May 24-25, 2018

Council Award Presented to Dr. Sarah Reid

Dr. Sarah Reid, an Ottawa expert in pediatric emergency medicine, was presented with the College’s Council Award in recognition of her work to ensure children across Canada receive evidence-based, high quality pediatric emergency care.

Dr. Reid is a pediatrician in the emergency department at the Children’s Hospital of Eastern Ontario (CHEO). She is also the medical lead for CHEO’s Emergency Department Outreach Program, and an assistant professor in pediatrics and emergency medicine at the University of Ottawa. 

It is well known that the majority of ill and injured children in Canada are treated not in tertiary care centres, but in community emergency departments where the physicians and nurses often have fewer resources and less experience and training in treating severely ill children. As the founding medical lead for the Outreach Program, Dr. Reid has been at the forefront of the creation and implementation of a program that provides outreach education to the 20 community hospitals within the Champlain and the South East LHINs to facilitate broad standardization of evidence-based care.

We have an interview with Dr. Reid in the next issue of Dialogue.

Continuity of Care - Draft for Consultation

Council reviewed several draft policies related to continuity of care issues developed by a policy working group. Council directed that, given the importance of this project, these policies should have an extended consultation to allow the profession and other stakeholders the opportunity to provide meaningful comment. The consultation is now open and runs for six months and we invite stakeholders, including physicians, to provide their feedback by December 9, 2018.

In recognition that there are a number of health system factors that are beyond the control or influence of individual physicians, the policy’s working group put its focus on developing policy expectations related to those elements of continuity of care where physicians do have a role to play. The College’s recommendations regarding broader systems issues that can be a barrier to or facilitator of continuity of care will be set out in a separate ‘white paper’ at a later date.

While continuity of care is a broad concept that could include a number of issues, the working group chose to prioritize four key areas as its focus: Availability and Coverage; Managing Tests; Transitions in Care; and Walk-in Clinics. These areas were identified as perceived areas of risk to the public or areas where the College had reason for being proactive in setting out expectations.

A draft umbrella Continuity of Care policy sets out the principles of professionalism that underpin the companion policies. The Availability and Coverage draft policy sets out the College’s expectations of physicians regarding physician availability, after-hours coverage, and coverage during temporary absences from practice. The Managing Tests policy sets out expectations for physicians regarding the management of all types of tests. This draft updates the current Tests Results Management policy. The Transitions in Care draft sets out expectations of physicians when patient care or an element of patient care is transferred between physicians, or between physicians and other health-care providers. This includes expectations in relation to keeping patients informed about who is responsible for their care, patient handovers within a hospital or health-care institution, discharges from hospital, and the referral and consultation process. And lastly, the Walk-In Clinics draft sets out expectations of physicians practising in walk-in clinics, focusing on those elements that most closely relate to continuity of care.

The drafts are reflective of feedback generated during preliminary consultations, the results of public polling and research conducted on an extensive body of literature. Dr. Brenda Copps, a Hamilton family physician and chair of the working group said while doing the groundwork, common themes quickly began to emerge. “This included the idea that patients should experience their care as being coordinated and connected, the importance of information flow throughout the health-care system, and the value of being provided care within a sustained physician-patient relationship,” she said.

“Council is sensitive to the realities of practice and the burdens currently facing practising physicians, however, the College is committed to making sure that breakdowns in continuity of care are minimized,” said College President, Dr. Steven Bodley.

Other medical regulators across Canada have continuity of care policies.

The Working Group included family physicians and specialists, and physicians who work in teaching and community hospitals as well as members of the public.

Bill 87: Psychotherapy Regulation Proposal

Council supported a proposed draft regulation to extend the physician-patient relationship five years past termination where the relationship has involved psychotherapy. The College’s proposed regulation, if approved, would mean that if a physician has a sexual relationship with a former psychotherapy patient any time within the five years following termination, the physician would be subject to mandatory revocation. The regulation qualifies that the “treatment provided by the member to the individual involves psychotherapy that is more than minor or insubstantial.”

