(1 of 2)
As from March 21, 2025, the following is imposed as a term, condition and limitation on the certificate of registration held by Dr. Raj Ramanna in accordance with an undertaking and consent given by Dr. Ramanna to the College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
(“Undertaking”)
of
DR. RAJ RAMANNA
(“Dr. Ramanna”)
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 Tribunal” means the Ontario Physicians and Surgeons Discipline Tribunal of the College;
“ICRC” means the Inquiries, Complaints and Reports Committee of the College; “IEP” means Individualized Education Plan;
“OHIP” means the Ontario Health Insurance Plan;
“Ontario Physicians and Surgeons Discipline Tribunal” means the Discipline Committee established under the Code;
“Practice Location or Practice Locations” means each and every location at which Dr. Ramanna practices, delegates, or has privileges, including, but not limited to, any hospitals, clinics, offices, and any Out-of-Hospital Premises or Independent Health Facilities with which Dr. Ramanna is affiliated, in any jurisdiction;
“Public Register” means the College’s register that is available to the public.
(2) I, Dr. Ramanna, certificate of registration number 62993, am a member of the College.
(3) I, Dr. Ramanna, acknowledge that following a public complaint, the College conducted an investigation bearing File Number CAS-463075-F2N8B1 (the “Investigation”) into my conduct and communication with a patient in my obstetrics and gynecology practice.
(4) I, Dr. Ramanna, acknowledge that, in addition to accepting this Undertaking, the ICRC will also require me to appear before a panel of the ICRC to be cautioned.]
(5) I, Dr. Ramanna, acknowledge that I also entered into an undertaking dated November 21, 2016, restricting my practice (“the November 2016 undertaking”) and that this Undertaking does not replace or supersede the November 2016 undertaking.
B. UNDERTAKING
(6) I, Dr. Ramanna, undertake to abide by the provisions of this Undertaking, effective immediately.
(7) Clinical Supervision
(a) I, Dr. Ramanna, undertake to practise under the guidance of a clinical supervisor or clinical supervisors acceptable to the College (the “Clinical Supervisor” or “Clinical Supervisors”), for at least six (6) months (“Clinical Supervision”). Clinical Supervision shall cease only upon approval from the College.
(b) I, Dr. Ramanna, undertake to remain free of any conflict of interest with the Clinical Supervisor.
(c) I, Dr. Ramanna, 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 IEP, attached hereto as Appendix “B”;
(ii) Review the materials provided by the College and have an orientation session with me, including to discuss the objectives for the Clinical Supervision;
(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 (“Moderate Level Supervision”);
(iv) After a minimum of three (3) months of Moderate Level 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 (“Low Level Supervision”), and until the College approves the end of Clinical Supervision;
(v) During Moderate and Low Level Supervision, directly observe at least ten (10) patient encounters at every meeting;
(vi) Review at least fifteen (15) of my patient charts at every meeting;
(vii) Discuss any concerns arising from the direct observation, chart reviews, interviews and any patient feedback;
(viii) Make recommendations to me for practice improvements and ongoing professional development and inquire into my compliance with the recommendations;
(ix) Perform any other duties, which shall include interviewing my Workplace Monitor(s), and may include reviewing other documents, interviewing other staff or colleagues, or obtaining patient feedback, that the Clinical Supervisor deems necessary to my Clinical Supervision;
(x) Submit written reports to the College at least once every month for three (3) months during Moderate Level Supervision, or until the College approves a reduction in the level of supervision to Low Level Supervision, and then once at the end of supervision, or more frequently if the Clinical Supervisor has concerns about my standard of practice; and
(xi) Remain free of any conflict of interest with me.
(d) I, Dr. Ramanna, acknowledge that the charts reviewed shall be selected by the Clinical Supervisor based on the educational needs identified in the IEP, attached hereto as Appendix ”B”, and concerns that may arise during the period of Clinical Supervision.
