California Law in Treating Family Members by a Nurse Prctioner

Physician Treatment of Cocky, Family Members, or Others Close to Them

Approved by Council: November 2001
Reviewed and Updated: November 2006, February 2016, June 2017; May 2018

Companion Resources: Communication to the Profession

Other References:

• "Treating Those Closest to You,"Dialogue, Issue 1, 2016
• Results from the most contempo consultation

Policies of the Higher of Physicians and Surgeons of Ontario (the "College") set out expectations for the professional conduct of physicians practising in Ontario. Together with the Practice Guide and relevant legislation and case law, they will be used by the College and its Committees when considering medico practice or conduct.

Within policies, the terms 'must' and 'advised' are used to clear the College'due south expectations. When 'advised' is used, it indicates that physicians tin can utilize reasonable discretion when applying this expectation to do.

Additional information, general advice, and/or best practices can be institute in companion resources, such as Advice to the Profession documents.

Definitions

Family fellow member: An individual with whom the physician has a familial connection and with whom the md has a personal or close relationship, where the relationship is of such a nature that information technology would reasonably bear on the physician's professional judgment. This includes, but is non limited to: the physician'southward spouse or partner, parent, child, sibling, members of the physician's extended family, or those of the doc's spouse or partner (for case: in-laws).

Others close to them: Whatsoever other individuals who have a personal or close relationship with the medico, whether familial or not, where the relationship is of such a nature that it would reasonably affect the md's professional judgment. This may include, simply is not express to, friends, colleagues, and staff.¹

Treatment: Anything that is done for a therapeutic, preventive, palliative, diagnostic, cosmetic or other health-related purpose. This includes: the performance of whatsoever controlled act;² ordering and performing tests (including blood tests and diagnostic imaging); providing a class of handling, program of treatment, or community treatment plan.^three

Minor condition: A non-urgent, not-serious condition that requires only short-term, episodic, routine intendance and is not likely to exist an indication of, or lead to, a more than serious condition, or a status which requires ongoing clinical care or monitoring.⁴

Emergency: an "emergency" exists where an individual is apparently experiencing severe suffering or is at risk of sustaining serious bodily damage if medical intervention is non promptly provided.

Policy

1. In lodge to run into their professional obligations to practice medicine safely and effectively, physicians must only provide treatment for themselves and family unit members in limited circumstances, equally set out in this policy.

Providing Treatment

2. Physicians must non provide handling for themselves or family members except:
   1. For a modest condition, or in emergency situations;
      and
   2. When another qualified wellness-care professional is not readily available.
3. Physicians must non provide recurring episodic handling to themselves or family members for the aforementioned disease or status, or provide ongoing management of a disease or condition, even where the disease or condition is small.
4. As the same risks of compromised objectivity and coming together the standard of care may arise when providing care to others close to them, physicians are advised to advisedly consider whether it would exist appropriate to provide handling in these instances.
   1. Where the human relationship would reasonably affect the physician's professional judgement, physicians must not provide treatment to an private close to them, except in accordance with the circumstance gear up out in provision 2 of this policy.
5. When the nature of the relationship with family members or others shut to them has changed, physicians must re-evaluate the nature of their human relationship to determine whether they tin can still exist objective.
   1. If the physician'due south professional judgment has been reasonably affected by changes in the relationship, physicians must transfer intendance of the private to another qualified health-care professional person as soon as is practical.

Scope of Handling and Transfer of Care

6. Physicians must always act within the limits of their noesis, skill and judgment.⁵
7. Providing treatment in accordance with this policy is limited to addressing the immediate medical needs associated with treating a minor condition or emergency. Where additional or ongoing care is necessary, physicians must transfer care of the individual to another qualified health-intendance professional as soon equally is applied.

Expectations about Documenting Care and Maintaining Confidentiality

8. Physicians must advise the individual receiving care to notify their main health-care professional of the treatment that the doctor has provided.
9. Where the individual does not have a primary health-care professional person, physicians are advised to explain to the individual the importance of informing their side by side health-care professional, where practical, of the treatment received from the physician.
10. Where information technology is impractical for the individual receiving treatment to inform their own principal health-care professional person of the treatment the private received (e.one thousand., children), physicians are advised to inform the individual's chief health-care professional person, with the individual's consent, of the handling they provided.
11. Physicians must maintain the confidentiality of the personal health information of whatever individual they treat.^{half dozen}

Spouses or Sexual/ Romantic Partners

12. Physicians must exist mindful that providing handling to a spouse, partner, or anyone else with whom they are sexually or romantically involved may give rise to a doc-patient relationship and that providing treatment that exceeds the circumstances ready out in this policy may give rise to a physician-patient human relationship⁷ such that the sexual abuse provisions⁸ of the Regulated Wellness Professions Act, 1991 would utilize.
13. Physicians must not provide treatment to a spouse, partner, or anyone else with whom they are sexually or romantically involved, beyond the circumstances of a pocket-size condition or emergency, and where no other qualified health-care professional is readily available.

