Spring/Summer 2011 newsletter
1. 2011 Council election results announced
Council elections were held in April 2011 for seats in District 5 (the county of Halifax) and District 2 (the counties of Pictou, Cumberland and Colchester).
Drs. Elizabeth Mann and Zachary Fraser were each elected to represent District 5. Dr. Fraser replaces Dr. Scott Theriault on Council.
Dr. James MacLachlan was re-elected via acclamation in District 2 (counties of Pictou, Cumberland and Colchester).
The College wishes to thank all the physicians who ran for election to Council in 2011.
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2. From the Investigation Committees:
Patient placed at risk by deceptive prescription
Note: The following summary describes a case examined by one of the College's Investigations Committees. This information is provided for educational purposes. All names and certain details have been changed to preserve confidentiality.
In March 2011, the College received a complaint from David Brown, a claims investigator at the Seashell Insurance Company. The complaint alleged that Dr. John White had written several deceptive prescriptions for cardiac medication for his patient, Mr. Frank Rose. Mr. Brown claimed that these prescriptions had been for a medication that was actually intended for Mr. Rose’s wife, who was also Dr. White’s patient. Later evidence revealed that Mrs. Rose did not have health insurance, and that Mr. Rose’s policy with Seashell Insurance was limited to medications intended for his own use.
In his March 2011 response to the complaint, Dr. White admitted that he had written prescriptions over three years in the name of Mr. Rose for the use of his wife. He stated that he was uncomfortable with Mr. Rose’s request for a deceptive prescription but that he sympathized with the Rose’s difficult financial situation. He said that he had initially agreed to write only one such prescription, but given his familiarity with Mrs. Rose’s medical problems, he found it difficult to decline further requests from Mr. Rose.
Dr. White apologized to the committee and indicated that he knew his actions were wrong. He also told the committee that he had subsequently helped the Roses find a legitimate and affordable means of paying for prescription medications.
Investigation Committee “A” received the complaint in May 2011 and obtained the medical records for both Mr. and Mrs. Rose. Mrs. Rose’s record indicated that she had been taken to hospital in June 2009 after collapsing in a department store. She had been admitted for 24 hours of cardiac monitoring, but at no point did she or her husband disclose to staff that she was taking prescription cardiac medication. She was discharged without further incident.
When Dr. White later met with the committee, he stated that he was ambivalent about writing deceptive prescriptions in the name of Mr. Rose, but was worried that Mrs. Rose might not otherwise receive the necessary medication. He admitted that prior to the complaint he had been unaware of Mrs. Rose’s 2009 hospital stay, even though his records contained an ER note and discharge summary for the admission.
In its decision, the committee acknowledged that access to affordable prescription medications can be a significant problem for certain patients, but that Dr. White’s practice of issuing deceptive prescriptions was in breach of the CMA Code of Ethics, particularly section seven, which states: Resist any influence or interference that could undermine your professional integrity.
The committee also expressed concern that the conduct could have put Mrs. Rose’s health at risk because hospital staff were not made aware of her cardiac medication at the time of her 2009 hospitalization. While recognizing that this failure to disclose was a poor decision on the Rose’s part, the committee felt that Dr. White’s behaviour nevertheless constituted a serious lapse of professional judgement.
The committee issued a written Caution* to Dr White to refrain from writing deceptive prescriptions. Dr White was also cautioned to conduct himself in an ethical manner at all times and to recognize that the reputation of the medical profession could be harmed by his actions.
* A Caution is intended to express the dissatisfaction of the Investigation Committee and to forewarn the physician that if the conduct recurs, more serious disciplinary action may be considered. A Caution is kept in the physician's file but is not disclosed to the public, on Certificates of Standing or to other licensing authorities without the physician’s consent.
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3. College releases five new/updated physician policies and guidelines
Please Note: Policies reflect the position of the College. Physicians licensed with the College are expected to be familiar with and to comply with College policies. Guidelines contain recommendations endorsed by the College. The College encourages its members to be familiar with and to follow its guidelines whenever possible and appropriate. A complete list of the College’s physician guidelines and policies is available at:
http://www.cpsns.ns.ca/PhysicianGuidelinesandPolicies.aspx
Policy Regarding Care of Patients Who Have Received Treatment Outside Canada 
This is a new policy that was approved by Council on March 25. It sets out the College’s expectations of physicians when dealing with patients who have been treated in other countries, particularly when such treatments are experimental or do not meet accepted Canadian standards.
