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A physician's foresight, a profession's pride
A history of the Canadian Medical Protective
Association
1901-2001
As told
by W.D.S. Thomas, MD,
FRCSC CMPA president 1996-2001
It seems to me that the 100th anniversary of our formation is an appropriate
time to review our beginnings, traditions, progress and accomplishments.
As the current president I have attempted in
this short narrative to highlight the history of an organization valued
by members and envied by other professional groups.
We have been fortunate in the physician leaders
we chose and in the counsel and staff we selected to bring exemplary services
to members.
I hope you enjoy our story.
Administering growth
Costs impact membership fees
Workload grows, staff is hired
Legal counsel serve CMPA members well
Meeting the members
Serving members
Attracting new members
Causes for concern
Services extended
Medical issues
Sidebar-Troublesome cases
Sidebar-Consent and informed consent
Points of law
CMPA principle upheld
Risk identification and management
Spreading the word
- Inspired leadership continues:
tribute to our leaders
Leadership, governance and administration
Annual meetings a communication channel
Expertise grows
A home of our own
From uniform to differential fees
A fully-funded financial base
Investment advice
Independent review of CMPA funding and operations
Case management review
Regional rating of membership fees
Membership growth
Services continue to expand
Medical changes and statistics
Sidebar-Good advice in any era
Points of law
Tort reform
Risk management
- What the future holds
- Acknowledgements
- Roll of service
- Progress in protection 1901-2001
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Inspiration
In September 1896 a young lad fell out of a
tree, breaking a bone in his forearm. Luckily, a neighbour in Smiths Falls,
Ont., a town near Ottawa, was a doctor who set the arm in padded splints
and was able to check his work frequently. But the boy and his parents
did not follow the doctor's instructions and complications resulted in
the boy losing the use of his thumb.
The boy's father sued the doctor for negligence.
The doctor won but the decision was twice appealed—on
points of law, not medicine. Each time the doctor won but could not claim
expenses from the plaintiff because he was, in the vernacular of the day,
"worthless". In the end the doctor's legal bills would have been his financial
ruin had not the doctor's colleagues taken up a collection to assist him.
Malpractice defined
What constitutes negligence on the part of
a physician? That age-old question pits doctor against patient in a court
of law, in a situation both would prefer to avoid.
Doctors, being human, may err; patients are
the victims of such misfortune. When this happens it is only fair that
patients receive compensation. That has been the position of the Canadian
Medical Protective Association (CMPA) for 100 years. Most bad medical
outcomes do not result from negligence or lack of skill. In these cases
the CMPA has always taken the position that the doctor's professional
integrity should and will receive a vigorous defence.
In 1896 a doctor faced financial and professional
ruin when a patient was dissatisfied. Today doctors have protection.
The story begins
The story of the CMPA is one of doctors banding
together to assist each other when their professional integrity is threatened.
It is also the story of new technologies, techniques, drugs and treatments,
of changing legal attitudes and precedents and of shifting societal values
affecting a doctor's practice.
It is the story of compensating patients when
errors have occurred. The story describes the CMPA's profound influence
on the practice of medicine—informing and teaching physicians about the
pitfalls of medical procedures and of practice in general.
Mainly it's a story about the people in a caring
profession striving to share the best possible medical care with the people
of Canada. It's a story told with pride in past achievements and anticipation
of continuing support to physicians that will ultimately benefit their
patients.
It's a story I am delighted to be part of and
to share with you now.
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Negligence versus lack of judgment
Negligence has been defined, redefined, expanded
and expounded upon, but the meaning remains remarkably similar to its
definition by Lord Chief Justice Tindal in Lanphier v. Phipos (1838):
"Every person who enters into a learned profession
undertakes to bring to the exercise of it a reasonable degree of care
and skill. He does not undertake, if he is an attorney, that at all events
you shall gain your case, nor does a surgeon undertake that he will perform
a cure; nor does he undertake to use the highest possible degree of skill.
There may be persons who have higher education and greater advantages
than he has, but he undertakes to bring a fair, reasonable and competent
degree of skill, and you will say whether, in this case, the injury was
occasioned by the want of such skill in the defendant."
In the 1925 CMPA annual report Chief Justice
Mathers' address to a jury on the definition of negligence is quoted by
General Counsel: "The definition I gave you was that the defendant would
not be liable for negligence unless he did something that an ordinary,
reasonable practitioner, in his branch of the profession, would not have
done, or that he omitted to do something which an ordinary practitioner
in his branch of the profession would have done.
"You are to measure his conduct by the standard
which the law has fixed for medical men.... The law does not ask from
them any higher degree of care or skill than possessed or exercised by
the average man of their class.... If he neglects any of the precautions
that are usually taken ... then he may be guilty of negligence ... but
if he used the care which is usual for practitioners to use, then he is
not guilty of negligence."
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Forming and building the
CMPA: the first 30 years
Back in Smiths Falls, one of the surgeon's colleagues
was Dr Robert Henry Wynyard Powell, a respected Ottawa physician active
in the medical politics of his day. Dr Powell was extremely upset that
a doctor faced financial ruin as the result of an unjust claim. He brooded
on the case, he later said in his writings.
Dr Powell knew of the work of medical defence
unions in the United Kingdom. When he served as president of the Canadian
Medical Association (CMA) from 1899 to 1900 he used his presidential address
to plead for the formation of a Canadian medical defence organization
to protect doctors against "unrighteous assaults."
At the CMA annual meeting on September 13,
1900 members set up a committee on medical defence to look into the advisability
of forming an association.
At the next annual meeting in 1901, Dr Russell
Thomas of Lennoxville, Quebec, delegated by the St. Francis District Medical
Association, presented the subject, The Question of Medical Defence. He
made a strong case for forming a medical defence union, citing two or
three notorious cases and commenting on the success of defence unions
in the United Kingdom. He also outlined the existing medical defence plan
supported by his district association, which he was authorized to hand
over entirely to the CMA.
Then, on August 30, Dr W.S. Muir of Truro,
N.S., presented the report of the committee on medical defence, which
recommended formation of the Canadian Medical Protective Association and
the motion carried. The members of the committee must have worked diligently
through the previous year because they were able to draw up the complete
framework for the organization. Each clause was voted on separately. At
the end of the presentation the committee recommended members of the existing
Medical Defence Union in the St. Francis District Medical Association
join the CMPA. The recommendation was not made until the committee had
assured itself there were "no current or impending debts."
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Frustration with frivolity
Dr Powell often referred, in his 33 years as
president of the CMPA, to doctors being harassed with frivolous actions
for alleged malpractice or true blackmail—referring to a patient's reluctance
to pay his bill for treatment and instead to threaten the doctor with
a legal suit.
Indeed it does appear in many early cases that
doctors were threatened after presenting a bill for their services. A
patient would suddenly become dissatisfied with the treatment and threaten
action, hoping at the very least to escape paying the bill and at best
to get the doctor to settle out of court for a generous amount of money.
The threat would upset the physicians and many would forfeit a settlement.
Dr Powell and his colleagues believed this was wrong and only by forming
a united front could such practices be eliminated, reputations protected
and doctors receive their financial due.
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A couple of interesting notes: The General
Counsel was a member of the executive committee. Provision was made for
remuneration for the secretary which "may be fixed by this association from
time to time." Of course there were no funds so it was a few years before
the secretary received an honorarium.
CMPA oldest CMA affiliate
Perhaps because the Canadian Medical Association
was parent to the CMPA, both organizations have enjoyed a long relationship.
The CMPA annual meeting is held in conjunction with that of the CMA.
The relationship was cemented in 1924. With
the revision of its constitution CMA was permitted to have affiliates;
the CMPA was the first to apply and receive affiliate status.
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Consistent core values
Dr Powell often reiterated the value for "our
organization does not consist in the fights we have put up or in the open
success we have had but rather in the silent influence we have swayed
against litigants who for a money gain have sought to blast the reputation
of conscientious, painstaking and reputable practitioners knowing or suspecting
that they have an easy mark and that to avoid publicity a medical man
will often submit to what amounts to blackmail.
"These litigants have found out that our Counsel
stands ready to accept service of the writ and your Executive stands ready
with a bank account to furnish the sinews of war.
"Dozens and dozens of cases have thus been
strangled at their inception and have disappeared like dew off the grass.
This feature gentlemen is the strength and glory of your association."
(CMPA Annual Report, 1919)
Object of the new Association
The preamble to Dr Muir's recommendation said:
"We believe it to be in the interest of the Medical Profession of Canada
that an Association should be formed by this body for the protection of
such members of the Medical Profession as may become members of this association
and who may be unjustly prosecuted for malpractice. The object of the
association is to protect its members from prosecution where such action
appears to our Counsel and solicitor as well as the Committee in charge
to be unjust, harassing or frivolous.
"That this association may be formed under
the name and style of the Canadian Medical Protective Association."
So, the CMPA was formed with Dr R.W. Powell,
Ottawa, as president; Dr J.O. Camirand, Sherbrooke, vice-president; Dr
F.W. McKinnon, Ottawa, secretary; and Dr James Grant, Jr., Ottawa, treasurer.
The first solicitor was Francis H. Chrysler, KC, who was General Counsel
until 1934. It fell to him to translate the founding dreams and principles
into legal processes.
It was the enthusiasm, energy and tenacity
of Dr Powell, and from 1906 Dr John Fenton Argue, elected to a combined
job of secretary-treasurer, that persuaded doctors to join their Association.
Dr Powell's annual reports optimistically predicted the CMPA would be
a large and important organization while describing the difficulties in
increasing the membership. His reports are interspersed with harangues
on recruiting new members and the 1911 annual report boasted, "We have
struck terror into the evil minded who have sought to besmirch and even
blackmail members of our noble profession."
Building the CMPA
As the CMPA got up and running certain practicalities
revealed themselves. At the annual meeting in 1904 the first amendments
to the by-laws were proposed and passed. The secretary and treasurer positions
were combined.
Another major change was the addition of one
appointed provincial executive per province. Their purpose was to create
awareness of the CMPA among the local medical practitioners, nominate
members and collect facts in malpractice claims. They played a major advisory
role for nearly a century but became redundant when members began electing
local representatives to the governing Council in 1997.
Incorporation
In 1906 Mr. Chrysler proposed incorporation
but wasn't successful. He raised it again in 1909 and 1911, and in 1912
members authorized it on hearing Dr Powell advocate incorporation to protect
the funds now at the "mercy of two men no matter how respectable and honourable
they might be." The voluntary association had proved its worth to members
and the profession. It had a growing bank account and the surplus funds
were invested for use on future claims. The process of incorporation was
set in motion.
On February 28, 1913, the Act to incorporate
the Canadian Medical Protective Association passed the House of Commons.
It cleared the Senate on April 4 and was signed into Royal Assent on May
13.
Throughout the spring, the by-laws were prepared
for presentation to the annual meeting in June. After due process they
received sanction from the Governor in Council on August 2.
Cited in the Act of Incorporation, the object
of the Association was and still is (although it is called a mission statement
now):
- To support, maintain and protect the honour,
character and interest of its members;
- To encourage honourable practice of the medical
profession;
- To give advice and assistance to and defend
and assist in the defence of members of the Association in cases where
proceedings of any kind are unjustly brought or threatened; and
- To promote and support all measures likely
to improve the practice of medicine.
Fees and funds
The first membership fee increase came in 1906
when the original fee of $2.50 was increased to $3.
Despite this modest fee, and because there
were few cases to contend with, the CMPA amassed a small surplus, which
was invested to get a better rate of return than the interest paid by
the bank.
Drs Powell and Argue had a reputation for pinching
pennies and they kept overhead to a minimum. Expenses in the early days
went for printing, postage and stationery, clerical assistance, advertising
in medical journals, auditors’ fees, honoraria paid to the two officers
along with their travel expenses, and legal expenses, which were generally
double the total of all other expenses.
The business of the CMPA was and still is protecting
physicians, which it does by hiring the best legal help. Testament to
the calibre of the legal assistance is evidenced by the number of CMPA
counsel who have been appointed to the bench in provincial and federal
courts through the years.
In 1928 members voted to increase the fee to
$5 effective January 1, 1929.
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Incorporation—a stormy passage
Although we often dismiss the Act of Incorporation
with a one-line mention of its date of passing, the Act in fact generated
considerable lively debate in both the House of Commons and Senate.
Dr John Leo Chabot, an Ottawa physician and
surgeon, introduced the private member's bill. Even at third reading it
was put over for a week because a member received a petition objecting
to it.
Major opposition surrounded issues such as
the phrase "unauthorized practice" included in the objectives. Members
of Parliament feared osteopaths, homoeopaths and Christian Scientists,
not authorized to practise under some provincial medical acts, would be
discredited. It was even suggested the CMPA name be changed to the Canadian
Allopathic Medical Association because members of the "school" represented
by the CMPA employed treatments from all schools.
Feelings ran high. An MP said in debate, "I
think this legislation is dangerous. It is legislation against the interests
of the mass of the people, and is the creation of a monopolistic corporation... against the rights of the individual in the matter of the selection
of his method of cure and treatment in the case of disease."
Distrust of centralizing power was rampant
in 1913, and the perceived interference with health—a provincial matter—was
an issue. MPs also wanted reassurance CMPA objectives would not encroach
on educating physicians or licensing them, both provincial matters.
A third MP questioned the constitutionality
of the Bill but the minister of justice replied, "The power of incorporation
generally rests with the Parliament of Canada."
Speaking about protecting the rights of the
individual, an MP summed up his comments: "If the individual realizes
that instead of going up against a man whom he believes to be guilty,
he has to go up against a strong corporation composed of the medical men
of the country, with a fund at their disposal to fight such cases, I think
he will feel that an injustice is being done."
There was also concern about recruiting physicians
to support a plaintiff's case in court.
Incorporating the Association's by-laws into
the Act was another issue. They would only come into force after deposition
in the department of the secretary of state, one month after publication
in the Canada Gazette, and sanction by the Governor in Council.
