Latest news with #CollegeOfPhysicians
CBC
3 days ago
- Health
- CBC
Manitoba plastic surgeon given suspension after professional misconduct involving 3 patients
A Manitoba plastic surgeon was suspended from practising medicine for six weeks and ordered to pay more than $34,000 after he admitted to displaying a lack of skill, knowledge and judgment during a number of surgical procedures involving three patients over more than a decade. During a March College of Physicians and Surgeons of Manitoba disciplinary hearing, Dr. Manfred Ziesmann pleaded guilty to professional misconduct while providing care to three patients who had post-surgery complications between 2012 and 2023. He admitted to displaying "a lack of knowledge, skill and judgment in the practice of medicine" in all three cases, including one in which he put the wrong implants into a woman's breasts, according to a May 25 written decision delivered by a three-person inquiry panel for the college. That decision said Ziesmann's actions had a particularly negative impact on that patient, who "has suffered significantly over the last few years" after surgery he performed on her in 2022. Ziesmann, who has been licensed as a plastic surgeon since 1987, began treating the woman in 2021, after an earlier surgery by another doctor left her right breast, which had an implant, larger than her left, which had no implant. On the day of her surgery, she signed a consent indicating a larger implant would be inserted in her right breast, and a smaller implant in the left. However, during the surgery, Ziesmann inserted the larger implant into the left breast and the smaller implant into the right breast, according to the decision. After the procedure, the woman experienced significant issues, but had difficulty getting followup care from Ziesmann and felt "her concerns [had] been disregarded," according to the panel's decision. She went to a hospital emergency room and was referred to the plastic surgeon resident on call, whose consultation report said the woman had complete necrosis on her nipples, with thick, black dead tissue. A different surgeon removed the implants Ziesmann had put in, but "there is little doubt that she will continue to be impacted for years to come," the panel's decision said. Ziesmann admitted to breaching the standards of medical practice after he failed to address the woman's symptoms in a timely manner, and "displaying a lack of empathy and compassion in communicating" with the patient, the decision said. Failed to remove patient's skin cancer The panel also reviewed the case of a patient Ziesmann performed surgery on after who developed basal cell carcinoma — a type of skin cancer — from excessive sun damage. She was referred to Ziesmann, who performed a procedure to remove the lesion in April 2023, the decision said. However, a pathology report noted that the part extracted didn't have a scar that had been visible in the biopsy. The patient had a second excision in August of that year, but after both procedures, a dermatologist determined the patient still had skin cancer. She was referred to a different surgeon for a third procedure. Ziesmann acknowledged that he "failed to appropriately address the … pathology report which indicated that the procedure may not have been successful," the panel's decision said, and to acknowledge the importance of a "heightened degree" of care in the second procedure, "particularly given the first procedure was not successful." He also acknowledged that he "did not document sufficient steps to identify the lesion" in August of 2023. The panel found other gaps in Ziesmann's record-keeping from the care he provided another patient, who complained about breast augmentation surgery in 2012 that resulted in a stitch abscess — an abscess that forms due to infection of sutures. The patient faced issues with wound healing, scarring and retained surgical drain from three other surgeries Ziesmann performed from 2014 to 2019. Ziesmann said the patient had multiple factors that put her at higher risk for infections and delayed healing, but some of that analysis was not documented in his chart notes, he told the panel. Ziesmann had a professional obligation to document the conversations he had with the patient on treatment options, but failed to do so, breaching various standards of medical practice over the 10 years he treated her, the decision said. Under a joint recommendation between Ziesmann and the College of Physicians and Surgeons, the surgeon was given a six-week suspension, which began on March 24. Following that, he was allowed to resume practising, but under "lengthy conditions" to maintain professional standards and public safety, the decision said. The doctor's practice was already subject to interim conditions at the time of the March hearing. The panel's decision said it was informed of six prior complaints in which he was "criticized and/or provided with advice or reminders" regarding obtaining informed consent from patients, his vigilance in followup care, and the accuracy and completeness of clinical documentation. The May decision also ordered him to pay the college $34,295.70 in costs. The joint recommendation acknowledged that Ziesmann's guilty plea spared the college from a full inquiry process, the decision said, but "acts not only as a specific deterrent to Dr. Ziesmann but also as a general deterrent in that it imposes serious punishment for serious misconduct," the decision said.
