The Politics of Interest

Pay equity. Public interest. Voters can smell the bullshit

The gap between political promise and post-election delivery mirrors the untended gap these days between the public interest and a politician’s personal interest. The gap costs both interests dearly, sometimes fatally.

Call it the Wounded Moose approach to governing: Wounded. Suffering. Knows he’s dying. Shits everywhere and makes a lot of noise on the way out. For Ball, it was the fiasco of Ed Martin’s contract. For Furey, it was the astonishingly stupid decision to call an unnecessary election in the middle of a pandemic and then bungle the catastrophe that ensued.

The Newfoundland government set up a committee of local doctors in 1893 - called the medical board at the time - to protect the public interest in the practice of medicine.

The government wanted to give the public “every confidence” - as the law put it - that the people calling themselves doctors could ease pain and suffering based on knowledge and skill. The best people to decide what made a good doctor were other doctors.

The College of Physicians and Surgeons in every province of Canada has the same goal: protect the public by regulating doctors. You’d have a hard time telling that, though, because - with one or two exceptions nationally - all of the Colleges spend all of their time talking to doctors. They have no time for the public.

The local crowd used to be much more accessible to the people they protect, but over the past half-dozen years, the College has become less and less interested in telling the public anything at all that the College does. Foe example, the local College used to keep a list of doctors taking new patients but with a change in management a few years ago, that went out the door. The one organization tasked with representing the *public* interest in medical practice thought that helping people find a doctor was a job for the association that represents the best interests of doctors. That’s how their heads work.

Captain Cluny MacPherson, MD served in the First World War as a medical officer. He invented the first practical gas helmet. After the war, MacPherson was registrar of the Newfoundland Medical Board. He died in 1965 but is still listed on the public CPSNL register as if he were alive. His status is “non-practicing.”

The list of doctors on the cpsnl.ca website reflects the same sort of thinking. It has nothing to do with what people are interested in. It’s just a list that has to be there because the Medical Act says so. So you will find Cluny MacPherson - inventor of the first practical protection for soldiers against poisoned gas helmet and license number 00085 - listed on the medical register right next to a doctor with a licence number in the 12000s who started practice this year.

Cluny’s status is non-practising, which is a good thing since he has been dead and in the ground for 56 years now. Skim the list online and you will find lots of “non-practising” doctors still listed as registered to practice medicine in Newfoundland and Labrador. Many are long dead. Many others have left the province, gone for decades, never to return. Others might be on leave for a year or more while others have only just retired.

If you went in to check the list around the middle of January, you’d have found the names of 43 doctors suspended from practice because they had not got all their paperwork finished for licence renewal by the deadline on January 15. This is something called “administrative suspension.”

“Administrative suspension” is a completely made up power. It has no legal basis. Under the Medical Act, 2011, the only way the College can suspend any doctor from practice - lift the doctor’s licence in ordinary language - is as the result of a finding against the doctor by a discipline tribunal. The offence has to be big enough to be like malpractice or some gross character flaw.

Taking a doctor’s licence away is a harsh punishment not only for the doctor but also for the patients who needed a prescription filled or needed a sick child tended to or needed surgery. Well, yes, some of you might say, a doctor should be responsible enough to get all their paperwork done on time. True, but then again we are talking about paperwork, potentially a minor form or piece of information, nothing that threatened any patient.

We know it’s nothing major because something serious enough to lift a licence would be, for example, not telling the College about something else - a criminal conviction, a medical problem, or a complaint to another regulator - that would be enough for a tribunal to lift your licence anyway. Those would show up in the College’s complaints statistics and, while officials are complaining about the caseload in complaints - if memory serves, they have more staff dealing with fewer cases than a decade ago - the numbers don’t line up.

Besides, the standard government approach - which would also apply here - is that a licence like this does not automatically disappear like a pumpkin after the ball. There has to be *cause* to take it away and that requires a lot of serious action. There is due process, as the lawyers call it. The Medical Act, 2011 is very careful to connect suspending a licence with a pretty serious offence that requires the Registrar to lay a complaint against the offending doctor and send the thing off to a discipline tribunal.

We don’t know how long those doctors couldn’t treat patients but it doesn’t matter whether it was 24 minutes, 24 hours, or 24 days. What matters is that the College left the people whose interest it is supposed to protect without health care because of what amounts to some minor bureaucratic infraction. The College officials put their interest in tidy files ahead of patient care.

It reflects the sad, bizarre attitude of the recently retired Registrar that somehow the College and public access to care were not joined up. As noted in a column last month, she told a 2018 health care forum that “it's very important to be clear up front [that] the College's role in relation to health care outcomes and costs is indirect.”

No matter how you may think of it, any reasonable person would have a hard time thinking that “health care outcome” wouldn’t connect to the fact you couldn’t see a doctor for a very bad cold, to have a test done for those chest pains or your rapid and unexplained weight lost, or to have a scheduled surgery just because the doctor didn’t get a form to the Registrar by an artificial deadline.

In other words, what the College of Physicians and Surgeons does and what it is supposed to do are not the same thing. The College’s governing Council can *claim* to protect the public interest in medicine but in practice it shows little concern for the smelly beggars who didn’t go to medical school even if it has just formed a “public engagement” committee, likely to hire consultants to help it figure out what that means.