Fenton, Peter Michael (CPSO#: 63915)

Current Status: Active Member as of 21 Sep 2017

CPSO Registration Class: Restricted as of 30 Apr 2016

Indicates a concern or additional information

Summary

Former Name: No Former Name

Gender: Male

Languages Spoken: English, Hungarian

Education:University of Toronto, 1991

Practice Information

Primary Location of Practice
Practice Address Not Available
View Professional Corporation Information

Professional Corporation Information

Corporation Name: Peter Fenton Medicine Professional Corporation

Certificate of Authorization Status: Inactive: Dec 19 2016

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 17 Jun 1991
Expired: Terms and conditions of certificate of registration Expiry: 15 Jun 1992
Subsequent certificate of registration Issued: Independent Practice Certificate Effective: 24 Jun 1992
Transfer of class of certificate to: Restricted certificate Effective: 30 Apr 2016
Terms and conditions amended Effective: 21 Mar 2017
Suspension of registration imposed: Discipline Committee Effective: 21 Mar 2017
Suspension of registration removed Effective: 21 Sep 2017
Terms and conditions amended by Discipline Committee Effective: 21 Sep 2017

Pending Hearings

Summary: Allegations of Dr. Fenton’s professional misconduct have been referred to the Discipline Committee of the College. It is alleged that Dr. Fenton engaged in disgraceful, dishonourable or unprofessional conduct by breaching the terms of the Undertaking that he had entered into with the College on July 3, 2016 by failing to attend regular appointments with his treating physician between January, 2017 and January, 2018 and by breaching the terms of the March 20, 2017 Discipline Committee Order by failing to take measures to ensure his completion of required activities within the required timeframe.

Notice of Hearing: Download Full Notice (PDF)

Practice Restrictions

Imposed By Effective Date Expiry Date Status  
Discipline Committee Effective: 21 Sep 2017 Active View Details [+]

            (1 of 3)
            As  from  September 21, 2017, the following is imposed as a term, condition and
            limitation  on the certificate of registration held by Dr. Peter Michael Fenton
            in accordance  with  an  Order  of  the  Discipline Committee of the College of
            Physicians and Surgeons of Ontario, dated March 20, 2017: 

            Dr. Peter Michael Fenton has ceased practising  medicine  until such time as he
            has obtained a Clinical Supervisor acceptable to the College.

            (2 of 3)
            As from 12:01a.m., March 21, 2017, by order of the Discipline  Committee of the
            College of Physicians and Surgeons of Ontario, the following terms,  conditions
            and  limitations  are  imposed  on the certificate of registration held by  Dr.
            Peter Michael Fenton:

            Education

            (a)   Dr. Fenton shall, at his own  expense,  participate  in  and successfully
                  complete the following educational courses within six (6)  months  of the
                  date of this Order:

                  (i)   the Medical Record Keeping Course offered through the University of
                        Toronto;
                  
                  (ii)  the  Pri-Med  Canada  Course  (formerly  Primary Care Today Course)
                        scheduled for May 10-13, 2017; 
                  
                  (iii) the Understanding Boundaries Course offered  through the University
                        of Western Ontario; 
                  
                  (iv)  individualized instruction in ethics, satisfactory  to the College,
                        with an instructor satisfactory to the College; and
                  
                  (v)   individualized instruction in communications, satisfactory  to  the
                        College, with an instructor satisfactory to the College. 
                  
            (b)   Further  to  paragraphs  6(a)(iv)  and  6(a)(v),  the instructor(s) shall
                  provide a summative report to the College including his or her conclusion
                  about whether the instruction was completed successfully  by  Dr. Fenton,
                  including information regarding Dr. Fenton's progress and compliance.

            Clinical Supervision

            (c)   Dr. Fenton shall, by September 21, 2017, retain a clinical supervisor  or
                  supervisors  (the  "Clinical  Supervisor") acceptable to the College, who
                  will sign an undertaking in the  form  attached  hereto  as Schedule "A".
                  For  a period of twelve (12) months thereafter, Dr. Fenton  may  practise
                  only  under   the  supervision  of  the  Clinical  Supervisor.   Clinical
                  Supervision  of   Dr.  Fenton's  practice  shall  contain  the  following
                  elements:  

                  (i)   The Clinical Supervision shall be at a moderate level for a minimum
                        of six (6) months,  commencing  on  the  date Dr. Fenton returns to
                        work following the expiry of the suspension  of  his certificate of
                        registration.   The Clinical Supervisor will meet with  Dr.  Fenton
                        weekly and review  ten  to  fifteen (10-15) of Dr. Fenton's patient
                        charts,  discuss Dr. Fenton's  patient  care,  treatment  plan  and
                        follow-up, identify any concerns regarding the care, treatment plan
                        and follow-up and make recommendations for improvement;
                  
                  (ii)  Dr. Fenton shall permit the Clinical Supervisor to directly observe
                        him in practice  for one half-day per week or, at minimum, five (5)
                        patients per visit, with the Clinical Supervisor providing a report
                        every month to the College; 
                  
                  (iii) After  three  (3) months,  and  only  upon  recommendation  by  the
                        Clinical Supervisor  and  approval of the College, the frequency of
                        the meetings with and observation by the Clinical Supervisor may be
                        reduced to biweekly;
                  
                  (iv)  After six (6) months of moderate level supervision, at minimum, and
                        only upon recommendation by the Clinical Supervisor and approval of
                        the College, the Clinical Supervision  may  be reduced to low level
                        supervision  for six (6) months.  During the period  of  low  level
                        supervision, the  frequency  of  the  Clinical Supervisor' meetings
                        with and, if required, observation of Dr.  Fenton  shall be reduced
                        to monthly;
                  
