Patel, Ramesh (CPSO#: 31791)

Current Status: Revoked: Discipline Committee as of 20 May 2015

CPSO Registration Class: None as of 20 May 2015

Indicates a concern or additional information

Summary

Former Name: No Former Name

Gender: Male

Languages Spoken: English, Gujarati, Hindi

Education:University of Bombay, 1973

Practice Information

Primary Location of Practice
Practice Address Not Available

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 15 Jun 1976
Expired: Terms and conditions of certificate of registration Expiry: 30 Jun 1978
Subsequent certificate of registration Issued: Postgraduate Education Certificate Effective: 01 Jan 1979
Transfer of class of registration to: Independent Practice Certificate Effective: 09 Jul 1980
Transfer of class of certificate to: Restricted certificate Effective: 01 May 2014
Suspension of registration imposed: Inquiries, Complaints and Repo Effective: 27 Aug 2014
Revoked: Discipline Committee. Effective: 20 May 2015

Previous Discipline Hearings

Committee: Discipline
Decision Date: 09 Mar 2015
Summary:

               NOTICE OF PUBLICATION BAN 
                
In the College of Physicians and Surgeons of Ontario and Dr. Ramesh Patel, this 
is notice that the Discipline Committee ordered that no person shall publish or 
broadcast the identity of patients or any information that could disclose the 
identity of patients referred to orally or in the exhibits filed at the hearing under 
subsection 45(3) of the Health Professions Procedural Code (the “Code”), which 
is Schedule 2 to the Regulated Health Professions Act, 1991, S.O. 1991, c. 18, as 
amended. 
                
Subsection  93(1)  of  the Code,  which  is  concerned  with  failure  to  comply  with 
these orders, reads: 
                
      Every person who contravenes an order made under … section 45 or 47… 
      is guilty of an offence and on conviction is liable, 
            (a) in the case of an individual to a fine of not more than $25,000 
            for  a  first  offence  and  not  more  than  $50,000  for  a  second  or 
            subsequent offence; or 
            (b) in the case of a corporation to a fine of not more than $50,000 
            for  a  first  offence  and  not  more  than  $200,000  for  a  second or 
            subsequent offence.  
                
                                
                                
                                
                                
                                
                                
                                
                                
                                
                                
                                
                                
                                
                                
     Indexed as: Ontario (College of Physicians and Surgeons of Ontario) v. 
                          Patel, 2015 ONCPSD 22 
                                      
            THE DISCIPLINE COMMITTEE OF THE COLLEGE 
              OF PHYSICIANS AND SURGEONS OF ONTARIO 
                                      
                      IN THE MATTER OF a Hearing directed 
                  by the Inquiries, Complaints and Reports Committee of 
                   The College of Physicians and Surgeons of Ontario 
             pursuant to Section 26(1) of the Health Professions Procedural Code  
               being Schedule 2 of the Regulated Health Professions Act, 1991, 
                           S.O. 1991, c. 18, as amended. 
                                      
 
B E T W E E N: 
 
                                      
      THE COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO 
                                      
                                      
                                  - and - 
                                      
                                      
                           DR. RAMESH PATEL 
 
 
 
PANEL MEMBERS:                
                              DR. P. CHART (CHAIR) 
                              S. BERI 
                              DR. P. TADROS 
                              DR. E. ATTIA (Ph.D.) 
                              DR. J. WATTS 
 
 
 
Hearing Dates:               March 9, 11 to 13, 2015 
Order Date:                  May 20, 2015 
Release of Written Reasons:  June 8, 2015 
 
                                
 
 
                     PUBLICATION BAN
                                    2 
 
                 DECISION AND REASONS FOR DECISION 

The Discipline Committee (the “Committee”) of the College of Physicians and Surgeons 
of Ontario heard this matter at Toronto on March 9 and 11 to 13, 2015. At the conclusion 
of the hearing, the Committee stated its finding that the member committed an act of 
professional misconduct and that the member is incompetent and reserved its decision on 
penalty after hearing evidence and submissions. 

THE ALLEGATIONS 

The Notice of Hearing alleged that Dr. Patel committed an act of professional 
misconduct: 
1.  under paragraph 1(1)2 of Ontario Regulation 856/93 made under the Medicine Act, 
    1991  (“O. Reg. 856/93”), in that he has failed to maintain the standard of practice of 
    the  profession; and 
    
2.  under paragraph 1(1)33 of O. Reg. 856/93, in that he 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 Notice of Hearing also alleged that Dr. Patel is incompetent as defined by subsection 
52(1) of the Code. 

RESPONSE TO THE ALLEGATIONS 

Dr. Patel admitted to the facts set out in paragraphs 1 to 22 of the Agreed Statement of 
Facts and Admission set out in full below. He admitted that, based on these facts, he 
engaged in professional misconduct by having failed to maintain the standard of practice 
of the profession in his care of 25 patients, and that he 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. 
Conduct, namely; inadequate supervision of staff; improper delegation of controlled acts; 
improperly prescribing and/or directing staff to prescribe to patients; inappropriately 
                                    3 
 
having staff care for and treat patients in his absence; inappropriate billing to OHIP; and 
breaching his undertaking with the College. 

Dr. Patel also admitted that he was incompetent in that his professional care of 25 
patients displayed a lack of knowledge, skill or judgment that was of such a nature or to 
such an extent that his practice should be restricted or that he is unfit to continue to 
practise.  

Dr. Patel did not contest the factual allegations set out in paragraphs 1 to 14 of the 
Statement of Uncontested Facts set out in full below, nor did Dr. Patel contest that these 
facts constitute professional misconduct as a failure to maintain the standard of practice 
of the profession, and as disgraceful, dishonourable and unprofessional misconduct on his 
part. 

THE FACTS  

The following admitted facts were set out in an Agreed Statement of Facts and 
Admission that was filed as an exhibit and presented to the Committee: 
 
1.    Dr. Ramesh Patel (“Dr. Patel”) is a general practitioner who received his 
certificate of registration authorizing independent practice in 1980.  At all relevant times 
he maintained a solo practice in Toronto, Ontario, providing family physician services, 
including walk-in services.    
 
Broad Investigation in Dr. Patel’s Practice Under Section 75(1)(a) of the Health 
Professions Procedural Code 
 
Initiation of the Investigation: Dr. Patel’s Staff Treated Patients While He Was out of 
Office 
 
2.    An investigation into Dr. Patel’s practice was initiated after the College received 
information in April 2011 from another family physician that Dr. Patel had been allowing 
staff to perform patient care beyond that which was appropriate for a non-physician staff 
member to provide.  A member of this physician’s staff also worked for Dr. Patel and had 
expressed concerns that Dr. Patel was going to be away, that patients were booked for 
                                    4 
 
physical examinations, and that staff members would be expected to perform these 
investigations and sign for prescription renewals.  
 
