Shuen, Paul King (CPSO#: 54846)

Current Status: Revoked: Discipline Committee as of 25 Jun 2018

CPSO Registration Class: None as of 25 Jun 2018

Indicates a concern or additional information

Summary

Former Name: No Former Name

Gender: Male

Languages Spoken: Cantonese, Chinese, English, Mandarin

Education:University of Melbourne, 1976

Practice Information

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

Professional Corporation Information

Corporation Name: Dr. Paul Shuen Medicine Professional Corporation

Certificate of Authorization Status: Issued Date:  Oct 28 2004

Shareholders:
Dr. P. Shuen ( CPSO# 54846 )

Business Address:
No business address available

Specialties

Specialty Issued On Type
Obstetrics and Gynecology Effective: 26 Nov 1985 RCPSC Specialist

Registration History

Action Issue Date
First certificate of registration issued: Independent Practice Certificate Effective: 31 Jul 1984
Suspension of registration imposed: Inquiries, Complaints and Repo Effective: 21 Aug 2017
Revoked: Discipline Committee. Effective: 25 Jun 2018

Previous Hearings

Committee: Discipline
Decision Date: 12 Apr 2018
Summary:

On April 12, 2018, the Discipline Committee found that Dr. Paul King Shuen committed an act of 
professional misconduct in that:  he has failed to maintain the standard of practice of the profession; 
and, he has engaged in 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 Committee also found that Dr. Shuen is incompetent.  
 
Dr. Shuen is an obstetrician/gynecologist with a subspecialty in gynecologic oncology. 
In September 2016, the College appointed investigators to review Dr. Shuen's practice, following 
receipt of a letter from the Hospital dated August 2016, notifying that Dr. Shuen had decided to retire 
from his hospital practice after meeting with hospital staff to discuss concerns relating to his practice. 
 
Dr. Shuen’s conduct leading to his resignation from the Hospital  
 
In February 2013, the Hospital was informed that a nurse found "a powdery tablet" in a patient's 
vagina that looked like prostin/misoprostol, a medication used to induce uterine contractions and 
labour. There were no orders for this medication in the chart. Dr. Shuen denied any knowledge of it. 
The substance found in Dr. Shuen's patient in February 2013 was not retained for analysis. 
 
In August, 2015, the Hospital was informed again that a nurse found a white powdery-tablet in the 
vagina of a patient. The substance was collected but no analysis was done at that time. Dr. Shuen 
denied any knowledge of the substance found in the patient's vagina. He denied ever placing any 
medication in the patient's vagina and stated he had never done this before. Dr. Shuen was advised by 
the Hospital that should the Hospital find out that Dr. Shuen had placed a medication used to induce 
labour in a patient's vagina in his office, especially without the patient's knowledge, that would be 
grounds for revocation of Dr. Shuen's privileges, and potentially "battery" if the patient was unaware. 
Subsequent discussions with the patient, confirmed that the patient was unaware of and did not 
consent to any medication being placed in her vagina. Dr. Shuen never discussed this with her. 
 
At a department meeting in August, 2015, the Hospital reiterated to staff that using medications to 
induce labour in an office setting would likely result in revocation of hospital privileges. Hospital 
policy and practice permitted the use of misoprostol only for intrauterine demise, termination of 
pregnancies and treatment for post-partum hemorrhaging.  
 
In May, 2016, a hospital incident report reflected that five of Dr. Shuen's patients arrived in triage 
with rapid labours. One of the patients required an immediate caesarean section. The incident report 
noted that there was a surge of patients with imminent deliveries on Saturday when less staff and 
resources are around, that this type of activity is not consistent with the practice of other members of 
the department, and that due to multiple precipitous deliveries arriving after being seen in a 
Physician's office, questions are raised about whether induction measures are being instituted in the 
office, which would fall outside of best practices with respect to monitoring for patients. 
 
Hospital investigation  
 
In Summer 2016, one of Dr. Shuen’s patients was admitted and the nurses were surprised about how 
quickly her labour progressed given that this was her first child. On internal examination of the 
patient, the nurse found white pill fragments on her glove. The Hospital commenced investigation. 
Disclosure was made to the patient and it was confirmed that the patient was unaware of and did not 
consent to any medication being placed in her vagina. Dr. Shuen never discussed this with her. A 
chemical analysis conducted on the substances found in Dr. Shuen's patients in 2015 and 2016 
confirmed that they were misoprostol.  
 
