Aly, Hoda Mohamed Mahmoud (CPSO#: 90512)

Current Status: Active Member as of 23 Sep 2018

CPSO Registration Class: Restricted as of 23 May 2018

Indicates a concern or additional information

Summary

Former Name: No Former Name

Gender: Female

Languages Spoken: Arabic, English

Education:Ain Shams University, 2003

Practice Information

Primary Location of Practice
200 - 20 Wynford Dr
Toronto ON  M3C 1J4
Phone: (416) 444-6161 Ext. 2
Fax: (416) 444-5849
Electoral District: 10

Specialties

Specialty Issued On Type
Family Medicine Effective: 01 Sep 2011 CFPC Specialist

Postgraduate Training

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

University of Toronto, 01 Jul 2009 to 22 Sep 2009
Assessment Verification Period - Family Medicine

University of Toronto, 23 Sep 2009 to 31 Jul 2010
PostGrad Yr 1 - Family Medicine

University of Toronto, 01 Aug 2010 to 30 Jun 2011
PostGrad Yr 2 - Family Medicine

University of Toronto, 01 Jul 2011 to 09 Sep 2011
PostGrad Yr 2 - Family Medicine

Registration History

Action Issue Date
First certificate of registration issued: Pre Entry Assessment Program Certificate Effective: 01 Jul 2009
Transfer of class of registration to: Postgraduate Education Certificate Effective: 23 Sep 2009
Expired: Terms and conditions of certificate of registration Expiry: 09 Sep 2011
Subsequent certificate of registration Issued: Independent Practice Certificate Effective: 26 Sep 2011
Transfer of class of certificate to: Restricted certificate Effective: 23 May 2018
Terms and conditions imposed on certificate by Discipline Committee Effective: 23 May 2018
Suspension of registration imposed: Discipline Committee Effective: 23 May 2018
Suspension of registration removed Effective: 23 Sep 2018

Practice Restrictions

Imposed By Effective Date Expiry Date Status  
Discipline Committee Effective: 23 May 2018 Active View Details [+]
            As from 12:00 p.m., May 23, 2018, 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. Hoda
            Mohamed Mahmoud Aly:

            Prescribing Log

                  (a)   Dr. Aly shall keep a log of prescriptions ("Prescribing Log") until
                        such time as the College has conducted the reassessment described
                        below and has deemed it successfully completed. The Prescribing Log
                        will include all prescriptions for:
                        (i)   Narcotic Drugs (from the Narcotic Control Regulations made
                              under the Controlled Drugs and Substances Act, S.C., 1996, c.
                              19);
                        (ii)  Narcotic Preparations (from the Narcotic Control Regulations
                              made under the Controlled Drugs and Substances Act, S.C.,
                              1996, c. 19);
                        (iii) Controlled Drugs (from Schedule G of the Regulations under
                              the Food and Drugs Act, S.C., 1985, c. F-27); 
                        (iv)  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); 
                              (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")
                        (v)   All other Monitored Drugs (as defined under the Narcotics
                              Safety and Awareness Act, 2010, S.O. 2010, c. 22 as noted in
                              Schedule "C").
                  
                  (b)   The Prescribing Log shall be in the form set out at Schedule "D",
                        which will include at least the following information:
                        (i)   the date of the prescription;
                        (ii)  patient identifier;
                        (iii) the medication, dose, direction, number of tablets to be
                              dispensed and frequency (if applicable);
                        (iv)  the clinical indication for use;
                        (v)   whether it is a new prescription; and 
                        (vi)  physician initials.
                  
            Education

                  (c)   Dr. Aly shall, at her own expense, participate in and successfully
                        complete individualized instruction in medical ethics, in
                        accordance with the Individualized Education Plan set out at
                        Schedule "E", to the satisfaction of the College. Dr. Aly will
                        initiate contact with the instructor within one (1) month of the
                        date of this Order. Dr. Aly will provide proof of successful
                        completion within six (6) months of the date of this Order. The
                        instruction will involve one-on-one sessions with a
                        College-approved instructor ("the Instructor"), incorporating
                        principles of guided reflection, tailored feedback, and other
                        modalities customized to the specific needs of Dr. Aly as assessed
                        by the Instructor. The Instructor will report to the College
                        regarding Dr. Aly's progress and compliance.
                  
