# Dr. Kevin Patterson- The Article



## Emenince Grise

A Canadian doctor and writer has written an account of his recent tour of the hospital in Kandahar. The publication of his story, 

http://www.motherjones.com/news/feature/2007/07/talk_to_me_like_my_father.html

has caused some distress and consternation because it describes, in graphic detail, the accidental death of Cpl. Kevin Megeney and the steps Canadian doctors took when Megeney was brought into the ER. A military investigation has been initiated. 

Certianly there are ethical issues involved here, but Cpl. Megeney's mother did read the article prior to publication, did not object to publication and asked that Cpl. Megeney's memorial web site be linked to the article on the Mother Jones web site. 

Globe & Mail article here:

http://www.theglobeandmail.com/servlet/story/RTGAM.20070804.wafghan04/BNStory/National/home


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## PMedMoe

I have to say, it's well-written (yes, graphic, too) but I think he shouldn't have mentioned Cpl Megeney's name.  Not really sure what should be done about it, though.


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## George Wallace

As stated in the News article, he would have changed the name, but as the name was so well known because of press releases, and the wide dissemination of the facts, there would not be much trouble in identifying the real person.  He did contact Cpl Megeney's mother and she was OK with releasing the facts.  That being the case, he has done everything reasonably possible in publishing the event.  I don't think it is necessary to ask the permission of other family relations, once, twice or even more removed, to print a story.  There was nothing derogatory in what he wrote.  He only wrote about what they did in a clinical manner to try and save a life.  If you are offended about things like that, then don't read any medical documentation, don't watch any medical shows, etc.  You have the right not to read medical documentation of procedures taken in an OR.

Next question, I beg to ask:  Did these family 'members' object to any of the descriptions of the other patients that he treated over there, or to his comments on how they treated mortally injured ANA soldiers?  NO.  They did not.  Seems that they are a little callus in their judgment of the Doctor.


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## Armymedic

He definitely could have done without mentioning the name. 

But the publisher of t blog page did ask permission of the parents. G&M is trying to make hay of the uncles feelings...

If he has problems, he should take it up with his in laws.


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## Donut

Very well written.

Could he have told it without the name or nationality?  Absolutely, but putting a name and a face to the account makes it that much harder hitting, brings it home: these are young Canadians, from small communities, in the service of their country.  They're your neighbors, your classmates, doing hard, dangerous work under appaling conditions at constant risk, because we as a nation have asked them to do it.

Kudos to the author for his writting, but also for his willingness to step out of his Vancouver Island hospital and take care of our troops.


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## 3rd Herd

Rather than an article in a blog, would it not have benefited the Doctor and the family more if the article had been geared towards some facet of medcine and published in the CMJ. Or is the good doctor building the hype for the release of  "in Outside The Wire, an anthology of writing about Canada's Afghan military mission co-edited by Dr. Patterson, to be published this fall."


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## Nemo888

(VENTING)Isn't the real issue that our "Hospital" is a piddly little shack with unpainted plywood walls? He didn't mention that the anaesthesiologist is also responsible for swatting the flies. Don't bother tubing ANA we'll need the bed for coalition forces. Didn't he have a family too?

But when it gets translated to the mainstream Canadian media it becomes, "How dare they name the soldier." I just don't get it.

(/VENT)


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## Donut

I agree an academic article should probably come out of his (and others) stays in K'Har;  This is a human interest story, much as TLC's "Tales of the ER" is as much a human interest story as a look at the weird and wonderful stuff that comes through the doors.

As to the MMU being a "shack", we've been trying to get a better facility up and running for some time, but the pressure on real estate in KAF is pretty intense, and we don't have the space to build a new one while keeping the existing one up and running.


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## The Bread Guy

St. Micheals Medical Team said:
			
		

> the publisher of t blog page did ask permission of the parents.



Better yet, the woman is the publisher of the magazine, not just the web page - pretty high up the food chain to be contacting sources for a story.  As much as I gripe about MSM, I have to agree that she did her best to brace the folks.  Here's the publisher's response in full (with comments, so far, seeming to support what was done in total).



			
				St. Micheals Medical Team said:
			
		

> G&M is trying to make hay of the uncles feelings...



How unlike some MSM  :  We'll see if they publish the REST of the story anytime soon...

- edited to add MoJo Response link -


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## Greymatters

I must have missed it, but who is complaining about the article?  I thought it rather well-written, and extending the courtesy of approval to the soldiers mother goes far beyond what your average keyboard-jockey shows a miliary member.  As previously stated, if you object to this kind of material, dont read it.


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## HItorMiss

The Role 3 in KAF though not luxurious by North American standards is a great place and the medics. doctors and nurses there do what they can to make sure people are comfortable. Could it stand to be concrete poured or in something sturdier, maybe bu it does it's job and does it well. I think the construction of the hospital is a non issue in my mind anyway.

If the publisher contacted the Mother and she was fine with the story going to print then really the rest of family hasn't say in it and the uncle really should STFU. I am betting, NO I know that families want to here how it is their loved one died and their last  moments they want the closer and I know as painful as it was to read it may have been the last little bit needed for the direct family.


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## Trooper Hale

I thought the story was fantastic, really well written and gave a great insight to the world that he lived in over there.
What is it with extended family members complaining about things? There was a story a little while ago of another uncle or aunt who kicked up a storm while the parents of the CF member killed supported the CF. I cant remember what it was all about though, only that i thought the uncle had no right to be doing what he was doing, especially seeing as the parents didnt feel the same as him and he seemed to be capitalizing on getting himself attention.
If the mother said "yes" then whats the issue? I'm sure there Christmas dinner this year will be a bit strained.


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## Blackadder1916

First off, let me say that I think that the article in question is excellent; it’s well written, informative and entertaining.  However the controversy should not revolve around the fact that some family members objected while others may not have, or around the supposition that Cpl Megenny would have been identified anyway if Dr. Patterson had described the tragic events using a pseudonym.  As much as Dr. Patterson is a good writer (judging from the quality of the article), I must fault him for a lapse in his medical practice.  As a physician, he is (or should be) very aware of his responsibilities regarding patient confidentiality. He did not had express permission to divulge identifying patient information prior to submitting this article to the magazine.  That permission could only be given by the Corporal’s surviving NOK and according to the magazine the NOK had not been in contact with Dr. Patterson at any time prior to the publication of the article.  And as the information was not used for the purpose for which it was collected, he could not have assumed that he had implied consent.   It does not matter why he wrote the article, he violated patient confidentiality.  If he had written a story that included details about the medical condition of a patient from his civilian practice without permission he would be subject to penalties available under applicable personal info/health info legislation.  Why should the rules be different because of the circumstances of the patient?

