board meeting · 1/29/2015 · guidelines for nominations and ... 14, 2015 - health regulators of...

APPROVED

Board Meeting College of Physicians and Surgeons of British Columbia

Members Staff Present: Present: • Dr. L.C. Jewett (President) • Dr. G.A. Vaughan (Vice-President) • Dr. A.I. Clarke (Treasurer) • Ms. J.N.Y. Choi • Mr. W.M. Creed • Ms. L. Charvat • Dr. M. Corfield (DM) • Dr. D.J. Etches • Dr. D.M.S. Hammell • Ms. V. Jenkinson • Dr. N.D. James • Dr. G. Parhar • Dr. P.D. Rowe • Dr. J.R. Stogryn

Regrets: • Dr. M.A. Docherty • Mr. S.S. Gill

• Dr. H.M. Oetter (Registrar)* • Dr. W.R. Vroom (Senior Deputy Registrar) • Dr. A.J. Burak (Deputy Registrar) • Dr. A.M. McNestry (Deputy Registrar) • Dr. J.G. Wilson (Deputy Registrar)

Regrets:

• Mr. M. Epp (Chief Operating Officer) • Ms. S. Prins (Director of Communications) • Mr. G. Keirstead (Chief Legal Counsel)

* indicates part time attendance

Recorder of Minutes: Ms. J. Bergen, Executive Assistant to the Registrar

Summary of Resolutions and Actions discussed at meeting of January 29, 2015 Item # Item January 29, 2015 Resolutions Resolution No. 1. Adoption of the

Agenda RESOLVED that the agenda for the Board open regular meeting scheduled January 29, 2015, be adopted as circulated.

15-87

MINUTES Minutes of the Board of the College of Physicians and Surgeons of British Columbia scheduled Thursday, January 29, 2015 in the 8th floor Board Room, 669 Howe Street, Vancouver, BC

REGULAR OPEN

College of Physicians and Surgeons of British Columbia APPROVED Board Regular Open Minutes January 29, 2015 page 2 of 20

Item # Item January 29, 2015 Resolutions Resolution No. 2.

Adoption of the Minutes

RESOLVED that the minutes of the Board open regular meeting held November 20, 2014 be adopted, as amended.

15-88

Meeting Convened A quorum being present, Dr. G. Vaughan, Vice-President, called the meeting to order at 1:30 p.m., Thursday, January 29, 2015.

1. Adoption of the Agenda

The following resolution was MOVED, SECONDED and CARRIED: RESOLUTION 15-87 RESOLVED that the agenda for the Board open regular meeting scheduled January 29, 2015, be adopted as circulated.

2. Adoption of the Minutes: November 20, 2014 The following resolution was MOVED, SECONDED and CARRIED: RESOLUTION 15-88 RESOLVED that the minutes of the Board open regular meeting held November 20, 2014 be adopted, as amended.

3. Report of the Registrar The registrar reported on the following: • Letter from the College of Physicians and Surgeons of Nova Scotia (CPSNS) The Council of the CPSNS has decided to stop their Physician Achievement Review (PAR) program as its quality assurance activity. Instead, they will be moving to a peer review program, and may make the multi-source feedback (MSF) tool a component of the peer review. Alberta is also moving to enhance their PAR program by adding peer reviews to the MSF tool. • Ebola activities The Ministry has taken significant steps to prepare the BC health system for a possible Ebola virus infected patient. This has included acquiring sufficient personal protective equipment (PPE), identifying referral centers, developing and implementing guidelines


