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Martinez, Lionel Gines

CPSO#: 70956

MEMBER STATUS
Suspended as of 12 May 2020
CPSO REGISTRATION CLASS
Restricted as of 13 Jul 2009
Flag: Indicates a concern or additional information

Summary

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Former Name: No Former Name

Gender: Male

Languages Spoken: English, French

Education:University of Toronto, 1996

Practice Information

Primary Location of Practice
Practice Address Not Available

Professional Corporation Information


Corporation Name: Dr. Lionel Martinez Medicine Professional Corporation
Certificate of Authorization Status: Inactive: Oct 15 2010
Corporation Name: Dr. Lionel Martinez Medicine Professional Corporation
Certificate of Authorization Status: Inactive: Feb 2 2017

Specialties

Specialty Issued On Type
No Speciality Reported

Postgraduate Training

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



McMaster University, 01 Jul 1996 to 30 Jun 1997
PostGrad Yr 1 - Family Medicine

McMaster University, 01 Jul 1997 to 31 Dec 1997
PostGrad Yr 1 - Family Medicine

McMaster University, 01 Jan 1998 to 30 Jun 1998
PostGrad Yr 2 - Family Medicine

McMaster University, 01 Jul 1998 to 30 Jun 1999
PostGrad Yr 2 - Family Medicine

McMaster University, 01 Jul 1999 to 30 Nov 1999
PostGrad Yr 3 - Family Medicine

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 10 Jan 1997
Transfer of class of registration to: Independent Practice Certificate Effective: 22 Jul 1999
Transfer of class of certificate to: Restricted certificate Effective: 13 Jul 2009
Terms and conditions imposed on certificate by member Effective: 13 Jul 2009
Terms and conditions amended by member Effective: 30 Aug 2010
Terms and conditions amended by Inquiries, Complaints and Repo Effective: 15 Jun 2011
Terms and conditions amended by Discipline Committee Effective: 11 May 2020
Suspension of registration imposed: Discipline Committee Effective: 12 May 2020

Practice Restrictions Flag: indicates a concern or additional information

Registration Status: Suspended     Effective From: 12 May 2020


Imposed By Effective Date Expiry Date Status
Discipline Committee Effective: 12 May 2020 Active

Previous Hearings Flag: indicates a concern or additional information

Committee: Discipline
Decision Date: 11 May 2020
Summary:

On May 11, 2020, on the basis of an Agreed Statement of Facts on Liability and 
 Admission, and a Statement of Uncontested Facts and Plea of No Contest, the 
 Discipline Committee of the College of Physicians and Surgeons of Ontario (“the 
College”) found that Dr. Lionel Gines Martinez (“Dr. Martinez”) committed an act of 
professional misconduct, in that in that he failed to maintain the standard of practice of 
 the profession, and engaged in an act or omission relevant to the practice of medicine 
 that, having regard to all the circumstances, would reasonably be regarded by members 
 as disgraceful, dishonourable or unprofessional.  
 
BACKGROUND 
 
 The facts set out in the Agreed Statement of Facts and Admission included the 
 following: 
  
 Dr. Martinez is a 58-year-old family physician who received his certificate of registration 
 authorizing independent practice from the College on July 22, 1999. At the relevant 
 times, Dr. Martinez practised at A+ Medical Clinic in Toronto, Ontario.  
  
 Reassessment Pursuant to 2014 Undertaking 
  
 In 2014, Dr. Martinez entered into an undertaking with the College that required him to 
 complete a period of supervision with respect to his medical record-keeping and 
 undergo a reassessment of his practice.  
  
 Pursuant to the terms of the 2014 Undertaking, after the supervision of Dr. Martinez’s 
 practice was complete, the College conducted a reassessment of Dr. Martinez’s 
 practice with a focus on his medical record keeping. The College retained Dr. Brian 
 Silver, an experienced family physician, to conduct the reassessment. Dr. Silver provided 
 a reassessment report to the College, dated May 4, 2017. In his report, Dr. Silver opined 
 that Dr. Martinez failed to maintain the standard of practice of the profession in his 
 record keeping in 17 out of 20 charts reviewed. Dr. Silver’s primary concerns were 
 legibility, organization and completeness of Dr. Martinez’s chart entries and Cumulative 
 Patient Profiles. Dr. Silver also opined that Dr. Martinez displayed a lack of knowledge, 
 skill, and judgment by prescribing a high-dosage steroid ointment to a patient to treat 
 breast intertrigo (an inflammatory skin condition), and by failing to document vital 
 statistics, such as height and weight, for his diabetic patient. 
  
