Ruggles, Janice Louise (CPSO#: 66668)

Current Status: Active Member as of 13 Dec 2016

CPSO Registration Class: Restricted as of 13 May 2016

Indicates a concern or additional information

Summary

Former Name: No Former Name

Gender: Female

Languages Spoken: English

Education:McMaster University, 1993

Practice Information

Primary Location of Practice
Suite 219
1885 Glenanna Road
Pickering ON  L1V 6R6
Phone: (905) 420-2556
Fax: (905) 420-3996
Electoral District: 05
View Professional Corporation Information

Professional Corporation Information

Corporation Name: Dr. Janice Ruggles Medicine Professional Corporation

Certificate of Authorization Status: Issued Date:  Dec 18 2014

Shareholders:
Dr. J. Ruggles ( CPSO# 66668 )

Business Address:
Suite 219
1885 Glenanna Road
Pickering ON  L1V 6R6
Phone Number: (905) 420-2556

Hospital Privileges

Hospital Location
Lakeridge Health,Ajax and Pickering Site Ajax

Specialties

Specialty Issued On Type
Obstetrics and Gynecology Effective: 30 Jun 1999 RCPSC Specialist

Post Graduate Training

Please note: This information may not be a complete record of post-graduate training.

University of Toronto, 01 Jul 1993 to 30 Jun 1994
PostGrad Yr 1 - Obstetrics and Gynecology

McMaster University, 01 Jul 1994 to 30 Jun 1995
Resident 1 - Obstetrics and Gynecology

McMaster University, 01 Jul 1995 to 30 Jun 1996
Resident 2 - Obstetrics and Gynecology

McMaster University, 01 Jul 1996 to 30 Jun 1997
Resident 3 - Obstetrics and Gynecology

McMaster University, 01 Jul 1997 to 31 Jan 1998
Resident 3 - Obstetrics and Gynecology

McMaster University, 01 Feb 1998 to 30 Jun 1998
Resident 4 - Obstetrics and Gynecology

McMaster University, 01 Jul 1998 to 30 Jun 1999
Resident 4 - Obstetrics and Gynecology

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 01 Jul 1993
Expired: Terms and conditions of certificate of registration Expiry: 30 Jun 1999
Subsequent certificate of registration Issued: Independent Practice Certificate Effective: 02 Jul 1999
Transfer of class of certificate to: Restricted certificate Effective: 13 May 2016
Terms and conditions amended by Discipline Committee Effective: 05 Oct 2016
Suspension of registration imposed: Discipline Committee Effective: 13 Oct 2016
Suspension of registration removed Effective: 13 Dec 2016

Practice Restrictions

Imposed By Effective Date Expiry Date Status  
Discipline Committee Effective: 05 Oct 2016 Active View Details [+]
            As from October 5, 2016, by order of the Discipline Committee of the College of
            Physicians and Surgeons of Ontario, the following terms, conditions and
            limitations are imposed on the certificate of registration held by Dr. Janice
            Louise Ruggles:

            Prescribing Privileges 
            (1)   Dr. Ruggles shall not issue new prescriptions or renew existing
                  prescriptions for any of the following substances:
                  (a)   Narcotic Drugs (from the Narcotic Control Regulations made under
                        the Controlled Drugs and Substances Act, S.C., 1996, c. 19);
                  (b)   Narcotic Preparations (from the Narcotic Control Regulations made
                        under the Controlled Drugs and Substances Act, S.C., 1996, c. 19); 
                  (c)   Controlled Drugs (from Part G of the Food and Drug Regulations
                        under the Food and Drugs Act, S.C., 1985, c. F-27); 
                  (d)   Benzodiazepines and Other Targeted Substances (from the
                        Benzodiazepines and Other Targeted Substances Regulations made
                        under the Controlled Drugs and Substances Act., S.C., 1996, c. 19);
                        or (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"); and
                  (e)   All other Monitored Drugs (as defined under the Narcotics Safety
                        and Awareness Act, 2010, S.O. 2010, c. 22 as noted in Schedule
                        "C"); and as amended from time to time.
                  
            (2)   Dr. Ruggles will return any supplies of the substances referred to in
                  paragraph (1) above that are presently in her possession, in any place,
                  to a pharmacy in a safe and secure manner, as stipulated in the College's
                  Policy Number 8-12, "Prescribing Drugs." 

