Discipline Committee Decisions
Dr. Padamjit Mohan Singh; Dr. Kwame Attuah; Dr. Eleazar H. Noriega
Jul 29, 2013
The College of Physicians and Surgeons of Ontario (“the College”) released the results of its most recent disciplinary hearings. The College is the licensing and disciplinary body for physicians in Ontario. Hearings are held to review allegations of professional misconduct and incompetence, and are open to the public. The following are brief summaries of recent discipline hearing results. The Discipline Committee’s full decisions and reasons for decisions are posted on the College’s website as they become available. Full decisions are located by entering the doctor’s name in the All Doctors Search section of the College’s website at www.cpso.on.ca.
Dr. Padamjit Mohan Singh, Bowmanville. On June 3, 2013, the Discipline Committee found that Dr. Singh is incompetent and committed an act of professional misconduct, in that she failed to maintain the standard of practice of the profession. Dr. Singh admitted the allegations in respect of three patients.
Dr. Singh is an obstetrician/gynecologist. After concerns were raised regarding Dr. Singh's ability to cope in emergency situations while on call at the hospital where she worked, Dr. Singh entered into an agreement with the hospital, the terms of which included the following:
a) Dr. Singh withdraws her reapplication for Active Staff privileges and applies for Courtesy Staff privileges only;
b) Dr. Singh will be granted privileges to work as a surgical assistant at the hospital;
c) Dr. Singh will be granted privileges to work in the Colposcopy Clinic two days per month;
d) Dr. Singh will be granted privileges to perform specified minor procedures under general anesthesia, where appropriate. The minor procedures include: inserting IUDS; cone biopsy; D&C; removal of polyps and vaginal cysts; biopsies; incision drainage; hysteroscopy; hysterosalpingogram; examination under anesthesia; balloon ablation; cauterization; and suture and repair.
e) In the event an urgent or emergency situation should arise while performing any of the specified procedures, Dr. Singh agrees to immediately refer and transfer care of the patient to the obstetrician on call.
On the basis of this information, the College commenced an investigation. On November 19, 2009, the Department of Anesthesiology determined that no current member of the department will be made available to provide anesthesiology coverage to Dr. Singh. As a result, since at least November 2009, Dr. Singh has not been performing: D & C; hysteroscopy; examination under anesthesia; and balloon ablation.
The College retained an expert, Dr. X, to provide an opinion on the care provided by Dr. Singh. With regard to Patient 1, Dr. X opined that Dr. Singh failed to demonstrate the appropriate knowledge, skill and judgment expected of a specialist, in that:
a) Dr. Singh failed to appreciate the significance of the fetal heart rate tracing and allowed the anesthetist to perform an elective epidural elsewhere instead of dealing with the patient's need for an urgent C-section;
b) Once in the operating room, Dr. Singh's difficulty in extracting the baby resulted in further delay of newborn resuscitation. Dr. Singh was unable to perform in an emergency situation;
c) The theme of panic and poor communication with colleague/team members was evident from the interview of those present;
d) The nurses felt that they had to push Dr. Singh to perform the C-section on a stat basis.
With regard to Patient 2, Dr. X opined that Dr. Singh failed to meet the expected standard with respect to obstetrical care, in that:
a) Dr. Singh failed to communicate the urgency to her colleagues and permitted the anesthesiologist to provide an elective epidural instead of focusing his attention on the high risk mother;
b) Dr. Singh had recognized the gravity of the situation by calling for the Sick Kids Transport Team instead of transferring the mother to a tertiary centre. However, Dr. Singh failed to act in a timely fashion to "deliver" the infant when there was a loss of fetal heart rate, as an emergency section would have been taken by a reasonable physician at that point in time under epidural or general anesthetic.
In respect of Patient 3, Dr. X opined that Dr. Singh had difficulty inserting the Veress needle or Hasson trocar for laparoscopy. Major blood loss for a minor procedure occured which called into question Dr. Singh's judgment, as well as her surgical skills.
The Committee ordered a public reprimand, and imposed the following restrictions Dr. Singh's certificate of registration:
i. Dr. Singh shall not engage in any labour and delivery practice;
ii. Except as otherwise specified in this Order, Dr. Singh shall not engage in any hospital-based obstetrical/gynecological practice;
iii. Dr. Singh is permitted to perform colposcopy in the Colposcopy clinic two days per month;
iv. Dr. Singh is permitted to perform the following minor procedures (the “permitted procedures”), none of which entail intra-abdominal surgery: insertion of IUDS; cone biopsy; D&C; removal of polyps and vaginal cysts; vulvar, vaginal, cervical and endometrial biopsies; incision drainage (vulvar, vaginal lesions); hysteroscopy; hysterosalpingogram; examination under anesthesia; endometrial ablation; cauterization; and vulvar/vaginal suture and repair (this does not include vaginal hysterectomy, cystocele or rectocele repairs).
v. Dr. Singh shall provide the College with 14 days' notice if she intends to commence performing of any one of the permitted procedures itemized above, under general anesthesia. Dr. Singh shall agree to undergo an assessment(s) of such practice(s) by an assessor appointed by the College within one year of commencing any permitted procedure under general anesthesia, at the College's expense; and
vi. In the event that an urgent or emergency situation arises while Dr. Singh is performing any of the permitted procedures, Dr. Singh shall immediately refer and transfer the care of the patient to the obstetrician/gynecologist on call.
