September 20, 2019

Dr. Mark Spiller receives Council Award

Dr. Mark Spiller of Kirkland Lake was presented with the CPSO Council Award at the September Council meeting. Dr. Spiller is the Chief of Staff at the Kirkland Lake and District Hospital, where he also serves as the Chief of Family Practice and Emergency Medicine.

Dr. Spiller has devoted 29 years of medical practice to his Kirkland Lake community, where he has had a profound effect, transforming the medical institutions and impacting the care of patients. In addition to many years of service as chief of staff, he has been a coroner and the telehealth medical director. He is an assistant professor at the Northern Ontario School of Medicine and, in addition to working in the Kirkland Lake hospital’s emergency room, he does emergency room shifts at the nearby Englehart and District Hospital. He also attends to patients at a clinic that helps serve the Matachewan First Nations Reserve.

Read more about Dr. Spiller in the next issue of Dialogue.

Registrar/CEO’s Report

In her report to Council, Dr. Nancy Whitmore, the College’s Registrar/CEO, reported on several key performance indicators.

We are continuing to see progress in our complaints/discipline process timelines. Most notably, the time to resolve a complaint has decreased by 37% over a one-year period and we have increased the number of complaints managed through early resolution (ADR) by 169% over the same one-year period. We have also reduced the time it takes to write an ICRC decision from 26 weeks to five weeks. In regard to our discipline process, we have reduced the time to release a discipline decision by 51%. We are committed to continue our work in improving our processes here at the College and will keep you updated on our progress.

Dr. Whitmore also reported that the Quality Improvement pilot project has attracted 278 interested physicians who volunteered to participate. The project is now underway and will be complete by the end of 2019. She also reported on initiatives to more meaningfully engage with the public and physicians.

Dr. Whitmore also announced Dialogue will soon have a digital version. The first issue will be arriving in physicians’ inboxes in the new year.

Continuity of Care

Following an extended six-month consultation and significant stakeholder engagement, the College’s Continuity of Care policies were approved. The policies were substantially changed in response to the significant feedback received from stakeholders during the consultation. The four inter-related policies include: Availability and Coverage, Managing Tests, Transitions in Care and Walk in Clinics. The policies are an essential component of patient-centred care and an important contributor to patient safety. As the burden on the health-care system increases and becomes more complex, the information exchange across different parts of the health-care system becomes increasingly important.

While the spirit and intention of the policies remain the same, a number of changes were made to ensure the expectations better reflect the realities of practice while still setting an appropriate minimum standard.

As the policies contains new expectations that may require time for physicians to adjust how they manage their practice, the CPSO has implemented a 30-day transition period to allow physicians to align with any new expectations that were not previously set out in policy or where there has been a substantial change in the expectations.                      

Closing a Medical Practice

After an external consultation, Council approved a policy that describes the steps a physician must take when closing his or her practice in order to minimize the impact on the practice’s patients. This policy is an update of the policy entitled Practice Management Considerations for Physicians who Cease to Practise, Take an Extended Leave of Absence or Close their Practice Due to Relocation.

The Closing a Medical Practice policy generally maintains the expectations that were set out in the consultation draft; however, some revisions were made. For example, the 90-day patient notice period expectation was modified to be more flexible where a successor is taking over a practice, and the methods of notification have been expanded, allowing for notification by phone and in-person at a scheduled appointment, in addition to written notification by mail or secure e-mail.

The accompanying Advice to the Profession document includes further explanation about expectations and includes a resources section identifying key resources from stakeholders.

Policy Redesign Implementation

Council has approved its second batch of policies redesigned to enhance their readability for physicians.

The nine policies set out expectations in a clear and concise manner and better distinguish between mandatory and permissive expectations. As with the first batch of redesigned policies approved by Council in May, the expectations articulated within the policies have not changed. To date, 24 policies not currently under review have been redesigned in the new format.

Some small housekeeping amendments were also made to the Mandatory and Permissive Reporting policy. Since the policy was last updated, a number of legislative amendments have come into force, necessitating that the amendments be made.

Effective Referral

As part of its policy redesign process, Council has clarified the language of its “effective referral” requirement that is embedded within two high profile policies. The expectation of the College is unchanged, and the language change is simply meant as a clarification.

