Messenger October Issue Liposuction

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    The Mes                  hysicia
                                    ns and
                                           Surgeons of

                  Collge of P

 In This Issue

CPSA                     1
A Successful             1
1997 Symposium
Accreditation            2
Programs Extended
Suicidal Behaviors       2
Council Election         2
Standards                3
for Liposuction
Lasers                   3
-Request for Feedback-
Renew                    4
Your License
HIPA                     4
Pre-Authorized           5
Payment Plan
Discipline               7
Letters To The           8
Medicine and the Law:    9
Did You Know?
New Assistant            9

                             October 1997              Issue 57
                      COUNCIL OF THE COLLEGE (1997)

                                President - Dr. (Betty) Flagler
                            Vice President - Dr. Doug A. Urness
                        Executive Member-at-large - Ms. Linda Hohol

Council Members are available throughout Alberta to answer questions and discuss current issues.

         DISTRICT               COUNCILOR                    PHONE            FAX

         Calgary               Sheila M. Malm                220-7990         283-8524
                               “Betty” A. Flagler            282-8664         289-6677
                               Walter B. Blahey              266-1246         233-9278
                               John S. Bradley               233-8330         263-6547

         Camrose               “Kam” Gangopadhyay            352-2511         352-7599

         Edmonton              Trevor W. Theman              484-1122         489-4121
                               Eugene M. Kretzul             484-8474         489-3836
                               “Chuck” H. Harley             944-2706         425-4179
                               Bonnie L. Abel                413-5735         420-0989

         Lethbridge            Joe Hope                      328-2326         327-0123
                               R. Sebastian David            553-3351         553-4549

         Medicine Hat          Michael L. Gammon             362-5501         362-8426

         Northeastern          Lyle Mittelsteadt             998-7757         998-0636
                               Harvey E. Albrecht            458-8400         458-8402

         Northwestern          Gary S. Nelson                778-2224         778-2127

         Red Deer              Doug A. Urness                783-7663         783-7730
                               Gerry A. Miller               227-3356          227-2702

         University Representatives
                               Lorne Tyrrell, Dean           492-9728         492-7303
                               D. Grant Gall, Dean           220-6842         270-1828
         Public Members
                               Mrs. Carol A. Kraychy         258-2508          258-2528
                               Ms. Linda M. Hohol            (416) 980-3010   (416) 980-5712
                               Dr. W. John McDonald          492-3354         492-3408

                                    THE MESSENGER
                            An official publication of the College of
                             Physicians and Surgeons of Alberta

                                        900 Manulife Place
                                         10180-101 Street
                                        Edmonton, Alberta
                                         Canada T5J 4P8

                              Next Publication: December 1997
                           Comments or Questions regarding The Messenger
                                        can be directed to:
                                          Lorie J. Webb
                                    Communications Assistant
                                         (403) 423-4764                                   The Messenger, Issue 57
   The following individuals were recognized for their outstanding achievements and contributions to the medical profession.
   Awards were presented by Dr. Ohlhauser and Dr. Flagler at the October 4th CPSA Symposium.
   Congratulations to all recipients.                                                                                                                 R
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               Council d profe

                                   A Succ sium
                                  1997 Sympo
   Physicians from across Alberta heard a report from Dr. Betty Flagler on Council’s activities, and took part in three educational
   sessions at the College’s 1997 Symposium . Topics included:
                                                Dr. Richard Irons, “Dealing with Difficult People”
                                       Dr. Harry Hodes, “First Nations Issues in Chronic Pain Management”
                                           Dr. Neil Hagen, “Management of Chronic Pain: New Insights”
   Cassette recordings of these scientific portions are available at cost (approximately $10/tape). Contact Lorie Webb at the College
   office to place an order.

   A special thank you to all who completed the event’s evaluation form. This feedback will help plan the College’s
   1998 Symposium.

       The Messenger, Issue 57
                Accre ditation d
              Programs E

          Alberta Health and the CPSA have agreed by contract to extend the College’s accreditation program to include
          hospital-based pulmonary function testing and clinical neurophysiology testing.

          Advisory Committees from both areas have modified related Guidelines & Standards and are interested in your

          Those individuals directly affected by the accreditation standards are asked to respond or forward comments by
          November 21, 1997. This enables the Committees to consider all comments before the final document is
          presented to Council.

          To receive a copy of the proposed Guidelines & Standards, please contact Ms. Tammy Pahl (Neurophysiology) at
          970-6243 or Ms. Melony Stewart (Pulmonary) at 970-6232.

