Ciurria, Nicholas Samuel (CPSO#: 29153)

Current Status: Active Member as of 16 Jun 1977

CPSO Registration Class: Restricted as of 06 Sep 2017

Indicates a concern or additional information

Summary

Former Name: No Former Name

Gender: Male

Languages Spoken: English, Italian

Education:University of Toronto, 1976

Practice Information

Primary Location of Practice
Danforth Medical Centre
1473 Danforth Avenue
Toronto ON  M4J 1N5
Phone: (416) 461-0785
Fax: (416) 461-0787
Electoral District: 10
View more practice locations

Additional Practice Location(s)

2754 Victoria Park Avenue
North York ON  M2J 4A8
Canada
Phone: (416) 491-3910
Fax: (416) 491-3919
County: City of Toronto
Electoral District: 10
View Professional Corporation Information

Professional Corporation Information

Corporation Name: N. Ciurria Medicine Professional Corporation

Certificate of Authorization Status: Issued Date:  Aug 09 2010

Shareholders:
Dr. N. Ciurria ( CPSO# 29153 )

Business Address:
Danforth Medical Centre
1473 Danforth Avenue
Toronto ON  M4J 1N5
Phone Number: (416) 461-0785

Business Address:
2754 Victoria Park Avenue
Toronto ON  M2J 4A8
Phone Number: (416) 491-3910

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 15 Jun 1976
Transfer of class of registration to: Independent Practice Certificate Effective: 16 Jun 1977
Transfer of class of certificate to: Restricted certificate Effective: 06 Sep 2017
Terms and conditions imposed on certificate by member Effective: 06 Sep 2017

Practice Restrictions

Imposed By Effective Date Expiry Date Status  
member Effective: 06 Sep 2017 Active View Details [+]
            As  from  September  6, 2017, the following is imposed as a term, condition and
            limitation on the certificate  of  registration  held  by  Dr.  Nicholas Samuel
            Ciurria, in accordance with an undertaking and consent given by Dr.  Ciurria to
            the College of Physicians and Surgeons of Ontario:

                        UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
                                          ("Undertaking") 
                  
                                                of
                  
                                    DR. NICHOLAS SAMUEL CIURRIA
                                          ("Dr. Ciurria") 
                  
                                                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;
                  
                  "ICR  Committee" means the Inquiries, Complaints and Reports Committee of
                  the College.
                  
                  "Narcotic  Drugs"  means from the Narcotic Control Regulations made under
                  the
                  Controlled Drugs and Substances Act, S.C., 1996, c. 19, as amended.
                  
                  "Narcotic Preparations"  means from the Narcotic Control Regulations made
                  under the Controlled Drugs  and  Substances  Act,  S.C.,  1996, c. 19, as
                  amended.
                  
                  "Controlled  Drugs"  means  from  Part G of the Food and Drug Regulations
                  under the
                  Food and Drugs Act, S.C., 1985, c. F-27, as amended.
                  
                  "Benzodiazepines  and  Other  Targeted   Substances"   means   from   the
                  Benzodiazepines  and Other Targeted Substances Regulations made under the
                  Controlled Drugs and Substances Act., S.C., 1996, c. 19, as amended
                  
                        (A summary of  the  above-named  drugs  [from  Appendix  I  to  the
                        Compendium  of  Pharmaceuticals and Specialties] is attached hereto
                        as Schedule "A";  and  the  current  regulatory  lists are attached
                        hereto as Schedule "B")
                  
                  "All  other Monitored Drugs" means as defined under the Narcotics  Safety
                  and Awareness  Act,  2010,  S.O.  2010,  c.  22,  as amended, as noted in
                  Schedule "C".
                  
                  "NMS"  means  the Drug Program Services Branch, the Narcotics  Monitoring
                  System implemented  under  the  Narcotics Safety and Awareness Act, 2010,
                  S.O. 2010, c. 22, as amended;

                  "OHIP" means the Ontario Health Insurance Plan;
                  
                  "Public Register" means the College's  register  that is available to the
                  public.
                  
            (2)   I, Dr. Ciurria, certificate of registration number  29153, am a member of
                  the College.

