February 17, 2013

CPSO's further investigation



Further Investigation of the
College of Physicians and Surgeons of Ontario


This is a continuation of the blog dated January 8, 2012. Please read that blog for a more detailed account of Dr. Victor Mak’s coldblooded medical malpractice and professional misconducts.

Synopses of Complaints against Dr. Victor Mak


On May 22, 2008, Mr. Ching went into York Central Hospital, Richmond Hill, Ontario, Canada (now renamed Mackenzie Richmond Hill Hospital) to undergo radical prostatectomy with bilateral lymph node dissection. The urologic surgeon was Dr. Victor Mak, a peer assessor of the College of Physicians and Surgeons of Ontario (CPSO).

Dr. Victor Mak’s surgical incompetence and errors:

  1. Dr. Mak failed to remove the lymph nodes, only fatty tissue was cut out.
  2. Dr. Mak failed to remove the whole prostate glands, he left behind cancerous cells
  3. Dr. Mak severed Mr. Ching’s 3 veins during the prostate surgery and that led to 4000 cc of blood transfusion. Blood transfusion was not able to catch up with the blood loss. Dr. Mak had bled out more than Mr. Ching’s total body blood volume in less than 45 minutes.
  4. Dr Mak perforated Mr. Ching's rectum during surgery. One day after the surgery, he prescribed Flagyl, a potent antibiotic which is used to treat bowel injury.
  5. At the rectal repair surgery that followed, Dr. Mak performed the oversewing of the urethra and the prostate surgical site.
  6. Mr. Ching underwent a 3rd surgery in 12 days to remove his bleeding colon.
  7. Mr. Ching died after 43 days of stay in York Central Hospital.

 

Dr. Victor Mak covered up his surgical incompetence and errors by:


Lying:

Among Dr. Mak’s many lies, one was that he lied to the family about the failed outcome of his lymph nodes dissection. Dr. Mak also lied that all cancer cells had been removed and Mr. Ching was cured for cancer. 

Omitting Facts:

Dr. Mak told the family he had severed 3 veins during the prostate surgery. Dr. Mak omitted this fact in his operative note.

Mr. Ching underwent a rectal repair surgery 8 days after the prostate surgery and Dr. Mak was one of the attending surgeons in this operation. Dr. Mak wrote his prostate surgery operative note 2 days after the rectal repair surgery but there was no mention of a rectal injury in his operative note.

Falsifying Operative Note:

Dr. Mak falsified his operative note by saying “no single bleeding blood vessel was encountered” and he attributed the massive bleeding to only “oozing” of blood to cover up the more than 4000 cc of blood loss.

Dr. Mak was the attending physician in the rectal repair surgery and had eye witnessed the damage he had done in the prostate surgery. Dr. Mak falsified his operative note citing that “caution was exercised not to injure the rectum” to cover up he had injured Mr. Ching’s rectum. He attributed the perforation of the rectum to other doctors’ rectal examinations. 

Dr. Mak prescribed Flagyl one day after the prostate surgery, a drug commonly used to treat bowel injury infection. Dr. Mak must have known he had injured Mr. Ching’s rectum.

Irrefutable Evidence:
  1. Pathology reports documented no lymph nodes were dissected, only fatty tissue was cut out
  2. Pathology reports documented Dr. Mak left behind cancer cells in Mr. Ching’s body
  3. Anesthesia report proving bleeding of more than total body blood volume in less than 45 minutes
  4. CT scan proved presence of abscess in the pelvic, a sign of intra-operative rectal injury.
  5. Dr. Fiture’s consultation report indicating physical and clinical findings of intra-operative rectal injury
  6. Doctor’s order in which Dr. Mak prescribed Flagyl, a treatment for bowel injury infection
  7. Dr. Bui's colonoscopy showing signs of rectal tear.

 

CPSO’s First Investigation


Missing Documents in the CPSO’s Investigation

The Ching family had obtained all 900 odd pages of medical documents of Mr. Ching’s stay at York Central. The following irrefutable evidential documents were missing in the CPSO’s investigation via the investigator:

1.     Anesthesia report
2.     CT scan
3.     Dr. Fiture’s consultation report
4.     Doctor’s order

Decision of CPSO’s First Investigation:

The family alleged Dr. Mak of incompetence and violating CPSO rules and regulations by acts of his professional misconducts but the CPSO stated that they did not refer to any CPSO’s policies, rules and regulations in their investigation.

Even though crucial documents were missing in the investigation, the CPSO ruled that Dr. Mak had met the standard of practice of a urologist where a radical prostatectomy was performed.

 

First HPARB Appeal

 

The Health Professions Appeal and Review Board (HPARB) returned the matter to the CPSO for further investigation for reasons of inadequacy and unreasonableness in its investigation. The HPARB decision was published by the Canadian Legal Information Institute (CanLII) on May 25, 2011:

 

CPSO’s Further Investigation

 

The CPSO asked the family to reauthorize release of the mysteriously missing documents for its further investigation. The CPSO returned its 2nd decision to the family but inexplicably the decision had first not made it to the family’s address.

Alarmingly, more documents were removed in the further investigation.

The assessor was again concerned about the unexplained nature and cause of the massive blood loss in the hands of Dr. Mak; the assessor was again concerned about Dr. Mak’s delayed dictation of his operative note and Dr. Mak’s unbelievable lymph nodes dissection where only fatty tissue was cut out. Amazingly, the assessor did not change his first opinion. There were no documents to show what additional documents the assessor was provided with in this further investigation.