for practitioners, and ensuring training of first responders and ER staff on the donning and doffing of PPE. The College has participated in weekly teleconferences called by the Ministry and provided an email distribution service for key updates from Dr. Perry Kendall. • Health Information Management Act (HIMA) consultation January 13, 2015 Dr. Oetter and Mr. Keirstead were interviewed by a third party to participate in structured interview in support of the Ministry's planned legislation that will address personal health information. It is anticipated that stakeholder consultation will continue through the spring, with possible legislation in 2016. Dr. Oetter and Mr. Keirstead emphasized the importance of reviewing this in the context of all the pieces of legislation that govern the health system and the need to share information about registrants across the sectors, as well as being able to access patient information (records, data banks etc.) for quality assurance purposes. • Assessment Bylaws The notice period has closed on the Assessment Bylaws proposed by the Board. No further comments were provided since the last update provided to the Board. A synopsis of comments was provided to the Professional Regulation and Oversight Department at the Ministry and the Bylaws have been filed. They will come into effect after 60 days, just in time for the first cohort of physicians to undergo an assessment in BC. • UBC postgraduate department working group on clinical fellows UBC has called a working group including representation from the College (Ms. C. de Bruin, Ms. S. Kanji, Drs. A.J. Burak and H. Oetter) and the health authorities to review the licensure of clinical fellows. It is clear that some health authorities use clinical fellows for service within the health authority, with less emphasis on the education. Even though the educational experience is unaccredited, it is the position of the College that these educational licenses are intended to be just that and not primarily a source of physician extenders. The working group will continue to meet over the next few months. • Board member election The College will have an election this spring for five of 10 physician board member positions. The electoral districts whose terms are expiring June 30, 2015 include District 2 (Vancouver Island, Central and Northern), one position in District 3 (Vancouver and surrounding area), one position in District 4 (Fraser), District 5 (Thompson-Okanagan) and District 6 (Kootenays). Voting is done electronically and is conducted by Kool-IP. We have engaged our new auditors, KPMG, to act as scrutineers for the counting of the electronic ballots.


The call for nominations went out January 12, 2015 and the nominations close February 13, 2015. Electronic voting starts March 2, 2015 and concludes at midnight April 12, 2015. The count will be conducted on April 13, 2015. The voting is a task overseen by the registrar in accordance with the Bylaws. Guidelines for nominations and campaigning have been set by the Board and all of that information is posted on the web.

• January 14, 2015 - Health Regulators of BC (HRBC)Annual General Meeting The first Annual General Meeting was held of the HRBC. The first year has been successful, with the not-for-profit society now regulating over 107,000 health practitioners in BC. The second phase of the public awareness campaign has been successfully launched and has had good earned media, especially op-ed pieces. HRBC are also focusing on web-based advertisements. The highlights for their first year include a very successful education day on quality assurance and a one day workshop on professional regulation for senior staff and boards. The HRBC annual report, soon to be published on the BC Health Regulators website will also acknowledge the research projects that HRBC has launched, largely as a result of its formalized structure (with UBC/CIHR). A culture of collaboration has truly been developed. Next steps for the second year will be the development of an HRBC strategic plan and phase 3 of the public awareness campaign.

• Continuity of Care One of the themes for the Federation of Medical Regulatory Authorities of Canada (FMRAC) Annual General Meeting is continuity of care. This is an issue that very much impacts the quality of care received by patients. Two of the College’s sister colleges have updated practice standards related to continuity of care. One is a standard from Manitoba that will come into effect July 1, 2015 and the others are from Alberta which are draft and currently on their web for consultation. The Board was provided with copies of both of these standards. The Board directed that this be an item for further review and discussion. • Injunction against a non-practitioner The BC Supreme Court issued an injunction on January 27, 2015 restraining an individual from using titles reserved for medical professionals and for providing a medical service which she is not authorized to perform. A recent investigation revealed that the individual is a non-registrant (an unlicensed practitioner) who was misrepresenting herself by using titles such as “doctor” and “physician” and for administering a schedule 1 prescription drug (Botox®), which is a medical service that only certain health professionals whose scope of practice allows it and who have completed appropriate training are authorized to perform (physicians, dental surgeons, and registered nurses


and licensed practical nurses under the order of a physician). This is the first time the College has sought an injunction for unauthorized practice. • Society of General Practitioners of BC Board meeting On January 25, 2015, Drs. Oetter and Jewett attended the Society of General Practitioners of BC’s Board meeting to discuss the College’s recent submission to the Select Standing Committee on Health. A formal presentation was given to Board on the role and responsibilities of the College, and the challenge arising from fragmentation of care. • Criminal Record Checks The Criminal Records Review Act provides that a criminal record check (CRC) must be completed for all registrants of the College. The CRC is administered by the Criminal Records Review Program and is based on the federal RCMP’s Canadian Criminal Real Time Identification Services (CCRTIS) policy. The CCRTIS changed its query parameters for determining who would undergo fingerprinting in August 2010 in order to uncover sexual offences where a record suspension (formerly a pardon) has been granted. The search requires applicants who have the same name and/or date of birth and gender combination to undergo fingerprinting to verify their identity. The College has recently been advised that a number of physicians have failed to comply with fingerprinting requirements. Registrants who do not comply with the completion of the CRC process will have their registration and licensure status reviewed by a College committee. The College is communicating this message to registrants and thanking them for their cooperation with the CRC requirements. • Annual License Renewal Form (ALRF) Statistics Total completed as of January 27, 2015, mid-day: 8,239 Total compared to January 27, 2014, end of day: 8,047

o # registrants who completed the online process in less than 20 minutes -> 5,979 o # registrants who completed the online process in less than 10 minutes -> 2,165 o Average completion time (mean) in minutes -> 15 minutes o Most common completion time (median) in minutes -> 9 minutes

