TRANSPARENCY OF PHYSICIAN INFORMATION SURVEY FEEDBACK - MEDICAL REGULATORY AUTHORITIES Question 1 How far back does your medical regulatory authority make public (or publish) details of censure and discipline? Can anyone discover details of their doctor going back before then? Response AB We publish on our website a summary of physician disciplinary findings for the past 5 years. Information about a physician from greater than 5 years ago can be found by searching our Messenger (newsletter) archive - also on the website - or by calling the College NB 1990 seems to be first. Little info available even to us before then. ON The College of Physicians and Surgeons of Ontario has an online register of physicians (the “public register”). Discipline findings are available from approximately 1980 on the public register. The public can contact the CPSO by telephone or in writing to inquire about physician discipline predating the online public register. Whether a discipline finding predating the online public register is available is determined by applicable legislation, which has been revised over the years to permit greater disclosure to the public. SK The information on our website goes back 16 years – the time that we began to collect the information electronically. In order to respond to a request for information prior to that time, we would need to perform a manual search of the physician’s College file. QC In Québec, all disciplinary procedures and auditions are public since August 1st 1988. Before that date, radiation decisions were published in newspapers. Information can be found historically for cases of radiation only, made before August 1st 1988. PEI I do not know. In my memory at the College (over 20 years), any finding that altered licensure was sent to the press. Currently such a finding would be on the web site a minimum of 2 years. Information on a physician before the College was founded in 1988, would be difficult to locate. YK While the Yukon Medical Council does not publish historical details of censure and discipline, if a request for information from the public of this nature was made, a review could be conducted as far back as records would allow. NL The College publishes license restrictions currently in effect for physicians currently in practice. Since 2005, discipline hearings are held in public. A summary of the tribunal decision is posted to the College website and remains there indefinitely. Inquires about matters dealt with before 2005 are dealt with on a case by case basis. BC The explicit legislated requirement for publishing information about the College’s formal actions is found in section 39.3 of the Health Professions Act, which came into effect for this College in June 2009. The requirement for the College’s medical register to be open to inspection by the public was found in section V of the Medical Ordinance 1867, and has been present in all subsequent versions of governing legislation. This means information on any cancellations or suspension of registration as a result of any formal actions taken by the College would be a record in the public domain since day one of the College. Prior to 2000, before the College first launched a public website, disciplinary actions were distributed to media outlets, regulatory 2 authorities, hospitals, and the Ministry of Health. Since 2000, disciplinary actions continue to be released to media and other agencies, and remain permanently on a physician’s profile in the College’s directory on the website. MB In 1990 Council passed a motion that hearings would be open to the public but the name of the physician was not published unless a finding of guilt was made. Revisions to the Medical Act incorporated this principle of open hearings. The panel retained the ability to order nonpublication of physician identity. Since 2005, on-line physician profiles contain information about final disciplinary actions about licensed physicians for the past ten years. Subject to orders of non-publication anyone can discover details of their doctors by calling the College. NS The College publishes on its website a summary of physician disciplinary findings as far back as 2005. An archive of pre-2005 findings is also available on the website. Question 2 What circumstances are necessary for a referral of a physician to police, and do medical regulatory authorities ever recommend to police that charges be laid against a physician? # Response AB S. 80(2) says that if a hearing tribunal has reasonable and probable grounds to believe that the investigated person has committed a criminal offence then the hearing tribunal must direct the Hearings Director to send a copy of the decision to the Minister of Justice and Attorney General NB Would likely not do so without patient's permission. In practice, police are often already involved. ON The CPSO has a “Reporting Physicians’ Acts to the Police” policy, approved in October 2015. Prior to the establishment of a formal policy, many of the practices outlined in the policy were followed on a case-by-case basis (i.e., suggesting to the individual who provided information that he/she may wish to contact the police to file a report, and providing assistance). Governing legislation does not permit the CPSO to provide