The Goudge Report Pt. 1 - the Physician Complaint Process

Introduction

Family members and patients who deal with doctors often have concerns about the care they received. Such issues are occasionally dealt with directly by the parties, sometimes through a hospital ombudsman, but most often by a direct written complaint to the College of Physicians and Surgeons of Ontario (CPSO). The CPSO receives the most complaints of any health care Regulator in Canada. When that happens, the physicians involved necessarily seek legal advice and representation. The cost of such counsel is paid for by the Canadian Medical Protective Association (CMPA). This, in turn, is funded by the Ontario taxpayer and the doctors themselves through their insurance payments. Given the dismissal rate of over 80%, the process, while valuable and necessary, was costing the public far more than expected. The Honourable Stephen Goudge was asked to review it and provide recommendations on changes and improvements.

The Complaint Process

The complaint process is an administrative one run by the CPSO and governed by the Regulated Health Professions Act (RHPA). It is a part of every College’s self-regulating responsibilities to ensure that the public is protected and provided with competent doctors. The process usually ends after an investigation by the CPSO. The complaint process operates independently of any lawsuit. Although the CPSO awards no compensation or damages for injuries, it can and does make findings which can lead to discipline, remedial training and other appropriate remedies.

Possible Outcomes of a CPSO Investigation

1. The complaint is dismissed, and no further action is taken where the charge is found to be without merit;
2. Provide advice to improve the doctor's future conduct;
3. Make the doctor appear to be cautioned by the CPSO;
4. Create a program of self-study for the doctor;
5. Create a system of supervision, monitoring and training;
6. Impose restrictions, suspension or termination of the doctor’s practice.

The Goudge Report

The Ministry of Health and Long Term Care commissioned the report from Justice Goudge in 2016. The purpose of the referral was to have him review the process and improve its efficiency and overall cost. The average number of complaints received by the CPSO in recent years is just over 2,400 annually. Justice Goudge noted that more than 80% of public complaints are dismissed after an investigation or conclude with summary advice only. The average time to completion was around 200 days with the statutory limit for completion being 150 days.

The Recommendations

1. The appointment of a Complaints Director as a triage person with the power to dismiss a complaint;
2. The empowerment of a Patient Advocate to review the complaint with the applicant to see if it has merit or can be resolved;
3. The creation of an alternative dispute resolution (ADR) process;
4. The CPSO chart review process should generally limit the number of files reviewed to ten (10);
5. At the start of all Registrars' investigations, the subject physician should be informed of the precise acts that are believed to be misconduct and the Registrar's basis for starting the investigation.

Takeaways

None of the recommendations have been implemented to date despite support for them from at least the CMPA. A primary goal of the recommendations was the creation of a triage system with the ability to dismiss more complaints at an earlier stage. This would seem like a benefit to all sides of the issue. What, if anything, will become of the report is unknown but we will continue to follow any developments. Next week, we will look at Justice Goudge's recommendations with respect to civil actions for medical malpractice.

At Wise Health Law, we rely on our significant experience with the complaint process for all health care professionals, our experience before discipline panels of various regulatory Colleges and Review Boards to provide our clients with exceptional guidance and representation through the often-overwhelming discipline process. To find out more about how we can help, contact us online, or at 416-915-4234for a consultation.

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