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VoHCA's Submission to the 5 year Review of the
Health Professions Act

Update on the Inquiry into the CPSO Handling of
Patients' Complaints

Patients' Rights to Their Medical Records

Toronto Chapter Update

VoHCA's Website

Other Health-care Topics of Interest to VoHCA Members
 

This issue is made possible through a generous
donation by Lynn, Victor and Victoria Chauvin

UPDATE FROM THE CHAIR

The last few weeks have seen both the completion of our submission to the HPRAC five year review and the start of the independent review on how the CPSO handles complaints and discipline. Both reviews are of tremendous importance to VoHCA. Please see p5 for more details of the CPSO review.

HPRAC SUBMISSION

The VoHCA submission to the HPRAC review has now been completed. On behalf of the membership I would like to thank the Toronto Chapter for their excellent work in preparing the
document. VoHCA members and the public will soon be able to view our submission on the HPRAC website www.hprac.org or the VoHCA website, VoHCA SUBMISSION TO HPRAC.

The document is too long to reproduce in the newsletter so a summary of some of the important points is included below.

Our submission concentrates mainly on the accountability issues particularly with regard to the CPSO.

Some of the concerns of our members are as follows:

 - poor performance of the present system in dealing with complaints over incidents causing harm, up to and including death;
 - inadequacy of follow-up and corrective actions;
 - use of a non-transparent Alternate Dispute Resolution (ADR) process fraught with the potential to avert attention to systemic problems and create outcomes not in the public interest;
 - the self-serving nature of the present self-regulated system resulting in unfairness to complainants.

Two public documents by George Belza and Professor Kluge of  Victoria University suggesting major reforms to the provincial Health Professions Acts are endorsed in our submission.

Recommendations include:

(a) Mandatory practice profiles for all health-care professionals and for each facility (similar to the system available to residents of Massachusetts).

(b) Increasing the proportion of public members at all Colleges to a two-third majority, on Council and on each committee of Council, to ensure that the interest of society as a whole will prevail over the self-interest of the health profession. The public members should be selected to better represent all sectors of society.

(c) Each complainant (or health professional subject to a disciplinary hearing) should have the right to have the hearing take place before a panel of the Health Professions Appeal and Review Board rather than a panel of the College's Discipline Committee.

(d) Time limits should be included in the legislation so that complaints are dealt with in a timely manner.

(e) In cases in which the complainant and the health-care provider cannot reach a mediated settlement acceptable to both, the respective statements of both are to be published and included in the practice profile of the health professional.

(f) ADR usage should be selective and only used to deal with non-critical, non-systemic problems.

VoHCA website -      members.xoom.com/vohca

The VoHCA website is now up and running. Included on the site are our philosophy, membership application form, current and some past editions of the newsletters, the Global survey of Access to Medical Records, our HPRAC submission and information on the CPSO review.

VoHCA community discussion board -    http://pub6.ezboard.com/bvohca

HEALTH-CARE SYSTEM IN CRISIS

We are bombarded daily by the media with reports on how our "world class" health care system is falling apart. Crises in ER, unacceptably long waits by cancer patients for treatment, patients seriously injured or dying from incompetent health-care providers, the scandals at Sick Kids Hospital and Health Canada, and the list goes on. No one is immune, it seems to touch the young and old. Even some well known personalities such as Sharon Hampson who was diagnosed with cancer and then, after having surgery, discovered she did not have it at all. On top of that we see that doctors are asking for a 30% increase over three years claiming the cost of running an office has increased significantly. I listened to one poor doctor on CBC radio stating this added expense was mainly due to the acquisition of computers and information technology devices, the very same ones that business has found to save significant costs!