                  (v)   Dr.  Fenton  shall  fully  cooperate with, and shall abide  by  any
                        recommendations  of  his Clinical  Supervisor,  including  but  not
                        limited  to  any  recommended  practice  improvements  and  ongoing
                        professional development; 
                  
                  (vi)  If a Clinical Supervisor  who  has given an undertaking in the form
                        attached at Schedule "A" to this  Order  is  unwilling or unable to
                        continue to fulfill its terms, Dr. Fenton shall, within twenty (20)
                        days of receiving notice of same, obtain an executed undertaking in
                        the same form from a similarly qualified person  who  is acceptable
                        to  the  College  and  ensure  that  it is delivered to the College
                        within that time; and 
                  
                  (vii) If  Dr.  Fenton  is  unable  to  obtain  a Clinical  Supervisor  in
                        accordance with paragraph 6(c) or paragraph 6(c)(vi) of this Order,
                        he shall cease practising medicine immediately  until  such time as
                        he has done so, and the fact that he has ceased practising medicine
                        will  constitute a term, condition or limitation on his certificate
                        of registration until that time. 
                  
            Reassessment

            (d)   Approximately   six   (6)   months   after  the  completion  of  Clinical
                  Supervision, Dr. Fenton shall undergo a reassessment of his practice by a
                  College-appointed assessor (the "Assessor").   The assessment may include
                  a review of Dr. Fenton's patient charts, direct 
                  observation,  interviews  with  staff  and/or  patients,   one   or  more
                  interviews  with Dr. Fenton, and/or a formalized evaluation.  The results
                  of the assessment shall be reported to the College after which Dr. Fenton
                  shall abide by  any  recommendations  made  by  the Assessor by which the
                  College has requested Dr. Fenton to abide. 
                  
            (e)   Dr.  Fenton  shall  consent  to  such  sharing of information  among  the
                  Assessor, the Clinical Supervisor, and the  College  as  any of them deem
                  necessary  or desirable in order to fulfill their respective  obligations
                  and in order to monitor Dr. Fenton's compliance with this
                  Order and with any terms, conditions or limitations on his certificate of
                  registration.
                  
            Monitoring

            (f)   Dr. Fenton shall  consent  to the College providing any Chief(s) of Staff
                  or a colleague with similar responsibilities, such as a medical director,
                  at  any  location  where he practises  ("Chief(s)  of  Staff")  with  any
                  information the College has that led to this Order and/or any information
                  arising from the monitoring of his compliance with this Order. 

            (g)   Dr. Fenton shall inform  the  College of each and every location where he
                  practices, in any jurisdiction  (his  "Practice Location(s)") within five
                  (5) days of this Order and shall inform  the  College  of any and all new
                  Practice  Locations within five (5) days of commencing practice  at  that
                  location.

            (h)   Dr. Fenton  shall  cooperate with unannounced inspections of his Practice
                  Location(s) and patient  charts  by  a  College representative(s) for the
                  purpose of monitoring and enforcing his compliance with the terms of this
                  Order.

            (i)   Dr. Fenton shall consent to the College making  enquiries  of the Ontario
                  Health  Insurance  Plan  ("OHIP"), the Drug Program Services Branch,  the
                  Narcotics Monitoring System  implemented  under  the Narcotics Safety and
                  Awareness  Act, 2010, S.O. 2010, c. 22, as amended  ("NMS"),  and/or  any
                  person who or  institution  that  may have relevant information, in order
                  for the College to monitor and enforce  his  compliance with the terms of
                  this  Order  and  any terms, conditions or limitations  on  Dr.  Fenton's
                  certificate of registration. 

            (j)   Dr. Fenton shall be  responsible  for  any  and all costs associated with
                  implementing the terms of this Order.

            (3 of 3)
            As  from  March  7, 2017, the following is imposed as  a  term,  condition  and
            limitation on the certificate of registration held by Dr. Peter Michael Fenton,
            in accordance with  an  undertaking  and  consent  given  by  Dr. Fenton to the
            College of Physicians and Surgeons of Ontario:

                               UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
                                            ("Undertaking")
                                                  of
                                          DR. PETER M. FENTON
                                            ("Dr. Fenton")
                                                  to
                             COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
                                            (the "College")

            A.    PREAMBLE

            (1)   In this Undertaking:

                  "Code" means the Health Professions Procedural Code, which  is Schedule 2
                  to  the  Regulated  Health  Professions Act, 1991, S.O. 1991, c.  18,  as
                  amended; 
                  
                  "NMS" means the Drug Program  Services  Branch,  the Narcotics Monitoring
                  System implemented under the Narcotics Safety and  Awareness  Act,  2010,
                  S.O. 2010, c. 22, as amended;
                  
                  "OHIP" means the Ontario Health Insurance Plan.
                  
            (2)   I,  Dr. Fenton, certificate of registration number 63915, am a member  of
                  the College.   The College has received information regarding my standard
                  of practice.

            (3)   I, Dr. Fenton, acknowledge  that  the  College initiated an investigation
                  bearing File Number 7215572 (the "Investigation")  into whether I engaged
                  in professional misconduct and/or am incompetent in  my  family practice,
                  including in my prescribing of controlled drugs and narcotics.

            (4)   I,  Dr.  Fenton, acknowledge that I am not currently practicing  medicine
                  and understand  that  this  Undertaking  will  be  in force if and when I
                  return to practice. 

            B.    UNDERTAKING

            (5)   I, Dr. Fenton, undertake to abide by the provisions  of this Undertaking,
                  effective upon the date this Undertaking is approved by the ICR Committee
                  ("Effective Date").

