Lack of respect and communication in Ontario's health-care system highlighted by patient ombudsman report

Thousands of complaints lodged by Ontario patients last year detail a lack of communication, sensitivity, and respect between patients, their families, and caregivers while navigating the health-care system, a new report by the province's patient ombudsman suggests.

The report, to be released Tuesday morning, reveals that the patient ombudsman's office received a total of 3,306 complaints in the 2021/2022 fiscal year.

Just over 60 per cent of those complaints were made in relation to experiences at public hospitals. Another 10 per cent involved experiences within Ontario’s long-term care homes.

The other complaints were related to home and community care, as well as other health facilities.

According to the report, more than one in 10 patients or caregivers “expressed concerns about premature, unsafe or poorly planned discharges or transitions between care settings.” Visitation restrictions and wait times were also frequently the topic of complaints, it said.

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While less complaints related to COVID-19 were lodged last year, Ombudsman Craig Thompson said the pandemic “has exposed existing vulnerabilities in our health system.”

“The complaints we received last year demonstrated the strain that everyone—both patients and care providers—is under,” Thompson wrote in the report.

“More and more we are seeing complaints that touch on issues of sensitivity, caring, courtesy and respect.”

The report said the pressures on Ontario’s health-care system are not likely to lessen in the near future.

MORE THAN 300 EMERGENCY ROOM COMPLAINTS

There was a 43 per cent increase in the number of patients and caregivers who reported they were treated with a lack of sensitivity and respect at hospitals last year, particularly in emergency rooms, the report says.

The patient ombudsman found that in addition to frustrations with wait times, patients and caregivers also detailed poor communications in their complaints.

In one of the more tragic complaint detailed in the report, an elderly patient died while in a hospital’s emergency department without family present.

The complaint alleges hospital staff discouraged the patient from seeking treatment based on risks related to COVID-19. The family, the complaint said, was not allowed inside the ER despite the fact the patient didn’t speak English and required translation services.

“The assessment in the emergency department revealed that the patient was failing rapidly and would likely not survive. The family was informed they could visit once the patient was admitted to a room,” the report said.

“After two days, the patient died in the emergency department and the family never had the opportunity to say goodbye.”

The complaint said the family was not informed of the patient’s death until several hours after the fact.

In an interview with CTV News Toronto, Thompson said this complaint “speaks to the challenges in the ER departments.”

“It's the nature of a system that has been asked a lot of it without the capacity, without the resources, without the people to be able to do it the way that they want to do the job. And families are finding themselves on the outside sometimes.”

This incident, Thompson added, was an “unintended consequence” of restrictions put in place during the pandemic to keep patients and staff safe.

In another complaint, an elderly patient who arrived via ambulance with blood in their urine waiting nine hours only to be discharged with antibiotics. When the issue persisted days later, the patient refused to go back due to their previous experience.

The report also highlighted an incident involving a patient with COVID-19 who was left overnight in the ER and denied medication to treat their fever. The second patient left and went to a second hospital, where they spent more than a week in intensive care, the report said.

Paramedics transfer patients to the emergency room triage but have no choice but to leave them in the hallway due to an at capacity emergency room at the Humber River Hospital during the COVID-19 pandemic in Toronto on Tuesday, January 25, 2022. THE CANADIAN PRESS/Nathan Denette

Thompson added that many of the complaints reflect the importance of communication. This can include providing details about wait times, having information available about alternatives to ER care, and ensuring family members or caregivers can remain in the ER with vulnerable patients or that they know who to contact if they are not permitted to stay.

“Just telling people how long they will have to wait goes a long way,” he said.

HOSPITAL SECURITY INTERVENTIONS

Of the complaints regarding negative interactions between health-care providers, patients and their caregivers, about five per cent involved hospital security.

Many of the complaints involved being restrained in an unsafe manner. Twenty-two of the 98 complaints alleged assaults or physical harm.

One patient who sought care at a mental health hospital reported being held on the ground and restrained by hospital staff and security. “The patient described having their arm bent behind them and being held down with a knee on their back,” the report says, adding that the patient reportedly told security they were having difficulty breathing.

In a separate incident detailed by the report, an Indigenous patient who was discharged and escorted out of the hospital by security in the middle of the night during a winter storm was not permitted to re-enter to retrieve their gloves and hat.

