Kitchener pain doctor can only provide care with supervision
KITCHENER — A Kitchener anesthesiologist specializing in pain management can practise only under supervision for a year after the College of Physicians and Surgeons of Ontario found he committed an act of professional misconduct.
The college launched an investigation into Dr. Kulbir Singh Billing’s practice after receiving information from the Ministry of Health and Long-Term Care in 2011.
Last November, the discipline committee ruled Billing failed to maintain the standard of practice of the profession. The penalty was issued on June 22.
After the clinical supervision is completed, Billing will undergo a reassessment of his practice by a college-appointed assessor. That will include a review of patient charts and observation of patient care.
Billing will also be required to inform the college of every location where he practises, and co-operate with unannounced inspections by a college representative.
In its investigation, the college enlisted two experts to review patient charts and observed care of certain patients by Billing, whose practice is primarily devoted to injection therapies for chronic pain, including nerve blocks, paravertebral blocks, epidural injections, and trigger point injections.
They found documentation in patient charts were deficient in several areas, including missing or incomplete patient histories, poor documentation of things such as treatment efficacy, discussion of potential complications and patient consent.
A report on the investigation’s findings also said Billing uses template-style reporting where he “cuts and pastes from patients’ previous clinical notes, carrying over grammatical and spelling errors.”
Deficiencies were also found in his treatment plans, including many patients receiving more blocks than the maximum paid by OHIP, many patients being given the same or similar sets of blocks and injections without documented rationale, and not adjusting treatment based on new evidence.
His sterile technique in administering blocks was also found to be deficient, potentially putting patients at risk of serious infection.
Billing must get a college-approved clinical supervisor within 20 days of the order, and then he may only practise chronic pain management under supervision. That will end after 12 months, during which the supervisor can decide if more moderate supervision is needed.
For at least the first four months, the supervisor will meet with Billing every two weeks to review charts, watch his treatment of patients, discuss any concerns and make recommendations.