            (6)   Resignation of Prescribing Privileges   

                  (a)   I,  Dr.  Fenton, acknowledge that I have executed  the  Prescribing
                        Resignation  Letter  to  Health Canada, which is attached hereto as
                        Schedule "A" (the "Resignation Letter").
                  
                  (b)   I,  Dr. Fenton, consent to  the  College  sending  the  Resignation
                        Letter to Health Canada on my behalf.
                  
                  (c)   I, Dr.  Fenton,  undertake  and  agree  that  I  will not issue new
                        prescriptions  or  renew  existing  prescriptions for  any  of  the
                        following substances:
                  
                        (i)   Narcotic Drugs (from the Narcotic  Control  Regulations  made
                              under the Controlled Drugs and Substances Act, S.C., 1996, c.
                              19);
                  
                  
                        (ii)  Narcotic  Preparations (from the Narcotic Control Regulations
                              made under  the  Controlled  Drugs  and Substances Act, S.C.,
                              1996, c. 19);
                  
                        (iii) Controlled  Drugs  (from  Part  G  of  the   Food   and  Drug
                              Regulations  under  the  Food  and Drugs Act, S.C., 1985,  c.
                              F-27); 
                  
                        (iv)  Benzodiazepines  and  Other  Targeted  Substances  (from  the
                              Benzodiazepines  and  Other Targeted  Substances  Regulations
                              made under the Controlled  Drugs  and  Substances Act., S.C.,
                              1996, c. 19); 
                  
                        (A  summary  of  the  above-named  drugs [from Appendix  I  to  the
                        Compendium of Pharmaceuticals and Specialties]  is  attached hereto
                        as  Schedule  "B";  and  the current regulatory lists are  attached
                        hereto as Schedule "C")
                  
                        (v)   All other Monitored  Drugs  (as  defined  under the Narcotics
                              Safety and Awareness Act, 2010, S.O. 2010,  c. 22 as noted in
                              Schedule "D");                       
                  
                        and as amended from time to time.
                  
                  (d)   I, Dr. Fenton, undertake to immediately refer all patients  to whom
                        I am prescribing any of the substances described in section (6)(c),
                        above, to other physicians for assessment and care.
                  
                  (e)   I, Dr.  Fenton, undertake to keep a log of all patients referred to
                        other physicians pursuant to section (6)(d), above (the "Log").  I,
                        Dr.  Fenton,  undertake  to  include  in  the  Log the name of each
                        patient referred, the name of the physician he/she was referred to,
                        and the date of referral. 
                  
            (7)   I,  Dr.  Fenton,  undertake  that  I  will  return  any supplies  of  the
                  substances referred to in section (6)(c) above that are  presently  in my
                  possession,  in any place, to a pharmacy in a safe and secure manner,  as
                  stipulated in the College's Policy Number 8-12, "Prescribing Drugs."

            (8)   I, Dr. Fenton, undertake to inform the College of each and every location
                  that I practise  or  have  privileges,  including,  but  not  limited to,
                  hospital(s),  clinic(s)  and office(s), in any jurisdiction (collectively
                  my "Practice Location(s)"),  within  fifteen  (15) days of executing this
                  Undertaking.  Going forward, I further undertake to inform the College of
                  any and all new Practice Locations within fifteen (15) days of commencing
                  practice at that location.

            (9)   Posting a Sign 

                  (a)   I, Dr. Fenton, undertake that I shall post  a  sign  in the waiting
                        room(s)  of  all  my  Practice Locations, in a clearly visible  and
                        secure location, in the  form set out at Schedule "E."  For further
                        clarity, this sign shall state as follows: 
                  
                                          IMPORTANT NOTICE
                  
                              Dr. Fenton must not prescribe any of the following: 
                              Narcotic Drugs
                              Narcotic Preparations
                              Controlled Drugs
                              Benzodiazepines and Other Targeted Substances
                              All other Monitored Drugs
                  
                              Further information may be found on the College of Physicians
                              and Surgeons of Ontario website at www.cpso.on.ca
                  
                  (b)   I, Dr. Fenton, undertake to  post  a  certified  translation in any
                        language  in  which  I provide services, of the sign  described  in
                        section (9)(a) above,  in  the  waiting  room(s) of all my Practice
                        Locations, in a clearly visible and secure  location,  in  the form
                        set out at Schedule "E." 
                  
                  (c)   I,  Dr.  Fenton,  undertake to provide the certified translation(s)
                        described in section (9)(b), to the College within thirty (30) days
                        of executing this Undertaking.
                  
                  (d)   I, Dr. Fenton, undertake  that  if  I elect, after the execution of
                        this Undertaking, to provide services  in  any other language(s), I
                        will notify the College prior to providing any such services. 
                  
                  (e)   I,  Dr. Fenton, undertake to provide to the College  the  certified
                        translation(s)  described  in  section (9)(c) prior to beginning to
                        provide services in the language(s) described in section (9)(d).
                  
            C.    ACKNOWLEDGEMENT

            (10)  I, Dr. Fenton, acknowledge that all schedules  attached to or referred to
                  in this Undertaking form part of this Undertaking.

            (11)  I,  Dr.  Fenton,  acknowledge  and  undertake  that  I  shall  be  solely
                  responsible  for  payment  of  all  fees, costs, charges, expenses,  etc.
                  arising  from  the  implementation  of any  of  the  provisions  of  this
                  Undertaking.

            (12)  I, Dr. Fenton, acknowledge that I have read and understand the provisions
                  of this Undertaking and that I have obtained independent legal counsel in
                  reviewing and executing this Undertaking,  or  have waived my right to do
                  so.

