Medical Assistance in Dying – What if I don’t agree with it

Posted on by Carole Hamp

Until recently, Medical Assistance in Dying (MAID) had been prohibited in Canada under the Criminal Code.  However, in the Carter v. Canada decision (February 6, 2015), the Supreme Court of Canada found that an absolute prohibition on MAID violated an individual’s legal rights under the Canadian Charter of Rights and Freedoms.  The Charter states that everyone in Canada has the legal right to “life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice”[i].

What some healthcare professionals want to know is – what about my rights?  What if MAID conflicts with my moral beliefs and values?  Well, many of the details are still being worked out but I think we can safely say that those who have a conscientious objection to MAID will not be forced to participate.  The Carter decision dealt only with the physician’s role, but it even then it did not compel physicians to provide physician-assisted death if it went against their beliefs.  It is altogether anticipated that the same will apply to all other health care professionals who could potentially be asked to assist in carrying out a patient’s wish to end their life. 

When an RT disagrees with the patient’s plan of care, the current expectation is that they do not proceed; however, they must do so in a manner that respects the patient’s dignity and does not impede the individual’s access to optimal care.  If all goes as planned, MAID will become another treatment option available to patients, and this will undoubtedly involve RTs as part of the team at times.  And so the same principle almost certainly applies to MAID.  If an RT objects on moral and/or religious grounds, s/he will be required to provide the necessary services until such time care can be transferred to an RT or another healthcare provider.

The federal and provincial governments have until June 6, 2016 to create laws related to MAID in Ontario.  Many groups and individuals are offering opinions on this issue.  Nonetheless, MAID is about to become a legal standard of care that patients will have a right to access – provided they meet the requisite criteria[ii].  Healthcare professionals have rights too.  As we continue to move forward it is vitally important that that everyone’s rights are considered and respected.

[i] Constitution Act (1982). The Canadian Charter of Rights and Freedoms. Part I. s.7. Retrieved from http://laws-lois.justice.gc.ca/eng/Const/page-15.html

[ii] House of Commons of Canada (2016, April). Bill C-14, Eligibility for medical assistance in dying, s 241.2 (1).  Retrieved from http://s3.documentcloud.org/documents/2803276/C-14-Medical-assistance-in-dying.pdf

 

Do I stay or do I go now…

Posted on by Carole Hamp

From time to time someone asks – what if I need to leave one hospital before shift change so I can make it to my next shift at a different facility? Is the CRTO okay with that? Well, the thing is that the position of the CRTO is not the primary consideration when determining the possible implications of leaving work early.   The employer and – most importantly – the patients are the most factors in this decision.

Occasionally, pretty much everyone needs to leave work a bit early (or arrives late) for one reason or another. Something urgent or unexpected might come up and, provided adequate coverage is provided, it’s not usually a problem. But what we are talking about here is something a bit more intentional and frequent, and – not be put too fine a point on it – something arguably self-serving. By that I mean, who benefits from the early departure? The patients who are left behind certainly don’t benefit, and neither does the employer or the RT’s colleagues who are left holding the bag.

I realize everyone needs to make a living, and that the current reality is many RTs need to work at multiple sites in order to cobble together a sufficient number of hours. However, that alone is not a good reason to leave work early. I’m not saying it can’t happen. But regardless of the practice setting or the type of coverage provided, before any RT walks out the door, they first need to ensure they have fulfilled their responsibilities to both to their (first) employer and their patients.

If leaving early is something that needs to happen from time to time, then the RT should have an honest conversation with their manager (or whoever they report to). It is also essential that the RTs charting and time sheet accurately reflects the number of hours that they actually worked. Interestingly enough, it is often not so much the leaving early that often causes the problem, (think suspension or termination) but trying to cover it up, falsifying charting and/or taking pay for hours not worked.

Finally – and most importantly – there are the patients to consider. It is the departing RTs responsibility to ensure that competent patient care will be provided in their absence. This requires a complete transfer of accountability to the appropriate healthcare professional who is ready and available to provide all necessary respiratory care services.

Proudly Own it All

Posted on by Carole Hamp

If you watch cable TV you may have already seen the Special K “Own it” marketing campaign that encourages women –no matter what their shape or situation is – to “proudly own it all”. It’s an interesting shift in perspective for a product that has always marketed itself to women as a diet cereal – but the ads are a refreshing change nonetheless. The concept of taking ownership rather than laying blame elsewhere for our situation is something we can apply across the board – including in our professional practice (come on, you knew I was going to bring this around to practice at some point).

