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Houshmand, Henry

CPSO#: 102769

MEMBER STATUS
Active Member as of 01 Apr 2014
CPSO REGISTRATION CLASS
Restricted as of 05 Sep 2017

Summary

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Former Name: No Former Name

Gender: Male

Languages Spoken: English, Farsi

Education:SHAHEED BEHESHTI UNIVERSITY, 1981

Practice Information

Primary Location of Practice
Practice Address Not Available

Medical Licences in Other Jurisdictions

Effective September 1, 2015, the College by-laws require the College to indicate on the register if the member has a licence or is registered to practise medicine in a jurisdiction outside Ontario, if this is known to the College.



New Brunswick

Hospital Privileges

No Privileges reported.


Hospital Notices

Source:  Hospital
Active Date:  February 2, 2018
Expiry Date:  
Summary:  
On February 4, 2018, Hawkesbury and District Hospital (HGH) notified the College, pursuant to s.33(d) of the Public Hospitals Act and s. 85.5(2)2 of the Health Professions Procedural Code, Regulated Health Professions Act, that effective February 2, 2018 Dr. Houshmand voluntarily ceased practice at HGH during the course of an investigation by HGH into Dr. Houshmand's practice. On May 17, 2018, HGH notified the College that Dr. Houshmand resigned from his staff appointment at HGH in April 2018.

Specialties

Specialty Issued On Type
No Speciality Reported

Registration History

Action Issue Date
First certificate of registration issued: Independent Practice Certificate Effective: 01 Apr 2014
Transfer of class of certificate to: Restricted certificate Effective: 05 Sep 2017
Terms and conditions imposed on certificate by member Effective: 05 Sep 2017
Terms and conditions amended by member Effective: 26 Sep 2017
Terms and conditions amended by member Effective: 02 Oct 2017
Terms and conditions amended by member Effective: 05 Feb 2018
Terms and conditions amended by Inquiries, Complaints and Repo Effective: 25 Apr 2018
Terms and conditions amended by Discipline Committee Effective: 14 Apr 2020

Practice Restrictions

Imposed By Effective Date Expiry Date Status
Discipline Committee Effective: 14 Apr 2020 Active
             As from 12:01 a.m., April 14, 2020, by order of the Discipline 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.
            Henry Houshmand: 

            Practice Restriction

            1.    Dr. Houshmand shall practice only in a hospital setting and shall not
                  practice or seek to practice in any out of hospital premises, independent
                  health facility or health clinic.

            Clinical Supervision

            2.    Subject to paragraphs 6, 9 and 10, Dr. Houshmand shall practice under the
                  guidance of a Clinical Supervisor(s) acceptable to the College. Within
                  ten (10) days of this Order, Dr. Houshmand shall have a College-approved
                  clinical supervisor (the "Clinical Supervisor") sign an Undertaking in
                  the form attached hereto as Schedule 2.

            3.    For a minimum of six (6) months, Dr. Houshmand may practice only under
                  the high-level supervision of a Clinical Supervisor(s) acceptable to the
                  College, at his own expense.  This will require that the Clinical
                  Supervisor(s) be on site and available at all times that Dr. Houshmand is
                  providing care or treatment to patients. The Clinical Supervisor's
                  responsibilities will include the following:

                  a.    For each patient for whom Dr. Houshmand intends to provide or has
                        provided general anesthesia, regional anesthesia or sedation, the
                        Clinical Supervisor will:
                  
                        i)    Review and approve of the pre-operative assessment and the
                              treatment plan prior to the anesthesia or sedation being
                              provided. The anesthesia or sedation is not to be provided by
                              Dr. Houshmand until approval of the Clinical Supervisor has
                              been obtained;
                  
                        ii)   In the case of sedation, observe Dr. Houshmand during the
                              administration of sedation and be immediately available
                              during the subsequent monitoring of the patient throughout
                              the procedure until the patient has fully returned to
                              consciousness;
                  