Dr Chabot steered Bill 89 through the House
with equanimity and patience, but when it reached the Senate it was delayed
again. The same issues prompted discussion in the Senate. As one MP had
stated, "There is always a disposition on the part of the public when
a medical Bill comes up, to look at it with suspicion. At the same time,
the doctors are the greatest philanthropists in the world."
The Bill did eventually pass.
Interestingly, Dr Chabot, who practised medicine
and surgery in Ottawa for another 30 years, was never listed among the
members of the CMPA.
Membership
Membership growth was slow for the first few
years. Each ad in a medical journal attracted only a few potential members.
At this point in Canada's history, the country
was a collection of provinces and Canadians did not think nationally.
Professional organizations, health acts and licensing bodies were provincial,
contributing to a natural distrust of national organizations. In the same
era the CMA also had trouble attracting members.
Many physicians thought they would never be
threatened, but as Dr Powell said in 1910, "Our association has even mounted
a successful defence for a CMA president".
Real growth began after the First World War.
The war supplied impetus to research and to developing the teaching of
medicine as many medical faculty joined the war effort and brought the
lessons learned back to the classroom.
Along with boosting the economy, the war contributed
to medical advances such as improving blood transfusion techniques and
to the rise of medical specialties such as rehabilitative medicine. These
advances raised the profiles of medical associations and stimulated growth
in membership.
Many physicians enlisted in the war effort,
but membership figures did not drop because the CMPA kept all members
who joined the action on its membership rolls in good standing and forgave
their fees on their return.
In his annual reports Dr Powell alternated
between congratulating members on the success of the organization and
haranguing them to persuade their medical friends to join and make the
organization even more successful.
Advertising, publicity in medical publications,
direct appeal and the beginning of medico-legal education contributed
to attracting more members to Dr Powell's cause. The membership had grown
to 2,208 from 242 in 30 years.
Expanding services
At first, the only service the CMPA offered
members was advice on defending themselves when threatened professionally.
As soon as funds began to accumulate, service was extended to paying legal
expenses for any matter arising out of a doctor's practice leading to
a civil suit.
Choosing the lawyer to undertake the defence
of their cases was an issue for members. General Counsel in Ottawa handled
all the cases, but he promised in 1906 that as soon as numbers warranted,
Counsel would be appointed in the provinces. This began to happen in 1911.
Having legal counsel familiar with malpractice cases and the law in each
province and territory was seen as the most effective way of achieving
the goal to provide high quality legal services.
Members requested assistance for matters pertaining
to billing and to criminal acts such as failing to report an infectious
disease. It was refused because these matters were beyond the scope of
service at the time.
However, the CMPA had extended assistance in
a criminal case, recorded in the 1904 annual report. A doctor subjected
to a civil suit of malpractice terminating in his favour was subsequently
charged criminally with manslaughter. The CMPA helped because the case
was founded on the allegation of negligence in his practice and would
damage him professionally.
A matter of principle
This case illustrates a couple of CMPA principles.
The first is that the leadership had the prerogative to determine whether
or not a member would be assisted, which leads to the second point. The
CMPA is not an insurance agency. It has never offered a contract to a
doctor, as a commercial insurance company would, but rather has the discretion
to extend services outlined in its constitution and by-laws to each member
in good standing.
The CMPA is a not-for-profit, mutual defence
organization run for the benefit of physicians, by physicians. Since 1929
it has been able to compensate patients who are proven to have suffered
harm caused by a member.
Another major tenet of the CMPA was and is
staunch defence of every case that is defensible, even if it might be
less expensive to settle than to defend. This differs from many commercial
insurance companies that frequently settle for economic reasons.
The wisdom of defending all defensible cases
has proved beneficial for both members and the CMPA. The doctor's professional
integrity is protected. Some cases brought to trial set legal precedents
that benefit other doctors in similar circumstances.
With a successful defence the CMPA often received
a flood of new membership applications from the area where the doctor
practised. Winning a case also sent a message to lawyers who, thinking
a doctor might be an easy mark, encouraged a suit. In addition, there
was a belief that settling cases bred more threats from patients who thought
doctors would pay rather than face public embarrassment. Doctors often
did settle rather than defend, despite the admonishments of Dr Powell
to stick together for the good of all.
Broadening the scope of assistance
For the first 28 years the services offered
to physicians included identifying the pitfalls in the practice of medicine,
advising on defence in the event of threat and reimbursement for legal
expenses in civil suits. With the membership requesting indemnification
and knowing that the British defence unions offered this service, Dr Argue
set out to investigate.
He approached the two British companies providing
re-insurance to the British defence unions. One declined to quote and
the second quote was too high. The solution was to increase the membership
fee to $5, with $2 to be deposited into an indemnity fund. Should those
funds be required immediately, members agreed to an additional $5 subscription
fee to make up a payout. A subscription was never needed. The by-law amendment
allowing the CMPA to pay up to $5,000 for damages per member in any one
year passed at the 1928 annual meeting to take effect January 1, 1929.
Medico-legal issues
There is a civil law principle warning that
"every person capable of discerning right from wrong is responsible for
the damage caused by his fault to another whether by positive act, imprudence,
neglect or want of skill."
When the CMPA was formed the medical milieu
was very different than it is 100 years later. Doctors in the early 20th
century performed much of their work free or were paid in goods. In fact
doctors often competed for paying patients. The Depression in 1929 reduced
the numbers of paying patients even more.
In the urban setting, doctors also worked for
free in hospital outpatient clinics to treat indigent people.
Patients were not always grateful for the care
they received. Many found fault just after the doctor's bill arrived.
The statute of limitations within which a legal action must be commenced
was, in most provinces, one year from the date of the last treatment for
the ailment. The CMPA advised doctors to wait until the one-year limit
had expired before putting an unpaid bill into the hands of a collection
agency. That avoided a few claims.
Between 1900 and 1930 there were many advances
in medical science. X-rays came into vogue as treatment for skin problems
and to diagnose fractures and check their reductions. Sulfa drugs were
developed to treat infections, blood transfusion techniques were refined,
and with the discovery of insulin in 1921 Canada began to make a contribution
to medical knowledge. It is interesting to note that Dr F.G. Banting attended
the CMPA annual meeting in 1921, the same year he co-discovered insulin.
Rise of specialization
During this time medicine also evolved from
general practice to specialization. Physicians began to choose an area
of expertise such as internal medicine, surgery, obstetrics and gynaecology,
paediatrics, radiology, pathology, or dermatology.
The specialists were judged against higher
standards of care than general practitioners in malpractice issues. Those
practising in urban areas with large teaching hospitals were judged against
higher standards than their rural counterparts. Defining those standards
for the Courts and expressing opinions on whether they were met required
testimony from "expert witnesses." The first time an expert witness provided
testimony was recorded in the 1920 annual report and involved a surgeon
in a public ward of a large metropolitan hospital. In Dr Powell's view,
this disclosed "much bickering and conflicting testimony with an ingenious
attempt to convict a surgeon by underhanded methods of cross opinions
from a so-called expert obtained through unworthy devices, without disclosing
the facts."
Happily we have moved on from that view and
both defendants and plaintiffs have benefited from expert testimony, which
has proved very helpful to the Courts.
Other legal issues of the era outlined by General
Counsel were the definitions of negligence and standard of care, consent
to a procedure, jury trials and attitudes of the Court. Judging by the
writings of General Counsel the Courts treated physicians very fairly.
By the time the CMPA reached its 21st birthday,
it had dealt with only 115 cases, 60 of which had gone to trial. The doctors
had won 59 and one was in appeal. The membership in 1922 was 1,385.
First cases
The first case lost, recorded in 1911, involved
a badly set limb, dislocated at the hip. It was decided for the plaintiff
upon conflicting evidence and the CMPA paid the plaintiff's costs. When
the CMPA was awarded costs at trial, it rarely attempted to collect, as
the plaintiffs were generally judged "worthless."
The first case mentioning consent as an issue,
recorded in 1916, involved the removal of a second tumour discovered during
an operation. The doctor was charged with trespass and assault, not having
previously obtained consent; the case was dismissed.
Two more cases of interest were reported that
year. One was the first case in which a hospital was named a co-defendant—Laverne
v. Smith's Falls General Hospital. The second was a very unusual
case where a British Columbia doctor was alleged to have made an incorrect
diagnosis of an obscure form of leprosy that resulted, through the action
of the medical health officer's staff, in the patient being sent to a
lazaretto—a hospital for contagious diseases—for observation. The action
was dismissed for want of prosecution, but imagine the degree of embarrassment
that would have fired the anger to launch that suit.
Other important cases addressing points of
law include Lumsden v. Gliddon (1920), which defined the duties
of physicians under Acts Respecting the Custody of Insane Persons. In
another case reported in 1928 the issue arose as to whether at examination
for discovery the doctor could give evidence regarding his opinion of
the result of his treatment of the case. It was decided that the doctor
could. Upon appeal the decision was reversed. Mr. Chrysler wrote that
the decision established a precedent.
Trouble spots in practice
What types of cases resulted in trouble for
doctors in those days? Burns on a heated operating room table or hot water
bottles in recovery rooms caused problems, as did the excess use of iodine
or patients falling from operating room tables. Sponges left in abdomens,
packing remaining in various orifices, badly set fractures, X-ray burns
on the skin, misdiagnosis of any condition, and questionable administration
of drugs were the other culprits.
Doctors got into trouble over certification
of insane patients on two counts: non-compliance with the Acts, usually
centered on the time of the patient's last visit; or often the patient
and/or a relative was unhappy over the certification itself.
Informing members about trouble spots
Almost from the beginning the CMPA made efforts
to inform members about troublesome drugs, treatments, procedures and
equipment. The suggestion was first made to get such information out to
members in 1909. While the annual reports described cases and the medical
publications reported regularly on the findings of cases, during the first
18 to 20 years most CMPA contacts with the medical profession were directed
to building membership. The leadership repeatedly said how easy it was
to get into trouble, therefore membership in the CMPA was necessary to
a physician.
In the 1920s, the CMA initiated a new lecture
series, considered to be the beginning of the continuing medical education
concept. The CMPA also began in earnest to coach physicians on how to
avoid trouble issuing its first Information Bulletin to members
about 1924.
An era ends
Two very forceful medical men had led the charge,
built the organization and influenced the practice of medicine well beyond
their sphere by the early 1930s.
They were assisted by General Counsel Francis
Chrysler, whose contribution to the work of the CMPA was outstanding.
He led them through the formative years, incorporation, the first trials
and legal problems. That he managed to work with both doctors for more
than 30 years was testament to his composure, patience and good judgment:
neither Drs Powell nor Argue were reputed to be easy to work with.
Dr Powell had practised medicine for more than
50 years by this time. His good friend and steadfast colleague Dr Argue,
secretary-treasurer since 1906, would succeed him and serve as president
for another 20 years. And to the CMPA scene came another stalwart proponent,
Dr Trenholm Laurence Fisher, nominated and elected secretary-treasurer
in 1935 in absentia and without consent to let his name stand. He was
the force behind the Association for the next 38 years.
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Forces that shaped history:
tribute to our leaders
History is made by those who have the strength
to challenge the status quo. The CMPA is fortunate to have had men with
such force of character as its leaders, especially in its formative years.
Robert Henry Wynyard Powell, MD, CM, FACS, was not the first
man to advocate a medical defence union of doctors for protection in unjust
malpractice claims. Nor was he the first CMA president to espouse the
cause. But he was the man with the determination, energy and persistence
to see the job through.
The grandson of a physician appointed to the
bench, and son of a career civil servant who retired as undersecretary
of state, Dr Powell graduated from McGill in medicine in 1876 with honours
and practised in Ottawa. According to his grandson, Alan Powell, he was
the personal physician and drinking companion of Sir John A. Macdonald,
Canada's first prime minister. When Sir John A. died in 1891, Dr Powell
signed his death certificate. He was also a well-known cricketeer and
a collector of fine art.
Dr Powell was president of the Canadian Medical
Association from 1899 to 1900 when he instigated the formation of the
CMPA that occurred in 1901. He was elected its first president. With the
establishment of the Medical Council of Canada in 1912, Dr Powell was
persuaded to become its first registrar. Holding administrative offices
along with practising medicine was not unusual for Dr Powell. He had been
the medical officer of the 43rd Battalion, gazetted surgeon in 1881, and
served in the No. 1 Company of the Governor-General's Foot Guards.
 John
Fenton Argue, MD, CM, like Dr Powell, took many honours on
his graduation from McGill in medicine in 1896. Also like Dr Powell he
was commissioned in the 43rd Battalion and was active in medical societies,
serving as president of the College of Physicians and Surgeons of Ontario
in 1921 and of the Ontario Medical Association in 1924.
Dr Argue took on administrative medicine as
well and served as Gloucester's medical officer of health from 1898 until
1946 and as gaol surgeon for the County of Carleton from 1900 to 1946.
In 1929, when Dr Powell became ill,
he became the registrar of the Medical Council of Canada and held that
office until 1954.
He joined the CMPA in 1901 and became secretary-treasurer
in 1906, serving in that capacity until 1935 when he succeeded Dr Powell
as president. In 1955 he was named honorary life president.
According to Alice Wilcox, secretary to Dr
Argue at the Medical Council, he was "a big man with a loud and booming
voice whose confidential conversations often were heard in adjacent offices."
Ms Wilcox has written a wonderful memoir full
of personal reminiscences, especially about his views on a woman's place,
wearing furs, differentiating the classes, his housekeeper ("Sadie and
Dr Argue were like the Kilkenny cats"), his being of "a saving turn of
mind," and the effect of the early demise of his wife Julia. She also
remarked that no one was kinder to people who were sick or in trouble.
At the CMPA we see evidence of Dr Argue's "saving
turn of mind," as many notes and carbon copies of memos and letters appear
on the back of previously used paper.
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Powell-Argue Room at CMA House
Drs Powell and Argue were recognized for their
foresight and long and faithful service to the CMPA in 1970 with the dedication
of the Powell-Argue Room at the Canadian Medical Association in Ottawa.
The plaque reads, "This Powell-Argue Room commemorates Dr R.W. Powell
and Dr J.F. Argue, founders of the Canadian Medical Protective Association."
