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Khan, Akbar Nauman

CPSO#: 65249

MEMBER STATUS
Active Member as of 15 Jun 1992
CURRENT OR PAST CPSO REGISTRATION CLASS
Restricted as of 30 Sep 2017

Summary

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Former Name: No Former Name

Gender: Male

Languages Spoken: English

Education: University of Toronto, 1992

Practice Information

Primary Location of Practice
Suite 301
4576 Yonge Street
Toronto ON  M2N 6N4
Phone: (416) 227-0037
Fax: (416) 227-1915 Electoral District: 10

Professional Corporation Information


Corporation Name: Dr. Akbar Khan Medicine Professional Corporation
Certificate of Authorization Status: Issued Date:  Oct 05 2020

Shareholders:
Dr. A. Khan ( CPSO# 65249 )

Business Address:
301 - 4576 Yonge Street
Toronto ON  M2N 6N4
Phone Number: (416) 227-0037

Specialties

Specialty Issued On Type
No Speciality Reported

Postgraduate Training

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



University of Toronto, 15 Jun 1992 to 14 Jun 1993
Other - Family Medicine

University of Toronto, 01 Jul 1993 to 30 Jun 1994
Resident 2 - Family Medicine

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 15 Jun 1992
Transfer of class of registration to: Independent Practice Certificate Effective: 16 Jun 1993
Terms and conditions amended by Inquiries, Complaints and Repo Effective: 29 Sep 2017
Transfer of class of certificate to: Restricted certificate Effective: 30 Sep 2017
Terms and conditions imposed on certificate by Inquiries, Complaints and Repo Effective: 30 Sep 2017
Terms and conditions amended by Inquiries, Complaints and Repo Effective: 27 Jan 2022

Pending Hearings

Summary:

Allegations of Dr. Khan’s professional misconduct and incompetence have been referred to what is now the Ontario Physicians and Surgeons Discipline Tribunal. It is alleged that Dr. Khan is incompetent and/or failed to maintain the standard of practice of the profession in his care of patients. It is also alleged that Dr. Khan engaged in disgraceful, dishonourable or unprofessional conduct and/or had a conflict of interest in his and/or his clinic’s relationship with a diagnostic service provider. In addition, it is alleged that Dr. Khan engaged in disgraceful, dishonourable or unprofessional conduct including but not limited to his communications with a patient regarding a College complaint and with respect to his billing practices regarding a patient.

Notice of Hearing: Download Full Notice (PDF)

Hearing Date(s): June 20-24 and 29, 2022

Practice Restrictions

Imposed By Effective Date Expiry Date Status
Inquiries, Complaints and Reports Committee Effective: 01 Feb 2022 Active
 (1 of 2)


As from January 27, 2022, by Order of the Inquiries, Complaints and Reports Committee of the College of Physicians and Surgeons of Ontario, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Akbar Nauman Khan:  

Practice Restriction 

(1)	Dr. Khan shall not provide medical exemptions in relation to vaccines for COVID-19;

(2)	Dr. Khan shall not prescribe ivermectin.

Posting a Sign and Translations 

(3)	Dr. Khan shall post a sign in all waiting rooms, examination rooms and consulting rooms, in all Practice Locations, in a clearly visible and secure location, at all times whether or not he is physically present at the Practice Location, in the form set out at Schedule "A." If providing care in a virtual setting, Dr. Khan shall display the sign to the patient at the outset of the patient encounter. If the patient encounter is by telephone, Dr. Khan shall read the sign to the patient at the outset of the patient encounter.  For further clarity, this sign shall state as follows: "Dr. Khan must not provide medical exemptions in relation to COVID-19 vaccines, mask requirements or testing. Further information may be found on the College of Physicians and Surgeons of Ontario website at www.cpso.on.ca".

(4)	Dr. Khan shall post a certified translation(s) in any language(s) in which he provides services, of the sign described in (3) above, in all waiting rooms, examination rooms and consulting rooms, in all of his Practice Locations, in a clearly visible and secure location, in the form attached hereto as Schedule "A". 

(5)	Dr. Khan shall provide the certified translation(s) described in (4) above to the College within 30 days of the date of this Order;

(6)	The College may accept an alternative arrangement with respect to signage in a hospital setting, in its sole discretion.

