(1 of 2)
Effective June 15, 2018, Dr. Syed has not yet obtained a clinical supervisor for his narcotics prescribing practice. Therefore, Dr. Syed must cease prescribing Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and All other Monitored Drugs until such time as he has obtained a Clinical Supervisor acceptable to the College.
(2 of 2)
As from 11:59 p.m., June 15, 2018, by order of the Discipline Committee of the College of Physicians and Surgeons of Ontario, the following terms, conditions and limitations are imposed on the certificate of registration held by Dr. Naseeruddin Syed:
A. Prescribing Log
(i) Dr. Syed, shall keep a Log of all prescriptions for Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and All other Monitored Drugs (as set out in Schedule "A"), in the form attached as set out in Schedule "B", which will include at least the following information (the "Prescribing Log"):
(a) the date of the appointment;
(b) the name of the patient and chart/file number;
(c) the name of the medication prescribed, dose, direction, number of tablets to be dispensed and frequency;
(d) the clinical indication;
(e) whether the prescription is for a new medication and/or different dose or frequency than currently prescribed to the patient (Y/N);
(f) Dr. Syed's signature;
(g) the date of the Clinical Supervisor's review (if applicable, as set out below); and
(h) the Clinical Supervisor's signature (if applicable, as set out below).
(ii) Dr. Syed is to keep a copy of all prescriptions he writes for Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and All other Monitored Drugs, in the corresponding patient chart.
B. Clinical Supervision re: Narcotic Practice
(i) Dr. Syed is to practise under the guidance of a clinical supervisor acceptable to the College (the "Clinical Supervisor"), for a minimum of nine (9) months on the terms set out below (the "Clinical Supervision").
(ii) The Clinical Supervisor shall sign an undertaking in the form attached hereto as Schedule "C".
(iii) Dr. Syed shall cooperate fully with the Clinical Supervision and abide by all recommendations of his Clinical Supervisor with respect to practice improvements and education.
(iv) Dr. Syed shall consent to the disclosure by the Clinical Supervisor to the College, and by the College to his Clinical Supervisor, of all information the Clinical Supervisor or the College deems necessary or desirable in order to fulfill the Clinical Supervisor's undertaking and to monitor Dr. Syed's compliance with this Order. This shall include, without limitation, providing the Clinical Supervisor with any reports of any assessments of Dr. Syed's practice in the College's possession.
(v) If the Clinical Supervisor who has given an undertaking in Schedule "C" to this Order is unable or unwilling to continue to fulfill its terms, Dr. Syed shall, within seven (7) 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.
(vi) Dr. Syed shall not prescribe any narcotics or controlled substances unless and until the Clinical Supervision is in place.
(vii) If Dr. Syed is unable to obtain a Clinical Supervisor on the terms set out in sections 4.B, he will cease prescribing Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and All other Monitored Drugs until such time as he has obtained a Clinical Supervisor acceptable to the College.
(viii)If Dr. Syed is required to cease prescribing Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and All other Monitored Drugs as a result of section 4.B(vii) above this will constitute a term, condition or limitation on his certificate of registration and that term, condition or limitation will be included on the Public Register.
Phase 1 of Clinical Supervision ("Phase 1")
(ix) Dr. Syed is to engage in Phase 1 of Clinical Supervision for a minimum of two (2) months on the terms set out below.
(x) During Phase 1, Dr. Syed is to meet with the Clinical Supervisor once a week to discuss the Clinical Supervisor's review of a minimum of twenty (20 charts for patients to whom Dr. Syed has prescribed:
(a) Narcotic Drugs, or
(b) Narcotic Preparations; or
(c) Controlled Drugs, Benzodiazepines and Other Targeted Substances and All other Monitored Drugs where the patient is also prescribed a Narcotic Drug and/or Narcotic Preparation.
(xi) If there are not twenty (20) charts for patients to whom Dr. Syed has prescribed the above substances, the Clinical Supervisor shall review the charts of all patients listed in the prescribing log since his prior review.
(xii) During Phase 1, the Clinical Supervisor must sign and date the Prescribing Log to confirm the charts that the Clinical Supervisor has reviewed and discussed with Dr. Syed.
(xiii) During Phase 1, the Clinical Supervisor will provide a report to the College at least once a week.
(xiv) After a minimum of two (2) months of Phase 1, if the Clinical Supervisor is satisfied that Dr. Syed has the necessary knowledge, skills and judgment to practice in a less highly supervised environment, the Clinical Supervisor may recommend to the College that supervision be reduced.
Phase 2 of Clinical Supervision ("Phase 2")
(xv) Upon the recommendation of the Clinical Supervisor and approval by the College, Dr. Syed shall engage in Phase 2 of Clinical Supervision for a minimum of three months on the terms set out below.
(xvi) During Phase 2, Dr. Syed is to with the Clinical Supervisor at least once every two (2) weeks the Clinical Supervisor's review of a minimum of fifteen (15) charts for patients to whom Dr. Syed has initiated a new prescription for:
(a) Narcotic Drugs, or
(b) Narcotic Preparations; or
(c) Controlled Drugs, Benzodiazepines and Other Targeted Substances and All other Monitored Drugs where the patient is also prescribed a Narcotic Drug and/or Narcotic Preparation.
