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A. THE DISCIPLINE PANEL MADE THE FOLLOWING FINDINGS of professional misconduct in relation to the following allegations set out in the Notice of Hearing, dated February 16, 2018:
1. That Dr. Sheikh committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Optometry Act, 1991, S.O. 1991, c. 35, as amended, and defined in paragraph 1.14 of Ontario Regulation 119/94 in that, on or about August 23, 2016, while practising as an optometrist at the ________ Eye Clinic in Hamilton, Ontario, he failed to maintain the standards of practice of the profession with respect to:
a. his delegation to Mr. S., the controlled act(s) of communicating a diagnosis and prescribing eyeglasses to Patient X and, specifically, with respect to his failure to:
i. obtain informed consent or to ensure that informed consent was obtained from Patient X for the delegation;
ii. establish a formal patient/practitioner relationship with Patient X prior to the delegation; and
iii. ensure that the delegation was appropriately and/or adequately documented in the patient record
2. That he committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Optometry Act, 1991, S.O. 1991, c. 35, as amended, and defined in paragraph 1.18 of Ontario Regulation 119/94 in that, on or about August 23, 2016, while practising as an optometrist at the ________ Eye Clinic in Hamilton, Ontario, he permitted, counselled, or assisted Mr. S., a person who is not a member of the College to perform one or more of the following controlled acts, which should be performed by a member of the College, in relation to Patient X:
a. communicating a diagnosis identifying, as the cause of Patient X’s symptoms, a disorder of refraction; and/or
b. prescribing, for vision or eye problems, eye glasses.
3. That he committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Optometry Act, 1991, S.O. 1991, c. 35, as amended, and defined in paragraph 1.24 of Ontario Regulation 119/94 in that, from approximately August 23, 2016 to approximately September 26, 2016, while practising as an optometrist at the ________ Eye Clinic in Hamilton, Ontario, he failed to make and/or maintain records in accordance with Part IV and, in particular, he failed to ensure that the patient health record for Patient X included:
a. information about his delegation of a controlled act(s) to Mr. S.; and
b. information that would allow his entries and the entries of Mr. S. in the health record for Patient X to be readily identifiable.
4. That he committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Optometry Act, 1991, S.O. 1991, c. 35, as amended, and defined in paragraph 1.28 of Ontario Regulation 119/94 in that, on or about August 23, 2016, while practising as an optometrist at the ________ Eye Clinic in Hamilton, Ontario, he allowed to be submitted an account for professional services that he knew or ought to have known was false or misleading and, in particular, he allowed a claim to be submitted to Patient X’s insurance company in relation to an eye examination in circumstances where the information submitted to the insurance company suggested that:
a. he had completed Patient X’s eye examination on that date, when that was not the case; and
b. Patient X had received a complete eye examination on that date, when that was not the case.
5. That he committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Optometry Act, 1991, S.O. 1991, c. 35, as amended, and defined in paragraph 1.30 of Ontario Regulation 119/94 in that, from approximately August 23, 2016 to approximately September 26, 2016, while practising as an optometrist at the ______ Eye Clinic in Hamilton, Ontario, the administrative staff who support his practice, failed to issue a statement or receipt that itemizes an account for professional goods or services provided to Patient X, when he requested such a statement or receipt.
