HEALTH POLICY REPORT

A summary of current health legislation and policy developments

by OMA Health Policy Department

 

December 2008

 

 

Personal Health Information Protection Act (PHIPA)


This past summer, the Standing Committee on Social Policy, a branch of the legislative assembly of Ontario, conducted a comprehensive review of the Personal Health Information Protection Act (PHIPA). The OMA provided comments relating to physician practices, with a focus on the lock box provisions, reasonable fees for access, abandoned records, and the emerging trend of electronic health records. The committee’s report, which was re­leased to the public in November, outlines priority recommendations for the legislative assembly that will require further action. The report has not yet been adopted by the legislative assembly, and may be debated at a later date.

Following are some of the committee’s recommendations that will be of interest to physicians:

  1. No change to the lock box provisions in PHIPA.
  2. Creating a regulation to set fees that may be charged by the health information custodian. The regulation would prescribe a fee for making the record available and for providing copies. Reasonable cost recovery will not be left to the discretion of health information custodians.
  3. Examining the use of the term “circle of care” in other jurisdictions, and considering whether the term should be defined in PHIPA.
  4. Amending section 54(2) of PHIPA to give health information custodians 10 working days to respond to a request for access to a personal health record (rather than the current requirement of 30 days).
  5. Developing a more comprehensive range of regulations related to e-health.

OMA staff contact: Juhee Makkar (ext. 2978)

Amendments to the Coroner’s Act

In response to recommendations made in a recent report by Justice Stephen Goudge, the Ontario government has introduced Bill 115, an Act to Amend the Coroner’s Act. The proposed changes attempt to make the death investigation system in the province more accountable and transparent.

The new legislation would establish a Death Investigation Oversight Council to oversee the work of the chief coroner and chief pathologist. A complaints committee would be created to track complaints about the handling of a particular death investigation and/or the conduct of a coroner or pathologist. Complaints about the medical roles of these professionals will be directed to the College of Physicians and Surgeons of Ontario. In addition, forensic pathology will be centralized under the chief forensic pathologist to ensure consistency in decision-making and procedure across Ontario. A registry of pathologists approved to conduct autopsies would be created and maintained by the chief forensic pathologist.

Due to current physician shortages in Northern, First Nations, and remote communities, section 16 of the Coroner’s Act would be amended to allow the coroner to appoint any person (not just a physician or police officer), in accordance with the regulations, to exercise the investigative powers and duties of a coroner. However, the decision to call an inquest into a death would rest with the Office of the Chief Coroner.
The bill passed its first reading on October 23.

OMA staff contact: Juhee Makkar (ext. 2978)

 

November 2008

 

Physician Assistant Project: OMA Meeting for Supervising Physicians


The OMA recently hosted a one-day information-sharing session for supervising physicians participating in the Ontario Physician Assistant (PA) Initiative. A total of 23 physicians attended: 14 from the hospital demonstration project; five from the community health centre demonstration project; and four from the physician-employed physician assistant (PEPA) demonstration project.

Various project-related issues were discussed, including interim evaluation results and a proposed mechanism for tracking PA activity, the ongoing development of medical directives and lessons learned, billing issues, and the sustainability of PAs moving forward.

For detailed information on these issues, or for general information on the OMA PEPA Demonstration Project, contact Carol Jacobson, OMA Health Policy Department (416-340-2984 or 1-800-268-7215, ext. 2984, e-mail: carol_jacobson@oma.org) or Rachel Bandele, OMA Health Policy Department (416-599-2580 or 1-800-268-7215, ext. 3330, e-mail: rachel_bandele@oma.org).

OMA staff contact: Carol Jacobson (ext. 2984), Rachel Bandele (ext. 3330)

CPSO Draft Policy: “Accepting New Patients”

The College of Physicians and Surgeons of Ontario (CPSO) has circulated a new draft policy entitled “Accepting New Patients.” OMA staff have prepared a response to the CPSO opposing this policy as it would require physicians to accept patients on a “first-come, first-served” basis, unless the physician is clinically incompetent to take on a patient, is practising within a defined scope of practice, or has a closed practice.
While the OMA does not condone physicians unfairly “screening out” patients, the OMA urges the CPSO to allow physicians to decide how to best manage their own professional practices within the context of the human rights code. The OMA is also concerned that this policy might conflict with the government’s wait times strategy (WTS), as it could place physicians who accept WTS patients on a priority basis at risk of a finding of professional misconduct.

