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KAMALA 0. HARRIS Attorney General of California JANE ZACK SIMON Supervising Deputy Attorney General State Bar No. 116564

455 Golden Gate Avenue, Suite 11000 San Francisco, CA 94102-7004 Telephone: (415) 703-5544 Facsimile: (415) 703-5480 E-mail: Janezack.simon@doj.ca.gov

Attorneys for Complainant

FILED STATE OF CALIFORNIA

MEDICAL BOARD OF CALIFORNIA SACRAMENTO l\-..k~\ 'be 20 ~ BY 1V_. ~'<de..'-'s. ANALYST

BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation Against:

ANUJA SHARMA, M.D. 448 Foote Cres Cobourg ON K9A OA3 CANADA

Case No. 800-2016-022105

ACCUSATION

15 Physician's and Surgeon's Certificate No.

16

17

18

C54913

Respondent.

19 Complainant alleges:

20 PARTIES

21 1. Kimberly Kirchmeyer (Complainant) is the Executive Director of the Medical

22 Board of California, Department of Consumer Affairs, and brings this Accusation solely in her

23 official capacity.

24 2. On October 12, 2011, Physician's and Surgeon's Certificate No. C54913 was

25 issued by the Medical Board of California to Anuja Sharma, M.D. (Respondent.) The certificate

26 is renewed and current with an expiration date of April 30, 2017.

27 Ill

28 Ill

1

(ANUJA SHARMA, M.D.) ACCUSATION NO. 800-2016-022105

1

2 3.

,JURISDICTION

This Accusation is brought before the Medical Board of California (Board) under

3 the authority of the following sections of the California Business and Professions Code (Code)

4 and/or other relevant statutory enactment:

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A. Section 2227 of the Code provides in part that the Board may revoke,

suspend for a period not to exceed one year, or place on probation, the license of any

licensee who has been found guilty under the Medical Practice Act, and may recover the

costs of probation monitoring.

4.

B. Section 141 of the Code provides:

"(a) For any licensee holding a license issued by a board under the jurisdiction of a department, a disciplinary action taken by another state, by any agency of the federal government, or by another country for any act substantially related to the practice regulated by the California license, may be a ground for disciplinary action by the respective state licensing board. A certified copy of the record of the disciplinary action taken against the licensee by another state, an agency of the federal government, or by another country shall be conclusive evidence of the events related therein.

"(b) Nothing in this section shall preclude a board from applying a specific statutory provision in the licensing act administered by the board that provides for discipline based upon a disciplinary action taken against the licensee by another state, an agency of the federal government, or another country."

FIRST CAUSE FOR DISCIPLINE

(Discipline, Restriction, or Limitation Imposed by Another Jurisdiction)

On February 22, 2016, the College of Physicians and Surgeons of Ontario, Canada

21 (Ontario College) issued a Decision and Reasons regarding Respondent's license to practice

22 medicine. The Decision and Reasons was issued in response to an investigation concerning

23 Respondent's practice of conditions, disorders or diseases of the skin, given that her qualifications

24 were in internal medicine and her Ontario license only allowed her to practice internal medicine.

25 The Ontario College also had concerns about specific patient cases and Respondent's billing for

26 dermatology procedures. The Decision and Reasons adopted an Undertaking, Acknowledgement

27 and Consent (Undertaking), under which Respondent is required to practice under the clinical

28 supervision of two dermatologists for a minimum of 12 months, under very specific terms of

2

(ANUJA SHARMA, M.D.) ACCUSATION NO. 800-2016-022105

1 supervision, and to complete professional education. At the end of the period of clinical

2 supervision, Respondent will undergo a reassessment, at which point the extent to which she can

3 treat conditions, disorders or diseases of the skin will be established. Respondent shall not refer

4 to herself or her practice using the word "dermatology" or any derivative thereof. At the time of

5 her reassessment, Respondent will be permitted to bill her services relating to conditions,

6 disorders or diseases of the skin using Family Medicine billing codes. Copies of the Decision and

7 Reasons and the Undertaking issued by the Ontario College are attached as Exhibit A.

8 5. Respondent's conduct and the action of the College of Physicians and Surgeons of

9 Ontario, as set forth in paragraph 4, above, constitute cause for discipline pursuant to section 141

10 of the Code.

11 PRAYER

12 WHEREFORE, Complainant requests that a hearing be held on the matters herein

13 alleged, and that following the hearing, the Board issue a decision:

14 1. Revoking or suspending Physician's and Surgeon's Certificate Number C54913

15 issued to respondent Anuja Sharma, M.D.;

16 2. Revoking, suspending or denying approval of Respondent's authority to supervise

17 physician assistants;

18 3. Ordering Respondent, if placed on probation, to pay the costs of probation

19 monitoring; and

20 4.

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22 DATED: ~~A=u_g~u~s~t~l~0~,,____,2~0~1=6~

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26 SF2016201289

27 41565805.doc

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Executive irector Medical Board of California Department of Consumer Affairs State of California Complainant

3

(ANUJA SHARMA, M.D.) ACCUSATION NO. 800-2016-022105

Exhibit A

CERTIFIED TO BE A TRUE AND CORRECT COPY OF THE ORIGINAL

COPIE AUTHENTIQUE CERTIF~E ET CONFORME A L'ORIGINAL

F;:;;\;

' '

THE

COlllliGit OF

JPJI-lIY§IT CRAN§ AND

3LM..12 rc__ot 0 §lUJRGitON§ ---4i----#-~---:':'.:':':~=:":~:-::-:'~ ON1rARKO T HYSICIA~~~~ ~LAINTS AND REPORTS COMMITTEE

(the "Committee")

DECISION AND REASONS

Dr. Anuja Sharma (CPSO# 97380)

Registrar's Investigation under Section 75(l)(a) of the Health Professions Procedural Code (the "Code"), which is

Schedule 2 to the Regulated Health Professions Act, 1991, S.O. 1991, c.18

CPSO FILE# 7214421

INTRODUCTION

In the summer of 2014, the Ontario Telemedicine Network (OTN) advised the College's Executive Office that a physician (later identified as Dr. Sharma, whose specialty qualification is in internal medicine) had approached the OTN regarding provision of certain dermatology services. The Executive Office advised the Committee of this in August 2014.

In September 2014, the Committee approved the Registrar's appointment of investigators under Section 75(1)(a) of the Code to examine Dr. Sharma's practice. Under this appointment, the Committee also retained dermatologist Dr. Wexler as a medical inspector (the "MI") to review a number of Dr. Sharma's patient charts and OHIP billings.

The Internal Medicine panel of the Committee considered this matter at its meeting on February 22, 2016.

INFORMATION BEFORE THE COMMITTEE

The Committee always has before it applicable legislation and regulations, along with policies that the College has developed, which reflect the College's professional expectations for physicians practising in Ontario. Current versions of these documents are available on the College's website at www.cpso.on.ca, under the heading "Policies & Publications." The Committee will provide a copy of any policy it refers to in this decision.

The Committee always has before it the physician's history with the College, if any.

QUALITY PROFESSIONALS/ HEALTHY SYSTEM J PUBLIC TRUST

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THE

CO lLlLJEGJE OF

JPJHif§IlCilAN§ AND

§1URGJEON§ OF

ON1fARilO The Committee carefully reviewed all the information and documentation gathered during the investigation, which included the following:

• information before the Committee on September 16, 2014, which included: o information received from Executive Office o information from IMCare website

• Dr. Sharma's completed Physician and Electronic Records Questionnaire • copy of Dr. Shanna's consultation forms • copy of Dr. Sharma' s letterhead • copy of Dr. Sharma's business card • MI's Report, received March 27, 2015 • investigator memorandum regarding analysis of Dr. Sharma's OHIP billings • Dr. Sharma' s College Annual Renewal, 2015 • Dr. Shanna's College Annual Renewal, 2014 • Dr. Shanna's College Annual Renewal, 2013 • Dr. Sharma's response to the MI report (with enclosures) • MI's Addendum Report • communications with counsel for Dr. Sharma.

