(1 of 2)
As from November 22nd, 2024, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Richard Nahas in accordance with an undertaking and consent given by Dr. Nahas to the College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
(“Undertaking”)
of
DR. RICHARD NAHAS
(“Dr. Nahas”)
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;
“ICR Committee” means the Inquiries, Complaints and Reports Committee of the College;
“OHIP” means the Ontario Health Insurance Plan;
“Ontario Physicians and Surgeons Discipline Tribunal” means the Discipline Committee established under the Code;
“Public Register” means the College’s register that is available to the public.
(2) I, Dr. Nahas, certificate of registration number 72330, am a member of the College.
(3) I, Dr. Nahas, acknowledge that the College has referred to the Discipline Tribunal, in the matter of College File Number CAS-468889-S6Y4C9 allegations that I am incompetent and/or failed to maintain the standard of practice of the profession in the care of patients.
(4) I, Dr. Nahas, have read the Notice of Hearing dated August 15, 2024, which sets out the allegations against me. I am aware of the College’s concern about protecting the public and I understand the nature of the allegations against me.
(5) I, Dr. Nahas, acknowledge that the ICR Committee has accepted this Undertaking in lieu of making an Order under section 25.4 of the Code at this time.
(6) I, Dr. Nahas, acknowledge that this Undertaking does not preclude the ICR Committee from making an Order at a later date in accordance with the Code.
(7) I, Dr. Nahas, acknowledge that, on June 14, 2018, the ICR Committee directed that I complete a Specified Continuing Education or Remediation Program (“the June 2018 SCERP”). I further acknowledge that I entered into an Undertaking with the College dated June 7, 2022 (“the June 2022 Undertaking”). This Undertaking does not replace or supersede the June 2018 SCERP or the June 2022 Undertaking, both of which remain in effect.
(8) I, Dr. Nahas, acknowledge that this Undertaking supersedes and replaces the current Order under section 25.4 effective July 21, 2023 (the “July 21, 2023 Order”) as the restrictions in the July 21, 2023 Order are contained in this Undertaking.
(9) I, Dr. Nahas, acknowledge that this Undertaking continues in force until the matter currently referred is disposed of by a panel of the Discipline Tribunal.
B. UNDERTAKING
(10) I, Dr. Nahas, undertake to abide by the provisions of this Undertaking, effective immediately (“Effective Date”).
(11) Practice Restrictions
(a) I, Dr. Nahas, undertake to restrict my practice as follows:
(i) I will not perform any neuraxial, paravertebral and plexus nerve blocks for adult chronic pain;
(ii) I will not perform any injections along or near the vertebral spine;
(iii) I will not administer any injection therapy for patients on anticoagulant or anti-platelet therapy, other than single antiplatelet therapy with acetylsalicylic acid (ASA); and
(iv) I will not prescribe, renew existing prescriptions, and/or administer systemic corticosteroids, and I will not perform extra-articular or neuraxial corticosteroid injections.
(12) Posting a Sign
(a) I, Dr. Nahas, undertake that I shall post a sign in all waiting rooms, examination rooms and consulting rooms, in all my Practice Locations, in a clearly visible and secure location, at all times whether or not I am physically present at the Practice Location, in the form set out at Appendix “A.” If providing care in a virtual setting, I shall display the sign to the patient at the outset of the patient encounter. If the patient encounter is by telephone, I shall read the sign to the patient at the outset of the patient encounter. For further clarity, this sign shall state as follows:
“Dr. Nahas shall not:
1. perform any neuraxial, paravertebral and plexus nerve blocks for adult chronic pain;
2. perform any injections along or near the vertebral spine;
3. administer any injection therapy for patients on anticoagulant or anti-platelet therapy, other than single antiplatelet therapy with acetylsalicylic acid (ASA); and
4. prescribe, renew existing prescriptions, and/or administer systemic corticosteroids, and he shall not perform extra-articular or neuraxial corticosteroid injections.
Further information may be found on the College of Physicians and Surgeons of Ontario website at www.cpso.on.ca”
(b) I, Dr. Nahas, undertake to post a certified translation in any language in which I provide services, of the sign described in section 12(a) in all waiting rooms of all my Practice Locations, in a clearly visible and secure location, in the form set out at Appendix “A”.
(c) I, Dr. Nahas, undertake to provide the certified translation described in section 12(b), to the College within thirty (30) days of executing this Undertaking.
(d) I, Dr. Nahas, undertake that if I elect, after the execution of this Undertaking, to provide services in any other language, I will notify the College prior to providing any such services.
(e) I, Dr. Nahas, undertake to provide to the College the certified translation described in section (12)(b) prior to beginning to provide services in any language described in section (12)(d).
(f) I, Dr. Nahas, acknowledge that the College may accept an alternative arrangement with respect to signage in a hospital or other setting, in its sole discretion.
