Blog on Judge Cory's Commission on
the Physician Audit System
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Dr. Green's WeB LOG On Hon. Judge Peter Cory's Commission On the
College of Physicians and Surgeons Audit System
October 25 - Nov 2, 2004
by Jerry Green, M.D.
Tuesday Nov 2, 2004
Dr. Larry Erlick Criticizes Overemphasis on Clinical Record
Past President of the Ontario Medical Association
Dr. Larry Erlick, a Scarborough family practitioner, said we
should "Not just rely on the
clinical record to explain what we do."
"We should be making medically appropriate notes."
He also said, "There is a perception that if you get
caught by the MRC, you will lose."
Dr. Allan Studniberg said
that the Schedule of Benefits should be
amended in consultation with the OMA.
College Registrar Admits Problems
Dr. Rocco Vincente Gerace, humbled with his head bowed to
Justice Cory and while wringing his hands as if
to pray
(for forgiveness?), admitted that
"No doubt problems have arisen." He claims the College
"led the call for a full independent review." Then why did we have
to demonstrate
on the steps of the College?
He pointed to Cool Hand Luke and blamed
the problems on a "Failure to communicate."
So I asked him after his presentation
if the College is now willing to
communicate with people. He claims he
frequently meets with citizens and concerned
groups and would consider
meeting with us. He said there is a process in order to speak to
Council
and he doubted that we would be successful.
I asked Pres Dr. Barry Adams if he would be saying anything to
unfairly audited doctors. He said, "Nothing." I said what
about "I'm sorry." He said, "No."
Dr. Garry Salisbury,
Educator
The Ministry of Health's Dr. Garry Salisbury got
the last
word at the oral presentations of the Cory commission today
by saying "My goal is to have no audits if
we can educate doctors."
He challenged Judge Cory's view that
if the record is sufficient
for patient care then it should be
good enough for billing. He gave an example
of a doctor who billed for a general assessment
that had a record entry that had, "The date and the
words 'flu shot'". If this was a consistent
repetitive pattern, the docror
would be sent to the Medical Review Committee.
I would be interested
in responses from this group on
this.
Media Attendance Poor on Wrap Up Day
Matthew Sylvain of the Medical Post and
myself were the only
journalists present.
Christie Blatchford of the Globe and Mail who wrote two
stinging articles earlier in the hearings last week,
had promised to attend again.
Monday Nov 1, 2004
"I Let Tony Down" Brings Room To Tears
In a passioned plea, Dr. Manjit Walia of Kitchener felt he failed Dr.
Anthony Hsu by failing to get him help, even though he spent many
hours
talking with him about the unfair audits. The MRC clawed back 3% of
Dr.
Walia's pediatric consultant practice and gave him a "sense of being
raped". Dr. Fionnuala O'Kelly who works close to College of
Physicians
President Barry Adams in Ottawa said Tony Hsu "should have received
accolades in his later years of life instead of an MRC audit." She
said we
are using "unrealistic yardsticks", "a dense, obtuse Schedule of
Benefits" that has caused "morale to be worn down." Drs. Umberto
Cellupica,
Chair Pediatric Section of the OMA and Hirotaka Yamashiro, Past Chair
of
Toronto also presented a criticism of the flawed audit process.
Specialist Coalition Encourages Cory to Ask For Public Inquiry
Dr. William Hughes and Paul French, Counsel for the Specialist
Coalition of Ontario bravely put the heat on Judge Cory to go beyond
his narrow
terms of reference. "The state has to step up to the plate for its
actions", says Paul French. "What policy context permits a physician
to
take his own life?". Cory argued with Mr. French, but did listen.
The
group is also asking for "redress for those wrongfully penalized".
"All money, interest and costs should be returned with interest." I
spoke
with Paul and William at the conclusion of their submission. I said
we
are happy for what we have achieved as limited as it may be. Many of
us are talking about further actions such as a class action suit,
compensation, public enquiry, individual prosecution etc. regardless
of what
judge Cory recommends. We have only just begun.
Dr. Jeffrey Lipsitz Calls Changes to Audit System Absurd
Dr. Jeffrey Lipsitz of the Association of Sleep Medicine of Ontario
criticized OHIP's decision to require physicians to be in attendance
at
night during a sleep study. He accused the stakeholders for having a
"corporate mentality". Since the Enron disaster, corporations have
been
under fire from the public for showing no remorse for breaking the
law
(see Prof. Joel Bakan, The Corporation). This is a characteristic of
psychopathy and could be applied to the College of Physicians and
others.
Drs. Doug Mark, Chris Pinto and Counsel Brian Schell Say Minister May
Take Different Course
Master of words, Counsel Brian Schell for the Coalition of Family
Practitioners called the audit process "oppressive", "mean spirited"
and
"treating doctors like thieves and thugs."
Extrapolation is "grotesque". He felt the Cory commission "may
trigger a different course". I agree. Minister Smitherman can do
what he
likes after he receives Judge Cory's recommendation. He could
eliminate
the College, prosecute its officials, set up a new body, compensate
the
victims, set up a full public enquiry etc.
