October Messenger 2018

Melissa Campbell CPSA, Messenger


The more things change, the more they stay the same

Cannabis will soon be legal—so what’s next?

With the legalization of cannabis taking effect on Oct. 17, you may be wondering: “What do I need to do differently?”

The short answer: Nothing!

The long answer: Our expectations regarding medical cannabis authorization will remain the same after legalization as they are today. A physician who chooses to authorize cannabis for medical purposes must:

  • register with the College as a cannabis authorizer by emailing  your name and registration number to CMPInfo@cpsa.ab.ca (once you receive confirmation of your registration from the College, you can start authorizing medical cannabis to your patients),
  • follow up with patients taking medicinal cannabis every three months at minimum, to evaluate the effectiveness of the treatment,
  • explore other conventional therapies,
  • review the patient’s medication profile on available prescription databases (e.g., Pharmaceutical Information Network), and
  • comply with all provincial and federal regulations.

Additionally, the Alberta College of Pharmacy has confirmed that as of Oct. 17, Alberta pharmacies will be able to accept medical cannabis for safe disposal.

Refer to our standard of practice Cannabis for Medical Purposes and corresponding Advice to the Profession document, plus additional resources on our website.

Questions? Send an email to CMPInfo@cpsa.ab.ca.


Give your feedback on a draft Opioid Agonist Treatment (OAT) standard

Advances in OAT and growing need call for a new approach

Please note: For the purpose of this standard, Opioid Agonist Treatment (OAT) refers to full opioid agonist therapies only and excludes the partial agonist/antagonist buprenorphine/naloxone.

From Oct. 1 – Nov. 30, the College will gather feedback on a new draft standard of practice: Opioid Agonist Treatment (OAT). The new standard is needed to better support physicians in using current, evidence-based guidelines to treat opioid use disorder (OUD) and ensure safe patient care. The language used in the draft also reflects our evolving understanding of OUD and the need to reduce stigma, so more Albertans can access this care.

The current clinically-oriented Methadone Maintenance Treatment standard is becoming less relevant as OAT evolves and will be rescinded once the new OAT standard is approved (likely in spring 2019). The College is also streamlining its OAT approval process.

Please read the draft and provide your feedback. You’ll have the option to comment by survey, web form or email.

We want to know:

  • Does the draft OAT standard enable safe, effective care for patients with OUD?
  • Are the requirements for initiating, maintaining or temporarily prescribing OAT appropriate?
  • If you treat patients with OUD, do you see challenges implementing the standard in your practice?

Your feedback will help us improve the draft before it goes to Council and also inform a companion Advice to the Profession document.

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


Telemedicine advice provides a framework for safe patient care

Digital technologies offer many benefits, but risks must be managed

New digital technologies and growing patient expectations are driving interest in telemedicine as a complement to traditional in-person care.

Telemedicine offers many benefits. In addition to facilitating access to health care for patients, it promises more efficient use of scarce resources, better engagement in personal health, better management of chronic health conditions and easier access to expert opinions.

As the medical regulator, the College’s role is to enable telemedicine while ensuring patients continue to receive safe, effective care. Working with practising physicians, Alberta Health Services, the Alberta Medical Association, and in consultation with the Canadian Medical Protective Association, we’ve developed a new Telemedicine Advice to the Profession document to provide a framework for safe patient care in a digital environment. The advice also links to FAQs for patients on a new webpage offering Advice for Patients.

We welcome your feedback.

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


New MAID reporting requirements explained

Tune into a live webinar on Oct. 25 at 7 a.m.

What’s changing?

On Nov. 1, 2018, the Government of Canada’s new Monitoring of Medical Assistance in Dying (MAID) Regulations come into effect. The new regulations will require physicians and nurse practitioners to file reports at each step in the MAID process, including when they receive a request for MAID. Pharmacists who dispense any substance for MAID will also be required to report basic information.

Who is impacted?

All Alberta physicians, nurse practitioners and pharmacists who participate in any aspect of the medical assistance in dying process.

