Previous Hearings
Committee: Discipline
Decision Date: 14 Jul 2017
Summary:
On July 14, 2017, the Discipline Committee found that Dr. Daniel Charles Sweet committed an act of professional misconduct in that he failed to maintain the standard of practice of the profession and in that 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. Sweet is a family physician who was practising in Ottawa. He received his certificate of registration authorizing independent practice in Ontario in June 1982 and was certified by the Royal College of Physicians and Surgeons of Canada as a specialist in Anesthesiology on June 7, 1989. Dr. Sweet transitioned from Anesthesiology to family medicine in 1994.
BACKGROUND
On August 6, 2002, the Discipline Committee ordered the Registrar to impose terms, limitations and conditions on Dr. Sweet’s certificate of registration, including restricting him from prescribing any controlled substances as defined by the Controlled Drugs and Substances Act, 1996. On October 5, 2006, Dr. Sweet entered into an Undertaking with the College, and agreed to cease to practise addiction medicine, chronic pain medicine and psychotherapy.
DISGRACEFUL, DISHONOURABLE AND UNPROFESSIONAL CONDUCT
Breach of 2002 Discipline Committee Order
Dr. Sweet breached the 2002 Order of the Discipline Committee by prescribing controlled substances on three occasions:
- On October 17, 2014, Dr. Sweet prescribed Androgel to Patient B;
- On January 3, 2015, Dr. Sweet renewed a prescription of Clonazepam to Patient C;
- On December 14, 2016, Dr. Sweet prescribed a hormone replacement therapy containing Testosterone to Patient E.
Prescribing Botox to Patient E
Dr. Sweet was Patient E’s family physician. In 2013, the College commenced an investigation into whether Patient E, who is not a regulated health professional, was performing rhinoplasties and injecting Botox at a clinic in her home.
In 2014, in the course of its investigation of Patient E, the College interviewed Dr. Sweet. Dr. Sweet indicated that Patient E was his patient since approximately 2010. He noted that about one or two years prior, Patient E informed him that she was performing face lifts and injections and tried to “lure” him into her cosmetic work by asking him to order local anaesthetics for her. Dr. Sweet indicated that he advised Patient E that these are obtained through a prescription and declined to order them. He stated that he had never purchased Botox or injected Botox in his entire career.
Following a temporary injunction order, dated March 6, 2014 and final injunction order, dated May 22, 2014 obtained by the College from the Superior Court of Justice, Patient E was ordered to permanently refrain from performing all controlled acts and other acts relating to the practice of medicine, including administering a substance by injection.
In 2016, the College conducted an investigation into whether Patient E was in breach of these Orders. A College investigator learned that Dr. Sweet had prescribed Botox to Patient E.
On November 10, 2016, Dr. Sweet indicated to the College investigator that since his last interview with the College in relation to Patient E and her esthetic business, he had taken a Botox training course to treat migraine headaches. He stated that he prescribed Botox to Patient E on two occasions:
- On April 25, 2016, Dr. Sweet prescribed Botox to Patient E on the assumption that she needed it for an injection to be performed by another physician for treatment of her chronic pain. He did not confirm with the other physician the reason for the prescription and never followed up with Patient E regarding the injection by the other physician.
- On September 28, 2016, Dr. Sweet prescribed Botox to Patient E again and she was to return for the injection on October 1, 2016. However, she did not show up. Dr. Sweet was unsuccessful in following up with Patient E to determine why she did not attend for her appointment.
Dr. Sweet indicated that it did not occur to him that Patient E might be diverting the Botox given the small amount he prescribed.
Breach of October 5, 2006 Undertaking – Care and Treatment of Patient D
In February 2015, a community social worker at a homeless shelter informed the College that a shelter client (Patient F), who was a former addict, had received free samples of Ralivia (also known as Tramadol) from Dr. Sweet for pain management. The College commenced an investigation into whether Dr. Sweet had breached his October 5, 2006 Undertaking to cease practising addiction and chronic pain medicine. The College retained an expert who reviewed 25 patient charts and interviewed Dr. Sweet. Dr. Sweet retained an expert who reviewed the same charts.
The College expert, a specialist in family medicine, opined that Dr. Sweet engaged in the practice of chronic pain management and in the practice of addiction management in respect to one of the patients, Patient D, as follows:
- Between September 2012 and October 2014, fifteen of Patient D’s appointments with Dr. Sweet involved some level of assessment or treatment of Patient D’s chronic pain, and on at least two occasions tramadol prescriptions were provided outside of a clinic visit;
- Dr. Sweet failed to adequately attempt to transfer Patient D to another physician for the treatment of Patient D’s pain symptoms;
- Dr. Sweet prescribed clonidine and tramadol to Patient D and utilized tramadol for the treatment of addiction.
Dr. Sweet’s expert, also a specialist in family medicine, did not provide an opinion whether Dr. Sweet engaged in the practice of chronic pain management and in the practice of addiction management in respect of Patient D.