The CMPA funded the furniture and fittings for the room.
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John Dickson Courtenay, MD, graduated from the University of
Toronto in medicine in 1885, and practised in Ottawa for 70 years minus
six weeks. He joined the CMPA at inception and was a member of the first
provincial executive in Ontario, formed in 1904. He joined the executive
committee in 1922 and served until his death in 1955. If Dr Argue was
Dr Powell's right hand, Dr Courtenay was his left. His assistance was
always available to the Association and he rarely missed a weekly meeting.
His medical specialty was ear, nose and throat.
 Alfred
Turner Bazin, MD, DSO, of Montreal, was called the "grand seigneur
of Canadian surgery" in a tribute by a friend and colleague. The CMPA
knew him as a sharp-minded, well-organized, kind gentleman who brought
honour on himself and those he served throughout his life. His colleague
continued, "When the history of Canadian medicine is written in full,
he will be ranked as one of the all-time greats in the field of surgery,
taking his place beside Shepherd who had been a graduate of McGill 21
years when Alfred Bazin, who was a 'student-dresser' for that eminent
surgeon and teacher, received his medical degree in 1894."
During the First World War he led a field ambulance
unit and won the DSO decoration. He was also commanding officer of No.
3 Canadian General Hospital (McGill) at Boulogne. During the Second World
War he organized facets of the Red Cross Society such as in blood units,
disaster preparation and even teaching swimming and lifesaving.
The Council minutes of September 10, 1958 record
in tribute at his death:
"His kindliness was natural, part of the man
himself, qualified and modified by his other exceptional attributes; we
saw it applied to the manner and degree of help that he thought the Association
should give its members. Yet he was no sentimentalist, his shrewdness
and practicality saved him from championing poor causes."
Dr Bazin's name is recorded among the members
of the CMPA in 1905. He became a member of the executive committee in
1934, first vice-president in 1943 and honorary life president in 1957.
Although in later years he was unable to attend regular weekly Council
meetings, his opinion on most matters was sought and received, in writing,
and his influence can be seen in all the major decisions of the day.
Trenholm Laurence Fisher, MD, CM, FACP, graduated from McGill
in 1927 and after two years of internship and a year of study in pathology
set up practice in Ottawa. He attended his first CMPA annual meeting in
1932 and was elected secretary-treasurer in absentia in 1935. He served
in that capacity for 38 years and then became a very active consultant
to Council until his death in 1976.
During his tenure as secretary-treasurer he
must have been the most well-known doctor in Canada, or at least the most
read, as he published nearly 200 articles in medical publications—109
in the Canadian Medical Association Journal alone. He never had
a paper rejected by an editor.
In addition, he spoke formally on medico-legal
issues about a dozen times each year. His passion for his work spilled
over into his relations with members. He was a man of intellectual honesty
and integrity according to those who knew him. Although intolerant from
time to time of the carelessness and indifference of some unrepentant
erring doctors, he was always fair-minded in his dealings.
His usually mild and modest demeanor concealed
an inner toughness and tenacity. His single-mindedness is credited with
the development of association policies some lawyers and judges believe
have had a significant influence on medical malpractice in Canada.
Dr Fisher was an internist. Dr James H. B.
Hilton, assistant secretary-treasurer from 1952 to 1966 before becoming
president, tells a story that illustrates Dr Fisher's time management
skills. "Dr Fisher did meticulous physical examinations relying heavily
on history and physical findings. He didn't order many tests. When taking
your history, he typed it up as you told it to him."
Dr Fisher's service was commemorated with the
establishment of a medico-legal library bearing his name at CMPA headquarters
in Ottawa. He was also the recipient of the CMA Medal of Service in 1973.
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Sharing experience: the
next 50 years
The CMPA's first 30 years were largely dedicated
to convincing physicians of the necessity for a mutual defence organization
and building membership. The next 50 years focused on educating members,
and indeed the entire profession, on the potential medico-legal pitfalls
in a doctor's practice.
The transition from the Powell-Argue era to
the Argue-Fisher era was not difficult for the CMPA. Although the personalities
had changed and to a degree the focus of activities had changed, the underlying
principles of the organization remained steadfast. The CMPA was and is
a mutual defence union of physicians and every president and secretary-treasurer
since Dr Powell has reaffirmed this.
Administering growth
Dr Alfred Turner Bazin was both a strong supporter
and a great critic of the Association. At an annual meeting in the early
30s he spoke about broadening the bases and spreading the responsibility
from Drs Powell and Argue and General Counsel. "The body of the association
is dead from the ears down. The executive committee rubber stamps and
the provincial executives are just a list of names. Give them responsibility."
He closed with the stinger, "I have never heard CMPA mentioned at any
provincial or local medical society."
Change did come in the form of amendments to
the by-laws. General Counsel was removed as a member of the executive
committee. The role, powers and composition of the executive committee
were redefined in 1934 and in 1938 its name was changed to Council to
eliminate confusion between executive committee and provincial executive.
By-law changes were extensive that year. It
appears from Dr Fisher's correspondence the by-law to limit assistance
to members at the discretion of Council resulted because a couple of members
had had many suits filed against them. Dr Fisher wrote, "The CMPA should
not lay itself open to needless expense unless these men are more willing
to be more reasonable in their practice."
It was discovered that two members were not
licensed in the provinces in which they were practising. After 1938 members
were to be "duly licensed" in the province in which they practised. Amendments
in 1950 pertained to fees. The office of honorary life president was created
in 1957 and the name "provincial executives" was changed to "provincial
advisory committees." Life membership was enacted in 1963. After the 1969
amendments, the secretary-treasurer and associate secretary-treasurer,
although still officers of the Association, were to be appointed by Council
now to comprise 15 members in addition to the officers.
Amendments in 1973 included new criteria for
terminating membership and defining assistance to physicians who were
no longer members, but who were sued for treatment undertaken during their
years as members.
Twenty-five years after he first advocated
organizational change, Dr Bazin was still not entirely satisfied. "An
unthinking membership is apt to consider it is run from Ottawa," he said,
"and appointments (to Council) should be spread across the country." He
went on to warn Dr Fisher and Council, "It would be easy for a group of
'rebels' to pack the annual meeting and get control of the Association."
He suggested a proxy system for voting on amendments but suggested, "There
is no need to include a stamped, return envelope." His warning elicited
an explanation in the 1957 annual report that geography was the reason
there was a preponderance of Ottawa men on Council. It was to keep costs
down. There was also a promise to hold one full Council meeting a year
in Ottawa.
Costs impact membership fees
The membership fee established in 1929 to set
up the Indemnity Fund remained in effect until 1950 when it doubled to
$10. The fund was closed in 1954. The subject of what later became differential
fees arose during the 1951 annual meeting. The report of Council contained
the explanation members of certain specialties had over the years cost
the Association more money than other specialties: surgeons with fractures
and with sponges left behind at operative sites, radiologists with burns
and anesthetists with ether bottles. It concluded there was insufficient
evidence to charge one group of physicians more than another.
Fees doubled again in 1954 to $20. Reserves
were growing but a proposal to increase services to members in 1960 was
turned down by Council and in 1962 fees were decreased to $15. By 1965
the reserves were getting low and in 1967 the fees were increased to $25
and in 1969 to $35.
Medico-legal actions were on the increase.
In the United States they were running rampant but Canada's experience
was more like Britain's—increase at a much slower pace. An actuarial study
in 1967 concluded the Association was solvent; solvency was assured for
a number of years and review should occur again in five years. The interpretation
of the fee rates was this: "Of 10 active members who will practise for
40 years, four will make an inquiry to the Association, two will receive
a threat and one will be served a writ."
By 1970 costs of awards and settlements were
rising at an alarming rate, more because of inflation than any change
in attitude on the part of the Courts, General Counsel reported.
In 1974 after actuarial consultation and another
discussion on differential fees, the fees were raised to $100 for 1975,
to $200 for 1976 and to $250 for 1977. For postgraduate trainees the fee
was fixed at $200 for five years following graduation. The overall costs
of defence were up but the cost of settlements and awards was the main
concern as the Courts now included additional aspects of damages such
as interest, inflation and cost of future care.
A million-dollar payout occurred in 1979! General
Counsel blamed the debasement of the currency. During the 1970s the purchasing
power of the dollar fell by more than half. Since 1974 the consumer price
index had risen at an annual average rate of 9.2 per cent. Even with the
onset of a recession in 1979, prices were expected to rise by 10 per cent.
Added to that was a reinterpretation by the Courts of the traditional
bases in fixing the amount of damages.
The old refrain by Dr Powell about CMPA membership
protecting a physician from financial ruin certainly rang true.
Workload grows, staff is hired
Although the CMPA had always employed part-time
clerical assistants, it was not until 1948 that Marat MacLeod became the
first full-time employee. Margaret Kells, a remarkable woman who ran the
show for 30 years, succeeded Mrs. MacLeod in 1952, and retired as executive
assistant to Council. Beverley Allen had worked with Mrs. Kells for many
years and was her chosen successor.
Because the caseload continued to grow, in
1952 Dr James H.B. Hilton was elected assistant secretary-treasurer to
Dr Fisher. Dr Hilton became associate secretary-treasurer from 1958 until
1966 when he was elected president, succeeding Dr George W. Armstrong.
Not until 1964 did Dr Fisher consider his job
at the CMPA to be full-time. It was probably due only to his extraordinary
time management skills that he continued to practise actively until that
time. Dr F. Norman Brown joined the CMPA as assistant secretary-treasurer
in 1965 and became associate secretary-treasurer in 1968. He succeeded
Dr Fisher as secretary-treasurer in 1971. Until then he continued to practise
and teach, as did Dr Hilton. Dr Stuart B. Lee, another outstanding secretary-treasurer,
joined the staff in 1972, the same year as Dr Hugh J. Bright. The first
French-speaking assistant secretary-treasurer, Dr Pierre Gaulin, joined
the staff in 1975. Dr Manuel Gluck joined in 1976 as assistant secretary-treasurer,
the same year Dr Bright retired. The next year, Jim T. Kenward, CA came
on board as the first professional business and financial administrator.
Dr Clifford S. Amundson became an assistant secretary-treasurer in 1979.
Legal counsel serve CMPA members well
Although not members of staff, General Counsel
worked so closely with the executive officers and the members in trouble,
they too were seen as the face of the organization. Edmund F. Newcombe,
KC, succeeded Francis Chrysler in 1934. His law firm was succeeded by
Gowling, MacTavish, Watt, the legal firm that has changed names but remains
as CMPA's General Counsel to this day.
J. Douglas Watt, KC, served from 1946 until
his early demise in 1950 and Duncan K. MacTavish, QC, took over. He was
ably assisted by Ronald C. Merriam, QC, who was held in high regard by
physicians across Canada. On his taking up legal association administration
in 1961, E. Peter Newcombe, QC, (son of Edmund), assumed and retained
the duties until he handed off in 1971 to Charles F. Scott, QC, a man
of supreme patience when it came to explaining points of law to CMPA members.
Meeting the members
The CMPA by-laws state an obligation to hold
annual meetings to coincide with those of the Canadian Medical Association.
With one exception, when a meeting was held in Ottawa, this has always
happened. At various times the annual meetings have been held jointly
with the British Medical Association, and once it was held in Atlantic
City where CMA and the American Medical Association were meeting jointly.
Along with conducting business, the annual
meetings were instructive to members through the reports on cases and
points of law. Frequently, after 1960, guest speakers on legal issues
were invited to luncheon sessions.
Serving members
The CMPA made early efforts to serve French-speaking
members in their own language. In fact the CMPA was probably among the
first of the national organizations to recognize that if it wanted to
reach French-speaking doctors, it would need to do so in French.
It is Dr A.T. Bazin who is recorded as first
suggesting in the mid 1930s that the Association brochure and application
forms be produced in French. Again in 1949, when a publicity plan was
directed toward increasing membership, it was hoped that "some way could
be found for circularizing to French-speaking doctors."
Little seems to have happened. In the mid 1950s
there was written correspondence between Drs Bazin and Fisher on the subject
of attracting doctors from Quebec. Dr Bazin recommended corresponding
and producing reports in French once more.
Dr Normand J. Belliveau, who later served as
CMPA president, joined the Quebec provincial advisory committee in 1958.
The report of the 1960 annual meeting records his thanks to those attending
for agreeing to produce literature and application forms in French. By
1972 the CMPA had a French version of its name approved and with the arrival
of Dr Pierre Gaulin a couple of years later, doctors speaking French could
be served from headquarters. Of course Quebec doctors needing legal assistance
had always had the benefit of legal firms located in Quebec.
Attracting new members
The CMPA was by the 1930s firmly established
but still the recruitment of members remained a concern. The Depression
had taken a financial toll with more patients failing to pay their bills
and staff doctors, such as radiologists, having to take a cut in salary.
Joining another association, even one as vital to their financial health,
was not a high priority.
With members representing only one-third of
the practising doctors in the country in the 1940s, the CMPA requested
that the provincial Colleges send CMPA application forms to every doctor
registering for the first time. A few years later the Colleges requested
a favour from the CMPA—notification when any College members were named
in a suit. Members voted against that request but the Association did
agree to alert the Colleges of a judgment or settlement registered against
a doctor when it became public knowledge.
By the 1950s the membership included more than
half of the doctors practising in Canada and the numbers have grown steadily
since.
Causes for concern
Members were not always happy with their Association.
The reverse was also true. The discontent of members centered on their
desire for expanded services. For the CMPA the concern was bad medical
outcomes caused by carelessness.
In addition, despite advice to the contrary,
members continued to take matters into their own hands, often complicating
their cases unnecessarily. Sometimes members carried additional commercial
malpractice insurance. In the event of a legal action there would be conflict
if the insurance company wanted to handle matters differently from the
CMPA. Doctors had to make a choice about which organization would defend
them.
Despite pleas to the contrary, doctors continued
to engage their own lawyers prior to informing the CMPA of their case.
In 1955 the Association refused to pay the legal expenses for a group
of doctors who had done so. The group resigned their membership en masse.
