May Messenger 2020

Table of contents

Medical Matters

Thank you from the CPSA Public Member Councillors

CPSA Council Election to go ahead in 2020

Immigration Medical Examinations during COVID-19

Antibiotic Prescription Atlas 2018 now available!

Reporting health conditions during postgraduate annual renewal

From AHS: COVID-19 asymptomatic transmission and healthcare worker risk

Professional Conduct reports

Optimized Prescribing with Seniors

CPSA Council Election to go ahead in 2020

In times of uncertainty, moving forward with set governance policies and processes, like Council elections, becomes critical to ensure we have a high functioning board that can meet its mandate and be accountable to Albertans. This is why we’ve decided to go ahead with the 2020 CPSA Council election to fill three physician vacancies. We understand a lot is going on right now for you, but we’ll make sure the elections process is efficient.

Please mark these key dates in your calendar. We’ll share more information in the months ahead and look forward to a successful election.

Immigration Medical Examinations during COVID-19

Panel physicians play an important role in the immigration process. They help protect the health of Canadians by doing Immigration Medical Examinations (IMEs).

The Government of Canada considers IMEs an essential service.

CPSA supports all Alberta panel physicians completing IMEs within the mandated 90-day window during COVID-19, so long as physicians are comfortable and able to take appropriate precautions to protect themselves, patients and other healthcare workers.

Learn more about IMEs and the role of panel physicians.

Antibiotic Prescription Atlas 2018 now available!

By adding reporting on Alberta’s antibiotic use to its repertoire, TPP Alberta is playing its part in the fight against antimicrobial resistance. TPP Alberta’s first-ever Antibiotic Prescription Atlas uses Pharmaceutical Information Network (PIN) dispense data to show antibiotic prescribing practices and utilization trends in the community.

During 2017 and 2018, there was an average of 2.5 million antibiotic prescriptions dispensed to 1.4 million unique patients in Alberta. Amoxicillin was the most commonly-used antibiotic for each report year, followed by Azithromycin, Cephalexin and Amoxi-Clav. Among the most commonly-prescribed antibiotics, while most patients received only one prescription, over 10% or more were dispensed two or more prescriptions for the same antibiotic in a year. Of known prescribers, 82.8% were physicians.

CPSA’s Antimicrobial Working Group, a multi-stakeholder interdisciplinary group, provided valuable input for the development of the TPP Alberta Antimicrobial Prescribing Atlas.

Questions or comments? We welcome your feedback! Email us at TPPinfo@cpsa.ab.ca.

Reporting health conditions during postgraduate annual renewal

Renewal for postgraduate trainees opened May 4. Besides providing up-to-date contact and practice information, annual renewal is an opportunity to reflect on your own personal health over the last year. This includes reporting any health conditions that have negatively impacted your practice (or could be reasonably likely to in the future).

We understand this can cause some anxiety, but we want to assure you our aim is simply to ensure you are managing your health condition appropriately, and that you’re able to take care of yourself-and your patients.

Do we have the best email to reach you?

Update your information by sending us an email or by logging into the Physician Portal-while you’re there, please take a moment to update your work status in the COVID-19 Physician Registry.

What happens when you report a health condition?

When you reply “yes” to one of the health questions on the renewal form, the Assistant Registrar from our Physician Health Monitoring Program (PHMP) will connect with you to better understand your unique situation. Our approach is customized with a focus on your health condition and work environment.

Sometimes, no further action is necessary or, with your consent, we may ask for information from your treating practitioners. Only rarely do we ask residents to take a leave. Leaves are usually temporary with residents returning once their health is stable and their treating physician confirms they can continue training safely.

Questions? Please connect with our PHMP team or learn more about PHMP and self-reporting on our website.

