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. 2024 Jan 16;8(4):319-327.
doi: 10.3138/jammi-2023-0022. eCollection 2024 Jan.

Medico-legal risk of infectious disease physicians in Canada: A retrospective review

Karen Pacheco  1 , Jun Ji  1 , Kate Barbosa  1 , Karen Lemay  1 , Jacqueline H Fortier  1 , Gary E Garber  1   2   3
Affiliations

Medico-legal risk of infectious disease physicians in Canada: A retrospective review

Karen Pacheco et al. J Assoc Med Microbiol Infect Dis Can. .

Abstract
in English, French

Objective: There is little known about the medico-legal risk for infectious disease specialists in Canada. The objective of this study was to identify the causes of these medico-legal risks with the goal of improving patient safety and outcomes.

Methods: A 10-year retrospective analysis of Canadian Medical Protective Association (CMPA) closed medico-legal cases from 2012 to 2021 was performed. Peer expert criticism was used to identify factors that contributed to the medico-legal cases at the provider, team, or system level, and were contrasted with the patient complaint.

Results: During the study period there were 571 infectious disease physician members of the CMPA. There were 96 patient medico-legal cases: 45 College complaints, 40 civil legal matters, and 11 hospital complaints. Ten cases were associated with severe patient harm or death. Patients were most likely to complain about perceived deficient assessments (54%), diagnostic errors (53%), inadequate monitoring or follow-up (20%), and unprofessional manner (20%). In contrast, peer experts were most critical of the areas of diagnostic assessment (20%), deficient assessment (10%), failure to perform test/intervention (8%), and failure to refer (6%).

Conclusion: While infectious disease physicians tend to have lower medico-legal risks compared to other health care providers, these risks still do exist. This descriptive study provides insights into the types of cases, presenting conditions, and patient allegations associated with their practice.

Objectif: On sait peu de choses sur les risques médico-légaux auxquels sont exposés les spécialistes des maladies infectieuses au Canada. L’objectif de cette étude est de cibler les causes qui sous-tendent ces risques et, ce faisant, d’améliorer la sécurité et l’issue clinique des patients.

Méthodes: Une analyse rétrospective sur 10 ans des dossiers médico-légaux conclus par l’Association canadienne de protection médicale (ACPM) entre 2012 et 2021 a été effectuée. Des experts ont été consultés pour cerner les facteurs à l’origine des dossiers médico-légaux en question, que ce soit à l’échelle des prestataires de soins, des équipes ou du système, et ces facteurs ont été mis en parallèle avec les plaintes des patients.

Résultats: Au cours de la période de l’étude, 571 médecins membres de l’ACPM étaient spécialisés dans le traitement des maladies infectieuses. Quatre-vingt-seize dossiers médico-légaux portant sur des patients ont été recensés : 45 plaintes auprès d’un Collège, 40 poursuites au civil et 11 plaintes intrahospitalières. Un préjudice grave ou un décès a été constaté dans dix dossiers. Les motifs de plainte les plus répandus chez les patients étaient les évaluations perçues comme déficientes (54 %), les erreurs de diagnostic (53 %), une surveillance ou un suivi inadéquats (20 %) et un comportement non professionnel (20 %). En revanche, les experts consultés se sont surtout montrés critiques à l’égard des évaluations diagnostiques (20 %), des évaluations déficientes (10 %), du manquement à faire un test ou une intervention (8 %) et du manquement à orienter quelqu’un vers une ou un collègue (6 %).

Conclusion: Les risques médico-légaux des médecins spécialisés dans le traitement des maladies infectieuses sont généralement moindres que ceux d’autres professionnels de la santé. Néanmoins, ces risques existent. Cette étude descriptive jette un éclairage sur le type de dossiers associés à la pratique de ces médecins, sur les motifs de consultation et sur les allégations formulées par les patients.

Summary: Infectious disease (ID) physicians play a vital role in managing a broad spectrum of illnesses, from common infections to complex conditions, through rapid disease detection, effective treatment, preventive measures, and appropriate use of antimicrobial agents. ID doctors generally have a lower risk of complaints and lawsuits compared to other types of doctors. However, these risks do still exist and are important to consider.Our research team conducted a review of medico-legal cases over a 10-year period (2012–2021) involving ID physicians, with the goal of identifying why these problems occurred and how physicians might avoid them in the future. We examined why patients complained, what the types of diseases were, and the extent of patient harm. We also looked at which other types of doctors were most often involved in these cases.Most of the cases were either complaints made to a college (47%) or civil legal cases (42%). The rate of cases remained relatively stable over the study period. Twenty percent of complaints were linked to conditions of the bones, muscles, and connective tissue, such as osteomyelitis and septic arthritis. More than half of the patients who complained specifically mentioned concerns with the physician's assessment or a diagnostic error. In contrast, when expert physicians reviewed these cases, they only identified diagnostic errors in 20% of cases, and deficient assessments in 10% of cases.This research is important for two reasons. First, it may help to create a clearer picture of the current medico-legal landscape within the ID specialty. Second, by identifying areas of potential risk, it can guide the development of strategies to reduce these risks, thereby improving patient safety and trust in health care providers.

Keywords: Canada; infections; infectious disease physicians; malpractice; medico-legal risk.

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Conflict of interest statement

All authors were employees of the Can­adian Medical Protective Association, a not-for-profit mu­tual defense organization for physicians, at the time of this study. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Breakdown of college, civil legal, and hospital complaint cases involving infectious disease physicians, Canadian Medical Protective Association (CMPA), 2012–2021 (n = 96 cases)
Figure 2:
Figure 2:
Trend over a 10-year period of medico-legal cases involving infectious diseases and all CMPA members per 1,000 members, CMPA closed cases, 2012–2021
Figure 3:
Figure 3:
The most common allegations from patients (A) and documented criticisms from peer experts (B) in closed medico-legal cases (n = 96) involving infectious disease physicians, 2012–2021
Figure 3:
Figure 3:
The most common allegations from patients (A) and documented criticisms from peer experts (B) in closed medico-legal cases (n = 96) involving infectious disease physicians, 2012–2021
See this image and copyright information in PMC

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