International Briefs

Progress to date

The legislation has now been passed but must come into operation before the Board can begin performance assessments. The Board and the Australian Medical Association (Victoria) have formed a working group to develop policies and procedures for the performance pathway that would be acceptable to the medical profession. The Board is also consulting with the colleges and has invited comments from all medical practitioners in previous editions of the Bulletin and on the Web site.

Principles underpinning the performance pathway

The performance pathway aims to protect the community from doctors’ poor performance while supporting the profession to maintain high standards. The pathway is being designed to be a flexible process that facilitates negotiation with the doctor concerned. The Board will be promoting as much autonomy as possible and will help doctors find a way of dealing with the unsatisfactory performance. Ideally this will remove the need for the Board to institute more formal procedures.

As a guiding principle the Board will support early detection of performance issues and their voluntary remediation. These should be addressed before patients are harmed and before the practitioner is exposed to the potential for litigation. In a supportive environment, any problems will be identified and corrected locally and the Board need not become involved at all.

When a performance assessment is required, it will focus on identifying the individual’s performance problems and any systemic issues that have contributed to his or her unsatisfactory performance. Systemic factors are often found to play an important role in the performance of individuals and addressing these may have a positive impact on all the health care professionals working in that environment.

When will a performance review be undertaken?

The Board intends to investigate practitioners’ performance when concerns are recurrent or when notifications indicate serious performance issues. A single poor outcome is unlikely to drive a full-scale investigation.

The Board also recognizes there are many factors that impact on a practitioner’s performance. Other jurisdictions have found that before assessing performance and attempting remediation, it is important to eliminate any health or social issues that might be causing the poor performance. For example, a practitioner suffering from depression might perform satisfactorily once the depression is treated.

The assessment process

The principles underpinning the assessment process are:

• Objectivity

• Procedural fairness

• Transparency

• Valid and reliable process

• Confidentiality of the doctor being assessed and the findings

Any practitioner undergoing a performance assessment will be assessed by two peers. The peers will be indemnified by the Board and must be acceptable to the practitioner being assessed. The Board is responsible for the cost of the assessments.

For the program to be effective, the assessment tools must be both reliable and valid. While most assessments are likely to take place at the doctor’s place of work, some specialties, such as anesthesia, might lend themselves to the use of simulators.

Where to now?

The Board and the AMA will continue to work together to develop an assessment process that is fair and acceptable. Assessment tools that are relevant to Victorian practice will be developed in consultation with the colleges, universities and other educational bodies.

The Board will also work closely with individual colleges, universities, hospitals, other education providers, clinics and potential mentors to coordinate relevant and effective remedial opportunities for doctors whose performance is unsatisfactory. Ultimately, the Board’s aim is to assist practitioners to remain in active practice while ensuring that the public is adequately protected.

Further information about the performance pathway can be found on the board’s Web site at http://www.medicalboardvic.org.au. Doctors wishing to provide feedback can do so by writing to Dr J Katsoris, GPO Box 773H, Melbourne, 3001 or at [email protected].

Responsibilities of individual medical practitioners

All medical practitioners and medical students should know their HIV, HBV and HCV antibody status. Doctors are at risk from contracting infections from their patients. They should therefore protect themselves and their patients by:

• Adhering to current infection control guidelines and protocols

• Being immunized against HBV at the earliest possible opportunity in their career and preferably before commencing clinical contact. They should ensure that they have responded by having post-vaccination testing

• Following post-exposure protocols, including seeking expert advice about early management and practice modification

Medical practitioners and medical students who carry a blood borne virus:

• Have an ethical duty to review their practice of medicine, health risks and health status. They should obtain and follow the advice of their treating specialist and must never rely on their own assessment of the risk that their condition may pose to patients

• Should not perform any exposure prone procedures if they have been infected with a blood borne virus and are viraemic. A specialist medical practitioner must ascertain whether the infected practitioner or student is viraemic, using the most sensitive tests available

• Who are not viraemic should not perform exposure prone procedures unless they have been given specific approval by their treating specialist

Responsibilities of treating medical practitioners

Medical practitioners who treat health care workers should observe the same standards of clinical practice and recordkeeping as they would when caring for any other patient.

The infected health care worker has the same rights of clinical care, counseling and confidentiality as any other patient, unless the treating doctor believes that the infected health care worker is putting the public at risk. In this case the matter must be referred to the appropriate registration body.

In caring for an infected health care worker, the treating doctor should assess and monitor the patient’s physical, emotional and cognitive status and his or her safety to practice medicine and/or maintain patient contact.

Further advice

Copies of the Board’s policy can be obtained by telephoning the Board at (03) 9655 0500 or via e-mail at [email protected]. The policy is also published on the Web at www.medicalboardvic.org.au. Practitioners who are managing doctors or students with infectious diseases can approach the office of the Chief Executive Officer of the Board if they would like help in assessing whether an infected practitioner should be practicing medicine and whether his or her practice should be limited. An expert advisory group can be convened to assess the case and provide advice.

