On October 15, 2018, the Discipline Committee found that Dr. Alan Howard Laity committed an act of professional misconduct, in that he has failed to maintain the standard of practice of the profession, and 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. Dr. Laity is a family physician who had a practice in London, Ontario until September 30, 2016 at which time he closed his practice. On June 26, 2017, he resigned his certificate of registration with the College.
In January 2016, the College received a complaint from Patient A, who had been a patient of Dr. Laity's since July 2007. An expert retained by the College to provide an opinion with respect to the standard of practice of the profession, reviewed Dr. Laity's patient chart for Patient A and identified deficiencies in Dr. Laity's record-keeping and prescribing.
Record-keeping Deficiencies
The Expert noted the following deficiencies in Dr. Laity’s record-keeping with respect to Patient A:
- The cumulative patient profile in Dr. Laity's chart for Patient A was difficult to read and follow due to Dr. Laity's handwriting and adjustments to the cumulative patient profile;
- The medication list on Patient A's cumulative patient profile was not current and did not include all medications Patient A was taking, such as methodone;
- At his first appointment with Patient A, Dr. Laity prescribed clonazepam with no documentation of dosing so or the amount of pills prescribed;
- Dr. Laity started Patient A on an antidepressant medication without documenting any depression anxiety symptoms or risk of self-harm, and benzodiazepines were renewed regularly with little documentation.
Prescribing Deficiencies
Dr. Laity prescribed escalating doses of benzodiazepines to Patient A throughout the 8.5-year doctor-patient relationship, despite multiple warning signs that Patient A was addicted to and/or abusing the medication he prescribed.
Dr. Laity acceded to numerous requests for early refills of benzodiazepines. In the period between December 2007 and August 2009, Patient A claimed she required early refills of medication because she was assaulted and had trouble sleeping, because her pills were stolen on four separate occasions, because her pills were lost on two occasions, because she said she was entering a residential treatment program for post-traumatic stress disorder, amongst other reasons. These requests were warning signs of benzodiazepine abuse. On each occasion, Dr. Laity provided early refills of Patient A's benzodiazepines, on at least one occasion as little as two days after the last prescription.
When Patient A told Dr. Laity that she was taking extra medications, Dr. Laity continued prescribing clonazepam and other medications to her without properly addressing this.
While Dr. Laity first prescribed Patient A clonazepam in 2007 on a dose of 0.5 mg twice a day, by 2014 he was prescribing 2 mg of clonazepam three times a day with 180 tablets every two months. In May 2015, he again increased Patient A's prescription to 300 tablets of clonazepam 2 mg three times a day every two months. In August 2015, Dr. Laity replaced Patient A's pills because she told him she "knocked" two bottles of pills into the toilet.
In September 2015, Patient A was admitted to hospital for lithium overdose and remained in hospital for several months for several reasons, including severe anxiety and benzodiazepine addiction.
On January 4, 2016, Dr. Laity's office received a consultation note from a hospital physician, which indicated that Patient A had been weaned off of diazepam and was no longer taking clonazepam or any benzodiazepines. The physician wrote in the consultation notes:
Benzodiazepine withdrawal is a significant concern, though not likely to be severe. Her risk for relapse if discharged at this time would be extremely high, and she will need to be monitored to ensure she has been successfully managed through the initial withdrawal symptoms. If she does require a return of benzodiazepine administration, my recommendation is to backtrack a single step (in this case to 2.5 mg of diazepam) and likely would be best administered at night so that she can become accustomed to the lowering blood levels during the day.
Three days later, on January 7, 2016, at his first appointment with Patient A since she had been admitted to hospital in September 2015, Dr. Laity prescribed Patient A clonazepam 1 mg three times a day, down from 2 mg three times a day prior to her hospital admission, but much higher than recommended by the hospital physician.
The expert opined in his report that the first visit post hospital discharge in January 2016 was very concerning, noting that according to the notes from the hospital physician, there was concern for the patient to relapse and return to benzodiazepine use and Dr. Laity was advised if a drug is needed to use diazepam at 2.5 mg. However, on January 7, 2016, Dr. Laity prescribed clonazepam 1 mg and gave the patient 90 tablets.
The expert concluded that Patient A presents as a very high risk for abuse, and addiction. The escalating use, and lost prescriptions and withdrawal symptoms, of benzodiazepines and specialist notes indicating abuse raised many red flags that Dr. Laity appeared to miss, or ignore. The expert noted that Dr. Laity ignoring the warnings of the hospital physician, post a three-month hospital admission for benzodiazepine abuse, is very concerning.
The expert opined that Dr. Laity has not met the standard of care of the profession in his care of Patient A. Based on the review of this chart, and the notes provided, the expert opined that Dr. Laity exposed Patient A to harm, and based on her last visit, may have exposed Patient A to future harm.
Undertaking
Dr. Laity resigned his certificate of registration in June 2017. Dr. Laity was referred to the Discipline Committee on allegations of professional misconduct in July 2017. In the face of these allegations, Dr. Laity has entered into an Undertaking with the College wherein he agreed never to apply or reapply for registration as a physician in Ontario or any other jurisdiction.
Disposition
On October 15, 2018, the Discipline Committee ordered and directed that:
- Dr. Laity attend before the panel to be reprimanded.
- Dr. Laity pay costs to the College in the amount of $10,180.00 within thirty (30) days from the date of this Order.