Details of Mississauga surgeon’s misconduct revealed

October 31, 2012 - All News

A Mississauga doctor being disciplined for professional misconduct and incompetence misdiagnosed a 12-year-old girl’s condition, performed unnecessary surgery on her and botched it so badly a follow-up operation was required.
In another routine procedure to remove a small bowel obstruction, Dr. John K. Pariag cut open a man’s hepatic artery causing him to bleed to death.
Details of Pariag’s medical errors are laid bare in a report prepared for the body that regulates Ontario’s doctors, obtained by the Star.
Pariag admitted to 21 cases of professional misconduct and incompetence in March and struck a plea bargain with the College of Physicians and Surgeons of Ontario. He may continue practising at a Mississauga walk-in clinic but will be restricted from performing major surgery.
The report evaluated 30 patient charts after Pariag’s medical incompetence came to light at Temiskaming Hospital in New Liskeard in April 2009.
In 22 cases, Pariag failed to act appropriately, wrote the report’s author, Dr. Tina Williams.
“Dr. Pariag exposed a number of his patients to harm and injury during his tenure at Temiskaming Hospital,” Williams wrote. “The density of the complications over a three-year period is striking.”
The Star obtained a copy of Williams’ report after repeated requests to the College for details of Pariag’s misconduct. All names in the report were censored to protect doctor-patient privilege.
After misinterpreting an X-ray sometime in 2008, Pariag diagnosed the 12-year-old girl with an ulcer, something “quite unusual” in someone so young, Williams wrote.
He opened her upper abdomen but was unable to find the cause of her pain. Pariag then made a second incision and removed her appendix, but didn’t give her enough antibiotics to prevent an abscess from forming, according to the report.
She was released, but returned to the emergency room with a fever. She underwent surgery a second time to drain the abscess.
In a December 2008 case, Pariag invented a diagnosis called “multiple polyposis syndrome,” and performed surgery on a woman at the hospital in northeastern Ontario.
If the appropriate diagnosis was actually familial polyposis syndrome, Williams wrote, he would have been required to consult with an expert polyposis centre like the one at Mt. Sinai Hospital in Toronto before operating.
Pariag’s errors involve lack of judgment, lack of skill, lack of knowledge and disregard for the patient’s welfare, Williams wrote.
Other botched procedures include:
• Removing healthy appendixes from three patients.
• Puncturing a man’s bowel while removing a tumour, causing fistula and months of additional treatment in a specialist facility.
• Removing a woman’s thyroid even though he had not been trained to do so.
• Leaving a surgical sponge in a woman and then performing a second operation to remove it without telling her why.
“Although one cannot expect a perfect record during this length of time in a surgical practice,” wrote Williams, “there is a worrisome density of problem cases in this snapshot of his practice.”
“This raises the question of how many other troubled cases were not examined in the review.”
A discipline committee panel recommended Monday that Pariag will have to inform all patients of his practice restrictions in writing and get them to sign a waiver. The panel’s decision is not yet final.
Attempts to contact Pariag and his lawyer went unanswered Tuesday, though Pariag has refused comment to the Star on three prior occasions.
Pariag told Williams he wasn’t happy in New Liskeard. He had been promised a signing bonus of $20,000 that wasn’t paid after the hospital changed administrators. As time wore on, Pariag decided he wasn’t making enough money through referrals and had to take on 70 per cent of the general surgery work at the hospital as a result, according to the report.
“He found this much work onerous,” Williams wrote.
Williams was retained by the College as a medical inspector to review 35 cases from Pariag’s tenure at Temiskaming Hospital. Some of the cases were chosen at random. Others were flagged by the hospital or chosen by the doctor himself.
In 22 cases, Pariag’s treatment did not meet the standard of care. In eight cases it did. Williams did not evaluate five cases that fell outside her area of expertise. Pariag failed to act properly in 73 per cent of the cases evaluated.
When Williams asked Pariag about his complication rate, he “opined that the rate is not worrisome if the total volume of his work and the concentration of emergency cases are considered.”
Though the exact number of procedures carried out by Pariag was impossible to determine, he said he saw at least 2,740 cases between October 2006 and July 2009.
Williams found that consent or partial consent for surgery was only obtained in eight of the 35 cases reviewed.
In one of them, Pariag claimed “informed consent” was given by a patient who had already been sedated that day.
— Torstar News Service