Nova Scotia

Doctor disciplined for failing to order CT scan for man later diagnosed with cancer

Dr. Donald Fay was reprimanded by the Nova Scotia College of Physicians and Surgeons for failing to order a CT scan of a male patient’s chest.

Scan later ordered by walk-in clinic showed tumours on kidney, spine and lungs

Dr. Donald Fay was reprimanded by the Nova Scotia College of Physicians and Surgeons for failing to order a CT scan of the male patient’s chest, as recommended by a radiologist. (Robert Short/CBC)

A family doctor in Halifax has been disciplined for failing to order a vital test for a long-time patient who was later diagnosed with cancer after tumours were found on his kidney, spine and lungs.

Dr. Donald Fay was reprimanded by the Nova Scotia College of Physicians and Surgeons for failing to order a CT scan of the male patient's chest as recommended by a radiologist in January 2017.

"Dr. Fay's failure to address the complainant's medical concerns is serious, and goes to the heart of patient care," an investigation committee wrote in a summary decision posted on the website of the Nova Scotia College of Physicians and Surgeons.

The college refused to provide a spokesperson to speak to the report.

Complicated case

The investigation committee said the anonymous patient had "multiple serious health issues." He'd been a patient of Fay's since 2001. 

Fay described the patient as a "pleasant man," but told investigators he "had problems encouraging the complainant to help himself."

The committee concluded that perception played a role in Fay's medical lapses. 

"Dr. Fay acknowledged he held a bias as the complainant had a motivational issue as to what he would want to do," investigators wrote. "The committee is concerned Dr. Fay's bias towards the complainant's motivational issues may have influenced his ability to provide appropriate and timely care."

Rib pain

In January 2017, the patient went to the emergency department of a Halifax hospital complaining of pain in his ribs.

A chest X-ray found deformations in his trachea and the space between his lungs, which could be symptoms of vascular problems or an enlarged thyroid.

The hospital radiologist recommended a low-dose CT scan of his chest. 

"The committee is concerned Dr. Fay failed to comply with accepted standards of the practice of medicine when he did not book a January 2017 CT thorax for the complainant," the report states. 

The committee also says, "it appears [Dr. Fay] did not act on the complainant's urinary system concerns," which included frequent peeing and accidents at night.

No evidence referrals made

The committee additionally expressed concern over Fay's failure to refer the patient to a pain clinic and a memory clinic. 

Fay's notes indicated in August 2017 the patient had lost 55 pounds, and included directives to "Refer to pain clinic at the VG," and "CT for back."

Investigators found no evidence those referrals were made. 

In April 2018, a doctor at a walk-in clinic referred the patient to a neurologist, who in turn referred the patient for a CT scan of his neck and pelvis.

That scan found a large mass on the patient's kidney "consistent with renal cell carcinoma." The cancer had already spread to his spine and lungs.

Busy practice

Fay's disciplinary committee noted that he has ceased providing care in long-term care homes to concentrate on his clinic patients.

"The committee is concerned Dr. Fay's busy practice may have negatively impacted his ability to care and followup for the complainant," the report says.

Fay was also reprimanded for failing to keep proper medical records, saying his records for the complainant were "not in keeping" with the college's professional standard for medical records.

A third reprimand said Dr. Fay failed to meet practice standards in his treatment of his patient's subclinical hyperthyroidism.