Dr. Singh was further ordered to pay the College costs in the amount of $3,650.
Dr. Kwame Attuah, no practice address. On July 4, 2013, the Discipline Committee found that Dr. Attuah committed an act of professional misconduct, in that he engaged in disgraceful, dishonourable, or unprofessional conduct. Dr. Attuah admitted the allegation.
Dr. Attuah is trained in obstetrics and gynaecology. On January 14, 2010, Dr. Attuah entered into an undertaking with the College which included specific requirements to limit his practice to a walk-in clinic, to work no more than 40 hours a week, to limit his practice to obstetrics and gynaecology and to practice under the supervision of a clinical supervisor.
On March 9, 2010, allegations that Dr. Attuah was incapacitated were referred to the Fitness to Practise Committee. On May 17, 2010, a section 62 Order was issued which required that Dr. Attuah's practice be limited to a walk-in clinic in the areas of obstetrics and gynaecology, that he see no more than 75 patients per week and that he practice under the supervision of a monitor. On September 28, 2010, a section 62 Order was issued, which included the continuation of the above restrictions, as well as the requirement for the monitor to observe Dr. Attuah's practice monthly, for a minimum of half a day.
An analysis of Dr. Attuah's OHIP billings illustrates that Dr. Attuah frequently and repeatedly breached the terms of his January 2010 undertaking and s.62 orders between January 2010 and September 2010 as well as in December of 2010 by seeing more than 75 patients a week and by treating male and child patients. Dr. Attuah breached terms of the September 28, 2010 Order through signing a letter for a male patient, Patient A. The letter signed was in support of Patient A, who was seeking an adjournment of a hearing on the basis of medical reasons. In signing this letter, Dr. Attuah failed to limit his practice to obstetrics and gynaecology.
On May 2, 2012, an Order under section 62 was issued which included the continuation of the previous section 62 restrictions, as well as the requirement that the monitor observe a minimum of 10 percent of the patients Dr. Attuah treated per month. By way of letter dated May 11, 2012, Dr. Attuah was notified by the College that he had to cease practising as he was without a monitor as required under the May 2, 2012 Order. Dr. Attuah breached terms of the May 2, 2012 Order through signing a further letter dated May 31, 2012 with respect to Patient A.
On November 22, 2012, the College withdrew the allegation of incapacity pending before the Fitness to Practise Committee after Dr. Attuah entered into an undertaking that addressed the College's incapacity concerns.
The Committee ordered a public reprimand, and directed the Registrar to suspend Dr. Attuah's certificate of registration for a period of three months commencing on July 5, 2013. Dr. Attuah was further ordered to pay the College costs in the amount of $4,460.
Dr. Eleazar H. Noriega, Toronto. On February 28, 2013, the Discipline Committee found that Dr. Noriega committed an act of professional misconduct, in that he has engaged in disgraceful, dishonourable or unprofessional conduct.
In 2009, Dr. Noriega was referred to the Discipline Committee for allegations, including sexual abuse and sexual impropriety. On July 22, 2009, Dr. Noriega entered into an undertaking with the College and undertook, among other things, not to engage in any professional encounters with female patients except in the presence of his practice monitor. He undertook to post a sign in his waiting room and in each of his examination rooms notifying the public of this practice restriction. Dr. Noriega's practice monitor also entered into an undertaking on July 22, 2009. It required the practice monitor to be present for all of Dr. Noriega's professional encounters with female patients.
Dr. Noriega engaged in professional misconduct based on the following failures to comply with his undertaking:
Dr. Noriega failed to post the required sign in the waiting room, which includes the obligation to take reasonable steps to ensure that the sign remains posted;
Dr. Noriega failed to post the required sign in an examination room, including covering up the required sign with a framed picture;
Dr. Noriega failed to have a chaperone present throughout the entirety of his patient encounters between July 2009 and February 2010; and
Dr. Noriega misled the College's compliance investigator in February 2010 when he told her that he doesn't see female patients in the consultation room.
On July 17, 2013, the Discipline Committee ordered a public reprimand and a six-month suspension of Dr. Noriega's certificate of registration.