(1 of 2) As from August 9, 2017, the following is imposed as a term, condition
and limitation on the certificate of registration held by Dr. Andrew John
Kiellerman, in accordance with an undertaking and consent given by Dr.
Kiellerman to the College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")
of
DR. ANDREW JOHN KIELLERMAN
("Dr. Kiellerman")
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 Committee" means Discipline Committee of the College;
"OHIP" means the Ontario Health Insurance Plan;
"Public Register" means the College's register that is available to the
public;
"QAC" means the Quality Assurance Committee of the College.
(2) I, Dr. Kiellerman, certificate of registration number 97058, am a member
of the College.
B. UNDERTAKING
(3) I, Dr. Kiellerman, undertake to abide by the provisions of this
Undertaking, effective upon the date this Undertaking is approved by the
QAC ("Effective Date").
(4) Practice Restrictions
(a) I, Dr. Kiellerman, undertake that I will cease to engage in
"walk-in" practice.
(5) I, Dr. Kiellerman, undertake to inform the College of each and every
location that I practise or have privileges, including, but not limited
to, hospital(s), clinic(s) and office(s), in any jurisdiction
(collectively my "Practice Location(s)"), within five (5) days of
executing this Undertaking. Going forward, I further undertake to inform
the College of any and all new Practice Locations within five (5) days of
commencing practice at that location.
(6) I, Dr. Kiellerman, undertake that I will not engage in "walk-in" practice
until each and every one of the following conditions have been met:
(a) I provide a minimum of forty-five (45) days' notice to the College
of my intent to return to "walk-in" practice and
(b) I provide the College with proof that I am participating in a
program of continuing professional development that meets the
requirements for continuing professional development of the Royal
College of Physicians and Surgeons of Canada, the College of Family
Physicians of Canada, or an organization that has been approved by
the College for that purpose that meets the requirements for
continuing professional development set by the Royal College of
Physicians and Surgeons of Canada or the College of Family
Physicians of Canada
(7) I, Dr. Kiellerman, undertake that upon my return to the "walk-in"
practice, I shall, at minimum, submit to a reassessment of my "walk-in"
practice within three (3) to six (6) months after resuming my "walk-in"
practice.
(8) I, Dr. Kiellerman, undertake that I will submit to, and not interfere
with, unannounced inspections of my Practice Locations and patient charts
by a College representative for the purposes of monitoring my compliance
with the provisions of this Undertaking.
C. ACKNOWLEDGEMENT
(9) I, Dr. Kiellerman, 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.
(10) I, Dr. Kiellerman, 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.
(11) I, Dr. Kiellerman, acknowledge that the College will provide this
Undertaking to any Chief of Staff, or a colleague with similar
responsibilities, at any Practice Location ("Chief(s) of Staff").
(12) I, Dr. Kiellerman, 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 any one or more of the following:
consideration by the QAC, an investigation by the College, or further
action by the College, including a referral of specified allegations to
the Discipline Committee.
(13) I, Dr. Kiellerman, acknowledge that this Undertaking constitutes terms,
conditions, and limitations on my certificate of registration for the
purposes of section 23 of the Code.
(14) Public Register
(a) I, Dr. Kiellerman, acknowledge that, during the time period that
this Undertaking remains in effect, this Undertaking shall be
posted on the Public Register.
(b) I, Dr. Kiellerman, acknowledge that, in addition to this
Undertaking being posted in accordance with section (14)(a) above,
the following summary shall be posted on the Public Register during
the time period that this Undertaking remains in effect:
Dr. Kiellerman has voluntarily ceased "walk-in" practice.
D. CONSENT
(15) I, Dr. Kiellerman, 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.
(16) I, Dr. Kiellerman, acknowledge that I have executed the OHIP consent
form, attached hereto as Appendix "A" and that the consent forms part of
this Undertaking.
(17) I, Dr. Kiellerman, give my irrevocable consent to the College to provide
all Chief(s) of Staff with any information arising from the monitoring of
my compliance with this Undertaking.
(18) I, Dr. Kiellerman, give my irrevocable consent to any Chief of Staff to
disclose to the College, and to one another, all information relevant to
this Undertaking and/or relevant for the purposes of monitoring my
compliance with this Undertaking.
(2 of 2) The certificate of registration held by Dr. Andrew John Kiellerman
also carries the following term, condition and limitation imposed by the
Registration Committee, effective November 25, 2011:
Dr. Andrew John Kiellerman may practice medicine independently in
General/Family Medicine, only.
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