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Regarding cautions -in-person to be made public, what this policy does is to essentially make such oral cautions by the ICRC into reprimands that are issued by the disciplinary committee. Even if the College publishes the caution with a lot of qualifying information to to explain what a caution is and isn’t in reference to the process and in contrast to a reprimand, the public will view it as a judgement against the physician. In other words, such a publication would bypass due process, investigations and hearings to achieve the same results as a reprimand.
This proposal may be viewed by physicians as very unfair. It will change the objective, scope and acceptability of an oral caution since it would now become a judgement in disguise as explained above. This will in turn have effects on the complaints process itself. It may also lead to legal disputes from physicians who may have accepted an oral caution before but not a publicly known judgement now.
The proposed amendment will not change a caution into a reprimand. A caution already is a reprimand. However; it does not change a caution into a disciplinary proceeding. The actions which may be taken by the investigations committee remain distinct from those available to the discipline committee. Making cautions public does not ‘bypass due process’. After a complaint is made against a doctor they have full opportunity to respond to that complaint. If the investigations committee determines a caution is warranted it is because the doctor has engaged in some conduct that needs correcting. The public has a right to know if a person in a position of public trust has made such errors.
” A caution already is a reprimand. However; it does not change a caution into a disciplinary proceeding.”
your statement is factually false and also makes logical sense as you say two opposites in the same sentence.
Factually, a caution is not a reprimand. A caution is issued by the Investigation committee after written only correspondence, usually no witnesses, and no hearings. On the other hand, a reprimand by the disciplinary committee after hearings, witnesses and more thorough investigation.
I think you’re missing the point: a caution, in and of itself, does not imply egregious conduct by a physician. ICRC may want to meet with the physician for a range of reasons, including a concern that the physician has a personality/communication style that predisposed to the complaint. Appearing for a caution in person does NOT automatically mean that the physician has committed an error. Public perceptions of this sort are precisely the reason why this information should NOT be made public, because a noncontextual summary of the information will be completely misleading and misperceived by the public at large.
I agree that there should be open access to all the appropriate context which surrounds ANY decision by the ICRC. As long as identifying details about the patient are removed, the more information given the public, the better. They will then finally be able to judge whether they wish to patronize a particular physician, and whether the decisions made by the secretive College are in fact proportional to the error/incident which prompted the complaint in the first place, and the possible damage done to the patient as a result.
At present, just 2 or 3% of all complaints by patients are referred to the Disciplinary Committee. So, 98% of complaints result in NO meaningful sanction against a doctor (unless you consider a request to correct educational deficiencies a sanction), even when a patient is harmed by a doctor’s negligence. It amazes me to see so many physicians on this feedback page moaning about how the present system is unfair to THEM!!!
In what other section of society can one indulge in negligence which injures another person and be almost assured of suffering absolutely no consequences? It just turns my stomach…and highlights the desperate need to try and refocus physicians on patient safety rather than their own personal convenience and enrichment.
“At present, just 2 or 3% of all complaints by patients are referred to the Disciplinary Committee. So, 98% of complaints result in NO meaningful sanction against a doctor.”
There is so much misinformation and presumptuousness here, one doesn’t know where to begin. It is absurd.
The premise for this statement is that all complaints made to the College are legitimate complaints resulting from legitimate instances of negligence directly resulting in harm and suffering. You do know that it’s free to complain to the College. The cost is 5 minutes of writing a paragraph by hand and a postage stamp of 50 cents.
This is like saying all complaints made to the police about people, must result in arrests and the people being complained about all must go to jail. It’s like saying just because someone made a complaint, a crime was definitely committed. You do know that a small percentage of complaints to the police end up in an arrest, and that of those most do not get convicted. I guess this poster forgot that people are doctors in this case are entitled to due process and that an accusation is not the same as a finding of guilt in all Westerniz3d countries and especially those using the Common Law system.
‘The public has a right to know if a person in a position of public trust has made such errors.’
Many jobs, maybe even most jobs, engender public trust to a greater or lesser extent. Why then, if we are going to hold doctors to this standard of transparency, do we not hold all others to it as well?
No human is perfect and all make mistakes. Making mistakes public knowledge for the whole world to see may help for the most egregious acts/omissions which clearly impact public safety and these are already publicly available. I don’t think cautions, as currently defined, fall into this category. Publishing cautions is in my view nothing more than voyeurism, a violation of privacy and overall will cause more harm than good.
I compleaty agree with you is there no more privacy to be a physician practicing in Ontario we can self regulate already serious offences will be made public there is no need to publish cautions, this will confuse patients
As a physician working in Ontario I currently feel what is published on the website to be an invasion of privacy the year and place I graduated is no one business and now u want to publish more info based on paranoia this has nothing to do with protecting the public just protecting cpso against lawsuits and poor media relations
“Many jobs, maybe even most jobs, engender public trust to a greater or lesser extent. Why then, if we are going to hold doctors to this standard of transparency, do we not hold all others to it as well?”
Because the others are not in a position of control over the bodies of patients.
The others do not have the same opportunities to harm the public ,who have virtually no recourse if they are mistreated, harmed or abused.
A caution has gone through an investigation. The College just doesn’t feel it is serious enough to send forward to the Disciplinary Committee. If you do the research the only complaints that go before the Disciplinary Committee are those that are or may be under a police investigation– sexual inappropriateness, defrauding the government, drug related etc. Harming a patient even causing death only warrants a written or oral caution. If you read the Toronto Star recently, you will learn there are many backroom deals made that the public is never aware of.
Haven’t you ever heard of the phrase plea bargain? the police do it, the crown attorneys do and so do every other part of law and regulation enforcement in every part of the world. An undertaking which was ignorantly mentioned in the Star article is just that: a plea bargain.
If it were up to the Star and the couple of malpractice lawyers feeding it, every complaint, no matter how ridiculous, would automatically end up in the doctor’s loss of license, and public shaming on the national evening news. Never mind that a complaint is perfectly free of charge to file and a person could file an endless number of them against any doctor. That’s exactly how ridiculous it’s getting and I am not exaggerating.
Its a great cause and good reasons for this project. As a physicians, there can be some issues with this information, as I do not see how it improves the patient care? Patients may know more about their doctor’s criminal or licence history in another province or in-person warning ; How does it improves patient care?
On the other hand a responsible doc, who may have slipped on any of these issues, now for life has this public record for life . I do not think it serves the purpose what CPSO is asked to do.
This kind of transparency just makes physicians unhappy and patients do not get any benefit or do not get a improved medical care.
The CPSO has a mandate to regulate the profession in the public interest. The public interest is not served by the issuance of secret cautions. By making the cautions public Ontarians will be able to evaluate the quality of health care they are receiving and make decisions about the health care professionals they choose to employ. With this information available we can push for changes to address systemic shortfalls and avoid Doctors who should be avoided. That is how making cautions public will improve patient care. Problems with the health care system will not be addressed if they remain secret.
You might be surprised to know that most physicians, over the course of their career, will receive a caution from the CPSO, written or oral. Many will receive more than one caution. The mere fact that a physician has received a caution does not make him/her inferior to his peers. The basic function of a caution is to help the physician improve their practice. Posting this information leads to misperception by the public and can be quite misleading. I fail to see how it improves the health care system or how it helps patients find a “better” doctor.
If you get a traffic ticket, would you be happy to stick a big red sticker in your car for life, to inform public that you violated traffic act?
You already improve your driving and correct your fault after first ticket. It does not need to be public to fix a problem; rather it is discouraging and makes more harm.
Going to a doctor isn’t like hiring a plumber where mistakes can be made, fixed and forgotten. Nor is it in any way like getting a ticket for a driving infraction. It is a far more serious and life-changing relationship where mistakes have real consequences. While good physicians will find this transparency invasive and distasteful the problem is that there are too many problems with the quality of medical care and ignoring mistakes is just a way to ensure that they continue to happen and that cannot be what most would want.
One of the biggest problems with transparency is in the context of third party medical examinations where a few bad apple (too many to call them rogue) physicians who examine injured and disabled patients are abusing your (treating practitioner) patients. Everyone knows this and it isn’t news. There are physicians out there who are not there to promote wellness or provide care, they are there to line their pockets with insurer money and could care less when they are doing harm to patients. As long as their income flows. As long as the good doctors don’t complain to the college and have this abuse stopped. As long as they can get away with it. These for-hire physicians who cause harm are relying on the status quo and they answer to no one even when they cause people harm. A quick oral or written caution and it is business as usual, a business that pays 4 to 5 times as much as the honest treating physicians make. Even HPARB takes the names of physicians who are cautioned for abusing MVA victims off their decisions now, protecting those who cause harm. Layers of secrecy means layers of protection for the bad apples. So the public has had enough, they risk too much and the dishonesty that secret cautions afford these unethical and immoral players has to be addressed. The college decided to protect the few over the interests of all doctors a long time ago and that’s something that good physicians knew and could have taken up with the college themselves and didn’t. You can’t be involved in an insurance claim or make a workman’s comp claim without having your perspective on the medical community forever changed by the display of greed and willingness to do harm for dollars. The few bad apples have caused a stench that discredits all physicians and caused a serious lack of trust that will take much to restore.
I am in full agreement with the above comment, couldn’t have said it better myself.
Very well said. As a mother who lost her son to gross negligence. The physician medically cleared him when he was NOT medically clear. He knew this and said he was not concerned. This is in the records. Many others in the hospital questioned this yet nobody did anything except the next two doctors tried to cover up his mistake and caused more harm. I did not find out about htis until after my son died and I got the records. The college continually protects the bad and incompetent doctors and if the good ones speak out they get black listed. We need good doctors and it is time to get rid of the ones that cause harm as they should not be in this profession left to do more harm to other unsuspecting patients. They have no idea the devastation it causes the families and I now have no trust or faith at all even though I know not all doctors are bad apples. My life will never be the same.
why are people worried about cautions they only give them out rarely and when they don’t mean anything from my experience, we’re talking about the tail, when we should be put the dog out to the farm!!!!
How can you compare a “traffic ticket” to harming a patient??? Thousands of patients across this province are injured and killed by preventable medical errors every single year, although not all such errors are made by physicians alone.
If you think that any error which harms a patient is referred by the College to their Disciplinary Committee, you are entirely mistaken. I can state that with absolute confidence due to a situation which occurred within my own family.
One of the benefits of increased, though still inadequate, transparency at the CPSO is that the public and the media will finally be able to find out what the College is doing, and whether the punishment (which is usually less than a traffic ticket now) actually fits the crime.
I am horrified that you’re so concerned about being identified “with a red sticker for life” due to your own incompetence, instead of being concerned for the patient who you may have damaged for the rest of THEIR LIFE.
Perhaps you should reflect on your self-absorbed attitude.
Please worry less about your own pride, and more about the safety of the patients you are supposed to serve.
I have yet to see anyone make a CLEAR link between posting the proposed categories of information and protecting the public.
You’re angry with physicians: fine. But that doesn’t entitle you to know anything and everything about the physician who is treating you. The stuff that CPSO wants to post, such as UNPROVEN criminal charges, SCERPs, cautions-in-person have NOTHING to do with protecting the public interest because the physicians who fall into these categories have not necessarily done anything wrong!
The fact that you can’t seem to grasp that concept is proof in itself the CPSO shouldn’t be posting this information!
It really changes the definition of a caution if it’s going to be known publicly. Who is the caution for? For the physician to be more cautious in his/her practice? Or for the public to consider avoiding this physician? It seems the purpose of this proposal is the latter as stated in the phrase “for the public to make informed choices”.
As a result of such transparency, the physician’s practice will invariably suffer in losing new and existing patients who may now try to go elsewhere, colleagues who will not make referrals, and potential employers and partners that may pass this doctor over for the next candidate. This is not the definition of a caution. This is penalty and disciplinary action, and as such it should be named.
Once it’s publicly known, it cannot be termed a caution anymore.
Thank you for the opportunity to post comments.
You are correct. The purpose of making cautions public is for the public to make informed choices. Informed choices about the doctor we want to visit and informed choices about the kind of health care system we want.
If cautions are made public Ontarians will be in a position to better evaluate the profession and the health care you provide. Before a problem can be fixed you have to know the problem exists. Making cautions public will help our communities address systemic problems. Keeping them secret allows these problems to persist.
A doctor will not lose new patients as a consequence of a minor mis-step such as an advertising infraction or a billing error. However; if you are cautioned for a medical error or for lying to a patient about the consequence of a medical error you deserve to lose patients and your conduct deserves public condemnation.
If such conduct remains secret the entire profession loses the public trust rather than the relatively few doctors who deserve it.
A caution by its nature is a remedial penalty whether public or not. That so many doctors apparently do not appreciate cautions represent a disciplinary action demonstrates the need to make it public. Only then will you take them seriously.
The vast majority of physicians will have a College complaint filed against them over the course of their career (if not more than one complaint). A caution, written or oral, is not an unusual circumstance (just look at the statistics), nor is it a form of discipline. If this proposal goes through, there will be plethora of useless information about physicians posted online, and none of it particularly relevant or helpful to patients.
Very, very well said! Thank you for your concise analysis of the real problem.
All patients are at risk unnecessarily until the system is completely transparent, and until disciplinary action is considered proper for professionals who do not make the appropriate authorities aware of negligence they observe.
At present, physicians and nurses are often ostracized or punished should they be ethical enough to report incompetence they witness, and this attitude has a devastating effect on public safety within our system.
Making a “Caution” public has no benefit other than to make patients afraid of a particular doctor. The “Caution” is for the doctor, not the patient.
There are some doctors that the public needs to be afraid of.
I agree that the public should be afraid of some physicians. But one would hope that when complaints are made to the CPSO against these physicians, the disciplinary committee will decide the physician requires remediation, or their license will be restricted or taken away. This of course, would be reasonable to make public from a transparency perspective. However, in cases of caution, this does not necessarily imply that the physician is not competent to properly care for their patients. If the CPSO feels physicians with a caution can maintain their license and that they are still capable of safely caring for their patients, then it is a disservice to the physician to make this information public as it will serve as a (likely underserved) black mark for the rest of their career. When a member of the public sees the caution on their record, they will also be left with the impression that the physician is in fact not safe to care for patients. I think information that will help patients make appropriate health care decisions should be public. But in most cases of caution, I don’t think this is the case and it will unfairly penalize the physician.
With respect to posting Criminal Charges, Canadian law subscribes to the concept of “innocent until proven guilty”. The same should apply to postings on the College website. CHARGES should not be posted, only CONVICTIONS.
What convictions? Doctors are above the law. Very few criminal charges are ever laid against doctors. The college goes to great lengths to make sure of this.
Respectfully, the comment that “the college to great lengths to make sure [criminal charges aren't laid]” is based on a common misconception. The College is a regulatory authority tasked with protecting the public, but it doesn’t not have any powers under criminal law and cannot lay criminal charges. It’s powers are limited by statute to standards of practice and licensure. The laying of criminal charges is the responsibility of the police and Crown prosecutor. The College has no jurisdiction in this area.
The CPSO is a Machiavellian government organization serving its own self-interests. It disempowers doctors and robs them of their wealth, freedom and constitutional rights under the guise of protecting public safety. It is time for Ontario doctors to make a legal and political stand against them as unabated they will certainly reek even further havoc.
This most recent phase of the transparency project takes the locus of control out of the hands of physicians and gives it to the most vexatious and sociopathic individuals. For example, a patient who does not get their way might falsely accuse a doctor of criminal conduct leading to criminal charges for the whole world to see. This could potentially rob a doctor of their career and livelihood without due process.
It also enables the government (CPSO) to destroy the career of any ‘dissident’ by, for example, picking apart their OHIP billings, finding a handful of ‘fraudulent’ claims and throwing them under the bus for billing fraud, again for the whole world to see. Make no mistake, this could happen to any doctor in Ontario.
So, what’s next? Perhaps greater transparency will involve exposing a doctor’s medical and psychiatric history to the public as well as the medications they take? After all, this could affect a patient’s decision about which doctor to see, right?
Time to stop this runaway train in its tracks before it causes further destruction.
About exposing a doctor’s medical and psychiatric history to the public, it may happen if a certain newspaper writes an article about how keeping it secret is bad for patients. After all, even a small unknown article in this publication seems to trigger a policy change at the CPSO. One reporter’s incoherent opinion is valued above all the physicians opinion and interest in this province. That’s how it works. The College fears that if it doesn’t doesn’t pay homage to the publication, then the legislature will write a law to force it thorough anyways, which would be bad for the self interest of the College. The interest of physicians is of the littlest importance in this process, it is politics as usual (it’s not even about patients), and there is no body that formally or even informally defends the rights of physicians vs. the gov and its proxy the College. Physicians are for all purposes completely defenseless and at their mercy, which is why it has become a big apology to be one. Unless there is dead physician martyrs and a court case such as in the MRC and Cory’s inquiry into it nothing happens.
In this case, the transparency project is being trampled through, if not, the private Ontario Bill 29 or another like it is waiting to become law, to make not just cautions public but all complaints ! That would be a first in the world regarding any organization and any complaints process!
These are hard times for doctors, and I am glad I am near retirement. I would never tell anybody to become a physician in this climate which keeps getting worse and worse.
Doctors who commit OHIP fraud and have drug addictions should not be practicing at all. Are we to believe a “handfull” of OHIP fraud is acceptable? it is criminal!
I’m sorry that doctors are human and some have drug addictions. But I think they deserve the right to therapy. I agree that intentional billing fraud is criminal such as billing for patients not seen, or services not performed.
