News Release

Discipline Committee Decisions

Dr. Rob J. Kamermans; Dr. Eleazar H. Noriega; Dr. Michael G. Sumner

Mar 27, 2013

The College of Physicians and Surgeons of Ontario (“the College”) released the results of its most recent disciplinary hearings. The College is the licensing and disciplinary body for physicians in Ontario. Hearings are held to review allegations of professional misconduct and incompetence, and are open to the public. The following are brief summaries of recent discipline hearing results. The Discipline Committee’s full decisions and reasons for decisions are posted on the College’s website as they become available. Full decisions are located by entering the doctor’s name in the Public Register Info section of the College’s website under All Doctors Search.

Dr. Rob J. Kamermans, Coe Hill. 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. Dr. Kamermans admitted to 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:

  1. 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;
  2. Improper use of Cerumex and irrigation as treatment for a pimple in a patient's ear;
  3. Inadequate follow up on a patient's elevated cholesterol and triglycerides;
  4. Failure to follow up on a patient following a decrease in her pain medication;
  5. Failure to follow up with a patient following a prescription of Crestor;
  6. 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;
  7. Inadequate management of Type II Diabetes;
  8. Inadequate management of hypercholesterolemia in multiple patients;
  9. Failure to follow up on lab results showing abnormal haemoglobin, creatinine and GFR levels;
  10. Failure to document dosages of medication; and
  11. 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 a public reprimand, and directed the Registrar to impose the following terms, conditions and limitations on Dr. Kamermans' certificate of registration:

  1. Dr. Kamermans shall undergo a preceptorship for a duration of one year under the supervision of a preceptor acceptable to the College. 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;
  2. 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, Dr. Kamermans shall, within 10 days, obtain another preceptor who is acceptable to the College, failing which Dr. Kamermans shall immediately cease practice until this requirement is satisfied;
  3. Following the completion of the preceptorship, Dr. Kamermans shall undergo a comprehensive practise assessment by an assessor or assessors appointed by the College;
  4. 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;
  5. Dr. Kamermans shall be solely responsible for all fees, costs and expenses associated with his compliance with the terms of the Order.

Dr. Kamermans was further ordered to pay the College costs in the amount of $3,650.

Dr. Eleazar H. Noriega, Toronto. On February 28, 2013, the Discipline Committee found that Dr. Noriega committed an act of professional misconduct, in that he has engaged in disgraceful, dishonourable or unprofessional conduct.

In 2009, Dr. Noriega was referred to the Discipline Committee for allegations, including sexual abuse and sexual impropriety. On July 22, 2009, Dr. Noriega entered into an undertaking with the College and undertook, among other things, not to engage in any professional encounters with female patients except in the presence of his practice monitor. He undertook to post a sign in his waiting room and in each of his examination rooms notifying the public of this practice restriction. Dr. Noriega's practice monitor also entered into an undertaking on July 22, 2009. It required the practice monitor to be present for all of Dr. Noriega's professional encounters with female patients.

Dr. Noriega engaged in professional misconduct based on the following failures to comply with his undertaking:

  • Dr. Noriega failed to post the required sign in the waiting room, which includes the obligation to take reasonable steps to ensure that the sign remains posted;
  • Dr. Noriega failed to post the required sign in an examination room, including covering up the required sign with a framed picture;
  • Dr. Noriega failed to have a chaperone present throughout the entirety of his patient encounters between July 2009 and February 2010; and
  • Dr. Noriega misled the College's compliance investigator in February 2010 when he told her that he doesn't see female patients in the consultation room.

A penalty hearing is yet to be scheduled.

Dr. Michael G. Sumner, Mississauga. On March 4, 2013, the Discipline Committee found that Dr. Sumner committed an act of professional misconduct, in that he has failed to maintain the standard of practice of the profession. Dr. Sumner admitted to the allegation.

