December Messenger 2017

Dina Baras CPSA

CPSA disciplines Dr. Waleed Khadher for not providing CPR to a collapsed patient

Dr. Waleed Khadher (General Practitioner) was found guilty of unprofessional conduct by a College of Physicians & Surgeons of Alberta (CPSA) Hearing Tribunal.


A staff member from Dr. Khadher’s clinic contacted the College claiming unprofessional conduct by Dr. Khadher toward a male patient who came to the clinic with a burn on the hand. When Dr. Khadher entered the examination room, he found the patient non-responsive on the floor in a semi-recumbent position. The complainant said Dr. Khadher:

  • failed to initiate or supervise staff providing CPR to the patient,
  • failed to ensure documentation of the attempted resuscitation, and
  • altered the patient’s clinical record (i.e., deleted an entry and inserted another one without recording the contents of the deleted entry) after the clinical encounter.

The College investigated and collected enough evidence to pursue a disciplinary hearing against Dr. Khadher. At the hearing, Dr. Khadher admitted to the charges and the Tribunal found him guilty of unprofessional conduct.

Orders of the Hearing Tribunal

The Tribunal ordered Dr. Khadher:

  • Receive a reprimand.
  • Achieve certification in both Basic and Advanced Life Support within three months.
  • Maintain current certification in Basic and Advanced Life Support as long as he is a CPSA member in active practice.
  • Confirm in writing his understanding of the CPSA’s Patient Record Content and Patient Record Retention standards of practice.
  • Pay the cost of the investigation and hearing ($11,969.86).*

We expect CPSA members to provide any possible assistance to patients in a critical situation as per the Canadian Medical Association’s Code of Ethics (#18): ‘Provide whatever appropriate assistance you can to any person with an urgent need for medical care. ’ While intervention may not save a patient’s life, we expect physicians to offer whatever care they can until emergency personnel arrive. We also expect them to lead or direct resuscitation efforts where required, and to be responsible for ensuring all documentation is up-to-date and preserved. These are basic responsibilities for medical professionals.

Questions? Contact

* Paid October 17, 2017

CPSA Disciplines Dr. Tariq Alshawabkeh for professional misconduct

Dr. Tariq Alshawabkeh (General Practitioner) was found guilty of unprofessional conduct by a College of Physicians & Surgeons of Alberta (CPSA) Hearing Tribunal.


A third party contacted the College claiming unprofessional conduct by Dr. Tariq Alshawabkeh after a minor female patient (“HC”) shared concerns following her initial clinic visit with Dr. Alshawabkeh. The complainant said Dr. Alshawabkeh:

  • failed to provide proper draping and privacy for “HC” when he examined her chest (including the removal of clothing except for a brassiere),
  • made inappropriate complimentary comments to “HC” during the exam, and
  • inappropriately touched her shoulder and back during the same examination.

“HC” was alone during this clinic visit. The College investigated the complaint and noted additional concerns in that Dr. Alshawabkeh:

  • created an inadequate chart record for patient “HC”, incongruent with the presenting complaints,
  • inappropriately prescribed “HC” 90 tablets of Zopiclone at the initial clinic visit, and
  • created chart records citing an examination of “HC’s” cranial nerves 2 through 12, all of her skin and all of her musculoskeletal system.

Dr. Alshawabkeh was in a supervised practice assessment at the time of the alleged conduct. The evidence presented was enough to pursue a disciplinary hearing.

At the hearing, Dr. Alshawabkeh admitted to charges (1) and (2). The Tribunal also found Dr. Alshawabkeh guilty of professional misconduct for failing to provide adequate gowning and draping to “HC”.

As for charge (3), the Hearing Tribunal found it unproven. The Tribunal also found Dr. Alshawabkeh not guilty of unprofessional conduct in his complimentary language and touching of the patient’s back/shoulder. While his behaviour did not breach a standard of practice, the Tribunal saw it as “poor judgement’ and cautioned him to use better care in future situations.

Orders of the Hearing Tribunal

The Tribunal ordered Dr. Alshawabkeh:

  • Receive a reprimand.
  • Complete an appropriate course on professional boundaries.
  • Complete a formal course in medical record keeping, and have the College’s Continuing Competence program review his clinical records.
  • Complete a formal prescribing course.
  • Pay 40% of the costs of the investigation and hearing ($32, 575.65).

