Waddell's Position against CPSO Charges

Found below is John Waddell's response to the charges filed against him by the lawyer for Dr. Green and Mr. Schmidt; legal fees being paid for out of WAHA's bank account.

September 4, 2018

[Redacted name]

Investigator, Investigations and Resolutions

College of Physicians and Surgeons of Ontario

80 College Street

Toronto, ON M5G 2E2

Dear [Redacted name]

Re: Investigation under section 75(1)(1) of the Health Professions Procedural Code (File No. 7216227)

Thank you for your letters dated July 11, 2018 and August 14, 2018 regarding the College’s investigation under s. 75(1)(a) of the Health Professions Procedural Code and the enclosed documents gathered as part of this investigation. I have reviewed the documentation disclosed and appreciate the opportunity to provide a response.

Education and Experience

I obtained my medical degree from the University of Toronto in 1989, and since then have practiced medicine for 28 years. Between 2005 and 2015 I practiced in the James Bay Coastal area at the Weeneebayko Hospital, now the Weeneebayko Area Health Authority (“WAHA”). I have practiced in various capacities over this time, including in the Department of Family Medicine primarily as active medical staff. My roles at WAHA included:

· Interim Chief of Staff from 2012-2013,

· Chief of Family Medicine 2013 pro bono,

· President of the Medical Staff 2007,

· Telemedicine and Tele Ophthalmology Physician Lead from 2007 - 2013,

· Exercise Stress and Pulmonary Function Testing Director from 2008 – 2013,

· Chairperson of the Pharmacy & Therapeutics Committee from 2006 – 2013,

· ACLS instructor from 2010 – 2012,

· Preceptor of medical learners from 2005 – 2013, and

· Coroner from 2011 – 2014.

Prior to September 25, 2015, my work record at WAHA and her predecessors was unblemished. I am currently working as a general practitioner at several Kingston Penitentiary locations, providing care for inmates and staff.

Submissions

As noted above, I have reviewed all of the documentation that has been disclosed to the College as well as the policies as cited in the July 11, 2018 correspondence. In addition to responding to the specific inquires as set out in both of your letters, I have also provided my comments with respect to a number of more general categories, as set out below. Prior to setting out my specific comments, I thought it would be helpful to provide some general comments to the Committee.

All of the documentation that has been disclosed to me relates to my time at WAHA (with the exception of the notes from the interview with Corrections Services Canada). As you are likely aware, I had and continue to have concerns about mismanagement at WAHA. Given my email correspondence and social media communications provide the specific details of my concerns, I have not set them out in any detail in these submissions. At all times I have had the best interests of the patients that WAHA serves in mind when voicing my concerns about the things I observed during my time practising there. I took measures as Chief of Staff to address egregious misconduct of staff physicians that compromised the public’s trust and reputation in their doctors.

I appreciate that in some of my communications with other colleagues and members of the administration at WAHA, I have used strong language. I also appreciate that some of my colleagues and administrators have been very unhappy about the manner in which I have raised my concerns about WAHA. I have not intended to be disrespectful or discourteous to anyone in raising the concerns that I have. My goal has always been to make sure that the concerns I had with what I observed at WAHA were addressed. It has not been my intention to negatively impact on the ability of WAHA to provide care to the community; rather, my goal has been to try and improve upon the care it provides.

As the College is aware, representatives of WAHA have also used strong language in their communications with and about me, including scathing and disparaging commentary about me that is without merit and the disclosure of my personal health information. While I was not aware of them until sometime after being advised by the College of this investigation, I acknowledge that the College has policies and regulations in place that address the use of social media and communications by physicians with other health care professionals and the public. However, these guidelines have to be balanced with my fundamental rights, as guaranteed under the Canadian Charter of Rights and Freedoms, including:

· Freedom of thought, belief, opinion and expression,

· Freedom of conscience and religion, and

· Freedom of association

Furthermore, these guidelines must also be balanced with my duty as a physician to advocate for my patients’ needs, including access to a safe, reliable and accountable health care system that fulfills its contractual obligations as agreed to by all of the Bands and municipalities, the provincial and federal governments and WAHA (and her predecessors, JBGH and WHA). In making the comments that I have made, as set out in the disclosure, I was exercising my rights under the Charter. I believe that open, and even forceful, criticism of our public institutions is fundamentally important. In addition to my own Charterrights, I would emphasize that the public has an interest in open discussion.

