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MedicalMalpracticeLiability:Canada

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ExecutiveSummary
TheCanadianHealthCareSystem
LiabilityInsurance

Negligence
ConcludingRemarks

ExecutiveSummary
Canadahasasinglepayerhealthinsuranceschemethatcoversvirtuallyallresidents.Mostphysiciansareinprivatepracticeandthey
billtheinsuranceplansfortheirservices.Beinginprivatepractice,theyrequiremedicalliabilityinsurance.Thisisusuallyobtained
throughaprofessionalorganization.However,physiciansarereimbursedforalargeportionoftheirinsurancepremiumsbyprovincial
governments.FeesarelowerthanintheUnitedStatesforanumberofreasons.TwoofthesearethatCanadashighestcourtshave
setlimitsonawardsandthecountrysliabilitylawsmakeestablishingprofessionalnegligencemoredifficult.Anotheristhatthe
physiciansinsurancecompanydefendslawsuitsveryvigorously.

TheCanadianHealthCareSystem
AlthoughCanadaisoftencharacterizedasacountrythathassocializedmedicine,itssystemdiffersconsiderablyfromcountriesin
whichphysiciansareessentiallyemployedbythestateortheentiremedicalprofessionisunderunifiedstatecontrol.InCanada,most
medicalpractitionersareinprivatepracticejustastheyareintheUnitedStates.Mostphysicianshavetheirownoffices,settheirown
schedules,andseepatientswhohavechosentocometothemonaregularbasisorforaparticularcondition.Canadiansarenot
assigneddoctorsbythegovernmentoraninsuranceplan.Theydohavechoices.[1]

WheretheCanadiansystemdiffersmostsignificantlyfromthatoftheUnitedStatesisinhowhealthinsuranceisprovided.InCanada,
alloftheprovinceshaveasinglehealthinsuranceprogramthatcoversvirtuallyallresidents.Forexample,OntariohastheOntario
HealthInsurancePlan[2]andQuebechastheQuebecHealthInsurancePlan.[3]Thefederalgovernmentsubsidizestheseprovincial
healthinsuranceplansthroughitsgeneralrevenues.Therearenoseparatepayrolldeductionstofundthehealthcareplansand
CanadadoesnothaveaseparateoldagehealthcareprogramlikeMedicareintheUnitedStates.

Whentheprovincialhealthinsuranceplanswerefirstcreatedinthe1960sand1970s,thefederalgovernmentpaidforabouthalfofthe
provincialplanscosts.Thispercentagefellbymorethanhalfinthe1990s,buthasgonebackupsomewhatinrecentyears.[4]The
provincialcontributionstotheplansarealsomostlyfromgeneralrevenues.However,thelargestprovince,Ontario,andacoupleof
otherprovincesalsoimposealevyonemployerstohelppayfortheirprograms.

Ascanbeseenfromtheabove,theCanadiansystemismoreaccuratelydescribedasasinglepayersystemthanasocializedone.
However,eventhisdescriptionneedstobequalified.Canadianphysiciansarenotrequiredtosubmitbillsfortheirfeestotheprovincial
healthinsuranceplans.Theycanoptoutofthesystemsandbilltheirpatientsdirectly.However,physicianswhododeclineto
participateinaprovincialplanmustoperateentirelyoutsideitastheyaregenerallyprohibitedfrombillingtheinsuranceplanforsomeof

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theirservicesandpatientsforothers.Inotherwords,physicianscannotbepartialparticipants.Forthisreason,thevastmajorityof
Canadasphysiciansareenrolledintheprovincialhealthinsuranceplansandearnvirtuallyalloftheirincomefromthebillstheysubmit
tothem.

