Discipline Decisions (Winter 2021)

• He dispensed less than the full quantity of the drug prescribed for the patients, [Patient 1 and Patient 2], without the consent of the patient or other authorization, notification to the prescriber and/or documentation of any valid reason for doing so, as required;
• He charged excessive dispensing fees for dispensing the drug prescribed for the patients, [Patient 1 and Patient 2], on a daily basis rather than the full quantity prescribed, without the consent of the patient or other authorization, notification to the prescriber and/or documentation of any valid reason for doing so.

In particular, the Panel found, with respect to each patient, that he:

• Failed to maintain the standard of practice of the profession;
• Failed to provide an appropriate level of supervision to a person whom he was professionally obligated to supervise;
• Charged a fee or amount that was excessive in relation to the service or product provided;
• Contravened the Pharmacy Act, the Drug and Pharmacies Regulation Act, the Regulated Health Professions Act, 1991, the Narcotics Safety and Awareness Act, 2010, the Drug Interchangeability and Dispensing Fee Act or the Ontario Drug Benefit Act or the regulations under those Acts, and in particular,
  • sections 5 and/or 6 of the Ontario Drug Benefit Act, R.S.O. 1990, c.O.10, as amended, and/or
  • sections 18 and/or 27 of Ontario Regulation 201/96, as amended;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members as dishonourable and unprofessional.

The Panel imposed an Order which included as follows:

1. A reprimand;
2. Directing the Registrar to impose the following specified terms, conditions or limitations on the Member’s certificate of registration, and in particular,

a. the Member shall successfully complete the College’s Jurisprudence e-learning modules and examination, at his own expense and within six (6) months of the date of this Order;

b. the Member shall complete a mentorship program within six (6) months of resuming responsibilities as a Designated Manager at any pharmacy, with the Member to:

i. retain, at the Member’s expense, a practice mentor acceptable to the College, within one (1) month of the date on which the Member advises the College that he intends to act as the Designated Manager of a pharmacy in Ontario;

ii. meet at least three (3) times with the practice mentor for the purpose of reviewing the Member’s practice and identifying areas in the Member’s practice as a Designated Manager that require remediation; to this end, the Member shall provide the practice mentor with the following documents related to this proceeding:

1. copies of the Notices of Hearing;
2. a copy of the Agreed Statement of Facts;
3. a copy of this Joint Submission on Order;
4. a copy of the Decision and Reasons, when available; and/or
5. a copy of the Order, if applicable and when available;

iii. develop a learning plan to address the areas requiring remediation;

iv. demonstrate to the practice mentor that the Member has achieved progress in meeting the goals established in the learning plan;

v. require the practice mentor to report the results of the mentorship meetings to the Manager, Conduct Operations, at the College, after their completion, which shall be no later than six (6) months from the date that the Member resumes the duties of the Designated Manager at any pharmacy;

3. Directing the Registrar to suspend the Member’s Certificate of Registration for a period of six (6) months, with one (1) month of the suspension to be remitted on condition the Member complete the remedial training program specified in paragraph 2(a), above. The suspension shall commence on November 10, 2020 and continue without interruption until April 9, 2021, inclusive. If the remitted portion of the suspension has to be served, the further suspension shall commence on May 11, 2021 and continue without interruption until June 10, 2021, inclusive, unless the time for completing the remedial steps in paragraph 2(a), above, is extended by the Registrar, in which case, the date the remitted portion of the suspension shall commence, if required, shall be adjusted accordingly;

4. Costs to the College in the amount of $15,000.

In its reprimand, the Panel expressed its deep disappointed to see Mr. Syed before the Discipline Committee again. The Panel noted that practicing pharmacy in Ontario is a privilege and not a right; with this privilege comes a responsibility to abide by all of the pharmacy regulations and rules, not just the ones that Mr. Syed chooses to follow.

The Panel related that it was extremely concerned that Mr. Syed continued inappropriate conduct despite the fact that he made submissions to the College in January 2018 that he had rectified his practice. His actions demonstrated ongoing poor judgement and a blatant disregard for the regulatory requirements of a pharmacist in Ontario.

The Panel observed that this inappropriate conduct cannot continue, especially given that Mr. Syed provides pharmacy services to vulnerable communities and patients. The result of his misconduct is that he has let down the public and the pharmacy profession.

The Panel expressed its view that, moving forward, Mr. Syed will not jeopardize his opportunity to practice by presenting himself again in front of a panel of the Discipline Committee.

• Conducted sterile compounding of atropine eye drops at a facility not accredited for that purpose;
• Kept products in the compounding area that were expired and/or not properly labelled;
• Failed to keep the compounding area in an acceptable state of cleanliness and organization.

In particular, the Panel found that he:

• Failed to maintain a standard of practice of the profession;
• Contravened sections 139 and 146 of the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H.4;
• Engaged in conduct or performed an act or acts relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members of the profession as unprofessional.

The Panel imposed an Order, as follows:

1. A reprimand;
2. That the Registrar is directed to impose specified terms, conditions or limitations on the Member’s certificate of registration, and in particular:

a. That the Member successfully complete an ethics course with Gail Siskind, or another professional ethics consultant chosen by the College, to be designed by the consultant, for the purpose of addressing the professional and ethical obligations arising in the Member’s case, within 12 months of the date of this Order. The following terms shall apply to the course:

i. the number of sessions shall be at the discretion of the consultant, but shall be at least two meetings;

ii. the manner of attendance at the session(s) (e.g. in person, via Skype, etc.) is a matter to be discussed in advance between the Member and the consultant, but shall ultimately be at the discretion of the consultant;

iii. the Member shall be responsible for the cost of the course;

iv. the Member shall provide to the consultant, in advance of the course, a copy of the Agreed Statement of Facts tendered before the Panel in this hearing;

v. Successful completion of the course will include completion of an essay, acceptable to the Registrar, addressing the objectives of professional regulation and the importance to the public interest of complying with a practitioner’s regulatory obligations;

vi. The essay shall be at least 1000 words in length. The Member shall be responsible for the cost of review by the consultant to assist the Registrar to determine whether the essay is acceptable, up to a maximum of $500;

vii. the Member will request a report from the consultant confirming that the Member has successfully completed the course to the satisfaction of the consultant, and the Member will provide a copy of the report and the essay referred to above to the College within 12 months of the date of this Order.

