1 of 2
As from February 1st, 2023, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Laferriere in accordance with an undertaking and consent given by Dr. Laferriere to the College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")
of
DR. JOSEPH RAYMOND GILLES ARTHUR LAFERRIERE
("Dr. Laferriere")
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. Laferriere, certificate of registration number 33396, am a member of the College.
(3) I, Dr. Laferriere, acknowledge that the College conducted an investigation bearing File Number CAS-367541-X6G7P8 (the "Investigation") into my general medicine practice.
B. UNDERTAKING
(4) I, Dr. Laferriere, undertake to abide by the provisions of this Undertaking, effective immediately.
(5) Practice Restrictions
(a) I, Dr. Laferriere, undertake to restrict my practice as follows:
(i) I will not provide medical exemptions in relation to vaccines for COVID-19;
(ii) I will not provide medical exemptions in relation to mask requirements for COVID-19;
(iii) I will not provide medical exemptions in relation to diagnostic testing for COVID-19;
(iv) I will not prescribe colchicine or hydroxychloroquine in relation to COVID-19; and
(v) I will not prescribe ivermectin.
(6) Posting a Sign
(a) I, Dr. Laferriere, 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. For further clarity, this sign shall state as follows: "Dr. Laferriere must not provide medical exemptions in relation to vaccines, mask requirements or diagnostic testing for COVID-19. Dr. Laferriere must not prescribe colchicine or hydroxychloroquine in relation to COVID-19. Dr. Laferriere must not prescribe ivermectin. Further information may be found on the College of Physicians and Surgeons of Ontario website at www.cpso.on.ca".
(b) I, Dr. Laferriere, undertake to post a certified translation in any language in which I provide services, of the sign described in section (6)(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. Laferriere, undertake to provide the certified translation described in section (6)(b), to the College within thirty (30) days of executing this Undertaking.
(d) I, Dr. Laferriere, 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. Laferriere, undertake to provide to the College the certified translation described in section (6)(b) prior to beginning to provide services in any language described in section (6)(d).
(7) Monitoring
(a) I, Dr. Laferriere, 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. Laferriere, 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.
(c) I, Dr. Laferriere, acknowledge that I have executed the OHIP consent form, attached hereto as Appendix "B".
(d) I, Dr. Laferriere, 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. ACKNOWLEDGEMENT
(8) I, Dr. Laferriere, acknowledge that all appendices attached to or referred to in this Undertaking form part of this Undertaking.
(9) I, Dr. Laferriere, 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.
(10) I, Dr. Laferriere, 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.
(11) I, Dr. Laferriere, 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").
(12) I, Dr. Laferriere, 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.
(13) I, Dr. Laferriere, acknowledge that this Undertaking constitutes terms, conditions, and limitations on my certificate of registration for the purposes of section 23 of the Code.
(14) Public Register
(a) I, Dr. Laferriere, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.
(b) I, Dr. Laferriere, acknowledge that, in addition to this Undertaking being posted in accordance with section (14)(a) above, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:
A College investigation was conducted into Dr. Laferriere's general medicine practice. As a result of the investigation:
Dr. Laferriere will not provide medical exemptions in relation to vaccines for COVID-19;
Dr. Laferriere will not provide medical exemptions in relation to mask requirements for COVID-19;
Dr. Laferriere will not provide medical exemptions in relation to diagnostic testing for COVID-19;
Dr. Laferriere will not prescribe colchicine or hydroxychloroquine in relation to COVID-19; and
Dr. Laferriere will not prescribe ivermectin.
D. CONSENT
(15) I, Dr. Laferriere, 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.
2 of 2
As from September 30, 2019, the following is imposed as terms, conditions and
limitations on the certificate of registration held by Dr. Joseph Raymond
Gilles Arthur Laferriere in accordance with an undertaking and consent given by
Dr. Laferriere to the College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")
of
DR. JOSEPH RAYMOND GILLES ARTHUR LAFERRIERE
("Dr. Laferriere")
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
links to the current regulatory lists are attached hereto as Schedule
"B")
"Monitored Drugs" means as defined under the Narcotics Safety and
Awareness Act, 2010, S.O. 2010, c. 22, as amended, with a link to the
current regulatory list attached hereto at 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. Laferriere, certificate of registration number 33396, am a member
of the College.