OMA staff contact: Ada Maxwell (ext. 2942)

 

 

October 2008

CPSO Draft Policy on Human Rights

The College of Physicians and Surgeons of Ontario (CPSO) recently circulated a draft policy entitled “Physicians and the Ontario Human Rights Code.” The policy was generated, in part, as a response to the Ontario Human Rights Commission’s (OHRC) concerns regarding a physician’s duty to accommodate patient needs.

This policy has generated concern among physicians, based on an understanding that it might circumscribe a physician’s right to refuse treatment based on religious or moral beliefs.

The OMA believes that the human rights of both physicians and patients should be respected. The OMA objects to a CPSO human rights policy that may have unfair disciplinary and legal implications for physicians. It is the OMA’s position that physicians should refer to the Ontario Human Rights Code when exercising their professional judgment on whether or not to provide care, and that the Ontario Human Rights Tribunal (and the courts) should be left to interpret the Code.

OMA staff contact: Ada Maxwell (ext. 2942)

Physician Employed Physician Assistant (PEPA)

As part of the OMA-led Physician Employed Physician Assistant (PEPA) demonstration project, physician assistants have begun working in community-based diabetes care clinics in Windsor and Toronto, and in long-term care homes in Kingston and Hamilton. It is expected that the remaining long-term care position will begin this autumn. The physician assistant initiative is already well underway in hospitals and in community health centres.

OMA staff contact: Carol Jacobson (ext. 2984) or Rachel Bandele (ext. 3330)

Wait Times Strategy

Local Health Integration Network (LHIN) working groups, composed of physicians and hospital representatives, recently began utilizing a new web-based reporting tool called iPort Access. This program will streamline access to surgeon-specific wait list data, which previously had to be requested from individual hospitals.

The Ministry of Health and Long-Term Care (MOHLTC) has made assurances that the data will be used strictly for planning purposes and to formulate a strategy to address wait times. The data will not be analyzed independently and will not be posted on websites.

In August 2008, the Wait Times Advisory Committee, which included representatives of the OMA, MOHLTC, and Ontario Hospital Association, circulated a communiqué to all LHIN CEOs and wait times co-ordinators, clarifying the manner in which this data is to be utilized. This letter is posted on the OMA website (http://www.oma.org/Health/Wait_Lists/index.asp).

The OMA Board has expressed concern regarding the potential for a Ministry or LHIN initiative aimed at creating a centralized referral intake process based on surgical wait times. The OMA will continue to work with both the Ministry and the LHINs to explore practical wait times strategies, while defending clinical autonomy and the patient’s right to choose.

Dr. Ved Tanden, Co-Chair of the Physician Hospital Care Committee, outlined these concerns in a letter to Dr. Joshua Tepper, Assistant Deputy Minister, MOHLTC Health Human Resources Strategy Division. This letter is posted on the OMA website (http://www.oma.org/Health/Wait_Lists/Dr_Tepper_letterJuly_08.pdf).

OMA staff contact: Jenn Yiokaris (ext. 2883)

HPRAC Consultation on Scopes of Practice

This spring, the Health Professions Regulatory Advisory Council (HPRAC) circulated a consultation document inviting various health professions to submit proposals on expanding their scopes of practice. In response to the new Minister of Health and Long-Term Care’s request for an update on proposed changes to the scope of practice for midwives, pharmacists, dieticians, and physiotherapists, HPRAC has held a number of consultations in recent weeks to gauge stakeholder reaction, including that of the OMA.

While the OMA restated its commitment to promoting inter-professional collaboration, it noted a number of fundamental concerns that emerge consistently across submissions related to patient safety, a lack of clarity with respect to responsibility for patient management, liability, and system inefficiencies and cost.

