Alexander, Alexander Michael (CPSO#: 58565)

Current Status: Active Member as of 29 Jun 1988

CPSO Registration Class: Restricted as of 24 May 2017

Indicates a concern or additional information

Summary

Former Name: No Former Name

Gender: Male

Languages Spoken: Bulgarian, English, French, Spanish

Education:Memorial University of Newfoundland, 1987

Practice Information

Primary Location of Practice
Practice Address Not Available

Hospital Privileges

Hospital Location
Humber River Hospital,Wilson Site Toronto

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 17 Jun 1987
Expired: Terms and conditions of certificate of registration Expiry: 13 Jun 1988
Subsequent certificate of registration Issued: Independent Practice Certificate Effective: 29 Jun 1988
Transfer of class of certificate to: Restricted certificate Effective: 20 Jul 2009
Terms and conditions amended Effective: 18 Apr 2012
Transfer of class of registration to: Independent Practice Certificate Effective: 10 Jan 2014
Transfer of class of certificate to: Restricted certificate Effective: 24 May 2017
Terms and conditions amended by member Effective: 08 Jan 2018

Pending Hearings

Summary: Allegations of Dr. Alexander’s professional misconduct have been referred to the Discipline Committee of the College. It is alleged that Dr. Alexander is incompetent and/or failed to maintain the standard of practice of the profession in his care of patients.

Notice of Hearing: Download Full Notice (PDF)

Hearing Date(s): September 24-28, 2018

Practice Restrictions

Imposed By Effective Date Expiry Date Status  
member Effective: 08 Jan 2018 Active View Details [+]
            As from May 24, 2017, the following is imposed as a term, condition and
            limitation on the certificate of registration held by Dr. Alexander Michael
            Alexander, in accordance with an undertaking and consent given by Dr. Alexander
            to the College of Physicians and Surgeons of Ontario:

                               UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT 
                                            ("Undertaking")

                                                  of

                                    DR. ALEXANDER MICHAEL ALEXANDER
                                           ("Dr. Alexander")

                                                  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;
                  
                  "OHIP" means the Ontario Health Insurance Plan;
                  
                  "Public Register" means the College's register that is available to the
                  public. 
                  
            (2)   I, Dr. Alexander, certificate of registration number 58565, am a member
                  of the College.  The College has received information regarding my
                  standard of practice.

            (3)   I, Dr. Alexander, acknowledge that the College has referred to the
                  Discipline Committee, allegations that I fell below the standard and/or
                  am incompetent.

            (4)   I, Dr. Alexander, have read the Notice of Hearing dated March 23, 2017,
                  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. Alexander, acknowledge that the College has accepted this
                  Undertaking in lieu of making an Order under section 37 of the Code.

            (6)   I, Dr. Alexander, acknowledge that this Undertaking continues in force
                  until the matters currently referred are disposed of by a panel of the
                  Discipline Committee.

            B.    UNDERTAKING

            (7)   I, Dr. Alexander, undertake to abide by the provisions of this
                  Undertaking, effective immediately.

            (8)   Clinical Supervision 

                  (a)   I, Dr. Alexander, undertake to practise under the guidance of a
                        clinical supervisor(s) acceptable to the College (the "Clinical
                        Supervisor(s)").
                  
                  (b)   I, Dr. Alexander, acknowledge that I have reviewed the Clinical
                        Supervisor(s)'s undertaking, attached hereto as Appendix "A", and
                        understand what is required of the Clinical Supervisor(s). The
                        Clinical Supervisor(s) will, at minimum: 
                  
                        (i)   Meet with me at my Practice Location, or another location
                              approved by the College, once every week; 
                  
                        (ii)  Review ten to fifteen (10 to 15) of my patient charts at
                              every meeting, which shall be selected by the Clinical
                              Supervisor(s) independent of my participation, on the basis
                              of the areas of concern identified in the medical inspector's
                              report(s), including both my care and my record-keeping,
                              received January 19, 2017, and any concerns that arise during
                              the period of Clinical Supervision;
                  
                        (iii) Once a month, observe no fewer than ten (10) of my patient
                              encounters, for no less than one-half (1/2) day;
                  
                        (iv)  Discuss any concerns arising from the observation of patient
                              encounters and review of patient records as well as provide
                              recommendations to me;
                  
                        (v)   Perform any other duties, such as reviewing other documents
                              or conducting interviews with staff or colleagues, that the
                              Clinical Supervisor(s) deem necessary to my Clinical
                              Supervision; and
                  
                        (vi)  Submit written reports to the College at least once every
                              month, or more frequently if the Clinical Supervisor(s) has
                              concerns about my standard of practice.
                  