                        iii)  In the case of general anesthesia, observe Dr. Houshmand
                              during the administration of sedation and the insertion of an
                              airway beyond the oropharynx ("intubation");

                        iv)   After the administration of sedation and subsequent
                              intubation, and until the patient has been extubated and has
                              fully returned to consciousness, be immediately available to
                              provide assistance if required; 
                  
                        v)    In the case of major regional anesthesia, such as spinals and
                              epidurals, observe Dr. Houshmand during the performance of
                              the procedure and be immediately available during the
                              subsequent monitoring of the patient throughout the
                              procedure;
                  
                        vi)   Review and approve all of Dr. Houshmand's perioperative
                              documentation prior to the patient leaving the recovery room;
                              and 
                  
                        vii)  Report to the College once every two weeks for the first
                              month, following which if the supervisor recommends and the
                              College approves, the reporting can be reduced to once a
                              month.  
                  
            4.    After a minimum of six (6) months of high-level supervision described in
                  paragraph 3, the level of clinical supervision of Dr. Houshmand's
                  practice may be reduced as follows, upon the recommendation of Dr.
                  Houshmand's Clinical Supervisor(s) and, in its discretion, approval by
                  the College:

                  a)    Dr. Houshmand shall pre-operatively review with the Clinical
                        Supervisor his plan for management of any patient who is a Class
                        ASA 3 or higher anesthetic risk;
                  
                  b)    Dr. Houshmand shall ensure that prior to performing intubation that
                        another anesthetist or anesthesiologist is present on the premises
                        and available to assist him if necessary;
                  
                  c)    Dr. Houshmand shall facilitate review by the Clinical Supervisor on
                        a weekly basis of all charts of patients he has treated;
                  
                  d)    Dr. Houshmand shall meet with the Clinical Supervisor in person on
                        a bi-weekly basis;
                  
                  e)    The Clinical Supervisor shall report to the College every month, or
                        more frequently if there is a risk of harm or other concerns.
                  
            5.    After a minimum of three (3) months of clinical supervision as described
                  in paragraph 4, the level of supervision of Dr. Houshmand's practice may
                  be further reduced as follows, upon the recommendation of Dr. Houshmand's
                  Clinical Supervisor(s) and, in its discretion, approval by the College:

                  a)    Dr. Houshmand shall facilitate review by the Clinical Supervisor of
                        10 charts on a monthly basis; 
                  
                  b)    Dr. Houshmand shall meet with the Clinical Supervisor in person on
                        a monthly basis;
                  
                  c)    The Clinical Supervisor shall report to the College every month, or
                        more frequently if there is a risk of harm or other concerns.
                  
            6.    After a minimum of six (6) months of clinical supervision as described in
                  paragraph 5, Dr. Houshmand may request a reassessment of his
                  hospital-based anesthesia practice (the "Reassessment") by a
                  College-appointed assessor (the "Assessor"). The Reassessment may include
                  a review of Dr. Houshmand's patient charts, direct observations,
                  interviews with staff and/or patients, and any other tools deemed
                  necessary by the College. The results of the Reassessment shall be
                  reported to the College after which, should it be recommended by the
                  Assessor, the College may in its discretion permit Dr. Houshmand to
                  practice with no restriction other than that in paragraph 1.

            7.    If all Clinical Supervisors who has given an undertaking to the College
                  are unable or unwilling to continue to fulfil its terms, Dr. Houshmand
                  shall 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.  

            8.    If Dr. Houshmand is unable to obtain a Clinical Supervisor(s) in
                  accordance with paragraphs 2-5 of this Order, he shall cease practising
                  medicine immediately until such time as he has done so, and the fact that
                  he has done so will constitute a term, condition or limitation on his
                  certificate of registration until that time. 


