Category Archives: Hospitals

Lack of civility as opinions differ

Posted on May 6, 2011 | 3 comments

This week OHA CEO Tom Closson wrote to a number of groups opposing the recent “hospital secrecy law” (Schedule 15 of Bill 173) that will allow the Ontario Hospitals to shield specific quality information from the public.

Given Schedule 15 had alredy been amended — presumably to the OHA’s approval — it is questionable as to the purpose of Closson’s sudden enthusiasm for letter writing. The actual amendment passed at the legislature’s finance and economic affairs committee Thursday morning.

What is most surprising from Closson’s letter-writing is his accusations that public interest groups were attempting to “grossly mislead” the public about the meaning of the Bill. The letters, all posted the OHA’s website, manage to insult the community organizations in a way we haven’t quite seen before.

He says Cybil Sack (Impatient4Change) “took significant liberties with the facts…while also making derogatory comments about hospitals, their leaders, and the professionals who work in them.” He further writes “it is apparent from your note that you believe the people who work in hospitals spend their days devising new ways to stifle public debate.”

To many of the organizations – including the Ontario Health Coalition, the Registered Nurses Association and the Service Employees International Union, he says he is writing to “rebut the grossly inaccurate claims.” He finishes all the letters with “on an issue as important as Ontarians’ health and safety, the “facts optional” approach your organization has taken to date is simply irresponsible. Ontarians deserve better.”

If these submissions were full of factual errors and misleading commentary, one might understand. Closson’s rebuttals fail to point out much in the way of factual error, but instead revisits the OHA’s original argumentation around the need for the schedule and takes issue with some of the intervenor’s interpretation of the role of the Quality of Care Information Act.

To suggest on this basis that anybody is trying to “grossly mislead” is a bit much. It also calls into question the OHA’s attitude towards public engagement.

By any interpretation, the government has opened the door to hospital transparency, and closed it to a degree with this amendment to the Freedom of Information and Protection of Privacy legislation. That’s a fact.

Closson is not the only one getting in on the act of incivility.

Georgina Thompson, Chair of the South East LHIN, recently told the media that prior to the LHIN’s recent Road Map plan, hospitals “talked to each other but they didn’t play together in the sandbox well.”

We could be wrong, but some hospitals may take umbrage to their characterization as children who got straightened out by the LHIN.

It’s been a long cold and wet spring. Here’s hoping that with a bit of better weather we can all go back to debating health care policy without this kind of nasty rancour.

Oh, and Tom – no need to reply.

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Hospital secrecy – changes to Budget Bill fail to protect public interest

Posted on May 2, 2011 | Leave a comment

The latest amendment to Ontario’s Budget Bill 173 fails to address concerns raised around a change to freedom of information legislation that will permit greater hospital secrecy.

Schedule 15 of Bill 173 enables a hospital CEO to shield from public scrutiny any information about quality of care produced for or by a hospital committee. More than a dozen groups appeared before the legislature’s Standing Committee on Financial and Economic Affairs in April asking the offending schedule be removed.

Instead the McGuinty government has amended the proposed Bill to exempt “information provided in confidence to, or records prepared with the expectation of confidentiality by, a hospital committee to assess or evaluate the quality of healthcare and directly related programs and services provided by a hospital, if the assessment or evaluation is for the purpose of improving that care and the programs and services.”

Ontario hospitals are the last in Canada to come under Freedom of Information legislation. After introducing a public sector accountability bill last fall that would open up hospitals to freedom of information requests beginning January 2012, the McGuinty government recently caved-in to a lobby by the Ontario Hospital Association, the Ontario Medical Association and a private insurance company to narrow what would be accessible.

“The government’s amendment allows hospital executives to make some documents secret by simply stamping ‘confidential’ on them or retroactively suggesting that the records were intended to be private,” says Cybele Sack of Impatient for Change, a patient advocacy group. “Our freedom of information laws are meant to increase transparency and this amendment undermines that spirit.”

The final act is expected to be passed by the majority Liberal government this Thursday (May 5).

