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Kakar, Ravi

CPSO#: 56389

MEMBER STATUS
Active Member as of 13 Apr 2021
CURRENT OR PAST CPSO REGISTRATION CLASS
Restricted as of 23 Oct 2013

Summary

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Former Name: No Former Name

Gender: Male

Languages Spoken: English, Hindi, Panjabi/Punjabi, Urdu

Education: University of Delhi, 1984

Practice Information

Primary Location of Practice
4597 14th Avenue
Markham ON  L3S 3K2
Phone: (905) 604-4452
Fax: (905) 604-4205 Electoral District: 05

Professional Corporation Information


Corporation Name: R. Kakar Medicine Professional Corporation
Certificate of Authorization Status: Issued Date:  Sep 20 2020

Shareholders:
Dr. R. Kakar ( CPSO# 56389 )

Business Address:
4597 14th Avenue
Markham ON  L3S 3K2
Phone Number: (905) 604-4452

Specialties

Specialty Issued On Type
Psychiatry Effective:12 Nov 1992 RCPSC Specialist

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 18 Oct 1985
Expired: Terms and conditions of certificate of registration Expiry: 30 Jun 1987
Subsequent certificate of registration Issued: Postgraduate Education Certificate Effective: 01 Apr 1992
Expired: Terms and conditions of certificate of registration Expiry: 30 Jun 1992
Subsequent certificate of registration Issued: Independent Practice Certificate Effective: 11 Jan 1993
Transfer of class of certificate to: Restricted certificate Effective: 23 Oct 2013
Terms and conditions imposed on certificate by member Effective: 23 Oct 2013
Terms and conditions amended by member Effective: 25 Feb 2014
Terms and conditions amended by member Effective: 22 Jan 2015
Terms and conditions amended by member Effective: 10 Feb 2016
Terms and conditions amended by Discipline Committee Effective: 12 Dec 2016
Terms and conditions amended by Discipline Committee Effective: 01 Jan 2017
Suspension of registration imposed: Discipline Committee Effective: 01 Jan 2017
Suspension of registration removed Effective: 01 Jul 2017
Suspension of registration imposed: Discipline Committee Effective: 15 Dec 2018
Suspension of registration removed Effective: 15 Jan 2019
Terms and conditions amended by Discipline Committee Effective: 30 Nov 2020
Transfer of class of certificate to: Restricted certificate Effective: 19 Dec 2020

Practice Restrictions

Imposed By Effective Date Expiry Date Status
Discipline Committee Effective: 14 Apr 2021 Active
 (1 of 3)

As from November 25, 2020, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Ravi Kakar in accordance with an undertaking and consent given by Dr. Kakar to the College of Physicians and Surgeons of Ontario:


UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")

of

DR. RAVI KAKAR
("Dr. Kakar")

to

COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
(the "College")
												

A.	PREAMBLE

(1)	In this Undertaking:

"Code" means the Health Professions Procedural Code, which is Schedule 2 to the Regulated Health Professions Act, 1991, S.O. 1991, c. 18, as amended; 

"Discipline Committee" means the Discipline Committee of the College;

 "OHIP" means the Ontario Health Insurance Plan;

"Public Register" means the College's register that is available to the public.

(2)	I, Dr. Kakar, certificate of registration number 56389, am a member of the College.  

(3)	I, Dr. Kakar, acknowledge that the College referred allegations of professional misconduct to the Discipline Committee by Notice of Hearing dated January 14, 2020. 

(4)	I, Dr. Kakar, acknowledge that I am the subject of a separate Order of the Discipline Committee dated December 12, 2016 ("Discipline Order") whereby my practice is restricted to psychiatry only and to seeing no more than 18 patients per day.

B.	UNDERTAKING

(5)	I, Dr. Kakar, undertake to abide by the provisions of this Undertaking, effective immediately. 

(6)	Practice Restrictions

(a)	I, Dr. Kakar, undertake that I will not prepare any third party reports, as defined in the College's Third Party Reports policy, as may be amended from time to time. 

(b)	I, Dr. Kakar, undertake to refer all patients requiring a third party report back to their family physician, or, in the event that the patient does not have a family physician, to a qualified specialist for the purposes of having the third party report prepared. I, Dr. Kakar, further undertake to keep a copy of all correspondence with the patient's family physician and/or qualified specialist relating to the referral in the corresponding patient chart.

