Ontario's Court of Appeal has been asked to decide whether doctors and hospitals can withdraw life-sustaining treatment, against the wishes and consent of patients and their families, without going to the Consent and Capacity Board (CACB).
Sunnybrook Hospital and the doctors of Hassan Rasouli, a 59-year-old engineer in what the doctors describe as a PVS state, argue that they should only have to go to the CACB when the patient wants to refuse treatment recommended by doctors. The hospital and doctors don't think they should have to go to the CACB when the patient and family want to continue treatment against the advice of their physicians, where the physicians perceive the care to be futile or of no benefit.
The word "futile" is a contentious one. An article appearing in the Canadian Medical Association Journal in 2007 defines medically futile care as "the use of considerable resources without a reasonable hope that the patient would recover to a state of relative independence or be interactive with his or her environment." The authors found that "pain and suffering would not be essential to the definition" and that attempting to generate a consensus definition of futile care would "itself have been futile" because "previous investigators have been unable to establish a universally accepted threshold for futility and physicians cannot predict the probability of success for an individual patient with any precision."
The Rasouli case could set a precedent for a much broader group than PVS patients. The arguments by the hospital and doctors, that the medical community be empowered as the final arbiter of benefit, without access to the CACB, has the potential to affect the autonomy and access to treatment of people with disabilities and seniors (who may not be able to live independently), some cancer patients and others who may want to continue treatment even when the chance of success is low.
Determination of benefit may also be affected by financial pressures on the healthcare system. The CMAJ article states that "the scarcity of such resources is a major driver behind the futility debate..."
In the Rasouli case, Sunnybrook Hospital and the doctors involved opted not to go to the CACB when they were unable to to get the consent of the patient's family to withdraw life support. The family filed an injunction in Superior Court.
In March, Justice Himel decided in favour of Rasouli's family on the matter of the Health Care Consent Act, ordering the hospital and doctors to take the case to the CACB.
The doctors want the Court of Appeal to overturn this decision and to allow doctors to use the end-of-life policy of the College of Physicians and Surgeons (CPSO). The CPSO policy indicates that physicians should secure the consent of a patient or substitute decision maker, but it doesn't make it mandatory. The policy also permits doctors to refuse or stop treatment in cases where doctors determine that treatment is of no benefit and falls outside the standard of care. This CPSO policy is up for review in 2011.
The hospital and doctors are also asking that they be absolved of criminal and civil liability for their decision.
Mark Handelman, the lawyer for the Euthanasia Prevention Coalition, which is intervening in the case, calls this the most important health care case ever in Ontario and he says the decision will likely ripple across the country.
Handelman says that what doctors are asking for is a "declaration that they not require consent to discontinue treatment that in their view is not medically indicated." He says that a decision in the doctors' favour would be applied very broadly. He expects that if the doctors lose, the case will go to the Supreme Court.
Harry Underwood, the lawyer representing the doctors in the Rasouli case, called this appeal "very significant".
The Court of Appeal will be hearing the Rasouli case on May 18 and a decision is expected shortly.
Tuesday, May 17, 2011
Monday, May 9, 2011
The Worse Tomorrow for Ontario Act
Tomorrow the Liberals will pass a budget bill they call the Better Tomorrow for Ontario Act.
Only tomorrow will be worse because buried in their budget bill is a giant loophole which will make our healthcare system less transparent and accountable to the public.
What the media dubbed the "hospital secrecy" law is an amendment to our freedom of information law. This amendment takes away our right to access a vast array of hospital quality information, by allowing hospital executives to withhold information about "system failures". Some hospitals don't want to answer the public's questions about what has been done to reduce hospital-acquired infections and adverse events.
The hospital secrecy loophole was pushed through legislative committee on May 5 by the Liberals, at the behest of the Ontario Hospital Association (OHA), malpractice insurance companies for hospitals and doctors, and the Ontario Medical Association. Tom Closson, CEO of the OHA, was particularly vocal in promoting this loophole. Minister of Health Deb Matthews told the legislature that she was "persuaded" by the "hospital sector" to put this loophole in the budget bill.
Many groups and individuals opposed the hospital secrecy loophole, on the grounds that the public should have a right to know what is happening in public hospitals. These groups include: the Canadian Civil Liberties Association, the Council of Canadians, the Medical Reform Group, ImPatient for Change, the Ontario Health Coalition, nurses (RNAO, ONA), healthcare worker unions (OPSEU, CUPE, SEIU, CAW, OFL), the Association for Reformed Political Action, the Ontario Trial Lawyers Association and other citizens.
Hospitals were put under the Freedom of Information and Protection of Privacy Act (FIPPA) in December 2010 as a response to the e-Health scandal. They were given until January 1, 2012 to start processing FIPPA requests, dating from 2007. Ontario was the last province to put hospitals under freedom of information legislation. We were finally catching up, but the new hospital secrecy loophole is considered by many to be a big step backwards.
The public can appeal denied requests to the Information and Privacy Commissioner (IPC) but these appeals can take years and injured patients don't always have time to wait. Appeals to the IPC may also interfere with freedom of the press if journalists require government approval to get public information for their stories. The broadly-worded hospital secrecy loophole is against the principle of FIPPA, that any exemption be limited and specific.
The amendment passed in committee, five to three. Five Liberals voted yes to hospital secrecy: Liz Sandals and Phil McNeely (Parliamentary Assistants to Minister Matthews), Bob Delaney, Helena Jaczek and Leeanna Pendergast.
Conservatives Toby Barrett and Norm Miller and NDP Peter Tabuns voted against the hospital secrecy loophole. The Conservative and NDP caucuses also opposed it.
The next provincial election is on October 6, 2011. This is your opportunity to elect a party which puts the public interest ahead of the interests of hospital and insurance lobbyists. We encourage you to vote for hospital transparency and accountability; ask your candidates if they intend to reverse the hospital secrecy law.