3. That the Registrar is directed to suspend the Member’s Certificate of Registration for a period of three months with one month of the suspension be remitted on condition that the Member complete the remedial training as specified in subparagraph 2(a). The suspension shall commence on November 23, 2020 and shall continue until January 22, 2021, inclusive. If the remitted portion of the suspension is required to be served by the Member because he fails to complete the remedial training as specified in subparagraph 2(a), that portion of the suspension shall commence on January 23, 2022, and shall continue until February 22, 2022, inclusive, unless the time for completing the remedial training in subparagraph 2(a), above is extended by the Registrar, in which case, the date on which the remitted portion of the suspension shall commence, if required, shall be adjusted accordingly.

4. Costs to the College in the amount of $8,000.

In its reprimand, the Panel expressed disappointment the events that brought Mr. Lin before them. The Panel noted that Mr. Lin is a member of the profession of pharmacy; integrity and trust are paramount to the profession in providing care to the public.

The Panel observed that the practice of pharmacy is a privilege, which carries with it significant obligations to the public, the profession, and oneself. The result of Mr. Lin’s professional misconduct is that he put patients at risk and cast a shadow over his integrity. The Panel expressed its hope that this hearing has given Mr. Lin the opportunity to pause for reflection, particularly in the area of sterile compounding. The Panel pointed out that enhanced vigilance in sterile compounding is necessary to meet current standards, which are there to protect the public and ensure a high quality product.

The Panel relayed its expectation that, moving forward, Mr. Lin will use this opportunity to remediate and will not be present before a Panel of the Discipline Committee again.

• Sold by retail and/or dispensed prescription drugs to patients in the U.S. without a lawful and/or otherwise valid prescription;
• Contravened the OCP Policy on Prescriptions-Out of Country, dated January-February 2003.

In particular, the Panel found that he:

• Failed to maintain a standard of practice of the profession;
• Contravened the Pharmacy Act, the Drug and Pharmacies Regulation Act, the Regulated Health Professions Act, 1991, or the regulations under those Acts, and in particular, sections 155 and/or 158 of the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H-4, as amended;
• Contravened, while engaged in the practice of pharmacy, any federal or provincial law or municipal by-law with respect to the distribution, sale or dispensing of any drug or mixture of drugs, and in particular, sections C.01.041 and/or C.01.042 of the Food and Drug Regulations, C.R.C., c. 870, as amended;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all circumstances, would reasonably be regarded by members as dishonourable and unprofessional.

The Panel imposed an Order, as follows:

1. A reprimand;
2. Directing the Registrar to impose the following specified terms, conditions or limitations on the Member’s Certificate of Registration, and in particular,

a. requiring the Member to complete successfully, at his own expense and within twelve (12) months of the date of this Order, the ProBE Program on Professional/Problem Based Ethics for Healthcare Professionals, with an unconditional pass; and

b. restricting the Member from being the Designated Manager at any pharmacy until he has completed the ProBE Program as specified above.

3. Directing the Registrar to suspend the Member’s Certificate of Registration for a period of four (4) months, with one (1) month of the suspension to be remitted on condition the Member compete the remedial training program as specified in paragraph 2(a) above. The suspension shall commence on November 26, 2020 and continue without interruption until February 25, 2021, inclusive. If the remitted portion of the suspension has to be served because the Member fails to complete the remedial training program as specified in paragraph 2(a) above, the further suspension shall commence on November 29, 2021 and continue without interruption until December 28, 2021, inclusive, unless the time for completing the remedial steps in paragraph 2(a) above is extended by the Registrar, in which case, the date the remitted portion of the suspension shall commence, if required, shall be adjusted accordingly.

4. Costs to the College in the amount of $10,000.

In its reprimand, the Panel noted that pharmacy is a self-regulated profession, the practice of which is a privilege, and which comes with significant obligations to the public, the profession and oneself.

The Panel observed that, through his actions, Mr. Shah failed in his obligations as a pharmacist and as a Designated Manager. The role of the Designated Manager is one of heavy responsibility. It includes the obligation to practise pharmacy at the highest standard, and to ensure that the pharmacy operates at the highest standard. The Panel expressed its view that, as the Designated Manager, Mr. Shah should have known that what he was doing was wrong.

The Panel pointed out that the suspension of Ms. Shah’s Certificate of Registration is essential to protect the public and to deter him from engaging in this type conduct in the future. The remediation ordered today is intended to provide him with an opportunity for rehabilitation of his conduct in his pharmacy practice.

The Panel related that it does not expect to see Mr. Shah again before the Discipline Committee of the Ontario College of Pharmacists.

• Failed to adequately supervise pharmacy assistants in the preparation of methadone and/or buprenorphine doses, and in doing so failed to comply with the National Association of Pharmacy and Regulatory Authorities Model Standards of Practice for Pharmacists;
• Improperly delegated responsibility for supervising the administration of methadone and/or buprenorphine doses to pharmacy assistants, and in doing so failed to comply with CAMH’s Opioid Agonist Maintenance Treatment: A Pharmacist’s Guide to Methadone and Buprenorphine for Opioid Use Disorder, and/or the Ontario College of Pharmacists’ Fact Sheet: Key Requirements for Methadone Dispensing as required by the Ontario College of Pharmacists’ Opioid Policy;
• Failed to adequately supervise pharmacy assistants [Person A] and/or [Person B] and/or [Person C] in the preparation of methadone doses for patients [Patient 1] and/or [Patient 2] and/or [Patient 3] and/or [Patient 4], from on or about January 3, 2019, to on or about May 30, 2019; and/or
• Signed the patient methadone logs of patients [Patient 1] and/or [Patient 2] and/or [Patient 3] and/or [Patient 4], indicating that he had observed the administration of their methadone doses when he had not, from on or about January 3, 2019, to on or about May 30, 2019, and/or he signed a daily dose log indicating he observed the administration of a buprenorphine dose for patient [Patient 5] on or about July 25, 2019, when he had not.

