Page 1 of4

$essional PaPer 4c\l7p]l

4 Session, 27 Legislature

To:ron@Vn6'c{fred.horne@assemb|y.ab.ca;tony'vandermeer@assemb|y.ab'ca;
crobb@h bas.ca
CC: paddy.meade@hbas.ca; chris.eagle@calgaryhealthregion.ca; deb.gordon@capitalhealth'ca
Subject: RE: Completely non-functional emergency departments
Date: Mon, 10 Nov 20OB 77:43:25 -0700

Hi Ron.

As you are the one responsible for healthcare, I thought that I should pass this onto you.

Dr. Paul Parks'letter relates to the UofA hospital, but similar circumstances exist in all emergency
departments in Edmonton as well as departments in Calgary.

The circumstances are in place that as soon as the flu hits (or even before), there will be multiple
adverse events and probably many preventable deaths in the ED's of Edmonton and Calgary over a
period of a few days directly as a result of the inability to examine and treat seriously ill patients in
treatment spaces (note: It's not the sore throats and bloody noses that are the problem in the
major cities),

Potential solutions:
1, Re-deployment of nursing staff from non-urgent areas to urgent areas to open up closed
hospital wards.(ie. healthlink, community nurses, education and research staff)

2. Partial implementation of the disaster plan. In, fact the circumstances that currently exist would
suffice for implementation of the disaster plan. The definition of a disaster is when the ability to
deliver care is overwhelmed by the need for care.

3, Put all long term care patients in acute care beds on long term care wards and staffing those
wards with the staffing ratios of NA's, LPN's and RN's as you would have in a long term care
facility, so that the highly trained and highly paid nurses will be looking after the sickest patients.

4. Proper Implementation of the Full Capacity Plan to decant the Emergency departments of
admitted patients onto ward hallways. The healthiest patients on the wards (1-2 days away from
discharge) should be the ones in the hallways'

5. Decanting of Long term patients from acute care beds in the city to medical facilities in
neighbouring towns, so that the cities can look after the sick patients not only from the city' but
also from the periphery.

6. Local meetings in all hospitals to educate ALL staff that this is a system and hospital issue, and
not an emergency issue. This will require the cooperation of alll staff in the hospital to allthe
sickest patients in the region to get safe and timely care.

1t29t20r0
 PageZ of 4

7. Tempering of the expectations of all admitted patients and their families,

B. Asking all nursing schools to increase the bedside time in their training schools. This will not only
improve their training, but also provide some service component to their training.

Dr. Parks is the incoming president of the emergency physicians of Alberta. While he is keeping the
decision makers in the loop, others in the front lines have waited for the situation to improve and
have only seen things go from bad to worse. I would expect individual physicians risk the wrath of
the AHSB by expressing their frustrations publically in the very near future.

I lust thought that you should know of what is happening.

Cheersr+

Raj Sherman, M.D.

P.S. The Winnipeg situation is child's play compared to what has already happened in Alberta's
ED's.

I would expect the Iocal media to report on the following article soon.

Here are some comments from one respected physician.

The Mis and the GNH used to be Catholic hospitals (now "faith
based"). When the regions were created, special legislation was
passed that essentially gave them almost complete independence from
the regions per se. They currently have their own Board, and don't
answer to Capital Health (or AHS), It would appear that we will be
seeing more of the same based upon the org chart.

is absolutely correct about the administrators rearranging the

deck chairs while the ship sinks. I have spoken to more than one
well placed physician who feels that the whole thing is going to
"blow up" before all this is done, Let's hope they are wrong, but
there certainly is the potential for even bigger trouble than we
currentlv have,

> Here's the email i sent on Friday morning,

> The situation is deplorable, and getting worse,

> > To: paddy,meade@hbas,ca, chris.eagle@calgaryhealthregion,ca, Deb.Gordon@capitalhealth.ca

> Date: Friday, November 7,2008, 10:53:37 AM
> Subject: Completely non-functional emergency department
;' ===$(=== ===== ==== ==Original message teXt---- ===== ======
> Dear Paddy, Chris, and Debbie,

r/29/20r0
 Page 3 of4

> I am writing to follow up on the ongoing crisis in Emergency Medicine

> care in Alberta, most specifically at the University of Alberta
> Hospital,
> I know that we will be meeting again on November 14th, but I thought
> it might be useful to share with you how horrendously overcrowded the
> night shift I just came off was'
> I started my shift at 0000 on Nov 7th to 34 EIPS in the ED, with
> another B definite admissions pending. I spent the vast majority of my
> shift doing non-clinical damage control - discussing the situation
> with the bed coordinator and executives on call, cajoling services
> into admitting sick patients that obviously needed their care, and
> taking critical care calls for patients in the periphery for whom I
> could not safely accept their transfer.

> Despite all efforts by the bed coordinator and executive

> administrators on call, and despite some creative movement of a few
> admitted EIPs out of the ED (we even metastasized and held some EIPs
> in the Peds ED), at 0900 when I left my shift there were
> 37 EIPs, 4 more patients who were definitely going to require
> admission, and very little expectation that future in-patient beds
> were imminent, (There are only 42 stretcher areas in our ED,47 if you
> count our five "fast track" beds that do not contain monitors and
> were expressly created for low acuity, non-admitted patients.) 41 out
> of 42 emergency beds blocked is deplorable and utterly unsafe'
> The only reason the waiting room decanted is because people tired of
> the extraordinary waits, and simply left without being seen (LWBS)'
> There were 29 patients (out of 211 who presented) that LWBS, which
> amounts to a staggering L4o/o of the patients presenting to our ED. One
> of the first patients that did finally receive an ED bed was a 70 year
> old male who waited in the waiting room over 10 hours with a large
> bowel obstruction.
> In regards to our ED's ability to deliver timely acute emergency carel
> the shifi can only be described as an unmitigated disaster.
> If multiple severely ill patients had arrived in the night - as is a
> frequent occasion at our ED - we would have been completely unable to
> provide them with care or to intervene on their behalf.
> considering the UAH is held to be one of the premiere tertiary care
> emergency departments within canada, our ability to deliver timely
> care was so impaired as to be essentially nonexistent.
> Unfortunately last night was not a freak one time occurrence. Since
> our meeting, and despite all of the short term crisis initiatives that
> have been implemented, the region's data show that the overcrowding is
> steadily worsening'
> I sincerely hope that this email is received as the plea for immediate
> lasti ng assistance as it is intended to be. If the overcrowding crisis
> is allowed to continue unabated, preventable deaths will occur.
> I anxiously await your thoughts and reply'

t/29t20t0
 Page 4 of 4

> Best regardq

> Paul Parks
> Emergency FlEtlitine
> University of Alberta Hospital

Win a trip with your 3 best buddies. Enter today,

t/29/20t0
 #
Raj Sherman M.D.
Section of Emergency Medicine
Albefta Medical Association

sessional Paper 48' l'Zot\

4 Session, 27 Legislature

September 10, 2006

@
Minister of Health
Edrnonton, Alberta

Dear Minister,

I wish to congratulate you on your tenure as the Minister of Health for Alberta, Through
the efforts of many, excellent work has been accomplished to secure a brighter future for
the health of Albertans. However, the Healthcare System in Alberta continues to face
many challenges.

