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Huebel, Stephen Charles

CPSO#: 59312

MEMBER STATUS
Expired: Failure to Renew Membership as of 28 Sep 2021
EXPIRY DATE
28 Sep 2021
CURRENT OR PAST CPSO REGISTRATION CLASS
Restricted as of 19 Jan 2015

Summary

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Former Name: No Former Name

Gender: Male

Languages Spoken: English

Education: University of Toronto, 1988

Practice Information

Primary Location of Practice
Practice Address Not Available

Professional Corporation Information


Corporation Name: Dr. Stephen C. Huebel Medicine Professional Corporation
Certificate of Authorization Status: Inactive: Sep 20 2021

Specialties

Specialty Issued On Type
No Speciality Reported

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 13 Jun 1988
Transfer of class of registration to: Independent Practice Certificate Effective: 29 Jun 1989
Transfer of class of certificate to: Restricted certificate Effective: 19 Jan 2015
Terms and conditions imposed on certificate by Discipline Committee Effective: 19 Jan 2015
Terms and conditions amended by Registration Committee Effective: 03 May 2017
Terms and conditions amended by Discipline Committee Effective: 07 Jun 2018
Suspension of registration imposed: Discipline Committee Effective: 07 Jun 2018
Suspension of registration removed Effective: 07 Sep 2018
Expired: Failure to Renew Membership Expiry: 28 Sep 2021

Previous Hearings

Committee: Discipline
Decision Date: 07 Jun 2018
Summary:

On June 7, 2018 the Discipline Committee of the College of Physicians and Surgeons of Ontario (the College) found that Dr. Stephen Charles Huebel has committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession.

Dr. Huebel failed to maintain the standard of practice of the profession in his care and treatment of patients in the seven cases described below. He also consistently failed to maintain the standard of practice of the profession in his documentation and charting, as demonstrated in 12 cases reviewed by the College.

At the relevant times, Dr. Huebel practised emergency medicine at the Hospital. As a result of his certificate of registration being subject to interim terms and conditions since May 3, 2017, Dr.Huebel has not practised since July 31, 2017.

Patient A

In October 2016, the College received a complaint from Patient A’s family member regarding Dr.Huebel’s care of Patient A, who was a teenager at the time. Dr. Huebel attended to Patient A when she presented to the Hospital emergency department with shortness of breath. It was documented at triage that she also had a grossly elevated heart rate of 148. Dr. Huebel diagnosed her with an upper respiratory tract infection and discharged her home with a Flovent™ inhaler. Patient A was returned to the emergency department on the following day with a decreased level of consciousness and was diagnosed with acute severe Diabetic Ketoacidosis (DKA).

An emergency medicine expert retained by the College opined that Dr. Huebel’s care of Patient A fell below the standard of practice, in that:

- Dr. Huebel’s charting is mostly illegible, with minimal history and physical exam documented.The standard of practice was not met in both the legibility and content of his charting;
- Dr. Huebel should have recognized, assessed and addressed Patient A’s grossly elevated heart rate. Even at the peak of flu season with upper respiratory tract infections being at the top of his differential diagnoses, Dr. Huebel should have recognized that this heart rate was out of keeping with his diagnosis and treatment plan for Patient A;
- Given patient A’s high heart rate, Dr. Huebel should not have ordered medications that further elevate the heart rate to treat the wheeze that he had heard in her respiratory exam;
- Dr. Huebel did not address Patient A’s grossly elevated heart rate at all in his contemporaneous patient records or narrative, despite him stating that he reviewed the triage vitals himself and with the patient and her family member.

The expert further noted that it is the standard of care in emergency medicine to assess, investigate and treat someone with an abnormal vital sign such as this prior to their discharge from the emergency department and that Dr. Huebel fell below that standard of care in both what he did and what he did not do. The expert concluded that Dr. Huebel’s clinical practice exposes his patients to harm as it clearly did so in the case of Patient A.

Reassessment Pursuant to Discipline Committee Order

On January 19, 2015, the Discipline Committee imposed terms and conditions on Dr. Huebel’scertificate of registration, which required him to undergo a12-month period of supervision followed by two reassessments of his practice. The expert retained by the College to conduct the
reassessment of Dr. Huebel’s practice reviewed 13 of Dr. Huebel’s patient charts. She opined that Dr. Huebel failed to meet the standard of practice of the profession in 11 of the 13 charts.