In particular, the Panel found that he:

• Failed to maintain standards of practice of the profession;
• Failed to provide an appropriate level of supervision to persons for whom he was professionally obligated to supervise;
• Falsified records relating to his practice or a person’s health record;
• Signed or issued, in his professional capacity, a document that he knew or ought to have known contained a false or misleading statement;
• Engaged in conduct or performed acts that, having regard to all the circumstances, would reasonably be regarded by members of the profession as unprofessional and dishonourable.

The Panel imposed an Order, as follows:

1. A reprimand;

2. Directing the Registrar to impose specified terms, conditions or limitation on the Member’s Certificate of Registration, and in particular:

a. That the Member shall complete successfully, at his own expense and with 12 months of the date of the Order:

i. The ProBE Program on Professional/Problem Based Ethics for healthcare professionals, with an unconditional pass;

ii. The Ontario College of Pharmacists’ Jurisprudence Exam;

iii. The CAMH Opioid Use Disorder Treatment (OUDT) Course;

iv. The Ontario College of Pharmacists’ Online Designated Manager e-Learning module;

b, that the Member shall be prohibited from acting as a Designated Manager in any pharmacy, until such time as the Member has successfully completed all the remedial training as specified in paragraph 2(a), above

3. Directing the Registrar to suspend the Member’s Certificate of Registration for a period of three (3) months, with one (1) month of the suspension to be remitted on condition that the Member completes the remedial training as specified in paragraph 2(a), above. The suspension shall commence on the date of this Order and shall continue for two (2) months, without interruption. If the remitted portion of the suspension is required to be served by the Member because he fails to complete the remedial requirements specified in paragraph 2(a), that portion of the suspension shall commence on the date that is twelve (12) months from the date of this order and continue without interruption for 30 days, inclusive. If the time for completing the remedial steps in paragraph 2(a), above, is extended by the Registrar, the date on which the remitted portion of the suspension shall commence, if required, shall be adjusted accordingly.

4. Costs to the College in the amount of $10,000.

In its reprimand, the Panel noted that Pharmacy is a self-regulated profession, the practice of which is a privilege, and which comes with significant obligations to the public, the profession, and oneself.

The Panel observed that pharmacists are trusted to act in the best interests of the public, and Mr. Mangalji’s actions put the public at risk due to a lack of supervision of staff involved in the provision of opioid agonist therapy. The responsibility for dispensing methadone and buprenorphine safely is incumbent on the pharmacist and Mr. Mangalji failed in fulfilling that responsibility.

The Panel noted that Mr. Mangalji did not adhere to the profession’s standards of practice, and that this is even more reprehensible in that he was serving a vulnerable patient population.

The Panel pointed out that despite the direction given by Practice Advisors, Mr. Mangalji continued to follow the same procedures that were singled out as unacceptable. He failed in his obligations as a pharmacist and as a Designated Manager by not following advice issued by his regulator and by not ensuring applicable standards of practice were adhered to.

The Panel expressed its expectation that, as a pharmacist, Mr. Mangalji will always have the best interest of the public and patients as his priority, and that he will not appear before a discipline panel again.

• Transmitted false electronic claims to [Insurance Claims Adjudicator] in respect of a Pharmacy patient, [Patient], from on or about August 18, 2017, to on or about January 28, 2019.

In particular, the Panel found that he:

• Failed to maintain a standard of practice of the profession;
• Falsified a record related to his practice or a person’s health record;
• Signed or issued in his professional capacity, a document that he knew or ought to have known contained a false a misleading or statement;
• Submitted an account or charge for services or products that he knew or ought to have known was false or misleading;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members as dishonourable and unprofessional.

The Panel imposed an Order, as follows:

1. A reprimand;
2. Directing the Registrar to impose specified terms, conditions or limitations on the Member’s certificate of registration requiring that the Member successfully complete, at his own expense, the ProBe Program on Professional/Problem Based Ethics for healthcare professionals, with an unconditional pass, within twelve (12) months of December 14, 2020;
3. Directing the Registrar suspend the Member’s Certificate of Registration for a period of four (4) months, with one (1) month of the suspension to be remitted on condition that the Member completes the remedial training as specified in paragraph 2, above. The suspension shall commence on the date of this Order and shall continue for three (3) months, without interruption. If the remitted portion of the suspension is required to be served by the Member because he fails to complete the remedial requirement specified in paragraph 2, that portion of the suspension shall commence on the date that is twelve (12) months from the date of this Order and shall continue for one (1) month, inclusive. If the time for completing the remedial steps in paragraph 2, above, is extended by the Registrar, the date on which the remitted portion of the suspension shall commence, if required, shall be adjusted accordingly;
4. Costs to the College in the amount of $10,000.

In its reprimand, the Panel noted that pharmacy is a self-regulated profession, the practice of which is a privilege, and which comes with significant obligations to the public, the profession and oneself. Through his actions, Mr. Al Hasan failed in his obligations as a pharmacist and as a Designated Manager. He breached the standards of practice of the profession, his ethical obligations, regulations, and pharmacy legislation.

The Panel pointed out that the role of the Designated Manager is one of heavy responsibility. It includes the obligation to practise pharmacy at the highest standard and to ensure that the pharmacy operates at the highest standard. Mr. Al-Hasan engaged in inappropriate conduct over a 17 month period. As the Designated Manager, he should have known that what he was doing was wrong.

The Panel related that the suspension of Mr. Al Hasan’s Certificate of Registration is essential to protect the public and is to deter him from engaging in this type of conduct in the future. The remediation ordered is intended to provide him with an opportunity for rehabilitation of his conduct in his pharmacy practice.

The Panel expressed its expectation that Mr. Al Hasan will not appear again before a panel of the Discipline Committee of the Ontario College of Pharmacists.