CBC
4 days ago
- Health
- CBC
Doctors Manitoba cheers changes to help U.S. physicians relocate to province
Regulatory changes intended to make it easier for U.S.-based physicians to relocate and practice in Manitoba are being loudly applauded by an advocacy group in the province. "We're really excited about it. Manitoba has one of the worst doctor shortages in the country, and as practising physicians, we see the consequences of this every day," said Doctors Manitoba president Nichelle Desilets. The College of Physicians and Surgeons of Manitoba and the provincial government recently took steps to streamline the process for qualified physicians from the United States to be granted a full licence to practice in the province, provided they meet certain requirements. They have to first complete an accredited residency program, have certification from the American Board of Medical Specialists and have a licence from a U.S. state medical board. "The training that American physicians undergo is very similar to a Canadian physician. I would even say nearly identical," said Desilets, who practises in Neepawa. "There is much more in common than there is different." Processes the government and college have agreed to remove include things like requiring supervisors and formal assessments, and restrictions on where a new doctor can practise — which can all be costly and time-consuming. Doctors Manitoba advocated for such changes more than a year ago, Desilets said. "Manitoba has been behind in making these changes, so it's really great to see that we're catching up on that," Desilets said. B.C., Saskatchewan, New Brunswick, Nova Scotia and P.E.I. have already simplified the process, she said. It's also important to underscore the fact that none of the changes will compromise the quality of patient care, she said. "The public should still be reassured that there is still a rigorous process making sure that every doctor that practises in Manitoba is qualified to do so and has been vetted by our college." The province has also followed the lead of Doctors Manitoba by launching recruitment campaigns in the U.S. The provincial government is targeting health-care workers in the nearby states of Michigan, Minnesota, North Dakota and South Dakota, touting Manitoba's strengths and priorities, including safe and inclusive communities, good schools, strong social supports and comparable affordability with a high quality of life. Doctors Manitoba had ramped up its own recruitment efforts late last year with a similar message in an effort to appeal to physicians in search of stability and respect after Donald Trump was elected U.S. president. "We have the privilege of working in an environment where the government doesn't generally get in between us and our patients, so that was the kind of the selling point that we brought," Desilets said. "We're grateful to see that our public advocacy efforts were able to influence government stakeholders and our own regulatory college to take a look at all of the requirements and to kind of take our lead." She couldn't say, though, if the efforts have prompted anyone to relocate north of the border. "As a front-line working doctor, I wouldn't be privy to that knowledge, but we do know that our office has had people reach out to inquire about the process and what the work environment looks like," Desilets said. "Despite the flaws in our health-care system, and I acknowledge that there are many of them, I am safe when I go to work, I know that the government is going to pay me for the services that I provide to patients, and I know that I have an organization that backs me and my colleagues up when we go to work every day." Doctors Manitoba will continue to promote those benefits through its own recruitment efforts in news media interviews, advertisements, and the website ManitobaMD.com. While the push to open the door more to American doctors is welcome, it's only one aspect of addressing the shortage, Desilets said. The barriers between provinces need to be dealt with, as well. "Even though people expect health care to be nationally available to them, it's still administered on a provincial level. So this is a barrier to recruiting physicians to Manitoba, no matter where you're coming from," she said. "The fact that we don't have enough doctors to serve our population is a multi-pronged challenge. There's not one golden answer … and we're going to continue to advocate. We need more doctors, we need more specialists."
CBC
5 days ago
- Health
- CBC
U.S. doctors, nurses will be able to work in Ontario more easily through new fast-tracked process
Social Sharing Doctors and nurses licensed in the United States will soon be able to more easily practise in Ontario, under changes announced today by the minister of health. Sylvia Jones says the move will increase the number of health-care professionals working in the province. The province is enabling qualified U.S.-licensed physicians, nurse practitioners, registered nurses, and registered practical nurses to start working in Ontario health settings before they register with the regulatory college. They will be allowed to work for up to six months while seeking registration with either the College of Physicians and Surgeons of Ontario or the College of Nurses of Ontario. Doctors and nurses would still have to go through he usual immigration processes, and to qualify they must be licensed in their home jurisdiction with no history of misconduct or incompetence. The government previously expedited the process for physicians, nurses, respiratory therapists and medical laboratory technologists registered in other jurisdictions in Canada to work in Ontario while going through the registration process.
