College of Physicians and Surgeons of British Columbia Minutes

APPROVED

Board (Open) May 22, 2020

1 of 10

College of Physicians and Surgeons of British Columbia

Minutes Board (Open)

Friday, May 22, 2020 – 9:00 a.m.

VIA TEAMS

ATTENDANCE

Members present:

• Mr. B.C. Bell (President) • Dr. G. Parhar (Vice-President) • Dr. B.A. Priestman (Treasurer) • Dr. R. Abrahams • Dr. L. Dindo • Dr. A. Du Preez • Ms. J.W.E. Dyson • Dr. J.J. Kingsley • Dr. C.S. Leger • Mr. T.T.S. Mann • Mr. B.D. Penner • Ms. H.N. Purewal • Ms. S.F.J. Ross • Dr. P.D. Rowe • Dr. W.D. Sanden

Staff present:

• Dr. H.M. Oetter (Registrar/CEO) • Dr. M. Murray (Deputy Registrar) • Dr. D.A. Unger (Deputy Registrar) • Dr. D. Puddester (Deputy Registrar) • Mr. M. Epp (Chief Operating Officer) • Ms. C. de Bruin (Executive Director,

Registration) • Mr. G. Keirstead (Deputy Registrar, Chief

Legal Counsel) • Ms. S. Prins (Director of Communications

and Public Affairs)

Recorder of minutes:

• Ms. J. Sherle (Executive Office and Board Manager)

SUMMARY OF RESOLUTIONS AND ACTIONS DISCUSSED

Record of resolutions

Item # Item May 22, 2020 Resolution no.

4 Adoption of the Agenda

RESOLVED that the agenda for the Board open regular meeting scheduled May 21 & 22, 2020, be adopted, as circulated.

20-629

APPROVED MINUTES


2 of 10

Item # Item May 22, 2020 Resolution no.

5 Consent Agenda RESOLVED that the consent agenda for the Board open meeting be approved, with the following items in the consent agenda, as attached:

5.1 Registration Committee report 5.2 Health Professions Review Board report

– registration decisions and complaints dispositions

5.3 Inquiry Committee – Panels A-E 5.4 Inquiry Committee – Panel A 5.5 Inquiry Committee – Panel B report 5.6 Inquiry Committee – Panel C report 5.7 Inquiry Committee – Panel D report 5.8 Inquiry Committee – Panel E report 5.9 Patient Relations, Professional Standards and Ethics Committee report 5.10 Physician Practice Enhancement Panel report 5.11 Diagnostic Accreditation Program report 1. DAP Quality Management Systems Annual Report 5.12 NHMSFAP Patient Safety Incident Review Panel report 5.13 Library Committee report 5.14 Prescription Review Panel report

20-630

6 Adoption of the Minutes- February 28, 2020

RESOLVED that that the minutes of the Board open regular meeting held February 28, 2020, be adopted, as circulated.

20-631

10.1.2 Bylaw amendments update- Section 2-16 - Provisional class – preregistration requirements

RESOLVED that the Board amend the Bylaws of the College of Physicians and Surgeons of British Columbia, in accordance with the authority established in section 19(1) of the Health Professions Act, RSBC 1996, c.183 (the “Act”), and subject to sections 19(3) and (6.2) of the Act, as follows: Section 2-16 is repealed and replaced in the attached form.

20-632

APPROVED MINUTES


3 of 10

Action items

RFA # Item #

Item Responsible Action/comments

Board O-20-05-22-001

8 Report of the Registrar- Emergency Register

CPA Article in the College Connector acknowledging the physicians who volunteered to be licensed on the emergency class

Board O-20-05-22-002

12.2 Board Retreat date

HMO Doodle poll to be sent out with October 2020 dates for a Board Retreat

1. Coast Salish Peoples acknowledgement The president acknowledged that the land on which we gathered as the unceded territory of the First Nations Peoples, at the start of the Board meeting.

2. Call to order and chair’s remarks A quorum being present, Mr. B.C. Bell, President, called the meeting to order at 9:02a.m. on Thursday, May 21, 2020.

3. Declaration of conflict of interest No board members declared a conflict of interest.

4. Adoption of the agenda The following resolution was MOVED, SECONDED and CARRIED: RESOLUTION 20-629 RESOLVED that the agenda for the Board open regular meeting scheduled May 21 & 22, 2020, be adopted, as circulated.

5. Consent agenda The following resolution was MOVED, SECONDED and CARRIED: RESOLUTION 20-630 RESOLVED that the consent agenda for the Board open meeting be approved, with the following items in the consent agenda, as attached:

5.1 Registration Committee report 5.2 Health Professions Review Board report – registration decisions and complaints dispositions 5.3 Inquiry Committee – Panels A-E 5.4 Inquiry Committee – Panel A 5.5 Inquiry Committee – Panel B report 5.6 Inquiry Committee – Panel C report 5.7 Inquiry Committee – Panel D report

APPROVED MINUTES


4 of 10

5.8 Inquiry Committee – Panel E report 5.9 Patient Relations, Professional Standards and Ethics Committee report 5.10 Physician Practice Enhancement Panel report 5.11 Diagnostic Accreditation Program report 1. DAP Quality Management Systems Annual Report 5.12 NHMSFAP Patient Safety Incident Review Panel report 5.13 Library Committee report 5.14 Prescription Review Panel report

6. Adoption of the minutes: February 28, 2020 The following resolutions were MOVED, SECONDED and CARRIED: RESOLUTION 20-631 RESOLVED that that the minutes of the Board open regular meeting held February 28, 2020, be adopted, as circulated.

7. Record of resolutions approved via facsimile/email No resolutions

8. Report of the registrar The registrar reported on the following:

• April 21, 2020 Amendments to the Health Professions General Regulation The Ministry of Health posted amendments to the Health Professions General Regulation with a 24-hour posting period. The amendments addressed two specific issues under the Health Professions Act. 1. The first amendment gives the Provincial Health Officer (PHO), during any declared public health

emergency, the power to give certain regulated health professionals to work outside their regular scope of practice, or for unregulated persons to do certain restricted activities under the supervision of a regulated practitioner. Such services would be subject to limits and conditions imposed by the PHO.

2. The second amendment allows for the temporary suspension of complaints and investigations timelines during the declared COVID-19 public health emergency. The expectation is that Colleges will still do their best to meet the expected timelines, but the statutory provisions will not be in effect until the emergency is over.

• Emergency Medicine Certification CCFP (EM) – email sent to registrants April 22, 2020 The College has confirmed with 151 registrants their CCFP(EM) certification since the email went out on April 22, 2020.

APPROVED MINUTES


5 of 10

• Meeting with Métis Nation BC - April 24, 2020 Dr. Oetter was contacted by Ms. Tanya Davoren and Dr. Danièle Behn Smith regarding access to physician data. Ms. Davoren is director of health and sport at Métis Nation BC. Dr. Behn Smith is a deputy in the Provincial Health Office in the Indigenous health portfolio. Both are members of the Métis Nation BC (MNBC) and both have an interest and a portfolio responsibility for developing reports on the status of health of Métis in BC. MNBC represents about 90,000 self-identified Métis people in BC, of whom 20,000 are registered as Métis citizens. MNBC is recognized by both the federal government and the provincial government as the governing nation for Métis in BC. They issue citizenship cards. Their interest is in health outcomes and determinants of health as well as quantifying health discrepancies for Métis citizens. MNBC was in the process of developing an on-line Métis cultural safety and humility module that was to be an add on to the San’yas module. This has been temporarily suspended because of COVID-19. MNBC has a good relationship with the First Nations Health Authority but feel that the Métis voice gets lost in the Indigenous voice, and they are a distinct nation with their own story and history. One third of the population who identify as Indigenous in BC are Métis, and I was told that 11 of the 13 graduating medical students who are Indigenous are Métis. They are aware of the questions that the College ask on license renewal and are seeking an opportunity to receive aggregate data about Métis physicians. They are hoping to have a relationship with the BC Health Regulators like that experienced by the FNHA. They were provided with a sample of the question that the College does each year and are committed to exploring a data sharing agreement with MNBC like the College has with FNHA.

