THE FOLLOWING INFORMATION WAS OBTAINED FROM THE PHYSICIAN REGISTER SECTION OF THE WEBSITE OF THE COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO (WWW.CPSO.ON.CA) AS OF THE DATE AND TIME NOTED BELOW
26/12/24 18:32:03 PM

General Information

Former Name: No Former Name
Medical School: Queen's University, 1986
Gender: Man
Languages Spoken: ENGLISH

Practice Information

Primary Business Location: 150 Katimavik Rd
Kanata ON K2L 2N2
Business Email: No Information Available
Phone: 6134820118
Fax: 6137020248

Specialties

SPECIALTY ISSUED ON CERTIFYING BODY
General Surgery
Effective: 12 Nov 1991
Royal College of Physicians and Surgeons of Canada
SPECIALTY: General Surgery
ISSUED ON: Effective: Nov 12 1991
CERTIFYING BODY: Royal College of Physicians and Surgeons of Canada

Hospital Privileges

No information available

Professional Corporation Information

Corporation Name: Paul Irwin Medicine Professional Corporation
Certificate of Authorization Status: Inactive End Date: 16 Jan 2018

General Information

Former Name: No Former Name
Gender: Man
Languages Spoken: ENGLISH
Medical School: Queen's University, 1986

Practice Information

Primary Business Location: 150 Katimavik Rd
Kanata ON K2L 2N2
Business Email: No Information Available
Phone: 6134820118
Fax: 6137020248

Specialties

SPECIALTY ISSUED ON CERTIFYING BODY
General Surgery
Effective: 12 Nov 1991
Royal College of Physicians and Surgeons of Canada
SPECIALTY: General Surgery
ISSUED ON: Effective: Nov 12 1991
CERTIFYING BODY: Royal College of Physicians and Surgeons of Canada

Hospital Privileges

No information available

Professional Corporation Information

Corporation Name: Paul Irwin Medicine Professional Corporation
Certificate of Authorization Status: Inactive End Date: 16 Jan 2018

Practice Conditions

IMPOSED BY EFFECTIVE DATE EXPIRY DATE STATUS
Member
16 Jul 2021
Restricted
IMPOSED BY: Member
EFFECTIVE DATE: Jul 16 2021
EXPIRY DATE:
STATUS: Restricted
A physician who has a restricted licence must follow specific terms and conditions in their practice.
A physician who has a restricted licence must follow specific terms and conditions in their practice.
VIEW DETAILS chevron-down icon
As from July 16, 2021, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Paul Maxwell Irwin in accordance with an undertaking and consent given by Dr. Irwin to the College of Physicians and Surgeons of Ontario:

UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
(“Undertaking”)

of

DR. PAUL MAXWELL IRWIN
(“Dr. Irwin”)

to

COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
(the “College”)

A. PREAMBLE

(1) In this Undertaking:

“Code” means the Health Professions Procedural Code, which is Schedule 2 to the Regulated Health Professions Act, 1991, S.O. 1991, c. 18, as amended;
“NMS” means the Drug Program Services Branch, the Narcotics Monitoring System implemented under the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22, as amended;

“OHIP” means the Ontario Health Insurance Plan;

“Public Register” means the College’s register that is available to the public.

(2) I, Dr. Irwin, certificate of registration number 57194, am a member of the College.

(3) I, Dr. Irwin, acknowledge that the College conducted an investigation bearing File Number 1106914 (the “Investigation”) into whether I engaged in professional misconduct and/or am incompetent.

(4) I, Dr. Irwin, acknowledge that, in addition to accepting this Undertaking, the College will also deliver a verbal caution in person.

B. UNDERTAKING

(5) I, Dr. Irwin, undertake to abide by the provisions of this Undertaking, effective immediately.

(6) Practice Restriction

a) I, Dr. Irwin, acknowledge that my practice is restricted to providing small surgical procedures requiring local anaesthesia and surgical consultations and that, for further specificity, I will not engage in any of the following areas of practice:

i) Primary Care.
ii) Palliative care.
iii) Chronic pain management.

(7) Resignation of Prescribing Privileges

(a) I, Dr. Irwin, acknowledge that I have executed the Prescribing Resignation Letter to Health Canada, which is attached hereto as Schedule “A” (the “Resignation Letter”).

(b) I, Dr. Irwin, consent to the College sending the Resignation Letter to Health Canada on my behalf.

(c) I, Dr. Irwin, undertake that I will not issue new prescriptions or renew existing prescriptions for or administer 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 Part G of the Food and Drug Regulations under the Food and Drugs Act, S.C., 1985, c. F-27);
(iv) Benzodiazepines and Other Targeted Substances (from the Benzodiazepines and Other Targeted Substances Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19);

(A summary of the above-named drugs [from Appendix I to the Compendium of Pharmaceuticals and Specialties] is attached hereto as Schedule “B”; and links to the current regulatory lists are attached hereto as Schedule “C”)

(v) Monitored Drugs (as defined under the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22, with a link to the current regulatory list attached hereto as Schedule “D”);

and as amended from time to time.

(d) I, Dr. Irwin, undertake to immediately notify my patients to whom I am prescribing any of the substances described in section 7(c), above of my prescribing restrictions and that they will require another physician for their assessment and care.

(e) I, Dr. Irwin, additionally undertake to make reasonable efforts to provide my patients to whom I am prescribing any of the substances described in section 7(c), above with a referral to another physician for assessment and care.

(f) I, Dr. Irwin, undertake to keep a log of all patients referenced in section (7)(d) above (the “Log”). I, Dr. Irwin, undertake to include in the Log details of all reasonable efforts I have made to refer the patient including, where applicable, the name of each patient referred, the name of the physician referred to, and the date of referral.

(g) I, Dr. Irwin, undertake that where a patient requires any of the substances described in section 7(c) above prior to or immediately following a small surgical procedure that I will perform, I will request that a colleague in the Clinic where I practice, or that the patient’s referring physician prescribe to this patient.

(8) I, Dr. Irwin, undertake that I will return any supplies of the substances referred to in section (7)(c) above that are presently in my possession, in any place, to a pharmacy in a safe and secure manner, as stipulated in the College’s Policy “Prescribing Drugs.”

(9) I, Dr. Irwin, undertake to inform the College of each and every location at which I practice, delegate, or have privileges, including, but not limited to, any hospitals, clinics, offices, and any Out-of-Hospital Premises and Independent Health Facilities with which I am affiliated, in any jurisdiction (collectively my “Practice Location” or “Practice Locations”), within five (5) days of executing this Undertaking. Going forward, I further undertake to inform the College of any and all new Practice Locations within five (5) days of commencing practice at that location.

(10) Posting a Sign

(a) I, Dr. Irwin, undertake that I shall post a sign in all waiting rooms and in each examination and consulting room, in all my Practice Locations, in a clearly visible and secure location, at all times whether or not I am physically present at the Practice Location, in the form set out at Schedule “E.” For further clarity, this sign shall state as follows:
IMPORTANT NOTICE

Dr. Irwin’s practice is restricted to providing small surgical procedures requiring local anesthesia and surgical consultations. For further clarity he does not practice any of the following: primary care, palliative care or chronic pain management.

Dr. Irwin has agreed not to prescribe or administer any of the following:

- Narcotic Drugs
- Narcotic Preparations
- Controlled Drugs
- Benzodiazepines and Other Targeted Substances
- Monitored Drugs

Further information may be found on the College of Physicians and Surgeons of Ontario website at www.cpso.on.ca

(b) I, Dr. Irwin, undertake to post a certified translation in any language in which I provide services, of the sign described in section (10)(a) above, in all waiting rooms and in each examination and consulting room, in all my Practice Locations, in a clearly visible and secure location, in the form set out at Schedule “E.”

(c) I, Dr. Irwin, undertake to provide the certified translation described in section (10)(b), to the College within thirty (30) days of executing this Undertaking.

