Quebec disciplinary process: a ‘traumatic’ experience

It is a memory that haunts them—a traumatic experience, as told by a few doctors and pharmacists to Profession Santé, the Canadian Healthcare Network's Quebec-based sister publication. The few who, facing disciplinary action, responded to our interview requests all asked for anonymity, an indication that medical error remains a taboo subject, and that in this environment where perfection is king, no one likes to expose their flaws in front of their colleagues. It’s proof, also, that we don't dare to speak publicly for fear of reprisals, whether a new complaint or another investigation by a trustee of the Collège des médecins du Québec (CMQ) or the l’Ordre des pharmaciens du Québec (OPQ).“I believe that my experience can help others in this world where the doctor is guilty until proven innocent and where the trustee has the incontestable truth,” said a specialist we spoke to. He said he was pursued for an administrative formality, and that the trustee was a “bully,” saying, “I couldn't believe it. I had the feeling that he wanted punishment at all costs. I tried to defend myself, but my arguments were not heard. For him, I was incompetent, I was guilty and I was going to lose my licence for six months.”A family doctor also believes that the investigator “had only one objective: to win his case. His mind was already made up. In his head, my case was settled in advance,” he said. From an ethical point of view, he believes that the action of the College trustee was “inhumane. He stretched the truth by wanting me to plead guilty to things that were not my responsibility.” Another GP said her interlocutor was condescending. “He treated me like a criminal. I got my fingers slapped like I was a child. It was not constructive when I would have wanted to learn from my mistake.”Similar for pharmacistsFor pharmacists, the story is much the same. “The trustees are righters of wrongs. . . . Their practices are very inquisitorial and very peremptory,” said one.Another said her rights were violated. “The trustee cut me off whenever I didn't go along with him. He completely ignored my explanations and ignored the context in which the error I was accused of occurred. I found it unfair and abusive,” she said. “I felt belittled, and it was so frustrating.”Harmful ignorance Such strong feelings and criticism from healthcare professions are hardly surprising given how stressful it is to be subject to one of these investigations. For lawyers who defend doctors and pharmacists accused of ethical violations, this is also due to their lack of knowledge of the disciplinary procedure. “The professionals have never dealt with a trustee. They think it's going to be OK because they're being judged by their peers. They believe that the trustee is there for them, when he is only there to protect the public,” noted lawyer Jocelyn Dubé. He said that his clients, mainly pharmacists, “often come out of this process broken.”An expert in disciplinary law, Jean-François Lehoux similarly noted that “professionals often misunderstand the role of the trustee and confuse it with that of the organization of which they are members. They think they will meet a colleague, but the trustee is not there to help them.”He added that the doctor or pharmacist is generally the last person the trustee meets. He “has already gathered the evidence and is asking questions to which he knows the answers. It doesn't have to be neutral. He must check whether he has the necessary proof to file a complaint before the disciplinary council.”Read: New program could subject Quebec docs to inspections for opioid prescriptions deemed unusual by their collegeAs a result, “the doctors have the impression of not having really been heard during the meeting with the trustee,” said Emmanuelle Poupart, of the McCarthy Tétrault law firm. “There is indeed a meeting that is held, but it is more for the sake of form because the trustee's decision has often already been made. [This] is illustrated by the fact that we are given a copy of a commitment already ready, which we ask the doctor to sign,” said Poupart, the head lawyer of the medical practice group, which represents practitioners on behalf of the Canadian Medical Protective Association.The negative perception of doctors and pharmacists is also due to the broad powers available to trustees. “They have more than any police officer and are autonomous in their mission. They are not accountable to anyone,” said lawyer Julie Chenette. “The trustee can seize all of the professional’s files without a search warrant. He can summon him two, three or four times if he wishes and the professional does not have the possibility of remaining silent. He has an obligation to collaborate and answer his questions. He is completely exposed in front of the trustee.”Blatant lack of fairnessAnother factor that does not favour of clinicians is that, “The trustee concentrates a lot of power. He is at the same time investigator, prosecutor and complainant," said Dubé. "When there is such a concentration of powers, there is a risk of abuse.” According to the lawyer, “Everything depends on the personality of the trustee. Some have a moderate approach, others have tunnel vision. They quickly form an idea and only retain the elements that confirm it. It’s then very difficult to defend yourself.”Beyond these procedural realities, the attitude and behaviour of certain CMQ and OPQ trustees towards their peers have been denounced before. These criticisms were publicly exposed within the framework of the special committee on the powers of trustees and their evaluation mechanism, created in 2019 by the Conseil interprofessionnel du Québec (CIQ).The briefs submitted by the Federation of General Practitioners of Quebec (FMOQ), the Federation of Specialist Physicians of Quebec (FMSQ), the Association of Young Doctors of Quebec (AJMQ) and the Quebec Association of Pharmacist Owners (AQPP) report “abrupt and arrogant tone;” “intimidating, accusatory, vindictive and mean-spirited language;” “baseless value judgments;” “distorted interpretation of the facts;” “humiliating remarks, disrespect, nastiness;” and “threats, bad faith, harassment, partiality, condescension, disrespect, nastiness, psychological violence.”Wind of change at the CMQ“Certain behaviours, observed too often in the past, on the part of certain members of the CMQ office have no place in (the disciplinary process) and have proven to be counterproductive with the emergence of situations of distress among our members as well as the development of a strong distrust with regard to the intentions of their trustee,” said the FMSQ. Four years after submitting its brief, the federation observed “a change of tone and a more respectful approach in the disciplinary investigation process carried out by the office of the CMQ office.” Things have “evolved favourably,” confirmed Dr. Sylvain Dion, first vice-president of the FMOQ until last December. “The approach is now more human, more constructive and less accusatory.” This development is also corroborated by the lawyers interviewed by Profession Santé, one of them noting that “clean up has happened.”Several changes have been made within the CMQ investigations department, noted the president of the College, Dr. Mauril Gaudreault. Trustees retired, new investigators were recruited, and a new trustee and director of investigations, Dr. Marie-Josée Dupuis, was appointed in 2020. The College also adopted a code of ethics and conduct as well as a policy to promote and maintain a respectful and harmonious work environment. “The assistant trustees, the investigators and all members of the staff must respect them,” said Dr. Gaudreault, adding that the members of the investigation department have also followed training on various aspects of their work, such as investigation techniques, investigation and disciplinary law.Since the appointment of Dr. Dupuis, “changes in terms of behaviour have been initiated. Clarity and courtesy are essential,” she said, adding that the culture now in place combines rigour and intellectual honesty and that she meets her team every week to standardize the philosophy of processing investigations. That said, “we are not there to please the patient or the doctor. When you have to ask questions, you ask them. This is not a pleasant moment for the doctor, I can understand that. But our goal is not to punish them, it is to protect the public.”Changes for pharmacistsOn the side of pharmacists, “the change in culture within the order does not come through to the (OPQ) trustee,” said AQPP president Benoit Morin. “Their approach is still accusatory. Pharmacists are guilty before being heard and they are not entitled to the benefit of the doubt or the benefit of good faith.” By calling on the trustees to be more humane, he indicates that as part of the ongoing reform of the professional system, “we are going to push our brief again,” submitted to the special committee of the CIQ.Former president of the OPQ and pharmacist, and now lawyer, Paul Fernet observed that at the start of his career in law, “the trustees were very inquisitive but behaved respectfully. Today, it is rarer. The disciplinary contest has become more confrontational and harsher. The fight is fiercer.” One of his colleagues, who wants to remain anonymous, finds that the OPQ trustees did not understand the message sent by the special committee of the CIQ in its final report. “They are very rigid, they lack empathy and respect.” However, Fernet sees the departure last November of Linda Chartrand, who was a union member and senior director of investigations at the OPQ for 12 years, as “a sign of a desire for change.”Her interim replacement, Josée Morin, emphasized that, “yelling, pushing the professional, trying to trap him or banging our fist on the table, that;s no longer our way of doing things. I am a pharmacist, I am a union member, but I remain a human being. If I want good collaboration [from the person under investigation], I have to respect them and show empathy."Morin understands that pharmacists prosecuted for ethics can be destabilized. When she asks them questions, it’s for a reason. “This is to corroborate the facts we have. If we don't get an adequate answer, we'll ask the question one, two, three or four times. The pharmacist may find it rough. Facing the reality of things is overwhelming,” she said, adding that it is not uncommon to see a professional cry in meetings. “It’s difficult to see a pharmacist ask for a break to regain his composure. It’s not pleasant for anyone.”From the end of February, the position of principal director of investigations and trustee of the OPQ will be occupied by pharmacist Martin Franco, who was until recently deputy head of the pharmacy department at the CIUSSS de l'Est-de-l 'Island of Montreal. His Linkedin profile mentions that he is “focused on the development of people, teams and organizations to achieve sustainable results based on high standards of quality, efficiency and safety.” His peers hope he will demonstrate this propensity in his new role.Read: Ontario patient ombudsman sees 33% surge in complaints: reportThis article was translated from its original French and was first published in our sister publication Profession Santé.

Quebec disciplinary process: a ‘traumatic’ experience

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