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Garcia, Yelian

CPSO#: 88666

MEMBER STATUS
Revoked: Discipline Committee as of 24 Jan 2020
CPSO REGISTRATION CLASS
None as of 24 Jan 2020

Summary

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Former Name: No Former Name

Gender: Male

Languages Spoken: English, Spanish

Education:Saba University School of Medicine, 2008

Practice Information

Primary Location of Practice
Practice Address Not Available

Professional Corporation Information


Corporation Name: Dr. Yelian Garcia Medicine Professional Corporation
Certificate of Authorization Status: Inactive: Nov 5 2018

Medical Records Location

Address: Yorkdale Clinic 11685 Yonge St Richmond Hill ON L4E 0K7
Date Received: 06 Dec 2018

Specialties

Specialty Issued On Type
No Speciality Reported

Postgraduate Training

Please note: This information may not be a complete record of postgraduate training.



McMaster University, 01 Jul 2008 to 23 Sep 2008
Assessment Verification Period - Orthopedic Surgery

McMaster University, 24 Sep 2008 to 30 Jun 2009
PostGrad Yr 1 - Orthopedic Surgery

McMaster University, 01 Jul 2009 to 31 Jul 2009
PostGrad Yr 2 - Orthopedic Surgery

McMaster University, 01 Aug 2009 to 31 May 2010
PostGrad Yr 1 - Family Medicine

McMaster University, 01 Jun 2010 to 31 May 2011
PostGrad Yr 2 - Family Medicine

Registration History

Action Issue Date
First certificate of registration issued: Pre Entry Assessment Program Certificate Effective: 01 Jul 2008
Transfer of class of registration to: Postgraduate Education Certificate Effective: 24 Sep 2008
Expired: Terms and conditions of certificate of registration Expiry: 31 May 2011
Subsequent certificate of registration issued: Restricted certificate Effective: 18 Aug 2011
Expired: Terms and conditions imposed on certificate by Registration Committee Effective: 12 Jan 2012
Subsequent certificate of registration Issued: Independent Practice Certificate Effective: 12 Jan 2012
Transfer of class of certificate to: Restricted certificate Effective: 07 Oct 2015
Terms and conditions imposed on certificate Effective: 07 Oct 2015
Terms and conditions amended by Discipline Committee Effective: 24 Jan 2018
Suspension of registration imposed: Discipline Committee Effective: 07 Feb 2018
Suspension of registration removed Effective: 07 Oct 2018
Terms and conditions amended by Discipline Committee Effective: 07 Oct 2018
Expired: Resigned from membership. Expiry: 05 Dec 2018
Revoked: Discipline Committee. Effective: 24 Jan 2020

Previous Hearings

Committee: Discipline
Decision Date: 24 Jan 2020
Summary:

On January 24, 2020, on the basis of uncontested facts and a plea of no contest, the Discipline 
Committee (the “Committee”) of the College of Physicians and Surgeons of Ontario found that 
Dr. Yelian Garcia committed an act of professional misconduct, and set out its penalty and 
costs order with written reasons to follow.  

FACTS 

Dr. Garcia is a 38-year-old former family physician. He received his certificate authorizing 
independent practice in 2012 and practiced in the Greater Toronto Area. Dr. Garcia resigned 
his membership on December 5, 2018. 

On February 15, 2017, in a previous discipline hearing, the Committee found that Dr. Garcia had 
committed an act of professional misconduct in that he failed to maintain the standard of 
practice of the profession and engaged in disgraceful, dishonourable or unprofessional 
conduct. A penalty hearing was scheduled to commence October 10, 2017. 

In preparation for his penalty hearing, Dr. Garcia retained an expert to provide an opinion 
regarding his current standard of practice. 

On September 9, 2017, the expert requested the charts of 12 patients in order to complete her 
report. She identified these patients by name, based on a list of patients provided to her by 
counsel for Dr. Garcia. One of the patients whose chart the expert requested was Patient A. 
Patient A was a resident at a long-term care facility where Dr. Garcia worked. 

