CONSULTATION 017

Duty to Report a Colleague

Tell us what you think

Consultation now open

During pre-consultation, many respondents correctly identified the requirements of An Act to Protect Patients missing from the standards—these are now included in the draft documents.

We received a number of comments suggesting Duty of Treating Physicians… be amalgamated into the Duty to Report a Colleague standard, as they are very similar. We have defined the two in one document with headings, to indicate when reporting must be done by a colleague and how a physician treating a physician-patient must proceed with reportable concerns.

While unprofessional behaviour unrelated to patient care is addressed in the current standard, feedback indicated a lack of clarity, which we have attempted to address in the draft.

Where clarity was called for by way of examples and scenarios, these will be addressed in the upcoming Advice to the Profession document.

Read the draft standard

Review the marked comparison with the current standard

Read the current standards:

Duty of Treating Physicians and Physicians Working in the Context of a Physician Health Program to Report a Physician to the College

Duty to Report a Colleague

CPSA members, partner organizations, other health care professionals and Albertans are invited to provide feedback from Dec. 2, 2019-Jan. 16, 2020. Council will consider non-nominal feedback when approving final amendments to the standard at its Feb, 2020 meeting.

Feedback may be shared in the following ways:

  1. Complete a short survey
  2. Email consultation@cpsa.ab.ca
  3. Mail to:
    CPSA
    2700-10020 100 Street NW
    Edmonton, AB T5J 0N3
    Attn: Standards of Practice
  4. Leave a comment via the form below (please note: you will have the option to have your comment published or to submit it without being published)

All feedback is subject to the CPSA’s Privacy Statement. CPSA reviews all comments before publication to ensure there is no offensive language, personal attacks or unsubstantiated allegations.

Consultation has been extended to January 31. If you have any questions or require further assistance, please contact Chantelle.Dick@cpsa.ab.ca.

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Comments

Janet Wright
Alberta Physician

Thank you for the opportunity to comment on this draft standard of practice. Overall I think this standard adequately deals with the issues intended. My only concern relates to the duty of a treating physician when sexual abuse is disclosed in the context of the treating relationship. It appears that this clause (7) does not require the treating physician to disclose sexual abuse by the physician patient but only to advise the physician patient of the duty to self disclose. The harm that is done to patients does not appear to be adequately addressed by this clause. Although I can appreciate the need to try to preserve the doctor patient relationship I can forsee an instance where a patient is being abused and it is not reported under this clause. This leaves me very uncomfortable.

Dr Kathleen Game
Alberta Physician

You have just made it even more unlikely for docs to seek help or diagnosis and treatment early if at all. If your family doc or psychiatrist or internist is going to report you then there is no confidentiality or trust in your relationship. Patients can expect ‘this unless they present a real and immediate danger to self and others. No one wants that designation to ruin their career. Hiding problems from the college or colleagues will be even more the norm.

Dr Kathleen Game
Alberta Physician

Retroactively applying new laws or regulations is not right. Behaviour at the time considered okay and decisions made at the time according to those standards in place at the time should not have new standards retroactiveljy judging this. It is not at all fair to ask that docs in the past have a crystal ball for the future. If my memory is correct one of the college registrars married a patient. Docs and nurses have relationships. Are you going to go after that registrar? How many years back to retroactively judge would you like to go? One year? Thirty years?

Abid Ahmed
Alberta Physician

Reporting of the physician-patient by treating physician should be considered only if two physicians after assessing the physician-patient consider that physician - patient condition warrants reporting to safe guard the patient or others working with the patient - physician. A single treating physician assessment may not be absolutely final judgement whether physician - patient medical issue would make him or her dangerous to his clients. This may help in avoiding errors in reporting and give more space for the physician-patient to have second opinion for his or her ability to be fit to continue his or her current practice.

alasdair drumond
Alberta Physician

still have concerns about reporting of charges as opposed to conviction. has the presumption of innocence been abrogated by the college?

Marianne Baird
Other healthcare professional

The only question I have is about the draft Duty to Report a Colleague. In the Reporting Requirements section, it is not clear whether 1 (b) through (f) would really apply to all other regulated health professionals of any college. For example, 1 (b) has a comment that the language is based on that used in the Health Law Institute’s report on physician health conditions – I’m not sure this would translate directly to all other regulated health professionals. My suggestion is to identify 1 (b) through 1 (f) as specific to reporting physician colleagues, and keep 1 (a) as applying to reporting of any regulated health professional, consistent with Bill 21 requirements.

Dr. James Watt
Alberta Physician

Hypothetical situation suppose you have a real finding of abuse and license removal happens but then after five years you have to re-train. My understanding of physician qualifications internationally is that once you haven’t practiced for five years you have to completely retrain. So, effectively the person is banned for life and can never work again .... do we want to do this to everyone in a first offence ?? What about wrongful convictions? Does the penalty for false allegations include the Ancient Greek method of the death penalty?
It would seem that is the equivalent for a first offence physician since you can’t retrain unless you get an educational license and there’s no money for that.
If five years minimum is truly the law then you have effectively given the physician a death penalty since they can’t retrain essentially. Do we really want to do this to everyone?? The consequences of this law have far reaching effects that have not been well thought out by lawyers. If someone is banned for five years then they have paid their time but really they can never practise again. What if the false accusers who get off Scott free as far as I can see.
Just an observation but one that may or may it ever come up. It will be IMPOSSIBLE to be funded for the required retraining. So perhaps the penalty should be 4.5 years.

