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 meeting of 5 April, 2013, Council considered the following matters.
A young adult patient alleged that a physician was improperly attempting to have contact with her outside of his office. The patient declined any of his attempts to meet with her or speak with her. The physician asserted an innocent explanation for his actions. The Committee felt it appropriate to Caution the physician to avoid any behaviour which could be subject to such misinterpretation.
A patient suffered a pulmonary embolus, alleging poor follow-up of a fracture by a surgeon. In response, the physician asserted that the patient had no symptoms suggesting any such significant complication. In reviewing the matter, the available records supported the version of the surgeon. The Committee concluded that the complication was an unfortunate one, but for which no fault could be found.
A patient asserted that a physician removed a gastrostomy tube in an unnecessarily aggressive and painful manner. Based on the response of the physician, the Committee wondered whether there could have been better preparation for the patient regarding any potential discomfort. The Committee felt it appropriate to Counsel the physician to prepare such patients as much as possible regarding what to expect.
It was alleged that a physician was improperly directing patients to receive prescriptions at a specific pharmacy. It was further alleged that the physician would decline treatment to patients who sought to have their prescriptions filled elsewhere. The physician responded that he felt it appropriate to take advantage of the specific services available from the pharmacy in question. In reviewing the matter, the Committee noted the longstanding College rule against the directing of prescriptions. This rule has been in place to avoid any potential inference of an improper financial arrangement between the physician and the pharmacy. On that basis, the Committee felt it appropriate to reinforce this standard and Censure the physician regarding the inappropriateness of directing such prescriptions.
A patient had foot surgery and suffered a prolonged course of infection and repeated complications. In reviewing the matter, the Committee noted the patient’s unfortunate and difficult course, but could find no fault with the care provided.
An elderly patient, with significant complications of cancer, was transferred to a community hospital under the care of the hospitalist. The physician felt it appropriate to treat the patient in a palliative manner, considering the extent of the cancer. The family rejected this, asserting that the patient’s cancer was “stable”. In reviewing the matter, it was clear the family did not have a complete understanding of the patient’s illness. It was unclear what information they had received at the previous hospital. The Committee noted that the hospitalist was, consequently, in an awkward position. The patient had become incompetent to make his own decisions and there was no clear direction from the family regarding the care he should receive. The Committee noted that, in many cases, advance planning with the patient while competent may be of some assistance in such situations. In any case, the Committee could find no fault with the physician’s approach in this extremely difficult situation.
A patient had a longstanding work injury for which some surgical intervention had been attempted. He was referred to another consultant who assessed the patient and responded to the referring physician, copying the report to Worksafe NB. The patient objected to this. The Committee noted that, in the context of ongoing care of a work injury, the physician was obligated to provide such reports to Worksafe NB.
A mother took her infant child to a physician. In responding to the clinical situation, the physician examined the child in a manner to which the mother objected. While the nature of the examination may have been clinically appropriate, the Committee was concerned that the physician had proceeded despite the mother’s denial of consent. In such circumstances, it would be expected that the physician should be prepared to provide a reasonable explanation of his intention, but, in any case, respect the parent’s wishes. The mother also objected to the fact that the physician had made inquiries regarding her national origin, which made her feel uncomfortable. In regard to all of this, the Committee felt it appropriate to Caution the physician regarding obtaining appropriate consent.
A consultant examined a patient in the Emergency Room. The patient alleged that, during the examination, the physician pressed himself against her body in a manner which made her feel uncomfortable. The Committee could not be certain what had transpired, but Cautioned the physician to be more careful regarding his approach during the assessment of patients. A patient complained that a physician had improperly reported his medical condition to the authorities, resulting in the loss of his driver’s licence. The Committee noted that there is a legal obligation for physicians to do such.
An adolescent patient attended a Walk-in clinic along with a female friend. She alleged that the physician made inappropriate comments regarding potential pregnancy and failed to appropriately diagnose a respiratory infection. The complaint arose from the patient’s mother who was not in attendance. In response, the physician asserted that his examination and assessment were appropriate. He noted that, in female patients of a certain age, he would routinely ask about the potential for pregnancy, which may affect the choice of antibiotics he could prescribe. In reviewing the matter, it did appear to the Committee that the physician had responded appropriately to the clinical situation. However, some of his remarks appeared to be subject to the potential for misinterpretation and he was urged to be more cautious in future encounters.
Preventing Follow-up Care Failures
Members will have noted that Council had adopted a brief guideline on this matter at its last meeting. In response to inquiries from members, Council has instructed that a legal opinion, outlining the rationale for the guideline, be made available to physicians. This opinion is now posted on the College website, along with the guideline. Alternatively, it is available directly from the College office.
Dr. Victor McLaughlin 1928 - 2013
Council wishes to acknowledge the passing of an individual very important in the evolution of medical regulation in New Brunswick. Dr. Victor McLaughlin was a member of the Council of the College from 1975 to 1984. He was also President of the College in 1980 and 1981. He was significantly involved in the development of the College under new legislation at that time. In time, he became President of the Federation of Medical Licensing Authorities of Canada. In 1986, he became the first full-time Registrar of the College. He continued in that capacity for six years, guiding the College through many difficult issues. Following his “retirement” in 1992, he went on to establish and then direct the Atlantic Provinces Medical Peer Review, for which he received the Canadian Medical Association Medal of Service. All of this followed a distinguished career as an obstetrician and gynecologist in Moncton. On behalf of all members of the College, Council wishes to acknowledge his many contributions as a physician, an administrator, as an individual, and extends best wishes to his family.
From the Archives