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Bickhram, Mahendra

CPSO#: 94497

MEMBER STATUS
Active Member as of 18 Oct 2010
CPSO REGISTRATION CLASS
Restricted as of 07 Mar 2021

Summary

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Former Name: No Former Name

Gender: Male

Languages Spoken: English

Education:St George's University of Grenada, 2010

Practice Information

Primary Location of Practice
Milton Health Center
Suite 200
1225 Maple Avenue
Milton ON  L9T 0A5
Phone: (905) 693-6400
Fax: (905) 693-6405 Electoral District: 04

Professional Corporation Information


Corporation Name: Bickhram Medicine Professional Corporation
Certificate of Authorization Status: Issued Date:  Oct 28 2013

Shareholders:
Dr. M. Bickhram ( CPSO# 94497 )

Business Address:
Milton Health Centre
Suite 200
1225 Maple Avenue
Milton ON  L9T 0A5
Phone Number: (905) 693-6400

Specialties

Specialty Issued On Type
Family Medicine Effective:12 Oct 2012 CFPC Specialist

Postgraduate Training

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



University Of Toronto, 18 Oct 2010 to 09 Jan 2011
AVP - Family Medicine

University Of Toronto, 10 Jan 2011 to 30 Jun 2011
PostGrad Yr 1 - Family Medicine

University Of Toronto, 01 Jul 2011 to 17 Oct 2011
PostGrad Yr 1 - Family Medicine

University Of Toronto, 18 Oct 2011 to 17 Oct 2012
PostGrad Yr 2 - Family Medicine

Registration History

Action Issue Date
First certificate of registration issued: Pre Entry Assessment Program Certificate Effective: 18 Oct 2010
Transfer of class of registration to: Postgraduate Education Certificate Effective: 10 Jan 2011
Transfer of class of registration to: Independent Practice Certificate Effective: 16 Oct 2012
Transfer of class of certificate to: Restricted certificate Effective: 07 Mar 2021
Terms and conditions imposed on certificate by member Effective: 07 Mar 2021

Practice Restrictions

Imposed By Effective Date Expiry Date Status
member Effective: 07 Mar 2021 Active
 As from March 7, 2021, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Mahendra Bickhram in accordance with an undertaking and consent given by Dr. Bickhram to the College of Physicians and Surgeons of Ontario:

UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT 
("Undertaking")

of

DR. MAHENDRA BICKHRAM
("Dr. Bickhram")

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.

"Narcotic Drugs" means from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19, as amended.

"Narcotic Preparations" means from the Narcotic Control Regulations made under the Controlled Drugs and Substances Act, S.C., 1996, c. 19, as amended.

"Controlled Drugs" means from Part G of the Food and Drug Regulations under the Food and Drugs Act, S.C., 1985, c. F-27, as amended.

"Benzodiazepines and Other Targeted Substances" means from the Benzodiazepines and Other Targeted Substances Regulations made under the Controlled Drugs and Substances Act., S.C., 1996, c. 19, as amended 
(A summary of the above-named drugs [from Appendix I to the Compendium of Pharmaceuticals and Specialties] is attached hereto as Schedule "A"; and links to the current regulatory lists are attached hereto as Schedule "B")

"Monitored Drugs" means as defined under the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22, as amended, with a link to the current regulatory list attached hereto at Schedule "C".	

"NMS" means the Drug Program Services Branch, the Narcotics Monitoring System implemented under the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22, as amended;

"OHIP" means the Ontario Health Insurance Plan;

"Public Register" means the College's register that is available to the public.

(2)	I, Dr. Bickhram, certificate of registration number 94497, am a member of the College.  

(3)	I, Dr. Bickhram, acknowledge that the College conducted an investigation bearing File Number 1113535 (the "Investigation") into whether I engaged in professional misconduct and/or am incompetent in my family practice.

B.	UNDERTAKING

(4)	I, Dr. Bickhram, undertake to abide by the provisions of this Undertaking effective immediately (the "Effective Date").