Canadasprovincialhealthinsuranceplansaregenerallysimilar,butdohavesomedifferences.Forexample,theProvinceofQuebec
hasmoregenerousprescriptiondrugcoveragethananyotherprovince.However,thesimilaritiesarefargreaterthanthedifferences.
Oneofthemajorreasonsforthisisthatinordertoqualifyforfederalsubsidies,provincialhealthinsuranceplansmustadheretothe
guidelinessetoutintheCanadaHealthAct.[5]Theoneguidelinethathasbeenthesubjectofthemostcontroversyovertheyearshas
concernedextrabilling.TheCanadaHealthActdoesnotallowtheprovincestopermitphysicianstobillpatientsforaportionoftheir
servicesthroughcopaymentsorothertypesofadditionalfees.Thefederalgovernmenthasremainedfirminthispositionformany
yearsonthegroundsthatitdoesnotwanttoseethecreationoftwotieredsystemsinwhichpatientswhocouldaffordtopayfora
portionoftheirhealthcarewouldreceivemorecomprehensivecoverageandpreferentialtreatmentcomparedtothosewhocouldnot
affordadditionalhealthcosts.Inthepast,someprovinceshavelostaportionoftheirtransferfundsforallowingsomeextrabilling,buta
numberwouldstillliketobeabletoallowforextrabillingincertaincasesinordertohelpkeeptheircostsdownwithouthavingtopaya
penaltyintheformofreducedtransferpayments.

Canadasprovincialhealthinsuranceplansdonotcoverallservices.Dentalcare,eyeexams,andcosmeticsurgeryarethreeexamples
ofservicesthatgenerallyarenotcovered.However,mostCanadianemployeeshavesupplementalmedicalinsuranceprovidedbytheir
employersthatgiveatleastpartialcoveragefortheseservices.Forexample,supplementalinsurancewillusuallycoveroneeyeexam
andonepairofglassesperyear.Manycollectivebargainingagreementsprovideforsupplementalinsurance.Inothercases,
supplementalinsuranceisofferedasanonmandatedworkbenefit,butitisnotrequired.

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LiabilityInsurance
Canadianphysicianswhoareinprivatepracticeorworkforhospitalsarerequiredtoobtainmedicalliabilityinsurance.Suchinsurance
isavailablethroughtheCanadianMedicalProtectiveAssociation(CMPA).Insurancepremiumsormembershipfeesarebasedupon
thetypeofworkaphysicianperformsandtheregioninwhichheorshepractices.ThethreefeeregionsareQuebec,Ontario,andthe
RestofCanada.TheCMPAhaspublishedFeeSchedules.[6]Feesarenotbaseduponaphysiciansrecordandarenotincreasedfora
historyofcomplaintsoronaccountofclaimspaid.

MembershipfeespaidtotheCMPAgivephysiciansinsurancecoverageandarighttorepresentationinmedicalmalpracticelawsuits.
However,provincialgovernmentsreimbursephysiciansforatleastaportionoftheirmembershipfees.Thesearrangementsarenot
generallymadepublic.However,arecentlyreleasedMemorandumofUnderstandingbetweentheMinistryofHealth,theOntario
MedicalAssociation,andtheCMPArevealsthatphysiciansarecurrentlyreimbursedforabout83percentoftheirmembershipfees.[7]It
hasbeenreportedthattheOntariogovernmentpaidaboutCan$112milliontoreimbursephysiciansformedicalmalpracticefeesin
2008.[8]GovernmentofficialsinOntariohaveexplainedthatthepurposeofthereimbursementprogramistoencouragephysiciansto
practiceintheprovinceandnottomovetoanotherprovinceortheUnitedStateswhereaverageincomesmaybehigher.Critics
contendthatbecausetheCMPAsfeesarenotbaseduponaphysiciansrecord,thesystemdoeslittletopenalizephysicianswhoare
foundtobeliableformalpracticeevenonmultipleoccasions.[9]Physicianswhohavecommittedactsofmalpracticemay,however,be
disciplinedbytheirprovinciallicensingbody.Disciplinecanrangefromsuspensionstolossesoftheprivilegetocontinuepracticing
medicine.

TheCMPAhasalsobeencriticizedfordefendingmedicalmalpracticesuitsextremelyvigorouslyandturningdownreasonableoffersto
settleclaimstodiscourageotherlawsuitsonanumberofoccasions.[10]OnejudgereportedlyreferredtotheCMPAaspursuinga
scorchedearthpolicy.[11]InCanada,alosingpartyisgenerallyrequiredtopayabouttwothirdsofasuccessfulpartyslegalfees.
SincetheCMPAoftenincurslargelegalexpensesindefendingclaims,thisisanadditionaldisincentivetopersonswhobelievethatthey
havebeeninjuredthroughmalpracticefrombringinganactionfordamages.

