As from November 2nd, 2023, the following is imposed as terms, conditions and limitations on the certificate of registration held by Dr. Thomas Roland Wenske in accordance with an undertaking and consent given by Dr. Wenske to the College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")
of
DR. THOMAS ROLAND WENSKE
("Dr. Wenske")
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. Wenske, certificate of registration number 67287, am a member of the College.
(3) I, Dr. Wenske, acknowledge that in 2002 the College conducted an investigation bearing File Number 7004914 (the "Investigation") into whether I engaged in professional misconduct and/or am incompetent in my family practice.
(4) I, Dr. Wenske, acknowledge that as a result of the investigation, I entered into an undertaking with the College dated April 2, 2003 (the "2003 Undertaking"), in which I agreed to limit my scope of practice to surgical assisting in a supervised setting.
(5) I, Dr. Wenske, acknowledge that the 2003 Undertaking was subsequently superseded by an undertaking dated June 26, 2005 (the "2005 Undertaking"), which more accurately described my scope of practice. In the 2005 Undertaking, I agreed that I would restrict my practice to the following: assisting with cardiac surgery; participating in an on-call schedule for in-patient care; assessing potential cardiac surgery patients in the emergency departments as the need arises; and assessing post-operative patients in the Intensive Care Unit as the need arises.
(6) I, Dr. Wenske, acknowledge that I entered into a further undertaking with the College dated September 13, 2019 (the "September 2019 Undertaking") in connection with a request to change my scope of practice to include Emergency Medicine. The September 2019 Undertaking replaced and superseded the 2005 Undertaking.
(7) I, Dr. Wenske, acknowledge that as I was unable to complete the September 2019 Undertaking, I entered into an undertaking dated February 26, 2021 (the "February 2021 Undertaking") in which I agreed to return to a restricted scope of practice.
(8) I, Dr. Wenske, acknowledge that I am entering into this Undertaking further to my renewed intention to change my scope of practice to include Emergency Medicine.
(9) I, Dr. Wenske, acknowledge that this Undertaking replaces and supersedes the February 2021 Undertaking.
B. UNDERTAKING
(10) I, Dr. Wenske, undertake to abide by the provisions of this Undertaking, effective immediately.
(11) Clinical Supervision
(a) I, Dr. Wenske, 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 eighteen (18) months ("Clinical Supervision"). Clinical Supervision shall cease only upon approval from the College.
(b) I, Dr. Wenske, undertake to remain free of any conflict of interest with the Clinical Supervisor.
(c) I, Dr. Wenske, undertake to practice under the following terms of Clinical Supervision:
Phase 1 - High Level Supervision
(i) I, Dr. Wenske, acknowledge that for a minimum of six (6) months, I will practice only under High Level Supervision, during which time I will be the Most Responsible Physician ("MRP"). The Clinical Supervisor will, at minimum:
1. Be immediately available on site;
2. Review all patients with me and approve management plans for all patients;
3. Directly observe my practice during a minimum of five (5) patient encounters each month, as well as when performing any new procedures, and shall observe any additional patient encounters based on my Clinical Supervisor's discretion;
4. Review various topics in the CFPC's "Priority Topics in EM" with me, as well as current practice guidelines, on a monthly basis; and
5. Submit written reports to the College in accordance with the requirements set out in my IEP at least after the first, third and sixth months of High Level Supervision, and on a monthly basis thereafter until my Clinical Supervisor recommends, and the College approves, a reduction in Clinical Supervision to Moderate Level Supervision.
Phase 2 - Moderate Level Supervision
(ii) I, Dr. Wenske, acknowledge that after a minimum of six (6) months of High Level Supervision, if my Clinical Supervisor recommends and the College approves a reduction in the level of supervision, I shall practice under Moderate Level Supervision for a minimum of six (6) months. I acknowledge that I am not permitted to practice under Moderate Level Supervision until I am notified in writing that the College in its sole discretion determined that I may practice under Moderate Level Supervision as set out in my IEP.
