mutual defence organization - TUUM EST

Table of contents
TABLE OF CONTENTS
The CMPA-Who and what we are
For physicians, by physicians 2
The CMPA-What we offer our members
Unparalleled service 3
Invaluable privileges 3
President's report
Maintaining tradition in the face of change 4
Secretary-treasurer/CEO's report
Charting a course to renewal 6
The year in numbers 8
General Counsel's report
Defending physicians in challenging times 10
Financial report
Auditor's report 13
Consolidated balance sheet 14
Consolidated statement of revenues and expenses 16
Consolidated statement of changes in net assets 18
Notes to the consolidated financial statements 19
Minutes of the 2000 annual meeting
Saskatoon, Saskatchewan, August 16, 2000 25
CMPA leadership
Council 32
Committees 33
Senior management 35
What to do when you need help from the CMPA 36

Who and what we are
THE CMPA-WHO AND WHAT WE ARE
FOR PHYSICIANS, BY PHYSICIANS
The Canadian Medical Protective Association (CMPA) is a defence
organization for Canadian medical doctors. Formed in 1901 and
incorporated by Act of Parliament in 1913, the CMPA is funded
and operated on a not-for-profit basis for and by physicians. Our
membership includes about 95 per cent of the doctors licensed to
practise in Canada.
Physician to physician
The CMPA's unique understanding of Canadian doctors comes from
100 years of meeting doctors' needs. Members are eligible to receive
help in connection with medico-legal difficulty arising from their
professional work in Canada. Members receive assistance from
experienced physicians; the professional support and guidance
provided by our medical secretariat is unique to the CMPA.
Elected Council
The CMPA is governed by an elected Council of generalist and specialist
physicians from across Canada. The Council, chaired by the President,
meets quarterly to deliberate issues of concern to our members. The
Executive Committee meets monthly to deal with matters of policy;
other committees work on specific topics (see pages 33-34).
Administration
The senior administrative officers are the secretary-treasurer/CEO and
the associate secretary-treasurer. They are supported by departmental
directors whose specialized expertise lies in particular areas of
administration. The medical secretariat includes assistant secretarytreasurers,
physicians with backgrounds in clinical practice who
understand and defend the interests of members. Legal expertise is
provided by an independent General Counsel and selected legal firms
in every province.
Risk pool
More than 60,000 doctors are members of the not-for-profit CMPA.
Annual membership fees and the income from investment fund a reserve
for future claims. The CMPA operates on an occurrence basis, which
means members are eligible to receive help for claims arising from
professional work done during the year for which membership fees were
paid, regardless of when the claim is made. Therefore, the reserve for
claims should be viewed as an already-spent fund because it will provide
for the costs of future judgments, settlements, legal expenses and
administration for all the medical care given in the past as well as in the
current year.
Unique protection
The CMPA is not an insurance company; we are a mutual defence
organization. Our occurrence-based protection means physicians are
protected not only during active practice but also during retirement.
Members' estates and survivors are also protected. This differs from most
commercial insurance, which only covers claims made during the period
that premiums were paid; in other words, protection ends when the
policy ends.
Fee structure
As of 2001, membership fees are differentiated by region and by type of
work to reflect the risks inherent in each member's practice as well as
regional variations in the costs of medico-legal defence. Those three
regions are Ontario, Quebec and the rest of Canada.
Determination of fees
Membership fees are set annually through a review of experience with
claims and costs, actuarial estimates of liabilities for the year and
projected estimates of the income from investment over the period–
up to and sometimes exceeding 20 years–in which liabilities must be met.
2

What we offer
THE CMPA-WHAT WE OFFER OUR MEMBERS
Not-for-profit
UNPARALLELED SERVICE
Members are eligible to receive a broad spectrum of help related to
medico-legal difficulties arising from their professional work in Canada.
Founded in 1901
For physicians, by physicians
Defence philosophy
Occurrence-based protection
Comprehensive protection
Scope of assistance
Stability of operation
100 years of national experience
Credible, competent resource for virtually
every medico-legal issue
No need to generate dividends for distribution
to shareholders
Experienced physicians provide comment and advice on
everyday medico-legal issues
Professional integrity is first and foremost
No negligence = no settlement
Protection independent of physician's history or track record
Membership in the CMPA at the time care was
provided protects members, no matter when a
claim may arise
Peace of mind
Protection after retirement - no tail-end fee
Protection for family and estate after physician's death
Security for patients and families
Ensures compensation to injured patients when they are
eligible to receive a settlement or court award
No limit on the cost of legal help a member
is eligible to receive
No limit on damages (plus interest) paid to
patients on behalf of members
Individual claims do not increase future fees
Protection during sabbatical, parental leave, LT
disability - no extra cost
Flexibility for locums, new physicians and those
joining from a commercial insurer
Advice for physicians, by physicians
Civil legal actions alleging malpractice or negligence
Criminal proceedings arising from medical care
Complaints and disciplinary proceedings related to
a licensing body
Human rights complaints arising from medical care
Coroner's or other fatality inquiries
Inquiries about doctors' work or conduct in hospital
Provincial or territorial billing agency inquiries
INVALUABLE PRIVILEGES
A voice and a vote
CMPA's Council is the governing body of the Association. Members
are entitled to nominate and vote for candidates, both generalists and
specialists, within their geographic area.
Annual meeting
All CMPA members are encouraged to attend the annual meeting,
which is usually held in August.
Annual report
The CMPA publishes an annual report of the previous year's highlights,
statistics on medico-legal activity and audited financial statements.
Risk management
The CMPA's national database is a unique repository of our extensive
medico-legal experience. We are uniquely positioned to see practice
pitfalls that can result in complaints and litigation. The collection,
analysis and dissemination of this information helps members and
their professional clinical organizations improve the care and service
provided to patients while helping avoid medico-legal problems.
Education
Every year, CMPA physicians and our legal counsel present more than
300 medico-legal educational sessions at medical schools, conferences
and meetings across Canada.
Information Letter
The CMPA produces a regular newsletter and special Information Sheets
on current topics or trends of medico-legal interest, including specialtyspecific
articles, as well as updates on CMPA policies, fees and activities.
Publications
When a topic requires further exploration, the CMPA produces a
more in-depth publication, such as the specialty-specific
Risk Identification papers.
Website
Members can receive immediate information by logging on to the
CMPA website at www.cmpa.org. Members can search for
information specific to their specialty or area of interest.
3

’
President s report
PRESIDENT'S REPORT
MAINTAINING TRADITION IN
THE FACE OF CHANGE
The year 2000 is now history and we are entering a new century and a
new millennium. In 2001, the CMPA celebrates its 100th anniversary and
a century of service to the doctors of Canada.
Surveys tell us that our members value highly the assistance provided to
them by the CMPA. We must not rest on our laurels, but rather strive to
maintain our tradition of excellence. We must move into the 21st century
looking to expand and improve on what we have done for the past 100 years.
In the past year, your Council and CMPA staff undertook an extensive
strategic planning exercise that laid out some exciting plans for the future
designed to keep the CMPA on the cutting edge of technical advancement
and at the forefront in the provision of medical malpractice protection for
the doctors of Canada.
Landmark change
On January 1, 2001 a landmark change occurred with the implementation
of regional rating. For this purpose the country has been divided into
three regions: Ontario, Quebec, and the remaining provinces and
territories. Members' fees are now calculated based on the true regional
costs of providing medical malpractice protection, as well as by type of
work. This change was made necessary when, for the first time, costs
were analyzed on a regional basis and significant cost differences among
regions were identified. In the interest of fairness, Council decided to
move to regional fees. This decision produced dramatic increases in
membership fees for Ontario, primarily reflecting the higher cost of
settlements and court awards in that province. In Quebec the converse
was true as fees were substantially lowered. The rest of Canada remained
almost unchanged.
To mitigate the sizable increases in Ontario, a three-year
memorandum of understanding was drawn up between the Ontario
government, the Ontario Medical Association and the CMPA in which
it was agreed that the fee increases would be phased in over the next
three years; in exchange, the Ontario government would provide
significant subsidies, eliminating the need for up-front payments and the
potential for serious cash-flow problems, especially for doctors in the high
risk specialties. All parties agreed to look seriously at ways to reduce the
cost of settlements and court awards through tort reform and risk
management. These measures must be invoked quickly if a further
medical malpractice crisis in Ontario in 2004 is to be averted.
In Quebec, members are generally pleased with the significant fee
reduction in their province. They have also indicated that they value the
extensive protection provided by the CMPA. Meanwhile, the Quebec
government continues to explore the possibility of a government-run
medical malpractice program for Quebec doctors. It is our sincere wish
that Quebec doctors will be able to remain with the CMPA and continue
to benefit from the experience and expertise we have shared with them
for so many years.
Future directions
For 100 years the CMPA has been a strong national association, admired
and respected by medical malpractice protection providers around the
world. It is my hope that this
tradition of excellence will
continue unaltered into the
new century.
For 100 years the CMPA
has been a strong national
association, admired and
respected by medical
malpractice protection
providers around the world.
In the past year your
Council, executive and CMPA
staff have worked very hard on
your behalf. They have faced
many difficult decisions and I
believe they have made them
wisely and with the continued
best interest of the membership
as their primary concern. Some
decisions and strategic advances
have involved sizeable financial commitment. I believe however that
4

