A discipline panel of the College of Dental Surgeons of BC (CDSBC) has found that Dr. Bobby Rishiraj administered deep sedation to a patient (HZ) when neither he nor the facility were authorized to do so, and without complying with CDSBC’s guidelines for deep sedation; ran his practice to promote “efficiencies” by treating as many patients in as short a time as possible; failed to recognize HZ’s cardiac arrest in a timely way and delayed resuscitative measures as a result; and failed to adequately monitor his patients while they were under sedation.

The discipline panel concluded that Dr. Rishiraj’s failure to adequately monitor his patients and to recognize HZ’s cardiac arrest could be characterized as incompetent practice.
The discipline panel`s summary posted on the CDSBC website said that Dr. Rishiraj is registered with the college as a certified specialist in oral and maxillofacial surgery. He operated a private dental facility in Kamloops, known as the Kamloops Oral Surgery and Implant Centre, and was approved to provide moderate sedation at his clinic.
The reported noted: “In November 2012, a patient, HZ, attended his clinic to have her wisdom teeth removed. During the procedure, HZ went into cardiac arrest and subsequently sustained a severe brain injury. Dr. Rishiraj filed a critical incident report with CDSBC as is required when an adverse event happens in a dentist’s office, or immediately after treatment.
“Following an investigation by CDSBC, the Inquiry Committee (which oversees investigations) directed that a citation be issued against Dr. Rishiraj. The citation included a number of allegations against Dr. Rishiraj.”

(A citation is a formal document that lists the allegations against the registrant and provides notice that there will be a hearing before the discipline committee.)

A hearing into the allegations contained in the citation took place from November 12-14, 2014, and January 26-30, 2015, in Vancouver. Dr. Rishiraj attended the hearing.
Dr. Rishiraj admitted to some of the allegations against him, including that he committed professional misconduct or unprofessional conduct by: providing deep sedation at his facility, when it was not approved as a deep sedation facility and he was not approved to provide deep sedation to patients; and not operating the facility in compliance with CDBSC’s sedation and general anaesthetic standards, according to the summary.

The discipline panel considered evidence and submissions, including testimony and reports from two expert witnesses on those allegations in the citation not admitted to by Dr. Rishiraj at the outset of the hearing. It issued its decision on June 23.
The discipline panel will hold a penalty hearing for Dr. Rishiraj. The hearing date and location will be published on the website when it has been set. The panel’s penalty decision will be posted when it becomes available.

In a note to the public, the college wrote: “Pending the outcome of the penalty phase of the hearing, Dr. Rishiraj continues to practise as an oral surgeon in Kamloops. From the time CDSBC first became aware of the HZ incident, CDSBC took steps to ensure protection of the public by imposing limits and conditions on Dr. Rishiraj’s practice. He is not entitled to administer anaesthesia beyond moderate sedation using only one class of agent (benzodiazepenes) and was required to hire additional expert staff and to change protocols and procedures in his office.Dr. Rishiraj has cooperated fully with CDSBC.”