THE FOLLOWING INFORMATION WAS OBTAINED FROM THE PHYSICIAN REGISTER SECTION OF THE WEBSITE OF THE COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO (WWW.CPSO.ON.CA) AS OF THE DATE AND TIME NOTED BELOW
05/11/25 14:57:42 PM

General Information

Former Name: No Former Name
Medical School: Schulich School of Medicine and Dentistry, Western University, 1990
Gender: Man
Languages Spoken: ENGLISH

Practice Information

Primary Business Location: 570 Wonderland Rd N
London Ontario N6H 3E3
Business Email: No Information Available
Phone: (519) 668-6074
Fax: No Information Available
Address: 1880 sismet
Toronto Ontario L4W 1W9
Phone: No Information Available
Fax: No Information Available

Specialties

SPECIALTY ISSUED ON CERTIFYING BODY
Family Medicine
Effective: 01 Jun 1992
College of Family Physicians of Canada
SPECIALTY: Family Medicine
ISSUED ON: Effective: Jun 01 1992
CERTIFYING BODY: College of Family Physicians of Canada

Medical Licences In Other Jurisdictions

Barbados
Guyana

Hospital Privileges

No information available

Professional Corporation Information

Corporation Name: E.D. Armogan Medicine Professional Corporation
Certificate of Authorization Status: Issued Date: 01 Nov 2012
Shareholders:
Dr. E. Armogan (CPSO#: 62095 )
Business Address: 570 Wonderland Road North
London Ontario N6H 3E3 (519) 681-3114
Business Address: 1880 Sismet Road
Mississauga Ontario L4W 1W9

General Information

Former Name: No Former Name
Gender: Man
Languages Spoken: ENGLISH
Medical School: Schulich School of Medicine and Dentistry, Western University, 1990

Practice Information

Primary Business Location: 570 Wonderland Rd N
London Ontario N6H 3E3
Business Email: No Information Available
Phone: (519) 668-6074
Fax: No Information Available
Address: 1880 sismet
Toronto Ontario L4W 1W9
Phone: No Information Available
Fax: No Information Available

Specialties

SPECIALTY ISSUED ON CERTIFYING BODY
Family Medicine
Effective: 01 Jun 1992
College of Family Physicians of Canada
SPECIALTY: Family Medicine
ISSUED ON: Effective: Jun 01 1992
CERTIFYING BODY: College of Family Physicians of Canada

Medical Licences In Other Jurisdictions

Barbados
Guyana

Hospital Privileges

No information available

Professional Corporation Information

Corporation Name: E.D. Armogan Medicine Professional Corporation
Certificate of Authorization Status: Issued Date: 01 Nov 2012
Shareholders:
Dr. E. Armogan (CPSO#: 62095 )
Business Address: 570 Wonderland Road North
London Ontario N6H 3E3 (519) 681-3114
Business Address: 1880 Sismet Road
Mississauga Ontario L4W 1W9

Practice Conditions

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(1) Dr. EDWARD DAVINDRA ARMOGAN may practise only in the areas of medicine in which Dr. ARMOGAN is educated and experienced.
VIEW DETAILS chevron-down icon
(1) Dr. EDWARD DAVINDRA ARMOGAN may practise only in the areas of medicine in which Dr. ARMOGAN is educated and experienced.

Current Tribunal Proceedings

No information available

Past Tribunal Proceedings (1)

Date of Decision: 14 Aug 2019
Summary of Decision:
On August 14, 2019, on the basis of an Agreed Statement of Facts and Admission, the Discipline Committee found that Dr. Armogan committed an act of professional misconduct, in that he has failed to maintain the standard of practice of the profession, and has engaged in an act or omission relevant to the practice of medicine that, having regard to all circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Background