President ’ s report
these investments are made in response to the expressed wishes
of our membership and will greatly enhance the strength of the
Association for years to come.
In closing, I would like to express my special thanks to a few
individuals. Dr Neil McPhail is stepping down after 12 years on Council
and innumerable hours as a key member of the case review committee.
His wise counsel and dedicated service has been greatly appreciated.
Dr John Gray has provided outstanding leadership in his first year
as secretary-treasurer/CEO; his past medical political experience and his
negotiating skills have proven to be invaluable. He has been ably assisted
by Dr Guy Lemay, who has smoothed Dr Gray's integration while at the
same time providing his own strong leadership role in Quebec. As
always, the Gowlings General Counsel team lead by Mrs Margaret Ross
has provided leadership and supervision of the excellent provincial
counsel who provide the day-to-day services to our members.
Mrs Beverley Allen, our executive assistant, and her dedicated staff
have once again provided valuable assistance to the executive and
Council throughout the year and we thank them.
the executive and Council, as well as the CMPA's medical
secretariat and other staff I have been fortunate to work with. It has
been a pleasure knowing you all and my life has been made richer for
having done so.
With sincere best wishes for the future,
W.D.S. Thomas, MD, FRCSC
Farewell
Finally, I would like to say that this will be my last report to you as
your president; my term will end with the annual meeting in August.
It has been an exciting and eventful five years since I assumed the
presidency following the annual meeting in Sydney. The Association
has made many changes and many advances over the past five years.
It has been a very satisfying and rewarding experience to be a part of
that change. I am greatly indebted to the many dedicated members of
In the past year your Council, executive
and CMPA staff have worked very
hard on your behalf. They have faced
many difficult decisions and I believe
they have made them wisely and with
the continued best interest of the
membership as their primary concern.
5

Secretary-treasurer/CEO s report
SECRETARY-TREASURER/CEO'S REPORT
’
6
CHARTING A COURSE TO RENEWAL
As I write this report I have been serving as secretary-treasurer/CEO for
the past 10 months. And what an exciting 10 months it has been!
It's also been exciting for CMPA employees. Much was asked of
them in 2000 and, to the benefit of all members, they delivered.
The year began with a non-event: the Y2K rollover. However, the
readiness of CMPA staff for the advent of the new millennium served as
preparation for the advent of a more significant–and unexpected–event:
regional rating.
When our actuaries began investigating the possibility of regional
differences in the cost of medical malpractice protection in the fall of
1999, the CMPA had no idea what the results and subsequent impact
would be. When the results of their study were presented to Council in
February 2000, and the significant differences among regions in the cost
of compensating patients found to have been harmed by medical care
were realized, the decision was made to move to a new membership fee
structure that would reflect those regional differences.
Implementing regional rating
CMPA immediately began advising members that changes would be made
in their membership fees beginning in 2001, and member feedback was
sought through focus groups and a national survey. Aware of the potential
impact on members we set to work to create a regional rating structure
that would preserve the CMPA's national character while addressing the
current and possible future financial burden that higher costs would
impose on some members.
This challenge fell to an internal project team ably led by
membership services director Pierrette Downey. The team
developed and implemented business rules that allowed for a
smooth transition to regional rates. These rules will also ensure
accurate financial reporting (costs will be tracked by province)
and accountability, as well as ensuring that our members are
fully protected no matter what and where they practise.
Improving relationships with our partners in care and
compensation has been a personal priority since I became secretarytreasurer/CEO
in May 2000. The enormity of regional rating–a
fundamental shift in the way the CMPA has done business–led me
almost immediately to criss-cross the country to visit and speak with
many groups and medical organizations, especially those representing
physicians whose fees would increase. These meetings were sometimes
difficult, but an essential element of the CMPA's new commitment to
transparency in its operations.
I want to thank Dr Guy Lemay, associate secretary-treasurer, for ably
managing the day to day affairs of the Association during the countless
days I was on the road in 2000, as well as leading our efforts to address
the concerns raised in Quebec by the regional rating initiative.
Corporate renewal
Regional rating also drove a shift in the speed with which we
communicate. This is a particular challenge for an organization that now
has more than 60,000 members across Canada. Members were invited to
join a new fax/e-mail network to allow them to receive breaking news
more quickly. This effort may be perceived as a qualified success, as
e-mail cannot currently be used as a two-way communication vehicle.
However, that may soon change.
As Dr Thomas noted in his report, the CMPA is aggressively exploring
the use of technology to make our work–and therefore our services to
members–more efficient, effective and in tune with the e-business world
around us. (For example, next year many of you may receive this annual
report electronically.) This is part of a corporate review aimed at
re-engineering our programs, systems, support services and business
practices. This initiative looks
to the future but will be
The CMPA is aggressively
exploring the use of technology to
make our work–and therefore our
services to members–more
efficient, effective and in tune with
the e-business world around us.
firmly guided by the
traditions of our past. We will
report regularly to you on the
progress of this major project.

Secretary-treasurer/CEO s report
’
On the horizon
The objective of better service to members is one pillar of a far-reaching
and ambitious strategic plan that was developed in 2000 with the full
participation of staff and Council. It was rewarding to witness the
enthusiastic involvement at every level in the planning of our future.
One of the most significant pillars of the strategic plan
is the development of a more comprehensive approach to risk
management. Dr Bill Beilby, director of research and education, is
spearheading the planning of this initiative, which will be more fully
developed in 2001.
The Association's vision and mission statements as approved by
Council are found on the inside front cover of this report. The strategic
plan is available on our website (www.cmpa.org); a printed version is
available on request (see the back cover for our co-ordinates).
Fiscal responsibility
The Council and staff continue to monitor and plan for the CMPA's
ongoing fiscal health. Much of the impetus behind the strategic plan is
the need to balance the realization of our mission with the desire to
control your membership fees.
Much of the impetus behind
the strategic plan is the need
to balance the realization of
our mission with the desire to
control your membership fees.
On behalf of the members
and staff I would like to
thank Dr Bill Thomas for
his tireless dedication and
commitment during the
past five years as president.
We all will miss his presence.
I wish him well in his future
endeavours, and I look
forward to working equally
closely with his successor.
I would also like to pay tribute to my predecessor,
Dr Stuart Lee. Dr Lee served the CMPA for 28 years, the last 11 as
secretary-treasurer, until his retirement in May 2000. His guiding
influence has been felt and appreciated at all levels of the Association.
I would like to thank him personally for helping to make my transition
from family practice to administration a smooth one.
During my 25 years in practice I have appreciated the CMPA's
principle of upholding the professional integrity of its members.
Since becoming secretary-treasurer/CEO I have become grateful for
the professional integrity of the energetic, forward-thinking staff at the
CMPA, as well as of our Council, and for the warm welcome and
enthusiastic support they have all demonstrated.
I sincerely hope we can maintain the momentum and positive spirit
of renewal that we have developed this year as we tackle the challenges
ahead. If we do, there is every expectation that the results will benefit not
only our members across Canada, but their patients as well.
John E. Gray, MD, CCFP, FCFP
7

The year in numbers
THE YEAR IN NUMBERS
MEDICO-LEGAL ACTIVITY
Total
2000 1999 1998 1997 1996 1996-2000
New files opened 14,168 13,531 11,738 11,462 11,581 62,480
Miscellaneous inquiries 3,636 3,473 2,971 2,748 2,823 15,651
Patient-related inquiries 7,304 7,044 6,034 6,015 5,758 32,155
Threats (of medico-legal difficulty) * 882 940 842 588 612 3,864
Legal actions commenced 1,337 1,354 1,339 1,399 1,415 6,844
Legal actions proceeding to trial
judgment for plaintiff 37 31 21 22 29 140
judgment for defendant physician 97 103 86 86 72 444
Legal actions settled 408 396 332 374 388 1,898
Threats settled 32 49 50 43 60 234
Legal actions dismissed, discontinued or
abandoned (without trial or settlement) 827 902 824 770 815 4,138
Inquests 88 93 66 67 92 406
College (licensing body) matters 2,279 2,067 2,116 2,078 2,131 10,671
Hospital matters 234 233 211 207 181 1,066
Billing matters 275 229 221 135 139 999
Criminal matters arising from medical care 12 20 17 15 15 79
Human rights matters arising from medical care 15 20 8 13 13 69
Membership 60,099 58,722 57,948 56,899 56,517
Educational presentations 305 205 244 220 207
* Beginning in 1998 this figure includes members named but not in contact with the CMPA by Dec. 31.
8

The year in numbers
BEHIND THE NUMBERS
15,000
12,000
9,000
6,000
3,000
0
’96 ’97 ’98 ’99 ’00
New files opened
New files opened
In 2000 there were just over
14,000 new files opened on
new matters reported to the
CMPA. These were mostly
related to miscellaneous and
patient-related inquiries and
represent a five per cent increase
over the previous year.
Legal actions commenced
The number of new legal actions
decreased by about one per cent.
In 2000, 2,379 members were
named in the 1,337 new legal
actions opened. This represents
one new legal action for every
45 members, with an average of approximately two members per legal
action. This means that in 2000, one in 25 CMPA members was named in
a new legal action.
Legal actions concluded
In 2000, for the second year in a row, there were more legal actions
concluded than new legal actions commenced. While the net difference
is a modest decrease of 32 actions, it continues the experience of 1999
and is a notable improvement over the net gain of 76 actions in 1998.
The outcomes of the 1,369 legal actions resolved in 2000 are as follows:
2000 1996-2000
(%) average (%)
Judgment for the physician 7 7
Judgment for the plaintiff 3 2
Settlement 30 29
Dismissal 60 62
It is noteworthy that of
those cases concluded in
2000 by a payment to a
plaintiff, 92 per cent were
settled out of court without
a trial, similar to 1999.
College matters
The number of matters related to provincial and territorial licensing
bodies increased by 10 per cent in 2000 with 2,279 new cases being
reported to the CMPA. It is recommended that members contact the
CMPA for assistance before responding to a complaint from their
licensing authority.
Criminal and human rights matters
The CMPA offers assistance to members in criminal and human
rights proceedings that arise from the physician's medical care.
It is clear that these matters represent a very small part of the
CMPA's work.
70,000
60,000
50,000
40,000
30,000
20,000
10,000
0 ’96 ’97 ’98 ’99 ’00
Membership
Educational sessions
The research and education
department co-ordinated 305
educational sessions for members
across Canada in 2000. This is a
50 per cent increase over 1999.
These sessions on a variety of
medico-legal topics are conducted
by CMPA staff physicians and
legal counsel.
Membership
CMPA membership has grown
steadily in recent years, surpassing
60,000 in 2000. That’s about
95 per cent of the physicians
licensed to practise in Canada.
9