            (3)   Notwithstanding paragraph 5.(1):
                  (a)   Dr. Ruggles may prescribe the above-noted substances to her
                        in-patients only, during the course of their in-patient stay
                        through the hospital pharmacy; and
                  (b)   Dr. Ruggles may issue prescriptions to patients she treats in the
                        emergency department while on call, hospital outpatients or
                        hospital inpatients on discharge of only:
                        (i) Tylenol #3 (to a maximum of 10 tablets, with no repeats); or 
                        (ii) OxyIR 10 mg (to a maximum of 10 tablets, with no repeats).
                  And said prescriptions may only be issued to emergency department
                  patients, hospital outpatients or to hospital inpatients on discharge in
                  relation to the following procedures: 
                        (i) Caesarean Sections; 
                        (ii) Complex Vaginal Deliveries;
                        (iii) Laparoscopic Surgery;
                        (iv) Open Abdominal Surgery; or
                        (v) Perineal/Vaginal procedures.
                  
            Posting a Sign
            (4)   Dr. Ruggles shall post a sign in the waiting room(s) of her office, in a
                  clearly visible and secure location, in the form set out at Schedule "D".
                  For further clarity, this sign shall state as follows: "Dr. Ruggles shall
                  not prescribe Narcotic Drugs, Narcotic Preparations, Controlled Drugs,
                  Benzodiazepines and Other Targeted Substances, or any other Monitored
                  Drugs. Dr. Ruggles shall not provide any medical advice, recommendations,
                  consultations, treatment or prescriptions to any of her employees.
                  Further information may be found on the College of Physicians and
                  Surgeons of Ontario website at www.cpso.on.ca". 

            (5)   Dr. Ruggles shall post a certified translation in any language in which
                  she provides services, of the sign described in paragraph 5.(4) above, in
                  the waiting room(s) of her office.

            (6)   Dr. Ruggles shall provide the certified translation(s) described in
                  paragraph 5.(5), to the College within thirty (30) days of this Order. 

            (7)   Should Dr. Ruggles elect to provide services in any other language(s),
                  she must notify the College prior to providing any such services. 

            (8)   Dr. Ruggles shall provide to the College the certified translation(s)
                  described in paragraph 5.(5) prior to beginning to provide services in
                  the language(s) described in paragraph 5.(7). 

            Prescription Log
            (9)   In the event that Dr. Ruggles writes a prescription pursuant to paragraph
                  5.(3), she shall record this prescription and other specified information
                  in a prescription log in the form attached as Schedule "E", which shall
                  be made available to the College at the College's request. Dr. Ruggles
                  shall also append to the prescription log a copy of each prescription she
                  issues under paragraph 5.(3). 

            (10)  Dr. Ruggles shall provide a document in the form set out at Schedule "F"
                  to each patient to whom she prescribed in accordance with paragraph
                  5.(3). The patient shall initial the document, and Dr. Ruggles shall
                  append a copy of the initialed document to the log referred to in
                  paragraph 5.(9).

            Treating Family Members or Employees
            (11)  Dr. Ruggles will not treat any office or hospital employees or family
                  members in any manner whatsoever, except in an emergency situation. This
                  includes, but is not limited to, providing advice, consultations,
                  treatment, prescriptions or treatment recommendations. 

            Coursework
             (12) At her own expense, Dr. Ruggles shall participate in and successfully
                  complete, within 6 months of the date of this Order, individualized
                  instruction in medical ethics satisfactory to the College, with an
                  instructor selected by the College.  The instructor shall provide a
                  summative report to the College including his or her conclusion about
                  whether the instruction was completed successfully by Dr. Ruggles.

            Reassessment
            (13)  Dr. Ruggles shall undergo a reassessment of her practice approximately
                  twelve (12) months from the date of this Order.

            Compliance
            (14)  Dr. Ruggles must inform the College of each and every location that she
                  practises or has privileges, including, but not limited to, hospital(s),
                  clinic(s) and office(s), in any jurisdiction (collectively the "Practice
                  Location(s)"), within fifteen (15) days of commencing practice at that
                  location.

            (15)  Dr. Ruggles shall be solely responsible for payment of all fees, costs,
                  charges, expenses, etc. arising from the implementation of any of the
                  terms of this Order. 

            (16)  Dr. Ruggles shall co-operate with unannounced inspections of her Practice
                  Location(s) and patient charts by the College and to any other activity
                  the College deems necessary in order to monitor her compliance with the
                  terms of this Order. 

            (17)  Dr. Ruggles shall provide her 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 any
                  person or institution that may have relevant information, in order for
                  the College to monitor her compliance with the terms of this Order. 

