Pasternak, Harvey Stephen (CPSO#: 26502)

Current Status: Active Member as of 18 Jun 1974

CPSO Registration Class: Restricted as of 25 May 2017

Indicates a concern or additional information

Summary

Former Name: No Former Name

Gender: Male

Languages Spoken: English

Education:University of Toronto, 1973

Practice Information

Primary Location of Practice
1302 Queen Street East
Toronto ON  M4L 1C4
Phone: (416) 466-8640
Fax: (416) 466-2949
Electoral District: 10
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Additional Practice Location(s)

531 Davis Drive.
Newmarket ON  L3Y 6P5
Canada
Phone: (905) 853-4220
Fax: (416) 466-2949
County: Regional Municipality of York
Electoral District: 05

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 18 Jun 1973
Transfer of class of registration to: Independent Practice Certificate Effective: 18 Jun 1974
Transfer of class of certificate to: Restricted certificate Effective: 25 May 2017
Terms and conditions imposed on certificate by member Effective: 25 May 2017
Terms and conditions amended by Discipline Committee Effective: 25 Jul 2018

Practice Restrictions

Imposed By Effective Date Expiry Date Status  
Discipline Committee Effective: 25 Jul 2018 Active View Details [+]
            As from 12:00 p.m., July 25, 2018, by order of the Discipline Committee of the
            College of Physicians and Surgeons of Ontario, the following term, condition
            and limitation is imposed on the certificate of registration held by Dr. Havey
            Stephen Pasternak:

            Clinical Supervision 

            (a)   Within twenty (20) days of this Order, Dr. Pasternak shall retain a
                  College-approved clinical supervisor or supervisors (the "Clinical
                  Supervisor") with respect to his prescribing of narcotics and controlled
                  substances, who will sign an undertaking in the form attached hereto as
                  Schedule "A".

            (b)   Dr. Pasternak shall practise under the guidance of the Clinical
                  Supervisor for a period of twelve (12) months, commencing on the date
                  that the Clinical Supervisor is approved by the College ("Clinical
                  Supervision").  

            (c)   Clinical Supervision of Dr. Pasternak's prescribing of narcotics and
                  controlled substances shall contain the following elements:

            (d)   Throughout the entire period of Clinical Supervision, Dr. Pasternak shall
                  maintain a log of all prescriptions ("Prescribing Log") 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 "B"; and
                  the current regulatory lists are attached hereto as Schedule "C")
                  
                  (v)   All other Monitored Drugs (as defined under the Narcotics Safety
                        and Awareness Act, 2010, S.O. 2010, c. 22 as noted in Schedule
                        "D").
                  
            (e)   The Prescribing Log shall be in the form set out at Schedule "E", 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.
                  
            (f)   For an initial period of at least six (6) months, the Clinical Supervisor
                  will engage in a period of moderate-level supervision, during which time
                  the Clinical Supervisor will, at minimum: 

                  i.    review materials and have an initial in-person meeting with Dr.
                        Pasternak to discuss issues and practice recommendations;
                  ii.   meet with Dr. Pasternak at his Practice Location, or another
                        location approved by the College, once every two (2) months
                        thereafter;
                  iii.  review charts and prescriptions for at least twenty (20) of Dr.
                        Pasternak's patients at every meeting, which shall 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;
                  iv.   review charts and prescriptions for any new patient(s) to whom Dr.
                        Pasternak prescribed a Narcotic Drug, Narcotic Preparation,
                        Controlled Drug, Benzodiazepine and Other Targeted Substance or
                        other Monitored Drug at the next meeting with the Clinical
                        Supervisor following any such prescribing;
                  v.    keep a log of all charts reviewed with patient identifiers and sign
                        and date the Prescribing Log to confirm the charts that the
                        Clinical Supervisor has reviewed and discussed with Dr. Pasternak;
                  vi.   evaluate whether the assessment, clinical examination, risk
                        assessment for addiction and on-going management and follow up is
                        appropriate in all cases reviewed; 
                  vii.  discuss with Dr. Pasternak any concerns the Clinical Supervisor may
                        have arising from the chart review and make recommendations for
                        practice improvements or ongoing professional development;
                  viii. perform any other duties, such as reviewing other documents or
                        conducting interviews with staff or colleagues, that the Clinical
                        Supervisor deems necessary to Dr. Pasternak's Clinical Supervision;
                        and
                  ix.   submit written reports to the College at least once every two (2)
                        months, or more frequently if the Clinical Supervisor has concerns
                        about Dr. Pasternak's standard of practice;
                  
