Council Updates
May 17-18, 2010
Council Awards to Gore Bay Physicians; Standards Approved for Out-of-Hospital Premises Inspections; Physician Assistants; Five Policies approved; Draft Policies: Joint Statement with Midwives
Council Recognizes the Dedication of Gore Bay Physicians
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The Council Award was presented to Dr. Shelagh McRae and Dr. Robert Hamilton, a family practice team from Gore Bay, Ontario.
Drs. McRae and Hamilton have provided support, commitment and excellent medical care to the residents of Western Manitoulin since the couple moved to the area in 1982, said Gore Bay Mayor Joyce Foster, in her nomination.
“Their ability to make effective, solid, long-term relationships with their patients and colleagues is evident. They go above and beyond the call of duty … it is not uncommon to have them seated beside a patient in the back of an ambulance en route to a hospital located more than 60 kilometers away when a patient needs hospital care,” said Ms. Foster.
Drs. McRae and Hamilton have also developed a telemedicine site in Gore Bay, which plays a critical role in ensuring specialist services to patients in the rural setting.
In addition to providing exemplary clinical care to their patients at their busy family practice, Drs. McRae and Hamilton are assistant professors at the Northern Ontario School of Medicine. They are both clinical lecturers for the Northeastern Ontario Family Medicine Program, and for many years have acted as preceptors to medical students and residents.
Standards Approved for Out-of-Hospital Premises Inspections
In early April, the government enacted the Out-of-Hospital Premises Inspection regulation. This gives the College the authority to inspect out-of-hospital premises (OHPs) where procedures, such as cosmetic surgery and endoscopy, are performed using certain types of anesthesia, and where interventional pain management occurs.
Council has now approved the document that will serve as the basis for the inspection of procedures that are performed in these premises.
Developed by a task force of specialty-specific physicians, the OHP Standards document encompasses the general and common standards and expectations for the variety of procedures that are performed in OHPs.
This regulation puts different layers of accountability in place and gives the College the authority to ensure that Ontario patients who undergo procedures in defined premises are receiving quality care in a safe environment and in compliance with the proper protocols.
Several months in development, the OHP Standards document was circulated for external review late last year. The feedback generated by that consultation informed the final document just approved by Council.
The document is now posted on the College’s website under Out-of-Hospital Premises Inspection Program. Look for more information about implementation of the premises inspection program and the new standards document in the next issue of Dialogue.
Note: Physicians who work in OHPs must notify the College - via the College’s online notification form - that they are providing services and where they are providing them by June 8, 2010.
Council Receptive to Physician Assistants Discussions
Council indicated that it was receptive to further research being conducted into the possibility of the College undertaking the regulation of physician assistants (PAs).
The initial phase of the Ontario PA demonstration project is now coming to an end and options are being considered by the government to make a permanent place for PAs in the Ontario health-care landscape. Council was advised that Ministry officials have indicated that they would like the College to regulate PAs.
Council authorized the Executive Committee to oversee further research and discussions with the government on the proviso that any expenses associated with developing and regulating physician assistants should be borne by government and/or physician assistants and be cost neutral to physicians and the College.
In a presentation about the work PAs are currently doing in Ontario, Dr. Ray Gaiardo, Chief of Emergency Medicine at Guelph General Hospital told Council that having PAs in the emergency department at his hospital has been a positive experience. “Work satisfaction has really improved for all members of the team,” he said. “Doctors ultimately want to be able to provide care in a timely way and PAs help us do that.”
Council Approves Five Policies
Council approved four updated policies and one new policy. All of the policies were approved after consultation with stakeholders.
The revised Disclosure of Harm policy articulates the College’s expectations of physicians for informing patients when harm is sustained in the course of receiving health care. The revised policy reflects feedback from stakeholder consultation and includes some additional information as a result of new legislation, but essentially maintains the same principles, expectations and general guidance as the previous policy.
The updated Block Fees and Uninsured Services policy sets out the College’s expectation of physicians who charge for uninsured services and/or offer a block fee. The revised policy reflects the feedback from two consultations but maintains the main components of the original policy.
One of the key elements of the updated Methadone Maintenance Treatment for Opioid Dependence policy is an exception to the prohibition against physician dispensing, which authorizes physicians to dispense methadone in rare circumstances. This clause was the subject of extensive and lengthy discussions with Health Canada, and the policy reflects its support for the position adopted by the College to prevent risk of overdose or withdrawal when the patient cannot access a pharmacy.
The Fetal Ultrasound for Non-Medical Reasons policy has been slightly revised after a consultation. The updated policy clarifies that the policy does not prevent physicians from providing their patients with a picture/video of the fetus that is created as a result of an ultrasound for medical reasons.
The new Dispensing Drugs policy sets out the College’s expectations for dispensing and articulates the standards which need to be met around procurement of drugs, storage, record keeping, packaging, labelling and disposal of drugs. The policy also includes expectations related to payment issues and compliance with drug-related legislation.
The policies are now on the College’s website under Policy. Articles about the Dispensing Drugs policy and the Block Fees and Uninsured Services policy will be featured in the next issue of Dialogue. The Disclosure of Harm policy will be the focus of an upcoming Doc Talk column in Dialogue.
Two Draft Policies to be Circulated for Consultation
Council approved two draft policies for external consultation. We encourage physicians, the public, and other interested parties to provide feedback on these drafts through the Consultations section on the College’s website.
The Withdrawal of Physician Services During Job Actions draft policy sets out the College’s expectations of physicians who consider withdrawing their services during job actions. The draft policy states that when contemplating a withdrawal of services, physicians must consider a number of factors and withdraw services as a last resort. If withdrawal of services is the only option available to resolve a concern, physicians should take reasonable steps to mitigate the impact of the withdrawal and act in accordance with the principles and expectations articulated in the Practice Guide and College policies.
The Anabolic Steroids and other Substances Used in Sport draft policy is intended to prohibit the prescribing of anabolic steroids for athletic performance enhancement and/or cheating. The revised draft takes a much firmer stance against doping than the current policy. It clearly states that physicians must not prescribe, administer or provide assistance relating to anabolic steroids or other doping substances.
Note: The current College policy on Complementary Medicine is in the early stage of review. A preliminary consultation on this policy is open until August 1, 2010. To assist with this process, we’d like to hear your thoughts on our current policy, along with any suggestions you may have for how the policy can be improved.
College of Midwives Joint Statement on Interprofessional Care
Council approved a joint statement on interprofessional care (IPC) with the College of Midwives of Ontario.
Council decided that such a statement would be an appropriate way for both colleges to signal their commitment to IPC, especially in the wake of the new duty in Bill 179, the Regulated Health Professions Statute Law Amendment Act, to promote interprofessional collaboration with other health profession colleges.
The statement makes the following key points:
- The CMO and CPSO are committed to IPC in the interest of Ontarians;
- The CMO and CPSO recognize the value of collaboration at the regulatory level and in supporting their members in fostering collaborative relationships built on trust and mutual respect;
- The CMO and CPSO will regularly consult each other regarding health systems issues that could impact the provision of maternity services.
Joint statements are already in place regarding physicians’ relationships with nurse practitioners and pharmacists. The CMO/CPSO statement is posted online and will appear in Dialogue.
By-law Amendment: Notice of Shareholder Changes by Health Profession Corporations
Council decided to amend a College by-law to remove the requirement for medicine corporations to provide notice to the College of shareholder changes involving only family members. The by-law continues to require notice for shareholder changes involving physicians.
The amendment brings the General By-law into line with the Regulated Health Professions Act which underwent a similar amendment in 2009 (as part of Bill 171 amendments).