COLLEGE OF PHYSICIANS AND SURGEONS OF NOVA SCOTIA SUMMARY OF DECISION OF INVESTIGATION COMMITTEE B. RE: Dr. SAIRA MALIK

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1 COLLEGE OF PHYSICIANS AND SURGEONS OF NOVA SCOTIA SUMMARY OF DECISION OF INVESTIGATION COMMITTEE B RE: Dr. SAIRA MALIK OVERVIEW Between September, 2013 and January, 2014, the Cllege received three cmplaints abut Dr. Malik, a family practice physician. While each f the three cmplaints dealt with separate matters, the cmplaints cllectively raised significant cncerns abut Dr. Malik s interactin with and care f her patients, her practice f medicine and her respnse t the regulatry prcess. Each f the three cmplaints is briefly utlined belw. Patient A Cmplaint: This cmplaint alleges that Dr. Malik: refused t prvide care t the cmplainant s partner because he suffered frm ADD; behaved inapprpriately twards staff in the presence f patients; verbally abused the cmplainant s partner; did nt cmmunicate effectively due t language difficulties; simply ignred the cmplainant at times; and refused t accept the cmplainant s statement that she did nt have any addictins. Dr. Malik respnded that her capacity t respnd was limited by the fact that the cmplainant and her partner were nt actually her patients and she nly had limited ntes frm a Meet and Greet appintment. She says she uses Meet and Greet appintments as an pprtunity t allw prspective patients t make a decisin whether t becme her patients. Her ntes f the encunter indicate that she said she may nt be able t help with ADD due t her lack f experience, nt that she refused t take the cmplainant s partner as a patient. Althugh Dr. Malik stressed her limited ability t cmment, she did nt refrain frm making sme inapprpriate persnal cmments regarding the Cmplainant. As t the allegatins abut yelling at her staff, she stated that this was nt Patient A s business. She als felt that Patient A was racist and crazy. She als ffered mre persnal cmments n Patient A s financial management skills, emplyability and unhappiness. The Cmmittee fund that Dr. Malik was defiant during her interview with the Cmmittee, appeared t be cherry-picking patients, and turned away bth Patient A and her partner, ntwithstanding the fact that they needed a dctr.

2 - 2 - Patient B Cmplaint: This cmplaint raises questins f whether the pre-natal care prvided by Dr. Malik was cmplete and met the quality f care standards expected in the pre-natal cntext. Specifically, Patient B alleges that Dr. Malik failed t prvide apprpriate care in relatin t an incmpetent cervix resulting in the necessity f a medical prcedure knwn as a rescue cerclage, and als suggests that Dr. Malik spke t her disrespectfully. Her cmplaint utlines that she spke t Dr. Malik n several ccasins abut her past pregnancy histry f incmpetent cervix diagnsed at 25 weeks, with resulting bed rest. She says she raised the questin at each visit and that Dr. Malik dismissed her cncerns stating that each pregnancy was different, it was t early t be cncerned, the diagnsis shuld wait until her rutine ultrasund, as ppsed t underging an earlier ultrasund. The rutine ultrasund was als perfrmed later than usual. In her respnse Dr. Malik indicates that Patient B had tld her nthing abut her previus histry f incmpetent cervix and that she had reprted having had a full-term nrmal delivery. Dr. Malik said that if Patient B had said anything abut the cervical issue, it wuld have been nted n the histry sheet f her chart, as well as n the varius individual entries. Likewise, she says she wuld have made a ntatin n the ultrasund referral had she been made aware f this issue. In her interview with the Cmmittee, Dr. Malik questined whether Patient B was in hspital fr eight weeks as she asserted. She accuses Ms. Patient B f lying, when she says that Dr. Malik spke t her disrespectfully and that her entire cmplaint is nthing mre than lies intended t be cruel t Dr. Malik. Patient C Cmplaint: This cmplaint raised a number f issues, namely: Althugh Dr. Malik will nt see patients n an urgent basis, she refused t fllw up n lab wrk rdered by walk-in clinic staff; Dr. Malik refused t d prescriptin refills ver the phne during the bus strike; Dr Malik denied having receiving lab reprts which the cmplainant was tld had been sent, with a resulting refusal t prvide treatment based n lab investigatins; Dr. Malik tld her a specialist had diagnsed gut, when he had tld the cmplainant she had fibrmyalgia; Dr. Malik embarrassed the cmplainant by making her cunt her tablets in the waiting rm; Dr. Malik failed t respect patient privacy, by cnsulting and examining with an pen dr; Dr. Malik yelled at patients and staff; Dr. Malik required the cmplainant t sign a cntract in rder t receive prescriptins fr medicatin.