(d) I, Dr. Irwin, undertake that if I elect, after the execution of this Undertaking, to provide services in any other language, I will notify the College prior to providing any such services.

(e) I, Dr. Irwin, undertake to provide to the College the certified translation described in section (10)(c) prior to beginning to provide services in any language described in section (10)(d).

C. ACKNOWLEDGEMENT

(11) I, Dr. Irwin, acknowledge that all schedules attached to or referred to in this Undertaking form part of this Undertaking.

(12) I, Dr. Irwin, acknowledge and undertake that I shall be solely responsible for payment of all fees, costs, charges, expenses, etc. arising from the implementation of any of the provisions of this Undertaking.

(13) I, Dr. Irwin, acknowledge that I have read and understand the provisions of this Undertaking and that I have obtained independent legal counsel in reviewing and executing this Undertaking, or have waived my right to do so.

(14) I, Dr. Irwin, acknowledge that the College will provide this Undertaking to any Chief of Staff, or a colleague with similar responsibilities, at any Practice Location (“Chief of Staff” or “Chiefs of Staff”).

(15) I, Dr. Irwin, acknowledge that a breach by me of any provision of this Undertaking may constitute an act of professional misconduct and/or incompetence, and may result in a referral of specified allegations to the Discipline Committee.

(16) I, Dr. Irwin, acknowledge that this Undertaking constitutes terms, conditions, and limitations on my certificate of registration for the purposes of section 23 of the Code.

(17) Public Register

(a) I, Dr. Irwin, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.

(b) I, Dr. Irwin, acknowledge that, in addition to this Undertaking being posted in accordance with section (17)(a) above, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:

A College investigation was conducted into whether Dr. Irwin engaged in professional misconduct and/or was incompetent in the practice. As a result of the investigation, in addition to the College delivering a verbal caution to Dr. Irwin:

Dr. Irwin’s practice is restricted to providing small surgical procedures requiring local anaesthesia and surgical consultations. For further clarity he does not practice any of the following: primary care, palliative care or chronic pain management.

Dr. Irwin must not issue new prescriptions or renew existing prescriptions for or administer 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 Part G of the Food and Drug Regulations under the Food and Drugs Act, S.C., 1985, c. F-27);
(iv) Benzodiazepines and Other Targeted Substances (from the Benzodiazepines and Other Targeted Substances Regulations made under the Controlled Drugs and Substances Act., S.C., 1996, c. 19);
(v) Monitored Drugs (as defined under the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22);

and as amended from time to time.

Dr. Irwin must post a clearly visible sign in the waiting rooms and each examination and consulting room, in all Practice Locations, which states as follows:

IMPORTANT NOTICE

Dr. Irwin’s practice is restricted to providing small surgical procedures requiring local anaesthesia and surgical consultations. For further clarity he does not practice any of the following: primary care, palliative care or chronic pain management.

Dr. Irwin has agreed not to prescribe or administer any of the following:

- Narcotic Drugs
- Narcotic Preparations
- Controlled Drugs
- Benzodiazepines and Other Targeted Substances
- Monitored Drugs

Further information may be found on the College of Physicians and Surgeons of Ontario website at www.cpso.on.ca

D. CONSENT

(18) I, Dr. Irwin, undertake that I will submit to, and not interfere with, unannounced inspections of my Practice Locations and patient charts by the College and to any other activity the College deems necessary in order to monitor my compliance with the provisions of this Undertaking.

(19) I, Dr. Irwin, give my irrevocable consent to the College to make appropriate enquiries of OHIP, NMS, and any person who or institution that may have relevant information, in order for the College to monitor my compliance with the provisions of this Undertaking.

(20) I, Dr. Irwin, acknowledge that I have executed the OHIP and NMS consent forms, attached hereto as Schedule “F” and Schedule “G”, respectively.

(21) I, Dr. Irwin, give my irrevocable consent to the College to provide all Chiefs of Staff with any information the College has that led to the circumstances of my entering into this Undertaking and any information arising from the monitoring of my compliance with this Undertaking.

VIEW DETAILS chevron-down icon
As from July 16, 2021, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Paul Maxwell Irwin in accordance with an undertaking and consent given by Dr. Irwin to the College of Physicians and Surgeons of Ontario:

UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
(“Undertaking”)

of

DR. PAUL MAXWELL IRWIN
(“Dr. Irwin”)

to

COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
(the “College”)

A. PREAMBLE

(1) In this Undertaking:

“Code” means the Health Professions Procedural Code, which is Schedule 2 to the Regulated Health Professions Act, 1991, S.O. 1991, c. 18, as amended;
“NMS” means the Drug Program Services Branch, the Narcotics Monitoring System implemented under the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22, as amended;

“OHIP” means the Ontario Health Insurance Plan;

“Public Register” means the College’s register that is available to the public.

(2) I, Dr. Irwin, certificate of registration number 57194, am a member of the College.

(3) I, Dr. Irwin, acknowledge that the College conducted an investigation bearing File Number 1106914 (the “Investigation”) into whether I engaged in professional misconduct and/or am incompetent.

(4) I, Dr. Irwin, acknowledge that, in addition to accepting this Undertaking, the College will also deliver a verbal caution in person.

B. UNDERTAKING

(5) I, Dr. Irwin, undertake to abide by the provisions of this Undertaking, effective immediately.

(6) Practice Restriction

a) I, Dr. Irwin, acknowledge that my practice is restricted to providing small surgical procedures requiring local anaesthesia and surgical consultations and that, for further specificity, I will not engage in any of the following areas of practice:

i) Primary Care.
ii) Palliative care.
iii) Chronic pain management.

(7) Resignation of Prescribing Privileges

(a) I, Dr. Irwin, acknowledge that I have executed the Prescribing Resignation Letter to Health Canada, which is attached hereto as Schedule “A” (the “Resignation Letter”).

(b) I, Dr. Irwin, consent to the College sending the Resignation Letter to Health Canada on my behalf.

(c) I, Dr. Irwin, undertake that I will not issue new prescriptions or renew existing prescriptions for or administer 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 Part G of the Food and Drug Regulations under the Food and Drugs Act, S.C., 1985, c. F-27);
(iv) Benzodiazepines and Other Targeted Substances (from the Benzodiazepines and Other Targeted Substances Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19);

(A summary of the above-named drugs [from Appendix I to the Compendium of Pharmaceuticals and Specialties] is attached hereto as Schedule “B”; and links to the current regulatory lists are attached hereto as Schedule “C”)

(v) Monitored Drugs (as defined under the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22, with a link to the current regulatory list attached hereto as Schedule “D”);

and as amended from time to time.

(d) I, Dr. Irwin, undertake to immediately notify my patients to whom I am prescribing any of the substances described in section 7(c), above of my prescribing restrictions and that they will require another physician for their assessment and care.

(e) I, Dr. Irwin, additionally undertake to make reasonable efforts to provide my patients to whom I am prescribing any of the substances described in section 7(c), above with a referral to another physician for assessment and care.

(f) I, Dr. Irwin, undertake to keep a log of all patients referenced in section (7)(d) above (the “Log”). I, Dr. Irwin, undertake to include in the Log details of all reasonable efforts I have made to refer the patient including, where applicable, the name of each patient referred, the name of the physician referred to, and the date of referral.

(g) I, Dr. Irwin, undertake that where a patient requires any of the substances described in section 7(c) above prior to or immediately following a small surgical procedure that I will perform, I will request that a colleague in the Clinic where I practice, or that the patient’s referring physician prescribe to this patient.

(8) I, Dr. Irwin, undertake that I will return any supplies of the substances referred to in section (7)(c) above that are presently in my possession, in any place, to a pharmacy in a safe and secure manner, as stipulated in the College’s Policy “Prescribing Drugs.”