One of the biggest challenges is the lack of resources to care for the ever increasing
medical needs of Albertans. As you are well aware, the Emergency Departments (EDs)
across the province have faced overcrowding issues for years. This protlem has
worsened and has now reached a critical point.

You may have read stories in the newspapers about someone having a miscarriage in the
waiting room in CaIgary, a city counselor calling for two more ambulances for Edmonton
and so on. What hasn't been mentioned is the fact that there are at times up to eight
ambulances waiting anywhere from 1-5 hours to unload patients onto a stietcher in ONE
inner city ED at one time...multiple EDs on RED alert at one time, not allowing an
ambuiance to come to the nearest and most appropriate facility...a trauma patient being
assessed in the hallway and going up to the operating room from that hallway, never
seeing the trauma rooms because they are all occupied by intubated ICU/CCU
patients...record number of patients seeking care and leaving the ED without ever being
assessed by a physician, many of whom have been referred to the ED for advanced care
by urbar/rural physicians, paramedics, and Healthlink...emergency physicians (Eps)
performing assessments in hallways, triage stretchers and waiting room
chairs...rural/urban family practitioners spending an hour on the phone to transfer their iil
to an ER department. . ..consultants refusing transfer of care for patients due to a
Patient
lack of beds etc. Unfortunately, in2006,this is the reality of EDs u.ros Alberta. All of
these scenarios are a result of ED Overcrowding.

The factors contributing to ED overcrowding include demand, throughput, outflow and

system-wide problems. Significant effort has been spent with t.rp..ito decreasing
demand via ambulance diversions, Healthlink, and PCN's. EDs across the province are
 continually evolving in their practice to improve tluoughput. Despite these efforts, we
continue to have difficulties. The main reason is the fact that the most significant issue
for EDs is getting admitted patients out of the ED to an in-hospital bed in a timely
fashion. Admitted patients waiting in the ED for beds on the wards of the hospital
(EIPs...emergency in-patients) are waiting in the EDs for up to three days for a bed, thus
occupying a stretcher that is needed to assess and treat new patients presenting to the ED.
This is a system wide problem and not just an ED problem. This affects care delivered to
all Albertans, as well as care provided by all physicians.
t/
,F At of Iast week. we now have evidence that we are not meeting the stantlarrl of care rn a
/' number of areas. Increased wait times have resulted in failure to meet benchmarks for
time to: first ECG to chest pain, thrombolysis for acute myocardial infarction and stroke,
antibiotics for pneumonia, and analgesia for chest pain. With this recent knowledge, it is
morally and ethically wrong for us not to present this information to you and to our
colleagues for discussion and implementation of immediate solutions.

We, the Section of Emergency Medicine request your assistance in facing this challenge.
This is a complex problem that requires innovative solutions with cooperation from all
parties involved in patient care. We can all agree that the long term solution lies in
increasing bed capacity within the system, however this will take years to implement.
The AMA Section of Emergency Medicine members have unanimously endorsed the
enclosed "Position Statement on Alberta Emergency Department Overcrowding and
a Proposed Short Term Solution".

Our Section Executive look forward to participating in any solution that will allow for us
to provide the top quality care that Alberlans deserve and that we are capable of
providing. We will be presenting our findings to the AMA Representative Forum next
week on Sept 15-16. I, along with other executive members, would like to meet with you
as soon as possible, preferably before the representative forum. As Minister of Health, we
think that you should be the first one to hear from us.

I am hopeful that you will be able to accommodate our request despite your very busy
schedule. I look forward to hearins from vou at vour earliest convenience.

Sincefely y'ours,

.--)

Alberta Medical Association

 erta
albcrlgpe.sb.$a

February 23,2008

Dr. Peter Kwan

President
4 Seseion, 27 Legislature
Section of Emergency Medicine
Alberta Medical Association
960 - lgth Street
Lethbridge. AB T1J 1W5

Dear Dr. Kwan:

Re: Emergency Services Standards and Access for Albertans

The Honourable Dave Hancock, Minister of Health and Wellness, has

kept me apprised of the
concerns sunounding access to emergency services in emergency departments
acioss the
province.

It is clear that, notwithstanding the Minister's work with health regions and emergency room
physicians to implement the Full Capacity Protocol and other measures
over the past year, flu
season, winter accidents, and ongoing staff shortages have contributed
to a very afncut
situation.

As emergency physicians have pointed out, the problem is complex and requires
a system-wide
approach that goes well beyond emergency department operations. Government
response to date
has included S300 million in funding for over 600 new uia zoo replacement
long-term care beds
across Alberta, and more are planned. This will help to move patients
waiting dr long-term care
out of acute care settings sooner, thereby freeing up capacity for patients aOniittea
through
emergency.

Of course, opening acute beds and long-tefin care beds requires staff and as you
know, this is
the most significant issue facing health systems across North America.
Our continued
investment in the Health Workforce Strategy is paying dividends, but the immediate
needs for
Registered Nurses, Licensed Practical Nurses, and Peisonal Care Aides
continue to require
collective action by government, health regions, and the professions.

PC Association of Altrerta
9919 - 106 SfeerNW
Edmontolr, Alberla, Canada, T5K I E2

Phone: 1 -888-880-3324
E-mail : in lbfrTralb ertapc_ab.ca
Page 1
 erta
albertape a .ab"e

As the Minister has indicated publicly, our major roadblock is securing timely accreditation of
internationally educated nurses. The Minister has worked extensively with the College and
Association of Registered Nurses of Alberta in this regard, providing additional funding and staff
to streamline and accelerate the accreditation plocess and get qualified nurses into care settings
as quickly as possible. I am advised that Capital Health alone has extended job offers to over
300 internationally educated, English-speaking nurses who could go to work immediately. The
Calgary Health Region and others have similarly been recruiting. We have also substantially
expanded nursing education programs and during this election have announced plans to add a
further 350 RN and 220 LPN spaces in Alberta post secondary institutions. By 2012, we expect
to graduate 2000 RNs and 1000 LPNs on an annual basis.