            Surgical Assisting

            9.    After a minimum of one (1) month of high-level clinical supervision as
                  described in paragraph 3, should it be recommended by both Dr.
                  Houshmand's Clinical Supervisor(s) and the Chief of Surgery at the
                  Hospital where Dr. Houshmand is being supervised, the College may in its
                  discretion permit Dr. Houshmand to practice with no restriction as a
                  surgical assistant at the hospital where Dr. Houshmand is being
                  supervised.

            10.    After a minimum of three (3) months of surgical assisting as described
                  in paragraph 9, should it be recommended by both Dr. Houshmand's Clinical
                  Supervisor(s) and the Chief of Surgery at the Hospital where Dr.
                  Houshmand is being supervised, the College may in its discretion permit
                  Dr. Houshmand to practice with no restriction as a surgical assistant in
                  any hospital setting.

            Notification of Practice Locations

            11.   Dr. Houshmand shall, within five (5) days of the date of this Order,
                  provide the College with the addresses of any locations where he
                  practises medicine ("Practice Location(s)"), and, if he commences
                  practice at a new location, shall provide the College with its address
                  within five (5) days. 

            Monitoring

            12.   Dr. Houshmand shall consent to the College providing the following
                  information to all Clinical Supervisors:

                  a)    Any information the College had that led to the imposition of this
                        Order;
                  
                  b)    Any information arising from any investigation into or assessment
                        of Dr. Houshmand's practice; and
                  
                  c)    Any information arising from the monitoring of Dr. Houshmand's
                        compliance with this Order.
                  
            13.   Dr. Houshmand shall consent to the College providing all Chief(s) of
                  Staff with any information the College has that led to the imposition of
                  this Order and/or any information arising from the monitoring of his
                  compliance with this Order;

            14.   Dr. Houshmand shall consent to all Clinical Supervisor(s) and Chief(s) of
                  Staff disclosing to the College, and to one another, any information:

                  a.    Relevant to this Order;
                  
                  b.    Relevant to the provisions of the Clinical Supervisor's Undertaking
                        to the College; and/or
                  
                  c.    Relevant for the purposes of monitoring Dr. Houshmand's compliance
                        with this Order.
                  
            15.   Dr. Houshmand shall submit to, and not interfere with, unannounced:

                  a.    inspections of his Practice Location(s) and to any other activity
                        the
                  
                  b.    College deems necessary in order to monitor his compliance with the
                        terms of this Order.
                  
            16.   Dr. Houshmand shall consent to the College making appropriate enquiries
                  of the Ontario Health Insurance Plan and/or any person who or institution
                  that may have relevant information, in order for the College to monitor
                  his compliance with the terms of this Order.

            17.    Dr. Houshmand shall be responsible for any and all costs associated with
                  implementing the terms of this Order.

Previous Hearings

Committee: Discipline
Decision Date: 06 Jan 2020
Summary:

On January 6, 2020, on the basis of an Agreed Statement of Facts and Admission and 
 Statement of Uncontested Facts, the Discipline Committee found that Dr. Henry 
 Houshmand committed an act of professional misconduct, in that he has engaged in 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. On January 20, the Committee held a hearing 
 regarding penalty and reserved its decision. 
  
 FACTS 
  
 Dr. Henry Houshmand is a 65-year-old general practitioner anesthetist. He received his 
 certificate of registration authorizing independent practice from the College of 
 Physicians and Surgeons of Ontario (the “College”) on April 1, 2014. 
At the relevant times, Dr. Houshmand worked at Provis Rudd Endoscopy Services-
 Ottawa (the “Provis Clinic”) and at the Hawkesbury & District General Hospital (the 
 “Hawkesbury Hospital”).  
  
 Dr. Houshmand ceased working at the Provis Clinic on June 8, 2015. Dr. Houshmand 
 ceased working at the Hawkesbury Hospital on February 2, 2018, pending an external 
 review of his practice. Dr. Houshmand’s privileges at the Hawkesbury Hospital were not 
 renewed at the end of April 2018. Dr. Houshmand has advised the College that he did 
 not re-apply for privileges at the Hawkesbury Hospital. Dr. Houshmand does not 
 currently have hospital privileges. Dr. Houshmand has not practised medicine since 
 February 2, 2018. 
  
