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COLLEGE OF PODIATRIC SURGEONS OF BRITISH COLUMBIA

ANNUAL REPORT

2018

….. THE PATH AHEAD


2018 ANNUAL REPORT

The College exists to regulate the practice

of podiatry in BC

Protecing the public’s right to excellence in podiatric medicine & surgery is the only thing that we do

2018 ANNUAL REPORT

CONTENTS

1. Duties and Objects of the College 1

2. Annual General Meeting Agenda 2

3. 2017 AGM Minutes 3

4. Board Members 7

5. Board / Chair Message 8

6. Registrar’s Message 10

7. Registration Committee 12

8. Quality Assurance Committee 14

9. Inquiry Committee 16

10. Discipline Committee 18

11. Patient Relations Committee 19

12. 2017 Financial Review 20

13. Organization Chart 29


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DUTIES & OBJECTS OF THE COLLEGE

HEALTH PROFESSIONS ACT - [RSBC 1996] CHAPTER 183

Duty and objects of a college 16 (1) It is the duty of a college at all times

(a) to serve and protect the public, and

(b) to exercise its powers and discharge its responsibilities under all enactments in the public interest.

(2) A college has the following objects:

(a) to superintend the practice of the profession;

(b) to govern its registrants according to this Act, the regulations and the bylaws of the college;

(c) to establish the conditions or requirements for registration of a person as a member of the college;

(d) to establish, monitor and enforce standards of practice to enhance the quality of practice and reduce incompetent, impaired or unethical practice amongst registrants;

(e) to establish and maintain a continuing competency program to promote high practice standards amongst registrants;

(f) to establish, for a college designated under section 12 (2) (h), a patient relations program to seek to prevent professional misconduct of a sexual nature;

(g) to establish, monitor and enforce standards of professional ethics amongst registrants;

(h) to require registrants to provide to an individual access to the individual's health care records in appropriate circumstances;

(I) to inform individuals of their rights under this Act and the Freedom of Information and Protection of Privacy Act;

(i.1) to establish and employ registration, inquiry and discipline procedures that are transparent, objective, impartial and fair;

(j) to administer the affairs of the college and perform its duties and exercise its powers under this Act or other enactments;

(k) in the course of performing its duties and exercising its powers under this Act or other enactments, to promote and enhance the following:

(i) collaborative relations with other colleges established under this Act, regional health boards designated under the Health Authorities Act and other entities in the Provincial health system, post-secondary education institutions and the government;

(ii) interprofessional collaborative practice between its registrants and persons practising another health profession;

(iii) the ability of its registrants to respond and adapt to changes in practice environments, advances in technology and other emerging issues.


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2018 ANNUAL GENERAL MEETING

Date Sunday, September 30, 2018

Time 11:00 a.m. – 2:00 p.m.

Location Whistler Ballroom A River Rock Conference Centre 8811 River Road, Richmond, BC

Special Guest Dr. Heidi Oetter MD, Registrar

College of Physicians & Surgeons of BC

AGENDA

1. CALL TO ORDER

2. WELCOME & INTRODUCTIONS

3. APPROVAL OF AGENDA

4. APPROVAL OF 2017 AGM MINUTES

5. BOARD CHAIR REPORT

6. ANNUAL FINANCIAL REVIEW

7. REGISTRAR’S REPORT

8. COMMITTEE REPORTS

a. REGISTRATION

b. QUALITY ASSURANCE

c. PATIENT RELATIONS

d. INQUIRY

e. DISCIPLINE

f. BYLAWS

9. UNAUTHORIZED PRACTICE REPORT

10. OTHER

11. ADJOURNMENT


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2017 ANNUAL GENERAL MEETING

MINUTES - DRAFT

Date: Saturday, October 14, 2017 Time: 10:00 pm - 12:00 p.m. Location: Sandman Hotel Vancouver City Centre, 180 West Georgia Street, Vancouver, B.C.

PRESENT: Board and Staff: Drs David Brooks (Board Chair), Dana Alumbaugh (Board Vice-Chair), Jaspaul Riar, elected

Board members; Messrs. Ken Stewart and Mahmood Awan, appointed Board members; Ms. Val Osborne, Registrar

Guests: Mr. Chris Ray, CPodSBC Bookkeeper

Regrets: Dr. Gavin Chalmers, Board member

zRegistrants: Drs. Gary Almas, Francis Chan, Faiyaz Dedhar, Howard Green, Rosemary Jones, Tammy Kallman, Greg Laakmann, Shervyn Polonsky, Scott Schumacher, Joe Stern, William Urton, Julie Yee

1. CALL TO ORDER

The Chair called the meeting to order at 10:15 a.m. A quorum is achieved with 12 registrants; 15 including the three registrants who are elected members of the Board were present.

2. WELCOME AND INTRODUCTIONS

The Chair welcomed the attendees. He noted the passing in late 2016 of Mr. Sandy Gray, a pubic Board member, and introduced the Board’s new member, Mr. Ken Stewart, and the Board’s guest, Mr. Chris Ray. Copies of the Annual Report, the new Quality Assurance Self-Assessment Questionnaire and a power point slide presentation on the latter topic were distributed.


