Review of Cancer Dr’s Practice Reveals Serious Issues
Thursday, April 11, 2013 @ 12:43 PM
Prince George, B.C.- The BC Cancer Agency’s released the report which resulted from the investigation into patient files of Dr. Suresh Katakkar. He is the oncologist who left Prince George after there were questions raised about his practice.
According to the investigation of all of his patient files, the final report concludes “there were cases of unacceptable standards of care”. The investigation says about 10% (54 cases) of Dr. Katakkar’s total patient caseload “received non-standard and unacceptable levels of care.”
The review further says that of the 54 cases eight resulted in “severe, preventable patient harm and four were critical patient safety events (they involved potentially preventable, treatment related death)”. The report says that while 42 cases received non-standard and unacceptable levels of care it did not appear to result in harm to those patients.
According to the review, the issues identified are:
1. Misdiagnosis and failure to refer.
2. Use of incorrect protocols causing patient harm.
3. Failure to heed warnings regarding patient safety concerns raised by colleagues.
4. Failure to follow medical standards.
The following contributing factors were identified:
1. Lack of orientation and supervision, including the absence of a performance review.
2. Operating a solo practice, with minimal participation in consultation and case discussion with peers.
3. Workload management was problematic, many action items remained outstanding.
4. Missing and/or incomplete patient documentation.
“These are serious findings” says Dr. Max J. Coppes, President of the BC Cancer Agency “and we have forwarded them on to the College of Physicians and Surgeons of British Columbia for further review.”
Dr. Coppes says several recommendations have been developed in the wake of this review:
1. Improve the orientation process for newly hired BC Cancer Agency physicians.
2. Develop additional systems for quality assurance and performance assessment for newly hired and external physicians working at the BC Cancer Agency.
3. Reinforce understanding and adherence to key patient safety policies at the BC Cancer Agency including those outlined in Commitment to a Culture of Safety and Stop the Line.
4. Collaboratively develop a plan with health authority leaders to ensure a culture of safety is promoted in the Community Oncology Network.
5. Improve the access and capacity for physician and staff consultation for patient case consultation at the Centre for the North by implementing regular interdisciplinary team meetings.
6. Review the BC Cancer Agency oncology documentation and dictation standards.
7. Ensure that quality and safety systems are in place at the Centre for the North, including weekly safety rounds, performing safety audits, participating in quality and safety orientation.
8. Review all of the current BC Cancer Agency Provincial Systemic Therapy Program (PSTP) standards, policies and procedures with the Centre for the North.
9. Provide additional training and resources for Provincial Systemic Therapy Program leaders engaged in the hiring of cancer specialists.
The BC Cancer Agency has accepted and is implementing all of the recommendations.
Dr. Coppes says a review of patient safety events at all BC Cancer Agency facilities has taken place, “the results were that no patterns or issues of repeat incidents were identified.”
A new Vice President of Medical Affairs role has been created. The new Vice President will be dedicated to overseeing physician credentialing and performance at the BC Cancer Agency.
“I want to express our profound regret over the distress caused by this situation. We have gone to extraordinary lengths to follow up with patients and their families, apologize and ensure they are informed of the situation and offer our complete support should they require it” says Dr. Coppes.
Comments
Send him back on the same boat he came on.
Balboa, bigotry in unacceptable!!!! Is that REALLY the best you can do????
Balboa. He came to us from Arizona.
âThese are serious findingsâ says Dr. Max J. Coppes, President of the BC Cancer Agency âand we have forwarded them on to the College of Physicians and Surgeons of British Columbia for further review.â
And nothing will come of it…..
Balboa is probably dumb enough to believe that a boat could sail to Arizona from BC.
The big question I have, is what sort of due diligence did Northern Health and/or the BC Cancer Agency undertake when Dr. Katakkar was brought to PG?
Do they have any culpability here? Or, did they just rely on the good ole PG old boys club to make sure things were managed “properly”?
