Weekly COVID-19 update January 21, 2021 A message from the Registrar Dear Colleagues,
This compelling infographic, produced by the CBC and based on Alberta Health data, demonstrates the effectiveness of recent COVID-19 restrictions to lower the provincial case count. Despite the personal or professional challenges these restrictions posed, case counts decreased. The decrease in case counts are an indicator of better health outcomes, which can ease the need for further restrictions that may threaten the ability for chiropractors to remain open and supporting Albertans and their health challenges. This week’s COVID-19 update covers:
Thank you, Dr. Todd Halowski ACAC Registrar
Minimum masking requirements The minimum mask is an ASTM level 1 procedure mask. Any other ASTM procedure mask that exceeds the minimum requirement may be used. N-95 masks are not required but may be used. No other masks are acceptable for use in practice.
The Alberta Dental Association and College has produced an excellent resource on mask selection.
Rapid Testing Pilot Program In response to questions on patient eligibility for care in instances of their participation in the International Border Pilot Project (or Rapid Testing Pilot Program), the ACAC sought clarity from Alberta Health.
Participants in the pilot program cannot work or visit in any setting where health-care services are provided, unless it’s to access emergency health services (in cases of being acutely ill, they should still present at Emergency).
As your staff often answer these questions from patients, we strongly recommend you share and review this information with your staff.
Managing COVID-19 screening questionnaires As this is an important and mandatory requirement, we urge members to read prior communications from the ACAC on this subject.
The ACAC strongly recommends you keep a record of screening in the patient chart. It is as simple as noting that the patient screened negative for COVID-19 symptoms.
The requirement is for you to screen your patients. There is no requirement that you use a patient form. If you do keep the screening form, you only need to keep the form for 14 days. Aside from this, the ACAC does recommend that you make an entry in the patient chart every time the patient screens negative for COVID-19 symptoms.
Guidance and considerations for mask-exempt patients Appropriate dealings with mask-exempt patients continues to be an evolving topic because of CMOH Order 42-2020 and the previously introduced municipal masking exemptions. Alberta Health Services’ COVID-19 Scientific Advisory Group prepared a rapid evidence report related to mask use.
The ACAC is aware that some patients seeking care are either mask exempt or are claiming mask exemptions. The following information provides guidance in managing situations, interactions, and challenges that may arise when discussing this topic with patients.
It is strongly recommended that you review and discuss all this information with your staff.
The ACAC supports your decision.
Whether your decision is to treat or not to treat a mask-exempt patient, the ACAC understands that you are making your decision based on the consideration of the safety of everyone involved. We support your professional determination on this matter.
Remember, whatever the final decision on treatment is, you and your staff are required to adhere to the ACAC COVID-19 Pandemic Practice Directive. If you are choosing to practice in violation of the Practice Directive or orders from the Medical Officer of Health, then the ACAC or Public Health may investigate you for non-compliance.
You have the right to not treat mask-exempt patients personally, or in your clinic, if doing so would compromise safety of any group, or individual, including yourself.
The first and most important consideration that you as a chiropractor or business owner need to answer is: What is the safest course of action for my staff, patients, and myself? Your staff, your patients, or you may have health conditions that make COVID-19 exposure potentially life threatening.
Because you are making decisions on individual health and safety, the information that led to your decision cannot be shared publicly. You cannot, and must not, share staff or patient’s health history with another patient. You are well advised to not share your personal health information as well; however, you may choose to share your relative health information with patients (such as history of asthma, etc.).
You can inform them that a safety consideration based on pre-existing health conditions has led to the determination that you are unable to support health care for mask-exempt patients in your clinic.
Mask exemptions are intended for public spaces. Mask exemptions are not intended for close contact situations, such as when you provide care.
A mask exemption in open indoor public spaces such as grocery stores or warehouse shopping is not equivalent to mask exemption when receiving chiropractic care.
A significant challenge that chiropractors face in dealing with mask-exempt patients is that our services require us to work in close contact (less than six feet). Alberta Health Services guidance on masking for mask-exempt patients directs the patient to avoid breeching the physical distance requirement of six feet. To receive in-person chiropractic care, the chiropractor and patient must breech the six-foot physical distance public health requirement. This poses a risk to you, and your patient, in becoming a close contact for COVID-19.
You have a right to know why patients are claiming mask exemptions.
Patients are required to disclose this information to you as part of any health history in the rule-in or rule-out determination for care. Some underlying mask exemptions could make chiropractic care riskier, and this increases your risk.
Most patients will share their health history without concern. Some mask-exempt patients may push back against your request claiming that they do not need to share this information. As a health-care provider, you are well advised to ask, and expect a detailed response from a patient for their exemption to masking.
There are indications in CMOH order 42-2020 that allow for mask exemptions. These conditions may make receiving chiropractic care riskier for the patient and must be considered in the determination of whether care is safe or not.
If a patient is withholding health information (by refusing to disclose why they are mask exempt) that you need to decide whether care is safe or not, they are not eligible to receive care until you have the required information.
If you have determined that mask-exempt patients cannot receive care in your clinic, inform them of other clinics that are treating mask-exempt patients.
If your decision is to not treat mask-exempt patients, it is both fair and reasonable to recommend other practitioners to address the patient’s urgent health concern.
Whatever the decision, ensure that the decision to treat or not treat is communicated to the patient clearly and a record is kept, preferably in the patient chart.
Reports from members to the ACAC have elevated the awareness that some mask-exempt patients have strong and sometimes volatile reactions to being provided notice that you are unable to provide care to them. This can lead to a challenging situation that may result in threats from the patient to intimidate or challenge your decision or to coerce you to change your stance. The ACAC recommends you do not alter your decision because of the bad behaviour and compromise the safety of those considered in making the decision.
If safety is not a barrier to care for mask-exempt patients, then it is strongly recommended that provisions for them to attend with as little collateral contact with staff or other patients be executed.
If your decision is to treat mask-exempt patients, you are well advised to arrange for mask-exempt patients to attend away from other patients and staff to diminish the risk for those patients and staff.
Whatever the decision, ensure that the decision to treat or not treat is communicated to the patient clearly and a record is kept, preferably in the patient chart.
Mask-exempt patients do not have human rights that supersede the safety of you, your staff, or other patients in your clinic.
Mask-exempt patients who are denied care and provided alternative solutions to receive care may claim that it is a human rights violation. While this claim may be made to scare or intimidate you in the moment, there is no allowance in the Canadian Charter of Rights and Freedoms to compromise the safety of an individual (you, your staff, or other patients) for the rights of another.
Your decision to not treat based on safety does not prevent them from filing a human right complaint. However, as human rights cases around mask exemption are heard, the decisions favor safety. If you find yourself in this situation you are well advised to reach out to the CCPA to seek legal support and advice.
This weekly, Thursday morning COVID-19 update provides non-urgent, yet important, information and answers questions posed by members as part of the ACAC’s ongoing efforts to keep members informed about public health responses to the pandemic. If you have questions related to policy, procedures, control measures, safety, or any other topic pertaining to effectively responding to COVID-19 in your practice, please send them to registrar@albertachiro.com.
The next update will be January 28, 2021.
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