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Martinez, Lionel Gines

CPSO#: 70956

MEMBER STATUS
Active Member as of 12 May 2021
CURRENT OR PAST CPSO REGISTRATION CLASS
Restricted as of 13 Jul 2009

Summary

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Former Name: No Former Name

Gender: Male

Languages Spoken: English, French

Education: University of Toronto, 1996

Practice Information

Primary Location of Practice
880 Browns Line
Alderwood Medical Centre
Etobicoke ON  M8W 3W2 Electoral District: 10

Additional Practice Location(s)

2549 Weston Rd
York ON  M9N 2A7
Canada
Phone: 416-240-8282
County: Regional Municipality of Haldimand-Norfolk
Electoral District: 04

Professional Corporation Information


Corporation Name: Dr. Lionel Martinez Medicine Professional Corporation
Certificate of Authorization Status: Inactive: Oct 15 2010
Corporation Name: Dr. Lionel Martinez Medicine Professional Corporation
Certificate of Authorization Status: Inactive: Feb 2 2017

Specialties

Specialty Issued On Type
No Speciality Reported

Postgraduate Training

Please note: This information may not be a complete record of postgraduate training.



McMaster University, 01 Jul 1996 to 30 Jun 1997
PostGrad Yr 1 - Family Medicine

McMaster University, 01 Jul 1997 to 31 Dec 1997
PostGrad Yr 1 - Family Medicine

McMaster University, 01 Jan 1998 to 30 Jun 1998
PostGrad Yr 2 - Family Medicine

McMaster University, 01 Jul 1998 to 30 Jun 1999
PostGrad Yr 2 - Family Medicine

McMaster University, 01 Jul 1999 to 30 Nov 1999
PostGrad Yr 3 - Family Medicine

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 10 Jan 1997
Transfer of class of registration to: Independent Practice Certificate Effective: 22 Jul 1999
Transfer of class of certificate to: Restricted certificate Effective: 13 Jul 2009
Terms and conditions imposed on certificate by member Effective: 13 Jul 2009
Terms and conditions amended by member Effective: 30 Aug 2010
Terms and conditions amended by Inquiries, Complaints and Reports Committee Effective: 15 Jun 2011
Terms and conditions amended by Discipline Committee Effective: 11 May 2020
Suspension of registration imposed: Discipline Committee Effective: 12 May 2020
Suspension of registration removed Effective: 12 May 2021
Terms and conditions amended by member Effective: 22 Aug 2023

Practice Restrictions

Imposed By Effective Date Expiry Date Status
member Effective: 22 Aug 2023 Active
 (1 of 2)

As from August 22, 2023, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Lionel Gines Martinez in accordance with an undertaking and consent given by Dr. Martinez to the College of Physicians and Surgeons of Ontario:

 UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT 
("Undertaking")

of

DR. LIONEL GINES MARTINEZ
("Dr. Martinez")

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. Martinez, certificate of registration number 70956, am a member of the College.  

(3)	I, Dr. Martinez, acknowledge that following a finding of the Discipline Tribunal, I underwent remediation and submitted to a reassessment of my practice. The reassessment report subsequently received by the College raised concerns about my standard of practice in family medicine.

B.	UNDERTAKING

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

(5)	Clinical Supervision 

(a)	I, Dr. Martinez, undertake to practise under the guidance of a clinical supervisor or clinical supervisors acceptable to the College (the "Clinical Supervisor" or "Clinical Supervisors"), for at least six (6) months ("Clinical Supervision"). 

(b)	I, Dr. Martinez, undertake to remain free of any conflict of interest with the Clinical Supervisor.

(c)	I, Dr. Martinez, acknowledge that I have reviewed the Clinical Supervisor's undertaking, attached hereto as Appendix "A", 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 Appendix "B";

(ii)	Review the materials provided by the College and have an orientation session with me, including to discuss the objectives for the Clinical Supervision;

(iii)	Meet with me at my Practice Location, or another location approved by the College, once every two (2) weeks for a minimum of three (3) months;

(iv)	After a minimum of three (3) months of Clinical Supervision, if my Clinical Supervisor recommends and the College approves a reduction in the level of supervision, my Clinical Supervisor will meet with me at my Practice Location, or another location approved by the College, once every month for a further three (3) months;