3.    College investigators attended at Dr. Patel’s clinic on April 18, 2011, when Dr. 
Patel was on vacation.  The office had a sign posted, which stated that “Dr. Patel will not 
be in office from 6th Apr. 2011 to 24th Apr. 2011.  He will resume on 25th Apr. 2011.  
Sorry for your inconvenience.”  However, there were approximately half a dozen patients 
in the waiting room, and 4-5 non-physician staff members wearing scrubs were also 
present.  An office worker advised investigators that Dr. Patel was on vacation, and that 
staff were performing only electrocardiograms and blood work in his absence.  Staff 
members stated that they were not conducting assessments in Dr. Patel’s absence.   
       
4.    Ontario Health Insurance Plan (“OHIP”) billings for the time period of Dr. Patel’s 
absence indicated that the total amount billed in his name while he was on vacation was 
$34,079.14.  An analysis of Dr. Patel’s OHIP billings for this period is attached at Tab 1 
(to the Agreed Statement of Facts and Admission).  Billings included, among other 
things, 325 billings for “minor assessments” (A001), 1 billing for an “enhanced 18 month 
well baby visit” (A002A), 84 “annual adult physicals” (A003A), 379 “intermediate 
assessments” (A007A), 1 “pre-operative assessment” (A903A), 43 episodes of 
“counselling” (K013A), 1 “annual health exam for child after 2nd birthday” (K017A), 2 
“minor prenatal assessments” (P004A), and 1 “incision of (2) abscess or haematoma with 
Local” (Z173A).  A total of 1,801 separate billing codes were submitted for the twenty-
day time period.  Dr. Patel was not present in the office while any services were 
performed during this time.   
       
Nature of Dr. Patel’s Practice 
       
5.    Information was gathered during the investigation about the nature of Dr. Patel’s 
practice.  Dr. Patel’s office was open six days per week, with patients being seen between 
10 and 13 hours per day when the clinic was open.  He advised that he saw 80 to 100 
patients a day.  In June 2011, Dr. Patel had 9 staff members, including an administrative 
assistant, 4 medical technologists who were members of the Ontario Society of Medical 
                                    5 
 
Technologists, 1 physician’s assistant who was an internationally trained physician 
unlicensed in Ontario, and 3 laboratory technicians who were not members of the Ontario 
Society of Medical Technologists.    
       
6.    A sample chart entry for an ‘annual physical examination’ from one of Dr. Patel’s 
patient records is attached at Tab 2 [to the Agreed Statement of Facts and Admission].  If 
a patient was new to Dr. Patel’s practice, the patient’s first appointment would consist of 
an ‘annual physical examination’ of the type described in the chart entry Registered 
patients also had annual physical examinations. Staff members would use templates 
found on Dr. Patel’s electronic medical recordkeeping (“EMR”) system to take the 
patient’s subjective history, vital signs, medical history, family history, and social factors.   
Staff would also complete the “review of systems,” conduct an electrocardiogram, take 
blood and urine samples, and, if prompted by the EMR system, conduct a pelvic 
examination and collect a Pap smear from a female patient.  Laboratory requisitions 
would be generated when prompted by the EMR system, including for chest x-rays and 
abdominal and pelvic ultrasounds. This would all occur prior to Dr. Patel seeing the 
patient.  Dr. Patel would generally conduct the physical examination noted at the end of 
the chart entry (beginning with the portion headed “Cardiovascular System”), although as 
noted above he did not conduct any portion of the patient encounter while he was on 
vacation in April 2011.  
       
7.    A sample chart entry for a patient, who was not new to Dr. Patel’s practice and 
was presenting with a specific complaint, is attached at Tab 3 [to the Agreed Statement of 
Facts and Admission].  The ‘diagnosis’ at the top of the entry would be carried forward 
by the EMR system from an earlier visit and did not necessarily reflect the purpose of the 
visit.  Staff would follow prompts in the EMR system based on what they determined to 
be the presenting symptom cited by the patient, e.g. ‘pharyngitis.’  That is, the 
information filled in by staff would be based on whatever prompts Dr. Patel had 
preloaded into the system for patients presenting with ‘pharyngitis.’  Staff would then 
take the patient’s vital signs and conduct or requisition any tests that the system prompted 
them to do. Dr. Patel would then see the patient, guided by the information provided by 
                                    6 
 
staff, although as noted above he did not conduct any portion of the patient encounter 
while he was on vacation in April 2011.  
       
8.    Dr. Patel did not obtain the informed consent of patients for the delegation of 
controlled acts to staff members, or to staff members’ involvement in their care in 
general.  In some cases, such staff involvement took place at Dr. Patel’s office, but before 
Dr. Patel had any direct physical encounter with the patients, including in some cases 
where it was the patient’s first visit to the office. 
       
9.    The majority of the entries in Dr. Patel’s patient encounter notes are derived from 
the use of “Click Notes” within the templates on his EMR system, i.e. following prompts 
to answer yes/no questions or to enter information in generic form from among the 
choices presented by the system.  
       
10.   Dr. Patel maintained a series of memoranda to his staff on his office computer 
system.  A sample of these is attached at Tab 4 [to the Agreed Statement of Facts and 
Admission].  These are not written medical directives within the meaning of the 
College’s Policy on Delegation of Controlled Acts, attached at Tab 5 [to the Agreed 
Statement of Facts and Admission], which requires a number of safeguards regarding 
delegation, including establishment of a physician-patient relationship, the existence of a 
medical directive or direct order, appropriate evaluation of the delegate, informed patient 
consent, and quality assurance steps including appropriate supervision and 
documentation.  As will be set out in greater detail below, certain of these safeguards 
were missing from Dr. Patel’s practice. 
 
Review of Care Provided to Dr. Patel’s Patients 
 
11.   In the course of the College’s investigation, Dr. X provided an independent expert 
opinion based on a review of 25 patient charts and an interview of Dr. Patel.  As found by 
Dr. X, Dr. Patel failed to meet the standard of practice of the profession and lacked 
knowledge and judgment in his care and treatment of 25 patients.   
                                    7 
 
12.   Dr. X’s report, received May 14, 2013, is attached at Tab 6 [to the Agreed 
Statement of Facts and Admission] and forms part of this Agreed Statement of Facts and 
Admission.  Among the 25 patient charts reviewed, Dr. X identified a number of areas in 
which Dr. Patel’s practice was unsatisfactory, including: 
 