As for the magazine’s supposed permission to publish this story identifying the Cpl,  the editor states that “_First, we sent a letter to Cpl. Megeney's parents, uncle, and sisters, ahead of publication, *informing them that this 7,000 word diary of a doctor's month of service at Kandahar Air Field did contain a scene involving the tragic death of their son*._”  There is no specific mention that they requested permission ahead of publication only that she had spoken to the mother and sent copies of the (already completed) magazine article.


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## George Wallace

Blackadder1916



> Responding to the onslaught of criticism, Mother Jones's co-editor, Clara Jeffery, said in a posting on the magazine's website that she had contacted the family prior to publication and that Cpl. Megeney's mother had said that the article would help the family have closure.



This quote found in the Globe and Mail article doesn't quite match your interpretation of the facts.


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## RHFC_piper

Good Article... Well written and a good read.  But I don't see how Cpl. Megeney's part is any more controversial than any other portion of the article.

But in any case, as HitorMiss put it;


			
				HitorMiss said:
			
		

> If the publisher contacted the Mother and she was fine with the story going to print then really the rest of family hasn't say in it and the uncle really should STFU.



Once the primary NoK has given consent to the author, any other issues arising should come down to the primary NoK... Meaning, if Cpl. Megeney's uncle, or any other family member, has an issue with the article, they should be taking it up with Cpl. Megeney's mother, not the author.


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## The Bread Guy

As George Wallace pointed out, if the G&M and MoJo were quoted accurately, Mrs. M could be seen as consenting if she did, indeed, say publishing could assist in healing and closure.

I think some of the issue might be the fact that after MoJo contacted the mother and family, the Halifax Chronicle-Herald shared this quote from Cpl. Megeney's mother:



> "I just wish I had seen it first," Karen Megeney, the dead soldier’s mother, said Friday.



That said, the next bit in the same piece is interesting....



> Her family was away on vacation when the magazine sent them an advance copy of the article.  "It was on the stands before we even knew about it," Ms. Megeney said.



So, the magazine made what appears to be every effort to give the family a head's up, as well as share copy with the family (something MSM is normally *HUGELY* reluctant about doing).  It also appears that nobody had a chance to look the material over before it hit the streets/internet.

Blackadder1916 also hits the nail on the head re:  any investigations -- Did the doc do the right thing sharing information about one of his patients with the public?  

You can even take that two ways:
1)  Did he do the morally ethical thing in releasing patient information to the public?
2)  Did he contravene the CF's and GoC's various privacy laws and regulations in releasing patient information to the public?


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## Greymatters

milnewstbay said:
			
		

> Blackadder1916 also hits the nail on the head re:  any investigations -- Did the doc do the right thing sharing information about one of his patients with the public?
> 
> You can even take that two ways:
> 1)  Did he do the morally ethical thing in releasing patient information to the public?
> 2)  Did he contravene the CF's and GoC's various privacy laws and regulations in releasing patient information to the public?



Good points... although I dont believe any actual privelaged information was released, it might be argued that the military has the right and the need to approve 'real-life stories' published while an actual operation is still in progress, as this may have unit morale and public relations effects on the operation... but I think its difficult to actually pin down specific transgressions.


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## Blackadder1916

GreyMatter said:
			
		

> Good points... although I dont believe any actual privilaged information was released...,



If based on the privacy/protection of info legislation that Dr. Patterson may be subject to in his civilian practice (and accepted medical ethical practice), the privileged information is the patient's name and the simple fact that the patient was under care.   A military member also has the right to medical confidentiality just like a civilian (though with certain caveats).  Cpl Megenney (or NOK) did not waive that right or grant Dr. Patterson permission to use personal information collected for the purpose of  providing medical care.  How current CF/GoC regulations (and how well/badly the doctor's contract was written) are applied is another matter.  At the very minimum his breach of medical confidentiality should be reported to his college.


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## Greymatters

Blackadder1916 said:
			
		

> If based on the privacy/protection of info legislation that Dr. Patterson may be subject to in his civilian practice (and accepted medical ethical practice), the privileged information is the patient's name and the simple fact that the patient was under care.



This is not an attempt to spark an argument but consider this - the patients name was already in the public realm as was the nature of the incident which contributed to the patients condition.  As pointed out earlier, even with an oblique reference, people would have been able to figure out who the case was refering to.  And, it is not privelaged information to say which patient is under your care.


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## geo

Considering the grizzly details we read about every day in our morning newspaper and watch on the evening news, I don't think Dr Patterson disclosed anything that wasn't already known through other means.... his delivery was probably a little rough for the Megenney family but, his description avoided sensationalism and told it like it is... err - was.


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## Blackadder1916

GreyMatter said:
			
		

> ...  And, it is not privelaged information to say which patient is under your care.



Actually it is.  Common principles in all (Canadian) personal info protection legislation are that personal information is to be collected only as necessary to accomplish a specific purpose,  that the person about whom the info is collected is aware of the purpose and that disclosure of the info only be made in order that the purpose be accomplished.

I am more familiar with Alberta's Health Information Act (and have had dealings with representatives of Alberta's Privacy Commissioner in regards to health information complaints) but as I cannot access their site for some reason today, I will quote from the guide to BC's Personal Information Protection Act (BC does not have specific health info legislation like Alberta).
http://www.oipc.bc.ca/pdfs/private/a-_GUIDE_TO_PIPA(3rd_ed).pdf


> *Personal information means information that can identify an individual * (for example, *name*, home address, home phone number, ID numbers), and information about an identifiable individual (for example, physical description, educational qualifications, blood type). Personal information includes employee personal information but does not include business contact information or work product information.


BC regulations may be more appropriate as (from what I got from the news articles) Dr. Patterson practices in British Columbia, so he should be familiar with the specific requirements of his jurisdiction.

As for disclosing information that is already in the news, that doesn't matter.  If a physician acquires personal information about a patient in the course of his medical practice he is bound by confidentiality, regardless what others may know about the patient.  If he is unable to tell his story without identifying a patient (and he doesn't have express permission from that patient to do so), then he doesn't (or shouldn't) tell the story.


