Patient complaints against Ontario doctors take too long to resolve and cost too much: government report

Canada’s largest medical regulator is taking too long to resolve its thousands of discipline cases, according to an inquiry commissioned by the Ontario government, with even unfounded lingering for months.

The College of Physicians and Surgeons should appoint a patient advocate to help those who file grievances, and set up a mediation system to streamline the clogged and pricey process, retired judge Stephen Goudge urges in the report.

Discipline cases in the province cost the medical- more than those in all the combined, yet eight in 10 complaints to the college have so little merit they result in minimal or no action, he suggested.

The college is run by doctors, but has legislative authority to handle complaints alleging incompetent or unprofessional conduct, and to impose penalties that can include revoking physicians’ licences.

“Quite simply, too many complaints and investigations are in the system too long,” concluded Goudge. “More time and money is spent on a disposition in Ontario than in other jurisdictions, with little apparent benefit to the in terms of better or safer physician services.”

But medical malpractice lawyer Paul Harte, a frequent critic of the agency, said Goudge overlooked one key cause of complaint delays – the fact doctors often receive free legal representation from the Canadian Medical Protective Agency.

The CMPA is a non-profit group that provides liability coverage to most doctors in the country, and in Ontario, as in many other , the premiums are mostly paid for by the government.

“When you have one side, the doctors, who have almost unlimited legal resources, and the other side has limited resources, that imbalance is going to lead to delay,” said Harte. “Should the public be providing legal aid to doctors for complaints to an administrative body? … Any time you have a you don’t pay for, that tends to be over-utilized.”

He believes that barring doctors from CMPA coverage for college cases is one way to speed up the discipline process and encourage doctors to improve their work.

The province has also voiced concern about the rising cost of subsidizing doctors’ liability coverage.

But Dr. Nadia Alam, president of the Ontario Medical Association, said her group fully supports Goudge’s ideas for fixing the system.

“The length of time it takes to sort out CPSO complaints doesn’t make sense for anyone,” she said.

The college received an average of 2,412 complaints a year from 2010 to 2014, almost 50 a week, according to Goudge’s report.

Ontario has 40 of the country’s doctors, but 50 of the discipline cases, which absorb more than 60 of the CMPA’s lawyer hours for such issues, he noted.

Even the one quarter of cases dealt with the most rapidly took an average of 97 days to close in the period Goudge studied. The average time for all cases until a decision by the investigation committee — the first stage of the complaint process — was 200 days.

Goudge pointed to Alberta’s college as a model. As in that province, an advocate who works with patients from the time they file a complaint could help explain whether a grievance fits into the college’s mandate or should be handled elsewhere.

Goudge also recommended that a college official be designated to dismiss any complaints lacking foundation early in the process, and an alternative dispute resolution — or mediation — system that could settle cases without lengthy investigation.

Goudge’s report was submitted to the Ontario government in February of 2016 but was kept under wraps until Monday, when the Health Ministry posted it online. Laura Gallant, a spokeswoman for Health Minister Helena Jaczek, said some of the recommendations were included in a broader bill last year on health-care regulation.

The fate of the rest of his advice is now up in the air until at least June 7, when an election could usher in a new Ontario government.

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