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I feel there is already enough transparency at the College. I do not agree to the listing of any more personal confidential information online!
It would appear that the most egregious offences occur during the IME conducted for the Insurer. The doctor writes his part and the Quality Control Ghostwriter inserts a few biased prejudicial remarks or exaggerates
the findings or leaves out key information.
The patients complain to the lawyer instead of the CPSO.Years later at arbitration the issue might be mentioned ,but since thre is no formal complaint the Doctor once again escapes discipline.Meanwhile the patient has carried these memories of abuse for years.Therefore the used car salesman has been elevated to sainthood while the IME Docter and Insurance Adjuster now are the pariahs.
IF my Complaint #41 is not printed, then, for sure there is censorship and corruption.
Doctors, “heal thyselves’!!
It’s easy to say that if you are not a car accident survivor who is sent to a insurer examination. If you were hurt, you would want rules and transparency in place to protect you at a time when you can’t look out for yourself. You would want transparency so greedy physicians don’t get a chance to hurt you just so they can line their pockets with big bucks from your insurance company.
If the purpose of transparency is to promote accountability I am all for it. I feel the CPSO would be doing the cause a great favour by immediately putting in place a program that ensures accountability for all actions taken by the CPSO.
The principle of accountability must of course apply to all staff and members, from the council president to the person who answers the phone.
The CPSO has great power and must not only act with fairness but be seen to act with fairness. I suggest creating a system whereby those members who fail to adhere to strict principles of fairness and natural justice while carrying out their work for the CPSO can be taken to task. This will greatly help ensure the trust of the profession and the public.
If you can solve the problem of who will watch the watchmen I for one would become a strong supporter of the role of the CPSO.
Thank you Mr or Ms Physician. I am an accident victim of a near-fatal MVA in 1997. I was treated fairly and with respect by my insurers and my care-givers. I have no complaints. What disturbs me now, however, is the abundance of cases in which the accident victim has been treated with neither fairness nor respect. I have been made sadly aware of the great number of so called “professional” medical assessments that have weighed in favour of insurance companies’ denying claims.
Transparancy to me means being able to be provided with all information regarding an accident victim’s case. Transparency is not judgement — it is merely unhindered openness. It should be the expected and legislated norm. Deviations from it can then be identified and investigated.
Makes sense. Transparency and accountability of the CPSO as a body is also in the public interest.
How does the CPSO choose which doctors to go after and which doctors to leave alone? The criteria chosen for investigating complaints should be transparent too.
Motor vehicle accident victims who complain about assessments are often turned away and even if an injured person pursues the complaint it is kept secret from the public. I’ve been injured in a car accident and the way my insurance company and their independent doctors have treated me is disgusting. From the orthopedic surgeon who suggested (a threat) anesthetizing me to see if I really could turn my head despite my spinal cord injury, to the assessment mill GP who remarked that my high blood pressure was ‘fear of white coat’ syndrome (I had a heart attack shortly after that). And then there was the assessor who worked out of the basement of his home and where I had to cling to a wall to reach the entry because the steps were uneven (all 25+ steps) and no handrail in sight. Or the assessment mills run by Ontario’s physicians where I’ve been left sitting in a chair for 6+ hours waiting to be seen in crowded waiting rooms full of other accident victims being abused this way. The college seems to have no concern about their members who examine accident victims and is using the absence of transparency to shield and protect some pretty sketchy characters to keep the disabled in the dark. Survivors of car crashes look at the medical profession in a whole different way after finding out it is a free for all abuse system that the college is ignoring. ‘Principle 2: Providing more information to the public has benefits, including improved patient choice and increased accountability for regulators.’ Maybe it’s time to start treating accident victims like patients who need care instead of treating them with disrespect. Shouldn’t doctors be living up to their promise to do no harm?
I reading the principles I found them too vague and wordy to really understand clearly what they are suggesting. Maybe I need clear guidelines and a decision tree to see how they work in practice.
when my undertaking is posted so that all the people who want to look it up can, it means that my income stream is threatened. I am depending on the prospect of inertia (that most people, referring doctors and patients alike) don’t bother to look me up.
I bet you (not you, personally, but the College) that when I am laying down the law about my prescribing practices in narcotics use I am going to get a number of desperate withdrawing opioid tolerant patients who are going to threaten to tell the College about me, with the rationale that I can be cowed by the prospect of the College paying any attention to me whatsoever (and frankly I think that might work with some doctors who would rather die than have the College start some other investigation into their practice with the Colleges’ many unconnected and non-communicating silos of authority and responsibility).
I draw to your attention my current situation and my tiny small practice in pain management whilst trying to comply with an undertaking that has nothing to do with my practice in pain management. It wasn’t brought to my attention until the very last week of this long and painful process (I mean drafting the undertaking, not the rest of the College process) that I had the option of just continuing my pain practice and not signing the undertaking about OR anesthesia. So that means that with a good lawyer and one that I communicated well with, I was still under a vast misapprehension about what signing that undertaking meant and whether I had any choice about signing it if I wanted to continue to practice in any way.
I am trying to clarify that the undertaking being transparent to the public AND the referring profession may be problematic in the time frame of also feeling like the College processes have destroyed your life.
Do you have any email addresses for my information on what has happened to me during the years that the college has been working its way up to drafting the undertaking?
Thank you for the opportunity to provide my view.
I agree with all the other statements – especially that the principles are very vague. I’ve read that there is a push to make the complaint process public rather than continuing to post outcomes. I feel strongly that to post accusations without findings or resolutions would unfairly smear a physician and would make us all vulnerable to disgruntled patients. Even if the complaint is dismissed it will take its toll on our performance, our confidence and our income. If there is indeed consideration given to changing the timing and information offered about complaints and discipline committee decisions then all doctors should be advised explicitly and in time to register opposition to the decision.
There is a need to make the process transparent to protect the vulnerable patients. Yes, there is a price to pay by the medical community but so far it’s been a free ride for them while the disabled, the ill and challenged have been paying a price. The system has become unsafe. Disabled people are rightly ‘disgruntled’ and are tired of having their good names smeared in a court of law so some expert can make a few bucks. There’s a toll taken there too and its pretty unfair especially since a insurance doctor often stands in the way of getting prescribed treatment from a family doctor. Is it really better to stay quiet about that?