(v)	Directly observe one half-day of patient encounters, during each of the first two (2) Clinical Supervision meetings;

(vi)	Review at least fifteen (15) of my patient charts at every meeting;

(vii)	Review and discuss my Continuing Professional Development activities with me;

(viii)	Discuss any concerns arising from the chart reviews or direct observation;

(ix)	Make recommendations to me for practice improvements and ongoing professional development and inquire into my compliance with the recommendations; 

(x)	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;

(xi)	Submit written reports to the College at least once every month for three (3) months or until the College approves a reduction in the level of supervision, and then once at the end of supervision, or more frequently if the Clinical Supervisor has concerns about my standard of practice; and

(xii)	Remain free of any conflict of interest with me.

(d)	I, Dr. Martinez, acknowledge that the charts reviewed shall be selected by the Clinical Supervisor based on the educational needs identified in the IEP, attached hereto as Appendix "B", as well as the areas of concern identified in the report of the assessor dated March 17, 2023, and concerns that may arise during the period of Clinical Supervision.

(e)	I, Dr. Martinez, undertake to cooperate fully with the Clinical Supervision of my practice, conducted under the term of this Undertaking and Appendix "A" to this Undertaking, and to abide by the recommendations of my Clinical Supervisor, including but not limited to, any recommended practice improvements and ongoing professional development.

(f)	I, Dr. Martinez, 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.

(g)	I, Dr. Martinez, 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.

(h)	I, Dr. Martinez, undertake that if I am unable to obtain a Clinical Supervisor on the provisions set out under sections (5)(f) and/or (g) above, I will cease practising medicine until such time as I have obtained a Clinical Supervisor acceptable to the College.  

(i)	I, Dr. Martinez, acknowledge that if I am required to cease practise as a result of section (5)(h) 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.

(6)	Professional Education  

(a)	I, Dr. Martinez, undertake to participate in and successfully complete all aspects of the detailed IEP, attached hereto as Appendix "B", including all of the following professional education (the "Professional Education"):

(i)	Enrollment and participation in the College of Family Physicians of Canada's Mainpro+ program; 

(ii)	Enrollment and participation in the Small Group Practice Based Learning Program (PBLP), Foundation for Medical Practice Education;

(iii)	Medical Record Keeping Seminar, Centre for Personalized Education for Professionals;

(iv)	Personalized Implementation Program (PIP), Center for Personalized Education for Professionals;

(v)	Review, reflection, and a discussion with my Clinical Supervisor of the following policies and other self-study:            

1.	Diabetes Canada Clinical Practice Guidelines, Diabetes Canada;

2.	Type 2 Diabetes, The Centre for Effective Practice;

3.	Choosing Wisely Canada: Family Medicine, Choosing Wisely Canada;

4.	Anti-Infective Guidelines for Community-acquired Infections, MUMS Health;

5.	Health Check-ups, Choosing Wisely Canada;

6.	Managing Tests, CPSO policy;

7.	Neck Pain and Headache, The Centre for Effective Practice;

8.	Manual Therapy for MSK Pain, The Centre for Effective Practice;

9.	Low Back Pain, The Centre for Effective Practice;

10.	Medical Records Documentation, CPSO Policy; and, 

(vi)	any additional professional education recommended by my Clinical Supervisor.

(b)	I, Dr. Martinez, undertake to provide proof to the College of my successful completion of the Professional Education, including proof of registration and attendance and participant assessment reports, within one (1) month of completing it. I acknowledge that the College will determine, in its sole discretion, whether I have successfully completed the Professional Education.

(c)	I, Dr. Martinez, undertake to complete this requirement within three (3) months or, if no satisfactory program is available by that time, by the first possible opportunity thereafter.

(d)	I, Dr. Martinez, acknowledge that a report or reports may be provided to the College regarding my progress and compliance with the Professional Education.

(e)	I, Dr. Martinez, acknowledge that if any of the programs listed above become unavailable, substitution requests will be reviewed by the College and the College will determine in its sole discretion whether substitution is appropriate.

(7)	Reassessment of Practice

(a)	I, Dr. Martinez, undertake that, approximately four (4) months after the completion of the Clinical Supervision set out in section (5) above and Appendix "A" to this Undertaking, and the completion of the Professional Education set out in section (6) above, I will submit to a reassessment of my practice ("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 of a minimum of fifteen (15) charts, direct observation of my care, interviews with me, colleagues and co-workers, feedback from patients, and any other tools deemed necessary by the College.

