Government tables new Medical Act to increase accountability and public protection

Proposed new legislation to govern the practice of medicine in the province will increase public protection and strengthen the authority and accountability of the Newfoundland Medical Board (NMB) with respect to doctors who practice medicine in the province, acting Minister of Health and Community Services Loyola Sullivan announced today.

�Changes to the existing Medical Act reflect government and the board�s commitment to ensure that adequate safeguards are in place to protect the public interest in the regulation of the province�s medical practitioners,� said Minister Sullivan. �The proposed legislation would create a disciplinary process that inspires confidence and is fair and accountable to patients, physicians, the board and general public.�

Features of the proposed legislation stem primarily from the recommendations of the OxyContin Task Force report released in August 2004, as well as consultations with the NMB, the self-regulating body for the province�s medical profession, over the last several months.

The OxyContin Task Force concluded that other equivalent legislation governing self-regulating professions in Canada had a more comprehensive discipline section than that contained in the province�s Medical Act. It recommended amendments to the Act including: definition of �reasonable cause� to begin an investigation; outline the board�s responsibility to act on complaints; specify rights of complainants; mandate a physician�s duty to report; outline authority of the board to copy medical records and documents related to investigations; stipulate time frames and require the board submit an annual report to the minister.

Under the proposed Medical Act 2005, the NMB would be re-named and continue as the College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL), a title consistent with the majority of medical licensing authorities in Canada.

The proposed legislation would establish new disciplinary procedures and governance structures within the medical licensing body including the creation of a Complaint Authorization Committee (CAC) to initially review all allegations of conduct that could be subject to sanction or discipline, unlike the current system where the registrar determines the course of action in response to an allegation. In addition, allegations referred for hearings would proceed to a new disciplinary panel independent of the CPSNL and the CAC. Discipline hearings would also be open to the public in most cases.

The new disciplinary process parallels the system for other self-governing professions in the province such as pharmacists and lawyers.

The proposed legislation would also require physicians to report any �conduct deserving sanction� of their peers, including professional misconduct, incompetence, incapacity, unfitness or breach of a physician�s Code of Ethics.

Other key highlights include a requirement of the CPSNL to submit an annual report to the minister; mandatory use by physicians of a tamper-resistant prescription pad for the prescribing of all narcotics and an extension of the existing right held by practicing physicians to incorporate to provisionally licensed physicians.

The proposed Medical Act 2005 represents the most substantive changes to the legislation in over 30 years and repeals the existing Act. Minister Sullivan noted that government will continue to work with the CPSNL to ensure this statute remains current and responds to changes in the working environment of the province�s physicians.

�The proposed changes to the Medical Act represent significant improvements in the effectiveness and accountability of what will become the College of Physicians and Surgeons of Newfoundland and Labrador,� said NMB registrar Dr. Robert Young. �The proposed new discipline process will give the college a better ability to investigate and resolve issues such as the ones discussed by the OxyContin Task Force.�

Dr. Young said the new Medical Act brings the province in line with other jurisdictions in Canada. �The board welcomes government�s commitment that the new Medical Act is a living document which will be updated regularly.�

This proposed legislation is part of the government�s comprehensive response to fight the abuse and misuse of OxyContin and other prescription drugs. Budget 2005 allocated $1.7 million to implement key recommendations of the Task Force, including a new methadone maintenance program and medical de-tox service in St. John�s, more addictions counsellors, four new detoxification beds at the Humberwood Treatment program in Corner Brook, a methadone-training program for physicians and an adolescent day treatment program at the Recovery Centre in Pleasantville. Government also confirmed an investment in a provincial pharmacy network to make medication histories available on-line to attending physicians and pharmacists.

Once passed in the House of Assembly, the Medical Act 2005 will take effect on July 1, 2005.

Media contact: Carolyn Chaplin, Health and Community Services, (709)729-1377, 682-5093

BACKGROUNDER
Medical Act 2005 to increase accountability, public protection

Government is increasing public protection with a proposed Medical Act 2005 that would strengthen the authority and accountability of the Newfoundland Medical Board (NMB) in regulating the practice of medicine in the province.