Dr. Edward Davindra Armogan (“Dr. Armogan”) is a 53 year-old family physician who received his certificate of registration authorizing independent practice from the College of Physicians and Surgeons of Ontario (“the College”) in June 1990.
At the relevant time, Dr. Armogan practised family medicine in London, Ontario. A significant portion of his practice has focused on providing general practitioner psychotherapy and treatment to patients with psychological disorders. The remaining portion of his practice is general family medicine for patients. Dr. Armogan also maintains a cosmetic medicine practice which is not the subject of this matter.
Dr. Armogan signed an undertaking on April 27, 2015 (the “2015 Undertaking”). Among other things, Dr. Armogan agreed to undergo clinical supervision of his prescribing of opioids and other controlled medications. As a result, Dr. Armogan engaged in clinical supervision with Dr. Rashmi Bhalla from June 8, 2015 to August 17, 2016.
During supervision, Dr. Bhalla identified concerns about Dr. Armogan’s prescribing of stimulants for treatment of attention deficit hyperactivity disorder (“ADHD”) in adults.
As a result of the concerns raised by Dr. Bhalla, Dr. Armogan entered into a supplemental undertaking on May 13, 2016 (the “2016 Supplemental Undertaking”). The 2016 Supplemental Undertaking specified that Dr. Armogan was not to prescribe stimulant medication to adults for augmentation in the treatment of depression or for the treatment of adult ADHD unless the medication was first prescribed by a psychiatrist.
Data obtained by the College from the provincial Narcotics Monitoring System (“NMS”) showed that on several occasions Dr. Armogan breached the 2016 Supplemental Undertaking, by initiating or re-initiating prescriptions for stimulants for adult patients for the treatment of ADHD without ensuring the medication was first prescribed by a psychiatrist.
In general, Dr. Armogan’s breaches of his 2016 Supplemental Undertaking comprised of the following circumstances:

a) Matters in which Dr. Armogan re-initiated prescribing of stimulants to adult patients without a psychiatrist having written the first prescription or having completed a consultation prior to Dr. Armogan’s prescribing;

b) Matters in which Dr. Armogan initiated prescribing of stimulants after having obtained a consultation with a psychiatrist, but where the psychiatrist had not written the first prescription and in some cases had not endorsed a current ADHD diagnosis or initiation of stimulant prescribing at this time; and

c) Matters in which Dr. Armogan initiated prescribing of stimulants based on information from the patient that the patient had been prescribed stimulants for ADHD in the past, but where Dr. Armogan did not ensure that the information was correct and/or did not ensure the currency of any first prescription written by a psychiatrist.

Standard of Practice

Dr. Armogan’s 2015 Undertaking required him to undergo a reassessment of his family practice after completion of a period of clinical supervision. Dr. Joy Weisbloom was retained to conduct the reassessment. She reviewed fifteen patient records and interviewed Dr. Armogan.

As concluded by Dr. Weisbloom, Dr. Armogan failed to maintain the standard of practice of the profession in eleven of the fifteen patient charts reviewed, including with respect to appropriate  prescribing of stimulants and narcotics, conduct of and response to urine drug screens, and medical record-keeping.

Dr. Weisbloom did find that Dr. Armogan had made positive changes since she first assessed his practice in 2014 prior to his entering into the 2015 Undertaking, and that it was evident he cared about his patients and was endeavouring to improve his practice to provide better care. She noted that the major deficiencies had been addressed and shown improvements.

Admission

Dr. Armogan admits the facts specified above, and admits that, based on these facts, he engaged in professional misconduct, in that:

a) he failed to maintain the standard of practice of the profession, under paragraph 1(1)2 of Ontario Regulation 856/93, made under the Medicine Act, 1991; and

b) he engaged in an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, under paragraph 1(1)33 of Ontario Regulation 856/93, made under the Medicine Act, 1991.

AGREED STATEMENT OF FACTS RELEVANT TO PENALTY

Clinical Supervision and Cooperation with the College

Dr. Armogan cooperated with the College Compliance Case Manager’s requests for information regarding prescriptions for specific patients. After the Compliance Case Manager drew the College’s compliance concerns to Dr. Armogan’s attention, no new compliance concerns arose.

Pending the discipline hearing, Dr. Armogan voluntarily agreed to abide by an interim undertaking to the College requiring, among other things, that his practice be under clinical supervision.

As a result of this interim undertaking, Dr. Armogan’s practice has been under the clinical supervision of Dr. Shelendra Joshi since August 2018. Among other things, Dr. Joshi undertook to review with Dr. Armogan every patient chart regarding each patient to whom Dr. Armogan prescribes any narcotic drugs, narcotic preparations, controlled drugs, benzodiazepines and other targeted substances, and/or all other monitored drugs to ensure that assessment, clinical examination, risk assessment for addiction and ongoing management and follow-up is appropriate.

Dr. Joshi’s report of May 26, 2019 notes among other things that:
- Dr. Armogan’s prescribing of controlled substances was reasonable in dose and amounts dispensed.
- Dr. Armogan has become more diligent regarding updating the medication lists in his cumulative patient profiles. His documentation for prescribing opioids has been meeting the standard of practice required.
- Dr. Armogan has been abiding by the terms of his restrictions regarding prescribing of stimulants for ADHD.

