Clinic’s patients warned of bacterial infection risk
KITCHENER — A Kitchener painmanagement clinic must stop injections while Region of Waterloo Public Health investigates the risk of a bacterial infection to patients.
Public health ordered the Dr. K.S. Billing Pain Management Centre on River Road East to suspend procedures that require infection prevention and control practices after a complaint led to an inspection last Thursday.
“Based on our inspection, we thought there was a possibility of a risk,” said Dr. Hsiu-Li Wang, the region’s associate medical officer of health.
“We have had one reported case of infection that may be associated with this clinic.”
The region conducted the inspection with the College of Physicians and Surgeons of Ontario, and both agencies are collaborating on the investigation.
Wang said public health’s concerns included inconsistent sterilization techniques; improper use of personal protective equipment; improper storage of sterile equipment, instruments or medical supplies; and improper medication practices.
The procedures that the clinic is not allowed to perform indefinitely include injections such as nerve blocks. The suspension does not include services where patients do not undergo procedures, such as consultations.
The college gave the clinic a failing grade, noting in the report “a lengthy list of infection control concerns.”
Those included open and unlabelled single-use medication vials that should have been immediately discarded; multi-dose vials not labelled or past expiry dates; skin preparation practices that were at high risk of crosscontamination; soiled trays for a sterile procedure; improperly stored supplies; a cluttered medication preparation area; and empty vials and syringes tossed in the regular garbage.
“The committee was significantly concerned that staff at the premises are not adequately familiar with infection prevention and control requirements,” the report said.
Wang would not say how serious the bacterial infection could be or how many patients were exposed, but injections are a common treatment at the clinic.
“It is a clinic that’s centred on pain management practices and these are common practices,” she said.
The patient complaint that led to the inspection was made July 11. The investigation is ongoing and Wang could not say how long it would take.
“We need to look into this further,” she said.
Public health advises patients who underwent a procedure at the clinic within 30 days to look for infection symptoms, which include pain or discomfort in the injection area that increases over time, increased drainage of the injection site, increasing redness, warmth and swelling of the injection area, and fever or chills.
Anyone with symptoms, including patients who had a procedure more than 30 days ago, should seek medical attention.
Doctors have also been asked to contact public health if they suspect a patient has an infection associated with the clinic.
“For now, they’re not practising these procedures, so there shouldn’t be an ongoing risk,” Wang said.
This is not the first time sterile techniques at the clinic were found to be lacking, potentially putting patients at risk of serious infection.
The college launched an investigation into Dr. Kulbir Singh Billing’s practice after receiving information from the Ministry of Health and Long-Term Care in 2011, and its discipline committee ruled in November 2016 that Billing committed an act of professional misconduct.
The experts enlisted by the college to review patient charts and care at Billing’s clinic found deficiencies in documentation in patient charts, treatment plans and his sterile technique when administering blocks.
A penalty was issued on June 22, 2017, and it stipulated that Billing, an anesthesiologist specializing in pain management, could practise only under supervision for a year and must co-operate with unannounced inspections by a college representative.
The supervision was to be “moderate level” during the first four months, with a supervisor meeting Billing every two weeks, including directly observing his treatment of patients for a minimum of three hours per visit. After that it could be reduced to a low level with a monthly visit.
Billing appealed the penalty to Ontario’s Superior Court of Justice on June 30, 2017, and the decision was stayed pending the appeal outcome. The appeal was dismissed on April 25, 2018.
The clinic passed a recent college inspection with conditions related to infection control. The July 9 report stated the committee required rewritten measures and procedures for the prevention and management of injuries from sharp objects, and for employee illness.
Public health investigates clinics only in response to complaints related to infection prevention and control practices, or concerns identified through monitoring of infections that are reportable to public health.
The college inspects out-of-hospital premises. “As part of that process, we determined that the Dr. K.S. Billing Pain Management Centre was failing to meet our expectations for patient safety,” it said in a statement.
“Working together with the Region of Waterloo Public Health, we conducted additional inspections in recent days that identified further concerns. As a result, both the college and the region have placed restrictions on the clinic,” the statement said.
“We will continue to work closely together to complete our investigation and ensure that this facility addresses any concerns that have been identified in order to operate safely.”