However, perhaps you would understand better about how nebulous and open to interpretation OHIP billings are if you do some research on how they work and on how the now defunct Medical Review Committee (MRC) of the CPSO interpreted honest billings as fraudulent. It lead to the suicide of an honest hard-working paediatrician earlier this decade after his reputation was ruined and a good chunk of retirement income taken away by the government for so-called fraudulent OHIP billings. Judge Peter Cory rendered a verdict in this regard which quashed the MRC.
On somewhat related note, why don’t we create a parallel private system where doctors can chose what they charge for their services and let the free-market decide how they do. I think this would be better for patient care as it would create competition and encourage excellence in care.
Similarly, let’s forget about complaints the College, which neither doctors nor the public seems to trust anyway, and let’s go straight to suing doctors for any perceived wrong. This way the complainant might be financially compensated for the perceived wrong, there would be less frivolous and vexatious complaints wasting everybody’s time, and doctors can have the right to due process and countersuits.
I empathize with the pain of any who have suffered from medical error or negligence but there is a risk inherent in using the healthcare system and I don’t think punishing and publicly humiliating doctors is the way forward. Let’s look at systemic changes.
Thank you for bringing up the Medical Review Committee of the CPSO. That was a terrible time for us doctors. I am glad it is gone and shamed in the courts. I however do not want a free market to decide what doctors charge. Sick people often can’t afford much but need the most so it would never be fair. I would hate to work in such a system. I prefer a complaint to the CPSO over a law suit. Lawyers have no business deciding complaints. The court is best for crimes etc.
I think this new transparency initiative is a good idea. Physicians should not view Phase 2 of the Transparency Project negatively as a personal attack against them or their profession. It should be embraced as an opportunity to recognize, self-reflect, learn and correct deficiencies in their practice to improve patient care. This information would be reassuring to the Public; not the opposite. However, it is not fair to Physicians or Complainants to limit Cautions in person and SCERPs to complaints received/investigated on or after January 1, 2015 as that would defeat the whole purpose of the transparency initiative. If the CPSO “chooses wisely” to embark on this new transparency initiative honestly and for the right reasons, all “Cautions in Person and SCERPs” for all physicians/members should be made available to the public including complaints received/investigated prior to January 1, 2015. The Public needs to have complete access to all information (including complaint history) that may in fact reveal “repeat offenders” to ensure they can make “informed choices”. The CPSO has all of this information available dating back many years and as such there should be no limitations in regards to the “date that the complaint was received or the date that the investigator was assigned” as that would deem the new transparency initiative unfair and yet another attempt by the CPSO to “mask previous complaints/complaint history under the veil of secrecy”.
our premiers record during the past week news reports were a good example on the promuised transparency ,and blind acceptance of the public of the same during the recent elections suggests how much transparency public needs and cares .i would like to know what you mean transparency and i request the physicians decide on the results and consequences and not the narrow thinking of the college .
As a patient who is entrusting my doctor with my wellbeing, and granting them a level of access to my person and to my personal information that goes well beyond what I share with most other people in my life, I feel that any relevant information should be available.
What’s relevant? Well, for starters, abuse. If a doctor abuses a patient, this should be made known. Period. In order to do their job, my doctor may have to touch me in ways that would be inappropriate (and, in many cases, illegal) in other contexts. If they’ve shown a tendency to abuse this privilege in the past, I cannot see any excuse for hiding this information from their patients. I need to have confidence that when my doctor touches me, it is being done purely for medical reasons.
Any findings regarding problems with the standard of care should also be disclosed. Your own document says that a caution indicates that “there is a significant concern about conduct or practice that can have a direct impact on patient care, safety or the public interest”. If my local burger joint has low standards that impact my safety, I can find out. If the model of tires on my car have low standards that impact my safety, I can find out. Why should I not be able to find this out about the person who’s responsible for my medical care? This includes findings from other jurisdictions, obviously; a doctor who doesn’t know what they’re doing in (say) Oregon will not magically become competent when they cross a line on a map.
Regarding criminal charges, the presumption of innocence does not imply that charges must be secret. In fact, they are not. Every day the news includes items about people who have been arrested and charge with crimes but who have not yet had their day in court. This should be no different for physicians, and if the news reports that a physician was charged with a crime yet the CPSO is silent, there is an appearance of a lack of transparency. The key is to make sure that any such information clearly differentiates between charges and convictions, and as your proposed policy states, that such information be updated or removed, as appropriate, once there is a finding.
Making charges public allows the potential for vexatious and unscrupulous individuals to make untrue allegations that can cause irreparable harm to a physician’s reputation without due process. Just because this happens in the public arena does not make it right.
As much as there are mechanisms in place to encourage true victims of abuse to come forward, there are also laws that protect against defamation. As such, making unproven charges public would certainly benefit trial lawyers. One wonders how much of a role they played fuelling this transparency project?
One cannot respond to you (poster of comment dated December 17, 2014 at 3:55 pm), without correcting you on your erroneous use of terminology. You use the words charge, arrest and CPSO in a way that clearly shows you have very little understanding of what the CPSO is and what it does. The CPSO is not law enforcement, and does not arrest doctors or lay criminal charges. The CPSO is mandated only to take action against a physician’s license. However if you were to understand the CPSO’s role and process you would understand that in fact the CPSO is already as transparent as the police, if not more.
To help you understand better, let’s use the police process in comparison. The police receives many complaints from the public about other people, businesses, etc. A small percentage of these complaints actually result in an arrest, and yet fewer lead to actual criminal “charge”. While the police may publicize some arrests and charges, complaints not leading to an arrest or charge are never publicized, neither are the police cations about them. Even many arrests and charges are not publicized at their discretion for many reasons. For example arrests and charges related to domestic disputes usually have the names unpublished.
Similarly at the CPSO, complaints not leading to an actual formal investigation (aka referral to the disciplinary committee), are not and should not be publicized. All complaints that are referred to the disciplinary committee are made known the public. It is really ridiculous for all complaints, before this stage, to be publicized, or even the cautions that result from them. Imagine if the police made public all complaints and cautions that they cite to people. Then some would try to damage someone else’s reputation by vexatiously making things up about them.
There is still one other difference between the police and the CPSO. It is a chargeable crime to lie to the police that someone for example raped someone or broke into your house. Yet there is no such law against someone making such lies about a physician to the CPSO.
Unfortunately there is a lot of misinformation and ignorance about the CPSO and what it does. These are due to lack of public education and also fueled mainly by some malpractice lawyers in order to gain leverage in their legal proceedings. This despite that there is legislation that CPSO matters cannot be used in a civil proceeding. I guess it doesn’t mean that they won’t try to change the legislation too.
You should include all these outcomes on the public register as well as written cautions and agreements where there is a concern about conduct or clinical care. Patients should have the ingormation they need to judge whether the issue identified is concern so they can protect their health. As it is, only employees of the cpso have the information they need to make informed healthcare choices. Past outcomes with violations of clinical or conduct standards that resulted in a negotiated agreement, oral or written caution, scerp, or any other formal outcome should also be made public. Otherwise there is still a lack of transparency.
I think it makes sense for the CPSO to be more transparent. That being said, I wonder whether oral cautions should follow physicians around for our whole careers or whether, if they do end up being reported to the public, they could be taken off the record after a period of time without further incidents? I actually think the College should place stricter restrictions on physicians who make the most serious errors in judgment (e.g. those who are involved in serious boundary violations) before considering increasing transparency for other complaints. Everyone makes mistakes in every profession and of course physicians need to be held to high standards, but there has to be a limit. I know the fear of medicolegal repercussions affects the way I practice, and possibly not always for the best.
I certainly don’t believe that patient complaints should be publicly available. Most psychiatrists receive complaints at some point in our careers, usually more than once. I know I received a ridiculous one last year that is basically guaranteed to be thrown out. If those complaints were to be public record I would be reluctant to see some of the more difficult patients, even though they are the ones who often need us the most.
I’d like to know if a doctor who has a practice is there because he is a doctor in good standing and Physicians & Surgeon’s has validated that. I don’t want to know his life history because I’d like to trust that he has no past if he is allowed to practice.
1. Forget about putting conditions on who a doctor can practice to when he has been found guilty molesting women. This doctor should have his/her license nulled…end of story. There’s no halfway.
2. As in the case of the Etobicoke dentist operating without a license and was charged in 2011. Excuse me, he’s given 90 days house arrest. He should be deported back to the Ukraine where he can operate on a street corner. And what happened in the period between 2011 and 2014? Is there no one watching the store?
3. A street food vendor in Toronto has to qualify for a license and must meet food handling standards. How many of these vendors lost their investment due to unrealistic criteria and yet a doctor/dentist can get away with fraud?
In summary, it’s not buyer beware. It’s confidence that he is there because he passed the rules.
Ontario needs an ombudsman devoted strictly to healthcare as there is no true protection for families and patients. The existing self-protectionists continue to favor professionals leaving the public to only realize the potential of harms after the fact. Case in point: a friend was referred to a specialist. After checking CPSO there were no indications of past performance issues. Online patient groups had differing opinions from their own experiences. The CPSO also indicated that this specialist had no hospital privileges which is odd given the specialty. For patients this could lead to an obvious speculation that indeed something was wrong. So…the patient/family is left with what conclusion? Something is not ringing true here.
Some physicians chose not to practice in hospitals it has no bearing on their level of competence for example some physicians practice on rural areas where there are no hospitals therefore they won’t hav any privileges so your assume potions is compleat,y false
The recommendations are reasonable except criminal charges. This recommendation will likely get struck down by courts anyway. Criminal convictions relevant to the practice of medicine should be listed. The College can certainly impose restrictions based on criminal charges if it is possible that the public could be at risk based on the criminal allegations.
I received a caution about 8 yrs ago. I debated with counsel whether to appeal a decision that was metered by the College’s expert. I had grounds from other national experts to contest this but the CMPA instructed me to “let it go”, and I did because this was “under the radar”. Had I known this might be dragged up, I would have most vigorously contested the decision, to keep my name “clean” in a “transparent” environment.
The majority of (these first 14) postings appear to have been made by doctors. Their collective sentiment can be summarized as follows: 1) complaints to the CPSO are usually ridiculous; 2)making oral cautions public will hurt a doctor’s revenue stream; 3)the public won’t benefit from the information.
I’m not sure the pros and cons of making oral cautions public can be discussed without contextualizing the debate. Oral cautions originate in all sorts of practice contexts for a wide variety of reasons/transgressions. My concern is how greater transparency might benefit the public in the Ontario auto insurance IME context. Surely (often severely) injured Ontario auto accident victims deserve to know if the medical expert to whom their auto insurer has referred them for an “independent” assessment is a recipient of any oral cautions related to the quality of her/his prior insurer-sponsored medico-legal assessments? Why? Because an Ontario injured auto accident victim has no choice but to submit to the medical assessor chosen by her/his auto insurer. First, failure to attend will result in suspension of all policy benefits (plus a $500 fine). Second, injured claimants are told by the insurer adjusters that their “preferred vendors” of medical assessments are highly qualified and completely impartial. Thus, (arguably)it would be unfair (perhaps even deceptive)to keep secret any oral cautions which speak to these glowing descriptors. So framing the issue and contextualizing the “to publicize or not to publicize” question, in this context, is as follows: if an Ontario auto insurer’s preferred medical assessor has prior oral cautions for have produced medical assessment replete with inflammatory language or for having been responsible for unqualified medic-legal assessments – do those being referred to that medical assessor (IME vendor)and who are for practical purposes forced to submit to the medical assessment – have a right to know about these past transgressions? Doctors might argue that oral cautions are intended to be educative rather than punitive. But this begs the question – are we to accept that long-time preferred insurer medical assessors actually need to be educated in this way (via oral cautions) that biased or unqualified medico-legal assessments aren’t acceptable? Aren’t we punishing the victim when we keep seriously injured accident victims in the dark and when we give the insurers’ preferred medical assessors a perpetual table rasa (in the form of secret oral cautions)? There may be other contexts in which the argument to keep oral cautions secret is stronger. Certainly, the arguments will change from one context to another. But I’d argue that in this personal injury/auto insurance context – in which the injured subjects of medical assessments are forced to submit to doctors chosen by their insurer – doctors who are touted by insurer vendor management teams to be stellar doctors – deserve to know if the doctor’s(sometimes multiple) oral cautions argue otherwise. Perhaps one or another of the doctors railing against publicizing oral cautions could comment on this grounded scenario? Or are their objections universal and happily devoid of particular context/circumstance?
To interpret your comment, essentially you are saying you support more transparency so you could employ the Complaints process as a way to blackmail physicians or intimidate them with it to provide IMEs that favor the insured. So much for “independent” in IMEs. Thanks for proving the points made by some of the physicians about how the complaint process can be abused in light of such proposals.
Have it your way. If disclosing oral cautions to the public helps put an end to unqualified and/or biased “independent” medical assessments – then I’m all for “blackmail” in the form of less College secrecy and more accountability. That you see regulatory transparency as “blackmail” is disturbing.
The issue of secret cautions in the IME context has been written up in Canadian Underwriter. The insurer sponsored IME bizz has been referred to in the Medical Post as the “underbelly of medicine”. The smug tone of your comment suggests that you want the insurers’ “preferred vendors” of “independent” medical assessments to remain unaccountable for shoddy, substandard assessments. And you want the captive subjects of these dubious medico-legal assessors to be kept in dark regarding (sometimes multiple) CPSO oral cautions for prior assessments found (by regulators)to be sadly wanting. Have I got it right?
I think most physicians, even when in the right, hate the idea of a complaint against them, as it can take very long to resolve. So perhaps you think by intimidating a physician with a complaint, even when out of place, will get a favorable IME our of them.
Having said that, I think any regulatory body could agree that a health practitioner asked to give an “independent” opinion, should not be penalized by the content of that opinion. Sure if the health practitioner is found to be incompetent or unethical then there is merit for a complaint, however a complaint solely based on the notion that you don’t like their opinion will not stand up anywhere. Of course, some complainers may try to deviate from the main reason (not liking the content) and try to complain about the reviewer in other ways, making up fallacies about their competence and ethics. That’s why there is an investigation process to weed out such complaints. I think regulatory bodies are experienced with these issues and can see through the motivation behind most complaints.
So I am afraid, even if oral cautions and SCERPs are made public as in this proposal, it won’t really help much in the sense of persuading more reviewers to make their contents more favorable for the insured. An vexatious complaint will still not amount to an oral caution. And since now public, the physicians will now be more inclined to appeal and fight such a result, if the complaint were to amount to one.
There is nothing “independent” about IMESs as it stands other than the name. A rose is still a rose even if you call it a helicopter.
The comments posted on the consultation for Phase 1 of the project were overwhelmingly and almost entirely against the proposal, yet the Counsel appears to have approved it unchanged. The question is what is the value of the consultation process then?
Hi, the following is a summary of my concerns regarding the proposed changes to the information available on the public register. In short, the proposal to publicly dispose SCERPs and oral cautions to the public runs counter to the vast majority of principles established by the College itself. It also sends the wrong message to the public that the CPSO has been hiding physician information that poses a risk to public safety, and this is simply not the case.
1) Oral cautions should not be made public. This proposition is counter to the transparency principles established by CPSO.
a. Principle #5 indicates that some regulatory processes intended to improve competence may have better outcomes if they occur confidentially. The purpose of a caution-in-person is purportedly to educate the physician in ways to improve his/her practice. Making this information public serves to make a caution-in-person punitive to the physician, and sends a message to the medical community that these cautions are really a form of punishment and not a form of education. The physician is less likely to be receptive to information provided by ICRC if they are of the view that they have received a reprimand by virtue of merely appearing before the committee. Making oral cautions public also serves to unduly blur the line between the educational functions served by ICRC, and the disciplinary functions served by the Discipline Committee, and has the effect of confusing the public about the educational functions of ICRC and the fact that their decisions are not meant to be punitive.
b. Principle #8 indicates that information available from colleges about members should be similar. To my knowledge, this will be the only college in Ontario that will make such cautions public. For this reason, oral cautions should not be made public.
c. Principle #2 indicates that providing information to the public has benefits. It is really difficult to imagine what benefit the public would have from a summary of a disposition without any contextual details regarding the complaint itself or why the college chose this particular course of action. It is also questionable how the public benefits from knowing that the physician appeared before a committee of the college for an educational purpose: does this then mean the instruction provided by the college makes for an inferior physician? The public will likely take educational discourse from the committee as a sign that a physician is inferior to his/her peers, which is quite misleading to the public.
d. Principle #3 indicates that information provided should enhance the public’s ability to make decisions. Again, does the public’s knowledge of an educational disposition from a committee (regarding a particular physician) serve to enhance the public’s ability to make decisions? For the reasons laid out in bullet (c), it is questionable whether public access to a summary of an educational disposition provides meaningful information that will reasonably inform the public’s decision-making.
e. Principle #4 indicates that for information to be helpful to the public it must include context and explanation. For the reasons mentioned in points (c) and (d), a summary of an educational disposition put out by ICRC does not meet this criterion.
f. Principle #6 indicates that transparency principles should balance the principles of public protection and accountability with fairness and privacy. It is patently unfair and punitive to physicians as a group to publicly post information that is meant to inform the practices of physicians. It also serves to undermine the relationship between physicians and their regulator by creating mistrust of College practices that are on the surface meant to inform, but actually serve to unfairly punish physicians.
g. Principle #7 indicates that the greater the potential risk to the public, the more important transparency becomes. The vast majority of oral cautions to the College involve a communications component that ICRC feels needs to be addressed in person. The vast majority of oral cautions do not constitute a material risk to the public, and publicly posting these outcomes sends the wrong message to the public that they are somehow at risk. Publicly posting this information also sends to the public the message that the CPSO has been hiding information that constitutes a material risk to the public for years – and this is simply not the case.
