Designated Medical Practitioner Handbook

Chapter 9: Incidents, Complaints and Dispute Resolution

Clearly defined and transparent complaint and dispute resolution procedures support client service initiatives, and the quality and integrity of the immigration medical program. This chapter is designed to help DMPs understand how CIC and the DMP report and manage incidents, critical comments and complaints about Canadian IME services and procedures.

9.1 Incidents Occurring During the IME Process

Hundreds of thousands of Canadian immigration medical examinations are performed each year. The vast majority of these examinations are completed without problem or difficulty. However, on rare occasions, the IME is associated with incidents or situations involving confusion, disagreement or events that can be expected to affect or compromise DMP service to clients. DMPs should report such events to the responsible regional medical office when they occur.

Events and situations that should be reported include the following:

• applicants or their representatives have become angry, threatening or violent towards the DMP or staff;
• applicants or their representatives have suggested or implied that the DMP is deliberately delaying the IME process, or requesting unnecessary or expensive investigations or follow-up for personal reason or gain;
• applicants or their representatives have refused the examination or aspects of the examination or investigation;
• the DMP or staff are aware of attempts to substitute, falsify or alter aspects of the IME, or clinical or laboratory investigations;
• the DMP or staff have been asked, induced or coerced in an attempt to overlook, ignore, modify, substitute or alter aspects of the IME, or clinical or laboratory investigations;
• applicants or their agents have threatened to complain to others about either the IME service or the process itself; and
• the DMP feels reporting may benefit the quality of the program and/or increase knowledge among other DMPs.

Reports to the RMO should include the date of the incident involved, the applicant’s file number and identification, and a brief description of the event or incident.

9.2 Complaints

Complaint Policy

Common to any client service process, complaints regarding the IME and related services may arise externally from the applicants or others outside of the Department. In addition, CIC personnel may provide critical comments or notifications of errors, problems, performance issues or situations of concern.

Both the individuals making a complaint or a critical comment regarding DMPs’ services and the DMPs themselves should be aware that their respective opinions and viewpoints will be considered by CIC’s Health Management Branch. Complaints and critical comments must be signed by individuals or their authorized representatives. Anonymous complaints and critical comments will be acted on only at the request of the Director of Operations, HMB.

Complaint/Performance Issue Resolution Process

Failure to meet performance standards may result in administrative or remedial action by the Department regarding the DMP’s appointment. The following are some examples of situations in which DMPs, their clinic, or laboratory staff would be seen as failing to meet performance standards:

• Serious behavioral activities or demonstrated misconduct
  • unprofessional or unethical conduct or activities
  • illegal activities
  • loss or suspension of medical license
  • failure to abide by fee guidelines
  • failure to apply the guidelines and instructions presented in the DMP Handbook and provided by CIC
• Persistent failure to maintain acceptable performance of DMP responsibilities as set out in the DMP Handbook or in written instructions from the RMO. This includes sustained or repeated (more than three times after initial notification) deficiencies in:
  • the timely and correct completion of immigration medical examinations (including errors, omissions or deliberate falsification in obtaining and recording the medical history and physical examination)
  • the appropriate provision of requisite laboratory and clinical investigations and interventions
  • the collection and management of medical information
  • the timely transfer of information and communication with HMB
  • Undertaking activities prohibited by the handbook (such as providing a copy of the medical exam or test results to the client)

Resolution of Simple Issues Through Explanation

In many cases, simple complaints or concerns regarding operational aspects of the IME, such as the management of case files, the need for documents or requests for additional tests, can be addressed by providing reference material or an explanation. This information may be supplied by fax or e-mail by the responsible regional medical officer.

Additional training or instruction in the performance of Canadian IMEs may be provided, depending on the circumstances. This training could be provided in person, in writing or by telephone.

Resolution of More Serious Complaints

More serious complaints about the performance or behavior of a DMP related to Canadian IMEs will require more documentation. The facts that gave rise to each issue or complaint will be summarized in a letter of inquiry sent to the DMP. The letter shall specify the nature of the performance issue or complaint, and request an explanation or information about the event from the DMP. Letters may be issued by the respective regional medical officer or Health Management Branch headquarters. DMPs should respond to such a letter within 14 days. That response may include a request for additional time to prepare a detailed response or assemble documentation.

Following receipt of the DMP’s comments, any necessary remedial or corrective measures resulting from this process will be forwarded to the DMP within 14 days of a decision being made. In order of consequence, these measures include:

• A letter of concern issued to the DMP
  • The letter will specify the particular issue(s) and suggest remedial action. The regional medical officer will follow up on this remediation and, after review, the DMP will be notified in writing of the outcome.
• A letter of suspension issued to the DMP
  • The letter will indicate that the DMP has been suspended from performing IMEs and give the date of the suspension. Depending upon the outcome of the investigation or review, the regional medical officer will inform the suspended DMP of the outcome, be it reinstatement or termination of DMP status.
  • In situations where the complaint or critical comment involves actions or performance that may be dangerous, injurious to clients, of questionable legality or otherwise damaging to CIC’s program delivery or client service reputation, immediate temporary suspension of the DMP may be authorized by the Director of Operations, HMB.
  • This suspension will be brought to the attention of the DMP in writing by the quickest means possible.
• A letter of termination regarding DMP status
  • The letter will officially notify the DMP of termination and removal from the roster, and indicate the date of the termination. The reason(s) for the termination will be explained.

9.3 Appeal Process

DMPs may appeal the issuance of a letter of concern, suspension or termination of status. Appeals or challenges must be issued in writing within 30 days of receipt of the letter and directed to:

Director of Operations
Health Management Branch, CIC
Canadian Building
219 Laurier Ave., West
Ottawa, ON K1A 1L1

DMPs shall receive a reply within 30 days of the receipt of their appeal.

 

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