Notification of Practice Locations

(7)	Dr. Khan shall inform the College of each and every location at which he practices including, but not limited to, hospital(s), clinic(s), office(s) and virtual care setting(s) in any jurisdiction (collectively the "Practice Location(s)"), within five (5) days of this Order.  Going forward, he shall inform the College of any and all new Practice Locations within five (5) days of commencing practice at or accepting patients from that location.

Monitoring

(8)	Dr. Khan shall, within fourteen (14) days of the date of this Order, provide to the College his irrevocable consent in the form attached at Schedule "B" for the College to make appropriate enquiries of the Ontario Health Insurance Plan ("OHIP"), to monitor his compliance with the terms of this Order.

(9)	Dr. Khan shall maintain a log of all professional encounters with patients, including both in-person encounters and encounters in a virtual setting, in the form attached at Schedule "C" ("Patient Log"). Dr. Khan shall include in the Patient Log the name of each patient with whom he has a professional encounter and the date of the encounter; the patient's date of birth; the reason for the visit; and the type of visit (i.e., telemedicine or in-person).

(10)	Dr. Khan shall provide a copy of the Patient Log to the College every two (2) weeks, or at any other time as requested by the College. 

(11)	Dr. Khan shall submit to, and not interfere with, unannounced inspections of his Practice Locations and to inspections of patient charts by the College and to any other activity the College deems necessary in order to monitor Dr. Khan's compliance with the terms of this Order.

(12)	Dr. Khan shall consent to the College providing the Order to any Chief(s) of Staff, or a colleague with similar responsibilities, at any Practice Location where he practices or has privileges ("Chief(s) of Staff"), and to provide said Chief(s) of Staff with any information the College has that led to this Order and/or any information arising from the monitoring of his compliance with this Order.


(2 of 2)
As from September 30, 2017, the following is imposed as a term, condition and
            limitation on the certificate of registration held by Dr. Akbar Nauman Khan,
            pursuant to section (x) of the order made by the Inquiries, Complaints and
            Reports Committee of the College of Physicians and Surgeons of Ontario,
            effective September 30, 2017:

                  Dr. Akbar Nauman Khan has ceased to provide chemotherapy until such time
                  as he has obtained a Clinical Supervisor acceptable to the College, and
                  provided the Clinical Supervisor's signed undertaking to the College.
                  
                  
            As from 12:01 a.m., September 30, 2017, by order of the Inquiries, Complaints
            and Reports Committee of the College of Physicians and Surgeons of Ontario, the
            following terms, conditions and limitations are imposed on the certificate of
            registration held by Dr. Akbar Nauman Khan:

            (i)   Dr. Khan shall practise under the guidance of a clinical supervisor(s)
                  acceptable to the College in respect of his provision of chemotherapy to
                  patients (the "Clinical Supervisor(s)").  

            (ii)  Dr. Khan acknowledges that he has reviewed the Clinical Supervisor(s)'s
                  undertaking, attached as Appendix "B" to the Order, and understands what
                  is required of the Clinical Supervisor(s) and the Clinical Supervision: 

                  i.    Dr. Khan shall meet with the Clinical Supervisor(s) once a week;
                  
                  ii.   At the initial meeting, Dr. Khan shall review the patient records
                        for each patient receiving chemotherapy from Dr. Khan. The Clinical
                        Supervisor's review shall include a review of all testing,
                        diagnostic imaging and other results, as well as the treatment plan
                        and diagnosis; 
                  
                  iii.  At each subsequent meeting, the Clinical Supervisor shall review
                        the patient records for each patient (who is receiving chemotherapy
                        from Dr. Khan) who were either treated during the week, or for whom
                        test results were received; 
                  
                  iv.   The Clinical Supervisor shall ensure that conventional diagnosis
                        and treatment plans as well as risks associated with treatment
                        plans are documented in the charts. The Clinical Supervisor shall
                        satisfy himself/herself that conventional diagnosis and treatment
                        plans as well as risks associated with treatment plans have been
                        communicated to patients, including as it pertains to test results
                        obtained throughout the course of the treatment;
                  
                  v.    The Clinical Supervisor shall, at least once a month, observe Dr.
                        Khan in practice administering chemotherapy;
                  
                  vi.   The Clinical Supervisor shall discuss any concerns arising from the
                        chart reviews or observation; 
                  
                  vii.  The Clinical Supervisor shall perform any other duties, such as
                        reviewing other documents or conducting interviews with staff or
                        colleagues, that the Clinical Supervisor(s) deem necessary to  his
                        Clinical Supervision; and
                  
                  viii. The Clinical Supervisor shall submit written reports to the College
                        at least once every month, or immediately if the Clinical
                        Supervisor(s) has concerns about Dr. Khan's standard of practice or
                        that Dr. Khan's patients may be exposed to the risk of harm or
                        injury.
                  
