Doctor suspending 6 months and banned from prescribing ketamine, TRT after tribunal finds 'fundamental problems' in his practice

An Ontario physician is facing a six-month suspension and a permanent ban from prescribing ketamine and testosterone replacement therapy after having been found guilty of several acts of professional misconduct.Dr. Michael Hart was found by the Ontario Physicians and Surgeons Discipline Tribunal to have prescribed ketamine and testosterone replacement therapy to patients without adequate assessment. He was also found to have deficiencies in billing and record keeping and had coerced patients to not file complaints or legal action against him.Back in 2022, a patient (referred to as “Patient A” in the case documents) sought treatment from the ReadyToGo clinic, which was owned by Dr. Hart. She had been interested in the use of psychedelics for managing anxiety and depression, but before her first appointment with Dr. Hart, she was required to sign a document that had the following statement:“I agree not to take any legal action against the assessing physician, the Readytogo Clinic, or to make a complaint of any kind to the College of Physicians and Surgeons in Ontario. [sic]”Patient A had a phone consultation with Dr. Hart and received a prescription for oral ketamine. When she took the initial dose, she said she experienced severe adverse effects, such as loss of balance, slurred speech, weakness, increased heart rate and dissociation—describing the experience as “horrific” and “scary.”During her initial consultation, Dr. Hart incorrectly told her that oral ketamine “differs significantly” from intravenous ketamine, and that she wouldn’t feel any effects—even advising that she could even take the medication and drive a car within an hour. He had also failed to provide any instructions for managing adverse effects and did not recommend any safeguards.Another patient (referred to as “Patient B”) who was treated over the phone between 2020 and 2021, was referred to Dr. Hart by a therapist for a prescription for ketamine-assisted psychotherapy (KAP) to treat depression.However, according to his notes of her intake appointment, Dr. Hart never documented assessing her suicidality, substance use, trauma history, psychosis, bipolar risk or past psychiatric history. Dr. Hart also failed to document any mental status examination, medical history, physical examination, vital signs, weight or cardiovascular assessment, but nonetheless prescribed her four capsules of ketamine to be taken prior to psychotherapy sessions.After six months, Dr. Hart noted that KAP showed improvements during sessions, but had not produced sustained benefit and upped the dosage. At the same time, the patient had been taking a medication known to increase the effects of ketamine, but Dr. Hart did not address this interaction.Four months later, Patient B once again reported that the benefits of KAP weren’t sustaining and reportedly expressed interest in unsupervised ketamine use at home. Dr. Hart did not document any discussion or assessment of addiction or dependence risk.During this phone appointment, Dr. Hart had also yelled at the patient and threatened to terminate the appointment, upset that she was taking the call from her car.Similar to Patient A, Patient B was required at intake to sign a document agreeing not to take any legal action or file a CPSO complaint. Patient B’s document also included this statement:“Please do not interrupt Dr. Hart or GrowWise Health Educators during your appointment. Interruptions are not tolerated, and your appointment will be immediately terminated.”Dr. Jinous Hamidi, a psychiatrist who served as an independent expert witness, reviewed Dr. Hart’s notes and found numerous deficiencies in his practice. For Patient A, he failed to properly assess her, offer a detailed risk-benefit discussion, select the proper dosages supported by clinical markers and adequately follow up.Similarly for Patient B, Dr. Hamidi concluded Dr. Hart failed to conduct a proper psychiatric assessment, thoroughly document the patient’s mental health history or explore differential diagnoses. He also had “a lack of diligence and expertise required for the complex and specialized work of KAP.” Many of these deficiencies and more were also present in 18 further patient charts reviewed by Dr. Hamidi.Further issues, including with OHIP billing, prompted a second review of Dr. Hart’s charts. Out of the 16 charts included in the review, a reviewer appointed by the CPSO found numerous practice concerns, including a lack of cumulative patient profiles or demographic info, no physical exam findings, no urine drug screens for cannabis patients, missing details in cannabis prescriptions, off-label use of drugs without consent, testing without indication, and a lack of follow-up after concerning test results.The reviewer also found issues with Dr. Hart’s prescription of testosterone replacement therapy (TRT). In several cases, he found that TRT was prescribed without indication, or when contraindicated. Dr. Hart also frequently prescribed TRT off-label and without specialist oversight, and the reviewer concluded patients were “exposed or likely exposed to harm.”On the issues regarding OHIP billing, all but one of the charts were missing start/stop times for time-based codes. There were also codes requiring in-person visits billed without indication of an in-person visit, mental health billing unsupported by documentation and urine drug screens billed but not present in the records.Based on the reviews of his charts, the Ontario Physicians and Surgeons Discipline Tribunal concluded Dr. Hart failed to maintain the standards of practice and said his failures show a “serious or persistent disregard for one’s professional obligations.”“What is more, it was disgraceful, dishonourable and unprofessional to ask clients to sign a document promising not to take legal action against him or make a complaint to the College and to discourage Patient A from complaining to the College,” the tribunal wrote.The “breadth” of Dr. Hart’s misconduct made this case particularly serious, the tribunal noted.“This was not a lapse or gap in one area; there are fundamental problems with Dr. Hart’s approach to the practice of medicine.”The tribunal also noted that Dr. Hart had been cautioned by the college eight times between 2016 and 2023, and that many of the same issues in this case were present in the previous cautions, such as record keeping, appropriate monitoring and dependence producing substances. The college has also previously ordered him to undergo clinical supervision, assessment by a college-appointed assessor, and complete an ethics course.In addition to the suspension and the ban on prescribing TRT and ketamine, Dr. Hart has been ordered by the tribunal to undergo another period of clinical supervision for a minimum of six months, as well as a one-on-one individualized instruction in medical professionalism and ethics, and monitoring. He will also be required to pay $6,000 in costs to the college.“The practice of medicine is a privilege. Future instances of misconduct may result in a more serious sanction,” the tribunal said in its reprimand to Dr. Hart. “We expect that you will reflect and learn from this disciplinary process and the further terms and conditions that we have ordered, and when you return to the practice of medicine you will do so in a manner that upholds the highest ethical and practice standards, ensuring that the trust patients place in you is well earned.”

Doctor suspending 6 months and banned from prescribing ketamine, TRT after tribunal finds 'fundamental problems' in his practice

Register for free access or login.

Related Topics