discipline summaries
with Local ” ( Z173A ). A total of 1,801 separate billing codes were submitted for the 20 day time period . Dr . Patel was not present in the office while any services were performed during this time . In the course of the College ’ s investigation , Dr . X provided an independent expert opinion based on a review of 25 patient charts and an interview of Dr . Patel . As found by Dr . X , Dr . Patel failed to meet the standard of practice of the profession and lacked knowledge and judgment in his care and treatment of 25 patients . Among the 25 patient charts reviewed , Dr . X identified a number of areas in which Dr . Patel ’ s practice was unsatisfactory , including : ( a ) Dr . Patel made unsubstantiated diagnoses , including of diabetes .
( b ) Dr . Patel ordered numerous unnecessary tests that were not appropriate to patients ’ circumstances , based on the use of templates and routine . This resulted in , for example , patients undergoing chest X-rays or abdominal and pelvic ultrasounds at successive annual physical examinations even if not indicated by the patient ’ s history or physical examination . Inappropriate blood tests were also ordered as a matter of routine , including for example blood tests that were not indicated during pregnancy . Decisions were generally made to order tests before Dr . Patel had seen the patient .
( c ) Dr . Patel inappropriately treated respiratory infections in both adults and pediatric patients with medications that did 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 ) Dr . Patel failed to address patients ’ presenting concerns on occasion , for example by : failing to conduct a musculoskeletal examination when a patient complained about musculoskeletal illnesses , and failing to address a urine infection that had been noted as a presenting concern . ( e ) Dr . Patel failed on one occasion to follow up appropriately on an abnormal electrocardiogram . ( f ) Dr . Patel inappropriately prescribed the ‘ morning sickness ’ medication Diclectin to a prenatal patient who did not complain of nausea or vomiting .
( g ) Dr . Patel failed to ensure that information in the patient chart was informative . For example , the information in the chart was sometimes contradictory , as in one chart that stated that a patient was ‘ in respiratory distress ’ when the patient ’ s oxygen saturation levels indicated otherwise , or in another chart in which a note indicates both that the patient had no history of high blood pressure and a problem with hypertension . An encounter note in another chart stated that the patient had no history of heart attack , then later documented a previous acute myocardial infarction . A chart for a five-yearold patient stated that the patient “ denies any problems with drug dependence .”
( h ) Dr . Patel 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 . It was apparent that care was being delivered by people other than Dr . Patel , but it was not clear “ how they were being directed or if they were being directed at all .” 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 ) Dr . Patel failed to obtain informed patient consent to the delegation of controlled acts to staff , or to staff involvement in their care .
In a number of the charts under review , Dr . X identified that care had been provided to the patient during the time that Dr . Patel was away from the office in April 2011 , and was not appropriately supervised or delegated . These appointments while Dr . Patel was out of the office included :
• a ‘ counselling ’ appointment for a 5-year-old child
• completion of a hospital preadmission form ;
• provision of a prescription ;
• a number of annual physical examinations at
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Dialogue Issue 2 , 2016