As from April 3, 2018, the following is imposed as a term, condition and
limitation on the certificate of registration held by Dr. Vlade Mitre Gagovski,
in accordance with an undertaking and consent given by Dr. Gagovski to the
College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")
of
DR. VLADE MITRE GAGOVSKI
("Dr. Gagovski")
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. Gagovski, certificate of registration number 56041, am a member of
the College. The College has received information regarding my standard
of practice.
(3) I, Dr. Gagovski, acknowledge that the College initiated an investigation
into my standard of practice. Further to the investigation the ICR
Committee required in their November 16, 2016 decision, that I undergo a
specified continued education or remediation program ("SCERP").
(4) I, Dr. Gagovski, acknowledge that the terms of this Undertaking replace
my obligations as set out in the November 16, 2016 SCERP.
B. UNDERTAKING
(5) I, Dr. Gagovski, undertake to abide by the provisions of this
Undertaking, effective immediately.
(6) Practice Restrictions
(a) I, Dr. Gagovski, undertake that I will not use metronomic
chemotherapy with insulin potentiation in the treatment of cancer
patients.
(b) I, Dr. Gagovski, undertake to restrict my Complementary/Alternative
Medicine practice to disease prevention/screening/early detection
of recurrent disease and to the provision of nutritional, metabolic
and dietary therapies and advice to patients including the
provision of nutritional infusions containing vitamins and
minerals.
(c) I, Dr. Gagovski, undertake to provide a referral to an oncologist
to every patient I treat who has been diagnosed with cancer and who
is not under the active care of an oncologist.
(7) Posting a Sign
(a) I, Dr. Gagovski, undertake that I shall post a sign in the waiting
room(s) of all my Practice Locations, in a clearly visible and
secure location, in the form set out at Appendix "A." For further
clarity, this sign shall state as follows: "Dr. Gagovski has agreed
not to use metronomic chemotherapy with insulin potentiation in the
treatment of cancer patients. He has restricted his Complementary/
Alternative Medicine practice to disease prevention/screening/early
detection of recurrent disease and to the provision of nutritional,
metabolic and dietary therapies and advice to patients including
the provision of nutritional infusions containing vitamins and
minerals.
Further information may be found on the College of Physicians and
Surgeons of Ontario website at www.cpso.on.ca".
(b) I, Dr. Gagovski, undertake to post a certified translation(s) in
any language(s) in which I provide services, of the sign described
in section (7)(a) in the waiting room(s) of all my Practice
Locations, in a clearly visible and secure location, in the form
set out at Appendix "A."
(c) I, Dr. Gagovski, undertake to provide the certified translation(s)
described in section (7)(b), to the College within thirty (30) days
of executing this Undertaking.
(d) I, Dr. Gagovski, undertake that if I elect, after the execution of
this Undertaking, to provide services in any other language(s), I
will notify the College prior to providing any such services.
(e) I, Dr. Gagovski, undertake to provide to the College the certified
translation(s) described in section (7)(b) prior to beginning to
provide services in the language(s) described in section (7)(d).
(8) Clinical Supervision
(a) I, Dr. Gagovski, undertake to practise under the guidance of a
clinical supervisor(s) acceptable to the College (the "Clinical
Supervisor(s)"), for six (6) months ("Clinical Supervision").
(b) I, Dr. Gagovski, acknowledge that I have reviewed the Clinical
Supervisor(s)'s undertaking, attached hereto as Appendix "B", and
understand what is required of the Clinical Supervisor(s). The
Clinical Supervisor(s) will, at minimum:
(i) Facilitate the education program set out in the
Individualized Education Plan ("IEP"), attached hereto as
Appendix "C";
(ii) Meet with me at my Practice Location, or another location
approved by the College, once every month;
(iii) Directly observe patient encounters for 1/2 day, once every
month;
(iv) Review at least fifteen (15) of my patient charts at every
meeting, or if there are less than fifteen patient encounters
since the last meeting, review all Complementary/Alternative
Medicine encounters;
(v) Discuss any concerns arising from the chart reviews;
(vi) Make recommendations to me for practice improvements and
ongoing professional development and inquire into my
compliance with the recommendations;
(vii) Perform any other duties, such as reviewing other documents
or conducting interviews with staff or colleagues, that the
Clinical Supervisor(s) deem necessary to my Clinical
Supervision; and
(viii)Submit written reports to the College at least once every two
(2) months, or more frequently if the Clinical Supervisor(s)
has concerns about my standard of practice.