• Executive meeting of the Medical Council of Canada (MCC) - April 27, 2020 In keeping with social distancing, this was another full day meeting done virtually. The biggest issue with the MCC has been the postponement of the spring sittings of the Part 1 and Part 2 examinations. This has resulted in less attention being focused on the governance review, but that still is a strategic priority of the organization. The short term COVID-19 related issues relate to examinations.

• Medical Council of Canada (MCC) Examinations In the earliest days of COVID-19, MCC successfully administered the NAC examination, an exam for International Medical Graduates, with only a few candidates from initial affected areas withdrawing. During that administration general public health advice and hygiene measures were followed by candidates and site staff. Both these groups were asked to self-identify if they had symptoms or had had contact with affected individuals. Shortly after that, in consultation with the RCSPC and the CFPC, and in order to comply directives from the World Health Organization and PHAC, the difficult decision to postpone the MCC Qualifying Examination (MCCQE) Part I session scheduled from April 15 to May 15, 2020 and our performance exam, the MCCQE Part II scheduled for May 2 and 3, 2020, was made.

APPROVED MINUTES


6 of 10

Prior to postponing, we worked with the Federation of Medical Regulatory Authorities of Canada (FMRAC) to confirm that provisions could be made to allow graduating residents to proceed through use of provisional licensing arrangements. Fifty days into the pandemic, the MCC is figuring out its new normal. MCCQE Part I Starting in June 2020, the MCC will use remote proctoring as well as test centres where available to administer the MCCQE Part I to candidates. The exam will be delivered through Prometric’s ProProctor remote assessment platform. Exam delivery will also resume at Prometric test centres with recommended physical distancing and personal protective measures in place. Council will receive additional information shortly as the announcement to candidates is anticipated for May 1. Performance exams - NAC and MCCQE Part II Performance based exams are somewhat more challenging. RCSPC and CFPC have cancelled their performance exams through the end of the year, however, MCC’s situation is different. The MCCQE Part II must be offered for candidates to attain the LMCC and, in many cases, be eligible for eventual full licensure. It is anticipated that the NAC and MCCQE Part II schedule and format for the fall may need to be adjusted. MCC directors of Examinations, Psychometrics and Medical Education have worked as a task force consulting its internal experts, national and international counterparts to develop several possible scenarios to administer exams. The intent is to use the opportunity provided by the pandemic to critically review the examination format. The Board will be kept apprised of progress in this discussion, and decisions that are made. The governance review is ongoing, and external counsel is drafting new bylaws for the organization. The Executive Committee had a chance to conduct a preliminary review, and the new council composed of 15 members is starting to shape up. The intent is to have a virtual meeting of the large Council in June to start the discussions and change management. The hoped-for AGM is the fall will now likely be a virtual meeting as well.

The following resolutions were passed by the Board in its closed session of the meeting:

• RESOLVED that the Board accept the 2019/20 audited financial statements for the year ended February 28, 2020.

• RESOLVED that the Board accept the 2019-2020 goals and objectives year-end report as presented.

• RESOLVED that the report of the Nominating Committee for membership on College committees for the year July 1, 2020 to June 30, 2021, be accepted.

• Emergency register

Dr. Oetter advised that she is meeting with PMSEC on May 28, 2020 and she will be recommending the discontinuation of emergency registration on June 30, 2020. She advised that the coronavirus pandemic in BC has reached a more manageable stage where emergency class licenses issued earlier this year can now be rescinded. This will mean that effective July 1, 2020 they will be unable to practice medicine (including having clinical contact of any kind), bill the MSP or prescribe in the province of BC. The College will keep this list of physician names in case their services are needed in the future.

APPROVED MINUTES


7 of 10

The Board recommended that the physicians who were issued emergency class licenses be recognized for their willingness to go back to work, especially given their age and risk associated. It was agreed that a general mention without their names be written in the College Connector

Request for Action: RFA # Board O-20-05-22-001 Board Article in the College Connector acknowledging the physicians who volunteered to be licensed on the emergency class

9. Report of the president The president provided a report in the closed session of the Board meeting.

10. Unfinished business 10.1 Bylaw amendments – update:

1. Part I – organization The Governance Working Group had drafted amendments to Part I of the bylaws. These amendments continue to be on hold until the Ministry of Health advises otherwise.

2. Section 2-16 - Provisional class – preregistration requirements

• Briefing note from Dr. Heidi Oetter, dated May 16, 2020

• Section 2-16 Preregistration requirements

• Section 2-16 Clean

• Section 2-16 Redline This year’s graduating cohort of residents have had their qualifying examinations postponed to the fall as a result of COVID-19. Typically graduating residents who do not have their certification and LMCC are registered in the provisional class and are subject to sponsorship and supervision until such time they have successfully completed all the required certification examinations.

This challenge has been discussed at the Federation of Medical Regulatory Authorities of Canada (FMRAC) on numerous occasions, and the provincial medical regulatory authorities (MRAs) have implemented processes to suspend the usual requirements for sponsorship and supervision during the few months that exist between the time of graduation from university programs and the fall examinations. Graduating residents typically have a very high success rate on passing their examinations on the first attempt (well over 90%). The expectation is that the graduating residents will be subject to usual requirements of sponsorship and supervision by the fall if they either fail to take their examinations or they fail the examinations. It is estimated that the time period of “provisional-lite” registration will be 12-16 weeks.

Typically, new graduates are likely to do locums in a variety of hospital/ community/ provincial locations and managing a constantly changing arrangement of sponsorship and supervision would be difficult for all parties. The risk is viewed to be very low, given the high rate of success on examinations for Canadian graduates and the fact that each successive locum positions will usually seek references from the prior locum arrangement.

Feedback on the posted bylaws was modest (less than 30 responses) with all supporting the waiver of the requirement for sponsorship and supervision until the fall sitting of the examinations.

APPROVED MINUTES


8 of 10

The Board was advised that the comments on the posted bylaws has dropped off considerably. The period to provide comment closes May 26, and it is anticipated that there will be no further feedback of note. The intent is to have this bylaw in effect at the earliest opportunity. The Board is being asked to approve the amended bylaw with a request to the Ministry to have an in-force date at the earliest opportunity.

In discussions with the ministry, they are supportive of the amended bylaw, and are prepared to shorten the filing period to one day, so as to permit a relatively seamless registration process for this year’s graduating cohort of residents.

The following resolution was MOVED, SECONDED and CARRIED: RESOLUTION 20-632 RESOLVED that the Board amend the Bylaws of the College of Physicians and Surgeons of British Columbia, in accordance with the authority established in section 19(1) of the Health Professions Act, RSBC 1996, c.183 (the “Act”), and subject to sections 19(3) and (6.2) of the Act, as follows: Section 2-16 is repealed and replaced in the attached form. 11. Committee reports

No committee reports.

