DISCIPLINE SUMMARIES
operating room at RVH. Also, the operating room nursing staff indicated that Dr. Zadra’ s dictation of the particular size of sutures he used while performing hernia repair on a patient were not in fact used according to the surgical count.
College Investigation The College retained an expert in urology and oncology, who opined that while Dr. Zadra’ s practice did not expose patients to harm, there were some planned or proposed procedures that could have exposed patients to potential harm if they had been carried out. In addition, similarly to the results of the RVH investigation, the expert reported concerns with Dr. Zadra’ s record keeping, documentation and description of the procedures performed, including the“ semantics and labeling of the procedures actually performed.” The expert noted that for five patients, Dr. Zadra dictated that he performed a“ water cystomerogram”, while he later admitted in his interview with the expert that the Ambulatory Care Unit at RVH did not have a functioning cystometrogram machine. It was noted, that in one case of a circumcision of an 8-year old boy, Dr. Zadra failed to dictate issues that should have been documented, such as pre- and post-operative urine stream. In another case, Dr. Zadra dictated a procedure of“ hernia repair with multiple 2-0 and 3-0 Vicryl sutures” that did not correspond to the operating room nurses’ suture count. The discrepancy was that 3-0 sutures were in fact used. In two other cases, Dr. Zadra dictated that he performed a“ urethrotomy”, when he should have dictated it as a“ meatotomy”. It was also revealed that in two cases, Dr. Zadra amended his dictated note to different procedures than he had initially recorded. The expert further opined that in a number of patient charts, the description of the procedures actually performed was inaccurate, leading to inaccurate and / or questionable claims submissions to OHIP. Although the amounts were small, a number of fee codes were billed in error due to the inaccurate description of procedures performed. For example, for several patients, Dr. Zadra had billed the OHIP code, which covers“ pelvis limited study other than pregnancy” done by ultra-sound and was paid at $ 21.95. In his interview with the expert, Dr. Zadra stated that in fact he had carried out a“ post-void residual urine measurement”, which should have been billed at the rate of $ 12.70. Another example was billing an OHIP code for what was dictated as a“ water cystometrogram”, when the procedure was not in fact performed on several patients.
ORDER The Committee ordered: a three-month suspension on Dr. Zadra’ s certificate of registration; the imposition on terms, conditions and limitations on Dr. Zadra’ s certificate of registration; a reprimand and costs to the College in the amount of $ 5,000. The terms and conditions and limitation on Dr. Zadra’ s’ certificate of registration include: successful completion of individualized instruction in medical ethics; successful completion of a medical record keeping course; retaining a clinical supervisor for six months; cooperation with unannounced inspections on his practice; and providing consent to the College to make inquiries of OHIP for one year to ensure Dr. Zadra is complying with the terms of the Order. For complete details of the Order, please see the full decision at www. cpso. on. ca. Select Find a Doctor and enter the doctor’ s name.
At the conclusion of the hearing, Dr. Zadra waived his right to an appeal and the Committee administered the public reprimand.
Full decisions are available online at www. cpso. on. ca. Select Find a Doctor and enter the doctor’ s name.
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DIALOGUE ISSUE 2, 2018