The College needs to think more about “good governance”, …”less about transparency and more about limiting deception.”
The College needs to communicate “in ways that are open to assessment”.
The College and the CMPA work together to protect the doctor, who may have learning needs and/or psychosocial needs, however, the process should never permit or promote a doctor to believe he or she has a “license to deceive”.
Patients (known only as “Complainants” to the CPSO) need an organization to represent their interests. This organization needs to be as powerful as the CMPA. Let’s call it the Canadian Patient Protective Association -CPPA.
This CPPA needs to have as it’s mandate Patient Safety and Patient Well-being.
The CPPA would promote transparency by having the vision to eliminate deception through the initiation of transparency in College Investigations.
The investigative process needs to become transparent. It must be an honest process, where the patient’s voice matters.
Active listening by the CPPA would allow the patient voice to be heard and a transparent process would permit patients’ genuine concerns to be addressed.
Engaging a CPPA would promote honesty, transparency, patient safety and trust.
When I complained about a doctor many years ago, it was never my intention for him to lose his license. I did however, believe that the doctor could be very unwell and I believed his care needed to be questioned.
I couldn’t see the doctor as a victim requiring the full support of the CPSO and the CMPA. I couldn’t see that the investigation would be carried out in a frivolous manner.
We cannot afford to have doctors inadvertently learn that deception works.
No doctor should ever be given a license to deceive, and the CPSO’s investigations need to become much less frivolous in order to prevent that from happening.
A CPPA could ensure the doctor, the investigator and the process are transparent.
Doctor’s need to be protected, but patients need protection too. There needs to be a balance, and I believe a CPPA could achieve that balance and bring us all the transparency we need.
I agree, the deck is stacked against those who complain about how they are treated and then the system set up to protect them, causes more harm. In the case of Third Party medico-legal assessments – the physician doesn’t owe a duty of care and isn’t treating that person. This exempts them from accountability in some ways and yet they make use of the CMPA, a publicly funded medical defense organization. How does that work? Not treating people as patients and yet making use of systems as if they are. The scorched earth policy of the CMPA has done as much damage as this lack of transparency, may be more so because those who commit offences against patients feel free to do so, protection is built in. I made a complaint many years ago about a insurer’s physician assessor who, for the thousands of car accident victims he screwed over in his practice, should have lost his licence. The whole time the College said he had no disciplinary actions against him and then I found out through HPARB when I appealed that he was no novice at beating up the disabled. All kinds of complaints kept secret by the College – if I had known, I would never have attended the examination. That made up assessment is still in my medical file somewhere – the college gave him an ‘oral caution’ and all the other victims of his crappy reports the shaft. Dozens of complaints kept from patients – you could call up today and the lie that he has no complaints is still in place and causing harm – this miscreant excuse for a doctor has seen thousands of accident victims and I’m sure never helped one of them – in fact likely harmed all of them. It took me years to undo what he did and get the treatment I needed. The college needs to do their job – protect the public. And stop giving the insurance company doctors a free pass to harm accident victims.
I believe one of the principles should be that any patient complaint or college investigation on a physician should not be made public unless both the following are met: 1) the physician is found guilty of the complaint or investigation 2) if the complaint or investigation is not dismissed, then the publishing of the findings is necessary for public safety.
Patients need access to critical information in order to trust their doctors and the College.
If for every complaint about a doctor’s “communication style”, he or she were to be given an amber light notation – the public would know that, although the doctor may be a very competent professional, the patient would be better served by employing a therapeutic communication style in order to receive the best care the doctor can provide.
Perhaps a Canadian Patient Protective Association could offer on-line courses for patients on therapeutic communication.
If for every concern about a doctor’s “documentation” there was an amber light – the public would know that they need to access and manage their file to ensure the doctor has not made an error.
Perhaps a Canadian Patient Protective Association could offer on-line courses for patients on self-management of their documentation.
Other reported concerns (innocent errors) could receive a amber caution light as well.
To err is human, and innocent errors will happen, but learning is vital. Other concerns, such as errors unrelated to communication and documentation could receive amber light designation too.
If there was a way of comparing the number of amber lights for communication, documentation, and other concerns, then that would provide patients with the objective evidence they need to protect their health and well-being.
Perhaps there could be time limitations for the amber light designations and as the designations decreased over time, it would be very evident to the public that learning had been achieved.
The College could communicate to the public where additional information can be found in regards to civil lawsuits. In addition, the reality concerning access to justice for injuries less than one hundred thousand dollars should be clearly communicated. Links to additional information on this matter could prevent years of additional unnecessary harm for the patient.
CPSO membership requires participation in academic development activities. Many of us participate in Alternate Funding Programmes that involve detailed submission of academic activities on an annual basis. These are carefully reviewed by peers in our university departments. Membership in the AFP typically demands a higher level of academic activity than is required for Royal College maintenance of certification programmes. I would propose that satisfactory maintenance of AFP standards be regarded as acceptable for MOCOMP purposes.
I have some concerns regarding the changes to the information to be available to the public. Whilst I agree with the principle of the public having access to information regarding limitations on doctors’ licenses, or disciplinary proceedings for proven misconduct, it is not appropriate for a doctor’s reputation to be tarnished or patients’ trust to be lost because an allegation is listed on the website.
It is not appropriate for patients’ health and well-being to suffer additional unnecessary harm or patients’ trust to be lost because the Investigator for the College repeatedly dismisses patients’ genuine concerns.
A doctor’s reputation is tarnished by his or her own doing. Disclosure of physician information in an open manner in turn gains trust of the public. Is it appropriate that potential patients be put at risk if only one doctor’s reputation is to be saved?
There is need for zero tolerance for all personnel involved in the administration of professional self regulation who practice xenophobia and/or cronyism. One way to do this is for the College to prescribe the tenure period which an officer can hold in any given position so as to avoid their getting entrenched.
Make the Investigative Process transparent.
Start by making medical experts accountable for their opinions. Their opinions must be based on the evidence in the literature as well as in the patient’s charts which is made available to the patient as well, for questions and concerns which would need to be addressed by the medical expert in the investigation.
Your recently revised policy didn’t clearly state how doctors would be held accountable for biased reports. If biased reports are still permitted, then harm continues to be promoted.
The CPSO could provide advanced education for medical experts. They could allow CME credits for competent, analytical investigations. Biased reports are a threat to patient safety.