From AHS: COVID-19 asymptomatic transmission and healthcare worker risk

AHS’ COVID-19 Scientific Advisory Group (SAG) recently investigated the latest evidence from around the world pertaining to two key topics:

Priority Groups for Asymptomatic Screening

As SARS-CoV-2 (COVID-19) cases increase and efforts to expand capacity of testing in Alberta continue, it is essential to determine which patient groups the additional testing capacity should be directed to, and ensure this is based on best evidence to slow the pandemic. It is biologically plausible that COVID-19 can be transmitted by patients that are asymptomatic, presymptomatic and/or presenting with atypical symptoms. However, the extent of transmission from asymptomatic cases remains unknown with wide estimates in the literature. If asymptomatic patient groups are screened, questions remain, including when to swab, what site, how frequently and how to make this a sustainable practice. After considering all of the data, the Scientific Advisory Group suggested that, subject to lab capacity, strongest consideration of testing of asymptomatic people be given to test the following groups (in priority order):

• Asymptomatic residents and staff in Long Term Care/Supportive Living in the context of an outbreak.
• Asymptomatic staff in high-risk work conditions, as well as household contacts of cases, in the context of an outbreak, cluster or several linked cases under public health review.
• Asymptomatic residents and staff in homeless shelters and similar agencies in the context of an outbreak, cluster or several linked cases under public health review.

At this time, routine testing of asymptomatic individuals in other populations is not recommended.

Healthcare Worker (HCW) Risk of COVID-19 in Alberta

Healthcare workers are concerned about their risk of developing SARS-CoV-2. Media reporting has highlighted the risks for HCW in other jurisdictions like Italy and New York, but getting risk information from the media is inherently biased as HCW cases are preferentially reported and this may drive physician anxiety. In this updated review, the Scientific Advisory Group worked with AHS Workplace Health and Safety (WHS) who have been tracking Alberta HCW data on SARS-CoV-2 to provide transparent information on HCW risks internationally and within Alberta.

Statistics from WHS indicate that the current proportion of AHS HCWs who developed SARS-CoV-2 from occupational exposure is 0.01%, with an overall HCW risk of 0.14% (the remainder being acquired in the community, based on detailed case investigation). This is compared with the overall current 0.1% infection rate in the community in Alberta and may also be influenced by fivefold higher testing rates in HCW. In other words, the majority of cases of COVID-19 infection in HCWs have arisen from non-occupational exposure to date. In contrast, in the SAG analysis, in exemplar countries where the healthcare system was overwhelmed by COVID-19, the increased risk to HCW of documented COVID-19 infection was 2.7% above the general population risk.

As personal protective equipment (PPE) is also a hot topic, it is important to note that there has been no evidence of aerosol generating medical procedures (AGMPs) as a cause for COVID-19 HCW infection on any of the four Calgary “Designated COVID-19” acute care wards, using the standard recommended precautions (gowns, gloves, medical masks, and face shield or goggles in routine care and the addition of N95 respirator for any AGMPs.)

These results all support that the current measures recommended to protect HCW are effective, and that in an Albertan context, current risk of documented COVID-19 in HCW using recommended precautions is lower than community based risk.

To see the complete list of Rapid Response Reports, please check the COVID-19 Scientific Advisory Group website. New reports and updates appear here on a daily basis.

Professional Conduct reports

Physician unsuccessfully appeals disciplinary decision to Alberta Court of Appeal

Grande Prairie orthopedic surgeon Dr. Mohammed Al-Ghamdi was previously found guilty of disruptive conduct and sanctioned by a CPSA hearing tribunal. He appealed to a CPSA Council Review Panel, where the decision was upheld. He then appealed to the Alberta Court of Appeal, where his appeal was dismissed.

Background

In 2017, Dr. Al-Ghamdi was found guilty of eight counts of disruptive conduct towards his colleagues at Grande Prairie’s Queen Elizabeth II Hospital. This conduct included:

• Failing to follow on-call schedules and claiming to have a schedule of his own.
• Failing to cooperate with colleagues to ensure surgical cases were performed based on the need for urgent care.
• Threatening legal action and making repeated complaints to hospital administration and the health authority about his colleagues.
• Failing to follow the hospital’s issue/dispute resolution processes.
• Having nursing staff open sterilized packs of surgical instruments not reasonably required, making them unavailable.