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3. APPROVAL OF AGENDA MOTION AGM1701: That the Agenda of the October 14, 2017 Annual General Meeting of the College of Podiatric Surgeons of British Columbia is approved as presented. CARRIED

4. APPROVAL OF PREVIOUS AGM MINUTES

MOTION AGM1702: That the minutes of the September 10, 2016 Annual General Meeting of the College of Podiatric Surgeons of British Columbia are approved as presented. CARRIED

5. BOARD REPORT

The Chair spoke about further advances over the past year in the College’s administration and practice policies. He noted that the issue and work on resolving the barriers to full patient care in the public interest must continue to be a priority. He highlighted the new College website, pending new bylaws, the activities of the College and other health regulators around culturally safe and sensitive health care, unauthorized practice matters, the receipt of funds from the BCPMA, and the need for medical record standards to be implemented within the next year.

6. FINANCIAL REPORT

The Chair presented the Financial Review Report and Financial Statements for the fiscal year January 1-December 31, 2017. The College is within budget. There are no plans to increase the annual registration fees, but increased expenses are anticipated for unauthorized practice, complaint investigation and discipline hearing matters.

7. REGISTRAR’S REPORT The Registrar reported on many of the same topics as the Chair, including the revised College bylaws, new website, the College’s involvement in a declaration by health regulators toward culturally safe and sensitive health care, the pending medical records standards and unauthorized podiatric practice generally and current UPP priorities for the College including some trade-mark objections filed at the Canadian Intellectual Property Office.


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8. COMMITTEE REPORTS

a. Registration Committee

The Committee Chair Dr. Julie Yee delivered the Committee report. Dr. Yee was appointed as a Committee member and its Chair in early 2017, replacing Dr. Michael Feist. Dr. Yee reported on changes and augmentations to the continuing education requirements, including the new fixed 2-year reporting cycles and an expanded CE category form. Additional categories and recognized CE training will include cultural sensitivity courses.

An extensive discussion took place surrounding possible registration avenues for domestic and international graduates of various foot care programs including the Quebec podiatry school. Credentialing studies would require government funding assistance. The College is in close contact with the Alberta regulator regarding their pilot project. Possible means of increasing recruitment of DPMs was also discussed.

b. Quality Assurance Committee

The Committee Chair Dr. Riar delivered the Committee report. Dr. Riar was appointed as a Committee member and its Chair in early 2017, replacing Dr. Dana Alumbaugh. Dr. Francis Chan and Mr. Ken Stewart, a public member of the Board, are other 2017 additions.

The Committee has been again busy over the past year, with additional practice standards amended or newly adopted. A major step is the implementation of an annual mandatory Self-Assessment Questionnaire, focusing on the Facility Practice Standards. Other such modules will be developed, and additional assessment processes in order to ensure public protection.

c. Patient Relations Committee

The Registrar reported that the proposed bylaw amendments include a clause providing that treatment of a spouse is not automatically ‘misconduct of a sexual nature’.

Also, the new policy on Access to Care deals with the issue of arbitrary or discriminatory refusal or withdrawal of patient care.


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d. Inquiry Committee

The Committee Chair Dr. Chalmers was not able to be present. The Registrar and Vice-Chair who is the main inspector (investigator) for the Committee made remarks. They reported on complaint levels and commonly observed practice issues, such as recommending unnecessary treatment, failure to follow up on surgical outcomes, meet acceptable sterility standards, perform a proper patient work up, obtain informed consent, and create and maintain adequate medical records.

Registrants were reminded of the expenses involved in complaint investigations, their professional obligation to cooperate with the College, and the College’s duty to ensure fair and timely process and outcomes. Several complaints have been resolved by consent agreements which is the preferred and more constructive avenue for disposition of complaints that cannot be dismissed, versus a hearing.

e. Discipline Committee

The Discipline Committee Chair Dr. David Brooks reported that there were no hearings in the past year, but at least one matter is anticipated in the coming year, which will likely necessitate increased expenditures.

f. Bylaws Committee

The Registrar reported that the Bylaw revisions are complete and approved by the Board and are now before the Ministry of Health for review. Most but not all bylaws must be approved by the Minister and are subject to a period of public posting for commentary.

9. UNAUTHORIZED PRACTICE REPORT

The Registrar summarized current issues and priorities, including use of laser by unregulated persons and trademark objections on which the College has support from the Alberta regulator.

10. ADJOURNMENT

The Chair declared the meeting adjourned at 12:15 p.m.


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CPodSBC BOARD 2017 – 2018 The College is overseen and governed by the Board. The Board has four peer-elected registrants of the College who are doctors of podiatric medicine (DPMs). Elections are held annually.

The Board generally has two members of the public, appointed by the Minister of Health, whose role is to ensure that a public perspective and other expertise is brought to Board and College decision making. Throughout 2018 the Board has had one public member. College operations are administered by the Registrar’s office.