            (3)   I,  Dr. Ciurria, acknowledge that the College received  information  from
                  the NMS  and  initiated an investigation bearing File Number 7215560 (the
                  "Investigation")  into  whether  I  failed  to  maintain  the standard of
                  practice  of  the  profession and/or am incompetent in my prescribing  of
                  controlled substances, including narcotics.

            B.    UNDERTAKING

            (4)   I, Dr. Ciurria, undertake  to abide by the provisions of this Undertaking
                  effective upon the date I sign it (the "Effective Date").

            (5)   I, Dr. Ciurria, shall keep a Log of all prescriptions for Narcotic Drugs,
                  Narcotic  Preparations,  Controlled   Drugs,  Benzodiazepines  and  Other
                  Targeted Substances and All other Monitored  Drugs,  in the form attached
                  as  set  out in Schedule "D", which will include at least  the  following
                  information (the "Prescribing Log"):

                  (i)   the date of the appointment;
                  (ii)  the name of the patient;
                  (iii) the  name  of the medication prescribed, dose, direction, number of
                        tablets to be dispensed and frequency;
                  (iv)  the clinical indication;
                  (v)   whether the  prescription  is for a new medication and/or different
                        dose or frequency than currently prescribed to the patient (Y/N);
                  (vi)  Dr. Ciurria's signature;
                  (vii) the date of the Clinical Supervisor's review (if applicable, as set
                        out below); and
                  (viii)the Clinical Supervisor's signature  (if  applicable,  as  set  out
                        below).
                  
            (6)   I, Dr. Ciurria, undertake to keep a copy of all prescriptions I write for
                  Narcotic  Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines
                  and Other Targeted  Substances  and  All  other  Monitored  Drugs, in the
                  corresponding patient chart.

            (7)   Clinical Supervision

                  (a)   I,  Dr.  Ciurria,  undertake  to practise under the guidance  of  a
                        clinical supervisor(s) acceptable  to  the  College  (the "Clinical
                        Supervisor(s)"), for a minimum of nine (9) months on the  terms set
                        out below (the "Clinical Supervision").

                  (b)   I,  Dr.  Ciurria,  acknowledge  and  undertake  that  each phase of
                        Clinical  Supervision  set  out  below  will  only be reduced  upon
                        recommendation of the Clinical Supervisor(s) and  approval  by  the
                        College.
                  
                  Phase 1 of Clinical Supervision ("Phase 1")
                  
                  (c)   I,  Dr.  Ciurria,  undertake  to  engage  in  Phase  1  of Clinical
                        Supervision  for a minimum of four (4) weeks on the terms  set  out
                        below.
                  
                  (d)   During Phase 1,  I, Dr. Ciurria, undertake to meet with my Clinical
                        Supervisor(s) at least  once  every  week  to  discuss the Clinical
                        Supervisor(s)'s review of:
                        i.    20  charts  for  patients to whom I have prescribed  Narcotic
                              Drugs,    Narcotic    Preparations,     Controlled     Drugs,
                              Benzodiazepines  and  Other Targeted Substances and All other
                              Monitored  Drugs  since the  Clinical  Supervisor(s)'s  prior
                              review, or if since the Clinical Supervisor(s)'s prior review
                              there are not 20 patients  listed  in  the Prescribing Log to
                              whom I have prescribed Narcotic Drugs, Narcotic Preparations,
                              Controlled   Drugs,   Benzodiazepines   and  Other   Targeted
                              Substances and All other Monitored Drugs , then the charts of
                              all patients listed in the Prescribing Log since the Clinical
                              Supervisor(s)'s prior review; and
                        ii.   At least 10 charts of patients to whom I have initiated a new
                              prescription for:
                              1.    Narcotic Drugs, or
                              2.    Narcotic Preparations; or
                              3.    Controlled  Drugs, Benzodiazepines and  Other  Targeted
                                    Substances and  All  other  Monitored  Drugs  where the
                                    patient  is  also  prescribed  a  Narcotic  Drug and/or
                                    Narcotic Preparation,
                              or  if since the Clinical Supervisor(s)'s prior review  there
                              are not  10  patients listed in the Prescribing Log to whom I
                              have  initiated   a  new  prescription  for  Narcotic  Drugs,
                              Narcotic Preparations  or  Controlled  Drugs, Benzodiazepines
                              and Other Targeted Substances and All other  Monitored  Drugs
                              where  the  patient is also prescribed a Narcotic Drug and/or
                              Narcotic Preparation,  then the charts of all patients listed
                              in  the Prescribing Log since  the  Clinical  Supervisor(s)'s
                              prior review.
                  