(e) I, Dr. Ramanna, undertake to cooperate fully with the Clinical Supervision of my practice, conducted under the term of this Undertaking and Appendix “A” to this Undertaking, and to abide by the recommendations of my Clinical Supervisor, including but not limited to, any recommended practice improvements and ongoing professional development.
(f) I, Dr. Ramanna, undertake to ensure that Appendix “A” to this Undertaking is signed and delivered to the College within thirty (30) days of the date I execute this Undertaking.
(g) I, Dr. Ramanna, 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. Ramanna, undertake that if I am unable to obtain a Clinical Supervisor on the provisions set out under sections (7)(f) and/or (7)(g) above, I will cease practising medicine until such time as I have obtained a Clinical Supervisor acceptable to the College.
(i) I, Dr. Ramanna, 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 that term, condition or limitation will be included on the public register.
(8) Professional Education
(a) I, Dr. Ramanna, 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”):
(i) PROBE Canada Program, Center for Personalized Education for Professionals;
(ii) Individualized instruction in professionalism satisfactory to the College, with an instructor selected by the College;
(iii) Review, reflection and discussion with my Clinical Supervisor of the following policies and other resources:
1. Essentials of Medical Professionalism, College of Physicians and Surgeons of Ontario;
2. Professional Behaviour, College of Physicians and Surgeons of Ontario;
3. Boundary Violations, College of Physicians and Surgeons of Ontario;
4. Medical Records Documentation, College of Physicians and Surgeons of Ontario; and
(iv) any additional professional education recommended by my Clinical Supervisor.
(b) I, Dr. Ramanna, 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, 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. Ramanna, undertake to complete this requirement within three (3) months or, if no satisfactory program is available by that time, by the first possible opportunity thereafter.
(d) I, Dr. Ramanna, acknowledge that a report or reports may be provided to the College regarding my progress and compliance with the Professional Education.
(e) I, Dr. Ramanna, acknowledge that if any of the programs listed above become unavailable, substitution requests will be reviewed by the College and the College will determine in its sole discretion whether substitution is appropriate.
(9) Workplace Monitoring
(a) I, Dr. Ramanna, undertake to practice under the oversight of a monitor who is a regulated health professional acceptable to the College the “Workplace Monitor” or
“Workplace Monitors”), for at least six (6) months (“Workplace Monitoring”). Workplace Monitoring shall cease only upon approval from the College.
(b) I, Dr. Ramanna, undertake to remain free of any conflict of interest with the Workplace Monitor(s).
(c) I, Dr. Ramanna, acknowledge that I have reviewed the Workplace Monitor undertakings attached hereto as Appendix “C” and “D”, and understand what is required of the Workplace Monitors, (or, in my hospital-based Practice Locations, a Regulated Health Professional acting under the oversight of a Supervising Workplace Monitor) including, but not limited to:
(i) monitoring my professional encounters with patients, in person or otherwise (“Professional Encounter” or “Professional Encounters”), as follows:
1. for a minimum of two (2) weeks, the Workplace Monitor(s) shall remain present at all times during all Professional Encounters with all patients (“High Level Monitoring”) in both my office and hospital-based Practice Locations, unless my Clinical Supervisor is present during the Professional Encounter;
2. after a minimum of two (2) weeks of High Level Monitoring, if my Workplace Monitor recommends and the College approves a reduction in the level of monitoring, the Workplace Monitor shall attend at one of my office or hospital-based Practice Locations, selected by me but subject to the approval of the College in its sole discretion, for one full day every two weeks (“Moderate Level Monitoring”). During Moderate Level Monitoring, the Workplace Monitor shall remain present at all times during all Professional Encounters with all patients taking place on the day of the monitoring visit;
3. after a combined minimum of three (3) months of High and Moderate Level Monitoring, if my Workplace Monitor recommends and the College approves a further reduction in the level of monitoring, the Workplace Monitor shall attend at one of my office or hospital-based Practice Locations, selected by me but subject to the approval of the College in its sole discretion, for one full day each month (“Low Level Monitoring”). During Low Level Monitoring, the Workplace Monitor shall remain present at all times during all Professional Encounters with all patients taking place on the day of the monitoring visit;
(ii) providing reports (as described in the Workplace Monitor’s undertakings) after the first two (2) weeks of Workplace Monitoring, and thereafter, on at least a monthly basis;
(iii) selecting the dates on which the monitoring visits shall occur, during the periods of Moderate and Low Level Monitoring. Selection of the dates of the monitoring visits shall be in the Workplace Monitor’s sole discretion and shall take into account the following criteria:
1. monitoring visits shall not occur on the same day as my meetings with the Clinical Supervisor;
2. monitoring visits shall occur on days when I have booked at least an average roster of patients for the day;
3. monitoring visits shall be coordinated with the Clinical Supervisor, to ensure that the Workplace Monitor can provide any information required by the Clinical Supervisor at the time required by the Clinical Supervisor.