General Counsel s report
GENERAL COUNSEL'S REPORT
’
DEFENDING PHYSICIANS IN
CHALLENGING TIMES:
MEDICO-LEGAL ISSUES CREATED BY SHRINKING
HEALTH CARE RESOURCES
Every year the CMPA responds to an increasing number of questions
from members about issues in their day-to-day work. Many inquiries are
related to the current health care environment in Canada. Have you faced
any of these questions?
• I am obliged, as a condition of my hospital privileges, to be on call
in the emergency department. What are my obligations when a
patient presents with a possible acute surgical abdomen in the
absence of surgical or anesthetic backup?
• How should I proceed when an urgent C-section is required and the
anesthesiologist on call is occupied with emergency surgery at the
hospital's other site, which is approximately 10 minutes away?
• The waiting list at our hospital for cardiac procedures is too long.
Do I have a duty to disclose this to patients and/or to advise them of
the possibility of obtaining faster treatment elsewhere?
• I am a specialist and head of the department at a large tertiary care
centre. I am the only one in the department with expertise in a
particular sub-specialty and receive many referrals. What is the
extent of my liability between the time the referral is received and
the patient is seen, often a period of three to four months?
• Most family physicians in our town have closed their practices to
new patients. This leaves many members of the community with
their only access to care through the emergency department. Who is
responsible for these "orphaned" patients once they are discharged?
This is only a small sample of the dilemmas plaguing physicians in
Canada today. Restructuring, funding cutbacks and cost containment are
all words that reflect the reality that doctors are still being asked to meet
the standard of care with fewer and often inadequate resources. How
should physicians respond when they are faced with making treatment
choices that are affected by cost considerations and the ever-changing
environment for the delivery of health care? What will be their liability
when long waiting lists, the lack of specialists or unavailability of
diagnostic tools impair the appropriate course of care?
10
The standard of care
The standard of care expected of a physician is still often described by
reference to this extract from a case decided in 1956:
Every medical practitioner must bring to his task a reasonable degree
of skill and knowledge and must exercise a reasonable degree
of care. He is bound to exercise that degree of care and skill which
could reasonably be expected of a normal, prudent practitioner of
the same experience and standing, and if he holds himself out as a
specialist, a higher degree of skill is required of him than of one
who does not profess to be so qualified by special training and ability.
Courts determine the appropriate standard of care through the
evidence of experts who function with similar training and in a similar
practice setting as the defendant physician. However, Courts have tried to
be cautious about applying the standard in the abstract and will usually
consider the circumstances surrounding a specific fact situation. Although
the test of the "reasonably prudent physician" is objective in nature,
certain factors may tend to alter the standard to be applied. These factors
include the place of practice and the resources available to the physician.
The locality principle
For a long time, Courts have recognized the effects of resource constraints
on the standard of care in examining the place of practice. The locality
principle is a factor that may persuade the Court to accept that the
geographic location of a doctor's practice may affect the experience,
facilities, equipment and staff available when treating a patient. Although
an argument can be made that physicians practising in remote areas
should not be held to a lower standard of care when working within these
limitations, it does make sense that Courts make some allowance for the
reality and unavoidable limitations of the practice setting.
Available resources and cost containment
The Courts have yet to fully address how the scarcity of health care
resources will affect the standard of care expected of physicians. To date,
the Courts appear unwilling to accept an "economic defence" to justify
withholding treatment or services from a patient for reasons of overall
resource containment. However, the decided cases to date have all
involved situations where the physician made a conscious choice, in
the face of cost containment pressures, not to make use of

General Counsel s report
’
resources that were actually available. Such cases can and should
be distinguished from the situation where those resources are simply
unavailable. If a physician is required, due to a lack of beds, to accept
only "unstable" patients in the emergency department, the physician's
decision would likely be construed as a decision made in response to a
scarcity or lack of resources and not one where the resources were
available but consciously withheld for cost containment reasons. This
may have an impact on what the Courts would expect of a physician in
the circumstances, as Courts usually take into account the facilities,
equipment and personnel available to a physician when determining the
applicable standard of care.
A physician owes a duty to a patient to act in the patient's best
interests once the doctor/patient relationship has been established.
Clearly, a physician would not be acting in the patient's best interests
if he or she accepted to treat the patient when doing so would endanger
the patient because of a lack of resources and might also compromise the
care of other patients. Nor is it appropriate for a physician to redirect or
delay transfer of an emergency patient where this would pose a danger
to the patient. In such a case, physicians may have no choice but to treat
the patient to the best of their ability even if the available resources are
not optimal.
Duty of hospital
Physicians are independent professionals who are usually responsible for
their own acts and omissions, but a hospital could be equally responsible
if it required physicians to work under unreasonable conditions.
Although physicians are not employees of the hospital at which they have
privileges, and as such the hospital will not be held vicariously liable for
the physician's failure to live up to the standard of care, the Courts have
made it clear that hospitals still have responsibility to ensure adequate
staffing and co-ordination of personnel and other resources. Hospitals
can be directly liable to the patient who is injured as a result of improper
protocols or lack of adequate facilities. Courts will usually take into
consideration the scarcity of resources and community standards when
evaluating whether the facilities and staffing were adequate under the
circumstances. For example, in Bateman vs. Doiron, a 1991 decision of
the New Brunswick Queen's Bench, the "non-availability of trained and
experienced personnel, to say nothing of the problems of collateral
resource allocation" were considered when evaluating what
community standard was expected of a hospital that staffed its
emergency department with general practitioners due to the
unavailability of emergency physicians.
In a recent decision of the Nova Scotia Supreme Court,
Thompson Estate vs. Byrne, it was stated that a hospital was not negligent
in its system of anesthesia coverage in a cardiovascular intensive care
unit. The Court, in making its determination, examined the coverage
available in other Canadian intensive care units and stated that "no
hospital could afford to have anesthesia residents always at hand, waiting
around without other responsibilities until such time as a patient might
have occasion to require their services." This case demonstrates that not
only might the fact of scarce resources be considered by a Court, but so
might the custom in other similar hospitals with respect to staffing.
However, the English Court of Appeal addressed the issue of
insufficient resources leading to inadequate care in the case of
Bow vs. Devon Area Health Authority and came to a different conclusion.
In this 1993 case, an infant plaintiff suffered brain damage as a result of
the defendant's inadequate system for providing emergency obstetrical
care. The case considered the liability of a hospital with two separate
facilities and the organization of services between them. The emergency
services were only available at one site, and the Health Authority argued
that it could not be expected to do more than its best with the limited
resources available. The Court rejected this defence, stating "it was not
necessarily an answer to allegations of unsafety that there were
insufficient resources to do everything that they would like to do." If a
Canadian Court were to adopt this approach, a hospital might not be
successful in raising as a defence that it was doing its best faced with
limited resources and that it should not be faulted for providing some
service under those circumstances rather than none.
Liability of physicians
As stated, the physician's duty is to do what is in the patient's best
interests and in the event of a choice between a doctor's duty to a patient
and that owed to the medical care system, the duty to the patient must
prevail. While to date in Canada only a few cases have touched on the
issue of lack of resources, a couple of recent decisions are illustrative of
where the Courts might be headed.
11

General Counsel ’ s report
In one case decided in January 1999, the patient, a 50-year-old
male with a history of heartburn and stomach problems, attended the
emergency room of the hospital complaining of severe chest pains. The
examination included a physical, an X-ray, an EKG and a review of the
charted medical information. The physician concluded that the patient
was suffering from an acid-related stomach disorder. The patient was
discharged and given a prescription for medication for heartburn. The
patient's symptoms persisted and he died two days later. The coroner's
report indicated the cause of death as cardiac arrest due to dissected
aortic aneurysm.
Having found that the doctor had breached the standard of care in
failing to conduct further investigations and in discharging the patient
despite the persistence of severe pain, the Court stated:
The Court must take into account the availability and cost of procedures,
medication and equipment to the attending physician at the time when
the cause of action arose. This consideration will affect the standard of
care in that a doctor cannot reasonably be expected to provide care
which is unavailable or impracticable due to the scarcity of resources.
In another case decided in January 2000, the patient was suing an
anesthesiologist for damage to his bridgework that occurred while he
was under general anesthesia. The plaintiff claimed that his injuries
flowed from the failure of the anesthesiologist to adequately explain the
risks of potential damage to his bridgework (his "pride and joy") and her
failure to advise of alternative forms of anesthesia that involved less risk.
The Court found that the anesthesiologist knew of the bridgework and of
the patient's apprehension about general anesthetic and knew that he
had requested a local anesthetic for the surgery, which was refused.
The Court stated:
... it was suggested that the time pressures involved in day surgery
require that the most expedient form of anesthesia be used so as not to
upset the routine of those involved in the process. No doubt there are
budgetary and time constraints involved in scheduling day surgeries
such as those undergone by the plaintiff but, in my view, this is a case
where those constraints worked against the patient's interest by
inhibiting the doctors in their judgment of what should be done for
him. That is to be deplored. I raise this in passing only to point
12
out that there are a number of references to the effect of time
constraints on the treatment of this patient. I respectfully say it is
something to be carefully considered by those who are responsible
for the provision of medical care and those who are responsible
for financing it. I also say that if it comes to a choice between the
physician's responsibility to his or her individual patient and his
or her responsibility to the medical care system overall, the former
must take precedence in a case such as this. It is difficult in this case
to resist the observation that the patient's problems were at least in
part related to what might be described as "production line medicine"
in that the procedures which were followed and the standard of
disclosure applied might be considered acceptable in the vast majority
of cases being handled, but this patient did not fit the mould. He had
an unusual situation which required care and treatment which was
not in accordance with the usual routine and it was not offered to him.
While many of the cases to date were decided on other grounds and
the Court's comments about the allocation of resources might be taken as
somewhat gratuitous, there is little doubt that very soon the Courts will
have to squarely face the issue and decide whether there should be any
change to the standard of care expected of physicians, depending on
the environment in which they work. In the meantime, it does not appear
that the Courts are prepared to exact a lower standard of care based on
cost considerations.
The CMA Code of Ethics requires physicians to "collaborate with
other physicians and health professionals in the care of patients and
the functioning and improvement of health services" and to "recognize
the responsibility of physicians to promote fair access to health care
resources." This ethical obligation requires an important and difficult
balancing act for the physician who must work within the system while
at the same time meeting the appropriate standard of care.
In the meantime, if physicians have concerns about lack of resources or
protocols in their hospitals that might adversely affect patient care, they
should make every attempt to draw those concerns to the attention of the
appropriate authorities and to work toward a resolution of the problem. All
such efforts and discussions should be appropriately documented.
Gowling Lafleur Henderson LLP
General Counsel