                  (e)   I, Dr. Ciurria,  acknowledge  that  during  Phase  1,  the Clinical
                        Supervisor(s) must sign and date the Prescribing Log to confirm the
                        charts  that the Clinical Supervisor(s) has reviewed and  discussed
                        with me.
                  
                  (f)   I, Dr. Ciurria,  acknowledge  that  during  Phase  1,  the Clinical
                        Supervisor(s)  will  provide a report to the College at least  once
                        every two (2) weeks.

                  (g)   I, Dr. Ciurria, acknowledge  that after a minimum of four (4) weeks
                        of Phase 1, if the Clinical Supervisor(s)  is satisfied that I have
                        the necessary knowledge, skills and judgment  to practice in a less
                        highly  supervised  environment,  the  Clinical  Supervisor(s)  may
                        recommend to the College that supervision be reduced.
                  
                  Phase 2 of Clinical Supervision ("Phase 2")
                  
                  (h)   Upon the recommendation of the Clinical Supervisor(s)  and approval
                        by the College, I, Dr. Ciurria, undertake to engage in Phase  2  of
                        Clinical  Supervision  for a minimum of two (2) months on the terms
                        set out below.
                  
                  (i)   During Phase 2, I, Dr. Ciurria,  undertake to meet with my Clinical
                        Supervisor(s) at least once every  two  (2)  weeks  to  discuss the
                        Clinical Supervisor(s)'s review of:
                        i.    15  charts  for  patients  to whom I have prescribed Narcotic
                              Drugs,    Narcotic    Preparations,     Controlled     Drugs,
                              Benzodiazepines  and  Other Targeted Substances and All other
                              Monitored  Drugs  since the  Clinical  Supervisor(s)'s  prior
                              review, or if since the Clinical Supervisor(s)'s prior review
                              there are not 15 patients  listed  in  the Prescribing Log to
                              whom I have prescribed Narcotic Drugs, Narcotic Preparations,
                              Controlled   Drugs,   Benzodiazepines   and  Other   Targeted
                              Substances and All other Monitored Drugs,  then the charts of
                              all patients listed in the Prescribing Log since the Clinical
                              Supervisor(s)'s prior review; and
                        ii.   At least 10 charts of patients to whom I have initiated a new
                              prescription for:
                              1.    Narcotic Drugs, or
                              2.    Narcotic Preparations; or
                              3.    Controlled  Drugs, Benzodiazepines and  Other  Targeted
                                    Substances and  All  other  Monitored  Drugs  where the
                                    patient  is  also  prescribed  a  Narcotic  Drug and/or
                                    Narcotic Preparation,
                              or  if since the Clinical Supervisor(s)'s prior review  there
                              are not  10  patients listed in the Prescribing Log to whom I
                              have  initiated   a  new  prescription  for  Narcotic  Drugs,
                              Narcotic Preparations  or  Controlled  Drugs, Benzodiazepines
                              and Other Targeted Substances and All other  Monitored  Drugs
                              where  the  patient is also prescribed a Narcotic Drug and/or
                              Narcotic Preparation,  then the charts of all patients listed
                              in  the Prescribing Log since  the  Clinical  Supervisor(s)'s
                              prior review.
                  
                  (j)   I, Dr. Ciurria,  acknowledge  that  during  Phase  2,  the Clinical
                        Supervisor(s) must sign and date the Prescribing Log to confirm the
                        charts  that the Clinical Supervisor(s) has reviewed and  discussed
                        with me.

                  (k)   I, Dr. Ciurria,  acknowledge  that  during  Phase  2,  the Clinical
                        Supervisor(s)  will  provide a report to the College at least  once
                        every two (2) weeks.
                  
