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Minutes One Hundred and First Annual Meeting College of Physicians and Surgeons of Saskatchewan

The One Hundred and First Annual Meeting of the College of Physicians and Surgeons of Saskatchewan was held at the Radisson Hotel, Saskatoon, Saskatchewan on Saturday, September 20, 2008, commencing at 12 noon.

Call to Order

The meeting was called to order by Dr. G. Fernandes, Vice-President of the College and Chair for the meeting.

Presidential Report

Dr. S. Kassett, President of the College, gave a report on some of the activities of Council over the past year.

Dr. Kassett reported that registration issues continued to take up a substantial portion of Council's time over the past year. Authenticating documentation from foreign trained physicians is often a very time consuming process and uses up a substantial amount of the College's financial as well as human resources.

Saskatchewan continues to rely heavily on International Medical Graduates (IMGs), but more so in rural or remote areas. The College's primary mandate continues to be public protection and in order to establish whether these physicians are considered safe to practice, they are required to take the CAPE Assessment as soon as possible after registration, often within six months. Approximately 9% of IMGs undergoing the CAPE are deemed unsafe to practice independently. Since the College cannot determine at the outset which physicians are capable of independent practice, a Group Practice Policy was adopted at the June Council meeting requiring IMG family physicians to work in a group setting of 3 or more physicians. This also provides IMGs with collegial support while they are attempting to obtain their registration requirements, which includes the CAPE Assessment.

Dr. Kassett noted that the Agreement on Internal Trade (AIT) is an agreement made between the Government of Canada, the Provinces, and the Territories in order to facilitate trade and mobility between the different areas of Canada. According to this agreement, any fully licensed physician in one jurisdiction would be licensable anywhere in Canada. Obviously this will allow physicians more portability and may have significant implications on Saskatchewan's physician manpower. Physicians who do not hold full registration and are on an alternate form of licensure may also be eligible for registration in other jurisdictions. Rural Saskatchewan relies heavily on physicians on alternate forms of licensure and therefore may be at risk of becoming even more under-serviced.

Dr. Kassett reported that the number of serious complaints filed against physicians significantly increased over the past year. Some of these have resulted in criminal charges being laid against the physician by the RCMP. All allegations of sexual misconduct are treated as serious complaints and, unfortunately, physicians sometimes feel they are presumed guilty before it is proven so. The appointment of a Preliminary Inquiry Committee simply implies that either Council or the Council's Executive Committee feels there are sufficient grounds to investigate the complaint further. The process for dealing with complaints is often very time-consuming and matters that end up in disciplinary hearings are typically expensive. Fortunately the high volume of complaints received this year is unusual, and Council is hopeful it will settle down to more normal levels in the near future.

Dr. Kassett reported that over the last few months there has been media attention regarding abandoned medical records. Often when physicians retire or relocate medical records can become a liability in terms of storage, and physicians may be unaware of their responsibility with reference to the records in their possession. He encouraged all physicians who are unsure of these obligations to contact the College of Physicians and Surgeons for advice.

Lastly, Dr. Kassett commented on the Pharmaceutical Information Program (PIP). Physicians who are using the PIP find it very useful, but unfortunately the uptake has been relatively small. He thought it could be that physicians do not fully understand that they are able to obtain any patient's current prescription profile by simply accessing this program. He noted that PIP can be extremely useful, for example, in situations where a patient arrives in an emergency department and is unable to provide or unable to recall what medications they have been prescribed. As a reminder, Dr. Kassett noted this program is available to all physicians who want to utilize it in their practices.

Registrar's Report

Dr. D.A. Kendel, Registrar, noted that as of January 1, 2009 he will have served twenty-three years as Registrar of the College. He also noted that Jeannette Heinen, his executive secretary and the secretary to the Council, has been employed by the College for forty-nine years and will be retiring at the end of 2008. He then introduced the senior management staff of the College, which is comprised of Dr. Karen Shaw (Deputy Registrar), Mr. Bryan Salte (Associate Registrar), who was absent from the meeting, and Ms. Barb Porter (Manager of Physician Registration). He noted that the College works on the basis of a governance policy made up of five main Ends:

Dr. Kendel commented on the College's involvement in the issue of patient safety. He reported that last year the Council engaged in a strategic planning process and rather than the plan where everything is to be tackled in a certain timeframe, the Council identified more strategies and potential actions the Council could do to advance these Ends than the College has resources and time to do at the moment. Therefore they are being worked at incrementally. He noted that two things were signaled by the Council. One is that in most of these Ends it's utterly impossible for the Council to achieve this on its own. So the College is going to have to work collaboratively with more and more organizations to achieve its Ends. The other is that Council is going to need to be somewhat innovative.

It's often said that if you keep doing things the way they have been done you should not be surprised it the results are always the same. In order to change some of the outcomes, Council will need to think of doing things in different ways and to that end has reserved some monies to actually create an Innovation Fund for use by the Registrar to foster some innovative approaches to quality improvement and patient safety. He noted the College is working collaboratively with two organizations he wished to particularly reference, the Saskatchewan Medical Association and the Health Quality Council. He stated the College and the SMA necessarily have different points of view on some issues because the responsibilities are different, but in relation to quality of care and patient safety the College and the SMA are absolutely on the same page. The Council has also decided to work with the Health Quality Council to increase physician engagement in quality improvement and patient safety. To that end the three organizations recently sponsored collectively six physicians going to a learning experience in Boston sponsored by the Institute for Healthcare Quality Improvement. Both the College and the SMA are prepared to use some funds to continue to help physicians become more engaged in this very important work.

