Issue 165

Messenger
The
College of Physicians & Surgeons of Alberta
Highlights
•Registrar’s Report
Healthcare in Alberta,CPSA Strategic Plan ..... Pg 3
•Prescribing Corner
Responding to potential prescription fraud. ...... Pg 8
•Discipline Reports:
Dr. Franklin Dean Collett........................... Pg 6
Dr. B10................................................. Pg 10
•When does a medical condition affect practice?................................................... Pg 14
February 2011 | issue 165
In this issue
Registrar’s Report - Healthcare in Alberta, College’s new strategic plan........................... 3
Bill 52 update: New Standard of Practice.................................................................... 4
U of C re-entry residency training positions available................................................... 4
Infection prevention in the physician’s office - ear syringe equipment.............................. 5
2011 Regional Tour - Join the discussion..................................................................... 5
Discipline Report: Dr. Franklin Dean Collett.............................................................. 6
For your information (UnConference on Patient-Centred Care; Surveying adult weight
management services in Canada; HQCA Patient satisfaction and experience survey results; ACFP 56th Annual Scientific Assembly (ASA); MCC call out for examiners)...... 7
Prescribing Corner: Responding to potential prescription fraud . ................................... 8
Changes in registration criteria................................................................................... 9
Discipline Report: Dr. B10....................................................................................... 10
Pharmacists ordering laboratory tests......................................................................... 11
Council Highlights................................................................................................... 12
When does a medical condition impact practice?........................................................ 14
Alberta Health Services Safe Surgery Checklist .......................................................... 15
84th Annual North/South Doctors’ Golf Tournament.................................................. 15
The Messenger
The official publication of the College
of Physicians & Surgeons of Alberta
2700-10020 100 Street NW
Edmonton AB T5J 0N3
General Inquiries Line
1-800-561-3899
Complaints Line
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Website
www.cpsa.ab.ca
next issue: March 2011
Deadline for submission of articles is
February 15. Please send submissions
to [email protected].
Alberta Rural Physician Action Plan (RPAP) - Award nominations............................ 16
2011 Council
Council members are available throughout Alberta to answer questions and discuss current issues. Email: [email protected].
Elected Members
Telephone
Dr. Ann Crabtree .................................................................................................. 403-287-3591
Dr. Louis H. Francescutti ..................................................................................... 780-492-6546
Dr. Selby A. Frank ................................................................................................ 780-632-6414
Dr. James A. Harder ............................................................................................. 403-955-7633
Dr. Stan C. Houston ............................................................................................ 780-407-8035
Dr. Karen A. Lundgard ......................................................................................... 780-624-2581
Dr. Cheri Nijssen-Jordan (President) .................................................................... 403-955-7070
Dr. Carl W. Nohr ................................................................................................. 403-580-4610
Dr. Randall W. Sargent (Vice President)................................................................ 403-861-0315
Dr. James Stone..................................................................................................... 403-571-8614
Dr. Monica L. Wickland-Weller ............................................................................ 403-843-2256
University Representatives Dr. Philip Baker, Dean (UofA) ............................................................................. 780-492-9728
Dr. Tom Feasby, Dean (UofC) .............................................................................. 403-220-6842
Public Members Ms. Janet Blayone ........................................................................................................ c/o CPSA
Mr. Blair E. Maxston ............................................................................................ 780-441-3413
Ms. Linda Spencer (Member at Large).......................................................................... c/o CPSA
PARA Observer Mr. Khalil Jivraj .......................................................................................................... c/o CPSA
The College of Physicians & Surgeons of Alberta (CPSA) is responsible for licensing physicians, administering standards of practice and conducting/
resolving physician-related complaints. We also provide leadership and direction on issues of importance to the health care system such as access to
services, quality improvement, patient safety and privacy.
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Messenger, February 2011
Registrar’s Report
Healthcare in Alberta, College’s new strategic plan
how well one is doing or to compare oneself to others. In this instance an industrious resident did the leg work, exposed
the data and gave the surgical staff a safe
environment in which to review their
results and to make appropriate changes.
I remember a surgical round at which
one of the senior residents presented
that hospital’s morbidity and mortality
statistics for the Whipple procedure (a
major pancreatic resection most commonly done for cancer of the pancreas)
and compared them with the literature.
He went on to discuss the methods used
at that hospital to manage the pancreatic
stump, the Achilles’ heel of the Whipple
procedure, and described what the literature of the day stated as the preferred
choice of management.
The literature was clear: stapling the
pancreas, as was in common use at that
institution, led to more complications.
Exposing the data within that institution
had a quick and profound effect. Stapling
of the pancreatic stump was abandoned
for more effective options.
This was a good news story for patients
and for that hospital. Future patients
who were candidates for the Whipple
procedure would receive the ‘evidencebased’ procedure, and those patients
should have better outcomes, which leads
to fewer hospital days and lower costs per
case. The surgeons who changed their
practice also benefited.
In the absence of data, it is hard to know
There are several points I’d like to make
from this story. The first is that, like the
surgeons in this hospital, we need useful
information and feedback to inform us
as to how well we’re doing as individual
practitioners, as teams, as a Primary Care
Network (PCN), or a department or a
hospital. We need data about the quality
of care we provide to patients.
