DISCIPLINE SUMMARIES
resigned his position in April 2017 following a refer-
ral of this matter to the Discipline Committee of the
College.
Dr. Ghumman received his medical degree in Paki-
stan in 1982 and a specialist qualification in general
surgery in Ireland in 1991. In 1999, Dr. Ghumman
obtained a certificate of independent practice in
Newfoundland and received his specialist qualifica-
tion in general surgery in Canada in 2004. In 2007,
Dr. Ghumman received his certificate of independent
practice in Ontario.
PATIENT X
In June, 2015, Patient X complained to the Col-
lege regarding Dr. Ghumman’s care in conducting
her laparoscopic gallbladder removal surgery and his
post-operative care.
Several months prior to the complaint, Dr. Ghum-
man assessed Patient X for symptomatic gallstones.
He explained to Patient X her treatment options,
discussed the potential risks and benefits of surgery,
and obtained Patient X’s informed consent for a
laparoscopic gallbladder removal surgery, which was
scheduled for the following month. On the day of
the surgery, Dr. Ghumman discussed the surgical
plan with Patient X in the day surgery area at the
hospital.
During the surgery, the clip applier that Dr. Ghum-
man applied on Patient X’s cystic artery unexpect-
edly jammed and could not be pulled off as it could
damage an artery. Dr. Ghumman considered convert-
ing to an open procedure, but decided to continue
laparoscopically and to take steps to divide the cystic
artery in order to remove the jammed clip applier.
Following the anesthetist’s suggestion to use Filshie
clips, which are applied with a narrower clipper
than other clips, Dr. Ghumman proceeded to place
a Filshie clip, but was concerned that he might have
mistakenly placed it on the common bile duct or the
right hepatic artery. Dr. Ghumman directed nurses
to make several telephone calls, but could not find a
way to remove the Filshie clip without risking torn
vessels or tearing the bile duct.
He continued with the procedure and applied
another Filshie clip on the cystic artery, which al-
lowed him to divide the cystic artery and remove the
jammed clipper.
Dr. Ghumman removed the gallbladder, which tore
during removal, placed a drain and completed the
surgery. He noted in his Operative Report that if a
clip is on a common bile duct, he may have to refer
Patient X to a hepatobiliary surgeon.
Following the surgery, Dr. Ghumman told Patient
X that the surgery went well. He indicated that
he encountered a complication when the clipper
jammed, which he was then able to remove, but was
concerned that he might have placed a clip on her
right hepatic artery or common bile duct.
Patient X was discharged home the same day with
instructions for monitoring and to return two days
later for a CT scan and to remove the drain placed
during surgery.
When Patient X returned two days later, she
reported feeling unwell, was in pain, and was hav-
ing trouble eating. Dr. Ghumman discussed the
results of Patient X’s CT scan with a radiologist at
the hospital, who opined that Patient X’s common
bile duct looked normal and indicated that no clip
was visualized on the common bile duct. Dr. Ghum-
man reported to Patient X’s family doctor that he
had a small incident during surgery but that he was
satisfied, after the CT scan, that the clip was not
on the common bile duct. He indicated that he was
concerned because he had applied the clip “a little bit
blind”, but now felt the clip was on tissues along the
gallbladder, which was not a problem. Dr. Ghum-
man decided not to remove the drain that day and
instructed Patient X to return three days later for
removal of the drain and follow up tests.
When Patient X returned to Dr. Ghumman for
drain removal three days later, she reported feeling
itchy, was unable to eat, and her complexion was
jaundiced.
The next day, Dr. Ghumman telephoned Patient X
and informed her that according to her blood work
results her bilirubin was high. Elevated bilirubin
levels may cause jaundice and may indicate problems
with the liver or bile duct, and may also account for
the type of itching experienced by Patient X. Dr.
Ghumman advised Patient X to drink plenty of fluids
to stay well hydrated and call his office if her condi-
tion worsened.
In two days, Patient X contacted Dr. Ghumman
and complained of increased itching. He booked an
ISSUE 2, 2018 DIALOGUE
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