The registrar read the following resolutions passed at the closed session of the Board meeting held January 28-30, 2015: • RESOLVED THAT the Board amend the Bylaws of the College and Physicians and

Surgeons of British Columbia, in accordance with the authority established in section 19(1) of the Health Professions Act, RSBC 1996, c. 183 (“the Act”), and subject to sections 19(3) and (6.2) of the Act, as follows: Section 1-18 is deleted in the attached form. Section 1-19 is repealed and replaced in the attached form. Section 1-20 is repealed and replaced in the attached form. Sections 1-22, 1-23 and 1-24 are deleted in the attached form.


Section 1-27 is repealed and replaced in the attached form. Sections 9-1 to 9-3 are added in the attached form.

• RESOLVED that the College budget for the 2015/2016 fiscal year be approved.

• RESOLVED that the Non-Hospital Medical and Surgical Facilities Program budget for

the 2015/2016 fiscal year be approved.

• RESOLVED that Diagnostic Accreditation Program budget for the 2015/2016 fiscal year be approved.

• RESOLVED that the revised Terms of Reference for the Nominating Committee be approved, as attached.

• RESOLVED that following board members be appointed to the ad hoc committee for

the Award of Excellence for 2015: Dr. Duncan Etches - Chair Dr. Joan Stogryn Mr. Walter Creed

4. Report of the President The president reported on the following: • On January 25, 2015, the president and Dr. Oetter attended the Society of General

Practitioners of BC’s Board meeting to discuss the College’s recent submission to the Select Standing Committee on Health. The president advised the Board that the College has received two letters from registrants regarding the College’s submission.

• The president congratulated Dr. Gurdeep Parhar on being the recipient of the Association of Faculties of Medicine of Canada 2015 May Cohen Equity, Diversity and Gender Award.

5. Unfinished Business

None.

6. Committee Reports 6.1 Diagnostic Accreditation Program – report of Dr. Vroom No report.


6.2 Non-Hospital Medical and Surgical Facilities Program – report of Dr. Vroom No report 6.3 Registration Committee – report of Dr. Corfield, Chair

• Registration Committee Report to Board, dated December 2014 • Registration Committee Report to Board, dated January 2015

Dr. M. Corfield, Chair of the Registration Committee, provided the Board with written reports for December 2014 and January 2015 committee meetings.

Overview/Summary The committee is in the process of reviewing the College Bylaws and their applicability to registrants in the context of resolutions of eligibility granted to provisional registrants. Specifically, the committee is reviewing options related to the Medical Council of Canada (MCC) licensing examinations and the availability of the Royal College of Physicians and Surgeons of Canada (RCPSC) Practice Eligibility Route B (PER) - the practice assessment. The committee has provided clear direction on these issues that will increase the ability of the committee and College staff to hold registrants accountable for their registration and licensure requirements. The committee reviewed a Delegation of Authority from the Registration Committee to the deputy registrar and information related to the return of service for the Practice Ready Assessment (PRA) BC Program. All these committee initiatives continue to increase the College’s ability to meet its mandate of public protection. Additionally, the committee is requiring provisional registrants who have deficiencies identified during summative assessments to provide evidence that they have addressed the deficiencies prior to authorizing their class change from the Provisional to the Full Class of registration and licensure.

Issues and Accomplishments Agenda items – December 2014 meeting • Medical Council of Canada (MCC) examinations, College Bylaws and current practice. • Federation of Medical Regulatory Authorities of Canada (FMRAC) Standards for

Medical Registration in Canada (specifically the requirement for international medical graduates to complete the MCC Evaluating Exam and the MCC Qualifying Exam Part I in order to move from the Provisional to Full Class of registration).

• Status update report regarding the Practice Ready Assessment (PRA) Program.


