The article “Assessing Adverse Outcomes and Learning Needs in Canadian Psychiatric Independent Medical Examinations” published in The Journal of the American Academy of Psychiatry and the Law delves into the critical evaluation of adverse outcomes and learning necessities within the realm of Canadian psychiatric independent medical examinations (IMEs). IMEs serve as pivotal components in legal and clinical settings, influencing important decisions concerning disability claims, legal disputes, and treatment plans. Through an analysis of Canadian IMEs, the authors shed light on prevalent adverse outcomes, including inaccurate diagnoses, insufficient documentation, and biased reporting, which can significantly impact the outcomes of legal proceedings and patient care.

Link to Full Article

The study underscores the importance of recognizing and addressing adverse outcomes to enhance the integrity and effectiveness of IMEs. Moreover, it emphasizes the imperative for ongoing education and training for psychiatrists engaging in IMEs to ensure competency and adherence to ethical standards. By identifying common pitfalls and learning needs, this research aims to facilitate improvements in the quality and reliability of psychiatric IMEs in Canada, ultimately promoting fair and equitable outcomes for individuals involved in legal and clinical proceedings.

Understanding and mitigating adverse outcomes in IMEs are crucial for upholding the medical profession’s ethical principles, safeguarding patient rights, and promoting the delivery of accurate and comprehensive psychiatric assessments. Through continued research, education, and collaboration, health care professionals can contribute to the advancement of best practices in conducting Independent Medical Evaluations, thereby enhancing the credibility and trustworthiness of expert opinion within the Canadian legal and healthcare systems.

Originally Published in the National Library of Medicine – J Am Acad Psychiatry Law 2024 Mar 11;52(1):33-40. doi: 10.29158/JAAPL.230116-23.

Brad D Booth ¹, Jeffrey C Waldman ², Jacqueline H Fortier ², Gary Garber ², Katie Hardy ², Karen Lemay ², Richard Liu ², Todd M Tomita ², Lisa A L Ramshaw ²

Integra is pleased to announce Bob LaBreceque has joined our team as Director of Business Development for Ontario.

Bob has decades of experience in the medical legal arena, both as a clinician working as a Case Manager and Employment Counselor as well as a Business Development Director with a variety of rehabilitation and related providers throughout Ontario.

Bob has worked providing case management services for seriously injured individuals, coordinated medical and rehabilitation services for individuals, and built relationships across the medical legal space for almost four decades.

Bob’s knowledge of the Ontario SABS, his large network of lawyers and healthcare professionals, and his vast experience as a case manager and as foster parent will serve him well in his new role.

Please join our team in welcoming Bob to the Integra Team. Bob can be reached at 519-890-9763 or bob@integraconnects.com

On behalf of the entire Integra team,

Erica Enstrom
Founder & President

We are thrilled and proud to officially announce and share the BIG NEWS that our very own Alexandra Biesok on her promotion to Director of Business Development! (BC, Alberta & Atlantic region – effective as of August 1st, 2023)

Alexa started with Integra part-time in February of 2022 in the role of Manager of Customer Success, and moved to this role full time in January of this year. 

Throughout her tenure, Alexa has had a positive impact on the entire business, not only from a growth and client relationships perspective, but equally important to our team’s core values, energy and culture.

Alexa, we are all looking forward to your continued contributions, growth and positive impact on Integra, our partners and our clients. Please join myself and our entire team in congratulating Alexa on her well deserved promotion!

On behalf of the entire Integra team,

Erica Enstrom
Founder & President

Integra and University Network Assessors Announce Merger 

February 1, 2023 | Vancouver, BC  

Independent medical evaluation and professional consulting services firm Integra Medical Consulting (doing business as Integra) is pleased to announce that it has merged with University Network Assessors (UNA), a Toronto-based medical assessment firm.   

Integra and its ownership team have long been a major player across Canada in the medical assessment space, and the newly merged firm will continue operating under the Integra brand. Leadership from both Integra and UNA will remain closely involved in the company, and clients will experience a smooth transition. Integra founder and managing director Erica Enstrom and UNA’s founder and managing director Dr. Richard Goldford will remain in place as President and Vice President Clinical Services, respectively, at Integra.  

