College Complaints:

Censure or Opportunity

Dr. Micheal Howard-Tripp

Deputy Registrar

College of Physicians and Surgeons of Saskatchewan

September 30, 2016

Disclosure

I do not have any conflict of interest to declare other than I am

an employee of the CPSS.

I will not refer to the unapproved use of products or services.

Objectives

• Understand the role and function of the College of

Physicians and Surgeons

• Understand the College’s complaints Processes

• How to avoid and respond to College complaints

• Improve attitudes to the complaints processes

Why Does The College Of Physicians And

Surgeons Exist?

• One of the standard definitions of a profession is

that its members are given a monopoly in relation

to the practice of a task requiring skill and

knowledge and in return are expected to regulate

members in the public interest.

• College: an organized group of professional

people with particular aims, duties, and privileges.

Professionally Led Regulation

It is the College that regulates the

medical profession on behalf of the

profession and in the interests of, and for

the protection of, the public

Benefits of Professionally Led

Regulation Professional organizations understand the core nature

of ethical values to which the profession subscribes

Issues of discipline and competence are decided

primarily by members who bring their knowledge of

professional standards

The majority of the members of the governing body of

the profession are elected by the membership

Professionally led regulation encourages those

members of the profession who are able to do so to

donate their time to their profession

The Medical Profession Act, 1981

69.1 In any proceeding before the competency

committee or the discipline hearing committee, in

any consideration by the council of a report from

either of these committees and in any appeal

pursuant to this Act, the protection of the public and

the safe and proper practice of medicine shall take

priority over the rehabilitation, treatment and welfare

of a member.

MAJOR COLLEGE ACTIVITIES

Registration and licensing

Complaints

Quality of Care

Discipline

Competency

Discipline• The College receives information alleging that

physicians have engaged in unprofessional conduct.

• It investigates those investigations and, if there is a

basis to do so, will charge the physician with

unprofessional conduct.

• A physician charged has the right to a hearing before

the discipline committee - a group of physicians and

lawyers with administrative law experience who are

independent of the other activities of the College. The

role of the discipline committee is to determine if the

charge of unprofessional conduct has been proved.

Discipline• If a physician admits that she/he has acted

unprofessionally, or if the discipline committee

concludes that the physician has acted

unprofessionally, the Council will impose penalty on

the physician.

• The penalty can range from a reprimand to revocation

of licence, and includes such measures as suspension

of the physician’s licence, imposition of a fine or

restriction on the physician’s practice.

Competency

• After receiving information that a physician is not

capable of practising with the expected skill and

knowledge, the College can appoint a committee to

evaluate the physician’s skill and knowledge.

• If it reports that the physician lacks skill and knowledge

in all, or a part of their practice, a hearing is held to

determine what measures should be taken to protect the

public.

• This can consist of specific remediation, restriction on

the physician’s practice or revocation of the physician’s

licence to practice

Quality of Care Process

• Majority of complaints to the College

• Reviews medical care using an educational, non-

punitive approach

• Medical Manager reviews file and decides on

most appropriate means of resolution

• A Committee, consisting of 3 physicians and 3

public members reviews complaints

• If deficiencies in care are identified it will provide

suggestions for improvement to the physician

Quality of Care Process

• Educational – advice and correction

• Cannot sanction or discipline

• Finding does not appear on Certificate of

Standing

• Limited appeal process

Administrative and Regulatory

Bylaws

7.1 The Code of Ethics

8.1 Bylaws Defining Unbecoming, Improper,

Unprofessional or Discreditable Conduct

16.2 Response to College Requests for Information

Standards, Policies and Guidelines

Standards

Standards are formal requirements established by the

College with which members must comply. They

supplement the College’s bylaws and mandate clinical

and/or ethical standards in relation to defined areas of

practice.

Standards, Policies and Guidelines

Policies

Policies contain requirements set by the Council of the

College to supplement the Act and Bylaws. Policies are

formal positions of the College in relation to defined

areas of practice with which members must comply. The

Council also sets policies on registration, administration,

and governance of the College.

Standards, Policies and Guidelines

Guidelines

Guidelines describe practices that are generally

recommended by the Council of the College as part of

providing quality medical care in a professional

manner. Physicians licensed with the College are

encouraged to follow these recommended courses of

action and should exercise reasonable discretion in

their decision-making based on this guidance

Common Reasons for a Complaint to

the College

Timeliness of third party forms

Timeliness of response to a College request for

information

Continuity of care (handovers)

Follow-up care

Privacy concerns

Common Reasons for a Complaint to

the College

Communication and attitude

• The digital world, and social networking, has

made communication really efficient, for getting

and sharing information; yet, the most common

thread through all complaints is poor

communication!

Essential

Documentation

Documentation

Documentation

Documentation

Documentation

Documentation

Documentation

How to avoid a Complaint to the

College

Good Medical Practice

Good Communication

Set and maintain appropriate professional boundaries

Maintain professional disposition at all times. Call time-

out or get a colleague to assist in difficult encounters.

How to Respond to a Complaint

Acknowledgement and apology

Insight and reflection

Remediation/action/implementation

Avoid making excuses

Do not alter notes – audit trail

Consult a lawyer

The Chinese use two brush strokes for the word

‘crisis’. One brush stroke stands for danger; the

other for opportunity. In a crisis, be aware of the

danger – but recognize the opportunity. John F. Kennedy