July Messenger 2018

Melissa Campbell CPSA


Making a difference: 2017 CPSA annual report

Stories, numbers and messages from College Council and our Registrar 

The College’s 2017 annual report is now online, profiling the work Council, staff and our members do to support good medical care for Albertans.

Read about one doctor’s experience with Group Practice Review and how another physician identified and thwarted an attempt at prescription fraud. You’ll also learn about how the College keeps physicians better informed with Practice Checkup and MD Snapshot, measures to bend the curve on opioid prescribing and much more!

Please provide us with your feedback by clicking the survey link at the bottom of the report’s home page. A downloadable PDF version of the report is also available from the site.

To request a printed report, contact Communications Advisor Barb Krahn at barb.krahn@cpsa.ab.ca.


Boundary Violations and Responsibility for a Medical Practice amended after consultation

Have you read the recent amendments? If not, do so now

After an extensive consultation process, significant changes were made to both of these standards. The amendments were approved by Council in May and took effect on July 1.

Learn more about why the standards were amended and review the amendments and companion advice documents:

  • Boundary Violations adds new expectations around non-clinical relationships with patients and learners, as well as prohibiting the sexualization of physician-patient relationships.
  • Responsibility for a Medical Practice defines what the College holds physicians accountable for in various practice arrangements and should be priority reading for every Alberta physician.

Questions? Email Standards of Practice Coordinator Chantelle Dick at chantelle.dick@cpsa.ab.ca.


High-risk exposures from MDR

How you can help keep your patients and reprocessing clinic safe

After 10 years and more than 1,000 assessments by the College’s Infection Prevention and Control (IPAC) program, reprocessing methods inconsistent with manufacturers’ instructions continues to be a top deficiency.

This can lead to high-risk exposures and a report to the Medical Officer of Health, with the potential for clinic liability. Literature exists linking these types of breaches to numerous health-related outbreaks.

What you can do:

  1. Follow accepted standards and guidelines for medical device reprocessing (i.e. cleaning and disinfection/sterilization of reusable devices).
  2. Obtain manufacturers’ instructions and ensure your clinic is reprocessing as per validated processes. This is your responsibility. Canadian legislation requires manufacturers to properly label reusable medical devices and have validated instructions for safe and effective reprocessing.

    • For devices already in use: Obtain the manufacturers’ instructions for use. Review the validated instructions and ensure your clinic processes align. If not, implement corrective actions or discontinue use.
    • Before purchasing a device in future: Ensure the device holds a valid Health Canada medical device licence where necessary. Obtain the manufacturer’s instructions for use prior to purchase and evaluate if the validated instructions can be met onsite. If the instructions are not achievable, do not purchase and seek an alternative.

  3. Familiarize yourself with the IPAC program’s generic standards, adopted from the Canadian Standards Association. This includes the MDR Standards for General Devices, and if applicable, MDR Standards for Flexible Endoscopes.

We are here to help:

If you need support or help finding or interpreting your manufacturers’ instructions, contact the IPAC program at ipac@cpsa.ab.ca or 780-969-5004. You can also visit our webpage for more information on medical device reprocessing or general infection prevention & control.


Annual renewal for postgrads complete

Next up… undergraduate trainees

Thank you to all our postgraduate trainees for completing their 2018-2019 renewal.

Next up is renewal for undergraduate trainees. Our first notice goes out July 25 and the deadline for renewal is Aug. 31.

Completing the annual Renewal Information Form (RIF) ensures we have updated contact information and important information about your health and professional activities.

What we heard from our postgrads:

Each year, we ask members for feedback on the RIF and our renewal process. Here is a summary of what we heard from our postgraduate trainees:

  • 100% strongly agreed or agreed that RIF questions were clear.
  • 100% strongly agreed or agreed the form functioned well, was easy to complete and was of reasonable length.
  • 100% strongly agreed or agreed the log in process was easy.
  • 50% strongly agreed or agreed help was readily available, while 50% were neutral.

A few members left specific comments on how we could make further improvements to the RIF. We will look at these closely, along with feedback from undergraduate trainees and physicians, after their renewal is completed.


CPSA Hearing Tribunals discipline two Alberta physicians

Dr. Mohammed Al-Ghamdi and Dr. Saurabh Gupta face penalties for separate offences

Guilty of disruptive behaviour reaching the threshold of unprofessional conduct

A Hearing Tribunal has found Dr. Mohammed Al-Ghamdi, an orthopedic surgeon from Grande Prairie, guilty of disruptive conduct on eight of 13 charges. Dr. Al-Ghamdi was the focus of three separate College investigations—two complaints from personnel within Alberta Health Services (AHS) and one initiated by the College’s Complaints Director.

