Committee: Discipline
Decision Date: 22 Aug 2016
Summary:
On August 22, 2016, the Discipline Committee found that Dr. Ira Michael Price has 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.
Dr. Price, who received an independent practice certificate from the College in 2010, is the medical director of Synergy Health Services Inc. in Hamilton, Ontario, where he provides care to patients being treated with medical cannabis.
Patient A sought treatment from Dr. Price for chronic pain with medical cannabis between December 2012 and April 2014. Following an email exchange with Dr. Price in April 2014, in which Patient A requested that his next appointment be rescheduled, Patient A was terminated from Dr. Price’s practice.
On April 24, 2014, the College received a complaint from Patient A that Dr. Price acted unprofessionally while Patient A was his patient, including by being unwilling to accommodate his request to reschedule his appointment and by terminating Patient A from his practice.
Dr. Price provided details of his interactions with Patient A in response to the complaint. Some of these details were inconsistent with Patient A’s descriptions of his appointments with Dr. Price, including Dr. Price’s statement that Patient A refused, during an appointment, to consent to a physical examination.
While Patient A denied ever having refused a medical examination by Dr. Price, the medical records provided by Dr. Price supported his version of events as set out in his response letter.
A College investigator asked Dr. Price whether his chart entries were made contemporaneously to Patient A’s visits or whether there were any changes, additions or deletions made to any of the chart entries following the date-time of Patient A’s visits.
Dr. Price wrote in response that “All chart entries made regarding [Patient A]’s visits were made at a time that was contemporaneous to the visits” and “All entries were made on the dates indicated in [Patient A]’s records, and at the same time as the other entries included under each date-entry.” Dr. Price claimed this was consistent with his “regular charting practice.”
The College retained a forensic examiner who concluded that multiple entries in Patient A’s chart were written during different writing episodes from the remainder of the handwriting on that page, including the following:
- The phrase “/day pt must Show to f/u to keep”, purporting to be written on a date in December 2012, was indented onto a form from a particular date in January 2013, suggesting that the note was written on or after that date in January, 2013;, purporting to be written on a date in December 2012, was indented onto a form from a particular date in January 2013, suggesting that the note was written on or after that date in January, 2013;
-The phrase “ discussed pain Scale Score to be 20”, purporting to be written on a date in early April 2013, was written in a different writing episode than the rest of the handwriting on the Progress Notes from the same date in early April 2013. The entry was indented onto a document that was printed on a date in late April 2013, indicating that the note was written on or after that date in late April 2013;
- The phrases “1yr”, “no renewal”, “Refusing exam.” and “ May have to D/C licence if this continues”, purporting to be written on a date in January 2014, were written in different writing episodes than the rest of the handwriting in the Follow-up Report dated that day in January 2014;
- The phrase “ Secretary feels threatened by conversation”, purporting to be written on a date in April 2014, was written in a different writing episode than the rest of the note from that same date in April 2014.
The College investigator sent the forensic report to Dr. Price in May 2015 and requested his comments. In his June 2015 response, Dr. Price did not dispute the forensic conclusions reached by the forensic expert. In his June 2015 response, Dr. Price advised the College, for the first time, of the following:
(a) He frequently writes chart notes in different sittings and with different pens;
(b) It is often the case that chart entries are not fully completed at the end of the appointment;
(c) It is his practice to make additions to his charts when doing dictations, performing chart audits, and during subsequent visits;
(d) He is sometimes unable to complete his charting until “a couple weeks” after appointments or within a “reasonable time period” thereafter;
(e) He often brings his patient charts home to complete his charting;
(f) Entries are made from different locations at different times;
(g) He is present at the medical cannabis clinic only on Mondays and uses the rest of the week to
complete chart entries;
(h) He cannot recall when he completed the entries in Patient A’s chart;
(i) He may have backdated his notes in Patient A’s chart;
(j) He may have written “ discussed pain Scale Score to be 20”, purporting to be written on the date in early April 2013, after he received the late April 2013 document;
(k) He would have written the phrase “ Secretary feels threatened by conversation”, purporting to be written on a date in mid-April 16, 2014, on the next day or later;
(l) He may have written the phrases “1yr”, “no renewal”, “Refusing exam.” and “ May have to D/C licence if this continues”, purporting to be written on a date in mid-January 2014, weeks after mid-January 2014.
PENALTY AND COSTS
On August 22, 2016, the Discipline Committee ordered and directed that:
- The Registrar suspend Dr. Price’s certificate of registration for a period of three (3) months, to commence at 12:01 a.m. on September 1, 2016.
- The Registrar impose the following terms, conditions and limitations on Dr. Price’s certificate of registration:
o Education
a) Dr. Price must successfully complete, at his own expense, the first available courses acceptable to the College in ethics and medical recordkeeping, within four (4) months of the date of this Order.
o Recordkeeping
b) Dr. Price will obtain and use as his only medical recordkeeping system in all his office-based Practice Locations in Ontario, an Electronic Medical Recordkeeping (“EMR”) System acceptable to the College within six (6) months of the date of this Order.
o Other
c) Dr. Price shall comply with the College Policy on Practice Management Considerations for Physicians Who Cease to Practise, Take an Extended Leave of Absence or Close Their Practice Due to Relocation in respect of his period of suspension, a copy of which forms Appendix “A” to this Order.
d) Dr. Price shall inform the College of each and every location where he practices, in any jurisdiction (his “Practice Location(s)”) within fifteen (15) days of this Order, and shall inform the College of any and all new Practice Locations within fifteen (15) days of commencing practice at that location.
e) Dr. Price shall submit to, and not interfere with, unannounced inspections of his Ontario Practice Location(s) and and to any other activity the College deems necessary in order to monitor his compliance with the provisions of this Order.
f) Dr. Price shall consent to the College making appropriate enquiries of the Ontario Health Insurance Plan and/or any person who or institution that may have relevant information, in order for the College to monitor his compliance with this Order.
g) Dr. Price shall be responsible for any and all costs associated with implementing the terms of this Order.
- Dr. Price appear before the panel to be reprimanded.
- Dr. Price pay costs to the College in the amount of $5,000.00 within thirty (30) days of the date this Order becomes final.