DISCIPLINE SUMMARIES
• f ailing to document an appropriate pre-anesthetic
assessment or to adequately document intraop-
eratively in his care of multiple patients; failing to
document discussion of the risks and benefits of
invasive procedures with multiple patients and not
having any discussion with a patient regarding a
transversus abdominis plane (TAPP) block which
he later administered;
• when administering general anesthesia, inappropri-
ately using 100 percent oxygen during the mainte-
nance phase as a matter of routine in every case;
• failing to organize and prioritize medical issues
in two complex patients undergoing emergency
surgery;
• administering an inappropriately small dose of
analgesic to a patient undergoing gynecological
surgery, as indicated by the patient’s respiratory rate
and end tidal carbon dioxide; and
• although Dr. Straka ultimately successfully intu-
bated a patient after several attempts due to the pa-
tient’s difficult airway, there were concerns regard-
ing Dr. Straka’s level of situational awareness. The
patient experienced a marked hypertensive response
as a result of an inadequate level of anesthesia for
the multiple attempts at intubation, and Dr. Straka
did not document the difficult airway, including
the number of attempts.
The College assessor made recommendations,
including that Dr. Straka practise under high level
supervision with respect to complicated/critically ill
patients, that the supervisor be immediately available
when conducting airway management, that he en-
gage a clinical preceptor for other aspects of his hos-
pital practice, and that he take educational courses.
Dr. Straka practised under supervision pending the
hearing as a result of an interim order. From January
to June 2016, the supervisor reviewed and approved
of all pre-operative assessments and treatment plans
in advance of Dr. Straka providing general anesthesia,
and observed intubation in each case. The reports by
Dr. Straka’s clinical supervisor were positive.
In April 2016, the expert retained by Dr. Straka
found that Dr. Straka’s documentation had improved
significantly, that his preoperative assessments were
complete, and that there were no issues with Dr. Stra-
ka’s performance of technical tasks under observation.
When observed by this expert, Dr. Straka discussed
the risks and benefits of blocks with patients. How-
ever, the expert identified that Dr. Straka appeared
to have some gaps in his knowledge, that his practice
of doing regional anesthesia without monitoring was
potentially unsafe, that his reaction to stress could
lead to poor judgment, and that his management of
complicated cases was an area for improvement.
The expert recommended that Dr. Straka not do
on-call coverage in anesthesia until completion of ed-
ucation and a reassessment, and that he continue to
be subject to clinical supervision with pre-operative
review of his plans for higher risk patients and the
supervisor’s presence at intubation if necessary. The
expert stated that the “gaps” in Dr. Straka’s practice
were remediable.
Nature of the Professional Misconduct
The Committee concluded that the evidence demon-
strated Dr. Straka’s failure to maintain the standard
of practice of the profession.
Dr. Straka’s documentation was deficient in pre-
anesthetic assessment, discussion regarding risks and
benefits of invasive procedures, and recording of
intraoperative care in multiple patient records.
There were also concerns regarding Dr. Straka’s rou-
tine use of 100 percent oxygen when administering
general anesthesia, his use of an inappropriately small
dose of analgesia as indicated by certain respiratory
parameters, and his ability to achieve an adequate
level of anesthesia for repeated attempts at intuba-
tion.
In addition, concern was voiced regarding Dr.
Straka’s independent management of complex cases
or where patients were critically ill.
The Committee noted that Dr. Straka’s deficiencies
were serious and constituted a risk to patients. With
anesthesiologists, the patient does not usually have a
choice of physician. Patients are left to assume that
Full decisions are available online at www.cpso.on.ca.
Select Doctor Search and enter the doctor’s name.
ISSUE 3, 2017 DIALOGUE
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