Pierre Champagne, M.D., FACEP ADMINISTRATIVE FOLLOW-UP PROGRAM (Physicians monitoring program) Pierre Champagne, M.D., FACEP

I work for and am compensated by the Collège des médecins du Québec DISCLOSURE I work for and am compensated by the Collège des médecins du Québec

Collège des médecins du Québec

Equivalent to a State Board in U.S. Governed by peers Physicians University medical schools Public His mission Protect the public

Province of Québec 19 451 physicians 48% = general practitionners 52% = specialists

Functions Create policies Adopt regulations Check competence and aptitude to practice Improve deficiencies Review complaints made against physicians

ORGANIZATION CHART OF THE COLLÈGE DES MÉDECINS DU QUÉBEC Board of directors Executive Committee President and chief executive officer Secretary Assistant executive officer and assistant to the secretary Assistant secretaries Inquiries Legal Services Medical Studies Practice Enhancement Public Affairs and Communications Administrative Services

Practice Enhancement Division Mandate To ensure the protection of the public Surveillance Performance enhancement

Practice Enhancement Division Practice surveillance Duty to monitor all physicians « including those with personal conditions that may affect their medical practice » …..so, this is the Administrative Follow- up Program of the CMQ

ADMINISTRATIVE FOLLOW-UP PROGRAM (Physicians monitoring program)

Origin Administrative Follow-up Program Pathologist with brain tumor Medical errors reported to CMQ Follow-up by the Inquiry division M.D. had surgery then, followed by his physician without any feedback to the CMQ

Origin Administrative Follow-up Program After the surgery, the follow-up was stopped by the Inquiry division of the Collège The doctor went back to practice, had disease progression over a period of months, and made hundreds of medical errors

Administrative Follow-up Program Reflection Human Rights Commission Public protection Lack of control The program is within the mandate of the Collège Benefits

Mandate Administrative Follow-up Program The mandate is to effectively follow physicians with physical health, mental health or substance abuse problems on a mid-term or a long-term basis

Administrative Follow-up Program Objective Professional reintegration

Administrative Follow-up Program How the program works Confidentiality Voluntary participation The process Interview with the physician (Fact-gathering) Risk Assessment Request periodic reports from the treating physician Limitations or conditions Remediation

ADMINISTRATIVE FOLLOW-UP PROGRAM Division of Inquiries Executive Committee Division of Medical Studies Practice Enhancement Division Impaired physicians program (2 years or 5 years) + CME + Inspection Residual Difficulties Success Emergency Prolongation End of program

AGREEMENT By way of administrative monitoring of physicians presenting with physical or psychological health problems that may compromise the quality of their professional practice, the Collège des médecins du Québec fulfills its mandate to protect the public The Practice Enhancement Division assumes this task through its supervision and improvement of the medical practice of physicians. commit myself for a period of 2 years to the following: I _____John Smith______ authorize the physician responsible for monitoring at the Collège des médecins du Québec to obtain from my therapist, _____Mary Johnson_____, periodic reports on my state of health and fitness to practice. I also authorize such physician to communicate with my therapist should clarification on his or her part be necessary. I commit myself to following the recommendations of my attending physician.

AGREEMENT I understand that the limitations or restrictions required by my state of health are public (Follow-up administrative program) and that the Collège may, in responding to a request, divulge these, while indicating the voluntary nature of my agreement to them. I agree to report, as soon as possible, any change of therapist to the person responsible for the administrative monitoring at the Collège des médecins du Québec. I accept that the results of random screening tests, to which I have consented, if need be, be sent to the physician responsible for monitoring. I agree to attend all meetings requested by the physician responsible, meetings warranted because of monitoring difficulties, or necessitated before the monitoring comes to an end. At all times, during these meetings, I may be accompanied by a lawyer if I deem it pertinent. I myself may request a meeting, should I wish to discuss any problem related to my monitoring program.

AGREEMENT In the event, during the monitoring process, of a deterioration in my condition compromising the quality of my practice, or of my withdrawal from the monitoring program, notification of such may be sent to the Syndic. All of the documents in the file of the physician responsible for monitoring shall be kept by the Practice Enhancement Division for a ten-year period following the end of the monitoring program. I accept that the data collected in the context of this program may possibly be used in the context of any study, research project, or publication issued by the Practice Enhancement Division (PED) in exercising its mandate. I am also assured that these data will be confidential and used in conjunction with data collected from other program participants, so as to ensure respect for the confidentiality of my file within the program. This agreement is subject to section 122 of the Code of Ethics of Physicians. In the event that further monitoring is advisable, after the authorized period, a new agreement shall be requested.   SIGNATURE _______________________________________________ LICENCE NUMBER__________________________________________ DATE _____________________________________________________ Follow-up administrative program representative___________________________

REPORT FOLLOW-UP PROGRAM Patient's name ________John Smith_________Licence number ____________ Diagnosis _Bipolar Disorder_____ Medication ____________________________________________________________________ Is it a recurrence: Yes_____ No_____ The doctor complies with recommendations Yes  No  Other professional involved in treatment Yes  No  Name and profession: ________________ __________________ _________________ _________________ Name Profession / Specialty Name Profession / Specialty _________________ __________________ ___________________ _______________ Name Profession / Specialty Name Profession / Specialty I consider this doctor fit to practice Yes  No  Is there any limitation or restriction practice Yes  No  Specify : ______________________________________________________________________ The doctor is presently working Yes  No  Specify all locations _______________________________________________________________________ The doctor was hospitalized since my last report Yes  No 

The doctor is on sick leave Yes  No  The doctor has given up treatment against medical advice Yes  No  The doctor has received his medical discharge Yes  No  SPECIFIC MENTIONS Treatment modification since last report Yes  No  Reason : Intolerance Allergy Addition Suppression Current treatment ____________________________________________________________________Drug screening Yes  No  Group therapy Yes  No  Type and frequence ____________________________________________________________________ Others ______________________________________________________________ Date _______________________ Signature ___________________ Accepted 2004-12-15 Translated 2009-09-22

ADMINISTRATIVE FOLLOW-UP PROGRAM Division of Inquiries Executive Committee Division of Medical Studies Practice Enhancement Division Impaired physicians program (2 years or 5 years) + CME + Inspection Residual Difficulties Well Emergency Prolongation End of program

Administrative Follow-up Program The program does not provide medical services It is a « risk management program »

Administrative Follow-up Program Clientele (85 Physicians) Alcoholism Drug abuse Benzo, Opioids, etc. Illegal substances Mental Health problems Bipolar disorders Depression

DISTRIBUTION PER YEARS OF PRACTICE Administrative Follow-up Program CLIENTELE DISTRIBUTION PER YEARS OF PRACTICE < 10 years 18.2% 10-20 years 24.2% 21-30 years 30.3% > 31 years 27.3%

The future of the program Risk indicators Inappropriate behaviors Aging physicians

CONCLUSION The Follow-up Administrative Program does not provide medical services of any kind. It is a risk management program.

CONCLUSION 2. Although it is a young program, it is a rapidly expanding program at the Collège.

CONCLUSION 3. The goal of the program is to help the doctors to return to an effective and professional level of medical practice.

Thank You