“The following contributing factors were identified:
1. Lack of orientation and supervision, including the absence of a performance review.”
I wonder how many reading this missed this? The three other contributing factors should all have been caught if #1 was implemented.
These are not the doctor’s fault. These seem to rest at the feet of the BC Cancer Agency.
So haw many doctors do they supervise and audit in this fashion.
Are they just seeing the tip of the iceberg?
Do they have inadequate protocols for the possibility of engaging in new approaches to treatment with the proper instruction to patients of the nature of the treatment and the consent of patients?
There are some people around here who call this doctor a hero for saving their lives because of his unorthodox methods adn not always playing by arcane rules that don’t always fit every case.
What gus wrote is very relevant, especially for a doctor coming into a new jurisdiction with cancer treatment protocols that are HIGHLY standardized.
I don’t know about Arizona, but I have interacted with many patients in the US whose care seemed to rest to a much greater degree on what their doctor felt was best for their given situation. In many cases, the doctors down there seem to have much greater flexibility when it comes to how they manage their patient care.
So, who is responsible for ensuring that docs are aware of the environments in which they are expected to operate when they come to BC?
Secondly, it would be very interesting to find out if Dr. Katakkar’s practise would have been seen as deficient in other jurisdictions. Is this the BC Cancer Agency having issues with someone not following THEIR protocols, or is there a larger issue of physician competence at play?
This certainly isn’t an open and shut case IMHO.
what i want to know is where is he now and is he still practicing, i hope not :-(
Posted by: PGguy1234 on April 11 2013 3:44 PM
There are some people around here who call this doctor a hero for saving their lives because of his unorthodox methods adn not always playing by arcane rules that don’t always fit every case.
——————-
I’ve heard that too.
Cancer is big business; heaven forbid someone make progress in helping their patients.
Out of 540 cases under his care, 8 resulted in “severe, preventable patient harm” and 4 were critical patient safety events (they involved potentially preventable, treatment related death).”
I.e. at least 4 deaths out of 540 cases under his care were due to carelessness. How his performance compares with other foreign and Canadian Doctors and what is the ethnic background of the patients who didn’t receive proper care?
What was the reason for him not giving proper care to 10%? Discrimination or just laziness/arrogance or another reason?
He will probably have to go to Alberta.
Cheers
“least 4 deaths out of 540 cases under his care were due to carelessness”
In whose opinion? What are those people’s credentials, not only on paper, but also experience wise?
How is carelessness defined?
What is the STANDARD practice? Not what is the BEST practice.
Is the standard of measurement that patients have grounds for malpractice?
It does not sound like there is any urgency to make such claims.
“Develop additional systems for quality assurance and performance assessment for newly hired and external physicians working at the BC Cancer Agency.”
So, not only did they not have an adequate orientation to the workplace and the assessment of doctors working for the agency, they did not have sufficient systems in place.
So, who should we be “throwiing out of the country”, the Doctor, the Agency, or both … or none ….?
The Agency, in my mind, should be the developer of the Best Practices Standard. Not only that, but they should be the organization which is the champion of that based on every single thing they do. Because kives are at stake, we cannot have anything much less than Best Practices for such an Agency.
Who audits the Agency?
“At least 4 deaths out of 540 cases under his care were due to carelessness”
Too simplistic, consider this possible scenario . . .
– Patient A has been diagnosed with terminal cancer and has been given 6-8 months to live while receiving palliative treatment endorsed by the BC Cancer Agency. Dr. B says to them, “there is another treatment option that could give you 12-16 months to live, BUT it also carries a much higher risk of complications and death than the treatment protocol approved by the BC Cancer Agency”.
If you were patient A, which would you choose? More importantly, is Dr. B being careless by offering the second treatment option or is providing an option for the patient to extend their life by twice the length of time (despite the additional risk), a moral path to pursue?
I also find the “potentially preventable, treatment related death” blurb interesting. To me, this implies that the course of treatment caused the death and that the treatment related death could have been prevented. Unless I am misunderstanding it, it doesn’t say that the patient would have lived had it not been for the treatment. Perhaps these were terminal patients willing to try absolutely everything possible and by dying from the treatment as opposed to the illness, their death is classified as “treatment related” instead of “natural causes”.