Finally, I think it is important to note that none of the concerns that have been raised relate to my clinical skills and judgment. While my colleagues and other individuals may take issue with the manner I have communicated with others and over social media, I do not believe there is any concern with respect to the care and treatment I provide to my patients.

My communication with individuals associated with WAHA

The materials you have provided include emails I sent to various colleagues, administrators and other individuals affiliated with WAHA, including hospital counsel. I also have considered the comments that the various individuals from WAHA have made in their interviews with the College. I repeat and rely upon my comments made above regarding my intentions when communicating with various colleagues, administrators and other individuals at WAHA. I also rely upon my Charter rights to express myself in a manner which is consistent with my beliefs and my physician duties to advocate for my patients and their health care system.  All communication by email to individuals associated with WAHA was intended to be considered/reviewed by the recipients that I directed the communication to. I did not copy members of the public in my communications by email. These were communications between myself and the various parties involved in the process of the termination of my privileges at WAHA.

My use of social media

I have used Facebook to communicate information about the mismanagement of WAHA to the community members WAHA serves. WAHA serves people who live in remote areas and who are often disconnected from each other, except by social media. Facebook serves an important function to these people by allowing the dissemination of information and ideas between them. By posting my opinions through social media, community members were able to engage in an open dialogue with each other about the provision of healthcare at WAHA. My Facebook comments were made on an open forum that allowed everyone to participate in a discussion on the provision of healthcare by WAHA, including those with opinions different from my own. At no point did I reveal confidential information about patients that could be identified by other members of the community. The information I shared was true and necessary to allow community members to know of the services they were being provided by WAHA.

To the best of my knowledge, the content of my Facebook posts have been true, and I believe that in posting my opinions online I provided information to the community to inform them of the mismanagement at WAHA that puts patients at risk. These posts reflect my personally held believes, which I was entitled to express. It was not my intention to undermine the ability of the healthcare professionals at WAHA to provide care and treatment to their patients. My intention has always been to ensure the patients served by WAHA receive the best possible care and treatment. I tried using conventional avenues to achieve this objective, however, after encountering resistance to my efforts, I realized that engaging with the community directly was the only course available to me to best serve these people.

I would note that my posts related to WAHA have been overwhelmingly embraced and supported by the people within the Mushkegowuk Territory who read, comment and share them with others.

I repeat and rely upon my comments made above regarding my intentions when communicating about my concerns with WAHA. I also rely upon my Charter rights to express myself in a manner which is consistent with my beliefs.

My use of WAHA email/access to WAHA email account

During my time at WAHA and up to the time that my access to my WAHA email was terminated, I acknowledge that in rare instances, I used my WAHA email account for personal use. Many of the emails I sent related to my concerns with WAHA were sent from my personal email address. In response to two emails I sent on December 15, 2016 to my colleagues at WAHA using my WAHA email account, hospital management denied me further access to my WAHA email account, effective December 16, 2016. I have not had direct access to my WAHA email account since that time.

With respect to the information contained in the emails I sent on December 15, 2016, I repeat and rely upon my comments made above regarding my intentions when communicating about my concerns with WAHA. I also rely upon my Charter right to express myself in a manner which is consistent with my beliefs.

The content of the emails I sent on December 15, 2016 was directly related to WAHA business and reflected my personally held beliefs. In my opinion, it was unfair for WAHA management to deny me access to my account at that time without first addressing their concerns with me. This was especially so in light of the appeal I had to bring before the Board, after the MAC refused recommend that the WAHA Board grant me privileges to be appointed to the Department of Family Medicine on a locum tenens basis. This decision was actively being decided at that time, which WAHA management knew when they denied me access to my email account. Although I reached out to various parties in an attempt to have my email access restored, I was not successful. Instead, I received a memory stick (that did not work, followed by an Outlook remedy performed remotely by WAHA IT staff) containing an incomplete copy of the content of my email account.