(5)	I, Dr. Bickhram, shall keep a Log of all prescriptions for Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and Monitored Drugs, in the form attached as set out in Schedule "D", which will include at least the following information (the "Prescribing Log"):  

(i)	the date of the appointment;

(ii)	the name of the patient and chart/file number;

(iii)	the name of the medication prescribed, dose, direction, number of tablets to be dispensed and frequency;

(iv)	the clinical indication;

(v)	whether the prescription is for a new medication and/or different dose or 	frequency than currently prescribed to the patient (Y/N); 

(vi)	Dr. Bickhram's signature;

(vii)	the date of the Clinical Supervisor's review (if applicable, as set out below); and

(viii)	the Clinical Supervisor's signature (if applicable, as set out below).

(6)	I, Dr. Bickhram, undertake to keep a copy of all prescriptions I write for Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and Monitored Drugs, in the corresponding patient chart.

(7)	Clinical Supervision

(a)	I, Dr. Bickhram, undertake to practise under the guidance of a clinical supervisor or clinical supervisors acceptable to the College (the "Clinical Supervisor" or "Clinical Supervisors"), for at least six (6) months ("Clinical Supervision") as outlined in the Clinical Supervisor's undertaking attached hereto as Appendix "E", the IEP attached as Appendix "F", and as set out below:.  

(i)	Moderate Level Supervision

i.	I, Dr. Bickhram, undertake that initially I will practise under moderate level supervision of the Clinical Supervision ("Moderate Level Supervision").

ii.	I, Dr. Bickhram, acknowledge that during the period of Moderate Level Supervision, the Clinical Supervisor will:

1.	Supervise for a minimum of three (3) months; 

2.	Meet with me bi-weekly, will take place at Dr. Bickhram's Practice Location, or another location approved by the College;

3.	Review fifteen (15) charts in order to comment on documentation and care; and

4.	Submit a written report to the College on a monthly basis.

5.	Upon receipt of the third monthly report and on the recommendation of the Clinical Supervisor, the College will determine if I may transition to Low Level Supervision.  If the College is not satisfied, I will continue at the Moderate Level Supervision until the College is satisfied.  

(ii)	Low Level Supervision

i.	I, Dr. Bickhram, acknowledge that during the period of Low-Level Supervision, the Clinical Supervisor will:

1.	Supervise for a duration of three months; 

2.	Meet with me monthly, will take place at Dr. Bickhram's Practice Location, or another location approved by the College;

3.	At each meeting review fifteen (15) charts in order to comment on documentation and care;

4.	Submit one (1) report to the College at the end of three (3) months; and

5.	The three (3) month final report must summarize the period of the Clinical Supervision and indicate whether or not I have incorporated changes into my practice in a sustained way.  

(b)	I, Dr. Bickhram, acknowledge that I have reviewed the Clinical Supervisor's undertaking, attached hereto as Schedule "E", and understand what is required of the Clinical Supervisor. The Clinical Supervisor will, at minimum:

i.	Facilitate the education program set out in the Individualized Education Plan ("IEP"), attached hereto as Schedule "F";

ii.	Review the materials provided by the College and have an initial meeting to discuss the objectives for the Clinical Supervision and practice improvement recommendations;

iii.	Meet with me at my Practice Location, or another location approved by the College, as set out above in section (7) and Appendix "E" to this Undertaking. 

iv.	Review at least fifteen (15)  of my patient charts at every meeting to whom I have prescribed Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and Monitored Drugs since the Clinical Supervisor's prior review, or if since the Clinical Supervisor's prior review there are not 15 patients listed in the Prescribing Log to whom I have prescribed Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and Monitored Drugs, then the charts of all patients listed in the Prescribing Log since the Clinical Supervisor's prior review;

v.	Sign and date the Prescribing Log to confirm the charts that the Clinical Supervisor(s) has reviewed and discussed with me;

vi.	Discuss any concerns arising from the chart reviews;

vii.	Make recommendations to me for practice improvements and ongoing professional development and inquire into my compliance with the recommendations; 

viii.	Perform any other duties, such as reviewing other documents or conducting interviews with staff or colleagues, that the Clinical Supervisor deems necessary to my Clinical Supervision; and

ix.	Submit written reports to the College at least once every month for three (3) months or until the College approves a reduction in the level of supervision, and then once at the end of supervision, or more frequently if the Clinical Supervisor has concerns about my standard of practice.