Certainly doctors did resign from time to time
for legitimate reasons, but there are few incidents recorded. In the early
1950s the Canadian Association of Radiologists recommended commercial
insurance to its members because it believed the CMPA resources to be
inadequate. By 1958 the radiologists were rejoining. In 1976 many Quebec
doctors left the Association, no doubt thinking they could get a better
deal in the commercial insurance plan initiated by family practitioners.
By the mid 1980s they too were rejoining the CMPA.
More salaried physicians from institutions,
governments and public health joined the CMPA as they began to be threatened.
Interns started to join in 1958.
Services extended
The CMPA often received requests from members
for assistance in situations arising out of professional practice but
not necessarily resulting from negligence or lack of skill. For example,
as early as 1938 a member requested help for reinstatement to a hospital
appointment from which he had been discharged. Doctors continued to request
help to defend themselves in criminal charges. Appearances at inquests
sometimes proved problematic. Doctors appearing before licensing bodies
were troubled. With limited exceptions, all these were beyond the scope
of assistance offered in earlier years.
One area where the Association was and continues
to be unable, with few exceptions, to help is in treating patients outside
Canada. Physicians serving in the Second World War were an exception.
They were advised to maintain their membership while they were overseas
as protection against threats incurred from their wartime work.
In 1949 there is the first reported case of
one doctor suing another. A hospital superintendent allegedly caused damage
to another doctor's professional reputation. The CMPA agreed to help investigate
but not to help in the legal action. In 1952 protection was extended to
retired doctors and to the estates of doctors and the next year two cases
involving estates were reported.
The assistance with College matters such as
improper billing or misrepresentation of services was extended in 1967.
The CMPA did not want to appear to be in opposition to the licensing bodies
of the profession who must investigate complaints on behalf of the public
in appearances before disciplinary committees; however the Colleges advised
physicians to request legal representation. The Association extended this
service on a trial basis in 1963 but no help was offered at appeals of
College decisions.
On the matter of settlements, the report of
Council summed up a discussion in 1963 this way: "The Association does
not pay claims for members; it pays settlements when it is apparent that
the work done was, in a legal sense, careless or negligent and it pays
awards when a Court says a doctor did not discharge his responsibility
to his patient. The Association does not exist to pay claims for doctors;
it exists to advise and defend them."
Medical issues
Social, political and religious issues affected
the growth of medicine from the 1930s to the 1970s as much as advances
in medicine did. The evolution of health insurance began in the 1930s
with limited assistance to welfare recipients and culminated in the 1960s
with Canada-wide tax-supported health insurance plans.
The Second World War affected health services
in a major way. Not only was there a shortage of available doctors, surgical
instruments, X-ray film and rubber goods, but battlefield experience led
to new procedures, treatments, drugs and even contributed to health administrative
skills on the home front.
With the rise of participatory democracy paternalism
gave way to the public right to know. A Patients' Rights Act was proposed
in Ontario in 1977. Charles Scott, General Counsel at the time, had this
to say: "Participatory democracy is misplaced when it results not in a
benefit to the patient but rather cuts and confines the doctor in his
exercise of his duty so as to make it impossible to exercise freely and
in his patient's best interests, the skill with which his training and
experience has fitted him."
Moreover, in the late 1960s, preventive medicine
had an enormous impact on medical malpractice in terms of increased opportunity
for bad outcomes to occur to younger patients. This provided increased
opportunity for a rise in the costs of settlements and court awards. Until
then most medicine treated existing conditions necessary to survival.
At this point disabling or life-threatening conditions were recognized
in advance and treatments intervened to avoid the conditions, for example,
repairing cardiac defects before heart failure occurs in healthy, contributing
individuals.
Preventive medicine did prove more costly to
the Association than survival medicine had. In 1970, the Association paid
out one award for $90,000 and another for $110,000. In 1952, a year when
legal fees had increased 28 per cent and damages 135 per cent, the largest
sum paid out was $48,000.
Doctors continued to be advised that using a
consultant or getting a second opinion was in the best interest of the
patient. Nurses' notes became admissible as Court documents and the CMPA's
advice was to read them, sign off or elaborate on them.
Medical advances included the continued development
of immunization against diseases; the release of penicillin for general
public use; electroencephalography as a diagnostic aid; the introduction
of psychotropic drugs; the Cobalt 60 Beam therapy for treating cancer;
transplants of kidneys and hearts; the use of CAT scans; and joint replacements,
to name a few. Each brought its share of legal activity.
Medical advances also created major concerns
such as sterilization for non-medical reasons or as a contraceptive. This
was the topic of many questions to the CMPA secretariat, many articles
by Dr Fisher published in medical journals and much study by General Counsel
resulting in the advice that it was illegal unless essential to preserve
life or health. This item remained a hot topic until the 1960s when it
became permissible in law to perform it for the health of the woman. The
advent of the birth control pill was a welcome option. Vasectomies and
tubal ligations presented their share of unique medico-legal cases.
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Troublesome cases
Some types of cases were repeated causes of
complaints and legal actions to the distress of the Association, for example:
- the misuse of, or failure to use or read,
X-rays as judges tended to consider misuse as malpractice;
- careless surgical incidents such as foreign
objects left in patients, operating on the wrong patient or the wrong
body part;
- varicose vein surgery where the femoral artery
was confused with the saphenous vein, which happened so regularly the
Association was prompted to advise this should be considered major surgery;
- transference and fantasies of psychiatric
patients;
- informed consent issues for plastic surgeons
who were shown by the Courts to have a higher duty than the average
surgeon to explain possible results to patients;
- equipment such as new apparatus for X-ray
treatment for eczema and non-standard anesthetic machines, using unfamiliar
equipment as well as faulty readouts from ECG machines;
- loss of teeth during anesthetic;
- acupuncture treatment;
- tourniquets, elastic adhesive dressings,
broken surgical needles, anti-tetanic serum, intramuscular injections,
transfusion reactions;
- paralysis following spinal anesthetic, pressure
sores, falls from examination or operating room tables, intravenous
injections and catheters;
- intravenous promazine hydrochloride, intravenous
pyelography, barium enemas, angiograms, triamcinolone acetonide, improper
committals, warming blankets and failed sterilization surgery.
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Consent and informed consent
The issue of consent for treatment and
its extension—informed consent—has figured prominently in the CMPA annals.
Doctors traditionally assumed the responsibility of explaining to patients
the nature of the treatment or operation and obtaining agreement or consent
to proceed.
During the 1960s, hospitals appeared to assume
the responsibility of obtaining consent. In 1967 General Counsel warned
members the hospitals' obligation extended only to ensuring the consent
had been obtained—it was the doctors' obligation to obtain it.
Informed consent was a doctrine originating
in the 1970s in the United States on the duty of disclosure of certain
information to patients before treatment commenced.
In the landmark Canadian case Reibl v. Hughes
(1977), Justice Haines found no negligence in the performance of an endarterectomy
but awarded the patient $225,000 based on the allegation the patient had
not given his informed consent to the operation. A former legal counsel
said, "No legal event in the last 50 years has so disturbed the practice
of medicine as the decision in this case."
This case followed Kelly v. Hazlett (1976),
where Justice Morden awarded a patient $12,500 because, although informed
of the nature of the operation, she claimed the doctor was negligent because
she had not understood there was a definite risk to the operation.
General Counsel warned members consent must
also be genuine, not obtained through threat nor given while the patient
is under the influence of medication.
Salgo v. Leland Sandford Jr. University
Board of Trustees (1957) is credited with spawning the modern doctrine
of informed consent. Natanson v. Kline (1960) described the four
standards for disclosure. In Canterbury v. Spence (1972) the judge
advised the doctor "to treat the patient as though he was your best friend
and you are telling him all about the procedure."
After the Kelly and Reibl cases
cited above, the burden of proof was on the physician to demonstrate informed
consent had been obtained.
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A unique case in 1967 illustrated that the Courts
do not expect perfection. The doctor was called to a house where several
family members were sick. He diagnosed flu. He was asked if it could be
gas but as he smelled nothing said no. The following day robbers broke
into the house, discovered dead children and the father, barely alive,
who was left with permanent disability. The subsequent suit claimed the
doctor failed to diagnose carbon monoxide poisoning. A government inspector
and a heating contractor were also named; the Court dismissed the suit
against the doctor.
There were sometimes unique problems leading
to claims. There was the patient who inserted a foreign object into his
urethra after he had had a surgical procedure. The resulting irritation
brought him to an urologist for emergency surgery. Later the patient claimed
the original surgery had caused a rupture. The defence was that the rupture
was not near the original surgery!
Points of law
The role of General Counsel was to direct the
defence of all cases, appoint legal firms in local jurisdictions and make
a yearly report to members on points of law affecting the practice of
medicine. This might include advising the profession on new or changed
statutes impacting their practices or defining legal concepts such as
negligence, standard of care and informed consent.
Members appreciated comment on major legal
topics such as abortion, sterilization as contraception and the corresponding
attitudes of the Courts to these issues.
Council determined if a case was defensible
on a medical basis. General Counsel made the recommendation from the legal
point of view and then planned the defence. It is a good, simple process
that has worked for 100 years. The devil's in the detail of each case.
From time to time General Counsel offered information
on the statutes of limitations in bringing a malpractice suit. Except
for Quebec the limitation period was one year from termination of the
treatment complained about. In 1965 General Counsel, Peter Newcombe commented
that legal actions in Quebec were notoriously slow as "there is no statute
of limitation in the Medical Act meaning actions can be brought long after
records have disappeared, witnesses are unavailable and doctors' memories
no longer accurate."
A change in the statute of limitation in section
17 of the Health Disciplines Act 1974 (Ontario) has had perhaps one of
the most significant and far-reaching medico-legal effects. With that
Act, the limitation became one year from the date the patient became aware
of the facts of his treatment rather than one year from the date the treatment
terminated. Among other things it meant physicians must keep records much
longer. More importantly it provided impetus for the CMPA's eventual move
to fully-funded, occurrence-based protection from a pay-as-you-go base.
By 1958 the Courts began to place a heavier
burden on the doctor or surgeon. The Courts substituted their own views,
based on what a reasonable man would do, rather than relying on evidence
from medical experts. This applied especially to cases involving foreign
objects left in the patient following an operation.
The CMPA often dealt with the public perception
that doctors stick together and will not testify against one another.
Plaintiffs’ lawyers complained frequently enough to medical bodies about
their inability to recruit expert witnesses that the topic was debated
widely. In fact the Association advised members "medical ethics did not
preclude justice for the plaintiff" and while one doctor was encouraged
not to cause another trouble, this encouragement did not extend to being
unfair to a plaintiff.
Despite these good intentions, the conspiracy
of silence perception persisted. But in 1975 Justice Andrews, of the Supreme
Court of British Columbia, said in defence of doctors, "It has been said
from time to time that doctors are notorious for their reluctance to testify
against one another. That may be so in those cases where there is a genuine
difference of opinion by competent professionals as to the diagnosis or
method of treatment. But in my limited experience I have found them to
be as critical of their confreres where they are honestly convinced he
was negligent, as they are vehement in his defence when they honestly
believe he was not negligent."
CMPA principle upheld
The CMPA principle of no negligence, no settlement,
received strong, third-party endorsement from none other than Justice
E.L. Haines writing in the Osgoode Hall Law Journal about 1972.
In an article entitled, The Medical Profession and the Adversary Process,
Justice Haines said, "Most Canadian doctors are members of a strong medical
protective association which has made it a practice never to settle on
the basis of economy. If a doctor is proven at fault, they pay. If he
is not at fault then they will spend a fortune in defence. They may not
always succeed, but they have rid the Canadian Courts of nuisance malpractice
claims and their members of the harassment of being sued without cause
or on flimsy grounds." Dr Powell's belief had been validated!
The no negligence, no settlement principle
was often criticized by certain judges and lawyers, but CMPA members have
always concurred with the protection of professional integrity as an aim.
Moreover, the Association did settle a significant number of indefensible
actions in any given year.
Risk identification and management
Through the years it became clear it was in
everyone's best interest to warn members about procedures, practices,
drugs and equipment that might make them vulnerable to legal action.
Although it appears there was no formal analysis
of cases during the CMPA's early years (bear in mind there were no full-time
professional staff until 1964), the secretary-treasurer and executive
committee members, who reviewed cases, certainly noted trends. When a
medical mishap occurred repeatedly it became the topic of a medical journal
article, a pamphlet, an article in the annual report or a speech to a
medical organization.
Common-sense items dominated the early education
efforts of the CMPA. It became apparent the lack of good records could
land a doctor in trouble frequently. So "keep good records" became an
oft-repeated refrain and like a good song the CMPA has never wearied of
replaying it.
Carelessness led to many indefensible actions.
Sponge and instrument counts were advised so often the message was eventually
received and counts became mandatory at all hospitals. The CMPA spread
the word about solutions to these systemic problems. For instance when
one hospital developed a system to track instruments the CMPA wrote about
it in the annual report. The same can be said about the plastic catheters
that often broke and found their way into the patient's blood stream,
requiring surgery for removal if they were located at all. Another warning
was issued on the use of intravenous promazine that required dilution
with water or saline. It was known to cause vascular spasm leading to
loss of arms, fingers or hands and members were advised to use it only
if nothing else was available.
Dental prostheses were a bane to anesthetists,
to whom frequent cautionary notes were directed.
In fact the annual reports from the 1930s until
1978 contained headers on pages throughout repeating advice on running
a thorough practice. Those annual reports also contained detailed descriptions
of cases leading to claims and the judgments from the Courts. Their purpose
was instructive and the tone was seldom judgmental. A judge's explanation
for his finding or dismissal was frequently reassuring as it pointed out
not all mishaps were caused by negligence.
Spreading the word
Dr Fisher had a reputation for precision in
language and conciseness in expression. His Reports of Council
to members were fascinating to read. He had not written many before
his skills were noticed and a member moved at the annual meeting "to give
wide publicity of the Report of Council." Although a few CMPA-authored
articles had appeared in medical journals in the early 1930s, this motion
spurred a new activity that made the Association a well-known and respected
authority in medico-legal matters, and the prolific Dr Fisher the face
of the organization. In 1947 a regular column on medico-legal issues was
negotiated with the editor of the CMAJ.