12. New business 12.1 Board 2021 meeting dates

• Board meeting dates 2021- suggested The following Board meeting dates were confirmed for 2021:

February 25 & 26 May 27 & 28 September 23 & 24 November 25 & 26

12.2 Board Retreat date The Board agreed that a Board Retreat should be held in the fall 2020. The Board discussed the value in meeting in person rather than virtually. It was agreed that the meeting be held face-to-face, if possible. The Board directed that a doodle poll be sent out with dates in October for a Board Retreat.

Request for Action: RFA # Board O-20-05-22-002 Doodle poll to be sent out with October 2020 dates for a Board Retreat

APPROVED MINUTES


9 of 10

13. Information items 13.1 Media summary report relevant to the CPSBC

• Media report to the Board, dated March 1 to May 18, 2020 The communications and public affairs department provided the Board with a media report on media articles mentioning the College for the period from March 1 to May 18, 2020. The Board expressed some concern that since COVID-19 a number of physicians have created private social media groups, i.e. Facebook, that include patient related descriptions. The Board was advised that the College’s Social Media professional guideline is under review to ensure this type of concern is addressed. The Social Media professional guidelines will be brought back to the Board at a future meeting. The Board thanked Ms. Prins for the communication and public affairs department’s thorough media summary report. The Board found the report to be very high level and valuable and agreed it was important to capture the College history. The Board agreed that this was the type of media summary coverage that they would like to be provided with at each meeting. This was provided to the Board for information.

13.2 RCPSC Update on Fall 2020 Subspecialty Exams

• RCPSC update on Fall 2020 Subspecialty Exams, dated April 27, 2020 The Board was provided with an update from the Royal College of Physicians and Surgeons of Canada on the Fall 2020 subspecialty exams. This was provided for information.

13.3 IAMRA Members General Assembly

• IAMRA Members General Assembly, dated May 4, 2020

The Board was provided with a notice to International Association of Medical Regulatory Authorities (IAMRA) members regarding the cancellation of the 14th IAMRA Conference scheduled to take place in September 2020 in Johannesburg, South Africa because of the COVID-19 pandemic. This was provided to the Board for information.

13.4 AFMC decision regarding the 2021 R-1 match

• AFMC decision regarding the 2021 R-1 match, dated May 4, 2020 The Board was provided with a notice from the Association of Faculties of Medicine of Canada (AFMC) regarding its decision regarding the 2021 R-1 match due to COVID-19.

The AFMC Board has made the following decisions regarding the 2021 R-1 Match: • Interviews will be in a virtual format including those for local candidates. • The match timeline will be:

o The Last Day of the Application Period: February 7, 2021 o The File Review Period: February 8 to March 5, 2021

APPROVED MINUTES


10 of 10

o The Virtual Interview Period: March 8 to March 28, 2021 o The Second Iteration Match Day being no later than: May 18, 2021.

This was provided to the Board for information.

13.5 Letter from Associate ADM of the Controlled Substances and Cannabis Branch

• Letter from Associate ADM of the Controlled Substances and Cannabis Branch, dated May 4, 2020

The Board was provided with correspondence from Health Canada providing a compiled number of resources in an effort to provide clarity regarding the rules that apply for substance use disorder treatment or providing a pharmaceutical grade alternative to the toxic street supply in Canada, in the context of COVID-19. This was provided to the Board for information. 14. Next meeting The next open regular meeting of the Board of the College of Physicians and Surgeons of British Columbia is scheduled for September 24, 2020. The open regular meeting of the Board of the College of Physicians and Surgeons of British Columbia held May 22, 2020 concluded at 9:35 a.m. Mr. B.C. Bell President and Chair BCB/js

Provisional - preregistration requirements

2-16 (l) To be granted provisional registration, an applicant must

(a) have successfully obtained a preliminary assessment of his or her eligibility forregistration from the College,

(b) have obtained an eligibility ruling for registration and licensure from theregistration committee,

(c) have fulfilled the subjects listed in the eligibility ruling of the registrationcommittee,

(d) have successfully completed Part 1 of the MCC Qualiffing Examination, and

have the Health Authority or Faculty of Medicine, UBC provide to the College, asponsorship letter satisfactory to the registration committee, that

(i) identifies the applicant's sponsor,

(ii) describes how the applicant will engage in the practise of medicine, and

(iii) identifies a supervisor satisfactory to the registration committee.

(e)

If successfully completed a family medicine program in Canada or a RCPSCspecialty program in Canada in2020, the requirements of section 2-16(l)(e) maybe waived by the Registrar until the results are available from the next availablesitting of the Part II of the MCC Qualifying Examination and the certificationexaminations of the CFPC or RCPSC.

(Ð

(â

.Gð-o"

BRITISH COLUMBIA*€*


Comm¡ttee Report tothe Board Open

Registration Committee

Committee chair: Dr, Oscar Casiro

Committee members in attendance: Dr. Michael CarterDr. Anneline Du Preez

Dr. lsabelle HughanThelma O'Grady (Public Member)David Goldsmith (Public Member)

Date: March 31,2020

ovERVTEW/SUMMARY

COVID-19 Update

The meeting was held via teleconference in keeping with the College efforts to work remotely due to theCOVID-19 pandemic.

The Committee was provided with information related to registration considering COVID-19.

Specifically, with respect to the following:1. The process for registrations in the emergency class.

2. The process for the cohort of 2020 Canadian graduates who are unable to sit their Canadiancertification examinations due to all certification examinations being postponed as a result of theCOVID-19 pandemic.

3. The College is currently not accepting any new applications for visiting resident electives, visitingphysicians or clinical observers as it is unlikely that registrants will be able to provide theappropriate supervision needed given the current circumstances of COVID-19.

Request for Waiver of the MCCQE Port I Requirement for Clinicol Observership Closs

The Committee waived the requirement for the obtainment of the Medical Council of Canada (MCC)

Qualifying Examination (MCCaE) Part I for all applicants applying for registration and licensure with theCollege in the clinical observership class as stipulated under section 2-29 of the College Bylaws (theBylaws) made under lhe Heolth Professions Act, due to the MCCQE Part I being on hold as a result of the

February 78,2020 7 o12

College of Physlciâns and Surgeons of British Columbia

COVID-19 pandem¡c. This waiver will only be in effect until results become available from the nextavailable sitting on the MCCQE Part L

This will impact any new applicants affected by the examination postponement, once the College is ableto accept and process these applications.

RCPSC PER - for opplicants outside of Conado

The Committee received information regarding the new proposed Royal College of Physicians andSurgeons of Canada (RCPSC) Practice Eligibility Route (PER) that is intended to replace the RCPSC

Approved Ju risdiction Route (AJ R).

The new PER policy is on schedule to be delivered bV 202L/22. However, the current AJR will remainopen for several years to allow fairness and grandfathering of candidates who are currently in training inapproved jurisdictions, so that they can exercise this option. Clear closure dates of the AJR will be wellcommunicated to all MRAs.

RCPSC management has sought input from all Medical Regulatory Authorities (MRAs)and developed a

policy that is a major overhaul of the PER to certification policy for primary disciplines.

The new PER policy is designed to open a viable route to certification for specialists that does notdetermine RCPSC examination eligibility based on jurisdiction of training, but rather by assessingequivalency of training and time in practice.

It maintains the requirement to pract¡ce in Canada prior to becoming certified but adds flexibility toallow applicants to sit the exam prior to their practice in Canada. This addition provides licensing-bodiesmore information on competence (through performance on the examination) and recognition oftraining (through assessment of training equivalency) that may be used to determine licensure.

