Effective as of March 27, 2017 , Dr. Salsberg is not permitted to practise primary care medicine until such time that he obtains a Clinical Supervisor acceptable to the College. As such, Dr. Salsberg’s scope of practice is limited to the following:
1. Teaching natropathic students, medical students and/or residents;
2. Reviewing laboratory results for laboratory testing requested by naturopaths;
3. Other laboratory work; and
4. Acting as a physician on duty during stress testing undertaken by a technician at the North York General Hospital or another hospital or laboratory where the scope of that role is set out at “Appendix I” to his Undertaking
As from February 10, 2017, the following is imposed as a term, condition and
limitation on the certificate of registration held by Dr. Michael Paul
Salsberg, in accordance with an undertaking and consent given by Dr. Salsberg
to the College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")
of
DR. MICHAEL PAUL SALSBERG
("Dr. Salsberg")
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;
"NMS" means the Drug Program Services Branch, the Narcotics Monitoring
System implemented under the Narcotics Safety and Awareness Act, 2010;
"OHIP" means the Ontario Health Insurance Plan;
"Public Register" means the College's register that is available to the
public.
(2) I, Dr. Salsberg, certificate of registration number 29169, am a member of
the College. The College has received information regarding my capacity
to practise medicine.
(3) I, Dr. Salsberg, entered into undertakings with the College on January
12, 2011, July 14, 2014 and March 4, 2015 whereby I, inter alia,
voluntarily resigned prescribing privileges and ceased to engage in
practice as a primary care physician or hospitalist as of January 12,
2011 (my "Previous Undertakings").
(4) I, Dr. Salsberg, entered into an undertaking on February 10, 2017
replacing and superseding my Previous Undertakings where I was able to
resume practice as a primary care physician subject to conditions (my
"February 10, 2017 Undertaking").
(5) I, Dr. Salsberg, acknowledge that the present Undertaking replaces and
supersedes my February 10, 2017 Undertaking.
B. UNDERTAKING
(6) I, Dr. Salsberg, acknowledge that I have been abiding by the provisions
of this Undertaking since February 10, 2017 (the "Effective Date") and I
undertake to continue to abide by the provisions of this Undertaking,
effective immediately.
(7) Clinical Supervision
(a) I, Dr. Salsberg, undertake to practise under the guidance of a
primary care clinical supervisor acceptable to the College (the
"Clinical Supervisor") for a minimum of eight (8) months, as
outlined in the Clinical Supervisor's undertaking attached hereto
as Appendix "A", the Individualized Education Plan ("IEP") attached
hereto as Appendix "B", and as set out below:
(i) High Level Supervision
1. I, Dr. Salsberg, undertake that I will initially
practise under the high level supervision of the
Clinical Supervisor ("High Level Supervision") for at
least two (2) months;
2. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will be the most responsible physician (MRP)
for all patients during the period of High Level
Supervision;
3. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will be present on site for regular
observation and discussion during the period of High
Level Supervision;
4. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will meet with me weekly to review all
patient charts and discuss any concerns arising from
the chart reviews during the period of High Level
Supervision;
5. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will make recommendations to me for practice
improvements and ongoing professional development and
inquire into my compliance with the recommendations
during the period of High Level Supervision;
6. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will 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, during the period
of High Level Supervision;
7. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will submit written reports to the College
at least once every month, or more frequently if the
Clinical Supervisor has concerns about my standard of
practice or compliance with the terms of this
Undertaking during the period of High Level
Supervision; and
8. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will keep a log of all patient charts
reviewed along with patient identifiers during the
period of High Level Supervision.