Always a man ahead of his time, in 1957 Dr
Bazin remarked that he saw the "chief function of the CMPA now was to
educate our present membership to avoid the pitfalls in practice." A spate
of bad publicity did plague the profession in 1963 about foreign objects
left in patients. The publicity nearly resulted in the elimination of
case descriptions from the annual reports. On balance it was determined
the advantage of alerting doctors to problems served both doctors and
patients, and the cases continued to appear.
By the 1960s the Association began to segment
its audience. The issue of medico-legal education for medical students
was raised at the 1965 annual meeting. Others at the same meeting felt
it would be better to concentrate on educating interns and suggested the
Association produce a film for presentation to trainees.
This thinking marked a turning point—an advance
from "sharing information" to "education" and the identification of risk.
Dr Fisher retired as secretary-treasurer in
1972 but remained as consultant to Council until his death in 1976. His
successor Dr Norman Brown, a surgeon, was cast in the Fisher mold as far
as CMPA activities were concerned. He believed fervently in making the
profession aware of the risks faced in practice and eventually established
the education department in the mid-1980s. He joined a short list of strong
leaders among an impressive group of men and women who created, established,
nurtured and groomed the CMPA as a medical mutual defence organization.
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Inspired leadership continues:
tribute to our leaders
The benefit to the CMPA of long-serving leaders
was a cumulative knowledge of history and operations. This was advantageous
particularly before full-time professional staff was employed.
George W. Armstrong, MB, MD, FRCSC, FACS, was elected in 1956
to replace Dr Argue, who had been named honorary life president although
he was reluctant to relinquish his duties despite ill health. As only
the third president of an organization already more than half a century
old, Dr Armstrong had long experience with the Association as a member
of Council since 1937. Well steeped as he was in CMPA affairs, he too
upheld the central objective of a medical mutual defence organization
dedicated to the protection of the professional integrity of members.
A highly-respected Ottawa orthopaedic surgeon
and one-time president of the Canadian Orthopaedic Association, he served
10 years as CMPA president and after his resignation from office in 1966
was named honorary life president, a post he held until his death in 1981.
 James
H.B. Hilton, MD, CM, FRCPC, FACP, succeeded Dr Armstrong as
president in 1966 and served with distinction in that capacity until 1988.
Dr Hilton had been elected to the CMPA secretariat in 1952 at a time when
the workload became too large for Dr Fisher to handle alone. As the second
part-time employee, he continued to practise in Ottawa as an internist
and was associate secretary-treasurer until 1965 when his appointment
as chief of medicine at the Ottawa Civic Hospital precluded his continuing
involvement in the day-to-day medico-legal affairs of the Association.
The following year he was elected president.
Throughout his tenure, he presided with dignity
in times of change that were sometimes difficult. On his retirement, as
a mark of esteem, Council appointed him honorary life president.
 F.
Norman Brown, MD, CM, FRCSC, FACS, stepped into Dr Fisher's
large footprints as secretary-treasurer in 1971. While continuing steadfastly
to support the objects of the Association, he managed nonetheless to expand
and enhance the CMPA during his tenure of 17 years.
Dr Brown began as a part-time assistant secretary-treasurer
in 1965, adding CMPA duties to an already busy career as senior general
surgeon at the Ottawa Civic Hospital and lecturer in the department of
surgery at the University of Ottawa. The only assistant to Dr Fisher at
the time was Dr Hilton.
In 1968 Dr Brown was appointed associate secretary-treasurer.
Like his predecessor Dr Fisher, Dr Brown became the foremost medico-legal
authority in Canada and his advice was sought and received by medical
defence organizations worldwide. Also like Dr Fisher he had a commanding
facility with the written word, which served the Association very well
as he continued Dr Fisher's hectic speaking and publishing ventures on
behalf of the profession.
Dr Normand Belliveau, former president, paid
tribute to Dr Brown describing him as a man interested in facts not hearsay,
clear-minded, polite, gentle, magnanimous and helpful. His years in office
were characterized by turbulent change for the Canadian medical profession
and astonishing growth in the size and in the activity of the CMPA. His
dedication was recognized by Council in the invitation extended and accepted
to become consultant to Council following his retirement in 1988.
Normand J. Belliveau, MD, FRCSC, FACS, FCCP, DSc (Hon.),
LLD (Hon.), was elected president in 1988 and held the position
until 1995. The CMPA's fifth president, Dr Belliveau is from Montreal,
was the first president from outside Ottawa and the first to be French-speaking.
A gregarious and personable gentleman originally
from Nova Scotia, Dr Belliveau has been honoured by Dalhousie University
and Ste. Anne's University. He was a senior surgeon at the Royal Victoria
Hospital in Montreal and associate professor of surgery at McGill University.
He began promoting CMPA membership for Quebec
doctors in 1956 along with Dr Gordon A. Copping, a long-time Council member.
Dr Belliveau became involved with CMPA work first as a member of the Quebec
provincial advisory committee in 1959. He was second vice-president from
1964 to 1972 and first vice-president from 1972 until his election to
the presidency.
He had been active in medical association affairs
throughout the years, first as a member of general council and then as
president in 1967 of the Canadian Medical Association.
He has also been president of the Quebec Medical
Association. Dr Belliveau was also to see and preside over the construction
of a new building for the CMPA.
 Stuart
B. Lee, MD, FRCSC, was secretary-treasurer for all but a few
months of Dr Belliveau's presidency. Dr Lee's training and clinical background
were in general surgery and while still active in practice and teaching,
he was appointed to Council in 1969. In 1972 he joined the medical secretariat
as assistant secretary-treasurer; he was appointed associate secretary-treasurer
in 1977 and secretary-treasurer in 1989.
An austere man, he was not devoid of humour.
Former staff member and secretary to Dr Lee, Joan Halpin, describes her
boss exiting his office on his knees in supplication when he really wanted
or needed a task done in a hurry. He was also known for his meticulous
attention to detail. Dr Belliveau described Dr Lee as decisive, responsible,
hard-working and very clear thinking. Dr Ruaraidh W. McIntyre, long-time
councillor, credits him with the expansion of services and support to
members.
There is much compassion in Dr Lee. This is
evidenced in Dr Orville Messenger's book, Borrowed Time, about
his struggle with transfusion-induced AIDS discovered just after he joined
CMPA as assistant secretary-treasurer. In his book Dr Messenger describes
the special arrangements Dr Lee made so he was able to keep working as
his disease progressed.
A retirement dinner in 2000 attended by staff,
Council members past and present and representatives of the legal community
demonstrated the great respect accorded to Dr Lee. I have known him since
we were residents together 40 years earlier and I, too, was always grateful
for his help and guidance.
 Hugh
F. Morrish, MD, FRCPC, has the distinction of being the CMPA's
shortest-serving president, having held the office for only one year.
It fell to him to chair the raucous annual meeting in Sydney, N.S. in
1996. Elections for the CMPA were still held at the annual meetings and
members voted against his re-election. He had served on Council since
1984.
One of his major contributions to the CMPA's
permanent home was the selection of art from the Canada Council Art Bank,
now enjoyed by Council members, staff, and visitors. He established the
arts committee that selected the art and then asked members of Council
to donate the funds to cover the rental costs of the art for the first
three-year contract.
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Maintaining tradition in
the face of change: the past 20 years
In the 1980s the Association entered its third
era — one of tremendous change.
Leadership, governance and administration
With nearly 35,000 members by 1980 and the
medical secretariat handling more than 800 new files yearly (in addition
to already open files) as well as the increased expenditures on legal
costs and payments of settlements and court awards, the CMPA was big business.
Corporate operations evolved to reflect the complexity.
Two major changes in governance occurred. The
first followed the adoption of differential fees. The impetus was accountability
to members and the chronic irritability regarding the apparent concentration
of "power" in Ottawa. Measures taken, reflected in by-law changes, included
a larger, more geographically representative Council.
The second major change resulted from the Sydney
"riot" as many described the annual meeting of 1996. What ignited the
ruckus was again the fee proposal, but the underlying issue was communication
with the membership and a perceived lack of accountability, fuelled by
government misunderstanding of the purpose of the CMPA's reserves (required
to compensate patients for medical misadventure, already sustained but
not yet reported, or currently open to dispute), and the discretionary
power of the Association (in this case the executive committee) to refuse
to defend a member.
Change was inevitable. The appointed councillors
(mostly from Ottawa, who conducted case review on a weekly basis) were
eliminated; the secretary-treasurer and associate secretary-treasurer
would no longer be members of Council, nor would there be a requirement
that either be a physician. There was also a motion to develop a risk
management program.
Council also established a communications committee.
One of its first undertakings was a membership needs survey. There was
an astounding response rate of 29,000 members—more than half the membership—and
19 out of 20 members confirmed that the CMPA provided value. The results
of the survey guided the effort to improve communication to members.
Major operational changes occurred too. Computers
were introduced for business purposes as well as for analysis of closed
cases. A 1995 study of the organizational structure and administration
resulted in department changes, staff terminations and reassignments.
The following year a review of how cases were managed resulted in new
procedures. Council and administration together worked out a multi-year
strategic plan in 2000 and the CMPA is currently engaged in a business
re-engineering that will improve the CMPA's communication with members
and put the Association on the leading edge of e-business.
Annual meetings a communication channel
There were other issues, raised by members at
annual meetings, that effected changes or enhancements. Some related to
fee categories. A toll-free number to reach the CMPA was requested and
implemented. An inadequate response to a request for statistical information
on the incidence and cost of professional liability on a provincial basis
resulted in a special committee being set up to respond to such requests.
At a rancorous annual meeting in St. John's,
Nfld., in 1992, questions surfaced about investment income, reserve funds,
administrative expenses, indemnity re-insurance and the release of information
on membership categories for negotiations between medical associations
and provincial/territorial governments. The Association was accused of
a "lack of openness." The CMPA for its part was concerned with maintaining
confidentiality and with possible competition. The pressure built, coming
to a head in 1996 at the annual meeting in Sydney.
Since that meeting, communication efforts have
continued to deal with some tough issues but members now receive timely
information about decisions.
Expertise grows
The medical secretariat continued to grow in
proportion to increasing membership numbers and inquiries. New assistant
secretary-treasurers arrived at the rate of one or two a year, on average,
outnumbering those who retired. A director of administration was hired
in 1991 and a director of information technology joined in 1994. A communications
director arrived at the end of 1997. Support staff and specialists were
hired as needed.
Not all staff were located in the Ottawa headquarters.
Drs E. Bruce Tovee, Ted Mullens and Donald Jones assisted provincial counsel
in Toronto and Dr Orville Messenger worked out of Halifax.
The end of the Argue-Fisher era was marked
by the death, in 1981, of Dr Armstrong, Council member since 1937 and
president from 1956 to 1966. Dr Hilton retired as president and Dr Brown
as secretary-treasurer in 1988 as did long-time General Counsel, Charles
Scott who was succeeded by Kenneth G. Evans and subsequently by Margaret
Ross, both of whom continue to live up to the traditional expectations.
Dr Hilton was succeeded as president by Dr Normand Belliveau, the genial
Montrealer with Acadian roots, by Dr Hugh Morrish of Calgary, who served
only one year and by me, from 1996. With my retirement this year another
Montrealer, Dr André Duranceau, will preside.
Dr Brown was succeeded as secretary-treasurer
by Dr Stuart Lee who had been on staff since 1972 and had progressed through
promotion from part-time assistant secretary-treasurer to secretary-treasurer
in 1989. His retirement in 2000 brought the Association another bright,
energetic physician and veteran of medical politics, Dr John E. Gray,
a family doctor from Peterborough, Ontario. Dr Gray had been a member
of Council and is a past-president of the Ontario Medical Association.
It is he who has launched the CMPA into e-business.
A home of our own
Through the years the CMPA resided in borrowed
spaces, rented premises adjacent to its leaders' offices, or with its
"parent" the CMA. The penultimate move occurred when the CMA ran out of
space and CMPA sought its own home. The move to leased space on Rochester
Street in Ottawa turned out to be short-lived as the Association grew
out of it, too. In 1989 an ad hoc premises committee was formed at the
urging of Dr Scott Wallace, a member of Council from Victoria. It found
a site in 1991. By 1993 the design development was approved by the City
of Ottawa and CMPA took possession of a permanent property.
Under the chairmanship of Council member Dr
Christopher F.G. Ellis, architects and project managers were hired, excavation
began and the beautiful granite-faced structure took shape. Move-in day
was March 28, 1994 and the official ribbon-cutting took place October
13, 1994. Site, building and fit-up went like clockwork due to the day-to-day
scrutiny of Dr Lee and Jim Kenward, business administrator, and was completed
well within budget.
The site was large enough to accommodate a
second building to the north of the first. The CMPA's own space needs
coupled with a lack of rental office space in the area, combined to make
building the second tower a good investment and Council has approved so
doing.
From uniform to differential fees
Costs for legal expenses, settlements and court
awards escalated sharply in the 1970s and early 1980s because of inflation
and the sheer numbers of actions.
The CMPA's actuaries studied the situation,
found certain types of practice generated more risk and incurred more
expense and proposed a differential fee schedule by type of work.
Executive assistant Beverley Allen made the
usual arrangements for the annual meeting in Saskatoon in 1982. The CMPA
had seldom attracted more than a quorum for its annual meetings. Members
flooded into the meeting room. The potential for a major change in their
fees had captured their attention.
The proposed differential fee schedule, based
on type of work, was not well received. Amid the uproar, Drs D. McAlpine
of Regina and P.G. Winkelaar of Medicine Hat moved that detailed information
be circulated to members before a vote. During the next year that information
was disseminated and the Montreal annual meeting in 1983 attracted an
even larger audience, but the CMPA succeeded in turning adversaries into
advocates and the motion passed to take effect in 1984.