(13) Monitoring
(a) I, Dr. Nahas, undertake to inform the College of each and every location at which I practice, delegate, or have privileges, including, but not limited to, any hospitals, clinics, offices, and any Out-of-Hospital Premises and Independent Health Facilities with which I am affiliated, in any jurisdiction (collectively my “Practice Location” or “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. Nahas, undertake that I will submit to, and not interfere with, unannounced inspections of my Practice Locations and patient charts by a College representative for the purposes of monitoring my compliance with the provisions of this Undertaking.
(c) I, Dr. Nahas, give my irrevocable consent to the College to make appropriate enquiries of OHIP, and/or any person 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. Nahas, acknowledge that I have executed the OHIP consent form, attached hereto as Appendix “B”.
C. ACKNOWLEDGEMENT
(14) I, Dr. Nahas, acknowledge that all appendices attached to or referred to in this Undertaking form part of this Undertaking.
(15) I, Dr. Nahas, 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.
(16) I, Dr. Nahas, 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.
(17) I, Dr. Nahas, acknowledge that the College will provide this Undertaking to any Chief of Staff, or a colleague with similar responsibilities, including Medical Director, at any Practice Location (“Chief of Staff” or “Chiefs of Staff”).
(18) I, Dr. Nahas, acknowledge that in the event of an appeal of any order of the Discipline Tribunal, if the Discipline Tribunal has directed the Registrar to revoke, suspend, or impose terms and conditions on my certificate of registration, that order will take effect immediately despite any appeal.
(19) I, Dr. Nahas, 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.
(20) I, Dr. Nahas, acknowledge that this Undertaking constitutes terms, conditions, and limitations on my certificate of registration for the purposes of section 23 of the Code.
(21) Public Register
(a) I, Dr. Nahas, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.
(b) I, Dr. Nahas, acknowledge that, in addition to this Undertaking being posted in accordance with section (21)(a) above, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:
Dr. Nahas is the subject of a referral to the Discipline Tribunal into allegations that he is incompetent and/or failed to maintain the standard of practice of the profession in his care of patients.
While the referral is ongoing, Dr. Nahas has restricted his practice as follows:
1. Dr. Nahas will not perform any neuraxial, paravertebral and plexus nerve blocks for adult chronic pain;
2. Dr. Nahas will not perform any injections along or near the vertebral spine;
3. Dr. Nahas will not administer any injection therapy for patients on anticoagulant or anti-platelet therapy, other than single antiplatelet therapy with acetylsalicylic acid (ASA); and
4. Dr. Nahas will not prescribe, renew existing prescriptions, and/or administer systemic corticosteroids, and he will not perform extra-articular or neuraxial corticosteroid injections.
Dr. Nahas shall post a clearly visible sign in the waiting rooms, examination rooms and consulting rooms of all Practice Locations, which states as follows:
“Dr. Nahas shall not:
1. perform any neuraxial, paravertebral and plexus nerve blocks for adult chronic pain;
2. perform any injections along or near the vertebral spine;
3. administer any injection therapy for patients on anticoagulant or anti-platelet therapy, other than single antiplatelet therapy with acetylsalicylic acid (ASA); and
4. prescribe, renew existing prescriptions, and/or administer systemic corticosteroids, and he shall not perform extra-articular or neuraxial corticosteroid injections.
Further information may be found on the College of Physicians and Surgeons of Ontario website at www.cpso.on.ca”
D. CONSENT
(22) I, Dr. Nahas, 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.
(23) I, Dr. Nahas, give my irrevocable consent to all Chiefs of Staff to disclose to the College, and to one another, any information relevant to this Undertaking and/or relevant for the purposes of monitoring my compliance with this undertaking.
(2 of 2)
As from June 7, 2022, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Richard Nahas in accordance with an undertaking and consent given by Dr. Nahas to the College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
(“Undertaking”)
of
DR. RICHARD NAHAS
(“Dr. Nahas”)
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;
“OHIP” means the Ontario Health Insurance Plan;
“Ontario Physicians and Surgeons Discipline Tribunal” means the Discipline Committee established under the Code;
“Public Register” means the College’s register that is available to the public.
(2) I, Dr. Nahas, certificate of registration number 72330, am a member of the College.
(3) I, Dr. Nahas, acknowledge that following a public complaint that raised concerns about my standard of practice and conduct in my pain management practice, the College conducted an investigation bearing File Number CAS-135240-L4F5S3 (previously, File Number 1112268) (the “Investigation”).
(4) I, Dr. Nahas, acknowledge that, in addition to accepting this Undertaking, the College will also deliver a caution in person.
B. UNDERTAKING
(5) I, Dr. Nahas, undertake to abide by the provisions of this Undertaking, effective immediately.
(6) Clinical Supervision
(a) I, Dr. Nahas, undertake to practise under the guidance of a clinical supervisor or clinical supervisors acceptable to the College (the “Clinical Supervisor” or “Clinical Supervisors”), for six (6) months (“Clinical Supervision”).
