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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.

At its meetings on 29 September and 24 November 2017, 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. 

A patient alleged that a physician had failed to advise him of important laboratory results over the course of two years. As a result, a significant anemia, as well as deteriorating kidney function, were untreated. The physician acknowledged the error, but noted that some personal issues may have interfered with his attentiveness to his practice. The Committee noted that the lack of response to the results had continued for some period of time. As a consequence, the Committee felt that a Censure was in order. Physicians are expected to maintain systems to both track and respond to significant results.

A patient was discovered to have a lesion which was potentially malignant. The issue was monitored over the course of several years with ongoing investigations. However, by the time a specific diagnosis could be reached, a malignancy was confirmed which had, by then, metastasized. It was alleged that the care provided was inadequate. In response, the physician noted that, for the situation in question, prevailing guidelines during this time suggested a watchful approach unless certain factors developed. It was also noted that, for reasons which were not explained, the patient sought no medical care at all over the course of a two year period. In reviewing the matter, the Committee felt that the physician had acted according to prevailing standards during the time in question and could find no fault with the care provided. It was also noted that the physician was developing systems to avoid such gaps in follow-up.

A patient was known to the physician for a number of years. There were also some social contacts. In the course of a difficult personal moment for the physician, he began sending texts to the patient discussing his own marital situation. This only occurred once, but went on for a few hours. When the physician’s wife became aware of this, the physician felt that he could no longer look after the patient in question and dismissed her. The patient complained. The Committee felt that the physician had created a situation which was unprofessional. His sharing of personal information, although only for a limited period of time, did cross a line which is unacceptable in a relationship with a patient. The Committee felt that a Caution was appropriate.

A patient was attending one of two physicians practicing at a clinic. She wished to transfer to the other physician and, on requesting an appointment, was granted one. However, when she arrived, the receptionist advised her that this was an error.

The patient was seen that day on a one time basis but subsequently, the other physician discharged the patient altogether from the clinic. While this was not the subject of the complaint, it was unacceptable.  As far as the issue of the complaint, this appeared to be a result of an error within the office which could have been resolved with appropriate communication.

Over the course of several months, a physician saw an elderly patient with a rash. The rash did not respond to the usual treatments and, in fact, gradually got worse to the point that it darkened, became lumpy, and began weeping.  It was only at that point that the physician arranged any investigations and referrals.  The patient subsequently saw another physician, was quickly referred, and found to have cutaneous leukemia to which he succumbed quickly.  The course of the rash was well documented by the family with photographs.  It was felt that the family physician had simply waited too long before realizing this was a situation requiring the assistance of a specialist.  A Counsel was warranted.

A pharmacist complained that a physician was improperly renewing prescriptions by simply noting “please continue as before” and signing it. The physician responded that this had been acceptable in the past from a number of other pharmacists.  In reviewing the matter, the Committee noted that a prescription is a legal document which has specific requirements.  The approach taken, whether accepted by a pharmacist or not, is unacceptable. The physician was Cautioned to meet appropriate requirements regarding the contents of a prescription.

A family physician was following an elderly patient for many years. She had been previously very active, but gradually began to show some deterioration.  However, her main symptoms were gastrointestinal and she was referred accordingly.  The consultant, after completing the investigation, felt that the patient had an altered sensorium and recommended further investigation.  It was eventually determined she had fluid accumulation on the brain resulting from the metastasis of a previous melanoma.  The family criticized the family physician.  The physician responded that the eventual diagnosis was extremely difficult to reach, requiring a number of investigations and consultants.  The physician noted that he had not sensed a significant deterioration in the patient over the time involved.  The Committee felt this may be a situation where the repeated assessments,each focused on a single symptom, resulted in the physician not taking a wider view of the patient.  The patient’s difficulties were only evident to the consultant who had no previous contact with the patient.  The Committee could find no specific fault with the care provided. 

The College received two complaints from Atlantic Provinces Medical Peer Review regarding physicians who had been reluctant or unable to improve the quality of their records. The physicians responded that they were undergoing professional development on this point.  It was determined to reassess the physicians at a later date. 

