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How a Toronto ob-gyn gamed the system and put his patients lives at risk
"The maternity ward of a Toronto on a hospital one Saturday in two thousand sixteen babies are being born at an alarming rate faster than they should have been and the short-staffed prove nurses skidding worried something was up but nobody raised any concerns. These were after all patients of highly respected O._B._G._Y._N.. Doctor Paul shoo-in who's on call at North York General Hospital. Most weekends wasn't until two nurses found evidence of wrongdoing and report it. The doctor Schuman's misdeeds were revealed and he lost his medical license. This is a story of greed ethical. Neglect disrespect of women and of a medical establishment tried to block this very story from being told and I'm filled in for Jordan Heath Rawlings and this is the big story Michael List wrote about oh Dr Xuan in an article published in the August issue of Toronto. Life is incredible reporting has shocked city. Thank you so much for joining US Michael. Oh It's supposed to be here so I read this the story with a pit in my stomach. I'm a woman in Toronto who has had a baby in a hospital in Toronto fairly recently and I know I'm not the only one who read your story and was just horrified fight but but let's start at the beginning who is Dr Paul Schwen and what how does he regarded as a doctor in the city so hall shoe and was you you know by all accounts for thirty years <hes> one of the city's most respected O._B._G._Y._N.'s. He was also a gynecologic oncologist. What sort of unusual about about that is that most gynecological oncologists once they once they sort of go down that road they I was told about ninety percent of them? Give up their obstetric practice but not delivering babies is awesome because they're dealing with cancer patient exactly but she decided to keep his obstetric practice. Since the late nineteen eighty s he worked at the North York General Hospital he also taught at the university city of Toronto. I spoke to a number of his colleagues. All of whom said that you know he was widely admired in the community until just a few years ago when when nurses at his hospital started to notice something odd about the way he was delivering babies there were often large numbers of women coming in and in Labor on the weekend more so than on a weekday or at least not necessarily more so but just didn't in sort of in unusually high numbers they all his his patience or yeah so he would he would take call on Saturdays and so this is sort of fishy that the same day he's taking call a lot of his his patients are coming in to deliver and they were in a kind of labor. That's called precipitous labor. What does that mean so it means the contractions are coming to quickly lasting too long? Sometimes we'll get a condition called hyperstimulation of the uterus. This is what those what that is is a sort of very common sign of having been induced but the nurses would look look at these patients charts and they would see that there was no indication for for induction that they hadn't been induced they would ask the patients themselves and and they would say no no. I wasn't induced what it turned out is that he Dr Shulin was also seeing many of these patients at his clinic the morning that they were later coming in in Labor this this is very odd and then what happened not once not twice but three times nurses who were tending to these patients found the dissolved remnants of of a of a powdery pill in their vaginas and again there is no indication should be a record of any medication given to you <hes> and as as a patient you should know about it right and neither of those things happened which means that that whatever this pill was it was given to these women without their consent without notifying them and it probably had something to do with why they were coming in in these large numbers and in precipitous Labor so what happened was that the third time that this pill was found docile tested it and it triggered an investigation to what was going on why why were Schuman's patients sort of arriving at the hospital hospital like this wh what was going on and what they found was that this pill was a drug called Misoprostol and missed Oprah Saul was originally developed as an ulcer medication medication and like lots of medications it was found to have these other effects that that they hadn't designed it for and and those effects include when given when it's given to a pregnant woman it softens the Cervix Cervix and can cause contractions <hes> the product induction method right sure. I mean yeah except the only thing is that using it for that purpose is against North York General Hospital. Oh policy it is used sometimes as <hes> usually as like sort of half the recipe of pharmacological abortion right an abortion pill. That's right but if you I use it on a woman who intends to deliver her baby in his term there are terrible side effects it can cause the death of the baby and it can cause the death of the mother and so you know there's a black box label warning on it that it isn't to be used for that purpose and he actually admitted that he was doing it for a long time and not only was he doing it. He had trained and another doctor to do it and he said something like why don't you why don't you go after him. So I do WanNa rewind a little bit though and just get give us a sense of sort of how and why why this happened if he had said he'd been doing a long time is there are there early signs of when these misdeeds began to occur that maybe were found later so shoe and would later. I admit that he had been doing this for years. Is the way that you know the the the problem with a sort of <hes> with misdeeds like Schuman's is that there's very very little evidence right because it's not in the it's not in the chart. It's nothing told to the patient. The only way that You can find the pill in the patient and collected so we we don't actually know how long shoe and has been doing it for except by his own admission that it had been for years. Another question is sort of like you know your question is