On December 12, 2014, the Discipline Committee found that Dr. Nicol committed an act of professional misconduct, in that he has failed to maintain the standard of practice of the profession in his care and treatment of 26 patients. Dr. Nicol admitted to the allegation.
Regarding a complaint received in July 2011 regarding the care of Patient A, Dr. X, an independent assessor retained by the College, opined that Dr. Nicol failed to maintain the standard of practice of a general practitioner: in the manner in which he prescribed narcotics to Patient A; in dealing with her underlying substance abuse problem and mood disorder; and, in the overall care of Patient A, including in the absences of history taking and physical exam as
well as failing to ensure that proper screening protocols were undertaken, such as a PAP test, colon cancer screening and diabetes screening.
In July 2012, the College commenced a broader investigation into Dr. Nicol’s practice and retained Dr. Y, an independent assessor, to opine on Dr. Nicol’s care and treatment of 25 patients. Dr. Y opined that Dr. Nicol’s record-keeping failed to maintain the standard of practice of medicine in each case. He also opined that Dr. Nicol’s overall care of multiple patients failed to maintain the standard of practice including:
• He failed to acknowledge test results or follow up on some results;
• He appeared hesitant in making the diagnosis of diabetes when the diagnostic criteria were met and seemed hesitant to manage these patients in an effective manner;
• With respect to pain management, he started patients on high-doses of narcotics and, in some cases, mixed varieties, without employing a slower, more cautious approach to the initiation of therapy. Initial screening steps and a clearer recording of functional abilities was lacking.
He did not consider drug interactions in his prescribing of medications;
• He was not diligent in minimizing the use of benzodiazepines;
• Being inconsistent in his lipid assessment and management;
• He needlessly treated what seemed to be viral respiratory infections with antibiotics;
• He displayed some lack of knowledge in the area of vaccines; and
• He displayed a lack of knowledge with respect to screening recommendations for mammography, PAP smears, colorectal screening and has not kept up to date with current concepts in osteoporosis.
In January 2014, Dr. Nicol entered into an undertaking with the College pending the disposition of the discipline hearing. In accordance with the undertaking, Dr. Nicol has practiced under supervision. The College has received regular reports from Dr. Nicol’s supervisor which indicate improvements in Dr. Nicol’s practice. Some improvements in Dr. Nicol’s practice were also noted by Dr. Y.
The Committee ordered and directed that:
• the Registrar place the following terms, conditions and limitations on Dr. Nicol’s certificate of registration:
(a) Dr. Nicol shall not issue new prescriptions or renew existing prescriptions for any of the following substances:
(i) Narcotic Drugs (from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19);
(ii) Narcotic Preparations (from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19);
(iii)Controlled Drugs (from Schedule G of the Regulations under the Food and Drugs Act, S.C., 1985, c. F-27);
(iv)Benzodiazepines/Other Targeted Substances (from the Benzodiazepines and Other Targeted Substances Regulations made under the Controlled Drugs and Substances Act., S.C., 1996, c. 19);
(collectively referred to as the “Restricted Substances”)
(A summary of the above-named drugs [from Appendix I to the Compendium of Pharmaceuticals and Specialties] is attached hereto as Schedule “A”; and the current
regulatory lists are attached hereto as Schedule “B”)
(v) All other Monitored Drugs (as defined under the Narcotic Safety and Awareness Act, S.O. 2010, c. 22 as noted in Schedule “C”) and as amended from time to
time;
(b) Dr. Nicol shall not take on any new chronic pain patients;
(c) Dr. Nicol shall refer patients who are diabetic or who have impaired glucose tolerance to a specialty clinic for assessment and treatment recommendations;
(d) Dr. Nicol shall post a clearly visible sign in his waiting room in the form set out at Schedule “D”;
(e) Dr. Nicol shall, within 30 days from the date of this Order, retain a College-approved clinical preceptor, who will sign an undertaking in the form attached
hereto as Schedule “E” (the “Clinical Preceptor”). For a period of twelve (12) months commencing on the day the Clinical Preceptor is retained, Dr. Nicol may
practice only under the supervision of the Clinical Preceptor and will abide at his own expense by all recommendations of his Clinical Preceptor with respect to his practice;
(f) If Dr. Nicol is unable to obtain a Clinical Preceptor on the terms set out under 1(e) above, he shall cease practicing medicine until such time as he has obtained a Clinical Preceptor acceptable to the College. If he required to cease practice as a result of this paragraph, this will constitute a term, condition and limitation on his Certificate of Registration and such term, condition and limitation shall be included on the public register;
(g) For a period of twelve (12) months, Dr. Nicol may practice only with a College-appointed clinical supervisor, who will sign an undertaking in the form attached hereto as Schedule “F”;
(h) Upon completion of this twelve (12) month period, as described in paragraphs 1(e) and 1(g), within three (3) months, Dr. Nicol shall undergo a re-assessment of his clinical practice by a College-appointed Assessor. This re-assessment by the Assessor will include a review of Dr. Nicol’s office charts and an interview with Dr. Nicol.
Dr. Nicol shall abide by all recommendations made by the College- appointed Assessor. The Assessor shall report the results of this re-assessment to the College;
(i) Two years after the completion of the re-assessment referred to above in paragraph 1(h), Dr. Nicol shall undergo a further re-assessment of his clinical
practice by a College- appointed assessor, in addition to the re-assessment referred to in paragraph 1(h) above and, regardless of that re-assessor’s recommendations.
Dr. Nicol shall abide by all recommendations made by the College-appointed assessor. The assessor shall report the results of this re-assessment to the College;
(j) On an annual basis, Dr. Nicol shall meet and demonstrate to the College that he has met the annual continuing medical education requirements expected of
members of the College of Family Physicians of Canada;
(k) Dr. Nicol shall be responsible for any and all costs associated with implementing the terms of this Order;
(l) Dr. Nicol shall consent to the sharing of information between the Preceptors, Supervisors, Assessor(s) and the College as any of them deem necessary or
desirable in order to fulfill their respective obligation; and
(m) Dr. Nicol shall co-operate with unannounced inspections of his office practice and patient charts by the College for the purpose of monitoring and enforcing his compliance with the terms of this Order and shall provide his irrevocable consent to the College to make appropriate enquiries of the Ontario Health Insurance Plan, the Narcotic Monitoring Database and/or any person or institution who may have relevant information for the purposes of monitoring and enforcing his compliance with the terms of this Order.
• Dr. Nicol appear before the panel to be reprimanded.
• Dr. Nicol pay costs to the College in the amount of $4,460.00 by January 12, 2015.
Terms and conditions imposed on certificate by: Member