We “own” the title Registered Respiratory Therapist in a number of ways – by maintaining the highest possible standard for ourselves in our practice, by conducting ourselves in a professional manner, and by meeting all the requirements of our certificate of registration. One of most basic registration requirements – and one that most of us are all too aware of – is to renew our membership on an annual basis and pay our registration fee on time. Seems straight forward enough and, for the majority of RRTs, it is. However, every year a certain number of RRTs don’t renew their Membership and their certificates of registration are suspended. That’s bad enough because now they have reinstatement fees to pay in addition to the renewal fee. Even worse, though, is the fact that they are not permitted to work with a suspended certificate of registration. It is really no different than our driver’s license – we renew and pay so that we can drive. If we choose not to renew that license – we don’t (or shouldn’t) drive because driving with an expired or suspended license is a serious offense. Practicing as an RRT with a suspended certificate of registration is also a serious offense – and one that could have far-reaching consequences (think referral to discipline for professional misconduct).

I don’t think any RRT looks forward to paying their yearly renewal fees. Apparently there are people in this world for which money is no object, but I have never met them. Most of us have just a bit less money than we would like to have and could probably find other things to do with $500 ($600 if you have to pay the late fee). But we are regulated professionals and so we have to own up to all that this entails – practicing with competence and integrity – and yes – renewing our Membership on time so that we can proudly call ourselves an RRT.

QA – What if I just say “No?”

Posted on by Carole Hamp

When considering the possible outcome of any given situation, I often find myself beginning with the worst possible scenario and working backwards from that (my friends will attest to this). I don’t see that as a bad thing. It’s RT Risk Management 101 – prepare for the worst and hope for the best. Even in my position at the CRTO, when I am asked, “what if…” I think it’s helpful to imagine the least desirable possible outcome and see if we can live with that.

Let’s try that strategy out on one question that we get asked from time to time regarding the CRTO’s QA Program which is, “What if I just don’t do it?” That’s actually an easy one, because the worst case scenario is also distinctly possible. Failure to comply with the QA Program could result in the revocation of a Member’s certificate of registration. Sure it takes a bit of time, and lawyers need to get involved, but that’s the ultimate result in cases where a Member completely refuses to participate in the QA Program. Could you live with that? Which would you rather do – complete an online, open-book, multiple-choice assessment in 30 days and submit an online PORTfolio that asks for 12 learning log activities and one learning goal – or risk losing your license to practice (pay the bills/buy food, etc.)? I know what I would choose, because I like to eat.  How about you?

The reason I bring this up is because it happens from time to time.  Not a lot, fortunately, but there have been a couple of such instances in recent memory where a Member has said “No” to QA.  When that happens I am always a bit astounded, because the QA requirements aren’t that onerous and in reality Members are learning all the time, whether they recognize or it not. So choosing to dig in one’s heels and refusing spend a few hours so that you end up in a “worst case scenario,” I think we can agree, is just not worth it.

In addition, the QA Program has a deferral process and you will find both the members of the QA Committee and the CRTO staff to be quite reasonable. We all want the same thing, which is to have competent RTs providing the best possible care to their patients. Saying “no” to quality assurance is not the way to achieve that.

Personal Information in the Information Age

Posted on by Carole Hamp

The astonishing array of personal information available at our fingertips has had two very different effects on our society, our healthcare system and on us as healthcare professionals. One is the growing awareness that we need to safeguard our privacy from the technology that has encroached on virtually every part of our lives. The other is the increasing importance we all place on our right to make informed choices about the things that affect us. As healthcare professionals, we have the ability to significantly impact the lives of our patients, and they trust us to make good decisions regarding their care and wellbeing. So what happens when we make bad decisions in our personal life? Does that make us more likely to make bad decisions in our professional life? Maybe.


We all make mistakes. Suppose an RT drinks a little too much at a Christmas party, tries to drive home, get pulled over by the police, and is charged with DUI. Not a good thing, but it happens; and it is unlikely that anyone would think any less of them as a healthcare professional as a result of one mistake. However, what if the same thing happened again on New Year’s Eve and yet again not long after the RT’s license is returned to him a year later? At what point do we feel that their drinking and driving has moved from being a mistake to a conscious (albeit somewhat inebriated) choice? We all know the dangers to ourselves and others when mixing alcohol with gasoline. So it may be argued that repeatedly choosing to do so demonstrates a pattern of poor decision-making – as well as an unwillingness to put the needs and safety of others above one’s own. Does it mean that they might apply the same flawed and self-centered reasoning when providing patient care? It’s difficult to guess, but a pattern of poor decision making may demonstrate that there is something going on with the RT that needs to be investigated (i.e., alcoholism, depression, etc.).


Let’s turn it around. It’s January 2nd and your child is about to undergo a routine surgical procedure. The surgeon who is about to operate on her has been charged with 3 DUIs over the past 2 years. Would you want to know that? What if we changed the DUI charges to theft under $5000 – or possession of stolen property – or domestic assault – ? I know it’s a bit different for Respiratory Therapists, in that our patients don’t always have an opportunity to choose us in the same way that they choose their physiotherapist or physician. This is likely to change, however, as more complex respiratory care moves into the community. Regardless, patients’ increasingly demand access to information that will enable them to make educated choices about who they entrust with their care. As healthcare professionals, we need to be aware of changing expectations.

