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THE FOLLOWING INFORMATION WAS OBTAINED FROM THE DOCTOR SEARCH SECTION OF THE WEBSITE OF THE COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO WWW.CPSO.ON.CA
Date: 28/03/24 16:36:50 PM

Chadda, Jasjot Kaur

CPSO#: 62269

MEMBER STATUS
Active Member as of 15 Dec 2019
CURRENT OR PAST CPSO REGISTRATION CLASS
Independent Practice as of 15 Jan 2021

Summary

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Former Name: No Former Name

Gender: Female

Languages Spoken: English

Education: Dalhousie University Faculty of Medicine, 1990

Practice Information

Primary Location of Practice
304-4002 Sheppard Ave E
Scarborough ON  M1S 1S6
Phone: 416-910-4513
Fax: 416-299-9221 Electoral District: 10

Professional Corporation Information


Corporation Name: JK Chadda Medicine Professional Corporation
Certificate of Authorization Status: Issued Date:  Sep 20 2020

Shareholders:
Dr. J. Chadda ( CPSO# 62269 )

Business Address:
304-4002 Sheppard Ave E
Scarborough ON  M1S 1S6

Specialties

Specialty Issued On Type
Psychiatry Effective:30 Jun 1997 RCPSC Specialist

Terms and Conditions

(1) Dr. JASJOT KAUR CHADDA may practise only in the areas of medicine in which Dr. CHADDA is educated and experienced.

Postgraduate Training

Please note: This information may not be a complete record of postgraduate training.



University of Toronto, 01 Jul 1995 to 30 Jun 1996
Resident 3 - Psychiatry

University of Toronto, 01 Jul 1996 to 30 Jun 1997
Resident 4 - Psychiatry

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 11 Jun 1990
Expired: Terms and conditions of certificate of registration Expiry: 17 Jun 1991
Subsequent certificate of registration Issued: Independent Practice Certificate Effective: 05 Jul 1991
Transfer of class of certificate to: Restricted certificate Effective: 24 May 2019
Terms and conditions imposed on certificate Effective: 24 May 2019
Suspension of registration imposed: Discipline Committee Effective: 15 Jun 2019
Suspension of registration removed Effective: 15 Dec 2019
Transfer of class of registration to: Independent Practice Certificate Effective: 15 Jan 2021

Previous Hearings

Committee: Discipline
Decision Date: 24 May 2019
Summary:

On May 24, 2019, the Discipline Committee found that Dr. Jasjot Kaur Chadda has committed an act of professional misconduct in that she has engaged in an act or omission relevant to the practice of medicine that, having regarding to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.

Dr. Chadda received her certificate of registration authorising independent practice from the College of Physicians and Surgeons of Ontario (“the College) on July 5, 1991 and began practising as a family physician. In 1997, she completed training in psychiatry and commenced practising as a psychiatrist. Dr. Chadda practises psychiatry as a sole practitioner in Toronto.

FACTS

Patient A

Patient A was a patient of Dr. Chadda’s from August 2013 until the end of 2014. She sought treatment for her depression from Dr. Chadda. Dr. Chadda provided psychotherapy to her. During the course of her treatment of Patient A, Dr. Chadda suggested that she join what Dr. Chadda described as a “meditation retreat” that she was organizing in Italy in July 2014 (the “Italy Retreat”). Patient A agreed to attend the Italy Retreat. Dr. Chadda charged Patient A $5295 plus HST for the retreat, exclusive of airfare and other expenses, which Patient A was required to pay in addition to the fee charged by Dr. Chadda.

Following the Italy Retreat, during one of her sessions with Patient A, Dr. Chadda requested that Patient A do a video testimonial for Dr. Chadda’s website to promote the Italy Retreat. Dr. Chadda told Patient A that she would have her hair and makeup done at Dr. Chadda’s house. Patient A told Dr. Chadda she needed to think about it, but ultimately declined. Despite Patient A’s refusal, Dr. Chadda brought it up again during therapy sessions, until Patient A asked that Dr. Chadda not raise it again. Dr. Chadda’s requests for a testimonial made Patient A uncomfortable.