          These documents are also available under “What’s New” on the CPSA web site:

                        ent                                                                date
             viors Docum                                                      l Election Up
Suicidal Beha                                                           Counci

     Suicide is a leading cause of death in Alberta,                          Ballot packages for the 1998 Council Election
     and accounts for a significant number of                                 will be in the mail on October 30, 1997.
     complaints reviewed by the College. To                                   Ballots must be received by the College
     heighten awareness and assist physicians in                              before the closing date of
     dealing with this important social and health                            November 28, 1997.
     care issue, Council approved distribution of
     Suicidal Behaviors at its October meeting.                               Successful candidates will be announced in
     Intended for use by the profession and the                               the January issue of The Messenger.
     public, this booklet is now being printed and
     will be available for distribution in the near

                                                                                                    The Messenger, Issue 57
                            Sta ndards
                          for Lipo

        Recent developments in liposuction, particularly in the tumescent technique have:

                          • decreased medical risks
                          • now permit more extensive procedures without general anaesthesia
        Consequently, liposuction has become one of the most common cosmetic procedures performed in North America.
        As there is no consensus in North America on standards for training and performance of liposuction, the College is
        currently developing standards for Alberta.

        Physicians wanting to contribute to the development of this process can write to Dr. Bryan Ward at the College.

                     Lasers back-
                         r Feed
              -Request fo

         The College has heard concerns that some physicians using lasers in their practices are not sufficiently trained in
         the specialty for which they use lasers. Of particular concern are making the appropriate diagnosis before treatment,
         and the appropriate management of complications of laser surgery.

         The College’s existing policy on “laser surgery” requires that a physician be recognized by the College in the
         discipline in which he/she wishes to use a laser. In addition, formal instruction must be complete in the following:

                  •   basic laser physics
                  •   laser safety
                  •   effects of lasers on tissues in the particular discipline
                  •   laser surgical principles involved in the particular discipline

         Dr. Bryan Ward is conducting a review of the College’s current laser surgery policy and welcomes any
         feedback or comments on whether changes are necessary.

The Messenger, Issue 57
                          your License

    Don’t forget! The deadline for renewing licenses is December 1, 1997. Notices are in the mail. Physicians practising
    in Alberta will also receive a Registration Information Form. Completion of this Form is required by the Medical
    Profession Act when renewing licenses.

    With countless end-of-year festivities, winter vacations, not to mention a potential postal strike, the College is
    strongly encouraging all physicians to enroll in its Pre-Authorized Payment Plan. This will eliminate unnecessary
    late payments and subsequent fines.

    This issue of The Messenger contains one last application form for your convenience. There are no fees with the PAP
    plan and your licensure payment will automatically be withdrawn from you account on December 1st each year.
    Completed forms must be returned to the College office, along with a VOID cheque no later than
    November 14, 1997. If your form is not in by November 14, the College cannot set you up in time for automatic
    withdrawal of the 1998 fee.

    Further questions on the Pre-Authorized Payment Plan option can be directed to the College’s Registration
    Department at (403) 423-4764 or 1-800-320-8624.

    Note: In the event of a postal strike, physicians not enrolled in the PAP are asked to contact their nearest
    medical delivery service:
                    Edmonton, Sherwood Park, St. Albert                  Calgary
                       Medical Delivery Systems Inc.                    Trans-Med
                              (403) 454-8989                          (403) 235-4777
    For other locations, please contact your local courier service.

                               HIPA Feedback
    Thank you for responding to the Health Information Protection Act featured in Issue 55 of The Messen-

    Physician and public responses were collated and presented to Council at their October 3rd meeting.
    Council is preparing a final report and will be presenting it to the Minister of Health at the end of this

    The College received a wide variety of comments and suggestions concerning the proposed bill. The only
    widespread theme appeared to be concern for the logistics of meeting Bill requirements in a busy clinical
4                                                                                                   The Messenger, Issue 57
                Pre-Authorized Payment (PAP) Authorization
                   for Business Pre-Authorized Debit Plan

 I hereby authorize the College of Physicians and Surgeons of Alberta (payee) to debit my account (as
 identified by the attached voided cheque) for the annual College re-licensure fee. This debit shall take
 place during the month of December each year, for the fee applicable for the following calendar year.

 I further authorize increases to this amount, as may be established by the Council of the College.

 This authorization may be cancelled at any time upon written notice to the College. Any delivery of this
 authorization to the College constitutes delivery by me.

 Name (Payor) print or type:

 College Registration Number:

 (see note 1)


 (1) For a joint account, if more than one signature is required, all signatories must sign this

 (2) A sample cheque of the account, marked VOID, must be enclosed with this authorization.