There has been significant media coverage of the hospital secrecy amendment already, including in the London Free Press, QMI Agency, Canadian Press, Toronto Star, Winnipeg Free Press, Guelph Mercury, Kitchener-Waterloo Record, Kingston Whig-Standard, Windsor Star, Sudbury Star, Global Toronto, CBC Radio, CFRA, and CTV.
Only tomorrow will be worse because buried in their budget bill is a giant loophole which will make our healthcare system less transparent and accountable to the public.
What the media dubbed the "hospital secrecy" law is an amendment to our freedom of information law. This amendment takes away our right to access a vast array of hospital quality information, by allowing hospital executives to withhold information about "system failures". Some hospitals don't want to answer the public's questions about what has been done to reduce hospital-acquired infections and adverse events.
The hospital secrecy loophole was pushed through legislative committee on May 5 by the Liberals, at the behest of the Ontario Hospital Association (OHA), malpractice insurance companies for hospitals and doctors, and the Ontario Medical Association. Tom Closson, CEO of the OHA, was particularly vocal in promoting this loophole. Minister of Health Deb Matthews told the legislature that she was "persuaded" by the "hospital sector" to put this loophole in the budget bill.
Many groups and individuals opposed the hospital secrecy loophole, on the grounds that the public should have a right to know what is happening in public hospitals. These groups include: the Canadian Civil Liberties Association, the Council of Canadians, the Medical Reform Group, ImPatient for Change, the Ontario Health Coalition, nurses (RNAO, ONA), healthcare worker unions (OPSEU, CUPE, SEIU, CAW, OFL), the Association for Reformed Political Action, the Ontario Trial Lawyers Association and other citizens.
Hospitals were put under the Freedom of Information and Protection of Privacy Act (FIPPA) in December 2010 as a response to the e-Health scandal. They were given until January 1, 2012 to start processing FIPPA requests, dating from 2007. Ontario was the last province to put hospitals under freedom of information legislation. We were finally catching up, but the new hospital secrecy loophole is considered by many to be a big step backwards.
The public can appeal denied requests to the Information and Privacy Commissioner (IPC) but these appeals can take years and injured patients don't always have time to wait. Appeals to the IPC may also interfere with freedom of the press if journalists require government approval to get public information for their stories. The broadly-worded hospital secrecy loophole is against the principle of FIPPA, that any exemption be limited and specific.
The amendment passed in committee, five to three. Five Liberals voted yes to hospital secrecy: Liz Sandals and Phil McNeely (Parliamentary Assistants to Minister Matthews), Bob Delaney, Helena Jaczek and Leeanna Pendergast.
Conservatives Toby Barrett and Norm Miller and NDP Peter Tabuns voted against the hospital secrecy loophole. The Conservative and NDP caucuses also opposed it.
The next provincial election is on October 6, 2011. This is your opportunity to elect a party which puts the public interest ahead of the interests of hospital and insurance lobbyists. We encourage you to vote for hospital transparency and accountability; ask your candidates if they intend to reverse the hospital secrecy law.
There has been significant media coverage of the hospital secrecy amendment already, including in the London Free Press, QMI Agency, Canadian Press, Toronto Star, Winnipeg Free Press, Guelph Mercury, Kitchener-Waterloo Record, Kingston Whig-Standard, Windsor Star, Sudbury Star, Global Toronto, CBC Radio, CFRA, and CTV.
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.
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.
Tuesday, May 3, 2011
The truth about OHA's "truth"
In the last few days, the Ontario Hospital Association (OHA) released a memo entitled, "The truth about FOI and hospitals' quality of care records" -
http://www.oha.com/CurrentIssues/Issues/Pages/TheTruthaboutFOIandHospitals%E2%80%99QualityofCareRecords.aspx
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Recently, in a memo called “The truth about FOI and Hospitals’ Quality of Care Records”, the Ontario Hospital Association, a lobby group for hospitals, suggested that “public interest groups” were attempting to “grossly mislead” the public about what Bill 173 schedule 15 (popularly known as the “hospital secrecy law”) would do or not do. We cannot take credit for inspiring their rhetoric.
But let’s test their assertions.
OHA Assertion #1: OHA claims it asked the government to include hospitals under the Freedom of Information and Protection of Privacy Act (FIPPA) in 2009 in order to demonstrate its commitment to public transparency and accountability. It further claims that the exemption in Bill 173 s.15 is for a “narrow and well-defined class of quality information” that it seeks to shield from public disclosure.
Fact: The OHA is seeking an exemption to FIPPA that will permit hospitals to negate transparency and accountability by shielding from disclosure “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.” (italicized is the most recent amendment to s.15, by the Liberal government).
This extremely broad ranging exemption belies the assertion of the OHA, as it demonstrates a retreat from transparency and accountability. The most recent amendment allows hospital executives to shield documents from disclosure simply by stamping them as “confidential” or by stating that they were intended to be private.
Press reports in the past month have exposed advice by a leading law firm which represents many Ontario hospitals (and whose expertise is still listed on OHA’s website), urging them to avoid the reputational risk of an e-Health like scandal by “cleansing existing files” before their documents become available to the public under FIPPA in 2012. It is evident from this advice and from the OHA’s efforts to lobby the government to pass Schedule 15, that hospitals were not pleased when the Broader Public Sector Accountability Act (BPSAA) – transparency and accountability legislation – passed in December 2010. Hospitals want to continue to control the disclosure of documents and withhold those which may reveal “systemic failures” or put their reputations at risk.
The BPSAA – the government’s response to the $1 billion LHIN scandal – put hospitals under FIPPA and banned the use of taxpayer-funded hospital lobbyists.