2) Specified Continuing Education and Remediation Plans (SCERPs) should not be made public. This proposition is counter to the transparency principles established by the CPSO.
a. Principle #5 indicates that some regulatory processes intended to improve competence may have better outcomes if they occur confidentially. The purpose of a SCERP is purportedly to educate the physician in ways to improve his/her practice. Making this information public serves to make a caution-in-person punitive to the physician, and sends a message to the medical community that these SCERPs are really a form of punishment and not a form of education. The physician is less likely to be receptive to information provided by ICRC if they are of the view that they have received a reprimand by virtue of merely participating in an educational program. Making SCERPs public also serves to unduly blur the line between the educational functions served by ICRC, and the disciplinary functions served by the Discipline Committee, and has the effect of confusing the public about the educational functions of ICRC and the fact that their decisions are not meant to be punitive.
b. Principle #8 indicates that information available from colleges about members should be similar. To my knowledge, this will be the only college in Ontario that will make SCERPs public. For this reason, SCERPS should not be made public.
c. Principle #2 indicates that providing information to the public has benefits. It is really difficult to imagine what benefit the public would have from a summary of a disposition without any contextual details regarding the complaint itself or why the college chose this particular course of action. It is also questionable how the public benefits from knowing that the physician undertook a SCERP: does this then mean the instruction provided by the college makes for an inferior physician? The public will likely take educational discourse from the committee as a sign that a physician is inferior to his/her peers, which is quite misleading to the public.
d. Principle #3 indicates that information provided should enhance the public’s ability to make decisions. Again, does the public’s knowledge of an educational disposition from a committee (regarding a particular physician) serve to enhance the public’s ability to make decisions? For the reasons laid out in bullet (c), it is questionable whether public access to a summary of an educational disposition provides meaningful information that will reasonably inform the public’s decision-making.
e. Principle #4 indicates that for information to be helpful to the public it must include context and explanation. For the reasons mentioned in points (c) and (d), a summary of an educational disposition put out by ICRC does not meet this criterion.
f. Principle #6 indicates that transparency principles should balance the principles of public protection and accountability with fairness and privacy. It is patently unfair and punitive to physicians as a group to publicly post information that is meant to inform the practices of physicians. It also serves to undermine the relationship between physicians and their regulator by creating mistrust of College practices that are on the surface meant to inform, but actually serve to unfairly punish physicians.
g. Principle #7 indicates that the greater the potential risk to the public, the more important transparency becomes. The vast majority of SCERPs involve a communications component that ICRC feels needs to be addressed in person. The vast majority of SCERPs do not constitute a material risk to the public, and publicly posting these outcomes sends the wrong message to the public that they are somehow at risk. Publicly posting this information also sends the public the message that the CPSO has been hiding information that constitutes a material risk to the public for years – and this is simply not the case.
Thankyou for this…well-thought out.
Fine. Make oral cautions and SCERPs public knowledge, but you can’t call them those names anymore. Call a spade a spade!
Once public, these items will have disciplinary effect, no matter how you spin the issue.
If I were to get one of these, I would take CPSO to Divisional court and argue these points before a judge. Would not just roll over.
CPSO can succumb to pressure from a few malpractice lawyers who have pushed this issue at the newspaper (you know which newspaper) and at the lobby desk of a couple of MPPs. This issue has not been prompted by patients and not meant to benefit patients. If approved, it will have big ripples in the whole complaints process, and will prompt lots of legal battles from physicians.
I second this as I would certainly not roll over. This is certainly what the trial lawyers want; more lawsuits and more appeals to enable some of them to continue making their livings off the sweat and backs of doctors. It’s obvious to me that this transparency project, and for that matter the College empire as a whole, is really all about business and creating jobs at the expense of front-line, hardworking doctors. The mandate to ‘protect the public’ and the propaganda that ‘self-regulation is a privilege’ are mantras to distract from the true self-serving interests of the College and excuses to pass all sorts of policies and initiatives that disempower and demoralize doctors. Would doctors put up with this if they were unified instead of divided into factions? The ingenious illusion that the CPSO is made up of doctors and therefore must represent the best interests and opinions of doctors leads most doctors to remain silent and accept any and all decrees coming from the CPSO. Whereas the reality is the CPSO is a front for the government and its affiliates to do what they will with doctors. Either the doctors of Ontario contest it now or pay the price in the future with more lawsuits and ever-worsening enslavement.
As the family member of a patient who died as a result of a medication administration error I can tell you the push for this transparency DOES come from patients.
After the Chief Physician of an Ontario hospital was found by the investigations committee to have mislead my family regarding the cause of death of a family member they issued a verbal caution.
Because of the secret nature of the verbal caution I appealed the decision to the Health Professions Appeal and Review Board. This wouldn’t have been necessary if cautions were made public.
Allowing such conduct to remain secret does not allow the pubic to take the necessary steps to ensure such conduct ceases in the future.
The public wants transparency.
can’t determine from your post if there was a cause and effect relationship here between the physician’s action and the patient dying. One can gather that there was no such relationship. So with a caution published, without the contextual information, the public may be misled into thinking that there was such a relationship (just you are insinuating yet not exactly stating). The public cannot and will not be able to tell the difference between a reprimand and a caution, which is the reason why one is public and disciplinary and the other is private and educational.
Your point is taken and I think you have every right to know the cause of your family member’s death to the extent that is is clearly known.
Making this doctor’s error in judgment available on the world wide web takes it to a whole new level of punishment and can do irreparable harm to their reputation. The doctor can still learn his/her lesson without being imprisoned by their mistake for the rest of their lives.
Also, I have got news for the people of Ontario; if you expect your doctors to be without flaws or without error, you are sadly mistaken. Simply by virtue of the sheer volume of cases they see, every doctor in Ontario without exception has made errors that have caused harm to patients. Many if not most have also made errors that have lead directly or indirectly to a patients death.
This is the reality of medical practice. If the public is looking for flawless doctors they will not find them. I would agree that the public should have internet access to information, as they already do, of the most serious mistakes involving intentional sexual abuse of patients and gross incompetence with repeat violations. However, access to all doctors’ mistakes, cautions and education plans with be overly punishing and counterproductive. It will demoralize doctors, increase their stress levels and ultimately result in poorer patient outcomes.
So, if you were to get a caution/SCERP from the College you would automatically take the CPSO to court? Suppose you were completely in the wrong, and had made a sloppy, negligent error which had injured of killed a patient? What then?
This issue is a societal one, and it will most certainly benefit all patients indirectly, because once the CPSO is open to public scrutiny, the public will be able to see how it operates, whether it’s decisions are appropriate, and whether doctors who pose a risk to patient safety are being properly overseen or removed from practice (which almost NEVER occurs now).
BTW, I am not a malpractice lawyer, nor any other type of solicitor, and I would suggest that the pressure for change is “prompted” by patients just like me. They see a family member disabled for life, and no action to discipline the doctor taken by CPSO, whose first concern seems to be protection of their members.
Suing the physician is a very frightening option because the “Canadian Health Protection Agency” (a misnomer if ever there was one) which insures doctors for malpractice has a policy of never settling with patients who have been harmed, even when it is abundantly clear that the physician is entirely at fault.
The CHPA always force the patient to go to court, with all it’s accompanying expense and stress, and engage in endless appeals which ensure that any settlement received is eaten up by lawyers fees. The CHPA knows this abusive behaviour is the most effective way to intimidate complainants, and it works very well.
Of course, the CHPA is never short of funds, AS TAXPAYERS COVER 90% OF DOCTORS’ MALPRACTICE PREMIUMS IN ONTARIO.
first of all it’s called ‘Canadian Medical Protective Association” not Canadian health protection agency. If you are gonna post so many falsehoods and misinformation about it, at least get the name right.
2ndly, I am not sure what the CMPA has to do with this College policy consult. Perhaps you mean that the College process should somehow substitute for when a civil suit against a physician is unsuccessful. Again, that shows your lack of knowledge about the legal process and the roles of the College.
I don’t really see that it is of particular importance whether the poster of the comment referred to the Canadian Medical Protection Agency by the correct acronym or not…the facts presented are entirely accurate in terms of who pays your malpractice premiums: 90 % are indeed covered by the taxpayer.
I think the point being made is that, with the lack of transparency at the College, patients who are dissatisfied with the results of their College complaint have nowhere else to go.
The CMPA does prevent most patients from suing, even when they have a reasonable case against the physician, due to the massive imbalance in power between the self-funded patient and the taxpayer funded physician.
I think if you are going to accuse a poster of “falsehoods” you should at least identify what you think is untrue. In my experience, the behaviour of the CMPA is usually exactly as described. Nor do I see any evidence that the poster is suggesting the College is a substitution for the legal process in terms of complaints regarding substandard care.
More transparency at the College, and a better understanding amongst the public as to how difficult it is for patients to sue their practitioners for malpractice in Ontario and why, will hopefully result in a more balanced playing field for patients who have legitimate complaints and have suffered injury as the result of physician negligence.
it has huge importance. if you don’t even know the proper name of something, it really diminishes your credibility about your opinion on it.
But regardless, if you have a real case of malpractice, then lawyers would be fighting over to take it on a contingency basis. The fact that no lawyer was interested in doing that and dumped the cost onto you, plainly shows that you didn’t have a malpractice case in reality, and just in your opinion.
Doctors have a right to negotiate with the gov and to legally defend themselves. If you have a problem with that, go take it up with provincial law and the constitution, not with the College. And once again, the College process is not a substitute for a failed malpractice claim.
Biased IME experts? – is that really a question – Ask a mva victim and find out how biased they really are. These so-called second opinions which determine whether your insurer will pay you accident benefits are meant to downplay your injury, or show it was caused by something other than the car accident i.e. psychological factors to do with your past, or better still, to shut down your claim by saying that you’re scamming the insurer. Diagnoses by a victims own specialists or family physician are frequently ignored, and treatment is denied or cut short. The OTLA can tell you that these IME medical experts are known to change diagnoses from catastrophic to non catastrophic. Anything not to pay – but just as long as these evaluators keep their cushy insurance contracts – and to keep them, it is best to write, more often then not, in favour of the insurer rather than the accident victim. Denied benefit claims are the norm. “So You Think You’re Covered!…”
Self regulation is a privilege and it can be taken away. The proposed by-law amendment is insufficient to restore public trust in the profession because it is only forward looking. If you want to address the concerns raised regarding the College’s lack of transparency and accountability you must make the amendment retroactive. All verbal and written cautions should be available to the public on the college’s website not just the ones based on complaints made after January 1st 2015. Past cautions issued to teachers are made public. Why shouldn’t the same apply to Doctors? You hold a position of public trust and that trust has been abused. The vast majority of Doctors are exemplary members of society. Continuing the hide the misconduct of the minority brings disrepute to your profession.
Please end this “privilege”:
“Self-regulation is a privilege”. Have heard this College mantra too much which has little meaning as anyone at the CPSO or outside would fail to explain what exactly constitutes “self” in self-regulation and how it is a privilege.
First of all, in all reality and practicality, the College is NOT self-regulated. It is strictly bound by a massive amount of legislation (the various Acts, etc) and the council is only part physicians and the rest are gov appointees. More importantly it is constantly having to apologize and appease the media and public to preserve the illusion of this privilege. The College is always bending backwards to accommodate things that are not usually agreed to by other medical regulatory bodies that don’t claim to be self-regulated. There are many examples but the closest are all the Medical Boards in the US. Even though their processes and council makeup are very similar to the Colleges here, they don’t claim dubiously that they are self-regulated. Also, btw they don’t’ make cautions a publicly known thing. Also their budget comes almost entirely from the gov, as opposed to the budget of the Colleges here that charge almost all their cost to the physicians because of “self” regulation. The most self thing in self-regulation here is in fact self pay.
Secondly, by advertising “self” regulation as a privilege, the College gives the public the feeling that the College is serving doctors, which it certainly is not. Ask any physician what they think of the College. Typically a complaint, which costs nothing or no risk to file, is punishment in itself. Thanks to the fact tht the College is mandated to investigate every single complaint, and its very slow pace, a physician can be utterly devastated by a complaint even before it gets to the investigation committee which could take over a year. That is a year of someone’s and their family’s life pretty much lost to uncertainty and anxiety –someone who needs to work and help the public. If a person makes a false statement to the police about a crime, that person can be arrested and go to jail. Not with a complaint! A person can make up all kinds of lies about a physician with absolutely no risk whatsoever. There is something fundamentally wrong with this process in a so called free and democratic society, where everyone should be and is entitled to due process and protection of the constitution. Somehow the constitution is suspended when it comes to professionals, presumably as they are considered privileged probably because they are making money.
The College should consider making everything public only in exchange for the public having to pay the cost of a complaint investigation if it’s found to be meritless or frivolous, and there should also be penalties for purposely making false complaints. Indeed, that is the procedure of the law in society at large. You can’t have it both ways, as they say, “you can’t have your cake and eat it too”!
If physicians, unlike teachers, nurses, and cops had not already been stripped by the law, of their right to unionize, then perhaps the gov and its proxy the College would be having a much tougher stance in playing politics with the lives of physicians and imposing anything they want on physicians to appease voters. So it looks like courts are the last place for them to fight for their rights.
So as a physician, I would like to say that please END SELF-REGULATION and transfer the power to the interim receivership of a judge so we can follow the law and the constitution as it applies to every citizen of this country.
Thank you for posting this.
The physicians of Ontario do not have any type of self regulation in sense of the meaning.
All rules, regulations, criteria, standards and anything else has been predetermined by extensive legislation and bylaws already.
Furthermore, if the government does not like in any way something that the CPSO is doing, then they simply pass new legislation or rules to make the CPSO do whatever they want them to do.
We, the PRIVILEGED physicians of the Province get to pay for all of this and the government basically gets a free ride. I have to agree, PLEASE end this professional self regulation immediately. I for one would be happy to have a system similar to a state regulated medical board.
It could certainly be not any more unfair and discriminatory to physicians than the CPSO.
Please recall the debacle of the Medical Review Committee and its blatant abuses. To this day the CPSO insists that its role in that process was justified.
I would be ecstatic to gain the same right and privileges as all other citizens of this Province.
I agree. The “privilege” of self-regulation should end.
Let the government regulate physicians and let them bear the cost.
the government already regulates physicians, ‘self-regulation’ is an illusion. The government passes the laws that govern the CPSO, the ‘self-regulation’ facade enables them to justify robbing doctors of their constitutional rights and freedoms not to mention their wealth. After all, it gives the illusion doctors are doing this to themselves, how can the government be to blame? Similar strategy is in place with the current Minister of Health and the current ‘contract’ imposed on doctors.
It’s time for Ontario doctors to take the veils off their eyes and wake up to the reality that they are currently enslaved by the government. Time to defend their rights, challenge the government to the Supreme court! Otherwise suffer ever-worsening enslavement and destitution of your guaranteed fundamental rights.
Agree completely. I think self regulation ended in the early seventies. Physicians and patients are much better served by the California licensing system where one deals with the “Department of Consumer Affairs” in Sacramento. No pretense. The downside would be that the College would have to move from it’s opulent Bloor Street offices and a lot of staff would lose their jobs The physicians could return to Medical practice and improve care, waiting lists etc. The self congratulatory, glossy College publication, “Dialogue” (Diatribe?) would be reduced to a yearly government pamphlet.
There are no perfect professions, and medicine is not different. I don’t see cautions made on police offers, politicians, employees, teachers etc listed on any website. I do believe the college is doing this for show, they are too incompetent to remove bad doctors, so now are washing their hands and justifying their self worth by introducing new guidelines. The public will not know the difference between cautions and disciplines, come on. Its funny how doctors have to pay the CPSO yearly for all their help.
By publishing cautions will forever ruin the reputation of many doctors, and will make medicine more about pleasing the patient to avoid a complaint, than about good medicine, but were heading down that path anyways. I do predict a rise in the suicide rate of doctors because of this and absolutely no improvement to patient safety. Just another way to put down a doctor along side ratemd.com.
‘ will make medicine more about pleasing the patient to avoid a complaint’
You got it right! In fact medicine in Ontario is already there.
The rule of law does not apply to doctors in the complaints process; they are presumed guilty and treated like criminals often for doing nothing or very little wrong.
The CPSO can come into their offices, examine their files, question their staff and even delve into the doctor’s own personal medical file if they deem relevant. All this is mandated by law.
If they’re lucky the doctor will be vindicated but not for months or years later and not without irreparable damage to their psyche.
Most complaints, I would argue, are meritless and vexatious in nature. They are an avenue for patients to blow off steam with virtually nothing to lose at the expense of the mental anguish of doctors. Thousands of complaints get filed against Ontario’s 28,000 practicing physicians yearly. This is big business; investigators, committees, and lawyers, the whole CPSO empire, thrives off of it.
Ask any doctor who’s gone through a complaint and most will tell you they’ll do anything to avoid another one. Sometimes they get a complaint from a patient because they did not yield to an inappropriate request on moral or ethical grounds. So what might do they do next time? Yield and slowly chip away at their integrity. The CPSO (government) turns doctors into minions of the state, jaded automatons catering to unreasonable demands of the public at the expense of their integrity. This can do more harm than good.
