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Enabling Legislation

College of Physicians and Surgeons of Saskatchewan - Bylaws

PART 3 – PRACTICE ENHANCEMENT

6.1 The Practice Enhancement Committee

(a) Composition
(i) There shall be a standing committee appointed pursuant to Section 6(2)(p) and 6(2)(q) of the Act for the purpose of peer assessment of medical office practices which shall be known as the Practice Enhancement Committee.
(ii) The Practice Enhancement Committee shall be composed of six persons appointed by the Council, three of whom shall be nominated by the Saskatchewan Medical Association.

(iii) The members of the Practice Enhancement Committee shall be appointed by the Council annually. The Council may fill a vacancy in the Committee by appointing such person or persons as the Council thinks appropriate.
(iv) From time to time, the chair, or one of the co-chairs, may appoint from the assessors one or more temporary members of the Practice Enhancement Committee as a temporary replacement for a member of the Committee who is unable to attend a meeting of the Committee, or as a temporary replacement for a member who has resigned. Such an appointment shall be made only for a single meeting of the committee.
(v) A member of the committee appointed pursuant to subsection (iv) is entitled, with respect to the meeting for which the person is appointed, to all the rights and privileges of a member appointed pursuant to subsection (iii).

(b) Objectives
(i) The purpose of the Practice Enhancement Committee is to establish, develop and administer an ongoing program of peer assessment of the office practice of members of the College in the member’s chosen field to the end that the public may be served by helping members of the College to maintain proper standards of practice in the care of patients and the keeping of records.

(c) Methods
(i) Subject always to the direction of the Council, the Practice Enhancement Committee shall conduct its business in such manner and may adopt, use and vary such programs and forms as it sees fit.
(ii) The Practice Enhancement Committee may from time to time appoint any one or more of its members or other persons as assessors and delegate to persons so appointed the authority to conduct an assessment and to report thereon to the Practice Enhancement Committee.
(ii) The Practice Enhancement Committee will select the members of the College to be assessed and in doing so will endeavour to have due regard for the distribution of medical practitioners in the province and the differences in practices and specialties to the end that the benefits of the activities of the Practice Enhancement Committee may be fairly extended to the public and the members of the College throughout the province.
(iv) Every member of the College whose standards of practice are the subject of an assessment as part of a peer assessment program shall co-operate fully with the Practice Enhancement Committee and with its assessors. The co-operation required of a member includes:
1. permitting assessors appointed by the Practice Enhancement Committee to enter and inspect the premises where the member engages in the practice of medicine;
2. permitting assessors appointed by the Practice Enhancement Committee to inspect the member’s records of the care of patients;
3. providing to the Practice Enhancement Committee or its assessors information requested by the Practice Enhancement Committee or the assessors in respect of the care of patients by the member, the member’s records of the care of patients or such other information that may be requested that is relevant to office practice of the member;
4. providing the information mentioned in paragraph 6.1(c)(iv)3 in the form requested by the Practice Enhancement Committee or its assessors; and
5. conferring with the Practice Enhancement Committee or its assessors when requested to do so by the Practice Enhancement Committee or its assessors.

