On October 17, 2019, the Discipline Committee found that Dr. Howard Wu committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession in his care of patients; he 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; he has been found guilty of an offence that is relevant to his suitability to practise; and he has had a conflict of interest. The Discipline Committee also found that Dr. Wu is incompetent.
Dr. Wu is a 50 year-old family physician who received his certificate of registration authorizing independent practice from the College of Physicians and Surgeons of Ontario in June 1997. He completed his medical degree at Queen’s University in 1994, and his postgraduate training in family medicine through the University of Toronto in 1997. At the relevant time, Dr. Wu practised family medicine in Markham, Ontario at the Smart Health Medical Clinic.
Registrar’s Investigation re Death of Patient A
On June 3, 2016, the College received a letter from the Chief Coroner for Ontario describing concerns about the care and treatment that Dr. Wu provided to Patient A in November and December 2015, specifically regarding Dr. Wu’s approach to medical assessment and care of a febrile neonate (a newborn with a fever). Patient A died on December 3, 2015 in hospital of E.coli sepsis due to meningitis.
He was 19 days old.
The College appointed investigators on June 23, 2016. A physician was retained as a medical inspector to provide an independent opinion regarding Dr. Wu’s care of Patient A. The medical inspector interviewed Dr. Wu, and reviewed Dr. Wu’s office chart as well as hospital and ER records.
In his report, dated September 28, 2016, the medical inspector opined that the care Dr. Wu provided to Patient A did not meet the standard of practice of the profession and displayed a lack of knowledge, skill, and judgment. The medical inspector was concerned regarding Dr. Wu’s chart note that he recommended the patient, a newborn, be given water and vitamin C-rich juice when he saw him on November 25, 2015. The infant’s elevated temperature reported in the subjective notes on that date was concerning and Dr. Wu should have recommended the mother bring her son to hospital immediately. On a subsequent visit two days later, the temperature was still elevated at 37.4°C and the inappropriate recommendation to add water was repeated in the chart. Dr. Wu also used an infrared thermometer to measure body temperature in the context of evaluating a potentially critical illness, which is not recommended. The medical inspector further opined that Dr. Wu’s clinical practice, behaviour or conduct exposed or was likely to expose newborn patients to harm or injury.
Dr. Wu failed to maintain the standard of practice of the profession and was incompetent in respect of his care and treatment of Patient A.
Registrar’s Investigation re Medical Devices
Sun Life Assurance Company of Canada (“Sun Life”) wrote to the College expressing concern regarding Dr. Wu’s completion of medical supply claims. Sun Life had received a “very high quantity of medical supply claims bearing referrals” from Dr. Wu, and, because it suspected there was no medical necessity
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underlying the claims, Sun Life had requested medical notes from the patients. Upon review, as noted by a Sun Life medical consultant, the clinical notes were all in the same format and cited similar complaints, stated that investigation had been refused by the patient, and contained identical treatment plans. There was no medical support for prescription of the devices. Sun Life also noted connections between Dr. Wu and the medical supplier, Health A. Smart Wellness Centre (also known as ‘Health Aid’), namely that Dr. Wu’s administrator was a director of the wellness centre.
College investigators were appointed as a result, and another physician was retained as the second medical inspector. She reviewed patient charts from Dr. Wu’s office and corresponding information from Sun Life, and interviewed Dr. Wu.
Dr. Wu does not admit but does not contest that, as he stated in his interview with the second medical inspector, he received financial compensation in respect of the patients to whom he prescribed the medical devices from the wellness centre that supplied the devices:
- the proprietor of the wellness centre had access to Dr. Wu’s computer system;
- the wellness centre would schedule patients for Dr. Wu to see;
- he prescribed those patients braces and other medical devices;
- this took place between 2011 and 2015;
- he was paid $100 per patient per year for every patient to whom he prescribed medical devices and referred to the wellness centre next door.
As the second medical inspector found, Dr. Wu failed to maintain the standard of practice of the profession in his care and treatment of nineteen patients (i.e. all of the patient charts reviewed by the second medical inspector) presenting with musculoskeletal complaints who were referred to him from the wellness centre next door, for example in the use of multiple bracing at a single visit or over several visits in a short period of time, lack of investigations, and lack of follow-up. While the second medical inspector did not find that Dr. Wu’s behaviour or conduct exposed the nineteen patients whose care she reviewed to harm or injury, she did find that his care displayed a lack of knowledge, skill and judgment.
The College investigator sought more information and documentation from Dr. Wu regarding his financial relationship with the wellness centre. However, Dr. Wu advised that he was unable to provide the information requested, by letter dated April 12, 2018.
In a prior investigation in 2013-2014, Dr. Wu provided responses to the College asserting that he had no financial interest in the sale of braces/medical devices which were sold by the same wellness centre next to his clinic, and that there was no conflict of interest in relation to Dr. Wu’s prescription of braces and the payment for these devices to the wellness centre. Dr. Wu does not admit but does not contest that the information Dr. Wu provided to the College at that time was untrue. Dr. Wu’s assertions to the College are contained in prior correspondence dated October 8, 2013, October 24, 2013, November 25, 2013, and January 15, 2014.