Policy on Physician Obligations Regarding Certification of Death 
This is a new policy that was approved by Council on March 25. It highlights provincial legislation regarding the completion of death certificates and stresses the College’s expectation that physicians complete these certificates in a timely manner.
Policy on Treating Self and Family Members
This is a new policy that was approved by Council on March 25. With reference to the Canadian Medical Association Code of Ethics, this document describes situations in which it is appropriate for physicians to treat friends and family members, and situations in which the College expects that physicians will not undertake such treatment.
Policies and Guidelines for Infection Prevention and Control in the Physician’s Office
This is a new set of policies and guidelines that was approved by Council on May 27. This concise document describes ten infection prevention and control measures that should be followed in physicians’ offices. Some of these measures have been adopted as College policy, while others are provided as guidelines.
Guidelines Regarding the Sale of Products and Services to Patients
This is an updated guideline that was approved by Council on May 27. Formerly entitled Selling Products out of the Office, this document has been significantly condensed and now refers extensively to the Canadian Medical Association Code of Ethics.
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4. Dr. Douglas A. (Gus) Grant to replace Dr. Cameron Little as College Registrar and CEO
The College is very pleased to announce that Dr. Douglas A. (Gus) Grant will replace Dr. Cameron Little as its Registrar and CEO following Dr. Little’s retirement in September 2011.
Dr. Grant has an impressive background in medicine, law, and the arts. He holds a bachelor of arts degree (cum laude) from Harvard University, a bachelor of law degree (honours) from McGill University, and a medical degree from Dalhousie University.
Dr. Grant has practiced family medicine in Canada and the USA for the past 12 years, including work in emergency medicine, occupational medicine, and geriatrics. He has extensive experience in medical, legal, and medico-legal affairs, having worked in legal litigation and arbitration, legislation and policy development, and medical-professional assessment.
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5. Online-only license renewal begins in November 2011
Handwritten annual license renewals in paper format will be replaced by online-only license renewals beginning in November 2011. As with other Canadian medical regulatory authorities, the College is moving to online-only license renewals to limit overhead costs and improve the accuracy of the licensing information it collects.
Over fifty percent of College members already use the online license renewal option, which is fast, secure, and instantly provides a receipt and verification of licensure. Payment can be made using all major credit cards and bank debit cards.
For members who have not yet renewed their licenses online, the College will provide telephone assistance during office hours and at certain times during the evening. The College also plans to offer physicians the option of receiving personal assistance with completing the online renewal at its offices in Halifax and at certain locations throughout the province.
Further information will be contained in the 2012 license renewal package, which will be mailed to members in mid-November. For those who have questions in the meantime, please contact the registration department by e-mail at registration@cpsns.ns.ca, or call (902) 422-5823, toll-free 1 (877) 282-7767.
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6. College of Pharmacists provides information on expanded scope of practice
Note: The following information is being provided to College members on behalf of The Nova Scotia College of Pharmacists (NSCPC). For further information, please contact the NSCPC at (902) 422-8528.
The Nova Scotia College of Pharmacists (NSCP) has recently introduced Standards of Practice for Prescribing of Drugs by Pharmacists. This expanded scope of practice is intended to enable pharmacists to more fully apply their skills and competencies within the healthcare system as experts in medication therapy and management. Pharmacist prescribing provides the opportunity for pharmacists to further support the objectives and challenges of health care delivery in the province.
The process for developing the standards was a collaborative effort, involving significant consultation with a number of key stakeholders, including the College of Registered Nurses of Nova Scotia, the College of Physicians and Surgeons of Nova Scotia, Doctors Nova Scotia, and Canadian Medical Protective Association. The input received from these groups is evident in the standards document. To provide a quick reference for other health professionals, the NSCP has prepared a two-page document called What Health Professionals Need to Know About Pharmacist Prescribing.
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7. Physician Mentor Network Program now available
The College has introduced its new Mentor Network Program in response to identified needs for a program that can assist administrators, mentors, and mentored physicians.
The program provides resources and training opportunities for all physician mentors in Nova Scotia, particularly those who are not part of the College’s Clinician Assessment for Practice (CAPP) program.