            (iii) Dr. Khan shall fully cooperate with the clinical supervision, and shall
                  abide by any recommendations of his Clinical Supervisor(s). Without
                  limiting the foregoing, if during or after an observation or a chart
                  review the Clinical Supervisor is of the view that Dr. Khan's conduct or
                  care will put a patient or patients at risk, Dr. Khan shall immediately
                  comply with any recommendation made by the Clinical Supervisor(s) to
                  protect the patient(s) from risk. 

            (iv)  Dr. Khan shall maintain a log of all patients receiving chemotherapy,
                  which shall include the dates of each visit, and testing or diagnostic
                  imagining ordered and received and the treatment provided. 

            (v)   Dr. Khan shall, within five (5) days of the date of the Order, provide
                  the College with the addresses of any locations where he practises
                  medicine, and, if he commences practice at a new location, shall provide
                  the College with its address within five (5) days. 

            (vi)  Dr. Khan  shall consent to the disclosure by his Clinical Supervisor(s)
                  to each other and to the College  and by the College to the Clinical
                  Supervisor(s) of all information the Clinical Supervisor(s) or the
                  College deem necessary or desirable in order to fulfil the Clinical
                  Superivisor(s)' undertaking and to monitor Dr. Khan's compliance with the
                  Order.

            (vii) Dr. Khan shall within five (5) days of the Order provide the College with
                  his irrevocable consent to make inquiries of the Ontario Health Insurance
                  Plan, attached at Appendix "C" to the Order, in order for the College to
                  monitor his compliance with the terms of the Order.

            (viii)Dr. Khan must ensure that Appendix "B" to the Order is signed and
                  delivered to the College within ten (10) days of the date of the Order.

            (ix)  If a person who has given an undertaking in Appendix "B" to the Order is
                  unable or unwilling to continue to fulfill its provisions, Dr. Khan
                  shall, within ten (10) days of receiving notice of same, obtain an
                  executed undertaking in the same form from a similarly qualified person
                  who is acceptable to the College and ensure that it is delivered to the
                  College within that time.

            (x)   If Dr. Khan is unable to obtain a Clinical Supervisor on the provisions
                  set out under sections (viii) and (ix) above, he shall cease providing
                  chemotherapy until such time as he has obtained a Clinical Supervisor
                  acceptable to the College.

            (xi)  If Dr. Khan is required to cease providing chemotherapy as a result of
                  section (x) above, this will constitute a term, condition or limitation
                  on his Certificate of Registration and that term, condition or limitation
                  will be included on the public register.

            (xii) Dr. Khan will submit to, and not interfere with, unannounced inspections
                  of his Practice Location(s) and to any other activity the College deems
                  necessary in order to monitor his compliance with the provisions of the
                  Order.

            (xiii)Dr. Khan shall be responsible for payment of all fees, costs, charges,
                  and expenses arising from the implementation of the Order.


Previous Hearings

Committee: Ontario Physicians and Surgeons Discipline Tribunal
Decision Date: 07 Feb 2022
Summary:

Dr. Akbar Nauman Khan is qualified as a family physician. He runs a medical clinic where he provides care to patients, many of whom have cancer. Over time Dr. Khan expanded his practice to include an integrative approach which combined complementary and alternative medicine (CAM) and therapies with his patients’ conventional medical care.

On August 17, 2017, the College referred allegations of professional misconduct to what is now the Ontario Physicians and Surgeons Discipline Tribunal. The College alleged Dr. Khan had engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional [paragraph 1(1)33 of Ontario Regulation 856/93] and failed to maintain the standard of practice of the profession [paragraph 1(1)2 of O Reg. 856/93]. The Notice of Hearing further alleged that Dr. Khan is incompetent as defined by subsection 52(1) of the Code.
On October 24, 2018, the College referred a further allegation of disgraceful, dishonourable or unprofessional conduct when Dr. Khan failed to co-operate with the College’s investigation.

The hearing took place on January 20-22, February 18-20, March 2-4, September 21-22, 24-25, October 5, 7-8 and November 2-3, 2020. Both parties were represented by counsel. Independent legal counsel to the Tribunal also took part in the hearing.

