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 This Bulletin is forwarded to every medical practitioner in the province. Decisions of the College on matters of standards, amendments to Regulations, guidelines, etc., are published in Bulletins. The College therefore assumes that a practitioner should be aware of these matters.

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 Officers and Councillors 2006-2007

Council Update
At its meeting on 30 March, 2007, Council considered the following matters:

COMPLAINTS
There was a complaint that a physician had improperly discharged a patient from the Emergency Department. The patient arrived complaining of chest pain. The pain had been unchanged for many hours. There were no other symptoms or laboratory indicators suggestive of heart pathology. The patient succumbed to a heart attack several weeks later. The family alleged that the initial care had been inappropriate. The Committee concluded that the patient had been properly assessed and discharged with appropriate advice for follow-up with his family physician.

A patient was treated by a consultant in an Emergency Department. The patient alleged that the physician made some unusual comments which she felt were inappropriate. The physician asserted that he was only trying to put the patient at ease. The Committee noted that the records showed the patient was in a great deal of discomfort at the time. The Committee felt that even well intentioned comments could be misinterpreted in this context. The Committee noted that the physician had apologized for any misunderstanding.

A patient alleged that she was improperly refused transfer to a regional hospital. She asserted that instructions had been left for her to be transferred immediately upon arrival at her local hospital. On reviewing the matter, the Committee could find no evidence that such was the case. The Committee felt the local physician had acted properly, in a non-emergent situation, by first waiting for acceptance of the patient by a consultant.

A patient was referred to a specialist for investigation. She was advised that an appointment would be available in a few months, after the physician reviewed the matter in order to prioritize it. She checked repeatedly with the office and was allegedly given different information as to whether the physician had reviewed the letter of referral. Eventually the patient sought another referral and was treated without significant delay. The Committee noted that there have been ongoing concerns regarding the management of referrals to consultants, especially when their waiting lists were very lengthy. In this context, the delay appeared related to the fact that the physician had not reviewed the referral letter in a timely fashion in order to determine the significance of the patient's problem. Physicians are reminded that they are usually considered to have received the information relating to a patient at the time it arrives.

It is only upon reviewing the available information that the consultant can determine the appropriate priority to give to the matter. Once this is done, the patient should be given as accurate information as is possible on arrangements for an appointment.

A patient complained about two consultants. Unsatisfied with the treatment provided by one, she was referred to another specialist in the same community. She alleged he declined to provide care because of her previous difficulties. In response, the physician asserted that he was willing to treat the patient, but made it clear that the patient may have to accept care from his colleague if he was absent. He asserts the patient was adamant that such was not acceptable. As a consequence, other alternatives in neighbouring communities were offered. While the Committee felt it would be inappropriate to deny care solely because of previous difficulties with a local colleague, in this situation the Committee felt it was the patient who had specifically refused to accept what was locally available. The Committee felt the physician had acted appropriately.

A family complained that an elderly patient had not received appropriate care from her longstanding family physician. In response, the physician noted that the patient had numerous medical problems, and was competent to accept or reject any treatment which was offered. The physician noted that the patient often sought to maintain her independence, even from her family. For example, she would decline appointments rather than have to seek assistance with transportation. The Committee felt the physician had treated the patient appropriately under the circumstances.

A patient had a persistent problem which required several visits to after-hours clinics and the local Emergency Department before the diagnosis of an unusual, but treatable, condition was made. On one of these visits, the patient alleged that the attending physician had expressed frustration with the patient, using several profanities. In response, the physician acknowledged that some of the language was inappropriate and apologized for such. The Committee felt the complaint had provided appropriate admonishment for the physician and determined to take no further action on the matter.

A patient alleged that a family physician failed to make a timely diagnosis of a significant illness. The patient claimed that, rather than arranging appropriate investigation, the physician had instructed him to attend the Emergency Department if the symptoms worsened. In response, the physician acknowledged that, at the outset, he may not have recognized the significance of some of the patient's symptoms. Nevertheless, he felt it appropriate, given the expected delays in investigation and treatment, that the patient may be assessed more quickly through admission in the hospital. The Committee noted that the patient's course was not completely typical, but there had only been a few weeks from initial presentation to final diagnosis. The Committee agreed that the physician may have provided better advice to the patient if the significance of the symptoms had been appreciated. 

OTHER BUSINESS
In other business, Council:

• Agreed to commence criminal background checks on new applicants.
  
  
• A greed to offer subspecialty recognition to a physician whose practice was exclusively in that area, but who had completed his training prior to formal recognition of that subspecialty. Council noted that this issue had been discussed at length in the past. Council determined to handle each request on a case-by-case basis.
  
  
• Reviewed and approved the draft budget for Atlantic Provinces Medical Peer Review. The budget provided for an increase in support payments with a view to increasing the frequency of assessments and the number of specialties covered.
  
  
• Reviewed draft financial statements for 2006 showing the College had posted a surplus for the year.
  
  
• Approved a donation to the New Brunswick Medical Society Foundation.
  
  
• Ordered the interim suspension of a physician whose license had been revoked in another province.
  
  
• Acknowledged the appointment of two new public members of Council by the government. They are Dr. Terez Retfalvi (PhD) and Mr. Jean Daigle, both of Moncton.

OUT-OF-COUNTRY CONSULTATIONS
Council has been asked to review the question of what obligations physicians have when a patient requests referral outside of Canada for investigation or treatment. In order to review this matter, Council would like to hear from members regarding their own experiences with such issues. These would include situations where the patient's condition or course was such as to warrant referral for very specialized treatment. This may also include patients' requests for less orthodox investigation and treatment at a foreign centre. Council would like to review physicians' opinions on their respective obligations to investigate such resources, as well as to acquiesce to patients' requests for such, particularly if the physician is unconvinced of the treatment's value. Physicians may provide comments to the College by any means they wish.

LEGAL SETTLEMENT CONFERENCES
At the request of the Chief Justice of the Court of Queen's Bench of New Brunswick, Council wishes to remind members of their legal obligations during the course of malpractice litigation. During a law suit, the parties involved may be requested by the presiding judge to attend a settlement conference to assist in concluding the matter. Physicians are reminded that, when such is ordered, they are obligated to attend with their lawyers. Failure to do so can result in the matter not being settled and additional costs being imposed.

FROM THE ARCHIVES

100 years ago
In 1907, Council revoked a physician's license solely for leaving the province, reaffirmed that the Council was there to protect physicians, and complained that the new province of Alberta was improperly denying access to physicians from elsewhere. There were 273 physicians licensed.

75 years ago
In 1932, Council decided to require the Medical Council of Canada exams of all applicants, initially warned hospitals that they could not employ medical students to provide service, but subsequently agreed to a legislative change to allow such. Despite pleas from several border communities, they also reaffirmed that Maine physicians could not practise in New Brunswick without an appropriate license.

50 years ago
In 1957, Council agreed to establish a Specialist Register. With payment of $10, physicians could apply for entry on this register. Initially, only physicians certified by the Royal College of Physicians and Surgeons of Canada would be eligible. The annual license fee, including the Medical Society portion, was set at $60.

25 years ago
In 1982, Council raised significant objections to proposed health disciplines legislation, and decided to have only one snake on the College seal. The College held its first general election for members of Council. This encountered some problems, as not all members read the ballot instructions. There were 849 physicians registered who paid an annual fee of $125.