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Botros, Wagdy Abdalla

CPSO#: 61884

MEMBER STATUS
Revoked: Discipline Committee as of 21 Sep 2018
CURRENT OR PAST CPSO REGISTRATION CLASS
None as of 16 Dec 2015

Summary

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Former Name: No Former Name

Gender: Male

Languages Spoken: English

Education: Ain Shams University Faculty of Medicine, 1975

Practice Information

Primary Location of Practice
Practice Address Not Available

Professional Corporation Information


Corporation Name: W. Botros Medicine Professional Corporation
Certificate of Authorization Status: Inactive: May 12 2016
 

Medical Records Location

Instructions/Address:
824 King St W
Kitchener, ON  N2G 1G1
Date Received: 04 Jan 2018

Specialties

Specialty Issued On Type
Psychiatry Effective:13 Nov 1989 RCPSC Specialist

Registration History

Action Issue Date
First certificate of registration issued: Independent Practice Certificate Effective: 24 Jan 1990
Transfer of class of certificate to: Restricted certificate Effective: 16 Dec 2015
Terms and conditions imposed on certificate Effective: 16 Dec 2015
Transfer of class of certificate to: Restricted certificate Effective: 16 Dec 2015
Terms and conditions imposed on certificate Effective: 16 Dec 2015
Suspension of registration removed Effective: 23 Jan 2017
Expired: Resigned from membership. Expiry: 04 Jan 2018
Revoked: Discipline Committee. Effective: 21 Sep 2018

Previous Hearings

Committee: Discipline
Decision Date: 20 Mar 2018
Summary:

On March 20, 2018, the Discipline Committee found that Dr. Wagdy Abdalla Botros has committed an act of professional misconduct, in that he has engaged in an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.

Dr. Botros is a psychiatrist who practised sleep medicine. During the period from May of 2014 to December of 2015, he was practising sleep medicine at three licensed independent health facilities known as Sleep Clinic Kitchener, Sleep Clinic London and Sleep Clinic Cambridge. Dr. Botros resigned his membership on January 4, 2018.

Breach of Undertaking

As a result of an assessment by the College as directed by the Director, Independent Health Facilities at the Ministry of Health and Long Term Care, Dr. Botros entered into an undertaking with the College on May 14, 2014, which provided in part that Dr. Botros practise under the guidance of a clinical supervisor acceptable to the College, who will meet with Dr. Botros at least once a week to review and discuss any issues or concerns arising from the review and /or observations of his practice.

Two successive compliance monitors were assigned to monitor Dr. Botros’ compliance with the undertaking. Dr. X was Dr. Botros’ Clinical Supervisor from May 14, 2014 to December 16, 2015.

The Discipline Committee found that there was a consistent pattern of missing meetings throughout the period of clinical supervision. This occurred despite the fact that the College repeatedly reminded Dr. Botros’ Clinical Supervisor and Dr. Botros of the need to comply with the terms and conditions of the Undertaking.

During the first six weeks of supervision, only one appointment was missed due to Dr. Botros attending a funeral. Between June 30, 2014 and December 20, 2014, however, 12 of 27 meetings were missed. The reasons for the missed meetings were a combination of illness (Dr. Botros), vacation (Dr. Botros and Clinical Supervisor) and simply that “Dr. Botros unavailable”.

Between December 20, 2014 and March 28, 2015, 9 of 14 weekly meetings were missed. The Clinical Supervisor was away on vacation for four weeks, there were additional holidays for another two weeks and Dr. Botros was “unavailable” for three weeks.

Between July 1 and October 1, 2015, 11 of 13 meetings were missed. The Clinical Supervisor was away for five appointments, including four consecutive weeks. There was a computer issue that prevented meeting on one week. Four other missed meetings were allegedly the result of Dr. Botros’ ankle injury. On another date, Dr. Botros was “unavailable.” Then finally, between November 16 and December 16, 2015, 3 of 5 weekly meetings were missed. Of these, the Clinical Supervisor was away for two and Dr. Botros was “unavailable” for one other.

