Syed, Naseeruddin (CPSO#: 60201)

Current Status: Suspended as of 15 Apr 2018

CPSO Registration Class: Restricted as of 17 Feb 2017

Indicates a concern or additional information

Summary

Former Name: No Former Name

Gender: Male

Languages Spoken: English, Urdu

Education:Osmania University, 1981

Practice Information

Primary Location of Practice
Practice Address Not Available

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 03 Aug 1988
Transfer of class of registration to: Independent Practice Certificate Effective: 30 Jul 1990
Transfer of class of certificate to: Restricted certificate Effective: 17 Feb 2017
Terms and conditions imposed on certificate by Inquiries, Complaints and Repo Effective: 17 Feb 2017
Suspension of registration imposed: Discipline Committee Effective: 15 Apr 2018

Practice Restrictions

Registration Status: Suspended     Effective From: 15 Apr 2018


Imposed By Effective Date Expiry Date Status
Discipline Committee Effective: 15 Apr 2018 Active

Previous Hearings

Committee: Discipline
Decision Date: 05 Mar 2018
Summary:

On March 5, 2018, the Discipline Committee found that Dr. Naseeruddin Syed committed an act of 
professional misconduct, in that he has failed to maintain the standard of practice of the profession.  
 
Dr. Syed is a general practitioner, with a practice in Peterborough. 
 
Investigation  One 
 
On August 2014, Dr. Syed’s former nurse contacted the College expressing concern regarding various 
aspects of Dr. Syed’s practice, including his prescribing practices. Based on the information requested by the 
College in April 2015 regarding claims for all monitored drugs made by Dr. Syed’s patients, the College 
commenced an investigation. 
 
The College retained an expert who reviewed 25 of Dr. Syed’s patient charts, pharmacy records, 
narcotic monitoring system data and conducted an interview with Dr. Syed. He opined that  Dr. 
Syed's dedication to the practice of medicine and his belief that he is truly acting in the best 
interests of his patients are not questioned, but he had concerns about Dr. Syed’s knowledge and 
judgment which may expose his patients to possible harm. He also was of the view that Dr. Syed’s 
skill was difficult to determine due the extremely poor and woefully sparse documentation on the 
charts reviewed. He concluded that 24 of 25 charts reviewed failed to meet standards; 6 out of 25 
patient charts displayed a lack of knowledge, the majority regarding dosing of psychoactive drugs; 
4 out of 25 patient charts displayed a lack of judgment, the majority regarding prescriptions of 
benzodiazepines, narcotics and antidepressants; and 6 of 25 patient charts reveal exposure of Dr. 
Syed's patients to harm or injury, specifically relating to his general prescribing practices. 
       
Investigation Two 
 
The College received information from two physicians who practise in a methadone maintenance practice at 
the Ontario Addiction Treatment Centres (“OATC”) in Peterborough, outlining concerns regarding Dr. 
Syed’s prescribing of high doses and large amounts of benzodiazepines to several methadone patients.  
Concerns regarding serious or fatal respiratory depression were relayed. 6 patients were identified and 
concerns were raised about an admission to the local hospital's Intensive Care Unit in the group of patients 
due to recent benzodiazepine overdose.  
       
Dr. Syed stated to the College investigator that he was not aware that the 6 patients were being prescribed 
methadone.  
 
The manager of the pharmacy located at the same address as Dr. Syed’s practice, relayed to the College 
investigator concerns regarding the early release of medications in patients claiming to have lost their 
prescriptions and regarding the maximum dosages of benzodiazepines being prescribed. By letter dated July 
5, 2015, one of the physicians who contacted the College expressing concerns regarding Dr. Syed’s 
prescribing provided a further report with respect to his concerns about specific patients. 
 
The College retained an expert who reviewed Dr. Syed’s general medicine practice, including his 
prescribing practice. After reviewing 10 patient charts, pharmacy records and interviewing Dr. Syed the 
expert concluded, among other things, that despite the guidelines for documentation afforded by the EMR, in 
not a single case during this chart review of these 6 patients was the record of treatment properly populated 
with adequate detail to meet College standards. In fact, there were glaring absences of documentation in the 
vast majority of charts reviewed, such that not one met record-keeping standards. The latter case is similar to 
that of the five previous, in that these patients were all prescribed psychoactive drugs, many in excessive 
quantities, despite all being on methadone and followed by a physician managing their addictions. While Dr. 
 
