A 72-year-old male presents to a busy general internal medicine clinic for follow-up regarding his poorly controlled type 2 diabetes and newly diagnosed congestive heart failure. During the appointment, Dr. Aris, a seasoned internist, efficiently reviews the patient's updated laboratory results, adjusts his medication dosages, and provides lifestyle recommendations. The patient, Mr. Bouchard, attempts to voice concerns about persistent fatigue and how the new medications are affecting his daily routine. Dr. Aris, noticing the waiting room is full and feeling pressured for time, briefly acknowledges Mr. Bouchard's fatigue but emphasizes the importance of medication adherence for cardiac stability. Mr. Bouchard leaves the clinic feeling unheard and believing that his doctor did not fully appreciate his overall well-being. He subsequently files a complaint with the College of Physicians and Surgeons of Ontario, alleging that Dr. Aris was dismissive and failed to adequately address his concerns, leading to a breakdown in trust and making him question the necessity of the prescribed changes. What is the most likely outcome of the College's review of this complaint?

Mr. Arthur Davies, a 78-year-old male, was admitted to a community hospital in rural Manitoba for aspiration pneumonia. His medical history includes well-controlled hypertension and mild dementia. On his second day of admission, his daughter, a retired healthcare professional, observed him becoming progressively lethargic, intermittently disoriented, and experiencing reduced urine output. She voiced her concerns to the ward nurses multiple times throughout the day, emphasizing that her father's state was deteriorating beyond what was expected. The nurses documented her concerns but did not escalate them to the attending physician, nor was a complete set of vital signs taken as frequently as indicated for a deteriorating patient. During the night shift, Mr. Davies was found unresponsive with shallow breathing and bradycardia. Resuscitation efforts were unsuccessful. A review of his chart later revealed he had been prescribed an opioid analgesic (hydromorphone) for cough-related chest discomfort at a standard adult dose, without adequate consideration for his age, potential renal impairment, or baseline cognitive status. His fluid intake and output chart also showed a significant negative balance over 24 hours, unaddressed by the medical team. In the context of medical practice and ethical principles, which of the following represents the MOST significant systemic failure contributing to Mr. Davies's tragic outcome?