Complainant v. The College of Physicians and Surgeons of British Columbia. DECISION NO HPA-070(a); 2017-HPA-071(a); 2017-HPA-072(a)

Transcription

1 Health Professions Review Board Suite 900, 747 Fort Street, Victoria, BC V8W 3E9 Complainant v. The College of Physicians and Surgeons of British Columbia DECISION NO HPA-070(a); 2017-HPA-071(a); 2017-HPA-072(a) (GROUP FILE: 2017-HPA-G03) January 9, 2018 In the matter of an application (the Application ) under section 50.6 of the Health Professions Act, R.S.B.C. 1996, c. 183, as amended, (the Act ) for review of a complaint disposition made by, or considered to be a disposition by, an inquiry committee BETWEEN: The Complainant COMPLAINANT AND: The College of Physicians and Surgeons of British Columbia COLLEGE AND: A Physician REGISTRANT 1 A Physician REGISTRANT 2 A Physician REGISTRANT 3 BEFORE: Marilyn Clark, Panel Chair REVIEW BOARD DATE: Conducted by way of written submissions closing on November 13, 2017 APPEARING: For the Complainant: Self-represented I STAGE 1 PROCEEDING [1] This complaint has been referred to a Stage 1 hearing. At this stage the following results are possible: (a) I may confirm the Inquiry Committee disposition under s.50.6 (8)(a) of the Health Professions Act, R.S.B.C. 1996, c. 183, (the Act ) if the application for review can be fairly, properly and finally adjudicated on the merits without the need for submissions from the College and Registrant; or (b) I may determine that the application requires adjudication in a Stage 2 hearing, in which case no decision will be made until after requesting

2 submissions from the College and Registrant, and further reply submissions from the Complainant. [2] In this Stage 1 hearing my review of the Inquiry Committee s disposition will be based solely on the Complainant s application for review, the record of investigation provided by the College (the "Record") and submissions from the Complainant. I find that this application for review can be fairly, properly and finally adjudicated on the merits without the need for further submissions from the College or Registrant. II INTRODUCTION [3] The Complainant was permanently disabled as a result of a Motor Vehicle Accident ( MVA ) in June His condition was further compromised by a second MVA on December 25, He was not at fault in either of these events. [4] The Complainant believes a conspiracy exists involving the three Registrants, his lawyer, ICBC and other levels of government, for among other things, to have him see a psychiatrist and be prescribed with "mind-altering" medication. He has sought justice through a number of means and his complaint to the College and subsequent Application for Review is one more attempt to achieve that. Registrant 1 was his family physician at the time of the second MVA; Registrant 2 and 3 saw him following the second MVA. [5] The Senior Deputy Registrar, on behalf of the Inquiry Committee, wrote, in response to the complaint that the "investigation found no basis for criticism of the conduct of any of the three Registrants." [6] The Complainant submits the College's investigation is inadequate and their disposition unreasonable. He wants the three Registrants to have their licenses to practice medicine withdrawn. III BACKGROUND [7] At the age of 25 in June 1989, the Complainant was rear-ended while stopped at a red light. His vehicle was pushed into the vehicle ahead of him and his head was thrown back against the back window of his pick-up truck. His vehicle was not equipped with head rests. [8] The Complainant suffered a "mild soft tissue strain of his cervical spine as a result of that accident" according to his physician at the time. His injuries precipitated a condition termed Myofacial Pain Syndrome, commonly referred to as Fibromyalgia. [9] As the Complainant continued to suffer from "headaches, neck pain, dizziness and numbness around his right ear," that physician referred him to a neurologist who diagnosed "a fairly typical cervical hyperflexion/hyperextension injury" following the MVA. He was advised not to drive and, in late September 1989, not to return to work. He eventually returned to part-time work but has not been able to work for wages since 1994.

