The Duty to Treat and the Duty of Follow-Up

Overview

Once a diagnosis has been made and consent obtained, the physician's obligations shift to two connected duties: the (obligation de traiter) and the (obligation de suivi). The course notes describe them as communicating vessels. A treatment that is well chosen but left unsupervised can injure as surely as a treatment that was wrong from the start, and a follow-up plan is only as good as the record that supports it. This ninth note in the Medical Liability series examines what conscientious treatment requires, why the so often decides the case, how the pharmacist's intervention affects liability for a , and where the physician's duty to accompany the patient begins and ends. Throughout, the measure remains the reasonably prudent and diligent physician (médecin raisonnablement prudent et diligent) placed in the same circumstances, and the obligation remains one of means (obligation de moyens).

Learning Objectives

State the three principal characteristics of a treatment that conforms to the (règles de l'art) and explain why a physician is not required to practise at the leading edge of research.
Explain the evidentiary weight of the medical file, including the presumption that an undocumented act did not take place, and identify the entries required by regulation.
Describe the content of the duty of follow-up, including the duties to disclose results, to fix the timing of the next visit, and to explain the warning signs that call for a new consultation.

The Duty to Treat

The recurring dilemma of treatment is whether to remain conservative or to attempt something new. Quebec law resolves it with a standard rather than a rule. According to Philips-Nootens and Kouri, prudence and diligence alone do not suffice; the physician must also act in conformity with the , which implies keeping one's knowledge up to date, using the investigations and treatments that are habitually recognized and in common use, and abandoning practices that have become obsolete. The same authors add the necessary counterweight: at no time is the physician required to act at the leading edge of scientific research, nor to resort at the outset to every available examination or treatment that has not yet entered common use.

Bérard-Guillette c. Maheux illustrates the balance. The physician was blamed for not having ordered alpha-fetoprotein testing during a pregnancy, even though the patient had already given birth to a child with myelomeningocele and hydrocephalus. The physician knew the test existed but had not proposed it because it was, at the time, still experimental and therefore not in current practice. The second child was born with a neural tube defect and hydrocephalus. The Court of Appeal (Cour d'appel) exonerated the physician, holding that conduct must be evaluated against the standard conduct of good physicians of the era rather than against what would have been ideal.

Principal Characteristics of Treatment

The course identifies three characteristics that a conforming treatment must display.

Conscientious and attentive care. The physician must remain engaged with the patient's condition and reactions rather than applying a protocol mechanically.
Care consistent with the current data of science. Treatment must reflect what the profession currently recognizes, neither obsolete nor experimental, as explained above.
Care within the physician's field of competence. A physician who lacks the required competence must know how to refuse the mandate or refer the patient to a specialist. Undertaking care beyond one's competence is itself a fault, independent of how the treatment is then performed.

Each characteristic returns to the same question the court will ask: would a prudent and diligent physician placed in the same circumstances have proposed or undertaken this treatment?

Examples of Substandard Treatment

The disciplinary and civil decisions collected in the course give concrete shape to the standard. They are worth recording because they show how far conduct must depart from accepted practice before a tribunal intervenes.

Suggesting that a patient consult a clairvoyant: Leclair c. Corporation professionnelle des médecins, [1990] D.D.C.P. 174 (C.D. Méd.).
Prescribing a complete fast for a case of arthritis: Comité-médecins - 7, [1978] D.D.C.P. 310 (C.D. Méd.).
Performing a phenol facial peel without taking the necessary precautions: Bardari c. Corporation professionnelle des médecins, [1994] D.D.C.P. 270 (T.P.).
Inserting implants that lodged in the sinuses: Brunet-Anglehart c. Donohue, [1995] R.R.A. 859.
Failing to consider treatment options other than radical cystectomy and related interventions: Médecins (Ordre professionnel des) c. Morris, 2015 CanLII 23458 (QC CDCM), appeal dismissed, 2017 QCTP 44.

The last example deserves emphasis. The fault lay in failing to weigh alternatives before committing the patient to the most invasive course, a reminder that the duty to treat includes the reasoning that precedes the treatment, and that the duty to inform (obligation de renseignement) about alternatives operates alongside it.

Keeping Good Notes in the File

The course offers a blunt warning: a physician who is negligent in writing notes may well be negligent in practice. Whether or not that inference is fair in a given case, the legal consequences of poor documentation are severe and predictable.

