As from January 29, 2019, the following is imposed as a term, condition and
limitation on the certificate of registration held by Dr. Eric John Ireland, in
accordance with an undertaking and consent given by Dr. Ireland to the College
of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")
of
DR. ERIC JOHN IRELAND
("Dr. Ireland")
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 the current regulatory lists are attached
hereto as Schedule "B")
"All other Monitored Drugs" means as defined under the Narcotics Safety
and Awareness Act, 2010, S.O. 2010, c. 22, as amended, as noted in
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. Ireland, certificate of registration number 28569, am a member of
the College.
(3) I, Dr. Ireland, acknowledge that the College received information from a
public complaint and initiated an investigation bearing File Number
7215346 (the "Investigation") into whether I failed to maintain the
standard of practice of the profession and/or am incompetent in my
prescribing of controlled substances, including narcotics.
B. UNDERTAKING
(4) I, Dr. Ireland, undertake to abide by the provisions of this Undertaking
effective upon the date I sign it (the "Effective Date").
(5) I, Dr. Ireland, shall keep a Log of all prescriptions for Narcotic Drugs,
Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other
Targeted Substances and All other 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. Ireland'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. Ireland, undertake to keep a copy of all prescriptions I write for
Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines
and Other Targeted Substances and All other Monitored Drugs, in the
corresponding patient chart.
(7) Clinical Supervision
(a) I, Dr. Ireland, undertake to practise under the guidance of a
clinical supervisor(s) acceptable to the College (the "Clinical
Supervisor(s)"), for a minimum of ten (10) months on the terms set
out below (the "Clinical Supervision").
(b) I, Dr. Ireland, acknowledge and undertake that each phase of
Clinical Supervision set out below will only be reduced upon
recommendation of the Clinical Supervisor(s) and approval by the
College.
Phase 1 of Clinical Supervision ("Phase 1")
(c) I, Dr. Ireland, undertake to engage in Phase 1 of Clinical
Supervision for a minimum of four (4) months on the terms set out
below.
(d) During Phase 1, I, Dr. Ireland, undertake to meet with my Clinical
Supervisor(s) at least once every two (2) months to discuss the
Clinical Supervisor(s)'s review of:
i. Fifteen (15) charts for patients to whom I have prescribed
Narcotic Drugs, Narcotic Preparations, Controlled Drugs,
Benzodiazepines and Other Targeted Substances and All other
Monitored Drugs since the Clinical Supervisor(s)'s prior
review.
(e) I, Dr. Ireland, acknowledge that during Phase 1, the Clinical
Supervisor(s) will provide a report to the College at least once
every two (2) months.
(f) I, Dr. Ireland, acknowledge that after a minimum of four (4) months
of Phase 1, if the Clinical Supervisor(s) is satisfied that I have
the necessary knowledge, skills and judgment to practice in a less
highly supervised environment, the Clinical Supervisor(s) may
recommend to the College that supervision be reduced.
Phase 2 of Clinical Supervision ("Phase 2")
(g) Upon the recommendation of the Clinical Supervisor(s) and approval
by the College, I, Dr. Ireland, undertake to engage in Phase 2 of
Clinical Supervision for a minimum of six (6) months on the terms
set out below.
(h) During Phase 2, I, Dr. Ireland, undertake to meet with my Clinical
Supervisor(s) at least once every three (3) months to discuss the
Clinical Supervisor(s)'s review of:
i. 15 charts for patients to whom I have prescribed Narcotic
Drugs, Narcotic Preparations, Controlled Drugs,
Benzodiazepines and Other Targeted Substances and All other
Monitored Drugs since the Clinical Supervisor(s)'s prior
review
(i) I, Dr. Ireland, acknowledge that during Phase 2, the Clinical
Supervisor(s) will provide a report to the College at least once
every three (3) months.
(j) I, Dr. Ireland, acknowledge that I have reviewed the Clinical
Supervisor(s)'s undertaking, attached hereto as Schedule "E", and
understand what is required of the Clinical Supervisor(s). In
addition to what is set out above, the Clinical Supervisor(s) will,
at a minimum:
(i) Facilitate the education program set out in the
Individualized Education Plan ("IEP") attached as Schedule
"F";
(ii) Discuss any concerns with me arising from chart reviews and
observations;
(iii) Make recommendations to me for practice improvements and
ongoing professional development and inquire into my
compliance with the recommendations; and
(iv) Perform any other duties, such as reviewing other documents
or conducting interviews with staff or colleagues, that the
Clinical Supervisor(s) deem necessary to my Clinical
Supervision.
(k) I, Dr. Ireland, undertake that all meetings with my Clinical
Supervisor(s) will take place at my Practice Location, or another
location approved by the College;
(l) I, Dr. Ireland, acknowledge that all charts reviewed shall be
independently selected by the Clinical Supervisor(s) based on the
educational needs identified in the IEP set out at Schedule "F" to
my Undertaking, as well as the areas of concern identified in the
report of the medical inspector dated December 5, 2016, and
concerns that may arise during the period of Clinical Supervision.
