Legal and regulatory proceedings

Medical-legal issues and other concerns have surfaced after one year of federal MAID legislation having been enacted.

Physicians who do administrative work require liability protection for the professional medical tasks they perform and also for the non-clinical administrative tasks they perform in support of an organization.

Typically, civil legal actions launched against physicians are initiated by a patient alleging negligence in care, but there are variations to this scenario that can result in more complex litigation involving multiple parties and claims.

Physicians can take reasonable steps to maintain the best interests of the patient in the midst of family disputes concerning the care of children or of elder patients.

The Supreme Court of Canada’s decision declaring the prohibition on physician-assisted dying unconstitutional concerns some CMPA members who object for moral or religious reasons to helping patients end their lives.

End-of-life treatment decisions can be difficult for both physicians and patients, but many issues can be avoided by following the key concepts outlined.

Medical regulatory authorities are making more information about physicians available to the public. This article provides an overview of this trend, and explains how the CMPA helps members.

The practice of marking transcribed reports or entries “dictated but not read” gives rise to medical-legal risks and can create uncertainty for those relying on that information in providing patient care.

A discussion of physicians’ obligations when certifying a patient’s death.

Physicians should understand the role of coroners and medical examiners in Canada, and how and when to provide information to them.

An overview of medical-legal problems resulting from physicians' decisions on whether to report patients with medical conditions that may make it dangerous to drive, or from physicians' decisions on whether to support the reinstatement of a licence to drive.

Physicians who treat or who are asked to treat transgender individuals should be aware of the ethical and legal considerations in these circumstances to avoid allegations of discrimination.

Physicians providing emergency care as good Samaritans often have questions about their legal and ethical obligations and the liability protection available to them.

Changes to the Criminal Code have raised the age of consent for sexual activity. Physicians should be guided by legislation in each province and territory on their duty to report such activity to the appropriate authorities if there are reasonable grounds to believe the child is being abused.

The Canadian medical liability system has evolved to meet the unique needs of Canadians, but there remains an opportunity to enhance its fairness and effectiveness.

Physicians participating in clinical research studies should be aware of their relevant legal, ethical, and professional obligations.

Physicians named in a hospital complaint can feel reassured that due process exists and will be followed, and that the CMPA is available to help.

Polices introduced by the medical regulatory authorities (Colleges) reflect concerns expressed by some in the medical community about the use of marijuana for medical purposes and the challenging role given to physicians and other healthcare providers.

Effective communication and awareness of legal requirements are key to obtaining consent for treatment of children.

While a Supreme Court of Canada decision clarifies that in Ontario, physicians must obtain consent before life support can be withheld or withdrawn, the effect of the decision in other jurisdictions is uncertain.

When working with nurse practitioners, physicians should understand the scope, responsibilities, and accountabilities of these independent healthcare providers, and should communicate clearly and in a timely manner.

Administrative and management practices, data sharing agreements, confidentiality agreements, and privacy impact assessments can help physicians to achieve compliance with their privacy obligations.

Certain provinces have legislation to prevent apologies for adverse events from being used in court proceedings.

Privacy legislation, regulatory policies and professional obligation require that CMPA members take reasonable measures to protect the privacy of their patients' personal health information. With the advent of electronic records, members should be cognizant that encryption can help secure personal health information and may be required by law.

Dealing with the stress of a College complaint is easier when a physician understands the complaint process and receives support, advice, and coping strategies from the CMPA.

Clarity about who is responsible for the care of a patient at any given time improves patient safety and reduces medico-legal risk.

Physicians considering various arrangements for practising medicine, other than the privileges-based model, need to consider any medico-legal implications.

A complaint to a medical regulatory authority (College) initiates a process that warrants a physician's attention and timely response.

Physicians can find themselves in a difficult ethical and legal position when patients refuse to be treated.

Changes in the relationship between physicians and hospitals may have medico-legal implications that could lead to difficulties for physicians, institutions, and patients. Recommendations to address these implications are identified.

In legal proceedings where courts are determining if the care provided met the standard of care, authoritative clinical practice guidelines may be considered as one piece of evidence.

When treating non-resident patients, Canadian physicians are advised to ensure they have adequate liability protection.

This article looks at the changes some provinces and territories have made or are considering making to the Rules of Procedure (also known as the Rules of Court or the "Rules") for expert witness reports in civil actions.

Responding to patient requests for exemptions to wearing a seatbelt while driving.

For many physicians, having a complaint lodged against them with a regulatory authority (College) is stressful. If a College asks for a response to the complaint, either in writing or verbally, CMPA members should seek advice from the Association.

A subpoena or summons to witness requires the person named to attend the court, tribunal, commission, inquiry, inquest or military board proceeding or hearing named in the subpoena.

Physicians should exercise care in modifying or correcting medical records. Suggestions on when and how to go about this are provided.

Key issues for physicians to consider when deciding to provide medical expertise in medico-legal proceedings.

Physicians should carefully consider the meaning and implications of indemnification clauses in contracts with employers, research organizations, governments, health care agencies and others.

Before giving advice on medical matters, even informally, physicians should be satisfied they have considered and documented the relevant information.

Documentation in clinical notes and in reports to third parties should be factual, objective, and appropriate to the purpose.

Considerations in responding to patients' requests for support in acquiring firearms.

Poor charting may be perceived as reflecting less attention to detail and risks the conclusion the care provided was poor.

Recommended ways to promote confidence and effectiveness when testifying in court.

Physicians may be asked to attest to the capacity of a patient if the patient's will is contested or at the time the will is being prepared.

Class actions are becoming more common in Canada.

Ontario court decides that a medical clinic is liable for sexual assault committed by a technologist, who was an employee of the medical clinic.

The CMPA will seek expert opinion regarding a physician's standard of care.

When involved in administrative proceedings (e.g. College proceedings, hospital proceedings etc.), an individual is entitled to fairness. The principles of “natural justice” are explained, and a hospital proceeding is used as a case example.

House calls place the doctor in an unfamiliar situation where it may be more difficult to obtain a history or to perform a physical examination.

Clinical care is increasingly provided by collaborative teams with the promise of better outcomes for patients. This document identifies potential medico-legal risks in collaborative care and proposes solutions to lessen those risks for patients and providers.

Certain practice management issues arise when a physician dies, and should be considered as part of estate planning.

The first paper in this series described the current Canadian medical liability system and how it responds to adverse medical events.