As from April 15, 2021, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Sarah Elizabeth Cook, in accordance with an undertaking and consent given by Dr. Cook to the College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")
of
DR. SARAH ELIZABETH COOK
("Dr. Cook")
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 Committee" means the Discipline Committee of the College;
"ICR Committee" means the Inquires, 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 Pharmaceutical and Specialties] is attached hereto as Schedule "A"; and 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 at Schedule "C";
"NMS" means 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. Cook, certificate of registration number 86719, am a member of the College.
(3) I, Dr. Cook, acknowledge that the College is conducting an investigation, bearing File Number 1115225, into whether I have engaged professional misconduct and/or am incompetent in my practice.
(4) I, Dr. Cook, acknowledge that the ICR Committee has accepted this Undertaking in lieu of making an interim Order under section 25.4 of the Code at this time.
(5) I, Dr. Cook, acknowledge that this Undertaking does not preclude the ICR Committee from making an order at a later date in accordance with the Code.
(6) I, Dr. Cook, acknowledge that this Undertaking continues in force until the matters currently being investigated are disposed of by a panel of the ICR Committee or the Discipline Committee.
B. UNDERTAKING
(7) I, Dr. Cook, undertake to abide by the provisions of this Undertaking, effective immediately.
(8) Prescribing Log
(a) I, Dr. Cook, undertake to 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 the chart/file number;
(iii) the name of the medication prescribed, dose, direction, and amount to be dispensed and the 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. Cook'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).
(b) I, Dr. Cook, 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(s).
(9) Clinical Supervision
(a) I, Dr. Cook, undertake to practise under the guidance of a clinical supervisor or clinical supervisors acceptable to the College (the "Clinical Supervisor" or "Clinical Supervisors"), ("Clinical Supervision").
(b) I, Dr. Cook, acknowledge that I have reviewed the Clinical Supervisor's undertaking, attached hereto as Schedule "E", and understand what is required of the Clinical Supervisor. The Clinical Supervisor will, at minimum:
(i) Meet with me at my Practice Location, or another location approved by the College, once every two (2) weeks;
(ii) Review at least twenty (20) of my patient charts at every meeting, at least (10) of which will be selected from the Prescribing Log for patients to whom I have prescribed Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and all other Targeted Substances, and all other Monitored Drugs, all of which shall be selected by the Clinical Supervisor independent of my participation;
(iii) Sign and date the Prescribing Log to confirm the selected charts that the Clinical Supervisor(s) has reviewed and discussed with me;
(iv) Discuss any concerns arising from the chart reviews;
(v) 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
(vi) Submit written reports to the College at least once (1) every month, or more frequently if the Clinical Supervisor has concerns about my standard of practice.
(c) I, Dr. Cook, acknowledge that the charts reviewed shall be selected by the Clinical Supervisor.
(d) I, Dr. Cook, undertake to cooperate fully with the Clinical Supervision of my practice, conducted under the term of this Undertaking and Schedule "E" attached, 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. Cook, undertake to ensure that Schedule "E" this Undertaking, is signed and delivered to the College within thirty (30) days of the date I execute this Undertaking.
(f) I, Dr. Cook, 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 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. Cook, acknowledge that if I am unable to obtain a Clinical Supervisor on the provisions set out under sections (9)(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. Cook, acknowledge that if I am required to cease practise as a result of section (9)(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.
(10) I, Dr. Cook, 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 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.
(11) I, Dr. Cook, undertake that I will submit to, and not interfere with, unannounced inspections of my Practice Location(s) and and to any other activity the College deems necessary in order to monitor my compliance with the provisions of this Undertaking.
(12) I, Dr. Cook, 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.
C. ACKNOWLEDGEMENT
(13) I, Dr. Cook, acknowledge that all schedules attached to or referred to in this Undertaking form part of this Undertaking.
(14) I, Dr. Cook, 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.
(15) I, Dr. Cook, acknowledge that I have read and understand the provisions of Undertaking and that I have obtained independent legal counsel in reviewing and executing this Undertaking, or have waived my right to do so.
(16) I, Dr. Cook, 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").
(17) I, Dr. Cook, acknowledge that, in the event of a referral to the Discipline Committee and in the event of an appeal of any Order of the Discipline Committee, if the Discipline Committee has directed the Registrar to revoke, suspend, or impose terms and conditions on my certificate of registration, that Order will take effect immediately despite any appeal.
(18) I, Dr. Cook, acknowledge that this Undertaking constitutes terms, conditions, and limitations on my certificate of registration for the purposes of section 23 of the Code.
(19) Public Register
(a) I, Dr. Cook, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.
(b) I, Dr. Cook, acknowledge that, in addition to this Undertaking being posted in accordance with section (19)(a) above, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:
The College is conducting an investigation into whether Dr. Cook engaged in professional misconduct and/or is incompetent. During the investigation and in the event of a referral to the Discipline Committee:
Dr. Cook must practise under the guidance of a Clinical Supervisor acceptable to the College.
D. CONSENT
(20) I, Dr. Cook, give my irrevocable consent to the College to make appropriate enquiries of OHIP, the Drug Program Services Branch, 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.
(21) I, Dr. Cook, acknowledge that I have executed the OHIP and NMS consent forms, attached hereto as Schedule "F" and Schedule "G", respectively.
(22) I, Dr. Cook, give my irrevocable consent to the College to provide the following information to all Clinical Supervisors:
(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.
(23) I, Dr. Cook, 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.
(24) I, Dr. Cook, give my irrevocable consent to all Clinical Supervisors and Chiefs of Staff 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 Schedule "E";
(c) any information relevant for the purposes of monitoring my compliance with this Undertaking.