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