Question Period

Dr. M. Vogel, CEO of the Saskatchewan Medical Association, stated it is with concern that he looks around the country and sees in some provinces the troubles medical colleagues are finding themselves in. He looks to the west and sees governments stepping in and legislating regulatory authority into the hands of politicians. He stated only way the medical profession can maintain self-regulation is if the public has absolute confidence that that job is being done well.

He asked that the Council of the College consider commissioning an independent review of the activities of the College Council to ensure that the public has absolute confidence in the function of the College.

The President stated the Council is often accused of being very regimented and "walk around with a big stick". He noted that most physicians are concerned when they get a letter from the College. He also noted the public needs to have confidence in the College that all complaints received are indeed reviewed. He did note his opinion that in Saskatchewan the College of Physicians and Surgeons is not at serious risk of government takeover. However, the College must remain very aware of what's going on, not just in Canada but the world (e.g. what happened in Great Britain).

The Registrar stated the College is always mindful of the fact that professionally led regulation is a privilege, not a right, and physicians need to continually earn that privilege. In terms of the events that have occurred across Canada in recent years in terms of legislation being modified to have government more directly attuned to the regulatory process or to have provisions in the legislation that says if they're not happy they can override the decisions of regulatory bodies, he stated he has always felt that if the College is sufficiently proactive and progressive and is doing things that frankly it would be difficult for the government to do then the College will deserve to continue to exist. If the College does not meet the public's expectations and, in fact, there's a better way to regulate than the current model, then the College must have the courage to acknowledge that fact.

The Registrar noted that since the conference is focused on inter-disciplinary collaboration, he believes that the one thing that must be changed in terms of how the professions are regulated is acknowledgement that health care outcomes are determined more often by team effort rather than the performance of individual professionals.

Ms. Donna Brunskill, Executive Director of the Saskatchewan Registered Nurses Association, said that within the nursing sector there had a very "hot" issue in the mid 1990's and one of the things arising out of this was the development of a policy by the SRNA whereby every one of their regulatory programs would go through an external evaluation at least every five years. She agreed that incidents will always happen, but when they do happen it is essential that a review be undertaken as to what can be improved so that it won't happen again. She said she believes that when one hears or sees something going on in other provinces it's good for Saskatchewan regulatory agencies to pay attention and then begin to initiate something as quickly as possible to prevent it from happening in this province. She said that if and when the SRNA can ever work with the College she would want the members to know that she highly values the collaborative relationship that exists between the SRNA, the College of Physicians and Surgeons and the College of Pharmacists.

Dr. M. Mirchandani from Yorkton acknowledged there are a lot of patient safety issues related to physicians, to nurses, to pharmacists (and to many good caregivers). However he believes the organizations must take it upon themselves to look at systemic failures in health care, but it should not just be limited to the professions of medicine, nursing and pharmacy.

Dr. Registrar stated he couldn't agree more; that probably the greatest proportion of risk in the system is systemic in nature. It is not due to incompetent practitioners. But when you use the word "systemic" it must be made clear what is meant by it. When one looks at the harm that occurs (the best data are in relation to hospital mortality) probably about 40% of the mortality is attributable to medication error and largely to communication errors between what physicians intended and what actually happens. Systemic programs, like the Medication Reconciliation, are ways to mitigate that risk and many regions are instituting these programs. It is his belief that in the area of medication safety the role of pharmacists has been under utilized.

A representative from the Saskatchewan College of Pharmacy gave a bouquet to Dr. Kendel and the Council for the leadership shown in the area of systemic situations.

Ms. Marg Moran McQuinn, Executive Director of the Communications Branch at the Ministry of Health had two questions, one of which relates to something that is going on in other provinces (in B.C.). There was a news story just the other day that the B.C. Health Minister is stepping in to require the College of Physicians and Surgeons and the College of Nursing in that province to publicly post disciplinary action taken against their members. What is done in Saskatchewan?

The Registrar explained the transparency process from the time that a charge is laid against a physician. He also noted that an Executive Summary is produced the next working day after each Council meeting that is disseminated to other regulatory agencies and to the public media. He stated that discipline hearings of the College are open to the public as are the occasions when the Council sets penalty following a discipline hearing.

The Registrar stated the one thing that is not consistent across the country yet, and which Saskatchewan has not yet done, is the use of physician profiling. The practice called Physician Profiling is readily accessible on a website where there is a summary of a physician's professional record of performance. This was broached with the Council two or three years ago but at that point the Council did not vote in favor of this procedure. There is a question of the "balance" of the information included on the website. This phenomenon started in the United States, but there is quite a bit of variation between different states as to what goes on the profile. Manitoba was the only College mandated by government to institute physician profiling.

The other question Marg Moran McQuinn had related to Physician Assistants and the fact that these have been used in other provinces. She wondered what the College's position is on this.

The Registrar replied that the term "physician assistants" is used quite differently. Some provinces, like Ontario, use anesthesiology assistants, but they are actually respiratory technologists who have had some additional training. The Physician Assistant Program in the United States was brought about because of the Viet Nam War because there were hundreds and thousands of paramedics recruited by the military who when they returned home wanted something to do and there were not enough jobs in the pre-hospital ambulance care business so they created the Physician Assistant. In some respects it has served people well in the U.S. The Canadian system is somewhat different and the Province of Manitoba is the only province at the moment that has created the legislative framework for physician assistants (they call them clinical assistants). His personal view is that the skill set in the existing 23 PAs in this province and there is an insufficient supply of them. So if there was a sufficient supply of, for instance, registered nurses and nurse practitioners there shouldn't be any call for physician assistants because that role would be largely filled. In his view, the Registrar stated that care must be taken not to create yet another worker category. As to the suggestion of using international medical graduates who do not meet the grade to meet this need, the Registrar stated there are already IMGs functioning in limited roles.

Adjournment

The meeting adjourned at 1:00 p.m.

Recording Secretary - J. Heinen