Dialogue Volume 13 Issue 3 2017 - Page 69

DISCIPLINE SUMMARIES • f  ailing to document an appropriate pre-anesthetic assessment or to adequately document intraop- eratively in his care of multiple patients; failing to document discussion of the risks and benefits of invasive procedures with multiple patients and not having any discussion with a patient regarding a transversus abdominis plane (TAPP) block which he later administered; • when administering general anesthesia, inappropri- ately using 100 percent oxygen during the mainte- nance phase as a matter of routine in every case; • failing to organize and prioritize medical issues in two complex patients undergoing emergency surgery; • administering an inappropriately small dose of analgesic to a patient undergoing gynecological surgery, as indicated by the patient’s respiratory rate and end tidal carbon dioxide; and • although Dr. Straka ultimately successfully intu- bated a patient after several attempts due to the pa- tient’s difficult airway, there were concerns regard- ing Dr. Straka’s level of situational awareness. The patient experienced a marked hypertensive response as a result of an inadequate level of anesthesia for the multiple attempts at intubation, and Dr. Straka did not document the difficult airway, including the number of attempts. The College assessor made recommendations, including that Dr. Straka practise under high level supervision with respect to complicated/critically ill patients, that the supervisor be immediately available when conducting airway management, that he en- gage a clinical preceptor for other aspects of his hos- pital practice, and that he take educational courses. Dr. Straka practised under supervision pending the hearing as a result of an interim order. From January to June 2016, the supervisor reviewed and approved of all pre-operative assessments and treatment plans in advance of Dr. Straka providing general anesthesia, and observed intubation in each case. The reports by Dr. Straka’s clinical supervisor were positive. In April 2016, the expert retained by Dr. Straka found that Dr. Straka’s documentation had improved significantly, that his preoperative assessments were complete, and that there were no issues with Dr. Stra- ka’s performance of technical tasks under observation. When observed by this expert, Dr. Straka discussed the risks and benefits of blocks with patients. How- ever, the expert identified that Dr. Straka appeared to have some gaps in his knowledge, that his practice of doing regional anesthesia without monitoring was potentially unsafe, that his reaction to stress could lead to poor judgment, and that his management of complicated cases was an area for improvement. The expert recommended that Dr. Straka not do on-call coverage in anesthesia until completion of ed- ucation and a reassessment, and that he continue to be subject to clinical supervision with pre-operative review of his plans for higher risk patients and the supervisor’s presence at intubation if necessary. The expert stated that the “gaps” in Dr. Straka’s practice were remediable. Nature of the Professional Misconduct The Committee concluded that the evidence demon- strated Dr. Straka’s failure to maintain the standard of practice of the profession. Dr. Straka’s documentation was deficient in pre- anesthetic assessment, discussion regarding risks and benefits of invasive procedures, and recording of intraoperative care in multiple patient records. There were also concerns regarding Dr. Straka’s rou- tine use of 100 percent oxygen when administering general anesthesia, his use of an inappropriately small dose of analgesia as indicated by certain respiratory parameters, and his ability to achieve an adequate level of anesthesia for repeated attempts at intuba- tion. In addition, concern was voiced regarding Dr. Straka’s independent management of complex cases or where patients were critically ill. The Committee noted that Dr. Straka’s deficiencies were serious and constituted a risk to patients. With anesthesiologists, the patient does not usually have a choice of physician. Patients are left to assume that Full decisions are available online at www.cpso.on.ca. Select Doctor Search and enter the doctor’s name. ISSUE 3, 2017 DIALOGUE 69