• Charged third party payers for drugs not dispensed, for one or more of certain identified drugs, from on or about May 1, 2017 to on or about June 1, 2019;
• Submitted and/or permitted, consented to or approved, either expressly or by implication, the submission of accounts or charges that he knew were false or misleading to the Ontario Drug Benefit program, [Claims Adjudicator A] and/or [Claims Adjudicator B] through the Pharmacy, for one or more of certain identified drugs, from on or about May 1, 2017 to on or about June 1, 2019;
• Falsified and/or permitted, consented to or approved, either expressly or by implication, the falsification of pharmacy records relating to his practice in relation to the dispensing of and/or claims made through the Ontario Drug Benefit program, [Claims Adjudicator A] and/or [Claims Adjudicator B] through the Pharmacy, for one or more of certain identified drugs, from on or about May 1, 2017 to on or about June 1, 2019;
• Signed or issued in his professional capacity, and/or permitted, consented to or approved, either expressly or by implication, the signing or issuing of a document that he knew or ought to have known contained a false or misleading statement including documents in relation to the dispensing of and/or claims made through the Ontario Drug Benefit program, [Claims Adjudicator A] and/or [Claims Adjudicator B] through the Pharmacy, for one or more of certain identified drugs, from on or about May 1, 2017 to on or about June 1, 2019;
• Submitted an account or charge for services or products that he knew or ought to have known was false or misleading with respect to claims made through the Ontario Drug Benefit program, [Claims Adjudicator A] and/or [Claims Adjudicator B] through the Pharmacy, for one or more of certain identified drugs, from on or about May 1, 2017 to on or about June 1, 2019;
• Charged a fee or amount that is excessive in relation to the service or product provided, with respect to claims made through the Ontario Drug Benefit program, [Claims Adjudicator A] and/or [Claims Adjudicator B] through the Pharmacy, for one or more of certain identified drugs, from on or about May 1, 2017 to on or about June 1, 2019;
• Failed to ensure that the Pharmacy complied with all legal and professional requirements, including but not limited to requirements regarding record keeping, documentation, and billing the Ontario Drug Benefit program, [Claims Adjudicator A] and/or [Claims Adjudicator B], from on or about May 1, 2017 to on or about June 1, 2019; and/or
• Repeatedly dispensed more than 30 tablets or capsules for a one month supply of medication, including but not limited to patients [A], [B], [C], [D], [E] and [F], contrary to the NAPRA Model Standards of Practice for Canadian Pharmacists which require pharmacists to ensure that quantities dispensed are correct.

In particular, the Panel found that he:

• Failed to maintain a standard of practice of the profession;
• Failed to keep records as required respecting his patients or practice;
• Falsified a record relating to his practice or a person’s health record;
• Signed or issued, in his professional capacity, a document that he knew or ought to have known contained a false or misleading statement;
• Submitted an account or charge for services or products that he knew or ought to have known was false or misleading;
• Charged a fee or amount that was excessive in relation to the service or product provided;
• Contravened the Pharmacy Act, the Drug and Pharmacies Regulation Act, the Regulated Health Professions Act, 1991, the Narcotics Safety and Awareness Act, 2010, the Drug Interchangeability and Dispensing Fee Act or the Ontario Drug Benefit Act or the regulations under those Acts, in particular but not limited to:
  • sections 155 and 156 of the Drug and Pharmacies Regulation Act; and/or
  • sections 5, 6 and 15 of the Ontario Drug Benefit Act;
• Contravened any federal, provincial or territorial law or municipal by-law, i. with respect to the distribution, purchase, sale, or dispensing or prescribing of any drug or product, the administering of any substance, or the piercing of the dermis, ii. whose purpose is to protect or promote public health, or iii. that is otherwise relevant to the member’s suitability to practise, in particular but not limited to:
  • sections 155 and 156 of the Drug and Pharmacies Regulation Act; and/or
  • sections 5, 6 and 15 of the Ontario Drug Benefit Act;
• Permitted, consented to, approved, counselled or assisted, whether expressly or by implication, the commission of an offence against any Act relating to the practice of pharmacy or the sale of drugs, in particular but not limited to:
  • sections 155 and 156 of the Drug and Pharmacies Regulation Act; and/or
  • sections 5, 6 and 15 of the Ontario Drug Benefit Act;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable and unprofessional.

Mr. Varghese agreed to permanently resign as a member of the College, effective December 15, 2020, while a discipline hearing into the allegations of professional misconduct against him was pending before the Discipline Committee.

The Panel imposed an Order as follows:

1. A reprimand;
2. Costs to the College in the amount of $10,000.00.

In its reprimand, the Panel expressed its concern with the seriousness of the allegations and the conduct that Mr. Varghese admitted to engaging in. The Panel noted that members of the profession would find his conduct disgraceful, dishonorable and unprofessional, and that the Panel found it necessary to impress upon Mr. Varghese the seriousness of his misconduct.

The Panel indicated that members of the public and patients hold the pharmacy profession in high regard. As such, it is expected that pharmacists conduct themselves with the highest degree of professionalism, integrity, respect, and trust.

The Panel pointed out that pharmacists are expected to comply with their professional, legal, and ethical obligations, and the standards of practice of this profession. Mr. Varghese failed to meet those obligations. His conduct was totally unacceptable, even reprehensible. Of particular concern to the Panel was the fact that his misconduct involved theft from at least three different drug plans, including the Ontario Drug Benefit Plan. Throughout this hearing, he did not demonstrate to the Panel any remorse other than simply agreeing that his actions amounted to professional misconduct. The Panel related that this does not diminish the moral failings that he has demonstrated through his actions.

The Panel expressed its hope that this hearing has given Mr. Varghese the opportunity to pause for reflection. His resignation does not negate the outcomes of his conduct and the obligations of a regulated health professional.

The Panel observed that the practice of Pharmacy is a privilege that carries with it significant obligations to the public, the profession, and to oneself. The result of Mr. Varghese’s professional misconduct is that he has eroded the public trust in the pharmacy profession and cast a shadow over his own integrity.