                  (l)   I, Dr. Ciurria, acknowledge  that after a minimum of two (2) months
                        of Phase 2, if the Clinical Supervisor(s)  is satisfied that I have
                        the necessary knowledge, skills and judgment  to practice in a less
                        highly  supervised  environment,  the  Clinical  Supervisor(s)  may
                        recommend to the College that supervision be reduced.
                  
                  
                  Phase 3 of Clinical Supervision ("Phase 3")
                  
                  (m)   Upon the recommendation of the Clinical Supervisor(s)  and approval
                        by the College, I, Dr. Ciurria, undertake to engage in Phase  3  of
                        Clinical  Supervision  for a minimum of six (6) months on the terms
                        set out below.
                  
                  (n)   During Phase 3, I, Dr. Ciurria,  undertake to meet with my Clinical
                        Supervisor(s) at least once every  month  to  discuss  the Clinical
                        Supervisor(s)'s review of:
                        i.    15  charts  for  patients  to whom I have prescribed Narcotic
                              Drugs,    Narcotic    Preparations,     Controlled     Drugs,
                              Benzodiazepines  and  Other Targeted Substances and All other
                              Monitored  Drugs  since the  Clinical  Supervisor(s)'s  prior
                              review, or if since the Clinical Supervisor(s)'s prior review
                              there are not 15 patients  listed  in  the Prescribing Log to
                              whom I have prescribed Narcotic Drugs, Narcotic Preparations,
                              Controlled   Drugs,   Benzodiazepines   and  Other   Targeted
                              Substances and All other Monitored Drugs,  then the charts of
                              all patients listed in the Prescribing Log since the Clinical
                              Supervisor(s)'s prior review; and
                        ii.   At least 10 charts of patients to whom I have initiated a new
                              prescription for:
                              1.    Narcotic Drugs, or
                              2.    Narcotic Preparations; or
                              3.    Controlled  Drugs, Benzodiazepines and  Other  Targeted
                                    Substances and  All  other  Monitored  Drugs  where the
                                    patient  is  also  prescribed  a  Narcotic  Drug and/or
                                    Narcotic Preparation,
                              or  if since the Clinical Supervisor(s)'s prior review  there
                              are not  10  patients listed in the Prescribing Log to whom I
                              have  initiated   a  new  prescription  for  Narcotic  Drugs,
                              Narcotic Preparations  or  Controlled  Drugs, Benzodiazepines
                              and Other Targeted Substances and All other  Monitored  Drugs
                              where  the  patient is also prescribed a Narcotic Drug and/or
                              Narcotic Preparation,  then the charts of all patients listed
                              in  the Prescribing Log since  the  Clinical  Supervisor(s)'s
                              prior review.

                  (o)   I, Dr. Ciurria,  acknowledge  that  during  Phase  3,  the Clinical
                        Supervisor(s) must sign and date the Prescribing Log to confirm the
                        charts  that the Clinical Supervisor(s) has reviewed and  discussed
                        with me.
                  
                  (p)   I, Dr. Ciurria,  acknowledge  that  during  Phase  3,  the Clinical
                        Supervisor(s)  will  provide a report to the College at least  once
                        every month.
                  
                  (q)   I, Dr. Ciurria, acknowledge  that after a minimum of six (6) months
                        of Phase 3, if the Clinical Supervisor(s)  is satisfied that I have
                        the necessary knowledge, skills and judgment  to  practice  without
                        supervision,  the  Clinical  Supervisor(s)  may  recommend  to  the
                        College that the Clinical Supervision cease.
                  
                  (r)   I,  Dr.  Ciurria,  acknowledge  and  undertake  that  the  Clinical
                        Supervision  will  only  cease  upon recommendation of the Clinical
                        Supervisor(s) and approval by the College.
                  
