health volume page i elliott... · eastern health volume 69 page 00 i medical advisory committee...

Eastern Health Volume 69 Page 00 I

MEDICAL ADVISORY COMMITTEE MEETING Wednesday, January 8, 2003

5:00 p.m. Room # 2J18 and 2J619, Health Sciences Centre

In Attendance: Dr. Lucinda Whitman Dr. Alan Goodridge Dr. Frank King Dr. Roger Butler Ms. Louise Jones Dr. Robert Williams Dr. Benvon Cramer

Dr. Tom Cantwell Dr. Barry Rose Dr. David Peddle Ms. Pamela Elliott Dr. Ted Callanan Dr. Alan Kwan Dr. Austin Cooper

Dr. Donald Cook Dr. George Fox Dr. Adrian Major Ms. Janet Squires Mr. George Tilley Dr. Donald Tennent Dr. Peter Noel

Regrets: Ms. Glenda Fagner Dr. AI Felix Dr. Eric Stone

1. Presentation on Wait List Management System Project Team

2. NO BUSINESS ARISING.

3. MINUTES OF PREVIOUS MEETING

MOTION: Upon motion by Dr. Ted Callanan and seconded by Dr. David Pedd Ie the minutes of the previous meeting dated December 11, 2002 were approved. CARRIED.

4. CLINICAL CHIEF/PROGRAM REPORT

Professional Practice Coordinators

Janet Squires, Director of Allied Health Service Development presented the report highlighting the following:

CIHRT Exhibit P-3469

Eastern Health Volume 69 Page 006

MEDICAL ADVISORY COMMITTEE Wednesday, February 12, 2003

5:00 p.m. Room #2J618 and 2J619 Health Sciences Centre

In Attendance: Dr. Lucinda Whitman Dr. Alan Goodridge Dr. Frank King Dr. Roger Butler Ms. Louise Jones Dr. Robert Williams Dr. Benvon Cramer Dr. AI Felix

Dr. Tom Cantwell Dr. Barry Rose Dr. David Peddle Ms. Glenda Fagner Dr. Ted Callanan Dr. Alan Kwan Dr. Austin Cooper Dr. Eric Stone

Dr. Donald Cook Dr. George Fox Dr. Adrian Major Ms. Janet Squires Dr. AI Felix Dr. Donald Tennent Dr. Peter Noel Dr. Paul Gardiner

Regrets: Mr. George Tilley Ms. Pamela Elliott Dr. Wayne Andrews

Dr. Whitman introduced Dr. Conleth Q’Maonaigh as the Acting Clinical Chief for the Emergency/Ambulatory Care Program (Emergency) until August 2003.

A. Previous Minutes

MOTION: Upon motion by Dr. Benvon Cramer and seconded by Dr. Adrian Major the minutes of the previous meeting dated January 8,2003 were approved. CARRIED.

B. Business Arising:

Draft Statement on Rights & Responsibilities

Members of the Medical Advisory Committee were in agreement with the "Draft #2" Statement of Rights & Responsibilities For Those Receiving Care".

Clinical Efficiency Meeting with Clinical Chiefs/Corporate Team

The minutes of the meeting with the Clinical Efficiency Group, Clinical Chiefs and Corporate Team were included in the Medical Advisory Committee package for members to review.

MOTION: Upon motion by Dr. Eric Stone and seconded by Dr. AI Felix, the Medical Advisory Committee support and endorse the recommendations within the Minutes of the Clinical Efficiency Meeting with the Clinical Chiefs and Corporate Team held on January 22, 2003. CARRIED.

Alternate Care Days

C. Clinical Chief/Program Reports

. Child and Women’s Health (Women’s)



MEDICAL ADVISORY COMMITTEE Wednesday, April 9, 2003

5:00 p.m. Room #2J618 and 2J619 Health Sciences Centre

In Attendance: Dr. Lucinda Whitman Dr. Alan Goodridge Dr. Adrian Major Dr. AI Felix Dr. Donald Tennent Dr. Eric Stone Ms. Pamela Elliott

Dr. Tom Cantwell Dr. Frank King Dr. Roger Butler Dr. Robert Williams Dr. Benvon Cramer Mr. George Tilley Dr. George Fox

Dr. Donald Cook Dr. David Peddle Ms. Louise Jones Dr. Alan Kwan Dr. Austin Cooper Dr. David Peddle

Regrets: Dr. Barry Rose Dr. Peter Collingwood Dr. Paul Gardiner

Ms. Glenda Fagner Dr. Alex Laurie Dr. Desmond Robb

Ms. Janet Squires Dr. Ted Callanan Dr. Wayne Andrews

1. Previous Minutes of March 12, 2003

MOTION: Upon motion by Dr. Roger Butler and seconded by Dr. David Peddle the Minutes of the previous meeting dated March 12, 2003 were approved. CARRIED.