Financial report
FINANCIAL REPORT
AUDITOR’S REPORT
To the Members of The Canadian Medical
Protective Association
We have audited the consolidated balance sheet of The Canadian
Medical Protective Association as at December 31, 2000 and the
consolidated statements of revenues and expenses and of changes in
net assets for the year then ended. These financial statements are the
responsibility of the Association's management. Our responsibility is
to express an opinion on these consolidated financial statements based
on our audit.
We conducted our audit in accordance with Canadian generally
accepted auditing standards. Those standards require that we plan
and perform an audit to obtain reasonable assurance whether the
financial statements are free of material misstatement. An audit
includes examining, on a test basis, evidence supporting the amounts
and disclosures in the financial statements. An audit also includes
assessing the accounting principles used and significant estimates
made by management, as well as evaluating the overall financial
statement presentation.
In our opinion, these consolidated financial statements present
fairly, in all material respects, the financial position of the Association
as at December 31, 2000 and the results of its operations and its cash
flows for the year then ended in accordance with Canadian generally
accepted accounting principles.
Deloitte & Touche
Chartered Accountants
March 2, 2001
13

Financial report
MANAGEMENT COMMENTARY
The margin notes that appear in italics on the following four pages have been
prepared by CMPA management to heighten understanding of the financial
statements. These notes are not covered by the Auditor's Report on page 13.
The balance sheet provides
a snapshot of CMPA assets
and liabilities, and the
resulting net amount
reserved for claims, on
December 31, 2000.
ASSETS
CURRENT ASSETS
While the year-end Cash position is little changed from
1999, it remains high in comparison to prior years. This
reflects continued caution around the impact of regional
fee implementation and the associated changes to
provincial reimbursement programs. Surplus cash is held
in short-term money market instruments, which in 2000
produced more than $5.2 million in interest income.
Accounts receivable in 1999 included payment of a
significant claim recoverable under the CMPA's indemnity
insurance program. This was received in 2000.
INVESTMENTS ($000s)
Market value at December 31, 1999 $1,837.4
Additional funds transferred to investment
managers in 2000 5.4
Portfolio income recognized in 2000 166.7
Market value at December 31, 2000 $2,009.5
Average time-weighted return on portfolio 9.1%
CAPITAL ASSETS include the CMPA building and land,
equipment, furniture, etc., less depreciation.
The Canadian Medical Protective Association
(Incorporated under the laws of Canada)
CONSOLIDATED BALANCE SHEET
December 31, 2000 (thousands of dollars)
ASSETS
CURRENT ASSETS
Cash and short-term investments
Accounts receivable and other
INVESTMENTS (Note 4)
CAPITAL ASSETS (Note 5)
LIABILITIES AND NETASSETS
CURRENT LIABILITIES
Accounts payable and accrued liabilities
Membership fees received in advance
ACCRUED POST-RETIREMENT BENEFITS (Note 6)
NET ASSETS
Invested in capital assets
Reserved for claims
14

Financial report
2000 1999
$ 75,391 $ 73,335
297 1,325
75,688 74,660
2,009,533 1,837,350
28,874 29,944
$ 2,114,095 $ 1,941,954
$ 56,372 $ 47,662
10,656 27,822
67,028 75,484
1,623 1,085
68,651 76,569
28,874 29,944
2,016,570 1,835,441
2,045,444 1,865,385
$ 2,114,095 $ 1,941,954
LIABILITIES AND NET ASSETS
CURRENT LIABILITIES
Accounts payable and accrued liabilities
($000s)
2000 1999 1998 1997 1996
Awards $22,076 $18,971 $11,428 $18,647 $25,193
Settlements 7,613 6,600 1,671 7,768 5,630
Legal fees 23,862 19,505 21,715 10,260 8,676
Other 2,821 2,586 1,615 1,011 1,276
$56,372 $47,662 $36,629 $37,784 $40,775
Year-end balances vary as a result of the
timing of legal cases' completion dates and
invoicing. The variation in the legal fee
accrual from year to year does not
necessarily reflect an underlying movement
in the annual cost of legal services.
Membership fees received in advance are
shown as a liability because they represent
fee revenue for the next year. These are
significantly lower than in 1999, reflecting the
introduction of the new 2001 Ontario
reimbursement program, which allows
members to defer payment of their 2001
fees until May 1.
ACCRUED POST-RETIREMENT
BENEFITS
These represent the future liability of
benefits for CMPA employees. This line
now discloses the net liability of all postretirement
benefits in accordance with
new accounting requirements. A detailed
breakdown between pension and other
benefits is provided in Note 6.
NET ASSETS
Reserved for claims is, by definition, all
net assets other than capital assets that are
held against the anticipated cost of claims
in future years. Based on actuarial
evaluation, the Reserved for claims of $2,017
million is sufficient to cover all outstanding
liabilities incurred on work performed up to
December 31, 2000. Note 7 discloses the
most recent actuarial estimate of the claim
liability.
On behalf of the Council
William D.S. Thomas, MD, President
John E. Gray, MD, Secretary-Treasurer and CEO
15

Financial report
The Canadian Medical Protective Association
(Incorporated under the laws of Canada)
CONSOLIDATED STATEMENT
OF REVENUES AND EXPENSES
Year ended December 31, 2000 (thousands of dollars)
REVENUES
MEMBERSHIP FEES
2000 1999 1998 1997 1996
Amount ($M) 236 235 241 216 216
Change 0.1% -2.4% 11.6% 0.0% 19.3%
REVENUES
Membership
Investment
Also known as an income
statement, this is a summary
of revenues and expenses for
all of 2000.
Five-year comparisons are
provided for information.
# Paid 56,815 55,503 54,698 53,970 53,593
members
Revenue from membership fees increased slightly from
1999, due primarily to the increase in the number of
members. This has been partially offset by a 0.8% drop in
the aggregate fees charged in 2000.
INVESTMENT INCOME
2000 1999 1998 1997 1996
Amount ($M) 173.1 176.7 129.6 135.4 194.0
Change -2% 36% -7% -30% 32%
Portfolio 9.1% 10.4% 8.6% 10.3% 17.1%
return
Investment revenues in 2000 were down slightly from
1999 but represent a small experience gain over the 9%
return anticipated by the CMPA's actuaries.
EXPENSES
Awards and settlements on behalf of members
Legal costs in support of members
Expert consultant costs in support of members
Indemnity insurance
Member support services
Governance and administration
Investment management
Amortization of capital assets
EXCESS OF REVENUES OVER EXPENSES
16

Financial report
2000 1999
$ 236,152 $ 235,098
173,101 176,705
409,253 411,803
118,714 99,690
69,586 66,466
9,225 8,714
2,122 2,296
13,928 11,755
8,381 7,510
5,534 5,896
1,704 1,655
229,194 203,982
$ 180,059 $ 207,821
EXPENSES
Awards, settlements, legal fees and expert
witness fees comprise more than 85% of the
CMPA's expenses and relate directly to current
legal actions or cases.
The costs of settlements and court awards vary
depending on the number of cases brought to
completion in a given year. The following table
shows numbers of cases and the resultant simple
average award/settlement per case in the last five
years (note: one or two multi-million dollar
settlements in a given year can have a significant
impact on the average cost per case):
2000 1999 1998 1997 1996
Awards & $118,714 $99,690 $83,145 $86,059 $101,594
settlements
($000s)
Number 445 427 353 396 417
of cases
Average $ 266.8 $ 233.5 $ 235.5 $ 217.3 $ 243.6
per case
($000s)
Investment management fees generally reflect
the market value of the funds being managed.
However, fees have been reduced by 6.1% in 2000
in spite of an increase in the value of the portfolio.
This reflects the CMPA's switch to betterperforming,
lower-cost fund managers.
Member support services report the direct
operating costs of the CMPA's core service
departments. The increase over 1999 is due
primarily to increases in the staff complement;
growth at the CMPA reflects growth in membership
and its resultant growth in services to members.
17

Financial report
The Canadian Medical Protective Association
(Incorporated under the laws of Canada)
CONSOLIDATED STATEMENT OF
CHANGES IN NET ASSETS
Year ended December 31, 2000 (thousands of dollars)
2000 1999
Net assets Net assets
Net assets invested in reserved for
unrestricted capital assets claims Total Total
BALANCE, BEGINNING
OF YEAR $ – $ 29,944 $ 1,835,441 $ 1,865,385 $ 1,657,564
Excess of revenues
over expenses 180,059 – – 180,059 207,821
Net decrease in
capital assets 1,070 (1,070) – – –
Transfer to reserve for claims (181,129) – 181,129 – –
BALANCE, END OF YEAR $ – $ 28,874 $ 2,016,570 $ 2,045,444 $ 1,865,385
Net decrease in capital assets is the excess of current amortization ($1,704)
over net acquisitions of capital assets ($634).
18