3 - 3 - With regard t the walk-in clinic issue, the evidence was that Patient C, wh suffers frm epilepsy, had experienced severe dizzy spells early in Octber. She attended a Walk-in Clinic due t her knwledge that Dr. Malik did nt d emergency visits. The Walk-in physician sent her fr bld wrk which shwed lw Phenbarbital levels. When Patient C asked Dr. Malik abut the bld wrk at the next visit in Nvember, Dr. Malik became angry and denied any knwledge f the bld wrk. N fllw-up was ffered. In January, Patient C had her first seizure in 33 years. Dr. Malik admitted she refused t fllw patients in respect f treatment initiated by physicians at walk-in clinics r ER s, as she cnsiders this respnsibility that f the treating physician. The Cmmittee was f the view that the physician shuld fllw up n abnrmal test results regardless f the surce f the lab wrk. This falls within the primary physician s respnsibility fr quality f care. Dr. Malik s explanatins fr her cnduct were nt satisfactry and demnstrate a lack f appreciatin f the issue Dr. Malik stated that whenever a patient cmplains against the dctr, the rule f thumb is t make the dctr lk as bad as pssible and that the cmments abut her screaming fall int that categry. Dr. Malik stated she cannt change her persnality and des nt care what the patient thinks. As t the privacy issues, Dr. Malik discunted them by saying that the examinatin rm was at the end f the hall, s dr clsure was irrelevant. While she did nt have curtains, if she did nt leave the examinatin rm while the patient was disrbing, she wuld nt necessarily lk at them. With regard t the issue f draping, she stated that 98% f patients d nt care if they have a sheet t drape themselves with and if they d, she said they can get themselves ne frm the drawer. With respect t Patient C s cncern that Dr. Malik requested she sign a cntract with respect t medicatins, the Cmmittee nted this cntract invlved restricted medicatins, and it was apprpriate fr Dr. Malik t request an agreement frm the patient with respect t the use f these medicatins. Overall, the Cmmittee had cncerns abut Dr. Malik s practice in relatin t fllw-up with patients wh have seen ther physicians, her behaviur with patients, staff and the cmmittee, and her apparently cavalier attitude abut cnfidentiality and patient privacy. Steps taken by Investigatin Cmmittee In additin t hearing frm Dr. Malik and reviewing patient charts and ther written material, the Cmmittee rdered tw audits f Dr. Malik s practice. The first audit reviewed Dr. Malik s prenatal practices. Apart frm cncerns identified in the case f Patient B the audit shwed a satisfactry standard f cmpetence in the ther recrds that were reviewed. The secnd audit was a general practice audit invlving a randm selectin f patient charts.

4 - 4 - This practice audit identified the fllwing areas f cncern: Recrds were nly abut 70% legible and it was nt pssible t determine whether prper recrd keeping practices were being carried ut; Sme inadequacies in charting were nted, fr example: full up-t-date patient prfiles were nt in evidence in sme cases; current medicatins were difficult t determine frm a review f the charts; Referral letters did nt always cntain full histries and medicatins; The 1985 versin f the Rurke Baby Recrd was included in infant charts, instead f the mre up t date versin, which is readily available at n cst n the Rurke website; Based n randm file selectin, there was ne instance f imprper immunizatin catchup schedule being fllwed; Privacy cncerns exist due t the fact that cnversatins in the examinatin rm can be readily verheard in the waiting area; Medical recrds and file flders are re-used, which culd result in recrd cnfusin r privacy breaches; Dr. Malik des nt have regular specimen delivery and relies n her patients t take their wn specimens t the lab; There is n temperature gauge n the vaccinatin fridge; There is n medicatin sample strage area; Dr. Malik nted that she experiences technical difficulties in relatin t the receipt f faxed patient recrds and that she has n slutin fr this prblem; and Dr. Malik s intake prcess fr new patients invlves a Meet and Greet. At this appintment, Dr. Malik reviews the client s medical cncerns and intrduces them t the rules f the ffice. Dr. Malik des nt bill MSI fr these meetings. Cnclusins f Investigatin Cmmittee After reviewing all f the materials befre it, including the audits, the Cmmittee has nted a number f cncerns in relatin t Dr. Malik s behaviur and practice. These include: Lack f prfessinalism twards the cmplaint prcess. Fr example, her cnduct twards the Investigatin Cmmittee was disrespectful, bellicse and inapprpriate; Dr. Malik has been nn-cmpliant r slw t cmply with requests frm the Cllege; Dr. Malik has spken in a disrespectful manner abut patients in bth written crrespndence and during interviews with the Cmmittee;