(a)   Dr. Patel made unsubstantiated diagnoses, including of diabetes. 
(b)   Dr. Patel ordered numerous unnecessary tests that were not appropriate to 
      patients’ circumstances, based on the use of templates and routine.  This resulted 
      in, for example, patients undergoing chest x-rays or abdominal and pelvic 
      ultrasounds at successive annual physical examinations even if not indicated by 
      the patient’s history or physical examination. Inappropriate blood tests were also 
      ordered as a matter of routine, including for example blood tests that were not 
      indicated during pregnancy. Decisions were generally made to order tests before 
      Dr. Patel had seen the patient. 
(c)   Dr. Patel inappropriately treated respiratory infections in both adults and pediatric 
      patients with medications that do not meet the standard of practice, and he failed 
      to consider asthma where it would have been indicated to do so.  Patients with 
      respiratory infections were sometimes required unnecessarily to come in daily or 
      almost daily for a period of time for a treatment that was not indicated. 
(d)   Dr. Patel failed to address patients’ presenting concerns on occasion, for example 
      by:  failing to conduct a musculoskeletal examination when a patient complained 
      about musculoskeletal illnesses, and failing to address a urine infection that had 
      been noted as a presenting concern. 
(e)   Dr. Patel failed on one occasion to follow up appropriately on an abnormal 
      electrocardiogram. 
(f)   Dr. Patel inappropriately prescribed the ‘morning sickness’ medication Diclectin 
      to a prenatal patient who did not complain of nausea or vomiting. 
(g)   Dr. Patel failed to ensure that information in the patient chart was informative.  
      For example, the information in the chart was sometimes contradictory, as in one 
      chart that stated that a patient was ‘in respiratory distress’ when the patient’s 
      oxygen saturation levels indicated otherwise, or in another chart in which a note 
                                    8 
 
      indicates both that the patient had no history of high blood pressure and a problem 
      with hypertension.  An encounter note in another chart stated that the patient had 
      no history of heart attack, then later documented a previous acute myocardial 
      infarction.  A chart for a five-year-old patient stated that the patient “denies any 
      problems with drug dependence.” 
(h)   Dr. Patel failed to appropriately supervise staff and improperly delegated 
      controlled acts.  There was no documentation in the charts of instructions by Dr. 
      Patel to his staff, including with respect to assessments and examinations 
      conducted in his absence, nor were there any medical directives provided.  It was 
      apparent that care was being delivered by people other than Dr. Patel, but it was 
      not clear “how they were being directed or if they were being directed at all.” Dr. 
      X identified instances in which the care delivered in this manner showed a lack of 
      appropriate clinical decision-making reflective of the lack of supervision.   
(i)   Dr. Patel failed to obtain informed patient consent to the delegation of controlled 
      acts to staff, or to staff involvement in their care. 
 
13.   In a number of the charts under review, Dr. X identified that care had been 
provided to the patient during the time that Dr. Patel was away from the office in April 
2011, and was not appropriately supervised or delegated.  These appointments while Dr. 
Patel was out of the office included: a ‘counselling’ appointment for a 5 year old child 
done by a person with the initials ‘RK’; completion of a hospital preadmission form; 
provision of a prescription; a number of annual physical examinations at which numerous 
tests were ordered without indication and/or  contradictory information was gathered; a 
patient who had 7 appointments for bronchitis, at which treatment initially ordered in 
March was continued at each; a postpartum appointment at which a glucometer was done 
without indication; an annual physical examination at which no plan or comment was 
made as to how to address the patient’s health complaints; a patient who was seen 
numerous unnecessary times for changing of a dressing and it was noted that the wound 
was ‘healing well;’ an 18 month well baby visit, which is a detailed developmental 
examination which should be conducted by a physician; advising a child patient’s mother 
                                    9 
 
of test results; an appointment at which a patient obtained medication and a special diet 
form (billed as an ‘intermediate assessment’).   
 
Inappropriate OHIP Billing  
 
14.   Dr. Patel inappropriately billed OHIP during the time period that he was on 
vacation in April 2011.  Physicians must be physically present in the office to bill OHIP 
for all but a limited number of simple office procedures (which must be rendered in 
accordance with the standard of practice).   
 
15.   In addition, as described in Dr. X’s report, Dr. Patel engaged in other 
inappropriate billing practices: 
  
      (a) billing for a ‘minor assessment’ when faxing prescription renewals to or 
         receiving them from pharmacies; 
      (b) billing for a ‘minor assessment’ when a patient’s family member dropped off 
         or picked up a document, prescription, or testing kit;  
      (c) billing inappropriately with respect to administration of the Rotateq 
         vaccination. 
 
Dr. Patel’s Breach of his Undertaking to the College 
 
16.   After allegations against him were referred to the College’s Discipline 
Committee, Dr. Patel entered into an undertaking dated May 1, 2014, which is attached at 
Tab 7 [to the Agreed Statement of Facts and Admission].  Among other things, Dr. Patel 
undertook that, effective immediately, he would not “delegate to any other person any 
Controlled Act, as that term is defined in the Regulated Health Professions Act, 1991.”  
He also undertook to engage a Clinical Supervisor who would review his practice and 
meet with him every two weeks to observe his encounters with no fewer than 10 patients; 
review no fewer than 10 patient records randomly, discuss any issues or concerns arising 
therefrom, and make recommendations to Dr. Patel.  The Clinical Supervisor would 
                                    10 
 
report to the College.  Dr. Patel undertook “to co-operate fully with the supervision of” 
his practice, and to abide by the recommendations made by his Clinical Supervisor, 
including but not limited to any recommended practice improvements and ongoing 
professional development.   
 
17.   Dr. Patel engaged Dr. Y as his Clinical Supervisor.  Dr. Y reviewed patient charts 
from Dr. Patel’s practice and observed patient encounters in his office as required by the 
Undertaking.   
       
18.   In the course of her duties, Dr. Y found that Dr. Patel continued to delegate 
controlled acts in breach of his Undertaking, namely:  
 
      (a) Staff put an instrument beyond the labia majora by continuing to perform Pap 
         tests delegated by Dr. Patel.  
      (b) Staff administered substances by injection and inhalation by carrying out 
         immunizations and B12 injections, and by administering treatment by 
         inhalation for respiratory issues. 
       
19.   Dr. Patel continued to delegate controlled acts in breach of his undertaking until 
July 8, 2014. 
 
20.   Dr. Patel failed to abide by practice recommendations made by Dr. Y, in breach of 
his undertaking, namely:  
 
      (a) Dr. Patel did not follow Dr. Y’s recommendation to cease having staff enter 
         billing codes for visits that were in progress and to begin entering billing 
         codes only upon completion of a patient encounter. 
      (b) Dr. Patel did not follow Dr. Y’s recommendation to cease billing for visits at 
         which the patient was not present, including missed appointments and where 
         the patient or family member was dropping off or picking up forms, specialist 
         information, or specimens for testing. 
                                    11 
 
      (c) Dr. Patel did not follow Dr. Y’s recommendation to augment subjective 
         histories documented by staff with his own additional questions. 
      (d) Dr. Patel did not follow Dr. Y’s recommendation to obtain informed consent 
         from patients prior to staff documenting patients’ subjective histories. 
      (e) Dr. Patel did not follow Dr. Y’s recommendation to take steps to ensure that 
         his EMR system clearly indicated which details were entered by which 
         individual. 
      (f) Dr. Patel did not follow Dr. Y’s recommendation to take steps to ensure his 
         staff did not make clinical decisions. 
      (g) Dr. Patel did not follow Dr. Y’s recommendation to cease ordering 
         unnecessary diagnostic tests. 
      (h) Dr. Patel did not follow Dr. Y’s recommendation to cease routinely 
         prescribing Biaxin and Alupent for cough symptoms.   
 