            Clinical Supervision 

                  (d)   Prior to resuming practice following the suspension of her
                        certificate of registration described above in paragraph 3, Dr. Aly
                        shall retain a College-approved clinical supervisor or supervisors
                        (the "Clinical Supervisor") with respect to her prescribing of
                        narcotics and controlled substances, who will sign an undertaking
                        in the form attached hereto as Schedule "F".
                  
                  (e)   Dr. Aly shall practice under the guidance of the Supervisor for a
                        period of nine (9) months ("Clinical Supervision").  
                  
                  (f)   Clinical Supervision of Dr. Aly's prescribing of narcotics and
                        controlled substances shall contain the following elements:
                  
            Moderate-Level Supervision

                  (g)   For an initial period of two (2) months, the Clinical Supervisor
                        will engage in a period of moderate-level supervision, during which
                        time the Clinical Supervisor will meet with Dr. Aly every two weeks
                        and will at minimum: 
                        (i)   review charts and prescriptions for twenty (20) of Dr. Aly's
                              patients, to be selected from the Prescribing Log at the sole
                              discretion of the Clinical Supervisor. If the Prescribing Log
                              contains fewer than twenty (20) patients, the Clinical
                              Supervisor shall review all charts and prescriptions
                              contained in the Prescribing Log. The review shall include
                              charts and prescriptions for all patients to whom Dr. Aly
                              initiated a new prescription for a Narcotic Drug, Narcotic
                              Preparation, Controlled Drug, Benzodiazepine and Other
                              Targeted Substance or other Monitored Drug since the Clinical
                              Supervisor's prior review;
                        (ii)  evaluate whether the assessment, clinical examination, risk
                              assessment for addiction and on-going management and follow
                              up is appropriate in all cases reviewed; 
                        (iii) discuss with Dr. Aly any concerns the Clinical Supervisor may
                              have regarding assessment, clinical examination, risk
                              assessment for addiction and on-going management and follow
                              up, and make recommendations for improvement; and
                        (iv)  submit written reports to the College at least once every two
                              weeks, or more frequently if the Clinical Supervisor has
                              concerns about Dr. Aly's prescribing practices.
                        (h)   After two (2) months, and only upon recommendation by the
                              Clinical Supervisor and approval of the College, the Clinical
                              Supervision may be reduced to a low level for the remaining
                              seven (7) months.
                  
            Low-Level Supervision 

                  (i)   If the transition is recommended by the Clinical Supervisor and
                        approved by the College, for a period of a further seven (7)
                        months, the Clinical Supervisor will engage in a period of
                        low-level supervision, during which time the Clinical Supervisor
                        will meet with Dr. Aly on a monthly basis and will, at minimum: 
                        (i)   review charts and prescriptions for fifteen (15) of Dr. Aly's
                              patients, to be selected from the Prescribing Log at the sole
                              discretion of the Clinical Supervisor. If the Prescribing Log
                              contains fewer than fifteen (15) patients, the Clinical
                              Supervisor shall review all charts and prescriptions
                              contained in the Prescribing Log. The review shall include
                              charts and prescriptions for all patients to whom Dr. Aly
                              initiated a new prescription for a Narcotic Drug, Narcotic
                              Preparation, Controlled Drug, Benzodiazepine and Other
                              Targeted Substance or other Monitored Drug since the Clinical
                              Supervisor's prior review;
                        (ii)  evaluate whether the assessment, clinical examination, risk
                              assessment for addiction and on-going management and follow
                              up is appropriate in all cases reviewed; 
                        (iii) discuss with Dr. Aly any concerns the Clinical Supervisor may
                              have regarding assessment, clinical examination, risk
                              assessment for addiction and on-going management and follow
                              up, and make recommendations for improvement; and
                        (iv)  submit written reports to the College at least once every
                              month, or more frequently if the Clinical Supervisor has
                              concerns about Dr. Aly's prescribing practices.
                  