(ii) Moderate Level Supervision
1. I, Dr. Salsberg, acknowledge that if, after a minimum
of two (2) months of High Level Supervision, my
Clinical Supervisor reports to the College that
satisfactory progress has been made during the period
of High Level Supervision and recommends the level of
supervision be reduced, and if the College approves,
the level of supervision will be reduced to a moderate
level ("Moderate Level Supervision");
2. I, Dr. Salsberg, undertake that I will practise under
Moderate Level Supervision for at least three (3)
months;
3. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will be available on site to assist with
patient management decisions during the period of
Moderate Level Supervision;
4. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will meet with me bi-weekly to review a
minimum of twenty (20) patient charts and discuss any
concerns arising from the chart reviews during the
period of Moderate Level Supervision;
5. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will make recommendations to me for practice
improvements and ongoing professional development and
inquire into my compliance with the recommendations
during the period of Moderate Level Supervision;
6. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will 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, during the period
of Moderate Level Supervision;
7. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will submit written reports to the College
at least once every month, or more frequently if the
Clinical Supervisor has concerns about my standard of
practice or compliance with the terms of this
Undertaking during the period of Moderate Level
Supervision; and
8. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will keep a log of all patient charts
reviewed along with patient identifiers during the
period of Moderate Level Supervision.
(iii) Low Level Supervision
1. I, Dr. Salsberg, acknowledge that if, after a minimum
of three (3) months of Moderate Level Supervision, my
Clinical Supervisor reports to the College that
satisfactory progress has been made during the period
of Moderate Level Supervision and recommends the level
of supervision be reduced, and if the College approves,
the level of supervision will be reduced to a low level
("Low Level Supervision");
2. I, Dr. Salsberg, undertake that I will practise under
the Low Level Supervision for at least three (3)
months;
3. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will be available for consultation within a
reasonable period of time to assist with patient
management decisions during the period of Low Level
Supervision;
4. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will meet with me monthly to review a
minimum of twenty (20) patient charts and discuss any
concerns arising from the chart reviews during the
period of Low Level Supervision;
5. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will make recommendations to me for practice
improvements and ongoing professional development and
inquire into my compliance with the recommendations
during the period of Low Level Supervision;
6. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will 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, during the period
of Low Level Supervision;
7. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will submit written reports to the College
at least once every three months, or more frequently if
the Clinical Supervisor has concerns about my standard
of practice or compliance with the terms of this
Undertaking during the period of Low Level Supervision;
and
8. I, Dr. Salsberg, acknowledge that the Clinical
Supervisor will keep a log of all patient charts
reviewed along with patient identifiers during the
period of Low Level Supervision.
(b) I, Dr. Salsberg, acknowledge that Clinical Supervision shall cease
only upon the recommendation of the Clinical Supervisor and the
approval of the College.
(c) I, Dr. Salsberg, 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.
(d) I, Dr. Salsberg, undertake to cooperate fully with the Clinical
Supervision of my practice, conducted under the term of this
Undertaking and Appendix "A" 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. Salsberg, undertake to ensure that Appendix "A" to this
Undertaking is signed and delivered to the College within thirty
(30) days of the Effective date.
(f) I, Dr. Salsberg, 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.
(g) I, Dr. Salsberg, agree that if I am unable to obtain a Clinical
Supervisor on the provisions set out under sections (6)(e) and/or
(f) above, I will cease practising primary care medicine until such
time as I have obtained a Clinical Supervisor acceptable to the
College.
(h) I, Dr. Salsberg, agree that if I am required to cease practise as a
result of section (6)(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.
(i) I Dr. Salsberg, agree that if I am required to cease practice
primary care as a result of section (6)(g) above, the entirety of
my scope of practice will be limited to only the following:
1. teaching naturopathic students, medical students and/or
residents;
2. reviewing laboratory results for laboratory testing requested
by naturopaths;
3. other laboratory work; and
4. acting as the physician on duty during stress testing
undertaken by a technician at the North York General Hospital
or another hospital or laboratory where the scope of that
role is set out at Appendix "I" to this Undertaking.