Webinar details:

On Oct. 25 from 7 – 8 a.m., you can attend a live webinar and Q&A session. You will learn:

  • Why reporting is required, by who and when in various scenarios
  • The role of Alberta’s Care Coordination Service (unique in Canada)
  • What’s expected of the practitioner
  • Referrals for MAID and what they mean for practitioners and their reporting

Access to a computer is highly recommended for this visual presentation, which will include a flow chart for reporting.

To attend, please RSVP to melonie.keehn@ahs.ca. The session will be recorded and made available at www.ahs.ca/maid for those who cannot attend.

If you would like to submit questions prior to the session, send them to melonie.keehn@ahs.ca. All questions and answers will be collated in an FAQ document and made available on the AHS MAID website following the webinar.


Beat the holiday rush and renew your practice permit early

Annual Renewal opens three weeks from today

Watch your inbox on Nov. 1 for your first renewal reminder. Completing the Renewal Information Form (RIF) and paying your fees early will save you time right before the end of the year. Practice permits and professional corporations (PC) have to be renewed by Dec. 31.

If you belong to a PC with multiple shareholders, only the designated physician will see the PC renewal information. The complete PC permit and receipt will be posted to the practice profile of ALL shareholders.

Questions? Email annualbilling@cpsa.ab.ca.


Sign up for pre-authorized payment by Nov. 9 and you could win back your annual renewal fee!

Never worry about renewing your practice or professional corporation permit on time again—sign up for our Pre-Authorized Payment (PAP) Plan and we’ll automatically withdraw your fees this year on Dec. 3!

Need more incentive?

Anyone who fills out our form and signs up for PAP by Nov. 9 will be entered into a draw to win back the cost of their 2019 annual renewal fee ($1,960 for physicians, $200 for professional corporations). One physician member and one professional corporation will be selected and their refund processed after 2019’s fees are withdrawn on Dec. 3.

Already on PAP? You’re automatically entered into the draw!

Please note: To be eligible for the draw, you must be a member in good standing, with no disciplinary action within the last 10 years. Members presently subject to a disciplinary activity (i.e. upcoming hearing) are not eligible. CPSA staff members are also ineligible.

Questions? Contact memberinquiries@cpsa.ab.ca.


Have your say—vote in the College Council election

College Council, the governing body of the College of Physicians & Surgeons of Alberta, plays an important role in the success of profession-led regulation and medical practice in our province.

Elected physician members join public members (appointed by Alberta’s Lieutenant-Governor), Alberta’s medical school deans, a medical resident and a medical student observer on Council.

This year, we have 18 qualified and diverse physician nominees running for four open seats. Each candidate would be an excellent addition to College Council.

To vote in the election, you must meet the following criteria as per the CPSA bylaws:

“A regulated member on the General Register, the Provisional Register or the Limited Practice Register, (whether a physician, surgeon, osteopath or physician assistant), who is in good standing, may vote in an election.

A regulated member of the College shall be in good standing only if:

  • no fees, costs, fines, assessments, levies, or any other sums are owing by the member to the College;
  • the member has a valid and current practice permit that is not currently suspended; and
  • the member is in compliance with all orders or directions made pursuant to the Act.”

Ballots were emailed on Oct. 4 with instructions on how to vote. Voting will remain open until Thursday, Nov. 1 at 4:15 p.m.

Questions? Send an email to elections@cpsa.ab.ca.


Do you know how to report a privacy breach?

New resources help you meet new reporting requirements

Resources are now available to help custodians and their affiliates understand new mandatory privacy breach reporting.

Published by the Office of the Information and Privacy Commissioner of Alberta (OIPC) and Alberta Health, these resources will help you:

  • understand the components of assessing “risk of harm” and when to notify individuals,
  • update your privacy breach response plan, and
  • train your affiliates.

New reporting resources:

The above sites also include downloadable notification and reporting forms.