Communication with Patients

The Tribunal found Dr. Khan failed to communicate with his patients in an open and honest manner. Dr. Khan was required to engage in a comprehensive consent discussion with his patients, outlining the risks and benefits of the options and information necessary to allow patients to make a fully informed decision. The Tribunal found he failed to do so. There was no evidence Dr. Khan told any of the 10 patients receiving SAFE chemotherapy treatment that it should be stopped because it was not working. Therapy stopped only when his patients either could not afford it any longer, their condition had deteriorated to such a degree that they could not tolerate it, they were so ill that they were admitted to hospital or they died.

Standard of Practice – Use of SAFE Chemotherapy

While acknowledging the College’s CAM policy does not specify the amount of research, trials evidence, general evidence or science that must support use of a CAM therapy, the Tribunal was satisfied Dr. Khan’s use of SAFE chemotherapy fell below the standard of practice. The Tribunal found an absence of any published data to support the therapy as an effective treatment for cancer. Dr. Khan’s testimony, letters and websites did not contain any data, supportive literature or evidence to support SAFE chemotherapy as an effective treatment for cancer. Dr. Khan’s personal beliefs, along with his limited and personal observations of his patients he treated do not constitute evidence or science supporting the use of SAFE chemotherapy as an effective cancer treatment that offers patients a favourable risk/benefit profile or a reasonable expectation of remedying or alleviating a patient’s health condition. By treating patients with SAFE chemotherapy Dr. Khan repeatedly breached the CAM policy and failed to maintain the standard of practice of the profession.

Standard of Practice - Dichloroacetate

Dr. Khan provided Dichloroacetate (DCA) to his adult patients as a cancer treatment and to a pediatric patient with medulloblastoma. Although it appears that published science does not yet support Dr. Khan’s recommendation of the use of DCA to treat cancer patients, the Tribunal accepted there is a body of research and experience that may support consideration of its use in some cancers.

Standard of Practice - Patient A

Patient A was diagnosed with pediatric medulloblastoma. The Tribunal found Dr. Khan both failed to maintain the standard of practice when he used DCA to treat this condition and in his treatment of Patient A. Specifically, the Tribunal found Dr. Khan:
  • made a diagnosis which was not a conventional diagnosis and did not satisfy the requirements of the CAM policy;
  • failed to obtain informed consent to use DCA;
  • used a medication that was not informed by evidence and science, did not possess a favourable risk/benefit ratio, and did not have a reasonable expectation of remedying or alleviating Patient A’s health condition. The two studies on pediatric medulloblastoma were not applicable to Patient A;
  • failed to provide accurate and objective information, substantiated by fact and sound clinical judgment, to Patient A’s parents. He provided inaccurate information about the potential benefits of DCA and inaccurate information about the results of treatment including interpreting results to deny the disease progression; and
  • demonstrated a disregard for Patient A’s welfare.
Standard of Practice - Patient B

Dr. Khan diagnosed Patient B with acute leukemia. The Tribunal found Dr. Khan failed to maintain the standard of practice in his treatment of Patient B when he:
  • made a diagnosis which was not a conventional diagnosis using an ONCOblot test which is not considered conventional or sufficient as a stand-alone diagnostic tool for the diagnosis of cancer and disregarded conventional diagnostic methods;
  • failed to obtain Patient B’s informed consent to the use of Low-Dose Naltrexone (LDN) and HonoPure;
  • used medications, LDN and HonoPure, which were not informed by evidence and science, did not possess a favourable risk/benefit ratio, did not have a reasonable expectation of remedying or alleviating Patient B’s health condition and were not the appropriate treatment for the presumed cancer; and
  • demonstrated disregard for Patient B’s welfare by diagnosing and treating them for a cancer they did not have, ignoring conventional testing that conclusively showed  they did not have cancer and continuing to tell them they had cancer that needed treatment with LDN to keep it “under control,” and using medications that were not informed by evidence and science, did not offer Patient B a beneficial risk/benefit ratio and could not reasonably be expected to alleviate their presumed cancer.
Standard of Practice - Patient C

Patient C was diagnosed with pancreatic cancer and metastases to the liver. The Tribunal concluded Dr. Khan failed to maintain the standard of practice with respect to Patient C’s care when he:
  • treated Patient C’s cancer using SAFE chemotherapy, which was not informed by evidence and science, did not possess a favourable risk/benefit ratio, and did not have a reasonable expectation of remedying or alleviating Patient C’s health condition or symptoms;
  • used carboplatin as a standalone off-label treatment. This was conventional chemotherapy in an unconventional setting and did not show a favourable risk-benefit profile;
  • failed to obtain informed consent to the use of SAFE chemotherapy; and
  • failed to recognize the progression of Patient C’s cancer and instead of treating them with palliative intent, pushed for aggressive therapy in the form of surgery and further SAFE chemotherapy treatments; and
  • exposed Patient C to risk of harm and failed to have regard for their welfare.
Standard of Practice - Patient D

