Dialogue Volume 14 Issue 1 2018 - Page 58

DISCIPLINE SUMMARIES and an inability to walk. Patient A was admitted to hospital in early No- vember 2010, where she was diagnosed with a severe allergic reaction to the Allopurinol, Toxic Epidermal Necrolysis. A College-retained expert opined that Dr. Kakar’s care of Patient A failed to maintain the standard of practice and displayed a serious lack of knowledge and judgment as follows: • Dr. Kakar’s prescribing of Allopurinol for gout arthritis was outside of his scope of practice and inappropriate; • Dr. Kakar inappropriately minimized the serious- ness of Patient A’s concerns after she experienced a reaction to Allopurinol; • Dr. Kakar’s records of his treatment of Patient A failed to maintain the standard as the vast major- ity were illegible; and • Dr. Kakar’s prescription of Allopurinol to Patient A seriously harmed her and put her at life-threatening risk. A second College-retained expert opined that Dr. Kakar’s failure to conduct an adequate clinical exami- nation, prior to diagnosis and prescribing of Allopu- rinol, failed to maintain the standard of practice and that he demonstrated a lack of knowledge, skill and judgment. Misleading College During Investigation In his January 15, 2013 response to Patient A’s complaint, Dr. Kakar stated to the College that he prescribed Allopurinol for Patient A at an appoint- ment in late October 2010. He also provided a copy of his chart for Patient A which indicated that there was a discussion about Allopurinol on that date in late October 2010, and that Dr. Kakar prescribed the medication on that day. Subsequently, after the College provided Dr. Kakar with information indicating that the complainant had filled the prescription in early October, Dr. Kakar claimed that he relied on his chart when he responded to the complaint, and since the reference to the discus- sion about Allopurinol was recorded in the chart for the appointment in late October, he had presumed that was when he prescribed the medication. He said it must have been a late entry from October of 2010 58 DIALOGUE ISSUE 1, 2018 which he had failed to indicate as such. Then, in May of 2013, Dr. Kakar’s counsel wrote to the College and admitted that Dr. Kakar had added the note in Patient A’s chart about Allopurinol after he received the complaint from Patient A, in October 2012, not in October of 2010, as he had claimed in his communication to the College. Patient B In January 2013, the College received a complaint about the psychiatric care provided by Dr. Kakar to a teenage girl, Patient B, in the fall of 2012. A College-retained expert concluded that Dr. Kakar failed to meet the standard of care in his record keep- ing for Patient B as follows: • D  r. Kakar’s original office notes are illegible and needed to be transcribed in order for her to read them; • Two of Dr. Kakar’s progress notes, dated August 2012 and September 2012, were identical. This failed to reflect the true progression, or lack of progression, of Patient B’s response to treatment; and • D  r. Kakar’s failure to document a rationale in his progress note of September 2012, for increasing the patient’s dosage of Cymbalta to 30 mg three times a day. It was also determined that Dr. Kakar made an error in his September 29, 2012 entry in Patient B’s chart when he recorded a prescription for Cymbalta three times a day (t.i.d.), when he actually intended to prescribe it two times a day (b.i.d.), as written on the prescription. Section 75.1(A) Investigation A College-retained expert reviewed Dr. Kakar’s care and treatment of 24 patients in his psychiatric practice and noted the following about his record- keeping: • D  r. Kakar’s charts have insufficient documenta- tion of the progress of his patie ¸(Z\&\\Z[Y\]X][HY[YHB][ۘ[H܈X]Y[[[]Y\¸(Z\&\\Z[Y\]X][H[\]]Y[Y\[H[\ܙ\Y\[\و[Z\H܈ۚ]]