Relevant History with the College

In October 2010, Dr. Armogan was required by the Inquiries, Complaints and Reports Committee (“ICRC”) to attend at the College to be cautioned regarding the assessment and management of anxiety, depression and ADHD and, specifically, what is required to assess these conditions before prescribing potentially dangerous combinations of medications.

In 2015, the ICRC accepted Dr. Armogan’s 2015 Undertaking in resolution of a public complaint regarding his care of a patient and a broader investigation into his prescribing to pediatric patients.

In the 2015 Undertaking, Dr. Armogan agreed to a restriction on his prescribing stimulants to patients under the age of 18 without prior approval of a consulting psychiatrist. This restriction remains in effect and is not in issue in the present matter. No concerns have arisen to date regarding Dr. Armogan’s compliance with this restriction.

Remediation

In addition to engaging in the remediation and clinical supervision required by his 2015 Undertaking, 2016 Supplemental Undertaking and interim undertaking pending the present discipline hearing, Dr. Armogan voluntarily attended the Safe Opioid Prescribing Course at the University of Toronto, which he completed on December 7, 2018.

ORDER

The Discipline Committee ordered that:
- Dr. Armogan to attend before the panel to be reprimanded

- The Registrar suspend Dr. Armogan’s certificate of registration for a period of two (2) months, commencing from August 15, 2019 at 12:01 a.m.

- The Registrar place the following terms, conditions and limitations on Dr. Armogan’s certificate of registration:

Compliance with Policy re Suspension

(i) Dr. Armogan shall comply with the College Policy on “Practice Management Considerations for Physicians Who Cease to Practise, Take an Extended Leave of Absence or Close Their Practice Due to Relocation”, a copy of which is attached at Schedule “A” to the Order, in respect of the suspension of his certificate of registration at paragraph 3 above.

Prescribing Restriction

(ii) Dr. Armogan shall not prescribe stimulant medication to patients who are eighteen (18) years of age or older, unless the medication has been first prescribed by a psychiatrist, as documented in a consultation letter from the psychiatrist to be maintained by Dr. Armogan in the patient’s chart. For greater certainty, and without restricting the foregoing, if a patient of Dr. Armogan who is eighteen (18) years of age or older was previously prescribed stimulant medication, but such prescribing has been discontinued or the medication has not been taken for the past three (3) or more months, Dr. Armogan shall not prescribe stimulant medication to the patient unless a psychiatrist first assesses the patient and initiates a new prescription, as documented in a consultation letter to be maintained by Dr. Armogan in the patient’s chart.

Individualized Ethics Instruction

(iii) Dr. Armogan shall participate in and successfully complete, within six (6) months of the date of the Order, individualized instruction in medical ethics satisfactory to the College, with an instructor approved by the College, who shall provide a summative report to the College including his or her conclusion about whether Dr. Armogan successfully completed the instruction.

(iv) Dr. Armogan shall consent to the College providing any information the College has that led to the circumstances of the Order and any information arising from the monitoring of his compliance with the Order to any person who requires this information to facilitate his completion of the individualized instruction in medical ethics.

Maintenance of Prescribing Log

(v) Dr. Armogan shall keep a log of all prescriptions for Narcotic Drugs, Narcotic
Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances (A summary of the above-named drugs [from Appendix I to the Compendium of Pharmaceuticals and Specialties] is attached to the Order as Schedule “B”; and links to the current regulatory lists are attached hereto as Schedule “C”), and All Other Monitored Drugs (as defined under the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22, as amended, with a link to the current regulatory list attached hereto at Schedule “D”), such log to be in the form attached at Schedule “E” (the “Prescribing Log”) to the Order, which will include at least the following information:

(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. Armogan’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).

(vi) Dr. Armogan shall 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.

Clinical Supervision

(vii) Upon the conclusion of the suspension of Dr. Armogan’s certificate of registration under paragraph 3 above, Dr. Armogan shall practise under the guidance of a clinical supervisor acceptable to the College (the “Clinical Supervisor”) who shall sign an undertaking in the form attached at Schedule “F” to the Order, for three (3) months, on the terms set out below and as described in Schedule “F” (the “Clinical Supervision”).

(viii) Dr. Armogan shall cooperate fully with the Clinical Supervision and abide by all recommendations of his Clinical Supervisor including, but not limited to, any recommended practice improvements and professional development.