Background Information

Dr. Sharma's training and experience includes the following:

• Dr. Sharma received her training at the Gandhi Medical College, India, before becoming board certified in internal medicine in the United States.

• In 2011, Dr. Sharma applied to the College under Pathway 4, for a certificate of registration to practice medicine in Ontario.

• On February 8, 2012, the Registration Committee issued Dr. Sharma a restricted certificate of registration with the terms, conditions and limitations that she may practice internal medicine only under the supervision of Dr. Jitendra Kumar Singh. The College continued to extend Dr. Sharma's license annually, with the same restrictions.

• On August 15, 2012, the Northumberland Hills Hospital issued a release announcing the addition of Dr. Sharma to the medical team. Dr. Sharma stated, "The primary focus of my practice is dermatology, including assessment and treatment of skin cancer, chronic diseases of the skin and lesions that do not heal."

QUALITY PROFESSIONALS/ HEALTH'r' S'YSTEM f PUBLIC TRUST

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2

THE

COlLlLJEGJt OF

JPJI-lif§ITCITAN§ AND

§URGlliON§ OF

ON1rAR[0 • On March 15, 2013, the College received a supervision report from Dr. Singh, indicating

that Dr. Sharma was involved in general internal medicine with a focus on endocrinology and dermatology.

• On July 19, 2013, Dr. Sharma completed and submitted a Physician Questionnaire indicating her practice focus was on dermatology, rheumatology and endocrinology, with code 306 (Dermatology) accounting for 61-80% of her actual practice.

• On August 8, 2013, the College's Applications and Credentials department sent Dr. Sharma a letter stating that she was authorized to practice internal medicine only and is not a specialist in dermatology. Dr. Sharma sent a response indicating that she understands and acknowledges that her certificate is that of an internal medicine specialist, and that she only receives referrals for internal medicine consultations.

• On September 30, 2013, Dr. Singh completed a Supervision Report, indicating Dr. Sharma is involved with general internal medicine with focus on endocrinology and dermatology.

• On December 17, 2013, the College received a Practice Assessment Report from Dr. Gary Victor, whom the College had retained to conduct an assessment of Dr. Sharma's practice in internal medicine as part of her application for registration through Pathway 4. Dr. Victor reported that there was one patient-physician interaction he could not comment on, as it was beyond the scope of practice of an internist and would require a dermatologist or someone with more experience in dermatology to evaluate. In the review of five patient records, Dr. Victor was unable to provide any comments as the records dealt with dermatological issues and were beyond his scope of practice for an internist.

• Dr. Sharma's website in 2013 indicated her specific focus on dermatology, endocrinology and rheumatology and stated that Dr. Sharma has additional training and experience in diseases of the skin.

• On February 19, 2014, the College received information from Dr. Sharma, including her recent CV and her continuing professional development (CPD) activities (including a number of activities related to dermatological care).

• On March 13, 2014, the Registration Committee met to review Dr. Sharma's application to modify the terms, conditions and limitations of the current certificate of registration and to request an independent practice certificate limited to internal medicine.

QUALITY PROFESSIONALS/ HEALTHY SYSTEM f PUBLIC TRUST

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3

THE

COJLJLJgGJ£ OF

JPil-lif §IT CRAN§ AND

§lUJRGJgON§ OF

ON1fARKO Further Information

• Dr. Sharma's Physician Questionnaire, received on October 17, 2014, indicates that Dr. Sharma sees approximately 73 patients per week. Dr. Sharma states that her practice consists of 61-80% dermatology; 0-10% endocrinology; and 0-10% rheumatology. The most common conditions she treats include evaluation and management of thyroid diseases, skin rashes/lesions, joint pain/arthritis, skin cancer/melanoma and chronic skin disease (eczema/psoriasis). Dr. Sharma indicated that she attended a clinical dermatology conference in Las Vegas in October 2013, and an Introduction to Dermatology in Cardiff, UK (March to May 2014). Dr. Sharma states that she is "currently pursuing online 1 year diploma in Clinical Dermatology" that started in September 2014 .

., In Dr. Sharma's Annual Renewal form for the College, 2015, she describes her clinical practice as 100% internal medicine.

• In Dr. Sharma's Annual Renewal form for the College, 2014, she describes her clinical practice as 50% dermatology, 10% endocrinology and 40% internal medicine

s In Dr. Sharma's Annual Renewal form for the College, 2013, she describes her clinical practice as 80% dermatology, 10% endocrinology and 10% rheumatology.

• On the "Patient Consult Request Form" for IMCare in Cobourg, Dr. Sharma's name is followed by the words, "Internal Medicine, Skin diseases, Rheumatologic & Endocrine diseases."

111 Dr. Sharma's letterhead and business card for IM Care state .she is a "Diplomate of the American Board oflnternal Medicine."

v Analysis.of Dr. Sharma's OHIP hilling shows:

o 79% of Dr. Sharma's OHIP billings were for non-skin /non-dermatology related codes such as A 13 5 - Internal Medicine Consult.

o 21 % of Dr. Sharma's OHIP billings were for skin or dermatology related codes such as Z 119 - Cryotherapy of 5 pre malignant lesions.

QUALITY PROFESSIONALS j HEALTHY SYSTE/'v1 f PUBLIC TRUST

80 College Street, Toronto, Ontario MSG 2E2 Tel: (416) 967-2600 Toll Free: (800)·268-7096 Fax: (416) 961-3330

4

THE

COlllbGib OF

JPHY§KCITAN§ AND

§[JRGlbON§ OF

ON1fAJRKO MI's Conclusions

Dr. Wexler was asked to opine on Dr. Sharma' s scope of practice, and specifically as to whether Dr. Sharma is practising dermatology medicine. Dr. Wexler reviewed 25 patient charts that were randomly selected using Dr. Sharma's dermatology related OHIP billings. Dr. Wexler reviewed the 25 charts along with Dr. Sharma's corresponding OHIP billing for the patients selected.

Dr. Wexler opined as follows:

• " ... Dermatology is not a sub specialty of internal medicine. Dr. [Sharma] does say that she is practising general internal medicine so she is practising it with a special interest in dermatology. She is taking referrals for general dermatology problems. She is not dealing solely with complex medical problems such as vasculitis, lupus, sarcoidosis which might have cutaneous manifestations but are really complex systemic diseases that a general internist would often be asked to manage."

• "As dermatology is not a subspecialty of internal medicine, I would have to say that Dr. [Sharma] having elected to practice with a special interest in dermatology is actually practising dermatology medicine."

• "In conclusion, I do feel this physician is practising dermatology medicine and that this would be outside of her scope of practice."

Dr. Wexler identified some specific clinical issues with Dr. Sharma's practice:

• "Dr. [Sharma] always refers to destroying lesions with liquid nitrogen, which at times may happen, but often treatment has to be repeated several times before complete clearing takes place. There is no description in the charts of any times used for liquid nitrogen or whether a double freeze and thaw treatment or single treatment is used. This notation in the chart helps if the lesion does not clear in order to decide how to improve the results if the lesion has to be sprayed a second time."