(c)	I, Dr. Kakar, undertake to keep a log of all requests for third party reports, and of my referral of the patient to their family physician or other qualified specialist as set out above ("Referral Log"), in the form attached as Appendix "A", which shall be provided to the College at any time upon request.  

(7)	Notification of patients regarding restriction 

(a)	I, Dr. Kakar, undertake to ensure that every patient seen by me signs a copy of the notification set out in Appendix "B", and that a copy of the signed notification is kept in the corresponding patient chart.  

(b)	I, Dr. Kakar, undertake to provide a certified translation of the notification described in (7)(a) in any language in which I provide services to the College within thirty (30) days of executing this Undertaking. 

(c)	I, Dr. Kakar, undertake that if I elect, after the execution of this Undertaking, to provide services in any other language, I will notify the College prior to providing any such services. 

(d)	I, Dr. Kakar, undertake to provide to the College the certified translation described in section (7)(b) prior to beginning to provide services in any language described in section (7)(c).

(8)	Monitoring 

(a)	I, Dr. Kakar, undertake to inform the College of each and every location at which I practise or have privileges, including, but not limited to, any hospitals, clinics, offices, and any Independent Health Facilities with which I am affiliated, in any jurisdiction (collectively my "Practice Location" or "Practice Locations"), within five (5) days of executing this Undertaking.  Going forward, I further undertake to inform the College of any and all new Practice Locations within five (5) days of commencing practice at that location.

(b)	I, Dr. Kakar, undertake that I will submit to, and not interfere with, unannounced inspections of my Practice Locations and patient charts by a College representative for the purposes of monitoring my compliance with the provisions of this Undertaking.

(c)	I, Dr. Kakar, give my irrevocable consent to the College to make appropriate enquiries of OHIP and/or any person who or institution that may have relevant information, in order for the College to monitor my compliance with the provisions of this Undertaking.

(d)	I, Dr. Kakar, acknowledge that I have executed the OHIP consent form, attached hereto as Appendix "C".

C.	ACKNOWLEDGEMENT

(9)	I, Dr. Kakar, acknowledge that all appendices attached to or referred to in this Undertaking form part of this Undertaking.

(10)	I, Dr. Kakar, acknowledge and undertake that I shall be solely responsible for payment of all fees, costs, charges, expenses, etc. arising from the implementation of any of the provisions of this Undertaking. 

(11)	I, Dr. Kakar, acknowledge that I have read and understand the provisions of this Undertaking and that I have obtained independent legal counsel in reviewing and executing this Undertaking, or have waived my right to do so.

(12)	I, Dr. Kakar, acknowledge that the College will provide this Undertaking to any Chief of Staff, or a colleague with similar responsibilities, at any Practice Location ("Chief of Staff" or "Chiefs of Staff").

(13)	I, Dr. Kakar, acknowledge that a breach by me of any provision of this Undertaking may constitute an act of professional misconduct and/or incompetence, and may result in a referral of specified allegations to the Discipline Committee.

(14)	I, Dr. Kakar, acknowledge that this Undertaking constitutes terms, conditions, and limitations on my certificate of registration for the purposes of section 23 of the Code. 

(15)	Public Register

(a)	I, Dr. Kakar, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.

(b)	I, Dr. Kakar, acknowledge that, in addition to this Undertaking being posted in accordance with section (15)(a) above, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:

Dr. Kakar must not prepare any third party reports as defined in the College's Third Party Reports policy, as may be amended from time to time.

Dr. Kakar shall refer all patients requiring a third party report back to their family physician or, in the event that the patient does not have a family physician, to a qualified specialist, for the purposes of having the third party report prepared. 
			
D.	CONSENT

(16)	I, Dr. Kakar, give my irrevocable consent to the College to provide all Chiefs of Staff with any information the College has that led to the circumstances of my entering into this Undertaking and/or any information arising from the monitoring of my compliance with this Undertaking.


