March Messenger 2020

College of Physicians and Surgeons of Alberta CPSA, Messenger


Navigating dream land

How do physicians fit into the new and quickly changing world of private home sleep apnea testing?

After CPSA rolled out new standards for Sleep Medicine Diagnostic Testing Facilities in January 2018, some facilities asked for our support to convince physicians to sign self-referred scripts for Home Sleep Apnea Testing (HSAT). There’s a lot of confusion in the world of sleep testing around who is responsible for what and we’re here to break some of that down.

So, does a script have to be signed by a physician in order to run HSAT?

Yes.

Does a physician have to sign a script for a patient?

The answer isn’t so cut and dry.

The main issue in the sleep medicine diagnostics community is this: a lot of testing is done by private labs who rely on direct-to-patient ads. Patients often approach the company offering HSAT first and fill out a screening form before the company sends a script for testing—and sometimes treatment—to the patient’s physician to sign.

In many of the companies that offer HSAT, there aren’t regulated health professionals with self-directed practice related to sleep medicine under the Health Professions Act. So these companies often rely on a patient’s family physician to sign the requisition to order the test and prescribe therapy.

It could feel like you’re being asked to rubber stamp a referral before you’ve even had the chance to see the patient yourself, and it comes with a catch. When you sign a requisition, you take responsibility for receiving the test results and following up on patient care. Maybe you have seen the patient before, but it’s been a while and now you’re being asked to take responsibility for a diagnostic test that may or may not be reasonable to order.

The landscape of health care is changing rapidly and not just in Alberta. Today, it’s a question of sleep diagnostic testing. Tomorrow, it could be another type of testing or treatment. As more health testing becomes available to people directly, they’re going to want to explore those options. Yet as physicians, the responsibility for a patient ultimately falls to us. 

While HSAT is a valuable test to rule out obstructive sleep apnea in adults, there are definite indications and contraindications and physicians should take time to consider if the test is appropriate. Remember that even if a test is harmless and free to the patient, there is still a cost to unnecessary testing.

Our recommendation to physicians: continue practicing good medicine, be thorough in your assessment of these types of requests and ultimately, use your professional judgment.

Here are a few helpful questions you can ask yourself, to help determine if the lab’s request is reasonable:

  1. What is the need for this patient to have this testing or treatment?
  2. Are they a patient I’ve seen recently or should I examine them myself first?
  3. Am I blocking this patient’s access to reasonable testing and care?
  4. Is the test or referral inappropriate or is it truly in the best interest of the patient?

Do you have a HSAT request that you’re not sure what to do with? We’re here to help.

Contact us at sleep.medicine@cpsa.ab.ca, 780-969-4938 or 1-800-561-3899 ext. 4938.


Working together to treat addiction

A committee of experts creates a new guidance document for substance abuse disorder

Illness and death from substance use disorder remains a public health crisis in Alberta.

To support effective, acute care for inpatients who use alcohol, opioids and methamphetamines, an advisory committee recently developed The Guidance Document on the Management of Substance Use in Acute Care, an Alberta-based, point-of-care resource.

CPSA sat on this advisory committee alongside front-line care providers, addiction specialists, a public health specialist, a medical ethicist, health administrators, individuals who have lived experience with addiction and representatives from other health regulatory colleges:

  • College and Association of Registered Nurses of Alberta (CARNA)
  • College of Registered Psychiatric Nurses of Alberta (CRPNA)
  • College of Licensed Practical Nurses of Alberta (CLPNA)
  • Alberta College of Pharmacy (ACP)

This resource is available on the Canadian Research Initiative in Substance Misuse (CRISM) Prairie Node website. We hope you will apply it to the care you provide patients who struggle with substance use disorder.


Are you a medical resident with an interest in infection prevention & control?

CPSA is recruiting a resident physician to join us on our Infection Prevention & Control (IPAC) Advisory Committee. We want your fresh perspective to help us make committee decisions. This great networking opportunity will connect you with community-based physicians, representatives from the AMA, and public health and IPAC experts. You’ll learn about the IPAC and medical device reprocessing (MDR) expectations and challenges faced by community clinics. You’ll also get familiar with medical self-regulation.

The details:

  • You’ll serve a one-year term as a non-voting consultant and attend three full-day committee meetings within the term year.
  • Meetings are in January, May and September.
  • You’ll be expected to review meeting materials in advance and occasionally may be assigned action items between meeting dates.
  • You’ll be compensated at a consultant rate of $75 an hour and reimbursed for reasonable expenses.

Interested in applying? Send your resume to Benjamin Kung ipac@cpsa.ab.ca.

About CPSA IPAC

CPSA creates standards, guidelines and resources for community clinics to help protect both patients and clinic staff from the risk of infection. We oversee both IPAC and MDR in community clinics.

CPSA assessors regularly perform on-site clinic reviews to make sure clinics meet best practices in IPAC and MDR. We also work closely with our partners at Alberta Health Services to investigate and resolve IPAC-related public concerns.

CPSA’s IPAC advisory committee helps develop our IPAC and MDR standards, reviews assessors' notes from clinic visits and determines whether a clinic receives a CPSA certificate for medical device reprocessing, or if the physicians in charge needs more training and resources to help them meet our expectations.

Questions? Contact Benjamin Kung at ipac@cpsa.ab.ca or 780-969-5004.


Professional Conduct report

CPSA cancels practice permit of physician from Stony Plain

After pleading guilty to six counts of unprofessional conduct, Dr. Sanjeev Bhardwaj, a family physician from Stony Plain, was stripped of his permit to practice medicine in Alberta by a CPSA hearing tribunal.

Background

At his disciplinary hearing in late 2018, Dr. Bhardwaj admitted to sexual involvement with four of his patients, prescribing high levels of opioids to one of those patients (who displayed clear signs of addiction) and failing to report this conduct to CPSA during the annual registration renewal process.

A hearing on sanction was held in 2019, during which CPSA’s Complaints Director asked the tribunal to revoke Dr. Bhardwaj’s practice permit. Dr. Bhardwaj acknowledged his misconduct but advised that he had taken steps to address his behaviour and improve himself.

After considering all of the arguments presented, the hearing tribunal agreed with the Complaints Director’s recommendation and ordered the cancellation of Dr. Bhardwaj’s permit to practice medicine. He was also ordered to pay 50 per cent of the costs associated with the investigation and hearing. Dr. Bhardwaj has 30 days from the date on the decision to notify CPSA in writing if he wishes to appeal—as of the date of this publication, he has not done so.

Commentary

This case predates Bill 21: An Act to Protect Patients, which means current sanctions against health care professionals who commit sexual misconduct did not apply. Regardless, CPSA still requested the cancellation of Dr. Bhardwaj’s practice permit, citing society’s increased understanding of the harm caused by sexual misconduct and the expectations of health professionals who have been entrusted with patient care.

The misconduct in this case took place over a prolonged period of time and in at least two instances, involved extremely vulnerable patients. Recognizing the gravity of Dr. Bhardwaj’s conduct and its continued impact on his patients, the hearing tribunal agreed license revocation was an appropriate sanction. CPSA trusts that this decision sends a strong message to both the profession and public and will be seen as a precedent for future, similar cases.