As from 11:59 p.m., December 18, 2017 by order of the Fitness to Practice Committee, the following terms, conditions and limitations are imposed on the certificate of registration held by Dr. Melanie Rose Marie Ursell:
(1) Addictions Medicine Physician
(a) Dr. Ursell shall engage in a treating and monitoring relationship with a physician with expertise in addiction medicine approved by the College who will sign an undertaking in the form attached hereto as Schedule "A" (the "Addictions Medicine Physician").
(b) Dr. Ursell shall have an initial appointment with her Addictions Medicine Physician at the outset of the treating and monitoring relationship at which Dr. Ursell will undergo an evaluation and assessment concerning her sedative, hypnotic, and anxiolytic dependence disorder by her Addictions Medicine Physician.
(c) Dr. Ursell's Addictions Medicine Physician will have available to him or her all relevant information in the College's possession, including reports prepared during the course of the Fitness to Practice matter.
(d) After her initial appointment with her Addictions Medicine Physician, Dr. Ursell shall maintain face to face contact with her Addictions Medicine Physician at least once every two (2) weeks for a minimum of two (2) months, or such additional period of time as her Addictions Medicine Physician determines is necessary. She will agree to increase the frequency of contact if requested by her Addictions Medicine Physician.
(e) After the first two (2) months of this Order, the frequency of Dr. Ursell's appointments with her Addictions Medicine Physician will be reviewed by her Addictions Medicine Physician, and may be decreased with the approval of her Addictions Medicine Physician and the College.
(f) The frequency of Dr. Ursell's appointments with her Addictions Medicine Physician will never be less than once per month.
(g) The Addictions Medicine Physician will submit a written report to the College after the initial appointment with Dr. Ursell, and will submit written reports to the College on a quarterly basis thereafter, or immediately if the Addictions Medicine Physician believes that the symptoms of Dr. Ursell's illness have become disabling, that Dr. Ursell may be at risk of harm or injury, that Dr .Ursell is exposing or is likely to expose her patients to harm or injury, or that Dr. Ursell is not in compliance with this Order.
(h) Dr. Ursell will comply with all treatment recommendations of her Addictions Medicine Physician.
(i) Dr. Ursell's Addictions Medicine Physician may terminate his or her undertaking on the basis of Dr. Ursell's chronic or repeated noncompliance.
(j) In instances where a report is made to the College related to Dr. Ursell's non-compliance with this Order, all documentation contained in her Addictions Medicine Physician's file relating to the compliance issue may be made available to the College upon request.
(2) Primary Care Physician
(a) Dr. Ursell will attend regular appointments with a family physician approved by the College, who will sign an undertaking in the form attached hereto as Schedule "B" ("Primary Care Physician").
(b) After an initial appointment with her Primary Care Physician, the frequency of Dr. Ursell's appointments with her Primary Care Physician will be reviewed and determined by her Primary Care Physician, with the approval of the College. Dr. Ursell will increase the frequency of contact if requested by her Primary Care Physician.
(c) The frequency of Dr. Ursell's appointments with her Primary Care Physician will never be less than twice per year.
(d) The Primary Care Physician will submit a written report to the College after the initial appointment with Dr. Ursell, and will submit written reports to the College on a twice per year thereafter, or immediately if the Primary Care Physician believes that the symptoms of Dr. Ursell's illness have become disabling, that Dr. Ursell may be at risk of harm or injury, that Dr. Ursell is exposing or is likely to expose her patients to harm or injury, or that Dr. Ursell is not in compliance with this Order.
(e) Dr. Ursell will comply with all treatment recommendations of her Primary Care Physician.
(f) Dr. Ursell's Primary Care Physician may terminate his or her undertaking on the basis of Dr. Ursell's chronic or repeated noncompliance
(3) Workplace Monitor
(a) Dr. Ursell will engage Workplace Monitor(s) approved by the College who will each sign an undertaking to the College in the form attached hereto as Schedule "C" ("Workplace Monitor(s)").
(b) The Workplace Monitors will assist in monitoring Dr. Ursell's behaviour in the workplace, at each of her office locations.