            Other Elements of Clinical Supervision

                  (j)   Throughout the period of Clinical Supervision, Dr. Aly shall abide
                        by all recommendations of her Clinical Supervisor.
                  
                  (k)   If a person who has given an undertaking in Schedule "F" to this
                        Order is unable or unwilling to continue to fulfill its provisions,
                        Dr. Aly 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.
                  
                  (l)   If Dr. Aly is unable to obtain a Clinical Supervisor as set out in
                        this Order, she will cease prescribing Narcotic Drugs, Narcotic
                        Preparations, Controlled Drugs, Benzodiazepines and Other Targeted
                        Substances and other Monitored Drugs until such time as she has
                        obtained a Clinical Supervisor acceptable to the College.
                  
                  (m)   If Dr. Aly is required to cease prescribing as a result of
                        paragraph (4)(l) above, this will constitute a term, condition or
                        limitation on her certificate of registration and that term,
                        condition or limitation will be included on the public register
                        until such time as she has obtained a Clinical Supervisor
                        acceptable to the College.
                  
            Reassessment of Practice 

                  (n)   Approximately nine (9) months after the completion of the Education
                        and Clinical Supervision, Dr. Aly shall undergo a reassessment of
                        her practice by a College-appointed assessor or assessors (the
                        "Assessor"). The Assessor shall report the results of the
                        reassessment to the College.
                  
                  (o)   The reassessment may include (at the College's discretion) a review
                        of a minimum of twenty (20) of Dr. Aly's patient charts, direct
                        observation of Dr. Aly's practice, an interview with Dr. Aly,
                        interviews with colleagues and co-workers, and any other tools
                        deemed necessary by the College. Dr. Aly shall abide by all
                        recommendations made by the Assessor.
                  
                  (p)   Dr. Aly shall consent to the sharing of information among the
                        Assessor, the Clinical Supervisor, the Instructor, and the College,
                        as any of them deem necessary or desirable in order to fulfill
                        their respective obligations.
                  
            Monitoring 

                  (q)   Dr. Aly shall inform the College of each and every location where
                        she practices, in any jurisdiction (her "Practice Location(s)")
                        within  fifteen (15) days of this Order and shall inform the
                        College of any and all new Practice Locations within fifteen (15)
                        days of commencing practice at that location.
                  
                  (r)   Dr. Aly shall cooperate with unannounced inspections of her
                        practice location(s) and patient charts and to any other activity
                        the College deems necessary in order to monitor her compliance with
                        the provisions of this Order.
                  
                  (s)   Dr. Aly shall consent to the College making appropriate enquiries
                        of the Ontario Health Insurance Plan, the Narcotics Monitoring
                        System and/or any person or institution that may have relevant
                        information, in order for the College to monitor and enforce her
                        compliance with the terms of this Order.
                  
                  (t)   Dr. Aly shall be responsible for any and all costs associated with
                        implementing the terms of this Order.

Previous Hearings

Committee: Discipline
Decision Date: 23 May 2018
Summary:

On May 23, 2018, the Discipline Committee found that Dr. Hoda Mohamed Mahmoud Aly 
committed an act of professional misconduct in that:  she has failed to maintain the standard of 
practice of the profession; and 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.  
 
Dr. Dr. Aly is a family physician who received her certificate of registration authorizing 
independent practice in September 2011 after completing her residency at the University of 
Toronto and obtaining her certification by the College of Family Physicians of Canada. At all 
relevant times, she was practising at the Don Mills Family Health Team (the Clinic) in Toronto. 
 
In August 2016, following the receipt of information of concern from York Regional Police 
regarding the arrest of an individual who was wrongfully in possession of Fentanyl that had been 
prescribed by Dr. Aly to a patient (Patient C as discussed below), College investigators were 
appointed. Prescribing data obtained from the Narcotics Monitoring System ("NMS") for the time 
period January 1, 2015 to August 25, 2016 indicated that narcotics prescribing was not a large part of 
Dr. Aly's practice. The data showed 161 prescriptions filled by 35 unique patients during that time 
period, including 17 prescriptions for Fentanyl, prescribed to four patients. 
 
