Council Update

May 28-29, 2015

Dr. Craig Campbell, Council Award recipient; CPSO Initiatives; Consent to Treatment; Policies for Consultation; Other News

Jun 09, 2015

Dr. Craig Campbell

Expert in CPD for specialists presented with Council Award

Dr. Craig Campbell, who has had a profound impact on the practice of medicine worldwide as one of Canada's leading standard setters for specialist physicians, was presented with the Council Award in May.

A world-renowned expert in Continuing Professional Development for specialist physicians, Dr. Campbell has been lauded as an innovative thinker in the relationship between providing outstanding care to patients and the education and practice-based methods needed to support specialists to do so.

Over the years, Dr. Campbell has held several leadership roles at the Royal College and is currently Director of Continuing Professional Development (CPD), coordinator of the ethics committee and also serves as Registrar, overseeing 68 specialties.

In addition to his academic and regulatory work, he also practises internal medicine in a clinic one-half day each week.

Dr. Campbell's nominators for this award say his peers and students describe him as a "complete package" who "exemplifies professionalism."

"He is thoughtful, courteous and always reliable. More importantly, he also teaches this approach," Dr. Kenneth Harris wrote in his nomination letter. "He works closely with his clinical colleagues to provide excellent care for the patient population they serve and works tirelessly at the Royal College to enhance the care provided to Canadian health-care consumers."

CPSO Initiatives

Proposing new measures to protect patients from sexual abuse

Council proposed a number of changes - both to the legislation which governs us, and to our own processes and practices - squarely aimed at better protecting and supporting patients from physician sexual abuse.

"When we set out on this initiative to look for ways to better protect and support patients, we made it clear that everything was on the table for discussion," said Dr. Carol Leet, College President. "Sexual abuse of patients is an issue that we take very seriously and it is behaviour that we will not tolerate."

We are now consulting on draft principles that articulate the College's approach toward physician sexual abuse of patients. These principles will ground the work of the initiative.  The content of these draft principles is informed by the College's mandate, the principles set out in the College's current policy on Maintaining Appropriate Boundaries and Preventing Sexual Abuse and earlier Council discussion. Please participate in our consultation and let us know what you think.

Council endorsed a number of proposed changes to the sexual abuse provisions in the governing legislation, the Regulated Health Professions Act.  The most significant is the proposal for two different definitions of sexual misconduct.  All physical sexual contact between a physician and patient would fall within the definition of sexual abuse, and would result in revocation.  Sexual comments and gestures would be defined as sexual impropriety, and penalties for sexual impropriety would be at the discretion of the Discipline Committee.

This approach would eliminate the list of specific acts that trigger mandatory revocation and would treat all physical sexual contact between a doctor and a patient as a fundamental breach of a physician's obligation to patients that requires revocation.

It also means that a wider range of conduct will be caught under mandatory revocation and, as such, the minimum five-year period prior to a reinstatement application may not be appropriate in all cases.  Council, therefore, is recommending that the Discipline Committee have the power to specify a period between one and five years before a physician can apply for reinstatement following a revocation for sexual abuse or other professional misconduct of a sexual nature.

In addition to making a number of recommendations to the sexual abuse provisions in the RHPA, Council also looked at our own processes and practices to determine what we can do better.  To that end, Council also directed the development of:

  • A Rights and Responsibilities document for patients that would focus on the duties and obligations that physicians owe their patients.  This would not be limited to addressing the issues of sexual abuse.
  • A multilingual education brochure about sexual abuse that would be used as an outreach tool to provide information about the College's role and to encourage patients to come forward.
  • A specialized ICRC panel for considering post discipline referral penalty instructions and settlement proposals.
  • A survey to better gauge the experience of patients who have been involved in the investigative/discipline processes.
  • An educational framework that provides opportunities for enhanced education and training of physicians, medical trainees, College Council, Committees and staff in relation to sexual abuse.

New by-laws will bring greater transparency to public register

Following an extended consultation, Council has approved by-laws that will make the following information public:

  • Criminal charges
  • Cautions-in-person
  • Specified Continuing Education or Remediation Program orders (SCERPs)
  • Licences - other jurisdictions
  • Discipline findings - other jurisdictions

The Transparency Initiative was born three years ago from the growing recognition that access to more information may assist the public in choosing a regulated health professional, enhance accountability and better inform any evaluation of the performance of professional regulation.

"These by-laws represent an important and fundamental change for both the public and the medical profession," says Dr. Carol Leet, College President.  "As such, CPSO Council took a deliberately thoughtful approach, carefully balancing transparency and fairness," she said.

For the most part, Council approved the by-laws as drafted, however, the consultation feedback was carefully considered and discussed at the meeting.  In regard to the by-law that will see discipline findings in other jurisdictions become public, Council decided to specify in the by-law that only those findings made on or after September 1, 2015, will be posted.  This will bring these matters in line with other information to be posted, such as licences in other jurisdictions. 

As a result of consultation feedback, Council directed further analysis on the issue of removal of information from the public register, including the development of criteria for removing information.  The by-laws, as approved, are currently silent on the issue.  This matter will come back for decision at a future Council meeting.

