 Providing care outside of Canada
Of interest to all physicians The CMPA is structured to assist members who encounter medico-legal difficulties arising in Canada out of their medical professional work done in Canada. The CMPA does not generally assist with difficulties that arise outside of Canada or that result from care provided outside of Canada, owing to the potential for prohibitively expensive legal actions in other jurisdictions, particularly the United States. In some circumstances, members may be eligible for assistance when working outside of Canada including: travelling with Canadian groups participating at international non-professional cultural events or amateur sporting events; Canadian Forces physicians posted overseas; members working for established charities or missionary organizations; and members providing medical care as part of certain teaching or research programs. In all of these instances, members should carefully consider the matter before participating in the care of patients, and consult the CMPA in advance about the extent of assistance that might be available. These situations are discussed in this article. Practising in a foreign country could mean practising without a licence Significant medico-legal concerns exist when providing care outside of Canada, including licensure and the potential of facing a legal action outside of Canada. Without a licence to practise in a foreign country, travelling Canadian physicians could find themselves accused of practising medicine illegally. With or without a foreign medical licence, physicians could find themselves facing litigation in a foreign country without adequate professional liability protection. Where possible, members are encouraged to make inquiries about licensure with the regulatory authority (College, State Medical Board, etc.) in the foreign jurisdiction. Many countries where missionary work is being done do not have established medical regulatory authorities. Under these circumstances, physicians should at least ensure the host hospital or any local sponsoring agency has resolved any privileges issues. Finally, to be eligible for CMPA assistance, members travelling abroad must continue to hold a Canadian medical licence. Travelling with Canadian non-professional cultural or sport groups The CMPA will generally extend assistance to members who provide care to the members of a Canadian non-professional cultural or amateur sport group, where the members of the group or team are residents of Canada who will return to Canada, and where the care provided by the member is limited to “advanced first aid.” The CMPA may also consider extending assistance where the member provides care to a team member, who is not a resident of Canada, but who is competing for a Canadian national team. Members of the group/team who require medical care beyond “advanced first aid” should be transferred to the care of local physicians who have a licence to practise in the host country. The CMPA will generally decline assistance with matters arising from care provided outside of Canada to individuals who were not official members of the group/team, such as family members, friends, media and Canadian diplomats. However, the CMPA may consider extending assistance where the care was provided in a true emergency. Again, members are expected to transfer the care of these individuals on to a local physician as soon as possible. CMPA members who agree to travel with Canadian groups internationally should clarify with the group the limitations of their medical care before leaving. They should also contact the CMPA beforehand to discuss their eligibility for assistance from the CMPA when outside Canada. In some circumstances, CMPA members may be advised they may not be eligible for the Association’s assistance, and therefore may need to arrange their own professional liability protection. In anticipation of requests to treat individuals accompanying the Canadian group/team, travelling CMPA members should consider contacting the Canadian embassy or consulate in the foreign jurisdiction ahead of time to establish contacts in the foreign medical community, to whom they can refer Canadian visitors with medical problems. Canadian Forces physicians Military physicians (including both government/military employees and contract civilian specialists) who are CMPA members will generally be eligible for assistance with medico-legal matters brought in Canada arising from treatment provided during foreign deployments to Canadian military personnel, residents of Canada who are working for the Department of National Defence, and residents of Canada who are visitors at the military base. Military physician members should generally look to the Crown for assistance and indemnity with medico-legal matters arising from the treatment of foreign military and civilian personnel in foreign jurisdictions. Military physician members who treat non-residents of Canada in Canada are generally eligible for assistance with legal matters brought in Canada, in accordance with the CMPA’s guiding principles outlined in “Treating non-residents of Canada”. Military physician members may also be eligible for CMPA assistance when doing educational and missionary work in local communities abroad, except in the United States and all other countries where the U.S. legal system is applied. Members are encouraged to contact the CMPA in writing prior to leaving Canada to determine their eligibility for assistance. Military physician members who wish to maintain membership during foreign deployment will pay the membership fee corresponding to their type of work and the fee region where their home military base is situated in Canada. Providing medical care for established charities or missionary organizations CMPA members who work for established charities or missionary organizations may be eligible for assistance while they carry out such work outside Canada, except for work performed in the United States and all other countries where the U.S. legal system is applied. The CMPA has a separate fee category
(type of work To determine their eligibility for CMPA assistance, physicians must provide to the CMPA the following information in writing prior to leaving Canada:
Providing medical care as part of an acceptable teaching or research program (such as visiting professorship) CMPA members involved in teaching and/or research will generally be considered eligible for CMPA assistance with medico-legal matters arising from their professional work outside Canada, except in the United States and all other countries where the U.S. legal system is applied. Teaching/research work abroad CMPA fee category nine (type of work code 9) applies to periods of work abroad from three to 12 months. For periods of less than three months, members are generally eligible for CMPA assistance under their current type of work and fee region. Eligibility for assistance for work abroad will not be extended for periods in excess of 12 months. To determine eligibility for CMPA assistance, physicians must provide to the CMPA the following information in writing prior to leaving Canada:
While it may be reasonable to accept payment or honorarium of minimal value or reimbursement of expenses, the CMPA will not generally assist with matters arising outside Canada where the member receives a salary or is paid a fee (such as for services provided to the patient). Members acting as a teacher or participant in a course that involves patient contact in the United States will not generally be eligible for assistance. Members should ensure that the centre or organization sponsoring the course provides adequate liability protection. Members are reminded they should comply with any licensure requirements in all applicable jurisdictions and satisfy themselves that the host hospital has resolved any privileges issues. The bottom line
It must be emphasized that, except in the
provision of “advanced first aid” to Canadian
Members who want further clarification and assistance are encouraged to call the CMPA.
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