Dr. Buttoo attend before the panel to be reprimanded.
Dr. Buttoo pay to the College costs in the amount of $3,650 within thirty (30) days of the date of this Order.
Terms and conditions imposed on certificate by: Discipline Committee
