Embattled kidney specialist Dr. Albert Kadri’s actions “disrupted the safe operation” of kidney care at Windsor Regional Hospital and “exposed or were reasonably likely to expose patients to harm,” an appeal board has ruled in upholding the hospital’s suspension of Kadri’s privileges.
The Health Professions Appeal and Review Board also found in its decision June 29 that Kadri’s conduct caused confusion and stress among hospital patients and staff, distracted staff from patient care, created a “toxic relationship” with other nephrologists, was “unprofessional and disruptive” and demonstrated “inappropriate use of hospital resources.”
Windsor Regional, following a recommendation by its medical advisory committee, revoked Kadri’s hospital privileges in 2018 because he had repeatedly failed to comply with a new model of care for kidney patients. The new program was based on the recommendations of an external review and was approved by the hospital and endorsed by the Ontario Renal Network, which leads kidney care in Ontario.
Kadri met with hospital CEO David Musyj, now-chief of staff Dr. Wassim Saad and two other senior administrators in March 2016 and said he would be a “team player” and support the new program, the ruling recounts. But then he “backed away from his promises of co-operation.”
That fall, he refused to refer patients to the hospital’s kidney clinic, as required. In December, he began placing notes in patients’ hospital charts directing staff to call the patients’ community-based nephrologists to discuss concerns or book appointments. The notes caused confusion among the kidney program team.
The following spring of 2017, Kadri stated that, contrary to the program, he would remain the most responsible physician or MRP for his patients. The program called for the nephrologist on call to care for hospital patients.
He continued to attend patients directed to the hospital’s clinic and issue orders for those patients. Sometimes, his orders were the same as the on-call nephrologist. Some contradicted the on-call nephrologist.
The appeal board found that Kadri’s orders were “disruptive to the safe operation of the … clinic.”
Patients who would require dialysis were to be sent to the hospital’s clinic for care before dialysis began. But Kadri refused to do that.
“The evidence showed that some patients, who were referred to dialysis by the appellant, were not properly prepared to start dialysis because they had not had the benefit of the … clinic’s pre-dialysis care and education,” the board stated.
The other four nephrologists in Windsor had OHIP billings for patients they had seen while they were on call rejected because another practitioner had already billed for that care. Kadri refused to confirm or deny whether he was the doctor who had billed for that care.
But he was the only one who didn’t have that problem, and when his hospital privileges were revoked, the incidents stopped.
“The appeal board finds, on the balance of probabilities, that the appellant converted the … billings of his fellow nephrologists to his own benefit, contrary to the terms of the model of care for the renal program,” the ruling stated.
Kadri also threatened to accuse nephrologists Dr. Amit Bagga and Dr. Wayne Callaghan of “unprofessional conduct” before the College of Physicians and Surgeons of Ontario, which regulates doctors, if they continued to follow the hospital’s new kidney program. He also later threatened them with legal action.
He did complain to the CPSO about Saad, former chief of staff Dr. Gary Ing and two other nephrologists. The CPSO dismissed the complaints.
Kadri told the hearing that the hospital implemented the new kidney program “in bad faith” and that the hospital targeted him.
The appeal board disagreed.
“The appeal board finds that it has been the appellant’s disruptive behaviour, including his attempts to resist the model of care for the renal program, that have caused the respondent to respond. The appeal board also notes that the appellant was the only member of the renal program who resisted the model of care for the renal program.”
Asked what would happen if Kadri’s privileges were reinstated, Saad testified:
“In a word, a catastrophe. It would be … a disaster. If his privileges were reinstated, I can tell you, and you can ask them directly, Dr. Walters and Dr. Patel would leave. I don’t know what Dr. Bagga and Dr. Callaghan would do. We would not be able to recruit; we would not be able to implement our model of care … it would be absolutely devastating. We would be decimated from a nephrology perspective, and I think it would take forever to recover from that.”
If Kadri’s privileges were reinstated, “there is no likelihood that he would comply with the model of care for the renal program,” the board concluded.
Windsor Regional declined to comment. Kadri referred requests for comment to his lawyers, who didn’t respond by press time.
Kadri can apply to Divisional Court for a judicial review of the board’s decision.
He still also faces a college discipline hearing for “disgraceful, dishonourable or unprofessional conduct.”
He is also under onerous new college restrictions that forbid him from practising unless he meets strict requirements, including transferring all kidney patients meeting certain conditions — including dialysis patients — to Windsor Regional’s kidney program.