As from May 26, 2022, by order of the Ontario Physicians and Surgeons Discipline Tribunal, the following terms, conditions and limitations are imposed on the certificate of registration held by Dr. Zvi Margaliot:
Clinical Supervision
(a) Prior to commencing practice, Dr. Margaliot shall retain at his own expense, a clinical supervisor acceptable to the College (the "Clinical Supervisor") who has executed an undertaking in the form attached at Schedule "A".
(b) Dr. Margaliot shall only practice under the supervision of the Clinical Supervisor, unless he is acting as a surgical assistant and is not the MRP.
(c) Clinical supervision shall cease only on approval of the College in its sole discretion in accordance with the terms outlined in this Order.
Moderate Level Supervision
(d) For a period of no less than six (6) months, Dr. Margaliot shall practice under moderate level supervision ("Moderate Level Supervision") by the Clinical Supervisor in accordance with the College-approved Individualized Educational Plan (the "IEP") attached hereto as Schedule "B", Schedule "A" and the terms set out below.
(e) During Moderate Level Supervision, Dr. Margaliot shall be the Most Responsible Physician ("MRP").
(f) During Moderate Level Supervision, Dr. Margaliot shall not practice unless the Clinical Supervisor is available onsite or by telephone at all times.
Moderate Level Supervision- Phase One
(g) During the first month of Moderate Level Supervision, the Clinical Supervisor shall:
(i) meet with Dr. Margaliot once every two (2) weeks, at which meeting the Clinical Supervisor will:
a. review a minimum of 10 charts, to be selected in the sole discretion of the Clinical Supervisor, to review and comment on diagnosis, documentation and treatment plan, and to discuss any issues or concerns arising from this review with Dr. Margaliot;
b. to make recommendations to Dr. Margaliot for any practice improvements and ongoing professional development, and inquire into Dr. Margaliot's compliance with the recommendations.
c. keep a log of all patient charts reviewed along with patient identifiers.
(ii) directly observe Dr. Margaliot performing his first 10 procedures, and maintain a log of all procedures observed along with patient identifiers.
This requirement shall remain in place until Dr. Margaliot has completed 10 procedures, regardless of whether they occur during the first month of supervision.
(iii) The Clinical Supervisor shall provide a report to the College after the completion of the first month of Moderate Level Supervision, and monthly thereafter if Phase One is extended, which shall include comment on:
a. Dr. Margaliot's management of patients;
b. procedures and presentations that Dr. Margaliot is competent to manage/perform;
c. the procedures and presentations for which Dr. Margaliot needs further education, if any;
d. topics reviewed and success in implementing changes in practice;
e. Dr. Margaliot's review of current practice guidelines;
f. a list of the type of procedures undertaken by Dr. Margaliot, and
g. all information that might assist the College in evaluating Dr. Margaliot's standard of practice, as well as Dr. Margaliot's participation in and compliance with the requirements set out in the Order.
(h) After a minimum of one (1) month of supervision, if the Clinical Supervisor is satisfied that Dr. Margaliot's care and treatment of patients meets the standard of practice of the profession, the Clinical Supervisor may recommend to the College that Dr. Margaliot commence Moderate Level Supervision - Phase Two, as set out below. For greater clarity, Moderate Level Supervision- Phase One shall continue until such recommendation is made and the College approves the transition to Moderate Level Supervision - Phase Two.
Moderate Level Supervision- Phase Two
(i) Upon the recommendation of the Clinical Supervisor and approval of the College to commence Moderate Level Supervision- Phase Two, Dr. Margaliot will meet with the Clinical Supervisor one (1) time per month, at which meetings the Clinical Supervisor will:
(i) review a minimum of 10 charts, to be selected in the sole discretion of the Clinical Supervisor, to review and comment on diagnosis, documentation and treatment plan, and to discuss any issues or concerns arising from this review with Dr. Margaliot;
(ii) to make recommendations to Dr. Margaliot for any practice improvements and ongoing professional development, and inquire into Dr. Margaliot's compliance with the recommendations.
(iii) keep a log of all patient charts reviewed along with patient identifiers.
