Skip to main content

Main menu

  • Home
  • Current Issue
  • Ahead of Print
  • Past Issues
  • Info for
    • Authors
    • Print Subscriptions
  • About
    • About the Journal
    • About the Academy
    • Editorial Board
  • Feedback
  • Alerts
  • AAPL

User menu

  • Alerts

Search

  • Advanced search
Journal of the American Academy of Psychiatry and the Law
  • AAPL
  • Alerts
Journal of the American Academy of Psychiatry and the Law

Advanced Search

  • Home
  • Current Issue
  • Ahead of Print
  • Past Issues
  • Info for
    • Authors
    • Print Subscriptions
  • About
    • About the Journal
    • About the Academy
    • Editorial Board
  • Feedback
  • Alerts
Research ArticleRegular Articles

Assessing Adverse Outcomes and Learning Needs in Canadian Psychiatric Independent Medical Examinations

Brad D. Booth, Jeffrey C. Waldman, Jacqueline H. Fortier, Gary Garber, Katie Hardy, Karen Lemay, Richard Liu, Todd M. Tomita and Lisa A. L. Ramshaw
Journal of the American Academy of Psychiatry and the Law Online March 2024, 52 (1) 33-40; DOI: https://doi.org/10.29158/JAAPL.230116-23
Brad D. Booth
Dr. Booth is an Associate Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Ottawa and Forensic Psychiatrist, Integrated Forensic Program, Royal Ottawa Health Care Group Ottawa, ON. Dr. Waldman is an Assistant Professor, Department of Psychiatry, Faculty of Medicine, University of Manitoba and Medical director, Roblin Medical Forensic Group, Winnipeg, MB. Ms. Fortier is a Medical Analyst Researcher for Safe Medical Care Research, Canadian Medical Protective Association Ottawa, ON. Dr. Garber is a Professor in the Department of Medicine and the School of Public Health and Epidemiology, University of Ottawa, Ottawa, ON, a Professor in the Department of Medicine, University of Toronto, Toronto, ON, and Director of Safe Medical Care Research, Canadian Medical Protective Association. Ms. Hardy is Chief Executive Officer, Canadian Psychiatric Association. Ms. Lemay is a Medical Analyst Researcher, Safe Medical Care Research, Canadian Medical Protective Association. Mr. Liu is a Statistical Data Analyst, Safe Medical Care Research, Canadian Medical Protective Association. Dr. Tomita is a Clinical Associate Professor, University of British Columbia, Vancouver, BC. Dr. Ramshaw is an Assistant Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Toronto and a Forensic Psychiatrist, Forensic Service, Centre for Addiction and Mental Health (CAMH), Toronto, ON.
MD, FRCPC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jeffrey C. Waldman
Dr. Booth is an Associate Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Ottawa and Forensic Psychiatrist, Integrated Forensic Program, Royal Ottawa Health Care Group Ottawa, ON. Dr. Waldman is an Assistant Professor, Department of Psychiatry, Faculty of Medicine, University of Manitoba and Medical director, Roblin Medical Forensic Group, Winnipeg, MB. Ms. Fortier is a Medical Analyst Researcher for Safe Medical Care Research, Canadian Medical Protective Association Ottawa, ON. Dr. Garber is a Professor in the Department of Medicine and the School of Public Health and Epidemiology, University of Ottawa, Ottawa, ON, a Professor in the Department of Medicine, University of Toronto, Toronto, ON, and Director of Safe Medical Care Research, Canadian Medical Protective Association. Ms. Hardy is Chief Executive Officer, Canadian Psychiatric Association. Ms. Lemay is a Medical Analyst Researcher, Safe Medical Care Research, Canadian Medical Protective Association. Mr. Liu is a Statistical Data Analyst, Safe Medical Care Research, Canadian Medical Protective Association. Dr. Tomita is a Clinical Associate Professor, University of British Columbia, Vancouver, BC. Dr. Ramshaw is an Assistant Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Toronto and a Forensic Psychiatrist, Forensic Service, Centre for Addiction and Mental Health (CAMH), Toronto, ON.
MD, FRCPC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jacqueline H. Fortier
Dr. Booth is an Associate Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Ottawa and Forensic Psychiatrist, Integrated Forensic Program, Royal Ottawa Health Care Group Ottawa, ON. Dr. Waldman is an Assistant Professor, Department of Psychiatry, Faculty of Medicine, University of Manitoba and Medical director, Roblin Medical Forensic Group, Winnipeg, MB. Ms. Fortier is a Medical Analyst Researcher for Safe Medical Care Research, Canadian Medical Protective Association Ottawa, ON. Dr. Garber is a Professor in the Department of Medicine and the School of Public Health and Epidemiology, University of Ottawa, Ottawa, ON, a Professor in the Department of Medicine, University of Toronto, Toronto, ON, and Director of Safe Medical Care Research, Canadian Medical Protective Association. Ms. Hardy is Chief Executive Officer, Canadian Psychiatric Association. Ms. Lemay is a Medical Analyst Researcher, Safe Medical Care Research, Canadian Medical Protective Association. Mr. Liu is a Statistical Data Analyst, Safe Medical Care Research, Canadian Medical Protective Association. Dr. Tomita is a Clinical Associate Professor, University of British Columbia, Vancouver, BC. Dr. Ramshaw is an Assistant Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Toronto and a Forensic Psychiatrist, Forensic Service, Centre for Addiction and Mental Health (CAMH), Toronto, ON.