About mandatory reporting:

As of Aug. 31, 2018, Alberta physicians must notify patients, the Information and Privacy Commissioner and the Minister of Health when health information has been subject to a privacy breach and there is a risk of harm to the individual.

Mandatory reporting applies to all health custodians, including Alberta Health Services, Alberta Health and Covenant Health. Physicians employed by these organizations should follow their employers’ internal reporting policies and procedures.

Physicians who do not report a privacy breach or do not have appropriate administrative, technical and physical safeguards in place to protect health information could face fines up to $50,000.

Questions? Contact the HIA Help Desk at 780-427-8089 or hiahelpdesk@gov.ab.ca.


College seeks community-based surgeon for IPAC Advisory Committee

Are you an experienced surgeon with an interest in infection prevention and control?

If so, we want you to consider an active role in profession-led governance with our Infection Prevention & Control (IPAC) Advisory Committee.

This multidisciplinary committee provides expertise and advice to the Competence Committee (a standing committee of College Council) to help ensure IPAC standards are consistently adopted and met in physician offices and clinics.

We promise an interesting, challenging and satisfying experience.

As a surgeon who performs office-based procedures using flexible endoscopes, you will add expertise and complement current representatives from Infection Prevention & Control, Public Health, the AMA and family physicians.

Qualifications:

  • Surgeon in good standing with the College
  • Experience performing endoscopic procedures (e.g. sigmoidoscopy, nasopharyngoscopy) in community settings
  • Minimum of five years’ practice experience
  • Participation in past IPAC program assessment(s) and knowledge of endoscope reprocessing are considered valuable assets

Expected time commitment:

The IPAC advisory committee meets three times a year, typically in January, May and September. As well as attending meetings, you will be expected to review meeting dossiers in advance (150-200 pages) so you can fully participate in discussion and decision-making.

Honorarium and expenses are paid at College rates.

For more information or to apply, contact Benjamin Kung, Program Manager, at 780-969-5004 or benjamin.kung@cpsa.ab.ca.


The importance of accurate billing and ethical practice

Why physicians cannot and should not provide treatment to family members

In 2017, the CPSA received information from the Minister of Health regarding a number of Alberta physicians and their compliance with the Canadian Medical Association’s Code of Ethics. In accordance with section 56 of the Health Professions Act, the CPSA’s Complaints Director treated the information as a complaint and opened an investigation.

One such Alberta Health audit conducted over a 26-month period found that Dr. Richard Flayne Byam, a general practitioner from Okotoks, had improperly invoiced Alberta Health on 191 occasions for care he provided to his grandchildren. He also failed to document the care provided during the majority of these visits.

Upon being contacted by the CPSA, Dr. Byam accepted responsibility for his incorrect billing practices, explaining that he mistakenly believed the restriction on providing care to “family” did not apply to grandchildren. Dr. Byam has since repaid all of the associated billing costs and agreed that the CPSA’s Complaints Director could publish his story in The Messenger as a condition of closing the complaint against him.

A lesson for the profession

During Alberta Health’s audit of all physicians billing the Alberta Health Care Insurance Plan, Dr. Byam was just one of over 450 physicians who were found to have improperly billed Alberta Health for providing care to family members.

All physicians practising in our province are expected to remain aware of all procedures, restrictions and rules regarding billing for services. Alberta Health has some great resources if you’re ever unsure or need a refresher.

With regard to treating family members, the CMA’s Code of Ethics states that physicians are to:

"Limit treatment of yourself or members of your immediate family to minor or emergency services and only when another physician is not readily available; there should be no fee for such treatment."

Furthermore, a 2012 Alberta Health Care Insurance Act bulletin defined a physician’s “family” as “children, grandchildren, siblings, parents, grandparents, spouse or adult interdependent partner or any person who is dependent on the practitioner for support in accordance with the Alberta Health Care Insurance Regulation”.

It is also important to be aware of the ethical implications of treating a family member. Physicians are expected to take a measured and objective approach and maintain professional boundaries in providing care, which can be difficult when treating someone you’re close to—there is an inherent bias. Referring your family members to a trusted colleague is the best way to ensure they are receiving excellent and appropriate health care and you’re meeting your ethical obligations as a physician.