(9) I, Dr. Irwin, undertake to inform the College of each and every location at which I practice, delegate, or have privileges, including, but not limited to, any hospitals, clinics, offices, and any Out-of-Hospital Premises and Independent Health Facilities with which I am affiliated, in any jurisdiction (collectively my “Practice Location” or “Practice Locations”), within five (5) days of executing this Undertaking. Going forward, I further undertake to inform the College of any and all new Practice Locations within five (5) days of commencing practice at that location.

(10) Posting a Sign

(a) I, Dr. Irwin, undertake that I shall post a sign in all waiting rooms and in each examination and consulting room, in all my Practice Locations, in a clearly visible and secure location, at all times whether or not I am physically present at the Practice Location, in the form set out at Schedule “E.” For further clarity, this sign shall state as follows:
IMPORTANT NOTICE

Dr. Irwin’s practice is restricted to providing small surgical procedures requiring local anesthesia and surgical consultations. For further clarity he does not practice any of the following: primary care, palliative care or chronic pain management.

Dr. Irwin has agreed not to prescribe or administer any of the following:

- Narcotic Drugs
- Narcotic Preparations
- Controlled Drugs
- Benzodiazepines and Other Targeted Substances
- Monitored Drugs

Further information may be found on the College of Physicians and Surgeons of Ontario website at www.cpso.on.ca

(b) I, Dr. Irwin, undertake to post a certified translation in any language in which I provide services, of the sign described in section (10)(a) above, in all waiting rooms and in each examination and consulting room, in all my Practice Locations, in a clearly visible and secure location, in the form set out at Schedule “E.”

(c) I, Dr. Irwin, undertake to provide the certified translation described in section (10)(b), to the College within thirty (30) days of executing this Undertaking.

(d) I, Dr. Irwin, undertake that if I elect, after the execution of this Undertaking, to provide services in any other language, I will notify the College prior to providing any such services.

(e) I, Dr. Irwin, undertake to provide to the College the certified translation described in section (10)(c) prior to beginning to provide services in any language described in section (10)(d).

C. ACKNOWLEDGEMENT

(11) I, Dr. Irwin, acknowledge that all schedules attached to or referred to in this Undertaking form part of this Undertaking.

(12) I, Dr. Irwin, acknowledge and undertake that I shall be solely responsible for payment of all fees, costs, charges, expenses, etc. arising from the implementation of any of the provisions of this Undertaking.

(13) I, Dr. Irwin, acknowledge that I have read and understand the provisions of this Undertaking and that I have obtained independent legal counsel in reviewing and executing this Undertaking, or have waived my right to do so.

(14) I, Dr. Irwin, acknowledge that the College will provide this Undertaking to any Chief of Staff, or a colleague with similar responsibilities, at any Practice Location (“Chief of Staff” or “Chiefs of Staff”).

(15) I, Dr. Irwin, acknowledge that a breach by me of any provision of this Undertaking may constitute an act of professional misconduct and/or incompetence, and may result in a referral of specified allegations to the Discipline Committee.

(16) I, Dr. Irwin, acknowledge that this Undertaking constitutes terms, conditions, and limitations on my certificate of registration for the purposes of section 23 of the Code.

(17) Public Register

(a) I, Dr. Irwin, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.

(b) I, Dr. Irwin, acknowledge that, in addition to this Undertaking being posted in accordance with section (17)(a) above, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:

A College investigation was conducted into whether Dr. Irwin engaged in professional misconduct and/or was incompetent in the practice. As a result of the investigation, in addition to the College delivering a verbal caution to Dr. Irwin:

Dr. Irwin’s practice is restricted to providing small surgical procedures requiring local anaesthesia and surgical consultations. For further clarity he does not practice any of the following: primary care, palliative care or chronic pain management.

Dr. Irwin must not issue new prescriptions or renew existing prescriptions for or administer 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 Part G of the Food and Drug Regulations under the Food and Drugs Act, S.C., 1985, c. F-27);
(iv) Benzodiazepines and Other Targeted Substances (from the Benzodiazepines and Other Targeted Substances Regulations made under the Controlled Drugs and Substances Act., S.C., 1996, c. 19);
(v) Monitored Drugs (as defined under the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22);

and as amended from time to time.

Dr. Irwin must post a clearly visible sign in the waiting rooms and each examination and consulting room, in all Practice Locations, which states as follows:

IMPORTANT NOTICE

Dr. Irwin’s practice is restricted to providing small surgical procedures requiring local anaesthesia and surgical consultations. For further clarity he does not practice any of the following: primary care, palliative care or chronic pain management.

Dr. Irwin has agreed not to prescribe or administer any of the following:

- Narcotic Drugs
- Narcotic Preparations
- Controlled Drugs
- Benzodiazepines and Other Targeted Substances
- Monitored Drugs

Further information may be found on the College of Physicians and Surgeons of Ontario website at www.cpso.on.ca

D. CONSENT

(18) I, Dr. Irwin, undertake that I will submit to, and not interfere with, unannounced inspections of my Practice Locations and patient charts by the College and to any other activity the College deems necessary in order to monitor my compliance with the provisions of this Undertaking.

(19) I, Dr. Irwin, give my irrevocable consent to the College to make appropriate enquiries of OHIP, NMS, and any person who or institution that may have relevant information, in order for the College to monitor my compliance with the provisions of this Undertaking.

(20) I, Dr. Irwin, acknowledge that I have executed the OHIP and NMS consent forms, attached hereto as Schedule “F” and Schedule “G”, respectively.

(21) I, Dr. Irwin, give my irrevocable consent to the College to provide all Chiefs of Staff with any information the College has that led to the circumstances of my entering into this Undertaking and any information arising from the monitoring of my compliance with this Undertaking.

Current Tribunal Proceedings

No information available

Past Tribunal Proceedings (1)

Date of Decision: 30 May 2018
Summary of Decision:
On May 30, 2018, the Discipline Committee found that Dr. Paul Maxwell Irwin committed an act of professional misconduct, in that he has failed to maintain the standard of practice of the profession. The Committee also found that Dr. Irwin is incompetent.

Dr. Irwin is a physician with a specialization in general surgery.

Cornwall Community Hospital Investigation

In 2014, the Hospital commenced an external review of Dr. Irwin’s surgical care of patients after concerns were raised regarding his clinical practice at the Hospital. In 2015, based on the results of the review indicating serious quality of care issues, the Medical Advisory Committee of the Hospital recommended that Dr. Irwin’s hospital privileges only be renewed if his practice was subject to a graduated return to practice under clinical supervision, and if he completed a six-month residency-type retraining program at a Canadian university centre in a surgical program approved by the hospital. While Dr. Irwin accepted the recommendation for a graduated return to practice under clinical supervision, he challenged the requirement for residency-type retraining. On March 30, 2016, the hospital’s Board of Directors upheld the requirement for the residency-type training as a condition of Dr. Irwin’s re-appointment.

In April 2015 the College commenced an investigation based upon the information it had received from the Hospital. An expert retained by the College reviewed a total of 36 charts of Dr. Irwin’s patients and found that Dr. Irwin fell below the standard of care in his care of 12 patients. The expert found “substantial deficits” in Dr. Irwin’s knowledge and judgment and noted that he was “extremely concerned with the patterns of practice” he observed. Regarding the 24 charts that did meet the standard, the expert noted that a significant number had minor issues such as violations of hospital booking policy and missing dictations.

Among the issues identified by the expert were the following:

- Incomplete medical records. Missing operative reports, missing discharge summaries or combined admission notes and discharge summaries usually indicating that these were not recorded contemporaneously.
- Unacceptable use of slang or colloquial terms in the medical record.
- Low threshold of operation. A number of cases were hastily taken to the operating room and would have benefited from more extensive preoperative work-up, further imaging and/or referral to colleagues experienced in alternative techniques.
- Multiple instances of incidental appendectomies and oophorectomies. Incidental appendectomies were historically practised but are rarely indicated in this era of advanced imaging and diagnostics. The frequency of incidental appendectomy was disconcerting in a small sample size of 36 cases and in one of the cases led to an appendiceal stump leak — this was significant in the patient's demise.
- Use of Demerol (meperidine). This medication has been removed from almost all hospital formularies and the indication for the medication is extremely limited. Dr. Irwin prescribed this medication in cases where better alternatives exist.
- Usage of antibiotics. Best Practices in General Surgery (BRIGS) has an Ontario based website that details optimal usage of antibiotics. Dr. Irwin's practice is at significant variance from the norm.
- Use of mesh in a potentially contaminated field. Use of polypropylene mesh is contraindicated in a field with open bowel. These cases reflect either a knowledge deficit or a cavalier attitude towards patient care.