            (18)  Dr. Ruggles acknowledges that the College may provide this Order to any
                  Chief(s) of Staff, or a colleague with similar responsibilities, at any
                  Practice Location where she practices or has privileges ("Chief(s) of
                  Staff"), or other person or individual as necessary for the
                  implementation of this Order and shall consent to the College providing
                  to said Chief(s) of Staff, person or organization with any information
                  the College has that led to this Order and/or any information arising
                  from the monitoring of her compliance with this Order.

Previous Discipline Hearings

Committee: Discipline
Decision Date: 05 Oct 2016
Summary:

On October 5, 2016, the Discipline Committee of the College of Physicians and Surgeons of 
Ontario found that Dr. Janice Louise Ruggles has committed an act of professional misconduct 
in that she has 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, and in that she failed to maintain the standard of practice of the 
profession. 
 
Dr. Ruggles, an obstetrician-gynecologist, practised at a private office in Pickering and held 
hospital privileges at the Rouge Valley Health System in the Greater Toronto Area.  
 
2011 College Investigation 
 
On January 31, 2011, the College received information from a pharmacist that Dr. Ruggles had 
written prescriptions for large quantities of OxyContin over the past several years to a non-
patient with whom Dr. Ruggles had a work-related association. The College launched a section 
75(1)(a) investigation under the Health Professions Procedural Code. 
 
Dr. Ruggles sent a response to the College investigation dated June 14, 2011, acknowledging 
that she had provided prescriptions to the individual (“Individual 1”), and promised to treat 
and/or prescribe only to those with whom she has a doctor/patient relationship and in 
circumstances where she has conducted a complete assessment.  
 
The Inquiries, Complaints and Reports Committee (“the ICRC”) cautioned Dr. Ruggles in 
writing regarding inappropriately prescribing narcotics and treating a person with whom she had 
a work-related association, including by prescribing narcotics to that individual. The ICRC noted 
that Dr. Ruggles’ prescription of narcotics and other medications to a person with whom she had 
a work-related association was clearly inappropriate; that this was an isolated event in Dr. 
Ruggles’ practice; and that Dr. Ruggles admitted to the indiscretion and agreed to appropriate 
remediation. The ICRC also required Dr. Ruggles to complete a boundaries course and a 
narcotics prescribing course, which she completed in 2012. 
 
Current College Investigation  
 
In May 2013, another individual with whom Dr. Ruggles had a work-related association 
(“Individual 2”) called the College to advise that Dr. Ruggles had been prescribing narcotics to 
that individual.  
 
The College commenced a s. 75(1)(a) investigation and obtained pharmacy records, which 
demonstrated that Dr. Ruggles had written the following prescriptions for Individual 2: 
July 6, 2011:     Clonazepam 5mg, 180 tablets, with 2 repeats 
Nov 3, 2011:      Azithromycin (Zithromax) 500 mg po OD, then 250mg po 4 days  
July 25, 2012:    Macrobid, 100mg for 7 days 
                  Naproxen 500mg po tid, 80 tablets, with 1 repeat;  
                  Oxy IR 10mg, 60 tablets, with 1 repeat 
Nov 20, 2012:     Oxy IR 10mg, 60 tablets, with 1 repeat;  
                  Naproxen 500mg po tid no substitution, 80 tablets, 1 repeat 

  
                                      2 

Dec 10, 2012:     Tamiflu, 75mg, 5 day supply 
  
In her response to this investigation, Dr. Ruggles admitted to treating Individual 2 and to 
providing these prescriptions to Individual 2 during their work-related association. 
 
Dr. Ruggles wrote the first prescription for Individual 2 within weeks of her June 14, 2011 
response to the College’s previous investigation. Dr. Ruggles wrote the additional prescriptions 
for Individual 2 both before and after she completed the boundaries and narcotics prescribing 
courses required by the College, and both before and after she received the ICRC decision 
cautioning her for this behaviour. 
 
Expert Report 
 
The College retained an expert to review Dr. Ruggles’ care of patients in her office practice, who 
stated that the main issues of concern, ordering much larger amounts of narcotics than commonly 
prescribed, in particular, Oxycodone, Clonazepam, and Ativan, were found in three of the 24 
charts reviewed and the related prescription analysis.  
 