information to the police about complainants/patients without their consent. Prior to the establishment of the formal policy, we did not forward discipline decisions to police. The Reporting Physicians’ Acts to the Police policy is as follows: On occasion, the College investigates a matter in which it appears that the physician has committed a criminal act(s). In the interests of public safety, the College may wish to report this to the Police. Upon receiving information that a member may have committed a criminal act (including but not limited to crimes of a sexual nature), if the provider of that information would be a potential complainant in a criminal investigation, College staff will: • suggest to the individual who provided that information that he/she may wish to contact the police to file a report; • offer to assist that individual with the filing of a report; and • advise the individual that the College may initiate a report to the police if there are reasonable grounds to believe that a physician has committed a criminal act(s) and patients or the public may be harmed. If, during an investigation of a member, there are reasonable grounds to believe that a physician has committed a criminal act(s) and patients or the public may be harmed, and a report to the police could reduce the risk of future harm, the College will initiate a report to the police, or provide information upon request. On public release of the College’s Discipline Committee decisions, any matter that raises issues of physician criminal actions will be reported to the police by forwarding a copy of the public decision. A report under (2) or (3) is not required if the police are already aware of the alleged activity. During an investigation, the 3 report will include the physician’s name and mailing address and a summary of the relevant allegations or documents redacted for confidentiality. Unless the complainant consents to the inclusion of his/her name, the name of the complainant must be redacted in a report to the police, along with any other information with respect to a person other than a member. SK One of the limitations is Saskatchewan’s privacy legislation. Information which discloses personal health information to the police cannot proactively be provided to the police unless the patient consents. The College has no specific policy as to when it will, or will not, report matters to the police that do not involve disclosing personal health information. Where a patient complains to the College about conduct that appears to constitute a criminal offence, the College will provide the patient with information about how to report the matter to the police. QC The inquiry process for a complaint against a physician goes through the role of the MRA officer called the syndic. Under the Québec Code of profession, a syndic has the level of power to do his inquiry at the level of a Commissioner. If the inquiry demonstrates criminal acts, the syndic can take any action to refer the case to the police. On the other hand, since 2008, if a physician has criminal charges against him, the law requires from the General prosecutor to inform the MRA where the executive committee can temporarily struck off the member from the membership roll if the charge has a link with the exercise of the profession and this decision is public. PEI Because the police can do little if a patient is unwilling, we have recommended to a complainant that they speak to the police and have offered support in laying a complaint. YK Any referrals/recommendations to police regarding a physician would be determined on a caseby-case basis. NL The duty to report abuse of minors, the elderly, and the infirm is established in several provincial statutes. BC There is no express authority under FIPPA or the HPA to disclose personal information to police where the College has reason to believe that an offence may have been committed but no police investigation is underway. It is not the role of the medical regulatory authority to recommend that charges be laid against a registrant. The College would not refer a matter to police absent complainant consent. The College would, however, facilitate contact between the complainant and law enforcement. The College is party to a MOU with law enforcement permitting them to provide the College with material for the purposes of investigation, but it does not permit the College to share personal information with police. MB Complainants are informed that they may make a report to the police if they so wish. The CPSM has reported potentially criminal conduct where there has been no complainant. It is not the role of the regulatory authority to recommend to the police that they lay charges. NS The College has a statutory obligation to notify law enforcement authorities when there are allegations of abuse of a minor. The Medical Act also directs the College as follows: Section 46 (2) (a) and where an investigation committee or hearing committee has reasonable grounds to believe that a members has committed, is committing or is about to commit a criminal offence, the committee may direct the Registrar to disclose to law enforcement authorities such limited information as is necessary to alert the authorities to the suspected activity. 