I do solemnly declare…

Posted on by Carole Hamp

The other day I downloaded a device driver to my computer in an (unsuccessful) attempt to fix something. And when the long, wordy agreement notice came up, I will freely admit that I didn’t read it – but instead quickly clicked “I agree”. I suppose its human nature to just want to get the job done and move on, and there are numerous instances when it may not really be necessary to read the fine print. However, there are other times when we need to be much more careful about what we are agreeing to, and the CRTO Registration Renewal process is one of them.

When you complete your registration forms – either for the first time or annually – there are a series of declarations where you are required to answer either “yes” or “no”. The renewal form is fairly lengthy, and I am sure that by the time you get to the end you are just anxious to get it over with. Consequently, I suspect that some Members simply respond “no” to all of the conduct questions and “yes” to all the declarations without considering what they are agreeing to. Yet it is important to remember that you are held accountable for your responses.

One such registration renewal declaration that can come back to haunt an RT is, “I declare that I am participating in the CRTO Quality Assurance Program by maintaining my professional portfolio on an ongoing basis”. It seems like a harmless little statement, right? And yet each year a certain number of Members who are selected for QA respond that they cannot submit their professional portfolios because they do not have any continuing education activities to report. But had they checked “yes” on the QA declarations on their renewal forms? Yes they had.

A number of years ago there was a new applicant to one of the other health regulatory Colleges in Ontario who responded “no” when asked if they had been “disciplined, suspended, required to resign, terminated or subjected to similar action in respect to employment or a contract of service”. This person was granted a license and, a short time later, ended up in front of the College’s discipline committee for causing serious harm to a patient. Turns out she had had been fired from several U.S. hospitals in several states for incompetence, but the matter had not been reported to the respective regulatory agencies, nor had she declared these to the Ontario College when she applied for registration.

Legislation has since changed to tighten up reporting requirements, but Colleges do still depend upon honest declarations from the healthcare professional. That is why one of the CRTO’s declarations asks Members if they “understand that making a false or misleading statement or representation to the CRTO may be considered professional misconduct…”

Sometimes we all need to think (and read) before we click.

Reflective Thinking

Posted on by Carole Hamp

Over the past 8 years, I have been asked a number of times “whose responsibility is it to ensure that I am competent to do my job”. The short answer is easy – you are. Certainly your employer has a stake in you being the most competent professional possible, and hopefully they do what they can to support your ongoing professional development. But there is simply no escaping the fact that there is only one person who truly knows if you are competent to do something or not– and it’s you.

Determining what else you need to know in order to become more competent requires careful self-assessment. However, the trouble with self-assessment is that it seems like such time-consuming and formal process. This may be in part why study after study has demonstrated that people are simply not that good at self-assessment. I like the concept of “reflective thinking” much better, because it seems like a type of self-assessment that can be done on the fly – just like most of us learn.

Reflective thinking is really more of a perspective than a process. It provides an opportunity to immediately step back and analyze every situation from the standpoint of what just happened, how you contributed and what you could have done better. That’s the key to a reflective thinking mindset – continually asking yourself what else you could learn to ensure the best possible outcome.

Your place of employment could always benefit from more money and more staff, but you likely don’t have much control over that. However, you do have complete control of making sure that you are competent to do your job – all of your job. Only you can do that.

“Once more unto the breach, dear friends…”

Posted on by Carole Hamp

For some reason I can’t quite understand, there have recently been a number of very serious privacy breaches involving health care professionals being caught snooping into patient personal health records. Surprisingly, some of these incidences have involved fairly high profile individuals (such as was the case concerning former Toronto Mayor Rob Ford)1, and some have occurred intentionally over a prolonged period of time for personal financial gain . In the latter case, a (now former) Rouge Valley employee sold personal health information obtained from confidential patient health records2. Unbelievable!

This problem is so concerning that the government now plans to increase financial penalties for each individual who inappropriately accesses patient health records. The fine, which was already quite steep at $50,000, will be doubled to $100,000. In addition, proposed amendments to the existing legislation will make it mandatory for organizations to report privacy breaches to the Information and Privacy Commissioner (and, in some cases, to the relevant regulatory College)3 . I’m not sure how much money the Rouge Valley employee made from selling personal health information, but I don’t think all that much – seeing as they were only charged with two counts of theft under $5,000. It certainly wasn’t worth incurring four other criminal charges, public humiliation and the loss of their livelihood.