            (13)  I, Dr. Fenton, acknowledge that the College will provide this Undertaking
                  to   any   Chief(s)   of   Staff,   or   a   colleague(s)  with   similar
                  responsibilities, at any Practice Location ("Chief(s) of Staff").

            (14)  I, Dr. Fenton, acknowledge that a breach by me  of  any provision of this
                  Undertaking  may  constitute  an  act  of professional misconduct  and/or
                  incompetence, and may result in a referral  of  specified  allegations to
                  the Discipline Committee.

            (15)  I,  Dr.  Fenton,  acknowledge  that  this Undertaking constitutes  terms,
                  conditions, and limitations on my certificate  of  registration  for  the
                  purposes of section 23 of the Code. 

            (16)  I,  Dr.  Fenton, acknowledge that this Undertaking shall be posted on the
                  College's Register that is available to the public during the time period
                  that the Undertaking remains in effect.

            (17)  I, Dr. Fenton,  acknowledge that the following summary will appear on the
                  College's Register that is available to the public during the time period
                  that this Undertaking remains in effect:

                        Dr. Fenton  was the subject of a College investigation into whether
                        he engaged in  professional misconduct and/or is incompetent in his
                        family practice,  specifically in his prescribing of controlled and
                        narcotic drugs. As a result of the investigation: 
                  
                        Dr. Fenton must not  issue  new  prescriptions  or  renew  existing
                        prescriptions for any of the following substances:
                        
                        (i)   Narcotic  Drugs  (from the Narcotic Control Regulations  made
                              under the
                               Controlled Drugs and Substances Act, S.C., 1996, c. 19);
                  
                        (ii)  Narcotic Preparations  (from the Narcotic Control Regulations
                              made under the Controlled  Drugs  and  Substances  Act, S.C.,
                              1996, c. 19);
                  
                        (iii) Controlled   Drugs   (from  Part  G  of  the  Food  and  Drug
                              Regulations under the  Food  and  Drugs  Act,  S.C., 1985, c.
                              F-27); 
                  
                        (iv)  Benzodiazepines  and  Other  Targeted  Substances  (from  the
                              Benzodiazepines  and  Other  Targeted  Substances Regulations
                              made  under the Controlled Drugs and Substances  Act.,  S.C.,
                              1996, c. 19); 
                  
                        (v)   All other  Monitored  Drugs  (as  defined under the Narcotics
                              Safety and Awareness Act, 2010, S.O. 2010, c. 22);        
                  
                              and as amended from time to time.
                  
                        Dr. Fenton must post a clearly visible sign in the waiting rooms of
                        all his Practice Locations, which states as follows: 
                  
                                                IMPORTANT NOTICE
                  
                                    Dr. Fenton must not prescribe any of the following: 
                                          Narcotic Drugs
                                          Narcotic Preparations
                                          Controlled Drugs
                                          Benzodiazepines and Other Targeted Substances
                                          All other Monitored Drugs
                  
                                    Further  information may be found  on  the  College  of
                                    Physicians   and   Surgeons   of   Ontario  website  at
                                    www.cpso.on.ca
                  
            D.    CONSENT

            (18)  I,  Dr.  Fenton,  undertake  and  agree that I will submit  to,  and  not
                  interfere with, unannounced inspections  of  my  Practice Location(s) and
                  patient charts by the College and to any other activity the College deems
                  necessary in order to monitor my compliance with the  provisions  of this
                  Undertaking.

            (19)  I,  Dr.Fenton,  give  my  irrevocable  consent  to  the  College  to make
                  appropriate  enquiries  of  OHIP,  NMS, and any person who or institution
                  that may have relevant information,  in  order for the College to monitor
                  my compliance with the provisions of this Undertaking.

            (20)  I, Dr. Fenton, acknowledge that I have executed  the OHIP and NMS consent
                  forms, attached hereto as Schedule "F" and Schedule "G", respectively.

            (21)  I, Dr. Fenton, give my irrevocable consent to the  College to provide all
                  Chief(s) of Staff with any information the College has  that  led  to the
                  circumstances  of  my  entering into this Undertaking and any information
                  arising from the monitoring of my compliance with this Undertaking.

Previous Hearings

Committee: Discipline
Decision Date: 20 Mar 2017
Summary:

On March 20, 2017, the Discipline Committee found that Dr. Peter Michael Fenton 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. The Discipline Committee also found that Dr. 
Fenton is incompetent. 
 
Dr. Fenton received his certificate of registration authorizing independent practice in Ontario in 
June 1992. At all relevant times, Dr. Fenton practised in a solo family medicine practice in 
Toronto. 

