U.S. doctor's offer of free medical help for Fogo Island rejected after licensing snag

When a Massachusetts doctor with Newfoundland ties heard Fogo Island has been without a permanent family doctor since June, he knew he wanted to help.

But Dr. Paul Hart's offer of three months of his medical services — for free — ran into licensing problems with the College of Physicians and Surgeons. On Friday, Hart received a letter informing him that his application for registration had been rejected.

Hart — originally from Toronto — came to Newfoundland and Labrador for university and was part of the first graduating class at Memorial University medical school in 1973. He says offering his services is his way of giving back to the province.

"It's my wish to say thank you to the province of Newfoundland for providing me with this phenomenal education and a wonderful medical career," Hart told CBC News in a recent interview.

Hart contacted the Fogo Island Health Centre and Central Health offering to work as a family doctor for up to three months. He said his services would be free and he would cover his own travel and living expenses.

"I will not ask for any compensation," said Hart. "And indeed, if you give me money, I will turn around and write a cheque back to the town of Fogo and to the island to use as they need."

Hart says the response to his offer from hospital administration and the provincial health minister was positive.

I provided that information to the college and I said, please look at it, can we have a dialogue? We have never had that dialogue.- Dr. Paul Hart

However, problems began during the online application process for a provincial medical licence, required by the provincial College of Physicians and Surgeons.

Rejected application

While he's fully licensed in Massachusetts, Hart does not meet some provincial licence requirements for the provincial application. 

"I've not been in active practice for two of the last three years," said Hart. "I've been doing telemedicine … telemedicine is not viewed as active medical practice."

In an emailed statement to the CBC, the College of Physicians and Surgeons said applicants must have practised medicine for at least 120 days within the three years leading up to the date of the application.

"At this time, for new applicants, virtual [or] telemedicine practice does not qualify toward active practice. These licensing practices are under active review."

According to the letter, Hart also doesn't meet the postgraduate clinical training requirement for family medicine. Hart said he began his training in Canada, but he didn't need to complete the Canadian exam in order to practice in the United States — where he's worked as a family physician for nearly five decades.

Physicians must also hold malpractice insurance, but Hart says he needs a provincial medical licence to get it.

"Don't have a licence number to give them, can't sign me up, so there's a few catch-22s," said Hart.

Hart contacted the college directly to explain his situation and was told to complete the online application and pay the application fee as a first step. Knowing his application would be rejected, Hart decided to email his application for review rather than submitting online. 

"They wanted $780 and I felt that no, I wasn't going to spend that money when I knew I would be rejected," said Hart. "I provided that information to the college and I said, 'Please look at it. Can we have a dialogue?' We have never had that dialogue."

Hart said he eventually submitted his application through the online portal with help from the provincial government. On Friday, his application for registration was rejected.

"Based on the information you have provided, the College is not satisfied that the requirements have been met to issue you a licence for primary care practice (family medicine)," said the College of Physicians and Surgeons in a letter to Hart, which he shared with CBC News.

Hart said he's frustrated, and he wished the college was more willing to communicate throughout the process — especially given the dire situation facing Fogo Island residents without a doctor.

"I have never, in 20 years of volunteering, spent so much time and effort to try and volunteer," he said.

The college declined to comment on Hart's case specifically., 

Help from the province, health authority

Provincial Health Minister Tom Osborne, who called Hart's offer "generous," said his department has been in touch with the college for guidance.

"Based on his offer especially to come and and volunteer his time, we'd offer to cover the fees for licensure so that we ensure we get him here," said Osborne. "We've had discussions with the college, we've had discussions with him where we're trying to see this process through."

Hart said both Osborne and Central Health have been helpful throughout the application process.

"Everybody's been supportive except the college," he said. "No, I don't have these two things. They didn't even go further: 'you don't have them, that's it, you're denied.'"

Hart has sent a letter to Premier Andrew Furey about the experience.

Despite the rejection, Hart said his offer still stands. He thinks the college should have to explain why it rejected his application after Fogo Island lost its only doctor.

"If you say no, that is your right, you are the body that grants it," said Hart. "But if you say no, then I think it's incumbent upon the board or the college to reach out to the people of Fogo Island and say, 'This is our reason for denying a licensed physician in the state of Massachusetts who's going to come for three months and no cost.'"

Read more from CBC Newfoundland and Labrador