discipline summaries
practice of the profession. He was also found to be incompetent in his care of several patients. Furthermore, his derogatory comments to College staff requires a significant sanction. His lack of compliance and delays in responding to College requests had the effect of impairing the investigation in this case. The Committee concluded on the basis of the findings made that a sixmonth suspension is appropriate in the circumstances of this case. It will serve as a specific deterrent to Dr. Botros and a general deterrent to the profession. Dr. Botros has a prior history with the College and the Committee looked at that history to appraise the doctor’ s amenability to rehabilitation, not to punish him further. In considering the current findings along with prior College decisions, it was apparent to the Committee that Dr. Botros is not only incompetent and failed to maintain the standard of practice of the profession in his care of sleep study patients, but also that his lack of compliance with the College processes in place to protect the public and fulfill the College’ s role as a self-governing regulator revealed a contempt of regulation that was of great concern. Counsel for Dr. Botros submitted that Dr. Botros had shown initiative in the past to learn and obtain advanced qualifications in Sleep Medicine. It was submitted that he has attempted to make improvements to his documentation practices by revising his Standard Sleep Study Interpretation Form. Although Dr. Botros did revise his form, there was no evidence presented to show that the form allowed him to be more comprehensive in his consultation reports to referring doctors and to present an analysis of the sleep study that was cogent and meaningful. The Committee was not presented with any other evidence of efforts the doctor had made to address deficiencies in his medical knowledge. In fact, the Committee found there was no acknowledgement on the part of Dr. Botros that he might need any continuing medical education or remediation at all. Furthermore, no evidence was presented that Dr. Botros had finally completed the communications course that was ordered in 2011 and the focus of the Discipline Committee decision of 2015. Although the Committee did not penalize Dr. Botros for his conduct in the past that led to cautions, and a subsequent further Discipline Committee hearing following the current one, the Committee did consider Dr. Botros’ past patterns of behaviour when considering his rehabilitation prospects. The Committee agreed with the adage that the best predictor of future behaviour is past behaviour. College counsel submitted that as part of an appropriate penalty order, the Registrar should place terms, conditions and limitations on Dr. Botros’ certificate of registration for an indefinite period that would restrict him from practising sleep medicine. Under the proposed order he would be restricted from ordering, supervising, and interpreting any sleep studies, diagnostic or therapeutic, and he would be restricted from assessing, managing, treating or prescribing to any patients for any sleep-related problem. The College submitted that Dr. Botros should not be prevented from practising psychiatry as there have been no complaints about this area of his practice.
Dr. Botros’ counsel argued that Dr. Botros should not be restricted from practising sleep medicine but instead should have a conditional restriction on his practice to allow him to complete remedial training in the area of sleep medicine. She also argued that the terms and conditions proposed by the College would limit Dr. Botros in his treatment of sleep problems in psychiatric patients.
The Committee was of the view, based on the evidence of his conduct, that Dr. Botros is not remediable. Sleep medicine has many facets that are very technical. There are bound to be errors or grey areas and some parts of consolidating treatment where art is mixed with science. However, in the course of the hearing over multiple days and the review of many patient charts, Dr. Botros never once conceded that perhaps he could have done something differently, or was in error, where the evidence indicated he was. There was an absence of self-reflection or self-monitoring which is required of physicians to maintain their continuing medical education. Dr. Botros seemed unable or unwilling to provide a comprehensive analysis of a patient’ s case to the referring doctor. He was argumentative, petulant, and spoke in a derogatory fashion to counsel and about the expert witnesses. The Committee did not consider that it would be appropriate to impose the Order submitted by his counsel that would enable Dr. Botros to practise sleep medicine after a period of remediation. It was
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Dialogue Issue 4, 2016