Canadian Medical Protective Association

The CMPA is a Special Act corporation because it was established by virtue of an Act of Canadian Parliament. The CMPA is not a regulated insurer. It offers medico-legal services to members, defined in the act as licensed physicians practicing in Canada. Unlike some insurers, the CMPA offers discretionary medico-legal assistance and follows by-laws dictating how and when it can offer its services.[4]

In its Strategic Plan,[5] the CMPA's stated mission is "To protect the professional integrity of physicians and promote safe medical care in Canada." To that end, the CMPA seeks to resolve medico-legal matters on behalf of its member, identify and promote practices that reduce physicians' medical liability risk, identify system-level changes to reduce adverse events, and support public policy that contributes to an effective and sustainable medical liability system.

In recent years the CMPA has promoted itself as a contributor to safer medical care, by claiming to reduce the number and severity of adverse medical events. Each year the CMPA hosts a series of "risk management" conferences and symposia for Canadian physicians, delivers approximately 400 customized workshops, and publishes a quarterly magazine (CMPA Perspective), among other activities.

The CMPA partners with the Canadian Patient Safety Institute (CPSI) to develop programs and tools aimed at improving patient safety: Canadian Disclosure Guidelines, CPSI Safety Competencies, Canadian Patient Safety Officer Course, Patient Safety Education Program, and the Advancing Safety for Patients in Residency (ASPIRE) program.[6]

Nevertheless, as noted by the 2008 Canadian Healthcare Safety Symposium, there is more work to be done to improve patient safety:

The progress of the patient safety movement is being stymied by regulatory, structural and attitudinal problems, according to speakers at the eighth annual Canadian Healthcare Safety Symposium. A 'huge gulf' exists between the number of Canadian patients injured by negligence and those who receive compensation, said University of Alberta law professor Gerald Robertson. 'One must seriously question the efficacy of a model which compensates so few who are entitled to it.' Only about 2% of patients injured by negligence in Canada receive compensation, he said, basing his calculation on figures from the Canadian Medical Protective Association research estimating the number of preventable adverse events in Canadian hospitals. Meanwhile, the number of lawsuits against Canadian doctors is dropping — down 30% since 1998 (from 1339 suits commenced in 1998, to 928 suits in 2007) — and only 30% of plaintiffs seeking compensation are successful in court, Robertson noted. Medical negligence cases are complex, time-consuming, expensive and almost always undertaken on a contingency-fee basis. As a result, lawyers are unlikely to take on cases unless there is a chance of a settlement valued over $100 000, he said, noting that lawyers usually seek a fee equal to 30% of a successful settlement. The patient-safety movement may 'raise consciousness' about the need for better compensation for patients, since it will likely raise awareness about the frequency of adverse medical events.[7]

One claimant who received compensation, Campbellford resident John Lewis, said "one of the main barriers to patient safety in this country" is the Canadian Medical Protective Association. "It's extremely powerful because of the political influence it wields."[8]

Critics of loser-pays rules and bans on contingency fees say such efforts discriminate against patients who can't afford to pursue a claim. However, Canada's loser-pays rule is rarely invoked by the CMPA, largely because most plaintiffs are not in a position to pay.[9]

The CMPA describes itself as a "mutual defense" organization for doctors. In other words, it is not an insurance company. There is no contract between the CMPA and member physicians ensuring that the CMPA pays damages to victims of medical malpractice. When a doctor is brought before the Canadian justice system, the doctor's legal defense is funded by the CMPA, which uses its discretion on the cases it takes. The CMPA may defend a doctor sued in civil court for medical negligence causing injury, and may also defend a doctor charged in criminal court for offenses ranging from financial fraud (such as over-billing), to malfeasance, sexual battery, and felony crimes.[10][11][12][13][14]

The national statistics for negligence lawsuits shown in the table (right) are from the 2012 CMPA Annual Report.[15] The CMPA does not distinguish between lawsuits which are dismissed, discontinued, or abandoned, but provides only an accumulated total for this category. A lawsuit may be dismissed by the courts, or a lawyer may inform a plaintiff that there is no reasonable chance of success with a lawsuit, in which case it may be abandoned or discontinued. Often, a Statement of Claim is filed years before the case is resolved, thus the number of actions commenced in a given year need not equal the sum of the resolved cases in that year.

Doctors pay annual membership fees to the CMPA. Provincial governments reimburse a portion of those fees as part of negotiated contracts with provincial medical associations, in lieu of other forms of compensation provided to Canadian physicians.

Membership fees, together with investment income, have enabled the CMPA to acquire a $2.6 billion reserve fund used to provide doctors with legal defence for cases in which the CMPA deems are defensible. CMPA funds are also used to provide compensation, in the form of awards and settlements, to patients and their families found to have been harmed by negligent clinical care. In 2012, CMPA paid out $249 million in awards and settlements.[15]

When the CMPA was incorporated there was an imbalance of knowledge between doctor and patient, which in turn led to what may be considered an imbalance of power in the doctor-patient relationship. Some point to abuse by MDs, both in the healthcare system[16][17] and in the court system.[18][19] The arrival of the internet brought a sea change.[20][21] Today, objective medical information is so readily available that patients no longer need to live in a city with a university medical library to become informed about their own health conditions. Doctor rating sites have sprung up, covering every continent.[22][23] The skill level of MDs, or lack thereof, may be exposed on such sites.[24][25] Doctors need to keep up to date with technical advances in their field, and demonstrate high ethical standards.[26][27] Patients, meanwhile, are demanding a medical Glasnost of transparency and accountability.[28][29][30]

Some critics of the current system want to replace the current tort-based system with a so-called "no-fault" medical compensation system. In 2008, the Canadian Medical Association Journal printed a three-part series on this topic.[31][32][33] In 2008, Healthcare Quarterly published "Giving Back the Pen: Disclosure, Apology and Early Compensation After Harm in the Health Care Setting." The title refers to a comment made by Bishop Desmond Tutu regarding the importance of restitution after harm: If you take my pen and say you are sorry and don't give me back my pen, nothing has happened.[34]

In 2005 the CMPA published a comparative analysis of medical liability systems internationally, including in countries with "no fault" systems. It called for "common sense reforms" within the current tort-based compensation system, concluding that Canada's current system is fundamentally sound and "is very likely the best possible model for our circumstances."[35]

• Medical malpractice
• Negligence

• Canadian Medical Protective Association
• Medical Malpractice Liability: Canada Library of Congress