            (g)   After a minimum of six (6) months, and only upon recommendation by the
                  Clinical Supervisor and approval of the College, the level of supervision
                  may be reduced for the balance of the period of Clinical Supervision.

            (h)   Once permission is received from the College, Clinical Supervision shall
                  continue as described in paragraph (3)(f) above for the balance of the
                  period of Clinical Supervision, subject to the following two
                  modifications: meetings between Dr. Pasternak and his Clinical Supervisor
                  shall occur once every three (3) months, and written reports from the
                  Clinical Supervisor shall be submitted to the College at least once every
                  three (3) months, or more frequently if the Clinical Supervisor has
                  concerns about Dr. Pasternak's standard of practice.


            Other Elements of Clinical Supervision  

            (i)   Throughout the period of Clinical Supervision, Dr. Pasternak shall abide
                  by all recommendations of his Clinical Supervisor.

            (j)   If a person who has given an undertaking in Schedule "A" to this Order is
                  unable or unwilling to continue to fulfill its provisions, Dr. Pasternak
                  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.

            (k)   If Dr. Pasternak is unable to obtain a Clinical Supervisor as set out in
                  this Order, he will cease prescribing Narcotic Drugs, Narcotic
                  Preparations, Controlled Drugs, Benzodiazepines and Other Targeted
                  Substances and other Monitored Drugs until such time as he has obtained a
                  Clinical Supervisor acceptable to the College.

            (l)   If Dr. Pasternak is required to cease prescribing as a result of
                  paragraph (3)(k) above, this will constitute a term, condition or
                  limitation on his certificate of registration and that term, condition or
                  limitation will be included on the public register until such time as he
                  has obtained a Clinical Supervisor acceptable to the College.

            Reassessment of Practice 

            (m)   Approximately six (6) months after completion of the Clinical
                  Supervision, Dr. Pasternak shall undergo a reassessment of his practice
                  by a College-appointed assessor or assessors (the "Assessor"). The
                  Assessor shall report the results of the reassessment to the College.

            (n)   The reassessment may include (at the College's discretion) a review of a
                  minimum of twenty (20) of Dr. Pasternak's patient charts, direct
                  observation of Dr. Pasternak's practice, an interview with Dr. Pasternak,
                  interviews with colleagues and co-workers, and any other tools deemed
                  necessary by the College. Dr. Pasternak shall abide by all
                  recommendations made by the Assessor.

            (o)   Dr. Pasternak shall consent to the sharing of information among the
                  Assessor, the Clinical Supervisor and the College, as any of them deem
                  necessary or desirable in order to fulfill their respective obligations.

            Monitoring 

            (p)   Dr. Pasternak shall inform the College of each and every location where
                  he practices, in any jurisdiction (his "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.

            (q)   Dr. Pasternak shall cooperate with unannounced inspections of his
                  Practice Location(s) and patient charts and to any other activity the
                  College deems necessary in order to monitor his compliance with the
                  provisions of this Order.

            (r)   Dr. Pasternak 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 his compliance with the
                  terms of this Order.

            (s)   Dr. Pasternak shall be responsible for any and all costs associated with
                  implementing the terms of this Order.

Previous Hearings

Committee: Discipline
Decision Date: 25 Jul 2018
Summary:

On July 25, 2018 the Discipline Committee of the College of Physicians and Surgeons of Ontario 
(the College) found that Dr. Harvey Stephen Pasternak has committed an act of professional 
misconduct, in that he failed to maintain the standard of practice of the profession.  
 