(c) All Workplace Monitors will have knowledge that Dr. Ursell suffers from a sedative, hypnotic, and anxiolytic dependence disorder and will have regular contact with her in her work environment.
(d) The Workplace Monitor(s) will submit written reports to the College once every three months as of the date they sign the undertaking to the College in the form attached hereto as Schedule "C", or immediately if the Primary Care Physician believes that the symptoms of Dr. Ursell's illness have become disabling, that Dr. Ursell may be at risk of harm or injury, that Dr. Ursell is exposing or is likely to expose her patients to harm or injury, or that Dr. Ursell is not in compliance with this Order.
(e) In addition to submitting written reports, all Workplace Monitors will respond to oral and/or written inquiries from the College.
(4) Therapist
(a) Dr. Ursell will see any therapist suggested by her Addictions Medicine Physician, her Primary Care Physician, or any other treating clinician, on a frequency to be determined by that therapist.
(b) Dr. Ursell's therapist will provide reports to her Addictions Medicine Physician on a regular basis as stipulated by her Addictions Medicine Physician, documenting Dr. Ursell's attendance in therapy and commenting on her progress, or providing other information the Therapist or Addictions Medicine Physician deems relevant.
(5) Independent Clinical Assessment
(a) There may be circumstances or situations that arise wherein Dr. Ursell's Addictions Medicine Physician determines that Dr. Ursell would benefit from an independent clinical assessment. Dr. Ursell will undergo one or more independent clinical assessments if requested to do so by her Addictions Medicine Physician.
(b) After Dr. Ursell undergoes any independent clinical assessment, an independent clinical assessment report will be provided to Dr. Ursell's Addictions Medicine Physician. Such assessments may necessitate revisions or amendments to this Order.
(6) Mutual Help Groups
(a) Dr. Ursell will attend a mutual help group such as an appropriate 12-step program, Rational Recovery, Women for Sobriety, Caduceus Group, or any other program acceptable to her Addictions Medicine Physician, on a regular basis throughout the term of this Order ("Mutual Help Group").
(b) Dr. Ursell will attend a Mutual Help Group at least once per week for at least the first three (3) months of this Order.
(c) After the first three (3) months of this Order, the frequency of Dr. Ursell's attendance will be reviewed by her Addictions Medicine Physician, and may be decreased with the approval of her Addictions Medicine Physician and the College.
(d) The frequency of Dr. Ursell's attendance at a Mutual Help Group will never be less than once per month.
(7) Alcohol and Other Substances of Abuse
(a) Dr. Ursell will abstain completely from the consumption of alcohol for the duration of this Order. This includes, but is not limited to, fermented fruit juices, non-alcoholic beer or wine and medicinal or hygiene products that contain alcohol.
(b) Dr. Ursell will abstain completely from the use of any other unauthorized substance of abuse on any occasion and in any form. She will not consume any controlled drugs unless they are:
(i) legitimately prescribed for her by a practitioner who has knowledge that she suffers from a sedative, hypnotic, and anxiolytic dependence disorder; and
(ii) specifically approved by her Addictions Medicine Physician.
(c) Dr. Ursell will not use over-the-counter ("OTC") preparations that are mood altering, such as sedating antihistamines and decongestants, without specific authorization from her Addictions Medicine Physician.
(d) Dr. Ursell will not self-medicate with any preparation without first consulting with, and obtaining the written approval of, her Addictions Medicine Physician.
(e) If Dr. Ursell drinks alcohol or ingests any unauthorized controlled drugs or substances of abuse whatsoever, she will immediately notify her Addictions Medicine Physician and her Primary Care Physician. A relapse may be considered to be a breach of this Order, and may result in an extension of the term of the Order.
(8) Random Drug and Alcohol Screening
(f) Dr. Ursell will participate in a random drug and alcohol screening process as described in this Order.
(g) During the first year of this Order, random urinalyses will be performed for a variety of drugs and alcohol at a rate of at least thirty-six (36) tests per year. Notification will take place according to the discretion of Dr. Ursell's Addictions Medicine Physician.