2. Clinical Chief/Program Reports

Mental Health Program

Dr. Tom Cantwell presented the Report of the Mental Health Program highlighting the following:

Rehabilitation/Continuing Care Program

Dr. Roger Butler presented the Report of the Rehabilitation/Continuing Care Program highlighting the following:



Medical Advisory Committee Tuesday, September 9, 2003 Lecture Theatre

In Attendance:

Absent: 1. 2. 3. 4.

Dr. Lucinda Whitman Dr. Conleth Peddle David Dr. Donald Tennent O’Maonaigh Dr. Geoff Higgins Dr. Dr. Frank King Dr. Bill Pollett Cramer Dr. Benvon Jones Ms. Louise Dr. Desmond Robb Dr. Roger Butler

5:00 P.M. "D", Health Sciences Centre

Dr. Change of Date and Location September Meeting. Whitman apologized for the change of meeting date. The change was made to accommodate the Royal College meetings. Dr. Whitman welcomed the following new members: Dr. Anne Sclater Clinical Chief, Medicine Program and Discipline Chair for Medicine Dr. Geoff Higgins Clinical President, Medical Staff Association. Dr. Nebojsa Denic Vice Chief, Diagnostic Imaging Program

Previous Minutes MOTION:

Welcome - - - Dr. Wayne Andrews Mr. George Tilley Dr. Robert Williams Dr. George Fox Dr. Eric Stone Thomas Cantwell Al Felix Dr. Donald Cook Dr. Nebojsa Denic Dr. Anne Sclater Dr. Austin Cooper Dr. Dr. Paul Gardiner Dr. Ted Callanan Rose Dr. Janet Squires Dr. Barry Elliott Ms. Ms. Pamela Sharon Hopkins Dr. Alan Kwan Dr. Robert Miller

St. Clare’s St. Site.

Upon motion by Ted Callanan and seconded by Tom Cantwell, the minutes of the previous meeting dated June 11, 2003 were approved. CARRIED.

Clinical Chief/Program Reports Laboratory Medicine Program

Donald Cook presented the Report of the Laboratory Medicine Program for information highlighting the following: Centralization of Pathology Technical Services Considerable discussion ensued on Centralization of Pathology Technical Services that is currently being pursued. This lead to a lengthy discussion on the role of the Clare’s Site with concern expressed about the long term plan for

Dr. Dr. Dr.



Medical Advisory Committee Page # 3

Surgical Pathology Review Committee The Surgical Pathology Review Committee has recently completed a review of requisition forms submitted to the Division of Pathology. The Committee has found that approximately 80% of request forms were deficient, particularly in regards to clinical history, which can be very important in the histological evaluation of tissue. A number of options have been recommended by the Surgical Pathology Review Committee for discussion at senior levels. This item was discussed at the last meeting of the clinical chiefs with a number of initiatives reviewed. It was felt that this is a significant patient care issue with adequate history a definite requirement. Since the clinical chiefs meeting Dr. Cook has had discussion with Dr. Ejeckam and has seen significant improvement in Child/Women’s Health Program (Women’s). Dr. Tennent advised that he serves on the committee and couldn’t believe the issues with lack of information on histories and physicals. He has since spoken to all his physicians in the program and requested that they make an effort. The problems are with the surgeons and plastic surgeons. Dr. Cook is quite prepared to send a letter to clinical chiefs and have them circulate down through their divisional meetings explaining the importance of histories and physicals on the requisitions. Dr. Donald Cook agreed to attend a Surgery Program meeting for discussion and to give some examples. A suggestion was made that there needs to be more space on the requisitions (only two lines available on the current form). Dr. Cook says that he will continue monitoring the issue and if it means changing the form then that is what will be done. Dr. Cook explained that there is representation on the Surgical Pathology Review Committee from all services. He will wait until the end of January at which time he will bring this item back to clinical chiefs. Cytogenetics Members of the Division of Immunology, Cytogenetics and Molecular Genetics have recently met with the Division of Hematology, Medicine Program to discuss prolonged turnaround times, particularly for cytogenetics. A number of initiatives have been formulated to try to deal with this issue. The Clinical Chief of the Laboratory Program will meet with the Divisional Chief of Hematology in late December 2003 or early January 2004 to further monitor this issue. Centralization of Microbiology and Pathology Technical Services Microbiology services have been centralized at the General Hospital Site. There are no major problems with this move and a special thank-you was extended to Mr. Winston Brown for his role in the transition. It was noted that this recommendation was one that was made by the HAY Group.