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Groups attack amendment that would protect hospitals from providing quality information

Posted on April 28, 2011 | Leave a comment

It was supposed to be a day of hearings on the provincial budget, but the insertion into the Act of an amendment to the Freedom of Information and Protection of Privacy Act that would exempt hospitals from providing information on quality had many individuals and organizations up in arms. Is the government getting anxious about its decision to open public hospitals to scrutiny? Schedule 15 in Bill 173 would exempt hospitals from divulging “information provided to, or records prepared by, a hospital committee for the purpose of assessing or evaluating the quality of health care and directly related programs and services provided by the hospital.”

Hospitals are to be subject to Freedom of Information beginning January 2012.

This is what some of the April 20 deputations to the standing committee on finance and economic affairs had to say on the issue (from Hansard):

“There’s absolutely no evidence that giving more information to patients means that lawsuit numbers will rise; in fact, the evidence is exactly the opposite. In the United States, where a few hospitals have taken the courageous position that regardless of the circumstances, patients are entitled to know the full details of errors—and the hospital has even assisted patients to file a claim—lawsuit numbers have plummeted, and the amount of money that is paid out per lawsuit is reduced. That’s the truth of what happens. Do you know why? If you think about it, you have a close relationship with the people who are looking after you in a health care setting. You don’t want to sue them. The people who come to me are not chomping at the bit to sue doctors and nurses; they’re doing it because it’s their last option, because they’ve tried other things and it hasn’t helped.”
–       Amani Oakley, medical malpractice lawyer

“I sued in frustration as a last resort, so that the truth would be told in the death of my father. Unfortunately, that has yet to happen. I wanted, and am still actively seeking, accountability, justice and transparency in the Ontario health care system in its entirety, and access to information that, in a democracy, must be available to the public.

I was offered the sum of $10,000 by University Health Network and the medical transportation company involved and told that if I took this money, I could never speak of my father’s case again or I would be sued. I refused this money, as I considered any monetary compensation as blood money, because this would not bring back my father and it would not right the wrong that had occurred, especially for people who still put their lives in jeopardy using the Ontario health care system.”
–       Lorraine Blue

“We in Niagara want, therefore, to have access to everything that the NHS and the LHINs have discussed under quality of care. Without that, we will not be able to have a full investigation, either under this government or a subsequent government. Without a full understanding of what has gone wrong—and this is not to put blame. I do not believe, and most of us do not believe, that we’re talking about individuals here at all. There has been a system breakdown because of the speed in having to do things and also because of financial constraints on an overly large amalgamated hospital.”
–       Fiona McMurran, Welland resident

“It boggled my mind when I saw this amendment, after the government had come so far in terms of opening up hospitals to freedom of information in the first place. No other province does this. All the other provinces open hospitals up to freedom of information. We’re the last province to put hospitals under freedom of information.”
–       Rick Janson, OPSEU staff expert on health care

“The hospital industry maintains that FIPPA will undermine patient safety culture, but has presented no data and no concrete example. The facts suggest that whatever is going on behind closed doors now is, in any event, ineffective. Recent data shows that adverse events in hospitals remain frustratingly high. The Canadian Medical Association recently estimated that between 9,000 and 24,000 deaths in hospitals across Canada were preventable.”
–       Paul Harte, President-elect of the Ontario Trial Lawyers Association

“Imagine our surprise when a question was put forward regarding schedule 15 and our honourable health minister said that this was added for patient safety. In our opinion, schedule 15 does just the opposite. Patient security and privacy is already covered by the Personal Health Information Protection Act.

The impact that this will have on Ontario’s health care system could potentially be frightening. Hospitals which engage in poor practices will be protected from scrutiny, potentially resulting in numerous victims. Even if your family doctor wants to access information regarding a hospital’s record of quality before he sends you there, access can be denied.”
–       Ed Vander Vegte, Niagara chapter of the Association for Reformed Political Action

“I’d like to know more clearly what it is that they’re concerned about. The examples that have been given so far don’t hold weight; they certainly don’t meet a public interest test. If there is something there, then we’d like to know what it is, but we haven’t been given that information. It certainly doesn’t belong in a budget bill and certainly not with the very short period of consultation that we’ve been given to date. There’s only one hearing; it’s only in Toronto. It’s just not the right way to do this properly.”
–       Natalie Mehra, Ontario Health Coalition

“RNAO agrees there is a need for protecting the identity of hospital staff when engaged in quality-of-care discussions, as the threat of disciplinary proceedings could indeed hamstring such discussions. On the other hand, it would not inspire great confidence in the hospital or the health care system if hospitals refused to release quality information for fear of litigation.

