Failure to communicate: Doctor hit with $20,000 penalty for breakdown in pre-op anticoagulation bridging plan

A Calgary urologist who failed to inform a patient of a plan for tapering anti-coagulation medication before a surgical procedure has been reprimanded and ordered to pay $20,064.21, which represents two-thirds of the investigation and hearing costs. Dr. Richard Barr is also required by the College of Physicians and Surgeons of Alberta to complete five courses on implementing healthcare improvement, and to determine if his clinic’s electronic systems can incorporate reminders for consult letters back to referring physicians as well as reports on patients’ attendance or procedures, within 14-day timelines. If the electronic systems cannot accommodate these reminders, then Dr. Barr must implement the changes at his own expense, according to the discipline decision document. Read: Nose out of joint: Doctor disciplined after patient's vascular event post cosmetic filler injection The case stems from January 2016, when Dr. Barr performed a lithotripsy on a patient. Two days after the procedure, the patient suffered a stroke. The discipline tribunal concluded, based on expert testimony, that the patient was already at risk of stroke six months before the procedure and that Dr. Barr’s actions did not cause the stroke. However, one expert witness did state that Dr. Barr “failed to arrange for optimal anticoagulant bridging management to reduce the risk for stroke prior to the lithotripsy.” The patient was supposed to go to a pre-admission anticoagulation clinic approximately one week before the procedure to discuss how to discontinue oral anticoagulation and bridge with injectable low molecular weight heparin until after the procedure. However, Dr. Barr was unable to schedule the patient with the anticoagulation clinic and had stated he would call the patient directly. The lithotripsy program’s unit manager later told the discipline tribunal that she would have tried to reschedule the procedure to a later date had she known that the patient had not gone to the anticoagulation clinic. The patient discontinued his anticoagulant, of his own accord, on the day of the procedure but had not been administered the injectable bridging anticoagulant. Based on expert testimony and on Dr. Barr’s admission, the tribunal’s investigation and findings focused on Dr. Barr’s failure to communicate to the patient in a timely fashion important details regarding a plan to taper anticoagulation drugs. Read: CPSA just getting started with unannounced inspections of Alberta docs with numerous COVID complaints against them

Failure to communicate: Doctor hit with $20,000 penalty for breakdown in pre-op anticoagulation bridging plan

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