Respectfu I ly su bm itted,

Dr. Oscar CasiroChair

Registr.ation CommitteeMarch 31, 2020

2of 2

-&- Department and Program Report to the Board


BHITISH COLUMBIAr9'

Legal Department Report:Health Professions Review Board Matters forMarch I,20L9 to February 29,2020

a

.8-

Department and Program Report to the Board


BRITISH COLUMBIA.ß*

Health Professions Review Board (HPRB) Matters - Report to the BoardMarch L,zOLg - February 29,2O2O

1. lnquiry Committee (lC) Matters

Under the Heolth Professions Act ("HPA"l, complainants have the right to request:1) a review of a final disposition of the lC; or,2) a review of a delay in the completion of the investigation.Between March L,2019 and February 29,2020, we received 82 applications for review. See table forfurther details:

March t,z0tg - February 29,2020

L) HPRB Applications re: lC Disposition 70

Panel A

Panel B (Clinical)

Panel C (Conduct)

Panel C (Clinical)

Panel D (Conduct)

Panel D (Clinical)

Panel D (Other)

2

9

3

3

19

33

L

2 HPRB ications re: dr tion

TOTAL

t2

82

lC Statistical lnformation by Year

I NB. This f¡gure may ¡nclude decìs¡ons relat¡ng to appl¡cat¡ons for review filed before the current fiscal year

Health Professions Review BoardReport to the Eoard - March 1, 2019 to February 29, 2O2O

2019 Fiscal

YearslLlte-

02/29120

2018Fiscal Year

20t7Fiscal Year

2016Fiscal Year

201sFiscal Year

2014Fiscal Year

ComblnedTotals

Total number of reviewable lC matters:Final lC dispositions and delay notifications 790 706 758 866 856 829 4,805

Number of applications filed with HPRB 82 76 75 90 100 96 519

Review rate r0.4% ro.8% 9.9% 71.2% L2% t2% to.8%Number of reviews returned(for further investigation or new decision) 2r 31 6 7 8 0 26

Page2 of 4

.å-GE



BRITISH COLUMBIA€.(ð.ø

ò

Rate of return for new decision 2.4%t 3.9%r 8% 8.6% 8% o% 5.0%

2. Registration Committee (RC) Matters

Between March I,2079 and February29,2O20, we received 16applicationsforreviewof a decision madeby the RC.

RC Statistical lnformation by Year

3. HPRB Decisions lssued during the 2019 Fiscal Year to Date:

From March 1,2019 to February 29,2020, the HPRB has issued 8 interim decisions and Tl finaldecisions inrespect of the College relating to lnquiry Committee matters:

I NB. This figure may include decisions relating to applicat¡ons for review filed before the current f¡scal year

Health Professions Review BoardReport to the Eoard - March 1, 2019 to February 29, 2O2O

2019 Fiscal Year3/tlLe-

02/2sl20

2018Fiscal

Year

20t7Fiscal

Year

20L6Fiscal

Year

2015

Fiscal

Year

2074Flscal

Year

CombinedTotals

Number of reviewable RC

decisions CPSBC issued 37t 427 25L 343 48r 228 2,TOINumber of applications filed withHPRB T6 9 25 18 12 2 82

Review rate 43% 2.1% 10% 5.25% 2.5% 0.9% 3.9%

Number of reviews returned t 2t t 1 0 5

Rate of return for new decision 6.2s% 22.2%r 4% 5.56% Oo/o o% 6.7%

lnquiry Committee: lnterim Decisions

o 1 = application to withhold documents pursuant to s. 42,4I4 denied(College made the application to withhold documents from the Complainant)

o 2 = applications to withhold personal information pursuant to s. 42 AIA granted(College made the application to withhold personal information of Registrant from Complainant)

o 2= applications to withhold medical records pursuant to s. 42 ATA granted(College made application to withhold medical information/records of 3'd parÇ from Complainant)

o 2 = applications from the Complainant to extend the time to file an application for review grantedo 1= application regarding combining matters

8+

lnquiry Committee: Finat Decisions

o HPRB confirmed lnquiry Committee dispositiono "Stage 1," hearing (Review of record and submissions from comp laina nt)

7r!

Page 3 of 4

'.å-&

COLLEGË



BRITISH COLUMBIA.ß*

. 38 = Panel D

. 2 =PanelC¡ 5 =PanelBt 2 = PanelA

o "Stage 2" hearing (Review of record, submissions of complainant, College and Registrant)r 1 =PanelD

o HPRB matters sent back to lnquiry Committee for reconsideration:. 1 =PanelB. 1 =PanelC

o 5 = Withdrawno 2= Applications for an extension of time deniedo 13 = Delayed investigation - Order to complete investigation by a specified dateo 1 = Delaved investigation - matter dismissed

From March t,2Ot9 to February 29,2020, the HPRB has issued l interim decision and ll final decisionsrelating to Registration Committee matters:

Michelle StimacLegal Counsel

* NB. This figure may include decis¡ons relating to applications for rev¡ew fìled before the current fls€al year

Health Professions Review BoardReport to the Board - March 1, 2019 to February 29, 2O2O

1 = application for stay of registration decision denied / extension of time to file an application for reviewgranted

o I

Final Decisions

o 1 = confirmed following Stage t hearing (Revíew of record, submissions from Registrant)o 3 = confirmed following Stage 2 hearing (Review of record, submissions from Registrant and

College)

o 3=applicationswithdrawno 1= application for an Extension of Time to file an Application for Review deniedo 2= matters dismissed - not within jurisdiction of HPRB

o

on Committee for reconsiderationo 1 = matter sent back to

1lt

Page 4 of 4

r.E^

Complaints and Practice Investigations DepartmentReport to the Board

College of Physicians and Surgeons of British ColumbiaSHITISH COLUMBIA

'e.'@.e'ò

lnquiry Committees - Panels A-E

Since the report provided to the Board at its meeting in November, the lnquiry Committee has concluded 313files in a three-month period (February L to April 30). During the period, the Registrar Stream (Panel D)

processed ïLo/oof the complaints investigated bythe lnquiry Committee.

ln this period, the following trends were observed relating to the department's 'timeliness' objective:

lnvestigation Streamlnvestigations

ConcludedMedian days /investigation

Proportion concludedwithin 255 davs

Registrar (Panel D) 254 268 4t%

lnquiry Committee(Panels A-C)

30 305 47o/o

Panel E* 29

TOTAL 313 269 42%

*Note: Practice lnvestigation files often take time to coordinate. Some remain open to allow the registrant to remediate pr¡orto ¡nspect¡on (or re-inspection). For these reasons, they are not considered in calculating the KPl.

The department continues to make positive gains in terms of processing complaint files. Since the lastreporting period and an additional 313 files have been concluded (an increase of 64 or 25%) and the mediandays/investigation decreased again from287 to 269. The team is happy to report that progress has also beenmade on concluding files within 255 days, the timeline mandated by the Health Professions Act, Over the lastyear, we saw the percentage continually decline and then stabilize between 30-35%. During this reportingperiod, we saw our first increase in the percentage of files concluded within 255 days. Even though thisnumber is still below our goal of greater than 80%, this increase is evidence that the continued work of theteam is starting to have a positive impact. Of note, in April over 50% of files were concluded within 255 days.

Our continued success is largely due to the team's ability to adapt quickly to rapid change and the lT team whohave enabled all staff to work effectively and efficiently from home during the COVID-19 pandemic.

