On September 22, 2015, the Discipline Committee found that Dr. Mohan committed an act of professional misconduct in that he has failed to maintain the standard of practice of the profession; and in that he has engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional. Dr. Mohan admitted to the allegations.
In February 2010, the College received information from a patient that she and her family had attended at Dr. Mohan’s clinic for travel medicine services, where they had been seen by a man whom they believed to be a physician. On returning home, they viewed Dr. Mohan’s website and realized that although they had received a prescription signed by “Dr. R. Mohan,” the man whom they had seen was not Dr. Mohan. Dr. Mohan explained to the patient that the man they had seen was not “licensed” to practise medicine in Ontario and had signed Dr. Mohan’s name on the prescription.
As a result, the College began an investigation into Dr. Mohan’s practice. In December 2010, he ceased to employ physician assistants in his general practice, and cooperated with the investigation. The investigation showed that Dr. Mohan had employed two assistants in his general practice, neither of whom was authorized to practise medicine in Ontario.
Dr. Mohan failed to familiarize himself with his professional obligations in regard to delegation and supervision of patient care and other issues arising from his employment of assistants. Appropriate delegation, under College policy, requires a number of safeguards, including the 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.
Dr. Mohan screened applicants for assistant positions, provided a period of job shadowing, and subsequently reviewed care provided by his assistants after the fact. However, his supervision, delegation and ongoing quality assurance were inadequate.
The following deficiencies in Dr. Mohan’s use of physician assistants were identified:
(a) Dr. Mohan delegated controlled acts in the absence of written medical directives or direct orders, and in fact did not have written medical directives in his office;
(b) Dr. Mohan inappropriately had his physician assistants provide care while he was out of the office, including during a period of time while he was on holiday, without ensuring that another physician was on the premises and would supervise them;
(c) Dr. Mohan did not ensure that there was a prior physician-patient relationship between himself and any patient seen by his physician assistants;
(d) Dr. Mohan did not adequately ensure that there was informed patient consent to care being provided by physician assistants in all cases;
(e) When introducing patients to his physician assistants, Dr. Mohan did not adequately ensure that patients were aware in all cases that physician assistants were not certified to practise medicine in Ontario;
(f) Dr. Mohan did not adequately ensure that his physician assistants and office staff introduced the physician assistants appropriately to patients when he was not present;
(g) Dr. Mohan inappropriately permitted his physician assistants to write prescriptions and test requisitions; and
(h) Dr. Mohan inappropriately billed the Ontario Health Insurance Plan for services provided by his assistants in circumstances where it was not permitted for him to do so.
Dr. X, retained as an expert by the College, opined that Dr. Mohan failed to meet the standard of practice of the profession with respect to delegation of controlled acts and appropriate supervision of his staff. Dr. Mohan also failed to maintain the standard of practice of the profession with respect to his medical record-keeping. His patient charts failed to indicate the care-provider where care was provided by an assistant, and there was inadequate documentation of follow-up management plans. In two cases the deficiencies in medical record-keeping resulted in patients’ abnormal test results being missed.
Dr. Y, an expert retained by Dr. Mohan, reviewed updated charts for some of the patients whose care had been reviewed by Dr. X. Dr. Y noted that since Dr. Mohan had moved to an electronic medical record-keeping system in 2013 there had been improvements, including in follow-up on test results and significant improvement in record-keeping. Dr. Y noted that in two cases Dr. Mohan should have monitored diabetes more closely and that there was overuse of broad templates, but overall opined that Dr. Mohan now met the standard of practice.
Dr. Mohan has been subject to an Order of the Inquiries, Complaints and Reports Committee since February 20, 2015, which has been effective on an interim basis pending the disposition of the allegations against him. Among other things, Dr. Mohan’s general practice has been under clinical supervision. The clinical supervisor has recommended some improvements, for example to the management of diabetic patients and to record-keeping. The clinical supervisor has also identified patient charts in which he found care to be well-documented, appropriate investigations ordered, and appropriate referrals made.
On September 22, 2015, the Discipline Committee ordered and directed that:
-the Registrar suspend Dr. Mohan’s certificate of registration for a period of three (3) months, commencing from October 23, 2015 at 12:01 a.m.
-the Registrar impose the following terms, conditions and limitations on Dr. Mohan’s certificate of registration:
(a) In his general practice, including with respect to care provided to his family practice patients, walk-in patients and travel clinic patients, Dr. Mohan shall not delegate controlled acts (as defined in the Regulated Health Professions Act, 1991), nor shall he permit individuals who are not regulated health professionals to conduct assessments, take histories, or conduct physical examinations of patients.
(b) Dr. Mohan shall successfully complete within three months of the date of this order an educational program in medical record-keeping that is satisfactory to the College, and shall provide proof to the College of his successful completion of the same.
(c) Approximately sixteen (16) months from the date of this order, Dr. Mohan shall undergo a reassessment of his general practice, including with respect to care provided to his family practice patients, walk-in patients and travel clinic patients, by a College-appointed Assessor.
The assessment may include review of Dr. Mohan’s patient charts, direct observations, and interviews with staff and/or patients. The Assessor shall report the results of the reassessment to the College.
(d) Dr. Mohan shall consent to sharing of information among the Assessor, the College and the provider of the educational program as any of them deem necessary or desirable in order to fulfill their respective obligations.
(e) Dr. Mohan 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, until the report of the reassessment of his practice has been reported to the College.
(f) Dr. Mohan 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.
(g) Dr. Mohan 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 his compliance with this Order.
(h) Dr. Mohan shall be responsible for any and all costs associated with implementing the terms of this Order.
- Dr. Mohan attend before the panel to be reprimanded.
- Dr. Mohan pay to the College costs in the amount of $4,460.00, within thirty (30) days of the date of this Order.