Counsel for Dr. Garcia responded to the expert by email, also on September 9, 2017, indicating 
 that the chart of Patient A was not readily available as she had left the retirement home. He 
 invited the expert to select a replacement chart, but did not receive a response. 

 Alteration of Patient Charts 

 On September 10, 2017, Dr. Garcia attended the long-term care facility, despite not being 
scheduled to work that day. He arrived at 8 am and was let into the nursing office, where the 
patient charts were located. 

Dr. Garcia requested that a nurse, Nurse X, bring him Patient A’s chart from storage. He also 
requested blank progress notes. Nurse X brought these to him. 

Dr. Garcia proceeded to alter Patient A’s chart, removing original chart entries and writing 
new progress notes for these dates. He removed and re-wrote notes for at least 16 
encounters, dating back two years. 

The altered progress notes were fabricated. For example: 

   -  The text of the altered notes was different from the original notes. The altered notes
      were more extensive and included objective physical findings that were not present in
      the original notes. This information was not present anywhere else in the chart;
   -  For at least one encounter, Dr. Garcia created a chart entry for an entirely new date,
      for which no original entry existed. No encounter had, in fact, taken place on this
      date;
    -  Dr. Garcia also destroyed at least one original entry without creating a replacement 
       note. 
  
 Dr. Garcia tore up the original chart entries and disposed of them in the trash can. After Dr. 
 Garcia left the office on September 10, Nurse X retrieved the torn-up original notes from the 
 trash and taped them back together. 
        
 On the same day, Dr. Garcia also created a fabricated encounter note for another patient, 
 Patient B. This patient was not one of the patients whose charts had been requested by Dr. 
 Garcia’s expert. 
   
 Patient B had fallen on September 4 and September 10, 2017 and was on 72-hour post-fall 
 monitoring. Dr. Garcia documented having seen this patient on September 10, which was not 
 true. His chart entry for the patient described the patient’s blood pressure as “stable per staff” 
 and that she was “steady with walker”. This was not accurate, as her blood pressure was low 
 and she was not steady (having fallen that day). 
                                         
 Provision of Altered Charts to Expert and Tendering Expert Testimony at Penalty Hearing 
  
 On September 12, 2017, counsel for Dr. Garcia emailed the expert to advise that Dr. Garcia 
 had been able to obtain the chart for Patient A (which he had previously indicated was 
unavailable). 
       
Dr. Garcia provided Patient A’s falsified chart to his expert through his legal counsel. He did 
not inform the expert that he had altered the chart before sending it to her. On the basis of 
this falsified chart, the expert prepared a report dated September 17, 2017. She concluded 
that Dr. Garcia had met the standard of practice of the profession in his care of Patient A. 
   
Dr. Garcia’s penalty hearing commenced on October 10, 2017. The hearing was contested. 
Dr. Garcia called his expert to testify on his behalf, in support of his submission that the 
penalty imposed by the Discipline Committee should be less onerous than the penalty 
sought by the College. 
   
The expert’s report was entered into evidence. She also testified in person, opining that Dr. 
Garcia had met the standard of practice of the profession in his care of Patient A. When 
she testified, the expert was unaware that her opinion was based on the review of a 
falsified patient chart. 
 
Penalty Hearing Suspended and Expert Evidence Withdrawn 
 
On October 11, 2017, midway through the penalty hearing, Nurse X contacted the College 
and advised that she had discovered Dr. Garcia tampering with patient charts. As a result of 
the information Nurse X provided about Patient A’s chart, the parties agreed that the penalty 
hearing should be adjourned. 
       
The penalty hearing resumed on January 28, 2018. On that date, counsel for Dr. Garcia 
withdrew Dr. Chapman’s evidence and requested that the Committee not rely on it. The 
parties submitted a joint proposal on penalty, whereby Dr. Garcia accepted an 8-month 
suspension. 
  
 FACTS ON PENALTY 

On February 15, 2017, the Committee previously found that Dr. Garcia had engaged in 
professional misconduct, in that he had failed to maintain the standard of practice of the 
profession and engaged in an act or omission that, having regard to all the circumstances, 
would reasonably be considered by members as disgraceful, dishonourable or unprofessional. 
On January 28, 2018, the Discipline Committee imposed a penalty including an eight-month 
 suspension and terms, conditions or limitations when Dr. Garcia returned to practice.  
  