Dr. Pasternak is a family physician practising medicine in Toronto. He received his medical degree 
at the University of Toronto in 1973 and his certificate of registration authorizing independent 
practice in Ontario in 1974. 
 
FAILURE TO MAINTAIN THE STANDARD OF PRACTICE - PATIENT A 
 
The College investigation began after receipt of information from an Emergency Room physician, 
practising in a hospital outside Toronto, that an adult female patient (“Patient A”) had been 
transported to the hospital by ambulance after a family member became concerned about a possible 
narcotics overdose. The Emergency Room physician expressed concern to the College regarding the 
amounts of narcotics in the possession of Patient A, which had been prescribed by Dr. Pasternak. 
      
An expert retained by the College to provide an opinion on the care provided by Dr. Pasternak to 
Patient A, concluded that Dr. Pasternak not meet the standard of practice in his care of Patient A, 
including in the following ways: 
 
 -  The patient was provided large doses of opioid and benzodiazepine medication from along with 
    dose escalations and changes to medication in the absence of a physical assessment and in the 
    absence of any documentation in the medical record. 
 -  Dr. Pasternak did not re-assess the patient to determine the effectiveness of the dose increases 
    and medication changes in order to support the ongoing prescribing of such large doses of 
    opioids with concurrent benzodiazepine medication. 
 -  Dr. Pasternak failed to assess the reasons for repeated early prescription refills of opioid 
    medication and by failing to do so did not fully assess for the possibility of drug diversion, 
    overuse and/or misuse. 
 -  Dr. Pasternak failed to maintain adequate medical records for the patient. 
 
In the expert’s opinion, Dr. Pasternak’s clinical care of Patient A potentially exposed the patient to 
harm or injury. 
 
FAILURE TO MAINTAIN THE STANDARD OF PRACTICE – 15 PATIENTS 
 
Following receipt the expert report, the College conducted a broader investigation of Dr. 
Pasternak’s prescribing practice. The expert reviewed fifteen patient charts and opined that the care 
provided by Dr. Pasternak did not meet the standard of practice in relation to the fifteen patients. In 
fourteen of the fifteen patients, Dr. Pasternak’s care potentially exposed the patient to harm or 
injury. In reviewing the fifteen patient charts, the expert noted amongst other things, that Dr. 
Pasternak failed to meet the standard of practice as follows: 
 
 -  Failing to document rationale for prescribing; 
 -  Failing to assess reasons for repeated early prescription refills and failure to fully assess the 
    possibility of diversion, overuse or misuse; 
 -  Failing to assess or re-assess, patients for potential adverse risks associated with big doses of 
    opioids and benzodiazepines including the risk of sedation, cognitive impairments and 
    overdose; 
 -  Providing large doses of opioid in the absence of physical assessments; and 
 -  Failure to maintain adequate medical records. 
DR. PASTERNAK’S CONDUCT SINCE THE COLLEGE’S INVESTIGATION  
 
Dr. Pasternak has no Discipline history with the College. Since the College investigation began, Dr. 
Pasternak completed two full-day interactive courses offered by the University of Toronto’s Faculty 
of Medicine as follows: 
 
 -  In May 2016, he completed the Medical Record Keeping Workshop.  
 -  In May 2017, he completed the Challenging Cases in Opioid Use and Misuse Workshop. 
     
