The College of Physicians and

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The College of Physicians and Surgeons of Ontario

Meeting of Council

March 6, 2015

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NOTICE OF MEETING OF COUNCIL

A Meeting of The College of Physicians and Surgeons of Ontario will take place on Friday, March 6, 2015, in the Council Chamber of the College, at 80 College Street, Toronto, Ontario.

The meeting will convene at 9:00 a.m.

Rocco Gerace, MD Registrar

February 10, 2015

3

Revised

MEETING OF COUNCIL

Council Chamber, 3rd Floor The College of Physicians and Surgeons of Ontario March 6, 2015

CALL TO ORDER

9:00 a.m.

President’s Announcements

Motion

Council Meeting Minutes of December 4 and 5, 2014

7

Executive Committee’s Report to Council

36

FOR DECISION

Motion

Marijuana for Medical Purposes Draft Policy

37

The draft Marijuana for Medical Purposes policy was released for external consultation between September and December 2014. After reviewing the feedback received, staff have revised the draft policy. Council is asked whether the revised draft policy can be approved as a policy of the College.

Motion

Professional Obligations and Human Rights – Consultation Report & Revised Draft Policy The draft Professional Obligations and Human Rights policy was released for external consultation between December 2014 and February 2015. Council is provided with a report on the consultation and the proposed revisions made to the draft policy in response to the feedback received. Council is asked whether the revised draft policy can be approved as a policy of the College.

60

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FOR DECISION

Motion

Quality Management Partnership Phase 2 Report

84

The Quality Management Partnership is a multi-year initiative of the CPSO and CCO. With a focus on colonoscopy, pathology and mammography services in the province, there are two goals: to improve quality of care at physician, facility and system levels, and to increase public confidence by improving accountability and transparency. The attached note provides Council with an overview of the Phase 2 Report on provincial quality management programs for colonoscopy, mammography and pathology, as well as an overview of implementation considerations for the CPSO. Council is being asked to approve the Partnership’s final report entitled “Provincial Quality Management Programs for Colonoscopy, Mammography and Pathology in Ontario” for submission to the Ministry of Health on March 31st, 2015.

Motion

Fee for Applications to Modify Terms, Conditions and Limitations of a Certificate of Registration Bylaw: Consultation Report

248

The Registration Committee recommends amending the CPSO’s Fee and Remuneration By-Law to add a fee which a member would pay for an application to modify the terms, conditions or limitations of his or her certificate of registration imposed as a result of a registration proceeding. The Council is being asked to approve amending the fees bylaw to include a new fee for Amendments to Restricted Certificates of Registration.

Motion

Investment Strategy

256

The Finance Committee is recommending to Council a change in how the College’s longer term investments are invested.

IN CAMERA

5 Meeting of Council March 6, 2015 Page 3

COUNCIL AWARD PRESENTATION

11:30 a.m.

Council Award Winner – Dr. Rosemary Moodie, Toronto, Ontario

12:00 p.m.

LUNCH

1:00 p.m.

278

MEMBER TOPICS

REGISTRAR’S REPORT

Strategic Priorities and Dashboard

279

Material now available

FOR DISCUSSION

Review of College Activities with External Organizations

280

The Deputy Registrar will provide an overview of the status of several major areas of College work, including the OHP/IHF review by HQO, Transparency and Sexual Abuse. Material now available

OHP/IHF Review – Submission to HQO – The Regulation of Facilities: Looking Forward Council will be provided with an overview of the status of the OHP/IHF Review currently being conducted by Health Quality Ontario. Material now available

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FOR DISCUSSION

2 – 4 p.m.

SEXUAL ABUSE

282

Motion

College Sexual Abuse Initiative In December 2014, Council approved a College initiative with respect to sexual abuse, including a review of legislative provisions and College processes. Council will be provided with background on prior sexual abuse reviews/recommendations and an update on current work underway. In addition, Council will be asked to discuss and consider a phased approach to next steps, including potential opportunities for change as well as sexual abuse principles to ground further work. Minister’s Sexual Abuse Task Force Council will be provided with an update on the Sexual Abuse Task force, including recent requests for information relating to the Patient Relations Committee and sexual abuse complaints. Material now available

FOR INFORMATION Discipline Committee – Table of Completed Cases

283

Government Relations Report

297

Supreme Court of Canada’s Physician-Assisted Death Ruling: Carter v. Canada

301

Material now available

Policy Report

302

Updates: 1. Policy Consultation Update I. Planning for and Providing Quality End-of-Life Care draft policy II. Consent to Treatment draft policy 2. Policy Status Table

ADJOURNMENT

7 D R A F T PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL OF THE COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO December 4 and 5, 2014

Attendees: Dr. Marc Gabel (President) Dr. El-Tantawy Attia (PhD) Mr. Sudershen Beri Dr. Steven Bodley Dr. Brenda Copps Ms. Lynne Cram Ms. Susan Davis (Dec. 4th) Ms. Diane Doherty Mr. Harry Erlichman Mr. Pierre Giroux Dr. Joel Kirsh Mr. John Langs Dr. Carol Leet Dr. Barbara Lent Dr. Rick Mackenzie

Dr. William McCready Mr. David McDonald Mr. Robert Pattillo Dr. Dennis Pitt Dr. Peeter Poldre Mr. Ron Pratt Dr. Jerry Rosenblum Dr. David Rouselle Dr. Wayne Spotswood Dr. Eric Stanton Dr. Peter Tadros Mr. Emile Therien Dr. James Watters Dr. John Watts Dr. Ronald Wexler

