Committee: Discipline
Decision Date: 02 Nov 2016
Summary:
On November 2, 2016, the Discipline Committee found that Dr. Paramjit Gill committed an act of professional misconduct in that: he engaged in an act or omission relevant to the practise of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional; he has been found guilty of an offence relevant to his suitability to practice; and, he contravened a term, condition or limitation on his certificate of registration.
Dr. Paramjit Gill, an internist, practised medicine at the Brampton Civic Hospital, William Osler Health Centre, in the Intensive Care Unit.
From about 1998 to 2006, Dr. Gill experienced alcohol addiction. In July 2006 he was admitted into the residential program at a facility dedicated to treating mental health and addiction issues. Upon completing that program, Dr. Gill entered into a contract with the Physicians Health Program, a program administered through the Ontario Medical Association, for a five-year period ending in August 2011.
As a result of a relapse into addiction, Dr. Gill engaged in a variety of misconduct in order to maintain a supply of narcotic opioids, including Percocet, Oxycocet, Oxycodone, Lorazepam and Endocet. Dr. Gill used narcotics that had been prescribed by other physicians for Dr. Gill’s close family members. He also prescribed narcotics himself, ostensibly for others, including his close family members, but these narcotics were for his own consumption. He solicited prescriptions for narcotics from colleagues. Dr. Gill also forged other physicians’ signatures and prescription pads in order to obtain narcotics for himself. Ultimately, as a result of his conduct, Dr. Gill was referred to discipline by the College and also faced multiple criminal charges.
CHRONOLOGY
The College commenced an investigation after hearing about concerns about Dr. Gill’s prescribing practice. On October 20, 2014, the College conducted an unannounced visit to Dr. Gill’s home. Dr. Gill advised the College he was on leave from the William Osler Health Centre, which was subsequently confirmed by the hospital.
The College initiated a preliminary Health Inquiry based on the concerns received from a pharmacist and information from the Ministry of Health and Long-Term Care that Dr. Gill was receiving opioid prescriptions from a number of physicians.
Dr. Gill failed to attend assessments, including an addiction assessment, ordered by the College’s Inquiries Complaints and Reports Committee (ICRC). He also failed to provide signed consents to the College for access to personal health information. As a result of both of these failures, his certificate of registration was suspended on December 23, 2014.
On April 1, 2015, Dr. Gill entered into a five-year monitoring contract with the Physician Health Program and subsequently entered into an undertaking with the College dated May 14, 2015. The suspension of Dr. Gill’s certificate of registration was lifted on June 12, 2015.
On April 29, 2016, following referral to discipline, Dr. Gill entered into a further undertaking with the College resigning his prescribing privileges except for issuing doctors’ orders for hospital inpatients that may be dispensed only by a hospital dispensary.
To date, Dr. Gill has complied with the terms of the undertakings provided to the College and has complied with the terms set out in the PHP contract.
THE COLLEGE INVESTIGATION – DISGRACEFUL, DISHONOURABLE OR UNPROFESSIONAL CONDUCT
In November 2013, a pharmacist reported to the College that, since at least 2009, Dr. Gill had been picking up prescriptions for Percocet in the name of a close family member and he was also the prescribing physician.
The College obtained information regarding the different means used by Dr. Gill to obtain narcotic opioids for his personal consumption: Dr. Gill wrote and filled prescriptions for narcotic opioids in the names of close family members on numerous occasions between 2009 and 2015. He also wrote and filled prescriptions for narcotic opioids in his own name and in two other individuals’ names between 2011 and 2014. These prescriptions were obtained from multiple pharmacies, and no OHIP billings were associated with the prescriptions. Most if not all of these narcotic opioids were for Dr. Gill’s own use.
Dr. Gill also forged prescriptions in three other physicians’ names, falsifying their signatures and the prescription itself, as well as using the physicians’ College registration numbers. The prescriptions were written in the names of Dr. Gill’s close family members and another individual. Dr. Gill filled the prescriptions and personally used these drugs.
Dr. Gill also sought out prescriptions for narcotics from his colleagues at the hospital, which was how the hospital learned that Dr. Gill was experiencing a narcotic addiction.
WRITING PRESCRIPTIONS POST-SUSPENSION
Following the suspension of his certificate of registration on December 22, 2014, Dr. Gill continued to prescribe himself narcotics and also wrote prescriptions for opioids in the names of close family members until at least January 27, 2015.
CRIMINAL CHARGES
On January 30, 2015, the Peel Regional Police charged Dr. Gill with 52 counts of fraud under $5,000.00 and 18 counts of uttering a forged document under the Criminal Code of Canada.
