Previous Hearings
Committee: Discipline
Decision Date: 25 Jul 2017
Summary:
On July 25, 2017, the Discipline Committee found that Dr. Rob Joseph Kamermans committed an act of professional misconduct, in that: 1) he has failed to maintain the standard of practice of the profession; 2) 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; 3) the governing body of a health profession in a jurisdiction other than Ontario has found that Dr. Kamermans committed an act of professional misconduct that would, in the opinion of the panel of the Discipline Committee holding this hearing, be an act of professional misconduct; and, 4) the governing body of a health profession in a jurisdiction other than Ontario has made a finding of professional misconduct or a similar finding against Dr. Kamermans, and the finding is based on facts which would be an act of professional misconduct.
Dr. Kamermans is a family physician who had a practice in Coe Hill, Ontario.
Failing to Maintain the Standard of Practice
In October, 2013, the College received a letter of complaint expressing concern about Dr. Kamermans’ prescribing of narcotics and controlled substances. The College retained a medical expert, who reviewed the standard of care provided by Dr. Kamermans. Upon review of twenty- five of Dr. Kamerman’s patient charts, the medical expert reported that eleven out of twenty-five patient charts were deficient with respect to narcotic prescribing and the medical records in all the files were disorganized. Dr. Kamermans admitted to not reviewing his patients' old files, which resulted in him overlooking some crucial pieces of information.
The medical expert noted that the control over who and what was prescribed often seemed to be in the hands of the patients, and not Dr. Kamermans’. Also, that by failing to maintain tight prescribing boundaries in patients with current or prior addictions, both the patients and their communities were placed at risk.
Noting that during their interview Dr. Kamermans commented, “we are not the police”, the medical expert emphasized in her report that the application of universal precautions in opiate prescribing is crucial, given that it is not possible to always know what patients may be doing with their medications and that despite Dr. Kamerman’s best intentions, safety was compromised by his benzodiazepine, hypnotic, and opioid prescribing practices.
In an addendum to her report dated March 9, 2015, the medical expert reiterated her concerns with respect to Dr. Kamerman’s prescribing of controlled substances and confirmed her opinion that his medical records were “inadequate”.
Failing to Notify Other Jurisdictions of Action Taken by Discipline Committee
On February 27, 2013, the Discipline Committee found that Dr. Kamermans committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession.Among other things, the Committee ordered and directed that Dr. Kamermans be reprimanded and imposed terms, conditions and limitations on Dr. Kamermans’ certificate of registration.
In March 2014, the Disciplinary Subcommittee of the Michigan Medical Board (the “Michigan Medical Board”) found that Dr. Kamermans violated the Public Health Code by failing to notify it, within 30 days, of the action taken by the Discipline Committee on February 27, 2013. As a result, the Michigan Medical Board imposed terms, conditions and limitations on Dr. Kamermans’ licence in Michigan, and ordered that he pay a fine.
In January, 2015, the New Mexico Medical Board made an order reprimanding Dr. Kamermans for failing to make a timely report of the action taken by the Discipline Committee of this College on February 27, 2013 and failure to report the action taken by the Michigan Medical Board in April 2014, and imposed conditions on his licence in New Mexico.
Penalty
The following facts were presented during the penalty portion of the hearing:
Preceptorship and Reassessment arising out of 2013 Discipline Committee Order
As part of the Discipline Committee’s Order dated February 27, 2013, Dr. Kamermans was required to undergo a one-year preceptorship, followed by a Comprehensive Practice Assessment by an assessor or assessors appointed by the College. Dr. Kamermans completed the practice preceptorship between April, 2013 and February, 2014 and then underwent the Comprehensive Practice Assessment. In her report dated March 31, 2015 the College assessor who conducted the Comprehensive Practice Assessment identified a number of concerns with respect to Dr. Kamermans' family medicine practice and made the following recommendations:
- continue chart review to address issues
- CME regarding management of patients with chronic diseases
- CME regarding current Canadian Screening Guidelines
- CME regarding Immunizations
- CME regarding guidelines for care of infants and children
- CME regarding Osteoporosis
- CME regarding Menopause
- Equipping office to deal with medical emergencies
- Adopting procedure recommended by CMPA for firing patients in practice.
Discipline Committee Decision Resulting in Revocation
On November 7, 2014, the Discipline Committee found that Dr. Kamermans committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession.The Committee also found that Dr. Kamermans is incompetent. Dr. Kamermans failed to maintain the standard of practice of the profession in his care and treatment in the Emergency Department of six patients and in his medical documentation regarding nine patients. Dr. Kamermans’ deficiencies in his care and treatment of the six patients displayed a lack of knowledge and judgment of a nature and to an extent that the allegation of incompetence was proved. The Committee ordered and directed that:
- The Registrar revoke Dr. Kamermans’ certificate of registration;
- Dr. Kamermans appear before the Committee to be reprimanded; and
- Dr. Kamermans pay costs to the College in the amount of $28,098.00.