Transparency and trust are essential in public services and we are opposed to any attempt by hospitals to withhold public information, whether by “cleansing” records or by pressing for the enactment of a “hospital secrecy law.”
OHA Assertion #2: The OHA claims that disclosing hospital quality information to the public would create a “chilling effect” – that staff would be unwilling to come forward with their concerns if they might be exposed to external analysis and public opinion. It calls closed discussions “a culture of safety” and it says that if documents are disclosed, it could be detrimental to patients.
Fact: This definition of a “culture of safety” suggests a culture of protecting hospitals, not patients. It is a recipe for keeping the public in the dark.
We believe that sunshine is the best disinfectant. When hospitals were mandated to disclose their mortality ratios, we found out Scarborough hospital wasn’t doing so well. That bit of exposure enabled this hospital to make safety improvements and it is pleased with its progress.[1] When hospitals were mandated to report on rates of hospital-acquired infections, media coverage led to more public awareness and to an effective effort to find solutions.
The OHA has not provided any evidence that shielding quality of care information from disclosure, beyond QCIPA, will improve patient outcomes. We know that transparency works and we believe that more transparency about quality of care, in the form of public information requests to hospitals under FIPPA, will work even better.
Other government services have already come under FIPPA and the “chilling effect” argument could be used by any of them. Nobody suggests that other organizations should be able to subvert the principles of FIPPA, which states “that information should be available to the public and that necessary exemptions from the right of access should be limited and specific” (FIPPA 1(a)).
OHA Assertion #3: The OHA claims that Bill 173 s.15 is comparable to legislation in other jurisdictions and may be less restrictive.
Fact: Ontario was the last province to put hospitals under freedom of information legislation. We are finally catching up to other provinces with the insertion of hospitals under FIPPA in the Broader Public Sector Accountability Act (BPSAA). This budget amendment (Bill 173 s.15) is a step backwards in efforts to improve patient safety.
The OHA calls the disclosure exemption provisions in Quebec “weaker and narrower” than those found in other provinces. In fact, in Quebec, there is no specific exemption for quality of care information. Thus, the public interest in Quebec is better protected than would be the case in Ontario if Schedule 15 passes.
The remainder of the OHA’s jurisdictional analysis also appears to be biased. For example, the Evidence Act in Alberta is not directly comparable to the exemption in Bill 173 s.15, as it applies to lawsuits. A full jurisdictional review by an independent legal expert agreed upon by all concerned parties in this debate should be undertaken.
In the U.S., the Institute of Medicine – the health arm of the National Academy of Sciences and an authoritative independent voice on patient safety – released a landmark report in 2001 called Crossing the Quality Chasm: A New Health System for the 21st Century. It described “the need for transparency” as one of the ten rules for a safer, more effective, patient-centred, timely, efficient and equitable healthcare system.
OHA Assertion #4: The OHA claims that Bill 173 s.15 applies only to quality of care information prepared for a committee, not all quality of care records.
Fact: The OHA and the government did not define the term “hospital committee.” We know that the OHA considers QCIPA committees too narrow and we know that the language of this amendment has been adjusted several times. The government has had an opportunity to define this term but it has chosen not to do so. We can fairly conclude that any quality of care information that hospital executives don’t want to share can be funnelled through a committee. This very note, “The Truth about OHA’s “truth””, could be assigned to a committee, under such vague language, and shielded from public disclosure. So could notes based on a discussion about quality which takes place between two doctors in the corridor.
This is not speculation. A memorandum from Borden Ladner Gervais by a health lawyer who has represented HIROC, the hospitals’ malpractice insurance company, provides practical tips to hospitals including one to “investigate how quality related activities are done and ask if this is still appropriate and what alternate methods might be. For example, are the activities done by individuals or on an ad hoc basis without direction from a more formal committee process? If so, an alternate method might be to bring it under a committee in order for the exemption or exclusion to apply.”[2]
OHA Assertion #5: OHA claims that QCIPA doesn’t protect enough information, because it doesn’t protect the “everyday” discussions that healthcare professionals regularly have relating to quality, safety and risk management. Information which might be shared with other hospitals about “lessons learned” and “system failures” are also not protected by QCIPA. And the OHA says QCIPA is a slow mechanism of disclosure to inform patients about investigations, so many such activities are conducted outside QCIPA.
Fact: QCIPA – the Quality of Care Information Protection Act – is a vehicle for private discussions of medical errors related to lawsuits and other adverse events. This Act, which the OHA claims is too strict, may actually be too broad to safeguard the public interest. The OHA has already suggested that if forced to disclose information under FIPPA, hospitals may attempt to withhold that information using QCIPA. We are opposed to efforts to shield public information from disclosure and we look forward to the opportunity to challenge provisions in QCIPA which may allow the OHA to do this.
The OHA is right about one thing. QCIPA doesn’t protect “everyday” discussions about healthcare quality and it doesn’t shield “lessons learned” and “system failures” from public disclosure. And that’s a good thing. Those are precisely the kinds of information the public needs to know. Hospitals are funded with taxpayer money and they should be transparent and accountable to the public.
The argument that QCIPA is too slow a tool for disclosure also illustrates our point – if QCIPA is too slow, why would we want to slow down FIPPA, by shielding even more information from disclosure, and then requiring patients, families and the public to undergo lengthy appeals to the Information and Privacy Commissioner? As the Ontario Nurses Association (ONA) put it, in its testimony opposing Schedule 15, “the process to put in an appeal of a decision to not disclose information under FIPPA is a lengthy and litigious one that many organizations and most members of the public simply will not undertake.” Expediting disclosure is in the public interest and that is a very good reason to vote against Schedule 15.[3], [4]
OHA Assertion #6: The OHA gives some examples of quality information which it doesn’t think should be shared with the public. It refers to a hospital with elevated rates of C. difficile, often a hospital-acquired infection and suggests that information which should be shielded from public disclosure includes reviews of infection control practices, changes in the working environment, and other contributing factors. The OHA also suggests that incident reviews, leading to identification of failures, recommendations for improvement and prevention of reoccurrences must be done in a sheltered environment.