This approach is very different to the one the Ontario Hospital Association and its members demonstrated when they participated in the important and popular hospital report card series, allowing many facility-level quality indicators to be released publicly. That showed bold leadership. Unfortunately, the public no longer enjoys access to this window on the hospital system, as it was terminated in 2008.”
–       Kim Jarvi, Registered Nurses Association of Ontario

“The number one thing I hear about is not lawsuits. It really isn’t. It’s not the money. It’s not even an apology, because with the Apology Act, it doesn’t mean much. It’s not even disclosure; that’s just the first step. What people really want is to know that what happened to them did not happen in vain, that we’re learning from it, that we’re measuring the change and that we’re accountable to that change, so that they know nobody else has to go through what they went through.”
–       Cybele Sack, ImPatient for Change

“In my opinion, I believe it is time for Ontario citizens to have full transparency and accountability in all matters related to the health care they receive. I also believe that our health care should reflect the human and democratic right we each have as Canadians to have a quality health care system regardless of age, race, ability or gender.”
–       Kim Hessels, “mother of a child with special needs”

“You’re being asked to throw a large blanket of protection of secrecy over anything related to quality within a hospital, and quality care makes up the core, the essence and many of the functions that hospitals perform for the public.”
– Eoin Callan, SEIU

Conspicuous by its absence was the Ontario Hospital Association and the Ontario Medical Association, which had lobbied for the exemption alongside a major malpractice insurance company.

To read the full transcripts, go to: http://www.ontla.on.ca/web/committee-proceedings/committee_transcripts_details.do?locale=en&Date=2011-04-21&ParlCommID=8858&BillID=2475&Business=&DocumentID=25696#P56_3174

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SE LHIN looking to rationalize surgeries to as few as one regional hospital

Posted on April 27, 2011 | Leave a comment

Surgical services may end at Perth-Smiths Falls and Napanee Hospitals as part of a new clinical services roadmap in the South East region of the province.

The South East LHIN is now consulting the public on the issue. A series of “workbooks” are on-line, some putting forward ideas for change, others broadly hinting at them.

Unlike other such exercises, the SE LHIN is placing the emphasis of this new plan on financial sustainability.

“Our existing hospital system was built on a model that is decades old, that doesn’t reflect the economic realities we face today,” the LHIN web site states.

Despite the fact that core hospital budgets are going up by less than 1.5 per cent, the LHIN erroneously claims the cost of hospital care is increasing at twice the rate of inflation.

April 19th staff of the Perth and Smiths Falls District Hospital were given an unvarnished version of the options for surgeries.

They were told at a general meeting the LHIN is looking at everything from the status quo to providing all regional surgeries in Kingston. It’s clear from the ordering of the potential rationalization of surgeries that Napanee and Perth-Smiths Falls are the most vulnerable to these changes.

“If you ask the general public if they’re going to get hip surgery in six weeks or two weeks, I can guarantee you they’ll take the two weeks if they have to go to Brockville,” Georgina Thompson, Chair of SE LHIN told the Belleville Intelligencer.

The irony is Perth and Smiths Falls District Hospital presently has among the shortest wait times for hip replacement in the province. The wait is 71 days compared to 79 days in Brockville, 141 days at Kingston General Hospital and 192 days at Kingston’s Hotel Dieu.

Two weeks wait for hip surgery may sound good to the uninformed, but the LHIN hasn’t explained how rationalizing services from hospitals with short waits to hospitals with longer waits is somehow going to accomplish this. Presently the shortest wait for hip replacement is 49 days, not two weeks. For that you would have to travel to Brantford.

When the government introduced the idea of Local Health Integration Networks, OPSEU had argued it was paving the way for rationalization of services. At the time the union was accused of fearmongering. Now it appears to be happening.

