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 2020-2021
| President - Dr. Nicole Matthews, Campbellton
| Registrar - Dr. Ed Schollenberg
| Vice President - Dr. Hanif Chatur, Grafton
| Dr. Éric Basque, Pointe-des-Robichaud
|Ms. Ruth Lyons, Tide Head
| Dr. Zeljko Bolesnikov, Fredericton
|Dr. Abdulaaiti Mahfud, Frederiction
| Ms. Diane Brideau-Laughlin, Ammon
|Ms. Patricia I. O'Dell, Riverview
| Dr. Michael Hayden, Miramichi
|Dr. Peter Ross, St. Andrews
| Ms. Denise Hollway, Rothesay
|Dr. Kerry Sheppard, Saint John
| Dr. Rina Lee, Dieppe
|Dr. James Stephenson, Saint John
| Dr. Éric Levasseur, Edmundston
|Dr. Julie Whalen, Moncton
At its meeting on June 25th, 2021 Council considered the following:
A Counsel is advice as to how to improve the physician’s conduct or practice.
A Caution is intended to express the dissatisfaction of the Committee and to forewarn the physician that if the conduct recurs, more serious disciplinary action may be considered.
A Censure is the expression of strong disapproval or harsh criticism.
Perhaps due to the pandemic, there were several complaints arising from Emergency Departments.
In one case, a patient was advised by Tele-Care to attend the hospital because she had a sore throat. When she advised the physician of this, he immediately began a rant about his opinion of the Tele-Care service. The patient felt that his subsequent assessment was inadequate. In response, the physician acknowledged that his remarks were improper. He also pointed out that there has been some pressure to reduce visits to the Emergency Department. The Committee felt his remarks were intemperate and felt a Counsel was appropriate.
In another case, a mother attended with her young child, who was an oncology patient and had an ongoing risk of neutropenia and infection. The mother expressed her concerns to all of the staff, but felt that the subsequent care over two visits was unresponsive. The physicians did not seem to be paying attention to the guidelines which were provided by the oncologist. Any investigations which were done were not done in a timely fashion. The complaint went against three physicians who were involved sequentially. It was noted that this occurred at the beginning of the pandemic protocols and, consequently, almost every process took much longer. The Committee felt that the physicians had responded appropriately to the clinical situation. It might have been less stressful if they had better explained to the mother how the matter was going to be handled.
A patient attended the Emergency Department with a range of symptoms including fainting, dizziness, blurry vision, and arm numbness. There was a delay in her being seen and the physician immediately began to “pepper” her with many questions, which caused her considerable stress. He also offered some critical and disparaging remarks. She subsequently left. In response, the physician stated that there had been some confusion regarding the patient’s entrance complaint and her primary symptoms. He found it difficult to obtain any history from her. In reviewing the matter, the Committee felt that the confrontation could have been avoided. A Counsel was felt appropriate.
In a complaint that involves failure to follow up on results, a patient complained that significant results regarding an ongoing pregnancy had not been provided to her by the Emergency physician. In response, the physician noted that the local policy was that patients are asked to return in order to obtain their results. In this case, such did not happen. The Committee noted that such circumstances have been the source of follow-up failures in the past and can create significant risks if the result is not acted on. While the physician himself was not responsible for the approach, he was functioning in that environment, which did not include a method for checking on results which may have been missed. The Committee felt a Counsel was appropriate.
A fifty-year-old patient was seen on two occasions in the local Emergency Room. The presenting complaint was unusual behaviour. On the first visit, some investigation was done. On the second visit, it was planned that the patient was to return in a few hours when a CT scan would be available. The family decided to go home while they waited. During that time, there was a sudden episode of uncontrolled behaviour, which eventually resulted in the patient’s death following a driving accident. The family questioned whether the patient had been adequately assessed. The Committee noted that, unfortunately, there could be no certainty regarding the patient’s clinical issues as, although this was a Coroner’s case, no examination of internal organs was done. As a consequence, the possibility of intracranial pathology could not be ruled in or ruled out. Considering all of this, the Committee could not find specific fault with the care provided.
There were several complaints against obstetricians / gynecologists. In one matter, a patient who had been troubled with recurrent vaginal yeast infections attended
the gynecologist based on systemic symptoms which she felt was the result of such. She had no local symptoms and the physician did not feel that such could be the cause of the symptoms she claimed. She pressed for further investigation and intervention, which he did not feel was necessary. In reviewing the matter, it was noted that, while the patient had her own view of matters, the physician had not clearly expressed his conclusions and recommendations. If the patient was to consent to any intervention, it must be with the appropriate information. This did not appear to have been offered, a Counsel was warranted.
A pregnant patient, with five previous miscarriages, was attending an obstetrician. The patient miscarried again and found out subsequently, through another physician, that originally significant results had been missed by the first obstetrician. Antiphospholipid values were provided to the first obstetrician, but no action followed. In response, the physician stated the situation arose because, while she had access to the information system of Horizon Health Network, at the time there was less efficient access to the patient’s results, as she had had the test done at a Vitalité facility. She felt this was the reason that she had missed the significant results. She acknowledged that the situation has somewhat changed and she has modified her own office practice to prevent a recurrence. In reviewing the matter, the Committee felt it had to express its dissatisfaction with a systemic process which could result in such miscommunication. Having said that, physicians are expected to anticipate when “systems” might fail to provide the right information and, consequently, must have a method to follow up such results if they are not actually received.
A patient was pregnant and had wished to be cared for by a midwife. None was available so she attended the obstetrician who had looked after her during her first pregnancy. However, she had a number of very strong preferences for how her delivery should be handled. The physician was prepared to accommodate many of these, but felt that some of them could create unnecessary risks. He consequently declined to follow such approaches. The Committee noted that a physician is never obligated to provide any service which is not in the patient’s best interest. In this case, due to receiving information from a range of sources, the patient had developed very specific ideas of what she wanted. There was little, if any, room for compromise. The Committee felt the physician had done all that he could ethically do under these circumstances.