In October 2015, Patient A complained to the College about various concerns she had about Dr. Chadda’s “care and conduct,” including the following:

- Patient A stated that she felt Dr. Chadda “blurred boundaries” with her and that she was often confused during her relationship with Dr. Chadda as to whether they were friends or whether Dr. Chadda was just her doctor;
- Patient A also complained that Dr. Chadda charged her a fee per session in addition to billing OHIP;
- Dr. Chadda failed to transfer her records, despite repeated requests from her and from Patient A’s subsequent care provider.


The College retained the services of a psychiatrist, Dr. Greg Chandler, to review Dr. Chadda’s care of Patient A and provide an independent expert opinion. Dr. Chandler opined as follows:

Patient A participated in a meditation retreat organized by Dr. Chadda During our training as physicians, we are taught about maintaining proper boundaries between ourselves and our patients. The principle is that by altering the relationship from a purely physician-patient one, we could adversely affect the care provided. In some circumstances, due to the limited scope of certain clinical encounters or with the passage of time after treatment has ended, some nonclinical relationships have been considered acceptable between physicians and patients. However, in our training as psychiatrists, we are taught that significant non-clinical relationships, including but not limited to romantic ones, would never be acceptable if a psychiatrist-patient relationship has ever existed; this includes when there has been only one meeting or after the clinical relationship has terminated. The rationale is that as part of the clinical encounters themselves, psychiatrists will make specific efforts to understand our patients' ways of thinking, anxieties, motivations and vulnerabilities. This makes psychiatrists more able to affect our patients' thinking and behaviour; in fact, this is generally the goal of psychotherapy and the mechanism of it working. This context also makes psychiatrists more at risk for taking advantage of our patients' vulnerabilities, even if done unintentionally. Furthermore, patients will usually be seeing psychiatrists because they feel psychologically vulnerable. When this is the case, it can feel especially important for patients to ensure good relationships with their psychiatrists. As such, when a psychiatrist asks something of a patient, the patient may comply because they do not want to risk the psychiatrist's disapproval, with the ultimate feared risk being the termination of the therapy. This could lead patients to compromise their own best interests in an attempt to please their psychiatrists.

The CPSO’s policy Physician Behaviour in the Professional Environment states, "The physician's primary responsibility is to act in the best interests of the individual patient." As per the CPSO's policy statement Maintaining Appropriate Boundaries and Preventing Sexual Abuse, "Physicians must establish and maintain appropriate professional boundaries with patients." As the dominant individual in the relationship, the CPSO advises that it is the physician's responsibilities to maintain boundaries. As mentioned, while maintaining clear boundaries is crucial in any physician-patient relationship, it is thought to be even more important in a psychotherapy relationship.

When a physician makes an offer that involves finances, it introduces the possibility that a physician could be in conflict of interest between their role as a business person and their role as a physician. This would include selling a patient a product or service unrelated to their medical care. In this particular case, there is a foreseeable risk that Patient A could feel pressure to purchase Dr. Chadda's product (the meditation retreat), with the worry that not doing so could lead to a change in the relationship, or even the termination of therapy. This would mean that even if the psychiatrist did not realize this service could be undesired by the patient, the patient may feel hesitant to raise this and/or refuse the offer. Furthermore, even if the patient wanted the product, coming from a trusted psychiatrist, the patient would be unlikely to conduct themselves in the same way they would in other business decisions, possibly compromising their needs. Dr. Chadda stated that she did not "persuade" Patient A to join the retreat, however it does not reasonably exclude the possibility of a perceived pressure.
Even if Patient A had raised the possibility of joining the retreat, Dr. Chadda should have declined. After paying over $5000 to participate, Patient A was dissatisfied with the quality of the meditation retreat; Patient A' complaint to the College seems to be motivated in part by this. Whether others would agree with Patient A's assessment that the retreat did not deliver what was advertised is not relevant. Rather, the possibility that this sort of tension could foreseeably occur illustrates why the relationship should not be entered into in the first place. As such, in selling a product to a patient she had worked with extensively,…[in] not considering the aforementioned ways this could affect the psychotherapeutic relationship, it also demonstrated a lack of skill and judgment as a psychiatrist. The risks of entering into a significant financial relationship should have been foreseeable to Dr. Chadda. In this case, it caused harm to the patient in that it contributed to the termination of a therapeutic relationship. The degree to which the loss of this or a future therapeutic relationship is harmful would depend on the nature of the relationship and severity of patient illness.

