Doctor who chose to do elective surgery instead of attending to severely bleeding patient must pay $85,000 in costs

A Manitoba surgeon who was found guilty of failing to provide appropriate assistance to a seriously ill patient who subsequently died—choosing instead to perform an elective procedure on another patient—has lost his appeal of a penalty decision that ordered him to serve a two-month suspension and pay $85,000 in investigation and hearing costs. Dr. Sonny Surej Dhalla, who practices in Brandon, Man., had argued he should pay only $17,000—or about 13% of the proceeding’s total costs of $134,699 and that the suspension order was unnecessary in light of his unblemished work history dating back more than 26 years. But the discipline panel at the College of Physicians and Surgeons of Manitoba found that Dr. Dhalla’s inadequate documentation of his involvement in the patient’s care—an oversight that he had previously admitted to—contributed to the greater effort and costs required to assess the charges against him. According to the decision document, the suspension was also justified because “while the panel considered (Dr. Dhalla’s) lack of prior disciplinary history, it also relied on the serious and deliberate nature of the conduct in determining the issue of specific deterrence. Read: Winnipeg doctor hit with licence cancellation and $100,000 in fine and costs The case is based on events that transpired in November 2015, when Dr. Dhalla was the physician on call at the Brandon Regional Health Centre’s emergency department. A male patient was admitted to hospital and diagnosed with a gastric volvulus. To reduce the volvulus, Dr. Dhalla performed an endoscopy on Nov. 10 which, as expected, did not eliminate the obstruction completely. Following the procedure, Dr. Dhalla’s plan was to perform a surgical reduction of the volvulus after the patient was stabilized. Shortly after, however, he diagnosed the patient with further conditions, some of which he treated. Over the course of the night, the patient’s condition deteriorated and Dr. Dhalla performed surgery to repair a previously diagnosed perforation of the stomach and to untwist the volvulus. He decided not to close the abdominal wound because the patient was severely unstable, opting instead to use a V AC ABThera dressing to manage the open incision. The patient remained unstable after surgery. Another doctor described him as being in a state of extremis with profound systemic inflammatory response syndrome and likely septic shock. He also experienced significant continued bleeding in his abdomen after the surgery and required significant and ongoing blood transfusions. The patient continued to deteriorate, with severe and ongoing bleeding that required transfusion of one unit of blood per hour. Blood availability was becoming a concern, according to the decision document. During this time, Dr. Dhalla rejected suggestions that the patient be returned to the operating room. Read: Lawsuit claims child's severe brain injury could have been avoided with C-section On Nov. 12—days after the patient underwent the first procedure at the hospital—another doctor, concerned about the continued massive bleeding, performed an exploratory procedure. When Dr. Dhalla arrived later that day, the doctor asked him to defer another patient’s elective Whipple procedure so he could perform follow-up surgery on the gastric volvulus patient. Dr. Dhalla declined and went ahead with the Whipple procedure. While he was in the operating room, another doctor came in and told him the gastric volvulus patient required immediate surgery to address the bleeding. Dr. Dhalla told the doctor to ask another surgeon to perform the necessary procedure. The patient’s intra-abdominal bleeding was brought under control by the surgery, but he continued to experience the effects of multi-organ failure and died on Nov. 20. The discipline panel described Dr. Dhalla’s actions as “deeply disturbing” in a number of respects. Dr. Dhalla had failed to address the patient’s significant bleeding and “there was no justification for the delays in returning the patient to the operating room after the surgical intervention on November 12.” Read: U.K. surgeon struck from medical register after carving initials into transplanted livers The panel found that Dr. Dhalla’s advice on how to deal with the continued bleeding on Nov. 12 was "inappropriate and ineffectual" and was "indicative of a reluctance to operate without valid reason, rather than a genuine attempt to care for a seriously ill patient." The panel also found Dr. Dhalla’s decision to proceed with the elective operation on Nov. 12 was "deeply troubling." If he was not intending to operate on the gastric volvulus patient, "he should have made much more detailed and thorough arrangements for another surgeon to be available to do so, and those arrangements should have been made far earlier than occurred in this case,” wrote the panel. When assessed against the "standard of other surgeons possessing a reasonable level of knowledge, competence and skill expected of surgeons in this jurisdiction," Dr. Dhalla’s conduct and behaviour fell significantly short of that standard, the panel wrote. Read: Four hugs and an air kiss add up to suspension, fine and hearing costs for doctor

Doctor who chose to do elective surgery instead of attending to severely bleeding patient must pay $85,000 in costs

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