Now-retired Halifax doctor reprimanded for conflict of interest
Dr. Jalal Hosein consented to 3 reprimands regarding case involving patient, family's estate
A now-retired Halifax doctor has been reprimanded by the College of Physicians and Surgeons of Nova Scotia.
The college has found Dr. Jalal Hosein broke conflict of interest rules by managing the expenses of an intellectually disabled patient and then allowed her to live in what were described as "extremely poor" conditions.
On Wednesday, the college released its decision regarding Hosein, who consented to three reprimands.
"The committee concluded the nature of the allegations are serious and go to the core of patient care, physician responsibility, and professional ethics," the decision stated.
The college's decision is in regards to a complaint made last year by an adult protection worker with Nova Scotia's Department of Health and Wellness.
A patient's will
It relates to the last will and testament of a man and the care of his daughter, a person who has intellectual disabilities and has found to be an adult in need of protection.
The man, his wife and his daughter were Hosein's patients.
Hosein held power of attorney for the father and later acted as executor and trustee for the estate. He was also the trustee of estate funds set aside to care for the daughter.
In the decision, Hosein said he was friends with the family. He said the mother and father asked him to act as executor and trustee of the estate that would be left to their daughter.
He said he "reluctantly agreed" because knew the parents and believed there was no one else they could rely upon.
Doctor in charge of money
The mother died in 2017 and the father died in 2018.
Hosein was not the daughter's legal guardian and did not have power of attorney for her, but he did control the money from her father's estate set aside to take care of her needs.
The adult protection worker who made the complaint alleged Hosein left the daughter to live "in a neglected state" and "failed to report her as an adult in need of protection."
The decision states after the mother and father were moved to a nursing home, the daughter lived in an apartment owned by one of Hosein's friends.
Hosein managed the daughter's expenses and arranged grocery delivery from a corner store owned by the landlord.
'Dead rodents and feces' at apartment
In April 2018, Nova Scotia's Adult Protection Services received an "anonymous referral" with concerns about the daughter's living conditions and her mental health.
She had been referred to Adult Protection Services twice before, in 2014 and 2016, about her living conditions. On both occasions, Hosein said the daughter didn't lack capacity and that her living conditions were sufficient.
The decision noted the daughter's apartment was visited by Adult Protection Services, the police and the mental health mobile crisis team. Each said the living conditions were unfit.
"The apartment had a foul odour, there were dead rodents and feces throughout, the sinks and toilet was plugged, it was full of cobwebs, the mattress was stained, the kitchen unsanitary and there was dried human feces on the furniture," the decision noted.
Dietary needs not met
The decision also noted the daughter did not have a proper diet.
"[The daughter] was eating foods that would exacerbate her condition, like fast food hamburgers and fried chicken, delivered to her by Dr. Hosein," the decision noted.
Hosein was never the daughter's legal guardian and felt no need to routinely assess her living premises, the decision noted, but Hosein said he visited her apartment periodically and tried to get cleaners in regularly.
By June 2018, he recognized the apartment had "deteriorated quite significantly" and "took it upon himself to have the cleaners increase their efforts with more frequent and better cleaning."
Hosein said he was "pleased" Adult Protection Services became involved. He had "previously tried in vain to get [the daughter] into a seniors facility, but she refused."
Doctor just wanted to help
Hosein, who retired from the Halifax medical clinic where he worked earlier this year, declined an interview and referred CBC News to speak with his lawyer, Brian Downie.
Downie said Hosein took a professionally mature approach to the situation and wishes to move on.
In the decision, Hosein said all he ever tried to do was help fulfil the father's wishes by tending to the daughter's expenses.
Further, he said a probate court will see "every dollar is accounted for in his role as executor and trustee."
Issue with medical records
When it came to the preliminary investigation, the college "identified" Hosein's medical records were "not in keeping with the college's professional standards regarding medical records."
Hosein said he made house calls to the daughter and called her regularly to discuss her care, but didn't document it.
"Dr. Hosein's medical records do not show any patient visits for [the daughter] in 2017. He did document two medical visits in 2016 and two in May and June 2018," the decision noted.
Investigators also found "Dr. Hosein did not act on recommended follow-up treatment and investigations for [the daughter]."
It also found Hosein's wife is named as a contingent beneficiary "in a codicil" to the father's will executed in 2014, after he moved to the nursing home.
The committee found issues with several aspects of this situation: Hosein could have breached the college's professional standards regarding conflict of interest when he acted as executor and trustee for the father's estate.
The college's conflict of interest guidelines defines a conflict of interest as "the clash between the physician's duty to act in the patient's best interests and the personal interests of the physician."
"The committee is concerned that there is a conflict between Dr. Hosein's duty to act in [the daughter's] best interest and his wife's potential residual interest in the estate," the decision noted.
"On the evidence before the committee, the estate is valued at over $300,000."
The committee said it also didn't appear Hosein was providing enough money to provide for the daughter's care, "which obviously includes healthy and appropriate food, adequate clothing, cleaning services and other supports."
The committee said it understands that Hosein intends to resign from his role as executor of the father's estate.
The three reprimands include:
- Failing to act in a prompt and timely manner on recommendations by Adult Protections and the clinic, and for failing to report [the daughter] as an adult in need of protection, pursuant to the college's guidelines regarding reporting requirements for Nova Scotia physicians.
- Failing to adhere to the college's professional standard regarding medical records.
- Failing to adhere to the college's professional standards regarding conflict of interest.