MAY2006

The Official Publication Of The

COLLEGE OF OPTOMETRISTS OF ONTARIO

Council Meeting May 30, 2006

Orillia

CSAO Exam May 29-31, 2006 in Montreal

in either English or French

May 29-31, 2006 in Waterlooin English only

Deadline for submittingcomments on the Conflict

of Interest Regulation June 12, 2006

Upcoming Events

A Word from the President......page 2Letter to the Registrar: Urgentand Emergent Care...............page 3Optometric BridgingProgram...................................page 4New Distance Education Module:Professional Boundaries ..........page 5The College Online...................page 5Other News in Brief..................page 62006-2007 Council andCommittees .............................page 8

Also in this Issue

Record Ownership andConflict of InterestChangesQ and A:On occasion, the College receives calls from members concerning regulations affecting their day-to-day practice. We have chosen two topics that are frequently brought to our attention: recordownership and conflict of interest.

Record Ownership

Q: I have recently left a practice where I worked as an associate. Do I have any claim to patientrecords and/or contact information for those patients I examined in that practice?

A: The College recommends that all practitioners working in associate positions enter into anassociate agreement that addresses the issue of record ownership. The College takes the positionthat the principal optometrist (the owner of the practice) owns the record, unless stated otherwise

in an agreement. Therefore, the associate wouldhave no inherent right to the record or patientcontact information upon termination. If anOptometry Professional Corporation is carrying onthe practice of optometry, then the records belongto that Corporation. Similarly, if two or moreoptometrists carried on practice in a partnership,then the partnership, in the absence of any

agreement to the contrary, owns the records. If a partnership dissolves, all partners have equalownership of all records and, therefore, may be required to make available copies of all records toeach partner.

Q: The staff where I formerly practised refuses to let my patients know where I am currentlypractising. Aren’t they required to inform my patients of my new location?

A: The Regulations under the Optometry Act, 1991 (O.Reg. 859/93 1. (1) #52) clearly state that itis an act of professional misconduct to fail to provide to a patient who requests them, the practiceaddress and telephone number of a member who formerly practised in association or partnershipwith the member, when the member knows or ought to know this information. Withholding thisinformation may be considered unprofessional and perceived as an attempt to coerce the patientinto remaining with the practice. It must ultimately be the patient’s decision to choose whoprovides care to them. A prudent practitioner should advise his/her patients of the new contactinformation and the former office should also have this information.

(continued on page 7)

It must ultimately be thepatient's decision tochoose who provides careto them.

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Speaking of regulation amendments, those of you who attendedthe General Meeting, as well as those of you who carefully readthe material the College sends you, are aware of the error thatwas over-looked in the Diagnostic Ultrasound RegulationAmendment background paper. I apologize for this error andregret any confusion it may have caused. Be assured that I, theCollege Staff, and the Clinical Practice Committee do know that,in fact, thick corneas may lead to artificially HIGH IOP readings,not LOW readings, and thin corneas may yield artificially lowreadings, not high!

Communication with the College

Last summer, your feedback was sought with respect to theeffectiveness of College communications. With that input, thePatient Relations Committee and College Staff have developed aCommunications Plan that aims to improve all aspects of ourability to listen to you, to the public, and to other stakeholders,as well as to provide needed information. As time goes on, theCollege web site will become the heart of our communicationsefforts. I encourage you to visit it periodically. You may find thatit’s easier to locate the information you seek than it is to findthat old copy of the Bulletin. We always appreciate anyrecommendations you offer to make the web site more useful.

Welcome to the new Council

My experience with the College has revealed that each Councilhas its own personality. I’m just getting to know this Council –we’ve had one meeting. I have learned to depend upon returningprofessional members: Lorne Berman (Toronto), Mike Cobean(North Bay), Debbie Lowy (Toronto), Michele Martin (Ottawa),and David White (London). Vice President, Linda Bathe,consistently meets the challenges of her position with insightand hard work. New professional members; Paul Padfield(Goderich), Richard Kniaziew (Leamington), are a welcomeaddition along with the School of Optometry representative,Rodger Pace. We have three returning public appointees: CraigBridges (North Bay), Henry Hodowany (Toronto) and NathaliePardy (Oshawa) who have proven their dedication to theCollege; and four energetic new public appointees: FrancisChristopher (Kitchener), Emad Hussain (Toronto), MarnyMotamedi (Toronto), and Elizabeth Rosenberg (Toronto). Ournext Council meeting will include a one-day training session onQuality Assurance and College Governance and some social timeto get to know one another better. I am regularly amazed that,along with a constant focus on protecting the public interest andsupporting excellence in optometric care and the work that itentails, we always manage to have a good time together!

