Dialogue Volume 14 Issue 2 2018 - Page 78

DISCIPLINE SUMMARIES DR. PATRICK WING NIN YAU PRACTICE LOCATION: Toronto AREA OF PRACTICE: General Surgery HEARING INFORMATION: Plea of No Contest; Statement of Uncontested Facts; Joint Submission on Penalty On April 12, 2017, the Discipline Committee found that Dr. Yau committed an act of professional mis- conduct in that he failed to maintain the standard of practice of the profession. Dr. Yau is a general surgeon who received his certificate of registration authorizing independent practice in Ontario in 1998 and has held privileges at Scarborough General Hospital since 1999. In addition, he held the position of a medical direc- tor and practised general surgery, including bariatric surgery, at the Prince Arthur Surgical Centre Inc. (“the clinic”), an out-of-hospital premises, located in Toronto, which offered weight loss surgical pro- cedures, including adjustable laparoscopic gastric banding. The clinic ceased operations as of March 22, 2017. Patient A In November 2013, Patient A attended at the clinic for bariatric surgery with Dr. Yau. Prior to meeting Dr. Yau in 2013, Patient A had two previous bariatric surgeries. At the time of her initial surgery, Patient A had a body mass index (BMI) of 41 and was morbidly obese. In a pre-surgery questionnaire, Patient A indicated that she hoped to reduce her BMI to 21. She also participated in a telephone pre-surgical consulta- tion with a clinic nurse, during which her BMI was noted to be 26, based on her self-reported weight and height. In addition, prior to surgery, Dr. Yau conducted a telephone consultation with Patient A, as she resided in another province, but did not note Patient A’s BMI at the time. On the day of the surgery, Patient A was weighed by clinic staff. Her BMI was recorded as being 24.9, which is 10 lbs. less than the weight she self-reported during the telephone pre-surgical consultation with a clinic nurse, and is considered to be in the normal range. 78 DIALOGUE ISSUE 2, 2018 Patient A consented to the gastric banding sur- gery and Dr. Yau attempted the surgery on that day. However, the surgery could not be completed due to many dense adhesions that made dissection diffi- cult. A tiny perforation was diagnosed and surgically repaired. The surgery was aborted, a drain was placed and the patient was sent to the hospital for observa- tion. She was ultimately discharged home without complications. The College retained an expert in bariatric surgery lap-band procedures and laparoscopy who opined that Dr. Yau fell below the standard of practice of the profession in deciding to perform the gastric band- ing surgery on Patient A when the bariatric surgery was not indicated given this patient’s normal BMI. The expert further noted that Dr. Yau’s decision to proceed with surgery exposed the patient to potential harm or injury, particularly given the risk that the patient’s well-functioning gastric bypass could be damaged during surgery. During the investigation, Dr. Yau advised the College that he missed the BMI noted as 24.9 on a computerized printout from an assessment done on the day of surgery and, inadvertently, proceeded with the surgery based on the initial numbers. Dr. Yau also advised the College that he has since, on his own initiative, implemented a number of changes to his practice, including improved documentation of patient discussions and indications for surgery, dicta- tion of pre-operative notes and scrutinization of all patients’ vitals, including morphological values, BMI, height and weight on the surgery day. Patient B In January 2012, Patient B attended the clinic for a laparoscopic gastric banding procedure to assist him in losing weight. In addition to obesity, Patient B suffered from Type 1 diabetes and hypertension, both of which were medically controlled. During Patient B’s post-surgery overnight stay in the clinic, the nurses documented abnormal and high glycemic results. At the time of his discharge from the clinic the next morning, Patient B’s blood sugar and glucose levels were not verified or recorded by the clinic nurse. Following his discharge from the clinic, Patient B boarded a plane as he resided in a different prov- ince. Upon landing, he checked into a hotel and was