skip to content

Kiellerman, Andrew John

CPSO#: 97058

MEMBER STATUS
Active Member as of 25 Nov 2011
CURRENT OR PAST CPSO REGISTRATION CLASS
Restricted as of 10 May 2023

Summary

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum ac diam sit amet quam vehicula elementum sed sit amet dui. Vivamus suscipit tortor eget felis porttitor volutpat. Curabitur non nulla sit amet nisl tempus convallis quis ac lectus. Curabitur aliquet quam id dui posuere blandit. Vivamus suscipit tortor eget felis porttitor volutpat. Curabitur arcu erat, accumsan id imperdiet et, porttitor at sem. Vestibulum ac diam sit amet quam vehicula elementum sed sit amet dui. Donec sollicitudin molestie malesuada. Pellentesque in ipsum id orci porta dapibus.

Former Name: No Former Name

Gender: Male

Languages Spoken: English, Polish

Education: Jagiellonian University Medical College, 1983

Practice Information

Primary Location of Practice
100 The Boardwalk
Kitchener ON  N2N 0B1
Phone: 5192794098
Fax: 5192794099 Electoral District: 03

Professional Corporation Information


Corporation Name: Andrew Kiellerman Medicine Professional Corporation
Certificate of Authorization Status: Inactive: Nov 21 2023

Specialties

Specialty Issued On Type
Family Medicine Effective:29 May 2017 CFPC Specialist

Registration History

Action Issue Date
First certificate of registration issued: Restricted certificate Effective: 25 Nov 2011
Terms and conditions imposed on certificate by Registration Committee Effective: 25 Nov 2011
Terms and conditions amended by member Effective: 09 Aug 2017
Transfer of class of certificate to: Restricted certificate Effective: 10 May 2023

Practice Restrictions

Imposed By Effective Date Expiry Date Status
member Effective: 11 May 2023 Active
 As from May 10th, 2023, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Andrew John Kiellerman in accordance with an undertaking and consent given by Dr. Kiellerman to the College of Physicians and Surgeons of Ontario:

UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")

of

DR. ANDREW JOHN KIELLERMAN
("Dr. Kiellerman")

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; 

"Discipline Tribunal" means the Ontario Physicians and Surgeons Discipline Tribunal of the College;

"IEP" means Individualized Education Plan;

"OHIP" means the Ontario Health Insurance Plan; 

"Ontario Physicians and Surgeons Discipline Tribunal" means the Discipline Committee established under the Code;

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

"QAC" means the Quality Assurance Committee of the College.

(2) I, Dr. Kiellerman, certificate of registration number 97058, am a member of the College.  

(3) I, Dr. Kiellerman, acknowledge that concerns have been identified with respect to my knowledge, skill and judgment. I am aware of the College's concern about protecting the public.

(4) I, Dr. Kiellerman, acknowledge that I entered into an undertaking dated June 30, 2017 ("the June 2017 undertaking") in which I ceased to practice in a walk-in setting. This Undertaking replaces the June 2017 undertaking.

B. UNDERTAKING

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

(6) Clinical Supervision of Walk-In Practice

(a) I, Dr. Kiellerman, undertake to practise in my walk-in practice under the guidance of a clinical supervisor or supervisors acceptable to the College (the "Clinical Supervisor" or "Clinical Supervisors"), for at least nine (9) months ("Clinical Supervision"). Clinical Supervision shall only cease upon approval of the College. 

(b) I, Dr. Kiellerman, undertake to practice under the following terms of Clinical Supervision of my walk-in practice: 
Phase 1 - Moderate Level Supervision (with direct observation)

(i) For a minimum of four (4) weeks, my Clinical Supervisor will:

1. Be immediately available onsite or by phone at all times; 

2. meet with me at my Practice Location, or another location approved by the College, once every week;

3. directly observe a minimum of five (5) patient encounters each week; 

4. review at least ten (10) of my patient charts at every meeting to comment on diagnosis, documentation and treatment plan;

5. discuss any concerns arising from the chart reviews or direct observation;

(ii) My Clinical Supervisor will submit a written report to the College at the end of four (4) weeks of Moderate Level Supervision (with direct observation) in accordance with the terms of the IEP, or more frequently if my Clinical Supervisor has concerns about my standard of practice;

