Thomas, Cholemkeril Kuncheria

 (1 of 3)

As from February 28, 2024 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. Cholemkeril Kuncheria Thomas: 

i. Dr. Thomas will, at his own expense, successfully complete the PROBE Ethics & Boundaries Program offered by the Centre for Personalized Education for Professionals or one-to-one instruction in professionalism with an instructor approved by the College.

(a) If Dr. Thomas proceeds with the PROBE course, he must receive a passing evaluation or grade, without condition or qualification. Dr. Thomas will complete the PROBE program within six (6) months of the date of this Order or, if it is not available within that timeframe, will complete it at the earliest availableopportunity. Dr. Thomas will provide proof to the College of his completion, including proof of registration and attendance and participant assessment reports, within one (1) month of completing it.

(b) If Dr. Thomas proceeds with one-on-one instruction, the instructor will submit a report to the College and the College will determine in its sole discretion if the instruction has been completed satisfactorily. The one-on-one instruction will be completed within six (6) months of the date of this Order.

(2 of 3)

As from August 13, 2019, the following terms, conditions and limitations are imposed on the certificate of registration held by Dr. Cholemkeril Kuncheria Thomas, in accordance with an undertaking and consent Dr. Thomas has given to the College of Physicians and Surgeons of Ontario:
            
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT 
("Undertaking")

of

DR. CHOLEMKERIL KUNCHERIA THOMAS
("Dr. Thomas")

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. Thomas, certificate of registration number 54092, am a member of the College.

(3)   I, Dr. Thomas, acknowledge that the College conducted an investigation bearing File Number 1100121 (the "Investigation") into whether I engaged in professional misconduct and/or am incompetent in my family practice.
                  
(4)   I, Dr. Thomas, acknowledge that I am the subject of an Order of the Discipline Committee of the College dated June 19, 2019 which provides for the supervision and reassessment of my practice.  I, Dr. Thomas, acknowledge that the supervision and reassessment components of this Undertaking operate in addition to, though run concurrently with, those
                  set out in the Order of the Discipline Committee dated June 19, 2019.
                  
B.    UNDERTAKING

(5)   I, Dr. Thomas, undertake to abide by the provisions of this Undertaking, effective immediately.

 (6)   Practice Restrictions

(a)   I, Dr. Thomas, undertake to restrict my practice to Emergency Medicine only, at a hospital where I hold privileges to so practice.  For greater clarity, I, Dr. Thomas, may practise in an Urgent Care clinic or centre at a hospital where I hold privileges to practice Emergency Medicine.  I, Dr. Thomas, shall not practice Family Medicine in any capacity or at any location including a Walk-In clinic.
                        
(b)   I, Dr. Thomas, shall not prescribe greater than a five (5) days' supply, with no repeats or refills, of any Narcotic Drug, Narcotic Preparation, Controlled Drug, Benzodiazepine and Other Targeted Substance or Monitored Drug to any patient.
                        
(c)   I, Dr. Thomas, 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 Appendix "A", 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. Thomas'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).
                  
(d)   I, Dr. Thomas, 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.
                        
(e)   I, Dr. Thomas, acknowledge that the practice restrictions set out at sections 6(b), (c) and (d) above, shall remain in effect until the College determines that I have successfully completed the Reassessment described at section 9 below.
                  
(7)   Clinical Supervision 

(a)   I, Dr. Thomas, undertake to practise under the guidance of a clinical supervisor or clinical supervisors acceptable to the College (the "Clinical Supervisor" or "Clinical Supervisors"), for seven (7) months ("Clinical Supervision"). 
                        
(b)   I, Dr. Thomas, acknowledge that I have reviewed the Clinical Supervisor's undertaking, attached hereto as Appendix "B", 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 Appendix "C";
(ii)  Review the materials provided by the College and have an initial meeting in August 2019 to discuss practice improvement recommendations;
(iii) Meet with me at my Practice Location, or another location approved by the College once in November 2019, and once in February 2020;
(iv)  At the meetings in November 2019 and February 2020, review the charts of all patients listed in the Prescribing Log, including the associated prescriptions;
(v)   Discuss any concerns arising from the chart reviews;
(vi)  Make recommendations to me for practice improvements and ongoing professional development and inquire into my compliance with the recommendations; 
(vii) 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
(viii) Submit written reports to the College after every meeting, or more frequently if the Clinical Supervisor has concerns about my standard of practice.
                  
(c)   I, Dr. Thomas, acknowledge that the charts reviewed shall be selected by the Clinical Supervisor based on the educational needs identified in the IEP, attached hereto as Appendix "C", as well as the areas of concern identified in the reports of the assessors dated October 8, 2018 and March 29, 2019, and concerns that may arise during the period of Clinical Supervision.
                        
