Physicians with infectious diseases
Patchwork of policies will likely persist
CMA News 1999;9(8): 5
Canadian licensing authorities are at many different stages as they try to determine how to strike a balance between safeguarding patient safety and protecting fundamental human rights when they deal with physicians who have hepatitis or other infectious diseases.
Last year Health Canada called for mandatory screening for hepatitis B infection and, for those who tested positive, forced suspension of privileges to perform "exposure-prone" surgical procedures. The CMA, while lauding the guidelines' intent, did not endorse them because they failed to guarantee the rights of privacy, confidentiality and autonomy for the health care workers they affected. The CMA is one of many medical organizations to argue that voluntary testing and strict adherence to universal precautions is a much better formula for minimizing the risk of blood-borne disease transmission by health care workers (CMAJ 1998; 159:45-6 and 159:64-5).
Canadian medical schools are also grappling with the issue and so far have failed to agree on issues such as mandatory testing and mandatory reporting. That the medical schools don't have a common policy should not be surprising given the state of affairs at the provincial/territorial level. Members of the Canadian Medical Forum discussed the disparate policies at their meeting in June, hoping to find some common ground upon which to devise a policy or guideline that could be widely used by licensing authorities, medical schools and others.
"We need to move forward, pull information together and develop a common policy that can be adopted broadly," said Dr. Dale Dauphinée, executive director of the Medical Council of Canada. "Currently students, who tend to be more mobile than physicians, face very different policies when they move to different jurisdictions."
To deal with the tangle of policies, General Council delegates called on the CMA last year to collect and publicize all policies concerning restriction of practice of physicians with infectious diseases. Members of the British Columbia delegation proposed the resolution because they were worried about the impact different policies in different areas would have on physicians, who might contravene regulations without even knowing it.
Currently, the provincial colleges in BC, Alberta, Saskatchewan, Manitoba and Ontario either have formal policies either in place or have approved them in principle. Several other jurisdictions rely on ethical principles spelled out in the CMA Code of Ethics or the association's policy on preventing the transmission of hepatitis B. Many hospitals and regional health bodies such as the Capital Health Authority in Edmonton have developed their own policies.
Although developing a common policy that would oversee all health care workers in Canada might be the goal, the fact that some jurisdictions currently enforce mandatory testing while others refuse to could make that a very difficult task.
"I think it would be very difficult to convince all licensing authorities to bring in mandatory testing [of physicians for blood-borne pathogens]," Dr. Cameron Little, immediate past president of the Federation of Medical Licensing Authorities of Canada, told the forum meeting.
|Resolution from General Council
That the CMA ascertain from provincial and territorial licensing authorities policies on restriction of practice of physicians with infectious diseases and communicate these policies to the divisions and members.
|Policies on restriction of practice|
|College of Physicians and Surgeons of BC|
- formal policy, referring to HIV and HBV, in 1995 policy manual. "A member who has a blood borne communicable disease that may pose a risk to patients must: consult an appropriate colleague for continuing care; and consult a designated panel regarding the need for any alteration in the scope of practice, modification of practice techniques and/or any other precautions that are appropriate to protect the public from risk of harm through the continuing clinical practice of the affected doctor. The panel will advise of harm through the continuing clinical practice of the affected doctor. The panel will advise as to how the affected doctor's health and practice should be monitored.
|College of Physicians and Surgeons of Alberta|
- formal policy, referring only to HIV, was published in 1992 and contains nine recommendations. The policy does not recommend mandatory testing of health care workers for HIV. The college says testing should be voluntary, with appropriate safeguards for confidentiality. As in BC, all HIV-positive health care workers are expected to contact an expert review panel for evaluation of their professional activities.
|The College of Physicians and Surgeons of Saskatchewan|
- two policies: Physicians at risk: A physician who has a communicable disease (as defined by the Public Health Act) or any other condition that puts patients at risk should refrain from professional activities. Any physician who knows that a colleague's professional activities places patients at risk should report this to the college.
|Physicians with HIV/HBV: College members, if they are infected with HBV or HIV, are HIV positive or have AIDS, should report their condition to the medical officer of health for their district. The information will be reported to the advisory committee of the college without identifying the physician. The committee will then issue specific recommendations with respect to appropriate actions to be taken to protect the public from risk of harm caused by the physician's continuing clinical practice.|
|The College of Physicians and Surgeons of Manitoba|
- revising formal policy covering HBV/HIV infection
|The College of Physicians and Surgeons of Ontario|
- recently adopted a policy in principle, currently studying operational issues (mainly the running of expert panels) with the Ontario Medical Association
- the policy will not be enforced until finalized
|Le College des medecins du Quebec|
|College of Physicians and Surgeons of New Brunswick|
- no formal policy
- relies on basic ethical principles, prevailing practice and the CMA Code of Ethics
- endorsed, in principle, various statements such as those generated by Alberta in 1993, and the CMA guidelines on the matter
|College of Physicians and Surgeons of Nova Scotia|
- no formal policy
- relies on the CMA Code of Ethics and principles within the CMA's policy on preventing the transmission of hepatitis B
|College of Physicians and Surgeons of PEI|
- no formal policy, but abides by the policy of the College of Physicians and Surgeons of Ontario that physicians with an infectious disease must be reported to the provincial medical officer of health
|Yukon Medical Council|
|Newfoundland Medical Board|
- no formal policy, but currently reviewing the need for a guideline or policy. Would apply Alberta policy if the need arises
|Northwest Territories (Department of Health and Social Services)||
- the department is in the developmental stages of forming a policy
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© 1999 Canadian Medical Association