September Messenger 2018

Melissa Campbell CPSA


Medical Assistance in Dying: important updates

Some significant changes impact the provision of Medical Assistance in Dying (MAID)

In most cases, the Medical Examiner (ME) won’t need to examine the patient’s body after MAID: Effective Aug. 20, 2018, if the MAID provider submits the required documents to the ME promptly (within 24 hours) and the ME has no questions, the family can keep the body of their loved one in their community and proceed with final arrangements. For patients who self-administer MAID medications at home, EMS will communicate with the Office of the Chief Medical Examiner to ensure paperwork from the providing practitioner is tracked. Full details and a fax cover sheet identifying all the documents required by the ME are posted in the Physician Portal, under Additional Resources.

New federal reporting requirements are coming: As of Nov. 1, practitioners will have to report various scenarios under new federal regulations for monitoring MAID. To make this as easy as possible, the AHS Care Coordination Service is working with the CPSA, the Alberta College of Pharmacists and the College and Association of Registered Nurses of Alberta to develop clear instructions, easy-to-use forms and support. More details will be available in the October Messenger and links to the materials will be posted in the Physician Portal under Additional Resources before the regulation takes effect.

Important reminder: MAID resources and information are updated regularly. If you receive an inquiry, please ensure you refer to the resources in the Physician Portal.

For more information on MAID, contact MAID.careteam@ahs.ca or CPSA Standards of Practice Coordinator Chantelle Dick at chantelle.dick@cpsa.ab.ca.


Do we have the best email to reach you?

To keep you informed of important details about your registration, annual renewal, continuing competence programs and other CPSA news, we need your most active email address—one you check often.

College members are responsible for being aware of their professional and ethical obligations. We support this by sending you information regularly.

Not sure if the College has your latest contact information?

  1. GO to the CPSA Physician Portal.
  2. LOG IN using your CPSA registration number and password.
  3. UPDATE your email address under My Profile.
  4. SIGN OUT of the portal after each use to protect your CPSA information. Do not just close your browser window.

Signing up for pre-authorized payment can save you late fees

Annual renewal happens over the holidays and almost every year, some members miss the Dec. 31 deadline to complete their Renewal Information Form (RIF), which results in late fees. Last year, 668 physician members and 698 professional corporations paid a late penalty.

Here are a few ways you can reduce your stress over the holiday season and make annual renewal easier: 

  • Make sure we have your correct email address. We’ll send you courtesy reminders over the next few months in Messenger and by email. If you’ve changed your email address recently, make sure you update your email in the Physician Portal or send us an update at memberinquiries@cpsa.ab.ca.
  • Ask Siri to remind you. While the College sends courtesy email reminders, these can be missed, bounced back or delivered to your junk mail. Even if you don’t see the email notice, you’re still responsible to renew before the Dec. 31 deadline. Set a personal reminder so you don’t forget!
  • Add info@cpsa.ab.ca to your email contacts. To prevent notices from going into your junk mail, make sure you put us on your list of allowed senders.
  • Beat the holiday crowd. If you’re planning a vacation or office closure, make early renewal part of your plan. There’s always a last minute rush to complete the RIF and pay fees before the year ends. We do our best to prepare for last minute renewals, but the sudden web traffic can overwhelm our servers, causing everyone frustration. The sooner you renew, the sooner you can relax!
  • Don’t forget to renew your professional corporation. Professional corporation (PC) renewal is a separate process, with its own form and fees. If your PC has multiple shareholders, only the designated physician will see the PC renewal information. The completed PC permit and receipt will be posted to the practice profile of ALL shareholders.
  • Sign up for the Pre-Authorized Payment (PAP) Plan. You’ll still have to submit your RIF, but we’ll automatically withdraw your fees in early December. Just one less thing for you to do! Members can also pay online by credit card. If you’re mailing a cheque, we need to receive it by Dec. 31, so make sure you mail it early.

Questions? Email memberinquiries@cpsa.ab.ca.