Dr. Huebel’s charting and documentation failed to meet the standard of practice in 11 of the charts reviewed, the expert observed were largely illegible with minimal history and physical exam documented. In a response to the College dated April 5, 2017, Dr. Huebel conceded that his recordkeeping remains inadequate and requires improvement. Dr. Hubel’s care and treatment of patients fell below the standard of practice in the following six cases, which were included in the expert’s reassessment of his practice:

Patient B

Patient B, a man in his 90s, was transported by paramedics to the Hospital emergency department after falling down an unknown number of stairs. He was not placed on a board and collar. He had a hematoma on the side of his head that had been bandaged by paramedics and had a past medical history of a subdural hematoma requiring surgical removal. Dr. Huebel ordered a CT scan of Patient B’s head, read it as negative and discharged the patient home. Formal radiological interpretation of the CT scan the next morning indicated that Dr. Huebel had missed an acute subdural haemorrhage.

The expert opined that Dr. Huebel’s care of Patient B fell below the standard of practice, in that:

- although Dr. Huebel properly ordered the CT scan, he missed a very important diagnosis of an acute subdural haemorrhage, when the patient had a history of same, making the index of suspicion for this disease entity quite high;
- there was no evidence on the chart that Dr. Huebel conducted a complete and systematic trauma survey, which would be the standard in this case, given visible injuries such as a parietal hematoma was indicated on the paramedic record;
- Dr. Huebel’s charting is illegible, with minimal history and physical exam documented.

Patient C

Patient C, a woman in her 70s, presented to the Hospital emergency department with right hip pain radiating to her lower leg and calf. She had fallen onto her right hip three months prior and had x-rays taken at that time, which were negative. She had visited the emergency department three times in the intervening period for the same pain. Dr. Huebel treated Patient C with medication, ordered a Doppler ultrasound of the right leg, and ordered a blood test for D-dimer, which assists in diagnosing Deep Vein Thrombosis (DVT).

The expert opined that Dr. Huebel’s care of Patient C fell below the standard of practice, in that:

- the Doppler ultrasound ordered by Dr. Huebel was not the appropriate choice of imaging to rule out DVT in Patient C given her age, history of trauma to the region and symptoms of this duration. Rather, the CT scan ordered by a subsequent physician was more appropriate. Both
the ultrasound and CT scan revealed no acute findings.
- Dr. Huebel’s assessment intentions were not indicated in his charting and his documentation of the physical exam was incomplete for the consideration of DVT as a potential cause for the patient’s pain.

Patient D

Patient D, a woman in her 20s, presented to the Hospital emergency department with suicidal thoughts and worsening depression, low mood, decreased sleep and daily use of marijuana and alcohol. She was seen by the crisis team and an on-call psychiatrist, who discharged her with a prescription for Cipralex and follow up with the Psychiatry outpatient clinic. She was then seen by Dr. Huebel, who documented her assessment time as 9:45 and her discharge time as 9:50.

The expert opined that Dr. Huebel’s care of Patient D fell below the standard of practice, in that:

- Dr. Huebel’s charting was illegible, with minimal history and physical exam documented;
- there was no legibly documented justification for the assessment of depression or the statement “medically clear”, which was written in the body of the chart;
- there was no documentation of any medical issues that may have been considered, nor any clinical toxicologic assessment given the patient’s daily use of drugs and alcohol, which is standard for this patient group.

Patient E

Patient E, a man in his late 20s, was trauma patient who presented to the Hospital emergency department after he was involved in a motor vehicle accident on Highway 401. He complained of a headache, dizziness and mid-back/neck pain; he was ambulatory with normal vital signs. Dr. Huebel’s assessment time is documented as 01:55 and the discharge time is documented as 02:00.