We need useful
information and feedback
to inform us as to how well
we’re doing. We need data
about the quality of care
we provide to patients.
The second point is that quality has
many dimensions beyond access (which
is the flavor of the day). Access is essential, but we need also to ensure the
services we provide are acceptable, appropriate, effective, efficiently delivered
and safe (just as the quality matrix of
the Health Quality Council of Alberta
tells us). The story about the Whipple
procedure is really one of safety – trying
to limit the complications from a very
complex procedure.
My third point is that we need a safe
and supportive environment in which
to consider and review that information
and to plan what changes, if any, we
should make. We need the opportunity
to reflect, and we need to be able to consider how to make improvements without
worrying about possible retribution.
All of you have now received the new
strategic plan for the College. From my
perspective, the most significant change
advanced by this plan is the focus on
quality - quality healthcare for Albertans and quality medical care from our
members.
The College will be working with our
partners – Alberta Health Services, the
Alberta Medical Association, other professional regulators, Covenant Health,
the Health Quality Council of Alberta,
Alberta Health and Wellness and others
– to advance this agenda.
We obviously need to ensure that our
members, and the groups with which
they work, receive useful feedback on
how well they’re doing in practice.
While recognizing the value of the feedback from the Physician Achievement
Review (PAR) program, we need to go
beyond PAR by providing information to
our members about their clinical processes and outcomes. We will continue
to use the prescribing data available to us
via the Triplicate Prescription Program,
but we want to expand that to include
other drugs from PIN (the Pharmaceutical Information Network) and we need
to mine other databases for additional
measures of quality.
As the medical administrative leadership
at Alberta Health Services and Covenant
Health is already responsible for the
quality of medical practice in their institutions, the College’s role will be much
less direct.
We need only to be assured that physicians who work in those settings are
receiving feedback (and support when
necessary) as to the quality of care they
deliver.
Registrar’s Report cont’ d Pg. 4...
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Messenger, February 2011
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Registrar’s Report...cont’d from page 3
We will, of course, work with Alberta
Health Services and Covenant Health
medical administration to address any
issues of common concern.
From where I sit, this is what the College’s new strategic plan is all about;
building a culture in medicine and in
healthcare that values measurement,
feedback and improvement.
While some specialties – cardiac surgery
comes to mind – have always measured
outcomes, doing so is unfortunately
not the norm in medicine. But if we are
to have ‘the best performing publicly
funded health care system in Canada’
as our health minister and premier have
committed, we will need to be able to
measure it. How else will we know it is
the best?
So let’s get started. We can, just like the
surgeons at the hospital I referenced at
the beginning of this article, begin by
looking at what each of us does in practice, measuring it, and asking ‘Can I do
better?’.
As always, your comments and feedback
are welcome.
Dr. Trevor Theman, Registrar
[email protected]
Bill 52 update:
New Standard of Practice being developed
The College is working on a new Standard of Practice to manage the information in medical records, and to protect
the privacy and security of electronic
medical records (EMRs).
across Canada. A proposed Standard
of Practice is being drafted under the
guidance of the Medical Informatics
Committee, and will go before College
Council at its March meeting.
This new Standard is required through
amendments made to the Health Information Act and its regulations (Bill 52),
which took effect September 1, 2010.
These amendments also require the College develop a process for physicians to
contribute certain patient information
to the Alberta Electronic Health Record
(EHR).
If Council approves the new Standard,
a formal consultation process will take
place from March 15 – May 15, 2011. All
physicians will receive an email notice of
the consultation, directing them to the
proposed draft Standard on the College’s
website. We encourage you to read the
draft version and provide us with your
feedback.
Since December 2010, the College has
been conducting research and gathering
input from individuals and groups with
expertise or an interest in health records
management, both within Alberta and
Council will consider all feedback from
the consultation at the June meeting, to
ensure the new Standard of Practice is in
place by September 1, 2011, as required.
Re-entry training positions available
Every year, the Office of Postgraduate Medical Education at the University of Calgary makes a few residency positions available for
physicians who are currently practising in Alberta (either in an urban or rural area) and would like to re-enter residency training in
a specialty of their choice.
The number of positions offered is limited. The re-entry application deadline is February 28, 2011.
For further information, please visit: http://medicine.ucalgary.ca/postgrad/canadian.
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Infection prevention in the physician’s office Ear syringe equipment
Physicians have raised concerns about the rigor of
requirements for the safe reprocessing of medical devices in
their offices, particularly the requirement for cleaning and
disinfecting ear syringe equipment.
In response, the College’s Infection Prevention & Control
Advisory Committee approved the following advice to
physicians. This advice replaces all other advice issued by
the College through audit reports or conversations with
College inspectors:
• Devices used in the cleaning of ears must be free of
contamination before use.
- If reusable devices are used to clean ear canals, they
must be high-level disinfected or sterilized between
uses in accordance with manufacturers’ instructions.
