Dialogue Volume 14 Issue 2 2018 - Page 69

DISCIPLINE SUMMARIES resigned his position in April 2017 following a refer- ral of this matter to the Discipline Committee of the College. Dr. Ghumman received his medical degree in Paki- stan in 1982 and a specialist qualification in general surgery in Ireland in 1991. In 1999, Dr. Ghumman obtained a certificate of independent practice in Newfoundland and received his specialist qualifica- tion in general surgery in Canada in 2004. In 2007, Dr. Ghumman received his certificate of independent practice in Ontario. PATIENT X In June, 2015, Patient X complained to the Col- lege regarding Dr. Ghumman’s care in conducting her laparoscopic gallbladder removal surgery and his post-operative care. Several months prior to the complaint, Dr. Ghum- man assessed Patient X for symptomatic gallstones. He explained to Patient X her treatment options, discussed the potential risks and benefits of surgery, and obtained Patient X’s informed consent for a laparoscopic gallbladder removal surgery, which was scheduled for the following month. On the day of the surgery, Dr. Ghumman discussed the surgical plan with Patient X in the day surgery area at the hospital. During the surgery, the clip applier that Dr. Ghum- man applied on Patient X’s cystic artery unexpect- edly jammed and could not be pulled off as it could damage an artery. Dr. Ghumman considered convert- ing to an open procedure, but decided to continue laparoscopically and to take steps to divide the cystic artery in order to remove the jammed clip applier. Following the anesthetist’s suggestion to use Filshie clips, which are applied with a narrower clipper than other clips, Dr. Ghumman proceeded to place a Filshie clip, but was concerned that he might have mistakenly placed it on the common bile duct or the right hepatic artery. Dr. Ghumman directed nurses to make several telephone calls, but could not find a way to remove the Filshie clip without risking torn vessels or tearing the bile duct. He continued with the procedure and applied another Filshie clip on the cystic artery, which al- lowed him to divide the cystic artery and remove the jammed clipper. Dr. Ghumman removed the gallbladder, which tore during removal, placed a drain and completed the surgery. He noted in his Operative Report that if a clip is on a common bile duct, he may have to refer Patient X to a hepatobiliary surgeon. Following the surgery, Dr. Ghumman told Patient X that the surgery went well. He indicated that he encountered a complication when the clipper jammed, which he was then able to remove, but was concerned that he might have placed a clip on her right hepatic artery or common bile duct. Patient X was discharged home the same day with instructions for monitoring and to return two days later for a CT scan and to remove the drain placed during surgery. When Patient X returned two days later, she reported feeling unwell, was in pain, and was hav- ing trouble eating. Dr. Ghumman discussed the results of Patient X’s CT scan with a radiologist at the hospital, who opined that Patient X’s common bile duct looked normal and indicated that no clip was visualized on the common bile duct. Dr. Ghum- man reported to Patient X’s family doctor that he had a small incident during surgery but that he was satisfied, after the CT scan, that the clip was not on the common bile duct. He indicated that he was concerned because he had applied the clip “a little bit blind”, but now felt the clip was on tissues along the gallbladder, which was not a problem. Dr. Ghum- man decided not to remove the drain that day and instructed Patient X to return three days later for removal of the drain and follow up tests. When Patient X returned to Dr. Ghumman for drain removal three days later, she reported feeling itchy, was unable to eat, and her complexion was jaundiced. The next day, Dr. Ghumman telephoned Patient X and informed her that according to her blood work results her bilirubin was high. Elevated bilirubin levels may cause jaundice and may indicate problems with the liver or bile duct, and may also account for the type of itching experienced by Patient X. Dr. Ghumman advised Patient X to drink plenty of fluids to stay well hydrated and call his office if her condi- tion worsened. In two days, Patient X contacted Dr. Ghumman and complained of increased itching. He booked an ISSUE 2, 2018 DIALOGUE 69