Can we expect our doctors to be happy in this environment? Are unhappy doctors good for patients? Will the government ever be satisfied with the stranglehold it has on doctors?
It is time for a truly independent body to represent doctors, one that will demand an end to ‘self-regulation’, not one who’s palms are greased by the same government that runs the CPSO. So long as ‘self-regulation’ prevails Ontario doctors will remain enslaved. Time for a change.
Here, from the Friday edition of the National Post, is a good argument for more College transparency and for making oral cautions public:
Inside Canada’s secret world of medical error: ‘There is a lot of lying, there’s a lot of cover-up’
by Tom Blackwell | January 16, 2015
Mistakes happen in any profession and medicine is no different. The challenge is dealing with mistakes in a productive manner which leads to improvement. As the article points out:
‘A health-care culture still straitjacketed by an old-fashioned hierarchy, fear of legal action and a focus on punishment rather than learning from mistakes also keeps missteps bottled up’.
The CPSO and this transparency initiative contributes to this ‘old-fashioned hierarchy’ and wants to publicly humiliate doctors for their ‘mistakes’. This is not the way forward.
Instead more compassion and understanding is needed. The public must accept that mistakes will occur and punishing doctors will not solve the problem.
Instead doctors should be encouraged to improve in a non-threatening environment, they should be protected against litigation and public humiliation arising from ‘innocent’ mistakes. Only the most serious and deliberate incompetence causing direct and repeated harm should be made public.
The comments on the phase 1 of this issue were almost all against, yet it was approved without change. So it will be no surprise when phase 2 is likewise approved despite the comments here, which are mostly negative.
Having followed the series of Toronto Star articles on this issue fed particularly by one particular malpractice lawyer, the relating correspondence between the College and the Minister of Health, and the private bill by Rep Clark on making all complaints public, it is pretty obvious the College is playing politics, and trying to keep all parties happy without losing its powers.
Having said all the above, the College is putting itself at legal risk by this proposal. Most people, including perhaps the majority of physicians who have not been subject of a lengthy compliant, do not understand the difference between an “oral caution” and a reprimand. Yet one is issued by the ICRC, without any hearings, witness testimonies and essentially a due process, and the other one is. It would be improbable to say that, when published, the public will understand the difference between the two. They will both have equally damaging effects on the reputation and psyche of any physician. The issue is that the College will bypass due process in imposing a public action, amounting to disciplinary effects, by publishing a caution or even SCERP. Even though there has not been a formal challenge from any physician or physician group on this violation of due process, it does not mean that there won’t be once it is enacted and applied.
Fought well in court, this proposal will not stand. The question is how long will it last before it is struck down, hopefully without any physicians committing suicide over it, as was the case with the College-run MRC before it was struck down in court.
I am generally in favour of the proposals.
I do have some concerns about posting physician’s criminal charges.
I presume this means while trial and judgement is pending.
We still live in a society that believes a person is innocent until proven guilty.
I appreciate the sentiment that patients should have information about their present or soon to be doctors but I feel the proposals are prejudicial and unfair.
The flip side is a physician who refuses to take a patient on the basis of their criminal record. This would be discriminatory. The proposed policy is even more harsh as it applies to doctors who face charges only and have not been tried.
Maybe a compromise would be to restrict divulging information only to certain charges ie violent etc.
Thank you for requesting feedback regarding public transparency.
I have concerns about physicians criminal charges being posted prior to conviction. In essence this will have judged the physician prior to their guilt being proven in court. I also don’t understand why you would remove it if a criminal finding is proven in court. There are obviously different levels of criminal behaviour. I could (I suppose, I am not a lawyer), be charged of something of which I am completely innocent, and yet my college record would show that. If I have been charged with murder, assault, or a major offence then it would be reasonable to publish that. Is there some way that you and the legal system can stratify charges? If I were charged with impaired driving, my medical diagnosis would be alcohol abuse, and the CPSO would step in and I would go into the Physician health program. Should my medical condition, if treated successfully be published? Are we here to keep our physicians healthy and to restore them to health and safe, effective practise? We have watched the circuses that erupt when celebrities are charged with sexual abuse. In a way, being a celebrity and banking on your name has taken away these peoples’ right to be presumed innocent until proven guilty. How do you decide when a physician’s charges are egregious enough to justify hanging him or her in the court of public opinion?
I certainly support publication of physicians’ criminal convictions.
I also have concerns about publishing findings from other jurisdictions, thinking that other jurisdictions have different processes and perhaps different ways of dealing with concerns. For example there have been cases in the US of physicians being charged with offenses related to their prescribing practises that have led to physicians being arrested and sent to jail. A case like this was discussed at the American Academy of Pain management in Arizona in 2012 by legal experts. The physician was eventually released and all charges were overturned. Is it fair to this physician, if they come to Canada to have this published?
I am relieved that a “SCERP” only applies when there has not been a voluntary agreement for an educational remediation program. We all have deficiencies in our knowledge and being life-long learners, should have the opportunity to remediate them.
I realize that the CPSO has given enormous thought to all these proposals and would be delighted to receive a response to my concerns eventually.
I don’t believe that more disclosure of the personal information of a physician will improve patient care while been fair to physicians as human beings themselves.
For starters, our present govt has shown that they do not believe in transparency. So this request from the Minister is politically motivated at the expense of the personal lives of physician.
I agree that the College needs to be more transparent to the public and that the public has a right to some of this information. My concern, however, is that I have heard from various colleagues over the years about the process involved in College complaints, and it seems that the process itself can be significantly flawed. What, if anything, is being done to ensure that the process of dealing with College complaints is more rigorous? If the process is not fair and rigorous, the act of being more transparent is probably meaningless (you can get the same quality of information on RateMD) and is also potentially harmful to some highly qualified and ethical physicians.
Looking forward to hearing your responses.
As many commenters have stated, I respectfully disagree with the proposal to post a physician’s criminal charges online. An individual is innocent until proven guilty and this innocence should be respected. While the College (appropriately) intends to remove said charges after an acquittal, by then I fear the damage to the innocent physician’s reputation will have been done. Trials can take years to conclude after the charge date. By that time, numerous “screenshots” of the charge posting may have been taken and widely circulated on the Internet, where they may exist in a perpetual state of digital indelibility. Hardly a fair or useful thing for an innocent professional to endure.
Due to political pressure, this proposal is already decided upon even though the College probably knows it is unjust and unfair. The College would never risk its status and power to stand up to the Gov for physicians.
Physicians are a divided bunch, leaderless and too busy to know or care what’s happening. Worst of all we don’t have a union like teachers, cops, or nurses to stand up for us. Basically we are defenseless at the mercy of the government and College that can write and impose on us any laws and bylaws that fit their political agenda dujour.
This is getting to be a sad, sadistic, and risky profession to practice in. Going to work is like going to walk in a minefield. Despite one’s best efforts and diligence, you never know when which patient, other party (anyone can file a complaint) will set off a mine as you walk on, and tangle you up in a compliant for months to come. There is no penalty to file a complaint and despite the outcome, a complaint is a sentence itself.
10 years into this profession, but honestly if someone had sat me down to discuss with me the College and what it can do to one’s psyche, I would have never chosen this one. Being academically at the top of my class in high school and university, I am sure I could have done well in another field. I am sure countless other physicians feel the same, as I come across them everyday.
I have read the Dialogue article on the Transparency initiative and overall am in support of it. The one aspect I question is including criminal charges that haven’t been proven. While it is true in Canada that charges are often reported in the media I am concerned that including this information will suggest to the public an element of guilt that hasn’t been proven. I am in favour of reporting the other 4 aspects listed in this phase of your project. I have no conflict of interest here and am not currently the subject of any police charges or investigation.
Thanks for the opportunity to give feedback.
Whether physicians like it or not a caution should be made public. A caution is the most serious outcome from an investigation only. The fact is that a physician could have fallen below the standard of care and still be issued a caution. It is also true that the CPSO could have concerns regarding the physician’s knowledge and skill in his area of practice. As a patient I WANT TO KONW THIS. A physician could be practising on the edge of incompetence and being issued several oral or written cautions. Just because he hasn’t killed anyone or made such an egregious error that caused serious harm doesn’t mean I want him treating me. I SHOULD HAVE A RIGHT TO KNOW IF THIS PERSON HAS FALLEN BELOW THE ACCEPTED STANDARD OF CARE WHEN TREATING PATIENTS. I want to make an informed decision when choosing my practitioner as I would if I hired a contractor, nanny, etc. I am dealing with a complaint now where the Committee has concerns with a physician’s, record keeping, treatment, skill and communication. He was issued with an oral caution. Others should know about his skill set or lack of skill when they choose him or are referred to him. Doctors need to realise that we are consumers, we are customers and we need to make informed decisions regardless of whether OHIP pays the physicians. WE HAVE A CHOICE IN WHICH DOCTOR WE SEE and we need to make educated an informed decisions. Having ALL of the discipline and concerns the CPSO has about a certain physician will assist us as consumers to make an informed and educated decision.
Physicians look after your health and in order to do so effectively they themselves must be healthy. To impose arbitrary, disempowering and stressful rules on them will be counterproductive.
A caution is just that and by no means the most serious outcome of an investigation; the most serious outcome of an investigation is taking a doctor’s license away for an egregious act like sexual abuse of a patient.
A caution is merely saying to a doctor that there is an area of their practice which can use improvement.
If the College followed any doctor around with a video camera 24/7 I’m sure they could find reason to issue every doctor in Ontario a caution as no doctor is flawless and all can use improvements to their practice. They would be much more likely to improve if deficiencies were pointed out in a non-threatening manner rather than punishing them with a public reprimand. To make an analogy, if your contractor installed a toilet and it leaked do you think it would be more effective to give the contractor a chance to remedy the issue before reporting them to the Better Business Bureau and publishing their mistake on the internet? How will they learn and improve if they are not given a fair chance to do so without punishing them first?
Moreover, if you want to avoid doctors in Ontario that have been issued cautions you’d have a really hard time navigating the system. How, for example, would you know if the radiologist reading your x-ray had not been issued a caution. How about the pathologist interpreting your biopsy specimen? There is risk inherent in using the healthcare system and there always will be. Doctors are humans and humans are not perfect. But doctors are highly trained and skilled professionals and by far and large do more good than harm. They should be allowed a fair chance to remedy their deficiencies without public humiliation.
Moving on to another of your points, just as you the consumer want as much information about a doctor before making your choice, don’t you think it would be fair then for the doctor to request information about your past too, especially as it relates to your criminality? After all as a prospective patient of a family doctor, for example, you would be entering into an enduring trust based relationship and could potentially be exposing the doctor and his/her staff to risk. Where are the doctor’s rights in this process?
Finally, as others have pointed out, the decisions by the CPSO, especially in relation to cautions where there is no formal process, can be arbitrary and misleading and frankly unfair. In the everyday court of law, a citizen would have the ability to defend themselves against a potentially defamatory and reputation damaging judgement which a caution would become if made public. I predict legal challenges will happen more and more if cautions are public as they are liable to adversely affect a doctor’s livelihood without due process.
Overall, making cautions public will make them overly punishing, it will stress doctors (just like so many CPSO initiatives), be counterproductive and overall bad for patient care. If the CPSO is being sincere in its intent to make cautions publicly available on the internet, I challenge them to demonstrate one iota of evidence apart from political rhetoric to show the public that this will improve patient care.
Thank you for considering these comments.
If any group is in need of surveillance and a review of their methods, practices and real utility to the public, not to mention the huge costs involved, it’s the CPSO.
I couldn’t agree more, CPSO self regulation has equated to little or no protection for the public and in the end, the public has learned to distrust the profession as whole. It isn’t fair to those who have done a good job but accountability means owning mistakes and learning from them.
CPSO themselves are responsible for the loss of trust of patients in Ontario. Own it and learn from it.
I have a License in the Province of Ontario as well work out side. I do not feel public needs to know every singe detail of a Physician after making mistakes.wrong decions. Every body has a right of Privacy. If Physician has done mistakes/errors deserves a punishment or take away his/her License but person/physician has a right to live a reasonable life without further shame from public. It is just a sugestion.
Making cautions, and other non-disciplinary information public on the College website without any action against the doctor is problematic, in the sense that how is the public going to use the information?
As another poster commented this “buyer beware” type of policing does not help me or any other consumers who are not doctors or nurse to understand medical lingo and risk.
How are consumers to decide if this doctor is safe or not? I thought that was the job of the College. The College should be deciding who is safe to practice medicine, not me. And what about people who are not internet savvy, or don’t have computers? I guess the College is gonna say too bad that you got botched, because we told you so on the website and it’s your fault for not checking the College website. As an example, the health dept doesn’t give cautions about restaurants. They either take their license or they don’t. There is no middle ground.
The point is giving cautions to public is useless and problematic unless you put the doctor under some kind of suspension, or take his license.
My comments about the proposed changes:
1) Completely agree with posting the cautions-in-person. This, though, should be in parallel with the ICRC being given direction that a verbal caution is not longer just “educational”. It will now represent a major punitive action not to be taken lightly. Many cases where a VC is on the table can be settled with undertakings. This will really help leverage the success of undertakings.
2) Don’t agree with publishing SCERPs. There are meant to be educational to improve knowledge and skills to facilitate the MD becoming a better physician, communicator, etc. Publishing this information will curtail it’s educational value and make it punitive. Also, the current heterogeneous process of determining SCERPs by ICRC is too variable (ie. some committees have a low threshold for SCERPs, while others don’t). So, it’s not an equal playing field.
3) I don’t think all criminal offences should be made public. For example, it makes no sense to me to publish relatively minor traffic offences. There should be some qualifiers. Secondly, I don’t agree with publication until there is a conviction. We should not support a process that publicizes your guilt before a fair hearing.
4) Agree with publication of licenses in other jurisdictions and discipline findings from other regulators.
Publishing the names of a physician when he/she is being charged but not yet convicted goes against that basic right of the individual.
Once published even if the person is found innocent the reputation has been ruined.
Has the college considered this important issue?
I have to state that the caution caused severe psychological distress for me. Documentation seems to be the only thing that mattered. I was very close to suicide during the process. I don’t see how posting this would have helped me to be a better physician. The only thing that the caution achieved was to increase my determination to leave the profession as soon as it becomes viable. If is very easy to sit in judgement after the fact with the benefit of hind sight.
This new transparency legislation represents a complete failure of the CPSO in doing its job of regulating our profession. Instead it pretends to be more transparent, but actually it will release more misinformation and incomplete information to the public which will only confuse and in no way improve patient care. It is no longer acting in the publics interest but its own bureaucratic interests.
The CPSO would love to have the public to think its doing its job by posting everything, but in reality its skirting its responsibilities as a regulator and pushing the decisions process back into the publics lap, in the hope that the lay person will figure it out what all of this new information means.
The witch-hunt on Ontario physicians by an inept government, a sadistic media, a voyeuristic public and a self serving college continues unabated on many fronts.
No worries…I will give the public what it WANTs…what Dr. Google tells it to demand of me.
I will give into every demand for x rays.
I will give in to demands for MRI’s.
I will give into demand from patients who come with a long ridiculous list of lab tests that their naturopath wants them to have.
I will give in to demands for that 6th opinion from yet another specialist.
I will give them antibiotics I know that they do not need.
I will respond to the many threats that I get every single days and give the patients what they want.
I will not be giving them what they need.
I will be costing taxpayers a mint at a time when I am being told to tighten my belt.
I will not be practising good medicine.
I will cease to be an actual doctor – just doling out what is wanted.
But…I will avoid a college complaint.
I will avoid a public ‘caution’
And I will be out of this god forsaken profession in less than 10 years.
Just providing some examples of where this could go and what the unintended consequences could be.
“Be careful what you wish for…you just might get it” – forgot who actually said that first but it holds true here.
Once cautions and SCERPs are published, I can just see the next media article about the College: “patients suffered, because physician was allowed to practice even after the College issued oral caution to him”.
The College thinks it’s going to solve problems by publishing more abut doctors. It’s going to create many more problems for itself. Once these items are published, the crazed irrational media and public will point fingers and demand that the subject doctors not be allowed to practice or be restricted when getting a caution or scerp.
A caution to a doctor to be made public? that’s fine, but who is the caution for? The doctor or the public? The proposal says this is to allow the public to make informed decisions about which doctor to see or not to see. So obviously the caution will now be meant for the public.
The point is if you change the nature of the what used to be a caution, it’s no longer a caution. Call it a public notice or advisory, but you can’t call it just a caution anymore when it will now be much more. You can’t have it both ways. Don’t be so illogical and blatantly contradictory.
Having read your rationale for displaying these on the website, I still feel very strongly that only charges with any semblance of connection to the practice of medicine should be displayed. Canadian society places a high value on privacy and while a member of the public might wish to know, I do not feel it is reasonable that there is easy unfettered access to highly personal information. It might be reasonable to have a mechanism for a member of the public to be able to access the information about unrelated charges by sending the college a written request but I do not feel it is reasonable to make the information totally public to anyone for any reason, which may be completely unrelated to the practice of medicine as well e.g. idle curiosity when the person has had no contact of any type with the physician. I might like to know if any neighbor has had criminal charges laid but that does not give me the right to know. I feel physicians as well as patients are entitled to reasonable privacy.
I want to let you know I support making all of this information publicly available as proposed. Given the power imbalance that is in the physician/patient relationship, this information is very important to be consistent with principles 1, 2 and 7. I disagree with principle 6 and have concerns about the application of principle 5. Some examples would be helpful with that one.
could you explain the “power imbalance”?
