Committee: Discipline
Decision Date: 15 Sep 2020
Summary:
On September 15, 2020, on the basis of an agreed statement of facts and admission, the Discipline Committee (the “Committee”) of the College of Physicians and Surgeons of Ontario found that Dr. Mohamed Abdel Hadi Elmorsi Ismail committed an act of professional misconduct. On September 15, 2020, the Discipline Committee heard submissions on penalty and costs and reserved its decision.
FACTS
Dr. Ismail is a forty-seven year old anesthesiologist. He received his certificate of registration authorizing independent practice from the College of Physicians and Surgeons of Ontario (the “College”) on June 30, 2017.
Dr. Ismail currently holds privileges and practices at the St. Thomas Elgin GeneralHospital (“STEGH”) in St. Thomas. Since approximately November 2018, Dr. Ismail holds affiliations with various Out of Hospital Premises in Mississauga, Ancaster, St. Catharines, Burlington, Oakville and Toronto.
Between 2017 and 2019, Dr. Ismail held privileges at the Windsor Regional Hospital (the “WRH”) in Windsor, Ontario. Dr. Ismail was appointed to the WRH’s Professional Staff on October 5, 2017. He resigned his privileges at WRH effective July 1, 2019.
Dr. Ismail’s Agreement with The Windsor Regional Hospital
On October 30, 2018, Dr. Ismail was working a shift at the WRH. While working with Dr. Ismail, operating room nursing staff reported having witnessed Dr. Ismail coming out of the washroom and walking with an unsteady gait, looking pale and slurring his speech, and repeatedly asking the same questions. The nursing staff reported these concerns to WRH. On November 2, 2018, while Dr. Ismail was working a shift at WRH, operating room nursing staff again reported having observed Dr. Ismail coming out of washroom walking with an unsteady gait and slurring in his speech. The nursing staff reported these concerns to WRH.
On November 2, 2018, as a result of the concerns raised regarding Dr. Ismail’s conduct and capacity, Dr. X, the Chief of Staff at WRH, met with Dr. Ismail. Dr. Ismail voluntarily agreed to cease exercising his privileges at WRH until reassurance was provided to WRH regarding Dr. Ismail’s ability to safely provide anesthesia services.
On November 8, 2018, Dr. Ismail provided WRH a letter from his family physician which stated that he was medically fit to return to work. WRH determined that this letter was insufficient to reassure WRH that Dr. Ismail was in fact fit to return to work.
On November 12, 2018, Dr. X sent a letter to Dr. Ismail advising of the next steps WRH proposed in order to provide Dr. Ismail with an opportunity to address the concerns raised regarding his conduct and capacity on October 30 and November 2, 2018. In the letter, WRH advised that it would not initiate Immediate Mid-Term Action in accordance with the hospital’s By-Law or recommend restrictions or conditions to Dr. Ismail’s privileges at WRH, if Dr. Ismail agreed to comply with the terms specified by WRH.
Among the various terms, WRH requested that: (1) Dr. Ismail take a leave of absence from WRH and during the leave of absence, voluntarily agree not to exercise his privileges at WRH and undertake not to provide anesthesia services at any other hospital or facility; (2) Dr. Ismail engage with the Physician Health Program (“PHP”) of the Ontario Medical Association on specified terms, including to undergo a comprehensive assessment through the PHP Assessment Service or an alternative third party assessment acceptable to WRH.
In the days following receipt of Dr. X’s letter, Dr. Ismail sent, what he acknowledged during the College investigation were, inappropriate and unprofessional text messages to Dr. X and inappropriate and unprofessional emails to WRH in which he expressed frustrations with the PHP process, and the way the hospital was handling the matter.
On November 22, 2018, Dr. Ismail entered into an agreement with WRH, which included the following terms:
- He agreed not to exercise his privileges at WRH until such time that the hospital received information satisfactory to it that Dr. Ismail may safely return to practice, and hospital approved the return;
- He undertook to notify WRH if he intended to provide services at any other hospital or facility in Ontario and to provide fifteen (15) days written notice prior to the commencement of any such practice; and
- He also confirmed that he had contacted PHP as requested by WRH but was pursuing the possibility of an alternative third-party assessment, details of which would be provided to the hospital for review and approval.
On November 22, 2018, Dr. Ismail confirmed to WRH that he was currently not providing anesthesia services at any other hospital or facility.