Dr. Sumner is a psychiatrist. An expert retained by the College reviewed Dr. Sumner's care of 15 patients and concluded that he failed to maintain the standard of practice in his care and treatment of four of them. The expert found some aspects of Dr. Sumner's practice to be commendable, and noted that he was a well-intentioned psychiatrist who has a real sense of advocacy on behalf of his patients. However, he had a number of concerns regarding Dr. Sumner's care of certain patients, including the following:

  1. The lack of documentation of any cognitive testing in certain patients for whom Dr. Sumner had made a diagnosis of brain injury with cognitive deficits;
  2. made diagnoses of brain injury where there was no clear or compelling evidence to support the diagnosis;
  3. provided treatment to certain patients that did not follow from the diagnosis made;
  4. charts failed to explore/document certain patients' presenting problem or chief complaint;
  5. failed to recognize that deficits in attention and concentration are not specific to an acquired brain injury but are also a core feature of affective disorders; and
  6. did not provide certain patients with standard pharmacotherapy for their depression, anxiety and psychosis.

The expert noted that Dr. Sumner's below standard care in the four charts identified resulted in his patients being exposed to the following risks:

  • Patients were exposed unnecessarily to psychotropic medications, specifically anticonvulsants, psychostimulants and cholinesterase inhibitors. However, there is no evidence from the charts reviewed that any significant harm or injury resulted from this unnecessary exposure;
  • Dr. Sumner failed to provide standard treatment, or provided inadequate treatment, of certain patients' underlying serious mental illness such as major depression, anxiety and psychosis, thus prolonging patients' suffering and increasing the risk of consequences as a result of the untreated underlying illness. However, there was no evidence that any serious permanent harm occurred; and
  • One patient's psychotic symptoms were extremely likely to have been precipitated and perpetuated by Dr. Sumner's clinical care.

An expert retained by Dr. Sumner opined on Dr. Sumner's use of topiramate and concluded that although Dr. Sumner employs topiramate earlier in the treatment algorithm than would be considered common practice by most practitioners and treatment guidelines, it is not outside of the realm of reasonableness to consider topiramate in the context in which he was using it.

Dr. Sumner's practice has been subject to supervision since June of 2011. The reports of the supervisor have noted improvements in Dr. Sumner's practice. The three most recent reports have concluded that patient care and record keeping is now meeting the standard of care.

In January of 2007, Dr. Sumner was found by the Discipline Committee, based on an agreed statement of facts, to have failed to maintain the standard of practice. He was reprimanded and required to practise under supervision which terminated in July of 2009.

The Discipline Committee ordered a three-month suspension of Dr. Sumner's certificate of registration, and directed the Registrar to impose a number of terms, conditions and limitations on his certificate of registration, including:

  1. Dr. Sumner may practise only under the supervision of a College-approved clinical supervisor, who will meet once a month with Dr. Sumner and review 10 of his patient charts and all of his charts for new patients, including a review and approval of all clinical treatment plans and of the psychopharmacology proposed by Dr. Sumner. The clinical supervisor will report to the College a minimum of once every three months;
  2. If the clinical supervisor is unable or unwilling to continue to fulfill its terms, Dr. Sumner shall, within 20 days, obtain a similarly qualified clinical supervisor who is acceptable to the College;
  3. If Dr. Sumner is unable to obtain a College-approved supervisor, he must cease practising medicine immediately until such time as he has obtained a clinical supervisor acceptable to the College.
  4. If, after a minimum of one year from the date of this Order, the clinical supervisor recommends a reduction in the frequency of their meetings, and if the College pre-approves of the recommendation, the frequency of the monitoring may be reduced;
  5. Dr. Sumner will abide by all recommendations of his clinical supervisor;
  6. Dr. Sumner may bring a motion to vary the terms of his supervision no earlier than three years after the date of this Order;
  7. Dr. Sumner will be responsible for all costs associated with the implementation of this Order.

Dr. Sumner was further ordered to pay the College costs in the amount of $14,600.