Here is the second story in a series of six on the Canadian Medical Protective Association provided to the Monitor Telegram.
Membership fees to the Canadian Medical Protective Association (CMPA) are paid by the doctors. Then the provincial governments reimburse those doctors a hefty percentage of those fees.
Provincial subsidization of CMPA fees in Ontario began in 1987 at the rate of 50%. Five years later, the CMPA fees had more than doubled and have been climbing steadily ever since, as has the percentage of reimbursement from public funds. The rate of reimbursement varies from province to province. Ontario currently finances 87.2 percent of the fees, amounting to an estimated $384 million dollars in 2017 alone.
The bountiful contribution that you and I have been making for the last 30-odd years was wrenched from us without a voice and without representation. This porcine drain on the public purse is not conducted under provincial legislation, it was never debated by our Members of Provincial Parliament. It was slipped in the back door under a Memorandum of Understanding between the Ministry of Health and the Canadian Medical Association. This occurred just after the 1986 doctors’ strike that was precipitated by the squabble over extra billing. The Province prevailed in their attempt to do away with extra billing, and then they quietly made it up to the doctors by subsidizing their CMPA fees. Can anyone say “prestidigitation”?
The CMPA has been very secretive about the content of this MOU to the extent that they stoutly resisted an effort to obtain a copy of it under the Freedom of Information of Information and Protection of Privacy Act. The CMPA’s efforts at concealment failed, however, in Ontario Superior Court where the Court ruled that the CMPA should be subject to the access provisions of that statute.
But how did this all start? Who thought it was a good idea to trample on victims of medical negligence and malpractice?
The CMPA was founded in the early 1900’s at the urging of Dr Robert Henry Wynyard Powell, President of the Canadian Medical Association from 1899 to 1900.
The CMPA’s stated mission was “to protect the professional integrity of physicians and promote safe medical care in Canada”.
Anecdotally, Powell was inspired to form such an organization after a Smith Falls, Ontario physician was wrongfully sued for negligence by the family of a boy whom he had treated. The physician won the case and two subsequent appeals but was unable to recover his legal costs because the litigants were indigent. This doctor’s colleagues, one of whom was Powell, took up a collection to assist him.
Incorporation of the CMPA was proposed under Bill 89, a Bill championed by John Leo Chabot, Conservative MP for the City of Ottawa. Chabot was also a practicing physician in Ottawa. Of course, he was.
According to Wikipedia, this Bill generated “considerable lively debate in both the House of Commons and Senate of Canada. Members of Parliament received petitions objecting to it. Feelings ran high.” That is entirely the case, as recorded in the Hansards. Some of the most strenuous objections were to a clause contained in the original draft which read “to encourage honourable practice and assist in the suppression and prosecution of unauthorized practice”. Some of the MP’s (and their constituents) had concerns that the CMPA proposed to regulate what was and what was not acceptable health care practices and that, for instance, people would no longer be able to elect homeopathy and osteopathy as their treatment of choice.
As one MP said in debate: “I think this legislation is dangerous. It is legislation against the interests of the mass of the people, and is the creation of a monopolistic corporation… against the rights of the individual in the matter of the selection of his method of cure and treatment in the case of disease.”
No mention is made of “other practices” in the finalized Bill; any overt provision for the suppression of those outside of mainstream medicine was removed.
On the subject of the CMPA’s purpose of defending doctors in the legal arena, lawyer Henry R. Emmerson, Liberal MP for Westmoreland (New Brunswick), said:
“Then the constitution [of the CMPA] provides for the payment of money into the treasury and it also provides machinery whereby an action for malpractice against any member of this association shall be taken hold of by the corporation, and handled anywhere within the Dominion … An action of this kind is brought on behalf of somebody against a physician on the ground that he feels he has been unjustly treated and the whole army of the corporation from one end of the country to the other is brought into action to fight the one poor individual who may claim to have a grievance with respect to the treatment he has received.
“This may be all right for the members of the medical profession who belong to this association but I hold that it is trifling with this Parliament to have a Bill brought before it with all these provisions hidden within the lines and not exposed to the view of the House or of the country.
“I do not want to use extravagant language, but I do hold that this is the most iniquitous Bill that has been presented to Parliament in my time”.
Another MP said:
“If the individual realizes that instead of going up against a man whom he believes to be guilty, he has to go up against a strong corporation composed of the medical men of the country, with a fund at their disposal to fight such cases, I think he will feel that an injustice is being done.”
Objections notwithstanding, the Bill was supported by enough MPs (many of whom were, coincidentally, physicians) that it passed. The CMPA was incorporated by an Act of Parliament in February 1913 and given Royal Assent in May of 1913.
Dr. Powell was the CMPA’s first President, a position he held for 33 years. In one of his annual reports, Powell predicted that the CMPA would be “a large and important organization”.
Both Henry Emmerson and Robert Powell turn out to have been entirely prophetic.
Stay tuned for the third installment of this series, entitled “The Growing Potential for Malpractice Law Suits,” coming out next week.
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