Halloween Sun Oct 31, 2004
If we were to dress in a Halloween costume at the Cory Commission
what
might that be? How about Alice since several presenters have said
that
attending the MRC was like being in Alice in Wonderland? How about a
skeleton to encourage judge Cory to get the skeletons out of the
College
of Physicians closet? Any other ideas? Oh well. I know I will see you
there Monday morning conforming to the "standard" real costume.
Fri Oct 28, 2004
Dr. Nicholas Prins Calls Audit Process "Crazy" North Bay family
practitioner is, thanks to us, frozen in the forth year of his audit.
Calling
the audits "crazy" he used other words including "devastating",
"totally ridiculous" and "wasteful of 100's of hours of my life".
When I asked
him to give a diagnosis he offered, "dementia" and "delusional".
(Picture enclosed)
Notes Not Representative Says Dr. Roland Wong
Toronto's Dr. Roland Wong feels there is a "potential conflict of
interest" in the Ministry giving money to the MRC and the College of
Physicians for rent. He feels that now that the audit process has
stopped the
"gross billers", the hardworking doctors are coming up for audits.
Like
many other patient dedicated presenters, he said, "what we have in
the
notes does not reflect the intense encounter with the patient."
(Picture enclosed)
"Standards" No Basis in "Reality" says Dr. Wayne Rankin Family
practitioner
Dr. Wayne Rankin came with his dedicated wife and office manager from
Sarnia to get a load off his chest and say that the so-called
"standards" have no basis in reality. He says "it's all about money."
If that is
true, then let us make the system pay us back for its mistakes. He is
in limbo with his audit. Still fighting an initial assessment of
$100,000 which he has whittled down to $33,000. He called the process
"destructive", "remote", "removed", "secret".
Why College of Physicians Council Member Fails to Respond to ODFFA
I asked a College Council member who attended Dr. Davey's
presentation
why he does not respond to his electorate on the discussion group of
the Ontario Doctors For Fair Audits. He says the reason is that he
does
not like the name calling and personal attacks especially directed
toward Past President Graeme Cunningham, whom he knows well. So I
asked him
what he thought about the variety of names that the College has
called
us. Any other questions for him?
Thurs Oct 28, 2004
Dr. John Gray of CMPA Criticizes the "Standards" Dr. John Gray
complained that the grounds on which the standards are based are
vague,
ambiguous and impossible to fulfill. That is interesting
because 'failure to
conform to the standards' is a common finding of doctors (including
this
one) by the College at the MRC, Discipline and other committees.
Judge
Cory asked, "Can medical necessity be defined?" Dr. Gray said each
province has a different definition.
OPA's Dr. Patrick Hewlett Presents to Cory Commission
In a revealing presentation to Judge Cory, Dr. Patrick Hewlett,
Director of the 600 strong Ontario Physicians' Alliance said many in
his group
feel "blamed, targetted and labelled as criminal by the abusive
nature
of the MRC and OHIP". He quoted an old letter from his MPP, Michael
Bryant (currently the Attorney General) saying the MRC
is "vulnerable,
open to review by the courts and may need intervention"! Thanks
mucho,
Michael.
College Of Physicians and Surgeon's Registrar Rocco Gerace Bows Head
at
Cory Inquiry
I am going to post a photo (on the "Photos" part of the Ontario
Doctors
For Fair Audits website) of Rocco with head bowed in front of Judge
Cory. The chickens (?ducks) have come home to roost. More on Rocco's,
Barry's and Rachel's presentation to follow.
Wed Oct 27, 2004
Dr. Till Davey Passes Audit But It Costs Him A Fortune
Dr. Till Davey a pediatrician origianally from Austria made a
spell-binding presentation to Judge Cory today. He passed the MRC
audit but it
cost him more in legal fees than if he had been found guilty. A
colleague of his did not fair as well. He said that no matter what we
do, we
cannot feel confident.
Monday October 25, 2004, 10 AM
Dr. Swayze Indicts College of Physicians Medical Review Committee
Toronto psychiatrist Dr. Allan G. Swayze lashed out at the Medical
Review Committee. He had few good words for the Ministry of Health as
well.
He feels a fair modern audit system should be independant of the
College. He likes to use satire, humor and poetry to show the bizarre
nature
of the MRC. He accused it of an abuse of human rights, compromising
the
Hippocratic Oath, abuse of legal rights and fostering a climate of
intimidation.
Ministry of Health's Dr. Garry Salisbury Says Audit System "Sound"
Dr. Garry Salisbury believes the audit process is sound but
misunderstood. That is physicians' problems: they just are lacking in
understanding? Judge Cory asked him what is the point in making the
doctor pay for
the costs of the audit when the federal government does not do so for
an income tax audit. When I asked him after his presentation about
problems between the College and the Ministry of Health, he said he
knew of
none.
Journalists Attend Cory Commission
Christie Blanchford columnist for the Globe and Mail, Dale Anne
Freed,
lawyer/reporter Harold Levy of the Toronto Star and this journalist
are
the only journalists to attend the Cory hearings so far. The
commission
sent our a news release on Friday.
-30-
Dr. Jerry Green, M.D. & Associates
Patient Advocacy . Medical-Legal Problems . Expert Witnesses .
Journalists . Lobbyists
416.223.0344
1.888.605.8889 Toll-free
www.drjerrygreen.com
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