The concerns arose from Dr. Al-Ghamdi’s interactions with healthcare colleagues (physicians and nurses) and from AHS management. The hearing began in April 2015, with a decision issued on April 11, 2017, followed by a further sanction decision on Dec. 21 2017.

Dr. Al-Ghamdi has appealed that decision and Council will hear that appeal in September of 2018.

Background:

It was alleged that “Since 2003 [Dr. Al-Ghamdi has] demonstrated a pattern of disruptive conduct in [his] dealings with a number of [his] medical colleagues and nursing staff at the Queen Elizabeth II hospital, which has resulted in a breakdown of [his] professional relationship with those colleagues and staff to the detriment of the health services at that hospital, with particular acts in one or more of the following categories of conduct,” which included these eight charges on which Dr. Al-Ghamdi was found guilty:

  1. Failing to participate in and follow the on-call schedule and procedures for orthopedic surgery at the hospital.
  2. Purporting to have a parallel on-call schedule of his own to try to avoid having to deal with the on-call orthopedic surgeon at the hospital when booking a patient for surgery.
  3. Failing to cooperate with his medical colleagues and nursing staff to ensure surgical cases were performed on the basis of medical need for urgent care.
  4. Cultivating a culture of fear and distrust through making complaints to the Alberta Human Rights commission, the College and Association of Registered Nurses of Alberta or the College of Physicians & Surgeons of Alberta.
  5. Cultivating a culture of fear and distrust through threatening legal action.
  6. Cultivating a culture of fear and distrust through making numerous complaints to administration at the hospital and the health authority.
  7. Failing to follow the issue/dispute resolution processes set out in the bylaws and policies applicable to hospital medical staff.
  8. Having nursing staff open sterilized packs of surgical instruments, which were not reasonably required for the procedure at hand and thereby making those instruments unavailable for other surgeons until the nursing staff had re-sterilized the instrument packs.

Penalty:

The penalty ordered by the Tribunal included:

  1. A practice permit suspension for a minimum of two years. Dr. Al-Ghamdi may apply to the Registrar for reinstatement after two years, if he completes a comprehensive assessment program to determine his fitness to practise. The program must be approved by the Registrar in advance and Dr. Al-Ghamdi is responsible for all costs of such an assessment. In addition, Dr. Al-Ghamdi would be expected to successfully complete any and all direction from the comprehensive assessment, including any recommended therapy, courses on interpersonal communication and endorsement of a mentor acceptable to the College. Dr. Al-Ghamdi would be responsible for all associated costs.
  2. Dr. Al-Ghamdi was awarded eight-thirteenths of the cost of the hearing, inclusive of the cost of legal counsel retained by the Hearing Director to assist with Dr. Al-Ghamdi’s multiple objections and other actions. The sum of $701,450.57 is to be paid in full, no later than three years from the date of the sanction decision – a failure to do so allows for the suspension of Dr. Al-Ghamdi’s practice permit.

Dr. Al-Ghamdi can still practise medicine while his appeal to Council is pending.

Commentary:

The basic tenet of the matters—the issue of physician disruption in the workplace and its impact on the healthcare team—cannot be overstated. The delivery of modern healthcare requires a responsible and functional team approach, as envisioned by the Code of Conduct and the Code of Ethics.

Guilty of inappropriate communication with a person thought to be a minor

Dr. Saurabh Gupta, an emergency room and family practitioner, was providing emergency room coverage in Medicine Hat when during his off hours, he contacted a person he believed to be a female under the age of majority through the website “Plenty of Fish”. Posing as a surgical resident, Dr. Gupta invited her, alone, to the hotel where he was staying. When he arrived at the arranged meeting place, he was instead confronted by several members of “Creep Catchers”, a local vigilante group. The group subsequently posted Dr. Gupta’s text messages and video of the encounter online, with Dr. Gupta identified by staff at the hospital in Medicine Hat.

Dr. Gupta self-reported the matter to the College, followed by a report from Alberta Health Services. Medicine Hat Police Service investigated but did not press criminal charges.

Background:

After a College investigation, Dr. Gupta was referred to a formal disciplinary hearing. He admitted to unprofessional conduct for inappropriately communicating by electronic means with a person he believed was a 15-year-old female high school student. Details of the communication included:

  • a request that she come to his hotel alone;
  • comments that to a reasonable person would imply they would listen to music together in his hotel room;
  • comments that to a reasonable person would imply there could be alcohol to consume or items to smoke;
  • an invitation to bring her bathing suit for a swim in the hotel pool;
  • a request to wear something pretty; and
  • comments that a reasonable person would interpret as an attempt to arrange a meeting alone, without the consent or approval of her parent or guardian, in circumstances potentially leading to sexual invitation.