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## Donut

Not completely on topic here, but an excellent clearinghouse of information on the various pieces of privacy legislation is Privacylawyer.ca

I know he's done a fair amout of work with the CMA, CMPA and various provincial bodies, as well as international privacy law.

PMT


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## Blackadder1916

My above post dealt primarily with privacy legislation as regards a physician's practice, but what about his ethical obligations.  However, ethics (or more so the practice of ethical behaviour) are a personal thing and difficult to enforce (thus we have legislation).  When privacy legislation was being proposed in Canada, the medical community did make many proposals that they should be exempt from some of the legislative mandates as they could meet the requirements due to their ethical obligations in the practice of medicine.  The Canadian Medical Association has compiled a Code of Ethics  for use by Canadian physicians from which the following section is excerpted:

Privacy and Confidentiality 

31.  Protect the personal health information of your patients. 
32.  Provide information reasonable in the circumstances to patients about the reasons for the collection, use and disclosure of their personal health information. 
33.  Be aware of your patient’s rights with respect to the collection, use, disclosure and access to their personal health information; ensure that such information is recorded accurately. 
34.  *Avoid public discussions or comments about patients that could reasonably be seen as revealing confidential or identifying information. * 
35.  *Disclose your patients' personal health information to third parties only with their consent, or as provided for by law*, such as when the maintenance of confidentiality would result in a significant risk of substantial harm to others or, in the case of incompetent patients, to the patients themselves. In such cases take all reasonable steps to inform the patients that the usual requirements for confidentiality will be breached.
36.  When acting on behalf of a third party, take reasonable steps to ensure that the patient understands the nature and extent of your responsibility to the third party. 
37.  Upon a patient’s request, provide the patient or a third party with a copy of his or her medical record, unless there is a compelling reason to believe that information contained in the record will result in substantial harm to the patient or others. 


I suggest that Dr. Patterson failed to meet the ethical obligations of his profession.  Hopefully it can be be shown that he failed to meet 'legal' obligations as well.


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## geo

Meanwhile this is happening in the states...
The plastic surgeon who did Boob enhancements for Anna Nicole Smith is releasing (selling) the video to the public of the surgical procedure.  While the executor of her estate (Stern) is complaining & threatening, the MD is claiming that, once the patient is deceased, the caregiver confidentiality obligation ends.....

Without being the same situation.... similar ethical issues.


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## RHFC_piper

geo said:
			
		

> once the patient is deceased, the caregiver confidentiality obligation ends.....




I have actually heard this before, many times and in many contexts (including the death of a close friend), as well as in movies and TV shows (I know.. not a good point of ref), but is this actually legal in Canada, is it a US thing, or is it just a steaming pile of movie magic?
I've been trying to find some kind of legal precedence or reference to this, in Canadian legal terms, and have been unsuccessful, especially since I don't know even whete to start looking.

Can anyone shed some light on this... 'cause if this is the case here in Canada, than this Doc is in the clear for sure.


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## geo

well... you could consider the boob job as a test case - stay tuned, do not adjust your set


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## RHFC_piper

geo said:
			
		

> well... you could consider the boob job as a test case - stay tuned, do not adjust your set



Heh... that whole case is about the adjustment of a set.  > (I know, bad joke.)


All joking aside, is there any legal precedence in Canada WRT caregiver / patient confidentiality being lost at time of death?  And would precedence set in the US hold water here?


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## Blackadder1916

Perhaps one of the shysters lawyers who post on these means may have a more current "legalistic" answer.  My frame of reference is in health administration.

The following is probably a good answer, though there has been changes in Canadian info privacy legislation since it was written.  

Legal: Does confidentiality continue after death? 
http://www.parkhurstexchange.com/qa/A.php?q=/qa/Legal/1998-08-07.qa


> "Do you need authorization for release of medical information if the patient has died, and if so, who authorizes this?" wonders GREG KARAGUESIAN, MD, of Haliburton, Ont.
> 
> I presume you are asking this question as an individual and not as a representative of an institution, in which case the Freedom of Information Act would apply. Although you don't say why the information is needed (for example -- research, study, statistics, court action, potential serious harm to a third party), I would suggest that you not release any information until you are ordered to do so by a court of law. The only explicit reference of which I am aware with regard to the continuance of patient privilege after death is in the World Health Organization's International Code of Medical Ethics which states that the physician must keep secret all he or she knows about the patient, even after the patient's death. The right to privacy is of fundamental importance, and the law is designed to protect us against the loss of dignity that may result from exposure of intimate details of our private lives. That protection doesn't simply evaporate with death. Only the patient has the power to release the physician from his duty of secrecy. Even under the Freedom of Information Act, the powers of a deceased individual may be exercised by his personal representative (executor or heir) only if the exercise of the power relates to the administration of the individual's estate. The other side of that coin is that the representative of the deceased can also act on his behalf where his rights have been breached; the release of privileged medical information might be considered such an instance, and therefore the heirs could sue. Information given to a physician in confidence is not always protected from disclosure in the courts. The Supreme Court of Canada held in 1992 that in the exercise of its discretionary power, the Court must balance the individual's claim to privacy against the interest of justice. In avoiding a miscarriage of justice, the public interest is more important than doctor-patient privilege. Consequently, under certain circumstances, a court of law can order medical records or physician testimony to be produced. To protect yourself from possible court action, wait for a court order before releasing confidential information, or get a legal opinion if you think there may be overriding public interest or danger to a third party. JF



The following from the American Medical Association Code of Ethics
http://www.ama-assn.org/ama/pub/category/8354.html