 Following his suspension, which took effect January 28, 2018, Dr. Garcia did not return to 
 practice. On December 5, 2018, Dr. Garcia resigned his certificate of registration with the 
 College.  
  
 DISPOSITION 
  
 On January 24, 2020, the Discipline Committee ordered that: 
  
   -   The Registrar revoke Dr. Garcia's certificate of registration effective immediately. 
        
    -  Dr. Garcia pay costs to the College in the amount $6,000.00 within 30 days of the date of 
       the Order. 
        
    -  Dr. Garcia attend before the panel to be reprimanded.  
   
 At the conclusion of the hearing, Dr. Garcia (via counsel) waived his right to an appeal under 
 subsection 70(1) of the Code. The Committee administered the public reprimand in the absence 
 of Dr. Garcia, who did not attend the hearing.


Decision: Download Full Decision (PDF)
Hearing Date(s): January 24, 2020 1:00 p.m. to 4:00 p.m.

 

Committee: Discipline
Decision Date: 15 Feb 2017
Summary:

On February 15, 2017, the Discipline Committee found that Dr. Yelian Garcia committed an act 
of professional misconduct in that:  he has failed to maintain the standard of practice of the 
profession; and, he has engaged in an act or omission relevant to the practice of medicine that, 
having regard to all the circumstances, would reasonably be regarded by members as disgraceful, 
dishonourable or unprofessional. 

Failing to Maintain the Standard of Practice 

After graduating from medical school and completing a residency program through McMaster 
University, Dr. Garcia practised under a restricted certificate of registration between August 18, 
2011 and January 12, 2012. During this time, he practised family medicine under the supervision 
of a physician at Wellington Medical Centre in Aurora, and under the supervision of a second 
physician at Oak Ridges Medical and Urgent Care Centre in Richmond Hill. 

Dr. Garcia obtained his certificate of registration authorizing independent practice in January of 
2012. Dr. Garcia continued to provide family medicine and walk-in services at Wellington 
Medical Centre and urgent care services at Oak Ridges Urgent Care Centre. He also began 
providing urgent care and walk-in services at One Care Medical Clinic in Scarborough and 
Woodbridge Urgent Care Centre in Woodbridge, as well as providing medical care to patients at 
three long-term/residential care facilities. 

According to Dr. Garcia, he was seeing on average 10 to 13 patients per hour at the Wellington 
Medical Centre in 2012. Because of this, Dr. Garcia would chart pertinent information during 
patient encounters and complete 50 to 70% of his charts at the end of the day. Dr. Garcia tried to 
be as efficient as possible while ensuring an evidence-based practice. He conducted some patient 
examinations and assessments very quickly in 2012. 

There was a pharmacy located in the same premises as the Wellington Medical Centre. In the 
summer of 2012, a pharmacist at the pharmacy expressed concern about Dr. Garcia’s narcotic 
prescribing practices to both Dr. Garcia and the physician who had supervised him at Wellington 
Medical Centre (“the supervising physician”). 

In the late summer and fall of 2012, the supervising physician reviewed the charts for most of the 
approximately dozen patients to whom Dr. Garcia was prescribing narcotics or opioids at the 
Wellington Medical Centre, met with several of these patients, along with Dr. Garcia, and 
conducted an assessment of each patient’s pain and the appropriateness of the narcotics 
prescriptions given by Dr. Garcia. Following this process, several patients seen together by the 
supervising physician and Dr. Garcia were referred to a pain clinic, specialist or detoxification 
program. 

In May 2013, the supervising physician contacted the College to report his concerns about the 
medical care provided by Dr. Garcia. 

Following receipt of this information, the College began an investigation into Dr. Garcia’s 
practice. The College obtained medical records with respect to 36 patients. Review by a medical 
inspector retained by the College concluded that Dr. Garcia provided very fine medical care to 
                                   1 

some patients and that Dr. Garcia failed to maintain the standard of practice of the profession in 
his care of other patients. 

