Huge class-action settlement worries neurologists

A recent $27.5-million class-action settlement involving a Toronto-area physician has left some neurologists concerned about potential damage to the specialty's reputation. The December settlement, the largest of its kind in Canadian medicolegal history, will see payments made to up to 15 000 patients who underwent electroencephalograms (EEGs) at 6 Toronto-area clinics between January 1990 and March 1996; about 75 of them subsequently developed hepatitis B. The clinics were operated by Dr. Ronald Wilson.

A subsequent investigation determined that the outbreak was caused by an infected technologist and inadequate infection control practices (see CMAJ 2000;162[8]:1127-31). That study concluded: “There were no written infection control procedures for any of the clinics. The technician reported that he did not wear gloves when conducting EEGs and … although [he] indicated that the use of needle electrodes rarely resulted in bleeding, patients' reports of bleeding were common.”

“Absolutely, we've been damaged by this,” said Dr. William Murphy of Calgary, a past president of the Canadian Society of Clinical Neurophysiologists. “Our profile is certainly harmed.”

Murphy says the case has also given many neurologists reason for pause. “I can't believe how one person can contaminate so many individuals.”

The case first gained public attention in 1996 after Toronto public health officials traced a hepatitis B outbreak to the EEG clinical technician employed by Wilson. He performed all EEGs done at the 6 clinics.

The infection rate among Wilson's patients was 600 times greater than normal. About 15 000 people who received EEGs during the 6-year period are expected to receive amounts ranging from $1000 to $130 000. Under the settlement, Wilson denied any responsibility for causing the problem. He still faces a hearing before the Ontario college.

Writing in CMAJ in 2000, the public health team that investigated the case concluded that guidelines were not followed at the Toronto clinics. “As stated in the guidelines,” it concluded, “it is preferable to use noninvasive techniques (e.g., disk electrodes) rather than invasive ones (e.g., subdermal electrodes).”

Dr. Gerald Tullio, a community neurologist at the William Osler Health Centre in Brampton, Ont., considers the case a wake-up call. He said he makes a point of opening new packages of electrodes in front of patients to help dispel any fears that products are being reused.

Tullio said many neurologists are worried about the impact the case will have on their malpractice fees, but Françoise Parent of the Canadian Medical Protective Association (CMPA) thinks the impact will be small because “assumptions [were] made about the cost of [this] class-action suit 6 years ago.” Ontario neurologists will pay $7116 for coverage in 2002.

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