An expert retained by the College reviewed Dr. Aly's care in respect of the four patients to whom 
she prescribed Fentanyl during the time period in question and two of whom were Dr. Aly's close 
personal relatives. According to the expert, Dr. Aly failed to maintain the standard of practice of the 
profession in her care of all four patients, her care for those patients displayed a lack of knowledge, 
skill or judgment, and her narcotics prescribing practice would pose a risk of harm to other patients 
in her practice.  
 
Patient A 
 
Dr. Aly became Patient A's family physician in 2012. Patient A had a number of health issues, 
including obesity, difficult mobility, and chronic back pain. She had been escalating use of Tylenol 
#2 obtained from a friend as well as extra strength Tylenol. She reported these medications to be 
insufficient for her pain. She was seen in the Emergency Department by another physician at one point 
and was given morphine, but was unable to tolerate it. She was also given Percocet and experienced 
nausea, vomiting, and difficult urination. Dr. Aly prescribed a trial of Fentanyl 100 microgram 
patches to Patient A in January 2016, noting "I gave her enough patches and instructed her to apply 
them [every] 48-72 hrs on an area where she doesn't sweat." A few weeks later the patient advised 
Dr. Aly that she did not want the patches and would not get them again. 
 
Dr. Aly's prescribing of narcotics to Patient A did not meet the standard of practice of the profession. 
She did not demonstrate an awareness of how to titrate narcotics safely and progressively, and 
instead started Fentanyl at a maximum dose without appropriate use of an opioid analgesic 
conversion. When interviewed by the expert, Dr. Aly indicated that she knew that there were 
opioid conversion guidelines, but that because she did not prescribe narcotics often, she did not 
know at the time how to do the conversion and had made a mistaken estimate. Nor did Dr. Aly have 
Patient A sign an opioid contract. 
Patient B 
 
Dr. Aly was Patient B's family physician from October 2014 to March 2015. Patient B had 
osteoarthritis, scoliosis, peptic ulcer disease, hypothyroidism, hypercholesterolemia, and migraines. 
Patient B had been receiving Oxycodone and Fentanyl, as well as Tylenol #3 for over 20 years 
and was aware that she was dependent on them, though she advised Dr. Aly that she did not 
escalate or take more than the prescribed dose, or "double doctor." Patient B also had been taking 
a benzodiazepine. Dr. Aly had Patient B sign an opioid contract in November 2014 and continued 
to prescribe 200 micrograms of Fentanyl per day to Patient B, as well as Oxycodone and a 
benzodiazepine. However, in March 2015 Dr. Aly terminated the doctor-patient relationship, 
noting in the patient chart that the patient was reluctant to follow medical advice and insisted on 
receiving narcotics rather than exploring other remedies for chronic pain. Dr. Aly noted in the chart 
that the patient would return to her previous physician. 
 
Dr. Aly' s care of Patient B did not meet the standard of practice of the profession. She prescribed 
high doses of narcotics and did not seek to wean the patient gradually from her dependency. She also 
failed to monitor the patient consistently, particularly by way of urine drug screening. 
 
Patient C 
 
Patient C was Dr. Aly's close personal relative. Patient C had a number of serious 
comorbidities. Dr. Aly acted as Patient C's family physician from 2012 until early 2016, including 
prescribing Fentanyl to Patient C and writing Patient C notes excusing Patient C from school and 
from attending court due to illness. She did not bill the Ontario Health Insurance Plan for this care, 
which was primarily provided in Patient C's home. 
 
Patient C had been prescribed morphine and hydromorphone in the past. Dr. Aly first prescribed 
Fentanyl to Patient C in August 2014 in response to Patient C's complaint of pain associated with 
surgery. Dr. Aly continued to prescribe Fentanyl to Patient C on occasion.   
 