Dr. Al-Ghamdi’s practice permit was suspended by the tribunal for three years, pending a fitness-to-practice assessment and the completion of any required remediation to the satisfaction of the Registrar. At that point, after a minimum of two years, he could request reinstatement of his practice permit. He was also ordered to pay a portion of costs associated with the investigation and hearings.

Dr. Al-Ghamdi appealed the decision to a CPSA Council Review Panel in 2018 and to the Alberta Court of Appeal in 2020, who both upheld the original decision. Dr. Al-Ghamdi’s practice permit was cancelled in February 2019 for failing to complete his annual registration requirements.

Commentary

While the Alberta Court of Appeals felt the CPSA hearing tribunal and Council Review Panel improperly relied on certain evidence, this was not enough to overturn the ruling and sanctions against Dr. Al-Ghamdi. Disruption in any workplace is not acceptable, particularly in medicine, where a functional team approach is key to the safe and responsible delivery of patient care.

Edmonton dermatologist reprimanded by CPSA

Dr. Barry Lycka (also known as Dr. Barry Allen Lycka or Dr. Allen Lycka), a dermatologist from Edmonton, was sanctioned by a CPSA hearing tribunal, after he was found guilty of unprofessional conduct in 2019.

Background

In 2017, a patient of Dr. Lycka’s asked about Dysport (botulinum toxin A) injections as a treatment for bruxism (teeth grinding). Dr. Lycka agreed to the treatment and administered the injections after quickly palpitating the patient’s jaw. Within a few days, the patient began experiencing complications, including pain in her face and down her arm, which worsened to the point where she sought treatment at the emergency room. At a follow-up appointment with Dr. Lycka, a demand was made of the patient, to sign a letter confirming she would not complain about her experience to CPSA. In exchange, the patient would receive a refund for the Dysport injections.

The hearing tribunal found that Dr. Lycka displayed a lack of skill and judgement when he failed to fully discuss the risks and benefits of the treatment with the patient, did not create a clinical record of having obtained informed consent for the procedure and attempted to prevent the patient from filing a complaint. They ordered the following sanctions:

1. Lycka received a reprimand.
2. If CPSA’s Physician Health Monitoring Program finds Dr. Lycka fit to continue practising medicine, his practice permit is suspended for two months.
3. Lycka is responsible for paying 85 per cent of the costs associated with the investigation and hearing (totalling $39,196.40).

Dr. Lycka’s registration with CPSA remains active but he has withdrawn from practice.

Commentary

The hearing tribunal found that Dr. Lycka’s conduct was a breach of the Canadian Medical Association’s Code of Ethics (the Code that was in force at the time of Dr. Lycka’s offense), the predecessor to the current Code of Ethics & Professionalism. The attempt to compel a patient to give up their right to complain especially undermines the medical professions ability to self-regulate, as physicians need to be held to account if they fail to meet their responsibility to provide good care to their patients.

Edmonton physician guilty of failing to respond to CPSA

A CPSA hearing tribunal found Dr. Kevin Mowbrey, a physician from Edmonton, guilty of unprofessional conduct after he repeatedly failed to respond to correspondence from CPSA.

Background

In 2019, staff from CPSA’s Professional Conduct department made several attempts to communicate with Dr. Mowbrey, by mail and email, about an inquiry into his conduct. Dr. Mowbrey failed to respond in a timely matter or at all, which conflicts with a physician’s duty to cooperate with their regulator as required by the Health Professions Act. After many failed attempts at contact, CPSA’s Complaints Director initiated a complaint against Dr. Mowbrey.

Dr. Mowbrey admitted to the charges against him to the hearing tribunal and was found guilty of unprofessional conduct. Sanctions will be determined at a later date. Dr. Mowbrey is not currently in practice.

Commentary

Any member of a self-regulated profession has a duty to cooperate and communicate with their regulator. Failing to do so not only goes against what is required under the HPA, it also undermines the integrity of the profession and can lead to a loss of trust from the public we are here to protect.