PATIENTS BECOMING MORE INFORMED

It is comforting to hear that more and more patients are taking responsibility for their own health-care. I see this from talking with VoHCA members and what I read in the media. The days when patients blindly put their faith and trust in doctors are slowly and thankfully going the way of the dinosaur. My own experience and that of most of our members has shown the tragic consequences of following the old path. We were brought up to put doctors on pedestals and accept their advice without question. Now we are realizing that could lead to disaster. We are now seeing that with a better educated population and the ease of access to information through the Internet that was once very difficult or almost impossible to obtain but is now available to anyone with a computer and modem a more informed society. In fact, I think the greatest threat to the medical profession, especially the GP, is the Internet. Many  patients are now doing their own research on the net and when they visit their doctor often know more about the treatment of their illness than the doctor. It is not surprising when you consider how complex the body is and how we all react differently to the various bacteria, viruses and medications. I feel it is impossible to expect a GP to be up to date on all of the vast number of diseases we may be afflicted with. Using a computer system, it is now possible to have all the current medical information, including the latest advances in symptoms recognition, diagnostics and treatment instantly available. When you consider the vast amount of information that is available and is continuously being modified and added to, you cannot expect your GP to remember it all. I think it is realistic to say that it is impossible for a GP to keep up to date.

A VoHCA survey showed that either being misdiagnosed or diagnosed too late is a major problem. I believe that more research money should be spent on symptoms recognition and
developing diagnostic techniques so that diseases can be diagnosed at an early stage. I feel we need to start training a new type of health-care worker, perhaps a nurse practitioner, who along with an expert system can effectively diagnose illnesses. The patient would then referred the to the appropriate specialist.

As well, I feel we need to start with the education and training of doctors. Even the criteria used in the selection process to enter medical school need re-evaluating. I believe the profession is attracting too many candidates who are in it for the money and prestige. Ethics need a lot more attention as well as people skills. In fact doctors should be in it for the patient and not their egos. It should be pointed out to them that they are human beings like the rest of the population and also have the frailties of the rest of us. Rather than choosing people based largely on their ability to memorize facts, I think people who genuinely care about their fellow human beings and who have an open mind would be far better to deal with patients than many of the egotistical, tunnel-visioned ones the universities now turn out.

Let's have the opinions of VoHCA members on how the health-care system should be improved.

INCORPORATION

We are now an incorporated body under the name VoHCA - Voices on Health-care Concerns and Accountability Inc. The delays were caused because the "Inc" was not included in the original application. VoHCA was not incorporated with a charitable status because it would not allow us to lobby for change which is what we are all about.

NEED HELP IN SUBMITTING A COMPLAINT?

Louise Marshall, a VoHCA member from Tamworth, Ontario, has kindly offered to assist members in preparing and submitting their complaints. She can be contacted at;

Box 201
Tamworth, Ontario
K0K  3G0

DONATIONS

VoHCA would like to thank Lynn, Victor and Victoria Chauvin of Montreal for their generous donation of $500. They believe there is a real need for an organization like VoHCA and would like to say "keep up the good work." Also, we would like to thank the Kingston Township Old Timers soccer team for a donation of $200.

PATIENTS' RIGHTS TO THEIR MEDICAL RECORDS

The VoHCA office is still receiving calls from patients having trouble obtaining copies of their medical records. On p9 you will find a copy of the CPSO article on this subject. If you take
it along to your doctor or hospital, it may help you in obtaining your records.

MEMBERS IN THE NEWS

Several VoHCA members have been featured by the media in the last few months.

An article published about Lani Fairchild's problems with her wheelchair is reproduced on p8.

The inquest into the tragic and completely unnecessary death of Sharon Shore's ten-year-old daughter Lisa at Toronto's Hospital for Sick Children was featured in most of the major
newspapers. Lisa died after receiving a very high dose of morphine and was not connected to a monitor as the doctor had ordered. As Sharon put it "Lisa didn't die because one person did one bad thing. I think she died because a number of people made a lot of terrible mistakes, and there were problems with the system." Our hearts go out to Sharon and her family.

DOCTORS' DEADLY MISTAKES

A recent article in Time magazine estimates that 98,000 Americans are killed annually by medical errors. Even though public health officials have known about if for years, but hadn't done anything about it.

