As from June 24, 2020, the following are imposed as terms, conditions and
limitations on the certificate of registration held by Dr. Zbigniew Andrzet
Marciniak in accordance with an undertaking and consent given by Dr. Marciniak
to the College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")
of
DR. ZBIGNIEW ANDRZET MARCINIAK
("Dr. Marciniak")
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;
"IEP" means Individualized Education Plan;
"OHIP" means the Ontario Health Insurance Plan;
"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. Marciniak, certificate of registration number 33744, am a member
of the College.
(3) I, Dr. Marciniak, 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. Marciniak acknowledge that due to COVID 19, I am not currently
seeing patients in-person.
B. UNDERTAKING
(5) I, Dr. Marciniak, undertake to abide by the provisions of this
Undertaking, effective immediately.
(6) I, Dr. Marciniak, undertake to notify the College within 5 days of
resuming seeing patients in-person.
(7) Clinical Supervision
(a) Upon resuming seeing patients in-person, I, Dr. Marciniak,
undertake to practise under the guidance of a clinical supervisor
or supervisors acceptable to the College (the "Clinical Supervisor"
or "Clinical Supervisors"), for six (6) months ("Clinical
Supervision").
(b) I, Dr. Marciniak, 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
Individualized Education Plan ("IEP"), attached hereto as
Appendix "B";
(ii) Review the materials provided by the College and have an
initial meeting to discuss the objectives for the Clinical
Supervision and practice improvement recommendations;
(iii) Meet with me at my Practice Location, or another location
approved by the College, once every two (2) weeks for a
minimum of three (3) months;
(iv) After a minimum of three (3) months of Clinical Supervision,
if my Clinical Supervisor recommends and the College approves
a reduction in the level of supervision, my Clinical
Supervisor will meet with me at my Practice Location, or
another location approved by the College, once every month
for a further three (3) months;
(v) Review at least fifteen (15) of my patient charts at every
meeting;
(vi) Discuss any concerns arising from the chart reviews;
(vii) Make recommendations to me for practice improvements and
ongoing professional development and inquire into my
compliance with the recommendations;
(viii)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
(ix) Submit written reports to the College at least once every
month for three (3) months or until the College approves a
reduction in the level of supervision, and then once at the
end of supervision, or more frequently if the Clinical
Supervisor has concerns about my standard of practice.
(c) I, Dr. Marciniak, 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, as
well as the areas of concern identified in the report of the
assessor, and concerns that may arise during the period of Clinical
Supervision.
(d) I, Dr. Marciniak, undertake to cooperate fully with the Clinical
Supervision of my practice described in section (7) 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.
(e) I, Dr. Marciniak, acknowledge that in making its determination that
I may return to unsupervised practice, the College may require that
I sign a further undertaking imposing terms, conditions and
limitations on my certificate of registration or requiring ongoing
re-assessments, clinical supervision and/or monitoring.
(f) I, Dr. Marciniak, undertake to ensure that Appendix "A" to this
Undertaking is signed and delivered to the College within thirty
(30) days of the date I resume seeing patients in person.
(g) I, Dr. Marciniak, 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. Marciniak, undertake that if I am unable to obtain a
Clinical Supervisor as set out in sections (7)(f) and (7)(g) above,
including returning a signed Appendix "A" within thirty (30) days,
I will cease practising medicine until such time as I have obtained
a Clinical Supervisor acceptable to the College.
(i) I, Dr. Marciniak, acknowledge that if I am required to cease
practise as a result of section (7)(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.
(8) Professional Education
(a) I, Dr. Marciniak, undertake to participate in and successfully
complete the following professional education (the "Professional
Education"):
(i) The following courses:
1. OCFP MSK Education: Joint Assessment Made Easy:
https://cpd.ocfp.on.ca/enrol/index.php?id=87;
2. OCFP Practising Wisely: Reducing Unnecessary Testing
and Treatment:
https://cpd.ocfp.on.ca/enrol/index.php?id=97; and
3. Medical Record-Keeping Course, University of Toronto:
www.cpd.utoronto.ca/recordkeeping/
(ii) Review, reflect upon and prepare a written summary of the
following resources:
1. Ontario Regulation 114/94 of the Medicine Act - section
17.: https://www.ontario.ca/laws/regulation/940114#BK1;
and
2. The Practice Guide, CPSO:
www.cpso.on.ca/Physicians/Policies-Guidance/Practice-Guide;
(iii) Review and discuss the following resources with my Clinical
Supervisor:
1. Medical Records Documentation Policy, CPSO:
www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Medical-Records-Documentation;
and
2. Guide to enhancing referrals and consultations between
physicians, CFPC and Royal College:
www.royalcollege.ca/rcsite/documents/health-policy/referrals-consultation-guide-e.pdf
(iv) all aspects of the detailed IEP, attached hereto as Appendix
"B"; and
(v) any additional professional education recommended by my
Clinical Supervisor.
(b) I, Dr. Marciniak, 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 where relevant, 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. Marciniak, acknowledge that a report or reports may be
provided to the College regarding my progress and compliance with
the Professional Education.
(d) I, Dr. Marciniak, undertake to complete the Professional Education
within three (3) months of the date I sign this Undertaking, or, if
no satisfactory program is available by that time, by the first
possible opportunity thereafter.
(9) Reassessment of Practice
(a) I, Dr. Marciniak, undertake that, approximately six (6) months
after the completion of the Clinical Supervision set out above and
in Appendix "A" and Appendix "B" attached, I will submit to a
reassessment of my 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. Marciniak, undertake to co-operate fully with the
Reassessment conducted under section (9) of this Undertaking.
(c) I, Dr. Marciniak, 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. Marciniak, 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.
(10) Monitoring
(a) I, Dr. Marciniak, undertake to inform the College of each and every
location at which I practise or have privileges, including, but not
limited to, any hospitals, clinics, offices, and any 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. Marciniak, 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
(11) I, Dr. Marciniak, acknowledge that all appendices attached to or referred
to in this Undertaking form part of this Undertaking.
(12) I, Dr. Marciniak, 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.
(13) I, Dr. Marciniak, 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.
(14) I, Dr. Marciniak, 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").
(15) I, Dr. Marciniak, 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 Committee.
(16) I, Dr. Marciniak, acknowledge that this Undertaking constitutes terms,
conditions, and limitations on my certificate of registration for the
purposes of section 23 of the Code.
(17) Public Register
(a) I, Dr. Marciniak, acknowledge that, during the time period that
this Undertaking remains in effect, this Undertaking shall be
posted on the Public Register.
(b) I, Dr. Marciniak, acknowledge that, in addition to this Undertaking
being posted in accordance with section (17)(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. Marciniak's
knowledge, skill and judgment. As a result:
- Dr. Marciniak will practise under the guidance of a
Clinical Supervisor acceptable to the College for 6
months.
- Dr. Marciniak will engage in professional education
in recordkeeping and certain clinical issues.
- Dr. Marciniak's practice will be reassessed by an
assessor selected by the College approximately 6 months
after the end of the period of Clinical Supervision.
D. CONSENT
(18) I, Dr. Marciniak, 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.
(19) I, Dr. Marciniak, acknowledge that I have executed the OHIP consent form,
attached hereto as Appendix "C".
(20) I, Dr. Marciniak, 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.
(21) I, Dr. Marciniak, 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.
(22) I, Dr. Marciniak, 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.
Terms and conditions imposed on certificate by: Member