Regulatory content. The Règlement sur les dossiers, les lieux d'exercice et la cessation d'exercice d'un médecin (RLRQ c. M-9, r. 20.3) requires the physician to enter in the medical file, among other things: the date of the consultation or of any entry, and the time in an emergency or critical situation; the medical observations gathered from the history (anamnèse) and the examination; the diagnosis and the differential diagnoses where the patient's clinical condition is imprecise; and a summary or account of any communication with the patient or a third party.

Evidentiary weight. Philips-Nootens and Kouri explain why the file is decisive in litigation. The file constitutes prima facie proof of its content, and the omission of elements that should have been included raises a presumption that they did not take place. The authors of the notes may be summoned by the party contesting their accuracy. The maxim they adopt is that memory forgets while writings remain. A physician who did examine the patient thoroughly but recorded nothing therefore starts the trial in the position of one who did not.

Two illustrations. In Succession d'El-Masri c. Bernier, 2021 QCCS 1475, an emergency physician's notes were criticized by both experts. One, the president of the Association des médecins d'urgence du Québec, acknowledged that the notes allowed a general picture but did not meet the standards: they did not specify what had been done for the heart and lungs and stated no . The other expert described the note as very brief and full of gaps, lacking the time and duration of the consultation, omitting much of what the physician said he had done, and giving little description of the patient's general condition or pain. The Superior Court (Cour supérieure) observed that a well-completed file allows more effective and coherent follow-up, all the more so when a different professional takes over, and that notes are more reliable than a professional's later recollection, particularly for emergency physicians who see many patients weekly without seeing them again. The court found fault on two levels: the physician had failed to document the file properly, and the absence of written notes left the initial questioning uncertain. Although the physician said he remembered the case well, his answers about the pain and symptoms were vague, and the palpation of pulses had not been recorded.

In Tremblay c. Maalouf, REJB 2000-20435 (C.S.), the expert reviewing the surgeon's file found no complete case history, no progress note justifying the surgical indication, uninformative post-operative notes, and an incomplete operative protocol that did not properly describe the appendix as the surgeon saw it. The diagnosis of acute appendicitis remained on the summary sheet in evident contradiction with the pathology report. The court could not see how a surgeon with such incomplete handwritten notes could recall the details of the patient's condition with precision years later. The practical lesson from the course is stark: the physician loses all credibility.

The Prescription and the Pharmacist's Intervention

Physicians have been sued over faulty prescriptions, but the pharmacist's intervention changes the analysis. The pharmacist typically knows more about medication than the physician, and the pharmacist's own professional duties create a second line of protection for the patient and, correspondingly, a second potential debtor.

Formal standards. The Règlement sur les normes relatives aux ordonnances faites par un médecin (RLRQ c. M-9, r. 25.1) provides at section 7 that an individual prescription must be legible and that the unused part of the prescription sheet must be struck through with an oblique line. These are small requirements, but a prescription that cannot be read is the first step toward a dispensing error.

Proof still required. In Hubert c. Fournier, 2008 QCCS 1584, the parents of a child who died at the age of three alleged that a specialist in pediatric cardiology and electrophysiology had prescribed an inappropriate medication, disopyramide, causing the death. They failed to persuade the court either that the physician had committed a fault or that a causal link (lien de causalité) existed between the prescription and the death. A tragic outcome does not by itself establish that the prescribing decision fell below the standard.

Distinct faults and solidarity. Jeannotte v. Couillard (1894), 3 B.R. 461, remains the reference for concurrent faults. The physician's fault was to prescribe the wrong medication, which caused the death of a child. The pharmacist's fault, characterized as negligence, was to have failed to ask for explanations about the unusual character of the prescription; that fault was treated as subsidiary to the physician's. Both were held liable. The course draws two lessons. First, courts are very reluctant to find that the pharmacist's intervening negligence breaks the causal chain back to the physician; the law does not want to let debtors escape. Second, the plaintiff may pursue several debtors, since the physician and pharmacist are bound solidarily (obligation solidaire) toward the victim. Continuity of care runs across professions.