(iv) carefully observing all of my Professional Encounters with patients during each monitoring visit, to ensure that my conduct and communication remains professional;
(v) maintaining a log of all Professional Encounters with patients in the form attached to this Undertaking as Appendix “E” (the “Log”) and in the manner described in Appendices “C” and “D”;
(vi) initialing all corresponding entries in the records of patients noted in the Log;
(vii) submitting the original Log to the College on a monthly basis; and (viii)remaining free of any conflict of interest with me.
(d) I, Dr. Ramanna, undertake to maintain an up to date copy of the Log by ensuring a copy is made at the end of each business day, and to make it available to the College upon request.
(e) I, Dr. Ramanna, undertake to ensure that each of Appendix “C” and “D” to this Undertaking are signed and delivered to the College within fourteen (14) days of the date I execute this Undertaking.
(f) I, Dr. Ramanna, undertake that if a person who has given an undertaking in Appendix “C” or “D” to this Undertaking is unable or unwilling to continue to fulfill its provisions, I shall, within fourteen (14) 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. Ramanna, undertake that if I am unable to obtain a Workplace Monitor on the provisions set out under sections (9)(e) and/or (9)(f) above, I will cease practising medicine until such time as I have obtained a Workplace Monitor acceptable to the College.
(h) I, Dr. Ramanna, acknowledge that if I am required to cease practise as a result of section (9)(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.
(10) Reassessment of Practice
(a) I, Dr. Ramanna, undertake that, approximately six (6) months after the completion of the Clinical Supervision set out in section (7) above and Appendix “A” to this Undertaking, and the completion of the Professional Education set out in section
(8) above, 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, my workplace monitor(s), colleagues and co-workers, feedback from patients, and any other tools deemed necessary by the College.
(b) I, Dr. Ramanna, undertake to co-operate fully with the Reassessment, conducted under the term of this Undertaking.
(c) I, Dr. Ramanna, acknowledge 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. Ramanna, 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.
(11) Monitoring
(a) I, Dr. Ramanna, undertake to inform the College of each and every one of my 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. Ramanna, 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) I, Dr. Ramanna, 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.
(d) I, Dr. Ramanna, acknowledge that I have executed the OHIP consent form, attached hereto as Appendix “F”.
C. ACKNOWLEDGEMENT
(12) I, Dr. Ramanna, acknowledge that all appendices attached to or referred to in this Undertaking form part of this Undertaking.
(13) I, Dr. Ramanna, 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. Ramanna, 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. Ramanna, 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”).
(16) I, Dr. Ramanna, 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 Tribunal.
(17) I, Dr. Ramanna, acknowledge that this Undertaking constitutes terms, conditions, and limitations on my certificate of registration for the purposes of section 23 of the Code.
(18) Public Register
(a) I, Dr. Ramanna, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.