All of this is also taking place as a provincial panel is looking at the question of what is the role of small and rural hospitals. That question may be answered before they get a chance to make their recommendations.

Thompson says such rationalization will streamline the way area hospitals work together, promising no hospital would close, but services may substantially change.

“We have seven hospital sites today. We will have seven hospital sites tomorrow,” she told the newspaper.

A committee from the Perth and Smiths Falls District Hospital has been meeting with the SE LHIN to demonstrate what the outcome of such choices would be on population health, including the impracticality of concentrating surgeries in a handful of regional hospitals.

The SE LHIN defines itself on-line as “an organization based in Belleville.”

Feedback on the roadmap will be accepted until May 15. To access the on-line workbooks, go to http://www.southeastlhin.on.ca/HealthCareRoadmap

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LHINs claim benefit of local decision-making amid attacks from Hudak

Posted on April 26, 2011 | Leave a comment

The Local Health Integration Networks (LHINs) appear to be making an effort to communicate their value amid increasing attacks from provincial PC Leader Tim Hudak.

Hudak is campaigning hard on a platform of eliminating the LHINs. The problem is, he has never said what he would replace them with.

In today’s Sudbury Star, Louise Paquette, CEO of the North East LHIN, makes a pitch about the importance of LHINs making decisions locally, despite the fact that the geography of her LHIN runs from Parry Sound to Hudson’s Bay and North Bay to Wawa.

April 2nd Gerry Macartney, CEO of the London Chamber of Commerce, echoes Paquette’s comments in the London Free Press, claiming “all decisions are made in our community at open, public board meetings.”

Macartney met with the South West LHIN’s CEO Michael Barrett and came away a convert, claiming that while not perfect, the LHINs “are a huge improvement over what was there before.”

The LHINs do provide some level of process and planning to changes in the health system, but it is far from consistent. It is also sometimes overstated – Paquette claims credit for reduction in wait times while remaining silent on the substantial transfers of cash from the Federal government and the province.

Having a LHIN in place has made a difference. A decision this spring to close a community-based transitional mental health facility was put on hold by the Central East LHIN after we raised questions about the lack of planning for patients who resided there.

At the beginning of this month we raised questions about a botched transfer of a preschool speech and language program from Grey Bruce Health Services to the Grey Bruce Health Unit.  Unable to come to an agreement as to how these services would transfer, the hospital simply issued layoff notices to the speech language pathologists and their assistants. The Health Unit is now attempting to recruit the same people.

The problem is, the hospital has yet to submit an integration proposal to the South West LHIN as required under the Local Health System Integration Act. That integration proposal is supposed to have a HR plan — something clearly missing.  They are shooting first, asking permission afterwards. The LHIN informs us they have notified Grey Bruce Health Services that the proposal must be treated as an integration.

If there is one profession health care providers have particular difficulty recruiting, it is speech language pathologists. On average, it takes a health care provider a year to recruit a SLP in Ontario. Should these individuals decide to take their experience elsewhere, the health unit may face difficulty maintaining the preschool speech and language services the hospital formerly provided.

In 2008 the South West LHIN received a report from their Children and Youth Priority Action Team. The team recommended greater integration between providers of adolescent and youth services, including speech language therapy. They also stressed the need to have more equitable service throughout the LHIN, particularly in the north – represented by Grey and Bruce counties. It is not clear how transferring the service outside the scope of the LHIN will help integrate the program with other services within the LHIN.

Media reports suggest the decision had been made by the Ministry of Children and Youth Services, which only partially funds the service.

So, will we actually see a real decision, or will the SW LHIN make another decision after the fact?

It wouldn’t be the first time – Regional Mental Health London and St. Thomas issued layoff notices to staff long before the LHIN was able to rubber stamp plans to move their work to Cambridge. This January the Central East LHIN approved an integration after the agency had already closed its doors at the end of December. The question is, when the activity happens before the decision, is the LHIN really making any decision at all?

Given the SLPs and their assistants will be finished at the hospital in August, there is little time left to make a real decision. There are enough questions here for the LHIN to do more than wield a rubber stamp and claim how important local decision-making is.  Stay tuned.

