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Suggested Amendments to AHS Medical Staff Rule and Bylaws 2022

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Dear Colleagues,

Kindly support our suggested changes to the AHS Medical Staff Rules and Bylaws by signing this "petition". We are trying to promote a just culture within AHS so that everyone is treated fairly if they ever find themselves having to defend a complaint brought against them. Thank you for being so supportive.

Respectfully,

Bukky Apantaku


Dr. Edmund Barker

Central Zone Medical Staff Association Representative

Innisfail, AB

Via Email

Dear Dr. Barker,

Re: Amendments to the AHS Medical Staff Rules and Bylaws

We would like to make the following recommendations as our contribution to the ongoing discussions regarding the amendments to the rules and bylaws.

We represent a group of physicians from an ethnic minority group. We believe that certain provisions in the rules and bylaws wittingly or unwittingly allow the perpetuation of individual and systemic racism within the organization.

We would like to make the following recommendations with a view to diminishing the racism that currently exists in AHS.

1. The AHS Medical Staff Rules should be amended to include a new section called 4.19.1 and entitled Racism and Discrimination in the Healthcare Workplace.

The suggested content for this section is as follows: Race is a social construct. This means that society forms an opinion about race based on physical traits, geographic, historical, and other factors even though none of these can be used to justify racial superiority or racial prejudice. Racism is a belief that one group is superior to others. Racism can be openly displayed in racial slurs, jokes, or hate crimes. It can also be more deeply rooted in values, attitudes, and stereotypical beliefs. In some cases, people do not even realize that they have these beliefs.

Racial discrimination is the illegal expression of racism. It includes any action, intentional or not, that has the effect of singling out physicians based on their race, imposing burdens on them and not on others, or withholding or limiting access to benefits available to other members of the medical community. Racial discrimination can often be very subtle, such as having clinical privileges held on a whim or being denied mentoring and training. It also means being held to different clinical standards than other physicians resulting in great emotional and professional turmoil.

2. The Bylaws pertaining to this rule would fall under section 4.2: Individual Practitioner Responsibilities and Accountability.

The subsection would be called 4.2.8 Medical Staff Members Commitment against Racism and or Discrimination and would:

(a) require all Medical Staff to undergo training on implicit bias on a 3-yearly basis.

(b) require all Medical Staff to practice and model tolerance, respect and open mindedness and peace for each other regardless of race.

(c) strongly frown on all manifestations of racism including those pertaining to racial jokes, slurs or hate crime.

(d) it is the joint responsibility of any medical staff member that observes or believes that an act of racism and or discrimination is being perpetrated against any other medical staff member reports such to his or her immediate supervisor who in turn must ensure that such concern is promptly and adequately addressed.

(e) make it clear that any incidence of suspected or overt racism will be investigated and may forms grounds for a triggered initial assessment (TIA) or referral to the CPSA for further action.

3. Part 6 – Triggered Initial Assessment and Triggered Review should be updated to allow for greater transparency and fairness in the investigation.

Section 6.2.1 should include the following amendments:

(a) Subsection (d) should be amended to say the affected physician should have the right to respond to the concern and such response objectively reviewed before any adversarial action or sanction, if any, is taken against him/her.

(b) Subsection (g) should be amended to say there should be timely disposition of the TIA consistent with the nature of the Concern, but not to exceed a total of one hundred and eighty days if the Affected Practitioner’s practice is unaffected or ninety days if any of the scope of practice of the Affected Practitioner is negatively affected.

(c) Subsection (j) should be amended to include the following

i. In cases where the Affected Practitioner is a member of an ethnic minority group, at least one member of the Hearing Committee must be from a similar or other ethnic minority group like the Affected Practitioner.

ii. In cases where the Affected Practitioner is a member of an ethnic minority group, the Department of Diversity and Equity in the AHS should be notified so that it can have a representative to serve as an observer in the Hearing Committee procedures and sittings.

iii. The Zone Medical Director or designate(s) shall, upon receipt of a Concern, and/or other information/complaints ensure that Facility Medical Director and or Complainant that submitted the Concern has no conflict of interest against the Affected Practitioner that might serve as incentive for such complaint or concern. If the Zone Medical Director believes such conflict of interest exists and serves as motivation for such complaint or concern, he or she must communicate such to the Complainant.

(d) Section 6.2.2. subsection (j) should be amended as follows: timely disposition of the Triggered Initial Assessment and/or Triggered Review consistent with the nature of the Concern, the completion of Consensual Resolution process including any recommendation therefrom, must not exceed 180 days if the Affected Practitioner’s scope of practice is not affected or 90 days if any aspect of scope of practice of the Affected Practitioner is negatively impacted.

(e) Subsection 6.3.2 should have the following addition:

i. 6.3.2.3 – the identity of the witnesses for a Triggered Initial Assessment must be revealed to the affected physician ahead of time and they must testify under penalty of perjury to ensure that false testimony is not given against the affected physician. The physician should also be given the option of providing a list of witnesses that he/she believes is relevant to the concern.

