News Release

2015 - 3 - 26 Discipline Committee Decisions

Dr. David Brian Opper; Dr. Ramesh Patel

Mar 26, 2015

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. David Brian Opper, Brantford. On February 24, 2015, the Discipline Committee found that Dr. Opper committed an act of professional misconduct, in that he has been found guilty of an offence that is relevant to his suitability to practise, and he has engaged in disgraceful, dishonourable or unprofessional conduct. Dr. Opper admitted to the allegations.

On October 25, 2012, Dr. Opper pleaded guilty and was found guilty of the following offences under s.44 (1)(a) of the Health Insurance Act:

  1. Failing to maintain records as may be necessary to demonstrate that a service for which he prepares or submits an account is the service that he provided. Dr. Opper was compensated for improper billings in the amount of $29,767.50 for the period of April 1, 2009 to March 31, 2010.
  2. Knowingly obtaining or attempting to obtain payment for any insured service that he was not entitled to obtain. Dr. Opper billed OHIP for services purportedly provided to a patient in December 2006 and July 2009. The patient denied having seen Dr. Opper at any time after June 2006, and Dr. Opper later admitted to not having provided the services to the patient. Dr. Opper received $265.30 for these billings.
  3. Knowingly giving false information in an application, return or statement made to the Plan or to the General Manager. Dr. Opper billed OHIP for services purportedly provided to a patient in July 2009. The patient denied having received services from Dr. Opper at any time after 2006, and Dr. Opper later admitted to knowingly giving false information to OHIP regarding the provision of insured services to this patient. Dr. Opper received $206.90 for this billing.

In addition, Dr. Opper agreed to facts, though he did not plead guilty to the associated counts, regarding billing OHIP for 17 Special Visit Premiums related to discussions with a colleague regarding the colleague’s personal medical issues and 11 Special Visit Premiums related to discussions with a member of his church.

In relation to the three charges of which he was found guilty, Dr. Opper was sentenced to a fine of $30,000 ($10,000 per count), plus court costs and victim surcharge. On October 25, 2012, prior to the hearing on the charges, Dr. Opper paid restitution in the amount of $29,816.20.

The Committee ordered a public reprimand and directed that the Registrar suspend Dr. Opper’s certificate of registration for three months. In addition, the following terms, conditions and limitations are imposed on Dr. Opper’s certificate of registration:

  1. Dr. Opper shall participate in and successfully complete an educational program satisfactory to the College in ethics, with a report or reports to be provided to the College regarding Dr. Opper’s progress and compliance. Dr. Opper shall complete this requirement by August 1, 2015 or, if no satisfactory program is available by that time, by the first possible opportunity thereafter;
  2. Within 30 days of the date of this Order, Dr. Opper shall obtain a physician practice monitor acceptable to the College, who will review his Ontario Health Insurance Plan (“OHIP”) billings and corresponding patient charts to ensure his compliance with the Health Insurance Act and who will sign an undertaking (the “practice monitor”);
  3. The practice monitor will review, at minimum, 25 of Dr. Opper’s patient charts for which he has billed OHIP once every three months for a minimum of one year. If Dr. Opper bills OHIP for fewer than 25 patients in any given three-month period, the practice monitor will review all of the patient charts for which Dr. Opper billed OHIP. In the event that Dr. Opper has billed OHIP for fewer than 100 patients during the one-year period of monitoring, the monitoring will continue until a minimum of 100 charts have been reviewed;
  4. If a practice monitor is unable or unwilling to continue to fulfill its terms, Dr. Opper shall, within 20 days of receiving notice of same, obtain an executed undertaking in the same form from a similarly qualified person who is acceptable to the College and ensure that it is delivered to the College within that time;
  5. If Dr. Opper is unable to obtain a practice monitor in accordance with paragraphs 4(ii), 4(iii) and 4(iv) of this Order, he shall cease to submit bills to OHIP until such time as he has done so;
  6. Dr. Opper shall consent to the disclosure of all information the practice monitor or the College deems necessary or desirable in order to fulfill the practice monitor’s undertaking and to monitor Dr. Opper’s compliance with this Order;
  7. For an indefinite period of time, Dr. Opper shall inform the College of each and every location where he practices including, but not limited to hospitals, clinics, and offices, in any jurisdiction, within 15 days of this Order, and shall inform the College of any and all new practice locations within 15 days of commencing practice at that location;
  8. For an indefinite period of time, Dr. Opper shall submit to, and not interfere with, unannounced inspections of his practice location(s) and patient records by a College representative for the purposes of monitoring his compliance with this Order;
  9. Dr. Opper shall consent to the monitoring of his OHIP billings and cooperate with inspections of his practice and patient charts by his practice monitor and College representatives for the purpose of monitoring and enforcing his compliance with the terms of this Order; and
  10. Dr. Opper shall be responsible for any and all costs associated with implementing the terms of this Order.