                                           

Syed maintained in his interview that he was unaware that these patients were on methadone, he 
acknowledged that many of the clientele of this walk-in clinic were drug addicts with poor social support. 
The expert noted that with this knowledge the physician managing these patients should be extremely 
diligent in assessing and treating these patients, including careful history taking and thorough physical 
examination to ensure the safety of the patient. According to the expert, in 6 patients whose charts were 
reviewed, Dr. Syed has failed to meet the standard of practice of the profession and at times may have 
exposed his patients to potential harm. 
 
Dr. Syed advised the College that he did not know the patients to whom the two physicians referred were on 
methadone. However, during the investigation, the College reviewed Dr. Syed’s charts for these patients, 
which revealed that: 
 
-  Dr. Syed had received a fax from the pharmacy indicating that Patient A, who was identified by the two 
   physicians, was on methadone in January, 2015. Despite this, he prescribed benzodiazepines to Patient 
   A in February, 2015. 
-  Dr. Syed continued to prescribe narcotics and benzodiazepines to Patient B throughout February, March 
   and April, 2015 and prescribed benzodiazepines to Patient C in March 2015 in two cases after being told 
   by both physicians that they were methadone patients. 
-  Patient D identified by both physicians was seen in the emergency department for overdose of sedatives 
   (specifically having taken many of the 2mg tablets of Clonazepam prescribed by Dr. Syed at once). The 
   patient was admitted to the ICU for overdose of sedatives. Five days later, there was no patient visit in 
   his chart, yet Dr. Syed prescribed Ativan to Patient D. About ten days later, Dr. Syed discussed the 
   recent overdose and admission to hospital with Patient D as well as the recent letter from the physician 
   and again prescribed Ativan to patient D.  
    
Complaint of Patient E  
 
In March 2015, the College received a complaint from Patient E expressing concerns that Dr. Syed failed to 
provide appropriate care when ordering medications for him during a walk-in visit. Specifically, Dr. Syed 
prescribed a medication that patient E was allergic to, prescribed high doses of benzodiazepines, knowing 
that Patient E is on methadone and has a general lack of knowledge concerning mental health patients and is 
over-prescribing to them.  
 
The College retained an expert who reviewed the standard of care provided by Dr. Syed to Patient E. The 
expert opined, in part, that not one of the patient’s eight visits in 2015 contained the required elements to 
meet the standards of record keeping of the College: the histories were incomplete, the physical exams often 
undocumented and the diagnoses usually only represented by OHIP billing codes. The plans for management 
were prescriptions only with rare advice as to how to specifically manage the patient's presenting 
complaints. Dr. Syed demonstrated lack of knowledge concerning the management of drug-seeking, 
habituated methadone patients. Dr. Syed demonstrated lack of skill in advising tapering of benzodiazepines 
without specific instructions. Dr. Syed demonstrated lack of judgment by allowing himself to be 
manipulated into repeat prescriptions of such a class of drugs and his prescriptions of narcotics, including 
Nucynta, in this patient. The pharmacist brought to light Dr. Syed's lack of knowledge of a potentially 
serious drug interaction between Nuycynta and Cymbalta. Dr. Syed demonstrated a lack of judgment by 
stopping the antidepressant instead of the narcotic in this instance. The clinical practice of Dr. Syed with 
regard to Patient E had the potential in several instances to expose his patient to harm. 
 
 
 
 
 
                                           

Complaint of Patient F  
 
In May 2016, the College received a complaint from Patient F expressing concerns that Dr. Syed failed to 
provide appropriate assessment, diagnosis and treatment when she attended the walk-in clinic with 
gynaecological concerns about a growth. Dr. Syed did not conduct a physical examination of the patient and 
proceeded to prescribe her medication without adequate explanation. The patient consulted a pharmacist, 
who expressed some disagreement with the prescription. As a result, the patient did not fill the complete 
prescription.  
 