A patient in most cases has many choices, and can without notice terminate the relationship with a provider and go to another one. A doctor cannot terminate a patient unless going through several difficult steps and risking a complaint.
A patient can file a complaint with the College free of charge and for any reason, thus tying up the physician in paperwork and lots of anxiety for many months. Where can a physician complain about an abusive patient? Any complaint has the potential of becoming professional misconduct which can end the physician’s livelihood.
If anything, the power balance seems skewed against the physician, not the patient.
I have some concerns regarding the proposal to post criminal charges against physicians on the public record. I think a more balanced proposal is to post proven criminal offences, but not to post unproven criminal charges.
Agree completely… thank you. Unproven charges that are eventually dismissed leaves CPSO open to lawsuit and loss of confidence in it by its members…both of these outcomes are unwelcome when they occur.
I would be very wary of publishing names of persons charged but with the charges unproven. The middle ground is for CPSO to indicate to the charged that it would in the best interests of all to ensure transparency in practice going forward; this would be done by a mutually-agreed-upon overseer of a practice (cost of which, I would suggest, would be born by the “loser” when the charge is finally adjudicated). This would ensure public, physician and CPSO protection…in particular, the physician would have a chance to explain to his/her own patients on his/her own terms what the situation is, thus being able to more fully clarify the situation (rather than a truncated/incomplete posted version on a website). As well, by the time the case was adjudicated, a large volume of practice-relevant material would have been collected which might make penalty much more sensible.
The attitude of most physicians is that their deliberations and suggestions with patients represent their best effort to be helpful in a given set of circumstances…we are generally proud of our ability in this regard, and often welcome the opportunity to display the care and thought that has gone in to our many daily decisions. Most practitioners, particularly if they thought they were being unfairly targeted, would be glad to have third party witness to their ongoing work to buttress their convictions that their habits comply with their oaths and undertakings as physicians.
Thank you for the opportunity to respond.
Re: Specifically the Caution in Person and Continuing Education and Remediation Programs being made public.
There is no greater professional failing and personal shame than being cautioned in person or worse sent for remediation programs.
I had a perfect storm of events that culminated in these two things happening to me at the same time. I “fired” or was about to “fire” three patients in short order for various reasons. They all complained at about the same time.
In retrospect I made many mistakes although none of them medical. I think that all would agree, including the committee that cautioned me and the educators who instructed me, that my mistakes were mostly innocent and thoughtless as opposed to an overall negative pattern of care.
The problem is that these “punishments” are determined based on written testimony and history without true due process or even legal input (as I foolishly did not seek advice). When my colleagues at the college actually sat down to talk to me they realized that I was not such a bad guy but that I had made some bad decisions. Unfortunately, by the time the interview was complete the process was already set in motion. There is no turning back.
I imagine you hear a great deal of this “excuse” and it is easily dismissed as trite but don’t take my word for it. Ask the past committee members and educators. Has there ever been a time when they met someone who was really not deserving of the penalty of a public shaming? The feelings I had of utter personal disgrace, dishonor and the resulting depression were overwhelming. I didn’t even tell my wife until the end of it. I can’t imagine how devastating it would have been to me if these decisions were made public. It nearly destroyed me as it was.
Indeed, some of the disclosures may be for the public good but I can certainly tell you that this would not have been the case with me. Is the public shaming and destruction of a few good physicians worth the “transparency” that you seek? Mark my words that if this goes through there will be a disaster looming soon after. We have seen it before.
My opinion is that there should be no blanket public disclosures. You must decide if the process is to be educational and enlightening or punitive and dishonoring. Make no mistake that a public disclosure is entirely punitive in the extreme. I personally could think of no worse punishment other than license suspension. If you wish such transparency it must be done on a case by case basis and you must insure that your net does not comprise of those thoughtless and innocent mistakes. A personal interview must be done prior to any public shaming as the process unfortunately can sometimes be unfair to the physician.
For me the horse has left the barn. It has been years since I did my penance and I am in a really good place but I still suffer. You will use my history against me forever. I must go the next 30 years without making a mistake as I am now and forever on the college’s radar. A relatively simple complaint, an unhappy or vexatious patient, would likely reflexly result in at least an in-person caution. Although I may disagree, I actually understand and regretfully accept that I am now and forever a college target.
Your job is to protect the public and you need to be sure that I am continuing to be thoughtful and ensure that indeed there is no negative pattern of care. I respect that fact and thus acknowledge my fate. And although working in fear is not an ideal way to practice medicine, I have managed to do well. This proposal alone has increased my fear.
Ask yourself, if it passes would it make me better or worse at what I do?
And isn’t that the point?
Today I came across and video on social media released by the Deputy Registar ‘The CPSO: Perception vs Reality’. I commend the effort and I would highly recommend any physician in Ontario view it, it is available on youtube.
Many statistics were released in this video including that in ‘a recent year’ 2,600 investigations were conducted by the College; 4.6 % resulting in written advice, 11.3% in a caution, 2.1 % in an undertaking, 3.4 % in a SCERP. It would have also been useful to know what the remaining outcomes were.
The clip also mentions that there are 1,000 (out of the 28,000) physicians in Ontario that give their time to the College as it can be ‘rewarding’.
In the spirit of transparency, I would request the College to also release statistics revealing what proportion of the 2,600 complaints investigated involved the 1, 000 physician participants of the College.
Also, if there was a concern expressed by a member of the public/colleague via a phone call letter about one of these 1,000 physicians, how many got dismissed without investigation? How does this compare to the rest of physicians in Ontario? Of those 1,000 who got investigated, what was the nature of the investigation, how long did it last, and what were the outcomes, again compared to the other 27, 000 doctors in Ontario.
Perhaps transparency here might also help debunk the ‘myth’ that the College is a self-serving, bureaucratic, ivory tower arm of the government which only a ‘vocal minority’ of physicians believe.
Thank you for your consideration.
It is a commonly held view than “where there’s smoke, there’s fire”. But sometimes there is not even an ember. Vexatious and malicious charges with no basis whatsoever have been known to exist. The mere existence of a charge without a conviction should not be posted in public. The accused may have done nothing at all wrong, but become embarrassed in front of friends, family and patients. The damage to livelihood and quality of life could be damaged irreparably and permanently (giving a vexatious/malicious accuser exacter what he/she wants).
Re: Member feedback, changes to by-laws, transparency phase 2 by-laws
I wish to comment about proposed changes to the by-laws of the College of Physicians and Surgeons.
I appreciate that the college has asked for feedback.
I have been a member of the College of Physicians and Surgeons since the 1980′s and have dealt with the College in matters not only pertaining to my practice but the practice of other colleagues and appreciate the excellent work that the College does to protect the public and to regulate my profession.
I have studied carefully some of the proposed changes to the by-laws of the College of Physicians and Surgeons.
I have myself been associated with one complaint that ended up with a caution in person which I recieved withing the last two years.
This was a difficult process for myself and I would without commenting on particularts of the case would say that it was an educational and certinaly changed my practice.
I think that this caution in person is a significant decision on the part of the Discipline’s Committee and certinaly had a significant impact on myself.
I am concerned that the process which I was told was an educational and constructive process might change in it’s nature if there was a permanent record of such events in the future on my publicly available record.
I think this greatly increases the severity of this type of discipline measure and I am not sure that it is a constructive change to the policy.
I do appreciate that in some cases where the physicians who is being cautioned is a “repeat offender” or does not cooperate or show appropriate insight that it may acutally be necessary to publish the findings of a caution in person on the permanent record.
I my case I do not think this was necessary as I took this process very seriously and again it was a practice changing process and an educational process with an interview with a committee with questions, answers and contructive criticism.
Leaving a permanent record of this interaction on the public record flags the doctor and I dont think in my case it would have added anything to it, in fact it would have made the process more difficult and more traumatic.
I think back to Nathaniel Hawthorns Scarlet Letter and the person made to wear a “Scarlet A” and again I am wondering if the leaving of this finding on the public record is in fact a postive measure.
I however must appreciate that the College has a duty to inform the public as to the physician’s and the findings against them up to a certian degree.
I would respectfully suggest that the committee which is deciding on the level of discipling have the discretion as to whether to publish the caution in person or have it just in the internal College records.
This would give a flexibility for the committee of being able to, at it’s discretion, increase the severity or seriousness of the finding.
I would be more than delighted to talk to anybody in the College who might be interested further in my feedback. I think my feedback is useful as somebody who has been through the process and realizes that a caution in person is a significant measure on it’s own and may not need in all cases to have the addional severity of permanent publishing on the record.
The reply posted by the ‘Information and Privacy Commissioner of Ontario’ is showing blatant disregard for the privacy of physicians (who are by the way also members of the public) by suggesting that charges under the Criminal Code Act, Health Insurance Act and Personal Health Information Protection Act be posted on the public register.
It is conspiring in the plot to sentence physicians to public humiliation for charges not yet proven. There is the presumption of guilt and punishment until proven innocent. Disappointing to say the least.
Furthermore, if the Information and Privacy Commissioner is really concerned about the collecting, using and disclosing of personal health information in contravention of the PHIPA, I suggest it look no further than the practices of the CPSO itself.
I challenge the Commissioner to delve into the CPSO’s section 75 investigations to determine how many times it has abused its power to invoke the personal clinical records of physicians without their consent and for no justifiable reason.
Please, Information and Privacy Commissioner of Ontario, protect the privacy of physicians too.
It’s interesting that ‘the Information and Privacy Commissioner of ONTARIO’, seems not one bit annoyed about the unprecedented sweeping change in the privacy of physicians who are by the way still people of Ontario. I don’t remember relinquishing my rights as a person when I was awarded the MD degree.
It is obvious this province does not respect the huge work and duties that physicians take on daily and is on a “witch hunt” of its doctors.
In the last few years, there have huge multibillion dollar power scandals of the ruling party in this province, and it is amazing that nothing was done to the politicians at the centre of the corruption allegations. What was done is that they got reelected.
The province applies rules that are different by 180 degrees to some and in this case to doctors. The ruling party should lead by example not by witch hunt.
Interesting that the “privacy” commissioner is advocating for less privacy. That’s would be like a human rights organization advocating for more capital punishment. An oxymoron, some would call it. How sad!
I guess when it’s physicians as the target, it’s open season for all gov bodies to rein in.
The Privacy Commissioner is advocating for more transparency, just as she would if Freedom of Information requests were unreasonably refused by the government which we, as citizens, pay for.
Well, we pay for our healthcare system too, and as citizens we have every right to expect that information about doctors who have provided negligent care be made publicly available.
It’s not “sad”, it is long, long overdue.
There is a big difference between making information available and posting it on the internet. Info on the internet will not be used just by patients, but also by many elements that may use the information in harmful ways that have nothing to do with patient care. The information should become available but not posted on the internet. Just remember 20 years ago, there was no internet and the CPSO had no website to post on.
I am not aware of any other jurisdiction in the world that puts so much info on the internet about doctors, as this policy is proposing.
There should be a balance between publicizing things on the internet and maintaining professional people’s dignity as persons. There is already a lot of regulatory pressure on physicians with the fear of that dreaded complaint. By putting more fear into the profession you can expect some good doctors with no records to leave the province or the profession. I mean who would want to risk their life’s career and PERSONAL (not just professional) reputation on a narrow string that may be cut at any time in circumstances that may be well beyond one’s control.
I feel charges should not be posted. Until charges are found proven the person is NOT Guilty, and putting it on the internet does not seem fair. The public will just see charges, and therefore assume guilt. This is a common response. Once thought to be guilty, a doctor would never get rid of the effect. If proven, I have no problem with any of the findings…
Phase 3 needs to look at the transparency of your process where the doctor is made the victim and the patient the villain.
You superficial investigations do not protect the public. The College investigation process is flawed and biased.
The College Investigator summarizes the patient’s complaints in a manner which makes defending the care possible.
The College permits the patient to reply to the Doctor’s response; the response may generate further specific concerns; these patient concerns should be an important part of the investigation, but they are disregarded.
What, exactly, does the College IME see? Is the IME given ALL the facts? And why does the College protect the identity of the IME?
The identity of the IME and the information they receive to make their decision needs to be transparent.
The patient should be given the opportunity to provide the missing data to the IME.
Why are OHIP records not an essential part of the investigation?
When the IME expresses concerns, the doctor is allowed to respond to the IME’s concerns, and that response goes unquestioned by the IME.
The panel for my complaint and two others against the same doctor had only one public member; the same public member each time. Two different doctors and one outnumbered member of the public – whoever decided that is quite clever.
Who is that clever person – the one who determines who gets on the panel?
The RHPA does not require “exhaustive investigations”.
The RHPA permits superficial investigations which promotes superficial College decisions, which doesn’t protect the public.
The superficial process causes secondary harm to the patient who cannot make himself heard by the College Investigator.
The College Investigator and CMPA lawyer work together; their communication is not included in the Investigative Report.
The Investigative report can portray the doctor as a victim and the complainant as a villain.
While the doctor may be a victim of the system, to make the investigation portray the patient as a villain who would spray paint the doctor’s office, or intentionally miss appointments tells a story more about the College than about the patient.
HPARB puts the patient through another superficial process, then rubber stamps the College decision, causing further unnecessary harm. Lawyers sit on HPARB’s panels. Doctors don’t. That works well for the doctor; the victim. The victim have their heroes, the CMPA lawyers present. The villain is mentally and emotionally destroyed by the rubber stamping process of the College process by HPARB.
And if not, the Ombudsman office will finish the job with their rubber stamping of HPARB’s process. The whole process is seriously flawed. Doctors are victims of the system, not innocent patients who come to them for help who cannot see the doctor, for whatever reason, was unable or unwilling to help them.
We believe a caution to a doctor should be transparent and posted on your website.
The more transparency and accountability is better for Ontario patients.
would a body camera on every doctor at all times help?
you say the more the better.
I do not believe that there should be any transparency to the general public of any decisions of the ICRC.
The ICRC does not respond to any letters directly from the physicians regarding complaints. Thus the ICRC
Is not willing to give any physician a just and fair consideration of the complaint.
The ICRC is not made up of lawyers, therefore it is not equipped to make any decision with or without reasonable doubt
Of the patient’s complaint.
The investigators at the college make up the list of complaints by reading the patient’s letter.These people should never be permitted to carry out such a function.
Please consider the above carefully.
The ICRC should not have legal impunity against slander and libel or other matters that affect a physician’s
There is no need to make cautions public.
Here are the reasons:
1 Members of the public lack the knowledge and context to properly assess the significance of a caution.
This is because the ordinary member of the public is unable to determine the professional abilities of a physician. They,the public, judge physicians as they do everyone else: Do they like the person?
2 Regrettably, there already exists a public rating system for physicians.Publicizing cautions is superfluous.
The system is called RateMDS.
While,justifiably,there are physicians who dislike RateMDS,my very limited experience is that overall the ratings on RateMDS are reasonably accurate as a measure of the “likeability” of a doctor. Of course, there are a few wacko or hateful postings that can be discounted.
The problem with RateMDS is that there is no obvious correlation between “likeability” and medical skill and knowledge. A highly skilled and dedicated curmudgeon will be crucified on RateMDS.
3 The last reason is ethical.Absent good reason to the contrary,we ought to be slow to speak ill of others even the truth. Immense harm, financial,emotional and otherwise can be done to anyone publicly subjected to a negative description of their character or ability.
Members of the public are far more intelligent than you give them credit. We can and continue to see just how often harm is covered up by the college. You speak about the harm to the doctors but say nothing about the horrific pain and suffering they cause many patients and families that have been affected by their harm. At present there is no accountability and doctors are above the law.
Do you speak for all members of the public? Are you an elected official? Are you do you have any fact or number? or just conspiracy theories and superlative absolute sob words with no basis in reality? “hoffific pain and suffering”, “no accountability and above the law”.
I speak for myself. My son was killed by negligence on June 12/12. The doctor medically cleared him knowing full well that the blood work showed otherwise. He was questioned by hospital staff about this and said “not concerned at this time”.. the next two doctors involved in his care prescribed a drug that they were told not to by Poison Control. This only added to the harm. I have all the records to prove this. I have been trying to get accountability ever since by complaining to the college and also HPARB. What this doctor did was no mistake. He knew exactly what he was doing. He got a letter of caution from the college. I have learned over the last 2 1/2 years that doctors are “above the law” and until this happens to you , you will never understand. And believe me this happens much more than you know. since my son’s death I have met many who have been through this process with no accountability and very legitimate complaints. I do not wish anyone to go through what I have gone through. Until this happened I believed as you seem to that for the most part we are safe in our medical system. I have had a very rude awakening. They are well protected by the college as well the CMPA (the doctors lawyers) are funded largely by our tax dollars and a civil suit against them is almost impossible as they will fight you until you run out of funds or give up. This is a fact.
Losing a child is tragic, but this board is not the place to say whether that doctor is to blame or not, since we are not officials and your assertions about the case cannot be fact-checked here.
The portion of your assertions that could be fact-checked here is very false. You stated: “They [physicians] are well protected by the college as well the CMPA (the doctors lawyers) are funded largely by our tax dollars”.
Firstly the College is not at all funded by taxpayers. Secondly the CMPA is now more and more self-funded and not by taxpayers. The gov subsidizes CMPA cost in order to contain overall healthcare expenditures, and not to have a runaway tort system like in the USA.
