FULL REPORT BELOW FROM THE CPSO
On August 23rd, 2019, the Discipline Committee released its decision on penalty in the Dr. Savic matter. The Committee ordered and directed that:
1. Dr. Savic appear before the panel to be reprimanded;
2. The Registrar revoke Dr. Savic’s certificate of registration effective immediately; and
3. Dr. Savic pay the College costs in the amount of $30,730.00 within thirty (30) days of the date of this Order.
Committee: Discipline
Decision Date: 18 Dec 2018
Summary:
On December 18, 2018, the Discipline Committee found that Dr. Mile Savic committed an act of professional misconduct in that: he has contravened a term, condition or limitation on his certificate of registration; he has failed to maintain the standard of practice of the profession; and he has engaged in an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Contravened a Term, Condition and Limitation on Certificate of Registration
Dr. Savic signed an undertaking with the College in November 2010 in exchange for the College agreeing to withdraw a referral to the Discipline Committee and to terminate a College investigation. As part of the undertaking, Dr. Savic agreed to voluntarily relinquish his prescribing privileges in respect of narcotic drugs, narcotic preparations, controlled drugs and benzodiazepines, and other targeted substances.
The College received information that Dr. Savic may have been in breach of his prescribing restriction and, in February 2016, it requested prescribing data from the Ministry’s Narcotics Monitoring System (NMS) for the period from January 2010 to that time. The NMS data that it provided identified instances in which Dr. Savic wrote or authorized prescriptions for clobazam (a benzodiazepine) for Patient C, Vyvanse (an amphetamine derivative and thus a controlled drug) for Patient D, phenobarbital (a controlled drug) for Patient E, and oxazepam (a benzodiazepine) for Patient F. Dr. Savic was specifically prohibited from prescribing each of these medications by the terms of his undertaking.
The Committee found that Dr. Savic prescribed or authorized prescriptions for four drugs after he had entered into an undertaking with the College that prohibited him from doing so and therefore, breached his November 2010 undertaking with the College and contravened a term, limitation or condition on his certificate of registration.
Failed to Maintain the Standard of Practice of the Profession
a. Prescribing for Patients A and B
Regarding prescribing to Patient A, the College-retained expert stated:
– Dr. Savic displayed a lack of skill in writing prescriptions in that his handwriting was poor and there was a discrepancy between his intended dose and the actual dose prescribed;
– Dr. Savic failed to meet the standard of practice in that he prescribed a third-line antibiotic without any documented reason;
– Dr. Savic showed a lack of knowledge in respect of proper antibiotic dosing and duration of treatment, and failed to meet the standard of practice by prescribing a higher dose for a longer course than what was proposed in guidelines;
– Dr. Savic’s prescribing exposed Patient A to the possibility of receiving an ineffective medication or an overdose of medication.
The Committee accepted expert’s opinion that Dr. Savic’s choice of antibiotic was inappropriate in that Dr. Savic provided no documentation of why he chose a third-line antibiotic. The Committee therefore found that Dr. Savic failed to maintain the standard of practice of the profession in his prescribing to Patient A.
Regarding Patient B, the College retained expert opined that Dr. Savic’s prescribing for Patient B displayed a lack of judgment in that he wrote ongoing prescriptions for gabapentin at escalating doses without any comprehensive assessment, management plan, or documented reasons for the choice of gabapentin or increasing doses. In these actions, Dr. Savic exposed Patient B to a risk of harm such as the use of inappropriate medication, interactions with other medications, and side effects such as drowsiness. The Committee accepted Dr. Law’s opinion, and found that Dr. Savic failed to maintain the standard of practice of the profession in his prescribing to Patient B.
b. Ordering of Diagnostic Testing
A second College-retained expert reviewed Dr. Savic’s ordering of diagnostic testing.
The expert reviewed 25 patient charts and interviewed Dr. Savic.
Holter Monitor Testing
In reaching her opinion, the expert relied on her clinical experience, the ACC/AHA Guidelines for Ambulatory Electrocardiography, published in 1999, and the British Columbia Guidelines on Ambulatory ECG Monitoring (Holter Monitoring and Patient- Activated Event Recorder), dated April 15, 2013. The expert pointed out that the ACC/AHA guidelines explicitly state that Holter monitor testing is not useful for routine screening of asymptomatic patients, or in the initial evaluation of chest pain patients who can exercise, and it may be harmful in some cases.
In only one of 24 charts did Dr. Savic document any reason for ordering Holter monitor testing, and often there was no documentation that it had even been ordered until the patient returned for follow-up. In just six patient charts did the expert find any medical evidence that might represent an indication for Holter monitor testing. There was no supporting medical evidence or documented reason in the instances in which Dr. Savic ordered repeated Holter monitor testing.
The Committee accepted the expert’s opinion that Dr. Savic displayed a lack of knowledge in that he ordered Holter monitor and other tests without appropriate indication or documentation. Dr. Savic ordered Holter monitor testing outside accepted guidelines for a large majority of the patients reviewed, not simply for a few patients whose circumstances might have been unusual. Further, there was virtually no documentation in Dr. Savic’s charts of any reasons that would support his clinical judgement in ordering Holter monitor testing for individual patients outside accepted guidelines.