- The College is aware that some of the common
systems in place present constraints on the degree
of disinfection attainable and that some compromise
may be necessary. In consideration of those
constraints and of the generally low risk of disease
transmission if cleaning and drying is performed
between each use, the College’s Infection Prevention
& Control Advisory Committee recommends the
following guidelines for reprocessing of ear syringing
devices and components:
• Reusable ear syringes and components that can
be sterilized (such as stainless steel ear syringes)
should be autoclaved.
• Reusable ear syringes and components that
cannot be sterilized (such as plastic syringes,
water reservoirs, pump mechanism and tubing)
should, at a minimum:
• be cleaned and flushed with an appropriate
instrument-grade detergent and then be dried
between uses,
• be fitted with a new single-use tip for each
use, and
• never be left with standing water in the
reservoir.
If you have questions about these or other reprocessing
instructions, please contact Ms. Shonda Holt, Program
Manager of Clinical Accreditation Services, at
[email protected].
2011 Regional Tour Program - join the discussion
The CPSA Regional Tour offers physicians the opportunity to meet with College Council members and senior staff
in a face-to-face setting that encourages
two-way dialogue through interactive
discussion.
The meetings provide an invaluable
forum to build relationships and help
College staff identify and address local
and provincial issues.
In 2010 we traveled to Red Deer, Lethbridge, Westlock, Camrose, Medicine
Hat, Calgary and Edmonton. We look
forward to seeing many of you in 2011.
For more information, or to book a
meeting, please contact Kelly Pandachuck at [email protected],
780-969-4972, or 1-800-561-3899 ext
4972 (Alberta only).
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Messenger, February 2011
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Discipline Report - Dr. Franklin Dean Collett
Following a thorough investigation and subsequent
disciplinary hearing, the Council of the College of Physicians
& Surgeons of Alberta (CPSA) has found Calgary family
physician Dr. Franklin Dean Collett demonstrated
unbecoming conduct in that he failed to fulfill the terms of
an Undertaking previously negotiated with the College.
On September 9, 2010, the Council of the College of
Physicians & Surgeons of Alberta found that Dr. Franklin
Dean Collett of Calgary, Alberta, demonstrated unbecoming
conduct in that:
1. He failed to fulfill the terms of his Undertaking to the
College dated May 8, 2007 in that he did not request an
exemption from the general drug restrictions in section
2 of the Undertaking, as required in section 3 of the
Undertaking, before prescribing a restricted drug to 78
patients.
The Council of the College of Physicians & Surgeons of
Alberta ordered that:
1. The allegation in the Notice to Practitioner, as admitted
by Dr. Collett, was proven and Dr. Collett was guilty of
unbecoming conduct.
2. Dr. Collett’s registration with the College be the subject
of a period of suspension of three months, the whole of
which is to be held in abeyance conditional upon Dr.
Collett’s fulfillment of the following conditions:
a. Dr. Collett shall not sell, prescribe, dispense or give
free samples of any drug in the following categories:
i. Drugs listed on the current College’s Triplicate
Prescription Program Product List, except:
a. narcotic analgesics for patients with
malignancy-related pain where the malignancy
has been diagnosed by a pathologist or
oncologist;
b. anabolic steroids used as treatment of
a malignancy or of documented testosterone
deficiency;
c. methylphenidate for school-aged children
as and when recommended by a pediatrician
or pediatric psychiatrist;
d. methylphenidate for adults as and when
recommended by a psychiatrist or neurologist;
ii. Drugs containing barbiturates except:
Phenobarbital when the Phenobarbital is used as
an anticonvulsant provided there is sufficient
objective evidence of convulsions;
iii.Drugs containing codeine, other than over the
counter medications;
3.
4.
5.
6.
7.
8.
9.
iv. Amphetamines and amphetamine-like appetite
suppressants containing diethylpropion
hydrochloride (e.g. Tenuate®), mazindol (e.g.
Sanorex®), or phentermine (e.g. Ionamin®);
v. Benzodiazepines and other anxiolytics, hypnotics
and sedatives including chloral hydrate and
zopiclone (e.g. Imovane®);
vi.Drug formulations containing “muscle relaxants”
such as carisoprodol (e.g. Soma®), meprobamate
(e.g. 282 Meps®) or methocarbamol (e.g.
Robaxisal®) except to provide treatment for a
maximum period of two weeks for each patient in
any three months period.
Dr. Collett shall keep daily a typed or legibly written log,
separate from any patient records, to record any of the
permitted exceptions set out in paragraph 2, and each log
entry shall contain the name of the patient, the specific
exception provision, the date of the patient visit, and
the amount, type and strength of drug prescribed, sold,
dispensed or given.
Dr. Collett shall provide to the Registrar a copy of the
daily log entries made during the previous month in
accordance with paragraph 3 and the Registrar may
review the original or a copy of the chart of a patient who
has been listed in the daily log to ensure the use of the
drug was appropriate.
The Registrar may obtain further non-nominal
information regarding Dr. Collett’s prescriptions of the
drugs listed in paragraph 2 from provincial or federal
drug databases.
Dr. Collett shall, at his own cost, be subject to random
practice visits, up to 2 per annum, by a trained assessor
selected based on availability from a pool of assessors
trained and utilized by the College for peer assessment.