As Erica Enstrom from Integra notes, “Dr. Goldford and I have known each other for over a decade and respect each other’s knowledge and expertise, work ethic and personal accountability. I have no doubt that the combined efforts of our groups will bring a strength to the Integra brand that will be unmatched in the Independent Medical Evaluation marketplace. We look forward to striving for continued transparency, integrity and responsibility in our space.”  

Integra is known not only for their loyalty, integrity, and their client-centric approach to medical assessments, but they are also lauded by the medical professionals with whom they work for their ability to seamlessly handle all the administrative duties associated with assessments. With two physicians as co-founders, UNA shares this commitment to ensuring medical professionals focus primarily on being excellent clinicians, resulting in thorough and well-executed assessments.   

Dr. Goldford of UNA points out, “As founders of University Network Assessors, we have a longstanding professional relationship with Erica. The merging of the two companies is a natural evolution that will allow us to leverage Integra’s operational expertise with our roster of renowned university, research-based experts to provide authoritative opinions on matters of impairment and disability across Ontario and Atlantic Canada.”  

This merger will allow Integra and UNA respectively to further expand their reach into Ontario and Atlantic Canada, offering medical consulting services and assessments to legal professionals, insurance adjusters, employers, and unions. It will also increase the breadth of service offerings available to existing clientele from both companies.   

About Integra  

Integra guides and connects health, insurance, HR, and legal professionals to achieve positive, and evidence-informed outcomes that move people forward. With over 20 years of medical, legal, and assessment industry knowledge and experience, Integra brings integrity, insight, and respect to every aspect of their work and relationships with clients, partners, and employees.  

About University Network Assessors  

University Network Assessors is a medical assessment firm with a strong medical footing. Located in the hospital corridor of downtown Toronto, UNA is at the epicenter of medical innovation and research. Their roster of assessors is vetted for their strong practical experiences and involvement in researched-based, academic medicine. UNA is committed to excellence in coordination of independent medical exams for clients, experts and claimants.  

How do you know if you need an employee assessment? 1 in 4 of your employees will experience a health event (i.e. an injury or illness) that potentially can take them out of the workplace.  This is not only disruptive to your business but there is real and significant harm that can happen to your employee due to long term worklessness.  When faced with an employee’s medical issue it can be challenging for employers to find the support they need or even know what to do to support their employees in the best way they can.  Despite wanting to be sensitive and accommodating to the needs of their employees, many employers can find it difficult to know exactly what is required of them in certain circumstances. If an employee requires a fitness to work or medical assessment, or they have requested a work from home accommodation for health reasons, many employers are unsure how to proceed.

At Integra, we deal with these challenges every day and often see the same types of challenges across employers and industries.  However, for an employer, the process can be unfamiliar, complicated, and the outcome uncertain which makes finding the right solution hard to determine.  We are here to help!

Integra offers free consultations to employers who are facing these challenges. To get the most out of a consultation, here are some simple steps to get started on the path to a good outcome. 

Step 1: Outline the general situation and the reason an employee might need an assessment in the first place.

– Tell us a little bit about the situation.  We don’t need to know every detail, but a brief summary is helpful.

– Why are you requesting an assessment? What information are you looking to gather?  What is the outcome are you seeking?

Step 2: Collect some details about the employee and their role.

a. What is the employee’s occupation? 

b. Do you have a job description or job demands analysis for their position?

c. Is the job safety critical or safety sensitive? (For example, if a mistake is made, is there risk to the employee or to others?)

d. Is there any other type of risk to the employer or employee?

e. Is the employee aware of the referral and prepared to provide consent to participate? (See Tips on how to gain participation from your employee.)

f. Where is the employee located?

Step 3:  Be clear on what your expectations are of Integra and the Medical Assessor. 

– Do you want Integra to secure copies of the employee’s medical file from the family physician as part of the assessment/review process?

– Will you receive a fitness to work report (limited information focused on functional restrictions and limitations) or a full medical disclosure report (typically sent only to healthcare professionals on an HR team.)

