discipline summaries
Dr. James shall, within seven days of date on which he became aware, report the infection to the College. Dr. James was ordered to pay costs of $ 4,460; and given a public reprimand. At the conclusion of the hearing, Dr. James waived his right to an appeal and the Committee administered the public reprimand.
Order For complete details of the Order, please see the full decision at www. cpso. on. ca. Select Doctor Search and enter the Doctor’ s Name.
Dr. ROB JOSEPH KAMERMANS
Practice Location: Coe Hill Area of Practice: General Practice Hearing InformATion: Contested Hearing( 9 days)
On November 7, 2014, the Discipline Committee found that Dr. Rob Kamermans committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession. The Committee also found that Dr. Kamermans is incompetent. Dr. Kamermans failed to maintain the standard of practice of the profession in his care and treatment in the Emergency Department of six patients( Patients 1 to 6) and in his medical documentation regarding nine patients( Patients 1 to 6, 12, 14, and 22). Dr. Kamermans’ deficiencies in his care and treatment of the six patients displayed a lack of knowledge and judgment of a nature and to an extent that the allegation of incompetence was proved.
Patient # 1 Patient # 1 was a child who presented with fever, stomach ache and vomiting. Dr. Kamermans failed to maintain the standard of practice in his documentation and care. Dr. Kamermans failed to do an ultrasound to rule out appendicitis, a significant differential diagnosis, and was deficient in his assessment and treatment of what he described as pharyngitis. Dr.
Kamermans’ deficiencies in his care of this patient displayed a lack of knowledge and judgment.
Ruling out Appendicitis Both the College expert, Dr. X and the defence’ s expert, Dr. Y, agreed that appendicitis was a significant differential diagnosis in a patient with this presentation and needed to be ruled out. The Committee was not persuaded that Dr. Kamermans considered appendicitis in this case. Dr. Kamermans ordered blood work, x-rays and laboratory work but he did not address appendicitis in his charting, one of the most serious potential problems given this presentation. When he signed off the chart that day and added the diagnoses, treatment and follow up instructions, Dr. Kamermans did not indicate in the record above his signature that appendicitis was a differential diagnosis, that it was ruled out or that the parents were given instructions about circumstances under which to return to the ER. In his testimony, Dr. X said that a differential diagnosis is a thought process about what could be accounting for the child’ s symptoms, or some of the possible diagnoses to explain the symptoms and findings on the examination. He testified that, when he interviewed Dr. Kamermans, he asked him about his thought process, about a pediatric patient presenting with a fever, gastrointestinal complaints, pallor and a stomach ache, and Dr. X indicated that Dr. Kamermans was not able to answer beyond reference to the concrete information in the chart. Dr. Kamermans was not able to expand on what he would have considered in a patient with this presentation in order to fill in the gaps in his charting.
Treatment of Pharyngitis Dr. X testified that it is impossible to say with certainty whether or not an inflamed throat is due to strep bacteria. A throat swab is necessary to determine if the pathogen is strep and whether antibiotics are indicated, he said. Both Dr. Y and Dr. Kamermans thought otherwise. Dr. Y assumed that because Dr. Kamermans treated the child with Amoxicillin that the child must have had a“ bad” pharyngitis, although there was no documentation to support that. Dr. Y said that he thought it was common practice to
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Dialogue Issue 1, 2017