> E-5.051 Confidentiality of Medical Information Postmortem
> 
> *All medically related confidences disclosed by a patient to a physician and information contained within a deceased patient's medical record, including information entered postmortem, should be kept confidential to the greatest possible degree. * However, the obligation to safeguard patient confidences is subject to certain exceptions that are ethically and legally justifiable because of overriding societal considerations (Opinion 5.05, "Confidentiality"). *At their strongest, confidentiality protections after death would be equal to those in force during a patient's life. Thus, if information about a patient may be ethically disclosed during life, it likewise may be disclosed after the patient has died.*
> 
> Disclosure of medical information postmortem for research and educational purposes is appropriate as long as confidentiality is maintained to the greatest possible degree by removing any individual identifiers. Otherwise, in determining whether to disclose identified information after the death of a patient, physicians should consider the following factors:
> 
> (1) The imminence of harm to identifiable individuals or the public health
> 
> (2) The potential benefit to at-risk individuals or the public health (eg, if a communicable or inherited disease is preventable or treatable)
> 
> (3) Any statement or directive made by the patient regarding postmortem disclosure
> 
> (4) The impact disclosure may have on the reputation of the deceased patient
> 
> (5) Personal gain for the physician that may unduly influence professional obligations of confidentiality
> 
> When a family member or other decision maker has given consent to an autopsy, physicians may disclose the results of the autopsy to the individual(s) that granted consent to the procedure. (IV)
> 
> 
> Issued December 2000 based on the report "Confidentiality of Medical Information Postmortem," adopted June 2000. Updated December 2001 (Arch Pathol Lab Med. 2001; 125:1189-92).



In the USA there's probably not as much legislative protection of personal/medical information as in Canada, so I won't speculate on the 'legal position' of a plastic surgeon releasing a video of a patient's procedure, but I would consider him an unethical turd.


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## geo

yup.... but a rich unethical turd.....


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## Danjanou

And to toss another can of naptha on the fire, here’s our national moonbat collectives take on the whole thing. http://www.rabble.ca/babble/ultimatebb.php?ubb=get_topic&f=2&t=009492

I particularly like the second post on why we shut down outgoing comms after and incident.


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## Greymatters

'Like' in a negative or positive way?


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## Danjanou

GreyMatter said:
			
		

> 'Like' in a negative or positive way?



One of these days we need to get that sarcasm smiley for here


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## Greymatters

Danjanou said:
			
		

> One of these days we need to get that sarcasm smiley for here



I thought it was this one?  :


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## 3rd Herd

Further from the Globe and Mail:
"Ms. McKennitt lashed out at Kevin Patterson, the B.C. doctor and author who used the death of Corporal Kevin Megeney, a Nova Scotia reservist, on the operating table as the climax of a 7,000-word memoir he penned for Mother Jones magazine about his month working at the base hospital in Kandahar."

"Dr. Patterson has conceded he never asked permission from the Megeney family before writing the account. His actions are currently the subject of two separate investigations by the Department of National Defence, which had hired him as a civilian internist to work at the military hospital because of a shortage of military doctors."

"Medical ethicists and doctors say that Dr. Patterson may find himself under investigation for breaching his responsibilities as a physician by the B.C. College of Physicians and Surgeons, which is responsible for his medical licence."

"Ms. McKennitt is honorary colonel of 435 Squadron, a search-and-rescue squadron based in Winnipeg."

Source:
ALAN FREEMAN,  "Canadian singer enters the fray over MD's story of soldier's death", August 9, 2007
http://www.theglobeandmail.com/servlet/story/LAC.20070809.DOCTOR09/TPStory/TPInternational/Asia/


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## Scotian

Lots of good points here.  I confess that, after reading the entire article, the idea of the deceased soldier's family being upset at the gruesome depiction of his death didn't cross my mind at all.  What caught me was the concept of troops from so many different countries, in the same war, same wounds, same hospital . . . but, despite that, different care, different habits, etc.

I think that many of the people who responded so negatively to that article were the victiams of massive email forwardings, and I doubt many of them took the time to read the whole article.  Now, if the immediate family of the soldier was so absolutely outraged at the description of their son's death, they had the right to be (not that it would have made a huge difference).  However, they were not.

This was a -good- article.  It was real, touched on human issues, and I would like to see more like it.


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## Blackadder1916

Something about closing the barn door comes to mind, but I suppose when the original contract was drafted the expectation was that a physician would adhere to his ethical obligations.

Department of Defence muzzles civilian MDs http://www.theglobeandmail.com//servlet/story/RTGAM.20070816.wmotherjones16/BNStory/Afghanistan/home


> Publication of article describing soldier's death in Afghanistan prompts DND to warn physicians not to release sensitive information
> ALAN FREEMAN From Thursday's Globe and MailAugust 16, 2007 at 4:28 AM EDT
> 
> OTTAWA — Stung by the publication of a magazine article by one of its doctors that includes the graphic description of the death of a Canadian soldier in Afghanistan, the Department of National Defence has changed its contracts with civilian physicians, warning them not to release sensitive information and to respect patient confidentiality.
> 
> The changes to contract wording were ordered on July 30, coinciding with the appearance in Mother Jones, a U.S. magazine, of a memoir by Kevin Patterson, a B.C. physician, describing the month he spent working on contract to DND at a coalition military hospital in Kandahar.
> 
> The article includes several passages describing, in excruciating detail, the death on the operating table of Nova Scotia Corporal Kevin Megeney. Family members and friends have objected to the portrayal as a breach of the doctor's responsibility to keep patient dealings confidential. The department has launched two inquiries into the incident.
> 
> Lieutenant-Commander Pierre Babinsky, a DND spokesman on justice issues, insisted the new contract wording was not changed because of the Mother Jones controversy, but conceded they could be seen as linked. "This is not directly in response to the article, but it does cover some of the issues that raised concern from the article," he said.
> 
> The new contract wording deals with the need for confidentiality, not just in the case of patients but for operational security reasons as well. A fellow Canadian doctor said he was surprised by the detailed description of the Kandahar base included in the Mother Jones account.
> 
> According to the new contract wording, "It is critical to the safety of personnel, as well as the potential success of an operation, that sensitive information not be discussed or released outside the Department/Canadian Forces."
> 
> The document goes on to say that "every contractor with access to any information dealing with personnel, equipment or operations has the potential to intentionally or unintentionally provide information that may result in compromise of an operation and/or increase the risk to our people.
> 
> "Therefore, it is requested that all contractors refrain from discussing or writing about their deployments except with those personnel who have a need to know."
> 
> On the issue of patient confidentiality, the new contract language reminds doctors that they must follow the Privacy Act and rules set by provincial medical licensing authorities, noting that "personal health information will not be disclosed without the consent of the individual to whom it relates or their next of kin, as the case may be."
> 
> DND has been hiring civilian doctors to augment its own full-time physicians because of a shortage of personnel, especially doctors experienced in trauma treatment.


