Dr. Andrew Mah – September 2018

This matter came before a panel of the Discipline Committee of the College of Optometrists of Ontario this 5th day September 2018, in Toronto, Ontario, at 9:30 a.m. at 65 St. Clair Ave. E.

THE DISCIPLINE COMMITTEE FOUND Dr. Mah guilty of professional misconduct for having committed an act or acts of professional misconduct as set out in subsection 51(1) of the Health Professions Procedural Code of the Optometry Act, 1991, S.O. 1991, c. 35, and as defined in Ontario Regulation 859/93 and/or Ontario Regulation 119/94, which were in effect at the relevant times.

Specifically, the discipline committee found that between January, 2014 and July, 2015 Dr. Mah recommended and/or provided unnecessary diagnostic or treatment services in relation to certain patients; failed to maintain the standards of practice of the profession in relation to his care and management of certain patients; failed to maintain records in accordance with Part IV in relation to certain patients; submitted or allowed to be submitted an account(s) for professional services in relation to certain patients that he knew was false or misleading; and engaged in conduct or performed an act that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable, unprofessional or unethical regarding his care and management of certain patients; all as set out in the Agreed Statement of Facts.

THE DISCIPLINE COMMITTEE MADE AN ORDER:

1. Requiring the Member to appear before the Panel to be reprimanded.

2. Directing the Registrar to suspend the Member’s certificate of registration for an uninterrupted period of approximately three and one half (3.5) months, starting on October 17, 2018 and finishing at 11:59 pm on Sunday, January 27, 2019.

3. Directing the Registrar to impose the following terms, conditions and limitations on the Member’s certificate of registration:

a) the Member shall successfully complete, at his own expense, with an unconditional pass, and within two (2) years of the date that this Order becomes final, both the ProBe Program on professional/problem-based ethics offered in Ontario and the ProBe Plus follow-up module;

b) the Member shall cooperate with, participate in, and pay for, eight (8) full day, one-on-one sessions (“the Sessions”) with a practice coach/monitor, who has been pre-approved by the Registrar (“the Practice Coach/Monitor”). The requirements for the Sessions are as follows:

i. each Session shall be at least six (6) hours in duration;

ii. the Sessions shall focus on the following subjects and/or areas of practice:

A. maintaining healthcare records that are legible, accurate, complete and that meet the standards of practice of the profession and the requirements set out in Ontario Regulation 119/94, including in relation to recording:

•  the patient’s health and oculo-visual history;

•  the clinical procedures used;

•  the clinical findings obtained; and/or

•  the diagnosis;

B. appropriate billing for optometric tests and procedures, including in relation to the criteria for submitting accounts to OHIP under billing codes V402, V406, V408, V409 and V410; and/or;

C. the appropriate investigations for patients suspected of having glaucoma and/or diplopia, including:

•  the appropriate tests to conduct;

•  the appropriate equipment to conduct such tests; and/or

•  the clinical findings necessary to support such a diagnosis;

D. when, from a clinical and timing perspective, it is appropriate to:

•  refer patients for consultations with an ophthalmologist;

•  recommend that patients return for office visits and/or ongoing monitoring;

•  recommend, provide, and/or bill diagnostic or treatment services with respect to:

o  visual field testing (AVF);o fundus photography;

o  Heidelberg retinal tomography (HRT);

o  digital retinal imaging (DRI);

o  optical coherence tomography (OCT);

o  corneal pachymetry;

o  anterior optical imaging (AOI); and/or o prescriptions for spectacles (together, “the Subjects”).

iii. the first three (3) to four (4) Sessions, shall take before the end of the Member’s suspension (“the Learning Sessions”), and shall focus on improving the Member’s knowledge, skill, judgment, and understanding in relation to the Subjects;

iv. any remaining Sessions that the Member has not completed by the end of his suspension (“the Implementation Review Sessions”) shall be scheduled once every four (4) to six (6) weeks thereafter, but in any event, all of the Sessions shall be completed with one (1) year of the date of the Panel’s Order, and all of the Implementation Review Sessions shall include:

A. a review of the Member’s patient health records and practice by the Practice Coach/Monitor to assess whether the Member has improved his knowledge, skill, judgment, and understanding  in relation to the Subjects and whether the Member has successfully incorporated those improvements into his practice;

B. a discussion between the Practice Coach/Monitor and the Member regarding the Practice Coach/Monitor’s assessment;

C. a learning plan to address any deficiencies identified by the Practice Coach/Monitor.

v. At least seven (7) days before the first Session, the Member shall provide the Practice Coach/Monitor with a copy of:

A. the Notice of Hearing;

B. the Agreed Statement of Facts;

C. this Joint Submission on Order and Costs, and

D. a copy of the Panel’s Order and the Panel’s Decision and Reasons, if available;

vi. the Member shall review, be familiar with, and be prepared to discuss with the Practice Coach/Monitor, at any of the Sessions:

A. Ontario Regulation 119/94, Part IV – Records;

B. the following sections of the College’s Optometric Practice Reference:A. Section 4.5 – Referrals;

B. Section 5.1 – the Patient Record;C. Section 6.3 – Refractive Assessment and Prescribing; and

D. Section 7.2 – Glaucoma; and

C. any other materials that the Practice Coach/Monitor asked the Member to review prior to the next Session.

vii. at the end of each Session, the Member shall request the Practice Coach/Monitor to forward, within thirty (30) days, a written report to the Registrar, which shall be copied to the Member,  confirming:

A. the date of the Session and, in relation to the first Session, whether the Member had provided the Practice Coach/Monitor with the documents specified in paragraph 3(b)(v), above;

B. whether the Member had reviewed and was prepared to discuss the materials listed in paragraph 3(b)(vi), above;

C. the Practice Coach/Monitor’s assessment of whether the Member has improved his knowledge, skill, judgment, and understanding  in relation to the Subjects and, with respect to the Implementation Review Sessions, whether the Member has successfully incorporated those improvements into his practice.

c. within twelve (12) to eighteen (18) months of the Member completing the Sessions, the Member shall undergo and cooperate in one (1) unannounced inspection of his practice, at his expense, to a maximum of $3,500 (“the Practice Inspection”). The requirements for the Practice Inspection are as follows:

i. The Practice Inspection shall be conducted by an individual chosen by the College’s (“the Inspector”) and shall include the Inspector’s review of twenty-five (25) patient health records and any other documentation and/or information the Inspector considers appropriate;

ii. The purpose of the Practice Inspection shall be to assess:

A. the Member’s compliance with the term set out in paragraph 3(d); and

B. whether the Member is maintaining the standards of practice and/or may be engaging in professional misconduct in relation to the Subjects.

iii. the Member shall request the Practice Inspector to forward, with thirty (30 days after completing the Practice Inspection, a written report to the Registrar setting out his/her assessment.

d. the Member shall ensure that his clinical records are legible for the purpose of the Sessions referred to in paragraph 3(b) and the Practice Inspection referred to in paragraph 3(c);

4. Directing the Member to partially reimburse the College for its costs in relation to this proceeding in the amount of $25,000 to be paid by post-dated cheques provided to the College by September 5, 2018, according to the following schedule:

a) one cheque dated September 5, 2018 in the amount of 5,000;

b) one cheque dated December 5, 2018 in the amount of $5,000;

c) one cheque dated March 5, 2019 in the amount of $5,000;

d) one cheque dated June 5, 2019 in the amount of $5,000; and

e) one cheque dated September 4, 2019 in the amount of $5,000.

At the conclusion of the hearing, Dr. Mah waived his right to appeal and the Discipline Committee delivered the reprimand.

Read the full Discipline decision