You’ve gone to the hospital for emergency medical treatment or surgery. You suffer an adverse event that leaves you with grievous injuries.  How will you find out what really happened? Who is accountable? Who will help you?

Patients are often encouraged to discuss their complaints concerning a hospital with a Quality Care Coordinator or Client Representative usually found at the regional or provincial/territorial level. Formal complaints against a doctor can be made to the College of Physicians and Surgeons within a province/territory. A patient may also wish to consult with legal counsel to file a medical malpractice claim. All of these complaint mechanisms are limited by various factors.

Most, if not all, client representatives are employees of the provincial/territorial government and must meet the needs of their employer. Many of the case reviews performed by professional self-regulating bodies often result in educational recommendations to their members. Anyone who has considered filing a legal claim soon discovers that most doctors are members of the Canadian Medical Protective Association (CMPA). The CMPA is a non-profit organization whose mandate is to promote the professional integrity of doctors and safer medical care in Canada. The legal and financial resources that the CMPA is able to offer each of its members is unmatched. In 2008, their assets were estimated to be $2.43 billion.

Victims of medical malpractice quickly learn that their legal options are limited by the severity of their injuries and their financial resources. It takes a number of years for a case to proceed through the courts and if the decision is in favour of the defendant doctor then you must also pay for their legal fees. Your injuries must be severe enough to insure that the amount of compensation being sought will cover your legal and medical bills. An interesting fact to note is that many provincial/territorial governments subsidize the fees doctors’ pay to belong to the CMPA which means that your own tax dollars are being used to fund the defendant’s case against you.

The CMPA’s 2008 Annual Report indicates that 884 legal cases commenced in Canada last year with only 88 of these proceeding to trial where only 13 judgements were found in favour of the (patient) plaintiff. There were 574 cases abandoned or dismissed and 341 settled.

What does all of this mean for you as a patient? If you experience an adverse event in one of our hospitals you will enter yet another labyrinth of government bureaucracy where you will eventually tire from your search for accountability. Along the way you will hear talk about “mandatory reporting”, “disclosure” and “apology” legislation and policies and will find excuses but no answers. You will have trouble finding a lawyer to represent you due to the legal and financial resources required for a medical malpractice claim. If you succeed in finding legal representation then be prepared to dedicate several years and at least $100,000 towards your legal claim and, depending on the courts, you may still end up without any compensation. These are some of the realities facing patients in our Canadian health care system.

Information on accountability in our health care system is scarce. The Canadian Policy Research Networks (CPRN), a social policy think tank, has  published a series of papers under the research area titled “Strengthening Accountability in the Canadian Health Care System”. The complexity of our system and its lack of accountability to the public are evident throughout the series. The CPRN was to prepare a final report that would provide specific recommendations for our health care system. This report, to date, is incomplete.

Pictured above is the stack of letters I’ve received during my search for accountability.  Where do you find accountability in the Canadian health care system?

Please let me know.