On June 18, 2019, the Discipline Committee found that Dr. Frederick Thomas Bray committed an act of professional misconduct in that: he has engaged in an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, and has failed to maintain the standard of practice of the profession.
Dr. Bray received his medical degree at the McGill University in 1989. He received his certificate of registration authorizing independent practice in Ontario in 1992. Dr. Bray received his specialist qualification in internal medicine in 1993 and in gastroenterology in 2000.
At the relevant times, Dr. Bray was the sole physician and the Medical Director of an Out-of-Hospital Premises (“OHP”), operating as “Frederick T. Bray Professional Medicine Corporation” in Ottawa, Ontario, providing gastroenterology services.
Overview of the Case
The Out-of-Hospital Premises Inspection Program, “OHPIP”, is administered by the College and applies to all premises outside a hospital (“OHP premises”) that perform procedures involving the use of anesthesia or sedation as defined in O.Reg. 114/94, made under the Medicine Act, 1991, (“the Regulation”). Part XI of the Regulation sets out the definition of “procedure” for the purposes of the OHPIP. The OHP program is based on trust and relies on self-reporting from Medical Directors and physicians.
Mandatory standards for OHP premises are set out in Program Standards (“the Standards”), authorized under the Regulation. Pursuant to Standard 2.2, the Medical Director of an OHP is responsible for the duties outlined in the Standards. In order to ensure patient safety and quality of care, strict adherence is required to the detailed requirements set out in the Standards.
As set out Standard 3.2, “Anesthesia”, medications producing “deep sedation”, including propofol, “must be administered by a physician qualified to provide deep sedation”. This point is further clarified in Standard 5.3 that states that general anesthesia can only be administered by an anesthesiologist.
By letter dated May 17, 2016, sent to all Medical Directors of OHPs, including Dr. Bray, Dr. Steven Bodley, then-chair of the Premises Inspection Committee (“PIC”), reminded Medical Directors that OHP Standard 3.2 required that only a qualified anesthesiologist is permitted to administer propofol.
Disgraceful, Dishonourable or Unprofessional Conduct
In contravention of Program Standards and his duties as Medical Director, Dr. Bray administered propofol to patients, in the absence of an anesthesiologist or any other physician qualified to administer propofol in accordance with the Standards.
On July 19, 2017, the OHPIP conducted an inspection-assessment of Dr. Bray’s OHP. The inspection–assessment included a review of the premises’ controlled substances storage and included review of the care provided by the premises to sedated patients. Dr. Bray did not advise the assessors that he was using propofol despite the fact that the assessors reviewed his practices and procedures around sedation and controlled substances.
The College became aware of Dr. Bray’s use of propofol through an anonymous report made to the College on August 3, 2017. As a result of the report, the College conducted an unannounced visit on August 24, 2017, and verified that Dr. Bray was administering propofol to patients without an anesthesiologist.
Twenty-five (25) patient charts were obtained in the College investigation. The charts were reviewed by an expert retained by the College, Dr. Ted Xenodemetropoulos, a gastroenterologist. As set out in Dr. Xenodemetropoulos’ report, Dr. Bray administered propofol to eleven (11) patients in contravention of Program Standards, in the absence of an anesthesiologist.
Failure to Maintain Standard of Practice
In respect of the eleven (11) patients to whom propofol was administered by Dr. Bray in the absence of an anesthesiologist, Dr. Xenodemetropoulos opined that Dr. Bray failed to maintain the standard of practice in his administration of intravenous propofol as additional sedation during procedures and displayed a moderate lack of judgment both in his role as Medical Director of the OHP and as most responsible physician to the patients in question.
Dr. Xenodemetropoulos concluded that Dr. Bray’s use of propofol did not result in an increased risk of harm or injury in a sedation-related adverse event to the patients.
Admission
Dr. Bray admits the facts specified above, and admits that, based on these facts, he engaged in professional misconduct:
(a) engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional; and
(b) he has failed to maintain the standard of practice of the profession.
Disposition
On June 18, 2019, the Committee ordered that:
- The Registrar suspend Dr. Bray’s certificate of registration for a period of 4 months.
- Dr. Bray attend before the panel to be reprimanded.
- Dr. Bray pay costs to the College in the amount of $6000.00
Terms and conditions imposed on certificate by: Member