The proposed legislation would repeal the existing Medical Act and, if passed, take effect on July 1, 2005. The new Medical Act improves the accountability and effectiveness of the province�s medical regulatory authority through changes in governance and the disciplinary process. The new disciplinary process will now be consistent with the process adopted by other self-governing professions in the province.

Governance
Under the new Medical Act, the Newfoundland Medical Board will continue as the College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL), a name consistent with the majority of medical licensing authorities in Canada. The college system emphasizes the responsibility of physicians for self-governance as members of the college in contrast to the current system, in which physicians are licensed by a 12-person board.

CPSNL will be governed by a council comprising:

• Seven (7) members elected by physicians licensed to practice medicine in Newfoundland and Labrador;
• Four (4) members appointed by the minister, at least three of whom must not be medical practitioners and one of whom is selected from nominations made by Memorial University�s Board of Regents; and,
• Two (2) members, appointed by the minister, who are medical practitioners, taken from a list submitted by the Newfoundland and Labrador Medical Association.

Discipline
The proposed legislation would establish a new complaints process and disciplinary model involving a physician�s conduct in the practice of medicine. The new disciplinary model would be consistent with best practices across the country and in keeping with other self-regulating professions.

The proposed legislation contains provisions for a graduated disciplinary process including provisions for the registrar, with the consent of all parties, to settle complaints without engaging the formal complaint process using alternate dispute resolution (e.g. mediation).

Highlights of the new complaints process:

• All allegations brought to the college by patients or other individuals alleging that the conduct of a physician may deserve sanction would be investigated, provided they are made in writing. Allegations may also be lodged by the CPSNL registrar.
• Allegations that can�t be resolved with the consent of the parties would be reviewed by a Complaints Authorization Committee (CAC) consisting of three council members; two (2) of whom are physicians and one (1) of whom is not a medical practitioner. The registrar is not a member of the CAC.
• The CAC will have several options in addressing complaints: it may dismiss an allegation, refer it for further investigation, counsel or caution the physician or refer the matter to a hearing before an adjudication tribunal.
• If the CAC determines that an allegation requires further investigation, the CAC would have the full powers of a commissioner under the Public Inquiries Act. This means the CAC may summon witnesses and require the production of documents necessary to fully investigate the matter.
• Once an allegation is referred for a hearing, it formally becomes a complaint.
• The Act would establish a disciplinary panel, a new body independent of the council. The panel comprises 15 members including ten (10) medical practitioners, appointed by the CPSNL Council; and five (5) persons who are not medical practitioners, appointed by the minister.
  � The adjudication tribunal hearing complaints referred by the CAC would consist of three members (two physicians and one non-medical practitioner) of the disciplinary panel.
• Hearings before the adjudication tribunal will be held in public.
• A complainant has the right to appeal to the Trial Division of the Supreme Court if the CAC dismisses a complaint.
• Decisions of an adjudication tribunal can be appealed to the Trial Division of the Supreme Court by either the CPSNL or the respondent.

Greater Accountability

• The CPSNL would have the regulatory authority to prescribe time limits for dealing with each stage of the complaint process. If the college does not enact regulations imposing time limits within a reasonable time, the minister would also have the authority to do so.
• The CPSNL would be required to submit an annual report to the minister before July 1 each year.
• The CPSNL will hold an annual meeting which may be attended by all licensed medical practitioners in the province to review annual financial statements, appoint auditors and address other matters as established in the college by-laws.
• Discipline hearings will be held in public, with prior notification of the date and place of the hearing.
• The legislation proposes that a summary of discipline findings will be published in a newspaper of general circulation and/or a local newspaper within 14 days of the finding being issued in cases where a physician�s license is suspended, required to be surrendered, or when restrictions or conditions are placed on continued practice.

2005 05 16                          12:10 p.m.