We’ll never know the circumstances around those specific cases that you mentioned, but unless more details are released, I think there are just as many questions as there are answers IMHO.
Wow. So he came here to throw whatever treatment he could against the wall in the faint hope that some would stick. Sounds like a ducking quack to me.
I agree with gus…it does seem the B.C. Cancer Agency has a level of responsibility here as well.
Let the lawsuits begin.
I’m pretty sure that if the top-heavy bureaucracy at Northern Health were made to “sing for their supper” there might be a different tune playing in the halls of every piece of their downtown real estate. My kid is fleecing us to the tune of 50 grand a year. Northern Health? Pah! Northern Wealth!
Cancer is big business; heaven forbid someone make progress in helping their patients.
Oh yes, BIG BUSINESS. They are also more interested in keeping you ” in treatment” rather than try to find a solution.
Generic brand treatments are pushed forward 1st and formost, rather than the more expensive treatment that has less side effects,which in turn make for less treatments and trips to the cancer centre.
Good luck to you Mr. Katakkar
Dr. Katakkar was not employed by Northern Health. The Cancer Centre is part of PHSA, Provincial Health Services Authority.
Billions or Trillions have been raised in the name of a cure for cancer. Anyone know, off the top of their head how much money has been raised say in the last 20 years? Someone dragging their feet? How many people would be out of work if the cure showed up?
I’m really sick of people making money off our backs. I don’t care if the Cancer agency is upset with this doctor, perhaps he had some insight. Perhaps he saved some lives. Yes, maybe he screwed up.
I think there’s a lot of people with their heads in the sand.
I would have to agree with hammmy’s post
For those of you who don’t know how the system works here it is: Big Pharm pays for the research, they only allow positive studies to be published (US Court findings have proved falsification of data, exaggeration of results and suppression of contrary studies, they have been fined BILLIONS of dollars but, it is a cost of doing business for the companies).
Anyways the corrupt research is used to write guidelines (incidentally most of those who write guidelines have significant financial ties to Big Pharm companies), your boots on the grass MD is supposed to follow guidelines, if they don’t they can get sued. Problem is guidelines are good for populations not individuals, so you have to have an MD who is willing to lose their license to do what they think is right for you.
I don’t know what happened in this case but maybe the good doctor was actually doing what he thought was best for the patient. Just because another doctor disagrees with him, doesn’t mean he did anything wrong. There is an art to medicine. And unfortunately with cancer, sometimes you can provide the very best treatment for the patient and they die anyways.
It is easy for everyone to blame BC Cancer since they cannot release much in the way of details due to privacy law. Suffice to say that the BC Cancer Agency has the best cancer survival outcomes in the world.
One can blame BC Cancer Agency for poorly orienting Dr. Katakkar and they have admitted to such but we are overlooking the fact that Dr.Katakkar failed to heed warnings regarding patient safety concerns raised by colleagues and failed to follow medical standards. He chose not to follow protocols based on the best research showing the best outcomes. Worse of all, he ignored warnings by colleagues.
People argue that the BC Cancer Agency had written people off and Dr.Katakkar had not given up on them. Is it ethical to try unproven treatments on someone who is going to dye regardless of treatment? A drowning person will clutch at anything to try to keep their head above water, they will even drown their rescuers in their panic to stay alive. Selling snake oil to those begging for it doesn’t make you a better snake oil salesman.
How many people who had cancer died from the treatment, not the cancer?
In my personal opinion, this is a which hunt to make an example of any Dr. who dares to step outside the box.
The stats are probably very similar to most every other overworked Dr. who works in a specialty area.
With regard to “due diligence”, Dr. Katakkar appears to be board certified in both internal medicine and oncology. Those are very good credentials. If there was any problem with his practice, and it is not clear to me from what I’ve read that there was, it is unlikely that it was due to a lack of qualifications on his part.
