Zadra, Joseph Antonio (CPSO#: 52584)

Current Status: Active Member as of 29 Aug 2017

CPSO Registration Class: Restricted as of 17 Apr 2017

Indicates a concern or additional information

Summary

Former Name: No Former Name

Gender: Male

Languages Spoken: English, French, Italian, Spanish

Education:McGill University, 1983

Practice Information

Primary Location of Practice
Suite 202
1 Quarry Ridge
Barrie ON  L4M 7G1
Phone: (705) 726-8281
Fax: (705) 726-8320
Electoral District: 05
View Professional Corporation Information

Professional Corporation Information

Corporation Name: Joseph A. Zadra Medicine Professional Corporation

Certificate of Authorization Status: Issued Date:  Sep 17 2003

Shareholders:
Dr. J. Zadra ( CPSO# 52584 )

Business Address:
Royal Court Medical Centre
Suite 202
1 Quarry Ridge Road
Barrie ON  L4M 7G1
Phone Number: (705) 726-8281

Hospital Privileges

Hospital Location
Royal Victoria Regional Health Centre Barrie

Specialties

Specialty Issued On Type
Urology Effective: 16 Nov 1988 RCPSC Specialist

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 13 Jun 1983
Transfer of class of registration to: Independent Practice Certificate Effective: 23 Aug 1984
Transfer of class of certificate to: Restricted certificate Effective: 17 Apr 2017
Terms and conditions imposed on certificate by Discipline Committee Effective: 17 Apr 2017
Suspension of registration imposed: Discipline Committee Effective: 29 May 2017
Suspension of registration removed Effective: 29 Aug 2017

Practice Restrictions

Imposed By Effective Date Expiry Date Status  
Discipline Committee Effective: 17 Apr 2017 Active View Details [+]
            As from 11:59 p.m., April 17, 2017, by order of the Discipline Committee of the
            College of Physicians and Surgeons of Ontario, the following terms, conditions
            and limitations are imposed on the certificate of registration held by Dr.
            Joseph Antonio Zadra:

            Instruction in medical ethics

            (i)   At his own expense and within twelve (12) months of the date of this
                  Order, Dr. Zadra shall participate in and successfully complete
                  individualized instruction in medical ethics satisfactory to the College,
                  with an instructor selected by the College.  The instructor shall provide
                  a summative report to the College including his or her conclusion about
                  whether the instruction was completed successfully by Dr. Zadra.

            Medical record-keeping

            (ii)  At his own expense and within twelve (12) months of the date of this
                  Order, Dr. Zadra shall participate in and successfully complete a
                  record-keeping course acceptable to the College, and provide proof of
                  completion thereof to the College;

            Clinical Supervision

            (iii) At his own expense and within thirty (30) days of this Order, Dr. Zadra
                  shall retain a Clinical Supervisor approved by the College, who will sign
                  an undertaking in the form attached to this Order as Schedule "A";

            (iv)        For a period of six (6) months commencing from the date Dr. Zadra
                        resumes practice following the suspension of his certificate of
                        registration described in paragraph 2, Dr. Zadra may practise only
                        under the supervision of the Clinical Supervisor ("Clinical
                        Supervision");

            (v)   Clinical Supervision of Dr. Zadra's practice shall contain the following
                  elements:

                  (a)   Review, on a monthly basis, operating room dictations and notes in
                        a minimum of twenty-five (25) patient charts, to be selected at the
                        sole discretion of the Clinical Supervisor, along with the
                        corresponding OHIP claims submissions;
                  
                  (b)   Discuss with Dr. Zadra any concerns the Clinical Supervisor may
                        have arising from the chart reviews;
                  
                  (c)   make recommendations to Dr. Zadra for practice improvements and
                        ongoing professional development, and inquire into Dr. Zadra's
                        compliance with the recommendations; 
                  
                  (d)   the Clinical Supervisor will keep a log of all patient charts
                        reviewed along with patient identifiers; and
                  
                  (e)   the Clinical Supervisor will provide reports to the College on a
                        bi-monthly basis for the six (6) month period of practice
                        monitoring, or more frequently if the Clinical Supervisor has
                        concerns about Dr. Zadra's standard of practice or conduct.
                  
