CRH Medical (CRHM) 10-K 11 Mar 20 2019 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Mar. 10, 2020	Jun. 30, 2019
Cover [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	FY
Entity Registrant Name	CRH MEDICAL CORPORATION
Entity Central Index Key	0001461119
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Entity Common Stock, Shares Outstanding		71,603,584
Entity Emerging Growth Company	true
Entity Ex Transition Period	true
Entity Small Business	true
Entity Current Reporting Status	Yes
Entity Shell Company	false
Entity File Number	001-37542
Entity Tax Identification Number	00-0000000
Entity Address Address Line One	World Trade Center
Entity Address, Address Line Two	Suite 578 – 999 Canada Place
Entity Address, City or Town	Vancouver
Entity Address, State or Province	BC
Entity Address, Country	CA
Entity Address, Postal Zip Code	V6C 3E1
City Area Code	604
Local Phone Number	633-1440
Document Annual Report	true
Document Transition Report	false
Entity Incorporation, State or Country Code	A1
Entity Interactive Data Current	Yes
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Public Float			$ 212.8
Title of each class	Common Shares, no par value
Trading Symbol	CRHM
Name of each exchange on which registered	NYSEAMER
Documents Incorporated by Reference	DOCUMENTS INCORPORATED BY REFERENCE Certain information required by Part III of this Annual Report on Form 10-K is incorporated by reference to the registrant’s definitive proxy statement related to its 2020 Annual General Meeting of Shareholders, to be filed pursuant to Regulation 14A not later than 120 days after the end of the fiscal year covered by this Annual Report on Form 10-K.

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 6,568,716	$ 9,946,945
Trade and other receivables, net	20,041,288	19,467,803
Income tax receivable	1,332,129	2,243,319
Prepaid expenses and deposits	729,483	822,119
Inventories	349,324	402,544
Total current assets	29,020,940	32,882,730
Non-current assets:
Property and equipment, net	251,933	303,291
Right of use assets	214,854
Intangible assets, net	163,108,193	179,384,263
Deferred asset acquisition costs	59,249	116,025
Deferred tax assets	10,440,100	6,301,687
Total non-current assets	174,074,329	186,105,266
Total assets	203,095,269	218,987,996
Current liabilities:
Trade and other payables	6,196,741	5,763,222
Employee benefits	992,845	827,436
Current portion of right of use asset liability	125,555
Current tax payable	28,589
Notes payable and bank indebtedness		2,239,637
Deferred consideration	1,868,052	1,043,645
Earn-out obligation	1,063,060	2,920,583
Short-term advances		26,783
Member loan	68,600	49,000
Total current liabilities	10,343,442	12,870,306
Non-current liabilities:
Deferred consideration		1,183,092
Right of use asset liability	54,300
Notes payable and bank indebtedness	68,380,345	67,621,470
Deferred tax liabilities	101,822	21,951
Total non-current liabilities	68,536,467	68,826,513
Equity
Common stock, no par value; 71,603,584 and 72,055,688 shares issued and outstanding at December 31, 2019 and 2018, respectively	56,056,113	55,372,884
Additional paid-in capital	7,168,156	9,329,335
Accumulated other comprehensive loss	(66,772)	(66,772)
Retained earnings	13,154,981	12,916,565
Total equity attributable to shareholders of the Company	76,312,478	77,552,012
Non-controlling interest	47,902,882	59,739,165
Total equity	124,215,360	137,291,177
Total liabilities and equity	$ 203,095,269	$ 218,987,996

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2019	Dec. 31, 2018
Statement Of Financial Position [Abstract]
Common stock, no par value	$ 0	$ 0
Common stock, shares issued	71,603,584	72,055,688
Common stock, shares outstanding	71,603,584	72,055,688

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Income - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Revenue:
Total revenue	$ 120,385,274	$ 112,749,380
Expenses:
Total expenses	105,703,079	92,454,250
Operating income	14,682,195	20,295,130
Finance expense	6,609,618	4,567,327
Gain from equity investment	(1,766,968)
Income before tax	9,839,545	15,727,803
Income tax expense	1,627,061	2,711,886
Net and comprehensive income	8,212,484	13,015,917
Attributable to:
Shareholders of the Company	3,771,163	4,679,921
Non-controlling interest	4,441,321	8,335,996
Net and comprehensive income	$ 8,212,484	$ 13,015,917
Earnings per share attributable to shareholders
Basic	$ 0.053	$ 0.064
Diluted	$ 0.052	$ 0.063
Weighted average shares outstanding:
Basic	71,536,310	72,582,733
Diluted	72,697,539	74,085,172
Anesthesia Services [Member]
Revenue:
Total revenue	$ 110,306,431	$ 101,790,165
Expenses:
Total expenses	94,506,039	81,079,150
Product [Member]
Revenue:
Total revenue	10,078,843	10,959,215
Expenses:
Total expenses	4,647,719	5,022,737
Corporate Expense [Member]
Expenses:
Total expenses	$ 6,549,321	$ 6,352,363

Consolidated Statements of Chan

Consolidated Statements of Changes in Equity - USD ($)	Total	Common Stock [Member]	Additional Paid-In Capital [Member]	Accumulated Other Comprehensive Loss [Member]	Retained Earnings [Member]	Non-Controlling Interest [Member]
Beginning Balance at Dec. 31, 2017	$ 131,298,045	$ 54,614,601	$ 8,219,760	$ (66,772)	$ 11,078,608	$ 57,451,848
Beginning Balance , shares at Dec. 31, 2017		73,018,588
Total net and comprehensive income (loss) for the period	13,015,917				4,679,921	8,335,996
Stock based compensation expense	2,800,750		2,800,750
Common shares issued on vesting of share units		$ 1,691,175	(1,691,175)
Common shares issued on vesting of share units, shares		364,000
Common shares repurchased in connection with normal course issuer bid and cancelled (note 12(e))	(3,743,548)	$ (925,076)			(2,818,472)
Common shares repurchased in connection with normal course issuer bid and cancelled (note 10(e)), shares		(1,254,500)
Common shares repurchased in connection with normal course issuer bid and held as treasury shares	(31,308)	$ (7,816)			(23,492)
Cancellation of treasury shares, shares		(72,400)
Distributions to members	(19,289,740)					(19,289,740)
Acquisition of non-controlling interest (note 4)	13,241,061					13,241,061
Ending Balance at Dec. 31, 2018	137,291,177	$ 55,372,884	9,329,335	(66,772)	12,916,565	59,739,165
Ending Balance , shares at Dec. 31, 2018		72,055,688
Total net and comprehensive income (loss) for the period	8,212,484				3,771,163	4,441,321
Stock based compensation expense	976,962		976,962
Common shares issued on exercise of options	$ 426,366	$ 733,165	(306,799)
Common shares issued on exercise of stock options, shares	840,000	840,000
Common shares issued on vesting of share units		$ 1,159,912	(1,159,912)
Common shares issued on vesting of share units, shares		325,875
Common shares repurchased in connection with normal course issuer bid and cancelled (note 12(e))	$ (4,742,595)	$ (1,209,848)			(3,532,747)
Common shares repurchased in connection with normal course issuer bid and cancelled (note 10(e)), shares		(1,607,579)
Cancellation of treasury shares, shares		(10,400)
Distributions to members	(15,825,600)					(15,825,600)
Purchase of equity interest from non-controlling interest	(9,348,324)		(1,671,430)			(7,676,894)
Acquisition of non-controlling interest (note 4)	7,224,890					7,224,890
Ending Balance at Dec. 31, 2019	$ 124,215,360	$ 56,056,113	$ 7,168,156	$ (66,772)	$ 13,154,981	$ 47,902,882
Ending Balance , shares at Dec. 31, 2019		71,603,584

Consolidated Statements of Ch_2

Consolidated Statements of Changes in Equity (Parenthetical)	12 Months Ended
	Dec. 31, 2018shares
Common Stock [Member]
Shares repurchased in connection with normal course issuer bid and held as treasury shares	10,400

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Operating activities:
Net income	$ 8,212,484	$ 13,015,917
Adjustments for:
Depreciation of property, equipment and intangibles	35,009,070	31,486,055
Stock-based compensation	976,962	2,800,750
Unrealized foreign exchange	8,925	(4,494)
Deferred income tax expense (recovery)	(3,440,121)	(2,407,176)
Change in fair value of contingent consideration	2,861,204	971,627
Accretion on contingent consideration and deferred consideration	133,450	166,575
Amortization of deferred financing fees	276,260	260,363
Gain on equity investment	(1,766,968)
Change in current tax receivable (payable)	939,779	(1,936,436)
Change in trade and other receivables	1,376,733	(3,981,491)
Change in prepaid expenses	132,290	171,911
Change in inventories	53,220	20,902
Change in trade and other payables	121,615	101,379
Change in employee benefits	110,654	326,681
Cash provided by operating activities	45,005,557	40,992,563
Financing activities
Proceeds from member loans	19,600	303,351
Repayment of member loans		(662,568)
Repayment of short-term advances	(26,783)
Repayment of notes payable and bank indebtedness	(82,550,000)	(14,250,000)
Proceeds on bank indebtedness	81,641,370	22,800,000
Payment of deferred financing fees	(839,892)
Payment of deferred consideration	(1,100,000)	(1,000,000)
Payment of earn-out obligation	(4,795,822)
Distributions to non-controlling interest	(15,825,600)	(19,289,740)
Proceeds from the issuance of shares relating to stock-based compensation	426,366
Repurchase of shares for cancellation	(4,742,595)	(3,774,856)
Cash used in financing activities	(27,793,356)	(15,873,813)
Investing activities
Acquisition of property and equipment	(59,508)	(35,105)
Deferred asset acquisition costs	(59,249)	(116,025)
Acquisition of equity interest from non-controlling interest	(9,924,381)
Acquisition of anesthesia services providers	(15,052,058)	(27,509,811)
Distribution received from equity investment	136,650
Purchase adjustment relating to anesthesia service providers acquired in prior periods	4,366,000
Cash used in investing activities	(20,592,546)	(27,660,941)
Effects of foreign exchange on cash and cash equivalents	2,116	2,252
Decrease in cash and cash equivalents	(3,378,229)	(2,539,939)
Cash and cash equivalents, beginning of year	9,946,945	12,486,884
Cash and cash equivalents, end of year	6,568,716	9,946,945
Supplemental disclosure of cash interest and taxes paid:
Cash interest paid	(3,055,374)	(3,180,808)
Lease payments made	(369,262)	(292,235)
Non-cash acquisition financing	(800,985)
Taxes paid	$ (4,127,443)	$ (7,055,498)

Reporting Entity

Reporting Entity	12 Months Ended
	Dec. 31, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Reporting Entity	1. CRH Medical Corporation (“CRH” or “the Company”) was incorporated on April 21, 2001 and is incorporated under the Business Corporations Act (British Columbia). The Company provides anesthesiology services to gastroenterologists in the United States through its subsidiaries and sells its patented proprietary technology for the treatment of hemorrhoids directly to physicians in the United States and Canada. CRH principally operates in the United States and is headquartered from its registered offices located at Unit 578, 999 Canada Place, Vancouver, British Columbia, Canada.

Basis of preparation

Basis of preparation	12 Months Ended
	Dec. 31, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Basis of preparation	2. Basis of preparation: (a) Basis of presentation: These consolidated financial statements have been prepared in accordance with US GAAP. ( b ) c t o n e s t t o c r e c y The s c n s o t f a c s t t m t a p e s ent l r s w i c i t p y’ presentation currency (c) U s s t at u m s The p p ti t o y’ c ns t f an c s t t nt i e n e t n s s t t ff c t p t m t s s t n t s c o s u c t en ss t t t t t f c i s t t t a t te t v e x n s e i t o t p i Reported amounts and note disclosures reflect the overall economic conditions that are most likely to occur and anticipated measures management intends to take. Actual results could differ from those estimates. ( i ) Estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting estimates are recognized in the period in which the estimates are revised and in any future periods affected. Significant areas requiring the use of management estimates relate to the assessment for impairment and useful lives of intangible assets, estimates supporting reported anesthesia revenues, the recoverability of trade receivables, the valuation of certain long term liabilities and other assets, including liabilities relating to contingent consideration, the valuation of acquired intangibles and the valuation of deferred tax assets. ( ii ) Significant judgments made by management in the process of applying accounting policies and that have the most significant effect on the amounts recognized in the consolidated financial statements includes the determination of control for the purposes of consolidation and the Company’s assessment of whether an acquisition is a business acquisition or an asset acquisition.

