April Messenger 2019

Table of contents

A message from Council President, Dr. John Bradley

Are you up to Standard?

Golf tournament

TPP Alberta – two-part form update

Methadone for analgesia

CPSA communications strategy survey

Discipline reports

92nd Annual North/South Doctors’ Golf Tournament

The sun is out, the snow is melting and golf season is just around the corner. This year, make a difference in the lives of Alberta’s medical students just by playing a round of golf-join us for the 92^nd Annual North/South Doctors’ Golf Tournament, presented by TD Insurance Meloche Monnex!

This important charitable event is Alberta’s longest-running golf tournament and all proceeds and sponsorship dollars raised directly fund medical student bursaries.

This year’s tournament returns to the prestigious Red Deer Golf & Country Club on Monday, June 17, where guests will enjoy 18 holes of premium golf on the private course. Guests have a choice of stroke or scramble play and will enjoy two hot and delicious meals, excellent prizes, souvenirs, sponsor offerings and much more.

Help support the next generation of physicians by purchasing your tickets today.

We look forward to seeing you in Red Deer!

TPP Alberta – two-part form update

In response to communications about changes to TPP Alberta and the move to a two-part form, we received some great questions and feedback. Please find some clarification and guidance below. As always, we encourage questions, concerns and feedback. Email TPPinfo@cpsa.ab.ca or call 1-800-561-3899 ext. 4939.

TPP prescription and pad management

Prescribers should take reasonable steps to ensure the security of their TPP Alberta secure forms (e.g., storage of pad under lock and key) to reduce the risk of individuals improperly obtaining TPP Alberta monitored medications. Prescribers should maintain possession/security of their forms at all times. Please do not leave blank forms with office staff to facilitate verbal orders when the prescriber is out of office.

To protect patient confidentiality, prescribers should not leave their copy of the secure form in the TPP Alberta pad (e.g., if a pad is lost or stolen). Instead, please keep the prescription with the patient record.

For clarity, prescribers can remove their copy from the TPP Alberta pad and affix it to the patient record in several ways:

• physically attach the original Prescriber Copy to the paper records;
• photocopy the original Prescriber Copy and attach it to the patient record, then destroy the original; or
• scan the original Prescriber Copy and electronically load it into the patient record, then destroy the original.

Faxing TPP Alberta prescriptions to the patient’s pharmacy

Faxing is allowed and a preferred approach for safe prescription management, risk mitigation and support of the one physician/one pharmacy approach.

When faxing, please confirm the pharmacy fax number. Fax the Pharmacy Copy of the TPP Alberta form, clearly identifying:

1. the unique TPP tracking #;
2. your TPP Alberta ID #; and
3. the patient’s name, date of birth and personal health care number.

Once faxed, destroy the original Pharmacy Copy or mark it “VOID”; do not give it to the patient. Remove the Prescriber Copy from the pad, attaching it to the patient record either physically or electronically.

At this time, prescribers cannot transmit TPP Alberta prescriptions to a pharmacy using an online platform.

Part-fills

Prescribers can write part-fills for TPP Alberta prescriptions if they indicate the full quantity, amount to fill each time and the interval between fills. For example, a prescriber may authorize the prescription for a year with directions to dispense a month’s supply every 30 days.

Locums

For prescribers with no fixed business address (e.g., locums), we issue secure TPP Alberta forms without a printed address or contact information. These forms only have the prescriber’s name and their unique TPP Alberta identification number. At each use, these prescribers must enter the appropriate medical clinic or hospital name (or the professional’s name for whom the prescriber is working), address and a contact number (telephone or pager).

Locum prescribers should remove the original Prescriber Copy from the pad, leaving it with the clinic to affix to the patient record (physically or electronically) and then destroy, as applicable.

Safe Prescribing Practices

In particular, for drugs prone to misuse:

• Prescribe reasonable quantities-you can prescribe controlled drugs as part-fills if you indicate the quantity to be dispensed each time and the interval between fills. Guidance for pharmacies recommends not dispensing more than a 30-day supply at a time, (e.g., for individuals on long-term opioid therapy).
• Consider weekly and/or compliance packaging for patients, as appropriate (note that this may result in increased costs for the patient).
• Discuss safe storage of medications with your patients.
• Consider recommending a naloxone kit to your patients who may be at greater risk of an overdose.
• Refer to applicable guidelines and standards of practice for additional recommendations.

For more information on TPP Alberta and the new two-part forms, visit cpsa.ca/tpp.

Methadone for analgesia

On May 19, 2018, Health Canada removed the requirement for an exemption under section 56(1) of the Controlled Drugs and Substances Act to prescribe methadone. The College of Physicians & Surgeons of Alberta implemented the standard of practice on Safe Prescribing for Opioid Use Disorder, which came into effect on April 1, 2019. This new standard of practice provides guidance for the use of Opioid Agonist Therapies (OAT), including methadone and slow-release oral morphine (SROM), in the management of Opioid Use Disorder (OUD).

This standard of practice does not address methadone when given for pain. While CPSA approval continues to be required when providing methadone as an OAT, an approval to prescribe methadone for analgesia is no longer required.