In committee testimony for the same amendment in its previously defeated incarnation to the BPSAA in 2010, the spokesperson for HIROC, the hospitals’ malpractice insurer, suggested other questions which she thought weren’t adequately shielded from public disclosure: “Do you have a fever protocol for paediatrics? Do you have physicians personally see patients before they’re discharged?”
Fact: This kind of information – about “system failures” – is exactly what we want to know about and what the OHA thinks the public shouldn’t get. Have hospitals implemented the recommendations resulting from analysis of the SARS outbreak? Do hospitals have good isolation protocols and are they well implemented? What about for a specific department or a specific illness? Answers to these questions are not available under any other current legislation and can only be addressed through public requests for information under FIPPA. The public has a right to know and transparency works to improve patient safety and save lives.
As for incident reviews, these are sometimes conducted without the input of the patient or family affected, and without analysis of the impact of an adverse event on a patient, so conclusions may be inaccurate and unverified. While personal health information must absolutely be protected, the public has a right to know: how many of these root cause analyses have been completed; did they result in binding recommendations; were those recommendations implemented, measured and enforced; and have they been effective in preventing recurrence?
Schedule 15 greatly limits the public’s ability to get answers to questions about priority setting policies and the extent of service cutbacks, which are ongoing concerns that have tremendous impact on patient safety.
We have many other questions about hospital quality which hospitals won’t answer if Schedule 15 passes. We are also happy to help people with specific healthcare concerns develop system-based questions of public interest value. If you want to know what is going on in your hospital and would like some assistance filing a FIPPA request, please contact us at impatient4change@gmail.com . Our goal is to protect the rights of patients and the public to access healthcare information including information about hospital quality.
OHA Assertion #7: The OHA claims that the risk of public disclosure of quality information may lead staff to stop identifying, commenting on or participating in investigations of patient care.
Fact: It is totally unacceptable to suggest that healthcare professionals won’t file reports about patient care and hospital quality. They have a professional responsibility to file these reports. The Ontario Nurses Association, CUPE Ontario, OPSEU and SEIU, all of whom represent healthcare workers, are opposed to Schedule 15 and in favour of transparency.
The Ontario Nurses’ Association (ONA) wrote in its submission to the Finance Committee that:
“the intent of Schedule 15 in Bill 173 appears to be counterproductive to the government’s intent to move forward with a quality agenda in Ontario hospitals...Quality care is a fundamental concern for nurses. Restrictions on access to information and records on quality health care provided in hospitals is a concern not only to nurses but to our patients. Schedule 15 in Bill 173 must not be passed since it will exempt the disclosure of information from many important hospital committees related to the quality of health care provided by our hospitals. This is not in the public’s interest, nor in the interest of the public’s right to know about quality issues in our hospitals. We respectfully submit this recommendation and request that it be given serious consideration by the Standing Committee so that patients in hospitals not only receive the quality care they deserve, but are able to access information and records related to the provision of that quality care.”
OHA Assertion #8: The OHA refers to sheltered discussions as “open”, “safe” and “protected”. And they say they will only use the amendment as “intended”.
Fact: To build a province whose healthcare system is truly open and transparent to the public, whose culture is safer for patients, and where public access information is protected, we must stop Schedule 15, the “hospital secrecy law.”
Unfortunately, when the OHA, in their memo, uses the word “open”, it means “internal” and when it uses the word “protect” (as it did 20 times in its memo), it means “from public disclosure”, “secrecy”, and “reputations.”
There are other problems with Schedule 15. The amendment is being rushed through in a budget bill with insufficient public consultation or debate. The amendment reverses the onus of FIPPA -- exemptions must normally be limited, specific and proven by the party which wants to withhold the information; in the case of the “hospital secrecy” amendment, the public would have to prove why its interest outweighs the hospital’s need to withhold the information. This contradicts the basic principles upon which FIPPA is based.
In a democracy, the government’s sense of balance must be weighted in favour of the public interest. Hospitals receive public funds and so must be accountable and transparent to the public. We hope the government will withdraw Schedule 15.
[1] Scarborough Hospital dramatically improves mortality ratio for 2010: http://www.tsh.to/pages/TSH-dramatically-improves-HSMR-results-for-2010
[2] Hawkins, Patrick et al. BLG “FOI-ables Bulletin. April 8, 2011. http://www.mondaq.com/canada/article.asp?articleid=129304
[3] We agree that personal health information must be protected and that it is already well protected under the Personal Health Information Protection Act (PHIPA). Patient privacy is essential and is not compromised by FIPPA.
[4] The Excellent Care for All Act (ECFAA), which the OHA refers to in their memo, has a noble name. But nothing in this law replaces the provisions of FIPPA. FIPPA alone provides a means to access information without all the filters of a hospital’s risk management department. The ECFAA provides hospital information in glossy bureaucratic reports, but FIPPA provides raw data, emails, internal reports, statistics, and meeting minutes, so the public can draw its own conclusions.
http://www.oha.com/CurrentIssues/Issues/Pages/TheTruthaboutFOIandHospitals%E2%80%99QualityofCareRecords.aspx
------------
Recently, in a memo called “The truth about FOI and Hospitals’ Quality of Care Records”, the Ontario Hospital Association, a lobby group for hospitals, suggested that “public interest groups” were attempting to “grossly mislead” the public about what Bill 173 schedule 15 (popularly known as the “hospital secrecy law”) would do or not do. We cannot take credit for inspiring their rhetoric.