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Hospitals warned to ‘cleanse’ files before 2012

Posted on April 20, 2011 | Leave a comment

There are further signs that by the time hospitals are subject to Freedom of Information legislation in 2012, what’s left to get won’t be worth the effort.

 The London Free Press reports that hospitals are being warned to “cleanse” their files of anything that might embarrass them before the public gets the right to access it come January 2012.

The warnings come from Toronto-based law firm Osler, Hoskin & Harcourt. Many hospitals across Ontarioare on OH&H’s client list.

“I was astounded at the language,” Ann Cavoukian,Ontario’s Information and Privacy Commissioner, told the newspaper. “Just using the word ‘cleansing’ is highly inappropriate. It suggests shredding, eliminating, hiding – getting rid of material before the end of the year.”

 Health Minister Deb Matthews said she expects hospitals to “embrace the spirit” of the legislation.

 However, while this is taking place, the province itself has slipped an amendment into the budget bill that will exclude hospitals form divulging “information provided to, or records prepared by, a hospital committee for the purposes of evaluating the quality of health care and directly related programs and services provided by the hospital.”

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Hospitals won’t be penalized for failing to reduce executive costs, clerical staff may take brunt of cuts

Posted on April 19, 2011 | 2 comments

In Ontario’s spring budget hospitals were asked to reduce executive costs by 10 per cent.

Now the province is saying there will be no penalty for hospitals that fail to do so.

“Hospital execs are supposed to reduce the costs of their office, but there won’t be financial penalty for those who fail,” said Andrew Chomensky, a spokesperson for Finance Minister Dwight Duncan.

OHA Presdient Tom Closson told the media that hospitals may have difficulty recruiting “top clinical talent” if Ontario is no longer competitive. Closson does not make the same argument about actual clinical staff. In the past year the OHA has been upset by modest increases awarded by arbitrators in the hospital sector.

Chomensky said the reductions in cost aren’t necessarily to the high executive salaries, suggesting hospitals may want to cut clerical staff instead to save the 10 per cent.

What started out as a response to high executive salaries appears to be quickly morphing into attacks on the lesser-paid clerical staff.

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McGuinty government reverses direction on hospital transparency

Posted on April 15, 2011 | Leave a comment

If you thought the recent provincial budget bill was about how Ontario allocates public resources, you may be in for a surprise.

After giving notice last fall that Ontario hospitals would finally be opened to Freedom of Information requests, the McGuinty government is backpedalling with an amendment to its budget bill that would restrict access to all information about hospital quality.

Freedom of Information already protects the personal information of patients.

This broadly worded amendment to the budget Act would allow a hospital to refuse disclosure of “information provided to, or records prepared by, a hospital committee for the purposes of evaluating the quality of health care and directly related programs and services provided by the hospital.”

The amendment is being pushed for a second time by the Ontario Hospital Association, the Ontario Medical Association and the Healthcare Insurance Reciprocal of Canada (Canada’s largest malpractice insurance company). The organizations were unsuccessful in getting a similar amendment last year under Bill 122 – Broader Public Sector Accountability Act.

The organizations are arguing that doctors will be less likely to disclose their mistakes if they might be subject to embarrassment and accusation.

Polly Stevens, VP of HIROC, told the London Free Press “we had to stop this naming, shaming and blaming.”

However, the organizations are not asking that doctors’ names be removed from the reports – instead they want all information kept secret.

In her testimony on Bill 122, Stevens said she didn’t want the public to find answers to questions such as “do you have a fever protocol for pediatrics? Do you have physicians to personally see patients before they’re discharged.”

Bill 173 (the budget bill) will go to a one-day hearing before the Finance and Economic Affairs Committee on April 21st.

A group calling itself “Impatient4 change” is calling for action to pressure the McGuinty government to drop this amendment.

They ask that you spread the word (hit our share button below), contact members of the government’s Finance and Economic Affairs Committee asking them how they will vote, and ask to be able to testify on April 21st before the Committee.