In addition to adding long-term care bed capacity and the education, recruitment and retention of
our health workforce, a Progressive Conservative government will work directly with emergency
physicians to establish, implement and monitor appropriate benchmarks and standards for
emergency services on a province-wide basis. As Premier, I will direct my Minister of Health to
establish an Expert Panel on Emergency Services to undertake this critical work. We will utilize
the AMA's Emergency Medicine Position Statement, including the reconrmended CTAS
benchmark and recommendations for overcapacity protocols, as the foundation for the review, to
be completed by June 30, 2008. I assure you Alberta's emergency physicians will play a central
role in both developing and implementing this province-wide framework. As Chair of the
Emergency Medicine Section, you will be invited to participate in this work.

I believe that progress is being rnade and that there is good collaborative action being taken by
emergency physicians, professional colleges, regional health authorities, professionals at the
front line and government to resolve emergency access and treatment issues. I thank you very
much for the work you and your members are doing to put patients first and to ensure Albertans
get the very best attention possible despite the systemic pressures facing our health system.

Yours very truly,

//?
fu- /Yfr4-,-A)
Ed Stelmach
Leader

PC Association of Alberta
9919 - 106 StreetNW
Edmonton, Alberta, Canada, T5K lE2

Phone: I -888-880-3324

E-mail: in {bilr albertepc.ab.cl Page 2

 Original Correspondence to both Ministers Hancock and Liepert:

From: Paul Parks <pparks@ualberta.ca>

To: dave@ hancock.ab.ca
Date: Friday, February 22, 2008, 2:26:02 PM
Subject: ED Overcrowding Crisis
$essionat Paper F\ lP-ctl
4 Session, 27 l.egislature
Dear Mr. Minister,

I am writing to further follow-up on our conversation of February

15th, 2008.

Unfortunately ED overcrowding is significantly hampering our ability

to provide safe, timely, standard levels of care to the patients in
our region. Since I sent you the last document regarding sub-optimal
care delivery due to overcrowding, things have seemed to only continue
to degrade, and we are still uncertain as to what is being initiated
to address this quintessential health care issue.

Attached is another document providing more examples of sub-optimal

outcomes at the UAH ED collected from Feb 12th - Feb 22nd. The system
is on the brink of collapse, emergency health care provider morale is
at an all time low, and patients are suffering daily.

At 10 am today, over half of ALL of the emergency beds in the city of

Edmonton were occupied with ElPs (admitted in-patients requiring an
acute care hospital bed, not an emergency stretcher). We know from
past experience that this ED overcrowding will only get worse over the
weekend. With an emergency medicine system constantly operating at 1/2
to 1/3rd functionalcapacity, it is only a matter of time until
preventable deaths occur.

As a group of concerned health care providers we are anxious to know

what is being done to address this crisis. As well, we are willing to
work with yourself, and with regional authorities, on this
challenging crisis in any way we can.

Thank you for taking the time address this issue. And thank you in
advance for taking the time to reply to this message so that I can
assure my group that meaningful action is being taken.
Best regards,
Dr. Paul Parks mailto:pparks@ualberta.ca
Emergency Medicine
University of Alberta Hospital
on behalf of the Emergency Medicine Physicians at the University of
Alberta Hospital
From: Paul Parks <pparks@ualberta.ca>
To: Ron.Liepert@ assemblV.ab.ca
CC: Ed.Stelmach@assemblv.ab.ca, Dave.Hancock@assemblv.ab.ca,
Rai.Sherman@assemblv.ab.ca, Paddy Meade <Paddv.Meade@sov.ab.ca>
Date: Thursday, July 3, 2008, t:22:t2PM
Subject: Systemic Health Care Overcrowding is negatively affecting Albertans

Dear Health Minister Liepert,

As a concerned health eare provider, I am writing to offer my

continued support in the effort to find a solution to the systemic
overcrowding issues that are directly impacting health care
delivery to the citizens of Alberta.

In my role as an Emergency Medicine physician at the University of

Alberta Hospital (UAH), as well as in my capacity as an executive
member of the Emergency Medicine subsection of the Alberta Medical
Association (AMA), I have been working with both regional and
provincial health authorities on this important issue. In fact, I

have provided similar information to your predecessor the

Honorable Mr. Hancock detailing the current crisis regarding
timely access to acute health care in Alberta.

Attached, please find documentation of the real impact that

systemic overcrowding is having on the delivery of care to
patients presenting to the UAH emergency department. The document
is a collection of sub-optimal and substandard levels of care
directly due to emergency and systemic overcrowding. These
encounters have been documented by the various Triage Liaison

Physicians (TLPs)who have been working in the UAH ED waiting

room; a role created solely to provide a modicum of care to the
swelling numbers of patients with prolonged waits in our waiting
room. Unfortunately, the document only represents a small sampling
of continued compromised care - this truly is only the tip of the
iceberg. (This same documentation has been sent to the
Capital Health Regional Executive to ensure they are fully
appraised of the situation as well.)

I am aware that Premier Stelmach is inthe process of creating an

expert panel to directly address emergency and systemic
overcrowding, and through my position as President Elect of the
Emergency Medicine Subsection of the AMA I have volunteered to
 sessionat Paper 4- | rct t

4 Session, 27 Legislature

Alberta Health Services

Code of Gonduct

Table of Contents

Message from the Alberta Health Services Board Chair and the
President and Chief Executive Officer
a A Guide to the Code of Conduct
a Our Values
a Our Code of Conduct Principles
a Our Responsibilities
a What to do if you have Questions or Concerns
a Who is Covered by the Code
a How the Code fits with the AHS Governance Framework
a Responsibilities and Consequences
a Conclusion

a Appendix A - Getting Help and Advice

o Appendix B - Alberta Health Services - Our Values
Message from the Alberta Health Services Board Chair and the
President and Ghief Executive 0fficer
Albertans look to us for health services, information and advice for themselves and for those they
care for. They entrust us with their {ives and the lives of the people they love. They share their most
personal information with us. They collaborate and work with us.