On August 24, 2016, Dr. Kamermans appealed the Discipline Committee’s decision to the Divisional Court of the Ontario Superior Court of Justice.
Inquiries, Complaints and Reports Committee Caution – 2013
In September, 2013, the Inquiries, Complaints and Reports Committee cautioned Dr. Kamermans about offering appropriate analgesics and arranging proper follow-up treatment.
Disposition
On July 25, 2017, the Discipline Committee reserved its decision on penalty. On September 25, 2017, the Discipline Committee ordered and directed on the matter of penalty and costs that:
- The Registrar revoke Dr. Kamermans’ certificate of registration, effective immediately.
- Dr. Kamermans appear before the panel to be reprimanded.
- Dr. Kamermans pay costs to the College in the amount of $5,500.00 within thirty (30) days of the date this Order becomes final.
On October 16, 2017, Dr. Kamermans appealed the penalty decision of the Discipline Committee to the Superior Court of Justice (Divisional Court). Pursuant to s. 25(1) of the Statutory Powers Procedure Act, the appeal operated to stay the penalty decision of the Discipline Committee pending the outcome of the appeal. The Discipline Committee revoked Dr. Kamermans’ certificate of registration on July 26, 2016 in relation to a previous hearing. Therefore, Dr. Kamermans’ registration status remains “Revoked: Discipline Committee.”
On November 8, 2018, the Divisional Court dismissed Dr. Kamermans’ appeal for delay.
Decision: Download Full Decision (PDF)
Appeal: Appeal Dismissed
Appeal Decision Date: 2018-11-8
Hearing Date(s): July 25, 2017
Committee: Discipline
Decision Date: 07 Nov 2014
Summary:
On November 7, 2014, the Discipline Committee found that Dr. Rob Joseph Kamermans committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession. The Committee also found that Dr. Kamermans is incompetent.
Dr. Kamermans failed to maintain the standard of practice of the profession in his care and treatment in the Emergency Department of six patients (Patients 1 to 6) and in his medical documentation regarding nine patients (Patients 1 to 6, 12, 14, and 22). Dr. Kamermans’ deficiencies in his care and treatment of the six patients displayed a lack of knowledge and judgment of a nature and to an extent that the allegation of incompetence was proved.
Regarding Patient #1, a child who presented with fever, stomach ache and vomiting, Dr. Kamermans failed to maintain the standard of practice in his documentation and care. Dr. Kamermans failed to do an ultrasound to rule out appendicitis, a significant differential diagnosis, and was deficient in his assessment and treatment of what he described as pharyngitis. Dr. Kamermans’ deficiencies in his care of this patient displayed a lack of knowledge and judgment.
Regarding Patient #2, an adult patient with rectal bleeding, rectal pain and a recent diagnosis of metastatic rectal cancer, Dr. Kamermans’ documentation and care failed to meet the standard of practice. Dr. Kamermans failed to properly evaluate the rectal bleeding and failed to adequately manage the rectal pain. Dr. Kamermans displayed a lack of knowledge and judgment in his investigation and management of the patient and in his inability to outline his approach to this patient.
Regarding Patient #3, an elderly patient with chest tightness, intermittent shortness of breath for the preceding twelve hours, heart rate of 162 and an implanted pacemaker/defibrillator, Dr. Kamermans diagnosed supraventricular tachycardia (SVT), rather than the correct diagnosis of ventricular tachycardia (VT), and prescribed Diltiazem, a medication which was contraindicated for this patient. When his treatment failed and the patient’s symptoms worsened, Dr. Kamermans called in a consultant who properly treated the patient. The Committee found that Dr. Kamermans’ care and documentation for this patient failed to meet the standard of practice and that he displayed a lack of judgment and a cavalier attitude considering the urgency of the situation. The Committee found that Dr. Kamermans demonstrated a lack of knowledge and judgment that the evidence established persists to the present day.
Regarding Patient #4, a child with respiratory distress, shortness of breath, a slightly dusky appearance and moderate to severe croup, Dr. Kamermans’ care of this patient failed to meet the standard of practice both in terms of documentation and treatment of this sick child. Dr. Kamermans used medication that was not helpful for croup and was not up to date with the current medication standards. The Committee found that Dr. Kamermans demonstrated a lack of knowledge and judgment with regard to the treatment of croup and that his knowledge deficits are current.
Regarding Patient #5, a child who was brought to Emergency with a history of possible antifreeze ingestion, Dr. Kamermans failed to maintain the standard of practice and was cavalier in the treatment of this patient. Dr. Kamermans appropriately obtained information from the Poison Control Centre but did not use it. He failed to order the recommended blood work, he failed to order an adequate observation period, and he assumed the child had not ingested much without any grounds to make that assumption, and he failed to appreciate the serious risk to the child of ingesting even a small amount. It was the Committee’s view that Dr. Kamermans’ knowledge and judgment deficiencies persist with respect to how to properly address the issue of the ingestion of antifreeze by a child.