The College retained an expert who reviewed the standard of care provided by Dr. Syed to Patient F. The 
expert concluded, in part, that the care provided by Dr. Syed did not meet the standard of the profession.  
The expert noted that the patient's concern was of the lesion on her labia, and it is standard practice to 
examine this lesion. According to the expert, sometimes a physician may defer exam, but this would be 
based on agreement with the patient, which was not the case in this instance. Regarding the concern about 
the prescription provided, the expert noted that for a typical yeast infection, a patient may potentially be 
prescribed Diflucan 150mg for one day and/or a topical treatment (such as the Terazol 7), while Dr. Syed 
prescribed Diflucan for seven days along with a repeat. According to the expert, this is a definite concern, as 
it is not the standard treatment for a common yeast infection (as Dr. Syed implied it was in his letter). The 
expert further noted that Patient F’s short visit demonstrated concerns regarding the knowledge, skill and 
judgment provided by Dr. Syed. According to the expert, there is reason to believe that Dr. Syed's clinical 
practice may expose patients to harm or injury, as examination of patients is vital to the correct diagnosis 
and that the prescription provided in the case of Patient F appears to be excessive and may cause harm to the 
patient. However, the expert noted that this is one short encounter, and may not be indicative of Dr. Syed's 
overall practice style. 
 
The Interim Order of the the Inquiries, Complaints and Reports Committee (ICRC) 
 
On February 14, 2017, the ICRC directed the Registrar to impose terms, conditions and limitations on Dr. 
Syed’s certificate of registration, which remain in effect until April 15, 2018. 
 
Disposition 
 
On March 5, 2018, the Discipline Committee ordered that: 
 
-  Dr. Syed attend before the panel to be reprimanded. 
-  the Registrar suspend Dr. Syed’s certificate of registration for two (2) months, to commence at 12:01 
   a.m.  on April 15, 2018. 
-  the Registrar impose the following terms, conditions and limitations on Dr. Syed’s certificate of 
   registration upon his return to practice at the conclusion of his suspension: 
   -  Prescribing Log  
      -  Dr. Syed, shall keep a Log of all prescriptions for Narcotic Drugs, Narcotic Preparations, 
         Controlled Drugs, Benzodiazepines and Other Targeted Substances and All other Monitored 
         Drugs (as set out in Schedule “A”), in the form attached as set out in Schedule “B”, which will 
         include at least the following information (the “Prescribing Log”): 
          -  the date of the appointment; 
          -  the name of the patient and chart/file number; 
          -  the name of the medication prescribed, dose, direction, number of tablets to be dispensed 
             and frequency; 
          -  the clinical indication; 
          
                                        

