DISCIPLINE SUMMARIES
copied and pasted in patient charts.
• The care provided demonstrated concerns about his knowledge and judgment in almost all charts reviewed. In various files, this related to one or more of timely or appropriate follow-up of abnormal test results, lack of knowledge of current guidelines, and over-extensive investigations without apparent clinical reasoning documented or explained. Dr. Mansour responded to the expert’ s report and said that he had not used a PA in his practice since these issues arose in August 2013. Dr. Mansour told the College that he has since completed the University of Toronto medical record-keeping course and had become more comfortable with the clinic’ s EMR system. He told the College that, in response to the expert’ s concerns about his knowledge of various guidelines, Dr. Mansour reviewed five CPSO policies, as well as a number of clinical guidelines. Dr. Mansour also told the College he had registered to take a course on diabetes management and a review course in internal medicine, and had performed a self-audit and repaid to OHIP the amounts he billed during the times he was not present at the clinic. Dr. Mansour completed the medical record-keeping course at the University of Toronto in November 2014.
REASONS FOR PENALTY The Committee was appalled at Dr. Mansour’ s disrespect to the both the College and to the profession at large when he wilfully obstructed the College’ s investigation into his misconduct for over a year. Dr. Mansour’ s lies to and disrespect of the College as his governing body impeded and delayed the College’ s investigation. Dr. Mansour should have familiarized himself with all of the components of the College’ s Delegation of Controlled Acts policy. Dr. Mansour should have strictly adhered to all components of that policy prior to engaging a PA who is an unregulated person. By ignoring his obligations regarding delegation, Dr. Mansour put his patients at risk of potential harm. He also required his PA to perform outside her scope of practice. The Committee was disturbed that Dr. Mansour ignored certain components of the policy while simultaneously deliberately capitalizing on improper delegation by billing of the Ministry of Health and Long-Term Care in relation to patient visits in July and August of 2013, when the patients were not seen by Dr. Mansour. All Ontarians suffer when a physician improperly bills OHIP because it leaves fewer dollars available for legitimate care. The Committee had grave concerns about Dr. Mansour’ s practice standards, especially as a physician in independent practice. These concerns included not only Dr. Mansour’ s delegation and record-keeping, but also the quality of his care as detailed by the College-appointed medical inspector. The medical inspection opined that Dr. Mansour:
• fell short in terms of timely or appropriate followup of abnormal test results;
• lacked knowledge of current guidelines; and
• conducted over-extensive investigations without apparent clinical reasoning or documentation. Counsel for the College and counsel for the member made a joint submission as to an appropriate penalty and costs order. The proposed penalty was a nine-month suspension followed by the imposition of certain terms, conditions, and limitations on Dr. Mansour’ s certificate of registration, as well as a reprimand. The Committee accepted the jointly-proposed penalty and costs as being both just and in the public interest. The Committee considered the following mitigating factors in coming to its determination:
• Dr. Mansour had no previous discipline findings;
• Dr. Mansour admitted the allegations;
• Dr. Mansour complied with his February 12, 2016 Undertaking with the College;
• Dr. Mansour has not delegated any acts since the College investigation commenced in August 2013;
• Dr. Mansour assessed what he owed to OHIP through a self-audit and repaid it; and
• Dr. Mansour has begun education and rehabilitation to improve his practice standards. The principles relevant to the imposition of penalty in disciplinary proceedings are well-established. The protection of the public is the paramount consideration. Others include maintenance of public confidence in the reputation and integrity of the profession and in the principle of effective self-governance;
84
DIALOGUE ISSUE 4, 2017