Both the College’s Professional Obligations and Human Rights and the Medical Assistance in Dying policies have sought to balance the rights of physicians who choose to limit the services they provide for reasons of conscience or religion with patients’ right to access care. To achieve this balance, an expectation was adopted requiring physicians who have a conscientious objection to make an “effective referral” to another non-objecting, available, and accessible physician, health-care professional, or agency.

CPR Orders

Council also took the opportunity of the policy redesign to reflect the direction of a recent court decision in the Planning for and Providing Quality End-of-Life Care policy.

The Ontario Superior Court’s decision clarified physicians’ obligations with respect to the writing of no-CPR orders and the provision of CPR.

The Court determined that the withholding of CPR, including the writing of a no-CPR order, is different than the withdrawal of life-sustaining treatment. In particular, it noted that while consent is required for the latter, which was at issue in the Rasouli case, the reasoning and conclusion of that case does not apply in the context of withholding CPR. Therefore, consent is not required.

The Court found that physicians are only obliged to provide CPR when doing so is within the standard of care.

Council approved the policy to reflect the court’s decision. The policy will be considered in its entirety in 2020.

Governance Update

In an effort to align with leading governance practices, Council has made a series of non-legislative changes to further its ongoing governance modernization work.

Council approved amendments that will remove three of the CPSO’s current standing committees: Council Awards Selection, Education, and Outreach. The Council Awards Selection Committee will continue as the Council Award Selection Advisory Group and the Education Committee as the Professional Learning Advisory Group. The mandate of the Outreach Committee has been incorporated into the mandate of the Executive Committee.

The College has also reviewed other best practices relating to committee member appointments in an effort to promote succession planning and committee membership renewal as well as to promote diversity with regard to demographics and clinical and committee experience. Council approved the following by-law amendments:

• Extending the length of most Committee appointments from one year to up to three years (effective December 2019).
• Introducing a 9-year term limit for Council members (excluding LGIC-appointed members) and members of any one Committee, whether those years are consecutive or non-consecutive (effective December 2020);
• Introducing an 18-year limit for individuals who have sat on any combination of Committees or Council, whether those years are consecutive or non-consecutive (effective December 2020).

The by-law amendments also include the creation of an “exceptional circumstances” provision that could apply in instances where a Committee requires the extension of an appointment for a particular member that exceeds the applicable term limit but is required to maintain stability and effective functioning of the Committee.

Transparency

The College will begin posting information related to charges and findings of guilt from international jurisdictions (under criminal laws, health insurance (billing) laws and controlled drugs and substances laws comparable to those in Canada / Ontario) that occurred on or after September 20, 2019.

Criminal Record Search

Council approved minor revisions to the newly titled Criminal Record Search policy. The new title reflects the variability in terminology used across jurisdictions. Amendments to the policy were made in response to process changes in the registration program area and to streamline the policy by focusing only on registration issues.

Feedback Wanted

Council is asking for your feedback on three draft policies now out for consultation.

The current Medical Records policy – the College’s most referenced policy – has been re-organized and divided into two, newly titled, draft policies that cover distinct topics related to medical records:

• Medical Records Stewardship sets out expectations related to the care, handling and management of medical records, particularly related to access and transfer, security and storage, and retention and destruction of records.
• Medical Records Documentation sets out expectations related to how and what to document in medical records. The draft focuses on foundational principles for documenting the patient encounter (i.e., legibility, accuracy, comprehensiveness and timeliness) and the required content of all records.

A companion Advice to the Profession document has been developed for each policy.

We are also consulting on a policy that expands upon the current policy, Confidentiality of Personal Health Information. The current policy’s emphasis on confidentiality and unauthorized disclosure of personal health information was identified as overly narrow, given the growing recognition and scrutiny of issues relating to patient privacy in health care.

Expectations for the Protecting Personal Health Information policy, as it is now called, have been revised, where appropriate, to address patient privacy and unauthorized collection and access of personal health information.

By-law Amendments

Council directed three housekeeping amendments to the by-laws to correct and clarify certain provisions. These are:

• Change the reference “regular meeting of the council held in November” to “annual general meeting of the council” as this is more accurate and consistent with other references in the by-laws.
• Correct a typo in the Registrar’s Election Duties Section
• Change the specific reference to “physician councillors” to “members of the College” as it was intended to be a reference to being a physician.