As from March 20, 2017, the following is imposed as a term, condition and
limitation on the certificate of registration held by Dr. Leanne Astawan, in
accordance with an undertaking and consent given by Dr. Astawan to the College
of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")
of
DR. LEANNE ASTAWAN
("Dr. Astawan")
to
COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
(the "College")
A. PREAMBLE
(1) In this Undertaking:
"Code" means the Health Professions Procedural Code, which is Schedule 2
to the Regulated Health Professions Act, 1991, S.O. 1991, c. 18, as
amended;
"ICR Committee" means the Inquiries, Complaints and Reports Committee of
the College;
"OHIP" means the Ontario Health Insurance Plan;
"Public Register" means the College's register that is available to the
public.
(2) I, Dr. Astawan, certificate of registration number 80212, am a member of
the College.
(3) I, Dr. Astawan, acknowledge that following an investigation arising from
a complaint regarding my care and treatment of a patient, the ICR
Committee referred specified allegations of professional misconduct and
incompetence to the Discipline Committee in a Notice of Hearing dated
October 15, 2015 (the "Notice of Hearing").
(4) I, Dr. Astawan, acknowledge that, after the College receives an original
copy of this Undertaking as signed by me, the College will withdraw the
Notice of Hearing.
B. UNDERTAKING
(5) I, Dr. Astawan, undertake to abide by the provisions of this Undertaking,
effective immediately.
(6) Clinical Supervision of Complementary/Alternative Medicine Practice
(a) I, Dr. Astawan, undertake to practise Complementary/Alternative
Medicine under the guidance of a clinical supervisor(s) acceptable
to the College (the "Clinical Supervisor(s)"), for twelve (12)
months ("Clinical Supervision").
(b) I, Dr. Astawan, acknowledge that I have reviewed the Clinical
Supervisor(s)'s undertaking, attached hereto as Appendix "A", and
understand what is required of the Clinical Supervisor(s). The
Clinical Supervisor(s) will, at minimum:
(i) Meet with me at my Practice Location, or another location
approved by the College, once every month.
(ii) Review at least twenty (20) of my patient charts for patients
to whom I have provided Complementary/Alternative Medicine at
every meeting. After the second month of supervision, if I
provided less than 20 patients with Complementary/Alternative
Medicine in the previous month, then the Clinical Supervisor
shall review the patient charts for all patients to whom I
provided Complementary/Alternative Medicine in that month;
(iii) Review and discuss my compliance with the College
Complementary/Alternative Medicine Policy and discuss any
concerns arising from the chart reviews, including the
consent obtained, and the fees and charges billed to patients
for treatments or products provided;
(iv) Make recommendations to me for practice improvements and
ongoing professional development and inquire into my
compliance with the recommendations;
(v) Perform any other duties, such as reviewing other documents
or conducting interviews with staff or colleagues, that the
Clinical Supervisor(s) deem necessary to my Clinical
Supervision; and
(vi) Submit written reports to the College at least once every
month or more frequently if the Clinical Supervisor(s) has
concerns about my standard of practice, the fees and charges
billed to my patients, or my compliance with the College's
Complementary/Alternative Medicine Policy.
(c) I, Dr. Astawan, acknowledge that the charts reviewed shall be
selected by the Clinical Supervisor(s) based on the areas of
concern identified in the report(s) of the independent opinion
provider dated November 8, 2013, February 2, 2014 and May 14, 2014,
and concerns that may arise during the period of Clinical
Supervision.
(d) I, Dr. Astawan, undertake to cooperate fully with the Clinical
Supervision of my practice, conducted under the term of this
Undertaking and Appendix "A" to this Undertaking, and to abide by
the recommendations of my Clinical Supervisor(s), including but not
limited to, any recommended practice improvements and ongoing
professional development.
(e) I, Dr. Astawan, undertake to ensure that Appendix "A" to this
Undertaking is signed and delivered to the College within thirty
(30) days of the date I execute this Undertaking.
(f) I, Dr. Astawan, undertake that if a person who has given an
undertaking in Appendix "A" to this Undertaking is unable or
unwilling to continue to fulfill its provisions, I shall, within
thirty (30) days of receiving notice of same, obtain an executed
undertaking in the same form from a similarly qualified person who
is acceptable to the College and ensure that it is delivered to the
College within that time.
(g) I, Dr. Astawan, undertake that if I am unable to obtain a Clinical
Supervisor on the provisions set out under sections (6)(e) and/or
(f) above, I will cease practicing Complementary/Alternative
Medicine until such time as I have obtained a Clinical Supervisor
acceptable to the College.