The CPSO could utilize the Canadian Patient Safety Institute’s (CPSI) Incidence Analysis for College Investigations rather than their usual strategies for serious concerns, whatever those may be.
Make the College a learning organization, rather than an organization which strikes fear in good doctors, and at the same time, permits and promotes unnecessary harm to patients.
“The public protection work of the regulator must not only be done, it must be seen to be done.”
Due to self regulation,and lack of provincial enforcement,accountability is forgone.It is egregious when a professional institution,or publicly funded health organization fights harder to trivialize an evidence based complaint via inaction rather than analysis.Leaving their members with an air of entitlement to treat patients, including IME consults in a manner in which they wouldn’t treat themselves.
1. Have we achieved a good balance between public protection and fairness/privacy?
Initiatives like the RHPA,and the Excellent Care For All Act needs to have a clear government driven enforcement path for the public. Privacy,complainants,including whistle blowers should be assigned a number to protect their identity,or they could face unwarranted discriminatory treatment by medical professionals.
2.Have we left out any significant issues in regards to regulatory transparency?
Delivery of the information should be clear,and summarize by category [eg.penalty,remedial,dismissal] number of issues.Where the public has the ability to click on a medical professional’s online profile to review specific reviews,or disciplinary action.OR be provided the information if they were to phone a professional college,or organization.ALL qualified issues should be made available, let a patient decide what’s insignificant. Remuneration,public funding, licensing [suspension,loss] should be impacted based on the number,and severity of problems.Where a victim can benefit from their financial penalty.Having skin in the game should incent many,and maybe deter misconduct.
3.What other factors should we consider when it comes to the principles of transparency?
Action,otherwise tax dollars are wasted on yet another “review.”
The CPSO’s Medical Professionalism and College Policies were written in 2007 to articulate the profession’s values. These values of compassion, service, altruism, and trustworthiness also need to provide the foundation for the Transparency Principles.
“Medical professionalism is the translation of these values into practice and underpins the social contract between the medical profession and the public: in return for the privilege of self-regulation, the profession makes a commitment to promote the public good.”
Investigations by the College should ensure that the profession’s values are upheld. The College has to be seen as having a backbone, and these values of compassion, service, altruism, and trustworthiness must serve as the backbone of the Transparency Principles.
Compassion: The College needs to have a deep awareness of the suffering of complainants (patients) coupled with the wish to relieve it through the effective and efficient resolution of complaints.
Service: The CPSO, (unlike the Canadian Medical Protective Association, CMPA, which puts the needs of doctors first), has an ethical and statutory responsibility to ensure honest, competent investigations. The CPSO must put the needs of the complainant (patient) above the needs of the doctor.
Altruism: When performing investigations, the College needs to ensure that the public’s needs are paramount. The defendant doctor, if ill, must be given the care he needs, but this cannot be done at the expense of public safety.
Trustworthiness: This is the “cornerstone” which demonstrates compassion, service and altruism, and earns the CPSO the trust of the public.
The CPSO needs to have zero tolerance for incidences of altered documentation, withholding of evidence, or disruption of the investigative process. The College must protect the public’s interests, and disruptive behaviour cannot be permitted.
The College needs to encourage the Canadian Medical Protective Association (CMPA) to protect the doctor’s interests, but also make it very clear that altered documentation, withholding of evidence, and the promotion of disruptive behaviour will have negative consequences.
A fearful doctor may want to withhold the truth in his response to the College, but lawyers for the CMPA, in fully protecting the doctor, must ensure that the doctor fully understands that deceiving the College will not be tolerated.
Patients cannot make healthy choices without having the facts.
Make the public aware of the FACTS which legislation permits and the CPSO promotes and make it available in clear, easy to understand English and French.
In fact, many languages, including sign language, should have access to the facts in order that we can make healthy choices.
Patients may get a novice doctor or they may get an expert.
Patients may get a doctor who makes an innocent error because they are not yet fully competent in an area. Additional learning should be carried out in a nonjudgmental fashion. Patients should receive an apology, and the doctor should receive all the support they need from both the CPSO and the CMPA.
On the other hand, patients may get a doctor who has been successfully defended by the CMPA a large number of times, and has become, with the aid of the experienced investigator, an expert in defending their reputation.
Complainants (patients) are given no support, and in some cases, further unnecessary harm happens to them. They would have been much better off not to complain at all.
Future patients are more at risk – which was the exact opposite of the Complainant’s intention – and should be the exact opposite of the College’s intent.
The College Transparency principles need to permit and promote learning and have zero tolerance for the permission and promotion of fraud.
Firstly, by using the term ‘non-physician’ instead of ‘Member of the Public’ it is clear that the public is considered less than a physician.
I don’t think that details of a complaint( a derogatory word for someone making a report to the College) should be made public although a notation that a fact finding process is in place.
It is imperative that any undertaking made with the Executive Committee be noted on the register. I would bet that the CMPA and OMA would fight this all the way.
Text uses jargon. Define “transparency” in CPSO context.Ask a lawyer to revise and use simple,clear English.
Nowhere is the need for increased health regulatory transparency greater than in Ontario’s auto insurance “Independent Medical Assessment” system. It’s integrity is in tatters. It is proliferted with “hired guns” (see Justice Osborne’s Access to Justice Report) who rely on a steady stream of injured auto accident victims for IMEs intended to challenged the diagnosis and prognosis of attending physicians. Doctors (eg. Dr. Micheal Lacerte) who recruit and train these IME “specialists” in “insurance medicine” say this is a “highly lucrative” area of practice. The Ontario auto insurers’ stable of “preferred vendors” of IMEs bil insurers three times what treating doctors bill OHIP for equivalent services. Many of these IME specialist in insurance medicine find, on the basis of their “independent” assessments that vitually all auto accident victims are malingerers. One such IME vendor told the CPSO exactly that – yet he was issued a “secret caution”. Another prominent IME vendor wrote in his “IME – the Gold Standard” article that he believes at least two thirds of injured auto accident victims as symptom exaggerating fraudsters. Many of the auto insurers’IME vendors say in conference speeches that attending physicians are corrupt and provide “useless treatment” that manufactures disability. This is the subset of “impartial” doctors who decide the fate of njured accident victims. Legislation is pending that will allow the auto insurers to fine an accident victims $500 for failing to submit to a scheduled IME. Adjusters tell injured claimants the IME vendor to whom they must submit is highly qualified and completely impartial. And yet that is not always – or even often – true. And the College knows it. And yet a senior College executive told the Medical Post in 2007 that he isn’t worried about complaints about insurer medical assessors. Isn’t it a bit silly to be issuing “educative” reminders to professional second opinion vendors that they ought not use inflammatory language in the “neutral” IMEs. Isn’t it a bit silly – and more than a bit dangerous – to issue a secret caution to a preferred vendor of insurer assessments who tells the College that he believes all injured accident victims are fakers? Why is the College protecting full time second opinion salesman from accountability? Why are injured auto accident victims – some of whom are highly vulnerable – kept in the dark about the fact that the “highly qualified and completely impartial” medical assessor to whom they must submit for an insurer commissioned “independent” second opinion has previous complaints and multiple ‘secret’ educative advisories and cautions. If Ontario’s doctors think this is how to protect the public – they ought to be ashamed. This is how to protect doctors who sell “favourable” assessments to auto insurers for a living. Period.
