UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking'') of
DR. TRINSA LINDBLAD
("Dr. Lindblad")
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;
"IEP" means Individualized Education Plan; "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; "QAC" means the Quality Assurance Committee of the College.
(2) I, Dr. Lindblad, certificate of registration number 52369, am a member of the College.
(3) I, Dr. Lindblad, acknowledge that concerns have been identified with respect to my knowledge, skill and judgment. I am aware of the College's concern about protecting the public.
B. UNDERTAKING
(4) I, Dr. Lindblad, undertake to abide by the provisions of this Undertaking, effective immediately.
(5) Clinical Supervision
(a) I, Dr. Lindblad, undertake to practise under the guidance of a clinical supervisor or supervisors acceptable to the College (the "Clinical Supervisor" or "Clinical Supervisors"), for three (3) months ("Clinical Supervision").
(b) I, Dr. Lindblad, acknowledge that I have reviewed the Clinical Supervisor's undertaking attached hereto as Appendix "A", and understand what is required of the Clinical Supervisor. The Clinical Supervisor will, at minimum:
(i) Facilitate the education program set out in the IEP attached 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) Meet with me at my Practice Location, or another location approved by the College, once every month;
(iv) Review at least fifteen (15) of my patient charts at every meeting;
(v) Discuss any concerns arising from the chart reviews;
(vi) Make recommendations to me for practice improvements and ongoing professional development and inquire into my compliance with the recommendations;
(vii) 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
(viii) Submit a written report to the College at the end of the Clinical Supervision, or more frequently if the Clinical Supervisor has concerns about my standard of practice.
(c) I, Dr. Lindblad, acknowledge that the charts reviewed shall be selected by the Clinical Supervisor based on the educational needs identified in the IEP set out at Appendix "B" to my Undertaking and concerns that may arise during the period of Clinical Supervision.
(d) I, Dr. Lindblad, undertake to cooperate fully with the Clinical Supervision of my practice described in section (5) of this Undertaking and Appendix "A" attached, and undertake to abide by the recommendations of my Clinical Supervisor, including but not limited to recommended practice improvements and ongoing professional development.
(e) I, Dr. Lindblad, undertake to ensure that Appendix "A" to this Undertaking is signed and delivered to the College within thirty (30) days of the date I execute this Undertaking.
(f) I, Dr. Lindblad, 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, 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.
(g) 1, Dr. Lindblad, undertake that if I am unable to obtain a Clinical Supervisor as set out in sections (5)(f) and (5)(g) above, l will cease practising medicine until such time as l have obtained a Clinical Supervisor acceptable to the College.
(h) I, Dr. Lindblad, acknowledge that if lam required to cease practise as a result of section (5)(h) above this will constitute a term, condition or limitation on my certificate of registration and said term, condition or limitation will be included on the public register.
(6) Professional Education
(a) l, Dr. Lindblad, undertake to participate in and successfully complete the following professional education (the "Professional Education"):
(i) Review, reflection, and discussion with my Clinical Supervisor of the following policies and other self-study:
1. Dobson, G., Chau, A., Denomme, J. et al. (2023). Guidelines to the Practice of Anesthesia: Revised Edition 2023. Can J Anesth/J Can Anesth 70, 16-55;
2. Thilen, S. R., Weigel, W. A., Todd, M. M., et al. (2023). 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade. Anesthesiology, 138(1), 13-41;
3. SolvingPain and the Perioperative Pain Management Pathway, Ontario Medical Association Ontario's Anesthesiologists Section;
4. Casserly, E., Alexander, J.C. Perioperative uses of intravenous opioids in adults: General considerations. UpToDate. Retrieved May 30, 2023;
5. Consent to Treatment, CPSO Policy;
6. Good Practices - Physician-patient, CMPA;
7. Medical Records Documentation, CPSO Policy; and
8. Managing Tests, CPSO Policy.
(ii) all aspects of the detailed IEP, attached hereto as Appendix "B"; and
(iii) any additional professional education recommended by my Clinical Supervisor.