After receiving a public complaint in June 2013 and information from a physician in July 2014 
expressing concern regarding Dr. Fenton’s prescribing to a patient, the College conducted a 
broader investigation into Dr. Fenton’s prescribing practices. 
The College retained a family physician expert who opined that Dr. Fenton’s care and treatment 
displayed a lack of knowledge, skill and judgment and that he failed to meet the standard of 
practice in the following respects: 
-  His charting is completely inadequate in terms of lack of substantive content for patient 
   encounters, lack of useful cumulative patient profiles, including current medication lists, and 
   when screening for controlled substances is begun in the fall of 2014, there is evidence of 
   lack of insightful enquiry. Referral letters to consultants are consistently insufficient in 
   content; 
-  There is a widespread lack of preventative care and chronic disease management; 
-  His acute presentation management as presented in his charts is generally superficial and 
   treatment is not evidence based. Referrals are made at patient’s request with little 
   documentation of thought of possible differential diagnoses; 
-  His failure to acknowledge and appropriately document follow up concerns such as systolic 
   blood pressure greater than 200 mm Hg and a neck mass growing in size could be considered 
   as risks to the patient; 
-  His EMR is not used effectively for medication management, cumulative patient profiles, or 
   lab result management.  
-  He prescribes controlled substances in excess quantities in many charts and there is lack of 
   knowledge of guidelines for safe prescribing as outlined in the CPSO Policy #8-12 regarding 
   prescribing of medications and the Canadian Guidelines for Safe and Effective Use of 
   Opioids for Chronic Non Cancer Pain. He does not have a solid understanding of the use of 
   urine toxicology screening for controlled substances. 
-  There is evidence that he continues prescribing controlled substances for patients with 
   possible adverse events, which may be directly related to the medication prescribed. Poly-
   pharmacy is often seen, and may be causing adverse effects such as decreased cognitive 
   functioning in the elderly or insomnia in the case of excessive stimulant doses; and 
-  He appears to lack the professionalism to practice evidence based medicine, which he 
   appears to have knowledge of, opting instead to prescribe as per the wishes of his “difficult” 
   “demanding” patients, as he describes them. 
In the course of the investigation, Dr. Fenton obtained a copy of expert’s report, which contained 
the initials, date of birth and sex for 26 of Dr. Fenton’s patients together with a detailed review of 
                                      1 

the treatment and care received. Dr. Fenton showed the expert report to at least one of his 
patients, including a patient who was not the subject of Dr. Morrison’s review.   
Dr. Fenton is incompetent and failed to maintain the standard of practice of the profession with 
respect to his prescribing of narcotic drugs, narcotic preparations, controlled drugs, 
Benzodiazepines and other targeted substances and all other monitored drugs (“Controlled 
Substances”), as described above.   
Dr. Fenton also failed to maintain the standard of practice of the profession as described above, 
including by failing to follow appropriate practices related to chronic disease management and 
preventative care; and failing to maintain appropriate clinical notes and records. 
Dr. Fenton engaged in conduct that would reasonably be regarded by members as disgraceful, 
dishonourable or unprofessional in failing to preserve and maintain patient confidentiality during 
the College’s investigation.  
 
Investigation regarding Patient A 

On December 8, 2014, the College received a public complaint from Patient A, who had been a 
patient of Dr. Fenton’s for approximately five years and whose care included treatment for 
chronic pain and anxiety. Dr. Fenton dismissed Patient A from his practice in late November 
2014.  
The College expert opined that Dr. Fenton’s medical records demonstrate a significant lack of 
knowledge, skill and judgment in medical record keeping and controlled substance prescribing, 
and do not meet the standard of care of the profession for a family physician as follows: 
-  Dr. Fenton’s recorded histories are often non-existent and lack detail to understand the 
   patient’s story. His documented physical examinations are either lacking entirely or 
   insufficient for the complex chronic pain condition this patient reports. No investigations are 
   done with respect to Patient A’s physical pain or anxiety conditions. Impressions and 
   management plans are not outlined regularly. Not all prescriptions given are recorded in the 
   EMR. Rational for the prescription of medications (choice of drug, dose or quantity) 
   including many controlled substances is not found in the medical record. CPP was not 
   completed until after the patient was discharged from the practice. 
-  Dr. Fenton’s prescribing of controlled substances including narcotics, benzodiazepines and 
   stimulants is excessive and without documented justification. 
-  Prescription information from the NMS database and Dr. Fenton’s chart calculate over 1000 
   morphine equivalents daily well in excess of “watchful dose” limits. There is a lack of 
   evidence of application of recognized controlled substance prescribing guidelines. There is 
   no adequate discussion of side effects, risks and alternative analgesic options. There are no 
   clear treatment goals documented. There is no documented indication for either stimulant or 
   sedative medication, or discussion about the use [of] both categories of medication being 
   prescribed concurrently. There is no supporting documentation of underlying diagnoses to 
   support the use of these medications. There is no supporting evidence of favourable clinical 
   outcomes as a result of these treatments. 
-  Dr. Fenton appropriately advised Patient A that because of repeated breaches of their opiate 
   treatment agreement, he would no longer continue to prescribe controlled substances for 
   Patient A. This would be partially considered to be within the standard of care for 
                                      2 

   termination of a physician patient relationship as per CPSO Policy, however the policy also 
   indicates a copy of this letter should be sent by registered mail to the patient and a copy be in 
   the patient record. There is no documentation in the chart or in the patient complaint that the 
   patient received such a letter. In addition, in considering termination of the patient physician 
   relationship, there is no evidence that arrangement for any consultations with a pain clinic or 
   alternate provider were made which would also be within the standard of care in family 
   medicine. More importantly there is no evidence that strategies of tapering doses of her 
   various medications or dispensing smaller quantities at one time, which would have 
   potentially mitigated some of her risk having been taking such high doses of narcotics and 
   sedatives prior to her dismissal. 
Dr. Fenton is incompetent and failed to maintain the standard of practice in his care and 
treatment of Patient A, as described above, including his failure to follow the College’s Policy 
regarding Ending the Physician-Patient Relationship.    
Investigation Regarding Patient B   