 In his response to Dr. Silver’s reassessment report, Dr. Martinez advised that he had 
 decided to engage in further remedial steps regarding his recordkeeping, as well as 
 management of skin conditions. He also advised that he left his previous practice 
 location and had also moved to an electronic medical record system (“EMR”) to address 
 issues of legibility. Dr. Martinez provided examples of more recent electronic chart 
 entries from his practice for Dr. Silver to review.  
  
 Dr. Silver provided an addendum report stating that Dr. Martinez’s response did not 
 change his opinion with respect to whether Dr. Martinez maintained the standard of 
 practice of the profession in the charts previously reviewed. Dr. Silver commented that 
 the more recent sample medical records showed improvement over the earlier charts, 
 but noted typographical errors and omissions in five charts.  
  
 Time-Based Billing Codes 
  
 On March 23, 2015, the College received information from the National Investigative 
 Unit of Medavie Blue Cross, the provider that administers the Interim Federal Health 
 Program (the “IFHP”) on behalf of the Canadian government. The IFHP provides limited, 
 temporary health coverage for certain groups, including refugees and refugee claimants 
 in Canada. Ontario physicians submit billing claims to the IFHP based on fee codes set 
 out in the Ontario Health Insurance Plan (“OHIP”) Schedule of Benefits.  
  
 Medavie Blue Cross advised the College that it had concerns regarding Dr. Martinez’s 
 practice after conducting a review of his billing claims and conducting an onsite audit of 
 his practice. Medavie Blue Cross’s concerns included: 
  
        a) overlapping time stamps for time-based billing codes; 
  
        b) multiple patients seen at the same time on the same date; and  
  
        c) patient records for time-based services that did not include time stamps 
           indicating the duration of the service provided.  
 
Medavie Blue Cross provided examples of each concern documented in its review of Dr. 
Martinez’s billing claims and patient records. 
  
 Under the OHIP Schedule of Benefits, mental health care services, including Cognitive 
 Behavioural Therapy (“CBT”), are time-based services. Time-based billing codes, 
 including K005 (Primary Mental Health Care) and K007 (Individual Psychotherapy), are 
 fee codes in the OHIP Schedule of Benefits that are claimed by physicians in time units 
 based on the amount of time the physician spends rendering the service to the patient. 
 Under the OHIP Schedule of Benefits, to claim these “K-Codes”, physicians are required 
 to spend a minimum amount of time with the patient per unit claimed, and to document 
 in the patient’s permanent medical record the time that the service started and ended.  
  
 Based on the information from Blue Cross, the College conducted an investigation of Dr. 
 Martinez’s billing claims and his provision of CBT. 
  
 The College retained Dr. Nancy Merrow, an experienced family physician and chief of 
 staff at Orillia Soldiers Memorial Hospital, as a Medical Inspector to opine on whether 
 Dr. Martinez maintained the standard of practice of the profession in his provision of 
time-based mental health services and in his billing claims. Dr. Merrow reviewed 30 of 
Dr. Martinez’s patient charts, as well as his billing claims and day sheets, and conducted 
an interview of Dr. Martinez.  
 
In her report, Dr. Merrow concluded, based on the discrepancies between Dr. Martinez’s 
patient encounter logs, patient records, and billing claims, that Dr. Martinez did not meet 
the standard of practice in terms of his administrative oversight of his office and his 
billing claims, including: 
 
       a) submitting claims for lengthy visits without any evidence that the patient 
          required services that would take 30-90 minutes to deliver;  
 
       b) submitting claims for counselling at the same visit as another assessment 
          without a distinct diagnosis as required by the OHIP Schedule of Benefits; 
 
       c) submitting claims to OHIP when he should have submitted them to the 
          Workplace Safety and Insurance Board; and 
 
       d) frequently submitting claims for providing CBT in circumstances in which 
          the only warranted service was an intermediate assessment, and/or without 
          documenting sufficient information (including any goal, plan, or outcome) to 
          demonstrate that the service was provided. 
 