(c)	I, Dr. Bickhram, acknowledge that the charts reviewed shall be selected by the Clinical Supervisor based on the educational needs identified in the IEP, attached hereto as Schedule "F" to my Undertaking and concerns that may arise during the period of Clinical Supervision.

(d)	I, Dr. Bickhram, undertake to cooperate fully with the Clinical Supervision of my practice, conducted under the terms of this Undertaking and Schedule "E" 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. Bickhram, undertake to ensure that Schedule "E" to this Undertaking, is signed and delivered to the College within thirty (30) days of the Effective Date.

(f)	I, Dr. Bickhram, undertake that if a person who has given an undertaking in Schedule "E" 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. Bickhram, undertake that if I am unable to obtain a Clinical Supervisor on the provisions set out under section (7)(e) and/or (f) above, I will cease prescribing Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and Monitored Drugs until such time as I have obtained a Clinical Supervisor acceptable to the College.  

(h)	I, Dr. Bickhram, acknowledge that if I am required to cease prescribing Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and Monitored Drugs as a result of section 7(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.

(8)	Professional Education  

(a)	I, Dr. Bickhram, undertake to participate in and successfully complete all elements of the detailed IEP, attached hereto as Schedule "F", including but not limited to, the following elements of professional education (the "Professional Education"):

(i)	Documentation: Principles of Medical Record Keeping eLearning Module, CMPA: www.cmpa-acpm.ca/serve/elearning/documentation/en/index.html

(ii)	Review, reflection and discussion with my Clinical Supervisor(s) the following resources:

1.	Medical Records Documentation, CPSO: www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Medical-Records-Documentation

2.	Medical Records Management, CPSO: www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Medical-Records-Management

3.	2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain, Michael G. DeGroote National Pain Centre: http://nationalpaincentre.mcmaster.ca/guidelines.html

4.	National Guideline for the Clinical Management of Opioid Use Disorder, CRISM
https://crism.ca/wp-content/uploads/2018/03/CRISM_NationalGuideline_OUD-ENG.pdf

5.	Prescribing Drugs, CPSO:  www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Prescribing-Drugs

6.	Management of Chronic Non-Cancer Pain Tool, Centre for Effective Practice: https://cep.health/clinical-products/chronic-non-cancer-pain/

7.	Opioid Manager, Centre for Effective Practice: https://cep.health/clinical-products/opioid-manager/

8.	Opioid Tapering Template, Centre for Effective Practice: https://cep.health/clinical-products/opioid-tapering-template/

9.	Opioid Use Disorder (OUD) Tool, Centre for Effective Practice: https://cep.health/clinical-products/opioid-use-disorder/

10.	Osteoarthritis Tool, Centre for Effective Practice:
https://cep.health/clinical-products/osteoarthritis/

11.	Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain: Appendix B-6: Benzodiazepine Tapering, Michael G. DeGroote National Pain Centre:
https://nationalpaincentre.mcmaster.ca/opioid/cgop_b_app_b06.html

12.	Keeping Your Patients Safe: A Guide to Primary Care Management of Mental Health and Addictions-related Risks and Functional Impairments, Centre for Effective Practice:
https://cep.health/media/uploaded/CEP_AMH_Keeping_your_patients_safe_2017.pdf

13.	Good Practice Guide: Communication: Key to safe patient care, CMPA:
www.cmpa-acpm.ca/serve/docs/ela/goodpracticesguide/pages/communication/communication-e.html

(iii)	any additional professional education recommended by my Clinical Supervisor(s).

(b)	I, Dr. Bickhram, undertake to provide proof to the College of my successful completion of each element of the Professional Education specified above, including proof of registration, attendance and participant assessment reports where available, within one (1) month of completion of each element. I acknowledge that the College will determine, in its sole discretion, whether I have successfully completed each element of the Professional Education.