• "Dr. [Sharma] prescribes Efudex cream anywhere from 2 weeks to 30 days for treatment of lesions. Thirty days might be indicated for treatment of lesions but I would want to see these patients for follow up at the end of two weeks to see whether in fact they were able to tolerate treatment for another two weeks. Many patients have difficulty tolerating even two weeks."

• "There were also some delays in diagnosis: one with a lentigo maligna (an early type of melanoma), on the right cheek and one with a basal cell carcinoma on the tip of the nose.

QUALITY PROFESSIONALS/ HEALTHY SYSTEM J PUBLIC TRUST 5 80 College Street, Toronto, Ontario MSG 2E2 Tel: (416) 967-2600 Toll Free: (800) 268-7096 Fax: (416) 961-3330

THE

C 0 ILIL JI;:GJE OF

JPJHif§llCllAN§ AND

§lURGJI;:ON§ OF

ON1fARITO Arguably these can be difficult diagnoses and even if seen by a dermatologist there can be some delay in diagnosis. I feel that there should have been some documentation that other options for treatment were discussed for the lesion on the tip of the nose prior to it being treated with curettage and electrodessication."

• "Also Dr. [Sharma] did some surgical excisions. One of these was quite a large cyst on the right cheek of an 18-year old. I am not certain whether she would have the surgical training which would allow this to be in her scope of practice. Knowledge of anatomy in this area would be a prerequisite for this type of procedure."

With respect to Dr. Sharma's OHIP billings, Dr. Wexler stated:

• "A dermatologist would normally bill A025 for a consultation $72.15, A023 $3 8. 70 for a specific assessment and A024 $21. 90 for a partial assessment... In internal medicine and as billed by Dr. [Sharma], a consultation would be A135 $157.00, a limited consultation A435 would be $105.25, a medical specific assessment A133 $79.85, a medical specific reassessment Al34 $61.25 and a partial assessment A138 $38.05. Dr. [Sharma] does bill internal medicine codes. This is because she is licensed to practice in Ontario as a general internist and cannot bill dermatology codes.''

• "Dr. [Sharma] bills an internal medicine consultation for every new referral which has to do with a skin problem. She very rarely would bill a limited consultation. All of her follow-ups are mainly medical specific assessments, occasionally medical specific reassessments and very rarely a partial assessment. Dr. [Sharma] seems at times to bill a new consultation when a patient has not been seen for a year even though the patient may not be re-referred. The OHIP schedule of benefits very clearly states that a consultation is an assessment rendered following a written request from a referring physician who in light of his/her professional knowledge of the patient requests the opinion of another physician because of their expertise. A request from Dr. [Sharma] to have a patient return for follow up a year later without a specific request from the referring physician does not constitute a consultation ... In addition, most of the patients seen for a dermatology problem by Dr. [Sharma] do not have multi system disease processes and the consultations are not as complicated as one would expect would be handled by a general internist and billed at $157.00 rate."

e ''This is definitely a fault in the system. Dr. [Sharma] with less expertise than a dermatologist is billing double the fee."

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6

THE

<COlLlLlbGlli OF

1PHf§IT<CKAN§ AND

§1UJRGlbONS OF

ON1fAJRKO Dr. Sharma's Response to the MI's Report

Dr. Shanna's comments on Dr. .Wexler'sreport include the following:

• "I disagree that I am practising outside the scope of my training and expertise in internal medicine. As an internal medicine specialist, I am trained to deal with diseases of the skin, and have specifically undertaken education in this area."

• "I was recruited by Northumberland Hills Hospital in Cobourg. The area physicians described a need for my services in the areas of my expertise and interests, including my interest in skin diseases. I applied for a registration with the College through Pathway IV .... Throughout the entire registration process, I was very clear about my interests, experience and focus."

• "In describing my areas of practice to the College, I was always very clear that I have a focus on diseases of the skin. I also note that the assessment report of Dr. Gary Victor of 2013 specifically noted the focus of my practice on diseases of the skin. There were no concerns expressed and my certification ofregistration was approved."

• "I approach diseases of the skin from the perspective of an internal medicine specialist. All referrals are sent to me specifically as an internal medicine specialist, with an interest in dermatology, and not as a dermatologist. I have ensured that there is no confusion about this point in the community. My consultation notes reflect a true pict1.1re of the comprehensive assessment of the patient and I use appropriate referrals to dermatologists as needed. Patients seen in my office do not have a single system exam as would be the case with a dermatologist. I do a comprehensive assessment which includes height, weight, vitals, review of symptoms, past family, social and medical history. Assessment and plan reflects a comprehensive multi-system assessment, not just a cutaneous system exam and plan."

• "I also note that any issues with billing, is not something I can respond to, nor do I see how a 'flaw in the system' is relevant in these circumstances."

• "If the College is not satisfied with my submissions, I would consider engaging in adding a scope of practice, which I would submit should be a relatively straightforward task gi\ieh all of the additional training that I have undertaken as well as a period of supervision that I have already completed."

• Dr. Sharma provided responses regarding specific patients where Dr. Wexler had noted a concern.

QUALITY PROFESSIONALS/ HEALTHY SYSTEM/ PUBLIC TRUST 7 80 College Street, Toronto, Ontario MSG 2E2 Tel: (416) 967-2600 Toll Free: (800) 268-7096 Fax: (416) 961-3330

THE

CO lLlLJEGJE OF

IPHY§[([AN§ AND

§1UIRGIBON§ OF

ON1rAR[0 Medical Inspector's Addendum

After reviewing Dr. Sharma's response to the MI's report, Dr. Wexler stated:

• She does not think that the training program which Dr. Sharma described is adequate to prepare a physician to set up a referral practice to see mainly patients with dermatology problems.

• While Dr. Sharma may have cumulative experience of 18 years in internal medicine, she does not feel that Dr. Sharma has training in dermatology to allow her to set up a referral practice in dermatology.

• Dermatology is not a subspecialty of internal medicine, according to the Royal College.

ANALYSIS AND CONCLUSIONS

The Committee considered the following points in reaching its decision to accept an undertaking from Dr. Sharma.

• As a result of this investigation, the Committee had concerns about the part of Dr. Sharma's practice that involved treating conditions, disorders or diseases of the skin, given that her qualifications are in internal medicine, rather than dermatology. Further, the Committee had concerns about Dr. Sharma's practice of particular procedures. The Committee was also concerned about how Dr. Sharma might properly describe her qualifications. In addition, the Committee was concerned about Dr. Sharma's billing dermatological procedures to OHIP under internal medicine codes.

• The Committee noted that its concerns would be satisfied if an undertaking could be obtained from Dr. Sharma to address the issues in question.

• An undertaking is a voluntary, binding promise which the physician makes to the College. It is posted on the public register. In such an undertaking, the physician agrees to do (or not do) certain things in order to address the Committee's concerns, and to protect the public interest. The undertaking may include education, supervision, and/or monitoring with reporting to the College, and may require further evaluation upon completion. The College monitors compliance and requires proof of successful completion. Breaches may result in further action by the College.

• In this case, Dr. Sharma expressed her intention to take necessary steps to comply with the College's change of scope process, pursuant to an undertaking.

QUALITY PROFESSIONALS/ HEALTHY SYSTEM f PUBLIC TRUST

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8

THE

COllJEGJE OF

IPJHIY§ITCITAN§ AND

§lUJRGJEON§ OF

ON1rAJPUO • The College and Dr. Sharma have now agreed upon an undertaking that addresses the

identified concerns.

• Accordingly, the Committee has accepted Dr. Sharma's undertaking, dated April 16, 2016. Along with various standard terms, the undertaking contains the terms summarized below.

