Council Update

May 30-31, 2016

Port Colborne FP presented with Council Award; Policy Updates; New Consultations; Compensation of Public Members; Transparency Initiative – QA SCERPs to be posted

Jun 07, 2016

Port Colborne FP presented with Council Award

Dr. Amanda BellA Port Colborne family physician was recently presented with a Council Award for her outstanding work as a doctor, teacher, mentor and community leader. 

Dr. Amanda Bell runs a full spectrum family practice with a special interest in adolescent health, women’s health and sexual health.  She is also an assistant professor at McMaster’s medical school.

Dr. Bell grew up in Ottawa and obtained her medical degree in 1998 from McMaster University. After completing her residency in family medicine (rural stream) at the University of Ottawa, she set up practice in Port Colborne, where she rapidly became an integral part of the community.

She has been praised for her compassionate nature, investment in her patients’ health and determination when advocating on their behalf.

“She is the rare combination of funny and approachable, conscientious and thorough, and evidence-based and patient-centred. She immediately puts patients at ease and earns their trust,” said one former medical student of Dr. Bell’s. “I am so grateful that Dr. Bell was my introduction to medicine and I hope that one day that I can do for someone else what Dr. Bell had done for me.”

Policy Updates

College provides guidance on physician-assisted death

As of June 6, by virtue of the Supreme Court’s decision in Carter v. Canada, physician-assisted death is now legal across the country. The College has a policy — called Physician-Assisted Death — now in place to help physicians navigate this complicated issue in the absence of government legislation.

This policy is substantively consistent with the College’s Interim Guidance on Physician-Assisted Death developed earlier this year, with minor changes to reflect the close of the interim period.

The federal government’s proposed legislation (Bill C-14) is currently making its way through the legislative process. The College has developed a draft policy, Medical Assistance in Dying, which will reflect the federal law. This policy is still in draft form, but will be finalized whenever the federal legislation is passed into law. The College undertook work on both policies to ensure that it could continue to provide the public and the profession with guidance on this important issue.

“Either way, you and your patients will not be left to consider PAD (or MAiD) in a vacuum. We will work as necessary to ensure that the College continues to provide accurate guidance to the profession and public on this important and challenging topic,” said College President, Dr. Joel Kirsh.

The government of Ontario has established a referral service to help facilitate access and support physicians to make an effective referral.  

Our Physician-Assisted Death policy and Q & As are available on online.

Planning for and Providing Quality End of Life – Post Approval Amendments 

Council has approved amendments to two sections in the College’s recently approved Planning for and Providing Quality End-of-Life Care policy.

The amendments relate to the policy expectations regarding no-CPR orders and content on physician-assisted death. The policy amendments regarding the no-CPR orders are in response to a proposal received from critical care physicians who were supportive of the policy, but felt that a minor clarification was needed. The amendments clarify that while conflict resolution is underway regarding the writing of a no-CPR order, there is a narrow set of circumstances in which CPR need not be provided: instances where the patient’s condition would prevent the physiologic goals of CPR from being achieved. The amendments provide an important clarification of the policy position, while maintaining important policy content to ensure that no-CPR orders cannot be unilaterally written by physicians and that physicians engage in conflict resolution when there is disagreement regarding a no-CPR order.

Amendments relating to the policy content regarding physician-assisted death were also approved to update the policy in light of recent developments.

Physician Behaviour in the Professional Environment

Council reviewed a report on the consultation feedback and proposed revisions made to the draft Physician Behaviour in the Professional Environment policy following the external consultation held earlier this year. Council approved the revised draft policy.

The updated policy states that physicians are expected to act in a respectful, courteous and civil manner towards their patients, colleagues, and others involved in the provision of health care. The policy also identifies a subset of unprofessional behaviour known as disruptive behaviour and articulates the negative impact that disruptive behaviour can have on patient safety and outcomes, and the communication and collaboration that underpin good medical practice. The policy is consistent with the earlier policy, approved by Council in 2007, and does not create new expectations for the profession.

“While there may be a myriad of reasons for disruptive behaviour, whether personal, professional, or situational, physicians are nevertheless expected to demonstrate professional behaviour at all times,” states the policy.

New Consultations

Continuity of Care Planning and Proposal

Council wants to engage members of the profession and the public in a conversation about continuity of care issues in order to help shape the development of a new policy.

As a part of this development process, we expect to explore a number of issues including, after-hours care, information exchange between health-care providers, physician availability to other health-care professionals, and walk-in clinics. 

This work is happening in concert with a review of the existing Test Results Management policy, as this comprises a critical aspect of continuity of care. The College is currently hosting two consultations online; one conversation is intended to get feedback on Continuity of Care issues more generally, and the other consultation is specifically related to our current Test Results Management policy. 

Going forward, we’re going to also explore additional opportunities to engage – all with the aim of encouraging our stakeholders to participate in an examination of this very complicated issue.

Medical Director Role in OHPs

Council supported proposed updates to the Out-of-Hospital Premises Inspection Program (OHPIP) Standards that, if passed, would enhance the responsibility and accountability of the Medical Director, and address matters concerning quality assurance, infection control and staff qualifications.

The draft OHPIP Standards have now been released for external consultation. 

By-law Amendments for Register Content 

Council approved for external consultation a number of proposed amendments to the register provisions in the General By-law. The proposed amendments fall into two main categories: revisions intended to better reflect current College practices, and corrections and minor improvements of a housekeeping nature.

These amendments do not propose new information to be posted; they reflect information that is already included on the register.

Preliminary Consultations

In addition to the consultations mentioned above, we are also holding two preliminary consultations on the following policies:

Preliminary consultations occur at the beginning of the review process, and feedback obtained will directly inform the review process.

Compensation of Public Members

Council will seek legislative change that would permit the College to provide compensation to public members of Council.  Ensuring the fair and equitable compensation for Public Council members of the College has been a long-standing College priority.

Public members are compensated at the rate of $150 per day for College work. This rate has not increased in approximately two decades and is not commensurate with the time, responsibility and workload associated with the role.

Transparency Initiative – QA SCERPs to be posted

Last year, as part of its continued commitment to transparency, Council voted to post SCERPs ordered by the Inquiries, Complaints and Reports Committee on the public register.

At this meeting, Council approved a by-law that will see SCERPs ordered by the Quality Assurance (QA) Committee posted on the public register. SCERP is the acronym for “Specified continuing education or remediation program” and is one of the options available to the QA Committee in determining the outcome of a peer assessment.  Moderate risk matters that require education will be managed with SCERPS, consistent with the ICRC framework.*

The rationale for this by-law amendment is that no matter where a matter originates, the determination of whether we make the outcome public should be based on an evaluation of risk and handled with a consistent framework between committees.

*Note: an earlier version stated that voluntary undertakings are confidential, which is incorrect.