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Kakar, Ravi (CPSO#: 56389)

Current Status: Active Member as of 01 Jul 2017

CPSO Registration Class: Restricted as of 23 Oct 2013

Indicates a concern or additional information

Summary

Former Name: No Former Name

Gender: Male

Languages Spoken: English, Hindi, Panjabi/Punjabi, Urdu

Education:University of Delhi, 1984

Practice Information

Primary Location of Practice
4597 14th Avenue
Markham ON  L3S 3K2
Phone: (905) 604-4452
Fax: (905) 604-4205
Electoral District: 05
View Professional Corporation Information

Professional Corporation Information

Corporation Name: R. Kakar Medicine Professional Corporation

Certificate of Authorization Status: Issued Date:  Jun 01 2005

Shareholders:
Dr. R. Kakar ( CPSO# 56389 )

Business Address:
4597 14th Avenue
Markham ON  L3S 3K2
Phone Number: (905) 604-4452

Specialties

Specialty Issued On Type
Psychiatry Effective: 12 Nov 1992 RCPSC Specialist

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 18 Oct 1985
Expired: Terms and conditions of certificate of registration Expiry: 30 Jun 1987
Subsequent certificate of registration Issued: Postgraduate Education Certificate Effective: 01 Apr 1992
Expired: Terms and conditions of certificate of registration Expiry: 30 Jun 1992
Subsequent certificate of registration Issued: Independent Practice Certificate Effective: 11 Jan 1993
Transfer of class of certificate to: Restricted certificate Effective: 23 Oct 2013
Terms and conditions amended Effective: 12 Dec 2016
Terms and conditions amended by Discipline Committee Effective: 01 Jan 2017
Suspension of registration imposed: Discipline Committee Effective: 01 Jan 2017
Suspension of registration removed Effective: 01 Jul 2017

Pending Discipline Hearings

Summary: Allegations of Dr. Kakar’s professional misconduct have been referred to the Discipline Committee of the College. It is alleged that Dr. Kakar was convicted of an offence relevant to his suitability to practise and engaged in disgraceful, dishonourable or unprofessional conduct when on approximately January 20, 2015, Dr. Kakar was found guilty of making a false or misleading statement contrary to s. 149(4) of the Workplace Safety and Insurance Act. It is also alleged that Dr. Kakar failed to maintain the standard of practice of the profession and/or is incompetent in his care of and interactions with a patient, in approximately 2016, including in his writing of a third party report in relation to the patient and in relation to his record keeping. It is further alleged that Dr. Kakar engaged in disgraceful, dishonourable or unprofessional conduct in approximately September, 2016, in his interactions with his Clinical Supervisor while the Clinical Supervisor was in the intensive care unit receiving medical care. Also, in approximately 2016, Dr. Kakar engaged in disgraceful, dishonourable and unprofessional conduct by breaching a term, condition or limitation on his certificate of registration and his undertaking with the College executed on February 10, 2016, requiring that he have all third party reports reviewed and approved by his Clinical Supervisor prior to being provided to the third party.

Notice of Hearing: Download Full Notice (PDF)

Practice Restrictions

Imposed By Effective Date Expiry Date Status  
Discipline Committee Effective: 01 Jan 2017 Active View Details [+]
            As from 11:59 p.m., December 12, 2016, by order of the Discipline Committee of
            the College of Physicians and Surgeons of Ontario, the following terms,
            conditions and limitations are imposed on the certificate of registration held
            by Dr. Ravi Kakar:

            a.    Dr. Kakar's practice shall be restricted to psychiatry only.

            b.    Dr. Kakar shall not see more than 18 patients in any 24-hour period.  Dr.
                  Kakar will also maintain a log of all patient encounters in the form
                  attached to this Order as Appendix "A" (the "Patient Log") and will
                  submit the Patient Log to the College on a monthly basis until the
                  reassessment referred to in paragraph 6(vi) below has been completed, and
                  the results of the reassessment have been considered by the ICR
                  Committee. Thereafter, Dr. Kakar shall produce the Patient Log at any
                  time upon request of the College. 

