discipline summaries
DR. AWAD IBRAHIM AWAD
Practice Location: Oakville
Practice Area: Psychiatry (Sleep Medicine)
Hearing Information: Admission to allegation of failing
to maintain standard of practice; No Contest to allegation 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; Agreed Statement of Facts and Admissions; Joint Submission on Penalty.
On April 4, 2014, the Discipline Committee found
that Dr. Awad committed acts of professional misconduct.
The Committee found that he failed to maintain
the standard of practice of the profession in respect
to his care of 13 sleep medicine patients. Dr. Awad
admitted to this allegation.
The Committee also found that he 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 relation
to his billing of OHIP for sleep medicine consultations. Dr. Awad pleaded no contest to this allegation.
The independent expert retained by the College
opined that Dr. Awad failed to maintain the standard
of practice with respect to 12 of 15 patient charts
reviewed. Examples of concerns included:
a) e routinely directed nasal Continuous Positive
H
Airway Pressure (CPAP) titration studies after the
patients had undergone sleep studies without having
seen and evaluated the patients in question;
b) patient had received Imovane (5 mg) prior to
A
CPAP titration study, without a physician assessment or clear physician’s order. On the basis of
severe obstructive sleep apnea and information
provided by the family doctor in the patient’s referral form, the patient could be seen to be at risk of
hypoventilation and excessive daytime somnolence.
c) e signed an Assisted Devices Program (ADP) form
H
for the use of nasal CPAP prior to having seen the
patient in consultation;
d) rough his staff, in the use of form letters, Dr.
Th
Awad influenced patients to return to his clinic for
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Dialogue Issue 2, 2015
follow-up studies, by indicating that the patient’s
condition was reportable to the Ministry of Transportation in case of lack of compliance to treatment
recommendations. Such communications were made
even in instances when patients were not documented to have excessive daytime somnolence or worrisome driving-related problems. The expert opined
that these letters were inappropriate and coercive;
and
e) e delegated tasks to non-physician members of his
H
staff inappropriately. A discussion of diagnosis and
treatment cannot be made by telephone by unqualified clerical and technical staff.
In response to the concerns identified by the expert, Dr.
Awad has changed his practice.
Regarding a complaint by Patient A, the independent
expert opined that Dr. Awad failed to maintain the
standard of practice as follows:
a) is letter to Patient A’s family physician provided
H
evidence that the clinic was predisposed to CPAP
therapy before patients had been seen by a sleep
physician;
b) is records of care show that he misinformed the
H
referring physician by declaring Patient A to have a
condition reportable to the Ministry of Transportation, before the patient had been seen or assessed by
a sleep physician.
Regarding the finding of disgraceful, dishonourable
and unprofessional conduct, Dr. ]