On October 11, 2017, the Discipline Committee found that Dr. Rosenhek committed an act of professional misconduct in that has engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all of the circumstances, would reasonably be regarded by members as unprofessional by practicing medicine without clinical supervision, in breach a 2010 Order of the Discipline Committee and contrary to the terms, conditions, and limitations on his certificate of registration.
Dr. Rosenhek is a cardiologist with a practice in Toronto, Ontario. Prior to 2016, he also had a practice in Windsor, Ontario.
2010 Discipline Committee Order
On November 8, 2010, the Discipline Committee found that Dr. Rosenhek had committed an act of professional misconduct in that he failed to maintain the standard of practice of the profession in cardiology between 2005 and 2007 in his care of multiple patients by:
a) failing to appropriately manage cardiac risk factors, such as dyslipidemia, and to prescribe appropriate therapy to reduce such risk;
b) failing to perform indicated investigations;
c) failing to diagnose medical conditions appropriately and in a sufficiently timely manner;
d) failing to appropriately monitor and/or ensure monitoring of complications of medications;
e) failing to monitor and act upon test results in an appropriate and sufficiently timely manner;
f) failing to engage in appropriate discharge planning for patients in the hospital, including failing to make appropriate and necessary arrangements for care and follow-up; and/or
g) failing to maintain legible and sufficiently detailed records of his care and treatment of patients.
The Discipline Committee ordered that the Registrar impose the following terms, conditions and limitations on Dr. Rosenhek’s certificate of registration for an indefinite period of time:
i) Dr. Rosenhek shall practise only under the supervision of a Clinical Supervisor retained at his own expense and approved by the College, and will abide at his own expense by all recommendations of his supervisor with respect to his practice, including with respect to any practice improvements and/or ongoing professional development and/or education;
ii) If, at any time after 24 months have passed since the commencement of the clinical supervision of his practice, Dr. Rosenhek’s clinical supervisor is of the opinion that Dr. Rosenhek is ready to practice without clinical supervision, such clinical supervision shall be discontinued only upon:
a. an assessment of Dr. Rosenhek’s practice, undertaken by a College-appointed assessor; and
b. at Dr. Rosenhek’s expense, the results of which are satisfactory to the College; and the approval of the College.
Terms of Clinical Supervision
As a result of the November 8, 2010 Discipline Committee Order, Dr. Rosenhek engaged a Clinical Supervisor, who undertook to act as Clinical Supervisor for Dr. Rosenhek, for the duration of at least 24 months. After 3 months of clinical supervision, the level of supervision could be varied at Clinical Supervisor’ discretion and with the approval of the College, provided that clinical supervision continued for at least 24 months in total. The Clinical Supervisor agreed to submit a written report to the College on a monthly basis for the duration of the clinical supervision.
The Clinical Supervisor further agreed that at any time after 24 months, if he is of the opinion that Dr. Rosenhek is ready to practise without clinical supervision, he shall advise the College of this so that the College may arrange for a practice reassessment to be conducted by an assessor of its choice. In such a case, the clinical supervision was not to terminate unless and until: (a) the College receives, evaluates, and is satisfied by the results of the practice reassessment; and (b) the College provides its approval for the termination of clinical supervision of Dr. Rosenhek’s practice.
Clinical Supervision and Breach of the 2010 Discipline Committee Order
The Clinical Supervisor provided the College with supervision reports during the period from January 14, 2011 to August 15, 2014.
On May 16, 2011, the Clinical Supervisor recommended that the number of patient charts reviewed per week be reduced from 10 to 5. The College agreed to this change on May 31, 2011. This was the only variation of the terms of Dr. Rosenhek’s clinical supervision for which permission was sought from the College, and the only variation approved by the College.
On December 8, 2011 and on June 20, 2012 the College advised the Clinical Supervisor that his reports did not contain enough information to determine whether Dr. Rosenhek was practising within the standard of practice, and requested that his future reports contain more fulsome information.