MSc
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Gary Garber
Dr. Booth is an Associate Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Ottawa and Forensic Psychiatrist, Integrated Forensic Program, Royal Ottawa Health Care Group Ottawa, ON. Dr. Waldman is an Assistant Professor, Department of Psychiatry, Faculty of Medicine, University of Manitoba and Medical director, Roblin Medical Forensic Group, Winnipeg, MB. Ms. Fortier is a Medical Analyst Researcher for Safe Medical Care Research, Canadian Medical Protective Association Ottawa, ON. Dr. Garber is a Professor in the Department of Medicine and the School of Public Health and Epidemiology, University of Ottawa, Ottawa, ON, a Professor in the Department of Medicine, University of Toronto, Toronto, ON, and Director of Safe Medical Care Research, Canadian Medical Protective Association. Ms. Hardy is Chief Executive Officer, Canadian Psychiatric Association. Ms. Lemay is a Medical Analyst Researcher, Safe Medical Care Research, Canadian Medical Protective Association. Mr. Liu is a Statistical Data Analyst, Safe Medical Care Research, Canadian Medical Protective Association. Dr. Tomita is a Clinical Associate Professor, University of British Columbia, Vancouver, BC. Dr. Ramshaw is an Assistant Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Toronto and a Forensic Psychiatrist, Forensic Service, Centre for Addiction and Mental Health (CAMH), Toronto, ON.
MD, FRCPC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Katie Hardy
Dr. Booth is an Associate Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Ottawa and Forensic Psychiatrist, Integrated Forensic Program, Royal Ottawa Health Care Group Ottawa, ON. Dr. Waldman is an Assistant Professor, Department of Psychiatry, Faculty of Medicine, University of Manitoba and Medical director, Roblin Medical Forensic Group, Winnipeg, MB. Ms. Fortier is a Medical Analyst Researcher for Safe Medical Care Research, Canadian Medical Protective Association Ottawa, ON. Dr. Garber is a Professor in the Department of Medicine and the School of Public Health and Epidemiology, University of Ottawa, Ottawa, ON, a Professor in the Department of Medicine, University of Toronto, Toronto, ON, and Director of Safe Medical Care Research, Canadian Medical Protective Association. Ms. Hardy is Chief Executive Officer, Canadian Psychiatric Association. Ms. Lemay is a Medical Analyst Researcher, Safe Medical Care Research, Canadian Medical Protective Association. Mr. Liu is a Statistical Data Analyst, Safe Medical Care Research, Canadian Medical Protective Association. Dr. Tomita is a Clinical Associate Professor, University of British Columbia, Vancouver, BC. Dr. Ramshaw is an Assistant Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Toronto and a Forensic Psychiatrist, Forensic Service, Centre for Addiction and Mental Health (CAMH), Toronto, ON.
BA(Hon)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Karen Lemay
Dr. Booth is an Associate Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Ottawa and Forensic Psychiatrist, Integrated Forensic Program, Royal Ottawa Health Care Group Ottawa, ON. Dr. Waldman is an Assistant Professor, Department of Psychiatry, Faculty of Medicine, University of Manitoba and Medical director, Roblin Medical Forensic Group, Winnipeg, MB. Ms. Fortier is a Medical Analyst Researcher for Safe Medical Care Research, Canadian Medical Protective Association Ottawa, ON. Dr. Garber is a Professor in the Department of Medicine and the School of Public Health and Epidemiology, University of Ottawa, Ottawa, ON, a Professor in the Department of Medicine, University of Toronto, Toronto, ON, and Director of Safe Medical Care Research, Canadian Medical Protective Association. Ms. Hardy is Chief Executive Officer, Canadian Psychiatric Association. Ms. Lemay is a Medical Analyst Researcher, Safe Medical Care Research, Canadian Medical Protective Association. Mr. Liu is a Statistical Data Analyst, Safe Medical Care Research, Canadian Medical Protective Association. Dr. Tomita is a Clinical Associate Professor, University of British Columbia, Vancouver, BC. Dr. Ramshaw is an Assistant Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Toronto and a Forensic Psychiatrist, Forensic Service, Centre for Addiction and Mental Health (CAMH), Toronto, ON.