Step 4: Contact Erica or Alexa at Integra. 

We will help you determine if and what type of an assessment is appropriate or necessary. If an assessment is appropriate and/or necessary, Integra will handle all the details, including making sure the paperwork is completed and ends up where it needs to go.

Struggling with an Accommodation request for Work from Home?

Employers can sometimes be faced with a request for an accommodation for working from home.  If you are unsure of how to proceed when an employee requests a temporary or permanent work from home accommodation for medical reasons, the first step is to get in touch with the employee’s treating doctor.

The treating doctor is the usually the best person to start with to help understand the accommodation request. 

Here is a sample letter to send to the treating doctor that can be tailored to your needs. 

Dear. Dr. XXX

As (EMPLOYEE’S) long-standing employer, (EMPLOYER) has temporarily accommodated (EMPLOYEE) in a work from home capacity for the past (DURATION).  We have received x medical notes from your office in the past 12 months.  

1. Is there any medical risk of harm or safety concern that would prevent your patient, (EMPLOYEE) from returning to their workplace/environment?

Yes ___________          No _____________

If yes, please explain.

2. Are there any specific activities or environmental issues that present a risk of harm or safety concern if (EMPLOYEE) that would prevent them from returning to the workplace.  What we are asking is whether there are any restriction — a restriction is an activity that, if engaged in by the worker, will cause harm to the worker or to another person in the workplace.

Yes ___________          No ___________

If yes, please explain:

If yes, to the best of your ability would you consider these restrictions temporary or permanent? If temporary, what is the timeline?

3. Has the employee undertaken appropriate treatments for his health conditions?  A yes or no response suffices:

a. Physical?

b. Mental?

4. We have the following COVID precautions in place. Are these sufficient to allow for any COVID risk related accommodations to be unnecessary? 

a. (LIST YOUR POLICIES)

b. (LIST YOUR POLICIES)

c. (LIST YOUR POLICIES)

d. (LIST YOUR POLICIES)

e. (LIST YOUR POLICIES)

5. Do you recommend any other COVID precautions to permit the employee to safely return to the workplace?

6. Is there any other information not identified above that you believe we ought to know to help facilitate a safe return to the workplace for this employee?

Returning your employees back to work can be challenging and often complex.  These steps and starting parts are to help you get on the path to a good outcome.  If you find yourself stuck or not sure what to do next, we are here to help.  Call us and Integra staff will work with you to help you decide the path forward.  If that path is an assessment, Integra will help you find the best medical professional to meet your, and your employee’s, needs.

Let us know if you need help securing copies of employee medical files from their family physician as part of the assessment review process.

We have over 25 years of knowledge, experience, and insight,  and Integra is ready to provide objective advice, assessment, and support to facilitate the best outcome for all stakeholders.

Call us at 604.259.3141, we’d love to help you find a clear path forward.

When Integra founder Erica Enstrom was approached by The Forum, a Canadian charity that empowers women entrepreneurs across Canada, to participate in their mentorship program, she was eager for the opportunity to give back to the community.

The Scotiabank Women Initiative Mentor Program partners with The Forum to provide opportunities for women entrepreneurs to connect with experienced business leaders through 1:1 mentorship. For over 20 years The Forum has been pairing both early-stage and established women entrepreneurs with mentors who understand their businesses, and now the Scotiabank Women Initiative will extend this offering to program participants at no cost.

After viewing her profile on LinkedIn, representatives from The Forum thought Erica would be an excellent mentor. Integra is driven by its values, including embracing opportunities and creating equality for women, so Erica knew getting involved with the mentorship program was a great fit. Giving back to her community has always been a priority of Erica’s, especially when it comes to supporting and promoting fellow women entrepreneurs. She felt that her business experiences, her successes and failures, and her unique set of skills at the confluence of medicine, law, and business might fill a niche, and The Forum agreed.

