Merotto, Robert Angelo (CPSO#: 53978)

Current Status: Active Member as of 11 Jun 1984

CPSO Registration Class: Restricted as of 10 Aug 2017

Indicates a concern or additional information

Summary

Former Name: No Former Name

Gender: Male

Languages Spoken: English

Education:University of Toronto, 1984

Practice Information

Primary Location of Practice
44 Main St. E.
Chelmsford ON  P0M 1L0
Phone: (705) 855-5099
Electoral District: 08
View Professional Corporation Information

Professional Corporation Information

Corporation Name: Dr. R. Merotto Medicine Professional Corporation

Certificate of Authorization Status: Issued Date:  Apr 04 2006

Shareholders:
Dr. R. Merotto ( CPSO# 53978 )

Business Address:
44 Main Street East
Chelmsford ON  P0M 1L0
Phone Number: (705) 855-5099

Business Address:
865 Regent Street South
Sudbury ON  P3E 3Y9
Phone Number: (705) 671-1000

Hospital Privileges

Hospital Location
Health Sciences North Sudbury

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 11 Jun 1984
Transfer of class of registration to: Independent Practice Certificate Effective: 12 Jul 1985
Transfer of class of certificate to: Restricted certificate Effective: 10 Aug 2017
Terms and conditions imposed on certificate by member Effective: 10 Aug 2017

Practice Restrictions

Imposed By Effective Date Expiry Date Status  
member Effective: 10 Aug 2017 Active View Details [+]
            As from August 10, 2017, the following is imposed as a term, condition and
            limitation on the certificate of registration held by Dr. Robert Angelo Merotto
            in accordance with an undertaking and consent given by Dr. Merotto to the
            College of Physicians and Surgeons of Ontario:

                               UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT 
                                            ("Undertaking")
                                                  of
                                       DR. ROBERT ANGELO MEROTTO
                                            ("Dr. Merotto")
                                                  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. Merotto, certificate of registration number 53978, am a member of
                  the College.  

            (3)   I, Dr. Merotto, acknowledge that the College received information from
                  the NMS and initiated an investigation bearing File Number 7215605 (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. Merotto, undertake to abide by the provisions of this Undertaking
                  effective immediately upon the signing of this Undertaking.

            (5)   I, Dr. Merotto, 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 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. Merotto'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. Merotto, 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. Merotto, undertake to practise under the guidance of a
                        clinical supervisor(s) acceptable to the College (the "Clinical
                        Supervisor(s)"), for a minimum of twelve (12) months on the terms
                        set out below (the "Clinical Supervision"). 
                  
                  (b)   I, Dr. Merotto, 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)   Upon the recommendation of the Clinical Supervisor(s) and approval
                        by the College, I, Dr. Merotto, undertake to engage in Phase 1 of
                        Clinical Supervision for a minimum of six (6) months on the terms
                        set out below.
                  
                  (d)   During Phase 1, I, Dr. Merotto, 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 there are not 15
                                    patients listed in the Prescribing Log meeting the
                                    description set out in (i) since the Clinical
                                    Supervisor(s)'s prior review, then the charts of all
                                    patients listed in the Prescribing Log meeting the
                                    description set out in (i) since the Clinical
                                    Supervisor'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 there are not 10 patients listed in the
                                    Prescribing Log since the Clinical Supervisor(s)'s
                                    prior review meeting the description set out in (ii),
                                    then the charts of all patients listed in the
                                    Prescribing Log meeting the description set out in (ii)
                                    since the Clinical Supervisor's prior review.
                  
                  (e)   I, Dr. Merotto, 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) have reviewed and discussed
                        with me.
                  
                  (f)   I, Dr. Merotto, acknowledge that during Phase 1, the Clinical
                        Supervisor(s) will provide a report to the College at least once
                        every month.
                  (g)   I, Dr. Merotto, acknowledge that after a minimum of six (6) months
                        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. Merotto, undertake to engage in Phase 2 of
                        Clinical Supervision for a minimum of six (6) months on the terms
                        set out below.
                  