The CPSO did not investigate the family’s 8 allegations against Dr. Mak including his lies, omission of facts, and falsification of his operative note to cover up everything; again the CPSO stated that they did not refer to any CPSO’s policies, rules and regulations in their investigation, thus the CPSO spared Dr. Mak of his incompetence and his professional misconducts, twice.

The CPSO upheld its first decision saying that Dr. Mak had met the standard of practice of a urologist. The CPSO could not present one single piece of medical evidence to support its arguments; every argument the CPSO put forward was pure speculation, they lacked common medical sense even to non-medical people, they were childish and absurd; the CPSO even made up non-existing facts to clear Dr. Mak of his despicable deeds. The CPSO resorted to the following to brush off the relevance of the missing documents: 

1.     The CPSO stated that prostatectomy can be bloody and they accepted Dr. Mak’s unexplained massive blood loss as a norm in surgery and they did not investigate.

2.     The CPSO stated that rectal injury likely happened post-operatively by suggesting that after the surgery:

a. There was no fever
b. There were no elevated white blood cell counts
c. There was no abscess found in the emergency rectal repair surgery
d. Antibiotics were prescribed for prevention, not that a rectal injury was suspected
e. The rectum would have been thinned out after prostatectomy, it might have been perforated by rectal examinations by others
f. The rectal repair was performed low in the anus

 3.     The CPSO stated that “no mention of a rectal injury” in Dr. Mak’s delayed operative note does not suggest that Dr. Mak had “doctored” his note and tried to cover everything up.

4.     The CPSO stated that Dr. Mak’s failure to adequately and timely document his note would not cause the unfortunate outcome of Mr. Ching’s death.

5.     The CPSO stated that Dr. Mak had no significant history of complaints with the CPSO.

Evidence Speaks 

1.    About the massive blood loss:

Anesthesia report proved the magnitude and severity of the blood loss within less than 45 minutes was not due to “oozing” as claimed by Dr. Mak. The chair of the expert panel committee is himself an anesthesiologist and he cannot tell the difference between “traumatic bleeding” and “oozing” of blood during surgery.

2.     About the rectal injury:

a. Nurses’ daily flow charts documented Mr. Ching was running fever over 38º C or 101º F post-operatively. The committee did not know what fever is. These documents were removed from the investigation.
b. Lab daily report charts documented elevated white blood cell counts post-operatively. The count came down after the rectal repair injury. The expert committee did not know what white cell count is.
c. CT scan indicated presence of an abscess.
d. Dr. Mak had prescribed antibiotics Gentamicin and Ampicillin pre-operatively and Cipro immediately after surgery. To give Mr. Ching a potent bowel injury infection fighting antibiotic Flagyl one day after the prostate surgery was a treatment for the rectal perforation, not prevention.
e. The “thinning out of the rectum” was an irresponsible statement created by Dr. Mak/the CPSO to avert Dr. Mak’s surgical incompetence causing intra-operative rectal injury. The CPSO could not present any clinical evidence of this non-sense. The CPSO deflected the rectal injury to other doctor’s rectal examination. Dr. Fiture’s consultation report that documented both physical and clinical findings of an intra-operative rectal perforation was never presented in both investigations even though the family had in their possession this ironclad document.
f.  Every male knows that urologists examine their prostate via the anus. One of the expert panel committee is a urologist and he/she does not possess this knowledge to have arrived at their conclusion.

3.     About “no mention of a rectal injury in Dr. Mak’s operative note”:

Dr. Mak wrote “caution was exercised not to injure the rectum” after eye witnessed the rectal repair surgery himself, how truthful could his note be? Dr. Mak waited to see the result of his surgery to cover everything up.

 4.     About Dr. Mak’s inadequate and delayed operative note “would not cause the unfortunate outcome of Mr. Ching’s death”:

a. The family complained about the truthfulness of Dr. Mak’s note, not his note causing Mr. Ching’s death
b. Dr. Mak’s inadequate and delayed note would definitely change the adverse outcome of his note

  5.     About the “no significant history of complaints with the CPSO”:

a. This is equivalent to saying that a murderer is not a murderer because he/she has no significant history of murdering.
b. How many more loss of lives by Dr. Victor Mak in this manner and how many more cover ups by Dr. Victor Mak before the CPSO will consider it to be significant?

Second HPARB Appeal


The CPSO’s both investigations were flawed. Incriminating documents were removed in both investigations to protect Dr. Mak of his incompetence and professional misconducts. The CPSO has abused its privileges as a self-regulated government body and has deliberately acted above the law so as to spare an insider Dr. Victor Mak, thus the CPSO has rendered injustice to the Ching family and has smothered the family’s long fight to have the truth revealed. The CPSO chose to ignore the family’s numerous inquiries about the missing documents; the CPSO has chosen to forsake its role of policing health providers’ professional conducts at the expense of protecting the well being of all Ontarians.

The family presented supporting documents in black and white to the appeal board to prove their case. The family appealed to the HPARB that certain party/parties had broken the regulated health professions law by intentionally withholding documents in the investigations, an act of obstruction of justice in the criminal code.

On January 16, 2013 the HPARB granted the family a 2nd appeal review.

The family appealed to the HPARB for a public disciplinary hearing on Dr. Victor Mak of his incompetence and his violation of the regulated health professions procedural codes by lying, omitting facts in his operative note and issuing a falsified operative note and signing it.

The Counsel’s Response

Dr. Mak was not there to answer the appeal board, his counsel’s defence:

  1. The CPSO has taken a long time to investigate the case
  2. The assessor did not change his first opinion
  3. The family's allegations about the qualifications of the expert panel committee were serious
  4. He would be happen to go back to the appeal board to explain things

A main stream Chinese newspaper reported the family’s second appeal on Thursday, January 17, 2013. The HPARB adjourned to render a decision.