As of February 7, 2019, Dr. Silverstein has completed the clinical supervision,
education and reassessment components of his undertaking of February 22, 2016.
The practice restrictions in the undertaking will remain in effect:
(i) I shall restrict my practice to adult psychiatry only (for patients
aged 18 years and older), and shall not treat medical conditions
outside the scope of psychiatry; and
(ii) I shall not see any patients in my home office.
As from February 22, 2016, the following is imposed as a term, condition and
limitation on the certificate of registration held by Dr. Paul Victor
Silverstein, in accordance with an undertaking and consent given by Dr.
Silverstein to the College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")
of
DR. PAUL VICTOR SILVERSTEIN
("Dr. Silverstein")
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.
(2) I, Dr. Silverstein, certificate of registration number 29746, am a member
of the College. The College has received information regarding my
standard of practice.
(3) I, Dr. Silverstein, acknowledge that I am currently the subject of a
College investigation bearing File Number 7214105 (the "Investigation")
into my practice.
B. UNDERTAKING
(4) I, Dr. Silverstein, acknowledge and agree that I am bound by this
Undertaking from the date on which I sign it.
(5) Practice Restrictions
(a) I, Dr. Silverstein, undertake that, effective immediately:
(i) I shall restrict my practice to adult psychiatry only (for
patients aged 18 years and older), and shall not treat
medical conditions outside the scope of psychiatry; and
(ii) I shall not see any patients in my home office.
(6) Clinical Supervision
(a) I, Dr. Silverstein, undertake to practise 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. Silverstein, 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) Facilitate the education program set out in the
Individualized Education Plan ("IEP") attached as Appendix
"B";
(ii) Review at least twenty (20) patient records every month or,
if less than twenty patients are seen in the month, all of my
patient records for that month;
(iii) Meet with me initially to discuss practice improvements and
then meet with me monthly at my place of practice.
(iv) Discuss any concerns arising from the chart reviews;
(v) Make recommendations to me for practice improvements and
ongoing professional development and inquire into my
compliance with the recommendations;
(vi) 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
(vii) Submit written reports to the College at least once
quarterly, or more frequently if the Clinical Supervisor(s)
has concerns about my standard of practice.
(c) I, Dr. Silverstein, acknowledge that the charts reviewed shall be
selected by the Clinical Supervisor(s) based on the educational
needs identified in the IEP set out at Appendix "B" to my
Undertaking, as well as the areas of concern identified in the
report(s) of the medical inspector dated May 11, 2015, and concerns
that may arise during the period of Clinical Supervision.
(d) I, Dr. Silverstein, undertake to cooperate fully with the Clinical
Supervision of my practice, conducted under the term of this
Undertaking and Appendix "A" and "B" attached, 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. Silverstein, undertake to ensure that Appendix "A" to this
Undertaking, is signed and delivered to the College within fifteen
(15) days of the date the ICRC Committee approves this Undertaking.
(f) I, Dr. Silverstein, 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
twenty (20) 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. Silverstein, agree 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 practising medicine until such time as I
have obtained a Clinical Supervisor acceptable to the College.
(h) I, Dr. Silverstein, agree that if I am required to cease practise
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.
(7) Professional Education
(a) I, Dr. Silverstein, undertake to participate in and successfully
complete the following professional education at the earliest
opportunity:
(i) a program(s) satisfactory to the College in:
1. pharmacology;
2. individualized instruction in professionalism approved
by the College, involving one to one sessions with the
Instructor incorporating principles of guided
reflection, tailored feedback and other modalities
specific to the needs of Dr. Silverstein as assessed by
the Instructor.
(ii) all aspects of the detailed IEP, attached hereto as Appendix
"B"; and
(iii) any additional professional education recommended by my
Clinical Supervisor(s).
(b) I, Dr. Silverstein, undertake to provide proof to the College of my
successful completion of the professional education set out in
section (7)(a) (i)within one (1) month of completing it.
(c) I, Dr. Silverstein, acknowledge that a report or reports may be
provided to the College regarding my progress and compliance with
the professional education set out in section (6)(a).
(8) Reassessment of Practice
(a) I, Dr. Silverstein, undertake that, approximately six (6) months
after the completion of the Clinical Supervision set out in section
(6) above and Appendix "A" attached, I will submit to a
Reassessment of my practice ("the Reassessment") by an assessor or
assessors selected by the College (the "Assessor(s)"). I
acknowledge and agree that the Reassessment may include a chart
review, 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. Silverstein, undertake to co-operate fully with the
Reassessment, conducted under the term of this Undertaking, and to
abide by those recommendations of the Assessor(s) that are approved
by the ICR Committee.
