Excellence in medical practice by zra16726

VIEWS: 369 PAGES: 48

									College of Physicians and Surgeons
of British Columbia

Annual Report 2009




           Excellence in medical practice


www.cpsbc.ca
Excellence in medical practice
The College’s overriding interest is the protection and
safety of patients, and the quality of care they receive
from licensed physicians in British Columbia.

Overview
The College of Physicians and Surgeons of British Columbia was established by the provincial legislature in
1886 as the licensing and regulatory body for all physicians and surgeons in the province. The College is
governed by provincial legislation*, which entrusts the College with the responsibility to establish, monitor and
enforce high standards of qualification and medical practice across the province.

The College recognizes that self-regulation of the medical profession is a privilege granted in the public interest
and for the public good. The responsibility to retain this privilege is taken very seriously by the College’s
council, committee members and staff.

The regulation of the profession requires both proactive and reactive measures. In its proactive role, the
College administers a number of quality assurance programs, maintains high educational standards and
licensure requirements, conducts periodic peer reviews of physicians and their practices, accredits diagnostic
and non-hospital medical surgical facilities, and analyzes prescribing practices. In its reactive role, the College
manages a comprehensive process for addressing public concerns, evaluates ethical issues, and establishes high
standards for physician conduct and performance.

    *On June 1, 2009, the Medical Practitioners Act was repealed and physicians and surgeons of
    British Columbia transitioned under the Health Professions Act, which applies to 21 self-regulated
    health professions governed by 20 colleges under a common legislative framework.

This Annual Report is a compilation of reports submitted by the chairs of the College’s standing committees
describing their work and activities of the past year.




                    2009 Annual General Meeting            400-858 Beatty Street
                        Friday, September 18, 2009         Vancouver, BC V6B 1C1
                Vancouver Convention and Exhibition        Telephone        604-733-7758
                              Centre, Vancouver, BC        Facsimile        604-733-3503
                                                           College Library 604-733-6671
                                                           www.cpsbc.ca
                                             Annual Report 2009




Table of Contents
A Year in Review                                             3
  •	 Minutes	of	the	2008	Annual	General	Meeting	             3
  •	 Report	from	the	President	                              5
  •	 Report	from	the	Registrar	                              8
  •	 Report	from	the	Public	Representative	                 10

Licensing and Registration                                  11
  •	 Report	on	Registration	                                11
  •	 Medical	Workforce	Statistics	                          12

Quality Assurance Programs and Remediation                  13
 •	 Report	on	the	Quality	of	Medical	Performance		          13
    Committee
 •	 Report	on	the	Ethical	Standards	and	Conduct		           15
    Review Committee
 •	 Report	on	the	Sexual	Misconduct	Review	Committee	       18
 •	 Report	on	the	Advisory	Committee	on		                   20	
    Prescription Review
 •	 Report	on	the	Advisory	Committee	on	Opioid		            21	
    Dependency
 •	 Report	on	the	Committee	on	Office	Medical		             23
    Practice Assessment
 •	 Report	on	the	Non-hospital	Medical	Surgical		           24
    Facilities Program
 •	 Report	on	the	Diagnostic	Accreditation	Program	         25
    – Statement of Operations                               26
 •	 Report	on	Physician	Health	                             27
 •	 Report	on	the	College	Library	                          28

Disciplinary Outcomes                                       29
  •	 Investigations,	Inquiries,	Discipline		                29
  •	 Actions	under	sections	47	and	48	of	the		              31
     Medical Practitioners Act

Operations and Administration                               32
 •	 Report	from	Legal	Counsel	                              32
 •	 Deceased	Members	                                       34
 •	 Report	on	Operations	                                   36
    – Statement of Operations                               38
 •	 College	Council	2008/2009	                              40
 •	 College	Committees	                                     42
 •	 College	Departments	and	Contacts	                       44
 •	 The	Medical	Directory	                                  45




                                                             1
                                                                                               Annual Report 2009


2008	Annual	General	Meeting
Friday, September 19, 2008
Sheraton Vancouver Wall Centre, Vancouver, BC


A YEAR IN REVIEW


Minutes	of	the	2008	Annual	General	Meeting	
1. Call to Order – 4:15 pm
The President of the College, Dr. Arthur Dodek, called the meeting to order at 4:15 pm.

Dr. Dodek recognized and thanked past presidents of the College who were in attendance namely, Drs. Ibbott,
Piercey,	Frinton,	Sent,	Wilson	and	McIver.

2. Roll Call of Deceased Members
The members of the College who died in the past year were published in the Annual Report. At the request of
the President, those members were remembered by a period of silence.

College members who died subsequent to the published list in the Annual Report will be remembered in the
list published in the next Annual Report.

3. Minutes of Annual Meeting, September 21, 2007
The	Minutes	of	the	meeting	of	September	21,	2007	had	been	previously	published	and	were	accepted	as	
circulated. A motion to approve was carried unanimously.

4. President’s Report
The report of the President, Dr. A. Dodek, was published in the Annual Report. Dr. Dodek summarized that report.

5. Announcement of Recipients of Award of Excellence
The President reported that four physicians had been selected as recipients of the “Award of Excellence” and
had	been	honoured	at	the	President’s	Dinner	in	May	2008.		The	individuals	so	honoured	were:

  •	 Dr.	Abdul	Aleem	of	Cranbrook
  •	 Dr.	David	F.	Hardwick	of	Vancouver
  •	 Dr.	Susan	J.	Harris	of	Vancouver
  •	 Dr.	Arthur	J.	Macgregor	of	Victoria

Dr.	Dodek	noted	that	this	award	recognizes	lifetime	achievement	as	a	physician.		He	encouraged	the	
membership to watch the College Quarterly for this year’s call for nominees and to submit their nominations.

6. Approval of Financial Statements
The College’s financial statements for the year ending February 28, 2008 had been circulated previously.

It was moved, seconded and passed unanimously that the audited financial statements for the year ending
February 28, 2008 be accepted.

7. Appointment of Auditors
Dr. Dodek noted the College was satisfied with the performance of the new auditors as appointed at the 2007
Annual	General	Meeting.		

It was moved, seconded and passed unanimously that the firm of Deloitte and Touche LLP be appointed as
auditors for the current year.



                                                                                                               3
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




8. Other Business
There were questions from the floor:

    - A member asked if a physician must be a member of this College to practise medicine in British Columbia.
      This was answered in the affirmative.
    - Several members voiced questions and concerns regarding the new pharmacy regulation. Specifically, a
      member	asked	if	prescription	pads	could	be	pre-printed	with	a	tick	box	“Do	Not	Alter.”		It	was	suggested	
      that this would not be appropriate and such directions must be a unique instruction subsequent to careful
      consideration.
    -	 A	member	asked	if	a	pharmacist	dispensing	a	medication	and	altering/renewing	the	prescriptions	would	
       not be a conflict of interest. It was noted that there was a potential of such conflict of interest.
    - Another member (a psychiatrist) voiced her concern regarding the “most responsible physician” and asked
      who would be responsible for a negative outcome from a patient’s altered or renewed medications. She
      was	reassured	that	PharmaNet	would	reflect	whether	the	prescription	was	renewed	or	altered	by	the	
      pharmacist.
    - A member voiced concern that if a patient was to follow the direction and prescribing of a pharmacist
      without the input of the physician, would it be appropriate for him to post a notice in his office that he
      would no longer be that patient’s physician. It was suggested this was not an appropriate approach and
      that each case should be dealt with on its own merits.
    -	 A	member	noted	that	a	London	Drugs	pharmacy	in	Kerrisdale	was	running	a	pilot	project	testing	INRs.
    -	 A	member	asked	about	the	progress	of	the	IMG	issue.		Dr.	VanAndel	addressed	this	issue.		Dr.	J.	Galt	
       Wilson,	past	president	of	the	council,	addressed	the	audience	on	the	progress	of	training	IMGs	and	the	
       need	for	more	spaces	and	money	from	the	ministry.		Dr.	Wilson	encouraged	any	physician	to	become	a	
       mentor.		Another	member	(an	IMG	practising	in	British	Columbia)	stated	his	appreciation	of	the	program.
    -	 Dr.	Dodek	announced	the	retirement	of	the	College’s	registrar,	Dr.	Morris	VanAndel,	and	thanked	him	for	
       his service and the trust and respect he has brought to the profession.
    -	 Dr.	Dodek	then	announced	the	appointment	of	the	new	registrar,	Dr.	Heidi	M.	Oetter.		

9. Adjournment
There being no further business, the meeting was adjourned at 5:00 pm.


M.	VanAndel,	MD
Registrar (Retired October 2008)




4
                                                                                               Annual Report 2009




Report from the President
                      Professionalism
                      Professionalism is a concept under significant review and examination by regulatory
                      authorities, educational bodies and professional associations.

                      Professionalism has been defined as a set of attitudes and behaviours appropriate
                      to a particular occupation. Such attitudes and behaviour serve to maintain patient
                      interest above the practitioner’s self-interest. It is not defined by the position held
                      but by one’s inner character and conduct.

                      The College
A.	Dodek,	MD,	FRCPC   Section 1 — Consider first the well-being of the patient.
President
                      (Canadian	Medical	Association Code of Ethics)

                      This is the first fundamental responsibility under the Code of Ethics, and is the
                      mandate of all physicians, and of the College of Physicians and Surgeons. The
                      College has a primary interest in and responsibility for ensuring both the protection
                      and safety of patients, and the quality of care that they receive. The College
                      supports excellence in medical practice, is accountable to the public, and has a
                      responsibility to review all written complaints from the public, professionals and
                      health care agencies. The College recognizes the stress, anxiety and burden that
                      physicians who are the subject of complaint carry, and thus strives to clarify, hear,
                      and resolve issues in a prompt manner. This process sometimes gives theimpression
                      that the physician’s actions were inappropriate, even though the investigation might
                      prove	otherwise.		When	dealing	with	issues	which	could	potentially	involve	charges,	
                      physicians are advised to seek legal counsel.

                      Section 46 — Recognize that the self-regulation of the profession is a
                      privilege and that each physician has a continuing responsibility to merit this
                      privilege and to support its institutions.
                      (Canadian	Medical	Association Code of Ethics)

                      Your ten elected physician members and five public members appointed by the
                      Ministry	of	Health	Services	devote	many	hours	to	council	business,	resolving	issues	
                      which pertain to quality of care, ethics, legislation, registration, the library, finance,
                      non-hospital facility issues and conduct reviews. As a self-regulating profession, we
                      are dependent on our members to serve, such that we can meet our mandate as
                      defined in the Medical Practitioners Act, and subsequently in the Health Professions
                      Act and Bylaws. The College’s efforts extend beyond regulation and discipline to
                      include educational and legislative functions.




                                                                                                                5
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




In addition to your elected council members, we wish to acknowledge and thank the physicians who are not
on council but who willingly provide their time and expertise on the following committees:

     Quality	of	Medical	Performance:		Drs.	P.D.	Rowe,	K.	Creedon,	D.	Price,	B.	Kassen
     Registration:		Drs.	P.	Newbery,	V.M.	Frinton,	J.	Wright
     Library:		Drs.	R.E.	Gallagher,	J.C.	Butt,	M.	McGregor
     Committee	on	Office	Medical	Practice	Assessment:		Drs.	J.	Barclay,	R.A.	Baker,	A.D.	Hosie,	C.	Penn,		 	
     B.	Gregory
     Non-Hospital	Medical	Surgical	Facilities:		Drs.	G.	McGregor,	S.	Sanmugasunderam,	J.P.	McConkey,		
     V.M.	Frinton,	K.	Stothers,	C.B.	Warriner,	N.	Wells
     Advisory	Committee	on	Prescription	Review:		Drs.	R.K.	Phillips,	G.	Vaughan,	M.	Khara,	D.M.	McGregor,		
     R. Shick
     Advisory	Committee	on	Opioid	Dependency:		Drs.	J.E.	Dian,	J.F.	Anderson,	D.	Hutnyk,	P.	Mark,		           	
     D.A.	Rothon,	P.W.	Sobey
     Advisory	Committee	on	Blood	Borne	Communicable	Disease:		Drs.	M.	Krajden,	G.	Stiver,	P.R.W.	Kendall,		
     V.	Montessori,	F.	Anderson,	A.	Ramji
     Diagnostic	Accreditation	Executive	Committee:		Drs.	H.	Huey,	D.	Carlow,	R.	Muir,	B.	Toews,	J.	Heathcote

Professional Associations
Section 43 — Recognize the responsibility of physicians to promote equitable access to health
care resources.
(Canadian	Medical	Association Code of Ethics)

Equitable access to care, in an environment where human resources and facilities are limited, poses significant
challenges	to	the	profession	and	to	society.		The	recent	collaborative	efforts	of	the	Ministry	of	Health	Services	
and	the	British	Columbia	Medical	Association,	fully	supported	by	the	College,	are	beginning	to	strengthen	
the	backbone	of	the	profession—general/family	practice—rewarding	the	provision	of	quality,	long-term	linear	
care of patients. Other collaborative initiatives to address wait times and improve access for patients are to be
applauded. Appropriate, fair and transparent allocation of financial resources is an imperative if our society is
to be provided with the balanced medical workforce it needs.

