discipline summaries
witnesses who had worked as Dr. Kamermans’ colleagues in the past, and a physician who had acted as Dr. Kamermans’ supervisor in 2012-2013. In addition, Dr. Kamermans testified at the penalty hearing. His evidence demonstrated that he has little insight into his deficiencies and that he did not take the 2013 findings and Order seriously. A failure of insight or refusal to take responsibility is not an aggravating factor in a penalty analysis, but it must be taken into account when considering whether or not rehabilitation is likely. When considering the potential for remediation, the first consideration is the physician’ s amenability to the process. If the physician does not engage with his or her own remediation, it is for naught. Where there is a finding of incompetence and where lack of knowledge, skill and judgment are found, the Committee must consider the implication of these findings on Dr. Kamermans’ practice of medicine in its entirety. Failure to do so would not achieve protection of the public, and could knowingly expose the public to harm. In 2013, Dr. Kamermans was found to have failed to maintain the standard of practice in his family practice. As a consequence, a number of terms were imposed to allow remediation, supervision and assessment. The evidence from the College-appointed assessor regarding her 2015 practice assessment is that Dr. Kamermans’ clinical care and documentation have not improved over the years. The Committee understands that the purpose of this penalty hearing is not to punish Dr. Kamermans for substandard care in his family practice. The Committee notes, however, that remediation efforts have been ineffective in achieving the desired results. To accept that Dr. Kamermans is incompetent to see a patient in the emergency room and yet may safely see that same patient in his family practice is logically inconsistent given the overlap in knowledge, skill and judgment in those practice areas. Dr. Kamermans’ family practice sees walk-in as well as a number of chronically ill patients. In the circumstances of this case, whether the practice setting is a rural hospital emergency room or a family practice office is irrelevant. The patients seen by Dr. Kamermans in the emergency room, with one exception, presented with complaints one would expect to encounter in family practice. It is the quality of practice that exposes patients to harm and presents an unacceptable risk to the public. In the circumstances of this case, the Committee is of the unanimous opinion that revocation of Dr. Kamermans certificate of registration is the only appropriate penalty Members must realize the importance of maintaining their clinical knowledge, acumen and documentation standards. They should take criticism seriously and strive to overcome any deficiencies, especially when their conduct or care has been subject to prior discipline proceedings. The reputation and integrity of the profession cannot be maintained when a member denies he has problems and fails to make changes that are required to deal with deficiencies. The profession must recognize that chances for change are not infinite, and that a member who has repeatedly failed to maintain the standard of practice and is also found to be incompetent cannot continue with unsuccessful education and remediation forever. The potential for patient risk cannot be allowed to continue until a tragic outcome results. The Committee thoroughly examined rehabilitation and remediation as options but concluded they are not applicable in this case. Awarding costs, if any, and their quantum is at the Committee’ s discretion in an appropriate case. The College has asked for $ 40,140 in costs, representing nine days at the tariff rate of $ 4,460 per day. Dr. Kamermans made no submissions in respect of costs. The Committee considered this to be an appropriate case in which to award costs. The findings made by the Committee are serious and impact both the care of patients and the effective functioning of the health-care system. The Committee is also mindful that the costs ought not to be punitive. The Committee is of the view that tariff amount for each of the nine days of hearing requested by the College would inflict significant hardship on Dr. Kamermans. The revocation of his certificate of registration will remove medical practice from his source of income. He also has had to support a practice monitor / supervisor in his family practice and has paid for previously-ordered reassessments.
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Dialogue Issue 1, 2017