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Alexander, Alexander Michael

CPSO#: 58565

MEMBER STATUS
Suspended as of 01 Sep 2022
CURRENT OR PAST CPSO REGISTRATION CLASS
Restricted as of 24 May 2017

Summary

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Former Name: No Former Name

Gender: Male

Languages Spoken: Bulgarian, English, French, Spanish

Education: Memorial University of Newfoundland Facu, 1987

Practice Information

Primary Location of Practice
Practice Address Not Available

Specialties

Specialty Issued On Type
No Speciality Reported

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 17 Jun 1987
Expired: Terms and conditions of certificate of registration Expiry: 13 Jun 1988
Subsequent certificate of registration Issued: Independent Practice Certificate Effective: 29 Jun 1988
Transfer of class of certificate to: Restricted certificate Effective: 20 Jul 2009
Terms and conditions imposed on certificate by member Effective: 20 Jul 2009
Terms and conditions amended by Discipline Committee Effective: 18 Apr 2012
Transfer of class of registration to: Independent Practice Certificate Effective: 10 Jan 2014
Transfer of class of certificate to: Restricted certificate Effective: 24 May 2017
Terms and conditions imposed on certificate by member Effective: 24 May 2017
Terms and conditions amended by member Effective: 24 Jun 2017
Terms and conditions amended by Discipline Committee Effective: 25 Sep 2018
Suspension of registration imposed: member Effective: 01 Nov 2018
Terms and conditions amended by member Effective: 01 Nov 2018
Suspension of registration removed Effective: 01 May 2019
Terms and conditions amended by Discipline Committee Effective: 30 Aug 2022
Suspension of registration imposed: Discipline Committee Effective: 01 Sep 2022

Previous Hearings

Committee: Ontario Physicians and Surgeons Discipline Tribunal
Decision Date: 30 Aug 2022
Summary:

On August 30, 2022, the Tribunal found that Dr. Alexander failed to maintain the standard of practice of the profession in his care of patients and engaged in disgraceful, dishonourable or unprofessional conduct by failing to comply with the terms of a prior Tribunal order. In doing so, Dr. Alexander was also found to have contravened a term, condition or limitation on his certificate of registration.

The Tribunal ordered that:
 
1. Dr. Alexander attend before the panel to be reprimanded;
2. the Registrar suspend Dr. Alexander’s certificate of registration for six months commencing September 1, 2022;
3. the Registrar place terms, conditions and limitations on Dr. Alexander’s certificate of registration;
4. Dr. Alexander pay the College costs in the amount of $6,000 by September 30, 2022.
 
The panel’s reasons for decisions will be released shortly. OPSDT reasons are also available at www.opsdt.ca and https://www.canlii.org/en/on/onpsdt/. The exhibits, including the Agreed Statement of Facts, can be obtained by contacting the Tribunal Office at [email protected]


Decision: Download Full Decision (PDF)
Hearing Date(s): 2022-08-30

 

Committee: Discipline
Decision Date: 25 Sep 2018
Summary:

On September 25, 2018, the Discipline Committee found that Dr. Alexander Michael Alexander committed an act of professional misconduct, in that he has failed to maintain the standard of practice of the profession, and in that he has engaged in conduct or 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.

Dr. Alexander is a general practitioner, who received his certificate of registration authorizing independent practice in June 1988. Throughout the relevant time, Dr. Alexander practised in Toronto.

Practice Assessment and Undertaking

In 2013, Dr. Alexander underwent an assessment of his practice by a College-appointed assessor, who identified concerns with Dr. Alexander’s practice, including his approach to chronic disease management, his conduct of physical examinations, his infection control techniques, his prescribing, his record-keeping, and his communication with consultants. As a result of the assessment, Dr. Alexander entered into an undertaking with the College on January 10, 2014, wherein he agreed, among other things, to engage a supervisor acceptable to the College, to participate in and successfully complete an educational plan and any additional professional education recommended by his supervisor, and to undergo a practice reassessment within six months after the completion of the clinical supervision. Dr. Alexander completed the clinical supervision as required by his undertaking.

