Doctor acquitted in case involving 50,000 opioid pills allowed to practise again

A Tantallon, N.S., family doctor acquitted of fraud in a case related to 50,000 opioid pills has been given the tentative green light by the province's physician regulator to begin practising again.

Dr. Sarah Jones faces certain conditions and must complete a competency assessment before she begins seeing patients, according to terms of a settlement agreement with the College of Physicians & Surgeons of Nova Scotia.

Jones has been suspended since October 2015, ever since allegations emerged she had written prescriptions for enormous amounts of oxycodone to a single patient. Under the terms of the deal, she will not face further suspension.

"We recognize that [Dr. Sarah] Jones is a young medical practitioner who has a lot to contribute. As a committee, we think she should have a chance to do that," said the college's hearing committee decision, issued Monday.

The trouble for Jones began after she took on Patient X, a man in his 60s with chronic pain, in January 2010.

Agreed facts in the matter

According to the agreed facts in the matter, Jones had determined Patient X's pain was not well controlled, so "she prescribed increasing amounts of opioids between [2010] and August 2015, when Patient X was hospitalized."

"The quantities of drugs prescribed were astonishing in comparison to the 2010 Canadian Guidelines for Safe and Effective Use if Opioids for Chronic Non-cancer Pain," the committee decision noted.

"For example, Dr. Jones prescribed Patient X 33,282 tablets of oxycodone from August 7, 2014 to August 12, 2015, totalling 584,220 mg ... these amounts of oxycodone could not have been safely ingested by one patient."

The decision noted that during a four-year period Jones made "frequent strength switches and dosage adjustments in the prescribed drugs which resulted in the dispensing of significant excess amounts of drugs, mainly oxycodone, beyond what Patient X could ever consume himself."

Sometimes Jones picked up Patient X's prescription and dropped it off at his home, the decision noted.

High dosages of opioids

Jones was prescribing opioids to Patient X, even though "as early as 2011, there was evidence that his use of opioids was harmful to him."

"Dr. Jones continued to prescribe high doses of opioids after there was demonstrable harm such as choking, falling, and confusion with dosing."

"The amount of opioids prescribed to Patient X while under Dr. Jones' care was excessive, dangerous and inappropriate."

Missing pills

The decision noted, given the quantities of opioids prescribed to Patient X, "it is likely pills left over, missing, not accounted for, diverted or consumed in excess or inappropriately by Patient X or others, which presented a real danger to Patient X and the public."

Jones did not properly document the patient's medication use, according to the decision. It said she did not monitor his actual consumption of opioids or monitor safe storage of pills.

Jones also "misled" others in the health-care system with "false explanations," the decision said.

An investigation committee ordered two audits of Jones's practice. But neither audit identified concerns with her clinic care of the patients whose charts were identified.

"The second assessor concluded that she provided very good clinical care and had excellent medical records. Except for her dealings with Patient X, no issues have arisen about her clinical care of patients."

Explanation needed

The hearing committee said Jones's treatment of Patient X, and misleading others about it, "cries out for an explanation."

"Her explanation for why she engaged in this behaviour is that she was a young, naive physician who got in over her head with a single patient whose pain she was not able to control."

The decision also acknowledged some suggestion that Jones's deception of the registrar of the college and her colleagues in October 2015 was the result of severe stress and reactions to sleeping medications.

The hearing committee said Jones's rationale doesn't come close to explaining the amount of oxycodone ordered for Patient X and her home visits to deliver the medications over a long period of time.

They said there is no explanation for what happened to the excess of drugs prescribed to Patient X and no explanation for Jones's "repeated misleading explanations" of her treatment of Patient X to others in the health system and authorities who questioned her conduct.

"There is no explanation, in particular, for her extensive false statements to the Prescription Monitoring Program."

The committee said there is no evidence Jones used the opioids herself or provided them to anyone but Patient X. There is no evidence Patient X provided excess medication to others.

Jones was acquitted of fraud and unlawful possession of narcotics after a trial in provincial court in Bridgewater, N.S. She originally faced charges of drug trafficking, but those were withdrawn.

Failure to meet standards

With regards to Patient X, the committee said Jones failed to meet the acceptable standards of practice respecting the prescription of opioids, failed to maintain appropriate physician/patient boundaries and violated several standards of practice and code of ethics. 

In addition to her licence suspension, she is also not to treat Patient X in the future if she holds a medical licence, must complete a competence assessment prior to returning to practice, must commence counselling with a therapist and must supply a hair sample to a testing agency chosen by the college.

Jones will also have a permanent restriction on her medical licence preventing her from prescribing narcotics and cannabis. A college-approved sign will be placed prominently in her office waiting room or examination room.

The hearing decision noted the three-year suspension is "noteworthy" as suspension ranges in other jurisdictions are generally between three and 18 months.