(j) The Clinical Supervisor shall provide a report to the College after the second month of Moderate Level Supervision- Phase Two, which shall include comment on:
a. Dr. Margaliot's management of patients;
b. procedures and presentations that Dr. Margaliot is competent to manage/perform;
c. the procedures and presentations for which Dr. Margaliot needs further education, if any;
d. topics reviewed and success in implementing changes in practice;
e. Dr. Margaliot's review of current practice guidelines;
f. a list of the type of procedures undertaken by Dr. Margaliot, and
g. All information that might assist the College in evaluating Dr. Margaliot's standard of practice, as well as Dr. Margaliot's participation in and compliance with the requirements set out in the Order
(k) The Clinical Supervisor shall provide a report to the College after the completion of five months of Moderate Level Supervision- Phase Two, and shall continue to report every three months thereafter if Moderate Level Supervision- Phase Two is extended, commenting on:
a. Dr. Margaliot's management of patients;
b. procedures and presentations that Dr. Margaliot is competent to manage/perform;
c. the procedures and presentations for which Dr. Margaliot needs further education, if any;
d. topics reviewed and success in implementing changes in practice;
e. Dr. Margaliot's review of current practice guidelines;
f. a list of the type of procedures undertaken by Dr. Margaliot;
g. All information that might assist the College in evaluating Dr. Margaliot's standard of practice, as well as Dr. Margaliot's participation in and compliance with the requirements set out in the Order; and
(l) After no less than six (6) months of Moderate Level Supervision (Phase One and Phase Two), the Clinical Supervisor shall provide their opinion as to whether Dr. Margaliot is ready to transition to independent practice.
Low Level Supervision
(m) Upon the recommendation of the Clinical Supervisor that Dr. Margaliot may transition to independent practice, Dr, Margaliot will practice under Low Level Supervision, until completion of the Assessment set out below, and until approved by the College to enter unsupervised practice.
(n) During Low Level Supervision, Dr. Margaliot will meet with the Clinical Supervisor one (1) time per month, at which meetings the Clinical Supervisor will:
(i) review a minimum of 10 charts, to be selected in the sole discretion of the Clinical Supervisor, to review and comment on diagnosis, documentation and treatment plan, and to discuss any issues or concerns arising from this review with Dr. Margaliot;
(ii) to make recommendations to Dr. Margaliot for any practice improvements and ongoing professional development, and inquire into Dr. Margaliot's compliance with the recommendations.
(iii) keep a log of all patient charts reviewed along with patient identifiers.
(iv) No further reporting is required by the Clinical Supervisor unless the Clinical Supervisor has concerns about Dr. Margaliot or his practice.
Assessment of Practice
(o) Upon the recommendation of the Clinical Supervisor that Dr. Margaliot may transition to independent practice and with the approval of the College, Dr. Margaliot shall undergo an assessment of his practice (the "Assessment") by a College-appointed assessor or assessors (the "Assessor"). For clarity, until the Assessment is complete and the College approves Dr. Margaliot's entry into unsupervised practice, Dr. Margaliot shall continue to practice under Low Level Supervision.
(p) The Assessment shall include, at the discretion of the College, any one or more of the following: a review of Dr. Margaliot's patient charts, direct observation of Dr. Margaliot's practice, an interview with Dr.Margaliot, interviews with colleagues and coworkers, feedback from patients, and any other tools deemed necessary by the College. Dr. Margaliot shall abide by all recommendations made by the Assessor.
(q) The Assessor shall be provided with all information the College determines is relevant including this Order, the Discipline Committee's Reasons for Decision in this matter, the copies of the reports of the Clinical Supervisor(s) referred to above, the decision of the (then called) Discipline Committee of the College of Physicians and Surgeons of Ontario in Ontario (College of Physicians and Surgeons of Ontario) v. Margaliot, 2016 ONCPSD 53 and the Statement of Facts and Plea of No Contest, as relied upon (and entered as Exhibit 2) in Ontario (College of Physicians and Surgeons of Ontario) v. Margaliot, 2016 ONCPSD 53.
(r) The Assessor shall submit a written report to the College regarding Dr. Margaliot's standard of practice and this report may form the basis for further action by the College.
(s) The College shall review the final assessment report of the Assessor and make a determination, in its sole discretion, as to whether Dr. Margaliot can enter unsupervised practice. For clarity, Dr. Margaliot shall not enter unsupervised practice unless and until the College approves him to do so.