Significant accounting policies

Significant accounting policies	12 Months Ended
	Dec. 31, 2019
Accounting Policies [Abstract]
Significant accounting policies	3. S i i i a n i p li i The a c c o ti i c e av p i c o s i s t tl the Company and its subsidiaries (a) Ba s c ns t These consolidated financial statements include the accounts of the Company and its subsidiaries. Subsidiaries are entities controlled by the Company through voting control and for anesthesia businesses, control over the assets and business operations of the subsidiary through operating agreements. Control exists when the Company has the continuing power to govern the financial and operating polices of the investee. Subsidiaries are included in the consolidated financial results of the Company from the effective date of acquisition up to the effective date of disposition or loss of control. Minority interests, if any, are valued at fair value at inception. All significant intercompany transactions and balances have been eliminated on consolidation. (b) Cash equivalents: The Company considers all highly liquid investments with an original maturity of 90 days or less, when acquired, to be cash equivalents. (c) Fore i c r e c y Tra n s a c t n f c rr c i a t a s te t t s p c t v f c t n c u e c e t s b s i e t p x c a te t t t t s c ti s Period end balances of monetary assets and liabilities in foreign currency are translated to the respective functional currencies using period end foreign currency rates. Foreign currency gains and losses arising from settlement of foreign currency transactions are recognized in earnings. N n on t s s t t e i t f i c ur n c e t a m a s r f v u t n s te t t fu c t c u e c t x c h n t t t w ic t f v u w a d t m N - o t t m t m a s r i s t c c s f g c rr c a t an s t s n t xc g t t at t t s c t (d) I v t e s Inventories c s s s z s t c c s c c s c s inventory r s c c Net i z a l v t s t te s i c t y o n c u s o s i e ss es t s t m t c o s t c t an s n x e s e s (e) Prop e t m t, net Property and equipment are measured at cost less accumulated depreciation and accumulated impairment losses. The s t m te s f v t t d r c t o f t c u r n c p r t v o a a f w s Asset Basis Rate Computer equipment Declining balance 30% Computer software Declining balance 100% Furniture and equipment Declining balance 20% Leasehold improvements initial lease Straight-line Shorter of term or useful life Injection mold Straight-line 5 years These depreciation methods most c l s f e c t t x c te tt c n s t o t f t e c n i f t mb t a s s t E s t t fo p e c t t d s us f v a e s u v l r r v w a c o t p i - e n a s te p p t (f) Intangible as s s Intangible assets, consisting of acquired exclusive professional service agreements to provide anesthesia services and the cost of acquiring patents, are recorded at historical cost. For patents, costs also include legal costs involved in expanding the countries in which the patents are recognized to the extent expected cash flows from those countries exceed these costs over the amortization period and costs related to new patents. The amortization term for professional services agreements are based on the contractual terms of the agreements. Intangible assets with finite lives are amortized on a straight-line basis over their estimated useful lives and are measured at cost less accumulated amortization and accumulated impairment losses. Intangible assets with finite lives are amortized over the following periods: Asset Basis Rate Intellectual property rights to the CRH O’Regan System Straight-line 15 years Intellectual property new technology Straight-line 20 years Exclusive professional services agreements Straight-line 4.5 to 15 years (g) I e t No n f n c s s t s The c a y u t t C pa y n n f a c a s s t s t t i v t e a f r t s s t s a r v e e c p t t t te w h t e t r o th p s m t s t s s t g u t t e t t s l s g as s t t e te c s f w f c t n u s t a i p e c a s f ow f th as s t o g up s s t If indicators of impairment exist, an asset or asset group is impaired if its carrying amount exceeds its fair value, being the projected future discounted cash flows that are directly associated with and that are expected to arise as a direct result of the use and eventual disposition of the asset or asset group. Projected cash flows are based upon historical results adjusted to reflect management’s best estimate of future market and operating conditions which may differ from actual cash flows. Significant assumptions included in projected cash flows include anesthesia revenue growth rates, discount rates, and operating cost growth rates. (h) I c t xes The Company is subject to income taxes in Canada and the United States. Judgment is required in determining the provision for income taxes and income tax assets and liabilities, including evaluating uncertainties in the application of accounting principles and complex tax laws. The Company records a provision for income taxes for the anticipated tax consequences of the reported results of operations using the asset and liability method. Under this method, it recognizes deferred income tax assets and liabilities for the expected future tax consequences of temporary differences between the financial reporting and tax bases of assets and liabilities. Deferred tax assets and liabilities are measured using the enacted tax rates that are expected to apply to taxable income for the years in which those tax assets and liabilities are expected to be realized or settled. The Company recognizes the deferred income tax effects of a change in tax rates in the period of the enactment. The Company records a valuation allowance to reduce its deferred tax assets to the net amount that management believes is more likely than not to be realized. The Company recognizes the effect of income tax positions only if those positions are more likely than not of being sustained. Recognized income tax positions are measured at the largest amount that is greater than fifty percent likely of being realized. The Company records interest related to unrecognized tax benefits in interest expense and penalties in operating expenses. Income tax expense is comprised of current and deferred tax. (i) Shar e a s e c p n s t o The Company records share-based compensation related to equity classified stock options and share units granted using the fair value based method estimated using either the Black-Scholes model or Binomial method. The vesting components of graded vesting employee awards, with only a service vesting condition, are accounted for as separate share-based arrangements. Each vesting installment is measured separately and expensed over the related installment’s vesting period. Compensation cost is measured at fair value at the date of grant and expensed as employee benefits over the period in which employees unconditionally become entitled to the award. Forfeitures are estimated in recognizing share-based compensation, s uc t t m t t l c i z e a x e s s t b r t t r t s v c o m r k f a c c n t n t v s t t (j) Share capital: Com m s ha a c as s if a e ty I c r t c o s t e c t tt t t t i s s (k) Earnings per share: The p n e s t b s i n t a n s h t f t c o on s a e s s i c l c te iv t ne os tt b t t c m s a h e t C o t w t v g n e c s are t s t n n t p a u s t f o s e h i c D t P t i b u s t t o l s tt b ta t c mm s a h d n t g t ve m e c o s a e o t s t n ust f o s a e h i i c fo t ff c t t v t t c m s a s. Diluted EPS for year-to-date (including annual) periods is based on the weighted average of the incremental shares included in each interim period for the year-to-date period. (l) Segment reporting: The Company’s operating segments consist of the sale of medical products and the provision of anesthesia services. (m) Finance costs: Finance cost is primarily comprised of interest on the Company’s notes payable and bank indebtedness and also includes the amortization of costs incurred to obtain loan financing and any fees in respect of arranging loan financing. Deferred finance costs are amortized using the effective interest method over the term of the related loan financing. Deferred finance costs are presented as a reduction to the related liability. (n) Asset acquisitions: Asset acquisitions are accounted for using the cost accumulation and allocation method. The acquisition cost includes directly related acquisition costs. The cost of the acquisition is allocated to the net assets acquired on a relative fair value basis. Contingent consideration, where the arrangement is not a derivative, is recognized when it is probable and estimable. After the initial acquisition accounting, changes in contingent and deferred consideration are recorded within finance (income) expense. The Company’s policy is to recognize any non-controlling interest on consolidation either at fair value of the non-controlling interest or at the fair value of the proportionate share of the net assets acquired. Where the Company acquires an asset via a step transaction, the Company remeasures any previously held interest to fair value. (o) Revenue recognition: Our anesthesia service revenues are derived from anesthesia procedures performed under our professional services agreements. The fees for such services are billed either to a third party payor, including Medicare or Medicaid or to the patient. We recognize anesthesia service revenues, net of contractual adjustments and implicit price concessions, which we estimate based on the historical trend of our cash collections and contractual adjustments. Anesthesia services procedures for each patient qualify as a distinct service obligation, as they are provided simultaneously with other readily available resources during the service procedure. The transaction price is variable and not constrained. Variable consideration relates to contractual allowances, credit provisions and other discounts. The standard requires management to estimate the transaction price, including any implicit concessions from the credit approval process. The Company adopted a portfolio approach to estimate variable consideration transaction price by payor type (patient, government and/or insurer) and the specifics of the services being provided. These portfolios share characteristics such that the results of applying a portfolio approach are not materially different than if the standard was applied to individual patient contracts. Revenue is recognized upon completion of the services to the customer (patient) for practical reasons as the service period is performed over a short time period. The Company recognizes revenue from product sales at the time the product is shipped, which is when title passes to the customer, and when all significant contractual obligations have been satisfied, collection is probable and the amount of revenue can be estimated reliably. Product sales contracts generally contain a single distinct performance obligation, but multiple performance obligations may exist when multiple product types are ordered by a physician in a contract. The transaction price for product sales is fixed and no variable consideration exists. Contract consideration is allocated to each distinct performance obligation in the contract based upon available stand-alone selling prices obtained from historical sales transactions for each product. The Company recognizes revenue from product sales at the point in time when control of the goods passes to the customer (physician) when the product is shipped, which is when title passes to the customer and an obligation to pay for the goods arises. Shipping services performed after control has passed to the customer, if any, is a separate performance obligation, but was determined to be nominal. (p) Adoption of new accounting standards: i) ASU 2016-02 Leases In February 2016, FASB issued ASU No. 2016-02 “ Leases (q) New standards and interpretations not yet applied: (i) Credit Losses In June 2016, FASB issued ASU No. 2016-13, “ Financial Instruments- Credit Losses (Topic 326)” (ii) Income Taxes – Simplifying the Accounting for Income Taxes In December 2019, the FASB issued ASU 2019-12, Income Taxes – Simplifying the Accounting for Income Taxes (iii) Intangibles – Goodwill and Other (Topic 350) In January 2017, the FASB issued ASU 2017-04, Intangibles – Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment.

Asset acquisitions

Asset acquisitions	12 Months Ended
	Dec. 31, 2019
Business Combinations [Abstract]
Asset acquisitions	4. Asset acquisitions: During the year ended December 31, 2019, the Company completed five asset acquisitions. These asset acquisitions have been included in the anesthesia segment of the Company and represents the following: Acquired Operation Date Acquired Consideration Anesthesia Care Associates LLC (“ACA”) January 2019 $ 5,355,028 South Metro Anesthesia Associates LLC (“SMAA”) May 2019 $ 1,791,431 Crystal River Anesthesia Associates LLC (“CRAA”) July 2019 $ 2,174,003 Triad Sedation Associates LLC (“TSA”) November 2019 $ 3,828,661 Florida Panhandle Anesthesia Associates LLC (“FPAA”) December 2019 $ 2,762,302 The results of operations of the acquired entities have been included in the Company’s consolidated financial statements from the date of acquisition as the Company has control over these entities. The following table summarizes the fair value of the consideration transferred and the allocated costs of the assets and liabilities acquired at the acquisition date. ACA SMAA CRAA TSA FPAA Total Cash $ 5,239,003 $ 1,752,465 $ 2,130,000 $ 3,185,843 $ 2,725,000 $ 15,032,311 Acquisition costs 116,025 38,966 44,003 15,173 37,302 251,469 Deferred consideration — — — 627,645 — 627,645 Pre-transaction equity interest — — — 1,595,275 — 1,595,275 Purchase consideration $ 5,355,028 $ 1,791,431 $ 2,174,003 $ 5,423,936 $ 2,762,302 $ 17,506,700 Non-controlling interest $ — $ 1,465,716 $ 2,088,748 $ 5,211,233 $ 2,653,976 $ 11,419,673 $ 5,355,028 $ 3,257,147 $ 4,262,751 $ 10,635,169 $ 5,416,278 $ 28,926,373 Assets and liabilities acquired: Exclusive professional services agreements $ 5,355,028 $ 3,257,147 $ 4,262,751 $ 8,891,711 $ 5,416,278 $ 27,182,915 Cash — — — 115,397 — $ 115,397 Accounts receivable — — — 1,950,219 — $ 1,950,219 Prepaid expenses and deposits — — — 1,518 — $ 1,518 Trade payables and other accruals — — — (323,676 ) — $ (323,676 ) Pre-close accounts receivable 50,000 — — — — $ 50,000 Pre-close accounts payable (50,000 ) — — — — $ (50,000 ) Fair value of net identifiable assets and liabilities acquired $ 5,355,028 $ 3,257,147 $ 4,262,751 $ 10,635,169 $ 5,416,278 $ 28,926,373 Exclusive professional services agreements – amortization term 6 years 5 years 5 years 5 years 5 years CRH ownership interest 100 % 55 % 51 % 51 % 51 % The value of the acquired intangible assets, being exclusive professional services agreements, relate to the acquisition of exclusive professional services agreements to provide professional anesthesia services. The amortization term for the agreements is based upon contractual terms within the respective acquisition agreements and professional services agreements. The non-controlling interest was determined with reference to the non-controlling interest shareholder’s share of the fair value of the net identifiable assets as estimated by the Company. The Company has obtained control over the acquired assets via the Company’s majority ownership in the shares of the entities and its agreements with the non-controlling interest shareholders. For those asset acquisitions where CRH ownership interest is less than 100%, in conjunction with the acquisition, both the Company and the non-controlling interest shareholder contributed loans. The terms of the loans are such that they will be repaid first, prior to any future distributions and are non-interest bearing. ACA SMAA CRAA TSA FPAA Total CRH member loan $ — $ 55,000 $ 63,750 $ — $ 71,400 $ 190,150 Non-controlling interest member loan $ — $ 45,000 $ 61,250 $ — $ 68,600 $ 174,850 Amount outstanding at December 31, 2019 $ — $ — $ — $ — $ 140,000 $ 140,000 Other Transactions In addition to the above asset acquisition, on April 3, 2019, a subsidiary of the Company entered into a membership interest purchase agreement to purchase the remaining 49% interest in Arapahoe Gastroenterology Anesthesia Associates LLC (“Arapahoe”); prior to the purchase the Company held a 51% interest in the Arapahoe entity. The purchase consideration, paid via cash, for the acquisition of the remaining 49% interest was $2,300,000 plus 49% of Arapahoe’s working capital as at March 31, 2019. Additionally, the Company incurred deferred acquisition costs of $26,086. On August 31, 2019, a subsidiary of the Company entered into a membership interest purchase agreement to purchase the remaining 49% interest in Central Colorado Anesthesia Associates LLC (“CCAA”); prior to the purchase the Company held a 51% interest in the CCAA entity. The purchase consideration, paid via cash, for the acquisition of the remaining 49% interest was $7,000,000 plus 49% of CCAA’s working capital as at August 31, 2019. Additionally, the Company incurred deferred acquisition costs of $18,658. In September 2019, the Company also received a payment of $4,366,000 in respect of the LWA acquisition which was a reduction in the purchase price. This payment served to reduce the value of the related LWA professional services contract intangible and did not modify ownership interest or the term of the LWA agreement. On November 1, 2019, the Company acquired an additional 36% interest in Triad Sedation Associates LLC and Triad Support Services PLLC (collectively “TSA”). Prior to this transaction, the Company held a 15% interest in TSA and it was accounted for under the equity method. Upon completing the transaction CRH acquired control of TSA; the Company has consolidated the results of TSA from the date control was obtained, November 1, 2019. On conversion from an equity method investment to consolidation, CRH revalued its investment in TSA, resulting in a gain of $1,318,769. See note 10. During the year ended December 31, 2018, the Company completed five asset acquisitions. These asset acquisitions have been included in the anesthesia segment of the Company and represents the following: Acquired Operation Date Acquired Consideration Shreveport Sedation Associates LLC (“SSA”) March 2018 $ 9,495,184 Western Ohio Sedation Associates LLC (“WOSA”) May 2018 $ 6,483,698 Lake Washington Anesthesia LLC (“LWA”) July 2018 $ 5,041,939 Lake Erie Sedation Associates LLC (“LESA”) September 2018 $ 4,233,115 Tennessee Valley Anesthesia Associates LLC (“TVAA”) December 2018 $ 2,255,875 The results of operations of the acquired entities have been included in the Company’s consolidated financial statements from the date of acquisition as the Company has control over these entities. The following table summarizes the fair value of the consideration transferred and the allocated costs of the assets and liabilities acquired at the acquisition date. SSA WOSA LWA LESA TVAA Total Cash $ 9,404,148 $ 6,409,000 $ 5,000,000 $ 4,180,000 $ 2,200,000 $ 27,193,148 Acquisition Costs 91,036 74,698 41,939 53,115 55,875 316,663 Purchase consideration $ 9,495,184 $ 6,483,698 $ 5,041,939 $ 4,233,115 $ 2,255,875 $ 27,509,811 Non-controlling interest $ — $ 6,229,435 $ 4,844,217 $ — $ 2,167,409 $ 13,241,061 $ 9,495,184 $ 12,713,133 $ 9,886,156 $ 4,233,115 $ 4,423,284 $ 40,750,872 Assets and liabilities acquired: Exclusive professional services agreements $ 9,391,036 $ 12,713,133 $ 9,886,155 $ 4,233,115 $ 4,423,284 $ 40,646,723 Prepaid expenses and deposits 104,149 — — — 104,149 Pre-close accounts receivable — — 652,506 — 652,506 Pre-close accounts payable — — (652,506 ) — (652,506 ) Fair value of net identifiable assets and liabilities acquired $ 9,495,185 $ 12,713,133 $ 9,886,155 $ 4,233,115 $ 4,423,284 $ 40,750,872 Exclusive professional services agreements – amortization term 7 years 10 years 7 years 10 years 7 years CRH ownership interest 100 % 51 % 51 % 100 % 51 % The value of the acquired intangible assets, being exclusive professional services agreements, relate to the acquisition of exclusive professional services agreements to provide professional anesthesia services. The amortization term for the agreements is based upon contractual terms within the respective acquisition agreements and professional services agreements. The non-controlling interest was determined with reference to the non-controlling interest shareholder’s share of the fair value of the net identifiable assets as estimated by the Company.

Trade and other receivables

Trade and other receivables	12 Months Ended
	Dec. 31, 2019
Receivables [Abstract]
Trade and other receivables	5. Trade a n t i v l 2019 2018 Trade receivables, gross $ 20,024,916 $ 19,373,260 Other receivables $ 50,756 141,141 Less: allowance for doubtful accounts $ (34,384 ) (46,598 ) $ 20,041,288 $ 19,467,803 Anesthesia segment – trade receivables, gross $ 19,081,177 $ 18,199,847 Product segment – trade receivables, gross 943,739 1,173,413 $ 20,024,916 $ 19,373,260

Trade and other payables

Trade and other payables	12 Months Ended
	Dec. 31, 2019
Payables And Accruals [Abstract]
Trade and other payables	6 . Trade and other payables: 2019 2018 Trade payables $ 1,213,276 $ 1,316,821 Accruals and other payables 4,983,465 4,446,401 $ 6,196,741 $ 5,763,222

Right of use assets and related

Right of use assets and related obligations	12 Months Ended
	Dec. 31, 2019
Leases [Abstract]
Right of use assets and related obligations	7. Right of use assets and related obligations: On adoption of ASU No. 2016-02 “Leases”, and subsequently ASU No. 2017-13, the Company recognized $332,512 and $295,188 as right of use assets and obligations, respectively at January 1, 2019. These amounts relate to two operating leases for premises existing as at January 1, 2019, with a further premises operating lease added in March 2019. The Company has applied the exemption to treat short-term leases as executory contracts as well as applied the practical expedient to choose not to separate non-lease components from lease components and instead to account for each separate lease component and the non-lease components associated with that lease component as a single lease component. During the year ended December 31, 2019, the Company incurred total operating lease expenses of $369,263; this included lease expenses associated with fixed lease payments of $285,890 and variable lease payments of $83,373. Lease expense is allocated to operating segments based on the location of the leases, as follows: 2019 2018 Anesthesia services expense $ 118,943 $ 74,265 Product sales expense 125,160 108,985 Corporate expense 125,160 108,985 $ 369,263 $ 292,235 The weighted average lease term of the Company’s three premises leases is 1.30 years. The weighted average discount rate used by the Company in calculating the obligation relating to right of use assets is based on the Company’s Credit Facility, which is disclosed in note 11. The following table presents a maturity analysis of the Company’s undiscounted lease obligations for each of the next five years, reconciled to the obligation as recorded on the balance sheet. Undiscounted lease payments 2020 $ 129,680 2021 55,498 $ 185,178 Accretion related to outstanding lease obligations (5,323 ) Total $ 179,855 Current obligation relating to right of use assets $ 125,555 Long-term obligation relating to right of use assets $ 54,300 Total $ 179,855

Property and equipment

Property and equipment	12 Months Ended
	Dec. 31, 2019
Property Plant And Equipment [Abstract]
Property and equipment	8 . Property and equipment: Property and equipment consist of the following: December 31, 2019 2018 Computer equipment and software $ 124,640 $ 94,566 Furniture and equipment 267,051 237,616 Leasehold improvements 5,784 5,784 Injection mold 408,062 408,062 Property and equipment $ 805,537 $ 746,028 Less: Accumulated depreciation (553,604 ) (442,737 ) Property and equipment, net $ 251,933 $ 303,291