(b)	I, Dr. Martinez, undertake to co-operate fully with the Reassessment, conducted under the term of this Undertaking. 

(c)	I, Dr. Martinez, 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. Martinez, 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. 

(8)	Monitoring 

(a)	I, Dr. Martinez, 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 or 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. Martinez, 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. Martinez, 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. 

(d)	I, Dr. Martinez, acknowledge that I have executed the OHIP consent form, attached hereto as Appendix "C". 

C.	ACKNOWLEDGEMENT

(9)	I, Dr. Martinez, acknowledge that all appendices attached to or referred to in this Undertaking form part of this Undertaking.

(10)	I, Dr. Martinez, 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. 

(11)	I, Dr. Martinez, 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.

(12)	I, Dr. Martinez, 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").

(13)	I, Dr. Martinez, 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 of the College.

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

(15)	Public Register

(a)	I, Dr. Martinez, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.

(b)	I, Dr. Martinez, acknowledge that, in addition to this Undertaking being posted in accordance with section (15)(a) above, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:

Following a finding by the Discipline Tribunal, Dr. Martinez underwent remediation and submitted to a reassessment of his practice. The reassessment report subsequently received by the College raised concerns about his standard of practice in family medicine. As a result:

Dr. Martinez will practise under the guidance of a Clinical Supervisor acceptable to the College for 6 months. 

Dr. Martinez will engage in professional education including in topics in primary care, clinical reasoning and medical record keeping.

Dr. Martinez's practice will be reassessed by an assessor selected by the College within 4 months of the end of the period of Clinical Supervision and professional education.

(c)	I, Dr. Martinez, acknowledge that this Undertaking remains in effect until the College determines its terms are satisfied.

D.	CONSENT

(16)	I, Dr. Martinez, 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.

(17)	I, Dr. Martinez, 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.

(18)	I, Dr. Martinez, give my irrevocable consent to any persons who facilitate 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 of the following:

(a)	any information relevant to this Undertaking;

(b)	any information relevant to the provisions of the Clinical Supervisor's undertaking set out at Appendix "A" to this Undertaking;

(c)	any information relevant to the Reassessment;

(d)	any information relevant for the purposes of monitoring my compliance with this Undertaking; and/or  

(e)	any information which comes to their attention in the course of providing the Professional Education and which they reasonably believe indicates a potential risk of harm to my patients.

(2 of 2)

As from July 13, 2009, the following is imposed as a term, condition and limitation on the certificate of registration held by Dr. Lionel Gines Martinez, in accordance with an undertaking and consent given by Dr. Martinez to the College of Physicians and Surgeons of Ontario:

I, Dr. Lionel Gines Martinez, have voluntarily relinquished my prescribing privileges with respect to the following drugs, substances and preparations set out in Schedules I through IV of the Controlled Drugs and Substances Act, S.C. 1996, c. 19, as amended, and related regulations (the "Act"), and summarized as follows:
                  
Drug/Substance    Relinquished             Not Relinquished
                  
Narcotic Drugs          Yes
                  
Narcotic Preparations         Yes
                  
Controlled Drugs                                 No
                  
Benzodiazepines/Other
Targeted Substances                              No


Previous Hearings

Committee: Discipline
Decision Date: 11 May 2020
Summary:

On May 11, 2020, on the basis of an Agreed Statement of Facts on Liability and Admission, and a Statement of Uncontested Facts and Plea of No Contest, the Discipline Committee of the College of Physicians and Surgeons of Ontario (“the College”) found that Dr. Lionel Gines Martinez (“Dr. Martinez”) committed an act of professional misconduct, in that in that he failed to maintain the standard of practice of the profession, and engaged in an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.

BACKGROUND

The facts set out in the Agreed Statement of Facts and Admission included the following:

Dr. Martinez is a 58-year-old family physician who received his certificate of registration authorizing independent practice from the College on July 22, 1999. At the relevant times, Dr. Martinez practised at A+ Medical Clinic in Toronto, Ontario.

