News Release

2014 - 08 - 29 Discipline Committee Decisions

Dr. Vipul Kumar Bhupal, Dr. Jamal Ali Mohamed Rakem, Dr. Andre Gagnon, Dr. Christiane Farazli,

Aug 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. Vipul Kumar Bhupal, Toronto.  On June 6, 2014, the Discipline Committee found that Dr. Bhupal committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession. Dr. Bhupal admitted to the allegation.

The referral relates to an investigation regarding the appropriateness of Dr. Bhupal's referrals of patients for cardiac testing to a company that rented part of his office space from him.

With respect to Patient A, Dr. Bhupal ordered echocardiograms without appropriate indications, and failed to order a lipid profile to fully assess the patient's cardiovascular risk. Dr. Bhupal further failed to refer the patient to a cardiologist for a nuclear stress test following her echocardiograms and stress echocardiograms, and failed to maintain the standard of practice with respect to record keeping in that his chart lacked adequate means of tracking test results.

With respect to Patient B, Dr. Bhupal ordered multiple echocardiograms and stress echocardiograms without sufficient indication for this patient, even after a cardiologist indicated they were unnecessary. Patient B underwent 12 echocardiograms over a period of five years.

With respect to Patient C, Dr. Bhupal failed to order appropriate laboratory tests and ordered stress echocardiography without indication before conducting an appropriate history and physical exam for this patient who presented with palpitations.

With respect to Patient D, Dr. Bhupal ordered unnecessary repeat echocardiography for this patient, even after consultation with a cardiologist who indicated the following: the cardiologist would be doing repeat tests; he does not believe the pain to be cardiac; and his impression is that there is nothing serious going on. Further, Dr. Bhupal failed to maintain the standard of practice with regard to his record keeping in that his chart contains no details of physical findings or history pertaining to his ordering of echocardiography and stress echocardiography for this patient.

With respect to Patient E, Dr. Bhupal ordered stress echocardiography without appropriate indications in this patient with a two-week history of dizziness with exertion, no chest pain or shortness of breath. There was no blood work, EKG or Holter, which should have been the first steps taken by Dr. Bhupal.
The Discipline Committee ordered a public reprimand and directed the that the following terms, conditions and limitations be imposed on Dr. Bhupal's certificate of registration:

  • Within six months of the date of this Order, Dr. Bhupal shall undergo a comprehensive practice assessment by an assessor(s) appointed by the College.
  • Dr. Bhupal shall abide by any and all recommendations of the assessor(s), including with respect to any practice improvements and/or ongoing professional development and/or education.
  • Dr. Bhupal shall be solely responsible for all fees, costs and expenses associated with his compliance with the terms of this Order. 

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

Dr. Jamal Ali Mohamed Rakem, Welland.  On July 7, 2014, the Discipline Committee found that Dr. Rakem committed an act of professional misconduct, in that he engaged in the sexual abuse of a patient, and that he has engaged in disgraceful, dishonourable or unprofessional conduct. Dr. Rakem admitted to the allegations.

At the time of the incident, Patient A was 18 years old and saw Dr. Rakem in 2011 for a sports injury to her knee. He performed an arthroscopy on Patient A, diagnosing and treating a partial ACL tear. Dr. Rakem saw Patient A for follow up in 2012 with her mother. In the course of an appointment, Dr. Rakem offered to have Patient A watch him operate the next time he was on call at the hospital as she had expressed an interest in attending medical school. Patient A and her mother accepted the offer. A few days later, Dr. Rakem called Patient A, inviting her to come watch some surgeries. Patient A observed Dr. Rakem perform a hip replacement surgery and then accompanied him to another floor to see a patient.  While mounting the stairs, Dr. Rakem patted Patient A on the buttock and chuckled. Patient A said nothing at the time.

Patient A observed Dr. Rakem perform a second surgery. After this surgery, in the evening after office hours, Dr. Rakem invited Patient A to accompany him to his office across the street from the hospital, where he suggested that he give her an anatomy lesson. In doing so, Dr. Rakem had the patient undress down to her t-shirt and underwear, and then touched and stroked her various body parts, including in her pelvic region, while naming the muscle groups. To facilitate this exercise, Dr. Rakem had Patient A lie down on a mattress on the floor of his office while he knelt between her legs. Patient A states that Dr. Rakem asked her to remove her underwear, which she refused to do. At that point, Patient A got up and dressed and told Dr. Rakem that she felt uncomfortable, that it was getting late and that she wished to go home rather than observe another surgery.

