As from October 17, 2024 by order of the Ontario Physicians and Surgeons Discipline Tribunal, the following terms, conditions and limitations are imposed on the certificate of registration held by Dr. Suganthan Kayilasanathan:
Clinical Supervision
(a) Prior to commencing practice, Dr. Kayilasanathan shall retain at his own expense, a clinical supervisor acceptable to the College (the “Clinical Supervisor”) who has executed an undertaking in the form attached at Schedule “A”.
(b) Dr. Kayilasanathan shall only practice under the supervision of the Clinical Supervisor.
(c) Clinical supervision shall cease only on approval of the College in its sole discretion in accordance with the terms outlined in this Order.
(d) During Clinical Supervision, Dr. Kayilasanathan shall be the Most Responsible Physician (“MRP”).
Moderate Level Supervision
(d) For a period of no less than three (3) months, Dr. Kayilasanathan shall practice under moderate level supervision (“Moderate Level Supervision”) by the Clinical Supervisor in accordance with the College-approved Individualized Educational Plan (the “IEP”) attached hereto as Schedule “B”.
(e) During Moderate Level Supervision, the Clinical Supervisor shall be available at all times during which Dr. Kayilasanathan is practicing, either on site or by telephone. For greater clarity, Dr. Kayilasanathan shall not practice unless the Clinical Supervisor is immediately available.
(f) The Clinical Supervisor shall directly observe Dr. Kayilasanathan’s first 10 patient encounters, or more in the Clinical Supervisor’s sole discretion, and will maintain a log of all patients observed along with patient identifiers. This requirement shall remain in place until Dr. Kayilasanathan has completed 10 patient encounters, or until the Clinical Supervisor is satisfied that no further direct observation is needed.
Moderate Level Supervision - Phase One
(g) During the first four (4) weeks of Moderate Level Supervision, the Clinical Supervisor shall:
(i) meet with Dr. Kayilasanathan at least weekly, at which meetings the Clinical Supervisor will:
a. review a minimum of 5 charts, to be selected in the sole discretion of the Clinical Supervisor, review and comment on diagnosis, documentation, and treatment plan, and discuss any issues or concerns arising from this review with Dr. Kayilasanathan.
b. make recommendations to Dr. Kayilasanathan for any practice improvements and ongoing professional development, and inquire into Dr. Kayilasanathan’s compliance with the recommendations.
c. keep a log of all patient charts reviewed along with patient identifiers.
(ii) provide a report to the College after the completion of the first four (4) weeks of Moderate Level Supervision, and at least every four (4) weeks thereafter if Phase One is extended, which shall include comment on:
a. Dr. Kayilasanathan’s management of patients;
b. clinical presentations that Dr. Kayilasanathan is competent to assess;
c. clinical presentations for which Dr. Kayilasanathan needs further education, if any;
d. topics reviewed and success in implementing changes in practice;
e. review of current practice guidelines;
f. quality of documentation;
g. whether, in the opinion of the Clinical Supervisor, Dr. Kayilasanathan is ready to transition to Moderate Level Supervision – Phase Two; and
h. all information that might assist the College in evaluating Dr. Kayilasanathan’s standard of practice, as well as Dr. Kayilasanathan’s participation in and compliance with the requirements set out in the Order.
(h) After a minimum of four (4) weeks of supervision, if the Clinical Supervisor is satisfied that Dr. Kayilasanathan’s care and treatment of patients meets the standard of practice of the profession, the Clinical Supervisor may recommend to the College that Dr. Kayilasanathan commence Moderate Level Supervision - Phase Two, as set out below. For greater clarity, Moderate Level Supervision - Phase One shall continue until such recommendation is made and the College approves the transition to Moderate Level Supervision - Phase Two.
Moderate Level Supervision - Phase Two
(i) Upon the recommendation of the Clinical Supervisor and the approval of the College, Dr. Kayilasanathan may commence Moderate Level Supervision - Phase Two.