Dr. Garcia acknowledged during the College investigation that he should slow down in terms of 
the manner in which he assessed and communicated with patients. Dr. Garcia also stated that his 
practice had changed since 2012 and early 2013, and that he had tried to slow down his patient 
interactions and communicate more effectively with patients. Dr. Garcia acknowledged during 
the College investigation that he was “duped” by a couple of patients who were engaged in drug-
seeking behaviour and that he was too trusting of patients who were seeking narcotics for pain 
medication. At that time, Dr. Garcia also stated that he had learned to be less trusting of patients 
and that he no longer had patients with chronic pain in his family practice. 
 
Dr. Garcia failed to maintain the standard of practice of the profession with respect to eleven 
patients. The deficiencies noted included: 
 
-  not obtaining an adequate history or doing a proper physical examination of a patient who 
   complained of “chronic pain”; 
-  for several patients, not recording any physical examination and not recording details about 
   the source or type of pain they experienced; 
-  prescribing narcotics to pain patients without taking a proper and full history and without 
   doing any physical examination; 
-  early renewal of narcotic prescriptions without a notation in the chart to explain why the 
   medication was renewed early;  
-  regarding one patient who was given a typhoid immunization, Dr. Garcia made no notes of 
   this appointment in the chart and no record was kept of the drug identification number or lot 
   number for the vaccine given. 
-  regarding one patient, Dr. Garcia’s charting was moderately below standard. Dr. Garcia’s 
   typed note for a visit incorrectly indicated he gave the patient a typhoid shot, although his 
   handwritten note correctly indicated that he gave patient N an allergy shot on that date.  
 
The medical inspector expressed concern that Dr. Garcia’s general patient population was put at 
risk because of his willingness to prescribe narcotics and repeated inability to detect the misuse 
of opioid medication. 

Disgraceful, Dishonourable or Unprofessional Conduct 
 
The Committee also found that Dr. Garcia has engaged in an act or omission relevant to the 
practice of medicine that, having regard to all the circumstances, would reasonably be regarded 
by members as disgraceful, dishonourable or unprofessional. 
 
First, the Committee found that Dr. Garcia prescribed medications and provided a medical 
service to Ms. A, a woman who was not a patient and with whom he had a personal and romantic 
relationship. Dr. Garcia prescribed medications to Ms. A on three occasions. On one of those 
occasions, he prescribed an IUD and referred Ms. A to a gynecologist to perform the IUD 
insertion. There was no record of an assessment, including a history and physical examination, 
prior to providing any of the prescriptions. The policy statement on Treating Self and Family 
                                   2 

Members clearly states when it is permissible to treat a family member or another individual 
whom the physician has a personal or emotional involvement. As stated in the Policy: 
“Physicians should not treat either themselves or family members, except for a minor condition 
or in an emergency situation and when another qualified healthcare professional is not readily 
available.” These conditions were not present on the occasions when Dr. Garcia chose to 
prescribe medications, an IUD and provide a medical service to Ms. A. When a physician treats 
someone with whom they have a personal/emotional relationship, there is a risk that the 
relationship will affect the doctor’s ability to provide quality care. Further, as Ms. A’s romantic 
partner, Dr. Garcia placed himself in a conflict of interest by providing Ms. A with a prescription 
and a referral for insertion of an IUD for birth control. 
 
Second, during Ms. A’s hospitalization, Dr. Garcia used his professional status as a physician in 
an attempt to persuade or pressure a nurse to provide confidential information in regard to Ms. A 
without her consent, despite the fact that he, as a physician, had full knowledge that he was not 
entitled to that information.  
 