       -  whether the prescription is for a new medication and/or different dose or frequency than 
          currently prescribed to the patient (Y/N); 
       -  Dr. Syed’s signature; 
       -  the date of the Clinical Supervisor’s review (if applicable, as set out below); and 
       -  the Clinical Supervisor’s signature (if applicable, as set out below). 
   -  Dr. Syed is to keep a copy of all prescriptions he writes for Narcotic Drugs, Narcotic 
      Preparations, Controlled Drugs, Benzodiazepines and Other Targeted Substances and All other 
      Monitored Drugs, in the corresponding patient chart. 
-  Clinical Supervision re: Narcotic Practice  
   -  Dr. Syed is to practise under the guidance of a clinical supervisor acceptable to the College (the 
      “Clinical Supervisor”), for a minimum of nine (9) months on the terms set out below (the 
      “Clinical Supervision”). 
   -  The Clinical Supervisor shall sign an undertaking in the form attached hereto as Schedule “C”. 
   -  Dr. Syed shall cooperate fully with the Clinical Supervision and abide by all recommendations of 
      his Clinical Supervisor with respect to practice improvements and education. 
   -  Dr. Syed shall consent to the disclosure by the Clinical Supervisor to the College, and by the 
      College to his Clinical Supervisor, of all information the Clinical Supervisor or the College 
      deems necessary or desirable in order to fulfill the Clinical Supervisor’s undertaking and to 
      monitor Dr. Syed’s compliance with this Order. This shall include, without limitation, providing 
      the Clinical Supervisor with any reports of any assessments of Dr. Syed’s practice in the 
      College’s possession. 
   -  If the Clinical Supervisor who has given an undertaking in Schedule “C” to this Order is unable 
      or unwilling to continue to fulfill its terms, Dr. Syed shall, within seven (7) 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. 
   -  Dr. Syed shall not prescribe any narcotics or controlled substances unless and until the Clinical 
      Supervision is in place. 
   -  If Dr. Syed is unable to obtain a Clinical Supervisor on the terms set out in sections 4.B, he will 
      cease prescribing Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines and 
      Other Targeted Substances and All other Monitored Drugs until such time as he has obtained a 
      Clinical Supervisor acceptable to the College. 
   -  If Dr. Syed is 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 4.B(vii) above this will constitute a term, condition or limitation on his 
      certificate of registration and that term, condition or limitation will be included on the Public 
      Register. 
   Phase 1 of Clinical Supervision (“Phase 1”) 
   -  Dr. Syed is to engage in Phase 1 of Clinical Supervision for a minimum of two (2) months on the 
      terms set out below. 
   -  During Phase 1, Dr. Syed is to meet with the Clinical Supervisor once a week to discuss the 
      Clinical Supervisor’s review of a minimum of twenty (20 charts for patients to whom Dr. Syed 
      has prescribed: 
      -  Narcotic Drugs, or 
      -  Narcotic Preparations; or 
      -  Controlled Drugs, Benzodiazepines and Other Targeted Substances and All other Monitored 
         Drugs where the patient is also prescribed a Narcotic Drug and/or Narcotic Preparation. 
   -  If there are not twenty (20) charts for patients to whom Dr. Syed has prescribed the above 
      substances, the Clinical Supervisor shall review the charts of all patients listed in the prescribing 
      log since his prior review. 
          
                                     

-  During Phase 1, the Clinical Supervisor must sign and date the Prescribing Log to confirm the 
   charts that the Clinical Supervisor has reviewed and discussed with Dr. Syed. 
-  During Phase 1, the Clinical Supervisor will provide a report to the College at least once a week. 
-  After a minimum of two (2) months of Phase 1, if the Clinical Supervisor is satisfied that Dr. 
   Syed has the necessary knowledge, skills and judgment to practice in a less highly supervised 
   environment, the Clinical Supervisor may recommend to the College that supervision be reduced. 
Phase 2 of Clinical Supervision (“Phase 2”) 
-  Upon the recommendation of the Clinical Supervisor and approval by the College, Dr. Syed shall 
   engage in Phase 2 of Clinical Supervision for a minimum of three months on the terms set out 
   below. 
-  During Phase 2, Dr. Syed is to meet with the Clinical Supervisor at least once every two (2) 
   weeks to discuss the Clinical Supervisor’s review of a minimum of fifteen (15) charts for patients 
   to whom Dr. Syed has initiated a new prescription for: 
   -  Narcotic Drugs, or 
   -  Narcotic Preparations; or 
   -  Controlled Drugs, Benzodiazepines and Other Targeted Substances and All other Monitored 
      Drugs where the patient is also prescribed a Narcotic Drug and/or Narcotic Preparation. 
-  If there are not fifteen (15) charts for patients to whom Dr. Syed has initiated a new prescription 
   for the above substances, the Clinical Supervisor shall review the charts of all patients listed in 
   the prescribing log since his prior review. 
-  During Phase 2, the Clinical Supervisor must sign and date the Prescribing Log to confirm the 
   charts that the Clinical Supervisor has reviewed and discussed with Dr. Syed. 
-  During Phase 2, the Clinical Supervisor will provide a report to the College at least once every 
   two (2) weeks. 
-  After a minimum of three (3) months of Phase 2, if the Clinical Supervisor is satisfied that Dr. 
   Syed has the necessary knowledge, skills and judgment to practice in a less highly supervised 
   environment, the Clinical Supervisor may recommend to the College that supervision be reduced. 
Phase 3 of Clinical Supervision (“Phase 3”) 
-  Upon the recommendation of the Clinical Supervisor and approval by the College, Dr. Syed, shall 
   engage in Phase 3 of Clinical Supervision for a minimum of four (4) months on the terms set out 
   below. 
-  During Phase 3, Dr. Syed shall mee with the Clinical Supervisor at least once a month to discuss 
   the Clinical Supervisor’s review of a minimum of fifteen (15) charts for patients to whom Dr. 
   Syed has initiated a new prescription for: 
   -  Narcotic Drugs, or 
   -  Narcotic Preparations; or 
   -  Controlled Drugs, Benzodiazepines and Other Targeted Substances and All other Monitored 
      Drugs where the patient is also prescribed a Narcotic Drug and/or Narcotic Preparation. 
-  If there are not fifteen (15) charts for patients to whom Dr. Syed has initiated a new prescription 
   for the above substances, the Clinical Supervisor shall review the charts of all patients listed in 
   the prescribing log since his prior review. 
-  During Phase 3, the Clinical Supervisor must sign and date the Prescribing Log to confirm the 
   charts that the Clinical Supervisor has reviewed and discussed with Dr. Syed. 
-  During Phase 3, the Clinical Supervisor(s) will provide a report to the College at least once every 
   month. 
-  After a minimum of four (4) months of Phase 3, if the Clinical Supervisor is satisfied that Dr. 
   Syed has the necessary knowledge, skills and judgment to practice without supervision, the 
   Clinical Supervisor may recommend to the College that the Clinical Supervision cease. 
 
