Bulletins

August 2005

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.

--------------------------------------------

Officers and Councillors 2004-2005

President - Dr. Douglas Brien, Saint John
Vice-President - Dr. Marc Bourcier, Moncton

Dr. Jean-Marie Auffrey, Shediac
Dr. Zeljko Bolesnikov, Fredericton
Dr. Terrance E. Brennan, Fredericton
Mr. Gilbert Doucet, Dieppe
Dr. Mary E. Goodfellow, Saint John
Dr. François Guinard, Edmundston
Dr. Paula M. Keating, Miramichi
Mr. Stanley Knowles, Miramichi

Registrar - Dr. Ed Schollenberg


Mr. Eugene LeBlanc, Dalhousie
Dr. John McCrea, Moncton
Dr. Richard Myers (PhD), Fredericton
Dr. Robert E. Rae, Saint John
Dr. Malcolm Smith, Tracadie-Sheila
Dr. Rudolph Stocek, Hartland
Dr. Mark Whalen, Campbellton


Council Update
At its meeting on 10 June, 2005, Council considered the following matters:

COMPLAINTS

There was an allegation of improper contact by a physician from an adolescent patient. After some months of investigation, the patient and her family declined to pursue the matter any further. As a consequence, the Committee determined to take no further action until the patient wished to go forward.

There was a complaint regarding a significant complication following an operative procedure. It was alleged that the procedure was performed improperly, that the complication was not recognized quickly, and that the physician had improperly contacted the patient later. In reviewing the matter, the Committee could find no evidence of deficiency in the procedure itself. Regarding the allegation that the physician had failed to properly assess the patient post operatively, the Committee could find no objective evidence that the patient's post operative course was anything but routine. Finally, the Committee noted that physicians are encouraged to follow-up and discuss any adverse events with patients.

There was an allegation that a physician had failed to properly investigate a patient presenting with an abdominal mass. Despite the physician's assertions, the evidence of an appropriate examination and appropriate initial investigation was questionable. Nevertheless, the Committee noted that the issue was resolved fairly quickly and, as a consequence, determined to take no further action on the matter.

There was a complaint by a patient that she was improperly discharged from a physician's practice. A number of reasons were given, but one included the fact that a screening test for narcotics was negative, despite the fact that the patient had been prescribed such. The physician felt this was evidence of possible diversion. In the course of reviewing this matter, the Committee became aware of the potential for misinterpreting the results of such urine screening. It now appears that, in many circumstances, the urine screening test may show no narcotics, even when the patient is taking the medication appropriately. This appears to be particularly the case with certain drugs, such as Oxycontin. The Committee noted that additional information on this will be forthcoming, but in the meantime, physicians should review the significance of any result with their local laboratory before coming to any specific conclusions.

There were three unrelated complaints arising from families regarding the care provided to patients in a terminal and palliative situation. The context of each complaint was quite different, but the Committee felt there were some potential lessons to be learned. First of all, it is noted that these can always be potentially difficult situations. Even when the patient is receiving all appropriate care, the physician must still need to be cognizant of the difficulties facing family members. Sometimes, despite all efforts, the grief of the family can be further compounded by feelings of confusion, distrust, and anger. In this light, the Committee noted several factors which may aggravate matters. For example, there are times when the family does not appear to have understood the gravity of the clinical situation. The eventual death does not appear to have been the result they themselves had expected. At other times, the family finds themselves dealing with a physician with whom they have had no previous relationship. This can be on the basis of referral to a consultant or on the basis of transfer of the patient to a hospital able to provide the appropriate level of care. In this context, unfamiliarity can lead to breakdowns in communication, which may become a source for a complaint later on. Finally, patients in these circumstances are often cared for by a number of physicians, each fulfilling a different role. It is possible for the patient and family to have some confusion regarding which physician is responsible for which aspect of the patient's treatment. In these situations, patients may find themselves improperly assigning blame to one physician or another for aspects of their care for which they are not directly responsible.

REVIEW COMMITTEE
At its recent meeting, the Committee dealt with a number of matters. It rejected two appeals from patients who were unsatisfied with the opinion of the Complaints Committee. One concerned a patient who had to make repeated visits to the Emergency Department before being properly diagnosed. The other concerned a patient dissatisfied with an independent medical examination.

In addition, following a number of complaints, a physician was ordered to undergo a psychiatric examination.


COUNCIL ELECTIONS
This spring, Drs. Mary Goodfellow of Saint John, Terry Brennan of Fredericton, and Jean-Marie Auffrey of Shediac, were each re-elected for a further three-year term. In addition, Dr. Zeljko Bolesnikov of Frederiction, was reappointed by the Minister of Health.