Dr. Chadda asked Patient A to provide a video testimonial for her business For similar rationale to 1, psychiatrists should not ask patients to perform tasks that are meant to serve the physician's benefit, rather than the patient's. In Dr. Chadda asking Patient A to provide a testimonial for her meditation retreat to post on her website, she is hoping that Patient A will increase the appeal of her retreat. As Dr. Chadda states, "the website is not related to my medical practice". Dr. Chadda is thus asking her patient to help generate revenue for her. There is always some pressure on a patient to appease a doctor with whom they want to maintain a relationship. Whether the patient ultimately accepts or not, the request has the potential to introduce tension into the relationship.

As such, in making this request of a patient she had worked with extensively,...[i]n not considering the ways this could affect the therapeutic relationship, it also demonstrated a lack of skill and judgment as a psychiatrist. While this issue did not seem to cause significant distress in this particular case - Dr. Chadda's easy acceptance of the refusal likely helped mitigate this - the risk of disruption was certainly present. As in 1, the degree to which the loss of a therapeutic relationship is harmful would depend on the nature of the relationship and severity of patient illness.

Billing, including charges for missed sessions
The CPSO Policy Statement “Block Fees and Uninsured Services”… states "Physicians are entitled to charge patients for uninsured services, which take physician time and resources". As per this policy, physicians are permitted to charge patients for uninsured services in recognition of non-insured activities that take their time. This policy states "Physicians offering a block fee must ensure the fee covers a period of not less than three months and not more than 12". While there was no agreement about block fees in the patient's chart. Given that upon request for additional documentation, Dr. Chadda later provided it and it bears her name and address, I will assume that the "Block fees for services not provide by OHIP" form is also used by her. On this form, it appropriately lays out what services are covered by the fees. However, this form indicates that the fees are charged per session, as opposed to the policy's 3-12 month period. As such, these fees are essentially a supplemental charge. The OHIP rate for 1 hour (or 2 units) of psychiatric care (billing code K198) is $160. Dr. Chadda's additional fee of $65 per session amounts to an extra 40% per session charge. The OHIP rate for a half session of 30 minutes (or 1 unit) of psychiatric care is $80; Dr. Chadda's additional fee of $45 per session amounts to a 55% extra charge. Given that Dr. Chadda runs a psychotherapy practice, she would often be seeing her patients several times per month. It is difficult to imagine what services could be provided to make these fair and reasonable amounts. Per the OHIP billing, Dr. Chadda and Patient A met an average of twice per month. This would mean a supplemental charge of over $1500 annually if most hourly sessions were held.

These charges would not seem to meet the policy criteria of ensuring the amounts charged are "reasonable in relation to the services provided". They would furthermore "pose a barrier to accessing health care services" for those who could not afford such a large amount, in contradiction with this policy and as such cause harm to potential patients by making care inaccessible. The amount of supplemental billing…demonstrates a lack of professionalism by Dr. Chadda.

Continuity of Care
Not providing a patient's medical records to their current treatment provider on a timely basis…demonstrates poor judgment and/or unprofessionalism, depending on Dr. Chadda's degree of intentionality.

