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.
President - Dr. Malcolm Smith, Tracadie-Sheila
Registrar - Dr. Ed Schollenberg
At its meetings on 15 September, and 24 November, 2006, Council considered the following matters:
After some delay, a patient was discovered to have retained a foreign body after an earlier procedure. Over a number of months, the patient had seen several physicians in several centres, and had had investigations for a number of reasons. These might have detected the problem. In reviewing the matter, the Committee first felt it unlikely that the clinical situation created significant risk for the patient. However, there was a great deal of stress when the patient became aware of the issue. In reviewing the care provided by each of the physicians involved, the Committee could not find any fault on an individual basis. Rather, the patient had encountered a number of circumstances which had resulted in an unfortunate series of events. Physicians are reminded of the importance of following up all investigations. Even those done routinely or for an unrelated reason may disclose a problem requiring intervention.
A specialist sent a patient to a referral centre for planned in-patient treatment. However, the patient was, instead, assessed by the local consultant and sent home with significant medication changes. The original physician felt this was inappropriate. In reviewing the matter, the Committee noted first that it was ultimately the patient's decision as to which treatment is to be accepted or rejected. Under these circumstances, however, the Committee felt that better cooperation between the physicians would have avoided the resulting dispute. The Committee felt that patients can seldom be well served if such communication does not take place.
There was an allegation that a physician had failed to properly report an alleged episode of child abuse which had been admitted by his patient. The physician asserted that he had, in fact, contacted the relevant authorities by phone in the presence of the patient. The Committee had no way of verifying whether such a call took place, but was concerned that the physician chose to make the call in the presence of the patient. The Committee was concerned that this would result in less candour on the part of the physician regarding any information which was disclosed. Furthermore, it may imply that the physician did not consider the allegation to be of serious concern. Finally, the Committee also noted that some physicians, such as those directly employed by a Regional Health Authority, are obligated to provide full disclosure of any relevant information when reporting such a matter.
There was a complaint that a longstanding patient of a physician had been discharged improperly. It was noted that the patient had been attending the physician for many years with numerous issues. The physician alleged that the situation between the physician and the patient had deteriorated to such a level that he felt he had no alternative. In reviewing the matter, it did appear to the Committee that there was rising frustration on both sides relating to a variety of matters, both clinical and otherwise. Nevertheless, the Committee was concerned that the physician's decision appeared precipitous. The Committee noted that College guidelines recommend that, when physicians are considering such action, the matter should be discussed directly with the patient in hopes of finding some means of maintaining care. In other words, it should rarely come as a surprise to the patient that they have been discharged from a practice.
A patient was referred to a consultant. She alleged that the physician suggested that it would have been better if she was seen by a physician closer to her own centre. She also alleged that the assessment done by the physician was inadequate. In reviewing the matter, the Committee could find no evidence of any deficiencies in the assessment or care provided by the physician. The Committee did note that certain comments, such as suggesting the patient should have been seen elsewhere, could cause the patient to suspect that the physician was not being objective in his assessment. On the other hand, the Committee also noted that the patient may have been dissatisfied with the conclusions the physician reached.
There was an allegation that a physician had failed to provide timely treatment of a patient who subsequently succumbed to malignancy. In response, the physician asserted that it was necessary for him to await a report from another physician in order to appropriately intervene. The Committee could find no fault with the care provided in that regard, but felt other aspects of the patient's care, such as the flow of relevant information, should be reviewed more closely.
There was an allegation that a physician had failed to provide appropriate care to a critically ill patient. The allegations included failure to provide a timely response to a deteriorating situation and making insensitive comments to the patient and family. In reviewing the matter, the Committee could find no fault with the care provided from a clinical point of view. The patient's situation was deteriorating quickly and the physician appeared to respond appropriately and as best he could. The Committee noted that some of the issues raised by the family were the result of misinterpretation of the hospital records. The Committee also noted that the family had expressed concern regarding the way in which the physician had apprised them of the situation. The Committee noted that it is the physician's obligation to be candid, but sensitive, in these very difficult situations.
The Committee reviewed an ongoing matter regarding a physician who, it was alleged, had breached an agreement not to practice pending a disciplinary matter in another province. The Committee noted that there continued to be extensive local support for allowing the physician to continue to practice in New Brunswick. Pending further developments, the Committee did not feel it could take further action on the matter until more specific information was received.
At its two most recent meetings, Council:
Determined to leave annual fees unchanged for 2007.
Decided to waive the current fee of $50 for Certificates of Standing for physicians currently licensed.
At the request of the Chief Coroner, reviewed the case of an infant who died of Group B Streptococcal infection. Physicians are reminded that almost any symptoms in young infants can be suggestive of significant infection. In the first few weeks of life, any fever or change in behaviour may warrant admission and treatment on the presumption of possible sepsis.
Reviewed a petition concerning the prevailing approach to Lyme Disease. Council noted that the matter is of some controversy. It is expected physicians will familiarize themselves with the condition. While remaining open minded, physicians are generally expected to follow prevailing guidelines in its diagnosis and treatment.
Accepted a guilty plea from a physician on a restricted license who admitted improperly treating a patient outside the scope of his employment with a Regional Health Authority.
Reviewed the recent seizure of a deceased physician's records. The College has authority to take such action where records are at risk of being discarded or otherwise made unavailable to patients. The College can also intervene if there is a potential for a breach of confidentiality.
At the request of a Regional Health Authority, agreed to consider the possibility of doing criminal records checks on new applicants for licensure.
At the request of a member, reviewed College policy on "administrative" or "chart fees" for new patients. Council determined that such fees remain unacceptable. The maintenance of adequate records is an ethical and legal obligation. Furthermore, the recording of findings from an assessment is already included in the fee for such.
The Executive of the College for 2006-2007 is as follows:
President: Dr. Malcolm Smith, Tracadie-Sheila
Vice-President: Dr. Robert Rae, Saint John
Public Member: Mr. Eugene LeBlanc, Dalhousie
Member at large: Dr. Paula Keating, Miramichi
Member at large: Dr. John McCrea, Moncton
By now, all physicians should have received notice regarding fees for their licenses for 2007, as well as that for their professional corporations. Physicians are reminded that all fees must be received in the College office by 1 January, 2007. Physicians who have not received such notices should contact the College office.
FROM THE ARCHIVES
90 years ago
In 1916, Council complained to a hospital that it was allowing unlicensed surgeons to operate and decided to leave the annual fee at $1.
60 years ago
IIn 1946, Council decided to accept as a medical student an applicant who was not born in New Brunswick, but had lived here since one year of age. In response to several applications from foreign physicians, Council decided to give priority to returning veterans. The annual fee was $20.
30 years ago
In 1976, Council received a complaint from Medicare that a physician had been submitting claims in advance of the services provided. Council also agreed that any physician could communicate to Council in the language of his choice, but the physician was not necessarily entitled to receive a response in that language, unless it was clearly a legal matter.