Intangible assets

Intangible assets	12 Months Ended
	Dec. 31, 2019
Goodwill And Intangible Assets Disclosure [Abstract]
Intangible assets	9 . Intangible assets: Professional Services Agreements Patents Total Cost Balance as at January 1, 2018 $ 215,844,537 $ 532,598 $ 216,377,135 Additions through asset acquisitions (note 4) 40,646,723 — 40,646,723 Balance as at December 31, 2018 $ 256,491,260 $ 532,598 $ 257,023,858 Additions through asset acquisitions and adjustments (note 4) 18,622,130 — $ 18,622,130 Balance as at December 31, 2019 $ 275,113,390 $ 532,598 $ 275,645,988 Professional Services Agreements Patents Total Accumulated depreciation Balance as at January 1, 2018 $ 45,752,303 $ 497,417 $ 46,249,720 Amortization expense 31,387,429 2,446 31,389,875 Balance as at December 31, 2018 $ 77,139,732 $ 499,863 $ 77,639,595 Amortization expense and adjustments (note 4) 34,895,944 2,256 34,898,200 Balance as at December 31, 2019 $ 112,035,676 $ 502,119 $ 112,537,795 Professional Services Agreements Patents Total Net book value December 31, 2019 $ 163,077,714 $ 30,479 $ 163,108,193 December 31, 2018 $ 179,351,528 $ 32,735 $ 179,384,263 At December 31, 2019, the Company identified indicators of impairment in respect of six of its professional services agreements. Upon performing undiscounted cash flow models for these assets, the Company identified only two assets that required further review for impairment. The Company performed discounted cash flow modelling for these assets and compared the resultant discounted cash flows expected over the life of the assets, including a terminal value, to the carrying amounts as at December 31, 2019. The income approach is used for the quantitative assessment to estimate the fair value of the assets, which requires estimating future cash flows and risk-adjusted discount rates in the Company's discounted cash flow model. The overall market outlook and cash flow projections of the reporting unit involves the use of key assumptions, including anesthesia growth rates, revenue rates per case, discount rates and operating cost growth rates. Due to uncertainties in the estimates that are inherent to the Company's industry, actual results could differ significantly from the estimates made. Many key assumptions in the cash flow projections are interdependent on each other. A change in any one or combination of these assumptions could impact the estimated fair value of the reporting unit. As a result of this test, no write-downs to the intangible assets were required. 9 . Intangible assets (continued): At December 31, 2018, the Company identified indicators of impairment in respect of four of its professional services agreements. Upon performing undiscounted cash flow models for these assets, the Company identified only two assets that required further review for impairment. Various of the Company’s professional services agreements are subject to renewal terms. The weighted average period before the Company’s professional services agreements are up for renewal is 3.28 years. The Company anticipates that it will be able to renew all contract terms under its professional services agreements. The weighted average remaining amortization period for the Company’s professional services agreements is 5.16 years. Based on the Company’s professional services agreements in place at December 31, 2019, the Company anticipates that the amortization expense to be incurred by the Company over the next five years is as follows: Amortization Expense For professional services agreements as at December 31, 2019: 2020 $ 37,438,739 2021 32,132,360 2022 25,411,084 2023 21,264,710 2024 19,339,571 $ 135,586,464

Equity investment

Equity investment	12 Months Ended
	Dec. 31, 2019
Investments Debt And Equity Securities [Abstract]
Equity investment	10 . Equity investment: In October 2018, the Company entered into an agreement with Digestive Health Specialists (“DHS”), located in North Carolina, to assist DHS in the development and management of a monitored anesthesia care program. Under the terms of the agreement, CRH was a 15% equity owner in the anesthesia business, Triad Sedation Associates LLC (“TSA”) and received compensation for its billing and collection services. Under the terms of the limited liability company agreement, CRH had the right, at CRH’s option, to acquire an additional 36% interest in the anesthesia business at a future date, but no sooner than November 2019. The Company assessed and concluded that, as TSA was an LLC, equity method accounting was required under ASC 970-323 until such time as a change in ownership interest occurred. On November 1, 2019, the Company acquired control of TSA via the exercise of its option to acquire an additional 36% interest. Refer to note 4. The results of operations of the TSA equity investment, up to the date control was obtained by CRH, is presented below. On obtaining control of TSA and completing its option to purchase an additional 36% interest in the entity, CRH revalued its original 15% equity investment with reference to the price paid for the additional 36% interest. This resulted in a gain arising on its equity investment of $1,318,769 in the year. Prior to obtaining control, CRH recorded equity income of $448,199 in relation to its 15% investment in TSA. Results of operations Ten months ended October 31, 2019 Anesthesia revenue $ 4,169,162 Anesthesia services expense 1,514,704 Net income $ 2,654,458

Notes payable

Notes payable	12 Months Ended
	Dec. 31, 2019
Debt Disclosure [Abstract]
Notes payable	11 . Notes payable: December 31, 2019 2018 Current portion $ — $ 2,239,637 Non-current portion 68,380,345 67,621,470 Total loans and borrowings $ 68,380,345 $ 69,861,107 J.P.Morgan Chase (“JP Morgan Facility”) On October 22, 2019, the Company entered into a new, three year revolving credit line which provides up to $200 million in borrowing capacity and represents an increase from the Company’s previous $100 million facility. The new facility includes a committed $125 million facility and access to an accordion feature that increases the amount of the credit available to the Company by $75 million. Interest on the facility is calculated with reference to LIBOR plus 1.25% to 1.75%, dependent on the Company’s Total leverage ratio. The Facility is secured by the assets of the Company and matures on October 22, 2022. Since the JP Morgan Facility is a syndicated facility, which includes the Bank of Nova Scotia as a lender, any remaining deferred financing fees under the previous Scotia Facility were retained and will be amortized over the term of the new facility. The Company incurred deferred financing fees of $839,893 in connection with this facility. Under the JP Morgan Facility, there are no quarterly or annual repayment requirements. As at December 31, 2019, the Company is required to maintain the following financial covenants in respect of this Facility: Financial Covenant Required Ratio Total leverage ratio Not greater than 3.00:1.00 Interest coverage ratio Not less than 3.00:1.00 The Company is in compliance with all covenants at December 31, 2019. The Bank of Nova Scotia (“Scotia Facility”) On November 24, 2015, the Company entered into a credit facility with the Bank of Nova Scotia. The facility, which had a maturity date of April 30, 2018, provided financing of up to $55,000,000, after amendment on June 15, 2016. On June 26, 2017, the Company amended the Scotia Facility to provide financing of up to $100,000,000 via a revolving and term facility. The amended facility had a maturity date of June 26, 2020. The facility bore interest at a floating rate based on the US prime rate, LIBOR or bankers’ acceptance rates plus an applicable margin. At December 31, 2018, interest on the facility was calculated at LIBOR plus 2.50% on the revolving portion and term portion of the facility. The Facility was secured by the assets of the Company. The Company repaid and extinguished its obligations under this facility on October 22, 2019. The consolidated minimum loan payments (principal) in the future for all loan agreements in place as of December 31, 2019 are as follows: Minimum Principal At December 31, 2019 2020 $ — 2021 — 2022 69,341,370 $ 69,341,370

Share capital

Share capital	12 Months Ended
	Dec. 31, 2019
Text Block [Abstract]
Share capital	1 2 . Share cap i al: (a) Authorized: 100,000,000 common shares without par value. (b) Issued and outstanding – common shares: Other than in connection with shares issued in respect of the Company’s share unit and share option plans and in connection with the Company’s normal course issuer bid (note 12(e)), there were no share transactions in the years ended December 31, 2019 and 2018. (c) Stock option plan: Under the Company’s Stock Option Plan, the Company may grant options to its directors, officers, consultants and eligible employees. The plan provides for the granting of stock options at the fair market value of the Company’s stock at the date of grant, and the term of options range from two to ten years. The Board of Directors may, in its sole discretion, determine the time during which options shall vest and the method of vesting. All options under the Plan will be subject to vesting provisions determined by the Board of Directors, over a period of not less than 18 months, in equal portions on a quarterly basis. Options granted to consultants providing investor relations activities will vest at the end of 12 months or longer from the date of issuance. As of December 31, 2019, the Company is authorized to grant a further 2,575,492 awards under its stock options plan. Number of options Weighted average exercise price CAD USD Outstanding, January 1, 2018 1,344,687 $ 0.69 $ 0.55 Issued — — — Exercised — — — Forfeited — — — Expired — — — Outstanding, December 31, 2018 1,344,687 $ 0.69 $ 0.53 Issued 500,000 3.56 2.73 Exercised (840,000 ) (0.68 ) (0.52 ) Forfeited — — — Expired — — — Outstanding, December 31, 2019 1,004,687 $ 2.12 $ 1.63 All but 500,000 options are vested as of December 31, 2019 (2018 – all options are vested). The weighted average fair value of stock options granted during the year ended December 31, 2019 was $1.43 (CAD$1.86) The estimated fair value of the stock options granted was determined using the Black-Scholes option-pricing model with the following weighted-average assumptions: 2019 Expected life of options 5.05 years Risk-free interest rate 1.61% Dividend yield 0% Volatility 63% Pre-vest forfeiture rate 3.67% There is no dividend yield because the Company does not pay, and does not plan to pay, cash dividends on its common shares. The expected stock price volatility is based on the historical volatility of the Company’s average monthly stock closing prices over a period equal to the expected life of each option grant. The risk-free interest rate is based on yields from Canadian Government Bond yields with a term equal to the expected term of the options being valued. The expected life of options represents the period of time that the options are expected to be outstanding based on historical data of option holder exercise and termination behavior For those options that were exercised in 2019, the intrinsic value of the options that were exercised was $2,067,497 and the fair value of the options that were exercised was $306,798. The following table summarizes information about the stock options outstanding as at: December 31, 2019: Exercise price Options outstanding Options exercisable $CAD $USD Number of options Weighted average remaining contractual life (years) Weighted average exercise price ($CAD) Weighted average exercise price ($USD) Number of options Weighted average exercise price ($CAD) Weighted average exercise price ($USD) 0.60 - 0.70 0.46 - 0.57 504,687 4.05 0.69 0.53 504,687 0.69 0.53 3.56 - 3.56 2.73 - 2.73 500,000 9.27 3.56 2.73 — — — December 31, 2018: Exercise price Options outstanding Options exercisable $CAD $USD Number of options Weighted average remaining contractual life (years) Weighted average exercise price ($CAD) Weighted average exercise price ($USD) Number of options Weighted average exercise price ($CAD) Weighted average exercise price ($USD) 0.60 - 0.70 0.44 – 0.51 1,344,687 5.05 0.69 0.50 1,344,687 0.69 0.50 For the year ended December 31, 2019, the Company recognized $239,413 (2018 - $468), in compensation expense as a result of stock options awarded and vested. Compensation expense is recorded in the consolidated statement of operations and comprehensive income and is allocated to product sales expenses, corporate expenses and anesthesia expenses on the same basis as the allocations of cash compensation. (d) Share unit plan: In June 2017, the shareholders of the Company approved a Share Unit Plan. Employees, directors and eligible consultants of the Company and its designated subsidiaries are eligible to participate in the Share Unit Plan. In accordance with the terms of the plan, the Company will approve those employees, directors and eligible consultants who are entitled to receive share units and the number of share units to be awarded to each participant. Each share unit awarded conditionally entitles the participant to receive one common share of the Company upon attainment of the share unit vesting criteria. The vesting of share units is conditional upon the expiry of time-based vesting conditions or performance-based vesting conditions or a combination of the two. Once the share units vest, the participant is entitled to receive the equivalent number of underlying common shares; the Company issues new shares in satisfying its obligations under the plan. As at December 31, 2019, the Company is authorized to grant a further 482,679 awards under its share unit plan. A summary of the status of the share unit plan as of December 31, 2019 and 2018 is as follows: Time based share units Performance based share units Outstanding, January 1, 2018 1,036,500 1,350,000 Issued 452,125 150,000 Exercised (364,000 ) — Forfeited (79,375 ) — Expired — — Outstanding, December 31, 2018 1,045,250 1,500,000 Vested — — Expected to vest 1,045,250 1,100,000 Outstanding, January 1, 2019 1,045,250 1,500,000 Issued 1,553,125 — Exercised (325,875 ) — Forfeited (125,000 ) (550,000 ) Expired — — Outstanding, December 31, 2019 2,147,500 950,000 Vested — - Expected to vest 2,147,500 - Time based share units Performance based share units Outstanding, January 1, 2019 1,045,250 1,500,000 Weighted average contractual life (years) 2.74 7.99 Outstanding, December 31, 2019 2,147,500 950,000 Weighted average contractual life (years) 3.03 7.02 For those share units that vested in 2019, the intrinsic value of the share units that vested was $1,038,456 and the fair value of the share units that vested was $1,159,913. During the year ended December 31, 2019, the Company granted 1,553,125 time based share units. The weighted average fair value for the time based units at the date of grant was $2.93 (CAD$3.81) per unit. The fair value per unit was based on the market value of the underlying shares at the date of issuance. During the year ended December 31, 2019, the Company issued 325,875 shares in respect of the 325,875 time-based share units which vested during the year. During the year ended December 31, 2018, the Company granted 452,125 time based share units and 150,000 performance based share units. The weighted average fair value for the time based units at the date of grant was $3.45 (CAD$4.71) per unit and the weighted average fair value per unit for the performance based share units granted in the in the period was $2.78 (CAD$3.79) per unit. The fair value per unit was based on the market value of the underlying shares at the date of issuance. During the year ended December 31, 2018, the Company issued 364,000 shares in respect of the 364,000 time-based share units which vested during the year. During the year ended December 31, 2019, the Company recognized $737,548 (2018 - $2,800,280), in compensation expense in relation to the granting and vesting of share units. (e) Normal Course Issuer Bid: On November 6, 2017, the Board of Directors of the Company approved a normal course issuer bid to purchase outstanding shares of the Company. On November 8, 2018, the Company’s normal course issuer bid was renewed, with a subsequent renewal on November 6, 2019. Under the renewed bid, the Company may purchase up to 6,974,495 shares pursuant to the bid, representing no more than 9.8% of the Company’s shares outstanding on October 31, 2019. All purchases of shares under the bid are made pursuant to an Automated Share Purchase Plan. Subject to any block purchases made in accordance with the rules of the TSX, the bid is subject to a daily repurchase maximum of 14,875 shares. Shares are purchased at the market price of the shares at the time of purchase and are purchased on behalf of the Company by a registered investment dealer through the facilities of the TSX or alternative Canadian and US marketplaces. During 2019, the Company repurchased 1,607,579 of its shares for a total cost, including transaction fees, of $4,754,295 (CAD$6,313,347). As at December 31, 2019, all of these shares have been cancelled. During 2018, the Company repurchased 1,264,900 of its shares for a total cost, including transaction fees, of $3,784,733 (CAD$4,945,155). As at December 31, 2018, 1,254,500 of these shares have been cancelled with the remaining 10,400 shares cancelled on January 4, 2019. (f) Earni n p s a The calculation of basic earnings per share for the years ended December 31, 2019 and 2018 is as follows: 2019 2018 Net earnings Weighted average number of common shares outstanding Per share amount Net earnings Weighted average number of common shares outstanding Per share amount Net earnings attributable to shareholders: Earnings per common share: Basic $ 3,771,163 71,536,310 0.053 $ 4,679,921 72,582,733 $ 0.064 Share options 421,249 1,122,708 Share units 739,980 379,731 Diluted $ 3,771,163 72,697,539 $ 0.052 $ 4,679,921 74,085,172 $ 0.063 For the year ended December 31, 2019, 502,529 options (2018 The average market value of the Company’s shares for purposes of calculating the dilutive effect of share options was based on quoted market prices for the period during which the options were outstanding. The treasury method is used to determine the calculation of dilutive shares.

