September Messenger 2020

Table of contents

A Message from Your Council

What’s new in your 2021 RIF?

CPSA Council Election

CPSA reviews ketamine as TPP Alberta adds new drug product to Type 1 list

Online privacy-related resources for physicians

Are you engaged in professional life-long learning?

Are you an experienced medical educator?

Professional Conduct reports

From AHS: What risk factors are associated with the development of severe outcomes in COVID-19?

Getting to Know Modified Early Warning Scores (MEWS) in ConnectCare

Optimized Prescribing with Seniors

What’s new in your 2021 RIF?

Renewal starts Nov. 2

Although annual renewal is still a couple of months away, we’ve been updating the Renewal Information Form (RIF) to ensure we collect information that meets HPA requirements and supports you in practice.

Here are a few of the things you can expect to see:

• More auto-populated data based on what you provided in the previous year. However, please ensure you go through all fields carefully. You will check a box at the end of the form (which acts as your signature) to confirm all the information in the form is true and accurate.
• A new practice status to capture physicians who are practising both within and outside of Alberta (such as a physician practicing in Alberta who has a virtual practice in another province).
• Removal of the Patient Records section and Practice Interests question. We also removed the “Education Outreach” section, which had multiple choice questions about CPSA Standards of Practice.
• Addition of a new, more relevant section on Digital Health/Virtual Care (replaces the EMR section). We also added a new section to gauge your knowledge and participation in Continuous Quality Improvement and Personal Development to better inform our Continuing Competence programs and initiatives.

Our goal is to continually improve the RIF. We thank those physicians who took time to fill out the annual feedback survey located at the end of the RIF. We look forward to your comments again this year.

Are you ready for annual renewal? See our tips to help you renew on time!

Questions? Please email revu.inquiries@cpsa.ab.ca.

CPSA Council Election

Voting opens Sept. 16 – watch your inbox

With nominations now closed, we’re gearing up for a successful election. This means getting physicians to vote.

On Sept. 16, 2020, all eligible voters will get an email from CPSA [info@cpsa.ab.ca] with a link to vote.

Voting will remain open until Oct. 14, 2020.

New, improved voting process
This year, you will cast your vote via CPSA’s physician portal. Our new voting application is secure and easy to use. You will simply:

1. Log in to the physician portal
2. Click the link in the Elections banner
3. View the list of candidates and read their profiles
4. Select the candidates you want to vote for and submit

Your voice matters-please take the time to vote!

If you have questions while using the new voting application, please email elections@cpsa.ab.ca.

Why vote?

Council helps guide and lead our profession to improve health care for all Albertans. Voting is your opportunity to see who is running and select who you feel is best suited to fill this important role and shape the future of medicine. This year you can vote for up to two candidates to fill two physician vacancies.

Who can vote?

A regulated member on the General Register, the Provisional Register or the Limited Practice Register (whether a physician, surgeon, osteopath or physician assistant) can vote in the election if:

• They have no fees, costs, fines, assessments, levies or any other sums owing to CPSA;
• They have a valid and current practice permit that is not currently suspended; and
• They are in compliance with all orders or directions made pursuant to the Health Information Act.

Only eligible voters will receive the election notice and see the election link in the portal

Questions? Email elections@cpsa.ab.ca.

CPSA reviews ketamine as TPP Alberta adds new drug product to Type 1 list

Health Canada recently approved the use of intranasal esketamine (Spravato) in combination with an oral antidepressant (SSRI or SNRI), for adults with major depressive disorder experiencing moderate-to-severe depressive episodes unresponsive to other therapies.

In light of the new product and potential safety risks associated with off-label or inappropriate use of this product and others containing ketamine, CPSA will join other regulatory bodies nationwide to review its policies related to the use of these drugs. A clinical toolkit document is in development to provide general prescribing advice and support safe use of ketamine and related drugs in community settings.

Stay tuned for more information. In the meantime, TPP Alberta has updated its drug list to include esketamine as a Type 1 drug requiring the use of a secure TPP form for prescribing.

Questions or comments? Email us at cc.inquiries@cpsa.ab.ca.

Online privacy-related resources for physicians

As clinics develop and evolve their privacy management programs, different concerns and challenges may come up, such as shifting from paper-based to electronic medical records, responding to privacy breaches, or incorporating telemedicine into their practice. Clinics are finding they need to access more resources to develop their privacy management program and complete privacy impact assessments (PIA).

Here are some resources to help you along your way:

Communicating with patients by email

• Communicating with patients via email (OIPC)
• Email Communications FAQs (OIPC)

General privacy awareness

• Securing Personal Information: A Self-Assessment Tool for Organizations
• Guidance for Electronic Health Record Systems
• Guidelines on Facsimile Transmission
• A Practical Guide to the HIA
• Privacy Impact Assessment Requirements
• Principles for Getting Information Sharing Right
• Cybersecurity from a Privacy Regulator’s Perspective
• Privacy in a Pandemic

Preparing for and managing privacy breaches

• Key Steps in Responding to Privacy Breaches (OIPC)
• Privacy Breach Response and Reporting under HIA (OIPC PowerPoint presentation)
• How to report a privacy breach (OIPC)
• Privacy breach resources (OIPC)

Below are useful resources from Alberta Health and the Alberta Medical Association

• Alberta Medical Association privacy management program resources

Includes resources for developing privacy management programs, conducting PIAs, delivering staff training, etc.

