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College of Physicians and Surgeons of Newfoundland & Labrador

Regulating MDs:  The Complaint Process, Discipline,
and Screening for Fitness to Practice

Disclosure Policies

Disclosure of an Adverse Outcome

College position:  Patients are entitled to be informed of all aspects of their health care. This includes the right to disclosure of an adverse outcome. Whenever possible, the disclosure should be made directly to the affected patient. The disclosue should be made by the medical practitioner who was most in charge of the treatment when the adverse event occurred.

Patients have a right to know their present medical status, not only as an intrinsic right but also to make informed decisions about their health care. This means patients have a right to know when an adverse treatment outcome impacts their present medical status. Leaving it to a patient, or to an alternate health care provider, to discover or act upon an adverse outcome is not consistent with the rights of patients, and in some circumstances the resultant delay may harm the patient.

Disclosure of Discipline Information on Certificates of Standing

Whenever a complaint has been lodged against a medical practitioner, the College of Physicians and Surgeons of Newfoundland and Labrador will include this information on the physician's Certificate of Standing:

  • Certificate of Standing – Dates and particulars of:
  • Hearing committee decision;
  • Finding of professional misconduct or conduct unbecoming;
  • Finding of incompetence or impairment;
  • Suspension or revocation of licensure;
  • Terms, conditions or limitations of licensure;
  • Consensual reprimands;
  • Finding of counsel or caution; and,
  • Open complaints.

Patient Questionaires:  Cherry-Picking is Discrimination

Certain doctors have begun to ask prospective patients to complete a detailed medical questionnaire before agreeing to accept a patient into their practice. But the College takes the position that cherry-picking patients abrogates the Canadian Charter of Rights. The Charter was adopted by the Canadian Medical Association Code of Ethics which states:

CMA Code of Ethics, Section 17
In providing medical service, do not discriminate against any patient on such grounds as age, gender, marital status, medical condition, national or ethnic origin, physical or mental disability, political affiliation, race, religion, or socioeconomic status. This does not abrogate the physician's right to refuse to accept a patient for legitimate reasons.

College Guideline for Physicians
Do not ask prospective patients to complete medical questionnaires before they meet you. If you chose to not accept that patient, he or she could allege that you turned them down due to their medical problems, a practice that is unethical and unprofessional. If you want to use a questionnaire, do so after you accept the patient into your practice. The College takes patient complaints seriously on this issue, and the offending MD may be subject to investigation by the Complaints Authorization Committee.

By-Law 7:  Verification of of Applicants for Registration or Licensing

Upon any application for registration, license, or renewal of license with the College, an applicant shall provide any and all of the following information upon College request:

  • Whether the applicant has been charged with or convicted of any offence. This includes offences in Canada under the Criminal Code, the Controlled Drugs and Substances Act, or the Food and Drugs Act. It further includes offences under the criminal law, controlled drugs and substances law, or food and drugs law of any jurisdiction outside Canada. It excludes any charge that has been withdrawn or resulted in a decision of not guilty, and it excludes traffic infractions or parking violations.
  • Information relating to the applicant's professional standing and fitness to practice, including but not limited to:
    • The applicant's health, as it may affect the applicant's fitness to practice or as it may pose a risk to patients;
    • The applicant's history of addiction or abuse of alcohol, drugs or other substances;
    • Complaints made against the applicant by other regulatory authorities or hospitals;
    • Any restriction on practice in other jurisdictions, whether voluntary or involuntary;
    • Any revocation, withdrawal, surrender, suspension, restriction, limitation, alteration, non-renewal, or resignation of registration or license to practice or of hospital privileges.

Any failure to provide the information shall be grounds for denial of an application.

Health Record Privacy and Amendment

Provincial and Federal Legislation

PIPEDA Personal Information Protection and Electronic Documents Act
This privacy law covers private-sector commercial organizations, including medical clinics and physicians in private practice.
Privacy Act Privacy Act
This privacy law relates to an individual's right to access and correct personal information the Government of Canada holds about them.
HIPA Health Information Protection Act
This legislation, locally enacted by each province, governs the trustees of health records.

The federal PIPEDA law governs private-sector organizations engaged in commercial activities across Canada. It sets down clear rules for how these organizations may collect, use, or disclose personal information, and guarantees concrete avenues for amending flawed information. PIPEDA applies to medical clinics and physicians in private practice.

Some provinces have HIPA legislation that, on inspection, is deemed substantially similar to the health-records subset of PIPEDA.  An organization that operates solely within such a province will be exempt from PIPEDA, unless the personal information crosses provincial or national borders.

But more than half the provinces and territories have HIPA legislation which is not substantially similar to PIPEDA. In such provinces, an application to PIPEDA may succeed.

Newfoundland/Labrador is a compliant province – its local HIPA legislation offers a pragmatic protection for health records that is deemed substantially similar to PIPEDA. Compliance oversight belongs to the Office of the Privacy Commissioner of Canada.

Georgena S. Sil
Saskatoon, Canada
Physicist & Technical Writer
Alumnus: University of British Columbia

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