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Social Sharing A Manitoba doctor can no longer perform a number of surgical procedures by himself, after he pleaded guilty to several professional charges related to four patients — including an incident where he tried to assess a patient for a bowel injury through a perforation he'd made in her uterus. Dr. Zakaria Mohammad Abdullah Al-Moumen, who specializes in obstetrics and gynecology, pleaded guilty to charges including professional misconduct and displaying a lack of skill, knowledge and judgment in the practice of medicine, the College of Physicians and Surgeons of Manitoba said in a recently released discipline decision. Those charges were related to four patients he operated on over several years beginning in 2020, according to a June 30 decision delivered by a three-person inquiry panel for the college, which regulates the medical profession in Manitoba. The patient who experienced the bowel injury went for surgery with Al-Moumen in August 2022 to remove pieces of fibroid and part of her endometrial cavity. But the procedure was complicated by a bowel injury after a uterine perforation, the decision said. Al-Moume noted that "blunt uterine perforation," but did not find any other signs of injury and finished the surgical procedure, it said. The college's decision said the doctor didn't meet the expected standard of care, after he attempted to assess the patient for a bowel injury with laparoscopy — involving the insertion of a tube — through the perforation. An external consultant retained by the college also found "several deficiencies" in the doctor's care including "a lack of adequate attention to address a possible bowel injury." In the consultant's opinion, quoted in the college's decision, it was not also reasonable for the patient to be discharged when she was. At the very minimum, it said, she should have been admitted overnight and monitored. "With a known complication, Dr. Al-Moumen should be on alert for the specific risks of perforation with an electric instrument," the consultant said. The patient later returned in severe pain to hospital, where doctors found she had peritonitis, the decision said. She needed emergency surgery, which included a part of her bowel being removed and the remaining colon getting redirected to a colostomy — an opening in the abdomen that allows waste to exit the body. Inadequate documentation Al-Moumen acknowledged he could have better documented information on the patient's record, the college's decision said. The decision said the doctor's documentation in the case didn't meet the expected standard, and noted proper documentation is "key" when there are surgical complications — and not having it can lead to more issues for other medical providers. "An adequate patient record is essential to proper patient care," the college's decision said. "Where a record is inadequate, it puts into doubt appropriate care was provided or that risks were adequately discussed with a patient." According to the decision, the doctor also failed to document information in the records of three other patients he treated. One of them underwent surgery in July 2020 for a high-grade squamous intraepithelial lesion, an abnormal growth of cells that can progress to cancer. During the procedure, the doctor's scalpel cut through the cervix, the decision said. The patient told the college she was not informed about the complication, and the college's decision said the doctor relied on clinical observation to determine if there was a bowel injury — but that relies on the patient being aware of the concern and the symptoms that could arise. The college found no documentation in the patient record that Al-Moumen disclosed the complication to the patient, even though the doctor said he did. There was also a lack of documentation on the operating report of a patient who developed a tissue infection after Al-Moume operated on them in October 2022. Concerns were raised related to the use of a drain that was placed near that patient's buttock, the decision said. A consultant retained by the college determined they could not say if the doctor did the procedure in accordance with expected standards, because the report lacked precise details. Similarly, the record completed by the doctor for another patient he treated was "less than satisfactory" and did not meet the standard of care, the decision said. 'Restorative' joint recommendation Under a joint recommendation reached between Al-Moumen and the college, the surgeon will now have restrictions on his practice that limit the procedures he can perform without another surgeon involved. He is also required to take remedial education and to pay the college for costs related to the investigation, the inquiry and monitoring his compliance. The joint recommendation, accepted by the college panel overseeing the case, is described in the decision as being "restorative" and intended to address and correct the issues that led to the charges. "The approach allows for Dr. Al-Moumen to continue to provide needed medical services while ensuring protection of the public," the decision said. "It should not be seen as a lesser penalty as it does not include a suspension of Dr. Al-Moumen's practice."
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