(3) I, Dr. Laferriere, acknowledge that I entered into an Undertaking with
the College on November 27, 1995 (the "1995 Undertaking"). Once signed,
this Undertaking replaces the 1995 Undertaking and the 1995 Undertaking
is no longer in effect.
B. UNDERTAKING
(4) I, Dr. Laferriere, undertake to abide by the provisions of this
Undertaking effective immediately (the "Effective Date").
Practice Restrictions
(5) I, Dr. Laferriere, undertake that I will not issue new prescriptions or
renew existing prescriptions for or administer Narcotic Drugs, Narcotic
Preparations, Controlled Drugs, Benzodiazepines and Other Targeted
Substances, or Monitored Drugs, subject to the following exceptions:
(a) I, Dr. Laferriere, may prescribe Narcotic Drugs, Narcotic
Preparations, Controlled Drugs, Benzodiazepines and Other Targeted
Substances, or Monitored Drugs to patients residing in a
rehabilitation or long-term care facility; and
(b) I, Dr. Laferriere, may prescribe up to a one month supply of
Narcotic Drugs, Narcotic Preparations, Controlled Drugs,
Benzodiazepines and Other Targeted Substances, or Monitored Drugs
to patients being released from a rehabilitation or long-term care
facility.
(6) Until such time as the Reassessment set out at section 10 of this
Undertaking is deemed to be completed by the College, I, Dr. Laferriere,
shall keep a Log of all prescriptions for Narcotic Drugs, Narcotic
Preparations, Controlled Drugs, Benzodiazepines and Other Targeted
Substances and 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 and chart/file number;
(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. Laferriere'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).
(7) I, Dr. Laferriere, undertake to keep a copy of all prescriptions I write
for Narcotic Drugs, Narcotic Preparations, Controlled Drugs,
Benzodiazepines and Other Targeted Substances and Monitored Drugs, in the
corresponding patient chart.
(8) Clinical Supervision
(a) I, Dr. Laferriere, undertake to practise under the guidance of a
clinical supervisor or clinical supervisors acceptable to the
College (the "Clinical Supervisor" or "Clinical Supervisors"), for
three (3) months ("Clinical Supervision").
(b) I, Dr. Laferriere, acknowledge that I have reviewed the Clinical
Supervisor's undertaking, attached hereto as Schedule "E", 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
Schedule "F";
ii. Review the materials provided by the College and have an
initial meeting to discuss the objectives for the Clinical
Supervision and practice improvement recommendations;
iii. Meet with me at my Practice Location, or another location
approved by the College, once every month;
iv. Review at least fifteen (15) of my patient charts at every
meeting to whom I have prescribed Narcotic Drugs, Narcotic
Preparations, Controlled Drugs, Benzodiazepines and Other
Targeted Substances and 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 Monitored
Drugs, then the charts of all patients listed in the
Prescribing Log since the Clinical Supervisor's prior review;
v. Sign and date the Prescribing Log to confirm the charts that
the Clinical Supervisor(s) has reviewed and discussed with
me;
vi. Discuss any concerns arising from the chart reviews;
vii. Make recommendations to me for practice improvements and
ongoing professional development and inquire into my
compliance with the recommendations;
viii. 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
ix. Submit one written report to the College upon completion of
the Clinical Supervision, or more frequently if the Clinical
Supervisor has concerns about my standard of practice.
(c) I, Dr. Laferriere, acknowledge that the charts reviewed shall be
selected by the Clinical Supervisor based on the educational needs
identified in the IEP and concerns that may arise during the period
of Clinical Supervision.
(d) I, Dr. Laferriere, 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 recommended practice improvements and
ongoing professional development.
(e) I, Dr. Laferriere, undertake to ensure that Schedule "E" to this
Undertaking, is signed and delivered to the College within thirty
(30) days of the Effective Date.