(ix) Dr. Armogan shall review with his Clinical Supervisor every patient for whom he has prescribed any Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and/or All Other Monitored Drugs to ensure that assessment, clinical examination, risk assessment for addiction and ongoing management and follow up is appropriate.
(x) Dr. Armogan shall ensure that his Clinical Supervisor confirms their review of his patient care with him as described above in paragraph 4(ix) by signing the Prescribing Log and the patient chart in question within two (2) weeks of Dr.Armogan issuing any prescription for Narcotic Drugs, Narcotic Preparations,Controlled Drugs, Benzodiazepines and Other Targeted Substances and/or All Other Monitored Drugs.

(xi) Dr. Armogan shall ensure that Schedule “F” to the Order is signed and delivered to the College by an approved Clinical Supervisor prior to the conclusion of the suspension of his certificate of registration.

(xii) If a person who has given an undertaking in Schedule “F” to the Order is unable or unwilling to fulfill its provisions, Dr. Armogan 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.

(xiii) If Dr. Armogan is unable to obtain a Clinical Supervisor on the terms set out in paragraphs 4(xi) and (xii) above, he will cease prescribing Narcotic Drugs,Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and/or All Other Monitored Drugs 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.

(xiv) Dr. Armogan shall consent to the disclosure by the Clinical Supervisor to the College, and by the College to the 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. Armogan’s compliance with the Order. This shall include, without limitation, providing the Clinical Supervisor with any reports of any assessments of or prior clinical supervision of Dr. Armogan’s practice in the College’s possession.

Reassessment

(xv) Approximately six (6) months after the Clinical Supervision above has ceased, Dr. Armogan will submit to a reassessment (the “Reassessment”) of his family practice, including but not limited to his prescribing of Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and All Other Monitored Drugs, by an assessor or assessors selected by the College (the “Assessor(s)”). The Reassessment may include chart reviews, direct observation of Dr. Armogan’s care, interviews with colleagues and co-workers, feedback from patients and any other tools deemed necessary by the College. The results of the Reassessment will be reported to the College and may form the basis of further action by the College.

(xvi) Dr. Armogan shall cooperate fully with the Reassessment and with the Assessor(s). Dr. Armogan shall consent to the disclosure among the Clinical Supervisor, the College, and the Assessor(s) of all information any of them deems necessary or desirable to complete the Reassessment and to monitor Dr. Armogan’s compliance with the Order. This shall include, without limitation, providing the Assessor(s) with any reports of any assessments of or clinical supervision of Dr. Armogan’s practice in the College’s possession

(xvii) If it deems the Reassessment satisfactory, the Inquiries, Complaints and Reports Committee of the College may direct that any or all of the terms, conditions and limitations on Dr. Armogan’s certificate of registration set out at paragraphs 4(ii), 4(v), and/or 4(vi) above be lifted.

Compliance and Monitoring

(xviii) Dr. Armogan shall cooperate with unannounced inspections of his office practice and patient charts for the purpose of monitoring and enforcing his compliance with the terms of the Order.

(xix) Dr. Armogan 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 ten (10) days of the 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.

(xx) Dr. Armogan shall give his irrevocable consent to the College to make 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 his compliance with the provisions of the Order.

(xxi) Dr. Armogan shall be responsible for any and all costs associated with implementing the terms of the Order.

- Dr. Armogan pay costs to the College in the amount of $6,000 within thirty (30) days of the date of the Order.
 
Reasons for Decision: Download Full Decision (PDF)
Hearing Date(s): August 14, 2019 half-day hearing start time 1:00 p.m.

Other Notifications (3)

Source: Inquiries, Complaints and Reports Committee
Effective Date: 19 Dec 2019
Summary:
Caution-in-Person:
               
A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed.  A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee.  The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015, or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.
 
See PDF for the summary of a decision made against this member in which the disposition includes a Caution-in-Person:

Download Full Document (PDF)
Source: Inquiries, Complaints and Reports Committee
Effective Date: 04 Sep 2019
Summary:
Caution-in-Person:
               
A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed.  A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee.  The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015, or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.
 
See PDF for the summary of a decision made against this member in which the disposition includes a Caution-in-Person:

Download Full Document (PDF)
Source: Inquiries, Complaints and Reports Committee
Effective Date: 17 May 2017
Summary:
Caution-in-Person:

A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed. A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee. The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015 or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.