Disposition 
 
On January 24, 2018 the Committee ordered that: 
 
1. Dr. Garcia appear before the Committee to be reprimanded. 
2. the Registrar suspend Dr. Garcia’s Certificate of Registration for a period 
   of eight (8) months, to commence at 12:01 a.m. on February 7, 2018. 
3. the Registrar  impose the following terms, conditions and limitations on 
   Dr. Garcia’s Certificate of Registration:  
           
Restriction 
(a) Dr. Garcia shall have clinical interactions with no more than a total of forty-eight 
   (48) patients per day, at a rate of no more than six (6) patients per hour within each 
   hour; 
Patient Log 
(b) At each of his Practice Locations, Dr. Garcia shall maintain an up-to-date daily log of 
   every patient with whom he has a clinical interaction, which shall include the 
   patient’s name, the date, and the hour within which the clinical interaction occurred 
   (“Patient Log”). Dr. Garcia shall maintain the original Patient Log and shall send a 
   copy to the College at the end of every calendar month; 
(c) At its sole discretion, the College may require Dr. Garcia to implement other 
   measures to ensure the accuracy of the Patient Log, including but not limited to 
   requiring him to have the Patient Log reviewed and/or approved by a person or 
   persons approved by the College; 
Prescribing Log 
(d) Dr. Garcia shall keep a log of all prescriptions (the “Prescribing Log”) for: 
    (i) Narcotic Drugs (from the Narcotic Control Regulations made under the 
        Controlled Drugs and Substances Act, S.C., 1996, c. 19, as amended from time 
        to time); 
                                   3 

    (ii) Narcotic Preparations (from the Narcotic Control Regulations made under 
        the Controlled Drugs and Substances Act, S.C., 1996, c. 19, as amended from 
        time to time); 
    (iii) Controlled Drugs (from Part G of the Food and Drug Regulations under the 
        Food and Drugs Act, S.C., 1985, c. F-27, as amended from time to time);  
    (iv) Benzodiazepines and Other Targeted Substances (from the Benzodiazepines 
        and Other Targeted Substances Regulations made under the Controlled Drugs 
        and Substances Act., S.C., 1996, c. 19, as amended from time to time);  
        (A current summary of the above-named drugs [from Appendix I to the 
        Compendium of Pharmaceuticals and Specialties] is attached hereto as 
        Schedule “A”; and the current regulatory lists are attached hereto as Schedule 
        “B”) 
    (v) All other Monitored Drugs (as defined under the Narcotics Safety and 
        Awareness Act, 2010, S.O. 2010, c. 22 as noted in Schedule “C” and as 
        amended from time to time);  
(e) The Prescribing Log shall be in the form set out at Schedule “D”, which will include 
   at least the following information:   
    (i) the date of the prescription; 
    (ii) the name of the patient with chart / file number; 
    (iii) the medication, dose, direction, number of tablets to be dispensed and 
        frequency (if applicable); 
    (iv) the clinical indication for use; 
    (v) whether it is a new prescription; and  
    (vi) physician initials. 
(f) Dr. Garcia shall keep a copy of all prescriptions written for all Narcotic Drugs, 
   Narcotic Preparations, Controlled Drugs, Benzodiazepines/Other Targeted 
   Substances and all other Monitored Drugs, in the corresponding patient chart. 
Instruction in Medical Ethics 
(g) At his own expense, Dr. Garcia shall participate in and successfully complete 
   individualized instruction in ethics approved by the College, at the instructor’s 
   earliest availability. Dr. Garcia will provide proof of successful completion within 
   three (3) weeks of completing the instruction. The instruction will involve one-on-
   one sessions with a College-approved instructor, incorporating principles of guided 
   reflection, tailored feedback, and other modalities customized to the specific needs of 
   Dr. Garcia as assessed by the instructor.  The instructor will report to the College 
   regarding Dr. Garcia’s progress and compliance.  
Instruction in Maintaining Boundaries 
(h) At his own expense, Dr. Garcia shall participate in and successfully complete the 
   next available course on “Understanding Boundaries and Managing the Risks 
   Inherent in the Doctor-Patient Relationship” offered by Western University, or an 
   equivalent program acceptable to the College, and shall forthwith thereafter provide 
   proof of completion thereof to the College. 
Clinical Supervision 
(i) Prior to resuming practice following the suspension of his certificate of registration 
   described above in paragraph 2, Dr. Garcia shall retain, at his own expense, a clinical 
                                   4 

