Judge blasts pain doctor who failed to change injection practices after string of spinal infections

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His infection-control practices would later be deemed clearly sub-standard, but when Dr. Stephen James learned that a patient had developed a serious abscess in his spinal column after a pain injection, he changed nothing.

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Instead, he gave the military veteran another needle in his back, again failing to wear a mask or gloves.

After 23 other patients in James’s “lucrative” Toronto practice suffered similar, severe infections — and one of them died as a result — he still did not alter his methods, a judge says.

Now after nine years and a drawn-out legal battle funded by the medical profession’s powerful defence agency, Justice Edward Morgan has condemned his behaviour, saying James put his own professional interests over those of his patients.

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The Ontario Superior Court judge also took the rare step of ordering punitive damages in the class-action lawsuit, chastising the physician for neglecting to act when he learned of a string of serious complications.

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“Dr. James not only failed to properly advise his patients of the medical risks they faced in having him perform an epidural injection on them” said Morgan. “He actively obscured the risk in order to protect his reputation and to continue what the evidence shows had become a lucrative practice.”

It’s gone on far too long

But the strongly worded ruling has been almost a decade in the making, despite James being repeatedly censured over the same events before. Ontario’s medical regulator found him guilty of misconduct six years ago and three years before that Toronto’s public-health department blamed an outbreak of meningitis and other infections on his actions.

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James was in hot water with the College of Physicians and Surgeons again this May, ordered to take remedial courses on record keeping and interventional pain treatment after a new assessment “raised concerns about his standard of practice.”

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In fact, another judge hearing the class action also found the anesthesiologist negligent in 2016. But James — represented like all the country’s doctors by the taxpayer-supported Canadian Medical Protective Association (CMPA) — successfully appealed that decision.

The Ontario Court of Appeal sent the case back to another judge to decide first if the class action should be “certified” and then to hold a trial, which finally took place earlier this year.

“It’s totally exhausting,” said Anne Levac, the chief plaintiff in the case and still debilitated by the after-effects of her 2012 infection. “It’s gone on far too long.”

Many of the affected patients are elderly and two have actually died while waiting for the case to be resolved, said Paul Harte, the lawyer spearheading the suit.

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Even now — if James does not appeal — each individual will have to come forward and either reach a settlement with the defence or have compensation assessed by the court.

“It appears to my clients that this is a textbook example of the scorched-earth approach of the CMPA,” said Harte, referring to allegations that the association – whose fees to doctors are largely reimbursed by the provinces – battles too hard in defence of its members. “It can be very frustrating.”

Neither James nor his lead lawyer, Darryl Cruz, could be reached for comment Thursday.

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The case began when Toronto Public Health investigated three cases of bacterial meningitis — a potentially devastating infection of the area around the spinal cord — in patients who had received steroid injections from the physician.

They were sickened by Staphylococcus aureus bacteria, which often sits harmlessly in nasal passages, and at least six of the cases were a rare strain of the bug, said Morgan’s ruling. Public health investigators found evidence of the strain in James but no other employee of the pain clinic where he worked.

Investigation eventually identified 24 people who contracted meningitis, epidural abscesses that put dangerous pressure on the spinal cord or related infections after receiving steroid injections from James.

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Infection usually occurs in only one in 10,000 of the treatments, but his patients suffered the complication at a rate 69 times the norm, concluded Morgan.

James himself admitted to practices that some expert witnesses at the trial deemed unacceptable. That included failing to wear a mask or gloves when doing “caudal” injections — into the tailbone area — and placing instruments on the used wrapper from surgical gloves rather than on “surgical drapes,” special sterile fabric.

The 2015 College of Physicians and Surgeons decision — which resulted in James’s licence being revoked for 10 months — described patients suffering severe back pain, confusion, fever, vomiting and hallucinations before being diagnosed with Staph A spinal infections.

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Patient Anne Littleton died two weeks after her injection, though James neither noted the death in the woman’s chart, contacted the hospital where she passed away nor talked to her family, said the ruling.

Levac said she nearly died after developing an epidural abscess following treatment by James. After 10 weeks in hospital, she had to learn to walk again and says she still suffers disabilities that keep her mostly house-bound.

“It ruins your life, period,” said the resident of Fenelon Falls, Ont.

Levac said she was shocked when she eventually discovered that several of James’s patients had fallen sick before her.

“I didn’t have to be infected, and that’s the hardest part.”

(Sept. 24, 10:05 a.m., clarifies nature of government funding of CMPA)

• Email: tblackwell@postmedia.com | Twitter: tomblackwellNP