Non-voting Academic Representatives on Council: Dr. Bob Byrick, Dr. Michael Franklyn, Dr. John Jeffrey Regrets:

Ms. Susan Davis (Dec.5th), Ms. Debbie Giampietri, Dr. Andrew Falconer, Mr. Martin Forget

Observers:

Dr. Haidar Mahmoud, Dr. Akbar Panju

8 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 2

CALL TO ORDER

President’s Announcements Dr. Marc Gabel, President, called the meeting to order at 9:00 a.m., and welcomed members of Council and guests. Dr. Gabel announced the results of the 2014 District Elections for Council: David Rouselle and Carol Leet were re-elected in District 5; Rick Mackenzie, Peeter Poldre and Marc Gabel were reelected in District 10; and Ronald Pratt was reappointed for a 2 year term. Dr Gabel welcomed two new members to Council, Dr. Haidar Mahmoud, newly elected to District 10, and Dr. Akbar Panju, the new academic representative from McMaster University.

FOR DECISION

Council Meeting Minutes of September 4 and 5, 2014

01-C-12-14 It is moved by Eric Stanton, and seconded by El-Tantawy Attia, that: The Council accepts as correct the minutes of the meeting of the Council held on September 4 and 5, 2014. CARRIED

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Motion to go In Camera 02-C-12-14

It is moved by Steven Bodley, and seconded by Emile Therien, that: The Council excludes the public from the part of the meeting starting immediately following the lunch break, under clause 7(2)(b), (d) and (e) of the Health Professions Procedural Code. CARRIED

EXECUTIVE COMMITTEE’S REPORT TO COUNCIL

The Executive Committee’s Report to Council was included for information.

FOR DECISION and INFORMATION

Transparency Initiative - Strategic Priority – Operations In September, 2014, Council established Transparency as a strategic initiative. To move the Transparency initiative forward, Council was asked to make a series of decisions regarding Phase 1 and Phase 2 by-laws. Maureen Boon, Senior Advisor and Lisa Brownstone, Co-Director, Legal Office reviewed the following with Council: a. b. c. d. e. f. g. h.

Letters from Minister and Assistant Deputy Minister Response to Minister and Assistant Deputy Minister Phase 1 By-laws: Consultation feedback Phase 2 By-laws: Draft for consideration Website Usability Review Premises Register Other Issues Strategic Initiative

10 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 4

Phase 1 – Transparency Initiative 03-C-12-14 It is moved by Sudershen Beri, and seconded by John Watts, that the Council of the College of Physicians and Surgeons of Ontario makes the following By-law No. 95: By-law No. 95 Subsection 49(1) of By-law No. 1 (the General By-Law) is amended by adding the following paragraph: 19. Where there has been a finding of guilt against a member under the Criminal Code or a finding of an offence under the Health Insurance Act, made on or after June 1, 2015, if the person against whom the finding was made was a member at the time of the finding, and if the finding and/ or appeal is known to the College, a brief summary of: (i)

the finding;

(ii)

the sentence;

(iii)

where the finding is under appeal, a notation that it is under appeal, until the appeal is finally disposed of; and

(iv)

the dates of (i)-(iii), where known to the College. CARRIED

Phase 1 – Transparency Initiative 04-C-12-14 It is moved by Gerry Rosenblum, and seconded by El-Tantawy Attia, that the Council of the College of Physicians and Surgeons of Ontario makes the following By-law No. 96: By-law No. 96 Subsection 49(1) of By-law No. 1 (the General By-Law) is amended by adding the following paragraph: 20.

Any currently existing conditions of release following a charge for a criminal or provincial offence, or subsequent to a finding of guilt and pending appeal, that relate to the member’s practice, or any variations to those conditions, when known to the College. CARRIED

11 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 5

Phase 1 – Transparency Initiative Motion to amend Motion 05-C-12-14 It is moved by Bill McCready, and seconded by Lynn Cram that Motion 05-C-12-14 be amended to exclude reference to ‘that relate to the member’s practice’, as follows:

05-C-12-14

It is moved by Emile Therien, and seconded by Sudershen Beri, that the Council of the College of Physicians and Surgeons of Ontario makes the following By-law No. 97: By-law No. 97 Subsection 51(1) of By-law No. 1 (the General By-Law) is revoked and the following is substituted: 51. (1) A member shall notify the College in writing or electronically as specified by the College of, (a)

the member's preferred addresses (both mailing and e-mail) for communications from the College;

(b)

the address and telephone number of the member's principal place of practice;

(c)

the identity of each hospital and health facility in Ontario where the member has professional privileges; and

(d)

Any currently existing conditions of release (not including any information subject to a publication ban) following a charge for a criminal or provincial offence, or subsequent to a finding of guilt and pending appeal, and any variations to those conditions.

CARRIED

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Phase 1 – Transparency Initiative

06-C-12-14

It is moved by Ron Pratt, and seconded by Barbara Lent, that the Council of the College of Physicians and Surgeons of Ontario makes the following By-law No. 98: By-law No. 98 Subsection 50.1(1) of By-law No. 1 (the General By-Law) is revoked and the following is substituted: 50.1(1) All information contained in the register, other than: (a)

a member’s preferred address for communications from the College,

(b)

a member’s e-mail address,

(c)

a member’s date of birth,

(d)

a member’s place of birth, and

(e)

any information that, if made public, would violate a publication ban, if known to the College.