Dr. Merrow observed that Dr. Martinez used the term “CBT” loosely to describe all kinds 
of discussions with his patients, and there was little evidence of Dr. Martinez practicing 
CBT with any kind of methodology. Dr. Merrow concluded that Dr. Martinez displayed a 
lack of knowledge and skill with respect to his practice of CBT, and a lack of judgment 
with respect to recording inaccurate start and stop times for patient encounters.  
 
Dr. Martinez provided a response to Dr. Merrow’s report dated February 8, 2016. Dr. 
Merrow provided an addendum report dated February 17, 2016, in which she addressed 
Dr. Martinez’s response to her report. Dr. Merrow’s opinion with respect to Dr. 
Martinez’s provision of CBT, billing issues, and poor documentation remained 
unchanged. 
 
Dr. Martinez wrote to the College on July 22, 2016, acknowledging that he was solely 
responsible for all of his billing errors. 
 
Dr. Martinez advised the College on December 10, 2018, that he had entered into a 
voluntary repayment agreement with the Ministry of Health to repay the amount of 
$29,275.27 in respect of improperly claimed K-Codes.  
 
On January 8, 2019, the Ministry of Health wrote to Dr. Martinez to confirm the voluntary 
repayment agreement, indicating that the agreed upon amount of $29,275.27 reflects 
30% of the services that Dr. Martinez improperly claimed as K005 primary mental health 
care for the period reviewed by the Ministry. The Ministry of Health acknowledged that 
this arrangement represents a full and final resolution of the incorrect claims for billing 
code K005 with service dates between April 2014 and May 2016.  
 
On November 18, 2015, the College investigator spoke with a representative of Medavie 
Blue Cross. The investigator was informed that Dr. Martinez had started making 
repayments to Medavie Blue Cross and at that point had repaid $500. 
 
In November 2019, Dr. Martinez also entered into an agreement with Medavie Blue 
Cross to repay the outstanding amount of $3,336.65 in respect of his improper billing 
claims. Dr. Martinez has made full repayment of the amount owing to Blue Cross.  
 
Diagnostic Imaging Referrals 
 
On January 22, 2016, the College received information from the Ministry of Health and 
Long-Term Care (the “Ministry”) advising that it had reviewed claims to the Ontario 
Health Insurance Plan (“OHIP”) for diagnostic studies rendered at an independent health 
facility where Dr. Martinez was listed on the claim to OHIP as the referring physician. 
The letter stated that the majority of patients referred in the period of April 1, 2014, to 
January 21, 2016 underwent multiple diagnostic studies on a single service date. 
Further, the Ministry reviewed requisitions and interpretive reports for a number of 
patients referred in this time period and stated in the letter that there was no medical 
necessity for the imaging tests. Based on the information from the Ministry, the College 
conducted an investigation of Dr. Martinez’s practice.  
 
The College retained Dr. Linda Klapwyk as a Medical Inspector to review Dr. Martinez’s 
practice, in particular his ordering of diagnostic imaging, and to opine on whether Dr. 
Martinez’s care met the standard of practice of the profession. Dr. Klapwyk is an 
experienced family physician and professor of family medicine at the University of 
Toronto. Dr. Klapwyk reviewed Dr. Martinez’s OHIP billing claims and 25 of Dr. 
Martinez’s patient charts and conducted an interview of Dr. Martinez. Dr. Klapwyk 
provided a report to the College, dated March 4, 2017.  
 
Dr. Klapwyk concluded that Dr. Martinez failed to maintain the standard of practice of 
the profession. Dr. Klapwyk opined that, in twenty-four out of twenty-five patient charts 
reviewed, there was evidence of diagnostic testing, including x-rays, ultrasounds, bone 
density scans, cardiac testing, and/or mammography ordered by Dr. Martinez without 
an indication for doing the tests.  
 