The ethical principles applicable to medical associations are similar to those that guide the behaviour of
individual physicians (JAMA 1999; 282: 984).

The Profession
Section 21 — Provide your patients with the information they need to make informed decisions
about their medical care, and answer their questions to the best of your ability.
(Canadian	Medical	Association Code of Ethics)

Good	communication	is	foundational	to	the	provision	of	good	care,	whether	that	communication	be	between	
physician and patient, or between colleagues. Communication issues are at the root of the majority of
complaints to the College.




6
                                                                                                   Annual Report 2009




A frequent complaint from patients and general practitioners relates to lack of communication from specialists.
In	making	or	receiving	a	referral,	it	is	acceptable	to	use	mail,	telephone,	fax	or	secure	email.		However,	it	is	
important	and	common	courtesy	for	the	specialist	to	notify	the	patient	and/or	the	referring	physician	of	the	
date of the appointment in a timely manner. There are specialist offices that accept referrals only by fax.
Patients are then notified of the date of the consultation at a later time. This leaves the patient in limbo,
vulnerable	and	uncertain	as	to	what	actually	is	happening	to	the	referral.		Meanwhile,	the	general	practitioner	
is completely out of the referral loop. It is only common professional courtesy that these fax referral specialists
promptly respond with an estimated time for the consultation. The patient and referring physician will know
that the referral has been received. They can then wait accordingly or seek out an alternative.

When	a	referral	for	consultation	is	made,	the	referring	physician	has	an	ethical	obligation	to	communicate	
effectively with the specialist, including important aspects of the patient history, a clear understanding of the
question asked, and an appreciation of what is expected for follow-up care.

The referring or primary care physician certainly deserves a copy of consultation notes, summaries, and
procedure reports in a timely fashion.

Physicians and the Legal Profession
Section 53 — Seek help from colleagues and appropriately qualified professionals for personal
problems that might adversely affect your service to patients, society or the profession.
(Canadian	Medical	Association Code of Ethics)

It is not unusual for some complaints that come to the College to involve physicians who are under personal,
financial,	marital,	or	emotional	stress.		We	have	a	responsibility	to	our	patients	but	also	to	ourselves	and	our	
families to ensure that our personal lives are in order and that such stresses are not negatively impacting
our	performance.		Members	are	reminded	of	the	resources	available	through	the	Physician	Health	Program,	
jointly	supported	by	the	College,	the	BCMA	and	the	Ministry	of	Health	Services.		The	work	and	records	of	the	
program are kept separate and confidential from the sponsoring agencies, except as required by legislation.

The	assistance	provided	to	practising	members	through	the	Canadian	Medical	Protective	Association	is	
acknowledged and appreciated. Physicians appearing before the College council are well represented by
lawyers who not only present legal argument but also consider the emotional state of the physician.

Professionalism in each Registrant
The practice of medicine involves the application of common sense, social skills, and appropriate skills
and	knowledge,	tempered	by	an	ethical	conscience.		We	must	all	strive	to	maintain	good	quality	records,	
communicate effectively, respect personal and cultural boundaries, avoid being prejudicial or judgmental,
participate in lifelong continuing education, take care of our own health needs, and cultivate strong
interpersonal relationships. True professionals honour their responsibilities to patients, society, the profession
and themselves.


Arthur Dodek, MD, FRCPC
President, College of Physicians and Surgeons of BC




                                                                                                                     7
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




Report from the Registrar
                                 Much	of	the	energies	of	the	College	this	year	have	been	focused	on	dealing	with	
                                 the	changing	legislative	landscape	in	BC.		What	is	happening	is	not	unique	to	BC,	
                                 and reflects changes that have been implemented in other Canadian jurisdictions as
                                 governments strive to modernize the statutes that we operate under as a regulatory
                                 body	for	the	practice	of	medicine.		Worldwide	we	see	increasing	demands	for	
                                 accountability and transparency of regulatory practices, consumer expectation of
                                 collaborative practice and choice of providers, and new obligations of self-regulating
                                 professions including expectations for demonstrating continuing competency and
                                 currency of practice. The demands of self-regulating professions have never been
H.M.	Oetter,	MD                  greater, and the College has focused on ensuring that patient safety and public
Registrar
                                 interest are top priorities for those who ultimately make legislative decisions.

                                 In review, the College was advised this year that it, like all the other regulated
                                 health professions in BC, would come under the omnibus legislation, the Health
                                 Professions Act. Setting aside profession-specific legislation is becoming more
                                 common in Canada, particularly as governments strive to ensure that new and
                                 emerging self-regulating professions meet the expectations of public protection.
                                 All self-regulating professions are held to a common standard of objects and duties,
                                 and the substantial amendments passed this spring included the creation of a lay
                                 tribunal to consider appeals of registration decisions and complaint dispositions.
                                 There is also an expectation of at least one third public representation on key
                                 committees of the College, including registration, inquiry, discipline and quality
                                 assurance. The new legislation has created a more complex process for College
                                 activities, and one that the council has considered carefully in drafting new bylaws
                                 for the profession.

                                 Successful regulation is dependent on leadership, resources and reasonable
                                 legislative	tools.		We	are	only	as	good	as	the	autonomy	that	we	are	granted	by	the	
                                 legislature. It is the firm position of the College that the regulation of the profession
                                 is best left in the hands of physicians with independence from government. The
                                 College expressed its considerable dismay to the federal and provincial ministers of
                                 trade following the signing of the Agreement on Internal Trade this past December,
                                 as the agreement dismisses the ability of regulatory bodies to exercise discretion to
                                 impose additional training, experience, examination or assessments on practitioners
                                 who have been granted a license in another jurisdiction in Canada.

                                 While	potentially	an	opportunity	for	Canada	to	set	national	standards	for	licensure,	
                                 the reality is that some jurisdictions grant licensure to internationally trained
                                 physicians who have passed no Canadian examinations to assess their knowledge
                                 and competency. This College sought a delay in the implementation of this
                                 agreement	so	that	through	the	Federation	of	Medical	Regulatory	Authorities	of	
                                 Canada	(FMRAC)	we	could	develop	minimal	acceptable	standards	for	independent	
                                 practice. Sadly, we were not afforded this opportunity, and time will tell if this



8
                                                                                                    Annual Report 2009




government encroachment will result in erosion of the current high standards that ensure that only competent
and ethical physicians are granted a licence for independent practice.

The College continues to work with government and universities on matters of mutual interest such as
physician supply. Unique opportunities have been given to the College with the new legislation including
restricted classes of licensure and the possibility of licensing and regulating the practice of physician assistants.
The problems of inadequate physician supply to meet the health care needs of the citizens of British Columbia
will not be resolved in the short term by increasing medical school enrollment. Considerable work will need to
be completed if the College is to develop and implement new classes of registration or novel practitioners in
a manner that protects patients and promotes quality care. The College will continue to advocate for rational
decisions in healthcare and regulatory reform. Solutions must be practical, pragmatic and evidence-based,
not political.

Historically	the	College	has	operated	a	number	of	quality	assurance	programs	including	the	Committee	on	
Medical	Practice	Assessment,	the	Prescription	Review	Program	and	the	Methadone	Program.		In	2009	the	
College will be implementing the first phase of revalidation. It is no longer acceptable to grant a licence to
a physician and never re-evaluate that licence over a career. Public trust and confidence demands that we
engage in demonstrable and effective life-long learning and critical self-appraisal. As part of revalidation
of licensure, all physicians will be required to participate in and fulfill the requirements of maintenance of
certification/competency	as	set	out	by	one	of	the	two	national	certifying	colleges,	the	Royal	College	of	
Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC). This is
but a first step in demonstrating currency of practice and competence. The College will continue to develop
evidence-based, efficient and cost effective tools to ensure that individually and collectively the profession
maintains and promotes high standards of practice and conduct.

The	College	currently	faces	skeptics	who	challenge	our	ability	to	self-regulate.		We	embrace	the	opportunities	
that the modernization of our legislation has offered. Physicians have the responsibility to enhance patients’
trust	in	the	system	to	continue	the	privilege	of	self-regulation.		We	must	all	do	our	part	to	contribute,	be	it	at	a	
local medical department, hospital, university, national college or regulatory body.

In	closing,	on	behalf	of	the	College	council	and	staff	I	would	like	to	acknowledge	the	retirement	of	Dr.	Morris	
VanAndel	in	October	2008.		He	provided	excellent	leadership	to	the	College	over	the	14	years	that	he	served	
as registrar and deputy registrar. The patients of British Columbia were well served by the commitment to
medical excellence that he fostered during his tenure.


H.M.	Oetter,	MD
Registrar




                                                                                                                     9
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




Report from the Public Representative
It has been a challenging year for the College council with much change. As public members appointed by
the provincial government, we have been proud to be involved in the deliberations of the council and its
many committees.

These changes and challenges include: anticipating the introduction of the Health Professions Act and
the related work of council and College staff in preparing bylaws and policies; the revised inter-provincial
agreement on trade causing watchful oversight to maintain the integrity of council registration processes,
and changes in registrar staff leadership positions to ensure thoughtful and strategic succession planning.

The public members have been pleased to provide their input to each of these initiatives bringing business
skills, political ability, legal knowledge and community connectivity to the discussion.

Two	public	members	have	completed	their	terms	with	council	this	year.		Mr.	Maurice	Mourton	who	
stepped	down	mid-year	to	accept	a	position	on	the	newly	formed	provincial	Health	Professions	Review	
Board,	and	Ms.	Jennifer	Clarke	who	describes	her	time	on	council	as	“richly	rewarding.”		Both	members	
have contributed extensively to the work of the College over the past few years and will be greatly missed.

The	council	welcomed	Mr.	Walter	Creed	as	the	newest	public	representative	in	January.


C. Evans
Public Representative on Council




10
                                                                                                   Annual Report 2009




LICENSING AND REGISTRATION


Report on Registration
During 2008, the Registration Committee met monthly to discuss issues pertinent to licensure, and specifically
to individual requests for registration. The Registration Committee is comprised of one public member and
three physician members of council, and three physicians from both the University of British Columbia and
community practice.

The	College	continues	to	receive	hundreds	of	inquiries	annually	from	International	Medical	Graduates	
(IMGs)	seeking	licensure	in	British	Columbia.		Of	these,	326	applications	were	considered	by	the	Registration	
Committee and 323 were approved as eligible for licensure.

During	2008,	156	IMGs	began	practice	in	British	Columbia,	of	whom	133	were	family	physicians	and	23	were	
specialists. One thousand four hundred and thirty-three physicians were placed on the educational register for
postgraduate training.

In 2008, much of the committee’s discussion focused on the Health Professions Act.

The deliberations of the committee focused on new pathways to licensure, and the assurance that both
Canadian	medical	graduates	and	IMGs	would	be	treated	similarly	and	equitably	with	respect	to	access	to	
licensure.

Under the new Health Professions Act,	a	Health	Professions	Review	Board	has	the	responsibility	to	review	
all decisions of the health professions with respect to registration. Any candidate who has been denied
registration may appeal to the board for review. College processes must be seen to be transparent, objective,
and impartial. Additionally, the new Act identifies a number of classes of registration to better reflect the
nature of practice today. Defined licensure will begin this summer with identification of physicians with respect
to their practice, specifically either family medicine or a specialty.