 Incompetence / Failure to Maintain the Standard of Practice 
  
 Initial Section 75(1)(a) Investigation and Reports of Dr. Miller 
  
 In June of 2015, the College’s Out-of-Hospital Premises Inspection Program (the 
 “OHPIP”) received information from a staff member at the Provis Clinic who had 
 concerns about Dr. Houshmand’s anesthesia practice and conduct. On the basis of the 
 information from that staff member, and other information, including a chart review 
 conducted by the OHPIP that revealed concerns regarding Dr. Houshmand’s practice, 
 the College commenced an investigation under section 75(1)(a) of the Health 
 Professions Procedural Code (the “Code”) to investigate into Dr. Houshmand’s 
 anesthesia practice. 
  
 The College retained the services of Dr. Paul Miller, a general practice anesthetist, to 
 conduct an assessment of Dr. Houshmand’s anesthetic practice. Dr. Miller reviewed 20 
 charts from Dr. Houshmand’s out-of-hospital premises-based practice at the Provis 
 Clinic and 25 charts from Dr. Houshmand’s hospital-based practice at the Hawkesbury 
 Hospital. Dr. Miller also reviewed the Provis Clinic schedule of patients for June 8, 2015, 
 Dr. Houshmand’s OHIP billing for June 8, 2015, and Dr. Miller interviewed Dr. 
 Houshmand.  

 With respect to Dr. Miller’s report dated October 17, 2016, Dr. Houshmand does not 
 admit the two paragraphs in the report immediately under the heading “Additional note 
 re: endoscopy clinic”. Of the 20 charts reviewed from the Provis Clinic, Dr. Miller did not 
 provide an opinion on the care provided by Dr. Houshmand in two charts. Of the 
 remaining 18 charts, Dr. Miller opined that most elements of the patient’s care were at 
 standard in 3 charts, some of the elements of the patient’s care fell below standard in 2 
 charts, most elements of the patient’s care fell below standard in 12 charts, and all 
 elements of the patient’s care fell below standard in 1 chart. Of the 25 charts reviewed 
 from the Hawkesbury Hospital, Dr. Miller opined that Dr. Houshmand’s performance 
 was on balance within the standard of care in 6 charts, that some elements of the 
 patient’s care were below standard while other elements met the standard in 8 charts, 
 most elements of the patient’s care were below standard in 10 charts, and all elements 
 of the patient’s care were at least in part below standard in one chart. Dr. Miller’s 
 conclusions were that Dr. Houshmand did not meet the standard of practice of the 
 profession in his care and treatment of 18 out of 18 patients whose charts Dr. Miller 
 reviewed from the Provis Clinic and Dr. Houshmand did not meet the standard of 
 practice of the profession in his care and treatment of 19 out of 25 patients whose 
 charts Dr. Miller reviewed from the Hawkesbury Hospital. As Dr. Miller further opined, 
 Dr. Houshmand demonstrated a lack of knowledge, judgment and/or skill in many of 
 these cases.  

Based on Dr. Miller’s review of patient charts and interview with Dr. Houshmand, Dr. 
 Miller identified the following list of knowledge/performance gaps in Dr. Houshmand’s 
 anesthesia practice: 