The expert opined that Dr. Huebel’s care of Patient E fell below the standard of practice, in that:

- Dr. Huebel’s chart was illegible;
- Dr. Huebel failed to clear Patient E for cervical spine injuries by applying a decision rule such as the Canadian C Spine Rules to determine if imaging was necessary, despite the fact that neck pain was included in the triage notes;
- there was no documentation of the speed of the cars or assessment as to the degree of injury predicted;
- the patient was only seen for 5 minutes, and it is extremely difficult to conduct an appropriate trauma assessment in that timeframe.

Patient F

Patient F, a man in his 50s, presented to the Hospital emergency department with heart palpitations,flushing and dizziness. His vital signs, EKG and blood work were normal, including levels of the cardiac enzyme troponin. Patient F was seen by Dr. Huebel at 22:05 and was discharged by him at 22:15. Dr. Huebel never ordered a second blood test for troponin levels.

The expert opined that Dr. Huebel’s care of Patient F fell below the standard of practice, in that:

- Most of his chart was illegible, with minimal history and physical exam documented;
- while appropriate bloodwork and an EKG were done, there was no legible documented timeframe for the onset of the patient’s symptoms, which made it impossible to know whether the appropriate time delay for testing of cardiac enzymes was met.

Patient G

Patient G, a man in his 80s, presented to the Hospital emergency department with bilateral shoulder aching pain. He had checked his blood pressure and heart rate at home and they were elevated. He had undergone an angiogram 2 weeks prior at a different facility but the Hospital did not have the results. Patient G was on an extensive list of medications and had a history of atrial fibrillation, hypertension and other comorbidities. He was placed on a cardiac monitor.

Dr. Huebel ordered an EKG and bloodwork. The EKG showed atrial fibrillation. The bloodwork was drawn, but then had to be redrawn half an hour lated due to hemolysis. The blood showed elevated troponin levels, which necessitated a subsequent assessment of cardiac enzymes such as troponins after a prescribed interval of time to rule out cardiac ischemia.

Dr. Huebel left the Hospital for several hours, assuming that Patient G would be transferred to another emergency physician and would receive an IV of Procainamide to encourage normal heart rhythm. Upon his return, he learned that Patient G had not been transferred to another physician in his absence. He was still in atrial fibrillation and had not yet received Procainamide. Dr. Huebel ordered an IV of Procainamide intended to convert the patient to a normal heart rhythm.Approximately an hour later, the nurses informed Dr. Huebel, who was working in a different area of the emergency department, that Patient G had converted to normal sinus rhythm. Dr. Huebel discharged Patient G home with a family member.

The expert opined that Dr. Huebel’s care of Patient G fell below the standard of practice, in that:

- Dr. Huebel’s chart was illegible;
- a second set of cardiac enzymes (troponins) was never drawn in order to rule out cardiac ischemia. Aching shoulder pain is recognized as a potential symptom of cardiac ischemia, which should have been considered in a patient with a known cardiac history and recent angiogram;
- a post-cardioversion EKG to document Patient G’s return to normal sinus rhythm was not completed before discharge;
- after being told that he had converted to normal sinus rhythm, Dr. Huebel failed to personally reassess Patient G before discharging him.

The expert noted that it is highly unusual for an emergency physician to be working two shifts in different locations, such that he would need to leave and return a few hours later.

Expert’s conclusion

After reviewing the above cases in detail, the expert concluded that Dr. Huebel does not meet the standard of care expected of a competent physician practicing emergency medicine in the majority of cases; his poor documentation is not up to the standard expected of emergency medicine practitioners; and he displays a lack of knowledge and judgment with respect to the assessment and management of cardiac, trauma, psychiatric and toxicological patients. In the expert’s opinion, this combination has the potential to cause harm to his patients.

Dr. Huebel’s Prior History with the College

In 2004, the Complaints Committee of the College ordered Dr. Huebel to be cautioned in person regarding the importance of performing and documenting a thorough assessment in the emergency department of a patient with symptoms suggestive of myocardial ischemia.

In 2006, the Complaints Committee ordered Dr. Huebel to be cautioned in writing regarding the importance of assessing patients thoroughly to justify his clinical decisions, documenting his assessments and treatment plan in the chart, and reassessing patients prior to discharge to answer questions and provide follow-up instructions.

