Dr.J.PARIAG MD(Univ.West Indies-Jamaica & Trinidad) FRCSC(McMaster-Hamilton)

Dr. John K. Pariag, Mississauga. On March 22, 2012, the Discipline Committee found that Dr. Pariag committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession. The Committee also found that Dr. Pariag is incompetent. Dr. Pariag admitted to the allegations of professional misconduct and incompetence, as follows:
Regarding a review of 35 patient charts from his surgical practice:

• improper placement of chest tubes in a CF patient;
• performing cholecystectomy in the presence of evidence that the common bile duct was not clear;
• failure to protect an anastomosis with a stoma where appropriate;
• improperly discharging three post-surgical patients with elevated white blood cell counts and fevers;
• unnecessary transfusion of one patient;
• questionable decision to perform a targeted bowel resection in a patient with rectal blood loss when the point of bleeding was unknown, and failure to investigate a possible foreign body as indicated by x-rays of the patient;
• incorrectly repairing a hernia, leading to recurrence;
• unnecessary removal of three healthy appendices;
• failure to obtain a right breast ultrasound despite a radiologist's suggestion in a cancer patient;
• failed to give DVT [deep vein thrombosis] prohylaxis perioperatively to a patient with known breast cancer;
• failure to properly control intraoperative bleeding;
• improperly performing surgery without first addressing the patient's elevated INR;
• perforating a patient's bowel while removing two 0.25 cm polyps;
• improperly ordering blood transfusion of a 12-year-old with a haemoglobin count of 108, which order was subsequently cancelled by another physician, and failure to investigate percutaneous pelvic abscess drainage before proceeding to perform a laparotomy on that patient;
• improperly performing an elective thyroidectomy without supervision when Dr. Pariag had never performed such a procedure at the hospital and had not reviewed thyroid surgery during his residency; and
• dissecting a patient's portal triad during surgery to correct a bowel obstruction, which error resulted in the patient's death due to hemorrhagic shock.

Regarding patient A, who had surgeries for an intra-abdominal mass, later identified as a sarcoma:

• failed to adequately document a differential diagnosis, treatment plan, or informed consent discussions with Patient A; and,
• after the recurrence of the sarcoma, failed to solicit an opinion from the Regional Cancer Centre where the patient had been seen in the past, and improperly attempted to treat the sarcoma outside a multi-disciplinary care center.

On December 19, 2012, the Discipline Committee ordered a public reprimand, and directed that specified terms, conditions and limitations be imposed on Dr. Pariag's certificate of registration for an indefinite period of time, including that:

1. Dr. Pariag is prohibited from engaging in any hospital-based surgical practice save and except as a surgical assistant when a College-approved certified surgeon is performing the surgery and is in attendance. At no time shall Dr. Pariag be the most responsible physician with respect to any patient in a hospital setting;
2. Dr. Pariag is prohibited from performing surgery in an office-based setting save and except for minor surgical procedures under local anaesthetic involving the skin and subcutaneous tissues;
3. At his own expense, Dr. Pariag shall undergo a comprehensive practice assessment (CPA) of the office-based practice described in paragraph (b) by an assessor selected by the College. Dr. Pariag shall abide by any and all recommendations made as result of the CPA; and Dr. Pariag shall promptly notify the College should he cease practising medicine before completion of the CPA.
4. The terms, conditions and limitations on Dr. Pariag's certificate of registration under (a) and (b) are to be included on a written form and the written form is to be presented to any patient before Dr. Pariag sees the patient, and a copy signed by the patient is to be included in the patient's chart.

Dr. Pariag was further ordered to pay to the College costs in the amount of $3,650.