DISCIPLINE SUMMARIES
DR. WAGDY ABDALLA BOTROS
PRACTICE LOCATION: Kitchener AREA OF PRACTICE: Psychiatry( Sleep Medicine)
HEARING INFORMATION: Allegations Denied; Contested Five-Day Hearing
On March 7, 2016, the Discipline Committee found that Dr. Botros committed acts of professional misconduct, in that he failed to maintain the standard of practice of the profession, and he has engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional. The Committee found that Dr. Botros failed to maintain the standard of the profession with respect to sleep medicine in his care of two patients. The Committee also found that Dr. Botros engaged in disgraceful, dishonourable, or unprofessional conduct in relation to his delay in providing records to and in his manner of communication with a personal injury law firm’ s request for information.
Patient A The Committee found that Dr. Botros failed to properly treat Patient A’ s condition of obstructive sleep apnea in 1998. The Committee accepted Dr. Z’ s expert evidence that Dr. Botros did not meet the expected standard of care because Dr. Botros failed to explore alternatives to Patient A’ s obstructive sleep apnea treatment after the initial CPAP trial was unsuccessful due to a poorly-fitting mask. Dr. Z’ s evidence, that this problem was easily correctable, was demonstrated by Patient A’ s subsequent successful use of a CPAP device with a custom fitting mask under Dr. V’ s direction. Untreated obstructive sleep apnea exposes the patient to the risk of harm.
Patient C The Committee found that Dr. Botros failed to respond adequately to a developing emergency when Patient C’ s CPAP machine broke in August 2013, thus leaving her severe obstructive sleep apnea untreated and exposing her to a risk of harm.
Patient C had first been diagnosed with obstructive sleep apnea in 2003. She had subsequently visited sleep clinics in various Ontario cities before moving to an area northwest of the city where Dr. Botros had his sleep clinic. Following her move, Patient C was unable to maintain contact with her previous sleep specialist. She had continued to use her CPAP device as previously prescribed. Patient C was referred to Dr. Botros’ sleep clinic in order to have her CPAP treatment reassessed. She was first seen at the clinic in May 2013 when she had a CPAP titration study. Patient C’ s May 2013 CPAP titration study confirmed that she has obstructive sleep apnea and indicated that the optimal pressure for her CPAP machine would have been 14 to 15 cm H 2
O. This study forms part of Patient C’ s clinical record at Dr. Botros’ sleep clinic. Dr. Botros never personally saw Patient C. Patient C was scheduled to see Dr. Botros to discuss the results of her study and to have her clinical status evaluated after her May 2013 CPAP titration study. Because the clinic had a long waiting list, Patient C’ s appointment to see Dr. Botros was scheduled for February 2014 – over eight months after her CPAP titration study. Patient C’ s status changed suddenly when her CPAP machine broke and was no longer usable. Without the CPAP machine, Patient C testified that she immediately started having problems: she was unable to sleep at night; she could only nap for short periods of time while sitting up; she felt exhausted during the day; she felt like she was drunk; and she had to stop driving, which caused her difficulty because she was caring for three children at home and was responsible for carpooling other children. In August 2013, Patient C called Dr. Botros’ sleep clinic to ask for assistance. Patient C testified that she called several times, and spoke to two different people at the clinic. She attempted to convey to them the urgency of her situation. She asked if she could be put on an urgent cancellation list to be seen quickly, or if the doctor could communicate with a CPAP provider to prescribe a new machine for her. Patient C testified that the responses she received from Dr. Botros’ sleep clinic were extraordinarily unhelpful. She felt that her concerns were not be-
48
DIALOGUE ISSUE 1, 2018