5 - 5 - Dr. Malik s patient intake prcess raises cncerns that she is cherry-picking patients, cntrary t the Cllege s Plicy Regarding Accepting New Patients; Dr. Malik s ffice space and behaviur raise cncerns that she is nt apprpriately safeguarding client cnfidentiality; Dr. Malik s ffice space and behaviur indicate that she is nt always respectful f patient privacy, fr example staying in the rm while they disrbe, nt always prviding exam sheets and draping, and leaving her dr pen during examinatins; Refusing t prvide fllw-up with her patients where treatment fr a cnditin is initiated by anther physician in a walk-in clinic r the ER; Yelling at staff in the presence f patients and speaking disrespectfully abut staff t her patients; Dr. Malik s files disclse a number f deficiencies in recrd-keeping: nly 70% legible; patient prfiles nt always up t date; current medicatins nt easily determinable frm chart review; Dr. Malik s referral letters did nt always cntain full histries and medicatins; Dr. Malik was utilizing an ut-f date patient prtcl fr infants; and A number f ther cnditins and practices pse a threat t patient care, safety, cnfidentiality and privacy. These include: nt utilizing a regular specimen delivery service, re-using paper materials fr charting, absence f a temperature gauge in the vaccinatin fridge, absence f a sample strage area, inadequate faxing technlgy, absence f a sund-prf examinatin area. It is nted that Dr. Malik des nt agree r acknwledge many f the issues raised. Sme f her answers were illgical and cntradictry. The Cmmittee als fund that Dr. Malik lacked insight and was disrespectful and cmbative in the investigatin prcess. DISPOSITION The Cmmittee directs the fllwing: Dr. Malik is reprimanded fr: 1. failing t prvide n-ging care t patients wh return t her and request lngitudinal care r treatment, after they have received episdic care at a walk-in clinic r ER, ntwithstanding that the treatment in questin was initiated by anther physician. This bligatin f the primary physician is nt incnsistent with, but supplements the bligatins f Walk-in Clinicians under the Guidelines n Standard f Care fr Walk-In Clinics, May, refusing r discuraging patients n inapprpriate grunds, cntrary t the Plicy Regarding Accepting New Patients, Octber, 2011 and s. 17 f the CMA Cde f Ethics; 3. failing t btain an apprpriate bstetrical histry, specifically failing t identify and act upn a histry f a previusly incmpetent cervix in a pregnant patient; 4. failing t maintain adequate medical recrds respecting her patients;

6 cmmunicating inapprpriately with ffice staff in the presence f patients; 6. failing t maintain the privacy f patients; 7. using an ut f date patient prtcl fr infants; 8. failing t use r have adequate ffice space, equipment r services, including: nt utilizing a regular specimen delivery service, re-using paper materials fr charting, absence f a temperature gauge in the vaccinatin fridge, absence f a sample strage area, inadequate faxing technlgy, and absence f a sund-prf examinatin area; 9. cmmunicating inapprpriately with and abut patients; 10. cmmunicating inapprpriately with Cllege staff and the Investigatin Cmmittee. In additin t this reprimand, Dr. Malik is required t cmply with the fllwing cnditins: a. Dr. Malik is required t take the next available Cllege f Physicians and Surgens f Ontari Medical Recrd Keeping Curse at her expense. In the event that Dr. Malik des nt register fr the next ffering f this curse r successfully cmplete it, her licence t practice medicine will be suspended pending successful cmpletin f the curse; b. Dr. Malik must successfully cmplete a prgram apprved by the Cllege s Medical Directr f Physician Perfrmance designed t address Dr. Malik s cmmunicatin style, disrespectful attitude, and generally unprfessinal behaviur. Dr. Malik shall be respnsible fr the csts f such prgram; c. Dr. Malik shall participate in a practice audit within 6 mnths f the date f this decisin, at her expense, designed t review the deficiencies identified in this decisin; In additin, Dr. Malik is cunselled : (i) (ii) t review ss. 31 and 34 f the CMA Cde f Ethics regarding patient privacy and cnfidentiality and t take whatever steps are necessary in respect f her physical ffice premises and practices t ensure that patient privacy and cnfidentiality are prtected; t review and fllw the Plicy Regarding Disruptive Behaviur by Physicians, May, 2013, the Plicy Regarding Physician Cperatin with the Cllege, May, 2014, and s. 2 f the CMA Cde f Ethics; and

7 - 7 - (iii) t review and fllw the Guidelines fr Physicians Regarding Referral and Cnsultatin, March, Finally, Dr. Malik is required t pay csts t the Cllege in the amunt f $ , as a cntributin tward the Cllege s csts in the investigatin and reslutin f this matter. These csts shall be paid in tw equal instalments, with the first instalment due by December 31, 2014, and the secnd instalment due n later than December 31, Failure t make payment in accrdance with this paragraph will result in the immediate suspensin f Dr. Malik s licence t practice medicine. In rdering the abve dispsitin, the Cmmittee tk int accunt Dr. Malik s previus histry with the Cllege where n fur ccasins she was either cunselled r cautined with respect t breaches f patient cnfidentiality, attitude, and failure t fllw required plicies regarding acceptance f new patients. The Cmmittee believes that the dispsitin utlined abve reflects the serius cncerns f the Cmmittee with regard t bth Dr. Malik s behaviur and the practice issues uncvered during the investigatin, while at the same time recgnizing that aside frm the individual incidents identified in the cmplaints and the practice review, n verall pattern f incmpetent medical skills was identified. Dated at Halifax, Nva Sctia this 13th day f January, 2015 Dr. Keri McAd, Chair Investigatin Cmmittee B