(f) I, Dr. Laferriere, 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
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. Laferriere, undertake that if I am unable to obtain a
Clinical Supervisor on the provisions set out under sections (e)
and/or (f) above, I will cease prescribing Narcotic Drugs, Narcotic
Preparations, Controlled Drugs, Benzodiazepines and Other Targeted
Substances and Monitored Drugs until such time as I have obtained a
Clinical Supervisor acceptable to the College.
(h) I, Dr. Laferriere, acknowledge that if I am required to cease
prescribing Narcotic Drugs, Narcotic Preparations, Controlled
Drugs, Benzodiazepines and Other Targeted Substances and Monitored
Drugs as a result of section (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) Professional Education
(a) I, Dr. Laferriere, 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 Safer
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;
and
2. 2017 Canadian Guideline for Opioids for Chronic
Non-Cancer Pain:
http://nationalpaincentre.mcmaster.ca/guidelines.html;
and
(iii) any additional professional education recommended by my
Clinical Supervisor(s).
(b) I, Dr. Laferriere, 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.
(c) I, Dr. Laferriere, undertake to complete the Professional Education
within three (3) months of the Effective Date or, if no
satisfactory program is available by that time, by the first
possible opportunity thereafter.
(d) I, Dr. Laferriere, acknowledge that a report or reports may be
provided to the College regarding my progress and compliance with
the Professional Education.
(10) Reassessment of Practice
(a) I, Dr. Laferriere, undertake that, approximately three (3) months
after the completion of the Clinical Supervision set out in section
8 above, I will submit to a reassessment of my prescribing of
Narcotic Drugs, Narcotic Preparations, Controlled Drugs,
Benzodiazepines and other targeted substances, or Monitored Drugs
("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, direct observation of my
care, interviews with colleagues and co-workers, feedback from
patients and any other tools deemed necessary by the College.
(b) I, Dr. Laferriere, undertake to co-operate fully with the
Reassessment, conducted under the term of this Undertaking.
(c) I, Dr. Laferriere, 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. Laferriere, 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.
(11) Monitoring
(a) I, Dr. Laferriere, undertake to inform the College of each and
every location at which I practise or have privileges, including,
but not limited to, any hospitals, clinics, offices, and any
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. Laferriere, 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. Laferriere, give my irrevocable consent to the College to
make appropriate enquiries of OHIP, NMS 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. Laferriere, acknowledge that I have executed the OHIP and
NMS consent form(s), attached hereto as Schedule "G" and Schedule
"H", respectively.
C. ACKNOWLEDGEMENT
(12) I, Dr. Laferriere, acknowledge that all schedules attached to or referred
to in this Undertaking form part of this Undertaking.
(13) I, Dr. Laferriere, 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.
(14) I, Dr. Laferriere, 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.
(15) I, Dr. Laferriere, 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").
(16) I, Dr. Laferriere, 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.
(17) I, Dr. Laferriere, acknowledge that this entire 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. Laferriere, acknowledge that, during the time period that
this Undertaking remains in effect, this Undertaking shall be
posted on the Public Register.
(b) I, Dr. Laferriere, acknowledge that, in addition to this
Undertaking being posted in accordance with section (a) above, the
following summary shall be posted on the Public Register during the
time period that this Undertaking remains in effect:
Dr. Laferriere must not issue new prescriptions or renew
existing prescriptions for or administer Narcotic Drugs,
Narcotic Preparations, Controlled Drugs, Benzodiazepines and
Other Targeted Substances, or Monitored Drugs, subject to the
following exceptions:
Dr. Laferriere may prescribe Narcotic Drugs, Narcotic
Preparations, Controlled Drugs, Benzodiazepines and
Other Targeted Substances, or Monitored Drugs to
patients residing in a rehabilitation or long-term care
facility; and
Dr. Laferriere may prescribe up to a one month supply
of Narcotic Drugs, Narcotic Preparations, Controlled
Drugs, Benzodiazepines and Other Targeted Substances,
or Monitored Drugs to patients being released from a
rehabilitation or long-term care facility.
D. CONSENT
(19) I, Dr. Laferriere, 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.
(20) I, Dr. Laferriere, 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.
(21) I, Dr. Laferriere, 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.