Patient A

Dr. Irwin saw Patient A several times in 2013 and in 2014 performed surgery on Patient A to detach the damaged bowel. About a week following the surgery, Patient A developed abdominal pain and later had to undergo additional surgery which was performed by another physician.

In 2014, Patient A complained to the College that although Dr. Irwin was in charge of her care while she was in hospital, he failed to properly communicate with her and her family about her care. She said he visited her late in the evenings when she was on medication and did not answer her family’s questions or keep them informed.
 
An expert retained by the College to provide an opinion on Dr. Irwin’s care of Patient A reported that Dr. Irwin’s care of the patient fell below standard and demonstrated a lack of knowledge and judgment in that Dr. Irwin:

- failed to adequately justify the patient's need for colon and ovarian surgery;
- failed to disclose to the patient that she had both ovaries in situ identified on preoperative imaging
- failed to sufficiently document that he had informed, discussed and ensured that the patient had a reasonable understanding of her medical and surgical management;
- did not further investigate the patient's abdominal pain and constipation before embarking on surgery;
- failed to adequately investigate whether the right ovarian cyst was responsible for any of Patient A’s symptoms. At the minimum, he should have sought the opinion from a gynecologist prior to consenting her for an oophorectomy, especially as the CT showed both ovaries, one of which was documented to be normal;
- failed to display adequate judgment when he identified both ovaries intra-operatively and then proceeded to resect them. No evidence was found in the documentation aside from Dr. Irwin's own view that the patient requested to have both ovaries removed. Despite the patient's signed consent for the removal of one ovary, the expert did not believe that she was fully aware that the recommendation was for interval follow-up as per the radiologist. Prophylactic bilateral oophorectomies in premenopausal women have been associated with premature death, cardiovascular disease, cognitive decline and osteoporosis. Based on these facts the expert opined that Patient A’s bilateral salpingo- oophorectomy was not justified. The expert further opined Dr. Irwin's clinical practice in this case subjected the patient to colon and ovarian surgery that may not have been entirely necessary and that has resulted in complications and subsequent harm.

Dr. Irwin responded to the expert’s report stating that:

- his approach to diverticular disease is non-operative, but that in his clinical judgment the patient had more than simple diverticular changes;
- the patient consented and intended to have any remaining ovaries removed; and
- the patient was peri-menopausal, thus reducing the potential risks of a bilateral salpingo-oophorectomy.

Dr. Irwin acknowledged his deficiencies in documentation.

Upon review of Dr. Irwin’s response, which did not change his opinion, the expert noted that the response did not substantiate Dr. Irwin’s belief that the patient suffered from complicated diverticular disease, nor was there any documentation of a discussion with Patient A confirming the clear radiologic evidence that she had two ovaries, or that she understood the risks, benefits and expectations of bilateral oophorectomies. The expert expressed concern that Dr. Irwin’s comments reflected a lack of acknowledgement and lack of insight that an anastomatic leak was the cause of Patient A’s peritonitis and sepsis.

Out-of-Hospital Premises Inspection Investigation

In addition to his hospital practice, Dr. Irwin also worked at the Clinic in Ottawa where he performed endoscopies and administered sedation.

In December, 2015, during the College’s Out-of-Hospital Premises Inspection Program conducted at the Clinic, the physician assessor observed Dr. Irwin performing gastroscopies and colonoscopies and had concerns with his technique and skill. The Premises Inspection Committee issued a Fail to the Clinic where patient safety issues had been revealed. The Committee had serious concerns regarding the quality of care that Dr. Irwin provided to his patients and referred the matter to the Inquiries, Complaints and Reports Committee (the “ICRC’).

The expert retained by the College to provide an opinion on Dr. Irwin’s care of patients at the Clinic reviewed 10 patient charts and directly observed two endoscopic procedures. The expert concluded regarding the 10 charts reviewed that Dr. Irwin demonstrated a lack of knowledge, skill or judgment in his care of 8 patients, and failed to meet the standard of care in 3 patients. With respect to the two patients observed, the expert concluded that Dr. Irwin has several deficiencies in his skills. The expert reported the following:

Standard of care
- fails to meet the standard of care in terms of his charting and documentation
- fails to keep up to date regarding current endoscopic guidelines.
- screening, surveillance and follow up of abnormal pathology should follow some formal guidelines

Lack of knowledge, skill and judgment
- displays lack of judgment, skill and knowledge and needs to keep up to date regarding current endoscopic guidelines.
- screening, surveillance and follow up of abnormal pathology should follow some formal guidelines. For example, recommended guidelines for the surveillance of low grade dysplasia and Barrett's esophagus were not followed
- in patients with poor bowel preparation, and inadequate visualization, additional testing or a repeat colonoscopy with more aggressive bowel preparation should have been offered.

Harm or injury
- in reviewing Dr. Irwin's charts, it does not seem that the patients are at an increased risk of harm or injury. Documentation and organization is the main deficiency.
- Concerns about Dr. Irwin's endoscopic proficiency: noted deficiencies and lack of endoscopic skills, which may potentially place patients at risk by missing pathology and increasing the risk of complications.

Breach of ICRC Order Restricting Dr. Irwin’s Practice

On February 14, 2017, the ICRC ordered and directed the Registrar to impose terms, conditions and limitations on Dr. Irwin’s certificate of registration restricting his practice to providing small surgical procedures requiring local anaesthesia and surgical consultations and required that he practice with a clinical supervisor who will review a minimum of 20 charts per month.

On December 12, 2017, the ICRC amended the order, increasing the frequency and intensity of supervision based on information received by the College. Dr. Irwin was required to provide the College with the addresses of all his practice locations. Dr. Irwin did not advise the College that, in addition to practising at clinics in Ottawa and Akwesasne, he had a “home practice” which involved visiting approximately 10 patients in their home. Some of the care provided by Dr. Irwin to patients in Akwesasne and in the home visits exceeded the restrictions on his scope of practice. There is no evidence this care was otherwise inappropriate or below standard.

Past History

In January, 2005, the College received a complaint in relation to Dr. Irwin’s care of a patient who died following surgery he provided for resection of a cancerous tumour. The Complaints Committee noted that there was no record of Dr. Irwin performing a complete clinical examination of his patient before the operation and that a thorough pre-operative assessment of the lesion should have been done. The Committee cautioned Dr. Irwin to ensure that he conducts a complete and thorough evaluation of patients pre-operatively, so that he can obtain properly informed consent from the patient before proceeding with surgery.

In January 2011, the College received a complaint about the care provided to a patient who underwent excision of a neck lesion and supraclavicular nodes at the Hospital in late 2010. The complainant alleged that Dr. Irwin only obtained his consent for a biopsy of a lesion and excised the mass without consent. The Committee found that:
- there was considerable confusion in the clinical record regarding what consent was provided by the patient;
- Dr. Irwin did not document the consent discussion until after the surgical procedure had been performed;
- Dr. Irwin’s dictation of his operative note was not done until two months after the procedure and after - the patient had complained to the College; and
- Dr. Irwin’s operative note had virtually no detail.
 The Committee issued a written caution to Dr. Irwin on his poor consent process in the case, including his documentation of that process, and on his failure to ensure a timely dictation of his operative note. In addition, the Committee required that Dr. Irwin complete a specified continuing education or remediation program involving the following:
- a course on medical ethics and informed consent;
- educational sessions with a preceptor on charting and record-keeping; and
- a reassessment.