Globe and Mail
5 days ago
- Business
- Globe and Mail
Ontario fast-tracks process for U.S. doctors, nurses to work in province
Doctors and nurses licensed in the United States will soon be able to more easily practise in Ontario, under changes announced today by the minister of health. Sylvia Jones says the move will increase the number of health-care professionals working in the province. The province is enabling qualified U.S.-licensed physicians, nurse practitioners, registered nurses, and registered practical nurses to start working in Ontario health settings before they register with the regulatory college. They will be allowed to work for up to six months while seeking registration with either the College of Physicians and Surgeons of Ontario or the College of Nurses of Ontario. Doctors and nurses would still have to go through he usual immigration processes, and to qualify they must be licensed in their home jurisdiction with no history of misconduct or incompetence. The government previously expedited the process for physicians, nurses, respiratory therapists and medical laboratory technologists registered in other jurisdictions in Canada to work in Ontario while going through the registration process.
Medscape
20-05-2025
- Health
- Medscape
Mixed Results for BC's Opioid Standard for Noncancer Pain
An opioid prescribing practice standard for chronic noncancer pain (CNCP) was associated with accelerated declines in opioid doses and high-dose prescribing in British Columbia (BC) but also with more aggressive and inappropriate dose tapering, a new analysis showed. In addition, the standard resulted in restricted access to opioids for patients who may have benefited from them. For some individuals, this restriction continues today, despite a subsequent update, experts said. Shifting Standards and Guidelines The practice standard 'Safe Prescribing of Drugs with Potential for Misuse/Diversion' was released by the College of Physicians and Surgeons of British Columbia in 2016, then revised in 2018 to clarify that clinicians should not use aggressive tapering or reduce access to opioids for patients with cancer or those receiving palliative care, according to the new analysis, which was published on May 12 in CMAJ. The 2016 standard, which was legally enforceable, was associated with the acceleration of preexisting declines in opioid prescriptions to patients with CNCP, as well as declines in high-dose prescribing. However, it also 'reflected the most worrisome recommendation by the US Centers for Disease Control and Prevention guideline,' which was published earlier [and has since been updated], Jason Busse, MD, professor of anesthesia at McMaster University in Hamilton, Ontario, told Medscape Medical News. Jason Busse, MD The 2016 standard recommended against increasing the dose of opioids to 90 morphine milligram equivalents or more per day for patients with CNCP but failed to clarify whether the recommendation pertained to new or legacy patients, said Busse. The result was that patients already on high doses risked being tapered aggressively to meet the new dose requirements. In addition, the standard 'seems to have limited access for populations that have historically benefited from opioids, including patients with cancer or those receiving palliative care,' study author Dimitra Panagiotoglou, MD, associate professor in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University in Montreal, told Medscape Medical News. Dimitra Panagiotoglou, MD The study's findings 'demonstrate the ability of practice standards to modify physician behavior but also highlight how misinterpretation can harm patients,' Panagiotoglou added. In 2017, between the publication of the original practice standard and its subsequent update, the Canadian government released the 'Guideline for Opioids for Chronic Noncancer Pain.' The 2017 guideline was not legally enforceable and was more open to interpretation than the 2016 practice standard, however, and so the effects of the guideline on physician prescribing in BC 'appear to be small, if present at all,' the study authors noted. The 2018 practice standard update is legally enforceable. But because appropriate access to opioid medications remains limited even now, clinicians on Panagiotoglou's team and patients they've spoken with have 'mixed feelings' about the updated standard and the 2017 prescribing guideline. Furthermore, Busse said, 'There are now several recent guidelines for opioids and chronic pain that make different recommendations. Some recommend against use of opioids for CNCP under any circumstances, while others do not. Research is needed to understand why these discrepancies have arisen and to provide guidance on which recommendations are most trustworthy.' One step in that direction is an update to the 2017 guideline, he noted. A quick reference summary of the update is available now, and full recommendations are expected to be published next winter. 'Unlearning' the Past Why did BC health officials decide to address opioid prescribing in 2016? 