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February 2018

Editor's Note: Revisionist Patient History
By Lee DeOrio
For The Record
Vol. 30 No. 2 P. 3

A recent case in Regina, Canada, struck me as particularly worrisome. According to the Regina Leader-Post, a local doctor was suspended for a month and fined by the College of Physicians and Surgeons of Saskatchewan after admitting she altered a chart numerous times over eight months following a patient's death.

First thought: Only a month? Judging by the details of the case, it seems apparent that the physician, Svitlana Cheshenchuk, MD, was concerned that her documentation did not present her in a favorable light, especially given the fact that the patient died. To receive a one-month suspension for such callous behavior is baffling. The fine amounted to $7,484 (less than $6,000 US) to cover the costs of the investigation. Big deal.

The accounts from Canadian news outlets leave many unanswered questions. What indeed were her motives? Was she concerned that her actions led, either directly or indirectly, to the patient's death?

On the day the patient died, Cheshenchuk altered S.H.'s (how he or she was referred to in the hearing) medical record, adding "suggested to go to ER, was reluctant to do ECG and go to ER, stated, 'It's bronchitis, I know.'"

A couple of days later, the medical record was altered to include reference to the doctor explaining the patient's ECG was abnormal, that the patient was irritated by the advice given, and that medications were being taken.

Over the next eight months, Cheshenchuk would further edit S.H.'s medical record, including adding that the patient did not want to listen to any suggestions, giving a new diagnosis, and changing blood pressure readings—twice.

If that wasn't enough, Cheshenchuk's office initially told the College of Physicians and Surgeons of Saskatchewan the records weren't altered in a substantive way. So on top of the liberal editing of S.H.'s medical record, Cheshenchuk blatantly lied to a professional organization.

In spite of the facts, Cheshenchuk's penalty amounted to, well, not enough. Trust is arguably the most important component in the physician-patient relationship. To say it's been broken here is an understatement. To maintain the integrity of the interactions between physicians and patients, the organizations that oversee physician behavior must come down hard on those who break that bond, especially in such callous fashion.

I hope the Canadian authorities investigate whether Cheshenchuk altered other patients' records. Were there audit logs in place? If so, it makes Cheshenchuk's behavior even more brazen.

While this occurred in Canada, it's a universal concern—abhorrent behavior deserving of harsh punishment.