Put more pa­tients on doc­tors’ board

Times Colonist - - Comment -

The B.C. Col­lege of Physi­cians and Sur­geons is the dis­ci­plinary body for doc­tors in our prov­ince. Its prin­ci­pal duty is to pro­tect pa­tient safety by mon­i­tor­ing the per­for­mance of physi­cians. But a case that came to light re­cently raises se­ri­ous ques­tions about how thor­oughly such over­sight is con­ducted.

In 2015, it was learned that Dr. Win­ston Tuck Loke Tam, an ob­ste­tri­cian-gy­ne­col­o­gist in Van­cou­ver, had been see­ing as many as 90 pa­tients a day. And he was billing up to $1.7 mil­lion a year — five times the av­er­age for his spe­cialty.

A gov­ern­ment au­dit even­tu­ally re­vealed his over­billing, and he was or­dered to re­pay $2.1 mil­lion. Tam re­signed and left the coun­try.

But his high rate of billing had been go­ing on for more than a decade. More trou­bling still, Tam had been the sub­ject of nu­mer­ous pa­tient com­plaints, in­clud­ing al­le­ga­tions that he con­ducted pelvic ex­ams with­out con­sent, made in­ap­pro­pri­ate re­marks about his pa­tients’ sex lives and mis­han­dled births. He once de­liv­ered 15 ba­bies in a sin­gle shift.

How­ever, when ques­tioned, the Col­lege of Physi­cians and Sur­geons re­fused to say when the com­plaints started, or how many there were. The rea­son given was the need to pro­tect Tam’s pri­vacy.

This is not an iso­lated in­stance. Over the past 10 years, the col­lege has dis­ci­plined 60 physi­cians for rea­sons that in­clude in­ap­pro­pri­ate re­la­tion­ships with pa­tients, fail­ing to dis­close dis­ci­plinary ac­tions in other prov­inces and over-billing.

But we are given only sum­mary ac­counts of the com­plaints that led to these mea­sures. The im­pres­sion this leaves is that the col­lege is more in­ter­ested in lim­it­ing the dam­age caused by such dis­clo­sures than pro­vid­ing full in­for­ma­tion to the pub­lic.

Yet B.C.’s pri­vacy statutes make clear that such in­for­ma­tion can be re­leased when it is in the pub­lic in­ter­est to do so. That ap­pears to be the case here.

One so­lu­tion would be to change the col­lege’s board struc­ture. At present, there are five mem­bers ap­pointed by the gov­ern­ment and 10 physi­cians. That means doc­tors tend to dom­i­nate the var­i­ous dis­ci­plinary com­mit­tees.

The for­mer Lib­eral ad­min­is­tra­tion in On­tario had planned such a change, be­fore its de­feat in the re­cent pro­vin­cial elec­tion. The re­bal­anc­ing was rec­om­mended by a task force set up to ex­am­ine al­le­ga­tions that physi­cians guilty of sex­ual abuse re­mained in prac­tice.

Some­thing of the sort has been done with univer­sity boards of gov­er­nors. Most uni­ver­si­ties in B.C. have a gov­er­nance body com­posed of eight gov­ern­ment ap­pointees and seven mem­bers of the aca­demic com­mu­nity.

The rea­son is that while post-sec­ondary in­sti­tu­tions have com­plete lat­i­tude in pre­serv­ing aca­demic in­de­pen­dence, the pub­lic has an im­por­tant role to play in pro­vid­ing over­all guid­ance.

It can be ar­gued that col­leges of physi­cians and sur­geons have more com­plex is­sues to deal with. Some of the com­plaints brought be­fore them are tech­ni­cal in na­ture, and re­quire ex­pert ad­vice to re­solve.

It must also be noted that many of the al­le­ga­tions made by pa­tients do not stand up un­der scru­tiny.

Yet there is a broader pub­lic in­ter­est at stake. Physi­cians hold a po­si­tion of con­sid­er­able power and pres­tige in the com­mu­nity.

But they are also hu­man be­ings, with the same weak­nesses we all pos­sess. While some com­plaints might be suf­fi­ciently well sup­ported that no rea­son­able per­son would dis­pute them, there are bound to be al­le­ga­tions that are more finely bal­anced.

It’s here that a stronger pres­ence of pub­lic mem­bers could bring a dif­fer­ent out­look to de­lib­er­a­tions. A com­plaint that prac­tis­ing physi­cians might be in­clined to dis­miss might take on a dif­fer­ent com­plex­ion when viewed from the pa­tient’s per­spec­tive.

But when pub­lic ap­pointees can be out­voted two to one, what as­sur­ance do we have that the col­lege re­ally is pa­tient-ori­ented?

In the end, it comes down to ap­pear­ances. Board mem­bers no doubt take their re­spon­si­bil­i­ties se­ri­ously.

But as things stand, the struc­ture of the board gives the ap­pear­ance of im­bal­ance. The pro­vin­cial Health Pro­fes­sions Act em­pow­ers the min­is­ter to in­crease the num­ber of pub­lic ap­pointees. This should be done.

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