• Failed to keep records as required by the Medication Procurement and Inventory Management Policy with respect to the inventory of narcotics and controlled drugs, including with respect to controlled substances used in compounding and expired and patient-returned substances;
• Failed to maintain security of narcotics and other controlled drugs, specifically with respect to expired and patient-returned medications;
• Failed to maintain accurate records of purchases, sales and remaining inventory for narcotics and other controlled drugs; and/or
• Failed to make timely reports of losses of narcotics and other controlled drugs to Health Canada, specifically with respect to reconciliations conducted in 2018.

In particular, the Panel found that she:

• Failed to maintain a standard of practice of the profession;
• Failed to keep records as required;
• Contravened a federal or provincial law or municipal by-law with respect to the distribution, sale or dispensing of any drug or mixture of drugs, including:
  • the Narcotic Control Regulations, sections 40, 42 and/or 43, under the Controlled Drugs and Substances Act, S.C. 1996, c. 19; and/or
  • the Food and Drug Regulations, sections G.03.010, G.03.012, G.03.013 and/or G.03.015, under the Food and Drugs Act, R.S.C. 1985 c.F-27; and/or
  • ss. 72 and 75 of the Benzodiazepines and Other Targeted Substances Regulation;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members of the profession as unprofessional.

The Panel imposed an Order, as follows:

1. A reprimand;

2. That the Registrar is directed to impose specified terms, conditions or limitations on the Member’s certificate of registration, and in particular:

a.That the Member complete an ethics course with Dr. Erika Abner, or another professional ethics consultant chosen by the College, to be designed by the consultant, for the purpose of addressing the professional and ethical obligations arising in the Member’s case, within 12 months of the date of this Order, or provide proof that she has completed it within the 12 months preceding the date of this Order. The following terms shall apply to the course:

i. the number of sessions shall be at the discretion of the consultant, but shall be at least two meetings;

ii.the manner of attendance at the session(s) (e.g. in person, via Skype, etc.) is a matter to be discussed in advance between the Member and the consultant, but shall ultimately be at the discretion of the consultant;

iii. the Member shall be responsible for the cost of the course;

iv. the Member will request a report from the consultant confirming that the Member has completed the course to the satisfaction of the consultant, and provide the report to the College.

b. That the Member complete successfully, at her own expense, within twelve months of the date of this Order, the Fundamentals of Addiction online course, offered by the Centre for Addiction and Mental Health.

c. That the Member:

i. retain, at the Member’s expense, a practice mentor acceptable to the College, within six (6) months of the date of this Order;

ii. meet at least two (2) times with the practice mentor, at the mentor’s place of practice, for the purpose of reviewing the Member’s practice with respect to protecting against narcotics loss and theft, and identifying areas in the Member’s practice with respect to these issues that require remediation; to this end, the Member shall provide the practice mentor with the following documents related to this proceeding:

1. a copy of the Notice of Hearing;

2. a copy of the Agreed Statement of Facts;

3. a copy of this Joint Submission on Order;

4. a copy of the Report of Investigation; and

5. a copy of the Decision and Reasons, when available.

iii. develop a learning plan to address the areas requiring remediation;

iv. demonstrate to the practice mentor that the Member has achieved success in meeting the goals established in the learning plan;

v. provide to the practice mentor two reconciliations of narcotics, controlled drugs and targeted substances, which must be deemed acceptable by the practice mentor; and

vi. require the practice mentor to report the results of the mentorship meetings, including the provision of the two reconciliations addressed in paragraph 2(c)(v), above, to the College after their completion, which shall be no later than eighteen (18) months from the date of this Order.

d. That the Member shall be prohibited, for a period of two years from the date of this Order, from acting as a Designated Manager or narcotic signer at any pharmacy.

e. That, for a period of two years from the date on which the Member resumes the role of Designated Manager at any pharmacy, the Member provide to the College the pharmacy’s reconciliations of narcotics, controlled substances and targeted substances every six months, for a total of four reconciliations. The reconciliations must be acceptable to the College.

3. That the Registrar is directed to suspend the Member’s Certificate of Registration for a period of six months with one month of the suspension be remitted on condition that the Member complete the remedial training as specified in subparagraphs 2(a) and 2(b). The suspension shall commence on January 20, 2021 and shall continue until June 19, 2021, inclusive. If the remitted portion of the suspension is required to be served by the Member because she fails to complete the remedial training as specified in subparagraphs 2(a) and/or 2(b), that portion of the suspension shall commence on January 20, 2022, and shall continue until February 19, 2022, inclusive, unless the time for completing the remedial training in subparagraphs 2(a) and/or 2(b), above is extended by the Registrar, in which case, the date on which the remitted portion of the suspension shall commence, if required, shall be adjusted accordingly.

4. Costs to the College in the amount of $10,000.

In its reprimand, the Panel noted that Ms. Barrett has returned again before the Discipline Committee for similar allegations of misconduct. The Panel expressed its view that this was very alarming and severely disappointing.

The Panel observed that pharmacists are gatekeepers who ensure the security and proper use of narcotics, benzodiazepines, and other targeted substances. Ms. Barrett’s failure to do so resulted in poor inventory control and had the potential to cause serious harm to the wellbeing of her community.

One of the responsibilities of a Designated Manager is to ensure that physical counts and reconciliations of all narcotics, controlled drugs, and targeted substances are completed at least once every six months. It is clear that Ms. Barrett failed in her duties as Designated Manger by not ensuring these reconciliations were completed, and this was of serious concern to the Panel.

The Panel expressed its hope that the remediation will provide Ms. Barrett the opportunity to learn, to pause for reflection, and to approach the dispensing and record keeping of narcotics, benzodiazepines, and other targeted substances with renewed diligence and attention to detail. The Panel relayed its expectation that Ms. Barrett will not appear before a panel of the Discipline committee ever again.

• Submitted claims to [Insurance Claims Adjudicator] that included markups on the unit drug cost that were excessive and unreasonable, in or about March 2017-March 2018.