Regarding Patient #6, an elderly patient with dementia who presented to the Emergency after an unwitnessed fall, Dr. Kamermans failed to maintain the standard of practice in his investigation, evaluation and documentation. The Committee found Dr. Kamermans’ investigation of the causal factors rudimentary. Although he said his physical examination of the heart would rule out some cardiac causes, he did not do an ECG, which would have been indicated. Similarly, he did not do further x-rays or a CT scan of the neck, which was indicated by Canadian standards. The Committee found Dr. Kamermans’ knowledge and judgment in the care of this patient deficient, and that those deficiencies are current.
***PENALTY***
On July 26, 2016, the Committee ordered and directed that:
- The Registrar revoke Dr. Kamermans’ certificate of registration at 11:59 p.m. on the date of this Order.
- Dr. Kamermans appear before the Committee to be reprimanded within 3 months of the date that this Order becomes final.
- Dr. Kamermans pay costs to the College in the amount of $28,098.00 within 6 months of the date that this Order becomes final.
APPEAL
On August 24, 2016, Dr. Kamermans appealed the Discipline Committee’s decision to the Divisional Court of the Ontario Superior Court of Justice.
On February 9, 2018, the Divisional Court dismissed the appeal. Therefore, the decision of the Discipline Committee remains in effect.
Decision: Download Full Decision (PDF)
Appeal: Appeal Dismissed
Appeal Decision Date: 2018-02-09
Hearing Date(s): June 2-6, June 16, 2014; January 18-20, 2016 (Penalty)
Committee: Discipline
Decision Date: 27 Feb 2013
Summary:
On February 27, 2013, the Discipline Committee found that Dr. Rob Joseph Kamermans committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession. Dr. Kamermans admitted the allegation.
Dr. Kamermans is a family physician. In the course of a s.75(b) investigation into Dr. Kamermans' practice, the College's expert opined that Dr. Kamermans failed to maintain the standard of practice in his care and treatment of 21 of the 25 patients under review. Among other concerns, the expert expressed the following concerns regarding Dr. Kamermans's standard of practise:
(a) Inadequate medical record keeping, including absence of a Cumulative Patient Profile, medical history and family history, and failure to record examinations, vital signs, test results, patient complaints, medications and treatment plan;
(b) Improper use of Cerumex and irrigation as treatment for a pimple in a patient's ear;
(c) Inadequate follow up on a patient's elevated cholesterol and triglycerides;
(d) Failure to follow up on a patient following a decrease in her pain medication;
(e) Failure to follow up with a patient following a prescription of Crestor;
(f) Inadequate investigation and treatment of on-going hypertension in multiple patients, and failure to make an urgent referral to a cardiologist or emergency department in the face of a patient's hypertensive crises;
(g) Inadequate management of Type II Diabetes;
(h) Inadequate management of hypercholesterolemia in multiple patients;
(i) Failure to follow up on lab results showing abnormal haemoglobin, creatinine and GFR levels;
(j) Failure to document dosages of medication; and
(k) Failure to document a cardiovascular risk analysis where indicated.
Since May, 2012, Dr. Kamermans has practised under the supervision of a Clinical Supervisor. According to the Clinical Supervisor, Dr. Kamermans has been compliant and cooperative in fulfilling the requirements of the supervision agreement.
The Committee ordered and directed that:
" Dr. Kamermans attend before this panel to be reprimanded.
" the Registrar impose the following terms, conditions and limitations on Dr. Kamermans' certificate of registration:
(i) Dr. Kamermans shall undergo a preceptorship for a duration of one year (the "Preceptorship") under the supervision of a preceptor acceptable to the College (the "Preceptor"). The Preceptor shall sign an Undertaking in the form attached to the Order as Appendix "A", and the Preceptorship shall include monthly chart reviews of 25 patient charts, selected by the Preceptor in his/her sole discretion, monthly meetings for discussion of any concerns and recommendations of the preceptor, and monthly reports to the College by the Preceptor;
(ii) Effective as of the date of this Order, and until such time as Dr. Kamermans has completed the Preceptorship, Dr. Kamermans shall practise only under the supervision of his College-approved Preceptor. If Dr. Kamermans' Preceptor is, at any time, unwilling or unable to continue to fulfill the terms of the Order and Appendix "A" [to the Order], Dr. Kamermans shall, within ten (10) days, obtain an Undertaking in the same form from a person who is acceptable to the College, failing which Dr. Kamermans shall immediately cease practice until this requirement is satisfied;
(iii) Following the completion of the Preceptorship, Dr. Kamermans shall undergo a Comprehensive Practise Assessment by an assessor or assessors appointed by the College (the "Assessor(s)");
(iv) Dr. Kamermans shall abide by any and all recommendations of his Preceptor(s), and the Assessor(s), including with respect to any practice improvements and/or ongoing professional development and/or education;
(v) Dr. Kamermans shall be solely responsible for all fees, costs and expenses associated with his compliance with the terms of the Order.
" Dr. Kamermans pay costs to the College in the amount of $3,650.00 within 30 days of the date of this Order.
Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): February 27, 2013