Income taxes

Income taxes	12 Months Ended
	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Income taxes	1 3 . Income taxes: (a) Income tax expense is comprised of the following: 2019 2018 Current tax expense $ 5,067,182 $ 5,119,062 Deferred tax recovery (3,440,121 ) (2,407,176 ) Total tax expense $ 1,627,061 $ 2,711,886 The reconciliation of income tax computed at statutory tax rates to income tax expense, using a 27% (2018 – 27%) statutory rate, is: 2019 2018 Net income before tax – Canada $ 6,889,481 $ 5,957,089 Net income before tax – United States 2,950,064 9,770,714 Net income before tax – All jurisdictions $ 9,839,545 $ 15,727,803 Tax expense at statutory income tax rates $ 2,656,677 $ 4,259,890 Permanent differences (50,235 ) 503,964 Income attributable to non-controlling interest (1,192,280 ) (2,245,809 ) Foreign income taxed at different rates 33,189 (26,042 ) Impact of change in tax rates 26,902 216,295 Other 152,808 3,588 Total tax expense $ 1,627,061 $ 2,711,886 (b) Deferred tax assets and liabilities: The Company had the following deferred tax assets and liabilities resulting from temporary differences recognized for financial statement and income tax purposes. 2019 2018 Deferred tax assets: Property and equipment $ 2,684 356 Intangible assets 9,222,824 4,752,898 Finance related costs 224,986 375,182 Reserves 64,755 — Share transaction costs — 87,337 Stock-based compensation 767,228 534,926 Earn-out obligation 265,660 732,986 Deferred tax liabilities: Property and equipment (23,757 ) (40,357 ) Deferred consideration (4,226 ) (18,388 ) Reserves (83,206 ) (55,568 ) Unrealized foreign exchange (20,610 ) (20,698 ) Finance related costs (78,060 ) (68,938 ) Net deferred tax asset $ 10,338,278 $ 6,279,736 Deferred tax assets by jurisdiction 2019 2018 Canada: Deferred tax asset $ — $ 87,343 Deferred tax liability (101,822 ) (109,294 ) Net deferred tax asset (liability) $ (101,822 ) $ (21,951 ) United States: Deferred tax asset $ 10,548,137 $ 6,396,341 Deferred tax liability (108,037 ) (94,654 ) Net deferred tax asset (liability) $ 10,440,100 $ 6,301,687 The realization of deferred income tax assets is dependent on the generation of sufficient taxable income during future periods in which the temporary differences are expected to reverse. If it is more likely than not that all or a portion of deferred tax assets will not be realized, a valuation allowance is provided against such deferred tax assets. In making such determination, the Company considers all available positive and negative evidence, including future reversals of existing taxable temporary differences, projected future taxable income, tax-planning strategies, and results of recent operations. As at December 31, 2019 and 2018, the Company had no valuation allowance against its deferred income tax assets. The Company currently does not have any unrecognized tax benefits or uncertain tax positions. The Company currently files income tax returns in Canada and the US, the jurisdiction in which the Company believes that it is subject to tax. The Company is currently under audit by the IRS for its 2017 taxation year. Management is not aware of any other material income tax examination currently in progress by any taxing jurisdiction. Tax years ranging from 2017 to 2019 remain subject to Canadian income tax examinations. Tax years ranging from 2016 to 2019 remain subject to U.S. income tax examinations.

Net finance expense

Net finance expense	12 Months Ended
	Dec. 31, 2019
Text Block [Abstract]
Net finance expense	1 4 . Net finance expense Recognized in earnings in the years ended December 31: 2019 2018 Finance expense: Interest and accretion expense on borrowings $ 3,288,704 $ 3,168,762 Accretion expense on earn-out obligation and deferred consideration 133,450 166,575 Amortization of deferred financing fees 276,260 260,363 Net change in fair value of financial liabilities at fair value through earnings 2,861,204 971,627 Other 50,000 — Total finance expense $ 6,609,618 $ 4,567,327 Net finance expense $ 6,609,618 $ 4,567,327

Financial instruments

Financial instruments	12 Months Ended
	Dec. 31, 2019
Investments All Other Investments [Abstract]
Financial instruments	1 5 . Financial instruments: The Company’s financial instruments consist of cash and cash equivalents, trade and other receivables, trade and other payables, employee benefit obligations, short term advances, loans, notes payable and bank indebtedness, deferred consideration and the Company’s earn-out obligation. The fair values of these financial instruments, except the notes payable balances, the deferred consideration and the earn-out obligation, approximate carrying value because of their short-term nature. The earn-out obligation is recorded at fair value. The fair value of the notes payable and bank indebtedness, which is comprised of the JP Morgan Facility, approximates carrying value as it is a floating rate instrument. The Company’s deferred consideration relating to its Austin Gastroenterology Anesthesia Associates LLC (“AGAA”) acquisition in 2016 was initially measured at fair value and is being accreted to its face value over a period of four years from the acquisition date. Additionally, the Company has included amounts within deferred compensation relating to payments under its TSA and CCAA transactions; these amounts are repayable within one year. See note 4. An established fair value hierarchy requires the Company to maximize the use of observable inputs and minimize the use of unobservable inputs when measuring fair value. A financial instrument’s categorization within the fair value hierarchy is based upon the lowest level of input that is available and significant to the fair value measurement. There are three levels of inputs that may be used to measure fair value: • Level 1 - quoted prices (unadjusted) in active markets for identical assets or liabilities; • Level 2 - inputs other than quoted prices included within Level 1 that are observable for the asset or liability, either directly (i.e. as prices) or indirectly (i.e. derived from prices); and • Level 3 - inputs for the asset or liability that are not based on observable market data (unobservable inputs). Liabilities December 31, 2019 Level 1 Level 2 Level 3 Earn-out obligation $ 1,063,060 $ — $ — $ 1,063,060 Total $ 1,063,060 $ — $ — $ 1,063,060 Liabilities December 31, 2018 Level 1 Level 2 Level 3 Earn-out obligation $ 2,920,583 $ — $ — $ 2,920,583 Total $ 2,920,583 $ — $ — $ 2,920,583 The Company’s earn-out obligation is measured at fair value on a recurring basis using significant unobservable inputs (Level 3). The earn-out obligation relates to the Company’s Gastroenterology Anesthesia Associates LLC acquisition, which was acquired in 2014. As part of the business combination, the Company is required to pay consideration contingent on the post-acquisition earnings of the acquired asset. In the year ended December 31, 2019, the Company paid $4,795,822 as partial payment of the amount owing under its earn-out obligation; the Company expects to pay the remaining obligation of $1,063,060 within one year, and expects payment in the second quarter of 2020. The Company measures the fair value of the earn-out obligation based on its best estimate of the cash outflows payable in respect of the earn-out obligation. This valuation technique includes inputs relating to estimated cash outflows under the arrangement. The Company evaluates the inputs into the valuation technique at each reporting period. During the year ended December 31, 2019, the Company revised its estimate underlying the remaining amount to be paid under the earn-out obligation. The amendment of the cash outflow estimates underlying the earn-out resulted in an increase During the year ended December 31, 2019, the Company recorded accretion expense of $77,095 (2018 - $73,531), in relation to this liability, reflecting the change in fair value of the liabilities that is attributable to credit risk. Reconciliation of level 3 fair values: Earn-out obligation Balance as at January 1, 2019 $ 2,920,583 Payment (4,795,822 ) Recorded in finance expense: Accretion expense 77,095 Fair value adjustment $ 2,861,204 Balance as at December 31, 2019 $ 1,063,060 The Company’s financial instruments are exposed to certain financial risks, including credit risk, and market risk. (a) Credit risk: Credit risk is the risk of financial loss to the Company if a counterparty to a financial instrument fails to meet its contractual obligations and arises principally from the Company’s cash and cash equivalents and trade receivables. The carrying amount of the financial assets represents the maximum credit exposure. The Company limits its exposure to credit risk on cash and cash equivalents by placing these financial instruments with high-credit quality financial institutions and only investing in liquid, investment grade securities. The Company has a number of individual customers and no one customer represents a concentration of credit risk. No one customer accounts for more than 10% of the Company’s consolidated revenue. The Company establishes a provision for losses on accounts receivable if it is determined that all or part of the outstanding balance is uncollectable. Collectability is reviewed regularly and an allowance is established or adjusted, as necessary, using a combination of the specific identification method, historic collection patterns and existing economic conditions. Estimates of allowances are subject to change as they are impacted by the nature of healthcare collections, which may involve delays and the current uncertainty in the economy. (b) Market risk: Market risk is the risk that changes in market prices, such as interest rates, will affect the Company’s income or the value of the financial instruments held. ( i ) As at December 31, 2019, the Company’s only interest bearing liability is its JP Morgan Facility. With respect to the Company’s Facility, with all other variables held constant, a 10% point increase in the interest rate would have reduced net income by approximately $329,000 (2018 - $295,000) for the year ended December 31, 2019. There would be an equal and opposite impact on net income with a 10% point decrease.

Commitments and contingencies

Commitments and contingencies	12 Months Ended
	Dec. 31, 2019
Commitments And Contingencies Disclosure [Abstract]
Commitments and contingencies	1 6 . Commitments and contingencies: The Company is a party to a variety of agreements in the ordinary course of business under which it may be obligated to indemnify third parties with respect to certain matters. These obligations include, but are not limited to contracts entered into with physicians where the Company agrees, under certain circumstances, to indemnify a third party, against losses arising from matters including but not limited to medical malpractice and product liability. The impact of any such future claims, if made, on future financial results is not subject to reasonable estimation because considerable uncertainty exists as to final outcome of these potential claims.

Related Party Transactions

Related Party Transactions	12 Months Ended
	Dec. 31, 2019
Related Party Transactions [Abstract]
Related party transactions	1 7 . Related party transactions: Balances and transactions between the Company and its wholly owned and controlled subsidiaries have been eliminated on consolidation and are not disclosed in this note. Details of the transactions between the Company and other related parties are disclosed below: (a) Related party transactions: During the year ended December 31, 2019, the Company made product sales totaling $35,095 (2018 - $29,685) to one company owned or controlled by one of the Company’s Directors. The transaction terms with related parties may not be on the same price as those that would result from transactions among non-related parties. There were no amounts owing by or to this related party as of December 31, 2019 (2018 - $nil).

Segmented information

Segmented information	12 Months Ended
	Dec. 31, 2019
Segment Reporting [Abstract]
Segmented information	1 8 . Segmented information: The Company operates in two industry segments: the sale of medical products and the provision of anesthesia services. The revenues relating to geographic segments based on customer location, in United States dollars, for the years ended December 31, 2019 and 2018 are as follows: 2019 2018 Revenue: Canada and other $ 225,807 $ 271,803 United States 120,159,467 112,477,577 Total $ 120,385,274 $ 112,749,380 The Company’s revenues are disaggregated below into categories which differ in terms of the economic factors which impact the amount, timing and uncertainty of revenue and cash flows. 2019 2018 Revenue: Commercial Insurers $ 90,332,380 $ 86,992,218 Federal Insurers 19,404,851 14,246,626 Physicians 10,078,843 10,959,215 Other 569,200 551,321 Total $ 120,385,274 $ 112,749,380 The Company’s property and equipment, intangibles, other assets and total assets are located in the following geographic regions as at December 31, 2019 and 2018: 2019 2018 Property and equipment: Canada $ 210,386 $ 276,621 United States $ 41,547 26,670 Total $ 251,933 $ 303,291 Intangible assets: Canada $ 30,478 $ 32,735 United States $ 163,077,715 179,351,528 Total $ 163,108,193 $ 179,384,263 Total assets: Canada $ 3,231,845 $ 9,293,796 United States $ 199,863,424 209,694,200 Total $ 203,095,269 $ 218,987,996 The financial measures reviewed by the Company’s Chief Operating Decision Maker are presented below for the years ended December 31, 2019 and 2018. The Company does not allocate expenses related to corporate activities. These expenses are presented within “Other” to allow for reconciliation to reported measures. 2019 Anesthesia services Product sales Other Total Revenue $ 110,306,431 $ 10,078,843 $ — $ 120,385,274 Operating costs 94,506,039 4,647,719 6,549,321 105,703,079 Operating income (loss) $ 15,800,392 $ 5,431,124 $ (6,549,321 ) $ 14,682,195 2018 Anesthesia services Product sales Other Total Revenue $ 101,790,165 $ 10,959,215 $ — $ 112,749,380 Operating costs 81,079,150 5,022,737 6,352,363 92,454,250 Operating income (loss) $ 20,711,015 $ 5,936,478 $ (6,352,363 ) $ 20,295,130 Additionally, the company incurs the following in each of its operating segments: 2019 Anesthesia services Product sales Other Total Finance expense $ 2,994,654 $ — $ 3,614,964 $ 6,609,618 Depreciation and amortization expense $ 34,908,764 $ 25,534 $ 74,772 $ 35,009,070 2018 Anesthesia services Product sales Other Total Finance expense $ 1,138,200 $ — $ 3,429,127 $ 4,567,327 Depreciation and amortization expense $ 31,394,245 $ 68,509 $ 23,301 $ 31,486,055

