Previous Hearings
Committee: Discipline
Decision Date: 25 Jul 2014
Summary:
On July 25, 2014, the Discipline Committee found that Dr. Haines committed an act of
professional misconduct, in that he has failed to maintain the standard of practice of the
profession in his care and treatment of sixteen patients. Dr. Haines admitted to the
allegation.
The College began an investigation into Dr. Haines’ practice following the receipt of
information from the Office of the Chief Coroner for Ontario regarding the death of one
of his patients. The cause of the patient’s death was determined to be Oxycodone toxicity.
As part of its investigation, the College retained a medical inspector, Dr. X. Dr. X
reviewed the charts of 25 of Dr. Haines’ patients. The patients whose charts were
reviewed had all been treated with pain control medications for chronic pain due to
various causes and clinical backgrounds.
Dr. X noted that Dr. Haines’ charts were generally clear to read, organized and reflected
genuine concern by Dr. Haines for his patients. Nonetheless, Dr. X opined that certain
concerning issues recurred a number of times in Dr. Haines’ practice. The areas of
concern identified by Dr. X were as follows:
• There were ongoing prescriptions for opiates and benzodiazepines in patients a)
with substance abuse problems as proven by urine drug testing; or b) with written
concerns by other doctors who saw these patients and advised that prescribing
such medications was likely causing problems for the patients. The office records
did not address such concerns.
• Combining high dose opiates and benzodiazepines. This combination is known to
be a factor in opiate related deaths.
• Prescribing multiple opiates and multiple benzodiazepines simultaneously. This
increases the risk of adverse effects without potential benefit.
• Two patients were given on-going prescriptions for opiates without any office
assessment for over a year.
• Many patients had blood cholesterol testing, however Dr. X did not find any chart
using the cholesterol results to calculate the patient’s heart risk – the
“Framingham risk score”. Such a risk calculation is needed to establish the need
for medication and treatment goals. Similarly, two patients with heart disease had
cholesterol (LDL) levels above target.
• There was a lack of screening for colon cancer. Many patients came in for an
Annual Health Exam and some had colonoscopy exams. Dr. X did not find any
home kit Fecal Occult Blood Testing results. The standard of care in Ontario now
is to utilize this test widely in patients over 50.
With respect to the specific patient who was the subject of the coroner’s report, Dr. X
opined that Dr. Haines did not meet standard of care, demonstrated a lack of skill and
knowledge, and that it is probably a danger to safety in combining benzodiazepines with
moderately high opiate dosing in patient who could unpredictably take other illicit drugs
and who has shown significant impulsivity in overdosing.
Overall, Dr. X concluded that the care provided in 16 of the 25 charts reviewed did not
meet the standard of practice of the profession and demonstrated a lack of knowledge,
skill or judgment. Dr. X also concluded that Dr. Haines’ care in 10 of the charts exposed
patients to potential harm or injury, ranging from mild or minimal danger to serious
safety concerns.
Dr. Haines entered into an undertaking in response to the College’s concern to protect the
public. Further to the undertaking, Dr. Haines was required, among other things, to practice
under the guidance of a clinical supervisor acceptable to the College. Dr. Haines supervisor
consistently indicated in his monthly reports to the College that he has identified no material
deficiencies with respect to Dr. Haines’ standard of practice.
After learning of the College’s investigation, Dr. Haines took steps at his own initiative to
update his medical knowledge and his prescribing practices in respect of narcotics. In
addition, throughout 2013, Dr. Haines completed several continuing medical education
programs, targeted at addressing deficiencies identified by Dr. X specifically, as well as
reviewing family medicine issues generally.
Following an interview, Dr. X made a number of observations about Dr. Haines’
generally heightened knowledge and skill, and also highlighted the various improvements
in Dr. Haines’ practice.
The Committee ordered and directed that:
• the Registrar impose the following terms, conditions and limitations on Dr. Haines’
certificate of registration:
a) Dr. Haines, at his own expense, to submit to an assessment of his practice by
an assessor selected by the College approximately twelve months after the
date of this order. The assessment shall pertain to Dr. Haines’ practice
overall, with a specific focus upon the areas of concern outlined in the
reports of Dr. X including safe prescribing and overall preventative
care. The reassessment shall include, at minimum, a full day direct
observation component.
b) Dr. Haines shall abide by the reasonable recommendations made by the
Assessor. Dr. Haines shall be permitted to make written submissions on his
own behalf within 30 days of receipt of the assessment to the Inquiries,
Complaints and Reports Committee. The Inquiries, Complaints and Reports
Committee may or may not vary the recommendations of the Assessor upon
receipt of Dr. Haines’ written submissions. Any recommendations accepted
by the Inquiries, Complaints and Reports Committee that are limitation(s) or
restriction(s) shall constitute terms, conditions or limitations on Dr. Haines’s
Certificate of Registration and shall be included on the public register.
• Dr. Haines appear before the panel to be reprimanded.
• Dr. Haines pay costs to the College in the amount of $4,460.00, within 60 days of the
date of this Order.
Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): July 25, 2014