Questions or concerns? Contact Dr. Michael Caffaro, CPSA Complaints Director, at michael.caffaro@cpsa.ab.ca, or 780-969-4971.


Ensure prescriptions don’t fall into the wrong hands

Why confirming your patient’s pharmacy-of-record is so important

A pharmacy in Alberta dispenses several medications prescribed on a Triplicate Prescription Program (TPP) list pad. At first glance, not an unusual situation.

Unfortunately, the patient for whom the medication was prescribed had recently passed away, which means an unknown person(s) picked up at least three prescription refills not meant for them.

We all know medications can become dangerous in the wrong hands. Here are some things you can do to ensure TPP drugs are only dispensed for use by the intended person:

  • Make sure you or your staff regularly confirm a patient’s pharmacy-of-record. In the above situation, the late patient had changed pharmacies and his physician was unaware.
  • If you discontinue prescribing a TPP-listed medication to a patient, or if your patient passes away, inform their pharmacy-of-record. This should be documented in a controlled substances contract.

As physicians, we share in the responsibility of ensuring the medications we’re prescribing are being dispensed and used appropriately.

For more information on the College’s prescribing expectations, check out these standards of practice, their companion Advice to the Profession documents and our TPP program page:

Questions? Email TPPInfo@cpsa.ab.ca.


Grande Prairie urologist breaches Code of Ethics

Grande Prairie urologist Dr. Camille Torbey was found guilty of unprofessional conduct and sanctioned by a College Hearing Tribunal.

The original decision in this case was made in July of 2016. However, sanctions were stayed as Dr. Torbey appealed to CPSA Council, who upheld the original decision in May of 2017. Dr. Torbey then appealed Council’s decision to the Alberta Court of Appeal, where it was dismissed on Sept. 5, 2018.

Background

In 2012, a review by the Surgical Services Committee at Grande Prairie’s Queen Elizabeth II Hospital resulted in a reduction to Dr. Torbey’s operating room allotments. Dr. Torbey disagreed with this decision and the situation exacerbated ongoing disputes he was having with the hospital’s administration.

After several attempts to address the situation directly with the Surgical Services Committee and leadership at the hospital, Dr. Torbey ultimately refused to use his scheduled time in the operating room between Feb. 1 and May 9, 2013. This was done without properly notifying the affected patients of his withdrawal of services.

Dr. Torbey also inappropriately sent a letter to several of his patients, asking them to become involved in his dispute with the hospital and advocate on his behalf. The letter specifically named certain members of the hospital administration and questioned their competency.

Dr. Torbey’s conduct in both instances was found to be in violation of the Canadian Medical Association’s Code of Ethics.

Orders of the Hearing Tribunal

The CPSA Hearing Tribunal ordered the following sanctions:

  1. Either a one-month suspension from medical practice or completion of a Comprehensive Occupational Assessment for Professionals—Dr. Torbey chose to complete the suspension, beginning Nov. 1, 2018.
  2. Payment of 50 per cent of the costs associated with the investigation and hearing (totaling $38,899.59), plus the costs associated with the Council Appeal ($3,325.48) and the Alberta Court of Appeal process ($3,367.25).

Commentary

The Hearing Tribunal recognized the mitigating factors in this case, mainly that the atmosphere in the hospital’s surgery department was, at the time, allegedly acrimonious and dysfunctional. As a result, Dr. Torbey felt bullied and mistreated by the hospital administration and believed that, through his actions, he was advocating for himself and his patients.

While there is no evidence Dr. Torbey meant to purposefully put anyone at risk, he ultimately did not account for the wellbeing of his patients as they were left without access to needed health resources. Physicians have a duty to place the interest of their patients ahead of their own, and while Dr. Torbey did not have any previous findings of unprofessional conduct, these charges were serious enough to warrant sanctions such as suspension and cost repayment as a deterrent against such conduct.