DISCIPLINE SUMMARIES
lege, no later than one year from the date of this
Order. The content of these courses shall include
the topic of child and adolescent psychopharmacology.
h) r. Shomair shall be responsible for any and all
D
costs associated with implementing the terms of
this Order.
3. r. Shomair shall pay to the College costs in the
D
amount of $3,650 within 30 days of the date of this
Order.
At the conclusion of the hearing, Dr. Shomair waived his
right to an appeal and the Committee administered the
public reprimand.
DR. MICHAEL VARENBUT
Practice Location: Richmond Hill
Practice Area: Family Medicine, Practising in Addiction
Medicine
Hearing Information: Agreed Statement of Facts and
Admission, Joint Submission on Costs and Penalty
On February 19, 2013, the Discipline Committee
found that Dr. Varenbut committed an act of professional misconduct, in that he failed to maintain the
standard of practice of the profession.
Dr. Varenbut admitted to the allegation.
Dr. Varenbut is a co-founder of the Ontario Addiction Treatment Centres (OATC), the country’s largest
network of methadone clinics. OATC provides a range
of harm reduction treatment modalities, including
Methadone Maintenance Treatment (MMT).
In 2005, Patient A sought help for her drug addiction
from OATC. She received treatment from OATC clinics in Town B, Town C, and Town D between 2005 and
the spring of 2008. In mid-2006, Dr. Varenbut became
the most responsible physician with respect to her care.
Throughout her involvement with OATC, Patient A’s
attendance for her regular urine samples, supervised
methadone doses and clinic appointments was sporadic.
Clinic staff felt Patient A was challenging and demanding and that her non-compliance and the hostile conduct of her partner created more challenges than most
patients within their clinic structure.
After travelling to Town E for a medical procedure
in the spring of 2008, Patient A stopped taking her
methadone dose. In August of 2008, Patient A asked to
re-start the methadone program at OATC. At the time
she was using cocaine and other opiates, including by
injection. Clinic staff told her she would have to leave
urine samples twice a week and have blood work and
an ECG done before she could see a doctor. Clinic staff
indicated that these preconditions were now required
for all patients seeking to be initiated on the program.
Although Patient A attended on 15 occasions to provide
witnessed urine samples at the OATC clinic between
August 2008 and
March 2009, she didn’t
Full decisions are available online
at www.cpso.on.ca.
complete her blood
work until March
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the doctor’s name.
of 2009 and did not
obtain an ECG. Dr.
Varenbut was unwilling to waive these requirements and allow Patient A to
be seen by a doctor, on the basis that, in his view, her
failure to complete the other tests demonstrated a lack
of commitment to the program.
In early 2009, Patient A stressed the importance of
seeing a physician as she would be leaving the country
for two weeks and wanted to be initiated on methadone
and receive take-home doses before going. In early
April 2009, after returning from her trip, she attended
at the clinic to provide a urine sample and was advised
by clinic staff that Dr. Varenbut was terminating her
care and OATC would not provide her with methadone treatment. Although the patient was referred to
a hospital in another town for methadone treatment,
the lengthy waiting list there meant that she could not
receive immediate treatment.
Admission
Dr. Varenbut failed to maintain the standard of care
with respect to Patient A in the following ways:
a) y failing to provide Patient A with a physician apb
pointment within a reasonable time after she sought
to be re-admitted to the MMT program in August
2008;
b) y failing to make a timely decision about whether
b
or not to accept Patient A back into the MMT program; and
DIALOGUE • Issue 2, 2014
49