Dr. Collett shall receive a copy of any written report or
reports arising from the practice visits exercised pursuant
to paragraph 6.
Dr. Collett shall, at his own cost, follow any reasonable
directions from the Registrar arising out of a report,
verbal or written, from an assessor who is conducting or
has conducted a practice visit pursuant to paragraph 6.
If Dr. Collett is unable to treat or continue to treat a
patient due to these conditions on his practice, Dr.
Collett shall make reasonable efforts to refer the patient,
in a timely manner, to a physician that can provide
the required treatment which is prohibited by these
conditions on Dr. Collett’s practice.
Discipline report cont’ d Pg. 7...
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Discipline Report - Dr. Franklin Collett ...cont’d from page 6
10. These conditions shall remain in effect until Dr. Collett’s
retirement from the practice of medicine.
11. Dr. Collett shall be responsible for the costs of the
investigation, all attendances before the Investigating
Committee, and Council in this matter, which costs
total $14,521.59, and any ongoing costs incurred by the
College of the monitoring of the conditions on practice,
all of which are to be paid within a time to be determined
by the College.
12. If it is alleged that Dr. Collett has breached any of
the terms of this order, including the conditions on
practice, this matter shall come back before Council
for determination of whether there should be any
modification of the conditions on practice or if Dr.
Collett should be required to serve all or a portion of the
period of suspension held in abeyance, or both.
13. That the name of Dr. Collett and the particulars of this
matter shall be published.
For your information
UnConference on Patient-Centred
Care - Patients’ Association of Canada
February 15, 2011 will mark the official
launch of the Patients’ Association of
Canada with its one day unconference in
Toronto.
The survey takes approximately 20 minutes to complete and is open to anyone
leading a Canadian weight management
program. For further details and to
access the survey go to: http://con-initiatives.com/adultscan.
The UnConference on Patient-Centred
Care will bring together patients, healthcare providers and healthcare policy
makers for a full-day plenary session on
strengthening patients’ voices in healthcare. The evening reception includes the
launch of My Operation: A Health Insider
Becomes a Patient, by PAC President
Sholom Glouberman.
Health Quality Council of Alberta
(HQCA) – Patient satisfaction and
experience survey
The Health Quality Council of Alberta
released its 2010 survey results regarding
Alberta patient experiences and satisfaction. Highlights of the results, based
on responses from 5,000 Albertans,
include:
• 62 per cent of those who received
health care services in the province in the past year rated their
satisfaction as 4 or 5 on a 5-point
scale. This is relatively unchanged
from 60 per cent in 2008 and significantly higher than 58 per cent
in 2006 and 52 per cent in 2004.
• The ease of obtaining health care
services continues to be the most
important factor associated with
patient’s overall satisfaction with
health care services received.
• 48 per cent of Albertans who used
the system rated access to health
care services as easy (4 or 5 on a
5-point scale). This is relatively
unchanged from 46 per cent in
2008 and significantly higher
than 42 per cent in 2003.
Further information is available at:
www.patientsassociation.ca.
Surveying adult weight management
services in Canada
In partnership with the Canadian
Obesity Network, a research team from
Université de Sherbrooke is performing a scan of adult weight management
services in Canada through an online
survey.
The survey aims to:
1. build a comprehensive picture of
adult weight management services
in Canada,
2. raise awareness of the variety of
programs that exist nationally,
3. provide opportunities for networking and collaboration between
sites.
A technical report and summary of the
findings is available at www.hqca.ca.
ACFP - 56th Annual Scientific
Assembly (ASA)
Register today for Alberta’s interactive
Family Medicine conference! The Alberta
College of Family Physicians (ACFP)
56th ASA will be held February 24-26,
2011 at the Rimrock Resort Hotel in
Banff, Alberta.
Visit www.acfp.ca for conference registration and accommodation information.
Questions? Contact [email protected].
MCC Call Out for Examiners
The Medical Council of Canada (MCC)
is looking for examiners for the upcoming fall examination, which will take
place on May 1, 2011 at the University of
Alberta Hospital.
The criteria for examiners includes:
• Licentiate of the Medical Council of
Canada (LMCC)
• Three years of independent practice
and three years post LMCC.
• Holding an unrestricted license and
currently practising medicine.
Note: Examiners may be community
physicians.
If you’re interested, please contact
Kathryn Wheaton at 780-477-2215, or
[email protected] using the subject
line LMCC II.
The
Messenger, February 2011
7
Prescribing Corner
Responding to potential prescription fraud
In early 2010, the College of Physicians
& Surgeons of Alberta (CPSA) and the
Alberta Medical Association (AMA)
conducted a survey on prescription
fraud.
677 Alberta physicians responded to the
survey and shared their experiences, the
results of which were reported in both
the AMA’s Doctors’ Digest and the College’s Messenger publications in September 2010.
Following publication of the results,
the College received requests from
physicians for further advice on how to
respond to possible prescription fraud
in their practices. Additional tips and
advice are included below for your reference:
Don’t jump to conclusions
A physician should obtain additional
information before deciding how the
situation should be handled. This information might include corroborative data
accessed through the College’s Triplicate
Prescription Program, the Pharmaceutical Information Network on Netcare
and/or from the patient’s pharmacy.