Penalty:

Dr. Gupta did not practise medicine from Aug. 29, 2016 to May 1, 2017. To complete the 12-month active suspension handed down by the Hearing Tribunal, he will be additionally withdrawn from practice from April 2 to Aug. 2, 2018, with a further six-month suspension held in abeyance pending his adherence to all orders of the Tribunal. These orders include:

  1. Entry into a Continuing Care Agreement for a minimum of five years with the College’s Physician Health Monitoring Program.
  2. A mandatory chaperone for all encounters involving females under the age of 18, which shall remain in place for at least as long as the Continuing Care Agreement is in force.
  3. Dr. Gupta is responsible for the costs of the investigation and hearing into this matter ($17,871.13).

Dr. Gupta underwent a fitness-to-work assessment prior to the hearing, which underscored his low probability of re-offence and suitability for practice under the above-noted conditions.

Commentary:

As stated by the Tribunal, Dr. Gupta’s presentation as a physician “afforded him a level of immediate credibility and status and tarnished the reputation of the medical profession”. The sanctions are intended to provide deterrence to both Dr. Gupta and the profession. While the College acknowledges that Dr. Gupta self-reported and was cooperative with the investigation and hearing processes, it must be recognized that a member of the medical profession has a certain standing in the community and his behaviour in this matter is incongruent with the high standards of conduct expected of physicians by our society, both within and beyond their professional lives.

This disciplinary decision was made prior to Council’s recent adoption of a Statement of Principles regarding sexual misconduct.


Meet the latest recipients of the Dr. Bryan Ward Memorial Endowment Fund

Established in memory of the CPSA’s former Deputy Registrar, this annual award supports medical students and residents who share Dr. Bryan Ward’s passion for rural practice. Find out more about this year’s recipients: Dr. Reid Hosford and Dr. Kaitlin Forbes.


Our annual golf tournament was a swinging success!

Funds raised at annual event supports medical student bursaries

Physicians and health care leaders from across the province teed off at the Red Deer Golf & Country Club on Monday, June 25 to support Alberta’s next generation of physicians.

All of the funds raised through the 91st Annual North/South Doctors’ Golf Tournament will be put towards bursaries awarded to Alberta medical students for the 2018-2019 school year.

Participants enjoyed a sunny day of golf (with a bit of wind to make things interesting), a BBQ lunch and great prize draws. Nine medical students and residents were sponsored by the CPSA to not only work on their swing, but to network and connect with their future colleagues in the medical profession.

Thank you to our sponsors (especially presenting sponsor TD Insurance) and all our participants for making this year’s tournament a success. See you on the links in 2019!

This annual tournament is co-hosted by the College of Physicians & Surgeons of Alberta, the Alberta Medical Association and the Canadian Medical Foundation.


Preventing delayed diagnosis of tuberculosis

Submitted by Dina Fisher, Stephen Field, Julie Jarand and Agnes Hunter, Medicine and Tuberculosis Services, University of Calgary and Calgary Zone, Alberta Health Services

Delayed diagnosis of tuberculosis (TB) remains a problem in Alberta, resulting in patients remaining ill longer, residual lung damage and opening up the public to the risks of infection.

TB is one of the deadliest infections and remains a major health concern amongst our most vulnerable citizens: people with HIV, inner-city dwellers, those with dependency issues and individuals who are immunosuppressed. Delayed diagnosis can result in unnecessary morbidity, permanent disability, greater risks of contagion and death. We are hoping to bolster a greater awareness of TB among primary care physicians and radiologists.

TB typically involves the upper lung zones and may result in cavitary disease. Yet there have been several recent cases where the radiology reports did not include TB in the differential diagnosis, resulting in delayed treatment, complications and exposure in the community.

If a patient with suspected pneumonia does not improve, especially if the repeat chest radiograph worsens, consider alternate diagnoses: a resistant bacterial infection, tuberculosis, other atypical infections or a non-infectious condition such as cryptogenic organizing pneumonia.

Primary care doctors depend on radiology reports for direction on patient management. Since the prevalence of TB is low, it may not always be a diagnosis considered by physicians, or by the radiologists who interpret chest radiographs.

Physicians and radiologists are encouraged to consider TB in patients from areas where TB is prevalent and in patients with upper lobe or superior segment pneumonias, especially when treatment is failing and cavitation is present.