Informed consent is the backbone of the doctor-patient relationship in Ontario. The 1996 Health Care Consent Act requires that physicians fully explain all procedures and treatments available to a patient, as well as any potential risks and benefits so that a patient can make a decision armed with all of the necessary information. When a doctor fails to include a patient in this process, it is a betrayal that can come with serious consequences and ultimately result in discipline, or worse, for the doctor involved.
This was the case with a well-regarded Toronto ob-gyn and gynecological oncologist Dr. Paul Shuen.
Impatience Leads to Injury and Procedures Without Consent
Shuen first faced disciplinary proceedings by the Ontario College of Physicians and Surgeons (the “College”) in 2008, after he performed an episiotomy on a patient without her consent and the patient suffered tearing so extensive, she required surgery to repair the damage. The patient had been left with Dr. Shuen after her own doctor had finished her shift and the patient had not yet delivered her child. She had been given an epidural, and so did not realize when Dr. Shuen performed the episiotomy until much later, after delivery. She later filed a formal complaint with the College, which ultimately issued a verbal caution to the doctor. There was no public record of these proceedings or the complaint. Public access to College disciplinary decisions would not be made available until 2015.
In another College Complaint, he treated a patient with Paget’s Disease, a malignancy on the vulva that he recommended should have a partial vulvectomy. The patient agreed, but after doing further research, found that the disease could sometimes be treated with a topical cream. Dr. Shuen told her that was an inappropriate treatment and advised she’d be charged a fee if she cancelled her surgery, so she went ahead with it. When she discovered after the fact that the doctor had removed one of her labia and her clitoris, she was devastated and made a formal complaint against him. The College said it would have been inappropriate to charge a cancellation fee a month before the surgery was scheduled and cautioned the doctor for failure to obtain informed consent from his patient. Again, these records were not made publicly available.
OHIP Billing Loopholes Open Door for Abuse by Physicians
OB-GYNs at North York General, where Dr. Shuen had privileges, were capped with respect to the number of deliveries they could perform in a given month. The hospital’s budget was determined by government funding, and so allotments were carefully spread out among the hospital’s OB-GYNs. Dr. Shuen, who was going through a divorce, chose to ignore the cap of 50 deliveries per month and delivered so many babies his superiors worried it could lead to unsafe conditions in the labour and delivery ward. When the hospital began to consider financial penalties for doctors who exceeded their caps, he apologized and agreed to restrict his deliveries to 45 per month. However, there was an OHIP loophole he found he could exploit without exceeding the monthly limit.
Doctors’ OHIP billings for deliveries increase considerably on weekends as opposed to weekdays, due to the fact that hospitals are generally short-handed on the weekend. Dr. Shuen found a way to induce labour in his patients without their knowledge, ensuring they’d go into labour on a more lucrative day of the week.
Nurses Find Evidence of Inducement and Take Action
In 2013, nurses attending to a patient in labour found a small white pill in the patient’s vaginal cavity. They alerted Dr. Shuen’s superior, who advised them to dispose of the pill. Two years later, nurses found a similar pill in a different patient. This time, they kept the tablet and Dr. Shuen’s superior warned him that he could face a revocation of his privileges and worse, if he was inducing patients without their consent. Dr. Shuen denied inducement and the hospital moved on. In 2016, two nurses again found a tablet in a patient of Dr. Shuen and informed his superior. They also sent the tablet to be tested at the hospital’s lab, along with the one from the previous year, which they had saved.
The drug turned out to be misoprostol, which can soften the cervix and cause contractions in pregnant women. It is against the hospital’s policy to use this drug for labour induction because there is no proof that the drug is safe in this context (its primary purpose is to treat ulcers). In fact, the drug, in combination with another medication, is used in some cases for a medical abortion! There are also several potential side effects when used for inducements, such as uterine rupture, severe bleeding or even death of the mother or the baby.
When questioned by senior hospital staff, the doctor denied using the drug to induce patients, but when they reviewed his labour records, they found that, improbably, 46% of his patients had delivered on a Saturday or Sunday. He had also exceeded the monthly cap, delivering an average of 58 babies per month. After being confronted with the evidence, he finally admitted to his actions but claimed the practice was safe. His superiors explained that, since there was no record of patients who had been induced, there was no way to follow up on their progress or any resulting complications. The hospital immediately revoked his privileges and referred the matter to the College’s disciplinary committee, which authorized over a dozen investigators to look through every aspect of his practice.
The lead investigator had the following to say:
Dr. Shuen fell below the standard of care in his practice of obstetrics by inserting induction agents into patients who had no indication for induction, in an outpatient setting, without their knowledge or consent. As a result of his actions, harm was likely being caused to his patients, either in the form of unnecessary Caesarean section, or perhaps worse. The extent of the harm it caused is difficult [to determine] due to the lack of record keeping and difficulty in knowing exactly which patients were affected.
In 2018, the College revoked Dr. Shuen’s licence to practice and ordered him to pay over $40,000 in costs. Further, the College posted a notice to patients that the doctor posed a danger to the public.
How Well Does the Disciplinary System Protect Patients?
Dr. Shuen has yet to face criminal charges for his actions, which could include criminal negligence, assault, assault causing bodily harm, administration of a noxious substance. Further, there was no indication of any investigation to search for patients who may have unknowingly suffered complications after being induced without their knowledge. Lastly, the author of the original article on this matter noted how difficult it was to obtain documentation around this investigation. Only after several requests and thousands of dollars in legal fees were they able to obtain enough information to piece the story together. This leaves open the question of how well the current investigatory and disciplinary process works to actually protect and inform patients who may have suffered harm.
If you would like to discuss a potential birth injury case with one of our highly experienced Toronto birth injury lawyers, contact Sommers Roth & Elmaleh. We are committed to getting our injured clients and their loved ones the legal assistance and guidance that they need following a medical error, including misdiagnosis of fetal distress and failure to perform a timely c-section. We work hard to secure financial assistance for the future of each of our clients. We take cases on a contingency basis only, ensuring that families can obtain the help they need, at the time that they need it most. We have been helping patients and families whose lives have been impacted by medical malpractice for more than 40 years. We have assisted clients in all over Ontario and from all across Canada, including Newfoundland, Quebec, Saskatchewan, Alberta, and British Columbia. Call us at 416-961-1212 or contact us online for a free consultation.
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