On June 3, 2013, Dr. Padamjit Mohan Singh admitted before the Discipline Committee that she is incompetent and that she failed to maintain the standard of practice of the profession in respect of three patients. On the basis of an Agreed Statement of Facts, the Discipline Committee found that Dr. Singh is incompetent and engaged in professional misconduct, in that she failed to maintain the standard of practice of the profession.

Dr. Singh is an Obstetrician and Gynaecologist. After concerns were raised regarding Dr. Singh's ability to cope in emergency situations while on call at the hospital where she worked, Dr. Singh entered into an agreement with the hospital, the terms of which included the following:
a) Dr. Singh withdraws her reapplication for Active Staff privileges and applies for Courtesy Staff privileges only;
b) Dr. Singh will be granted privileges to work as a surgical assistant at the hospital;
c) Dr. Singh will be granted privileges to work in the Colposcopy Clinic two days per month;
d) Dr. Singh will be granted privileges to perform specified minor procedures under general anaesthesia where appropriate. The minor procedures include: inserting IUDS; cone biopsy; D&C; removal of polyps and vaginal cysts; biopsies; incision drainage; hysteroscopy; hysterosalpingogram; examination under anaesthesia; balloon ablation; cauterization; and suture and repair
e) In the event an urgent or emergency situation should arise while performing any of the specified procedures, Dr. Singh agrees to immediately refer and transfer care of the patient to the obstetrician on call.

On the basis of this information, the College commenced an investigation under s.75(1)(a).

On November 19, 2009, the Department of Anaesthesiology determined that no current member of the department will be made available to provide anaesthesiology coverage to Dr. Singh. As a result, since at least November 2009, Dr. Singh has not been performing: D & C; hysteroscopy; examination under anaesthesia; and balloon ablation.

The College retained an expert, Dr. X, to provide an opinion on the care provided by Dr. Singh. With regard to Patient 1, Dr. X opined that Dr. Singh failed to demonstrate the appropriate knowledge, skill and judgment expected of a specialist, in that:
a) Dr. Singh failed to appreciate the significance of the fetal heart rate tracing and allowed the anaesthetist to perform an elective epidural elsewhere instead of dealing with the patient's need for an urgent C-section;
b) Once in the operating room, Dr. Singh's difficulty in extracting the baby resulted in further delay of newborn resuscitation. Dr. Singh was unable to perform in an emergency situation;
c) The theme of panic and poor communication with colleague/team members was evident from the interview of those present;
d) The nurses felt that they had to push Dr. Singh to perform the C-section on a stat basis.

With regard to Patient 2, Dr. X opined that Dr. Singh failed to meet the expected standard with respect to obstetrical care, in that:
a) Dr. Singh failed to communicate the urgency to her colleagues and permitted the anaesthesiologist to provide an elective epidural instead of focusing his attention on the high risk mother;
b) Dr. Singh had recognized the gravity of the situation by calling for the Sick Kids Transport Team instead of transferring the mother to a tertiary centre. However, Dr. Singh failed to act in a timely fashion to "deliver" the infant when there was a loss of fetal
heart rate, as an emergency section would have been taken by a reasonable physician at that point in time under epidural or general anaesthetic.

In respect of Patient 3 case, Dr. X opined that: Again, another surgical complication arose for a thin patient as Dr. Singh had difficulty with insertion of the Veress needle or Hasson trocar for laparoscopy. Major blood loss for a minor procedure and benign state begs the question as to Dr. Singh's judgment as well as her surgical skills once more.

In response, Dr. Singh provided the report of Dr. Y, who was asked to provide an opinion in 15 cases in which the College experts were critical of Dr. Singh. He was prepared to provide a supportive opinion of only 11 of those cases and did not provide a supportive opinion in respect of Patient 1, Patient 2 or Patient 3.

With respect to Dr. Singh's colposcopy practice, Dr. Singh provided a report from Dr. Z. At the request of the hospital, Dr. Z reviewed Dr. Singh's colposcopy practice and concluded that she appears to practice within the standard of the profession and did not demonstrate any lack of knowledge, skill or judgment or disregard for the safety of her patients.

The Committee ordered and directed that:

Dr. Singh attend before the Panel to be reprimanded.
the Registrar impose the following terms, conditions and limitations on Dr. Singh's
certificate of registration:
a) Dr. Singh shall not engage in any labour and delivery practice;
b) Except as otherwise specified in this Order, Dr. Singh shall not engage in any hospital-based obstetrical/gynaecological practice;
c) Dr. Singh is permitted to perform colposcopy in the Colposcopy clinic two days per month;
d) Dr. Singh is permitted to perform the following minor procedures ("Permitted Procedures"), none of which entail intra-abdominal surgery:
i) Insertion of IUDS;
ii) Cone biopsy;
iii) D&C; iv) Removal of polyps and vaginal cysts;
v) Vulvar, vaginal, cervical and endometrial biopsies;
vi) Incision drainage (vulvar, vaginal lesions);
vii) Hysteroscopy;
viii)Hysterosalpingogram;
ix) Examination under anesthesia;
x) Endometrial ablation;
xi) Cauterization; and
xii) Vulvar/vaginal suture and repair (this does not include vaginal hysterectomy,cystocele or rectocele repairs).
e) Dr. Singh shall provide the College with 14 days' notice if she intends to commenceperforming of any one of the Permitted Procedures itemized in paragraph 3(d) above,under general anaesthesia. Dr. Singh shall agree to undergo an assessment(s) of suchpractice(s) by an assessor appointed by the College of Physicians and Surgeons of Ontariowithin one year of commencing any Permitted Procedure under general anaesthesia, at theCollege's expense; and
f) In the event that an urgent or emergency situation arises while Dr. Singh is performing any of the Permitted Procedures, Dr. Singh shall immediately refer and transfer the care of the patient to the obstetrician/gynaecologist on call. Dr. Singh pay costs to the College in the amount of $3,650.00 within (60) days from the date of this Order.