A fully-funded financial base
Drs Brown and Hilton also had the foresight
to realize the Association had to examine the method of funding and its
impact on the CMPA's future financial health. With the existing pay-as-you-go
approach for funding to meet current expenses, the CMPA could easily get
into a precarious financial position. In addition the CMPA faced competition
from commercial insurance companies attempting to lure away doctors at
lower risk for claims.
Jim Kenward, now retired, described the issue:
"In 1984 we began to fund ourselves forward. On the pay-as-you-go basis
the CMPA collected enough money in each year, through fees and investments,
to pay any expenses required in that year. As the costs of damages and
the number of claims continued to increase drastically, this became dangerous.
Many commercial insurance companies had gone under because of under funding."
Forward or full funding means collecting fees in a given year to cover
the expenses for all actions that may occur resulting from treatment undertaken
in that year, regardless of when an action might be initiated. It means
doctors now in practice are funding claims that may arise from their work
and doctors practising in future will not be burdened for expenses resulting
from current practice.
The arithmetic was obviously complex. The CMPA
needed to build a large reserve base, which would not happen overnight.
The goal was to be fully funded by 1998. The CMPA entered 1999 with the
large reserve base to ensure patients who suffer from medical misadventure
are fairly compensated.
The Association also carried re-insurance,
which Mr. Kenward referred to as "catastrophe insurance."
Investment advice
Investment income has helped to keep membership
fees down. As the investment portfolio became more complicated, the CMPA
sought outside experts to join its investment committee and was fortunate
to obtain the services of Gerald Bouey, ex-governor of the Bank of Canada
and Rob Paterson, former senior vice-president of the Royal Bank of Canada.
Other eminent financial experts have since joined that committee and the
CMPA is grateful for their contributions.
The committee has physician members as well.
Notable among CMPA members is the late Senator E.W. (Staff) Barootes,
a physician from Saskatchewan, long-time member of Council and vice-president
of the Association. Highly respected for his business acumen, he had been
a director at large of the Investment Dealers Association.
Independent review of CMPA funding and
operations
Lack of understanding about the reserve funds
triggered An Independent Review of the CMPA by the Hon. Charles
L. Dubin. The Association did not request a fee increase for 1995 in light
of a general economic downturn; however, for 1996 the aggregate fee increase
proposed was nearly 20 per cent.
The fee for service paid to doctors, including
a portion of their liability protection fees, is negotiated by provincial
medical associations with the provincial and territorial governments.
In 1995 the Ontario government took exception to the proposed fee increase
saying, "This government is not interested... in further contributions
to the CMPA while the CMPA continues to accumulate an unacceptable reserve...
We do not believe that this is a responsible use of taxpayers' money."
After a detailed explanation from Dr Lee, the minister of health responded
citing a litany of objections such as lack of consultation, CMPA assistance
to members with billing problems or appearances before discipline committees,
high legal and administrative expenses, lack of regulation of the CMPA
and of course the reserve funds.
Under these circumstances the CMPA requested
Justice Dubin to conduct an independent review on the funding policy,
accrued liabilities and current year costs, malpractice claims management
and operational costs. Pending his report, the minister of health reinstated
reimbursement of CMPA membership fees at the 1995 schedule.
Justice Dubin was assisted in his review by
three independent audit firms and the CMPA made its actuaries and all
information available to him. His summary of findings and recommendations
ran to 55 items, most of which confirmed the status quo with respect to
funding, services to members (except billing disputes), occurrence-based
coverage, discretion to deny assistance, management and administration,
principles such as the vigorous defence of unmeritorious claims, education
and risk management, cost of coverage calculations, use of alternative
compensation regimes and tort reform. He made recommendations about governance
and accountability, most of which the Association has implemented. And
he recommended reinstating the uniform fee subject to certain conditions,
so that doctors in high-risk specialties would not leave their practices.
He endorsed the proposed fee schedule for 1997.
He reiterated a central premise of the 1990
Report to the Conference of Deputy Ministers of Health of the
Federal/Provincial/Territorial Review on Liability and Compensation
Issues in Health Care, by Professor J. Robert S. Prichard,
University of Toronto, that "on balance the good effects of the threat
of litigation outweigh the bad...the quality of health care provided by
our physicians and health care institutions is higher than it would be
in the absence of the threat of litigation." The Prichard report was a
response to a perceived liability crisis in the mid-1980s, specifically
claims against hospitals and subsequent costs of damages.
Case management review
In an attempt to contain costs and streamline
processes in the handling of cases, the CMPA undertook an aggressive case
management review, completed in 1996. The goals were to shorten the "life"
of cases and to identify indefensible cases as early as possible. The
result is a case management program that adheres to provincially adopted
milestones and increases communication and co-operation between the CMPA
and legal counsel.
Regional rating of membership fees
Membership fees have continued to rise to meet
expenses and the funding formula objectives, but in the latter years of
the century, it became apparent in actuarial studies that there was disparity
by geographic region in the costs of settlements and court awards. This
resulted in a regional rating structure for fee setting. The country has
been divided into three regions—Ontario, Quebec and the rest of Canada.
Fees are now calculated based on costs incurred by type of work within
each region.
Membership growth
By the 1980s the value of membership in the
CPMA was evident and recruitment became a less pressing activity. The
numbers of doctors joining grew steadily until the end of the century
when more than 95 per cent of Canadian doctors are members. From time
to time there is a threat to membership growth but rather than from commercial
insurers, it comes now from provincial or territorial governments toying
with the idea of establishing their own liability programs.
Membership has grown to more than 60,000 doctors
by 2001 from 34,375 in 1980. One member in 25 will be named in a legal
action in any given year.
Members of other professions look with envy
on the doctors and their Association. Many of the lawyers who have worked
with the CMPA have expressed the wish the legal profession had such an
organization.
Services continue to expand
Part of the reason for the growth at CMPA is
the expansion of services offered to members. Until this period assistance
comprised physician-to-physician advice, civil legal actions, payment
of settlements and court awards, appearances at coroners' inquests and
complaints and college disciplinary proceedings, always with discretion.
Beginning in the 1980s assistance expanded to include criminal matters
arising from medical care, hospital administrative and committee matters,
billing agency inquiries and human rights complaints.
In 1995 the CMPA considered providing assistance
to a physician as plaintiff but eventually rejected the concept as inconsistent
with the Association being a defence organization.
Emerging practice areas of concern are doctors
who provide advice through 1-900 telephone lines or over the Internet,
who practice telemedicine, who teach or who are sued in foreign jurisdictions.
Medical changes and statistics
With more knowledgeable patients seeking earlier
intervention and treatment with multiple new procedures, drugs and equipment,
a rise in the number of legal actions was certainly predictable. In 1980
the CMPA completed or closed 251 cases; in 2000 the number of cases closed
was 1,369.
Interestingly, it was not the new techniques
and technology that posed problems for doctors. As far as causes for claims,
it was still a case of "second verse, same as the first." Foreign objects
remained in patients. Still there is femoral artery ligation in varicose
vein operations, nerve injury in node biopsies, diagnostic errors, delays
in diagnosis, failure to recognize ischemia, technical errors, leaks,
obstructions, failed tubal ligations and post-op complications.
Doctors in the
highest-risk specialties—neurosurgery, orthopaedics and obstetrics and
gynaecology—still run a greater risk for legal action than the general
membership. For specialists in these categories, the risk is one suit
for every seven doctors; for members generally, the risk is one in 43.
The outcome of those legal actions does not differ significantly for specialists.
Overall the CMPA's statistics on closed cases are: 64 per cent are dismissed;
28 per cent are settled; six per cent are found for the doctor; and two
per cent are found for the patient.
In the early 1990s there was a significant
increase in the number of complaints made to Colleges, especially about
sexual impropriety. This occurred about the time the College in Ontario
ran a series of advertisements to let the public know how and where to
seek redress for complaints against doctors.
In more recent years, the CMPA experienced
different types of cases such as the blood inquiry and more recently a
class-action suit. There are also "scandals" to face—multiple deaths at
one hospital, untested blood leading to AIDS or hepatitis C.
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Good advice in any era
When it comes to advising physicians on the
easiest ways to keep out of trouble, the refrain has remained unchanged
for 100 years:
- maintain good rapport with the patient;
- keep good records;
- inform the patient and obtain consent;
- treat the right patient and the correct body
part;
- identify and protect adjacent structures;
- make notes on the operation;
- follow up lab results; and
- get second opinions.
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Points of law
The consent/informed consent issue dominated
the medico-legal scene for a period in the late 1970s and early 1980s,
but the traditional issues didn't go away. In a unique mix of health and
social policy, members still contended with abortion, wrongful birth,
wrongful life, organ and tissue transplantation, in vitro fertilization,
determination of death and continuance of life-sustaining efforts, rights
of psychiatric patients, rights of children, as well as actions against
manufacturers of drugs and devices and against hospitals.
The disposition of professional records and
statutes of limitations remained items of contention and by 1986 causation
became an issue when two important (non-CMPA) cases illustrated that plaintiffs
must prove their injuries were caused by defendants' wrongdoings, and
that these wrongdoings were not necessarily the only cause. These cases
were based on the precedent set in McGhee v. National Coal Board, England
(1972), where the judge said, "It has oft been said that the legal
concept of causation is not based on logic or philosophy. It is based
on the practical way in which the ordinary man's mind works in the everyday
affairs of life."
Early in the 1980s General Counsel Charles
Scott noted a new attitude in the courts that seemed to apply the principle
of liability without fault—especially when the burden of loss was large
or the medical circumstances tragic— by spreading the financial responsibility
among as many parties as possible.
The concept of "the lost years" meant a person's
estate could be given an award for the amount he or she would have earned
in a lifetime. This proved to have cost consequences for the CMPA, especially
relating to compromised baby cases.
By 1985 there was further increase both in
the number of lawsuits and the size of the awards. General Counsel reported
there was no apparent deterioration in the quality of work by members
and attributed the increase to a mood of anti-professionalism, unrealistic
expectations resulting from the advances in medical technology or a tendency
to equate complications in treatment with negligence. He also mentioned
there was a school of thought in the Courts that the burden of loss should
be placed on those best able to pay—insured hospitals or doctors.
Changes in rules of procedure and various court
decisions across the country led to the elimination and/or reduction of
the element of surprise in civil actions by requiring greater pre-trial
disclosure.
Despite a mini-recession in the mid 1990s, operational
costs were increasing because of the tremendous surge in activity. Nearly
12,000 new files were opened each year.
Legal expenses generally have been a major
component of the CMPA's expenditures and are spread over the many thousands
of open cases. The best available legal counsel is still selected in each
province and territory. The CMPA is invoiced on a "time for service" basis
with no premium billing for favourable results. Costs are subject to intensive
review. In reviewing the activities legal counsel assist with, General
Counsel Margaret Ross included legal actions, trials, inquests, College
proceedings, hospital matters, billing disputes, certain criminal matters
and federal/provincial inquiries. Among the latter she listed the Dubin
inquiry into the deaths at Toronto's Hospital for Sick Children, the Krever
inquiry into the Canadian blood delivery system and the inquest into the
deaths of infants undergoing surgery at the Health Sciences Centre, Winnipeg.
Tort reform
An area of aggressive interest to the CMPA
is tort reform. The increased costs of settlements and court awards do
not mean more patients are suing more doctors or that more cases are lost.
Those figures remain fairly constant. It's the cost of the settlements
and awards that has increased.
In the tort-based approach to awards, compensation
follows a finding that the patient suffered harm caused by negligence
by a doctor who owed the patient a duty of care. The CMPA's challenge
is to ensure patients receive their due, but at a lower cost to society
as a whole. This can be addressed through the following changes:
- Structure settlements—create annuities that
generate regular payments to patients to provide for future care and
to compensate for future income.
- Eliminate subrogation—current legislation
allows health ministries to recover the costs to the system resulting
from negligence by a doctor or a hospital. As virtually all funding
of physicians and hospitals comes from health ministries, this cost
recovery is really coming from the same pot of money. Eliminating this
practice will not harm the injured patient and will benefit society
because the administrative costs for the subrogation system would cease,
the attendant legal costs would disappear and the malpractice costs
of physicians and hospitals would be reduced.
- Eliminate the gross-up factor in future care
and loss of income payments—when a lump sum is paid to a plaintiff the
interest generated is taxable thereby eroding the amount available for
care or to replace income. As a result payments must be inflated, or
grossed-up, so after-tax dollars are available.
- Eliminate unrealistic interest rates payable
on certain aspects of damages.
- Eliminate double recovery by taking collateral
benefits into account when the plaintiff has financial support such
as insurance, welfare or workers' compensation.
- Streamline the defence process—by reducing
the number of expert witnesses required, using alternative dispute resolution
wherever possible and shortening trials by agreeing to certain facts
or aspects of damages in advance where appropriate.
The Association continues to bring these issues
before stakeholders who may influence reform. The CMPA presented a major
conference on tort reform in November 1998.
Risk management
One lesson learned from the debate over differential
fees in Saskatoon was the value of communicating with members. With the
increase in numbers of cases and costs of damages at that time, the CMPA
adopted targeted communication as a goal.
A second impetus for improved communication
was the number of requests for specific information from medical groups
such as the Society of Obstetricians and Gynaecologists of Canada who
wanted data to help identify the scope and direction of problems involving
its members.
The first task was to identify the risks. The
second step was to demonstrate ways and means to eliminate those risks.
The third was to develop communication vehicles and channels to get the
message to the members. Initially Council focused on a possible public
relations program but gradually thinking turned to education.
Dr Orville Messenger, an assistant secretary-treasurer,
took on the challenge of setting up the new education program even though
he was, as he confesses in his autobiography, dubious about how it would
be accomplished. The goal of the program was to help doctors stay out
of trouble and it fell within the CMPA objective "to promote and support
all measures to improve the practice of medicine." A Council committee
on education, chaired by Dr Leslie P. Ivan, a neurosurgeon, proposed the
new department of research and education.
The focus was on prevention of risk and had
three components: to help doctors become thoroughly familiar with their
legal obligations; to make doctors aware of areas of clinical practice
where they are most vulnerable to litigation; and to assist physicians
to undertake management methods to enhance doctor/patient relationships.