With respect to training and education

o Dr. Sharma will practice under the clinical supervision of two dermatologists for a minimum of 12 months, including an initial period of at least three months where she will schedule all of her cases involving conditions, disorders or diseases of the skin to take place at the office of the Clinical Supervisor, followed by a period of at least nine months of further supervision. The Clinical Supervisors' undertakings set out very specific terms for the periods of supervision.

o Dr. Sharma will complete CPD as recommended by the Clinical Supervisors,

With respect to reassessment

o At the end of the period of clinical supervision, Dr. Sharma will undergo a reassessment by a specialist certified in dermatology, selected by the College, and will abide by the assessor's recommendations.

With respect to professional title

o After satisfactory completion of the steps required in the undertaking, if the College is of the view that Dr. Sharma has satisfactorily completed the change in scope program, she will be permitted to refer to herself as an internal medicine specialist, with a special interest in treating conditions, disorders or diseases of the skin. At no time before, during, or after the change of scope practice, will she refer to herself or her practice using the word "dermatology" or a derivative of that word.

With respect to billing

o After satisfactory completion of the steps required in the undertaking, if the College is of the view that Dr. Sharma has satisfactorily completed the change in scope program, she will be permitted to bill her services relating to conditions, disorders or diseases of the skin using a Family Medicine billing code.

QUALITY PROFESSIONALS j HEALTHY SYSTEM f PUBLIC TRUST

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9

THE

COlllEGIE OF

JPJHIY§IlCilAN§ AND

§lUJRGJEONS OF

ONtARilO • The Committee is satisfied that such an undertaking will fully address the concerns

identified in the College's investigation about Dr. Sharma's practice. The Committee regards the undertaking as an appropriate resolution of this matter.

• The Committee is satisfied that no further action is required, given Dr. Shanna's undertaking, other than to ensure Dr. Sharma's compliance with the terms of her undertaking, by which she is bound.

DISPOSITION

For the reasons set out above, the Committee accepts Dr. Sharma's undertaking.

PANEL MEMBERS: February 22, 2016

W. SPOTSWOOD, MD -Chair, ICR Committee C. LEET, MD L. SCHWARTZ, MD A. PANJU, MD E. THERIEN, Public Member

QUALITY PROFESSIONALS/ HEALTHY SYSTEM/ PUBLIC TRUST

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10

04/iB/2016 10•51 FAX 416 885 9010 LEt~CZNER SLAGHT ~003/017

UNDERTAKING, ACKNOWLEDGEMENT AND CD..~"T., ("'Undertal<ing") CERTTF ED TO BE A TRUE AND

· CORRECT COPY OF THE ORIGINAL of COPIE AUTHEl.JTlQUE CERTIF~E

ET CONFORME A L'ORIGINAL

DR_ ANU.fA SHARMA ("Dr. Shanna")

to

COLLEGE OF PHYSICIANS Al\'D SURGEONS OF 01 (the ·•college")

..\. PRF.:\l\1BLE

(l) Jn this Unckrrllking:

.. Code., means the l leaJth Professions Proccd.ural Cod<:, which is Schedule 2 tc:> the Regularr:.d !f<!a/th Pro.fe.t\"inns lier. 1991. S.O. 1991. c. 18, as am1.:nded;

·'IC!{ Committ';'.c;" means the Inquiries, Complaints .:uid Reports Commiuc;:- of 1he College.

r2) l. Dr, Sharm';l, cmificate of ~gisu~tion n\.lillbCr 97380. am a member of the College. 'Ilic College has re;;eiwd information regarding m)' staridard of pracricc

\3) I. Dr. Sharm~. acknowledgi:: thar T am curremly rhe subject of tt C(illege investigation b<.!aring fik Number 72 l 442 l (ihe "'hwc$tigaiion'') into ttllcgations about the part of my prat:ticc that involve• treating conditions. disorders~'' diseases of the skin.

B. lr-.lDF..1-lT AKING

(4) r. Dr. Shuma, acknowledge and agree that! am bound by this Undertaking from the date on which I sign iL

(5) !, Dr. Sharni:a. undertake to comply with the: College's Cha..ttge in S<::opc process. as scl ou1 hduw.

(6) Clinical Supervision

(a) l, Or. Sharma. undertake: to practise urukr the guidance o( at least two clinical supervisor(s) who arr: certified speci:i.li S'!S in Dermatology and who are 11cccptahlc- 'CO

:he College (the ''Clinical Supcrvisor{s)"; "(linii;al Supervism .A."~ "Ctinical StJ~rvi;;or B"), for a minimum of rwelve (12) months ("Clinical Supervision"). "fhc Ctinic<il Supervision shall cons:i:.-:t of the following elcmenlS:

i) an initial period LifCJinica! Supervision which sh:ill !Rst for a minimum of three (3) months {"lnitial Period of Clinical Supel'\ision-), during

th

04/18/2018 10 52 FAX 416 865 9010 LENCZNER SLAGHT ~004/017

which time [ will !\chedule all of my cases involving conditions, 1.fowrdcrs or diseases of lhe skin to take place ilt the office of Clini~al Supervisor A. I, Dr. Shonni.. l'!cknowledgc that lhc Initial Period of Clinical Supervision will not rerminate 1.1nti! Clinical Supervisor A has obs.ervc:d a minim1.tm ot' sixty (60) of my cases in\·otving conditi<ms. disorders or diseases of 1he skin during a period of at least three ( 3) months; and

ii) an additional period o-f Clinical Supervision wbii.;h sh;ill continue for nine (9) momhs following completion of the l11itial Period of Clinical Supervision {''Additivn;i! Period ofClin1ci\f Su~n-isitin-).

(h) I, Dr. Sharm3, undertake that during the entire period of Clinical Supervision I shall maintain a log of all of my ~s in\lol ving condition:;, disorders or diseases of 1.he skin.

(c1 I, Dr. Sharmn. acknowledge that [ h~ve reviewed the Clinical Supervisor(s)'s undcrnikings., ;i.nachcd hereto as Appe:ldix ''A" and Appendix "8 .. , and unecrstand v-·hat is required of lhe Clinical Sopervist)t(S). The C!i11ical Superviwrts) will. <'.!!

minimum:

( i) Duririg lhe lnitill Period of Clinical Supervision, Clinical Supervisor/\ will mct:t with me once every wed•, al a minimum, at the office of ch~ Clinical Supervisor to observe all .:if my c.ascs involving conditions, disorders or diseases of rhe ~kin, unless I do no1 have any patients presenting for condicions. disorders or diseu:;es of 1hc skin during {hac week. Clink.al Supervisor A v.ill also review ~JI of my patient charts involving conc!itions, disorders or <.lisesses of the skin, as well as my log of cases involving condilions, disorders or diseases of th~ !;k.in:

(ii) During the Additional PcrioJ of Clinical Supervision~ Clinical Supervisor A will mce1 with me once every month to review t-.venry (2Q) of my paticm charts invoh'ing conjitions, di~ordc:rs or diseases Llf the skin:

(iii) During the Addition4ll Period of Clinical Supi::rvision, Clmic;il Supervisor 11 will meet with me a~ my practice loo.nion for one (l)houronce every month to obsl!r·ve my CU$CS involving conditions, disorck.TS or diseases o f1hc skin. I, Dr. Shi:irma, undertake that during the Additional Period of Clinical Su.pcr"Vision l will schedule cases involving conditions. disorders or diseases of the :skin io tak.: pl4.ce during the visit o!the Clinic.a! Supuvisor(S)

(iv) Discuss any concerns arising from the chart reviews and/or observation:

l ~·) \fake recommrndiltions lei me for pratricc improvemcnu; and ongoing profrssional developmcm and inquin: into rny compliance wHh the recommcndatioris;

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rvi) P~'Orrn any other du lies. such as reviewing other documcnrs or conducting !nterv1e'''"S v.ith staff or colleagues. that T~ Clinical Supervisor(s) d~m necessary l~ my Chnicw Supcr.ision: (lnd

(vii) Submit written reports to the College ai leris1 once i=very month during the Initial Period of Clinical Supc=rvision, and once every three (3) month!> during the Additional Period of Clinicru Supervision, or more frequently if the Ciinical Supcrvisor(s) has con.cerr.s aboo1 my standll.fd of prm;tice.

