Bulletins

September 2001

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 2000-2001

President - Dr. Beatriz Sainz, Oromocto
Vice-President - Dr. Christine Davies, Saint John

Ms. Barbara Bender, Saint John
Dr. Zeljko Bolesnikov, Fredericton
Dr. Marc Bourcier, Moncton
Dr. Douglas Brien, Saint John
Mr. Stanley Knowles, Miramichi
Mr. Eugene LeBlanc, Dalhousie
Dr. William Martin, Miramichi

Registrar - Dr. Ed Schollenberg


Dr. Marc Panneton, Campbellton
Dr. Robert E. Rae, Saint John
Dr. Beatriz Sainz, Oromocto
Dr. Malcolm Smith, Tracadie-Sheila
Dr. Rudolph Stocek
Dr. Pamela Walsh, Riverview
Dr. Claudia Whalen (PhD), Fredericton




At its meeting on 7 September 2001, Council considered the following matters:

Complaints:

A young adult was admitted with shortness of breath, but died unexpectedly after a few days in hospital. The cause of death was determined to be a pulmonary embolism. There was an allegation that the diagnosis should have been made earlier. On reviewing the facts, the Committee noted there were some hints for such a problem, but these were only evident in retrospect. The Committee found no evidence that the care provided was deficient.

There were two separate complaints regarding surgical care. The complications developed, specifically a bladder fistula and an injury to a ureter, were both likely due to the procedure being more difficult as a result of significant adhesions from previous surgery. These were felt to be complications which were known to occur despite the best of care. No action was taken on either complaint.

There was a complaint from a hospital that a physician had breached contractual obligations by accepting a position elsewhere. This further aggravated the hospital's difficulties in recruiting. On reviewing the matter, the Committee noted that the College did not have a specific provision such that breaches of a contract for medical services constituted professional misconduct. Such provisions do, however, exist in other provinces. Lacking such a provision, the Committee felt that no further action could be taken on the matter. The Committee recommended that appropriate remedies for this issue should be written into the contracts themselves.

There was an allegation that an elderly man had suffered a stroke as the result of being prescribed sildenafil (Viagra) despite his underlying medical condition. On reviewing the matter, the Committee felt there were other causes likely. Furthermore, it was noted that the contraindications to prescribing this medication had been evolving. No fault was found with the care provided.

An elderly man presented to the Emergency Department after a fall. X-rays were taken, read as negative, and he was sent home. He died there a few days later. At the same time, the x-ray was reported as showing significant injuries which were not detected by the original physician. The Committee accepted that this was a diagnostic error and did not feel that further action was necessary.

A physician had stated that a requested medical report would only be provided if the patient changed lawyers. When this did not occur, the patient was asked to leave the physician's practice. It was the Committee's view that the conduct of the physician was unacceptable. Patients should be free to choose their own lawyer or any other professional. Asserting this right should not result in their care being terminated.

here was an allegation that a physician had failed to make a timely diagnosis of Hirchsprung's disease in an infant. On reviewing the matter, the Committee noted that the child had been referred to a consultant at an early age. Furthermore, any delay in this diagnosis is determined by the severity of the disease. The Committee could find no fault with the care provided by the physician. Other than maintaining some index of suspicion in children with certain symptoms, the Committee did not feel such situations can be always avoided.

An elderly patient attended her physician's office accompanied by her daughter. There was confusion regarding the appointment time and a discussion subsequently ensued with the receptionist. When eventually seen by the physician, no care was provided. Instead a heated and loud argument developed between the physician and the daughter. Such occurred in the presence of other patients. The Committee could find little excuse for the response of the physician to this particular circumstance. Furthermore, it can be difficult for other patients to feel their needs are met when seeing a physician who has been so distracted. Other than providing these comments, the here was an allegation that a physician had failed to make a timely diagnosis of Hirchsprung's disease in an infant. On reviewing the matter, the Committee noted that the child had been referred to a consultant at an early age. Furthermore, any delay in this diagnosis is determined by the severity of the disease. The Committee could find no fault with the care provided by the physician. Other than maintaining some index of suspicion in children with certain symptoms, the Committee did not feel such situations can be always avoided.

An elderly patient attended her physician's office accompanied by her daughter. There was confusion regarding the appointment time and a discussion subsequently ensued with the receptionist. When eventually seen by the physician, no care was provided. Instead a heated and loud argument developed between the physician and the daughter. Such occurred in the presence of other patients. The Committee could find little excuse for the response of the physician to this particular circumstance. Furthermore, it can be difficult for other patients to feel their needs are met when seeing a physician who has been so distracted. Other than providing these comments, the Committee did not feel further action was necessary on the matter.

An elderly patient was admitted to hospital. The family gathered and wished to speak to the physician who had been caring for her in the nursing home. Although present on the ward, the physician advised he was too busy to see them. The family consequently wished the patient transferred to another physician. The Committee felt that the situation was avoidable. In circumstances where other matters require the physician's attention, a simple explanation and an arrangement to meet at another time would have avoided these difficulties.