On May 25, 2017, Dr. Pasternak voluntarily entered into an Undertaking, pending the disposition of 
this matter by the Discipline Committee. Dr. Pasternak undertook to practice under the guidance of 
a Clinical Supervisor, who reviews the charts for patients to whom Dr. Pasternak prescribes 
narcotics or controlled substances and makes regular reports to the College. Pursuant to the 
Undertaking, Dr. Pasternak retained a Clinical Supervisor who reported to the College confirming 
that Dr. Pasternak’s prescribing practices have improved and currently adhere to the Canadian 
Guideline for Opioids for Chronic Non-Cancer Pain. Specifically, the Clinical Supervisor has noted 
Dr. Pasternak’s use of the following practices which meet the standard of practice for prescribing: 
     
-    Recording patient identifiers; 
-    Completing the functional pain scale at visits; 
-    Using a pain scale to track patients’ complaints of pain; 
-    Having patients sign opioid treatment agreements and reviewing the agreements with them; 
-    Completing opioid risk assessment tools; 
-    Reviewing non-pharmacological approaches to pain control with patients; 
-    Documenting discussions of side effects;  
-    Recording morphine equivalents; 
-    Prescribing small/limited quantities; 
-    Documenting discussions about tapering to reduce dosage; and 
-    Booking follow up visits to assess pain control. 
 
Since the commencement of the investigations into Dr. Pasternak’s prescribing practices, the 
College has published a number of articles in Dialogue magazine about opioid prescribing with an 
aim to alerting the profession to the current opioid crisis and working with physicians to ensure 
appropriate and safe prescribing of opioids to patients who need them. The College has also 
published several articles regarding investigations into information about high prescribers received 
from the Narcotics Monitoring System and the remedial approach taken in the majority of cases.. 
 
Disposition 
 
On July 25, 2018, the Discipline Committee ordered that:  
 
  -  The Registrar to impose the following terms, conditions and limitations on Dr. Pasternak’s 
     certificate of registration: 
 
     Clinical Supervision  
      -  Within twenty (20) days of this Order, Dr. Pasternak shall retain a College-approved 
         clinical supervisor or supervisors (the “Clinical Supervisor”) with respect to his 
         prescribing of narcotics and controlled substances, who will sign an undertaking in the 
         form attached as Schedule “A” [to the Order]. 
 -  Dr. Pasternak shall practise under the guidance of the Clinical Supervisor for a period of 
    twelve (12) months, commencing on the date that the Clinical Supervisor is approved by 
    the College (“Clinical Supervision”).   
 -  Clinical Supervision of Dr. Pasternak’s prescribing of narcotics and controlled 
    substances shall contain the following elements: 
 -  Throughout the entire period of Clinical Supervision, Dr. Pasternak shall maintain a log 
    of all prescriptions (“Prescribing Log”) for: 
     -  Narcotic Drugs (from the Narcotic Control Regulations made under the Controlled 
        Drugs and Substances Act, S.C., 1996, c. 19); 
     -  Narcotic Preparations (from the Narcotic Control Regulations made under the 
        Controlled Drugs and Substances Act, S.C., 1996, c. 19); 
     -  Controlled Drugs (from Schedule G of the Regulations under the Food and Drugs 
        Act, S.C., 1985, c. F-27);  
     -  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 as Schedule “B” [to the Order]; and the 
        current regulatory lists are attached as Schedule “C” [to the Order]) 
     -  All other Monitored Drugs (as defined under the Narcotics Safety and Awareness 
        Act, 2010, S.O. 2010, c. 22 as noted in Schedule “D” [to the Order]). 
-   The Prescribing Log shall be in the form set out at Schedule “E” [to 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. 
-   For an initial period of at least six (6) months, the Clinical Supervisor will engage in a 
    period of moderate-level supervision, during which time the Clinical Supervisor will, at 
    minimum:  
     -  review materials and have an initial in-person meeting with Dr. Pasternak to discuss 
        issues and practice recommendations; 
     -  meet with Dr. Pasternak at his Practice Location, or another location approved by 
        the College, once every two (2) months thereafter; 
     -  review charts and prescriptions for at least twenty (20) of Dr. Pasternak’s patients at 
        every meeting, which shall 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; 
     -  review charts and prescriptions for any new patient(s) to whom Dr. Pasternak 
        prescribed a Narcotic Drug, Narcotic Preparation, Controlled Drug, Benzodiazepine 
        and Other Targeted Substance or other Monitored Drug at the next meeting with the 
        Clinical Supervisor following any such prescribing; 
     -  keep a log of all charts reviewed with patient identifiers and sign and date the 
        Prescribing Log to confirm the charts that the Clinical Supervisor has reviewed and 
        discussed with Dr. Pasternak; 
     -  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. Pasternak any concerns the Clinical Supervisor may have arising 
        from the chart review and make recommendations for practice improvements or 
        ongoing professional development; 
     -  perform any other duties, such as reviewing other documents or conducting 
        interviews with staff or colleagues, that the Clinical Supervisor deems necessary to 
        Dr. Pasternak’s Clinical Supervision; and 
     -  submit written reports to the College at least once every two (2) months, or more 
        frequently if the Clinical Supervisor has concerns about Dr. Pasternak’s standard of 
        practice; 
-   After a minimum of six (6) months, and only upon recommendation by the Clinical 
    Supervisor and approval of the College, the level of supervision may be reduced for the 
    balance of the period of Clinical Supervision. 
-   Once permission is received from the College, Clinical Supervision shall continue as 
    described in paragraph (3)(f) above for the balance of the period of Clinical Supervision, 
    subject to the following two modifications: meetings between Dr. Pasternak and his 
    Clinical Supervisor shall occur once every three (3) months, and written reports from the 
    Clinical Supervisor shall be submitted to the College at least once every three (3) 
    months, or more frequently if the Clinical Supervisor has concerns about Dr. Pasternak’s 
    standard of practice. 
     