At no time prior to December 19, 2016 was I made aware of any of the policies at WAHA related to the use of information technology. It was only when I was attempting to have access to my email account restored, that I was informed that the emails I had sent on December 15 were allegedly contr

ary to WAHA’s Information Technology Policy. I was provided with a copy of this policy on December 19 for the first time. When I began my working relationship with WAHA’s predecessor, I was not provided with any orientation related to its IT policies. I was not aware, until December 19, 2016 that I was precluded from using my WAHA email for personal use. Over the course of my employment at WAHA, I may have sent a few emails to my family using my WAHA email, but the vast majority of the emails I sent were in relation to WAHA business. I believe that the use of my WAHA email that related to WAHA business was not contrary to the policy. I deny that I routinely used my WAHA email for personal use in the time period as alleged by WAHA. In cases where I did use my WAHA email account for personal use, such use was consistent with the normal practice at WAHA.

[Redacted name]

I note that there appears to be some dispute as to whether I was involved with the care and treatment of [redacted name] as it relates to [redacted pronoun & diagnosis]. I can confirm (as does [redacted pronoun]) that I was involved in [redacted pronoun] care and treatment as it related to [redacted pronoun and diagnosis]. Given I do not have access to the records related to [redacted name], I cannot comment as to the lack of chart notations regarding my involvement.

I have no recollection of asking [redacted name] to be a Facebook friend. It is possible I clicked on [redacted pronoun] profile by way of the Facebook ‘Suggest a Friend’ feature. I am also aware, through my legal counsel, that friend requests from Facebook are often automatically generated without any action on the part of the user if a Facebook profile is accessed.

I have never named a patient in any of my posts and have only shared limited information and personal experiences to demonstrate the mismanagement at WAHA that puts patients at risk. I have never posted information about a patient that would allow them to be identified by members of the community, without consent. I was present during the [redacted procedure and name] on [redacted date] and witnessed a situation where a physician unnecessarily and recklessly placed the life of a patient at risk. By sharing anonymous details of that experience with the community, I sought to illustrate what was, at that time, a common occurrence at WAHA, and to allow the community to know how their care was being handled at their hospital.

I did not post any story in the Humans of Moose River. There was a story posted that was done by the owners’ of that website that I have no control over.

Accessing [redacted name] electronic health record

While I have no independent recollection of accessing [redacted name] electronic health record on December 13, 2011, January 7, 2012 or February 26, 2012, it is my practise to only access a patient’s chart for patient related matters. As you may be aware, I acted as Interim Chief of Staff at WAHA in 2012-2013. When Dr. Hill joined the staff at WAHA, I expressed concern that he should not be granted [redacted] privileges as he had not [redacted procedure] in over 30 years. Dr. Hill was granted privileges in any event. My concerns about Dr. Hill continued after he was granted privileges and I approached the then Chief of Staff to query whether Dr. Hill should continue to have [redacted] privileges. The Chief of Staff stated that the issue of Dr. Hill’s [redacted] privileges would be left to me to address when I became Chief. As a result, I began to compile the relevant information and documents necessary for me to address the situation with Dr. Hill. In that context, I do remember that I accessed [redacted name] chart to document and confirm the concerns I had about Dr. Hill.

I have no independent recollection of editing the demographics in [redacted name] chart on December 13, 2011. However, it is my usual practise to edit patient demographics in their chart to ensure patient information remains up to date and accurate. As a lead in the hospital’s EMR at the time, I had the skill to edit patient demographics. It is only in this context that I would have edited the demographics in [redacted name] chart.

