On December 9, 2013, the Discipline Committee found that Dr. Leona Constance Rudinskas committed an act of professional misconduct, in that she failed to maintain the standard of practice of the profession. Dr. Rudinskas admitted the allegation. She practises oncology, haematology and internal medicine in Toronto, Ontario.
Patient A
Dr. Rudinskas failed to: perform appropriate assessments; round at an appropriate hour; review patient's condition as documented in her chart and in test results in a timely manner, and to respond in a timely manner to information about her condition; appropriately assess her following a haemoglobin drop; order a CT scan on a 'stat' basis; review results of abdominal x-rays demonstrating the existence of a bowel obstruction in a timely manner; diagnose a bowel obstruction in a timely manner; and communicate in a timely manner with the patient's family.
Patient B
Patient B, an infant, died of known cardiac congenital abnormalities. In her role as Coroner, Dr. Rudinskas attended at the hospital and communicated in an insensitive and unprofessional manner with the patient's parents immediately after his death in the course of communicating to them about the policy of the Coroner's office regarding co-sleeping.
Patient C
Dr. Rudinskas failed to: conduct her first patient encounter with Patient C at an appropriate hour; conduct a physical examination during her time as his most responsible physician; communicate in a timely and professional manner with the patient and his family, including by failing to adequately discuss her plan of care with him; terminate the physician-patient relationship in accordance with College policy; and accurately document her reason for termination. In terminating the relationship, Dr. Rudinskas communicated with the patient's daughter in an insensitive and unprofessional manner.
Patient D
Dr. Rudinskas communicated additional information confirming the patient's cancer diagnosis to her in an inappropriate manner and at an inappropriate hour and failed to document an appropriate discussion of the risks and benefits of treatment.
Patient E
Dr. Rudinskas failed to document in patient's chart the rationale for a treatment decision, an appropriate discussion regarding the same, and an appropriate discussion regarding the use of a taxane regime. She also failed to make a physician-to-physician transfer when the patient moved to another city to complete her treatment.
Patient F and G
Dr. Rudinskas failed to document in the patients' charts an appropriate discussion of the risks and benefits of treatment.
Patient H
Dr. Rudinskas failed to consider additional steps to investigate a differential diagnosis for this patient's anemia.
Patient I and Patient M
Dr. Rudinskas failed to document in the patients' charts appropriate physical examination and appropriate discussion regarding the risks of benefits of treatment.
Patient J
Dr. Rudinskas failed to document appropriate assessment of Patient J when she presented complaining of gait instability and failed to document the treatment plan in the patient's chart.
Patient K
Dr. Rudinskas failed to document in the patient's chart the reasons for her decision to administer a seventh round of chemotherapy and appropriate discussion regarding the risks and benefits of doing so.
Patient L
Dr. Rudinskas failed to make appropriate inquiries to identify the patient's treating physician(s) in order to communicate the existence of a fistula, which could result in renewed sepsis or other
issues.
On January 25, 2010, Dr. Rudinskas entered into an interim undertaking, to remain in effect until the allegations in this hearing had been finally disposed of by the Discipline Committee. Among other things, Dr. Rudinskas agreed to complete routine rounds of all patients before 10:00 pm each evening and engage a supervisor acceptable to the College to review all aspects of both her hospital and office practice and to meet with her to discuss any issues or concerns. Pursuant to Dr. Rudinskas' interim undertaking, she engaged Dr. X as her Clinical Supervisor. She also completed Medical Record-Keeping for Physicians in October 2010, pursuant to the interim undertaking.
The Discipline Committee ordered and directed that:
Dr. Rudinskas appear before the panel to be reprimanded;
the Registrar suspend Dr. Rudinskas's Certificate of Registration for a period of three (3) months, to commence on January 15, 2014 and ending at 11:59 p.m. on April 14, 2014. the Registrar impose the following terms, conditions and limitations on Dr. Rudinskas' Certificate of Registration:
a. Dr. Rudinskas shall, within six months of the date of this Order, attend, and successfully complete, an education program satisfactory to the College in Communications, which will involve multiple one-on-one sessions with a College-approved instructor (the "Instructor"), incorporating counseling, guided reflection, tailored feedback, and/or other modalities to be determined by the Instructor, with a report or reports to be provided to the College regarding Dr. Rudinskas's progress and compliance. This term, condition and limitation shall be removed from Dr. Rudinskas' Certificate of Registration upon completion of this requirement;
b. Dr. Rudinskas shall attend and successfully complete the first available educational program satisfactory to the College in Ethics, with a report or reports to be provided to the College regarding Dr. Rudinskas' progress and compliance. This term, condition and limitation shall be removed from Dr. Rudinskas' Certificate of Registration upon completion of this requirement;
c. Dr. Rudinskas shall undergo an assessment of her hospital and office practice within one year of this Order (the "Assessment"), which shall be conducted by a College-appointed assessor (the "Assessor"). Dr. Rudinskas shall cooperate fully with the Assessment, including but not limited to: providing access to her patient records, consenting to disclosure by the College or any hospital at which she practices to the Assessor of any information the Assessor deems relevant, permitting the Assessor to directly observe her provision of patient care, participating in interviews by the Assessor and facilitating interviews by the Assessor of other persons whose information the Assessor considers relevant. The results of the Assessment shall be reported to the Inquiries, Complaints and Reports Committee of the College (the "ICRC") and Dr. Rudinskas shall abide by the recommendations of the Assessor.
d. Dr. Rudinskas shall comply with all policies at any hospital where she practices regarding the frequency and timing of patient rounds and shall, in any event and without limiting the foregoing requirement, complete routine rounds of all patients before 10:00 p.m. each evening. This term, condition and limitation shall remain on Dr. Rudinskas' Certificate of Registration for an indefinite period of time;
e. Dr. Rudinskas shall, within 30 days, ensure that the Chief of Staff, Chief of Medicine, Director, office manager or other person who is acceptable to the College, at any hospital or facility, not including Dr. Rudinskas' office, at which Dr. Rudinskas practices (the "Reporting Director(s)"), signs an undertaking in the form attached as Appendix "A" to this Order (the "Undertaking"), and that the Reporting Director(s) provide quarterly reports notifying the College of any concerns that have arisen with regard to Dr. Rudinskas's conduct, patient care, communications or collegiality. Dr. Rudinskas shall cooperate in all respects with the Reporting Director(s) and shall consent to the disclosure of any information the Reporting Director(s) require for the purposes of complying with the Undertaking attached hereto;
f. If a Reporting Director who has given an Undertaking is unwilling or unable to continue to fulfill its terms, Dr. Rudinskas shall, within 30 days, obtain an Undertaking in the same form from a person who is acceptable to the College;
g. If Dr. Rudinskas is unable to obtain a Reporting Director at a hospital or facility at which she practices as set out in (e) or (f) above, she shall cease to practice at that location immediately until such time as she has obtained a Reporting Director at that location;
h. Upon completion of the Assessment and consideration of same by the ICRC, provided the reports of the Reporting Director(s) and the report of the Assessment are deemed satisfactory by the ICRC, then the quarterly reports of the Reporting Director(s) may be reduced to one further report to the ICRC, to be delivered after one further year's time. If that further report is deemed satisfactory by the ICRC, no further reports shall be required from the Reporting Director(s); and
i. Dr. Rudinskas shall consent to the monitoring of her OHIP billings and cooperate with inspections of her practice and patient charts by a College representative(s) for the purpose of monitoring and enforcing her compliance with the terms of this Order.
Dr. Rudinskas pay to the College costs in the amount of $55,000 to be payable by no later than May 1, 2014.