Previous Hearings
Committee: Discipline
Decision Date: 09 May 2017
Summary:
On May 9, 2017, the Discipline Committee found that Dr. Rakem committed an act of professional misconduct, in that he has failed to maintain the standard of practice of the profession, and in that he has engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional. The Discipline Committee also found that Dr. Rakem is incompetent.
Dr. Rakem practised in the Welland area as an orthopedic surgeon, in an office practice and in the local hospital, from about 2010 to 2014. He completed his medical training in Libya and practised there for ten years, beginning in 1990. Upon immigrating to Canada, he completed the orthopedic training at McMaster University and obtained his Royal College Fellowship in orthopedic surgery in 2007. Dr. Rakem has not practised in Canada since 2014. In August 2016, he resigned from the College.
Narcotic Prescribing Practices
In March 2014, the College received a complaint from a pharmacy concerning a patient’s narcotic prescription written by Dr. Rakem and a narcotic prescription written for Dr. Rakem.
The College commenced a formal investigation on June 9, 2014. A College retained expert reviewed the available patient records, pharmacies’ prescription records, Narcotic Monitoring System data, and OHIP billing records and reported concerns regarding five of Dr. Rakem’s patient records – Patient A, C, D, E and F.
Patient A
Dr. Rakem had seen Patient A in August, 2010 after an accident. The expert noted that between March 2013 and March 2014, Dr. Rakem provided five prescriptions of long-acting narcotics to Patient A, without any clinical records to indicate ongoing assessment and review of narcotic use: there was no record of an attempt to assess Patient A’s pain to justify any narcotic or appropriate alternate treatment strategies, and there was no record of evaluation of the efficacy of the narcotic treatment strategy.
Patients C, D, E, and F
Narcotic Monitoring System Records revealed that Dr. Rakem prescribed narcotics and controlled medications to Patients C, D, E, and F, while there was no record that Dr. Rakem diagnosed, assessed, or created a planned treatment evaluation for these patients or evaluated the risk of the narcotics he prescribed.
Other inappropriate prescribing practices
Dr. Rakem admitted that he prescribed medications to his patients and social acquaintances in social setting to ‘save them a long trip to his office’. Dr. Rakem further admitted and the Committee found that he had a narcotic prescription filled for himself and had asked a colleague to write a prescription for a large amount of long-acting narcotics so he could take the medications to Libya for humanitarian use and for his mother’s use.
The Committee determined that Dr. Rakem is incompetent in that:
- he demonstrated a lack of knowledge regarding the necessity to provide ongoing patient assessment in order to justify ongoing narcotic prescriptions to Patient A for four years and displayed a lack of judgement by failing to assess the harmful risk of the narcotic overdose and addiction to the patient;
- he demonstrated a lack of knowledge of the requirement to provide documentation of diagnosis, assessment, and a treatment plan for prescriptions for patients C, D, E, and F and demonstrated a lack of judgment when he prescribed narcotics to the patients without diagnosing, assessing, or creating a planned treatment and patient evaluation, or considering the risk of harm of his prescriptions;
- he demonstrated a lack of knowledge of the requirement of not prescribing in a social setting for convenience and failed to reflect or further recognize the inherent risk of diversion of the narcotics to the public;
- he demonstrated a lack of insight and poor judgment when he prescribed for himself large quantities of narcotics for humanitarian purposes and for his mother’s use in a war-torn Libya without considering the risk of diversion of narcotics to the public by transporting the large quantities of narcotics;
- he failed to recognize his responsibility to be knowledgeable of the College’s Prescribing Drugs policy and Record Keeping policy and the necessity of keeping his clinical record secure.
The Committee further found that Dr. Rakem failed to maintain the standard of practice of the profession in that:
- he prescribed large quantities of long-acting narcotics, including opiate-based medications, to patients without maintaining proper clinical records and without diagnosis, assessment and treatment plan, or assessment and review of narcotic use. Dr. Rakem failed to appreciate that ongoing patient assessments were necessary to prevent risks of narcotics addiction or overdose to patients;
- he submitted to the large quantity narcotic requests of the patients in a social setting for convenience and failed to appreciate that he put the patients at risk for overdose and addiction, and put the public at risk of diversion of narcotics.
Failure to Complete the Boundary Course
The Committee found that Dr. Rakem violated an order of the Discipline Committee, in that he failed to successfully complete the Boundary Course. While Dr. Rakem attended Part A of a three-part Boundary course on May 26 and 27, 2015 and received a fair to poor evaluation, he did not complete the second and third parts of the Boundary course (Parts B and C).
Dr. Rakem confirmed that he did not request an exemption to complete Parts B and C from the College’s compliance monitor.
Disposition
On January 4, 2018, the Committee ordered and directed on the matter of penalty and costs that:
- The Registrar revoke Dr. Rakem’s certificate of registration effective immediately.
- Dr. Rakem appear before the panel to be reprimanded.
- Dr. Rakem pay to the College its costs of this proceeding in the amount of $22,000 within thirty (30) days from the date of this Order.