OMA staff contact: Ada Maxwell (ext. 2942)

Public Hospitals Act

The Ontario Hospital Association/OMA Taskforce, struck to undertake a review of the Public Hospitals Act (PHA) and a targeted review of the OHA/OMA Prototype Bylaws, convened its first meeting in September 2008.

OMA staff contact: Jenn Yiokaris (ext. 2883)


September 2008

Role of Physicians under the Mandatory Blood Testing Act

The Mandatory Blood Testing Act, 2006 was proclaimed into force on August 10, 2007. This piece of legislation permits an individual who, as a result of being a victim of a crime, or while providing emergency health-care services, or in the course of his or her professional duties, comes into contact with the bodily substance of another person (the respondent) to apply to a medical officer of health (MOH) to have the blood of the respondent analyzed for HIV/AIDS, Hepatitis B and Hepatitis C. Upon receipt of an application that meets the legislative requirements, the MOH will contact the respondent and request that he or she provide either a blood sample for analysis or other evidence of seropositivity.

The application process includes the completion of a Physician Report, which can be found online (http://www.mcscs.jus.gov.on.ca/English/about_min/MBTA_forms.html). To comply with the Act, the physician must complete all parts of the Physician Report. If any of the information required in the report is missing, the MOH will not approach the respondent or take any further action. For a detailed account of the roles and responsibilities of the physician under the Act, visit the OMA website (www.oma.org) and click on “Health Policy” and “Mandatory Blood Testing Act.”

Inclusion of Physicians under the Mandatory Blood Testing Act

On Friday June 27, 2008, Section 3 of Ontario Regulation 449/07 was amended to include “members of the College of Physicians and Surgeons of Ontario and medical students engaged in training” to the list of persons who can make an application under Section 2 of the Mandatory Blood Testing Act, 2006. This amendment was made in response to a request by the OMA.

Under Section 2(3) of the Act, persons belonging to a prescribed class are entitled to have the blood of another person tested if the applicant has been exposed to a foreign bodily substance. Section 3 of Ontario Regulation 449/07 lists the various prescribed classes of persons. The list refers to a number of health-care workers and emergency first responders, such as police officers, paramedics, and members of the College of Nurses of Ontario.

Prior to the amendment, there was no explicit mention of physicians or medical students. The OMA welcomes this legislative change as it ensures that physicians receive the same protection extended to all other classes of professionals mentioned in the Regulations.

OMA staff contact: Juhee Makkar (ext. 2978)


July 2008

Patient Safety — “Red Rules”

Some health-care organizations are considering the use of “Red Rules” to enhance safety and reduce the risk of patient harm. When a rule is designated a Red Rule, it signifies that it is of absolute importance, and that an employee must take appropriate action if the rule is violated. Traditionally, Red Rules have been used in the manufacturing industry, where they apply to all, are few in number, easy to remember, and do not contain exceptions. 

The Institute for Safe Medication Practices (ISMP) cautions against taking the Red Rule approach with organizational policies or standard operating procedures in the health-care environment. While absolutes are not generally appropriate in the realm of patient care, Red Rules may be considered suitable for procedures such as sponge reconciliation or “time out” for patient verification before invasive surgery. The April 24 ISMP Bulletin contains further information regarding Red Rule criteria, and suggestions for health-care organizations considering developing Red Rules. The Bulletin is posted online at: http://www.oma.org/Health/Safety/.

OMA staff contact: Jenn Yiokaris (ext. 2883)

OMA Response to HPRAC Scope of Practice Review

As part of its ongoing consultation related to the Ministerial Referral on Interprofessional Care, the Health Professions Regulatory Advisory Council (HPRAC) is in the process of collecting information from various health colleges and professionals on the issue of scope of practice. HPRAC has invited a number of colleges to comment on the ways in which current scopes of practice can be changed to promote interprofessional collaboration between health-care professionals.

The OMA remains committed to assisting in developing constructive dialogue on the issue of interprofessional care and increased access to care. To that end, the OMA submitted a response to HPRAC on June 30, which emphasizes the need for improvements in the health system to promote interprofessional care, before focusing on expanded scopes of practice.

