Complaints about doctors rarely lead to formal discipline

Nearly 8,000 Canadians filed a complaint about a physician last year, but on average only about 54 doctors were formally disciplined in each of the past 15 years. Of those complaints, just over half were determined to require no further action. 

Historical data examined by CBC News found cases of 817 physicians that resulted in formal discipline, which is the only part of the disciplinary process for colleges of physicians and surgeons that is consistently made public across Canada.

"That number's not anywhere near what's actually happening. Those are the ones you could get to," said Ann Van Regan, a volunteer responder with TELL (Therapy Exploitation Link Line), a network of survivors of sex abuse by physicians and psychotherapists. "They say they're taking it seriously, but their actions show that they are not."

Complaints related to quality of care, billing, communication, unprofessional behaviour and sexual misconduct poured into colleges last year, but if the historical trends discovered by CBC persist, only a handful will result in formal discipline.

Across Canada, just over half of the complaints were determined to require no further action after an initial review. Some complaints may not have been concluded in the same fiscal year.

In Ontario, 60 per cent of complaints were found not to require further action and just 72 of those cases were referred to a discipline committee. The college took action on 40 per cent of the complaints: issuing advice to physicians; issuing cautions; requiring physicians to sign undertakings; agreeing to restrictions; and ordering further education.

Some of those actions in Ontario are made public on the physician's profile even when a formal hearing is not held.

Of the 950 complaints made to the British Columbia college in fiscal 2014, 500 were treated as non-critical by the Inquiries committee.

"The 500 you are referring to were files where the inquiry committee was either not critical, or only somewhat critical, of the physician's behaviour, conduct or clinical practice." wrote Susan Prins with the College of Physicians and Surgeons of British Columbia in an email. "Usually these files relate to concerns about communication, e.g., the physician was rude or dismissive." 

The Alberta College of Physicians and Surgeons received 677 complaints last year, and a third of those were dismissed while 266 went to a less formal discipline process.

"Every complaint receives an initial review. If there is insufficient evidence — or the complaint was vexatious or trivial, the complaint can be dismissed." wrote Kelly Eby, a college spokeswoman in an email.

"I'd like to know who makes that decision about what gets to investigations," said Van Reagan. "Who is making a decision there about what goes to complaints, and what is frivolous and vexatious as they call it?"

$310M support for liability coverage

Once a complaint is made to a college, the physician may get legal help from Canadian Medical Protective Association (CMPA), a non-profit organization that provides medical liability coverage to over 90 per cent of Canada's physicians.

Last year, provincial governments reimbursed $310,399,665 of the fees physicians paid for this coverage.

"We have public tax dollars that are invested in the legal defence of professionals, particularly doctors," said Marilou McPhedran, a University of Winnipeg professor.

Reimbursement of CMPA fees are negotiated as part of physician master agreements medical associations have with their respective provinces.

"We assist in about 4,000 college complaints per year," said Dr. Douglas Bell, associate executive director of the CMPA, "There aren't always lawyers involved."

He said the association's fee reimbursement started back in the mid-'80s in lieu of fee increases for doctors.

"The government could be just paying it directly to doctors in their fees or doing what they are doing now, which is instead of a fee increase, what they agreed to is a reimbursement," he said. "It's still compensation to the physician."

Provincial health departments cited physician recruitment and retention, competitiveness and consistency with other provinces as some of their reasons to fund reimbursements.

"Nothing, nowhere in Canada do you have any form, anything like that for patients," said McPhedran. "There's nothing remotely similar on the public patient side of this equation." 

Bell said annual licensing fees paid to colleges by physicians go toward paying for investigations.

"The colleges use that money," he said. "As long as the college does what they are supposed to do, it's not lopsided, it's the physicians that are paying for the investigations."