Significant accounting polici_2

Significant accounting policies (Policies)	12 Months Ended
	Dec. 31, 2019
Accounting Policies [Abstract]
Basis of presentation	(a) Basis of presentation: These consolidated financial statements have been prepared in accordance with US GAAP.
Use of estimates, assumptions and judgments	(c) U s s t at u m s The p p ti t o y’ c ns t f an c s t t nt i e n e t n s s t t ff c t p t m t s s t n t s c o s u c t en ss t t t t t f c i s t t t a t te t v e x n s e i t o t p i Reported amounts and note disclosures reflect the overall economic conditions that are most likely to occur and anticipated measures management intends to take. Actual results could differ from those estimates. ( i ) Estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting estimates are recognized in the period in which the estimates are revised and in any future periods affected. Significant areas requiring the use of management estimates relate to the assessment for impairment and useful lives of intangible assets, estimates supporting reported anesthesia revenues, the recoverability of trade receivables, the valuation of certain long term liabilities and other assets, including liabilities relating to contingent consideration, the valuation of acquired intangibles and the valuation of deferred tax assets. ( ii ) Significant judgments made by management in the process of applying accounting policies and that have the most significant effect on the amounts recognized in the consolidated financial statements includes the determination of control for the purposes of consolidation and the Company’s assessment of whether an acquisition is a business acquisition or an asset acquisition.
Basis of consolidation	(a) Ba s c ns t These consolidated financial statements include the accounts of the Company and its subsidiaries. Subsidiaries are entities controlled by the Company through voting control and for anesthesia businesses, control over the assets and business operations of the subsidiary through operating agreements. Control exists when the Company has the continuing power to govern the financial and operating polices of the investee. Subsidiaries are included in the consolidated financial results of the Company from the effective date of acquisition up to the effective date of disposition or loss of control. Minority interests, if any, are valued at fair value at inception. All significant intercompany transactions and balances have been eliminated on consolidation.
Cash equivalents	(b) Cash equivalents: The Company considers all highly liquid investments with an original maturity of 90 days or less, when acquired, to be cash equivalents.
Foreign currency	(c) Fore i c r e c y Tra n s a c t n f c rr c i a t a s te t t s p c t v f c t n c u e c e t s b s i e t p x c a te t t t t s c ti s Period end balances of monetary assets and liabilities in foreign currency are translated to the respective functional currencies using period end foreign currency rates. Foreign currency gains and losses arising from settlement of foreign currency transactions are recognized in earnings. N n on t s s t t e i t f i c ur n c e t a m a s r f v u t n s te t t fu c t c u e c t x c h n t t t w ic t f v u w a d t m N - o t t m t m a s r i s t c c s f g c rr c a t an s t s n t xc g t t at t t s c t
Inventories	(d) I v t e s Inventories c s s s z s t c c s c c s c s inventory r s c c Net i z a l v t s t te s i c t y o n c u s o s i e ss es t s t m t c o s t c t an s n x e s e s
Property and equipment, net	(e) Prop e t m t, net Property and equipment are measured at cost less accumulated depreciation and accumulated impairment losses. The s t m te s f v t t d r c t o f t c u r n c p r t v o a a f w s Asset Basis Rate Computer equipment Declining balance 30% Computer software Declining balance 100% Furniture and equipment Declining balance 20% Leasehold improvements initial lease Straight-line Shorter of term or useful life Injection mold Straight-line 5 years These depreciation methods most c l s f e c t t x c te tt c n s t o t f t e c n i f t mb t a s s t E s t t fo p e c t t d s us f v a e s u v l r r v w a c o t p i - e n a s te p p t
Intangible assets	(f) Intangible as s s Intangible assets, consisting of acquired exclusive professional service agreements to provide anesthesia services and the cost of acquiring patents, are recorded at historical cost. For patents, costs also include legal costs involved in expanding the countries in which the patents are recognized to the extent expected cash flows from those countries exceed these costs over the amortization period and costs related to new patents. The amortization term for professional services agreements are based on the contractual terms of the agreements. Intangible assets with finite lives are amortized on a straight-line basis over their estimated useful lives and are measured at cost less accumulated amortization and accumulated impairment losses. Intangible assets with finite lives are amortized over the following periods: Asset Basis Rate Intellectual property rights to the CRH O’Regan System Straight-line 15 years Intellectual property new technology Straight-line 20 years Exclusive professional services agreements Straight-line 4.5 to 15 years
Impairment	(g) I e t No n f n c s s t s The c a y u t t C pa y n n f a c a s s t s t t i v t e a f r t s s t s a r v e e c p t t t te w h t e t r o th p s m t s t s s t g u t t e t t s l s g as s t t e te c s f w f c t n u s t a i p e c a s f ow f th as s t o g up s s t If indicators of impairment exist, an asset or asset group is impaired if its carrying amount exceeds its fair value, being the projected future discounted cash flows that are directly associated with and that are expected to arise as a direct result of the use and eventual disposition of the asset or asset group. Projected cash flows are based upon historical results adjusted to reflect management’s best estimate of future market and operating conditions which may differ from actual cash flows. Significant assumptions included in projected cash flows include anesthesia revenue growth rates, discount rates, and operating cost growth rates.
Income taxes	(h) I c t xes The Company is subject to income taxes in Canada and the United States. Judgment is required in determining the provision for income taxes and income tax assets and liabilities, including evaluating uncertainties in the application of accounting principles and complex tax laws. The Company records a provision for income taxes for the anticipated tax consequences of the reported results of operations using the asset and liability method. Under this method, it recognizes deferred income tax assets and liabilities for the expected future tax consequences of temporary differences between the financial reporting and tax bases of assets and liabilities. Deferred tax assets and liabilities are measured using the enacted tax rates that are expected to apply to taxable income for the years in which those tax assets and liabilities are expected to be realized or settled. The Company recognizes the deferred income tax effects of a change in tax rates in the period of the enactment. The Company records a valuation allowance to reduce its deferred tax assets to the net amount that management believes is more likely than not to be realized. The Company recognizes the effect of income tax positions only if those positions are more likely than not of being sustained. Recognized income tax positions are measured at the largest amount that is greater than fifty percent likely of being realized. The Company records interest related to unrecognized tax benefits in interest expense and penalties in operating expenses. Income tax expense is comprised of current and deferred tax.
Share-based compensation	(i) Shar e a s e c p n s t o The Company records share-based compensation related to equity classified stock options and share units granted using the fair value based method estimated using either the Black-Scholes model or Binomial method. The vesting components of graded vesting employee awards, with only a service vesting condition, are accounted for as separate share-based arrangements. Each vesting installment is measured separately and expensed over the related installment’s vesting period. Compensation cost is measured at fair value at the date of grant and expensed as employee benefits over the period in which employees unconditionally become entitled to the award. Forfeitures are estimated in recognizing share-based compensation, s uc t t m t t l c i z e a x e s s t b r t t r t s v c o m r k f a c c n t n t v s t t
Share capital	(j) Share capital: Com m s ha a c as s if a e ty I c r t c o s t e c t tt t t t i s s
Earnings per share	(k) Earnings per share: The p n e s t b s i n t a n s h t f t c o on s a e s s i c l c te iv t ne os tt b t t c m s a h e t C o t w t v g n e c s are t s t n n t p a u s t f o s e h i c D t P t i b u s t t o l s tt b ta t c mm s a h d n t g t ve m e c o s a e o t s t n ust f o s a e h i i c fo t ff c t t v t t c m s a s. Diluted EPS for year-to-date (including annual) periods is based on the weighted average of the incremental shares included in each interim period for the year-to-date period.
Segment reporting	(l) Segment reporting: The Company’s operating segments consist of the sale of medical products and the provision of anesthesia services.
Finance costs	(m) Finance costs: Finance cost is primarily comprised of interest on the Company’s notes payable and bank indebtedness and also includes the amortization of costs incurred to obtain loan financing and any fees in respect of arranging loan financing. Deferred finance costs are amortized using the effective interest method over the term of the related loan financing. Deferred finance costs are presented as a reduction to the related liability.
Asset acquisitions	(n) Asset acquisitions: Asset acquisitions are accounted for using the cost accumulation and allocation method. The acquisition cost includes directly related acquisition costs. The cost of the acquisition is allocated to the net assets acquired on a relative fair value basis. Contingent consideration, where the arrangement is not a derivative, is recognized when it is probable and estimable. After the initial acquisition accounting, changes in contingent and deferred consideration are recorded within finance (income) expense. The Company’s policy is to recognize any non-controlling interest on consolidation either at fair value of the non-controlling interest or at the fair value of the proportionate share of the net assets acquired. Where the Company acquires an asset via a step transaction, the Company remeasures any previously held interest to fair value.
Revenue recognition	(o) Revenue recognition: Our anesthesia service revenues are derived from anesthesia procedures performed under our professional services agreements. The fees for such services are billed either to a third party payor, including Medicare or Medicaid or to the patient. We recognize anesthesia service revenues, net of contractual adjustments and implicit price concessions, which we estimate based on the historical trend of our cash collections and contractual adjustments. Anesthesia services procedures for each patient qualify as a distinct service obligation, as they are provided simultaneously with other readily available resources during the service procedure. The transaction price is variable and not constrained. Variable consideration relates to contractual allowances, credit provisions and other discounts. The standard requires management to estimate the transaction price, including any implicit concessions from the credit approval process. The Company adopted a portfolio approach to estimate variable consideration transaction price by payor type (patient, government and/or insurer) and the specifics of the services being provided. These portfolios share characteristics such that the results of applying a portfolio approach are not materially different than if the standard was applied to individual patient contracts. Revenue is recognized upon completion of the services to the customer (patient) for practical reasons as the service period is performed over a short time period. The Company recognizes revenue from product sales at the time the product is shipped, which is when title passes to the customer, and when all significant contractual obligations have been satisfied, collection is probable and the amount of revenue can be estimated reliably. Product sales contracts generally contain a single distinct performance obligation, but multiple performance obligations may exist when multiple product types are ordered by a physician in a contract. The transaction price for product sales is fixed and no variable consideration exists. Contract consideration is allocated to each distinct performance obligation in the contract based upon available stand-alone selling prices obtained from historical sales transactions for each product. The Company recognizes revenue from product sales at the point in time when control of the goods passes to the customer (physician) when the product is shipped, which is when title passes to the customer and an obligation to pay for the goods arises. Shipping services performed after control has passed to the customer, if any, is a separate performance obligation, but was determined to be nominal.
Adoption of new accounting standards	(p) Adoption of new accounting standards: i) ASU 2016-02 Leases In February 2016, FASB issued ASU No. 2016-02 “ Leases
New standards and interpretations not yet applied	(q) New standards and interpretations not yet applied: (i) Credit Losses In June 2016, FASB issued ASU No. 2016-13, “ Financial Instruments- Credit Losses (Topic 326)” (ii) Income Taxes – Simplifying the Accounting for Income Taxes In December 2019, the FASB issued ASU 2019-12, Income Taxes – Simplifying the Accounting for Income Taxes (iii) Intangibles – Goodwill and Other (Topic 350) In January 2017, the FASB issued ASU 2017-04, Intangibles – Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment.

Significant accounting polici_3

Significant accounting policies (Tables)	12 Months Ended
	Dec. 31, 2019
Accounting Policies [Abstract]
Estimated Useful Lives and the Methods of Depreciation for Current and Comparative Periods	The s t m te s f v t t d r c t o f t c u r n c p r t v o a a f w s Asset Basis Rate Computer equipment Declining balance 30% Computer software Declining balance 100% Furniture and equipment Declining balance 20% Leasehold improvements initial lease Straight-line Shorter of term or useful life Injection mold Straight-line 5 years
Intangible Assets Finite Lives Amortized Over Period	Intangible assets with finite lives are amortized on a straight-line basis over their estimated useful lives and are measured at cost less accumulated amortization and accumulated impairment losses. Intangible assets with finite lives are amortized over the following periods: Asset Basis Rate Intellectual property rights to the CRH O’Regan System Straight-line 15 years Intellectual property new technology Straight-line 20 years Exclusive professional services agreements Straight-line 4.5 to 15 years

Asset acquisitions (Tables)

Asset acquisitions (Tables)	12 Months Ended
	Dec. 31, 2019
Business Combinations [Abstract]
Summary of Asset Acquisitions	During the year ended December 31, 2019, the Company completed five asset acquisitions. These asset acquisitions have been included in the anesthesia segment of the Company and represents the following: Acquired Operation Date Acquired Consideration Anesthesia Care Associates LLC (“ACA”) January 2019 $ 5,355,028 South Metro Anesthesia Associates LLC (“SMAA”) May 2019 $ 1,791,431 Crystal River Anesthesia Associates LLC (“CRAA”) July 2019 $ 2,174,003 Triad Sedation Associates LLC (“TSA”) November 2019 $ 3,828,661 Florida Panhandle Anesthesia Associates LLC (“FPAA”) December 2019 $ 2,762,302 During the year ended December 31, 2018, the Company completed five asset acquisitions. These asset acquisitions have been included in the anesthesia segment of the Company and represents the following: Acquired Operation Date Acquired Consideration Shreveport Sedation Associates LLC (“SSA”) March 2018 $ 9,495,184 Western Ohio Sedation Associates LLC (“WOSA”) May 2018 $ 6,483,698 Lake Washington Anesthesia LLC (“LWA”) July 2018 $ 5,041,939 Lake Erie Sedation Associates LLC (“LESA”) September 2018 $ 4,233,115 Tennessee Valley Anesthesia Associates LLC (“TVAA”) December 2018 $ 2,255,875
Summary of Fair Value of Consideration Transferred and Allocated Costs of Assets and Liabilities Acquired at Acquisition Date	The following table summarizes the fair value of the consideration transferred and the allocated costs of the assets and liabilities acquired at the acquisition date. ACA SMAA CRAA TSA FPAA Total Cash $ 5,239,003 $ 1,752,465 $ 2,130,000 $ 3,185,843 $ 2,725,000 $ 15,032,311 Acquisition costs 116,025 38,966 44,003 15,173 37,302 251,469 Deferred consideration — — — 627,645 — 627,645 Pre-transaction equity interest — — — 1,595,275 — 1,595,275 Purchase consideration $ 5,355,028 $ 1,791,431 $ 2,174,003 $ 5,423,936 $ 2,762,302 $ 17,506,700 Non-controlling interest $ — $ 1,465,716 $ 2,088,748 $ 5,211,233 $ 2,653,976 $ 11,419,673 $ 5,355,028 $ 3,257,147 $ 4,262,751 $ 10,635,169 $ 5,416,278 $ 28,926,373 Assets and liabilities acquired: Exclusive professional services agreements $ 5,355,028 $ 3,257,147 $ 4,262,751 $ 8,891,711 $ 5,416,278 $ 27,182,915 Cash — — — 115,397 — $ 115,397 Accounts receivable — — — 1,950,219 — $ 1,950,219 Prepaid expenses and deposits — — — 1,518 — $ 1,518 Trade payables and other accruals — — — (323,676 ) — $ (323,676 ) Pre-close accounts receivable 50,000 — — — — $ 50,000 Pre-close accounts payable (50,000 ) — — — — $ (50,000 ) Fair value of net identifiable assets and liabilities acquired $ 5,355,028 $ 3,257,147 $ 4,262,751 $ 10,635,169 $ 5,416,278 $ 28,926,373 Exclusive professional services agreements – amortization term 6 years 5 years 5 years 5 years 5 years CRH ownership interest 100 % 55 % 51 % 51 % 51 % The following table summarizes the fair value of the consideration transferred and the allocated costs of the assets and liabilities acquired at the acquisition date. SSA WOSA LWA LESA TVAA Total Cash $ 9,404,148 $ 6,409,000 $ 5,000,000 $ 4,180,000 $ 2,200,000 $ 27,193,148 Acquisition Costs 91,036 74,698 41,939 53,115 55,875 316,663 Purchase consideration $ 9,495,184 $ 6,483,698 $ 5,041,939 $ 4,233,115 $ 2,255,875 $ 27,509,811 Non-controlling interest $ — $ 6,229,435 $ 4,844,217 $ — $ 2,167,409 $ 13,241,061 $ 9,495,184 $ 12,713,133 $ 9,886,156 $ 4,233,115 $ 4,423,284 $ 40,750,872 Assets and liabilities acquired: Exclusive professional services agreements $ 9,391,036 $ 12,713,133 $ 9,886,155 $ 4,233,115 $ 4,423,284 $ 40,646,723 Prepaid expenses and deposits 104,149 — — — 104,149 Pre-close accounts receivable — — 652,506 — 652,506 Pre-close accounts payable — — (652,506 ) — (652,506 ) Fair value of net identifiable assets and liabilities acquired $ 9,495,185 $ 12,713,133 $ 9,886,155 $ 4,233,115 $ 4,423,284 $ 40,750,872 Exclusive professional services agreements – amortization term 7 years 10 years 7 years 10 years 7 years CRH ownership interest 100 % 51 % 51 % 100 % 51 %
Summary of Asset Acquisition Loan Contribution	The terms of the loans are such that they will be repaid first, prior to any future distributions and are non-interest bearing. ACA SMAA CRAA TSA FPAA Total CRH member loan $ — $ 55,000 $ 63,750 $ — $ 71,400 $ 190,150 Non-controlling interest member loan $ — $ 45,000 $ 61,250 $ — $ 68,600 $ 174,850 Amount outstanding at December 31, 2019 $ — $ — $ — $ — $ 140,000 $ 140,000

Trade and other receivables (Ta

Trade and other receivables (Tables)	12 Months Ended
	Dec. 31, 2019
Receivables [Abstract]
Summary of Trade Receivables and Other Receivable	2019 2018 Trade receivables, gross $ 20,024,916 $ 19,373,260 Other receivables $ 50,756 141,141 Less: allowance for doubtful accounts $ (34,384 ) (46,598 ) $ 20,041,288 $ 19,467,803 Anesthesia segment – trade receivables, gross $ 19,081,177 $ 18,199,847 Product segment – trade receivables, gross 943,739 1,173,413 $ 20,024,916 $ 19,373,260

Trade and other payables (Table

Trade and other payables (Tables)	12 Months Ended
	Dec. 31, 2019
Payables And Accruals [Abstract]
Summary of Trade and Other Payables	2019 2018 Trade payables $ 1,213,276 $ 1,316,821 Accruals and other payables 4,983,465 4,446,401 $ 6,196,741 $ 5,763,222

Right of use assets and relat_2

Right of use assets and related obligations (Tables)	12 Months Ended
	Dec. 31, 2019
Leases [Abstract]
Schedule of Lease Expense Allocated to Operating Segments	Lease expense is allocated to operating segments based on the location of the leases, as follows: 2019 2018 Anesthesia services expense $ 118,943 $ 74,265 Product sales expense 125,160 108,985 Corporate expense 125,160 108,985 $ 369,263 $ 292,235
Schedule of undiscounted lease obligations	The following table presents a maturity analysis of the Company’s undiscounted lease obligations for each of the next five years, reconciled to the obligation as recorded on the balance sheet. Undiscounted lease payments 2020 $ 129,680 2021 55,498 $ 185,178 Accretion related to outstanding lease obligations (5,323 ) Total $ 179,855 Current obligation relating to right of use assets $ 125,555 Long-term obligation relating to right of use assets $ 54,300 Total $ 179,855

Property and equipment (Tables)

Property and equipment (Tables)	12 Months Ended
	Dec. 31, 2019
Property Plant And Equipment [Abstract]
Summary of Property and Equipment	Property and equipment consist of the following: December 31, 2019 2018 Computer equipment and software $ 124,640 $ 94,566 Furniture and equipment 267,051 237,616 Leasehold improvements 5,784 5,784 Injection mold 408,062 408,062 Property and equipment $ 805,537 $ 746,028 Less: Accumulated depreciation (553,604 ) (442,737 ) Property and equipment, net $ 251,933 $ 303,291

Intangible assets (Tables)

Intangible assets (Tables)	12 Months Ended
	Dec. 31, 2019
Goodwill And Intangible Assets Disclosure [Abstract]
Summary of Intangible Assets	Professional Services Agreements Patents Total Cost Balance as at January 1, 2018 $ 215,844,537 $ 532,598 $ 216,377,135 Additions through asset acquisitions (note 4) 40,646,723 — 40,646,723 Balance as at December 31, 2018 $ 256,491,260 $ 532,598 $ 257,023,858 Additions through asset acquisitions and adjustments (note 4) 18,622,130 — $ 18,622,130 Balance as at December 31, 2019 $ 275,113,390 $ 532,598 $ 275,645,988 Professional Services Agreements Patents Total Accumulated depreciation Balance as at January 1, 2018 $ 45,752,303 $ 497,417 $ 46,249,720 Amortization expense 31,387,429 2,446 31,389,875 Balance as at December 31, 2018 $ 77,139,732 $ 499,863 $ 77,639,595 Amortization expense and adjustments (note 4) 34,895,944 2,256 34,898,200 Balance as at December 31, 2019 $ 112,035,676 $ 502,119 $ 112,537,795 Professional Services Agreements Patents Total Net book value December 31, 2019 $ 163,077,714 $ 30,479 $ 163,108,193 December 31, 2018 $ 179,351,528 $ 32,735 $ 179,384,263
Summary of Amortization Expense to be Incurred by Company Over Next Five Years	Based on the Company’s professional services agreements in place at December 31, 2019, the Company anticipates that the amortization expense to be incurred by the Company over the next five years is as follows: Amortization Expense For professional services agreements as at December 31, 2019: 2020 $ 37,438,739 2021 32,132,360 2022 25,411,084 2023 21,264,710 2024 19,339,571 $ 135,586,464