 (3) If this account is closed, it is the responsibility of the physician to notify the College immediately of
     alternative arrangements for payment of the annual fee.
The Messenger, Issue 57
      Authorization for Business Pre-Authorized Debit Plan
                      Terms & Conditions
1.   In this Authorization “we”, “us” and “our” refers to the Payor indicated on the reverse hereof.

2.   We agree to participate in this Business Pre-Authorized Debit Plan and we authorize the College of Physicians and Surgeons of Alberta
     (the “Payee”) indicated on the reverse hereof and any successor or assign of the Payee to draw a debit in paper, electronic or other form
     for the purpose of making payment for goods or services related to our commercial activities (a “Business PAD”) on our account
     indicated on our attached void cheque (the “Account”) at the financial institution indicated on our attached void cheque (the “Financial
     Institution”) and we authorize the Financial Institution to honor and pay such debits. This Authorization is provided for the benefit of
     the Payee and our Financial Institution and is provided in consideration of our Financial Institution agreeing to process debits against
     our Account in accordance with the Rules of the Canadian Payments Association. We agree that any direction we may provide to draw a
     Business PAD, and any Business PAD drawn in accordance with this Authorization, shall be binding on us as if signed by us, and, in the
     case of paper debits, as if they were cheques signed by us.

3.   We may revoke this Authorization at any time by delivering a written notice of revocation to the Payee. This Authorization applies only
     to the method of payment and we agree that revocation of this Authorization does not terminate or otherwise have any bearing on any
     contract that exists between us and the Payee.

4.   We agree that our Financial Institution is not required to verify that any Business PAD has been drawn in accordance with this Authori-
     zation, including the amount, frequency and fulfillment of any purpose of any Business PAD.

5.   We agree that delivery of this Authorization to the Payee constitutes delivery by us to our Financial Institution. We agree that the Payee
     may deliver this Authorization to the Payee’s financial institution and agree to the disclosure of any information which may be contained
     in this Authorization to such financial institution.

6.   We agree to either waive the requirement of receiving written notice from the Payee of the amount to be debited and the due date(s) of
     debiting, or to abide by any modification to the requirement as agreed to with the Payee.

7.   We may dispute a Business PAD by providing a signed declaration to our Financial Institution under the following conditions:

          (a)       the Business PAD was not drawn in accordance with this Authorization;
          (b)       this Authorization was revoked; or
          (c)       any pre-notification required and not waived by section 6 was not received by us.

     We acknowledge that, in order to obtain reimbursement from our Financial Institution for the amount of a disputed Business PAD, we
     must sign a declaration to the effect that either (a), (b) or (c) above took place and present it to our Financial Institution up to and
     including but not later than ten (10) business days after the date on which the disputed Business PAD was posted to the Account. We
     acknowledge that, after this ten (10) business day period, we shall resolve any dispute regarding a Business PAD solely with the Payee,
     and that our Financial Institution shall have no liability to us respecting any such Business PAD.

8.   We certify that all information provided with respect to the Account is accurate and we agree to inform the Payee, in writing, of any
     change in the Account information provided in the Authorization at least ten (10) business days prior to the next due date of a Business
     PAD. In the event of any such change, this Authorization shall continue in respect of any new account to be used for Business PADs.

9.   We warrant and guarantee that all persons whose signatures are required to sign on the Account have signed this Authorization on the
     reverse hereof.

10. We understand and agree to the foregoing terms and conditions.

11. We agree to comply with the Rules of the Canadian Payments Association, or any other rules or regulations which may affect the
    services described herein, as may be introduced in the future or are currently in effect and we agree to execute any further documentation
    which may be prescribed from time to time by the Canadian Payments Association in respect of the services described herein.

                                    Please complete sections on other side of this page.
                                                                                                                 The Messenger, Issue 57
                                  D isciplin
                                   R  eports
                                                       Dr. ‘F97’
On March 20, 1997 the Council of the College of Physicians and Surgeons of Alberta found Dr. ‘F97’ guilty of demonstrating a lack
of skill or judgment in that:

1) upon his patient presenting on a second occasion at the outpatient department of the hospital in the early morning hours of the
   11th day of April, 1995 with complaints of continuing pain and with noted shortness of breath and sweating, he failed to arrange
   to attend and re-examine his patient;
2) upon receiving a telephone call from his patient’s wife at about noon hour on the 11th day of April, 1995 advising that the
   patient’s condition was not improving, he failed to have the patient re-attend with him for further examination.

The President of Council issued the following reprimand to Dr. ‘F97’.

“Dr. ‘F97’, will you please stand.

“Dr. ‘F97’, you have been found guilty of demonstrating a lack of skill and judgment in the care of your patient. I have been
instructed, as the President of Council, to give you a reprimand.