   supervisor or supervisors (the “Clinical Supervisor”) acceptable to the College, who 
   will sign an undertaking in the form attached hereto as Schedule “E”;   
(j) For a period of twelve (12) months, commencing as of the date Dr. Garcia resumes 
   practice following the suspension of his certificate of registration described above in 
   paragraph 2, Dr. Garcia may practice only under the supervision of the Clinical 
   Supervisor (“Clinical Supervision”). Clinical Supervision of Dr. Garcia’s practice 
   shall contain the following elements: 
   Chart Review: 
    i.  All charts reviewed shall be independently selected by the Clinical Supervisor 
        without the participation of Dr. Garcia. 
    Phase 1 of Chart Review 
     ii. For a minimum of two (2) months, Dr. Garcia and the Clinical Supervisor will 
        meet at least once every week to discuss the Clinical Supervisor’s review of the 
        elements set out in (v), below. 
    iii. After a minimum of two (2) months of Phase 1 of Chart Review, if the Clinical 
        Supervisor is satisfied that Dr. Garcia has the necessary knowledge, skills and 
        judgment to practice in a less highly supervised environment, the Clinical 
        Supervisor may recommend to the College that the chart review component of 
        supervision be reduced. 
    Phase 2 of Chart Review 
     iv. Upon the recommendation of the Clinical Supervisor and approval of the 
        College, the chart review component of clinical supervision will be reduced. 
        Dr. Garcia and the Clinical Supervisor will continue to meet at least once every 
        month to discuss the Clinical Supervisor’s review of the elements set out in (v) 
        below. 
    Elements of Chart Review 
     v. At each meeting described in (ii) and (iv) above, Dr. Garcia and the Clinical 
        Supervisor will discuss the Clinical Supervisor’s review of: 
          (a) The Prescribing Log; 
          (b) 20 charts, selected as follows: 
          ?   5 charts selected from Dr. Garcia’s clinic practice; 
          ?   5 charts selected from Dr. Garcia’s long-term care/retirement home 
              practice; and 
          ?   10 charts of patients to whom Dr. Garcia has prescribed Narcotic 
              Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and 
              Other Targeted Substances and All other Monitored Drugs since the 
              Clinical Supervisor’s prior review; or 
          ?   If there are fewer than 10 patients listed in the Prescribing Log to whom 
              Dr. Garcia has prescribed Narcotic Drugs, Narcotic Preparations, 
              Controlled Drugs, Benzodiazepines and Other Targeted Substances and 
              All other Monitored Drugs since the Clinical Supervisor’s prior review, 
              then the charts of all patients listed in the Prescribing Log and 
              additional charts selected from both Dr. Garcia’s clinic and long-term 
              care/retirement home practices, resulting in a total of 10 charts. 
          (c) The chart of every patient to whom Dr. Garcia has issued a new 
              prescription for a Narcotic Drug, Narcotic Preparation, Controlled 
                                5 

