News Release

2014 - 04 - 29 Discipline Committee Decisions

Dr. Awad I. Awad, Oakville

Apr 29, 2014

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 Doctor Search section of the College’s website at www.cpso.on.ca.

Dr. Awad I. Awad, Oakville. On April 4, 2014, the Discipline Committee found that Dr. Awad committed acts of professional misconduct, in that he failed to maintain the standard of practice of the profession in respect to his care of 13 sleep medicine patients; and he engaged in disgraceful, dishonourable or unprofessional conduct in relation to his OHIP billing for sleep medicine consultations.

Dr. Awad is a psychiatrist, practising sleep medicine. He is a diplomate of the American Board of Sleep Medicine.

The independent expert retained by the College opined that Dr. Awad failed to maintain the standard of practice with respect to 12 of 15 patient charts reviewed. Examples of concerns include:

  1. He routinely directed nasal Continuous Positive Airway Pressure (CPAP) pressure titration studies after the patients had undergone sleep studies without having seen and evaluated the patients in question.
  2. A patient had received immovane (5 mg) prior to CPAP titration study, without a physician assessment or clear physician's order. On the basis of severe obstructive sleep apnea and information provided by the family doctor in the patient's referral form, the patient could be seen to be at risk of hypoventilation and excessive daytime somnolence.
  3. In one instance, he signed an Assisted Devices Program (ADP) form for the use of nasal CPAP prior to having seen the patient in consultation.
  4. He, through his staff in the use of form letters, influenced patients to return to his clinic for follow-up studies, by indicating that the patient's condition was reportable to the Ministry of Transportation in case of lack of compliance to treatment recommendations. Such communications were made even in instances when patients were not documented to have excessive daytime somnolence or worrisome driving-related problems. The expert opined that these letters were inappropriate and coercive.
  5. e) He has delegated tasks to non-physician members of his staff inappropriately. A discussion of diagnosis and treatment cannot be made by telephone by unqualified clerical and technical staff.

In response to the concerns identified by the expert, Dr. Awad has changed his practice.

Regarding a complaint by Patient A, the independent expert opined that Dr. Awad failed to maintain the standard of practice as follows:

  1. His letter to Patient A's family physician provides evidence that the clinic was predisposed to CPAP therapy before patients had been seen by a sleep physician;
  2. His records of care show that he misinformed the referring physician by declaring Patient A to have a condition reportable to the Ministry of Transportation, before the patient had been seen or assessed by a sleep physician.

Regarding the finding of disgraceful, dishonourable and unprofessional conduct, Dr. Awad's office had billed OHIP for consultations, listing Dr. X as the referring physician in relation to 29 patients. Dr. X indicated that he does not and never has referred patients to Dr. Awad and that he has no record of having seen any of these 29 patients.

The Discipline Committee ordered a public reprimand and a three-month suspension of Dr. Awad’s certificate of registration, to commence immediately. Furthermore, the following terms, conditions and limitations are imposed on his certificate of registration:

  1. Dr. Awad, at his own expense, shall submit to an assessment of his practice by an assessor selected by the College within six months of the date of this order. The assessor shall focus the assessment upon the deficiencies identified in the review of Dr. Awad's practice and shall additionally consider Dr. Awad's performance as Quality Advisor as referenced in the Independent Health Facilities Act, Ontario Regulation 57/92.
  2. Dr. Awad shall abide by all reasonable recommendations of the assessor.

Dr. Awad was further ordered to pay to the College costs in the amount of $4,460.