- © 2007 Canadian Medical Association
New challenges face Canada's doctors, and “our environment is likely to become more, not less threatening,” Dr. Peter Fraser told the annual meeting of the Canadian Medical Protective Association on Aug. 22 in his last report as outgoing president.
The event in Vancouver focused on the increased risk of liability from factors ranging from new technologies to wait lists. The meeting of the not-for-profit mutual defence organization was followed by a combined session with the Canadian Medical Association (CMA) to discuss wait times and medical liability.
The good news is that legal actions against physicians have declined over the past decade, reported Fraser, from about 26 per 1000 members to 13 per 1000 members.
“Our members are roughly half as likely to be involved in a legal action than they were 10 years ago,” he said, attributing the cause to “the growing emphasis on patient safety, risk management and the prevention of adverse events.”
But the bad news is that system costs of medical liability have increased, he said, with annual damages and legal and expert administration costs rising from about $170 million in 1997 to more than $400 million in 2006. The median damage cost increased from more than $30 000 in 1996 to nearly $100 000 in 2006.
Fraser also warned about a trend of “increasing intrusions on a physician's right to due process” in the name of patient safety, and stressed that the association believes that professional accountability, liability and support to patient safety “are separate but supporting functions.”
The association has 71 164 members, with membership increasing at about 3.6% per year, reported Dr. Guy Gokiert, chair of the association's audit committee.
Membership growth from among international medical graduates now working in Canada was raised as a related concern. Increasing numbers of members are newly-licensed, “in some cases without rigorous speciality exams based on past training. … I believe this may present us with some risk,” said former CMA President Dr. Albert Schumacher of Windsor, Ont. “There may be a perception that the quality of some members … is different from what the members until now have been.”
Any licensed physician in Canada is eligible for Canadian Medical Protective Association membership. The association has no control over licensing. “We do share your concerns that this is an area that needs watching,” said Dr. John Gray, executive director and chief executive officer. Gray added that the association “commits to work with the regulatory colleges ... to try and make sure issues of patient safety are raised at the community level, institutional level and that civil claims are addressed.”
Gray also warned members to beware of risks from current national measures to tackle wait times. “Accountability and liability concerns may put physicians at risk,” said Gray. “We do have concerns that may be lost in the debate about numbers and funding. There's a current lack of clarity.”
Gray said it's not clear under wait time strategies who is responsible for what, and whether there's a potential liability for doctors if they're found accountable. “We risk the situation of ‚having everyone accountable means that no one is'.”
The danger is that if a patient suffers an adverse effect from a long wait time, the courts may assume that evolving guidelines represent standards and may hold doctors accountable to them.
“Physician groups and others should be cautious,” said Gray, warning of “unintended legal consequences.”
“Courts, regulatory colleges and patients will continue to hold doctors accountable to how they treat individuals, regardless of the pressures to treat waiting lists,” he said.
The lack of reliable data also emerged as a wait time problem. Different jurisdictions are using different methods to collect data about wait times, said speaker Dr. Lorne Bellan, a Winnipeg ophthalmologist and co-chair of the Wait Time Alliance. Another problem, said Bellan, is that when wait times are calculated, they don't take into account the time between when a general practitioner refers a patient to a specialist, and when that first visit takes place. “Unless we measure that whole wait, we're really not getting a true picture,” he added.
The lack of data may increase the risk of liability for primary care physicians, he suggested, because they have no way of knowing how long it will take for their patients to see a specialist after a referral. “You can't fix problems like this unless you can measure them.”