One of these 3 charts was that of Individual 2. The care Dr. Ruggles provided to Individual 2 did 
not meet the standard of practice. The expert noted: “A large amount of narcotics and sedatives 
were prescribed… She did not show good judgment and her management of this patient fell 
below the standard of practice. The same can be said about the Doctor’s failure to recognize the 
conflict of interest and potential harm created by continuing to keep [Individual 2] as a patient 
…Dr. Ruggles also failed to maintain proper boundaries in this relationship.” 
 
With respect to a second patient, the expert stated: “I find it concerning that the patient was seen 
only twice within 1 month and had 2 prescriptions for a total of 300 Oxy RI [sic] tabs, 200 
Ativan tabs, and 180 Rivotril tabs. Based on the above information, I feel that in this case the 
standard of care was not met. The Physician was not likely prescribing within her scope of 
practice and did not show good judgement.” 
 
With respect to a third patient, the expert noted that the patient was given a prescription of 200 
Percocets in March 2011, and 60 Percocets and 60 Toradol in June 2011. 30 more Percocets 
were prescribed in November 2011. The expert concluded that this was overly generous 
prescribing and that Dr. Ruggles did not meet the standard of care as she prescribed an excessive 
amount of narcotics, putting the patient at risk.  
 
The expert opined that Dr. Ruggles demonstrated a lack of knowledge and judgment in respect of 
these three cases, and that, in respect of the first and second cases, Dr. Ruggles was not likely 
prescribing within her scope of practice. 
 
With respect to the 21 other patients reviewed, the expert opined that the care provided by Dr. 
Ruggles met the standard of practice.  
 
On September 29, 2014, in response to this investigation and the expert report, Dr. Ruggles 
volunteered to cease all prescriptions of narcotics other than to patients seen in her hospital 

  
                                      3 

practice. Dr. Ruggles also offered to undertake to no longer treat or have any clinical dealings 
with those people with whom she had work-related associations. 
 
PENALTY 
 
On October 5, 2016, the Discipline Committee ordered and directed that: 
 
-  the Registrar suspend Dr. Ruggles’ certificate of registration for a two (2) month period, to 
   commence at 12:01 a.m. on October 13, 2016 and concluding at 12:01 a.m. on December 13, 
   2016.  
-  the Registrar impose the following  terms, conditions and limitations on Dr. Ruggles’ 
   certificate of registration: 
      Prescribing Privileges  
      (1)   Dr. Ruggles shall not issue new prescriptions or renew existing prescriptions for 
            any of the following substances: 
            (a)   Narcotic Drugs (from the Narcotic Control Regulations made under the 
                  Controlled Drugs and Substances Act, S.C., 1996, c. 19); 
            (b)   Narcotic Preparations (from the Narcotic Control Regulations made under 
                  the Controlled Drugs and Substances Act, S.C., 1996, c. 19);  
            (c)   Controlled Drugs (from Part G of the Food and Drug Regulations under 
                  the Food and Drugs Act, S.C., 1985, c. F-27);  
            (d)   Benzodiazepines and Other Targeted Substances (from the 
                  Benzodiazepines and Other Targeted Substances Regulations made under 
                  the Controlled Drugs and Substances Act., S.C., 1996, c. 19); or (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”); and 
            (e)   All other Monitored Drugs (as defined under the Narcotics Safety and 
                  Awareness Act, 2010, S.O. 2010, c. 22 as noted in Schedule “C”); and as 
                  amended from time to time. 
      (2)   Dr. Ruggles will return any supplies of the substances referred to in paragraph (1) 
            above that are presently in her possession, in any place, to a pharmacy in a safe 
            and secure manner, as stipulated in the College's Policy Number 8-12, 
            "Prescribing Drugs."  
      (3)   Notwithstanding paragraph 5.(1): 
            (a)   Dr. Ruggles may prescribe the above-noted substances to her in-patients 
                  only, during the course of their in-patient stay through the hospital 
                  pharmacy; and 
            (b)   Dr. Ruggles may issue prescriptions to patients she treats in the 
                  emergency department while on call, hospital outpatients or  hospital 
                  inpatients on discharge of only: 
                     (i) Tylenol #3 (to a maximum of 10 tablets, with no repeats); or  
                     (ii) OxyIR 10 mg (to a maximum of 10 tablets, with no repeats). 
                  And said prescriptions may only be issued to emergency department 
                  patients, hospital outpatients or to hospital inpatients on discharge in 
                  relation to the following procedures:  