Equity investment (Tables)

Equity investment (Tables)	12 Months Ended
	Dec. 31, 2019
Investments Debt And Equity Securities [Abstract]
Summary of Results of Operations of the TSA Equity Investment	The results of operations of the TSA equity investment, up to the date control was obtained by CRH, is presented below. Results of operations Ten months ended October 31, 2019 Anesthesia revenue $ 4,169,162 Anesthesia services expense 1,514,704 Net income $ 2,654,458

Notes payable (Tables)

Notes payable (Tables)	12 Months Ended
	Dec. 31, 2019
Debt Disclosure [Abstract]
Schedule of Notes Payable	December 31, 2019 2018 Current portion $ — $ 2,239,637 Non-current portion 68,380,345 67,621,470 Total loans and borrowings $ 68,380,345 $ 69,861,107
Summary of Detailed Information about Financial Covenants Ratios	As at December 31, 2019, the Company is required to maintain the following financial covenants in respect of this Facility: Financial Covenant Required Ratio Total leverage ratio Not greater than 3.00:1.00 Interest coverage ratio Not less than 3.00:1.00
Summary of Consolidated Minimum Loans Payments	The consolidated minimum loan payments (principal) in the future for all loan agreements in place as of December 31, 2019 are as follows: Minimum Principal At December 31, 2019 2020 $ — 2021 — 2022 69,341,370 $ 69,341,370

Share capital (Tables)

Share capital (Tables)	12 Months Ended
	Dec. 31, 2019
Text Block [Abstract]
Summary of Stock Option Activity	A summary of the status of the plan as of December 31, 2019 and 2018 is as follows (options are granted in CAD and USD amounts are calculated using prevailing exchange rates): Number of options Weighted average exercise price CAD USD Outstanding, January 1, 2018 1,344,687 $ 0.69 $ 0.55 Issued — — — Exercised — — — Forfeited — — — Expired — — — Outstanding, December 31, 2018 1,344,687 $ 0.69 $ 0.53 Issued 500,000 3.56 2.73 Exercised (840,000 ) (0.68 ) (0.52 ) Forfeited — — — Expired — — — Outstanding, December 31, 2019 1,004,687 $ 2.12 $ 1.63
Summary of Weighted Average Assumptions Used to Estimate Fair Value of Stock Options Granted	The estimated fair value of the stock options granted was determined using the Black-Scholes option-pricing model with the following weighted-average assumptions: 2019 Expected life of options 5.05 years Risk-free interest rate 1.61% Dividend yield 0% Volatility 63% Pre-vest forfeiture rate 3.67%
Schedule of Information With Respect to Stock Options Outstanding and Exercisable	The following table summarizes information about the stock options outstanding as at: December 31, 2019: Exercise price Options outstanding Options exercisable $CAD $USD Number of options Weighted average remaining contractual life (years) Weighted average exercise price ($CAD) Weighted average exercise price ($USD) Number of options Weighted average exercise price ($CAD) Weighted average exercise price ($USD) 0.60 - 0.70 0.46 - 0.57 504,687 4.05 0.69 0.53 504,687 0.69 0.53 3.56 - 3.56 2.73 - 2.73 500,000 9.27 3.56 2.73 — — — December 31, 2018: Exercise price Options outstanding Options exercisable $CAD $USD Number of options Weighted average remaining contractual life (years) Weighted average exercise price ($CAD) Weighted average exercise price ($USD) Number of options Weighted average exercise price ($CAD) Weighted average exercise price ($USD) 0.60 - 0.70 0.44 – 0.51 1,344,687 5.05 0.69 0.50 1,344,687 0.69 0.50
Summary of Status of Share Unit Plan for Other Equity Instruments	A summary of the status of the share unit plan as of December 31, 2019 and 2018 is as follows: Time based share units Performance based share units Outstanding, January 1, 2018 1,036,500 1,350,000 Issued 452,125 150,000 Exercised (364,000 ) — Forfeited (79,375 ) — Expired — — Outstanding, December 31, 2018 1,045,250 1,500,000 Vested — — Expected to vest 1,045,250 1,100,000 Outstanding, January 1, 2019 1,045,250 1,500,000 Issued 1,553,125 — Exercised (325,875 ) — Forfeited (125,000 ) (550,000 ) Expired — — Outstanding, December 31, 2019 2,147,500 950,000 Vested — - Expected to vest 2,147,500 - Time based share units Performance based share units Outstanding, January 1, 2019 1,045,250 1,500,000 Weighted average contractual life (years) 2.74 7.99 Outstanding, December 31, 2019 2,147,500 950,000 Weighted average contractual life (years) 3.03 7.02
Summary of Calculation of Basic Earnings Per Share	The calculation of basic earnings per share for the years ended December 31, 2019 and 2018 is as follows: 2019 2018 Net earnings Weighted average number of common shares outstanding Per share amount Net earnings Weighted average number of common shares outstanding Per share amount Net earnings attributable to shareholders: Earnings per common share: Basic $ 3,771,163 71,536,310 0.053 $ 4,679,921 72,582,733 $ 0.064 Share options 421,249 1,122,708 Share units 739,980 379,731 Diluted $ 3,771,163 72,697,539 $ 0.052 $ 4,679,921 74,085,172 $ 0.063

Income taxes (Tables)

Income taxes (Tables)	12 Months Ended
	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Summary of Income Tax Expense	(a) Income tax expense is comprised of the following: 2019 2018 Current tax expense $ 5,067,182 $ 5,119,062 Deferred tax recovery (3,440,121 ) (2,407,176 ) Total tax expense $ 1,627,061 $ 2,711,886 The reconciliation of income tax computed at statutory tax rates to income tax expense, using a 27% (2018 – 27%) statutory rate, is: 2019 2018 Net income before tax – Canada $ 6,889,481 $ 5,957,089 Net income before tax – United States 2,950,064 9,770,714 Net income before tax – All jurisdictions $ 9,839,545 $ 15,727,803 Tax expense at statutory income tax rates $ 2,656,677 $ 4,259,890 Permanent differences (50,235 ) 503,964 Income attributable to non-controlling interest (1,192,280 ) (2,245,809 ) Foreign income taxed at different rates 33,189 (26,042 ) Impact of change in tax rates 26,902 216,295 Other 152,808 3,588 Total tax expense $ 1,627,061 $ 2,711,886
Summary of Deferred Tax Assets and Liabilities	The Company had the following deferred tax assets and liabilities resulting from temporary differences recognized for financial statement and income tax purposes. 2019 2018 Deferred tax assets: Property and equipment $ 2,684 356 Intangible assets 9,222,824 4,752,898 Finance related costs 224,986 375,182 Reserves 64,755 — Share transaction costs — 87,337 Stock-based compensation 767,228 534,926 Earn-out obligation 265,660 732,986 Deferred tax liabilities: Property and equipment (23,757 ) (40,357 ) Deferred consideration (4,226 ) (18,388 ) Reserves (83,206 ) (55,568 ) Unrealized foreign exchange (20,610 ) (20,698 ) Finance related costs (78,060 ) (68,938 ) Net deferred tax asset $ 10,338,278 $ 6,279,736 Deferred tax assets by jurisdiction 2019 2018 Canada: Deferred tax asset $ — $ 87,343 Deferred tax liability (101,822 ) (109,294 ) Net deferred tax asset (liability) $ (101,822 ) $ (21,951 ) United States: Deferred tax asset $ 10,548,137 $ 6,396,341 Deferred tax liability (108,037 ) (94,654 ) Net deferred tax asset (liability) $ 10,440,100 $ 6,301,687

Net finance expense (Tables)

Net finance expense (Tables)	12 Months Ended
	Dec. 31, 2019
Text Block [Abstract]
Summary of Net Finance Expense	Recognized in earnings in the years ended December 31: 2019 2018 Finance expense: Interest and accretion expense on borrowings $ 3,288,704 $ 3,168,762 Accretion expense on earn-out obligation and deferred consideration 133,450 166,575 Amortization of deferred financing fees 276,260 260,363 Net change in fair value of financial liabilities at fair value through earnings 2,861,204 971,627 Other 50,000 — Total finance expense $ 6,609,618 $ 4,567,327 Net finance expense $ 6,609,618 $ 4,567,327

Financial instruments (Tables)

Financial instruments (Tables)	12 Months Ended
	Dec. 31, 2019
Investments All Other Investments [Abstract]
Schedule of Fair Value of Financial Instruments	Liabilities December 31, 2019 Level 1 Level 2 Level 3 Earn-out obligation $ 1,063,060 $ — $ — $ 1,063,060 Total $ 1,063,060 $ — $ — $ 1,063,060 Liabilities December 31, 2018 Level 1 Level 2 Level 3 Earn-out obligation $ 2,920,583 $ — $ — $ 2,920,583 Total $ 2,920,583 $ — $ — $ 2,920,583
Summary of Reconciliation of Level 3 Fair Values	Earn-out obligation Balance as at January 1, 2019 $ 2,920,583 Payment (4,795,822 ) Recorded in finance expense: Accretion expense 77,095 Fair value adjustment $ 2,861,204 Balance as at December 31, 2019 $ 1,063,060

Segmented information (Tables)

Segmented information (Tables)	12 Months Ended
	Dec. 31, 2019
Segment Reporting [Abstract]
Summary of Revenues Relating to Geographic Segments	The revenues relating to geographic segments based on customer location, in United States dollars, for the years ended December 31, 2019 and 2018 are as follows 2019 2018 Revenue: Canada and other $ 225,807 $ 271,803 United States 120,159,467 112,477,577 Total $ 120,385,274 $ 112,749,380
Summary of Revenue from Contract with Customer	The Company’s revenues are disaggregated below into categories which differ in terms of the economic factors which impact the amount, timing and uncertainty of revenue and cash flows. 2019 2018 Revenue: Commercial Insurers $ 90,332,380 $ 86,992,218 Federal Insurers 19,404,851 14,246,626 Physicians 10,078,843 10,959,215 Other 569,200 551,321 Total $ 120,385,274 $ 112,749,380
Summary of Property and Equipment, Intangibles and Other Assets Located in Geographic Regions	The Company’s property and equipment, intangibles, other assets and total assets are located in the following geographic regions as at December 31, 2019 and 2018: 2019 2018 Property and equipment: Canada $ 210,386 $ 276,621 United States $ 41,547 26,670 Total $ 251,933 $ 303,291 Intangible assets: Canada $ 30,478 $ 32,735 United States $ 163,077,715 179,351,528 Total $ 163,108,193 $ 179,384,263 Total assets: Canada $ 3,231,845 $ 9,293,796 United States $ 199,863,424 209,694,200 Total $ 203,095,269 $ 218,987,996
Summary of Operating Segments	The financial measures reviewed by the Company’s Chief Operating Decision Maker are presented below for the years ended December 31, 2019 and 2018. The Company does not allocate expenses related to corporate activities. These expenses are presented within “Other” to allow for reconciliation to reported measures. 2019 Anesthesia services Product sales Other Total Revenue $ 110,306,431 $ 10,078,843 $ — $ 120,385,274 Operating costs 94,506,039 4,647,719 6,549,321 105,703,079 Operating income (loss) $ 15,800,392 $ 5,431,124 $ (6,549,321 ) $ 14,682,195 2018 Anesthesia services Product sales Other Total Revenue $ 101,790,165 $ 10,959,215 $ — $ 112,749,380 Operating costs 81,079,150 5,022,737 6,352,363 92,454,250 Operating income (loss) $ 20,711,015 $ 5,936,478 $ (6,352,363 ) $ 20,295,130 Additionally, the company incurs the following in each of its operating segments: 2019 Anesthesia services Product sales Other Total Finance expense $ 2,994,654 $ — $ 3,614,964 $ 6,609,618 Depreciation and amortization expense $ 34,908,764 $ 25,534 $ 74,772 $ 35,009,070 2018 Anesthesia services Product sales Other Total Finance expense $ 1,138,200 $ — $ 3,429,127 $ 4,567,327 Depreciation and amortization expense $ 31,394,245 $ 68,509 $ 23,301 $ 31,486,055

Significant Accounting Polici_4

Significant Accounting Policies - Estimated Useful Lives and the Methods of Depreciation for Current and Comparative Periods (Detail)	12 Months Ended
	Dec. 31, 2019
Computer Equipment and Software [Member]
Property, Plant and Equipment [Line Items]
Basis	Declining balance
Rate	30%
Computer Software [Member]
Property, Plant and Equipment [Line Items]
Basis	Declining balance
Rate	100%
Furniture And Equipment [Member]
Property, Plant and Equipment [Line Items]
Basis	Declining balance
Rate	20%
Leasehold Improvements Initial Lease [Member]
Property, Plant and Equipment [Line Items]
Basis	Straight-line
Lease term or useful life	Shorter of term or useful life
Injection Mold [Member]
Property, Plant and Equipment [Line Items]
Basis	Straight-line
Lease term or useful life	5 years

Significant Accounting Polici_5

Significant Accounting Policies - Intangible Assets Finite Lives Amortized Over Period (Detail)	12 Months Ended
	Dec. 31, 2019
Intellectual Property Rights to the CRH O'Regan System [Member]
Finite-Lived Intangible Assets [Line Items]
Basis	Straight-line
Rate	15 years
Intellectual Property New Technology [Member]
Finite-Lived Intangible Assets [Line Items]
Basis	Straight-line
Rate	20 years
Exclusive Professional Services Agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Basis	Straight-line
Exclusive Professional Services Agreements [Member] | Minimum [Member]
Finite-Lived Intangible Assets [Line Items]
Rate	4 years 6 months
Exclusive Professional Services Agreements [Member] | Maximum [Member]
Finite-Lived Intangible Assets [Line Items]
Rate	15 years

Significant Accounting Polici_6

Significant Accounting Policies - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Jan. 01, 2019
Significant Accounting Policies [Abstract]
Minimum percentage likelihood to recognize tax benefit from uncertain tax position	50.00%
Right of use assets	$ 214,854	$ 332,512
Operating Lease, Liability	$ 179,855	$ 295,188

Asset acquisitions - Additional

Asset acquisitions - Additional Information (Detail)	Nov. 01, 2019USD ($)	Aug. 31, 2019USD ($)	Apr. 03, 2019USD ($)	Sep. 30, 2019USD ($)	Dec. 31, 2019USD ($)Acquisition	Dec. 31, 2018USD ($)Acquisition	Oct. 30, 2019	Aug. 30, 2019	Apr. 02, 2019
Business Acquisition [Line Items]
Number of asset acquisitions completed | Acquisition					5	5
Asset acquired control, description					The Company has obtained control over the acquired assets via the Company’s majority ownership in the shares of the entities and its agreements with the non-controlling interest shareholders.
Ownership interest acquired					100.00%
Business combination loan contribution description					For those asset acquisitions where CRH ownership interest is less than 100%, in conjunction with the acquisition, both the Company and the non-controlling interest shareholder contributed loans. The terms of the loans are such that they will be repaid first, prior to any future distributions and are non-interest bearing.
Total cash consideration					$ 15,052,058	$ 27,509,811
Deferred asset acquisition costs					59,249	$ 116,025
Purchase adjustment relating to anesthesia service providers acquired in prior periods					4,366,000
Gain from equity investments					$ 1,766,968
Arapahoe [Member]
Business Acquisition [Line Items]
Ownership interest acquired			49.00%						51.00%
Total cash consideration			$ 2,300,000
Percentage of working capital paid for acquisition of remaining ownership interest			49.00%
Deferred asset acquisition costs			$ 26,086
CCAA [Member]
Business Acquisition [Line Items]
Ownership interest acquired		49.00%						51.00%
Total cash consideration		$ 7,000,000
Percentage of working capital paid for acquisition of remaining ownership interest		49.00%
Deferred asset acquisition costs		$ 18,658
Lake Washington Anesthesia LLC [Member]
Business Acquisition [Line Items]
Purchase adjustment relating to anesthesia service providers acquired in prior periods				$ 4,366,000
TSA [Member]
Business Acquisition [Line Items]
Options to acquire additional interest percent	36.00%
Percentage of equity interest							15.00%
Gain from equity investments	$ 1,318,769