• Alberta Health HIA resources
  • AH’s HIA guidelines and practices manual

• • Questions about the HIA? Contact the HIA Help Desk at 780-427-8089 or 310-0000 (toll-free in Alberta) or email hiahelpdesk@gov.ab.ca.

Questions? Please contact Raylene Campbell, Privacy Coordinator, at Raylene.Campbell@cpsa.ab.ca.

Are you engaged in professional life-long learning?

More importantly, are you interested in supporting your colleagues’ continued improvement?

We are currently seeking physicians for our Assessment Program Advisory Committee.

In this role, you would provide guidance on assessment and remediation activities supporting Alberta physicians in both quality improvement and quality assurance. We want your expertise to develop, implement and evaluate competence programs to ensure fairness, transparency and value to all Alberta physicians, and to ensure the best medical care for Albertans.

Qualifications:    

• You hold a valid, active Alberta Medical Practice Permit and are in good standing with CPSA.
• You have a minimum of five years practice experience.
• We also consider involvement in teaching, education and remediation an asset.

Time commitment:

• Our APAC meets up to four times per year, ranging from three to six hours in length. Meetings can be virtual or in person.
• All committee members need to review and familiarize themselves with meeting material prior to meetings.

Honorarium:

• CPSA pays committee members an honorarium and reimburses relevant expenses based on CPSA rates.

How to apply:

• If you have questions or want to apply, simply email Shelley Howk, Senior Medical Advisor at shelley.howk@cpsa.ab.ca.  The deadline to apply is Friday, Oct. 2.

This is your opportunity to help us “Do It Better.”
We look forward to hearing from you!

Are you an experienced medical educator?

Do you also have an interest in physician competence and continuing professional development?

If so, consider an active role in profession-led governance by joining CPSA’s Competence Committee. Our committee is currently seeking three new members.

Under the Health Professions Act (HPA), the Competence Committee makes recommendations to CPSA’s Council about general assessments, continuing professional development and competence assessments. As a committee member, you will provide direction and guidance on the development, implementation and evaluation of these programs, in both quality improvement and assurance.

Qualifications:    

• You hold a valid, active Alberta Medical Practice Permit and are in good standing with CPSA.
• You have a minimum of five years’ practice experience.
• We also consider involvement in teaching, education, remediation and continuous quality improvement an asset.

Time commitment:

• Our Competence Committee meets up to four times per year, for three to six hours. Meetings can be virtual or in person.
• All committee members need to review and familiarize themselves with meeting material prior to meetings.

Honorarium:

• CPSA pays committee members an honorarium and reimburses relevant expenses based on CPSA rates.

How to apply:

• If you have questions or want to apply, simply email Kimberley Murphy at kimberley.murphy@cpsa.ab.ca. The deadline to apply is Friday, Oct. 2.

We look forward to hearing from you!

Professional Conduct reports

Retired physician sanctioned for boundary violation

After admitting to a personal relationship with a patient, Dr. Allan Garbutt, a Family Physician who previously practised in the Crowsnest Pass area, was found guilty of unprofessional conduct by a CPSA hearing tribunal.

Background

Between 2002 and 2004, Dr. Garbutt engaged in an inappropriate, sexual relationship with a patient. He failed to disclose this relationship to CPSA, as required by our standards of practice, falsely reporting that he had not committed any boundary violations while in practice.

CPSA learned of this matter in 2018 and Dr. Garbutt acknowledged that the relationship took place. The hearing tribunal accepted Dr. Garbutt’s admission of guilt and ordered him to pay two-thirds of the costs associated with the investigation and hearing (totaling $13,775.36), as well as a $5,000 fine, given the seriousness of the unprofessional conduct. Dr. Garbutt is now retired from the practice of medicine and signed an agreement with CPSA not to seek reinstatement of his practice permit in Alberta, or with any other medical regulators in any other jurisdiction.

Commentary

While the hearing tribunal determined the conduct displayed by Dr. Garbutt was unacceptable and worthy of significant sanction, a suspension could not be considered as Dr. Garbutt retired from practice at the end of 2019.

There is an inherent power imbalance in the relationship between physicians and their patients, making firm, clear boundaries an important part of providing quality health care. Dr. Garbutt’s failure to maintain these boundaries is not only inappropriate and unprofessional, it harms the integrity of the medical profession, along with the trust Albertans put into their physicians.

Edmonton physician sanctioned for boundary violations

Dr. Haroon Imtiaz, a Family Physician practising in Edmonton, admitted to five charges of unprofessional conduct and was sanctioned by a CPSA hearing tribunal.