Derek MartinigDirector, Complaints & Practice lnvest¡gations

COMMITTEE REPORT TO THE BOARD


lnquiry Committee Panel AJanuary 30,2020

Committee chair: Dr. P.D. Rowe

Committee members: Dr. G.A. Vaughan, Ms. S.F,J. Ross, Ms. J. Erickson, Mr. B. Bell (Board President)

Overview/Summary

20 files naming 20 registrants, 12 with direction to conclude; 3 for further investigation, 5 citations.

Files included:o 6 of unfinished business: 3 concluded, 2 for further investigation,o t2legal/clinical/conduct: 5 concluded; 6 citations (4 for failure to respond L to external counsel

for investigation, 1 breach of undertaking). 2 boundary: both concluded remedially

Respectfully submitted,

Dr. J.G. Wilson, on behalf ofDr. P.D. Rowe, Chair.

.&'



BRITISH COLUMBIA."ß*

lnquiry Committee Panel B

March 16,2020

Committee Chair (Acting): Dr G. Vaughan

Committee members: Dr. B.M. Bagdan, Ms. C. Gordon, Dr. J. Soles, Dr. A.E. McNamara, Dr. P. Blair, Ms.H. Muller, Mr. T. Mann, Dr. M. Janette McMillan, Dr. T. Cordoni. Regrets: Ms. J. Choi

All Committee members attended via teleconference due to COV|DLg restrictions.

Overview/Summary

o ll files naming L8 physicians; all concludedc 7 of 18 physicians concluded with criticism¡ Direction to seek consent to remedial disposition-HPA s 36(1):

o 2 for specified education:. Complex regional pain syndrome. Obstetrical care for high risk patients

o 1 formal undertaking to utilize fluoroscopy for a specified orthopedic procedureo HPS s 33(a) practice investigations: 2

¡ 6 interviews

Representative Cases

Abnormal urine findings may mandate immediate investigation

A 16 year old male attended his local emergency department with a complaint of back pain, with nohistory of activity or injury to explain it. A well-documented assessment was otherwise negative.Dipstick urinalysis was positive for blood and protein. An MSK diagnosis was made and the patientdischarged with an analgesic and instructions to follow-up electively for a repeat urinalysis. Two dayslater the patient was taken to another hospital where acute tubular necrosis was diagnosed. ln hisresponse the registrant commented that "transient proteinuria and hematuria are common inadolescents". The Committee disagreed and concluded the complaint with criticism of the registrant fornot ordering immediate blood work to assess renal function. The Committee directed a concludinginterview and directed that the matter of the physicians competence be brought back to the Committeeif safety concerns are identified at the time of the interview..

Acute impairment of consciousness requires urgent imaging before a functional cause is considered

A young woman arrived at hospital by ambulance with depressed consciousness. Nursing triage notesdescribed her as "somnolent". The physician elicited a history of escalating headaches over a period ofseveral days. Based on his assessment, the physician diagnosed "elective mutism". A CT scan performedafter his shift demonstrated significant intracranial pathology with mass effect. The Committeedetermined that the care fell well below the standard expected of an emergency physician. Toxic andneurological causes should have been ruled out and imaging performed before consideration of a

functional disorder. Physical examination was not documented and no rationale for the diagnosis wasprovided. The Committee was critical of the registrant for inadequacy of his assessment of the patient,documentation and response to the complaint and resolved that his competence be investigated as a

separate matter.

A first ever psychotic episode is a psychiatric urgency requiring deliberate management

A psychiatrist provided a consultation assessment for a young man and apparently failed to recognize a

first psychosis characterized by paranoid delusions and impairment of insight and judgment. TheCommittee determined that the presentation mandated immediate further assessment and treatment,including consideration of involuntary admission under the Mental Health Act. The Committee directeda concluding interv¡ew and resolved to investigate the competence of the registrant as a separatematter.

JG Wilson, Deputy Registrar, on behalf of:

Dr. Gerrard Vaughan, Acting Chair

College of Physicians and Surgeons of British Columbialnquiry Committee Panel B Report to the Board for March L6, ZO2O

2

..å-COLLEGE OF



BRITISH COLUMBIA

'ß*

lnquiry Committee Panel CMarch 17,2020

Committee chair: Dr. Anne Priestman

Committee members: Dr. R. lrvine, Ms. J Dyson, Ms. PA McDonald, Ms. K. Brooks, Dr. L. Wong, Dr. G.A.Vaughan.

Overview/Summary

r 8 files; 8 registrants namedo 7 of 8 registrants concluded with criticismr Seek remediation by consent--HPA s 36(1)-4 registrants, one or more of:

o 1 formal undertaking not to repeat the conducto L for remedial education: communications and specified physical examinationo 1 remedial reprimando 1 commitment to transition complex patients to new physicians at retirement

o 2 HPA s 33(4) practice investigation as separate matters, by own motion resolutiono 6 interviews

Representative Cases

Patients reasonably considered impaired by excessive use of medication and alcohol must not drive

The Committee considered an anonymous report from a man identifying himself as an emergencyphysician expressing concern about a patient receiving an extraordinary combination of sedatingmedications (benzodiazepines, opioids and a tricyclic antidepressant) and, by his own account,consuming excessive amounts of alcohol daily, allegedly signed-off as safe to drive by his familyphysician. ln his response, the physician maintained that moderating the burden of medication wasunrealistic in this instance and that the patient did not drive if he was drinking. Following deliberation,the Committee did not accept the physician's assessment, concluding that permitting the patient todrive posed unacceptable risk to the community. Section 230 of the Motor Vehicle Act obliges physiciansto instruct patients with medical conditions likely to pose a danger to themselves or members of thepublic to not drive and to report them to the superintendent if they resist. The Committee considered itunacceptable forthe physician to make the determination that he did and directed a concludinginterview with Registrar staff. Subsequently, at interview, the registrant advised that he agreed with theCommittee. The patient is no longer driving.

Physicians are legally and professionally obliged to complete ICBC forms with care

It is rare for ICBC to submit a formal complaint to the College alleging deficient documentation. TheCommittee considered the complaint of an ICBC advisor alleging a number of serious deficiencies in tworeports. Patients often rely on insurance payments for the necessities of life. Treating physicians have a

legal duty to provide reports to inform adjudicative processes. The standard titled "Medical Certificatesand Other Third Party Reports" ( https://www.cpsbc.calfiles/pdf/PSG-Medical-Certificates.pdf ) detailsexpectations. Additionally, the lnsurance (Vehicle) Act imposes a statutory duty to provide reports toICBC in the form the corporation prescribes. Finally, fees and requirements form part of a negotiatedagreement between ICBC and the Doctors of British Columbia. Based on its review of the records, theCommittee determined that the registrant had failed in her duty to provide a clear, objectiveassessment in each instance and directed that she be required to attend for a remedial interview toaddress the deficiencies.

Respectfully submitted,Dr. J.G. Wilson, Deputy Registrar, on behalf of,Dr. Anne Priestman, Chair.

College of Physicians and Surgeons of British Columbialnqu¡ry Com inittee Pa nel C Report to the Boa rd for March L7 , 2O2O

2

r.E'-



BRITISH COLUMBIA

'ß*

lnquiry Committee, Panel E February 26,2020

Committee chair: Dr. M. McCarthy

Committee members: Dr. G.A. Vaughan, Mr. B.D. Penner

Overview/Summary

27 practice investigations reviewed; 1-6 concludedo 8 with the issues addressed to the satisfaction of the Committeeo 7 with resignation/retiremento L referred to Board for consideration of a25.2 investigation of skillFor the lL not concluded, next steps include:

o 8 will proceed to an on-site reviewo 1 direction for off-site chart audito L for investigative interviewo 1 to provide detailed update on current clinical activities, if any

Themes

Older physicians for whom a timely retirement would best serve the public interest (and theirown)comprise a large port¡on of the work of our practice investigation team and lnquiryCommittee Panel E. The March meeting included 7 files (26%l concluded with resignation.