See PDF for the summary of a decision made against this member in which the disposition includes a caution-in-person.

Download Full Document (PDF)

Current Tribunal Proceedings

No information available

Past Tribunal Proceedings (1)

Date of Decision: 14 Aug 2019
Summary of Decision:
On August 14, 2019, on the basis of an Agreed Statement of Facts and Admission, the Discipline Committee found that Dr. Armogan committed an act of professional misconduct, in that he has failed to maintain the standard of practice of the profession, and has engaged in an act or omission relevant to the practice of medicine that, having regard to all circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Background

Dr. Edward Davindra Armogan (“Dr. Armogan”) is a 53 year-old family physician who received his certificate of registration authorizing independent practice from the College of Physicians and Surgeons of Ontario (“the College”) in June 1990.
At the relevant time, Dr. Armogan practised family medicine in London, Ontario. A significant portion of his practice has focused on providing general practitioner psychotherapy and treatment to patients with psychological disorders. The remaining portion of his practice is general family medicine for patients. Dr. Armogan also maintains a cosmetic medicine practice which is not the subject of this matter.
Dr. Armogan signed an undertaking on April 27, 2015 (the “2015 Undertaking”). Among other things, Dr. Armogan agreed to undergo clinical supervision of his prescribing of opioids and other controlled medications. As a result, Dr. Armogan engaged in clinical supervision with Dr. Rashmi Bhalla from June 8, 2015 to August 17, 2016.
During supervision, Dr. Bhalla identified concerns about Dr. Armogan’s prescribing of stimulants for treatment of attention deficit hyperactivity disorder (“ADHD”) in adults.
As a result of the concerns raised by Dr. Bhalla, Dr. Armogan entered into a supplemental undertaking on May 13, 2016 (the “2016 Supplemental Undertaking”). The 2016 Supplemental Undertaking specified that Dr. Armogan was not to prescribe stimulant medication to adults for augmentation in the treatment of depression or for the treatment of adult ADHD unless the medication was first prescribed by a psychiatrist.
Data obtained by the College from the provincial Narcotics Monitoring System (“NMS”) showed that on several occasions Dr. Armogan breached the 2016 Supplemental Undertaking, by initiating or re-initiating prescriptions for stimulants for adult patients for the treatment of ADHD without ensuring the medication was first prescribed by a psychiatrist.
In general, Dr. Armogan’s breaches of his 2016 Supplemental Undertaking comprised of the following circumstances:

a) Matters in which Dr. Armogan re-initiated prescribing of stimulants to adult patients without a psychiatrist having written the first prescription or having completed a consultation prior to Dr. Armogan’s prescribing;

b) Matters in which Dr. Armogan initiated prescribing of stimulants after having obtained a consultation with a psychiatrist, but where the psychiatrist had not written the first prescription and in some cases had not endorsed a current ADHD diagnosis or initiation of stimulant prescribing at this time; and

c) Matters in which Dr. Armogan initiated prescribing of stimulants based on information from the patient that the patient had been prescribed stimulants for ADHD in the past, but where Dr. Armogan did not ensure that the information was correct and/or did not ensure the currency of any first prescription written by a psychiatrist.

Standard of Practice

Dr. Armogan’s 2015 Undertaking required him to undergo a reassessment of his family practice after completion of a period of clinical supervision. Dr. Joy Weisbloom was retained to conduct the reassessment. She reviewed fifteen patient records and interviewed Dr. Armogan.

As concluded by Dr. Weisbloom, Dr. Armogan failed to maintain the standard of practice of the profession in eleven of the fifteen patient charts reviewed, including with respect to appropriate  prescribing of stimulants and narcotics, conduct of and response to urine drug screens, and medical record-keeping.

Dr. Weisbloom did find that Dr. Armogan had made positive changes since she first assessed his practice in 2014 prior to his entering into the 2015 Undertaking, and that it was evident he cared about his patients and was endeavouring to improve his practice to provide better care. She noted that the major deficiencies had been addressed and shown improvements.

Admission

Dr. Armogan admits the facts specified above, and admits that, based on these facts, he engaged in professional misconduct, in that:

a) he failed to maintain the standard of practice of the profession, under paragraph 1(1)2 of Ontario Regulation 856/93, made under the Medicine Act, 1991; and

b) he engaged in an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, under paragraph 1(1)33 of Ontario Regulation 856/93, made under the Medicine Act, 1991.