Reassessment Pursuant to 2014 Undertaking

In 2014, Dr. Martinez entered into an undertaking with the College that required him to complete a period of supervision with respect to his medical record-keeping and undergo a reassessment of his practice.

Pursuant to the terms of the 2014 Undertaking, after the supervision of Dr. Martinez’s practice was complete, the College conducted a reassessment of Dr. Martinez’s practice with a focus on his medical record keeping. The College retained Dr. Brian Silver, an experienced family physician, to conduct the reassessment. Dr. Silver provided a reassessment report to the College, dated May 4, 2017. In his report, Dr. Silver opined that Dr. Martinez failed to maintain the standard of practice of the profession in his record keeping in 17 out of 20 charts reviewed. Dr. Silver’s primary concerns were legibility, organization and completeness of Dr. Martinez’s chart entries and Cumulative Patient Profiles. Dr. Silver also opined that Dr. Martinez displayed a lack of knowledge, skill, and judgment by prescribing a high-dosage steroid ointment to a patient to treat breast intertrigo (an inflammatory skin condition), and by failing to document vital statistics, such as height and weight, for his diabetic patient.

In his response to Dr. Silver’s reassessment report, Dr. Martinez advised that he had decided to engage in further remedial steps regarding his recordkeeping, as well as management of skin conditions. He also advised that he left his previous practice location and had also moved to an electronic medical record system (“EMR”) to address issues of legibility. Dr. Martinez provided examples of more recent electronic chart entries from his practice for Dr. Silver to review.

Dr. Silver provided an addendum report stating that Dr. Martinez’s response did not change his opinion with respect to whether Dr. Martinez maintained the standard of practice of the profession in the charts previously reviewed. Dr. Silver commented that the more recent sample medical records showed improvement over the earlier charts, but noted typographical errors and omissions in five charts.

Time-Based Billing Codes

On March 23, 2015, the College received information from the National Investigative Unit of Medavie Blue Cross, the provider that administers the Interim Federal Health Program (the “IFHP”) on behalf of the Canadian government. The IFHP provides limited, temporary health coverage for certain groups, including refugees and refugee claimants in Canada. Ontario physicians submit billing claims to the IFHP based on fee codes set out in the Ontario Health Insurance Plan (“OHIP”) Schedule of Benefits.

Medavie Blue Cross advised the College that it had concerns regarding Dr. Martinez’s practice after conducting a review of his billing claims and conducting an onsite audit of his practice. Medavie Blue Cross’s concerns included:

a) overlapping time stamps for time-based billing codes;

b) multiple patients seen at the same time on the same date; and

c) patient records for time-based services that did not include time stamps indicating the duration of the service provided.

Medavie Blue Cross provided examples of each concern documented in its review of Dr. Martinez’s billing claims and patient records.


Under the OHIP Schedule of Benefits, mental health care services, including Cognitive Behavioural Therapy (“CBT”), are time-based services. Time-based billing codes, including K005 (Primary Mental Health Care) and K007 (Individual Psychotherapy), are fee codes in the OHIP Schedule of Benefits that are claimed by physicians in time units based on the amount of time the physician spends rendering the service to the patient.

Under the OHIP Schedule of Benefits, to claim these “K-Codes”, physicians are required to spend a minimum amount of time with the patient per unit claimed, and to document in the patient’s permanent medical record the time that the service started and ended.

Based on the information from Blue Cross, the College conducted an investigation of Dr. Martinez’s billing claims and his provision of CBT.

The College retained Dr. Nancy Merrow, an experienced family physician and chief of staff at Orillia Soldiers Memorial Hospital, as a Medical Inspector to opine on whether Dr. Martinez maintained the standard of practice of the profession in his provision of time-based mental health services and in his billing claims. Dr. Merrow reviewed 30 of Dr. Martinez’s patient charts, as well as his billing claims and day sheets, and conducted an interview of Dr. Martinez.

In her report, Dr. Merrow concluded, based on the discrepancies between Dr. Martinez’s patient encounter logs, patient records, and billing claims, that Dr. Martinez did not meet the standard of practice in terms of his administrative oversight of his office and his billing claims, including:

a) submitting claims for lengthy visits without any evidence that the patient required services that would take 30-90 minutes to deliver;

b) submitting claims for counselling at the same visit as another assessment without a distinct diagnosis as required by the OHIP Schedule of Benefits;

c) submitting claims to OHIP when he should have submitted them to the Workplace Safety and Insurance Board; and

d) frequently submitting claims for providing CBT in circumstances in which the only warranted service was an intermediate assessment, and/or without documenting sufficient information (including any goal, plan, or outcome) to demonstrate that the service was provided.