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## geo

Interesting....
Guess that, because the event took place in a foreign country, the rules & regs of a licencing authority might not have come into force... unless it was stipulated in the contract.

Drat & double drat!


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## Blackadder1916

geo said:
			
		

> Guess that, because the event took place in a foreign country, the rules & regs of a licencing authority might not have come into force...



Not necessarily.  The conduct/actions of a physician are usually judged by his licensing body (College of Physicians and Surgeons of British Columbia in Dr Patterson's case) in their totality and not always specific to activities that occur only in that jurisdiction.  Dr. Patterson gets to practice medicine (in parts of Canada and overseas with the CF) because the CPSBC says he is competent to do so.  Any action of his part (done anywhere) that brings into question his competency or ethical behaviour or may bring discredit to his profession could be subject to sanctions by his college.  (It was interesting to read some of the discpilinary actions taken against doctors by the CPSBC.)

DND may not have a good case to take legal action against Dr. Patterson because of the wording of his contract.  Based on experience, that does not surprise me in the least.  Additionally, it would be a PR nightmare.   But it does not rule out action by the CPSBC if the doctor's conduct is the subject of a complaint from DND or the patient's family.


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## Greymatters

Would there be a time restriction in this clause, i.e. not allowed to speak on the subject for x number of years, or are they talking silence in perpetuity?


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## geo

naming names?... probably in perpetuity.
that having been said, the Doc could probably discuss the case, in general terms without naming names.
In this case, Dr Patterson was about as subtle as a blunt pick-axe AND he may yet feel some pain for having been too free wth discussing some of his "life events".


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## Blackadder1916

There are time limits of a sort.  The following is from the BC Personal Information Protection Act, but other federal and provincial privacy legislation probably have similiar provisions.

http://www.qp.gov.bc.ca/statreg/stat/P/03063_01.htm#section22


> Disclosure for archival or historical purposes
> 22.  An organization may disclose, without the consent of the individual, personal information for archival or historical purposes if
> 
> (a) a reasonable person would not consider the personal information to be too sensitive to the individual to be disclosed at the proposed time,
> 
> (b) the disclosure is for historical research and is in accordance with section 21,
> 
> *(c) the information is about someone who has been dead for 20 or more years, or*
> 
> (d) the information is in a record that has been in existence for 100 or more years.


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## Greymatters

Blackadder1916 said:
			
		

> There are time limits of a sort.  The following is from the BC Personal Information Protection Act, but other federal and provincial privacy legislation probably have similiar provisions.



All legal and true, but I am wondering about the contract that the DND is proposing to have contractors sign, which wouldnt be covered by the BC PIPA.


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## Donut

If it's a federal jurisdiction matter, it's probably under the jurisdiction of the Privacy Act, or PIPEDA (as it's a private sector contractor versus a federal agency).

Privacylawyer.ca


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## Greymatters

ParaMedTech said:
			
		

> If it's a federal jurisdiction matter, it's probably under the jurisdiction of the Privacy Act, or PIPEDA (as it's a private sector contractor versus a federal agency).
> 
> Privacylawyer.ca



That makes more sense...


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## Donut

Latest from the National Post:

http://www.canada.com/nationalpost/news/story.html?id=8d4535f4-4db0-46b9-a02e-8d409c8eadf3&k=5844

Doctor faces possible court martial over article
Robert Barron, CanWest News Service
Published: Friday, August 24, 2007


NANAIMO, B.C. -- A doctor faces potential court-martial proceedings after the Canadian military launched two investigations into a story he wrote for an American political magazine in which he describes the death of a soldier in his care while in Afghanistan.

Lt.-Cmdr. Pierre Babinsky, a spokesman for Canadian Forces Legal Services, said Dr. Kevin Patterson, a B.C. doctor who worked at a Canadian Forces-led hospital in Kandahar earlier this year, faces military investigations for the story Talk to me like a father, which appeared in the July/August issue of Mother Jones.

Babinsky said the story, which describes in graphic detail Patterson's attempt to save the life of Canadian reservist Cpl. Kevin Megeney of Nova Scotia after he was shot by friendly fire in his own tent, has raised "some concerns" from within the military...


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## armyvern

I just read through this thread for the first time.

Obviously, with the article below there were valid grounds for investigation. 

Many have made mention that the article, blog etc make mention of the mother being "informed beforehand." That leaves me one query.

Is Cpl Megeney's mother the _*Primary*_ NOK?? I'm sure that he had a dad too, and if his father was listed by him as the Primary NOK, then it would be the father who would have had to express the written consent to the release of the information and details. A lot of people seem to be making reference to the mother in the articles. She obviously is NOK, but she may not, necessarily, be the Primary NOK.

I only hope that, if investigation shows that this information was indeed published without the proper Primary NOK consent, and/or it was in violation of any contractual agreements signed by the Doc WRT PERSEC/OPSEC, and/or any Federal or Provincial regulations were circumvented in its release to the public, that justice is swift and hard.

Although scholarly articles are good for learning, I disagree with anyone making a single dime off the publication of details improperly or illegally released regarding someones death. If that's the case ... all proceeds should be directed to the family affected by its release. Anyone, including the publisher, complicit in the improper/illegal release of the information certainly should not be allowed to financially benefit from such release.

What a truly sad situation.


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## Armymedic

The sadest part of it all is that it is quite an excellent article.


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## Emenince Grise

And the difference between the Mother Jones article and this National Geographic is what? 

http://www7.nationalgeographic.com/ngm/0612/feature3/


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## armyvern

Emenince Grise said:
			
		

> And the difference between the Mother Jones article and this National Geographic is what?
> 
> http://www7.nationalgeographic.com/ngm/0612/feature3/



That it involves American soldiers, under different circumstances. Different laws are applicable, than in Canadian Law.

In the Mother Jones' incident, the doctor etc providing the details was subject to Canadian Law, and to OPSEC/PERSEC agreements he signed when contracted by the CF.

The National Geographic article is irrelevant; it is an apple that is being compared to an orange.


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## Emenince Grise

ArmyVern said:
			
		

> That it involves American soldiers, under different circumstances. Different laws are applicable, than in Canadian Law.
> 
> In the Mother Jones' incident, the doctor etc providing the details was subject to Canadian Law, and to OPSEC/PERSEC agreements he signed when contracted by the CF.
> 
> The National Geographic article is irrelevant; it is an apple that is being compared to an orange.