                  (c)   I, Dr. Alexander, acknowledge that the charts reviewed shall be
                        selected by the Clinical Supervisor(s) based on the areas of
                        concern identified in the report(s) of the medical inspector
                        received January 19, 2017, and concerns that may arise during the
                        period of Clinical Supervision.
                  
                  (d)   I, Dr. Alexander, undertake to cooperate fully with the Clinical
                        Supervision of my practice, conducted under the term of this
                        Undertaking and Appendix "A" attached, and to abide by the
                        recommendations of my Clinical Supervisor(s), including but not
                        limited to, any recommended practice improvements and ongoing
                        professional development.
                  
                  (e)   I, Dr. Alexander, 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. Alexander, 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. Alexander, acknowledge that if I am unable to obtain a
                        Clinical Supervisor on the provisions set out under sections (8)(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. Alexander, acknowledge that if I am required to cease
                        practise as a result of section (8)(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.
                  
            (9)   I, Dr. Alexander, undertake to inform the College of each and every
                  location that I practise or have privileges, including, but not limited
                  to, hospital(s), clinic(s) and office(s), in any jurisdiction
                  (collectively my "Practice Location(s)"), 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.

            (10)  I, Dr. Alexander, undertake that I will submit to, and not interfere
                  with, unannounced inspections of my Practice Location(s) and and to any
                  other activity the College deems necessary in order to monitor my
                  compliance with the provisions of this Undertaking.

            (11)  I, Dr. Alexander, 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.

            C.    ACKNOWLEDGEMENT

            (12)  I, Dr. Alexander, acknowledge that all appendices attached to or referred
                  to in this Undertaking form part of this Undertaking.
            (13)  I, Dr. Alexander, 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. Alexander, acknowledge that I have read and understand the
                  provisions of 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. Alexander, acknowledge that the College will provide this
                  Undertaking to any Chief(s) of Staff, or a colleague with similar
                  responsibilities, at any Practice Location ("Chief(s) of Staff").

            (16)  In the event of an appeal of any order of the Discipline Committee, I,
                  Dr. Alexander, acknowledge that if the Discipline Committee 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.

            (17)  I, Dr. Alexander, 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. Alexander, acknowledge that, during the time period that
                        this Undertaking remains in effect, this Undertaking shall be
                        posted on the Public Register.
                  
                  (b)   I, Dr. Alexander, 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:
                  
                              Dr. Alexander is the subject of a referral to the Discipline
                              Committee into allegations that he fell below the standard
                              and/or is incompetent.  As a result of the referral:
                  
                              *     Dr. Alexander must practise under the guidance of a
                                    Clinical Supervisor acceptable to the College. 
                  
            D.    CONSENT

            (19)  I, Dr. Alexander, 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. 

            (20)  I, Dr. Alexander, acknowledge that I have executed the OHIP consent form,
                  attached hereto as Appendix "B". 

            (21)  I, Dr. Alexander, give my irrevocable consent to the College to provide
                  the following information to all Clinical Supervisors:

                  (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.
                  
            (22)  I, Dr. Alexander, give my irrevocable consent to the College to provide
                  all 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.

            (23)  I, Dr. Alexander, give my irrevocable consent to all Clinical Supervisors
                  and Chiefs of Staff to disclose to the College, and to one another, any
                  information:

                  (a)   relevant to this Undertaking;
                  
                  (b)   relevant to the provisions of the Clinical Supervisor's undertaking
                        set out at Appendix "A"; and/or
                  
                  (c)   relevant for the purposes of monitoring my compliance with this
                        Undertaking. 

Previous Discipline Hearings

Committee: Discipline
Decision Date: 18 Apr 2012
Summary:

On April 18, 2012, the Discipline Committee found that Dr. Alexander Michael Alexander 
committed an act of professional misconduct, in that he failed to maintain the standard of 
practice of the profession in his care of Patient A and 27 other patients. Dr. Alexander admitted 
the allegation. 
 
