A new Act that regulates health care, the Health Professions and Occupations Act, received Royal Assent in November 2022 but is not yet in force. There are some significant differences between the new Act and the current Health Professions Act, notably the obligation to self-report if you are lacking the competence or capacity to do your job.

To better understand the duties to report under both the current and pending Acts, VPSA organized a presentation with Renée Gagnon, a lawyer with Harper Grey who works with its Health Law & Professional Regulation Groups, and Dr. Ashok Krishnamoorthy, Regional Medical Director, Medical Staff Wellness, at VCH. They reviewed the duty to report, supports and resources in place, and what to expect when a process is initiated. The presentation was facilitated and organized by Drs. Anna Borowska and Soma Ganesan on behalf to VPSA’s Community Building & Wellness Task Group.

Ms. Gagnon handled the legal side of the conversation and emphasized the importance of physicians considering self-reporting or reporting a health-care colleague to speak first with the Canadian Medical Protective Association, which all physicians are members of. The organization can provide advice and, because physicians are members, there is no cost.

Reasons to report a colleague include:

• The person is not competent / unfit to practice, and their continued practice presents a risk of harm to the public.
• The person is not practicing in an ethical manner or in accordance with ethical standards. That is, there are concerns with boundary violations or disruptive conduct.

Ms. Gagnon stressed that while no one wants to report a colleague, there is a legislative duty to do so if you believe the conditions to report are being met. If you self-report or are reported, she emphasized the importance of obtaining a legal representative through CMPA to advocate for you.

Wellness supports and resources

Dr. Krishnamoorthy advises that your department or division head should be your first point of support. Senior medical directors can support all types of duty-to-report issues with advice and coaching. In his role as a regional medical director, Dr. Krishnamoorthy is available for well-being-related supports.

VCH’s peer support program is ideal for physicians who have been reported. The reporting physician can also seek support to deal with personal distress.

Doctors of BC’s Physician Health Program can provide significant levels of support to those in need. It offers confidential advocacy, support, and referral assistance for individual physicians and physicians-in-training. PHP also provides wellness initiatives to promote the ongoing health of our physician community.

VPSA’s weekly Checkup newsletter includes a standing section on wellness resources available to medical staff.

Case examples

Dr. Krishnamoorthy provided examples of situations where there is a duty to report. These included a physician who was referred for possible depression and found to have significant impairment of baseline cognitive functions during an initial appointment. There was a duty to report this significant mental condition. This was discussed with the physician and family supports were involved. The case was then discussed with the College of Physicians and Surgeons of BC’s deputy registrar. The physician was encouraged to take temporary inactive (TI) status, eventual resignation from work, and withdrawal of their license.

Another example was a physician who was slow at completing records and showed symptoms of depression and clinical ADHD. The physician was encouraged to take TI status and then underwent treatment including executive coaching support. The College was involved and supported the plan that included a return-to-work component. (Dr. Krishnamoorthy noted that in approximately 90 per cent of the cases he has been involved with, the person who went on temporary inactive status had returned to work.)

Dr. Krishnamoorthy reminded attendees that the College’s job is to protect the public and that involving CMPA provides you with legal counsel support to navigate the process and negotiate terms for monitoring your health and determining when you can return to work. If the case is contentious, his advice is to call CMPA: let the lawyers fight the regulators.

An ounce of prevention is worth a pound of cure

Self-disclosure is the best situation to find yourself in. However, it is better to look after yourself so you could avoid getting into this situation in the first place. Seek help and support, starting with the VCH peer support and the Provincial Physician Health Program. Look after your health.