I guess you’d say we’re engaged.

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A Word from thePresidentEngagementThe word for this issue’s column is“engagement”. No, I am notreferring to a promised change inmarital status and there’s nodiamond ring in sight. However, Ido think the College has capturedthe attention, if not the heart, of ourmembership over the past year. Thisapparent interest in College activitiesis substantiated by good attendance and participation at ourGeneral Meeting in London last month. The questions andcomments offered by members demonstrated genuine interestin the issues that currently face the profession– not just self-interest, but interest in the public protection aspects of theissues. I thank each of you that attended, and trust you werewell rewarded by the informative and entertaining presentationon Cultural Sensitivity by our guest speaker, Lionel Laroche.

Further evidence of engagement is the strong slate of candidatesthat recently ran for election to Council. I do not recall such ahotly contested campaign in the College’s recent history. I thankall of the candidates for their willingness to serve the public andthe profession. To those who were declared elected, I saycongratulations and welcome (back) to Council. We lookforward to the continued dedication and contributions of Dr.David White who returns to Council for his third term. This isDr. Richard Kniaziew’s first term on Council. I fully expect he willbring the same energy and innovation to the College that hascharacterized his long career of service to the profession. Dr.Paul Padfield was acclaimed in the by-election that was held forthe Northern district. Dr. Padfield’s experience and interest inTPAs will hopefully be put to good use in the coming two yearsshould the Minister of Health and Long-Term Care, theHonourable George Smitherman, receive a positiverecommendation on the matter from HPRAC. Upon receiving arequest from the Minister, the College is prepared to moveforward with developing a legislative amendment to authorizeoptometrists to treat eye disease with prescription drugs.

Yet another indication of our members’ interest in current issuesis the response to the proposed amendments to the Conflict ofInterest Regulation . You have recently received a relatedcirculation asking for your consideration of some changes theEthics Committee has made in response to comments received,as well as the related Professional Misconduct RegulationAmendments. The Committee depends upon yourrecommendations to formulate its final recommendations toCouncil.

Mark Teeple, O.D., President

Mark Teeple, O.D.

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The case history may be of interest to you, and is presentedas follows:

• An 82 y/o female presented for a routine ocular assessment ona Friday afternoon,with no ocular complaints or positive ocularfamily history. She was 20/25 uncorrected in each eye, with clearocular media, healthy fundi including discs and cupping, slit lampexamination showing Grade 2-3 angles, but pressures of OD 15,OS 25. Subsequent thresholding fields were unremarkable. Myplan was to have her return at a different time of day to re-measure the pressures for diurnal variation.

• The next day at 10 am, the pressures were OD 15, OS 52without pain. I performed gonioscopy to find Plateau IrisSyndrome and the angles closed for 360 degrees in left eye. Iknew the local ophthalmologist was on holidays, and none of theother surgeons were available by phone. The local hospitals didnot have the “on-call” list, and I had been told in the past not tosend my patients to the local ER for such eye emergencies, asthey had the same problem finding emergency ophthalmologicalcare as I did.

• Recognizing this as an ocular emergency, I elected to treat thisangle closure in my office, following the College’s Guidelines asmentioned above. Within the hour, her pressures had come downto OS 10, OS 22. I followed up over the rest of the weekend, anddid not have to re-treat her again before I was able to arrange forlaser peripheral iridotomies on the following Monday.

This case highlights the increasing difficulty many rural practicesin Ontario have in seeking urgent and emergent ophthalmologicalcare. It was only through the foresight of the College in providingthis document that I was able to provide this patient withemergency care until an ophthalmological consultation wasarranged.

Letter to theRegistrarThe following letter from a member,addressed to the Registrar, speaks tothe College’s proactive approach inassisting optometrists whenassessing and treating an emergencysituation. Many patients in ruralOntario do not have ready access tourgent and emergent medical eyecare. With specific guidelines set bythe College, optometrists can handle many emergency situations,informed and confident that they can rely on those guidelines forassistance. The Guideline on the Use of Drugs had a dramaticimpact on how this particular patient was treated. The Collegecontinues to be proactive and is currently supporting anamendment to authorize optometrists to treat eye disease withprescription drugs.

Dear Dr. Turnour:

RE: Treatment of Angle Closure in my Office

I want to begin by thanking the College of Optometrists of Ontariofor taking a proactive approach with guidance in providingemergency care to my patients. This was recently highlighted

when an elderlylady presented inmy office with angleclosure glaucoma. Icould not find anophthalmologistavailable to treatthis vision-threateningcondition, and so Iused theinformationprovided by the

College, in its Guidelines for the Use of Drugs in the Practice ofOptometry, to provide her with emergency “in-office” treatmentuntil I could get her into the ophthalmologist to completeher care.