 In November of 2014, the College received a patient complaint regarding Dr. Irwin’s care provided in 1999 when he performed a gastroscopy, colonoscopy and incisional hernia repair at the Hospital.

Following the procedure, the patient developed sepsis and other complications. An expert opinion obtained by the College found Dr. Irwin’s care met the standard and did not demonstrate a lack of knowledge, skill or judgment. However, the ICRC concluded that Dr. Irwin did not meet the standard with respect to his decision to discharge the patient when there was evidence that clearly demonstrated a wound infection following the surgery. The Committee found that Dr. Irwin should have diagnosed a wound infection and that his discharge note indicating that there were no signs of wound infection and her white blood cell count was normal was inaccurate. The Committee issued advice to Dr. Irwin with respect to his postoperative wound management and assessment before discharge, particularly in patients with fever and elevated white blood count.

In March, 2015 the College received a complaint from a patient in relation to care he received from Dr. Irwin at the Hospital in 2012 when Dr. Irwin performed an elective anterior resection of his colon for diverticulitis. After the surgery, he developed sepsis and Dr. Irwin found an anastomotic leak and created a colostomy. Further complications arose thereafter. An expert opinion obtained by the College found Dr. Irwin’s care met the standard and did not demonstrate a lack of knowledge, skill or judgment, but did note that Dr. Irwin’s operating notes lacked detail. The ICRC agreed that Dr. Irwin’s documentation in the operative note lacked sufficient details, including details of the anastomosis and the consent discussion. It also concluded that there was an excessive delay in bringing the complainant back to the OR when he began to experience complications, particularly as he was high risk and should have been followed closely. The Committee issued advice to Dr. Irwin to:
- document thoroughly in the OR note;
- document the details of his consent discussion with patients; and
- ensure closer post-operative follow-up of high-risk patients, and noted that in this case there was excessive delay in returning the patient to the OR when the patient had concerning clinical signs of complication.

Disposition

On May 30, 2018, the Committee ordered and directed that:

- Dr. Irwin attend before the panel to be reprimanded.
- the Registrar suspend Dr. Irwin’s certificate of registration for a period of five (5) months commencing immediately.
- the Registrar impose the following terms, conditions and limitations on Dr. Irwin’s certificate of
- registration:

- Dr. Irwin’s practice is restricted to providing small surgical procedures requiring local anesthesia and surgical consultations.
- Dr. Irwin shall retain a College-approved clinical supervisor or supervisors (the “Clinical Supervisor”), who will sign an undertaking in the form attached hereto as Appendix “A.” [to the Order] For a period of at least six (6) months commencing on the date Dr. Irwin returns to practice following the suspension of his certificate of registration, Dr. Irwin may practise only under the supervision of the Clinical Supervisor and will abide by all recommendations of his Clinical Supervisor with respect to his practice, including but not limited to practice improvements, practice management and continuing education. Clinical supervision of Dr. Irwin’s practice may end after a minimum of six (6) months, only upon the recommendation of the Clinical Supervisor and, in its discretion, approval by the College. Clinical supervision of Dr. Irwin’s practice shall contain the following elements:
- The Clinical Supervisor will review a minimum of fifteen (15) of Dr. Irwin’s patient charts every two (2) weeks, which shall be drawn from both his surgical procedures and surgical consultation areas of practice if he has engaged in both areas of practice during the period
under review, and any other practice area if he has expanded his scope of practice in accordance with paragraph 5(xii) of this Order; and
- The Clinical Supervisor will meet with Dr. Irwin in person a minimum of once a month and will report to the College every month, or more frequently if there is a risk of harm or other concerns.

- The Clinical Supervisor will also facilitate the education program set out in the Individualized Education Plan (“IEP”) in the form attached hereto as Appendix “B” [to the Order].

- If Dr. Irwin fails to retain a Clinical Supervisor as required above or if, prior to completion of Clinical Supervision, the Clinical Supervisor is unable or unwilling to continue in that role for any reason, Dr. Irwin shall within twenty (20) days retain a new College-approved Clinical Supervisor who will sign an undertaking in the form attached hereto as Appendix “A,” and if he has not been able to do so within twenty (20) days he shall cease to practise until the same has been delivered to the College.

- Approximately six (6) months after the completion of Clinical Supervision, Dr. Irwin shall undergo a reassessment of his practice (the “Reassessment”) by a College-appointed assessor (the “Assessor”). The Reassessment may include a review of Dr. Irwin’s patient charts, direct observations and interviews with staff and/or patients, and any other tools deemed necessary by the College. The Reassessment shall be at Dr. Irwin’s expense and he shall co-operate with all elements of the Reassessment. Dr. Irwin shall abide by all recommendations made by the Assessor subject to paragraph 5(vi) below, and the results of the Reassessment will be reported to the College and may form the basis of further action by the College.
- If Dr. Irwin is of the view that any of the Assessor’s recommendations are unreasonable, he will - have fifteen (15) days following his receipt of the recommendations within which to provide the College with his submissions in this regard. The Inquiries Complaints and Reports (“ICR”) Committee will consider those submissions and make a determination regarding whether the recommendations are reasonable, and that decision will be provided to Dr. Irwin. Following that decision Dr. Irwin will abide by those recommendations of the Assessor that the ICR Committee has determined are reasonable
- Dr. Irwin shall consent to sharing of information among the Assessor, the Clinical Supervisor and the College, as any of them deem necessary or desirable in order to fulfill their respective obligations.
- Dr. Irwin shall inform the College of each and every location where he practises, in any jurisdiction (his “Practice Location(s)”) within fifteen (15) days of this Order and shall inform the College of any and all new Practice Locations within fifteen (15) days of commencing
practice at that location.
- Dr. Irwin shall cooperate with unannounced inspections of his practice and patient charts by a - College representative(s) for the purpose of monitoring and enforcing his compliance with the terms of this Order.
- Dr. Irwin shall consent to the College making appropriate enquiries of the Ontario Health - Insurance Plan and/or any person who or institution that may have relevant information, in order for the College to monitor and enforce his compliance with the terms of this Order.
- Dr. Irwin shall be responsible for any and all costs associated with implementing the terms of this Order.
- If Dr. Irwin wishes to expand his scope of practice, including to engage in general surgical - practice, general family medicine and/or palliative medicine, he will follow the College’s Policy on Ensuring Competence: Changing Scope of Practice and/or Re-entering Practice, a copy of which is attached hereto as Appendix “C” [to the Order], and must receive approval to expand his scope from the College in accordance with that policy.

- Dr. Irwin pay to the College costs in the amount of $10,180.00, in accordance with a payment plan approved by the College or, in the absence of such a plan, within thirty (30) days of the date of this Order.
 
Reasons for Decision: Download Full Decision (PDF)
Hearing Date(s): Hearing Dates: May 30, 2018

Other Notifications (4)

Source: Inquiries, Complaints and Reports Committee
Effective Date: 22 Jan 2022
Summary:
Caution-in-Person:
               
A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed.  A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee.  The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015, or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.

See PDF for the summary of a decision made against this member in which the disposition includes a Caution-in-Person:

Download Full Document (PDF)
Source: Member
Effective Date: 16 Jul 2021
Summary:
Summary of the Undertaking given by Dr. Paul Maxwell Irwin to the College of Physicians and Surgeons of Ontario, effective July 16, 2021:

A College investigation was conducted into whether Dr. Irwin engaged in professional misconduct and/or was incompetent in the practice.

As a result of the investigation, in addition to the College delivering a verbal caution to Dr. Irwin:

Dr. Irwin’s practice is restricted to providing small surgical procedures requiring local anaesthesia and surgical consultations. For further clarity he does not practice any of the following: primary care, palliative care or chronic pain management.