A patient was referred to an obstetrician after a number of miscarriages. She was advised to return if she ever got pregnant. This happened quite quickly and the patient made several attempts to contact the physician, but such were precluded by the physician’s staff. When eventually contacted a few weeks later, the patient was quite upset and, consequently, the physician felt it appropriate to discharge her from the practice. The reason stated was that there was no longer any “trust and respect” which would allow an ongoing relationship. The Registrar first attempted to conciliate the matter, but the physician was firm in her opinion. In reviewing the matter, the Committee noted that the patient had been in a highly stressed situation and was frustrated by her inability to connect with the physician, even though that was the instructions she had received. It was felt that difficulty could have been solved with better communication between the patient, the physician, and her staff. The Committee was also concerned that terminating the patient’s care was handled inappropriately. Physicians are not to expect a patient’s “trust and respect” automatically, but must act in a way which warrants such. The entire matter was felt worthy of a Counsel.
There were two complaints against psychiatrists regarding medication choices. In one case, the patient complained that the medications prescribed were causing unpleasant side effects and, consequently, she frequently declined to take them. The physician noted that the patient’s pathology was complicated and he felt that he had made the best choices he could in such circumstances. Based on other opinions, the Committee agreed, and felt there was no fault with the care provided.
In another matter, a pharmacist complained that a physician had declined to provide any explanation for the unusual dosages and unusual combinations of medications he was prescribing to a particular patient. In response, the physician asserted he had no obligation to explain his decisions to a pharmacist. In reviewing the matter, the Committee noted that professionals are expected to work together in a patient’s best interest. Physicians are also expected to appropriately respect others who are doing their own professional duties. The Committee felt that a Caution was appropriate.
There was a complaint about another psychiatrist who a patient was seeing for the first time, after her previous therapist left practice. The visit became confrontational quickly and the physician persisted in asking about suicidal thoughts. The patient denied such, but the physician stated that he felt it best that she be assessed in the hospital. She left, but was subsequently taken to the hospital by the police, which she found very embarrassing. She was assessed at the hospital and discharged. In response, the physician asserted that he felt obligated to take that action as there was, in his view, evidence of a suicide risk. In reviewing the matter, the Committee noted that the purpose of such involuntary admission is to provide an appropriate assessment of the patient. The Committee could not find any direct fault with the care provided.
There were complaints against two surgeons regarding a refusal to operate. In one case, the patient felt she was unnecessarily criticized for her obesity. The Committee noted that physicians’ concerns about the risks of surgery are appropriate. The patient had to be adequately informed. Nevertheless, this did not appear to be what she felt the visit was to be about. In the end, the Committee could find no specific fault.
In another case, a patient had a past history of several episodes of cancer when another, but separate, tumor developed. The patient was not offered surgery although the family felt she could have such. They based this opinion on the information provided by a service which reviewed the patient’s charts and subsequently offered expert opinions. In this case, the tumor was unpredictable and, when biopsied, showed unusual pathology, and was not suitable for resection in a way that would benefit the patient. The Committee could find no fault with the care provided.
In a case related to COVID, the daughter of an elderly patient complained that he had not been treated appropriately by his family physician. Because of the pandemic, patients were instructed to wait in their car and they would be phoned. The patient did not hear well and, consequently, at some point, went directly to the office where he was advised that he was there too early. Subsequently, a confrontation arose between the patient, the receptionist, and eventually, the physician. The complaint alleged that the patient had been discharged from the practice. The physician responded that the patient had been rather notorious for attending his appointments at the wrong time. Under the circumstances, the physician asserted that the patient was handled politely and was eventually seen. She denied discharging the patient. On reviewing the matter, the Committee noted that the complaint arose from information provided by the patient’s daughter who had not witnessed the events. In the end, the Committee could find no specific fault with the care provided.
A mother complained regarding the care provided by a physician at a specialized clinic which treated pediatric metabolic diseases. At some point, a mother had missed numerous appointments over the course of a year. A different excuse was offered each time. The complainant alleged that the physician subsequently complained about the family to Social Development. In response, the physician noted that the call did not arise from her, but rather from other staff. There was never any sense of abuse, but repeatedly missing children’s appointments can be a sign of improper care. Eventually, matters were sorted out and follow up of the patient was arranged in an alternate way. The Committee could not find any fault with the care provided by the physician.
A Special Message to the Members
I have always realized there was a point when I had to move on. I had no specific time in mind in hopes that I would be one of those individuals who could work satisfactorily despite the advance of years. I was very conscious of any limitations which might arise and I always told myself that I would rather quit a day before everybody thinks I should than a day after. Now I am not sure that I am past my “best before” date yet, but I do feel there are factors other than my personal comfort which need to be considered. If one looks around, one sees many organizations, in government, in sports, in education, where slow turnover at the top can result in stagnation from a lack of imagination or initiative.
Consequently, a short time ago, I decided our College was in the same state. It was time for me to move on. While I could continue to do the tasks competently, it would be better if new leadership was recruited to move the organization forward. Thus, it is my intention to resign my position as soon as a suitable replacement can be found. A search process has been commenced. *
In any case, my final day is likely not here yet. I can, perhaps, save some special remarks for that time. I can only warn you in advance that I do not wish to have a dinner, receive any gifts, or have any place or thing named after me.
“I’d rather people ask why I have no monument, than why I have one.” Cato the Elder
Thank you and good luck.
Ed Schollenberg, MD, LLB, FRCPC, Registrar