    -  He tended to give the same anesthetic to all patients irrespective of their age 
       and medical comorbidities. For example, he gave the same initial bolus dose 
       of propofol for sedation to all of his endoscopy patients. 
   -   He used the same ventilator parameters for normal, obese and asthmatic 
       patients. This could lead to hypoventilation, atelectasis and hypoxia in some 
       and potential barotrauma in others. 
    -  He uses abnormally high flow rates (4 liters). While this would not cause 
       harm to patients directly it does increase the cost and environmental impact 
       of the volatile gases used. 
    -  He uses unusually high doses of intrathecal opioids in his spinal blocks. This 
       would lead to an increased risk of respiratory depression, pruritus and 
       nausea. 
    -  There were a number of instances where patients were hypotensive for 
       prolonged periods of time. Nothing was documented regarding the probable 
       cause(s) and no steps were taken to correct the derangement. 
    -  His charted airway assessments were incomplete. In the interview he did not 
       perform significantly better. 
   -  He does not typically describe the extent or impact of a medical comorbidity 
      on the patient's functional capacity. He merely documents that it is present. 
      This is fundamental to assessing the likely impact that the illness will have 
      on the patient's ability to tolerate the planned surgery and anesthetic. 
   -  He rarely gives an assessment of the patient’s functional capacity. 
  -   He proceeds with a spinal anesthetic in a patient with a significant infection 
      (Fournier's gangrene) and possible sepsis. This may have been indicated but 
      there needs to be a well detailed discussion of the risks and potential 
      benefits. 
   -  In the charts reviewed by Dr. Miller, there was no routine screening for 
      obstructive sleep apnea and there was no detailed management plan for 
      those who are found to have it. 
   -  The dose of Toradol (an intravenous non-steroidal anti-inflammatory [NSAID]) 
     should be reduced in elderly and those with renal impairment. This was not 
     done in one of his cases. 
   -  In several of his cases, a history of gastroesophageal reflux disease (GERD) 
      was not documented though clearly identified elsewhere in the chart. A 
      history of uncontrolled GERD should prompt a change in the approach to 
     securing the airway.  
   -  Long acting opioids were not routinely used in longer cases where significant 
      pain might be expected. 
   -  Neuromuscular monitoring is checked as being done but actual levels of 
      block are not recorded. The timing and dosing of the reversal agents are not 
      regularly documented. Inadequate neuromuscular block reversal can have 
      significant impacts on post-operative respiratory function, aspiration risk and 
      patient comfort. 
   -  Dr. Houshmand’s approach to the difficult airway during the interview was 
      substandard. He did not follow any of the difficult airway algorithms. His 
      documented assessment of the airway was substandard throughout the 
      majority of the cases reviewed. 
  -   Dr. Houshmand’s approach to managing massive transfusion during the 
      interview was substandard. He failed to ask for the appropriate blood work in 
      a timely way. He failed to give platelets and either fresh frozen plasma or 
      cryoprecipitate when it was clearly indicated. 
 
With respect to his assessment of Dr. Houshmand’s anesthetic practice, Dr. Miller 
concluded, “I believe that there are significant enough lapses in knowledge, judgement 
and skill so as to put patients at potential risk of harm.” 
 
Dr. Houshmand provided a response to Dr. Miller’s October 17, 2016 report and 
provided a letter from a family practice anesthetist, Dr. Jesse Guscott. Upon reviewing 
these materials, Dr. Miller provided the College with an addendum to his initial report 
dated March 28, 2017. Following his review of Dr. Houshmand’s comments and the 
comments provided by Dr. Guscott, Dr. Miller did not change the conclusions reached in 
 his initial report. Rather, Dr. Miller remained concerned that Dr. Houshmand had gaps in 
 his knowledge and performance of anesthesia. Dr. Miller opined, “I believe that there are 
 still significant lapses in knowledge, judgment and skill so as to put patients at potential 
 risk for harm.” 
  
 In response to further information, Dr. Miller provided a second addendum to his initial 
 report dated June 26, 2017. Dr. Miller did not change the conclusions reached in his 
 initial report or his addendum report. Dr. Miller concluded that the additional information 
 did not dissuade him from his original assessment that Dr. Houshmand did not meet 
 the standard of care. 
  
 Dr. Houshmand admits that he failed to maintain the standard of practice of the 
 profession in his care and treatment of 37 patients whose charts were reviewed by Dr. 
 Miller. Dr. Houshmand does not contest that his care of 37 patients, whose charts were 
 reviewed by Dr. Miller, displayed a lack of knowledge, skill or judgment of a nature or to 
 an extent that demonstrates that Dr. Houshmand is unfit to continue to practice or that 
 his practice should be restricted.  
     