How we interact with Albertans - and how we rnteract with each other - has a huoe impact on their
lives and our own.

Albefta Health Services' (AHS') reputation is shaped by our actions, choices and decisions each day.
Together. we must:
. Work in the best interests of our patients and clients
. Act fairly and objectively
. Recognize and address conflicts of interest
' Think about how our actions may impact our patients, co-workers, clients and communitv
panners
. Exercise our best judgment
. Protect the confidentiality of the information entrusted ro us
' Raise our hands if we see something we think is not best for our patients or our organization
. Have the courage to stand up for what is right

The AHS Code of Conduct (Code) outlines the values, principles and standards of conduct that
guide our actions and interactions. lt is at the heart of the AHS bylaws, policies, procedures,
standards, guidelines, regulations and directives that set out how we conduct ourselves as we carrv
out our work on behalf of Albertans
We are proud to be parl of AHS and look forward to working with you as we fulfill our mission:

To provide a patient-focused, quality health system that is accessible and

sustainable for all Albertans.

Officially signed on December 3, 2009 by:

Mr. Ken Hughes

Dr- Stephen Duckett

A Guide to the Code of Conduct
At Albeda Health Services, we work in a
complex environtnent and serve a multicultural
population. We often have very different
backgrounds, training and education' What we
share is a commitment to improve the health
and quality of life for our patients, each other
and the public. Our ability to provide high
qualiiy care has been, and will continue to be
possible due to the quality and integrity of the
people who are part of AHS.
That's why a Code is so important. lt can help us
to better understand each other and the people
we serve and assist us in working togeiher.
Our Code is orincioles-based. lt anchors all of
the specific AHS bylaws, policies, procedures,
standards, guidelines, regulations and directives
that set out the rules by which we govern
ourselves {see Appendix A) and the steps we
take should we fall shot't.
Our Code is based on both rights and
responsibilities. lt protects and guides equally
all of those who are part of, or work within, our
health system. lt recognizes the challenges we
face, the high standards expected and needed
of us, and the paramount impoftance of our
shared duty to the people we serve.
Regardless of where we are working - in one
of the AHS facilities, on the road or at home
- our actions should always be guided by the
Code. Each of us needs to make sure that we
understand the Code and know who we should
talk to when we find ourselves in a challenoino
situation.
Our Values
Our values, which were first outlined in the AHS
Strategic Directions, 2009-201 2, create a shared
understanding about how we relate to our
patients, each other and the public and are at
the centre of allthat we do' Our values are:
. Respect
. Accountability
r Transparency
' Engagement
Together, these four values form the basis of
our strategic foundation and guide our actions
under the Code. (See APPendix B.)
Our Code of Conduct PrinciPles
Principles set out how we live our values"
Principles are less specific than policy or rules.
They guide us in the grey areas and help us
answer the question: What is the right thing to
do?
We can't create policies or rules to cover all
possrble situations. However, we can build a
foundation based on trust and respect where
our principles guide us and can help us to do
the right thing.
Our five principles are:
1. Treat people with respect, compassion,
dignity and fairness
Treating people with respect, compassion,
dignity and fairness includes:
. Showing empathy and understanding
. Being sensitive to diversity and the
unique needs of individuals and groups
. Listening to and considering ideas and
concerns of others
. Fostering healthy relationships with
colleagues and others
2. Be open, honest and loyal
4. Take responsibility
Being open, honest and loyal is fundamental
to fostering an atmosphere of trust where
people share and learn from each other and
work together to achieve common goals.
Being open, honest and loyal includes:
. Communicating in a timely and
appropriate manner
. Coming forward if you think you have
been treated unfairly, and supporting
others to do the same
. Taking responsibility for, correcting and
learning from mistakes
. Considering how what we say or do may
impact our own reputation or that of AHS
5. Respect confidentiality and privacy
r Building trust and being trustworthy
3- Act ethically and uphold professional
standards
Acting ethically and upholding professional
standards includes:
. Always striving to behave in an
honourable fashion
. Displaying integrity and ethical behaviour
. Upholding all standards, codes of
conduct and codes of ethics that apply
to us
. Upholding applicable laws, regulations,
bylaws, principles, policies, procedures,
standards and any other applicable
guidelines, directives or regulations
. Recognizing and addressing real,
potential or perceived conflicts of
interest
for our own actions
and expect the same of others
Taking responsibility {or our own actions
means being accountable to our patients
and clients, AHS as an organization,
ourselves and to the public. This includes:
. Doing what we say we are going to do
. Evaluating and improving the quality,
safety and effectiveness of our services
and the outcomes of our decisions
. Promoting excellence, innovation and
continuous improvement
. Recognizing our limitations and seeking
help and guidance when needed
Respecting confidentiality and privacy
means we will protect all confidential health
and personal information of our patients,
co-workers, the public and AHS business
informatron. This includes understanding
and complying with the provisions of the
Health Information Act and the Freedom of
Information and Protectron of Privacy Act,
along with their respective regulations and
any other applicable privacy legislation.
Respecting confidentiality and privacy also
includes:
. Collecting, using, accessing, disclosing
and storing the minimum amount of
information necessary to do our work
r Protecting patient, client, co-worker and
other personal information, as well as
AHS business information
. Not engaging in public discussions
or comments about confidential
information, whether it concerns
patients, clients, employees or AHS
business

