DISCIPLINE TRIBUNAL IS NOT A COURT.
(tribunal members not identified by name plates)
Chair:Toronto GP Pamela Lynne CHART MD (McGill, Monteal 1967)
Govt.appointed member:Psychologist Dr El-Tantawi ATTIA PhD. ( White beard)
Govt appointed member: Mr Sudershen BERI
Windsor(Tecumseh) Radiologist Peter TADROS MD (Saskatchewan 1965) FRCPC (Black dyed beard and hair)
"Judge" Legal referee: Mr Robert William Hayden COSMAN BA(Loyola 1968) LLB(Tor.1972) Partner of Fasken, Martineau (sits to side of Tribunal near door)
CPSO Prosecutors: Tall, sturdy, in short black skirt Ms Morgana KELLYTHORNE
Petite, slim, in short flared red skirt Ms Seyran .SULEVANI
Lawyers for Defense
McCarthy Tetrault : 66 Wellington St. (Toronto office.)
PARTNER Christopher HUBBARD BA-Hons (U.Toronto: Phil.& Bio-med.ethics 1997) LLB(Univ. Western Ont.2000) Tall, slim,suit & tie. Careful questioning
ASSOCIATE: Eric PELLEGRINO BA (Pol.Sci. & Psych.York Univ. 2006) BEd (York 2007) JD(York-Osgood Hall 2011)Tall, suit & tie,with bass voice. .
During examination of CPSO Toronto GP "expert witness" Howard Lawrence RUDNER MD(Tor.82), of 586 Eglinton Av.East, Dr .Patel was described as being " on a leash". and that "old dogs can learn new`tricks".
In Ontario Docs are charged $3,600 a day for CPSO Tribunal costs. This makes many plead guilty or.make deals.
CMPA (Can.Med.Protective Assn) pays for legal costs of CPSO TRIBUNALS :but NOT for Appeal costs in a Provincial COURT,(can be easily $100,000). A reason why Ont. Docs often plead "Guilty" or accept "Deals" from CPSO..
CPSO accepts complaints against a Ontario Registered Doctor from ANYONE, ANYWHERE in the WORLD. The complaint (which can be NON-MEDICAL) is then reported worldwide to all other Medical Registration offices.
Blog comment: In Ontario it is safest for a career to work in non-clinical practice (e.g. Admin;Insurance); followed by Hospital-only practice then large Group practice. Most dangerous is solo practice as easiest target for CPSO due to limited funds and need for paid locum to continue practice. In Ont. OHIP solo practice has minimal sale value of furniture unless includes property.
See Law Soc Upper Canada site for list of Lawyers with Health :Law Certificates.
Committee: Discipline
Decision Date: 09 Mar 2015
Summary:
On March 9, 2015, the Discipline Committee found that Dr. Patel committed an act of
professional misconduct by failing to maintain the standard of practice of the profession in his
care of 25 patients and is incompetent, in that, his professional care of these patients displayed a
lack of knowledge, skill or judgment that was of such a nature or to such an extent that his
practice should be restricted or that he is unfit to continue to practise. The Committee also found
that Dr. Patel engaged in disgraceful, dishonourable or unprofessional conduct, namely:
inadequate supervision of staff; improper delegation of controlled acts; improperly permitting
and/or directing staff to prescribe to patients; inappropriately having staff care for and treat
patients in his absence; inappropriate billing to OHIP; and breaching his undertaking to the
College. Dr. Patel admitted to the allegations.
In addition, Dr. Patel pleaded no contest to and the Discipline Committee found that Dr. Patel
committed an act of professional misconduct, in that he failed to maintain the standard of
practice of the profession and that he engaged in disgraceful, dishonourable or unprofessional
conduct regarding his care of Patients A and B.
An investigation into Dr. Patel's practice was initiated after the College received information that
Dr. Patel had been allowing staff to perform patient care beyond that which was appropriate for a
non-physician staff member to provide. When College investigators attended at Dr. Patel's clinic
in April 2011, staff and patients were present. College investigators were advised that Dr. Patel
was on vacation.
Dr. Patel inappropriately billed OHIP during the time period that he was on vacation in April
2011. OHIP billings for the time period of Dr. Patel's absence indicated that the total amount
billed in his name while he was on vacation was $34,079.14. Dr. Patel was not present in the
office while any services were performed during this time. Dr. Patel inappropriately billed OHIP
during this time period. Dr. Patel also engaged in other inappropriate billing practices: billing for
a minor assessment when faxing prescription renewals to or receiving them from pharmacies;
billing for a minor assessment when a patient's family member dropped off or picked up a
document, prescription or testing kit; and billing inappropriately with respect to administration of
the Rotateq vaccination.
Dr. X, independent expert, identified a number of areas in which Dr. Patel's practice was
unsatisfactory, including that he:
(a) made unsubstantiated diagnoses, including of diabetes.
(b) ordered numerous unnecessary tests that were not appropriate to patients' circumstances,
based on the use of templates and routine. Inappropriate blood tests were also ordered as a
matter of routine. Decisions were generally made to order tests before Dr. Patel had seen the
patient.
(c) inappropriately treated respiratory infections in both adults and pediatric patients with
medications that do not meet the standard of practice, and he failed to consider asthma
where it would have been indicated to do so. Patients with respiratory infections were
sometimes required unnecessarily to come in daily or almost daily for a period of time for a
treatment that was not indicated.