 Interim Undertaking, Clinical Supervision and Resignation of Clinical Supervisor 
  
 In July 2017, the College gave notice to Dr. Houshmand that the Inquiries, Complaints 
 and Reports Committee of the College (the “ICRC”) would be considering whether to 
 suspend or to impose restrictions on Dr. Houshmand’s certificate of registration 
 pursuant to s. 25.4 of the Code. On September 5, 2017, Dr. Houshmand signed an 
 interim undertaking with the College, in lieu of the ICRC making an order under s. 25.4 of 
 the Code. The Undertaking required, among other things, that Dr. Houshmand practice in 
 a hospital setting only, and that he practice under the guidance of a Clinical Supervisor 
 who would conduct monthly chart reviews.  

Pursuant to the Undertaking, Dr. Richard McCall was retained as Dr. Houshmand’s 
Clinical Supervisor on September 18, 2017. On November 19, 2017, Dr. McCall wrote to 
the College expressing concerns about Dr. Houshmand’s practice. These concerns 
included Dr. Houshmand’s management of an obstetrical patient on October 19, 2017 
(the “index case”). Dr. McCall advised that, in light of the situation, the hospital decided 
to take the unusual action of restricting Dr. Houshmand’s hospital privileges to 
providing anesthesia services for endoscopy sedation only while waiting for further 
guidance from the hospital Medical Affairs Committee and the College. 

 On February 4, 2018, Dr. McCall resigned as Dr. Houshmand’s Clinical Supervisor. In his 
 letter to the College, Dr. McCall wrote, among other things: 

        I have been the clinical supervisor for Dr. Houshmand since September 
        28th, 2017. As per my letter of letter [sic] November 13th, 2017, Dr. 
        Houshmand has been restricted to preforming sedation for endoscopy 
        procedures only… 
        I have been spending a lot of time on the clinical supervision of Dr. 
        Houshmand for the last 4 months. It has been one of my most difficult 
        responsibilities. I have been trying to balance the supervisory role of 
        mentoring my friend and colleague Dr. Houshmand while protecting the 
        public as part as my role of Chief of Anesthesia, at the Hawkesbury 
        General Hospital. I have come to the conclusion that Dr. Houshmand's 
        practice falls below the standard of practice of the profession and that 
        his patients may be exposed to risk of harm or injury. I therefore resign 
        as the clinical supervisor of Dr. Henry Houshmand effective immediately. 

 As a result of Dr. McCall’s resignation as Dr. Houshmand’s Clinical Supervisor, pursuant 
 to the terms of Dr. Houshmand’s September 5, 2017 Undertaking, Dr. Houshmand was 
 required to cease to practice medicine.  
     
 ICRC’s s. 25.4 Interim Order 
  
 On April 24, 2018, the ICRC ordered terms, conditions and limitations to be placed on Dr. 
 Houshmand’s certificate of registration pursuant to s. 25.4 of the Code (the “ICRC’s s. 
 25.4 Interim Order”). Pursuant to the ICRC’s s. 25.4 Interim Order, among other things: 
 
   -  Dr. Houshmand shall practice only in a hospital setting and shall not practice or 
      seek to practice in any out of hospital premises, independent health facility or 
      health clinic. 
   -  Dr. Houshmand shall practice only under high-level supervision of a Clinical 
      Supervisor acceptable to the College. The Clinical Supervisor must be on site and 
      available at all times that Dr. Houshmand is providing care or treatment to 
      patients and must review and approve treatment plans, and observe Dr. 
      Houshmand during the administration of sedation and during intubation of a 
      patient. 
 
As of January 6, 2019, Dr. Houshmand has not commenced Clinical Supervision under 
the terms of the ICRC’s s. 25.4 Interim Order. Dr. Houshmand has not been in medical 
practice since February 2, 2018. 
    