Respectfully submitted,

Dr. J.G. Wilson, Deputy Registrar, on behalf of,

Dr. M. McCarthy, Chair.



Inquiry Committee - Panel D

Meeting Dates: February L9, 2020, March 20,2020, and April 2t,2O2O

Committee chair: Dr. L. Dindo

Committee members: Dr. A. Sear, Ms. C. Evans

Overview/Summary

The committee has met three times since the last board meeting and endorsed246 registrardecisions in that time. ln addition, the committee has authorized registrar staff to investigate32 complaints on behalf of the lnquiry Committee (matters to be reviewed by Panels A, B andC)and passed l-L resolutions to investigate a physician's practice as per section 33(4) of theHealth Professions Act.

Respectf u I ly su bmitted,

Dr. D. Puddester, Deputy Registrar, on behalf of,Dr. L. Dindo, Chair.

..&-&

COLLEGE



BRITISH COLUMBIA*ß*

Patient Relations, Professional Standards and Ethics CommitteeMarch 2,2020

Committee chair: Shirley Ross

Committee members: Brenda Wagner, Philip Crowell, Ronald Abrahams, Lori Charvat, Justin Kingsley

Overview/Summary

The PRPSE Committee met on March 2,2020 to review several draft practice standards, results from arecent consultation with key external stakeholders, and a new patient resource.

The Boundary Violotions in the Potient-Physician relationship practice standard had been separated intotwo standards: Non-Sexuol Boundary Violotions and Sexuol Misconduct following direction from thecomm¡ttee at its previous meeting. The newly drafted standards were brought to the committee forreview, and several revisions were suggested. The amended draft standards were approved by thecommittee for a physician consultation.

Results from a recent consultation aimed at guiding the College's public consultation on sexualmisconduct were shared with the committee. The consultation included semi-structured telephoneinterviews with eight individuals from five different advocacy groups across the province. lnsight fromthese conversations helped the committee understand the use of appropriate language andterminology, and the complexity of consulting with survivors of sexual misconduct or abuse. lt wassuggested that an in-person meet¡ng with representatives from the public advocacy and support groupsbe held, so that this group could collectively generate appropriate questions and content aimed at thepublic.

The committee then discussed lhe Complementary ond Alternotive Theropies draft practice standardand the feedback received from the Canadian Medical Protective Association and the Ministry of Health.The committee proposed several amendments to the standard and agreed that the revisions be madeand circulated back to the committee via email for final review. The group was then presented with a

new patient resource, üfled What to Expect: Complementory and Alternative Therapies. A few minorrevision suggestions were offered, and the resource was approved for publication.

The committee was presented with the draft tntravenous Therapy in the Community Setting practicestandard. This draft standard was endorsed for a consultation with the profession and key externalstakeholders; results will be provided to the PRPSE Committee at a future meeting.

t

2

3

4

Lastly, an update on the BC Public Advisory Network (BC-PAN)was shared with the committee. The BC-

PAN which has now completed a successful pilot phase and looks to expand during the year ahead. Thecommittee was advised that additional colleges would like to join the initiative, a local facilitator and a

part-time engagement coordinator will be hired, and several additional public advisors will be recruited

lssues and Accomplishments

Agenda items

Coast Salish Peoples acknowledgement

Call to order and chair's remarks

Declaration of conflict of interest

Adoption ofthe agenda

5. Adoption of the minutesMinutes of the Patient Relations, Professionalstandards, and Ethics Committee meeting heldDecember 9,2OLg

6. Sexual Misconducti. Draft standards

o. Non-Sexuol Boundory Violationsb. SexuolMisconduct

ii. Update on public consultation plan and advocacy groups relations to sexual misconductiii. Mandatory Course (CPSA)

7. Complementory ond Alternative Therapies practice standardi. Consultation results from key stakeholdersii. Final draft practice standard¡ii. Draft patient resource

8. lntravenous Therapy in the Community Setting practice standardi. Draft practice standard

9. For information: CPSBC response to the report of the Steering Committee on Modernization ofHealth Professional Regulations

10. BC Public Advisory Network Update

11. Next Meeting

Accomplishments

The PRPSE Committee reviewed and endorsed the following, pending minor revisions:o Complementory ond Alternative Therapies practice standardo Complementory and Alternative Therapies; What to Expect pat¡ent resource

College of Physicians and Surgeons of British ColumbiaPatient Relations, Professional Standards and Eth¡cs comm¡ttee Report to the Board ,lor March 2,2O2o

2

Focus for the Future

The committee will meet again on May 25,2020. Before this meeting, a consultation on a new patientresource regarding Sexual Misconduct will be held with key interest groups and patient advocacyorganizations.

Two physician consultations had been planned; one on the SexuolMisconduct and Non-SexualBoundaryViolations standards, and another on the lntrovenous Theropy in the Community Setting practicestandard. However, these consultations have been placed on-hold due to COVID-19.

The following will be brought back to the committee at the group's next meeting:

A new Sexual Misconduct patient resource, with feedback incorporated from key externalpatient advocacy/su pport groups

Update on FSMB's key learnings related the Reporton Physician Sexual Misconduct; discussionof medical pract¡ce monitorsUpdate on progress with the BC-PAN

Respectfully su bmitted,

Shirley Ross, Chair

College of Physicians and Surgeons of British ColumbiaPatient Relat¡ons, Professional Standards and Ethics Committee Report to the Board for March 2, 2020

a

a

a

3

PANEL REPORT TO THE BOARD (Open)


BRITISH COLUMBIA4æ-s

d

Physician Practice Enhancement Panel

March 5,2020 meeting

Panelchair: Dr. B. A. Priestman

Panel members:¡ Dr. B. A. Priestman (Chair)¡ Dr. J. Kingsley (Vice-Chair) - via

teleconference¡ Dr. K. Eva - via teleconferenceo Dr. L Fadyeyeva -via

teleconferenceo Dr. D. Haslam - via

teleconference

Regrets:¡ Dr. M. Docherty

¡ Dr. C. Kwiatkowski - via teleconferenceo Mr. T. Mann -via teleconferencer Ms. B. Maxwell - via teleconference¡ Dr. J. Slater - via teleconference¡ Ms, W, Winslow - via teleconference

Others present:

Dr. M. Murray (Deputy Registrar)Ms. N. Castro (Director, PPEP)

Dr. N. James (MedicalAdvisor)Ms. A. Thewlis (Senior Administrative Assistant, PPEP)

Overview/SummaryThe Panel reviewed the following new business arising since its last meeting

o New Assessment Reviews: 1

¡ AssessmentFollow-up:4o Office assessments: 0¡ Chart submission review reports:

o Reports for discussion and action: 2

o Reports with further action directed: 9o Reports with no further action required: 25

¡ Outcome letters sent:o FY 2018-2019 = 15

o FY2OI9-202O=1O7. Medical advisor calls made: 7. Referrals made to the Prescription Review Program (pRp): 15

a Resolutions passed to refer registrants to the lnquiry Committee due to practice concerns: 5

The Panel was provided with an update on the status of assessments initiated between March L,2O2Oand February 28,202t as follows:

o 75 assessments have been initiated, to date (Goal= 600)o 75 assessments are in progress (awaiting outstanding components)

