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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 2009-2010

Council Update

 At its meeting on 11 June 2010, Council considered the following matters. 

 COMPLAINTS

A Counsel is advice as to how to improve the physician’s conduct or practice.

A Caution is intended to express the dissatisfaction of the Committee and to forewarn the physician that if the conduct recurs, more serious disciplinary action may be considered. 

A Censure is the expression of strong disapproval or harsh criticism. 

 There were two separate complaints dealing with complications from procedures.  In one case, in dealing with a problem following surgery, the patient had been assessed by a number of individuals, including the surgeon, all of whom did not detect a developing complication.  The Committee felt the physician had been appropriately responsive to the patient, noting that symptoms had not yet progressed sufficiently for a timely diagnosis to be made.  In a separate matter, a patient developed a complication from an injection.  Repeated attempts to make an appointment with the physician were denied.  The patient subsequently sought care elsewhere.  The Committee notes that, in the case of any procedure, there is a presumption that it is the physician who performed the procedure who will be available to deal with any complications.  This should apply in most circumstances.  However, if alternate arrangements are necessary, the patient should be appropriately instructed. 

A patient complained that a cosmetic procedure had failed to produce satisfactory results.  In reviewing the matter, the Committee could not find any evidence that the procedure was performed improperly, nor conclusive evidence that the results were unsatisfactory.  In any case, the Committee notes that any expected results cannot be completely guaranteed.  With appropriate informed consent, patients are considered to accept the risk that results may not meet their expectations. 

There was a complaint regarding a physician’s response to several chest x-rays that suggested the possibility of a lung mass.  Further studies were recommended, some of which were done.  However, a specific recommendation for a CT scan was not followed.  A subsequent chest x-ray had an ambiguous report.  While the physician may have been reassured by this, the fact of the inconsistency should have raised some questions in the physician’s mind which warranted further investigation or, at the least, a discussion with the radiologist. 

A patient complained regarding a pelvic examination performed by a female physician.  The patient and physician were not previously known to each other.  The patient had advised the staff that she had some anxiety over the procedure.  Signage in the office did advise that an attendant was available, but none was offered.  There was no evidence that the examination was performed improperly, but under the circumstances, the Committee wondered whether the patient’s difficulties might have been lessened by the presence of an attendant, who was ostensibly available.  

There were three separate complaints alleging improper discharge from a practice.  In one case, an argument developed between the physician and the patient regarding access to a report.  The patient was immediately discharged, which the Committee felt was inappropriate in that no warning letter was provided, as required under College guidelines.  As a consequence, the Committee issued a Counsel to the physician.  In another matter, a family was discharged without notice after the mother made a comment to the staff regarding access to the physician.  The Committee felt the physician’s response to the comment was inappropriate and, given that there had been a previous complaint regarding discharge from his practice, determined to issue a Caution, as a warning regarding future occurrences.  Finally, an elderly patient was discharged from a physician’s practice after the patient became upset regarding difficulties making appointments.  The Committee acknowledged that the physician had followed appropriate guidelines regarding the matter, but questioned whether the physician’s threshold for discharging this patient was appropriate. 

Two complaints, from related individuals, raised a number of allegations regarding a physician.  The Committee felt there were a number of areas of concern.  In one case, in order to assess an injury, the patient was required to make three appointments in advance.  The Committee did not feel this represented appropriate care.  On other occasions, the patient requested that her blood pressure be checked.  The physician routinely refused to do so even though the patient was on medication for such.  There was also an allegation that the physician had failed to advise the patient regarding an abnormal Pap smear.  The Committee noted that it is the physician’s responsibility to make reasonable efforts to advise patients of abnormal results.  There was also a dispute regarding the completion of an insurance form.  The physician insisted on payment in advance, but completed the form, with the patient present, and subsequently claimed for the visit through Medicare, even though no other service was provided.  In considering all of these matters, the physician was issued a Caution regarding each complaint.

Narcotic Guidelines

As members were advised earlier, a national committee has now published guidelines on appropriate narcotic prescribing.  The complete guideline is currently only available on line at http://nationalpaincentre.mcmaster.ca/opioid.  It is expected that additional, more practical “tools” will be developed and available at the same location.  At this point, a French version of the guideline is not yet available.

Personal Health Information

In anticipation of the proclamation of Personal Health Information Protection and Access Act (PHIPAA), Council has approved a new guideline on medical records to incorporate changes arising from this legislation.  When PHIPAA is proclaimed, the new guideline will be available on the College website, or directly from the College office.  

Council Elections

Elections were held in five districts this spring.  Re-elected by acclamation were Dr. Santo Filice of Moncton, Dr. Lachelle Noftall of Fredericton, and Dr. Mark Whalen of Campbellton.  Newly elected members of Council are Dr. Stephen Bent of Miramichi and Dr. Kathleen Keith of Saint John.