Yes, that is somewhat true. However, the outline of the medical experience is quite similar. My point is that the larger issue of confidentiaity/disclosure is a very varied area. To narrowly define the issue is, I believe, to miss the larger point. As has been said above, the Mother Jones article is a well-written piece. And this shows that the issue can be treated in a very different manner.


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## armyvern

Emenince Grise said:
			
		

> Yes, that is somewhat true. However, the outline of the medical experience is quite similar. My point is that the larger issue of confidentiaity/disclosure is a very varied area. To narrowly define the issue is, I believe, to miss the larger point. As has been said above, the Mother Jones article is a well-written piece. And this shows that the issue can be treated in a very different manner.



I'd agree that the Mother Jones' article is a well-written piece, but if the provider of the details did so illegally in contravention of confidentiality agreements that he signed, and/or without the primary NOK permission required by Canadian Law, the ongoing investigation is fully warranted.

And, I would hope that, if the facts show the above to be the reality, both he and the publisher of the information be dealt with appropriately and swiftly.

No matter how scholarly the article, the law still applies. The neglect to apply the law and/or breaches of OPSEC/PERSEC and/or confidentiality agreements in this case (ie because it is scholarly) may lead to others, of not so scholarly intent, abusing or neglecting that law and those agreements using this incident as their precedent.


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## Fishbone Jones

The 'family' members can think whatever they want. IF his mother was the primary NOK, and IF she read the article before hand and approved of it (and everything points to this as true), the 'family' members can complain all they want. It's not their call and that should have been the end of the story.


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## armyvern

recceguy said:
			
		

> The 'family' members can think whatever they want. IF his mother was the primary NOK, and IF she read the article before hand and approved of it (and everything points to this as true), the 'family' members can complain all they want. It's not their call and that should have been the end of the story.



Actually, I believe that the Doc has conceded that he did not seek the family's (ie the mother's - if she's NOK) prior to writing the article. Indications are that it was written and then the mother was *advised* beforehand of it's impending publication by the mailing of a copy of the article to her residence. The mother has said that the copy of the article was received at her residence during a time period when her family was away on vacation, and that its publication actually took place before that vacation ended.

I'm getting that from links in this thread. That doesn't sound to me that the NOK consented to it's publication or to it's writing. It sounds as if they were simply _advised_ that it was written and going to be published shortly. Of course, if this _advising_ occured as detailed by the mother while her family was away from home on vacation, they weren't really advised in advance that it was coming either, but rather found it all out after the fact.

I guess that's why it's under investigation. Time will tell.


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## George Wallace

I would hesitate a guess, but does it matter if the Dr or his publisher working on his behalf makes contact with the NOK?  As stated in the article, the Mother felt that this publication would help to bring closure.  

Now we have debated this for how many pages and all we are doing is restating what was stated previously.........who feels like a dog chasing his/her tail?


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## Fishbone Jones

ArmyVern said:
			
		

> Actually, I believe that the Doc has conceded that he did not seek the family's (ie the mother's - if she's NOK) prior to writing the article. Indications are that it was written and then the mother was *advised* beforehand of it's impending publication by the mailing of a copy of the article to her residence. The mother has said that the copy of the article was received at her residence during a time period when her family was away on vacation, and that its publication actually took place before that vacation ended.
> 
> I'm getting that from links in this thread. That doesn't sound to me that the NOK consented to it's publication or to it's writing. It sounds as if they were simply _advised_ that it was written and going to be published shortly. Of course, if this _advising_ occured as detailed by the mother while her family was away from home on vacation, they weren't really advised in advance that it was coming either, but rather found it all out after the fact.
> 
> I guess that's why it's under investigation. Time will tell.



If that's the case, my point is moot.

Cheers,
rg


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## tannerthehammer

What an amazing and gripping first hand account of the realities of war...


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## Yrys

http://www.cbc.ca/cp/health/070920/x092013A.html

Published: Thursday, September 20, 2007 | 7:39 PM ET
Canadian Press: Murray Brewster, THE CANADIAN PRESS



> OTTAWA - Military police have decided not to charge a Canadian doctor who published a graphic description of the last moments of a wounded soldier's life in Afghanistan.
> 
> The National Investigative Service (NIS) looked at whether Dr. Kevin Patterson broke any laws in an article written last summer about the operating room death of Cpl. Kevin Megeney, a 25-year-old reservist from Stellarton, N.S. "There was no evidence to support criminal or service charges under the National Defence Act," said Capt. Cindi Tessier, a spokeswoman for the NIS.
> 
> The article, which appeared in the July-August issue of Mother Jones magazine, resulted in a storm of criticism from the friends and family of the soldier, who said the account was tasteless and violated medical ethics standards. The Defence Department launched two investigatons into the article in which Patterson described in graphic detail the wounds suffered by Megeney, who was shot in the chest in his tent at Kandahar Airfield, the main NATO base in southern Afghanistan.
> 
> While deciding no charges will be laid, the military has yet to decide whether Patterson, who worked as a doctor at the airfield's coalition medical facility - known as the Role 3 - breached any ethical guidelines.The review by the military's medical services branch will determine, among other things, whether he is allowed to work for the military ever again under contract. "There are a whole bunch of options that could come out of the medical group's investigation," said Tessier. The shooting of Megeney - on March 6, 2007 - is also still under investigation by military police officers and it's not clear when it will be completed, she said.
> 
> Even though he was essentially a civilian contractor, Patterson was subject to the National Defence Act and to the military code of service discipline while overseas. He could have faced criminal charges or even administrative sanctions, such the docking of pay, just like soldiers. Since returning from Kandahar, his contract with the military has expired.
> 
> Patterson's 7,000 word memoir recounts the six weeks he spent at the Kandahar military base, the climax of which was Megeney's shooting. His vivid description of the young's soldier's massive bleeding wound and the desperate, ultimately unsuccessful effort to save him angered not only the family, but Defence Minister Peter MacKay, who comes from the same home town and attended the funeral.


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## Bruce Monkhouse

A related thread.
http://forums.army.ca/forums/threads/60408.0.html


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## Armymedic

He will not be changed under NDA, nor should he as his article and description did not contravene any of those regulations. That was never an issue.

How his article is interpreted ethically by his peers will not result in "charges" but reprimands of some kind if it is warranted.