(f) Section 6.4.11 should have the following amendment – Completion of Consensual Resolution process, including any recommendation therefrom, must not exceed 180 days if the Affected Practitioner’s scope of practice is not affected or 90 days if any aspect of scope of practice of the Affected Practitioner is negatively affected.

(g) The Hearing Committee Section 6.5.4 should have the following addition:

i. 6.5.4.8 - witnesses for Hearing must be selected with consultation with the affected physician and must testify under penalty of perjury to ensure that false testimony is not given against affected physician.

(h) Immediate Action Section 6.7 needs addition of the following subsection:

i. 6.7.11 – Notwithstanding the foregoing, no affected physician shall be subjected to or threatened with Immediate Action without due process and without being given opportunity to receive a copy of and respond to the Concern or Complaint engendering such Immediate Action.

6. We would like to suggest the following amendments to section 2.5 Facility and Community Medical Directors:

Subsection 2.5.1 Appointment and Accountability

2.5.1 (a) Each Facility will have a Facility Medical Director. The Facility Medical Director is the most senior administrative leader for a Facility. Vacancy for Facility Medical Director shall be announced to all Medical Staff Members of the involved facility by the Zone Medical Director. If more one candidate applies for the vacant position, the Zone Medical Director shall conduct an election among the physician staff members to determine the most suitable candidate for this position.

(b) Vacancies for Facility and Community Medical Directors shall be announced to all physician staff members of the involved facility by the Zone Medical Director. In case more than one candidate applies for the vacant position, the Zone Medical Director shall conduct an election among the physician staff members to determine the most suitable candidate for this position.

(c) Facility and Community Medical Directors shall be directly accountable to the Zone Medical Director or designate and shall also be responsible to the physician staff members that they lead.

2.5.2 Responsibilities and Duties. The following subsections should be added:

f) Ensure that all medical staff members are treated with equity without racist and or discriminatory animus, action, treatment and or behavior.

g) Declare any conflict of interest that may affect the fiduciary responsibilities as Facility or Community Medical Director.

h) Recuse self from any action or activity or decision-making process that he or she may be considered or adjudged as having conflict of interest.

i) Desist from any retaliatory action against any opposition or business competitor and avoid abuse of power against any member of Medical Staff or anyone else.

k) avoid appointing leader of any section or department without appropriate consultation with members of medical staff such leader will be leading.

7. We would like to suggest the following amendments to section 2.6.10 Facility or Community Clinical Department, Medical Staff and Physician Recruitment Committee Meetings:

i. 2.6.10.1 Facility or Community Clinical Department, Medical Staff and Physician Recruitment Committee Meetings shall be defined by the Facility Rules. The agenda for such meetings shall be prepared by the Facility or Community Clinical Department Executive Committee. Active and Probationary Staff members shall attend Facility or Community Clinical Department and Medical Staff Meetings while Physician Recruitment Committee shall be attended by members of that committee typically comprising representatives from each clinics and community that the facility and or community it is serving. Community, Temporary, and Locum Tenens Staff may attend Facility or Community Clinical Department and Medical Staff Meetings.

ii. 2.6.10.2 Facility or Community Clinical Department and Medical Staff Meetings shall address internal organization, resource allocation, the facilitation of teaching, research and other pertinent Zone Clinical Departmental matters while the Physician Recruitment Committee shall address recruitment and retention strategies and plans.

iii.2.6.10.3 Quality of patient care and safety activities shall be conducted by each Facility or Community Clinical Department in accordance with requirements established by the Facility Medical Director, the Zone Medical Director or Chief Medical Officer.

8. We would like to suggest the following amendment to section 2.1.2 – General Provisions – Term of Appointment - Unless otherwise specified in the vacancy posting, the term of appointment for AHS medical administrative leadership positions shall be up to three years, renewable once.

9. In section 2.12.2 of the Medical Staff Rules - Composition of Bylaws and Rules Review Committee – we would like to suggest that a provision should be made for mandatory membership by a physician(s) from a racialized group in this committee.

10. In section 2.13 of the Medical Staff Rules - Hearing Committees, Immediate Action Review Committee and Pool Membership Section Process – we would like to suggest the following amendments:

i. 2.13.6 – criteria for selecting hearing committee and IA review committees should include provision for mandatory membership by a physician(s) from a racialized group as the rule foresees that a population of physicians may not be fairly treated by a committee that lacks diversity in its membership.

11. In Section 2.17 of the Medical Staff Rules – Zone Application Review Committee – should include provision for mandatory membership by a physician(s) from a racialized group.

12. In section 3.2.1 of the Medical Staff Rules – AHS Practitioner Workforce Plan, we would suggest that subsection 3.2.2 (Recruitment) should give greater say to the medical staff members in a facility or community when it comes to recruiting new physicians.

We humbly hope that these policy changes would help in stemming the systemic racism and injustice that currently exist in AHS creating space for all physicians to contribute maximally to the delivery of quality healthcare to Albertans.

Thank you for taking on this onerous task of revising the Medical Staff Bylaws.

Yours sincerely,

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