Physicians must treat minor patients, new to the practice, with significant care. Shortened medical record charting is not defensible, especially when the presenting complaints can have significant gravity. Similarly, physicians in such situations must prescribe with considerable care. They can, and sometimes should, limit quantities or refuse to prescribe pharmaceuticals that have the potential for misuse – particularly when contraindicated in certain age groups.

Finally, not providing appropriate gowning, draping and privacy before an examination breaches the College’s Sexual Boundary Violations standard of practice. Physicians should always offer to provide gowning and draping, and document it in the patient record. This is vitally important in cases involving unaccompanied minors.

Questions? Contact

Accurate diagnosis starts with consistent testing

Secure proper sleep testing & treatment for your patients by referring them to accredited sleep medicine facilities

All sleep medicine facilities that employ or contract a physician to read their tests will need to be accredited by 2020.
Two weeks ago, College Council approved accreditation standards for all diagnostic sleep medicine facilities in Alberta. The standards will ensure safe, quality and consistent patient care and will be in place by January 1, 2018. In the months following, we’ll be preparing for facility assessments.

“Without accreditation standards, no one is accountable for the quality of testing we expect for Albertans,” says Patrick Litwin, CPSA Accreditation. “Right now, there are several companies offering diagnostic sleep services and we don’t know who some of them are. They’ve never been regulated and are difficult to identify. We’ll be asking our members and patients to help us do that.”

By 2020, these facilities will need to be registered with the CPSA and meeting the accreditation standards. The College will work with referring physicians, insurance companies, equipment vendors and other healthcare stakeholders. Our goal is to have everyone on board and ready for assessment by mid-2018.

You can help…
By registering your facility for assessment or referring your patients to CPSA-accredited facilities. Not sure if your facility or provider of choice is already accredited? Check our resource below.

Is telemedicine a way to reduce rural pressures on good medical care?

The College heard from docs and community leaders in Wainwright and Cold Lake.
The College hosted meetings in Wainwright and Cold Lake on Wednesday, November 29th to hear from physician members, community leaders and the public: What’s working in health care in your community and what could use work?

We heard physicians’ concerns about the survival of medical practice in small communities, the impact change in government has on rural practice and the assessment of IMGs based on the duties they’ll be expected to perform in their new town. Across the board, physicians in both regions have a full workload impacted by rural pressures – they are busy.

In Wainwright, some physicians brought up telemedicine as a potential remedy to some of the pressures faced by rural healthcare practitioners. The concept received favorable response from the town Chamber of Commerce, PCN, local EMS and elected officials.

“There is a lot of research being done on how telemedicine fits into the broader picture of medical self-regulation,” says CPSA Council President and public member Kate Wood. “The College is trying to understand what the future of healthcare looks like and how we can work within our healthcare system to influence improvements that impact physicians’ lives – for everyone’s sake.”

A well-attended Town Hall in Cold Lake showed that the same pressures felt by rural physicians and the complexities of the Alberta healthcare system affect the public. Practising medicine means accepting serious responsibility for patients’ wellbeing. “While the responsibility is great, the calling has many rewards, including the high respect shown by the public,” says Ms Wood. “Physicians, as a profession – and that includes the College, are continuing to do whatever is possible to maintain that trust and respect.”


The College hosts meetings throughout Alberta with local physicians to discuss their realities and challenges, the public in town-hall-style discussions and PCNs, health advisory councils and community leaders, looking for synergies to help address common issues. This outreach program identifies local issues affecting good medical practice and helps the College deliver relevant programs and services that make sense to Albertans. If you’d like a Regional Tour visit in your area, contact

Sudden Sensorineural Hearing Loss: Will you recognize it when you see it?

We’ve received a number of complaints alleging physicians are providing substandard care when assessing patients with sudden onset hearing loss. In some cases, physicians did not diagnose or even consider Sudden Sensorineural Hearing Loss (SSNHL), and the patient’s loss became permanent.