A new class of licensure will be created to allow the reassignment of physicians who hold Royal College
certification	but	lack	the	Medical	Council	examinations	in	their	entirety.		A	new	class	of	licensure	will	also	be	
developed for residents in postgraduate training where it is considered appropriate to provide service in their
specialty, in a limited and restricted fashion, with approval from their program director or designate.

Of significant concern to the committee has been the implementation of the Agreement on Internal Trade
(AIT). The AIT requires that any physician who has been provided a full, unrestricted unconditional licence to
practise by another regulatory body in Canada must be provided the identical full licensure in British Columbia.
Many	of	the	provinces	have	alternate	pathways	to	registration	which	do	not	include	the	requirement	for	the	
Medical	Council	examinations	in	some	cases,	or	the	certification	exams	of	the	national	accrediting	bodies	–	the	
College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada.

Similarly, the College is required to provide licensure to those physicians who presently have conditional
licences in other provinces provided that the limits and conditions can be replicated in this province.

It	is	well	known	that	many	IMG	specialists	practising	in	British	Columbia	have	had	difficulty	in	obtaining	
the support necessary to complete their Royal College examinations successfully. The committee has
communicated with the university and regional health authorities to find a better way to help these
international graduates who are practising, servicing and contributing to rural medical communities in their
goal to complete the required examinations. Discussions have taken place with the university and the heads of



                                                                                                                     11
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




numerous departments in an attempt to ensure
that candidates will have access to the academic
                                                         Medical Workforce Statistics*
environment.                                             Total Active Membership       2008          2007     2006

In the next year, the College will liberalize the        Total                          10,613     10,367    10,151
requirements for examinations with respect to              Male	                         7,291	     7,177	    7,080
physicians who obtained postgraduate training              Female                        3,322      3,190     3,071
in the United States and who hold US medical               Residents of BC              10,006      9,689     9,496
licensing examinations, as well as the specialty           Non-residents	of	BC	            605	       678	      655

examinations	of	the	American	Board	of	Medical	
                                                         New Fully Licensed               2008       2007     2006
Specialties.                                             Physicians in BC

The committee is also looking forward to the             Country of Origin
                                                           Canada                          314        295      267
eventual harmonization of the examinations of
                                                           United Kingdom                   12          8        8
the	Medical	Council	of	Canada	and	the	College	of	          United States                     6          6        2
Family Physicians of Canada.                               South Africa                     26         35       33
                                                           Australia	and	New	Zealand	        4	         3	       1
The College continues to support efforts to provide        Others                           58         56       51
clinical	traineeship	positions	for	IMGs	to	acquire	        Total                           410        403      362
experience in the Canadian medical system. The
registration department also provides licensing          New Temporary                    2008       2007     2006
information	regularly	to	Health	Match	BC	to	             Registrants in BC

support	efforts	to	recruit	IMGs	for	underserviced	       Country of Origin
                                                           Canada (locum physicians)        66         61       76
areas or positions of need.
                                                           United Kingdom                   23         32       18
Owing to an increased number of applications               United States                    22         25       26
                                                           South Africa                     58         41       42
from the United Kingdom for licensure, the
                                                           Australia	and	New	Zealand	        9	         6	       7
College	attended	at	the	Postgraduate	Medical	              Others                           44         44       44
Education Training Board of the UK and the                 Total                           222        209      213
General	Medical	Council	to	gain	further	
information concerning the standards and
                                                         *Figures calculated at December 31, 2008
competencies necessary to be licensed in the             Country of origin is defined by Medical Degree
United Kingdom. The knowledge gained will
allow fair evaluation of these physicians with
respect to potential licensure in British Columbia.

The chair wishes to thank the members of the
Registration Committee for their time and effort
in dealing with the complex issues of licensing
and registration.


L.C.	Jewett,	MD,	FRCSC
Chair, Registration Committee

E.J.	Phillips,	MD,	FRCSC
Deputy Registrar



12
                                                                                                 Annual Report 2009




QUALITY ASSURANCE PROGRAMS AND REMEDIATION


Report	on	the	Quality	of	Medical	Performance	Committee	
The	College’s	Quality	of	Medical	Performance	Committee	(QMPC)	reviews	complex	inquiries	and	complaints	
related to a physician’s medical practice and clinical performance. The committee is comprised of seven
physicians, including elected physician council members and practising physicians, as well as two public
council members. The physician members represent a broad spectrum of clinical practice both in terms of
environment (university, community hospital and rural clinical practice) and areas of expertise (general practice
and a range of specialties). The committee may seek assistance from outside experts for cases that are highly
specialized	or	complex.		While	committee	assessments	are	often	retrospective,	primarily	involving	a	review	of	
written documentation from charts and correspondence, the committee does have the option of interviewing
physicians when necessary.

Learning of a patient complaint can be stressful for physicians. The committee is aware that expressions of
non-confidence	in	clinical	performance	are	unpleasant	and	emotionally	difficult	for	the	physician.		However,	
adjudication of such concerns is an integral part of the College’s accountability to the public. Physicians should
be aware that:

  •	 The	privilege	of	self-regulation	is	contingent	on	the	completeness	and	fairness	of	complaint	adjudication;	
  •	 The	complainant	likely	harbours	similar	emotions	of	anger,	disappointment,	sadness	and	fear;	
  •	 Even	minor	complaints	should	lead	a	physician	to	pause	and	reflect	on	how	things	might	have	evolved	
     more effectively;
  •	 Many	complaints	do	not	find	errors	in	medical	care	but	do	identify	a	lack	of	adequate	or	empathetic	
     communication to the patient or family members; and
  •	 Societal	status	or	ego	should	never	come	before	patients’	needs	and	well-being.

Physicians are reminded that most correspondence received by the College from physicians in response
to complaints can be obtained by the complainant under the Freedom of Information and Protection of
Privacy Act.		Under	the	new	legislation,	the	correspondence	and	records	must	also	be	provided	to	the	Health	
Professions Review Board in the event of an appeal. Physicians are reminded of their duty to be factual and
professional	when	responding	to	any	allegation.		Seeking	counsel	and	assistance	from	the	Canadian	Medical	
Protective Association is strongly advised.

Over the past year the committee reviewed numerous cases of missed colon cancer, often due to inadequate
or delayed investigation of ongoing anemia. In several cases, the committee was critical of members who
had	failed	to	refer	patients	with	persistent	unexplained	anemia	for	GI	investigation.		In	other	instances,	the	
committee was not critical but appreciated the difficulty for all involved when extensive colonic cancer was
encountered in patients within a year of having a normal colonoscopy.

The committee reminds physicians that a dispute about patient care is best dealt with in the appropriate medical
administrative or regulatory forum rather than in a patient’s medical chart. In one instance, an unfortunate
comment by a surgeon in an operative report about a poorly performed previous surgery by another surgeon
resulted in considerable angst for both parties when the patient obtained a copy of the report.

On a similar note, several complaints were reviewed by the committee regarding operative complications.
The	committee	accepts	the	occurrence	of	operative	complications,	even	in	the	best	of	hands.		However,	the	
committee was critical of several physicians when complaints were launched by patients about undisclosed


                                                                                                                  13
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




complications, despite contrary statements by the physicians. The lack of a detailed operative note addressing
the complications did little to defend the position of the physicians involved.

Poor documentation and sparse medical records are a recurring theme that cause doubt about appropriate
patient care. In many cases of episodic care, records were minimal and very little attention was given to
underlying disease processes or pre-existing medications. Regardless of the setting, quality medical care and
appropriate documentation are expected by the College.

The Health Professions Act	will	change	the	governance	of	the	College	in	many	ways.		The	Quality	of	Medical	
Performance Committee will be replaced by inquiry committee panels. The new Act requires expedited
adjudication of complaints, including responses from physicians. Furthermore, rebuttals of adjudication by
complainants	or	physicians	will	no	longer	be	reviewed	by	the	College,	but	instead	will	be	sent	to	the	Health	
Professions Review Board – a new board designed to review disputed adjudications of all health professions in
British Columbia. This review board is made up of government appointees who are not physicians.

Although intended as an educational and remedial process, there are times where the deficiencies in care require
that the case be referred to the Executive Committee for consideration of further action, including discipline.
However,	the	committee	can	affirm	that	the	number	of	complaints	received	in	relation	to	the	large	number	of	
clinical	services	being	performed	by	physicians	across	the	province	is	extremely	small.		We	can	all	be	proud	of	that.

The committee members put in many hours of their own time prior to meetings reviewing charts, letters,
hospital notes and reference material. The chair commends the committee members for their dedication to
their fellow professionals and to the general public.

The attached tables show the breakdown of the 2008 workload in detail.


M.A.	Docherty,	MBChB,	CCFP,	FCFP	         	                             	           W.R.	Vroom,	MD
Chair, Quality of Medical Performance Committee                                     Deputy Registrar



Quality of Medical Performance — 2008 Statistics

Total complaints received by the quality of medical performance department*                484

Quality of Medical Performance Review Committee
  •	 Complaints	referred	to	committee	for	first	review																																      58
  •	 Complaints	brought	to	committee	for	further	review		                                   13
  •	 Total	number	of	complaints	reviewed	by	committee	                                      71
  •	 Complaints	considered	to	be	valid	                                                     34
  •	 Physicians	interviewed	by	the	committee		                                               3

Complaints dealt with by deputy registrar**
  •	 Complaints	responded	to	by	deputy	registrar	                                          376
  •	 Complaints	considered	to	be	valid		                                                    84
  •	 Complaints	withdrawn	or	no	consent	received	                                           35

*Of these, 21 cases were coroner’s inquiries
**These numbers are not reconcilable as some files were outstanding at the end of the year.




14
                                                                                                  Annual Report 2009




Report on the Ethical Standards and Conduct Review Committee
The Ethical Standards and Conduct Review Committee (ESCRC) is responsible for reviewing complaints related
to physician conduct or behaviour. As part of the privilege of self-regulation, the College is obliged to respond
to and consider every complaint from both the public and College registrants. The committee also considers
broader ethical issues that arise out of specific complaints, changes in practice (such as cosmetic and private-
pay practices), and, increasingly, ethical and confidentiality issues arising from the use of electronic medical
records.

The committee is composed of three physician members from College council, two publicly-appointed non-
physician members of council, and a medical ethicist. The committee applies a framework of ethical principles
to its deliberations and is guided in its decisions by societal expectations, case law, the legislation, and the
Canadian	Medical	Association Code of Ethics.

The majority of complaints received by the ethics department are adjudicated by the deputy registrar. The
deputy refers complaints to the committee for further adjudication when:

  •	 The	matter	appears	to	be	egregious;
  •	 The	adjudication	by	the	deputy	registrar	has	not	satisfied	either	the	patient	or	the	physician;	or
  •	 The	issue	involves	a	physician	complaining	about	another	physician.

For every complaint received by the College, the deputy registrar requests a response from the physician
involved	to	provide	further	information	and	his/her	perspective	of	the	situation.		If	the	complaint	is	well-
founded, the deputy registrar communicates with the physician in a collegial fashion to educate the physician
and	to	encourage	self-reflection	about	how	to	modify	his/her	behaviour	to	avoid	future	complaints.		Specific	
reading material or courses on ethics may be recommended.

Occasionally the physician may be required to attend for an interview with the deputy registrar or the
committee itself for the purpose of clarifying the issues, supplying education, and recommending changes.
These interviews are remedial rather than disciplinary in nature and will often identify that the behaviour
arose out of overwork, personal stress, or physician illness. In these situations, the committee will offer the
appropriate counsel, advice, and follow up. There are occasions when, because of the seriousness of the
behaviour, physician intransigence, or repeated offenses, the committee may refer a complaint to the Executive
Committee for further review.

On occasion, senior committees of the College refer members for a conduct review with the Ethical Standards
and Conduct Review Committee. This occurs when a complaint has not resulted in charges for disciplinary
action but there remains a need to ensure that the physician understands the gravity of the concerns raised,
has pursued appropriate educational and remedial measures, and will take all necessary steps to avoid similar
behaviour in the future.

