DISCIPLINE SUMMARIES
and an inability to walk . Patient A was admitted to hospital in early November 2010 , where she was diagnosed with a severe allergic reaction to the Allopurinol , Toxic Epidermal Necrolysis . A College-retained expert opined that Dr . Kakar ’ s care of Patient A failed to maintain the standard of practice and displayed a serious lack of knowledge and judgment as follows :
• Dr . Kakar ’ s prescribing of Allopurinol for gout arthritis was outside of his scope of practice and inappropriate ;
• Dr . Kakar inappropriately minimized the seriousness of Patient A ’ s concerns after she experienced a reaction to Allopurinol ;
• Dr . Kakar ’ s records of his treatment of Patient A failed to maintain the standard as the vast majority were illegible ; and
• Dr . Kakar ’ s prescription of Allopurinol to Patient A seriously harmed her and put her at life-threatening risk .
A second College-retained expert opined that Dr . Kakar ’ s failure to conduct an adequate clinical examination , prior to diagnosis and prescribing of Allopurinol , failed to maintain the standard of practice and that he demonstrated a lack of knowledge , skill and judgment .
Misleading College During Investigation In his January 15 , 2013 response to Patient A ’ s complaint , Dr . Kakar stated to the College that he prescribed Allopurinol for Patient A at an appointment in late October 2010 . He also provided a copy of his chart for Patient A which indicated that there was a discussion about Allopurinol on that date in late October 2010 , and that Dr . Kakar prescribed the medication on that day . Subsequently , after the College provided Dr . Kakar with information indicating that the complainant had filled the prescription in early October , Dr . Kakar claimed that he relied on his chart when he responded to the complaint , and since the reference to the discussion about Allopurinol was recorded in the chart for the appointment in late October , he had presumed that was when he prescribed the medication . He said it must have been a late entry from October of 2010 which he had failed to indicate as such . Then , in May of 2013 , Dr . Kakar ’ s counsel wrote to the College and admitted that Dr . Kakar had added the note in Patient A ’ s chart about Allopurinol after he received the complaint from Patient A , in October 2012 , not in October of 2010 , as he had claimed in his communication to the College .
Patient B In January 2013 , the College received a complaint about the psychiatric care provided by Dr . Kakar to a teenage girl , Patient B , in the fall of 2012 . A College-retained expert concluded that Dr . Kakar failed to meet the standard of care in his record keeping for Patient B as follows :
• Dr . Kakar ’ s original office notes are illegible and needed to be transcribed in order for her to read them ;
• Two of Dr . Kakar ’ s progress notes , dated August 2012 and September 2012 , were identical . This failed to reflect the true progression , or lack of progression , of Patient B ’ s response to treatment ; and
• Dr . Kakar ’ s failure to document a rationale in his progress note of September 2012 , for increasing the patient ’ s dosage of Cymbalta to 30 mg three times a day .
It was also determined that Dr . Kakar made an error in his September 29 , 2012 entry in Patient B ’ s chart when he recorded a prescription for Cymbalta three times a day ( t . i . d .), when he actually intended to prescribe it two times a day ( b . i . d .), as written on the prescription .
Section 75.1 ( A ) Investigation A College-retained expert reviewed Dr . Kakar ’ s care and treatment of 24 patients in his psychiatric practice and noted the following about his recordkeeping :
• Dr . Kakar ’ s charts have insufficient documentation of the progress of his patients ;
• Dr . Kakar ’ s charts fail to adequately identify the rationale for treatment modalities ;
• Dr . Kakar ’ s charts fail to adequately document follow up with patients suffering from mood disorders regarding risk of self-harm or cognitive
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DIALOGUE ISSUE 1 , 2018