Phase 2 - Moderate Level Supervision (no observation) 

(iii) After a minimum of four (4) weeks of Moderate Level Supervision (no observation), if my Clinical Supervisor recommends and the College approves a reduction in the level of supervision, my Clinical Supervisor will:

1. be immediately available onsite or by phone at all times; 

2. meet with me at my Practice Location, or another location approved by the College, once every two (2) weeks for at least two (2) months;

3. review at least ten (10) of my patient charts at every meeting to comment on diagnosis, documentation and treatment plan;
4. discuss any concerns arising from the chart reviews;

(iv) My Clinical Supervisor will submit a written report to the College at the end of two (2) months of Moderate Level Supervision (no observation) in accordance with the requirements of the IEP, or more frequently if my Clinical Supervisor has concerns about my standard of practice;

Phase 3 - Low Level Supervision

(v) After a minimum of two (2) months of Moderate Level Supervision (no observation), if my Clinical Supervisor recommends and the College approves a further reduction in the level of supervision, my Clinical Supervisor will:

1. meet with me at my Practice Location, or another location approved by the College, once every month for a further six (6) months;

2. Review at least fifteen (15) of my patient charts at every meeting to comment on diagnosis, documentation and treatment plan;

3. Discuss any concerns arising from the chart reviews;

4. Submit a written report to the College every three (3) months during Low level Supervision in accordance with the requirements of the IEP, or more frequently if my Clinical Supervisor has concerns about my standard of practice;

(vi) At the end of a minimum of six (6) months of Low Level Supervision, my Clinical Supervisor will submit a final summative report to the College in accordance with the requirements of the IEP, which report shall include the Supervisor's recommendation as to whether they support my return to independent practice.  

(c) I, Dr. Kiellerman, acknowledge that I have reviewed the Clinical Supervisor's undertaking attached hereto as Appendix "A", and understand what is required of the Clinical Supervisor. The Clinical Supervisor will, at minimum:

(i) Facilitate the education program set out in the IEP attached as Appendix "B";

(ii) Review the materials provided by the College and have an orientation session with me, including to discuss the objectives for the Clinical Supervision;

(iii) Make recommendations to me for practice improvements and ongoing professional development and inquire into my compliance with the recommendations;

(iv) 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.

(d) I, Dr. Kiellerman, acknowledge that the charts reviewed shall be selected by the Clinical Supervisor based on the educational needs identified in the IEP set out at Appendix "B" to my Undertaking and concerns that may arise during the period of Clinical Supervision.

(e) I, Dr. Kiellerman, undertake to cooperate fully with the Clinical Supervision of my practice described in section (6) of this Undertaking and Appendix "A" attached, and undertake to abide by the recommendations of my Clinical Supervisor, including but not limited to recommended practice improvements and ongoing professional development. 

(f) I, Dr. Kiellerman, undertake to ensure that Appendix "A" to this Undertaking is signed and delivered to the College within thirty (30) days of the date I execute this Undertaking. 

(g) I, Dr. Kiellerman, undertake that if a person who has given an undertaking in Appendix "A" 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.

(h) I, Dr. Kiellerman, undertake that if I am unable to obtain a Clinical Supervisor as set out in sections (6)(f) and (6)(g) above, I will cease practicing walk-in medicine until such time as I have obtained a Clinical Supervisor acceptable to the College.  

(i) I, Dr. Kiellerman, acknowledge that if I am required to cease practise as a result of section (6)(h) above this will constitute a term, condition or limitation on my certificate of registration and said term, condition or limitation will be included on the public register.

(7) Professional Education

(a) I, Dr. Kiellerman, undertake to participate in and successfully complete the following professional education (the "Professional Education"):

(i) Course: Test Results Follow-up, Canadian Medical Protective Association; 

(ii) Review, reflection and a discussion with my Clinical Supervisor of the following policies and other resources: 

1. Medical Records Documentation, College policy; 

2. Walk-in Clinics, College policy; 

3. Managing Tests, College policy; 

4. Choosing Wisely Canada - Using Antibiotics Wisely;

(iii) all aspects of the detailed IEP, attached hereto as Appendix "B"; and

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

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

(d) I, Dr. Kiellerman, undertake to complete this requirement within three (3) months or, if no satisfactory program is available by that time, by the first possible opportunity thereafter.