As far as Canada is concerned, this would translate into about 10,000 deaths a year. The US figures are consistent with several studies which have estimated the number of deaths and serious injuries caused by medical malpractice in Ontario alone as around the 5000 per year level.

In a report entitled "To Err is Human", issued by the Institute of Medicine, a branch of the National Academies, the reasons why medical errors happen are explored.

A new Center for Patient Safety is proposed that would set error-reduction standards for hospital procedures and medical equipment, as well as a mandatory reporting system that would require hospitals to fess up to what they like to call "adverse events."

CPSO Review Finally Underway

The independent review of the complaints and discipline process of the College of Physicians
and Surgeons of Ontario (CPSO) announced by Health Minister Witmer in December 1998, is
finally underway. Because of pressure from groups like ours and individuals like Georgina
Hunter, Ms. Witmer really had no choice but to order this inquiry. This review is very important to VOHCA and we ask all members who have made a complaint to the CPSO to get involved. If you need assistance in completing your questionnaire, please call the VoHCA office at (613) 389-5599. A copy of the newspaper advert asking for input is shown on the following page and has appeared in approximately 20 newspapers throughout the province.

KPMG, a leading North American consulting company, was chosen to conduct the independent review from the bids submitted. The cost is probably going to be very high so we should try to get the most out of it.

I called the Ministry to ask what had been budgeted but was informed it was none of my business. Apparently, taxpayers are not allowed to know how their tax dollars are spent.

When you call KPMG you will be asked to leave your name and address or fax number. A
questionnaire will then be forwarded to you. Because of the large number of people expected
to call in, it will not be possible for them to conduct personal interviews over the phone.

I called KPMG on Friday 14m January and spoke to Steve Lough who is in charge of the review.
Some of the questions I asked and the answers given are listed below.

1. How many calls have been received so far? More than 120 (at this time the ad had only
appeared in about half of the newspapers).

2. Had the Ministry of Health informed KPMG about our group as they had promised? No.
He had not heard of VoHCA (Marilyn Wang told VoHCA that once the reviewer had been
announced she would pass on information about our group - Mr. Lough said he was expecting more information next week from the Ministry so it may be included in that.)

3. Would KPMG be interested in meeting with VOHCA? No, but a telephone interview in a
couple of weeks would be a possibility

4. What is the mandate given to KPMG? It was spelled out in the request tor submissions
to conduct the review. Basically, Minister Witmer feels there is a major problem with the present complaints and discipline procedure at the CPSO and KPMG has been contracted to determine what the problems are, and then make recommendations to improve the process.

5. What methodology would be used in the review?
Adverts would be placed in newspapers across Ontario requesting input from patients and doctors who had direct experience with the process.
Questionnaires would then be sent out to those who had responded to the ad.
Telephone interviews would be conducted with a selection of the persons who had returned completed questionnaires.
The CPSO would be asked to assign a number to all complaint files and KPMG would randomly submit 200 numbers. These files would then be forwarded to KPMG after removing names and other confidential material (I find this a bit worrisome as I am not sure how they can assure that the CPSO would not handpick complaints that had been satisfactorily resolved).
Comparisons would also be made to the complaints and discipilne procedures used in: (a) other provincial Colleges of Physicians and Surgeons, (b) other countries, such as UK and Australla and (c) other self-regulating bodies, such as lawyers.

I mentioned to Mr. Lough that our recent submission to the HPRAC  review made suggestions
to improving the complaints and discipline procedure at the CPSO.  He said he would be
interested in receiving a copy.

So, please, if you have made a complaint, call the number, ask for the questionnaire, And after
completing it, return it to KPMG.

I cannot stress enough the importance of this review and ask all members who have made a complaint to participate.

Have you made a complaint to the College of
Physicians and Surgeons of Ontario?

Or are you a physician who has been through
the complaints process?

We want to hear from patients and physicians who have had direct
experience with the complaints and discipline process.

Your input will remain confidential, KPMG Consulting LP has
been commissioned by the Ontario Ministry of Health and
Long-Term Care to conduct an independent review of the
complaints and discipline process of the College of Physicians and
Surgeons of Ontario.