Not providing the information on a timely basis (at least 7 weeks) would demonstrate poor judgment on Dr. Chadda's part. By not providing Patient A's clinical information to her GP, it exposed Patient A to substandard medical care. In this case, it seems that Dr. King was aware of Patient A’s antidepressant regimen, which was uncomplicated, which mitigated the potential harm. However, if this were done with a patient with a more complicated treatment patter, it could expose them to significant harm, either by prescribing medications that interact with medications the MD would be unaware of, incorrect dosing, or omission of necessary medications.

Patient B

Patient B was a patient of Dr. Chadda’s from July to October 2016. Dr. Chadda provided psychotherapy to Patient B. Dr. Chadda charged Patient B $75/session in addition to billing OHIP. Dr. Chadda did not offer Patient B a block fee option. After Patient B terminated therapy with Dr. Chadda, she requested receipts, for income tax purposes, for the amounts that Dr. Chadda had billed her in excess of the OHIP schedule of benefits. Dr. Chadda provided a receipt to Patient B on April 3, 2017.

In January 2017, Patient B complained to the College about Dr. Chadda’s billing practices, “misuse of uninsured services,” and her failure to provide receipts upon request.

Dr. Greg Chandler was again retained by the College to review this matter and provide an independent expert opinion. Dr. Chandler opined as follows:

Additional fees being charged by Dr. Chadda to Patient B
According to the CPSO Policy Statement Block Fees and Uninsured Services, "Physicians are entitled to charge patients for uninsured services, which take physician time and resources". As such, Dr. Chadda is permitted to charge for non-clinical activities. The agreement signed by Patient B, entitled "Block fees for services not provide by OHIP", appropriately lays out what services are covered by the fees. However, the CPSO policy deems that an insured service is comprised of several "constituent elements" which are not eligible to be separately charged for. This would include at least three items listed on Dr. Chadda's form, including:
-Referring patients to other health care professionals as needed,
-Writing prescriptions (separate from what is noted as "phone calls for prescription refills")
-Having phone calls with hospital staff if the patient is referred to the emergency department.

These items are clearly part of the standard clinical care of a patient. By including them on the agreement, a patient would have to assume they are part of the extra service and thus would not be included without payment.

The CPSO states "Physicians must ensure that the fees charged for uninsured services are reasonable" in relation to the services provided. As per the OHIP payment schedule provided, most of Ms K's sessions lasted one hour, which constitutes two units of psychotherapy; this is a typical length of individual psychotherapy sessions. The OHIP rate for 2 units of psychotherapy is $160 (Schedule of Benefits for Physician Services under the Health Insurance Act, billing code K197). Dr. Chadda's additional fee of $75 per session amounts to a 47% extra per session charge; for context, OHIP pays $80 for 30 minute sessions, or one unit, of psychotherapy. Essentially, an additional 30 minutes of care is being charged for every one hour session. Four sessions were conducted in each of July and October, three in September and two in August. It is difficult to imagine what services could be provided per session that would meet the Policy's requirement of being considered reasonable in relation to the services provided. I would note that I would consider this to be the case even if this particular patient had used some extra services i.e. the fact that this patient did not receive additional services is not what proves the excess of the charge.

The policy also requires that the amounts charged would not “pose a barrier to accessing health care services” for those who could not afford them. The amounts involved here would be in contravention of this policy if paying them were a condition of receiving care. As such, it would potentially cause harm by making care inaccessible to certain people in need of psychiatric care. The agreement used does not state that these fees are optional and that not agreeing to them would not exclude this patient from this doctor's care. If Dr. Chadda clearly indicates to patients that clinical care, including all constituent elements, will be provided regardless of willingness to pay the extra fees, then of course the barrier is removed. If that is the case here, then this would be more of an issue of Dr. Chadda's failure to have the patient clearly understand this. Unclear communication about the policy would be a much lesser transgression than insisting on payment of these charges to ensure eligibility for clinical care.

I would note that some confusion likely stems from Dr. Chadda's incorrect use of the term “block fees” for charges related to individual sessions. "A block fee is a flat fee charged for a predetermined set of uninsured services" and "covers a period of not less than three months and not more than 12 months. I do not think this significant in terms of any findings here, but could help reduce future confusion.