CARRIED

13 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 7

Phase 2 - Transparency By-Laws

07-C-12-14

It is moved by Bill McCready, and seconded by Steven Bodley, that the Council of the College of Physicians and Surgeons of Ontario proposes to make the following By-law No. 101, after circulation to stakeholders: By-law No. 101 Subsection 49(1) of By-law No. 1 (the General By-Law) is amended by adding the following paragraphs: 21.

In respect of a decision of the Inquiries, Complaints and Reports Committee that includes a disposition of a caution-in-person, if the complaint that led to the decision, or, in a case where there is no complaint, the first appointment of investigators in the file, is dated on or after January 1, 2015, a summary of that decision, and, where applicable, a notation that the decision has been appealed.

22.

Where a decision referred to in paragraph 21 above is overturned on appeal or review, the summary shall be removed from the Register.

Explanatory Note: - This by-law must be circulated to the profession and will return to the Council after the circulation.

CARRIED

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Phase 2 - Transparency By-Laws

08-C-12-14

It is moved by John Watts, and seconded by Jim Watters, that the Council of the College of Physicians and Surgeons of Ontario proposes to make the following By-law No. 102, after circulation to stakeholders: By-law No. 102 Subsection 49(1) of By-law No. 1 (the General By-Law) is amended by adding the following paragraphs: 23. In respect of a decision of the Inquiries, Complaints and Reports Committee that includes a disposition of a Specified Continuing Education or Remediation Program (“SCERP”), if the complaint that led to the decision, or, in a case where there is no complaint, the first appointment of investigators in the file is dated on or after January 1, 2015, a summary of that decision, including the elements of the SCERP, and, where applicable, a notation that the decision has been appealed. 24.

In respect of the elements of the SCERP, a notation that all of the elements have been completed, when so done.

25.

Where a decision referred to in paragraph 23 above is overturned on appeal or review, the summary shall be removed from the Register.

Explanatory Note: - This by-law must be circulated to the profession and will return to the Council after the circulation.

CARRIED

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Phase 2 - Transparency By-Laws

09-C-12-14

It is moved by Sudershen Beri, and seconded by Barbara Lent, that the Council of the College of Physicians and Surgeons of Ontario proposes to make the following By-law No. 103, after circulation to stakeholders: By-law No. 103 Subsection 49(1) of By-law No. 1 (the General By-Law) is amended by adding the following paragraph: 26.

Where a member has been charged with an offence under the Criminal Code of Canada or the Health Insurance Act, and the charge is outstanding and is known to the College, the fact and content of the charge and, where known to the College, the date and place of the charge.

Explanatory Note: - This by-law must be circulated to the profession and will return to the Council after the circulation.

CARRIED

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Phase 2 - Transparency By-Laws

10-C-12-14

It is moved by Steven Bodley, and seconded by Eric Stanton, that the Council of the College of Physicians and Surgeons of Ontario proposes to make the following By-law No. 104, after circulation to stakeholders: By-law No. 104 Subsection 49(1) of By-law No. 1 (the General By-Law) is amended by adding the following paragraph: 27. Where a member is currently registered or licenced to practice medicine in another jurisdiction, and such license or registration has been made known to the College as of September 1, 2015, the fact of that licensure or registration.

Explanatory Note: - This by-law must be circulated to the profession and will return to the Council after the circulation.

CARRIED

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Phase 2 - Transparency By-Laws

11-C-12-14

It is moved by Emile Therien, and seconded by Ron Pratt, that the Council of the College of Physicians and Surgeons of Ontario proposes to make the following By-law No. 105, after circulation to stakeholders: By-law No. 105 Subsection 49(1) of By-law No. 1 (the General By-Law) is amended by adding the following paragraph: Discipline Findings in Other Jurisdictions 28. Where a member has been the subject of a disciplinary finding by another medical regulatory or licensing authority and that finding is known to the College, (i) (ii)

the fact of the finding; the date of the finding, where known to the College;

(iii)

the jurisdiction in which the finding was made;

(iv)

the date upon which the College was notified of the finding; and

(v)

the existence and status of any appeal, when known to the College.

Explanatory Note: - This by-law must be circulated to the profession and will return to the Council after the circulation.

CARRIED

18 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 12

Telemedicine – Consultation Report and Revised Draft Policy Dr. Joel Kirsh provided an update regarding the consultation feedback and final draft of the Telemedicine Policy. 12-C-12-14 It is moved by Emile Therien, and seconded by Ron Pratt, that: The Council approves the “Telemedicine” policy, (a copy of which forms Appendix “A” to the minutes of this meeting) as a policy of the College. CARRIED

Consent to Treatment Policy – Draft for Consultation Dr. Dennis Pitt, Chair, Consent to Medical Treatment Working Group, provided background information on the development of the Consent to Treatment Policy. 13-C-12-14 It is moved by Rick McKenzie, and seconded by Barbara Lent, that: The College engage in the consultation process in respect of the draft policy “Consent to Treatment” (a copy of which forms Appendix “B” to the minutes of this meeting).

CARRIED

COUNCIL AWARD

Ms. Susan Davis presented the Council Award to Dr. Robin S. McLeod, Toronto, Ontario.