Failure to Maintain the Standard of Practice of the Profession

The College retained an expert to perform the reassessment of Dr. Alexander’s practice required by his 2014 undertaking. The expert’s review focused on care provided from April 2015 onwards,and involved review of fifteen patient charts and observation of professional encounters with six other patients. The expert reported on January 19, 2017 that Dr. Alexander failed to maintain the standard of practice of the profession and observed that Dr. Alexander:

- Took limited patient histories;
- Performed physical examinations that were not tailored to the patient’s presenting problems and/or were performed incorrectly;
- Did not consistently document physical examinations;
- Performed assessments that were lacking;
- Developed treatment plans that were lacking or absent;
- Failed to take appropriate steps to manage infection control; and
- Provided only monthly prescriptions to patients on chronic medication, requiring them to return frequently and unnecessarily to the office.

The following was noted with respect to Dr. Alexander’s care of two patients (patients A and B):

- Patient A: while Dr. Alexander did not fail to maintain the standard of practice of the profession by failing to acknowledge a fracture shown by an x-ray (as the patient was being followed by an orthopedist and Dr. Alexander did not order the x-ray), or by referring the patient to a dermatologist for a diagnosis of vitiligo, he otherwise failed to maintain the standard of practice of the profession regarding patient A.
- Patient B: while Dr. Alexander did not fail to meet the standard of the profession by failing to order an x-ray and ultrasound of the shoulder, he otherwise failed to maintain the standard of practice of the profession regarding patient B.

Disgraceful, Dishonourable or Unprofessional Conduct

In the course of communicating with the College regarding the cases reviewed by the College’s expert, Dr. Alexander, through his counsel, forwarded to the College a copy of a patient agreement for opioid therapy pertaining to Patient C. Dr. Alexander’s counsel advised that this agreement was signed in 2009. However, the agreement had a copyright date of 2011 on it from the pharmaceutical company and referred to the 2010 Canadian Guideline (“Guideline”) for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain.

The College obtained three complete patient charts in respect of patients C, D, and E, all of whom were patients whose care was reviewed by the College’s expert. Each patient’s chart contained a signed agreement for opioid therapy. Despite the fact that all three agreements contained a 2011 copyright date and references to the Guideline, the agreement for opioid therapy for each of the three patients was dated before 2011, as follows: Patient D’s agreement was dated November 21, 2009; Patient E’s agreement was dated February 27, 2008, and Patient C’s agreement was dated April 11, 1996.

Dr. Alexander backdated each of the three patient agreements for opioid therapy, which constituted disgraceful, dishonourable or unprofessional conduct. It was misleading that Dr.Alexander provided Patient C’s agreement to the College asserting that it had been signed in 2009, while it was dated 1996 and signed at some time during or after 2011. Dr. Alexander advised College investigator that he could not identify when any of the agreements were signed,but that it would have been in or after 2011 and many years after they were dated. Dr. Alexander further stated that he backdated the agreements to reflect approximately when he would have first started prescribing narcotics to the patient, and their initial dosage. He said that this is not his current practice, but represents something that he did in the past.

Dr. Alexander’s Discipline History

Dr. Alexander has been the subject of two prior findings by the Discipline Committee of the College:

- In June 1991, the Discipline Committee found that Dr. Alexander engaged in disgraceful, dishonourable or unprofessional conduct by failing to report an incident of abuse to the Children’s Aid Society. Dr. Alexander was reprimanded.
- In April 2012, the Discipline Committee found that Dr. Alexander failed to maintain the standard of practice of the profession in his care of twenty-eight patients. The Discipline Committee ordered that Dr. Alexander submit to an assessment of his practice and abide by the assessor’s recommendations. It also ordered a reprimand and costs.

The 2013 assessment of Dr. Alexander’s practice was conducted pursuant to the Discipline Committee’s 2012 order.