This additional regulation would supplement, not replace, the Ministry’s regulation defining a patient that came into force on May 1st.

As detailed in an advisory that was sent to all members in April, changes to the College’s governing legislation, which flow from Bill 87, the Protecting Patients Act, means that now for the purposes of sexual abuse, a person will be considered to be a patient for a year after the termination of the doctor-patient relationship. This means that any physician who engages in a sexual relationship with a patient within one year of the termination of the doctor-patient relationship is subject to mandatory revocation. The regulation includes an exemption from the definition if all of the following conditions are satisfied: a sexual relationship is already in place between the individual and member at the time the health care services are provided; the member provided the health care services to the individual in emergency circumstances or in circumstances where the service is minor in nature; the member has taken reasonable steps to transfer the care of the individual to another member or there is no reasonable opportunity to transfer care to another member.

Council’s proposed regulation recognizes the unique nature of psychotherapy and the particular vulnerabilities of patients undergoing psychotherapy and therefore extends the time that an individual is considered a patient.

The proposed regulation also reflects the current expectations of those providing care to patients in the most vulnerable of circumstances, as outlined in the College’s Maintaining Appropriate Boundaries and Preventing Sexual Abuse policy.

We will be consulting on the proposed regulation shortly. Stay tuned. 

Rescindment of Methadone By-Law

Council has rescinded the Methadone by-law to allow the transition of the Methadone Committee from a by-law committee to a specialty panel of the Quality Assurance Committee (QAC).

The benefit of this transition is that the QAC has a full range of powers at its disposal under the Regulated Health Professions Act (RHPA) that can be used when it determines that education and remediation for a prescriber are required. These powers include conducting more comprehensive assessments, directing SCERPs and, when necessary, using the authority of the Health Professions Procedural Code to impose terms, limits and conditions or refer matters to the Inquiries, Complaints and Reports Committee. This move will also allow physicians the confidentiality protections afforded under the RHPA.

Health Canada’s recent announcement that methadone prescribers no longer need to hold a federal exemption negates the need for any ongoing regulatory structure in support of the exemption itself.

The College believes, however, that given the safety risk posed by methadone if not prescribed appropriately for the treatment of opioid use disorder, explicit expectations for methadone prescribers remain in place, while we review our longer term strategy for the oversight of opioid prescribing. In the near term, the College will expect physicians who wish to begin prescribing methadone for the treatment of opioid use disorder to first provide the College with written notification of their intention to begin prescribing methadone, complete the core CAMH Opioid Dependence Treatment course, complete a one day pre-approved preceptorship; undergo an assessment one year after they begin prescribing methadone; and adhere to the Methadone Maintenance Treatment Program’s Standards and Clinical Guidelines.

Governance Review

Governance changes to Ontario’s health colleges are coming – it is simply a question as to when. That was the message from a Council group tasked with reviewing the College’s governance model.

The Council working group noted the changes in the external environment that signaled a new era in the governance structure of regulatory bodies. Most significantly, Bill 87, the Protecting Patients Act lays important groundwork for modernization and includes the most comprehensive changes to the Regulated Health Professions Act since it was put in place 25 years ago. For example, government now has the ability to establish the composition and functions of all College statutory committees.

So, given this landscape, how can the College governance structure be modernized? How can we strengthen the integrity of the regulatory system to ensure public protection? Those were the questions before Council as it engaged in a discussion to identify the core principles that should underpin the College’s governance structure, the characteristics of a high-performing board and any changes that would improve the College’s effectiveness.

In summary, several themes emerged from the Council discussion:

• Council/board’s role should focus on strategy planning and decision-making, and not on operational activity;
• A smaller board could improve the ability of a board to be nimble and respond more quickly to change; however any move to a smaller board will require consideration as to how to ensure diversity and engagement;
• Diversity of board members is important – this includes geographic diversity, different fields of practice, different skill sets, and different career stages;
• A move to separate or create more independence between board and adjudicative functions could enhance public trust.

College governance will be discussed at each Council meeting in 2018. The work plan for the review includes consideration of foundational principles in September and structural recommendations in December.