discipline summaries
more inclined to do cervical spine radiography if the patient had come in with a neck collar .
Assessment of cause of fall Dr . X opined that a more comprehensive investigation into the cause of the patient ’ s fall was indicated during her assessment in the ER , including a simple electrocardiogram ( ECG ). He said that the blood work that was done indicated a significant anemia which could have caused a syncopal event but no mention of these findings was made on Dr . Kamermans ’ record . Counsel for Dr . Kamermans pointed out that Dr . Kamermans ’ note on discharge recommends follow up with the patient ’ s family doctor , and a return to clinic if there were any acute changes . Although Dr . Kamermans did not get to the bottom of the reason for the fall , he did address the acute situation by addressing the potential for a subdural hematoma and gave her follow up instructions , he argued . After his interview with Dr . Kamermans , Dr . X was of the opinion that Dr . Kamermans ’ approach to the evaluation and management of this patient demonstrated a lack of knowledge and judgment regarding an appropriate ER evaluation to determine the cause of the patient ’ s chief problem , which was the fall and the reason for the fall . Dr . Y also expressed his concern that the possible causes for the fall were not examined . Both experts mentioned cardiac causes , and Dr . X opined that at the very least an ECG should have been done . Dr . X did not view that the standard of care for the practice of emergency medicine was maintained with regards to this patient encounter , in regard to investigating further the cause of the fall or the possibility of a cervical spine injury . Dr . Kamermans ’ investigation of why this patient fell was rudimentary and failed to maintain the standard of practice in the Committee ’ s view . Although he said that his physical examination of the heart would rule out some cardiac causes of the patient ’ s fall , he did not do an ECG , which both experts acknowledged would have been indicated .
Investigation of possible neck injury Similarly , Dr . Kamermans did not do further x-rays or a CT scan of the patient ’ s neck , which was indicated according to Canadian standards . There is no note that he examined her neck . The Committee finds that Dr . Kamermans was not thorough in his investigation of this patient and his follow up instructions seem to pass the problem off to the family doctor , when it would have been prudent for him to do tests to assess the patient . The Committee finds that Dr . Kamermans failed to maintain the standard of practice regarding a proper evaluation for neck injury . The Committee also finds Dr . Kamermans ’ knowledge and judgment deficient , and that those deficiencies are current .
Patient Charts #’ s 12 , 14 and 22 There was agreement between the parties that these patient records demonstrate charting deficiencies and the Committee finds that the standard of practice was not maintained in these cases in terms of documentation .
Reasons for Penalty College counsel sought revocation of Dr . Kamermans ’ certificate of registration , a reprimand , and costs of $ 4,460 per day for nine days , for a total of $ 40,140 . Counsel for Dr . Kamermans submits that the following sanctions would fulfill the penalty principles : a restriction on his certificate of registration to not practise emergency medicine ; additional terms and conditions with respect to his family practice , including attendance at a record keeping course , an individualized education plan , working with a practice monitor for one year , a reassessment ; and a reprimand . In 2013 , Dr . Kamermans admitted and the Discipline Committee found that he committed an act of professional misconduct in that he failed to maintain the standard of practice of the profession with regard to his family practice . The Discipline Committee ordered a reprimand and directed that the Registrar impose terms , conditions and limitations on Dr . Kamermans ’ certificate of registration , at his own cost , including :
• the appointment of a preceptor for one year , whose responsibilities included monthly chart review , meetings with Dr . Kamermans and reports to the
60
Dialogue Issue 1 , 2017