In addition, the committee considers more general ethical issues arising in clinical practice, and assists the
College in developing formal policies, positions and guidelines for the profession on matters of an ethical
nature. Typical issues include: entrepreneurism in medicine and the resulting conflicts of interest that arise;




                                                                                                                  15
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




physician relationships with the pharmaceutical industry; and relationships between walk-in clinics and family
physicians, and between general practitioners and specialists. Policies and guidelines developed or amended
by the committee in this past year are:

     1. Expectations of the Relationship between the Primary Care/Consulting Physician and the Consultant
        Physician
     2. Requests from Defence Lawyers

These	documents	are	published	in	the	Physician	Resource	Manual	on	the	College’s	website.

Following is a brief overview of some common complaints received this past year.

     •	 Issues	of	confidentiality	have	arisen	when	there	has	been	inappropriate	access	to	patient	electronic	records	
        by persons, including family members, who are not directly involved in a patient’s care;
     •	 Faith-based	practices	have	given	rise	to	complaints	from	patients	who	were	not	advised	in	advance	of	the	
        physician’s religion-based beliefs with regard to treatment;
     •	 Inappropriate	boundaries	with	employees,	business	dealings	with	patients,	and	physicians	treating	friends	
        with resultant loss of objectivity;
     •	 Poor	communication,	lack	of	empathy,	and	perceived	disrespectful	behaviour	to	patients	or	colleagues;		
     •	 The	management	of	disruptive	physicians	in	the	hospital;	
     •	 Patient	expectations	about	cosmetic	practices;	and
     •	 Failure	to	respond	to	requests	for	information	from	third	parties	in	a	timely	fashion	leading	to	financial	
        hardship for the patient.

The most recent ethical issue considered by the committee is the plethora of private enterprises seeking to
persuade physicians to outsource medical support services to third parties and other agents, often without
consent and with hidden charges to the patient. These include off-shore transcription services and practice
management services such as referrals, and collecting fees for uninsured services.

The chair acknowledges the contribution of time and thoughtful deliberation of the committee members this
past year.


J.R.	Stogryn,	MD,	CCFP,	FCFP	          	         A.J.	Burak,	MD
Chair, Ethical Standards and                     Deputy Registrar
Conduct Review Committee




16
                                                                                             Annual Report 2009




Ethical Standards and Conduct — 2008 Statistics

Total complaints received by the ethics department                   504

Ethical Standards and Conduct Review Committee
  •	 Complaints	referred	to	committee	for	first	review	               21
  •	 Complaints	brought	to	committee	for	further	review	              28	
  •	 Total	number	of	complaints	reviewed	by	committee	                31	          	
  •	 Complaints	considered	to	be	valid	or	partially	valid	            19

Complaints dealt with by deputy registrar*
  •	 Complaints	responded	to	by	deputy	registrar	                    319
  •	 Complaints	considered	to	be	valid	or	partially	valid	           152
  •	 Complaints	withdrawn	or	no	consent	received	                     33


*These numbers are not reconcilable as some files were outstanding at the end of the year.




                                                                                                            17
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




Report	on	the	Sexual	Misconduct	Review	Committee
The College of Physicians and Surgeons of British Columbia continuously strives to ensure excellence in medical
practice and to protect the public interest. This includes upholding the ethical principles that patients must be
treated with dignity and respect at all times and that at no time are patients to be exploited by physicians for
personal advantage. Therefore, all allegations of sexual misconduct are taken very seriously by the College.
Such allegations may range from concerns regarding sensitive physical examinations and sexualized comments
to sexually exploitative actions by physicians. Prevention of sexual misconduct is a major priority for the
College.

In 2008, the College completed its review of complaints related to allegations of sexual misconduct involving
40	different	physicians.		All	of	these	complaints	were	reviewed	by	the	Sexual	Misconduct	Review	Committee.		
This committee included the president of the College, the president-elect and a public member of council.
The committee determined that the conduct of four of these physicians was of such significance that those
physicians were disciplined by the College. As always, those disciplinary actions were identified in media
releases and published in the College Quarterly and in the Annual Report. Punishment normally includes
suspension from practice, assessment, counselling and remediation prior to any return to practice, and
monitoring following return to practice. At the other end of the spectrum, the committee was unable to
determine that the conduct alleged in 15 of the complaints was inappropriate or sexually motivated.

About 75% of the allegations of sexual misconduct received by the College are related to examination
technique	and/or	comments	which	were	perceived	by	the	patient	to	be	inappropriate,	sexualized	or	lacking	
in the provision of dignity and respect. Included in this category were situations in which the physician did
not leave the examination room while the patient undressed or in which the physician unilaterally adjusted
the patient’s undergarments causing the patient discomfort. These most frequent complaints often offer
opportunities for physician education and remediation and, hopefully, prevention. Through education,
physicians become more aware of things that are said and done that may cause a patient physical or emotional
discomfort.

The College actively engages in endeavours to minimize situations which may cause patients to complain.
Proactive endeavours commence with involvement in the teaching of first-year medical students at the
University of British Columbia so that they are all aware of the issues related to sexual misconduct from the
beginning of their training and career in medicine. Similarly, all new registrants in British Columbia have an
in-person orientation session at the College which includes the topics of sexual misconduct and sensitive
examinations. The College website has related resources, such as, Sexual Boundaries in the Physician/Patient
Relationship and Sensitive Examinations. The College’s publication of formal disciplinary actions is not only a
penalty for the guilty physician but also provides education and deterrence to the rest of the profession. In
2008,	the	College	engaged	in	two	new	initiatives.		It	partnered	with	the	Ministry	of	Health	Services	and	the	
continuing	professional	development	division	of	the	Faculty	of	Medicine	of	the	University	of	British	Columbia	
in the presentation of a mandatory two-day orientation program for all new international medical graduates
registered in the province. This program included presentations and discussions on sexual misconduct, ethics
and sensitive examinations. The other new initiative in 2008 was the introduction of a two-day workshop on




18
                                                                                              Annual Report 2009




boundaries, ethics and professionalism. It is anticipated that this workshop will become an annual event. In
addition to these formalized proactive activities, physicians who have demonstrated a need for instruction have
had to attend the College for individualized remedial sessions. All physicians who have been disciplined for
sexual misconduct have undergone formal assessment and counselling to minimize the potential for recurrence
of such behaviour.

The College will continue to identify and promote opportunities to prevent any degree of sexual misconduct
by physicians as part of its mandate to protect the public interest and to ensure high standards of care by
physicians.


A.	Dodek,	MD,	FRCPC	      	       	       	          M.L.	Piercey,	MD
Chair, Sexual Misconduct Review Committee            Special Deputy Registrar




                                                                                                              19
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




Report on the Advisory Committee on Prescription Review
The Advisory Committee on Prescription Review is a peer review committee composed of practising physicians
who have backgrounds in pain management, addiction medicine, psychiatry, research and family practice. The
committee’s main focus is to promote optimal prescribing of controlled substances through educational advice
and feedback to physicians in the form of:

     •	 Practice	advice	for	physicians	in	need	of	assistance;
     •	 Sponsoring	the	new	three-day	intensive	Prescriber’s	Course,	a	collaborate	venture	with	the	
        Colleges	of	Alberta,	Saskatchewan	and	Manitoba;
     •	 Sponsoring	the	annual	Federation	of	Medical	Excellence	spring	course	on	the	Management	of	the	
        Patient with Complex Chronic Pain; and
     •	 Sponsoring	and	collaborating	in	the	development	of	the	soon-to-be-released	national	Guidelines
        for the safe and effective use of opioids for chronic non-cancer pain.

The committee appreciates the difficulty that physicians face in treating patients with chronic non-cancer pain
and	realizes	that	a	subset	of	these	patients	suffering	psychiatric	co-morbidity	and/or	addiction	issues	associated	
with the general unavailability of adequate consultation and multi-disciplinary clinic services are extremely
challenging to treat.

The committee notes frequent themes encountered when reviewing prescribing concerns arising out of
treating	patients	with	chronic	non-cancer	pain	(CNCP):

     •	 Most	physicians	lack	education	in	the	treatment	of	CNCP	patients;	
     •	 In	prescribing	opioids	to	CNCP	patients,	compassion	and	trust	often	trumps	caution;
     •	 Fee	for	service	and	volume	pressures	are	not	conducive	to	optimal	CNCP	treatment;
     •	 It	is	far	easier	to	continue	to	mal-prescribe	than	to	stop;
     •	 The	fear	of	regulatory	scrutiny	scares	many	physicians	away	from	providing	optimal	analgesic	
        pharmacotherapy	for	patients	suffering	CNCP;		
     •	 CNCP	treatment	is	not	the	same	as	the	treatment	of	acute	pain;	
     •	 CNCP	opiate	prescribing	is	always	a	trial,	contingent	on	benefits	of	pain	relief	and	increased	functionality;
     •	 Many	physicians	have	difficulty	in	selecting	appropriate	patients	for	chronic	opiate	trials;
     •	 Many	physicians	continue	prescribing	when	lack	of	objective	benefit	and	recurrent	aberrant	behaviours	
        such as lost prescriptions, would mandate reconsideration for reassessment, and alternative treatments.

The chair acknowledges the dedication of the committee members for their solid commitment to peer
education and support.


G.A.	Vaughan,	MD	         	             	         W.R.	Vroom,	MD
Chair, Advisory Committee                         Deputy Registrar
on Prescription Review




20
                                                                                                Annual Report 2009




Report on the Advisory Committee on Opioid Dependency
One	of	the	responsibilities	of	the	College	is	the	administration	of	the	Methadone	Program.		This	includes	
making	recommendations	to	the	federal	Minister	of	Health	on	behalf	of	members	who	wish	to	prescribe	
methadone for either pain or the treatment of opioid dependency. The College also maintains a register of
patients receiving methadone for the treatment of opioid dependency. The work of the College is enhanced
and facilitated by the expert advice provided by the Advisory Committee on Opioid Dependency (ACOD).

In order to receive authorization to prescribe methadone for maintenance, a physician must complete a one-
day workshop and two half-days of preceptorship. During the past calendar year, two full-day workshops
were held. The first workshop (101) was presented at the Simon Fraser University campus in Surrey in June
2008 focusing on the fundamentals of methadone maintenance therapy. The second workshop (201) was
held in Vancouver in October 2008 in conjunction with the 20th Annual Scientific Conference of the Canadian
Society of Addiction Medicine focusing on the management of opioid dependence complicated by chronic
pain,	co-occurring	mental	health	problems,	HIV	infection	and	pregnancy.

A 101 introductory workshop designed primarily for residents in training and hospitalists was held at St Paul’s
Hospital	in	Vancouver	in	February	2009.		Hospitalists	are	authorized	to	continue	methadone	maintenance	for	
patients in hospital who had previously been on maintenance in the community. This helps to improve access
to methadone maintenance treatment in hospitals in British Columbia. Further workshops will be presented
later in 2009.

Audits, or peer reviews, are an integral part of the program and are essential to maintaining standards of care.
All newly authorized physicians are reviewed by their peers within the first year of practice and as necessary
thereafter. During 2008, 12 peer reviews were undertaken. Six were deemed satisfactory and six were
required to take corrective action prior to a repeat review.

The committee reviews coroners’ reports that have been submitted to the College involving deaths where
methadone may have been a contributing cause. Follow-up recommendations are made when necessary.

As of December 31, 2008, 9,885 patients were registered with the program; 365 physicians are methadone
maintenance exempted; 209 have registered patients; and 38 physicians were granted methadone
maintenance exemptions in 2008.

The revised Methadone Maintenance Guidelines, which were due for publication this past year, were
unfortunately delayed. The updated and revised guidelines will be published and available for distribution
during 2009.

The chair thanks all of those physicians who perform peer reviews and preceptorships on behalf of the College.


J.	Dian,	MD	      	       	         	        A.J.	Burak,	MD
Chair, Advisory Committee                    Deputy Registrar
on Opioid Dependency




                                                                                                               21
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




Methadone Program — 2008 Statistics*

Number	of	methadone	patients	registered	                 9,885
on the program

Number	of	physicians	with	opioid	dependency	exemption	    365	

Number	of	physicians	with	opioid	dependency	              209		   	
exemption with patients registered

Number	of	new	physicians	with	opioid	dependency	           38	    	
exemption (Jan. 1 to Dec. 31, 2008)

Number	of	physicians	with	analgesic	exemption	            695

Number	of	physicians	with	both	dependency	                171	    	
and analgesic exemption


*As of December 31, 2008




22
                                                                                               Annual Report 2009




Report	on	the	Committee	on	Office	Medical	Practice	Assessment	Program
The	Committee	on	Office	Medical	Practice	Assessment	(COMPA)	was	initiated	by	council	in	1988	as	a	quality	
assurance program with a remedial and educational, not a disciplinary focus. To date more than 2,400
physician practices have been assessed.