Other Elements of Clinical Supervision and Assessment
(t) Dr. Margaliot shall cooperate fully with the Clinical Supervision and abide by all recommendations of the Clinical Supervisor(s), including but not limited to, any recommended practice improvements and professional development.
(u) The Clinical Supervisor shall immediately notify the College if they are concerned that Dr. Margaliot's practice may fall below the standard of practice of the profession, Dr. Margaliot may not be in compliance with the provisions of this Order or Dr. Margaliot's patients may be exposed to risk of harm or injury.
(v) If a person who has given an undertaking in Schedule "A" to this Order is unable or unwilling to fulfill its provisions during Moderate Level Supervision, Dr. Margaliot shall cease practicing medicine immediately until he has obtained a Clinical Supervisor acceptable to the College, and this will constitute a term, condition, or limitation on his certificate of registration, which will be included on the College's public register.
(w) If a person who has given an undertaking in Schedule "A" to this Order is unable or unwilling to fulfill its provisions during Low Level Supervision, Dr. Margaliot shall, within fourteen (14) days of receiving notice of the same, ensure that he has delivered to the College an executed undertaking in the same form from a similarly qualified person who is acceptable to the College.
(x) If Dr. Margaliot is unable to obtain a Clinical Supervisor as set out in this Order within 14 days, he shall cease practicing medicine until he has obtained a Clinical Supervisor acceptable to the College, and this will constitute a term, condition, or limitation on his certificate of registration, which will be included on the College's public register.
(y) The patient charts reviewed by the Clinical Supervisor pursuant to this Order shall be selected by the Clinical Supervisor based on the educational needs identified in the IEP and based on any concerns that may arise during the period of Clinical Supervision.
(z) Dr. Margaliot shall consent to the disclosure and sharing of information between the Clinical Supervisor(s), the Assessor(s) and the College as the College deems necessary or desirable in order to fulfill their respective obligations.
Professional Education
(aa) Dr. Margaliot shall review, reflect and discuss with his Clinical Supervisor the College of Family Physicians of Canada three-part article on patient centred interviewing:
(i) https://www.cfpc.ca/CFPC/media/Resources/Examinations/Patient-Centred-Interviewing.pdf
(ii) https://www.cfpc.ca/uploadedFiles/Education/Finding%20Common%20Gro und.pdf
(iii) https://www.cfpc.ca/CFPC/media/Resources/Examinations/Five- Provocative-Questions.pdf
(bb) Dr. Margaliot shall participate in, and successfully complete, all aspects of the IEP, attached hereto as Schedule "B", including but not limited to professional education stipulated in the IEP, including:
(i) Completion of the continuing professional development ("CPD") program relevant to the practice of Plastic Surgery approved by the College (the "Personal CPD Program") as specified in Appendix "A" to the IEP (Schedule B);
(ii) Discuss the Personal CPD Program with the Clinical Supervisor and complete any additional CPD assigned by the Clinical Supervisor, if any
(iii) Complete the CPD Program during the twelve (12) months following reinstatement; and
Monitoring and Other Terms
(cc) Dr. Margaliot shall inform the College of each and every location where he practices, including but not limited to hospitals(s), clinic(s) and office(s), in any jurisdiction, within five (5) days of this Order. Going forward, he shall inform the College of any and all new Practice Locations in any jurisdiction five (5) days in advance of commencing practice at that location.
(dd) Dr. Margaliot shall cooperate, and shall not interfere with, unannounced inspections of his practice by the College and to any other activity the College deems necessary for the purpose of monitoring Dr. Margaliot's compliance with the terms of this Order.
(ee) Dr. Margaliot shall provide the College with his irrevocable consent to make enquiries of the Ontario Health Insurance Plan, and/or any person(s) or institution(s) that may have relevant information, in order for the College to monitor his compliance with the terms of this Order.
(ff) If Dr. Margaliot wishes to perform procedures which were not the subject of Clinical Supervision and Assessment, Dr Margaliot shall be subject to the College Ensuring Competence Policy and shall not perform such procedures until receiving College approval to do so.
(gg) Dr. Margaliot shall be solely responsible for any and all fees, costs, charges, expenses, etc. associated with implementing the terms of this Order.