A comprehensive range of resources are located on the program’s website (http://mentornetwork.net), including training material and educational guides, an online MainPro accredited course on the mentorship process, an overview of participants’ roles and expectations, and a step-by-step guide through the mentoring cycle.
The College wishes to thank the many physicians and organizations who assisted in the development of this program. For further information, please contact Sandra Taylor, Mentor Network program manager, at staylor@cpsns.ns.ca or by phone at (902) 422-5823.
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8. Province offers guidance regarding family practice nurses and EMRs
Note: This information is being distributed to College members on behalf of the Nova Scotia Department of Health and Wellness. For further information, please contact Janis Brown MN, RN A/Nursing Policy Advisor, Nursing Advisory Services at 902 424-0122.
With many family practice teams across the province adopting electronic medical records (EMR) in family practices, some concerns related to how the system records nursing documentation have come to the forefront. Family practice nurses (FPN) have expressed concern that the EMR records documentation in such a manner that it might appear that the FPN has prescribed a drug or made a diagnosis. The reason for this is that in some EMRs the FPN’s name is attached to these activities. This has resulted in some nurses feeling uncomfortable in documenting the diagnosis or printing the prescription. In these highly collaborative team practices, this can have an impact on patient care, efficiency and productivity.
In response to this concern, key stakeholders from the Department of Health and Wellness (including PHIM) were consulted about the best approach and the following is advised:
- When a registered nurse documents a diagnosis in the EMR, this does not mean that she/he has made the diagnosis. The nurse is documenting that a patient has been seen for a pre-existing diagnosis or that another team member (physician or nurse practitioner) has made the diagnosis at that visit. This is within the scope of practice for a registered nurse.
- When a registered nurse prints a prescription or prepares a prescription to be faxed, this does not mean that the nurse has prescribed a medication. The act of prescribing occurs when the physician or nurse practitioner reviews and signs the prescription. The prescription is not valid and cannot be filled without this signature.
- It is recommended that nurses, physicians, nurse practitioners, and other health care providers document care under their individual “log-in” and not share their password or log-in with other providers.
Family practice teams in the province can be reassured that registered nurses can continue to work to the full scope of practice without concern for the implications of the documentation practices described above. This is how the EMR software functions and should not alter appropriate nursing practice.
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9. Prescription Monitoring Program to continue assisting physicians if postal strike occurs
The following information is provided to College members on behalf of the Nova Scotia Prescription Monitoring Program (NSPMP). For further information, see the NSPMP contacts below.
In the event of a mail disruption caused by a Canada Post strike, prescribers will still be able to access the Nova Scotia Prescription Monitoring Program (NSPMP) services:
- To ensure duplicate pad orders are received by the NSPMP it is recommended that you place orders via telephone by calling (902) 496-7123, toll-free at toll free at 1 (877) 476-7767, or by fax at (902) 481-3157. Information routinely sent to the NSPMP via mail can be sent by secure fax at (902) 481-3157.
- In the event of a postal disruption you should allow 3 to 4 business days for duplicate pad delivery. If a postal disruption occurs, the NSPMP will continue to process orders for prescribers who require delivery of duplicate pads during the strike.
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10. Guidelines now available on surveillance and treatment of asbestos-related diseases
The SafetyNet Centre for Occupational Health and Safety Research at Memorial University has recently published Health Care for Patients with Exposure to Asbestos that covers topics such as screening and clinical recommendations for the management of asbestos-related disease.
The document is available at: http://www.safetynet.mun.ca/pdfs/Asbestos_Exposure_2010.pdf.
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11. Physicians asked to complete national survey on adult weight-management services
Note: The following information is being provided to College members on behalf of the Canadian Obesity Network. For further information, see the Network’s contact information below.
The Canadian Obesity Network and the Ministry of Health and Social Services of Québec are performing the first Canada-wide environmental scan of adult weight-management services. The project aims to build a comprehensive picture of adult weight management services in Canada and to raise awareness of the variety of Canadian programs.
The online survey can be completed by anyone who leads a weight management program or service (including specialists who treat obesity on a solo basis). For further details or to complete the survey, please go to: http://con-initiatives.com/adultscan.
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12. How to contact the College
A list of College contacts is available HERE.
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