           Drug, Benzodiazepine and Other Targeted Substance or other 
           Monitored Drug since the Supervisor’s prior review. 
 Direct Observation 
 Phase 1 of Direct Observation 
  vi. For a minimum of one (1) month, the Clinical Supervisor shall directly observe 
     Dr. Garcia in practice for ½ day (3.5 hours) at least once per week; 
 vii. During Phase 1 of Direct Observation, the Clinical Supervisor’s observation of 
     Dr. Garcia’s practice shall rotate between Dr. Garcia’s clinical practice and his 
     long-term care/retirement home practice; 
viii. For greater clarity, during Phase 1 of Direct Observation, the Clinical 
     Supervisor shall observe Dr. Garcia in practice at least twice in his clinic 
     setting and at least twice in his long-term care/retirement home practice; 
  ix. After a minimum of one (1) month of Phase 1 of Direct Observation, if the 
     Clinical Supervisor is satisfied that Dr. Garcia has the necessary knowledge, 
     skills and judgment to practice in a less highly supervised environment, the 
     Clinical Supervisor may recommend to the College that the direct observation 
     component of supervision be reduced; 
 Phase 2 of Direct Observation 
  x. Upon the recommendation of the Clinical Supervisor and approval of the 
     College, the direct observation component of Clinical Supervision will be 
     reduced and will take place on the following terms: For a minimum of two (2) 
     months, the Clinical Supervisor shall directly observe Dr. Garcia in practice for 
     ½ day (3.5 hours) at least once per month in Dr. Garcia’s clinic practice and at 
     least once per month in his long-term care/retirement home practice; 
  xi. After a minimum of two (2) months of Phase 2 of Direct Observation, if the 
     Clinical Supervisor is satisfied that Dr. Garcia has the necessary knowledge, 
     skills and judgment to practice in a less highly supervised environment, the 
     Clinical Supervisor may recommend to the College that the direct observation 
     component of supervision be reduced; 
 Phase 3 of Direct Observation 
 xii. Upon the recommendation of the Clinical Supervisor and approval of the 
     College, the direct observation component of Clinical Supervision will be 
     reduced and will take place on the following terms: For the remainder of the 
     Clinical Supervision, the Clinical Supervisor shall directly observe Dr. Garcia 
     in practice for ½ day (3.5 hours) at least once every three (3) months in Dr. 
     Garcia’s clinic practice and at least once every three (3) months in his long-
     term care/retirement home practice; 
 Meetings 
xiii. As set out above in (ii) and (iv), Dr. Garcia and the Clinical Supervisor will 
     meet at least once every week, for a minimum of two (2) months, and at least 
     once every month thereafter. In addition to the elements of chart review 
     described above, meetings will include the following: 
     (a) Prior to meeting with the Clinical Supervisor, Dr. Garcia shall provide the 
        Clinical Supervisor with the audit trail for each patient whose chart is to be 
        reviewed at that meeting, if the chart is maintained in an Electronic 
        Medical Record; 
                                   6 

        (b) The Clinical Supervisor shall discuss with Dr. Garcia any concerns the 
           Supervisor may have arising from the direct observations or review of 
           charts, Prescribing Log or audit trail; 
        (c) The Clinical Supervisor shall make recommendations to Dr. Garcia for 
           practice improvements and shall follow up on same; 
        (d) The Clinical Supervisor shall make recommendations to Dr. Garcia for 
           ongoing professional development and inquire of Dr. Garcia to determine 
           compliance with same;  
        (e) Dr. Garcia shall review and discuss with the Clinical Supervisor the 
           educational resources and College policies set out below in section (k); 
           and 
        (f) Any other activities which the Clinical Supervisor deems necessary to Dr. 
           Garcia’s Clinical Supervision. 
  Reporting 
  xiv. The Clinical Supervisor will keep a log of all patient charts reviewed along with 
       patient identifiers; and 
   xv. The Clinical Supervisor will provide reports to the College: 
        (a) At least once every two (2) weeks for the first two (2) months; 
        (b) If the Clinical Supervisor so recommends and subject to the approval of 
           the College, at least once every month thereafter; or  
        (c) More frequently if the Clinical Supervisor has concerns about Dr. Garcia’s 
           standard of practice or conduct. 
(k) Dr. Garcia will review and discuss with his Supervisor the following resources: 
    i. CPSO Policy “Prescribing Drugs”: http://www.cpso.on.ca/Policies-
       Publications/Policy/Prescribing-Drugs; 
   ii. 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain: 
       http://nationalpaincentre.mcmaster.ca/guidelines.html; 
   iii. CMPA advice regarding preventing the misuse of opioids: https://www.cmpa-
       acpm.ca/en/advice-publications/browse-articles/2015/preventing-the-misuse-of-
       opioids; 
   iv. the Centre for Effective Practice Management of Chronic Non-Cancer Pain 
       Tool: https://thewellhealth.ca/cncp 
    v. CPSO Policy “Medical Records”:  http://www.cpso.on.ca/Policies-
       Publications/Policy/Medical-Records;  
   vi. CPSO Policy “Maintaining Appropriate Boundaries”: 
       http://www.cpso.on.ca/Policies-Publications/Policy/Maintaining-Appropriate-
       Boundaries-and-Preventing 
(l) Dr. Garcia shall abide by the recommendations of the Clinical Supervisor; 
(m) If a Clinical Supervisor who has given an undertaking as set out in Schedule “E” to 
   this Order is unable or unwilling to continue to fulfill its terms, Dr. Garcia shall, 
   within twenty (20) days of receiving notice of same, obtain an executed undertaking 
   in the same form from a person who is acceptable to the College and ensure that it is 
   delivered to the College within that time; 
(n) If Dr. Garcia is unable to obtain a Clinical Supervisor in accordance with this Order, 
   he shall cease to practice until such time as he has done so; 
                                   7 

