One of Ontario’s top-billing doctors will have his medical license suspended for four months after being found to have committed professional misconduct for providing substandard care and making erroneous billings.
In a virtual hearing before a College of Physicians and Surgeons of Ontario disciplinary panel on Monday, Chatham ophthalmologist Christopher Anjema admitted to failing to maintain the standard of practice of the profession.
He also pleaded no contest to allegations that he engaged in behaviour regarded as disgraceful, dishonourable or unprofessional — a plea that means he did not challenge the facts presented to the panel but also did not admit guilt.
“It seems to this committee that you put your own interests in front of your patients,” Pierre Giroux, chair of the disciplinary panel, said in reprimanding Anjema.
“The College must protect the public by sending a clear message to the profession that your conduct is unacceptable.”
Anjema’s suspension will begin July 1.
In a statement posted on his business’s Facebook page, Anjema told his patients, “I’ve always tried to be the best doctor I can be no matter what.”
“I’m sorry to say that they have found that I did not always meet College standards during the period they studied through 2011-2016. So, I’m being disciplined accordingly. I accept what has happened and I am accountable for the outcome,” Anjema’s post read.
Anjema’s suspect billings to the Ontario Health Insurance Plan were exposed in a 2019 Star investigation. The Star found Anjema, the fourth highest biller in Ontario in 2017-18, charged the province for performing an uncommon eyelid procedure at a frequency per patient that experts said at the time was medically impossible.
The Star revealed that over seven years, Anjema had billed for performing the reconstructive procedure known as a Tenzel flap more than 3,300 times — more than all other doctors in the province combined, including the oculoplastic surgeons who specialize in these kinds of procedures.
He charged the province more than $1.6 million for the fee code associated with that procedure, part of the more than $31 million he billed between 2011 and 2018. (Fee-for-service compensation, in which doctors bill OHIP for each service they provide using a unique fee code, is done on the honour system.)
The disciplinary panel heard that Anjema struck a settlement agreement with the Ministry of Health for his use of this fee code in 131 records reviewed. Under the deal, which was reached in 2019 but previously undisclosed, the Anjema Eye Institute will pay the province $31,222.02 in restitutions.
Anjema’s lawyer, Neil Perrier, said the billings were simply the result of Anjema inadvertently using the wrong fee code when billing for procedures.
“Dr. Anjema has learned that there was a more accurate billing code to do since then. There was never any allegations that Dr. Anjema engaged in any malfeasance in the form of an intention to mislead OHIP with respect to his billing. It was just an inaccurate billing,” Perrier told the hearing.
Anjema did not contest that an expert who re-assessed his practice found he had also billed OHIP for follow-up visits after cosmetic eye lift surgeries that had been paid for by patients.
The lawyer for the college of physicians, however, stressed that the “breadth of the clinical deficiencies in Dr. Anjema’s practice” extended far beyond billing problems.
“Anjema’s failure to exercise appropriate clinical judgment and discernment have serious consequences,” Morgana Kellythorne told the hearing.
Kellythorne said that while Anjema performed repeated tests and treatments for some patients “without clinical indication,” he also missed clear evidence that showed a patient was suffering from glaucoma-induced vision loss.
That patient, referred to only as Patient A, complained to the medical regulator in 2017 about the care he received from Anjema.
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“Anjema missed opportunities over the years to make the diagnosis over several visits despite clear evidence in the available diagnostic tests of severe and progressive glaucoma-induced vision loss,” according to the agreed statement of facts filed in the hearing.
“Glaucoma is a common disorder and all ophthalmologists are trained to recognize and arrange appropriate and timely treatment.”
Untreated, Patient A’s vision deteriorated and he is now legally blind.
Anjema’s lawyer said the doctor is “very upset with himself and is very sad that Patient A lost his vision.”
“(Anjema) admits…the miss he had in this instance has bothered him every day since it happened,” Perrier said.
The patient blames Anjema not just for bungling his treatment but for overcharging him as part of his cataract surgery, according to facts submitted to the disciplinary panel that Anjema did not admit but also did not contest.
Staff at Anjema’s clinic sold Patient A a “silver-level” package for $595, which he understood meant he would be having a higher quality lens implanted compared to the lens covered under OHIP.
Most importantly to the patient, paying for the special package “would permit him to avoid a long wait time for cataract surgery,” according to the uncontested facts submitted to the disciplinary panel.
Patient A later learned the lens he had implanted was the same one covered by OHIP. (Anjema, according to the uncontested statement of facts, has explained that the “silver level” package included testing only, not an upgrade of lens.)
In an interview, Patient A told the Star that he was upset by the decision to only suspend Anjema’s license for four months and feels like the plea deal deprived him of the opportunity to testify on the impact this has had on his life.
“He got a slap on the wrist and I got a slap in the face,” said the patient, who is also suing Anjema.
“He might get a summer off and I go around blind for the rest of my life. He might get time to spend with his kids this summer…and I am not going to see my grandkids. I physically cannot see them.”
In reaching a plea deal with Anjema, the college of physicians agreed to withdraw an allegation that Anjema was incompetent in his care.
This is the first time Anjema has been formally disciplined by the regulator, though the disciplinary panel heard that the regulator had repeatedly flagged concerns with the doctor’s practice for several years.
“The committee is profoundly disappointed that despite the fact that concerns with your practice were first raised in 2013, and you were given the opportunity to remediate, this committee has today found that you have engaged in acts of professional misconduct,” Giroux, chair of the panel, told Anjema.
Anjema’s lawyer told the panel that since 2018 the doctor has voluntarily sought out educational courses to improve his record keeping, patient interactions and understanding of glaucoma. Supervisors overseeing his practice while Anjema was under investigation gave favourable reviews, Perrier said.
“Anjema has used this (disciplinary) process to entirely rehabilitate himself,” Perrier said.
In the meantime, as he awaits the beginning of his suspension this summer, Anjema plans to see as many patients as possible.
“We are scheduling as many appointments as possible — including more than 600 cataract surgeries before then — to minimize any potential inconvenience for our patients,” he said in a Facebook post.
Jesse McLean is a Toronto-based investigative reporter for the Star. Reach him at [email protected]. Follow him on Twitter: @jesse_mclean
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