Dr. Ismail Provided Anesthesia Services at a Hospital or Facility Without Notice to WRH Contrary to his Agreement
The Report to the College
On March 8, 2019, WRH notified the College that it had received information on March 5, 2019, that Dr. Ismail may have been providing anesthesia services at a facility in Ontario. Contrary to his agreement with WRH, Dr. Ismail did not notify WRH of his intention to provide anesthesia services at a hospital or facility. WRH had received no written notice from Dr. Ismail.
On March 6, 2019, on inquiry by WRH, Dr. Ismail confirmed that he had been providing anesthesia services without notice to WRH. Dr. Ismail stated that since November 22, 2018, “he has only assisted with sedation in relation to endoscopy procedures on a few occasions in Toronto and area between the end of January and February 1.”
The College Investigation
During the investigation, the College obtained data from Ontario Health Insurance Plan (“OHIP”) for claims submitted by Dr. Ismail for services rendered to all patients between the time period of October 1, 2018 and June 11, 2019.
The OHIP data shows that between November 22, 2018, and February 1, 2019, Dr. Ismail repeatedly submitted claims for anesthesia services rendered to patients at hospitals and facilities in Ontario. He did not provide notice to WRH of his intention to provide these services, contrary to his agreement.
The OHIP data confirms that Dr. Ismail provided misleading information to WRH on November 22, 2018 when he stated that he was currently not providing anesthesia services at any other hospital or facility in Ontario. The OHIP data shows that on the same date, Dr. Ismail submitted twenty-seven (27) claims to OHIP for anesthesia services provided to fifteen (15) different patients.
The OHIP data also shows that between December 3, 2018, and December 8, 2018, Dr. Ismail submitted claims for anesthesia services provided to over thirty-five (35) patients at STEGH.
Following his leave of absence from the WRH, in November 2018, Dr. Ismail applied for Term privileges in the Department of Anaesthesia at STEGH. His application for Term privileges received temporary approval from STEGH on December 3, 2018. Contrary to his agreement with WRH, Dr. Ismail did not provide WRH notice of his intention to provide anaesthesia services at STEGH.
During the College investigation, the College also learned that Dr. Ismail was practicing at the Castlemore Endoscopy and Digestive Disease Clinic in Brampton. The College received records from the Castlemore Endoscopy and Digestive Disease Clinic of all the patients Dr. Ismail provided anaesthesia services to at the clinic between November 2018 and February 2019. During this time period, Dr. Ismail provided anaesthesia services to fifty-two (52) patients
On March 6, 2019, in response to WRH’s inquiry seeking confirmation that Dr. Ismail was abiding by the terms of his agreement WRH, Dr. Ismail provided misleading and inaccurate information, when he stated that since November 22, 2018, “he has only assisted in sedation in relation to endoscopy procedures on a few occasions in Toronto and area between the end of January and February 1.” In fact, the OHIP data and show that Dr. Ismail was repeatedly providing anaesthesia services at hospital and facilities since November 2018, including at STEGH, Cornwall Community Hospital and the Castlemore Endoscopy and Digestive Disease Clinic.
Dr. Ismail engaged in disgraceful, dishonourable or unprofessional conduct by repeatedly providing anesthesia services at a hospital or facility in Ontario without notice to WRH contrary to his agreement with WRH.
Dr. Ismail Created and Submitted Fraudulent Letters of Employment
The Report to the College
On March 21, 2019, WRH notified the College that it had received further concerning information in respect to Dr. Ismail.
The College was advised that on March 18, 2019, WRH’s Director of Medical Affairs, Ms. Y, was contacted by Ms. X, a representative from Helen Ziegler & Associates, Inc, a recruitment agency.
Ms. X had contacted Ms. Y to confirm the accuracy of an employment letter she had received directly from Dr. Ismail, which was purportedly written and signed by Ms. Y.
Ms. Y confirmed that she did not write the employment letter on behalf of Dr. Ismail and the signature on the letter was not hers.
The College Investigation
During the investigation, the College received further information from Ms. X of Helen Ziegler & Associates, Inc.
Ms. X advised that Helen Ziegler & Associates, Inc. is a recruitment agency that recruits healthcare professionals for hospitals in the Middle East. Dr. Ismail was offered a locum position at one of Helen Ziegler & Associates, Inc. client hospitals. Ms. X was responsible for collecting documents from Dr. Ismail in preparation for credentialing at a hospital in the Middle East.