Patient D was diagnosed with stage IV colon cancer and metastatic disease of the liver. Despite an aggressive multidisciplinary treatment approach, the cancer continued to progress. Patient D’s  conventional physicians eventually informed them that treatment options going forward were non-curative. The Tribunal concluded that Dr. Khan failed to maintain the standard of practice with respect to Patient D’s care when he:
  • treated Patient D’s cancer using SAFE chemotherapy that was not informed by evidence and science, did not possess a favourable risk/benefit ratio, and did not have a reasonable expectation of remedying or alleviating Patient D’s health condition or symptoms;
  • used SAFE chemotherapy on Patient D although they were likely resistant to it and myelosuppressed;
  • exposed Patient D to potential harm due to the bone marrow suppression perpetuated by the SAFE chemotherapy, limiting options for conventional treatments had they, at any point, wished to utilize them and displayed a disregard for their welfare;
  • demonstrated a lack of knowledge, skill, and judgment across numerous areas of Patient D’s care
  • failed to obtain informed consent from Patient D for the use of SAFE chemotherapy; and
  • failed to provide accurate and objective information, substantiated by fact and sound clinical judgment, to Patient D and their family about the progress of the cancer.
Standard of Practice - Patient E

Patient E was diagnosed with non-small cell lung cancer which metastasized to the brain. The prognosis was terminal. The Tribunal found Dr. Khan did not maintain the standard of practice when he:
  • treated Patient E’s cancer using SAFE chemotherapy which was not informed by evidence and science, did not possess a favourable risk/benefit profile, and did not have a reasonable expectation of remedying or alleviating Patient E’s  health condition or symptoms;
  • failed to obtain informed consent from Patient E for the use of SAFE chemotherapy and DCA. Dr. Khan’s notes do not state which or in what detail standard chemotherapeutic options were reviewed with Patient E or their likely resistant to the carboplatin in SAFE chemotherapy;
  • failed to provide accurate and objective information, substantiated by fact and sound clinical judgment, to Patient E about progress of the cancer;
  • demonstrated a lack of judgment by placing Patient E on SAFE chemotherapy when they were likely resistant to this class of chemotherapeutic drugs;
  • displayed a lack of knowledge and judgment in his email communication to another health care professional and to Patient E that did not accurately reflect Patient E’s actual response to SAFE chemotherapy; 
  • exposed Patient E to risks of harm from the side effects and toxicities of carboplatin and disregarded their expressed wish to avoid immunosuppressing medication; and
  • demonstrated a disregard for Patient E’s welfare.
Standard of Practice - Patient F

Patient F was diagnosed with breast cancer which progressed despite conventional treatments. The Tribunal found Dr. Khan did not maintain the standard of practice when he:
  • treated Patient F’s cancer using SAFE chemotherapy, which was not informed by evidence and science, did not possess a favourable risk/benefit ratio, and did not have a reasonable expectation of remedying or alleviating the patient’s health condition or symptoms. Patient F was likely resistant to platinum-based therapies. Use of carboplatin exposed Patient F to side effects such as the risk of bone marrow suppression, which they had already experienced when previous conventional chemotherapy caused bone marrow damage;
  • failed to obtain informed consent for the use of SAFE chemotherapy. There was no documentation in Patient F’s chart describing which standard chemotherapeutic treatment options had been discussed or how their risks and benefits compared with the treatments Dr. Khan was offering;
  • showed a lack of knowledge and judgment in using a SAFE chemotherapy/gemcitabine regimen, which was unlikely to benefit Patient F while it simultaneously exposed them to the risk of side effects and toxicities;
  • exposed Patient F to the risk of harm from the side effects and toxicities of both gemcitabine and carboplatin; and
  • demonstrated a disregard for Patient F’s welfare.
Standard of Practice - Patient G