OMA staff contact: Ada Maxwell (ext. 2942)

Pharmacist Scope of Practice and Prescribing Power

The Health Professions Regulatory Advisory Council is currently reviewing the scopes of practice for several professions in Ontario, including pharmacists.

The OMA recently participated in a stakeholder information session hosted by the Ontario College of Pharmacists and made comments in support of enhanced pharmacist involvement in medication management within a team context.

HPRAC is also examining the authority given to non-physician health professions to prescribe and/or use drugs in the course of their practice under the Regulated Health Professions Act, 1991 (RHPA) and the health profession acts.

The OMA will engage in ongoing consultation with HPRAC and other pharmacy stakeholders to ensure that the physician perspective is brought to the table.

OMA staff contact: Juhee Makkar (ext. 2978)


June 2008

Reporting On Patient Safety Indicators

In consultation with the Patient Safety Indicators Working Group (PSIWG), of which the OMA is a member, the Ministry of Health and Long-Term Care has identified the cluster of indicators it will mandate hospitals to report on, in addition to finalizing the accompanying regulation.

Hospitals will be required to report the majority of the eight indicators on their websites beginning in December 2008 or April 2009, however as a result of recent media focus, Clostridium difficile will have an expedited reporting date of September 2008. Due to the short timeline, hospitals will likely have some initial flexibility as to reporting methodology. This will allow smaller hospitals additional time to familiarize themselves with processes and to address anticipated challenges. By June 2009, the Ministry expects to have a more stringent hospital data collection and reporting program established, and plans to eventually transition to an external data reporting organization.

This initiative results from the May 2007 announcement by Minister of Health and Long-Term Care George Smitherman, which stressed the need for legislative changes to increase transparency in an effort to enhance safety and accountability in health care.

The OMA will continue to actively participate in the PSIWG in an effort to promote reasonable reporting.

OMA staff contact: Jenn Yiokaris (ext. 2883)

Disclosure of Critical Incidents

A new regulation comes into effect in July that amends Regulation 965 under the Public Hospitals Act in order to mandate the disclosure of a critical incident to a patient. A critical incident is defined as: “any unintended event that occurs when a patient receives treatment in the hospital, (a) that results in death, or serious disability, injury or harm to the patient, and (b) does not result primarily from the patient’s underlying medical condition or from a known risk inherent in providing the treatment.”

Hospitals will be expected to adopt and implement the regulation, however, they may also retain or develop expanded disclosure policies that exceed (but do not contravene) the requirements of the Act. The amendments place responsibility on hospital administrators to set up a system for ensuring the disclosure of critical incidents, therefore, it will be their task to designate staff duties around reporting, and to establish internal protocols based on what is most appropriate for their particular facility.

Note: In February 2003, the Council of the College of Physicians and Surgeons of Ontario (CPSO) approved a policy that mandates disclosure of a critical incident, and the Canadian Medical Protective Association (CMPA) encourages appropriate disclosure of harm.

OMA staff contact: Jenn Yiokaris (ext. 2883)

Bill 59 — The Apology Act

In April, Sault Ste. Marie Liberal MPP David Orazietti tabled a private members’ bill entitled The Apology Act. The intent of the Act is to allow an individual to express an apology in connection with any civil matter, without that apology being considered an implied or expressed admission of fault or liability, or admissible as such in any court of law. Removing the threat of litigation from an apology could lead to more open communications in the health-care environment, and evidence supports the notion that apologies offered promptly after an incident lead to timely and cost-effective resolutions. The OMA has joined the CMPA in welcoming Bill 59.

OMA staff contact: Ada Maxwell (ext. 2942)

CPSO — Inspections of Out-of-Hospital Facilities

As a follow-up to its consultation on proposed regulation and bylaw amendments, the CPSO solicited feedback on a document entitled “Procedures Performed in Out-of-Hospital Facilities.” The purpose of this document will be to provide an exhaustive list of the specific procedures that are performed under anesthetic that will trigger an inspection of the facilities in which they are carried out.

The OMA reviewed the document and provided feedback to the CPSO in an effort to ensure that physicians have a clear understanding of when their facilities can be subject to an inspection. While the OMA was generally satisfied with the content and clarity of the list of procedures selected, there was an objection to inspecting facilities where physicians perform surgical excisions of normal tissue under local anesthetic for cosmetic purposes.

