discipline summaries
adequately investigate or treat her mother’s ongoing health concerns. Dr. X opined that Dr. Syan
provided care that, at times, fell below the standard
expected and charting that was consistently brief,
lacking in essential components, did not document
medications, and was, overall, sub-standard.
Patient B was seen by Dr. Syan at a walk-in clinic
when he sought care for his elbow after a fall. Patient
B’s wife complained that Dr. Syan failed to order an
X-ray. Dr. Syan diagnosed an olecranon bursitis and
aspirated 20cc of blood. Patient B attended upon
another physician and was subsequently found to
have an elbow fracture for which he required surgery.
Dr. X opined that Dr. Syan’s care of Patient B fell
below the standard of practice of the profession. Dr.
X noted that the first diagnosis to be considered and
ruled out given this patient’s history and findings
would be a fracture and an X-ray would be a standard investigation to determine this.
On November 11, 2014, the Inquiries, Complaints
and Reports Committee (ICRC) directed the Registrar to impose terms, conditions and limitations
on the certificate of registration of Dr. Syan on an
interim basis, prior to the hearing of this matter.
In accordance with the terms of the Section 37
Order, Dr. Syan has seen approximately 10 patients a
week, with supervision. Recent reports received from
Dr. Syan’s supervisors indicate that she has displayed
an appropriate level of medical knowledge and clinical judgment in her care and treatment of patients,
that her record-keeping is improving and she has
followed their recommendations.
The relevant facts from Dr. Syan’s history with the
College include the following: In July 2008, Dr. Syan
completed the Medical Record-Keeping Course.
In February 2011, Dr. Syan was cautioned by the
ICRC to maintain adequate and legible records and
it directed that she complete the Medical RecordKeeping course for a second time and be re-assessed.
In September 2012, Dr. Syan completed the Medical
Record-Keeping course for a second time. Dr. Syan is
currently completing a preceptorship in record-keeping in her non-surgical cosmetic medicine practice
and will be reassessed in this area of her practice
upon completion of the preceptorship.
50
Dialogue Issue 1, 2016
Reasons for Penalty
Counsel for the College and counsel for the member
made a joint submission as to an appropriate penalty
and costs order.
The Committee was satisfied that these core principles of penalty are met with the proposed order, and
accepted the joint submission.
The Committee considered mitigating factors. Dr.
Syan has no prior discipline findings. Also, Dr. Syan
has cooperated with the College investigation. Her
admission to the allegation of professional misconduct has spared witnesses from testifying and has
saved College resources.
However, the Committee was dismayed to learn
that, although Dr. Syan has not been disciplined
previously, there is a history of concerns regarding
her record-keeping. The independent expert retained
by the College identified multiple concerns regarding Dr. Syan’s record-keeping in her review of 25
patient charts and in relation to Patient A. The fact
that she has taken the record-keeping course, now
on two occasions, causes concern for the Committee.
It is very important for all physicians, and especially
those working in a walk-in setting, to have complete,
organized, legible charts so that other health-care
providers who are involved in the patient’s care are
able to rely on what is charted as a useful, accurate,
and complete record of the patient’s condition and
the care provided.
In addition to the charting deficiencies, the College expert identified far-reaching concerns regarding Dr. Syan’s general care of patients, her research
study practices and a failure to maintain the standard
of practice in failing to order an X-ray to rule out
a fracture in relation to Patient B. These pervasive
concerns call for a serious sanction.
The significant penalty of a two-month suspension
of Dr. Syan’s certificate of registration will demonstrate to Dr. Syan, and the profession as a whole,
the seriousness of her failure to meet the standard of
care of the profession. The public reprimand ordered
serves to denunciate the misconduct.
Dr. Syan will have indefinite and significant terms,
conditions and limitations placed on her certificate
of registration. The