As from April 6, 2020, the following are imposed as terms, conditions and
limitations on the certificate of registration held by Dr. Nicholas Samuel
Ciurria in accordance with an undertaking and consent given by Dr. Ciurria to
the College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")
of
DR. NICHOLAS SAMUEL CIURRIA
("Dr. Ciurria")
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;
"NMS" means the Drug Program Services Branch, the Narcotics Monitoring
System implemented under the Narcotics Safety and Awareness Act, 2010;
"OHIP" means the Ontario Health Insurance Plan;
"Public Register" means the College's register that is available to the
public.
(2) I, Dr. Ciurria, certificate of registration number 29153, am a member of
the College.
(3) I, Dr. Ciurria, acknowledge that the College received information from
the NMS and conducted an investigation into whether I failed to maintain
the standard of practice of the profession and/or was incompetent in my
prescribing of controlled substances, including narcotics (the
"Investigation"). As a result of the Investigation, I underwent
remediation and submitted to a reassessment of my practice. The
reassessment report subsequently received by the College continued to
raise concerns about my practice, including my prescribing of controlled
substances.
B. UNDERTAKING
(4) I, Dr. Ciurria, undertake to abide by the provisions of this Undertaking,
effective immediately.
(5) Professional Education
(a) I, Dr. Ciurria, undertake to participate in and successfully
complete all aspects of the detailed IEP, attached hereto as
Appendix "A", including all of the following professional education
(the "Professional Education"):
(i) review and reflection on:
1. Benzodiazepine Deprescribing Algorithm,
deprescribing.org
www.cfp.ca/content/cfp/suppl/2018/05/14/64.5.339.DC1/Algorithm_eng.pdf;
2. Clinical Toolkit - Benzodiazepines: Use and Taper,
College of Physicians and Surgeons of Alberta
www.cpsa.ca/wp-content/uploads/2017/06/Benzodiazepine-Clinical-Toolkit-Use-and-Taper.pdf;
3. Managing Benzodiazepine Use in Older Adults, Centre for
Effective Practice
https://cep.health/clinical-products/benzodiazepine-use-in-older-adults/;
4. Opioid Tapering Template, Centre for Effective Practice
https://cep.health/clinical-products/opioid-tapering-template/.
(ii) completion of CMPA's Documentation: Charting Medical Records
and Documentation II: Principles of Medical Record Keeping
eLearning modules; and
(iii) enrolment and engagement in Project ECHO's Addiction Medicine
and Psychosocial Interventions program.
(b) I, Dr. Ciurria, 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. Ciurria, undertake to complete this requirement within three
(3) months or, if no satisfactory program is available by that
time, at the first possible opportunity thereafter.
(d) I, Dr. Ciurria, acknowledge that a report or reports may be
provided to the College regarding my progress and compliance with
the Professional Education.
(6) Reassessment of Practice
(a) I, Dr. Ciurria, undertake that, approximately twelve (12) months
after the completion of the Professional Education set out in
section (5) above, 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. Ciurria, undertake to co-operate fully with the
Reassessment, conducted under the term of this Undertaking.
(c) I, Dr. Ciurria, 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.
(7) Monitoring
(a) I, Dr. Ciurria, 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. Ciurria, 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. Ciurria, 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. Ciurria, acknowledge that I have executed the OHIP and NMS
consent forms, attached hereto as Appendix "B" and Appendix "C",
respectively.
C. ACKNOWLEDGEMENT
(8) I, Dr. Ciurria, acknowledge that all appendices attached to or referred
to in this Undertaking form part of this Undertaking.
(9) I, Dr. Ciurria, 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.
(10) I, Dr. Ciurria, 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.
(11) I, Dr. Ciurria, 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").
(12) I, Dr. Ciurria, 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.
(13) I, Dr. Ciurria, acknowledge that this Undertaking constitutes terms,
conditions, and limitations on my certificate of registration for the
purposes of section 23 of the Code.
(14) Public Register
(a) I, Dr. Ciurria, acknowledge that, during the time period that this
Undertaking remains in effect, this Undertaking shall be posted on
the Public Register.
(b) I, Dr. Ciurria, acknowledge that, in addition to this Undertaking
being posted in accordance with section (14)(a) above, the
following summary shall be posted on the Public Register during the
time period that this Undertaking remains in effect:
Dr. Ciurria underwent remediation and submitted to a
reassessment of his practice following an investigation into
his prescribing of controlled substances, including
narcotics. The reassessment report subsequently received by
the College continued to raise concerns about his practice,
including his prescribing of controlled substances. As a
result:
Dr. Ciurria will engage in professional education in
opioid and benzodiazepine prescribing, and medical
record-keeping.
Dr. Ciurria's practice will be reassessed by an
assessor selected by the College 12 months after
completion of the professional education.
(c) I, Dr. Ciurria, acknowledge that this Undertaking remains in effect
until the College determines its terms are satisfied.
D. CONSENT
(15) I, Dr. Ciurria, 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
all 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.
(16) I, Dr. Ciurria, 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.
(17) I, Dr. Ciurria, give my irrevocable consent to any persons who facilitate
my completion of the Professional Education, and to 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 Reassessment;
(c) any information relevant for the purposes of monitoring my
compliance with this Undertaking; and/or
(d) 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.