Dr. David Brooks DPM Dr. Dana Alumbaugh DPM Board Chair (to Dec. 31, 2017) Vice Chair & Acting Chair (from Jan. 1, 2018)

Dr. Gavin Chalmers DPM

Dr. Jaspaul Riar DPM (to Dec. 31, 2017)

Dr. Julie Yee DPM (from Jan. 1, 2018)

Dr. Hiedi Postowski DPM (from Jan. 27, 2018)

Mr. Mahmood Awan Public Appointee (to Dec. 31, 2017)

Mr. Ken Stewart Public Appointee


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BOARD CHAIR’S MESSAGE

It has been a privilege to serve as Acting Chair for the Board of the College of Podiatric Surgeons of British Columbia (CPodSBC) since the retirement of Dr. David Brooks DPM. I thank him for his years and untold hours of dedication and service to the Board and previously as Chair of the Board of Medical Examiners of the BC Association of Podiatrists. Dr. Brooks has been at the helm since the inception of the College as the podiatry regulator and under his guidance the College developed from a theoretical idea to a member of the group of regulatory bodies under the BC Health Professions Act. Dr. Julie Yee was appointed to the Board to fill in the gap left by the departure of Dr. Brooks. Dr. Yee has brought with her enthusiasm and a hard work ethic. She has taken on the role as Chair of the Registration Committee, serves on the Patient Relations Committee and is leading the effort in addressing the Cultural Diversity and Sensitivity mandate of the Board. In January we saw the departure of Dr. Jaspaul Riar from the Board, but he maintains his position as Chair of the Quality Assurance Committee. The Committee has been productive developing new guidelines and standards and updating a few of the older policies. Of note: development of an annual self-assessment process to help compliance with Practice Facility Standards as part of our quality assurance program. Dr. Hiedi Postowski was appointed to replace Dr. Riar on the Board. Dr. Postowski has taken on the role of Chair of the Patient Relations Committee. She has proven to have an eye for detail and been very valuable to the committee oversight function. She is also tasked with the development of a practice assessment tool.

Mr. Ken Stewart was appointed as a Public Member of the Board on February 10, 2017. He is a valuable addition. He brings with him many years of experience in health and hospital facility project management including in an executive capacity with the Interior Health Authority. Mr. Stewart is currently our only public member. Mr. Mahmood Awan served as a public member of the Board for over 6 years and his final term expired at the end of 2018. We acknowledge and thank Mr. Awan for the many years of dedication and service that he provided for this College. The BC Crown Agencies and Board Resourcing Office have not yet appointed a replacement for Mr. Awan.

Over the past year the CPodsBC continued to progress in our mandate to serve the public interest. Despite a significant workload and limited resources, we enhanced many areas of college operations. The web site continues to grow and is a very valuable resource for our registrants. We are working towards more on-line submission abilities and hope to bring those functions forward soon. The College has augmented its staff. Recently Louise Crowe was hired to assist the Registrar. Louise comes to us with impressive experience including as an acting Registrar of another college. We welcome Louise and look forward to her continued assistance.

The Board oversees and is responsible for the College’s operations. The Board, College committees and Registrar’s office ensure that the College fulfills the core mandate to regulate the profession in the public interest. The College staff also help guide and support the Board and committees in their roles.


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Our revised Bylaws are still before the Ministry of Health and we hope to have progress there in the near future, if indeed there is a continued need for them. On this, see more below. In the late spring I sent a letter requesting an interview with the Minister of Health, the Honorable Adrian Dix MLA. Topics listed for discussion include barriers to practice, podiatrist access to hospitals and non-hospital surgical facilities and podiatrist access to Pharmanet. We will continue to follow up with this request. The College continues to pursue the issue of unauthorized practice as this is a key component of our mandate. Unregulated laser application continues to a concern and we continue to pursue a number of cases. We continue to vigorously pursue trademarks by unregulated, non-podiatric organizations and have made some progress on this front. We invite registrants to inform the college of concerns about possible unauthorized practice. The Board has attended various government sponsored training sessions over the past year including governance training that strengthened our understanding of our mandate as regulators under the Health Professions Act. We also were able to meet and converse with regulatory colleagues from other health professions. As seen in the Financial Report for 2017, the College is in a much better position to weather potential storms and function to a fuller capacity. It is our hope that we will be able to reduce the annual registration fees in the near future. The Board are looking at this issue in earnest, while keeping in mind that generally we are still underfunded and under-resourced.

There are important developments in the direction of policy and legislation for the Ministry of Health. There is a trend toward reducing the number of regulators and increasing efficiency.

The Registrar will explain this in more detail with her report to follow.

The Board recognizes that change is likely. It is our preference to be proactive and actively participate in the decisions and process. We are engaged in conversations with the College of Physicians and Surgeons of BC (CPSBC) and the Ministry. The exact mechanism for any new arrangement is not clear at this point, but will emerge as we move forward with our discussions. There are many positives to be gained from a potential relationship with the CPS, and there are many issues to address. I invite registrants to contact us with your questions and concerns as we move forward. The Board does not take the issue lightly. We are dedicated to encouraging the best decisions within our obligation of public protection through continued high standards in the profession. I believe that these goals are not exclusive from the interests of the profession in that the public will trust a profession that maintains high standards of competence and ethical conduct. It has been an honour to serve in the role of Acting Chair for the Board of Podiatric Surgeons. I feel very optimistic about the future of podiatry in BC. Finally, I wish to send my great appreciation to the Board, committees and staff with whom I am honored to serve. Respectfully,

Dr. Dana Alumbaugh DPM

The College is engaged in discussions with the College of Physicians and Surgeons of BC and the Ministry of Health about the future of regulation of podiatric medicine in British Columbia