The Discipline Committee ordered a public reprimand and directed that Dr. Rakem's certificate of registration be suspended for six months. In addition, a number of terms, conditions and limitations were imposed on Dr. Rakem's certificate of registration, including:

Practice Monitoring - Office Setting

  1. Dr. Rakem shall not engage in any professional encounters with female patients except in the presence of a practice monitor who shall be a member of a regulated health profession, who is acceptable to the College;            
  2. The practice monitor must be present in the examination or consultation room at all times when professional encounters with female patients occur, and must carefully observe, with an unobstructed view, all physical examinations performed by Dr. Rakem on female patients;
  3. The practice monitor is required to maintain a log of all female patient encounters which shall provide the patient’s name, and the purpose and date of the appointment. The practice monitor will sign and date the corresponding entry in the patient's medical record;
  4. Dr. Rakem shall post a sign in each examination and consultation room, as well as the waiting room, that states as follows:

"Dr. Rakem may only have encounters with female patients if a Practice Monitor acceptable to the College of Physicians and Surgeons of Ontario is present in the examination or consultation room."

Practice Monitoring - Hospital Setting

  1. In the case of Dr. Rakem's hospital practice, the practice monitor shall be a member of a regulated health profession who is employed by the hospital where Dr. Rakem has privileges;
  2. The practice monitor must be present for all encounters as in (ii) above, which includes all surgeries and post-operative examinations;
  3. The practice monitor must initial the patient's chart at the end of the encounter, whether surgery or otherwise, to confirm her presence.  If more than one monitor is present but at different times during a surgery, each monitor shall sign the patient's chart; 
  4. Dr. Rakem shall ensure that the Chief of Staff in all hospitals in which he practises is aware of this restriction on his practice;
  5. Dr. Rakem shall keep the College updated with respect to all locations where he practises including, but not limited to, hospitals, clinics and offices, in any jurisdiction;
  6. Dr. Rakem shall provide his irrevocable consent to the College to make appropriate enquiries of the Ontario Health Insurance Plan and/or any person or institution who may have relevant information; and shall submit to unannounced inspections of his office(s) and practice(s) and patient charts by a College representative for the purposes of monitoring and enforcing his compliance with the terms of this Order;

Other

  1. Dr. Rakem shall successfully complete a boundary issues course approved by the College; and
  2. Dr. Rakem shall be solely responsible for all fees, costs and expenses associated with his compliance with the terms of this Order.
  3. Dr. Rakem shall reimburse the College for any funding provided to Patient A for therapy and counselling under the program required under section 85.7 of the Code up to the amount of $16,060.

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

Dr. Andre Gagnon, Gatineau.  On July 16, 2014, the Discipline Committee found that Dr. Gagnon committed an act of professional misconduct, in that the governing body in Quebec has found that he committed an act of professional misconduct that would be an act of misconduct as defined in the regulations in Ontario. Dr. Gagnon admitted the allegation.

Dr. Gagnon is a psychiatrist who focuses his practice on child and adolescent psychiatry. Dr. Gagnon was Patient A's psychiatrist from April 1994, when she was 14 years old, until February 2009 when Patient A was 28 years old. Dr. Gagnon's treatment of Patient A and interactions with Patient A took place in Quebec, where he practices medicine. Patient A was a vulnerable patient with mental health issues that were difficult to treat. Between 2003 and February 2009, Dr. Gagnon violated therapeutic boundaries with Patient A.

In October 2011, Dr. Gagnon was found guilty by the College des medecins du Quebec (CMQ), the regulatory body for physicians and surgeons in Quebec, of having breached the Code of Ethics of Physicians in relation to his conduct with and treatment of Patient A.  First, Dr. Gagnon was found to have transgressed the limits of the professional relationship, in particular after resuming psychotherapy with Patient A in 2003, and to have abused his position of authority with a vulnerable young person.  In particular, he failed to remain neutral and independent, and failed to reinforce respect for a strictly therapeutic environment.  He thereby breached and violated therapeutic boundaries, in an increasingly serious and intense manner, and allowed an emotionally intimate relationship with physical proximity to develop.  This was similar to a "father-daughter type of relationship".

Dr. Gagnon was also found to have failed to take into account his own capacities and limits, in particular during the period from 2003 to 2009.  He failed to consult with a colleague or to take into account a colleague's opinion regarding his diagnosis and therapeutic approach for Patient A.  Dr. Gagnon failed to refer Patient A to a colleague or other health professional, in particular after May 2008, although she was not making progress in regards to her condition.  Dr. Gagnon consulted a colleague who treated his own distress with the situation. The CMQ found that Dr. Gagnon's relationship with Patient A was without any sexual connotation. 

Dr. Gagnon pleaded guilty to professional misconduct before the CMQ, which accepted a joint submission as to penalty.  As a result, the CMQ ordered that Dr. Gagnon be suspended for a period of three months, and that Dr. Gagnon publish, at his own expense, a notice of the CMQ decision in a newspaper in the area where he practised.  He was also ordered to pay costs of the proceeding against him. 