0ur Responsibilities
Each one of us is responsible for:
" Ensuring that we act in ways that are in
keeping with this Code
" Reading and understanding the Code
and staying current with uPdates
. they were addressed to the Ethics and
Understanding, staying current and
complying with applicable AHS bylaws,
principles, policies, procedures,
standards and any other applicable
guidelines, directives or regulations
What to do if you have Questions
or concerns
lf you have questions or concerns about the
Code or what to do in a particular situation,
you should first consider consulting with your
colleagues or professional practice leader or
speaking to the person or persons involved.
lf this is inappropriate, or if you are unable to
resolve your concern, you have three options:
1. You can speak to your manager (the person
you reporl to, the next highest level, or the
physician leader);
2. You can speak to the Ethics and Compliance
Officer if you are uncomfortable raising
your concern with your manager or if it is
impracticalto do so; or,
3. You can call the External Confidential
Reporting and Disclosure Service.
Their roles are as follows:
Your manager:
. Responds to questions and concerns
and takes action to resolve them as soon
as practical
. Utilizes the appropriate expertise within
AHS to help resolve issues (such as
Hurnan Resources)
. lf appropriate, refers the issue to their
manager or aliernatively to the Ethics
and Compliance Officer
. Documents and reports issues and how
Compliance Officer
The Ethics and Gompliance Officer:
. Provides guidance and direction on the
Code
. Assesses, reviews, and may investigate
or direct an investigation of questions
and concerns
. Has discretion to determine if matters
raised warrant an investigation
. Determines whether there has been a
breach of the Code of Conduct, Conflict
of Interest Bylaw or Safe Disclosure
Policy
. Advises appropriate decision makers
that a breach has occurred in order that
appropriate action can be taken
. Takes any other actions that the
Ethics and Compliance Officer deems
appropriate
. Reports to committees of the Board
The Ethics and Compliance Officer is not
an appeal body for operational or policy
decisions of AHS.
The External Confidential Reporting and
Disclosure Servicel
. Receives anonymous confidential
questions and concerns
. Acts upon questions and concerns in a
confidential manner and forwards them
io the Ethics and Compliance Officer.
The Governance Committee of the Board has
an oversight role and overall responsibility for
the Code, As part of its mandate, the committee
receives reporls from the Ethics and Compliance
Officer.
Who is Covered by the Code
The Code applies to everyone who provides
care or services or who acts on behalf of AHS.
This includes:
. AHS Board members
. All levels of AHS administration and
management including the President
and Chief Executive Officer and other
members of Senior Executive
r Employees of AHS and its subsidiaries
including permanent and probationary
full time and part time employees, term
employees, casual employees, and
individuals employed under an individual
consulting or service contract
. Physicians,dentists,podiatrists,
midwives and other allied health
professionals with an AHS appointment
and privileges, who provide care or
services on behalf of AHS
a Subsidiaries
a Researchers working with AHS or
studying AHS staff or patients
a Students, trainees and educators
a Volunteers
a Consultants, contractors, agents or other
representatives of AHS
How the Code fits with the AHS
Governance Framework
Our Code is part of the AHS governance
framework which also includes:
. Bylaws such as Conflict of Interest Bylaw
and Medical Staff Bylaws which, where
inconsistencies exist, take priority over
the Code
. Governance, corporate and clinical
policies such as the Safe Disclosure
Policy
. Procedures that orovide the detail
needed to meet policy requirements
. Standards, guidelines, regulations and
directives
Everyone who provides care or services on
behalf of AHS must familiarize themselves with
the bylaws and policies that apply across all
of AHS, as well the procedures, standards,
guidelines and directives applicable to therr own
position or activities. Please see your manager
for more information or if you have any questions.
Responsibilities and
Consequences
It is important to be aware of your
responsibilities under the Code and to ask
questions if you are in doubt or want to
understand the Code more clearly.
Everyone covered by this Code is expected
to abide by it. Breaches of the Code are
considered to be a serious matter. lf you are
found to have contravened the Code, the
consequences are as set out in the terms of
your employment or other relationship with AHS
and may result in discipline up to and including
termination of your employment or other
relationship with AHS.
Conclusion
ln summary, the Code is based on five
principles:
. Treat people with respect, compassion,
dignity and fairness
. Be open, honest and loyal
e Act ethically and uphold professional
standards
. Take responsibility for our own actions
and expect the same of others
o Respeet confidentiality and privacy

These principles reflect our values, guide our

actions and serve as a compass when we have
to decide what course to take in a challenging
situation. lf you have questions or need help
or advice, please talk to your manager or
contact the Ethics and Compliance Officer ar
complianceofficer@albertahealthservices.ca.
Appendix A: Getting HelP and Advice
Conflicts of Interest
Safe Disclosure
l
I.
Board Governance
AHS Governance
Privacy and ConfidentialitY
6af*ry.irrill;r'i
.. .:
:.:'
,.,
Corporate Accountability
and Financial Stewardship
Information Technology and
Telecommunications Use
and Security
:.: .'..:- .:
External Communications
and Media Felations
Abuse and Harassment
Human Resources
NOTE: The above is not an exhaustive list of policies and procedures. Policies and procedures are
added and updated on an ongoing basis. To ensure you have the most up-to-date information, you
should check the AHS website.
See under Bylaws
. Conflict of Interest IIFtiE
See under Ethical Conducl- i
. SafeDisclosure'iiFtiFl
See under Governance
. Delegation of Authority and Establishment of Controls for
commitmentt
1* , and,tB1t4Wi
- - -, h.,- :
See under Governance Documents
r -.-
Document Frarnework riJlll
: , i, . ,l
Strategic Governance - , '
. General BylawsIfFEFI
See under In{ormation and Technology Management
. Delegation of Authority and Responsibilities for compliance with
FOIPP and the HIA E'Fon
l
See under Environmental Management Supportilie Work Enryigngent
. Responsibilities for Occupational Health and Safetyanlul
r Occupation Exposure to Blood:and nooy ntuios'3i--Fq-F-l- '
. Contracts'!lE
. Delegation of Authority For Financial Commitments
See under Information and Technology Managqment
. --.
Access to Information (Physical, Electronic, Hemote) '-"iIE
.
Information Technology Acceptable Use Ei P0Fl
o
Protection and PrivaCy of Health gnq Personal tnformation S.E_r_-
.
,
,:
Transmission of Information by,Faesimile and,Eleeironic Mail s-e!A
. Communications (lnternal and ExternalE{pDF];
see U nd er Envi ronm ental Man agem ent and'supoorti've wor:k Environrnent
. WOrkplace AbuSe and HarASSmgnt [tE-' ']' .'ri ',:.,:.r, i,i.r,.,,' .i ,'l
See under Employee and Associate Relationships
. Delegation of Human Resources Authority E{FDfl
. Recruitment and Employment pps6{i6ss'ffFbE
tt '
See under Information and Technology Mair?gem"nt. ': , , ,,
. Contractor Requirements for,$,gcur$y_of Information ffid, ',
lnformation Technology R€sourcebE{"ffiFl . ,1, . .r ;, r' , ', , -.ir , : '' ':'
Contacts
In addition to your manager, the following are
available to discuss any ethical questions or
concerns.