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REGISTRAR’S MESSAGE

How quickly (almost) 5 years has gone by. This will be my last annual report as I have planned to retire before the end of 2018 as the College’s transition to a new registrar is accomplished. Originally, I had stepped in on an interim basis, to help bring organization to the College regulatory framework, processes and practices and achieve better compliance with the Health Professions Act. We have made strides, yet, the small size of the profession - and as a result the College - brings constant challenges to reach the level of efficiency and development seen in the larger, more resourced regulators. The College’s work will carry on. The regulatory environment will continue to evolve within BC and no doubt present plenty of interesting, positive changes and challenges ahead for the podiatric profession. On that note, transition is in the air for the CPodSBC in more ways than one. In the mid to late fall of 2018 as our current lease ends, we had planned to move to new office space with a number of other health regulators in the old Sun tower at the foot of Granville Street in downtown Vancouver. This collective, referred to as the ‘regulatory hub’, would benefit the College through increased opportunities for shared resources, collaboration and consultation with our regulatory colleagues. That relocation is still a possibility. However, at the same time dialogue has been reinitiated on the potential for a closer relationship between the College of Physicians and Surgeons (CPS) and the podiatric profession. It is inescapable reality that the CPodSBC is disproportionately under-resourced compared to all other health profession regulators in BC.

Regulators like the CPodSBC struggle to devote the sufficient resources to their duties because they are not able to reach needed economies of scale. Recent trends in regulatory design seek to address and prevent such challenges. Increasingly, current regulation is seen as overly complex and siloed, with resulting inefficiency. Other risks of the multiple regulator model are that over-lapping scopes can lead to inconsistency in rule application and duplication of effort and cost. For such reasons, there is increasing support for fewer colleges overall, with the colleges that do exist made responsible for the oversight of more than one profession. In fact, the Minster of Health has asked BC’s health regulators to help to modernize regulation and maximize resources for enhanced public safety, with one goal being to reduce the number of colleges.

A merger is likely to be more efficacious where there is strong alignment of core aspects such as education and scope of practice, and this speaks to the potential for the regulation of allopathic general medicine and podiatric medicine under one umbrella. Given the parallels between the two professions, and the vastly greater resources and maturity of the CPS, both the public and the profession stand to benefit. Moreover the CPS believes that its processes and resources can easily accommodate a podiatrist class of registrant. The concept of combining is at present a proposal. Both Colleges have expressed readiness to work together with the Ministry to identify a path to consolidation of oversight of the two professions. Any decision on the future regulation of the profession falls to the Minister of Health, and should the Minister so decide, the CPodS and CPS will continue to develop a transition plan with the goal of achieving a smooth and effective integration.

In BC and elsewhere, there is increasing support for fewer colleges overall, with the colleges that do exist made responsible for the oversight of more than one health profession.


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Shifting the perspective to reflect on the past year, the College continued on its upward trajectory as a professional regulator.

On the communications side, the College had in 2017 created and launched a vastly improved website. This has been augmented and is continually updated. It is a main resource and touchstone for the public who seek information about the profession and its governance within BC, as well as registrants and all stakeholders. Other communications have been regularly produced in 2018 with a view to keeping registrants informed on relevant matters. This year, the College created many new or amended practice standard policies. More information can be found elsewhere in this report and on the website. Highlights include: policies on Environmental Cleaning, Critical Incident Response, Emergency Preparedness, Surgical Patient Safety, and Orthotic Devices. The Quality Assurance Committee has been charged with two very important tasks: revision of the Narcotic Module, and development of ‘podiatrist office medical device reprocessing assessment’ tools similar to the ‘POMDRA’ of the CPS. As well, the Board has taken on development of on-site clinic assessment for quality assurance. At their fruition these projects will bring greater public protection and certainty for practitioners. More information on current and pending initiatives can be found in the QAC report. The revised bylaws were under discussion during 2018 between the Registrar’s office and the Ministry. A ‘hold’ has been put on the initiative while we await clarity on the College’s future. If the College does not move toward integration with the CPS, bylaws will again be a top priority. A more descriptive discussion of the proposed amendments is available in last year’s report.

The College has many interagency activities and relationships. The Registrar’s office continued to converse, consult and meet with the other Canadian regulators for podiatry, the BC Health Regulators - which consists of the registrars of the regulators under the Health Professions Act, and the Ministry. The Canadian regulators met in Banff in June and discussed many issues including the continued hope for harmonization of the profession across Canada. As a member of the BCHR we participated in many meetings, surveys and initiatives. These include working groups on infection control and instrument sterility, in-clinic sale of prescription drugs, antibiotic prescribing and definitions of delegation and related concepts. Recently the BCHR developed uniform Patient Relations and Quality Assurance frameworks which will be put before the Board for adoption. A common framework on discipline information disclosure has previously been adopted by all of the HPA regulators. Even without amalgamations, the

HPA colleges have worked toward and achieved harmonized procedural policy as

we see the opportunity. This approach will continue. I will not say much about the Registration, Inquiry or Patient Relations aspects of the College as these are dealt with in other reports. All have seen progress over the past year. Registration compliance is very high. We disposed of many complaints and have brought the age of complaints down. Lastly, I warmly thank the Board and committee members with whom I have the privilege to work over the past (almost) 5 years, and our bookkeeper Chris Ray and Louise Crowe who are both much-needed invaluable additions to the College. They are all true professionals. I have no doubt that they will all keep up their outstanding work in the regulatory field.

