College of Physicians and Surgeons of Ontario approves premises standards to improve patient safety

At its Council meeting today, the College of Physicians and Surgeons of Ontario welcomed new regulatory oversight and approved premises standards that will improve patient safety in a wide variety of settings.

The College now has the authority to inspect out-of-hospital premises where procedures, such as cosmetic surgery and endoscopy, are performed using certain types of anesthesia.

Today's announcement marks the realization of the College's Patient Safety Plan set in April 2007. Legislative change was a key point identified in the plan, and was required to ensure effective regulation of these premises to greater protect the public.

"The premises inspection regulation is the result of much discussion and collaboration between the government of Ontario and the College," said Dr. Jack Mandel, College President. "In increasing numbers, Ontario patients are going to out-of-hospital premises for cosmetic and non-cosmetic procedures alike, yet the regulatory control to govern these facilities had not evolved at the same pace," said Dr. Mandel, a Toronto family physician.

"This regulation gives the College the authority to help ensure that patients who undergo procedures are receiving quality care in compliance with the proper standards," said Dr. Mandel.

The College fully supports increased access to services outside hospitals and inspections of these premises will ensure appropriate standards for procedures, infection control and quality assurance are in place. The program will also make sure that physicians are managing medical and surgical conditions within the scope of their specialty training, certification and experience.

The inspection standards approved by Council were developed by a specialty-specific task force and encompass the core requirements and expectations for the procedures that are performed in out-of-hospital premises.

"The knowledge and expertise of this group of specialists has helped the College develop a program that is both solid and sensible and achieves our goal of protecting the public. We thank them for their hard work," said Dr. Mandel.

Quality Professionals, Healthy System, Public Trust

Backgrounder

CLOSING THE PATIENT SAFETY GAP

Three years ago, the College set a four-point plan to overhaul regulatory oversight of cosmetic surgery in Ontario. Today, as a result of legislative and regulatory changes, the College has not only tightened oversight of cosmetic surgery, but has put new protections in place for patients in a variety of different ways.

In 2007, the College identified the following concerns:

- Patients did not understand physicians' qualifications; - The rules about what physicians could call themselves (i.e., their specialty title) were not well developed, not widely known and not well used; - Potential patients did not always have objective information to help them make decisions about cosmetic procedures and they were unaware of the risks of some cosmetic procedures; - Some physicians gravitated to invasive cosmetic procedures without having the necessary training and without telling the College that they had or were going to change their scope of practice; - There was insufficient oversight of community-based facilities in which many types of procedures are performed.

The Four Point Plan

At the April 2007 meeting, the Council of the College of Physicians and Surgeons of Ontario established a patient safety plan that would tighten regulatory control. The goals of this initiative were to:

- Assure that physicians currently performing cosmetic procedures in Ontario are qualified, competent and practising in environments that foster patient safety; - Enhance the regulatory oversight of physicians who wish to practise cosmetic procedures in the future and the facilities in which they practise; - Review and propose recommendations about alternative regulatory models for cosmetic procedures; and - Provide information to assist patients in making informed decisions about cosmetic procedures, the qualifications required of physicians and the differences between unregulated facilities and hospitals.

Actions Taken

Over the past three years the College has consulted with the public, government and the profession to help ensure an adequate system of regulatory oversight. The College has strongly advocated for legislative and regulatory change.

- Determined which physicians were performing cosmetic procedures, where they were performing them, and their formal training (October 2007); - Provided new information to help the public ask their physicians questions about cosmetic procedures (November 2007); - Passed a bylaw, updated our Changing Scope of Practice policy and modified the annual renewal for physicians requiring them to notify the College when they wish to change their scope of practice (February & April 2008); - The entire annual survey was made mandatory, increasing the breadth of information that physicians must provide to the College (April 2008); - Developed, consulted and finalized a regulation for use of specialist title which is currently before the Ministry of Health and Long-Term Care. Once it is enacted, it will provide a consistent framework for physicians to accurately describe their training and credentials in their advertising and other communications materials (February 2009). As of this date, this regulation is still awaiting government passage; - Added new questions on the physician's annual survey which articulate that physicians are obligated to advise the College if they have tested positive for a blood borne pathogen and they perform exposure prone procedures (April 2009); - Achieved the authority to make regulations to allow for the observation of physicians in out-of-hospital facilities and clarified other investigative powers and duties (April 2009); - Developed, consulted and submitted the regulation to government which would create an out-of-hospital premises program (November 2009). When passed, the regulation would allow the College to assess physicians who perform anesthetic-related procedures in prescribed premises, and to inspect the premises to ensure that patients are receiving quality care that is provided safely (Regulation enacted in April 2010); - Established standards for out-of-hospital premises so that the standards are widely available and form the basis for inspections and assessments (May 2010)