                  (s)   I,  Dr. Ciurria, acknowledge that  I  have  reviewed  the  Clinical
                        Supervisor(s)'s  undertaking,  attached hereto as Schedule "E", and
                        understand  what  is  required of the  Clinical  Supervisor(s).  In
                        addition to what is set out above, the Clinical Supervisor(s) will,
                        at a minimum:
                  
                        (i)   Facilitate   the   education   program   set   out   in   the
                              Individualized Education  Plan  ("IEP")  attached as Schedule
                              "F";
                  
                        (ii)  Discuss any concerns with me arising from  chart  reviews and
                              observations;
                  
                        (iii) Make  recommendations  to  me  for practice improvements  and
                              ongoing  professional  development   and   inquire   into  my
                              compliance with the recommendations; and
                  
                        (iv)  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.
                  
                  (t)   I,  Dr.  Ciurria,  undertake  that  all  meetings  with my Clinical
                        Supervisor(s) will take place at my Practice Location,  or  another
                        Location approved by the College;
                  
                  (u)   I,  Dr.  Ciurria,  acknowledge  that  all  charts reviewed shall be
                        independently selected by the Clinical Supervisor(s)  based  on the
                        educational needs identified in the IEP set out at Schedule "F"  to
                        my  Undertaking,  as well as the areas of concern identified in the
                        report of the medical  inspector  dated  May 16, 2017, and concerns
                        that may arise during the period of Clinical Supervision.

                  (v)   I,  Dr.  Ciurria, undertake to cooperate fully  with  the  Clinical
                        Supervision  of  my  practice,  conducted  under  the terms of this
                        Undertaking  and  Schedule  "E"  attached,  and  to  abide  by  the
                        reasonable recommendations of my Clinical Supervisor(s),  including
                        but   not   limited   to,   any   reasonable  recommended  practice
                        improvements and ongoing professional development.
                  
                  (w)   I,  Dr. Ciurria, undertake to ensure  that  Schedule  "E"  to  this
                        Undertaking, is signed and delivered to the College within fourteen
                        (14) days of the Effective Date.
                  
                  (x)   I, Dr.  Ciurria,  undertake  that  if  a  person  who  has given an
                        undertaking  in  Schedule  "E"  to  this  Undertaking is unable  or
                        unwilling to continue to fulfill its provisions,  I  shall,  within
                        fourteen  (14) 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.
                  
                  (y)   I, Dr. Ciurria,  agree  that  if  I  am unable to obtain a Clinical
                        Supervisor  on  the  terms set out in sections  (7)(w)  and/or  (x)
                        above,   I  will  cease  prescribing   Narcotic   Drugs,   Narcotic
                        Preparations,  Controlled Drugs, Benzodiazepines and Other Targeted
                        Substances and All  other Monitored Drugs until such time as I have
                        obtained a Clinical Supervisor acceptable to the College.
                  
                  (z)   I, Dr. Ciurria, agree  that  if  I am required to cease prescribing
                        Narcotic   Drugs,   Narcotic   Preparations,    Controlled   Drugs,
                        Benzodiazepines  and  Other  Targeted  Substances  and   All  other
                        Monitored  Drugs  as  a  result  of  section (7)(y) 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.
                  
            (8)   Professional Education

                  (a)   In  the  course  of  this  investigation,  I,  Dr.  C., voluntarily
                        enrolled  in the University of Toronto Faculty of Medicine  program
                        in  Safe Opioid  Prescribing  (all  three  webinars  and  in-person
                        workshop): www.cepd.utoronto.ca/opioidprescribing.
                  
                  (b)   I, Dr.  Ciurria,  undertake  to  participate  in  and  successfully
                        complete  all  elements  of  the  detailed IEP, attached hereto  as
                        Schedule "F", including but not limited  to, the following elements
                        of professional education (the "Professional Education"):
                  
                        (i)   University  of Toronto Faculty of Medicine  program  in  Safe
                              Opioid  Prescribing   (all   three   webinars  and  in-person
                              workshop): www.cepd.utoronto.ca/opioidprescribing;

                        (ii)  Review  and  discuss  with  my  Clinical  Supervisor(s)   the
                              following resources:
                  
                              1.CPSO          Policy          "Prescribing          Drugs":
                              http://www.cpso.on.ca/Policies-
                              Publications/Policy/Prescribing-Drugs;
                  