When possible, a physician should also
discuss the situation directly with the
patient to determine the clinical context.
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The
Messenger, February 2011
For example: altering a prescription may
indicate dependency, addiction, inadequate analgesia or financial issues.
Should a physician discharge the patient from his or her practice?
Some patients move through a series of
prescribers to obtain their drugs, never
receiving treatment for an underlying
dependency or addiction. A physician
can be more helpful to a patient in this
circumstance if he or she is willing to
continue working with the patient. If the
underlying issue that led to the prescription alteration or theft is addressed, the
patient has a much better chance at successfully being treated in the long run. If
the patient is persistently non-compliant,
uncooperative or manipulative, terminating the relationship may be the physician’s only reasonable option.
Tips for managing a patient’s prescribing status if the physician continues to
treat the patient
The physician should first tighten control
of the patient’s treatment and make
boundaries very clear. If an opioid contract is not in place, this would be a good
time to implement one. A sample version
of the contract is available at: www.cpsa.
ab.ca/Services/Physician_Prescribing_
Practices/P4_Resources.aspx or http://
nationalpaincentre.mcmaster.ca/opioid/
cgop_b_app_b05.html.
A physician can also:
• Fax all prescriptions (including
blister pack medications) directly
to the pharmacy.
• Opt for shorter dispensing intervals, including daily dispensing if
possible.
• Avoid prn doses.
• Increase the frequency of follow
ups.
• Conduct random Urine Drug
Screens.
• Access prescribing data on a regular basis.
• Enlist help from patient addiction
support or through a chronic pain
referral.
Health Information Act – what can a
physician disclose?
Part 5 of the Health Information Act
covers what health information can be
disclosed without special patient consent,
including:
• Disclosure of patient information to the College as part of the
administration of the Triplicate
Prescription Program,
• Disclosure to comply with a subpoena, warrant or court order,
• Disclosure to another health professional in the patient’s “circle of
Prescribing Corner cont’ d Pg. 9...
Prescribing Corner...cont’d from page 8
care” and/or police services when
there are reasonable concerns of
fraud, commission of an offence or
abuse of health services
• Disclosure that protects the health
and safety of Albertans
What information should be provided
to the police and the College if TPP
prescriptions are stolen?
• Date of loss or theft.
• Serial number(s) of the missing
pad(s).
• Name of the last patient for whom
a triplicate prescription was written
Note: It is recommended that:
• the minimum patient data necessary is disclosed, including not
releasing medical conditions or
details.
• the physician makes note of the
police file number, investigating
constable name and phone number.
and conduct regular inventory monitoring of your supply to avoid prescription
fraud and theft.
For further information, contact Dr.
Susan Ulan, Senior Medical Advisor at: 780-969-4930, 1-800-5613899 ext. 4930 (in Alberta), or email
[email protected].
Bottom Line
Prescription fraud is rare but upsetting
for physicians when it happens. Keep
regular and triplicate pads in a secure
place on your person (when with patients) or in a locked drawer for storage,
Changes in registration criteria
To facilitate the mobility of physicians under the Agreement
on Internal Trade, the Federation of Medical Regulatory
Authorities of Canada has created national standards for
registration. To be compliant with the new standards, College Council approved the following changes to the College’s
registration criteria:
•
•
•
General Register: only the Licentiate of the Medical
Council of Canada (LMCC) will be accepted for licensure
on the General Register. The USMLE and COMLEX will
no longer be accepted as alternatives to the LMCC.
Provisional Register Conditional Practice: all international medical graduates, including those entering
specialty practices in Alberta, will be required to pass
the Medical Council of Canada Evaluating Examination
(MCCEE).
MCCEE Exemption ends: The College will no longer
offer an exemption to the MCCEE requirement for those
international candidates who will be practising in Alberta
for less than 90 days.
Additional information is available on the College website
at www.cpsa.ab.ca under Programs & Services/Licensing
& Registration/Alberta Medical Licence/General Eligibility
Requirements.
Note: Changes take effect March 1, 2011. Applications
already in progress will not be affected by the changes.
The
Messenger, February 2011
9
Discipline report - Dr. B10
On September 9, 2010, the Council of
the College of Physicians & Surgeons
of Alberta heard a matter involving Dr.
B10, a regulated member.
A complaint was received regarding Dr.
B10’s advertising, claiming ads that appeared in June 2008 and in early 2009
did not comply with the College’s Advertising Bylaws.
As usual, the College attempted to work
with the physician to informally resolve
the complaint. As the College and the
physician were unable to reach an informal agreement, the matter was referred
to an Investigating Committee (IC).
The IC heard the case on September 28,
2009 and on December 9, 2009 released
a written decision concluding the following allegation was NOT proven.
• on or about June 27, 2008 Dr. B10’s
clinic advertised in the local newspaper using language which made
comparison of the pricing of cosmetic procedures offered at Dr. B10’s
clinic to the pricing of cosmetic
procedures offered at other clinics,
contrary to section 38(3) of the College Bylaws.