(d) Reporting
(i) Where the Practice Enhancement Committee forms the opinion that the information it has gathered respecting a physician indicates that:
1. the public is at an immediate risk of harm; or
2. the physician has failed, after due notice, to comply with provisions of these bylaws pertaining to the Practice Enhancement Program, or has otherwise failed or refused to co-operate with the Practice Enhancement Committee in its assessment; or
3. the physician has refused to undertake remedial measures recommended by the Committee and the Committee considers that such refusal is unreasonable; or
4. the physician has done or failed to do something that is a serious breach of ethics;
it shall report the matter to the Council in accordance with paragraphs 6.1(d)(ii) and (iii).
(ii) Where the Practice Enhancement Committee concludes that one or more of the conditions in paragraph 6.1(d)(i) have been satisfied, the Practice Enhancement Committee shall report the matter to the College. When reporting such matter to the College, the Practice Enhancement Committee shall, at first instance, provide only sufficient information to permit the College to fulfill its responsibilities pursuant to the Act. Such information shall, at first instance, be limited to:
1. where the Committee has formed the opinion that the public is at immediate risk of harm, the name of the physician, the conclusion of the Committee and general information pertaining to the harm perceived by the Committee;
2. where the Committee has formed the opinion that the physician has failed, after due notice, to comply with the provisions of these bylaws pertaining to the Practice Enhancement Program, or has otherwise failed or refused to cooperate with the Practice Enhancement Committee in its assessment, the name of the physician and sufficient particulars of the physician’s failure or refusal to permit the College to appoint a Preliminary Inquiry Committee to investigate such failure or refusal, or to permit the Council to lay a charge of unbecoming, improper, unprofessional or discreditable conduct against the physician;
3. where the Committee has formed the opinion that the physician has refused to undertake remedial measure recommended by the Committee and the Committee considers that such refusal is unreasonable, the name of the physician, information respecting the remedial measures recommended by the Committee and information pertaining to the physician’s refusal;
4. where the Committee has formed the opinion that the physician has done or failed to do something which a serious breach of ethics, the name of the physician and sufficient particulars of the physician’s action or failure to permit the College to appoint a Preliminary Inquiry Committee to investigate such action or failure, or to permit the College to lay a charge of unbecoming, improper, unprofessional or discreditable conduct against the physician.
(iii) Notwithstanding paragraph 6.1(d)(ii), if the physician with respect to whom the report ismade applies to a court to prevent action being taken by the College, or if the physician seeks to quash an action taken by the College, or to appeal from a decision made by the College, or if the physician should oppose the appointment of a Preliminary Inquiry Committee or a Competency Committee by the College, the Practice Enhancement Committee shall provide to the College such additional information as may be necessary to provide the Court or the College with full information pertaining to the factual basis for the Committee’s opinion.
(iv) Notwithstanding paragraphs 6.1(d)(ii) and 6.1(d)(iii) above, the Committee may, in its absolute discretion, provide additional information to the College relating to the matters in paragraph 6.1(d)(i) above, if the Committee concludes that the information is required by the College to protect the public interest.
(v) The Practice Enhancement Committee shall keep confidential all information gathered in the course of an assessment of an individual, and shall disclose such information only in accordance with the provisions of paragraphs 6.1(d) (i), (ii), (iii) and (iv). The Practice Enhancement Committee may provide information to the Council of a general nature, which does not identify the physicians involved, to permit the Council to assess the Practice Enhancement Program and to prepare reports of a general nature to the members of the College. The Council shall maintain confidential all information which it obtains from the Practice Enhancement Committee and shall not utilize such information unless:
1. If the Practice Enhancement Committee has provided this information to the Council pursuant to paragraphs 6.1(d) (i), (ii), (iii) and (iv), the information may be used solely for the purpose of determining whether to lay a charge of unbecoming, improper, unprofessional or discreditable conduct, or to appoint a Preliminary Inquiry Committee or a Competency Committee, or for the purpose of an interview conducted by the Council or a Committee appointed by the Council, and for no other purpose; or
2. For the purpose of preparing a report of a general nature by the Council to the members of the College. Such information shall not identify the physicians involved.
(vi) The Practice Enhancement Committee shall report to the Council and the Saskatchewan Medical Association on its activities and programs of assessment at such times and in such manner as the Council may from time to time direct.

