Further information on mask exemption order

May 21, 2021

Dear Members:
 
As you are aware, on May 13 government released a new public health order stipulating that medical exemptions for mask use will be allowed for a list of “verified health conditions,” and that an exemption letter will be required from a physician, nurse practitioner or psychologist. I provided some initial information on this topic in my May 14 President’s Letter, including a communication from the College of Physicians & Surgeons of Alberta that provided the list of conditions that qualify for a mask exemption and some guidance on billing for this service.
 
This morning, myself and Dr. Samantha Myhr, Section of Rural Medicine President, Dr. Craig Hodgson, Section of Family Medicine President, Dr. Michelle Bailey, Section of Pediatrics President and AMA senior staff met with Dr. Scott McLeod, CPSA Registrar, to get a better understanding of the health order and to raise some of the most urgent concerns we’ve been hearing from members, including the time burden, difficulty of assessment, potential risk to the therapeutic relationship with patients and liability for physicians. Yesterday, the Section of Psychiatry also had a meeting with Drs. Hinshaw and McLeod to share their concerns.
 
Dr. McLeod was responsive to our feedback, and I was reassured by his comments. There will be messaging from the CPSA in the coming days. He emphasized that clinical judgement should balance the severity of the patient’s condition and the risk that mask wearing might worsen it, with the risk of severe illness from COVID-19 to both the patient and the general public. Simply being diagnosed with one of the listed medical conditions should not lead to an automatic exemption. He also indicated that any complaints to the CPSA related to mask exemptions would be triaged through a separate process.
 
I realize that this has been a source of stress for many physicians and has even caused great moral angst for some. I hope the clarity the CPSA will provide will help, at least in part. In the meantime, the Canadian Medical Protective Association offered the following advice to physicians responding to requests for notes that exempt patients from mask wearing:
 
Physicians should exercise clinical judgment on a case-by-case basis in determining whether an exemption note is warranted based on the patient’s medical condition and circumstances. Although physicians have a general obligation to help patients by providing medical reports or certificates when warranted, they are also responsible for giving sound medical advice.
 
Physicians should generally only complete these documents if the request is clinically indicated and in keeping with published guidelines. Any statements made should be truthful and based on objective clinical information.
 
It is reasonable to decline completing exemption notes if the request is not clinically indicated or you do not have the sufficient knowledge or expertise to opine on the issue. You should explain to the patient in a compassionate and professional manner why the request cannot be granted. An appropriate notation in the medical record of the discussion with the patient, including the basis for providing or refusing the exemption note, will be invaluable in responding to any later challenge of your decision.
 
For further information and advice on face mask exemptions for patients, you can visit the CMPA website. You can also contact them directly, via telephone, at 1-800-267-6522.
 
Once again, we will share any further developments or information on this issue as we receive it. Please take care this long weekend and I hope you find some time to do the things that help restore you.
 
Your comments are welcome in the following ways:

• Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org 
• Comment publicly on this President’s Letter on the AMA website (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member).

Sincerely,
 
Paul E. Boucher, MD, FRCPC
President, Alberta Medical Association