On January 22, 2015, the College received a public complaint from Patient B who had been a 
patient of Dr. Fenton’s from approximately July 2008 until November 2014.  Patient B’s medical 
history includes hypertension, hypercholesterolemia, diabetes and chronic pain.  
The College expert opined that Dr. Fenton’s care of Patient B did not meet the standard of care, 
including in his record keeping, his chronic disease management and his follow up on abnormal 
test results and suggestions of consultants. Specifically, the expert noted the following 
deficiencies: 
-  There is evidence that medications are prescribed but not recorded within the EMR. A large 
   gap exists in that there is no evidence of chronic disease management between the periods 
   June 2013 to May 2014. There is evidence that abnormal test results and suggestions of 
   consultant (in this case the ER doctor) are not followed up.  
-  Dr. Fenton’s treatment of [Patient B’s] hypertension is not clear from the documentation 
   found in the chart in that a complete list of medications being prescribed is not found in the 
   record provided. It is unclear as to when or why hydrochlorothiazide appears to have been 
   added. There is no documented risk stratification. There is no assessment of possible end 
   organ damage. The management of hypertension and its risks as documented does not meet 
   the standard of care as expected of a competent practitioner in Family Medicine and 
   demonstrates a lack of skill and judgment in the management of this chronic disease. 
-  The diagnosis and management of diabetes by Dr. Fenton does not follow the current 
   guidelines of the Canadian Diabetic Association. Dr. Fenton appears from the chart to have 
   made the diagnosis of diabetes based on a single laboratory reading of HbA1c equaling 
   0.065. There is no discussion of repeating this test on a different day as recommended. Once 
   diagnosed, appropriate treatment based on the information provided would begin with 
   discussion of lifestyle management of weight loss, exercise, and dietary habits including 
   referral to allied health professionals for education would be the expected standard of care. 
   The only documentation in this regard is “weight loss discussed” following the visit where 
   metformin therapy was instituted. 
-  There is mention in the chart provided of discussion of lipid management, however targets 
   were not identified. Again there is no evidence of risk stratification to guide treatment 
                                      3 

   decisions as outlined in current guidelines. The patient appears to have been put on sub 
   therapeutic doses of atorvastatin and had Ezetrol added in 2012, with no follow up to 
   document response to treatment, or potential side effects until 2014. There is no discussion 
   documented regarding maximizing the dose of the statin, or reasons why this would not be 
   appropriate, before starting another class of medication which is considered standard of care 
   by current guidelines. There is no discussion of lipid management following the lab work 
   done in May 2014, which included a lipid profile and Dr. Fenton’s diagnosis of diabetes. 
On December 17, 2015, the College’s investigator received a call from Patient B who described 
running into Dr. Fenton recently at a Tim Horton’s in their neighbourhood. During that 
encounter, Dr. Fenton asked Patient B to call the College and drop the investigation regarding 
Dr. Fenton. Patient B asked the College investigator to contact Dr. Fenton and request that Dr. 
Fenton not approach him in the future if they see each other in the community.    
Dr. Fenton failed to maintain the standard of practice of the profession in his care and treatment 
of Patient B, as described above, including his failure to follow the College’s Policy regarding 
Test Results Management. 
Dr. Fenton engaged in conduct that would reasonably be regarded by members as disgraceful, 
dishonourable or unprofessional in his failure to transfer Patient B’s medical chart in a timely 
manner; and his communications with Patient B regarding his complaint to the College and his 
request for Patient B to withdraw his complaint.   
Investigation Regarding Patient C   

On July 28, 2015, the College received a public complaint from Patient C’s lawyer who was 
representing Patient C with respect to an insurance claim and accident benefits arising out of a 
motor vehicle accident in 2010. Patient C was a patient of Dr. Fenton’s since approximately 
2009. Between August 2011 and July 2015, Patient C’s lawyer made several attempts to obtain 
Patient C’s medical chart from Dr. Fenton. Despite multiple requests by the College, the EMR 
and the paper charts were provided to Patient C’s lawyer for the first time in March 2017. 
In January 2016, Patient C had an appointment with Dr. Fenton. During that appointment, Dr. 
Fenton asked Patient C to contact the College and tell them that Patient C had no problem with 
Dr. Fenton as a doctor. Dr. Fenton told Patient C that it would be helpful if Patient C could call 
the College and tell them he had no concerns. 
Dr. Fenton engaged in conduct that would reasonably be regarded by members as disgraceful, 
dishonourable or unprofessional in his failure to transfer Patient C’s medical chart in a timely 
manner; his failure to respond to inquiries from the College within a reasonable time; and his 
communications with Patient C regarding his complaint to the College and his request for Patient 
C to call the College and tell them he had no concerns with Dr. Fenton as a doctor. 
Investigation Regarding Patient D 
On February 19, 2016, the College received a public complaint from a family member of Patient 
D expressing concern regarding the care provided by Dr. Fenton to Patient D, who had been a 
patient of Dr. Fenton’s since approximately April 2010.   
The College retained a family physician expert who opined as follows:  
                                      4 