Other Elements of Clinical Supervision   
-   Throughout the period of Clinical Supervision, Dr. Pasternak shall abide by all 
    recommendations of his Clinical Supervisor. 
-   If a person who has given an undertaking in Schedule “A” to the Order is unable or 
    unwilling to continue to fulfill its provisions, Dr. Pasternak 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. Pasternak is unable to obtain a Clinical Supervisor as set out in this Order, he will 
    cease prescribing Narcotic Drugs, Narcotic Preparations, Controlled Drugs, 
    Benzodiazepines and Other Targeted Substances and other Monitored Drugs until such 
    time as he has obtained a Clinical Supervisor acceptable to the College. 
-   If Dr. Pasternak is required to cease prescribing as a result of paragraph (3)(k) above, 
    this will constitute a term, condition or limitation on his certificate of registration and 
    that term, condition or limitation will be included on the public register until such time 
    as he has obtained a Clinical Supervisor acceptable to the College. 
     
Reassessment of Practice  
-   Approximately six (6) months after completion of the Clinical Supervision, Dr. 
    Pasternak shall undergo a reassessment of his 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. Pasternak’s patient charts, direct observation of Dr. Pasternak’s 
    practice, an interview with Dr. Pasternak, interviews with colleagues and co-workers, 
    and any other tools deemed necessary by the College. Dr. Pasternak shall abide by all 
    recommendations made by the Assessor. 
     -   Dr. Pasternak shall consent to the sharing of information among the Assessor, the 
         Clinical Supervisor and the College, as any of them deem necessary or desirable in order 
         to fulfill their respective obligations. 
          
     Monitoring  
     -   Dr. Pasternak shall inform the College of each and every location where he practices, in 
         any jurisdiction (his “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. Pasternak shall cooperate with unannounced inspections of his Practice Location(s) 
         and patient charts and to any other activity the College deems necessary in order to 
         monitor his compliance with the provisions of this Order. 
     -   Dr. Pasternak 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 his 
         compliance with the terms of this Order. 
     -   Dr. Pasternak shall be responsible for any and all costs associated with implementing the 
         terms of this Order. 
          
-   Dr. Pasternak attend before the panel to be reprimanded. 
     
-   Dr. Pasternak pay to the College its costs of this proceeding in the amount of $10,180 within 
    thirty (30) days from the date of this Order.

Decision: Download Full Decision (PDF)
Hearing Date(s): July 25, 2018