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IN CAMERA Council entered into an In-Camera session at 1:00 p.m. and returned to open session at 1:54 p.m.

Planning for and Providing Quality End-of-Life Care Policy – Draft for Consultation Dr. Carol Leet, Chair, Decision-making for the End of Life Working Group, provided Council with an update regarding revisions to the Planning for and Providing Quality End-of-Life Care Policy.

14-C-12-14 It is moved by Eric Stanton, and seconded by John Watts, that: The College engage in the consultation process in respect of the draft policy “Planning for and Providing Quality End-of-Life Care” (a copy of which forms Appendix “C” to the minutes of this meeting). CARRIED

MEMBER TOPICS

Dr. Peeter Poldre brought two items to Council: an information item from the Royal College of Physicians & Surgeons of Canada; and, continuing professional development for non-practicing non-billing physicians.

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Professional Obligations and Human Rights – Draft for Consultation Dr. Marc Gabel provided Council with background information on the Professional Obligations and Human Rights Working Group.

15-C-12-14 It is moved by Diane Doherty, and seconded by Peeter Poldre, that: The College engage in the consultation process in respect of the draft policy “Professional Obligations and Human Rights” (a copy of which forms Appendix “D” to the minutes of this meeting). CARRIED

21 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 15

Friday, December 5th, 2014

CALL TO ORDER

Dr. Marc Gabel, President, called the meeting to order at 9:00 a.m.

PUBLIC MEMBERS REPORT

The Public Members Report was deferred to the next Council meeting to be held on March 6, 2015.

PRESENTATION Dr. Joshua Tepper, President and Chief Executive Officer, Health Quality Ontario, provided a presentation entitled, Physicians & Quality: Our Opportunity (a copy of the presentation forms Appendix “E” to the minutes of this meeting).

FOR DECISION

Sexual Abuse by Physicians – Reinforcing the College`s Commitment to Protecting Patients Ms. Vicki White, Co-Director, Legal, reviewed CPSO’s approach to managing sexual abuse issues.

22 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 16

16-C-12-14

It is moved by Sudershen Beri, and seconded by Emile Therien, that: Council direct staff to take necessary steps to ensure the College continues to adopt and advocate for changes to allow the best practices for protecting patients from sexual abuse by physicians, including the following: a) review the provisions of the RHPA and the Health Professions Procedural Code relating to sexual abuse, and prepare for Council an analysis of whether changes are required to strengthen the legislative scheme and if so of what nature; b) use the results of the review to support, inform and assist in the Minister’s review of the sexual abuse provisions of the RHPA; and c) examine the manner in which the College handles complaints, investigations and discipline hearings relating to sexual abuse by physicians, and prepare for Council an analysis of proposed changes to strengthen its processes and practices. Motion to amend Motion 16-C-12-14 It is moved by David Rouselle, and seconded by David McDonald that Motion 16-C-12-14, section b), be amended to the following: b) use the results of the review to support, inform, and assist in the College's response to the Minister’s review of the sexual abuse provisions of the RHPA; and

Motion to amend Motion 16-C-12-14 CARRIED Motion 16-C-12-14 CARRIED

No abstentions Unanimous Decision

23 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 17

FINANCE COMMITTEE REPORT on the 2015 BUDGET

2015 Budget Mr. Harry Erlichman, Chair of the Finance Committee, reported on the 2015 Budget. 17-C-12-14 It is moved by Pierre Giroux, and seconded by Emile Therien, that: Council approve the “Budget for 2015” (a copy of which forms Appendix “F” to the minutes of this meeting) authorizing expenditures for the benefit of the College during the year 2015. CARRIED

2015 Increase to Per Diems 18-C-12-14 It is moved by El-Tantawy Attia, and seconded by Steven Bodley, that: The Council of the College of Physicians and Surgeons of Ontario makes the following By-law No. 99: By-law No. 99 Paragraphs 20(3)(a)(i),(ii), and (iii) of By-Law No. 2 (the Fees and Remuneration By-Law) are revoked and the following are substituted, effective January 1, 2015: Council and Committee Remuneration 20.-(3) The amount payable to members of the council and a committee is, subject to subsection (4), (a) for attendance at, travel to, and preparation for, meetings to transact College business, (i) (ii) (iii)

$599.50 per half day for the president, $493.50 per half day for the vice-president, and $466 per half day for the other members, and

Explanatory Note: - This proposed by-law does not need to be circulated to the profession. CARRIED

24 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 18

Signing Authority (By-Law No. 100) 19-C-12-14 It is moved by Harry Erlichman, and seconded by Eric Stanton, that: The Council of the College of Physicians and Surgeons of Ontario makes the following By-law No. 100: By-Law No. 100 1.

Section 1(3) of the general by-law, which is By-Law No. 1, is revoked.

2.

The general by-law, which is By-Law No. 1, is amended by adding the following section and heading to it: Execution of Contracts and Other Documents 1a. Except as provided otherwise in section 4 of this By-law, contracts, agreements, instructions and other documents shall be signed on behalf of the College by the registrar or deputy registrar.

3.

Subsections 4(1) and (2) are revoked and the following are substituted:

4.

