discipline summaries
College;
• that he practise only under the supervision of the preceptor;
• that he undergo a comprehensive practice assessment at the end of his preceptorship; and
• that he abide by all recommendations of his preceptor and the assessor.
Accordingly, Dr. Kamermans underwent a period of preceptorship and supervision with a view to addressing his practice deficiencies.
2015 Practice Assessment – Family Practice The allegations and findings in this hearing related only to Dr. Kamermans’ ER practice. In determining an appropriate penalty, however, the Committee considered whether the deficiencies the Committee had identified in Dr. Kamermans’ ER practice could reasonably impact his family practice. The Committee also explored Dr. Kamermans’ insight into and response to the Committee’ s prior findings regarding his family practice, as it was the Committee’ s view that this would help the Committee judge his amenability to rehabilitation. As indicated above, Dr. Kamermans’ submission was that he should be able to continue family medicine, whereas the College’ s position was that his certificate of registration should be revoked. The Committee therefore considered evidence arising out of the family practice Discipline Committee Order. This included evidence about the comprehensive assessment of Dr. Kamermans’ family practice conducted in January, 2015. The College expert who undertook that assessment opined that Dr. Kamermans failed to maintain the standard of practice of the profession in his practice of family medicine based on her review of 25 of his patient charts, her observation of several patient interactions, and his answers to clinical scenario discussions. The expert had concerns with Dr. Kamermans’ documentation and clinical management of patients whose charts she reviewed, In addition her written report summarized the following concerns regarding Dr. Kamermans’ responses to the clinical scenarios:
• Dr. Kamermans lacked awareness of current immunizations and the recommended immunization schedule for pediatric and adult patients;
• Dr. Kamermans was unable to offer immunizations at his clinic;
• Dr. Kamermans lacked equipment and supplies to manage a medical emergency given paramedic support and the ER facility are 20 to 30 minutes away;
• Dr. Kamermans lacked awareness of the Canadian Screening Guidelines impacting his ability to practise preventative health care;
• Dr. Kamermans was unable to obtain a complete history of the patient’ s presenting complaints in patients presenting with sore throat, history of a cough, or fatigue;
• Dr. Kamermans was unable to describe the relevant history, clinical examination, and information regarding developmental milestones in infants and children;
• Dr. Kamermans responses were not in keeping with the standard of practice for a patient presenting with a history of osteoporosis; and
• Dr. Kamermans responses were not in keeping with the standard of practice in a post-menopausal patient.
In summary, the expert stated that she had concerns about Dr. Kamermans’ chart organization, incomplete histories, physical exams, and incomplete management plans. Dr. Kamermans used a list of patient diagnoses as an assessment, instead of an actual statement of the reason why the patient was there for a visit. She also testified that the ER cases that were in issue were similar to what would be seen in family practice, with the exception of the acute cardiac patient. She stated that it is common to see older patients in family practice who have had falls, although it would not be common to see older patients who arrive via ambulance in family practice. The expert testified that she would expect a family physician to be able to assess and manage all of these ER patients’ clinical presentations in a family practice, including referring them to the ER if needed. The Committee also considered letters of support for Dr. Kamermans, as well as the evidence of two
Full decisions are available online at www. cpso. on. ca. Select Doctor Search and enter the doctor’ s name.
Issue 1, 2017 Dialogue 61