(b) I, Dr. Ramanna, acknowledge that, in addition to this Undertaking being posted in accordance with section (18)(a) above, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:
Following a public complaint, a College investigation was conducted into Dr. Ramanna’s conduct and communication with a patient in his obstetrics and gynecology practice. As a result of the investigation:
For at least six months, Dr. Ramanna will practise under the oversight of a Workplace Monitor, who will observe patient encounters in accordance with the terms of his Undertaking to the College.
Dr. Ramanna will practise under the guidance of a Clinical Supervisor acceptable to the College for at least 6 months.
Dr. Ramanna will engage in professional education, including in professional boundaries, communication and medical record- keeping.
Dr. Ramanna’s practice will be reassessed by an assessor selected by the College within 6 months of the end of the period of Clinical Supervision and the completion of the professional education.
D. CONSENT
(19) I, Dr. Ramanna, 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 and to all Workplace Monitors, 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.
(20) I, Dr. Ramanna, give my irrevocable consent to the College to provide all Chiefs 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.
(21) I, Dr. Ramanna, give my irrevocable consent to any persons who facilitate my completion of the Professional Education, and to all Workplace Monitors, Clinical Supervisors, Chiefs of Staff and Assessors, to disclose to the College, and to one another, any of the following:
(a) any information relevant to this Undertaking;
(b) any information relevant to the provisions of the Clinical Supervisor’s undertaking set out at Appendix “A” to this Undertaking or the Workplace Monitors’ undertakings set out at Appendix “C” and “D” to this Undertaking;
(c) any information relevant to the Reassessment;
(d) any information relevant for the purposes of monitoring my compliance with this Undertaking; and/or
(e) any information 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.
(2 of 2)
As from November 17, 2016, the following are imposed as terms, conditions and
limitations on the certificate of registration held by Dr. Raj Ramanna, in
accordance with an undertaking and consent given by Dr. Ramanna to the College
of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")
of
DR. RAJ RAMANNA
("Dr. Ramanna")
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;
(2) I, Dr. Ramanna, certificate of registration number 62993, am a member of
the College.
(3) I, Dr. Ramanna, acknowledge that the College initiated an investigation
bearing File Number 7214342 (the "Investigation") into whether I engaged
in professional misconduct.
(4) I, Dr. Ramanna, acknowledge that, if an original copy of this Undertaking
as signed by me is accepted by the Inquiries, Complaints and Reports
Committee, the College will also deliver a caution in person.
B. UNDERTAKING
(5) Practice Restrictions
(a) I, Dr. Ramanna, undertake that, effectively immediately:
(i) I will cease all teaching activities and will not engage in
teaching activities in the future;
(ii) I will not apply for an academic appointment or
reappointment.
C. ACKNOWLEDGEMENT
(6) I, Dr. Ramanna, acknowledge 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.
(7) I, Dr. Ramanna, acknowledge and confirm 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.
(8) I, Dr. Ramanna, acknowledge that this entire Undertaking constitutes
terms, conditions, and limitations on my certificate of registration for
the purposes of section 23 of the Code. I understand that this
Undertaking shall be information on the College's Register that is
available to the public during the time period that the Undertaking
remains in effect.
(9) I, Dr. Ramanna, acknowledge that the following summary will appear on the
College's Register that is available to the public during the time period
that this Undertaking remains in effect:
Dr. Ramanna was the subject of a College investigation into whether
he engaged in professional misconduct. As a result of the
investigation, Dr. Ramanna has agreed to cease all teaching
activities and not engage in teaching activities in the future, and
will not apply for an academic appointment or reappointment.
D. CONSENT
(10) I, Dr. Ramanna, give my irrevocable consent to the College to provide
this Undertaking to any Chief of Staff, or a colleague with similar
responsibilities, at any Practice Location ("Chief(s) of Staff"), and to
provide said 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.
(11) I, Dr. Ramanna, undertake to abide by the provisions of this Undertaking,
effective upon the date this Undertaking is approved by the ICR Committee
("Effective Date"), and 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.
Terms and conditions imposed on certificate by: Member