            c.    Dr. Kakar shall retain a College-approved clinical supervisor or
                  supervisors (the "Clinical Supervisor"), who will sign an undertaking in
                  the form attached hereto as Appendix "B."  For a period of at least
                  twelve (12) months commencing on the date Dr. Kakar returns to practice
                  following the suspension of his certificate of registration, Dr. Kakar
                  may practise only under the supervision of the Clinical Supervisor and
                  will abide by all recommendations of his Clinical Supervisor with respect
                  to his practice, including but not limited to practice improvements,
                  practice management, third party report writing, and continuing
                  education.  Clinical supervision of Dr. Kakar's practice may end after a
                  minimum of twelve (12) months, only upon the recommendation of the
                  Clinical Supervisor and, in its discretion, approval by the College.
                  Clinical supervision of Dr. Kakar's practice shall contain the following
                  elements:
                  i.    Dr. Kakar shall facilitate review by the Clinical Supervisor of
                        fifteen (15) patient charts per month and will meet with the
                        Clinical Supervisor at least once a month to discuss his care of
                        patients; and
                  ii.   Dr. Kakar will have all third party reports as defined in the
                        College Policy Third Party Reports, a copy of which is attached as
                        Appendix "C" to this Order, reviewed and approved by the Clinical
                        Supervisor before they are provided to the third party.  Before Dr.
                        Kakar provides the report to the party requesting it, he must
                        ensure the Clinical Supervisor has approved and has indicated such
                        approval by personally affixing his/her signature on the report.
                        Dr. Kakar will also maintain a log with the name of each patient
                        for whom a third party report is requested, the date he saw the
                        patient, the date the report was sent to the Clinical Supervisor
                        for approval, the date it was approved by the Clinical Supervisor,
                        and the date it was sent to the third party, in the form attached
                        to this Order as Appendix "D" (the "Third Party Report Log"). Dr.
                        Kakar will provide the Third Party Report Log to the Clinical
                        Supervisor each time they meet.  He will also provide the original
                        Third Party Log to the College upon request.  This restriction will
                        remain in place until the reassessment referred to in paragraph
                        6(vi) below has been completed, and the results of the Reassessment
                        have been considered by the ICR Committee.

            d.    Dr. Kakar shall successfully complete and provide proof thereof to the
                  College within six (6) months of the date of the Order: 
                        i.    Education in ethics acceptable to the College; and
                        ii.   Education in third party report writing acceptable to the
                              College.
                  
            e.    If Dr. Kakar fails to retain a Clinical Supervisor as required above or
                  if, prior to completion of Clinical Supervision, the Clinical Supervisor
                  is unable or unwilling to continue in that role for any reason, Dr. Kakar
                  shall within twenty (20) days retain a new College-approved Clinical
                  Supervisor who will sign an undertaking in the form attached hereto as
                  Appendix "B," and shall cease to practise until the same has been
                  delivered to the College.

            f.    Approximately nine (9) months after the completion of Clinical
                  Supervision, Dr. Kakar shall undergo a reassessment of his practice (the
                  "Reassessment") by a College-appointed assessor (the "Assessor").  The
                  Reassessment may include a review of Dr. Kakar's patient charts, direct
                  observations and interviews with staff and/or patients, and any other
                  tools deemed necessary by the College.  The Reassessment shall be at Dr.
                  Kakar's expense and he shall co-operate with all elements of the
                  Reassessment.  Dr. Kakar shall abide by all recommendations made by the
                  Assessor subject to paragraph 6(vii) below, and the results of the
                  Reassessment will be reported to the College and may form the basis of
                  further action by the College.

            g.    If Dr. Kakar is of the view that any of the Assessor's recommendations
                  are unreasonable, he will have fifteen (15) days following his receipt of
                  the recommendations within which to provide the College with his
                  submissions in this regard.  The Inquiries Complaints and Reports ("ICR")
                  Committee will consider those submissions and make a determination
                  regarding whether the recommendations are reasonable, and that decision
                  will be provided to Dr. Kakar. Following that decision Dr. Kakar will
                  abide by those recommendations of the Assessor that the ICR Committee has
                  determined are reasonable

            h.    Dr. Kakar shall consent to sharing of information among the Assessor, the
                  Clinical Supervisor, the College, and any education providers under
                  paragraph 6(iv) above as any of them deem necessary or desirable in order
                  to fulfill their respective obligations.