Dr. Aly's care of Patient C did not meet the standard of practice of the profession. She did not 
demonstrate an awareness of how to titrate narcotics safely and progressively, nor did she use an 
opioid contract for Patient C. She demonstrated a significant lapse in judgment in acting as her 
close personal relative's family physician and in prescribing Patient C narcotics. Dr. Aly stated in 
her interview with the expert that the reason she did not have Patient C sign an opioid contract was 
that she was not objective because Patient C was her close personal relative.  
 
The College's Policy on Treating Self and Family Members provides, among other things, that 
physicians should not treat their family members except for minor conditions or in an emergency 
situation, and only when other qualified health professionals are not readily available. Where it 
is necessary to treat themselves or family members, physicians must transfer care to another qualified 
health professional as soon as is practical. Dr. Aly was aware of this policy while she was 
engaging in the conduct above, and was aware that her conduct contravened the policy. Dr. Aly 
stated that she felt "pressure" from her family and felt "emotionally involved." 
 
Patient D 
 
Patient D is Dr. Aly's close personal relative. Patient D had a number of serious comorbidities. 
While Patient D was registered to another family physician from 2008 onwards, Dr. Aly stated in 
her interview with the expert that Patient D had only seen that physician once and not returned. 
Instead, Patient D received primary care from Dr. Aly, beginning in approximately November 2013. 
This included prescribing Gabapentin, Oxycontin, and, beginning in December 2014, 100 
microgram patches of Fentanyl. The care was provided in Patient D's home. Dr. Aly stated that she 
told Patient D she was not allowed to provide treatment to Patient D, but felt emotional pressure 
because Patient D wanted to be treated by her and not to travel for care. Dr. Aly did not bill the 
Ontario Health Insurance Plan for care provided to Patient D. 
 
Dr. Aly failed to have Patient D sign an opioid contract. When initiating Patient D on Fentanyl, 
she did not have the requisite knowledge to titrate the dose appropriately and instead relied on 
advice from another relative who was a pharmacist. Dr. Aly states that she then looked up the 
dose and thought it was "pretty high" and should go down, but her pharmacist relative said that it 
was appropriate and the dose that "most doctors" would give. Dr. Aly demonstrated a significant 
lapse in judgement in treating her close personal relative as a primary care physician for several 
years and in prescribing narcotics to her close personal relative, and failed to meet the standard of 
practice of the profession in this regard. 
 
Summary 
 
Dr. Aly' s care of the patients noted above did not meet the standard of practice of the 
profession: 
 -  Dr. Aly's prescribing was not in keeping with the Canadian Guideline for Safe and Effective 
    Use of Opioids for Chronic Non-Cancer Pain (2010); 
 -  Dr. Aly did not demonstrate an awareness of how to titrate narcotics safely and 
    progressively; 
 -  Dr. Aly did not use an opioid contract with three of the four patients; 
 -  Dr. Aly used Fentanyl, a potent drug, in high doses with non-compliant patients who were 
    refusing to participate in chronic pain clinics or follow up with chronic pain specialists, in an 
    attempt to reduce their pain; 
 -  Dr. Aly prescribed narcotics to and acted as a primary care provider for two close personal 
    relatives for years despite being aware of the College policy on the topic and despite her 
    relationship with them affecting her objectivity; 
 -  Dr. Aly did not consistently initiate referrals for her patients on high dose opioid therapy to a 
    chronic pain specialist; 
 -  Dr. Aly relied on a relative who is a pharmacist to guide her as to dosages and approach in 
    prescribing potent narcotics such as Fentanyl, rather than familiarizing herself with the 
    appropriate prescribing and monitoring practices. 
 
