No Current Referrals.
03 Jun 2013
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Past Findings of the Discipline or Fitness To Practise Committee
Decision Date: 03 Jun 2013
On June 3, 2013, Dr. Padamjit Mohan Singh admitted before the Discipline Committee that she
is incompetent and that she failed to maintain the standard of practice of the profession in respect
of three patients. On the basis of an Agreed Statement of Facts, the Discipline Committee found
that Dr. Singh is incompetent and engaged in professional misconduct, in that she failed to
maintain the standard of practice of the profession.
Dr. Singh is an Obstetrician and Gynaecologist. After concerns were raised regarding Dr. Singh's
ability to cope in emergency situations while on call at the hospital where she worked, Dr. Singh
entered into an agreement with the hospital, the terms of which included the following:
a) Dr. Singh withdraws her reapplication for Active Staff privileges and applies for Courtesy
Staff privileges only;
b) Dr. Singh will be granted privileges to work as a surgical assistant at the hospital;
c) Dr. Singh will be granted privileges to work in the Colposcopy Clinic two days per
d) Dr. Singh will be granted privileges to perform specified minor procedures under general
anaesthesia where appropriate. The minor procedures include: inserting IUDS; cone
biopsy; D&C; removal of polyps and vaginal cysts; biopsies; incision drainage;
hysteroscopy; hysterosalpingogram; examination under anaesthesia; balloon ablation;
cauterization; and suture and repair
e) In the event an urgent or emergency situation should arise while performing any of the
specified procedures, Dr. Singh agrees to immediately refer and transfer care of the
patient to the obstetrician on call.
On the basis of this information, the College commenced an investigation under s.75(1)(a).
On November 19, 2009, the Department of Anaesthesiology determined that no current member
of the department will be made available to provide anaesthesiology coverage to Dr. Singh. As a
result, since at least November 2009, Dr. Singh has not been performing: D & C; hysteroscopy;
examination under anaesthesia; and balloon ablation.
The College retained an expert, Dr. X, to provide an opinion on the care provided by Dr. Singh.
With regard to Patient 1, Dr. X opined that Dr. Singh failed to demonstrate the appropriate
knowledge, skill and judgment expected of a specialist, in that:
a) Dr. Singh failed to appreciate the significance of the fetal heart rate tracing and allowed
the anaesthetist to perform an elective epidural elsewhere instead of dealing with the
patient's need for an urgent C-section;
b) Once in the operating room, Dr. Singh's difficulty in extracting the baby resulted in
further delay of newborn resuscitation. Dr. Singh was unable to perform in an
c) The theme of panic and poor communication with colleague/team members was evident
from the interview of those present;
d) The nurses felt that they had to push Dr. Singh to perform the C-section on a stat basis.
With regard to Patient 2, Dr. X opined that Dr. Singh failed to meet the expected standard with
respect to obstetrical care, in that:
a) Dr. Singh failed to communicate the urgency to her colleagues and permitted the
anaesthesiologist to provide an elective epidural instead of focusing his attention on the
high risk mother;
b) Dr. Singh had recognized the gravity of the situation by calling for the Sick Kids
Transport Team instead of transferring the mother to a tertiary centre. However, Dr.
Singh failed to act in a timely fashion to "deliver" the infant when there was a loss of fetal
heart rate, as an emergency section would have been taken by a reasonable physician at
that point in time under epidural or general anaesthetic.
In respect of Patient 3 case, Dr. X opined that: Again, another surgical complication arose for a
thin patient as Dr. Singh had difficulty with insertion of the Veress needle or Hasson trocar for
laparoscopy. Major blood loss for a minor procedure and benign state begs the question as to Dr.
Singh's judgment as well as her surgical skills once more.
In response, Dr. Singh provided the report of Dr. Y, who was asked to provide an opinion in 15
cases in which the College experts were critical of Dr. Singh. He was prepared to provide a
supportive opinion of only 11 of those cases and did not provide a supportive opinion in respect
of Patient 1, Patient 2 or Patient 3.
With respect to Dr. Singh's colposcopy practice, Dr. Singh provided a report from Dr. Z. At the
request of the hospital, Dr. Z reviewed Dr. Singh's colposcopy practice and concluded that she
appears to practice within the standard of the profession and did not demonstrate any lack of
knowledge, skill or judgment or disregard for the safety of her patients.
The Committee ordered and directed that:
Dr. Singh attend before the Panel to be reprimanded.
the Registrar impose the following terms, conditions and limitations on Dr. Singh's
certificate of registration:
a) Dr. Singh shall not engage in any labour and delivery practice;
b) Except as otherwise specified in this Order, Dr. Singh shall not engage in any
hospital-based obstetrical/gynaecological practice;
c) Dr. Singh is permitted to perform colposcopy in the Colposcopy clinic two days per
d) Dr. Singh is permitted to perform the following minor procedures ("Permitted
Procedures"), none of which entail intra-abdominal surgery:
i) Insertion of IUDS;
ii) Cone biopsy;
iv) Removal of polyps and vaginal cysts;
v) Vulvar, vaginal, cervical and endometrial biopsies;
vi) Incision drainage (vulvar, vaginal lesions);
ix) Examination under anesthesia;
x) Endometrial ablation;
xi) Cauterization; and
xii) Vulvar/vaginal suture and repair (this does not include vaginal hysterectomy,
cystocele or rectocele repairs).
e) Dr. Singh shall provide the College with 14 days' notice if she intends to commence
performing of any one of the Permitted Procedures itemized in paragraph 3(d) above,
under general anaesthesia. Dr. Singh shall agree to undergo an assessment(s) of such
practice(s) by an assessor appointed by the College of Physicians and Surgeons of Ontario
within one year of commencing any Permitted Procedure under general anaesthesia, at the
College's expense; and
f) In the event that an urgent or emergency situation arises while Dr. Singh is performing
any of the Permitted Procedures, Dr. Singh shall immediately refer and transfer the care
of the patient to the obstetrician/gynaecologist on call.
Dr. Singh pay costs to the College in the amount of $3,650.00 within (60) days from the
date of this Order.
Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): June 3, 2013
Member-reported Findings of Malpractice/Professional Negligence
Effective June 4, 2009, the Regulated Health Professions Act, 1991 (RHPA) requires members to report to the College any finding of professional
negligence or malpractice made against them.
No findings reported since June 4, 2009.