Patient G was diagnosed with non-small cell lung cancer in both lungs, metastatic to the brain, lymph nodes, and liver. The Tribunal found Dr. Khan did not maintain the standard of practice when he:
  • treated Patient G’s cancer using SAFE chemotherapy, which was not informed by evidence and science, did not possess a favourable risk/benefit ratio and did not have a reasonable expectation of remedying or alleviating Patient G’s health condition or symptoms. The Tribunal accepted that, by conventional definitions, Patient G was resistant to platinum agents, including carboplatin. Dr. Khan failed to recognize this;
  • failed to obtain Patient G’s informed consent for the use of SAFE chemotherapy. The chart contained no written documentation of which standard chemotherapeutic treatment options were discussed with Patient G nor how their risks and benefits compared with SAFE chemotherapy. He also failed to inform Patient G they were likely resistant to platinum-based chemotherapy and, without this information, Patient G could not provide informed consent;
  • failed to provide accurate and objective information, substantiated by fact and sound clinical judgment, to Patient G about the progress of the cancer; and
  • showed a lack of knowledge when he failed to recognize Patient G was resistant to platinum agents;
  • showed a lack of judgment by placing Patient G on carboplatin;
  • demonstrated a lack of skill by failing to properly interpret the evidence and science and failing to recognize that SAFE chemotherapy would not overcome platinum resistance; and
  • exposed Patient G to the risk of harm from the known side effects and toxicity of carboplatin without providing the “more aggressive therapy” Patient G requested and disregarded their welfare.
Standard of Practice - Patient H

Patient H had pancreatic cancer and possible metastatic disease of the liver. The Tribunal found that, in his care and treatment of Patient H, Dr. Khan failed to maintain the standard of practice when he:
  • treated Patient H’s cancer using SAFE chemotherapy which was not informed by evidence and science, did not possess a favourable risk/benefit ratio, and did not have a reasonable expectation of remedying or alleviating Patient H’s health condition or symptoms. The use of carboplatin was inappropriate because it would have no activity on pancreatic cancer;
  • failed to obtain informed consent to the use of SAFE chemotherapy. Patient H’s earlier physicians would not have compared conventional options with SAFE chemotherapy and that was an essential part of the consent process. Anything less than a full risks-benefits discussion is insufficient to obtain informed consent;
  • exposed Patient H to a risk of harm by placing them on SAFE chemotherapy in the absence of sufficient evidence showing the use of the medication mesna protects patients from the toxic side effects of carboplatin. Patient H needed rehydration in the emergency department for intractable nausea and vomiting.
  • exposed Patient H to the risk of harm from the opportunity cost of leaving their home and family to travel across the country for ineffective treatment when they had little time to live. By telling Patient H that, cost allowing, they should consider SAFE chemotherapy over conventional chemotherapy Dr. Khan displayed a disregard for Patient H’s welfare; and
  • failed to provide accurate and objective information, substantiated by fact and sound clinical judgment, to Patient H’s family and others about the progress of the cancer.
Standard of Practice - Patient I

Patient I had a CT scan demonstrating the likely presence of metastatic lung cancer with enlarged lymph nodes. They declined a bronchoscopy and a biopsy and started natural therapies on their own. Patient I was referred to Dr. Khan by a naturopath for DCA treatment. While the Tribunal found Dr. Khan met the standard of care in some aspects of Patient I’s treatment, he failed to do so when he:
  • treated Patient I’s cancer using SAFE chemotherapy that was not informed by evidence and science, did not possess a favourable risk/benefit profile and did not have a reasonable expectation of remedying or alleviating Patient I’s health condition or symptoms. Dr. Khan did not have any published literature or robust scientific evidence demonstrating the efficacy of SAFE chemotherapy and little in the way of personal experience or data to validate its use on Patient I.
  • As there was no evidence supporting the use of CTC (circulating tumour cells) counts to monitor cancer, or that a falling CTC count has clinical implications towards cancer response to therapy, the Tribunal rejected Dr. Khan’s claim that a falling CTC count meant Patient I was having a partial response to therapy;
  • failed to obtain informed consent for the use of SAFE chemotherapy. The evidence did not support finding Dr. Khan described standard chemotherapeutic options to Patient I before beginning SAFE chemotherapy;
  • showed a lack of judgment in using SAFE chemotherapy to treat Patient I which exposed them to the known risks and side effects of carboplatin, even though it was unlikely to treat the presumed cancer;
  • showed a lack of knowledge in failing to recognize the significance of the various radiological studies showing cancer progress in Patient I;
  • misdiagnosed Patient I’s disease progress in the brain as pseudoprogression. This demonstrated a lack of knowledge; and,
  • exposed Patient I to the risk of harm or injury from the well-established side effects and toxicities to conventional chemotherapy carboplatin.
Standard of Practice - Patient J

