DISCIPLINE SUMMARIES
DR . WAGDY ABDALLA BOTROS
PRACTICE LOCATION : Kitchener AREA OF PRACTICE : Psychiatry ( Sleep Medicine )
HEARING INFORMATION : Allegations Denied ; Contested Five-Day Hearing
On March 7 , 2016 , the Discipline Committee found that Dr . Botros committed acts of professional misconduct , in that he failed to maintain the standard of practice of the profession , and 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 . The Committee found that Dr . Botros failed to maintain the standard of the profession with respect to sleep medicine in his care of two patients . The Committee also found that Dr . Botros engaged in disgraceful , dishonourable , or unprofessional conduct in relation to his delay in providing records to and in his manner of communication with a personal injury law firm ’ s request for information .
Patient A The Committee found that Dr . Botros failed to properly treat Patient A ’ s condition of obstructive sleep apnea in 1998 . The Committee accepted Dr . Z ’ s expert evidence that Dr . Botros did not meet the expected standard of care because Dr . Botros failed to explore alternatives to Patient A ’ s obstructive sleep apnea treatment after the initial CPAP trial was unsuccessful due to a poorly-fitting mask . Dr . Z ’ s evidence , that this problem was easily correctable , was demonstrated by Patient A ’ s subsequent successful use of a CPAP device with a custom fitting mask under Dr . V ’ s direction . Untreated obstructive sleep apnea exposes the patient to the risk of harm .
Patient C The Committee found that Dr . Botros failed to respond adequately to a developing emergency when Patient C ’ s CPAP machine broke in August 2013 , thus leaving her severe obstructive sleep apnea untreated and exposing her to a risk of harm .
Patient C had first been diagnosed with obstructive sleep apnea in 2003 . She had subsequently visited sleep clinics in various Ontario cities before moving to an area northwest of the city where Dr . Botros had his sleep clinic . Following her move , Patient C was unable to maintain contact with her previous sleep specialist . She had continued to use her CPAP device as previously prescribed . Patient C was referred to Dr . Botros ’ sleep clinic in order to have her CPAP treatment reassessed . She was first seen at the clinic in May 2013 when she had a CPAP titration study . Patient C ’ s May 2013 CPAP titration study confirmed that she has obstructive sleep apnea and indicated that the optimal pressure for her CPAP machine would have been 14 to 15 cm H 2
O . This study forms part of Patient C ’ s clinical record at Dr . Botros ’ sleep clinic . Dr . Botros never personally saw Patient C . Patient C was scheduled to see Dr . Botros to discuss the results of her study and to have her clinical status evaluated after her May 2013 CPAP titration study . Because the clinic had a long waiting list , Patient C ’ s appointment to see Dr . Botros was scheduled for February 2014 – over eight months after her CPAP titration study . Patient C ’ s status changed suddenly when her CPAP machine broke and was no longer usable . Without the CPAP machine , Patient C testified that she immediately started having problems : she was unable to sleep at night ; she could only nap for short periods of time while sitting up ; she felt exhausted during the day ; she felt like she was drunk ; and she had to stop driving , which caused her difficulty because she was caring for three children at home and was responsible for carpooling other children . In August 2013 , Patient C called Dr . Botros ’ sleep clinic to ask for assistance . Patient C testified that she called several times , and spoke to two different people at the clinic . She attempted to convey to them the urgency of her situation . She asked if she could be put on an urgent cancellation list to be seen quickly , or if the doctor could communicate with a CPAP provider to prescribe a new machine for her . Patient C testified that the responses she received from Dr . Botros ’ sleep clinic were extraordinarily unhelpful . She felt that her concerns were not be-
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DIALOGUE ISSUE 1 , 2018