Respectfully,

Ms. Val Osborne BSc, JD

Despite the challenge of limited resources, the College has continued on an upward trajectory as a regulator


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REGISTRATION COMMITTEE

Registrant Base This College currently has 78 full time registrants (down 1 from 2017), and 7 non-practising. Of the two registrants who left practice during the registration renewal cycle; one opted to cancel, and one moved to the non-practising class. One long-time registrant sadly passed unexpectedly in February 2018. The renewal process for 2018 saw a very high level of compliance with documentation and fees as has been the trend for a few years. This, and the receipt of monies from the BCPMA, have led to fiscal improvement which may bring about a reduction in the annual registration fee for 2019. The Board is considering this option. Application(s) for Registration/License to practice Under the CPodSBC bylaws, the Registration Committee must make the decision as to whether to grant registration. The Registrar and staff administer the application process and refer complete applications to the Committee with a recommendation. Two individuals had their applications reviewed and were granted registration by the Registration Committee in 2018. We welcome both registrants to British Columbia. One more application is in process. Historical Trend The table at right sets out the movement in and out of active practice since 2010. The profession’s size has remained somewhat steady, with the number of registrants hovering generally around the low 80’s. The profession’s inherently small sample size makes it very difficult to obtain any truly statistically significant figures. As always, the Committee hopes to see growth in the coming months.

Status of Revised Registration Bylaws The Registrar worked very hard to review, revise and amend our registration and other bylaws in 2017 and 2018. The proposed revised bylaws are still under review with the Ministry of Health; however given the possibility of pending changes to the College, it is unclear if the bylaws will be enacted. CME requirements for a 2-year closed, fixed cycle All registrants are about 21 months into the College’s first two-year closed, fixed CE cycle. All registrants (except new registrants direct from a residency program) must earn at least 60 CE credits before December 31, 2018. The College requires a minimum number of 20 category A hours biennially of academic lectures and allows other categories of CE up to various maximums, depending on the category. Registrants will document credits they earned yearly on the CE form provided with their annual registration application. Any surplus CE credits earned from the previous cycle are not carried over to the next two year closed fixed cycle (which will be January 1, 2019 - December 31, 2020).

NUMBER OF REGISTRANTS IN THE FULL CLASS / ACTIVE PRACTICE

Year # starting registrants

# leaving practice

# new registrants

2010 82 0 1

2011 83 1 1

2012 83 2 0

2013 81 0 4

2014 85 2 2

2015 85 5 1

2016 81 4 3

2017 80 2 1

2018 79 3 2


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New CE Category for Cultural Sensitivity The CPodSBC is committed to promoting cultural competence among registrants. Registrants who take the Cultural Sensitivity Checklist will be awarded 2 CE credit hours. Further, the Committee has recommended that cultural sensitivity CE be made a biennial requirement for registration renewal. The Cultural Sensitivity category will continue to evolve and grow as the Registration Committee explore new opportunities for registrants to earn CE credits in this very important area. CE Hours – Committee Members and Inspectors/Investigators

The College recognizes that committee work is time consuming. Recent Board resolutions have created a category of CE for committee work and allow a claim of 2 hours per Inquiry Committee or Quality Assurance Committee meetings up to a maximum of 12 hours per year.

Narcotic Module Requirement 2018 would normally be a year where the narcotics module would be a mandatory CE requirement for most registrants given the 5-year cycle. The Board considered a request that the College consider dropping the narcotic module requirement for the following reasons:

- BC podiatrists do not yet have the authority to prescribe schedule 1A drugs and will not until the Podiatrists Regulation under the BC Health Professions Act is amended to include the term ‘1A’ in section 5(1)(i),

- the module content is dated and needs to be modernized with more Canada-specific content,

- registrants are especially concerned about renewal of the module given the risks associated with opioid narcotics in the wake of the current fentanyl crisis in BC.

For these reasons the Board recently resolved that the Narcotic Module and exam requirement are now optional, effective immediately. Registrants who do choose to complete the narcotic module and exam will earn 3 CE credits per annum. Foreign Qualification Recognition The Alberta government has requested that the College of Podiatric Physicians of Alberta initiate a foreign qualification recognition pilot project. The purpose is to accommodate international graduates of non-DPM foot care programs into the Alberta health care professions framework with a view to a path for upgrading or bridging to the DPM level. The BC College remains open to government policy interest and provincial and federal sources of funding for a BC initiative. If the need and means exist, the Committee will proceed to develop a strategy for BC for the inclusion of other level of Canadian and international foot care trainees within the regulatory scheme of the College. Any such decision is a matter for the Minister of Health. It is an honour to serve this College and profession as Chair of the Registration Committee. I am looking forward to the interesting work ahead. Respectfully,

Dr. Julie Yee DPM

The Registration Committee is responsible for registration, renewal and reinstatement decisions of the College, in accordance with section 20 of the Health Professions Act and the CPodSBC bylaws.

COMMITTEE MEMBERS

Appointed

Dr. Julie Yee DPM, Chair Dr. Dana Alumbaugh DPM Mr. Ken Stewart, Public Board Member

Ex-Officio

Dr. Dana Alumbaugh DPM, Board A/Chair Ms. Valerie Osborne B.Sc., J.D., Registrar


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QUALITY ASSURANCE COMMITTEE

The College’s Quality Assurance Committee’s mission statement is:

To ensure that British Columbia Doctors of Podiatric Medicine meet and exceed the required standard of practice throughout their career and to prevent incompetent, impaired and unethical practice

During 2018 the Quality Assurance Committee diligently worked toward the goal set out in the QAC Mission Statement, with the public interest in mind at all times. The Committee members contributed a great deal of time and effort into further developing of various practice guidelines and standards to meet our mandate under the Health Professions Act and the College bylaws (see box at right).