(2 of 3)
As from 11:59 p.m., December 12, 2016, 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. Ravi Kakar:

a.    Dr. Kakar's practice shall be restricted to psychiatry only.

b.    Dr. Kakar shall not see more than 18 patients in any 24-hour period.  Dr.
Kakar will also maintain a log of all patient encounters in the form
attached to this Order as Appendix "A" (the "Patient Log") and will
submit the Patient Log to the College on a monthly basis until the
reassessment referred to in paragraph 6(vi) below has been completed, and
the results of the reassessment have been considered by the ICR
Committee. Thereafter, Dr. Kakar shall produce the Patient Log at any
time upon request of the College. 

c.    Dr. Kakar shall retain a College-approved clinical supervisor or
supervisors (the "Clinical Supervisor"), who will sign an undertaking in
the form attached hereto as Appendix "B."  For a period of at least
twelve (12) months commencing on the date Dr. Kakar returns to practice
following the suspension of his certificate of registration, Dr. Kakar
may practise only under the supervision of the Clinical Supervisor and
will abide by all recommendations of his Clinical Supervisor with respect
to his practice, including but not limited to practice improvements,
practice management, third party report writing, and continuing
education.  Clinical supervision of Dr. Kakar's practice may end after a
minimum of twelve (12) months, only upon the recommendation of the
Clinical Supervisor and, in its discretion, approval by the College.
Clinical supervision of Dr. Kakar's practice shall contain the following
elements:

i.    Dr. Kakar shall facilitate review by the Clinical Supervisor of
fifteen (15) patient charts per month and will meet with the
Clinical Supervisor at least once a month to discuss his care of
patients; and

ii.   Dr. Kakar will have all third party reports as defined in the
College Policy Third Party Reports, a copy of which is attached as
Appendix "C" to this Order, reviewed and approved by the Clinical
Supervisor before they are provided to the third party.  Before Dr.
Kakar provides the report to the party requesting it, he must
ensure the Clinical Supervisor has approved and has indicated such
approval by personally affixing his/her signature on the report.
Dr. Kakar will also maintain a log with the name of each patient
for whom a third party report is requested, the date he saw the
patient, the date the report was sent to the Clinical Supervisor
for approval, the date it was approved by the Clinical Supervisor,
and the date it was sent to the third party, in the form attached
to this Order as Appendix "D" (the "Third Party Report Log"). Dr.
Kakar will provide the Third Party Report Log to the Clinical
Supervisor each time they meet.  He will also provide the original
Third Party Log to the College upon request.  This restriction will
remain in place until the reassessment referred to in paragraph
6(vi) below has been completed, and the results of the Reassessment
have been considered by the ICR Committee.

d.    Dr. Kakar shall successfully complete and provide proof thereof to the
College within six (6) months of the date of the Order:

i.    Education in ethics acceptable to the College; and
ii.   Education in third party report writing acceptable to the
College.
                  
e.    If Dr. Kakar fails to retain a Clinical Supervisor as required above or
if, prior to completion of Clinical Supervision, the Clinical Supervisor
is unable or unwilling to continue in that role for any reason, Dr. Kakar
shall within twenty (20) days retain a new College-approved Clinical
Supervisor who will sign an undertaking in the form attached hereto as
Appendix "B," and shall cease to practise until the same has been
delivered to the College.

f.    Approximately nine (9) months after the completion of Clinical
Supervision, Dr. Kakar shall undergo a reassessment of his practice (the
"Reassessment") by a College-appointed assessor (the "Assessor").  The
Reassessment may include a review of Dr. Kakar's patient charts, direct
observations and interviews with staff and/or patients, and any other
tools deemed necessary by the College.  The Reassessment shall be at Dr.
Kakar's expense and he shall co-operate with all elements of the
Reassessment.  Dr. Kakar shall abide by all recommendations made by the
Assessor subject to paragraph 6(vii) below, and the results of the
Reassessment will be reported to the College and may form the basis of
further action by the College.

g.    If Dr. Kakar is of the view that any of the Assessor's recommendations
are unreasonable, he will have fifteen (15) days following his receipt of
the recommendations within which to provide the College with his
submissions in this regard.  The Inquiries Complaints and Reports ("ICR")
Committee will consider those submissions and make a determination
regarding whether the recommendations are reasonable, and that decision
will be provided to Dr. Kakar. Following that decision Dr. Kakar will
abide by those recommendations of the Assessor that the ICR Committee has
determined are reasonable

h.    Dr. Kakar shall consent to sharing of information among the Assessor, the
Clinical Supervisor, the College, and any education providers under
paragraph 6(iv) above as any of them deem necessary or desirable in order
to fulfill their respective obligations.