Asset acquisitions - Summary of

Asset acquisitions - Summary of Asset Acquisitions (Detail) - Anesthesia Services [Member] - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Consideration	$ 17,506,700	$ 27,509,811
Anesthesia Care Associates LLC [Member]
Business Acquisition [Line Items]
Date Acquired	2019-01
Consideration	$ 5,355,028
South Metro Anesthesia Associates LLC [Member]
Business Acquisition [Line Items]
Date Acquired	2019-05
Consideration	$ 1,791,431
Crystal River Anesthesia Associates, LLC [Member]
Business Acquisition [Line Items]
Date Acquired	2019-07
Consideration	$ 2,174,003
Triad Sedation Associates LLC [Member]
Business Acquisition [Line Items]
Date Acquired	2019-11
Consideration	$ 5,423,936
Consideration	$ 3,828,661
Florida Panhandle Anesthesia Associates LLC [Member]
Business Acquisition [Line Items]
Date Acquired	2019-12
Consideration	$ 2,762,302
Shreveport Sedation Associates LLC [Member]
Business Acquisition [Line Items]
Date Acquired		2018-03
Consideration		$ 9,495,184
Western Ohio Sedation Associates LLC [Member]
Business Acquisition [Line Items]
Date Acquired		2018-05
Consideration		$ 6,483,698
Lake Washington Anesthesia LLC [Member]
Business Acquisition [Line Items]
Date Acquired		2018-07
Consideration		$ 5,041,939
Lake Erie Sedation Associates LLC [Member]
Business Acquisition [Line Items]
Date Acquired		2018-09
Consideration		$ 4,233,115
Tennessee Valley Anesthesia Associates LLC [Member]
Business Acquisition [Line Items]
Date Acquired		2018-12
Consideration		$ 2,255,875

Asset acquisitions - Summary _2

Asset acquisitions - Summary of Fair Value of Consideration Transferred and Allocated Costs of Assets and Liabilities Acquired at Acquisition Date (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Assets and liabilities acquired:
CRH ownership interest	100.00%
Anesthesia Services [Member]
Business Acquisition [Line Items]
Cash	$ 15,032,311	$ 27,193,148
Acquisition costs	251,469	316,663
Deferred consideration	627,645
Pre-transaction equity interest	1,595,275
Purchase consideration	17,506,700	27,509,811
Non-controlling interest	11,419,673	13,241,061
Fair value of net identifiable assets and liabilities acquired	28,926,373	40,750,872
Assets and liabilities acquired:
Exclusive professional services agreements	27,182,915	40,646,723
Cash	115,397
Accounts receivable	1,950,219
Prepaid expenses and deposits	1,518	104,149
Trade payables and other accruals	(323,676)
Pre-close accounts receivable	50,000	652,506
Pre-close accounts payable	(50,000)	(652,506)
Fair value of net identifiable assets and liabilities acquired	28,926,373	40,750,872
Anesthesia Services [Member] | ACA [Member]
Business Acquisition [Line Items]
Cash	5,239,003
Acquisition costs	116,025
Purchase consideration	5,355,028
Fair value of net identifiable assets and liabilities acquired	5,355,028
Assets and liabilities acquired:
Exclusive professional services agreements	5,355,028
Pre-close accounts receivable	50,000
Pre-close accounts payable	(50,000)
Fair value of net identifiable assets and liabilities acquired	$ 5,355,028
Exclusive professional services agreements – amortization term	6 years
CRH ownership interest	100.00%
Anesthesia Services [Member] | SMAA [Member]
Business Acquisition [Line Items]
Cash	$ 1,752,465
Acquisition costs	38,966
Purchase consideration	1,791,431
Non-controlling interest	1,465,716
Fair value of net identifiable assets and liabilities acquired	3,257,147
Assets and liabilities acquired:
Exclusive professional services agreements	3,257,147
Fair value of net identifiable assets and liabilities acquired	$ 3,257,147
Exclusive professional services agreements – amortization term	5 years
CRH ownership interest	55.00%
Anesthesia Services [Member] | CRAA [Member]
Business Acquisition [Line Items]
Cash	$ 2,130,000
Acquisition costs	44,003
Purchase consideration	2,174,003
Non-controlling interest	2,088,748
Fair value of net identifiable assets and liabilities acquired	4,262,751
Assets and liabilities acquired:
Exclusive professional services agreements	4,262,751
Fair value of net identifiable assets and liabilities acquired	$ 4,262,751
Exclusive professional services agreements – amortization term	5 years
CRH ownership interest	51.00%
Anesthesia Services [Member] | TSA [Member]
Business Acquisition [Line Items]
Cash	$ 3,185,843
Acquisition costs	15,173
Deferred consideration	627,645
Pre-transaction equity interest	1,595,275
Purchase consideration	5,423,936
Non-controlling interest	5,211,233
Fair value of net identifiable assets and liabilities acquired	10,635,169
Assets and liabilities acquired:
Exclusive professional services agreements	8,891,711
Cash	115,397
Accounts receivable	1,950,219
Prepaid expenses and deposits	1,518
Trade payables and other accruals	(323,676)
Fair value of net identifiable assets and liabilities acquired	$ 10,635,169
Exclusive professional services agreements – amortization term	5 years
CRH ownership interest	51.00%
Anesthesia Services [Member] | FPAA [Member]
Business Acquisition [Line Items]
Cash	$ 2,725,000
Acquisition costs	37,302
Purchase consideration	2,762,302
Non-controlling interest	2,653,976
Fair value of net identifiable assets and liabilities acquired	5,416,278
Assets and liabilities acquired:
Exclusive professional services agreements	5,416,278
Fair value of net identifiable assets and liabilities acquired	$ 5,416,278
Exclusive professional services agreements – amortization term	5 years
CRH ownership interest	51.00%
Anesthesia Services [Member] | Shreveport Sedation Associates LLC [Member]
Business Acquisition [Line Items]
Cash		9,404,148
Acquisition costs		91,036
Purchase consideration		9,495,184
Non-controlling interest		0
Fair value of net identifiable assets and liabilities acquired		9,495,184
Assets and liabilities acquired:
Exclusive professional services agreements		9,391,036
Prepaid expenses and deposits		104,149
Pre-close accounts receivable		0
Pre-close accounts payable		0
Fair value of net identifiable assets and liabilities acquired		$ 9,495,185
Exclusive professional services agreements – amortization term		7 years
CRH ownership interest		100.00%
Anesthesia Services [Member] | Western Ohio Sedation Associates LLC [Member]
Business Acquisition [Line Items]
Cash		$ 6,409,000
Acquisition costs		74,698
Purchase consideration		6,483,698
Non-controlling interest		6,229,435
Fair value of net identifiable assets and liabilities acquired		12,713,133
Assets and liabilities acquired:
Exclusive professional services agreements		12,713,133
Prepaid expenses and deposits		0
Pre-close accounts receivable		0
Pre-close accounts payable		0
Fair value of net identifiable assets and liabilities acquired		$ 12,713,133
Exclusive professional services agreements – amortization term		10 years
CRH ownership interest		51.00%
Anesthesia Services [Member] | Lake Washington Anesthesia LLC [Member]
Business Acquisition [Line Items]
Cash		$ 5,000,000
Acquisition costs		41,939
Purchase consideration		5,041,939
Non-controlling interest		4,844,217
Fair value of net identifiable assets and liabilities acquired		9,886,156
Assets and liabilities acquired:
Exclusive professional services agreements		9,886,155
Prepaid expenses and deposits		0
Pre-close accounts receivable		652,506
Pre-close accounts payable		(652,506)
Fair value of net identifiable assets and liabilities acquired		$ 9,886,155
Exclusive professional services agreements – amortization term		7 years
CRH ownership interest		51.00%
Anesthesia Services [Member] | Lake Erie Sedation Associates LLC [Member]
Business Acquisition [Line Items]
Cash		$ 4,180,000
Acquisition costs		53,115
Purchase consideration		4,233,115
Non-controlling interest		0
Fair value of net identifiable assets and liabilities acquired		4,233,115
Assets and liabilities acquired:
Exclusive professional services agreements		4,233,115
Prepaid expenses and deposits		0
Pre-close accounts receivable		0
Pre-close accounts payable		0
Fair value of net identifiable assets and liabilities acquired		$ 4,233,115
Exclusive professional services agreements – amortization term		10 years
CRH ownership interest		100.00%
Anesthesia Services [Member] | Tennessee Valley Anesthesia LLC [Member]
Business Acquisition [Line Items]
Cash		$ 2,200,000
Acquisition costs		55,875
Purchase consideration		2,255,875
Non-controlling interest		2,167,409
Fair value of net identifiable assets and liabilities acquired		4,423,284
Assets and liabilities acquired:
Exclusive professional services agreements		4,423,284
Fair value of net identifiable assets and liabilities acquired		$ 4,423,284
Exclusive professional services agreements – amortization term		7 years
CRH ownership interest		51.00%

Asset acquisitions - Summary _3

Asset acquisitions - Summary of Asset Acquisition Loan Contribution (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Acquisition Date [Line Items]
Amount outstanding at December 31, 2019	$ 68,600	$ 49,000
Anesthesia Services [Member]
Acquisition Date [Line Items]
CRH member loan	190,150
Non-controlling interest member loan	174,850
Amount outstanding at December 31, 2019	140,000
Anesthesia Services [Member] | SMAA [Member]
Acquisition Date [Line Items]
CRH member loan	55,000
Non-controlling interest member loan	45,000
Anesthesia Services [Member] | CRAA [Member]
Acquisition Date [Line Items]
CRH member loan	63,750
Non-controlling interest member loan	61,250
Anesthesia Services [Member] | FPAA [Member]
Acquisition Date [Line Items]
CRH member loan	71,400
Non-controlling interest member loan	68,600
Amount outstanding at December 31, 2019	$ 140,000

Trade and Other Receivables - S

Trade and Other Receivables - Summary of Trade Receivables and Other Receivable (Detail) - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Balance Sheet Related Disclosures [Line Items]
Trade receivables, gross	$ 20,024,916	$ 19,373,260
Other receivables	50,756	141,141
Less: allowance for doubtful accounts	(34,384)	(46,598)
Receivables net current	20,041,288	19,467,803
Anesthesia Services [Member]
Balance Sheet Related Disclosures [Line Items]
Trade receivables, gross	19,081,177	18,199,847
Product Sales [Member]
Balance Sheet Related Disclosures [Line Items]
Trade receivables, gross	$ 943,739	$ 1,173,413

Trade and Other Payables - Summ

Trade and Other Payables - Summary of Trade and Other Payables (Detail) - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Debt Instruments [Abstract]
Trade payables	$ 1,213,276	$ 1,316,821
Accruals and other payables	4,983,465	4,446,401
Total	$ 6,196,741	$ 5,763,222

Right of use assets and relat_3

Right of use assets and related obligations - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Jan. 01, 2019
Right of use assets	$ 214,854		$ 332,512
Operating Lease obligations	179,855		295,188
Lease cost	369,263	$ 292,235
Fixed lease payments	285,890
Variable lease cost	$ 83,373
Weighted average lease term	1 year 3 months 18 days
Accounting Standards Update 2016-02 [Member]
Right of use assets			332,512
Operating Lease obligations			$ 295,188

Right of use assets and relat_4

Right of use assets and related obligations - Lease expense (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Lease, Cost	$ 369,263	$ 292,235
Anesthesia Services [Member]
Lease, Cost	118,943	74,265
Product Sales [Member]
Lease, Cost	125,160	108,985
Corporate Segment [Member]
Lease, Cost	$ 125,160	$ 108,985

Right of use assets and relat_5

Right of use assets and related obligations (Detail) - USD ($)	Dec. 31, 2019	Jan. 01, 2019
Leases [Abstract]
2020	$ 129,680
2021	55,498
Total	185,178
Accretion related to outstanding lease obligations	(5,323)
Operating Lease, Liability	179,855	$ 295,188
Current obligation relating to right of use assets	125,555
Long-term obligation relating to right of use assets	54,300
Total	$ 179,855	$ 295,188

Property and Equipment - Summar

Property and Equipment - Summary of Property and Equipment (Detail) - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Line Items]
Property and equipment, Gross	$ 805,537	$ 746,028
Less: Accumulated depreciation	(553,604)	(442,737)
Property and equipment, net	251,933	303,291
Computer Equipment and Software [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, Gross	124,640	94,566
Furniture and Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, Gross	267,051	237,616
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, Gross	5,784	5,784
Injection Mold [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, Gross	$ 408,062	$ 408,062

Intangible Assets - Summary of

Intangible Assets - Summary of Intangible Assets (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Finite-Lived Intangible Assets [Line Items]
Beginning balance	$ 257,023,858	$ 216,377,135
Additions through asset acquisitions and adjustments (note 4)	18,622,130	40,646,723
Ending balance	275,645,988	257,023,858
Beginning balance	77,639,595	46,249,720
Amortization expense and adjustments (note 4)	34,898,200	31,389,875
Ending balance	112,537,795	77,639,595
Net balance	163,108,193	179,384,263
Professional Services Agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Beginning balance	256,491,260	215,844,537
Additions through asset acquisitions and adjustments (note 4)	18,622,130	40,646,723
Ending balance	275,113,390	256,491,260
Beginning balance	77,139,732	45,752,303
Amortization expense and adjustments (note 4)	34,895,944	31,387,429
Ending balance	112,035,676	77,139,732
Net balance	163,077,714	179,351,528
Patents [Member]
Finite-Lived Intangible Assets [Line Items]
Beginning balance	532,598	532,598
Ending balance	532,598	532,598
Beginning balance	499,863	497,417
Amortization expense and adjustments (note 4)	2,256	2,446
Ending balance	502,119	499,863
Net balance	$ 30,479	$ 32,735

Intangible Assets - Additional

Intangible Assets - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2019Service	Dec. 31, 2018USD ($)Service
Intangible Assets Net Excluding Goodwill [Abstract]
Number of professional services agreements identified with impairment indicators	6	4
Number of professional services agreements identified for impairment upon undiscounted cash flow models	2	2
Impairment of Intangible Assets | $		$ 0
Renewal term of professional services agreements	3 years 3 months 10 days
Weighted average amortization period	5 years 1 month 28 days

Intangible Assets - Summary o_2

Intangible Assets - Summary of Amortization Expense to be Incurred by Company Over Next Five Years (Detail) - Professional Services Agreements [Member]	Dec. 31, 2019USD ($)
Finite Lived Intangible Assets, Future Amortization Expense [Line Items]
2020	$ 37,438,739
2021	32,132,360
2022	25,411,084
2023	21,264,710
2024	19,339,571
Amortization Expense	$ 135,586,464

Equity investment - Additional

Equity investment - Additional Information (Detail) - USD ($)	Nov. 01, 2019	Oct. 31, 2019	Dec. 31, 2019	Dec. 31, 2018	Oct. 31, 2018
Income/gain from equity investment			$ 1,766,968
Triad Sedation Associates LLC [Member] | Anesthesia Services [Member]
Percentage of equity interest					15.00%
Options to acquire additional interest percent				36.00%
Exercise of options to acquire additional interest percent	36.00%
Income/gain from equity investment	$ 1,318,769	$ 448,199

Equity investment - Summary of

Equity investment - Summary of Results of Operations of the TSA Equity Investment (Detail) - Triad Sedation Associates LLC [Member]	10 Months Ended
	Oct. 31, 2019USD ($)
Results of operations
Anesthesia revenue	$ 4,169,162
Anesthesia services expense	1,514,704
Net income	$ 2,654,458

Notes Payable - Summary of Note

Notes Payable - Summary of Notes Payable (Detail) - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Notes Payable [Line Items]
Total loans and borrowings	$ 69,341,370
Scotia Facility [Member]
Notes Payable [Line Items]
Current portion		$ 2,239,637
Non-current portion	68,380,345	67,621,470
Total loans and borrowings	$ 68,380,345	$ 69,861,107

Notes Payable - Additional Info

Notes Payable - Additional Information (Detail) - USD ($)	Oct. 22, 2019	Jun. 26, 2017	Nov. 24, 2015	Dec. 31, 2018	Sep. 30, 2019	Jun. 15, 2016
JP Morgan Facility [Member]
Notes Payable [Line Items]
Line of credit facility, initiation date	Oct. 22, 2019
Line of credit facility, maturity period	3 years
Line of credit facility, maximum borrowing capacity	$ 200,000,000				$ 100,000,000
Line of credit facility, committed amount	125,000,000
Line of credit facility, additional borrowing capacity	$ 75,000,000
Line of credit facility, maturity date	Oct. 22, 2022
Deferred financing fees	$ 839,893
Line of credit facility, annual repayment	0
Line of credit facility, quarterly repayment	$ 0
Scotia Facility [Member]
Notes Payable [Line Items]
Line of credit facility, maximum borrowing capacity		$ 100,000,000				$ 55,000,000
Borrowings, adjustment to interest rate basis				2.50%
Credit facility maturity date		Jun. 26, 2020	Apr. 30, 2018
Borrowing interest rate				LIBOR plus 2.50%
LIBOR [Member] | JP Morgan Facility [Member] | Minimum [Member]
Notes Payable [Line Items]
Borrowings, adjustment to interest rate basis	1.25%
LIBOR [Member] | JP Morgan Facility [Member] | Maximum [Member]
Notes Payable [Line Items]
Borrowings, adjustment to interest rate basis	1.75%