I think it is important to highlight that the purpose of any regulatory body is to protect the public. Sorry doctors, this is not about you, but about what the public wants and needs to make informed choices. What does it say about your College when people can get more information from Rate My MD than from the body tasked with regulating the practice?
If the public is telling you they want to know about cautions and warnings then you have an obligation to comply.
The public, and physicians, need to remember that these warnings are issued AFTER the investigation and when the College decides that there was wrongdoing. Therefore, making these public does nothing to the large amount of complaints the College will see that do not require any action. The public just wants to know, as it values the opinion of the College, which doctors need a tune up and why. This is especially true in Medical Legal domains where honestly some of the “independent assessments” are far from “independent” and people feel the need to complain as they felt violated and wronged by a physician that was paid $2000 to spend 20 minutes with them before writing a report calling them a malingerer.
I am a member of another regulatory body and I can tell you that the CPSO has an opportunity to change the game here. What you do, the other College’s will follow. As a RHP I support my clients, and the public in general, to accessing information about my profession that helps them feel informed in their choice of who to hire (or not). The good doctors will prevail here, as they should. That is the point.
Your “secret cautions” issued to some of the Ontario auto insurers’ rogue, “preferred vendors” of IMEs – and the College’s expressed indifference to the consequences for injured accident victims of their shoddy, abusive IMEs (eg. Dr. Gerace’s “no worries” cavalier attitude in a 2007 Medical Post column) – have combined to allow hundreds – maybe thousands of Ontario auto accident victims to be abused by wrongful accusations of malingering proffered by “hired gun” medical assessors. And now your paternalistic yattering about whether the public might become too “confused” if given more information adds insult to the harm the CPSO has for too long been up to its neck in perpetrating. And all this to protect your members who sell “favourable” medical assessments to auto insurers rather protect the public. Perhaps it is the CPSO policy makers and its executive who are confused? Your pompous buffoonery and arrogant hand-wringing over potentially confusing the public with too much information is tragi-comedy writ large.The CPSO has become a danger to the public.
The public should have access to all information you have about doctors in Ontario. As the organization dedicated to protecting patients, this is your duty. I should know about my doctor’s performance record, record of complaints, investigations, discipline, etc. The CPSO should also make this easily accessibly, not buried on a website. I think this approach would encourage doctors to improve, which is good for everyone. Thank you.
Here is a very important principle:
“The driver of fear is secrecy and shame, and the antidote is honesty and transparency.”
Secrecy and shame drives fear and also encourages further unnecessary harm, fueling further secrecy and shame.
The antidote – honesty and transparency, needs to be permitted and promoted.
The medical and legal systems need to work together to provide the necessary antidote in a timely, effective manner.
This would encourage healing, and learning for both the doctor and the patient.
The current system does not permit and promote listening to the patient. It does not promote healing. Listening and healing are so important to the patient who has not felt heard by the doctor.
Transparency and accountability should start with the investigators. CPSO investigators who give misleading information or who violate legislated health regulations and rules such as withholding medical records should be held accountable.
The CPSO must be genuine, honest, fair, and just in its decision making dealing with complaints, not protecting bad doctors and further harming the complainants.
There should be zero tolerance to incompetent doctors who deny mistakes and wrongful deeds by deception and lies.
The general public should have the right to access physicians’ public records regarding complaints, investigations, professional misconduct, surgical complications and mortality rate. Our well-being relies on available information and we will have a safer health care system.
I once complained about a general practitioner who, at the time, was one of the Ontario auto insurers’ “preferred” vendors of second opinions used to paint injured auto accident victims as malingerers. Upon receipt of my complaint the CPSO investigator wrote a letter stating that the CPSO has no jurisdiction over doctors who specialize in insurance medicine and that I should take my complaint to FSCO which regulates Ontario auto insurers’ and deceptive practices. That this doctor passed himself off as an “orthopaedic surgeon” was of no concern to the College. I then complained to HPARB and they told the College it does have jurisdiction over Ontario doctors who sell medico-legal opinions to insurers and that the CPSO must investigate the complaint. But by that point the complaint seemed pointless to me given the CPSO agenda (to shield this doctor from accountability) had become obvious so I simply dropped the complaint rather than waste more time with this deceitful college investigator who flat-out lied.
Transparency would be taking accountability for your mistakes, offering explanations and apologies, and then communicating the lessons learned and how you will apply them.
Doctors who make repeated mistakes and kill their patients should be made public. My sister was killed by a doctor’s mistake and because it wasn’t made public, people did not have the option of seeking procedures with more competent surgeons, thus resulting in him killing further patients. This needs to stop! Transparency is what is needed – if you are a competent physician than there is nothing to worry about.
“The post‐error process often finds those harmed and those who have inflicted the unintentional harm on opposite sides of the table, positions that create further anguish for everyone, at a time when healing is needed most.”
Patients can be completely blind to the fact that the doctors, the College and the CMPA are on the opposite side of the table.
Patients are vulnerable at a time when they need healing, and when they cannot be heard they cannot heal and may suffer a great deal of further unnecessary harm.
A transparent process is needed.