PROJECTS COMPLETED IN 2018

Self-Assessment Questionnaire Review In calendar year 2018 the Committee performed the first review of the College’s self-assessment questionnaire after it was distributed to the registrants in late 2017. The goal of the process is to help registrants gain insight on how well they are meeting College practice standards and to make improvements where warranted. After questionnaires were collected and reviewed, a process was developed to help create rigorous but supportive remedial measures. Overall, the initiative is a success and was expected to evolve in the coming years. Should the College not integrate with the CPS, we will continue to refine the policy around the use of the responses. Should regulation be transferred to the CPS, the well-developed assessment

QAC MANDATE

The QAC’s main responsibilities are set out in the College bylaws:

a. Proactively review and make recommendations to the board regarding standards of practice and guidelines,

b. Proactively review and make recommendations to the board regarding mandatory continuing professional development requirements and any other requirements for re-licensure

c. Administer the quality assurance programs of the college and without limiting the above, to

d. Assess the professional performance including the clinical ability of individual registrants,

e. Establish remedial measures to assist individual registrants in identifying and correcting deficiencies in their clinical abilities or practice facilities,

f. Establish guidelines and restrictions as warranted for the practice of any registrant,

g. Collect information from registrants in furtherance of the objects of this section, in order to promote and enhance high standards of practice and reduce incompetent, impaired, unsafe or unethical practice by registrants.


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processes of that College will oversee podiatry in the future, with podiatric input. Emergency Preparedness Policy The Emergency Preparedness Policy was adopted by the Board in January of 2018. Both standards and guidelines were created to ensure patient safety in the office setting. A key requirement implemented in this standard is that registrants must report emergency events to the College no more than 48 hours after the immediate danger to patients and staff has been addressed and resolved.

Critical Incident Report Form This tool also helps alert the College to risk areas within registrant practices. Registrants are required to report promptly to the College when certain adverse patient situations occur in the clinic or in relation to care provided at the clinic. Orthotic Devices The College has revised its Orthotics policy to better guide the profession. Podiatric training and true regulatory, enforceable standards are very important to ensure public protection. Orthotic devices are very important in the treatment of pedal pathologies; the point of the devices is to control the function and stability of the foot by preventing or encouraging certain motion of the foot joints. Proper assessment, prescription and adjustment of orthotics involve multi-factorial and complex consideration. The policy addresses the approach and outcome of patient assessment, orthotic prescription, selection, manufacturing and dispensing.

Ongoing and future tasks for the QAC include: - Development of a CPodS Podiatric Office

Medical Device Reprocessing Assessment (POMDRA) process, similar to the CPS

- Development of a general in-clinic practice assessment program

- Policy and practice supports for registrants with communicable diseases

- Surgical centre standards - Remedial programs and resources - Administration of controlled substances - Surgical Patient Safety Checklist - Occupational health and safety

All QA tools are on the website at www.cpodsbc.org.

The QA process is remedial and supportive; it is not an avenue or source for complaints. The HPA contains measures to build registrant trust, including a bar to disclosure of information to the Inquiry process except in very rare circumstances of misleading conduct. The Committee aims to continually foster trust with the College’s registrants. Respectfully,

Dr. Jaspaul Riar DPM

The Quality Assurance Committee is responsible for recommending standards of practice and continuing education, and administering assessment and remedial programs to encourage excellence in the profession.

COMMITTEE MEMBERS

Appointed

Dr. Jaspaul Riar DPM, Chair Dr. Neil Brown DPM Dr. Francis Chan DPM Dr. Anthony Yung DM Mr. Mahmood Awan Mr. Ken Stewart, Public Board Member Mr. Murray Watt

Ex-Officio

Dr. Dana Alumbaugh DPM, Board Chair Ms. Valerie Osborne B.Sc., J.D., Registrar

http://www.cpodsbc.org/


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INQUIRY COMMITTEE

The CPodSBC has an obligation to protect the public as mandated by the Health Professions Act (HPA). A key element in acting in the public interest is the complaint process, to help ensure a competent and ethical standard of practice and conduct among College registrants.

The Inquiry Committee (IC) is responsible for the investigation of complaints with the sole duty of serving the public interest. The investigation or “inquiry” process must be dispassionate, open, transparent and accountable. Further, the process must be consistent and comply with the mandate to act only in the public interest. The IC may investigate complaints involving competence, conduct or fitness of registrants. Complaints may originate from the public, another registrant, other committees of the College or information that comes to our attention through any means. The IC may utilize an IC-appointed investigator to aid its process.

Once a complaint is received and the inquiry initiated, one of three scenarios can occur. One, for complaints found to be trivial or vexatious, the IC may dismiss them under the HPA. Two, if the Committee believes that there is sufficient evidence to support a finding of a regulatory conduct or competence wrong, the Committee will not dismiss the matter and will attempt to resolve it with a consent resolution. Any such outcome must involve measures to ensure that the competence or conduct issue is not likely to occur in the future and in this way public protection is served.

