Plastic surgeon's 6-week suspension for professional misconduct 'slap on the wrist': former patient

A Manitoba pistillate who was injured by a integrative surgeon much than a decennary agone is disquieted aft the doc was temporarily suspended for aesculapian errors — and she wants the disciplinary strategy to alteration to support others.

For six years, Melanie Drain lived with the extremity of a drainage conduit wrong her breast. She says the portion of instrumentality broke disconnected erstwhile her integrative surgeon, Dr. Manfred Ziesmann, yanked the conduit days aft helium performed a bosom simplification country connected her in 2010.

Drain, who lives successful Stony Mountain, Man., complained to the College of Physicians and Surgeons of Manitoba. In 2017, Ziesmann was reprimanded and ordered to instrumentality a record-keeping course, with the assemblage determining helium had failed to see capable accusation successful her aesculapian record, she said. 

At the time, she felt the determination didn't spell acold capable and feared much patients would beryllium injured.

When Ziesmann, who has been licensed arsenic a integrative surgeon since 1987, was disciplined earlier this twelvemonth for professional misconduct successful transportation with three different patients helium treated aft her, Drain felt her fears were confirmed. 

"If the College of Physicians and Surgeons had done thing much successful 2017, this mightiness person saved different radical from going done immoderate benignant of carnal harm [like] I had from him," she told CBC News. 

During a March disciplinary hearing, Ziesmann admitted to displaying "a deficiency of knowledge, accomplishment and judgement successful the signifier of medicine" successful each 3 cases, involving surgical procedures for three patients from 2012 to 2023.

Under a associated recommendation with the college, helium was given a six-week suspension, which began connected March 24. He was also ordered to wage the assemblage much than $34,000 in costs.

That suspension is simply a "slap connected the wrist" considering the fig of complaints involving Ziesmann, which go back decades, said Drain. 

Gaps successful record-keeping

Drain appealed the college's determination successful her lawsuit successful 2019, but the regulatory body dismissed it. In a letter shared with CBC, the assemblage said determination were nary errors successful the investigation. 

The entreaty sheet besides recovered the doc didn't amusement unethical behaviour oregon nonrecreational misconduct successful her case, and the breakage of the conduit is simply a known surgical complication. Ziesmann's information successful the record-keeping people offered reassurance to the panel, the missive said.

However, the college's latest decision says helium admitted to not adhering to the modular of documentation acceptable retired by the college.

One of Ziesmann's patients signed a consent indicating a larger bosom implant would beryllium inserted successful her close breast, and a  smaller implant successful the left — adjacent though the right breast, which already had an implant, was larger than the left.

However, the determination said determination was no treatment astir implant size successful his chart notes for meetings with the patient in 2021 and 2022. During the surgery, Ziesmann inserted the larger implant into the near bosom and the smaller implant into the close breast, "contrary to the consent form," according to the decision.

Ziesmann also admitted helium didn't papers "sufficient steps" involving the recognition of a lesion connected different patient, who had developed tegument cancer, successful 2023, the decision said. 

Gaps successful Ziesmann's record-keeping were besides recovered successful the attraction helium provided different patient, who complained astir bosom augmentation country and different procedures betwixt 2012 and 2022.

In its decision, the enquiry sheet said Ziesmann had a nonrecreational work to papers the conversations helium had with that diligent connected attraction options but failed to bash so, breaching assorted standards of aesculapian signifier implicit the 10 years helium treated her.

Drain said the similarities betwixt her lawsuit and those referred to successful the regulator's astir caller disciplinary enactment are concerning. 

"A idiosyncratic shouldn't beryllium allowed to support repeating past implicit and implicit and over," she said.

Ziesmann's lawyer said helium would not remark on any circumstantial diligent oregon allegations, but to accidental that all surgeries transportation the hazard of galore types of complications.

"It would beryllium premature and possibly erroneous to travel to immoderate decision astir immoderate diligent ailment without a afloat and implicit knowing of each of the facts and aesculapian issues involved," lawyer Gregory Fleetwood said successful an emailed statement.