Disposition 
 
On May 23, 2018, the Committee ordered and directed that: 
 
-   the Registrar suspend Dr. Aly’s certificate of registration for a period of four (4) months, 
    effective immediately. 
-   the Registrar impose the following terms, conditions and limitations on Dr. Aly’s certificate of 
    registration: 
    Prescribing Log 
    -  Dr. Aly shall keep a log of prescriptions (“Prescribing Log”) until such time as the College 
       has conducted the reassessment described below and has deemed it successfully completed. 
       The Prescribing Log will include all prescriptions for: 
         (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 Schedule G of the 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);  
         (e) (A summary of the above-named drugs [from Appendix I to the Compendium of 
            Pharmaceuticals and Specialties] is attached as Schedule “A” to the Order; and the 
            current regulatory lists are attached as Schedule “B” to the Order) 
         (f) All other Monitored Drugs (as defined under the Narcotics Safety and Awareness Act, 
            2010, S.O. 2010, c. 22 as noted in Schedule “C” of the Order). 
    -  The Prescribing Log shall be in the form set out at Schedule “D” of the Order, which will 
       include at least the following information: 
       -   the date of the prescription; 
       -   patient identifier; 
       -   the medication, dose, direction, number of tablets to be dispensed and frequency (if 
           applicable); 
       -   the clinical indication for use; 
       -   whether it is a new prescription; and  
       -   physician initials. 
    Education 
     - Dr. Aly shall, at her own expense, participate in and successfully complete individualized 
       instruction in medical ethics, in accordance with the Individualized Education Plan set out at 
       Schedule “E” of the Order, to the satisfaction of the College. Dr. Aly will initiate contact 
       with the instructor within one (1) month of the date of this Order. Dr. Aly will provide proof 
       of successful completion within six (6) months of the date of this Order. The instruction will 
       involve one-on-one sessions with a College-approved instructor (“the Instructor”), 
       incorporating principles of guided reflection, tailored feedback, and other modalities 
       customized to the specific needs of Dr. Aly as assessed by the Instructor. The Instructor will 
       report to the College regarding Dr. Aly’s progress and compliance. 
    Clinical Supervision  
     - Prior to resuming practice following the suspension of her certificate of registration 
       described in the paragraph above, Dr. Aly shall retain a College-approved clinical supervisor 
       or supervisors (the “Clinical Supervisor”) with respect to her prescribing of narcotics and 
       controlled substances, who will sign an undertaking in the form attached as Schedule “F” to 
       the Order. 
       -  Dr. Aly shall practice under the guidance of the Supervisor for a period of nine (9) 
          months (“Clinical Supervision”).   
   -  Clinical Supervision of Dr. Aly’s prescribing of narcotics and controlled substances shall 
      contain the following elements: 
Moderate-Level Supervision 
 -   For an initial period of two (2) months, the Clinical Supervisor will engage in a period of 
     moderate-level supervision, during which time the Clinical Supervisor will meet with Dr. 
     Aly every two weeks and will at minimum:  
      - review charts and prescriptions for twenty (20) of Dr. Aly’s patients, to be selected 
        from the Prescribing Log at the sole discretion of the Clinical Supervisor. If the 
        Prescribing Log contains fewer than twenty (20) patients, the Clinical Supervisor shall 
        review all charts and prescriptions contained in the Prescribing Log. The review shall 
        include charts and prescriptions for all patients to whom Dr. Aly initiated a new 
        prescription for a Narcotic Drug, Narcotic Preparation, Controlled Drug, 
        Benzodiazepine and Other Targeted Substance or other Monitored Drug since the 
        Clinical Supervisor’s prior review; 
      - evaluate whether the assessment, clinical examination, risk assessment for addiction 
        and on-going management and follow up is appropriate in all cases reviewed;  
      - discuss with Dr. Aly any concerns the Clinical Supervisor may have regarding 
        assessment, clinical examination, risk assessment for addiction and on-going 
        management and follow up, and make recommendations for improvement; and 
      - submit written reports to the College at least once every two weeks, or more 
        frequently if the Clinical Supervisor has concerns about Dr. Aly’s prescribing 
        practices. 
 -   After two (2) months, and only upon recommendation by the Clinical Supervisor and 
     approval of the College, the Clinical Supervision may be reduced to a low level for the 
     remaining seven (7) months. 
Low-Level Supervision  