There was a complaint regarding the prescribing of medical marijuana. The prescription was for a full year, with no clear follow up care, and a possible improper relationship with a supplier on the part of the physician.  The Committee felt that the errors were significant enough to warrant a Caution against the physician for the approach taken.  It is also noted that guidelines from the College regarding prescribing medical marijuana have been amended significantly.

A patient had inguinal hernia repairs which subsequently failed. He alleged the surgery was not performed properly. On review, it was noted that the repair was done using mesh patches as used by many surgeons. Such may be subject to failure, but this does not necessarily represent deficient care.

A patient complained she did not have a thorough or private assessment in an Emergency Department. She felt that the comments made by the physician were inappropriate. The physician acknowledged some comments, but felt they were taken out of context.  He noted that a busy Emergency Department may not always offer appropriate privacy.  The Committee felt that a Counsel was appropriate.  The physician should have been more cautious in his remarks to a patient not previously seen.  Secondly, any discussion which has the potential to be overheard should only take place with clear consent of the patient. 

The patient saw a colleague of a physician who ordered stool for occult blood. The result was positive, but the report did not make it to her own physician’s chart. When she attended his office a few weeks later to discuss the result, also present was her husband. The entire visit was predominated by the husband’s concerns regarding his driving privileges. The same situation occurred several times and the patient was never informed of the results, nor was the physician, it seemed, aware that a test had been done at all. The patient eventually succumbed to colon cancer. The Committee felt this was an unfortunate sequence of events resulting in a breakdown in communication. One lesson might be relating to the situation when two patients attend at the same time and the physician must make sure the needs of both are met.

SUSPENSION

Following a complaint that a physician had engaged in an improper relationship with a patient, the physician acknowledged his guilt as professional misconduct and has had a suspension imposed by the Council. The physician will be suspended for a minimum of twelve months.  The suspension will commence shortly.  The physician’s identity will be published at that time.

MEDICAL MARIJUANA

Council has amended the College guidelines on this matter. The full guideline is available on the College website.  The amendments are an attempt to avoid some of the difficulties that have arisen in recent years regarding the prescribing of marijuana.  It highlights the importance of informed consent, communication with the primary physician, as well as the availability of the prescriber for follow-up.  The initial prescription should be limited to three months.  In addition, physicians should take care to avoid any perception of a conflict of interest with any service or agency involved in the supply of medical marijuana.  It is understood that access to medical marijuana by prescription will continue after general legislation in 2018.

ANNUAL RENEWALS

By now, all physicians should have received their combined invoice for their annual fees and those of their Professional Corporation, where applicable. Physicians should contact the College immediately if such has not been received.  Members who have changed their contact information, their banking information, or do not wish to renew their licences, should contact the College office by email or fax.

FROM THE ARCHIVES

One hundred years ago

In 1917, Council decided that the Medical Council of Canada exams were not sufficient for licensure in New Brunswick.  They also objected to a recent malpractice judgment and agreed to help the physician with the costs of the appeal.  The Registrar resigned to take on overseas military service.  He resumed his duties on his return two years later.

Seventy-Five years ago

In 1942, the annual fee was set at $10 which $6 went to the Medical Society. Council determined not to modify its rules to allow physicians associated with air force training programs to be licensed in order to treat families and other personnel.  The Council of Physicians and Surgeons also changed its name to the Medical Council of New Brunswick.

Fifty years ago

In 1967, Council agreed to allow certain physicians from France to practise here in a limited way. This was an arrangement with the French government which allowed certain physicians to avoid military service by going to New Brunswick (Council continued to resist licensing physicians from Quebec to provide such service).  In addition, it was reported that the regulators across the country had agreed to form a national association.

Twenty-Five years ago

In 1992, Council considered several serious complaints of sexual impropriety. Council determined to appoint a Committee to deal with the matter.  Council reviewed a significant case of inappropriate narcotic prescribing, and also recruited a new Registrar.