(8) Professional Education
(a) I, Dr. Salsberg, undertake to participate in and successfully
complete all aspects of the detailed IEP, attached hereto as
Appendix "B", including all of the following professional education
(the "Professional Education") as a component of the Clinical
Supervision:
(i) Review and discuss the following with my Clinical Supervisor:
1. CPSO Medical Records Policy #4-12;
2. The Ontario Anti?infective Guidelines for Community
acquired infections;
3. Choose Wisely Canada's recommendations for primary care
physicians;
4. Canadian Guidelines for Safe and Effective Use of
Opioids for Chronic Non-Cancer Pain;
5. Cancer Care Ontario's guidelines for screening and
diagnosis of cancer relevant to primary care
physicians;
6. The Society of Obstetricians and Gynecologists of
Canada Clinical Practice Guidelines relevant to primary
care physicians' management of women's health issues;
7. The Canadian Task Force on Preventive Health Care
Periodic Health Exam Guidelines;
8. The Canadian Thoracic Society Asthma Guidelines on the
diagnosis and management of asthma in preschoolers,
children and adults;
9. The Canadian Cardiovascular Society Atrial Fibrillation
Guidelines;
10. The Canadian Thoracic Society
Chronic-Obstructive-Pulmonary-Disease clinical practice
guidelines;
11. The Canadian Diabetes Association Clinical Practice
Guidelines relevant to primary care physicians;
12. Hypertension Canada's guidelines on diagnosis and
management of hypertension;
13. Osteoporosis Canada's 2010 Guidelines;
14. Province of Ontario Publicly Funded Immunization
Schedules; and
(ii) Any additional professional education recommended by my
Clinical Supervisor.
(b) I, Dr. Salsberg, acknowledge that a report or reports may be
provided to the College regarding my progress and compliance with
the Professional Education.
(c) I, Dr. Salsberg, undertake to complete this requirement before the
end of eight (8) months of the Clinical Supervision set out in
section 6 above.
(9) Reassessment of Practice
(a) I, Dr. Salsberg, undertake that, after at least eight (8) months of
the Clinical Supervision set out in section 6 above and Appendix
"A" attached, and after the Clinical Supervisor submits at least
one (1) written report to the College after at least three (3)
months of Low Level Supervision set out in section 6(a)(iii) above,
I will submit to a Reassessment of my practice ("the Reassessment")
by an assessor or assessors selected by the College (the
"Assessor"). I acknowledge and agree that the Reassessment may
include a chart review, direct observation of my care, interviews
with colleagues and co-workers, feedback from patients and any
other tools deemed necessary by the College.
(b) I, Dr. Salsberg, undertake to co-operate fully with the
Reassessment, conducted under the term of this Undertaking, and to
abide by those recommendations of the Assessor that are approved by
the ICR Committee.
(c) I, Dr. Salsberg, acknowledge and agree 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. I also acknowledge that the results of the
Reassessment will be provided to me and reported to the College and
the report may form the basis of further action by the College.
(10) Resignation of Prescribing Privileges
(a) I, Dr. Salsberg, acknowledge that I have executed the Voluntary
Resignation of Prescribing Privileges Form, which is attached
hereto as Appendix "C" (the "Resignation") and forms part of this
Undertaking.
(b) I, Dr. Salsberg, undertake and agree that I will not issue new
prescriptions or renew existing prescriptions for any of the
following substances:
(i) Narcotic Drugs (from the Narcotic Control Regulations made
under the Controlled Drugs and Substances Act, S.C., 1996, c.
19);
(ii) Narcotic Preparations (from the Narcotic Control Regulations
made under the Controlled Drugs and Substances Act, S.C.,
1996, c. 19);
(iii) Controlled Drugs (from Schedule G of the Regulations under
the Food and Drugs Act, S.C., 1985, c. F-27); or
(iv) Benzodiazepines/Other Targeted Substances (from the
Benzodiazepines and Other Targeted Substances Regulations
made under the Controlled Drugs and Substances Act., S.C.,
1996, c. 19)
(A summary of the above-named drugs [from Appendix I to the
Compendium of Pharmaceuticals and Specialties] is attached hereto
as Appendix "D"; and the current regulatory lists are attached
hereto as Appendix "E")
(v) All other Monitored Drugs (as defined under the Narcotics
Safety and Awareness Act, 2010, S.O. 2010, c. 22 as noted in
Appendix "F");
and as amended from time to time.