The mentorship program pairs mentors and mentees for a 12-month period, over the course of which mentees receive support and guidance from an established and experienced business owner. Mentors provide feedback, actionable next steps, and encouragement as their mentees work toward and achieve their goals. The program offers mentees:

• Personalized support and guidance from a mentor who understands the mentee’s industry and needs.
• Virtual planning and time-efficient resources to succeed, including suggested agendas, feedback forms, and more.
• Accountability and motivation, with goal setting and progress tracking.

The Scotiabank Women Initiative Mentor Program makes it easy for mentees to manage their time while providing them with the necessary guidance to grow.

While the mentorship program focuses on benefits to the mentee, Erica found that as a mentor, she also receives a lot of value from the relationship. Erica’s mentee was seeking guidance related to Erica’s business resources, knowledge, and experience, but as a published author and podcaster, the mentee was highly accomplished  in her own right. The mentee’s different set of resources, knowledge, and experiences were things Erica deeply respected and valued. Erica quickly realized that the mentoring process would be meaningful and beneficial to them both.

In addition to the chance to learn from her mentee, Erica values the related opportunity for contemplation and reflection. She looks forward to the biweekly sessions, which force her to slow down and get into ‘listening mode’. As a busy entrepreneur, Erica’s default mode is action – thinking and moving quickly – so this is a practice she really appreciates.

It’s not surprising, then, that Erica heartily recommends the program to other entrepreneurs, citing not only the need for more female business mentors, but also her desire to have had a mentor herself when she was starting out.

“I really wish I had a female mentor in my early career,” Erica explains.  “I had one leader I really looked up to, and then quite a few peers, colleagues, and direct reports that I learned a lot from.  But I wish I had someone to bounce things off of, someone who was unattached to my personal success.  I think that’s what comes with being a mentor: you have a level of detachment that helps create objectivity in your guidance.”

To learn more about the Scotiabank Women Initiative Mentor Program and to get involved as a mentor or a mentee, visit their website here.

To see the difference working with a company that lives their values, contact Integra today.

A message from co-owner and founder, Erica Enstrom:

I can’t believe it’s been five years since Integra was born. It has been an exciting, fruitful, challenging, life-changing experience. I can’t say enough about being a business owner.

As my colleagues, some of you as clients, as stakeholders, as friends, as employees to Integra. Thank you from the bottom of my heart for the support you’ve shown us over the last five years. It hasn’t been without its challenges, but I wouldn’t change anything. I’ve grown immensely as a leader, as a parent and as a colleague, and I’ve thoroughly enjoyed all of it.

What I’ve loved most, which has come alive in the last five years since the pandemic, is the presence of remote work. Now that this is more accepted, we are free to actively treat adults like adults, performance for the sake of performance. We can focus on quality and quantity and balance the needs of the business with the needs of the human. We can bring our whole selves to work.

I’ve really loved the autonomy of focusing on building a fantastic culture that puts people over profits. It’s been really empowering to be a business owner during this time. Erica five years ago would never have contemplated working remotely for a four-week stint, and yet here I am enjoying my son’s adventures in a way that only I can.

And so, COVID has changed us. Some of the things that have come to fruition during the last five years has allowed us to drop any pretense. Now I can confidently say “Hey, guess what guys? I hate getting dressed up. I don’t like the conferences. I’m not really an extrovert. I like wearing in yoga pants to work.” How fantastic is that?

To our employees past and present and future:

Thank you for your contributions. I’m grateful to know you, to care about you, to get to share life with you. We have some great times. We’re a growing organization, and I hope that you take lots of lessons away from your time at Integra.

To our clients and healthcare professionals:

The trust you put in us, the confidence in our abilities to deliver, the graciousness with which you deal with our mistakes, and just your candor and your feedback, this has helped us grow. We have so much appreciation for your support. We wouldn’t be where we are without you.

Happy 5th Birthday, Integra!

On August 10, 2020 Section 12 of the Evidence Act was revised to restrict the number of expert reports that may be tendered in what is defined in the Act as a “vehicle injury proceeding”.  Specifically, Section 12.1(2)(a) restricts expert evidence on the issue of vehicle injury damages to no more than 3 experts and no more than one report from each of those experts.  Section 12.1(5) gives the court authority, upon application by any party, to allow additional expert reports to be tendered, and/or more than one report from a single expert, provided the conditions of Section 12.1(6) are met; the subject matter of the additional evidence is not already addressed by another expert; or, “without the additional expert evidence, the party making the application would suffer prejudice disproportionate to the benefit of not increasing the complexity and cost of the proceeding.”

