Committee: Discipline
Decision Date: 22 Mar 2012
Summary:
On March 22, 2012, the Discipline Committee found that Dr. John Kenrick Pariag committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession. The Committee also found that Dr. Pariag is incompetent. Dr. Pariag admitted to the allegations of professional misconduct and incompetence, as follows:
Regarding a review of 35 patient charts from his surgical practice:
improper placement of chest tubes in a CF patient;
performing cholecystectomy in the presence of evidence that the common bile duct was
not clear;
failure to protect an anastomosis with a stoma where appropriate;
improperly discharging 3 post-surgical patients with elevated white blood cell counts and
fevers;
unnecessary transfusion of one patient;
questionable decision to perform a targeted bowel resection in a patient with rectal blood
loss when the point of bleeding was unknown, and failure to investigate a possible
foreign body as indicated by x-rays of the patient;
incorrectly repairing a hernia, leading to recurrence;
unnecessary removal of three healthy appendices;
failure to obtain a right breast ultrasound despite a radiologist's suggestion in a cancer
patient;
failed to give DVT [deep vein thrombosis] prohylaxis perioperatively to a patient with
known breast cancer;
failure to properly control intraoperative bleeding;
improperly performing surgery without first addressing the patient's elevated INR;
perforating a patient's bowel while removing two 0.25 cm polyps;
improperly ordering blood transfusion of a 12-year-old with a haemoglobin count of 108,
which order was subsequently cancelled by another physician, and failure to investigate
percutaneous pelvic abscess drainage before proceeding to perform a laparotomy on that
patient;
improperly performing an elective thyroidectomy without supervision when Dr. Pariag
had never performed such a procedure at the Hospital and had not reviewed thyroid
surgery during his residency; and
dissecting a patient's portal triad during surgery to correct a bowel obstruction, which
error resulted in the patient's death due to hemorrhagic shock.
Regarding patient A, who had surgeries for an intra-abdominal mass, later identified as a sarcoma:
failed to adequately document a differential diagnosis, treatment plan, or informed consent discussions with Patient A; and, after the recurrence of the sarcoma, failed to solicit an opinion from the Regional Cancer Centre where the patient had been seen in the past, and improperly attempted to treat the sarcoma outside a multidisciplinary care center.
On December 19, 2012, the Discipline Committee ordered and directed that:
1. the Registrar impose the following terms, conditions and limitations on Dr. Pariag's certificate of registration for an indefinite period of time:
a) Dr. Pariag is prohibited from engaging in any hospital-based surgical practice save and except as a surgical assistant when a College-approved certified surgeon is performing the surgery and is in attendance. At no time shall Dr. Pariag be the most responsible physician with respect to any patient in a hospital setting;
b) Dr. Pariag is prohibited from performing surgery in an office-based setting save and except for minor surgical procedures under local anaesthetic involving the skin and subcutaneous tissues;
c) At his own expense, Dr. Pariag shall undergo a comprehensive practice assessment of the office-based practice described in paragraph 3(b) of this Order by an assessor selected by the College (the "CPA"). Dr. Pariag shall cooperate fully with the CPA, including permitting the College's assessor to observe him in the performance of any permitted procedures the assessor deems necessary, provided it is possible to schedule the procedure in question. Subject to paragraph
2(d) of this Order, the CPA shall be completed within eight months of the date of this Order. Dr. Pariag shall abide by any and all recommendations made as result of the CPA; and Dr. Pariag shall promptly notify the College should he cease practising medicine before completion of the CPA. If he does cease practising medicine prior to completion of the CPA, Dr. Pariag shall provide the College with at least 45 days advance notice of his intention to resume the practice of medicine. If this occurs, the CPA shall be completed within eight months of Dr. Pariag's resuming practice, in addition to any other requirements that may apply at that time to physicians resuming the practice of medicine following a leave of absence. Nothing in this order shall alter or detract from Dr. Pariag's obligations pursuant to the College's policy on Re-entering Practice, or such equivalent policies as may apply to Dr. Pariag in the future.
2. The terms, conditions and limitations on Dr. Pariag's certificate of registration under 1(a) and 1(b) of the Order be included on a written form and the written form is to be presented to any patient before Dr. Pariag sees the patient, and a copy signed by the patient is to be included in the patient's chart;
3. Dr. Pariag attend before the Panel to be reprimanded, with the fact of the reprimand to be recorded on the register; and
4. Dr. Pariag shall within 30 days of this Order pay the College its costs of this proceeding in the amount of $3,650.00.