In the past year, 85% of practices assessed met the expected standard of record keeping and care on first
assessment. Those with deficiencies in record keeping were given specific remedial advice. Their practices will
be reassessed in one year’s time to ensure quality improvement.

Occasionally a physician’s records are deficient to the degree that the quality of care cannot be determined.
Those physicians are invited for interview with the committee for further discussion and review of the records
to determine the quality of care being provided. They are given specific remedial advice, including direction
regarding their continuing professional development. Again, their practices are reassessed in one year’s time to
ensure that the advice has been heeded and the quality of care and record keeping improved.

The	feedback	from	members	who	have	undergone	review	continues	to	be	positive.		While	there	is	initial	
angst that “the College is coming,” physicians have found the assessment to be a valuable collegial quality-
improvement	exercise.		Many	have	commented	that	they	wished	it	had	occurred	earlier	in	their	careers.		

Recognizing that there were a number of physicians who would benefit from explicit advice regarding medical
record keeping, the committee developed a course – Medical Record Keeping for Physicians. This course is
open to all registrants of the College.

Under the Health Professions Act,	the	program	will	be	retained,	reporting	to	the	Quality	Assurance	Committee.	
                                                                                                             	
Some aspects of the program will likely become linked to the College’s revalidation initiative as it becomes
further developed.

The chair wishes to publicly thank those who serve as assessors in the program. Their commitment to the
College’s mandate of public protection and to professionalism is appreciated.


J.W.	Barclay,	MD	 	       	       	         D.H.	Blackman,	MD,	CCFP
Chair, Committee on Office Medical          Deputy Registrar
Practice Assessment Program




                                                                                                               23
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




Report	on	the	Non-hospital	Medical	Surgical	Facilities	Program
The	past	year	has	been	one	of	continued	growth	and	development	in	the	Non-hospital	Medical	Surgical	
Facilities	(NHMSF)	program	with	enhancements	and	improvements	made	to	the	website,	accreditation	
processes, and guideline revisions in keeping with current evidence and consensus-based best practices.

There are currently 68 accredited non-hospital facilities in BC, with two new facilities being accredited for the
first time this year, and several applications pending for new facility approval.

Highlights	for	the	past	year	include:

Revenues
Annual Fees:
Facility annual fees were restructured in collaboration with medical director representation from facilities to
ensure	costs	are	fully	contained	within	the	NHMSF	program.

Accreditation Fees:
A review of costing was conducted to ensure accreditation fees are maintained as cost-recovery. A new facility
application fee was implemented to cover the cost of start-up and additional program staff time required to
assist new facilities.

Accreditation Process
This year saw continued enhancement and streamlining of accreditation processes with the active recruitment
of expert accreditors in anesthesia, surgical, nursing and sterile processing services.

Reprocessing of Medical Devices
The	Ministry	of	Health	Services’	Best Practice Guidelines for the Cleaning, Disinfection and Sterilization of
Medical Devices in Health Authorities, 2007 was approved by the committee and mandated as policy in all
facilities. College staff and accreditation teams are working to assist facilities to meet acceptable practices
through renovation improvements, practice improvements and education opportunities for personnel working
in sterile processing departments.

Surgical Procedures
The	list	of	MSP	surgical	procedures	has	been	adapted	into	an	approved	“appropriate	list”	of	procedures	
suitable to be performed in a non-hospital setting. This new standardized list will enhance statistical tracking
and ensure standardization and continuity of care amongst facilities.

Human Resources
A full-time perioperative registered nurse was recruited in September 2008 to assume the role as coordinator
of	the	NHMSF	program.		The	coordinator	will	assist	in	program	development,	accreditation	processes,	website	
enhancements and patient complication review and analysis.

The	NHMSF	program	is	committed	to	improving	services,	guidance	and	careful	monitoring	to	fulfill	its	mandate	
of excellence in medical practice and patient safety in the most effective and efficient way.


M.	Elliott,	MD,	FRCPC	    	        	            	        E.J.	Phillips,	MD,	FRCSC
Chair, Non-hospital Medical Surgical                     Deputy Registrar
Facilities Committee


24
                                                                                                    Annual Report 2009




Report on the Diagnostic Accreditation Program
With	a	continued	focus	on	promoting	excellence	in	diagnostic	health	care,	the	College’s	Diagnostic	
Accreditation Program completed the implementation of several assessment and educational activities.

During	2008/09,	the	program	completed	144	on-site	peer	review	surveys.		Since	on-site	surveying	commenced	
using the 2007 accreditation standards, 66% of diagnostic imaging facilities and 57% of medical laboratories
have been assessed through on-site surveying. By the middle of 2010, all diagnostic imaging facilities and
medical laboratories in the province will have been surveyed.

Having	completed	over	200	on-site	surveys	since	2006,	the	program	was	able	to	identify	significant	trends	in	
the performance of BC diagnostic facilities. This data identified common challenges faced by these facilities
and in response the program hosted the conference, Improving Quality of Care and Patient Safety through
Accreditation, which was attended by over 200 people.

After extensive field testing, the accreditation standards for point-of-care laboratory medicine testing were
implemented. Accreditation standards for D testing and RhIg administration in outpatient clinics were also
developed	and	outpatient	clinics	providing	this	service	will	be	surveyed	in	May	2009.		Accreditation	standards	
for hospital-based pulmonary function testing proceeded through field testing and will be fully implemented in
2009. Draft standards for polysomnography have been completed and will be field tested in 2009.

The program continues its ongoing review of diagnostic laboratory facilities, which encompasses proficiency
testing	and	quality	control	results,	including	the	area	of	immunohistochemistry	(IHC).		There	are	currently	11	
laboratories	in	the	province	performing	IHC	testing	for	breast	tumour	biomarkers.		The	proficiency	testing	
performance of these laboratories has met the standards required for effective, reliable and appropriate
testing.

The program also manages the quality control program for the category III pulmonary function laboratories
and continuous feedback on their performance has resulted in these laboratories improving patient care.
A quality control and education program for category II pulmonary function testing provided by hospitals and
community based offices and clinics has been developed and will be implemented in 2009.

The program actively collaborates with other provincial and national diagnostic accrediting organizations.
In	May	2008,	the	program	hosted	the	annual	meeting	of	the	Canadian	Coalition	for	Quality	in	Laboratory	
Medicine.		The	program	continues	to	work	with	Health	Canada	and	has	participated	in	meetings	regarding	
standards	for	molecular	genetic	testing	and	the	implementation	of	Health	Canada	Safety	Code	35:	Radiation	
Protection in Radiology. The implementation of this code in British Columbia will have significant implications
for radiology facilities. In an effort to prepare facilities for the implementation of the code, in February 2009
the	program	partnered	with	WorkSafe	BC	to	present	information	at	an	education	session	hosted	by	Radiation	
Protection Services.

Through the efforts of the program, the College strives to ensure that the public is receiving high quality diagnostic
services. The program acknowledges the commitment of those who give of their time and expertise in conducting
the onsite assessments of facilities. This important work could not be completed without you.


H.	Huey,	MD,	FRCPC	        	        	      	      	               S.	Vigouret	Lee,	RT,	BMLSc,	MHA
Chair, Diagnostic Accreditation Program Committee                 Executive Director


                                                                                                                    25
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




Diagnostic Accreditation Program                   Statement of Operations — Diagnostic Accreditation Program
— 2008 Statistics
Number of accredited                               Year Ended February 28                                     2009             2008
facilities/locations             511

Diagnostic Imaging                                 Revenue                                                      $                $
Public                  141                            Accreditation fees                               2,223,073        1,523,685
Private                  64                            Site Survey Costs Recovered                        513,951           66,228
                                                   	   Grant	Revenue	                                     130,917          533,924
Vascular Laboratories                                  Investment Income                                   21,171           27,358
Public                     5                           Other                                                2,735                -
Laboratory	Medicine	                                                                                    2,891,847        2,151,195
Public               109
Private               21
                                                   Expenditure
Pulmonary Function                                     Salaries and Employee Benefits                   1,238,700          863,424
Public                   63                            Site Survey Costs                                  566,376          177,411
Private                  27                            Professional Fees                                  155,313           43,857
EEG                                                    Rent and Occupancy Costs                           135,405          145,718
Public                   25                            Council and Committees                             133,591          139,628
Private                   1                        	   Miscellaneous	Expenses	                             79,172           42,186
                                                       Office Expenses                                     68,097           84,113
EMG                                                    Amortization, Leaseholds                            35,452           27,607
Public                   20                            and Equipment
Private                  24                            Travel                                                24,060         23,634
                                                       Bank Charges                                             813            730
Polysomnography
Public                     8                                                                            2,436,979        1,548,308
Private                    3
                                                   Excess of Revenue over Expenditure                     454,868          602,887
Number of initial                      20
assessments/focused visits
Number of on-site surveys             144          Notes:
                                                   1 Certain comparative figures have been reclassified to conform to the financial
Number of new surveyors                97             statement presentation adopted for the current year.
trained

Total number of active
DAP surveyors                         240
Medical	surveyors	               		     60
Technical surveyors                   144
Management	surveyors	            	     	36




26
                                                                                                 Annual Report 2009




Report	on	Physician	Health
The College acknowledges the dedication of its registrants to provide quality care to their patients. It
recognizes, however, that not infrequently they do so while neglecting their own physical and emotional health
and well-being. Physicians themselves are vulnerable to illness, stress and fatigue. If such becomes long-
standing or severe, it may affect the quality of care that is provided by the physician. This could be manifest
as a poor treatment decision, a missed diagnosis, a medication error, unprofessional conduct or ineffective
or inappropriate communication with patients and other caregivers. Some physicians recognize the need to
address their own health issues by removing themselves from practice for a period of time, and contacting the
College to discuss the provision of continuity of patient care during their absence. The most common reasons
are personal illness or burn-out.

The College understands the demands on the profession and the vulnerability of physicians as individual
human beings. Physicians are encouraged to take care of themselves, to have their own family physician,
and to seek medical care and professional assistance when necessary. Although the College has the legal
power to formally remove a physician from practice because of impairment and inability to provide safe care,
it very rarely has to exercise this ability. It has become increasingly apparent that most physicians are willing
to voluntarily sign undertakings to refrain from practice until they have received treatment and been deemed
by their caregivers to be fit to return to practice, thereby forgoing the need for formalized action. In 2008, 18
physicians voluntarily withdrew from practice because of impairment due to serious mental health problems,
addiction issues or cognitive concerns. Following thorough assessment and intensive treatment, many were
able to return to work under medical supervision and with ongoing monitoring by the College.

The College is dedicated to encouraging and supporting physicians in being healthy caregivers. Each year it
provides	significant	funding,	along	with	the	British	Columbia	Medical	Association	and	the	Ministry	of	Health	
Services,	to	support	the	Physician	Health	Program	of	British	Columbia.		Since	November	2006,	this	program	
has been an independent non-profit society with a governing board. Its day-to-day functions are entirely
separate from the funding bodies.

The	College	encourages	all	members	to	acquaint	themselves	with	the	Physician	Health	Program	and	to	utilize	
its valuable resources. It also encourages members to reach out and help colleagues who may require support.
Physicians are welcome to contact the College registrar staff at any time to discuss matters causing them
distress.		Early	attention	to	personal	problems	often	prevents	subsequent	personal,	family	and/or	practice	
concerns.


Physician Health Program
Telephone 604-742-0747 or 1-800-663-6729
Website		www.physicianhealth.com


M.L.	Piercey,	MD
Deputy Registrar




                                                                                                                27
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




Report on the College Library
The Library Committee provides oversight and consultation on College library policies and services. It advises
and supports the co-managers on administrative issues such as operations and budgets, and regularly reports
to the College council on library matters. The 2010 College Library Vision Statement, espousing values of
access, confidentiality, respect, excellence and leadership, provides a framework for the library’s activities. A
number of initiatives and ongoing services were approved in the past year to fulfill the library’s mission.