Patient J was a young person with stage IV melanoma with brain metastases. Despite extensive conventional treatment the disease was progressing. The Tribunal found Dr. Khan failed to maintain the standard of practice of the profession when he:
  • treated Patient J’s cancer using SAFE chemotherapy and DCA, both of which were not informed by evidence and science, did not possess a favourable risk/benefit ratio, and did not have a reasonable expectation of remedying or alleviating the health condition or symptoms. Melanoma is a chemo resistant cancer. Dr. Khan would have had to use Carboplatin with Taxol to achieve even a very low effect. He did not do this;
  • failed to obtain informed consent for the use of SAFE chemotherapy and DCA;
  • failed to provide accurate and objective information, substantiated by fact and sound clinical judgment, to Patient J about the progress of the cancer. He deprived his patient of critical information that could have helped them to better understand the clinical status; and
  • treating Patient J with SAFE/carboplatin and DCA exposed them to side effects and toxicities of these treatments even though they were unlikely to provide effective treatment for their cancer. This showed a lack of judgment, exposed Patient J to a risk of harm or injury, and disregarded Patient J’s welfare.
Standard of Practice - Patient K

Patient K was diagnosed with limited stage small cell lung cancer. The Tribunal found Dr. Khan failed to maintain the standard of practice of the profession when he:
  • treated Patient K’s cancer using SAFE chemotherapy, which was not informed by evidence and science, did not possess a favourable risk/benefit ratio and did not have a reasonable expectation of remedying or alleviating Patient K’s health condition or symptoms. The literature does not show benefit from extended chemotherapy beyond the initial treatment cycles or using a conventional platinum-containing chemotherapy in a patient who had already received sufficient platinum therapy. SAFE/carboplatin failed to offer Patient K any known benefit and, in the event the cancer recurred, potentially rendered any future treatments less effective. The fact Patient K feared cancer recurrence does not shift the risk/benefit profile of SAFE chemotherapy. Patient demand is not a sufficient reason to provide medical therapy that is not indicated or has no evidence supporting its use in cancer;
  • did not obtain from or provide Patient K with key information needed to provide informed consent for the use of SAFE chemotherapy;
  • did not confirm which conventional chemotherapy regimen Patient K received earlier, failed to take an appropriate patient history and failed to provide an adequate clinical assessment;
  • diagnosed Patient K with microscopic disease based on the results of a CTC test instead of accepting the conventional diagnosis of no evidence of disease. In doing so , Dr. Khan failed to come to a conventional diagnosis;
  • showed a lack of judgment in placing Patient K on more platinum-containing medication and exposing them to the side effects, toxicities and risk of harm from such medications when there was no added benefit;
  • showed a lack of judgment by starting and treating Patient K with chemotherapy for several months before confirming previous therapy received from the conventional oncology team and by placing Patient K, who showed no evidence of disease, on a regime that could render the cancer more resistant to future chemotherapeutic agents if it recurred;
  • exposed Patient K to the risk of harm, including significant risk of developing renal impairment, from the side effects and toxicities of this medication due to previous cycles of cisplatin and to the risk that if the cancer returned, certain chemotherapeutic agents could be less effective; and,
  • demonstrated a disregard for Patient K’s welfare when he exposed them to all these risks in the absence of benefit and may have undermined his goal of reducing risk of cancer returning in the process.
Standard of Practice - Patient L

Patient L was diagnosed with esophageal cancer that had metastasized to his liver. The Tribunal concluded that Dr. Khan’s care and treatment of Patient L failed to meet the standard of practice when he:
  • treated Patient L’s cancer using SAFE chemotherapy, which was not informed by evidence and science, did not possess a favourable risk/benefit ratio, did not have a reasonable expectation of remedying or alleviating Patient L’s health condition or symptoms and was not the appropriate treatment for Patient L’s cancer. Single agent carboplatin would not be regarded as standard of care and Dr. Khan should not have used carboplatin alone to treat Patient L;
  • failed to obtain informed consent in the use of SAFE chemotherapy. Dr. Khan did not document discussion of standard chemotherapeutic treatment options and comparison of their risks and benefits with those of the SAFE chemotherapy treatment. Dr. Khan’s claims about the efficacy and lower side effect profile for SAFE chemotherapy were not based on evidence. He did not inform Patient L of this;
  • failed to diagnose Patient L’s disease progress. Dr. Khan ignored clear clinical signs and radiological investigations and persisted in telling the family and other physicians that the treatment was working;
  • failed to provide accurate and objective information, substantiated by fact and sound clinical judgment, about the progress of Patient L’s cancer. Dr. Khan made statements to the family that were inaccurate, contradicted the scoping physician’s report and misled Patient L and family about the true clinical status;
  • demonstrated a lack of judgment when he treated Patient L with SAFE chemotherapy, which did not have a likelihood of remedying the cancer but exposed them to the risk of harm from the side effects and toxicities of carboplatin;
  • demonstrated a lack of knowledge in terms of the standard treatment and management of Patient L’s esophageal cancer;
  • exposed Patient L to the risk of harm from the side effects and toxicities of carboplatin and by giving patient and family false hope; and
  • showed a disregard for Patient L’s welfare.
Incompetence