i.    Dr. Kakar shall inform the College of each and every location where he
practises, in any jurisdiction (his "Practice Location(s)") within
fifteen (15) days of this Order and shall inform the College of any and
all new Practice Locations within fifteen (15) days of commencing
practice at that location.

j.    Dr. Kakar shall cooperate with unannounced inspections of his practice
and patient charts by a College representative(s) for the purpose of
monitoring and enforcing his compliance with the terms of this Order.

k.    Dr. Kakar 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
and enforce his compliance with the terms of this Order.

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

m.    Dr. Kakar shall comply with the College's Policy on Practice Management
Considerations for Physicians Who Cease to Practise, Take an Extended
Leave of Absence or Close Their Practice Due to Relocation, in respect of
his period of suspension, a copy of which is attached hereto as Appendix
"E".

(3 of 3)
As from October 23, 2013, the following is imposed as a term, condition and
limitation on the certificate of registration held by Dr. Ravi Kakar, in
accordance with an undertaking and consent given by Dr. Kakar to the College of
Physicians and Surgeons of Ontario:

Dr. Kakar's practice is restricted to the practice of psychiatry.
                  
                  
                  




Previous Hearings

Committee: Discipline
Decision Date: 27 Nov 2020
Summary:

On November 27, 2020, the Discipline Committee held a hearing into an allegation of professional misconduct by Dr. Kakar, by way of videoconference in the presence of Dr. Kakar, his counsel and counsel for the College.

In its decision released on February 18, 2021, the Committee found that under paragraph 1(1)2 of O. Reg 856/93, Dr. Kakar committed an act of professional misconduct in that he failed to maintain the standard of practice of the profession in his preparation of three third-party reports.

The Committee’s full reasons for decision on liability and penalty are available for review on the College website.
Disposition

The Committee issued its order on December 8, 2020 and, following a motion to vary, amended its order on December 14, 2020. The Committee ordered and directed:
• Dr. Kakar to attend before the panel to be reprimanded.
• The Registrar to suspend Dr. Kakar’s certificate of registration for a period of four months, commencing on December 19, 2020.
• Dr. Kakar to pay costs to the College in the amount of $10,370.00 within 90 days from the date of the Order.
 


Decision: Download Full Decision (PDF)
Hearing Date(s): November 27, 2020

 

Committee: Discipline
Decision Date: 16 Nov 2018
Summary:

On November 16, 2018, Dr. Ravi Kakar admitted and the Discipline Committee found that he  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.

FACTS

BACKGROUND

1. Dr. Kakar is a 59-year-old psychiatrist who practises in Markham, Ontario. Dr. Kakar graduated from the University of Delhi and obtained his independent practice certificate in Ontario in 1993.

DISGRACEFUL, DISHONOURABLE OR UNPROFESSIONAL CONDUCT

(i) Third Party Report Concerns

2. Patient A was referred to Dr. Kakar by her family physician to assess her mental health arising from her adjustment issues and alienation at school. Her family physician noted no history of mental health concerns or hospital admission although Patient A had previously been hospitalized in March of 2016.

3. Dr. Kakar first met Patient A in July, 2016. Patient A reported to Dr. Kakar a one-day hospitalization in March 2016 for depression resulting from alienation. Dr. Kakar concluded that Patient A was suffering from an adjustment disorder with depressed mood but saw no evidence that Patient A was suffering from psychosis. Dr. Kakar concluded that Patient A was not suffering from an identifiable mental disorder, but he continued to see and monitor Patient A.

4. Dr. Kakar next saw Patient A in August, 2016, for a follow up appointment. Patient A was a student at a local community college and requested a letter from Dr. Kakar to provide an opinion about whether she was fit to attend school for the fall semester. He provided a report which concluded that she was fit to attend school. Dr. Kakar did not obtain any of Patient A’s medical records or additional information about her hospitalization prior to completing the third party report. He continued to treat Patient A with psychotherapy until December 2016.