                  (i)   During Phase 2, I, Dr. Merotto, undertake to meet with my Clinical
                        Supervisor(s) at least once every three months 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 there are not 15
                                    patients listed in the Prescribing Log meeting the
                                    description set out in (i) since the Clinical
                                    Supervisor(s)'s prior review, then the charts of all
                                    patients listed in the Prescribing Log meeting the
                                    description set out in (i) since the Clinical
                                    Supervisor'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 there are not 10 patients listed in the
                                    Prescribing Log since the Clinical Supervisor(s)'s
                                    prior review meeting the description set out in (ii),
                                    then the charts of all patients listed in the
                                    Prescribing Log meeting the description set out in (ii)
                                    since the Clinical Supervisor's prior review.
                  
            (j)   I, Dr. Merotto, 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) have reviewed and discussed with
                  me.

            (k)   I, Dr. Merotto, acknowledge that during Phase 2, the Clinical
                  Supervisor(s) will provide a report to the College at least once every
                  three months.

            (l)   I, Dr. Merotto, acknowledge that after a minimum of six (6) months of
                  Phase 2, 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.

            (m)   I, Dr. Merotto, acknowledge and undertake that the Clinical Supervision
                  will only cease upon recommendation of the Clinical Supervisor(s) and
                  approval by the College.

            (n)   I, Dr. Merotto, 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.
                  
            (o)   I, Dr. Merotto, undertake that all meetings with my Clinical
                  Supervisor(s) will take place at my Practice Location, or another
                  location approved by the College;

            (p)   I, Dr. Merotto, 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, received April 19, 2017, and concerns that may
                  arise during the period of Clinical Supervision.

            (q)   I, Dr. Merotto, 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 recommendations of my
                  Clinical Supervisor(s), including but not limited to, any recommended
                  practice improvements and ongoing professional development.

            (r)   I, Dr. Merotto, undertake to ensure that Schedule "E" to this
                  Undertaking, is signed and delivered to the College within fourteen (14)
                  days of the Effective Date.

            (s)   I, Dr. Merotto, 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.

            (t)   I, Dr. Merotto, agree that if I am unable to obtain a Clinical Supervisor
                  on the terms set out in sections (7)(r) and/or (s) 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.  

            (u)   I, Dr. Merotto, 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)(t) 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)   I, Dr. Merotto, 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.    Preventing the misuse of opioids
                                    https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2015/preventing-the-misuse-of-opioids
                  
                        (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).
                  
            (b)   I, Dr. Merotto, 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. Merotto, 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. Merotto, 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. Merotto, 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. Merotto, undertake to co-operate fully with the
                        Reassessment, conducted under the terms of this Undertaking 
                  
                  (d)   I, Dr. Merotto, 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. Merotto, 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. Merotto, undertake to inform the College of each and every
                        location that I practise or have privileges, including, but not
                        limited to, hospital(s), clinic(s) and office(s), in any
                        jurisdiction (collectively my "Practice Location(s)"), within 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. Merotto, 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. Merotto, 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. Merotto, 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. Merotto, acknowledge that all schedules attached to or referred to
                  in this Undertaking form part of this Undertaking.

            (12)  I, Dr. Merotto, 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. Merotto, 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. Merotto, 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. Merotto, 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. Merotto, 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. Merotto, acknowledge that, during the time period that this
                        Undertaking remains in effect, this Undertaking shall be posted on
                        the Public Register.
                  
                  (b)   I, Dr. Merotto, 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. Merotto's prescribing of controlled substances,
                        including narcotics.
                        Based on the information received, the College conducted an
                        investigation into whether Dr. Merotto 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. Merotto'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 a minimum of twelve (12) months. 
                  
                              "Dr. Merotto will engage in professional education in the
                              prescribing of controlled substances, including narcotics.
                  
                              "Following the professional education and period of
                              supervision, Dr. Merotto's prescribing of controlled
                              substances, including narcotics, will be re-assessed by an
                              assessor selected by the College.
                  
            D.    CONSENT

            (18)  I, Dr. Merotto, 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. Merotto, 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. Merotto, 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: August 10, 2017
Expiry Date:
Summary:
Summary of the Undertaking given by Dr. Robert Angelo Merotto to the College of Physicians and Surgeons of Ontario, effective August 10, 2017:

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

Based on the information received, the College conducted an investigation into whether Dr. Merotto 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. Merotto’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 a minimum of twelve (12) months.

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

Following the professional education and period of supervision, Dr. Merotto’s prescribing of controlled substances, including narcotics, will be re-assessed by an assessor selected by the College.