Dr. Rocco Gerace, College Registrar, made it clear that the Transparency Initiative is not meant to shift the onus onto the public to protect itself.  "The College's mandate is public protection, whether information is public or not.  We will continue to ensure that physicians are safe to practise.  We have many processes to ensure that if there are risks to the public, physician practice is limited or stopped. The purpose of providing greater transparency is to ensure that the public has information to make decisions based on their values and to demonstrate the regulatory actions taken by the College in cases where potential risk was identified."

We will have an article in the coming issue of Dialogue.

Consent to Treatment

Revised Policy Approved

Council approved the revised Consent to Treatment policy.  The policy articulates the obligations codified in the Health Care Consent Act, 1996 (HCCA), as well as professional expectations set out by the College.  The policy emphasizes that consent is a process that involves a dialogue between the physician and the patient or substitute decision-maker; not simply a piece of paper to be signed.

Some revisions and additions had been made to the policy directly in response to feedback received during our consultation process.  These include:  adding a principle regarding respect for patient autonomy; stating that physicians have a legal obligation to ensure substitute decision makers understand the substitute decision-making requirements set out in the HCCA; and a recommendation that physicians document the risks of not treating the condition discussed with the patient, especially if the patient refuses the treatment that the doctor thinks is clinically indicated.

Policies for Consultation

Your feedback helps create a better informed policy. That is why consultation and engagement with the profession is such a crucial part of getting it right.  We encourage you to add your voice to the conversation.  

The draft Physician Treatment of Self, Family Members, or Others Close to Them was approved by Council for release for external consultation.  The revised draft policy maintains the central position of its predecessor and only permits physicians to treat themselves, family members and others close to them in specific circumstances.  This position is directly informed by the strong consensus in both the literature and in the policy positions of medical regulatory bodies across a range of jurisdictions which indicated that it is inappropriate for physicians to treat themselves and family members as well as others close to them as the standard of care may not be met due to the physician's compromised objectivity.

Our Accepting New Patients and Ending the Physician-Patient Relationship policies are now currently under review and out for preliminary consultation, in accordance with our regular policy review cycle. 

We are reviewing the policies to determine how they can be improved to ensure they reflect current practice issues, embody the values and duties of medical professionalism, and are consistent with the College's mandate to protect the public. Visit our Consultations page for more information and to share your feedback.

Other News

CPD Non-Responders

Council has put a strategy in place to address the issue of those members who are not reporting their continuing professional development (CPD) to one of three approved CPD tracking organizations.

  • Those members who are ill, fully retired or working outside the province, will be given an opportunity to sign a Cease and Desist Practice Undertaking.  This will enable physicians to keep their certificate but not practise or have to report CPD. 
  • At the end of the 2015 annual survey cycle, all physicians who have not signed up with a CPD tracking organization and are not eligible to sign a Cease to Desist Practice Undertaking, will be issued a notice of intent for an administrative suspension.

Adoption of CanMEDS Framework for Education & Assessment

Council formally approved adopting the CanMEDS' organizing  framework as the framework for the College's Educational and Assessment matters.

The College already uses the CanMEDS framework in much of the work that we do.  The CanMEDS framework describes the knowledge, skills and attitudes that physicians need across seven roles: Medical Expert, Communicator, Collaborator, Manager/Leader, Health Advocate, Scholar, and Professional.

Revised "Guidelines for College-Directed Supervision"

Council approved the revised "Guidelines for College-Directed Supervision."  

The 2013 guidelines were updated to better align with changes to the public register resulting from the recent by-law change associated with the College's Transparency Initiative.

One of the proposed by-laws would see the College post summaries of those decisions that include a disposition of Specified Continuing Education or Remediation Program (SCERP).

The guidelines have been re-organized to ensure their content and definitions are in harmony with the type of information to be posted to the public register. The changes include no longer defining preceptorship as a form of supervision and restructuring the current document into three stand-alone documents - Clinical Supervision; Practice Monitoring; and Health Monitoring. All of these continue to be defined as supervision.  As well, the Clinical Supervision document has been enhanced to clearly reflect the educational component. The revised documents are available online

Buprenorphine Hydrochloride for the Treatment of Opioid Dependence

Council has decided that the existing Buprenorphine Hydrochloride policy will be replaced with a frequently asked questions and answers (FAQ) document on the CPSO website.

The current Buprenorphine Hydrochloride for the Treatment of Opioid Dependence policy was originally approved by Council in 2007, and sets out the College's expectations for physicians who prescribe buprenorphine for opioid dependence. 

Council decided that the information contained in the current policy would be more effectively communicated in another type of document. 

Election Changes

Council approved minor amendments to the College by-laws that pertain to district elections on the recommendation of the Governance Committee.  These include:

  1. Changing fixed date for voters list from the thirtieth day prior to the date fixed for the election to the forty-fifth;
  2. Re-phrasing section to clarify member voting eligibility; and
  3. Updating title - from Electoral Districts to Electoral Districts and Voter Eligibility.