3 [10] It appears that it was at this point, suffering from migraine headaches, that he was prescribed medications for the headaches that were also intended to allay his anxieties. He found the drugs impacted his memory, his concentration, gave him anxiety and to quote the Complainant, "They put handcuffs on my brain." [11] It is likely this experience that caused him to fight so diligently against psychiatric medications during the course of his disability. Over the course, he was prescribed Amitriptyline (an antidepressant) and Risperdal (an antipsychotic medication). The Complainant denies having any mental disorder. [12] On Christmas day, 2008, while a passenger in the back seat of a car, he was reinjured as a result of a head-on collision. This event led to increasing headaches and left arm pain. He suffers to this day with chronic pain. Registrant 1 [13] The Complainant submits Registrant 1 "did not care for my eyes or neck or upper back." Registrant 1, according to the Complainant, wanted him to take a psychiatric medication or see a psychiatrist. The Complainant writes that blue collar workers who have back injuries and individuals who have visual problems "do not go see psychiatrist for diagnosis or confirmation." Anyone, he states, could have heard the "cracking, ripping, tearing, grinding" of his neck as a result of the car accidents but instead of listening and treating, Registrant 1 referred him to a psychiatrist. [14] The Complainant further submits that Registrant 1 sabotaged his ICBC claim and obstructed his ability to have a second opinion. [15] Registrant 1 rejects and denies the various complaints the Complainant has filed against him. Registrant 2 [16] On referral from Registrant 1, Registrant 2, a neurologist saw the Complainant one time on December 17, 2009, relating to his long time pain in his neck and arms, primarily on his left side. [17] The Complainant submits that Registrant 2 prescribed Topiramate which side effects the Complainant states cause "memory loss, concentration disorder, word finding difficulties." According to the Complainant, that drug also "causes Glaucoma within 2 months of taking it. [Registrant 2] prescribed me that for my left arm pain which I still get. What a perfect way to cover up visual disturbances and shut somebody up." [18] Registrant 2 submits: I offered him the option of initiating headache prophylactic medication for chronic daily migraine, however he was not interested in initiating medication at that time. I suggested topiramate as an option for him to discuss with his family physician if he decided in the future.

4 Further investigation with nerve conduction studies and EMG were arranged. Those studies did not occur and a follow-up visit did not take place... There was a note dated February 12, 2010 outlining a phone call with him asking if he was planning on returning for the studies and he indicated that he did not think it was necessary. I did not hear anything further from his family doctor about any ongoing symptoms or issues after that. Registrant 3 [19] Registrant 3, a specialist in Physical Medicine and Rehabilitation, saw the Complainant on one occasion on September 28, 2010, at the request of the Complainant's lawyer, to perform an independent medical evaluation. She recorded her impression as: 1. Grade two whiplash associated disorder cervical spine and upper back region. 2. Daily posttraumatic headaches. [20] The Complainant is convinced the three Registrants conspired, along with others, to have him lose out on ICBC benefits relative to the December 2008 MVA, and to have him take drugs that were "handcuffs on his brain... because of their mistaken belief that he suffered from schizophrenia." He is adamant he has no mental deficits. IV LEGISLATIVE ROLE [21] As the hearing chair, I am limited by the Act which stipulates in s.50.6(5) and s.50. 6(8) that: the review board must conduct a review of the disposition and must consider one or both of the following: (a) the adequacy of the investigation conducted respecting the complaint; (b) the reasonableness of the disposition. On completion of its review under this section, the review board may make an order: (a) confirming the disposition of the inquiry committee, (b) directing the inquiry committee to make a disposition that could have been made by the inquiry committee in the matter, or (c) sending the matter back to the inquiry committee for reconsideration with directions. If I find the investigation was adequate and the disposition falls within a range of reasonable outcomes, then I must confirm the decision of the Inquiry Committee. V DISCUSSION [22] This matter was assigned to the Registrar under s.32(3)(c) of the Act. According to s.32(5), it is considered a decision of the Inquiry Committee and as such, I will refer to it as a decision of the Inquiry Committee.