OneotherfeatureofCanadianlawthattendstodiscouragepartiesfromsuingphysiciansformalpracticeisthattheSupremeCourthas
setoutguidelinesthateffectivelycapawardsforpainandsufferinginallbutexceptionalcases.Inatrilogyofdecisionsreleasedin
1978,theSupremeCourtestablishedalimitofCan$100,000ongeneraldamagesfornonpecuniarylossessuchaspainandsuffering,
lossofamenitiesandenjoymentoflife,andlossoflifeexpectancy.[12]TheSupremeCourtdidstatethattheremaybeextraordinary
circumstancesinwhichthisamountcouldbeexceeded,andcourtshaveallowedthefiguretobeindexedforinflationsothatthecurrent
suggestedupperlimitonawardsfornonpecuniarylossesiscloseto$300,000.[13]Nevertheless,theflexiblecaponnonpecuniary
lossesisamajordisincentivetopersonsconsideringwhethertheyshouldsueaphysicianformalpracticeandforlawyerstospecializein
orseekoutmalpracticecases.

TheSupremeCourtofCanadahasalsolimitedthetypesofcasesinwhichpunitivedamagesmaybeawarded,althoughithasallowed
asmuchasCan$1millioninpunitivedamagesinanextraordinarycase.[14]ACanadianlawfirmhassummarizedtheholdinginthis
leadingcaseconcerningpunitivedamagesasfollows:
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1.Punitivedamagesareverymuchtheexceptionratherthantherule
2.Imposedonlyiftherehasbeenhighhanded,malicious,arbitraryorhighlyreprehensiblemisconductthatdepartstoamarked
degreefromordinarystandardsofdecentbehaviour.
3.Wheretheyareawarded,punitivedamagesshouldbeassessedinanamountreasonablyproportionatetosuchfactorsasthe
harmcaused,thedegreeofthemisconduct,therelativevulnerabilityoftheplaintiffandanyadvantageorprofitgainedbythe
defendant,
4.Havingregardtoanyotherfinesorpenaltiessufferedbythedefendantforthemisconductinquestion.
5.Punitivedamagesaregenerallygivenonlywherethemisconductwouldotherwisebeunpunishedorwhereotherpenaltiesareor
arelikelytobeinadequatetoachievetheobjectivesofretribution,deterrenceanddenunciation.
6.Theirpurposeisnottocompensatetheplaintiff,but
7.togiveadefendanthisorherjustdesert(retribution),todeterthedefendantandothersfromsimilarmisconductinthefuture
(deterrence),andtomarkthecommunityscollectivecondemnation(denunciation)ofwhathashappened.
8.Punitivedamagesareawardedonlywherecompensatorydamages,whichtosomeextentarepunitive,areinsufficientto
accomplishtheseobjectives,and
9.theyaregivenanamountthatisnogreaterthannecessarytorationallyaccomplishtheirpurpose.
10.Whilenormallythestatewouldbetherecipientofanyfineorpenaltyformisconduct,theplaintiffwillkeeppunitivedamagesasa
"windfall"inadditiontocompensatorydamages.
11.Judgesandjuriesinoursystemhaveusuallyfoundthatmoderateawardsofpunitivedamages,whichinevitablycarryastigmain
thebroadercommunity,aregenerallysufficient.[15]

Thus,punitivedamagesintortactionsinCanadaarerelativelyrare.

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Negligence
DespitetheabovefactorsthatdiscouragemedicalmalpracticelawsuitsinCanada,therearenumerousreportedcasesinwhichdoctors,
hospitals,andhealthcareprofessionalshavebeenfoundliableforactsofnegligenceinthedeliveryofhealthcare.Inordertobe
successful,aplaintiffmustshowthatthedefendantowedhimorheradutyofcare,thedefendantdidnotdeliverthestandardofcare
owed,theplaintiffsinjurieswerereasonablyforeseeable,andthedefendantsbreachofthedutyofcarewastheproximatecauseofthe
plaintiffsinjuries.[16]Anerrorofjudgmentisnotnecessarilynegligenceevenifitcausesinjury.[17]

Commontypesofnegligenceactionsareasfollows:

1.Failuretoattendapatient
2.Failuresindiagnosis
3.Failuresinrediagnosis
4.Failuresinreferralorconsultation
5.Failuretocommunicatewithotherphysicians
6.Failuretoprotectorwarnthirdparties
7.Failuretoreportabuse
8.Substandardtreatment[18]