In responding to the CPSO, the OMA stressed that many family physicians and dermatologists remove superficial skin formations at the patient’s request, in medical offices, and that these short and simple procedures should not warrant an inspection of the facility. The OMA also asked the CPSO to be clear that it will in fact limit any inspections to facilities where the procedures identified in the published list are performed. The OMA Health Policy Department plans to monitor the implementation of this inspection policy, and participate in ongoing collaboration with the CPSO in developing a transparent process for inspections of out-of-hospital facilities.

OMA staff contact: Ada Maxwell (ext. 2942)

Personal Health Information Protection Act

The Personal Health Information Protection Act (PHIPA) establishes rules regarding the collection, use and disclosure of personal health information in the hands of health service providers and others. Under section 75 of the Act, a committee of the legislative assembly must conduct a comprehensive review of the legislation. The review is expected to occur this summer.

There are a variety of issues that require further discussion, such as the impact privacy law has on the electronic sharing and storage of patient information. The OMA is interested in hearing from its members about any areas of concern under this piece of legislation.

OMA staff contact: Juhee Makkar (ext. 2978)


May 2008

CPSO CHANGES TO REGULATIONS REGARDING USE OF SPECIALIST TITLE

At its April Council meeting, the College of Physicians and Surgeons of Ontario (CPSO) voted to amend regulations limiting the use of specialist titles by non-specialists. The amendment is intended to restrict the use of a specialist title, or the words “surgeon” or “surgery,” to those in the profession certified by the Royal College of Physicians and Surgeons of Canada or the CPSO. The regulation amendments have been submitted to the Ministry of Health and Long-Term Care for its consideration, and the CPSO will develop an implementation plan. The OMA will continue to participate in dialogue with the CPSO and affected membership groups on this issue.

OMA staff contact: Ada Maxwell (ext. 2942)

HEALTH PROFESSIONS REGULATORY ADVISORY COUNCIL CONSULTATION ON INTERPROFESSIONAL CARE

At the request of the Minister of Health and Long-Term Care, the Health Professions Regulatory Advisory Council (HPRAC) has circulated a Con­sultation Discussion Guide that poses a number of questions regarding interprofessional collaboration, with a focus on the roles of regulatory colleges in promoting team-based care. The OMA will submit a response to the Discussion Guide in order to assist HPRAC in developing its advice to the minister. HPRAC may also use this feedback in framing further research initiatives in the field of interprofessional care. The OMA has taken the position that while it supports interprofessional care initiatives, it has specific concerns with a number of the proposals set out in the Discussion Guide. Most significantly, the OMA believes that regulatory colleges are not the primary enablers of interprofessional care. The OMA has also taken the position that while conjoint quality assurance programs across colleges may offer benefits to interprofessional collaboration, joint investigations and tribunals between colleges are likely to undermine collaboration. The OMA will engage in ongoing consultation with HPRAC and other stakeholders as various means to facilitate the development of effective interprofessional care.

OMA staff contact: Ada Maxwell (ext. 2942)

PHYSICIAN-EMPLOYED PHYSICIAN ASSISTANT DEMONSTRATION PROJECT

The hiring deadline for the Physician-Employed Physician Assistant (PEPA) Demonstration Project has now passed, and seven out of a possible 11 positions have been filled. There will be three physician assistants working with endocrinologists in diabetes care (two in Toronto, one in Windsor), and four physician assistants working with primary care physicians in long-term care (two in Kingston, two in Hamilton).

The OMA will be hosting an information-sharing session in Toronto on June 7, 2008, for the supervising physicians across all projects, including those in hospitals and community care centres. Topics that will be addressed include: compensation and billing for the work of physician assistants, developing and using medical directives, evaluation and lessons learned.

OMA staff contact: Carol Jacobson (ext. 2984) or Rachel Bandele (ext. 3330)


April 2008

OUT-OF-HOSPITAL PROCEDURES USING LOCAL ANESTHETIC

At its February meeting, the Council of the College of Physicians and Surgeons of Ontario voted to proceed with a proposed regulation change to enable the College to inspect out-of-hospital facilities (e.g., cosmetic surgery clinics).