But let’s test their assertions.
OHA Assertion #1: OHA claims it asked the government to include hospitals under the Freedom of Information and Protection of Privacy Act (FIPPA) in 2009 in order to demonstrate its commitment to public transparency and accountability. It further claims that the exemption in Bill 173 s.15 is for a “narrow and well-defined class of quality information” that it seeks to shield from public disclosure.
Fact: The OHA is seeking an exemption to FIPPA that will permit hospitals to negate transparency and accountability by shielding from disclosure “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.” (italicized is the most recent amendment to s.15, by the Liberal government).
This extremely broad ranging exemption belies the assertion of the OHA, as it demonstrates a retreat from transparency and accountability. The most recent amendment allows hospital executives to shield documents from disclosure simply by stamping them as “confidential” or by stating that they were intended to be private.
Press reports in the past month have exposed advice by a leading law firm which represents many Ontario hospitals (and whose expertise is still listed on OHA’s website), urging them to avoid the reputational risk of an e-Health like scandal by “cleansing existing files” before their documents become available to the public under FIPPA in 2012. It is evident from this advice and from the OHA’s efforts to lobby the government to pass Schedule 15, that hospitals were not pleased when the Broader Public Sector Accountability Act (BPSAA) – transparency and accountability legislation – passed in December 2010. Hospitals want to continue to control the disclosure of documents and withhold those which may reveal “systemic failures” or put their reputations at risk.
The BPSAA – the government’s response to the $1 billion LHIN scandal – put hospitals under FIPPA and banned the use of taxpayer-funded hospital lobbyists.
Transparency and trust are essential in public services and we are opposed to any attempt by hospitals to withhold public information, whether by “cleansing” records or by pressing for the enactment of a “hospital secrecy law.”
OHA Assertion #2: The OHA claims that disclosing hospital quality information to the public would create a “chilling effect” – that staff would be unwilling to come forward with their concerns if they might be exposed to external analysis and public opinion. It calls closed discussions “a culture of safety” and it says that if documents are disclosed, it could be detrimental to patients.
Fact: This definition of a “culture of safety” suggests a culture of protecting hospitals, not patients. It is a recipe for keeping the public in the dark.
We believe that sunshine is the best disinfectant. When hospitals were mandated to disclose their mortality ratios, we found out Scarborough hospital wasn’t doing so well. That bit of exposure enabled this hospital to make safety improvements and it is pleased with its progress.[1] When hospitals were mandated to report on rates of hospital-acquired infections, media coverage led to more public awareness and to an effective effort to find solutions.
The OHA has not provided any evidence that shielding quality of care information from disclosure, beyond QCIPA, will improve patient outcomes. We know that transparency works and we believe that more transparency about quality of care, in the form of public information requests to hospitals under FIPPA, will work even better.
Other government services have already come under FIPPA and the “chilling effect” argument could be used by any of them. Nobody suggests that other organizations should be able to subvert the principles of FIPPA, which states “that information should be available to the public and that necessary exemptions from the right of access should be limited and specific” (FIPPA 1(a)).
OHA Assertion #3: The OHA claims that Bill 173 s.15 is comparable to legislation in other jurisdictions and may be less restrictive.
Fact: Ontario was the last province to put hospitals under freedom of information legislation. We are finally catching up to other provinces with the insertion of hospitals under FIPPA in the Broader Public Sector Accountability Act (BPSAA). This budget amendment (Bill 173 s.15) is a step backwards in efforts to improve patient safety.
The OHA calls the disclosure exemption provisions in Quebec “weaker and narrower” than those found in other provinces. In fact, in Quebec, there is no specific exemption for quality of care information. Thus, the public interest in Quebec is better protected than would be the case in Ontario if Schedule 15 passes.
The remainder of the OHA’s jurisdictional analysis also appears to be biased. For example, the Evidence Act in Alberta is not directly comparable to the exemption in Bill 173 s.15, as it applies to lawsuits. A full jurisdictional review by an independent legal expert agreed upon by all concerned parties in this debate should be undertaken.
In the U.S., the Institute of Medicine – the health arm of the National Academy of Sciences and an authoritative independent voice on patient safety – released a landmark report in 2001 called Crossing the Quality Chasm: A New Health System for the 21st Century. It described “the need for transparency” as one of the ten rules for a safer, more effective, patient-centred, timely, efficient and equitable healthcare system.
OHA Assertion #4: The OHA claims that Bill 173 s.15 applies only to quality of care information prepared for a committee, not all quality of care records.
Fact: The OHA and the government did not define the term “hospital committee.” We know that the OHA considers QCIPA committees too narrow and we know that the language of this amendment has been adjusted several times. The government has had an opportunity to define this term but it has chosen not to do so. We can fairly conclude that any quality of care information that hospital executives don’t want to share can be funnelled through a committee. This very note, “The Truth about OHA’s “truth””, could be assigned to a committee, under such vague language, and shielded from public disclosure. So could notes based on a discussion about quality which takes place between two doctors in the corridor.
This is not speculation. A memorandum from Borden Ladner Gervais by a health lawyer who has represented HIROC, the hospitals’ malpractice insurance company, provides practical tips to hospitals including one to “investigate how quality related activities are done and ask if this is still appropriate and what alternate methods might be. For example, are the activities done by individuals or on an ad hoc basis without direction from a more formal committee process? If so, an alternate method might be to bring it under a committee in order for the exemption or exclusion to apply.”[2]
OHA Assertion #5: OHA claims that QCIPA doesn’t protect enough information, because it doesn’t protect the “everyday” discussions that healthcare professionals regularly have relating to quality, safety and risk management. Information which might be shared with other hospitals about “lessons learned” and “system failures” are also not protected by QCIPA. And the OHA says QCIPA is a slow mechanism of disclosure to inform patients about investigations, so many such activities are conducted outside QCIPA.