Therefore, the Discipline Committee ordered a public reprimand and directed that the following term, condition and limitation be imposed on Dr. Gagnon’s certificate of registration:

  • Dr. Gagnon shall successfully complete, at his own expense, education approved by the College regarding boundaries in the doctor-patient relationship.

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

Dr. Christiane Farazli, Ottawa.  On July 24, 2014, the Discipline Committee found that Dr. Farazli committed acts of professional misconduct, in that she has failed to maintain the standard of practice of the profession, she has contravened the Medicine Act, the Regulated Health Professions Act, or the regulations under either of those Acts, and she has engaged in disgraceful, dishonourable or unprofessional conduct. The Discipline Committee also found that Dr. Farazli is incompetent. Dr. Farazli pleaded no contest to the allegations.

This case comprises two s. 75(1)(a) investigations into Dr. Farazli's practice, as well as 20 patient complaints.

Dr. Farazli owned and operated an out-of-hospital premises where she conducted colonoscopies and gastroscopies. The premises were subject to inspection/assessment by the College's Out-of Hospital Premises Inspection Program in May 2011. As a result of that inspection, largely on the basis of serious infection control concerns, the premises received a grade of "fail", which meant that Dr. Farazli could no longer perform procedures there as of early June 2011. After receiving this information from the College, Ottawa Public Health conducted a retrospective review, a "look-back", and notified several thousand of Dr. Farazli's former patients that they may have been exposed to Hepatitis C virus, Hepatitis B virus, or HIV and should be tested for these pathogens.

An expert retained by the College opined that Dr. Farazli failed to maintain the standard of practice of the profession and displayed incompetence in the unacceptable practice at the clinic, including in her infection control and instrument re-processing failures; the lack of training and certification of her staff; her failure to provide and maintain an adequate facility; and lack of emergency preparedness. Another expert opined that the care provided to the patients did not meet the standard of practice reasonably expected of a competent practitioner in the field of gastroenterology. In particular, Dr. Farazli did not consider it necessary to offer to patients and referring physicians reasonable options for management.

In respect to Patient A, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in her interaction with the nurse and the patient in respect of Patient A's care and in exposing Patient A to potential infection. Patient A saw Dr. Farazli on four occasions between 1997 and 2010 for various procedures.

In respect to Patient B, Dr. Farazli failed to maintain the standard of care in proposing to engage a sales representative to assist her in a procedure when no nurse was available. Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient B in proposing to engage a sales representative to assist her in a procedure when no nurse was available, and in engaging in inappropriate and incomplete communications with Patient B. Patient B attended Dr. Farazli in about March 2010 for a colonoscopy.

In respect to Patient C, Dr. Farazli failed to maintain the standard of practice of the profession in relation to her care and treatment of Patient C. Dr. Farazli also engaged in disgraceful, dishonourable or unprofessional conduct in her communications with the patient including comments about pain management; in being rough and callous with the patient; and in exposing the patient to potential infection. Patient C attended Dr. Farazli's office for a procedure in January 2011, having been referred for a complaint of rectal bleeding and a family history of colorectal cancer, for a colonoscopy and removal of a polyp. The patient expressed that she was experiencing extreme pain during the procedure.

In respect to Patient D, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in her communications with Patient D, in persisting with the procedure despite the patient's request to stop due to unbearable pain, and in exposing the patient to potential infection. Patient D attended at Dr. Farazli for a colonoscopy and gastroscopy in 2003 or 2004. During the procedure, the patient experienced severe pain and asked Dr.  Farazli to stop the procedure due to pain.

In respect to Patient E, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient E in failing to provide the patient with enough sedation to be comfortable and in exposing the patient to potential infection. Patient E was referred to Dr. Farazli by her family physician for a colonoscopy in 2002 and experienced terrible pain during the procedure. 

In respect to Patient F, Dr. Farazli engaged in disgraceful, dishonourable and unprofessional conduct in not providing the patient with enough sedation to be comfortable, and in being callous, unprofessional and disrespectful in her communication with the patient and in her pain management, and in exposing the patient to potential infection. Patient F was referred to Dr. Farazli by her family physician for a colonoscopy. During the colonoscopy, she experienced severe discomfort, but Dr. Farazli disregarded her complaints of pain.

In respect to Patient G, Dr. Farazli failed to maintain the standard of practice of the profession in relation to Patient G in her documentation. Dr. Farazli further engaged in disgraceful, dishonourable or unprofessional conduct in her callous and unprofessional communication with Patient G, and in failing to stop the procedure despite the patient complaining of unbearable pain and inadequate anaesthesia. Patient G underwent procedures by Dr. Farazli in about 2000 and 2001. 

In respect to Patient H, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient H in her callous, unprofessional, rough and hurried examination of the patient; in her communications with the patient; in continuing with the procedure when the patient was in excruciating pain; and in exposing the patient to potential infection. Patient H underwent a gastroscopy and colonoscopy by Dr. Farazli in March 2009. 

