Wait Times A Medical Liability Perspective - The Canadian ...

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MANAGING WAIT TIMES —PROGRESS TO DATEAnumber of health care organizationsand blue ribbon groups haveconsidered the current wait-times situationand many have offered recommendationsfor reducing wait times. When viewedindividually, the majority of theserecommendations are generally very soundand, if implemented, would make a usefulcontribution to reducing wait times.However, when viewed in toto, theyhighlight the enormity of the challengefacing the health-care system.In his final report 3 released in June 2006,Dr. Brian Postl, the federal government’sWait Time Advisor, notes the wait-timeinitiative should be viewed as a long-termeffort. His report urges immediate action inthe following areas:• Ongoing research to supportbenchmarking and operationalimprovements;The British Columbia Medical Association’sCouncil on Health Economics andPolicy report on wait times 4 makes29 recommendations based on existingevidence and research, under five categories:• Building capacity;• Establishing wait time benchmarks for alldiagnostic, therapeutic and surgicalservices;• Developing and implementing wait listmanagement tools;• Improving accountability; and• Funding.For its part, the College of Family Physiciansof Canada has also released a report 5highlighting the significance of the shortageof family physicians as a factor in restrictingtimely access to care.• Adoption of management practices andinnovations in health systems;6• Accelerated implementation ofinformation technology solutions;• Cultural change amongst healthprofessions;• Development of regional surge capacity;and• Public education to support systemtransformation.3Final Report of the Federal Advisor on Wait Times is available at www.hc-sc.gc.ca4Waiting Too Long: Reducing and Better Managing Wait Times in BC is available at www.bcma.org5When the Clock Starts Ticking is available at www.cfpc.ca
ACCOUNTABILITY AND LIABILITYThe concepts of accountability andliability are fundamental both toreducing wait times and to addressingissues that result from an inability toachieve benchmarks and/or careguarantees. Governments, health-careauthorities, hospitals and health-careproviders all have some accountability forproviding health-care services, but thisaccountability needs to be defined in a waythat is practical for all involved.Physician’s duty of careThe accountability and liability issues facingphysicians as a result of health-care waittimes flow from physicians’ duty of care totheir patients. In law, physicians owe a dutyof care to their patients and they may beheld accountable and liable for damagessuffered by their patients as a result of afailure to fulfill their duty of care. This dutyrequires the physician to exercise care in allthat is done to and for the patient, includingattendance, diagnosis, referral, treatmentand instructions. This duty of care is guidedby the following considerations:• A duty of care arises if there is a doctorpatientrelationship.• A doctor-patient relationship may becreated when the patient is assigned to aphysician for treatment, where thephysician is contacted or consulted abouta patient, or possibly when a patient isplaced on a physician’s waiting list.• The scope of the duty of care is unique toeach circumstance and depends on theextent of the physician’s contact withthe patient.Physician accountabilityWithin their particular scope of practice,physicians have a responsibility to directtheir patients’ care. It is generally thephysician who determines whichinvestigations are to be recommended,which prescriptions should be provided andwhich medical and surgical interventions areproposed. Notwithstanding this importantrole in care delivery, physicians do notultimately make many of the decisions thatimpact on service accessibility. Suchdecisions are often made by health-careauthorities and institutions who managephysicians’, and consequently patients’,access to resources.Effective accountability requires those beingheld accountable to have the necessarypowers to effectively carry out their duties.Individuals should therefore be heldaccountable if they have not followedprocedures prescribed to govern theirprofession or to access the resourcesnecessary to enable them to deliver upontheir accountabilities.For this approach to be viable, suchprocedures must be in place and beunderstood and accepted by all involved.The CMPA is concerned that, in manyinstances, workable procedures do not exist.In such a circumstance, physicians riskbeing faced with the need to deliver care topatients without having timely access tothe resources necessary to meet theirtreatment obligations.In a world in which timely access to care isnot a problem, managing the queue ofpatients waiting for care would be astraightforward issue. This is often not thecase. Regardless of the length of the queue,physicians remain responsible to placepatients in the queue and to adjust queuepositioning based on changing clinicalpriorities. The need to ensure queuemanagement remains adaptable to changingclinical needs can not be overstated. Thisrequires an ongoing monitoring ofpatients to ensure their clinical needsremain paramount.
Page 1: WAIT TIMESA MEDICAL LIABILITYPERSPE
Page 4 and 5: BACKGROUND4As a starting point, it
Page 8 and 9: 8Individual and collectiveresponsib
Page 10 and 11: 10worst possible situation in which
Page 12 and 13: 12• Implement reliable wait-time
Page 14 and 15: CONCLUSIONS14All Canadians recogniz
Page 16: Mailing Address: P.O. Box 8225, Sta

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