Prescribing or Administering Drugs

14. If prescribing drugs is required as part of providing intendance in accordance with this policy, physicians must comply with the Higher'southward Prescribing Drugs
15. Physicians must non prescribe or administer the post-obit for themselves, family members, or others close to them:
    1. narcotics^9,10,
    2. controlled drugs or substances^11,12,
    3. monitored drugs¹³,
    4. cannabis for medical purposes¹⁴, or
    5. whatever drugs or substances that are addicting or habituating.
16. Physicians must not prescribe or administer the drugs or substances set out in provision¹⁵ even when another wellness-care professional is in accuse of managing the treatment of the disease or condition.

Endnotes

^1. Physicians are advised to contact the College's Physician Advisory Services or the Canadian Medical Protective Association (CMPA) for farther guidance as to which individuals may be included in this term.

^2. Controlled acts for physicians, as set up out in due south. 4 of the Medicine Human activity, Due south.O. 1991, c. 30.

^iii. The definition of "treatment" has been adapted, and modified, from the definition of "treatment" every bit set out in the Wellness Intendance Consent Human action, 1996, S.O. 1996, c. 2, Schedule A, at Section 2(1); the exceptions to "treatment" under the Health Care Consent Act practise not utilise to this policy.

^4. For the purposes of this policy, "minor status" does not include providing sick notes or completing insurance claims for themselves, family members, or others shut to them.

^5. Sections two(1)(c), 2(5), O. Reg. 865/93 (Registration), enacted under the Medicine Human action, 1991, Southward.O 1001., c.30.

^vi. Physicians must abide past their legal obligations nether the Ontario Personal Health Information Protection Act, 2004, Due south.O. 2004, c. three Sched. A (PHIPA), also as the expectations set out in the College'southward Confidentiality of Personal Wellness Information policy.

^vii. Patient criteria, O. Reg. 260/18, under subsection 1(6) of the Health Professions Procedural Code, Schedule 2 of the Regulated Health Professions Act, 1991, S.O. 1991, c.18 (hereinafter HPPC). For more information, see the College's Maintaining Boundaries and Preventing Sexual Abuse policy section "Determining Whether a Physician-Patient Relationship Exists".

^8. Legislative provisions relating to sexual abuse are fix out in Sections 1(3) to (half-dozen) and Sections 51(1) to (3) and (4.1) to (9) of the HPPC. This includes the amendments to the HPPC independent in Bill 87 (Protecting Patients Human action, 2017) in strength as of May ane, 2018. Information technology does not include any other requirements that may be developed in regulation. Physicians are advised that the passing of Bill 70, the Regulated Health Professions Amendment Act (Spousal Exception), 2013, has not inverse the law with respect to physicians, equally the College has non opted to exempt physicians who treat their spouses from the sexual abuse provisions. For more than data, meet the College's Maintaining Boundaries and Preventing Sexual Abuse policy.

^nine. Narcotics are defined in s. ii of the Narcotic Control Regulations, C.R.C. c. 1041, enacted nether the Controlled Drugs and Substances Human activity, S.C. 1996, c. 19 (future the CDSA)  CDSA: the term 'narcotics' includes opioids.

^10. While these drugs or substances may be a legitimate handling, regulations under the CDSA prohibit physicians from prescribing or administering narcotics, or controlled drugs or substances for anyone other than a patient whom the medico is treating in a professional chapters. There are no exceptions under the CDSA for prescribing or administering these drugs or substances to non-patients, even in emergencies. Run into southward. 53(2) of the Narcotic Control Regulations C.R.C. c. 1041, and s. 58 of the Benzodiazepines and Other Targeted Substances Regulations, SOR/2000-217, nether the CDSA.

^11. Controlled drugs and substances are divers in southward. ii(1) of the CDSA and mean a drug or substance included in Schedule I, Two, Three, Four or V of the Human action.

^12. Delight come across footnote ten.

^13. The Ontario Ministry building of Health and Long-Term Care (Ministry building) monitors a number of prescription narcotics and other controlled substance medications as function of its Narcotics Strategy. A list of monitored drugs is bachelor on the Ministry'due south website http://health.gov.on.ca/en/pro/programs/drugs/monitored_productlist.aspx. Encounter also s. ii of the Narcotics Prophylactic and Awareness Act, 2010, S.O. 2010, c. 22 for a definition of 'monitored drug'.

^14. See the College's Cannabis for Medical Purposes policy for more information.

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Source: https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Physician-Treatment-of-Self-Family-Members-or

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