On August 18, 2016, during a meeting with the Hospital authorities, Dr. Shuen was confronted about 
his prior denials when he had been asked about powdery white substances found in his patients. Dr. 
Shuen was advised that the substances found in his patients in 2015 and 2016 had been analysed and 
were in fact misoprostol. At this meeting, Dr. Shuen again denied any knowledge of these labour 
inducing medications, and denied ever using them in his office. After a lengthy discussion, including 
about the potential for revocation of his privileges, Dr. Shuen admitted that he had been using 
misoprostol in his office for many years for out-patient inductions. Dr. Shuen defended this practice 
as safe and asserted that his outcomes were better than most of his colleagues. Dr. Shuen’s active 
hospital staff privileges were suspended on August 18, 2016.  
 
On August 21, 2016, in his email to the Hospital, Dr. Shuen stated that he had done a great deal of 
soul-searching since the meeting of August 18, and could now see the seriousness of his mistakes. He 
expressed remorse and took responsibility for what he had done. He indicated that he did not intend 
to fight the Hospital’s ruling and requested the Hospital to allow him six months to care for his 
current load of patients. He indicated that he had always taken very good care of his patients, that his 
patients counted on seeing him through delivery, and that he felt that because of the current situation, 
which was his fault, he was letting them down. He noted that if the Hospital granted his request, he 
would immediately announce his retirement from Hospital work (effective, March 1, 2017) and put 
an immediate halt to accepting new obstetrics patients. He vowed to never again do anything to 
artificially induce labour without the patient's consent. By letter dated August 22, 2016, Dr. Shuen 
resigned his privileges at the Hospital. 
 
College investigation  
 
The College conducted interviews with physicians and nurses at the Hospital. All of those 
interviewed confirmed that they were unaware of Dr. Shuen's practice of using misoprostol for office 
based inductions. An expert retained by the College reviewed Dr. Shuen’s seven hospital and 
corresponding office charts and interviewed Dr. Shuen. The expert opined that Dr. Shuen fell below 
the standard of care in his practice of obstetrics by inserting an induction agent into patients who had 
no indication for induction, in an outpatient setting, without their knowledge or consent. During his 
interview with the expert, Dr. Shuen admitted, among other things, that he did not inform patients, 
discuss the risks, or obtain patients' consent before engaging in office-based inductions, nor did he 
document this practice or keep records documenting these patients' outcomes. This was despite 
earlier suggestions by him, which were not true, that the nurses at the Hospital who had seen his 
patients were aware of and had consented to this practice. He admitted to engaging in this practice for 
many years. 
 
Dr. Shuen's practice was contrary to the Hospital’s practice and policies, and to the SOGC 
Guidelines for Induction of Labour (2013 and updated in 2015). 
 
Dr. Shuen's prior to inappropriate Conduct at the Hospital 
 
In September 2012, the Chief of Obstetrics and Gynecology spoke with Dr. Shuen about exceeding 
his cap on deliveries. Dr. Shuen apologized, citing financial pressure from his divorce. In January 
2013, the Chief of Obstetrics and Gynecology spoke to Dr. Shuen about his inappropriate and 
intimidating behaviour with patients and staff. He noted that Dr. Shuen showed very little insight. 
 
Prescribing Concerns 
 
Information was obtained from the Shoppers Drug Mart Pharmacy located in Dr. Shuen's office 
building regarding medications ordered by Dr. Shuen for "office use." By letter dated May 15, 2017, 
Dr. Shuen confirmed that he prescribed medications "for office use" that were in fact for himself and 
his wife. These included sedative-hypnosis for sleep, anti-anxiety medications, antibiotics, 
medication for erectile dysfunction, cholesterol medication, hormone therapy, anti-depressants, 
dermatological cream, acne medication, mouth sore medication, thyroid medication, vaccines, and 
medication for stomach acid, irritable bowel syndrome, constipation, and rectal pain. 
 
This prescribing was contrary to the College Policy on Physician Treatment of Self, Family 
Members, or Others Close to Them. 
 
Disposition 
 
On June 25, 2018, the Discipline Committee ordered and directed that: 
 
-  The Registrar revoke Dr. Shuen’s certificate of registration, effective immediately. 
-  Dr. Shuen appear before the Committee to be reprimanded. 
-  Dr. Shuen pay to the College costs in the amount of $40,720.00 within 30 days of the 
   date of this Order.

Decision: Download Full Decision (PDF)
Hearing Date(s): April 9-12 and April 16-19, 2018