21.   Dr. Patel failed to abide by a patient-specific treatment recommendation made by 
Dr. Y, in breach of his undertaking, in that he did not discontinue an outdated drug, 
Diabeta, which he had prescribed to an elderly patient to treat diabetes.  Diabeta is 
associated with hypoglycemia, and the patient had been released from the hospital after a 
hypoglycemic episode.  The hospital discontinued the Diabeta and partially attributed the 
patient’s hypoglycemic episode to it, but Dr. Patel re-started the Diabeta when he saw the 
patient the following week. Dr. Y, upon seeing this in the patient chart, recommended 
that the patient be seen urgently.  Dr. Patel agreed to see the patient urgently.  Dr. Y 
recommended that the patient’s Diabeta be stopped and a safer alternative used instead.  
Upon following up on her recommendation, Dr. Y later learned that Dr. Patel had decided 
not to stop Diabeta.  Dr. Y contacted the College on an urgent basis because Dr. Patel’s 
failure to follow this recommendation placed the patient at risk. 
 
22.   Dr. Patel failed to abide by further patient-specific treatment recommendations 
made by Dr. Y, in that he continued to prescribe narcotics to a patient without adequate 
documentation and continued to prescribe Ventolin to a patient without the suggested 
addition of another inhaler such as Advair to provide better symptom relief. 
                                    12 
 
Admission 
 
23.   Dr. Patel admits the facts specified above, and admits that, based on these facts, 
he engaged in professional misconduct by having failed to maintain the standard of 
practice of the profession in his care of 25 patients, and was incompetent in that his 
professional care of 25 patients displayed a lack of knowledge, skill or judgment that was 
of such a nature or to such an extent that his practice should be restricted or that he is 
unfit to continue to practice. 
 
24.   While in admitting to his incompetence as set out above, Dr. Patel does not admit 
that he is unfit to continue to practice, Dr. Patel acknowledges that this determination will 
be made by the Discipline Committee. 
 
25.   Dr. Patel also admits that, based on the facts specified above, he engaged in 
disgraceful, dishonourable or unprofessional conduct, namely: inadequate supervision of 
staff; improper delegation of controlled acts; improperly permitting and/or directing staff 
to prescribe to patients; inappropriately having staff care for and treat patients in his 
absence; inappropriate billing to OHIP; and breaching his undertaking to the College. 

The following facts are alleged in a Statement of Uncontested Facts that was filed as an 
exhibit and presented to the Committee: 
 
Patient A  
1.    Patient A was experiencing foot problems and looking for a family physician. She 
called Dr. Patel’s office to book an appointment and was told by office staff that a 
‘physical’ was required for first-time patients. 
 
2.    When Patient A attended Dr. Patel’s office for her appointment in June 2012, a 
female staff member took her into the examination room and took down Patient A’s 
history in detail, as well as her blood pressure, weight, and height.  Patient A believed 
that this staff member was a nurse, but was not sure.  The staff member was not in fact a 
nurse.  Patient A explained to the staff member that she was being followed by Hospital 1 
                                    13 
 
in relation to her breasts and did not require a breast examination. Patient A told the staff 
member that the Hospital 1 physicians clearly stated that no other breast-related 
assessments or tests were needed. The staff member typed information into a computer 
while Patient A spoke. The staff member gave a paper gown to Patient A and told her to 
lie down, and that the doctor would come in to see her.  
 
3.    When Dr. Patel entered the room, he looked over the patient’s chart on the 
computer. Dr. Patel then complained to Patient A that while he treated a lot of patients, 
no one appreciated him. This conversation made Patient A feel uncomfortable. 
       
4.    Dr. Patel asked Patient A some questions. She explained again that she was being 
followed at Hospital 1 for her breasts and did not require a breast examination. She told 
Dr. Patel that she had a problem with her feet, and that this was the primary reason for 
her visit. Dr. Patel told her without looking at her feet that she should exercise and skip 
rope to relieve her discomfort.  
       
5.    Dr. Patel then came closer to Patient A and without explanation or seeking her 
consent, pulled down her gown, looked first at her collar bone, and then pulled the gown 
down below her breasts, exposing her breasts.  Patient A was shocked that her breasts 
were exposed without warning. Dr. Patel was rough in his examination, and asked her 
repeatedly where the fibroids were. Patient A repeated that she was being followed by 
Hospital 1 for that issue.  
 
6.    After Dr. Patel examined her breasts, he examined Patient A’s stomach and recent 
surgical stitches. He then left the examination room.  
       
7.    The College obtained an independent opinion from Dr. X on the care provided to 
Patient A.  Dr. X’s report, received August 26, 2013, is attached at Tab 1 [to the 
Statement of Uncontested Facts] and forms part of this Statement of Uncontested Facts.  
As found by Dr. X, Dr. Patel’s care did not meet the standard of practice of the 
profession.  The history and other information in the chart obtained were contradictory.  
Patient A was subjected to unnecessary investigations, and did not have her concerns 
                                    14 
 
regarding her presenting complaint addressed.  She had a breast examination to which she 
had not consented.  There were errors in judgment in not seeking to obtain information 
from Hospital 1 or ordering appropriate tests, and there was a lack of adequate 
supervision of the staff member who saw Patient A before Dr. Patel.  Dr. Patel’s care 
displayed a lack of knowledge and judgment.   
       
8.    Dr. Patel failed to provide an audit trail for Patient A’s electronic medical record 
that accorded with College policy upon request by the College investigator. 
 
Patient B 
9.    Patient B attended at the office of Dr. Patel, his family physician, in August 2012 
complaining of chest pain. Patient B was initially seen by a member of Dr. Patel’s staff, 
who recorded his history and vital signs, and performed an electrocardiogram.  Dr. Patel 
subsequently entered the examination room and reviewed the information obtained by his 
staff. Dr. Patel informed Patient B that his electrocardiogram was normal, and that Dr. 
Patel could not treat him. Patient B continued to express concern about his pain, and Dr. 
Patel advised him that he could go to a hospital emergency department if he wished.  Dr. 
Patel did not insist that Patient B attend an emergency department, although the last entry 
in the encounter note states ‘advise to go to ER.’  No diagnosis was stated in the chart.   
       
10.   The next day, Patient B was admitted to hospital, where he underwent triple 
bypass surgery. In September 2012, Patient B was discharged from hospital with 
instructions to follow up with his family physician. 
       
11.   In September 2012, Patient B attended Dr. Patel’s clinic. However, after Patient B 
voiced concerns regarding post-operative care, he was discharged from Dr. Patel’s 
practice by letter to Patient B, which was five days after the patient’s discharge from 
hospital.  The letter stated “you are hereby advised to get a new family physician.” 
 
12.   The College obtained an independent opinion from Dr. X on the care provided to 
Patient B.  Dr. X’s report, received August 26, 2013, is attached at Tab 2 [to the 
Statement of Uncontested Facts], and forms part of this Statement of Uncontested Facts.  
                                    15 
 
Dr. X opined that based on Patient B’s account of his patient encounter in August 2013, 
Dr. Patel did not meet the standard of practice of the profession and lacked knowledge 
and judgment in his treatment of Patient B.  It would have been appropriate for Dr. Patel 
to either call the emergency department or send information to the emergency department 
either separately or with the patient, but this was not done.  Patient B’s discharge from 
Dr. Patel’s practice also exposed him to harm, as he was not given any time to find a new 
primary care provider, and the discharge instructions from the hospital had indicated the 
need to see his primary care provider within the week. 
       