(o) Dr. Garcia shall consent to the disclosure by his Clinical Supervisor to the College, 
   and by the College to his Clinical Supervisor, of all information the Clinical 
   Supervisor or the College deems necessary or desirable in order to fulfill the Clinical 
   Supervisor’s undertaking and Dr. Garcia’s compliance with this Order; 
(p) Dr. Garcia shall consent to the Clinical Supervisor and/or the College making 
   inquiries of any staff/employees at any of his practice locations in relation to any of 
   the terms of this Order and any aspect of the Clinical Supervision, and shall consent 
   to staff/employees providing information and/or documentation to the Clinical 
   Supervisor and the College, including but not limited to information regarding Dr. 
   Garcia’s charting practices; 
Assessment   
(q) Approximately twelve (12) months after the completion of the period of supervision 
   as set out above, Dr. Garcia shall undergo an assessment of his practice (the 
   “Assessment”) by a College-appointed assessor (the “Assessor(s)”).  The Assessor(s) 
   shall report the results of the Assessment to the College; 
(r) The Assessment shall include both Dr. Garcia’s clinic and long-term care/retirement 
   home practices. The Assessment may include chart reviews, direct observation of Dr. 
   Garcia’s care, interviews with colleagues and co-workers, feedback from patients 
   and any other tools deemed necessary by the College.  Dr. Garcia shall abide by all 
   recommendations made by the Assessor(s), and the results of the Assessment will be 
   reported to the College and may form the basis of further action by the College; 
(s) Dr. Garcia shall consent to the disclosure to the Assessor(s) of the reports of the 
   Clinical Supervisor arising from the supervision, and shall consent to the sharing of 
   all information between the Clinical Supervisor, the Assessor(s) and the College, as 
   the College deems necessary or desirable;   
Other 
(t) Dr. Garcia shall comply with the College Policy on Practice Management 
   Considerations for Physicians Who Cease to Practise, Take an Extended Leave of 
   Absence or Close Their Practice Due to Relocation in respect of his period of 
   suspension, a copy of which forms Schedule “F” to this Order;  
(u) Dr. Garcia shall inform the College of each and every location where he practices, in 
   any jurisdiction (his “Practice Location(s)”) within fifteen (15) days of this Order 
   and again prior to resuming practice following the suspension of his certificate of 
   registration described above in paragraph 2, and shall inform the College of any and 
   all new Practice Locations within fifteen (15) days of commencing practice at that 
   location, until the report of the Assessment has been provided to the College; 
(v) Dr. Garcia shall co-operate  unannounced inspections of his Practice Location(s) and 
   patient charts and to any other activity the College deems necessary for the purpose 
   of monitoring and enforcing his compliance with the terms of this Order and shall 
   provide his irrevocable consent to the College to make appropriate enquiries of any 
   person or institution who may have relevant information for the purposes of 
   monitoring and enforcing his compliance with the terms of this Order;  
(w) Dr. Garcia shall consent to the College making appropriate enquiries of the Ontario 
   Health Insurance Plan, the Narcotics Monitoring System and/or any person who or 
   institution that may have relevant information, in order for the College to monitor his 
   compliance with this Order; 
                                   8 

(x) Dr. Garcia shall be responsible for any and all costs associated with implementing 
   the terms of this Order. 
 
On July 11, 2018 the Committee ordered that: 
 
   -  Dr. Garcia pay to the College costs in the amount of $49,000.00 within 45 days of 
      the date of this Order.


Decision: Download Full Decision (PDF)
Hearing Date(s): July 18 - 21, 2016, August 4 - 5, 2016; Penalty Hearing October 10 and 12, 2017, January 24, 25, 26, 2018