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