(h) After the first year of this Order, the frequency of random testing may change during the course of this Order, depending on Dr. Ursell's progress in recovery and as determined by her Addictions Medicine Physician.
(i) Dr. Ursell will submit to blood or urine screening, or hair analysis or breathalyzer at any time upon the request of her Addictions Medicine Physician.
(j) Dr. Ursell will proceed to a collection site approved by her Addictions Medicine Physician before closing time on the same day of notification to provide a specimen. Dr. Ursell will provide the specimens utilizing a forensic protocol.
(k) Failure to adhere to this alcohol and drug screening procedure will be considered a missed test. Missed test(s) that have not been excused by Dr. Ursell's Addictions Medicine Physician will be considered a breach of this Order.
(9) Vacations
(a) For the first three (3) months of this Order, Dr. Ursell will submit to urine drug screening as requested by her Addictions Medicine Physician without exception.
(b) After the first three (3) months of this Order, Dr. Ursell must inform her Addictions Medicine Physician in writing in advance of any circumstances that might cause her to miss a test. If she is planning a vacation or knows that she will otherwise not be available for testing in the usual way, she will provide two (2) weeks' prior notification to her Addictions Medicine Physician. Dr. Ursell may be expected to make special arrangements to be available for testing using alternative procedures during that time and/or submit to a urine test according to the procedures normally used in the implementation of this Order on the day she becomes available once again.
(c) Frequent vacations, or vacations of greater than two (2) weeks, may require extraordinary procedures in order to maintain the integrity of this Order. Any intent to be unavailable in such a manner must be reviewed by Dr. Ursell's Addictions Medicine Physician in advance for approval and for alternative monitoring planning, if appropriate.
(10) Positive Test Screens
(a) Any positive urine, blood, hair, or breath screen shall be reported to the College.
(b) A urine test is considered positive if an unauthorized mood-altering substance is present in the specimen, or if the sample is found to be adulterated, substituted or diluted.
(c) It is Dr. Ursell's responsibility not to ingest any products that may induce positive test results, including, but not limited to, foods or hygienic products containing alcohol, "non-alcoholic" beer or wine and products containing poppy seed (e.g. a bagel, muffins or cakes). Dr. Ursell will inform her Addictions Medicine Physician immediately of prescriptions or over-the-counter medications being consumed for legitimate medical purposes that may result in a positive test prior to providing the sample(s) described above. Failure to do so may result in a positive test.
(d) Dr. Ursell will provide her Addictions Medicine Physician with verification of all prescriptions that she receives.
(11) Payment for Fees, Costs, Charges, Expenses
(a) Dr. Ursell shall be solely responsible for payment of all fees, costs, charges, expenses, etc. arising from the implementation of any of the provisions of this Order, including but not limited to the cost of any and all laboratory services required for the implementation of this Order.
(12) Breach of this Order
(a) Any failure to abide by the terms and conditions of this Order shall constitute a breach of the Order, and may lead to an inquiry regarding her capacity to practise medicine, 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 and/or the Fitness to Practise Committee of the College.
(13) Consent
(b) Dr. Ursell shall submit to and not interfere with unannounced inspections by the College of her Practice Location(s) and to the inspection of patient charts, her personnel file, or any other records relevant to her practice of medicine and to the collection of information (in person, orally and/or in writing) from staff that the College deems necessary in order to monitor her compliance with the terms of this Order.
(c) Dr. Ursell shall give her irrevocable consent to the College to provide any information it deems necessary to any person, organization or institution who requests or requires this information for the purposes of facilitating or verifying her compliance with this Order, the Addictions Medicine Physician's compliance with the Addictions Medicine Physician's undertaking at Schedule "A", the Primary Care Physician's compliance with the Primary Care Physician's undertaking at Schedule "B", the Workplace Monitor's compliance with the Workplace Monitor's undertaking at Schedule "C", including but not limited to any information:
(i) relevant to this Order.