MEDICAL ADVISORY COMMITTEE Thursday, January 15, 2004

5:00 p.m. Main Auditorium, Health Sciences Centre

In Attendance: Dr. Lucinda Whitman Ms. Cathy Burke Dr. Don Cook Ms. Louise Jones Dr. Frank King Dr. Paul Gardiner Dr. David Peddle Sharon Hopkins Dr. Ann Colbourne Dr. Tom Cantwell Dr. Al Felix

Dr. Robert Williams Dr. Anne Sclater Dr. Nebojsa Denic Dr. Wayne Andrews Dr. Benvon Cramer Dr. Anne Sclater Dr. Scott Wilson

Mr. George Tilley Dr. Eric Stone Dr. Bill Pollett Dr. Ted Callanan Dr. Alan Kwan Ms. Janet Squires Dr. Roger Butler Special Guests: Regrets:

Ms. Louanne Kinsella Dr. George Fox Dr. Desmond Robb Ms. Pamela Elliott Dr. Don Tennent

A. Presentation "Strategic Direction for Clinical Teaching Units in Internal Medicine: Request for Stakeholder Input" Dr. Ann Colbourne/Dr. Anne Sclater. Dr. Whitman advised that there were no Clinical Chiefs/Program Reports as clinical chiefs did not meet in December therefore the opportunity was taken to have Dr. Ann Colbourne, Site Chief, Medicine Program, St. Clare’s Site along with Dr. Anne Sclater, Clinical Chief, Medicine Program to speak on two issues within the Medicine Program. Dr. Sclater explained the trigger for this presentation; Role of Clinical Chief in Quality of Care Reviews and an invitation by Vice-President, Medical Services on two of the Quality of Care Issues that have arisen in the past four months. Issue # 1

Process of Review Concerns have been raised by family medicine residents on the Clinical Teaching Units (CTU’s) at St. Clare’s. This led to quality of care review of a particular internist. The quality of care provided by the internist was found to be entirely appropriate however, the environment of CTU’s was believed to contribute to the concerns of the residents. This has been one stimulus that has led to a review of the CTU’s in the Medicine Program. Dr. Sclater presented the process that has been initiated for that review and will report back to the Medical Advisory Committee when the review has been completed. Dr. Eric Stone raised the concerns of some members of the Discipline of Medicine about the early presentation of information on CTU’s restructuring to the Medical Advisory Committee. Issue # 2

Quality of Care Review of a Patient seen by many services at the St. Clare’s site.



MEDICAL ADVISORY COMMITTEE Wednesday, April 14, 2004

5:00 p.m. 2J618 and 2J619

In Attendance: Dr. Lucinda Whitman Dr. David Peddle Dr. Geoff Higgins Dr. Eric Stone Dr. Wayne Andrews Dr. Ted Callanan Ms. Pamela Elliott Dr. Paul Gardiner Ms. Louise Jones Dr. George Fox

Dr. Robert Williams Dr. Tom Cantwell Dr. Scott Wilson Dr. Don Cook Dr. Desmond Robb Dr. Benvon Cramer

Dr. Donald Tennent Dr. Ann Sclater Dr. Nebojsa Denic Dr. Bill Eaton Dr. Al Kwan Dr. William Pollett Regrets: Dr. Barry Rose Ms. Cathy Burke Dr. Al Felix

Mr. George Tilley Ms. Janet Squires

1. CHIEF EXECUTIVE OFFICERS’ REPORT Dr. Williams presented a verbal report in the absence of Mr. George Tilley. Dr. Williams alluded to the issues surrounding the strike and advised that there will be a full discussion later in the meeting. He commented that although the strike was causing significant problems in the short term, the major challenge to this organization this year will be coping with the delivery of health care services within the allocated budget that we would be receiving from the Department of Health & Community Services. Dr. Williams advised that on a preliminary review it looks like we will be looking at a $10 m problem. Final figures from the Department of Health & Community Services have not been received to date however we should receive them in the near future. The budget shortfall will be a result of the funds allocated, additional revenue measures that government has generated (ie. an increase in ambulance fees and in private and semi-private accommodate rates and based upon the collection of these rates government will reduce our budget accordingly) and a plan to save $5m in the health care system through attrition over the coming year. We are not aware as to what our percentage of this $5m will be but we are 43% of the board related health care budget. This magnitude of fiscal problem will present a severe challenge to this organization. Dr. Williams advised an early meeting with clinical chiefs, program directors and executive management would need to take place soon after the budget figures are received. This issue would also come back to the Medical Advisory Committee at the next meeting in May. Salaried Positions Dr. Cook alluded to restrictions on the salaried physicians budget. Dr. Williams responded by stating that in past years the Department of Health and Community Services had approved the number of positions and they were never filled thus there was no budgetary problems. Last year most of the positions were filled and the Department overran the salaried physicians budget by some $6m. Based



Medical Advisory Committee Thursday, May 20, 2004

5:00 P.M. Room 2860, Health Sciences Centre

In Attendance: Dr. Lucinda Whitman Dr. David Peddle Dr. AI Felix Dr. Geoff Higgins Dr. Frank King Dr. Paul Gardiner Dr. Bill Pollett Dr. Bill Eaton