FAILURE TO MAINTAIN THE STANDARD OF PRACTICE OF THE PROFESSION
Patient Charts reviewed by College Expert and Dr. Sweet’s Expert
The College expert who reviewed the patient charts in respect of Patient D and others concluded that Dr. Sweet failed to maintain the standard of practice of the profession in respect of fifteen of the twenty-five patients whose charts were reviewed.
Dr. Sweet’s expert concluded that Dr. Sweet failed to maintain the standard of practice of the profession in his care and treatment of Patient F, the person about whom the community social worker had contacted the College on February 25, 2015.
Reassessment pursuant to August 16, 2013 Undertaking
As a result of a prior College process, Dr. Sweet entered into an Undertaking dated August 16, 2013, pursuant to which he was to undergo a period of clinical supervision for 6 months, followed by a reassessment of his practice. The College assessor, a different family physician from the College expert who reviewed the patient charts in respect of Patient D and others, reviewed additional twenty-five patient charts and concluded that Dr. Sweet failed to maintain the standard of practice of the profession in respect to fifteen patients, in that:
- Dr. Sweet failed to document a patient encounter with Patient G at which an injection was administered and at which he prescribed a medication;
- Dr. Sweet did not provide adequate preventative care and failed to adequately work up or manage the Patient H’s diagnosis of reflex sympathetic dystrophy;
- Dr. Sweet failed to document that he discussed the risks and side effects of prescribing Imovane, a sedative, as a sleep aid to Patient I who was a 90-year-old patient with poor mobility requiring the use of a cane and had a history of pelvic fracture due to fall;
- Dr. Sweet’s charting and documentation in relation to Patient J had inconsistencies, including two different chart notes for the same clinical encounter;
- Dr. Sweet’s charting and documentation in relation to Patient K was inconsistent and that he prescribed Myrbetriq for enuresis to this 9-year-old patient at a time when Myrbetriq was not approved for use in children;
- Dr. Sweet’s pediatric patient’s immunizations for Patient L were incomplete or incompletely documented;
- Dr. Sweet failed to investigate and rule out a possible G.I. source for Patient M’s anemia, in circumstances where the patient may have had a hysterectomy.
Dr. Sweet’s expert reviewed the same patient charts and agreed with the College assessor that Dr. Sweet failed to maintain the standard of practice of the profession with respect to three patients (Patients I, K, and M). Dr. Sweet’s assessor further opined that Dr. Sweet may have failed to maintain the standard of practice of the profession in that:
- Dr. Sweet prescribed to Patient N a year-long course of Wellbutrin, an anti-depressant ten days after she had been assessed in the Emergency Room for depression and without a clinical encounter at the time of the prescription;
- Dr. Sweet’s pediatric patient’s (Patient O) immunizations were incomplete or incompletely documented.
DISPOSITION
On July 12, 2017, Dr. Sweet signed an undertaking and agreed to resign from the College effective July 12, 2017 and not to apply or re-apply for registration as a physician to practise medicine in Ontario or any other jurisdiction after July 12, 2017.
On July 14, 2017, in light of the undertaking to resign and to not re-apply, the Committee ordered and directed on the matter of penalty and costs that:
- Dr. Sweet attend before the panel to be reprimanded.
- Dr. Sweet pay costs to the College in the amount of $5,500.00 within thirty (30) days of the date this Order becomes final.
Decision: Download Full Decision (PDF)
Hearing Date(s): Hearing Date: July 14, 2017
Committee: Discipline
Decision Date: 22 Feb 2012
Summary:
On February 22, 2012, the Discipline Committee found that Dr. Daniel Charles Sweet committed an act of professional misconduct, in that 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.
This was Dr. Sweet's fourth appearance before the Discipline Committee.
Dr. Sweet prescribed Delatestryl and Cessamet in contravention of a 2002 Discipline Committee Order that he not prescribe narcotics and controlled substances.
Dr. Sweet saw Patient A in June of 2010 who complained of Erectile Dysfunction, in addition to other problems. Dr. Sweet states that he planned to send Patient A to an Erectile Dysfunction Clinic where he could be assessed and treated. Dr. Sweet advised Patient A of the plan. The patient was insistent that he wanted a prescription for Delatestryl immediately and was not content to wait for his referral. Dr. Sweet reports that Patient A is a large gentleman and that Dr. Sweet felt pressured to provide him with the requested prescription which he provided on a one-time basis.
Dr. Sweet saw Patient B in October 2010. Patient B was being followed by a psychologist for his Post Traumatic Stress Disorder. Patient B reported feeling anxious and reported that he had heard that Cessamet could help with his anxiety and stress. Patient B requested a prescription for Cessamet. Initially Dr. Sweet advised Patient B that he could not prescribe controlled substance and offered Patient B the alternatives of Seroquel or Olanzapine. Patient B told Dr. Sweet that Cessamet was not a controlled substance. Dr. Sweet provided the prescription with instructions to tell the pharmacist that if this substance was controlled then the prescription should not be filled. The prescription was subsequently returned to the Clinic and Dr. Sweet prescribed Olanzapine instead.