On September 22, 2016, Dr. Gill was found guilty in the Ontario Court of Justice of one count of fraud and one count of uttering a forged document, following his guilty plea. Sentencing in the Ontario Court of Justice has been put over to January 19, 2017.
PENALTY
The Discipline Committee ordered and directed that:
- The Registrar suspend Dr. Gill’s Certificate of Registration for a five (5) month period effective immediately
- The Registrar impose the following terms, conditions and limitations on Dr. Gill’s certificate of registration:
Prescribing Privileges
(a) Dr. Gill shall not issue new prescriptions or renew existing prescriptions, except as specifically set out in paragraph 5(a) below for any of the following substances:
(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 Part G of the Food and Drug 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), as amended from time to time; (A current 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”); and
(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”); as amended from time to time.
(b) Dr. Gill will return any supplies of the substances referred to in paragraph 3(a) above that are presently in his possession, in any place, to a pharmacy in a safe and secure manner, as stipulated in the College's Policy Number 8-12, "Prescribing Drugs."
(c) Notwithstanding paragraph 3(a):
Dr. Gill may prescribe the above-noted substances to his in-patients, only during the course of their in-patient stay and only through the hospital pharmacy.
(d) Upon request of the College, Dr. Gill will provide a Prescribing Resignation Letter to Health Canada consistent with this Order.
Posting a Sign
(e) Dr. Gill shall post a sign in the waiting room(s) of any practice location, except hospitals, in a clearly visible and secure location, in the form set out at Schedule “D”. For further clarity, this sign shall state as follows:
IMPORTANT NOTICE
Dr. Gill must not prescribe any of the following:
Narcotic Drugs
- Narcotic Preparations
- Controlled Drugs
- Benzodiazepines and Other Targeted Substances
- All other Monitored Drugs
Further information may be found on the College of Physicians and Surgeons of Ontario website at www.cpso.on.ca
(f) Dr. Gill shall post a certified translation in any language in which he provides services, of the sign described in paragraph 3(e) above, in the waiting room(s) of his office.
(g) Dr. Gill shall provide the certified translation(s) described in paragraph 3(f), to the College within thirty (30) days of this Order.
(h) Should Dr. Gill elect to provide services in any other language(s), he must notify the College prior to providing any such services.
(i) Dr. Gill shall provide to the College the certified translation(s) described in paragraph 3(g) prior to beginning to provide services in the language(s) described in paragraph 3(h).
(j) Dr. Gill shall be subject to an assessment of his practice, within two (2) months of his return to practice, by an assessor acceptable to the College and at Dr. Gill’s expense. The assessor shall select and review twenty five (25) patient charts or the patient charts for the total number of patients seen by Dr. Gill in the two (2) month period if less than twenty five (25). The assessor shall provide a report to the College following the assessment and Dr. Gill shall abide by the recommendations of the assessor.
Compliance
(k) Dr. Gill must inform the College of each and every location that he practises or has privileges, including, but not limited to, hospital(s), clinic(s) and office(s), in any jurisdiction (collectively the "Practice Location(s)"), within fifteen (15) days of commencing practice at that location.
(l) Dr. Gill shall be solely responsible for payment of all fees, costs, charges, expenses, etc. arising from the implementation of any of the terms of this Order.
(m) Dr. Gill shall provide his irrevocable consent to the College to obtain all reports prepared by his Physician Health Program (“PHP”) workplace monitor pursuant to Dr. Gill’s current contract with the PHP.
(n) Dr. Gill shall co-operate with unannounced inspections of his Practice Location(s) and patient charts by the College and to any other activity the College deems necessary in order to monitor compliance with the terms of this Order.
(o) Dr. Gill shall provide 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 any person or institution that may have relevant information, in order for the College to monitor his compliance with the terms of this Order.
(p) Dr. Gill acknowledges that the College may provide this Order to any Chief(s) of Staff, or a colleague with similar responsibilities, at any Practice Location where he practices or has privileges ("Chief(s) of Staff"), or other person or individual as necessary for the implementation of this Order and shall consent to the College providing to said Chief(s) of Staff, person or organization with any information the College has that led to this Order and/or any information arising from the monitoring of his compliance with this Order and with his PHP contract.
(q) Dr. Gill shall comply with the terms of his current PHP contract and shall comply with any recommendations made by the PHP at the completion of the contract term in April 2020.
- Dr. Gill appear before the panel to be reprimanded.
- Dr. Gill pay costs to the College for a one day hearing in the amount of $5,000.00 within 60 days of the date of this Order.
The reprimand was administered after the hearing concluded.