Toronto police identify 36-year-old man fatally stabbed in east end
A large police presence can be seen in the Danforth area after a man in his 20s was stabbed and later died in hospital. Janice Golding has the details.
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Plastic surgeon's 6-week suspension for professional misconduct 'slap on the wrist': former patient
Social Sharing A Manitoba woman who was injured by a plastic surgeon more than a decade ago is worried after the doctor was temporarily suspended for medical errors — and she wants the disciplinary system to change to protect others. For six years, Melanie Drain lived with the end of a drainage tube inside her breast. She says the piece of equipment broke off when her plastic surgeon, Dr. Manfred Ziesmann, yanked the tube days after he performed a breast reduction surgery on her in 2010. Drain, who lives in Stony Mountain, Man., complained to the College of Physicians and Surgeons of Manitoba. In 2017, Ziesmann was reprimanded and ordered to take a record-keeping course, with the college determining he had failed to include enough information in her medical record, she said. At the time, she felt the decision didn't go far enough and feared more patients would be injured. When Ziesmann, who has been licensed as a plastic surgeon since 1987, was disciplined earlier this year for professional misconduct in connection with three other patients he treated after her, Drain felt her fears were confirmed. "If the College of Physicians and Surgeons had done something more in 2017, this might have saved other people from going through any type of physical harm [like] I had from him," she told CBC News. During a March disciplinary hearing, Ziesmann admitted to displaying "a lack of knowledge, skill and judgment in the practice of medicine" in all three cases, involving surgical procedures for three patients from 2012 to 2023. Under a joint recommendation with the college, he was given a six-week suspension, which began on March 24. He was also ordered to pay the college more than $34,000 in costs. That suspension is a "slap on the wrist" considering the number of complaints involving Ziesmann, which go back decades, said Drain. Gaps in record-keeping Drain appealed the college's decision in her case in 2019, but the regulatory body dismissed it. In a letter shared with CBC, the college said there were no errors in the investigation. The appeal panel also found the doctor didn't show unethical behaviour or professional misconduct in her case, and the breakage of the tube is a known surgical complication. Ziesmann's participation in the record-keeping course offered reassurance to the panel, the letter said. However, the college's latest decision says he admitted to not adhering to the standard of documentation set out by the college. One of Ziesmann's patients signed a consent indicating a larger breast implant would be inserted in her right breast, and a smaller implant in the left — even though the right breast, which already had an implant, was larger than the left. However, the decision said there was no discussion about implant size in his chart notes for meetings with the patient in 2021 and 2022. During the surgery, Ziesmann inserted the larger implant into the left breast and the smaller implant into the right breast, "contrary to the consent form," according to the decision. Ziesmann also admitted he didn't document "sufficient steps" involving the identification of a lesion on another patient, who had developed skin cancer, in 2023, the decision said. Gaps in Ziesmann's record-keeping were also found in the care he provided another patient, who complained about breast augmentation surgery and other procedures between 2012 and 2022. In its decision, the inquiry panel said Ziesmann had a professional obligation to document the conversations he had with that patient on treatment options but failed to do so, breaching various standards of medical practice over the 10 years he treated her. Drain said the similarities between her case and those referred to in the regulator's most recent disciplinary action are concerning. "A person shouldn't be allowed to keep repeating history over and over and over," she said. Ziesmann's lawyer said he would not comment on any specific patient or allegations, except to say that all surgeries carry the risk of many types of complications. "It would be premature and perhaps erroneous to come to any conclusion about any patient complaint without a full and complete understanding of all of the facts and medical issues involved," lawyer Gregory Fleetwood said in an emailed statement. 'College has to prove itself trustworthy': prof While Ziesmann's case points to a number of serious medical mistakes, Arthur Schafer, a professor at the University of Manitoba specializing in bioethics, said it is hard for outside parties to determine whether the college's judgment on a doctor was strong enough. College panels review a great deal of evidence to determine disciplinary action, some of which is not publicly released, so it can be difficult to know how they came to a decision, said Schafer. In this case, he thinks the college did take steps to safeguard the public, referencing both interim conditions Ziesmann was under before the college's March decision — including that he be monitored during surgeries while the college investigated — and the final decision to temporarily suspend him. "That's pretty rigorous," Schafer said. "He will be more carefully monitored than maybe any other physician in the province." But Schafer — who was a patient of Ziesmann's many years ago — said in general, the public should be concerned when physicians repeatedly make mistakes, because it suggests a lack of monitoring. He also said generally, the reason a doctor's licence might not have been revoked is because the college's panel thinks their behaviour can be corrected while protecting the public. "One has to hope that the performance of the college will be more rigorous going forward than perhaps what it has been up until now" in Ziesmann's case, said Schafer, noting it involves repeated mistakes with patient note-taking — a task that is paramount in medical practice, especially as patients are treated by different people. "If the patient's medical record isn't accurate and complete, then discovering what's gone wrong, correcting it, becomes that much more difficult," he said. The disciplinary panel in Ziesmann's March hearing also highlighted the importance of patient record-keeping, citing a decision from Manitoba's highest court that record-keeping is not merely administrative, but part of "proper medical practice and patient care." Schafer said the college's first priority should be to protect public safety, and cases where doctors repeat errors, despite being disciplined, can erode public trust. "The college has to prove itself trustworthy," he said. Patient safety, recovery support Dr. Guillaume Poliquin, an assistant registrar for the College of Physicians and Surgeons of Manitoba, said for privacy reasons, the regulatory body can't comment on the specifics of Ziesmann's case. He said the college is improving its monitoring of doctors who have been disciplined, but wouldn't go into more specifics, saying it's dependent on individual cases. Poliquin also said the college is also undergoing "significant changes" in how complaints about doctors are handled to ensure Manitoba patients are protected. The college is also working to identify doctors who are struggling earlier in their careers, and help them improve their practice, leaving more severe disciplinary actions as a last resort, said Poliquin. "Early intervention is what leads to ongoing success," he said. Serious allegations against doctors can also lead to legal action — as happened in Drain's case. Dissatisfied with the college's decision on Ziesmann, she decided to sue him. The Manitoba Court of King's Bench sided with her in 2023, with the judge ruling Ziesmann had breached the expected standard of care. It's not rare for a patient dissatisfied with a regulator's decision to pursue legal action, but it is rare that they win, said Jacob Shelley, an associate law professor who teaches health-care policy at Western University in London, Ont. In court, the threshold of medical negligence is hard to establish, he said. "[The doctors] are the ones in the room the entire time. They are the ones with the expertise. And so it's a really big hurdle for patients to actually be able to seek compensation," Shelley said. He believes an overarching change is needed to how patients' complaints are treated in Canada, with a stronger focus on patient safety. In cases like Ziesmann's, regulators should consider moving away from the "patient versus physician" model to one where the injured patient is more supported, he said. "We should talk about responsibility. We should talk about adequate training, and making sure people are competent and can meet the standard of care," said Shelley. "These are not easy problems to resolve. But what we do know is that patients suffer more as a result."