RN
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Richard Liu
Dr. Booth is an Associate Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Ottawa and Forensic Psychiatrist, Integrated Forensic Program, Royal Ottawa Health Care Group Ottawa, ON. Dr. Waldman is an Assistant Professor, Department of Psychiatry, Faculty of Medicine, University of Manitoba and Medical director, Roblin Medical Forensic Group, Winnipeg, MB. Ms. Fortier is a Medical Analyst Researcher for Safe Medical Care Research, Canadian Medical Protective Association Ottawa, ON. Dr. Garber is a Professor in the Department of Medicine and the School of Public Health and Epidemiology, University of Ottawa, Ottawa, ON, a Professor in the Department of Medicine, University of Toronto, Toronto, ON, and Director of Safe Medical Care Research, Canadian Medical Protective Association. Ms. Hardy is Chief Executive Officer, Canadian Psychiatric Association. Ms. Lemay is a Medical Analyst Researcher, Safe Medical Care Research, Canadian Medical Protective Association. Mr. Liu is a Statistical Data Analyst, Safe Medical Care Research, Canadian Medical Protective Association. Dr. Tomita is a Clinical Associate Professor, University of British Columbia, Vancouver, BC. Dr. Ramshaw is an Assistant Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Toronto and a Forensic Psychiatrist, Forensic Service, Centre for Addiction and Mental Health (CAMH), Toronto, ON.
MCSci
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Todd M. Tomita
Dr. Booth is an Associate Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Ottawa and Forensic Psychiatrist, Integrated Forensic Program, Royal Ottawa Health Care Group Ottawa, ON. Dr. Waldman is an Assistant Professor, Department of Psychiatry, Faculty of Medicine, University of Manitoba and Medical director, Roblin Medical Forensic Group, Winnipeg, MB. Ms. Fortier is a Medical Analyst Researcher for Safe Medical Care Research, Canadian Medical Protective Association Ottawa, ON. Dr. Garber is a Professor in the Department of Medicine and the School of Public Health and Epidemiology, University of Ottawa, Ottawa, ON, a Professor in the Department of Medicine, University of Toronto, Toronto, ON, and Director of Safe Medical Care Research, Canadian Medical Protective Association. Ms. Hardy is Chief Executive Officer, Canadian Psychiatric Association. Ms. Lemay is a Medical Analyst Researcher, Safe Medical Care Research, Canadian Medical Protective Association. Mr. Liu is a Statistical Data Analyst, Safe Medical Care Research, Canadian Medical Protective Association. Dr. Tomita is a Clinical Associate Professor, University of British Columbia, Vancouver, BC. Dr. Ramshaw is an Assistant Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Toronto and a Forensic Psychiatrist, Forensic Service, Centre for Addiction and Mental Health (CAMH), Toronto, ON.
MD, FRCPC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lisa A. L. Ramshaw
Dr. Booth is an Associate Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Ottawa and Forensic Psychiatrist, Integrated Forensic Program, Royal Ottawa Health Care Group Ottawa, ON. Dr. Waldman is an Assistant Professor, Department of Psychiatry, Faculty of Medicine, University of Manitoba and Medical director, Roblin Medical Forensic Group, Winnipeg, MB. Ms. Fortier is a Medical Analyst Researcher for Safe Medical Care Research, Canadian Medical Protective Association Ottawa, ON. Dr. Garber is a Professor in the Department of Medicine and the School of Public Health and Epidemiology, University of Ottawa, Ottawa, ON, a Professor in the Department of Medicine, University of Toronto, Toronto, ON, and Director of Safe Medical Care Research, Canadian Medical Protective Association. Ms. Hardy is Chief Executive Officer, Canadian Psychiatric Association. Ms. Lemay is a Medical Analyst Researcher, Safe Medical Care Research, Canadian Medical Protective Association. Mr. Liu is a Statistical Data Analyst, Safe Medical Care Research, Canadian Medical Protective Association. Dr. Tomita is a Clinical Associate Professor, University of British Columbia, Vancouver, BC. Dr. Ramshaw is an Assistant Professor, Division of Forensic Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Toronto and a Forensic Psychiatrist, Forensic Service, Centre for Addiction and Mental Health (CAMH), Toronto, ON.
MD, DPhil, FRCPC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Figure 1.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1.