(b) I, Dr. Lindblad, 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. l acknowledge that the College will determine, in its sole discretion, whether l have successfully completed the Professional Education.
(c) l, Dr. Lindblad, acknowledge that a report or reports may be provided to the College regarding my progress and compliance with the Professional Education.
(d) l, Dr. Lindblad, undertake to complete this requirement within three (3) months or, if no satisfactory program is available by that time, by the first possible opportunity thereafter.
(7) Reassessment of Practice
(a) l, Dr. Lindblad, undertake that, approximately six (6) months after the completion of the Clinical Supervision and the Professional Education set out above and in Appendix "A" and Appendix "B" attached, l will submit to a reassessment of my practice (the "Reassessment") by an assessor or assessors selected by the College (the "Assessor" or "Assessors"). l acknowledge that the Reassessment may include a chart review of a minimum of fifteen ( 15) charts, 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. Lindblad, undertake to co-operate fully with the Reassessment conducted under section (7) of this Undertaking.
(c) I, Dr. Lindblad, acknowledge and provide consent 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 Reassessment.
(d) l, Dr. Lindblad, acknowledge that the results of the Reassessment will be provided to me and reported to the College and the Reassessment may f01m the basis of further action by the College.
(8) Monitoring
(a) I, Dr. Lindblad, undertake to inform the College of each and every location at which l practice, delegate, or have privileges, including, but not limited to, any hospitals, clinics, offices, and any Out-of-Hospital Premises and Independent Health Facilities with which l am affiliated, in any jurisdiction (collectively my "Practice Location" of "Practice Locations"), 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.
(b) I, Dr. Lindblad, undertake that l 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. ACKNOWLEDGEMENT
(9) l, Dr. Lindblad, acknowledge that all appendices attached to or referred to m this Undertaking form part of this Undertaking.
(10) l, Dr. Lindblad, 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.
(11) I, Dr. Lindblad, acknowledge that l have read and understand the provisions of this Undertaking and that l have obtained independent legal counsel in reviewing and executing this Undertaking, or have waived my right to do so.
(12) l, Dr. Lindblad, 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').
(13) I, Dr. Lindblad, 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 Tribunal.
(14) I, Dr. Lindblad, acknowledge that this Undertaking constitutes ten11s, conditions, and limitations on my certificate of registration for the purposes of section 23 of the Code.
(15) Public Register
(a) I, Dr. Lindblad, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.
(b) l, Dr. Lindblad, acknowledge that, in addition to this Undertaking being posted in accordance with section (15)(a) above, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:
Concerns have been identified with respect to Dr. Lindblad's knowledge, skill and judgment. As a result:
Dr. Lindblad will practise under the guidance of a Clinical Supervisor acceptable to the College for 3 months.
Dr. Lindblad will engage in professional education including in regional anesthesia for pain management, consent to treatment, managing tests and medical record keeping.
Dr. Lindblad's practice will be reassessed by an assessor selected by the College within 6 months of the end of the period of Clinical Supervision and Professional Education.
D. CONSENT
(16) I, Dr. Lindblad, 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.
(17) I, Dr. Lindblad, acknowledge that I have executed the OHIP consent form, attached hereto as Appendix "C".
(18) I, Dr. Lindblad, give my irrevocable consent to the College to provide the following information to any person who facilitates my completion of the Professional Education and to all Clinical Supervisors and 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.
(19) I, Dr. Lindblad, give my irrevocable consent to the College to provide all Chiefs of Staff with any information arising from the monitoring of my compliance with this Undertaking.
(20) I, Dr. Lindblad, give my irrevocable consent to all Clinical Supervisors, Chiefs of Staff, Assessors, and any persons who facilitate my completion of the Professional Education, to disclose to the College, and to one another, any information:
(a) relevant to this Undertaking;
(b) relevant to the provisions of the Clinical Supervisor's undertaking set out at Appendix "A";
(c) relevant to the Reassessment;
(d) Relevant for the purposes of monitoring my compliance with this undertaking; and
(e) 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