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Malpractice concerns lead to unprecedented cooperation as CMPA, CMA seek answers.

The Canadian Medical Protective Association (CMPA) is working hard to head off potential rifts within its membership as a result of increases in fees for several “high-risk” specialties. One year after Charles Dubin, Ontario’s former chief justice, released his widely publicized report on CMPA practices and recommended measures such as uniform fees for malpractice protection (see CMAJ 1997;156:685-7), the organization has joined a working group that includes representatives from the CMA and several of its provincial divisions. Dr. Robert Burns, a working group member, says its goal is to pursue suggestions for tort reform contained in Dubin’s report and elsewhere. Burns, executive director of the Alberta Medical Association, said a second thrust is to consider CMPA funding. “There are legitimate and significant threats to the ability to provide services unless something is done,” he said. “That very real threat, and the costs and concerns accompanying it, is one reason why the profile of this issue is now high enough that the potential exists to get something done.” Dr. Stuart Lee, the CMPA secretary-treasurer, says the existing fault-based system used in malpractice cases, designed to compensate patients injured by medical treatment, must be overhauled to contain costs. “The court awards are driving up the cost of malpractice protection,” said Lee. “The real tragedy is that access [to care by physicians] is being affected by the increase in malpractice protection fees.” Everyone knows that obstetricians have been hit hardest by the most recent increase — their 1998 fees increased by 24%, to roughly $29 000 — but Canada’s orthopods and neurosurgeons aren’t far behind. Lee said the CMPA is concerned that the huge fee disparities — an FP who performs some obstetrics faces CMPA fees of just under $5000 in 1998 — will mean fewer physicians will be prepared to provide “high-risk” services. “We have received some calls and letters from physicians who say ‘I can’t practice without them [high-risk specialists].’ If we are agreed that we are all in this together, we need to find a way to help each other out.” Helping one another out is one thing, but most of the 1100 CMPA members surveyed in September flatly rejected paying a uniform fee so that the burden of insuring their higher-risk colleagues would be shared. However, 74% of respondents agreed that the government should be lobbied to reform the tort, or fault-based, system of compensating patients. Although the number of obstetrical cases where fault is found has remained fairly steady in the 1990s — fault is found in about 10 cases a year out of the 40 suits brought forward — the average settlement jumped from $1 million in 1989 to more than $2 million in 1996. Lee said that even though the likelihood of being sued has remained fairly Features