Metis nurse-practitioner after wrong organization, defense lawyer argues

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A Metis nurse-practitioner who is suing the College of Physicians and Surgeons of Alberta for $75,000 for interfering with her right to practise is after the wrong organization, argued defense lawyer Donald Boyer.

Joyce Atcheson elected to work with the Thickwood Family Medical Clinic in Fort McMurray, therefore her action should be against the doctors at the clinic and not the College, lawyer Donald Boyer said in the Court of Queen's Bench.

The College was operating under the powers of the Medical Professions Act to deal and their power was paramount to the agreement made by Thickwood clinic and Atcheson, Boyer argued.

Atcheson's case was heard in court Nov. 10-12. The court reconvened to hear final arguments from the lawyers on Dec. 2.

The dispute started in May 1991 when the Thickwood clinic cancelled its conrtract with Atcheson. The action was taken after 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.

While under contract to the clinic, Atcheson routinely conducted physical examinations, took blood pressures readings and pap smears, did breast examinations and assessed patients' 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 after 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.

When the college ordered the clinic to stop the billing practise, the doctors terminated Atcheson's contract.

The college's actions were in direct interference with Atcheson's employment with Thickwood clinic and as a government-sanctioned board for physicians, it had gone beyond its powers, argued Janet Dixon, Atcheson's lawyer. The college is not at liberty to retrain the practice of Joyce Atcheson in a profession practised under its own act, she said.

"They have been courteous in what they said, but most destructive in what they have done," Dixon said. "This action is taken so this does not happen again."

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 in1988.

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 kilometres 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.

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 have 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.

Justice Ellen Picard indicated she will be ordering a complete transcript for a review of the case before she gives her decision in the new year.