            i.    Dr. Kakar shall inform the College of each and every location where he
                  practises, in any jurisdiction (his "Practice Location(s)") within
                  fifteen (15) days of this Order and shall inform the College of any and
                  all new Practice Locations within fifteen (15) days of commencing
                  practice at that location.

            j.    Dr. Kakar shall cooperate with unannounced inspections of his practice
                  and patient charts by a College representative(s) for the purpose of
                  monitoring and enforcing his compliance with the terms of this Order.

            k.    Dr. Kakar shall consent to the College making appropriate enquiries of
                  the Ontario Health Insurance Plan and/or any person who or institution
                  that may have relevant information, in order for the College to monitor
                  and enforce his compliance with the terms of this Order.

            l.    Dr. Kakar shall be responsible for any and all costs associated with
                  implementing the terms of this Order.

            m.    Dr. Kakar shall comply with the College's Policy on Practice Management
                  Considerations for Physicians Who Cease to Practise, Take an Extended
                  Leave of Absence or Close Their Practice Due to Relocation, in respect of
                  his period of suspension, a copy of which is attached hereto as Appendix
                  "E".


            As from October 23, 2013, the following is imposed as a term, condition and
            limitation on the certificate of registration held by Dr. Ravi Kakar, in
            accordance with an undertaking and consent given by Dr. Kakar to the College of
            Physicians and Surgeons of Ontario:

                  Dr. Kakar's practice is restricted to the practice of psychiatry.
                  
                  
                  

Previous Discipline Hearings

Committee: Discipline
Decision Date: 12 Dec 2016
Summary:

On December 12, 2016, the Discipline Committee of the College of Physicians and Surgeons of 
Ontario found that Dr. Ravi Kakar has committed an act of professional misconduct in that he 
has failed to maintain the standard of practice of the profession and has engaged in 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. Kakar is incompetent. 
 
Dr. Kakar is a psychiatrist who practised at a private office in Markham. 
  
PATIENT A 
 
In October 2012, Patient A complained that Dr. Kakar diagnosed her with gout arthritis and 
prescribed a medication, Allopurinol, to which she had a severe allergic reaction resulting in 
serious side effects.  
 
Patient A had started seeing Dr. Kakar for psychiatric care in August 2010. Dr. Kakar diagnosed 
Patient A’s mental health issues and chronic pain, and prescribed psychiatric medications. Dr. 
Kakar also requisitioned blood work.  
 
In September 2010, Patient A attended for a follow-up appointment to discuss her psychiatric 
conditions. At this visit, Dr. Kakar observed that the blood work results showed elevated uric 
acid levels, diagnosed gout arthritis and prescribed Allopurinol. There was no emergency or 
urgency requiring that Dr. Kakar treat Patient A at that time.  
 
Patient A filled the prescription for Alluporinol on a date in early October 2010 and developed 
side effects including a fever and cough, a generalized rash, and swelling of the mouth, lips and 
tongue. Her side effects worsened into severe pain, swelling of the feet, and an inability to walk. 
Patient A was admitted to hospital on in early November 2010, where she was diagnosed with a 
severe allergic reaction to the Allopurinol, Toxic Epidermal Necrolysis.  
 
A College-retained expert opined that Dr. Kakar’s care of Patient A failed to maintain the 
standard of practice and displayed a serious lack of knowledge and judgment as follows: 
   -  Dr. Kakar’s prescribing of Allopurinol for gout arthritis was outside of his scope of 
      practice and inappropriate;  
   -  Dr. Kakar inappropriately minimized the seriousness of Patient A’s concerns after she 
      experienced a reaction to Allopurinol;  
   -  Dr. Kakar’s records of his treatment of Patient A failed to maintain the standard as the 
      vast majority were illegible; and 
   -  Dr. Kakar’s prescription of Allopurinol to Patient A seriously harmed her and put her at 
      life-threatening risk.  
  