Fact: QCIPA – the Quality of Care Information Protection Act – is a vehicle for private discussions of medical errors related to lawsuits and other adverse events. This Act, which the OHA claims is too strict, may actually be too broad to safeguard the public interest. The OHA has already suggested that if forced to disclose information under FIPPA, hospitals may attempt to withhold that information using QCIPA. We are opposed to efforts to shield public information from disclosure and we look forward to the opportunity to challenge provisions in QCIPA which may allow the OHA to do this.
The OHA is right about one thing. QCIPA doesn’t protect “everyday” discussions about healthcare quality and it doesn’t shield “lessons learned” and “system failures” from public disclosure. And that’s a good thing. Those are precisely the kinds of information the public needs to know. Hospitals are funded with taxpayer money and they should be transparent and accountable to the public.
The argument that QCIPA is too slow a tool for disclosure also illustrates our point – if QCIPA is too slow, why would we want to slow down FIPPA, by shielding even more information from disclosure, and then requiring patients, families and the public to undergo lengthy appeals to the Information and Privacy Commissioner? As the Ontario Nurses Association (ONA) put it, in its testimony opposing Schedule 15, “the process to put in an appeal of a decision to not disclose information under FIPPA is a lengthy and litigious one that many organizations and most members of the public simply will not undertake.” Expediting disclosure is in the public interest and that is a very good reason to vote against Schedule 15.[3], [4]
OHA Assertion #6: The OHA gives some examples of quality information which it doesn’t think should be shared with the public. It refers to a hospital with elevated rates of C. difficile, often a hospital-acquired infection and suggests that information which should be shielded from public disclosure includes reviews of infection control practices, changes in the working environment, and other contributing factors. The OHA also suggests that incident reviews, leading to identification of failures, recommendations for improvement and prevention of reoccurrences must be done in a sheltered environment.
In committee testimony for the same amendment in its previously defeated incarnation to the BPSAA in 2010, the spokesperson for HIROC, the hospitals’ malpractice insurer, suggested other questions which she thought weren’t adequately shielded from public disclosure: “Do you have a fever protocol for paediatrics? Do you have physicians personally see patients before they’re discharged?”
Fact: This kind of information – about “system failures” – is exactly what we want to know about and what the OHA thinks the public shouldn’t get. Have hospitals implemented the recommendations resulting from analysis of the SARS outbreak? Do hospitals have good isolation protocols and are they well implemented? What about for a specific department or a specific illness? Answers to these questions are not available under any other current legislation and can only be addressed through public requests for information under FIPPA. The public has a right to know and transparency works to improve patient safety and save lives.
As for incident reviews, these are sometimes conducted without the input of the patient or family affected, and without analysis of the impact of an adverse event on a patient, so conclusions may be inaccurate and unverified. While personal health information must absolutely be protected, the public has a right to know: how many of these root cause analyses have been completed; did they result in binding recommendations; were those recommendations implemented, measured and enforced; and have they been effective in preventing recurrence?
Schedule 15 greatly limits the public’s ability to get answers to questions about priority setting policies and the extent of service cutbacks, which are ongoing concerns that have tremendous impact on patient safety.
We have many other questions about hospital quality which hospitals won’t answer if Schedule 15 passes. We are also happy to help people with specific healthcare concerns develop system-based questions of public interest value. If you want to know what is going on in your hospital and would like some assistance filing a FIPPA request, please contact us at impatient4change@gmail.com . Our goal is to protect the rights of patients and the public to access healthcare information including information about hospital quality.
OHA Assertion #7: The OHA claims that the risk of public disclosure of quality information may lead staff to stop identifying, commenting on or participating in investigations of patient care.
Fact: It is totally unacceptable to suggest that healthcare professionals won’t file reports about patient care and hospital quality. They have a professional responsibility to file these reports. The Ontario Nurses Association, CUPE Ontario, OPSEU and SEIU, all of whom represent healthcare workers, are opposed to Schedule 15 and in favour of transparency.
The Ontario Nurses’ Association (ONA) wrote in its submission to the Finance Committee that:
“the intent of Schedule 15 in Bill 173 appears to be counterproductive to the government’s intent to move forward with a quality agenda in Ontario hospitals...Quality care is a fundamental concern for nurses. Restrictions on access to information and records on quality health care provided in hospitals is a concern not only to nurses but to our patients. Schedule 15 in Bill 173 must not be passed since it will exempt the disclosure of information from many important hospital committees related to the quality of health care provided by our hospitals. This is not in the public’s interest, nor in the interest of the public’s right to know about quality issues in our hospitals. We respectfully submit this recommendation and request that it be given serious consideration by the Standing Committee so that patients in hospitals not only receive the quality care they deserve, but are able to access information and records related to the provision of that quality care.”
OHA Assertion #8: The OHA refers to sheltered discussions as “open”, “safe” and “protected”. And they say they will only use the amendment as “intended”.
Fact: To build a province whose healthcare system is truly open and transparent to the public, whose culture is safer for patients, and where public access information is protected, we must stop Schedule 15, the “hospital secrecy law.”
Unfortunately, when the OHA, in their memo, uses the word “open”, it means “internal” and when it uses the word “protect” (as it did 20 times in its memo), it means “from public disclosure”, “secrecy”, and “reputations.”
There are other problems with Schedule 15. The amendment is being rushed through in a budget bill with insufficient public consultation or debate. The amendment reverses the onus of FIPPA -- exemptions must normally be limited, specific and proven by the party which wants to withhold the information; in the case of the “hospital secrecy” amendment, the public would have to prove why its interest outweighs the hospital’s need to withhold the information. This contradicts the basic principles upon which FIPPA is based.
