On April 23, 2018, the Discipline Committee found that Dr. Richard Kok Tiong Chan committed an act of professional misconduct, in that he has engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all of the circumstances, would reasonably be regarded by members as unprofessional.
Dr. Richard Kok Tiong Chan (“Dr. Chan”) is a neurologist with the Department of Clinical Neurological Sciences, London Health Sciences Centre.
Between 2011 and 2015, Dr. Chan on numerous occasions prescribed Fentanyl patches to his relative (Relative 1) who lives abroad. On each of these prescriptions the ID of the relative was her passport number and the address was Dr. Chan’s home address. Dr. Chan prescribed to another relative (Relative 2) who also lives abroad. In July 18, 2014, this relative filled a prescription, which was written by Dr. Chan, for 150 tabs of hydromorphone. The prescription bore this relative’s passport number, and indicated her address to be Dr. Chan’s home address.
Dr. Chan went personally to the drug store himself to have each of the prescriptions he wrote for both of his relatives filled. The Fentanyl patches he prescribed to Relative 1 and the hydromorphone tabs he prescribed to Relative 2were provided to him by the pharmacy.
On January 13, 2016, Dr. Chan wrote a prescription for Relative 1 for 180 Fentanyl patches. As with the previous prescriptions, it bore her passport number and indicated her address to be Dr. Chan’s home address. On the prescription he submitted to the Shoppers Drug Mart (“SDM”) pharmacy, Dr. Chan wrote “Patient leaving town, OK to release all supplies now”.
When in January, 2016, the SDM pharmacist telephoned a number believed to be for the patient, Dr. Chan answered the pharmacist’s call and confirmed that he was the prescribing physician, and that he had written the prescription for Relative 1. The pharmacist advised Dr. Chan that the prescription he had written would not be filled because it was for his relative. In a separate conversation with the pharmacy owner, it was suggested to Dr. Chan that he have the patient’s family physician write the prescription.
Several days later, Dr. Chan asked Dr. X, a clinical fellow working under his supervision, to write a prescription for Fentanyl for Relative 1. Dr. Chan approached Dr. X during clinic hours and when she was between patients, he told her that his relative had been using the medication and he had been prescribing to her for years. Dr. Chan also told Dr. X that he would have asked another colleague to write the prescription, but that there were no other staff doctors around and that he needed it right away. He told her what medication to prescribe, and he specified the dose and quantity. Dr. Chan told Dr. X that he had already presented a prescription for Fentanyl to the pharmacy, but the pharmacy requested that he have another physician issue the prescription.
Dr. X did not assess Dr. Chan’s relative. She did not feel she could refuse Dr. Chan’s request, as Dr. Chan was her supervisor and wrote the prescription as requested by Dr. Chan. The same day Dr. Chan submitted the prescription written by Dr. X to the SDM pharmacy to be filled. The pharmacy did not fill the prescription written by Dr. X.
Over January 18 and 19, 2016, Drs. Chan and X exchanged the text wherein Dr. Chan wrote Dr. X that he ended up not sending the prescription to the pharmacy as the pharmacy returned the stocks, that he is glad that he didn’t have to use it as he feels awkward for asking her to write the script, and stated that he will bring his relative to the doctor when he gets home. Several days later, the pharmacy telephoned Dr. X to confirm whether the prescription she had written was valid. Dr. X confirmed having written it, but stated that she had not seen the patient.
In the course of the College’s investigation into Dr. Chan’s prescribing, Dr. Chan provided conflicting or inaccurate information regarding:
- Dr. Chan’s contact with a physician who treated Dr. Chan’s Relative 1in the foreign country where she resides;
- The length of time for which he had been prescribing Fentanyl to Relative 1;
- The number of pharmacies at which he had filled Relative 1’s Fentanyl prescriptions;
- Where and how he treated and examined Relative 1; and
- How he got the Fentanyl to Relative 1.
In the course of the College’s investigation into Dr. Chan’s prescribing, Dr. Chan provided some information that conflicted with information provided to the College by the pharmacist and/or pharmacy owner.
Disposition
On April 23, 2018, the Committee ordered and directed that:
- the Registrar suspend Dr. Chan’s certificate of registration for a five (5) month period, to commence at 12:01 a.m. on May 1, 2018.
- the Registrar to impose the following terms, conditions and limitations on Dr. Chan’s certificate of registration:
Prescribing Privileges
- Dr. Chan shall issue new prescriptions or renew existing prescriptions for any of the following substances only to patients whom Dr. Chan is treating in a hospital setting (including in-patients, clinic patients, and emergency department patients):
- Narcotic Drugs (from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19); and
- Narcotic Preparations (from the Narcotic Control 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 as Schedule “A” to the Order dated April 23, 2018; and the current regulatory lists are attached as Schedule “B” to the Order dated April 23, 2018.
Prescription Log
- Dr. Chan shall record all prescriptions he writes for the substances set out in paragraph 4.(1), and other specified information, in a prescription log or logs containing the information set out in the attached Schedule “C” to the Order Dated April 23, 2018, which shall be made available to the College at the College’s request. A copy of each prescription written by Dr. Chan for a drug set out in paragraph 4(1) shall be maintained either in the appropriate hospital records or Dr. Chan’s office chart.
Coursework
- At his own expense, Dr. Chan shall participate in and successfully complete by the end of 2018:
- A prescribing course acceptable to the College; and
- The PROBE course in ethics and professionalism by obtaining an unconditional pass, or any alternate course in ethics and professionalism approved by the College. Dr. Chan will agree to abide by any recommendations of the PROBE program and provide proof of completion to the College.
Compliance
- Dr. Chan must inform the College of each and every location at which he practices or has privileges, including, but not limited to, hospital(s), clinic(s) and office(s), in any jurisdiction (collectively the "Practice Location(s)"), within fifteen (15) days of commencing practice at that location.
- Dr. Chan shall be solely responsible for payment of all fees, costs, charges, expenses, etc. arising from the implementation of any of the terms of this Order.
- Dr. Chan shall co-operate with unannounced inspections of his Practice Location(s) and patient charts by the College and to any other activity the College deems necessary in order to monitor his compliance with the terms of this Order.
- Dr. Chan shall provide his irrevocable consent to the College to make appropriate enquiries of the Ontario Health Insurance Plan ("OHIP"), the Drug Program Services Branch, the Narcotics Monitoring System ("NMS") implemented under the Narcotics Safety and Awareness Act, 2010 and any person or institution that may have relevant information, in order for the College to monitor his compliance with the terms of this Order.
- The College may provide this Order to any Chief(s) of Staff, or a colleague with similar responsibilities, at any Practice Location where he practices or has ("Chief(s) of Staff"), or other person or individual as necessary for the implementation of this Order and shall consent to privileges the College providing to said Chief(s) of Staff, person or organization with any information the College has that led to this Order and/or any information arising from the monitoring of his compliance with this Order.
- Dr. Chan appear before the panel to be reprimanded.
- Dr. Chan pay to the College its costs of this proceeding in the amount of $6,000 within thirty (30) days from the date of this Order.
Terms and conditions imposed on certificate by: Discipline Committee