Murray J. Turnour, O.D., Registrar

The College continues tobe proactive and iscurrently developing alegislation amendment toauthorize optometrists totreat eye disease withprescription drugs.

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A need for a better understanding of the clinical proceduresused in Ontario

The participants in the pilot program reported that their timespent in case analysis and clinical training was critical in theirsuccess on the CSAO. Becoming familiar with clinical equipmentand learning the ‘Canadian way of practice’ was extremelybeneficial.

Cultural differences and a need for Canadian workplaceexperience

The most effective way to adjust to a new professional culture isto spend time working in it and learning from it. Professionalcolleagues may also act as a cultural sounding board and mentorfor the IOG.

A lack of familiarity with the format and structure of theCSAO exam

North American graduates have developed the test-taking skillsrequired for the CSAO, without even being aware of that fact.IOGs need to be taught many of these skills that North Americangraduates take for granted.

The optometric credential assessment now consists of anacademic credential assessment and a prior learning assessment.The University of Waterloo, in conjunction with the College ofOptometrists of Ontario and with funding from the OntarioMinistry of Training, Colleges and Universities (MTCU), isdeveloping a bridging program for optometrists trained outsideCanada and the United States. Although this initial program isbeing developed for optometrists wishing to immigrate toOntario, it has been accepted by many Canadian optometricregulators and is well on its way to becoming a national program.The other provinces have recognized the benefit of this programand are prepared to accept those who have completed it.

Bridging One is a four-week program with focus on culturalorientation, additional practice of clinical skills, and two weeks ina professional practice externship.

However, it is important to provide assistance not only to thosedeemed equivalent who need some orientation to the professionin Ontario, but also to those whose education and experience areclose to those of a North American optometric graduate, but notclose enough to be deemed equivalent.

Bridging Two is a 48-week program that will allow eligible IOGs toupgrade their knowledge and clinical skills and enhance theirlanguage skills with the goal of reaching a level of equivalencythat would allow them to challenge the CSAO exam and moveforward with the registration process.

As noted at the beginning, the goal of this program is simple:develop a program that makes it possible for all qualifiedinternational optometric graduates to practice in Canada. Theroute to achieving this goal requires a team of dedicatedprofessionals to make it happen. UWSO and COO have puttogether such a team and are well on their way to making thisgoal a reality. With the assistance of MTCU, the proposedprogram will be developed and implemented, but with thenecessary care to serve the needs of internationally educatedoptometrists, the immigrant community and the peopleof Canada.

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LookingForward…toPractice in Canada The International OptometricBridging ProgramExcerpts from: Canadian Journal of Optometry, Susan Cooper

When discussing international optometric graduates, it’simportant to acknowledge the unique value they bring to theirpractice. Canada welcomes approximately 225,000 newimmigrants each year, 120,000 of whom settle in Ontario.Enabling international optometric graduates to practise theirprofession will not only meet the health care needs of the generalpopulation, but will have the added benefit of allowing the vastnumber of new immigrants to have access to eye care in theirnative language. These optometrists not only speak the languageof the new immigrants, they have a fundamental understanding ofany potential differences in culture and customs that may arise.Some barriers which may hinder their success in moving towardsregistration or licensure include:

Educational gaps

Applicants for registration must have successfully completed aprogram that is the equivalent and comparable to the course anddegree granted by the University of Waterloo. The University ofWaterloo School of Optometry (UWSO) requires a minimum oftwo years of undergraduate training (soon to be increased tothree years) followed by a four-year professional optometrydegree. This is more rigorous than in many parts of the worldand makes it difficult for some IOGs to meet the educationalrequirement for registration. That being said, many IOGs haveeducational gaps that can be addressed with an appropriatebridging program. Based on the data available to date, it isanticipated that many IOGs with an optometry degree from aneducational institution accredited outside North America willbe ‘bridgeable’.

Lack of occupation-specific language and communication skills

A pilot program at the University of Waterloo showed that whilethose with English as a first language perform better on theCSAO, English language skills alone do not ensurecomprehension of profession-specific language. It’s important toprovide IOGs with profession-specific instruction with regard todescribing symptoms, communicating with other health careprofessionals, gathering patient information, obtaining informedconsent, etc.

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The CollegeOnline:www.collegeoptom.on.caCE….on your timeThe Distance Education Module: Professional Boundaries will alsobe available online at the College website(www.collegeoptom.on.ca) by this summer. There is no deadlinefor this CE, so you are able to submit your Answer Sheet with thenominal fee for CE credit, at your convenience.