13.   In responding to the College’s investigation, Dr. Patel stated, among other things, 
that he had terminated the doctor-patient relationship with Patient B as a result of the 
patient’s “defiant attitude.” 
       
14.   Dr. Patel failed to provide an audit trail for Patient B’s electronic medical record 
that accorded with College policy upon request by the College investigator. 
 
Plea of No Contest 
 
15.   The facts as set out above are not contested for the purposes of this proceeding, 
nor does Dr. Patel contest that these facts constitute professional misconduct as a failure 
to maintain the standard of practice of the profession and as disgraceful, dishonourable 
and unprofessional conduct on his part. 
 
FINDINGS 
 
(1) With respect to the Agreed Statement of Facts and Admission, the Committee 
accepted these facts and the admission made and found that Dr. Patel engaged in 
professional misconduct by having failed to maintain the standard of practice of the 
profession in his care of 25 patients, and by engaging in disgraceful, dishonourable and 
unprofessional misconduct. The Committee also found Dr. Patel to be incompetent in that 
his professional care of the 25 patients displayed a lack of knowledge, skill or judgment, 
                                    16 
 
that was of such a nature or to such an extent, that his practice should be restricted or he 
is unfit to continue to practise.  
 
(2) With respect to the Statement of Uncontested Facts and the plea of no contest, Rule 
3.02 of the Discipline Committee’s Rules of Procedure states: 
 
   3.02(1)  Where a member enters a plea of no contest to an allegation, the member 
   consents to the following: 
      a) that the Discipline Committee can accept as correct the facts alleged against 
         the member on that allegation for the purposes of the proceeding only; 
      b) that the Discipline Committee can accept that those facts constitute 
         professional misconduct or incompetence or both for the purposes of the 
         proceeding only; and 
      c) that the Discipline Committee can dispose of the issue of what finding ought 
         to be made without hearing evidence. 

Accordingly, the Committee accepted as true all of the facts set out in the Statement of 
Uncontested Facts and found that these facts constituted professional misconduct, in that 
Dr. Patel has failed to maintain the standard of practice of the profession, and that he 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, 
dishonorable or unprofessional.  

EVIDENCE AND SUBMISSIONS ON PENALTY 

Counsel for the College submitted that the only appropriate penalty consisted of a 
reprimand and revocation of Dr. Patel’s certificate of registration. Counsel for Dr. Patel 
submitted that although the misconduct was serious, an appropriate penalty consisted of a 
reprimand, suspension of his certificate of registration for six months (with credit being 
given for the suspension of his certificate to date) and a detailed program of re-education 
that incorporated a three month period of supervision during which he would not be the 
                                    17 
 
Most Responsible Physician (MRP) and a further twelve month period of supervision as 
the MRP. Two Agreed Statements of Facts were filed on the penalty hearing. 

The following facts were set out in an Agreed Statement of Facts on Penalty: 

1.         In January 2015, the College initiated an investigation to determine whether Dr. 
Patel was treating patients while under suspension.  By  letter  dated  January  13,  2015  
the College retained   an  investigation   firm   to  send  undercover investigators  posing 
as patients to Dr. Patel's  clinic.   A copy of the College’s letter setting out the 
investigation firm’s mandate is attached hereto at Tab 1 [to the Agreed Statement of 
Facts] and forms part of this Agreed Statement of Facts. 

2.        A preliminary report of the investigator, Mr. M from the investigation firm, was 
provided to the College by email from Mr. N dated January 15, 2015. 

3.    A formal report from the investigation firm dated January 21, 2015 was 
subsequently provided to the College.  A  copy  of  the  report  is  attached  hereto  at Tab  
2 [to the Agreed Statement of Facts]  and  forms  part  of  this  Agreed Statement of 
Facts. 

4.         As described in the document attached hereto at Tab 2 [to the Agreed Statement 
of Facts], on January 14, 2015, Mr. M called Dr. Patel’s clinic and asked to book an 
appointment with the doctor for an ailment. The receptionist informed Mr. M that Dr. 
Patel does not take walk-in patients, but that he was currently taking new patients.  The 
receptionist further advised Mr. M that he could attend the clinic to enroll as a new 
patient of Dr. Patel and see Dr. Patel.  She advised Mr. M to fast for at least 12-14  hours  
before  attending  the  clinic,  as  he  would  undergo  a  mandatory  physical examination, 
which would include taking a sample of his blood. 

5.       On a Thursday in January 2015, Mr. M attended at Dr. Patel's clinic. Mr. M told a 
woman at reception wearing scrubs that he had contacted the office the day before and 
been told to come in if he needed to see Dr. Patel.   When Mr. M agreed to join the clinic, 
the staff member handed him a computer tablet and requested that he fill in information 
on the device. 
                                    18 
 
6.        There were two other females wearing blue scrubs in the clinic.  After Mr. M had 
filled in the information on the device, one of the females wearing blue scrubs gave him a 
cup and asked for a urine sample. 

7.        Subsequently, a staff member that took the initial information led Mr. M to an 
examination room. On the way, Mr. M saw Dr. Patel sitting in an office area (this was not 
a patient examination room).  There were three large monitors at the station where Dr. 
Patel was sitting, one of which was connected to a CCTV system that showed footage of 
what was happening in the office.  Dr. Patel appeared to be browsing through some 
paperwork.  Dr. Patel was wearing street clothes (not scrubs). 

8.        In the examination room, the staff member appeared to operate a voice recording 
device to record her interaction with Mr. M.  She checked Mr. M's height and weight and 
asked him to sit on the examination table. She then asked a series of questions regarding 
Mr. M's family history, medical history and symptoms for approximately fifteen minutes, 
pausing at one point to take his blood pressure.  When Mr. M asked if the doctor was 
busy, the staff member stated "later, he not here now." 

9.        The staff member then informed Mr. M that she needed to take his blood, and 
removed five vials of blood from Mr. M. When asked why so much blood was taken, she 
replied, "just the one time, once in a year." 

10.      The staff member then informed Mr. M that he would need to go for x-rays or 
ultrasound and suggested that since he was already fasting, he could go in for the 
examination that day. She gave him directions to a lab and printed out an x-ray 
requisition form (attached to Mr. M's report) and handed it to Mr. M. She then advised 
Mr. M that the doctor would be with him shortly and exited the room. 

11.      Dr. Z, who was working as a locum at the clinic at the time, then entered the room 
and introduced himself as "Dr.  Z".   Among other things, Dr. Z took a history of the 
presenting complaint, checked Mr. M's  vital signs, used a tongue depressor to check  his  
throat,  and  used  a  stethoscope to  listen for  any  irregularities  in  the  breathing. Dr. Z 
                                    19 
 
also consulted the computer where the staff member had recorded Mr. M's medical 
history. 

12.    During the assessment, Mr. M asked Dr. Z if he was Dr. Patel.  Dr. Z said "No". 

13.      Dr. Z gave Mr. M a prescription and suggested that he go for a chest x-ray. 

14.     On his way out of the examination room, Mr. M noted that Dr. Patel was still 
sitting in the office area looking at the computer monitor in front of him. 