why like why why would why would he be doing this. There are sort of two explanations the the explanation that shoe and gave is that he was doing these these women a favor <hes> that he was trying to get around the hospital is the way that he later put it to his sort of interlocutors around the red tape of the hospital when she called called it and certainly a lot of patients and the Canadian health care system. You know sometimes you're frustrated. That things aren't happening as quickly as you would like them to happen you wait around and that's what he sort of said you know like sometimes we book someone you know. Either you know either it could be you know could be cancelled. It would have to be rescheduled. It's a big pain in the butt. You know there's like this whole sort of <hes> sluggish bureaucracy up to deal with this is a way to sort of get around it but what his <hes> lead investigator in the culture physicians and surgeons later said is that he can't rule out pecuniary Mary reasons for having done it. What do you mean by that so he's suggesting that he could that could have been doing it for the money and you're like even when I was reporting the straps Sorta like wait ah like in a socialized medical world? How can you do something like this for money well so shoe and took call on Saturdays hit looks like he was doing this on the weekend and what we what we later found out through documents at the show for one of the years that we <hes> that we have information on this <hes> two thousand fifteen to two thousand sixteen shoe and delivered almost most seven hundred babies a year at North General Hospital which is more than any other doctor there but what's really odd is that forty seven percent of the babies were born on the weekend? She wants boss at North York. General Neural <hes> had sort of told you that Hsun was only allowed to do fifty deliveries a month and that's partly sort of it's it's it's part of safety issue. When it's it's also impart part sort of budgetary issues but shoot isn't paid from from that budget right like doctors in doctors around the country they are sort of like high-powered freelancers right bill for service right so they get a fee for service? So if you do x you can bill you can build the you know the the provincial health insurance for having done it. It's not just a matter of volume though that's true right. If you deliver more babies you can you can charge more for having done it but in the there's a there's a strange range of incentive <hes> built into when it makes sense for an O._B._G._Y._N.. Deliver a baby. If you deliver a baby in Ontario on a weekday weekday you can charge four hundred dollars but if you deliver that same baby on a weekend you can charge over seven hundred dollars. It's about two hundred and fifty bucks more so that's the reason why you know or at least according to his his medical investigator <hes> he couldn't rule out that shoe and was doing this on Saturdays <hes> when he took call so that he could deliver those babies for a higher rate then he could if he was delivering them on on a weekday so money aside I've another major problem with with his conduct seems would be informed patient consent and another example which also shocked me had to do with evolve ectomy. Is that what it's called what what happened there so this is not even necessarily delivering babies that he was sort of blowing past patient consent on it was other matters to what was going on there so this this was this was a <hes> an issue with his <hes> oncology practice. What happened was that when we were investigating the story we we asked the culture physicians and surgeons for the evidence that was entered hurt against you in in the in the what resulted in the loss of his license and two of those documents that were released to us worth the previous complaints that were lodged against chewing and have an and were found to be credible? What's odd is that those were not available to to the public right? It used to be that that when <unk> something from the Complaints Committee at the was found to be credit credible and resulted in ruling against a doctor that that would not be released to you so if you want to know so if your doctor had any problems with something like consent you couldn't know right so so what happened with this woman was had was that <hes> she had this rare malignancy called paget's disease and it sort of manifests as as little sort of a sort of lesions on on the Volva and so she went to Dr Soon Dr Shulan said listen we need to partial vol back to me and she was really nervous as you as you can imagine right excuse me and so so this this is what you need to do. We need to do the surgery so she said I mean okay. If you think that's what's Best I'll I'll book it. How many of us have been like okay? Let Dr Nells Bass Drink. You're going to say right like argue with your doctor right so medical professional acted right sure so she said Okay and then she said listen. If you want more information you can go home and Google paget's disease and so she did and she looked it up and she found that in some cases aces it could be treated with a cream so she came back and she said listen. I you know I I read. We can just use a cream. That's what I want Chu and said that's not going to help for your <hes> for your version of of paget's disease so you need to have the surgery and more than that even though the surgery was a month out if she canceled it she would have two hundred bucks cancellation flation view a month in advance a month and she said well I mean I you know I don't WanNa pay the cancellation fee. My doctor says I should do it so we'll do it. So when you woke up from the surgery she found that not only had it been this per show victim that they talk talked about but he also cut off her clitoris that to me was my job was on the floor. I was like you know is that her her fault for not asking more like about that the other thing to stop me in the story. was you know and there's no proof of this at all. There's no way of knowing for sure but like if he had had male You have been so cavalier with his decision. Making with the lack of