How British Columbia laws leave patients in the dark

A problem in public policy not specifically related to psychiatrists, but relevant to health providers of all specialties. Of course, statistics in many locales indicate that psychiatrists offend at a rate surpassing other medical specialties, and so they are covered by this discussion. From the Times Colonist

If you needed help for a sore back, you might want to know if your chiropractor was facing multiple sex-assault charges.

You might want to know, too, if your physical therapist had ever been reprimanded for alleged sexual misconduct, or why the registered nurse treating you had been suspended for three months.

But, if you live in British Columbia, there's no easy way to get that information -- if you can get it at all.

Despite moves to greater transparency in other jurisdictions, the B.C. laws that grant health professions the privilege to set up colleges and regulate themselves in the public interest place few obligations on those same colleges to tell patients about the records of their health care providers.

The Health Professions Act, which governs most and will soon cover all 24 regulated professions, permits the public to inspect college records during regular office hours to find out whether nurses, psychologists or other professionals have had their registrations suspended or revoked, or whether they're working under certain conditions.

But the law puts no onus on colleges to publish disciplinary decisions, tell the public about fines or reprimands, post notices of cases where people resign in the face of an investigation, or provide details of the vast majority of complaints resolved behind closed doors.

The Times Colonist examined complaint statistics from a dozen colleges over five years and found that less than one per cent of files ever make it to a disciplinary hearing -- the one point at which a college is required by law to make findings public.

The rest are dismissed or resolved in secret, so a patient might never know whether the person treating them has a history of complaints.

In essence, if you don't ask, they don't have to tell. And that means a lot of things that a patient might like to know slip through the cracks.

Among the TC's findings:

• A B.C. psychologist was suspended pending a disciplinary hearing last year because his college feared he was a risk to the public. The college then waited more than four months before telling the public about the suspension.
  
  
• A pair of Vancouver Island chiropractors, each facing multiple counts of sexual assault, continue to practice under the condition they see female patients in the presence of a chaperone. The presence of the chaperone must be documented, and those records are checked by the college on a regular basis. But the chiropractors are under no obligation to notify patients why they are practising under these conditions.
  
  
• The majority of colleges have no online registry like that of the College of Physicians and Surgeons, which allows the public to search by doctor's name to check his or her disciplinary record. Ontario now requires colleges to post their entire registries online "in a manner that is accessible to the public." But there is debate in B.C. over whether colleges can release limited information even over the telephone.
  
  
• If they do post disciplinary decisions online, few colleges make it easy for the public to find them. The doctors' college, which is not yet governed by the Health Professions Act, is the most transparent, posting disciplinary decisions -- including fines, reprimands and consent agreements -- in a prominent place on its website for a 10-year period. But most colleges put the onus on the public to sift through annual reports or newsletters, though usually there is nothing on the website telling the public where to look.
  
  
• Even when they do publish decisions, there is little consistency among colleges about how much detail they give the public. Some publish case summaries without names. Some publish names without case summaries. And a number of colleges do not even post annual reports, newsletters or complaint statistics on the Internet. For example, despite repeated telephone calls and e-mails, the College of Chiropractors took more than three months to provide the TC with complaint statistics, which are unavailable on its website.
  
  
• The colleges are under no obligation to post malpractice or negligence findings by the courts, now required by law in Ontario.

Despite the gaps, the colleges insist the public is well protected by the current system.

"When we need to take action quickly, absolutely we do," says Cynthia Johansen, director of regulatory services at the College of Registered Nurses. "Our number 1 reason for being here is public protection."

But patients' rights advocates say the lack of transparency poses a risk. The TC found that only 75 of more than 8,300 complaints to 12 colleges went to a public hearing from 2001 to 2006.

"Clearly, there isn't enough information out there now," says Ann Van Regan, co-ordinator of the Zero Tolerance Network, a group dedicated to stopping abuse of patients by health professionals.

A victim of sexual abuse by an Ottawa-area physician in 1989, Van Regan says the obvious danger when the public doesn't have ready access to the discipline history of offending professionals is "that it happens again."