Financial report
NOTES TO THE CONSOLIDATED
FINANCIAL STATEMENTS
Year ended December 31, 2000
1. DESCRIPTION OF BUSINESS
The Association is a not for profit medical mutual defence
organization. Its membership comprises a large majority of the
medical profession in Canada. It is governed by a Council elected
by its members.
2. CHANGE IN ACCOUNTING POLICY
The Association has adopted a new standard for accounting for
employee future benefits, including pension benefits and postretirement
benefits other than pensions, in accordance with the
Section 3461 of the CICA Handbook. This policy changes the
accounting for non-pension post-retirement benefits to an accrual
basis, from the cash accounting basis previously used. In addition,
it uses a current settlement discount rate to measure the accrued
pension benefit obligation, rather than the long-term rate of return
that was used prior to the adoption of this new accounting standard.
The Association has adopted the new standard on a
prospective basis effective January 1, 2000. Transitional balances
arising from the application of the new policy will be amortized
over the expected average remaining service life of the employees
participating in each plan.
3. ACCOUNTING POLICIES
The consolidated financial statements include the accounts of
the Association and its subsidiary, which was incorporated to
own the land and building occupied by the Association. These
financial statements have been prepared in accordance with
accounting principles generally accepted in Canada and include
the following significant accounting policies:
Membership fees
Membership fees are recorded as revenue on a pro-rata basis
over the membership year. Membership fees received in
advance are deferred.
Awards and settlements
Costs related to awards and settlements incurred on behalf
of members are recorded when management determines that
their payment will become likely. The amounts recorded are
based in part on estimates and assumptions made by management
and therefore are subject to measurement uncertainty. Actual
amounts paid, if any, could differ from the amounts accrued at
the previous year end. Differences would be recognized in the
year they are determined.
It is not possible to determine precisely the amount of the
potential costs the Association may be exposed to as a result of
pending or future litigation against its members for which it may
take or be assigned responsibility, and consequently the financial
statements reflect no liability for such costs. An estimate of the
Association's outstanding claims liability including awards and
settlements, legal and administrative expenses, is prepared by
independent actuaries on an annual basis. To provide funding
towards such costs, a portion of net assets has been reserved for
claims. Annual membership fees are set at an amount to provide
full funding of the expected costs for all claims arising out of
work done by members during the year. In addition, annual
membership fees are adjusted as necessary from time to time to
provide for full funding of claims already in hand from earlier
years. The Association is satisfied that its assets, together with
such fee adjustments, will allow it to meet its potential costs
payable over a period of years.
Investment management expenses
Fees levied by investment managers for the provision of
investment management services to the Association are recorded
as an expense in the year they are incurred. Investment revenue
is disclosed on a gross basis before investment management fees.
Investments
Investments are recorded at market value including interest and
dividend revenue receivable. Realized and unrealized gains
(losses) together with interest and dividend revenue are
reported as investment revenue.
19

Financial report
Foreign currency
Transactions denominated in foreign currencies are translated into
Canadian dollars at the rates of exchange prevailing at the dates
of the transactions. Investments and cash balances denominated
in foreign currencies are translated at the rates in effect at year
end. Resulting gains or losses from changes in these rates are
included in investment revenue.
Capital assets
Capital assets are recorded at cost. Amortization is computed
using the straight-line method over the following terms:
Building
Furniture and equipment
Software
Computer equipment
Building improvements
Deferred leasing costs
4. INVESTMENTS
50 years
10 years
3 years
3 years
10 years
terms of leases
Investments are summarized as follows: (thousands of dollars)
2000 1999
Market
Market
value Cost value Cost
Cash and short- $ 75,314 $ 75,314 $ 39,691 $ 39,691
term investments
Investment revenue
receivable 10,819 10,819 9,706 9,706
Bonds 843,629 832,523 696,322 724,242
Equities 1,079,771 886,995 1,091,631 800,216
$2,009,533 $1,805,651 $1,837,350 $1,573,855
Determination of market values
Cash and short-term investments, which include bank deposits,
treasury bills, bankers' acceptances and short-term corporate
notes, are valued at cost which approximates market value.
Bonds are debt obligations of governments and corporate
bodies paying interest at rates appropriate to the market at the
date of their purchase. Bonds are recorded at prices based upon
published market quotations. They mature at face value on a
staggered basis over the next 32 years. Effective interest rates to
maturity for these securities range from 3.25% to 9.19%.
Equities include listed and unlisted securities. Listed
securities are recorded at prices based upon published market
quotations. Unlisted securities consist of pooled fund units and
private placements. Pooled fund units are valued at prices based
on the market value of the underlying securities held by the
pooled funds. Private placements are valued at prices based upon
management's best estimates using one of the following methods:
cost, trade prices for similar securities and appraised values.
Investment risk
Investment in financial instruments renders the Association
subject to investment risks. These include the risks arising from
changes in interest rates, in rates of exchange for foreign currency,
and in equity markets both domestic and foreign. They also
include the risks arising from the failure of a party to a financial
instrument to discharge an obligation when it is due.
The Association has adopted investment policies,
standards and procedures to control the amount of risk to
which it is exposed. The investment practices of the Association
are designed to avoid undue risk of loss and impairment of
assets and to provide a reasonable expectation of fair return
given the nature of the investments. The maximum investment
risk to the Association is represented by the market value
of the investments.
20

Financial report
Investment risk (Continued)
a) Concentration risk
Concentrations of risk exist when a significant proportion of the portfolio is invested in securities with similar characteristics or
subject to similar economic, political or other conditions. Management believes that the concentrations described below do not
represent excessive risk. (% of market value)
2000 1999
Cash and short-term investments 4 2
Investment revenue receivable – 1
4 3
Bonds
Government of Canada 19 18
Corporate 13 12
Provinces of Canada 10 8
Equities
42 38
CANADIAN
Financial services 8 5
Industrial products 6 7
Oil and gas 3 3
Pooled fund units 2 2
Utilities 2 4
Metals and minerals 1 1
Consumer products 1 1
Communications and media 1 2
Private placements and other 3 2
Gold and silver - 1
FOREIGN
27 28
U.S. pooled fund units 14 16
International pooled fund units 13 15
27 31
54 59
100 100
21

Financial report
Investment risk (Continued)
b) Foreign currency risk
Foreign currency exposure arises from the Association's holdings of non-Canadian denominated investments, as follows:
(thousands of dollars)
2000 1999
Bonds
Canadian corporate bonds denominated
in U.S. dollars $ 4,046 $ 4,670
Canadian provincial bonds denominated
in U.S. dollars 1,723 –
5,769 4,670
Equities
U.S. Pooled Fund Units 285,817 284,895
International Pooled Fund Units 263,164 279,534
548,981 564,429
$ 554,750 $ 569,099
5. CAPITAL ASSETS
(thousands of dollars)
22
2000 1999
Land $ 7,611 $ 7,611
Building 21,994 21,994
Furniture and equipment 1,927 1,815
Software 3,996 3,920
Computer equipment 2,850 2,540
Building improvements 1,031 918
Deferred leasing costs 133 1,334
39,542 40,132
Accumulated amortization 10,668 10,188
$ 28,874 $ 29,944

Financial report
6. POST-RETIREMENT BENEFITS
The Association sponsors a number of defined benefit plans for most employees, which plans provide pension and postretirement
health and dental benefits. Information about the Association's defined benefit plans as at December 31, in aggregate,
is as follows: (thousands of dollars)
2000 1999
Pension Other post- Pension Other postbenefit
retirement benefit retirement
plans benefit plans Total plans benefit plans Total
Fair value of plan assets $16,876 $ – $16,876 $15,989 $ – $15,989
Accrued benefit obligations 9,405 6,075 15,480 8,332 5,555 13,887
Funded status -
plan surplus (deficit) 7,471 (6,075) 1,396 7,657 (5,555) 2,102
Less amounts not yet
recognized in the
financial statements:
Unamortized transitional
assets (liabilities) 3,882 (917) 2,965 4,165 (978) 3,187
Other 41 13 54 – – –
3,923 (904) 3,019 4,165 (978) 3,187
Accrued postretirement
benefits $ 3,548 $(5,171) $ (1,623) $ 3,492 $(4,577) $ (1,085)
23

Financial report
POST RETIREMENT BENEFITS (Continued)
The significant actuarial assumptions adopted in measuring the
Association's accrued benefit obligation are as follows:
2000 1999
Pension benefit plans
Discount rate 7.0% 7.0%
Expected long-term rate of
return on plan assets 8.0% 8.0%
Rate of compensation increase 6.0% 6.0%
Other post-retirement benefit plans
Discount rate 7.0% 7.0%
Health care cost trend rate 5.0 - 9.0% 5.0 - 9.0%
Other information about the Association's defined benefit plans for the
year is as follows: (thousands of dollars)
2000 1999
Pension benefit plans
Plan expense (revenue) $ (97) $ 3
Employer contributions – –
Employee contributions 291 258
Benefits paid 239 413
Other post-retirement benefit plans
Plan expense 854 –
Benefits paid 238 161
7. OUTSTANDING CLAIMS LIABILITY
As at the date of the last estimate, December 31, 1999,
the Association's outstanding claims liability, calculated
by independent actuaries in accordance with the standards
of practice of the Canadian Institute of Actuaries, was
$1,730,920,000 (including a provision for adverse deviation in
the amount of $364,641,000). The corresponding estimate as at
December 31, 2000 is not yet available and could be materially
different than the amount calculated as at December 31, 1999.
8. CONTINGENCIES
The Association is one of the defendants in an action filed by
a member, the plaintiff alleging negligent failure to provide a
proper defence in various medical malpractice actions. This legal
action is considered wholly defensible.
There is an application for declaratory relief in which the
applicant, an insurance broker in Quebec, alleges that the
Association has failed to comply with the provisions of the
Insurance Act. The applicant seeks a court order striking out those
provisions. No monetary relief is sought. This action is considered
to be wholly defensible.
The Association is also the defendant in a class action filed
on behalf of members in Quebec alleging that the Association
has failed to comply with the provisions of the Insurance Act
and that as a result, the members are entitled to obtain recovery
of past membership dues. This matter is currently on hold
pending a determination of the above action. It is considered
to be wholly defensible.
9. STATEMENT OF CASH FLOWS
A statement of cash flows has not been prepared as information
relating to cash flows is otherwise adequately disclosed.
10. COMPARATIVE FIGURES
Certain of the prior year's comparative figures have been
reclassified to conform with the current year's presentation.
24

