The College’s Regulatory Bylaws establish expectations for physicians and for the College.  They establish practice standards, establish a Code of Ethics  and Code of Conduct , define certain forms of conduct as unprofessional and establish requirements for licensure.

There were nine (9) changes to College regulatory bylaws since the last edition of the Newsletter.
 
 

Regulatory Bylaw 35.1 - Payment at Specialist Rates

Given the ongoing pandemic, the College recognized that Royal College examinations might not be available for all specialties in 2021.  In order to address the potential billing implications of this situation, the Council amended bylaw 35.1 to allow physicians completing residency in 2021 to bill at specialist rates if an examination in their specialty is not available.  As with the previous amendment to address the 2020 cohort, the authorization only extends until there is an examination available in the physician’s specialty.  If a physician does not take the available examination or fails that examination, they will only be eligible to bill at the non-specialist rate.
 

Regulatory Bylaw 24.1 - Reporting of Blood-borne Viruses

This bylaw was amended together with the updated policy Blood-borne Viruses:  Screening, Reporting and Monitoring of Physicians/Medical Students. The primary changes include: 1) Physicians/medical students who perform or may perform / assist or may assist in performing exposure prone procedures (EPPs) must know their status and must comply with a specific testing schedule for blood-borne viruses; 2) Reporting of seropositive status is only required for physicians/medical students who perform or may perform / assist or may assist in performing EPPs; and 3) Monitoring will be performed on an arm’s length basis by the Physician Health Program (PHP) of the Saskatchewan Medical Association rather than by the Registrar’s office. While the bylaw and policy are now in force, transition work is still underway; the College will advise when the transition to the new policy/bylaw has been completed.

Regulatory Bylaw 18.1 - List of Prescription Review Program Medications

The Council updated the list of medications that are subject to the Prescription Review Program to include Lemborexant.

Regulatory Bylaws 17.1 - Minimum standards for Written and Verbal Medication Prescriptions Issued by Physicians and 18.1 - List of Prescription Review Program Medications

The College recognized that there were inconsistencies between bylaws 17.1 and 18.1 and the position taken by the Saskatchewan College of Pharmacy Professionals (SCPP) to authorize pharmacy technicians to receive prescriptions from physicians, and not to authorize pharmacists or pharmacy technicians to receive prescriptions by email message.  Bylaws 17.1 and 18.1 were amended to ensure consistency with the requirements of the SCPP.  This included amendments to bylaw 17.1 to authorize licensed pharmacy professionals (pharmacists or pharmacy technicians) to receive prescriptions from physicians, and an amendment to bylaw 18.1 to recognize secure electronic prescribing but to remove the ability to send prescriptions by email. 

Regulatory Bylaw 2.5 - Requirements relating to provisional licensure and 2.6 - Requirements relating to provisional licensure

The Council amended the bylaws to address eligibility and conditions of licensure for physicians who achieve eligibility to challenge the Royal College examinations through the Practice Eligibility Route (“PER”).  In addition, bylaw 2.6 was amended to authorize the Registrar to temporarily suspend the supervision requirement for a physician who has a provisional licence requiring supervision, but who is temporarily not practising in Saskatchewan.
 

Regulatory Bylaw 2.13 - Podiatric Surgery Permits

Following the approval by the FMRAC Board of Directors of a change in the FMRAC English Language Proficiency model standards, the Council amended bylaw 2.13 to remove the TOEFL and to add the Occupational English Test (OET-medicine) and the Canadian English Language Proficiency Index Program (CELPIP) as acceptable tests to demonstrate English language proficiency.

Council regularly reviews the policies, guidelines and standards which are then made available on the College’s website. 

Since the last Newsletter, Council has adopted adopted two new policies, amended four policies, amended one set of standards and guidelines, and completed a sunset review on one additional guideline.

*Click on each title below to view the complete version of the policy, standard or guideline.
 
 

NEW! POLICY - Medical Assistance in Dying (MAiD)

Patient's Death is NOT Reasonably Foreseeable

Patient's Death is Reasonably Foreseeable

While these policies had been approved by the Council at its June 2020 meeting, they were to come into effect when the legislation came into effect.  Legislation was not passed until March 2021, but it differed from what had been anticipated.  As such, these policies were updated to ensure consistency with changes to the MAiD legislation in June 2021.  Those legislative amendments included the removal of the criterion requiring that a person’s natural death must be reasonably foreseeable, a time-limited exclusion from eligibility for individuals whose sole underlying medical condition is a mental illness, and a two-track approach to procedural safeguards for practitioners to follow, based on whether or not the individual’s natural death is reasonably foreseeable.

The requirements for MAiD for an individual whose death is reasonably foreseeable are largely unchanged from the legislation in effect in 2016.  One notable change is a patient’s ability to make an advance request that they be provided MAiD if they lose consciousness before MAiD can be administered.

There were significant changes to the MAiD legislation addressing the provision of MAiD to patients whose death is not reasonably foreseeable.  Those include: 1) a 90-day waiting period before MAiD can be provided; 2) a requirement that a physician or nurse practitioner with expertise in the condition causing the suffering must provide a written opinion which confirms that the person meets the criteria for MAiD; 3) increased requirements to advise patients of resources that may be available to address their suffering; and 4) that a patient cannot provide an advance directive that MAiD be provided if they lose capacity before MAiD is provided.

Both policies are comprehensive and address the legal requirements and College expectations for physicians dealing with a request for MAiD, both in relation to patients whose death is reasonably foreseeable, and patients whose death is not reasonably foreseeable.  The policies include relevant definitions and foundational principles; address conscientious objection and the requirements for access to MAiD in the two tracks (death is or is not reasonably foreseeable); address the assessment of capacity and obtaining informed consent; address various issues arising in the administration of MAiD; and address the use of standard forms and requirements for reporting and data collection.

POLICY – Opioid Agonist Therapy (OATP) Prescribing and
STANDARDS AND GUIDELINES - CPSS OAT Standards and Guidelines for the Treatment of Opioid Use Disorder

The Council approved amendments to permit the equivalent of direct training in order for a physician to be approved to prescribe methadone and/or buprenorphine/naloxone.  This permits the continuation of a virtual training option that has been successfully piloted during the pandemic. 

POLICY – Public Access to Council Documents and Redaction of Sensitive Information Contained Therein

The Council conducted a sunset review of this policy and approved the policy with two changes: 1) the addition of a reference to Council deciding whether a full charge or synoptic charge should be published on the website when it lays a charge of unprofessional conduct, and 2) a reference to the fact that the policy on Alternative Dispute Resolution (ADR) sets out what will be published in the event of an ADR. 
 

POLICY – Physicians at Risk to Patients

This policy underwent a sunset review and was approved with the addition of reference to the duties to report contained within the following:  1) paragraph 31 of the Code of Ethics  contained within bylaw 7.1, 2) the policy “Sexual Boundaries ”, 3) the policy “Blood-borne Viruses:  Screening, Reporting and Monitoring of Physicians/Medical Students ,” and 4) bylaw 24.1 – “Reporting of Blood-borne Viruses” .
 

GUIDELINE – Infection Prevention and Control (IPAC) Guidelines for Clinical Office Practice

This guideline underwent a sunset review and was approved without changes.

POLICY – Scope of Practice Change

This policy underwent a sunset review and a number of amendments were approved.  This included an updated format and the addition of a ‘scope of this policy’ section, additional examples of changes in scope of practice, details with respect to supervision, and a ‘resources’ section.