(d) [, Dr. Sharma, acknowledge lh3t th~ charts reviewed shall be selected by the Clin i{,;(11 St1pc1Visor(~) based on the area~ of concern identifiod in the rcport(s) of the medical inspector rec~ived by the College on Matth 27 end July 2, 2015 and concerns that may arise during the period of Clinical Supi.:rvision,

lC) l, Or. Sharma, urn:lcrtake to cooperate folly with ihc Clinical Supervi~ion of m~· pracu~e. conducted under the It:nn of this Undertaking and Appel1dices ''A" and "W <1ttachl!d. and to abide by the recommendations of my Clinical SlJpcrvisor(s}, including but not limited to, any recommendc<l practice irnpro\icments and ongoing professional development.

\fl l. Dr. Sharma. undertake to ensure that Appendices "'A'' and "'B" to this Undertaking, are signed and deliven:d io the College witJ1in lhmy (30) days of the Jatc I execute thi~ Undcrlaking.

(~) L Dr. Shannu, undertnkc thal if a pe~on who has given an undenakmg in Appendix "A- or Appendix "B" rn thi:s Undertaking is unable or unwilling 10 CQntin~ to fultili its provisions, I shal!, within twenty (20) days ofrecciving notice of same, obtain an executed undertakir:g in the same form from a similarly qualifieC. person who ($ acceptable to the College and ensure that it is delivered to the College mchin lhar time.

rh) r. Dr. Sharma, agree thal if I arn unable 10 obtain a Clinical Supervisor on the provisions set out under set:tions (6)(f) and/Qr (g) above. ! will cease to prov!de any ~an; or creatm\m! to :patients presenting "vith conditions, disorders or diseases of the skin until such time as I have obtained n Cllnical Supervisor acceptable 10 I.he: College.

(i) L Dr. S~r-ma, agr~e that if ram r~uired to CC!ISC (0 p?'Ovide any care or \fCatment

iu patlcnls presenting wirh conditions. disorder.; or discas<!S of the skin ns a re5ult of £ectioo (6)(h) above mis will cor.stiiutc a tenn. condition or limitatiori on m> ccrtifiatc of r~gistralion and lha.t term, condition or !imitation ,.,~JI be included on ~he public regisrer.

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( 7) f'roft::fsio11al Edu ca.lien

(a) l. nr. Sharma. undertakt: w rarticipate in and su<.:e<;ssfuily complete the foll1.1wing f}rvression;il education.

::) <iriy pro1--.,.,sional education rccomtnendi:-d hy my Clinical Supa-.·isor(s).

rb) I. Ur. Sharma, underrnke to provide proof w the ColJ'!gC of my succcssfo! completion of the protcssional educ1:1tion set out in 3~lion (7)(a) wiiJJin on~(!) month or comrlcting it.

(c) l. Dr. Sharma. acknowledge !hat a report or reports may be prnvided to the College regarding my progress and complittncc wi!h the professional cdi1i,;atil1n scr ou1 in

s-:ction (?)(11:1.

:.d) l, Dr. Shlllrms., undenakc to complete Lhis requirement by twelve ( 12) momhs after :he completion of my Clinical Supervision or. if no ~iatisfoccory program is avail11ble by that time, by the fir::t po:ssiblc npportunily thereafter.

( ~) R easuss menl of Practice

\al l, DT. Sharm11, und¢n.akc that, at tbe end of my Clinical Sup~rvision set out in section (6) ab~vc end /\ppi.!ndiccs .. A'' and ''B'' uHached, T will subrni: to a R easscssmcnl of my practice (''the Rc~~essmcnt''J by an asse~$0r or as;;c..>sors ~ch:ctc<l hy the Colkg~ (the "A.ss~·ssoris)'"), who shall be a ccnificd ~pcci<ilis1 in Dermatology. I acknowkdg~ and agree th<Jt th~ Rea~essmem may include a chan ~evil!w, dirci.:I observation of my cnrc, interviews with colli:aguc.s and co-workers. feedback from parienn and any other too!:; deemed nec~ssary by rhe Colkgt

: b) l. Dr. Sharma, un<lena.kc to c~opt:ratc fully \\'J Lh the Reassessment. comlucred umfor lhc term of this umknaking and lo abide: by those re!:omnit.:ndetion~ of the .'\ssessor(s) that are apprnvc:d by the JCR Committ~.

(~) I. Or. Sharma, acl<nov.kdgc and agree that my Clinkal Supenisor(s) may receive: .:nd r<:" iew the finding~ ci flhe /\ssessorts). and may discuss wirh the AsscsS<lr(s) any i:;sucs or c(lncems arising from !he Reas.sess:mem. l also acknowl"'dgt:t.hat the results of the Reassessment will be provided to me and reported to the College and the report rnay fonn tl\e basis of furth.:r attion by the College.

rd) l, Or. Sharmi4, unckr!ltond und agree thal if l am of the view that any of th~ Asscssor(s)'.<; recommendatiC1ns arc lmrcas.onable, I will have thirty (30) days fo llowi:"Jg my receipt of the recommeridntions within which 1.0 provide !.he Colk:ge with my submissions in this regard. I further understand and agn.'C that thcreal'lcr. th.! lCR Committei: 'Nill consider my $Ubmissio.ns and make a dctem1mation regarding wllc:tht:r or nc.>t rhe recommendations, or an}' of lhem, ai-e reasonable and if so, wh~1hc;r they, or any of them, constitmc limitations or n .. -strictions on my practice. ;md li4li dt"'cisi<in \I. ill be provided io r.'le.

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(c) I. Dr. Sharma, undertake lhaL follov,.mg lhe decision referenced in secuon (8)(d) above, I \'\.ill abide by those recommendations of me Assessor(s) tha1 the fCR Committee ha.~ derennine-d are reasonable.

( fJ f, Dr. Sharma. hereby consent to any of the following being included on the publi:: register as terms, condition .. '> or limiuirio.n..i; on my certificare of rcgistratio11. for the purpose:; of section 23 of the Code

(ii any recommendations of the Ass~sm{s.) which ere terms.. condition~ ur limitations on my practice:

Ui) any rccornml!ndalions of the As~sor(s) which the lCR Committee lrns idemified in lt.'i decision referenced in section (8)(d) as temis. condition5 or limi ta.! icms on my prncticc.

r9; F'urthu Terms

(a) l. Dr. Sh.amul, undertake that. after the satisfactory completion of all ~teps rcq\.lircd i:i \hj3 U11<lcnaking, if the Colh:g.: is ofchc view thu\ l have sutisfac!orily cornple1ed the Cha11gc in Scope program. I, .... ~!~:

ti) Ix permitted ro n:t~r w mys.tlf as ill\ intcmal m!!dicinc spcci<l!ist, \.\ith a special interest in treating conditions. disord<:rs or disc::nses of the skill. At no time before, during, or after th~ Change of Scope p~ticc will I refer 10

my::;elf or my practice using the word "dermatology" or a derivative lhcreo f~

Lii) be pennitted to bill my scnices reluting to condilions. disorders or diSt.l:;cs of the :>kin using a Family MediciM billing c-0de.