(d)   I, Dr. Thomas, undertake to cooperate fully with the Clinical Supervision of my practice, conducted under the term of this Undertaking and Appendix "B" to this Undertaking, and to abide by the recommendations of my Clinical Supervisor, including but not limited to, any recommended practice improvements and ongoing professional development.
                        
(e)   I, Dr. Thomas, undertake to ensure that Appendix "B" to this Undertaking is signed and delivered to the College within twenty (20) days of the date I execute this Undertaking.
                        
(f)   I, Dr. Thomas, undertake that if a person who has given an undertaking in Appendix "B" 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. Thomas, undertake that if I am unable to obtain a Clinical Supervisor on the provisions set out under sections (7)(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. Thomas, acknowledge that if I am required to cease practise 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. Thomas, undertake to participate in and successfully complete all aspects of the detailed IEP, attached hereto as Appendix "C", including all of the following professional education (the "Professional Education"):
                        
(i)   University of Toronto Faculty of Medicine program in Safe Opioid Prescribing (all three webinars and in-person workshop): www.cepd.utoronto.ca/opioidprescribing;
(ii)  Review and discuss with my Clinical Supervisor the following resources:
                  
1.    2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain: http://nationalpaincentre.mcmaster.ca:opioid;
                                    
2.    CPSO Policy "Prescribing Drugs": http://www.cpso.on.ca/Policies-Publications/Policy/Prescribing-Drugs;
                  
3.    the Centre for Effective Practice Management of Chronic Non-Cancer Pain Tools:
                  
(i)   https://thewellhealth.ca/wp-content/uploads/2017/03/CEP_CNCP_Main_V1.pdf
(ii)  https://www.cfpc.ca/centre-effective-practice-updates-opioid-manager-tool/; and
(iii) any additional professional education recommended by my Clinical Supervisor.
                  
(b)   I, Dr. Thomas, undertake to provide proof to the College of my successful completion of the Professional Education, including proof of registration and attendance and participant assessment reports, within one (1) month of completing it. I acknowledge that the College will determine, in its sole discretion, whether I have successfully completed the Professional Education.
                                    
(c)   I, Dr. Thomas, undertake to complete the Professional Education within three (3) months of signing this Undertaking.
                                    
(d)   I, Dr. Thomas, 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. Thomas, undertake that, approximately six (6) months after the completion of the Clinical Supervision set out in section (7) above and Appendix "B" 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, 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. Thomas, undertake to co-operate fully with the Reassessment, conducted under the term of this Undertaking. 
                        
(c)   I, Dr. Thomas, 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. Thomas, 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. Thomas, 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. Thomas, 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. Thomas, 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. Thomas, acknowledge that I have executed the OHIP and NMS consent forms, attached hereto as Appendix "D" and Appendix "E", respectively. 
                  
 C.    ACKNOWLEDGEMENT

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

(12)  I, Dr. Thomas, 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. Thomas, 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. Thomas, acknowledge that the College will provide this Undertaking to any Chief of Staff, or a colleague with similar responsibilities, at any Practice Location ("Chief of Staff" or "Chiefs of Staff").
                  
 (15)  I, Dr. Thomas, 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. Thomas, 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. Thomas, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.
                        
(b)   I, Dr. Thomas, 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:
                        
A College investigation was conducted into whether Dr. Thomas engaged in professional misconduct and/or is incompetent in his family medicine practice. As a result of the investigation:
                  
Dr. Thomas shall practice Emergency Medicine only, at a hospital where he holds privileges to so practice, and shall not practice Family Medicine including at a walk-in clinic. 
                  
Dr. Thomas shall not prescribe greater than a five (5) days' supply, with no repeats or refills, of any Narcotic Drug, Narcotic Preparation, Controlled Drug, Benzodiazepine and Other Targeted Substance or Monitored Drug to any patient.
                        
Dr. Thomas will practise under the guidance of a Clinical Supervisor acceptable to the College for seven (7) months. 
                  
Dr. Thomas will engage in professional education in the prescribing of narcotics and controlled substances.
                  
Dr. Thomas's practice will be reassessed by an assessor selected by the College approximately six (6) months following the period of Clinical Supervision.
                        