As a follow-up to this process, the College circulated a document entitled “Procedures Performed Under Local Anesthetic.” The College has stated that only certain procedures performed under local anesthetic will trigger a facility inspection. This document was generated in an effort to have the College clarify the types of out-of-hospital facilities that will be targeted for inspections.

The OMA Health Policy Department is co-ordinating the formal response to the College on this consultation document.

OMA staff contact: Ada Maxwell (ext. 2942)

HPRAC CONSULTATION DISCUSSION ON INTERPROFESSIONAL COLLABORATION

In response to a request for advice from the Minister of Health and Long-Term Care, the Health Professions Regulatory Advisory Council (HPRAC) is seeking comments from members of the health professions on viable approaches to interprofessional collaboration among health college professions.

HPRAC will be submitting its advice on how the colleges and the regulatory environment can support interprofessional care to the Minister later this year. The OMA Health Policy Department is co-ordinating an OMA response to the HPRAC Discussion Guide. Upon referral from the Minister, HPRAC has circulated this Guide, which contains questions that are designed to assist in implementing mechanisms to facilitate and support interprofessional collaboration between health colleges. The OMA response will address issues related to several important areas of interprofessional care, including scope of practice of health professionals, interprofessional relations, quality assurance across professional colleges, liability concerns across professional colleges, joint complaints/investigations bodies for health professionals and discipline processes in a multidisciplinary context.

The Health Policy Department has invited all OMA Sections to forward comments, questions or suggestions regarding the Discussion Guide, to be included in the OMA submission to HPRAC.

MA staff contact: Ada Maxwell (ext. 2942)


March 2008

CPSO PROPOSALS ON COSMETIC FACILITIES, USE OF SPECIALIST TITLES AND MANDATORY PHYSICIAN QUESTIONS

The Council of the College of Physicians and Surgeons of Ontario (CPSO) recently proposed amendments to its bylaws and regulations related to mandatory physician questions, out-of-hospital facilities, and use of specialist titles. The OMA submitted a response to these proposals, voicing strong opposition to many of the changes based on concerns that the amendments were too broad. The OMA engaged the CPSO in active dialogue prior to its Council meeting in an effort to have its concerns understood and the amendments redrafted.

The CPSO Council approved the following amendments: mandatory physician questions will include information about addiction as well as civil lawsuits and specific criminal offences; inspection of out-of-hospital facilities administering anesthesia will take place every five years; and the definition of “change of scope of practice” has been clarified. As a result of discussions with the OMA Executive, the CPSO agreed to defer the issue of specialist titles until further consultation with the Royal College of Physicians and Surgeons.

The CPSO Council also deferred the issue of mandatory disclosure of physicians’ serological status for one year.

OMA staff contact: Ada Maxwell (ext. 2942)

CPSO DRAFT POLICIES ON ESTABLISHING AND ENDING THE PHYSICIAN-PATIENT RELATIONSHIP

The College of Physicians and Surgeons of Ontario recently circulated a draft policy on “Establishing Physician-Patient Relationships,” which set out guidelines for doctors in the process of deciding whether to accept individuals as new patients. Along with this draft policy, the CPSO distributed a revised policy on “Ending the Physician-Patient Relationship.” The College requested general feedback, as well as specific comments on certain aspects of these policies.

The CPSO’s position on patient-physician relationships seems to be, in part, a response to frustrations patients have experienced while seeking out a new physician and securing doctor care. A good deal of the draft policy on establishing a relationship addresses the parameters of the “interview” process many doctors have implemented in deciding whether or not to accept prospective patients. Although the draft policies offer some guidance, one of the CPSO’s objectives is to limit the circumstances under which a physician may refuse patients. The CPSO risks unreasonably limiting a physician’s right to enter into an independent contract with a patient.

After consultation with its members and Sections, the OMA Health Policy Department drafted separate responses to each policy, which have been approved by the OMA Board. The OMA believes that these policies are overly restrictive for physicians who turn away patients and terminate existing relationships. The OMA response to the CPSO emphasizes the importance of protecting every physician’s right to terminate a physician-patient relationship when it is reasonable to do so.