(m) I, Dr. Ireland, 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
reasonable recommendations of my Clinical Supervisor(s), including
but not limited to, any reasonable recommended practice
improvements and ongoing professional development.
(n) I, Dr. Ireland, undertake to ensure that Schedule "E" to this
Undertaking, is signed and delivered to the College within thirty
(30) days of the Effective Date.
(o) I, Dr. Ireland, 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
thirty (30) 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.
(p) I, Dr. Ireland, agree that if I am unable to obtain a Clinical
Supervisor on the terms set out in sections (7)(n) and/or (o)
above, I will cease prescribing Narcotic Drugs, Narcotic
Preparations, Controlled Drugs, Benzodiazepines and Other Targeted
Substances and All other Monitored Drugs until such time as I have
obtained a Clinical Supervisor acceptable to the College.
(q) I, Dr. Ireland, agree that if I am required to cease prescribing
Narcotic Drugs, Narcotic Preparations, Controlled Drugs,
Benzodiazepines and Other Targeted Substances and All other
Monitored Drugs as a result of section (7)(p) 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. Ireland, undertake to participate in and successfully
complete all elements of the detailed IEP, attached hereto as
Schedule "F, including:
i. Review and discussion with my Clinical Supervisor(s) of the
following:
1. Narcotics and Controlled Substances section of the CPSO
Policy: Prescribing Drugs;
2. Current Canadian Guideline for Opioids for Chronic
Non-Cancer Pain and resource on tapering;
3. CMPA article: Preventing the Misuse of Opioids; and
ii. Any additional professional education recommended by my
Clinical Supervisor(s).
(b) I, Dr. Ireland, 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. Ireland, undertake that, approximately six (6) months after
the Clinical Supervision set out under section 7 of the Undertaking
has ceased, I will submit to a reassessment of my practice (the
"Reassessment") by an assessor or assessors (the "Assessor" or
"Assessors") selected by the College.
(b) I, Dr. Ireland, acknowledge and agree that the Reassessment shall
include a chart review of a minimum of fifteen (15) patient charts,
and may include: direct observation of my care, an interview of me,
interviews with colleagues and co-workers, feedback from patients
and any other tools deemed necessary by the College.
(c) I, Dr. Ireland, undertake to co-operate fully with the Reassessment
conducted under the terms of this Undertaking.
(d) I, Dr. Ireland, acknowledge and agree that my Clinical
Supervisor(s) may receive and review the findings of the
Assessor(s), and may discuss with the Assessor(s) any issues or
concerns arising from the Reassessment.
(e) I, Dr. Ireland, acknowledge that the results of the Reassessment
will be provided to me and reported to the College and that the
Reassessment may form the basis of further action by the College.
(10) Monitoring
(a) I, Dr. Ireland, 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(s)"), within five (5) business
days of executing this Undertaking. Going forward, I further
undertake to inform the College of any and all new Practice
Locations within five (5) business days of commencing practice at
that Location.
(b) I, Dr. Ireland, undertake and agree that I will submit to, and not
interfere with, unannounced inspections of my Practice Location(s)
and patient records by a College representative for the purposes of
monitoring my compliance with the provisions of this Undertaking.
(c) I, Dr. Ireland, give my irrevocable consent to the College to make
appropriate enquiries of the Ontario Health Insurance Plan
("OHIP"), the Drug Program Services Branch, the Narcotics
Monitoring System ("NMS") implemented under the Narcotics Safety
and Awareness Act, 2010 and/or any person or institution who may
have relevant information, in order for the College to monitor my
compliance with the provisions of this Undertaking.
(d) I, Dr. Ireland, 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. Ireland, acknowledge that all schedules attached to or referred to
in this Undertaking form part of this Undertaking.
(12) I, Dr. Ireland, 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. Ireland, 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. Ireland, 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. Ireland, 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. Ireland, 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. Ireland, acknowledge that, during the time period that this
Undertaking remains in effect, this Undertaking shall be posted on
the Public Register.
(b) I, Dr. Ireland, acknowledge that, in addition to this Undertaking
being posted in accordance with the section 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 arising from a public complaint
about Dr. Ireland's prescribing of controlled substances, including
narcotics.
Based on the information received, the College conducted an
investigation into whether Dr. Ireland failed to maintain the
standard of practice of the profession and/or was incompetent in
his prescribing of controlled substances, including narcotics. As
a result of the investigation:
* Dr. Ireland's prescribing of narcotic drugs, narcotic
preparations, controlled drugs, benzodiazepines and other
targeted substances, and other monitored drugs will be
supervised by a Clinical Supervisor acceptable to the College
for minimum of ten (10) months.
* Dr. Ireland will engage in professional education in the
prescribing of controlled substances, including narcotics.
* Following the professional education and period of
supervision, Dr. Ireland's prescribing of controlled
substances, including narcotics, will be re-assessed by an
assessor selected by the College.
D. CONSENT
(18) I, Dr. Ireland, 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. Ireland, give my irrevocable consent to the College to provide all
Chief(s) 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. Ireland, 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.