Ethics and Compliance Officer

Noela Inions, QC,
Suite 900, Nodh Tower, Capital Health Centre
1 0030 - 1 07 st.
Edmonton AB TsJ 3E4
E-mail: comolianceofficer@
albertahealthservi ces.ca

External Confidential Reporting and

Disclosure Service
AHS representatives as well as the public can
report improper activity or alleged breaches
using an independent third party 24/7 (live
operator) external reporting line by calling
1 -800-661 -9675,
 . Providing clearly defined expectations
Appendix B
I Being clear about what and how
Alberta Health Services - Our Values decisions are made
Respect means... Engagement means...
. Valuing each other and each patient/ . Collaborating with patients and their
family/client we interact with as families, health care providers, research
individuals and education institutions, government
. Being compassionate and the communitY
. As staff, treating people with dignity, . lnvolving community, clinicians and
fairness and respecting confidentiality colleagues in meaningful waYs
r As patients, treating staff with dignity, . Listening to and considering ideas
fairness and respect and concerns of others in the decision
. making process
Being sensitive to diversity
. . Facilitating people to understand choices
Being inclusive and recognizing
and take responsibility for their own
contributions
health
Accountability means.. .
AHS Strategic Direction, 2009 - 2012,
. Displaying integrity and ethical behaviour released June 30, 2009
. Being honest
. Doing what we say we are going to do
. Taking responsibility for our own
decisions and actions, and holding each
other responsible for theirs
. Building trust and being trustworthy
. Evaluating and improving the quality,
safety and effectiveness of our services
and the outcome of our decisions
. Promoting excellence, innovation and
continuous improvement through using
best evidence/best practice

Transparency means...

" Being open, honest and having timely

communication
. Disclosing information to help learn from
mistakes
. Providing accessible, understandable
information about svstem and financial
oerformance
 sessional Paper SZlbt t
4 Sesgion, 27 Legislature
Ed itorio I:

Abuse of the "Disruptive Physicion" Clquse

Lawrence R. Huntoon, M,D., Ph.D.
Buried deep in the "CorrectiveAction" section of most medical
staff bylaws is a provision known as the "Disruptive Physician"
clause. lt is arguably the most dangerous and, in recent years. the
most abused provision in medical staffbylaws.
The term "disruptive physician" is purposely general, vague,
subjective, and undefined so that hospital administrators can
interpret it to mean whatever they wish.
Florv this treacherous trap got intcl medical statTbylaws is no
mystery in most instances. It was added at the urging of hospital
adrninistrators, often with help from a medical staff president who
was duped into believing that the ciause would oniy be used in those
extreme cases where a physician was fbr-urd running dnrnk or nake d
through the halls ofthe hospital.
Lack ofvigilance by physicians, and laiiure ofmedical staffs to
obtain independent legal advice on changes to the bylaws, allowed
most hospital administrations to insert this clause without difficulty
or any rneaningful opposition.
Whythis clause was strategically placed in rnedical staff bylaws
is also no mystery. It is parl of the strategic plan deveioped in 1990
by the hospital industry. The stated goal was to gain more control
over physicians in hospitais. Abuse of the disruptive-physician
clause and increasing nse ofsham peer review has allowed hospital
administrations to make great strides in achieving that goal.
Attorneys who specialize in replesenting hospitals have
definite recomrnendations on how "disruptive physician" can be
defined by a hospital, in order to remove a targeted physician from
staff. In t-act, some law fimrs offer seminars for hospital olficiais
and their legal representatives that teach optimal rnethods fbr
eliminatin_q certain physicians that the hospital dislikes. Here are a
few ofthe criteria for identi$ring a "disruptive physician":
AlthoLrgh the disrupiive-physioian olause and sham peer revierv
are current weapons of choice used by hospital administrations
across the country, lnore weapons of physician destruction loorn on
the horizon.
Physicians should be aware of the "Code of Conduct" and
"Exclusion from the Hospital Premises" clauses currently being
promoted by the hospital bar.
AAPS has posted a letter dated January 31,2003, to the
General CoLrnsel of the Joint Comrnission on Accreditation of
Healthcare Organizations (JCAHO), which was drafted by the
leaders of the credentialing and peer review practice group of the
American Health Lawyers Association, in the Hall of Shame on
our website (see www.aapsonline.org). The letter is rated "R" for
stark Reality. Phystcians need to wake up quickly and take notice
because this is what hospitals really have in n.rind for medical staffs
across the nation. lnterested readers can also learn more about the
hospital industry's strategic plan, developed in 1990: see
"Hospital Industry Reveals lts Strategic Plan: Control Over
Physicians" intheAAPS Hall of Shame.
Physician vigilance, and advice from knowledgeable,
independent counsel, are key to preventing further abrLse ofmedical
staff bylaws by hospital adrninistrations.
Lawrence R, Huntoon, M.D., Ph.D., is a practicing neurologist and
edilor-in-chief allhe J ournal of American P hysicians and Surgeons.
Mento to the Disruptiue Pltysician
Olt how we strive
For qttulirv high,
For health
Arrd nrost of'all suJbq'.

1. Political: Expressing political vieu's that are disagreeable to the But a vord to llt( u'isc;
hospital adrninistration. Reproof we despise
2. Economic: Refusing to join physician-hospital venture, or to
a ,4trd o tr t spohe tt pltys i c i a n :' ;

pafiicipate in an H\,IO oflered to hospital employees, or lVe hate thee.

offering a service that competes with the hospital.
Concern for quality care: Speaking out about deficiencies in Feel Ji'ee to opinv,
quality of care orpatient safely in the hospital, or simply bringing Bttt note we define
such concems to the attention ofthe hospital administration. All critics
4, Personality: Engaging in independent thought or resisting a A s rt Yva r ( ltls I t'LtL' t ire.
hospital adm inistration's "aLithority. "
5. Competence: Striving for a high level of competence, or And, thus shall ensue
cclnsidering oneself to be right most of the time in clinicai A sham peer review
judgment. And hencefortlt
6. Tirning: Making rounds at times different than those of tl.re "herd." YoLt' re ln beled " disruptitte. "

Journal ofAmerican Physicians and Surgeons Volume 9 Number 3 ['all 2004

 College of Physicians and Surgeons of Alberta
Physician Health Monitoring Committee

Section: Approved Date Revised Date

Disruptive Behaviour June 25, 2008 April 15,2010

1 of 3
Policy: Page

Disruptive Behaviour

Definition of Disruptive Behaviour

Disruptive behaviour is an enduring pattern of conduct that disturbs the work environment.
(Graham & Stacy). A physician whose behaviour is disruptive cannot, or will not, function well
with others to the extent that his or her behaviour, by words or actions, interferes with or has the
potential to interfere with quality health care delivery. The gravigr of disruptive behaviour
depends on its nature, the context in which it arises and the consequences which flow from it
(CPSA Planning Group 2008).

