On December 18, 2015, the Discipline Committee found that Dr. Esmond committed an act of professional misconduct in that he failed to maintain the standard of practice of the profession and he 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. Dr. Esmond admitted to the allegations.
On July 31, 2013, the College received a letter from the Office of the Chief Coroner notifying the College of the death of a patient of Dr. Esmond. The Coroner raised concerns with respect to the care provided by Dr. Esmond, including the dose of morphine prescribed prior to the patient’s death. This information led the College to initiate an investigation into Dr. Esmond’s practice.
The College retained a Medical Inspector, Dr. X as part of its investigation. Dr. X found that Dr. Esmond failed to meet the standard of practice in the care provided to 16 of the 36 patients whose charts were reviewed and one of seven patient encounters observed in Dr. Esmond’s office. Further, Dr. Esmond’s care exposed patients to risk of harm by “placing [them] in a situation of reliance on major analgesics for an undefined and indeterminate length of time.”
On May 20, 2014, after receiving Dr. X’s report, Dr. Esmond voluntarily entered into an undertaking relinquishing his privileges to prescribe narcotics, benzodiazepines and all other monitored drugs and controlled substances. Dr. Esmond also undertook to refer all patients on opioid therapy to other physicians for assessment and care. On February 12, 2015, following the referral of this matter to the Discipline Committee, Dr. Esmond signed an interim undertaking imposing substantially similar restrictions on his certificate of registration pending the hearing.
In addition, Dr. Esmond treated a family member between 2007 and 2014, acting as the family member’s primary care provider between 2007 and 2011, and following the family member for a number of serious medical conditions. In the course of treating his family member, Dr. Esmond made diagnoses, ordered investigations, made referrals to specialists, wrote prescriptions, including prescriptions for psychotropic medication, billed the Ontario Health Insurance Program (“OHIP”), and completed insurance forms. Some of Dr. Esmond’s treatment of his family member was not documented in his records or billed to OHIP. By treating his family member in this manner over the course of many years, Dr. Esmond acted in direct contravention of the College’s Policy on Treating Self and Family Members.
A second investigation into Dr. Esmond’s practice was commenced after the College received a third- party complaint alleging that Dr. Esmond had entered into a relationship with a physician whom he was a supervising, Dr. A, between February 2009 and March 2011. Dr. Esmond and Dr. A subsequently developed a personal and intimate relationship.
While acting as her supervisor, Dr. Esmond sought and received medical treatment from Dr. A on approximately 40 occasions for various conditions, including a burn to his hand and chronic back pain. In addition, Dr. A referred Dr. Esmond to a chiropractor, urologist, psychiatrist, nephrologist and a Physical Medicine specialist as well as prescribed various medications to him, completed a disability form for him, ordered a CT scan of his lumbar spine and ordered an MRI scan of his thoracic spine. Dr. Esmond continued to seek intermittent treatment from Dr. A following the conclusion of the period of supervision.
In addition, after the conclusion of the period of supervision, Dr. A completed an insurance assessment for Dr. Esmond which was submitted to his insurance company in support of his application for disability benefits.
Dr. Esmond also treated Dr. A during the period of supervision. Dr. Esmond continued to provide incidental treatment to Dr. A on occasion following the conclusion of the period of supervision, including ordering an ultrasound for Dr. A and referring Dr. A to a gynaecologist.
The Discipline Committee ordered and directed that:
- the Registrar suspend Dr. Esmond’s certificate of registration for a period of four (4) months commencing immediately.
- the Registrar impose the following terms, conditions and limitations on Dr. Esmond’s certificate of registration:
(a) Dr. Esmond shall not issue new prescriptions or renew existing prescriptions for any of the following substances:
(i) Narcotic Drugs (from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19);
(ii) Narcotic Preparations (from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19);
(iii) Controlled Drugs (from Schedule G of the Regulations under the Food and Drugs Act, S.C., 1985, c. F-27);
(iv) Benzodiazepines 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 [to the Order] as Schedule “A”; and the current regulatory lists are attached [to the Order] as Schedule “B”)
(v) All other Monitored Drugs (as defined under the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22 as noted in Schedule “C” [to the Order]).
(b) Dr. Esmond shall post a sign that is clearly visible upon entering his office(s) in the form set out at Schedule “D” [to the Order]. For further clarity, this sign shall state as follows:
IMPORTANT NOTICE
Dr. Esmond must not prescribe any of the following:
Narcotic Drugs
- Narcotic Preparations
- Controlled Drugs
- Benzodiazepines and Other Targeted Substances
- All other Monitored Drugs
Further information may be found on the College of Physicians and Surgeons of Ontario website at www.cpso.on.ca
A sign reflecting this restriction will also be posted in Spanish.
(c) Dr. Esmond shall cooperate with unannounced inspections of his practice and patient charts and such other steps as the College may take for the purpose of monitoring and enforcing his compliance with the terms of this Order and will make his Ontario Health Insurance Plan billings and Narcotics Monitoring System data accessible to the College for this purpose.
(d) Dr. Esmond must successfully complete, at his own expense, the first available Professional Boundaries and Ethics (“ProBE”) Canada course and University of Toronto Medical Record Keeping course, or, if these courses are unavailable, other courses acceptable to the College in ethics, boundaries, and medical record keeping, within four (4) months of the date of this Order.
- Dr. Esmond appear before the panel to be reprimanded.
- Dr. Esmond pay to the College costs in the amount of $4,460 within 30 days of the date of this Order.
Terms and conditions imposed on certificate by: Member
