Committee: Discipline
Decision Date: 05 Nov 2012
Summary:
On November 5, 2012, the Discipline Committee found that Dr. Jacob Veenstra committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession. Dr. Veenstra admitted the allegation.
With respect to Patient A: care provided in the diagnosis and treatment of the patient's pearly penile papules, as well as Dr. Veenstra's record keeping practices, were deficient and did not meet the expected standard of practice.
With respect to a review of 24 patient charts during a College investigation, the College's expert, Dr. X, identified the following major concerns in Dr. Veenstra's practice in her July and October 2010 reports: recordkeeping deficiencies, including illegible or incomplete records;
concerns regarding prescribing, including combinations of prescription medications, prescription of multiple medications and changing of medications frequently; inadequate histories, physical examinations and investigations; use of potent biological agent without adequate screening or monitoring in one case; failure to follow-up test results; and failure to consult with or follow the advice of specialists.
In November 2011, Dr. Veenstra's clinical supervisor, Dr. Y, reported to the College that he found no evidence of any documented activity that raised concerns or undue risk to Dr. Veenstra's patients' safety or wellbeing. Dr. Veenstra retained Dr. Z to review the charts of Patient A, as well as Charts 1 to 24. In his October 2012 report, Dr. Z opined that although Dr. Veenstra's practices with respect to record keeping, prescribing, and referrals to specialists demonstrate significant deficiencies and require improvement, he is not lacking in the necessary skills to practise successfully or to meet the standard of care expected of a general practitioner, and that the deficiencies should be remediable.
The Committee ordered and directed that:
the Registrar suspend Dr. Veenstra's certificate of registration for a period of six months commencing immediately.
the Registrar place the following terms, conditions and limitations on Dr. Veenstra's certificate of registration:
(a) Dr. Veenstra shall complete the Ontario CPD Consortium's Record Keeping Course and Prescribing Skills Course;
(b) Upon Dr. Veenstra's return to practice, he shall obtain a Clinical Supervisor or Supervisors, acceptable to the College;
(c) For a period of at least three months, Dr. Veenstra will only see patients in the presence of the Clinical Supervisor, who will be present during Dr. Veenstra's clinical visits, and who will conduct a contemporaneous review of those patient charts. During the period of high supervision, the Clinical Supervisor shall provide bi-weekly reports to the College. The period of high supervision will continue until the Clinical Supervisor in his sole discretion agrees that the level of supervision may be reduced to moderate supervision. The Clinical Supervisor
shall reconsider the need for high supervision after the first three months of Dr. Veenstra's return to practice, and at the beginning of every month thereafter for so long as the period of high supervision continues. If the supervisor believes that Dr. Veenstra is ready to practise under moderate supervision, he/she shall provide the College with a report addressing the practise concerns raised by Drs. X, Y and Z, and explaining why Dr. Veenstra's progress under high supervision justifies a transition to medium supervision;
(d) Following the period of high supervision described in paragraph (c) above, provided that the Clinical Supervisor and the College agree that the level of supervision can be reduced, for a further three months, at a minimum, the Clinical Supervisor will engage in a period of moderate supervision, during which time he will meet with Dr. Veenstra on a bi-weekly basis to review a minimum of 15 of his patient records and discuss any issues or concerns arising therefrom. If, during this period, Dr. Veenstra has fewer than 15 patient encounters in a specific two-week period, the Clinical Supervisor shall review the records of all patient encounters during that period. The Clinical Supervisor shall provide monthly reports to the College;
(e) Following the period of moderate supervision described in paragraph
(d) above, provided that the Clinical Supervisor and the College agree that the level of supervision can be reduced, for a further six months, at a minimum, the Clinical Supervisor will engage in a period of low supervision, during which time he will meet with Dr. Veenstra on a monthly basis to review a minimum of 15 of his patient records and discuss any issues or concerns arising therefrom. If, during this period, Dr. Veenstra has fewer than 15 patient encounters in a specific month, the Clinical Supervisor shall review the records of all patient encounters during that period. The Clinical Supervisor shall provide monthly reports to the College;
(f) The combined period of supervision set out in paragraphs (c), (d) and (e) above shall not be less than 12 months;
(g) Dr. Veenstra shall fully cooperate with and abide by any recommendations of, his Clinical Supervisor, including any recommendations that Dr. Veenstra participate in further educational opportunities;
(h) Dr. Veenstra shall consent to the disclosure by his Clinical Supervisor to the College, and by the College to his Clinical Supervisor, of all information
necessary to fulfill the Clinical Supervisor's undertaking and to monitor Dr. Veenstra's compliance with the Order. This shall include, without limitation, providing the supervisor with the reports of any assessments of Dr. Veenstra's
practice in the College's possession;
(i) All costs associated with the Clinical Supervisor shall be at Dr. Veenstra's expense;
(j) Following the period of low supervision described in paragraph (e) above, Dr. Veenstra shall submit to a comprehensive practice assessment of his clinical practice, at Dr. Veenstra's expense, by an assessor or assessors selected by the College. The assessor shall report the results of the assessment to the College, who shall determine on the basis of the supervisor and assessment report, whether Dr. Veenstra can engage in unsupervised practice;
(k) Dr. Veenstra shall co-operate fully with the assessment of his practice, conducted under this term of this Order, and shall abide by the recommendations of the assessor(s);
(l) Dr. Veenstra shall consent to the disclosure to the assessor(s) of the reports of the Clinical Supervisor arising from the supervision, and shall consent to the sharing of such information between the Clinical Supervisor, the assessor and the College, as any of the parties deem necessary or desirable in order to fulfill their respective obligations; and
(m) Dr. Veenstra shall submit to, and not interfere with, unannounced inspections of his office(s), practice(s) and patient charts by a College representative for the purposes of monitoring his compliance with the terms of this Order.
the matter of costs be reserved and will be dealt with in a supplementary order.
the results of this proceeding be included in the register.