  
                                 4 

                (i) Caesarean Sections;  
                (ii) Complex Vaginal Deliveries; 
                (iii) Laparoscopic Surgery; 
                (iv) Open Abdominal Surgery; or 
                (v) Perineal/Vaginal procedures. 
 Posting a Sign      
 (4)   Dr. Ruggles shall post a sign in the waiting room(s) of her office, in a clearly 
       visible and secure location, in the form set out at Schedule “D”. For further 
       clarity, this sign shall state as follows: "Dr. Ruggles shall not prescribe Narcotic 
       Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and Other 
       Targeted Substances, or any other Monitored Drugs. Dr. Ruggles shall not 
       provide any medical advice, recommendations, consultations, treatment or 
       prescriptions to any of her employees. Further information may be found on the 
       College of Physicians and Surgeons of Ontario website at www.cpso.on.ca".  
 (5)   Dr. Ruggles shall post a certified translation in any language in which she 
       provides services, of the sign described in paragraph 5.(4) above, in the waiting 
       room(s) of her office. 
 (6)   Dr. Ruggles shall provide the certified translation(s) described in paragraph 5.(5), 
       to the College within thirty (30) days of this Order.  
 (7)   Should Dr. Ruggles elect to provide services in any other language(s), she must 
       notify the College prior to providing any such services.  
 (8)   Dr. Ruggles shall provide to the College the certified translation(s) described in 
       paragraph 5.(5) prior to beginning to provide services in the language(s) described 
       in paragraph 5.(7).  
 Prescription Log 
 (9)   In the event that Dr. Ruggles writes a prescription pursuant to paragraph 5.(3), she 
       shall record this prescription and other specified information in a prescription log 
       in the form attached as Schedule “E”, which shall be made available to the 
       College at the College’s request. Dr. Ruggles shall also append to the prescription 
       log a copy of each prescription she issues under paragraph 5.(3).  
 (10)  Dr. Ruggles shall provide a document in the form set out at Schedule “F” to each 
       patient to whom she prescribed in accordance with paragraph 5.(3). The patient 
       shall initial the document, and Dr. Ruggles shall append a copy of the initialed 
       document to the log referred to in paragraph 5.(9). 
Treating Family Members or Employees 
(11)   Dr. Ruggles will not treat any office or hospital employees or family members in 
       any manner whatsoever, except in an emergency situation. This includes, but is 
       not limited to, providing advice, consultations, treatment, prescriptions or 
       treatment recommendations.  
 Coursework 
  (12)  At her own expense, Dr. Ruggles shall participate in and successfully complete, 
       within 6 months of the date of this Order, individualized instruction in medical 
       ethics satisfactory to the College, with an instructor selected by the College.  The 
       instructor shall provide a summative report to the College including his or her 
       conclusion about whether the instruction was completed successfully by Dr. 
       Ruggles. 

               
                                      5 

      Reassessment 
      (13)  Dr. Ruggles shall undergo a reassessment of her practice approximately twelve 
            (12) months from the date of this Order. 
     Compliance 
     (14)   Dr. Ruggles must inform the College of each and every location that she practises 
            or has privileges, including, but not limited to, hospital(s), clinic(s) and office(s), 
            in any jurisdiction (collectively the "Practice Location(s)"), within fifteen (15) 
            days of commencing practice at that location. 
     (15)   Dr. Ruggles shall be solely responsible for payment of all fees, costs, charges, 
            expenses, etc. arising from the implementation of any of the terms of this Order.  
     (16)   Dr. Ruggles shall co-operate with unannounced inspections of her Practice 
            Location(s) and patient charts by the College and to any other activity the College 
            deems necessary in order to monitor her compliance with the terms of this Order.  
     (17)   Dr. Ruggles shall provide her 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 any person 
            or institution that may have relevant information, in order for the College to 
            monitor her compliance with the terms of this Order.  
     (18)   Dr. Ruggles acknowledges that the College may provide this Order to any 
            Chief(s) of Staff, or a colleague with similar responsibilities, at any Practice 
            Location where she practices or has privileges ("Chief(s) of Staff"), or other 
            person or individual as necessary for the implementation of this Order and shall 
            consent to the College providing to said Chief(s) of Staff, person or organization 
            with any information the College has that led to this Order and/or any information 
            arising from the monitoring of her compliance with this Order. 
-  Dr. Ruggles appear before the panel to be reprimanded; 
-  Dr. Ruggles pay to the College its costs of this proceeding in the amount of $5,000.00 within 
   thirty (30) days from the date of this Order.

Decision: Download Full Decision (PDF)
Hearing Date(s): October 5, 2016