Council Update

December 3-4, 2015

Dr. Joel Kirsh, New President of CPSO; Council Award Winner; Consultations; Policy Updates; Other News

Dec 09, 2015

Dr. Joel Kirsh, New President of CPSO

At the December meeting of Council, Dr. Joel Kirsh became the new President of the College of Physicians and Surgeons of Ontario. Dr. Kirsh is a pediatric cardiologist specializing in heart rhythm disorders at the Hospital for Sick Children (SickKids) in Toronto.

Dr. Kirsh is cross-appointed in the Cardiac Critical Care program at SickKids and maintains courtesy privileges at the University Health Network, Mount Sinai Hospital, and Schneider Children's Hospital (Tel Aviv). He is the Founder and Medical Director of Camp Oki, which was Canada's first summer camp program for children with heart disease when it was launched in 2004.

Council Award Winner: Dr. Sadhana Prasad

A Waterloo physician has been presented with a Council Award for her work to improve the lives of older patients.

Dr. Sadhana Prasad was the first and only internist-geriatrician in the community from 1987 to 2004. There are now four. She leads the Centre for Bone Health, which she founded at St. Mary's Health Hospital and also sees patients at stroke and dementia prevention clinics at Grand River Hospital and Listowel Memorial Hospital.

Dr. Prasad is one of only 200 certified geriatricians in Canada and works to raise the profile of the specialty with medical residents by providing them with rotational opportunities at McMaster medical school's satellite campus in Kitchener.

After noticing some gaps in seniors' care, she initiated and worked collaboratively with the faculty of nursing at McMaster to develop a geriatric certificate training program for nurses.  "The breadth and depth of her medical knowledge is astounding and at all times she teaches with incredible ease, passion and enthusiasm," wrote Dr. Sharon Marr, who heads the division of geriatric medicine at McMaster University, in a letter nominating Dr. Prasad for the Council Award.

"She has demonstrated many of the CanMed roles to ensure that our older and frail patients receive the highest level of care," wrote Dr. Marr.


CPSO Interim Guidance: Physician-Assisted Death

The Supreme Court of Canada's (SCC's) decision to lift a blanket prohibition on physician-assisted death is scheduled to go into effect shortly. The College is consulting on a draft document that will serve as interim guidance for the profession, in the event that the government does not have a framework in place when the decision goes into effect.

Carter v Canada legalizes physician-assisted death in circumstances where a competent adult is suffering intolerably from a grievous and irremediable medical condition, and clearly consents to the termination of life.

The SCC suspended its decision for 12 months to allow the federal and/or provincial governments to design, if they so choose, a framework to govern the provision of physician-assisted death. This decision takes effect on February 6, 2016, unless the federal government is granted an extension.

The draft CPSO Interim Guidance on Physician-Assisted Death document includes:

  • The professional and legal obligations articulated in existing College policies and legislation that apply in the physician-assisted death context;
  • The criteria for physician-assisted death as set out by the SCC; and
  • Guidance for physicians on practice-related elements specific to the provision of physician-assisted death.
  • In order to ensure that this draft interim guidance document is finalized in advance of February 6, 2016, we are conducting a shortened consultation. Should the Supreme Court grant an extension, this timeline will be extended.

Please read more and provide your feedback.

Physician Behaviour in the Professional Environment

Council has approved the release of the draft Physician Behaviour in the Professional Environment policy for an external consultation. The draft updates the current policy, although the key provisions and expectations have not changed.

Like the current policy, the draft sets out expectations for physician behaviour grounded in the principles of medical professionalism, namely that physicians act in a respectful, courteous and civil manner towards their patients, colleagues and others involved in the provision of care and that they not engage in disruptive behaviours. The draft also identifies a subset of unprofessional behaviour known as disruptive behaviour.

Among the key revisions, the negative impact of disruptive behaviour on patient safety, outcomes, and the work environment is more clearly articulated in the revised draft.

Please provide your feedback by the deadline.

Posting SCERPs ordered by Quality Assurance Committee

Council approved the circulation of a by-law that contemplates making public those SCERPs - Specified Continuing Educational or Remediation Programs - which are ordered by the Quality Assurance Committee (QAC).

As a result of our Transparency Initiative, the College has been posting SCERPs ordered by the Inquiries, Complaints and Reports Committee on doctors' profiles in the public register for the past several months.

The argument for making the outcomes of QAC public is one of consistency of approach. Regardless of where a matter originates, if an evaluation of risk is used to determine the outcome, then matters determined to be of similar risk should be treated consistently with respect to whether they are public.

When the College requires an Ontario doctor to undergo a SCERP, it is generally done in a moderate-to-high risk situation. Historically, very few SCERPs are ordered by the QAC.

The by-law proposes making public only the elements of the SCERP. The information considered by the QAC would remain confidential.

Please provide your thoughts on the by-law.

Budget 2016

The College is now seeking feedback on a draft amendment to the Fees and Remuneration By-law that would see an increase of 1.6% ($25) in membership fees. This increase would bring the fee that a physician pays to renew an independent practice certificate of registration from $1,570 to $1,595.

There was no fee increase last year.

Council also approved an increase to the tariff rate that can be ordered by the Discipline Committee as costs for a single hearing day. The tariff rate is the amount that can be ordered by the Discipline Committee without the need for proof of expenses. The tariff rate was raised from $4,460 to $5,000 for a hearing day. This increase represents approximately 50% of the estimated direct costs for a day of hearings. It does not include such things as investigative costs and legal costs to prepare the matter for a hearing, witness expenses, expert expenses, etc.).

The change is effective January 1, 2016.