(e) Meetings
(i) The Committee will meet at the call of the Chair.
(f) Other provisions
(i) A witness before a Discipline Hearing Committee or a Competency Hearing Committee may not be asked and is not permitted to answer any question or make any statement with respect to any proceeding before a Practice Enhancement Committee, and may not be asked to produce and is not permitted to produce any report, statement, memorandum, recommendation, document, information, data or record that is:
1. prepared exclusively for the use of or made by; or
2. used exclusively in the course of, or arising out of, any investigation by a Practice Enhancement Committee.
(ii) No report, statement, memorandum, recommendation, document, information, data or record mentioned in paragraph 6.1(f)(i) is admissible as evidence before a Discipline Hearing Committee or a Competency Committee.
(iii) Paragraphs 6.1(d)(v), 6.1(f)(i) and 6.1(f)(ii) do not apply to hearings before a Discipline HearingCommittee on a charge that a physician is guilty of unbecoming, improper, unprofessional or discreditable conduct for failing or refusing to co-operate with the Practice Enhancement Committee or for failing to comply with the provisions of these bylaws pertaining to the Practice Enhancement Program.
(iv) If, during the course of an assessment or assessments, the Practice Enhancement Committee identifies concerns of a systemic nature that, in the opinion of the Committee:
1. should be remedied; and
2. are not limited to the practice of the physician being assessed
the Committee may report their concerns to the individuals or organizations that, in the Committee’s opinion, have the responsibility to remedy such concerns.
(v) If a report pursuant to paragraph 6.1(f)(iv) is made to a physician, or to more than one physician, the Practice Enhancement Committee may:
1. meet with the physician(s);
2. prepare recommendations to the physician(s) to address the concerns identified by the Practice Enhancement Committee;
3. arrange for a review, at some future time, to determine if the concerns of a systemic nature identified by the Committee have been rectified.
(vi) Where the Committee has formed the opinion that the physician(s) has refused or neglected to remedy the concerns of a systemic nature identified by the Committee pursuant to paragraph 6.1(f)(iv) the Committee may refer that matter to the College and the provisions of paragraph 6.1(d) apply, with such changes as may be necessary.
(vii) If a report pursuant to paragraph 6.1(f)(iv) is made to a person who is not a physician, or to an organization, the Practice Enhancement Committee may:
1. meet with such person or persons as the Committee think advisable;
2. prepare recommendations to the person or persons to address the concerns identified by the Practice Enhancement Committee;
3. arrange for a review, at some future time, to determine if the concerns of a systemic nature identified by the Committee have been rectified.
(viii) The Committee may also report the matter to the Minister of Health if the report pertains to:
1. a regional health authority or a health care organization within the meaning of The Regional Health Services Act, the Saskatchewan Cancer Foundation, or a person or organization that provides health services pursuant to an agreement with the Minister of Health, or
2. any other persons or organization, on an informational basis.

PART 4 – CODE OF ETHICS, UNPROFESSIONAL CONDUCT, DISCIPLINE, AND COMPETENCY ASSESSMENTS
7.1 The Code of Ethics
(a) Subscription to and observance of the Code of Ethics is a condition of registration under the Act.
(b) No person who is registered under the Act shall contravene or fail to comply with the Code of Ethics.
(c) Contravention of or failure to comply with the Code of Ethics is unbecoming, improper, unprofessional or discreditable conduct for the purpose of the Act.
(d) Every person who applies for registration under the Act shall subscribe to The Code of Ethics, as adopted by the College of Physicians and Surgeons from time to time, as a condition of registration.
(e) Every person who is registered under the Act shall observe The Code of Ethics, as adopted by the College of Physicians and Surgeons from time to time, as a condition of maintaining his or her registration.
(f) The Code of Ethics as adopted by the College of Physicians and Surgeons is the 2004 Canadian Medical Association Code of Ethics, with a change to paragraph 48 of the CMA Code of Ethics.
(g) The Code of Ethics adopted by the College of Physicians and Surgeons is as follows:

CODE OF ETHICS
This Code has been prepared by the Canadian Medical Association as an ethical guide for Canadian physicians, including residents, and medical students. Its focus is the core activities of medicine – such as health promotion, advocacy, disease prevention, diagnosis, treatment, rehabilitation, palliation, education and research. It is based on the fundamental principles and values of medical ethics, especially compassion, beneficence, non-maleficence, respect for persons, justice and accountability. The Code, together with CMA policies on specific topics, constitutes a compilation of guidelines that can provide a common ethical framework for Canadian physicians. Physicians should be aware of the legal and regulatory requirements that govern medical practice in their jurisdictions. Physicians may experience tension between different ethical principles, between ethical and legal or regulatory requirements, or between their own ethical convictions and the demands of other parties. Training in ethical analysis and decision-making during undergraduate, postgraduate and continuing medical education is recommended for physicians to develop their knowledge, skills and attitudes needed to deal with these conflicts. Consultation with colleagues, regulatory authorities, ethicists, ethics committees or others who have relevant expertise is also recommended.

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