Editorial: Put more patients on doctors’ board

The B.C. College of Physicians and Surgeons is the disciplinary body for doctors in our province. Its principal duty is to protect patient safety by monitoring the performance of physicians.

But a case that came to light recently raises serious questions about how thoroughly such oversight is conducted.

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In 2015, it was learned that Dr. Winston Tuck Loke Tam, an obstetrician-gynecologist in Vancouver, had been seeing as many as 90 patients a day. And he was billing up to $1.7 million a year — five times the average for his specialty.

A government audit eventually revealed his over-billing, and he was ordered to repay $2.1 million. Tam resigned and left the country.

But his high rate of billing had been going on for more than a decade. More troubling still, Tam had been the subject of numerous patient complaints, including allegations that he conducted pelvic exams without consent, made inappropriate remarks about his patients’ sex lives and mishandled births. He once delivered 15 babies in a single shift.

However, when questioned, the College of Physicians and Surgeons refused to say when the complaints started, or how many there were. The reason given was the need to protect Tam’s privacy.

This is not an isolated instance. Over the past 10 years, the college has disciplined 60 physicians for reasons that include inappropriate relationships with patients, failing to disclose disciplinary actions in other provinces and over-billing.

But we are given only summary accounts of the complaints that led to these measures. The impression this leaves is that the college is more interested in limiting the damage caused by such disclosures than providing full information to the public.

Yet B.C.’s privacy statutes make clear that such information can be released when it is in the public interest to do so. That appears to be the case here.

One solution would be to change the college’s board structure. At present, there are five members appointed by the government and 10 physicians. That means doctors tend to dominate the various disciplinary committees.

The former Liberal administration in Ontario had planned such a change, before its defeat in the recent provincial election. The rebalancing was recommended by a task force set up to examine allegations that physicians guilty of sexual abuse remained in practice.

Something of the sort has been done with university boards of governors. Most universities in B.C. have a governance body composed of eight government appointees and seven members of the academic community.

The reason is that while post-secondary institutions have complete latitude in preserving academic independence, the public has an important role to play in providing overall guidance.

It can be argued that colleges of physicians and surgeons have more complex issues to deal with. Some of the complaints brought before them are technical in nature, and require expert advice to resolve.

It must also be noted that many of the allegations made by patients do not stand up under scrutiny.

Yet there is a broader public interest at stake. Physicians hold a position of considerable power and prestige in the community.

But they are also human beings, with the same weaknesses we all possess. While some complaints might be sufficiently well supported that no reasonable person would dispute them, there are bound to be allegations that are more finely balanced.

It’s here that a stronger presence of public members could bring a different outlook to deliberations. A complaint that practising physicians might be inclined to dismiss might take on a different complexion when viewed from the patient’s perspective.

But when public appointees can be outvoted two to one, what assurance do we have that the college really is patient-oriented?

In the end, it comes down to appearances. Board members no doubt take their responsibilities seriously.

But as things stand, the structure of the board gives the appearance of imbalance. The provincial Health Professions Act empowers the minister to increase the number of public appointees. This should be done.

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