In April 2003, Dr. Alexander wrote a prescription for anabolic steroids to Patient "A", even 
though the prescription was not clinically indicated. Dr. Alexander continued to prescribe 
anabolic steroids to Patient "A", even though it was not clinically indicated, until September 
2004. 
 
Regarding a review of 27 of Dr. Alexander's patient charts, as well as the care he provided to 
Patient "A", the following care and record-keeping deficiencies were identified: 
 
      a)    Dr. Alexander's patient records are inadequate in documentation. There was no 
            CPP or family history. The records were mostly illegible with sparse details. 
      b)    Dr. Alexander failed to follow up and investigate Patient "A"'s abnormal 
            echocardiogram beyond repeating the test.   A referral to a cardiologist should 
            have been done. 
      c)    Dr. Alexander poorly managed diabetic patients. 
      d)    Dr. Alexander poorly managed a patient with presumed coronary disease. 
      e)    Dr. Alexander failed to use a cautious approach with narcotic patients including 
            no contracts and no screening for opioid addiction, though most of the patients for 
            whom opioids were prescribed had a legitimate reason for prescribing these 
            medications. 
      f)    Dr. Alexander displayed a lack of knowledge of the investigation and 
            management for H. Pylori. 
 
Dr. Alexander acknowledged the concerns raised by the College's expert and enrolled in and 
successfully completed:  
 
      a)    the Understanding Boundaries and Preventing Boundary Violations in the 
            Doctor-Patient Relationship course;  
      b)    the Physicians Prescribing Skills Course: A Focus on Prescribing of Addictive 
            and Psychoactive Drugs; and  
      c)    the Medical Record-Keeping Course for physicians. 
 
Dr. Alexander's clinical supervisor notes that Dr. Alexander has implemented Cumulative Patient 
Profiles in all of his patient charts; he finds Dr. Alexander's approach to diabetes, coronary artery 
disease, hepatitis, and H. Pylori to be appropriate; Dr. Alexander uses written agreements signed 
by both the patient and Dr. Alexander; and Dr. Alexander's indications for ECHO nuclear stress 
testing are appropriate, as is his antibody testing. 
 
Therefore, the Committee ordered and directed that:  
 
      1.     the Registrar impose the following terms, conditions and limitations on Dr. 
            Alexander's certificate of registration: 
 
       
 
a)    Dr. Alexander, at his own expense, submit to an assessment of his practice by an assessor 
      selected by the College approximately three months after the date of this order. The 
      assessment shall pertain to Dr. Alexander's family practice overall, with a specific focus 
      upon the areas of concern outlined in the reports of Dr. Toomas Sauks. The reassessment 
      shall include, at minimum, a full day direct observation component. 
 
b)    Dr. Alexander shall abide by the recommendations made by the Assessor. If any of the 
      recommendations made by the Assessor limit or in any way restrict Dr. Alexander's 
      practice, Dr. Alexander shall be permitted to make written submissions on his own behalf 
      within 30 days of receipt of the assessment to the Inquiries, Complaints and Reports 
      Committee. The Inquiries, Complaints and Reports Committee may or may not vary the 
      recommendations of the Assessor upon receipt of Dr. Alexander's written submissions. 
      Any recommendations accepted by the Inquiries, Complaints and Reports Committee that 
      are limitation(s) or restriction(s) shall constitute terms, conditions or limitations on Dr. 
      Alexander's Certificate of Registration and may be included on the public register if 
      required by the College in its sole discretion. 
 
2.    Dr. Alexander appear before the panel to be reprimanded.  
 
3.    Dr. Alexander pay costs to the College in the amount of $3650.00 within 60 days of the 
      date of this order. 
 
 

Decision: Download Full Decision (PDF)
Appeal: No Appeal
Hearing Date(s): April 18, 2012

Concerns

Source: Member
Active Date: May 24, 2017
Expiry Date:
Summary:
Summary of the Undertaking given by Dr. Alexander Michael Alexander to the College of Physicians and Surgeons of Ontario, effective May 24, 2017:

Dr. Alexander is the subject of a referral to the Discipline Committee into allegations that he fell below the standard and/or is incompetent. As a result of the referral:

Dr. Alexander must practise under the guidance of a Clinical Supervisor acceptable to the College.