Statement from the College of Physicians and Surgeons of Ontario

We know of no investigative process where detailed information about the investigation is available to the public during the course of the investigation. This is because the purpose of an investigation is to gather information to determine whether any action is required based on the findings of the investigation. Public disclosure of information during the investigatory process in many circumstances could compromise the integrity of the investigation. Be it a regulatory or police investigation, agencies charged with this responsibility are often able to confirm that an investigation is underway but that is the extent of information available to the public, unless and until such time as evidence has been gathered to establish that action needs to be taken.

Furthermore, at the investigative stage, the College does not have the authority to impose restrictions on a doctor's practice. However, if a doctor has been referred for a discipline or fitness to practise hearing and we have evidence that suggests the doctor exposes or is likely to expose patients to harm or injury, we can restrict the doctor's practice or suspend the doctor pending the outcome of the hearing, and we inform the public of this restriction on the "public register" on our website.

Sometimes when the College is investigating the competence or conduct of doctors, they might voluntarily restrict their practice to address on an interim basis the concerns that are arising from the investigation, or they may undertake to be supervised by another physician during the investigation. These undertakings are on the public register and thus are available for patients to make decisions about choosing a doctor, but at the investigative stage, conclusions have not been made about the physician's conduct or competence and thus the details and evidence cannot yet be shared with the public.

We endeavour to intervene as quickly as possible when there are conduct or competence issues that need to be addressed. High-risk investigations are given priority. However, there will always be investigations that take longer to complete for any one or a combination of the following reasons:

• We have to wait for evidence from a third-party source, such as billing data, court transcripts, and hospital records.
• We have to wait for an explanation of operational electronic medical records systems (EMRs) from physicians or vendors to properly and efficiently obtain patient records. The multiple EMRs with individual idiosyncrasies contribute to complexity of investigations.
• Investigations into sexual misconduct are typically very detailed and require extensive time, given the mandatory revocation penalty if these allegations are proven at a discipline hearing. Witnesses must be interviewed and the information they provide must be corroborated or refuted. If the witnesses are ambivalent, live in a remote setting, or are transient, locating and obtaining their information is time-consuming. Corroborating it may require such steps as obtaining cell phone records from providers and analysing the calls. If concurrent criminal charges have been filed or if the police have investigated, records must be obtained from the Crown and the courts. It is critical that these steps be undertaken and completed with the greatest attention to detail if we hope to succeed with a discipline finding.
• Investigations involving one physician and numerous complainants are complex and take considerably more time than an investigation involving one complaint. By bringing all investigations about a physician to the ICR Committee for review and decision we can ensure that the case presented is complete and deals with all current concerns about that doctor, including those which arise in the course of the initial investigation.
• Furthermore, in suspected serious cases, external assessor or expert opinions on the care provided are required. This process includes securing an appropriate expert or assessor, obtaining and analysing many patient charts, possible interviews with the physician and completion of a detailed report with opinions about whether or not the care or conduct met the standards of the profession.

Despite these challenges, the investigative process does effectively identify issues requiring remediation or review by the Discipline Committee and the College has a robust process for engaging physicians in remedial programs.

Remedial activities undertaken by doctors to address concerns about a doctor's practice or competence are monitored by the College. Clinical supervision involves the oversight and ongoing assessment of a physician's practice to ensure that the physician is meeting the expected standard of care and that patient safety is not being compromised. Supervision also commonly has a significant educational component for the physician being supervised.

The clinical supervisor is required to review the physician's work, through a review of charts, to assess and report on the quality of documentation and care. Where indicated, clinical supervision will also require the direct observation of a physician in their practice, and interviewing relevant stakeholders regarding their care, among other things.

Physicians who require clinical supervision usually demonstrate meaningful progress and improvement, but to ensure public protection, these remedial undertakings contain provisions such that further action will be taken by the College in instances where improvement is not made.

In terms of the effectiveness of the discipline process, if the discipline panel determines that the College has proved its case, the appropriate penalty is decided, which often includes taking action that affects the doctor's ability to practise medicine, including imposing practice restrictions, a suspension or revocation of the doctor's licence.

Lastly, we would comment that the College is a leader amongst medical regulators in providing physician-specific information to the public. We began a multiphase initiative in late 2012 to review how we could make more physician-specific and process information available to the public on our website. After consulting with physicians and the public on each category of information that was being proposed, the following new information has been added to the CPSO public register as part of this initiative:

• Criminal Charges
• Cautions - a summary of any decision in which a caution is ordered by the Inquiries, Complaints and Reports Committee for investigations commenced on or after January 1, 2015. A caution is ordered when the Committee has a significant concern about conduct or practice. It will also be noted if the decision has been appealed and, if the decision is overturned, it will be removed.
• SCERPs (specified continuing education and remediation program) - if educational or remediation needs for a physician are identified by the Inquiries, Complaints and Reports Committee and a voluntary agreement cannot be reached, a physician may be required to take a specified continuing education or remediation program (SCERP). This information is posted for investigations commenced on or after January 1, 2015.
• Licences and Discipline Findings in Other Jurisdictions
• Criminal Convictions (as of June 1, 2015) and Health Insurance Act offences.
• Current bail conditions, if any, which affect a physician's right to practise.
• Illegal Practitioners
• Medical Records Location (where a physician has left practice and this information is known to the CPSO).
• Notices of Hearing (setting out allegations of professional misconduct or incompetence awaiting hearing by the Discipline Committee that relate to a doctor, as well as the status of the discipline proceeding (e.g., scheduled hearing dates; whether the hearing has been adjourned; etc.).
• Reinstatement Decisions, where a physician has been granted a certificate of registration through the application for reinstatement process.
• Outcome/status of inspections of out-of-hospital clinics conducted by the CPSO.