Designated Medical Practitioner Handbook

Chapter 3: The Work of Designated Medical Practitioners

3.1 Responsibilities and Duties

DMPs [note 1] (either institutional or individual) for the Canadian immigration medical program are responsible for several duties and activities that are related to specific aspects of their role in the IME process.

When performing Canadian immigration medical examinations, DMPs are responsible for:

Responsibilities related to knowledge

• Maintaining familiarity with and knowledge of the DMP Handbook, and departmental instructions and requirements regarding the performance of Canadian IMEs
• Ensuring that office, clinic or laboratory staff under their direct control are aware of and knowledgeable about the requirements and standards for the Canadian IME
• Ensuring that laboratories and radiology clinics used to provide routine tests and investigations are aware of and knowledgeable about CIC requirements, and adhere to instructions regarding verification of the applicant’s identity
• Ensuring that consultants and facilities providing consultation, specialist reports, or additional tests and investigations are aware of and knowledgeable about departmental requirements, and adhere to instructions regarding verification of the applicant’s identity

Responsibilities related to standards

• Adhering to and applying the guidelines and instructions presented in the DMP Handbook and provided by CIC
• Providing timely appointments for any applicant requesting an IME
• Conducting an IME, including physical and mental examination and routine tests, according to the guidelines provided in this Handbook, and subsequent amendments and instructions issued by CIC
• Ensuring that clinical laboratories and radiological clinics used for Canadian IMEs are registered, licensed by local regulatory authorities, and meet local, national and international standards as defined by the responsible regional medical office and CIC
• Providing appropriate counselling for clients who undergo HIV testing
• Arranging appropriate consultations or additional tests, and ensuring that those providing the supplemental tests or consultations are aware of the reason for the request (i.e., medical assessment for immigration and not therapeutic purposes)
• Completing appropriate CIC Medical Report forms and documentation, and forwarding these documents to a CIC regional medical office
• Ensuring that the fees charged for immigration medical services fairly represent the services performed and adhere to local, CIC-defined or other standard fee guidelines, where appropriate
• Advising the responsible regional medical office of any change in practice location or contact information (phone, fax, e-mail) within 14 days of that change

Responsibilities related to official languages

• Ensuring that CIC is aware of their linguistic abilities and capacities so that applicants can be advised should they request services in an official language
  In locations where CIC has bilingual service obligations, ensuring that Canadian immigration medical forms and information are available in both official languages

Responsibilities related to conflict of interest and ethics

• Maintaining the confidentiality of all immigration medical information in their control
  Adhering to the conflict of interest guidelines described in Section 3.2 of this Handbook

Responsibilities related to performance evaluation

• Ensuring that they make themselves and their staff available, on sufficient notice, for evaluation, monitoring, training or educational activities or visits when requested by the regional medical officer

3.2 Professional Conduct, Ethics and Conflict of Interest

In their role of providing services for CIC, DMPs may become involved in situations where their loyalties may be divided or where the personal interests of the applicant for immigration may conflict with the DMPs’ responsibilities. [note 2] DMPs are expected to display professional behavior, to conduct themselves and perform their IME-related activities in a manner that reflects the principles of both their medical profession and CIC. When issues or events arise involving professional conduct or behavior, the DMP must notify the responsible regional medical office (RMO). The following events require notification to the regional medical officer within the times specified:

Events or activities requiring notification to RMO:

• DMPs who are suspended or under investigation by their respective medical or regulatory authorities (within 14 days of the event)
• DMPs charged or convicted of offences (within 14 days of the event)
• Any unprofessional or inappropriate activity in relation to the undertaking of Canadian IMEs by clinic, office, laboratory or radiology staff (within 14 days of the event)
• Any disciplinary action or termination of employment of clinic, office, laboratory or radiology staff related to issues or situations involving Canadian IMEs
  (within 14 days of the event)

To reduce the risk of conflict of interest, DMPs should take the following action:

• Note that applicants are entitled to attend the DMP of their choice. DMPs should not criticize other DMPs or attempt to influence applicants’ selection of DMPs. Any concerns regarding the activities of other DMPs in terms of the performance of Canadian immigration medical examinations should be brought to the attention of the RMO.
• Not perform Canadian immigration medical examinations for members of their family, employees, current patients or other persons to whom they owe a personal or legal obligation, unless authorized by CIC.
• Ensure that remuneration for IMEs and related services is limited to a fee schedule provided to officials in CIC’s Health Management Branch (HMB) and posted in the DMPs’ clinic or facility. See Chapter 7 for more information about fees.
• Ensure that advice and prognosis provided as part of the IME are not influenced by differences in access to or availability of care in Canada and the applicant’s current place of residence (for example, advocating admission to Canada to obtain services more easily).
• Avoid involvement or association with agencies, organizations or enterprises that attempt to influence or have either legal or commercial interests related to immigration to Canada. This includes immigration consulting services, legal firms representing immigration clients and organizations involved in immigration policy formulation.
• Not use information or knowledge acquired as a result of their IME-associated activities for purposes unrelated to that position (for example, DMPs advised of a pending change in medical screening procedures or requirements must not release that information or discuss it with clients until authorized by HMB).
• Avoid the acceptance of gifts, gratuities or favors resulting from the performance of IMEs.
• Avoid suggesting, indicating or advertising that their association with CIC and the Government of Canada provides or authorizes any privileges, benefits or services except those defined by the DMP Handbook.

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3.3 Individual Stamp

A stamp with a unique number is issued to DMPs or to the organization representing institutional DMPs. This stamp must be used to authenticate each Medical Report completed by the DMP and is also used to indicate that the DMP has verified applicants’ identity. There are a few rules for DMPs to follow regarding the stamps:

• The stamp should not be shared with other practitioners and is to be used only by the DMP to whom it has been issued unless authorized by CIC.
  
• Should the stamp become damaged, worn or otherwise illegible, a replacement is to be requested from the responsible RMO.
• When a replacement stamp is provided, the original must be returned to the responsible RMO.
• DMP stamps remain the property of the Government of Canada and must be returned on request or when a DMP appointment terminates.
• In the case of institutional designation, a single DMP stamp is sometimes issued to the organization. In this case, alternates, assistants or locums functioning for DMPs should sign IME Medical Report forms and other communications related to the IME “for and on behalf of Dr. _______”, stamp them with the DMP’s stamp, and indicate the DMP stamp number and their own personal identification obtained from the RMO.

The use of the DMP stamp in verifying the identity of applicants and completing documents is described in detail in Section 11.2.

3.4 Absences

Depending on the DMPs’ location of practice and the number of applicants they examine, absence from the practice location can affect program delivery. There are two types of absences:

• Short-term absence — Constitutes an absence from the practice for 10 or more working days but less than 20 working days
• Long-term or extended absence — Absence or inability to undertake IMEs for 20 or more working days

Both types of absences must be brought to the attention of the regional medical officer beforehand with the estimated date of return. The officer will review each situation individually and, depending on the nature of the absence, determine an appropriate course of action. Extended or repeated absences may result in the termination of DMP status.

3.5 Fraud Prevention

The integrity of the entire immigration medical examination process is based on verifying the identity of those presenting for examination and ensuring that all clinical investigations and records correspond to that individual. On occasion, attempts may be made to circumvent the immigration medical examination through substitution or fraud. This handbook contains references and instructions on various procedures and standards to prevent fraud. Good identity management of the applicant, and proper adherence to specific procedures when filling forms, stamping photos and performing exams are examples of fraud prevention.

DMPs can also help prevent fraud by educating their staff about these procedures, following the standards announced in this handbook and incorporating quality processes in their practice whenever possible. Examples of the latter include the use of chaperones or escorts to accompany applicants during off-site x-ray and laboratory testing, and ensuring that clinical and radiological laboratories use the identity verification processes defined in this handbook.

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1.  In this chapter, “DMP” refers to both individuals appointed as designated medical practitioners and institutions or organizations appointed by CIC to undertake IMEs.

2.  Examples include situations where the DMP becomes involved in the delivery or provision of direct medical care to the applicant, or situations in which the DMP believes that the applicant’s medical condition(s) could be better treated in Canada and becomes an advocate for the applicant.

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