Three, if in such a case the Committee is unable to obtain a consent resolution, a hearing may be warranted and the Committee may direct the Registrar to issue a citation or notice of hearing.

Even serious issues may be resolved. Considering most complaints to date, registrant cooperation and agreement to adopt measures to avoid competence

or conduct wrong occurrence in the future have been sufficient to attain resolution on many files.

One matter (actually a consolidation of three files involving the same former registrant) was pending hearing and the IC rescinded its citation. The file was held in abeyance pending the outcome of another tribunal’s proceeding. The tribunal’s second hearing was recently struck down by the Courts, as was the first, and the matter is headed for a third hearing. This transpired over years. The delay was a major factor in the IC’s decision. They also considered the fact that the former registrant is no longer in the jurisdiction and that the Registration Committee has authority to probe suitability if the former registrant applied for reinstatement. At the time of writing, no other inquiry matters are pending a hearing.

COMMITTEE MEMBERS Appointed

Dr. Gavin Chalmers DPM, Chair Dr. Greg Laakmann DM Mr. Ken Stewart, Public Board Member

Ex-Officio


The Inquiry Committee is responsible for investigation of complaints about competency and conduct of podiatrists in BC, and to respond to complaints to ensure that the public interest is served.


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The Inquiry Committee usually meets in person 4 – 5 times per year and has case investigation meetings when needed. The complaint process can be exhaustive and expensive. Complaints can be broad in scope involving multiple registrants or issues, premises inspection, many communications between the IC and the complainants and registrants, and the gathering and review of medical records from hospitals and other health care professionals.

Complaint issues are wide ranging. Some issues before the College in the past year include office cleanliness or sterility, competence, procedural morbidity (including laser applications), advertising, misleading conduct toward the College, charting deficiencies, lack of informed consent, unauthorized practices and failure to complete registration renewal requirements.

The HPA has rules on complaint processing times and although complaint age has come down, the IC still at times has challenges in meeting the deadlines. Reasons include registrant complaint response laxity, and a mismatch between the College resources and demands. Nevertheless, we can do better. The College and registrants share a responsibility in this regard. Complaint response is not optional for either. The HPA imposes our mandate, and registrants are professionally bound to cooperate with and respond to the IC process on a timely basis. In addition, delays may bring further complaints by patients, an added serious issue of failure to respond, and consequential involvement of the Health Professions Review Board (HPRB), who may take over a case. The College usually receives about 10 - 12 complaints per year. The numbers do not include telephone calls about concerns, rules and process, which greatly outnumber formal complaints; not every caller submits a complaint.

Since the 2017 AGM the complaint statistics:

A few notes. The 2017 figures are skewed by factors we are not able to divulge due to HPA confidentiality constraints. Many open complaints are headed for consent resolution. Lastly, files in consent resolution monitoring are considered ‘disposed of’ or closed though some requirements have yet to be fulfilled. Lastly, I have been honoured to act as Inquiry Committee Chair and am very grateful to serve with Mr. Ken Stewart, Dr. Greg Laakmann DPM and ex-officio members, Dr. Dana Alumbaugh DPM (College Chair) and Ms. Val Osborne (Registrar) as well as inspector Dr. David Brooks DPM. To function appropriately, the IC requires integrated and cohesive interactions of the various arms of the College. I also thank the College Board and other committees, and those registrants who have been the subject of complaints and showed a high standard of professionalism with their cooperation. A special thanks to our Registrar Val Osborne who continues to offer “blood, toil, tears and sweat” for our College, without whom the IC could not function. A closing comment: elsewhere in this Annual Report we ponder the future of regulation for podiatry in BC. With the CPS, the profession will no doubt have very competent, capable oversight and will still need volunteers to serve on these committees.

Respectfully,

Dr. Gavin W.G. Chalmers, BSc,

MSc, DPM, FACFAS, DABFAS

New: 9 (2-2017, 7-2018)

Closed: 16 (1-2012, 1-2013, 2-2014, 5-2016, 3-2017, 4-2018)

Open: 15 (1 - 2015, 1 - 2016, 9 – 2017, 4 - 2018)

At HPRB: 0

Consent Resolution Monitoring: 5


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DISCIPLINE COMMITTEE

What follows is very similar to the report for 2017, as the Discipline Committee (DC) saw no activity over the past year.

The mandate of the Committee flows from the Health Professions Act. A statutory Committee, appointed by the Board, it is responsible for holding hearings on complaint investigation matters if referred by the Inquiry Committee. Hearings may involve individual registrants and/or their podiatric corporations. Cases are referred to hearing when the Inquiry Committee directs the Registrar to issue a citation, or notice of hearing. The IC resorts to citations when complaint matters are not dismissed or resolved by consent resolution. Most matters are resolved by consent or ultimately dismissed when they are not deemed provable after investigation by the IC. Consent resolutions can address serious cases if they contain appropriate measures to protect the public interest in a safe, effective and ethical standard of care. The DC has authority to, when it is deemed necessary in order to ensure protection of the public, impose interim conditions or suspension on a respondent. For the serious matters that are deemed provable and are not resolved by a consent agreement, a hearing is likely. Few complaints proceed to hearing, and no hearings were held in 2017 or yet in 2018. Further, none are expected.

At any time up until the end of the hearing the IC may still resolve a case by a ‘Consent Order’. Such resolutions provide certainty and public protection, and bring the hearing to an end.

