NOVEMBER 15-30, 2007
VOLUME 4 NO. 19

POLICY & POLITICS

Alberta bill takes aim at MD self-regulation

"Draconian" law would let gov't seize control of College: doctors


Proposed legislation in Alberta could mean the end of self-regulation for doctors in the province, warn physician leaders.

"That's irrational," retorts health minister Dave Hancock, speaking to NRM by cellphone from his car. Mr Hancock has pledged to bring Bill 41 to a vote in the Tory-majority provincial Legislative Assembly as early as this month and no later than early December.

The debate stems from Bill 41's controversial Section 135. That section would allow the health minister to dictate changes to the code of ethics, standards of practices and bylaws of the College of Physicians and Surgeons of Alberta and similar professional organizations, as well as to appoint administrators to govern the organizations if the minister deems it necessary to do so for reasons of public safety.

"There is a general consensus amongst practising physicians about the potential threat of Bill 41 to self-regulation," says Alberta Medical Association (AMA) president Dr Darryl Labuick. In a rare moment of unanimity, all 116 AMA representatives voted to condemn Bill 41 after Mr Hancock appeared at the group's annual Representative Forum meeting on September 28 to argue his case.

OVERSIGHT SLIGHT
Bill 41 was introduced in June after two highly publicized medical equipment sterilization scandals came to light in March. After improper sterilization led to an MRSA outbreak at St Joseph's Hospital in Vegreville, the government turfed out the hospital's administrators and hand-picked their replacements. Then the College of Physicians and Surgeons of Alberta revealed it had investigated two obstetricians at a Lloydminster clinic two years earlier but didn't report the incident to the government until after it learned of the Vegreville problem.

Bill 41's timing proves the government is using the legislation to shift blame away from the health ministry's appointed regional health authority officials and onto MDs, charges Alberta NDP MLA Raj Pannu, who serves as his party's caucus representative to the legislative committee that held the hearings on Bill 41. "The incidents in March had nothing to do with self-governance," he says. "Putting these extremely important powers in the hands of the minister is not justified, in my view."

Mr Hancock insists that the plan for Bill 41 had been in the works since January, before Vegreville and Lloydminster hit headlines, as part of an effort to shore up government accountability.

CONFLICT OVER CHANGES
Ministry officials have repeatedly insisted Bill 41 is not intended to take away professional organizations' powers of self-regulation - "That's an overreaction," says Mr Hancock — but rather to help provide interim governance to very small organizations that can't yet regulate themselves.

But Mr Pannu and Dr Trevor Theman, registrar of the College of Physicians and Surgeons of Alberta, agree that if that is truly the government's motive behind Bill 41 then Section 135 must be clarified to reflect that.

Accordingly, Dr Theman has submitted a set of suggested changes to the law. Firstly, remove Section 135 in its entirety. (The rest of Bill 41 consists of changes to public health reporting rules and other changes that are largely uncontested.) If Section 135 is not removed, he says, several changes are needed. "In our view the Bill should not address references to standards of practice or codes of ethics and bylaws," says Dr Therman. "There should be a preamble that explains when the legislation could be used, only after consultation and all efforts at cooperation [with the professional organization] have failed. There also should be legislative review - 'sober second thought' allowed before the use of the legislation."

HOPE FOR COMPROMISE
"The devil is in the details," says Mr Hancock when asked about possible amendments being made to Bill 41 before it goes to a vote. "Government being able to carry out assurance is something I can't play with, but if we can change some wording to give them [physicians] comfort that we won't jump in on a whim, that we have a duty to do consultation, then I am happy to try to arrive at that kind of an amendment."

He suggests that mentions of codes of ethics could be left out of the final draft of Bill 41 but he says the power to change standards of practices likely won't budge, especially in light of new government initiatives to implement multidisciplinary teams of health professionals.

As for the proposal to add a requirement of legislative review, he says, "I don't like to set up rigid structures where rigid structures are not needed, but we can look at it if they [physicians] feel it is an oversight."

Mr Pannu says the NDP will vote against the legislation as long as it retains Section 135's current wording. The Alberta Liberal Party is equivocal: health critic Laurie Blakeman says she's "open to debate" but adds, "Frankly, I find more credence in the College's concerns."

 

 

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