A prominent cardiologist once described as the highest paid in Ontario is facing a disciplinary hearing over allegations that he, among other things, over-tested patients and over-billed OHIP.

Dr. Bill Hughes, past president of the Ontario Association of Cardiologists, has been charged with professional misconduct.

Some 75 per cent of diagnostic tests that the Peterborough doctor billed the province’s health insurance plan were “inappropriate,” Louis Sokolov, a prosecutor for the College of Physicians and Surgeons of Ontario, said Tuesday during a hearing before a five-person panel.

He was citing the conclusions of a report from Victoria, B.C., cardiologist Dr. Dave Massel, who was commissioned by the college to review Hughes’ practice.

While Sokolov won’t lay out his case against Hughes until Wednesday, glimpses of it were offered during arguments over whether Massel should be permitted to testify as an expert witness.

In an unusual move, Hughes’ lawyer, Anne Spafford, argued against Massel, claiming he was not objective or impartial.

Spafford argued that Massel had revealed bias in a 2013 telephone conversation with a college investigator, telling him that Hughes’ practice was “outrageous” and that he was “ripping off the system,” according to the investigator’s notes.

Massel told the panel he couldn’t recall making the remarks and insisted he was open-minded in his review.

Sokolov said that even if Massel had made the remarks, they were based on thousands of pages of documents he had analyzed in producing the first of five reports on the case.

It’s ultimately up to the disciplinary panel to decide whether Hughes over-tested patients, but if Massel is correct in concluding that 75 per cent of testing was inappropriate, Sokolov said, “that is outrageous.”

“It’s not surprising someone would use colourful words,” he added.

Spafford argued that Massel overstepped his bounds in making findings of fact and in offering opinions on OHIP billings when he is not an expert in that field.

The panel ruled that Massel could serve as an expert witness. He will be the prosecution’s sole witness.

Hughes is a high-profile figure in Ontario medical circles. For years, he has butted heads with the province during contract talks with doctors.

He made headlines in 1996 after holding a news conference calling for a one-day doctors’ strike.

An assistant to then health minister Jim Wilson leaked to the Globe and Mail that Hughes was the “Number 1 biller” in the province. The leak itself became the story, and Wilson was forced to temporarily step down from his post, while the assistant was forced to leave his job.

The college has taken the unusual, though not unheard-of, step of having two Toronto police officers on hand during the hearing. No specific reason was given.

Additional information from Massel’s report cited Tuesday offers further insight into the case against Hughes.

Massel reviewed 25 patient files, which he described as disorganized and missing information. He said many diagnostic tests were of very poor quality.

It appears Hughes “cut corners somewhere to see as many patients as he does in one day,” Massel told the panel.

He questioned whether Hughes saw some patients, or nurses did. “I can’t say whether he did or didn’t. I can tell you, though, I can’t see 80 patients in a day,” Massel said.

There is no mention in the charts of patients being advised of the cancer risk from radiation in diagnostic testing, Massel noted.

Cardiologists should follow U.S. guidelines on diagnostic testing, Massel said, suggesting that Hughes follows the Ontario guidelines, which he described as outdated.

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One of Hughes’ patients died after he failed to appropriately diagnose her, Massel said. “Chances are she would still be alive today” if she had been properly diagnosed and then treated accordingly, he said.

Spafford pointed out that Hughes was not the only clinician involved in that patient’s care.

Spafford asked about a database Massel created to track the testing of patients, which he relied upon for his review. Massel said he lost it when his computer died two years ago.