The full text of this Decision can be found here

The full Oral Ruling of this Application by Mr. Justice Kirchner, April 26, 2021, can be found here

Written by Stella Gowans, Paralegal

The Reasons for Judgment of The Mr. Honourable Justice G. E. Taylor were given June 13, 2019 at Hamilton, Ontario.

On June 7, 2012 at approximately 1:30 a.m., PJ was operating a motor vehicle approaching a T intersection in the community of Fonthill, in the Town of Pelham. The plaintiff, WH was the front seat passenger in the vehicle and was not wearing a seatbelt. P was driving at 80 kilometers an hour when the posted speed limit was 50 kilometers an hour. P failed to observe the stop sign at the intersection. The vehicle left the roadway, hit a tree, rotated 180 degrees and came to rest facing west on the front lawn of a residence. W suffered serious injuries including comminuted, depressed skull fracture, subarachnoid hemorrhage, subdural hemorrhage, intraparenchymal hemorrhage and diffuse axonal injury.

On the evening of June 6, 2012, P and W with four other friends and acquaintances attended the All Star Tap and Grill House in Fonthill to watch a Stanley Cup finals hockey game and take advantage of a “12 for 12 special” – that is 12 cups of beer for $12.00. The group ordered and consumed 4 trays of beer. It was determined that P drank more than an equal share of the 48 glasses of beer that were served. At approximately 1:00 a.m. P drove the group home, after which he, W and their friend G went out to buy cigarettes. On the way home G and W encouraged P to drive faster, which he did.

P was found 80% at fault for the accident and the All Star Tap and Grill House was found 20% liable as they failed to fulfil their obligations, pursuant to Smart Serve, to engage in behaviour designed to keep their patrons safe. W was found contributorily negligent for failing to wear a seatbelt, riding in a vehicle when he knew the driver was intoxicated and, encouraging the driver to speed. As a result his award was reduced by 25%. In that regard, the Court found that All Star breached its duty to W and the All Star is therefore 20% responsible for having overserved W.

Dr. Rosenbloom, an expert in pharmacology, testified that, at the time P left the All Star, he would have had a blood alcohol concentration between 217 and 254 milligrams of alcohol per 100 millilitres of blood. (This is referred to as a BAC of 192) “Dr. Rosenbloom said that at the BACs that he determined, there would be noticeable signs of impairment including red eyes, staggering, stumbling, slurred speech and impaired fine motor skills. He said these signs of impairment should be apparent to a trained observer.”

Dr. Flor Muniz, physical medicine and rehabilitation expert with respect to acquired brain injuries concluded that W had suffered a severe traumatic brain injury which has resulted in significant cognitive consequences. She opined that there could be deterioration of W’s condition in the future. “The aging process could be more severe and it could occur earlier. She said there could be a higher likelihood of dementia.”

Dr. Michael Rathbone, neurologist, performed a neurological examination of W. According to Dr. Rathbone “W has lost approximately one third of his brain cells and the connectors between his brain cells. This is a significant loss of brain function. He doubts that there will be any further recovery”

Conclusion – Non-pecuniary damages were assessed at $300,000.00; Past income loss – $356,627.00; Future income loss – $1,741,863.00; Cost of future care – $9,055,000.00. A management fee of 2% is allowed. W’s parents were awarded $175,000.00 each and W’s siblings were awarded $25,000.00 each for their claims under the Family Law Act.

The full text of this Decision can be found here

For further analysis and reporting of the decision please download the linked PDF

If you would like to book an assessment with Dr. David Rosenbloom, Pharmacology, Dr. Michel Rathbone, Neurology or Dr. Flor Muniz Rodriguez, Physiatry, please contact us at Integra

Written by Stella Gowans, Paralegal