discipline summaries
family medicine physicians.
The subject matter of Dr. W’s evidence was the
structure and implementation of a proposed program
of supervision, re-education and remediation for Dr.
Patel. The Committee admitted Dr. W’s evidence not
as a substitute for its own expertise and experience or
determining an appropriate penalty, but rather for his
expertise on the structure and implementation of programs of supervision, re-education and remediation.
Dr. W stated an opinion that Dr. Patel’s behaviour
was remediable; he based this opinion on his review
of the College’s expert’s report, his own review of the
medical records on which that report had been based,
the report of Dr. Patel’s supervisor and an interview
with Dr. Patel lasting 2 ½ hours. Dr. W had drawn
up a proposed remediation plan.
Dr. W testified that he felt that Dr. Patel’s choice
of practice style was less a matter of poor judgment
than it was an attempt, albeit misguided, to meet the
needs of a large and demanding patient population
who had difficulty finding a culturally appropriate physician. Dr. W freely admitted that he tended
to “give Dr. Patel the benefit of the doubt”. Dr. W
appeared surprised when faced with a report that he
had written on behalf of Dr. Patel in 1999 during
an earlier investigation of Dr. Patel, and said that
although he recalled it when it was shown to him, he
had not remembered doing the report when developing his current recommendations. In that earlier report, Dr. W had identified problems in the standard
of care in 5 out of 17 patient records reviewed (with
occasional deficiencies in a further 12), and problems
with record keeping in all 17 charts. Dr. W’s view
at that time was that the chart deficiencies could be
attributed to problems in a new computer program.
In that report he was critical of another expert for
failing to give Dr. Patel the “benefit of the doubt”.
Counsel for Dr. Patel submitted a volume of letters
of support for Dr. Patel. This contained seven letters
from consultant physicians to whom Dr. Patel had
referred patients, attesting to the timeliness and appropriateness of referrals and Dr. Patel’s responsiveness
to recommendations. Two letters from members of Dr.
Patel’s staff described his dedication to his patients,
and a further 10 letters from patients supported Dr.
Patel, his importance to their care and their willingness to travel substantial distances to see him.
In determining the appropriate penalty, the Committee considered the seriousness of Dr. Patel’s misconduct, and the finding of incompetence, together
with both aggravating and mitigating factors. The
Committee took into account penalties imposed in
somewhat similar cases while recognizing that cases
are rarely identical and that each case must be considered on its own specific facts. The Committee also
considered the principles that are well established in
considering an appropriate penalty: the protection of
the public; specific deterrence of the member; general
deterrence of members of the profession; maintenance of the integrity of the profession and the
College’s ability to govern itself in the public interest; maintenance of public trust; and, where possible,
rehabilitation of the member.
The Committee took into account that it had disciplined Dr. Patel on two previous occasions, both for
a failure to maintain the standard of practice of the
profession. The findings in 1991 related to his failure
to provide appropriate care for a patient with a lifethreatening illness (stroke and atrial fibrillation), and
in 1999 for prescribing of oral contraceptives to a
patient with multiple contraindications, including
a history of deep vein thrombosis; also a potentially
life-threatening failure of maintenance of the standard of care. In the current hearing, although most
of the failures consisted of the ordering of unnecessary tests and the provision of unnecessary treatments
and visits, they included a failure to follow-up on an
abnormal ECG and the prescription of medications
that are no longer recommended or commonly used,
thereby exposing his patients to harm. The Committee also noted a pattern of increasingly extensive and
more serious levels of misconduct. The 1991 hearing
involved a single patient’s care. In 1999, Dr. Patel
admitted not only his failures with respect to a single
patient, but also multiple examples of “extremely
poor records”, including some in which notes had
been re-written and others where documentation was
missing entirely. The current Statement of Agreed
Facts incorporated not only Dr. Patel’s failure to
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Issue 2, 2016 Dialogue
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