Minutes of the 2000 annual meeting
MINUTES OF THE 2000 ANNUAL MEETING
MINUTES OF THE 2000 ANNUAL MEETING
SASKATOON, SASKATCHEWAN, AUGUST 16, 2000
INTRODUCTION
1. The annual meeting of the Canadian Medical Protective
Association was held at 1330h on Wednesday, August 16, 2000 in the
Sheraton Centre Room of the Sheraton Cavalier Hotel, Saskatoon,
Saskatchewan. There were 118 members present.
2. The president, Dr W.D.S. Thomas, called the meeting to order
and extended a welcome to the members. He introduced those seated at
the head table: Dr André Duranceau, vice-president, Dr John Gray,
attending his first meeting as secretary-treasurer, Dr Guy Lemay, associate
secretary-treasurer, and Mrs Margaret Ross of Gowling Lafleur Henderson,
General Counsel.
3. In his opening remarks the president reminded members that
the CMPA is one of the oldest medical organizations in Canada, having
been founded in 1901 and now approaching its 100th anniversary. He
extended a special invitation to members to attend the Association's
centennial meeting in Quebec in August 2001. Referring to the many
changes which have taken place during the Association's evolution the
president emphasized that what has remained constant throughout the
years is the Association's commitment to the vigorous defence of its
members and their professional integrity. Pointing to its more than
56,000 members as its greatest strength, the president expressed the
hope that despite regional and type of work differences the members
can and will remain united as a strong national organization with a rich
heritage and a secure future.
4. The President recognized two individuals who had retired
from Council and from the staff during the past year. First,
Dr Jack Alexander, a long-time member of Council from Saskatchewan,
who retired recently from Council. The president extended sincere thanks
to Dr Alexander for his major contributions to the Association over many
years. Secondly, the president paid tribute to Dr Stuart B. Lee who
retired in May 2000 after 28 years with the Association.
As secretary-treasurer, a position he had held since 1989,
Dr Lee guided the Association through many difficult and challenging
times. He was devoted to the philosophy of the CMPA and always held
the protection of a member's professional reputation foremost in his
mind. The Association owes Dr Lee a debt of gratitude for his many years
of loyal service to the CMPA.
5. Dr Athol Roberts moved THAT the members extend their
profound gratitude to Dr Lee for his outstanding service to the Canadian
Medical Protective Association and that they send him very best wishes
for a satisfying retirement. The motion was seconded severally and
carried unanimously.
APPOINTMENT OF SCRUTINEERS
6. The president proposed that Dr A. L. Roberts, Dr B. J. L'Heureux
and Dr P. Bruce-Lockhart be appointed scrutineers. His proposal
was accepted on a motion by Dr Allon Reddoch, seconded by
Dr L. T. Diduch, and carried.
NOTICE OF ANNUAL MEETING
7. The secretary-treasurer, Dr John E. Gray, read the
Notice of Annual Meeting whereupon the President declared the
meeting to be duly constituted.
APPROVAL OF MINUTES OF 1999 ANNUAL MEETING
8. The minutes of the 1999 annual meeting were printed in the
Annual Report for 1999 which had been circulated to all members.
No errors were noted. It was moved by Dr B. J. L'Heureux, seconded
by Dr L. E. Groves, that the minutes be approved.
Carried.
Dr Ian White complimented the Association on the presentation
and format of the Annual Report for 1999. However, he asked that in
future the report be distributed to members in a more timely manner so
that they might have the opportunity to adequately review it in advance
of the annual meeting.
25

Minutes of the 2000 annual meeting
BUSINESS ARISING FROM THE MINUTES
Choice of Counsel
9. During debate on this issue at the 1999 annual meeting several
members recounted personal experiences which had led to their
dissatisfaction with the legal services provided by the Association. In
response the CMPA Council asked that the secretary-treasurer and
General Counsel review the circumstances which had given rise to the
dissatisfaction. Their report was considered by Council in October. On
behalf of Council the president conveyed the message that Council is
satisfied that the CMPA has an appropriate appeals process in place and
that in the case of conflict it does address concerns raised by members as
they become known.
Life membership exceptions
10. With respect to the motion passed at the 1999 annual meeting,
Council agreed to consider exceptions on an individual basis. One such
request was considered and an exception was denied. To date there have
been no additional requests for consideration.
REPORT OF COUNCIL
11. The president pointed out that now more than ever the CMPA is
dependent on provincial governments to provide reimbursement of
CMPA membership fees, a fact which makes cost containment of
paramount concern both for members and for the governments which
support them. He introduced Dr André Duranceau who would chair a
panel discussion on the various components of costs and the strategies
the Association is developing to contain them. Dr Duranceau introduced
the panel: Dr Lawrie Groves, a family physician and member of Council
from Manitoba, Dr Vyta Senikas, an obstetrician and member of Council
from Montreal, Dr Michael Lawrence, a family practitioner from
Vancouver and chair of the Association's working group on tort reform,
and Dr John Gray, CMPA's secretary-treasurer.
PANEL DISCUSSION ON COST CONTAINMENT
Administrative costs
12. Dr Duranceau noted that during its 100-year existence six major
events have had a profound effect on the Association's structure and
administrative costs: the decision to change from a pay-as-you-go basis
to a fully-funded position (1984), government involvement in
reimbursement schemes (1986), the Prichard report (1990), the
Dubin report (1997), the governance review that followed, and most
recently the decision to move to regional rating. The Association's
response to each of these events led to changes in structure and
corresponding increases in administrative costs, principally due
to the expanded activities of three CMPA departments: research and
education, case management and communications. The Association's
current administrative costs represent 9.8% of total expenses,
9.2% of membership fees and 4.9% of total revenues, figures which
compare favourably with those of insurance companies and other
not-for-profit organizations.
Legal cost containment
13. In his presentation Dr Groves outlined the long-term view the
Association has adopted in the development of a comprehensive strategy
to contain legal costs, and set out for the members the four key elements
of that strategy as follows:
• an aggressive defence philosophy that discourages frivolous
lawsuits;
• rigorous scrutiny of legal billings and hourly billing rates to
ensure that they are appropriate and competitive;
• implementation of effective legal case management systems
and techniques;
• a clearly articulated legal fees and disbursements policy to guide
provincial counsel firms across the country.
Dr Groves provided some specific examples of the success the strategy
has achieved thus far. The number of new legal actions commenced
against members has remained relatively constant for the past five years,
26

Minutes of the 2000 annual meeting
and of those which went to trial the Association's success
rate has remained in the 75% to 80% range. During this same period
increases in legal costs have levelled off, averaging approximately
4% per year. The implementation of the CMPA's computerized case
management system has helped to achieve earlier resolution of legal
actions which reduces not only legal costs but also the stress
experienced by members. In 1999, for the first time in its history, the
Association closed more cases than it opened, i.e. the balance of cases
deficit was eliminated. Continuation of this trend over time will be
a contributing factor in the reduction in legal costs. For the future,
Dr Groves said the challenges for the Association will be to continue
to maintain high quality legal services in support of members, and to
demonstrate unequivocally to members and to governments that the
resources they contribute through fees and reimbursement programs
are being sensibly managed.
Containing costs through case
management/education/risk identification
14. Dr Senikas talked about some of the benefits which have
been derived from the implementation in 1998 of the computerized
case management system, specifically the ability to track both open
and closed cases and to identify trends which will assist in the
future management of cases and in risk identification and reduction.
Dr Senikas described the composition of the case review committee and
the role it plays in auditing selected closed cases and in determining the
defensibility and ultimate direction of an ongoing legal action. Among
the educational activities of the Association, Dr Senikas cited the everincreasing
number of medico-legal sessions attended by CMPA
representatives, the cases reported in the Information Letter, the CMPA
website, and the Risk Identification papers introduced in 1999 with the
objective of presenting a concise report of data analysis on defined
medical practices. Dr Senikas described risk reduction as a complex
issue involving multiple players including the CMPA, its members,
paraprofessionals, hospitals and specialty organizations. To this end the
research and education committee continues to look at ways in which
the Association can interact effectively with medical societies and
other interested groups to provide the information they require to
assist in their risk management activities, with the ultimate
goal of not only reducing risks but also costs for the Association
and its members.
Containing costs through tort reform
15. Dr Lawrence commented that the Association is pursuing tort
reform for a variety of reasons and has targeted reforms in three main
areas, two of which speak directly to the damages component of awards
and settlements, i.e. structured settlements and the elimination of
subrogation. Court-ordered structured settlements could result in savings
of up to 40% of the damages cost of a settlement or award while
elimination of subrogation could see savings of 4% of the annual cost of
damages. The third priority for tort reform comprises a number of
initiatives aimed at reducing the complexity and shortening the duration
of legal actions. To speed up the tort reform process, a joint working
group comprised of representatives from the CMA and the CMPA was
formed in February 2000. Specific jurisdictions for enhanced structures
legislation and the elimination of subrogation have been targeted and
lobbying is being pursued in the target provinces. In addition the Ministry
of Health in Ontario has agreed to seriously consider tort reform as a
condition of a formal Memorandum of Understanding with the Ontario
government, the Ontario Medical Association and the CMPA. Because
universal tort reform has the potential to save a significant proportion of
total damages costs, Dr Lawrence assured members that he and his
colleagues will vigorously pursue the implementation of damages cost
controls that are in the interest of doctors and protect patients' interests
at the same time. He expressed the hope that CMPA will be able to report
real progress in the area of tort reform at CMPA's next annual meeting in
Quebec City in August 2001.
Cost strategy surrounding regional cost analysis
16. As background to Council's decision to move to regional rating
Dr Gray pointed out that the major component of the steadily increasing
costs the Association has faced over the last several years is damages,
i.e. awards and settlements, which in Ontario have been shown to be
considerably higher than in the rest of the country. With the move to
27