For input into this review, please call toll-free long distance
1-877-525-2776 or local 4l6-969-6559. or write to KPMG,
405-121 Bloor St. E., Toronto, Ontario M4W 3M5
Attention: CPSO Review

Before February 15, 2000
KPMG

NEW POWER FOR AVMA

Arnold Simanowitz, Chief Executive, explains AVMA's exciting new role in advising on legal aid

In October 1997, the Lord Chancellor announced his intention to abolish legal aid for all money claims and replace it with the 'No Win, No Fee' system. Although he maintained that this was to increase 'access to justice it was clear that one of his major concerns was the money that was being wasted' on unsuccessful legal aid actions.

AVMA viewed these proposals as a disaster for those people who qualify for legal aid, whatever kind of legal action they were contemplating. No Win, No Fee can have many disadvantages for litigants and most solicitor, will not take on a case under that system unless it is certain to succeed.

No Win, No Fee can have many disadvantages for litigants

As representatives of victims of medical accidents, (now as a result of another mis-guided decision by the Lord Chancellor called 'clinical accidents') however, it was those people for whom we had to fight. We therefore mounted a campaign to preserve legal aid at least for clinical negligence litigation. Fortunately we were successful. While legal aid is still to be abolished for other money claims, it remains available for clinical negligence. But the Legal Aid Board was required to bring forward plans to make the granting of legal aid in that area more efficient and fairer. So, happily, they turned to AVMA.

In a move which was very flattering to AVMA, they asked us whether we would screen cases for them. We agreed. As from 1st April this year, therefore, the Legal Aid Board will be able to refer applications for legal aid to AVMA when it is considering refusing an application. That has major implications for our clients. Whereas in the past a legal aid application could be refused by the LAB without any input from anyone with real knowledge of clinical negligence litigation, now AVMA will not only have a chance to make its views known but those views will be taken into account by the Legal Aid Board in deciding whether or not to refuse the application.

It was always a cause of great frustration for us that when highly skilled solicitors submitted an application for legal aid it could be rejected by those who had far less knowledge of the subject. Whilst AVMA could help solicitors to make representations where appropriate we often witnessed what we regarded as significant injustice. Now we will have the power to influence the decision.

But the implications are no means as simple as that. Quite clearly becoming involved with the Legal Aid Board in that way may be seen by some people as changing the role of AVMA. AVMA is, and is seen to be, first the champion of victims of medical accidents. Will victims see us as part of the Legal Aid Board, the very authority which sometimes refuses legal aid and thereby stops victims from pursuing their claims.

Before agreeing to this new rote, we at AVMA, staff and Trustees, agonised over this decision. We eventually came to the conclusion rot only was it right that we should do it, the interests of victims themselves we had no alternative but to do it. One of the strongest reasons for that is that if we did not do it then the Legal Aid Board would employ some other person or organisation to do it. Who would that be? Is there anyone who has the independent status, case-work knowledge and the interests of victims at heart to the same extent as AVMA? The Board might even have used someone who antagonistic towards clinical negligence claims - a doctor perhaps - or an insurance company, both of whom might well see their purpose as trying to reduce the amount of negligence claims that are being brought.

AVMA's purpose is entirely different. We want to ensure that only the right claims are brought. That will mean on occasion advising the Legal Aid Board that legal aid should not be granted. But we have always believed that to grant legal aid in a case that has little merit is just as bad as refusing legal aid where a claim does have merit. It does no favour to a devastated and distressed victim of medical accident, to encourage them to go on with a claim, to get all excited about the possibility of having their case vindicated by the court and receiving the compensation to which they are entitled, only to have their expectations dashed perhaps as long as four years later when it becomes apparent that there wasn't really a case at all. We did realise, however, when we agreed to do it, that there were going to be problems. It will be difficult to persuade everyone that it is in the interests of victims, There will be times when our clients are turned down for legal aid and will look to AVMA to fight for them and AVMA will say that we have already considered the position and there is no point in fighting. The fact is, however, that we will have put in the same effort in protecting the victims interests and indeed with a much better chance of doing that given that our advice would be more likely to be taken. The crucial point is that we will not be helping to reject an application that might otherwise have been granted. The Legal Aid Board will only be using our services when they are minded to refuse an application, so AVMA will have an opportunity, which did not exist before, of ensuring a positive decision.

