A Toronto-area obstetrician has been suspended from practising because of “professional misconduct” after he admitted to giving pregnant patients medication to induce labour without their consent.
The College of Physicians and Surgeons of Ontario’s Discipline Committee writes in a recently released decision that it found Dr. Paul King Shuen incompetent and said he failed to meet the standards of practice of his profession.
The CPSO's Inquiries, Complaints and Reports Committee suspended Dr. Shuen in August, 2017. The college's Discipline Committee has reserved its final decision on penalty or costs; Dr. Shuen remains suspended until those decisions are made.
Dr. Shuen, who speaks both Cantonese and Mandarin, has been practising medicine in Ontario since 1984 and is a popular obstetrician among North York’s Chinese-Canadian community.
He had privileges at North York General Hospital, where he conducted deliveries, until August, 2016.
The College says the hospital first began receiving complaints about Dr. Shuen in February, 2013, when a nurse found a “powdery” substance in a patient’s vagina during delivery.
The patient said she was unaware of anything being placed in her vagina, and had not consented to any medication use. Dr. Shuen denied any knowledge of the substance, which was not collected for analysis.
Similar incidents were recorded at the hospital in August, 2015, and again in the summer of 2016. In each case, the women said they had not consented to medication being placed in their vaginas, and Dr. Shuen denied any knowledge.
In May, 2016, five of Dr. Shuen's patients arrived at the hospital in labour on the same Saturday. All had recently seen Dr. Shuen in his office and all were experiencing rapidly progressing labours. One of the patients required an immediate caesarean section.
In August, 2016, after another of Dr. Shuen’s patients was found with pill fragments in her vagina after an unusually fast labour, a sample of the substance was taken. It was found to be misoprostol, a medication used to induce labour or uterine contractions.
Misoprostol is permitted for use under the hospital’s guidelines only to induce delivery in cases of “intrauterine demise” (miscarriage), termination of pregnancies, and for the treatment of postpartum bleeding.
After the hospital met with Dr. Shuen and warned him his privileges at the hospital could be revoked, Dr. Shuen admitted he had been using misoprostol in his clinic for years to induce labours.
“Dr. Shuen admitted, among other things, that he did not inform patients, discuss the risks, or obtain patients' consent before engaging in office-based inductions, nor did he document this practice or keep records documenting these patients' outcomes,” the CPSO writes in its report.
“Dr. Shuen defended these uninformed induction as safe and asserted that his outcomes were better than most of his colleagues.”
The hospital suspended Dr. Shuen’s privileges on August 18, 2016. The following day, Dr. Shuen resigned from the hospital.
The CPSO also wrote in its decision that it had concerns about Dr. Shuen’s prescribing habits. The college said it obtained information from the Shoppers Drug Mart pharmacy in the physician’s office building regarding several medications Dr. Shuen ordered for "office use."
They included sedatives for sleep, anti-anxiety medications, antibiotics, medication for erectile dysfunction, cholesterol medication, hormone therapy, acne medication, vaccines, and medication for stomach acid and rectal pain.
Dr. Shuen confirmed in a letter to the College in May, 2017, that the medications prescribed for “office use" were in fact for himself and his wife.
The college also noted in its report that in September 2012, prior to the other allegations, the hospital’s chief of obstetrics and gynecology informed Dr. Shuen that he was exceeding his cap on deliveries. Dr. Shuen apologized, citing financial pressure from his divorce.