A second College-retained expert opined that Dr. Kakar’s failure to conduct an adequate clinical 
examination, prior to diagnosis and prescribing of Allopurinol, failed to maintain the standard of 
practice and that he demonstrated a lack of knowledge, skill and judgment.  
 
Misleading College during investigation 
In his January 15, 2013, response to Patient A’s complaint, Dr. Kakar stated to the College that 
he prescribed Allopurinol for Patient A at an appointment in late October 2010. He also provided 
a copy of his chart for Patient A which indicated that there was a discussion about Allopurinol on 
that date in late October 2010, and that Dr. Kakar prescribed the medication on that day.  
 
Subsequently, after the College provided Dr. Kakar with information indicating that the 
complainant had filled the prescription in early October, Dr. Kakar claimed that he relied on his 
chart when he responded to the complaint, and since the reference to the discussion about 
Allopurinol was recorded in the chart for the appointment in late October, he had presumed that 
was when he prescribed the medication. He said it must have been a late entry from October of 
2010 which he had failed to indicate as such.  
 
Then, in May of 2013, Dr. Kakar’s counsel wrote to the College and admitted that Dr. Kakar had 
added the note in Patient A’s chart about Allopurinol after he received the comlaint from patient 
A, in October 2012, not in October of 2010, as he had claimed in his communication to the 
College.   
 
PATIENT B 
 
In January 2013, the College received a complaint about the psychiatric care provided by Dr. 
Kakar to a teenage girl, Patient B, in the fall of 2012.  
 
A College-retained expert concluded that Dr. Kakar failed to meet the standard of care in his 
record-keeping for Patient B as follows: 
   -  Dr. Kakar’s original office notes are illegible and needed to be transcribed in order for 
      her to read them; 
   -  Two of Dr. Kakar’s progress notes, dated August 2012 and September 2012, were 
      identical. This failed to reflect the true progression, or lack of progression, of Patient B’s 
      response to treatment; and 
   -  Dr. Kakar’s failure to document a rationale in his progress note of September 2012, for 
      increasing the patient’s dosage of Cymbalta to 30 mg three times a day. 
 
It was also determined that Dr. Kakar made an error in his September 29, 2012 entry in Patient 
B’s chart when he recorded a prescription for Cymbalta three times a day (t.i.d.), when he 
actually intended to prescribe it two times a day (b.i.d.), as written on the prescription. 
 
SECTION 75.1(A) INVESTIGATION  
 
A College-retained expert reviewed Dr. Kakar’s care and treatment of 24 patients in his 
psychiatric practice and noted the following about his record-keeping:  
   -  Dr. Kakar’s charts have insufficient documentation of the progress of his patients;  
   -  Dr. Kakar’s charts fail to adequately identify the rationale for treatment modalities; 
   -  Dr. Kakar’s charts fail to adequately document follow up with patients suffering from 
      mood disorders regarding risk of self-harm or cognitive deficits; and 
   -  Dr. Kakar’s medical reports lack contemporaneous information, are often repetitive in 
      nature and sometimes contain information seen in the charts of other patients.  
 
The expert opined that Dr. Kakar showed sufficient knowledge, skills and judgment in the 
clinical practice of psychiatry to meet the standards of the profession. However, while he 
appeared to have sufficient knowledge and judgment regarding information which should be 
documented in charts, his documentation did not meet the standard of practice. 
 
THE DR. D. COMPLAINT  
 
In August 2015, Dr. D, a psychologist, complained to the College regarding a psychiatric report 
Dr. Kakar prepared on behalf of Patient C, an insured woman who sustained injuries in a car 
accident. Dr. D examined Patient C in November 2013 and completed a psychological report 
dated December 2013. Dr. Kakar saw the same patient later in December 2013, and produced a 
psychiatric report in January 2014.  
 
In May 2015, Dr. D was asked to do a follow up report, and reviewed Patient C’s file in order to 
do so. In the file, he found the report of Dr. Kakar in relation to Patient C, which contained 
extensive sections that were copied from Dr. D’s initial report, with virtually no changes.  
 