AGREED STATEMENT OF FACTS RELEVANT TO PENALTY

Clinical Supervision and Cooperation with the College

Dr. Armogan cooperated with the College Compliance Case Manager’s requests for information regarding prescriptions for specific patients. After the Compliance Case Manager drew the College’s compliance concerns to Dr. Armogan’s attention, no new compliance concerns arose.

Pending the discipline hearing, Dr. Armogan voluntarily agreed to abide by an interim undertaking to the College requiring, among other things, that his practice be under clinical supervision.

As a result of this interim undertaking, Dr. Armogan’s practice has been under the clinical supervision of Dr. Shelendra Joshi since August 2018. Among other things, Dr. Joshi undertook to review with Dr. Armogan every patient chart regarding each patient to whom Dr. Armogan prescribes any narcotic drugs, narcotic preparations, controlled drugs, benzodiazepines and other targeted substances, and/or all other monitored drugs to ensure that assessment, clinical examination, risk assessment for addiction and ongoing management and follow-up is appropriate.

Dr. Joshi’s report of May 26, 2019 notes among other things that:
- Dr. Armogan’s prescribing of controlled substances was reasonable in dose and amounts dispensed.
- Dr. Armogan has become more diligent regarding updating the medication lists in his cumulative patient profiles. His documentation for prescribing opioids has been meeting the standard of practice required.
- Dr. Armogan has been abiding by the terms of his restrictions regarding prescribing of stimulants for ADHD.

Relevant History with the College

In October 2010, Dr. Armogan was required by the Inquiries, Complaints and Reports Committee (“ICRC”) to attend at the College to be cautioned regarding the assessment and management of anxiety, depression and ADHD and, specifically, what is required to assess these conditions before prescribing potentially dangerous combinations of medications.

In 2015, the ICRC accepted Dr. Armogan’s 2015 Undertaking in resolution of a public complaint regarding his care of a patient and a broader investigation into his prescribing to pediatric patients.

In the 2015 Undertaking, Dr. Armogan agreed to a restriction on his prescribing stimulants to patients under the age of 18 without prior approval of a consulting psychiatrist. This restriction remains in effect and is not in issue in the present matter. No concerns have arisen to date regarding Dr. Armogan’s compliance with this restriction.

Remediation

In addition to engaging in the remediation and clinical supervision required by his 2015 Undertaking, 2016 Supplemental Undertaking and interim undertaking pending the present discipline hearing, Dr. Armogan voluntarily attended the Safe Opioid Prescribing Course at the University of Toronto, which he completed on December 7, 2018.

ORDER

The Discipline Committee ordered that:
- Dr. Armogan to attend before the panel to be reprimanded

- The Registrar suspend Dr. Armogan’s certificate of registration for a period of two (2) months, commencing from August 15, 2019 at 12:01 a.m.

- The Registrar place the following terms, conditions and limitations on Dr. Armogan’s certificate of registration:

Compliance with Policy re Suspension

(i) Dr. Armogan shall comply with the College Policy on “Practice Management Considerations for Physicians Who Cease to Practise, Take an Extended Leave of Absence or Close Their Practice Due to Relocation”, a copy of which is attached at Schedule “A” to the Order, in respect of the suspension of his certificate of registration at paragraph 3 above.

Prescribing Restriction

(ii) Dr. Armogan shall not prescribe stimulant medication to patients who are eighteen (18) years of age or older, unless the medication has been first prescribed by a psychiatrist, as documented in a consultation letter from the psychiatrist to be maintained by Dr. Armogan in the patient’s chart. For greater certainty, and without restricting the foregoing, if a patient of Dr. Armogan who is eighteen (18) years of age or older was previously prescribed stimulant medication, but such prescribing has been discontinued or the medication has not been taken for the past three (3) or more months, Dr. Armogan shall not prescribe stimulant medication to the patient unless a psychiatrist first assesses the patient and initiates a new prescription, as documented in a consultation letter to be maintained by Dr. Armogan in the patient’s chart.

Individualized Ethics Instruction

(iii) Dr. Armogan shall participate in and successfully complete, within six (6) months of the date of the Order, individualized instruction in medical ethics satisfactory to the College, with an instructor approved by the College, who shall provide a summative report to the College including his or her conclusion about whether Dr. Armogan successfully completed the instruction.

(iv) Dr. Armogan shall consent to the College providing any information the College has that led to the circumstances of the Order and any information arising from the monitoring of his compliance with the Order to any person who requires this information to facilitate his completion of the individualized instruction in medical ethics.