While visiting our website, if you have not already done so, youmay be interested in completing another online CE option: theHome Show on Professionalism and Professional Ethics.Members of the Ethics Committee developed this home studyprogram to make optometrists more aware of the ethical issuesof practice. To receive CE credit, simply complete the AnswerSheet and submit it with the nominal fee.

ImprovingAwareness ofProfessionalBoundaries In 2005, the Patient Relations Committee (PRC) directed an auditon the College’s communications with its membership andCommittee members. This audit included a survey on members’satisfaction with the College’s communications methods.Feedback from this audit, while generally positive, also providedthe PRC with valuable information about where improvementshould be made. Some of the comments involved improvingaccess to continuing education (CE) provided by the College. TheCollege regularly conducts successful education sessions formembers in conjunction with its annual meetings. However, it isnot always convenient or easy for interested optometrists to taketime away from their busy practices to attend.

In response to this feedback, the PRC is pleased to provide anadditional option for CE – the Distance Education Module:Professional Boundaries, which is enclosed. This module focuseson awareness of professional boundaries, how to maintain themand how to rectify the doctor/patient relationship when they arecrossed. By providing CE that can be completed at yourconvenience and through various media, such as the Internet, theCollege hopes to increase member access to CE provided by theCollege.

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Other News in Brief Helping your fellow optometrist:Quality Assurance Coaches Needed

Would you like to volunteer with the College and at the same timeassist in improving quality of care?

If you answered ‘yes’, then why not consider applying for aposition as a Quality Assurance Coach?

The College of Optometrists of Ontario’s Quality AssuranceProgram (QAP) is designed to facilitate the delivery of highquality care to patients. The QAP encourages lifelong learningand assesses the care its members provide against establishedstandards of practice. When the quality of care is found to bedeficient, the QA Committee uses one of a number ofmechanisms available to assist members to improve the carethey provide. One of the mechanisms that may be used is regularconsultation with a QA Coach.

Who is a QA Coach?

At times, in order to remediate substandard performance, aprogram involving one-on-one consultation is necessary. A QACoach plays an important role in the remedial process and isrelied upon to provide guidance and support to the memberundergoing remediation. The QA Coach is a practisingoptometrist who has been selected by the QA Committee to assist

his/her peers toaddress identifieddeficiencies in theirclinical ability. QACoaches arerequired tosuccessfullycomplete a CoachesTraining Session

specifically designed to assist them to manage the remedialprogram. This year, the Training Session will be held in Toronto inOctober 2006.

Remediation with a Coach may last up to 9 months. Mutuallyconvenient meeting dates during this term are arranged betweenthe Coach and the member in remediation. Depending on thenature of practice deficiency, a Coach and member will meet atleast once a month.

Interested?

The QA Committee is currently seeking members with thefollowing attributes.

Members who are: • Active in clinical practice and have been practising for

at least five years.

• Interested in acquiring the skills to be a Coach orbelieve they have the skills to be a Coach.

• Able to teach a range of skills and techniques usingvarious equipment and/or instrumentation.

• Willing and able to assist at least one of their peersper year.

• Willing to learn about adult education.

Please note that depending on the level of interest, applicantsmay be selected according to their practice location in order toensure geographic diversity.

Being a Quality Assurance Coach is a very rewarding experienceto both you and the member whom you are assisting. As a Coachyou will play a vital role in raising the collective performance ofthe profession. If you are interested, please complete theenclosed application form and submit it and any other relevantmaterial to the College of Optometrists of Ontario by June 30,2006 by fax or regular mail only.

Contact:

Ms. Monifa MillerCoordinator, Quality ProgramsCollege of Optometrists of Ontario6 Crescent Road, 2nd FloorToronto, ON M4W 1T1(Fax) 416-962-4073

As a Coach you will play avital role in raising thecollective performance ofthe profession.

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(continued from page 1)

Q: I feel it is only proper to inform my patients of my new practicelocation, but the owner of the practice won’t provide me with contactinformation for the patients I saw in that practice.

A: Patients expect their record to be in the location where they werelast examined. Therefore, if a practitioner leaves a practice, but therecord remains, there is no obligation to inform patients that theoptometrist has moved, except when requested by the patient. Itwould be the decision of the practice owner whether or not to providethis information to the associate leaving his/her practice.

For more information regarding ownership of records, please refer tothe November 2003 College Bulletin. Past Bulletins and AnnualReports can be found on the College website at:www.collegeoptom.on.ca. and click on: College Communications.

Conflict of Interest Changes

Q: I have been approached to open a practice in association with anoptical dispensary, but am aware that the current Conflict of InterestRegulation prohibits me from doing this. When do you anticipate thenew Regulation will take effect?