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

Dr. Ramesh Patel, Scarborough.  On March 9, 2015, the Discipline Committee found that Dr. Patel is incompetent and committed an act of professional misconduct by failing to maintain the standard of practice of the profession in his care of 25 patients and by engaging in disgraceful, dishonourable or unprofessional conduct, namely: inadequate supervision of staff; improper delegation of controlled acts; improperly permitting and/or directing staff to prescribe to patients; inappropriately having staff care for and treat patients in his absence; inappropriate billing to OHIP; and breaching his undertaking to the College. Dr. Patel admitted to the allegations.

In addition, Dr. Patel pleaded no contest to and the Discipline Committee found that Dr. Patel committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession and that he engaged in disgraceful, dishonourable or unprofessional conduct regarding his care of Patients A and B.

An investigation into Dr. Patel’s practice was initiated after the College received information that Dr. Patel had been allowing staff to perform patient care beyond that which was appropriate for a non-physician staff member to provide. When College investigators attended at Dr. Patel’s clinic in April 2011, staff and patients were present. College investigators were advised that Dr. Patel was on vacation. 

Dr. Patel inappropriately billed OHIP during the time period that he was on vacation in April 2011. OHIP billings for the time period of Dr. Patel’s absence indicated that the total amount billed in his name while he was on vacation was $34,079.14. Dr. Patel was not present in the office while any services were performed during this time. Dr. Patel inappropriately billed OHIP during this time period. Dr. Patel also engaged in other inappropriate billing practices: billing for a minor assessment when faxing prescription renewals to or receiving them from pharmacies; billing for a minor assessment when a patient’s family member dropped off or picked up a document, prescription or testing kit; and billing inappropriately with respect to administration of the Rotateq vaccination.

Dr. X, independent expert, identified a number of areas in which Dr. Patel’s practice was unsatisfactory, including that he:

  1. made unsubstantiated diagnoses, including of diabetes.
  2. ordered numerous unnecessary tests that were not appropriate to patients’ circumstances, based on the use of templates and routine. Inappropriate blood tests were also ordered as a matter of routine. Decisions were generally made to order tests before Dr. Patel had seen the patient.
  3. inappropriately treated respiratory infections in both adults and pediatric patients with medications that do not meet the standard of practice, and he failed to consider asthma where it would have been indicated to do so. Patients with respiratory infections were sometimes required unnecessarily to come in daily or almost daily for a period of time for a treatment that was not indicated.
  4. failed to address patients’ presenting concerns on occasion.
  5. failed on one occasion to follow up appropriately on an abnormal electrocardiogram.
  6. inappropriately prescribed the ‘morning sickness’ medication Diclectin to a prenatal patient who did not complain of nausea or vomiting.
  7. failed to ensure that information in the patient chart was informative. 
  8. failed to appropriately supervise staff and improperly delegated controlled acts.  There was no documentation in the charts of instructions by Dr. Patel to his staff, including with respect to assessments and examinations conducted in his absence, nor were there any medical directives provided. Dr. X identified instances in which the care delivered in this manner showed a lack of appropriate clinical decision-making reflective of the lack of supervision. 
  9. failed to obtain informed patient consent to the delegation of controlled acts to staff, or to staff involvement in their care.