    CMPA legal cases involving IMEs and psychiatry.

Tables

  • Figures
    • View popup
    Table 1

    IMEs Involving Psychiatry from 2016 to 2020

    Total CMPA Cases = 37,866 Total IMEs = 108
    Physician profile (75 psychiatrists involved)81% were men (61/75)
    65% were in practice >20 years (49/75)
    69% had only 1 case in data set (52/75)
    Type of legal concern88% regulatory body complaints (95/108)
    12% Civil legal action (13/108)
    Province56% Ontario (60/108)
    25% Quebec (27/108)
    19% Other (21/108)
    • View popup
    Table 2

    Peer Expert Contributing Factors and Comments on Psychiatric IME Cases (n = 43)

    Contributing FactorPeer Expert Comments
    Professionalism and conduct concerns (n = 20)Psychiatrist IME opinions were biased, not approached objectively
    Information gathered for IME not done in collaboration with other healthcare providers (e.g. staff of group home)
    Clinical decision-making (n = 13) (less than thorough clinical assessment)Failure to complete a mental status exam or include differential diagnoses
    Inappropriate reliance on information from the employer's investigative report, which had not been independently verified
    Deficient medical history (e.g. current level of physical activities) and limited details regarding clinical observations
    Procedural violations (n < 10)aNonadherence to the legislative framework and regulatory body policies governing IMEs, including required notation of physician's qualifications and experience, and a list of the documents reviewed
    Deficient documentation (n = 21)Failure to explain or document thought processes or how the conclusions were reached
    Sparse, sometimes illegible documentation, which lacked details
    Communication breakdowns with evaluees (n = 14)Consent not obtained to disclose health information to a third party
    Not alerting evaluee about diagnostic findings that would likely require further treatment (e.g., serious mental illness)
    Not ensuring communication is respectful regarding cultural sensitivity
    Not explaining the reasons for the IME and the physician’s role in the process
    Office problems (n <10)aDelay in sending a report caused ineligibility for disability benefits
    • ↵a For confidentiality purposes, exact numbers are not reported when there are fewer than 10 cases.

