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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