The IC noted that “Bylaw 38(3)(c) does
mention fees, but there must be a deprecation of others regarding their fees for
the advertisement to be prohibited.” As
the IC found there was no deprecation
of others, they concluded Dr. B10 was
NOT GUILTY in this matter.
The following allegations were PROVEN.
• during the months of January to
March of 2009, Dr. B10’s clinic
subsequently known as Clinic AA,
advertised on the internet that Dr.
B10’s clinic was the number one
Botox provider in the area, contrary
to section 38(3) of the Bylaws of the
College; and
10
The
Messenger, February 2011
• on or about February 13, 2009 and
on or about February 20, 2009 Dr.
B10’s clinic advertised in local newspaper that Dr. B10’s clinic was the
number one Botox provider in the
area and the area’s trusted cosmetic
aesthetic clinic, contrary to section
38(3) of the Bylaws of the College.
As a result, the IC recommended Dr. B10
receive a one-day suspension for unprofessional conduct and that Dr. B10 be
responsible for the costs of the investigation and proceedings.
The findings and recommendation of
the IC came before College Council
on September 9, 2010. The Council, in
their Order dated October 28, 2010, did
not accept the IC’s findings and recommendations and concluded all three
allegations against Dr B10 were NOT
PROVEN.
Council found that the analysis and
reasons of the IC were reasonable and
sufficient to support its conclusions that
both advertisements had breached Article
38 of the Bylaws. However, Council
found that it was not clear how the IC
then concluded these specific breaches
constituted unbecoming conduct.
For those reasons, the Council held that
the findings of unbecoming conduct
could not be upheld and dismissed both
findings of unprofessional conduct.
Although Dr. B10 was not found
guilty of violating the College’s
Standard of Practice on Advertising, it was primarily because of a
technicality.
As a result of the challenges in
adjudicating this matter, College
Council discussed a number of
possible revisions to the Advertising Standard at its December 2010
meeting.
As a result of that discussion, a
new Advertising Standard is being
developed.
This Standard will be circulated to
the profession in 2011 as part of
the required consultation process
for new or amended Standards of
Practice.
Pharmacists ordering laboratory tests
Pharmacists ordering laboratory tests
Pharmacists are approved to refer clients for laboratory tests
in accordance with standards and supporting guidelines
adopted by the Alberta College of Pharmacists (ACP).
In December 2010, 60 pharmacists across Alberta began
participating in a pilot project to test the logistics of referrals.
Results will be reviewed monthly and the pilot project
enhanced as necessary, inviting additional pharmacists with
PRAC ID’s to participate incrementally.
The ACP provides guidance on which tests may be ordered
and requires pharmacists to take steps to avoid unnecessary
duplication of testing as well as to have arrangements for
24/7 coverage to respond to and act on test results.
Results for all lab tests ordered by pharmacists will be
available on Netcare in the same way as results ordered by
physicians. Examples of testing include:
• INR for patients taking warfarin
• Blood levels for drugs such as anticonvulsants, lithium,
and theophylline
• Serum creatinine (and subsequent calculation of
estimated creatinine clearance) for drugs that are cleared
renally (e.g., metformin)
• Lipid panels for patients taking lipid-lowering drugs
• HbA1C for patients with diabetes
• Thyroid tests for patients taking levothyroxine or
methimazole
• CBC for patients taking iron supplements and/or
cyanocobalamin
• Liver function for hyper-cholesteremic/hyper-lipidemic
patients
• INR for warfarin patients started on medications
that are likely to effect INR results (e.g. amiodarone,
metronidazole)
• CBC and liver function tests of patients taking
methotrexate
• Electrolytes for patients taking diuretics
• White blood cell count and differential cell count for
patients taking clozapine prior to dispensing the next refill
The ACP’s Standards of Practice is available at https://
pharmacists.ab.ca/nAboutACP/default.aspx and https://
pharmacists.ab.ca/Content_Files/Files/Std2-amendment_
Dec2010.pdf.
Guidelines for pharmacists ordering laboratory tests are also
available at https://pharmacists.ab.ca/Content_Files/Files/
Lab_Guidelines.pdf.
Following the pilot project, we will provide an update to the
profession.
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Messenger, February 2011
11
Council Highlights
Council of the College of Physicians & Surgeons of Alberta
met in Edmonton on December 2 and 3rd, 2010. Significant
outcomes of the meeting included:
Registrar’s Report
Dr. Trevor Theman provided an update on a number of topics impacting the College including:
•
•
•
•
Strategic plan – A revised draft of the College’s new
strategic plan will be distributed to the profession for
consultation in early 2011.
PAR program – The College of Physicians & Surgeons
of Manitoba has stated its intention to be the next
regulatory authority in Canada to implement the PAR
program (currently in operation in AB and NS).
Annual renewal status update – The College received
88 per cent of member renewals as of December 1, which
is an increase from 75 per cent during the same time
period in 2009.
Labor mobility – Following discussions with other
Canadian medical regulators, the College’s registration
process is now compliant with the new national standards under the Agreement for Internal Trade. Note: As
the College of Physicians & Surgeons of New Brunswick
did not participate in these discussions, the registration criteria for a New Brunswick physician moving to
Alberta is based on the Health Professions Act rather than
the labor mobility provisions of the AIT.