In 2008, following receipt of complaints regarding Dr. Huebel’s assessment and treatment of two patients in the emergency department, one of whom had suffered a cardiac event and the other was involved in a motor vehicle accident, the College commenced investigation. In the course of the investigation, Dr. Huebel completed the College’s record-keeping course. As a result of the 2008 complaints and investigation, Dr. Huebel entered into an Undertaking with the College in September 2010 (“the 2010 Undertaking”), pursuant to which he was subject to supervision for a period of six months, followed by reassessment.

In October 2010, in response to a patient complaint, the Inquiries, Complaints and Reports Committee (the “ICRC”) issued a verbal caution to Dr. Huebel regarding his inadequate and cursory examination and making a referral too quickly before properly assessing the urgency level
of the patient.

On February 1, 2013, following the reassessment pursuant to the 2010 Undertaking, College inspector reviewed 27 charts selected from Dr. Huebel’s emergency medicine practice and reported that:
- Dr. Huebel’s charting was illegible;
- there was a consistent pattern of deficiencies in Dr. Huebel’s documentation of patient history,physical exam, working or provisional diagnosis and reassessments prior to discharge;
- significant results for investigations and lab tests were not documented; and
- Dr. Huebel’s use of consultants was problematic as he relied on them to assume care of his patients with no further management by him.
As a result of this report, Dr. Huebel was subject to a preceptorship, with a preceptor acceptable to the College meeting with Dr. Huebel every one to two months to review charts selected by the Chief of Emergency Medicine and who would also supervise Dr. Huebel’s ongoing education.

As a result of reassessment as well as a complaint received by the College in 2013 regarding “Patient AA”, the College commenced another investigation of Dr. Huebel’s Emergency Medicine practice. An expert retained by the College reviewed 21 charts selected from Dr. Huebel’s
emergency medicine practice, observed Dr. Huebel’s assessment and treatment of 14 patients and conducted an interview of Dr. Huebel. In his report, dated February 6, 2014, the expert found Dr. Huebel’s documentation regarding his clinical encounters to be “cursory and incomplete”, concluding that it did not meet the expectation for record keeping as set out in the College Policy on Medical Recordkeeping. The expert further opined that Dr. Huebel’s clinical handling of Patient BB did not meet the standard of practice of emergency medicine.

In March and November 2014, allegations of failing to maintain the standard of practice of the profession with respect to Patient AA and Patient BB were referred to the Discipline Committee. In May 2014, Dr. Huebel entered into an undertaking with the College in lieu of an interim order of the ICRC and was subject to the undertaking from May 2014 until his discipline matter was disposed of in January 2015. Pursuant to this undertaking, Dr. Huebel retained a clinical supervisor who met with him once each month, and reviewed at least 10 charts selected by the emergency department Chief or his designate. Dr. Huebel also reviewed at least 50 questions that he had completed from the Emergency Medicine examination preparation handbook or similar web-based program.

Prior Discipline Committee Finding

On January 19, 2015, the Discipline Committee of the College found that Dr. Huebel committed an act of professional misconduct in that he failed to maintain the standard of practice of the profession in his care and treatment of two patients. The Discipline Committee found that:
- Dr. Huebel failed to adequately investigate, diagnose and manage the care of Patient AA, who presented with classical symptoms of aortic dissection, and who subsequently died.
- Dr. Huebel failed to adequately evaluate and care for Patient BB, an insulin-dependent diabetic woman who presented with hypoglycaemia and was seven months pregnant.
- Dr. Huebel’s documentation with respect to Patient BB was cursory and incomplete; it did not meet the standard of care for record-keeping.

The Discipline Committee ordered a reprimand and directed the Registrar to impose the terms of the 2015 Undertaking as terms, conditions and limitations on Dr. Huebel’s certificate of registration, which provided that Dr. Huebel was to undergo a further period of clinical supervision for 12 months, to be followed by two reassessments of his practice.

Subsequent Events

The reports of the clinical supervisor who supervised Dr. Huebel over the following 12 months, meeting with him to review 10 charts selected by the emergency department Chief or his designate, and submitting quarterly reports to the College, were generally positive, though he did consistently note problems with illegibility and insufficient documentation. The clinical supervisor’s final report to the College was dated December 11, 2015.