Background

It was alleged Dr. Imtiaz did not maintain professional boundaries on several occasions. This included inappropriate personal comments and conduct towards two patients, and failing to have a chaperone present during sensitive exams. Dr. Imtiaz also allegedly failed to keep complete patient records, suggested examinations that were not medically required and inappropriately billed Alberta Health.

Dr. Imtiaz admitted to the charges brought against him to avoid a lengthy and costly discipline hearing. The hearing tribunal considered all the evidence and issued the following sanctions:

• A six-month suspension with two months considered served and the remaining four months deferred, on the condition Dr. Imtiaz demonstrates good character for 12 months following the hearing.
  • If CPSA’s Complaints Director becomes aware of any behaviour that does not demonstrate good conduct in the 12 months following the hearing, the remaining four months of the suspension will be imposed.
  • If Dr. Imtiaz and the Complaints Director disagree on the condition of good character in the 12-month period, the hearing tribunal will make the final decision.
• The 2017 undertaking requiring a chaperone condition on Dr. Imitiaz’s practice permit will remain in effect until Dec. 31, 2021, unless a further boundary violation is reported at which point it may be extended.
• Imtiaz is responsible for 50 per cent of the costs of the investigations and the hearing, totaling $14,162.79.

Because this complaint predates Bill 21, An Act to Protect Patients, sanctions under that legislation do not apply.

Commentary

It was noted by the hearing tribunal that Dr. Imtiaz was new to the Canadian medical system at the time of the unprofessional conduct and has since completed CPSA-required courses on appropriate professional boundaries and record-keeping. He also agreed to keep a chaperone condition on his practice until at least 2021. That said, the tribunal found Dr. Imtiaz’s conduct to be very serious and damaging to the medical profession, and felt the jointly-submitted sanction promoted both the safety of patients and deterrence to the profession. Albertans should be able to trust that they’ll receive quality care and be treated respectfully by their physicians at all times.

From AHS: What risk factors are associated with the development of severe outcomes in COVID-19?

AHS’ COVID-19 Scientific Advisory Group (SAG) recently investigated the latest evidence from around the world pertaining to a key question: What risk factors are associated with the development of severe outcomes in COVID-19?

COVID-19 studies show that age is a strong and consistent predictor of severe outcomes in COVID-19. However, it is less clear what other aspects, such as comorbidities, lifestyle influences and sociological factors, are associated with severe outcomes. Current evidence shows six principle findings:

• Age is strongly linked with severe COVID-19 outcomes, including death; increased risk is observed for individuals 50+ with the highest risk for patients 65+.
• Pregnant patients may have greater risk of COVID-19 mortality; however, the absolute risk appears low.
• Obesity (BMI 35) and diabetes mellitus have a higher risk for hospitalization or ICU admission.
• Chronic heart failure and chronic pulmonary disease (specifically COPD) may be linked to severe COVID-19 outcomes.
• Multiple comorbidities (obesity, diabetes, advanced CKD, pregnancy) appear to be associated with severe outcomes, but the strength and consistency of this relationship is unclear.
• The relationship between cancer, as well as immunosuppression and severe outcomes was out of scope for this review; a specific review is underway.

Practical considerations

In order to reduce COVID-19 infection and potentially severe health outcomes, adults ages 50, particularly those 65, with multiple risk factors (at least two of BMI 35, diabetes, hypertension, pregnancy, advanced CKD) should take great care to follow recommended physical distancing and hand hygiene guidelines or avoid situations, including work environments, where there is a high risk of contracting COVID-19 (particularly areas under a COVID-19 public health watch).

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.

Getting to Know Modified Early Warning Scores (MEWS) in ConnectCare

If you’re a physician using ConnectCare, or anticipating the subsequent wave of launch, Early Warning Systems (EWS) are here to help you care for patients.

What is an Early Warning System?

• EWS are implemented in acute inpatient medicine and surgery settings.
• Modified Early Warning Systems (MEWS) for adults are composite scores of vital signs and clinical parameters to identify patients with deteriorating conditions.
• Often, significant clinical changes can be seen through subtle changes over time.
• The purpose of MEWS is to help detect deterioration early, so the team can intervene early, and avoid FAILURE TO RESCUE.
• Studies have shown that Early warning system scores can predict patient deterioration.
• MEWS scores are calculated according to the table below:

• Based on the MEWS score, patients are categorized as follows:

• The MEWS Score will be displayed in your patient list:

The above list does not contain real patient data and is for example only

• If the MEWS score falls within the “Watcher” or “Unstable” range, a Best Practice Advisory (BPA) alert will appear for nurses and respiratory therapists on the patient’s storyboard.
• The alerts will prompt nurses/RTs to notify the care team to reassess the patient. With acute physiological deteriorations, the most responsible physician and team will be notified, and involvement of rapid response teams as deemed appropriate.
• The Pediatric Early Warning System (PEWS) functions similarly to MEWS but uses different vital signs, clinical parameters, and ranges for pediatric patients.

Questions? Please contact humanfactors@ahs.ca or visit ahs.ca/connectcare.