On September 6, 2012, the Clinical Supervisor reported that Dr. Rosenhek has made tremendous improvements in his practice and that he is at the point to practise without clinical supervision. The College responded on October 15, 2012, indicating that pursuant to the Discipline Committee Order, the 24-month period of clinical supervision is calculated from the time the supervision commences, and, therefore, the earliest date on which Dr. Rosenhek’s supervision could potentially end is on a date after November 2012.
On January 10 and April 11, 2013, respectively, the Clinical Supervisor reported that in his opinion the chart reviews could be eliminated and that he believes that it would be appropriate to end this ongoing review.
The College responded on June 13, 2013, indicating that pursuant to the Discipline Committee Order, the clinical supervision must continue until Dr. Rosenhek undergoes reassessment by the College and the discontinuation of the supervision is approved by the College following a review of the assessor’s report. The College informed the Clinical Supervisor that the review was being arranged and that it could take six months to complete, during which time he was to provide supervision of Dr. Rosenhek’s practice, until the College approves discontinuation of supervision.
The College was in correspondence with Dr. Rosenhek from July 2013 to March 2014 in an attempt to schedule practice reassessment. Dr. Rosenhek’s practice reassessment proceeded in March 2014.
On April 9, 2014 and on April 11, 2014, the Clinical Supervisor reported to the College that he has provided clinical supervision of Dr. Rosenhek’s practice since November 2010, and that it was his understanding that the supervision would last for 24 months, until November 2013. He indicated that he had no concerns with Dr. Rosenhek’s practice, that there is no further value in continuing to do reviews of Dr. Rosenhek’s records, and that he believes that he had completed his initial agreement with the College.
On April 9, 2014, the College wrote to the clinical supervisor, indicating that Dr. Rosenhek is expected to practise under supervision until his practice reassessment is completed, that Dr. Rosenhek is currently in the process of submitting the information required for the reassessment and to continue to provide supervision as per his undertaking until the reassessment is completed and the College communicates approval of its discontinuation. On July 30, 2014, the College wrote to the Clinical Supervisor to provide him with templates for his future reports and requesting that he completed and submitted the reports each month.
The Clinical Supervisor’s last supervision report dated July 16, 2014 was received by the College on August 15, 2014. On August 25, 2014, the College wrote to the Clinical Supervisor requesting him to submit the August 2014 report, but no response was received .
Following the College’s inquiry during the practice reassessment as to whether Dr. Rosenhek’s practice is still under the clinical supervision as per the 2010 Discipline Committee’s Order, Dr. Rosenhek’s counsel informed the College on October 8, 2015 that the Clinical Supervisor had not received the College’s letter of August 25, 2014 and that the Supervisor was of the understanding that no further reports were required of him, and that he advised Dr. Rosenhek that ongoing supervision was not required as he had fulfilled his undertaking. Dr. Rosenhek’s counsel further indicated that the Clinical Supervisor now recognizes that he wrongly interpreted his obligations under his undertaking and that he regrets his error.
On October 3, 2017, Dr. Rosenhek advised the College that following the College’s letter of September 15, 2015, he has sent copies of his patient charts to the Clinical Supervisor for the period from August 2014 to August 2015, and that he continued to periodically provide his records from September 2015 until approximately March 2016.
After July 2014, Dr. Rosenhek continued to practise medicine without supervision, in breach of the requirements in the 2010 Discipline Committee Order; he did not meet and did not follow-up with the Clinical Supervisor to determine if he was reviewing the patient charts that he resumed sending to the Supervisor after September 2015.
The College did not advise either the Clinical Supervisor or Dr. Rosenhek that supervision was no longer required. The College repeatedly advised the Clinical Supervisor that his clinical supervision of Dr. Rosenhek was to continue until he was advised by the College that it approved of the discontinuation of supervision. The College never approved the discontinuation of Dr. Rosenhek’s supervision. Dr. Rosenhek did not attempt to confirm with the College whether his apparent understanding, or the Clinical Supervisor’s apparent advice, that supervision was no longer required, were correct. Similarly, at no time did Dr. Rosenhek bring a motion to vary the terms of the 2010 Discipline Committee Order to permit him to return to unsupervised practice.