(j) During Moderate Level Supervision – Phase Two, the Clinical Supervisor shall:
(i) meet with Dr. Kayilasanathan at least once every two (2) weeks, at which meetings the Clinical Supervisor will:
a. review a minimum of 10 charts, to be selected in the sole discretion of the Clinical Supervisor, review and comment on diagnosis, documentation, and treatment plan, and discuss any issues or concerns arising from this review with Dr. Kayilasanathan.
b. make recommendations to Dr. Kayilasanathan for any practice improvements and ongoing professional development, and inquire into Dr. Kayilasanathan’s compliance with the recommendations.
c. keep a log of all patient charts reviewed along with patient identifiers.
(ii) provide a report to the College after two (2) months of Moderate Level Supervision - Phase Two, and at least every two (2) months thereafter if Phase Two is extended, which shall include comment on:
a. Dr. Kayilasanathan’s management of patients;
b. clinical presentations that Dr. Kayilasanathan is competent to assess;
c. clinical presentations for which Dr. Kayilasanathan needs further education, if any;
d. topics reviewed and success in implementing changes in practice;
e. review of current practice guidelines;
f. quality of documentation;
g. whether, in the opinion of the Clinical Supervisor, Dr. Kayilasanathan is ready to transition to Low Level Supervision
h. all information that might assist the College in evaluating Dr. Kayilasanathan’s standard of practice, as well as Dr. Kayilasanathan’s participation in and compliance with the requirements set out in the Order.
(k) After a minimum of two (2) months of Moderate Level Supervision - Phase Two, if the Clinical Supervisor is satisfied that Dr. Kayilasanathan’s care and treatment of patients meets the standard of practice of the profession, the Clinical Supervisor may recommend to the College that Dr. Kayilasanathan commence Low Level Supervision, as set out below. For greater clarity, Moderate Level Supervision - Phase Two shall continue until such recommendation is made and the College approves the transition to Low Level Supervision.
Low Level Supervision
(l) Upon the recommendation of the Clinical Supervisor and the approval of the College, Dr. Kayilasanathan may commence Low Level Supervision.
(m) During Low Level Supervision, Dr. Kayilasanathan shall not practice unless the Clinical Supervisor is available onsite or by telephone, but the Clinical Supervisor need not be immediately available.
(n) During Low Level Supervision, the Clinical Supervisor shall:
(i) Meet with Dr. Kayilasanathan at least once every four (4) weeks, at which meetings the Clinical Supervisor will:
a. review a minimum of 15 charts, to be selected in the sole discretion of the Clinical Supervisor, review and comment on diagnosis, documentation, and treatment plan, and discuss any issues or concerns arising from this review with Dr. Kayilasanathan;
b. make recommendations to Dr. Kayilasanathan for any practice improvements and ongoing professional development, and inquire into Dr. Kayilasanathan’s compliance with the recommendations.
c. keep a log of all patient charts reviewed along with patient identifiers.
(ii) Provide a report to the College after three (3) months of Low Level Supervision, and at least every three (3) months thereafter so long as Low Level Supervision continues, which shall include comment on:
a. Dr. Kayilasanathan’s management of patients;
b. clinical presentations that Dr. Kayilasanathan is competent to assess;
c. clinical presentations for which Dr. Kayilasanathan needs further education, if any;
d. topics reviewed and success in implementing changes in practice;
e. review of current practice guidelines;
f. quality of documentation;
g. whether, in the opinion of the Clinical Supervisor, Dr. Kayilasanathan is ready to transition to independent practice; and
h. all information that might assist the College in evaluating Dr. Kayilasanathan’s standard of practice, as well as Dr. Kayilasanathan’s participation in and compliance with the requirements set out in the Order.
(o) Dr. Kayilasanathan shall practice under Low Level Supervision for a minimum of three (3) months, and shall continue to practice under Low Level Supervision on the terms outlined above until the College, in its sole discretion, determines it is no longer necessary.