(1) Goods may be purchased or leased, and services may be obtained, for the benefit of the College if the purchase, lease or obtaining of services is authorized by,

(a) a signing officer (as defined in subsection 4(7)) if the expenditure is authorized by the College budget;

(b) a signing officer if the resulting obligation does not exceed $25,000 and the expenditure is not authorized by the College budget;

(c) the registrar, deputy registrar or corporate services officer if the resulting obligation exceeds $25,000 but does not exceed $75,000 and the expenditure is not authorized by the College budget;

(d) one of the registrar, deputy registrar or corporate services officer and one of the

president or vice-president, after conferring with the chair of the finance committee, if the resulting obligation exceeds $75,000 and the expenditure is not authorized by the College budget; or

(e) the executive committee or the council, by resolution.

25 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 19

(2) Two signing officers one or both of whom did not authorize the purchase, lease or obtaining of services may sign,

(a) a cheque or other form of payment for goods purchased or leased, or services obtained, in accordance with subsection (1); and

(b) a document for or relating to the purchase, lease or obtaining of services authorized by the council or the executive committee by resolution.

4.

Section 4 is amended by adding the following paragraphs: (6) Despite section 4(2), an offer of employment or an agreement for employment with the College, which employment position is authorized by the College budget, may be signed by the director or associate director of the department in which the employee is to be working, the manager responsible for hiring the employee, the associate director of Human Resources, the registrar or the deputy registrar. (7) For purposes of section 4, the term “signing officer” means any of the following: the registrar, the deputy registrar, the corporate services officer, the manager of finance and the corporate accountant. CARRIED

FOR DISCUSSION

Legislative Change – Current Initiatives

Dr. Gerace provided an overview of the status of CPSO requests for legislative change.

PRESENTATIONS

Delivering on the Promise of Medicare: Self-regulation and the Future of Health Care in Ontario Dr. Danielle Martin, Vice-President Medical Affairs & Health System Solutions, Women’s College Hospital, shared her thoughts and took questions from Council regarding self-regulation and the future of health care in Ontario.

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Assessment Re-visioning – Focus on Peer Assessment Redesign Ms. Rhoda Reardon, Manager, Research and Evaluation, updated Council on CPSO’s multiyear, cross-College assessment re-visioning project (a copy of which forms Appendix “G” to the minutes of this meeting). CCO and CPSO Quality Management Partnership Update Mr. Wade Hillier, Director, Quality Management Division, updated Council on the Quality Management Partnership between CPSO and Cancer Care Ontario (a copy of which forms Appendix “H” to the minutes of this meeting).

GOVERNANCE COMMITTEE: Part I

Conflict of Interest and Impartiality in Decision Making Policies Dr. Eric Stanton, Chair, Governance Committee, provided information regarding the Governance Committee’s recommendations on the Conflict of Interest and Impartiality in Decision Making and Impartiality in Decision Making Policies.

Conflict of Interest Policy

20-C-12-14 It is moved by Steven Bodley, and seconded by Emile Therien, that: The Council approves the revised policy “Conflict of Interest” (a copy of which forms Appendix “I” to the minutes of this meeting) as a policy of the College.

CARRIED

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Impartiality in Decision Making Policy 21-C-12-14

It is moved by Brenda Copps, and seconded by El-Tantawy Attia that: The Council approves the revised policy “Impartiality in Decision Making” (a copy of which forms Appendix “J” to the minutes of this meeting) as a policy of the College.

CARRIED

2014 Council Performance Assessment Results Dr. Stanton reviewed the 2014 Council Performance Assessment Results.

ANNUAL COMMITTEE REPORTS

Dr. Stanton addressed Council and summarized the role and relationship of Committees to Council. Council reviewed the following Annual Committee Reports: Discipline Committee

Methadone Committee

Education Committee

Outreach Committee

Executive Committee

Patient Relations Committee

Fitness to Practise Committee

Premises Inspection Committee

Governance Committee

Quality Assurance Committee

Inquiries, Complaints and Reports Committee

Registration Committee

REGISTRAR’S REPORT Strategic Priorities & Year-End Dashboard Dr. Rocco Gerace provided a progress update on goals set out, Strategic Priorities and the YearEnd Dashboard (a copy of the presentation forms Appendix “K” to the minutes of this meeting).

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TOPICS FOR INFORMATION

2014 Council Awards Recipients 2014 District Council Elections Additional Colonoscopy Quality Standards Incorporated into the Out-of-Hospital Premises Inspection Program (OHPIP) Endoscopy/Colonoscopy Companion Document Discipline Committee – Table of Completed Cases Evaluating Registration Pathways and Policies – Project Update Independent Health Facilities – Unpaid Assessment Fees Government Relations Report Opioids: Fentanyl Patch for Patch Program Outstanding Cost Orders Physician Resources Task Force Policy Report External Consultation Responses: 1. College of Nurses of Ontario Consultation on Revised Draft Medication Practices Standard 2. Transitional Council of the College of Naturopaths of Ontario Consultation on a Proposed Premises Inspection Program Updates: 3. Policy Consultation Update I. Marijuana for Medical Purposes 4. Policy Status Table

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PRESIDENT’S TOPICS Presidential Address Dr. Marc Gabel delivered his Presidential Address to Council and reflected on his experiences during his year as President. He thanked his fellow Council members for their time, particularly Dr. John Watts and Dr. Robert Byrick, whose terms on Council had come to an end. Dr. Gabel thanked the Registrar and College staff for their support throughout his presidential term on Council. Induction of New President: Dr. Carol Leet Dr. Gabel presented Dr. Leet with a President’s pin and the chains of office. Induction of New Members of Council Dr. Gabel presented Council pins to Dr. Haidar Mahmoud and Dr. Akbar Panju and invited them to take their seats at the Council table.