(iii) I, Dr. Wenske, acknowledge that during the period of Moderate Level Supervision, my Clinical Supervisor will:
1. Be immediately available on site.
2. Meet with me at my Practice Location, or another location approved by the College once every week for a minimum of two (2) months, to review a minimum of ten (10) charts and comment on diagnosis, documentation and treatment plan. Each chart review meeting must include a review of all patients I cared for who:
a) were triaged as a CTAS level 1;
b) required a life-saving intervention (emergency intubation or other invasive airway management, emergency non-invasive ventilation, cardiopulmonary resuscitation, central line placement, inotropic support, cardioversion, placement of thoracostomy tubes);
c) required transfer to another centre for higher level care for a life or limb-threatening condition.
3. After a minimum of two (2) months of Moderate Level Supervision, my Clinical Supervisor will:
a) be immediately available either on site or by telephone.
b) meet with me once every two (2) weeks for a further minimum of four (4) months, to review a minimum of ten (10) charts and comment on diagnosis, documentation and treatment plan. Each chart review meeting must include a review of all patients I cared for who:
(i) were triaged as a CTAS level 1;
(ii) required a life-saving intervention (emergency intubation or other invasive airway management, emergency non-invasive ventilation, cardiopulmonary resuscitation, central line placement, inotropic support, cardioversion, placement of thoracostomy tubes);
(iii) required transfer to another centre for higher level care for a life or limb-threatening condition.
4. Review various topics in current practice guidelines and the CFPC's "Priority Topics in EM" on a monthly basis with me, and focus half of the charts reviewed on the guidelines and topics being discussed that month; and
5. Submit written reports to the College in accordance with the requirements set out in my IEP at least after the second and sixth month of Moderate Level Supervision, and on a monthly basis thereafter until my Clinical Supervisor recommends, and the College approves, a reduction in Clinical Supervision to Low Level Supervision.
Phase 3 - Low Level Supervision
(iv) I, Dr. Wenske, acknowledge that after a minimum of six (6) months of Moderate Level Supervision, if my Clinical Supervisor recommends and the College approves a reduction in the level of supervision, I shall practice under Low Level Supervision for a minimum of six (6) months. I acknowledge that I am not permitted to practice under Low Level Supervision until I am notified in writing that the College in its sole discretion determined that I may practice under Low Level Supervision as set out in my IEP.
(v) I, Dr. Wenske, acknowledge that I will remain under Low Level Supervision until the College approves that Clinical Supervision shall cease.
(vi) I, Dr. Wenske, acknowledge that during the period of Low Level Supervision, my Clinical Supervisor will:
1. Be available, either on site or by telephone to discuss patient care, not necessarily in real time;
2. Meet with me at my Practice Location, or another location approved by the College once every month, to review a minimum of ten (10) charts to comment on diagnosis, documentation and treatment plan. Each chart review meeting must include a review of all patients I cared for who:
a) were triaged as a CTAS level 1;
b) required a life-saving intervention (emergency intubation or other invasive airway management, emergency non-invasive ventilation, cardiopulmonary resuscitation, central line placement, inotropic support, cardioversion, placement of thoracostomy tubes);
c) required transfer to another centre for higher level care for a life or limb-threatening condition.
3. Review various topics in current practice guidelines and the CFPC's "Priority Topics in EM" on a monthly basis with me, and focus half of the charts reviewed on the guidelines and topics being discussed that month; and
4. Submit a written report to the College in accordance with the requirements set out in the IEP at least every three (3) months during Low Level Supervision, and on a monthly basis thereafter until the College approves that Clinical Supervision shall cease, in accordance with the requirements of the IEP.
(d) I, Dr. Wenske, acknowledge that I have reviewed the Clinical Supervisor's undertaking attached hereto as Appendix "A", and understand what is required of the Clinical Supervisor. In addition to what is set out above, 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) Discuss any concerns arising from the chart reviews;
(iv) Review any feedback from co-workers (physician, residents, allied health, nurses, clerical staff) and identify areas of improvement;
(v) Make recommendations to me for practice improvements and ongoing professional development and inquire into my compliance with the recommendations;
(vi) Perform any other duties, such as reviewing other documents or conducting interviews with staff or colleagues, that the Clinical Supervisor deems necessary to my Clinical Supervision; and
(vii) Remain free of any conflict of interest with me.
(e) I, Dr. Wenske, 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 concerns that may arise during the period of Clinical Supervision.