Peter Hamilton
Alberta Physician

"Duty of Treating Physicians and Physicians Working in the Context of a Physician Health Program to Report a Physician to CPSA. "
This undermines the confidentiality of the patient(doctor) - doctor relationship. Why would any physician seek help from a Physician Health Program where their right to confidentiality will be breached and could compromise their career?

Jamila. Kureshi
Alberta Physician

I think it is just fair and ethical to advise the physician patient of the duty to self disclose.

Noel Corser
Alberta Physician

Just a few comments on the "Duty to Report a Colleague" draft Standard:

- the Standard is named "Duty to Report a Colleague", but it starts off by describing the duty to report any regulated health professional of any college. Maybe this meets the requirements of Bill 21, but it gets messy when it moves beyond physician self-regulation, to physicians trying to regulate other health professions (e.g. deciding what "is reasonably likely to negatively impact their work" or "what is reasonably considered competent care"). On the other hand, when "a colleague" is used in paragraph 3 it's clearly about a physician, and not non-physician colleagues. I think the CPSA should be careful not to overstep its mandate here (physician self-regulation), and if new legislation requires docs to participate in regulation of other health professions, that should be a clear sub-section of this new Standard, and not mixed up throughout.

- suggest 1(b) be re-worded to "presently has a physical, cognitive, mental and/or emotional condition that negatively impacts their work, or is reasonably likely to negatively impact their work in the future".

- paragraph 2 is interesting: docs are NOT required, but are "permitted", to disclose suspected sexual abuse/misconduct towards a patient, by their patient. I.e. physician-patient confidentiality trumps mandatory reporting of possible sexual abuse of a patient, but a doc who does report is presumably protected from a complaint themselves for breaking confidentiality? Suggest that removing "in the interest of confidentiality in the physician-patient relationship per the HPA" would reduce confusion somewhat, or alternatively rewording it to "...is not required (in the interest of confidentiality in the physician-patient relationship per the HPA), but is permitted, to report this matter to CPSA". It remains unclear what the College is asking us to do, however - report potential abuse (not mandatory) OR maintain physician-patient confidentiality? As it reads, either is ok, but I'd suggest the CPSA needs to think about this more, and clarify whether this situation warrants breaking confidentiality (despite the HPA)? Same comments apply to paragraph 7.

- might be worth removing "provincial" from "...within a provincial Physician Health Program in a non-treating capacity", as such programs could be national or specialty-specific instead.

- there's a discrepancy in paragraph 6 between "...could be harmed..." and the quoted footnote 12 " 'Serious harm' is defined as..." It's unclear whether the draft Standard is mandating reporting for reasonably foreseeable harm or only for serious harm, and this needs fixing.

I think adding the very last bit, that REQUIRES docs to ask for advice if they're unsure what to do, is an exceptionally good idea - the grey zones are the difficult ones, and I think it'll help us to confidentially bounce these questions off someone else, if we know that doing so is spelled out as a College requirement. Consider adding this kind of clause to other Standards of Practice!

Sha Tao
Alberta Physician

I agreed and shared with Dr. Game's feedback, " Retroactively applying new laws or regulations is not right. Behaviour at the time considered okay and decisions made at the time according to those standards in place at the time should not have new standards retroactiveljy judging this." That was then and it is now. If we apply the new laws and regulations to judge what we were done 10, 20, or 30 years ago, some things would be highly considered "wrong doing". Why the CPSA and Government timely, regularly-regular changes the laws and regulations, because there are new demanding by the modern societies, cultural needs, patients and patient's family members requirements, what were okay and normal or acceptable in the past become significant problematic and unacceptable in the advanced and developed societies. The CPSA and the Government absolutely have to protect our patients, it is equally important the CPSA and the Government have to protect the physicians.

marwan aldoor
Alberta Physician

I think one of our duties as physician is to make sure our patient are safe and get care from competent physician, therefore I agree with our duty to report a colleague, even though it might have a negative impact on that person and your professional relationship with your colleague.

Amaresh Swaro
Alberta Physician

I agree with the proposed standards on reporting

Appolinaire Katumba
Alberta Physician

The physician patient not only is aware of this code of practice but is also a patient needing to be reminded of his duties to self disclose by the treating physician.

Viktor Yakymovych
Alberta Physician

This feedback is written in regards to proposed changes to CPSA standards on Duty to Report a Colleague and Self.

There is no questions that the sexual abuse or sexual misconduct, any findings of professional negligence or malpractice, unprofessional conduct and charges or convictions of a criminal offense should be reported.

However, in my opinion, both drafts posted on the college website (http://www.cpsa.ca/consultation/consultation-017/) have significant deficiencies.