A: Proposed amendments to the Conflict of Interest Regulation andRelated Professional Misconduct Regulations were first circulated inFall 2005 and further changes were sent to members andstakeholders in late March 2006. Once this latest circulation periodends on June 12, 2006, the Ethics Committee will review thecomments received and make recommendations to Council based onthis input. When Council passes these Regulations, they will be sentto the Ministry of Health and Long-Term Care for review and finalapproval. The College cannot anticipate the time frame forcompletion of this process. Therefore, members are advised tocontinue to make practice arrangements based on the currentRegulation until such time as a new Regulation receives final approvaland is passed into law by the Government.

For all documents relating to the Proposed Amendments to theConflict of Interest Regulation and Related Professional MisconductRegulations, please go to our website at: www.collegeoptom.on.caand click on: Current Issues.

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College of Optometrists of Ontario6 Crescent Road, 2nd Floor,Toronto, Ontario M4W 1T1Telephone (416) 962-4071Toll Free (888) 825-2554Facsimile (416) 962-4073Web site www.collegeoptom.on.ca

Ordre des Optométristes de l’Ontario6 Rue Crescent, 2ième Etage,Toronto, Ontario M4W 1T1Téléphone (416) 962-4071Sans frais (888) 825-2554Facsimile (416) 962-4073Site web www.collegeoptom.on.ca

Excellence in Optometric Care

Serving the Public Interest by Guiding the Profession

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MEMBERS OF COUNCIL/MEMBRE DU CONSEIL

COMMITTEES/COMITÉS

GTA Electoral District/district électoral du centre

Dr. Lorne BermanDr. Deborah Lowy

Eastern Electoral District/district électoral de l’est

Dr. Michèle Martin

Northern Electoral District/district électoral du nord

Dr. Paul Padfield

Western Electoral District/district électoral de l'ouest

Dr. Mark Teeple

Provincial Electoral District/district électoral provincial

Dr. Linda Bathe Dr. Mike CobeanDr. Richard KniaziewDr. David White

University of Waterloo/Université de Waterloo

Dr. Rodger Pace

Lieutenant Governor in Council/le lieutenant-gouverneur en conseil

Mr./M. Craig BridgesMr. Francis ChristopherMr./M. Henry HodowanyMr. Emad HussainMs./Mme. Marny MotamediMs./Mme. Nathalie PardyMs. Elizabeth Rosenberg

Executive/le bureauDr. Mark Teeple, PresidentDr. Linda Bathe, Vice PresidentDr. Mike CobeanMr. Henry HodowanyMs./Mme. Nathalie Pardy

Clinical Practice/de l’exercice cliniqueDr. Paul Padfield, ChairDr. Heather BlainDr. Ken HadleyDr. Pooya HemamiDr. Harvey MayersMs. Elizabeth RosenbergDr. David White

Complaints/des plaintesDr. Deborah Lowy, ChairDr. John BrunoMr./M. Henry HodowanyMs. Marny MotamediDr. Jim Wilkinson

Discipline/de disciplineDr. Mike Cobean, ChairDr. Lorne BermanMr./M. Craig BridgesDr. Bruce HawkinsDr. Jim HooverMr. Emad HussainMs. Marny MotamediMs./Mme. Nathalie PardyDr. Hans Schuster

Ethics/de déontologieDr. Linda Bathe, ChairDr. Lorne BermanMr./M. Craig BridgesDr. Kan ChhatwalDr. Agnieszka FranzmannDr. Richard Samuell

Fitness to Practise/d’aptitudeprofessionnelle

Dr. Paul Monk, ChairDr. Lorne BermanMr. Francis Christopher

Optometry Review/d'étude del'optometrie

Dr. Josee Martineau, ChairMr. George AtkinsonDr. Dagmar LutziDr. Greg Simpson

Patient Relations/de relationsavec les patients

Mr./M. Craig Bridges, ChairDr. Dave BryerMr. Emad HussainDr. Deborah LowyDr. Josephine PepeDr. Peter Shaw

Quality Assurance/d’assurancede la qualité

Dr. David White, ChairDr. Richard KniaziewDr. Kamy MorcosDr. Patrick QuaidMs. Elizabeth RosenbergDr. Karin SchellenbergDr. Vince Timpano

Registration/d'inscriptionDr. Michèle Martin, ChairMr. Francis ChristopherDr. R. J. MacKenzieDr. Lisa NgDr. Wendy Tam-Wai

COLLEGE OF OPTOMETRISTS OF ONTARIOCOUNCIL & COMMITTEE MEMBERS (2006-2007)

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