As part of the College’s new website, the library has implemented a simple search tool that helps physicians
locate clinical information quickly without necessarily knowing the intricacies of a database’s interface or even
of its existence. This tool, known as a federated search engine, takes the form of search boxes displayed on
various pages of the library’s website. The user enters a query into the search box and the query is sent to
numerous electronic resources (databases, the library’s online catalogue, clinical practice guidelines, and patient
information websites). The search engine enhances access to the College library’s e-journal subscriptions and
links to full-text documents are provided where available. User feedback from an online survey has been very
positive regarding ease of use and quality of retrieved information.

In response to College registrants’ requests for electronic access to information and in the interest of fiscal
responsibility, the library’s print journal subscriptions were assessed and reduced from 252 titles to 148 titles,
a	savings	of	approximately	$85,000.		New	opportunities	for	investment	in	electronic	information	resources	are	
being pursued, including a potential for cost-effective consortia purchasing through the College’s membership
in	the	Electronic	Health	Library	of	BC.

Education in computer searching and evidence-based medicine is expanding as a library function. The
library entered into a partnership with UBC Continuing Professional Development to develop and facilitate
an accredited, interactive workshop on Internet searching for evidence-based clinical information. Finding
Medical Evidence/Supporting Patient Care: Using the Internet to Your Advantage, was delivered several times
in Vancouver and Victoria. A demonstration or shorter, computer-based version of this program was presented
to	physicians	in	Prince	Rupert,	Terrace,	Kitimat,	Smithers,	Vanderhoof,	Fort	St.	James,	Quesnel	and	Williams	
Lake. The College library continues to offer instruction to registrants through regularly scheduled monthly
group sessions, as well as individual in-person and online training.

The library’s reference service continues to be well-used and valued by registrants. Usage statistics for the
library this past year included a 12% increase in extended research questions over the previous year, and a
21% increase since the library was physically re-integrated with the College. The monthly newsletter, Cites &
Bytes, also continues to be a popular service, generating 11,378 requests for photocopies in 2008 (53% of the
total of articles requested during the year).


A.I.	Sear,	MBBS	 	       	             L.	Clendenning,	BA,	BLS	(Retired	December	2008)	     	        	        	
Chair, Library Committee               K.	MacDonell,	PhD,	MLIS
	    	    	       	      	             J.	Neill,	BA,	MLS
                                       Librarians/Co-Managers




28
                                                                                                 Annual Report 2009




DISCIPLINARY OUTCOMES


Investigations, Inquiries, Discipline
Section 50 Medical Practitioners Act – Conviction of indictable offence
No	physicians	were	convicted	of	an	indictable	offence.	

Section 51 Medical Practitioners Act – Adequacy of skill and knowledge
One	new	investigation	into	skill	and	knowledge	was	initiated	in	2008.		While	the	investigation	has	been	
completed, the hearing before council is pending.

Two investigations commenced in 2007, were concluded as follows:

March	31,	2008
Dr. Chow TAI, Vancouver

Following an investigation and a hearing pursuant to s.51 of the Medical Practitioners Act, the Council of the
College decided that Dr. Tai did not have the requisite skill and knowledge to practise medicine. Pursuant to
s.60(3)(a) of the Medical Practitioners Act,	Dr.	Tai	was	erased	from	the	Medical	Register	effective	2400	hours,	
January 24, 2008.

June 3, 2008
Dr. Clement Elmhirst WILLIAMS, West Vancouver

Following an investigation pursuant to s.51 of the Medical Practitioners Act and pending a hearing, Dr.
Williams	offered	to	resign	his	membership	with	the	College	and	agreed	not	to	reapply	for	registration	in	British	
Columbia or any other jurisdiction and to refrain from any form of employment related to the practice of
medicine.		Dr.	Williams	ceased	to	be	a	member	effective	2400	hours,	May	31,	2008.

Section 53(6) Medical Practitioners Act – Investigations, inquiries and disciplinary related matters

Investigations commenced                                              35
Categories of concerns:
  •	 breaches	of	terms	and	conditions	of	temporary	registration	       1
  •	 requests	for	medical	records	                                     1
  •	 prescribing	                                                      2
  •	 quality	of	care	and	practice	concerns	                           16
  •	 sexual	misconduct	                                               13
  •	 other	(unethical	and	unprofessional	conduct)	                     2

Closed                                                                12
Ongoing investigations                                                23

Cases proceeding to charges under the Medical Practitioners Act        8
Categories of concerns:
  •	 prescribing	                                                      1
  •	 requests	for	medical	records	                                     1	
  •	 sexual	misconduct	                                                4
  •	 other	(unethical	and	unprofessional	conduct)	                     2



                                                                                                                29
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




Sections 53 and 60 Medical Practitioners Act – Inquiries into unprofessional conduct
Five disciplinary matters were concluded:

June 30, 2008
Dr. Deepakkumar Vallabbai PATIDAR, Maple Ridge

Dr. Patidar admitted that he was guilty of unprofessional conduct in that, in 2006, he performed an
examination of a patient in a manner that did not meet the requisite standard of care. Dr. Patidar had
previously been disciplined in June 2007 with respect to the examination of a patient and had been suspended
from practice for 18 months. Subsequent to that disciplinary action, the College received a further complaint
and imposed a penalty that included ongoing suspension from the practice of medicine until Dr. Patidar had
participated in assessments and counselling, and completed remedial education. The College also required
monitoring of practice and payment of $1,500 in costs.

August 5, 2008
Dr. Jonathan Mark FOLLOWS, Victoria

Dr. Follows admitted that he was guilty of unprofessional conduct in inappropriately touching a patient
in a sexual manner during medical attendances in 2003 and 2004. After considering various mitigating
circumstances, the College imposed a penalty that included transfer to the Temporary Register, a six month
suspension from practice effective July 18, 2008 (with three months stayed if all other requirements were met),
assessments and counselling. Dr. Follows was required to participate in a mentorship and monitoring of his
practice and to obtain College approval of his practice setting.

September 30, 2008
Dr. Farzad TANHA, Abbotsford

Dr. Tanha, a neurologist, admitted that he was guilty of unprofessional conduct in that, in 2007, he conducted
a physical examination of his patient in a manner which was and could reasonably be perceived by the patient
as sexualized in nature. The College imposed a penalty that included transfer to the Temporary Register, a
three month suspension from practice effective September 30, 2008, assessments and counselling and costs of
$5,000. Upon return to practice, Dr. Tanha was required to comply with various conditions, including having
a chaperone present for all physical examinations and all breast, pelvic or otherwise sensitive examinations
of female patients and examinations of female patients that require disrobing, and to have his practice
monitored.

October 1, 2008
Dr. Daniel Archie BUIE, Victoria

Dr. Buie admitted that he was guilty of unprofessional conduct in that, in 2006, during medical attendances
he hugged a patient and, in 2007, he hugged and kissed the patient. Dr. Buie also made comments to the
patient that were inappropriate and unprofessional. The College imposed a penalty that included transfer
to the Temporary Register, suspension from practice for six months commencing 2400 hours, June 1, 2008,
assessments and counselling, costs of $1,800 and future monitoring of his practice.




30
                                                                                               Annual Report 2009




October 22, 2008
Dr. Jeannine Inez HOWEY, Surrey and Vancouver

Dr.	Howey	admitted	that	she	was	guilty	of	unprofessional	conduct	in	failing	on	numerous	occasions	to	reply			
to College communications. The College imposed a penalty of a formal reprimand, a fine of $2,500 and
costs of $1,200.

Section 53(7) Medical Practitioners Act – Reprimand
Three physicians were formally reprimanded under s.53(7) and agreed to participate in various remedial
measures.

Section 60(7) Medical Practitioners Act – Breaches of conditions of registration
One inquiry commenced in 2007 was concluded as follows:

April 4, 2008
Dr. James Christopher Anscombe MORRANT, Vancouver

Dr.	Morrant,	a	psychiatrist,	acknowledged	that	he	breached	various	conditions	of	his	temporary	registration	
imposed in January 2006 after disciplinary action. Specifically, he breached conditions that required him
to limit his practice of psychotherapy to short-term interventional psychotherapy focusing on consultation,
assessment and pharmacotherapy to a maximum of 12 sessions per patient, that he see patients only when
other clinic staff are present in the clinic, and that he not initiate contact with former patients out of the
office.		Dr.	Morrant	was	formally	reprimanded	under	s.60(7),	required	to	pay	a	fine	of	$10,000,	participate	in	a	
treatment program, assessments, counselling and monitoring and be interviewed by the Executive Committee.

Section 63 Medical Practitioners Act – Inquiries into incapability
No	physicians	were	the	subject	of	s.63	inquiries	in	2008.	




Actions under sections 47 and 48 of the Medical Practitioners Act – 2008

Erased from register under section 47(4) of the Medical Practitioners Act – Non-payment of dues
10 members

Removed from register at own request under section 48 of the Medical Practitioners Act
82 members

Restored to register under section 47(2) of the Medical Practitioners Act – Payment of back dues
and fines
29 members

Names available upon request.




                                                                                                              31
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




OPERATIONS AND ADMINISTRATION


Report from Legal Counsel
Before the Courts and the British Columbia Human Rights Tribunal

The	following	matters	were	before	the	Courts	and	the	British	Columbia	Human	Rights	Tribunal	in	the	last		
fiscal year:

     1. Jerry Douglas Rose Jr. v. The College and others
        The plaintiff has commenced legal action against the College and many other parties including
        Microsoft	Corporation	and	the	Attorney	General	of	BC	alleging	various	assaults	upon	him	as	a	result	of	
        being subjected to Invasive Brain Computer Interface Technology. The lawsuit was dismissed against all
        defendants including against the College.

     2. Mohamed Ahmed v. The College and others
        This plaintiff has sued the College and a number of others including two Vancouver hospitals.
        Although it is difficult to determine the basis for his lawsuit, it appears the plaintiff complains about
        a	bad	outcome	from	heart	procedures	performed	on	him.		His	lawsuit	was	ordered	dismissed	in	the	
        Supreme Court of British Columbia. Subsequently, the plaintiff took an appeal to the Court of Appeal
        for British Columbia and the matter has not proceeded to a hearing in that Court.

     3. Richard Austin Vollrath and Roy Gene Hopkins v. The College
        These petitioners, inmates of the Federal Correctional Service of Canada, allege that the College was
        incorrect in not accepting their complaints against a number of members of the College until the
        inmates’	internal	rights	of	review	had	been	exhausted.		No	further	action	has	been	taken	at	this	time.

     4. George Vrabec, Charalambous Andreou and Peter Pommerville v. The College
        These petitioners brought legal proceedings against the College as a result of the College’s refusal to
        allow	the	petitioners	the	ability	to	use	a	High	Intensity	Focused	Ultrasound	Machine	for	prostate	cancer	
        at a non-hospital medical surgical facility. The petitioners allege that the College did not have the
        authority to pass the rules accrediting and governing such facilities. Alternatively, the petitioners made
        other allegations against the College including an allegation that the College’s decision to deny the use
        of the machine was an unreasonable one.

         The legal arguments were completed in early January 2009 in the Supreme Court of British Columbia
         and judgment was reserved. At the time of this report, Reasons for Judgment have not been handed
         down.

     	 	 The	Attorney	General	of	British	Columbia	participated	in	the	legal	arguments	and	supported	the	
         College’s ability to regulate such facilities.

     5. Pratten v. The College and the Attorney General of British Columbia
        In this lawsuit, proposed as a class action, the plaintiff, a child of a gamete donor seeks access to and
        permanent preservation of gamete donor records, and legislative change with respect to the rights
        afforded to the children of gamete donors. Pending the trial or conclusion of the action, or further
        court order, the British Columbia Supreme Court has ordered that individuals who have gamete donor
        records are prohibited from destroying, disposing, redacting or transferring those records out of British
        Columbia. A trial date has not yet been set for the lawsuit to be heard.