Dr. Irwin must not issue new prescriptions or renew existing prescriptions for or administer 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 Part G of the Food and Drug Regulations under the Food and Drugs Act, S.C., 1985, c. F-27);
(iv) Benzodiazepines and Other Targeted Substances (from the Benzodiazepines and Other Targeted Substances Regulations made under the Controlled Drugs and Substances Act., S.C., 1996, c. 19);
(v) Monitored Drugs (as defined under the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22);

and as amended from time to time.

Dr. Irwin must post a clearly visible sign in the waiting rooms and each examination and consulting room, in all Practice Locations, which states as follows:

IMPORTANT NOTICE

Dr. Irwin’s practice is restricted to providing small surgical procedures requiring local anaesthesia and surgical consultations. For further clarity he does not practice any of the following: primary care, palliative care or chronic pain management.

Dr. Irwin has agreed not to prescribe or administer any of the following:

- Narcotic Drugs
- Narcotic Preparations
- Controlled Drugs
- Benzodiazepines and Other Targeted Substances
- Monitored Drugs

Further information may be found on the College of Physicians and Surgeons of Ontario website at www.cpso.on.ca
 

Source: Inquiries, Complaints and Reports Committee
Effective Date: 22 Jan 2021
Summary:
Caution-in-Person:
               
A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed.  A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee.  The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015, or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.

See PDF for the summary of a decision made against this member in which the disposition includes a Caution-in-Person:

Download Full Document (PDF)
Source: Inquiries, Complaints and Reports Committee
Effective Date: 08 Jul 2020
Summary:
Caution-in-Person:
               
A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed.  A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee.  The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015, or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.

See PDF for the summary of a decision made against this member in which the disposition includes a Caution-in-Person:

Download Full Document (PDF)

Current Tribunal Proceedings

No information available

Past Tribunal Proceedings (1)

Date of Decision: 30 May 2018
Summary of Decision:
On May 30, 2018, the Discipline Committee found that Dr. Paul Maxwell Irwin committed an act of professional misconduct, in that he has failed to maintain the standard of practice of the profession. The Committee also found that Dr. Irwin is incompetent.

Dr. Irwin is a physician with a specialization in general surgery.

Cornwall Community Hospital Investigation

In 2014, the Hospital commenced an external review of Dr. Irwin’s surgical care of patients after concerns were raised regarding his clinical practice at the Hospital. In 2015, based on the results of the review indicating serious quality of care issues, the Medical Advisory Committee of the Hospital recommended that Dr. Irwin’s hospital privileges only be renewed if his practice was subject to a graduated return to practice under clinical supervision, and if he completed a six-month residency-type retraining program at a Canadian university centre in a surgical program approved by the hospital. While Dr. Irwin accepted the recommendation for a graduated return to practice under clinical supervision, he challenged the requirement for residency-type retraining. On March 30, 2016, the hospital’s Board of Directors upheld the requirement for the residency-type training as a condition of Dr. Irwin’s re-appointment.

In April 2015 the College commenced an investigation based upon the information it had received from the Hospital. An expert retained by the College reviewed a total of 36 charts of Dr. Irwin’s patients and found that Dr. Irwin fell below the standard of care in his care of 12 patients. The expert found “substantial deficits” in Dr. Irwin’s knowledge and judgment and noted that he was “extremely concerned with the patterns of practice” he observed. Regarding the 24 charts that did meet the standard, the expert noted that a significant number had minor issues such as violations of hospital booking policy and missing dictations.

Among the issues identified by the expert were the following:

- Incomplete medical records. Missing operative reports, missing discharge summaries or combined admission notes and discharge summaries usually indicating that these were not recorded contemporaneously.
- Unacceptable use of slang or colloquial terms in the medical record.
- Low threshold of operation. A number of cases were hastily taken to the operating room and would have benefited from more extensive preoperative work-up, further imaging and/or referral to colleagues experienced in alternative techniques.
- Multiple instances of incidental appendectomies and oophorectomies. Incidental appendectomies were historically practised but are rarely indicated in this era of advanced imaging and diagnostics. The frequency of incidental appendectomy was disconcerting in a small sample size of 36 cases and in one of the cases led to an appendiceal stump leak — this was significant in the patient's demise.
- Use of Demerol (meperidine). This medication has been removed from almost all hospital formularies and the indication for the medication is extremely limited. Dr. Irwin prescribed this medication in cases where better alternatives exist.
- Usage of antibiotics. Best Practices in General Surgery (BRIGS) has an Ontario based website that details optimal usage of antibiotics. Dr. Irwin's practice is at significant variance from the norm.
- Use of mesh in a potentially contaminated field. Use of polypropylene mesh is contraindicated in a field with open bowel. These cases reflect either a knowledge deficit or a cavalier attitude towards patient care.

Patient A

Dr. Irwin saw Patient A several times in 2013 and in 2014 performed surgery on Patient A to detach the damaged bowel. About a week following the surgery, Patient A developed abdominal pain and later had to undergo additional surgery which was performed by another physician.

In 2014, Patient A complained to the College that although Dr. Irwin was in charge of her care while she was in hospital, he failed to properly communicate with her and her family about her care. She said he visited her late in the evenings when she was on medication and did not answer her family’s questions or keep them informed.
 
An expert retained by the College to provide an opinion on Dr. Irwin’s care of Patient A reported that Dr. Irwin’s care of the patient fell below standard and demonstrated a lack of knowledge and judgment in that Dr. Irwin:

- failed to adequately justify the patient's need for colon and ovarian surgery;
- failed to disclose to the patient that she had both ovaries in situ identified on preoperative imaging
- failed to sufficiently document that he had informed, discussed and ensured that the patient had a reasonable understanding of her medical and surgical management;
- did not further investigate the patient's abdominal pain and constipation before embarking on surgery;
- failed to adequately investigate whether the right ovarian cyst was responsible for any of Patient A’s symptoms. At the minimum, he should have sought the opinion from a gynecologist prior to consenting her for an oophorectomy, especially as the CT showed both ovaries, one of which was documented to be normal;
- failed to display adequate judgment when he identified both ovaries intra-operatively and then proceeded to resect them. No evidence was found in the documentation aside from Dr. Irwin's own view that the patient requested to have both ovaries removed. Despite the patient's signed consent for the removal of one ovary, the expert did not believe that she was fully aware that the recommendation was for interval follow-up as per the radiologist. Prophylactic bilateral oophorectomies in premenopausal women have been associated with premature death, cardiovascular disease, cognitive decline and osteoporosis. Based on these facts the expert opined that Patient A’s bilateral salpingo- oophorectomy was not justified. The expert further opined Dr. Irwin's clinical practice in this case subjected the patient to colon and ovarian surgery that may not have been entirely necessary and that has resulted in complications and subsequent harm.

Dr. Irwin responded to the expert’s report stating that:

- his approach to diverticular disease is non-operative, but that in his clinical judgment the patient had more than simple diverticular changes;
- the patient consented and intended to have any remaining ovaries removed; and
- the patient was peri-menopausal, thus reducing the potential risks of a bilateral salpingo-oophorectomy.

Dr. Irwin acknowledged his deficiencies in documentation.

Upon review of Dr. Irwin’s response, which did not change his opinion, the expert noted that the response did not substantiate Dr. Irwin’s belief that the patient suffered from complicated diverticular disease, nor was there any documentation of a discussion with Patient A confirming the clear radiologic evidence that she had two ovaries, or that she understood the risks, benefits and expectations of bilateral oophorectomies. The expert expressed concern that Dr. Irwin’s comments reflected a lack of acknowledgement and lack of insight that an anastomatic leak was the cause of Patient A’s peritonitis and sepsis.

Out-of-Hospital Premises Inspection Investigation

In addition to his hospital practice, Dr. Irwin also worked at the Clinic in Ottawa where he performed endoscopies and administered sedation.