Second Section 75(1)(a) Investigation and Report of Dr. Knox  
 
Based in part on concerns raised by Dr. McCall, the College commenced a second 
investigation under section 75(1)(a) of the Code, including an additional chart review. 
 
The College retained the services of Dr. Andrew Knox, a general practice anesthetist, to 
conduct an assessment of Dr. Houshmand’s anesthetic practice. Dr. Knox reviewed 25 
charts from Dr. Houshmand’s practice at the Hawkesbury Hospital including the ‘index 
 case’ and interviewed Dr. Houshmand. 
  
Dr. Knox’s report was received by the College on June 4, 2018. Dr. Knox concluded that 
Dr. Houshmand fell below the standard of practice of the profession in his care and 
treatment of 15 out of 25 patients whose charts Dr. Knox reviewed. Dr. Knox concluded 
that Dr. Houshmand met the standard of practice in the ‘index case’. 
 
Based on Dr. Knox’s review of patient charts and interview with Dr. Houshmand, Dr. 
Knox raised the following concerns about Dr. Houshmand’s anesthesia practice, and his 
knowledge, skill, and judgment: 
   -  Dr. Houshmand erroneously ordered acetaminophen for a patient in the 
      preoperative period, failing to recognize that another physician had already 
      ordered the same medication, and then erroneously ordered acetaminophen 
      again in the postoperative period; 
   -  with respect to a patient who reported dysphoria and then dizziness in the post-
      operative period, Dr. Houshmand did not consider a diagnosis of acute 
      emergence reaction to ketamine and during questioning was unable to identify 
      an appropriate approach to emergence phenomenon, such as the use of 
      benzodiazepines; 
   -  in three cases Dr. Houshmand incorrectly documented the Ramsey Sedation 
      Score for a patient on the anesthetic record. He then was unable to accurately 
      describe the scale during the interview;  
   -  in six cases, the time of administration of anesthetic agents was incorrect and 
      had been estimated by Dr. Houshmand after the case had begun; 
   -  in four cases, oxygen saturation and/or blood pressure were not monitored for 
      significant periods of time during the intraoperative period; 
   -  in an endoscopy case where the patient suffered from asthma, Dr. Houshmand 
      inappropriately gave metoprolol to treat intraoperative hypertension, which could 
      have induced bronchospasm in a patient who was already hypoxic; 
   -  in a case where sevoflurane was used as the primary anesthetic agent with a 
      concurrent low dose ketamine infusion for lengthy surgery (reversal of 
      Hartmann’s procedure), Dr. Houshmand permitted the end-tidal Sevoflurane 
      percentage concentration to be as a low as 0.28%, and at less than 1.0% for a 
      lengthy period of time, corresponding to Minimum Alveolar Concentration 
      (“MAC”) of less than 0.5%, placing the patient at risk of intraoperative awareness 
      and subsequent emotional distress, PTSD and life-changing suffering; 
   -  in a case involving dental extractions, Sevoflurane end-tidal percentage 
      concentration was allowed to fall to 0.98% in the middle of the case, 
      corresponding to MAC of 0.49%, again placing this patient at risk of 
      intraoperative awareness and subsequent emotional distress; 
   -  in an endoscopy case involving a patient with Reynaud’s syndrome, Dr. 
      Houshmand failed to take appropriate steps to obtain an alternate monitoring 
      site for oxygen saturation, leading to a failure to respond to the warning signs of 
      respiratory compromise. 
 
 Dr. Knox concluded that of the 15 cases in which Dr. Houshmand failed to meet the 
 standard of practice, the patients were put at risk of harm by Dr. Houshmand’s actions 
 in six cases. These risks were caused by poor or absent intraoperative monitoring, a 
 lack of care, or poor judgment with respect to anesthetic depth. The errors occurred in 
 areas of expertise that should be considered key competencies for an anesthetist. 
  