            (vi)  Throughout the period of Clinical Supervision, Dr. Zadra shall abide by
                  the recommendations of the Clinical Supervisor;

            (vii) If a clinical supervisor who has given an undertaking as set out in
                  Schedule "A" to this Order is unable or unwilling to continue to fulfill
                  its terms, Dr. Zadra shall, within twenty (20) days of receiving notice
                  of same, obtain an executed undertaking in the same form from a person
                  who is acceptable to the College and ensure that it is delivered to the
                  College within that time;

            (viii)If Dr. Zadra is unable to obtain a clinical supervisor in accordance with
                  paragraph (vii) of this Order, he shall cease to practice until such time
                  as he has done so;

            (ix)  Dr. Zadra shall consent to the disclosure by his Clinical Supervisor to
                  the College, and by the College to his Clinical Supervisor, of all
                  information the Clinical Supervisor or the College deems necessary or
                  desirable in order to fulfill the Clinical Supervisor's undertaking and
                  Dr. Zadra's compliance with this Order;

            (x)   Dr. Zadra shall inform the College of each and every location where he
                  practices including but not limited to hospital, clinics and offices, in
                  any jurisdiction (collectively his "Practice Location(s)), within fifteen
                  (15) days of this order and shall inform the College of any new Practice
                  Locations within fifteen (15) days of commencing practice at that
                  location, for the purposes of monitoring his compliance with this Order;

            (xi)  Dr. Zadra shall submit to, and not interfere with, unannounced
                  inspections of his Practice Locations(s) and patient records by a College
                  representative, for the purposes of monitoring his compliance with this
                  Order;

            (xii) Dr. Zadra shall consent to the monitoring of his OHIP billings and
                  cooperate with inspections of his practice, his patient charts and his
                  OHIP billings by his Clinical Supervisor and College representatives for
                  the purpose of monitoring his compliance with the terms of this Order;

            (xiii)Dr. Zadra shall provide consent to the College to make appropriate
                  enquiries of OHIP, for a period of one (1) year after he resumes practice
                  following the suspension of his certificate of registration described in
                  paragraph 2, for the purpose of monitoring his compliance with the terms
                  of this Order; and

            (xiv) Dr. Zadra shall be responsible for any and all costs associated with
                  implementing this Order.

Previous Discipline Hearings

Committee: Discipline
Decision Date: 17 Apr 2017
Summary:

On April 17, 2017, the Discipline Committee found that Dr. Zadra committed an act of 
professional misconduct 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. Zadra is a staff urologist at the Royal Victoria Regional Health Centre (RVH) in Barrie, 
Ontario. Dr. Zadra received his certificate of registration authorizing independent practice in 
Ontario in 1984 and his specialist qualification in urology in 1988. Dr. Zadra has maintained his 
privileges at the RVH throughout the College investigation, described below, to the present.  
 
In March 2014, the College received a complaint indicating that Dr. Zadra had been dictating 
operative reports that did not accurately reflect the work he had done. No patient harm was 
reported as a result of this practice.  
 
RVH INVESTIGATION 
 
RVH conducted a review of a portion of Dr. Zadra’s work, which revealed that Dr. Zadra 
inaccurately recorded the names of certain procedures that he performed.  
 
Specifically, Dr. Zadra indicated that he performed a procedure named “cystometrogram” or 
“water cystometrogram”, while RVH had not had a functioning cystometrogram machine for at 
least several years. In addition, Dr. Zadra dictated that he performed a “urethrotomy” in three 
cases, when RVH did not have a pediatric urethrotome and this procedure should have been 
recorded as a “meatotomy”. Furthermore, in one case, Dr. Zadra dictated that he performed a 
procedure using a urethrotome under local anesthetic, which is considered to be an unusual 
practice as the urethrotome is only used in the operating room at RVH. Also, the operating room 
nursing staff indicated that Dr. Zadra’s dictation of the particular size of sutures he used while 
performing hernia repair on a patient were not in fact used according to the surgical count.  
 
