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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 will be aware of these matters.

Officers and Councillors 2019-2020

At its meetings on April 3, 2020 and June 12, 2020, Council considered the following matters.

Complaints

A patient complained that a physician refused to order an antibiotic by injection rather than orally, which she believed her young child would not tolerate. The physician asserted that there was no clear evidence that the child would not be able to take the medication by mouth and, in any case, such approach was not recommended as the first option in any prevailing guidelines.  The Committee determined that the physician had acted appropriately.

A family complained that a patient had developed a malignancy during the course of treatment by his physician. They alleged that the condition should have been noted earlier.  In response, the physician noted that this was a “legacy” patient who had been on longstanding narcotics for a number of reasons.  In addition, there were other issues relating to ongoing medical issues and injuries.  In this context, the physician could find no specific reason to suspect anything more was going on other than the patient’s ongoing issues.  In any case, no primary tumor was ever located.  The Committee could find no fault with the care provided. 

A patient discovered that a significant result, an A1C, had been abnormal some months earlier, but not reported by the physician. On reviewing the matter, the physician noted that significant efforts were made in the office practice to avoid mishandling results.  Nevertheless, for a number of reasons, this particular one was not noted.  While no reminder system is perfect, the Committee felt it was important to have some process.  Physicians are reminded to accept the responsibility for failing to note a result which is not received when expected, or received but not noted.

The family of a young child with leukemia, and associated severe neutropenia, attended at the Emergency Department. The child was placed in isolation, but after several hours, was still not seen. The family asserted this was inappropriate care by the physician.  In response, the physician noted that the child was triaged and was not to be seen with any priority.  The physician asserted the decision is not made by him.  The Committee felt that the care provided by the physician was acceptable under the circumstances. They, however, thought in these situations, particular efforts should be made by the hospital for the sake of such patients’ safety.

A family alleged that a physician had failed to make a timely diagnosis of pulmonary embolus in a patient. The patient subsequently died.  The physician acknowledged that, in hindsight, this was an error. From the Committee’s point of view, there were conflicting expert opinions regarding whether the physician’s care fell below the standard excepted. In the end, the Committee was unable to reach a clear conclusion.  Having said that, the Committee did note that the physician did not even further assess the patient.  There was no effort to pursue an alternative diagnosis.   Such warranted a Censure.

A patient visited the Emergency Department with abdominal pain. After the initial investigation, she was transferred to the regional centre for a CT scan, which was reported to the physician, through the nurse, as normal.  The patient was sent home, but returned the next day with increasing pain.  At this point, it became known that the scan had actually shown a kidney stone.  The patient alleged that her treatment was improperly delayed and the physician should have taken greater care to make sure he received an accurate report.  In reviewing this matter, the Committee could not completely see how the physician could have done anything different.  It is common and acceptable practice to receive reports through other staff.  The physician had no reason to doubt its accuracy.  The exact cause of the error was never identified. 

An elderly patient was admitted with a fractured hip. On the day of admission she came under the care of an on-call physician.  She then began to complain of shoulder pain.  In response, the physician appeared to become irritated that she had another problem in addition to the one for which she was admitted.  An X-ray was ordered, but never done.  Over the next day, the patient became increasingly unwell with the pain spreading in different directions. She appeared pale and distressed.  She eventually arrested and died.  The on-call physician was called several times over the course of the day, but did not arrive until after the patient had passed.  The nursing notes suggested strongly that they were pressing for the physician to attend this patient.  When a physician chooses not to attend the patient directly, he must accept the responsibility for any outcome which flows from that.  The Committee felt that the physician’s care was inattentive and warranted a Censure.

A patient complained regarding a number of errors committed by the family physician, including the inability to locate her previous chart. The physician noted that he had recently taken over the practice and the longstanding secretary had left.  Consequently, he had no assistance for several weeks and struggled to access relevant information when patients presented.  The Committee understood the difficulties the physician faced, but felt that he should be Cautioned regarding proceeding in some situations when past information could be necessary to make appropriate clinical decisions.

PEER ASSESSMENT COMMITTEE 

The Peer Assessment Committee is seeking Physician Assessors - physician peers engaged in the same field of practice as the physician being assessed. Assessors must be sensitive to the professional judgement of individual physicians, conscious of the concerns about confidentiality, and committed to making the peer assessment process a positive and rewarding experience for those involved.

In general, assessors will be expected to:

• serve as an Assessor for a minimum five-year term
• commit a minimum of 2-3 days/year to PAC assessments
• attend annual/biannual assessor training or PAC workshops
• sign a Letter of Undertaking re the confidentiality of the program, and other confidentiality oaths as may be required by individual health authorities
•  

Assessors shall be reimbursed for their time and expenses in accordance with the current CPSNB expense policy.

For further information or to discuss your interest in becoming an assessor, please contact:

Sue Murray, PAC Program Director at 506-852-4441 or via email: This email address is being protected from spambots. You need JavaScript enabled to view it. .

A “Choosing Wisely” guideline on Covid 19 is enclosed for interest and guidance.

https://choosingwiselycanada.org/covid-19/