Winnipeg doctor disciplined for sending patients to ER

In a rare move, the College of Physicians and Surgeons of Manitoba (CPSM) has disciplined a doctor for sending patients to the emergency room without examining them himself - a practice the CPSM says can contribute to long waits in the ER.

Dr. Leonard Elia Lockman vows to fight 'unfair' decision

The College of Physicians and Surgeons of Manitoba has disciplined a doctor for sending patients to the emergency room without examining them himself 2:13

In a rare move, the College of Physicians and Surgeons of Manitoba (CPSM) has disciplined a doctor for sending patients to the emergency room without examining them himself — a practice the CPSM says can contribute to long waits in the ER.

Dr. Leonard Elia Lockman was censured by the CPSM at the beginning of May because he sent 10 patients to the St. Boniface ER without properly assessing how sick they were. 
Dr. Leonard Elia Lockman vows to fight the discipline imposed on him.

"It is a case of a physician shifting his professional responsibility for the care of patients to the emergency department," said Dr. Anna Ziomek, registrar of the CPSM in an email. 

"It is a case of a physician shifting his professional responsibility for the care of patients to the Emergency Department" -  Dr. Anna Ziomek, registrar of the CPSM 

Lockman doesn't see it that way.

"It's not even fair. A patient didn't complain," said Lockman in an interview. "All these patients did very well, some of my patients actually benefited from these referrals."

Lockman, who is a family physician, said the censure is the result of complaints filed by St. Boniface ER doctors. 

I felt I signed this censure under duress- Dr. Leonard Lockman

"I was forced to sign this censure. I felt I signed this censure under duress," said Lockman, who vowed to fight the decision. 

Ziomek questioned why he signed.

"He did not have to sign," said Ziomek. "I'm not sure how one would sign under duress. He has a lawyer with him who is giving him advice."

Lockman is the only Manitoba doctor to be disciplined for inappropriately sending patients to the ER in the past 15 years of published cases reviewed by CBC News. 

Lockman's actions could carry larger implications to patients and the medical system as a whole, according to Ziomek.

"[T]here is potential for harm to the patient in an extensive wait period in the ER for care which could have been received in the office setting. There is potential for harm to other patients in the ER through the unnecessary addition of patients (and thereby delay) to the ER workload," said Ziomek.

She added the medical system could be harmed through wasted resources if the doctor billed for the office visit without actually doing the work which was required by the standard of the profession.

Manitoba Health considering audit

"It's a very bold move by the college because it's one of those things where we all want to know we are getting the best care," said Manitoba's Health Minister Sharon Blady. 

"Manitoba Health is reviewing the decision to see if there was inappropriate physician billing to Manitoba Health and if an audit of the physician's billing practice is warranted." said Blady's spokesperson in an email, adding they won't speak specifically to the college's decision.

Lockman, who practices at the St. Vital Family Medical Clinic, repeatedly sent patients to emergency between September 2011 and March 2012 without an adequate examination, according to the CPSM document.

The patients records contained the notes, "Exam not necessary [according] to patient," followed by, "Refer [to] St. Boniface ER STAT."
Ziomek is concerned about the possible harms that can arise when patients are unnecessarily sent to the ER.

Lockman disputes the college's conclusion that he did not adequately examine the patients.

"I did examine these patients," said Lockman "We know our patients. I have been practicing for almost 30 years, and I am very familiar with a lot of my patients."

He added he sees some of them almost every day. 

The CPSM said family doctors must assess the severity of a patient's condition through physical examination and history taking.

Once the patients got to hospital, they all consented to a physical exam, which could have been done by Lockman in his office, according to the CPSM document.

In addition, six of the patients reported history that was not included in Lockman's records. 

Eight of the 10 cases were triaged as less urgent or non-urgent according to the college, yet Lockman described some of the patients as very sick, including one patient who vomited blood and was almost admitted to hospital

An independent family doctor reviewed the patient files for the CPSM and was of the opinion that Lockman's management and documentation fell below the standard of the profession because of minimal history taking, lack of proper examination and improper referrals to the ER.

In addition to the public censure, Lockman paid the costs of the $20,000 CPSM investigation. 

"I'm bitter about it, and I feel done in because this is not just. If I had harmed a patient, I should pay for it. That I'll do. But if I've done nothing wrong?"  said Lockman "It's ridiculous."


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