Not sending a receipt for fees paid
There seems to be agreement on the facts, which is that Ms. K paid $600 in fees in two installments and Dr. Chadda did not provide receipts for them. As with any payment for services rendered, normal business practice is to issue a receipt immediately upon payment, even without a client asking for it. There is no justification for withholding these receipts upon request. There would be financial harm to a patient if they did not ultimately receive the receipts, in the full amount if it is covered by a patient's insurance, or a lesser amount if it is being used as a tax deduction.

Summary
 
I have made assessments for the area of specific complaint about Dr. Chadda's care, as well as others that seemed relevant to an assessment of her practice.Dr. Chadda charges an expensive supplemental fee on top of OHIP billings received for clinical care. This exposes potential patients to harm in that it creates a barrier to services.If agreeing to these fees is not mandatory, then the risk is the same if potential patients are not made aware of this, which is the physician's responsibility. If the intent is for agreement to these charges to be a condition of treatment, then this would be more serious lack of professionalism.
For those who have agreed to the policy, the amounts involved here are not reasonable using the relevant CPSO policy on the matter. As a result, they are harmed by the excess amount they pay. Not provided receipts for amounts paid upon a patient’s request also demonstrates a lack of professionalism and causes harm in the proportion to the amount paid.

Section 75(1)(a) Investigation
 
In February 2017, as a result of concerns raised by Dr. Chandler, the College commenced an investigation under section 75(1)(a) of the Health Professions Procedural Code.

In addition to Patient A, Dr. Chadda took three other patients (Patients C, D and E) on her Italy Retreat. Dr. Chadda charged each of these patients between $5295 and $5695 plus HST for the retreat, exclusive of airfare and other expenses, which the patients were required to pay in addition to the fee charged by Dr. Chadda.

Patient C was Dr. Chadda’s patient between 2011 and 2017. Dr. Chadda treated Patient C for depression and prescribed anti-depressants to her.
Patient D was a patient of Dr. Chadda’s from October 2007 to October 2015. Dr. Chadda diagnosed Patient D as having a recurrent major depression. Dr. Chadda provided psychotherapy and prescribed anti-depressants to Patient D.
Patient E was a patient of Dr. Chadda’s from April 2007 to October 2016. Dr. Chadda provided psychotherapy to Patient E.

Dr. Chadda charged Patients C, D, and E an additional fee per session in addition to the amount she billed OHIP. Dr. Chadda did not provide any of them with a block fee option.

Dr. Chandler was again retained to review the care provided to Patients C, D and E and provide an independent expert opinion. As part of his review, he interviewed Dr. Chadda in October 2017.

Dr. Chandler opined as follows:

The patients participated in a meditation retreat organized by Dr. Chadda During our training as physicians, we are taught about maintaining proper boundaries between ourselves and our patients. The principle is that by altering the relationship from a purely physician-patient one, we could adversely affect the care provided. In some circumstances, due to the limited scope of certain clinical encounters or with the passage of time after treatment has ended, some nonclinical relationships have been considered acceptable between physicians and patients. However, in our training as psychiatrists, we are taught that significant non-clinical relationships would never be acceptable if a psychiatrist-patient relationship has ever existed. The rationale is that as part of the clinical encounters themselves, psychiatrists will make specific efforts to understand our patients' ways of thinking, anxieties, motivations and vulnerabilities. This makes psychiatrists more able to affect our patients' thinking and behavior; in fact, this is generally the goal of psychotherapy and the mechanism of it working. This context also makes psychiatrists more at risk for taking advantage of our patients' vulnerabilities, even if done unintentionally. Furthermore, patients will usually be seeing psychiatrists because they feel psychologically vulnerable. When this is the case, it can feel especially important for patients to ensure good relationships with their psychiatrists. As such, when a psychiatrist asks something of a patient, the patient may comply because they do not want to risk the psychiatrist's disapproval, with the ultimate feared risk being the termination of the therapy. This could lead patients to compromise their own best interests in an attempt to please their psychiatrists.