Dr. Alexander’s Complaints Committee and Inquiries, Complaints and Reports Committee (the “ICRC”) History

In August 1995, the Complaints Committee required Dr. Alexander to attend in person for a caution regarding: the importance of proper wound management, including thorough cleansing, especially in animal bites where there is a high potential for infection; improper dosage of prescribed medication; the need for clear follow-up instructions; and, his basic knowledge of rabies management. The decision arose from a complaint about Dr. Alexander’s care of a four-year old boy who had been bitten by a dog.

In January 1999, the Complaints Committee cautioned Dr. Alexander to consider the utility of a cardiogram when investigating undiagnosed abdominal and arm pain.

In April 2010, the ICRC required Dr. Alexander to attend in person for a caution regarding his premature destruction of patient records before the time period after which it is allowed by law.

In December 2014, the ICRC required Dr. Alexander to attend in person for a caution regarding filling out Special Diet Forms (and other medical forms) without properly investigating the patient’s eligibility for the benefit.

Interim Undertaking and Subsequent Clinical Supervision

On May 24, 2017, Dr. Alexander entered into an interim undertaking, which was accepted by the ICRC in lieu of making an interim order. The undertaking has been in place pending the Discipline Committee’s decision regarding the allegations against him. Among other things, it has required that Dr. Alexander practise under the guidance of a clinical supervisor, who must meet with him weekly to review ten to fifteen patient charts and must also observe no fewer than ten of his patient encounters for no less than one-half day per month.

As a result of his interim undertaking, Dr. Alexander has been practising under the clinical supervision. The Clinical Supervisor has made numerous recommendations for practice improvement to Dr. Alexander and has noted that Dr. Alexander has made improvements in many of the areas in issue. The Clinical Supervisor continues to make recommendations in some of these areas.

Dr. Alexander’s Subsequent Education

Since the allegations of professional misconduct were referred to the Discipline Committee in 2017, Dr. Alexander has completed The University of Toronto Medical Record Keeping course,the 48th Annual Winter Refresher Course for Family Medicine at the University of Wisconsin, and the Endocrinology in Primary Care course offered by Medical Education Resources Inc.

Disposition

On September 25, 2018, the Discipline Committee ordered and directed that:

- the Registrar suspend Dr. Alexander’s certificate of registration for a period of six (6) months, commencing at 12:01 a.m. on November 1, 2018.

- the Registrar to place the following terms, conditions and limitations on Dr. Alexander’s certificate of registration:

Public Protection Prior to Suspension and Remediation
- Until the commencement of the period of suspension of his certificate of registration set out above, Dr. Alexander shall continue to be bound by the terms of the undertaking into which he entered on May 24, 2017;

Professional Education and Clinical Supervision

- Dr. Alexander shall participate in and successfully complete all aspects of the Individualized Education Plan (“IEP”) attached to this Order as Schedule “A,” including all of the following professional education:

- Within six (6) months of the date of this Order, Dr. Alexander shall complete individualized instruction in medical ethics satisfactory to the College, with an instructor approved by the College. The instructor shall provide a summative report to the College including his or her conclusion about whether the instruction was completed successfully by Dr. Alexander;
- The period of Clinical Supervision described below; and
- Any additional professional education recommended by his Clinical Supervisor (defined below).

- For a period of twelve (12) months commencing on the date that he resumes practice following the suspension of his certificate of registration described above, Dr.Alexander may practise only under the guidance of a clinical supervisor or clinical supervisors (the “Clinical Supervisor”) acceptable to the College, who has executed an undertaking in the form attached to the Order as Schedule “B.” Dr. Alexander shall successfully complete his IEP under the guidance of his Clinical Supervisor. Dr. Alexander shall cooperate fully with the Clinical Supervision of his practice, which shall contain the following elements:

- Dr. Alexander shall meet with his Clinical Supervisor at his Practice Location, or another location approved by the College, once every week for at least three (3) months. Thereafter, if recommended by the Clinical Supervisor and approved by the College, they may meet every two (2) weeks.
- At every meeting, Dr. Alexander and his Clinical Supervisor shall review ten to fifteen (10-15) of his patient charts, which shall be selected by the Clinical Supervisor independently of Dr. Alexander’s participation, on the basis of areas of concern identified in the assessor’s report(s) received on January 19, 2017, the Discipline Committee’s decision and reasons for decision in this matter, as well as any concerns that may arise during the period of Clinical Supervision or that have arisen during the prior period of Clinical Supervision under Dr. Alexander’s interim undertaking entered into on May 24, 2017;
- Once a month, the Clinical Supervisor shall observe no fewer than ten (10) of Dr. Alexander’s patient encounters, for no less than one-half (1/2) a day;
- The Clinical Supervisor shall discuss with Dr. Alexander any concerns arising from the observation of patient encounters and review of patient records, as well as provide recommendations to him, if any;
- The Clinical Supervisor may perform any other duties, such as reviewing other documents or conducting interviews with staff, colleagues, or patients, that the Clinical Supervisor deems necessary to the Clinical Supervision;
- The Clinical Supervisor shall submit written reports to the College at least once every month, or more frequently if the Clinical Supervisor has concerns about Dr. Alexander’s standard of practice; and
- Dr. Alexander shall abide by the recommendations of his Clinical Supervisor, including but not limited to any recommended practice improvements and ongoing professional development;
- If a Clinical Supervisor is unable or unwilling to continue to fulfill the terms of the Clinical Supervisor’s undertaking as set out in Appendix “A” to the Order, Dr. Alexander shall, within twenty (20) days of receiving notice of the same, deliver to the College an executed undertaking in the same form from a person who is acceptable to the College;
- If Dr. Alexander is unable to obtain a Clinical Supervisor in accordance with this Order, he shall cease to practise medicine until such time as he has done so, and the fact that he has ceased to practise medicine will be a term, condition, and limitation on his certificate of registration;
- Dr. Alexander 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. Alexander’s compliance with this Order, as well as the monitoring thereof;

Practice Reassessment
- Approximately six (6) months after completion of the period of Clinical Supervision set out above, Dr. Alexander shall undergo a reassessment of his practice by a College-appointed assessor or assessors (the “Assessor”). The reassessment shall include direct observation by the Assessor of Dr. Alexander’s patient encounters. The Assessor shall report the results of the reassessment to the College;
- Dr. Alexander shall consent to the disclosure to the Assessor of the reports of the Clinical Supervisor, and shall consent to the sharing of all information between the Clinical Supervisor, the Assessor, and the College, as the College deems necessary or desirable;

Practice Restrictions
- Dr. Alexander shall practise only in a practice setting that has been approved by the  College;
- Dr. Alexander shall engage in professional encounters with no more than eight (8) patients every two (2) hours.
- Dr. Alexander shall engage in professional encounters with patients for no more than seven (7) hours per day;
- Dr. Alexander may engage in professional encounters with patients five (5) days per week, and one (1) additional day every second week;

Monitoring of Compliance
- Dr. Alexander shall cooperate with unannounced inspections of his practice and shall consent to monitoring by a College representative(s) of claims that he submits to the Ontario Health Insurance Plan (“OHIP”), for the purpose of monitoring and enforcing his compliance with the terms of this Order;
- Dr. Alexander shall keep a log of all patient encounters, in the form set out at Schedule - “C” to the order, which will include at least the following information:
- the date of the patient encounter, including the day of the week;
- the name of the patient with the chart/file number, if any;
- the start time of the patient encounter;
- the end time of the patient encounter; and
- Dr. Alexander’s initials.
- Dr. Alexander shall submit the original log of patient encounters to the College on a monthly basis, and shall maintain his own copy of the log of patient encounters at all times, making it available to the College upon request;

Other
- Dr. Alexander shall be responsible for any and all costs associated with implementing this Order.