Dr. Kakar said that when he was asked to provide a report, he reviewed the medical brief, which 
included Dr. D’s report, in preparation for his independent psychiatric evaluation of the patient. 
He said he used Dr. D’s report as a guide to his interview and as a means of obtaining an 
accurate and detailed history from the patient. 
 
AGREED FACTS ON PENALTY 
 
In May 2006, the Complaints Committee issued a verbal caution regarding Dr. Kakar’s care of a 
patient, and in particular, regarding the preparation of third party reports regarding the patient’s 
mental state and ability to care for his child. In June of 2009, following a public complaint and 
investigation regarding his standard of practice, Dr. Kakar entered into an undertaking with the 
College which required among other things, that he practise under the guidance of a clinical 
supervisor; complete courses in pharmacological monitoring, assessment of suicide, 
communication skills and record keeping; and attend psychiatric rounds every two months for 
one year.  
 
During 2012 and 2013, Dr. Kakar experienced a series of stressors which impacted his health. 
Ultimately, he signed an undertaking to cease practice medicine which was in effect between 
February 2014 and January 2015.  
 
 
Pursuant to an October 23, 2013 undertaking, which he executed after receiving the complaint of 
Patient A Dr. Kakar has publicly restricted his practice to that of psychiatry only. 
 
Pursuant to a February 10, 2016 undertaking, which he executed in lieu of a s. 37 Order, Dr. 
Kakar has been practising under supervision since this matter was referred to discipline.  
 