In December, 2015, during the College’s Out-of-Hospital Premises Inspection Program conducted at the Clinic, the physician assessor observed Dr. Irwin performing gastroscopies and colonoscopies and had concerns with his technique and skill. The Premises Inspection Committee issued a Fail to the Clinic where patient safety issues had been revealed. The Committee had serious concerns regarding the quality of care that Dr. Irwin provided to his patients and referred the matter to the Inquiries, Complaints and Reports Committee (the “ICRC’).

The expert retained by the College to provide an opinion on Dr. Irwin’s care of patients at the Clinic reviewed 10 patient charts and directly observed two endoscopic procedures. The expert concluded regarding the 10 charts reviewed that Dr. Irwin demonstrated a lack of knowledge, skill or judgment in his care of 8 patients, and failed to meet the standard of care in 3 patients. With respect to the two patients observed, the expert concluded that Dr. Irwin has several deficiencies in his skills. The expert reported the following:

Standard of care
- fails to meet the standard of care in terms of his charting and documentation
- fails to keep up to date regarding current endoscopic guidelines.
- screening, surveillance and follow up of abnormal pathology should follow some formal guidelines

Lack of knowledge, skill and judgment
- displays lack of judgment, skill and knowledge and needs to keep up to date regarding current endoscopic guidelines.
- screening, surveillance and follow up of abnormal pathology should follow some formal guidelines. For example, recommended guidelines for the surveillance of low grade dysplasia and Barrett's esophagus were not followed
- in patients with poor bowel preparation, and inadequate visualization, additional testing or a repeat colonoscopy with more aggressive bowel preparation should have been offered.

Harm or injury
- in reviewing Dr. Irwin's charts, it does not seem that the patients are at an increased risk of harm or injury. Documentation and organization is the main deficiency.
- Concerns about Dr. Irwin's endoscopic proficiency: noted deficiencies and lack of endoscopic skills, which may potentially place patients at risk by missing pathology and increasing the risk of complications.

Breach of ICRC Order Restricting Dr. Irwin’s Practice

On February 14, 2017, the ICRC ordered and directed the Registrar to impose terms, conditions and limitations on Dr. Irwin’s certificate of registration restricting his practice to providing small surgical procedures requiring local anaesthesia and surgical consultations and required that he practice with a clinical supervisor who will review a minimum of 20 charts per month.

On December 12, 2017, the ICRC amended the order, increasing the frequency and intensity of supervision based on information received by the College. Dr. Irwin was required to provide the College with the addresses of all his practice locations. Dr. Irwin did not advise the College that, in addition to practising at clinics in Ottawa and Akwesasne, he had a “home practice” which involved visiting approximately 10 patients in their home. Some of the care provided by Dr. Irwin to patients in Akwesasne and in the home visits exceeded the restrictions on his scope of practice. There is no evidence this care was otherwise inappropriate or below standard.

Past History

In January, 2005, the College received a complaint in relation to Dr. Irwin’s care of a patient who died following surgery he provided for resection of a cancerous tumour. The Complaints Committee noted that there was no record of Dr. Irwin performing a complete clinical examination of his patient before the operation and that a thorough pre-operative assessment of the lesion should have been done. The Committee cautioned Dr. Irwin to ensure that he conducts a complete and thorough evaluation of patients pre-operatively, so that he can obtain properly informed consent from the patient before proceeding with surgery.

In January 2011, the College received a complaint about the care provided to a patient who underwent excision of a neck lesion and supraclavicular nodes at the Hospital in late 2010. The complainant alleged that Dr. Irwin only obtained his consent for a biopsy of a lesion and excised the mass without consent. The Committee found that:
- there was considerable confusion in the clinical record regarding what consent was provided by the patient;
- Dr. Irwin did not document the consent discussion until after the surgical procedure had been performed;
- Dr. Irwin’s dictation of his operative note was not done until two months after the procedure and after - the patient had complained to the College; and
- Dr. Irwin’s operative note had virtually no detail.
 The Committee issued a written caution to Dr. Irwin on his poor consent process in the case, including his documentation of that process, and on his failure to ensure a timely dictation of his operative note. In addition, the Committee required that Dr. Irwin complete a specified continuing education or remediation program involving the following:
- a course on medical ethics and informed consent;
- educational sessions with a preceptor on charting and record-keeping; and
- a reassessment.

 In November of 2014, the College received a patient complaint regarding Dr. Irwin’s care provided in 1999 when he performed a gastroscopy, colonoscopy and incisional hernia repair at the Hospital.

Following the procedure, the patient developed sepsis and other complications. An expert opinion obtained by the College found Dr. Irwin’s care met the standard and did not demonstrate a lack of knowledge, skill or judgment. However, the ICRC concluded that Dr. Irwin did not meet the standard with respect to his decision to discharge the patient when there was evidence that clearly demonstrated a wound infection following the surgery. The Committee found that Dr. Irwin should have diagnosed a wound infection and that his discharge note indicating that there were no signs of wound infection and her white blood cell count was normal was inaccurate. The Committee issued advice to Dr. Irwin with respect to his postoperative wound management and assessment before discharge, particularly in patients with fever and elevated white blood count.

In March, 2015 the College received a complaint from a patient in relation to care he received from Dr. Irwin at the Hospital in 2012 when Dr. Irwin performed an elective anterior resection of his colon for diverticulitis. After the surgery, he developed sepsis and Dr. Irwin found an anastomotic leak and created a colostomy. Further complications arose thereafter. An expert opinion obtained by the College found Dr. Irwin’s care met the standard and did not demonstrate a lack of knowledge, skill or judgment, but did note that Dr. Irwin’s operating notes lacked detail. The ICRC agreed that Dr. Irwin’s documentation in the operative note lacked sufficient details, including details of the anastomosis and the consent discussion. It also concluded that there was an excessive delay in bringing the complainant back to the OR when he began to experience complications, particularly as he was high risk and should have been followed closely. The Committee issued advice to Dr. Irwin to:
- document thoroughly in the OR note;
- document the details of his consent discussion with patients; and
- ensure closer post-operative follow-up of high-risk patients, and noted that in this case there was excessive delay in returning the patient to the OR when the patient had concerning clinical signs of complication.

Disposition

On May 30, 2018, the Committee ordered and directed that:

- Dr. Irwin attend before the panel to be reprimanded.
- the Registrar suspend Dr. Irwin’s certificate of registration for a period of five (5) months commencing immediately.
- the Registrar impose the following terms, conditions and limitations on Dr. Irwin’s certificate of
- registration:

- Dr. Irwin’s practice is restricted to providing small surgical procedures requiring local anesthesia and surgical consultations.
- Dr. Irwin shall retain a College-approved clinical supervisor or supervisors (the “Clinical Supervisor”), who will sign an undertaking in the form attached hereto as Appendix “A.” [to the Order] For a period of at least six (6) months commencing on the date Dr. Irwin returns to practice following the suspension of his certificate of registration, Dr. Irwin may practise only under the supervision of the Clinical Supervisor and will abide by all recommendations of his Clinical Supervisor with respect to his practice, including but not limited to practice improvements, practice management and continuing education. Clinical supervision of Dr. Irwin’s practice may end after a minimum of six (6) months, only upon the recommendation of the Clinical Supervisor and, in its discretion, approval by the College. Clinical supervision of Dr. Irwin’s practice shall contain the following elements:
- The Clinical Supervisor will review a minimum of fifteen (15) of Dr. Irwin’s patient charts every two (2) weeks, which shall be drawn from both his surgical procedures and surgical consultation areas of practice if he has engaged in both areas of practice during the period
under review, and any other practice area if he has expanded his scope of practice in accordance with paragraph 5(xii) of this Order; and
- The Clinical Supervisor will meet with Dr. Irwin in person a minimum of once a month and will report to the College every month, or more frequently if there is a risk of harm or other concerns.

- The Clinical Supervisor will also facilitate the education program set out in the Individualized Education Plan (“IEP”) in the form attached hereto as Appendix “B” [to the Order].