4 Question 3 Does your medical regulatory authority have the ability to impose on a doctor a permanent or lifetime ban on practising, and since when does that ability exist? Under what circumstances could this be imposed? # Response AB Yes (S. 82(1)(g) of the Alberta Health Professions Act. It would be a decision of the hearing tribunal. It is difficult to define when a physician might have his license struck/revoked in certain the circumstances. From experience it typically occurs when the physician has been found guilty on more than one occasion of a serious breach of ethics or is found to be ungovernable. NB We have always had the authority to revoke a license for significant professional misconduct. ON In appropriate circumstances, the Discipline Committee can order the Registrar to revoke a physician’s certificate of registration. Revocations are permanent in the event that the physician does not apply for and be granted reinstatement of his or her certificate of registration. The legislation permits physicians who have had their certificate of registration revoked to apply for reinstatement if a number of procedural requirements are met. There are also a number of timing requirements, one of which will apply in the particular circumstances. An application for reinstatement can be made: • one year after the date of revocation/suspension for professional misconduct or incompetence; or • in the case of revocation for sexual abuse of a patient, five years after the date of revocation; or • six months after a decision is made on an unsuccessful application. If these requirements are met, the Registrar must give the complainant in the original proceeding notice of the application (where applicable); and refer the application to the Discipline Committee if the person was suspended or revoked on the grounds of professional misconduct or incompetence. The burden of proof rests with the applicant (physician) and he or she must persuade the Committee that the certificate of registration should be reinstated. The standard of proof is the balance of probabilities. SK Our legislation does not permit a lifetime ban. A physician whose licence has been revoked always has the opportunity to apply for restoration of his/her licence. The Council of the College will determine whether to restore the physician’s licence and when doing so will consider whether the interests of the public have been adequately protected by measures taken by the physician since revocation of his/her licence. QC Permanent or lifetime ban exists since 1847, the year of foundation of the Collège des médecins du Québec. The decision is taken by the Disciplinary Council which is an independent professional court. Because it is a court, decisions are made public. PEI This is called revocation, and would only occur in a serious situation such as irremediable sexual offence or incompetence, after a formal enquiry. YK The Yukon Medical Council may, (a) cause the medical practitioner to be removed from any register; or (b) suspend the medical practitioner from the practice of medicine for any period prescribed by the council. Council may impose either of these if it considers that a medical practitioner registered under the Medical Profession Act has been guilty of unprofessional conduct or that the medical practitioner is suffering from a mental ailment, emotional disturbance, or addiction to alcohol or drugs that might, if the medical practitioner continues to 5 practice medicine, constitute a danger to the public. NL Yes. Since 2005 the College has stricken physicians from the register in two types of cases. One physician was convicted of multiple criminal offenses including drug diversion, assault, and sexual assault. Three other psychiatrists have been stricken from the register for engaging in sexual activity with patients. The College sought this penalty to reflect the egregious nature of the boundary violation in such cases. BC Yes, the current statute and previous statutes have always given the College authority to cancel a physician’s registration as a result of a discipline finding. In all cases of cancellation, physicians have the right of appeal to the court, and potentially the right of a reinstatement hearing at a future date based on the court’s ruling. MB No. There is authority for revocation of registration in the Medical Act, but the physician has the legal right to apply for reinstatement. NS Yes. Disposition of a hearing committee as outlined in section 115 A hearing committee that finds professional misconduct, conduct unbecoming, incompetence or in capacity on the part of a respondent may dispose of the matter in any manner it considers appropriate, including doing 1 or more of the following, and must include orders for the action in the committee’s disposition of the matter: (a) revoke the respondent’s registration and licence; The Act also provides for Consent revocation section 105 (1) A respondent who admits or does not contest the allegations set out in either of the following may, with the consent of the Registrar, submit a proposed consent revocation agreement to the hearing committee for approval: (a) the complaint; or the decision of an investigation committee under subsection 99(7) Question 4 Does your medical regulatory authority