On March 14, 2019, Ms. X emailed Dr. Ismail a list of necessary documents needed as part of his credentialing application. Among various documents, Ms. X required Dr. Ismail to submit an employment letter or employment certificate from WRH, as this hospital was listed as Dr. Ismail’s current employer in his curriculum vitae.
On March 18, 2019, Dr. Ismail sent Ms. X a fraudulent employment letter, dated January 29, 2019, (the “January Employment Letter”), purportedly written and signed by Ms. Y, Director of Medical Affairs at WRH.
The January Employment Letter did not contain information about Dr. Ismail’s dates of service at WRH. Ms. X required this additional information and requested Dr. Ismail to provide an employment letter which included dates of service.
Later the same day on March 18, 2019, Dr. Ismail sent Ms. X another fraudulent letter of employment dated March 11, 2019 (the “March Employment Letter”), which now contained dates of service at WRH. This letter was again purportedly written and signed by Ms. Y, Director of Medical Affairs at WRH.
Ms. Y did not write the January Employment Letter or the March Employment Letter. Both of these employment letters were fraudulently created by Dr. Ismail.
In his response to the College investigation, Dr. Ismail provided the College with an unaltered original employment letter that he had received from WRH (the “Original Employment Letter”) in the past for the purposes of a mortgage application.
During the investigation, Dr. Ismail initially provided misleading information to the College that he had only “revised the dates” and “did not alter the content” of the Original Employment Letter. In fact, the January Employment Letter and March Employment Letter show that Dr. Ismail had not only revised the date of the Original Employment Letter but also altered the contents. Dr. Ismail subsequently, in a further response to the College investigation, corrected the misleading information he had provided to the College after locating the Original Employment Letter and comparing it to his fraudulent letters.
In addition to submitting the fraudulent employment letters to Helen Ziegler & Associates, Dr. Ismail also submitted the fraudulent January Employment Letter and the fraudulent March Employment Letter to a second agency, DataFlow Group, for thepurpose of obtaining employment overseas.
Dr. Ismail engaged in disgraceful, dishonourable or unprofessional conduct by creating and submitting fraudulent letters of employment.
ADMISSION
Dr. Ismail admits the facts specified above and admits that, based on these facts, he engaged in professional misconduct, in that he 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, under paragraph 1(1)33 of Ontario Regulation 856/93, made under the Medicine Act, 1991.
AGREED STATEMENT OF FACTS ON PENALTY
Dr. Ismail was born in Egypt. He is married and has three (3) children.
Interactions with Physician Health Program
In late November 2018, the Windsor Regional Hospital (“WRH”) referred Dr. Ismail to the Ontario Medical Association’s Physician Health Program (“PHP”) for an assessment as a result of concerns raised regarding Dr. Ismail’s conduct and capacity at the WRH on October 30, 2018 and November 2, 2018.
On January 23, 2019, Dr. Ismail underwent an independent clinical evaluation, specifically regarding potential substance use disorders. The evaluation was conducted for PHP by the Work, Stress and Health Program at the Centre for Addiction and Mental Health (“CAMH”). In the CAMH report dated March 7, 2019, the evaluation found that Dr. Ismail did not have a substance use disorder. Despite this, the report noted a discrepancy between Dr. Ismail’s self-reported medication history, and oxazepam identified in his urine toxicology test (done on January 25, 2019) during the evaluation.
Therefore, the report recommended “substance use (no diagnosis) monitoring” for a period of one year, including a workplace monitor for that period of time.
Following Dr. Ismail’s evaluation with CAMH, and while Dr. Ismail’s PHP assessment was in process, the PHP received additional information from WRH about other issues (which are the subject of these proceedings) regarding Dr. Ismail. In addition, on March 25, 2019, Dr. Ismail reported to the PHP that on February 1, 2019, while on shift, his workplace was concerned about his health and he was sent to the emergency room by ambulance. He added that he did not remain in the emergency department for the evaluation. In light of this new information, the PHP recommended that Dr. Ismail undergo a second independent clinical evaluation.
Between April 29 and May 2, 2019, Dr. Ismail underwent a second clinical evaluation at Acumen Assessments in Lawrence, Kansas. In a report dated June 5, 2019, among other things, the evaluation found that Dr. Ismail was fit to practice medicine with mental skill. During the evaluation, Dr. Ismail underwent urine testing (on April 29, 2019) and fingernail testing (on May 2, 2019). The report states that: “[t]he results of the urine and finger nail testing done in the evaluation were negative for medications and drugs of abuse (other than the prescribed Tramadol) and for metabolites of Propofol.” The report also states that “the results of the nail tests are reported to cover a period of six months, taking the window of detection back to late October/Early November 2018.” However, the report concluded that “the ruling out of a medication misuse/addiction problem can only happen with a period of monitoring.” The report recommended that “in order to ensure that Dr. Ismail can remain fit to practice with safety, it will be important for him to undergo a period of diagnostic monitoring.”