Maintenance of Prescribing Log

(v) Dr. Armogan shall keep a log of all prescriptions for Narcotic Drugs, Narcotic
Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances (A summary of the above-named drugs [from Appendix I to the Compendium of Pharmaceuticals and Specialties] is attached to the Order as Schedule “B”; and links to the current regulatory lists are attached hereto as Schedule “C”), and All Other Monitored Drugs (as defined under the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22, as amended, with a link to the current regulatory list attached hereto at Schedule “D”), such log to be in the form attached at Schedule “E” (the “Prescribing Log”) to the Order, which will include at least the following information:

(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. Armogan’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).

(vi) Dr. Armogan shall 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.

Clinical Supervision

(vii) Upon the conclusion of the suspension of Dr. Armogan’s certificate of registration under paragraph 3 above, Dr. Armogan shall practise under the guidance of a clinical supervisor acceptable to the College (the “Clinical Supervisor”) who shall sign an undertaking in the form attached at Schedule “F” to the Order, for three (3) months, on the terms set out below and as described in Schedule “F” (the “Clinical Supervision”).

(viii) Dr. Armogan shall cooperate fully with the Clinical Supervision and abide by all recommendations of his Clinical Supervisor including, but not limited to, any recommended practice improvements and professional development.

(ix) Dr. Armogan shall review with his Clinical Supervisor every patient for whom he has prescribed any Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and/or All Other Monitored Drugs to ensure that assessment, clinical examination, risk assessment for addiction and ongoing management and follow up is appropriate.
(x) Dr. Armogan shall ensure that his Clinical Supervisor confirms their review of his patient care with him as described above in paragraph 4(ix) by signing the Prescribing Log and the patient chart in question within two (2) weeks of Dr.Armogan issuing any prescription for Narcotic Drugs, Narcotic Preparations,Controlled Drugs, Benzodiazepines and Other Targeted Substances and/or All Other Monitored Drugs.

(xi) Dr. Armogan shall ensure that Schedule “F” to the Order is signed and delivered to the College by an approved Clinical Supervisor prior to the conclusion of the suspension of his certificate of registration.

(xii) If a person who has given an undertaking in Schedule “F” to the Order is unable or unwilling to fulfill its provisions, Dr. Armogan 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.

(xiii) If Dr. Armogan is unable to obtain a Clinical Supervisor on the terms set out in paragraphs 4(xi) and (xii) above, he will cease prescribing Narcotic Drugs,Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and/or All Other Monitored Drugs 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.

(xiv) Dr. Armogan shall consent to the disclosure by the Clinical Supervisor to the College, and by the College to the 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. Armogan’s compliance with the Order. This shall include, without limitation, providing the Clinical Supervisor with any reports of any assessments of or prior clinical supervision of Dr. Armogan’s practice in the College’s possession.

Reassessment

(xv) Approximately six (6) months after the Clinical Supervision above has ceased, Dr. Armogan will submit to a reassessment (the “Reassessment”) of his family practice, including but not limited to his prescribing of Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and All Other Monitored Drugs, by an assessor or assessors selected by the College (the “Assessor(s)”). The Reassessment may include chart reviews, direct observation of Dr. Armogan’s care, interviews with colleagues and co-workers, feedback from patients and any other tools deemed necessary by the College. The results of the Reassessment will be reported to the College and may form the basis of further action by the College.

(xvi) Dr. Armogan shall cooperate fully with the Reassessment and with the Assessor(s). Dr. Armogan shall consent to the disclosure among the Clinical Supervisor, the College, and the Assessor(s) of all information any of them deems necessary or desirable to complete the Reassessment and to monitor Dr. Armogan’s compliance with the Order. This shall include, without limitation, providing the Assessor(s) with any reports of any assessments of or clinical supervision of Dr. Armogan’s practice in the College’s possession

(xvii) If it deems the Reassessment satisfactory, the Inquiries, Complaints and Reports Committee of the College may direct that any or all of the terms, conditions and limitations on Dr. Armogan’s certificate of registration set out at paragraphs 4(ii), 4(v), and/or 4(vi) above be lifted.

Compliance and Monitoring

(xviii) Dr. Armogan shall cooperate with unannounced inspections of his office practice and patient charts for the purpose of monitoring and enforcing his compliance with the terms of the Order.

(xix) Dr. Armogan 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 ten (10) days of the 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.