One hearing of 3 consolidated matters involving a former registrant was held in abeyance pending the outcome of another tribunal’s process. Recently the decision of the second hearing before the other tribunal was struck out by the Supreme Court and the matter is now headed for a third hearing. These events have transpired over a number of years. The Discipline Committee was advised that the citation is rescinded on the basis of delay, the absence of the former registrant from the jurisdiction and the ability of the registration process to deal with concerns in the event of an application for reinstatement.

As always, it is an honour to serve the public as Committee Chair.

Respectfully,

Dr. David L. Brooks DPM

COMMITTEE MEMBERS

Appointed

Dr. David Brooks DPM, Chair Dr. Albert Mollica DPM Mr. Ken Stewart,

Public Board Member

Ex-Officio


The Discipline Committee is a trier of fact; they conduct and decide on the hearings of complaint cases that are sent to hearing by the Inquiry Committee.


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PATIENT RELATIONS COMMITTEE

The object of a College under the Health Professions Act section 16(2)(f) is to establish a patient relations program to seek to prevent professional misconduct of a sexual nature. The Patient Relations Committee is appointed by the Board under the Bylaws to establish and administer a patient relations program, and its mandate extends beyond sexual misconduct.

This year the work of the Committee focused on two areas; professional boundaries and cultural sensitivity and safety. In May 2018 the British Columbia Health Regulators, the society of registrars of the health professions under the Health Professions Act, hosted a one-day symposium on Patient Boundaries in Vancouver. Board and Committee members and the Registrar attended.

Important take-aways include the following. Establishing a clear and concise professional boundary between patient and practitioner is essential. A podiatrist is expected to have only a professional relationship with their patient. Professional boundaries create safety for both the practitioners and the public they serve.

When a boundary is disregarded, a boundary violation occurs. Boundary violations harm the patient-podiatrist relationship. They include sharing of personal information, engaging in inappropriate conversations that have no relevance to the clinical issue, entering financial or business relationships with patients, accepting gifts and favours, and sexual involvement with patients. Appropriate emotional and physical distance must be maintained so that the patient-podiatrist relationship is not compromised. The symposium highlighted the need for unbiased investigations into allegations of misconduct and the complexity and sensitivity of such investigations. Violations of professional boundaries are a serious matter and must be acted on swiftly by the College.

Podiatrists also have a statutory duty under the Health Professions Act section 32.4 to report sexual misconduct by another professional to their College.

Cultural safety is an important and integral aspect of patient relations. In 2017, the College with the other HPA regulators signed a Declaration of Commitment to Cultural Safety and Humility. The College’s six-point plan includes promotion of the Cultural Competence Self-Assessment Checklist, which is a valuable self-assessment tool for the College and its registrants. The College is also actively seeking further sources of education on sensitivity training with the mindset of inclusivity of all cultures.

The College is committed to cultural sensitivity and competence. Canada is a diverse multicultural society and podiatrists need to take steps to deliver meaningful and effective healthcare to all Canadians.

Respectfully,

Dr. Hiedi Postowski DPM

COMMITTEE MEMBERS

Appointed

Dr. Hiedi Postowski, Chair Dr. Julie Yee DPM Mr. Ken Stewart, Public Board Member

Ex-Officio


The Patient Relations Committee’s role is to help establish and administer a patient relations program including guidelines and educational materials for practitioners with a view to preventing misconduct of a sexual nature by registrants toward their patients or staff.


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FINANCIAL STATEMENTS

2017 FISCAL YEAR

JAN. 1, 2017 - Dec. 31, 2017


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ORGANIZATIONAL CHART

BOARD

POSITION DPM/Elected DPM/Elected DPM/Elected DPM/Elected Public/Apptd Public/Apptd

INCUMBANT D.Alumbaugh DPM (V/C, A/Chr) G.Chalmers DPM J.Yee DPM H.Postowski DPM K.Stewart TBD

STAFF

REGULATORY COMMITTEES (Required by the HPAct and/or bylaws)

COMMITTEE REGISTRATION INQUIRY DISCIPLINE PATIENT RELATIONS QUAL. ASSURANCE SURG. PRACTICE STDS

Chair J.Yee DPM G.Chalmers DPM D.Brooks DPM H.Postowski DPM J.Riar DPM A.Mollica DPM

Other members DPM D.Alumbaugh DPM G.Laakman DPM A.Mollica DPM J.Yee DPM N.Brown DPM T.Kalla DPM

F.Chan DPM

A.Yung DPM

Other members K.Stewart, public K.Stewart, public TBD, public K.Stewart, public M.Awan, public S.Reznick MD

K.Stewart, public

M.Watt, public

Inspectors (IC) n/a D.Brooks DPM n/a n/a S.Polansky DPM n/a

Advisors (QAC) D.Alumbaugh DPM I.Yu DPM

S.Schumacher DPM W.Urton DPM

REGISTRAR

V.Osborne

COLLEGE ADMINISTRATOR

L.Crowe

BOOKKEEPER

C.Ray

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College of Podiatric Surgeons of British Columbia

101 - 850 Harbourside Drive, North Vancouver, B.C.

V7P 0A3

Tel: 604-986-0403 Fax: 604-986-0399

Email : [email protected]

Website : www.cpodsbc.org

mailto:[email protected]

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