Dr. Merrow observed that Dr. Martinez used the term “CBT” loosely to describe all kinds of discussions with his patients, and there was little evidence of Dr. Martinez practicing CBT with any kind of methodology. Dr. Merrow concluded that Dr. Martinez displayed a lack of knowledge and skill with respect to his practice of CBT, and a lack of judgment with respect to recording inaccurate start and stop times for patient encounters.

Dr. Martinez provided a response to Dr. Merrow’s report dated February 8, 2016. Dr. Merrow provided an addendum report dated February 17, 2016, in which she addressed Dr. Martinez’s response to her report. Dr. Merrow’s opinion with respect to Dr. Martinez’s provision of CBT, billing issues, and poor documentation remained unchanged.

Dr. Martinez wrote to the College on July 22, 2016, acknowledging that he was solely responsible for all of his billing errors.

Dr. Martinez advised the College on December 10, 2018, that he had entered into a voluntary repayment agreement with the Ministry of Health to repay the amount of $29,275.27 in respect of improperly claimed K-Codes.

On January 8, 2019, the Ministry of Health wrote to Dr. Martinez to confirm the voluntary repayment agreement, indicating that the agreed upon amount of $29,275.27 reflects 30% of the services that Dr. Martinez improperly claimed as K005 primary mental health care for the period reviewed by the Ministry. The Ministry of Health acknowledged that this arrangement represents a full and final resolution of the incorrect claims for billing code K005 with service dates between April 2014 and May 2016.


On November 18, 2015, the College investigator spoke with a representative of Medavie Blue Cross. The investigator was informed that Dr. Martinez had started making repayments to Medavie Blue Cross and at that point had repaid $500.

In November 2019, Dr. Martinez also entered into an agreement with Medavie Blue Cross to repay the outstanding amount of $3,336.65 in respect of his improper billing claims. Dr. Martinez has made full repayment of the amount owing to Blue Cross.


Diagnostic Imaging Referrals

On January 22, 2016, the College received information from the Ministry of Health and Long-Term Care (the “Ministry”) advising that it had reviewed claims to the Ontario Health Insurance Plan (“OHIP”) for diagnostic studies rendered at an independent health facility where Dr. Martinez was listed on the claim to OHIP as the referring physician. The letter stated that the majority of patients referred in the period of April 1, 2014, to January 21, 2016 underwent multiple diagnostic studies on a single service date. Further, the Ministry reviewed requisitions and interpretive reports for a number of patients referred in this time period and stated in the letter that there was no medical necessity for the imaging tests. Based on the information from the Ministry, the College conducted an investigation of Dr. Martinez’s practice.

The College retained Dr. Linda Klapwyk as a Medical Inspector to review Dr. Martinez’s practice, in particular his ordering of diagnostic imaging, and to opine on whether Dr. Martinez’s care met the standard of practice of the profession. Dr. Klapwyk is an experienced family physician and professor of family medicine at the University of Toronto. Dr. Klapwyk reviewed Dr. Martinez’s OHIP billing claims and 25 of Dr. Martinez’s patient charts and conducted an interview of Dr. Martinez. Dr. Klapwyk provided a report to the College, dated March 4, 2017.

Dr. Klapwyk concluded that Dr. Martinez failed to maintain the standard of practice of the profession. Dr. Klapwyk opined that, in twenty-four out of twenty-five patient charts reviewed, there was evidence of diagnostic testing, including x-rays, ultrasounds, bone density scans, cardiac testing, and/or mammography ordered by Dr. Martinez without an indication for doing the tests.

In his interview with Dr. Klapwyk, Dr. Martinez blamed his office staff for adding tests onto his requisition forms without his knowledge by checking off additional tests on the requisition forms after Dr. Martinez had signed them. Assuming this was the case, Dr. Klapwyk noted there was no documented concern by Dr. Martinez at follow-up visits with patients about the amount of testing that had been done without Dr. Martinez’s authorization. Dr. Martinez advised Dr. Klapwyk that he had been aware of tests being added since 2014, and told Dr. Klapwyk that he had attempted to resolve the issue by speaking to office staff and the clinic’s owner. Dr. Martinez acknowledged that he did not call the police, perform a practice audit, or document his concerns.