The College should be more aware of protecting the rights of the public and not championing its own membership agenda. The CPSO Complaint Process is not fully disclosed to the complainant until after a complaint is made. This includes the fact that in the case of a complaint for a deceased person a Certificate of Appointment of Estate Trustee with/without at Will is required. Yet if the Will is still in Probate the CPSO can access the files anyhow. Why bother? Also, it is only disclosed to the Complainant through a request for a review by HPARB that the criteria for the investigation is to be adequate not thorough or accurate. I was willing to discuss my case with the physician to see what the flaws were on both sides and perhaps find solutions to help others and was told that the physician doesn’t do that. How can there be an open dialogue when the Doctors involved don’t want to converse with the public. Everyone needs to know where we are going and how we are going to get there
Transparency will create a discourse to find this out.
“…it is only disclosed to the Complainant through a request for a review by HPARB that the criteria for the investigation is to be adequate not thorough or accurate…”
I believe a principle of transparency should include the disclosure to the public what the College considers to be an “adequate” investigation.
And disclose what is considered to be “exhaustive” for the College.
Example: Reporting of an x-ray as negative:
If the doctor’s response (perhaps with the assistance of the CMPA), claims that the x-ray was “reported as normal”, the investigator, the CPSO medical expert, the College panel (2 doctors, 1 public member), will agree the x-ray was normal.
No evidence is required. The actual x-ray report can be absent from the investigation, and the College may consider it too “exhaustive” to have the medical expert review the original x-ray. An “adequate” College investigation can “resolve” the complaint based on the assumption that the x-ray was normal.
The patient can appeal to the Health Professions Appeal and Review Board for a review of the College decision.
The doctor and the investigator (who are not required to attend the appeal), are defended by two lawyers from the CMPA (supported by taxpayers), and will remind HPARB that the investigation does not have to be “exhaustive”.
HPARB can agree the results of the x-ray do not matter and support the decision of the College.
The College and the CMPA “win”. The x-ray didn’t matter.
This can leave the patient feeling that they don’t matter, and to be left feeling like that, when the x-ray may actually show a problem, makes the patient feel that they don’t matter, and to conclude that patient safety doesn’t really matter to the College and the CMPA.
My relative died at the hands of an incompetent surgeon who caused 2 subsequent major operations following an elective surgery. HPARB reviews disclosed that pertinent medical documents were removed in the investigations. The CPSO claimed that all information was reviewed, there was transparency, and the investigation was adequate. Yet more patients suffered unnecessary harm by this surgeon.
The CPSO should include in its transparency policy that no parties can obstruct an investigation, so there is TRUE transparency, the CPSO should also state what consequence will arise when its policy is not observed so there is TRUE accountability.
“…No evidence is required. The actual x-ray report can be absent from the investigation, and the College may consider it too “exhaustive” to have the medical expert review the original x-ray. An “adequate” College investigation can “resolve” the complaint based on the assumption that the x-ray was normal…”
The CPSO committee cannot dismiss concrete medical data as insignificant or not abnormal when in fact they are part of the complainant’s evidence of a doctor mistake or an inaccurate operative report to mislead. For example: consecutive days of high fever and elevated white blood cell counts would be considered by the CPSO as “insignificant” and not signs of infection. Another example: a total body blood volume loss within less than 45 minutes into a well-controlled elective surgery would be deemed by the CPSO as “normal.” The CPSO does not need to present concrete data to support its claims of being “insignificant” and “normal”, by simply stating that investigations do not need to be exhaustive is equivalent to “This is what I said”, it wipes out any opportunity to get to the bottom of the truth.
Patients will not benefit when the CPSO adds more harm in the complaint and investigation processes. Complainants do not deserve to carry the burden of a non-closure of the death of their loved ones for life but to bear an oversight system which favours doctors at fault and which helps to re-victimize the complainants and harm more patients. Your and my tax dollars should be used for a safer and more just system. I want to see a transparency principle truly at work and the CPSO is going to do that.
Will your principles really increase transparency or are they only a justification for status quo opacity?
Perhaps we need to push the envelope the other way. Why not release data (with anonymized doctor identification numbers) of all complaints (by phone, email or in writing) by patients to the CPSO? This way, patients will see just how many complaints are made and how many doctors have multiple complaints against them. These complaints are unproven allegations so it wouldn’t be fair to immediately identify a doctor involved but perhaps if there are a certain number of complaints against a particular physician, there should be evidence that the CPSO has taken that into account in deciding whether to pursue disciplinary proceedings.
When cautions are provided to doctors, why are these not included in their record? A statement was included in your principles for transparency that making this information public might interfere with the education mandate of the CPSO. To the contrary, greater transparency will ensure greater accountability, to ensure that those educational recommendations have been implemented.
Let the sunshine in. Hiding abuses and multiple errors by public figures, leaders and professionals has never been in the public interest. Nor has it ever been in the interest of non-offending leaders and professionals. The reputation of the good performers is at stake; don’t let it get spoiled by covering up for a few bad apples.
Many patients don’t report errors and adverse incidents to the CPSO because they doubt the effectiveness of your organization in getting results. How can the public believe that you will prevent the harm that has befallen them or their loved ones from being replicated by care that falls below standard? If you want to build trust with the public, show your work.
I had the worst experience, And it was over privacy but not the doctors the patient. While I was substitute decision maker for health because the POA died I had great difficulty getting attention to a major medical crisis The doctor involved was caught between the nursing home and the SDM and a family member that was trying for guardianship All was ignored and a third world infection developed When it came to evidence of neglect the rules were, even though the information from the SDM was available the college wasn’t given permission by the guardian because he was complicit and actually responsible for the lack of attention by the doctor …. Now this had turned fatal again from neglect of proper follow up ! I don’t think privacy trumps death we have many issues with privacy in medical practice and isn’t always about MD s If the doctor had been reprimanded or at least warned she may have taken steps to prevent the complication causing death that arose from the initial neglect to recognize and treat an ear infection that became do deadly the patient spent 10 days in hospital
Gee, you don’t seem to want to post my comments? Why?
See the two articles written by Alan Shanoff of the Toronto Sun regarding the death of my daughter and the totally inept investigation by the College!!!! How can you adopt a transparency (& accountability)document when you only allow certain comments to be posted.
I noticed that you have, as well, not posted comments from others who I am in contact with. They have also had dealings with the College and have been abused by this institution.