In particular, the Panel found that he:

• Failed to maintain a standard of practice of the profession;
• Charged a fee that was excessive in relation to the service provided;
• Charged a fee or amount that was excessive in relation to the service or product provided;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable and unprofessional.

The Panel imposed an Order, as follows:

1. A reprimand;
2. Directing the Registrar to impose the following specified terms, conditions or limitations on the Member’s certificate of registration, and in particular, requiring the Member to complete successfully, at his own expense and within twelve (12) months of the date of this Order, the ProBE Program on Professional/Problem Based Ethics for Healthcare Professionals, with an unconditional pass;
3. Directing the Registrar to suspend the Member’s Certificate of Registration for a period of three (3) months, with one (1) month of the suspension to be remitted on condition the Member complete the remedial training program as specified in paragraph 2 above. The suspension shall commence on January 27, 2021, and shall run without interruption until March 26, 2021. If the remitted portion of the suspension has to be served because the Member fails to complete the remedial training program as specified in paragraph 2 above, the further suspension shall commence on January 27, 2022 and continue without interruption until February 26, 2022, inclusive, unless the time for completing the remedial steps in paragraph 2 above is extended by the Registrar, in which case, the date the remitted portion of the suspension shall commence, if required, shall be adjusted accordingly;
4. Costs to the College in the amount of $10,000.

In its reprimand, the Panel noted that pharmacy is a self-regulated profession, the practice of which is a privilege, and which comes with significant obligations to the public, the profession, and oneself.

The Panel observed that, through his actions, Mr. Abdou failed in his obligations as a pharmacist. The role of the pharmacist is one of heavy responsibility. It includes the obligation to practise pharmacy at the highest standard and to ensure that the pharmacy operates at the highest standard. As a pharmacist, Mr. Abdou knew or should have known that what he was doing was wrong.

The Panel pointed out that the suspension of Mr. Abdou’s Certificate of Registration is essential to protect the public and is to deter him from engaging in this type conduct in the future. The remediation ordered is intended to provide Mr. Abdou with an opportunity for rehabilitation of his conduct in his pharmacy practice.

The Panel expressed its expectation that Mr. Abdou will not appear again before a panel of the Discipline Committee of the Ontario College of Pharmacists.

• Submitted claims to [Insurance Claims Adjudicator] that included markups on the unit drug cost that were excessive and unreasonable, in or about March 2017-March 2018.

In particular, the Panel found that he:

• Failed to maintain a standard of practice of the profession;
• Charged a fee that was excessive in relation to the service provided;
• Charged a fee or amount that was excessive in relation to the service or product provided;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable and unprofessional.

The Panel imposed an Order, as follows:

1. A reprimand;
2. Directing the Registrar to impose the following specified terms, conditions or limitations on the Member’s certificate of registration, and in particular, requiring the Member to complete successfully, at his own expense and within twelve (12) months of the date of this Order, the ProBE Program on Professional/Problem Based Ethics for Healthcare Professionals, with an unconditional pass;
3. Directing the Registrar to suspend the Member’s Certificate of Registration for a period of three (3) months, with one (1) month of the suspension to be remitted on condition the Member complete the remedial training program as specified in paragraph 2 above. The suspension shall commence on January 27, 2021, and shall run without interruption until March 26, 2021. If the remitted portion of the suspension has to be served because the Member fails to complete the remedial training program as specified in paragraph 2 above, the further suspension shall commence on January 27, 2022 and continue without interruption until February 26, 2022, inclusive, unless the time for completing the remedial steps in paragraph 2 above is extended by the Registrar, in which case, the date the remitted portion of the suspension shall commence, if required, shall be adjusted accordingly;
4. Costs to the College in the amount of $10,000.

In its reprimand, the Panel noted that pharmacy is a self-regulated profession, the practice of which is a privilege, and which comes with significant obligations to the public, the profession, and oneself.

The Panel observed that, through his actions, Mr. Guerguis failed in his obligations as a pharmacist and as a Designated Manager. The role of the Designated Manager is one of heavy responsibility. It includes the obligation to practise pharmacy at the highest standard and to ensure that the pharmacy operates at the highest standard. As the Designated Manager, Mr. Guerguis knew or should have known that what he was doing was wrong.

The Panel pointed out that the suspension of Mr. Guerguis’s Certificate of Registration is essential to protect the public and is to deter him from engaging in this type conduct in the future. The remediation ordered is intended to provide Mr. Guerguis with an opportunity for rehabilitation of his conduct in his pharmacy practice.

The Panel expressed its expectation that Mr. Guerguis will not appear again before a panel of the Discipline Committee of the Ontario College of Pharmacists.

• Submitted claims to [Claims Adjudicator] that included markups on the unit drug cost that were excessive and unreasonable, in or about February 2017-February 2018.

In particular, the Panel found that he:

• Failed to maintain a standard of practice of the profession;
• Charged a fee that was excessive in relation to the service provided;
• Charged a fee or amount that was excessive in relation to the service or product provided;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members as unprofessional.

The Panel imposed an Order, as follows:

1. A reprimand;
2. Directing the Registrar to impose the following specified terms, conditions or limitations on the Member’s certificate of registration, and in particular, requiring the Member to complete successfully, at his own expense and within twelve (12) months of the date of this Order, the ProBE Program on Professional/Problem Based Ethics for Healthcare Professionals, with an unconditional pass;
3. Directing the Registrar to suspend the Member’s Certificate of Registration for a period of two (2) months, with one (1) month of the suspension to be remitted on condition the Member complete the remedial training program as specified in paragraph 2 above. The suspension shall commence on January 27, 2021 and continue without interruption until February 26, 2021, inclusive. If the remitted portion of the suspension has to be served because the Member fails to complete the remedial training program as specified in paragraph 2 above, the further suspension shall commence on January 28, 2022 and continue without interruption until February 27, 2022, inclusive, unless the time for completing the remedial steps in paragraph 2 above is extended by the Registrar, in which case, the date the remitted portion of the suspension shall commence, if required, shall be adjusted accordingly;
4. Costs to the College in the amount of $10,000.