It may be that the terms and conditions of the Undertaking were onerous, but this was an Undertaking which Dr. Botros had entered into in May of 2014 to allow him to continue to practise sleep medicine until the College completed reassessments of each of Dr. Botros’ clinics and reported to the Director of the IHF that the results were satisfactory. If his chosen Clinical Supervisor was not able to meet more 1 frequently due to his vacation schedule or other reasons, Dr. Botros should have looked for an alternative Clinical Supervisor, as had been recommended by his compliance monitor. Further, many of the missed meetings were the result of Dr. Botros’ own unavailability and were not related to the Clinical Supervisor.

It was clear from the express wording of the Undertaking that a change in the terms and conditions could only be made with the approval of the College. As submitted by College counsel, it was not the role of Clinical Supervisor to determine the extent to which the Undertaking was being complied with, that was the responsibility of the compliance monitors. Further, neither the Clinical Supervisor nor Dr. Botros could unilaterally change or relax any of the conditions in the Undertaking.

After Dr. Botros’ ankle injury in June 2015, the College accepted that there would be problems with compliance due to Dr. Botros’ injury. The Committee concluded, however, that if Dr. Botros could see 383 patients and travel to two of his clinics one month after sustaining his ankle injury, he should have been able to meet with Clinical Supervisor during that time. If he was well enough to see his patients, he should have been well enough to meet with his Clinical Supervisor.

Further, even if a number of the missed meetings were the result of Clinical Supervisor’s vacation schedule, it was Dr. Botros’ responsibility to ensure that he was complying with the terms of the Undertaking. Given the repeated warnings from the compliance monitors, he should have taken steps to provide for an alternative clinical supervision.

The Committee found that Dr. Botros breached the terms of his Undertaking by failing on repeated occasions to meet on a weekly basis with his Clinical Supervisor. In particular, the Committee found that his failure to meet with his Clinical Supervisor during the month of July 2015, when he was able to see 383 patients, was a flagrant breach of the Undertaking.

The Committee found that Dr. Botros’ breach of the Undertaking is clearly an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional. The Committee stated that undertakings are to be treated seriously and are not to be entered into lightly. They are not to be complied with simply at the convenience of the member. It was Dr. Botros’ obligation to ensure he was complying with the Undertaking. The in-person meetings were important because they protect the public and provide remediation or assistance to the physician in improving his practice. Without the meetings, the Clinical Supervisor could not provide feedback to the physician on concerns and recommendations, as contemplated by the Undertaking.

Failure to Co-operate with College Investigation

In January, 2016, the College commenced an investigation into Dr. Botros’ compliance with his undertaking. Dr. Botros failed to co-operate fully with the College investigation by refusing to provide information sought by the College investigator, taking the position that there was no reasonable basis for the inquiries. Despite the Investigator’s follow-up to remind Dr. Botros of his duty to co-operate, he refused, through his legal counsel, to provide the requested information and again took the position that there was no reasonable basis for the request.
 
The Committee found that the College investigator’s inquiries were relevant to an investigation into whether or not Dr. Botros had been compliant with his undertaking. The Committee further found that Dr. Botros’ failure to respond to those inquiries constituted a failure to co-operate fully with the College investigation.

Disposition

On September 21, 2018, the Discipline Committee ordered and directed that:

- The Registrar revoke Dr. Botros’ certificate of registration, effective immediately. 
- Dr. Botros pay costs to the College in the amount of $39,948.71, within 30 days of the date that this order becomes final.
 
 


Decision: Download Full Decision (PDF)
Hearing Date(s): Hearing Dates: January 22, 2018 Penalty hearing date: March 21, 2018

 

Committee: Discipline
Decision Date: 07 Mar 2016
Summary:

On March 7, 2016, the Discipline Committee found that Dr. Wagdy Abdalla Botros committed an act of professional misconduct in that he failed to maintain the standard of practice of the profession and that he has engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all
the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.

The Committee found that Dr. Botros failed to maintain the standard in relation to leaving one patient’s
Obstructive Sleep Apnea untreated and failing to attempt to assist a second patient when an emergency arose when her CPAP machine broke. The Committee also found that Dr. Botros engaged in disgraceful, dishonourable, or unprofessional conduct in relation to his delay in providing records to and in his manner of communication with the X Law Firm.