(11) Monitoring
(a) I, Dr. Salsberg, undertake to inform the College of each and every
location that I practise or have privileges, including, but not
limited to, hospital(s), clinic(s) and office(s), in any
jurisdiction (collectively my "Practice Location(s)"), within
fifteen (15) days of the Effective Date. Going forward, I further
undertake to inform the College of any and all new Practice
Locations within fifteen (15) days of commencing practice at that
location.
(b) I, Dr. Salsberg, 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. Salsberg, give my irrevocable consent to the College to make
appropriate enquiries of OHIP, 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.
(d) I, Dr. Salsberg, acknowledge that I have executed the OHIP and NMS
consent forms, attached hereto as Appendix "G" and Appendix "H",
respectively.
C. ACKNOWLEDGEMENT
(12) I, Dr. Salsberg, acknowledge that all appendices attached to or referred
to in this Undertaking form part of this Undertaking.
(13) I, Dr. Salsberg, 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.
(14) I, Dr. Salsberg, 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.
(15) I, Dr. Salsberg, 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").
(16) I, Dr. Salsberg, 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.
(17) I, Dr. Salsberg, acknowledge that this Undertaking constitutes terms,
conditions, and limitations on my certificate of registration for the
purposes of section 23 of the Code.
(18) I, Dr. Salsberg, acknowledge that this Undertaking shall be posted on the
Public Register during the time period that the Undertaking remains in
effect.
(19) I, Dr. Salsberg, acknowledge that the following summary will appear on
the Public Register during the time period that this Undertaking remains
in effect:
Dr. Salsberg entered into undertakings with the College whereby he
voluntarily ceased to engage in practice as a primary care
physician or hospitalist as of January 12, 2011.
Dr. Salsberg may now resume practice as a primary care physician or
hospitalist subject to the following conditions:
- Dr. Salsberg will practise under the guidance of a Clinical
Supervisor acceptable to the College for a minimum of eight
months.
- Dr. Salsberg will engage in professional education in primary
care medicine.
- Dr. Salsberg's practice will be reassessed by an assessor
selected by the College after a minimum of eight months of
Clinical Supervision.
Dr. Salsberg voluntarily relinquished his prescribing privileges as
of January 12, 2011 with respect to the following drugs, substances
and preparations set out in the corresponding regulations, as
amended from time to time, and summarized as follows:
(i) Narcotic Drugs (from the Narcotic Control Regulations made
under the Controlled Drugs and Substances Act, S.C., 1996, c.
19);
(ii) Narcotic Preparations (from the Narcotic Control Regulations
made under the Controlled Drugs and Substances Act, S.C.,
1996, c. 19);
(iii) Controlled Drugs (from Part G of the Food and Drug
Regulations under the Food and Drugs Act, S.C., 1985, c.
F-27);
(iv) Benzodiazepines and Other Targeted Substances (from the
Benzodiazepines and Other Targeted Substances Regulations
made under the Controlled Drugs and Substances Act., S.C.,
1996, c. 19);
In addition, Dr. Salsberg has voluntarily relinquished his
prescribing privileges with respect to the following drugs,
substances and preparations set out in the corresponding
regulations, as amended from time to time, and summarized as
follows:
(v) All other Monitored Drugs (as defined under the Narcotics
Safety and Awareness Act, 2010, S.O. 2010, c. 22);
and as amended from time to time.
D. CONSENT
(20) I, Dr. Salsberg, 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
set out in section (7) above 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.
(21) I, Dr. Salsberg, 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.
(22) I, Dr. Salsberg, give my irrevocable consent to any person who
facilitates my completion of the Professional Education set out in
section (7) above, 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 Appendix "A";
(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 set out in section (7) above and which he or
she reasonably believes indicates a potential risk of harm to my
patients.
Terms and conditions imposed on certificate by: Member