Analysis revealed trouble arose in most instances
not from incompetence but from lack of communication. Certain misadventures
occurred repeatedly. The new program was introduced to the members through
a regular newsletter. A speaker pool of CMPA staff and legal counsel introduced
risk management to new doctors through the medical schools and to practising
physicians through medical society meetings and seminars. Medico-legal
presentations were made during annual meetings. Speaker support materials
were developed and detailed studies of case files and analysis were computerized.
The department of research and education has
gone from success to success. More than 500 registrants came to Toronto
from around the world to attend the first major symposium on perinatal
asphyxia in 1988. A second held in 1992 in Vancouver was equally well
received. Publications were added including A Medico-Legal Handbook
for Canadian Physicians by General Counsel Ken Evans and Consent:
A Guide for Canadian Physicians by Dr Brown and Mr. Evans.
Information Sheets on timely topics are circulated with
the Information Letter, and more recently a series of Risk Identification
papers has been produced.
A first for the CMPA was receiving continuing
medical education (CME) accreditation from the Royal College of Physicians
and Surgeons for the August 2001 symposium on risks in clinical practice.
Although credits had previously been given for programs where CMPA staff
were presenters, this is the first CMPA program to achieve this status.
The department has had two energetic leaders
in Drs Robert Robson and William Beilby.
With all the increased activity to educate
doctors, the CMPA continued to use its regular channels such as annual
reports, articles and columns in medical journals and contributions to
medical specialty associations. Dr Ruaraidh McIntyre put his knowledge
and experience of the CMPA's work to very good use as a member of the
standards of practice committee of the Canadian Anesthetists (now called
Anesthesiologists) Society. He helped develop new standards that contributed
to lowering the number of incidents in anesthesiology.
Throughout the development of the department
the CMPA has taken great care to avoid seeming to set standards for practice,
a task properly belonging to the colleges and the professional or specialty
societies.
CMPA staff now make more than 300 educational
presentations a year and as the Association enters a second century of
service, the department is poised to do more analysis, more writing and
more presentations through electronic channels of communication as well
as by traditional methods.
Return to top
What the future holds
Like most everyone else, I would like to have
a crystal ball. It would be beneficial to see what lies ahead in advancing
medical technology, to learn where the human genome mapping leads, to
look at the results of cloning, to know if telemedicine lives up to its
potential, to deal with the difficult and heartbreaking issues such as
euthanasia. Or maybe not. What I do know is that whatever comes along,
the CMPA will be among the first to experience the effects.
In this limited space, so much is left unwritten.
I have attempted to give a fair expression of what has happened to our
Association in the last 100 years. No doubt I have missed much and I hope
I may be forgiven.
In the end what has impressed me the most about
the CMPA is the number of excellent doctors willing to take time from
their practices and indeed, their busy lives, to serve their colleagues.
It makes me proud to belong to a mutual defence organization dedicated
to providing an essential service for physicians by physicians, with a
little help from our legal confreres. I think that Dr Powell would be
proud of us all too.
My thanks, on your behalf, to all those colleagues
who went before and my best wishes to all who follow in the footsteps
of our founder. Who could have imagined the great organization that would
result from a fractured forearm and a physician's foresight?
Return to top
Acknowledgements
Many people assisted with the production of
this document originally initiated by Council member Dr Robert Taylor.
I am indebted in particular to Dr Clifford Amundson, retired assistant
secretary-treasurer, for his hours of interviews with former and current
Council members, Association officers, counsel and staff; to Judy Valley
who transcribed the interviews during her leisure time; and to members
of the communications department who researched, wrote, edited, translated,
designed and produced this booklet— in particular Margaret Chartrand.
My gratitude, too, is extended to all those who supplied information and
to those who reviewed the text. I am indebted also to the authors of many
legal and medical texts and of histories of various medical associations
and societies. This document would not have been possible without review
of Council minutes, Association correspondence and files and special files
compiled by staff, past and present.
Return to top
Roll of service
A debt of gratitude
Many men and women in the medical profession
served as Council members through the years. Some such as Dr J.D. Courtenay
served for many decades with great distinction. The profession owes each
great thanks. My own association goes back to 1972 when I was asked to
join the provincial advisory committee in British Columbia. My father,
Dr Joseph C. Thomas, had served in that capacity and retired as vice-president
in 1971, having served the CMPA since 1953. The names and dates of service
for all Council members are included here, along with other physicians
and professionals who serve CMPA members.
Councillors
| 1905-1954 |
John Dickson Courtenay, MD |
Ottawa, ON |
| 1921-1933 |
A.S. McElroy, MD
|
Ottawa, ON |
| 1934-1958 |
Alfred Turner Bazin,
MD, DSO |
Montreal, QC |
| 1934-1943 |
M.J. MacCallum,
MD |
Toronto, ON |
|
1934-1944 |
L.J. Austin, MD |
Kingston, ON |
| 1934-1951 |
R.K. Paterson, MD
|
Ottawa, ON |
|
1934-1943 |
G.S. MacCarthy, MD |
Ottawa, ON |
| 1934-1936 |
J.M. Murray, MD
|
Ottawa, ON |
|
1934-1936 |
Stuart Evans, MD |
Ottawa, ON |
| 1934-1942 |
R.E. Valin, MD |
Ottawa, ON |
|
1934-1955 |
W.S. Lyman, MD |
Ottawa, ON |
| 1935-1971 |
Trenholm Laurence
Fisher, MD, CM, FACP |
Ottawa, ON |
|
1937-1966 |
George W. Armstrong, MB, MD, FRCSC, FACP |
Ottawa, ON |
| 1937-1970 |
George Hooper, MB,
MD, CM, FRCSC, FACS |
Ottawa, ON |
|
1943-1973 |
J.L. Coupal, MD |
Ottawa, ON |
| 1943-1951 |
F.S. Patch, MD |
Montreal, QC |
|
1944-1947 |
R.R. Graham, MD |
Toronto, ON |
| 1945-1977 |
W.F. Connell, MD,
CM, FRCPC, FACP, FACC |
Kingston, ON |
|
1947-1969 |
G.W. Dunning, MB, FACS |
Ottawa, ON |
| 1948-1953 |
V.F. Stock, MD |
Toronto, ON |
|
1952-1975 |
Gordon A. Copping, MD, CM, FRCPC, MRCP (Lond.) |
Montreal, QC |
| 1952-1988 |
James H.B. Hilton,
MD, CM, FRCPC, FACP |
Ottawa, ON |
|
1952-1982 |
T.G. Stoddart, MD, CM, FACR, FACP |
Ottawa, ON |
| 1954-1965 |
H.K. Detweiler,
MD |
Toronto, ON |
|
1954-1969 |
R.E. Smart, MD, DOMS, FACS |
Brockville, ON |
| 1956-1969 |
W.E. Collins, MD,
CM, FRCSC, FACS |
Ottawa, ON |
|
1957-1971 |
R.Gordon Mackenzie, MD |
Ottawa, ON |
| 1964-1997 |
Normand J. Belliveau,
MD, FRCSC, FACS, FCCP |
Montreal, QC |
|
1965-1988 |
F. Norman Brown, MD, CM, FRCSC, FACS |
Ottawa,
ON |
| 1966-1984 |
E. Bruce Tovee, MD,
FRCSC, FACS |
Toronto, ON |
|
1969-1996* |
Stuart B. Lee, MD, FRCSC |
Ottawa, ON |
| 1970-1991 |
W.A. Blair, MD,
CM, FRCPC, FAPA |
Ottawa, ON |
|
1970-1986 |
W.A. Britton, MD, CM, FRCSC |
Ottawa, ON |
| 1970-1984 |
J.F. Fielding, MD,
FRCSC, FACS |
Ottawa, ON |
|
1970-1976 |
G.D. Hurteau, MD, CM Ottawa, ON |
|
| 1970-1994 |
Leslie P. Ivan,
MD, FRCSC, FACS |
Ottawa, ON |
|
1970-1993 |
Robert Jackson, MD, CM, FRCPC |
Ottawa, ON |
| 1970-1976 |
Wilbert J. Keon,
MD, FRCSC |
Ottawa, ON |
|
1970-1992 |
I.M. Todd, MB, BCh, MCFP |
Ottawa, ON |
| 1971-1972 |
A.W. Bruce, MB,
BCh, FRCSC, FACS |
Kingston, ON |
|
1971-1997 |
Christopher F.G. Ellis, MD, FRCSC |
Ottawa, ON |
| 1972-1982 |
Peter Lehmann, MD,
FRCSC |
Vancouver, BC |
|
1972-1996 |
Ruaraidh W. McIntyre, MB, BCh, FRCPC |
Ottawa, ON |
| 1974-1995 |
D. Douglas McKercher,
MD, CM, FRCSC |
Ottawa, ON |
|
1976-1995 |
Hon. E.W. (Staff) Barootes, MD, FRCSC |
Regina, SK |
| 1977-1980 |
Peter J. Beardall,
MD, FRCSC, FRCOG |
Ottawa, ON |
|
1977-1997 |
Patrice Drouin, MD, FRCPC |
Quebec, QC |
| 1977-1988 |
T. Keith Scobie,
MD, FRCSC |
Ottawa, ON |
|
1981-1994 |
Emily J. Gear, MD, FRCSC |
Ottawa, ON |
| 1982- |
W.D.S.Thomas, MD,
FRCSC |
Vancouver, BC |
|
1983-1999 |
John P. Anderson, MD, FRCPC |
Halifax, NS |
| 1983-1995 |
C.M. Burns, MD,
FRCSC |
Winnipeg, MB |
|
1983- |
André Duranceau, MD, FRCSC, CSPQ |
Montreal, QC |
| 1983-1993 |
L.J. Genesove, MD,
CCFP |
Toronto, ON |
|
1983-1996 |
Hugh F. Morrish, MD, FRCPC |
Calgary, AB |
| 1983-1994 |
A.L. Roberts, MD,
CM, MCFP |
Charlottetown, PE
|
|
1984-1987 |
D.M. Bachop, MB BCh, FRCPC |
Vancouver, BC |
| 1984- |
Peter K. Fraser,
MD, MCFP |
Oromocto, NB |
|
1984-1993 |
J.A.
Hutchison, MD, FRCPC |
Victoria, BC |
| 1984-1995 |
W.D. Parsons, MD,
CM, FRCPC |
St. John's, NF |
|
1984-1987 |
A.A. Scott, MD, DA, FRCPC |
Toronto, ON |
| 1984-1996 |
R.W. Sherbaniuk,
MD, FRCPC, FACP |
Edmonton, AB |
|
1985-2000 |
J.F. Alexander, MD, FRCPC |
Regina, SK |
| 1985-1996 |
B.J. L'Heureux,
MD |
Laval, QC |
|
1985-1994 |
G.S. Wallace, MB, ChB |
Victoria, BC |
| 1986-1998 |
M.C. Bouffard, MD,
MCFP |
Sudbury, ON |
|
1986- |
C. Anthony Johnson, MD, FCFP |
Kingston, ON |
| 1987-1996 |
George Mintsioulis,
MD, FRCSC |
Ottawa, ON |
|
1987-1995 |
Marc Couturier, MD |
Val d'Or, QC |
| 1987-1995 |
D.W. Fear, MD, FRCPC
|
Toronto, ON |
|
1987- |
Paul Guertin, MD |
Granby, QC |
| 1988- |
Michael R. Lawrence,
MD |
Vancouver, BC |
|
1988-2000 |
J. Robert Taylor, MD, FRCPC |
Ottawa, ON |
| 1989-2001 |
Neil V. McPhail,
MD, FRCSC |
Ottawa, ON |
|
1991-1996 |
Marvin Silverman, MD, FRCPC |
Ottawa, ON |
| 1993- |
Karen L. Cronin,
MD, CCFP |
Downsview, ON |
|
1993- |
Barbara J. Kane, MD, FRCPC |
Prince George, BC |
| 1993-1996 |
?D.P. Girvan,
MD, FRCSC |
London, ON
|
|
1994-1996 |
W.B. Callaghan, MD, FRCSC |
Ottawa, ON |
| 1994- |
E. Jane Wright,
MB, ChB |
Victoria, BC |
|
1994-1996 |
Kathryn E. Treehuba, MD, FRCSC |
Ottawa, ON |
| 1994- |
William S. Tucker,
MD, FRCSC |
Toronto, ON |
|
1994-2000 |
Robert E. Colborne, MD |
Montague, PE |
| 1995- |
Lawrence E. Groves,
MD, MCFP |
Brandon, MB |
|
1995- |
Douglas F. Birt, MD, FRCSC |
Winnipeg, MB |
| 1995- |
Jean-Joseph Condé,
MD |
Val d'Or, QC |
|
1995- |
Kari G. Smedstad, MD, ChB, FRCPC |
Hamilton, ON |
| 1995- |
David B. Peddle,
MD, FRCSC |
St John's, NF |
|
1996- |
Jacques R. Beauchamp, MD |
Laval, QC |
| 1996- |
Lawrence T. Diduch,
MD, FRCSC |
Edmonton, AB |
|
1996-1998 |
R.E. Fraser, MB, ChB, FRCSC |
Edmonton, AB |
| 1996- |
George E. Yee, MD,
FRCPC |
Windsor, ON |
|
1997- |
Gordon A. Crawford, MD, FRCSC |
Barrie, ON |
| 1997- |
Stephen J. Wetmore,
MSc, MD, CCFP |
London, ON |
|
1997- |
Jean Deslauriers, MD, FRCSC |
Sainte-Foy, QC |
| 1997- |
Louise Passerini,
MD, FRCPC |
Brossard, QC |
|
1997- |
Vyta M. Senikas, MD, FRCSC, CSPQ |
Montreal, QC |
| 1998-2000 |
John E. Gray, MD,
CCFP, FCFP |
Peterborough, ON
|
|
1998- |
Brent W. Winston, MD, FRCPC |
Calgary, AB |
| 1999- |
Kim R. Crawford,
MD, FRCPC |
Liverpool, NS |
|
2000- |
Michael T. Cohen, MD |
Grand Falls/Windsor, NF |
| 2000- |
William A. Easton,
MD, FRCSC |
Toronto, ON |
|
2000- |
Nancy L. Naylor, MD, CCFP |
Fort Frances, ON |
| 2000- |
Sandra S. Wirth,
MD |
Rosthern, SK |
* In 1996 Association executive officers were
no longer Council members. Dr Lee continued to serve CMPA as secretary-treasurer
until 2000
Return to top
Presidents |
| 1901-1934 |
Robert Henry Wynyard
Powell, MD, CM, FACS |
Ottawa, ON |
| 1934-1955 |
John Fenton Argue,
MD, CM |
Ottawa, ON |
|
1956-1966 |
George W. Armstrong, MB, MD, FRCSC, FACS |
Ottawa, ON |
| 1966-1988 |
James H.B. Hilton,
MD, CM, FRCPC, FACP |
Ottawa, ON |
|
1988-1995 |
Normand J. Belliveau, MD, FRCSC, FACS, FCCP |
Montreal, QC |
| 1995-1996 |
Hugh F. Morrish,
MD, FRCPC |
Calgary, AB |
|
1996-2001 |
William D.S. Thomas, MD, FRCSC |
Vancouver,
BC |
| 2001- |
André Duranceau,
MD, FRCSC, CSPQ |
Montreal, QC |
Honorary life presidents |
|
1955-1956 |
John Fenton Argue, MD, CM |
Ottawa, ON |
| 1957-1958 |
Alfred Turner Bazin,
MD, DSO |
Montreal, QC |
|
1966-1981 |
George W. Armstrong, MB, MD, FRCSC, FACS |
Ottawa, ON |
| 1988- |
James H.B. Hilton,
MD, CM, FRCPC, FACP |
Ottawa, ON |
First vice-presidents |
| 1901-1921
|
J.O.