As RTs, I know it can be a bit challenging to define who our patients are, because we can be asked to see any patient at any time – often at a moment’s notice. Therefore, when accessing patient health records, we must always ask ourselves one important question: “If questioned, could I provide a reasonable explanation for viewing this patient’s records?” If an RT has provided– or reasonably thinks they may be required to provide – a health care service to a particular patient, then accessing their records is likely acceptable. However, it’s essential that we understand that the only purpose for accessing personal health records is for the patient’s benefit – never our own.

 

 

1CBC News. (2014, Oct 16). Rob Ford’s medical records accessed by 2 unauthorized hospital staff members: Hospital took ‘appropriate action against individuals involved in privacy breach. Retrieved from http://www.cbc.ca/news/canada/toronto/rob-ford-s-medical-records-accessed-by-2-unauthorized-hospital-staff-members-1.2802038

2 CBC News. (2015, Jun 2). Rouge Valley Health System privacy breaches lead to 19 charges: 5 people accused of criminal and securities offences over sale of new mothers’ confidential records. Retrieved from http://www.cbc.ca/m/touch/canada/toronto/story/1.3097374

3 Ministry of Health and Long Term Care. (2015, June 10). Ontario to Introduce New Measures to Protect Patient Privacy: Strengthening Privacy and Accountability in the Health Care System. Retrieved from http://news.ontario.ca/mohltc/en/2015/06/ontario-to-introduce-new-measures-to-protect-patient-privacy.html

We wear our license-to-practise everywhere we go

Posted on by Carole Hamp

By now you have probably heard about the individuals who thought it would be “hilarious” and “amazing” to direct an extremely obscene comment at a CityNews reporter covering a TFC game. Their behaviour was undeniably shameful and disgraceful – and the reporter (good on her) called them on it.

But what is truly fascinating about this incident is that the fallout didn’t stop there. The video immediately went viral, and a number of private citizens quickly mined Facebook and LinkedIn to find the offenders’ names and employers. This information was then shared on Twitter – tagging the employers’ corporate accounts – with demands that the companies take action. The response was swift. According to a Globe and Mail article, “with pressure mounting, both companies released statements before the end of the business day” and one of the offenders was immediately terminated from his employment. 1

There is a lesson here for all of us – even if you never intentionally set out to publicly make a fool of yourself. If we had any lingering notion that our private life is somehow separate from our professional life, I think we can let that go now. Most organizations, big and small, have Codes of Conduct that their employees are expected to abide by during employment hours. However, with smart phones and social media, these conduct expectations have moved from 9 – 5 to 24/7. It doesn’t matter where you work – no organization can afford to have their reputation damaged by an employee behaving badly for all to see, regardless of where and when it happens.

Most of us know that employers use social media to check-out a potential employee before making hiring decisions. However, not everyone realizes that when problems arise, police, lawyers and regulatory bodies also use and reference all of the information we so freely put out there. In fact, criminal charges were also pending for these offenders. You can be sure that if any of them were regulated professionals, public outcry would call for the suspension or revocation of their licenses (certificates of registration) as well.

 

1 Ha, T., & Bascaramurty, D. (2015, May 13). Social media bring workplace-harassment rules into play for men who lewdly heckled reporter. Globe and Mail. http://www.theglobeandmail.com/news/national/toronto-tv-reporter-fights-back-against-obscene-on-the-job-hecklers/article24390881/

Fight for the Right to Call Yourself an RRT

Posted on by Carole Hamp

I think we can all agree that we’ve had to work pretty hard to become RRTs. First, there were three years of schooling (only two for oldsters like me – but still), the HPTC exam, and then years and years of ongoing professional development. But did you know that each year approximately 35 RRTs have their certificates of registration suspended, simply for failing to renew their CRTO Membership? Once they are suspended, these individuals no longer have the right to call themselves an RT. Effective immediately. Just like that.

This is concerning because those who have had their certificate of registration suspended cannot continue to work as an RRT. If they do, it’s considered professional misconduct – which is a very serious matter, as I’m sure you know. Any procedure performed while suspended places both the individual and their employer at risk- and by employer, I mean often, soon-to-be, former employer. It’s important to remember that registration statuses, including suspensions, are placed on the Public Register for all to see. No employer wants to jeopardize their organization by having an employee performing controlled acts when they are no longer legally authorized to do so.

So there they are – no professional designation and maybe even no job – plus extra money spent reinstating the membership ($250 extra, to be exact). But the right to use the title “Registered Respiratory Therapist” is about more than just the ability to earn a living. The title of RRT is a symbol of professional identity, skill and integrity that is recognized by other health care professionals, employers, and the public. It has taken 50 years and a lot of RTs struggling to achieve the advancements that make our profession what it is today.

I think that the right to call ourselves RRTs is still worth fighting for.  It’s certainly worth renewing a Membership for.