 
PENALTY 
 
On December 12, 2016, the Discipline Committee ordered and directed that: 
   -  Dr. Kakar attend before the panel to be reprimanded. 
   -  The Registrar to suspend Dr. Kakar’s certificate of registration for a period of six (6) 
      months commencing January 1, 2017. 
   -  The Registrar impose the following terms, conditions and limitations on Dr. Kakar’s 
      certificate of registration: 
         -  Dr. Kakar’s practice shall be restricted to psychiatry only. 
         -  Dr. Kakar shall not see more than 18 patients in any 24-hour period. Dr. Kakar 
            will also maintain a log of all patient encounters in the form attached to this Order 
            as Appendix “A” (the “Patient Log”) and will submit the Patient Log to the 
            College on a monthly basis until the reassessment referred to in paragraph 6(vi) 
            below has been completed, and the results of the reassessment have been 
            considered by the ICR Committee. Thereafter, Dr. Kakar shall produce the Patient 
            Log at any time upon request of the College.  
         -  Dr. Kakar shall retain a College-approved clinical supervisor or supervisors (the 
            “Clinical Supervisor”), who will sign an undertaking in the form attached hereto 
            as Appendix “B.” For a period of at least twelve (12) months commencing on the 
            date Dr. Kakar returns to practice following the suspension of his certificate of 
            registration, Dr. Kakar may practise only under the supervision of the Clinical 
            Supervisor and will abide by all recommendations of his Clinical Supervisor with 
            respect to his practice, including but not limited to practice improvements, 
            practice management, third party report writing, and continuing education. 
            Clinical supervision of Dr. Kakar’s practice may end after a minimum of twelve 
            (12) months, only upon the recommendation of the Clinical Supervisor and, in its 
            discretion, approval by the College. Clinical supervision of Dr. Kakar’s practice 
            shall contain the following elements: 
               -  Dr. Kakar shall facilitate review by the Clinical Supervisor of fifteen (15) 
                  patient charts per month and will meet with the Clinical Supervisor at least 
                  once a month to discuss his care of patients; and 
               -  Dr. Kakar will have all third party reports as defined in the College Policy 
                  Third Party Reports, a copy of which is attached as Appendix “C” to this 
                  Order, reviewed and approved by the Clinical Supervisor before they are 
                  provided to the third party. Before Dr. Kakar provides the report to the 
                  party requesting it, he must ensure the Clinical Supervisor has approved 
                  and has indicated such approval by personally affixing his/her signature on 
                  the report. Dr. Kakar will also maintain a log with the name of each 
                  patient for whom a third party report is requested, the date he saw the 
                  patient, the date the report was sent to the Clinical Supervisor for 
                  approval, the date it was approved by the Clinical Supervisor, and the date 
                  it was sent to the third party, in the form attached to this Order as 
                  Appendix “D” (the “Third Party Report Log”). Dr. Kakar will provide the 
                  Third Party Report Log to the Clinical Supervisor each time they meet. He 
                  will also provide the original Third Party Log to the College upon request. 
                  This restriction will remain in place until the reassessment referred to in 
         paragraph 6(vi) below has been completed, and the results of the 
         Reassessment have been considered by the ICR Committee.  
-  Dr. Kakar shall successfully complete and provide proof thereof to the College 
   within six (6) months of the date of the Order:  
      -  Education in ethics acceptable to the College; and 
      -  Education in third party report writing acceptable to the College. 
-  If Dr. Kakar fails to retain a Clinical Supervisor as required above or if, prior to 
   completion of Clinical Supervision, the Clinical Supervisor is unable or unwilling 
   to continue in that role for any reason, Dr. Kakar shall within twenty (20) days 
   retain a new College-approved Clinical Supervisor who will sign an undertaking 
   in the form attached hereto as Appendix “B,” and shall cease to practise until the 
   same has been delivered to the College. 
-  Approximately nine (9) months after the completion of Clinical Supervision, Dr. 
   Kakar shall undergo a reassessment of his practice (the “Reassessment”) by a 
   College-appointed assessor (the “Assessor”). The Reassessment may include a 
   review of Dr. Kakar’s patient charts, direct observations and interviews with staff 
   and/or patients, and any other tools deemed necessary by the College. The 
   Reassessment shall be at Dr. Kakar’s expense and he shall co-operate with all 
   elements of the Reassessment. Dr. Kakar shall abide by all recommendations 
   made by the Assessor subject to paragraph 6(vii) below, and the results of the 
   Reassessment will be reported to the College and may form the basis of further 
   action by the College.  
-  If Dr. Kakar is of the view that any of the Assessor’s recommendations are 
   unreasonable, he will have fifteen (15) days following his receipt of the 
   recommendations within which to provide the College with his submissions in 
   this regard. The Inquiries Complaints and Reports (“ICR”) Committee will 
   consider those submissions and make a determination regarding whether the 
   recommendations are reasonable, and that decision will be provided to Dr. Kakar. 
   Following that decision Dr. Kakar will abide by those recommendations of the 
   Assessor that the ICR Committee has determined are reasonable 
-  Dr. Kakar shall consent to sharing of information among the Assessor, the 
   Clinical Supervisor, the College, and any education providers under paragraph 
   6(iv) above as any of them deem necessary or desirable in order to fulfill their 
   respective obligations. 
-  Dr. Kakar shall inform the College of each and every location where he practises, 
   in any jurisdiction (his “Practice Location(s)”) within fifteen (15) days of this 
   Order and shall inform the College of any and all new Practice Locations within 
   fifteen (15) days of commencing practice at that location. 
-  Dr. Kakar shall cooperate with unannounced inspections of his practice and 
   patient charts by a College representative(s) for the purpose of monitoring and 
   enforcing his compliance with the terms of this Order. 
-  Dr. Kakar shall consent to the College making appropriate enquiries of the 
   Ontario Health Insurance Plan and/or any person who or institution that may have 
   relevant information, in order for the College to monitor and enforce his 
   compliance with the terms of this Order.  
      -  Dr. Kakar shall be responsible for any and all costs associated with implementing 
         the terms of this Order. 
      -  Dr. Kakar shall comply with the College’s Policy on Practice Management 
         Considerations for Physicians Who Cease to Practise, Take an Extended Leave of 
         Absence or Close Their Practice Due to Relocation, in respect of his period of 
         suspension, a copy of which is attached hereto as Appendix “E”. 
-  Dr. Kakar pay to the College costs in the amount of $5,000.00, within thirty (30) days of 
   the date of this Order.

Decision: Download Full Decision (PDF)
Hearing Date(s): December 12, 2016