15.      The patient chart which was created as a result of Mr. M’s attendance is attached 
at Tab 3 [to the Agreed Statement of Facts] and forms part of this Agreed Statement of 
Facts. 

16.      Dr. Patel did not speak or interact with Mr. M in any way.  To the best of Mr. M's 
knowledge, information and belief, Dr. Patel did not have any involvement in his medical 
treatment and care. 

17.      In total, Mr. M was at the clinic for approximately 40 minutes from 11:00 am to 
11:40 am.   During that time, Mr. M did not observe Dr. Patel in any of the patient 
examination rooms.  Mr. M did not observe Dr. Patel providing medical treatment or care 
to any patients. Mr. M did not observe Dr. Patel speaking or interacting with patients. 

18.      On Monday in January 2015, a second investigator, Ms O, called Dr. Patel's clinic 
at approximately 1:36pm. As of that time, Dr. Patel had not yet been advised by the 
College that an undercover patient had been sent to his office to determine whether he 
was providing medical care while under suspension.   Ms O asked if she could see Dr. 
Patel for an illness.   The receptionist informed Ms O that Dr. Patel was temporarily not 
practising medicine.  The receptionist indicated that she did not know when he would 
return to practice. 

19.      The investigator provided a verbal report to the College regarding this call to Dr. 
Patel’s clinic.  The investigator was not asked to attend at the clinic and pose as a patient. 
                                    20 
 
20.       A copy of the investigation firm’s report dated January 26, 2015, received January 
30, 2015, is attached hereto at Tab 4 [to the Agreed Statement of Facts] and forms part of 
this Agreed Statement of Facts. 

Additional facts were set out in a supplementary Agreed Statement of Facts on Penalty 
that was filed as an exhibit and presented to the Committee: 
 
1.         By letter dated July 31, 2014, Dr. Patel provided reimbursement the Ministry of 
Health and Long-Term Care in the amount of $86,428.94, for overpayments received 
from OHIP.  A copy of the letter is attached at Tab 1 [to the Agreed Statement of Facts] 
and forms part of this Agreed Statement of Facts. 
 
2.         By   letter   dated   August   11, 2014,   the   Ministry   of   Health   and   Long-
Term   Care acknowledged receipt of the repayment. A copy of the letter is attached at 
Tab 2 [to the Agreed Statement of Facts] and forms part of this Agreed Statement of 
Facts. 

The College filed two previous disciplinary findings against Dr. Patel. In January 1992, 
the Discipline Committee found that he had failed to maintain the standard of practice of 
the profession with respect to his investigation, management and discharge of a patient 
with atrial fibrillation and stroke. Dr. Patel was reprimanded and required to participate in 
a series of educational programs including the completion of the McMaster Physician 
Review Program (PREP) and any recommended Physician Enhancement Program(s). In 
August 1999, Dr. Patel was found to have failed to maintain the standard of practice of 
the profession with respect to his prescription of an oral contraceptive to a patient with 
multiple contra-indications to such medication, failure to deal with the same patient’s 
depression and failure to follow up on suggestions from consultants, or on abnormal 
laboratory results on this patient. In addition, his record-keeping was found to be 
“extremely poor”. Dr. Patel received a second reprimand, was required to undergo a 
second assessment by the PREP program and to undertake a record-keeping course. A 
suspension of his certificate for three months was ordered, but this was itself suspended if 
he completed the required courses. 
                                    21 
 
The Committee admitted in the penalty hearing the evidence of Dr. W, an experienced 
Family Physician who received his CCFP in 1985, and who has practised in north 
Toronto for 30 years. In addition to his medical qualifications, Dr. W has a Masters and a 
Doctoral degree in education and practised as an educational psychologist prior to 
qualifying as a physician. Dr. W teaches and supervises medical students and Family 
Medicine residents; he has mentored at least one Family Medicine trainee every year for 
the past 27 years. He has received a university award for his teaching and is an Assistant 
Professor in Family Medicine at the University of Toronto. 

Dr. W has been a Peer Assessor, Practice Monitor and Medical Inspector for the College 
for many years, and has served on the Family Medicine Review Panel of the Quality 
Assurance Committee. He was one of only five assessors for PREP. In his varied roles at 
the College he has experience in the development and implementation of Individualized 
Education Plans (IEPs) for practising physicians. 

The Committee accepted Dr. W as an expert in family medicine and medical education 
who is qualified to opine on the practice of family medicine and the assessment, 
remediation of deficits (including the development, implementation and supervision of 
remediation and education programs) and supervision and monitoring of community 
based family medicine physicians.  

The subject matter of Dr. W’s evidence was the structure and implementation of a 
proposed program of supervision, re-education and remediation for Dr. Patel. The 
Committee admitted Dr. W’s evidence not as a substitute for its own expertise and 
experience or determining an appropriate penalty, but rather for his expertise on the 
structure and implementation of programs of supervision, re-education and remediation. 
The required terms of such a program are complex and fall, at least in part, outside the 
individual or corporate knowledge and experience of the Committee.  

Dr. W stated an opinion that Dr. Patel’s behaviour was remediable; he based this opinion 
on his review of the College’s expert’s report, his own review of the medical records on 
which that report had been based, the report of  Dr. Patel’s supervisor and an interview 
                                    22 
 
with Dr. Patel lasting 2 ½ hours. He had drawn up a proposed remediation plan consisting 
of the following elements:  

   ?  cessation of the use of templates; 

   ?  prohibition of the employment of office assistants for anything other than taking 
      basic vital signs and performing venipuncture, spirometry and ECGs; 

   ?  seeing no more than 30 patients per day and scheduling 15 minute encounter 
      periods; 

   ?  limiting the number of walk-in patients; 

   ?  refraining from prescribing Alupent and Glyburide, and using office nebulisers or 
      performing surgical excisions of potential neoplastic skin lesions; 

   ?  maintenance of his CFPC required program of Continuing Professional 
      Development; 

   ?  assigning the care of all patients for three months to another licenced physician, 
      while shadowing that physician’s care; and 

   ?  practising under the supervision of a physician approved by the College for one 
      year, with that physician observing a minimum number of patient encounters, 
      reviewing a selected number of charts, and discussing with Dr. Patel both the 
      management of those patients, while monitoring Dr. Patel’s ongoing learning and 
      means whereby his learning could be incorporated into practice. 

Dr. W had laid out this plan using a template for an IEP which was recommended by, and 
used by the College, and which laid out suitable assessment methods and expected goals 
using a framework (CanMEDS) approved by the Royal College of Physicians and 
Surgeons and the Canadian College of Family Physicians. Dr. W also recommended that 
a repeat assessment of Dr. Patel’s practice should be conducted after a year of 
supervision. 
                                    23 
 
Dr. W testified that he felt that Dr. Patel’s choice of practice style was less a matter of 
poor judgment than it was an attempt, albeit misguided, to meet the needs of a large and 
demanding patient population who had difficulty finding a culturally appropriate 
physician. Dr. W freely admitted that he tended to “give Dr. Patel the benefit of the 
doubt”. Dr. W appeared surprised when faced with a report that he had written on behalf 
of Dr. Patel in 1999 during an earlier investigation of Dr. Patel, and said that although he 
recalled it when it was shown to him, he had not remembered doing the report when 
developing his current recommendations. In that earlier report, Dr. W had identified 
problems in the standard of care in 5 out of 17 patient records reviewed (with occasional 
deficiencies in a further 12), and problems with record keeping in all 17 charts. Dr. W’s 
view at that time was that the chart deficiencies could be attributed to problems in a new 
computer program. In that report he was critical of another expert for failing to give Dr. 
Patel the “benefit of the doubt”. 