GOVERNANCE COMMITTEE REPORT: Part II Dr. Eric Stanton, Chair, Governance Committee, presented Part II of the Governance Committee Report.

Election of Governance Committee 22-C-12-14

It is moved by Ron Pratt, and seconded by Sudershen Beri, that: The Council appoints Dr. William McCready (as physician member), El-Tantawy Attia (as public member) and Emile Therien (as public member), to the Governance Committee for the 2014-15 Governance Committee. CARRIED

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Patient Relations Committee Chair Appointment for 2014-15 23-C-12-14 It is moved by Marc Gabel, and seconded by Peter Tadros, that: The Council appoints Dr. Melvin Goodman as Chair of the Patient Relations Committee.

CARRIED

Committee Membership Appointments for 2014-2015 24-C-12-14

It is moved by Sudershen Beri, and seconded by El-Tantawy Attia, that the Council appoints the following people to the following committees: Council Award Selection Committee:

Discipline Committee:

Dr. Bob Byrick Dr. Marc Gabel Dr. Carol Leet Dr. Eric Stanton Mr. Martin Forget Dr. El-Tantawy Attia (PhD) Mr. Sudershen Beri Dr. Steven Bodley Dr. Paul Casola Dr. Pamela Chart Dr. Carole Clapperton Dr. Melinda Davie Ms. Susan Davis Ms. Diane Doherty Dr. Andrew Falconer Mr. Martin Forget Dr. Marc Gabel Dr. Paul Garfinkel Ms. Debbie Giampietri Mr. Pierre Giroux Dr. William L. M. King Dr. Joel Kirsh

31 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 25

Dr. Danny Kraftcheck Mr. John Langs Dr. Barbara Lent Dr. Cheryl Levitt Dr. Richard Mackenzie Dr. William McCready Dr. Tracey Moriarity Dr. Dennis Pitt Dr. Peeter Poldre Dr. Hugh Scully Dr. Ashok Sharma Dr. Robert Sheppard Dr. Alan Simpson Dr. Fay Sliwin Dr. Eric Stanton Dr Peter Tadros Dr. David Walker Dr. Sheila-Mae Young Dr. John Watts Dr. Paul Ziter Education Committee:

Finance Committee:

Ms. Diane Doherty Dr. Michael Franklyn Dr. John Jeffrey Dr. Joel Kirsh Dr. Barbara Lent Dr. William McCready Dr. Akbar Panju Dr. Karen Smith Dr. James Watters

Dr. Charlie Chan Mr. Harry Erlichman Mr. Pierre Giroux Dr. Joel Kirsh Dr. Carol Leet Dr. Rami Mozes Mr. Ron Pratt Dr. Jerry Rosenblum

32 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 26

Fitness to Practise Committee:

Governance Committee:

Dr. El-Tantawy Attia (PhD) Dr. Steven Bodley Dr. Pamela Chart Dr. Carol Clapperton Dr. Melinda Davie Ms. Diane Doherty Mr. Martin Forget Dr. Marc Gabel Dr. Paul Garfinkel Ms. Debbie Giampietri Dr. William L.M. King Dr. Barbara Lent Dr. Richard Mackenzie Dr. William McCready Dr. Tracey Moriarity Dr. Dennis Pitt Dr. Robert Sheppard Dr. John Watts Dr. Paul Ziter

Dr. El-Tantawy Attia, (PhD) Dr. Marc Gabel Dr. Joel Kirsh Dr. Carol Leet Mr. Emile Therien Dr. William McCready

Inquiries, Complaints and Reports Committee: Dr. Scott Allan Dr. George Arnold Dr. Haig Basmajian Dr. Harvey Blankenstein Dr. Brian Burke Dr. Bob Byrick Dr. Angela Carol Dr. Anil Chopra Dr. Nicholas Colapinto Ms. Lynne Cram Dr. Nazim Damji Dr. Naveen Dayal Dr. William Dunlop Dr. James Edwards Mr. Harry Erlichman

33 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 27

Dr. Karen Fleming Dr. Bernard Goldman Dr. Mara Goldstein Dr. Michael Gordon Dr. Christine Harrison Dr. Keith Hay Dr. Robert Hollenberg Dr. Nasimul Huq Dr. Francis Jarrett Dr. Wayne Johnston Dr. Edith Linkenheil Dr. Haidar Mahmoud Dr. Jack Mandel Dr. Edward Margolin Dr. J. Neil Marshall Dr. Peter Maskens Dr. Bill McCauley Mr. David McDonald Dr. Robert McMurtry Dr. Patrick McNamara Dr. Dale Mercer Dr. Lawrence Oppenheimer Dr. Akbar Panju Dr. Eugenia Piliotis Mr. Ron Pratt Dr. Peter Prendergast Dr. Jerry Rosenblum Dr. David Rouselle Dr. Leonard Schwartz Dr. Wayne Spotswood Dr. Marina Straszak-Suri Dr. Michael Szul Mr. Emile Therien Dr. Lynne Thurling Dr. Donald Wasylenki Dr. Ron Wexler Dr. Stephen White Dr. Stephen Whittaker Dr. Lesley Wiesenfeld Dr. Jim Wilson Dr. Preston Zuliani

34 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 28

Methadone Committee:

Outreach Committee:

Patient Relations Committee:

Premises Inspection Committee:

Dr. Steven Bodley Ms. Diane Doherty Dr. Michael Franklyn Dr. Trevor Gillmore Dr. Kumar Gupta Dr. Karen Jones Ms. Lynne Cram Ms. Diane Doherty Dr. Marc Gabel Dr. Joel Kirsh Dr. Carol Leet Dr. Jerry Rosenblum Dr. Eric Stanton Mr. Emile Therien Dr. Lynne Thurling Dr. Ron Wexler Dr. Philip Cheifetz Dr. Timothy Frewen Dr. Melvin Goodman Mr. David MacKinnon Ms. Lisa McCool-Philbin Mr. Sudershen Beri Dr. Steven Bodley Dr. Bob Byrick Dr. Wayne Carman Dr. John Davidson Mr. Harry Erlichman Dr. James Forrest Dr. Norman Hill Dr. Jeffrey Hurwitz Dr. Hugh Kendall Dr. Gillian Oliver Dr. Dennis Pitt Mr. Emile Therien Dr. James Watson Dr. Michael Zitney

35 DRAFT PROCEEDINGS OF THE ANNUAL MEETING OF COUNCIL December 4 & 5, 2014 Page 29

Quality Assurance Committee:

Registration Committee:

Mr. Sudershen Beri Ms. Susan Davis Ms. Debbie Giampietri Dr. Steven Bodley Dr. Brenda Copps Dr. James Forrest Mr. Pierre Giroux Dr. Natasha Graham Dr. Karen Jones Dr. Anil Joseph Dr. Hugh Kendall Mr. John Langs Dr. William McCready Dr. Rami Mozes Dr. Deborah Robertson Dr. Patrick Safieh Dr. Bernard Seguin Dr. Eric Stanton Dr. Lori Teeple Dr. Smiley Tsao Dr. James Watters Mr. Sudershen Beri Dr. John Jeffrey Dr. Barbara Lent Mr. David McDonald Dr. Akbar Panju Dr. Wayne Spotswood Dr. Marlene Spruyt Dr. John Watts CARRIED

ADJOURNMENT As there was no further business, Dr. Leet adjourned the meeting at 3:18 p.m.

___________________________________ Dr. Carol Leet, President ___________________________________ Lori Blinn, Recording Secretary

36

March 2015 Council

EXECUTIVE COMMITTEE’S REPORT TO COUNCIL October – December 2014 In Accordance with Section 12 HPPC The College of Physicians and Surgeons of Ontario

November 4, 2014 EXECUTIVE COMMITTEE MEETING 1.

College of Nurses of Ontario Consultation on Revised Draft Medication Practices Standard The Executive Committee reviewed the College of Nurses’ revised draft Medication Practices Standard, which was circulated for external consultation. The Standard describes nurses’ accountabilities when engaging in medication practices. The Executive Committee directed staff to submit a response to the College of Nurses that articulates the concerns.

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March 2015

COUNCIL BRIEFING NOTE TOPIC:

Marijuana for Medical Purposes – Consultation Report and Revised Draft Policy FOR DECISION

ISSUE: •

The draft Marijuana for Medical Purposes policy was circulated for external consultation between September and December 2014.

•

Council is provided with a report on the consultation and the proposed revisions made to the draft policy in response to the feedback received.

•

Council is asked whether the revised draft policy can be approved as a policy of the College.

BACKGROUND: •

The College’s current Medical Marijuana policy (Appendix A) was being reviewed in light of new federal regulations that significantly alter the legislative framework governing patient access to dried marijuana.

•

Among other changes, the new Marihuana for Medical Purposes Regulations (MMPR) transfer responsibility for the decision to authorize patient use of dried marijuana from Health Canada to individual physicians. 1 Physicians enable patients to obtain a legal supply of dried marijuana by completing a “medical document” that is, in effect, equivalent to a prescription. 2

•

During the initial stages of this review, extensive research was undertaken into the central issues related to the medical use of dried marijuana. This included a comprehensive literature review, consideration of the positions taken by other key stakeholders, including those of other medical regulators within Canada and

1

The MMPR permit both physicians and nurse practitioners to “prescribe” dried marijuana for medical purposes; however, to date the College of Nurses of Ontario has prohibited their members from prescribing. 2 The new regulations do not use the word “prescription”, but instead refer to the requirement for a medical document. The language of the new regulations, together with other materials from Health Canada, suggests that this is a matter of semantics; the medical document is effectively the same as a prescription and contains similar information.

1

38

March 2015

internationally, and an external consultation soliciting feedback on the College’s current policy. •

With the assistance of Dr. Marc Gabel, Dr. Mara Goldstein (medical advisor), Colin Johnston (legal counsel), and Dr. Howard Jacobs (a specialist in pain medicine and CPSO Assessor), this research was used to help inform the development of an updated draft policy entitled Marijuana for Medical Purposes.

•

Council considered this draft policy at their September 2014 meeting and approved that it be released for external consultation.

CURRENT STATUS: •

Council is provided with a report on the consultation, as well as a summary of the revisions undertaken in response to the feedback received.

A. Report on Consultation Consultation process •

Invitations to participate in the consultation were sent via email to a broad range of stakeholders, including the entire CPSO membership and key stakeholder organizations. In addition, a general notice was posted on the College’s website, Facebook page, and announced via Twitter. It was also published in Dialogue and Noteworthy (the College’s public e-newsletter).