Minutes of the 2000 annual meeting
regional rating, Ontario members faced a dramatic increase
in fees, a substantial portion of which would have to be paid by the
Ontario government. Therefore, an arrangement which would allow
for a predictable increase in costs and provide some measure of easing
the burden for the government and for Ontario members was sought.
The CMPA entered into intense negotiations with the Ontario
government and the Ontario Medical Association and a memorandum
of understanding was reached, a complete copy of which is available
to members on CMPA's website. The underlying problem of costs will
be addressed by the medical malpractice coverage committee, a
tripartite committee with a fairly broad mandate comprised of three
representatives from each of the parties to the MOU. In summary,
physicians will continue to be reimbursed for their CMPA fees through
2003 and will be the beneficiaries of an improved reimbursement
program during that period of time.
17. In February 2000, when the actuaries reported on regional cost
differences, the information was presented on the basis of six regions:
Ontario, Quebec, British Columbia, Alberta, the Prairies and the Atlantic
provinces. At that time the actuaries were satisfied that each of these
regions was large enough with sufficient numbers of members to stand
alone. However, they also observed that because the differences in costs
among the four regions outside Ontario and Quebec were not materially
different, these regions could be combined into one region. Feedback
from the provincial medical associations was unanimous that they
would prefer only one region outside Ontario and Quebec in order to
provide greater protection against volatility. The three-region concept
was subsequently endorsed by Council. However, it was agreed that the
actuaries will continue to monitor and track costs on a provincial and
territorial basis and will present financial reports to each province
periodically. Dr Gray briefly reviewed some of the business rules which
will be implemented in January 2001 to assist the Association in this
financial reporting.
The chair invited questions from the floor.
18. Dr Groves responded to a question about whether it
might be less costly for the Association to retain in-house counsel,
saying that the issue has been and will continue to be discussed and
monitored closely but that at the present time the Association is satisfied
that the value it receives for the money it spends is appropriate and that it
is being well served by external counsel.
19. About the fees to be paid by Ontario members in 2001, Dr Gray
explained that the catch-up fee paid over the years by all members to
permit the Association to reach full funding has allowed the Association
to be in a surplus position. Ontario has chosen to draw on its per capita
share of that surplus on an accelerated basis in order to cushion the
impact of the fee increase over the next few years, using its own money
and in effect mortgaging its future.
20. Dr Janice Willett asked about the Association's definition of risk
management. Dr Gray advised Dr Willett that to preserve the concept of
mutuality the Association does not set fees based on an individual
member's risk; it does not cancel policies or place limits on the protection
it provides, but rather functions as a defence organization, an aspect of
risk management that is not currently under discussion. Dr Senikas
acknowledged it is difficult to define risk management precisely; the
words mean different things to different people. She referred to extensive
work the Association's research and education department has done
and continues to do in this area. She reiterated her earlier comments
that risk management involves not only physicians but also hospitals,
paraprofessionals, medical associations and others and that a high level
of cooperation among the various groups will be necessary to achieve a
reduction in risk.
21. As a participant in the process which led to the recent agreement
in Ontario, Dr Elliot Halparin of Ontario commended the important role
played by Dr John Gray and his colleagues in ensuring a successful
outcome of the negotiations and the preservation of CMPA's strong
presence in Ontario.
It was moved by Dr B. J. L'Heureux, seconded severally, that the
Report of Council be accepted for information.
Carried.
28

Minutes of the 2000 annual meeting
YEAR 2001 AGGREGATE FEE REQUIREMENT
22. Dr Peter Fraser, a member of Council and of its executive
committee, articulated the annual actuarial review process which
includes past and current claims experience, trends in damages and legal
costs and adjustments for actual vs predicted experience. He pointed out
that for 2001 costs have been calculated on a regional basis and for 2002
and later years adjustments will be made on a region's own experience.
Dr Fraser advised members that for medical work done in 2001 the
actuarial predictions are that the cost of awards and settlements will
require fees 4.8% higher than in 2000. Using the following tables he
illustrated the projected regional costs per member for 2001 and the
aggregate fee requirement per member for the same period, subject to
transitional adjustments for Ontario and the rest of Canada:
Projected actuarial regional costs (per member)
2001 (without transition) Change (%) over 2000
$ $
Quebec 2,039 -51.3
Ontario 6,296 50.4
Rest of Canada 3,840 -8.3
Aggregate fee requirement (per member)
2001 (with transition) Change (%) over 2000
$ $
Quebec 2,039 -51.3
Ontario 4,843 15.7
Rest of Canada 3,816 -8.8
At its meeting in October Council will determine how the
aggregate fee requirement will be distributed across the differential
fee structure by region. In closing Dr Fraser stressed the importance
of addressing the factors which lead to high costs by moving forward
as quickly as possible with risk management, tort reform and other
initiatives to reduce costs.
AUDITOR’S REPORT
23. Dr Karen Cronin, chair of the audit committee, read from the
auditor’s report for the year 1999 which concludes with the statement by
Deloitte & Touche, that "... these consolidated financial statements present
fairly, in all material respects, the financial position of the Association as
at December 31, 1999 and the results of the operations and its cash flows
for the year then ended in accordance with Canadian generally accepted
accounting principles."
24. In the absence of the director of finance, Mr Stephen Campbell,
Dr John Gray spoke to the 1999 financial statements. He addressed the
modified format of the financial statements in the Annual Report,
highlighting some of the key operating results for 1999 and focusing on
two changes to accounting policy and disclosure from the 1998
statements. In response to feedback from members, and because of the
unique nature of the Association, additional margin notes were provided
to heighten readers' understanding of the statements, and to provide
answers to their questions. Turning to the summary of revenues and
expenses Dr Gray pointed out that based on current actuarial assumptions
the $235 million collected in membership fees in 1999 represents less
than half of the ultimate costs that will be paid out for actions arising in
1999. On the expense side, less than $18 million of the $204 million
disbursed in 1999 relates to the 1999 occurrence year. The remainder
represents the cost of administering, defending and settling claims which
arose in 1998 and prior years, back as far as 1976.
Dr Gray concluded his presentation by reiterating that the 1999
financial statements clearly reflect the tremendous underlying financial
strength and stability of the CMPA. As a relative newcomer to the CMPA
he commended the foresight and commitment of Council and the
29

Minutes of the 2000 annual meeting
membership at large in the early 80s for implementing
the difficult changes required to introduce and maintain a full
funding model.
There were no questions. It was moved by Dr B. J. L'Heureux,
seconded severally, that the Auditors Report and Financial Statements
be approved.
Carried.
REPORT OF GENERAL COUNSEL
25. The Report of General Counsel which appeared in the
Annual Report dealt with the activities of General Counsel and provincial
counsel and their interactions with the CMPA. Over the years members
had expressed an interest in hearing more about the cases with which
Counsel deals and in response Mrs Ross dissembled from her report to
present a case summary which demonstrated clearly the CMPA's
aggressive defence philosophy on behalf of members. The plaintiff in
the action was a 39-year-old woman whose young daughter had died
under tragic circumstances. The woman sued the family physician, a
psychiatrist, a psychologist, a mental health unit and the director of
that unit, alleging that the defendants' failure to appropriately treat her
psychiatric problems was the ultimate cause of her daughter's death.
The Association's case review committee determined that the lawsuit
was fully defensible and instructed counsel to defend the case through
trial. On the eve of trial lawyers for the non-physician defendants
reached a monetary settlement on behalf of their clients and the action
proceeded to trial before a jury against the CMPA members. During trial
counsel was successful in obtaining dismissal of the action as against
the family physician defendant and the director of the mental health
unit. The action proceeded solely against the psychiatrist. At the
conclusion of a lengthy trial during which extensive expert evidence
was adduced on behalf of the defendant doctor, the jury was instructed
to determine whether the plaintiff intentionally caused the death of her
daughter. After deliberating for more than four hours the jury concluded
that she did. On the basis of this finding, the issue of negligent
medical care was never addressed and no damages were awarded.
Subsequently three articles critical of the medical care provided
and of the health care system generally were published in the media.
Although informed of the jury's findings, the reporter wrote nothing
further and the decision of the jury was never reported.
It was moved by Dr L'Heureux, seconded severally, that the
Report of Counsel be received for information.
Carried.
ELECTION OF MEMBERS TO COUNCIL
26. The secretary-treasurer announced the results of the
2000 election of members to Council, as follows:
Nominations for election
Area 1, Division A (one vacancy)
Number of votes
Dr Norman D. Finlayson, Shawnigan Lake, BC 674
Dr E. Jane Wright, Victoria, BC 1,234*
Area 1, Division B (one vacancy)
Dr William D.S. Thomas, Vancouver, BC
Area 2, Division A (one vacancy)
Elected by acclamation
Dr J. Guy Gokiert, Westlock, AB 1,325
Dr Sandra S. Wirth, Rosthern, SK 1,335*
Area 3, Division A (one vacancy)
Dr Stephen J. Wetmore, London, ON
Area 3, Division B (three vacancies)
Elected by acclamation
Dr Gordon A. Crawford, Barrie, ON 3,708*
Dr William A. Easton, Scarborough, ON 3,746*
Dr J. Robert Taylor, Nepean, ON 3,662
Dr William S. Tucker, Toronto, ON 4,424*
30