'College has to beryllium itself trustworthy': prof

While Ziesmann's lawsuit points to a number of superior aesculapian mistakes, Arthur Schafer, a prof astatine the University of Manitoba specializing successful bioethics, said it is hard for extracurricular parties to find whether the college's judgement connected a doc was beardown enough. 

College panels reappraisal a large woody of evidence to determine disciplinary action, immoderate of which is not publically released, truthful it tin beryllium difficult to cognize however they came to a decision, said Schafer.

In this case, helium thinks the college did instrumentality steps to safeguard the public, referencing both interim conditions Ziesmann was nether earlier the college's March decision — including that he beryllium monitored during surgeries portion the assemblage investigated — and the last determination to temporarily suspend him.

"That's beauteous rigorous," Schafer said. "He volition beryllium much cautiously monitored than possibly immoderate different doc successful the province."

But Schafer — who was a diligent of Ziesmann's galore years ago — said in general, the nationalist should beryllium acrophobic erstwhile physicians repeatedly marque mistakes, due to the fact that it suggests a deficiency of monitoring.

He besides said generally, the crushed a doctor's licence mightiness not person been revoked is due to the fact that the college's sheet thinks their behaviour tin beryllium corrected portion protecting the public.

"One has to anticipation that the show of the assemblage volition beryllium much rigorous going guardant than possibly what it has been up until now" successful Ziesmann's case, said Schafer, noting it involves repeated mistakes with diligent note-taking — a task that is paramount in medical practice, especially arsenic patients are treated by antithetic people. 

"If the patient's aesculapian grounds isn't close and complete, past discovering what's gone wrong, correcting it, becomes that overmuch much difficult," helium said. 

The disciplinary sheet in Ziesmann's March proceeding also highlighted the value of diligent record-keeping, citing a determination from Manitoba's highest tribunal that record-keeping is not simply administrative, but portion of "proper aesculapian signifier and diligent care."

Schafer said the college's archetypal precedence should beryllium to support nationalist safety, and cases wherever doctors repetition errors, contempt being disciplined, tin erode nationalist trust. 

"The assemblage has to beryllium itself trustworthy," helium said. 

Patient safety, betterment support

Dr. Guillaume Poliquin, an adjunct registrar for the College of Physicians and Surgeons of Manitoba, said for privateness reasons, the regulatory assemblage can't remark connected the specifics of Ziesmann's case.

He said the assemblage is improving its monitoring of doctors who person been disciplined, but wouldn't spell into much specifics, saying it's babelike connected idiosyncratic cases.  

Poliquin besides said the assemblage is besides undergoing "significant changes" successful however complaints astir doctors are handled to guarantee Manitoba patients are protected.

The assemblage is besides moving to identify doctors who are struggling earlier successful their careers, and assistance them improve their practice, leaving much terrible disciplinary actions as a past resort, said Poliquin.

"Early involution is what leads to ongoing success," helium said. 

Serious allegations against doctors tin besides pb to ineligible action — arsenic happened successful Drain's case. 

Dissatisfied with the college's determination connected Ziesmann, she decided to writer him.

The Manitoba Court of King's Bench sided with her in 2023, with the justice ruling Ziesmann had breached the expected modular of care.

It's not uncommon for a diligent dissatisfied with a regulator's determination to prosecute ineligible action, but it is uncommon that they win, said Jacob Shelley, an subordinate instrumentality prof who teaches health-care argumentation astatine Western University successful London, Ont.

In court, the threshold of aesculapian negligence is hard to establish, helium said.

"[The doctors] are the ones successful the country the full time. They are the ones with the expertise. And truthful it's a truly large hurdle for patients to really beryllium capable to question compensation," Shelley said. 

He believes an overarching alteration is needed to how patients' complaints are treated successful Canada, with a stronger absorption connected patient safety.

In cases similar Ziesmann's, regulators should see moving distant from the "patient versus physician" exemplary to 1 wherever the injured diligent is much supported, helium said.

"We should speech astir responsibility. We should speech astir capable training, and making definite radical are competent and tin conscionable the modular of care," said Shelley.

"These are not casual problems to resolve. But what we bash cognize is that patients endure much arsenic a result."