contact all the physician’s patients to alert them when the physician has been found to have committed an offence of a sexual nature? # Response AB No. When a physician has been found guilty of such an offence the physician will usually have been removed from practice (or will have withdrawn from practice). When there is a guilty finding that decision is published. If the physician is able to return to practice (usually after serving a suspension and after undergoing treatment as defined by an independent assessment, including a risk of reoffending assessment) the physician will have conditions and restrictions on his/her practice, often including mandatory use of a trained chaperone. NB Has never been necessary. Always lots of publicity and formal publication. ON No, we do not have access to physicians’ patient contact information and there is no requirement to contact patients directly. However, we publicly release the CPSO’s discipline decision in the following ways: the decision is posted to the College’s online public register; a jurisdictional notice is sent to regulatory authorities in Canada, the US, and other jurisdictions; and notice is 6 given to other stakeholders such as Ontario hospitals; OHIP; and the police where the policy applies. In addition, the CPSO contacts the media via a news release on a monthly basis to report recent discipline findings and to alert the media to upcoming discipline hearings. SK No. However, the information will be disseminated to the media in a summary of the Council meeting and will be posted on the College’s website. The College would have no ability to identify who the physician’s patients are. QC No. But information is published on our website, and an advice is published in local newspapers where the physician practices and in any other location where the physician may have practiced in the past. PEI The information would be made public. We would have no access to the names of other patients. YK Were such a situation to arise, the Yukon Medical Council would determine its obligations and options under the legislation and may choose to seek legal advice in that regard. NL The College publishes the decision of all discipline tribunals in a local newspaper of general circulation and on its website. These cases typically receive wide publicity through the conventional media. BC No, the College does not contact patients directly. Patients are informed of disciplinary actions by way of public notification in media and on the College website. MB No. The information is available to patients through College publications on the website and media reports. NS The College would notify all stakeholders of a disposition regarding a physician and any restrictions in place. Such stakeholders include the two provincial health authorities. Dispositions and restrictions are posted on the College’s website. Question 5 Is your medical regulatory authority moving towards making more and more physician information publicly available? # Response AB Yes, recognizing that we currently make public significant information about our members. NB Ideally, but very few inquiries from patients on the issue. Most from media. ON The CPSO is committed to providing easily understandable information about physicians that will help patients make informed choices and enhance our accountability to the public. We began a multiphase initiative in late 2012 to review how the CPSO could make more physician-specific and process information available to the public on our website. After consulting with physicians and the public on each category of information that was being proposed, the following new information has been added to the CPSO public register as part of this initiative: 2013 • Medical Records Location (where a physician has left practice and this information is known to the CPSO). • Notices of Hearing (setting out allegations of professional misconduct or incompetence awaiting hearing by the Discipline Committee that relate to a doctor, as well as the status of the discipline proceeding (e.g., scheduled hearing dates; whether the hearing has been adjourned; etc.). • Reinstatement Decisions, where a physician has been granted a certificate of registration 7 through the application for reinstatement process. • Outcome/status of inspections of out-ofhospital clinics conducted by the CPSO. 2014 • Criminal Convictions (as of June 1, 2015) and Health Insurance Act offences. • Current bail conditions, if any, which affect a physician’s right to practise. • Illegal Practitioners 2015 • Criminal Charges • Cautions - a summary of any decision in which a caution is ordered by the Inquiries, Complaints and Reports Committee for investigations commenced on or after January 1, 2015. A caution is ordered when the Committee has a significant concern about conduct or practice. It will also be noted if the decision has been appealed and, if the decision is overturned, it will be removed. • SCERPs (specified continuing education and remediation program) - if educational or remediation needs for a physician are identified by the Inquiries, Complaints and Reports Committee and a voluntary agreement cannot be reached, a physician may be required to take a specified continuing education or remediation program (SCERP). This information is posted for investigations commenced on or after January 1, 2015. • Licences and Discipline Findings in Other Jurisdictions SK The College has taken substantial steps to make more information available publicly, including information about physicians’ training and experience, nature of practice, etc. The College is not presently considering expanding that. QC Yes. Currently the Office of Professions of Québec, which is the governmental body in charge of monitoring professional orders activities, is in the process of reviewing the Code of professions to provide more information about professionals to the public. PEI No. I do not know what the question is addressing. YK The Yukon Medical Council always considers its mandate of public safety when contemplating the release of physician information. NL Over the past 12 months, the College has made more physician information to patients and will continue to look for ways to provide patients with more information about their physicians while balancing the physicians’ right to privacy. The College is considering ways to make data on licensing and registration trends available to researchers and others based on the concept of open data. BC Yes. MB The profile initiative (2005) enhanced the information available to the public. Further enhancements may occur when this College comes under the RHPA. NS Yes. The College has recently completed a database upgrade which lays the foundation for providing more physician information on its website. As such, an enhanced ‘physician search’ project is currently underway at the College which will provide for improved and expanded access to physician information, including disciplinary information. 8 Question 6 Is transparency one of your MRA's values? Also, is your MRA currently addressing the need for more transparency and/or is this issue part of your strategic plan? # Response AB Yes (we act in the public interest). NB: S. 119 of the Health Professions Act outlines information available re: members NB We now have open discipline hearings, the first of which will be in 2016. ON Yes, as outlined in response to Question 5, this is a strategic priority for the CPSO. SK Transparency is one of the values of the College. It is contained in the Governance Policies established by the Council which regulate College activities. The issue of transparency requires a balancing of the public interest in knowing about the public protection measures taken by the College and the legitimate privacy interests of patients and physicians with whom the College interacts. While the College regularly reviews its transparency practices, there is no current identified need to establish additional transparency expectations for the College. QC Yes it is for all professional orders in Québec. Professional orders have to comply with Québec's Act on access to documents of public organizations and protection of personal information. PEI We are guided by determining what the public needs to know in the interest of public safety. YK The Yukon Medical Council values transparency and considers the need for increased transparency in various aspects of its work. NL Yes and yes. See the answer to Q5 for details. BC Yes, the College has a legislative duty, as articulated in the Health Professions Act, to establish and administer registration, inquiry and discipline procedures that are transparent, objective, impartial and fair. Aligned with these duties, the College’s core values include Accountability, Justice, Integrity and Collaboration. The College Board is committed to transparency and accountability as core objectives in its three-year strategic plan: “Enable ease of access to relevant information and data that describes the work, activities and outcomes of the College’s core regulatory functions and its registrants.” MB Transparency is one of CPSM’s values. Consideration of transparency is part of this College’s planning for RHPA implementation. NS Yes. The College has identified transparency as a strategic priority and as such this priority is identified in the College’s Strategic Plan approved by its Council at its annual general meeting last year. 9 Respondents Trevor Theman, Registrar College of Physicians & Surgeons of Alberta Ed Schollenberg, Registrar, CPS New Brunswick Kathryn Clarke, Senior Communications Coordinator, College of Physicians and Surgeons of Ontario Karen Shaw, College of Physicians and Surgeons of Saskatchewan Yves Robert M.D. M.Sc., Secretary (registrar), Collège des médecins du Québec Cyril Moyse, Registrar, CPS PEI Micheal Noseworthy, Registrar of Medical Practitioners, Government of Yukon Ed Hollett, Director of Communications, College of Physicians and Surgeons of Newfoundland and Labrador Heidi M. Oetter, MD, Registrar and CEO, College of Physicians and Surgeons of British Columbia Anna Ziomek, Registrar/CEO - College of Physicians & Surgeons of Manitoba Via email: Samantha Van Genne, Registrar, Dept. of Health and Social Services, Government of the Northwest Territories: Our answers would be that of the CPSA, as they are under contract with us to handle our discipline related issues. Responses received and compiled via FluidSurveys Federation of Medical Regulatory Authorities of Canada December 11, 2015