Prior Dispositions by the Complaints Committee
In November 2003, the Complaints Committee of the College required Dr. Rosenhek to attend at the College to be cautioned when aspects of his practice, and his response to a College complaint, were found to be concerning. Dr. Rosenhek was cautioned with regard to, among other things, the intemperate nature of his response to the patient complaint, the “threatening and intimidating tone” of which the Committee found to be “unnecessarily belligerent in the extreme”.
In June 2004, the Complaints Committee of the College required Dr. Rosenhek to attend at the College to be cautioned regarding his professional communications.
In October 2006, the Complaints Committee of the College cautioned Dr. Rosenhek regarding his communications with patients and the importance of maintaining a professional and courteous demeanour.
In December 2008, the Complaints Committee of the College required Dr. Rosenhek to attend at the College to be cautioned regarding his professional attitude and demeanour in interacting with a patient, and the importance of understanding the fundamental nature of positive and effective communications
with patients.
2013 Discipline Committee decision
On October 21, 2013, the Discipline Committee found that Dr. Rosenhek had 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 for:
- falsely representing himself as a member of the Royal College of Physicians and Surgeons of Canada and using the “FRCP(C)” designation when in fact he was not in good standing with the Royal College because of his failure to pay fees and his failure to report his continuing medical education hours pursuant to the Royal College’s Maintenance of Competence (“MOC”) program, between December 1986 when was removed from the register of Fellows in good standing with the Royal College because of his failure to pay annual dues and November 2008 when he paid his dues; and
- providing incomplete and inaccurate information to the Windsor Regional Hospital (where he held privileges) as part of its credentialing/re-appointment process regarding his compliance with a program of continuing medical education between 2006 and 2008.
As a result, Dr. Rosenhek was required to appear before the panel to be reprimanded, and to pay costs to the College.
March 23, 2016 Undertaking in lieu of s. 37 Order
On March 23, 2016 and on July 21, 2016 Dr. Rosenhek entered into interim undertakings with the College, which remained in effect until the date the Discipline Committee disposed of his discipline case.
Dr. Rosenhek undertook, among other things, to limit his practice to an initial maximum of the equivalent of two days per month, which limit was later raised to three days per month. He also agreed to practice under the supervision of a Clinical Supervisor acceptable to the College, who was required to meet with Dr. Rosenhek once per month to review at least ten patient charts from the equivalent of each full day of patient care provided by Dr. Rosenhek, and to submit written reports to the College at least once every two months.
As a result of the interim undertakings, Dr. Rosenhek practised under the supervision of a different Clinical Supervisor, beginning March 23, 2016. In early 2017, the new Clinical Supervisor advised that he would be discontinuing his supervision of Dr. Rosenhek’s practice as of April 30, 2017. Dr. Rosenhek was not able to locate a replacement supervisor. Dr. Rosenhek has not practiced medicine since May 1, 2017.
No concerns regarding Dr. Rosenhek’s compliance with the interim undertakings have been identified by either the Clinical Supervisor or the College’s compliance monitor.
October 11, 2017 Undertaking
Dr. Rosenhek has entered into an undertaking with the College, dated October 11, 2017, by which he has agreed, among other things, that he shall see a maximum of three patients per hour.
On October 11, 2017, the Committee ordered and directed that:
- the Registrar suspend Dr. Rosenhek’s certificate of registration for a period of one (1) month commencing on October 12, 2017.
- Dr. Rosenhek appear before the panel to be reprimanded.
- Dr. Rosenhek pay costs to the College in the amount of $5,500.00 within 30 days of the date of this Order.
- the results of this proceeding be included in the register.
Terms and conditions imposed on certificate by: Member