5. On August 17, 2016, the College received information from the local community college regarding the psychiatric report prepared by Dr. Kakar on behalf of Patient A.

6. As a result of the concerns, the College retained Dr. Nicholas Delva as Medical Inspector to provide an opinion on the care Dr. Kakar provided to Patient A and on the third party report that had been prepared by Dr. Kakar on behalf of Patient A. Dr. Delva is a psychiatrist whose primary practice is located in the Department of Psychiatry, Hotel Dieu Hospital, Kingston, Ontario.

7. In Dr. Delva’s opinion, there were no issues with Dr. Kakar’s clinical care of Patient A and no concerns about harm or injury to Patient A. Dr. Delva identified, however, deficiencies with Dr. Kakar’s third party report and his record-keeping.

8. Specifically Dr. Delva found that Dr. Kakar’s report was not comprehensive and there was inadequate substantiation of facts because: a) Dr. Kakar should have obtained the hospital records reflecting Patient A’s hospital admission prior to writing the report; and b) the report should have made it clear that it was based on information obtained directly from Patient A and that Dr. Kakar had failed to independently confirm information obtained from the patient.

9. Dr. Kakar admits that he was unprofessional in preparing the third party report on behalf of Patient A in that he did not obtain Patient A’s hospital records prior to writing his report. Dr. Kakar’s conduct is not consistent with professional obligations of a physician as articulated in
the College Policy # 2-12, “Third Party Reports”.

(ii) Breach of February 10, 2016 Undertaking with the College

10. On February 16, 2016, Dr. Kakar entered into an undertaking with the College in lieu of an Order under (then) s. 37 of the Health Professions Procedural Code in respect of a prior discipline referral. The undertaking required, inter alia, that all third party reports authored by Dr. Kakar be reviewed and approved by his Clinical Supervisor before being provided to the third party.

11. On October 13, 2016, College staff attended at Dr. Kakar’s office to monitor his compliance with the terms on his certificate of registration. They identified four forms, for four different patients, from Dr. Kakar which were not approved by his Clinical Supervisor before being provided to the third party.

12. These four forms were:

- A Psychological Health Medical Update Form dated April 5, 2016 for Patient B;
- An Application for Determination of Catastrophic Impairment Form completed on May 22, 2016 for Patient C;
- A Clinical Information Form dated June 3, 2016 for Patient D; and
- A Medical Follow-Up Form dated October 13, 2016 for Patient E.

13. All of these four forms constituted Third Party Reports pursuant to the College’s Third Party Reports Policy.

14. With respect Patient C, Dr. Kakar subsequent to his completion of the form above, also completed a more comprehensive third part report. This report was sent to his Clinical Supervisor for review and approval.

15. Dr. Kakar admits that the above four reports were not sent for approval to his Clinical Supervisor.

DISPOSITION

The Discipline Committee ordered and directed that:
- The Registrar suspend Dr. Kakar’s certificate of registration for a period of one (1) month,commencing December 15, 2018 at 11:59 p.m.
- Dr. Kakar appear before the panel to be reprimanded.
- Dr. Kakar pay costs to the College in the amount of $10,180.00 within thirty (30) days from the date of this Order.
 


Decision: Download Full Decision (PDF)
Hearing Date(s): November 16, 2018

 

Committee: Discipline
Decision Date: 12 Dec 2016
Summary:

On December 12, 2016, the Discipline Committee of the College of Physicians and Surgeons of Ontario found that Dr. Ravi Kakar has committed an act of professional misconduct in that he has failed to maintain the standard of practice of the profession and 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. The Discipline Committee also found that Dr. Kakar is incompetent.

Dr. Kakar is a psychiatrist who practised at a private office in Markham.

PATIENT A

In October 2012, Patient A complained that Dr. Kakar diagnosed her with gout arthritis and prescribed a medication, Allopurinol, to which she had a severe allergic reaction resulting in serious side effects.

Patient A had started seeing Dr. Kakar for psychiatric care in August 2010. Dr. Kakar diagnosed Patient A’s mental health issues and chronic pain, and prescribed psychiatric medications. Dr. Kakar also requisitioned blood work.

