(1 of 2)
As from October 12, 2022, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Zvi Margaliot, in accordance with an undertaking and consent given by Dr. Margaliot to the College of Physicians and Surgeons of Ontario:
ACKNOWLEDGEMENT, UNDERTAKING AND CONSENT
("Undertaking")
of
DR. ZVI MARGALIOT
("Dr. Margaliot")
to
COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
(the "College")
A. PREAMBLE
(1) I, Dr. Margaliot, certificate of registration number 68746, am a member of the College.
(2) I, Dr. Margaliot, acknowledge that I am subject to an Order of the Ontario Physicians and Surgeons Discipline Tribunal dated May 17, 2022, Margaliot v. College of Physicians and Surgeons of Ontario, 2022 ONPSDT 20 ("Order"), regarding the reinstatement of my certificate of registration subject to terms, conditions and limitations, which Order remains in effect. This Undertaking is supplemental to, and does not replace or supercede, the Order.
(3) I, Dr. Margaliot, acknowledge that I commenced my re-entry to practice on June 6, 2022 at an approved Out of Hospital Premises ("OHP") plastic surgery clinic, under supervision of a Clinical Supervisor ("Clinical Supervisor") in accordance with the Order, and that this supervision is ongoing.
(4) I, Dr. Margaliot, acknowledge that in August 2022, I sought the College's approval to engage in additional procedures within a hospital setting, specifically:
(a) Hand or wrist fracture/dislocation/non-union;
(b) Tendon repair/reconstruction/tenolysis/transfer;
(c) Joint or ligament repair/reconstruction/replacement;
(d) Peripheral nerve decompression/neurolysis/transposition/repair/graft;
(e) Contracture release/fasciectomy/lengthening - joint/skin/fascia/muscle;
(f) Regional/free flap reconstruction; skin, muscle or fascia;
(g) Vascular repair/reconstruction/revascularization/replantation;
(h) Amputation/revision-amputation finger/hand/toe/foot;
(i) Burn wound/chronic wound debridement/skin grafting/secondary reconstruction.
(Collectively the "Additional Procedures").
(5) I, Dr. Margaliot, acknowledge that the College's approval of Additional Procedures is subject to my entering into this Undertaking.
(6) I, Dr. Margaliot, acknowledge that until such time as the College's assessment of my practice in accordance with the Order is concluded, and the College approves my entry into unsupervised practice, this Undertaking shall remain in effect.
B. SUPERVISION
(7) I, Dr. Margaliot, undertake to practise in the hospital setting under the supervision of a hospital Clinical Supervisor acceptable to the College ("Hospital Clinical Supervisor"), for a minimum of three months, and until such time as the College approves a transition to Low Level Supervision in accordance with section (m) of the Order.
(8) I, Dr. Margaliot, acknowledge that I have reviewed the Hospital Clinical Supervisor's undertaking, attached hereto as Schedule "A", and understand what is required of the Hospital Clinical Supervisor.
(9) I, Dr. Margaliot, acknowledge that the chart reviews referenced in the Order will be conducted by my Clinical Supervisor, and will include a minimum of 5 charts from the hospital setting at each meeting, to be selected in the sole discretion of the Clinical Supervisor with input from my Hospital Clinical Supervisor.
(10) I, Dr. Margaliot, acknowledge that the College's assessment of my practice pursuant to the Order will include both my practice in the OHP and Hospital settings.
(11) I, Dr. Margaliot, undertake that until such time as the College's assessment of my practice in the Hospital is concluded, and the College approves my entry into unsupervised practice, I shall not perform any on-call surgical procedures unless my Hospital Clinical Supervisor is available on-site to provide back up and supervision in accordance with the Hospital Clinical Supervisor's undertaking.
C. CONSENT
(12) I, Dr. Margaliot, give my irrevocable consent to the College to provide the following information to the Clinical Supervisor and Hospital Clinical Supervisor, and/or Assessors:
(a) any information the College has that led to the circumstances of my entering into this Undertaking;
(b) any information relevant for the purposes of any assessment of my practice; and
(c) any information relevant for the purposes of the monitoring of my compliance with this Undertaking.
D. ACKNOWLEDGMENT
(13) I, Dr. Margaliot, acknowledge that all appendices attached to or referred to in this Undertaking form part of this Undertaking.
(14) I, Dr. Margaliot, 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. Margaliot, 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.
(16) I, Dr. Margaliot, 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. Margaliot, 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 Tribunal of the College.