(b) I, Dr. Nahas, 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 Individualized Education Plan (“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;
(iv) During the first three (3) months of clinical supervision, perform direct observation of three (3) patient encounters at each meeting;
(v) After a minimum of three (3) months of Clinical 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;
(vi) Review at least fifteen (15) of my patient charts at every meeting;
(vii) Discuss any concerns arising from the chart reviews;
(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, such as reviewing other documents or conducting interviews with staff or colleagues, that the Clinical Supervisor deems necessary to my Clinical Supervision; and
(x) Submit written reports to the College at least once every month for three (3) months or until the College approves a reduction in the level of supervision, and then once at the end of supervision, or more frequently if the Clinical Supervisor has concerns about my standard of practice.
(c) I, Dr. Nahas, 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”, as well as the areas of concern identified in the report of the assessor dated March 16, 2021 and May 22, 2021, and concerns that may arise during the period of Clinical Supervision.
(d) I, Dr. Nahas, 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.
(e) I, Dr. Nahas, 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.
(f) I, Dr. Nahas, 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.
(g) I, Dr. Nahas, undertake that if I am unable to obtain a Clinical Supervisor on the provisions set out under sections (6)(e) and/or (f) above, I will cease practising medicine until such time as I have obtained a Clinical Supervisor acceptable to the College.
(h) I, Dr. Nahas, acknowledge that if I am required to cease practise as a result of section (6)(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.
(7) Professional Education
(a) I, Dr. Nahas, 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) Medical Record Keeping Program, University of Toronto;
(ii) Documentation: Principles of Medical Record Keeping eLearning Module, CMPA;
(iii) Review, reflection, written summary and discussion of the following with the Clinical Supervisor:
1. Complementary/Alterative Medicine, College Policy;
2. Medical Records Documentation, College Policy;
3. The Practice Guide;
4. Ending the Physician‐Patient Relationship, College Policy;
5. Consent to Treatment, College Policy.
(iv) individualized instruction in medical ethics and professionalism satisfactory to the College, with an instructor selected by the College;
(v) any additional professional education recommended by my Clinical Supervisor.
(b) I, Dr. Nahas, 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. Nahas, undertake to complete this requirement by September 1, 2022 or, if no satisfactory program is available by that time, by the first possible opportunity thereafter.
(d) I, Dr. Nahas, acknowledge that a report or reports may be provided to the College regarding my progress and compliance with the Professional Education.
(e) I, Dr. Nahas, 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.
(8) Reassessment of Practice
(a) I, Dr. Nahas, undertake that, approximately six (6) months after the completion of the Clinical Supervision set out in section (6) above and Appendix “A” to this Undertaking, and the completion of the Professional Education set out in section (7) 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, colleagues and co-workers, feedback from patients, and any other tools deemed necessary by the College.
(b) I, Dr. Nahas, undertake to co-operate fully with the Reassessment, conducted under the term of this Undertaking.
(c) I, Dr. Nahas, 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. Nahas, 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.
(9) Monitoring
(a) I, Dr. Nahas, undertake to inform the College of each and every location at which I practice, delegate, or have privileges, including, but not limited to, any hospitals, clinics, offices, and any Out-of-Hospital Premises or Independent Health Facilities with which I am affiliated, in any jurisdiction (collectively my “Practice Location” or “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. Nahas, 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. Nahas, 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. Nahas, acknowledge that I have executed the OHIP consent form, attached hereto as Appendix “C”.
C. ACKNOWLEDGEMENT
(10) I, Dr. Nahas, acknowledge that all appendices attached to or referred to in this Undertaking form part of this Undertaking.
(11) I, Dr. Nahas, 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.
(12) I, Dr. Nahas, 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.
(13) I, Dr. Nahas, 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”).
(14) I, Dr. Nahas, 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 of the College.
(15) I, Dr. Nahas, acknowledge that this Undertaking constitutes terms, conditions, and limitations on my certificate of registration for the purposes of section 23 of the Code.
(16) Public Register
(a) I, Dr. Nahas, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.
(b) I, Dr. Nahas, acknowledge that, in addition to this Undertaking being posted in accordance with section (16)(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. Nahas’s standard of practice and conduct in his pain management practice. As a result of the investigation:
Dr. Nahas will practise under the guidance of a Clinical Supervisor acceptable to the College for 6 months.
Dr. Nahas will engage in professional education in medical record-keeping, complementary/alterative medicine, ending the physician-patient relationship, consent to treatment, and medical ethics/professionalism.
Dr. Nahas’s practice will be reassessed by an assessor selected by the College within 6 months of the end of the period of Clinical Supervision.
(c) I, Dr. Nahas, acknowledge that this Undertaking remains in effect until the College determines its terms are satisfied.
D. CONSENT
(17) I, Dr. Nahas, 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 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.
(18) I, Dr. Nahas, 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.
(19) I, Dr. Nahas, give my irrevocable consent to any persons who facilitate my completion of the Professional Education, and to all 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;
(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.
Terms and conditions imposed on certificate by: Member