Copy to my MPP, Ms Wynne, Ms Horwath, Mr. Hudak, Ms Matthews.
In developing the draft transparency principles, the group had several objectives:
To focus on principles only, not to develop detailed guidelines, a ‘how-to’ manual or a decision tree
YES, LET’S NOT BE TOO FOCUS ON DETAILS—- THAT WAY YOU CAN CONTINUE TO OPERATE AS YOU ARE NOW!
To keep the number of principles low, with good rationales and supporting evidence
YES, LET’S KEEP THE NUMBER LOW—- THAT WAY YOU CAN CONTINUE TO OPERATE AS YOU ARE NOW!
To strike a balanced tone, one that demonstrates openness to transparency, as well as a thoughtful, careful approach and recognition of the strengths of the existing legislative framework.
WHAT A LOVELY MOTHERHOOD STATEMENT
The purpose of the draft principles is to guide future decisions about making more information available to the public.
The principles are meant to relate to both information about individual health care providers as well as broader information about processes and aggregate outcome data.
WHAT ABOUT THE PAST COVER-UPS THAT WE ALL KNOW THE COLLEGE HAS BEEN A PART OF. SO, LET’S FORGET ABOUT THE PAST, KEEP THE SURGEONS/DOCTORS PAST SECRET AND THAT WAY WE ARE BEING TRANSPARENT??? NOT!
In reviewing these principles, we ask commenters to consider the following questions:
Have we achieved a good balance between public protection and fairness/privacy?
TELL THE TRUTH, WHICH THE COLLEGE HAS NOT DONE FOR YEARS, ACTUALLY DECADES!
Have we left out any significant issues in regards to regulatory transparency?
WOW, YOU HAVE LET OUT SO MUCH, THERE IS NOT ENOUGH ROOM TO REALLY COMMENT!
What other factors should we consider when it comes to the principles of transparency?
WOW, YOU HAVE LET OUT SO MUCH, THERE IS NOT ENOUGH ROOM TO REALLY COMMENT!
I do not see the benefit or necessity to list the fact on a members CPC that there is an on going but as yet unresolved CPSO investigation into a complaint about a members professional activity. Many of these complaints are ultimately resolved in favour of the member. However simply highlighting the fact on the CPC that there is an ongoing investigation potentially raises a red flag which could adversely affect a member’s application for new employment.
As a member of the public, I believe that a large number of complaints are made because the doctor needs to learn to communicate in a more appropriate manner. Having the concerns of the public (and including the complainants’ names to help promote validity of the complaint), could motivate the doctor to improve his communication skills.
The patient just might get the apology he or she deserves.
It is very true that because of the CMPA’s power, many complaints are resolved in favour of the doctor, and as a result of this some doctors may inadvertently learn that their unprofessional behavior is acceptable.
Because of the power of the CMPA, the doctor can mislead the College and because the CPSO does not have perform “exhaustive investigations” (check the actual test results), the CMPA often “wins” in protecting the reputation of the doctor.
The reputation of all the honest, hard-working doctors can suffer in the eyes of the public as they learn the College is ineffective in holding doctors accountable.
When no red flags are raised, the doctor does not need to be accountable for his poor communication. A “disruptive doctor” can do whatever he wants. The College and CMPA permit and promote his behaviour, and patients are silenced.
Good doctors are silenced as well. His colleagues will not report him as the College does not have mandatory reporting for physical and mental abuse and the CMPA discourages it.
“Jogger hit, driver faces impaired charges” Hamilton Spectator, November 1, 2013.
A 33 year old woman was very seriously harmed. The driver was charged with “impaired operation causing bodily harm, impaired operation of a motor vehicle, and possession of a controlled substance.”
If a doctor or nurse seriously harms a patient while under the influence, their identity and their livelihood is protected as their addiction is an illness, not a crime – even if they steal the drugs.
In the newspaper article, it is noted that a concerned citizen had contacted the police, but an accident occurred before the police could take action.
When a patient contacts the College with concerns about the doctor’s behavior, what action does the College take? The College isn’t required to do an exhaustive investigation to see if the doctor has a substance abuse or mental health problem. The CMPA encourages his colleagues to remain silent. Who gets protection; the public or the doctor?
While I fully believe doctors and nurses should have access to justice and full support for their health care needs, the public’s health care needs and access to justice should matter. Public safety is not the priority it needs to be.
In your physician practice guide there is guideline on “disclosure of harm.” Your transparency principles should also include disclosure of harm by colleagues, i.e. whistleblowers on incompetence and professional misconducts.
What about cautions – should they be kept from the public as well?
If you read the CPSO testimony at the Goudge Inquiry you see that the College had become aware of Dr. xxxx ineptitude long before defence lawyers stopped treating him as some sort of infallible God. But the College kept those complaints about Dr. xxxx under the radar – out of the public eye – even as this medical “expert” was sending innocent people off to prison. So the CPSO had a hand in allowing Dr.xxxx to undermine the integrity of Ontario’s criminal justice system with all those wrongful convictions. And on the civil justice side of the regulatory equation, the CPSO had received many complaints about Dr. yyyy – all of which were dealt with via secret remedial cautions (and the like). In one complaint investigation Dr. yyyy told a College investigator that all injured claimants/litigants are fakers – thus earning himself another secret caution. Dr. yyyy was found (by CPSO and the HPARB) to have undermined the integrity of the entire Ontario IME system (and by extension the civil justice system) by having proliferated the system with the “expert” opinions of an unqualified assessor (FSCO won’t talk about all those cases tainted by Dr. zzzz who was hired by Dr. yyyy). The College kept the Dr. yyyy cautions a secret. Ontarians would have no way of knowing this but for the fact Divisional Court said so. Bottom line – the CPSO’s lack of transparency contributes to a health regulatory environment which undermines public trust not just in the Ontario health regulatory system but also undermines the integrity of the Ontario justice system(s). The CPSO needs to stop protecting rogue medical “experts” with its lack of transparency – and start protecting their victims (the public).