                              2.2017 Canadian Guideline for Opioids  for Chronic Non-Cancer
                              Pain: http://nationalpaincentre.mcmaster.ca/guidelines.html;
                  
                              3.CMPA  advice  regarding  preventing the misuse  of  opioids
                              https://www.cmpa-acpm.ca/en/advice-publications/browse-
                              articles/2015/preventing-the-misuse-of-opioids;
                  
                              4.the  Centre  for  Effective  Practice Management of Chronic
                              Non-
                              Cancer Pain Tool https://thewellhealth.ca/cncp
                  
                        (iii) Review and discuss with my Clinical  Supervisor(s)  the  CPSO
                              Policy "Medical Records": http://www.cpso.on.ca/Policies-
                              Publications/Policy/Medical-Records; and
                  
                        (iv)  any  additional  professional  education  recommended  by  my
                              Clinical Supervisor(s).
                  
                  (c)   I,  Dr.  Ciurria,  undertake  to provide proof to the College of my
                        successful completion of each element of the Professional Education
                        specified above, including proof  of  registration,  attendance and
                        participant  assessment  reports  where available, within  one  (1)
                        month of completion of each element. I acknowledge that the College
                        will determine, in its sole discretion, whether I have successfully
                        completed each element of the Professional Education.
                  
                  (d)   I,  Dr.  Ciurria,  acknowledge that a  report  or  reports  may  be
                        provided to the College  regarding  my progress and compliance with
                        the Professional Education.
                  
            (9)   Reassessment of Practice

                  (a)   I, Dr. Ciurria, undertake that, approximately  six (6) months after
                        the Clinical Supervision set out under section 7 of the Undertaking
                        has ceased, I will submit to a reassessment of my  practice  by  an
                        assessor or assessors selected by the College (the "Reassessment").
                  
                  (b)   I,  Dr.  Ciurria,  acknowledge  and agree that the Reassessment may
                        include a chart review, direct observation of my care, an interview
                        of me, interviews with colleagues  and  co-workers,  feedback  from
                        patients and any other tools deemed necessary by the College.

                  (c)   I, Dr. Ciurria, undertake to co-operate fully with the Reassessment
                        conducted under the terms of this Undertaking
                  
                  (d)   I,   Dr.   Ciurria,   acknowledge   and   agree  that  my  Clinical
                        Supervisor(s)   may  receive  and  review  the  findings   of   the
                        Assessor(s), and  may  discuss  with  the Assessor(s) any issues or
                        concerns arising from the Reassessment.
                  
                  (e)   I, Dr. Ciurria, acknowledge that the results  of  the  Reassessment
                        will  be  provided  to me and reported to the College and that  the
                        Reassessment may form the basis of further action by the College.
                  
            (10)  Monitoring

                  (a)   I, Dr. Ciurria, undertake  to  inform the College of each and every
                        Location at which 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 ten
                        (10) business days of executing   this  Undertaking. Going forward,
                        I  further  undertake to inform the College  of  any  and  all  new
                        Practice Locations  within  ten  (10)  business  days of commencing
                        practice at that Location.
                  
                  (b)   I, Dr. Ciurria, undertake and agree that I will submit  to, and not
                        interfere  with, unannounced inspections of my Practice Location(s)
                        and patient records by a College representative for the purposes of
                        monitoring my compliance with the provisions of this Undertaking.
                  
                  (c)   I, Dr. Ciurria,  give my irrevocable consent to the College to make
                        appropriate  enquiries   of   the  Ontario  Health  Insurance  Plan
                        ("OHIP"),  the  Drug  Program  Services   Branch,   the   Narcotics
                        Monitoring  System  ("NMS")  implemented under the Narcotics Safety
                        and Awareness Act, 2010 and/or  any  person  or institution who may
                        have relevant information, in order for the College  to  monitor my
                        compliance with the provisions of this Undertaking.
                  
                  (d)   I, Dr. Ciurria, acknowledge that I have executed the OHIP  and  NMS
                        consent  form(s), attached hereto as Schedule "G" and Schedule "H",
                        respectively.
                  
