Summer 2012 Newsletter
1. Dr. Elizabeth Mann of Halifax new College President
Dr. Elizabeth Mann, a Halifax internist, began her two-year term as the College’s president at the May 25 Annual General Meeting. Dr. Mann replaces Dr. Ethel Cooper-Rosen, a Dartmouth family physician, who served as president for the 2010-2012 term.
Elections were held in April and May for two Council seats in District 5 (Halifax County) and one seat in District 3 (the Counties of Yarmouth, Shelburne, Queens and Lunenburg).
Dr. William Stanish, a Halifax orthopedic specialist, was elected to represent District 5 for a three-year term. He replaces Dr. Cooper-Rosen.
Dr. Fiona Bergin, a Halifax family physician, was re-elected to represent District 5 for another 3-year term.
Dr. Brian Moses, a Yarmouth internist, was elected to represent District 3. He will serve a one-year term, completing the term of Dr. Shelagh Leahey of Yarmouth, who retired from Council in May.
The College extends thanks to all physicians who ran in the Council election and to all those who served on Council and committees in the past year.
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2. College releases Methadone maintenance treatment handbook
In early June, the College released its Methadone Maintenance Treatment Handbook, a resource created to support physicians providing methadone maintenance treatment (MMT), and to encourage physicians to enter the field.
In the absence of a Nova Scotia-specific document on MMT, local physicians have relied on guidelines from other jurisdictions. The new College handbook is intended to be the definitive guideline for Nova Scotia physicians who prescribe methadone for addiction. It was developed by a panel of local experts in the areas of pharmacy, pain and addiction, and is informed by feedback from various stakeholders in the field.
The handbook is available at http://www.cpsns.ns.ca/PhysicianGuidelinesandPolicies.aspx?EntryId=62
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3. From the Registrar and CEO: The evolving relationship between the College and the DHAs
The College enjoys a close, collaborative relationship with each of the District Health Authorities and the IWK. Our respective spheres have considerable overlap. College licensing and registration are not terribly dissimilar to privileging. Further, whether it is done at the College or DHA level, the complaint investigation and discipline processes involving physicians carry with them the same difficult and sometimes painful challenges.
I believe that the Cochrane report, as it ripples its way across Canada, is going to force the College and the DHAs into an even more intimate relationship.
Following the 2010 discovery of numerous misread CT scans and ultrasounds that led indirectly to the death of at least one patient, the British Columbia government commissioned a report by Dr. Douglas Cochrane, a highly respected expert on patient safety. Issued in two parts over 2011 and 2012, the Cochrane Report focused on the state of specialist medical credentialing and quality assurance within BC.
Dr. Cochrane found that the privileging and credentialing processes within BC Health authorities were inadequate to protect the public from physicians entering into a scope of practice for which they are not competent, and that the essential communication between the BC College’s licensing function and the health authorities’ privileging functions was inadequate.
Dr. Cochrane’s recommendations were directed toward province’s health authorities, the College of Physicians and Surgeons and the Ministry of Health Services. He recommended that a timely peer-review system for diagnostic imaging be implemented across the province, starting with greater oversight of newly privileged radiologists including locums and doctors with provisional licenses; establishing a common, electronic provincial physician registry accessible to the College and health authorities to track current information about physician licensing, credentials and privileges; and creating consistent rules around communication and patient notification in the event of adverse events.
Similar situations involving diagnostic imaging and pathology have occurred in several Canadian provinces in recent years. Fortunately, no such situation has occurred in Nova Scotia. Nevertheless, the College, the DHAs, and the Department of Health and Wellness have decided to implement the recommendations of the Cochrane Report to limit the possibility of a similar situation occurring here. Other Canadian jurisdictions are implementing or considering similar actions.
While the specifics and timelines for the upcoming Nova Scotia changes are still being worked out, it has been agreed that serious consideration will be given to the needs of physicians. Rest assured that we will update you on forthcoming changes as the project proceeds.
Douglas (Gus) Grant is the registrar and CEO of the College of Physicians and Surgeons of Nova Scotia.
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4. From the Investigations Committees: Head lice and conflict of interest
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 significant details have been changed to preserve confidentiality.
In May 2010, the College received a written complaint from Mary White, the office manager of a six-physician pediatric practice in Halifax. Ms. White alleged that Dr. John Green, a former partner in the practice, had dealt with certain patients in an unethical and potentially dangerous manner.
Ms. White indicated that Dr. Green left the practice in late 2009 to work independently. Shortly afterward, she got a call from the mother of a child who had been one of Dr. Green’s patients. The woman said that she was very impressed by the head-lice pills Dr. Green had given her son, and that several other parents at the child’s school wanted to know how to get them.
Ms. White checked the child’s medical records, but could find no indication that he had been prescribed or directed to take any head lice treatment she was familiar with. However, she found a small note in the file that said “Dispensed # 7 - 50 mg NoNit qd”. Reasoning that this might be the medication the mother was looking for, she did an internet search and discovered that NoNit was a novel head-lice treatment available by prescription in Korea and Japan, but not approved for sale in North America.
Ms. White said she immediately recognized the name of NoNit’s Korean manufacturer. As office manager, she was aware that Dr. Green had been appointed to the US medical advisory board of the company in 2008 and that he had attended quarterly board meetings in New York. Concerned that Dr. Green might have had a conflict of interest and had dispensed a non-approved oral medication to his patients, she attempted to contact him several times to discuss the matter. He did not return her calls. Unable to reach Dr. Green, Ms. White decided to file a written complaint with the College.