Members of the Finance & Economic Affairs Committee:

Liberals:
Leeanna Pendergast (Kitchener), 416-325-3581, 519-571-3276,
lpendergast.mpp.co@liberal.ola.org
Laura Albanese (York) 416-243-7984, lalbanese.mpp@liberal.ola.org
Bob Delaney (Mississauga) 416-325-0161, 905-569-1643, bdelaney.mpp@liberal.ola.org
Kevin Flynn (Oakville), 416-325-7215, 905-827-5141, kflynn.mpp.co@liberal.ola.org
Helena Jaczek (Markham), 905-294-4931, hjaczek.mpp@liberal.ola.org
Pat Hoy (Chatham) – 416-325-9099, 519-351-0510, phoy.mpp@liberal.ola.org

Conservative:
Norm Miller (Parry Sound), 416-325-1012, 705-645-8538, norm.millerco@pc.ola.org
Toby Barrett (Haldimand) – 416-325-8404, 519-428-0446, toby.barrett@pc.ola.org

NDP:
Peter Tabuns (TO Danforth) 416-325-3250, 416-461-0223,
tabunsp-qp@ndp.on.ca

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Hospital professionals rally: there’s more to a modern health team

Posted on April 11, 2011 | 1 comment
In his first rally following re-election at OPSEU’s Convention, April 8th President Warren (Smokey)Thomas challenged Ontario Hospital Association President Tom Closson to sit down and talk about the hundreds of hospital professionals that get treated as an afterthought by hospitals and the Ontario government.

OPSEU’s Hospital Professionals are upset that the OHA offered little at the central bargaining table, resulting in a quick referral to binding arbitration.

Sandi Blancher, Chair of the HPD bargaining team, said the hospital professionals are being treated differently that the nurses, who have recalled their mediator in an attempt to reach an agreement.

“Somehow I don’t think the Ontario Nurses’ Association is looking at the same kind of offers the OHA thought was good enough for our hospital professionals,” she told the crowd of about 500.

OPSEU members carried signs representing different professions to the rally, such as “Physiotherapists are essential to a modern health team” or “Laboratory Technologists are an essential to a modern health team.”

Retiring 1st Vice-President Patty Rout contrasted the mandatory full-time targets for nurses to the situation of laboratory technologists, of which more than 50 per cent are part-time.

She also spoke of the lack of consistent support by the OHA for pharmacy technicians, who are facing substantial costs in time and money to re-qualify for their jobs. The pharmacy techs must be accredited under the College of Pharmacists by 2015.

“They have little support from this government or many of the hospitals they work for through this process,” she said.

After rallying outside of Simcoe Park, the group marched around the downtown office tower in which the OHA is headquartered.

Demonstrators hold cards representing different hospital professions at Friday's rally outside the Ontario Hospital Association offices in downtown Toronto.

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Hospital cuts jobs of speech language pathologists in absence of orderly transfer

Posted on April 5, 2011 | Leave a comment

OWEN SOUND – Grey Bruce Health Services has cut the jobs of seven speech language pathologists and assistants and is hoping they will apply for new jobs at the Grey Bruce Health Unit.

The hospital has issued a memo stating that they “were not successful in reaching a seamless transfer of the program” that helps children with speech problems.

Workers received notice of layoff March 31, 2011. Their final day will be August 31.

The Ministry of Children and Youth approved transfer of the service to the Grey Bruce Health Unit, but made no provision for the pathologists and their assistants.

“The lack of a transfer agreement likely stems from an attempt by the Health Unit to take on the work without paying the existing salaries and benefits of the displaced workers,” says Warren (Smokey) Thomas, President of the 130,000-member Ontario Public Service Employees Union. “This is a bald-faced attempt to save money on the backs of these workers.”

Whether the workers will migrate to the Health Unit is an open question given extreme shortages of speech language pathologists across the province.

Many may choose to take the severance from the hospital and work elsewhere.

The union is arguing the workers should be able to transfer with their rights intact, as have other displaced health care workers across the province.

“This is the health unit that can never get it right, so this is not entirely a surprise,” says Thomas. “And the gamble may backfire: If the health unit is unable to hire, parents may lose access to speech language pathology for their children.”

The Public Sector Labour Relations Transition Act (PSLRTA) was introduced to facilitate a broad range of transfers within the health system. The Health Unit is arguing that they are outside the definition of a health provider and should not be subject to the legislation.

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