PRESENTATION TO CTCMPAO COUNCIL MEEETING – OCTOBER 3, 2016

By:       Cedric Cheung, President of CMAAC, AND

Brendan Dolan, TCM Policy & Communications Committee member

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Good Morning Madame President and Council Members,

On behalf of CMAAC and its members, we thank you for the opportunity to present our concerns at this public meeting.  We ask Council to consider and rectify a number of issues that we have identified.

Our members’ are concerned with:

1. Council’s recent deliberation to revise the standards of “Reasonable language fluency” for registration of members;
2. Council’s unexplained delays in consulting on development of the regulation on “Doctor” title;
3. Inadequate Professional Member representations on Council and Committees; and
4. Duties of Council and the Registrar to adequately and openly report on the use of funds collected from membership fees

As we are only given 10 minutes to make our presentation. I and Brendan will only present the essence of each of our concerns, we are not able to present detailed backgrounds to the issues. We wish Council, its Committees and the Registrar will contact us when they deliberate and work on solutions.

 

1. Language Fluency

We understand the current Council’s wish to regulate TCM members by simply borrowing from practices of the well-established Colleges like physicians, nurses and pharmacists. There is also the wish to measure up to these Colleges. We caution that what works with these established colleges may not work with TCM. This had been recognized by the Ministry of Health and Long-Term Care and by the Transitional Council of the College from day one. Even in deciding the regulation of the profession, the government took an approach quite different from the other 23 health professions.

I sat on the Transitional Council from 2008-2013, working collaboratively with the Ministry and the TCM profession to develop the regulations and policies for proclamation of this College. During that time, I saw tremendous effort being spent on consulting and listening to TCM practitioners. The resulting regulations and policies balanced public protection with fairness to the professional members. We held the principle that a regulator can be effective only if there is general support of the profession.

When responding to the ADM of the Health Human Resources Strategy Division in 2012 on the question of language requirements, the Transitional Council clearly stated that “the College will not require practitioners to take any formal language tests such as TOFEL. The College will consider that a practitioner has attained reasonable language fluency if he/she can complete the registration application form; the jurisprudence course and safety program and be able to understand the communications coming from the College which are in English”.  The intent is that a registered member is expected to have the ability to communicate in the official language with patients and other health professionals on diagnosing and treatment of patients in the terminology and language specific to TCM care, not general usage of the language; and be able to keep records in the official language.  Members are assumed to have met the reasonable fluency requirements when they meet these criteria.

What is currently being considered by Council is relinquishing the original promise. We cannot support Council’s proposals to investigate using separate language testing such as TOFEL to determine member’s language fluency. It is contrary to the original intent of the Transitional Council and creates additional entry-to-practice barriers for registration and is an attempt to limit the continual practice grandparented members. There has been no proper consultation or justification to the membership on the proposed changes on this matter.

As far as we understand, there has not been consultation with the Fairness Commissioner, Labour Mobility Officers-AIT, the TCM provincial Colleges, TCM Associations and the Ministry of Health.

Language fluency from the practice perspective as communicated over and over again, by the College since proclamation was, “the member can communicate with patients, understand patients’ conditions, able to explain diagnosis and treatment plans, provide instruction in English or French and maintain patient records in English. The member must be able to communicate with other health professionals, understand referral information and reports from the referring health professional.” The College must not back-track.

CMAAC is concerned that the College is going too far in trying to “screen out” applicants by setting up unreasonable barriers. We are concerned that additional tests means additional fees making entry to the profession so costly to candidates.

 

2. Regulation on Doctor Title

CMAAC would like to encourage the CTCMPAO to prioritize and move forward quickly to research and consult stakeholders for development of the Doctor Title Regulation.

Government authorized the TCM profession in section 12 (a-e) of the TCM Act, 2006, the right to make regulations with respect to the use of the Dr. Title. While some College may not be happy with this provision, it was authorized to our profession after many years of Consultations and Standing Committee presentations for which strong evidence proved that this designation was warranted for the protection of the public; to allow patients access to well experienced, highly qualified TCM practitioners beyond entry-level competencies.