The Panel was provided with an update on the status of assessments ¡n¡t¡ated between March t,z}tgand February 29,2020 as follows:

o 650 assessments were initiated (Goal = 650; 600 PPEP assessments + 50 MCC 360 pilotassessments)

r 313 registrants have been sent their outcome letter + PPEP report in total, to datec 707 registrants have been sent their outcome letter + PPEP report since the last Ponel meetingo 8 assessments were partially completed¡ L5 assessments were cancelledo 37 are in the process of being sent their outcome lettero 277 assessments are in progress (awaiting outstanding components)

The Panel was provided with an update on the status of assessments initiated between March t, ZOtgand February 28,2OL9 as follows:

. 60l assessments in total were initiatedo 560 registrants have been sent their outcome letter + PPEP report in total, to dateo L5 registronts hove been sent their outcome letter + PPEP report since the lost Ponel meeting¡ 6 assessments were partially completed. 9 assessments were cancelled¡ 1 is in the process of being sent their outcome lettero 25 assessments are in progress (awaiting outstanding components)

The Panel was provided with an update on the status of the Physician Office Medical DeviceReprocessing Assessments (POMDRA) initiative from March t,2Ot9 to February 29,2OZOz

r Pre-assessment questionnaires (PAQs) sent to registrants, to date: 37g¡ Cases initiated (eligible to be assessed): 154. Phone assessments completed:2o Of the goal of 225 on-site assessments:

o Number completed: 224o Number booked: 6 (on-site assessment scheduled, awaiting completion)o To be initiated: 0

¡ Outcome summary for the 200 cases completed:o Reusable:146o Disposable:44o Stopped:10

Respectfully su bmitted,

Dr. B. Anne PriestmanChair

College of Physicians and Surgeons of British ColumbiaPhysician Practice Enhancement panel Report to the Board for March 5, 2020 meeting

7

REPORT TO THE BOARD - OPEN


BRIÏISH COLUMBIA€,{ùe

d

Diagnostic Accreditation Program CommitteeFebruary t9,2O2O

Overview and Summary

Laboratory Medicine (LM)

-Statistics compiled: November t6,2Ot9 to January 3I,2O2O

Members present:

. Dr. Romina Reyes, Chair* (via TC)

. Dr. Francis Ervin* (via TC)

. Dr. Spencer Lister* (via TC)

. Dr. Reza Alaghehbandan* (via TC)

. Lisette Vienneau* (via TC)

. Dr. Charlotte Yong-Hing* (via TC)

. Dr. David Sanden* (via TC)

. Tim Rode* (via TC)

(Via TC) - Attended v¡a teleconference(1.P.) - Attended in person

* voting members

Regrets:

Mariana Diacu

Staff present:

Dr. Michael Murray, Deputy Registrar (1.P.)

Jonathan Agnew (PhD), Director (1.P.)

Colin Carey, Manager, Laboratory Medicine (1.P.)

Debbie Penn, Manager, Quality Systems (1.P.)

Regrets:

Sharan Manship, Manager, Diagnostic Services (1.P.)

Recorder of minutes:

. Barbara Kmiec, Senior Administrative Assistant(t.P.)

LM Accreditation awards as a result of initial assessments tLM Accreditation awards as a result of a self-audit 1

LM Accreditation awards as a result of i 5mplementine OMRs

LM Extension of accreditation status 0

LM Accredltation cessation of service 5

LM Accreditation awards as a result of focused 6assessments

LM Accreditation awards as a result of on-site assessments 7

Item Number

LM Accreditation awards as a result of relocation assessments 0

LM Extension of accreditat¡on status 0

LM Extension of OMR requirement timelines 26

LM Variance requests for OMR requirements 0

LM RegionalAssessment 0

Diagnostic Services ( DS)

- Statistics compiled: November t6,2019 to January 3\,2020

Community Spirometry (CS)

-Statistics compiled: November t6,20L9 to January 3I,2020

College of Physicians and Surgeons of British ColumbiaD¡agnost¡c Accredltation Program Comm¡ttee Report to the Board

2

DS Accreditation awards as a result of initial assessments 2

DS Accreditation awards as a result of on-site assessments L0

DS Accreditation awards as a result of relocation assessments T

DS Accreditation awards as a result of implementing OMRs 31

DS Extension of accreditat¡on status 0

DS Extension of OMR requirement t¡mel¡nes 7

DS Variance requests for OMR requirements 0

DS Accreditation cessation of service 0

DS Awards as a Result of Focused Assessment 0

Item Number

CS Accreditation Awards 4

CS Performa nce Escalation 0

CS Extension of Corrective Action Timelines 0

CS Follow-up to Performance Escalation 0

CS Accreditation cessation of service 0

Item Number

-8-PANEL REPORT TO THE BOARD (Open)


Non-Hospital Medical and Surgical Facilities Accreditation Program(NHMSFAP) Patient Safety lncident Review Panel

March t2,2020 meeting

Panel chair: B. Bell

Panel members:. B. Bell (Chair). Dr. R.R. Abrahams (Vice-Chair). Dr. J.S. Arneja. Dr. C. Ho. Dr. J.M. Leith. Dr. R.L. Preston

S,F.J. Ross

Dr. D. Sanden

Dr. K. SeethramDr. N.K, WadeB, Willson

Regrets:. B, Abbott. A. Wray

Others present:

. Dr. M. Murray, deputy registrar

. Dr. J. D. Agnew, director, accreditation programs

. T. Steele, manager, NHMSFAP

. K. Fairweather, Ql Lead, Accreditation programs

. J. Levett, manager, accreditation, NHMSFAP

. Linh Vu, accreditation assessment officer, NHMSFAP

. N. Korgaonkar, accreditation assistant, NHMSFAP

. A. Murphy, accreditation assistant, NHMSFAP

. Barbara Kmiec, senior administrative assistant, QA and accreditation programs

Overview/SummaryPatient Safety lncidents

1, Two patient safety incident reports were brought forward from the November 21,,2OL9NHMSFAP Patient Safety lncident Review Panel meeting.

2. Thirty-nine new patient safety incident reports were reviewed.

3. Twenty-eight patient safety incident reports were determined to be recognized complicationsand/ or managed appropriately.

4. Eleven patient safety incident reviews required further discussion/action by the panel.

Action items arising from the panel review included letters with recommendations to improve patientsafety and requests for responses from physicians and medical directors.

Respectfu lly su bmitted,

B. Bell

Chair

College of Physic¡ans and Surgeons of Brlflsh ColumblaNon-Hospital Medlcal and Surgical Facilitles Accred¡tation Program (NHMSFAP) Patient safety lncident Revlew panel Report to the Boardfor March 12, 2020 meetlng

2

t6-COLLãGË



BFITISH COLUMBIA.@-@'s

€)

Library Committee

February 27,2020

Committee chair: Mr. Barry Penner, Q.C.Committee members: Attendees: Mr. Barry Penner, Q.C. (Chair), Dr. Joelle Bradley (Vice-chair), Dr. Gail Ann Knudson,Dr. PavelGlaze.Committee members: Regrets: Dr. Carolyn Hall.Staff support: Dr. J. Galt Wilson (Deputy Registrar), Dr. Karen MacDonell, PhD. (Library Director),Mr. Scott Anderson (Recording Secretary).