5 A. The Investigation [23] The College had extensive documentation provided by the Complainant. They requested responses to the complaint from each of the Registrants. Each responded comprehensively. Registrant 1 [24] Registrant 1 was his family physician from 1995 to December 7, Registrant 1 provided the following background to the complaint prior to his becoming the Complainant's family physician that identified a number of care providers including a neurologist, psychiatrists, a rheumatologist, an orthopedic surgeon, and an ophthalmologist: (1) An initial diagnosis of paranoid personality disorder by [Psychiatrist A] in February (2) A subsequent diagnosis of paranoid schizophrenia by [Psychiatrist A] in February (3) Chronic myofascial pain in the neck and upper back reported as following a motor vehicle accident in approximately (4) Recurrent left sided retro-orbital headaches also reported as following a motor vehicle accident in approximately (5) Amblyopia in the right eye, secondary to high myopic status from birth. (6) Borderline hypertension. (7) Periodical Motor Vehicle Branch Driving Assessments; required because of a history of a psychiatric disorder. (8) Left arm pain following a motor vehicle accident December 25, [25] Registrant 1 reported he had consultation reports from three psychiatrists from the period 2000 to 2003, all of whom had diagnosed the Complainant with schizophrenia, two of them using the adjective paranoid schizophrenia. One of those psychiatrists reported that his "diagnosis of paranoid schizophrenia was in remission (and on treatment) on Nov 9, 2000." [26] The Complainant was admitted to psychiatry at the local hospital on July 28, 2003, and diagnosed at that time with schizophrenia. [27] His chronic pain in the area of his neck was present prior to the Complainant seeing Registrant 1 and Registrant 1 submits that he acknowledges that pain but "was never able to identify any surgically correctable problem." [28] In 2004, the Complainant, who states he has been legally blind in one eye since a childhood accident, saw an ophthalmologist in regard to his headaches. At that time

6 he was diagnosed with "Right high myopia and anisometropic amblyopia" but his vision was considered "adequate for a class 5 license without any correction." [29] In 2008 and 2009, especially following the December 25, 2008, MVA, the Complainant saw Registrant 1 frequently in regard to pain, increasing headaches and left arm pain. A number of tests were conducted and the results identified a normal cervical spine, a normal chest x-ray, a normal CT scan of the head, normal CPR and normal ESR. [30] In regard to his psychiatric state, the Complainant does not acknowledge, according to Registrant 1, that he "suffers from a psychiatric disorder. He does not believe that he suffers from schizophrenia. He does not believe that he suffers from a paranoid disorder." Registrant 1 further submits: I believe that he does suffer from paranoid schizophrenia. I believe that he would benefit from psychiatric care. I believe that he would benefit from treatment with an antipsychotic medication. [31] At a December 7, 2010, appointment, Registrant 1 again attempted to persuade the Complainant that it was necessary for the Complainant to recognize that he needed to "address his psychiatric issues as well as his physical complaints." [32] Registrant 1 advised the Complainant at that time that he could not provide care if the Complainant refused to accept his recommendations, specifically about seeing a psychiatrist and going back on risperidone. [33] At that appointment, the Complainant requested the Registrant to change the medical record by eliminating the reference to schizophrenia. Registrant 1 did so and submits: I was very reluctant to do this but he was quite adamant about the issue. My recollection was that he felt this particular diagnosis basically stigmatized him when receiving care from other physicians and was also a barrier in his wish to transfer his care to another physician. I amended his problem list to read: "Chronic pain syndrome, long term Risperdal". [34] That was the last time the Complainant saw Registrant 1. Registrant 2 [35] As stated previously, Registrant 1 referred the Complainant to Registrant 2, a neurologist for headaches and left arm pain. This Registrant's response to the College is recorded in para. [18] above, but for ease of reference I have repeated it here: I offered him the option of initiating headache prophylactic medication for chronic daily migraine, however he was not interested in initiating medication at that time. I suggested topiramate as an option for him to discuss with his family physician if he decided in the future.

