The founding of the Canadian Medical Protective Association (CMPA) in 1901 was pivotal to Canadian medical malpractice law. At first, the CMPA was a small mutual defence organization that pooled membership fees to cover the costs of physicians facing malpractice litigation. In its early days, the association fiercely protected its members, framing patient-plaintiffs as "unscrupulous charlatans" and refusing to settle any case brought against its members. But by the late 1920s, it took on responsibility for paying damages awarded in lost court cases, and it began settling cases it deemed legally indefensible. (1) At the same time, the organization asked its members to report threats of malpractice litigation (before any litigation had commenced) while also keeping track of trends in successful litigation. With this information, the association was well positioned to warn doctors about interventions that put the public at risk, and that also generated a risk to the association's bottom line. An example of the CMPA's risk-management strategy was its effort from the 1940s to the 1960s to warn practitioners about the dangers of varicose vein treatments.
Varicose veins had long been treated with compression, but by the mid-20th century, aggressive interventions were on the rise. Various practitioners experimented with treatments that included "ligation" (tying off the greater saphenous vein) or "stripping"--removing the vein through incisions in the groin area or behind the knee. Some used injections, often of sodium morrhuate, to stop the flow of blood through troublesome veins.
Aggressive treatment of varicosities, however, sometimes left patients with serious injuries, and the procedures were controversial. (2) In 1948, 2 Montreal surgeons issued an early warning about these poor outcomes, complaining that it "appears to be the belief of the occasional operator that this is a simple, easily carried out procedure, free from hazard," with the result that the operation was "widely practised by inexperienced surgeons and hospital internes." (2)
In its 1948 annual report, the CMPA described a female patient who had suffered from gangrene and the amputation of her leg after a varicose vein procedure, resulting in a settlement of $7800 (about $87 000 in 2021 dollars). The association and its lawyers had debated whether to settle or fight the...