6. That he committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Optometry Act, 1991, S.O. 1991, c. 35, as amended, and defined in paragraph 1.39 of Ontario Regulation 119/94 in that, from approximately August 23, 2016 to approximately September 26, 2016, while practising as an optometrist at the _____ Eye Clinic in Hamilton, Ontario, he engaged in conduct or performed an act that, having regard to all the circumstances, would reasonably be regarded by members as dishonourable and unprofessional and, in particular, he:
a. delegated a controlled act(s) to Mr. S. in relation to Patient X without:
i. obtaining informed consent and/or ensuring that informed consent was obtained from Patient X for the delegation;
ii. establishing a formal patient/practitioner relationship with Patient X prior to the delegation; and/or
iii. ensuring that the delegation was appropriately and/or adequately documented in the patient record;
b. permitted, counselled, or assisted Mr. S., a person who is not a member of the College, to perform one or more of the following controlled acts, which should be performed by a member of the College, in relation to Patient X:
i. communicating a diagnosis identifying, as the cause of Patient X’s symptoms, a disorder of refraction; and/or
ii. prescribing, for vision or eye problems, eye glasses;
c. failed to make and/or maintain records in accordance with Part IV and, in particular, he failed to ensure that the patient health record for Patient X included:
i. information about his delegation of a controlled act(s) to Mr. S.; and
ii. information that would allow his entries and the entries of Mr. S. to be readily identifiable.
d. submitted an account for professional services that he knew or ought to have known was false or misleading and, in particular, he allowed a claim to be submitted to Patient X’s insurance company in relation to an eye examination in circumstances where the information submitted to the insurance company suggested that:
i. he had completed Patient X’s eye examination on that date, when that was not the case; and
ii. Patient X had received a complete eye examination on that date, when that was not the case; and/or
e. failed to have the appropriate administrative processes in place to ensure that Patient X received an itemized statement or receipt when he requested one.
B. THE DISCIPLINE PANEL MADE AN ORDER:
1. Requiring the Member to appear before the Panel to be reprimanded at the conclusion of the hearing on October 3, 2018.
2. Directing the Registrar to suspend the Member’s certificate of registration for three (3) weeks, uninterrupted, commencing at 12:01 am on October 4, 2018 and ending at 11:59 pm on October 24, 2018.
3. Directing the Registrar to impose the following terms, conditions and limitations on the Member’s certificate of registration:
a. the Member successfully complete, at his own expense, with an unconditional pass, and within one (1) year of the date that this Order becomes final, the ProBe Program on professional/problem-based ethics offered in Ontario;
b. the Member shall submit, to the Registrar, an essay of at least 1,000 words on the following topics, that the Registrar deems satisfactory:
i. the delegation of controlled acts, as defined in the Regulated Health Professions Act, 1991, and the assignment of care, with discussion of the following specific topics:
A. the legislation and College publications the Member reviewed relevant to the delegation of controlled acts and to the assignment of care;
B. the process for optometrists to delegate controlled acts and the process for optometrists to assign care, with reference to the applicable standards of practice and/or other legislated requirements;
C. the purpose of allowing regulated health professionals, including optometrists, to delegate controlled acts and to assign care;
D. the purpose of the controls that exist to limit the circumstances in which regulated health professionals, including optometrists, can delegate controlled acts and can assign care; and
ii. the Member’s reflections on how the appointment of the patient at issue in his discipline hearing should have been handled differently.
c. the Member shall not delegate controlled acts (as defined in the Regulated Health Professions Act, 1991) until he has received written confirmation from the Registrar that the essay referred to in 3(b), above, is satisfactory; and
d. the Member shall co-operate fully in an unannounced inspection of his practice by the College, within one (1) year of either the end of the suspension referred to in paragraph 2, or the date of the Registrar’s approval referred to in paragraph 3(b), whichever occurs later. The practice inspection shall include any inquiries, chart reviews, interviews, attendances and/or investigative techniques the Registrar deems appropriate to assess the Member’s compliance with the College Standards and applicable legislation relating to the delegation of controlled acts and the assignment of care, and shall be at the Member’s cost, up to a maximum of $1,500.
4. Directing the Member to partially reimburse the College for its costs in relation to this proceeding in the amount of $20,000 to be paid according to the following schedule:
a. one cheque dated October 3, 2018 in the amount of $2,000; and
b. twelve, post-dated cheques, provided to the College on October 3, 2018, each in the amount of $1,500 and each dated on the third day of the month commencing, November 3, 2018.
At the conclusion of the hearing, Dr. Sheikh waived his right to appeal and the Discipline Committee delivered the reprimand.