The misconduct currently at issue occurred between February and May 2016. It came to the College’s attention in late 2016 and was referred to the Discipline Committee on April 10, 2017. On May 2, 2017, the ICRC made an interim order imposing a number of terms, conditions and limitations on Dr. Huebel’s certificate of registration, pending this hearing. The Order required Dr.Huebel to engage a Clinical Supervisor who shall attend in person at all of Dr. Huebel’s encounters with patients and review all patient charts. Dr. Huebel retained a Clinical Supervisor, who supervised him from May 2017 until July 2017. Dr. Huebel has not practised medicine since July 31, 2017.

Disposition

On June 7, 2018, the Discipline Committee ordered that:

- the Registrar suspend Dr. Huebel’s Certificate of Registration for a period of three (3) months, effective immediately.
- the Registrar impose the following terms, conditions and limitations on Dr. Huebel’s Certificate of Registration:

Practice Restrictions
- Dr. Huebel shall not engage in the practice of medicine as the Most Responsible Physician for any patient(s) whatsoever.
- The entirety of Dr. Huebel’s scope of practice shall be limited in the following ways:
-  He shall only practise medicine in a hospital setting as a surgical assistant of a surgeon:
- certified by the Royal College of Physicians and Surgeons or recognized as a surgical specialist by the College; and
- who has been approved by the College,(collectively, a “Qualified Surgeon”);
 and
- for further clarity, but without limiting the generality of the above:
- Dr. Huebel shall not provide any pre-operative or post-operative care whatsoever; and
- a Qualified Surgeon must always be physically in attendance when Dr.Huebel is engaging in practice as a surgical assistant.
- Dr. Huebel shall not engage in any practice of medicine that is not expressly and specifically listed above.
Monitoring
- Dr. Huebel shall inform the Collge 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.
- Dr. Huebel shall submit to, and not interfere with, unannounced inspections of his Practice Location(s) and patient charts by a College representative for the purposes of monitoring and enforcing his compliance with the terms of this Order.
- Dr. Huebel shall consent to the College making appropriate enquiries of the Ontario Health Insurance Plan and/or any person or institution that may have relevant information, in order for the College to monitor and enforce his compliance with the terms of this Order.
- Dr. Huebel shall consent to the College providing all Qualified Surgeon(s) and Chief(s) of Staff with any information relevant to this Order and/or arising from the monitoring of his compliance with the terms of this Order.
- Dr. Huebel shall consent to any Qualified Surgeon and any Chief of Staff disclosing to the College, and to one another, all information relevant to this Order and/or relevant for the purposes of monitoring his compliance with the terms of this Order.
General
- Nothing in this Order shall be construed as preventing Dr. Huebel from seeking to vary this Order in the future.
- Dr. Huebel shall be responsible for any and all costs associated with implementing the terms of this Order.

- Dr. Huebel appear before the panel to be reprimanded.
- Dr. Huebel pay to the College its costs of this proceeding in the amount of $10,180.00 within thirty (30) days from the date of this Order.
 


Decision: Download Full Decision (PDF)
Hearing Date(s): June 7, 2018

 

Committee: Discipline
Decision Date: 19 Jan 2015
Summary:

On January 19, 2015, the Discipline Committee found that Dr. Huebel committed an act of professional misconduct in that he failed to maintain the standard of practice of the profession. Dr. Huebel admitted to the allegation.

Patient A presented to the Emergency Department in August 2012 with back and chest pain and a history of some slurred speech. She was seen by an emergency physician, had some investigations done and was discharged with a diagnosis of TIA and chest pain not yet diagnosed. The blood work conducted that day at the Emergency Department was unremarkable.She was to have follow-up tests.

Dr. Huebel saw Patient A when she returned two days later and documented her past medical history. He documented her history of a sudden sharp chest and mid-back pain that occurred two days prior with an episode of an altered state of consciousness. He noted that the CT head scan done at that time showed no acute abnormality and that the Troponin done at that visit was negative. There are scant details of a physical examination, which was essentially unremarkable.Dr. Huebel ordered blood work, a chest x-ray, a thoracic spine x-ray and a CT scan to rule out pulmonary embolism. He also ordered medication, including Zofran and Toradol.