7 Further investigation with nerve conduction studies and EMG were arranged. Those studies did not occur and a follow-up visit did not take place... There was a note dated February 12, 2010 outlining a phone call with him asking if he was planning on returning for the studies and he indicated that he did not think it was necessary. I did not hear anything further from his family doctor about any ongoing symptoms or issues after that. Registrant 3 [36] As stated above, Registrant 3 saw the Complainant at the request of his lawyer who was representing him following the 2008 MVA. Registrant 3 was asked to perform an Independent Medical Examination which she did. The lawyer requested her to specifically address a number of symptoms the Complainant alleged to suffer from following the accident and to what extent they could be attributable to that MVA and how long that aggravation could be anticipated to continue. [37] Registrant 3 provided the College with a copy of the lawyer's letter and of her response to the lawyer. [38] In her six page report, Registrant 3 wrote: I do think he will see some improvement over time with regards these ongoing symptoms following the motor vehicle accident that occurred on December 25 th, He has most likely not reached the point of maximal medical improvement. However, I think he will have persistent symptoms of neck and upper back pain and headaches because he did have chronic pain symptoms involving these areas since [39] Registrant 3 also suggested that it would be valuable to have a psychiatrist`s opinion "regarding the stability of his mental health." B. The Disposition [40] In his response to the complaint, the Senior Deputy Registrar found no evidence to support the Complainant's allegations of conspiracy among the three Registrants and found no grounds on which to be critical of their care. [41] He did make note of the alteration Registrant 1 made to the medical record at the request of the Complainant. The alteration was a matter of eliminating the word "schizophrenia" from the record and replacing it with a notation referencing the long term use of Risperdal. In the disposition, it was stated that "It is not appropriate to make an alteration to the medical record in these circumstances... It would have been better if [Registrant 1] had documented your disagreement with his diagnosis but declined to make the change." Other than that, there was no criticism of the care provided by Registrant 1 nor was there criticism of the other two Registrants. VI ANALYSIS [42] My role is to determine whether the investigation was adequate and the disposition reasonable.

8 [43] With respect to the adequacy of the investigation, the College received comprehensive responses from each of the Registrants. [44] The Review Board articulated in Review Board Decision No HPA-0001(a) HPA-0004(a) at para. [97] the extent to which a College must investigate a complaint: A complainant is not entitled to a perfect investigation, but he or she is entitled to an adequate investigation. Whether an investigation is adequate will depend on the facts. An investigation does not need to have been exhaustive in order to be adequate, provided that reasonable steps were taken to obtain the key information that would have affected the inquiry committee s assessment of the complaint. [45] Although there may have been other information they could have sought and reviewed, given the information provided by the three Registrants, it is my view the investigation is adequate based on the above-noted protocol established early on in the life of the Review Board with respect to the adequacy of an investigation. [46] The Registrants all state they have not colluded or had discussions with one another and each states their opinions are entirely their own. I can find no evidence of collusion, except in the certainty that it exists in the mind of the Complainant. [47] The disposition was reasonable in that it met the Review Board standard which was articulated in para. [92] of Decision 2009-HPA-0001(a) 0004(a): The review board's focus is nonetheless not to step into the shoes of the inquiry committee, but rather to determine whether the inquiry committee's disposition falls within the range of acceptable and rational solutions, and is, viewed in the context of the whole record, sufficiently justified, transparent and intelligible to be sustained.. [48] The disposition of the Inquiry Committee falls within such a range. VII CONCLUSION [49] The Complainant has provided a remarkable narrative of the impact of a disabling event on an individual transforming what appeared to be a normal life to one of poverty. He relates moving from a two bedroom home to ever smaller quarters, eventually to a single room in a rooming house; how his interest in restoring automobiles had to be curtailed and how he attempted to use his innate artistic talents to establish something productive; how his desire to make his mom proud and eventually marry and establish a family became impossible. [50] The Complainant has significant complaints related to ICBC, the lawyer representing him in the matter of two MVAs, actions of the RCMP, the Motor Vehicle Branch, and others. I remind him that my only role as a member of the Review Board is to determine whether the complaint filed with the College relating to the care provided by the three registrants was adequately investigated and their disposition reasonable. I understand he has overwhelming issues with a number of institutions but those issues are beyond my mandate.

9 VIII DECISION [51] Based on my review of the Record, the Complainant s Application for Review and the Statement of Points, I find that the requirements of the Act have been met. I find that the investigation of the complaint was adequate and that the disposition was reasonable, falling within a range of acceptable outcomes. [52] Pursuant to s.50.6(8)(a) of the Act, I confirm the disposition of the Inquiry Committee. In making this decision I have considered all of the information and submissions before me whether or not I have specifically referred to them. Marilyn Clark Marilyn Clark, Panel Chair Health Professions Review Board