Decision: Download Full Decision (PDF)
Hearing Date(s): November 4 & 7, 2016
Penalty Hearing date: January 4, 2018
Committee: Discipline
Decision Date: 07 Jul 2014
Summary:
On July 7, 2014, the Discipline Committee found that Dr. Rakem committed an act of professional misconduct, in that he engaged in the sexual abuse of a patient, and that he has engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional. Dr. Rakem admitted to the allegations.
At the time of the incident, Patient A was eighteen years old and saw Dr. Rakem in 2011 for a sports injury to her knee. He performed an arthroscopy on Patient A, diagnosing and treating a partial ACL tear. Dr. Rakem saw Patient A for follow up in 2012 with her mother. In the course of an appointment, Dr. Rakem offered to have Patient A watch him operate the next time he was on call at the hospital as she had expressed an interest in attending medical school. Patient A and her mother accepted the offer. A few days later, Dr. Rakem called Patient A, inviting her to come watch some surgeries. Patient A observed Dr. Rakem perform a hip replacement surgery and then accompanied him to another floor to see a patient. While mounting the stairs, Dr. Rakem patted Patient A on the buttock and chuckled. Patient A said nothing at the time.
Patient A observed Dr. Rakem perform a second surgery. After this surgery, Dr. Rakem invited Patient A to accompany him to his office across the street from the hospital, where he suggested that he give her an anatomy lesson. In doing so, Dr. Rakem had the patient undress down to her t-shirt and underwear, and then touched and stroked her various body parts, including in her pelvic region, while naming the muscle groups. Patient A states that Dr. Rakem asked her to remove her underwear, which she refused to do. At that point, Patient A got up and dressed and told Dr. Rakem that she felt uncomfortable, that it was getting late and that she wished to go home rather than observe another surgery.
The Discipline Committee ordered and directed that:
the Registrar suspend Dr. Rakem's certificate of registration for a six-month period, to
commence at 12:01 a.m. on July 8, 2014.
the Registrar impose the following terms, conditions and limitations on Dr. Rakem's
certificate of registration:
Practice Monitoring - Office Setting
(i) Dr. Rakem shall not engage in any professional encounters with female patients except in the presence of a monitor who shall be a member of a regulated health profession pursuant to the Regulated Health Professions Act, 1991, S.O. 1991, c. 18 as amended, who is acceptable to the College (the "Practice Monitor") and who has executed an undertaking with the College in the form attached to this Order as Appendix "A";
(ii) The Practice Monitor must be present in the examination or consultation room at all times when professional encounters with female patients occur, and must carefully observe, with an unobstructed view, all physical examinations performed by Dr. Rakem on female patients;
(iii) The Practice Monitor is required to maintain a log of all female patient encounters and the log shall provide the name of the female patient, and the purpose and date of the appointment. The Practice Monitor will sign and date the corresponding entry on the female patient's medical record;
(iv) Dr. Rakem shall post a sign in the form attached to this Order as Appendix "B" in each examination and consultation room, as well as the waiting room, that states as follows: "Dr. Rakem may only have encounters with female patients if a Practice Monitor acceptable to the College of Physicians and Surgeons of Ontario is present in the examination or consultation room."
Practice Monitoring - Hospital Setting
(v) In the case of Dr. Rakem's hospital practice, the Practice Monitor shall be a member of a regulated health profession who is employed by the hospital where Dr. Rakem has privileges;
(vi) The Practice Monitor must be present for all encounters as in (ii) above, which includes all surgeries and post-operative examinations;
(vii) The Practice Monitor must initial the patient's chart at the end of the encounter, whether surgery or otherwise, to confirm her presence. If more than one monitor is present but at different times during a surgery, each monitor shall sign the patient's chart;
(viii) Dr. Rakem shall ensure that the Chief of Staff in all hospitals in which he practises is aware of this restriction on his practice;
(ix) Dr. Rakem shall keep the College updated with respect to all locations where he practises including, but not limited to, hospitals, clinics and offices, in any jurisdiction (collectively his "Practice Location(s)") within 15 days of this Order, and shall inform the College of any and all new Practice Locations within 15 days of commencing practice at that location;
(x) Dr. Rakem shall provide his irrevocable consent to the College to make appropriate enquiries of the Ontario Health Insurance Plan and/or any person or institution who may have relevant information, for the purposes of monitoring and enforcing his compliance with the terms of this Order;
(xi) Dr. Rakem shall submit to, and not interfere with, unannounced inspections of his office(s) and practice(s) and patient charts by a College representative for the purposes of monitoring and enforcing his compliance with the terms of this Order;
Other
(xii) Dr. Rakem shall participate in and successfully complete the next available course regarding boundary issues and risks inherent in the doctor-patient relationship approved by the College; and
(xiii) Dr. Rakem shall be solely responsible for all fees, costs and expenses associated with his compliance with the terms of this Order.
Dr. Rakem appear before the panel to be reprimanded.
Dr. Rakem reimburse the College for any funding provided to Patient A under the program required under section 85.7 of the Code, and shall post an irrevocable letter of credit or other security acceptable to the College to guarantee payment of such amounts, within 30 days of the date of this Order, in the amount of $16,060.
Dr. Rakem shall within 30 days pay the College its costs of this proceeding in the amount of $4,460.00.
Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): July 7, 2014