On February 12, 2020, the Discipline Committee (the “Committee”) of the College of Physicians and Surgeons of Ontario held a hearing on specified allegations regarding Dr. Paul Russell Hanson (“Dr. Hanson”), and reserved its decision.
In April 2020, the Committee heard Dr. Hanson’s motion to re-open the penalty phase of the hearing in order that Dr. Hanson could tender into evidence the Reassessment Report of Dr. Mamdouh Andrawis dated February 29, 2020 (the “Andrawis Reassessment Report”), and permitting the parties to make submissions regarding the Andrawis Reassessment Report. By order dated April 6, 2020, the Committee granted the relief sought and subsequent received and considered the Andrawis Reassessment Report and the parties’ further submissions.
On May 8, 2020, the Committee released its finding that Dr. Hanson committed an act of professional misconduct in that he
- failed to maintain the standard of practice of the profession
- has engaged in conduct or 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
- has been found guilty of an offence that is relevant to his suitability to practise.
In its decision, the Committee also set out its penalty and costs order.
Dr. Hanson is 61 years old. He first received his certificate of registration authorizing independent practice from the College in 1992, and is a general practitioner with offices in Windsor and Chatham, Ontario.
File #7212620
In 2010, Dr. Hanson was charged with having committed fraud over $5,000, contrary to s. 380(1) of the Criminal Code of Canada. It was alleged that Dr. Hanson had defrauded OHIP and the Ministry of Health and Long-Term Care (“MOHLTC”) by billing OHIP for insured services not provided. On August 26, 2010, Dr. Hanson was interviewed by police.
On May 9, 2013, in the Ontario Court of Justice, the criminal charge of fraud over $5,000 was withdrawn, after Dr. Hanson pleaded guilty to an offence under s. 37.1(1) of the Health Insurance Act for failing to maintain records as may be necessary to establish whether he provided an insured service to a person between January 1, 2000 and February 4, 2009. Upon being convicted of the s. 37.1(1) offence, Dr. Hanson was ordered to pay $2,500 in restitution and a $7,500 fine.
1
At the guilty plea to the s. 37.1(1) offence on May 9, 2013, the following facts were
agreed:
-The investigation began with the MOHLTC providing information to the OPP Anti-Rackets Health Fraud Investigation Team in September, 2007. The MOHLTC’s focus was billing combinations submitted by Dr. Hanson between January 2000 and February 2008 with respect to four separate insured services for the same patient on the same service date: general assessments, sigmoidoscopies, pulmonary function tests, and EKGs.
-With respect to sigmoidoscopies, numerous patients interviewed by police stated they did not have the sigmoidoscopy procedure for which Dr. Hanson had billed. For the patients who were interviewed, the OPP determined that the total for services not rendered but billed by Dr. Hanson totaled $5,048. When Dr. Hanson was interviewed by police, he stated that when he performed sigmoidoscopies, it was rarely necessary for him to insufflate (activate the air pump on the sigmoidoscope). This was an acknowledgment that he did not necessarily complete the full procedure that was required.
-A preliminary hearing was conducted. Approximately 40 witnesses testified. Many witnesses testified that they did have a sigmoidoscopy, which was not in accordance with what they had told the OPP or what they had submitted to the OHIP through verification letters. Many of the patients who had originally indicated that they had not received sigmoidoscopies were misled by the erroneous indication on the questionnaires that a sigmoidoscopy is “a procedure whereby a laxative is required”. Others at the preliminary hearing testified that they did have rectal exams, but they could not testify with any certainty as to whether it was a digital exam, a sigmoidoscopy or simply any other type of rectal examination, and the evidence was tenuous as to whether the procedure was performed. Lastly, there were witnesses who testified unequivocally that no such rectal exam had been rendered by Dr. Hanson.
-It was determined (by the Crown) after a thorough analysis of the witness testimony from the preliminary hearing that, on the basis of what could be proven to a criminal standard, Dr. Hanson owed approximately $2,500 to MOHLTC in restitution for services billed but not rendered.)
