On May 15, 2017, the Discipline Committee found that Dr. Kennet Werezak Adams committed an act of professional misconduct in that he failed to maintain the standard of practice of the profession and in that he has engaged in 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.
Dr. Adams received his certificate of registration authorizing independent practice in Ontario in 1983. At the relevant time, he practised medicine in Toronto.
FAILURE TO MAINTAIN STANDARD OF PRACTICE
On January 26, 2014 Patient A complained to the College about the care he received from Dr. Adams.
In August 2010, Dr. Adams provided a serious of four filler injections to Patient A in an attempt to correct hollows in his cheeks resulting from cosmetic procedures (liposuction and fat removal) several years prior with another physician.
For the injections, Dr. Adams used hyaluronic acid that was compounded at a compounding pharmacy as a filler, rather than a filler that was commercially available and approved by Health Canada.
Although Patient A was initially pleased with the result of the injections, the effects dissipated rapidly and the hollows re-appeared. In addition, about three months after beginning the series of injections, Patient A noticed what he described as a “rather ugly, hook or bow-shaped demarcation” above the jaw line on his face. Patient A’s family physician confirmed to the College that Patient A was left with a hard 1 cm mobile lump over his left mandible.
Dr. Adams provided a series of injections of Hyaluronidase, but the attempts to dissolve the lump were unsuccessful.
The College retained an expert certified in dermatology, who concluded that Dr. Adams failed to maintain the standard of practice of the profession in that he displayed a lack of judgment in using a compounded form of hyaluronic acid which is not commercially available. The expert noted that the use of compounded product is not the standard of practice. The expert further noted that perhaps in very rare instances where someone may have allergy to a component of the product, using a compounded product can be considered. However, this comes with risks and patients must be aware of these risks. The expert pointed out that there was no patient consent form in Patient A’s chart and no documentation of potential side effects.
Commercial fillers have labels attached to them and the label is commonly affixed to the patient chart to confirm the dose and brand used and allows for tracking if there is something faulty with the filler. In this case, there was no label because Dr. Adams used a compounded filler.
The expert recommended that Dr. Adams use only commercially available fillers going forward and ensure that the patient records contain a signed consent form in respect of the treatment provided.
DISGRACEFUL, DISHONOURABLE OR UNPROFESSIONAL CONDUCT
On July 20, 2016, the College received a complaint from the Associate Dean of a University, indicating that Dr. Adams had provided a medical note, dated April 22, 2016, for a student, for the purpose of seeking accommodation from an instructor at the University. The student is Dr. Adams’ family member.
The instructor who received the medical note became suspicious, because the note indicated the student was incapacitated during a period in which the student had written an exam and because all possible symptoms had been checked off on the form.
When the instructor telephoned the number indicated on the medical note, which is Dr. Adams’ private cellular telephone number, Dr. Adams confirmed that he had provided care to the student and would continue to do so. Dr. Adams did not reveal the fact that the student was his family member in the initial telephone conversation with the instructor.
In addition to the note dated April 22, 2016, Dr. Adams’ authored four other medical notes for his family member submitted to the University.
In his response to the College investigation, Dr. Adams confirmed that the student is in fact his family member and confirmed that he had written the five medical notes provided to the College by the University. He also confirmed that had provided medical care to his family member.
According to Dr. Adams’ family member’s patient charts dating from April 2010 to December 2013 and from April to July 2016, Dr. Adams provided medical treatment for his family member. In addition, he has provided and billed OHIP for treatment for his family member on two occasions in May and July 2016.
In his response to the College regarding the OHIP billings, Dr. Adams acknowledged that he ought not to have billed OHIP. Dr Adams has repaid OHIP for this improper billing.
The care that Dr. Adams provided to his family member violates professional boundaries and is contrary to professional obligations articulated in College Policy, which prohibits physicians from providing treatment for themselves or family members except:
i) for a minor condition or in an emergency situation, and
ii) when another qualified health-care professional is not readily available.
These conditions were not present when Dr. Adams repeatedly treated his family member.
On May 15, 2017, the Committee ordered and directed on the matter of penalty and costs that:
- The Registrar suspend Dr. Adams’ certificate of registration for a three (3) month period commencing June 3, 2017, at 12:01 a.m.
- the Registrar impose the following terms, conditions and limitations on Dr. Adams’ Certificate of Registration:
Instruction in Medical Ethics
(a) At his own expense, Dr. Adams shall participate in and successfully complete, within 6 months of the date of this Order, individualized instruction in medical ethics satisfactory to the College, with an instructor approved by the College. The instructor shall provide a summative report to the College including his or her conclusion about whether the instruction was completed successfully by Dr. Adams.
Clinical Supervision
(b) Prior to resuming practice following the suspension of his certificate of registration, Dr. Adams shall retain, at his own expense, a College-approved clinical supervisor to review Dr. Adams’ medical record keeping, who will sign an undertaking as the “Clinical Supervisor”;
(c) For a period of six (6) months commencing within thirty (30) days from the date Dr. Adams resumes practice following the suspension of his certificate of registration, Dr. Adams may practice only on terms of the Clinical Supervision set out herein;
(d) Clinical Supervision of Dr. Adams practice shall contain the following elements:
(i) Meet with Dr. Adams on a monthly basis and review a minimum of 15 charts for the duration of the supervision, to be selected in the sole discretion of the Clinical Supervisor;
(ii) the Clinical Supervisor will keep a log of all patient charts reviewed along with patient identifiers; and
(iii) the Clinical Supervisor will provide reports to the College on a monthly basis for the six (6) month period of practice monitoring, or more frequently if the Clinical Supervisor has concerns about Dr. Adams’ standard of practice or conduct.
(e) Dr. Adams shall abide by the recommendations of the Clinical Supervisor;
(f) If a clinical supervisor who has given an undertaking is unable or unwilling to continue to fulfill its terms, Dr. Adams shall, within twenty (20) days of receiving notice of same, obtain an executed undertaking in the same form from a person who is acceptable to the College and ensure that it is delivered to the College within that time;
(g) If Dr. Adams is unable to obtain a clinical supervisor in accordance with this Order, he shall cease to practice until such time as he has done so;
(h) Dr. Adams shall consent to the disclosure by his Clinical Supervisor to the College, and by the College to his Clinical Supervisor, of all information the Clinical Supervisor or the College deems necessary or desirable in order to fulfill the Clinical Supervisor’s undertaking and Dr. Adams’ compliance with this Order;
(i) Dr. Adams shall inform the College of each and every location where he practises including but not limited to hospital, clinics and offices, in any jurisdiction (collectively his “Practice Location(s)), within fifteen (15) days of this order and shall inform the College of any new Practice Locations within fifteen (15) days of commencing practice at that location, for the purposes of monitoring his compliance with this Order.
Re-Assessment
(j) Approximately six (6) months after the completion of the period of supervision as set out above Dr. Adams shall undergo a re-assessment of his medical record keeping by a College-appointed assessor (the “Assessor(s)”).
The Assessor(s) shall report the results of the re-assessment to the College;
(k) Dr. Adams shall consent to the disclosure to the Assessor(s) of the reports of the Clinical Supervisor arising from the supervision, and shall consent to the sharing of all information between the Clinical Supervisor, the Assessor(s) and the College, as the College deems necessary or desirable.
- Dr. Adams be responsible for any and all costs associated with implementing this Order.
- Dr. Adams to appear before the panel to be reprimanded.
- Dr. Adams pay costs to the College for a one day hearing in the amount of $5,500.00 within 30 days of the date of this Order.
Terms and conditions imposed on certificate by: Member