(xx) Dr. Armogan shall give his irrevocable consent to the College to make 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 his compliance with the provisions of the Order.

(xxi) Dr. Armogan shall be responsible for any and all costs associated with implementing the terms of the Order.

- Dr. Armogan pay costs to the College in the amount of $6,000 within thirty (30) days of the date of the Order.
 
Reasons for Decision: Download Full Decision (PDF)
Hearing Date(s): August 14, 2019 half-day hearing start time 1:00 p.m.

Other Notifications (3)

Source: Inquiries, Complaints and Reports Committee
Effective Date: 19 Dec 2019
Summary:
Caution-in-Person:
               
A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed.  A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee.  The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015, or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.
 
See PDF for the summary of a decision made against this member in which the disposition includes a Caution-in-Person:

Download Full Document (PDF)
Source: Inquiries, Complaints and Reports Committee
Effective Date: 04 Sep 2019
Summary:
Caution-in-Person:
               
A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed.  A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee.  The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015, or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.
 
See PDF for the summary of a decision made against this member in which the disposition includes a Caution-in-Person:

Download Full Document (PDF)
Source: Inquiries, Complaints and Reports Committee
Effective Date: 17 May 2017
Summary:
Caution-in-Person:

A summary of a decision of the Inquiries, Complaints and Reports Committee in which the disposition includes a "caution-in-person" is required by the College by-laws to be posted on the register, along with a note if the decision has been appealed. A “caution-in-person” disposition requires the physician to attend at the College and be verbally cautioned by a panel of the Committee. The summary will be removed from the register if the decision is overturned on appeal or review. Note that this requirement only applies to decisions arising out of a complaint dated on or after January 1, 2015 or if there was no complaint, the first appointment of investigators dated on or after January 1, 2015.

See PDF for the summary of a decision made against this member in which the disposition includes a caution-in-person.

Download Full Document (PDF)

Training

Medical School: Schulich School of Medicine and Dentistry, Western University, 1990

Registration History

DETAILS DATE
Transfer of class of registration to: Independent Practice Certificate Effective: 03 Jun 2021
Suspension of registration removed. Effective: 15 Oct 2019
Terms and conditions amended by Discipline Committee. Effective: 15 Aug 2019
Suspension of registration imposed: Discipline Committee Effective: 15 Aug 2019
Terms and conditions amended by Member. Effective: 12 Jul 2018
Terms and conditions amended by Member. Effective: 05 Jul 2018
Terms and conditions amended by Member. Effective: 20 Jun 2018
Terms and conditions amended by Member. Effective: 13 May 2016
Terms and conditions amended by Member. Effective: 10 Aug 2015
Terms and conditions amended by Member. Effective: 27 May 2015
Transfer of class of registration to: Restricted Certificate Effective: 27 Apr 2015
Arrow_iconTerms and conditions imposed on certificate by: Member Effective: 27 Apr 2015
Transfer of class of registration to: Independent Practice Certificate Effective: 09 Jul 1991
First certificate of registration issued: Postgraduate Education Certificate Effective: 15 Jun 1990
DETAILS: Transfer of class of registration to: Independent Practice Certificate
Date: Effective: 03 Jun 2021
DETAILS: Suspension of registration removed.
Date: Effective: 15 Oct 2019
DETAILS: Terms and conditions amended by Discipline Committee.
Date: Effective: 15 Aug 2019
DETAILS: Suspension of registration imposed: Discipline Committee
Date: Effective: 15 Aug 2019
DETAILS: Terms and conditions amended by Member.
Date: Effective: 12 Jul 2018
DETAILS: Terms and conditions amended by Member.
Date: Effective: 05 Jul 2018
DETAILS: Terms and conditions amended by Member.
Date: Effective: 20 Jun 2018
DETAILS: Terms and conditions amended by Member.
Date: Effective: 13 May 2016
DETAILS: Terms and conditions amended by Member.
Date: Effective: 10 Aug 2015
DETAILS: Terms and conditions amended by Member.
Date: Effective: 27 May 2015
DETAILS: Transfer of class of registration to: Restricted Certificate
Date: Effective: 27 Apr 2015
DETAILS: Terms and conditions imposed on certificate by: Member
Date: Effective: 27 Apr 2015
DETAILS: Transfer of class of registration to: Independent Practice Certificate
Date: Effective: 09 Jul 1991
DETAILS: First certificate of registration issued: Postgraduate Education Certificate
Date: Effective: 15 Jun 1990