The Discipline Committee ordered and directed that:
1. the Registrar suspend Dr. Sweet's certificate of registration for a period of four (4) months, to commence April 1, 2012.
2. Dr. Sweet appear before the panel to be reprimanded.
3. the terms, conditions and limitations currently on Dr. Sweet's certificate of registration shall remain in full force and effect.
4. Dr. Sweet pay to the College costs in the amount of $3,650.00, within 90 days of the date of this Order.
5. the results of this proceeding to be included in the register.
Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): February 22, 2012
Committee: Discipline
Decision Date: 29 Apr 2008
Summary:
On April 29, 2008, the Discipline Committee of the College of Physicians and Surgeons of Ontario found that Dr. Daniel Charles Sweet 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 the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional. The Discipline Committee ordered and directed the following:
1) The Discipline Committee directs Dr. Sweet to appear before the Discipline Panel to be reprimanded.
2) The Discipline Committee directs the Registrar to suspend Dr. Sweet(s certificate of registration for a period of two (2) months, to commence on May 1, 2008.
3) The Discipline Committee orders Dr. Sweet to pay costs to the College in the amount of $3,650.00 within 60 days of the date of this Order.
4) The Discipline Committee directs that the terms, conditions and limitations currently on Dr. Sweet(s certificate of registration shall remain in full force and effect.
5) The Discipline Committee directs the results of this proceeding to be included in the register.
Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): Apr 29, 2008
Committee: Discipline
Decision Date: 03 Jun 2004
Summary:
On June 3, 2004, the Discipline Committee found Dr. Sweet to have committed an act of professional misconduct that would reasonably be regarded by members as disgraceful, dishonourable or unprofessional by prescribing either Tylenol #3 or clonazepam on six different occasions in contravention of terms, conditions and limitations on his certificate of registration imposed in an earlier order of the Discipline Committee dated August 6, 2002.
The Committee ordered the following penalty:
1) The Discipline Committee directs the Registrar to suspend Dr. Sweet(s certificate of registration for a period of three (3) months, to commence on July 1, 2004.
2) The Discipline Committee directs that the terms, conditions and limitations currently on Dr. Sweet(s certificate of registration shall remain in full force and effect.
3) The Discipline Committee directs that the following term, conditions and limitation be imposed on Dr. Sweet(s certificate of registration:
a) That Dr. Daniel Charles Sweet must successfully complete an ethics course acceptable to the College by October 31, 2004.
4) The Discipline Committee directs that if the Registrar receives information which indicates that there has been failure to comply with any terms of this Order, the Registrar shall suspend Dr. Sweet(s certificate of registration immediately and provide Dr. Sweet with fourteen days( notice that the matter will be reported to the Executive Committee.
Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): Jun 03, 2004
Committee: Discipline
Decision Date: 06 Aug 2002
Summary:
On August 6, 2002, the Discipline Committee accepted Dr. Sweet(s plea of guilty and found him guilty of incompetence in that he displayed a lack of knowledge, skill or judgment or disregard for the welfare of the patients of a nature and that his practice be restricted. The Committee directs the Registrar to impose the following terms, conditions and limitations on Dr. Sweet(s certificate of registration:
1) that Dr. Daniel Charles Sweet be restricted from prescribing any controlled substances as defined by the Controlled Drugs and Substances Act, 1996, being any substance included in Schedules I, II, III, IV and V of that Act, and
2) that Dr. Daniel Charles Sweet display a sign in plain view to patients entering his office waiting room notifying patients that he is restricted from prescribing any controlled substances included in Schedules I, II, III, IV and V of the Controlled Drugs and Substances Act, 1996;
3) that the terms, conditions and limitations on Dr. Sweet(s certificate of registration, as set out in paragraph (1) and (2) above, shall remain in full force and effect unless and until they are removed or varied by a subsequent panel of the Discipline Committee on application for that purpose; and,
4) that Dr. Sweet shall pay the College its costs in the amount of $2,500.00 within one month of the date of this order.
Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): Aug 06, 2002
Concerns
Source:
Discipline Committee
Active Date: July 12, 2017
Expiry Date:
Summary:
Summary of the Undertaking given by Dr. Daniel Charles Sweet to the College of Physicians and Surgeons of Ontario, effective July 12, 2017:
Dr. Sweet was referred to the Discipline Committee on allegations of professional misconduct and incompetence.
Dr. Sweet admitted that 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, and that he failed to maintain the standard of practice of the profession.
Dr. Sweet also signed an undertaking never to apply or reapply for registration as a physician in Ontario or any other jurisdiction. On the basis of Dr. Sweet’s admissions and undertaking, the College withdrew the allegation of incompetence set out in the Notice of Hearing.
Download Full Document (PDF)