32
                                                                                                 Annual Report 2009




   6. Dr. Paul Fenje, Jr. v. The College and others
      Last year’s report identified two lawsuits against the College relating to the College’s refusal to grant
      the plaintiff licensure to practice. Since that report, the lawsuits have been dismissed.

   7. Dr. Paola Nasute Fauerbach v. The College and the University of British Columbia
      The reference to this matter in last year’s report was incomplete and should have said that the
      complainant	has	filed	a	complaint	to	the	British	Columbia	Human	Rights	Tribunal	against	both	the	
      College and the University of British Columbia alleging discrimination because, as an international
      medical graduate and a Canadian citizen, she was not granted an education licence to practice
      medicine in British Columbia. All issues between Dr. Fauerbach and the College have now been
      resolved.

   8. Dr. Ashley Robinson v. The College
   	 	 The	complainant	has	filed	a	complaint	to	the	British	Columbia	Human	Rights	Tribunal	alleging	
       discrimination due to the fact that the College requires him to pass the Royal College’s examinations.
       Dr. Robinson had previously written the examinations and failed them. The hearing before the Tribunal
       is	currently	set	to	commence	November	23,	2009.


D.	Martin
Miller Thomson LLP
Barristers & Solicitors




                                                                                                                  33
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




Deceased	Members
Reported from May 1, 2008 to April 30, 2009

Arato, Dr. Judith, Vancouver, BC                         April 19, 2008
Ball,	Dr.	Roger	John	Tudor,	Kelowna,	BC	                 March	31,	2009
Barker,	Dr.	Arthur	John,	North	Vancouver,	BC	            December	6,	2008
Bean,	Dr.	Helen	Alice,	Vancouver,	BC	                    February	8,	2009
Bell-Irving,	Dr.	Robin	Watson,	West	Vancouver,	BC	       August	28,	2008
Brighton,	Dr.	John	Weir,	Parksville,	BC	                 March	1,	2009
Brooks,	Dr.	Henry	Joseph,	Victoria,	BC	                  March	28,	2009
Bryans,	Dr.	Frederick	Edward,	Vancouver,	BC	             March	11,	2009
Burgess,	Dr.	Geoffrey	Watkins,	West	Vancouver,	BC	       September	1,	2008
Burns, Dr. Robert Arthur, Delta, BC                      October 6, 2007
Cardwell,	Dr.	David	McDonald,	Parksville,	BC	            March	27,	2009
Chan, Dr. Edward, Burnaby, BC                            June 22, 2008
Chodos,	Dr.	Hedwige	Elfried	Habegger,	Vancouver,	BC	     July	24,	2008
Coburn,	Dr.	Harris	Christie,	Price	Rupert,	BC	           August	11,	2008
Collins, Donald Ralph, Powell River, BC                  July 30, 2008
Coursley,	Dr.	Gerald,	New	Westminster,	BC	               March	23,	2009
D’Amico,	Dr.	Rosarina	Maria,	Williams	Lake,	BC	          December	19,	2007
De	Montigny,	Dr.	Joseph	Leo	Pol,	Chilliwack,	BC	         August	18,	2006
Doty, Dr. David Allen, Victoria, BC                      June 7, 2008
Doyle,	Dr.	Patrick	John,	Vancouver,	BC	                  May	21,	2008
Dunn,	Dr.	Henry	George,	Vancouver,	BC	                   December	9,	2008
Eckersley,	Dr.	Anthony	Paul	Ryley,	Prince	George,	BC	    March	19,	2009
Fetterly,	Dr.	John	Clinton	McIntosh,	Victoria,	BC	       July	29,	2008
Fumerton, Dr. John Laidlaw, Aldergrove, BC               January 12, 2009
Gallagher,	Dr.	Donald	James	Peter,	Maple	Ridge,	BC	      January	1,	2009
Gibson,	Dr.	Gary	Allen,	Salt	Spring	Island,	BC	          January	3,	2008
Graf-Blaine,	Dr.	Ida	Marie,	Victoria,	BC	                January	17,	2009
Graham,	Dr.	Douglas,	Cobble	Hill,	BC	                    December	11,	2008
Grewal,	Dr.	Joginder	Singh,	Abbotsford,	BC	              June	28,	2008
Gulley,	Dr.	John	Lewis,	Victoria,	BC	                    August	20,	1996
Hall,	Dr.	Arnold	Anton,	New	Westminster,	BC	             April	22,	2008
Hardyment,	Dr.	Archibald	Frost,	Vancouver,	BC	           February	23,	2002
Hunt,	Dr.	John	Egerton,	Victoria,	BC	                    December	10,	2008
Hurley,	Dr.	James	Brian,	Victoria,	BC	                   January	9,	2008
Inglis,	Dr.	Alan	Moore,	Hornby	Island,	BC	               January	12,	2005
Jackson, Dr. Thomas Ernest, Vancouver, BC                April 18, 2009
Jaron,	Dr.	Peter	Winston,	Prince	George,	BC	             May	4,	2008
Jurcic,	Dr.	Predrag	Juraj	Karl,	West	Vancouver,	BC	      May	6,	2008
Kadziora,	Dr.	Max	Benno,	Victoria,	BC	                   April	30,	2008
Kellett, Dr. John Robert, Vancouver, BC                  July 16, 2008
Klassen,	Dr.	Bernhard	Gerhard,	Chilliwack,	BC	           March	26,	2009


34
                                                                                 Annual Report 2009




Klassen, Dr. David, Chilliwack, BC                          September 3, 2008
Lamplugh,	Dr.	Charles	Mann,	Vancouver,	BC	                  August	21,	2008
Lavoie, Dr. Julye, Vancouver, BC                            September 26, 2008
LeBlanc,	Dr.	Marianne	Louise,	Victoria,	BC	                 March	20,	2008
Lee,	Dr.	David	Bruce,	Mission,	BC	                          January	12,	2008
LeRiche, Dr. Jean Charlotte, Vancouver, BC                  February 20, 2009
Lipkewich, Dr. Sonya, Calgary, AB                           January 16, 2009
Macphail,	Dr.	Archibald	Sinclair,	Waglisla,	BC	             December	19,	2007
MacPhail,	Dr.	Hugh	Rose,	Calgary,	AB	                       December	20,	2007
Marinatos,	Dr.	Nicholas	Gerassimos,	Richmond,	BC	           October	26,	2008
McKinley,	Dr.	William	John,	Dawson	Creek,	BC	               November	1,	2008
McNaughton,	Dr.	Robert	Henry	Francis,	Salem,	OR,	USA	       February	18,	2009
Meihuizen,	Dr.	Sytse	Hero,	Cumberland,	BC	                  November	19,	2008
Meintjies,	Dr.	Leo	Clive	Oxford,	Vancouver,	BC	             August	14,	2007
Menard,	Dr.	Michael	Reald,	Vancouver,	BC	                   January	17,	2009
Mohamed,	Dr.	Aneez	Shiraz,	Vancouver,	BC	                   February	7,	2009
Molaro,	Dr.	Alphonso	Lawrence,	Vancouver,	BC	               June	1,	2008
Moore,	Dr.	John	Robert,	Gagetown,	NB	                       July	7,	2008
Munro,	Dr.	James	Grant,	Surrey,	BC	                         May	15,	2008
Murphy,	Dr.	Harold	Ormond,	Vancouver,	BC	                   October	24,	2008
Osborne,	Dr.	James	Claude,	West	Vancouver,	BC	              August	30,	2008
Pankratz,	Dr.	James	Edward,	Abbotsford,	BC	                 May	29,	2008
Pauw,	Dr.	Christoffel	Petrus,	Creston,	BC	                  March	16,	2009
Phelps,	Dr.	Albert	Henry,	Chilliwack,	BC	                   November	29,	2007
Pledger,	Dr.	Robert	George,	Victoria,	BC	                   February	8,	2009
Preswick,	Dr.	George,	Abbotsford,	BC	                       November	15,	2007
Puddicombe,	Dr.	Robert	Thomas	Mardi,	North	Vancouver,	BC	   December	17,	2007
Purser,	Dr.	Margaret	Joy,	North	Vancouver,	BC	              May	6,	2008
Reynolds,	Dr.	Peter	John,	Nanaimo,	BC	                      April	22,	2008
Rich,	Dr.	Park	Judson,	Prince	Albert,	SK	                   May	29,	2008
Sidorov,	Dr.	Joseph	J.,	Prince	George,	BC	                  March	29,	2009
Smailes, Dr. Colin Leslie, Surrey, BC                       July 29, 2008
Stevenson,	Dr.	John	Donaldson,	West	Vancouver,	BC	          August	31,	2007
Tanaka,	Dr.	Shuzo,	Nanoose	Bay,	BC	                         March	9,	2008
Townsley, Dr. Benjamin Reid, Salt Spring Island, BC         December 24, 2007
Trembath,	Dr.	James	Henry,	Aldergrove,	BC	                  March	3,	2009
Tucker,	Dr.	Desmond	Keith,	Nanaimo,	BC	                     August	29,	2008
Van	Norden,	Dr.	Jacoba,	Vancouver,	BC	                      February	26,	2008
Villanueva,	Dr.	Marcos	Perez,	Comox,	BC	                    February	22,	2008
Williams,	Dr.	David	Keith,	Victoria,	BC	                    August	13,	2008
Wright,	Dr.	Elizabeth	Jane	Waite,	Victoria,	BC	             March	16,	2009
Wu,	Dr.	William	Tit-Yue,	Edmonton,	AB	                      March	17,	2009
Yakura,	Dr.	Florence	Haruko,	Burnaby,	BC	                   February	18,	2009
Yong,	Dr.	Gabriel	Y.S.,	Vancouver,	BC	                      July	29,	2008




                                                                                                35
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




Report on Operations
This past year was one of preparation: preparation for new legislation; preparation for continued growth
and technology enhancements; and preparation for a stable and fiscally sound future. The key operations
highlights are outlined below:

Investments
While	the	recent	economic	downturn	saw	worldwide	stock	markets	plummet,	the	College	maintains	a	very	
conservative investment portfolio, with 80-90% of financial assets in fixed income investments. The College,
however, has not been immune to the financial turbulence, and experienced a loss of approximately five per
cent on investments. To improve performance on the equity portion of the College investments, alternative
money managers have been approached. The Finance and Audit Committee will make a recommendation this
summer.

Revenues
Despite the increase for 2009, College registrants still pay the second lowest annual fee of all the provinces.
This increase will help offset the costs associated with transitioning to the Health Professions Act. One of
the significant changes required under the new legislation is the upgrade and modification of the College’s
information technology including:

     •	 Improvements	to	the	firewall	and	increased	website	security
     •	 Search	enhancements	to	the	website
     •	 Improvements	to	the	internal	registrant	and	complaints	databases		

All of these upgrades began in late 2008 and will continue through 2009.

Additional	revenues	were	secured	in	2008/09	through	a	multi-year	contract	to	provide	the	BC	government	
the electronic Provider Registry, and through further increases in the non-hospital medical surgical facility
accreditation fees to better reflect actual program costs.

Expenditures
The	largest	expenditure	increase	in	2008/09	was	in	office	rent	and	occupancy,	as	this	was	the	first	year	under	
a new lease. Bank charges and credit card fees also increased significantly as more registrants renewed online.
Council	and	committee	costs,	as	well	as	professional	fees,	decreased	from	2007/08	to	2008/09.		However,	the	
College	anticipates	significant	increases	in	both	categories	in	2009/2010	due	to	new	legislative	requirements.		
To	enhance	internal	expenditure	controls	and	processes,	Microsoft	Dynamics	Accounting	software	has	been	
implemented. This allows for more detailed tracking of expenditures by each department, and will allow the
College to automatically link the registrant database to accounting, which in the past has been a manual
process.

Building Search
The College is in the process of securing a new building, which must be suitable for College operations and
administration for many years. To date, 13 different properties have been viewed and assessed. It is hoped
that this transaction occurs later this year or early in 2010.




36
                                                                                                Annual Report 2009




Human Resources
A	key	human	resource	focus	for	2008/09	was	to	improve	the	College’s	performance	review	process.		The	
council endorsed an enhanced leadership review process, including a “360°” review for the registrar.