            C.    ACKNOWLEDGEMENT

            (11)  I, Dr. Ciurria, acknowledge that all schedules attached to or referred to
                  in this Undertaking form part of this Undertaking.

            (12)  I, Dr. Ciurria,  acknowledge  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.

            (13)  I, Dr. Ciurria, acknowledge  and  confirm 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.

            (14)  I,  Dr.  Ciurria,  acknowledge  that  the  College   will   provide  this
                  Undertaking   to  any  Chief  of  Staff,  or  a  colleague  with  similar
                  responsibilities, at any Practice Location ("Chief(s) of Staff").

            (15)  I, Dr. Ciurria,  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 of the College.

            (16)  I, Dr. Ciurria, acknowledge  that  this  entire  Undertaking  constitutes
                  terms, conditions, and limitations on my certificate of registration  for
                  the purposes of section 23 of the Code.

            (17)  Public Register

                  (a)   I,  Dr. Ciurria, acknowledge that, during the time period that this
                        Undertaking  remains in effect, this Undertaking shall be posted on
                        the Public Register.
                  
                  (b)   I, Dr. Ciurria,  acknowledge  that, in addition to this Undertaking
                        being posted in accordance with  the  section  above, the following
                        summary  shall  be  posted on the Public Register during  the  time
                        period that this Undertaking remains in effect:
                  
                        The College received  information  from  the  Narcotics  Monitoring
                        System  about  Dr.  Ciurria's prescribing of controlled substances,
                        including narcotics.
                  
                        Based  on  the  information  received,  the  College  conducted  an
                        investigation into  whether  Dr.  Ciurria  failed  to  maintain the
                        standard  of  practice of the profession and/or was incompetent  in
                        his prescribing  of controlled substances, including narcotics.  As
                        a result of the investigation:
                  
                        *     Dr.  Ciurria's   prescribing   of  narcotic  drugs,  narcotic
                              preparations,  controlled drugs,  benzodiazepines  and  other
                              targeted  substances,  and  other  monitored  drugs  will  be
                              supervised by a Clinical Supervisor acceptable to the College
                              for minimum of nine (9) months.
                  
                        *     Dr. Ciurria  will  engage  in  professional  education in the
                              prescribing of controlled substances, including narcotics.

                        *     Following   the   professional   education   and  period   of
                              supervision,   Dr.   Ciurria's   prescribing   of  controlled
                              substances,  including narcotics, will be re-assessed  by  an
                              assessor selected by the College.
                  
            D.    CONSENT

            (18)  I, Dr. Ciurria, 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.
                  
            (19)  I, Dr. Ciurria, 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.

            (20)  I, Dr. Ciurria, give my irrevocable consent to any person who facilitates
                  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 information:
                  (a)   relevant to this Undertaking;
                  
                  (b)   relevant to the provisions of the Clinical Supervisor's undertaking
                        set out at Schedule "E";
                  
                  (c)   relevant to the Reassessment;
                  
                  (d)   relevant for the  purposes  of  monitoring  my compliance with this
                        Undertaking; and/or
                  
                  (e)   which comes to his or her attention in the course  of providing the
                        Professional  Education  and  which  he or she reasonably  believes
                        indicates a potential risk of harm to my patients.

Concerns

Source: Member
Active Date: September 6, 2017
Expiry Date:
Summary:
Summary of the Undertaking given by Dr. Nicholas Samuel Ciurria to the College of Physicians and Surgeons of Ontario, effective September 6, 2017:

The College received information from the Narcotics Monitoring System about Dr. Ciurria’s prescribing of controlled substances, including narcotics.

Based on the information received, the College conducted an investigation into whether Dr. Ciurria failed to maintain the standard of practice of the profession and/or was incompetent in his prescribing of controlled substances, including narcotics. As a result of the investigation:

- Dr. Ciurria’s prescribing of narcotic drugs, narcotic preparations, controlled drugs, benzodiazepines and other targeted substances, and other monitored drugs will be supervised by a Clinical Supervisor acceptable to the College for minimum of nine (9) months.

- Dr. Ciurria will engage in professional education in the prescribing of controlled substances, including narcotics.