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 2007-2008
President - Dr. Robert Rae, Saint John
Dr. Santo Filice, Moncton
Registrar - Dr. Ed Schollenberg
Dr. J. Anthony G. Lordon, Saint John
Dr. Mary FC Mitton, Moncton
Dr. Lachelle Noftall, Fredericton
At its meeting on 30 Novmeber, 2007, Council considered the following matters:
The family of an elderly patient complained about the care provided following a fall. Based on initial examination of the patient, and a review of an x-ray with a colleague, the Emergency Room physician determined that there was no significant injury and discussed the possibility of discharging the patient. After discussion with the family, the patient remained in hospital. A repeat x-ray disclosed a hip fracture. The physician met with the family and expressed regret for any deficiencies in the care provided. The Committee determined this was a satisfactory conclusion.
An elderly patient required surgical treatment. Due to limited local resources, the patient was to be referred to another centre. However, while waiting for transfer, the local surgeon advised the family that he was available to provide treatment, but that the attending physician had failed to contact him. He then transferred the patient to himself without discussing the matter with the attending physician. The patient was treated satisfactorily, although there may have been some consequent delay. The family complained that the attending physician should have arranged for a direct referral to the local surgeon. In reviewing the matter, the Committee noted that a system of regional referral had been set up due to the demands placed on the local consultants. In this case, the physician had, in fact, followed appropriate procedures. When the local surgeon determined that he was available to accept the patient, the proper approach would have been to advise the attending physician of this so that appropriate arrangements could be made. It was improper for the surgeon to imply that the attending physician had acted improperly. Furthermore, it was improper for him to assume care of the patient without discussing the matter with the physician under whom the patient was admitted.
There were also two separate complaints against a physician alleging improper prescribing of narcotics and other controlled drugs. These matters were referred to the Review Committee for further investigation.
DR. JAMES B. HANLEY
This psychiatrist, having been found guilty by the College of Physicians and Surgeons of Newfoundland and Labrador of professional misconduct in relation to sexual abuse of a patient, and having pled guilty before a Board of Inquiry in New Brunswick, was similarly found guilty of professional misconduct by the College in New Brunswick. As a consequence, Council has revoked his license to practise medicine in New Brunswick. This action is subject to legal challenge.
MEDICAL TREATMENT OUTSIDE CANADA
In follow-up to an earlier discussion, the College wishes to offer some guidance in hopes of avoiding difficulties for both physicians and their patients who are seeking coverage for treatment outside of Canada. These comments are of a general nature. Definitive information should always be sought directly from Medicare.
There are basically three situations where such might occur, only one of which would normally require any input from a New Brunswick physician.
Firstly, patients who are outside of Canada and require emergency treatment can apply to Medicare for reimbursement. Such is somewhat limited. For example, hospital in- patient services are compensated at $100/day, out-patient care at $50/day and physician services reimbursed at New Brunswick rates. The difference between these amounts and what the patient will actually pay highlight the importance of supplemental private insurance.
It sometimes happens that patients seek compensation for non-emergent treatment which they have pursued and received outside of Canada, but for which they have not sought pre-approval from Medicare. They may have received mistaken information that there would be some coverage. Medicare is legally precluded from compensating patients in any amount for such after the fact.
Finally, patients may need or wish to pursue treatment outside Canada for a number of reasons. While assistance with travel and accommodation is never available, full funding for the actual treatment may be, so long as the request is approved by Medicare in advance. However, it is critical that the request must be accompanied by evidence that neither the proposed treatment, nor an equally good alternative, is available anywhere in Canada. It is the absence of any Canadian alternative, not the convenience or timeliness of treatment at a foreign centre, that is determinative of the entitlement to coverage. In this situation, a New Brunswick physician will be required to support the request by providing evidence to that effect. The amount of such will vary with the circumstances. Almost inevitably, supporting documentation from local or regional specialists will be expected. Without such information, and prior approval from Medicare, no coverage can be provided.
By now, all physicians should have received invoices relating to their dues for 2008. Physicians are reminded that any payment for such must be received in the College office by 1 January, 2008 in order to avoid suspension of license. This also applies to renewal of licenses for professional corporations.
For physicians with Border Area licenses and Courtesy licenses, it should be noted that the College is no longer collecting annual dues for the New Brunswick Medical Society. The Society is invoicing physicians directly for this amount.