(c) I, Dr. Silverstein, acknowledge and agree 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.
(d) I, Dr. Silverstein, understand and agree that if I am of the view
that any of the Assessor(s)'s recommendations are unreasonable, I
will have thirty (30) days following my receipt of the
recommendations within which to provide the College with my
submissions in this regard. I further understand and agree that
thereafter, the ICR Committee will consider my submissions and make
a determination regarding whether or not the recommendations, or
any of them, are reasonable and if so, whether they, or any of
them, constitute limitations or restrictions on my practice, and
that decision will be provided to me.
(e) I, Dr. Silverstein, undertake that, following the decision
referenced in section (8)(d) above, I will abide by those
recommendations of the Assessor(s) that the ICR Committee has
determined are reasonable.
(f) I, Dr. Silverstein, hereby consent to the following being included
on the public register as terms, conditions or limitations on my
certificate of registration, for the purposes of section 23 of the
Code: any recommendations of the Assessor(s) which are terms,
conditions or limitations on my practice and/or which the ICR
Committee has identified in its decision referenced in section
(8)(d) as terms, conditions or limitations on my practice.
(9) Monitoring
(a) I, Dr. Silverstein, 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
fifteen (15) days of executing this Undertaking. Going forward, I
further undertake to inform the College of any and all new Practice
Locations within fifteen (15) days of commencing practice at that
location.
(b) I, Dr. Silverstein, undertake and agree 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. Silverstein, give my irrevocable consent to the College to
make appropriate enquiries of the Ontario Health Insurance Plan
("OHIP"), and/or any person or institution who may have relevant
information, in order for the College to monitor my compliance with
the provisions of this Undertaking.
(d) I, Dr. Silverstein, acknowledge that I have executed the OHIP
consent form(s), attached hereto as Appendix "C".
(10) I, Dr. Silverstein, undertake to comply with this Undertaking and
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.
C. ACKNOWLEDGEMENT
(11) I, Dr. Silverstein, acknowledge that all appendices attached to or
referred to in this Undertaking form part of this Undertaking.
(12) I, Dr. Silverstein, acknowledge 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. Silverstein, acknowledge and confirm 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. Silverstein, acknowledge that this entire Undertaking constitutes
terms, conditions, and limitations on my certificate of registration for
the purposes of section 23 of the Code. I understand that this
Undertaking shall be information on the College's Register that is
available to the public during the time period that the Undertaking
remains in effect.
(15) I, Dr. Silverstein, acknowledge that the following summary will appear on
the College's Register that is available to the public during the time
period that this Undertaking remains in effect:
Dr. Silverstein was the subject of a College investigation into his
practice. As a result of the investigation:
- Dr. Silverstein will engage in adult psychiatry only
and will not treat medical conditions outside the scope
of psychiatry;
- Dr. Silverstein will not see any patients in his home
office;
- Dr. Silverstein will practise under the guidance of a
Clinical Supervisor acceptable to the College for
twelve (12) months;
- Dr. Silverstein will engage in professional education,
including in pharmacology;
- Dr. Silverstein's practice will be reassessed by an
assessor selected by the College within six (6) months
of the end of the period of Clinical Supervision.
D. CONSENT
(16) I, Dr. Silverstein, give my irrevocable consent to the College to provide
the following information to any person who requires this information for
the purposes of facilitating my completion of the professional education
set out in section (7) above and to all Clinical Supervisors, 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.
(17) I, Dr. Silverstein, give my irrevocable consent to the College to provide
this Undertaking to any Chief(s) of Staff, or a colleague with similar
responsibilities approved by the College, at any Practice Location
("Chief(s) of Staff"), and to provide said Chief(s) of Staff with any
information the College has that led to the circumstances of my entering
into this Undertaking and/or any information arising from the monitoring
of my compliance with this Undertaking.
(18) I, Dr. Silverstein, give my irrevocable consent to any person who
facilitates my completion of the professional education set out in
section (7) above, and 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";
(c) relevant to the Reassessment;
(d) relevant for the purposes of monitoring my compliance with this
Undertaking; and/or
(e) which comes to his or her attention in the course of providing the
professional education set out in section (7) above and which he or
she reasonably believes indicates a potential risk of harm to my
patients.