As the College continues to grow, it is crucial to have experienced and knowledgeable employees. Recently, J.
Galt	Wilson,	MD	was	recruited	as	the	College’s	newest	deputy	registrar.		Other	professional	staff,	including	an	
in-house lawyer and a complaints coordinator, will support the detailed administrative processes resulting from
the transition to the Health Professions Act.

As the College moves forward, it remains committed to balancing growth needs with careful financial
monitoring and tracking, and to fulfill the mandate—excellence in medical practice—in the most cost-effective
and efficient way.

The following Statement of Operations provides an overview of the College’s revenue and expenditures for the
year ending February 28, 2009.


Michael	Epp,	MBA
Chief Operating Officer




                                                                                                               37
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




Statement of Operations — Excluding the Diagnostic Accreditation Program

Year Ended February 28                                                        2009        2008


Revenue                                                                        $              $
	   Members	Dues	                                                     11,474,008     10,759,039
    Investment Income                                                  1,758,915      1,547,026
    Other                                                                468,384        214,847
	   Grant	Revenue	                                                       438,500        451,126
    Accreditation Fees                                                   339,471        117,433
    Registration Fees                                                    335,600        317,548
    Fines and Costs                                                       59,150         95,578
	   Medical	Directory	                                                    50,316         76,846
	   Medical	Library	Service	                                              10,148         17,139

                                                                      14,934,492     13,596,582


Expenditure
    Salaries and Employee Benefits                                      7,450,378     6,983,281
	   Unrealized	Loss	(Gain)	on	Investments	                              1,748,268       (74,514)
    Rent and Occupancy Costs                                            1,426,686       802,255
    Council and Committees                                              1,041,438     1,161,086
    Office Expenses                                                       439,468       379,157
    Information Technology                                                408,935       361,189
    Professional Fees                                                     348,861       525,349
	   Physician	Health	Program	                                             302,000       300,000
	   Medical	Library	                                                      284,803       303,331
	   Miscellaneous	Expenses	                                               259,783       686,563
    Publications                                                          223,186       211,597
    Bank Charges and Credit Card Fees                                     198,155       107,598
    Travel                                                                192,702       152,299
    Amortization, Leaseholds and Equipment                                152,111       378,784
	   Grants	                                                               140,403       165,017
	   Federation	Membership	Dues	                                           139,608       125,385
	   Annual	Meeting	and	Election	                                           82,238         55,679
    Scholarships                                                           20,500         20,500
	   Chronic	Disease	Management	Initiative	                                      -         13,291

                                                                      14,859,523     12,657,847

Excess of Revenue over Expenditure                                         74,969      938,735



Notes:
1 Certain comparative figures have been reclassified to conform to the financial
     statement presentation adopted for the current year.




38
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




College	Council	2008/2009




Back	row,	left	to	right:	Ms.	E.	Peaston,	Dr.	R.D.	Kinloch,	Dr.	E.J.	Phillips,	Dr.	M.	Elliott,	Dr.	H.M.	Oetter	(Registrar),	Mr.	G.	Stevens,		
Mr.	M.	Epp,	Mr.	R.	Sketchley,	Dr.	J.	Stogryn,	Dr.	A.J.	Burak,	Dr.	D.H.	Blackman,	Dr.	W.R.	Vroom,	Ms.	C.	Evans,	Dr.	E.M.S.	Frew
Front	row,	left	to	right:		Mr.	W.M.	Creed,	Dr.	D.	Hammell	(Vice	President),	Dr.	L.	Jewett,	Dr.	L.	Sent,	Dr.	A.	Dodek	(President),		 	
Dr.	M.L.	Piercey,	Dr.	A.I.	Sear,	Ms.	J.	Clarke
Missing:	Dr.	M.A.	Docherty




The College is governed by an elected body of ten physicians and five public representatives who are
appointed	by	the	Ministry	of	Health	Services.		The	daily	operations	of	the	College	are	administered	by	the	
registrar and other medical and professional staff.




40
                                                          Annual Report 2009




Officers of Council
Dr. A. Dodek, President
Dr. L. Sent, Past President
Dr.	D.	Hammell,	Vice	President
Dr.	M.A.	Docherty,	Treasurer

Registrar and Deputy Registrars
Dr.	M.	VanAndel,	Registrar	(Retired	October	31,	2008)
Dr.	H.M.	Oetter,	Registrar	(Effective	November	1,	2008)
Dr.	D.H.	Blackman,	Sr.	Deputy	Registrar
Dr. A.J. Burak, Deputy Registrar
Ms.	E.	Peaston,	Deputy	Registrar	(Legal)
Dr. E.J. Phillips, Deputy Registrar
Dr.	M.L.	Piercey,	Deputy	Registrar
Dr.	W.R.	Vroom,	Deputy	Registrar

Elected Members of Council
District 1   Dr. R.D. Kinloch, Victoria
	            Dr.	D.	Hammell,	Victoria
District	2		 Dr.	E.M.S.	Frew,	Nanaimo
District 3   Dr. A. Dodek, Vancouver
	            Dr.	M.	Elliott,	Vancouver
             Dr. L. Sent, Vancouver
District 4   Dr. J. Stogryn, Coquitlam
District	5		 Dr.	M.A.	Docherty,	Kelowna
District 6   Dr. L. Jewett, Cranbrook
District	7		 Dr.	A.I.	Sear,	Quesnel

Appointed by the Minister of Health Services
Ms.	J.	Clarke
Mr.	W.M.	Creed	(Effective	January	2009)
Ms.	C.	Evans
Mr.	M.	Mourton	(Retired	January	2009)
Mr.	R.	Sketchley
Mr.	G.	Stevens




                                                                         41
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




College Committees
The council of the College establishes standing and ad hoc committees made up of council members and
other medical professionals who review issues, and provide guidance and direction to council and the College’s
staff, ensuring a well-balanced and equitable approach to medical self-regulation.

Executive Committee                                      Quality of Medical Performance Committee
Dr. A. Dodek, President and Chair                        Dr.	M.A.	Docherty,	Chair
Dr.	D.	Hammell                                           Dr. K. Creedon
Dr.	M.A.	Docherty                                        Dr.	M.	Elliott	
Dr. L. Sent (Alternate)                                  Dr. D. Price
Dr. L. Jewett                                            Dr. R.D. Kinloch
Ms.	C.	Evans,	Public Representative                      Dr. B.O. Kassen
Mr.	G.	Stevens,	Public Representative                    Dr. P.D. Rowe
                                                         Mr.	W.M.	Creed,	Public Representative
Medical Council of Canada                                Mr.	R.	Sketchley,	Public Representative
Dr.	M.	VanAndel
Dr.	H.M.	Oetter                                          Advisory Committee on Prescription Review
                                                         Dr.	G.	Vaughan,	Chair	(Retired December 2008)
Preliminary Review Committee                             Dr. R.K. Phillips, Acting Chair (Effective
Dr. A. Dodek, President and Chair                        December 2008)
Dr.	D.	Hammell                                           Dr. L. Sent
Dr. L. Sent                                              Dr.	M.	Khara
Ms.	C.	Evans,	Public Representative                      Dr.	D.M.	McGregor
                                                         Dr. R. Shick
Sexual Misconduct Review Committee
Dr. A. Dodek, President and Chair                        Advisory Committee on Opioid Dependency
Dr.	D.	Hammell                                           Dr. J.E. Dian, Chair
Dr. L. Sent                                              Dr. J. Stogryn
Ms.	C.	Evans,	Public Representative                      Dr. J.F. Anderson
                                                         Dr.	D.	Hutnyk
Ethical Standards and Conduct Review                     Dr.	P.	Mark
Committee                                                Dr. D.A. Rothon
Dr. J. Stogryn, Chair                                    Dr.	P.W.	Sobey
Dr. A.I. Sear
Dr.	E.M.S.	Frew                                          Advisory Committee on Blood Borne
Mr.	G.	Stevens,	Public Representative                    Communicable Disease
Ms.	C.	Evans,	Public Representative                      Dr.	M.	Krajden,	Chair
Ms.	L.	D’Agincourt,	PhD                                  Dr.	F.H.	Anderson
                                                         Dr.	P.R.W.	Kendall
                                                         Dr. A. Ramji
                                                         Dr.	H.G.	Stiver
                                                         Dr.	V.	Montessori




42
                                                                                       Annual Report 2009




Non-Hospital Medical Surgical Facilities          Finance and Audit Committee
Committee                                         Ms.	J.	Clarke,	Chair and Public Representative
Dr.	M.	Elliott,	Chair                             Dr. A. Dodek
Dr.	V.M.	Frinton                                  Dr.	D.	Hammell
Dr.	E.M.S.	Frew	                                  Dr.	M.	Docherty	 	
Dr. K. Stothers                                   Mr.	W.M.	Creed,	Public Representative
Dr.	G.	McGregor	
Dr.	C.B.	Warriner                                 Library Committee
Dr. S. Sanmugasundram                             Dr. A.I. Sear, Chair
Dr.	N.	Wells                                      Dr. J.C. Butt
Dr.	J.P.	McConkey	                                Dr.	R.E.	Gallagher	
Mr.	G.	Stevens,	Public Representative             Dr.	M.	McGregor
Ms.	M.	Gauthier,	RN
                                                  Legislation, Policy and Communications
Diagnostic Accreditation Program Executive        Committee
Committee                                         Dr. R.D. Kinloch, Chair
Dr.	H.	Huey,	Chair                                Dr. A. Dodek
Dr. D. Carlow                                     Dr. L. Sent
Dr.	J.C.	Heathcote                                Dr.	D.	Hammell
Dr.	R.	Muir                                       Mr.	R.	Sketchley,	Public Representative
Dr. B. Toews

Committee on Office Medical Practice Assessment
Dr. J. Barclay, Chair
Dr. C. Penn
Dr. R. Baker
Dr.	A.D.	Hosie	
Dr.	B.	Gregory,	BCMA Representative

Registration Committee
Dr. L. Jewett, Chair
Dr. V. Frinton
Dr.	D.	Hammell	
Dr.	J.	Wright
Dr. L. Sent
Dr.	P.	Newbery
Ms.	J.	Clarke,	Public Representative




                                                                                                      43
COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
Excellence in medical practice




College Departments and Contacts
Registration
Dr. E.J. Phillips, Deputy Registrar

Public Inquiries and Complaints
Dr. A.J. Burak, Deputy Registrar – Ethics
Dr.	M.L.	Piercey, Deputy Registrar – Sexual Misconduct
Dr.	W.R.	Vroom,	Deputy Registrar – Clinical Performance

Media and Communications
Ms.	S.	Prins, Director

Records, Information and Privacy
Ms.	J.	Liu,	Director

Legal
Ms.	E.	Peaston, In-house Counsel

Operations and Administration
Mr.	M.	Epp, Chief Operating Officer

Professional Incorporation
Dr.	D.H.	Blackman,	Deputy Registrar

Controlled Prescription Review Program
Dr.	W.R.	Vroom,	Deputy Registrar

BC Methadone Program
Dr. A.J. Burak, Deputy Registrar

Non-Hospital Medical Surgical Facility Program
Dr. E.J. Phillips, Deputy Registrar
Ms.	P.	Fawcus, RN, Director

Committee on Office Medical Practice Assessment
Dr.	D.H.	Blackman, Deputy Registrar

College Library
Ms.	L.	Clendenning, Librarian/Co-Manager (Retired December 2008)
Ms.	K.	MacDonell,	Librarian/Co-Manager
Ms.	J.	Neill, Librarian/Co-Manager




44
The	Medical	Directory
A	complimentary	copy	of	the	2008/09	Medical	Directory	was	mailed	to	current	registrants	of	the	College	
in October 2008. Additional copies are available for purchase by physicians, health authorities and others
approved	by	the	College	in	accordance	with	current	privacy	legislation.		The	Medical	Directory	is	published	
each year in the fall. It is also available as an electronic file to physicians upon request.

An	online	version	of	the	Medical	Directory	is	accessible	to	the	public	on	the	College’s	website	at		 	
www.cpsbc.ca.
   College of Physicians and     Telephone         604-733-7758
Surgeons of British Columbia     Toll free         1-800-461-3008
       400 – 858 Beatty Street   Facsimile         604-733-3503
      Vancouver, BC V6B 1C1      College Library   604-733-6671

                                 www.cpsbc.ca

								
To top