PENALTY

On September 23, 2016, the Discipline Committee ordered and directed that:

- Dr. Botros to appear before the Panel to be reprimanded;
- The Registrar suspend Dr. Botros’ certificate of registration for a period of four (4) months commencing immediately, to run concurrently with respect to any unexpired portion of the
suspension imposed by the Discipline Committee in its decision of February 22, 2016;
- At his own expense, Dr. Botros shall participate in and successfully complete, within 6 months of the date of this Order, individualized instruction in medical ethics satisfactory to the College, with
an instructor provided by the College. The instructor shall provide a summative report to the College including his or her conclusion about whether the instruction was completed successfully
by Dr. Botros;
- Dr. Botros shall, within three months, pay a fine to the Minister of Finance in the amount of $20,000.00, and that Dr. Botros shall provide proof of this payment to the Registrar of the
College; and
- Dr. Botros pay costs to the College in the amount of $17,840.00 within 60 days of the date of this Order.
 
 


Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): Hearing Dates: September 28-30, December 21, 2015 Penalty Hearing Date: September 23, 2016 Reprimand Date: April 20, 2017

 

Committee: Discipline
Decision Date: 31 Jul 2015
Summary:

On July 31, 2015, the Discipline Committee found that Dr. Wagdy Abdalla Botros committed an
act of professional misconduct in that he failed to maintain the standard of practice of the
profession and he has engaged in conduct or an act or omission relevant to the practice of
medicine that, having regard to all the circumstances, would reasonably be regarded by members
as disgraceful, dishonourable or unprofessional. The Committee also found that Dr. Botros is
incompetent.

The Committee found that Dr. Botros failed to maintain the standard of practice of the profession
in his care and treatment of 22 patients in his sleep medicine practice between 2007 and 2010
including:
He failed to maintain the standard of practice with regard to his sleep study interpretation
-   regarding all 22 patients. The independent experts retained by the College and
Independent Health Facilities, Clinical Practice Parameters and Facility Standards, Sleep
Medicine (the Standards) were clear that the sleep medicine physician needed to provide
a report of the sleep medicine physician’s interpretation of the sleep study data so that the
referring physician would know what the diagnosis was and if there was a problem, the
recommendation. Dr. Botros’ Standard Sleep Study Interpretation form documented
neither of these.

He failed to triage all patient referrals as required by the Standards.

-   He failed to complete a physical examination for one patient, and either did not do a
-   physical examination or did not chart a physical examination with respect to three
additional patients.

He prescribed inappropriate Continuous Positive Airway Pressure (CPAP) pressures
-   following CPAP titration with respect to five patients.

He failed to take appropriate steps to treat three patients with severe obstructive sleep
-   apnea within a reasonable time frame.

He allowed two patients to be prescribed CPAP without first being seen by a sleep
-   physician.

He incorrectly or incompletely diagnosed five patients.

-   He failed to appropriately notify or follow up with the Ministry of Transportation
-   regarding three patients.

He failed to appropriately prescribe supplemental oxygen for one patient who was on
-   CPAP therapy.

He demonstrated poor knowledge and understanding of CPAP treatment.

-   The Committee also found Dr. Botros incompetent in that his care of patients showed a lack of
knowledge, skill or judgment generally, and specifically in the care of four patients who had
severe conditions and one patient who was inappropriately diagnosed and managed.

The Committee also found that Dr. Botros engaged in behaviour that was unprofessional in his
treatment of the College investigators. During an office visit, Dr. Botros interfered with the
investigators’ chart pull and made comments that were derogatory and demeaning to the
professionalism of the College investigators. Following a medical inspector’s review of ten of
Dr. Botros’ charts, Dr. Botros failed to comply with multiple requests for information within a
reasonable period of time.

On December 16, 2015, the Discipline Committee ordered and directed that:
Dr. Botros appear before the panel to be reprimanded.

-   the Registrar suspend Dr. Botros’ certificate of registration for a period of six (6) months,
-   commencing immediately.

the Registrar place the following terms, conditions and limitations on Dr. Botros’
-   certificate of registration for an indefinite period:
a) Dr. Botros is restricted from practising in sleep medicine, including but not limited to:
i) Ordering, supervising and interpreting any sleep studies, diagnostic, or
therapeutic; and

ii) Assessing, managing, treating or prescribing to any patients in relation to any
sleep disorder problems; except that this Order does not preclude Dr. Botros
prescribing medication for sleep difficulties associated with a psychiatric disorder.

b) Dr. Botros shall co-operate with unannounced inspections of his practice and patient
charts, conducted at his own expense, by a College representative(s), for the purpose
of monitoring and enforcing his compliance with these terms, conditions and
limitations.

