Doctor says motivation is good care, not money

No financial gains made from ordering medical tests, cardiologist maintains

Aprominent Ontario cardiologist accused of overtesting an excessive number of patients says he is motivated by a desire to provide good care, not to make money.

“The only reason I order any tests on any patients is because I think it can help me in their management. I can’t tell in advance what the result is going to be, but if I don’t do the test then I’m not going to find out,” Dr. Bill Hughes testified at his disciplinary hearing at the College of Physicians and Surgeons of Ontario on Tuesday.

Hughes, founder of the Kawartha Cardiology Clinic in Peterborough, Ont., and former president of the Ontario Association of Cardiologists, has been charged with professional misconduct and falling below the standard of care expected of a cardiologist.

In response to a question from his lawyer, Anne Spafford, Hughes said he does not derive any financial benefit from testing patients.

He described how, since 2011, he has owned a one-third stake in an independent health facility where nuclear imaging tests are performed, but that the venture has not been profitable. Money was borrowed from a bank for the purchase of the facility under an arrangement that denies any of the owners from taking a profit or dividend until the debt is retired in 2018 or 2019, Hughes explained. But at that time, they will have to invest in new cameras for the facility.

His wife, Jennifer Fraser, owns a 50-per-cent stake in equipment for conducting stress echocardiograms at the clinic.

That portion of the business has “lost quite a bit of money,” Hughes said.

Cardiologist Dr. Dave Massel, an expert witness for the prosecution, previously told a four-member disciplinary panel that Hughes sees up to 80 patients a day while most cardiologists only see up to 20. Massel also testified that 75 per cent of the testing done at the clinic is inappropriate.

Another cardiologist, Dr. David Fitchett of St. Michael’s Hospital, testified Tuesday as an expert witness for the defence. He disagreed with Massel that Hughes fell below the standard of care in how he handled a number of patient cases.

In fact, compared with other community cardiologists, “I suspect he gives a much higher standard of ongoing care,” Fitchett said.

When patients’ conditions change, Hughes responds “very, very fast,” Fitchett said, referring to the response times as “quite outstanding.”

Hughes had testified that in urgent cases he will see patients on the same day.

Fitchett said Hughes has patients’ best interests at heart.

“The major criticism is excessive care. Dr. Hughes clearly cared very much for his patients and investigated them a lot, but that is not necessarily a criticism. It reflected the amount of care that he gave these patients,” Fitchett said.

There is no consensus among cardiologists on how often patients should undergo repeat testing and the issue is a hot topic of debate, Fitchett testified.

“The controversy is how frequently you should do repeat testing,” he said.

“The range of repeat testing is enormous, from some people not doing any repeat testing to other people doing it every six to 12 months,” he continued, “and I’m not sure what is right.”

“The only reason I order any tests on any patients is because I think it can help. . . . I can’t tell in advance what the result is going to be.”

DR. BILL HUGHES