The pharmacist alone. Sometimes only the pharmacist errs. In Larouche c. Simard, 2009 QCCS 529, affirmed 2011 QCCA 911, a woman who had just undergone a bone marrow transplant died after her medication was interrupted. Two pharmacists were ordered to pay more than $450,000 in damages for failing to advise the patient adequately that the prescription had been executed only in part, with medication placed on hold, and for failing to conduct sufficient follow-up. They had supplied only the first week's medication and had not told her that the prescription had to be repeated; after about fifteen days she stopped taking the drug and died. The case shows that the duty of follow-up, examined below for physicians, has a counterpart in pharmacy practice.

The Duty of Follow-Up

The governing principle is simple to state: the physician may not leave the patient to fend for himself or herself. The difficulty lies in defining what follow-up the patient's condition requires and when responsibility for it passes to someone else.

Content of the Obligation

Statutory and deontological sources. Section 5 of the Act respecting health services and social services (Loi sur les services de santé et les services sociaux, RLRQ c. S-4.2) gives every person the right to receive health and social services that are scientifically, humanly, and socially adequate, with continuity, and in a personalized and safe manner. Article 32 of the Code de déontologie des médecins (RLRQ c. M-9, r. 17) provides that a physician who has examined, investigated, or treated a patient is responsible for ensuring the medical follow-up required by the patient's condition following the intervention, unless the physician has made sure that another physician, another professional, or another authorized person can do so instead. The same article requires a physician who signs a collective prescription, or one for adjusting a medication or drug therapy, to ensure that it includes measures for taking charge of or following the patient where required. The Supreme Court of Canada's recognition in Marcoux c. Bouchard, 2001 CSC 50, that the physician-patient relationship is supports the same idea: the patient relies on this physician, and the reliance does not end when the intervention does.

What follow-up includes. Dufour c. Tanios Hanna, 2018 QCCS 4434, states the content of the duty in practical terms. Following the patient means ensuring medical follow-up and not abandoning the patient once treatment has been administered. It includes the duty to disclose the results of examinations, to tell the patient clearly when and how often the physician wishes to see the patient again in light of the condition and the risk of complications, and to explain the warning signs that should bring the patient back for another consultation. The standard, once again, is conduct compatible with that of a prudent and diligent practitioner in the same circumstances. In that case, the patient argued that the physician should have ensured a return within 24 to 48 hours, which would have led to further investigation and the discovery of an arterial embolism. The court held that this chain of events was hypothetical and unsupported by the evidence, and found neither fault nor causation. Yet the judgment contains a warning about documentation that connects to the previous section: the absence in the consultation note of any mention of a two-day follow-up, and the physician's felt need to add such a mention two years later, cast doubt on the reliability of his after-the-fact testimony and suggested that he might have omitted to give the instruction in this particular case.

Post-operative information. Brochu c. Camden-Bourgault, [2001] R.R.A. 295 (C.A.), confirms that the duty to inform operates both before and after an operation. In the pre-operative phase it serves free and informed consent; applied to follow-up, it requires the physician to tell the patient what to watch for so that the patient can self-monitor. The Court of Appeal also noted that a physician practising emergency medicine within an institution with high-level resources is judged by the standard of a specialized emergency physician with those resources, which is not a standard foreign to or higher than that required of any physician in the same circumstances. The difficulty on the facts was that the patient was diabetic and needed precise instructions on what to monitor, yet the only indication he received concerned the presence of pain.

Hospitals share the duty. In Duval c. Centre universitaire de santé McGill, 2022 QCCQ 201, a decision of the Small Claims Division, a healthy 33-year-old man diagnosed with Hodgkin lymphoma responded well to aggressive chemotherapy but died five days after his last treatment, not of the cancer but of diabetic ketoacidosis induced by the treatment. His blood glucose had been worrying during his final visits with nursing staff. His parents settled with the hematologist and sued the hospital for the jurisdictional limit of $15,000 for their moral injury. Relying on section 5 of the Act, the court held that the patient had the right to be adequately informed of the evolution of his condition, of the risks and consequences of his treatments, and of any accident occurring during them, together with the measures needed to counter its consequences. The hospital had failed in its primary mission of providing diagnostic services appropriate to the evolution of his condition and ensuring that his needs were assessed promptly. It should have prepared an intervention plan identifying his needs, objectives, means, and expected duration of services, and coordinated the services provided by his various caregivers. It had not done so adequately and was liable.