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## geo

He will not be charged..... and will probably not be employed by the CF anytime soon.


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## schart28

https://www.cpsbc.ca/files/pdf/Dr_Kevin_Lee_Patterson_090127_f.pdf

January 27, 2009
Dr. PATTERSON, Kevin Lee
Salt Spring Island, BC
When reporting this release, it is requested that the name and location of the physician be provided in full in order to avoid confusion with other physicians who may have a similar name or initials.

VANCOUVER, BC, January 27, 2009: Following the issuance of disciplinary charges, Dr. Kevin Lee Patterson has admitted that he was guilty of unethical and unprofessional conduct with respect to breaching patient confidentiality. The disciplinary charges issued by the College were that Dr. Patterson breached his professional duty of confidentiality by writing an article which identified personal health information, including the name and details of his treatment of his patient, Canadian Forces Corporal Kevin Megeney (deceased), when he had no consent to do so. The article was published in the July/August 2007 edition of Mother Jones magazine. In determining the disposition of this matter, the College acknowledged and weighed the contribution that Dr. Patterson has made through his efforts as a civilian contract physician with the Canadian Forces, and through his published accounts of his experiences in war-torn regions. Dr. Patterson has assured the College that in
any future writings based on medical scenarios, or in any future works of journalism or fiction, he will not include the identities of patients or any information that could identify patients.
The College has imposed the following penalty: 

(a) A formal written Reprimand by the Council of the College pursuant to section 60(3) of the Medical
Practitioners Act;

(b) Participation in reading and continuing medical education in the areas of ethics and professionalism
as directed by the College;

(c) Costs in the amount of $5,000.

Dr. Patterson’s future professional conduct must be beyond reproach in every respect. The penalty imposed by the College took into account Dr. Patterson’s admission of guilt, his contriteness and
remorse for his conduct, and his full cooperation throughout the College’s investigative process. Dr. Patterson also agreed to make a donation to a registered charity, acceptable to the College, in the amount of $7,000, representing the amount received by Dr. Patterson for the article he authored and published in Mother Jones magazine. The College of Physicians and Surgeons is the licensing and regulatory body for all physicians and surgeons in the province. Governed by provincial legislation, the College’s role is to protect the public by establishing, monitoring and enforcing high standards of qualification and ethical practice across the province.


Heidi M. Oetter, MD
Registrar
For more information / media inquiries, please contact:
Susan Prins
Director, Communications
604-733-7758, ext. 2248

---------------------

unfortunately this will not stop the unethical and unprofessional conduct of certain MO which have no respect to health information and the consent required to divulge this info...


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## The Bread Guy

Shared in accordance with the "fair dealing" provisions, Section 29, of the _Copyright Act._

*B.C. doctor disciplined for writing about soldier's death in Afghanistan *
Canadian Press, 27 Jan 09
Article link

A British Columbia doctor has been fined and ordered to undertake ethics training for publishing a graphic account of the death of a Canadian soldier in Afghanistan.

Dr. Kevin Lee Patterson admitted to unethical and unprofessional conduct for breaching confidentiality when he wrote the story that identified Cpl. Kevin Megeney and gave a detailed account of his March 2007 death.

The B.C. College of Physicians has ordered Patterson to pay $5,000 for the cost of his hearing and make a charitable donation of $7,000 - the amount he received for the story published in Mother Jones magazine.

"The penalty imposed by the College took into account Dr. Patterson's admission of guilt, his contriteness and remorse for his conduct, and his full co-operation throughout the College's investigative process," college registrar Dr. Heidi M. Oetter said in a statement issued Tuesday.

Patterson could not be reached for comment.

Karen Megeney, the deceased soldier's mother, said she was satisfied with Patterson's admission.

"I'm glad he did admit it," Karen Megeney said from her home in Stellarton, N.S. "We were shocked at the article. It was very graphic."

Patterson, of Saltspring Island, B.C., will also get a formal reprimand from the college and will have to participate in ethics education.

The Canadian Forces did not charge Patterson for writing the account, but Cpl. Matthew Wilcox faces multiple charges in connection with the death.

Megeney, a 25-year-old reservist from Stellarton, died after he was shot in the chest in his tent at Kandahar Airfield, the main NATO base in southern Afghanistan.

In the Mother Jones story, Patterson named Megeney and described in detail the final moments of his life.

"Cpl. Kevin Megeney's uniform is soaked with blood where the bullet has entered his right chest, just below his armpit. His eyes are wide open and his pupils fixed and dilated; there is no pulse. One of the men who brought him in says, 'We were just walking by his tent and heard the shot. Sounded like a 9-mm. No idea what happened.' "

He described the incisions doctors made in Megeney's chest to try to repair the damage and finding a bullet hole in his heart.

"'There is no cardiac activity at all. The lab tech arrives with armloads of packed red blood cells at the same time I manage to get a line into Megeney's femoral vein. Filips (another doctor) says, 'He's been pulseless now for 20 minutes. We should stop.' The room freezes as we all realize he is right. "

Megeney's family was outraged by the publication.

Karen Megeney said she and her husband had never heard of Mother Jones and were unaware of the article until it was published.

"We were out of town and by the time we got home and found out about it (the article) was already on the market."

She seemed to accept the college's penalties.

"They know what they're doing, I guess. That's what those people are there for."

She is a licenced practical nurse "and I know about ethics.

"I know I can't go and talk about any case, not name names, not discuss it, nothing."

It's been almost two years since her son's death and she and her husband are "doing well."

"The family's just changed. The whole world changed that day. We're just not the same but I think we're doing rather good."

The statement from the college said it took into account in disciplining Patterson his efforts as a civilian contract physician for the Canadian Forces working in war-torn countries.

It said Patterson assured the disciplinary board that any future writings based on medical scenarios, either journalism or fiction, would not include the identities of patients or any information that could identify patients.


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## PMedMoe

schart28 said:
			
		

> unfortunately this will not stop the unethical and unprofessional conduct of certain MO which have no respect to health information and the consent required to divulge this info...



Wow, you really have it in for someone, don't you?  Do you have any proof of this?


