On July 13, 2023, the Ontario Physicians and Surgeons Discipline Tribunal (“OPSDT”) revoked the medical license of Dr. Albert Kadri, a nephrologist from Windsor, in addition to ordering him to pay $250,510 in costs as a result of a previous finding that he had committed professional misconduct and that he was incompetent.

FACTS

Nephrology is a medical specialty that focuses on the diagnosis, treatment, and management of acute and chronic kidney problems and diseases. Dialysis, which is a procedure to remove waste products and excess fluid from the blood when the kidneys are not working properly, is a treatment modality that is commonly managed by nephrologists.

The conduct giving rise to Dr. Kadri’s revocation from the practice of medicine in Ontario was dealt with in a previous OPSDT decision, College of Physicians and Surgeons of Ontario v. Kadri, 2023 ONPSDT 10 (CanLII).

The essence of the concerns arose after the Windsor Regional Hospital (the “Hospital”) decided to implement a new model of care for renal patients after external consultation. The new model included: 

1. the recruitment of two additional nephrologists;
2. the requirement that all nephrologists refer all patients who would eventually require dialysis or who required pre-dialysis care to the Hospital’s multi-care kidney clinic (“MCKC”) based on set criteria; and
3. a rotation of the on-call nephrologists for the management of patients receiving hemodialysis at a hospital or satellite site. According to this model, the on-call physician manages all professional aspects of chronic dialysis and end-stage renal failure in hemodialysis patients and, as the most responsible physician (MRP), bills the CDTF (the chronic dialysis team fee). The CDTF is an Ontario Health Insurance Plan (“OHIP”) fee code that provides an all-inclusive benefit for the services of all physicians participating in the patient’s dialysis treatment. 

This new model of care by the Hospital would have an impact on how Dr. Kadri would manage patients and bill OHIP. He objected to this new model alleging it was neither safe nor in the patient’s best interests. The OPSDT disagreed and found Dr. Kadri to have:

• engaged in disruptive conduct with the Hospital staff and administrators regarding his persistent refusal to comply with the new model of care;
• mislead patient communications while he was still practicing and after he ceased practicing,
• effectively stole from his colleagues in his billing of a team fee to OHIP;
• recruited and misled a junior physician whom he used as a pawn in his battle with the Hospital;
• faxed orders (at times on an urgent basis) to a hospital where he no longer held privileges instead of directly speaking to the on-call nephrologist;
• delayed referring or failed to refer his patients to the multi-care kidney clinic (MCKC);
• deprived his patients of the coordinated care of the MCKC which resulted in urgent surgeries, patients who were ill-prepared, and the initiation of dialysis by a team of nephrologists who had never previously been involved in the patients’ care and who had limited information about the patients.

Furthermore, the OPSDT found that Dr. Kadri displayed a lack of judgment in his professional care of patients by his persistent refusal to abide by Hospital policies to his patients’ detriment. He showed no remorse for any of his actions during the hearing. Dr. Kadri’s lack of judgment led to the OPSDT’s finding of incompetence.

Dr. Kadri also failed to comply with an order of the Inquiries, Complaints and Reports Committee (“ICRC”). Most significantly, after being mandated to transfer the care of his patients, he effected the patient transfers in the most disorderly way possible. He left the transfers to the last minute such that some patients were not transferred within the required timeline and he did not advise his patients of the transfers; instead, on some occasions he gave his patients and their families misleading information. Ultimately, the late and disorganized patient transfer resulted in patient confusion, distress, and delays in care.

The OPSDT observed that Dr. Kadri’s failure to comply with the terms of the ICRC order is a very serious matter. An order of this nature is put in place to protect the public and must be honoured. Dr. Kadri’s failure to do so demonstrates disrespect for the authority of his governing body, undermines the CPSO’s authority, and compromises the CPSO’s ability to fulfill its primary mandate, the protection of the public.

DECISION

The OPSDT revoked Dr. Kadri’s licence and ordered him to pay costs of $250,510 for the lengthy tribunal hearing over his competence. In so do, the OPSDT made the following finding (at para. 23):

Dr. Kadri is entrenched in his belief of the propriety of his actions. He has no insight into how his actions impacted not only his patients but also his nephrology colleagues, hospital staff, and a young physician who considered him his mentor. Dr. Kadri did not present any evidence that he would make changes or would abide by terms, conditions or limitations on his certificate of registration. On the contrary, he has already shown that he is not prepared to abide by terms, conditions or limitations, as evidenced in his failure to comply with the ICRC orders. If a physician has no insight into his deficiencies and is not willing to change, remediation is not possible. See College of Physicians and Surgeons of Ontario v. Hill, 2017 ONCPSD 21; aff’d Hill v. College of Physicians and Surgeons of Ontario, 2018 ONSC 5833. In such cases, nothing short of revocation will protect the public. 

Decision Date: July 13, 2023

Jurisdiction: Ontario Physicians and Surgeons Discipline Tribunal

Citation: College of Physicians and Surgeons of Ontario v. Kadri, 2023 ONPSDT 15 (CanLII)

Media: Tribunal rules Kadri ‘incompetent;’ Windsor doctor says he only challenged care model, Kidney doctor loses court appeal of Windsor Regional Hospital decision