Why join College Council? Let us list the reasons why…

We are accepting nominations for four physician members of Council, for three-year terms beginning Jan. 1, 2019. Wondering if you should run for a spot? Here are some reasons why you should:

  • Develop your leadership. Being on Council means playing a direct role in moving your profession forward.  As a Council member, you’ll meet other physician leaders and take part in the conversations that will ultimately shape the way you and your fellow physicians deliver patient care.
  • You have an important perspective. Every physician has experienced unique successes and challenges that have shaped how they view and practise medicine. Different outlooks around the table contribute to well-rounded decisions.
  • Health care is changing every day. From telemedicine to team-based health care, the medical profession is evolving. By joining Council, you can be part of the evolution.
  • A different kind of commitment. When physicians enter practice, they commit to providing their patients with the best possible care. Joining Council means expanding that commitment to building a quality health care environment for all Albertans.

Serving on College Council means truly making a difference.

We are accepting nominations until Sept. 26. Don’t miss out on this challenging, engaging and rewarding opportunity!

Questions? Email elections@cpsa.ab.ca.


Three Alberta physicians face CPSA Hearing Tribunals

Long-time Edmonton cardiologist disciplined for follow-up failure

In a joint submission by Dr. Zaherrali Lakhani and the College’s Complaints Director, Dr. Lakhani admitted to unprofessional conduct before a College Hearing Tribunal.

Background

In 2012, patient ‘AB’ saw Dr. Lakhani in referral from his family physician for concerns of tachycardia and hypertension. As part of his work-up, Dr. Lakhani ordered an echocardiogram, which was performed on Nov. 23, 2012. The results were sent to his office but were not reviewed by Dr. Lakhani and were simply filed in the patient’s record. At two subsequent office visits on Jan. 10 and Feb. 8, 2013, AB was never informed of an incidental finding of the echocardiogram—a mass of unknown etiology adjacent to the right adrenal gland. AB’s care was subsequently returned to his primary care physician. Years later, when AB was seen by another physician, he was made aware of the finding from 2012. Unfortunately, at that time a significant medical condition was diagnosed.

The matter was brought to the attention of the College and investigated. Dr. Lakhani cooperated fully throughout and demonstrated practice improvements in the interim that would prevent a recurrence of this incident. However, because the complainant did not agree to an informal resolution short of a hearing and the incident was a clear violation of the Preventing Follow up Care Failures standard of practice (now called Continuity of Care), the Complaints Director proceeded with formal discipline.

Orders of the Hearing Tribunal

The agreed-to charges included:

Between Nov. 6, 2012 and Feb. 9, 2013, Dr. Lakhani did display a lack of knowledge or a lack of skill or judgment in the provision of professional services to his patient, particulars of which include one or more of the following;

  • Dr. Lakhani failed to review the report dated Nov. 23, 2012 from the echocardiogram he ordered,
  • Dr. Lakhani failed to inform his patient of the results of the echocardiogram report, dated Nov. 23, 2012,
  • Dr. Lakhani failed to have a consent discussion with his patient regarding the options for further investigation or treatment of the mass on or near his right adrenal gland, noted on the echocardiogram report dated Nov. 23, 2012.

The Tribunal sanction included:

  1. A reprimand, and
  2. Payment of 50% of the costs of the investigation and hearing ($6,753.62).

Commentary

This was an unfortunate case for both the patient and Dr. Lakhani, a practitioner with more than 30 years of unblemished medical practice in Alberta. The seemingly mundane task of receiving and directing various investigation reports for patients is expected to be done in a consistent and organized fashion that ensures the ordering physician reviews and actions each result. While the reporting radiologist identified the unexpected finding in this case, Dr. Lakhani was responsible to review the finding and take appropriate action.

There are parallels in this case to the matter of Mr. Greg Price, a patient who died unexpectedly following surgery for testicular cancer and the subject of a 2013 review by the Health Quality Council of Alberta (Continuity of Patient Care Study). Regulated members are reminded that the ordering physician must ensure there are systems in place to review investigation results and ensure appropriately follow-up with the patient.

Calgary physician disciplined for failing to recognize labour complications

In a joint submission by legal counsel for the College of Physicians & Surgeons of Alberta and the regulated member respectively, Dr. Malgorzata Ejsmont admitted to a charge of unprofessional conduct and was sanctioned by a College Hearing Tribunal.