(d) failed to address patients' presenting concerns on occasion.
(e) failed on one occasion to follow up appropriately on an abnormal electrocardiogram.
(f) inappropriately prescribed the 'morning sickness' medication Diclectin to a prenatal patient
who did not complain of nausea or vomiting.
(g) failed to ensure that information in the patient chart was informative.
(h) failed to appropriately supervise staff and improperly delegated controlled acts. There was
no documentation in the charts of instructions by Dr. Patel to his staff, including with
respect to assessments and examinations conducted in his absence, nor were there any
medical directives provided. Dr. X identified instances in which the care delivered in this
manner showed a lack of appropriate clinical decision-making reflective of the lack of
supervision.
(i) failed to obtain informed patient consent to the delegation of controlled acts to staff, or to
staff involvement in their care.
After a referral to the Discipline Committee, Dr. Patel entered into an undertaking dated May 1,
2014. Among other things, Dr. Patel undertook that, effective immediately, he would not
"delegate to any other person any Controlled Act, as that term is defined in the Regulated Health
Professions Act, 1991." He also undertook to engage a Clinical Supervisor, Dr. Y, who would
review his practice. Dr. Patel undertook "to co-operate fully with the supervision of" his practice,
and to abide by the recommendations made by his Clinical Supervisor, including but not limited
to any recommended practice improvements and ongoing professional development.
Dr. Y reviewed patient charts from Dr. Patel's practice and observed patient encounters in his
office as required by the Undertaking. In the course of her duties, Dr. Y found that Dr. Patel
continued to delegate controlled acts in breach of his Undertaking.
Dr. Patel failed to abide by practice recommendations made by Dr. Y, in breach of his
undertaking, namely:
(a) to cease having staff enter billing codes for visits that were in progress and to begin entering
billing codes only upon completion of a patient encounter.
(b) to cease billing for visits at which the patient was not present, including missed
appointments and where the patient or family member was dropping off or picking up forms,
specialist information, or specimens for testing.
(c) to augment subjective histories documented by staff with his own additional questions.
(d) to obtain informed consent from patients prior to staff documenting patients' subjective
histories.
(e) to take steps to ensure that his EMR system clearly indicated which details were entered by
which individual.
(f) to take steps to ensure his staff did not make clinical decisions.
(g) to cease ordering unnecessary diagnostic tests.
(h) to cease routinely prescribing Biaxin and Alupent for cough symptoms.
In addition, Dr. Patel failed to abide by patient-specific treatment recommendations made by Dr.
Y, in that he did not discontinue a drug, Diabeta, which is associated with hypoglycemia to a
patient who had experienced a hypoglycemic episode, continued to prescribe narcotics to a
patient without adequate documentation, and continued to prescribe Ventolin to a patient without
the suggested addition of another inhaler such as Advair to provide better symptom relief.
With respect to Patient A, she attended at Dr. Patel's office because she was experiencing foot
problems and looking for a family physician. A female staff member, whom Patient A believed
was a nurse but who was not a nurse, documented Patient A's history in detail, as well as her
blood pressure, weight, and height. Patient A expressed to both the staff member and to Dr.
Patel that she was being followed by Hospital 1 for a health issue related to her breasts, and did
not require a breast examination. During the examination, Dr. Patel made comments that made
Patient A feel uncomfortable, did not examine her feet, and conducted a breast examination
without her consent.
Dr. X indicated that Dr. Patel's care did not meet the standard of practice of the profession. The
history and other information in the chart obtained was contradictory. Patient A was subjected to
unnecessary investigations, and did not have her concerns regarding her presenting complaint
addressed. She had a breast examination to which she had not consented. There were errors in
judgment in not seeking to obtain information from Hospital 1 or ordering appropriate tests, and
there was a lack of adequate supervision of the staff member who saw Patient A before Dr. Patel.
Dr. Patel's care displayed a lack of knowledge and judgment.
With respect to Patient B, he attended at the office of Dr. Patel complaining of chest pain. He
was initially seen by a staff member, who recorded his history and vital signs, and performed an
electrocardiogram. Dr. Patel informed Patient B that his electrocardiogram was normal, and that
he could not treat him. Dr. Patel advised him that he could go to a hospital emergency
department if he wished.
The next day, Patient B was admitted to hospital, where he underwent triple bypass surgery.
Patient B was discharged from hospital with instructions to follow up with his family physician.
After Patient B voiced concerns regarding post-operative care, he was discharged from Dr.
Patel's practice by letter, five days after his discharge from hospital.
Dr. X opined that based on Patient B's account of his patient encounter, Dr. Patel did not meet
the standard of practice of the profession and lacked knowledge and judgment in his treatment of
Patient B. It would have been appropriate for Dr. Patel to either call the emergency department
or send information either separately or with the patient. Patient B's discharge from Dr. Patel's
practice also exposed him to harm, as he was not given any time to find a new primary care
provider, and the discharge instructions from the hospital had indicated the need to see his
primary care provider within the week.
With respect to both Patients A and B, Dr. Patel failed to provide an audit trail for their
electronic medical records that accorded with College policy upon request by the College
investigator.
Penalty decision under reserve.