(c) I, Dr. Gagovski, acknowledge that the charts reviewed shall be
selected by the Clinical Supervisor(s) based on the educational
needs identified in the IEP, attached hereto as Appendix "C", as
well as the areas of concern identified in the report(s) of the
medical inspector, and concerns that may arise during the period of
Clinical Supervision.
(d) I, Dr. Gagovski, undertake to cooperate fully with the Clinical
Supervision of my practice, conducted under the term of this
Undertaking and Appendix "B" to this Undertaking, and to abide by
the recommendations of my Clinical Supervisor(s), including but not
limited to, any recommended practice improvements and ongoing
professional development.
(e) I, Dr. Gagovski, undertake to ensure that Appendix "B" to this
Undertaking is signed and delivered to the College within thirty
(30) days of the date I execute this Undertaking.
(f) I, Dr. Gagovski, undertake that if a person who has given an
undertaking in Appendix "B" 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. Gagovski, undertake that if I am unable to obtain a Clinical
Supervisor on the provisions set out under sections (8)(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. Gagovski, acknowledge that if I am required to cease
practise as a result of section (8)(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.
(9) Reassessment of Practice
(a) I, Dr. Gagovski, undertake that, approximately six (6) months after
the completion of the Clinical Supervision set out in section (8)
above and Appendix "B" to this Undertaking, I will submit to a
reassessment of my practice ("the Reassessment") by an assessor or
assessors selected by the College (the "Assessor(s)"). I
acknowledge 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. Gagovski, undertake to co-operate fully with the
Reassessment, conducted under the term of this Undertaking.
(c) I, Dr. Gagovski, acknowledge that my Clinical Supervisor(s) may
receive and review the findings of the Assessor(s), and may discuss
with the Assessor(s) 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.
(d) I, Dr. Gagovski, acknowledge that if I am of the view that any of
the Assessor(s)'s recommendations are unreasonable, I will have
thirty (30) days following my receipt of the recommendations within
which to provide the College with my submissions in this regard. I
further acknowledge that thereafter, the ICR Committee will
consider my submissions and make a determination regarding whether
or not the recommendations, or any of them, are reasonable and if
so, whether they, or any of them, constitute limitations or
restrictions on my practice, and that decision will be provided to
me.
(e) I, Dr. Gagovski, undertake that, following the decision referenced
in section (9)(d) above, I will abide by those recommendations of
the Assessor(s) that the ICR Committee has determined are
reasonable.
(f) I, Dr. Gagovski, hereby consent to the following being included on
the public register as terms, conditions or limitations on my
certificate of registration, for the purposes of section 23 of the
Code:
(i) any recommendations of the Assessor(s) which the ICR
Committee has identified in its decision referenced in
section (9)(d) as terms, conditions or limitations on my
practice.
(10) Monitoring
(a) I, Dr. Gagovski, 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 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. Gagovski, undertake 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. Gagovski, 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. Gagovski, acknowledge that I have executed the OHIP and NMS
consent form(s), attached hereto as Appendix "D" and Appendix "E",
respectively.
C. ACKNOWLEDGEMENT
(11) I, Dr. Gagovski, acknowledge that all appendices attached to or referred
to in this Undertaking form part of this Undertaking.
(12) I, Dr. Gagovski, 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. Gagovski, 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. Gagovski, 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").
(15) I, Dr. Gagovski, 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.
(16) I, Dr. Gagovski, 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. Gagovski, acknowledge that, during the time period that this
Undertaking remains in effect, this Undertaking shall be posted on
the Public Register.
(b) I, Dr. Gagovski, 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:
A College investigation was conducted into Dr. Gagovski's
standard of practice As a result of the investigation:
Dr. Gagovski has agreed not to use metronomic
chemotherapy with insulin potentiation in the treatment
of cancer patients. He has restricted his practice to
disease prevention/screening/early detection of
recurrent disease and to the provision of nutritional,
metabolic and dietary therapies and advice to patients
including the provision of nutritional infusions
containing vitamins and minerals.
Dr. Gagovski will practise under the guidance of a
Clinical Supervisor acceptable to the College for 6
months.
Dr. Gagovski's practice will be reassessed by an
assessor selected by the College within 6 months of the
end of the period of Clinical Supervision.
D. CONSENT
(18) I, Dr. Gagovski, give my irrevocable consent to the College to provide
the following information 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.
(19) I, Dr. Gagovski, 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.
(20) I, Dr. Gagovski, give my irrevocable consent 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 "B" to this Undertaking;
(c) relevant to the Reassessment;
(d) relevant for the purposes of monitoring my compliance with this
Undertaking; and/or
(e) which comes to their attention and which they reasonably believe
indicates a potential risk of harm to my patients.
Terms and conditions imposed on certificate by: Member