Effective July 18, 2019, Dr. Ismail entered into a one (1) year Concurrent Behavioural Substance Use (No Diagnosis) Monitoring Contract with PHP (the “PHP Contract”).
The final report of the PHP, dated August 10, 2020, confirms that Dr. Ismail has successfully completed the terms of the PHP Contract and no further monitoring has been requested by PHP, and states that “Dr. Ismail has been fully compliant with all aspects of the PHP monitoring program.”
PRIOR HISTORY WITH THE COLLEGE
Incapacity Investigation
In February 2019, the College received information from Dr. S, the Medical Director of Castlemore Endoscopy and Digestive Disease Clinic in Brampton (the “Castlemore Clinic”) concerning Dr. Ismail. Dr. S reported that on February 1, 2019, Dr. Ismail, who was about to provide anesthesia services to a patient at the Castlemore Clinic, appeared disoriented and confused. Another physician working at the Castlemore Clinic stopped Dr. Ismail from providing the anesthesia services to the patient. The Castlemore Clinic called emergency services and Dr. Ismail was taken to hospital. Dr. S reported that upon discussion with other staff, he learned that Dr. Ismail had looked disoriented prior to the procedure and was spending long periods of time in the washroom. Dr. Ismail appeared to have blood stains on his clothing, bruising above hisleft eye, and discolouration and bruising of his left decubital fossa.
On March 8 and March 20, 2019, the College received further information (which is the subject of these proceedings) from the WRH concerning Dr. Ismail’s conduct and capacity. In WRH’s report to the College on March 8, 2019, it stated that prior to October 30, 2018, no formal concerns had been raised about Dr. Ismail’s conduct or capacity at the hospital.
Based on the information from Castlemore Clinic and the WRH, on April 16, 2019, the Inquiries, Complaints and Reports Committee proceeded with a capacity inquiry, pursuant to section 58 of the Health Professions Procedural Code, which is Schedule 2 to the Regulated Health Professions Act, 1991, S.O. 1991, c. 18, to inquire whether Dr. Ismail was incapacitated.
As stated above, effective July 18, 2019, Dr. Ismail entered into the PHP Contract.
As a resolution to the College’s incapacity investigation, Dr. Ismail entered into an Undertaking to the College whereby he acknowledged he had entered into the PHP Contract. Among other things, Dr. Ismail undertook to remain a participant in the PHP, and to fully comply with the requirements of the PHP Contract.
Dr. Ismail has successfully completed the terms of the PHP Contract and he has met all the terms of the Undertaking to the College, dated October 2, 2019. Therefore Dr. Ismail is no longer subject to the College Undertaking.
Other History
- Dr. Ismail has no prior history with the Discipline Committee.
- Dr. Ismail has not been the subject of any prior complaints to the College.
FINDING
On September 15, 2020, the Committee found that Dr. Ismail committed an act of professional misconduct under paragraph 1(1)33 of Ontario Regulation 856/93 made under the Medicine Act, 1991, in that he has engaged in an act or omission relevant to the practice of medicine that, having regarding to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
At the conclusion of the hearing, the Committee reserved its decision on penalty and costs.
On December 15, 2020, the Committee released its decision and ordered that:
1. - Dr. Ismail attend before the panel to be reprimanded.
2.The Registrar suspend Dr. Ismail’s certificate of registration for a period of 6 months, commencing from January 1, 2021 at 12:01 a.m.
3. The Registrar place the following terms, conditions and limitations on Dr. Ismail’s certificate of registration effective immediately:
(a) Dr. Ismail will participate in the PROBE Ethics & Boundaries Program offered by the Centre for Personalized Education for Professionals, by receiving a passing evaluation or grade, without any condition or qualification. Dr. Ismail will complete the PROBE program within six (6) months of the date of this Order, and will provide proof to the College of his completion, including proof of registration and attendance and participant assessment reports, within one (1) month of completing it.
4. Dr. Ismail to pay costs to the College in the amount of $10,370 within thirty (30) days of the date of this Order.