The OMA will continue to assert the importance of preserving each physician’s individual right to begin and end a professional relationship, and will work with the College on these policies.

OMA staff contact: Ada Maxwell (ext. 2942)

PHYSICIAN-EMPLOYED PHYSICIAN ASSISTANTS

The Physician Employed Physician Assistant (PEPA) Demonstration Project will involve up to 11 physician assistants (PAs) working in diabetes care and long-term care. PA candidates are currently being screened, and numerous on-site interviews have taken place. It is antici­pated that all positions will be filled by the March 31 hiring deadline.

A recent orientation session held at the OMA provided physicians who are supervising PAs with an opportunity to raise issues surrounding compensation and liability, recruitment, scope of practice, and the use of medical directives, data collection and evaluation. Further orientation sessions will occur to assist with the integration of PAs into their various practice settings.

OMA staff contact: Carol Jacobson (ext. 2984)
Rachel Bandele (ext. 3330)

WAIT-TIMES INITIATIVE SYSTEM

In order to address surgical wait times, the Ministry of Health and Long-Term Care is in the process of expanding the areas in which participating hospitals must collect data. Beginning in March 2008, three new categories will be added: ophthalmology, orthopedic surgery, and general surgery. With the Ministry’s intention of eventually phasing in all surgical specialties, hospitals may be collecting wait times data on additional areas (e.g., neurological, vascular, thoracic, cardiovascular, pediatric, etc.) by March 2009. In addition, the Ministry is examining the viability of capturing ER wait times.

Recognizing the impact on physicians, the OMA negotiated $3 million (as part of the recent Reassessment of the Master Agreement) to provide for a one-time recognition payment for those physicians who participated in the start-up of the provincial WTIS. This money was dispersed in December 2007; physicians entering into the WTIS between August 2007 and March 2008 will receive a recognition payment in their May 2008 Remittance Advice. The OMA continues to work closely with both the Ministry and the Ontario Hospital Association to acknowledge and address the impact these and future wait-time expansions have on physicians, and to emphasize the need for continuing support.

OMA staff contact: Jenn Yiokaris (ext. 2883)

DISRUPTIVE PHYSICIAN BEHAVIOUR

The OMA is working with the CPSO and the Ontario Hospital Association to develop an educational piece for physicians and hospitals on understanding and addressing disruptive physician behaviour. It is anticipated that there will be both videoconferences and a number of in-person sessions during the early spring. More information will be provided as it becomes available.

OMA staff contact: Barb LeBlanc (ext. 2965)


February 2008

CPSO BYLAW AND REGULATION AMENDMENTS

The College of Physicians and Surgeons of Ontario (CPSO) recently circulated proposed changes to regulations and bylaws relating to cosmetic and other high-risk out-of-hospital procedures, physician titles, and expansion of the CPSO mandatory questions.

Most of the amendments have professional misconduct implications, and the OMA is concerned that some of the proposed amendments may result in relatively minor infractions triggering disciplinary proceedings.

Although these proposals arise from the CPSO’s need to deal with high-risk cosmetic procedures, the OMA stresses the broad scope of the proposed amendments, and the latitude it offers the CPSO in imposing new requirements on physicians.

The OMA is preparing a response to the CPSO ahead of the College’s February Council meeting. After consultation with its members and Sections, the OMA takes the position that the CPSO should only implement new regulations and bylaws that respect physicians’ interests while promoting public safety surrounding cosmetic procedures.

OMA staff contact: Ada Maxwell (ext. 2942)

DRUGS AND PHARMACOTHERAPY

On January 15, 2007, the Ministry of Health and Long-Term Care (MOHLTC) made changes to the benefit status of some generic drugs as a result of alleged unauthorized price increases by generic drug manufacturers. Although the Ontario Public Drug Program Division has ensured that there is, at minimum, one generic product available for each strength and dosage form, pharmacies in some regions have experienced difficulty in filling prescriptions, as their inventory did not reflect the recent formulary changes and they were unable to adapt quickly.