Counsel for Dr. Patel further submitted a volume of letters of support for Dr. Patel. This 
contained seven letters from consultant physicians to whom Dr. Patel had referred 
patients, attesting to the timeliness and appropriateness of referrals and Dr. Patel’s 
responsiveness to recommendations. Two letters from members of Dr. Patel’s staff 
described his dedication to his patients, and a further ten letters from patients supported 
Dr. Patel, his importance to their care and their willingness to travel substantial distances 
to see him. 

In determining the appropriate penalty, the Committee considered the seriousness of Dr. 
Patel’s misconduct, and the finding of incompetence, together with both aggravating and 
mitigating factors. The Committee took into account penalties imposed in somewhat 
similar cases while recognizing that cases are rarely identical and that each case must be 
considered on its own specific facts. The Committee also considered the principles that 
are well established in considering an appropriate penalty: the protection of the public, 
specific deterrence of the member, general deterrence of members of the profession, 
maintenance of the integrity of the profession and the College’s ability to govern itself in 
the public interest; maintenance of public trust, and where possible, rehabilitation of the 
member. 
                                    24 
 
The Committee took into account that it has disciplined Dr. Patel on two previous 
occasions, both for a failure to maintain the standard of practice of the profession. The 
findings in 1991 related to his failure to provide appropriate care for a patient with a life-
threatening illness (stroke and atrial fibrillation), and in 1999 for prescribing of oral 
contraceptives to a patient with multiple contraindications, including a history of deep 
vein thrombosis; also a potentially life-threatening failure of maintenance of the standard 
of care. In the current hearing, although most of the failures consisted of the ordering of 
unnecessary tests and the provision of unnecessary treatments and visits, they included a 
failure to follow-up on an abnormal ECG and the prescription of medications that are no 
longer recommended or commonly used, thereby exposing his patients to harm. The 
Committee also noted a pattern of increasingly extensive and more serious levels of 
misconduct. The 1991 hearing involved a single patient’s care. In 1999, Dr. Patel 
admitted not only his failures with respect to a single patient, but also multiple examples 
of “extremely poor records”, including some in which notes had been re-written and 
others where documentation was missing entirely. The current Statement of Agreed Facts 
incorporated not only Dr. Patel’s failure to maintain the standard of care, but also his 
failure to properly manage his practice, failure to properly supervise and delegate to his 
staff, and failure to demonstrate an understanding of his professional responsibilities, by 
allowing billing for activities when he was not present to supervise, as well as excessive 
billing for activities when he was present, such as renewing prescriptions. The cumulative 
impact of the breadth and pervasiveness of Dr. Patel’s clinical misconduct, and its extent, 
together with his failure to respond to the recommendations of his College appointed 
supervisor, provided evidence of ungovernability and constitutes professional misconduct 
that in the view of the Discipline Committee deserves the most serious sanction, that of 
revocation of his certificate of registration. 

Although Dr. W testified that he believed that Dr. Patel’s conduct was remediable, the 
Committee did not accept his opinion and did not agree. Not only did Dr. Patel repeat 
(and extend) his misconduct, but, even when he was under the scrutiny of a supervisor 
and facing a disciplinary hearing by his professional governing body, he failed to abide 
by:  
   ?  an undertaking not to delegate controlled acts; 
                                    25 
 
   ?  a series of recommendations from his supervisor to change his practices of 
      delegation, billing or documentation; 
   ?  several recommendations from his supervisor regarding the prescription of certain 
      drugs; and 
   ?  patient specific recommendations from his supervisor, by continuing to use the 
      drug Diabeta (glyburide) and prescribing narcotics without adequate 
      documentation. 

Dr. Patel’s actions while under supervision provide the Committee with no confidence at 
all into his insight and his ability and willingness to take the necessary steps to be 
rehabilitated. In addition, the observations of the practices of his locum physician while 
Dr. Patel was under suspension were so similar to the practices of Dr. Patel himself that it 
is hard for the Committee to avoid the inference that Dr. Patel had a continuing influence 
on the nature of the practice in his office, even though he was not observed to be 
communicating with the staff at the time of the observations. That he would be sitting at 
computer terminals in the office without having an effect on what was going on around 
him was simply unbelievable and worrisome, having regard to public safety. 

The Committee recognizes the seriousness of the penalty of revocation, but does not 
accept the sometimes used description of revocation as a “professional death sentence”, 
and refers to the Alberta Court of Appeal in Adams v. Law Society (Alberta), 2000, where 
the court states: 

      “It is erroneous to suggest that only the most serious misconduct by the most 
      serious offenders warrants disbarment…..it is not reserved for only the very worst 
      conduct engaged in by the very worst lawyers”. 

Furthermore, the legislation allows for an application for reinstatement after one year, 
and on such an application the member must persuade the Discipline Committee, among 
other things, that public safety will not be endangered by reinstating the certificate of 
registration of the physician.  
                                    26 
 
The letters of reference provided by Dr. Patel are in sharp contrast with the facts agreed 
to by Dr. Patel. In comparing the comments of the physicians to whom Dr. Patel has 
referred patients, together with the experience of Dr. Patel’s recent supervisor, the 
Committee found the latter to be of considerably greater value with respect to the 
potential for rehabilitation. 

Although Dr. Patel has made restitution to OHIP of his over-billing, this was done in 
August 2014 for billings in April 2011, over three years later. The Committee does not 
accept this as sufficient mitigation to modify the penalty that is otherwise called for. 

Dr. Patel’s delegation practices, and his billing offences, represent a serious breach of 
public trust. The safety of the public, the maintenance of public confidence in the 
profession and its ability to govern itself, and the maintenance of the integrity of the 
profession, call for the imposition of a penalty of revocation in this case.  

ORDER 

Therefore, by written order on May 20, 2015, the Committee ordered and directed that: 

   1. the Registrar revoke Dr. Patel’s certificate of registration, effective immediately. 

   2. Dr. Patel appear before the Committee to be reprimanded, and that the fact of the 
      reprimand be recorded on the register. 

   3. The parties deliver written submissions with respect to costs payable to the 
      College, to be exchanged and filed with the Hearings Office of the College within 
      21 days of the date of this order. 

The Committee directs the Hearings Office to schedule a date for Dr. Patel’s reprimand.  
 
              ORDER AND REASONS FOR ORDER ON COSTS 

In its Decision and Reasons for Decision released on June 8, 2015, the Discipline 
Committee (“the Committee”) gave reasons for its finding of professional misconduct 
that Dr. Patel: failed to maintain the standard of practice of the profession in his care of 
                                    27 
 
27 patients; engaged in disgraceful, dishonourable, and unprofessional conduct; and was 
incompetent. The Committee also provided reasons for its penalty order of May 20, 2015, 
revoking Dr. Patel’s certificate of registration effective immediately and ordering him to 
appear before the Committee to be reprimanded.  