“The differential diagnosis to be considered when a middle-aged man presents to a physician with sudden onset of chest pain
necessarily includes several serious and life-threatening conditions.

“Although you were led to believe that, in this instance, a muscle strain and spasm explained the pain clearly, as an experienced
clinician, you should have reconsidered the etiology of the pain when you were notified on two further occasions that the pain
was worsening.

“I imagine that you would have done so, if only you had made arrangements to repeat your clinical examination of this patient.

“Instead, you fell into the pitfall of prescribing parenteral narcotics, over the phone, without re-assessing your patient, nor did
you make arrangements for further evaluation by clinical or laboratory means.

“Unfortunately, this contributed to a significant delay in the diagnosis of a serious pneumonia. Fortunately, the patient sur-

“Although it is increasingly challenging for physicians to provide quality care in the face of bed and staff shortages, it remains
their responsibility to do so. If hospital beds are unavailable for observation of such patients, other arrangements for repeat
evaluation and follow-up must be made.

“I hope that you have learned from the unfortunate event, and that you will carefully reconsider all of your medical practices in
light of it. We can all make mistakes … but such mistakes are harder to accept when they happen because of failure to follow
basic, good clinical principles.
“You are dismissed.”

Dr. ‘F97’ was assessed the costs of the Investigation and hearing in the amount of $9,129.99 payable within 30 days of the final
order of the Council. The costs were paid.

 The Messenger, Issue 57                                                                                                   7
                                               Di scipline
                                                R  eports
                                                                        Dr. ‘G97’
            Dr. ‘G97’ was charged with unbecoming conduct, professional or otherwise, in that,
                                  between the 5th day of December, 1985 and the 2nd day of May, 1987
                                  he entered a sexual relationship with an adult female patient in his care.

            On March 20, 1997, Council ordered that the allegation in the Notice to Practitioner be dismissed on the basis of the
            evidence presented.

            The President of Council extended Council’s gratitude to Dr. ‘G97’ for his forbearance and co-operation in this very
            difficult situation.

                                                o The
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If you have a message for the profession or want to express an opinion, write a Letter to the Editor. Please include a first name or two initials with surname, and include a
                                                      daytime telephone number. All letters are subject to editing.

                                                    E-Mail:                   Mail: Letters to the Editor
                                                   Subject: Letters to the Editor               Attention: Lorie Webb
        8                                                                                                                             The Messenger, Issue 57
                               he Law
                        e and t ..?
                 Medicin u Know.
                   Did Yo
                                                               -prepared by Bryan & Company, Barristers and Solicitors-

             Most practitioners rely heavily on their office staff to deal with patient inquiries and on many occasions to
             provide advice relating to those inquiries. It is a fact of life in a busy medical practice that the telephone can
             be an enemy of time-lines and patient care.

             It is a further fact of life that communication between two persons who are not medically trained can lose
             something of importance in the exchange. In other words, what did your employee understand from the
             patient’s inquiry? More importantly, what did you understand from the employee’s description of the

             You must appreciate that when you delegate to your employee the task of responding to patient inquiries you
             are professionally responsible for such advice.

             Do you presently:

                 •        Have your employee prepare a note of the conversation and attach it to the patient’s chart?

                 •        Review the notes with your employee prior to the closing of your office each day?
                 •        Telephone and review the matter with the patient as soon as possible?
                 •        Record that call and its general content on the chart?

             Remember the patient who is a consistent caller to your office may, just this once, have good cause and
             require your immediate professional attention.

                                   New As ar
                                     R egistr
Congratulations to Dr. Trevor Theman, the College’s new Assistant Registrar.

Dr. Theman is a specialist in general surgery currently practising in Edmonton. He has
been an active member of the Council for the last six years, serving as President of the
College Council in 1995 and 1996.

Dr. Theman will assume his position and role as complaints director early in the New

  The Messenger, Issue 57
       S & Health Care Expo ‘97
Come Join TELUS October 28th and 29th at the Edmonton Convention Centre for
                                          Health Care Expo ’97
This is a fantastic opportunity to view many of the products and services TELUS has developed in conjunction with
members of the health care industry. Many of these products and services are now available for use in every-day health
care applications.

For further information on Health Care Expo ’97, visit

Hope to see you there!

                 This advertisement is published to acknowledge the support TELUS provides the College’s
                                              Triplicate Prescription Program.

                       e Messenger

   900 Manulife Place, 10180-101 Street                                                        00919098 99
   Edmonton, Alberta, Canada T5J 4P8                                                            The Messenger, Issue 57

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