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Ontario doctor to leave country after financially-devastating battle with Ontario College of Physicians

National Post

October 28, 2012

Tom Blackwell

Faced with hundreds of thousands of dollars in debt and the prospect of prolonged scrutiny by regulators, an Ontario physician says she plans to leave the country after being disciplined for charging patients fees to access her enhanced pediatric clinic.

Dr. Karen Dockrill has become something of a poster child for advocates of more free enterprise in Canadian medicine, but the physician from Whitby, Ont., said her rare prosecution by the Ontario College of Physicians and Surgeons has been a devastating ordeal personally.

Her own lawyer suggested she leave the province, warning that she would be under watch by the college for years, said Dr. Dockrill, who has already had to sell her house to cope financially.

She said she intends to relocate to nearby Buffalo, N.Y., as soon as she sells the building that housed her “Mom and Baby Depot” business — and now doubles as her home.

“I’m bruised, financially impacted, but I firmly believe that what we did was the best quality of care I’ve seen in a very long time,” said Dr. Dockrill. “Every one of us wants a really strong universal health-care system, but I believe it requires some patient responsibility, and it cannot provide everything. We can do better than what we’re doing now.”

She was found guilty earlier this year of violating college policies by requiring patients that were part of her practice to pay fees of $500 to $2,200 a year. In return they received a range of services not covered by medicare, including appointments with dieticians and breast-feeding consultants, around-the-clock telephone access and even a gymnasium, earning rave reviews from many patients. Medicare was charged for services that it covered.

Like the legal wrangling over Dr. Brian Day’s private Cambie surgery clinic in Vancouver, the case has underscored ongoing debate over the role for-profit enterprise should play in a predominantly taxpayer-funded system. Supporters say she provided the kind of entrepreneurial innovation that is desperately needed in health care; critics say such clinics improperly restrict access to crucial medical services.

Making patients pay a fee, even if it subsidized add-on services, as a precondition for seeing a government-funded doctor is a fundamental problem, said Dr. Danielle Martin of Canadian Doctors for Medicare, advocates for universal, public health care.

“She chose to go ahead and build a business model that was in flagrant violation of the ethical standards the profession has clearly set out,” said Dr. Martin, a Toronto family physician. “This is not a grey-zone example.”

Dr. Dockrill — a former head of neo-natal care at Ontario’s Lakeridge Hospital — was specifically found to have violated the college’s rules on “block fees,” annual charges doctors can ask patients to pay to cover services not covered by medicare,.

At issue was that Dr. Dockrill’s fees were not voluntary — patients had to pay the money if they wanted to be part of her primary-care pediatrics practice. She she said it was the only way to run the business, which meant keeping other health professionals on staff, and provide the enhanced services patients seemed to crave.

As the college investigated, then charged her with disciplinary offences and forced her to end the business, she drew the attention of the Alberta-based Canadian Constitution Foundation, which discussed launching a constitutional challenge of the rules.

Ultimately, though, Dr. Dockrill said she could not afford the costs of a marathon legal battle, and reached a settlement with the college this summer. Much of the expenses directly related to the disciplinary proceedings would have been covered by the Canadian Medical Protective Association, which provides liability insurance to physicians. But she said she and her husband have already gone into the red to the tune of “many hundreds of thousands” of dollars because of other legal costs and business losses stemming from the regulatory action.

Under the settlement, the College suspended her for a month and ruled she had to undergo an ethics course and submit to inspections by the regulator for at least nine months — longer if they discover problems with her block-fees practices.

Ironically, she said she actually lost money on the Mom and Baby Depot, though was hoping to turn a profit within a year or two. Now she is just seeing patients referred to her by other physicians.

The Ontario Medical Association has said it supports the college rules on block fees. But the dissident Ontario Coalition of Specialists and Family Physicians has taken up Dr. Dockrill’s cause, calling her treatment by the regulator and plans to leave Ontario a “disaster.”

“The college just wiped her off the map. I think it went too far,” said Dr. Doug Mark, president of the coalition. “They seem to be the henchman for the government, to keep an archaic, monopolized health care system going.”

Meanwhile, Dr. Dockrill said she believes there are growing numbers of physicians running the same kind of fee-based service in possible violation of the rules. Patients have recently told her about physicians who asked them to pay extra to get after-hours service or priority in booking appointments.

Read the article online here.

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