President’s Pen
Risk Management, Tort Reform, and Fair Compensation: The CPA’s Advocacy
Role With the Canadian Medical Protective Association
N el-Guebaly, MD, FRCPC
CPA President 1998–1999; Calgary, Alberta.
Concerned, as I am sure are all of you, about the ever-rising cost of malpractice
insurance in Canada, I have always been surprised by the minimal amount
of information we receive from the Canadian Medical Protective Association
(CMPA) regarding the use of our annual dues. A groundswell of concerns
about this matter led to the Dubin Report, which has resulted in 2 major
consultations: one on risk management and the other on tort reform.
In the United Kingdom (UK) and the United States (US), continuing education
in risk management has resulted in the de-escalation of the cost of lawsuits
resulting from malpractice (1). In Canada, psychiatrists’ annual dues of
approximately $2000 yearly are less than those of specialists such as obstetricians,
who are charged $29 000 yearly, and orthopedic surgeons, who are charged
$26 000 yearly. These enormous overhead expenses are reduced by provincial
government subsidies. For these specialties, the cost of malpractice has
resulted in physicians shunning work in busy hospital emergency departments
and rural practices, recruitment difficulties in training programs, and,
for some, early retirement.
Major access-to-care issues have resulted. Some statistics of interest
include the following:
Legal costs have increased from 10% to 22% (increased complexity, “shotgun”
subpoenas) between 1992 and 1998. Taking into account the increase in population
and number of practitioners, the number of lawsuits has increased by 4.6%
over the last 10 years, but the damages awarded have increased by 7.6%
for low-risk groups. For psychiatrists, the major causes of lawsuits are
boundary issues, unempirically based treatment approaches, and negligence
issues. We must enhance our awareness of these potential pitfalls.
The second conference on tort reform was held in Toronto recently and attracted
approximately 300 participants from government, the medical profession,
and the legal profession. In 1990, a report from Robert Pritchard, then
dean of the Faculty of Law, University of Toronto, and now president of
the University of Toronto, proposed 3 major recommendations:
1.
Continuing the fault system with the implementation of reforms to acheive
the following:
2.
Increasing the responsibility of hospitals and other health care institutions
for the quality of health care.
3.
Designing a compensation system that would provide an available and accessible
alternative (to the tort system) to ensure that a greater proportion of
those injured by medical care would receive compensation. This “no fault”
scheme should offer patients an option to litigation, the benefits of which
would focus on rehabilitation, compensation for past and future income
loss, and future care not covered by provincial health insurance plans.
To date, except in the most limited of ways, none of these recommendations
have been implemented.
The speakers at the conference unanimously upheld the need for a major
reform of the tort system, but the proposed recommendations focused mainly
on making the settlement less costly while providing the plaintiff with
similar amounts (different payment schedules, tax breaks) and, most importantly,
stated that “all courts provide the opportunity for mediation or some form
of alternate dispute resolution as early as possible in the action” (2).
The political process required to change legislation will, I assume, take
awhile.
So what should the Canadian Psychiatric Association (CPA) do for its members?
My recommendations are as follows:
Other national associations have similar packages. Anesthesiologists have been successful in reducing the cost of their malpractice insurance though this process. Obstetricians and gynecologists have a program aimed at achieving the same goal. In the US, the Psychiatrists’ Purchasing Group Inc, at arms’ length from the American Psychiatric Association, has a similar package.
2. Packages such as those mentioned above should be selected through a joint consultation process between CMPA and CPA. A joint meeting on this issue has been planned in conjunction with the CPA Committee and Board meetings in April 1999. The goal of meeting is to strategize about the development of a similar continuing medical education–risk reduction plan for psychiatrists.3. We should continue to support CMPA and Canadian Medical Association efforts in their tort reform efforts. Ministers of Health will be briefed about the conference and the need for reform to maintain a publicly accessible health system.
Differential fees have been suggested for those who attend a risk-management program. CMPA dues for psychiatrists will not increase in 1999 and are reduced an average of 4% in 2000, that is, from $2160 to $2076.
I invite members to share their experiences with risk- management issues: this can help shape our education as well as our continuing dialogue with CMPA. Send your comments to Dr Nady el-Guebaly, c/o CPA, 260-441 MacLaren Street, Ottawa, Ontario K2P 2H3; by fax: 613-234-9857; or by email: cpa@medical.org.
– N el-Guebaly
References
1. Canadian Medical Association. Report on the Forum on Risk Management. May 29–30 1998.
2. Ross MA. Tort Reform. November 5, 1998. Ottawa: Canadian Medical Protective Association; 1998.