Dr. Huebel’s documentation indicates that the patient returned from diagnostic imaging with a diagnosis of dissection of the carotid artery. The chart appears to contain a provisional diagnosis of probable thoracic degenerative spine disease/spasms/carotid dissection. When the patient returned from the CT scan, a Code Blue was called. The patient could not be revived.

Dr. X, Assessor for the College, was asked to provide his opinion on the care provided by Dr.Huebel to Patient A. Dr. X stated that Dr. Huebel fell below the standard of care for a practising emergency physician in Ontario, among other things:

When a patient with severe back pain radiating to the front presents with such a difference in blood pressures, the standard of care would be to consider an aortic dissection first and foremost above all other diagnoses and to order immediate investigations to rule out that possibility. Any delays by ordering other different types of tests would be inappropriate in the presence of such a classical presentation of an aortic dissection…the standard of care would have been to order an immediate ECG, and to arrange an immediate CT scan to rule out an aortic dissection…

Patient B was an insulin-dependent diabetic female who was pregnant at the time Dr. Huebel saw her in January 2013. She presented to the Emergency Department with an altered mental status.Dr. Huebel provided Patient B with food to verify that she was PO tolerant and to give her a more complex source of carbohydrates to prevent a relapse into hypoglycemia. He discharged Patient B with a final diagnosis of hypoglycemia.

Dr. Y, Assessor for the College, opined, among other things, that the evaluation and care of Patient B and Dr. Huebel’s documentation were inadequate, and the risks posed to the unborn fetus were not accurately considered and assessed. Dr. Huebel failed to maintain the standard of practice of the profession in his care and treatment of Patient B.

On the basis of two complaints in 2008 and Dr. Huebel’s history with the College (Caution in person in 2004, Caution in writing in 2006), the College commenced an investigation of Dr.Huebel’s emergency medicine practice.

In 2010, Dr. Huebel entered into an Undertaking with the College. That Undertaking provided that Dr. Huebel would be subject to supervision for a period of six months, after which he would be reassessed by the College.

In her report to the College, Dr. Q, Assessor for the College, noted that Dr. Huebel’s charting was illegible, that there was a consistent pattern of deficiencies in Dr. Huebel’s documentation of patient history, physical exam, working or provisional diagnosis and reassessments prior to discharge, that significant results for investigations and lab tests were not documented, and that
Dr. Huebel’s use of consultants was problematic as he relied on them to assume care of his patients with no further management by him.

Commencing in 2013, Dr. Huebel has undertaken significant remedial and educational efforts to expand his knowledge base and improve his practice, which included: becoming a member of the College of Family Physicians of Canada, obtaining 198.3 CME credits from January 2013 to October 2014, and he applied for and was accepted into the Alternative Route for Certification (ARC) program, which is a practice eligible route to the CCFP Designation.

In the context of its investigation of Dr. Huebel’s emergency medicine practice, the College retained Dr. Y to review Dr. Huebel’s practice. Dr. Y found Dr. Huebel’s clinical handling of the 14 patient encounters he reviewed to be appropriate and that he met the standard of care expected by the profession and did not expose any of his patients to harm or injury.

In March 2014, Dr. S, Chief of Dr. Huebel’s Emergency Department, advised the College of improvements to Dr. Huebel’s clinical practice over the past year.

In May 2014, Dr. Huebel entered into an undertaking with the College, pending this hearing.Pursuant to the undertaking, Dr. Huebel retained Dr. T, Chief of Emergency Services, as a clinical supervisor. To date, Dr. T has expressed no concerns about Dr. Huebel’s care or treatment of patients.

On January 13, 2015, Dr. Huebel signed an undertaking with the College requiring him to continue supervision with a Clinical Supervisor, continue in the ARC program, and submit to two reassessments of his practice.

The Discipline Committee ordered and directed that:
1. Dr. Huebel appear before the panel to be reprimanded.
2. the Registrar impose the terms of Dr. Huebel’s undertaking with the College dated January 13, 2015, as terms, conditions and limitations on Dr. Huebel’s certificate of registration.
3. Dr. Huebel 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): January 19, 2015