Notes Payable - Summary of Deta

Notes Payable - Summary of Detailed Information about Financial Covenants Ratios (Detail)	Dec. 31, 2019
Minimum [Member]
Notes Payable [Line Items]
Total leverage ratio	3
Maximum [Member]
Notes Payable [Line Items]
Interest coverage ratio	3

Notes Payable - Summary of Cons

Notes Payable - Summary of Consolidated Minimum Loan Payments (Detail)	Dec. 31, 2019USD ($)
Debt Disclosure [Abstract]
2022	$ 69,341,370
Total loans and borrowings	$ 69,341,370

Share Capital - Additional Info

Share Capital - Additional Information (Detail)	Jan. 04, 2019shares	Nov. 08, 2017shares	Dec. 31, 2019USD ($)$ / sharesshares	Dec. 31, 2019CAD ($)$ / sharesshares	Dec. 31, 2018USD ($)$ / sharesshares	Dec. 31, 2018CAD ($)$ / sharesshares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of shares authorized			100,000,000	100,000,000
Share based payment awards issued			0	0	0	0
Dividend yield			0.00%	0.00%
Compensation expense related to granting and vesting of share unit | $			$ 737,548		$ 2,800,280
Number of shares authorized to repurchase		6,974,495
Maximum percentage of shares approved in normal course issuer bid		9.80%
Maximum daily repurchase in normal course issuer bid		14,875
Repurchase of shares			1,607,579	1,607,579	1,264,900	1,264,900
Total cost, including transaction fee			$ 4,754,295	$ 6,313,347	$ 3,784,733	$ 4,945,155
Options [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares excluded from diluted weighted average number of common shares calculation			502,529	502,529	221,979	221,979
Share units [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares excluded from diluted weighted average number of common shares calculation			1,883,204	1,883,204	2,095,260	2,095,260
Common Stock [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Common shares issued on vesting of share units, shares			325,875	325,875	364,000	364,000
Shares cancelled under normal course issuer bid	10,400				1,254,500	1,254,500
Options [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of shares authorized to grant			2,575,492	2,575,492
Options nonvested			500,000	500,000
Weighted average fair value of stock options granted | (per share)			$ 1.43	$ 1.86
Dividend yield			0.00%	0.00%
Intrinsic value of options, exercised | $			$ 2,067,497
Fair value of options, exercised | $			306,798
Compensation expense | $			$ 239,413		$ 468
Options [Member] | Minimum [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options term			2 years	2 years
Stock options vesting period			18 months	18 months
Options [Member] | Minimum [Member] | Consultants Providing Investor Relations Activities [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options vesting period			12 months	12 months
Options [Member] | Maximum [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options term			10 years	10 years
Restricted Stock Units (RSUs) [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of other equity instruments issued			482,679	482,679
Intrinsic value of share units, vested | $			$ 1,038,456
Fair value of share units, vested | $			$ 1,159,913
Time Based Share Units [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of other equity instruments issued			1,553,125	1,553,125	452,125	452,125
Weighted average exercise price of other equity instruments issued | (per share)			$ 2.93	$ 3.81	$ 3.45	$ 4.71
Number of other equity instruments vested			325,875	325,875	364,000	364,000
Performance Based Share Units [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of other equity instruments issued					150,000	150,000
Weighted average exercise price of other equity instruments issued | (per share)					$ 2.78	$ 3.79

Share Capital - Summary of Stoc

Share Capital - Summary of Stock Option Activity (Detail)	12 Months Ended
	Dec. 31, 2019$ / sharesshares	Dec. 31, 2019$ / sharesshares	Dec. 31, 2018$ / sharesshares	Dec. 31, 2018$ / sharesshares
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Number of options, Beginning balance	1,344,687	1,344,687	1,344,687	1,344,687
Issued	500,000	500,000	0	0
Exercised	(840,000)	(840,000)
Number of options, Ending balance	1,004,687	1,004,687	1,344,687	1,344,687
Weighted average exercise price, Beginning balance | (per share)	$ 0.53	$ 0.69	$ 0.55	$ 0.69
Weighted average exercise price, Issued | (per share)	2.73	3.56
Weighted average exercise price, Exercised | (per share)	(0.52)	(0.68)
Weighted average exercise price, Ending balance | (per share)	$ 1.63	$ 2.12	$ 0.53	$ 0.69

Share Capital - Summary of Weig

Share Capital - Summary of Weighted Average Assumptions Used to Estimate Fair Value of Stock Options Granted (Detail)	12 Months Ended
	Dec. 31, 2019
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Expected life of options	5 years 18 days
Risk-free interest rate	1.61%
Dividend yield	0.00%
Volatility	63.00%
Pre-vest forfeiture rate	3.67%

Share Capital - Schedule of Inf

Share Capital - Schedule of Information With Respect to Stock Options Outstanding and Exercisable (Detail)	12 Months Ended
	Dec. 31, 2019$ / sharesshares	Dec. 31, 2019$ / shares$ / sharesshares	Dec. 31, 2018$ / sharesshares	Dec. 31, 2018$ / shares$ / sharesshares	Dec. 31, 2019$ / sharesshares	Dec. 31, 2018$ / sharesshares
Exercise Price Range One [Member]
Disclosure of Compensation Related Costs, Share based Payments [Abstract]
Exercise price | (per share)	$ 0.46	$ 0.60	$ 0.44	$ 0.60
Exercise price | (per share)	$ 0.57	$ 0.70	$ 0.51	$ 0.70
Number of options	504,687	504,687	1,344,687	1,344,687	504,687	1,344,687
Options outstanding Weighted average remaining contractual life (years)	4 years 18 days	4 years 18 days	5 years 18 days	5 years 18 days
Options outstanding Weighted average exercise price | (per share)	$ 0.53	$ 0.53	$ 0.50	$ 0.50	$ 0.69	$ 0.69
Number of options	504,687	504,687	1,344,687	1,344,687	504,687	1,344,687
Options exercisable Weighted average exercise price ($CAD) | (per share) | (per share)	$ 0.53	$ 0.53	$ 0.50	$ 0.50	$ 0.69	$ 0.69
Exercise Price Range Two [Member]
Disclosure of Compensation Related Costs, Share based Payments [Abstract]
Exercise price | (per share)	2.73	$ 3.56
Exercise price | (per share)	$ 2.73	$ 3.56
Number of options	500,000	500,000			500,000
Options outstanding Weighted average remaining contractual life (years)	9 years 3 months 7 days	9 years 3 months 7 days
Options outstanding Weighted average exercise price | (per share)	$ 2.73	$ 2.73			$ 3.56

Share Capital - Summary of Stat

Share Capital - Summary of Status of Share Unit Plan for Other Equity Instruments (Detail) - shares	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Time Based Share Units [Member]
Disclosure of Compensation Related Costs, Share based Payments [Abstract]
Beginning balance	1,045,250	1,036,500
Issued	1,553,125	452,125
Exercised	(325,875)	(364,000)
Forfeited	(125,000)	(79,375)
Ending balance	2,147,500	1,045,250
Expected to vest	2,147,500	1,045,250
Expected to vest	2,147,500	1,045,250
Weighted average contractual life (years)	3 years 10 days	2 years 8 months 26 days
Performance Based Share Units [Member]
Disclosure of Compensation Related Costs, Share based Payments [Abstract]
Beginning balance	1,500,000	1,350,000
Issued		150,000
Forfeited	(550,000)
Ending balance	950,000	1,500,000
Expected to vest		1,100,000
Expected to vest	950,000	1,500,000
Weighted average contractual life (years)	7 years 7 days	7 years 11 months 26 days

Share Capital - Summary of Calc

Share Capital - Summary of Calculation of Basic Earnings (loss) Per Share (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net earnings, Basic	$ 3,771,163	$ 4,679,921
Net earnings, Diluted	$ 3,771,163	$ 4,679,921
Weighted average number of common shares outstanding, Basic	71,536,310	72,582,733
Weighted average number of common shares outstanding, Diluted	72,697,539	74,085,172
Earnings per common share, Basic	$ 0.053	$ 0.064
Earnings per common share, Diluted	$ 0.052	$ 0.063
Options [Member]
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Weighted average number of common shares outstanding, Basic	421,249	1,122,708
Share units [Member]
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Weighted average number of common shares outstanding, Basic	739,980	379,731

Income Taxes - Summary of Incom

Income Taxes - Summary of Income Tax Expense (Recovery) (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Line Items]
Current tax expense	$ 5,067,182	$ 5,119,062
Deferred tax recovery	(3,440,121)	(2,407,176)
Total tax expense	1,627,061	2,711,886
Net income before tax – All jurisdictions	9,839,545	15,727,803
Tax expense at statutory income tax rates	2,656,677	4,259,890
Permanent differences	(50,235)	503,964
Income attributable to non-controlling interest	(1,192,280)	(2,245,809)
Foreign income taxed at different rates	33,189	(26,042)
Impact of change in tax rates	26,902	216,295
Other	152,808	3,588
Canada [Member]
Income Tax Disclosure [Line Items]
Net income before tax – All jurisdictions	6,889,481	5,957,089
United States [Member]
Income Tax Disclosure [Line Items]
Net income before tax – All jurisdictions	$ 2,950,064	$ 9,770,714

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Company's statutory tax rate	27.00%	27.00%
unrecognized tax benefits	$ 0	$ 0
Unrecognized tax benefits	$ 0

Income Taxes - Summary of Defer

Income Taxes - Summary of Deferred Tax Assets and Liabilities (Detail) - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Deferred tax assets:
Property and equipment	$ 2,684	$ 356
Intangible assets	9,222,824	4,752,898
Finance related costs	224,986	375,182
Reserves	64,755
Share transaction costs		87,337
Stock-based compensation	767,228	534,926
Earn-out obligation	265,660	732,986
Deferred tax liabilities:
Property and equipment	(23,757)	(40,357)
Deferred consideration	(4,226)	(18,388)
Reserves	(83,206)	(55,568)
Unrealized foreign exchange	(20,610)	(20,698)
Finance related costs	(78,060)	(68,938)
Net deferred tax asset	10,338,278	6,279,736
Canada [Member]
Deferred tax assets:
Deferred tax asset		87,343
Deferred tax liabilities:
Deferred Tax Liabilities, Gross	(101,822)	(109,294)
Net deferred tax liability	(101,822)	(21,951)
United States [Member]
Deferred tax assets:
Deferred tax asset	10,548,137	6,396,341
Deferred tax liabilities:
Deferred Tax Liabilities, Gross	(108,037)	(94,654)
Net deferred tax asset	$ 10,440,100	$ 6,301,687

Net Finance Expense - Summary o

Net Finance Expense - Summary of Net Finance Expense (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Finance expense:
Interest and accretion expense on borrowings	$ 3,288,704	$ 3,168,762
Accretion expense on earn-out obligation and deferred consideration	133,450	166,575
Amortization of deferred financing fees	276,260	260,363
Net change in fair value of financial liabilities at fair value through earnings	2,861,204	971,627
Other	50,000
Total finance expense	6,609,618	4,567,327
Net finance expense	$ 6,609,618	$ 4,567,327

Financial Instruments - Schedul

Financial Instruments - Schedule of Fair Value of Financial Instruments (Detail) - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Fair Value Assets Measured On Recurring and Nonrecurring Basis [Line Items]
Total Liabilities	$ 1,063,060	$ 2,920,583
Earn-out obligation [Member]
Fair Value Assets Measured On Recurring and Nonrecurring Basis [Line Items]
Total Liabilities	1,063,060	2,920,583
Fair Value, Inputs, Level 3 [Member]
Fair Value Assets Measured On Recurring and Nonrecurring Basis [Line Items]
Total Liabilities	1,063,060	2,920,583
Fair Value, Inputs, Level 3 [Member] | Earn-out obligation [Member]
Fair Value Assets Measured On Recurring and Nonrecurring Basis [Line Items]
Total Liabilities	$ 1,063,060	$ 2,920,583

Financial Instruments - Additio

Financial Instruments - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Financial Instruments [Line Items]
Concentration risk, percentage	10.00%
Interest Rate Risk [Member] | 10% Point Increase in Interest Rate [Member]
Financial Instruments [Line Items]
Increase (decrease) in net income	$ (329,000)	$ (295,000)
Interest Rate Risk [Member] | 10% Point Decrease in Interest Rate [Member]
Financial Instruments [Line Items]
Increase (decrease) in net income	329,000	295,000
Fair Value, Measurements, Recurring [Member]
Financial Instruments [Line Items]
Accretion expense related to earn-out obligation	77,095	$ 73,531
Fair Value, Inputs, Level 3 [Member]
Financial Instruments [Line Items]
Payments on partial amount of earn-out obligation	4,795,822
Remaining obligation payable	$ 1,063,060
Expects to pay the remaining obligation period	1 year
Increase (decrease) in fair value of earn-out obligation	$ 2,861,204
Accretion expense related to earn-out obligation	$ 77,095

Financial Instruments - Summary

Financial Instruments - Summary of Reconciliation of Level 3 Fair Values (Detail)	12 Months Ended
	Dec. 31, 2019USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Payment of earn-out obligation	$ (4,795,822)
Fair Value, Inputs, Level 3 [Member]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Balance as at January 1, 2019	2,920,583
Payment of earn-out obligation	(4,795,822)
Accretion expense	77,095
Fair value adjustment	2,861,204
Balance as at December 31, 2019	$ 1,063,060

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Related Party Transactions [Abstract]
Product sales	$ 35,095	$ 29,685
Amounts owing by or to related party	$ 0	$ 0

Segmented Information - Additio

Segmented Information - Additional information (Detail)	12 Months Ended
	Dec. 31, 2019Segment
Segment Reporting [Abstract]
Number of segments	2

Segmented Information - Summary

Segmented Information - Summary of Revenues Relating to Geographic Segments (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Segment Reporting, Revenue Reconciling Item [Line Items]
Total revenue	$ 120,385,274	$ 112,749,380
Canada and Other [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Total revenue	225,807	271,803
United States [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Total revenue	$ 120,159,467	$ 112,477,577

Segmented Information - Summa_2

Segmented Information - Summary of Revenue from Contract with Customer (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Disaggregation of Revenue [Line Items]
Revenue	$ 120,385,274	$ 112,749,380
Commercial Insurers [Member]
Disaggregation of Revenue [Line Items]
Revenue	90,332,380	86,992,218
Federal Insurers [Member]
Disaggregation of Revenue [Line Items]
Revenue	19,404,851	14,246,626
Physicians [Member]
Disaggregation of Revenue [Line Items]
Revenue	10,078,843	10,959,215
Other [Member]
Disaggregation of Revenue [Line Items]
Revenue	$ 569,200	$ 551,321

Segmented Information - Summa_3

Segmented Information - Summary of Property and Equipment, Intangibles and Other Assets Located in Geographic Regions (Detail) - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Segment Reporting, Asset Reconciling Item [Line Items]
Property and equipment	$ 251,933	$ 303,291
Intangible assets	163,108,193	179,384,263
Total assets	203,095,269	218,987,996
Canada [Member]
Segment Reporting, Asset Reconciling Item [Line Items]
Property and equipment	210,386	276,621
Intangible assets	30,478	32,735
Total assets	3,231,845	9,293,796
United States [Member]
Segment Reporting, Asset Reconciling Item [Line Items]
Property and equipment	41,547	26,670
Intangible assets	163,077,715	179,351,528
Total assets	$ 199,863,424	$ 209,694,200

Segmented Information - Summa_4

Segmented Information - Summary of Operating Segments (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Segment Reporting Information [Line Items]
Revenue	$ 120,385,274	$ 112,749,380
Operating costs	105,703,079	92,454,250
Operating income (loss)	14,682,195	20,295,130
Finance expense	6,609,618	4,567,327
Depreciation and amortization expense	35,009,070	31,486,055
Anesthesia Services [Member]
Segment Reporting Information [Line Items]
Revenue	110,306,431	101,790,165
Operating costs	94,506,039	81,079,150
Operating income (loss)	15,800,392	20,711,015
Finance expense	2,994,654	1,138,200
Depreciation and amortization expense	34,908,764	31,394,245
Product Sales [Member]
Segment Reporting Information [Line Items]
Revenue	10,078,843	10,959,215
Operating costs	4,647,719	5,022,737
Operating income (loss)	5,431,124	5,936,478
Depreciation and amortization expense	25,534	68,509
Other [Member]
Segment Reporting Information [Line Items]
Operating costs	6,549,321	6,352,363
Operating income (loss)	(6,549,321)	(6,352,363)
Finance expense	3,614,964	3,429,127
Depreciation and amortization expense	$ 74,772	$ 23,301