Secondly, the notion that the College is protecting doctors is so illogical because there is no organization that the College is protecting physicians from. If the College is protecting doctors, one would be baffled why the CMPA is routinely hired at the cost of 10,000s of dollars to help just one physician against a College complaint.
Yes the CMPA offers legal assistance to help doctors in trouble with lawsuits and college complaints. That’s the physicians’ constitutional right, as with every other person in Canada who is entitled to due process of the law. Just because there is an accusation, the College or a court will not and should not automatically find the physician guilty.
Just because the system didn’t get you the result you desired, it doesn’t mean that the system is inherently flawed. There is no system that could make everyone happy all the time.
“They are well protected by the college”
your statement is baseless, vindictive and has no basis in fact.
I am writing to encourage a larger number of doctors to learn of how they can improve their practice. The process of complaining enables the physician to learn a broader number of skills. It stops them from making unsafe decisions and validates the concerns of the client.
Physicians have very little opportunity to improve their practice, who is their watchdog?
I do not think cautions-in-person and continuing education or remediation goes far enough in ensuring doctors who are making poor decisions for their patients are disciplined. For example, the public does not know how many complaints are being made about a particular doctor before the caution-in-person is made. Ontario tax-paying citizens are funding the Ontario College of Physicans and Surgeons to be our watch-dog. The opportunity for complaining is the opportunity for grow and learning for all Ontarians’ health. Please be more rigorous in the discipline process.
actually you could not be any more wrong.
The entire cost of the CPSO is paid by physicians. There are factual problems with your other assertions too.
a little research would help.
Unfortunately after my experience with the college I find it hard to believe that you would actually do anything to promote transparency. This is just a way to make the public think the college has our best interests in mind. What we really need is a complete independent body to govern doctors. Not doctors overseeing doctors. Until this happens there will be no transparency.
“complete independent body to govern doctors”
we as physicians wish for the same thing. at least it would save physicians money and stop demoralizing comments such as this and others like “the College is an old boy’s club” or “the College is about covering up for doctors”.
Perhaps physicians in this province need to ask why is transparency being made an issue? Something has become very wrong with healthcare in this province.
Many patients and their families are frustrated with the entire medical system.
They are frustrated with how they are/have been treated by the medical community. The comments in this forum show just how contentious the issue of transparency is. It also shows that patients and their families must be more proactive and ask questions of their medical practitioner. I would hope that the doctors would welcome questions and try to answer them without being insulted. Its about discourse and dialogue. The only way to improve the process is everyone wanting to work towards a common goal.
Complaints to the College need to be addressed in a healthy, transparent manner, making complaints “opportunities for learning” and “opportunities for healing” for both the healthcare professional and patient. The investigative process which is supported by legislation needs to be investigated to see where these opportunities are missed.
I have noticed that the investigative report starts with the identification of the patient’s age (late 80’s) or mental health status (bipolar disorder). It appears to me that a College Investigator can diminish a patient by just highlighting their age or mental status in the first line of the investigation. As a nurse, it would be considered unprofessional to mistreat a patient because of their age or mental status, but the nurse working for the College as an Investigator does not have a client/patient relationship, and therefore legislation allows her to bias the investigation.
Another way to bias the investigation is to summarize the investigation in an unprofessional manner. Opportunities for learning are missed when the College Investigator summarizes the patient’s concerns inappropriately, going as far as making the complaint frivolous. Why does the legislation allow this?
Frivolous investigations must be seen as lost opportunities for learning and healing, and that, in my opinion, is what needs to be made transparent – that the investigative process itself needs to be investigated. It is harmful to our health and well-being.
Bill 29 totally misses the point. Of course it does not make sense to publicize oral or written caution. The problem is that good doctors and bad doctors are treated the same in Canada. Most patients have no way of knowing the difference, unless they suffer a disaster and then it is too late. We need better rewards for doctors who are innovative, careful and responsible, and a means of punishing and exposing doctors who are incompetent and negligent. We need incentives to improve practice. Anyway, making cautions public will only serve to chance how and when cautions are used.
A couple of malpractice lawyers that are directly quoted in all the stories, have been feeding a couple of Star reporters for some years now.
It’s getting ridiculous that the College keeps entertaining this bunch with policy changes.
If they got something legal, let them bring it on in courts or through the legislature, otherwise hold your peace and go away. The more the College entertains this witch hunt, the bolder they get. It’s never gonna end. What they want is for the College to revoke every doctor’s license without any due process and with public shaming, every time there is a complaint, no matter how insignificant. That’s what they want.
If you have nothing to hide than you should have no fear about transparency. This is not about a witch hunt. This is about weeding out the bad apples and keeping the good ones. The bad apples only make all physicians look bad in the public eye. Stop protecting the incompetent ones. There is no place in the medical system for incompetence.
This is not about incompetence, this is about Dr’s rights which are being trampled on more and more everyday in this province. There are mechanisms/regulations already in place, in fact Ontario doctor’s are drowning in regulations to ensure that incompetent doctors do not see patients. Here we’re talking about publicly shaming doctor for their innocent mistakes, which every doctor makes as there are no perfect doctors and to believe otherwise is simply not living in reality. No matter how transparent things become, even if you had a live web cam following doctors around 24/7, doctors will still make mistakes and should be given a fair chance to remedy their mistakes without public humiliation.
Exactly, if they have something, let them bring it to the legislature or the courts.
New policies should be based on evidence, logic, laws and experience from other jurisdictions. They should not be decided by one reporter at the Star and her usual couple of malpractice lawyers as experts. Doesn’t she know that malpractice lawyers have a conflict of interest in this area? They make a living (and a good one) by chasing after doctors.
Most of the articles on the College lack much readership, thus have to be over-sensationalized with catchy titles to attract attention, and thus are not rational or balanced.
Re: “What they want is for the College to revoke every doctor’s license…every time there’s a complaint, no matter how insignificant”
Huh? Gee, I guess it’s all one big conspiracy theory, eh? Complaints are usually made because SOMEBODY HAS BEEN HURT by a doctor’s incompetence.
Why would anybody want a competent and careful physician to lose their license?
That makes absolutely no sense to anyone, even those like me, who are highly critical of the College for good reason.
Patients want to have some reassurance that those people to whom they must turn for health care will not damage them through negligence. Why would Ontarian’s ever WANT good doctors to be stressed and harassed by “insignificant” complaints? We want good physicians to be well paid and well treated because we need and respect them.
What we don’t need or respect are physicians like you making hateful and irrational statements. It worries us. Can you not fathom why?
“Complaints are usually made because SOMEBODY HAS BEEN HURT by a doctor’s incompetence”
no need to capitalize.
a very vindictive and very ignorant statement.
All it takes to file a complaint is 5 minutes of handwriting a paragraph and a postage stamp. There are so many complaints lodged due to disputes with physicians over $15, about waiting 15 min too long in the waiting room, not liking the tone of the secretary, being let go to another doctor after extremely abusing the doctor and their staff, not liking the doctor’s personality, not getting the dopey medication the patient was after, not getting happy pills to go sell on the street, not getting put on disability when there was disagreement, simply not getting what the patient wanted despite what the physician thought was ethically allowed, just plain malice and vindication, etc etc
most complaints fall in the above or similar categories. So don’t make false assertions and don’t make up about figures and stats you obviously know very little about.
I am very concerned that you appear to see the majority of complaints to the College as vexatious in nature. Why are you unable to acknowledge that, in fact, many complaints occur because there has been serious concern on the part of the complainant that a preventable medical error has indeed occurred, and that is has had a serious effect on their life and health?
If a complaint involves “waiting 15 min too long in the waiting room” or “not getting happy pills to sell on the street”, it certainly will not be taken seriously by anyone, so what are you so concerned about?
More importantly, you do not provide any evidence to support your assertion that “most complaints fall into the above or similar categories”. As the College is so non-transparent, how would you know?
The college is required to investigate ALL complaints, regardless of content. The statement ” it certainly will not be taken seriously by anyone, so what are you so concerned about? ” demonstrates your complete lack of situational awareness and the considerable stress, aggravation and time involved in dealing with such a complaint.
Information and Privacy Commissioner of OntarioRevised Comments in PDF form.
One of the unintended consequences I suspect of putting cautions on the public record will be the release of personal health information of the patient that lodged the complaint in the first place. There may not be release explicitly of personal health information but it would not be too difficult to determine who the patient was in many circumstances when reasons for the caution are provided. When this is realized, will there be a reluctance on the part of patients to lodge complaints?
When the patient appeals the decision of the Committee (with a panel having only one public member, over-ruled by doctors), the lawyer for the CMPA can use past appeals to defend the care provided. I was shocked to see a patient’s complete medical history used in that manner; I don’t imagine she consented to that. Once a patient appeals to HPARB, it’s definitely game on for the CMPA lawyers. There is legislation whereby the panel at HPARB are not health professionals, (perhaps because legislation has declared “exhaustive investigations” are unnecessary). Interestingly, the lawyers who have (or maybe still are) working for the CMPA can sit on the HPARB panel! The system needs a thorough overhaul, and that is evidenced by the CPSO’s whiteboard presentation – “Perception vs Reality”. It’s become a system which good doctors fear, adding unnecessary stress, which is, in my opinion, counterproductive. I don’t believe transparency of the innocent mistakes of doctors is needed, however, transparency of the system which promotes unnecessary harm and human rights’ violations definitely needs to be addressed.
Re: “…will there be a reluctance of on the part of patients to lodge complaints?” Hell no! Patients will be rejoicing that the CPSO is no longer able to hide their worthless decisions and the lack of action against doctors behind a wall of secrecy.
Appropriate vetting and redaction should effectively prevent patients’ identity and private medical information from being disclosed. I imagine close attention of the Privacy Commissioner to any violations will make sure of that.
Hopefully more patients will come forward, if they are convinced that legitimate complaints about doctors’ negligence will actually be dealt with in an appropriate manner, instead of ignored.
Doctors are in a very privileged position in society and have the honour of looking after the health of its citizens. The job can be most rewarding and wonderful but it can also be very stressful and demoralizing, especially if policies like this pass.
Yes there’s no doubt doctors make mistakes, even good doctors. Unfortunately, because the stakes are so high, the consequences of these mistakes can be devastating to patients and their families. But isn’t that how human beings learn, from mistakes? Doctors are no different.
I believe patients and families should be given the opportunity to come to terms with suffering resulting from medical error or negligence and they deserve truth and transparency and financial compensation for harm resulting from medical negligence.
Having said that, I think it’s important to remember that doctors sacrifice al lot to become doctors because deep down they really care about people and want to help. They also care about their reputations. Only the most criminal intentionally harm patients and there are already mechanisms in place to detect and remove them from practice.
When you have an initiative like this, where one or two bad apples can ruin the reputation of any doctor by making untrue allegations, you have the potential for devastating consequences to good doctors without due process.
By publishing criminal charges on the world wide web for everyone to see, including a doctor’s family and friends, you may tarnish or ruin their reputation forever, demoralize them and take away a large part of what motivates them to keep going.
Good doctors with pride and self-esteem will not tolerate this and after they are exonerated they will leave the province or the profession altogether.
I urge the CPSO to consider very carefully what it proposes to do as it may leave the province with fewer good doctors, and more patients without a good doctor, due to the actions of a few bad apples.
The Canadian Medical Protective Association (CMPA)Response in PDF format.
I absolutely disagree with charges being made public. Charges are not convictions, and physicians have the right to trial and ‘innocent until proven guilty’. However, this usually does not hold in the court of public opinion. A charge appearing on the college website has the potential of ruining an innocent person’s career.
And what of charges that are later dropped or physicians found not guilty in court? Will this also be reflected on the College website?
I would suggest caution
Transparency does not come with any filters
Opinion of the significance of the report will depend on the lense you are viewing it through
I don’t think it helpful to comment on College policies. The attitude of our governing groups in the CPSO is troubling to the extreme. To-day’s Editorial in The National Post points out that the Euthanasia policy violates our Charter rights to a free conscience. (I believe the College might have chosen to set up a web page of doctors willing to provide this, or other services).
Sadly, this is not the first time our College has acted ultra vires. It did so with the Uninsured Services policy, disregarding three Divisional Court Rulings (three judges each decision) that physicians have the right to engage in contracts with patients freely. In setting rules and limits, the CPSO disregarded them.
Why bother with consulting us if you discard not only our views, but also the Laws of our land?
Please reconsider your entire approach in this troubling need to balance patient needs, our freedoms and rights and Government demands. I agree that in mediating between these different approaches the College has a difficult job, but you fail when you reflexively create patient “rights” over physicians’ mandated ones.
That is why I no longer offer my opinion; neither do many of my friends for similar reasons.
Well said .. I agree with you as we ( doctors) are overlooked all the time as if we are not a part of this public ( or even we are not human in the first place ) and have no rights as other people do ..
I have a very logic question , what about doctor,s right to know about the criminal and other discipline history of the patient who wants to join his or her practice and be under his care .??!! do not you think that it is the same situation that you want to do now ?, what if this patient has a bad record with law for example, and will cause lots of problems to the doctor who will take him in his practice as many and many incidences happened to a lot of us before !!?? where our rights as people ( before being doctors)?? Do we have any rights at all ?? I do not think so ( as so many other doctors think ).
regarding ‘licenses in other jurisdictions’.
can you explain to me why this is relevant? I can understand if there are problems in other jurisdictions, but the fact that a physician has a license in another jurisdiction seems not relevant.
Note: the CPSO already requires every physician to inform the CPSO of any and all licenses held in all other jurisdictions, and standing in that jurisdiction. So, if a problem happens somewhere else, the CPSO is made aware of that. The new rule is really just if the fact a doctor has a license somewhere else whether this should be published to the public…. no matter if the doctor ever works there or not? (many doctor’s keep a license somewhere that they used to work and pay all the dues ‘just in case’ because it is so hard to apply again later)
I fully agree with these amendments; our patients deserve this level of transparency.
Let us keep things simple. List physicians who have a license to practice. If they do not qualify, take away their licenses and do not list them.
So, this should be province wide and include Nursing, EMS, Dentists, Chiropractors, Optometrists, RMTs, Physiotherapists, Psychologists….?
Every citizen of Canada has a right to privacy, including physicians. If a physician’s transgression is adequately serious, then the CPSO should take the appropriate disciplinary actions— if the physician’s license is not revoked, then clearly there is no perceived effect on patient care and safety, so there should be no need to publish anything publicly. This public shaming nonsense is just that, and typical of our gossip-prone and superficially-inclined society. The CPSO should keep some decorum and treat physicians with some deserved respect.
While I support and respect the need for transparency I do feel that the SCERP mentioned in item#2 should NOT be included.
The idea of remediation is very important to our doctors and is to be encouraged, but it sends the wrong message to Ontario’s doctors if we post that as public information.
Does it help to protect the public by publishing ICRC recommendations for remedial education? I doubt it.
Thank you for inviting input to the good work you do in self-regulation.
No, under no circumstance should minor criminal charges be posted on the CPSO website!
First of all, a charge is NOT a conviction.
Second of all, this places physicians at a disadvantage compared to all other members
of society. Even the sex offender registry is not this harsh!!
This provision is utterly unacceptable!
I agree , you are righty
Will patients be subject to the same transparency? Will we have access to info about patients who play the system, doctor shop for drugs, have stalking behaviour … Have violent and threatening behaviour towards clinicians for reporting to ministry of transportation … Or disability assessments or medical legal reports they don’t like …or have known diseases that put us at risk caring for them if we have disciplines that expose us to those risks so that we are able to protect ourselves when we care for them … I agree that our behaviour and professionalism should be transparent … But surely it should go both ways … CQ (one who has been stalked by patients and threatened for not completing forms to their liking)
you are right 100%
I disagree with posting criminal charges and would suggest posting convictions instead. I think there should be an obligation to report to the college any charges however this should not be made public until the member has had due process followed ad convicted.
I am entirely in support of the principle that the public needs to know about bad doctors, however I think it is unethical and detrimental to a physician’s well being and reputation if a caution is placed on the public domain prior to investigation and determination of outcome of the complaint.
I am also concerned about the SCERP and support the view of the CMPA on this.
I totally disagree with this ( by the way I have no any -ve records for me by any means ) but this is not right .. makes hard working doctors look like criminals ??!!!!! put more burden and load on the doctors ( who are already carry a huge one on their shoulders ) encourage public to disrespect , mistreat, and up use us , doctors are suffer enough so, do not increase their suffering.
It is clear that the purpose of a public register is for the benefit of the public, and to that end, listing the standing of the members of the profession is of benefit. It is also clear, however, that such information is prejudicial, and can influence patients choices, and physicians ability to fairly practice medicine. I would suggest that the information in the Register more often contributes to a decision AGAINST seeing a physician, than TOWARD that physician.
The problems with listing the new initiatives in the public Register are twofold: firstly, in the case of a SCERP, by the time the SCERP is completed, it is reasonable to believe that the physician is once again achieving the Standard of Care, and no further deficiencies exist; second, the listing is permanent, although the physicians deficiencies may not be.
SCERPS represent the College’s response to a failure to meet the Standard of Care. At the completion of the SCERP, one assumes that the serious deficiencies in areas of practice in which the CPSO have been addressed. Although deficiencies may still exist for any provider, the likelihood that they continue to function below the Standard should be assumed to be the same as any other provider, and they have the right to be treated as such. (If serious deficiencies routinely exist at the completion of the SCERP, then the problem likely lies with the remediation, as it fails to properly address these deficiencies). Permanent listing on the Register represents a penalty that never disappears – even though the deficiency does.