Unjustified absence. Fédération des médecins spécialistes du Québec c. Conseil pour la protection des malades, 2014 QCCA 459, arose from a class action on behalf of patients whose specialist appointments were cancelled because their physicians attended study days organized as a pressure tactic. The plaintiffs sued the federation rather than each physician. The federation, as a third party, had prevented the physicians from performing their contracts and was treated as complicit in that non-performance, engaging its (responsabilité civile extracontractuelle). That analysis still required a fault by the physicians. Physicians have a contractual obligation to honour the appointments they give; the duty of follow-up includes the duty not to absent oneself and leave the patient alone; participation in the study days was not mandatory. The fault was therefore an unjustified absence. The broader principle is that a physician cannot end the relationship with a patient without a justified reason.

Physical absence when needed. In C.L. c. St-Arnaud, 2011 QCCS 2360, the physician was on call, five minutes from the hospital, and was the only physician with obstetric privileges in Lac-Mégantic and apparently within 125 kilometres. Nothing prevented him from going to the hospital immediately. He chose to leave the patient to herself and never met her. The court found a breach of the duty to protect her health.

Discharge without examination. Moreau c. Fugère, [2002] R.J.Q. 404 (C.S.), shows the duty at the moment of discharge. The patient underwent a vaginal hysterectomy with repair of a cystorectocele on January 8, 1997, was discharged on January 14, and was admitted to the emergency department the next day with fecal peritonitis caused by a post-operative rectal perforation about three centimetres long. Her condition deteriorated rapidly and she died on the operating table of septic shock. No member of the hospital staff testified that the surgeon had examined her before discharge. The court held that a prudent and diligent gynecologist would not have authorized discharge without examining the patient and studying her file, characterized the conduct as a breach of the rules of the profession rather than a simple imprudence, and described the fault as inexcusable. The course also cites Legault c. Parenteau, [1988] R.J.Q. 2883 (C.S.), where discharge was given three days after surgery following a vertebral crush without a control X-ray, and Dufour c. Roy, 2019 QCCS 770.

Institutional continuity. In Collins c. Centre hospitalier de Sept-Îles, [2000] R.J.Q. 2110 (C.Q.), an overwhelmed emergency department was held not to be a valid defence. The hospital had breached its obligation of continuity of services and of follow-up of the patient until her arrival in Quebec City. A regional hospital that adopts a policy must ensure that persons requiring its services are directed as early as possible to the establishments best able to help them.

Absence without arrangements. Blitte c. Médecins (Ordre professionnel des), [1998] D.D.O.P. 321 (T.P.), is a disciplinary case that reads like a catalogue of what not to do. The physician left on vacation having installed only an answering machine announcing a return in early September. His house had just been sold and emptied, apart from a few items in the basement that included his patients' files. The answering machine stopped working before the announced return, worrying several patients, and the vacation lasted longer than usual, so that many patients had to go to hospital emergency departments where the on-call physicians, unable to access the files, encountered all sorts of problems in treating them. The course notes for comparison the former article 26 of the Code de déontologie des optométristes (RLRQ c. O-7, r. 5, since repealed), which required an optometrist absent for more than five consecutive working days to take the measures necessary to inform persons trying to reach the office of the duration of the absence.

Limits of the Obligation

The physician is not required to be at the patient's side at every moment. Three situations mark the boundary of the duty: the patient who does not cooperate, during an absence, and the end of the relationship by transfer or cessation of practice.

Lack of cooperation. A minimum of cooperation from the patient is required. Centre hospitalier de l'Université de Montréal c. Batoukaeva, 2008 QCCA 104, is the leading illustration of the limits of the duty. The patient attended the hospital for an abortion and was told to consult a physician four to six weeks after the procedure. A few days later, the pathology reports revealed that the abortion had not succeeded, and the hospital tried to reach her several times. She did not attend the follow-up she had been advised to attend and learned some weeks later that she was pregnant with twins. She also knew, from a previous experience, that a post-surgical consultation was needed. The trial court had found that the hospital's follow-up was deficient, but the Court of Appeal allowed the appeal: the duty of the physician and of the hospital is tempered by a certain cooperation on the part of the patient.