• Whether a Canadian Medical Graduate CMG) who has not obtained Royal College of Physicians and Surgeons of Canada (RCPSC) certification in their subspecialty can be registered in the Provisional Class of registration and licensure.

• RCPSC – PER Route B, Practice Ready Assessment availability and current College Bylaw provisions.

Agenda items – January 2015 meeting • Registrants in the Provisional-Specialty Class: Medical Council of Canada

examinations and the Conditional Practice Setting Class. • Royal College of Physicians and Surgeons of Canada (RCPSC) – Practice Eligibility

Route Information. • PRA-BC Program information related to the Return of Service Agreements signed by

the Ministry and the applicants who successfully complete the PRA-BC Program. Accomplishments – December 2014 meeting • The committee reviewed the following physicians to determine eligibility for

registration: o Four Provisional General/Family Practice o Six Provisional Specialists • The committee reviewed four summative assessments • Letter to be sent from the chair of the committee to the PRA-BC Steering Committee

outlining input from the committee on key issues that will lead to the success of the program in terms of the community setting, type of practice (i.e. group setting), the location and proximity of the supervisor and an evaluation framework for the program.

• Clear direction from the committee that a CMG who has not obtained RCPSC certification in their subspecialty is not eligible to be registered in the Provisional Class of registration and licensure under the College Bylaws.

Accomplishments – January 2015 meeting • New eligibility resolutions passed by the committee will mandate completion of the

LMCC within five years of registration and licensure even if a registrant is transferred to the Conditional Practice Setting Class or registration once the registrant has obtained their RCPSC certification.

• By policy, availability of the RCPSC – PER means that the Route B is available in its entirety (including Component 3 – the practiced based assessment). o This means current eligibility resolutions passed by the committee will only

provide the RCPSC PER option for applicants who are specialists in psychiatry (the only RCPSC – PER Route B available in its entirety).

o Those registrants (approximately 90) currently on the register and waiting for the RCPSC –PER Route B will be required to undergo an assessment after two years of practice in British Columbia .

• The committee reviewed the following physicians to determine eligibility for registration:


o 20 Assessment Class and Provisional General/Family Practice for the PRA-BC Program.

o Three Provisional General/Family Practice. o Six Provisional Specialists.

• The committee reviewed three summative assessments • Letter sent in January from the chair of the committee to the PRA-BC Steering

Committee outlining input from the committee on key issues that will lead to the success of the program in terms of the community setting, type of practice (i.e. group setting), the location and proximity of the supervisor and an evaluation framework for the program. Awaiting response from the PRA-BC Steering Committee.

Focus for the future • Committee decision regarding the MCC licensing examination requirements and its

impact on future committee resolutions of eligibility for registration and licensure. • Committee decision regarding RCPSC – PER – Route B practice assessment

availability and its impact on future committee resolutions of eligibility for registration and licensure.

• Policy development, review and approval by the committee of: o Delegation of Authority from Registration Committee to the Deputy Registrar

which includes defining routine vs non-routine decisions, appeal rights for applicants not in agreement with an operational registration application decision.

o Availability of PER, two year assessments and costs of the assessments. o Completion of the LMCC within five years including if transferred to the

Conditional Practice Setting Class. • Holding registrants accountable for their registration and licensure requirements

(i.e. completion of exams, providing results) within time frames of original resolutions granted unless extended by the Registration Committee in extenuating circumstances

• Determine if the amount of times a registrant can write components of the Medical Council of Canada exams can be capped through policy.

• Review what measures program directors are utilizing to define that a graduating resident is competent and ready for independent practice.

1. Health Professions Review Board – registration decision

• Report on Health Professions Review Board Matters, dated December 31, 2014

The Board was provided with a report from Ms. S. Hellman, legal counsel, of appeals to the Health Professions Review Board (HPRB) regarding registration decisions from January 1, 2014 to December 31, 2014 and statistical information by year for 2009 to 2014. This was received for information and is appended to the minutes.


6.4 Inquiry Committee – Panels A, B, C, D & E • Inquiry Committees – Panels A-E – Report to the Board, June – December

2014 Mr. B. Fishbook, director of complaints, submitted an aggregate report of complaints concluded by Inquiry Committee Panels since the November 2014 Board meeting. This was received for information and is appended to the minutes. 1. Health Professions Review Board – complaints dispositions

• Report on Health Professions Review Board Matters, dated December 31, 2014

The Board was provided with a report from Ms. S. Hellman, legal counsel, of appeals to the Health Professions Review Board (HPRB) regarding complaint dispositions from January 1, 2014 to December 31, 2014 and statistical information by year for 2009 to 2014. This was received for information and is appended to the minutes. 6.5 Inquiry Committee – Panel A – report of Dr. Jewett, Chair

• On-table Inquiry Committee, Panel A Report to Board, dated January 26, 2015 Dr. L.C. Jewett, Chair of the Inquiry Committee Panel A, provided the Board with a written report of the committee’s meeting on December 18, 2014.