Under the draft on Duty to Report Self the section 1 is more or less clear:(1) "A regulated member must report the following personal circumstances to CPSA at the time of registration or as soon as reasonably possible once they become aware e.g. sexual misconduct with the patient. To be aware in other words to be certain that someone was involved in some activity and this doesn't leave any space for speculation.

However under the draft on Duty to Report a Colleague the same section 1 sounds quite different.
(1) A regulated member must report the following circumstances to the complaints director of the relevant college as soon as they have reasonable grounds to believe a regulated member of any college’s: e.g. engaging in sexual misconduct.

Term "reasonable grounds" is employed in many aspects of law enforcement. Police officers can use it but we are doctors and not police officers. To have reasonable grounds to believe is a probability. Therefore it must be replaced with "become aware or become certain". So I must report a colleague if I am aware or certain that e.g, he was involved in sexual misconduct.

The greatest concern is in regards to the section 1b of both drafts.
We must report a Colleague or Self in case::
(b) a physical, cognitive, mental and/or emotional condition that negatively impacts, or is reasonably likely to negatively impact, the regulated member’s work in the future
Conditions (which must be reported) would include, but not be limited to, the following:
(a) blood borne viral infections
(b) conditions affecting primary senses: vision, hearing etc.
(c) neurological conditions affecting cognition, motor or sensory function, seizure disorder
(d) psychiatric conditions
(e) substance use disorder
(f) physical disability
(g) metabolic conditions

Of course, one has to be cautious in regards to blood borne viral infections and there is the Public policy "Physicians with blood borne viral infections: Understanding and managing the risks" on the CMPA website: https://www.cmpa-acpm.ca/en/research-policy/public-policy/physicians-with-blood-borne-viral-infections-understanding-and-managing-the-risks
However what about other conditions indicated above? Are they really prohibiting physicians from practicing? Dr. Jacob Bolotin, a congenitally blind man was particularly recognized for his expertise on diseases of the heart and lungs. Dr. Kristin Seaborg, a famous pediatrician with a seizure disorder. Dr. Steven Miles, a well-respected gerontologist and professor of biomedical ethics at the University of Minnesota Medical School was diagnosed with bipolar disorder. And there are many others.

It is well known that there is a strong social stigma attached especially to mental health illness, and people with mental health problems can experience discrimination in all aspects of their lives.
As a psychiatrist I have patients-physicians in my caseload and I am certain that the above-mentioned standards will create a tremendous stress for them.

According to the section 5 and 6 of the proposed standards: A regulated member treating another physician, or a regulated member working within a provincial Physician Health Program in a non-treating capacity (e.g., the AMA’s Physician and Family Support Program), must report to the College when the physician-patient presently has a physical, cognitive mental and/or emotional condition where it is reasonably foreseeable that patients, or others within the context of the physician-patient’s medical practice, could be harmed (physically or psychologically) as a result of the medical condition."

I don't have any doubts that the above-mentioned will cause physicians to avoid seeking medical treatment due to fear of repercussions.

I encourage you to read an article "Doctors fear mental health disclosure could jeopardize their licenses" by Leah Samuel (https://www.statnews.com/2017/10/16/doctors-mental-health-licenses/)
As you can:" Medicine is grappling with rising levels of physician burnout, one of the factors driving high rates of depression and suicide in the profession. But physicians who suffer from mood disorders are often reluctant to seek treatment — in part because it might jeopardize their license to practice".

In the USA revoking licensure or preventing a physician from working due to mental disorders is actually illegal under the Americans with Disabilties Act. Covered conditions include mental illnesses such as depression, bipolar disorder, and schizophrenia. The law defines as a form of discrimination “employment tests or other selection criteria that screen out or tend to screen out an individual with a disability or a class of individuals with disabilities.” In Canada we have the Canadians with Disabilities Act which indicates the same. It does mean that even simple questions in regards to Self-Reporting Health Concerns from the CPSA Renewal Information Form can be considered as discriminatory.

Moreover, The Canadian Charter of Rights and Freedoms guarantees persons with disabilities the right to "equal protection and equal benefit of the law without discrimination based on … mental or physical disability." The Canadian Human Rights Act also prohibits discrimination, as do provincial human rights codes.

As you can see from all the above both drafts have significant deficiencies not only from the ethical but also legal point of view.

The statement “We’re re-emphasizing to physicians the importance of taking responsibility for issues that might affect their own fitness for practice” may sound good for someone but for some others may open a Pandora's box. For me, personally, the statement "Empowering Doctors with Disabilities" sounds much better.

maureen bakken
Alberta Physician

i support the concerns of Dr Yakymovych and Dr James Watt in particular. There are many other relevant points brought up by other s in the comment section that the College should consider serious concerns, including that there will be FAIR AND DUE PROCESS for the Physician/s involved, considering how rapid the College ensures their focus of transparency of information to the public is fulfilled .
i believe the proof is in the draft wording that the College is stepping way over what a self governing body should be doing when many of the standards will and should be challenged as breaching canadian law at either a provincial or Federal level.