The matter of costs was not addressed in the earlier oral submissions, and the Committee 
directed the parties to deliver written submissions on costs. The Committee received and 
considered the written costs submissions of the College; the written submission of Dr. 
Patel; the reply submissions of the College; and the written advice of the Committee’s 
independent legal counsel delivered on September 29, 2015. 

The College submitted that it should be awarded legal costs and expenses for a total of 
$31,220.00 and that it would be unfair to have the general membership shoulder the costs 
of a successful prosecution. Counsel for Dr. Patel submitted that this was not an 
appropriate case in which to award the College its full tariff rate for its hearing costs, and 
instead submitted that a reduced amount totaling $5,575.00 would be an appropriate and 
reasonable costs award. 

 

ORDER AND REASONS 

Section 53.1 of the Health Professions Procedural Code 

Section 53.1 of the Health Professions Procedural Code provides the Committee with the 
discretion, in an appropriate case, to require a member to pay legal costs and the costs of 
investigating and hearing allegations, when a finding of professional misconduct or 
incompetence has been made. After considering the detailed submissions of counsel and 
the case law referenced, the Committee found that this is an appropriate case to award 
costs. The following factors were taken into account in the assessment of costs: 

 

Relative Success of the Parties 
                                    28 
 
Each allegation against Dr. Patel – namely, that he failed to maintain the standard of 
practice of the profession; that he conducted himself in a manner that would be regarded 
as disgraceful, dishonourable, and unprofessional; and that he was incompetent – was 
successfully proved by the College. 

 

Nature of the Misconduct 

The findings against Dr. Patel are very serious, and represent an increase in severity of 
findings made by the Committee regarding Dr. Patel over the years, with little or no 
evidence of insight on the part of Dr. Patel, nor his maintenance of any degree of 
rehabilitation. 

The findings are for misconduct that put the health of patients at risk. As well, Dr. Patel’s 
conduct in billing inappropriately, together with his practices of inappropriate delegation, 
put at risk both the safety of the public and the maintenance of public trust in the 
profession. 

 

Financial Hardship 

The Committee considered the issue of financial hardship that counsel for Dr. Patel 
argued was the result of Dr. Patel’s discipline hearing and the loss of his certificate of 
registration. The Committee noted that no evidence was tendered regarding Dr. Patel’s 
financial status. The evidence indicates that he appears to maintain an involvement in the 
practice even though he is not himself practising.  

Any physician undergoing an investigation and hearing on a matter of this nature is likely 
to suffer economic consequences when the Committee imposes a serious penalty. On the 
issue of costs, the Committee understands that its order must not be unduly harsh or 
punitive. In this matter, we are not persuaded in the absence of evidence of Dr. Patel’s 
financial status that an award of costs that is otherwise fair and reasonable should be 
reduced. 
                                    29 
 
 

Quantum of Costs 

The Committee assessed the quantum of costs by excluding the half day taken up by the 
College’s unsuccessful motion to exclude expert evidence from Dr. X, the defence’s 
expert. The Committee also determined that the late-vacated days should be assessed at 
50 percent of the usual tariff, as those lost days were not the sole responsibility of Dr. 
Patel. It is understood that the recovery of costs at tariff represents only a portion of the 
full costs incurred by the College. 

The Committee concluded, in the exercise of its discretion, that a fair and reasonable 
costs award against Dr. Patel would include the following: 

         Hearing on finding        One full day            $4,460.00 

         Hearing on penalty        Two-and-a-half days     $11,150.00 

         Three late-vacated days   @ 50 percent tariff     $6,690.00 

                                   Total                   $22,300.00 

ORDER 

Therefore, the Discipline Committee orders Dr. Patel to pay costs to the College in the 
amount of $22,300.00 within 60 days of this Order. 
 

Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): March 9, 11-13, 2015


Committee: Discipline
Decision Date: 17 Aug 1999
Summary:

 On August 17, 1999, the Discipline Committee accepted Dr. Patel(s plea of guilty to the allegations 
 set out in the Notice of Hearing and found him guilty of professional misconduct with regard to 
 failing to maintain the standard of practice of the profession and unprofessional conduct.

The 
 Discipline Committee ordered the following:

The penalty imposed by the Discipline Committee is as 
 follows:

(1)	Dr. Patel is required to appear before the panel to be reprimanded, the reprimand to 
 be recorded on the Register.

(2)	The Registrar will be directed to suspend Dr. Patel(s 
 certificate of registration for a period of three months;

(3) 	The three month suspension will 
 itself be suspended, provided that: 

(i)	Dr. Patel attends, as soon as possible but not later 
 than November 30, 1999, at his own expense, a PREP assessment and completes any remedial and 
 assessment steps recommended by the PREP assessor;

(ii)	In the event that Dr. Patel scores level 
 3 or better at PREP, he will be permittedto practise while undergoing those remedial steps.  In 
 the event Dr. Patel scores level 4 or worse, he will be required to withdraw from practice pending 
 his achieving level 3 or higher on re-assessment;

(iii)	Dr. Patel will take, at his own expense, 
 the course offered by The College entitled (Record-Keeping for Family Physicians( to be held on 
 September 17, 1999;

(iv)	Dr. Patel(s office records will be re-assessed by the College at his 
 expense, on a date to be arranged between September 1, 2000, and December 31, 2000.
 
(v)	In the 
 event that Dr. Patel fails to comply with Paragraph 3(i), 3(ii), 3(iii) or 3(iv) herein, the 
 Registrar shall be directed to suspend Dr. Patel(s Certificate of Registration for a period of 
 three months, to commence an a date to be fixed bythe Registrar.

Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): Aug 17, 1999


Committee: Discipline
Decision Date: 09 Oct 1991
Summary:

 In October 1991, Dr. Patel pleaded guilty to a charge of professional misconduct, as defined in s. 
 27(21) of Ontario Regulation 448/80, as amended, in that he failed to maintain the standard of 
 practice of the profession.  The Discipline Committee accepted this plea and found Dr. Patel 
 guilty of professional misconduct.  Consequently, the Committee imposed the following 
 penalty:

1.	Dr. Patel was to be reprimanded, with the fact of the reprimand to be recorded on the 
 Register.

2.	Dr. Patel was to attend an Educational Tutorial Program and was to provide the 
 Registrar with a report from the program supervisor indicating his satisfactory completion of the 
 course.

3.	Dr. Patel was to participate in a Heart and Stroke Seminar.
 
4.	Dr. Patel was to 
 consent to the Registrar sending to the McMaster Physician Review Program (PREP) a copy of these 
 reasons, and was to complete the PREP and any Physician Enhancement Program(s) recommended, to the 
 satisfaction of the Registrar.

5.	Dr. Patel was to agree to bear all costs associated with 
 fulfillment of the terms of this penalty.

6.	In the event that Dr. Patel failed to meet any of 
 these requirements within twelve months of this Order becoming final, his licence to practice was 
 to be suspended until the conditions were met.

Appeal: No Appeal
Hearing Date(s): 09 Oct 1991