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## Blackadder1916

schart28 said:
			
		

> VANCOUVER, BC, January 27, 2009: Following the issuance of disciplinary charges, Dr. Kevin Lee Patterson has admitted that he was guilty of unethical and unprofessional conduct with respect to breaching patient confidentiality. The disciplinary charges issued by the College were that Dr. Patterson breached his professional duty of confidentiality by writing an article which identified personal health information, including the name and details of his treatment of his patient . . .
> 
> Dr. Patterson’s future professional conduct must be beyond reproach in every respect. . . .  Dr. Patterson also agreed to make a donation to a registered charity, acceptable to the College, in the amount of $7,000, representing the amount received by Dr. Patterson for the article he authored and published in Mother Jones magazine.  . . .



I would say that the BC College has paid appropriate attention to an " attention wh@@e* ".  It will be interesting to see how this affects his future scribblings.  Though it will be never revealed, I would be interested in whether there was a "formal" complaint (usually a formal complaint will only be accepted and acted upon by the college from a party with standing such as, in this case, the patient's family, DND, other physicians or the college itself) or if there was more than one letter of complaint from an interested member of the general public.

_* this descriptive term was used by an old friend and former colleague when relating some of his experiences during his tour in Khandahar.  The doctor in question was there during part of his tour._

However, this action is not surprising:



			
				Blackadder1916 said:
			
		

> Not necessarily.  The conduct/actions of a physician are usually judged by his licensing body (College of Physicians and Surgeons of British Columbia in Dr Patterson's case) in their totality and not always specific to activities that occur only in that jurisdiction.  Dr. Patterson gets to practice medicine (in parts of Canada and overseas with the CF) because the CPSBC says he is competent to do so.  Any action of his part (done anywhere) that brings into question his competency or ethical behaviour or may bring discredit to his profession could be subject to sanctions by his college.  (It was interesting to read some of the discpilinary actions taken against doctors by the CPSBC.)
> 
> DND may not have a good case to take legal action against Dr. Patterson because of the wording of his contract.  Based on experience, that does not surprise me in the least.  Additionally, it would be a PR nightmare.   But it does not rule out action by the CPSBC if the doctor's conduct is the subject of a complaint from DND or the patient's family.





			
				3rd Herd said:
			
		

> Further from the Globe and Mail:
> . . .
> 
> "Medical ethicists and doctors say that Dr. Patterson may find himself under investigation for breaching his responsibilities as a physician by the B.C. College of Physicians and Surgeons, which is responsible for his medical licence."
> . . .


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## Gunner98

What about the book - "Outside The Wire: The War In Afghanistan In The Words Of Its Participants" - surely his advances and royalties from the book will easily take care of his fines.  Surely the furor over the article helped in book sales?


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## schart28

just stating a fact, the facts of my situation.... not only the MO but the ASurg BSurg and Case Manager have no sense of what the term consent mean. very sad..... The worst part is that it does not bother them to exchange medical/personal information without my consent. I certainly have lots of proofs, it can't be more clear then an email from the xSurg that says we are contacting your doctor even though I told them not without my consent. In the case of the case manager... it had to be VAC who did the investigation and it came out positive....



			
				PMedMoe said:
			
		

> Wow, you really have it in for someone, don't you?  Do you have any proof of this?


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## George Wallace

schart28 said:
			
		

> just stating a fact, the facts of my situation.... not only the MO but the ASurg BSurg and Case Manager have no sense of what the term consent mean. very sad..... The worst part is that it does not bother them to exchange medical/personal information without my consent. I certainly have lots of proofs, it can't be more clear then an email from the xSurg that says we are contacting your doctor even though I told them not without my consent. In the case of the case manager... it had to be VAC who did the investigation and it came out positive....



Now that tells me that you have no concept of what goes on.  How can the ASurg, BSurg, and Case Manager determine with any accuracy what your personal situation is, if they do not have all the information?  YOU are the cause for concern.  YOU are the one creating any delays in any decisions on your case.  YOU are at fault, not the people trying to consult and make the correct decisions.


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## geo

With respect to Dr Patterson, it is good to see that we have closure all round.  The MD has shown he is sorry for having grieved the family of the deceased - he has been fined & will undergo continual professional development on ethics... all is as it should be.

While I could probably weigh in on the other subject that has cropped up (schart28), might I suggest that this thread is not the place to kick that can around.  Might I suggest that we start a new thread & remove the last couple from this one.


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## The Bread Guy

Frostnipped Elf said:
			
		

> What about the book - "Outside The Wire: The War In Afghanistan In The Words Of Its Participants" - surely his advances and royalties from the book will easily take care of his fines.  Surely the furor over the article helped in book sales?



I think this could be countered by the fact that most proceedings of medical self-governing colleges like this one are NOWHERE as public and high-profile as this is, so I'm guessing he loses on the reputation side.  Anyone who can shed any light on how much this might affect a doc in his/her day-to-day work, I'd love to hear it.


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## Blackadder1916

milnews.ca said:
			
		

> I think this could be countered by the fact that most proceedings of medical self-governing colleges like this one are NOWHERE as public and high-profile as this is, so I'm guessing he loses on the reputation side.  Anyone who can shed any light on how much this might affect a doc in his/her day-to-day work, I'd love to hear it.



While (almost all) "proceedings" of medical colleges are conducted very quietly and usually involving only the parties to the complaint, the "outcome" of those proceeding are generally made public if resulting in disciplinary action against the physician.  Since most of these events are generally of significance to a local area, the publicity it generates is usually proportional.  But this one got particularly wide publicity, just as his actions that led to it did - 'punishment fitting the crime' comes to mind.  Sometimes it can make interesting reading, seeing what naughtiness some of these boys and girls with an MD after names get up to.

In the case of Dr Patterson, there is little (or no) restriction on his continued practice of medicine.  Not being familiar with his practice, it would be difficult to say whether any damage to his reputation will result in a related decrease in his "business" of medicine.  However, with the shortage of doctors in all jurisdictions, one would have to be a pretty bad physician to not be able to continue a reasonably lucrative practice.  And the college did not fault Dr. Patterson on his skills just that he does did not know when to keep his mouth shut.  I would say that most physicians do not like having a blackmark on their record.  Should there be future substantiated complaints against him (and it doesn't have to be for the same reason), having previous disciplinary action could potentially result in a significant restriction of his ability to practice (temporary or permanent).

Though the circumstances are completely different, if you look at the news release regarding disciplinary action from CPSBC that was issued the day following Dr Patterson's you can see that medical colleges are not hesitant to strike someone from their rolls if their conduct warrants it.


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