About Sudden Sensorineural Hearing Loss
SSNHL affects the patient quickly, usually over 72 hours or less. The cause is largely idiopathic; however, viral infection is sometimes associated. Other symptoms may include tinnitus, vertigo and a sense of aural fullness, and it can affect all or a portion of hearing frequency. In all the cases brought to our attention, the hearing loss was severe.

Quick Facts

Experts estimate SSNHL strikes one in 5,000 people every year, typically adults in their 40s and 50s. The actual number of new cases could be higher because the condition often goes undiagnosed. Many people recover quickly and never seek medical help.

Only 10 to 15 per cent of those diagnosed with SSNHL have an identifiable cause.

Complaint commonalities
We found similar issues in the complaints surrounding SSNHL. We hope sharing these will help you with your differential. In all cases, we found the physician:

  • Did not take an appropriate patient history, including a full exploration of symptoms, past medical history (including possible barotrauma, ototoxic medications and focal neurological symptoms).
  • Did not exam the patient thoroughly (or did not examine at all). Usually there was no Rinne and Weber testing, no cranial nerve/ocular testing and no cerebellar review, all which a physician should use to delineate if the hearing loss is conductive or sensorineural.
  • Did not arrange urgent audiometry for the patient.
  • Did not consider appropriate differential diagnoses.
  • Did not recognize the urgent nature of the loss, and did not initiate contact with/provide for urgent otolaryngology consultation.

Treatment and prognosis
While many patients have spontaneous recovery of hearing, some do not. The evidence for acute intervention is weak – however, most authorities suggest immediate initiation of steroid therapy (certainly no later than 7-14 days after the onset of symptoms) such as prednisone 1 mg/kg for 7-14 days, with a taper of equal duration following (maximal dose 60 mg/day). Authorities also recommend follow-up with an otolaryngologist and a non-urgent MRI.

Although treatment may not be successful and spontaneous resolution is possible, you are still responsible for recognizing the differential diagnosis of SSNHL. Sudden and permanent hearing loss is devastating for anyone. Ensure you do a thorough history and physical exam to consider SSNHL and advise the patient on treatment and the prognosis.


  1. Canadian Family Physician October 2014, 60 (10) 907-909: Can you hear me? Sudden sensorineural hearing loss in the emergency department
  2. CMAJ March 20, 2017: Sudden sensorineural hearing loss
  3. Otolaryngology–Head and Neck Surgery, 146(1S) S1–S35, © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2012: Clinical Practice Guideline: Sudden Hearing Loss
  4. Ansari et al. Journal of Otolaryngology - Head and Neck Surgery (2016) 45:17 : Oral corticosteroid prescribing habits of Canadian Otolaryngologist-Head and Neck Surgeons
  5. Am Fam Physician. 2012 Jun 15;85(12):1150-1156: Hearing loss in Older Adults

2018 Annual Renewal – Just over 2 weeks left to renew!

Practice permit & PC permit renewal due Dec. 31, 2017

If you have already completed your annual renewal, thank you.

If not, you have just over two weeks left to renew your practice permit and/or professional corporation (PC) permit before late fees apply. Note: Only the designated physician completes the PC renewal on behalf of all shareholders. Late fees are $400 for your practice permit and $150 for your professional corporation permit.

We must receive both your completed forms and payment by Dec. 31. If paying by cheque, please allow enough time for mail delivery.

Not sure if your 2018 renewal is complete?
Log in to the physician portal. Any outstanding items will be listed.

Need help? Email or call us Mon-Fri, 8:15 a.m. – 4:15 p.m. MT at 780-969-4925 (Edmonton and area) or 1-877-629-3787 (toll-free in North America).

*Note holiday office hours below.


Our office will be closed December 23, 2017 - January 1, 2018.
Please note we will not be able to respond to your inquiries or post permits to the physician portal during this time.

After you complete your renewal, it takes three (3) business days to post your permit and receipt in the physician portal. If you renew during our office closure, please allow extra days.

If you have questions during the closure, please call 780-423-4764 or 1-800-320-8624 and leave your full name and a contact number. We will respond starting January 2, 2017. This includes physicians who encounter problems and cannot complete their annual renewal. Please note practice permits will still be valid, and any waiving of late fees due to technical difficulties will be discussed and assessed when we reopen.

If your call is URGENT, an answering service will be available to direct your message to on-call staff as necessary.