On February 21, 2022, the patient was seen by Dr. Duic after returning by ambulance to the emergency department, 23 days after a medical termination of pregnancy.

Dr. Duic assessed the patient, noting diffuse abdominal tenderness with a peritonitic abdomen and diffuse guarding. Dr. Duic ordered intravenous morphine, point of care urinalysis, laboratory studies, a pelvic ultrasound, and chest and abdominal x-rays. Dr. Duic did not document a reassessment or a differential diagnosis for the patient. He noted a provisional diagnosis of “abdominal pain not yet diagnosed ? cyclic vomiting” and discharged her with a prescription of 16 pills of oxycodone (Percocet).

The CPSO had retained two experts in emergency medicine to review the care by Dr. Duic. They opined that the doctor had failed to maintain the standard of practice, demonstrated a lack of knowledge, skill and judgment in his care and treatment of the patient and exposed the patient to risk of harm and injury. The emergency medicine experts pointed to Dr. Duic’s failure to perform additional tests, such as a CT scan to determine the cause of the patient’s peritonitis, and to document and establish a reassessment, adequate differential diagnosis or discharge instructions prior to discharge.

One of the experts also stated that the care provided in this case, with deficits in history taking, differential diagnosis and clinical reasoning, if provided to populations of patients, would likely cause harm to a substantial proportion of such patients.