Overview/Summary The committee reviewed 16 investigations, confirmed resolutions relating to a case of alleged unauthorized practice and directed the issuance of three citations and the performance of two practice investigations.

Issues and Accomplishments Themes that emerged from this meeting: Unauthorized practice of medicine for cosmetic purposes In the course of discussing a complex, high stakes investigation, the committee considered current related societal norms and expectations. There is clearly a market for cosmetic interventions and they are expensive. It is clear that members of the public are seeking low cost alternatives with unregulated providers. It is apparent that the risks are underestimated by many. Botulinum toxin derivatives (Botox® and others) are Schedule I drugs under applicable regulations under provincial law (the Pharmacy Operations and Drug Scheduling Act, PODSA). Hyaluronic acid injection at concentrations over 5% (marketed as JuvedermTM and others, as “fillers”) is a Schedule II drug—it does not require a prescription, but must be kept behind the counter. Both are licensed for use under different degrees of specified medical supervision. The


committee concluded that while many members of the community may take the position that administration of botulinum toxin and hyaluronic acid products need not be regarded as the practice of medicine, this is a case where relevant laws and regulations, the scientific literature, and the experience of the College establish a clear public interest in College regulation. The committee reviewed two investigations relating to substandard prescribing of opioids In medical practice it is expected that physicians distinguish between three contexts for pain: acute, end-of-life and chronic non-cancer pain. Medication is central to the first two and has a limited, not-very-effective role in the latter. Accordingly, when College registrants are found to be prescribing too liberally, our expectation is that they will remediate, rather than giving up their Duplicate Prescription Pads (DPP) altogether. Pharmacotherapy for acute pain and palliative care is foundational to general medical practice. It is unacceptable for generalist physicians to not manage it adequately. Most physicians remediate acceptably, but despite the College’s interventions and their best intentions a few do not. In those minority of cases, the College does ask the physician to agree to give up the privilege of DPP prescribing. At this meeting the committee considered two such cases. In one, the physician was cooperative. In the other, assisted by legal counsel, the registrant has provided detailed submissions arguing that his performance meets expected standards, contrary to the College’s view. In that latter case, the committee directed that interim (or permanent) undertakings be sought. Failing that, the committee directed an on-site practice investigation and a legal opinion as to whether the documented care warranted a citation. 6.6 Inquiry Committee – Panel B – report of Dr. Rowe, Chair

• Inquiry Committee - Panel B Report to Board, dated January 2015 Dr. P.D. Rowe, Chair of the Inquiry Committee Panel B, provided the Board with a written report of the committee’s meeting on January 27, 2015.

Overview/Summary The committee reviewed 21 new files, involving complaints directed towards 38 registrants. The committee also considered a file previously brought before the Health Professions Review Board (HPRB) and agreed to re-open the file for further consideration. Of the 38 registrants identified, the committee was critical of 13 and elected to defer a complaint against two while awaiting further information. Four registrants will be requested to attend the College for an interview and two resolutions for a practice investigation have been approved.


The committee identified a number of themes: the importance of care and diligence during prenatal and antenatal care and the ongoing requirement for registrants to clearly document consent discussions and patient encounters. However, the committee was also reminded of the profound care and attention that many of the registrants display towards the care of patients and heartened by the strenuous efforts many displayed.

Issues and Accomplishments The accomplishments and discussions are summarized in the above section. Inquiry Committee Panel B continues to seek opportunities to fulfil the College’s mandate for public protection both through the regulatory process directed towards individual registrants, and by utilizing these opportunities to more broadly inform the profession through teaching rounds at local hospitals and through the College Connector.

Focus for the Future • Continued robust examination of Inquiry Committee files specific to Panel B. • Vigilance with regard to identifying themes and issues that require broader

communication and education. 6.7 Inquiry Committee – Panel C – report of Dr. James, Chair

• Inquiry Committee, Panel C Report to Board, dated January 26, 2015 Dr. N.D. James, Chair of the Inquiry Committee Panel C, provided the Board with a written report of the committee’s meeting on January 26, 2015.