We understood this was being given priority and an Ad Hoc Committee which included myself, had done considerable work, first with a Presentation from Richard Steinecke, then with Emily Cheung. We reviewed extensive background information including the HPRAC report on the doctor title, recommendations from the MPP working group, and the RHPA, TCM Act. The College at its November 2, 2015 meeting gave the green light to move forward under the Working Group with clear Terms of Reference to conduct further studies, formulate next steps, workplan and budget.  It was agreed that the next step should be the hiring of a Consultant and the Registrar being the Project Manager, would draft an RFP to recruit an external consultant to develop standards of competencies and begin the work of reaching out to members with consultations and surveys.

CMAAC is puzzled that nothing had been done to this date. Our members are confused and upset this prolonged wait with no update from the College. As it stands now, after the hiring of a consultant it will take a minimum of 1-2 years to complete the study and have Council review, consult with the membership and then at least another 2 years for Government approval. It is now getting to the 4^th quarter of 2016.  PLAR and the lack of resources cannot be used as an excuse to delay such an important project. The College has large surpluses not being used for any specific projects or activities.  Compared to colleges of similar size, the College has more than enough staff.

CMAAC stands committed to support the College ensuring this project is prioritized and given the attention it should have. We are committed to working with the College in this regard.

 

3. Professional Member Representation on Council and Committees

Council decided not to run by-election in District 1 at its last meeting. Although the decision is entirely allowed by the College bylaw, it effectively throws the RHPA self-regulation concept out of the window.

From the day the profession applied to the government for regulation, we understand that for the profession to be self-governing, the Council must have at least 50% plus one professional members either appointed by government or elected from the membership. Self-regulation also means when it comes to professional discipline, setting standards for entry, continue practice, clinical review etc. members are to be judged by a panel with a majority of peers.

Considering the election timeline, we are concerned that eligible members may not have been able to stand for election as renewal of membership was still in process. Even at the last Council meeting, 200 were still outstanding.

Also, CTCMPAO election requires a practitioner become General Class member in order to be nominated. Yet currently, there were only 350-400 registered members in the General Class, the majority are in the Grandparented class.  This is unfair and open discrimination of Grandparented members intentionally blocking them from participating.  As a result, the nomination process excludes possible participation by many members with the end result being the Council not truly reflecting the TCM practitioners of Ontario.

A higher ratio of public members is not the intention of self-regulation. The question is not about being properly constituted. It is clear that a public member with little knowledge of the profession cannot address issues of standards of practice or make informed decisions that protects the public and is fair to the profession.

The College bylaw was drafted with the intent to allow flexibility and indeed some committee indicate that there should be more professional members than public members and that is because Council or Committee to make decisions without full understanding of professional practice will be risky to the public. CMAAC has been actively engaged in the legislative process for over 30 years and was instrumental in championing the TCM Act, 2006.

 

4. College Finance

Council and the Registrar are responsible for the safe custody and effective management of College funds.  The College is sustained mainly by fees from membership. CMAAC and its members are concerned with the ever increasing fees that the College required of its members with no justification on the increase and clear reporting on how funds are being used.

From the audited financial statements of April 1, 2014-March 31, 2015, we note an excess of revenue over expenses of over $1.18 millions and cash in hand at the end of March 3, 2015 in the region of $3 millions. We request an open explanation from Council on how these funds are to be used, the allocation to activities or projects. We wonder why Council keep looking to increase membership fees without first considering investment of idle funds to generate interests to defray costs.

We believe Council and the Registrar are jointly accountable for the effective use, and legitimate use of College funds. They need to provide justifications for use of every dollar of fees collected from the members.

 

Again, we thank Council for the time. We understand that Council will not deliberate our concerns at this meeting.  We would appreciate that Council urgently consider our concerns and provide us in writing, before the end of November, on how it intends to deal with EACH issues that we raise.