Manitoba plastic surgeon given suspension after professional misconduct involving 3 patients

A Manitoba plastic surgeon was suspended from practising medicine for six weeks and ordered to pay more than $34,000 after he admitted to displaying a lack of skill, knowledge and judgment during a number of surgical procedures involving three patients over more than a decade. 

During a March College of Physicians and Surgeons of Manitoba disciplinary hearing, Dr. Manfred Ziesmann pleaded guilty to professional misconduct while providing care to three patients who had post-surgery complications between 2012 and 2023.

He admitted to displaying "a lack of knowledge, skill and judgment in the practice of medicine" in all three cases, according to a May 25 written decision delivered by a  three-person inquiry panel for the college.

That decision said Ziesmann's actions had a particularly negative impact on one of his patients who "has suffered significantly over the last few years" after breast implant surgery he performed on her in 2022. 

Ziesmann, who has been licensed as a plastic surgeon since 1987, began treating the woman in 2021, after an earlier surgery by another doctor left her right breast, which had an implant, larger than her left, which had no implant.

On the day of her surgery, she signed a consent indicating a larger implant would be inserted in her right breast, and a  smaller implant in the left.

However, during the surgery, Ziesmann inserted the larger implant into the left breast and the smaller implant into the right breast, according to the decision.

After the procedure, the woman experienced significant issues, but had difficulty getting followup care from Ziesmann and felt "her concerns [had] been disregarded," according to the panel's decision.

She went to a hospital emergency room and was referred to the plastic surgeon resident on call, whose consultation report said the woman had complete necrosis on her nipples, with thick, black dead tissue. 

A different surgeon removed the implants Ziesmann had put in, but "there is little doubt that she will continue to be impacted for years to come," the panel's decision said.

Ziesmann admitted to breaching the standards of medical practice after he failed to address the woman's symptoms in a timely manner, and "displaying a lack of empathy and compassion in communicating" with the patient, the decision said. 

Failed to remove patient's skin cancer

The panel also reviewed the case of a patient Ziesmann performed surgery on after who developed basal cell carcinoma — a type of skin cancer — from excessive sun damage.

She was referred to Ziesmann, who performed a procedure to remove the lesion in April 2023, the decision said. However, a pathology report noted that the part extracted didn't have a scar that had been visible in the biopsy.

The patient had a second excision in August of that year, but after both procedures, a dermatologist determined the patient still had skin cancer.  She was referred to a different surgeon for a third procedure.

Ziesmann acknowledged that he "failed to appropriately address the … pathology report which indicated that the procedure may not have been successful," the panel's decision said, and to acknowledge the importance of a "heightened degree" of care in the second procedure, "particularly given the first procedure was not successful."

He also acknowledged that he "did not document sufficient steps to identify the lesion" in August of 2023.

The panel found other gaps in Ziesmann's record-keeping from the care he provided another patient, who complained about breast augmentation surgery in 2012 that resulted in a stitch abscess — an abscess that forms due to infection of sutures.

The patient faced issues with wound healing, scarring and retained surgical drain from three other surgeries Ziesmann performed from 2014 to 2019.

Ziesmann said the patient had multiple factors that put her at higher risk for infections and delayed healing, but some of that analysis was not documented in his chart notes, he told the panel. 

Ziesmann had a professional obligation to document the conversations he had with the patient on treatment options, but failed to do so, breaching various standards of medical practice over the 10 years he treated her, the decision said. 

Under a joint recommendation between Ziesmann and the College of Physicians and Surgeons, the surgeon was given a six-week suspension, which began on March 24.

Following that, he was allowed to resume practising, but under "lengthy conditions" to maintain professional standards and public safety, the decision said. 

The doctor's practice was already subject to interim conditions at the time of the March hearing. The panel's decision said it was informed of six prior complaints in which he was "criticized and/or provided with advice or reminders" regarding obtaining informed consent from patients, his vigilance in followup care, and the accuracy and completeness of clinical documentation.

The May decision also ordered him to pay the college $34,295.70 in costs.

The joint recommendation acknowledged that Ziesmann's guilty plea spared the college from a full inquiry process, the decision said, but "acts not only as a specific deterrent to Dr. Ziesmann but also as a general deterrent in that it imposes serious punishment for serious misconduct," the decision said.