After a referral to the Discipline Committee, Dr. Patel entered into an undertaking dated May 1, 2014. Among other things, Dr. Patel undertook that, effective immediately, he would not “delegate to any other person any controlled act, as that term is defined in the Regulated Health Professions Act, 1991.” He also undertook to engage a clinical supervisor, Dr. Y, who would review his practice. Dr. Patel undertook “to cooperate fully with the supervision of” his practice, and to abide by the recommendations made by his clinical supervisor, including but not limited to any recommended practice improvements and ongoing professional development. 

Dr. Y reviewed patient charts from Dr. Patel’s practice and observed patient encounters in his office as required by the undertaking. In the course of her duties, Dr. Y found that Dr. Patel continued to delegate controlled acts in breach of his undertaking.

Dr. Patel failed to abide by practice recommendations made by Dr. Y, in breach of his undertaking, namely:

  1. to cease having staff enter billing codes for visits that were in progress and to begin entering billing codes only upon completion of a patient encounter.
  2. to cease billing for visits at which the patient was not present, including missed appointments and where the patient or family member was dropping off or picking up forms, specialist information, or specimens for testing.
  3. to augment subjective histories documented by staff with his own additional questions.
  4. to obtain informed consent from patients prior to staff documenting patients’ subjective histories.
  5. to take steps to ensure that his EMR system clearly indicated which details were entered by which individual.
  6. to take steps to ensure his staff did not make clinical decisions.
  7. to cease ordering unnecessary diagnostic tests.
  8. to cease routinely prescribing Biaxin and Alupent for cough symptoms. 

In addition, Dr. Patel failed to abide by patient-specific treatment recommendations made by Dr. Y, in that he did not discontinue a drug, Diabeta, which is associated with hypoglycemia to a patient who had experienced a hypoglycemic episode, continued to prescribe narcotics to a patient without adequate documentation, and continued to prescribe Ventolin to a patient without the suggested addition of another inhaler such as Advair to provide better symptom relief.

With respect to Patient A, she attended at Dr. Patel’s office because she was experiencing foot problems and looking for a family physician. A female staff member, whom Patient A believed was a nurse but who was not a nurse, documented Patient A’s history in detail, as well as her blood pressure, weight, and height.  Patient A expressed to both the staff member and to Dr. Patel that she was being followed by Hospital 1 for a health issue related to her breasts, and did not require a breast examination. During the examination, Dr. Patel made comments that made Patient A feel uncomfortable, did not examine her feet, and conducted a breast examination without her consent.

Dr. X indicated that Dr. Patel’s care did not meet the standard of practice of the profession. The history and other information in the chart obtained was contradictory. Patient A was subjected to unnecessary investigations, and did not have her concerns regarding her presenting complaint addressed. She had a breast examination to which she had not consented. There were errors in judgment in not seeking to obtain information from Hospital 1 or ordering appropriate tests, and there was a lack of adequate supervision of the staff member who saw Patient A before Dr. Patel.  Dr. Patel’s care displayed a lack of knowledge and judgment. 

With respect to Patient B, he attended at the office of Dr. Patel complaining of chest pain. He was initially seen by a staff member, who recorded his history and vital signs, and performed an electrocardiogram. Dr. Patel informed Patient B that his electrocardiogram was normal, and that he could not treat him. Dr. Patel advised him that he could go to a hospital emergency department if he wished.

The next day, Patient B was admitted to hospital, where he underwent triple bypass surgery. Patient B was discharged from hospital with instructions to follow up with his family physician.
After Patient B voiced concerns regarding post-operative care, he was discharged from Dr. Patel’s practice by letter, five days after his discharge from hospital. 

Dr. X opined that based on Patient B’s account of his patient encounter, Dr. Patel did not meet the standard of practice of the profession and lacked knowledge and judgment in his treatment of Patient B. It would have been appropriate for Dr. Patel to either call the emergency department or send information either separately or with the patient. Patient B’s discharge from Dr. Patel’s practice also exposed him to harm, as he was not given any time to find a new primary care provider, and the discharge instructions from the hospital had indicated the need to see his primary care provider within the week.

With respect to both Patients A and B, Dr. Patel failed to provide an audit trail for their electronic medical records that accorded with College policy upon request by the College investigator.

The Discipline Committee’s decision on penalty is under reserve.