Dr. X, retained as an expert by the College, opined that Dr. Mohan failed to meet the standard of pracdiscipline summaries
DR. RAJESH MOHAN
Practice Location: Toronto Practice Area: General Practice
Hearing Information: Agreed Statement of Facts; Admission; Joint Submission on Penalty
On September 22, 2015, the Discipline Committee found that Dr. Mohan committed acts of professional misconduct, in that he has failed to maintain the standard of practice of the profession; and he has engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional. Dr. Mohan admitted to the allegations. In February 2010, the College received information from a patient that she and her family had attended at Dr. Mohan’ s clinic for travel medicine services, where they had been seen by a man whom they believed to be a physician. On returning home, they viewed Dr. Mohan’ s website and realized that although they had received a prescription signed by“ Dr. R. Mohan,” the man whom they had seen was not Dr. Mohan. Dr. Mohan explained to the patient that the man they had seen was not“ licensed” to practise medicine in Ontario and had signed Dr. Mohan’ s name on the prescription. As a result, the College began an investigation into Dr. Mohan’ s practice. When Dr. Mohan was made aware of the investigation, he ceased to employ physician assistants in his general practice, and cooperated with the investigation. The investigation showed that Dr. Mohan had employed two assistants in his general practice, neither of whom was authorized to practise medicine in Ontario. Dr. Mohan failed to familiarize himself with his professional obligations in regard to delegation and supervision of patient care and other issues arising from his employment of assistants. Appropriate delegation, under College policy, requires a number of safeguards, including the establishment of a physician-patient relationship, the existence of a medical directive or direct order, appropriate evaluation of the delegate, informed patient consent, and quality assurance steps, including appropriate supervision. Dr. Mohan screened applicants for assistant positions, provided a period of job shadowing, and subsequently reviewed care provided by his assistants after the fact. However, his supervision, delegation and ongoing quality assurance were inadequate. The following deficiencies in Dr. Mohan’ s use of physician assistants were identified:
( a) Dr. Mohan delegated controlled acts in the absence of written medical directives or direct orders, and in fact did not have written medical directives in his office;
( b) Dr. Mohan inappropriately had his physician assistants provide care while he was out of the office, including during a period of time while he was on holiday, without ensuring that another physician was on the premises and would supervise them;
( c) Dr. Mohan did not ensure that there was a prior physician-patient relationship between himself and any patient seen by his physician assistants;
( d) Dr. Mohan did not adequately ensure that there was informed patient consent to care being provided by physician assistants in all cases;
( e) When introducing patients to his physician assistants, Dr. Mohan did not adequately ensure that patients were aware in all cases that physician assistants were not certified to practise medicine in Ontario;
( f) Dr. Mohan did not adequately ensure that his physician assistants and office staff introduced the physician assistants appropriately to patients when he was not present;
( g) Dr. Mohan inappropriately permitted his physician assistants to write prescriptions and test requisitions; and
( h) Dr. Mohan inappropriately billed the Ontario Health Insurance Plan for services provided by his assistants in circumstances where it was not permitted for him to do so.
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Dialogue Issue 2, 2016