Overview/Summary

The College library accessed UBC Library resources through a UBC Library card that gave remote access to UBCelectronic resources, such as e-journals and databases, and borrowing privilegesfor print books. UBCchangedits website login process and the College library's card no longer provides remote access to UBC Library e-resources, impacting the speed and comprehensiveness of core library services, including document deliveryand literature searches for registrants. The College library's services directly support the 6,000+ registrants whoare Clinical Faculty in the UBC Faculty of Medicine. Attempts to reconstitute remote e-access to UBC'scollections through discussions at senior-management levels among the College, UBC Faculty of Medicine, andUBC Library were unsuccessful: the UBC Library declined to restore access due to resource licensing concerns. Tomitigate the access loss, a subscription to the OVID EMBASE database has been purchased and College librarystaff now access e-journals on behalf of registrants by visiting UBC Robson Campus using guest access facilitatedby a member of the UBC Clinical Faculty. We continue to borrow print books on the original UBC Library card.

The College library is at the start of another 3-year visioning and strategic planning cycle. A Visioning Day isplanned with the aim to draft a high-level Strategic plan,

Library usage statistics for 2019 were reviewed and discussed. Overall patron contacts remained stable, with anincrease in unique users. Reference questions and staff-mediated services for article copies increased relative tothe previous year. Electronic resources saw mixed usage, with e-Journal articles downloaded increasing and e-Book chapters viewed decreasing, Outreach numbers increased in comparison to the previous year, partly dueto the relaunch of the library's hands-on computer-based workshop with increased CpD credits, Fost Evidence.

To review progress on the library's 2019-2020 KPls, the Committee discussed:o EMR integration: The progress of the library's EMR integration project was discussed, noting the Applied

lnformatics for Health Society (AIHS), vendor of the MOIS system, plans to integrate single sign-on toMOIS in an upcoming upgrade, after AIHS completes testing of the College-programmed Windows appprototype that emulates their Windows client-based system.

o Outreach events and contacts - service delivery maintenance: The KPI target is to maintain the samenumber of registrants contacted and events offered as the 20L8-201.9 results, being 23 events and 2g9reg¡strant contacts. As of the end of 2019, the College Library recorded 32 events and 375 contacts.

o lncrease use of online resources and literature search service among all registrants:This Kpl target is forall registrants to receive at least one specialty-specificemail highlighting literature search services,accomplished by sending L,000 promotional emails per month. The target is a LO% increase in literature

a

a

search requests compared to 2018-20L9. As of the end of 20t9, the College Library recorded a 27%average monthly increase in literature search requests compared to the same months in 2018-201.9.This KPI also includes a promotionalemailsent to all registrants in November, highlightingwebresources, which resulted in an average resource usage increase of I23%.

Canada QBank for UBC students was cancelled based on financial constraints, especially the new EMBASEsubscription. Dr. Roger Wong, Faculty of Medicine Executive Associate Dean, Education and Dr. Janine McMillan,UBC Associate dean in Faculty of Medicine, asked that we extend the subscription for UBC Year 4 students whilethe administration investigates a replacement. The College agreed to do so, and access to Canada QBank fromMar L to Jun 30, 20201or all UBC medical students was arranged and paid for by the College.

Accomplishments. The library committee supported the library's efforts and progress in the EMR integration project.. The library committee supported planning the library's 3-year visioning and strategic planning workshop.

Focus for the Future

. The integration of library resources into an electronic medical record system (MOIS) using single sign-on technology

. Continue considering means for raising awareness about the library with new registrants and younger physicians.

Respectfu lly su bmitted,Mr. Barry Penner, Q.C. (Chair)

College of Physicians and Surgeons of British ColumbiaLibrary Committee Report to the Board for ZOZOO227 meet¡ng

a

2

..8*COLLËGE

PANEL REPORT TO THE BOARD


BFIÏISH COLUMBIA€.{ô-e

d

Prescription Review Panel

March 12,2O2O

Panel chair: Ms. Jane Dyson

Panel members present: Dr. Shao-Hua Lu, Dr. Wendy Woodfield, Dr. Michael Butterfield, Dr. MandyManak, Mr. David Pavan

Regrets: Dr. Christy Sutherland, Ms. Colleen Regehr

Overview/SummaryAt this meeting:

o The panel orientation was presented by Dr. H. Oetter. This had previously been deferred due toscheduling conflicts with the new panel members and presenter availability.

o The program medical consultant discussed how to properly present a case file at meetings. Areference document was created to assist panel members in their reviews.

r Panel reviewed nine Prescription Review program (pRp) files.

lssues and Disposition of FilesOf the 9 PRP files reviewed:

¡ Two files will be referred to the lnquiry Comm¡ttee. The physicians'files with the PRp will beclosed.

¡ Two old process files will be moved to Stage 6 (second interview) with a medical consultant anddeputy registrar.

o One new process file will be reviewed again at the September 2O2O panel meeting.o One old process file will be asked to complete a chart review and the file reviewed again at the

September 2020 panel meeting,¡ One old process file will be requested to attend the next available Prescribers Course, with a file

review by the medical consultant scheduled in June and a panel review in Septembe r 2020.r One old process file will be requested to arrange a telephone discussion with a psychiatrist

panel member and medical consultant in order to review challenging cases, and receiveguidance (relevant to the practise of psychiatry) on adhering to the Colleges prescribingstandards. The file will be reviewed again by the panel in septembe r 2020,

o One new process file will be requested to arrange a Stage 5 (first interview) with a psychiatristpanel member and medical consultant.

Representative Files

Dr, X is a 67-year-old family physician practising in the Northern Health Authority. The file was opened in20L6 and the physician has completed all stages within the old PRP process. The file had previously beenreviewed by the Prescription Review Panel in September 2019. At that time, the panel had noted thatdespite Dr. X's attendance at the FME Chronic Pain Management Conference earlier in the year andcompletion of a Stage 5 (first interview), there had not been a noticeable improvement in prescribing.The panel had directed Dr. X to retain legal counsel and to arrange a Stage 6 (second interview) todiscuss ongoing prescribing challenges and remaining options with the program. The interview tookplace in February 2020 with the program deputy registrar and medical consultant. The file was broughtback to the March panel meeting for an interview update. The interview demonstrated no significantchanges had been made since the previous interview one year ago; pharmacovigilance practices had notbeen implemented and patients were still receiving high doses of medications, with two patientexamples clearly demonstrating a concern for public safety, There were significant concerns pertainingto Dr. X's skill set and clinicaljudgements. Considering this, the panel directed the file with the PRP beclosed and a referral be made to the lnquiry Committee.

Dr. Y is a 49-year-old psychiatrist practising in the Vancouver Coastal Health Authority. The file wasopened in May 20L7 and Dr. Y has completed the first five stages within the old PRP process. Mostrecently, a Stage 5 (first ¡nterview) was completed via teleconference in August 2019. The file was thenreviewed by the medical consultant in January 2020. Following this, a request was made for the file tobe reviewed by the Prescription Review Panel to obtain the expert advice of the two psychiatrist panelmembers to determine next steps, Review of Dr. Y's prescribing demonstrated ongoing concernsregarding combinations of stimulants and benzodiazepines and the use of archaic medications. Thepanel agreed Dr. Y would benefit from guidance from a psychiatrist on the panel. Therefore, the paneldirected Dr. Y to arrange a telephone call with a psychiatrist panel member and program medicalconsultant to review and discuss ongoing prescribing challenges. The file will be reviewed again at theSeptember 2020 panel meeting to allow Dr. Y enough time to continue to implement changes.

Respectfu lly su bm itted,

Jane Dyson, Chair

JDlmt

College of Physicians and Surgeons of British ColumbiaPrescription Review Panel Report to the Board for March 12,2020

2

Documents

College of Physicians and Surgeons of British Columbia Minutes