•
•
Status of Self-reporting Standard – The Health Law
Institute has agreed to work with the College and the
Alberta Medical Association to present options for the
structure, roles and responsibilities of an ideal physician
health program. The Health Law Institute will host a
panel that includes a lawyer with experience in health
care, a healthcare ethicist and a public member.
Physician Assessment & Remediation - This program
is a critical component in ensuring the competency of
those applying for provisional practice. The addition of a
physician lead to the process will help meet some of the
current challenges, such as the limited number of available assessors, particularly in family medicine. The physician lead will train and assist physicians, thus creating an
identified pool of trained assessors.
Election results – Council terms as of January 1, 2011
Council accepted and ratified the November 17th election
results as follows: Dr. Cheri Nijssen-Jordan (re-elected); Dr.
Louis Francescutti (re-elected); Dr. Ann Crabtree (newly
elected) and Dr. James Stone (newly elected). Further details
are available on the College website at: www.cpsa.ab.ca under
AboutUs/Council/CouncilMembers.
2011 Executive members of Council
• Dr. Cheri Nijssen-Jordan – President
• Dr. Randall Sargent – Vice President
• Ms. Linda Spencer – Member at Large
Council highlights cont’ d Pg. 13...
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Messenger, February 2011
Council highlights...cont’d from page 12
Amendments to the Rules of Participation in the PAR
program
Following a formal consultation with the profession,
amendments to the PAR program rules were approved by
Council. The revised rules are available on the PAR website
at www.par-program.org/PAR_Rules.htm.
Revised Standard of Practice – Advertising by Physicians
Council requested a review of relevant policies, standards
and regulations from other jurisdictions and professions,
and samples of related case law, to determine what would
be appropriate for the College and its members. Based
on this review, recommended revisions to the Standard
of Practice on Advertising by Physicians were presented
to Council. Following discussion, Council requested an
amended version reflecting Council’s input be presented at
the March 2011 meeting. Once approved, the draft Standard will be distributed to the profession for consultation.
Alberta Health Services (AHS) – Safe Surgery Checklist
Council endorsed the new provincial Safe Surgery Checklist, as requested by the Surgical Clinical Network of
Alberta Health Services. The AHS Safe Surgery Checklist
is adapted from the World Health Organization version, which has been shown to reduce surgical morbidity
in hospitals in both high and low income. To access the
Checklist and related information go to: http://www.albertahealthservices.ca/1948.asp. (See page 16)
Limited Practice Register, Administrative Medicine
Assistant
Council approved the addition of the Administrative
Medicine Assistant category to the College’s Limited Practice Register. Candidates for this Register would not meet
the criteria for independent practice and would instead
provide limited medical activities under supervision, with
no direct patient contact. Successful candidates will be
registered as regulated members and permitted to use the
title “Dr.”, and likely work with organizations such as the
Workers’ Compensation Board of Alberta, insurance agencies, Alberta Health Services, Alberta Health & Wellness
and Primary Care Networks. With this policy direction
from Council the College will ask government to amend
its regulations to allow creation of this category.
Competence Committee
Under the Health Professions Act, a Competence Committee
oversees the continuing competence program of the regulated
health profession. As directed by Council, an interim Competence Committee considered the roles and responsibilities
of such a committee within the College and developed Terms
of Reference and membership criteria for approval. Council
approved the recommendations.
Amended General Register criteria
Council was presented with amended registration criteria for
the General Register. The changes are necessary for the College to be compliant with the Agreement on Internal Trade.
Council approved the amendments, which remove USMLE
and COMLEX as acceptable alternatives to the LMCC for
initial appointment to the General Register. The changes
are effective March 1, 2011. Physicians with the USMLE or
osteopathic physicians with the COMLEX credential will be
eligible for the provisional register, assuming they meet all
other registration criteria. (See page 9)
Physician Assistant registration
Earlier this year, the Alberta Government mandated the College to register Physician Assistants (PAs) as non-regulated
members. Council approved an addition to the College’s
bylaws that would allow this to happen. More information
on PA registration is available on the College website at www.
cpsa.ab.ca under Information For Physicians/Physician Assistants.
Finance and Audit Committee
Council approved the Finance and Audit Committee’s revised Terms of Reference, which included a recommendation
to expand the committee membership from five to seven.
This recommendation was made to ensure Council is more
engaged in the financial and related issues of the College.
Council also approved:
• The registration fee for Physician Assistants at $350,
$120 for renewal.
• A reduction in the fee for an extended stay Non-Hospital
Surgery Facility.
• No change to the 2011 fees for the Research Ethics Review Committee.
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Messenger, February 2011
13
When does a medical condition impact practice?
Physician Health
Monitoring
Commmittee - policies
that guide the College
The Physician Health Monitoring
Committee has developed a series of
policies to guide the action of the College when addressing and managing
physicians with health conditions that
could impact their practices.
These policies outline the approach
taken by the College, including the
various aspects of monitoring that
are required. Most physicians return
to work successfully with appropriate monitoring and engagement in a
recovery process.
Some of these policies may appear
rigorous, but outcomes have been
excellent and allow physicians to
continue effectively caring for patients
and remain active.