D.    CONSENT

(18)  I, Dr. Thomas, 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. Thomas, 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. Thomas, give my irrevocable consent to any persons who facilitate 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 of the following:

(a)   any information relevant to this Undertaking;
                  
(b)   any information relevant to the provisions of the Clinical Supervisor's undertaking set out at Appendix "B" to this Undertaking;
                  
(c)   any information relevant to the Reassessment;
                  
(d)   any information relevant for the purposes of monitoring my compliance with this Undertaking; and/or

(e)   any information which comes to their attention in the course of providing the Professional Education and which they reasonably believe indicates a potential risk of harm to my patients.
        
(3 of 3)

As from 4:00 p.m., June 19, 2019, by order of the Discipline Committee of the College of Physicians and Surgeons of Ontario, the following terms, conditions and limitations are imposed on the certificate of registration held by Dr. Cholemkeril Kuncheria Thomas:

i.    Dr. Thomas shall comply with the College Policy #2-07 "Practice Management Considerations for Physicians Who Cease to Practise, Take an Extended Leave of Absence or Close Their Practice Due to Relocation", a copy of which is attached at Schedule "A" to this Order; 
                         
Clinical Supervision

ii.   For a period of nine (9) months from the date of this Order, Dr. Thomas shall practice medicine only under the supervision of a clinical supervisor approved by the College (the "Clinical Supervision").
                  
iii.  Within ten (10) days of this Order, Dr. Thomas shall have a College-approved clinical supervisor (the "Clinical Supervisor") sign an Undertaking in the form attached hereto as Schedule "B".
                  
 iv.   Dr. Thomas shall meet with the Clinical Supervisor once in August 2019, once in November 2019, and once in February 2020.  At each meeting, the Clinical Supervisor shall:
                  
i.    Review a minimum of twenty (20) patient charts, to be selected by the Clinical Supervisor in accordance with the educational needs identified in the Individualized Education Plan attached hereto at Schedule "C" (the "IEP");

 ii.   Discuss with Dr. Thomas any concerns the Clinical Supervisor may have arising from the chart reviews;

iii.  Make recommendations to Dr. Thomas for practice improvements and inquire into Dr. Thomas' compliance with the recommendations; and
                  
iv.    Keep a log of all patient charts reviewed along with patient identifiers.
                  
v.    The Clinical Supervisor shall submit written reports to the College promptly after every meeting with Dr. Thomas, or immediately if the Clinical Supervisor has concerns about Dr. Thomas' standard of practice or that Dr. Thomas' patients may be exposed to harm or injury. 
                  
 vi.   Dr. Thomas shall fully cooperate with the Clinical Supervision and shall abide by all recommendations of the Clinical Supervisor.
                  
vii.  If a person who has given an Undertaking in Schedule "B" to this Order is unable or unwilling to continue to fulfill its provisions, Dr. Thomas 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.
                        
 viii. If Dr. Thomas is unable to obtain a Clinical Supervisor as set out in this Order, he shall cease practising medicine until such time as he has obtained a Clinical Supervisor acceptable to the College.
                        
ix.   If Dr. Thomas is required to cease practise as a result of section 4.(viii) above, this will constitute a term, condition or limitation on his certificate of registration and that term, condition or limitation will be included on the public register.

Reassessment

x.    Approximately six (6) months following completion of the Clinical Supervision, Dr. Thomas shall undergo a reassessment of his practice by a College-appointed assessor (the "Reassessment"). 
                        
xi.   The Reassessment shall focus on the educational needs addressed during the period of Clinical Supervision as set out in the IEP and may include a review of Dr. Thomas's patient charts, direct observations, and interviews with staff and/or patients and any other tools deemed necessary by the College.  The Assessor shall report the results of the Reassessment to the College.
                        
Monitoring

 xii.  Dr. Thomas shall inform the College of each and every location where he practices, in any jurisdiction (his "Practice Location(s)") within fifteen (15) days of this Order and shall inform the College of any and all new Practice Locations within fifteen (15) days of commencing practice at that location.
                  
xiii. Dr. Thomas shall consent to the sharing of information between the Clinical Supervisor, the Assessor and the College as any of them deem necessary or desirable in order to fulfill their respective obligations.
                        
 xiv.  Dr. Thomas shall consent to the College making enquiries of the Ontario Health Insurance Program, the Narcotics Monitoring System and/or any person or institution that may have relevant information, in order for the College to monitor his compliance with this Order and shall promptly sign such consents as may be necessary for the College to obtain information from these persons or institutions.
                        
xv.   Dr. Thomas shall co-operate with unannounced inspections of his office practice and patient charts by the College for the purpose of monitoring and enforcing his compliance with the terms of this Order. 
                  
xvi.  Dr. Thomas shall notify any employer, or any hospital at which he may have privileges, about this Order.
                  
xvii. Dr. Thomas shall be responsible for any and all costs associated with implementing the terms of this Order.