Dr. Khan’s testimony demonstrated little insight into his failings. The Tribunal was satisfied that the lack of knowledge, skill and judgment Dr. Khan displayed in the care of all 12 patients continues to the present. This lack of knowledge, skill and judgment is serious and the consequences, or potential consequences, of such deficiencies are grave. The Tribunal was satisfied Dr. Khan is incompetent and found him unfit to continue to practise or his practice should be restricted.

Disgraceful, Dishonourable or Unprofessional Conduct

OHIP Billings

The Tribunal reviewed OHIP billings for six of Dr. Khan’s patients. The Tribunal found Dr. Khan submitted palliative care billing codes K023A and G512A for these patients but did not provide them with palliative care as defined by the OHIP Schedule of Benefits. In doing so, he engaged in conduct that was disgraceful, dishonourable or unprofessional.

Although some of the patients were in the last year of their life, part of the definition of palliative care in the OHIP Schedule of Benefits, the Tribunal concluded this was insufficient to indicate palliative care was provided. The patient chart is key to showing the care the physician provided to the patient. The Tribunal found Dr. Khan’s records for these six patients did not demonstrate he was providing palliative care.

Further, the relevant patient records contained no documentation that a “decision has been made that there will be no aggressive treatment of the underlying disease and care is to be directed to maintaining the comfort of the patient until death occurs.” To the contrary, all six patients signed the SAFE chemotherapy consent form, in which they declined to have only comfort care or palliative care in favour of a treatment that “it is hoped…will cause shrinking of cancer, or remission of cancer… early data indicate the likelihood [of these benefits] is substantially greater [with SAFE chemotherapy] than conventional chemotherapy…”

Failure to Co-operate

The College made repeated requests that Dr. Khan produce Patient A’s chart and the charts of 19 other pediatric patients during the investigation. An investigator was required to attend Dr. Khan’s office to obtain Patient A’s chart. The College did not obtain the 19 other charts. Dr. Khan denied that he failed to cooperate. He testified that he found himself in a conflict between his professional obligations to the College and what he saw as his duty to Patient A’s parents, who objected to the release of their child’s chart. With respect to the request for the 19 pediatric patient charts, Dr. Khan submitted that he did not fail to cooperate. He took a principled legal position through his counsel that he did not have to produce them. He did not destroy the records or take any steps to prevent the College from seizing them. The College could have, but chose not to, seize the records, as it had done with Patient A’ records.

The Tribunal found Dr. Khan’s failure to cooperate in providing the charts as requested constitutes a significant departure from the acceptable standard of the medical profession. The College’s powers of investigation are a necessary component of its public interest mandate. To carry out its duty to protect the public, the College must investigate physicians to ensure that their care meets the standard of practice of the profession. This requires access to patient records. The Code articulates the legal framework for the release of patient records to the College. Dr. Khan’s behaviour actively obstructed the College in its investigation. The failure to provide the records was conduct that would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional.

More detail can be found in the reasons for decision on finding linked below. 

Following a penalty hearing the panel reserved its decision on penalty. The panel’s reasons for decision on penalty will be released shortly.
OPSDT reasons are also available at www.opsdt.ca and https://www.canlii.org/en/on/onpsdt/. Exhibits can be obtained by contacting the Tribunal Office at [email protected].


Decision: Download Full Decision (PDF)
Hearing Date(s): Merits: Jan 20-22, Feb 18-20, Mar 2-4, Sep 21, 22, 24-25, Oct 5, 7-8 & Nov 2-3, 2020 | Penalty: May 6, 2022