So our decision was based firmly on the ground that if AVMA was given this power, it would be used only in the interests of victims of medical accidents. The contract with the Legal Aid Board will be reviewed after a year. If it is not working in that way we will discontinue the arrangement.
 

November-December 1999 IMAGE novembre-decembre 1999

Wheelchair rage
by Lani Fairchild

Let me tell you about my 15 months of hell in a "Sabre" wheelchair.

Because of chronic disabilities, I qualify for an electric wheelchair paid for by the provincial government as I am on a permanent medical disability pension. I like to be active and independent. Over a year ago, a physiotherapist with the medical supply company Canada Care placed an order for my wheelchair, I learned to operate my "Sabre" quickly and I was elated to have some freedom - shopping, visiting friends, just being outside.

During the first three months one of the footrests popped off. Canada Care replaced it but it continued to fall off and soon the other one did too.

Next the cane holder strap on the back popped off while I was cruising on a sidewalk As a result, my back became sore and felt twisted, and my right shoulder and elbow began aching. I found out that part of the problem was the steering column was too far forward, an over-sight on the part of the physiotherapist.

Unbelievably, my left arm rest kept falling down too, so that I'd fall over to the left without warning. I began noticing soreness in my hips, but my complaints were to no avail.

By this time I'd had the chair for about eight months and I was starting to hate it. I could not stand to use it for more than two or three hours at a time.

A bad wobble developed in the back tires, which by this time did not surprise me. Again the chair went into the repair crew at Canada Care---but afterwards, the wobble was worse. So the chair went back for more repairs and a velcro strap was installed.

Then the front wheels started rubbing on the back of the footrests. I was told, "Oh, they do that."

By now I could not stand being in the Sabre for more than an hour -- in fact I did not want to use it at all. But there was no one to help me deal with the problem: once you get your chair, your file is, closed and you're on your own - no follow up, nothing. Also, "my" physiotherapist had left Canada Care.

One day a fellow Para Transpo passenger heard about my "piece of junk" and when I told him it was from Canada Care, he was not surprised. He advised me to try Motion Specialties.

I asked Canada Care for a copy of the invoices for all the repairs done on my chair. I was shocked -- the costs associated with just over a year of use came to more than $1,000

I made an appointment with Motion Specialties.  When I explained that I hoped to use my chair seven or eight hours a day, the consultant told me I had been given the wrong model for that kind of activity. The Sabre, it turns out, is usually for nursing home patients who are in it only an hour or two a day, maximum.

I needed a Storm, a much sturdier chair.

At this point, I was enraged. I called Canada Care's head office. I demanded that they reopen my file but they said there was a backlog of clients needing physiotherapy and it would take at least three months even to be put on a waiting list. I said I had already put in several months of hell and they said they would see what could be done. Two weeks later I was told would he at least six months before a physiotherapist could be assigned to my case. I'm not sure if it was my threat, but by the end of that conversation I was told that a physiotherapist would see me in two weeks.

That physiotherapist suggested I get a gel cushion to absorb the shock of bumping around on city streets, but she was not too concerned about the wobbles or the foot rests or the collapsing
arm rest. When she installed the gel cushion, it did feel better

When I next saw her, she said they were gathering information. And on the visit after that, she said she wanted to change the backrest--the one thing that was not bothering me! After she left I cried.

About midnight that day, I had an idea. I got into that wheel chair, grabbed my cane and went to the parking lot at the bottom of the hill. I got out of the chair, stood up and whacked the damn thing until it rolled away. Then with my cane, I maneuvered very slowly back up the hill and rested on the big rocks. I felt better.