(b) l. Dr. Sharma, uck.nowledgc an<l agree thm, l'.l.tl~r my rcasse:ssrnent as set ~)ut above, this portion of my practice shall be restricted to those conditions, disorders or Jit;~ases of the skin as the Assessor advises and the College approves, an<l J 1,1.ill com-ply With those restrictions

(I 0) Monitoring

(n) 1. Dr . .Sharma, undertake to inform the College of e<i.ch ond every location thut I practise or have privilege~, including, but not limited to, hosphal(s), clinic(s) and ofliccU). in any jurisdiction (co\\ectively my "Practice Loca.tion(s) .. ). within fift~~1 ( 15) days of executing this L'nde:"taking. Going fQn\.imi. f further uadert<ikc 10

in.form the Colle&re of any and all new Practice Locations within fif~ecn ( 15) dnys of cornmeocing prnctico a1 that loc!!.tion.

tb) l. Dr. Sbannll, u.ndennkc and agree that I will :submit to, and not interfere with. unannoune«i inspections of my Practice Location(s) arx:1 patient rccordsbv I!.. Callcgt!

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r~presenlaltVC for The purpose:> vf monilOriog my compliance V.·ith l'ie provisions of 1his Lindcnaking

(c) l. Dr. Sharma, g;ve my irrcvocublc: consen! lo th1,: College to make: appropriate c:141.:iries OJ the Ontsrio Health rnsunL'1CC Plan r·oHf P"), and/or any pcnwn OT i::s-titution who may have relevant informiition, in order for the College to :r1onitor rny compliance with the provisions or this Und..-:rtaking.

Cd) L l)r. Sharma. acknowledge that! have cxecut¢d the OH!? ccm1cnr fonn, nita,hed hereto as Appendix ''C".

( ! 1) i. Dr. Sharma, undertake to comply with this Undertaking and acknowledge tha! a breach hy me of any provision of this Undertaking may constiruie an act of profo.ssionaJ misconduct :~nJJur im::ompettncc, and may result in a rcf(:nal of s~d ficcl allegations to the Discipline Co;;1rn1lle~ ofthc College.

C. ACKNOWLEDGEMENT

l l;: l l, Dr. Sharma. acknowledge that all appendices attached lo or referred lo in this lJndl!rrnking form p:i.rl <if this. Und~rtakirig,

(I~) I, Dr, Sharma, acknowledg¢ thnt I 5h;i.JI be sokly responsible for pnymcnt<rfall fees. costs. charge~. expenses, etc. arising from the implementation of any or the provisions ot· this l"ndcnakins.

i 141 l. Dr. Sharma, acknowledge and con!inn 1hat I have read and under!:.illlld the prcwislon:; of this l! nrlertaking and that I have obtained illdependen1 legal counsel in reviewing ~nd ,~xc:\:\llin~ this 1Jnderw.ldng, or huvc waivcu my right to dD so.

( 15 J l, Dr_ Sharma. ar.:knowledge that this tmiri: Undenaking consiin:te$ tenris, conditions. :me limitati\>ns on my certificate or rcgi$tf.ation for tbt purpo~t:S of :;ection 23 or th\! Cude. l understand that this Undertaking shall be infonnation on the College ·s Register that is •rvailab!c to 1he public during ihe time period rhai lhe Und<;rtaking remains in effai::t

1 16) [. D-r. Sharma. ack.no-..vledge that chc following summary \\-ill apix;ar on the Col!cgc·s Rcg,is-1.:r that is a1'aiJablc LO the puhlic during rhc lim~ pe1iod that this Undertaking remains in effect:

Dr Sharma '''aS rhe subject ol a College investigation into allegations aboul the pan nf her practice ihat involves rreating conditions, disorders or diseases of the ski 11. As a n:suh or the hwi:siigatiorl

Dr Shanna will, \~ith respect to thi~ pan or h(:r prJ.Ctic~. prilcrise under the S\Jidancc or <l Clinical Suµ.;rvisor acceptable ttl the College for lwdVI:'. ( l 2) months. Dr. Sharma v.i!J engage in professional e.duca1io11

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•

Dr. Sharrna's practice will be rea~scssed by an assessor selected by me College at •he end of th~ period of Clinici:l Supervision, !ll which point the cl\tcnt lO which :;he can treat cor.ditions, disorder~ or disca;;cs of the skin will be cstabli:;hcd. r\t no nmc ""ill Dr. Sharma refer to her pni1:ricc using the words dr!rmatolog), Ji;:rmat0logis1, or any vananon or derivative thereof. At the end of her reassessment, such conditions, disorders at diseases orihe skin ii$ Dr. Sharma is p<:nnirted lo treat shall be billed to OH1P using Family Medicine codes.

D. CO!"SENT

( l 7) l. Dr. Sharma, g.i vc rny irrevocable cons<.!nL to the College to provide the following mformalion to any person who reg1.11re.<; this information for the purposes u!' facilitating my completion of the professional education scl out in .~ection (7) nbove and to all Clinical Su~rvisor~. 3ndtor AsscsS("lrs:

(a) <iny information the College has th al Jed to the circuni!;ta.nces of my cn:ering Into rhis Undertaking:

(bJ <my information arising from any investigation into, or assessment of. my prnctice; and

It:) 3Jl¥ inionnaliun arising from the monitoring of my compliance \1.ith chis Uncknaking.

1 18) I. Dr. Slrn r mii, give my irrevocable consent to the Coll~ge lo provide this lJndcrtaking to any Chicf(s) of Staff, or a collcagLle with similar responsibilities approvi::d by the College, a1

~nv Prnctice \ .-0ca11on ("Chief( s) of Smff'). and to provide said Chlef(s) of Staff with nny i11forma1ion 1he Collc.1,re has 'hat Jct.! to the; drcumstanccs of my entering into this L;ndercaking ;md!or any informati\'.'ln arising from the monitorir.g of my complia.~c wilh th1s IJmlenuk. ing

l ! 9} !. Dr. Sha rm~. gi\·c my irrevocable conscm 10 any per.:;on who faciliuitc~ rn:i complc1ion of 1hc profes~ion;;il education set Nit in section (7) above, and to all Clinical Supc-rvisor(s), Chicf(s) or Staff and Asscssor{s), co disclose to th\! College. and w one nno\hcr, any i~fotrnnlion:

(a) relevant lo this Undermklng:

(h) relevant to the provisions 0f the Clinical Supervisor(~)'s undertaking set out al

Appencli.'< '"A - an<i Appendix ·'B.':

(c) relevant to the Rcasses8mtnr;

(d) :-cl<:v.:ml for !.he purposes of moniroring my compliance v..ith this Lil'ldertaking; and/or

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(c) whi~h comes to his or her attention in rhe course of providing th¢ professionai education se1 oul in si::ction (7' above and which h~ or she rnas.onab!r believ~ indicates a potential risk of harm to my pa11ems.

,tilisl£dayof kJ-.. __ 2016 .