Policies for dealing with physician disruptive behaviour should be aimed at prevention and early
intervention. These policies should also be similar for all members of healthcare teams, However,
the College of Physicians and Surgeons of Alberta, hereafter referred to as the College,
recognizes that differences do exist for physicians due to a potential power differential in the
healthcare system and due to the fact that most physicians are not employees of the health
authority and thus disciplinary mechanisms may vary from those related to employees.

In situations where the physician involved in disruptive behaviour is considered an employee or

under contract with the health authority. The college recommends the mechanisms to deal with
such individuals. These include, but are not limited to:

1) clear policies on inappropriate workplace behaviour,

2) educational programs to inform all healthcare members of workplace expectations,
3) proper methods to report disruptive behaviour which is made available to all members of
the healthcare team,
4) mechanisms to attempt to resolve disruptive behaviour,
5) clear communication with the college for resources and managing such behaviours; and
6) a readiness to terminate contracts and employment if the disruptive behaviour does not
cease or is deemed severe enough to result in immediate termination of the physicians
involvement with the health region as outlined in Medical Staff Byraws.

The College does not tolerate disruptive behaviour. When disruptive behaviour occurs, the
perpetrator involved should be held accountable and measures taken to prevent recurrence. Once
becoming aware of disruptive behaviour the College must then decide what information needs to
be gathered, what assurances are needed to determine fitness to practice and the monitorins
required.

1. Identification of physicians demonstrating disruptive behaviour:

a. selfreport
b. report by a colleague
c. report by a treating healthcare professional
d. identification through a complaint process
4 Session, 27 Legislature
 Coltege of Physicians and Surgeons of Alberta
Physician Health Monitoring Committee

Section: Approved Date Revised Date

Disruptive Behaviour June 25, 2008 April 15,2010

Policy:
-LJ r
Page of r

Disruptive Behaviour

Reporting Disruptive Behaviours

L Any individual who experiences unacceptable conduct or harassment, either personally or as

a witness, is entitied and should be enabled to:

. inforrn the physician that such behaviour is unwelcome;

. seek confidential advice frorn, or report a complaint to a person in authority with the
agency or institution (e.g. hospital, RHA, university, CPSA) (CPSA Planning group
2008).

2. Information gathering in situations of physician disruptive behaviour, Regardless of the way

in which a physician is identified, the process to determine their fitness to practice will be
similar and include the following:

a. Reporls of individuals affected by disruptive behaviour.

b. Reports from colleagues of work performance.
c. Reporl from health authorities involved in the situation and past physician performance
evaluations.
d. Additional investigations or requirements.

This information initially may be provided either verbally or in written form. The reporter is
entitled to assistance in fonnatting a written complaint if help is needed. It should include all
relevant detail about the individuals involved, the circumstances, and the effect on the
reporter and on immediate patient safety (CPSA Planning group 2008).

Ifthere is a serious concern about a physician's fitness to practice, they can be asked to
voluntarily withdraw from practice until all information is gathered or they could be
suspended until fitness to practice was determined. This is a serious matter but patient safety
must come first and the College will need to ensure that there is not a risk to patients. In both
cases, the physician will be reminded to seek legal advice to ensure a fair process.

3. Additional information may include the following:

a. Cognitive assessment and neuropsychological testing to determine ability to practice.

b. Physical assesslnent tailored to the specific problem: i.e.: orthopedic surgeon,
neurologist, sleep disorder specialist, internists
c. Psychiatricassessment.

Multidisciplinary assessment for complex cases or when there is a direct patient concem
involved.

Physicians must agree to allow the College access to medical records which confinn their
fitness to practice.
 College of Physicians and Surgeons of Alberta
Physician Health Monitoring Committee

Section:
Revised Date

Disruptive Behaviour April 15,2010

Policy: Page
-JJ r of r

Disruptive Behaviour

4. Potential outcomes:

a. Unfit to practice with no chance of recovery.

b. unfit to practice at the time of assessment but improvements likely.
c. Fit to practice with practice limitations or restrictions.
d. Fit to practice with no restrictions
Monitoring:

Disruptive behaviour can impair the ability to practice, but in many cases physicians can be
rehabilitated. Ongoing monitoring is required to ensure compliance to recommendations of
treating experts, to reassess for fitness to practice and to ensure compliance with any practice
restrictions or limitations. This can include the followins:

a. Reports from treating physicians.

b. Reports from colleagues or designated practice monitor.
c. Reassessment by a third party.
d. Practice visits or audits to review their practice.
e. Competency assessment.
f' Monitoring of billing or medical records to determine compliance to practice restrictions.
6. Continuing Care Contracts: These contracts are entered into to ensure compliance to the
requirements as a condition of continued practice and using an informal pro""r, rather than
the complaints process to resolve issues related to disruptive behaviour.

References

American Medical Association: Physicians and Disruptive Behavior. Website: www.ama-

assn.org

Molea J. When Behavior disrupts the physician-healer. MedGenMed .2006;8(1):87. March 30,
2006.

Texas Medical Association, How to address disruptive behavior. Website: www.texnred.org

The College of Physicians & Surgeons of Alberta Disruptive Physicians and Healthcare Workers
Planning Group 2008

The College of Physicians and Surgeons of Saskatchewan (CPSS) Disruptive Workplace

Behavior. Website: www.quadrant.net/cpss/resource/workplace.htrnl
 Sessional Paper 54
4 Session, 27 Legislature
CPSA Code of Conduct
Expectotions of Professionolism for Alberto physicions

Introduction
Integrity, trustworthiness, compassion and ethical conduct underpins the practise of medicine.
Patients, co-workers, residents and students expect professional behavior from physicians, and
this behavior has an enormous impact on how health care is delivered and received,

The vast majority of physicians act professionally, and research shows this behavior translates
to a healthier workplace and good patient outcomes. Alternatively, inappropriate physician
behavior can contribute to a number of issues in the health care environment, including:
(a) Negative effect on patient safety and quality of care
(b) Erosion of relationships with staff, patients, learners, families
(c) Difficulty recruiting and retaining staff
(d) Reduced work attendance by co-workers, colleagues
(e) Direct impact on a physician's health and/or reputation

In order to address these issues, expectations of physicians rnust be clear.

The CPSA Code of Conduct was developed in response to requests from physicians for clarity
and advice about professional behavior. lt was written in consultation with physicians, other
health care providers, health care organizations, regulatory bodies and post secondary
institutions.