A patient developed post-operative complications and returned to the hospital to be seen by another surgeon. It was alleged that the surgeon made inappropriate comments regarding the care provided by the original surgeon. The patient felt confused by this. There were other concerns as well regarding the approach taken, but the Committee felt that, if a physician does, indeed, disagree with an approach taken by another, such comments can be provided in a way which does not create unnecessary uncertainty and difficulty for the patient.

A patient with a back injury had seen many physicians in another province. He was referred to a New Brunswick physician who initially felt there was a possibility of surgery. However, later the patient was determined not to be suitable. The patient alleged that the surgeon was improperly influenced by the insurance company. On reviewing the matter, the Committee noted that the patient had been non-compliant with recommended investigations and, furthermore, based on the known facts, it was questionable whether the patient would have benefited from the surgery.

An elderly patient saw a consultant for several years regarding a variety of problems. On one visit, the diagnosis of Parkinson's disease was suggested and treatment commenced. The patient was only seen one more time by this physician for an unrelated problem. The family complained that the diagnosis was made improperly. From the facts available, the approach taken from the physician was not clearly unreasonable. The fact that the patient did not return for any follow-up precluded the physician from reviewing his approach. No action was taken on the matter.

Two other complaints were referred to the Review Committee for further assessment.

CODE OF ETHICS


Due to a change in provincial legislation, a change to the commentary on Section 16 was necessary. Council approved the following provision:

Recognize the need to balance the developing competency of children and the role of families in medical decision-making.

Physicians should be mindful of the Medical Consent of Minors Act. Patients aged sixteen and older have the full rights of adults for all aspects of their medical care, including consent, refusal of treatment, and confidentiality. Those under sixteen have similar rights if they are considered competent to consent by a physician and the treatment is in their best interest.

REGULATION REVIEW

Council is in the process of reviewing the Regulation dealing with professional misconduct. It commenced this process by looking at provisions which existed in other jurisdictions to determine whether any may be applicable here.

To that end, Council gave preliminary approval to amendments to:

Prevent members assigning an interest in their medical records as a pledge on a loan.

Further clarify that physicians can only provide services for which they can demonstrate both training and recent experience.

Obligate physicians to report to the College any settlements or other disposition of any legal action alleging negligence. This is in addition to the existing obligation to report to the College any adverse finding by another licensing authority, hospital, government agency, or court.

Preclude a member influencing a patient regarding a will such that indirect benefits flow to the physician, such as through a family member.

At the same time, Council determined not to add certain provisions. One dealt with a provision, existing in some other provinces, making it professional misconduct to breach a contract for professional services. It was felt that this was best dealt with as a matter of contract law.

A provision from some other provinces making harassment a specific form of misconduct was also rejected. When such behaviour may affect patient care, such can already be dealt with under existing rules. Where there is no potential affect on patient care, Council felt such issues are best addressed by other means.

In addition, Council noted that many other jurisdictions preclude "conduct unbecoming a physician". This provision is designed to include activity by a professional which is not directly related to the practice of medicine, but may be of such a nature as to undermine the individual's ability to provide appropriate care. Council has requested further information on how such a provision has been applied elsewhere.

Comments from members are welcomed. The specific proposals are available from the College office.

ANNUAL FEES

Invoices for annual fees will be forwarded on or about November 15th.

There will be no increase in most fees for 2002. The fee for physicians who pay by direct deposit remains at $490.

For those physicians who pay by other means, the fee remains at $510. Payment for such must be received by January 1st, 2002.

The annual fee for professional corporations has been increased to $100. This is reduced to $80 for corporations which pay by direct deposit.

The annual fee for Border Area licenses has been increased to $100. At this time, direct deposit is not available for these physicians.

The annual fee for Courtesy Licenses remains at $60.

FROM THE ARCHIVES

Thirty years ago

In 1971 Council considered the question of recognition of specialists, established a temporary register which would allow Quebec physicians to practise here pending obtaining the LMCC, and established a Border Area license for physicians resident in neighbouring jurisdictions. Council also considered the question of licensing physician assistants. They rejected a request by the Medical Society to offer a reduced fee for physicians unable to practise due to illness. In 1971 the office of the Medical Council moved to space beside the Medical Society.

Sixty years ago

In 1941 Council expressed strong objection to government employment of a refugee physician. Council did grant permission for a student to attend medical school, notwithstanding that he had not been born in New Brunswick. During 1941 there was a lengthy discussion regarding excess prescribing of narcotics. In that year, the annual fee was increased to $10. This amount was shared with the Medical Society.

Ninety years ago

In 1911 Council prosecuted two illegal practitioners. That year, the Canada Medical Act was passed creating the Medical Council of Canada and eventually the LMCC exam. In 1911 there were 264 physicians licensed in New Brunswick. The annual fee was $1. The Registrar's annual salary was $150. Total expenditure on postage and telephone for 1911 was $3.50.

EXECUTIVE COMMITTEE

Council elected the following to the Executive for 2001-2002:

President: Dr. Ludger Blier, Edmundston
Vice-President: Dr. Marc Panneton, Campbellton
Member at large: Dr. Rudolph Stocek, Hartland
Public member: Mr. Eugene LeBlanc, Dalhousie
Past President: Dr. Christine Davies, Saint John