In respect to Patient I, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient I in her inappropriate communications with the patient; her failure to be responsive to the patient's complaints of lack of sufficient anaesthesia; and in exposing Patient I to potential infection. Patient I was treated by Dr. Farazli in about 2007 after a referral by her family physician for a gastroscopy and colonoscopy.

In respect to Patient J, Dr. Farazli failed to maintain the standard of practice of the profession and displayed incompetence in relation to Patient J by giving inadequate analgesic. Further, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient J in her communications with the patient; in proceeding with an excruciating procedure despite the patient screaming in pain; and in exposing the patient to potential infection. Patient J was referred to Dr. Farazli by her family physician for a colonoscopy in about 2002.

In respect to Patient K, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient K in her inappropriate and unprofessional communications with the patient; in failing to provide the patient with sufficient sedation; in charging the patient for a drug not administered; and in exposing the patient to potential infection. Patient K was referred to Dr. Farazli by her family physician in January 2002.

In respect to Patient L, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient L in her callous and unprofessional communications with the patient; in her pain management; and in exposing the patient to potential infection. Patient L was referred to Dr. Farazli by her family physician in February 2000. She became very uncomfortable during the procedure, which was performed in March 2000.

In respect to Patient M, Dr. Farazli contravened the regulations made under the Medicine Act in relation to Patient M by failing to maintain records in accordance with the regulation. Dr. Farazli also engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient M in her callous, rough and unprofessional communications with the patient; charging for medications not needed for her procedure; and in exposing the patient to potential infection. Patient M was referred to Dr. Farazli by her family physician and underwent a procedure by Dr. Farazli in about April 2003. Patient M believed she saw Dr. Farazli again in 2010. Dr. Farazli did not have records of treatment for this patient.

In respect to Patient N, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient N in her inappropriate and unprofessional communications with the patient; in proceeding with a procedure when the patient was in obvious distress from insufficient sedation; and in exposing the patient to potential infection. Patient N was treated by Dr. Farazli for a colonoscopy procedure in about July 2006.  

In respect to Patient O, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient O in her inappropriate and unprofessional communications with the patient; in proceeding with a procedure when the patient was in obvious distress from insufficient sedation; and in exposing the patient to potential infection. Patient O was seen by Dr. Farazli in 2004 and 2009. Patient O experienced extreme pain during the colonoscopy.

In respect to Patient P, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient P in her unprofessional communications with the patient and in exposing the patient to potential infection. Patient P saw Dr. Farazli in September and November 2010. Dr. Farazli was unable to complete the procedure because she said she could not advance the scope.

In respect to Patient Q, Dr. Farazli demonstrated incompetence in relation to Patient Q in that she displayed a lack of knowledge, skill or judgment in not aborting the procedure. Further, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient Q in being abusive in her communications with the patient. Patient Q was referred to Dr. Farazli by her family physician in July 1999. The patient underwent a gastroscopy by Dr. Farazli in November 1999. Dr. Farazli had difficulty gaining intravenous access and Patient Q was in terrible pain. Dr. Farazli yelled at her and shouted at the nursing staff to hold Patient Q down while Dr. Farazli attempted to insert the IV and to spray the throat anaesthetic. Dr. Farazli then herself roughly pulled Patient Q's head to the side and sprayed her throat while she was struggling. After the procedure, Dr. Farazli was yelling very loudly at the patient, about the patient needing the procedure and not being cooperative.

In respect to Patient R, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient R in her inappropriate and unprofessional communications with the patient and in exposing the patient to potential infection. Patient R was referred to Dr. Farazli by her family physician and underwent procedures by Dr. Farazli in 2006.

In respect to Patient S, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient S in her inappropriate and unprofessional communications with the patient; in proceeding with a procedure when the patient was in obvious discomfort and felt there was insufficient sedation; and in exposing the patient to potential infection. Patient S was referred to Dr. Farazli by his family physician, and was treated by Dr. Farazli in 2004. When Dr. Farazli asked him about his history, she behaved in an accusatory way toward him.

In respect to Patient T, Dr. Farazli engaged in disgraceful, dishonourable or unprofessional conduct in relation to Patient T in her inappropriate and unprofessional communications with the patient; in proceeding with a procedure when the patient was in obvious distress from insufficient sedation; and in exposing the patient to potential infection. Patient T saw Dr. Farazli on several occasions between 1997 and 2002. In 2002, the patient underwent a colonoscopy and was caused excruciating pain by the procedure.

Dr. Farazli has executed an undertaking never to engage in the practice of medicine again.

The Discipline Committee ordered a public reprimand, and directed Dr. Farazli to pay the College costs in the amount of $4,460.