Topliceanu c. Bojanowski, 2018 QCCS 658, points in the same direction. The patient consulted a specialist and underwent tests; magnetic resonance imaging revealed a meningioma. The physician who received the result classified the file as abnormal but not dangerous and did not call the patient. The evidence on the practice of specialists was that it fell to the patient to book the appointment to review the results, and the plaintiff had not done so. The course frames the underlying idea as an economic calculation of information: the duty to communicate must be allocated in a way that a reasonable practice can sustain, and the patient who has been told to book a follow-up bears part of the burden.

The limit cuts both ways, however. In Brochu c. Camden-Bourgault, the defence argued that the patient should have reacted faster to his symptoms. The Court of Appeal rejected the argument, treating it as a double-edged sword that turned against the physician. At paragraph 46, the court held that where grave complications are possible, even if the risk is statistically small, the information given to the patient must be adequate, and it is not adequate when it does not allow a reasonable person to react appropriately. To react faster, the patient would have needed the information: he had not been told when to react, nor that the risk was amputation. A patient cannot be blamed for failing to cooperate with instructions that were never given.

Temporary Replacement and Transfer

Temporary replacement. When Dr A takes a vacation and refers patients to Dr B, Dr A's contract is suspended for the duration and Dr B becomes responsible for follow-up. This happens routinely, for instance when physicians attend medical conferences for a few days. The arrangement is only effective if three things are done: the patient is informed; the file is complete and contains all pertinent information; and Dr B has actually been informed. The replaced physician must choose someone competent for the patients and transmit the right information so that follow-up can continue without interruption. The earlier note in this series on the patient-physician relationship explains how the replacing physician's fault can engage the replaced physician's contractual liability; here the point is narrower, namely that a properly organized replacement discharges the duty of follow-up for the period of absence.

Transfer. Article 33 of the Code de déontologie des médecins provides that a physician who directs a patient to another physician must assume responsibility for that patient as long as the other physician has not taken charge. Article 35 provides that a physician who can no longer ensure the medical follow-up a patient requires must, before ceasing to do so, make sure that the patient can continue to obtain the required professional services and contribute to that as necessary. Article 36 requires a physician who ceases practice, completely or partially, to inform patients by giving reasonable advance notice.

Drolet c. Parenteau, [1991] R.J.Q. 2956 (C.S.), affirmed 1994 CanLII 5444 (QC CA), shows why a transfer must be formal. After cosmetic surgery on the eyelids, there was no transfer of the patient from the cosmetic surgeon to the patient's son-in-law, himself a physician. It is not enough to assume that a physician in the patient's entourage will look after the follow-up. Transfer means a deliberate handover, accepted by the receiving physician, with the information needed to continue care.

End of the relationship. The same principles govern retirement. A physician who leaves the profession cannot simply stop; the physician remains responsible for the patient until another physician has taken over. Read together, articles 33, 35, and 36 establish that the duty of follow-up ends by handover, not by departure.

Worked example: an unbriefed replacement

A general practitioner in a regional clinic treats a patient with a suspected deep infection of the foot. He prescribes an antibiotic, writes "return if pain worsens" on the discharge sheet, and records nothing else about the visit beyond the date and the prescription. The patient, who has told him she is diabetic, is not warned that numbness, discoloration, or fever also require immediate attention, nor that a risk of amputation exists. The physician then leaves for a ten-day conference, forwarding calls to a colleague but not sending the file. The patient's foot becomes discoloured without much pain; she waits, then presents to the emergency department, where the colleague, without the file, cannot tell what was prescribed. Amputation follows.

On the treatment side, the choice of antibiotic may well have been reasonable, and a court will not second-guess it if it corresponds to current practice. The file, however, contains almost nothing. Under the presumption discussed above, the absent entries will be treated as acts that did not occur, and the physician will struggle to establish what he examined or said, as in El-Masri and Tremblay. On the follow-up side, Brochu and Dufour c. Tanios Hanna indicate that instructions limited to pain are inadequate for a diabetic patient facing a risk of amputation, so the defence that the patient should have reacted sooner is unlikely to succeed. The replacement was organized in form but not in substance: the colleague was neither properly informed nor given the file, which is the situation the course warns against. The physician's liability would then turn on causation, that is, whether adequate instructions and a complete handover would probably have avoided the loss.