Ordering of Other Tests
The expert opined that Dr. Savic’s ordering of EKGs and stress tests lacked any acceptable indication for the most part. As with Holter monitor testing, Dr. Savic stated to the expert that the typical reason he ordered the tests was screening.
The expert expressed strong concern about a recurrent practice of Dr. Savic seeing patients for an EKG just days after a normal stress test. Dr. Savic acknowledged to her that he had no justification, and that such testing represents a duplication of service in that the patients would have had an EKG prior to their stress test.
In respect of Dr. Savic’s ordering of tests, the expert described a “cascade” of unnecessary cardiac testing in a patient with no cardiac concerns and no cardiac findings on physical examination.
The Committee found that Dr. Savic displayed a lack of knowledge and failed to maintain the standard of practice of the profession in his ordering of Holter monitor testing, EKGs, and stress tests without appropriate indication or documented justification.
c. Record Keeping
The expert opined that Dr. Savic’s documentation in relation to ordering Holter monitor testing fell significantly below the standard of practice. She noted that Dr. Savic displayed a lack of skill in terms of the completeness of his documented histories and examinations, and a lack of judgment in failing to document a proper evaluation in patients presenting with potentially significant symptoms. The Committee accepted her opinion that Dr. Savic failed to maintain the standard of practice in respect of his documentation in multiple charts reviewed.
With respect to Patient A, there was no indication in the documented history and examination that Patient A’s symptoms were severe. With respect to Patient B, there was no documentation of history, examination, investigation or management plan over an extended period. The Committee found that Dr. Savic failed to maintain the standard of practice of the profession in his record-keeping for Patients A and B.
d. Overall Management
The Committee considered Dr. Savic’s overall management of patients. The College-retained expert opined that Dr. Savic’s care of patients fell below the standard of practice of the profession in respect of additional aspects of his care. In general, the expert commented on Dr. Savic’s:
– failure to recognize and/or take appropriate action based on Holter monitor test results (patients #14, #1A, #4A);
– failure to properly investigate patients with cardiac symptoms or findings (patients #14, #3A, #4A, #6A). Among the patients for whom Dr. Savic ordered Holter monitor testing, other cardiac testing would have been more appropriate for the few who presented with cardiac symptoms;
– failure to properly investigate and/or follow up on patients who presented with non- cardiac symptoms (patients #5, #12, #1A, #2A); and
– failure to maintain an adequate referral system so that patients who Dr. Savic refers to specialists were in fact seen within an appropriate time (patients #8 and #14).
The expert opined that Dr. Savic’s knowledge was below standard and expressed “very serious concerns regarding the competence of [his] practice.” She identified “a marked and consistent lack of thoroughness in his case management, with frequent evidence of insufficient history, physical exam, inappropriate investigation, and incomplete followup.”
With respect to Dr. Savic’s care of Patient A, Dr. Savic displayed a lack of knowledge and judgment and failed to meet the standard of practice in not obtaining a throat swab or rapid antigen testing, in assessing the severity of Patient A’s illness, and in his rationale for management. With respect to Dr. Savic’s care of Patient B, there was no proper history, examination, investigations or comprehensive management plan of a patient with chronic pain. Dr. Savic displayed a lack of knowledge, skill and judgment in his care of Patient B.
The Committee found that Dr. Savic failed to maintain the standard of practice of the profession in his overall management of patients.
Disgraceful, Dishonourable or Unprofessional Conduct
Dr. Savic ordered unnecessary diagnostic testing without clinical indication or justification. In doing so, he exposed his patients to the stress, discomfort, inconvenience, and personal costs associated with medical testing. Further, he exposed patients to the risk that an important diagnosis would be missed because they did not get the appropriate test. He also exposed patients to the risk of receiving a false positive result to the Holter monitor test. A false positive result could lead to additional tests being recommended that were unnecessary. The additional tests would have their own risk of complications.
Dr. Savic has violated the trust patients have that he as a medical professional will act with competence, integrity, and in his patients’ best interests. This conduct is disgraceful, dishonourable and unprofessional.
Dr. Savic billed OHIP for services relating to the unnecessary testing he ordered. In doing so, he diminished the public funding that could otherwise have been directed to appropriate health care services. Thus, Dr. Savic has failed in his stewardship of our limited health care resources and his responsibilities to the profession and society at large.
The Committee found that, in his ordering of unnecessary tests and billing for related services, Dr. Savic has engaged in conduct or an act or omission that would reasonably be regarded by the members of the profession as disgraceful, dishonourable and unprofessional.
Decision on Penalty
On August 23rd, 2019, the Discipline Committee released its decision on penalty. The
Committee ordered and directed that:
1. Dr. Savic appear before the panel to be reprimanded;
2. The Registrar revoke Dr. Savic’s certificate of registration effective immediately; and
3. Dr. Savic pay the College costs in the amount of $30,730.00 within thirty (30) days of the date of this Order.