Overview/Summary The committee reviewed one item of unfinished business and 16 new complaints.

Issues and Accomplishments Challenging and sometimes failed communications lie at the heart of most conduct complaints, particularly in the context of disappointing outcomes and/or tragic events. As always, that was true of the cases considered on this agenda. Inquiry Committee Panel C remains a major beneficiary of the two Prescription Review Program (PRP) Courses, the College Medical Record Keeping Course and the College Boundaries Workshop. The committee is grateful to the PRP for increasing the capacity of the Prescribers’ Course and have been challenged by limits in the capacity of the Medical Record Keeping Course.


Specific themes that emerged at this meeting included: • Physician performance prescribing opioid analgesics, benzodiazepines, and

methadone-for opioid-replacement. The committee completed its investigation of the last of over 50 registrants who had prescribed to a woman who had impersonated other people in order to obtain oxycodone. This person presented with a very compelling story—the committee sympathizes with at least some of the physicians who were fooled by her, but notes that application of expectations set out in current College guidelines (admittedly not yet available at the time much of this took place) would have prevented significant criminal diversion. The College was first alerted to this story by a report on the CBC news. For the committee, the result was significant case-finding of physicians in need of an interview, our three relevant remedial courses (the two PRP courses and medical record keeping) and a number of practice investigations. Physician adherence to expected prescribing standards was positively influenced by this large number of investigations. It has been a productive exercise.

• A complaint brought by the former spouse of a College registrant alleging care of the couple’s children by the physician parent illustrated the significant challenge that these circumstances pose for everyone affected. This was yet another variation on a familiar theme: it is important to avoid treating self and family.

• An internal investigation triggered by a hospital report of an academic surgeon permitting a volunteer student research assistant to participate in the care of a patient spoke to another familiar theme: unauthorized job shadowing in clinical settings is never acceptable. For reasons of patient privacy and safety, individuals who are not either registrants of a health professions college or regular staff members of the clinic must not be present when patients are being seen, even with the consent of the patient. It is acknowledged that informal shadowing by students interested in a career in medicine and others was common in the past; as in this case, for many years College registrants have been firmly advised that standards have long since changed in this regard.

Focus for the Future The committee’s role is an investigative one. The future is determined by complaints and other matters that are brought before it. 6.8 Inquiry Committee – Panel E – report of Dr. Vaughan, Chair

• Inquiry Committee, Panel E Report to Board, dated January 27, 2015 Dr. G. Vaughan, Chair of the Inquiry Committee Panel E, provided the Board with a written report of the committee’s meetings on January 27, 2015.


Overview/Summary The committee reviewed 12 investigations and gave direction that should allow us to conclude ten of them.

Issues and Accomplishments 1. Deficient documentation was, as usual, the most common issue. On-site practice

investigations now invariably include direct observation of patient encounters, the most high-fidelity assessment mode. Accumulated experience confirms our long-held impression that many physicians with substandard documentation do have the capacity to provide safe care. The committee noted that we are on the cusp of remote access to EMRs—a development that will facilitate follow-up when documentation is the primary concern. The committee continues to rely heavily on the College Medical Record Keeping Course.

2. Section 25.4, the statutory protection of complementary and alternative practices,

regularly challenges the committee. Typically, the practitioner meets standards for record keeping and operates out of considerably above-average facilities, but goes to great lengths to transfer responsibility for conventional medical management to others.

3. The committee is regularly concerned by the potential risk posed by a small

number of physicians who choose to remain in practice well beyond the usual age of retirement. These doctors are usually found to meet requisite standards at the time of on-site practice investigations and formal competency assessments—that is, based on the information available to us, there is no basis to question their competence. But there is also no way to test the ability of a physician to recognize rare, critical presentations that may challenge any doctor. If a patient with a pulmonary embolism, atypical coronary event, stroke-in-evolution, early sepsis, or malignancy were to present to the elderly doctor, would he or she be as capable of making the diagnosis as a younger practitioner? And, if not, what is the minimal standard for safe practice in that context? While mindful of legal prohibitions against ageism, as with elderly drivers, we are left to initiate a serious conversation with such physicians, remain as vigilant as practicable, and promote a realistic and professional approach to retirement planning, reminding them of their obligation at all times to give primary consideration to the well-being of patients.

