One of Ontario’s top-billing doctors has resigned from his position as head of ophthalmology at a Chatham hospital in the wake of a Star investigation into physicians who receive the most from the public purse.

Dr. Christopher Anjema, who was the fourth highest biller in Ontario in 2017-18, has resigned from the Chatham-Kent Health Alliance, effective July 19.

Hospital President and CEO Lori Marshall told the Star she can’t speak to why Anjema decided to leave the post, as it’s his “personal decision.”

A recent Star investigation raised questions about the frequency of an eyelid reconstruction procedure billed by Anjema.

Anjema, 51, could not be reached for comment. No one picked up the phone at the Anjema Eye Institute clinics in Chatham or Sarnia on Friday afternoon.

A statement sent to the Star from the Chatham-Kent Health Alliance reads, “We would like to extend our gratitude for his valuable contribution to this program over the years. Dr. Elizabeth Haddad, general surgeon, chief of surgery, will be acting head of Ophthalmology until a permanent appointment is made by the board of the Chatham-Kent Health Alliance.”

Read more from The Star’s Operation Transparency series:

Search the Star’s database of Ontario’s top-billing doctors

Of the 194 highest-billing doctors in Ontario, 54 are ophthalmologists. Why?

A top-billing doctor charged OHIP for doing an eye procedure more times than all other MDs combined. Another billed for 128 laser treatments in one day. The numbers have some medical experts baffled

Chatham-Kent Health Alliance is a 200-plus bed community hospital in southwestern Ontario.

As part of a continuing series examining billing data, the Star is pressing for greater transparency in a cash-strapped health care system.

Seven years of Ontario Health Insurance Plan data obtained by the Star identifies 194 doctors out of the 31,500 across the province whose annual billings — from a high of around $6.9 million to a low of $1.4 million — placed them in the Top 100 at least once between fiscal years 2011-12 and 2017-2018.

Anjema, who billed OHIP about $4.1 million in 2017-18, has been a top biller every year in the data provided by the ministry, ranking as low as sixth and as high as second. He has billed more than $31 million since 2011.

Most doctors in the province, including all those in the ministry’s Top 100, get at least some of their compensation under a fee-for-service model, one of three ways they can be paid by OHIP. (They can also earn additional money both privately and publicly.)

Under this model, doctors bill for each service they provide using a unique fee code.

This is done on the honour system.

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Ontario spent roughly $6.7 billion on fee-for-service payments to physicians in fiscal year 2017-18. The billings are not the doctors’ take-home pay and do not account for the often hefty overhead costs physicians pay for expenses such as equipment, staff salaries and rent. These costs come out of their billings.

A Star investigation found that, between 2011 and 2018, Anjema charged the province for 3,305 treatments under the fee code associated with the Tenzel flap, a surgical procedure for eyelid reconstruction, according to billing data released by the Ministry of Health and Long-Term Care.

That’s more than all the other doctors in the province combined, including the oculoplastic surgeons who specialize in these types of procedures.

“That’s more than most busy oculoplastic surgeons do in a career,” Dr. Timothy McCulley, chief of oculoplastics surgery at the renowned Johns Hopkins Wilmer Eye Institute in Baltimore, told the Star investigation into Anjema. McCulley said he performs fewer than 10 Tenzel flaps a year.

Anjema is also the subject of a current investigation by the College of Physicians and Surgeons of Ontario, the body that regulates doctors, which is examining his “standard of practice.” During this probe, he has agreed to perform cosmetic blepharoplasty (surgery sometimes referred to as eye lift or eyelid tuck) only under the guidance of a clinical supervisor acceptable to the college.

CPSO spokesperson Shae Greenfield said, to the best of his knowledge, the resignation is not connected to anything related to the college.

In 2017, in a separate case, the college gave Anjema a verbal caution on his clinical care and professionalism following a complaint from a patient. It also ordered him to complete a special continuing education and remediation program and be reassessed after six months.

According to a summary posted on the CPSO website, the patient went to a hospital emergency department a week after cataract surgery with eye pain and loss of vision. She said Anjema, the on-call ophthalmologist, did not see her in person or give her proper treatment. The next morning she saw her regular ophthalmologist who diagnosed a serious eye infection and performed immediate surgery. She was left with limited vision in the eye.

Anjema told the college’s Inquiries, Complaints and Reports Committee he met all his obligations as the ophthalmologist on-call and determined he did not need to assess the patient that night, based on information from the emergency room physician.

The committee ruled the situation required “Dr. Anjema to be far more comprehensive and careful in his review and consideration of the patient’s history and presentation, and to attend personally to assess her in a timely manner.”

It found he showed “very poor judgment” in failing to do so.

—with files from Jesse McLean, Theresa Boyle and Temur Durrani