Dr. Klapwyk opined that if Dr. Martinez ordered the diagnostic imaging tests, he displayed a lack of knowledge or judgment and did not maintain the standard of practice of the profession.

Dr. Klapwyk also opined that even if the tests were ordered by Dr. Martinez’s office staff without his knowledge, Dr. Martinez still failed to maintain the standard of practice of the profession as follows:

a) Dr. Martinez failed to protect his patients from harm due to unnecessary tests, worry, and radiation exposure;

b) Dr. Martinez demonstrated a profound lack of judgment in not documenting any concern about tests being done that he did not order or notifying appropriate authorities when he became aware of tests being ordered in his name; and

c) Dr. Martinez was complicit in his staff’s actions by continuing to review patient test results from 2014 to 2016 without documenting any concerns or taking actions other than speaking with his staff.

In Dr. Klapwyk’s opinion, Dr. Martinez exposed his patients to a risk of harm or injury.

Dr. Klapwyk also expressed concerns about other aspects of Dr. Martinez’s care including inadequate knowledge of vitamin B12 deficiency, vaccinations, illegible records, and instances of inappropriate billing in which Dr. Martinez billed OHIP for codes that were not supported by his documentation, as well as specific care-related concerns in four patient charts.

Dr. Martinez provided a response to Dr. Klapwyk’s report, dated April 13, 2017, in which he acknowledged Dr. Klapwyk’s comments about the ordering of unnecessary tests. Dr. Martinez wrote that he “recognizes that he ought to have taken further steps in and after 2014 to stop the unnecessary and inappropriate ordering of x-rays and other diagnostic studies for his patients.”

Dr. Klapwyk provided an addendum report dated November 29, 2017, in which she addressed Dr. Martinez’s response to her report. Dr. Klapwyk’s opinion with respect to Dr. Martinez’s care remained unchanged.

A Statement of Uncontested Facts and Plea of No Contest filed as an exhibit and presented to the Committee included the following further facts:

Orthotic Devices

In January 2017, the College received information from Sun Life Financial (“Sun Life”), an insurance provider, that Dr. Martinez had provided medical referrals for orthotic devices while working at a facility that Sun Life was investigating, called “Therapeutic Mobile Care” (“TMC”). Sun Life advised the College that Dr. Martinez had admitted that he had signed prescription forms for patients without seeing or assessing them. Sun Life also advised that Dr. Martinez offered to make repayments to Sun Life. Based on the information provided by Sun Life, the College investigated Dr. Martinez’s orthotics- prescribing practice.

Sun Life provided the College with a summary of an interview its investigators conducted of Dr. Martinez. According to the interview summary, Dr. Martinez told the Sun Life investigators that he initially did not pre-sign any forms at TMC, and that he saw patients and prescribed only what they needed; however, this “morphed” into him pre-signing prescriptions for orthotics without seeing patients, allowing the clinic and patients to submit claims and receive payment.

The College conducted an interview of Dr. Martinez, during which Dr. Martinez provided information that was false and misleading, and inconsistent with what he told Sun Life.

Contrary to what he told Sun Life, Dr. Martinez stated in his interview by the College that he saw and examined all the patients for whom he prescribed devices. Dr. Martinez also told the College that his statements to the Sun Life investigators about pre-signing prescriptions were not accurate.

PENALTY
 
The following additional facts were presented to the Committee in an Agreed Statement of Facts Regarding Penalty:

Dr. Martinez currently works at clinics in Toronto and Vaughan. His practices consist primarily (but not exclusively) of psychotherapy.

In his current practice settings, Dr. Martinez utilizes EMR systems, which help him address the organization, completeness, and legibility of his medical records.

Dr. Martinez’s History with the College

Dr. Martinez does not have any discipline history.

In early 2009, as a result of a public complaint to the College about his conduct and care, Dr. Martinez was cautioned in writing by the Complaints Committee about the importance of undertaking and documenting a thorough history and physical examination, and ensuring that the necessary investigations are ordered with appropriate follow-up. The Committee also cautioned Dr. Martinez to review mandatory reporting requirements for Ontario physicians.