In a democracy, the government’s sense of balance must be weighted in favour of the public interest. Hospitals receive public funds and so must be accountable and transparent to the public. We hope the government will withdraw Schedule 15.
[1] Scarborough Hospital dramatically improves mortality ratio for 2010: http://www.tsh.to/pages/TSH-dramatically-improves-HSMR-results-for-2010
[2] Hawkins, Patrick et al. BLG “FOI-ables Bulletin. April 8, 2011. http://www.mondaq.com/canada/article.asp?articleid=129304
[3] We agree that personal health information must be protected and that it is already well protected under the Personal Health Information Protection Act (PHIPA). Patient privacy is essential and is not compromised by FIPPA.
[4] The Excellent Care for All Act (ECFAA), which the OHA refers to in their memo, has a noble name. But nothing in this law replaces the provisions of FIPPA. FIPPA alone provides a means to access information without all the filters of a hospital’s risk management department. The ECFAA provides hospital information in glossy bureaucratic reports, but FIPPA provides raw data, emails, internal reports, statistics, and meeting minutes, so the public can draw its own conclusions.
Thursday, April 21, 2011
Response to the Ontario Hospital Association's Press Release
Re: the Ontario Hospital Association's Press Release: http://bit.ly/dOtIX1
The Ontario Hospital Association (OHA) is trying to distance itself from comments by law firm Osler, that hospitals should "cleanse" their records to prevent scandal. But its arguments simply don't stand up.
The OHA claims Osler doesn't represent it, but the firm represents many of the OHA's member hospitals.
While the OHA is clearly not pleased that Osler has "chosen to publicly share" their advice on avoiding compliance with FIPPA, it's not clear what steps the OHA is prepared to take to show its commitment to transparency.
While the OHA pays lip service to the Freedom of Information Act (FIPPA), its actions belie its words: it has been lobbying the government for months to pass a hospital secrecy law which undermines the Act in both letter and spirit.
The hospital secrecy law (Bil 173 s.15) will build a wall around hospitals so high and thick that the public can't get through.
The Ontario Hospital Association (OHA) is trying to distance itself from comments by law firm Osler, that hospitals should "cleanse" their records to prevent scandal. But its arguments simply don't stand up.
The OHA claims Osler doesn't represent it, but the firm represents many of the OHA's member hospitals.
While the OHA is clearly not pleased that Osler has "chosen to publicly share" their advice on avoiding compliance with FIPPA, it's not clear what steps the OHA is prepared to take to show its commitment to transparency.
While the OHA pays lip service to the Freedom of Information Act (FIPPA), its actions belie its words: it has been lobbying the government for months to pass a hospital secrecy law which undermines the Act in both letter and spirit.
The hospital secrecy law (Bil 173 s.15) will build a wall around hospitals so high and thick that the public can't get through.
Ontario government pushes hospital secrecy law
Thursday, April 21, 2011 - 8:30-10 AM and 2:00-6:00 PM.
TORONTO, QUEEN'S PARK --
Finance and Economic Affairs Committee Room -
Public Hearings for Bill 173 - budget bill
Schedule: http://bit.ly/eezdQT
Includes comment on s.15 of Bill 173, Hospital Secrecy Law
Premier Dalton McGuinty, who told the press today that he wants open, accountable and transparent hospitals, is advancing a budget through the legislature that keeps hospital information secret.
McGuinty offered the statement of transparency in response to news stories which quoted a Toronto law firm advising hospitals to avoid scandal by "cleansing" their existing records.
But on Thursday, the government's finance committee will be hearing an earful from angry health citizen groups, who are upset that the Liberals have buried a hospital secrecy law in their budget.
The hospital secrecy law is an amendment to the Freedom of Information and Protection of Privacy Act (FIPPA), which allows hospitals to refuse to disclose hospital quality information.
This hospital secrecy law was defeated in the fall when it was first suggested as an amendment to the Broader Public Sector Accountability Act (BPSAA) by Canada's largest malpractice insurance company for hospitals (HIROC), the Ontario Hospital Association (OHA), and the Ontario Medical Association (OMA).
The BPSAA, which was enacted as a response to the LHIN e-Health scandal, received royal assent in December. This act granted the public access to hospital quality information through FIPPA beginning in January 2012 and dating from 2007.
The lobbyists were not happy about this, so Health Minister Deb Matthews told the legislature that they "persuaded" her to resurrect the amendment and stick it back in the budget bill.
A number of groups are opposed to this hospital secrecy law, including the Registered Nurses Association of Ontario, the Ontario Health Coalition, ImPatient for Change (a patient rights group), church groups, and other citizens. They argue that transparency is important and that the public should have a right to know what is going on in our public healthcare system.
Federal parties say they plan to increase transfer payments to the provinces for healthcare. In order to determine if federal dollars are being spent wisely, the federal government will need access to healthcare information. But they won't have this access to information from Ontario, if this hospital secrecy law passes.
The vote on the hospital secrecy law, which will revoke the public's right to access healthcare information, is on May 5.
Here are some highlights of media coverage of this amendment:
Toronto Star: http://bit.ly/hT4Wji
London Free Press: http://bit.ly/fRods9
Global Toronto: http://bit.ly/gv59YS
CFRA 580: http://bit.ly/fcF5Aa
CTV Toronto: http://bit.ly/govmD7
Kitchener-Waterloo Record: http://bit.ly/hJ4pgz
Guelph Mercury: http://bit.ly/erdcEB
Winnipeg Free Press - http://bit.ly/f73WYU
Canadian Press - http://bit.ly/eJgiXx
QMI Agency - SunMedia: http://bit.ly/fBEpWx
The London Free Press: http://bit.ly/eThY6q (re: cleansing records)
The London Free Press: http://bit.ly/fW63bI (re: hospital secrecy law)
CBC Radio Windsor interview: http://bit.ly/g2RiNO
Toronto Star before the fall vote: http://bit.ly/iiCdj5
Sudbury Star after amendment defeated in the fall: http://bit.ly/gB0eJw
-30 -
ImPatient for Change is a new patient rights organization whose goal is to exchange information about patient safety and to advocate for medical reform in the public interest. We believe that Every Patient Matters. For more information, please contact impatient4change@gmail.com or visit us on Facebook at Every Patient Matters.
