Eliminate Taxpayer Subsidy of Doctor’s Insurance

Protecting doctors by having the public pay part of their insurance premiums harms true accountability to patients and families.

Read  Kathleen’s Finlay’s  newest arti­cle on why Canada’s sys­tem for med­ical neg­li­gence needs rad­i­cal surgery. 

For years, the Cana­di­an pub­lic has shov­eled mil­lions of dol­lars into sub­si­diz­ing the lia­bil­i­ty insur­ance of doc­tors. The result is the Cana­di­an Medi­cal Pro­tec­tive Asso­ci­a­tion (CMPA), an orga­ni­za­tion run by a group of lawyers that has amassed a war chest of some $2.6 bil­lion to fight mal­prac­tice claims.  So rich has this Frankenstein-like cre­ation of gov­ern­ment become that “The CMPA would spend $100,000 pro­tect­ing the doc­tor against a $5,000 claim,” as one for­mer Cana­di­an judge observed.

It works out well for doc­tors and their lawyers, but it is an insult to any con­cept of fair­ness and account­abil­i­ty for injured patients and aggriev­ed fam­i­lies who seek jus­tice, or even answers.  Time and again, patients and fam­i­ly mem­bers have con­tact­ed The Cen­ter for Patient Pro­tec­tion to share the night­mare of their expe­ri­ences involv­ing the CMPA

As Uni­ver­si­ty of Alber­ta law pro­fes­sor Ger­ald Robert­son not­ed in a 2008 study, “One must seri­ous­ly ques­tion the effi­ca­cy of a mod­el which com­pen­sates so few who are enti­tled to it.” Only about 2 per­cent of patients injured by neg­li­gence in Cana­da receive com­pen­sa­tion.

Indeed, low-income patients and fam­i­lies who have been harmed by neg­li­gence are often unable to pur­sue their cas­es because they lack the finan­cial resources to do so.  They are not eli­gi­ble for legal assis­tance.  But the doc­tors who may have com­mit­ted the harm­ful act are ful­ly sub­si­dized by tax­pay­er funds when it comes to their legal rep­re­sen­ta­tion. 

This one-sided pub­lic fund­ing of legal rep­re­sen­ta­tion for the med­ical pro­fes­sion prompt­ed former Ontario Chief Jus­tice Charles Dubin to com­ment, “Although it is in the pub­lic inter­est that any per­son charged with a crim­i­nal offence be prop­er­ly rep­re­sent­ed, it seems dif­fi­cult to jus­ti­fy pub­lic expen­di­tures to place doc­tors on a dif­fer­ent foot­ing from oth­er accused per­sons.” 

It is hard to imag­ine how this arrange­ment is not any­thing but a seri­ous imped­i­ment to the con­cept of account­abil­i­ty and, there­fore, to safer patient care. The deal is a crea­ture of pol­i­cy mak­ers in the ear­ly 1900s, a time when ideas about trans­paren­cy and account­abil­i­ty, like the vote for women, the min­i­mum wage, child labor laws and fed­er­al inspec­tion of meat prod­ucts, were non-existent.  

This is 2015.  It’s time to end this unique­ly Cana­di­an med­ical gravy train.

Read Kath­leen Finlay’s wide­ly quot­ed arti­cle on the CMPA in The Huff­in­g­ton Post.

(Kath­leen Finlay’s views on the need for elim­i­nat­ing gov­ern­ment fund­ing of the CMPA and reform in Canada’s med­ical tort sys­tem are quot­ed in The Ottawa Law Review)

Fur­ther read­ing on the sub­ject, from the per­spec­tive of patients and fam­i­lies, is avail­able at these links:

More read­ing    |  More read­ing   |   More read­ing


  1. The Cana­di­an Med­ical Pro­tec­tive Asso­ci­a­tion

    Modern public scrutiny

    Excerpt from Wikipedia

    In 2003, CBC News broad­cast Inside the CMPA, the first in-depth look at the Cana­di­an Med­ical Pro­tec­tive Asso­ci­a­tion. Fea­tured was for­mer CMPA insid­er Paul Harte who broke with that orga­ni­za­tion and is now high­ly crit­i­cal of it. Harte offered first­hand, mate­r­i­al knowl­edge of the orga­ni­za­tion. The broad­cast dis­cussed five patients (Mor­gan Byst­edt, Bet­ty O’Reilly, Shan­non Shobridge, Anne McSween, and Lor­raine Emmonds) who suf­fered seri­ous injury or death due to med­ical neg­li­gence. They were sub­ject­ed to what some have described as delib­er­ate wearing-down tac­tics from the CMPA. Lawyer Pete Mock­ler was quot­ed as say­ing, “…the CMPA fights them so hard… They basi­cal­ly take the view that any­one suing a doc­tor is in the extor­tion busi­ness.”