4. The committee considered and opted to pursue a new approach to investigating the

competence and performance of diagnostic radiologists. Conventional practice investigations centre on the on-site review. For clinicians, there is an opportunity to randomly sample patient records for review and discussion. It is more difficult to achieve randomness when observing a radiologist in real time. The committee will trial an approach where a random set of imaging studies is requested (based on dates and times), copied and provided to the investigator for independent review,


followed by comparison with the report of the registrant who is the subject of the investigation.

6.9 Quality Assurance Committee – report of Dr. Docherty, Chair

• Quality Assurance Committee Report to Board, dated January 2015 Dr. M. Docherty, Chair of the Quality Assurance Committee, provided the Board with a written report of the committee’s meeting on January 27, 2015. Issues and Accomplishments Agenda items

• Committee Reports to QA o MPAC (Physician Performance Enhancement Program – PPEP)

Accomplishments: Registrant assessments initiated between January 1, 2013 through February 28, 2014 have nearly all been completed with outcome letters and PPEP report. Assessments initiated January 1, 2013 – February 28, 2014:

• 754 assessments initiated; • 87 outcome letters & PPEP reports sent since last MPAC meeting; • 690 outcome letters & PPEP reports total sent to date.

Assessments initiated March 1, 2014 – February 28, 2015: • 593 assessments initiated to date (target = 600); • 33 outcome letters & PPEP reports sent since last MPAC meeting; • 47 outcome letters & PPEP reports total sent to date.

Focus for the future: Continue development of the Enhanced Office Assessment; Update the MPAC committee regarding the MSF following the January

2015 PAR meeting in Toronto; Develop specialty assessments, starting with pediatrics and internal

medicine. PPEP Assessments - Outcome Data for Assessments Initiated January 1, 2013 - February 28, 2014 As of December 30, 2014 PPA report + MSF report + outcome letter sent

Good = Cat. 1 or 2 Poor = Cat. 3, 4 or 5


Age under 70: (Total number sent so far = 629) Multi-source feedback Peer Practice Assessment Age 70 & over: (Total number sent so far = 61) Multi-source feedback Peer Practice Assessment Cumulative total - all physicians: (Total number sent so far = 690) Multi-source feedback Peer Practice Assessment Total # of 2013-2014 assessments initiated: 754 Additional info: Number of registrants with outcome sent who were granted an exemption from the MSF: 34 Number of registrants who have been directed at least one outcome action: 239 Number of registrants who retired during the PPEP process (before outcome letter sent): 2 Number of registrants who retired during the PPEP process (after outcome letter sent): 4

o PRC (Prescription Review Committee) Accomplishments: 63 files reviewed;

• 1 kept in Stage 2 • 10 transferred to Stage 3 • 7 transferred to Stage 4

Good Poor Exempt from MSF

Good 367 (58%) 88 (14%) 19 (3%)

Poor 110 (17%) 43 (7%) 2 (1%)


Good 26 (43%) 7 (11%) 9 (15%)

Poor 11 (18%) 4 (6.5%) 4 (6.5%)


Good 393 (57%) 95 (14%) 28 (4%)

Poor 121 (17%) 47 (7%) 6 (1%)


• 12 transferred to Stage 3 & 4 • 8 transferred to Stage 5 • 9 transferred to Stage 6 • 3 transferred to Stage 7

Definitions: - Stage 2: Feedback (guidelines, scientific literature and other

materials, feedback from medical consultant providing feedback on physician’s prescribing practices)

- Stage 3: Self-reflection (physician creates a self-directed action plan to improve prescribing practices, tailoring standard guidelines to individual clinical situation)

- Stage 4: Courses (physician invited to attend CME prescribing course)

- Stage 5: First interview (face-to-face with medical consultant to discuss barriers to and opportunities for improvements in prescribing practice)

- Stage 6: Second interview (with deputy registrar to discuss remaining options within the Prescription Review Program)

- Stage 7: Referral to Inquiry Committee. 6.10 Library Committee – report of Ms. Jenkinson, Chair

• On-table Library Committee Report to Board, dated January 28, 2015 Ms. V. Jenkinson, Chair of the Library Committee, provided the Board with a written report of the committee’s meeting on January 28, 2015. Overview/Summary The committee discussed approaches to promotion of library resources and services to registrants through accurate information on website, follow-through on promotion plans and use of focus groups to troubleshoot new resources. The committee reviewed the significant value of the library to supporting physician competency and, thereby, protection of the public. The need for accurate communication of library's cost-effectiveness and utility to stakeholders such as the Board was recognized. The committee is aware that many significant library resources are paid in US dollars and will be especially attentive to this issue as the 2015-2016 fiscal year rolls out. Agenda items • 2015-2016 Business Plan review • Key Performance Indicators (KPIs) 2015-2016 review • 2014-2015 Budget


Accomplishments • Business plan was considered comprehensive and reflects well the current

state of library affairs, intentions for coming year and forecast for human resources, IT and space needs for t h r e e years.

