Regulatory Issues of Physician Conduct

Respect for Colleague

Fraud is defined by the Oxford dictionary as ‘wrongful or criminal deception intended to result in financial or personal gain.

Issuance of a False Medical Certificate

• A physician who issues a false medical certificate of ‘birth, death, notice of disease, state of health, vaccination or disinfection or respecting any matter relating to life, health, or accident insurance’ is viewed by the Medical Board of Trinidad and Tobago to be guilty of infamous or disgraceful conduct.


• Where there is evidence that the validity of a sick leave certificate is in question, it is within the right of the employer to seek more information about the certificate issued and to enter a complaint to the Medical Board of Trinidad and Tobago for further inquiry.


• The conduct of an inquiry by the Medical Board of Trinidad and Tobago into the matter of an invalid sick leave certificate is not contingent on a finding of guilt in a court of law but is conducted as an independent inquiry.

• The issue of a false sick leave certificate is in breach of the Medical Board Act (Section 24 [5] [c]



• A physician is deemed to be guilty of serious professional misconduct by the court if they knowingly give a false sick leave certificate.



• Such a finding will form part of the permanent records of the member and will be included in a letter of good standing, if this is requested by other registration or professional bodies.

Self-prescription/self-administration of drugs

A physician is deemed to be guilty of serious professional misconduct if they are addicted to narcotic drugs or other drugs of dependence. Where there is proof that a physician has knowingly issued a false sick leave certificate and/or is addicted to narcotic drugs or other drugs of dependence the physician will be liable to the sanctions as provided for under Section 24 [2] of the Medical Board Act namely

• Censure or reprimand


• Suspension for a period not exceeding two years


• Revocation of temporary licence .


• Revocation of temporary licence .

Where a physician seeks to extract from another practitioner a sick leave certificate in circumstances where the requirements of issuance are not fulfilled; the physician requesting the certificate could be deemed guilty of serious professional misconduct under Section 24 [5] [i] of the Medical Board Act and be subject to the sanctions of Section 24 [2] of the said Act.

The foregoing notwithstanding‚ in certain circumstances‚ a case may be made out in a Court of Law for fraud against either or both parties in the situations outlined above.

Abandonment

According to the American Medical Association this is defined as “the termination of a professional relationship between physician and patient at an unreasonable time and without giving the patient the chance to find an equally qualified replacement”.

There are two major types of abandonment:
Intentional Abandonment:

This occurs when a physician ends their professional relationship with a patient due to non-payment of fees. This constitutes a legal liability since the relationship is not defined by the financial but by the fiducial responsibility to the patient.

In other instances, a physician may justifiably choose to end a professional relationship with a patient who is threatening to the physician or their staff; the patient is unreasonably demanding or non-compliant. In these instances, the guidelines below should be followed to ensure proper handing over of care to another physician.

Inadvertent Abandonment:

This occurs where the physician-patient relationship is terminated as a result of relocation or retirement of the physician or the practice; failures in scheduling appointments; where patient care is compromised because of the patient’s inability to have access to the physician in a timely manner; or physician’s lack of adequate cover for time away from work.

The Board would like to recommend the following to avoid a claim of abandonment against a physician:

• Notice of termination of physician-patient relationship should be given in writing, with the reason for termination outlined in the written communication.


• A specified ‘grace period’ should exist during which time the physician continues to provide care, while waiting on the patient to find another health care provider.


• A letter of referral to another physician with a transfer of notes should be offered

Medical Negligence and the ‘Bolam test’

Medical negligence is deemed to have occurred if the standard of care provided by the physician or health care organisation is below that which would be expected of a ‘ reasonable’ health care professional at the same level and with the same qualifications. The Bolam test is a test of whether the physician acted in accordance with accepted practice by a ‘responsible body of medical opinion’

Fee splitting and/or referral commission

This occurs when a physician receives financial remuneration for referring a patient to a specific practitioner or for a specific service. This practice is not acceptable.