Facebook Post- “The Sewage”

I am not able to provide the documents to anyone as my Facebook account is logged out and I have no access to it. This is based in instructions that I received from my lawyer representing me before the Ontario Superior Court and the Human Rights Tribunal of Ontario. This will remain the case until the these matters are concluded. The reason for that is ‘The Sewage’ is one of the posts before the presiding judge. None of the documents are patient records.

Facebook Posts- “Over the Hill”, “New Life or Same Old Death” and “The Sewage”

You have asked me to provide copies of the written permission that I received from patients to disclose confidential health information on Facebook.  I do not have copies of written permission from the patients I described in my postings on Facebook. Given that I did not include any identifying information about any patients in my description of these cases in my postings, I did not believe that written permission or consent was required.

I do not believe I required written consent with respect to the individuals referred to in ‘New Life or Same Old Death’ because these individuals were not my patients and the information I disclosed was already known to the public. The baby died in June 2018 and I have not been in practice in the region since August, 2014. The details of the circumstances of death came to me through person-to-person communication, not doctor-patient. I had no access to any patient records. Furthermore, this information did not come to me from the treating physician. The time as to when the baby died was public knowledge which is how I learned of it. The patient referred to in “The Sewage’ died approximately 5 years ago. My post was published 4 to 5 years later. As a result, I would not have been in a position to obtain the written consent of the patient.   As noted above, I will no longer post or communicate any information about any particular patient cases that I observed while at WAHA.

Disclosure of Health Care Records to Patients

I have reviewed the comments from [redacted name] at Bath Institution regarding the fact that I have provided inmates with copies of documents from their chart at their request. Given that the patients had made a request for their records, I believe that I was able to provide them with this documentation, based on Section 52 of PHIPA that governs these patient requests in the province. As a contract physician, I have received no orientation to any CSC Policy at any time since I started 3½ years ago. Furthermore, this policy, like many others, is not uniformly applied from one prison to the next. Specifically, at Collins Bay Prisons (Medium & Maximum), Regional Treatment Centres (Bath & Millhaven), Regional Hospital & Joyceville Prison, both myself and nursing staff give patients copies of their own records on a routine basis without incident or protest. However, I apologize if the disclosure of this documentation did not follow the formal policy in place.

Concluding Remarks

While I have been critical of some of my former colleagues and WAHA management through the use of emails and Facebook posts, it has never been my intention to have my comments disrupt the provision of care and treatment to the patients of WAHA. My goal has been to inform the community that it was my belief that their hospital has historically been mismanaged to the detriment of their care and treatment. The people served by the WAHA are generally disenfranchised, facing high poverty and unemployment rates, malnourishment, many diverse physical and mental health issues and lack the social infrastructure that many of us take for granted. After years of attempting to address the systemic healthcare issues faced by the community through conventional means, I took to engaging with community members directly to share my experiences and help them address the mismanagement of their hospital. My goal has always been to protect the patients at WAHAand safeguard the reputation of the profession who serve them.

I regret that the information that I included in my Facebook posts has made [redacted name] feel the way she described in her communications with the College. That was never my intent and I apologize to [redacted name] for causing the issues that she has reported to the College. While I do not believe that I disclosed any personal health information about [redacted name], I do not want any patient to feel the way [redacted name] has reported. On that basis, I will only post or communicate any information about any particular patient cases that I observed while at WAHA with patient consent and in compliance with the policies of the College.

In light of the concerns that have been raised by my former colleagues and others about my communications, I ceased posting information about my experience with WAHA on Facebook as of June 20, 2018. In addition, I have not (and will not) communicate by email with any of my former colleagues or other representatives at WAHA, unless the communication is for the sole purpose of the ongoing legal dispute with WAHA. In those instances, I anticipate that my legal counsel with be responsible for those communications.

I would be pleased to answer any further questions you may have.

Yours truly,

Dr. John Waddell

Editorial note: Dr. Waddell had his medical license suspended for three (3) months starting on January 28, 2020 for professional misconduct. In doing so, none of the above was taken into consideration by the College.