“…Many of these complaints are ultimately resolved in favour of the member…”
A CPSO formula to ultimately resolve complaints in favour of the member would include:
1.water down allegations to simply general dissatisfaction of care
2.break the “Obstruction Prohibition” health law by removing relevant medical records and evidence
3.accept whatever the member writes on the operative report
4.state false affidavits which are in direct contrary to documented medical records
5.twist universally accepted clinical facts
6.fabricate statements to blame it on other doctors
7.employ deceptive and empty rhetoric
8.committee decision inexplicably not making it to your address
9.committee non-supported opinions are bigger than all clinical data and accepted universal medical facts
10.state it does not refer to CPSO’s own rules and regulations towards complaints on a member’s professional misconduct
11.accept its medical experts’ collective mistakes, not your medical advisor’s true evidence
12.member has no significant prior complaints
Here’s how my complaints were ultimately “resolved” in favour of a member.
I filed 8 specific allegations against a member regarding his incompetence and professional misconduct that caused the abrupt death of my previously healthy husband 6 years ago. The CPSO categorized my complaints as general dissatisfaction of care.
The member cut out only fatty issue in a bilateral lymph node dissection, The CPSO stated that the member met the standard of practice of his profession.
The member bled out my husband’s total body blood volume in less than an hour. The member dictated in the operative note that there was no bleeding. The CPSO accepted the member’s statement and surgery can be bloody.
The member injured my husband’s rectum in this surgery. A CT scan and a later consultation progress report confirming a tear in the rectum following the 1st surgery. The CPSO did not include this CT scan in its investigation and the consultation report is still missing after 2 investigations; the CPSO fabricated statements to blame the tear on other rectal examining doctors.
The member prescribed bowel infection treatment one day after the surgery. The CPSO further removed nurses’ notes showing 7 consecutive days of high fever and high white cell counts and claimed no findings of fever and no infection and that the prescription was used to prevent infection. The doctor’s order was missing in the investigation.
The member assisted in the 2nd surgery to repair the rectum. The member dictated the 1st surgery report 2 days after the rectal repair surgery, 7 days after the 1st surgery, and before the 3rd surgery to remove my husband’s colon, in the report the member wrote that caution was exercised not to injure the rectum. The CPSO claimed that the delayed operative note did not cause the death of my husband.
The member caused devastating harm to my husband and subsequent death. The CPSO claimed that the member has no significant history of complaints, meaning my husband’s unnecessary demise was insignificant to be considered a significant complaint.
The member lied to me and retrofitted a deceptive operative note to cover up, thus violating College code of professional misconducts. The CPSO stated that the committee did not refer to any rules or regulations of the College in its investigations.
My medical advisor presented hospital records, medical literature, statistics, and facts to support my allegations. The CPSO only based on its committee experts’ non-supported opinions, therefore a collective mistake in not mistake.
The CPSO 2nd decision did not make it to my address.
Why should I trust that you will increase transparency when there are already laws and rules and regulations for you to follow? Clean up you acts and show us your work.
It should read:
…The member dictated the 1st surgery report 2 days after the rectal repair surgery, 10 days after the 1st surgery…
Favour #3 should read:
…surgery can be bloody. The anesthesia report showing tremendous blood loss was missing in the investigation.
Words carry little weight. Deeds speak. Probably complainants who have been harmed by your system should re-file complaints against the bad doctors because your transparency principles would be expected to be effective. Don’t shut them out, conduct thorough and transparent investigations, be humane, and rebuild the public’s trust.
Why does the College let “multitudes” of complaints pile up – in some cases for over a decade – before taking action that makes the public aware of the danger? Is it because too much information might confuse the public? Or is it because the CPSO’s first priority is to (with the help of the CMPA) protect its members?
How does leaving accident victims without relevant information about their physician assessors “serve and protect the public interest”? For many years the college has protected the insurance industry’s independent medical assessors, denied the problem exists and kept complaints about the poor standards and unprofessional conduct of some members confidential. Fostered a climate of enabling by doing so and now the entire profession has lost integrity and trust. The college has done a terrible job protecting the public because too much attention and effort has gone into protecting the members. It is a model of why self regulation doesn’t work.
“Principle 7: The greater the potential risk to the public, the more important transparency becomes” – thousands of people are sent to assessments every year. If the college isn’t willing to rein in these insurance doctors or at least warn the public of the dangers by simple transparency then maybe a sign on the physician’s door – ‘Enter at your own risk, unaccountable ‘independent’ medical examination physician on duty’ would work?
The Ontario Medical AssociationSee comment in PDF format
I am currently awaiting a decision on complaints I have filed with the CPSO. It will be interesting to see just how transparent it will be. My son died as a result of negligence on the part of not one but three doctors. There is no doubt. It is clearly in the records. So far I have witnessed cover ups and lies on the part of these doctors and the hospital involved so I don’t hold much hope for the decision either. I believe the Canadian public deserve transparency and nothing less. It is our right and I believe there should be a new body to rule over complaints that is independent from the College.
Hope you filed for more than just a complaint for your son who can’t.Three civil suits would be more appropriate for malpractice.It is absurd to see things like the Ontario Excellent Care for All Act suggest accountability to the patient,even go as far as speak of enforcement.Yet there’s no avenue for a tax payer/patient to USE the ECFAA. Something else a tax payer paid for to “protect”them without teeth.We are talking about public health, yet accountability is forced only on patients to not contravene things like OHIP,ODB legislation. Irony, sue a hospital, we pay for that law suit.UNLESS a judge removes indemnity from its CEO,and board of directors to make them actually accountable.
14. Every person who contravenes a provision of this Act or the regulations is guilty of an offence and on conviction is liable to a fine,
(a) not exceeding $10,000, in the case of an individual; and
(b) not exceeding $25,000, in the case of a corporation. 2010, c. 14, s. 14.
To Whom it may concern:
I’ve been asked to give my complaint to this “College of Physicians and Surgeons of Ontario”. Frankly, I don’t believe much will be attained for the thousands that have been affected with negligence, malpractice and cover up. This business of (privacy) is the weapon this organization and many shoddy health so called professionals have used for decades.
I am a victim of incredible medical maltreatment – all my life and justice with always elude me.
From the time I was a child, then when I was a married woman, then I became a grieving grandmother/mother who’s precious granddaughter and daughter died by hanging due to the brainwashing of unlicensed/unqualified mental health quacks. They dealt with my mentally ill daughter and without referring her to competent medical treatment, convinced her with their now condemned (Recovered Memory Therapy). These psychological terrorists had the power to throw a bomb at my family and totally destroy it. Of course, when I demanded the records of these deadly therapukes, their rights to privacy were protected and I was shoved aside. I went to your organization and of course, you passed the buck and ignored my pleas for help. I wanted these records so this would never happen to another innocent family.
