Cardiologist saw unusually high number of patients
Peterborough doctor facing hearing on overbilling allegation
A cardiologist facing a disciplinary hearing ordered so many taxpayer-funded tests on patients that an expert witness questioned who owned the testing facility and whether there was a conflict of interest.
“It didn’t make sense to me the amount of testing that was being done, so I just sought clarification about whether there was any possible conflict of interest,” Dr. Dave Massel testified Wednesday.
Massel was asked by the College of Physicians and Surgeons to review the practice of Dr. Bill Hughes, who faces a charge of professional misconduct related to his referrals of patients for diagnostic testing. It’s alleged he over-tested patients and overbilled OHIP.
The ownership of the Kawartha Cardiology clinic, where Hughes works and testing was done, has not been revealed at the hearing.
Massel said he suspects Hughes was “self-referring” patients.
Asked by prosecutor Louis Sokolov what that means, Massel said: “It has been a long-standing issue in medicine. (Physicians) refer patients they see for tests for which they are paid or may have a financial interest.”
The Star reported in 2012 that the province tried to cut self-referral fees during OMA contract negotiations, citing studies that show doctors who own diagnostic equipment perform too many tests. The move was aimed at cardiologists, ophthalmologists and radiologists who are among the highest paid specialists.
But the government backed off after the specialists launched public campaigns warning of dire consequences. Front and centre in the battle was Hughes, then president of the Ontario Association of Cardiologists.
“It didn’t make sense to me the amount of testing that was being done so I just sought clarification about whether there was any possible conflict of interest.” DR. DAVE MASSEL ON PRACTICE OF DR. BILL HUGHES
In a YouTube video, he warned clinics would be forced the shut down and that more patients would die and become disabled. (The video was not evidence at the hearing.)
Massel, a cardiologist from Victoria, B.C., said Hughes saw up to 80 patients a day, four times the number cardiologists typically see.
“If you see that volume of patients a day, it stands to reason the amount of time spent with one patient must be very short,” Massel said. “I don’t think you can give the patients the proper care and the proper attention our patients deserve.”
On most patients, Hughes did not conduct physical examinations, which would have taken up to half an hour each, and instead referred them for tests, Massel said.
Physical examinations are “the cornerstone of what we do,” and in conjunction with patient histories, they drive 85 per cent of decisions, Massel said.
Of all the testing Hughes ordered, in Massel’s opinion 75 per cent was inappropriate, done as a matter of routine rather than to help influence medical decisions and manage patients, the expert witness explained. “I have never seen anything like it,” he said.
Massel said that when he asked Hughes to justify his high rate of testing, “he was unable to base it on any scientific (evidence).”
Cardiologists are expected to keep up with medical literature that explains when testing should be done, he said.
Hughes fell below the standard of care for a cardiologist and showed a lack of knowledge, skill and judgment, in Massel’s expert opinion.
A 35-year-old female patient may have died needlessly because Hughes failed to properly diagnose her, Massel said. In 2001, Hughes did not detect a heart murmur that her family doctor was able to pick up. In the ensuing five years, she went from having a mildly narrowed hard valve to a severely narrowed one.
It would have been “easily fixable” with surgery, but she ended up suffering from a lethal heart arrhythmia, Massel said. On one day that the woman had an appointment, Hughes was scheduled to see a total of 51patients, leaving not much time for any of them, Massel noted.
Describing 24 paper patient files he reviewed as unorganized, Massel said there was missing information in 63 per cent of them. Hughes told him more information was available electronically, but practice guidelines stipulate that all information should be in one place in the event another practitioner needs access to patient records, Massel said.