“There is no effective, independent, investigative oversight of hospital administration. Period.” – Ontario Ombudsman Andre Marin, 2008
Ontario has been resisting Ombudsman oversight of its public hospitals for long enough. Marin says he is not the first to demand this oversight – Arthur Maloney called for this extension of the Ombudsman’s scope in 1975, and successive holders of the office have followed suit to successive and unresponsive governments of all stripes.
Last week NDP Leader Andrea Horwath added Ombudsman oversight of health care to her shopping list of initiatives to improve the spring budget.
Given recent experiences with ORNGE and the diluted chemotherapy drug error, one would think that the time has finally come, Ontario the last province to issue such powers.
Marin himself wrote to the Premier in March regarding changes the province was making in the wake of the privatization scandal at ORNGE. Marin pointed out that Bill 11 would create “new bureaucracy of special investigators” which would report to the Minister of Health and Long Term Care, not to Provincial Parliament.
“Far from being watchdogs, they would operate on a ministerial dog leash,” he wrote.
Similarly the position of ORNGE “patient advocate” is even more toothless, reporting not to the public or to Parliament or even the ORNGE board of directors, but to the ORNGE vice-president.
In February the British Columbia government received a 216-page report on seniors care. In it are 176 recommendations covering home care, assisted living and residential care. It is the second major report on senior’s care in that province since 2009. Both reports were investigated and prepared by the BC Ombudsperson.
BC walks the talk on integration: the Ombudsperson includes many recommendations to bring consistency to seniors’ care in that province.
It also makes important recommendations around mandatory staffing standards — something Ontario has resisted for years. The BC Ombudsperson pointed out the inconsistency between the province’s handling of vulnerable seniors and vulnerable children, of which there are measurable staff-to-children ratios for child care facilities but not for seniors’ care.
The BC Ombudsperson says the regional health authorities were asked to work towards a staffing level of 3.36 direct care hours per resident per day, but failed to achieve it despite a new residential rate structure that was introduced in 2010.
By comparison, Ontario maintains that its nursing homes have an average of 3.0 hours of care per resident per day, but Ontario counts paid hours, not direct care hours. Nor is any of this made mandatory by legislation.
As the BC Ombudsperson points out, “measuring the hours that staff provide direct care is more precise than measuring the number of staff hours because it accounts for the fact that not all staff provide direct care, and the even those who do also have other duties to perform.”
In Ontario the Ombudsman’s office is shut out from investigating long-term care homes. Andre Marin points out that the Ombudsman has authority over long-term care in most other provinces.
As private not-for-profit corporations, Ontario’s hospitals are not normally subject to review by the Ombudsman’s office – a point Andre Marin has made over and over as he attempts to wrestle for jurisdiction of the MUSH sector – municipalities, universities, school boards and hospitals.
However, when the Ministry takes over a hospital, as it did with the appointment of Kevin Smith last August 31st, the rules change.
To date, the Ombudsman has received 79 complaints about Niagara Health System, but says he has not begun an investigation. According to the Niagara’s Bullet News, the Ombudsman’s office has been looking at each complaint and raising issues with Smith.
The complaints have also been petering out over time. Forty of the 79 complaints were received last September. Only a “handful” have been made this year according to the news report.
You might call it the McGuinty Liberals first campaign promise on health care. June 10 the government announced that it would regulate private non-emergency transportation that moves patients between hospitals and other facilities.
The private patient transfer service came under the microscope of the ombudsman’s office in January after Andre Marin said he received more than 60 complaints about the service.
Marin said that patients would be better off calling a cab rather than take one of these unregulated ambulances.
Ontario is the only province not to have regulated these transfers.
It’s allowed private companies to charge hundreds of dollars per patient for transports in old, beat-up ambulances operated by “kids” with no medical training, Marin told the Canadian Press.
“Our investigation uncovered serious issues, from a lack of infection control to unsafe vehicles and poorly trained staff,” Marin stated in a release last week. “These vehicles look like ambulances and are often transporting vulnerable patients. People need to know they can trust these services.”
The New Democrats were critical the Liberals for having waited so long to act. “Anybody who had the health file knew about this, and they did nothing for the eight years that they were in power,” NDP health critic France Gelinas told CP.
The McGuinty government said they would introduce legislation at the earliest possible moment – which at this point will be after the October 6, 2011 election.