The CPSO's policy Physician Behaviour in the Professional Environment states, "The physician's primary responsibility is to act in the best interests of the individual patient." As per the CPSO's policy statement Maintaining Appropriate Boundaries and Preventing Sexual Abuse, "Physicians must establish and maintain appropriate professional boundaries with patients.'' As the dominant individual in the relationship, the CPSO advises that it is the physician's responsibilities to maintain boundaries. As mentioned, while maintaining clear boundaries is crucial in any physician-patient relationship, it is thought to be even more important in a psychotherapy relationship.

When a physician makes an offer that involves finances, it introduces the possibility that a physician could be in conflict of interest between their role as a business person and their role as a physician. This would include selling a patient a product or service unrelated to their medical care. In this particular case, there is a foreseeable risk that a patient could feel pressure to purchase Dr. Chadda's product (the meditation retreat), with the worry that not doing so could lead to a change in the relationship, or even the termination of therapy. This would mean that even if the psychiatrist did not realize this service could be undesired by the patient, the patient may feel hesitant to raise this and/or refuse the offer. Furthermore, even if the patient wanted the product, coming from a trusted psychiatrist, the patient would be unlikely to conduct themselves in the same way they would in other business decisions, possibly compromising their needs. Even if Dr. Chadda does not attempt to persuade patients to join the retreat, it does not reasonably exclude the possibility of a perceived pressure. Even if patients raise the possibility of joining the retreat, the physician should have decline.

As such, in selling a product to three patients she had worked with extensively,…[i]n not considering the aforementioned ways this could affect the psychotherapeutic relationship, it demonstrated a lack of skill and judgment as a psychiatrist. The degree to which patients would be affected would depend on the nature of the relationship and severity of patient illness.

Billing, including charges for missed sessions
 
According to the CPSO Policy Statement Block Fees and Uninsured Services, "Physicians are entitled to charge patients for uninsured services, which take physician time and resources". The OHIP rate for 1 hour (or 2 units) of psychiatric care is $160, based on the Ministry of Health's Schedule of Benefits (code K198). There was an agreement about block fees in one patient's chart which indicated a charge of $450 for a three month period when patients see her every two weeks. Each of these patients averaged nine sessions per three month period, meaning the per session charge amounts to an extra 30% per session. For these three patients, the amounts documented ranged from $845-1770 in one year periods, so it is less clear if they were all on this block fee arrangement. Nonetheless, it is unclear what services could be provided to make these fair and reasonable amounts. It is unclear that these charges meet the policy criteria of ensuring the amounts are "reasonable in relation to the services provided". These amounts are substantial enough that they could "pose a barrier to accessing health care services" for many patients, in contradiction and as such causing harm to potential patients by making care inaccessible. The amount of supplemental billing … demonstrates a lack of professionalism by Dr. Chadda.

Summary
 
I have reviewed the charts of three patients and made assessments for the areas of Dr. Chadda's care that seemed relevant to an assessment of her practice…The three patients were receiving treatment in the form of psychotherapy and two were also receiving pharmacotherapy. All three patients struggled with psychological distress which could result in depressive symptoms…Dr. Chadda…charging an excessive supplemental fee for sessions also exposes patients to harm in that it creates a potential barrier to services.


DISPOSITION

On May 24, 2019, the Discipline Committee ordered that:

- The Registrar suspend Dr. Chadda’s certificate of registration for a period of six (6) months, commencing from June 15, 2019 at 12:01 a.m.
- The Registrar place the following terms, conditions and limitations on Dr. Chadda’s certificate of registration:
-Dr. Chadda attend before the panel to be reprimanded.
-Dr. Chadda pay costs to the College in the amount of $6,000.00 within 30 days of the date of this Order. 
 


Decision: Download Full Decision (PDF)
Hearing Date(s): May 24, 2019 at 9:00 a.m.