-  Dr. Fenton’s practice does not meet the standard for record keeping. This includes the lack of 
   an up to date Cumulative Patient Profile, lack of documentation to demonstrate physical 
   findings, differential diagnoses and well thought out treatment plans. His referral notes to 
   specialists were incomplete. 
-  Dr. Fenton’s practice does not meet the standard for the safe and effective use of opioids in 
   the management of chronic non cancer pain. He documented risk factors for addiction and 
   adverse events (alcohol abuse, lorazepam abuse) and did not apply harm reduction strategies 
   such as tapering Benzodiazepines; weekly prescribing; referral to a pain specialist. 
-  Dr. Fenton’s practice does not meet the standard of care for the safe and effective use of 
   Benzodiazepines in the management of anxiety and insomnia. This patient became dependent 
   on lorazepam. She was falling, complaining of general malaise, dizziness, and tremor. 
   Medication adverse effects were never documented as a possible contributing factor to her 
   progressive debility. 
The College expert further opined that Dr. Fenton’s care and treatment of Patient D displayed a 
lack of knowledge, skill and judgment as follows:  
-  Lack of knowledge: Dr. Fenton knew Patient D had a history of alcohol abuse. He 
   documented Patient D’s dependence and abuse of lorazepam. He continued to prescribe as 
   Patient D became older and frailer (21 Dec 2015- “needs more help now every 2 weeks”), 
   experiencing episodes of dizziness, poor balance, low appetite and multiple falls. There is no 
   evidence that he has a comprehensive and organized approach to managing chronic non-
   malignant pain with resources other than controlled drugs. 
-  Lack of skill: Dr. Fenton continued to prescribe opioids and benzodiazepines for Patient D 
   without taking any extra precautions to manage the risk of potential abuse. He did not refer 
   Patient D to a pain or addiction specialist. He did not reduce her prescribed doses in an 
   attempt to safely wean her from these drugs. There is no evidence that he had a thoughtful 
   approach to the overall health risk management of this frail elderly woman with multiple 
   chronic conditions. 
-  Lack of judgment: Dr. Fenton acceded to [Patient D’s] demands for stronger pain medication 
   without establishing any safeguards against increasing dependence and adverse effects. He 
   cautioned Patient D about drug and alcohol use but he took no effective steps to treat these 
   conditions or reduce harm from his part, which was the prescribing. Dr. Fenton put the 
   responsibility for managing dependence and abuse of controlled drugs onto his patient 
   despite clear ongoing indications that Patient D was not taking the best self-care. 
The expert concluded that “it is reasonably foreseeable that if Patient D’s prescribed medications 
and alcohol use continue Patient D will experience serious adverse health outcomes from some 
kind of in home accident, a fall or an overdose.” Also, Dr. Fenton’s care is likely to expose other 
patients to harm or injury as well if it is conducted similarly to his care of Patient D.  
In order to investigate this complaint, the College requested Dr. Fenton’s medical records for 
Patient D on March 16, 2016. Subsequent requests from the College, including from the Chair of 
the ICRC, were sent to Dr. Fenton on April 28 and May 16, 2016.  No records were received in 
response to these written requests.  On July 13, 2016, the College’s investigator contacted Dr. 
Fenton by telephone and requested that he provide his medical records for Patient D. These 
records were ultimately received by the College on July 18, 2016. 
                                      5 

Dr. Fenton is incompetent and failed to maintain the standard of practice in his care and 
treatment of Patient D, as described above. Dr. Fenton engaged in conduct that would reasonably 
be regarded by members as disgraceful, dishonourable or unprofessional in his failure to respond 
to inquiries from the College within a reasonable time. 
The Discipline Committee ordered that: 
-  The Registrar suspend Dr. Fenton’s certificate of registration for a period of six (6) months 
   commencing on March 21, 2017, at 12:01 a.m. 
-  The Registrar impose the following terms, conditions and limitations on Dr. Fenton’s 
   certificate of registration: 
Education 
   (a)   Dr.  Fenton  shall,  at  his  own expense,  participate  in  and  successfully  complete  the 
         following educational courses within six (6) months of the date of this Order: 
         (i)   the  Medical  Record  Keeping  Course  offered  through  the  University  of 
               Toronto; 
         (ii)  the Pri-Med Canada Course (formerly Primary Care Today Course) scheduled 
               for May 10-13, 2017;  
         (iii) the  Understanding  Boundaries  Course  offered  through  the  University  of 
               Western Ontario;  
         (iv)  individualized  instruction  in  ethics,  satisfactory  to  the  College,  with  an 
               instructor satisfactory to the College; and 
         (v)   individualized instruction in communications, satisfactory to the College, with 
               an instructor satisfactory to the College.  
   (b)   Further to paragraphs 6(a)(iv) and 6(a)(v), the instructor(s) shall provide a summative 
         report to the College including his or her conclusion about whether the instruction 
         was  completed  successfully  by  Dr.  Fenton,  including  information  regarding  Dr. 
         Fenton’s progress and compliance. 
Clinical Supervision 
   (c)   Dr. Fenton shall, by September 21, 2017, retain a clinical supervisor or supervisors 
         (the “Clinical Supervisor”) acceptable to the College, who will sign an undertaking in 
         the  form  attached  hereto  as Schedule  “A”.  For  a  period  of  twelve  (12)  months 
         thereafter,  Dr.  Fenton  may  practise  only  under  the  supervision  of  the  Clinical 
         Supervisor.  Clinical Supervision of Dr. Fenton’s practice shall contain the following 
         elements:   
         (i)   The Clinical Supervision shall be at a moderate level for a minimum of six (6) 
               months, commencing  on the date Dr.  Fenton  returns to  work  following  the 
               expiry  of  the  suspension  of  his  certificate  of  registration.    The  Clinical 
               Supervisor will meet with Dr. Fenton weekly and review ten to fifteen (10-15) 
               of  Dr.  Fenton’s  patient  charts,  discuss  Dr.  Fenton’s  patient  care,  treatment 
               plan and follow-up, identify any concerns regarding the care, treatment plan 
               and follow-up and make recommendations for improvement; 
         (ii)  Dr.  Fenton  shall  permit  the  Clinical  Supervisor  to  directly  observe  him  in 
               practice for one half-day per week or, at minimum, five (5) patients per visit, 
               with the Clinical Supervisor providing a report every month to the College;  
         (iii) After  three  (3)  months,  and  only  upon  recommendation  by  the  Clinical 
               Supervisor and approval of the College, the frequency of the meetings with 
               and observation by the Clinical Supervisor may be reduced to biweekly; 
                                      6 