(h) I, Dr. Astawan, acknowledge that if I am required to cease practise
Complementary/Alternative Medicine as a result of section (6)(g)
above this will constitute a term, condition or limitation on my
certificate of registration and that term, condition or limitation
will be included on the public register.
(i) I, Dr. Astawan, undertake that during the period of supervision, I
shall maintain a log of all patients to whom I provide
Complementary/Alternative Medicine treatment. The log shall
include: the name of the patient, the date of the treatment, and
the nature of the treatment (including any supplements or products
sold to the patient) and the charges incurred by the patient for
the treatment and/or product.
(7) Practice Restrictions - Conflict of Interest
(a) I, Dr. Astawan, undertake to post a sign in a form acceptable to
the College, regarding the sale of items to patients. I shall post
the sign in all waiting rooms, examination rooms and consulting
rooms, in all of my Practice Locations, in a clearly visible and
secure location.
(b) I, Dr. Astawan, undertake to submit to the College a copy of the
sign referenced in 7(a) above for approval within 30 days of the
execution of this Undertaking.
(c) I, Dr. Astawan, acknowledge and agree that I have completed a
comprehensive review of the regulations with respect to physician
conflict of interest, namely Part IV of Ontario Regulation 114/94
made under the Medicine Act, 1991 ("Conflict of Interest
Regulations") and professional misconduct, namely Ontario
Regulation 856/93 ("Professional Misconduct Regulations") and that
I am aware of my duty to comply fully with the Conflict of Interest
Regulations and the Professional Misconduct Regulations as amended
from time to time.
(d) I, Dr. Astawan, acknowledge that I am prohibited from selling or
supplying any medical product or biological preparation including
supplements at a profit and that it is professional misconduct to
charge a fee that is excessive in relation to services performed.
(e) I, Dr. Astawan, undertake to ensure I shall bill patients in
compliance with all applicable legislation and regulations,
including Ontario Regulation 114/94 and Ontario Regulation 856/93.
(f) I, Dr. Astawan, undertake to provide every patient with an itemized
invoice for billing of all Complementary/Alternative Medicine
services and products that I provide, including, but not limited
to: laboratory services, procedure fees and charges arising from
any product I sell. The itemized invoice shall indicate which
products or services are subject to HST, and shall clearly indicate
any additional charges that I am applying to that invoice.
(8) Complementary/Alternative Medicine Policy
(a) I, Dr. Astwan, acknowledge that I have completed a detailed review
of the College's policy regarding "Complementary/Alternative
Medicine." The College's most current "Complementary/Alternative
Medicine" is currently found on the College's website at:
http://www.cpso.on.ca/Policies-Publications/Policy/Complementary/Alternative
Medicine
I acknowledge my understanding that I must at all times comply with
this policy and any amendments to it.
(b) I, Dr. Astawan, undertake to submit to the College copies of all
consent forms for Complementary/Alternative Medicine treatments for
approval by the College within two months of the date of the
execution of this undertaking.
(9) Reassessment of Practice
(a) I, Dr. Astawan, undertake that, approximately six (6) months after
the completion of the Clinical Supervision set out in section (6)
above and Appendix "A" to this Undertaking, I will submit to a
reassessment of my Complementary/Alternative Medicine practice
("the Reassessment") by an assessor or assessors selected by the
College (the "Assessor(s)"). I acknowledge that the Reassessment
may include a chart review (including invoices and consent forms),
direct observation of my care, interviews with colleagues and
co-workers, feedback from patients and any other tools deemed
necessary by the College.
(b) I, Dr. Astawan, undertake to co-operate fully with the
Reassessment, conducted under the term of this Undertaking.
(c) I, Dr. Astawan, acknowledge that my Clinical Supervisor(s) may
receive and review the findings of the Assessor(s), and may discuss
with the Assessor(s) any issues or concerns arising from the
Reassessment. I also acknowledge that the results of the
Reassessment will be provided to me and reported to the College and
the report may form the basis of further action by the College.
(10) Monitoring
(a) I, Dr. Astawan, undertake to inform the College of each and every
location that I practise or have privileges, including, but not
limited to, hospital(s), clinic(s) and office(s), in any
jurisdiction (collectively my "Practice Location(s)"), within five
(5) days of executing this Undertaking. Going forward, I further
undertake to inform the College of any and all new Practice
Locations within five (5) days of commencing practice at that
location.
