Nurse-practitioner takes doctors to court

Page 3

A Metis nurse-practitioner who filed a $75,000 lawsuit against the College of Physicians and Surgeons of Alberta for interfering with her right to practise had her day in court earlier this month.

"The College of Physicians and Surgeons, in my mind, interfered in an area of jurisdiction that was not their's," said Joyce Atcheson. "As a registered nurse, my licensing body is the AARN, the Alberta Association of Registered Nurses, it is not the College of Physicians and Surgeons of Alberta."

The dispute started in May 1991 when the Thickwood Family Medical Clinic in Fort McMurray cancelled its contract with Atcheson.

After receiving a letter of complaint from one of its members in 1991, the College of Physicians and Surgeons threatened disciplinary action against the clinic for allowing Atcheson to perform tasks the college said went beyond the scope of nursing and constituted the practise of medicine without a license. When the college ordered the clinic to stop the billing practise, the doctors terminated Atcheson's contract.

An expert witness for the College of Physicians and Surgeons, Dr. Nigel Flook testified on the role of a family physician and expertise in primary medical care. He said examples of a typical day's list of activities of two doctors were similar to what Joyce Atcheson was doing.

But, Atcheson was doing what she was hired to do, he said.

"As a nurse, Joyce Atcheson is a superb nurse, highly skilled."

Dr. Larry Ohlhauser, registrar for the college, testified during the Court of Queen's Bench hearing Nov. 9-12 that Atcheson practised too independently.

While under contract to the clinic, Atcheson routinely conducted physical examinations, took blood pressures readings and pap smears, did breast examinations and assessed patents' conditions. She would also make recommendations for medication, but prescriptions were signed by the doctors. She consulted the doctors whenever she felt it necessary.

She never worked without at least one doctor present in the clinic. At the end of each day, a supervising doctor reviewed her cases.

Atcheson was paid $25 an hour. Her case load was reviewed every three months and she was to be paid 60 per cent of the Alberta Health Care billings made for her work by the clinic.

Atcheson, 46, received her nursing diploma in 1968 and graduated in 1975 from the nursing practitioners program at the University of Alberta. She received her master's degree in health science, with a specialty in primary health care, from McMaster University in 1988.

A nurse practitioner is a registered nurse with special training in primary health care. They often work in isolated areas where no doctors are available.

Atcheson has worked in the northern Alberta communities of Fox Lake, Assumption and Garden River. In Garden River, 800 km north of Edmonton, she was the only health-care professional in a community of 380 people. A doctor flew in for three or four hours every two weeks.

"My concern is that the College of Physicians and Surgeons of Alberta interfered in my practise of nursing; they have identified it as the practise of medicine. If it is a practise of medicine, then they had an obligation in their mandate to protect the public, to charge me under the medical profession act if I was practising medicine without a license," Atcheson said.

"If I'm practising medicine without a license in Fort McMurray, then nurses who are working in isolated communities in northern Alberta and nurses who are working in sexually transmitted diseases clinics, penal institutions, home care, hospitals and anywhere a doctor does not see the client or the patient before treatment is initiated...all those nurses are practicing without a license," Atcheson continued.

There is a double standard in the health care services provided to the isolated Native communities compared to non-Natives in the south, Atcheson said. Medical care in isolated communities can be provided by anybody as long as they hae a protocol agreement with the College of Physicians and Surgeons. But, the non-Native middle class society's health care has to be provided by a physician, Atcheson said.

Presentation of final arguments by the lawyers on this case will be made on Dec. 2.

Because of the importance of this issue, Justice Ellen Picard said she will likely reserve her decision until early in the near year.