    • View popup
    Table 3

    IME Experience And Perceived Learning Needs among Canadian Psychiatrists (n = 306)

    Time in PracticeMean = 23.8 years (Median = 22 years)
    Have conducted an IME115/306 (39%)
     1 to 2 per year50/115 (43%)
     3 to 5 per year13/115 (11%)
     More than 5 per year52/115 (42%)
     Had adverse outcome42/115 (37%)
     Had specific training46/115 (40%)
    Had specific training55/306 (19%)
     During residency26/55 (47%)
     Post-residency47/55 (85%)
     Online course/literature39/55 (71%)
     Took courses43/55 (78%)
     Training with supervision33/55 (60%)
     Other source11/55 (20%)
     Want more training21/55 (38%)
    No specific training231/306 (80%)
     Want more training146/231 (63%)
    • View popup
    Table 4

    IME Risk Mitigation Recommendations

    Pursue ongoing professional development and training in IMEs
    Review the CAPL Canadian Guidelines for Forensic Psychiatry Assessment and Report Writing
    Complete self-assessments, and where appropriate and permitted, seek peer review of your IMEs
    Attend training at conferences and by IME organizations
    Adhere to regulatory and legislative requirements in your jurisdiction
    Consult IME resources with your regulatory body, medical organizations and the CMPA
    Only undertake IMEs for which you are qualified
    Obtain informed consent, including ensuring the evaluee understands the reasons and expectations for the IME
    Perform objective, unbiased, and thorough assessments of IME evaluees
    Use precise language to document the assessment and how an evaluee’s clinical presentation led to conclusions
PreviousNext
Back to top

In this issue

Journal of the American Academy of Psychiatry and the Law Online: 52 (1)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 52, Issue 1
1 Mar 2024
  • Table of Contents
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in recommending The Journal of the American Academy of Psychiatry and the Law site.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Assessing Adverse Outcomes and Learning Needs in Canadian Psychiatric Independent Medical Examinations
(Your Name) has forwarded a page to you from Journal of the American Academy of Psychiatry and the Law
(Your Name) thought you would like to see this page from the Journal of the American Academy of Psychiatry and the Law web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Assessing Adverse Outcomes and Learning Needs in Canadian Psychiatric Independent Medical Examinations
Brad D. Booth, Jeffrey C. Waldman, Jacqueline H. Fortier, Gary Garber, Katie Hardy, Karen Lemay, Richard Liu, Todd M. Tomita, Lisa A. L. Ramshaw
Journal of the American Academy of Psychiatry and the Law Online Mar 2024, 52 (1) 33-40; DOI: 10.29158/JAAPL.230116-23

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Assessing Adverse Outcomes and Learning Needs in Canadian Psychiatric Independent Medical Examinations
Brad D. Booth, Jeffrey C. Waldman, Jacqueline H. Fortier, Gary Garber, Katie Hardy, Karen Lemay, Richard Liu, Todd M. Tomita, Lisa A. L. Ramshaw
Journal of the American Academy of Psychiatry and the Law Online Mar 2024, 52 (1) 33-40; DOI: 10.29158/JAAPL.230116-23
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Methods
    • Results
    • Discussion
    • Conclusions
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Mental Health and Social Correlates of Reincarceration of Youths as Adults
  • Legal and Ethics Considerations in Capacity Evaluation for Medical Aid in Dying
  • Mental Health Aftercare Availability for Juvenile Justice-Involved Youth in New York City
Show more Regular Articles

Similar Articles

Keywords

  • psychiatry
  • forensic psychiatry
  • independent medical examinations
  • liability
  • Canada

Site Navigation

  • Home
  • Current Issue
  • Ahead of Print
  • Archive
  • Information for Authors
  • About the Journal
  • Editorial Board
  • Feedback
  • Alerts

Other Resources

  • Academy Website
  • AAPL Meetings
  • AAPL Annual Review Course

Reviewers

  • Peer Reviewers

Other Publications

  • AAPL Practice Guidelines
  • AAPL Newsletter
  • AAPL Ethics Guidelines
  • AAPL Amicus Briefs
  • Landmark Cases

Customer Service

  • Cookie Policy
  • Reprints and Permissions
  • Order Physical Copy

Copyright © 2025 by The American Academy of Psychiatry and the Law