On July 25, 2014, the Discipline Committee found that Dr. Haines 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 sixteen patients. Dr. Haines admitted to the allegation.
The College began an investigation into Dr. Haines’ practice following the receipt of information from the Office of the Chief Coroner for Ontario regarding the death of one of his patients. The cause of the patient’s death was determined to be Oxycodone toxicity.
As part of its investigation, the College retained a medical inspector, Dr. X. Dr. X reviewed the charts of 25 of Dr. Haines’ patients. The patients whose charts were reviewed had all been treated with pain control medications for chronic pain due to various causes and clinical backgrounds.
Dr. X noted that Dr. Haines’ charts were generally clear to read, organized and reflected genuine concern by Dr. Haines for his patients. Nonetheless, Dr. X opined that certain concerning issues recurred a number of times in Dr. Haines’ practice. The areas of concern identified by Dr. X were as follows:
• There were ongoing prescriptions for opiates and benzodiazepines in patients a) with substance abuse problems as proven by urine drug testing; or b) with written concerns by other doctors who saw these patients and advised that prescribing such medications was likely causing problems for the patients. The office records did not address such concerns.
• Combining high dose opiates and benzodiazepines. This combination is known to be a factor in opiate related deaths.
• Prescribing multiple opiates and multiple benzodiazepines simultaneously. This increases the risk of adverse effects without potential benefit.
• Two patients were given on-going prescriptions for opiates without any office assessment for over a year.
• Many patients had blood cholesterol testing, however Dr. X did not find any chart using the cholesterol results to calculate the patient’s heart risk – the “Framingham risk score”. Such a risk calculation is needed to establish the need for medication and treatment goals. Similarly, two patients with heart disease had cholesterol (LDL) levels above target.
• There was a lack of screening for colon cancer. Many patients came in for an Annual Health Exam and some had colonoscopy exams. Dr. X did not find any home kit Fecal Occult Blood Testing results. The standard of care in Ontario now is to utilize this test widely in patients over 50.
With respect to the specific patient who was the subject of the coroner’s report, Dr. X opined that Dr. Haines did not meet standard of care, demonstrated a lack of skill and knowledge, and that it is probably a danger to safety in combining benzodiazepines with moderately high opiate dosing in patient who could unpredictably take other illicit drugs and who has shown significant impulsivity in overdosing.
Overall, Dr. X concluded that the care provided in 16 of the 25 charts reviewed did not meet the standard of practice of the profession and demonstrated a lack of knowledge, skill or judgment. Dr. X also concluded that Dr. Haines’ care in 10 of the charts exposed patients to potential harm or injury, ranging from mild or minimal danger to serious safety concerns.
Dr. Haines entered into an undertaking in response to the College’s concern to protect the public. Further to the undertaking, Dr. Haines was required, among other things, to practice under the guidance of a clinical supervisor acceptable to the College. Dr. Haines supervisor consistently indicated in his monthly reports to the College that he has identified no material deficiencies with respect to Dr. Haines’ standard of practice.
After learning of the College’s investigation, Dr. Haines took steps at his own initiative to update his medical knowledge and his prescribing practices in respect of narcotics. In addition, throughout 2013, Dr. Haines completed several continuing medical education programs, targeted at addressing deficiencies identified by Dr. X specifically, as well as reviewing family medicine issues generally.
Following an interview, Dr. X made a number of observations about Dr. Haines’ generally heightened knowledge and skill, and also highlighted the various improvements in Dr. Haines’ practice.
The Committee ordered and directed that:
• the Registrar impose the following terms, conditions and limitations on Dr. Haines’ certificate of registration:
a) Dr. Haines, at his own expense, to submit to an assessment of his practice by an assessor selected by the College approximately twelve months after the date of this order. The assessment shall pertain to Dr. Haines’ practice overall, with a specific focus upon the areas of concern outlined in the reports of Dr. X including safe prescribing and overall preventative care. The reassessment shall include, at minimum, a full day direct observation component.
b) Dr. Haines shall abide by the reasonable recommendations made by the Assessor. Dr. Haines shall be permitted to make written submissions on his own behalf within 30 days of receipt of the assessment to the Inquiries, Complaints and Reports Committee. The Inquiries, Complaints and Reports Committee may or may not vary the recommendations of the Assessor upon receipt of Dr. Haines’ written submissions. Any recommendations accepted by the Inquiries, Complaints and Reports Committee that are limitation(s) or restriction(s) shall constitute terms, conditions or limitations on Dr. Haines’s Certificate of Registration and shall be included on the public register.
• Dr. Haines appear before the panel to be reprimanded.
• Dr. Haines pay costs to the College in the amount of $4,460.00, within 60 days of the date of this Order.
Terms and conditions imposed on certificate by: Discipline Committee