•

Stakeholders were given the option of submitting their feedback in writing, via email or regular mail, via a brief online survey, or by posting comments to a consultationspecific webpage.

•

The consultation was held from September 18th until December 5th, 2014.

Number of responses •

In total, 284 submissions were received in response to this consultation. This included 156 comments either submitted by mail or posted to the online discussion page, and 128 completed online surveys.

•

Approximately 45% of respondents identified themselves as physicians, 27% as members of the public, 23% as “other” or “unidentified”, and 5% as organizations 3.

3

15 responses were received from stakeholder organizations, including the College of Physicians and Surgeons of Alberta, the Professional Association of Residents of Ontario, the Medico-Legal Society of Toronto, and the Ontario Medical Association. To date, feedback has not been received from a number of key stakeholder organizations, including the Canadian Medical Association and the Canadian Medical Protective Association.

2

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March 2015

Feedback •

All stakeholder feedback has been posted publicly on the consultation-specific page of the College’s website.

General comments •

Broadly speaking, respondents expressed support for the draft policy and were appreciative of the College’s efforts to provide guidance around the medical use of dried marijuana.

•

Of those respondents who were complimentary of the draft policy, many, including the Ontario Medical Association (OMA) and the College of Physicians and Surgeons of Alberta (CPSA), believed that it was clear, concise, and struck an appropriately balanced tone.

•

Of the respondents to the online survey, over 75% indicated that the draft policy was clearly written and articulated clear expectations for physicians.

•

Respondents were most divided on whether the draft policy was comprehensive and whether it articulated reasonable expectations for physicians. Of those respondents who indicated that the draft policy had failed to address an important issue or contained an unreasonable expectation, comments focused on the key issues outlined below.

Issue specific comments The lack of clinical guidelines and conclusive research o The draft policy requires physicians who prescribe dried marijuana to be knowledgeable about its risks and benefits, and weigh the available evidence in support of it against other available treatment options. Given the current lack of clinical guidelines and high quality research, some respondents felt that meeting this requirement would be difficult. Alternative methods of consuming dried marijuana o Given the risks associated with smoking, a number of respondents, including the Medico-Legal Society of Toronto, suggested that the draft policy endorse alternative methods of consuming dried marijuana, such as inhalation via vaporizer, consumption of “edibles”, or the use of cannabis oils.

3

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March 2015

Physicians’ obligation to prescribe o A number of respondents, including the OMA, suggested that the draft policy be revised to state explicitly that physicians are not obligated to prescribe dried marijuana. Increased risk of harm in children, adolescents, and young adults o Several respondents highlighted a growing body of research that suggests that younger patients are at an increased risk of marijuana-related harm, potentially due to its impact on the developing brain. They suggested that the draft policy be revised to limit or prohibit physicians from prescribing dried marijuana to younger patients. 4 Prescribing high potency (high THC) strains of dried marijuana o Several respondents highlighted a growing body of research that suggests that the risk of harm associated with the consumption of dried marijuana increases with strains that are higher in the psychoactive compound tetrahydrocannabinol (THC). o THC is the primary psychoactive compound found in marijuana. It is responsible for both the “high” that users experience when consuming marijuana, but also potentially some of marijuana’s beneficial therapeutic effects. o Commercial producers of dried marijuana are currently marketing strains of dried marijuana that vary considerably in their concentration of THC, from as low as 90%

70-89%

Assure and Enhance Physician Competence

Physician compliance with CPD requirements

Time from application received by College to (a) first application contact for nonregistration committee cases; (b) first applicant contact for registration committee cases % of registrants participating in, and reporting CPD to a CPSO-approved organization # of physician assessments in College programs % of IEPs developed with (1) specified interventions (2) target outcomes (3) outcome measures Average # of responses/policy

Attention Required 98%

90-97%

= 2600

Tracking 2400-2599

Tracking 75% IEPs meet expectations

60-75% IEPs meet expectations

100 responses

75-99 responses

50-75 responses

Every physician assessed every 10 years Develop, implement and evaluate IEPs for physicians in need Increase participation in development of major policy, regulation and program development.

4

279-5

Objective

Optimize Investigations, Discipline and Monitoring Processes

Measure

Target

On Track

Approaching Target

Existing policies are current and remain relevant. Reduce time for completion of high risk investigations

# of policies considered/Council meeting # days of investigation

6-8 policies in active review/development

>= 2 policies/Council

1 policy/Council

90% of High Profile and/or High Risk investigations are completed in an average of 243 days or less.

90% of High Profile and/or High Risk investigations are completed in an average of 243 days or less.

90% of High Profile and/or High Risk investigations are completed in an average of between 244 and 256 days.

Schedule discipline hearings more quickly

Time from referral to hearing date

Target: 1 year

90% of hearings began within 365 days ( 12 months) on average from the NOH date

90% of hearings began within 457 days ( 15 months) on average from the NOH date)

Improve service level targets Improve service level targets Media coverage

Live answer for PPAS and A&C Call abandonment rate Positive or neutral media coverage

80% live answer

80% or greater

70-79%

90% of High Profile and/or High Risk Investigations are completed in an average of 257 days or more. 90% of hearings began more than 457 days (15 months)on average from the NOH date Less than 70%

15% call abandonment 85%+ positive/neutral media coverage

15% or less

16-20%

Greater than 20%

80-100%

60-80%