My presentation to the Romanow Commission at the federal level finally brought about better treatment of our mentally ill children and our precious grandbabies.
The botched autopsies of my girls would rival a (Dr. Smith) case. I have the proof of all I’ve just stated.
NOW, after all that has befallen me, I was in a horrible car accident, (not my fault), on a busy highway, vehicle destroyed, my companion’s life compromised and he’s affected for life.
As if I haven’t been through enough, I too live in constant pain, have been designated as disabled and this has been going on for 8 years.
In these eight years, I have been degraded, mistreated and lied about by so called (independent medical examiners). I need medical treatment, prescribed by my current excellent doctor, however; my Insurance company (my good neighbours) have cut me off. I am now forced to fight for my rights and hopefully in a court of law. However; I’ve lost faith in all forms of government and agencies and will probably go by the wayside as my desperate/mentally ill/poverty stricken/family destroyed daughter was.
We’ve known for a very long time that the insurance companies and governments have been in bed together for decades while innocent victims suffer and are robbed blind due to so much corruption in this Ontario of ours.
Why in the hell should I believe that you, in this institution, would believe in the oath that you are suppose to have taken:
“Above all, do no harm)???
“Context is extremely important. Limited information or information without explanation is potentially unhelpful and could be misleading.”
Here’s some context that might put what happens to car accident victims in perspective and why the public expects transparency.
Over 60,000 people are injured in car accidents in Ontario each year.
Virtually all of them have an ‘independent’ medical examination report in their file.
The reports written by Ontario’s for hire medical doctors are the information used to decide if they get treatment for their injuries.
If accident victims are never told if their assessor has had a complaint, or the complaints are kept secret, how is that in any way protecting the public from predatory practices?
Why is it that a person can get more information from ratemd.com than we can from the college who regulates?
Why does the college tell consumers that they have no complaints on file about a doctor but if you call the HPARB, you’ll can be told there is a complaint about that physician?
It’s a dishonest and misleading system of information in place right now, one that only serves only those who have been abusing accident victims by either ignoring complaints, keeping them secret and by misleading information.
Transparency is the window to the truth and a system built on deception can never be respected.
The College of Physicians and Surgeons of AlbertaThank you for the opportunity to participate in the College of Physicians and Surgeons of Ontario (CPSO) consultation that is seeking feedback on five items.
The Consultation Newsletter indicates a feedback deadline of November 11, 2013 on two of the items:
1. By-Law Amendment – Committee and Program Fees
2. Draft Transparency Principles
Both of these documents are supported by the CPSA as written; we have no further comments of value to improve these documents. Feedback on the remaining three items of this consultation is still being compiled and will follow prior to the November 22, 2013 deadline.
I hope you find this submission supportive of the CPSO consultation work. Please contact me if you have any questions or concerns regarding this submission.
Ontario Trial Lawyers AssociationSee response in PDF form.
FAIR (fair association of victims for accident insurance reform) See feedback in PDF form.
The CPSO’s policy postions on auto insurer medical assessments (third party assessments) have been pretty much written by the CSME. The CSME President warned its members that “bias, amateurism and fruad” might not be “tolerated” much longer due to the threat of “public scandal”. But the CPSO didn’t care about a “public scandal” due to bogus accusations of malingering made by auto insurer “hired guns” who masquarade as impartial medical assessors – and who hide behind CPSO’s opaque regulatory process to avoid accountability for the abuses they perpetrate against the subjects of their pro-insurer, partisan assessments. The CPSO is a disgrace and the “public scandal” the CSME prophesized is upon us. Just read these posts – read Toronto Sun columns on auto insurance assessments. Nobody trust or respects the CPSO; probably not even its own members and certainly not injured Ontario auto accident victims and their families.
Principle 1: The mandate of regulators is public protection and safety. The public needs access to “THE NECESSARY” information in order to trust that this system of self-regulation works effectively.
What is inappropriate is the College, may be NECESSARY for public protection and safety.
Who decides if the information is inappropriate and unnecessary? Does the CPSO work with the CMPA? The public needs an advocate organization as strong as the CMPA.
Principle 2: Providing more information to the public has benefits, including PERMITTING AND PROMOTING patient choice and increased accountability for regulators.
Providing the necessary information provides the opportunity for the patient to have a choice. Without sufficient information, the public is at increased risk of improper assessments, incompetent interventions, and unnecessary harm.
The College investigative process is not mandated to perform “exhaustive investigations”, therefore, the College cannot be held accountable for the doctor’s misleading responses and alteration of documentation.
The public deserves to know the truth. Is the College powerless to determine if a doctor is providing a deceptive response regarding a complaint because the CMPA will defend the doctor regardless of whether his response is truthful or not?
When the College asks the defendant doctor’s colleagues for their input, does the CMPA instruct them to disclose their genuine concerns, or are they advised to remain neutral?
The CMPA is very effective in protecting doctors. When you work together to protect the doctor, who works to protect the patients?
Principle 5: If the College provides a “safe harbour” permitting and promoting the doctor and the CMPA to mislead the College, “true improvement” doesn’t happen. “Only a very small fraction of health care providers are the subject of multiple actions at the committee level”.
The privacy of this “very small fraction” of doctors matters more than patient safety.
Principle 6: While the protection of the public is paramount, regulators need to take into account their obligation to provide procedural fairness to members. Both duties are important and undermining one does not, in the long run, advance the other.
I believe procedural fairness to the doctor AND the patient should be paramount. Undermining procedural fairness to the patient is unethical and when it happens, the truth can be told by the patient via the internet to promote safety and learning.
The powerful CMPA ensures procedural fairness for the doctor, and this is good. But who ensures procedural fairness for the patient?
When procedural fairness is questioned by the doctor or the patient, HPARB listens. The doctor has experienced lawyers from the CMPA. The patient has nobody.
The College is careful to ensure procedural fairness for the doctor because they know they will be held accountable. Patients have not been able to hold the College accountable for procedural fairness.
Please know that undermining procedural fairness to patients is unacceptable as it undermines patient safety in the long run.
The Canadian Medical Protective Association (CMPA)See response in PDF form.