Camirand, MD |
Sherbrooke, QC |
| 1921-1943 |
H.S. Birkett, MD
|
Montreal, QC |
|
1943-1956 |
Alfred Turner Bazin, MD, DSO |
Montreal, QC |
| 1956-1963 |
Ross Mitchell, MD
|
Winnipeg, MB |
| 1964-1971 |
Joseph C. Thomas,
MD |
Vancouver, BC |
| 1972-1988 |
Normand J. Belliveau,
MD, FRCSC, FACS, FCCP |
Montreal, QC |
|
1988-1995 |
Hon. E.W. (Staff) Barootes, MD, FRCSC |
Regina,
SK |
| 1996-2001 |
André Duranceau,
MD, FRCSC, CSPQ |
Montreal, QC |
|
2001- |
Peter K. Fraser, MD, MCFP |
Oromocto, NB |
Second vice-presidents |
|
1921-1936 |
J.S. McEachern, MD |
Calgary, AB |
| 1936-1953 |
H.M. Robertson,
MD |
Victoria, BC |
|
1954-1963 |
Joseph C. Thomas, MD |
Vancouver,
BC |
| 1964-1971 |
Normand J. Belliveau,
MD, FRCSC, FACS, FCCP |
Montreal, QC |
|
1972-1982 |
Peter Lehmann, MD, FRCSC |
Vancouver, BC |
| 1982-1989 |
Hon. E.W. (Staff)
Barootes, MD, FRCSC |
Regina, SK |
|
1989-1995 |
W.D.S. Thomas, MD, FRCSC |
Vancouver,
BC |
| 2000-2001 |
Peter K. Fraser,
MD, MCFP |
Oromocto, NB |
|
2001- |
William S. Tucker, MD, FRCSC |
Toronto, ON |
| SECRETARY
|
|
1901-1904 |
F.W. McKinnon, MD |
Ottawa, ON |
| TREASURER
|
|
1901-1904 |
James Grant Jr., MD |
Ottawa, ON |
Consultants to council |
|
1972-1976 |
Trenholm Laurence Fisher, MC, CM, FACP |
Ottawa, ON |
| 1984-1987 |
E. Bruce Tovee,
MD, FRCSC, FACS |
Toronto, ON |
|
1988- |
F. Norman Brown, MD, CM, FRCSC, FACS |
Ottawa, ON |
Secretary-treasurers |
| 1904-1906
|
James
Grant Jr., MD |
Ottawa, ON |
| 1906-1935 |
John Fenton Argue,
MD, CM |
Ottawa, ON |
|
1935-1971 |
Trenholm Laurence Fisher, MD, CM, FACP |
Ottawa, ON |
| 1971-1988 |
F. Norman Brown,
MD, CM, FRCSC, FACS |
Ottawa, ON |
|
1988-2000 |
Stuart B. Lee, MD, FRCSC |
Ottawa, ON |
| 2000- |
John E. Gray, MD,
CCFP, FCFP |
Peterborough, ON
|
Associate secretary-treasurers |
|
1955-1965 |
James H.B. Hilton, MD, CM, FRCPC, FACP |
Ottawa, ON |
| 1968-1971 |
F. Norman Brown,
MD, CM, FRCSC, FACS |
Ottawa, ON |
|
1977-1988 |
Stuart B. Lee, MD, FRCSC |
Ottawa, ON |
| 1989-1992 |
Manuel Gluck, MD,
FRCSC, FACOG |
Ottawa, ON |
|
1993-1998 |
Robert Robson, MD, CM, FRCPC |
Ottawa, ON |
| 1998- |
Guy Lemay, BA, MD
|
Ottawa, ON |
Assistant secretary-treasurers |
|
1952-1965 |
James H.B. Hilton, MD, CM, FRCPC, FACP |
Ottawa, ON |
| 1965-1968 |
F. Norman Brown,
MD, CM, FRCSC, FACS |
Ottawa, ON |
|
1972-1977 |
Hugh J. Bright, MD, DPH, DHA |
Ottawa, ON |
| 1972-1976 |
Stuart B. Lee, MD,
FRCSC |
Ottawa, ON |
| 1975-1991
|
Pierre
Gaulin, MD, FRCSC |
Ottawa, ON |
1977-1989,
1992-1995 |
Manuel Gluck, MD,
FRCSC, FACOG |
Ottawa, ON |
|
1975-1996 |
Clifford S. Amundson, MD, CCFP |
Ottawa, ON |
| 1981-1994 |
Maurice Patry, MD,
MCFP |
Welland, ON |
|
1985- |
Ruth A. Cottrill, MB, ChB |
Ottawa, ON |
| 1895-1992 |
Orville Messenger,
MD, CM, FRCSC, FACS |
Moncton, NB |
| 1985-1991 |
Edward Mullens,
MD, FRCSC, FACS |
Ottawa, ON |
| 1986-1998 |
Guy Lemay, BA, MD
|
Ottawa, ON |
|
1988- |
Chris J. Parsons, MD, FRCSC |
Burlington, ON |
| 1988- |
Allan R.E. Eix,
BSc, MD |
Port Perry, ON |
|
1989-1998 |
Robert Robson, MD, CM, FRCPC |
Ottawa, ON |
| 1990- |
Anne M.J. Cornet,
MD, FRCPC |
Ottawa, ON |
|
1991- |
Pierre Doucet, MD, FACC |
Valleyfield,
QC |
| 1991- |
Michael J. Hardie,
MB, ChB, FRCPC |
Ottawa, ON |
|
1992- |
William J. Beilby, MD, MCFP(EM) |
Ottawa, ON |
| 1992- |
Thomas C. Heckman,
MD |
Wallaceburg, ON
|
|
1993- |
Indu B. Gambhir, MB, BS |
Cornwall, ON |
| 1993- |
E. Douglas Bell,
MD, FRCSC |
Ottawa, ON |
|
1995- |
Wayne L. Helmer, MD |
Ottawa,
ON |
| 1995- |
Martine L. Gagnon,
MD, FRCSC |
Montreal, QC |
| 1995-
|
James
R. Sproule, MD, CM, CCFP(EM), MBA |
London, ON |
| 1996- |
Robert N. Rivington,
MD, FRCPC |
Ottawa, ON |
|
1996- |
Margot Morrison-Morissette, MD, FRCPC |
Ottawa, ON |
| 1996- |
Philip G. Winkelaar,
MD, CCFP |
Medicine Hat, AB
|
|
1998- |
Patrick J. Ceresia, MD |
North Bay, ON |
| 1998-
|
Louise
Dion, MD, FRCSC |
Montreal,
QC |
| 1998- |
Jacques Guilbert,
MD, MSc, FRCSC |
Gatineau, QC |
| 1998- |
R. James Williamson,
MD, CCFP |
Hull, QC |
|
1999- |
Angela D. Sirnick, MD, FRCPC |
Ottawa, ON |
| 2001- |
Dale McMahon, MD
|
Halifax, NS |
Senior managers |
| 1977-1997
|
Jim
T. Kenward, CA |
Director
of Finance |
| 1997- |
Stephen Campbell,
CA |
Director of Finance
|
| 1987-1989
|
Orville
Messenger, MD, CM, FRCSC, FACS |
Director
of Education |
| 1989-1993 |
Robert Robson, MD,
CM, FRCPC |
Director of Education
|
| 1994-
|
William
J. Beilby, MD, MCFP(EM) |
Director
of Research and Education |
| 1991- |
Jean (Brown) Vanderzon,
Director of CA, MBA |
Administration |
| 1995-1999
|
Richard
Martel |
Director
of Information Services |
| 1999- |
David From |
Director of Information
Technology |
| 1994-
|
Pierrette
Downey |
Director
of Membership |
| 1996- |
Chris J. Parsons,
MD, FRCSC |
Director of Case
Management |
| 1997-
|
Françoise
Parent |
Director
of Communications |
Executive assistants |
| 1952-1982 |
Margaret E. Kells
|
|
| 1982- |
Beverley Allen |
|
General counsel |
|
1901-1934 |
Francis H. Chrysler, KC
Chrysler, Bethune & Larmouth |
Ottawa, ON |
| 1934-1945 |
Edmund F. Newcombe,
KC
Newcombe & Company |
Ottawa, ON |
|
1945-1950 |
J. Douglas Watt, KC
Gowling, MacTavish, Watt,Osborne & Henderson |
Ottawa, ON |
| 1950-1961 |
Duncan K. MacTavish,
QC and Ronald C. Merriam, QC
Gowling, MacTavish, Osborne and Henderson |
Ottawa, ON |
|
1961-1970 |
E. Peter Newcombe, KC
Gowling & Henderson |
Ottawa, ON |
| 1970-1988 |
Charles F. Scott,
QC
Gowling & Henderson |
Ottawa, ON |
|
1988-1995 |
Kenneth G. Evans
Gowling, Strathy & Henderson |
Ottawa, ON |
| 1995- |
Margaret Ross
Gowling Lafleur Henderson |
Ottawa, ON |
Return to top
Progress in protection
1901-2001 (at five-year intervals)
|
YEAR |
MEMBERS |
FEE |
CASES CLOSED |
LEGAL COSTS |
COSTS FOR AWARDS AND SETTLEMENTS |
COSTS FOR EXPERT CONSULTANTS |
|
|
FOR
THE YEAR |
TOTALS
FOR EACH FIVE-YEAR PERIOD |
| 1901 |
0 |
$ 2.50 |
0 |
$ 1,457 |
|
|
| 1906 |
471 |
$ 3.00 |
7 |
$ 1,956 |
|
|
|
1911 |
730 |
$ 3.00 |
18 |
$ 3,962 |
|
|
| 1916 |
762 |
$ 3.00 |
7 |
$ 3,649 |
|
|
| 1921 |
1,268 |
$ 3.00 |
18 |
$ 16,818 |
|
|
| 1926 |
2,163 |
$ 3.00 |
13 |
$ 18,620 |
|
|
|
1931 |
2,427 |
$ 5.00 |
26 |
$ 33,924 |
|
|
| 19361 |
2,975 |
$ 5.00 |
32 |
$ 28,067 |
$ 16,426 |
|
|
1941 |
3,402 |
$ 5.00 |
39 |
$ 34,462 |
$ 13,007 |
|
| 1946 |
4,745 |
$ 5.00 |
32 |
$ 41,141 |
$ 61,591 |
|
|
1951 |
6,651 |
$ 10.00 |
27 |
$ 99,744 |
$ 209,729 |
|
| 1956 |
9,403 |
$ 20.00 |
57 |
$ 90,148 |
$ 138,582 |
|
|
1961 |
12,947 |
$ 20.00 |
65 |
$ 129,322 |
$ 209,268 |
|
| 1966 |
17,275 |
$ 15.00 |
121 |
$ 247,039 |
$ 372,950 |
|
|
1971 |
23,668 |
$ 35.00 |
434 |
$ 1,002,952 |
$ 1,217,121 |
|
| 1976 |
31,421 |
$ 200.00 |
948 |
$ 3,419,601 |
$ 5,091,028 |
|
|
19812 |
35,335 |
$ 350.00 |
2,229 |
$ 10,679,707 |
$ 17,591,724 |
$ 599,763 |
| 19863
|
48,618
|
$1,238.00
|
2,311
|
$ 37,454,173
|
$ 62,907,132
|
$ 3,112,279
|
| 1991 |
54,469 |
$2,583.00 |
3,819 |
$100,471,539 |
$175,720,459 |
$ 9,480,844 |
| 1996 |
56,517 |
$3,827.00 |
4,038 |
$234,044,000 |
$313,513,000 |
$21,232,000 |
|
20004 |
60,099 |
$3,929.00 |
5,319 |
$263,451,000 |
$387,608,000 |
$32,741,000 |
1 Payment of damages was approved
in 1929 but the first payments did not occur until 1932 (and are therefore
not recorded on this chart until 1936). They are currently referred to
as "awards and settlements."
2 Prior to 1977, expert consultant
costs were included under administration (and are therefore not recorded
on this chart until 1981).
3 Differential fees determined by
type of work were established in 1984, and further differentiation by
province of work was introduced in 2001. From 1986, the figures shown
are a weighted average of the aggregate fees.
4 Figures available for four-year
interval only to the end of 2000.
|
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