         (iv)  After  six  (6)  months  of  moderate  level  supervision,  at  minimum,  and  only 
               upon recommendation by the Clinical Supervisor and approval of the College, 
               the Clinical Supervision may be reduced to low level supervision for six (6) 
               months.    During  the  period  of  low  level  supervision,  the  frequency  of  the 
               Clinical Supervisor’ meetings with and, if required, observation of Dr. Fenton 
               shall be reduced to monthly; 
         (v)   Dr. Fenton shall fully cooperate with, and shall abide by any recommendations 
               of  his  Clinical  Supervisor,  including  but  not  limited  to  any  recommended 
               practice improvements and ongoing professional development;  
         (vi)  If a Clinical Supervisor who has given an undertaking in the form attached at 
               Schedule  “A”  to  this  Order  is  unwilling  or  unable  to  continue  to  fulfill  its 
               terms, Dr. Fenton shall, within twenty (20) days of receiving notice of same, 
               obtain  an  executed undertaking in  the same  form  from  a similarly  qualified 
               person who is acceptable to the College and ensure that it is delivered to the 
               College within that time; and  
         (vii) If  Dr.  Fenton  is  unable  to  obtain  a  Clinical  Supervisor  in  accordance  with 
               paragraph 6(c) or paragraph 6(c)(vi) of this  Order, he shall cease practising 
               medicine immediately until such time as he has done so, and the fact that he 
               has ceased practising medicine will constitute a term, condition or limitation 
               on his certificate of registration until that time. 
Reassessment 
   (d)   Approximately six (6) months after the completion of Clinical Supervision, Dr. Fenton 
         shall  undergo  a  reassessment  of  his  practice  by  a  College-appointed  assessor  (the 
         “Assessor”).    The  assessment  may  include a  review  of  Dr.  Fenton’s patient  charts, 
         direct observation, interviews with staff and/or patients, one or more interviews with 
         Dr. Fenton, and/or a formalized evaluation.  The results of the assessment shall  be 
         reported to the College after which Dr. Fenton shall abide by any recommendations 
         made by the Assessor by which the College has requested Dr. Fenton to abide. 
   (e)   Dr.  Fenton  shall  consent  to  such  sharing  of  information  among  the  Assessor,  the 
         Clinical Supervisor, and the College as any of them deem necessary or desirable in 
         order  to  fulfill  their  respective  obligations  and  in  order  to  monitor  Dr.  Fenton’s 
         compliance  with  this  Order  and  with  any  terms,  conditions  or  limitations  on  his 
         certificate of registration. 
Monitoring 
   (f)   Dr. Fenton shall consent to the College providing any Chief(s) of Staff or a colleague 
         with  similar  responsibilities,  such  as  a  medical  director,  at  any  location  where  he 
         practises (“Chief(s) of Staff”) with any information the College has that led to this 
         Order and/or any information arising from the monitoring of his compliance with this 
         Order.  
   (g)   Dr. Fenton shall inform the College of each and every location where he practices, in 
         any  jurisdiction  (his  “Practice  Location(s)”)  within  five  (5)  days  of  this  Order  and 
         shall inform the College of any and all new Practice Locations within five (5) days of 
         commencing practice at that location. 
   (h)   Dr. Fenton shall cooperate with unannounced inspections of his Practice Location(s) 
         and patient charts by a College representative(s) for the purpose of monitoring and 
                                   7 

      enforcing his compliance with the terms of this Order. 
(i)   Dr.  Fenton  shall  consent  to  the  College  making  enquiries  of  the  Ontario  Health 
      Insurance  Plan  (“OHIP”),  the Drug Program  Services  Branch,  the  Narcotics 
      Monitoring System implemented under the Narcotics Safety and Awareness Act, 2010, 
      S.O. 2010, c. 22, as amended (“NMS”), and/or any person who or institution that may 
      have  relevant  information,  in  order  for  the  College  to  monitor  and  enforce  his 
      compliance with the terms of this Order and any terms, conditions or limitations on 
      Dr. Fenton’s certificate of registration.  
(j)   Dr. Fenton shall be responsible for any and all costs associated with implementing the 
      terms of this Order. 
-  Dr. Fenton appear before the panel to be reprimanded. 
-  Dr. Fenton 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): March 20, 2017

Concerns

Source: ICR Committee
Active Date: February 21, 2018
Expiry Date:
Summary:
Caution-in-Person:

A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed. A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee. The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015 or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.

See PDF for the summary of a decision made against this member in which the disposition includes a caution-in-person.
Download Full Document (PDF)


Source: Member
Active Date: March 7, 2017
Expiry Date:
Summary:
Summary of the Undertaking given by Dr. Peter Michael Fenton to the College of Physicians and Surgeons of Ontario, effective March 7, 2017:

Dr. Fenton was the subject of a College investigation into whether he engaged in professional misconduct and/or is incompetent in his family practice, specifically in his prescribing of controlled and narcotic drugs. As a result of the investigation:

Dr. Fenton must not issue new prescriptions or renew existing prescriptions for any of the following substances:

(i)Narcotic Drugs (from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19);
(ii)Narcotic Preparations (from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19);
(iii)Controlled Drugs (from Part G of the Food and Drug Regulations under the Food and Drugs Act, S.C., 1985, c. F-27);
(iv)Benzodiazepines and Other Targeted Substances (from the Benzodiazepines and Other Targeted Substances Regulations made under the Controlled Drugs and Substances Act., S.C., 1996, c. 19);
(v)All other Monitored Drugs (as defined under the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22);
and as amended from time to time.

Dr. Fenton must post a clearly visible sign in the waiting rooms of all his Practice Locations, which states as follows:

IMPORTANT NOTICE

Dr. Fenton must not prescribe any of the following:
Narcotic Drugs
Narcotic Preparations
Controlled Drugs
Benzodiazepines and Other Targeted Substances
All other Monitored Drugs

Further information may be found on the College of Physicians and Surgeons of Ontario website at www.cpso.on.ca