Physicians who provide methadone for analgesia (chronic pain or palliative conditions) are expected to acquire the relevant education and training. Physicians must also be familiar with the standard of practice on Prescribing: Drugs Associated with Substance Use Disorders or Substance Related Harm, including the commitment to regularly review each patient’s Netcare/PIN profile for safe prescribing and communication with the patient’s other health professionals where necessary.

Physicians with limited experience regarding the use of methadone for analgesia are strongly encouraged to consult with an experienced colleague before starting a patient on methadone. It is not recommended to initiate methadone for patients who are considered opioid-nave (no prior exposure to, or intermittent use of, opioids), except in certain palliative or end-of-life care situations.

It is strongly recommended that physicians who wish to provide methadone for analgesia complete the Canadian Virtual Hospice’s free, one-hour accredited online course on methadone for pain in palliative care.

When prescribing methadone for analgesia or OUD, physicians must use a TPP Alberta prescription pad.

If you have questions, contact us at cc.inquiries@cpsa.ab.ca.

CPSA communications strategy survey

In January, CPSA completed research on how the College should communicate and be perceived going forward. Please complete this five-minute survey to tell us if the feedback we received is aligned with how you would like to see the CPSA in the future.

Discipline reports

Dr. Habeeb Tunde Ali’s practice permit cancelled

Cochrane family physician Dr. Habeeb Tunde Ali’s practice permit has been cancelled for failure to pay the outstanding fees related to previous unprofessional conduct.

Background

In 2009, Dr. Ali entered into a five-year Continuing Care Agreement with CPSA in response to a matter involving a sexual boundary violation. He was not compliant with all of the terms of this agreement and was subsequently found guilty of unprofessional conduct in 2014 after facing three charges, including failure to pay annual fees to the CPSA, failure to cooperate and meet the CPSA’s Continuing Care Agreement and failure to comply with his obligations as a bankrupt person.

Dr. Ali appealed the decision to both CPSA Council in 2016 and the Alberta Court of Appeal in December 2017. Both appeals were unsuccessful and the decision was upheld.

Last spring, Dr. Ali received a stay in his permit cancellation from the Alberta Court of Appeal to allow him to seek leave to appeal the costs award to the Supreme Court of Canada. On March 14, 2019, the Court declined to hear Dr. Ali’s appeal. This immediately expired the stay on the College process and his practice permit was cancelled.

Commentary

Physicians are expected to maintain a high level of professionalism, which includes upholding their agreements with the College and meeting their obligations, whether financial or otherwise. A permit to practise medicine in Alberta is a commitment to upholding the trust that medical professionals have earned over many decades. Failing to cooperate with the College regarding a Continuing Care Agreement, not paying College fees and failing to follow the law demonstrates a lack of professionalism and prioritization of responsibilities to the profession and the public. 

CPSA unsuccessful in appeal of sanction decision for Dr. Johann Maritz

A Hearing Tribunal Decision to impose an 18-month suspension on Dr. Johann Maritz‘s practice permit was upheld by a Council Review Panel, following an unsuccessful appeal by the CPSA to revoke his practice permit.

Bill 21 legislation does not apply to the sanctions in this case because it was initiated prior to April 1, 2019. However, the Complaints Director will now appeal the decision to the Alberta Court of Appeal to ensure the legislation is appropriately interpreted to protect the public while ensuring a fair and lawful process.

Background

In 2018, Dr. Maritz was found guilty of four charges of unprofessional conduct, including sexual misconduct and prescribing medication to a patient which violated practice restrictions to which he had previously agreed. The Hearing Tribunal denied the CPSA’s argument to revoke Dr. Maritz’s practice permit.

In an appeal to College Council, CPSA asked for the revocation of Dr. Maritz’s practice permit while Dr. Maritz’s legal counsel asked the Review Panel to reduce his payment owed to the College.

Order of College Council

After reviewing the evidence presented at the original hearing and additional submissions by both the Complaints Director and Dr. Maritz, Council found that the Tribunal’s decision was reasonable and dismissed the CPSA’s appeal. Council also accepted Dr. Maritz’s cost appeal, adjusting the cost percentage from 100 to 60 per cent.

Council sanctions:

1. The Panel affirms the Hearing Tribunal’s decision to order that Dr. Maritz serve an 18-month suspension.
2. The Panel allows Dr. Maritz’s costs appeal and varies the order of the Hearing Tribunal that required Dr. Maritz to pay 100 per cent of the investigation and hearing costs:
3. Maritz is hereby ordered to pay 60 per cent of the investigation and hearing costs, totalling $62,423.37. The terms of payment are at the discretion of the Complaints Director.
4. If there are any disputes regarding the payment of costs, the matter may be remitted to a hearing tribunal for consideration.

Commentary

CPSA’s future appeal to the Alberta Court of Appeal will explicitly identify whether an independent court would come to the same conclusion as the Tribunal in this complex case and post-Bill 21 environment. The outcome of the upcoming appeal to the Alberta Court will set the precedent for similar cases in the future.

This is a challenging time for Council and CPSA to manage cases initiated before Bill 21 legislation, but it’s important we learn from these cases to better protect patient safety in the future.