'Today, there is an overall understanding that overprescribing can lead to opioid use disorder, but for a long time, that wasn't the case,' said Monty Ghosh, MD, an addiction physician and researcher and assistant professor at the University of Alberta, Edmonton, and the University of Calgary, Calgary. Monty Ghosh, MD 'The previous philosophy was that pain was the fifth vital sign, that we should be prescribing opioids freely for all types of pain, and that they didn't have addictive potential,' he told Medscape Medical News . 'That is all being undone right now.' In 2016, health officials saw higher than normal rates of drug poisonings and overdoses, spurring the declaration of an opioid 'crisis' in BC as well as in Alberta, Ghosh said. 'An alert went out to ensure that physicians were not fueling the crisis because at points in time, we were. That is when we started to see the gears change in terms of prescribing. Changes started trickling in before but really ramped up in 2017 to 2018.' Nevertheless, he noted, 'It's much harder to unlearn than it is to learn, and the standards and the guideline increased awareness of the potential harms.' Prescribing changed due to other practice modifications as well, he said. For example, in Alberta, prescribers now receive quarterly memos showing the amount of opioids they've prescribed and where they fit in the spectrum of prescribers. The memos show, for example, whether the prescriber is in the top or bottom 5% of prescribers. 'Those memos link to information on how to properly prescribe for patients with CNCP that are pretty much in keeping with the guideline and standard,' said Ghosh. Nonopioid Options If the goal is to reduce inappropriate opioid prescribing, then it's important to take advantage of nonopioid options, Busse said. But although opioids are a 'treatment of last resort' for CNCP, several nonopioid options are inaccessible for many patients with chronic pain because services are unavailable where they reside, out-of-pocket costs are high, or waiting lists are long. One potentially more accessible option is remote, therapist-guided cognitive-behavioral therapy, which seemed to be as effective as in-person therapy for chronic pain in a recent study by Busse's team. 'In addition, some emerging therapies for chronic pain, such as pain-reprocessing therapy, suggest large effects, and further high-quality trials are needed to confirm findings,' he said. Evidence-based preventive strategies for CNCP also should be incorporated into clinical practice, he added. For example, a recent study showed that a program of education and progressive walking effectively reduces recurrence of low back pain. Ghosh advised using as many adjunct interventions as possible when treating patients with CNCP. These interventions include physical therapy, proper sleep habits, and, if needed, treatment of concomitant depression and anxiety that can worsen pain perception. Potentially helpful medications could include acetaminophen, gabapentin, or selective serotonin reuptake inhibitors. 'We need to be maximizing those interventions before we start initiating, reducing, or tapering opioids,' he said. In a related commentary, Kiran Grant, MD, and colleagues at the University of British Columbia, Vancouver, pointed out that evidence-based treatments for chronic pain are often inaccessible for many people with a concurrent diagnosis of opioid use disorder. They suggest integrating chronic pain management into the care for these patients to reduce overdose rates and improve outcomes. 'Prescribe Diligently' When an opioid prescription is appropriate, Ghosh said, 'We should be prescribing it and making sure we do it diligently and that we really deal with the patient's pain. Importantly, people who have a substance use disorder should not be prevented from accessing pain medications if they're in acute pain. In fact, they should be worked with to make sure we're not underprescribing for the acute pain because we're worried about feeding their substance use. 'We need to prescribe higher amounts of pain medications to treat their acute pain: For example, if they've pulled a muscle or if they've been in a motor vehicle accident and sustained a fractured rib,' he said. 'That prescribing should trend down over time as their pain resolves, and we wean them from the extra opioids.' 'We know that the evidence for chronic pain management for all patients is limited and that opioid use can be detrimental,' he said. 'So, when we decide to prescribe, we need to be careful, and we need to do it appropriately.' The study was supported by a Canadian Institutes of Health Research Project grant. Panagiotoglou, who holds a Tier 2 Canada Research Chair in the Economics of Harm Reduction, declared having no relevant financial relationships. Ghosh cofounded Canada's National Overdose Response Service, belongs to the Canadian Society of Addiction Medicine, and reported having no relevant financial relationships. Busse holds government grants to study opioids and chronic pain, including for the update of the opioid guideline, and he is on a funded grant with Panagiotoglou to study the spillover effects of opioid guidelines but reported having no relevant financial relationships.