In his written response to the complaint, Dr. Green said that he had given free samples of NoNit to roughly 30 patients during 2009. He stated that the product had been approved abroad, and was likely to get approval in Canada and the US shortly. He noted that clinical trials in Asia had shown it to be superior to existing treatments because no known strains of lice had developed resistance to it. Although NoNit was not approved in Canada, he felt it was the best available treatment for his patients because it was known to be extremely effective and did not contain petroleum-based pesticides.
Dr. Green met with an Investigation Committee in October 2010. The Committee asked if he felt there was a connection between his dispensing of NoNit and his affiliation with the company that produced it. He said that he had collected data about the drug`s effectiveness among his 30 patients and had uploaded this information to an online database maintained by the company in the US. He said he believed this data would be used in a forthcoming new drug application to the FDA. He also said that he sat on the company`s US medical advisory board, but was not compensated for this work or for contributing information to the database. Asked if he had any other involvements, he indicated that he did not own shares in the company or receive payment of any kind. He said that although he was not directly compensated for this work and that his dealings were entirely with the US subsidiary of the company, he might have had a “minor conflict of interest”. He reiterated that he had never charged his patients for the product.
The Committee reviewed the written complaint along with Dr. Green’s written and oral responses. In its decision, the Committee noted the following concerns:
- Dr. Green had personally dispensed a non-approved oral medication to patients, and as such had violated federal regulations and accepted standards of practice.
- Dr. Green had effectively undertaken research without having secured approval from a recognized research ethics board or receiving informed consent from the patients or their proxies. As such, he had violated policies and guidelines issued or endorsed by the College.
- By accepting several week-long trips to New York City paid for entirely by the pharmaceutical company, Dr. Green had violated the spirit, if not the letter, of the College’s
Conflict of Interest Guidelines and two related CMA policies approved by the College.
In Dr. Green’s favour, the Committee noted that no patients appeared to have suffered adverse effects from the treatment and that Dr. Green was forthcoming and cooperative in his dealings with the Investigations Committee and College staff.
The Committee issued a written Caution* to Dr. Green, and specified that he carefully review and comply with the following guidelines and policies issued or endorsed by the College.
CPSNS Policy and Guidelines Regarding Informed Patient Consent to Treatment:
http://www.cpsns.ns.ca/PhysicianGuidelinesandPolicies.aspx?EntryId=53
CPSNS Conflict of Interest Guidelines:
http://www.cpsns.ns.ca/PhysicianGuidelinesandPolicies.aspx?EntryId=8
Physicians and the Pharmaceutical Industry (CMA document endorsed by CPSNS):
http://www.cpsns.ns.ca/PhysicianGuidelinesandPolicies.aspx?EntryId=25
Canadian Medical Association Code of Ethics (CMA document endorsed by the College):
http://www.cpsns.ns.ca/PhysicianGuidelinesandPolicies.aspx?EntryId=7
A full list of the College’s physician policies and guidelines is available at:
http://www.cpsns.ns.ca/PhysicianGuidelinesandPolicies.aspx
* 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. The Committee considers a caution to be a notice of a serious nature.
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5. Inter-Professional Pain Conference: Sept. 28-29 in Halifax
The following information is provided to College members on behalf of Capital Health. For further information, please see the contact information below.
Capital Health Pain Services will present a CME-accredited pain conference on September 29 -29 in Halifax. The conference is designed to provide an update in the field of pain management for family physicians, medical specialists and other health professionals who have an interest in assisting patients suffering with chronic pain.
The objective is to cover an intensive curriculum within a short period of time. The program will give clinicians an appreciation of the importance of taking an interdisciplinary approach as well as provide updates on key areas of pain management such as management of pain in the pediatric patient, neuropathic pain, community vocational counseling, and management of opioid medications for chronic pain.
The program includes faculty from multiple disciplines and is tailored to facilitate a team approach including nursing, medicine, physiotherapy, psychology, dentistry, pharmacy and occupational therapy.
For more information, please visit: http://www.cdha.nshealth.ca/employees/event/atlantic-provinces-inter-professional-pain-conference
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6. Doctors’ Electronic Bookshelf offers new opportunities to access information
The following information is provided to College members on behalf of Doctors Nova Scotia. For further information, please see the contact information below
The Electronic Bookshelf at www.doctorsNS.com offers services and resources, including access to journals and a librarian, free of charge to members of Doctors Nova Scotia.
A recent analysis of the Electronic Bookshelf and its resources included a survey of close to 700 members and interviews with 18 others. The analysis initiated a shift in how information will be provided to Doctors Nova Scotia members who include physicians, residents and medical students. Both information and services for members in rural areas will be increased. In addition, the Electronic Bookshelf will focus most of its resources on family practice physicians.
“When practicing medicine in the community, separate from a university and perhaps even outside a hospital, sources of health information can seem more limited,” explained Pat Lee, the Electronic Bookshelf librarian. “This is especially true for those who don’t have hospital privileges and access to a hospital’s information resources,” she added.
Doctors Nova Scotia members use the Electronic Bookshelf to access resources such as journals from MDConsult, the American Medical Association, and EBSCO’s Medline with full text. Text books from MDConsult, drug information from e-CPS and Micromedex, evidence-based information from Cochrane Library, and clinical practice guidelines are also among the resources available.
Doctors Nova Scotia offers a variety of services including information searches and developing a short list of results with abstracts or full-text articles, planning search strategies, and providing training with information resources.
For information about the resources available through the Electronic Bookshelf and other services throughout the province, contact Pat Lee at 1-866-890-5563, or e-mail pat.lee@doctorsns.com
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7. How to contact the College
Address and contact information:
http://www.cpsns.ns.ca/ContactUs.aspx
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