Committee: Discipline
Decision Date: 06 Feb 2012
Summary:
On February 6, 2012, the Discipline Committee found that Dr. Padma Jain committed an act of professional misconduct, in that she failed to maintain the standard of practice of the profession in her care and treatment of 27 cosmetic surgical patients between 2001 and 2008 in the following ways:
Her pre-operative care was substandard:
• Her pre-operative evaluation of abdominoplasty patients was consistently minimal with no record of the presence of hernia, amount of laxity or surgical plan;
• Her pre-operative evaluation of blepharoplasty was consistently inadequate with no inquiry about eye history and inadequate examination of the lids recorded;
• Her pre-operative evaluation of breast augmentation was minimal without standard comments on nipple position;
• Liposuction was performed on patients with relative contraindications for this type of surgery, including one patient with lupus;
• The pre-operative evaluation for breast reduction and gynecomastia was insufficient in that nipple position was not documented and discussed.
Her intra-operative care of patients was substandard:
• The operative notes for abdominoplasty, blepharoplasty and breast augmentation were anatomically inaccurate and demonstrated a lack of knowledge in these areas of surgery;
• The volume of fluid aspirated in one liposuction was above that which is acceptable in an out-patient setting;
• In another liposuction, surgery was performed within 48 hours after the completion of another liposuction on the same patient;
• DVT prophylaxis was not used in a large number of surgeries lasting longer than four hours;
• Excised breast tissue was not sent for pathological examination in the case of a patient who was a 48 year old woman;
• Breast augmentation surgery was routinely performed without intravenous antibiotic coverage;
• Surgical counts of sharps, sponges and instruments were routinely inadequate;
• Liposuction for breast reduction was performed on a patient who was not suited for the procedure;
• In one case, a clean surgical procedure was combined with a contaminated procedure without intravenous antibiotic coverage.
Her post-operative care was substandard:
• Patients were routinely discharged too quickly after surgery;
• One patient was not treated for symptoms of hypertension after major surgery;
• A patient with a history of sleep apnea was not monitored overnight following surgery.
Her charting was substandard:
• Many OR notes were illegible and some were missing;
• No recovery room record exists for any of the surgeries.
The Discipline Committee ordered and directed that:
1. the Registrar place the following terms, conditions and limitations on Dr. Jain’s certificate of registration:
i. Dr. Jain shall be prohibited from engaging in all procedures as defined in Part XI of O.Reg. 114/94 made under the Medicine Act, 1991;
ii. At her own expense, Dr. Jain shall retain a College approved preceptor on record keeping in relation to her cosmetic practice for a period of six months, and who has signed an undertaking in the form attached as Schedule “A” [to the Order] (the “Cosmetic Practice Preceptor”). The Cosmetic Practice Preceptor shall meet with Dr. Jain monthly and review a minimum of 10 randomly chosen patient records per month with reports to the College every two months. Dr. Jain will abide at her own expense by all recommendations of the Cosmetic Practice Preceptor with respect to her medical record keeping, including with respect to any charting improvements; and
iii. Dr. Jain shall co-operate with unannounced inspections of her practice and such other steps as the College may take for the purpose of monitoring and enforcing her compliance with the terms of the Order.
2. Dr. Jain appear before the panel to be reprimanded.
3. Dr. Jain pay costs to the College in the amount of $3,650 within thirty (30) days from the date of this Order.