“The outcomes demonstrate that the College will take a remedial approach,
whenever appropriate, to help physicians practise to current standards”
expected to be completed by end of year. The outcomes
of the completed investigations are on the infographic
on the facing page.
“The outcomes demonstrate that the College will take
a remedial approach, whenever appropriate, to help
physicians practise to current standards,” said Dr. Rocco
Gerace, College Registrar. “Our goal, where possible, is
to support education and continued prescribing under
supervision, where the physician’s capacity for remedia-
tion is apparent,” he said.
Investigations that arise from receipt of information
from the NMS entail seeking more information from
the prescribing physician and others in order to better
understand and evaluate the context of the prescribing.
These investigations include a review of patient charts
and interviews by an external assessor to understand
whether the physician is practising to current standards,
in the patient’s best interest. After a comprehensive
investigation has been completed, the Inquiries, Com-
plaints and Reports Committee (ICRC), which oversees
and determines the outcome of investigations, decides
the outcome from a variety of available options:
No Action
When the investigation confirms that the care provided
by the physician is appropriate, no further action will be
taken.
Examples of situations in which it is appropriate to
take no further action are:
• Patients are receiving appropriate care;
• D
osages are being tapered, when clinically indicated
to the patient’s circumstances. In some cases, physi-
cians have changed their own prescribing practices in
response to more recent evidence, or they are tapering
dosage levels initiated by other physicians.
Advice or Remedial Self-Study
Where minor issues are identified, advice will be given
to the physician to improve future practice or the physi-
cian may be required to participate in self-study with
follow-up from the College to ensure the identified
learning needs have been addressed.
If an investigation results in no action, advice, or
remedial self-study, these outcomes are not available on
the public register.
Mandated Remediation
The terms of a physician’s mandated remediation are
set out in an “undertaking”, which is a binding and
enforceable agreement between the College and the
physician. In general, undertakings set out an obligation
or restriction that a physician is giving to the Col-
lege (i.e., an agreement by the doctor to participate in
remediation; practise under clinical supervision; cease to
practise medicine; or abide by practice restrictions, such
as no longer being permitted to prescribe narcotics and
controlled drugs).
ndertakings to Complete Individualized
U
Education; Clinical Supervision; Reassessment
The majority of physicians with identified learning
needs have undertaken to participate in and suc-
cessfully complete an individualized education plan
developed by the CPSO to address the identified spe-
cific learning needs of each physician. The elements
of professional education include completion of the
University of Toronto Faculty of Medicine program
in Safer Opioid Prescribing; and may include the U
of T’s Medical Record-Keeping Course. Additionally,
a review of a number of resources (e.g., CPSO Pre-
scribing Drugs policy; 2017 Canadian Guideline for
Opioids for Chronic Non-Cancer Pain, etc.) is gener-
ally undertaken. Physicians practise under the guid-
ance of a clinical supervisor, over a graduated period
of time, who oversees completion of the educational
plan. The level of supervision is reduced to the next
phase only when recommended by the clinical su-
ISSUE 3, 2017 DIALOGUE
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