(p) After a minimum of three (3) months of Low Level Supervision, if the Clinical Supervisor is satisfied that Dr. Kayilasanathan’s care and treatment of patients meets the standard of practice of the profession, the Clinical Supervisor may recommend to the College that Dr. Kayilasanathan transition to independent practice.
Assessment of Practice
(q) After the Clinical Supervisor has provided the recommendation outlined in subparagraph (p) above, and upon the approval of the College, Dr. Kayilasanathan shall undergo an assessment of his practice (the “Assessment”) by a College- appointed assessor or assessors (the “Assessor”).
(r) The Assessment shall include, at the discretion of the College, any one or more of the following: a review of Dr. Kayilasanathan’s patient charts, direct observation of Dr. Kayilasanathan’s practice, an interview with Dr. Kayilasanathan, interviews with colleagues and coworkers, feedback from patients, and any other tools deemed necessary by the College. Dr. Kayilasanathan shall abide by all recommendations made by the Assessor.
(s) The Assessor shall be provided with all information the College determines is relevant including this Order, materials related to Dr. Kayilasanathan’s application for reinstatement and the Discipline Tribunal’s Reasons for Decision regarding reinstatement, copies of the reports of the Clinical Supervisor(s) referred to above, and the decision of the (then called) Discipline Committee of the College of Physicians and Surgeons of Ontario in Ontario (College of Physicians and Surgeons of Ontario) v. Kayilasanathan 2018 ONSCPSD 50.
(t) The Assessor shall submit a written report to the College regarding Dr. Kayilasanathan’s standard of practice and this report may form the basis for further action by the College.
(u) The College shall review the final assessment report of the Assessor and make a determination, in its sole discretion, as to whether Dr. Kayilasanathan can enter independent practice. For clarity, Dr. Kayilasanathan shall continue to practice under supervision and shall not enter independent practice until the College, in its sole discretion, approves him to do so.
Other Elements of Clinical Supervision and Assessment
(v) Dr. Kayilasanathan shall cooperate fully with the Clinical Supervision and abide by all recommendations of the Clinical Supervisor(s), including but not limited to, any recommended practice improvements and professional development.
(w) The Clinical Supervisor shall immediately notify the College if they are concerned that Dr. Kayilasanathan’s practice may fall below the standard of practice of the profession, Dr. Kayilasanathan may not be in compliance with the provisions of this Order, or Dr. Kayilasanathan’s patients may be exposed to risk of harm or injury.
(x) If a person who has given an undertaking in Schedule “A” to this Order is unable or unwilling to fulfill its provisions during Moderate Level Supervision, Phase One or Phase Two, Dr. Kayilasanathan shall cease practicing medicine immediately 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, which will be included on the College’s public register.
(y) If a person who has given an undertaking in Schedule “A” to this Order is unable or unwilling to fulfill its provisions during Low Level Supervision, Dr. Kayilasanathan 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.
(z) If Dr. Kayilasanathan is unable to obtain a Clinical Supervisor as set out in subparagraph (y) of this Order within 14 days, he shall cease practicing medicine 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, which will be included on the College’s public register.
(aa) The patient charts reviewed by the Clinical Supervisor pursuant to this Order shall be selected by the Clinical Supervisor based on the educational needs identified in the IEP and based on any concerns that may arise during the period of Clinical Supervision.
(bb) Dr. Kayilasanathan shall consent to the disclosure and sharing of information between the Clinical Supervisor(s), the Assessor(s), and the College as the College deems necessary or desirable in order to fulfill their respective obligations.