(b) I, Dr. Astawan, undertake that I will submit to, and not interfere
with, unannounced inspections of my Practice Location(s) and
patient records by a College representative for the purposes of
monitoring my compliance with the provisions of this Undertaking.
(c) I, Dr. Astawan, give my irrevocable consent to the College to make
appropriate enquiries of OHIP, and/or any person who or institution
that may have relevant information, in order for the College to
monitor my compliance with the provisions of this Undertaking.
(d) I, Dr. Astawan, acknowledge that I have executed the OHIP consent
form(s), attached hereto as Appendix "B"
C. ACKNOWLEDGEMENT
(11) I, Dr. Astawan, acknowledge that all appendices attached to or referred
to in this Undertaking form part of this Undertaking.
(12) I, Dr. Astawan, acknowledge and undertake that I shall be solely
responsible for payment of all fees, costs, charges, expenses, etc.
arising from the implementation of any of the provisions of this
Undertaking.
(13) I, Dr. Astawan, acknowledge that I have read and understand the
provisions of this Undertaking and that I have obtained independent legal
counsel in reviewing and executing this Undertaking, or have waived my
right to do so.
(14) I, Dr. Astawan, acknowledge that the College will provide this
Undertaking to any Chief of Staff, or a colleague with similar
responsibilities, at any Practice Location ("Chief(s) of Staff").
(15) I, Dr. Astawan, acknowledge that a breach by me of any provision of this
Undertaking may constitute an act of professional misconduct and/or
incompetence, and may result in a referral of specified allegations to
the Discipline Committee of the College.
(16) I, Dr. Astawan, acknowledge that this Undertaking constitutes terms,
conditions, and limitations on my certificate of registration for the
purposes of section 23 of the Code.
(17) Public Register
(a) I, Dr. Astawan, acknowledge that, during the time period that this
Undertaking remains in effect, this Undertaking shall be posted on
the Public Register.
(b) I, Dr. Astawan, acknowledge that, in addition to this Undertaking
being posted in accordance with section (16)(a) above, the
following summary shall be posted on the Public Register until such
time as the period of supervision and reassessment are complete and
reported back to the ICR Committee.
Dr. Astawan was referred to the Discipline Committee on
allegations of professional misconduct and incompetence. In
the face of these allegations, Dr. Astawan has undertaken
that:
Dr. Astawan will practise Complementary/Alternative
Medicine under the guidance of a Clinical Supervisor
acceptable to the College for 12 months.
Dr. Astawan's practice will be reassessed by an
assessor selected by the College within 6 months of the
end of the period of Clinical Supervision.
Dr. Astawan shall ensure all consent forms for
Complementary/Alternative Medicine treatments are
submitted to the College for approval within two months
of the date of this Undertaking.
Dr. Astawan shall post a sign, in a form approved by
the College, in her office regarding the sale of items
to patients.
Dr. Astawan will provide her patients with itemized
invoices for all services, treatments and products
charged to the patient and will bill patients in
compliance with all applicable regulations.
(c) I, Dr. Astawan, acknowledge that, in addition to this Undertaking
being posted in accordance with section (16)(a) above, the
following summary shall be posted on the Public Register after the
period of supervision and reassessment are complete and reported
back to the ICR Committee.
Dr. Astawan was referred to the Discipline Committee on
allegations of professional misconduct and
incompetence. In the face of these allegations, Dr.
Astawan has undertaken that:
Dr. Astawan shall post a sign, in a form approved by
the College, in her office regarding the sale of items
to patients.
Dr. Astawan will provide her patients with itemized
invoices for all services, treatments and products
charged to the patient and will bill patients in
compliance with all applicable regulations.
D. CONSENT
(18) I, Dr. Astawan, give my irrevocable consent to the College to provide the
following information to all Clinical Supervisors, all Chief(s) of Staff
and/or Assessors:
(a) any information the College has that led to the circumstances of my
entering into this Undertaking;
(b) any information arising from any investigation into, or assessment
of, my practice; and
(c) any information arising from the monitoring of my compliance with
this Undertaking.
(19) I, Dr. Astawan, give my irrevocable consent to all Clinical Supervisors,
Chiefs of Staff and Assessors, to disclose to the College, and to one
another, any information:
(a) relevant to this Undertaking;
(b) relevant to the provisions of the Clinical Supervisor's undertaking
set out at Appendix "A" to this Undertaking;
(c) relevant to the Reassessment; and/or
(d) relevant for the purposes of monitoring my compliance with this
Undertaking.