-As it pertains to sigmoidoscopy procedures, Dr. Hanson did not maintain accurate patient records necessary to establish whether or not he in fact had performed the insured service to the person.
File #7214569
2
In light of the issues raised in the matter resolved in the Ontario Court of Justice on May 9, 2013, College investigators were appointed to investigate whether Dr. Hanson, in his general medicine practice, engaged in professional misconduct or is incompetent, with a particular focus on general assessments, sigmoidoscopies, pulmonary function tests, and EKGs.
Two medical inspectors were retained to review 30 of Dr Hanson’s patient charts (15 charts from the 2000 to February 2008 timeframe, and 15 charts after February 2008): Dr. Jerome Jadd, a family physician, and Dr. Jonathan Love, an internist.
Dr. Hanson failed to meet the standard of practice for the profession for record-keeping as set out in the report of Dr. Jadd, whose conclusions included the following:
-Dr. Hanson’s general assessments often consisted of sparse functional inquiries; and often lacked many details such as a review of current problems, medications, therapeutic plans, and responses to treatment; in one patient, recent significant medical events were not reviewed. Dr. Hanson also performed general assessments too soon after a patient’s last general assessment, without documented justification;
-Some Cumulative Patient Profiles were not up to date and lacked information;
-Some of Dr. Hanson’s progress notes did not reflect patients’ ongoing management, and it was often difficult to interpret or follow the patient’s story without reference to consultants’ notes and imaging results. As a result, it can be difficult to appreciate a patients’ significant ongoing issues;
-Dr. Hanson documented using acronyms, the meaning of which were not always clear;
-In documenting prescriptions, Dr. Hanson failed to record the dose, quantity and potential side effects of a narcotic and NSAID; failed to record the name of the medication prescribed; failed to document a discussion regarding overdose potential and other risks in prescribing Elavil, an antidepressant; Dr. Hanson prescribed Champix for smoking cessation to a patient diagnosed with depression, without recording the potential for exacerbation of depression with this medication;
-Some of Dr. Hanson’s notes had inconsistencies, including recording a family history of colon cancer as “no” when it was also documented that the patient’s brother had colon cancer; Dr. Hanson recorded that a patient had been a six pack year smoker and quit three years earlier on the CPP, and recorded “Smoker N prev” in the note of a functional inquiry;
3
-Dr. Hanson failed to record follow-up on test results received (such as a head CT) or on conditions arising at prior visits (such as leg swelling/cellulitis treated in the ER); and
-Some of Dr. Hanson’s psychosocial notes were too sparse.
Dr. Hanson failed to meet the standard of practice for the profession for patient care as set out in the report of Dr. Jadd, whose conclusions included the following:
-Performing pulmonary function tests without indication in 6 patients, and incomplete charts displaying a lack of indication in 3 patients;
-Performing EKGs without indication in 4 patients, and incomplete charts displaying a lack of indication in 2 patients;
-Interpreting pulmonary function tests in 19 charts which lacked written pulmonary function interpretation and related documentation; and
-Interpreting EKGs in 18 charts as these lacked written interpretation of the tests and related documentation of same.
Dr. Hanson displayed a lack of judgment as set out in the reports of Dr. Jadd and Dr. Love, whose conclusions in this regard included the following:
-Performing general assessments, EKGs, spirometry without indication;
-Performing diabetes checks on two patients when the blood work did not support a diagnosis of diabetes.
-Failing to adequately document a patient’s complaint of new onset chest pain with left arm numbness. His history-taking, examination, assessment and plan did not meet the standards expected. The potential seriousness of the complaint did not appear to have been appreciated by Dr. Hanson.
-Inconsistency in the medical record of the patient’s complaint of shortness of breath but active lifestyle including exercising by bike 7 times a week and normal respiratory systems on review.
-Prescribing an NSAID to a patient despite cautionary comments made by a nephrologist and treated this same patient who has chronic severe kidney disease for a urinary tract infection twice without sending urine for culture and sensitivity.
