discipline summaries marizing her review of the same 25 charts that Dr. R had reviewed, Dr. U noted:“ In general, I do agree that Dr. Wojcicki’ s notes tend to be quite brief and more complete notes would often be helpful. I would encourage him to be more complete in his note writing / dictation, perhaps following a template including all parts of a complete consultation letter. However, in general, I find his care to be appropriate. Occasionally, I do find that I had to extrapolate based on the rest of the chart and other consult notes and orders. Overall documentation seems to be sparse, for example in admitted patients there are only progress notes seen. In someone admitted for a very short period of time, an admit note and discharge summary suffices as adequate; however when patients are admitted for longer durations I would expect to see more documentation from the MRP( Most Responsible Physician). This is likely to be a systems issue [ at the hospital ], given that Dr. Wojcicki is not generally the MRP and likely multiple other physicians serve this role, and in this sampling of 25 charts I found this to be a common issue.
I understand that the system of writing discharge notes is often left to the weekend covering attending instead of the usual MRP. This is a system issue, which could use correction in the hospital … Similarly another easy careless error which can occur is a mistaken dose of medication. This should also have a system level backup, such as with an electronic medical record or pharmacy, which should catch such dosing errors.”
Ontario Health Insurance Plan( OHIP) Billing Issues The College obtained OHIP billing information regarding care and treatment Dr. Wojcicki provided at the Vivian Medical Spa in the first Section 75( 1)( a) investigation, covering services provided between November 1, 2011 and December 31, 2012. The College concluded that Dr. Wojcicki billed OHIP on numerous occasions for services for which there is no documentation. In particular, 21 of the patients whose charts were reviewed attended for intravenous treatment on a weekly or twice weekly basis, and Dr. Wojcicki never directly assessed these patients on many of these occasions. They were instead under supervision of nurses. Dr. Wojcicki would do‘ rounds’ with the nurses to discuss any issues with respect to individual patients.
On these occasions, Dr. Wojcicki submitted claims to OHIP using billing codes such as A138, which is the internal medicine code for a partial assessment which requires direct examination of the patient, without assessing patients directly.
Section 37 Interim Order by the College On December 10, 2014, after referring allegations of professional misconduct to the Discipline Committee, the Inquiries Complaints and Reports Committee directed the Registrar to impose terms, conditions and limitations on Dr. Wojcicki’ s certificate of registration pursuant to Section 37 of the Code. The Order required that Dr. Wojcicki cease to engage in complementary / alternative medicine practice, among other things.
Undertaking to the College As part of the resolution of the allegations referred to the Discipline Committee, Dr. Wojcicki executed an undertaking to the College on February 19, 2016. Dr. Wojcicki agreed to cease engaging in any CAM practice and has undertaken not to apply or reapply to practise CAM in Ontario. He must also post a sign indicating this restriction in all locations where he practises primary care.
Penalty and Reasons for Penalty Counsel for the College and counsel for the member made a joint submission as to an appropriate penalty and costs order.
Aggravating Factors The Committee considered the degree to which Dr. Wojcicki failed to meet the standard of practice as an aggravating factor in this case. In his CAM practice, Dr. Wojcicki’ s care did not meet the standard of practice in all 25 of the charts reviewed. In his Internal Medicine Hospital practice, Dr. Wojcicki did not meet the standard of practice in 16 of the 24 charts reviewed. The Committee was particularly concerned by the fact that both of the College-retained independent assessors stated that Dr. Wojcicki’ s clinical practice is likely to expose his patients to risk of harm or injury.
Full decisions are available online at www. cpso. on. ca. Select Doctor Search and enter the doctor’ s name.
Issue 4, 2016 Dialogue 77