Dr. Martinez’s 2009 Undertaking and 2013 Reassessment

In 2009, as a result of concerns regarding his prescribing practices that arose in two College investigations, Dr. Martinez entered into an undertaking with the College (the “2009 Undertaking”). In the 2009 Undertaking, Dr. Martinez agreed to voluntarily resign his prescribing privileges for Narcotic Drugs and Narcotic Preparations, to complete professional education in medical record-keeping and prescribing skills, and to submit to a reassessment of his practice.

In 2013, pursuant to the terms of the 2009 Undertaking, the College retained Dr. Irene Cohen to conduct a reassessment of Dr. Martinez’s practice. Dr. Cohen is an experienced family physician who was also the medical director of the Thames Valley Family Health Team. In her reassessment report, Dr. Cohen opined that Dr. Martinez overall met the standard of practice of the profession and did not display a lack of knowledge, skill or judgment. However, Dr. Cohen expressed some concerns about Dr. Martinez’s record-keeping and boundary-setting with patients. Dr. Cohen also expressed concerns about Dr. Martinez’s billings in a number of charts. Dr. Cohen recommended that Dr. Martinez undergo a further period of clinical supervision with respect to these issues.

As a result of the concerns identified by Dr. Cohen, Dr. Martinez agreed to enter into the 2014 Undertaking, which superseded his 2009 Undertaking with the College.

Subsequent Remediation Efforts by Dr. Martinez

Following receipt of Dr. Silver’s addendum report dated July 16, 2017, Dr. Martinez delivered a further response to the College, dated November 29, 2017. In his response, Dr. Martinez advised the College that he had requested literature from the CMA and completed self-study in a number of areas in which Dr. Silver had expressed concerns about his care. Dr. Martinez provided a list of the resources that he told the College he had reviewed. Dr. Martinez also advised the College that he had “shadowed” a dermatologist in November 2017, and had engaged in 12 hours of one-on-one training on the topic of psychotherapy.

Dr. Martinez attended the University of Toronto Medical Recordkeeping course on June 22, 2017, and attended a Continuing Medical Education course on cardiovascular disease in diabetes on November 8, 2017.

On November 23, 2018, the College was advised of additional continuing education activities Dr. Martinez had pursued since responding to the addendum report of Dr. Silver on November 29, 2017. Dr. Martinez advised the College that he had completed additional CME activity covering topics including: mindfulness-based chronic pain management, mental health care, and the provision of psychotherapy.

Since November 23, 2018, Dr. Martinez has completed additional continuing education activities on topics including mental healthcare and dialectical behavioural therapy.

DISPOSITION

The Discipline Committee ordered:

- Dr. Martinez to attend before the panel to be reprimanded
- The Registrar to suspend Dr. Martinez’s certificate of registration for a period of 12 months, commencing May 12, 2020 at 12:01 a.m.
- The Registrar to place terms, conditions and limitations on Dr. Martinez’s certificate of registration, including: compliance with Policy re suspension; professional education; and clinical supervision with a reassessment.
- Dr. Martinez to pay costs to the College in the amount of $6,000.00 within 30 days of the date of the Order.

DECISION AND REASONS

On July 6, 2020, the Committee released its full decision and reasons in this matter. The Decision and Reasons are available for review on the College’s website.


Decision: Download Full Decision (PDF)
Hearing Date(s): May 11, 2020 9:30 a.m. to 12: 30 p.m. Reprimand: August 27, 2020 at 12:00 p.m.

Concerns

Source: Member
Active Date: August 22, 2023
Expiry Date:
Summary:
Summary of the Undertaking given by Dr. Lionel Gines Martinez to the College of Physicians and Surgeons of Ontario, effective August 22, 2023:
 
Following a finding by the Discipline Tribunal, Dr. Martinez underwent remediation and submitted to a reassessment of his practice. The reassessment report subsequently received by the College raised concerns about his standard of practice in family medicine. As a result:

Dr. Martinez will practise under the guidance of a Clinical Supervisor acceptable to the College for 6 months.

CPSO will be closed on March 29, 2024. We will re-open on Monday, April 1, 2024, at 8:00 am.