5. 1 If a physician/medical student’s result is positive for a BBV, they must comply with the terms of this policy prior to performing or assisting to perform EPPs.
5.2 Physicians/medical students who are seropositive for a BBV must have a treating physician.
5.3 Physicians/medical students who perform or assist in performing EPPs and are seropositive for a BBV must report this finding to the Registrar or Registrar’s designate. Reporting must occur on first becoming aware of the finding, and thereafter on annual licence renewal.
5.4 Physicians/medical students who have reported to the Registrar or Registrar’s designate will be referred to the Physician Health Program (“PHP”) of the Saskatchewan Medical Association (“SMA”) for management and monitoring.
5.5 The PHP will apply the guidelines agreed upon by the EAC, or if necessary will consult with the EAC on a non-nominal basis to obtain its recommendations, as described in 5.6 below. The PHP will then convey written instructions to the physician/medical student and/or their treating physician of expectations with respect to the alteration of scope of practice, modification of practice techniques, and/or other precautions that are deemed appropriate to protect the public from risk of harm associated with the continuing clinical practice of the physician/medical student, as well as strategies for effective continuous monitoring of the physician/medical student (the “PHP instructions”).The PHP will obtain written commitment of compliance from the physician/medical student.
5.6 When consulted by the PHP, the EAC will review the practice of the reporting physician/medical student according to the level of risk for BBV transmission, and will issue explicit written recommendations with respect to the alteration of scope of practice, modification of practice techniques, and/or other precautions that are deemed appropriate to protect the public from risk of harm associated with the continuing clinical practice of the physician/medical student.
5.7 Physicians/medical students who have been referred to the PHP will have a reasonable opportunity to participate in this process, on a non-nominal basis, including making submissions in response to the PHP instructions, the right to respond with an expert opinion, and the right to request a review of the PHP instructions by the EAC, on a non-nominal basis.
5.8 On such a review by the EAC, the EAC may make a recommendation that the PHP should reconsider its instructions to the physician/medical student and may make recommendations as to the appropriate PHP instructions (the “EAC recommendation”).
5.9 After proceeding through the EAC review as described in paragraph 5.8, if the physician/medical student believes that the process established in this Policy was not met, or that there was a violation of the principles of natural justice or fairness, the physician/medical student may make an appeal to Council. All such appeals will be presented to Council in written form and will be restricted to issues of process and/or natural justice/fairness.
5.10 Upon receiving an appeal pursuant to paragraph 5.9, Council may make any order as may be appropriate and necessary which, without limiting the generality of the foregoing, may include one or more of the following:
5.11 Council may confirm the PHP instructions or the EAC recommendation;
a) Council may refer the matter back to the PHP or EAC with a direction as to elements to be reconsidered or process to be followed.
b) Physicians/medical students are required to follow the PHP instructions under paragraphs 5.5 and 5.13 and Council instructions under paragraph 5.10 with respect to their practice, and the appropriate treatment of their disease as recommended by their treating physician.
5.12 Provided the physician/medical student remains compliant with the treatment protocol directed by their treating physician and the PHP instructions, and their viral loads remain in the safe range as designated by the EAC from time to time, there will be no further College involvement aside from annual reporting at licence renewal.
5.13 If at any time the physician/medical student’s viral loads exceed the designated acceptable threshold, the PHP, in consultation with the EAC if necessary, will convey written instructions to the physician/medical student as to appropriate practice restrictions until such time as the viral loads are again below the acceptable threshold.
5.14 If at any time the physician/medical student is non-compliant with the treatment recommended by their treating physician and/or the PHP instructions, the PHP will refer the physician/medical student back to the Registrar or Registrar’s designate.
5.15 If the physician/medical student is non-compliant, the College will exercise its statutory authority to ensure compliance or take other measures to protect the public from risk of harm. This may include suspending the physician/medical student’s ability to practice or entering into an undertaking restricting their practice such that they will not perform EPPs until they are compliant and/or their viral load is below the designated threshold.
5.16 If practice restrictions are imposed as referenced in 5.5, 5.10, 5.13 or 5.15, the PHP (or, in the case of 5.15, the College) will report those restrictions (but not the underlying personal health information) to the necessary organizations such as the Saskatchewan Health Authority, specific institutions, and the College of Medicine.
If a physician/medical student becomes aware that one of their colleagues is practising in contravention of this policy, as a first step that physician/medical student should encourage their seropositive colleague to comply with this policy and Bylaw 24.1 and to self-report if required.
Ultimately, physicians/medical students have an ethical responsibility to report to the Registrar or Registrar’s designate a physician/medical student who is known to be practising in contravention of this policy.
A treating physician of a physician/medical student with a BBV who is subject to section 5 of this policy has an ethical responsibility to report to the PHP and the Registrar or Registrar’s designate such physician/medical student if they are non-compliant with their recommended treatment or the PHP instructions.
7. Confidentiality and privacy
The College respects the confidentiality and privacy of all information it receives or creates in the course of fulfilling its regulatory functions. This includes information about blood-borne viruses and physician/medical student health.
Information about a physician/medical student’s serological status is not shared beyond the Registrar and/or Registrar’s designate except 1) to the extent necessary to refer the physician/medical student to the PHP, 2) to address non-compliance, or 3) to advise other regulatory authorities of a health issue on a request for a Certificate of Professional Conduct in accordance with College bylaws.[7] Consultation with the EAC will be on a non-nominal basis. All those who have access to this information know and understand their obligations regarding confidentiality and privacy.
While practice restrictions may be posted on the College website, underlying personal health information will not be included.
Acknowledgements
The College acknowledges that this policy has been adapted, in many parts with no changes, from the respective policies of the College of Physicians and Surgeons of British Columbia, College of Physicians and Surgeons of Ontario, and College of Physicians and Surgeons of Manitoba:
- - CPSBC Practice Standard “Blood-borne Viruses in Registrants”
- - CPSO Policy “Blood borne Viruses”
- - CPSM Standards of Practice of Medicine, Schedule J – Bloodborne Pathogens
The College recognizes, with thanks, the contributions of those organizations to the development of this revised policy.
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