In September 2010, Patient A attended for a follow-up appointment to discuss her psychiatric conditions. At this visit, Dr. Kakar observed that the blood work results showed elevated uric acid levels, diagnosed gout arthritis and prescribed Allopurinol. There was no emergency or urgency requiring that Dr. Kakar treat Patient A at that time.

Patient A filled the prescription for Alluporinol on a date in early October 2010 and developed side effects including a fever and cough, a generalized rash, and swelling of the mouth, lips and tongue. Her side effects worsened into severe pain, swelling of the feet, and an inability to walk.

Patient A was admitted to hospital on in early November 2010, where she was diagnosed with a severe allergic reaction to the Allopurinol, Toxic Epidermal Necrolysis.

A College-retained expert opined that Dr. Kakar’s care of Patient A failed to maintain the standard of practice and displayed a serious lack of knowledge and judgment as follows:
- Dr. Kakar’s prescribing of Allopurinol for gout arthritis was outside of his scope of practice and inappropriate;
- Dr. Kakar inappropriately minimized the seriousness of Patient A’s concerns after she experienced a reaction to Allopurinol;
- Dr. Kakar’s records of his treatment of Patient A failed to maintain the standard as the vast majority were illegible; and
- Dr. Kakar’s prescription of Allopurinol to Patient A seriously harmed her and put her at - life-threatening risk.

A second College-retained expert opined that Dr. Kakar’s failure to conduct an adequate clinical examination, prior to diagnosis and prescribing of Allopurinol, failed to maintain the standard of practice and that he demonstrated a lack of knowledge, skill and judgment.

Misleading College during investigation
In his January 15, 2013, response to Patient A’s complaint, Dr. Kakar stated to the College that he prescribed Allopurinol for Patient A at an appointment in late October 2010. He also provided a copy of his chart for Patient A which indicated that there was a discussion about Allopurinol on that date in late October 2010, and that Dr. Kakar prescribed the medication on that day.

Subsequently, after the College provided Dr. Kakar with information indicating that the complainant had filled the prescription in early October, Dr. Kakar claimed that he relied on his chart when he responded to the complaint, and since the reference to the discussion about Allopurinol was recorded in the chart for the appointment in late October, he had presumed that was when he prescribed the medication. He said it must have been a late entry from October of 2010 which he had failed to indicate as such.

Then, in May of 2013, Dr. Kakar’s counsel wrote to the College and admitted that Dr. Kakar had added the note in Patient A’s chart about Allopurinol after he received the comlaint from patient A, in October 2012, not in October of 2010, as he had claimed in his communication to the College.

PATIENT B

In January 2013, the College received a complaint about the psychiatric care provided by Dr. Kakar to a teenage girl, Patient B, in the fall of 2012.

A College-retained expert concluded that Dr. Kakar failed to meet the standard of care in his record-keeping for Patient B as follows:
- Dr. Kakar’s original office notes are illegible and needed to be transcribed in order for her to read them;
- Two of Dr. Kakar’s progress notes, dated August 2012 and September 2012, were - identical. This failed to reflect the true progression, or lack of progression, of Patient B’s
response to treatment; and
- Dr. Kakar’s failure to document a rationale in his progress note of September 2012, for increasing the patient’s dosage of Cymbalta to 30 mg three times a day.

It was also determined that Dr. Kakar made an error in his September 29, 2012 entry in Patient B’s chart when he recorded a prescription for Cymbalta three times a day (t.i.d.), when he actually intended to prescribe it two times a day (b.i.d.), as written on the prescription.

SECTION 75.1(A) INVESTIGATION

A College-retained expert reviewed Dr. Kakar’s care and treatment of 24 patients in his psychiatric practice and noted the following about his record-keeping:
- Dr. Kakar’s charts have insufficient documentation of the progress of his patients;
- Dr. Kakar’s charts fail to adequately identify the rationale for treatment modalities;
- Dr. Kakar’s charts fail to adequately document follow up with patients suffering from mood disorders regarding risk of self-harm or cognitive deficits; and
- Dr. Kakar’s medical reports lack contemporaneous information, are often repetitive in nature and sometimes contain information seen in the charts of other patients.