In his interview with Dr. Klapwyk, Dr. Martinez blamed his office staff for adding tests 
onto his requisition forms without his knowledge by checking off additional tests on the 
requisition forms after Dr. Martinez had signed them. Assuming this was the case, Dr. 
Klapwyk noted there was no documented concern by Dr. Martinez at follow-up visits 
 with patients about the amount of testing that had been done without Dr. Martinez’s 
 authorization. Dr. Martinez advised Dr. Klapwyk that he had been aware of tests being 
 added since 2014, and told Dr. Klapwyk that he had attempted to resolve the issue by 
 speaking to office staff and the clinic’s owner. Dr. Martinez acknowledged that he did 
 not call the police, perform a practice audit, or document his concerns. 
  
 Dr. Klapwyk opined that if Dr. Martinez ordered the diagnostic imaging tests, he 
 displayed a lack of knowledge or judgment and did not maintain the standard of 
 practice of the profession.  
  
 Dr. Klapwyk also opined that even if the tests were ordered by Dr. Martinez’s office staff 
 without his knowledge, Dr. Martinez still failed to maintain the standard of practice of 
 the profession as follows: 
  
        a) Dr. Martinez failed to protect his patients from harm due to unnecessary 
           tests, worry, and radiation exposure; 
 
        b) Dr. Martinez demonstrated a profound lack of judgment in not documenting 
           any concern about tests being done that he did not order or notifying 
           appropriate authorities when he became aware of tests being ordered in his 
           name; and 
 
        c) Dr. Martinez was complicit in his staff’s actions by continuing to review 
           patient test results from 2014 to 2016 without documenting any concerns 
           or taking actions other than speaking with his staff. 
  
 In Dr. Klapwyk’s opinion, Dr. Martinez exposed his patients to a risk of harm or injury. 
  
 Dr. Klapwyk also expressed concerns about other aspects of Dr. Martinez’s care 
 including inadequate knowledge of vitamin B12 deficiency, vaccinations, illegible 
 records, and instances of inappropriate billing in which Dr. Martinez billed OHIP for 
 codes that were not supported by his documentation, as well as specific care-related 
 concerns in four patient charts.  
  
 Dr. Martinez provided a response to Dr. Klapwyk’s report, dated April 13, 2017, in which 
 he acknowledged Dr. Klapwyk’s comments about the ordering of unnecessary tests. Dr. 
 Martinez wrote that he “recognizes that he ought to have taken further steps in and after 
 2014 to stop the unnecessary and inappropriate ordering of x-rays and other diagnostic 
 studies for his patients.” 
  
 Dr. Klapwyk provided an addendum report dated November 29, 2017, in which she 
addressed Dr. Martinez’s response to her report. Dr. Klapwyk’s opinion with respect to 
Dr. Martinez’s care remained unchanged. 
 
 A Statement of Uncontested Facts and Plea of No Contest filed as an exhibit and 
 presented to the Committee included the following further facts: 
  
 Orthotic Devices 
  
 In January 2017, the College received information from Sun Life Financial (“Sun Life”), 
 an insurance provider, that Dr. Martinez had provided medical referrals for orthotic 
 devices while working at a facility that Sun Life was investigating, called “Therapeutic 
 Mobile Care” (“TMC”). Sun Life advised the College that Dr. Martinez had admitted that 
 he had signed prescription forms for patients without seeing or assessing them. Sun 
 Life also advised that Dr. Martinez offered to make repayments to Sun Life. Based on 
 the information provided by Sun Life, the College investigated Dr. Martinez’s orthotics-
 prescribing practice. 
  
 Sun Life provided the College with a summary of an interview its investigators 
 conducted of Dr. Martinez. According to the interview summary, Dr. Martinez told the 
 Sun Life investigators that he initially did not pre-sign any forms at TMC, and that he 
 saw patients and prescribed only what they needed; however, this “morphed” into him 
 pre-signing prescriptions for orthotics without seeing patients, allowing the clinic and 
 patients to submit claims and receive payment.  
 
The College conducted an interview of Dr. Martinez, during which Dr. Martinez provided 
information that was false and misleading, and inconsistent with what he told Sun Life. 
Contrary to what he told Sun Life, Dr. Martinez stated in his interview by the College that 
he saw and examined all the patients for whom he prescribed devices. Dr. Martinez also 
 told the College that his statements to the Sun Life investigators about pre-signing 
 prescriptions were not accurate.  
  
 PENALTY 
  
 The following additional facts were presented to the Committee in an Agreed Statement 
 of Facts Regarding Penalty: 
  
 Dr. Martinez currently works at clinics in Toronto and Vaughan. His practices consist 
 primarily (but not exclusively) of psychotherapy.  
  