Regrets: Dr. Roger Butler Ms. Pam Elliott Dr. Alan Kwan

Dr. Robert Williams Dr. Desmond Robb Dr. Donald Tennent Dr. Donald Cook Dr. Rick Cooper Dr. Barry Rose Ms. Cathy Burke

Dr. Wayne Andrews Dr. Scott Wilson Dr. Eric Stone Dr. Anne Sclater Dr. Ted Callanan Mr. George Tilley Ms. Janet Squires

Dr. N. Denic Dr. George Fox Dr. Robert Miller

Ms. Louise Jones Dr. Tom Cantwell Dr. Benvon Cramer

Guests: Mr. Jeff Lee, G.E. Medical Systems Mr. Terry Mouland, Information Management and Technology, HCCSJ

1. PRESENTATION - PACS (Picture Archiving Communication System)

2. PREVIOUS MINUTES

MOTION: It was motioned by Dr. AI Felix and seconded by Dr. Geoff Higgins that the minutes of the previous meeting dated April 14, 2004, be approved. CARRIED

3. CLINICAL CHIEF/PROGRAM REPORTS There were no Clinical Chief/Program Reports due to the cancellation of the Clinical Chiefs Meeting during the strike.

4. MEDICAL STAFF COMMITTEE REPORTS

Credentials Committee The Credential’s Committee minutes of May 3, 2004, were presented.



Medical Advisory Committee May 20, 2004

Page 9

Budget: Mr. Tilley advised that he was mandated to balance the budget for 2003/2004 however this was not accomplished. The Corporation ended the 2003/2004 fiscal year with a $1 M deficit and are unable to pay down the debt load.

Mr. Tilley’s immediate concern is the budget for the 2004/2005 fiscal year. After a tally of all program’s predicted spending for 2004/2005, there is a $11 M shortfall. Prior to the NAPE strike, Government’s message was there is no new money. Since the strike, they are enforcing a $1.4 budget reduction for attrition.Mr. Tilley explained that the Corporation is prepared to follow through with the following initiatives in order to reduce the projected $11 M shortfall for 2004/05 including:

holding back $2.4M on service volume changes which includes projected increases in Ambulatory Care; putting a limit on high-risk procedures, e.g. lCD’s; laying off a number of employees which can be done without affecting the efficiency of services; looking at bed closures in the adult (10) and possibly the child health area.

The above initiatives would reduce the projected deficit from $11 M to approximately $7M.

The Corporation plans to ask Government to delay repaying the debt for 2004/2005 and request they retain the savings from the NAPE strike.

Mr. Tilley and Mr. John Abbott, Chairman of the Board, have been invited to give a presentation on the Corporation’s budget to the group of ministers or Treasury Board on June th. As part of their presentation, they will advise ministers that any reduction in services of the Health Care Corporation of St. John’s will impact patients province-wide. Extensive waiting lists for Cardiac and General Surgery will be presented expressing concerns if reductions have to be made in those areas. As well, issues such as Infection Control and Patient Safety will not be dealt with appropriately.

Mr. Tilley will be making a presentation at the next Board meeting in hopes that they will support this position to Government.

Dr. Higgins voiced his concerns regarding placing restrictions on changing technology and innovation which could stifle physicians and the quality of medical care provided if prevented from learning/implementing.

If Government says "No" to the above, the Corporation has a contingency plan which includes the reduction of services in the Operating Room and Diagnostic Imaging.

Health Care Restructuring: Mr. Tilley advised that he expects Government to announce their plans for health care restructuring as early as the end of June.



Medical Advisory Committee May 20,2004

Page 10

6. REPORT OF THE PRESIDENT OF THE MEDICAL STAFF

7. NEWFOUNDLAND CANCER TREATMENT & RESEARCH FOUNDATION Dr. Paul Gardiner reported on the following:Board Integration: The NCTRF has a sense of the inevitable and will provide no resistance to move if mandated to do so.

Budget: The NCTRF has been given a directive not to spend beyond a six-month period. (Mr. Tilley noted that the HCCSJ has been given the same directive.)

Recruitment of Oncologists: Dr. Gardiner has been approached by three medical students who have entered the CARMS Program and wish to return to Newfoundland as Radiation Oncologists in 2008/09. They will be looking for bursary funding for a return- in-service commitment for radiation oncology. The NCTRF will continue to monitor this.

Mr. Tilley advised that recruitment of medical staff may present issues related to budget. Dr. Stone reminded Mr. Tilley that the Province does have a Medical Human Resource Plan for 5 years and voiced his concern regarding the importance of continued planning for future medical staff. Mr. Tilley will add this to his presentation on the budget to the Department of Health and Community Services.

8. OTHER BUSINESS


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