“Hospital security would not allow the patient to retrieve their hat and gloves and the patient suffered frost bite to their fingers,” the report said.

“As a result of this negative experience, the patient was reluctant to return to the hospital for assessment by a plastic surgeon. Ultimately, several of the patient’s fingers were amputated.”

In reviewing complaints, patient relation representatives will often defer to hospital security and fail to take an active role, the report found. It also identified a need for standardized investigative processes for incidents involving security and patients. All incidents should be fully documented and comprehensive policies on restraint incident investigations should be implemented, the report recommends.

DISCHARGE OF PATIENTS REQUIRING LONG-TERM CARE

Complaints about patient discharges from hospitals and other care settings, including long-term care, have been consistently in the top three complaints to the Patient Ombudsman since its office opened in 2016, the report said.

About 11 per cent of hospital-related complaints were about discharges and care transitions, with many patients reporting poor communication, inconsistent information, and pressure to rush decision-making.

In one complaint, a patient in their late 90s who was admitted to the hospital with an infection was discharged and given a letter stating that if they didn’t leave, they would be charged a daily fee.

When the patient’s family, who had previously been in contact with patient relations regarding in-home support, questioned the decision, they were told to arrange a hotel room.

Another complaint was lodged after the family of a patient was allegedly told their loved one would be moved to another hospital just days after an application for long-term care was submitted. The transition occurred quickly after notification, meaning the family could not be present, the report read.

“After the transfer, the patient became confused and began to exhibit challenging behaviour, including refusing to take medication to prevent another stroke,” the report said.

The family was also informed that if they did not accept the first available long-term care bed, they’d have to pay the full hospital daily fee. At the time, this assertion was “not supported by law,” the report found.

This scenario took place before newly implemented legislation made it so that hospital patients waiting for space in long-term care homes can be moved to other locations not of their choosing up to 150 km away. If the patient or decision-maker refuses, they can be billed $400 per day.

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Prior to these regulations, the maximum rate for alternative level of care (ALC) patients choosing to stay in hospital rather than move to one of their five homes of choice was $62.18 per day

The challenging discharge transitions detailed in the report, among others, highlight the need for early discharge planning that engages patients, family members and substitute decision-makers, the patient ombudsman said.

Clear and consistent information should be relayed, in writing, he suggests. The office also recommends flexibility, ensuring individual needs and circumstances are taken into consideration.

34 SEXUAL ASSAULT AND INSENSITIVE CARE COMPLAINTS

Fifteen complaints were made to the patient ombudsman regarding sexual assaults last year – thirteen in hospitals and two in other care settings.

The patient ombudsman also highlighted a cluster of sexual assault complaints in its previous annual report and said his office “continue to have concerns about how these complaints are addressed by health sector organizations.”

In one complaint lodged last year, an Indigenous person reported they were sexually assaulted by hospital staff during admission to a mental health facility. Staff, the complaint alleges, refused to carry out a sexual assault investigation and video footage had not been retained.

The patient ombudsman said the complaint was ultimately withdrawn so the patient could pursue other recourse.

Nineteen other complaints outlined “insensitive care” for patients who experienced a sexual assault.

The patient ombudsman reiterated that all reports of sexual assault should be taken seriously and that health facilities should have clear, trauma-informed guidelines that ensures patients are treated with dignity and respect.

“While it may not be possible for all hospitals to have trained assault nurse examiners available, all hospitals should have protocols to ensure safe, supportive care for victims of sexual assault.” This includes, the report specified, a safe place to wait for care and supported transportation to care settings.

EXPANDING JURISDICTION TO PRIVATE CLINICS

There were 879 complaints in 2021-2022 that involved concerns about organizations outside of the patient ombudsman’s jurisdiction, including incidents involving private clinics, family practices and municipal public health.

However this will change going forward.

New proposed legislation introduced earlier this month will allow independent health facilities to conduct OHIP-related surgeries and diagnostic procedures. The Ministry of Health said at the time that each clinic will have a process in place to deal with complaints and that any unresolved issues can be brought to the patient ombudsman.

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Thompson said it makes sense that complaints will be streamlined to a single place, but there are still questions about how his office is going to tackle the expansion.

“How we will operationalize that is something that we're still working through with our stakeholders because obviously, it would mean an increase in complaints to our office, from several 100 organizations that previously were not under our jurisdiction,” he told CTV News Toronto.