(18) I, Dr. Margaliot, 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. Margaliot, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.
(b) I, Dr. Margaliot, 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:
Dr. Margaliot is subject to an Order of the Ontario Physicians and Surgeons Discipline Tribunal dated May 17, 2022, ("the Order") regarding the reinstatement of his certificate of registration. He has entered into an Undertaking, supplemental to the Order, expanding his reinstatement to include practice in a hospital setting.
Dr. Margaliot will practise in the hospital setting under the guidance of a Hospital Clinical Supervisor for a minimum of three (3) months.
(2 of 2)
As from May 26, 2022, by order of the Ontario Physicians and Surgeons Discipline Tribunal, the following terms, conditions and limitations are imposed on the certificate of registration held by Dr. Zvi Margaliot:
Clinical Supervision
(a) Prior to commencing practice, Dr. Margaliot shall retain at his own expense, a clinical supervisor acceptable to the College (the "Clinical Supervisor") who has executed an undertaking in the form attached at Schedule "A".
(b) Dr. Margaliot shall only practice under the supervision of the Clinical Supervisor, unless he is acting as a surgical assistant and is not the MRP.
(c) Clinical supervision shall cease only on approval of the College in its sole discretion in accordance with the terms outlined in this Order.
Moderate Level Supervision
(d) For a period of no less than six (6) months, Dr. Margaliot shall practice under moderate level supervision ("Moderate Level Supervision") by the Clinical Supervisor in accordance with the College-approved Individualized Educational Plan (the "IEP") attached hereto as Schedule "B", Schedule "A" and the terms set out below.
(e) During Moderate Level Supervision, Dr. Margaliot shall be the Most Responsible Physician ("MRP").
(f) During Moderate Level Supervision, Dr. Margaliot shall not practice unless the Clinical Supervisor is available onsite or by telephone at all times.
Moderate Level Supervision- Phase One
(g) During the first month of Moderate Level Supervision, the Clinical Supervisor shall:
(i) meet with Dr. Margaliot once every two (2) weeks, at which meeting the Clinical Supervisor will:
a. review a minimum of 10 charts, to be selected in the sole discretion of the Clinical Supervisor, to review and comment on diagnosis, documentation and treatment plan, and to discuss any issues or concerns arising from this review with Dr. Margaliot;
b. to make recommendations to Dr. Margaliot for any practice improvements and ongoing professional development, and inquire into Dr. Margaliot's compliance with the recommendations.
c. keep a log of all patient charts reviewed along with patient identifiers.
(ii) directly observe Dr. Margaliot performing his first 10 procedures, and maintain a log of all procedures observed along with patient identifiers.
This requirement shall remain in place until Dr. Margaliot has completed 10 procedures, regardless of whether they occur during the first month of supervision.
(iii) The Clinical Supervisor shall provide a report to the College after the completion of the first month of Moderate Level Supervision, and monthly thereafter if Phase One is extended, which shall include comment on:
a. Dr. Margaliot's management of patients;
b. procedures and presentations that Dr. Margaliot is competent to manage/perform;
c. the procedures and presentations for which Dr. Margaliot needs further education, if any;
d. topics reviewed and success in implementing changes in practice;
e. Dr. Margaliot's review of current practice guidelines;
f. a list of the type of procedures undertaken by Dr. Margaliot, and
g. all information that might assist the College in evaluating Dr. Margaliot's standard of practice, as well as Dr. Margaliot's participation in and compliance with the requirements set out in the Order.
(h) After a minimum of one (1) month of supervision, if the Clinical Supervisor is satisfied that Dr. Margaliot's care and treatment of patients meets the standard of practice of the profession, the Clinical Supervisor may recommend to the College that Dr. Margaliot commence Moderate Level Supervision - Phase Two, as set out below. For greater clarity, Moderate Level Supervision- Phase One shall continue until such recommendation is made and the College approves the transition to Moderate Level Supervision - Phase Two.
Moderate Level Supervision- Phase Two
(i) Upon the recommendation of the Clinical Supervisor and approval of the College to commence Moderate Level Supervision- Phase Two, Dr. Margaliot will meet with the Clinical Supervisor one (1) time per month, at which meetings the Clinical Supervisor will:
(i) review a minimum of 10 charts, to be selected in the sole discretion of the Clinical Supervisor, to review and comment on diagnosis, documentation and treatment plan, and to discuss any issues or concerns arising from this review with Dr. Margaliot;
(ii) to make recommendations to Dr. Margaliot for any practice improvements and ongoing professional development, and inquire into Dr. Margaliot's compliance with the recommendations.