    Paul Harte, along with for­mer B.C. Supreme Court judge Thomas Berg­er, also spoke out in the CBC broad­cast:

    It is dri­ven by pro­tect­ing the doctor’s rep­u­ta­tion, almost at all costs. The CMPA would spend $100,000 pro­tect­ing the doc­tor against a $5,000 claim. The CMPA may keep a low pro­file, but if you sue a doc­tor, it’s almost always the Cana­di­an Med­ical Pro­tec­tive Asso­ci­a­tion run­ning the show. Ninety-five per­cent of Cana­di­an doc­tors are mem­bers. Just how far will the CMPA go to pro­tect a doc­tor? The legal strat­e­gy is well worn: Deny the doc­tor did any­thing wrong, even when the neg­li­gence seems pret­ty clear. That’s their strat­e­gy. It’s coor­di­nat­ed across the coun­try. It’s intend­ed to make these cas­es as dif­fi­cult as pos­si­ble for plain­tiffs. The truth is, few plain­tiffs – or their lawyers – sur­vive the CMPA’s suf­fo­cat­ing tac­tics.” [7]

    Public financing

    Crit­ics argue that pub­lic mon­ey should not be used to defend doc­tors accused of neg­li­gence or oth­er wrong­do­ing[8] Civ­il tri­al lawyers fear that sub­si­dies paid to fund the defence of doc­tors cre­ates an unequal play­ing field for patients who hope to pur­sue a med­ical neg­li­gence case. They argue that the gov­ern­ment is fund­ing one side of a legal dis­pute, but not the oth­er.[9] For­mer Ontario Chief Jus­tice Charles Dubin com­ment­ed that: “Although it is in the pub­lic inter­est that any per­son charged with a crim­i­nal offence be prop­er­ly rep­re­sent­ed, it seems dif­fi­cult to jus­ti­fy pub­lic expen­di­tures to place doc­tors on a dif­fer­ent foot­ing from oth­er accused per­sons.” [10]

    One MD was charged in crim­i­nal court for sex­u­al­ly assault­ing mul­ti­ple patients, was con­vict­ed, then was sued by those vic­tims in civ­il court. The CMPA fund­ed the doctor’s crim­i­nal defence, and lat­er the CMPA fund­ed the doctor’s civ­il defence. The CMPA, how­ev­er, will not pay civ­il dam­ages to a patient assault­ed by a doc­tor even if the assault occurred dur­ing a med­ical exam. This sce­nario is seen by crit­ics as stack­ing the deck against vic­tims attempt­ing to seek redress from physi­cians.[11]

    In 2008, Ontario tax­pay­ers spent $112 mil­lion to sub­si­dize the med­ical mal­prac­tice fees paid by doc­tors. Doc­tors them­selves paid $24 mil­lion, which means tax­pay­ers picked up 83 per­cent of the cost of the mal­prac­tice fees. The sub­si­dies paid to the CMPA are part of a “Mem­o­ran­dum of Under­stand­ing” between the Ontario Min­istry of Health, the Ontario Med­ical Asso­ci­a­tion, and the Cana­di­an Med­ical Pro­tec­tive Asso­ci­a­tion. Details of this Mem­o­ran­dum of Under­stand­ing between the par­ties were kept from pub­lic view until a court ordered it released fol­low­ing a Free­dom of Infor­ma­tion request in 2008.[12]

    For­mer CMPA exec­u­tive direc­tor and CEO Dr. John Gray explained that while Ontario doc­tors’ invoic­es from the CMPA will rise dra­mat­i­cal­ly, the provin­cial physi­cian reim­burse­ment pro­gram will be in effect. ‘‘So their out-of-pocket will be no dif­fer­ent than they were in 2011/12. The mon­ey they pay to CMPA will increase, but they will be eli­gi­ble to have much of that reim­bursed.’’ [13]