(ii) relevant to the Addictions Medicine Physician's undertaking at Schedule "A";
(iii) relevant to the Primary Care Physician's compliance with the Primary Care Physician's undertaking at Schedule "B";
(iv) relevant to the Workplace Monitor's compliance with the Workplace Monitor's undertaking at Schedule "C";
(v) relevant for the purposes of monitoring her compliance with this Order; and/or
(vi) which comes to his or her attention and which he or she reasonably believes indicates a potential risk of harm to Dr. Ursell's patients.
(d) This Order will be considered to have been breached if Dr. Ursell revokes her consent to the release of any information or communication between persons described herein.
(14) Miscellaneous
(a) Dr. Ursell shall ensure that Schedules "A", "B" and "C" to this Order are signed and delivered to the College within thirty (30) days of the date of this Order.
(b) If a person who has given an undertaking in Schedules "A" "B" or "C" to this Order is unable or unwilling to continue to fulfill its provisions, Dr. Ursell 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.
(c) If Dr Ursell is unable to obtain any one or more of an Addictions Medicine Physician, Primary Care Physician, or Workplace Monitor on the terms set out above, she will cease practicing medicine until such a time as she has obtained each of an Addictions Medicine Physician, Primary Care Physician, and Workplace Monitor acceptable to the College.
(d) If Dr. Ursell is required to cease practice in accordance with the terms of this Order, this will constitute a term, condition or limitation on her certificate of registration and said term, condition or limitation will be included on the public register.
(e) The following summary shall be posted on the Public Register during the time period that this Order remains in effect:
The Fitness to Practice Committee has found that Dr. Ursell is incapacitated, as defined in subsection 1(1) of the Health Professions Procedural Code, being Schedule 2 to the Regulated Health Professions Act, 1991, S.O. 1991, c. 18.
As a result of that finding, the Committee has ordered that detailed terms, conditions and limitations be imposed on Dr. Ursell's certificate of registration for a minimum of five (5) years ("the Order"), which can be summarized as follows:
Dr. Ursell will engage in a treating and monitoring relationship with a Specialist, and a Primary Care Physician. She will comply with all of their treatment recommendations;
Dr. Ursell shall engage Workplace Monitors to assist in monitoring her behaviour in the workplace;
Dr. Ursell will abstain completely from the consumption of alcohol, controlled drugs, or over-the-counter preparations that are mood-altering, with certain specified and limited exceptions;
Dr. Ursell will be subject to health monitoring by the College;
Dr. Ursell shall be solely responsible for payment of all fees, costs, charges, expenses, etc. arising from the implementation of any of the provisions of the Order;
Any failure to abide by the terms and conditions of the Order shall constitute a breach of the Order, and may lead to an inquiry regarding Dr. Ursell's capacity to practise medicine, 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 and/or the Fitness to Practise Committee of the College.
Dr. Ursell shall submit to and not interfere with unannounced inspections by the College of her Practice Location(s) and to the inspection of patient charts, her personnel file, or any other records relevant to her practice of medicine and to the collection of information (in person, orally and/or in writing) from staff that the College deems necessary in order to monitor her compliance with the terms of the Order.
Dr. Ursell shall give her irrevocable consent to the College to provide any information it deems necessary to any person, organization or institution who requests or requires this information for the purposes of facilitating or verifying her compliance with the Order, the Specialist's compliance with the Specialist's undertaking, the Primary Care Physician's compliance with the Primary Care Physician's undertaking, the Workplace Monitor's compliance with the Workplace Monitor's undertaking, including but not limited to any information:
relevant to the Order;
relevant to the Specialist's undertaking;
relevant to the Primary Care Physician's compliance with the Primary Care Physician's undertaking;
relevant to the Workplace Monitor's compliance with the Workplace Monitor's undertaking;
relevant for the purposes of monitoring her compliance with the Order; and/or
which comes to his or her attention and which he or she reasonably believes indicates a potential risk of harm to Dr. Ursell's patients.
The Order will be considered to have been breached if Dr. Ursell revokes her consent to the release of any information or communication between persons described in the Order.
(f) Dr. Ursell may bring a motion before a panel of the Fitness to Practice Committee to remove or modify any of the terms, conditions and limitations imposed on her certificate of registration under this Order, but not earlier than five (5) years after the date of this Order.
Terms and conditions imposed on certificate