Case and Article Pointers

Bérard-Guillette c. Maheux: no fault for failing to offer a test that was still experimental; the standard is the good physician of the era, not the ideal.
Médecins (Ordre professionnel des) c. Morris, 2015 CanLII 23458 (QC CDCM), appeal dismissed 2017 QCTP 44: failure to consider alternatives to radical cystectomy.
Succession d'El-Masri c. Bernier, 2021 QCCS 1475, and Tremblay c. Maalouf, REJB 2000-20435 (C.S.): deficient notes as fault and as destroyer of credibility.
Jeannotte v. Couillard (1894), 3 B.R. 461: distinct faults of physician and pharmacist; both liable.
Larouche c. Simard, 2009 QCCS 529, affirmed 2011 QCCA 911: pharmacists liable for partial execution of a prescription and insufficient follow-up.
Hubert c. Fournier, 2008 QCCS 1584: fault and causation for an allegedly inappropriate prescription not proven.
Dufour c. Tanios Hanna, 2018 QCCS 4434: content of the duty of follow-up; hypothetical causation rejected.
Brochu c. Camden-Bourgault, [2001] R.R.A. 295 (C.A.): post-operative information; the patient cannot react to warnings never given.
Duval c. Centre universitaire de santé McGill, 2022 QCCQ 201: hospital's duty of continuity and coordination under section 5 of the Act.
Fédération des médecins spécialistes du Québec c. Conseil pour la protection des malades, 2014 QCCA 459: unjustified absence as fault.
C.L. c. St-Arnaud, 2011 QCCS 2360; Moreau c. Fugère, [2002] R.J.Q. 404 (C.S.); Collins c. Centre hospitalier de Sept-Îles, [2000] R.J.Q. 2110 (C.Q.); Blitte c. Médecins (Ordre professionnel des), [1998] D.D.O.P. 321 (T.P.): failures of follow-up.
Centre hospitalier de l'Université de Montréal c. Batoukaeva, 2008 QCCA 104, and Topliceanu c. Bojanowski, 2018 QCCS 658: the .
Drolet c. Parenteau, [1991] R.J.Q. 2956 (C.S.), affirmed 1994 CanLII 5444 (QC CA): transfer must be formal.
Arts. 32, 33, 35, and 36, Code de déontologie des médecins; s. 5, Act respecting health services and social services; s. 7, Règlement sur les normes relatives aux ordonnances faites par un médecin; Règlement sur les dossiers, les lieux d'exercice et la cessation d'exercice d'un médecin.

Practice Checklist

Treatment

Confirm that the treatment chosen was recognized and in common use at the relevant time, and that any unusual method was explained to the patient.
Verify that the physician stayed within his or her field of competence or referred the patient to a specialist.
Ask whether alternatives to the chosen treatment were considered and discussed with the patient.

Documentation

Check the file for the entries required by regulation: date and time, observations from history and examination, diagnosis and differential diagnoses, and summaries of communications.
Identify acts the physician claims to have performed that are not recorded, and anticipate the presumption that they did not occur.
Compare the diagnosis recorded on the summary sheet with the pathology or imaging reports for contradictions.

Prescription

Confirm that the prescription was legible and complied with regulatory form.
Determine whether the pharmacist questioned an unusual prescription, executed it only in part, or failed to advise the patient about repeats.
Assess whether the physician and pharmacist committed distinct faults giving rise to solidary liability.

Follow-up

Verify that the patient was told the results of examinations, when to return, and which warning signs required a new consultation.
Confirm that discharge was preceded by an examination and review of the file.
Ask whether the patient received, and could reasonably act on, the instructions before relying on a lack of cooperation.
For any absence, confirm that the patient was informed, the file was complete, and the replacing physician was actually briefed.
For any transfer or cessation of practice, confirm a formal handover accepted by the receiving physician and reasonable advance notice to patients.