- Dr. Alexander appear before the panel to be reprimanded.

- Dr. Alexander pay the College its costs of this proceeding in the amount of $6,000 within thirty (30) days of the date of this Order.


Decision: Download Full Decision (PDF)
Hearing Date(s): September 25, 2018 9:00 a.m. start

 

Committee: Discipline
Decision Date: 18 Apr 2012
Summary:

On April 18, 2012, the Discipline Committee found that Dr. Alexander Michael Alexander committed an act of professional misconduct, in that he failed to maintain the standard of practice of the profession in his care of Patient A and 27 other patients. Dr. Alexander admitted the allegation.

In April 2003, Dr. Alexander wrote a prescription for anabolic steroids to Patient "A", even though the prescription was not clinically indicated. Dr. Alexander continued to prescribe anabolic steroids to Patient "A", even though it was not clinically indicated, until September 2004.

Regarding a review of 27 of Dr. Alexander's patient charts, as well as the care he provided to Patient "A", the following care and record-keeping deficiencies were identified:

a) Dr. Alexander's patient records are inadequate in documentation. There was no CPP or family history. The records were mostly illegible with sparse details.
b) Dr. Alexander failed to follow up and investigate Patient "A"'s abnormal echocardiogram beyond repeating the test. A referral to a cardiologist should have been done.
c) Dr. Alexander poorly managed diabetic patients.
d) Dr. Alexander poorly managed a patient with presumed coronary disease.
e) Dr. Alexander failed to use a cautious approach with narcotic patients including no contracts and no screening for opioid addiction, though most of the patients for whom opioids were prescribed had a legitimate reason for prescribing these medications.
f) Dr. Alexander displayed a lack of knowledge of the investigation and management for H. Pylori.

Dr. Alexander acknowledged the concerns raised by the College's expert and enrolled in and successfully completed:

a) the Understanding Boundaries and Preventing Boundary Violations in the Doctor-Patient Relationship course;
b) the Physicians Prescribing Skills Course: A Focus on Prescribing of Addictive and Psychoactive Drugs; and
c) the Medical Record-Keeping Course for physicians.

Dr. Alexander's clinical supervisor notes that Dr. Alexander has implemented Cumulative Patient Profiles in all of his patient charts; he finds Dr. Alexander's approach to diabetes, coronary artery disease, hepatitis, and H. Pylori to be appropriate; Dr. Alexander uses written agreements signed
by both the patient and Dr. Alexander; and Dr. Alexander's indications for ECHO nuclear stress testing are appropriate, as is his antibody testing.

Therefore, the Committee ordered and directed that:

1. the Registrar impose the following terms, conditions and limitations on Dr. Alexander's certificate of registration:

a) Dr. Alexander, at his own expense, submit to an assessment of his practice by an assessor selected by the College approximately three months after the date of this order. The assessment shall pertain to Dr. Alexander's family practice overall, with a specific focus upon the areas of concern outlined in the reports of Dr. Toomas Sauks. The reassessment shall include, at minimum, a full day direct observation component.

b) Dr. Alexander shall abide by the recommendations made by the Assessor. If any of the recommendations made by the Assessor limit or in any way restrict Dr. Alexander's practice, Dr. Alexander shall be permitted to make written submissions on his own behalf within 30 days of receipt of the assessment to the Inquiries, Complaints and Reports Committee. The Inquiries, Complaints and Reports Committee may or may not vary the recommendations of the Assessor upon receipt of Dr. Alexander's written submissions.Any recommendations accepted by the Inquiries, Complaints and Reports Committee that are limitation(s) or restriction(s) shall constitute terms, conditions or limitations on Dr.Alexander's Certificate of Registration and may be included on the public register if required by the College in its sole discretion.

2. Dr. Alexander appear before the panel to be reprimanded.

3. Dr. Alexander pay costs to the College in the amount of $3650.00 within 60 days of the date of this order.
 


Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): April 18, 2012