Dr. Wu admitted that he failed to maintain the standard of practice of the profession with respect to the nineteen patients whose care was reviewed by the second medical inspector. Dr. Wu does not contest that he had a conflict of interest and engaged in disgraceful, dishonourable or unprofessional conduct with respect to his financial relationship with the medical devices supplier. Dr. Wu does not contest that he also engaged in disgraceful, dishonourable or unprofessional conduct in failing to disclose this
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financial relationship to the College in a prior investigation and in providing untruthful information regarding to the College about it.
Registrar’s Investigation regarding Eye Examinations
On April 2, 2015, the College received information from an investigator at Sun Life raising concern regarding claims submitted for eye examinations by Dr. Wu. Sun Life had received approximately eight hundred eye examination claims for services rendered by Dr. Wu between January 3, 2012 and March 20, 2015. To determine whether eye examinations were within Dr. Wu’s scope of practice, Sun Life had sought to contact Dr. Wu on four occasions, but he had failed to respond. Dr. Wu apologized for failing to respond to the email from Sun Life in a letter to the College investigator on June 7, 2018.
The College initiated an investigation. It faced challenges in obtaining Dr. Wu’s patient records for review during the course of its investigation. The College began to seek the records in the summer of 2015. Dr. Wu advised in November 2015 that none of the twenty-five individuals whose records were sought (based on claims having been submitted to Sun Life for eye examinations he conducted) were “patients of his clinic,” but instead were “customers of Fuji Optical Company.” Between November 2015 and September 2016, the College attempted to retrieve Dr. Wu’s medical records in respect of these patients from Fuji Optical, eventually being provided with eight two-page patient charts in September 2016. Dr. Wu advised he had no document, file, record, or other material in relation to any of the listed individuals.
The College retained a third medical inspector to provide an independent opinion regarding Dr. Wu’s care and treatment of patients based on seven patient charts that were able to be retrieved from Fuji Optical as well as fifteen other patient records regarding eye care obtained from Dr. Wu’s office in 2017. The third medical inspector also interviewed Dr. Wu.
The third medical inspector’s report was received on April 4, 2017 and addendum received on April 11, 2017. As the third medical inspector concluded, Dr. Wu did not meet the standard of practice of the profession in the care and treatment of the twenty-two patients whose charts were reviewed. The refractions he performed were incomplete with key elements not being performed. Major elements of the exam were missing in periodic oculo-visual assessments. Dr. Wu lacked both knowledge and judgment, for example having trouble in the interview describing basic instruments used for refraction or articulating the basic steps refracting a patient. Dr. Wu had advised the third medical inspector in his interview that he was no longer performing refractions or complete eye examinations. The third medical inspector opined that if Dr. Wu were to continue to perform refractions or complete eye examinations, there would be significant risks to patients, with risk to children and older patients in particular.
As the third medical inspector observed in his report, Dr. Wu submitted claims to the Ontario Health Insurance Plan for periodic oculo-visual examinations performed in his office, without performing minimum elements required by the Schedule of Benefits.
Dr. Wu provided a response to the third medical inspector’s report. Upon reviewing it, the third medical inspector provided the College with a further report containing his reply, dated November 12, 2017. The third medical inspector remained concerned that Dr. Wu had gaps in his knowledge of the basic technique of refracting and had trouble identifying basic equipment. Some charts did not identify pre-op
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vision and none identified post-op vision. Nor was the third medical inspector confident that Dr. Wu was in a position to identify issues that required directing the patient to a doctor for a proper examination. There continued to be concerns regarding Dr. Wu’s in-office examinations and the specific charts reviewed.
Dr. Wu admitted that he failed to maintain the standard of practice of the profession in his care and treatment of the twenty-two patients whose charts were reviewed by the third medical inspector and that he was incompetent in respect of his care and treatment of these patients. Dr. Wu admitted that he engaged in disgraceful, dishonourable or unprofessional conduct in respect of his failure to respond to Sun Life’s inquiries, in submitting claims to OHIP that were not appropriately supported by his records and failing to ensure appropriate storage and maintenance of his medical records.
Reassessment of Family Practice
On March 8, 2016, Dr. Wu entered into an undertaking which required him to complete professional education, including clinical supervision, and to undergo a reassessment. Dr. Wu had entered into the 2016 Undertaking as a result of a prior unsatisfactory reassessment of his family practice, performed in March 2015 by a physician assessor, who had found that Dr. Wu had failed to maintain the standard of practice of the profession and showed a lack of judgment in his care of four patients and in maintaining proper hygiene.
As required by the 2016 Undertaking, Dr. Wu completed a medical record-keeping course offered by the University of Toronto and completed summaries regarding his review of a number of policies, guidelines, and clinical issues. Dr. Wu also completed a period of supervision from March 2016 to July 2017.