(iii) keep a log of all patient charts reviewed along with patient identifiers.
(j) The Clinical Supervisor shall provide a report to the College after the second month of Moderate Level Supervision- Phase Two, which shall include comment on:
a. Dr. Margaliot's management of patients;
b. procedures and presentations that Dr. Margaliot is competent to manage/perform;
c. the procedures and presentations for which Dr. Margaliot needs further education, if any;
d. topics reviewed and success in implementing changes in practice;
e. Dr. Margaliot's review of current practice guidelines;
f. a list of the type of procedures undertaken by Dr. Margaliot, and
g. All information that might assist the College in evaluating Dr. Margaliot's standard of practice, as well as Dr. Margaliot's participation in and compliance with the requirements set out in the Order
(k) The Clinical Supervisor shall provide a report to the College after the completion of five months of Moderate Level Supervision- Phase Two, and shall continue to report every three months thereafter if Moderate Level Supervision- Phase Two is extended, commenting on:
a. Dr. Margaliot's management of patients;
b. procedures and presentations that Dr. Margaliot is competent to manage/perform;
c. the procedures and presentations for which Dr. Margaliot needs further education, if any;
d. topics reviewed and success in implementing changes in practice;
e. Dr. Margaliot's review of current practice guidelines;
f. a list of the type of procedures undertaken by Dr. Margaliot;
g. All information that might assist the College in evaluating Dr. Margaliot's standard of practice, as well as Dr. Margaliot's participation in and compliance with the requirements set out in the Order; and
(l) After no less than six (6) months of Moderate Level Supervision (Phase One and Phase Two), the Clinical Supervisor shall provide their opinion as to whether Dr. Margaliot is ready to transition to independent practice.
Low Level Supervision
(m) Upon the recommendation of the Clinical Supervisor that Dr. Margaliot may transition to independent practice, Dr, Margaliot will practice under Low Level Supervision, until completion of the Assessment set out below, and until approved by the College to enter unsupervised practice.
(n) During Low Level Supervision, Dr. Margaliot will meet with the Clinical Supervisor one (1) time per month, at which meetings the Clinical Supervisor will:
(i) review a minimum of 10 charts, to be selected in the sole discretion of the Clinical Supervisor, to review and comment on diagnosis, documentation and treatment plan, and to discuss any issues or concerns arising from this review with Dr. Margaliot;
(ii) to make recommendations to Dr. Margaliot for any practice improvements and ongoing professional development, and inquire into Dr. Margaliot's compliance with the recommendations.
(iii) keep a log of all patient charts reviewed along with patient identifiers.
(iv) No further reporting is required by the Clinical Supervisor unless the Clinical Supervisor has concerns about Dr. Margaliot or his practice.
Assessment of Practice
(o) Upon the recommendation of the Clinical Supervisor that Dr. Margaliot may transition to independent practice and with the approval of the College, Dr. Margaliot shall undergo an assessment of his practice (the "Assessment") by a College-appointed assessor or assessors (the "Assessor"). For clarity, until the Assessment is complete and the College approves Dr. Margaliot's entry into unsupervised practice, Dr. Margaliot shall continue to practice under Low Level Supervision.
(p) The Assessment shall include, at the discretion of the College, any one or more of the following: a review of Dr. Margaliot's patient charts, direct observation of Dr. Margaliot's practice, an interview with Dr.Margaliot, interviews with colleagues and coworkers, feedback from patients, and any other tools deemed necessary by the College. Dr. Margaliot shall abide by all recommendations made by the Assessor.
(q) The Assessor shall be provided with all information the College determines is relevant including this Order, the Discipline Committee's Reasons for Decision in this matter, the copies of the reports of the Clinical Supervisor(s) referred to above, the decision of the (then called) Discipline Committee of the College of Physicians and Surgeons of Ontario in Ontario (College of Physicians and Surgeons of Ontario) v. Margaliot, 2016 ONCPSD 53 and the Statement of Facts and Plea of No Contest, as relied upon (and entered as Exhibit 2) in Ontario (College of Physicians and Surgeons of Ontario) v. Margaliot, 2016 ONCPSD 53.
(r) The Assessor shall submit a written report to the College regarding Dr. Margaliot's standard of practice and this report may form the basis for further action by the College.