COLLEGE INVESTIGATION 
 
The College retained an expert in urology and oncology, who opined that while Dr. Zadra’s 
practice did not expose patients to harm, there were some planned or proposed procedures that 
could have exposed patients to potential harm if they had been carried out.  
 
In addition, similarly to the results of the RVH investigation, the expert reported concerns with 
Dr. Zadra’s record keeping, documentation and description of the procedures performed, 
including the “semantics and labeling of the procedures actually performed.”  
 
The expert noted that for five patients, Dr. Zadra dictated that he performed a “water 
cystomerogram”, while he later admitted in his interview with the expert that the Ambulatory 
Care Unit at RVH did not have a functioning cystometrogram machine. It was noted, that in one 
case of a circumcision of an 8-year old boy, Dr. Zadra failed to dictate issues that should have 
been documented, such as pre- and post-operative urine stream. In another case, Dr. Zadra 
dictated a procedure of “hernia repair with multiple 2-0 and 3-0 Vicryl sutures” that did not 
correspond to the operating room nurses’ suture count. The discrepancy was that 3-0 sutures 
were in fact used. In two other cases, Dr. Zadra dictated that he performed a “urethrotomy”, 
when he should have dictated it as a “meatotomy”. It was also revealed that in two cases, Dr. 
Zadra amended his dictated note to different procedures than he had initially recorded.  
 
The expert further opined that in a number of patient charts, the description of the procedures 
actually performed was inaccurate, leading to inaccurate and/or questionable claims submissions 
to OHIP. Although the amounts were small, a number of fee codes were billed in error due to the 
inaccurate description of procedures performed.  
 
For example, for several patients, Dr. Zadra had billed the OHIP code, which covers “pelvis 
limited study other than pregnancy” done by ultra-sound and was paid at $21.95. In his interview 
with the expert, Dr. Zadra stated that in fact he had carried out a “post-void residual urine 
measurement”, which should have been billed at the rate of $12.70. Another example was billing 
an OHIP Code for what was dictated as a “water cystometrogram”, when the procedure was not 
in fact performed on several patients.  
 
On April 17, 2017, the Committee ordered and directed on the matter of penalty and costs that: 
 
-  The Registrar suspend Dr. Zadra’s certificate of registration for a period of three (3) months; 
    
-  The Registrar  impose the following terms, conditions and limitations on Dr. Zadra’s 
   Certificate of Registration: 
 
      Instruction in medical ethics 
      (i) At his own expense and within twelve (12) months of the date of this Order, Dr. 
          Zadra shall  participate  in  and  successfully  complete  individualized  instruction  in 
          medical  ethics  satisfactory  to  the  College,  with  an  instructor  selected  by  the 
          College.  The instructor shall provide a summative report to the College including 
          his or her conclusion about whether the instruction was completed successfully by 
          Dr. Zadra. 
           
      Medical record-keeping 
      (ii) At his own expense and within twelve (12) months of the date of this Order, Dr. 
          Zadra shall  participate  in  and  successfully  complete  a  record-keeping  course 
          acceptable to the College, and provide proof of completion thereof to the College; 
           