Dr. Botros pay costs to the College in the amount of $53,520.00, within 60 days of the
-   date of this Order.

On January 22, 2016, Dr. Botros appealed the decision of the Discipline Committee to the
Divisional Court. The Discipline Committee’s decision remained in effect pursuant to s. 71 of
the Health Professions Procedural Code.

On June 16, 2016, Dr. Botros abandoned his appeal to Divisional Court.


Decision: Download Full Decision (PDF)
Appeal: Appeal Abandoned
Hearing Date(s): July 15-18, August 26-27 and 30, 2013 January 20, 22-24, June 10, 2014

 

Committee: Discipline
Decision Date: 21 Apr 2015
Summary:

On April 21, 2015, the Discipline Committee found that Dr. Wagdy Abdalla Botros committed an act of professional misconduct, in that he has engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.

In May 2013, the Inquiries, Complaints and Reports Committee (the “ICRC”) referred the allegation of disgraceful, dishonourable and unprofessional conduct to the Discipline Committee in relation to Dr. Botros’ alleged failure to comply with the March 2011 Order of the ICRC requiring him to complete a specified continuing education or remediation program in Communications. Dr. Botros requested that the Health Professions Appeal and Review Board (HPARB) review the decision. In April 2012, HPARB rejected Dr. Botros’ appeal and confirmed the decision of the ICRC. Dr. Botros did not request a judicial review, therefore, the ICRC Order remained in effect.

On December 16, 2015, which was after the conclusion of the penalty hearing in this case, Dr. Botros’ certificate of registration was suspended for six months by a differently-constituted panel of the Discipline Committee in another matter (CPSO v. Botros, 2015 ONCPSD 31). The panel in that case also ordered that Dr. Botros be reprimanded, that certain terms, conditions and limitations be placed on his certificate of registration, and that he pay costs. In view of this, the Committee asked counsel for the parties to provide written submissions as to when the suspension in this case should take effect: specifically, should it commence immediately upon the coming into effect of the Committee’s order, such that it runs concurrently with the existing suspension, should it take effect upon the conclusion of the current suspension, or should it commence at some other time?

This Committee concluded that there is some commonality between this case and the other Dr. Botros case in relation to Dr. Botros’ unprofessional conduct toward the College over a similar time period. The Committee therefore determined that a six-month suspension is necessary and appropriate in this case.

However, having regard to the degree of commonality in the two cases in regard to Dr. Botros’ unprofessional conduct, the Committee deems it appropriate to have two months of the six- month suspension run concurrently with, and the remaining four months to run consecutively to, the suspension in the other Dr. Botros case.

The Committee’s order will therefore provide that the suspension of Dr. Botros’ certificate of registration will be from April 16, 2016 (four months after the commencement of his current suspension) until the later of: (a) six months from that date and (b) the date he provides to the College proof of his compliance with the SCERP that the ICRC ordered. The period of suspension should be more than enough time for Dr. Botros to complete the Communications Skills course.

Should there be a stay of the suspension in the other Dr. Botros case as a result of an appeal by Dr. Botros in that case at any time prior to April 16, 2016, the suspension in this case will take effect immediately upon the stay taking effect.

ORDER

The Committee therefore orders and directs that:

1. The Registrar suspend Dr. Botros’ certificate of registration commencing on the earlier of April 16, 2016 and the date of any stay of the Order in the other Dr. Botros case, and running until the later of:

a) six months after the date the suspension commences; and

b) the date Dr. Botros provides to the College proof of his compliance with the Specified Continuing Education and Remediation Program directed by the Inquiries, Complaints and Reports Committee in its March 16, 2011 decision.

2. Dr. Botros appear before the panel to be reprimanded.

3. Dr. Botros pay costs to the College in the amount of $24,656.10.
 
 


Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): Hearing Dates: October 6-7, 2014, Penalty Hearing Date: August 20, 2015

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