 In his current practice settings, Dr. Martinez utilizes EMR systems, which help him 
 address the organization, completeness, and legibility of his medical records.  
  
 Dr. Martinez’s History with the College 
  
 Dr. Martinez does not have any discipline history.  
  
In early 2009, as a result of a public complaint to the College about his conduct and 
care, Dr. Martinez was cautioned in writing by the Complaints Committee about the 
importance of undertaking and documenting a thorough history and physical 
examination, and ensuring that the necessary investigations are ordered with 
appropriate follow-up. The Committee also cautioned Dr. Martinez to review mandatory 
reporting requirements for Ontario physicians.  
 
Dr. Martinez’s 2009 Undertaking and 2013 Reassessment 
 
In 2009, as a result of concerns regarding his prescribing practices that arose in two 
College investigations, Dr. Martinez entered into an undertaking with the College (the 
“2009 Undertaking”). In the 2009 Undertaking, Dr. Martinez agreed to voluntarily resign 
his prescribing privileges for Narcotic Drugs and Narcotic Preparations, to complete 
professional education in medical record-keeping and prescribing skills, and to submit 
to a reassessment of his practice. 
 
In 2013, pursuant to the terms of the 2009 Undertaking, the College retained Dr. Irene 
Cohen to conduct a reassessment of Dr. Martinez’s practice. Dr. Cohen is an 
experienced family physician who was also the medical director of the Thames Valley 
Family Health Team. In her reassessment report, Dr. Cohen opined that Dr. Martinez 
overall met the standard of practice of the profession and did not display a lack of 
knowledge, skill or judgment. However, Dr. Cohen expressed some concerns about Dr. 
Martinez’s record-keeping and boundary-setting with patients. Dr. Cohen also expressed 
concerns about Dr. Martinez’s billings in a number of charts. Dr. Cohen recommended 
that Dr. Martinez undergo a further period of clinical supervision with respect to these 
issues.  
 
As a result of the concerns identified by Dr. Cohen, Dr. Martinez agreed to enter into the 
2014 Undertaking, which superseded his 2009 Undertaking with the College.  
 
Subsequent Remediation Efforts by Dr. Martinez 
 
Following receipt of Dr. Silver’s addendum report dated July 16, 2017, Dr. Martinez 
delivered a further response to the College, dated November 29, 2017. In his response, 
Dr. Martinez advised the College that he had requested literature from the CMA and 
completed self-study in a number of areas in which Dr. Silver had expressed concerns 
about his care. Dr. Martinez provided a list of the resources that he told the College he 
had reviewed. Dr. Martinez also advised the College that he had “shadowed” a 
dermatologist in November 2017, and had engaged in 12 hours of one-on-one training 
on the topic of psychotherapy. 
 
Dr. Martinez attended the University of Toronto Medical Recordkeeping course on June 
22, 2017, and attended a Continuing Medical Education course on cardiovascular 
disease in diabetes on November 8, 2017.  
 
On November 23, 2018, the College was advised of additional continuing education 
activities Dr. Martinez had pursued since responding to the addendum report of Dr. 
Silver on November 29, 2017. Dr. Martinez advised the College that he had completed 
additional CME activity covering topics including: mindfulness-based chronic pain 
management, mental health care, and the provision of psychotherapy.  
 
Since November 23, 2018, Dr. Martinez has completed additional continuing education 
activities on topics including mental healthcare and dialectical behavioural therapy. 
 
DISPOSITION 
 
The Discipline Committee ordered: 
 
   -  Dr. Martinez to attend before the panel to be reprimanded 
   -  The Registrar to suspend Dr. Martinez’s certificate of registration for a period of 
      12 months, commencing May 12, 2020 at 12:01 a.m. 
   -  The Registrar to place terms, conditions and limitations on Dr. Martinez’s 
      certificate of registration, including: compliance with Policy re suspension; 
      professional education; and clinical supervision with a reassessment.  
   -  Dr. Martinez to pay costs to the College in the amount of $6,000.00 within 30 
      days of the date of the Order.

Hearing Date(s): May 11, 2020 9:30 a.m. to 12: 30 p.m.