The policies are available on the College website for your review at www.
cpsa.ab.ca/Resources/PHMC_Overview.aspx.
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Generally, physicians are reported to have
better health outcomes than the general
population. This group smokes less, eats
better, and exercises more than many others. However, this does not make physicians immune from contracting illnesses
that can impact their practice.
Physicians can often be late seeking help
for illnesses and may continue working
when they should be at home recuperating. Stories about the physician who
returns to work a few days days after
surgery, or the one who continues to work
while suffering from a serious infection
are common as it can be difficult for physicians to allow themselves the same care
they would advise for their patients.
In most cases, medical illnesses and conditions will have only a transient impact
on a physician’s practice. However some
can lead to more severe impairment and
loss of ability. For example, a pathologist
who loses his or her eyesight, a surgeon
with a significant tremor, or an orthopedic surgeon who loses function in his
or her hands. In cases such as these, the
College arranges an assessment to determine the scope of practice that can be
conducted safely.
It’s worth noting that most physicians
are able to continue practising, even if a
restricted scope of practice and/or accommodations are put in place.
Conditions that affect cognition are perhaps the most difficult for physicians to
deal with. To begin to lose cognitive function, whether from a traumatic injury or
disease of the brain, can be heartbreaking
to go through, or observe in a colleague.
In the last few years, strokes, repeated
TIAs, dementia and brain tumors are
conditions that have been brought to the
attention of the College. The College’s approach in these cases is to obtain medical
information from treating physicians, and
in some cases request neuropsychological
testing to determine fitness to practise. In
other cases, modified practice may allow
physicians to continue to practise, or
retirement may be required.
In all cases, a physician’s personal health
information is managed in a confidential
manner with restricted access and kept
separate from his or her registration file.
I welcome your comments and questions
regarding how the College addresses concerns about medical conditions that can
impact practice.
Dr. Janet L. Wright, Assistant Registrar
780-969-4940
[email protected]
Alberta Health Services - Safe Surgery Checklist
One of the most remarkable surgical
studies of the past decade was the report
in the New England Journal of Medicine
(2009:360; 491-499, January 29, 2009)
about the use of a checklist to reduce
surgical morbidity and mortality. This
study was done under the leadership of
the World Health Organization (WHO)
which was looking for interventions
or practices to improve the safety
of healthcare delivery that could be
implemented universally.
What is most remarkable is that this
study was conducted in eight institutions
around the world including Toronto,
London, Seattle, New Delhi, Manila and
Amman, and resulted in the reduction
in surgical morbidity in both low and
high income sites. While the baseline
complication rates were higher in low
income sites, there was improvement in
surgical outcomes in all sites. Even the
best institutions can do better by using
checklists!
The intervention is a checklist (building
upon the surgical ‘time out’ and the
steps taken to ensure correct side, site
and level surgery) that includes an oral
confirmation by the surgical team of the
completion of basic steps to ensure safe
delivery of anesthesia, prophylaxis against
infection and effective teamwork.
To its credit, Alberta Health Services
(AHS) has adapted the WHO checklist
and is now implementing it. At its
December 2010 meeting, College Council
endorsed the AHS checklist, as a signal
to our members of our commitment to
evidence-based processes to improve the
safety of patients in our health system.
I encourage all of my surgical colleagues
and all of our members who work in
operating theaters to embrace the use of
this checklist. As a profession, we need
to pay attention to new evidence and to
adopt it when the evidence, such as this
publication, is compelling. And, to my
mind, this is compelling evidence.
Dr. Trevor Theman, Registrar
[email protected]
Annual North/South
Golf Tournament
The 84th Annual North/South Doctors’
Golf Tournament is scheduled for:
Monday, July 25th, 2011
Red Deer Golf & Country Club
Your registration fee will include one
round of golf, breakfast, lunch, a
souvenir and the chance to win prizes.
Co-hosted by the College and the
Alberta Medical Association to raise
funds for medical student bursaries.
Mark your calendar!
84th
Annual
North
South
Doctors’ Golf Tournament
The
Messenger, February 2011
15
Alberta Rural Physician Action Plan (RPAP) Award Nominations
Rural residents and physicians, communities and organizations are invited to nominate a rural family physician or a
rural community for the following awards:
Early Careerist Award – recognizes the significant contributions by a rural physician within the first 12 years of practice.
Award of Distinction – recognizes a rural physician who
presently lives and works in rural Alberta and has done so for
more than 12 years.
Alberta Rural Community Recruitment and Retention
Award – recognizes a rural Alberta community that has
best developed innovative and collaborative approaches and
solutions that result in successful physician recruitment and
retention.
The deadline for nominations is March 31, 2011. For more
information, go to the RPAP website at www.rpap.ab.ca or call
1-866-423-9911.
Messenger
The
College of Physicians & Surgeons of Alberta
Publication Mail Agreement #40065612
Return Undeliverable Canadian Addresses to:
2700-10020 100 Street NW
Edmonton, Alberta, Canada T5J 0N3
Email: [email protected]
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The
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Visit our website at:
www.cpsa.ab.ca
It’s information at your
fingertips!