(c)	I, Dr. Bickhram, undertake to complete this requirement within four months or, if no satisfactory program is available by that time, by the first possible opportunity thereafter.

(d)	I, Dr. Bickhram, acknowledge that a report or reports may be provided to the College regarding my progress and compliance with the Professional Education.

(9)	Reassessment of Practice

(a)	I, Dr. Bickhram, undertake that, approximately six (6)  months after the completion of the Clinical Supervision set out in section (7) above and Appendix "E" to this Undertaking, I will submit to a reassessment of my practice ("the Reassessment") by an assessor or assessors selected by the College (the "Assessor" or "Assessors").  I acknowledge that the Reassessment may include a chart review of a minimum of fifteen (15) charts, direct observation of my care, interviews with me, colleagues and co-workers, feedback from patients and any other tools deemed necessary by the College.

(b)	I, Dr. Bickhram, undertake to co-operate fully with the Reassessment, conducted under the term of this Undertaking. 

(c)	I, Dr. Bickhram, acknowledge that my Clinical Supervisor may receive and review the findings of the Assessor, and may discuss with the Assessor any issues or concerns arising from the Reassessment.

(d)	I, Dr. Bickhram, acknowledge that the results of the Reassessment will be provided to me and reported to the College and the Reassessment may form the basis of further action by the College. 

(10)	Monitoring 

(a)	I, Dr. Bickhram, undertake to inform the College of each and every location at which I practise or have privileges, including, but not limited to, any hospitals, clinics, offices, and any Independent Health Facilities with which I am affiliated, in any jurisdiction (collectively my "Practice Location" or "Practice Locations"), 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. Bickhram, undertake that I will submit to, and not interfere with, unannounced inspections of my Practice Locations and patient records by a College representative for the purposes of monitoring my compliance with the provisions of this Undertaking.

(c)	I, Dr. Bickhram, give my irrevocable consent to the College to make appropriate enquiries of OHIP, NMS 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. Bickhram, acknowledge that I have executed the OHIP and NMS consent form(s), attached hereto as Schedule "G" and Schedule "H", respectively. 

C.	ACKNOWLEDGEMENT

(11)	I, Dr. Bickhram, acknowledge that all schedules attached to or referred to in this Undertaking form part of this Undertaking.

(12)	I, Dr. Bickhram, 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. Bickhram, 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. Bickhram, 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. Bickhram, 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. Bickhram, acknowledge that this entire 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. Bickhram, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.

(b)	I, Dr. Bickhram, acknowledge that, in addition to this Undertaking being posted in accordance with section (17)(a) above, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:

The College received information about Dr. Bickhram's family medicine practice. As a result of the investigation:

Dr. Bickhram will practise under the guidance of a Clinical Supervisor acceptable to the College for six (6) months. 

Dr. Bickhram will engage in professional education in Medical-Record Keeping and in Safer Opioid Prescribing.  

Dr. Bickhram'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.

(c)	I, Dr. Bickhram, acknowledge that this Undertaking remains in effect until the College determines its terms are satisfied.

D.	CONSENT

(18)	I, Dr. Bickhram, 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 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.

(19)	I, Dr. Bickhram, give my irrevocable consent to the College to provide all Chiefs 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.

(20)	I, Dr. Bickhram, give my irrevocable consent to any person who facilitates my completion of the Professional Education, 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 Schedule "E";

(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 and which he or she reasonably believes indicates a potential risk of harm to my patients.


Concerns

Source: Member
Active Date: March 7, 2021
Expiry Date:
Summary:
Note: This matter has been appealed to the Health Professions Appeal and Review Board.

Summary of the Undertaking given by Dr. Mahendra Bickhram to the College of Physicians and Surgeons of Ontario, effective March 7, 2021:

The College received information about Dr. Bickhram’s family medicine practice. As a result of the investigation:

Dr. Bickhram will practise under the guidance of a Clinical Supervisor acceptable to the College for six (6) months.

Dr. Bickhram will engage in professional education in Medical-Record Keeping and in Safer Opioid Prescribing.

Dr. Bickhram’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.