Likewise Cautions in person represent a serious level of failure in professional practice. However, no matter how much, and how permanently the provider improves, they will always carry the permanent, prejudicial listing in the Register.
Forward thinking jurisdictions are examining the permanence of information on the internet. From a personal point of view, it is becoming generally accepted that information posted by people at one time in their lives, should not haunt them for the rest of it. The United States in contemplating a ‘Right to be Forgotten ‘ Law, which addresses peoples rights to have information expunged from the otherwise eternal Internet. Criminal can be pardoned, and have their record expunged. Drivers lisence ‘points’ toward suspension expire over time, as evidence of continued good driving is shown.
The CPSO itself imposes penalties of suspension, that are time-limited. We demand Preceptorships that are time-limited. The goal of self-governance, after protection of the Public, is supporting and educating the Profession. Permanent listing on the Register for these issues, particularly SCERP and oral Cautions, represent penalties that last forever, in response to behaviour that we acknowledge (through continuation of licensure), does not.
I would propose that these listings be time-limited. The time limits could be mutually agreed upon by CPSO and MOH. Possibilities are either a fixed number of years, or they could expire upon the providers next Peer Assessment without issues. Please consider this suggestion.
Well written. I agree whole heartedly with the comments above. These listings should be TIME-LIMITED.
I disagree with 1 and 2, and agree with 3,4 and 5.
I would suggest that criminal charges should not be publicly released but criminal convictions ok. Just because one is charged with an offense does not mean that one is guilty of that offense.
Criminal charges should not be posted in my opinion. The presumption is innocent until proven guilty, and the mere posting of a criminal charge can be punitive and needlessly harmful. Criminal convictions, however, can and should be posted.
I completely Agree.
INNOCENT until proven guilty.
Re. Cautions In Person
It is my belief that there should be a time limit for how long a statement of Caution should be on a physician’s record. After a caution is issued it is assumed that the College will monitor that physician to ensure that they have made changes in their practice.
After a period of monitoring (Eg. 5 years) the record should be removed from the public register.
Transparency of the recommendations of the ICR committee does not allow the public to fully appreciate how the committee came to their conclusions. The whole file should become a public record with full disclosure of the investigation. That would be true transparency and would make the ICR accountable for its judgements. Otherwise it becomes another threat to the physician and suggests a bullying tactic for the ICR to hand down lesser sentences that do not go on the record.
Really. It seems to me that unless someone in a position to make ‘new rules’ is not doing so his/her job is meaningless. I don’t see any advantage of this amendment to the public and certainly not to the unfortunate physician caught up in this scenario. Good grief can we not be more imaginative and constructive in our thinking! This comment is not meant to exclude such egregious conduct as already subject to publication such as sexual offenses from the public record.I worry about the motivation behind these recommendations and wonder if the advocates are leading perfect lives.
This ‘transparency project’ is a form cyberbullying and proposes to publicly shame doctors for their perceived deficiencies. It contributes to making the practice environment increasingly toxic for doctors. When you combine initiatives such as this with the unilateral actions of the government against Ontario doctors, it’s no wonder Ontarians suffer from a chronic doctor shortage. Those proposing these policies should get off their high horse and really take a good look at what they’re doing; ‘absolute power corrupts absolutely’.
It is imperative that the employees and professional medical staff of the CPSO set the example of transparency for all provincial physicians in dealing with issues of professional concern;otherwise they leave themselves open to the critique of hypocrisy.And that would definitely tarnish its good name.
The College should not bow to the pressure of the Toronto Star. In my opinion, the College will NEVER be able to please the public that they are truly transparent because it is doctors policing doctors. So stop trying to do that, and just try to be fair to all parties.
The new transparency proposal is totally unfair to doctors. Look around at other public servants and healthcare personnel and lets see if the same disclosure requirements exist for them: nurses, pharmacists, physio, chiro, police, firefighters, teachers and so on.
If not, then let’s drop the whole thing. It will not protect the public any more to know every little detail about the doctor, and it begins to go too far and infringe on our privacy.
The few militant patients who have engaged in a battle for this level of disclosure can go and see a NP instead of a doctor for their care if they are so unhappy with us.
Doctors are not perfect (and neither is any health care professional). Disclosing every little detail is really not useful. If a patient thinks they can find a “better” or more caring doctor by looking for a 100% clean CPSO record, then good luck to them. They may be finding a physician who never takes any personal risk on their behalf, and does everything by standard protocol, and doesn’t take complex cases etc etc. just to keep out of trouble. If that is what they really want, then that is what they will get.
Regarding 1. cautions-in person, I do not believe that making such notifications public information will be beneficial for the physician or the public, but rather cause issues to be taken out of context and negatively harm the physician. I would not support such an action by the College.
2. SCERPs – related information in my opinion should remain private between the College and the Physician, making such information public will be not be of any benefit to anyone.
3. Criminal charges – is public information anyway once they have been verified by court of law. Until they have been proven in court making a “pending” criminal charge public by the college is highly unfair.
4. Making license information in other jurisdictions public would neither be harmful or beneficial for the public. I don’t think this would harm the physician or their patients.
5. Disciplinary findings in other jurisdictions may not necessarily be relevant I don’t think such information should be made public. If the physician is grossly regalement, he/she shouldn’t get a license to practice medicine in Ontario.
The College needs to be cognizant of the fact that the courts not infrequently put innocent people in jail. If these people are lucky to be later exonerated, many members of the public continue to regard them,these innocent people, as guilty, criminals and, treat them in accordance with these views. Against this backdrop, CPSO should refrain from its punitive approach and not further complicate the lives of those who have already suffered the consequences of their “actions”, by publishing information thereby feeding the frenzy of those, all too many, who wish to see doctors hurt. I also fail to see the need to publish the list of jurisdictions in which physicians hold licences. Do we need to do all this in the name of self-regulation? Really…
Caution in person – is a personal warming to the physician. Making it public defeats the purpose and makes it publicly punitive in nature.
Similarly ICRC is a personal “negotiations ” between college and physician. Making these public will make physicians challenge them and it will be more litigious and expensive to all parties without improving care and quality.
I have a number of concerns about these proposals and while I believe that transparency is necessary, there also has to be a balance between promoting transparency and the potential for harm of patients as a consequence of transparency.
Knowing where a physician has licenses and where other Colleges or regulatory bodies have disciplined the physician seems, to me, to be the same as the CPSO record of decisions/restrictions and so forth that is already posted on the public registry but is more global in scope. Wouldn’t it be helpful for the College, at the same time, to demonstrate to the public whether the College has any concerns about the disciplinary findings of other jurisdictions?
Posting criminal convictions or the like on the public registry seems, in my mind, to be reminiscent of “the scarlet letter”, “Les Miserables” or other stigmatizing actions. I don’t mean to seem melodramatic but I have difficulty seeing how this information could be other than harmful. Stigma, to me, seems bad, as a general statement, and harmful to the physician-patient relationship, specifically.
I wonder how posting cautions or remediation efforts publically doesn’t also create stigma. While I believe that it is important that the public look to the College as a body to ensure that physicians and surgeons in the Province of Ontario are practicing safely, I’m not sure that this form of transparency achieves that goal. I worry that it could create mistrust and sabotage the physician-patient relationship by creating stigma.
If the intent of the transparency project is to show the public that the CPSO is actively responding to complaints or concerns then perhaps there is the need for a College-run practice review of a physician at some specified time after a problem has been identified to ensure that practice quality has achieved the appropriate level? General and anonymous reports of the number of physicians so reviewed could easily be published so as to demonstrate to the public that the College is ensuring safe, appropriate care.
Firstly, I cannot believe that the CPSO is even considering publishing criminal charges. As has been mentioned, a charge is not a conviction. Our entire society operates on the presmise of presumed innocence, not presumed guilt. Charges can be laid against innocent people.
For the College to publish a notation about a criminal charge, it implies a) that there is some wrongdoing on behalf of the physician, which may not be the case and b) there is somehow relevance to the physician’s ability to practice medicine that is standard-of-care, which also may not be the case. For example, does a traffic violation impact my ability to provide excellent care? I do not think that even CONVICTIONS of this nature are relevant to the practice of medicine.
Is there a reason that physicians are not also innocent until proved guilty? No matter what the CPSO says, by noting a charge on a physician record, they are implying that it is relevant for the public to know about it, ie relevant to patient care.
I understand there is great public pressure for increased transparency. I do not think that it will improve patient care (nor is there any evidence that this will be the case). I think that it will increase, rather than decrease, public fear and mistrust.
Regarding publishing cautions and SCERPs, I think these may be misunderstood by the public. I think there will be some patients who interpret “caution” to mean “use caution when seeing this doctor.”
If a decision is made to publish cautions and SCERPs, then I think that once the physician has met the conditions of remediation, or re-education, whatever is required, then they should absolutely be REMOVED from the public register. If the conditions have been met, and the CPSO is satisfied, then the issue essentially no longer exists, or has been rectified. To keep the caution/SCERP there with a “notation” that the conditions have been met only serves to punish the physician further, and apparently for all eternity. Even 20 years later a patient may choose to avoid a physician who had a caution or SCERP, fulfilled the requirements set out by the CPSO, and then practiced impeccable medicine ever since. Is this fair? It seems to me that it is certainly not fair to the physician, who has already been disciplined, publicly shamed, and remediated; and if the patient uses the information to avoid a doctor who is now practicing standard-of-care medicine, it isn’t even fair to the patient.
Is the idea behind this to help patients make decisions about which doctors they feel are “safe” or appropriate for them to see, to trust? If there were doctors who were considered to be unsafe, or inappropriate, then wouldn’t their licenses have been revoked as they came to disciplinary action with the CPSO?
The final issue, which has been raised elsewhere in these comments, is that of physician privacy. It applies to both the idea of publishing criminal charges, and leaving reassessed cautions/SCERPs on the website indefinitely. I don’t think physicians deserve more than the rights of any other public citizen, but I also don’t think they deserve less. I can’t think of other examples of public citizens/professionals who would have this type of information published about them on the internet indefinitely.
One last note about transparency – if the public demands more transparency about CPSO proceedings, I would like to demand more transparency about CPSO proceedings for physicians too. As physicians we are expected to endure complaint processes, of which many are unfounded (but regardless, extremely stressful), that are cloaked in secrecy. We don’t know who is involved on the panels that make the decisions about us, what “expert” opinions are being used. Surely if transparency is the buzzword of the day, then this process could become more transparent to physicians enduring it as well.
Thank you for the opportunity to provide feedback.
I disagree with the posting of Criminal Code charges being posted. Is this information available for other professionals that the public has to deal with? Do we know the past history of a lawyer, an accountant, a dentist or other professionals that deal with the public. You could argue this for every person who deals with the public – the nurse, the physiotherapist, the school teacher, etc. Certainly some people would like to know but is it relevant to what they are doing. If it is posted then there should be a time limit on how long – does an offence 10 or 20 years ago mean anything? Is it fair to be labelled that way. We are professionals and there is a standard we are expected to maintain but we are also human and do make mistakes outside our practice life – does that need to be broadcasted even if it does not effect our ability to provide sound patient care?
I also don’t think the public needs to know we practice in another jurisdiction. To work elsewhere, we need to pass the same or similar criteria as the CPSO. Please explain the relevance to providing patient care. If I happen to holiday and work somewhere else, why is it my patients business to know?
I think transparency is important. The public needs to know when there is a legitimate concern about a physicians ability to provide care or that complaints have been made about care or their interaction. The public doesn’t need to know every detail of our private lives.
In principle I am in favor of transparency.
I am concerned that the proposed changes do not adequately protect physicians who are worthy of it. A physician could have been in difficulty at some point in his/her career, remediated the problem(s), and now be a trustworthy physician. Having this episode posted as public information for the rest of his/her career could unnecessarily damage this physician’s reputation in an ongoing fashion, and make it difficult or impossible for that physician to continue in practice. The public’s right to know must be balanced against a (now trustworthy) physician’s right to practice his/her profession and make a living.
My concerns about making public in person’s cautions relate to complementary medicine practitioners who might have the committee make cautions without having a true peer assess them. Conventional doctors might be quick to make judgement despite literature supporting alternative practices. Having these cautions public even prior to having an appeal maybe detrimental.
As a physician I think that while transparency about an individual physician against whom there is a criminal conviction and disciplinary actions taken in any jurisdiction current or previous is fine, it is a bit much to open up a whole pandora’s box with making cautions, SCERPs available on a public space. The public may be screaming for such transparency, I am not certain that it will really improve patient care.
There is enough regulatory pressure on physicians currently without adding even more..might turn out to be counterproductive.
This isn’t done in any area of society so why should it be for physicians
Criminal charges- I’m sure there are special cases where a criminal charge from decades in the past aren’t relevant to the physician’s current credibility to practice- eg a single instance of being charged with marijuana smoking as a 20-year old.
Also all of the proposed additions to the physician record are permanent- would there not be cases where it was reasonable to put a limit on the duration of the posting online? Eg physician required to remediate something, and ultimately clearly complies, and maintains the mandated behaviour for some prescribed number of years.
I just wanted to send a couple of comments regarding the Transparency Project.
Overall, I think the initiative is a good one in that patients can make an informed decision on their care.
1) Criminal Charges.
While I am not a lawyer, when I looked up the definition of criminal charges I found a general definition:
A criminal charge is a formal accusation made by a governmental authority asserting that somebody has committed a crime.
My concern about posting an accusation is that it may colour the patients view of the physician without having had the due process of the law. In other words, a person is presumed innocent until proven guilty. By posting a ‘charge’ then you are posting an accusation which may mislead the public. This hardly seems of benefit to anyone until the charge is either proven or disproven.
2) Typically, health care is a provincial matter. While I am familiar with the Ontario College of Physicians and Surgeons, I do not receive correspondence from any of the other provinces and therefore do not know how their Colleges function. If one is to take a Disciplinary Decision from another College’s jurisdiction then I think it should be accompanied by the process of how the decision was arrived at to ensure the public, and the CPSO has all the facts.
Criminal charges against a member are very serious, however, until they are presented and adjudicated by a court of law, publication of these would be unjustified
Thanks for your hard work. Transparency is absolutely necessary.
Cautions-in-person, Specified Continuing Education and Remediation Plans (SCERPs), criminal charges, medical licences in other jurisdictions, and discipline findings in other jurisdictions should all be added to the public register.
Emphasis might be placed on steps taken to resolve each issue, demonstrating the goal of restorative justice to protect the public from further harm.
We should aim to uphold higher-than-expected standards as a profession; otherwise we risk losing whatever respect the public holds for trust in doctors.
I support the transparency-related changes that have been proposed.
I have reviewed the proposed amendments regarding transparency.
Caution-in-person: I feel that this should NOT be posted to the general public, given that this is less than a disciplinary proceeding. Assuming the physician would use this caution to improve his/her practice pattern, that this improvement would be monitored and documented by the CPSO, and most importantly no harm to the public has occurred, it would be fair not to post this.
Specified Continuing Education and Remediation Program (SCERPs): for the same reasons noted above, it is my recommendation that this NOT be posted.
I am in agreement with the other proposals.
I agree with the suggestions.
In regards to the proposed transparency project, I have to say to this is going to far.
Any professional should behave. Doctors are not public figures and they should not have to give more confidential informations to the general public.
The college is not protecting the public by doing that. It seems like it is hyper focusing on specifics that are not relevant and it would shape the ideas that the patients would have about these doctor. It is very well studied and documented in socio-psychology.
The consequences can be numerous.
If the misconduct pose a future threat to the public, it will be known anyway and the college would probably radiate that doctor.
You are ideologic and there are no real concrete gain for anybody.
I will let you think, I don’t have the time to write a thesis and give examples.
As far as transparency goes, can we have all salaries of all cpso employees and the specifics of their jobs and any relation they have to any other members or politicians, any criminal charges past or present? Can we have that on the cpso website too? Can we get all the details about any note to their files? Can we see the specific tasks of their jobs and the yearly evaluations of their realizations? That is what doctors and the public is also concern about.
i think some of these should have discretion to be made private. many times there are very unreasonable patients who make demands to doctors and despite the doctors best efforts there is no good outcome. my doctor has got some reprimands, but i know the cases well and the doctor in fact had tried hard to help that patient out. in the era of decresing resources, i think doctors are really unfarily treated. while transparency is important there should be discretion to keep many of these private.
Principally I cannot agree that I find that any of the proposed changes are justifiable except for the criminal charges publications. Any doctor can get caught in the other disciplinary proceedings by circumstances beyond his/her control at some point in his/her career. I think it is repeat disciplinary actions that deserve publication, not a single offence. You could ruin a doctor’s career by an event that he/she would have avoided if it were under his/her control. If I new at the beginning of my medical career that a single infraction could ruin my career because it is published I would not engage in the laborious training and very hard work ahead of me. Between increasing law suits, decreasing pay and now potential publication of a single infraction I find myself increasing squeezed as a medical doctor.
I was very pleased with much of what appears regarding your proposals to increase transparency within CPSO. I certainly support the moves to post cautions-in-person on the public register, to order SCERPs as required and to post those on the public register, to post all Criminal Code and Health Insurance Act charges on the register, and to post the fact that a physician has a license in another jurisdiction, along with any discipline findings in the other jurisdiction.
While the College’s movement in this direction is very encouraging, I am troubled by the degree to which some physicians seem to be resisting the proposals for increased transparency. It hardly inspires confidence in the profession, especially in light of what we already know about the most effective ways to reduce hospital errors and so on (e.g., to have an open and problem-solving approach). How could that be any different within the College itself and for individual physicians?
