CMPA & Quick Legal Tips
- CMPA Basics
- Medical Marijuana
- Patient Records
- Letting Staff Go
The Canadian Medical Protective Association (CMPA)
The CMPA is a not-for-profit, mutual defence association which is governed by a council of physicians representing members from across Canada. It provides medical liability advice and assistance when medico-legal difficulties arise, and resources to help manage risk and contribute to safe medical care; it also offers professional development and training.
I'm facing a professional complaint. What now!?
If you are a General Surgeon faced with a complaint, the OAGS strongly advises its members to contact the CMPA and request to speak with a "Medical Officer" as soon as possible to seek advisory before responding to the matter. The Medical Officer will arrange for appropriate legal counsel to assist you, if the situation requires it.
What exactly happens when I call the CMPA? What exactly is a medical officer?
The CMPA has posted a YouTube video that answers some questions and introduces you to the kinds of people who will be helping you: download
Medical Liability Protection Reimbursement Program
Physicians who pay their Canadian Medical Protective Association (CMPA) membership fees in one instalment receive ministry reimbursement in advance. Medical Liability Protection reimbursement for General Surgery (work code #83) in is updated in the MLPRP schedule on an annual basis and can be found here.
CMPA Website: www.cmpa-acpm.ca
Phone: 1-800-267-6522 / 613-725-2000 (M-F, 8:am-4:30pm ET)
Secure Email (medico-legal requests): CMPA Members Only
Examples of medico-legal difficulties with which the CMPA can help you:
- civil legal actions
- regulatory authority (College) complaints, investigations, and disciplinary hearings
- coroner's inquest and other fatality inquiries
- billing audits and inquiries
- hospital complaints and privilege matters
- criminal proceedings
- some general contract and research contract matters
- privacy legislation breaches and privacy complaints
- human rights complaints
Medical Marijuana - Regulations
CMPA: Since the phased-in introduction of the Marihuana for Medical Purposes Regulations (MMPR) in 2013 and 2014,1 most medical regulatory authorities (Colleges) have updated their policies on medical marijuana. These policies reflect the concerns that have been expressed by some in the medical community. Among those concerns are the absence of scientific evidence on the benefits of medical marijuana and the challenging role being given to physicians and other healthcare providers when a patient requests access to medical marijuana.
The College of Physicians and Surgeons of Ontario's Policy Statement on Marijuana for Medical Purposes (March 2015) states that “physicians must weigh the available evidence in support of dried marijuana against other available treatment options,” and must not sign medical documents for marijuana for patients under the age of 25 unless all other conventional treatment has been attempted and failed to alleviate the patient’s symptoms. Doctors must also “advise patients about the material risks and benefits of dried marijuana.” The College recommends that physicians who prescribe dried marijuana first require patients to sign a written treatment agreement.
Finally, when considering whether or not to provide patients with access to medical marijuana, physicians must be aware of the regulations governing the drug and of their College’s policies or guidelines. They must also determine if their clinical knowledge of the drug is sufficient and if it is appropriate for the specific patient.
1.On February 24, 2016, the Federal Court invalidated the MMPR regulations, but suspended the declaration of invalidity for six months (until August 24, 2016) to allow the federal government to enact a new or parallel medical marijuana regime (Allard v Canada, 2016 FC 236). Until August 24, 2016, or sooner if new regulations are approved, the MMPR will continue to apply.
2.A federal court injunction remains in place allowing those who had a personal production licence under the previous regulations to continue to grow medical marijuana until the court issues a final decision.
Patient Records - Medico-Legal Tips
Patient Records - Tips to Avoid Medico Legal Conflicts (OMA):
- Support your conclusions with facts - An error in judgment is not negligence. Explain in your notes how you got the wrong answer. You have to illustrate that you exercised intelligent judgment.
- Do not state your "subjective" feelings about patients - Or at least do not do so without recording the "objective" facts on which they're based. These notes will be used as evidence if a complaint arises years afterward. Do not simply state "patient was difficult and left abruptly". Explain why and what transpired between you to cause that behaviour.
- Quote the patient if possible - A patient's own words are a powerful reflection of their thoughts and mood and adds credibility to your record.
- Read what others have written in the patient chart - This is especially important with respect to test results, vital signs and medications. This could make you take a second look at otherwise dismissive flu symptoms.
- Content rather than length - Just chart enough information which would allow a new physician to take over without having to rely on addtitional information from previous doctor/nurses. Chart to protect the patient from the most probable disaster that could occur. Note: You may want to chart more if the patient or family have a specific concern.
Letting Staff Go - Medico-Legal Tips
Whether it's because of financial reasons or other reasons, be sure you know the legalities involved before dismissing staff. Is there an existing written contract with terms and conditions? Is the dismissal with or without cause? If a dismissal is not done properly, physicians can risk legal action or a complaint to the Ministry of Labour. Here are some tips:
- Direct and Indirect Costs - Cutting jobs is not always the best way to cut costs. Frequent staff turnover costs time and money with respect to advertising/interviewing a replacement, training, paperwork, severence pay, stressful, etc. Downsizing could also affect productivity and morale of remaining staff.
- Assess Other Solutions - If it's for financial reasons, perhaps consider options other than reducing staff: part time instead of full time, sharing staff costs with a partner or group, improve billing practices or generate more income.
- Know the Law - Consider using an employment law specialist to ensure you do not violate any employment laws and minimize the risk of a law suit. Ask colleagues/peers for the name of a lawyer.The OMA, CMA or MD Management might be able to advise in this regard.
- Always Give Staff Notice or Pay in Lieu of Notice - The Employment Standards Act sets out minimum requirements. Allowing more notice than is required can help avoid legal issues/concerns. If proper notice is not given, the ESA requires pay instead - usually made in a lump sum. A termination document will have to be prepared and signed by both the office manager and employee in question.
- Get a Professional - The paperwork and laws can be complicated, so an employment lawyer is advised.
ResourcesHaving problems with staff, partners, lease issues, etc.? This Ontario Medical Review article has a lot of helpful hints. Below is a list of more in depth articles by the CMPA:
- Pre-operative period — Patient assessments [PDF]
- Intra-operative period — Unintentionally retained surgical items [PDF]
- Post-operative period — Patient discharge and follow-up [PDF]
- Psychiatry — Patients at risk for suicide [PDF]
- Informed consent [PDF]
- Patient handovers [PDF]
- Medication reconciliation [PDF]
- Intra-operative issues in spinal surgery [PDF]