Dialogue Volume 14 Issue 2 2018 - Page 73

DISCIPLINE SUMMARIES primarily of immigrants from Iran, many of whom spent time regularly in Iran while also seeing phy- sicians there, and that it was difficult to provide comprehensive coordinated care to those patients. He indicated that Dr. Pardis provided care with cultural sensitivity and demonstrated knowledge of the cir- cumstances of their lives. However, the expert found a number of concerns with Dr. Pardis’ practice and that he failed to meet the standard of practice of the profession. Among other things: (a) Dr. Pardis’ record-keeping fell below the standard with respect to eighty percent of the charts he reviewed; (b) Dr. Pardis failed to provide preventive care that met the standard of practice of the profession to his patients in the majority of cases; (c) Dr. Pardis lacked a coordinated approach to chronic disease management; (d) Dr. Pardis did not document having weighed the risks appropriately when prescribing non-ste- roidal anti-inflammatory drugs to patients with cardiovascular risk factors and/or gastrointestinal inflammation, and lacked knowledge regarding these risks; (e) Dr. Pardis did not take steps to provide renal and vascular protection to patients with diabetes; (f ) Dr. Pardis engaged in over-testing and over- screening, including by ordering unnecessary echocardiograms and routine blood and urine testing without justification; (g) Dr. Pardis overprescribed antibiotics for viral ill- nesses; and (h) Dr. Pardis coordinated care poorly with consul- tants regarding medication management. The medical expert found a more immediate risk of harm in four cases, and found that, on balance, Dr. Pardis’ care was “substandard” and represented a potential risk of harm. Methadone Practice As a result of clinical concerns on the part of the College’s Methadone Committee regarding Dr. Pardis’ methadone practice and his ongoing devia- tions from the Methadone Maintenance Treatment Guidelines, Dr. Pardis entered into an undertaking on November 9, 2010, by which he agreed that his methadone practice would be subject to clinical supervision and would be reassessed by a College- appointed assessor. The assessor found that Dr. Pardis failed to meet the standard of practice of the profession regarding three patients, and in his medical record-keeping, which was so deficient that it was not possible to determine in other cases whether his care met the standard of practice of the profession. The assessor also noted concerns regarding Dr. Pardis’ prescribing of testosterone replacement to methadone patients, specifically appropriate dosage and regular monitor- ing of the same in eight cases. In response to the assessor’s concerns, Dr. Pardis indicated that he had made changes to his prac- tice, including only prescribing medications in his methadone practice that are related to methadone treatment and its side effects, sought to improve his counselling of patients about side effects and risks of medications and documenting those discussions, and documented patient counselling. He also advised that he had upgraded his electronic medical record- keeping system to include a methadone module. College History In February 2013, the ICRC of the College con- sidered a report of an investigation into Dr. Pardis’ family practice, which noted deficiencies of care, including in primary prevention. The ICRC ordered Dr. Pardis to undergo a SCERP, which resulted in the preceptorship described above. The ICRC also issued Dr. Pardis a written caution with respect to his record-keeping, which it described as “very deficient,” and provided him with advice about his practice management. Also in February 2013, the ICRC issued a writ- ten caution to Dr. Pardis in a public complaint. The ICRC’s written caution to Dr. Pardis was with respect to compliance with the College policy on Ending the Physician-Patient Relationship and also with respect to practice deficiencies that result in poor patient care, including that: • He should not treat methadone patients for chronic pain; Full decisions are available online at www.cpso.on.ca. Select Find a Doctor and enter the doctor’s name. ISSUE 2, 2018 DIALOGUE 73