The expert opined that Dr. Kakar showed sufficient knowledge, skills and judgment in the clinical practice of psychiatry to meet the standards of the profession. However, while he
appeared to have sufficient knowledge and judgment regarding information which should be documented in charts, his documentation did not meet the standard of practice.

THE DR. D. COMPLAINT

In August 2015, Dr. D, a psychologist, complained to the College regarding a psychiatric report Dr. Kakar prepared on behalf of Patient C, an insured woman who sustained injuries in a car accident. Dr. D examined Patient C in November 2013 and completed a psychological report dated December 2013. Dr. Kakar saw the same patient later in December 2013, and produced a psychiatric report in January 2014.

In May 2015, Dr. D was asked to do a follow up report, and reviewed Patient C’s file in order to do so. In the file, he found the report of Dr. Kakar in relation to Patient C, which contained extensive sections that were copied from Dr. D’s initial report, with virtually no changes.

Dr. Kakar said that when he was asked to provide a report, he reviewed the medical brief, which included Dr. D’s report, in preparation for his independent psychiatric evaluation of the patient.

He said he used Dr. D’s report as a guide to his interview and as a means of obtaining an accurate and detailed history from the patient.

AGREED FACTS ON PENALTY

In May 2006, the Complaints Committee issued a verbal caution regarding Dr. Kakar’s care of a patient, and in particular, regarding the preparation of third party reports regarding the patient’s mental state and ability to care for his child. In June of 2009, following a public complaint and investigation regarding his standard of practice, Dr. Kakar entered into an undertaking with the College which required among other things, that he practise under the guidance of a clinical supervisor; complete courses in pharmacological monitoring, assessment of suicide, communication skills and record keeping; and attend psychiatric rounds every two months for one year.

During 2012 and 2013, Dr. Kakar experienced a series of stressors which impacted his health.  Ultimately, he signed an undertaking to cease practice medicine which was in effect between February 2014 and January 2015.

Pursuant to an October 23, 2013 undertaking, which he executed after receiving the complaint of Patient A Dr. Kakar has publicly restricted his practice to that of psychiatry only.

Pursuant to a February 10, 2016 undertaking, which he executed in lieu of a s. 37 Order, Dr. Kakar has been practising under supervision since this matter was referred to discipline.