In its reprimand, the Panel noted that pharmacy is a self-regulated profession, the practice of which is a privilege, and which comes with significant obligations to the public, the profession and oneself.

The Panel related that, through his actions, Mr. Girgis Boktor failed in his obligations as a director and owner of a pharmacy. The role of the pharmacy owner is one of heavy responsibility. It includes the obligation to ensure that the pharmacy operates at the highest standard. The Panel related that it was encouraged that Mr. Girgis Boktor took the appropriate steps to correct the misconduct once it was identified.

The Panel relayed its hope that the suspension and the ethics course will provide with an opportunity to remediate Mr. Girgis Boktor’s misconduct and prevent this type of conduct from occurring in his future pharmacy practice.

The Panel reported its expectation that Mr. Girgis Boktor will not appear again before a panel of the Discipline Committee of the Ontario College of Pharmacists.

• Failed to adequately document patient assessments (if any) before dispensing narcotic prescriptions to patients for the first time to ensure that the medication(s) being dispensed was appropriate contrary to the Ontario College of Pharmacists’ Documentation Guidelines;
• Failed to document pertinent discussions with other pharmacies and prescribers after receiving Drug Utilization Review warning response codes from the Narcotics Monitoring System, and accordingly, failed to comply with the Ontario College of Pharmacists’ Documentation Guidelines on the following occasions:

i. On or around October 1, 2018 with respect to prescription #[number];

ii. On or around October 4, 2018 with respect to prescription #[number]; and

iii. On or around October 4, 2018 with respect to prescription #[number]

• Failed to record her assessments (if any) of the appropriateness of dispensing narcotics prescribed by physician Dr. [Name] between approximately October 1, 2018 to November 19, 2018; and
• Engaged in the practice of pharmacy without keeping accurate and/or complete records as required

In particular, the Panel found that she:

• Failed to maintain standards of practice of the profession;
• Failed to keep records and/or documentation with respect to her patients and/or practice; and
• Engaged in conduct or performed acts that, having regard to all the circumstances, would reasonably be regarded by members of the profession as unprofessional.

The Panel imposed an Order, as follows:

1. A reprimand;

2. Directing the Registrar to impose the following specified terms, conditions or limitations on the Member’s certificate of registration:

a. Requiring that the Member successfully complete, at her own expense and within twelve (12) months of the date of this Order, a course with Gail E. Siskind Consulting Services, or another professional ethics consultant approved by the College, to be designed by the consultant, with the general aim of addressing the facts and findings of professional misconduct in this case, including the role of pharmacists in identifying problematic prescribing patterns and preventing narcotic misuse and/or diversion. The following terms shall apply to the course:

i. The number of sessions shall be at the discretion of the consultant, but shall be no fewer than one (1);

ii. The manner of attendance at the session is a matter to be discussed in advance between the Member and the consultant, but shall ultimately be at the discretion of the consultant;

iii. The Member shall be responsible for the cost of the course;

iv. In order to successfully complete the course, the Member must ensure that the consultant delivers a report on the results of the course to the College after completion, which shall be no later than twelve (12) months from the date of this Order;

b. Requiring that the Member successfully complete, at her own expense and within twelve (12) months of the date of this Order, the “Safe and Effective Use of Opioids for Chronic Non-cancer Pain” course offered online through the Centre for Addiction and Mental Health;

3. Directing the Registrar to suspend the Member’s Certificate of Registration for a period of one (1) month, to be fully remitted on condition that the Member complete the remedial training specified in paragraph 2a) and 2b) above. If the suspension is required to be served, it shall commence on February 2, 2022, and continue without interruption until March 1, 2022, inclusive, unless the time for completing the remedial steps in paragraph 2a) and/or 2b), above, is extended by the Registrar, in which case the commencement date of the suspension, if required, shall be adjusted accordingly;

4. Costs to the College in the amount of $8,500.

In its reprimand, the Panel noted that pharmacy is a self-regulated profession. Pharmacists bear the responsibility to follow the standards of practice and accompanying laws and recommendations for detailed record keeping and documentation. As a pharmacist and a member of this College, Ms. Xie has significant obligations to the public, the profession, and herself.

The Panel voiced its concern that Ms. Xie failed in her responsibilities as a pharmacist by dispensing narcotics to patients without documenting the patient assessments and/or counselling. She also failed to document her assessments of the notices she received from the Ontario Narcotic Monitoring System.

Keeping patients safe, especially when it comes to potentially addictive, high risk, and over prescribed medications, is paramount. Ms. Xie failed to do so. The Panel found the potential impact of her actions on public safety to be particularly upsetting, given the magnitude of narcotic diversion concerns in Ontario today.

The Panel observed that Ms. Xie acknowledged lapses in her practice and admitted to breaches of the profession’s standards of practice. The Panel expressed its expectation that she will complete the remedial courses and use this opportunity to improve her professional conduct. To that end, the Panel relayed that it does not expect to see her in front of a Discipline panel again.

• Sold by retail and/or dispensing prescription drugs to patients in the U.S. without a lawful and/or otherwise valid prescription;
• Contravened the OCP Policy on Prescriptions-Out of Country, dated January-February 2003.

In particular, the Panel found that he:

• Failed to maintain a standard of practice of the profession;
• Contravened the Pharmacy Act, the Drug and Pharmacies Regulation Act, the Regulated Health Professions Act, 1991, or the regulations under those Acts, and in particular, sections 155 and/or 158 of the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H-4, as amended;
• Contravened, while engaged in the practice of pharmacy, any federal or provincial law or municipal by-law with respect to the distribution, sale or dispensing of any drug or mixture of drugs, and in particular, sections C.01.041 and/or C.01.042 of the Food and Drug Regulations, C.R.C., c. 870, as amended;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all circumstances, would reasonably be regarded by members as disgraceful, dishonourable and unprofessional.