The Code of Conduct is intended to:

. Support a culture that values professionalism, integrity, honesty, fairness and
collegiality, and that aids and encourages effective care of patients.
. Promote an optimally caring environment of quality and safety for the health and well-
being of patients and families, physicians, nurses and other health care workers,
learners and teachers, and others in the health care workplace.
. Help physicians meet the principles outlined in the CMA Code of Ethics and the CPSA
Stondords of Proctice
. Help physicians model professional behavior and teach their younger colleagues.
. Encourage open and respectful discussion related to the delivery of health care.
. Support physicians and others to address physician behavior that does not meet their
expectations.
Use of the Code
The Code of Conduct clarifies the College's expectations for Alberta's physicians in all stages of
their careers, in all facets of medicine, and in all methods of care deliverv.

lt is consistent with the Canadian Medical Association's Code of Ethics and complements the
CPSA's Stondards ot' Proctice. Physicians are expected to know and abide by these rures; any
breach of professional behavior will be judged against all three of these foundation documents.

While the Code outlines expectations regarding professional behavior, the College willconsider
the following when inappropriate behavior occurs:
o The well-being of the physician must be addressed
. Systemic issues within the health care system. NOTE:Although these stressors must be
identified and considered, they cannot be used as an excuse for inappropriate behavior.

General Principles
The CPSA Code of Conduct is based on the following ethical and professional principles:
o Strive for high-quality patient care
o Focus on safety
o Treat others with respect
r Maintainconfidentiality
o Do the right things for the right reasons
r Be aware of your professionaland ethical responsibilities
o Be collaborative
r Take action when inappropriate behavior occurs
o Communicate clearlv

Specific Expectations
Accountability
Asophysicion,lwill:
(a) Act, speak, and otherwise behave in the health care workplace in a way that promotes
safety, high quality patient care and effective collaboration with others in the health
care team.
(b) Maintain high standards of personal and professional honesty and integrity.
(c) Take responsibility for my own behavior and ethical conduct regardless of the
circumstances.
(d) Be accountable for my personal decisions, actions or non-actions in the workplace.
(e) Record and report accurately and in a timely fashion clinical information (history,
physicalfindings, and test results), research results, assessments and evaluations.
(0 Communicate with integrity and compassion.
(g) Accurately attribute ideas developed with others and credit work done by others.
 (h) Dealwith conflicts of interest, real or perceived, openly and honestly.
(i) Engage in lifelong learning.

Confidentiality
As o physician, lwill:
(a) Regard the confidentiality and privacy of patients, research participants, and
educational participants as well as their associated health records as a primary
obligation.
(b) Ensure confidentiality by limiting discussion of patient health issues to settings
appropriate for clinical or educational purposes, and to caregivers within the 'circle of
care'. Discussion with others should occur only with explicit patient consent or as
permitted by legal and ethical principles.
(c) Know and comply with applicable legislation regarding confidentiality and health
information.

Respect for Others

Asophysicion, lwill:
(a) Interact with patients and families, visitors, employees, physicians, volunteers, health
care providers and any others with courtesy, honesty, respect, and dignity.
(b) Refrain from conduct that may reasonably be considered offensive to others or
disruptive to the workplace or patient care, such conduct may be written, oral, or
behavioral, including inappropriate words and/or inappropriate actions or inactions.
(c) Respect patient autonomy at all times by appropriate discussion of investigation and
treatment options with the competent patient and, only with consent, identified other
persons.
(d) Ensure appropriate consultation occurs when a patient lacks the capacity to make
treatment decisions, save for emergency circumstances.
(e) Respect the personal boundaries of patients, including, but not limited to, refraining
from physical contact outside the proper role of a physician, including sexual or
romantic overtures.
(0 Respect the personal boundaries of co-workers and their rights to privacy and
confidentiality in the same manneras lwould patients. Avoid unwanted physical
contact, including sexual or romantic overtures.
(e) Avoid discrimination based on, but not limited to, age, gender, medicalcondition, race,
colour, ancestry, national or ethnic origin, appearance, political belief, religion, marital
or family status, physical or mental disability, sexual orientation, or socioeconomic
status. (NorE: In human rights legislation, this is known as protected grounds.)
(h) Allow colleagues to disagree respectfully without fear of punishment, reprisal, or
retribution.
(i) Recognize the important contributions of colleagues, whether generalist or specialist
Responsible Behavior
Asophysicion, Iwill:
(a) Ensure that patient care and safety assume the highest priority in the clinical setting.
The duty of physicians to advocate for patients does not excuse or justify unacceptable
behavior; it must be done constructively.
(b) Attend to my personal health and well-being to enable attendance to professional
respo nsibilities.
(c) Recognize my own limitations and seek consultation or help when personal knowledge,
skills, or physical/mental status is inadequate or compromised.
(d) Supervise and assist others appropriate to their need and level of expertise.
(e) Participate in quality improvement initiatives and strategies to dealwith errors, adverse
events, close calls, and disclosure.
(0 Express my opinions on health care matters in a manner respectful of others'views and
the individuals expressing those views.
(g) Abstain, when conducting my professional activities, from exploitation of others for
emotional, financial, research, educational, or sexual purposes.
(h) Teach and model the concepts of professional behavior in research, clinical practice and
ed ucational encou nters.

(i) Encourage and model language, appearance, and demeanor appropriate to the
professional health care setting.
0) Avoid misuse of alcohol or drugs that could impair my ability to care safely for a patient.
(k) Attend to other factors that could impair my ability to provide safe care to my patients.
(l) Address breaches of professional or scientific conduct or unskilled practice by a health
care professional by discussion directly with that person or, if necessary, by reporting to
the appropriate authorities or through established procedures. Respect the need to
avoid unjustly discrediting the health care system or the reputation of other members of
the health care, research or academic team by trivial or vexatious reports.
(m) Know and adhere to the CPSA Sfondords of Practice
(n) Participate in professional development and assessment processes.
(o) Respect the authority of the law and understand my professional and ethical
obligations,

Acknowledgement
This document wos developed with input from vorious heolth professions ond using codes of conduct from other
institutions and orgonizotions. Particulorly helpful were statements from the College of Physicians and Surgeons of
ontario, the University of Colgary Faculty of Medicine, the University of Alberto Office of Equity ond Foculty
Development, and the Medicol Council of Conado.

April 2010