Policy Updates:

Blood Borne Viruses

Council has approved a policy that sets expectations for physicians who perform or assist in performing exposure prone procedures with respect to reducing the risk of acquiring or transmitting Hepatitis B, Hepatitis C and HIV.

The Blood Borne Viruses policy also includes expectations for physicians if they are exposed to a blood borne virus, and lastly, expectations for physicians if they are infected with any of these viruses.

Significantly, the policy changes the testing requirements. The previous policy's requirement for HIV testing and HCV testing has been changed from every year to every three years. The policy only requires annual HBV testing for physicians who have not been confirmed immune to HBV.

Registration Policies

Council reviewed and approved minor changes that the Registration Committee recommended be made to the Re-entering Practice and the Changing Scope of Practice policies.  Both policies are scheduled for a full review later this year.

Physician Treatment of Self, Family Members or Others Close to Them

Council reviewed the consultation feedback received on the draft policy and the revisions that had been proposed in response. Council determined that the draft needed further revisions and deferred its decision to approve.  The draft sets out the circumstances in which it may be acceptable for physicians to provide treatment for themselves, family members or others close to them.  The draft will come back before Council once the changes have been made for consideration for approval.

Other News:

Sexual Abuse:  Update on College's Initiative

Council was presented with a progress report on the work that has been undertaken as part of the College's Sexual Abuse Initiative, the focus of which is to better support and protect patients from physician sexual abuse. Council provided further direction on several issues related to this work.

One of the issues Council considered related to the College's funding for therapy/counselling program. This program provides funding for therapy/counselling to survivors of sexual abuse committed by physicians. Council provided specific direction regarding how to expand the scope of the funding it provides as part of its current program. At its last meeting, Council directed that the scope of funding provided to eligible applicants be expanded to include costs associated with accessing the therapy/counselling. This would provide the College with discretion to fund costs such as child care and medication, and reasonable travel and accommodation expenses. Eligible applicants may not be otherwise able to access therapy/counselling if funding for these associated costs is not provided.

At this meeting, Council directed staff to pursue legislative change to expand the scope of funding the College provides as part of its current program to costs associated with accessing therapy/counselling, and in the interim, to explore the creation of a separate College fund for these costs. If determined to be feasible, creating a separate fund could provide the College with the means to fund these costs in the absence of legislative change.

Council also reviewed the consultation feedback received on the draft Rights and Responsibilities document. This document - now entitled What to Expect During Medical Encounters - describes what patients can expect from their physician during a medical encounter, what rights they have as a patient and how the College can help if they have questions or concerns about the care they received. It also specifically addresses sexual abuse and boundary issues by outlining the responsibilities physicians have to maintain a strictly professional relationship with patients and to conduct physical examinations and procedures in an appropriate and respectful manner.

Council considered the revisions to the draft document that had been made in response to the consultation feedback and directed that some additional changes be made before it is distributed to patients and the public.

Council was also updated on the College's Education and Training Project Plan related to sexual abuse and maintaining boundaries for a wide range of audiences/learners: physicians, medical trainees, and Council and Committee members. The Project Plan includes the following four key deliverables:

  1. Remediation in Committee Decisions
  2. Training Member-Specific Committees
  3. Education of Medical Trainees, and
  4. Education of Membership.

Council was provided with an update on planning, including needs assessments where relevant, that have been completed, and the work underway to achieve the deliverables identified in the Project Plan.

Removal of information from public register

Council considered the principles for use by the Registrar in exercising discretion to remove information from the public register when a physician has made the request. The Registrar is allowed the discretion under a section in the Health Professions Procedural Code.

Some of the factors that the Registrar may consider in exercising discretion include: How recent is the information? Does the information have continued relevance? What is the seriousness/severity of the information? Does the information serve to enhance protection of the public?

The principles now indicate that physicians wait at least two years from the date of the decision to make an application for removal. As well, physicians are advised to wait at least six months between applications. This approach reflects the view that a certain amount of time must pass to meet the Code's requirement that information is obsolete and no longer relevant.  Read more.

Factors of Risk and Support to Physician Performance

Medical regulatory authorities from six provinces have joined together to design and manage a project that will identify, understand and use empirically defined factors of practice that support physician performance or that suggests a risk of poor performance.

Council was provided with a progress report for this pan-Canadian project and discussed how it might integrate with the CPSO's objective for more physician assessments ("every doctor every ten years").

The organizations involved include this College, and the Colleges from Alberta, British Columbia, Nova Scotia, Quebec and Manitoba. The Federation of Medical Regulatory Authorities of Canada is also involved.

Fertility Services Oversight

Council has directed that staff continue to work with the Ministry of Health to develop a comprehensive quality oversight regime for infertility services.

A change to the OHP regulation will be required in order to enable the College to regulate these services. Currently, the OHP program only covers some of the procedures associated with IVF.

Council agreed that this is an area of medicine that could benefit from quality oversight. Infertile patients are particularly vulnerable and problems have arisen in the past with respect to both billing and clinical practices.

The Government has announced its intention to fund IVF in Ontario by the end of 2015.

QMP - Interim Report: Building on Strong Foundations

Council was provided with an overview of the Quality Management Partnership's inaugural report "Building on Strong Foundations: Inaugural Report on Quality in Colonoscopy, Mammography and Pathology".

Building on the Phase 2 Report (March 2015), the inaugural report begins to provide a provincial baseline for quality in each of the three service areas. The aim of the report is to invite dialogue with stakeholders and to illustrate to those audiences how the quality management programs can build on the baseline to fill gaps and increase consistency of service delivery.