 
 
                                           

   -  Clinical Supervision re: Non-Narcotic Practice  
      -  By June 15, 2018, Dr. Syed shall obtain a clinical supervisor acceptable to the College, who will 
         supervise Dr. Syed’s general practice upon completion of his suspension for a period of nine (9) 
         months, and who will sign an undertaking in the form attached hereto as Schedule “D” (the 
         “General Practice Clinical Supervisor”). 
      -  Dr. Syed shall cooperate fully with the Clinical Supervision and abide by all recommendations of 
         his General Practice Clinical Supervisor with respect to practice improvements and education. 
      -  Dr. Syed shall consent to the disclosure by the General Practice Clinical Supervisor to the 
         College, and by the College to his General Practice Clinical Supervisor, of all information the 
         General Practice Clinical Supervisor or the College deems necessary or desirable in order to 
         fulfill the General Practice Clinical Supervisor’s undertaking and to monitor Dr. Syed’s 
         compliance with this Order. This shall include, without limitation, providing the General Practice 
         Clinical Supervisor with any reports of any assessments of Dr. Syed’s practice in the College’s 
         possession. 
      -  If the General Practice Clinical Supervisor who has given an undertaking in Schedule “D” to this 
         Order is unable or unwilling to continue to fulfill its terms, Dr. Syed 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. 
      -  If Dr. Syed is unable to obtain a General Practice Clinical Supervisor in accordance with 
         paragraphs 4(C)(i) or 4(C)(iv) of this Order, he shall cease practising medicine until such time as 
         he has done so, and the fact that he has will constitute a term, condition or limitation on his 
         certificate of registration until that time. 
   -  Reassessment of Practice  
      -  Approximately three (3) months after each aspect of the Clinical Supervision set out above has 
         ceased, Dr. Syed will submit to a comprehensive reassessment of his entire practice by an 
         assessor or assessors selected by the College (the “Assessor(s)”). The Reassessment may include 
         a chart review, direct observation of Dr. Syed’s care, interviews with colleagues and co-workers, 
         feedback from patients and any other tools deemed necessary by the College. Dr. Syed shall 
         abide by all recommendations made by the Assessor(s), and the results of the Reassessment will 
         be reported to the College and may form the basis of further action by the College. 
   -  Compliance  
      -  Dr. Syed shall co-operate with unannounced inspections of his office practice and patient charts 
         for the purpose of monitoring and enforcing his compliance with the terms of this Order. 
      -  Dr. Syed shall inform the College of any and all new practice locations including, but not limited 
         to, hospital(s), clinic(s) and office(s), in any jurisdiction five (5) days in advance of commencing 
         practice at that location. 
      -  Dr. Syed shall give his 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 Order. 
      -  Dr. Syed shall be responsible for any and all costs associated with implementing the terms of this 
         Order. 
-  Dr. Syed pay costs to the College in the amount of $10,180.00 within 30 days of the date of this Order 
   becomes final

Hearing Date(s): March 5, 2018