Reprinted from the Medical Practitioners Board of Victoria Bulletin, Vol. 1, March 2003

Why is the College taking this step?

The majority of physicians have not and will not intentionally harm those in their care; however, the Council believes that, as part of its legislated mandate to regulate physicians in the public interest, its duty is to help ensure the safety of all patients.

Council acknowledges that the results of a criminal record screen are not predictive of future behavior, and they cannot guarantee the good character of a physician or whether he or she might pose a future safety risk. Nevertheless, the Council endorses the criminal record screening policy as part of its efforts to promote the safety and quality of the health care environment.

Who does this policy affect?

The College will now begin conducting criminal record screens on: all applicants for certificates of registration; those physicians applying for a transfer in certificate type; College Council members; College's senior staff members; and all members of the College staff who deal with the public. Eventually, all practicing physicians will be screened. Members' Dialogue will inform you when the College will begin this phase.

Can you do a screen without my permission?

No, a screen cannot take place until the physician authorizes the check. However, the College has recently passed a by-law that makes criminal record screening a condition of registration for new applicants.

Will I lose my license if there is a positive finding under my name?

The College will need to make decisions about positive findings on criminal record screening on a case-by-case basis.

All positive results will be reviewed. If the information was previously unknown to the College, the physician will be contacted to provide details of the criminal conviction. If necessary, further investigation will be undertaken.

Council chose not to designate certain criminal convictions as automatic grounds for disciplinary action, instead stating that it can only make a decision about the seriousness of behavior for which a physician is convicted once the details of the conduct are known. However, Council agreed that the following factors would be used to determine whether action should be taken:

• Whether the conviction occurred recently;

• Seriousness of the matter; and

• Relevance of the matter to the practice of medicine.

Council will continue to monitor and evaluate this review process over the course of the first year of implementation and will revise this policy, as necessary.

Do other medical regulatory bodies do criminal record screens?

Yes. In 1998, the British Columbia College did a criminal background screen on all physicians and now conducts screens on new applicants for medical licenses. There is a similar process now under way at the Manitoba College. In Alberta, provincial legislation requires that any physician working for a health institution must complete a criminal record screen prior to employment.

Purpose:

The purpose of this policy is to clarify the College's responsibility, as part of its fiduciary duties to the public, to conduct criminal record screening of Ontario physicians and applicants for certificates of registration to practice medicine in Ontario in order to enhance the safety of the health care environment.

Scope:

This policy will affect all Ontario physicians.

Underlying Principles:

1. The Council of the College of Physicians and Surgeons of Ontario affirms that all Ontario citizens have the right to receive and/or provide health care in a safe environment, free from intrusions or threats to their dignity or person. This right applies equally to members of the public, physicians and allied health professionals.

2. While acknowledging the fact that the majority of physicians providing health services in Ontario have not and will not intentionally harm those in their care, or with whom they provide services, the Council asserts that as part of its legislated mandate to regulate physicians in the public interest, its duty is to help ensure the safety of all participants in the health sector.

3. The Council further acknowledges that the results of a criminal record screen are not predictive of future behavior, and they can not guarantee the good character of a physician or whether he or she might pose a future safety risk. Nevertheless, the Council endorses the criminal record screening policy as part of its efforts to promote the safety and quality of the health care environment.

4. The Council supports the principles of openness and accountability. Criminal record screening provides official confirmation of information already self-reported by physicians on CPSO applications for certificates of practice, and on the annual information return. This official confirmation of current practices enhances the transparency of College processes and the accountability of the College and the profession.

Physicians:

1. As a requirement of registration and in order to maintain the right to practice medicine in Ontario, all Ontario physicians must submit to a criminal record screen.

2. The screen will be completed by running a criminal record check against the Canadian Police Information Centre (CPIC) computerized database at the time of application for a certificate of registration in the province of Ontario, or by receipt of a valid letter of clearance based on a CPIC check conducted no longer than 6 months before the date of submission of application to the Registration Committee of the College.

3. Criminal record screening is required in the following circumstances:

   1. For all applicants for a first-time certificate of registration, regardless of class of registration;

   2. For CPSO members applying for a transfer in certificate type; and

   3. For currently practicing physicians — as part of the regular practice review and revalidation process, at set intervals from such a time as the Council announces the initiation of the criminal record screening process for all currently practicing physicians.

4. Positive findings arising from the criminal record screen will be considered for further action by the College based on the following criteria;

   1. The recency of the conviction;

   2. The seriousness of the offence; and

   3. The relevance of the details of the offence to the practice of medicine.

5. The cost of conducting the criminal record screen will be borne by the applicant as part of the standard application fee set by CPSO by-law.

Reprinted from the College of Physicians and Surgeons of Ontario Web site