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