The Panel imposed an Order, as follows:

1. A reprimand;

2. Directing the Registrar to impose the following specified terms, conditions or limitations on the Member’s Certificate of Registration, and in particular,

a. requiring the Member to complete successfully, at his own expense and within twelve (12) months of the date of this Order, the ProBE Program on Professional/Problem Based Ethics for Healthcare Professionals, with an unconditional pass; and

b. restricting the Member from being the Designated Manager at any pharmacy until he has completed the ProBE Program as specified above;

3. Directing the Registrar to suspend the Member’s Certificate of Registration for a period of six (6) months, with one (1) month of the suspension to be remitted on condition the Member complete the remedial training program as specified in paragraph 2(a) above. The suspension shall commence on February 24, 2021 and continue without interruption until July 23, 2021, inclusive. If the remitted portion of the suspension has to be served because the Member fails to complete the remedial training program as specified in paragraph 2(a) above, the further suspension shall commence on February 25, 2022 and continue without interruption until March 24, 2022, inclusive, unless the time for completing the remedial steps in paragraph 2(a) above is extended by the Registrar, in which case, the date the remitted portion of the suspension shall commence, if required, shall be adjusted accordingly.

4. Costs to the College in the amount of $10,000.00.

In its reprimand, the Panel noted that, as a staff pharmacist and sole director and majority shareholder of the corporation that owned the pharmacy, Mr. Shah seriously failed in his obligations to maintain the standards of practice of the profession.

The Panel observed that the role of pharmacy owner is one of substantial responsibility. In his practice, Mr. Shah failed to provide patient care respecting the prescriptions that he dispensed through [Prescription Service Provider]. In addition, he failed to ensure the presence of a physician-patient relationship respecting those prescriptions. He put patient safety and the public at risk.

The Panel noted that it found Mr. Shah’s actions to be completely for the purposes of financial gain and self interest, as opposed to patient safety and care. Patient safety needs to be paramount. Mr. Shah failed in this duty. He must put his patients first before his business interests.

The Panel pointed out that pharmacy is a self-regulated profession. The practice of pharmacy is a privilege and it comes with significant obligations to the public, the profession, and oneself. The Panel expressed its hope Mr. Shah take this opportunity to reflect on his serious misconduct and that he will not appear again before a panel of the Discipline Committee.

• Submitted false claims for one or more of certain identified drugs and other products that were not actually dispensed to patients.

In particular, the Panel found that he:

• Failed to maintain the standards of practice of the profession;
• Falsified records relating to his practice;
• Signed or issued, in his professional capacity, a document that he knew or ought to have known contained a false or misleading statement;
• Submitted an account or charge for services or products that he knew or ought to have known was false or misleading;
• Contravened the Pharmacy Act, the Drug and Pharmacies Regulation Act, the Regulated Health Professions Act, 1991, or the regulations under those Acts, and in particular, ss. 155 and 156 of the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H-4, as amended;
• Contravened a federal or provincial law or municipal by-law with respect to the distribution, sale or dispensing of any drug or mixture of drugs, and in particular, ss. 5 and 15(1) of the Ontario Drug Benefit Act, R.S.O. 1990, c. O.10, as amended;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable and unprofessional.

The Panel imposed an Order, as follows:

1. A reprimand;

2. That the Registrar is directed to impose specified terms, conditions or limitations on the Member’s certificate of registration, and in particular:

a. that the Member complete successfully, with an unconditional pass, at his own expense and within 12 months of the date of this Order, the ProBE Program on Professional/Problem-Based Ethics offered by the Center for Personalized Education for Professionals;

b. That the Member shall be prohibited, for a period of three years from the date of this Order:

i. from acting as a Designated Manager of any pharmacy; and

ii. from holding an ownership interest, of any kind, in any pharmacy.

3. That the Registrar is directed to suspend the Member’s Certificate of Registration for a period of 12 months with one month of the suspension be remitted on condition that the Member complete the remedial training as specified in subparagraph 2(a). The suspension shall commence on February 25, 2021 and shall continue until January 24, 2022, inclusive. If the remitted portion of the suspension is required to be served by the Member because he fails to complete the remedial training as specified in subparagraph 2(a), that portion of the suspension shall commence on February 26, 2022, and shall continue until March 25, 2022, inclusive, unless the time for completing the remedial training in subparagraph 2(a) is extended by the Registrar, in which case, the date on which the remitted portion of the suspension shall commence, if required, shall be adjusted accordingly;

4. Costs to the College in the amount of $10,000

In its reprimand, the Panel noted that, as the designated manager and the owner of the pharmacy, Mr. Besada failed in his obligation to maintain the standards of practice of the profession, his ethical obligations, and pharmacy legislation.

The Panel observed that the roles of pharmacy owner and designated manager are ones of heavy responsibility, and expressed its view that Mr. Besada’s conduct demonstrates a failure to understand and fulfil his ethical obligations while engaging in the practice of pharmacy. The Panel pointed out that it found his actions to be completely for the purposes of financial gain and self interest.

The Panel explained that pharmacy is a self-regulated profession, the practice of which is a privilege, and which comes with significant obligations to the public, the profession, and oneself. The Panel voiced its hope that the suspension and the ethics course will provide Mr. Besada with an opportunity to prevent this type of conduct from occurring in his future pharmacy practice, and an opportunity to remediate his misconduct.

The Panel expressed its expectation that Mr. Besada will not appear again before the Discipline Committee of the Ontario College of Pharmacists.

• failed to maintain professional boundaries when she developed and engaged in a non-professional, personal relationship with the patient, [Name], from in or about [Specified Date 1] to in or about [Specified Date 2].

In particular, it was alleged that she:

• Failed to maintain a standard of practice of the profession;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional.

Following the hearing, in a decision delivered orally on June 29, 2020, the Panel made no findings against Member “Z” with respect to these allegations. The Panel found that the College did not establish, on a balance of probabilities, that Member “Z” engaged in the misconduct alleged, as she was working solely in the capacity of a pharmacy assistant at the relevant time.