. ANU.JA SHARMA

~~~~-\V~i-<n~·

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6

Dr Gooderham 7057753376

TO Tflf UND£RT AKT'iG Q'(i' OR. ANL'JA SHA.R;\IJA

\'"Dr. Sli::mnll".l

COLLEGE OF' PHYSJCIA;.;S /\:-.'D SVRGEOKS Of O~TARIO (th~ "C()lle~e .. )

c:-;01-~RTAKI~G OF CUMCAI.. st:rERV1so& A, DR. Goo..o~Hfui1 ,To THE (0LLt:G'E

p.2

l ~m il pr .. 'H.:t!~fr.g ir.C1"!'10C( ofi.ht C:e>llcgc ccrtifireic of n:gis1ro;ion mtmb<..": )~a,~~ . -.--....... ...-.~·--

1 h;i.ve 11."<id L'1c L'ndcnaking. of Dr Sh:mna rn~d1: v.·!1h fr1e Cc!fc;!,~ ~n the !.5_ __ day ;;ii 1}1..iL.L.k-_2016, r have a!so read ~he l.'nderwkin£ ofC!i11ic:il Sup~r:isor 3. whidi i~

.\ppc!ldi:-:: R 10 the t.:ncicr..tlmg cf Dr. Sh:i.r:r:!

: ack.:"lo·.vleJg.c lh~ J ha,,~ ~·kwcd, o~ will rt::\'icw as soon QS Dr!lC?ic~ble. ti:c m<ncTi:!:s ~::-.~nrdi!"lg Dr. Sh:;irrn'1 ·.s pracC!CI! ~1-idcd to me by tile Co LI egc indlv..diT.y !hc :-epon.\sJ m· ;he : n eJ ic.il 1nsp.;:cwr, dard March 27 .md J:.i!y 2. 2.015. <is well iil.S \he College· s Guide! irics for (ollcge·Di~-:.:ted Clinicel Supcrvi~ion.

I u:.:lmo":t~c ~c thE!>l Dr. Sh.arm:< has ·.mdcna~er. to prnc~ice 'Jnd::!r 1hc g_lli<iznce af u dinica: :;llj)t::-VcSOf(3J a minimu.n1 o~·-:we!vc (:2) n11.mlhs (•"Clinica! Supcr.·is:on'"i. This .>hwll con:>'.st 0:' <lll 1:di:.I period or Clil'!:;a: $u~r.:isim1 lasting" minimum t~r tb:c {~) monti~f {"hi1i:i1 f'crinci orC linii;ciJ Supel'\isio:i"i and a:1 a.:.!dffiOnal pcrio:l of Clinical Supcl'\·isrnr. i<L•liri!:,£ r:in.,. (9) !!ionth,; (··1\ddirional Period of Clinical Supcrvi.\!on",1.

! :.gre\! t.hac i::o::imenci:ig Ti-um the dare ! sign !.his w:.dem.~ing, J sh:il: ~! as Cb1~·l!I Supcn·i!or for Dr. Shmna (''C!!rrical S\.l.pC:-visor"), for ii m!r..imwm of twdw ti:) mcimhs.

I agree chat jiJring the perk>d of C!:ni:al Supen.ision, l will, :it minimum:

(3 l Durin~ the IniLi<il Period or Clinlc:ll Supervision. which wif J Jas1 il rnfr1imum of t.'v~e ( 3) nronths, mCL'.l wilh Dr. Sha.'lTl~ cni:e every wee!I.. a\ ;t ii:tru::ruin. ro t"h~('ri.'c: al: (If l~~ ~u~:> in•·olv'.r.g conditions. c:;wrders o:· <li:sd.S~S of;n~ ~:.::n, urJt..-ss !;ht: <Joe~ n1,11

havL! any plltii:ncs prcsc:nling for oond;dons. disor:icr.; r:r disca.-~s ur rhe okin dui·ing th81 .,._,t'Ck .. ·\i'. such obscrvlition :shl!.11 :eke plm:c 11t my pr~cticc. Dming rh~ Tnitinl Pmoc 0fClinic.!l Superv~sion. I w:ll .a!so rc .. ie ..... tsll of Dr. Shcum;i·:c patient ~h3rts :nvuh·in~ rnnditions, di~orden or di!'>':<:S~ .:if the skh1 :ind her lo~ or'i.:ascs invo: ,·in!-'. i.:on'-iLiuro.s, dismdecs or di:."t.'<LSCS :'.lf1he skin. I acknowleege that th: lnir:a1 l'cr'.cd of Ctinicd SutX:rd.sioo v.il! nOI terrniml(:! uatil r hJ.ve obscr.·ed a mi~ir:i:.im o1°5i:ny (50)

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o! Dr. Si1CT"!la-:; cases io-.,oJ<. ing <.;cmdniOilS_ r.::wrdcrs or •lise~..::sor ih.: $ki~ Ju:in~a p~rio<l of 11~ lcas1 thi-c;; (:i) moml1s~

· t>J Ou:-ing lhc ,\dditior.al Pt'riod of Clinical Sur1:!>·~s.ion, m~t \\1Ih Dr. Sh;i~ once "-"CtY momh tt; review tw<!~ny (20) of her p2tient charts invc-f\'ing .;('Jnditicir.s, d\.sorders or disc:ases uf th!! ,;kio. During the i\.dditianaJ Period of Clir.kal Supc.7\isior;. l wi 11 b~ >Ulel;: respun~ib ~c for sclect'.r.g all Cha.-:-ts u) be :-ev;~\'CC hr r'C.

-Jn the ~;!': o.f the .ll't::is o~- cor.t.::::rn iJ.;riti.l:c~ in I.he :nedicat in~p.;Ct:)r·~ 1';1)0!'" .... ~, ;:lnicd Mater. 11 ::ind fol} '.!, 20: 5. i:rrtl any .:oncerr.s :-:-:nt ari:r<: <:!'J:ing lhc pcr;o,j :-;' Clini::.l Sup1:rvis1011; - ·

(d1 \la.kt- rccC\rnmcr.d111icns 10 Dr. Sha.-rna for practice improvc1T.e111s and on_¥cing prot\:ssional d~vc;oprncm and ir..quin:: i:no h~1· c0mptian1.:c with d1.:­r.:comn1i:ndat1ou:;;

'.C:-1 Y1.·rf<-rm an~· other duties_ such a..<: rc"i.;" i11g o~r doc.iin1,.'11I:: m corn.iJJcting ;~lc,....ie· .. vs wi·,;, suit-o~ colleague~. lhlll [ dec-:n necCS$:ii;· to Dr_ S!i~e·s Clinical SurcrvJsion.

~ ! .a~n.~ ~o ~ul.,mit .l "°'·riu:n repcri :o Lhe ColJegt~ .:!! minin1um. ouce per rrcar.lh d~r;:-ig thl.! lni1i~ ?CTiod ofCJinic:il Supervision. !.nd ~incc cvcry tr;',;!c •))month:! during chc .A.ddiuon;i.! !'~riod of Clinical S1rpcrvisioc. or more ~rcquen1ly if r ~m concerned obout Dr. $0.-uma's :>ra<:ticc. Such reports shtJ!l be in ~neble i.kt3.ii. a:-:-: shall contain :tll infonnaiion [ tx:1ii;\"I: might as:;hn the Co!lc:t1e ir. c•w.luating Dr. Sha..-:nn·s standard cf rrrattice. as wd: U;i iJr. Si;2:ma·s participation in ant! ~oinpliaricc with lhc rcq\J.irom~nt5 ser O'.l! in lft_ Sharrna's UnJe~!<.ini.

~ I .J!;re-c Ulllt if Jam concerned tha.1 Dr. Shanna's j)ril.l.'tice rrwy f!'JI h:low the st.:::rndard o(

f'l';tC'i~ allhc profc.~sicm, or \hat Dr Sha.rrnil m:l)' not l:ie in compliance \\ilh the rrov1sirn:> 11t'r_.e;r L n<le>.aki~ \~-i1h !he College. and.11'.lr ~h<'.t :-ier palieni.s m:i.;: be c:w.:po:<cd tfl risk n!"ha.m1 nr ini~'. :hen ! shall >:Tl-T.ediarc!y notify 1he OJH.;ge..