(f) I, Dr. Wenske, undertake to cooperate fully with the Clinical Supervision of my practice, conducted under the terms 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.
(g) I, Dr. Wenske, undertake to ensure that Appendix "A" to this Undertaking is signed and delivered to the College prior to commencing practice in emergency medicine.
(h) I, Dr. Wenske, 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 cease practice until such time as I obtain an executed undertaking in the same form from a similarly qualified person who is acceptable to the College.
(i) I, Dr. Wenske, acknowledge that if I am required to cease practise as a result of section (11)(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.
(12) Professional Education
(a) I, Dr. Wenske, 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) Review the CFPC's "Priority Topics in EM" on a monthly basis, as well as current practice guidelines;
(ii) Review current clinical guidelines for patient care and documentation;
(iii) Maintenance of certification in ACLS, ATLS, PALS, and POCUS;
(iv) Review, reflection, and a discussion with my Clinical Supervisor of the following policies and other self-study:
1. Medical Records Documentation, College Policy;
(v) any additional professional education recommended by my Clinical Supervisor.
(b) I, Dr. Wenske, 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. Wenske, undertake to complete these requirements in accordance with the IEP or, if no satisfactory program is available by that time, by the first possible opportunity thereafter.
(d) I, Dr. Wenske, acknowledge that a report or reports may be provided to the College regarding my progress and compliance with the Professional Education.
(e) I, Dr. Wenske, 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.
(13) Assessment of Practice
(a) I, Dr. Wenske, undertake that, immediately after the completion of the educational program set out in the IEP at Appendix "B", I will submit to an assessment of my practice ("the Assessment") by an assessor or assessors selected by the College (the "Assessor" or "Assessors"). I acknowledge that the Assessment will include a chart review of a minimum of twenty-five (25) charts and may include: 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. Wenske, undertake to co-operate fully with the Assessment, conducted under the term of this Undertaking.
(c) I, Dr. Wenske, 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 Assessment.
(d) I, Dr. Wenske, acknowledge that the results of the Assessment will be provided to me and reported to the College and the Assessment may form the basis of further action by the College.
(14) Monitoring
(a) I, Dr. Wenske, undertake that I will practice exclusively in the Emergency Department at Georgian Bay General Hospital.
(b) I, Dr. Wenske, 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. Wenske, 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. Wenske, acknowledge that I have executed the OHIP consent forms, attached hereto as Appendix "C".
C. ACKNOWLEDGEMENT
(15) I, Dr. Wenske, acknowledge that all appendices attached to or referred to in this Undertaking form part of this Undertaking.
(16) I, Dr. Wenske, 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.
(17) I, Dr. Wenske, 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.
(18) I, Dr. Wenske, 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").
(19) I, Dr. Wenske, 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.
(20) I, Dr. Wenske, acknowledge that this Undertaking constitutes terms, conditions, and limitations on my certificate of registration for the purposes of section 23 of the Code.
(21) Public Register
(a) I, Dr. Wenske, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.
(b) I, Dr. Wenske, acknowledge that, in addition to this Undertaking being posted in accordance with section (21)(a) above, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:
In an Undertaking dated February 26, 2021, Dr. Wenske agreed to limit his scope of practice to: assisting with cardiac surgery; participating in an on-call schedule for in-patient care; assessing potential cardiac surgery patients in the emergency departments as the need arises and assessing post-operative patients in the Intensive Care Unit as the need arises. Dr. Wenske now wishes to commence practice in emergency medicine. As a result:
Dr. Wenske will practise under the guidance of a Clinical Supervisor acceptable to the College for a minimum of 18 months, initially at a high level.
Dr. Wenske will engage in professional education in priority topics in emergency medicine, and maintenance of certification in ACLS, ATLS, PALS, and POCUS.
Dr. Wenske's practice will be assessed by an assessor selected by the College immediately following completion of the educational program.
(c) I, Dr. Wenske, acknowledge that this Undertaking remains in effect until the College determines its terms are satisfied.
D. CONSENT
(22) I, Dr. Wenske, 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.
(23) I, Dr. Wenske, 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.
(24) I, Dr. Wenske, 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 Assessment;
(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.