An internal medicine specialist at Nanaimo Regional General Hospital was given a one-day suspension Thursday for writing orders on paper.
A group in internal medicine, including Nanaimo Medical Staff Association president Dr. David Forrest, returned to writing paper orders Thursday morning feeling they could no longer support an electronic computer order management process. The move prompted suspension of one member, Dr. Paul Mitenko, and Forrest said the group suspects more discipline to follow.
“It’s just awful that the health authority who have consistently ignored the concerns that have been raised by medical and allied health professional staff now for over a year, that we have to put our careers on the line in the interest of patient safety,” said Forrest, adding that as a member of the internal medicine group and one of those who writes orders, he will stick to his ethical principles.
“Patient safety is paramount and even if that means disciplinary action, my responsibility as a physician is to do the right thing for patients,” Forrest said.
The decision to write paper orders comes after Island Health announced the reversal of an earlier decision to suspend a key part of the IHealth system, which allows doctors to place electronic orders for tests and medication. The health authority had agreed in February to put the order entry system on hold, following a vote of 75 per cent of the Nanaimo Medical Staff Association who felt it should be suspended until redesigned.
But according to a statement this April from Island Health, that order system is “fundamentally interwoven” with other key parts of IHealth and suspending it would significantly impact those functions and jeopardize benefits realized by patients, like enhanced medication safety.
Forrest said the medical staff association was disturbed by the reversal of the decision. There’s broad concern among staff that there are problems with the system that have not been addressed and that it needs to be redesigned and suspension is required to do that, he said. He added that Island Health doesn’t seem to understand that the computer order management process is laborious, prone to error and inefficient, and that raises safety concerns in the entry of orders and a reduction in efficiency, which reduces access.
Among issues, he said, are problems with the order process that lead to medications being dropped off the medication record and orders being altered in the system, which can lead to error.
Forrest said Island Health was given six weeks’ notice that because no action was being taken to suspend the system, steps would be taken to do so, “so we’ve given them plenty of notice to put procedures in place in order to deal with this.” Further notice was given March 24 and April 21, correspondence shows.
“It’s not a protest, it’s an unwillingness to continue to use a system we feel poses a risk of harm to our patients,” Forrest said.
Mitenko said it’s ‘strange,’ but when orders are written on the computer they tend to change, some get lost or transferred to other patients and some get different doses. He was suspended after writing orders on paper. He said he had a ‘double black eye’ because of an earlier incident connected to the computer system that was seen as disruptive.
While he said the suspension is being built up by administration as a black mark on his 50-year career in medicine, he sees it as a badge of honour, telling the News Bulletin this thing they were forbidden to do, they saw they had to, to make sure their conscious is clear about patients.
He expects to be back at work after the weekend. As for whether he’ll continue to write paper orders, he said a strategy on that is still being decided. On Friday, the group in internal medicine continued to write paper orders.
Dr. Alan Ruddiman, Doctors of B.C. president, said in a e-mailed statement: “We are extremely concerned that Island Health would impose this disciplinary action on a physician who is following his ethical principles to protect patient safety.”
He said internal medicine specialists who reverted to prescribing on paper did so after more than a year of advocating for suspension of the IHealth system so it can be fixed to ensure it’s safe for patients. The suspension took place despite other departments in the hospital doing paper-based prescribing.
“The issue at Island Health is a symptom of a bigger problem – a growing tension and mistrust between the health authority administrators and the physicians. We urge the health authority to work constructively and in a meaningful way with physicians whose input is critical to providing the best quality patient care,” he said.
In a written response April 21 to internal medicine going to paper-based orders, Dr. Jeremy Etherington, chief medical officer, said it was inconsistent with Island Health policy and places patients at risk.
In an e-mail to the News Bulletin, Dr. Ben Williams, medical director for Oceanside, said Island Health cannot and will not discuss personnel matters and Island Health expects all members of the medical staff to follow Island Health policies and rules.