• 2015-2016 KPIs were considered appropriate and valuable, being focused on continuous improvement of library services and maximizing resource usage. They are: optimize library services in response to key knowledge leader feedback, complete non-rush literature searches faster and maximize use of information resources.

• Line-by-line 2014-2015 expenditures and revenues to date were not available from accounting so will be reviewed by committee at next meeting. Preliminary reports from a ccounting do not show any points of particular concern in library's bottom line.

Focus for the Future • Key knowledge leader survey #1 data analysis and survey #2 distribution. This is

dependent on CaSPeR Phase 2 priorities. • Continued rollout of promotion plan for Clinical Key and Psychiatry Online.

Success is completion of all planned promotion events. • Continued monitoring of reference service speed. Success is accumulation of

complete data for year-end analysis. The Board was provided with a copy of a summary of library priorities for 2015-2016. Ms. Jenkinson advised the Board that the College of Physicians and Surgeons in BC is the only College in Canada with a library. She stated that the library is a tremendous resource and great benefit to registrants. She noted that in 2014, 2484 individual registrants contacted the library 13, 174 times. In the last three years, 4540 individual registrants directly (i.e. in-person, by phone, email) used the library almost 50,000 times. The website is another well used point of service: in 2013, 34,000 articles were downloaded and e-books and point of care tools were consulted 11,000 times. 6.11 Communications Consultation Committee – report of Ms. Charvat, Chair No report.

7. New Business 7.1 UBC distributed medical education program

2:00 p.m., Thursday, January 29, Drs. Dave Snadden and Chris Lovato, UBC Dr. David Snadden, EAD, Education and Dr. Chris Lovato, Director of Evaluation, at the University of British Columbia, provided the Board with a powerpoint presentation on


“Evaluating the Contribution of UBC’s Distributed Medical Education Program to Physician Human Resources”. This presentation had been previously provided to the UBC Full Faculty of Medicine Committee meeting. A copy of their presentation is attached to these minutes. Drs. Snadden and Lovato responded to questions from the Board. This was provided to the Board for their information.

8. Information Items 8.1 Order of the Minister of Health re Amendment of the Bylaws Schedule A

• Letter to Dr. Oetter, from Mr. B. Westgate, Director, Regulatory Initiatives, Professional Regulation & Oversight, Ministry of Health, dated December 29, 2014 with the following attachments:

o Ministerial Order No. M 468 o Original stamp copy of resolution 14-718

The Board was provided with a copy of Ministerial Order 468-2014, which confirms the amendment of the College Bylaws by repealing and replacing Schedule A regarding fees. This was provided to the Board for their information. 8.2 BC Medical Journal article “Measuring and improving quality of care in family

practice” • Article “Measuring and improving quality of care in family practice” from the

BC Medical Journal, Vol. 56, No. 10, December 2014 Received for information. 8.3 Society of Rural Physicians of Canada editorial “President’s message. Still

competent?” • Article “President’s message. Still competent?” from Dr. John Sales, President

of the Society of Rural Physicians of Canada, 2014 Received for information. 8.4 American Medical Association article “Mandatory Use of Prescription Drug

Monitoring Programs” • Article “Mandatory Use of Prescription Drug Monitoring Programs”, from the

American Medical Association, published online at www.jama.com, January 26, 2015


Received for information.

9. Next Meeting The next open regular meeting of the Board of the College of Physicians and Surgeons of British Columbia is scheduled for March 26, 2015. Conclusion The open regular meeting of the Board of the College of Physicians and Surgeons of British Columbia held Thursday, January 29, 2015 concluded at 3:45 p.m. H.M. Oetter, MD Registrar HMO/jb

board meeting · 1/29/2015 · guidelines for nominations and ... 14, 2015 - health regulators of...

Documents