Glossary

Current data of sciencedonnées actuelles de la science: The investigations and treatments generally recognized and in common use at the relevant time, as opposed to experimental or obsolete practices.
Differential diagnosisdiagnostic différentiel: The list of conditions that could explain the patient's presentation, which must be entered in the file when the clinical condition is imprecise.
Duty of follow-upobligation de suivi: The physician's obligation, after examining, investigating, or treating a patient, to ensure the medical follow-up required by the patient's condition, unless another qualified person has taken over.
Duty to treatobligation de traiter: The physician's obligation to administer care that is conscientious and attentive, consistent with the current data of medical science, and within the physician's field of competence.
Extra-contractual liabilityresponsabilité civile extracontractuelle: Liability for injury caused outside a contractual relationship.
Intuitu personae: Said of a relationship formed in consideration of the identity of the other party, so that who the physician is matters to the patient.
Medical filedossier médical: The physician's record of consultations, observations, diagnoses, and communications; it constitutes prima facie proof of its content.
Patient's duty of cooperationobligation de collaboration: The patient's corresponding obligation to follow reasonable instructions, attend scheduled follow-up, and remain reachable.
Prescriptionordonnance: A physician's written direction for medication or treatment, which must be legible and comply with regulatory standards.
Rules of the artrègles de l'art: The body of recognized professional standards against which a physician's acts are measured.
Solidary obligationobligation solidaire: An obligation under which each of several debtors may be compelled to pay the whole debt to the creditor, who may then pursue any of them.
Temporary replacementsubstitution temporaire: The arrangement by which a physician who must be absent entrusts patients to a competent colleague, suspending the original relationship for the duration of the absence.
Transfertransfert: The formal act by which a physician directs a patient to another physician and remains responsible until the other physician has taken charge.

References and Further Reading

Civil Code of Quebec: arts. 1457, 1458, 1523 and following (solidary obligations), 2803, 2849.
Act respecting health services and social services (Loi sur les services de santé et les services sociaux), RLRQ c. S-4.2, s. 5.
Code de déontologie des médecins, RLRQ c. M-9, r. 17, arts. 32, 33, 35, 36.
Règlement sur les dossiers, les lieux d'exercice et la cessation d'exercice d'un médecin, RLRQ c. M-9, r. 20.3.
Règlement sur les normes relatives aux ordonnances faites par un médecin, RLRQ c. M-9, r. 25.1, s. 7.
Code de déontologie des optométristes, RLRQ c. O-7, r. 5, former art. 26 (repealed).
Selected case law: Bérard-Guillette c. Maheux; Leclair c. Corporation professionnelle des médecins, [1990] D.D.C.P. 174 (C.D. Méd.); Comité-médecins - 7, [1978] D.D.C.P. 310 (C.D. Méd.); Bardari c. Corporation professionnelle des médecins, [1994] D.D.C.P. 270 (T.P.); Brunet-Anglehart c. Donohue, [1995] R.R.A. 859; Médecins (Ordre professionnel des) c. Morris, 2015 CanLII 23458 (QC CDCM), 2017 QCTP 44; Succession d'El-Masri c. Bernier, 2021 QCCS 1475; Tremblay c. Maalouf, REJB 2000-20435 (C.S.); Hubert c. Fournier, 2008 QCCS 1584; Jeannotte v. Couillard (1894), 3 B.R. 461; Larouche c. Simard, 2009 QCCS 529, 2011 QCCA 911; Marcoux c. Bouchard, 2001 CSC 50; Duval c. Centre universitaire de santé McGill, 2022 QCCQ 201; Fédération des médecins spécialistes du Québec c. Conseil pour la protection des malades, 2014 QCCA 459; C.L. c. St-Arnaud, 2011 QCCS 2360; Brochu c. Camden-Bourgault, [2001] R.R.A. 295 (C.A.); Collins c. Centre hospitalier de Sept-Îles, [2000] R.J.Q. 2110 (C.Q.); Blitte c. Médecins (Ordre professionnel des), [1998] D.D.O.P. 321 (T.P.); Moreau c. Fugère, [2002] R.J.Q. 404 (C.S.); Dufour c. Tanios Hanna, 2018 QCCS 4434; Legault c. Parenteau, [1988] R.J.Q. 2883 (C.S.); Dufour c. Roy, 2019 QCCS 770; Centre hospitalier de l'Université de Montréal c. Batoukaeva, 2008 QCCA 104; Topliceanu c. Bojanowski, 2018 QCCS 658; Drolet c. Parenteau, [1991] R.J.Q. 2956 (C.S.), 1994 CanLII 5444 (QC CA).
Doctrine: Suzanne Philips-Nootens and Robert P. Kouri, Les éléments de la responsabilité médicale, 5th ed., Montreal, Éditions Yvon Blais, 2021.

Disclaimer

This article is for informational purposes only and does not constitute legal advice. Quebec civil law may evolve through legislation and judicial interpretation. For advice on a specific situation, consult a qualified Quebec lawyer or notary.