(8) Reassessment of Practice of Walk-In Practice

(a) I, Dr. Kiellerman, undertake that, approximately six (6) months after the completion of the Clinical Supervision and the Professional Education set out above and in Appendix "A" and Appendix "B" attached, I will submit to a reassessment of my walk-in 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. Kiellerman, undertake to co-operate fully with the Reassessment conducted under section (8) of this Undertaking. 

(c) I, Dr. Kiellerman, acknowledge and provide consent 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. Kiellerman, 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. 

(9) Monitoring

(a) I, Dr. Kiellerman, undertake to inform the College of each and every location at which I practice, delegate, or have privileges, including, but not limited to, any hospitals, clinics, offices, and any Out-of-Hospital Premises and Independent Health Facilities with which I am affiliated, in any jurisdiction (collectively my "Practice Location" of "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. Kiellerman, 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. ACKNOWLEDGEMENT 

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

(11)	I, Dr. Kiellerman, 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.

(12)	I, Dr. Kiellerman, 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.

(13)	I, Dr. Kiellerman, 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").

(14)	I, Dr. Kiellerman, 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 any one or more of the following: consideration by the QAC, an investigation by the College, or further action by the College, including a referral of specified allegations to the Discipline Tribunal.

(15)	I, Dr. Kiellerman, acknowledge that this Undertaking constitutes terms, conditions, and limitations on my certificate of registration for the purposes of section 23 of the Code. 

(16)	Public Register

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

(b) I, Dr. Kiellerman, acknowledge that, in addition to this Undertaking being posted in accordance with section (16)(a) above, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:
Concerns have been identified with respect to Dr. Kiellerman's knowledge, skill and judgment in relation to his walk-in practice. 

As a result:

 Dr. Kiellerman, at his walk-in practice, will practise under the guidance of a Clinical Supervisor acceptable to the College for a minimum of 9 months. 

 Dr. Kiellerman will engage in professional education, including in medical record-keeping, and patient and family-centred care.

 Dr. Kiellerman's walk-in practice will be reassessed by an assessor selected by the College within 6 months of the end of the period of Clinical Supervision.

D. CONSENT

(17)	I, Dr. Kiellerman, give my irrevocable consent to the College to make appropriate enquiries of OHIP 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.

(18)	I, Dr. Kiellerman, acknowledge that I have executed the OHIP consent form, attached hereto as Appendix "C".

(19)	I, Dr. Kiellerman, give my irrevocable consent to the College to provide the following information to any person who facilitates my completion of the Professional Education and to all Clinical Supervisors and 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.

(20)	I, Dr. Kiellerman, give my irrevocable consent to the College to provide all Chiefs of Staff with any information arising from the monitoring of my compliance with this Undertaking.

(21)	I, Dr. Kiellerman, give my irrevocable consent to all Clinical Supervisors, Chiefs of Staff, Assessors, and any persons who facilitate my completion of the Professional Education, 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 Appendix "A";
(c) relevant to the Reassessment;
(d) relevant for the purposes of monitoring my compliance with this Undertaking; and  
(e) 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.


Concerns

Source: Member
Active Date: May 10, 2023
Expiry Date:
Summary:
Summary of the Undertaking given by Dr. Andrew John Kiellerman to the College of Physicians and Surgeons of Ontario, effective May 10th 2023:
 
Concerns have been identified with respect to Dr. Kiellerman’s knowledge, skill and judgment in relation to his walk-in practice. As a result:
 
Dr. Kiellerman, at his walk-in practice, will practise under the guidance of a Clinical Supervisor acceptable to the College for a minimum of 9 months.
 
Dr. Kiellerman will engage in professional education, including in medical record-keeping, and patient and family-centred care.
 
Dr. Kiellerman’s walk-in practice will be reassessed by an assessor selected by the College within 6 months of the end of the period of Clinical Supervision.

CPSO will be closed on March 29, 2024. We will re-open on Monday, April 1, 2024, at 8:00 am.