Since then, I have acquired a purple walker from Stride which I am paying for with monthly installments. Stride is privately run non-profit organization, not affiliated in any way with the government, and I trust them.

The police recovered my Sabre wheelchair and it is back sitting in my apartment.

So when you see a six-foot-tall, red-haired woman strugglin' up and down Chapel Street or along Rideau Street or riding the 316 bus, it's me. If you think it's better using a walker, think again. It's hard and painful to keep on trucking but I'm still not sorry I abandoned that wheelchair from Canada Care.

Postscript: Lani Fairchild called IMAGE on Nov 26 to say funding has been approved for a new wheelchair.  She is jubilant.
 

CPSO INFO -   Medical Records - The Patient's Rights
http://www.cpso.on.ca/faqanswer.asp?FAQNum=42
CPSO's webpage has changed and this information does not appear to be currently available on their site.
Aug 18, 2000
Try
http://www.cpso.on.ca/faqanswer.asp?FAQNum=13

The Supreme Court of Canada ruled that patients have a right to obtain their medical records

 1.  In the ordinary case, these records should be disclosed upon the request of the patient unless there is a significant likelihood of a substantial adverse effect on the physical, mental or emotional health of the patient or harm to a third party.

  2.  If a physician refuses a request for access to a patient's medical records, the patient may apply to the court for a remedy. If the court is not satisfied that the physician acted in good faith, it should not hesitate to exercise its discretion to grant appropriate relief by way of costs. The general rule of access should not be frustrated by the patient's fear of incurring costs in the pursuit of what is fundamentally his or her right.

  3.  The patient is not entitled to the records themselves. The patient is entitled to reasonable access to examine and copy the records, provided the patient pays a legitimate fee for the preparation and reproduction of the information.

Supreme Court Decision:   Patients' Right to Access their Medical Records
Go to the information page.

TORONTO CHAPTER HIGHLIGHTS

The Toronto Chapter held a stimulating public meeting at Toronto City Hall in September 1999. Marilou McPhedran, a prominent lawyer and advocate for patients' rights, was our guest speaker. She entitled her topic; "Do Ontario 's Patients need a Bill of Rights?".

Marylou expressed strong support of VoHCA's efforts to improve accountability within the health care system. She indicated that the need for citizens like ourselves (VoHCA) to speak up and advocate for change is very real. Her extensive experience in patients' rights issues has been first hand. For example, Marilou previously chaired the Independent Task Force on Sexual Abuse of Patients, CPSO that successfully brought about favourable legislative changes affecting patients' rights. Consequently, she has considerable insight into the governance issues surrounding health care professionals, and the practical difficulties involved in effecting change.

Marilou suggested that developing a patients' bill of rights (from scratch) would be an enormous undertaking. It is likely beyond the scope or resources of grass root advocacy groups like VoCHA at this time. Hence, Marilou recommended that we focus on improving what we have, effecting positive changes within the current legislative framework as, for example, we are doing with the HPRAC Five Year Review.

The Steering Committee has met several times in the intervening time period. We have been involved in helping to prepare VoHCA's submission to HPRAC and meet the deadline for submission, 31 December 1999.

The Steering Committee is presently preparing for Toronto's next public meeting. This will be in late February or early March. We are lining up an interesting guest speaker. We will also review VoHCA' s submission to HPRAC. Toronto members will be contacted with meeting details once finalized.
 
 

KINGSTON CHAPTER MEETINGS

 February 17th Ongwanada Resource Centre, 191 Portsmouth Ave. 7:30pm
Topic: CPSO and HPRAC Reviews

 April 27th Ongwanada Resource Centre, 191 Portsmouth Ave. 7:30pm
Topic: Update and Support
 
 

Patient Pulse is published by:
VoHCA - Voices on Health-care Concerns and Accountability Inc.
Box 27018, Gardiners P0,
Kingston ON   K7M 8W4,
Tel: (613) 389-5599        Fax; (613) 389-8036
 

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VoHCA SUBMISSION TO HPRAC