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On May 24, 2019, the Discipline Committee found that Dr. Baldeep Takhar committed an act of professional misconduct in that he failed to maintain the standard of practice of the profession.
Dr. Baldeep Takhar is a 52 year-old family physician who received her certificate of registration authorizing independent practice from the College of Physicians and Surgeons of Ontario (“the College”) in November 2004. At the relevant time, Dr. Takhar practised family medicine in Cambridge and Kitchener, Ontario. Dr. Takhar also maintained a cosmetic medicine practice which is not the subject of this matter.
FACTS
In November 2013, Dr. Takhar, along with three other doctors, created the Franklin Family Health Organization (“FHO”). Dr. Takhar assumed the role of “Lead FHO Physician.” Dr. Takhar had previously been a signatory member at another FHO, the Canamera FHO, since 2011.
Between December 2013 and December 2015, the practices of Dr. Takhar and the Associate Lead Physician, Dr. Jodie Wang, grew quickly. The Franklin FHO’s total patient enrolment count grew from 8,774 to 18,123 patients. Patients were rostered under approximately seven member physicians, but some member physicians left the FHO and most patients came to be rostered under Dr. Takhar or Dr. Wang. During this time period, Dr. Takhar’s individual patient enrolment count increased from 4,453 patients to 7,282 patients.
Dr. Takhar practised at two locations of the Franklin FHO in Kitchener, and at one location in Cambridge. A further location opened in Guelph in 2014, which was run by two other member physicians.
The FHO was staffed by both signatory physicians (who were members of the FHO) and locum physicians who were paid by the hour, as well as other staff such as physician assistants, nurse practitioners, registered practical nurses, and office staff.
Patients enrolled with the Franklin FHO were rostered to an individual physician. However, the Franklin FHO used a “shared care model”, in which each patient could book an appointment to see any of the physicians on staff or walk in on the weekend to do so. The rapid growth of the Franklin FHO and the problems that arose in implementing the “shared care model” contributed to Dr. Takhar’s failure to maintain the standard of practice of the profession, as outlined below.
After receiving information of concern regarding Dr. Takhar’s clinical and administrative practices, the College commenced an investigation into her family practice in September 2014. An expert was retained who reviewed twenty-two family practice charts and related records, and interviewed Dr. Takhar. The College expert opined in reports in March and October 2016 that Dr. Takhar had failed to maintain the standard of practice of the profession with respect to record keeping, practice management, and clinical management of patients.
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In the period reviewed by Dr. Cohen (i.e. 2005 through January 2015), Dr. Takhar failed to maintain the standard of practice of the profession as set out below.
In terms of clinic management, Dr. Takhar rostered too many patients at the Franklin FHO and personally to herself, without ensuring that continuity of care could be provided to rostered patients.
The Franklin FHO used an electronic medical records system (“EMR”). However, the system in place for physicians to be alerted as to test results or possible charting errors did not reliably reflect whether a result entered into the system had been reviewed by a physician, whether a patient had taken a test that had been ordered, or whether a test result was lost. There was no clear policy or procedure administratively on who should receive this information or follow up in this regard. It was also difficult to determine who was the “most responsible physician” for the patient. This resulted in inconsistent follow-up, and in necessary follow-up sometimes being missed.
In terms of medical record keeping, issues were identified with Dr. Takhar’s charting
practices in a number of the charts reviewed:
- Information was missing in the comprehensive patient profiles of patients rostered to her, including regarding social history, past medical history, preventive health history, and
immunizations;
- Progress notes were frequently incomplete or vague as to history, physical examination, diagnosis, plan, and follow-up;
- Patient charts lacked appropriate diabetes care documentation regarding a diabetic patient and a potentially diabetic patient whose care was reviewed; and
- The patient charts did not document the clinical indication for tests Dr. Takhar ordered or medications she prescribed.
In terms of clinical care, following review of the patient charts from this same period, the College’s expert opined that Dr. Takhar’s clinical care of patients did not meet the standard of practice of the profession in the following ways:
- Letters referring patients to specialists for consultation did not set out all the necessary clinical details;
- Follow-up on test results for rostered patients and patients for whom she had ordered tests was inconsistent, and necessary follow-up was sometimes delayed or missed;
- Follow-up for her patients regarding recommended preventive healthcare was inconsistent, including for Pap smears, mammograms, faecal occult blood tests, and immunizations;
- Vitamin B12 injections were given without documented clinical indication, and the chart did not indicate why oral B12 had not been given instead;
- Testing was ordered that appeared to be excessive and lacking documented clinical indication in some cases, including blood work and ECHO cardiograms;
- Necessary physical examinations were not always documented;
- Follow-up for patients with hypertension was sometimes not carried out;
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- Antibiotics were prescribed to some patients without noting clinical indication in the chart, and in one instance there was no indication why primary care guidelines were not followed regarding otitis media (ear infection) in children; and
- Medications were prescribed to some patients without noting a clear clinical indication in the chart.
DISPOSITION
On May 27, 2019, the Discipline Committee ordered that:
- Dr. Takhar attend before the panel to be reprimanded.
- The Registrar to place the following terms, conditions and limitations on Dr. Takhar’s certificate of registration:
- Dr. Takhar shall attend the entirety of Pri-Med Canada, or the College of Family Physicians of Canada’s Family Medicine Forum, or another similar family medicine program or conference acceptable to the College. Dr. Takhar shall complete this requirement within seven (7) months of the date of this Order or, if no such program or conference is available within that time, as soon thereafter as one is available. Dr. Takhar shall provide proof of her attendance to the College within one (1) month of completion, including the number of credits received;
- Dr. Takhar shall attend and successfully complete the course, “Effective Team Interactions,” offered by SAEGIS. Dr. Takhar shall complete this requirement within six (6) months of the date of this Order and shall provide her certificate of attendance to the College within one (1) month of completion, including the number of credits received. If the program is unavailable within that time, Dr. Takhar may fulfill this requirement by completing another program related to this topic acceptable to the College within the same time period and forthwith providing proof of completion to the College;
- Dr. Takhar shall participate in and unconditionally pass the PROBE Ethics & Boundaries Program offered by the Centre for Personalized Education for Professionals, with a report or reports to be provided by the provider to the College regarding Dr. Takhar’s progress and compliance. Dr. Takhar shall complete this requirement within six (6) months of the date of this Order;
- Within approximately twelve (12) months of the date of this Order, Dr. Takhar shall submit to an assessment of her family medicine practice by an assessor or assessors selected by the College (the “Assessment”). The Assessment may include chart reviews, direct observation of Dr. Takhar’s care, interviews with colleagues and co-workers, feedback from patients and any other tools deemed necessary by the Assessor. The results of the Assessment will be reported to the College and may form the basis of further action by the College; and
- Dr. Takhar shall be responsible for any and all costs associated with implementing the terms of this Order.
- Dr. Takhar pay costs to the College in the amount of $6,000.00 within thirty (30) days of the date of this Order.
Terms and conditions imposed on certificate by: Member