I do have a couple of questions/comments beyond those remarks.
1. Why is it that if a physician voluntarily agrees to undertake remediation or continuing education in response to a complaint and the decision of the ICRC, the details of this agreement would not be posted on the public register? Whether the physician undertakes remediation voluntarily or not is largely irrelevant to the public. What patients or potential patients should have the right to see is that the need for remediation has been identified. This is relevant to transparency. That an agreement to undertake remediation is voluntary does not justify a lack of transparency.
2. When an agreement to undertake remediation has been voluntary, how is compliance assessed, monitored, and ensured? To my mind, evidence-based follow up is essential.
Thank you for your efforts to increase transparency within CSPO. Ultimately, that is in everyone’s best interests, patients and physicians alike.
I would strongly recommend that before the college proceeds with any decision regarding issues of quality of care that the members be up to date and current in the field or discipline they are commenting upon.
It is entirely inappropriate for committee members in one field commenting or rendering judgement on the quality of care or standards of practice in an entirely different field of practice. Even more so if those committee members have been out of current practice and are basing their opinions on the standards they learned in earlier during their active practice.
Medicine is a constantly evolving field. What we believed to be true, quite often under the scrutiny of evidence based medicine and further research we find out to be incorrect.
Before any decision is rendered on a physician that become a permanent public record that physician should have the opportunity to refute the committees conclusions if indeed they are not what is current practice standards.
If the committee makes recommendations on standards of practice then they must then distribute these recommendation to the greater body of physicians in that area.
Just some input that I hope you find useful:
I can see why the CPSO would want to include this, but although serious it is not discipline. Some of my colleagues think this is overdoing it. In any case, it seems prudent to post decisions after an appeal is over not before.
2. Mandatory Education
Similar to #1, how much does publishing this really help patients?
3. Criminal charges
the temptation to post this is there, but it seems completely against the value of our society and the values of the CPSO of innocent until proven guilty. How many physicians have been charged and later found innocent or the charges withdrawn? More importantly, does this action correctly display the values of the CPSO? I think we have to be careful about anything that might be seen as punishment, disapproval, etc. prior to a finding. We are public figures and what we do will come to the attention of the public regardless. What the CPSO does with that will reflect not just on the member but on the CPSO as well. I hope the CPSO will not become a news agency in the name of transparency.
4. Licenses in other jurisdictions
This is a great idea, but this could be logistically problematic. How would this reflect on the CPSO if the information was not up to date and accurate? This would be a great deal of work to maintain. I am not sure the public would be happy with the CPSO if it decided to include this information and then found out it was misleading because of changes that the CPSO could not keep up with. The public and patients could be sent mixed messages if one website indicates registration in another jurisdiction but the other does not on the same day. Which one does the public rely on? Does the CPSO really want to take on that responsibility?
5. Discipline findings in other jurisdictions
This is difficult to comment on. There would seem to be a need to publish this. However, other jurisdictions may have different regulations that do not match regulations in Ontario. Will the findings that are considered relevant to the CPSO be published? All findings regardless? Will this reflect that the CPSO has the same position as another jurisdiction? Or worse, reflect the the CPSO supports a different set of regulations?
There is already a requirement to report by physicians of findings in other jurisdictions. I imagine that the CPSO would make and publish it’s own findings which most certainly and more accurately would reflect the opinion of the CPSO on outside matters.
In summary, protection of the public is the goal, but not at the expense of the values of the profession and our society. The CPSO needs to be seen by the public as reliable. The CPSO needs to publish its own opinion and not be just a message board or news agency. I respectfully submit the the CPSO consider that these changes may not protect the public as much as it will degrade the profession or the values that we hold so highly.
Could the rationale behind posting licenses in other jurisdictions be explained?
How is this supposed to help a patient or patient care? You plan to post violations in other jurisdictions anyway, so what do you need to list the jurisdictions for if there has been no violation?? This is really like an invasion of privacy with purpose other than appeasing the media.
If really needed, the information should be made available to the public but not posted on the internet. They can write or call the CPSO for the information, and perhaps reveal who they are when getting the information.
Where is this notion coming from that all publicly available information should be posted on the the website. Just remember there was no internet and no CPSO website till 20 years ago. Was life and medical care much different back then? Were there much more medical errors because there was no website to post everything on?
I was the recipient of an oral caution by the CPSO. By your new definition, this information would be made available to the public because my behaviour represented a danger to the public. It was in fact a communication issue. I do not believe my behaviour or clinical decision was a danger to the public.
I was commended at one point during my hearing that this was the first time in my then 16 years of practice that I had a complaint against me. The board insinuated that I must be a very caring, careful clinician. I found this to be quite contrary to the tone of the whole meeting.
I was devastated by the entire process and at one point considered giving up my emergency medicine privileges. I thought I was an impostor, a clinician who had been faking her last 16 years of practice and that the College had finally discovered my secret…..I was a substandard physician. I doubted myself in every clinical decision I made in the emergency department and my family practice after that hearing for several months.
Luckily I had supportive colleagues who had experienced similar complaints and interactions with the College. That helped. My family and friends didn’t judge me. That helped too.
But if this became a matter of public record, I can guarantee the outcome would have been different. I don’t think I could have mentally overcome it. I would feel incredibly ashamed.
Beware of this new policy….while you may feel it is protecting the public, it will have a much more devastating impact on those sensitive physicians who take every mistake to heart. You may lose some incredibly caring physicians in the process who were never a danger to the public in the first place.
Unquestionably, in the eyes of the public, an oral caution will be viewed just like what is now a public reprimand. The public and the media will never know or want to know the difference.
This policy will do away with the disciplinary process in issuing public reprimands. The ICRC will now be given the power to issue them as well as the disciplinary committee.
I agree with you. Please see comment no. 53 (above) of 3 March 2015.
Member of the Public
Thank you for the opportunity to comment on Transparency 2. I think it is a step in the right direction, but a very tiny step. As only 4 % of the College’s decisions constitute “cautions in person” according to your own Annual Report, the vast majority of information about a doctor’s record will remain unavailable to the public. This is completely unacceptable in my view.
Provided that adequate context about complaints and their outcomes are provided, so that the public is able to judge whether the outcome is fair and reasonable, all outcomes should be made available. If your judgement is indeed appropriate, what is there to fear?
I feel that allowing professions, including my own, to “self-regulate” involves an inherent conflict of interest. I would far prefer to see a truly independent and transparent body handle complaints of physician negligence.
There must also be some attention to the criteria that restrict those referred to Discipline by the College to situations where the harm caused was “deliberate” and the substandard care provided was “extreme” and “beyond remediation”. It is no wonder such a small percentage of complaints result in disciplinary action under such rules.
I don’t think it’s necessary to make this information public. If the physician addresses the weakness in skill or knowledge, voluntarily or involuntarily, what benefit is there for the public to have this information? If it’s a matter of professionalism (anger management, etc) then I agree, but educational remediation should be encouraged, not advertised.
I fully agree with the proposed by-laws. They are clear and straight
I theoretically agree that there should be more transparency and that more information should be made available to the public. However, the current process whereby decisions are made for oral caution and disciplinary action is not rigorous enough. Physicians have been asked to appear for oral caution, only later to find out that the CPSO panel did not have the expertise to judge the physician or missed important information in the case leading to their decision. In at least 2 cases I am aware of, the panel at the hearing tried to reinforce its decision, only to realize they had made mistakes in making their decision. They admitted that most of the members of the panel were old and might be out of date, leading to mistakes in judging the case (in this case, not recognizing that the physician was correct in how they acted because of newer technology available). They claimed that there is currently not enough young physician volunteering to work for CPSO. In another case, the panel missed supporting evidence that the patient was abusing drugs and was at fault. There is currently no fair process to appeal a decision made by CPSO as the appeals board lacks medical knowledge to recognize whether the decision rendered by CPSO was medically sound in the first place. The appeals board, made of lay people, only determines whether the investigation was complete, or decision “reasonable”. The latter is impossible to judge without medical expertise.
Because of all of these problems in the current process, I would NOT be in favour of having this information made public. Once there is more standardization as to when a physician should have an oral caution or receive disciplinary action (i.e. only for issues related to safety, rather than issues of communication), and when there is a more rigorous process for judging which physician gets penalized, and finally when there is a more fair process of appeal for the physician, then I think the issue of releasing these sorts of information to the public should be reconsidered.
Ontario Medical AssociationResponse in PDF Form.
According to the Royal College of Physicians and Surgeons of Canada, patient safety is the “reduction and mitigation of unsafe acts within the health-care system as well as through the use of best practices shown to lead to optimal patient outcomes.” Transparency when a mistake occurs is the change which is needed. The transparency which makes cautions and SCERPS public knowledge will lead to a lack of transparency when a mistake occurs, and that is unsafe act.
I don’t think Cautions-in-person or the SCERP’s need to go on public record. I think Criminal charges, Licenses in other jurisdictions fine. The discipline findings in other jurisdictions I would only think relevant if it is something that has been made public in other jurisdiction.
The College’s main role is to ensure excellent medical care for the people of Ontario. To this end, it wants to be seen as protecting the public. It is not, however in the business of ruining lives or destroying reputations. Contrary to what the public may believe, the ICRC’s investigations are not formal legal proceedings. As such, its decisions are based on investigations of a very limited scope.
A caution is given so that the MD can rectify his/ her behaviour and improve medical care. By posting more information on cautions, it will render such cautions meaningless. The public will assume that the College has conducted a thorough investigation, that the allegations have been proven beyond reasonable doubt, and the MD condemned by the College. This effectively means that a caution is not meant as a warning to guide future practice, but rather as a punishment.
If a complaint is deemed serious enough, then it requires extensive investigation and appropriate action. If not and the ICRC feels a caution is adequate under the circumstance, then why irrevocably affect an MD’s life, both professionally and personally by posting it online where it will remain forever? I cannot think of another profession where an entire life’s work can be undone so easily and with minimal evidence.
The public deserves the reassurance that their health and safety and paramount and that the College does all it can to protect these, but I do not feel that the proposed measures achieve that. This is a case where the punishment would not fit the infraction. I would urge the College to re-think this decision as it risks making MD’s more cynical about the profession they have chosen.
Physicians have a sincere desire to be of service to society and they are generally conscientious and caring individuals. The effect of a caution is powerful enough to affect meaningful change in an MD’s behaviour. The added humiliation will simply drive MD’s from the profession altogether and discourage others from pursuing it at all.
Agree with all changes except publishing a criminal charge before the prosecution or acquittal.
One is innocent until proven guilty.
should only make the discipline committee decisions in public like other worldwide medical regularities do it. rest should be kept private.
To whom it may concern -2015
My comments are based on my own experience and knowledge of others experiences with the CPSO . Personally , I had a flawed process costing unnecessary stress and CMPA costs .
The first step is to identify whether the deficiency or problem is a threat to care of the patient . For example a side effect of a nutritional product should not be considered any differently than a side effect of a pharmaceutical . In other words , discipline should not be administered for a nutritional reaction .
If disclosure of side effect of a product was not documented , and the person suffered no significant problem with a therapy , the physician should not be considered delinquent to the extent of public notification .
Before ” caution in person” and/or ” remediation” are published , you should consider the seriousness of the offence , and whether the public needs to be notified . From personal experience , my major offence was failure to document my entire communication with the patients . In spite of better health , I and other physicians ,are subjected to overzealous scrutiny , and marshaled into unnecessary programs . So your intent would be to damage the physicians credibility for providing a service which has resulted in improved patient care .
Where the patient care has not been compromised , but it is a documentation issue , the physician should be informed of the required deficiencies , and permitted 6 months to make corrections . In my opinion , and some cases , the remediation and education programs are punishment , particularly for those providing integrative medicine .
Unless the physicians practice is a danger to the public , with examples of neglect or faulty prescribing , no notification should be made public . Maybe the physician should have an opportunity to appearance before the committee to explain his practice . The CPSO needs to be more flexible .
I missed making a comment for the December deadline re the criminal charge issue . As you know as soon as you make a charge , the public labels you guilty which can destroy a persons practice and health . So 8 years ago I had a narcotic charge for which I was innocent . In fact the conclusion never stated that I was innocent , only that my practice was within guidelines . What does the CPSO do to repair the damage ?
In summary , the CPSO is destroying medical care because physicians are afraid of erring . I have people complain to me frequently about their family doctor , no time to talk to them and doing referrals for situations they were probably trained to do . Doctors don’t treat patients any more , they treat a diagnosis .
I do not think any of this information should be passed on to the public by the college. The release of this information is for the purposes of providing information to patients, so that they can make decisions about their own healthcare. I think this is a patient right, and not a general public right. I make this differentiation. When the public at large is released information, the information can be used punitively, and destructively. This is against the doctor’s rights as a person in Canada.
I suggest, that it is the responsibility of the physician to inform the patients they are treating themselves. That physicians are then accountable to the College to do this. Then, the College can check in with patients of the physican involved to assess accountability. It is along the same lines as what we do when we make a medication error. We acknowledge the error to the individual patient and deal with the individual issues, including what needs to happen so that an error doesn’t happen again with that patient. It would be interesting to see if this level of accountability has an impact on decision making… for people who happen to be physicians. Accountability, as a form of natural consequence seems to be useful in my clinical experience .
If there is a criminal charge that is not directly related to patient care, the physician has the right to be treated as any other citizen. The most common example, is physicians who drink and drive, charged with a DUI. I am a psychiatrist who sees many physicians as patients. To publicly humiliate a physician will help no one. Humiliation and punishment is not part of healing. Accountability is.
The OCPS of Ontario’s main theme is “The care of the patient”. If Doctors are councilled by the College,then the reason for this discinaplinary action needs to be available to the public,for their protection,whatever the infraction was.Either—why bother with this procedure?.Clifford A. Hall.
Professional Association of Residents of Ontario (PARO)Response in PDF format.
I am not in favour of posting Names of physicians with respect to Cautions-in-Person.
As mentioned in the text.., cautions-in-person may encompass many reasons for the decision, either rightfully, or wrongfully.
However.., posting names is akin to a conviction list of Wrongdoing in the Eyes of the Public.
this really strips the Dignity of a Physician even in the setting of No Wrongdoing.
The Layperson will more than likely see these lists as the “criminal, or unsafe” doctors
Not a fair process for the Physician.
I am a psychiatrist who sees seriously mentally ill people on an ACT team.
I have had frivolous complaints made by delusional patients that went all the way to the appeals committee and ultimately dismissed because the College is too craven to judge a complaint as frivolous. I object to any increase in transparency without a change in CPSO policy which requires each complaint to be investigated no matter how absurd. That policy leaves us way too vulnerable to anyone with from public to paranoid people.
The College has encouraged me to send feedback re Canadian Physicians
practising in other jurisdictions and the College’s Requirements.
It would seem reasonable to mandate “Local” requirements should be applied
only to MD’s who had an active billing license.
Many Canadian Physicians find themselves overseas for many reasons, whether
working for the UN/WHO, Doctor’s without Borders, Save the Children, or married
to ex-patriots or simply working overseas.
Most are registered and up to date within their jurisdictions.
To make them “pay” extra fees to fly to continental North America and pay for
flights, accommodations and courses to obtain “your” accredited CME’s is
a huge financial and time burden.
Will you recognize CME’s from other jurisdictions?
Would you consider asking if they are up to date in their jursidctions?
To ask Canadian’s overseas to pay huge fees to keep our Canadian licences can only be
considered punitive and a ploy to drive us away.
It encourages Canadian’s overseas to drop our license and not come back.
Please give this some thought and look to a broader horizon and more global point of view.
Do not become a bureaucratic entity at the expense of human beings.
Canadians are bigger and better than that.
FAIR Association of Victims for Accident Insurance ReformResponse in PDF format.
Response in PDF format.
Transparency will lead to accountability and better patient outcomes. Everyone wants that, especially the public.
The transparency which is needed is that the College uses a flawed process which, in my opinion, needs to be investigated. The doctor I complained about was given a caution and SCERPS for his communication and documentation. Transparency would not make the public safer as the flawed investigation process failed to uncover the fact that the doctor was unethical and needed a course in ethics. If the CPSO’s flawed process remains the same, the CPSO transparency measures are not going to make the public any safer.
Because of the CPSO’s flawed process, I needed to try to uncover the truth through years of civil litigation, which, because of the way “independent medical experts” and lawyers work, was impossible to do. The doctor’s legal expenses were fully funded by the CMPA and no expense was spared. But the cost to the doctor’s mental health and his subsequent patients is something I had not thought of throughout the years. Because of the stress of the college complaint and the lawsuit, the doctor and his subsequent patients may have paid very dearly. In seeing this, the cost to me was so much more than money.
It’s clear to me that the public could pay quite dearly for “transparency”. It could cause Ontario doctors unnecessary stress which could affect the quality of patient care. And it will definitely lead to more work for CMPA lawyers (which taxpayers fund) as doctors will want to appeal in order to protect their reputation.
Patients want access to the truth in order to make wise decisions about their healthcare. I like the doctor’s idea of making the healthcare provider responsible to the patient (or family) and the College when a mistake occurs. Apology legislation would allow the doctor to communicate a medical mishap without the fear of litigation. OHIP could reimburse the doctor for communicating the error to both the patient and the CPSO. It would be money very well spent, rather than on lawyers to fund appeals. Lessons could be learned effectively and efficiently and shared among doctors, and the College would be proactive in protecting the public.
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