 -   If the transition is recommended by the Clinical Supervisor and approved by the College, 
     for a period of a further seven (7) months, the Clinical Supervisor will engage in a period 
     of low-level supervision, during which time the Clinical Supervisor will meet with Dr. 
     Aly on a monthly basis and will, at minimum:  
      -  review charts and prescriptions for fifteen (15) of Dr. Aly’s patients, to be selected 
         from the Prescribing Log at the sole discretion of the Clinical Supervisor. If the 
         Prescribing Log contains fewer than fifteen (15) patients, the Clinical Supervisor 
         shall review all charts and prescriptions contained in the Prescribing Log. The review 
         shall include charts and prescriptions for all patients to whom Dr. Aly initiated a new 
         prescription for a Narcotic Drug, Narcotic Preparation, Controlled Drug, 
         Benzodiazepine and Other Targeted Substance or other Monitored Drug since the 
         Clinical Supervisor’s prior review; 
      -  evaluate whether the assessment, clinical examination, risk assessment for addiction 
         and on-going management and follow up is appropriate in all cases reviewed;  
      -  discuss with Dr. Aly any concerns the Clinical Supervisor may have regarding 
         assessment, clinical examination, risk assessment for addiction and on-going 
         management and follow up, and make recommendations for improvement; and 
      -  submit written reports to the College at least once every month, or more frequently if 
         the Clinical Supervisor has concerns about Dr. Aly’s prescribing practices. 
 Other Elements of Clinical Supervision   
 -   Throughout the period of Clinical Supervision, Dr. Aly shall abide by all 
     recommendations of her Clinical Supervisor. 
     -   If a person who has given an undertaking in Schedule “F” to the Order is unable or 
         unwilling to continue to fulfill its provisions, Dr. Aly 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. Aly is unable to obtain a Clinical Supervisor as set out in this Order, she will cease 
         prescribing Narcotic Drugs, Narcotic Preparations, Controlled Drugs, Benzodiazepines 
         and Other Targeted Substances and other Monitored Drugs until such time as she has 
         obtained a Clinical Supervisor acceptable to the College. 
     -   If Dr. Aly is required to cease prescribing as a result of the paragraph above, this will 
         constitute a term, condition or limitation on her certificate of registration and that term, 
         condition or limitation will be included on the public register until such time as she has 
         obtained a Clinical Supervisor acceptable to the College. 
    Reassessment of Practice  
     -   Approximately nine (9) months after the completion of the Education and Clinical 
         Supervision, Dr. Aly shall undergo a reassessment of her practice by a College-appointed 
         assessor or assessors (the “Assessor”). The Assessor shall report the results of the 
         reassessment to the College. 
     -   The reassessment may include (at the College’s discretion) a review of a minimum of 
         twenty (20) of Dr. Aly’s patient charts, direct observation of Dr. Aly’s practice, an 
         interview with Dr. Aly, interviews with colleagues and co-workers, and any other tools 
         deemed necessary by the College. Dr. Aly shall abide by all recommendations made by 
         the Assessor. 
     -   Dr. Aly shall consent to the sharing of information among the Assessor, the Clinical 
         Supervisor, the Instructor, and the College, as any of them deem necessary or desirable in 
         order to fulfill their respective obligations. 
    Monitoring  
     -   Dr. Aly shall inform the College of each and every location where she practices, in any 
         jurisdiction (her “Practice Location(s)”) within  fifteen (15) days of this Order and shall 
         inform the College of any and all new Practice Locations within fifteen (15) days of 
         commencing practice at that location. 
     -   Dr. Aly shall cooperate with unannounced inspections of her practice location(s) and 
         patient charts and to any other activity the College deems necessary in order to monitor 
         her compliance with the provisions of this Order. 
     -   Dr. Aly shall consent to the College making appropriate enquiries of the Ontario Health 
         Insurance Plan, the Narcotics Monitoring System and/or any person or institution that may 
         have relevant information, in order for the College to monitor and enforce her compliance 
         with the terms of this Order. 
     -   Dr. Aly shall be responsible for any and all costs associated with implementing the terms 
         of this Order. 
-   Dr. Aly attend before the panel to be reprimanded. 
-   Dr. Aly pay costs to the College in the amount of $10,180.00 within thirty (30) days from the 
    date this Order.

Decision: Download Full Decision (PDF)
Hearing Date(s): May 23, 2018