PENALTY

On December 12, 2016, the Discipline Committee ordered and directed that:
- Dr. Kakar attend before the panel to be reprimanded.
- The Registrar to suspend Dr. Kakar’s certificate of registration for a period of six (6) months commencing January 1, 2017.
- The Registrar impose the following terms, conditions and limitations on Dr. Kakar’s certificate of registration:
- Dr. Kakar’s practice shall be restricted to psychiatry only.
- Dr. Kakar shall not see more than 18 patients in any 24-hour period. Dr. Kakar - will also maintain a log of all patient encounters in the form attached to this Order as Appendix “A” (the “Patient Log”) and will submit the Patient Log to the College on a monthly basis until the reassessment referred to in paragraph 6(vi) below has been completed, and the results of the reassessment have been considered by the ICR Committee. Thereafter, Dr. Kakar shall produce the Patient Log at any time upon request of the College.
- Dr. Kakar shall retain a College-approved clinical supervisor or supervisors (the - “Clinical Supervisor”), who will sign an undertaking in the form attached hereto as Appendix “B.” For a period of at least twelve (12) months commencing on the date Dr. Kakar returns to practice following the suspension of his certificate of registration, Dr. Kakar may practise only under the supervision of the Clinical Supervisor and will abide by all recommendations of his Clinical Supervisor with respect to his practice, including but not limited to practice improvements, practice management, third party report writing, and continuing education. Clinical supervision of Dr. Kakar’s practice may end after a minimum of twelve (12) months, only upon the recommendation of the Clinical Supervisor and, in its discretion, approval by the College. Clinical supervision of Dr. Kakar’s practice  shall contain the following elements:
- Dr. Kakar shall facilitate review by the Clinical Supervisor of fifteen (15) patient charts per month and will meet with the Clinical Supervisor at least once a month to discuss his care of patients; and
- Dr. Kakar will have all third party reports as defined in the College Policy Third Party Reports, a copy of which is attached as Appendix “C” to this Order, reviewed and approved by the Clinical Supervisor before they are provided to the third party. Before Dr. Kakar provides the report to the party requesting it, he must ensure the Clinical Supervisor has approved and has indicated such approval by personally affixing his/her signature on the report. Dr. Kakar will also maintain a log with the name of each patient for whom a third party report is requested, the date he saw the patient, the date the report was sent to the Clinical Supervisor for approval, the date it was approved by the Clinical Supervisor, and the date it was sent to the third party, in the form attached to this Order as Appendix “D” (the “Third Party Report Log”). Dr. Kakar will provide the Third Party Report Log to the Clinical Supervisor each time they meet. He will also provide the original Third Party Log to the College upon request.This restriction will remain in place until the reassessment referred to in paragraph 6(vi) below has been completed, and the results of the Reassessment have been considered by the ICR Committee.
- Dr. Kakar shall successfully complete and provide proof thereof to the College within six (6) months of the date of the Order:
- Education in ethics acceptable to the College; and
- Education in third party report writing acceptable to the College.
- If Dr. Kakar fails to retain a Clinical Supervisor as required above or if, prior to completion of Clinical Supervision, the Clinical Supervisor is unable or unwilling to continue in that role for any reason, Dr. Kakar shall within twenty (20) days retain a new College-approved Clinical Supervisor who will sign an undertaking in the form attached hereto as Appendix “B,” and shall cease to practise until the same has been delivered to the College.
- Approximately nine (9) months after the completion of Clinical Supervision, Dr. Kakar shall undergo a reassessment of his practice (the “Reassessment”) by a College-appointed assessor (the “Assessor”). The Reassessment may include a review of Dr. Kakar’s patient charts, direct observations and interviews with staff and/or patients, and any other tools deemed necessary by the College. The Reassessment shall be at Dr. Kakar’s expense and he shall co-operate with all elements of the Reassessment. Dr. Kakar shall abide by all recommendations made by the Assessor subject to paragraph 6(vii) below, and the results of the Reassessment will be reported to the College and may form the basis of further
action by the College.
- If Dr. Kakar is of the view that any of the Assessor’s recommendations are unreasonable, he will have fifteen (15) days following his receipt of the recommendations within which to provide the College with his submissions in this regard. The Inquiries Complaints and Reports (“ICR”) Committee will consider those submissions and make a determination regarding whether the recommendations are reasonable, and that decision will be provided to Dr. Kakar.
Following that decision Dr.Kakar will abide by those recommendations of the Assessor that the ICR Committee has determined are reasonable
-  Dr. Kakar shall consent to sharing of information among the Assessor, the Clinical Supervisor, the College, and any education providers under paragraph 6(iv) above as any of them deem necessary or desirable in order to fulfill their respective obligations.
- Dr. Kakar shall inform the College of each and every location where he practises, - in any jurisdiction (his “Practice Location(s)”) within fifteen (15) days of this Order and shall inform the College of any and all new Practice Locations within fifteen (15) days of commencing practice at that location.
- Dr. Kakar shall cooperate with unannounced inspections of his practice and patient charts by a College representative(s) for the purpose of monitoring and enforcing his compliance with the terms of this Order.
- Dr. Kakar 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 and enforce his compliance with the terms of this Order.
- Dr. Kakar shall be responsible for any and all costs associated with implementing the terms of this Order.
- Dr. Kakar shall comply with the College’s Policy on Practice Management Considerations for Physicians Who Cease to Practise, Take an Extended Leave of Absence or Close Their Practice Due to Relocation, in respect of his period of suspension, a copy of which is attached hereto as Appendix “E”.
- Dr. Kakar pay to the College costs in the amount of $5,000.00, within thirty (30) days of the date of this Order.
 


Decision: Download Full Decision (PDF)
Hearing Date(s): November 16, 2018

Concerns

Source: Member
Active Date: November 25, 2020
Expiry Date:
Summary:
Summary of the Undertaking given by Dr. Ravi Kakar to the College of Physicians and Surgeons of Ontario, effective November 25, 2020:

Dr. Kakar must not prepare any third party reports as defined in the College’s Third Party Reports policy, as may be amended from time to time.

Dr. Kakar shall refer all patients requiring a third party report back to their family physician or, in the event that the patient does not have a family physician, to a qualified specialist, for the purposes of having the third party report prepared.