Thank you NMG for your intelligent posts. I enjoyed reading them and totally agree with them as well.
Exactly. Interesting how a report is released many months after the doctor has left and can not defend himself. Cancer treatment is big business. To what do we also compare these statistics to.
Apparently in 2006, “a former patient in Tucson sued and won $1-million after a jury ruled that Dr. Katakkar had wrongly diagnosed a rare, incurable cancer of the bone marrow.”
Who was responsible for hiring him and who was the Minister of Health? Was Dr Charles Jago in charge? There could be a class action lawsuit in the works and you could hear the sounds of the gold coins ….
Seems to me we were in a big hurry to hire an oncologist. I remember wondering at the time we hired this Doctor why we would hire someone who was already past the age of 65 and under normal circumstances (in Canada) would have been retired.
In any event he was hired.
Apparently he has now left the Country,
Sasha wrote: âthe BC Cancer Agency has the best cancer survival outcomes in the worldâ
The study which the BC Cancer Agencyâs refers to was published in the Lancet, http://www.thelancet.com
If you read it carefully you would know that:
1.The study included 5 countries â Australia, Canada, Denmark, Norway, Sweden as well as the UK. It did not deal with the rest of the world.
2.Canada was represented from stats from four agencies â Ontario, Manitoba, Alberta and BC.
3.The tables show survival rates for each of the four agencies plus an agglomerated rate representing Canada for purposes of the study.
4.Cancer survival was based on only four categories of cancer â colorectal, lung, female breast, and ovarian.
Here are survival rates for the four categories studied.
â¢The first figure is for âCanadaâ as represented by the 4 districts.
â¢The second figure is for the USA, which is over a slightly different time period which ends in 2006. That is one of the problems if studies are done under different time periods even though methodology is comparable.
â¢The third is for Alberta, then comes BC, Manitoba and Ontraio
breast85.3%89.0%84.9%87.1%86.0%84.9%
colorectal58.1%65.0%56.3%59.8%57.6%58.0%
ovarian38.2%45.2%41.4%35.1%32.7%39.0%
lung15.7%15.8%13.8%13.9%16.6%16.6%
So BC is best in Breast and Colorectal; third best in Ovarian and third best in Lung.
In the case of Breast, Colorectal and Ovarian, the USA is best, in some case by a significant percentage. Both Manitoba and Ontario take the lead over the USA when it comes to the treatment of Lung Cancer.
So, taking a cue from medical malpractice suits, can I sue you Sasha, for promulgating misinformation about the BC Cancer Agency. ;-)
“someone who was already past the age of 65 and under normal circumstances (in Canada) would have been retired.”
I see you need to learn a bit more about the practice of medicine by the m,any senior doctors, Palopu.
This guy is young compared to some of the specialists practicing. They are also teaching students at UNBC, as well as other universities.
Think of a specialist …. think of Board Certified specialist, which are a rare breed in this part of the world, and think about how long it takes them to get the personal experience to make relatively reliable diagnoses.
Retiring when one is in their prime is really not in their makeup and would set the profession back a half century at least.
Chemicals, radiation and surgery. Still waiting for a cure. Let’s get busy, eh?
@Gus – people have been slagging BC Cancer for rigid protocols that do not address individual needs. Protocols based on research that establishes best practice outcomes for patients yield better results than lone Doctor’s struggling to keep current. It is splitting hairs to dissect each cancer survival rate to discredit the comment I made. The point is, BC Cancer has “some of the best” outcomes in the world. Does that make you feel better?
How does the airline industry do business and self regulate?
How does BC Cancer do business and self regulate?
Even with the best guidelines based on the best research – planes still fall out of the sky and people still die of cancer.
“the absence of a performance review.”
The problem is that “Performance review” doesn’t have any place in an institution dominated by Dr Charles Jago. Instead of performance review you see a medieval system from the Machiavellian era and post Moorish Spain.
“The fact is that a man who wants to act virtuously in every way necessarily comes to grief among so many who are not virtuous.”
[Machiavelli]
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