July Messenger 2019

Table of contents

Medical Matters

Message from your Council: Do you believe your ideas have value? Do you think you’d make a good leader?

Make a difference as a physician leader. Join us for an information session about the upcoming CPSA Council Election!

“We want every physician to feel empowered and motivated to self-assess their quality of practice.”

Are you up to standard? Informed consent and sensitive exams of minor patients

Buprenorphine/naloxone to change from Type 1 to Type 2 TPP drug

Ensuring the purity of the patient record

Discipline reports

Optimized Prescribing with Seniors

Make a difference as a physician leader. Join us for an information session about the upcoming CPSA Council Election!

Did you know that you may just have what it takes to run for Council?

You’re invited to join members of CPSA Executive and Council for a town hall-style meeting and reception to learn more about the upcoming CPSA Council Election. These sessions are ideal for those interested in running for CPSA Council, but want more information before seeking nomination.

You’ll have the opportunity to meet and mingle with current CPSA Councillors, ask questions and learn more about the vital role CPSA Council plays in leading the medical profession. Through a short presentation and Q&A session, we will discuss:

• the responsibilities of being a member of Council;
• eligibility criteria for potential new members;
• the nomination process and deadline; and
• the voting process and deadline.

Please RSVP below:

• Calgary: Tuesday, Aug. 6 at 5 p.m.
  • University of Calgary’s Health Science Centre – Room G500
  • 3330 Hospital Drive NW
  • Click here to RSVP to the Calgary session
• Edmonton: Wednesday, Aug. 7 at 5 p.m.
  • CPSA Council Chambers
  • 10020 100 St NW (TELUS House 27^th floor)
  • Click here to RSVP to the Edmonton session

Light refreshments will be served. Please RSVP at your earliest convenience as space is limited.

Want to submit a question ahead of the town halls? Please email Gail.Jones@cpsa.ab.ca.

“We want every physician to feel empowered and motivated to self-assess their quality of practice.”

In September 2018, a cardiologist from Edmonton bravely shared a story in CPSA’s Messenger, about missing a significant, but unexpected, abdominal finding on a cardiac ultrasound report. His openness, vulnerability and willingness to share his learnings from the situation is just one example of a primary tenet of medicine-lifelong learning. Learn more about how CPSA is using data and encouraging openness in the CPSA Report to Albertans.

Buprenorphine/naloxone to change from Type 1 to Type 2 TPP drug

Effective July 15, 2019, buprenorphine/naloxone products will move from Type 1 to Type 2 TPP Alberta status. This means registration with TPP Alberta and use of a secure TPP prescription pad will no longer be required when writing prescriptions for these drugs. Buprenorphine/naloxone products will continue to be monitored through TPP Alberta as a Type 2 drug.

Single-entity buprenorphine (e.g., BuTrans patches) and all buprenorphine products for veterinary use will remain a Type 1 TPP drug-registration with TPP Alberta and use of the secure TPP form are still required.

This change was made to facilitate prescribing of buprenorphine/naloxone for Albertans with Opioid Use Disorder (OUD). While much work has been done to address the opioid crisis, Albertans continue to overdose and lose their lives to opioids. The co-chairs of the federal, provincial and territorial Special Advisory Committee on the Epidemic of Opioid Overdoses recently issued a statement on the release of new data on the opioid crisis.

Buprenorphine/naloxone is as effective as methadone for treatment of OUD, but with an improved safety profile. The agonist/antagonist action of buprenorphine/naloxone results in a “ceiling effect,” which lowers the risk of respiratory depression and overdose, side effects and diversion/non-medical use (CRISM Guideline for the Clinical Management of Opioid Use Disorder).

While registration with TPP Alberta is no longer required in order to prescribe buprenorphine/naloxone, completion of a buprenorphine/naloxone prescribing course is strongly encouraged. The following courses are recommended:

• Centre for Addiction and Mental Health (CAMH) Buprenorphine-Assisted Opioid Dependence Treatment course
• Alberta Opioid Dependence Treatment (ODT) Virtual Training Program

When prescribing buprenorphine/naloxone products, please remember:

• Prescriptions must be signed and dated. Only written or faxed prescriptions are acceptable; verbal prescriptions are not permitted.
• No refills are permitted.

• • All “re-orders” must be new written prescriptions.
  • Part-fills are allowed. For part-fills, the prescriber must indicate the total amount of medication, the quantity for each part-fill and the interval between fills.

• Provide clear directions for use, including instructions:

• • for witnessed ingestion and the frequency with which this is to occur; and
  • identifying the days in which a patient is permitted to receive carry doses (as applicable).
• The end date or effective timeframe for the prescription.

Click here for a sample prescription.

For more information on TPP Alberta, please visit cpsa.ca/tpp.

Discipline reports

Dr. David Odugbemi appeals Hearing Tribunal decision

Edmonton family physician Dr. David Odugbemi has appealed a Hearing Tribunal decision that ordered the cancellation of his practice permit after being found guilty of unprofessional conduct.

Background

In Feb. 2015, Dr. Odugbemi entered into a Terms of Resolution Agreement (TORA) with CPSA to resolve issues arising from a number of significant complaints about his medical practice. He failed to fulfill several aspects of the agreement, including:

• completion of a fitness-to-practice assessment;
• pursuit of further education;
• quality of charting improvement;
• quality of care improvement;
• compliance with restrictions on his practice permit; and
• payment of costs in a timely manner.

Commentary

Dr. Odugbemi’s practice permit remains active until the completion of the appeal hearing. During this time, CPSA will continue to closely monitor his practice.

Dr. Sanjeev Bhardwaj found guilty of unprofessional conduct

Stony Plain family physician Dr. Sanjeev Bhardwaj was found guilty of unprofessional conduct by a Hearing Tribunal. The sanction decision for Dr. Bhardwaj is pending.

Background

Dr. Bhardwaj faced six allegations, spanning between 2005 and 2016. He admitted to unprofessional conduct for all of them, including failing to meet the minimum standard of care in regards to opioid prescribing and charting for a patient, four counts of sexual involvement with patients and failing to report these relationships during CPSA’s annual practice renewal process.

Commentary

As the complaint process for this case predates April 1, 2019, amendments to the Health Professions Act (HPA) based on An Act to Protect Patients will not apply.

CPSA files notice of discontinuance for Dr. Johann Maritz case to Court of Appeal of Alberta

CPSA has filed a notice of discontinuance to the Court of Appeal of Alberta, withdrawing our appeal in the case of Dr. Johann Maritz.

Background

In August 2018, Dr. Maritz was found guilty by a Hearing Tribunal of four counts of unprofessional conduct for boundary violations, and was sanctioned to serve an 18-month suspension. The decision was upheld by a Council Review Panel following an appeal by CPSA to revoke Dr. Maritz’s licence.

CPSA pursued the opportunity to obtain a higher review from the Court of Appeal of Alberta. However, upon legal review of section 27 of An Act to Protect Patients, it was determined the right of appeal does not apply to this matter as it predates when the Act came into effect.

Commentary

While Dr. Maritz has served his suspension and is eligible to practise medicine in Alberta, CPSA will continue to closely monitor his compliance with current practice restrictions and CPSA’s Standards of Practice and the Code of Ethics.