- If Dr. Irwin fails to retain a Clinical Supervisor as required above or if, prior to completion of Clinical Supervision, the Clinical Supervisor is unable or unwilling to continue in that role for any reason, Dr. Irwin shall within twenty (20) days retain a new College-approved Clinical Supervisor who will sign an undertaking in the form attached hereto as Appendix “A,” and if he has not been able to do so within twenty (20) days he shall cease to practise until the same has been delivered to the College.

- Approximately six (6) months after the completion of Clinical Supervision, Dr. Irwin shall undergo a reassessment of his practice (the “Reassessment”) by a College-appointed assessor (the “Assessor”). The Reassessment may include a review of Dr. Irwin’s patient charts, direct observations and interviews with staff and/or patients, and any other tools deemed necessary by the College. The Reassessment shall be at Dr. Irwin’s expense and he shall co-operate with all elements of the Reassessment. Dr. Irwin shall abide by all recommendations made by the Assessor subject to paragraph 5(vi) below, and the results of the Reassessment will be reported to the College and may form the basis of further action by the College.
- If Dr. Irwin is of the view that any of the Assessor’s recommendations are unreasonable, he will - have fifteen (15) days following his receipt of the recommendations within which to provide the College with his submissions in this regard. The Inquiries Complaints and Reports (“ICR”) Committee will consider those submissions and make a determination regarding whether the recommendations are reasonable, and that decision will be provided to Dr. Irwin. Following that decision Dr. Irwin will abide by those recommendations of the Assessor that the ICR Committee has determined are reasonable
- Dr. Irwin shall consent to sharing of information among the Assessor, the Clinical Supervisor and the College, as any of them deem necessary or desirable in order to fulfill their respective obligations.
- Dr. Irwin shall inform the College of each and every location where he practises, in any jurisdiction (his “Practice Location(s)”) within fifteen (15) days of this Order and shall inform the College of any and all new Practice Locations within fifteen (15) days of commencing
practice at that location.
- Dr. Irwin shall cooperate with unannounced inspections of his practice and patient charts by a - College representative(s) for the purpose of monitoring and enforcing his compliance with the terms of this Order.
- Dr. Irwin shall consent to the College making appropriate enquiries of the Ontario Health - Insurance Plan and/or any person who or institution that may have relevant information, in order for the College to monitor and enforce his compliance with the terms of this Order.
- Dr. Irwin shall be responsible for any and all costs associated with implementing the terms of this Order.
- If Dr. Irwin wishes to expand his scope of practice, including to engage in general surgical - practice, general family medicine and/or palliative medicine, he will follow the College’s Policy on Ensuring Competence: Changing Scope of Practice and/or Re-entering Practice, a copy of which is attached hereto as Appendix “C” [to the Order], and must receive approval to expand his scope from the College in accordance with that policy.

- Dr. Irwin pay to the College costs in the amount of $10,180.00, in accordance with a payment plan approved by the College or, in the absence of such a plan, within thirty (30) days of the date of this Order.
 
Reasons for Decision: Download Full Decision (PDF)
Hearing Date(s): Hearing Dates: May 30, 2018

Other Notifications (4)

Source: Inquiries, Complaints and Reports Committee
Effective Date: 22 Jan 2022
Summary:
Caution-in-Person:
               
A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed.  A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee.  The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015, or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.

See PDF for the summary of a decision made against this member in which the disposition includes a Caution-in-Person:

Download Full Document (PDF)
Source: Member
Effective Date: 16 Jul 2021
Summary:
Summary of the Undertaking given by Dr. Paul Maxwell Irwin to the College of Physicians and Surgeons of Ontario, effective July 16, 2021:

A College investigation was conducted into whether Dr. Irwin engaged in professional misconduct and/or was incompetent in the practice.

As a result of the investigation, in addition to the College delivering a verbal caution to Dr. Irwin:

Dr. Irwin’s practice is restricted to providing small surgical procedures requiring local anaesthesia and surgical consultations. For further clarity he does not practice any of the following: primary care, palliative care or chronic pain management.

Dr. Irwin must not issue new prescriptions or renew existing prescriptions for or administer 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 Part G of the Food and Drug Regulations under the Food and Drugs Act, S.C., 1985, c. F-27);
(iv) Benzodiazepines and Other Targeted Substances (from the Benzodiazepines and Other Targeted Substances Regulations made under the Controlled Drugs and Substances Act., S.C., 1996, c. 19);
(v) Monitored Drugs (as defined under the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22);

and as amended from time to time.

Dr. Irwin must post a clearly visible sign in the waiting rooms and each examination and consulting room, in all Practice Locations, which states as follows:

IMPORTANT NOTICE

Dr. Irwin’s practice is restricted to providing small surgical procedures requiring local anaesthesia and surgical consultations. For further clarity he does not practice any of the following: primary care, palliative care or chronic pain management.

Dr. Irwin has agreed not to prescribe or administer any of the following:

- Narcotic Drugs
- Narcotic Preparations
- Controlled Drugs
- Benzodiazepines and Other Targeted Substances
- Monitored Drugs

Further information may be found on the College of Physicians and Surgeons of Ontario website at www.cpso.on.ca
 

Source: Inquiries, Complaints and Reports Committee
Effective Date: 22 Jan 2021
Summary:
Caution-in-Person:
               
A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed.  A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee.  The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015, or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.

See PDF for the summary of a decision made against this member in which the disposition includes a Caution-in-Person:

Download Full Document (PDF)
Source: Inquiries, Complaints and Reports Committee
Effective Date: 08 Jul 2020
Summary:
Caution-in-Person:
               
A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed.  A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee.  The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015, or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.

See PDF for the summary of a decision made against this member in which the disposition includes a Caution-in-Person:

Download Full Document (PDF)

Training

Medical School: Queen's University, 1986

Registration History

DETAILS DATE
Terms and conditions amended by Member. Effective: 16 Jul 2021
Terms and conditions amended by Member. Effective: 02 Feb 2021
Terms and conditions amended by Member. Effective: 01 Nov 2018
Terms and conditions amended by Member. Effective: 31 Oct 2018
Suspension of registration removed. Effective: 30 Oct 2018
Terms and conditions amended by Discipline Committee. Effective: 30 May 2018
Terms and conditions amended by Inquiries, Complaints and Reports Committee. Effective: 15 Dec 2017
Transfer of class of registration to: Restricted Certificate Effective: 18 Feb 2017
Arrow_iconTerms and conditions imposed on certificate by: Inquiries, Complaints and Reports Committee Effective: 18 Feb 2017
Transfer of class of registration to: Independent Practice Certificate Effective: 13 Mar 1989
First certificate of registration issued: Postgraduate Education Certificate Effective: 01 Jul 1986
DETAILS: Terms and conditions amended by Member.
Date: Effective: 16 Jul 2021
DETAILS: Terms and conditions amended by Member.
Date: Effective: 02 Feb 2021
DETAILS: Terms and conditions amended by Member.
Date: Effective: 01 Nov 2018
DETAILS: Terms and conditions amended by Member.
Date: Effective: 31 Oct 2018
DETAILS: Suspension of registration removed.
Date: Effective: 30 Oct 2018
DETAILS: Terms and conditions amended by Discipline Committee.
Date: Effective: 30 May 2018
DETAILS: Terms and conditions amended by Inquiries, Complaints and Reports Committee.
Date: Effective: 15 Dec 2017
DETAILS: Transfer of class of registration to: Restricted Certificate
Date: Effective: 18 Feb 2017
DETAILS: Terms and conditions imposed on certificate by: Inquiries, Complaints and Reports Committee
Date: Effective: 18 Feb 2017
DETAILS: Transfer of class of registration to: Independent Practice Certificate
Date: Effective: 13 Mar 1989
DETAILS: First certificate of registration issued: Postgraduate Education Certificate
Date: Effective: 01 Jul 1986