 Dr. Houshmand responded to Dr. Knox’s report by letter dated July 20, 2018. In 
response to this letter, Dr. Knox provided a supplementary report to the College dated 
August 12, 2018. Dr. Knox’s opinion that Dr. Houshmand failed to meet the standard of 
practice remained unchanged. Dr. Knox further noted that Dr. Houshmand’s pattern of 
practice repeatedly placed his patients at risk by failing to monitor them appropriately 
during anesthesia.  
 
Dr. Houshmand admits that he failed to maintain the standard of practice of the 
profession in his care and treatment of 15 patients whose charts were reviewed by Dr. 
Knox. 
 
Dr. Houshmand does not contest that his care of 15 patients, whose charts were 
reviewed by Dr. Knox, displayed a lack of knowledge, skill or judgment of a nature or to 
an extent that demonstrates that Dr. Houshmand is unfit to continue to practice or that 
his practice should be restricted. 
    
Additional Information 
 
The College also obtained a report prepared for the Hawkesbury Hospital by an external 
reviewer, Dr. Paul Kenny, a general practice anesthetist who retired from practice in 
2017. Dr. Kenny’s review raised concerns regarding Dr. Houshmand’s standard of 
practice and his risk of harm to patients. Dr. Kenny’s review consisted of the ‘index 
case’, as well as 25 additional charts that had been pre-screened for possible problems 
by the head of the anesthesia department. Dr. Kenny also interviewed Dr. Houshmand. 
Dr. Kenny’s report is dated February 7, 2018. 
Dr. Kenny opined that Dr. Houshmand did not meet the standard of practice in the ‘index 
case’. With respect to his review of 25 of Dr. Houshmand’s pre-screened patient charts 
from the Hawkesbury Hospital, Dr. Kenny opined, among other things, that: 
 
   -  None of the charts met the standard of care, although some of the deficiencies 
      were minor. 
   -  8 out of 25 charts demonstrated a significant violation of the standard of care of 
      an anesthetist practising in a community hospital in Canada, although in 3 of 
      those cases, the loss of patient records secondary to a problem with the new 
      electronic medical record had not been ruled out. 
   -  11 out of 25 charts provided evidence of non-standard drug use, some of which 
      could cause patient harm. 
   -  In 15 out of the 25 cases reviewed by Dr. Kenny, the patient suffered harm or 
      potential harm, but in no case was the harm serious and permanent harm was 
      not foreseen in any of the cases reviewed. 
  -  Dr. Houshmand’s standard general anesthetic management did not appear to 
     vary much according to patient age, procedure, comorbidities, or length of 
      procedure. Young healthy patients with short procedures received remarkably 
      similar techniques to those having longer techniques or those with multiple 
      comorbidities. 
 
Dr. Kenny also concluded that there was evidence of other clinical practices that did not 
meet the standard of practice of the profession, including that Dr. Houshmand admitted 
that he has occasionally, maybe three times in the recent past, reused the same syringe 
containing a drug, for more than one patient, after changing the infusion line that 
connects the drug-containing syringe to the main line, which introduces the risk of blood 
borne infection, and which practice is absolutely contraindicated. 
 
Dr. Houshmand admits that he failed to maintain the standard of practice of the 
profession in his care and treatment of 25 patients whose charts were reviewed by Dr. 
Kenny. Dr. Houshmand does not admit that he failed to maintain the standard of 
practice of the profession in his care and treatment of the patient in the ‘index case’. 
 
Dr. Houshmand does not contest that his care of these 25 patients, whose charts were 
reviewed by Dr. Kenny, displayed a lack of knowledge, skill or judgment of a nature or to 
an extent that demonstrates that Dr. Houshmand is unfit to continue to practice or that 
his practice should be restricted.


Decision: Download Full Decision (PDF)
Hearing Date(s): Hearing: January 6, 2020 Penalty Hearing: January 20, 2020 Reprimand: August 27, 2020 at 10:00 a.m.