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Thursday, May 5, 2011

More truth about OHA's "truth"

Yesterday, Tom Closson, President and CEO of the Ontario Hospital Association, responded to my blog post, "The truth about OHA's truth" http://impatient4change.blogspot.com/2011/05/truth-about-ohas-truth.html with a personal letter which he then posted online: http://bit.ly/mGDHX4 .

It's always a compliment to get reader comments. Here is my latest response to him:

Dear Mr. Closson,

Re: your email of May 4, 2011, I must take exception to personal remarks not addressed to the issues. Suggestions that I have taken “significant liberties with the facts” and have made “derogatory comments”, without your giving any specific references, will simply not do. Comments that I am “imputing motives” to hospital personnel are without foundation. In fact, I very much admire nurses and other healthcare staff who have stood up to oppose the passage of Schedule 15, because they believe the public has a right to know what is going on in our public hospitals. I would ask you, Mr. Closson, to rethink your position and support them.

In my earlier memorandum of May 3, I made a number of points. You have responded to only a few. I hope this means that you have been persuaded by the remainder, and so I will not belabour those points by repeating them. Let me deal with the points that you do address.

You have said that I “inadvertently” picked the best example available in Ontario of a hospital (Scarborough) which improved its safety record after public disclosure of its mortality ratios. There was nothing “inadvertent” about choosing Scarborough Hospital as an example. It is a very good example of how public exposure of mortality ratios spurred improvements in patient safety. I do not doubt that the hospital is continuing to make improvements; the point is that transparency and public attention will help the hospital to continue its work.

You have referred to the “Hospital Standardized Mortality Ratio.” This indicator was only released after the government mandated it. But even this information is not adequate; we need mortality rates, not just ratios. This means we should have a right to know how many real people die in hospitals, in each department, and not just a weaker comparative figure. Only a right to request information under FIPPA will satisfy this need. Schedule 15 provides a giant loophole.

Your email warns about hospital “conjectures” being “splashed on the front page of the newspaper or made the subject of talk radio.” This is simply hyperbole. What schedule 15 will allow, as your email and memos admit, is the shielding of “systemic failures” from public disclosure. Other government bodies have accepted this responsibility since FIPPA came into effect in 1990. It is time for hospitals to become more transparent.

Reference is made in your memo to Dr. Ross Baker as an “expert” who supports the OHA’s position. However, Dr. Baker, a sociologist rather than a physician, has testified before the social policy committee, not as an independent expert, but as an advocate on behalf of the OHA. I would refer you instead to the views of medical doctor Rob Robson, former chief patient safety officer of the Winnipeg Regional Health Authority and now the Principal Advisor of Healthcare System Safety and Accountability. Dr. Robson told us that “transparency and truth-telling are at the heart of improving safety and quality of care.” He called Schedule 15 “a step backwards” and he says that “it doesn’t make sense that people who are affected by and who pay for the healthcare system aren’t allowed to know what is happening inside it.”

You speak glowingly of the OHA’s Hospital Report series as the recognized “gold standard” in Canada for outcomes reporting. However, the RNAO has pointed out in response to your memo that the full reports have been discontinued. The RNAO is concerned about this and we are too.

Your email claims that nothing in Schedule 15 would change the outcome reporting regime in the slightest. That is beside the point. The current reporting regime is no match for FIPPA. The application of FIPPA to hospitals, which we won last year, will mean that, as of 2012 and for records dating from 2007, the public can ask hospitals in Ontario for important hospital quality information, not just what the hospitals have agreed to report. Schedule 15 will effectively dismantle the newly won rights under FIPPA.

Mr. Closson refers to a statement by a Conservative MPP in November 2010, supporting an amendment similar to Schedule 15. I think most people would agree that our legislators are entitled to change their minds based on the information that they receive during the legislative process. The Conservative caucus has listened to the public about this issue and have taken a principled position, by recommending that their committee members vote against Schedule 15 in the budget bill. Democracy works through public consultation and an evaluation of the public interest. We’re grateful for the opportunity to express our public interest concerns to our political representatives and for their willingness to address them.

You have suggested Schedule 15 is an exemption to FIPPA (rather than an exclusion) and as such is subject to appeal to the Information and Privacy Commissioner (IPC). This issue was addressed in our last memo (see fact #5, 3rd paragraph). As the nurses put it, the IPC appeal process is “lengthy and litigious...and most members of the public simply will not undertake” it. People may get sick or even die while waiting for information. A FIPPA request requires a response within 30 days; an appeal can take over a year. Media should not have to get their stories vetted by the government’s Information and Privacy Commissioner; this is contrary to our fundamental right of freedom of the press.

Please see my blog post at http://impatient4change.blogspot.com/2011/05/truth-about-ohas-truth.html for more detail about the other relevant points you have left unchallenged.

Finally, you point out that Ontario’s hospitals are among the best in the world. I am sure that this is the case but it does not mean that they cannot be better. Even the hospitals’ own experts acknowledge that up to 24,000 deaths and 70,000 injuries each year in Canada are due to preventable adverse events occurring in our public hospitals. This is a powerful reason for greater transparency.

What we don’t know about can injure, maim and kill us. We all want Ontario to have an exemplary healthcare system. FIPPA is a good start. Schedule 15 is a big step backward.

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