(s) The College shall review the final assessment report of the Assessor and make a determination, in its sole discretion, as to whether Dr. Margaliot can enter unsupervised practice. For clarity, Dr. Margaliot shall not enter unsupervised practice unless and until the College approves him to do so.
Other Elements of Clinical Supervision and Assessment
(t) Dr. Margaliot shall cooperate fully with the Clinical Supervision and abide by all recommendations of the Clinical Supervisor(s), including but not limited to, any recommended practice improvements and professional development.
(u) The Clinical Supervisor shall immediately notify the College if they are concerned that Dr. Margaliot's practice may fall below the standard of practice of the profession, Dr. Margaliot may not be in compliance with the provisions of this Order or Dr. Margaliot's patients may be exposed to risk of harm or injury.
(v) If a person who has given an undertaking in Schedule "A" to this Order is unable or unwilling to fulfill its provisions during Moderate Level Supervision, Dr. Margaliot shall cease practicing medicine immediately until he has obtained a Clinical Supervisor acceptable to the College, and this will constitute a term, condition, or limitation on his certificate of registration, which will be included on the College's public register.
(w) If a person who has given an undertaking in Schedule "A" to this Order is unable or unwilling to fulfill its provisions during Low Level Supervision, Dr. Margaliot shall, within fourteen (14) days of receiving notice of the same, ensure that he has delivered to the College an executed undertaking in the same form from a similarly qualified person who is acceptable to the College.
(x) If Dr. Margaliot is unable to obtain a Clinical Supervisor as set out in this Order within 14 days, he shall cease practicing medicine until he has obtained a Clinical Supervisor acceptable to the College, and this will constitute a term, condition, or limitation on his certificate of registration, which will be included on the College's public register.
(y) The patient charts reviewed by the Clinical Supervisor pursuant to this Order shall be selected by the Clinical Supervisor based on the educational needs identified in the IEP and based on any concerns that may arise during the period of Clinical Supervision.
(z) Dr. Margaliot shall consent to the disclosure and sharing of information between the Clinical Supervisor(s), the Assessor(s) and the College as the College deems necessary or desirable in order to fulfill their respective obligations.
Professional Education
(aa) Dr. Margaliot shall review, reflect and discuss with his Clinical Supervisor the College of Family Physicians of Canada three-part article on patient centred interviewing:
(i) https://www.cfpc.ca/CFPC/media/Resources/Examinations/Patient-Centred-Interviewing.pdf
(ii) https://www.cfpc.ca/uploadedFiles/Education/Finding%20Common%20Gro und.pdf
(iii) https://www.cfpc.ca/CFPC/media/Resources/Examinations/Five- Provocative-Questions.pdf
(bb) Dr. Margaliot shall participate in, and successfully complete, all aspects of the IEP, attached hereto as Schedule "B", including but not limited to professional education stipulated in the IEP, including:
(i) Completion of the continuing professional development ("CPD") program relevant to the practice of Plastic Surgery approved by the College (the "Personal CPD Program") as specified in Appendix "A" to the IEP (Schedule B);
(ii) Discuss the Personal CPD Program with the Clinical Supervisor and complete any additional CPD assigned by the Clinical Supervisor, if any
(iii) Complete the CPD Program during the twelve (12) months following reinstatement; and
Monitoring and Other Terms
(cc) Dr. Margaliot shall inform the College of each and every location where he practices, including but not limited to hospitals(s), clinic(s) and office(s), in any jurisdiction, within five (5) days of this Order. Going forward, he shall inform the College of any and all new Practice Locations in any jurisdiction five (5) days in advance of commencing practice at that location.
(dd) Dr. Margaliot shall cooperate, and shall not interfere with, unannounced inspections of his practice by the College and to any other activity the College deems necessary for the purpose of monitoring Dr. Margaliot's compliance with the terms of this Order.
(ee) Dr. Margaliot shall provide the College with his irrevocable consent to make enquiries of the Ontario Health Insurance Plan, and/or any person(s) or institution(s) that may have relevant information, in order for the College to monitor his compliance with the terms of this Order.
(ff) If Dr. Margaliot wishes to perform procedures which were not the subject of Clinical Supervision and Assessment, Dr Margaliot shall be subject to the College Ensuring Competence Policy and shall not perform such procedures until receiving College approval to do so.
(gg) Dr. Margaliot shall be solely responsible for any and all fees, costs, charges, expenses, etc. associated with implementing the terms of this Order.