Hospitalscanbeheldliableunderthedoctrinesofvicariousliabilityordirectliabilityfortheconductoftheirstaffs.[19]

ConcludingRemarks
ControversyovertheeffectthatmalpracticelawsuitsarehavingonthedeliveryofhealthcarehaveneverriseninCanadatothelevels
thattheyhaveintheUnitedStates.Awardsagainstphysicianshave,onapercapitabasis,beenmuchlessfrequentthanintheUnited
Statesandawardshavegenerallybeenmuchsmallerforsimilarinjuries.Thereareanumberoffactorsastowhythisisthecase.
Provingnegligencecanbeharder,theCMPAdefendsmalpracticelawsuitsveryvigorously,thereisaflexiblecaponnonpecuniary
losses,andpunitivedamagesareseldomawarded.Nevertheless,thereisagrowingbodyofcaselawrespectingmedicalmalpractice
thatdemonstratesatendencyofthecourtsandjuriestobesomewhatmoreopentoclaimsthataphysicianshouldbeheldliablefor
committinganactofnegligencethatcausesinjurytoapersontowhomheorsheowesadutyofcare.

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FormoreinformationonCanadasee:

GlobalLegalMonitor:Canada
GuidetoLawOnline:Canada
ChildrensRights:Canada

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HabeasCorpusRights:Canada
SexSelection&Abortion:Canada

PreparedbyStephenF.Clarke,
SeniorForeignLawSpecialist
June2009

1.BruceRobinson,CanadasSinglePayerHealthCareSystemItsWorthaLook,http://bcn.boulder.co.
us/health/healthwatch/canada.html(externallink)(lastvisitedJune10,2009).[BacktoText]
2.OntarioMinistryofHealthandLongTermCare,OntarioHealthInsurancePlan,http://www.health.gov.
on.ca/english/public/program/ohip/ohip_mn.html(externallink)(lastvisitedMay27,2009).[BacktoText]
3.Quebec,RegiedelAssuranceMaladie,HeathInsurance:CoverageforYourHealth,http://www.ramq.
gouv.qc.ca/en/citoyens/assurancemaladie/index.shtml(externallink)(lastvisitedMay27,2009).[BacktoText]
4.HealthCanada,FederalTransfersandDeductions,http://www.hcsc.gc.ca/hcssss/mediassur/chalcs/transfereng.php(external
link)(lastvisitedJune8,2009).[BacktoText]
5.CanadaHealthAct,R.S.C.c.C6(1985),asamended,availableathttp://laws.justice.gc.ca/en/C6/(externallink)(lastvisitedMay
27,2009).[BacktoText]
6.CanadianMedicalProtectiveAssociation,MembershipFees,availableathttp://www.cmpaacpm.ca/
cmpapd04/docs/membership/fees/2009cale.pdf(externallink)(PDF)(lastvisitedMay27,2009).[BacktoText]
7.SteveBuist,TaxpayersFootingtheBillforMalpracticeInsurance,HamiltonSpectator,Feb.7,2009,availableat
http://www.thespec.com/News/Local/article/509183(externallink)(lastvisitedMay28,2009).[BacktoText]
8.Id.[BacktoText]
9.Id.[BacktoText]
10.Id.[BacktoText]
11.Id.[BacktoText]
12.Andrewsv.Grand&ToyAlbertaLtd.,[1978]2S.C.R.229.[BacktoText]
13.Koukounakisv.Stainrod,23O.R.(3d)299(Ont.)(1995).[BacktoText]
14.Whitenv.Pilot,[2002]1S.C.R.595,availableathttp://scc.lexum.umontreal.ca/en/2002/2002scc18/2002scc18.html(externallink).
[BacktoText]
15.NelliganOBrienPayneLLP,AggravatedandPunitiveDamages(2006),availableat
http://www.nelligan.ca/e/pdf/Aggravated_&_Punitive%20_Damages.pdf(externallink)(PDF).[BacktoText]
16.CanadianHealthFacilitiesLawGuide(C.C.H.Can.)3815(2009).
[BacktoText]
17.Lapointeetal.v.Chevrette,90D.L.R.(4th)7(S.C.C.1992).
[BacktoText]
18.CanadianHealthFacilitiesLawGuide,supranote15,41054150.[BacktoText]
19.Id.4151.

[BacktoText]

LastUpdated:06/06/2015

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