As from May 7, 2021, the following are imposed as terms, conditions and limitations on the certificate of registration held by Dr. Siva Subramaniam Murugappan in accordance with an undertaking and consent given by Dr. Murugappan to the College of Physicians and Surgeons of Ontario:
UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
("Undertaking")
of
DR. SIVA SUBRAMANIAM MURUGAPPAN
("Dr. Murugappan")
to
COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
(the "College")
A. PREAMBLE
(1) In this Undertaking:
"Clinical Services" means consultations, office clinics, follow-up visits, case conferences, and telephone calls with patients;
"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;
"ICR Committee" means the Inquiries, Complaints and Reports Committee of the College;
"Minor Surgery/Surgeries" means the excision of lumps and bumps, closure of skin wounds and lacerations, dressings and dressing changes and procedures under local anesthesia;
"OHIP" means the Ontario Health Insurance Plan;
"Public Register" means the College's register that is available to the public.
(2) I, Dr. Murugappan, certificate of registration number 82089, am a member of the College.
(3) I, Dr. Murugappan, acknowledge that I previously entered into an undertaking with the College dated January 12, 2019 ("the January 2019 undertaking") regarding my return to surgical practice. This Undertaking replaces the January 2019 undertaking.
B. UNDERTAKING
(4) I, Dr. Murugappan, undertake to abide by the provisions of this Undertaking, effective immediately.
(5) Practice Restrictions
(a) I, Dr. Murugappan, undertake that my practice will be restricted to:
(i) Clinical services;
(ii) Minor surgery/surgeries; and
(iii) Endoscopy, excluding endoscopic retrograde cholangiopancreatography (ERCP), and in accordance with the terms of Clinical Supervision outlined in section (6) below. I will ensure that for any endoscopy procedure I perform, in the event of a complication requiring surgical intervention, I will not perform the surgery and instead, will refer the patient to the appropriate service.
(6) Clinical Supervision - Endoscopy
(a) I, Dr. Murugappan, undertake to practise under the following terms of Clinical Supervision for endoscopy:
(i) I will practice under the guidance of a clinical supervisor or clinical supervisors acceptable to the College (the "Clinical Supervisor" or "Clinical Supervisors") until I have completed a minimum of twenty (20) endoscopies, which shall be a combination of upper gastrointestinal endoscopies and colonoscopies. The endoscopies shall be completed over a period of four (4) weeks and a maximum of two (2) to three (3) procedure days. In order to qualify as a completed endoscopy, I shall perform the entire procedure from start to finish;
(ii) I will be the primary surgeon for endoscopies under the direct observation of a Clinical Supervisor who will be in the procedure room at all times and who will be the Most Responsible Physician (MRP) for all patient care;
(iii) Once a minimum of twenty (20) endoscopies have been performed by me, if the Clinical Supervisor recommends and the College approves, I may practice independently in endoscopy. Clinical Supervision will only end upon College approval.
(b) I, Dr. Murugappan, acknowledge that I have reviewed the Clinical Supervisor's undertaking, attached hereto as Appendix "A", and understand what is required of the Clinical Supervisor, including providing a report to the College at the end of Clinical Supervision.
(c) I, Dr. Murugappan, undertake to cooperate fully with the Clinical Supervision of my practice, conducted under the term of this Undertaking and Appendix "A" to this Undertaking, and to abide by the recommendations of my Clinical Supervisor, including but not limited to, any recommended practice improvements and ongoing professional development.
(d) I, Dr. Murugappan, undertake to ensure that Appendix "A" to this Undertaking is signed and delivered to the College within fourteen (14) days of the date I execute this Undertaking.
(e) I, Dr. Murugappan, 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 seven (7) 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.
(f) I, Dr. Murugappan, acknowledge that if I am unable to obtain a Clinical Supervisor on the provisions set out under sections (6)(d) and/or (e) above, the College's public register will be updated to reflect that I will not perform endoscopies until such time as I have obtained a Clinical Supervisor acceptable to the College.
(7) Monitoring
(a) I, Dr. Murugappan, undertake to inform the College of each and every location at which I practise or have privileges, including, but not limited to, any hospitals, clinics, offices, and any Independent Health Facilities with which I am affiliated, in any jurisdiction (collectively my "Practice Location" or "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. Murugappan, undertake that I 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) I, Dr. Murugappan, 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.
(d) I, Dr. Murugappan, acknowledge that I have executed the OHIP consent form, attached hereto as Appendix "B".
C. ACKNOWLEDGEMENT
(8) I, Dr. Murugappan, acknowledge that all appendices attached to or referred to in this Undertaking form part of this Undertaking.
(9) I, Dr. Murugappan, 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. Murugappan, 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. Murugappan, 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").
(12) I, Dr. Murugappan, 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 a referral of specified allegations to the Discipline Committee of the College.
(13) I, Dr. Murugappan, 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. Murugappan, acknowledge that, during the time period that this Undertaking remains in effect, this Undertaking shall be posted on the Public Register.
(b) I, Dr. Murugappan, 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 I remain under Clinical Supervision for endoscopies:
Dr. Murugappan's practice is restricted to:
(i) Clinical services;
(ii) Minor surgery; and
(iii) Endoscopy, excluding endoscopic retrograde cholangiopancreatography (ERCP), until he has been approved by the College to return to independent practice.
(c) I, Dr. Murugappan, acknowledge that, in addition to this Undertaking being posted in accordance with section (14)(a) above, once I have completed the Clinical Supervision for endoscopies and am practicing independently in endoscopy, the following summary shall be posted on the Public Register during the time period that this Undertaking remains in effect:
Dr. Murugappan's practice is restricted to:
(i) Clinical services;
(ii) Minor surgery; and
(iii) Endoscopy, excluding endoscopic retrograde cholangiopancreatography (ERCP).
D. CONSENT
(15) I, Dr. Murugappan, give my irrevocable consent to the College to provide the following information to all Clinical Supervisors:
(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.
(16) I, Dr. Murugappan, give my irrevocable consent to the College to provide all Chiefs of Staff with any information the College has that led to the circumstances of my entering into this Undertaking and/or any information arising from the monitoring of my compliance with this Undertaking.
(17) I, Dr. Murugappan, give my irrevocable consent to all Clinical Supervisors and Chiefs of Staff, to disclose to the College, and to one another, any of the following:
(a) any information relevant to this Undertaking;
(b) any information relevant to the provisions of the Clinical Supervisor's undertaking set out at Appendix "A" to this Undertaking; and/or
(c) any information relevant for the purposes of monitoring my compliance with this Undertaking.