      Clinical Supervision 
      (iii) At his own expense and within thirty (30) days of this Order, Dr. Zadra shall retain 
          a Clinical Supervisor approved by the College, who will sign an undertaking in the 
          form attached to this Order as Schedule “A”; 
      (iv)  For  a  period  of  six  (6)  months  commencing  from  the  date  Dr.  Zadra  resumes 
          practice  following  the  suspension  of  his  certificate  of  registration  described  in 
          paragraph  2,  Dr.  Zadra  may  practise  only  under  the  supervision  of  the  Clinical 
          Supervisor (“Clinical Supervision”);   
      (v) Clinical Supervision of Dr. Zadra’s practice shall contain the following elements: 
          (a)  Review,  on  a  monthly basis,  operating  room  dictations  and  notes  in  a 
               minimum  of  twenty-five  (25)  patient  charts,  to  be  selected  at  the  sole 
               discretion  of  the  Clinical  Supervisor,  along  with  the  corresponding  OHIP 
               claims submissions; 
          (b)  Discuss with Dr. Zadra any concerns the Clinical Supervisor may have arising 
               from the chart reviews; 
          (c)  make recommendations to Dr. Zadra for practice improvements and ongoing 
               professional development, and inquire into Dr. Zadra’s compliance with the 
               recommendations;  
          (d)  the Clinical Supervisor will keep a log of all patient charts reviewed along 
               with patient identifiers; and 
          (e)  the Clinical  Supervisor will provide reports to  the College on  a bi-monthly 
               basis for the six (6) month period of practice monitoring, or more frequently if 
               the Clinical Supervisor has concerns about Dr. Zadra’s standard of practice or 
               conduct. 
      (vi)  Throughout  the  period  of  Clinical  Supervision,  Dr.  Zadra  shall  abide  by  the 
            recommendations of the Clinical Supervisor; 
      (vii) If a clinical supervisor who has given an undertaking as set out in Schedule “A” 
            to this Order is unable or unwilling to continue to fulfill its terms, Dr. Zadra shall, 
            within  twenty  (20)  days  of  receiving  notice  of  same,  obtain  an  executed 
            undertaking in the same form from a person who is acceptable to the College and 
            ensure that it is delivered to the College within that time; 
      (viii) If Dr. Zadra is unable to obtain a clinical supervisor in accordance with paragraph 
            (vii) of this Order, he shall cease to practice until such time as he has done so; 
      (ix)  Dr. Zadra shall consent to the disclosure by his Clinical Supervisor to the College, 
            and  by  the  College  to  his  Clinical  Supervisor,  of  all  information  the  Clinical 
            Supervisor  or  the  College  deems  necessary  or  desirable in  order  to  fulfill  the 
            Clinical Supervisor’s undertaking and Dr. Zadra’s compliance with this Order; 
      (x)   Dr. Zadra shall inform the College of each and every location where he practices 
            including  but  not  limited  to  hospital,  clinics  and  offices,  in  any  jurisdiction 
            (collectively his “Practice Location(s)), within fifteen (15) days of this order and 
            shall inform the College of any new Practice Locations within fifteen (15) days of 
            commencing  practice  at  that  location,  for  the  purposes  of  monitoring  his 
            compliance with this Order; 
      (xi)  Dr. Zadra shall submit to, and not interfere with, unannounced inspections of his 
            Practice  Locations(s)  and  patient  records  by  a  College  representative,  for  the 
            purposes of monitoring his compliance with this Order; 
      (xii) Dr. Zadra shall consent to the monitoring of his OHIP billings and cooperate with 
            inspections of his practice, his patient charts and his OHIP billings by his Clinical 
            Supervisor  and  College  representatives  for  the  purpose  of  monitoring  his 
            compliance with the terms of this Order; 
      (xiii) Dr. Zadra shall provide consent to the College to make appropriate enquiries of 
            OHIP,  for  a  period  of  one  (1)  year  after  he  resumes  practice  following  the 
            suspension  of  his  certificate  of  registration  described  in  paragraph  2,  for  the 
            purpose of monitoring his compliance with the terms of this Order; and 
      (xiv) Dr. Zadra shall be responsible for any and all costs associated with implementing 
            this Order. 
             
-  Dr. Zadra attend before the Committee to be reprimanded; 
    
-  Dr. Zadra pay costs to the College in the amount of $5,000.00 within thirty (30) days of the 
   date this Order becomes final.

Decision: Download Full Decision (PDF)
Hearing Date(s): April 17, 2017