TORONTO, QUEEN'S PARK --
Finance and Economic Affairs Committee Room -
Public Hearings for Bill 173 - budget bill
Schedule: http://bit.ly/eezdQT
Includes comment on s.15 of Bill 173, Hospital Secrecy Law
Premier Dalton McGuinty, who told the press today that he wants open, accountable and transparent hospitals, is advancing a budget through the legislature that keeps hospital information secret.
McGuinty offered the statement of transparency in response to news stories which quoted a Toronto law firm advising hospitals to avoid scandal by "cleansing" their existing records.
But on Thursday, the government's finance committee will be hearing an earful from angry health citizen groups, who are upset that the Liberals have buried a hospital secrecy law in their budget.
The hospital secrecy law is an amendment to the Freedom of Information and Protection of Privacy Act (FIPPA), which allows hospitals to refuse to disclose hospital quality information.
This hospital secrecy law was defeated in the fall when it was first suggested as an amendment to the Broader Public Sector Accountability Act (BPSAA) by Canada's largest malpractice insurance company for hospitals (HIROC), the Ontario Hospital Association (OHA), and the Ontario Medical Association (OMA).
The BPSAA, which was enacted as a response to the LHIN e-Health scandal, received royal assent in December. This act granted the public access to hospital quality information through FIPPA beginning in January 2012 and dating from 2007.
The lobbyists were not happy about this, so Health Minister Deb Matthews told the legislature that they "persuaded" her to resurrect the amendment and stick it back in the budget bill.
A number of groups are opposed to this hospital secrecy law, including the Registered Nurses Association of Ontario, the Ontario Health Coalition, ImPatient for Change (a patient rights group), church groups, and other citizens. They argue that transparency is important and that the public should have a right to know what is going on in our public healthcare system.
Federal parties say they plan to increase transfer payments to the provinces for healthcare. In order to determine if federal dollars are being spent wisely, the federal government will need access to healthcare information. But they won't have this access to information from Ontario, if this hospital secrecy law passes.
The vote on the hospital secrecy law, which will revoke the public's right to access healthcare information, is on May 5.
Here are some highlights of media coverage of this amendment:
Toronto Star: http://bit.ly/hT4Wji
London Free Press: http://bit.ly/fRods9
Global Toronto: http://bit.ly/gv59YS
CFRA 580: http://bit.ly/fcF5Aa
CTV Toronto: http://bit.ly/govmD7
Kitchener-Waterloo Record: http://bit.ly/hJ4pgz
Guelph Mercury: http://bit.ly/erdcEB
Winnipeg Free Press - http://bit.ly/f73WYU
Canadian Press - http://bit.ly/eJgiXx
QMI Agency - SunMedia: http://bit.ly/fBEpWx
The London Free Press: http://bit.ly/eThY6q (re: cleansing records)
The London Free Press: http://bit.ly/fW63bI (re: hospital secrecy law)
CBC Radio Windsor interview: http://bit.ly/g2RiNO
Toronto Star before the fall vote: http://bit.ly/iiCdj5
Sudbury Star after amendment defeated in the fall: http://bit.ly/gB0eJw
-30 -
ImPatient for Change is a new patient rights organization whose goal is to exchange information about patient safety and to advocate for medical reform in the public interest. We believe that Every Patient Matters. For more information, please contact impatient4change@gmail.com or visit us on Facebook at Every Patient Matters.
Sunday, December 19, 2010
Reaching Out to the Stars
"I will love the light for it shows me the way, yet I will endure the darkness because it shows me the stars."
- Og Mandino
When we first look at the night sky, we see only darkness. But after we blink, we start to notice the flickering light of the stars. They flicker because we see them through a turbulent atmosphere. And the longer we look, the more of them we see.
So it is with survivors of medical error - we are numerous, but we often feel alone until we find each other, flickering through the turbulence. We are strong and we shine.
Some have been shining for longer, or with more resources, and some are already changing the system.
Here are a couple more Canadian survivor websites worth highlighting:
Empowered Patient Canada
There are other Canadian groups listed through the site advocatedirectory.org, which is a project of Mothers Against Medical Error. We have much to learn from American advocates, who have more experience strengthening the patient voice in dialogue about patient safety.
Many Canadians have tenaciously pursued their own battles for answers, compensation and legislative changes to protect others; not all of them have websites. Many are working in their communities to advocate for their family members and friends, and helping survivors who stumble into their midst. Others have joined together for specific initiatives.
The closer you look, the more people you find.
Many Canadians have tenaciously pursued their own battles for answers, compensation and legislative changes to protect others; not all of them have websites. Many are working in their communities to advocate for their family members and friends, and helping survivors who stumble into their midst. Others have joined together for specific initiatives.
The closer you look, the more people you find.
What unites all these people are some inspiring characteristics: they remain independent of government so they can advocate for the patient interest without conflict*; they are often personally affected (through direct experience or grief); and they are committed to making the Canadian healthcare system better and safer, so that we all benefit.
Rhonda Nixon of Empowered Patient Canada sent me this song as encouragement, and I'm happy to share it with you:
*Independence in Canada can be difficult to maintain. There is little to no funding for patient-led initiatives. Some government grants for specific programs can be helpful, but sometimes these come with strings which contradict the public and patient interest. We must be ever mindful, and continue to push for more independent funding.
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