(xvii) If there are not fifteen (15) charts for patients to whom Dr. Syed has initiated a new prescription for the above substances, the Clinical Supervisor shall review the charts of all patients listed in the prescribing log since his prior review.
(xviii) During Phase 2, the Clinical Supervisor must sign and date the Prescribing Log to confirm the charts that the Clinical Supervisor has reviewed and discussed with Dr. Syed.
(xix) During Phase 2, the Clinical Supervisor will provide a report to the College at least once every two (2) weeks.
(xx) After a minimum of three (3) months of Phase 2, if the Clinical Supervisor is satisfied that Dr. Syed has the necessary knowledge, skills and judgment to practice in a less highly supervised environment, the Clinical Supervisor may recommend to the College that supervision be reduced.
Phase 3 of Clinical Supervision ("Phase 3")
(xxi) Upon the recommendation of the Clinical Supervisor and approval by the College, Dr. Syed, shall engage in Phase 3 of Clinical Supervision for a minimum of four (4) months on the terms set out below.
(xxii)During Phase 3, Dr. Syed shall with the Clinical Supervisor at least once a month the Clinical Supervisor's review of a minimum of fifteen (15) charts for patients to whom Dr. Syed has initiated a new prescription for:
(a) Narcotic Drugs, or
(b) Narcotic Preparations; or
(c) Controlled Drugs, Benzodiazepines and Other Targeted Substances and All other Monitored Drugs where the patient is also prescribed a Narcotic Drug and/or Narcotic Preparation.
(xxiii) If there are not fifteen (15) charts for patients to whom Dr. Syed has initiated a new prescription for the above substances, the Clinical Supervisor shall review the charts of all patients listed in the prescribing log since his prior review.
(xxiv) During Phase 3, the Clinical Supervisor must sign and date the Prescribing Log to confirm the charts that the Clinical Supervisor has reviewed and discussed with Dr. Syed.
(xxv) During Phase 3, the Clinical Supervisor(s) will provide a report to the College at least once every month.
(xxvi)After a minimum of four (4) months of Phase 3, if the Clinical Supervisor is satisfied that Dr. Syed has the necessary knowledge, skills and judgment to practice without supervision, the Clinical Supervisor may recommend to the College that the Clinical Supervision cease.
C. Clinical Supervision re: Non-Narcotic Practice
(i) By June 15, 2018, Dr. Syed shall obtain a clinical supervisor acceptable to the College, who will supervise Dr. Syed's general practice upon completion of his suspension for a period of nine (9) months, and who will sign an undertaking in the form attached hereto as Schedule "D" (the "General Practice Clinical Supervisor").
(ii) Dr. Syed shall cooperate fully with the Clinical Supervision and abide by all recommendations of his General Practice Clinical Supervisor with respect to practice improvements and education.
(iii) Dr. Syed shall consent to the disclosure by the General Practice Clinical Supervisor to the College, and by the College to his General Practice Clinical Supervisor, of all information the General Practice Clinical Supervisor, of all information the General Practice Clinical Supervisor or the College deems necessary or desirable in order to fulfill the General Practice Clinical Supervisor's undertaking and to monitor Dr. Syed's compliance with this Order. This shall include, without limitation, providing the General Practice Clinical Supervisor with any reports of any assessments of Dr. Syed's practice in the College's possession.
(iv) If the General Practice Clinical Supervisor who has given an undertaking in Schedule "D" to this Order is unable or unwilling to continue to fulfill its terms, Dr. Syed 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.
(v) If Dr. Syed is unable to obtain a General Practice Clinical Supervisor in accordance with paragraphs 4(C)(i) or 4(C)(iv) of this Order, he shall cease practising medicine until such time as he has done so, and the fact that he has will constitute a term, condition or limitation on his certificate of registration until that time.
D. Reassessment of Practice
(i) Approximately three (3) months after each aspect of the Clinical Supervision set out above has ceased, Dr. Syed will submit to a comprehensive reassessment of his entire practice by an assessor or assessors selected by the College (the "Assessor(s)"). The Reassessment may include a chart review, direct observation of Dr. Syed's care, interviews with colleagues and co-workers, feedback from patients and any other tools deemed necessary by the College. Dr. Syed shall abide by all recommendations made by the Assessor(s), and the results of the Reassessment will be reported to the College and may form the basis of further action by the College.
E. Compliance
(i) Dr. Syed shall co-operate with unannounced inspections of his office practice and patient charts for the purpose of monitoring and enforcing his compliance with the terms of this Order.
(ii) Dr. Syed shall inform the College of any and all new practice locations including, but not limited to, hospital(s), clinic(s) and office(s), in any jurisdiction five (5) days in advance of commencing practice at that location.
(iii) Dr. Syed shall give his irrevocable consent to the College to make appropriate enquiries of the Ontario Health Insurance Plan ("OHIP"), the Drug Program Services Branch, the Narcotics Monitoring System ("NMS") implemented under the Narcotics Safety and Awareness Act, 2010 and/or any person or institution who may have relevant information, in order for the College to monitor my compliance with the provisions of this Order.
(iv) Dr. Syed shall be responsible for any and all costs associated with implementing the terms of this Order.
Terms and conditions imposed on certificate by: Inquiries, Complaints and Reports Committee