Background

On June 19, 2014, Dr. Ejsmont, a recently-qualified family physician with training in obstetrics and gynecology, was on duty at Calgary’s Foothills Medical Centre. During this shift (her ninth in low-risk obstetrics), she became responsible for the care of patient “R-A”, who was in labour with her first child. Dr. Ejsmont failed to recognize that R-A’s labour was not progressing satisfactorily or that the fetal heart rate had become abnormal, and did not respond appropriately to either situation. As a result, the on-call senior obstetrical resident stepped in and moved R-A to the operating room for a forceps delivery. The baby suffered shoulder dystocia, had low Apgar scores and spent nine days in hospital after birth, diagnosed with stage II hypoxic ischemic encephalopathy.

The Hearing Tribunal found that Dr. Ejsmont demonstrated a lack of knowledge, skill and judgment in failing to recognize that R-A’s labour was not progressing or that her unborn child was in distress. While Dr. Ejsmont was a relatively new physician at the time, all members practising in Alberta are held to a minimum standard of care. That standard was not met in this case, constituting unprofessional conduct.

Orders of the Hearing Tribunal

The Hearing Tribunal accepted the joint submission on sanction and ordered that Dr. Ejsmont:

  • receive a reprimand;
  • be restricted to practising low-risk obstetrics only;
  • be required to participate in the Society of Obstetricians and Gynecologists of Canada’s Managing Obstetrical Risk Efficiently (MOREOB) program, for as long as her practice includes obstetrical deliveries;
  • pay the cost of the investigation and subsequent hearing (totalling $18,619.09).

Commentary

The Hearing Tribunal considered several factors before making a decision in this case. Dr. Ejsmont had no prior history of unprofessional conduct and was deeply apologetic and forthright in acknowledging what occurred. She has demonstrated insight into her conduct and taken steps to improve her practice, such as completing professional development courses to increase her knowledge in obstetrics and to advance her communication skills.

It’s important that sanctions promote deterrence and demonstrate consistency with penalties handed down in similar cases. A reprimand is a serious consequence for a physician, and the conditions placed on Dr. Ejsmont’s practice will help ensure safe practice going forward and meet the College’s mandate to protect the public.

Calgary practitioner sanctioned for failing to communicate with the College

Dr. Moises Lasaleta, a general practitioner from Calgary, admitted to four counts of unprofessional conduct before a College Hearing Tribunal.

Background

In June 2016, an allegation was made to the College that Dr. Lasaleta had engaged in an inappropriate relationship with a patient (the complainant’s wife). Soon after, Dr. Lasaleta returned to his native country (the Philippines) without notifying the College.

In July 2017, an additional complaint was lodged against Dr. Lasaleta, alleging he had failed to respond to a March 2017 request for medical records. Numerous attempts by the College to communicate with Dr. Lasaleta regarding these issues via mail, email and telephone went unanswered for unreasonable lengths of time.

While mitigating factors contributed to the delay in responding adequately to the College while overseas (e.g., unreliable internet service and a 14-hour time difference), the Hearing Tribunal noted that Dr. Lasaleta did have access to email and was back in Canada for a period of time before returning to the Philippines. Given the importance of responding to College communications, the Hearing Tribunal accepted Dr. Lasaleta’s admission and sanctioned him for unprofessional conduct. Dr. Lasaleta has since agreed to respond to any and all communications from the College in a timely manner.

The alleged boundary violation remains under investigation.

Orders of the Hearing Tribunal

 The Hearing Tribunal ordered that Dr. Lasaleta:

  1. Receive a one-month suspension of his practice permit. As Dr. Lasaleta’s permit is currently inactive, this suspension will commence once a new practice permit has been issued by the College.
  2. Pay for the costs of the investigations and hearing (yet to be determined).

Commentary

The Tribunal considered several factors in determining an appropriate sanction, such a previous complaint in which Dr. Lasaleta was found guilty and reprimanded for failing to answer communication from the College, as well as the length of time between the initial requests from the College and Dr. Lasaleta’s eventual responses. Failing to respond to requests from one’s regulatory body falls outside the range of accepted conduct for physicians in Alberta and it is important to deter this kind of behaviour.