Professional Education
(cc) Dr. Kayilasanathan will review and discuss the following literature with his Clinical Supervisor and how these principles apply to his discussions with patients in the clinical setting:
CFPC Parts I, II and III: Patient-Centered Interviewing:
• https://www.cfpc.ca/uploadedFiles/E ducation/Patient%20Centred%20Inte rviewing.pdf
• https://www.cfpc.ca/uploadedFiles/E ducation/Finding%20Common%20Gr ound.pdf
• https://www.cfpc.ca/uploadedFiles/Education/Five%20Provocative%20Questions.pdf
(dd) Dr. Kayilasanathan shall participate in, and successfully complete, all aspects of the IEP, attached hereto as Schedule “B”, including but not limited to professional education stipulated in the IEP, which includes:
(i) Completion of the continuing professional development (“CPD”) program relevant to family medicine approved by the College (the “Personal CPD Program”) as specified in Appendix “A” to the IEP (Schedule B);
(ii) Discuss the Personal CPD Program with the Clinical Supervisor and complete any additional CPD assigned by the Clinical Supervisor, if any;
(iii) Complete the CPD Program during the twelve (12) months following reinstatement; and
Monitoring and Other Terms
(ee) Dr. Kayilasanathan 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 five (5) days of this 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.
(ff) Dr. Kayilasanathan shall cooperate, and shall not interfere with, unannounced inspections of his practice by the College and to any other activity the College deems necessary for the purpose of monitoring Dr. Kayilasanathan’s compliance with the terms of this Order.
(gg) Dr. Kayilasanathan shall provide the College with his irrevocable consent to make enquiries of the Ontario Health Insurance Plan, and/or any person(s) or institution(s) that may have relevant information, in order for the College to monitor his compliance with the terms of this Order.
(hh) Dr. Kayilasanathan shall be solely responsible for any and all fees, costs, charges, expenses, etc. associated with implementing the terms of this Order.
(ii) Dr. Kayilasanathan shall, at his own expense, undergo an assessment by the Physician Health Program (“PHP”) and, if recommended, enroll in a Physician Support Advocacy and Accountability Program (“PSAAP Agreement”) with the PHP.
(jj) In the event that Dr. Kayilasanathan meets the enrollment criteria for the PHP, he shall:
(i) enroll in the PHP;
(ii) ensure that the College is provided with a copy of the PSAAP Agreement, including any amendments thereto, within three (3) weeks of execution;
(iii) enter into a concurrent undertaking, as may be required by the College;
(iv) fully comply with the requirements of the PSAAP Agreement, including completing the contractual term of the PSAAP Agreement; and
(v) ensure that the PHP provides periodic reports to the College in respect of his compliance with the PSAAP Agreement.
(kk) Dr. Kayilasanathan may commence Supervision in accordance with the terms of this Order notwithstanding the above terms set out in subparagraphs (ii) and (jj).
(ll) The College shall not approve Dr. K’s return to independent practice in accordance with the terms of this Order until Dr. Kayilasanathan has provided to the College either a) proof that he has satisfied the terms set out in subparagraphs (ii) and (jj), or
b) proof that, following its assessment, the PHP did not recommend Dr. Kayilasanathan's enrollment in a PSAAP Agreement.
(mm) Dr. Kayilasanathan, shall continue to undergo psychotherapy from, and shall comply with all recommendations of his psychiatrist, Dr. J. Ennis, or with another psychotherapist or psychiatrist approved to the College (“Psychotherapist”). Dr. Kayilasanathan shall provide to his Psychotherapist a copy of this Order and the Discipline Tribunal’s Reasons for Decision. Dr. Kayilasanathan shall meet with the Psychotherapist at least once every four (4) months for one (1) year, or longer if the Psychotherapist determines continued treatment is necessary. The Psychotherapist shall submit a minimum of one (1) report to the College at the end of the first year, or more frequently if Dr. Kayilasanathan’s psychotherapist has concerns that his patients may be at risk of harm or injury and that he has failed to attend for appointments (without sound reason).
Terms and conditions imposed on certificate by: Ontario Physicians and Surgeons Discipline Tribunal