Dr. Hanson failed to meet the standard of practice of the profession with respect to patient care as set out in the report of Dr. Love, whose conclusions in this regard included the following:
4
-Dr. Hanson failed to meet the standard of care with respect to documenting sigmoidoscopies in 17 of 30 charts, and demonstrated a lack of skill in documentation in 2 charts;
-Dr. Hanson lacked knowledge and judgement in 13 charts in the area of medical record keeping and standard terminology; failure to workup rectal bleeding in patients over 50; proper use of fecal occult blood testing; and management in colo-rectal polyps;
-Performing sigmoidoscopies without indication in 7 patients, thereby subjecting these patients to unnecessary intrusive testing;
-There was a risk of harm in 9 patients as it pertains to rigid sigmoidoscopies only regarding the potential risk of a missed lesion when not properly referred for colonoscopy, and a delay in treatment.
File #99430
In September 2015, Ms A complained to the College about an appointment her daughter, Patient B, had had at Dr. Hanson’s Chatham office on August 27, 2015 for the administration of a vaccine. In her complaint, Ms A stated the vaccine had been administered by a female staff member, and not Dr. Hanson.
In responding to this complaint, Dr. Hanson provided inconsistent, inaccurate and misleading information to the College regarding:
- The identity of the person who administered the vaccine; and
- The charting with respect to Patient B’s appointment.
In his responses to the College, Dr. Hanson claimed that he had administered the vaccine to Patient B. In fact, the vaccine was administered by his receptionist, Emily Lindsay.
Dr. Hanson provided the College with a typewritten patient encounter note for Patient B’s appointment. In his initial responses to the College, Dr. Hanson claimed that he had made this patient encounter note contemporaneously, but that he had done so outside of the Electronic Medical Record (“EMR”), and that he arranged for his receptionist to scan it into EMR. Initially, Dr. Hanson advised the College that he was unable to recall the specific circumstances regarding why he had created the chart note outside of the EMR. Finally, in a subsequent response to the, Dr. Hanson admitted that the note had not been made contemporaneously, and that he had created it after he received notice of Ms A’s complaint when he realized that there was no patient encounter note for that visit. Further, he finally acknowledged that the note did not originate from the EMR, and had never been scanned into the EMR.
During the College investigation, the receptionist advised the College that Dr. Hanson approached her and asked her “take responsibility for the mistake with the chart note”.
5
PART II - ADMISSION
Dr. Hanson admits the facts at paragraphs 1 to 16 above, and admits that, based on these facts, he engaged in professional misconduct:
-under paragraph 1(1)2 of Ontario Regulation 856/93 made under the Medicine Act, 1991 (“O. Reg. 856/83”), in that he has failed to maintain the standard of practice of the profession;
-under paragraph 1(1)33 of O. Reg. 856/83, in that he has engaged in conduct or 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; and
-under clause 51(1)(a) of the Health Professions Procedural Code which is Schedule 2 to the Regulated Health Professions Act, 1991, S.O. 1991, c.18, in that he has been found guilty of an offence that is relevant to his suitability to practise.
PENALTY AND COSTS
On May 8, 2020, the Discipline Committee ordered:
- Dr. Hanson is to attend before the panel to be reprimanded
- The Registrar is to revoke Dr. Hanson’s certificate of registration, effective immediately
- Dr. Hanson is to pay costs to the College in the amount of $6,000.00 within 30 days of the date of this Order.
APPEAL
On May 25, 2020, Dr. Hanson appealed the Discipline Committee’s decision on penalty to the Divisional Court.
DIVISIONAL COURT DECISION
On January 27, 2021, the Divisional Court released a decision dismissing Dr. Hanson’s appeal from the Discipline Committee’s May 2020 decision. The effect of the Divisional Court’s decision is that the Discipline Committee’s May 8, 2020 penalty order is in effect.
Terms and conditions imposed on certificate by: Discipline Committee