Minutes of the 2000 annual meeting
Area 4, Division B (three vacancies)
Dr Jean Deslauriers, Ste Foy, QC 3,033*
Dr Claude Godin, Montreal, QC 2,453
Dr Louise Passerini, Brossard, QC 3,381*
Dr Vyta M. Senikas, Montreal, QC 2,735*
Area 5, Division A (one vacancy)
Dr Michael T. Cohen, Grand Falls-Windsor, NF 478*
Dr Robert E. Colborne, Montague, PEI 317
Dr Robert F. Martel, Windsor, NS 395
*Elected to Council
On behalf of the CMPA the president offered congratulations to
the successful candidates and thanked all those who had participated in
the election process.
NEW BUSINESS
27. Dr Albert Schumacher of Windsor, Ontario spoke to the issue of
liability coverage for Canadian physicians who provide non-elective
medical care to foreigners in Canada. Understanding that a waiver signed
by the patient will not necessarily preclude a legal action being brought
in the United States, Dr Schumacher asked whether the CMPA might
consider offering additional coverage for members who are interested in
providing these services in a variety of specialty areas. Dr Gray pointed
out that the CMPA operates under a federal charter which allows it to
provide medical malpractice protection on a mutual basis only to
physicians in Canada. To offer protection in the United States would
be in violation of that charter. Rather, the CMPA has been focusing its
efforts on finding a cooperative referral relationship with insurers in the
United States who share the CMPA's defence philosophy, an endeavour
which so far has been unsuccessful. Dr Gray assured the members that
he will continue to pursue this avenue so that the CMPA can take
comfort in referring its members to a reputable insurer who can offer
adequate protection.
ADJOURNMENT
28. There was no further business. The president thanked the
members who attended and those who had participated in the
presentations, and invited all those present to attend a reception in
the adjoining room following the meeting. The meeting was adjourned
at 1610h.
31

leadership
CMPA LEADERSHIP
COUNCIL (AUGUST 2000 TO AUGUST 2001)
BY AREA AND DIVISION
(A = generalists; B = specialists)
AREA 1, DIVISION A
Michael R. Lawrence, MD
Vancouver, BC
E. Jane Wright, MB, ChB Victoria, BC
AREA 1, DIVISION B
Barbara J. Kane, MD, FRCPC
Prince George, BC
William D.S. Thomas, MD, FRCSC Vancouver, BC
AREA 2, DIVISION A
Lawrence E. Groves, MD, MCFP Brandon, MB
Sandra S. Wirth, MD
Rosthern, SK
AREA 2, DIVISION B
Douglas F. Birt, MD, FRCSC
Winnipeg, MB
Lawrence T. Diduch, MD, FRCSC Edmonton, AB
Brent W. Winston, MD, FRCPC
Calgary, AB
AREA 3, DIVISION A
Karen L. Cronin, MD, CCFP
Downsview, ON
C. Anthony Johnson, MD, FCFP Kingston, ON
Nancy L. Naylor, MD, CCFP
Fort Frances, ON
(appointed February 2000)
Stephen J. Wetmore, MSc, MD, CCFP London, ON
AREA 3, DIVISION B
Gordon A. Crawford, MD, FRCSC
William A. Easton, MD, FRCSC
Neil V. McPhail, MD, FRCSC
Kari G. Smedstad, MB, ChB, FRCPC
William S. Tucker, MD, FRCSC
George E. Yee, MD, FRCPC
AREA 4, DIVISION A
Jacques R. Beauchamp, MD
Jean-Joseph Condé, MD
Paul Guertin, MD
AREA 4, DIVISION B
Jean Deslauriers, MD, FRCSC
André Duranceau, MD, FRCSC, CSPQ
Louise Passerini, MD, FRCPC
Vyta M. Senikas, MD, FRCSC, CSPQ
AREA 5, DIVISION A
Michael T. Cohen, MD
Peter K. Fraser, MD, MCFP
AREA 5, DIVISION B
Kim R. Crawford, MD, FRCPC
David B. Peddle, MD, FRCSC
Barrie, ON
Toronto, ON
Ottawa, ON
Hamilton, ON
Toronto, ON
Windsor, ON
Laval, QC
Val-d'Or, QC
Granby, QC
Sainte-Foy, QC
Montréal, QC
Brossard, QC
Montréal, QC
Grand Falls-Windsor, NF
Oromocto, NB
Liverpool, NS
St. John's, NF
32

CMPA leadership
COMMITTEES (AUGUST 2000 TO AUGUST 2001)
EXECUTIVE COMMITTEE
Mandate: The Council may delegate to the executive committee all or
part of its powers, except the power to appoint officers and
committees. Acts for Council between its meetings and provides a
focus on governance to enhance the CMPA's performance.
Dr W.D.S. Thomas, chair
Dr G.A. Crawford
Dr André Duranceau
Dr P.K. Fraser
Dr L.E. Groves
AUDIT COMMITTEE
Mandate: Assists Council by reviewing the financial information to be
provided to the public and others, the internal control systems
established by management and Council, and the audit process.
Dr K.L. Cronin, chair
Dr J.-J. Condé
Dr K.R. Crawford
CASE REVIEW COMMITTEE
Mandate: Conducts a review of cases brought forward by the medical
secretariat with all power and authority of Council regarding decisions
as to the conduct of cases. This includes the authority to determine
the nature and extent of assistance to a member.
Dr André Duranceau, chair
Dr Jacques Beauchamp
Dr D.F. Birt
Dr Jean Deslauriers
Dr N.V. McPhail
Dr Paul Guertin
Dr M.R. Lawrence
Dr W.S. Tucker
Dr S.J. Wetmore
Dr L.T. Diduch
Dr Sandra Wirth
Dr G.E. Yee
Dr V.M. Senikas
Dr Kari Smedstad
Dr W.S. Tucker
Consultants: Dr D.B. Peddle
Dr J.R. Taylor
COMMUNICATIONS COMMITTEE
Mandate: Assists the CMPA to achieve its mission through effective
communications to members, the medical community and
governments.
Dr M.R. Lawrence, chair
Dr D.F. Birt
Dr M.T. Cohen
Dr K.R. Crawford
HUMAN RESOURCES AND
COMPENSATION COMMITTEE
Mandate: Reviews, reports and provides recommendations to
Council regarding human resources matters including management
recruitment and development, management succession, employee and
management compensation programs, pension matters and significant
human resource policies.
Dr Kari Smedstad, chair
Dr J.-J. Condé
Dr L.E. Groves
INVESTMENT COMMITTEE
Mandate: Establishes the investment policy and process of the CMPA,
and reviews the results in comparison to the approved investment
plan.
Dr W.D.S. Thomas, chair
Dr J.-J. Condé
Dr L.T. Diduch
Dr André Duranceau
Dr P.K. Fraser
Dr W.A. Easton
Dr Paul Guertin
Dr Sandra Wirth
Dr B.W. Winston
Dr B.J. Kane
Dr W.D.S. Thomas
Mr Brian Drummond
Mr W.W. Ogilvie
Mr Robert Paterson
Mr S.J. Susinski
33

CMPA leadership
LEGAL SERVICES COMMITTEE
Mandate: Reviews the CMPA's working relationship, including roles
and responsibilities, with its General Counsel and provincial counsel
firms to provide members with legal services of the highest quality;
gives direction and supervision in containing the cost of legal services.
Dr W.D.S. Thomas, chair
Dr P.K. Fraser
Dr L. Passerini
Dr W.S. Tucker
NOMINATING COMMITTEE
Mandate: Prepares a slate of nominations of such number of members
as are required to fill vacancies in the Council at the
next annual meeting of members.
Dr W.D.S. Thomas, chair
Dr G.A. Crawford
Dr B.J. Kane
Dr John Gray
Dr Guy Lemay
Mrs Margaret Ross
Dr L. Passerini
Dr B.W. Winston
Dr C.A. Critchley
RESEARCH AND EDUCATION COMMITTEE
Mandate: Reduces, through research and education, members'
risk of exposure to medico-legal problems and decreases the burden
experienced by members facing medico-legal difficulties.
Dr D.B. Peddle, chair
Dr Jacques Beauchamp
Dr C.A. Johnson
Dr N.L. Naylor
TORT REFORM WORKING GROUP
Mandate: Manages the CMPA's tort reform initiative, including the
activities of four sub-groups: legal policy advisory, legislative drafting,
economics/actuarial and education.
Dr M.R. Lawrence, chair
Dr Paul Guertin
Dr John Gray
Dr V.M. Senikas
Dr E.J. Wright
Dr G.E. Yee
Dr Guy Lemay
Mrs Françoise Parent
Mrs Margaret Ross
34

CMPA leadership
SENIOR MANAGEMENT
Secretary-treasurer/CEO
Associate Secretary-treasurer
Director of Administration
Director of Case Management
Director of Communications
Director of Finance
Director of Information Technology
Director of Membership Services
Director of Research and Education
Administrative Assistant Secretary-treasurers
Assistant Secretary-treasurers
Executive Assistant
John E. Gray, MD, CCFP, FCFP
Guy Lemay, BA, MD
Jean E. Vanderzon, CA, MBA
Chris J. Parsons, MD, FRCSC
Françoise Parent
Stephen Campbell, CA
David From
Pierrette Downey
William J. Beilby, MD, MCFP(EM)
E. Douglas Bell, MD, FRCSC
James R. Sproule, MD, CM, CCFP(EM)
Pierre Doucet, MD, FCCP (Acting)
Michael J. Hardie, MB, ChB, FRCPC (Acting)
Patrick J. Ceresia, MD
Anne M.J. Cornet, MD, FRCPC
Ruth A. Cottrill, MB, ChB
Louise Dion, MD, FRCSC
Allan R.E. Eix, BSc, MD
Martine L. Gagnon, MD, FRCSC
Indu B. Gambhir, MB, BS
Jacques Guilbert, MD, MSc, FRCSC
Thomas C. Heckman, MD
Wayne L. Helmer, MD
Margot Morrison-Morissette, MD, FRCPC
Robert N. Rivington, MD, FRCPC
Angela D. Sirnick, MD, FRCPC
R. James Williamson, MD, CCFP
Philip G. Winkelaar, MD, CCFP
Beverley Allen
35

What to do
WHAT TO DO
WHAT TO DO WHEN YOU NEED HELP FROM THE CMPA
To be eligible to receive assistance, a physician must have been a member of the CMPA at the time when the professional
work complained about was done.
If you are faced with a serious complaint or a threat of a lawsuit:
• Notify the CMPA at once.
• Wait for advice from the CMPA before taking any further steps.
• Be sure your clinical records are secure. Do not alter or change them in any way.
• Do not consult a lawyer without instructions from the CMPA. The Association does not accept responsibility for the
payment of legal expenses incurred without our prior approval.
• Seek advice from the CMPA before answering letters of complaint from patients, lawyers or others.
When you consult with a CMPA physician, discuss the facts of the case; in addition, be sure to talk about how to best
meet your emotional needs.
JOIN THE CANADIAN MEDICAL PROTECTIVE ASSOCIATION BEFORE PROVIDING ANY PATIENT CARE.
36