A second physician assessor was retained by the College to reassess Dr. Wu’s practice under the terms of his 2016 Undertaking. The second assessor reviewed twenty of Dr. Wu’s patient charts, observed Dr. Wu’s encounters with six patients on November 29, 2018, performed an infection control office inspection, and interviewed Dr. Wu. The second assessor’s reassessment report was received January 8, 2019 and his addendum report received January 21, 2019. As the second assessor found, Dr. Wu failed to maintain the standard of practice of the profession and displayed a lack of judgment in his care of three patients, placing them at risk of harm.
Dr. Wu admitted that he failed to maintain the standard of practice of the profession in his care and treatment of the three patients identified by the second assessor. Dr. Wu admitted that he was incompetent in his care and treatment of one patient whose care was reviewed by the second assessor in what he identified in his report as Chart #1. In that case, Dr. Wu failed to conduct a pertinent history and investigation in managing a patient with suspected angina.
Registrar’s Investigation regarding Offences
On August 24, 2017, the College received an anonymous letter alleging that Dr. Wu “was suspended from driving and again recently for Criminal Code violation,” and that the information was not contained on the College’s public Register, which should be remedied.
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The College initiated an investigation. It obtained Dr. Wu’s criminal record and driver’s licence history from the Ontario Provincial Police (“OPP”) on August 31, 2017. As they indicate, on September 10, 2015 Dr. Wu was convicted of dangerous driving under the Criminal Code, and on January 9, 2017, Dr. Wu was convicted of driving while disqualified under the Criminal Code.
Additional information obtained from the OPP on January 4, 2018, demonstrates that on August 4, 2014, Dr. Wu was arrested on Highway 407 by the OPP and charged under the Criminal Code with dangerous operation of a motor vehicle, flight while pursued by a police officer, and assault with intent to resist arrest, as well as offences under the Compulsory Automobile Insurance Act and the Highway Traffic Act.
As a member of the College, Dr. Wu was required to complete an annual renewal report. On May 20, 2015, Dr. Wu completed his Annual Renewal Report to the College. In it, he answered “no” to the question, “Since April 1, 2014, have you been charged with any offence in Canada or elsewhere?” This was untrue.
On September 10, 2015, Dr. Wu attended court in Newmarket, Ontario, where he pleaded guilty to the charge of dangerous operation of a motor vehicle under the Criminal Code (s. 249(1(a)) and received an absolute discharge for the dangerous driving charge. He was prohibited from driving for one year under the Criminal Code. He also pleaded guilty to operating a motor vehicle without insurance under the Compulsory Automobile Insurance Act (s. 2(1)(a)) and was fined.
Nonetheless, on May 20, 2016, Dr. Wu answered ‘no’ to the following question on his Annual Renewal Report to the College: “Since April 1, 2015, have you been charged with and/or found guilty of, any offence in Canada or elsewhere? (Include all offences under the Criminal Code of Canada, the Controlled Drugs and Substances Act, the Food and Drugs Act, the Health Insurance Act, and/or related legislation in any Province or jurisdiction. In addition, include any other offences related to the practice of medicine.”). Dr. Wu’s response was untrue.
On September 5, 2016, Dr. Wu was arrested by the York Regional Police and charged with driving while disqualified under the Criminal Code and operating a motor vehicle without insurance under the Compulsory Automobile Insurance Act. On January 9, 2017, Dr. Wu pleaded guilty to driving while disqualified under the Criminal Code, receiving a fine and a prohibition from driving for one year.
Nonetheless, on May 15, 2017, Dr. Wu answered ‘no’ to the following question on his Annual Renewal Report to the College: “Since April 1, 2016, have you been charged with, and/or found guilty of, any offence in Canada or elsewhere? (Include all offences under the Criminal Code of Canada, the Controlled Drugs and Substances Act, the Food and Drugs Act, the Health Insurance Act, and/or related legislation in any province or jurisdiction. In addition, include any other offences related to the practice of medicine.).” On October 18, 2017, after having been contacted by the College investigator in August regarding this matter, Dr. Wu emailed the College’s “Membership” email address, stating, “I am writing to correct one of the mistake [sic] I might have made on the renewal of membership last time. I was convicted criminally because [sic] driving disqualify. Please correct the mistake I might have made filling out the questionnaire.”
Dr. Wu admitted that he engaged in disgraceful, dishonourable, or unprofessional conduct with respect to his failure to disclose to the College, as required, the information relating to have been charged with
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and found guilty of offences. Dr. Wu admits that he has also been found guilty of offences relevant to his suitability to practice.
Disposition
On October 17, 2019, the Discipline Committee ordered that:
- Dr. Wu attend before the panel to be reprimanded
- the Registrar revoke Dr. Wu’s certificate of registration, effective immediately
- Dr. Wu to pay costs to the College in the amount of $31,110.00 within thirty (30) days of the date of its Order.
Terms and conditions imposed on certificate by: Member