'I. : :Jc.:1..no>·vkdbrc: thill !)r, Sniil"rna ha~ C(l!'lscntcd to :ny di~Josure la :ho: c~)llcgc .Jl'Jtl a:l Lither Clir:ical Supcn-iso:-s :me Asses.son ofi1ll bCorrr:arion rck•:ar.i ~o Dr. Sham-.;.(~ l.h:du·illi.:ing \t) :he Co!l~5t!, rclc\'l!nt to th~ prov!'.:lion:; o! this. my Clinical Supcrviscir's \tndi;rtAkir'lg. r.:l'-' ,·;.i:t lCI llr.y Rt.::issessrnent of Dr. 3ham1a ·s pr:ie1:cc il'1d!Or re!evan; ·:"or lOc Pl!rpP."1!5 er' m<e,-;i;mi":g. flr. Sh:trtr1'1'~ compl!u:K~ wiill her Cnd(.'rt.iki!:g l~ 1he C,1!!.:g~·-

,(J l :icknowli:di;.~ tha< aJI info:matio11 l.ha1 I b<lcomc :iu.;ir.:-cfin 1l~c co'..l!:$C ofrr.; .,J11t:~<; ;::..s :Jr-. ':>h3.1m~·s Cliri:al Svper>i.<:or is con!lden1;u.1 !nform;;~ion and 1hat I jjn' ::rohibi:cd, bo1h Jur1ng :111c !ll'H.'T the period of Clmi~ Supe:vision, f('(lm cor:unmfr~ating it.1:i. My form and t::y any means c:xcep; in tlle !lmii:~ci circumstances s;;t aur :n S-..."Cti<tr,~ '.i6t 1 )(l.l) through .~6\ I J(j) ..;(the Reg11f.:m.:d Hec,1/rh Profem'o11L4l'I 1991. S.O. 1991, c. lll (the "TUli' A-'),

(4)012/017

04/18/2018 10 53 FAX 418 885 9010 LrnCZNER SLAGHT ~013/017

j 14 Apr 16 02 54p Dr Gooderham 7057753376 p4

1.---11 ,,

11.

,-,

r ur:dcrtaki.: to notify (he Collegl! and Dr. Shmn~ in :u1v~1ct wi:e:evc; p<:>ssible. but m iiny ~~e imaiediaw\y following, 3Il:; communica.1ioi:; ofinfonnatior. uodcr section ~6(1) of th:; R.HI' A

l agrc:: :-o immedi3tciy inform the College in v.."rirmgifOr. Sharma and I have tcmiinn.~<.J oi.:r Clin;eill Supervision rel1ni0oship, or if! otherwise ce.nnot f•illill the ?rovisicns of r.i~· vrd..:rtakinb

-----··--·-----.. ~---· Or. GOOIX1Z-~

A~

04/18/2016 10 53 FAX 418 865 8010 LUiCZNER SLAGHT ~014/017

APPE,'\D(X '·B"

TO THF: t;NDEfff AKfNG UF OR. AN(JJA SHARMA ("Dr. Sharmll")

ro

COLLEGE OF PHYSICIANS AND SURGEONS OF ONT A RIO (the "College"')

C~DF.:RTAKING OF CLP.'TJCAL SliPERVJSOR B, OR. (r"}C Q W105}(Z;: ,T'O TJU:: COLLEGE

l. I sm a practiliing rnem~ of the College, cenificate of rcgilitre1ion numbi:r51_6 <J. 8 1. I have r.c;:d the Undcrraking of Dr. Shamui made w~th the College on the l:i_ day of .~L __ 2016. I have also read the Undimaking of Clinical Supervisor A. which is .\opt:ndix /\ 10 the Undcrr.aking of Dr. Shanna.

3 I ackno\>fl('Jdge that l have: reviewc<;i, or will review as soon as pr:icticablc, the materials regarding, Dr. Shanna's practice provide<! to me by the College including the report(s) of'lhe medical inspector, dated March 27 and July 2, 2015, as well as the Callcge'sOuidclincs for Collcgc-Dircctcd Clinical Supervision .

.; I acknowledge that Dr. Sharma ha..~ undertaken to practice under 1he guid..mce of ft clinical supcr11isor(s) far a minimum of twelve t 11) months ("Clinical Sl.lpervision·l This ~sll consist of an ini:ial rcriod of Clinic.<11 Supervision lasting a minimum of thri.:e {3) months (Initial Period of Clinic<il Supervi~ion") and an e1dditional period Qf Clinical Supervision ltlStinQ nine (9) months ('Additkinal Period of Clinical S~1pcrvision'').

5 l ag:e! ch.at commencing from th~ date the Additional Period ofClinioaJ Supcrvisi<in begins. 1.c_, immediately following Dr. Shanna.·s completion of the Initial Period of Clinica; Supervision, I shall a.c.:l as Clinical Supervisor for Dr. Shann3 ("Cli11ical Supervisor"), for 1:i11e (9} monrbs (''Clinical Supervision").

6. ! ;:13~cc 1hiU during the period of Clinical Supervision. I will. 11\ minimum;

(a) During the Additional Period ut Clinical Supervision, meet W'ilh Dr. Sharma at her pruclice location for -0ne (1) hous once every rnonth to observe her cases involving conditions. disord~rs or disca~cs of the skin.

(h') If during my monthly observation Dr. Sharma do:s not have a full case load vfpu1iencs presenting for condicions, disorder~ or diseusc~ oflhe skin, l .,.,;11 review her log of cases involving conditions, disorders or d!sea.ccs of the skin for zhe prec~ding month:

04/18/2016 10 53 FAX 416 865 9010

-Dr.

LENCZNER SLAGHT ~015/017

tbis i3 ~ayof ,D(?vi· ( , ---- J 2016

(f/~ ·----~,--·-

04/18/2016 10 53 FAX 418 865 9010 LENCZNER SLAGHT

APPENDIX "C''

TO THE UNDERTAKING OF DR. ANTJA SHAR.Pl;JA ("'Or. Shuman)

to

COLLEGE OF PHYSfCIANS AND SURGEONS OF ONTARIO ((he "College")

CONSF:l\'T A~D DIRECTlO:-.' FOH THE RELEASE OF lNFORMATJON FROM TTIC

ONT ARIO HEALTH TNSUR.A~CE PLAN

@016/017

~4/18/2016 10 53 FAX 416 865 8010 LENCZNER SLAGHT @017/017

-----~-----·- ___ ,,,

nJE

COLl1:G£ OF

JPHYSITCIANS

CONSE;\'T AND DIRECTION fOR THE RELEASE OF lNFOR.\1ATJON FROM THE

ONTARIO HEAL TH fNSGRANCE PLAN

AN'D

SURGEONS Of

ONTA.Rl!O

l consent to the release of bi I ling information by 1he Ontario I Icallh ln.•l.lram;c Plan t('l the COLLEGE OF PHYSICIANS /\ND SURGEONS Of ONTARIO for;

1. Name of Physician: DR. ANUJA SHARMA

2. OH!P billing number:

CPSO #: 97380

4. Date{s) or Time Period: -Z016 onward

D~rcdat ____ Cobll<-\"14 'ON .this_{_f_cta;vof Atvi{ ,2016 . ..J

Witness (.)1gnamre1