A brief memorandum addressing the formulary amendments, entitled “Tool to Educate Physicians,” posted on the Ontario Pharmacists’ Association (OPA) website, contained incorrect information and resulted in some consternation to the physicians who received it from their local pharmacist. Nevertheless, supply uncertainties have the potential to seriously jeopardize patient care and impede physician practice; therefore the OMA will continue to be in frequent contact with the Ministry, both to monitor the supply issue, and to communicate the Association’s concerns regarding the potential impact on patient care.

OMA Staff Contact: Peter Brown (ext. 2989)

CPSO POLICIES ON ESTABLISHING AND ENDING PHYSICIAN-PATIENT RELATIONSHIPS

In early December, the CPSO circulated a draft policy entitled “Establishing a Physician-Patient Relationship,” which set out guidelines for doctors in the process of deciding whether to accept individuals as new patients. Along with this draft policy, the CPSO distributed a revised policy entitled “Ending the Physician-Patient Relationship.” The CPSO requested general feedback, as well as specific comments on certain aspects of these policies.

The CPSO’s firmer position on patient-physician relationships seems to be, in part, a response to frustrations patients have experienced while seeking out a new physician and securing doctor care.

A good deal of the draft policy addresses the parameters of the “interview” process that some doctors have implemented in deciding whether or not to accept prospective patients. Although it offers some guidance, the CPSO’s objective seems to be to limit the circumstances under which a physician may refuse patients. While the CPSO acknowledges that physicians should be allowed to exercise discretion in accepting new patients, it risks unreasonably limiting a physician’s right to enter into an independent contract with a patient.

After consultation with its members and Sections, the OMA has drafted separate responses to each policy. The OMA has expressed concerns that the policy on establishing relationships may be overly restrictive for physicians turning away patients. In the case of ending physician-patient relationships, the OMA response emphasizes the importance of protecting every physician’s right to terminate a physician-patient relationship when it is reasonable to do so.

OMA staff contact: Ada Maxwell (ext. 2942)


January 2008

ESTABLISHING AND ENDING THE PHYSICIAN-PATIENT RELATIONSHIP

The College of Physicians and Surgeons of Ontario (CPSO) recently circulated two new policy documents for input by stakeholders. The first document involves policy outlining principles related to establishing a physician-patient relationship, with an emphasis on screening/ interviewing prospective patients. The second document is an updated version of an existing policy on terminating the physician-patient relationship.

The OMA will be reviewing and responding to each of these proposed policies.

OMA staff contact: Ada Maxwell (ext. 2942)

PHYSICIAN BEHAVIOUR IN THE WORKPLACE

The CPSO is concluding a lengthy project related to physician behaviour in the workplace. This initiative has involved many stakeholders and is designed to provide the information and education necessary to help physicians and institutions deal with behaviour that is generally viewed as “disruptive.”

There are two parts to this issue that will be of interest to physicians:

  1. A new CPSO policy on appropriate physician behaviour in the work environment has been developed. The policy is posted on the CPSO website (http://cpso.on.ca/Policies/behaviour.htm).

  2. A toolkit that provides a framework for dealing with physician behaviour — including a sample code of conduct — is being developed and will be posted on the CPSO website at the conclusion of the project.

The OMA will be working with the CPSO and the Ontario Hospital Association (OHA) on a communications strategy to ensure that physicians and hospitals understand that the toolkit has been developed as a constructive and educational device, and is not intended as a means to stifle physician advocacy, or to impose arbitrary rules and regulations.

More information on this issue will be forthcoming in the weeks ahead.

OMA staff contact: Jenn Yiokaris (ext. 2883)

REGULATIONS RELATED TO COSMETIC SURGERY

The CPSO is undertaking a significant review of the regulation related to high-risk cosmetic procedures. As part of that review, input is being sought on a proposed new regulation under the Medicine Act. The OMA will be reviewing the regulation and responding to the College.

OMA staff contact: Ada Maxwell (ext. 2942)


Previous Health Policy Updates

Homepage | Contacts | Privacy Policy | Media | FAQ
Copyright 2004-2005 OMA