Expert advice for Ontario Ombudsman on his bid for jurisdiction over hospitals and long term care facilities

Ontario Ombudsman André Marin’s bid for jurisdiction to investigate complaints about patients’ experiences at the province’s hospitals and long-term care facilities has support from a wide range of patient advocacy groups.

Marin stresses that his counterparts in all the other provinces have jurisdiction to investigate these types of complaints, although the scope of their powers varies.

If granted an extension of power, he anticipates his office will be one of  “last resort” for complaints and estimates an additional 50 staff, in a specialized unit, will be needed to handle the influx of complaints.

Across Canada, there’s a wide variation in how patient complaints are handled and there appears to be a dearth of research that describes and compares the provincial approaches. Also lacking is evidence about the most effective ways to address complaints at different levels.

Still, experience from other Canadian jurisdictions, and advice from health policy and legal experts, suggest that if the Ombudsman’s office is granted this extension of powers, certain conditions should be put in place that would improve the office’s effectiveness. These include:

  • beefing up the training of staff at patient complaint offices at the institution/health region level, and ensuring the independence of these offices
  • providing clarity to patients about their rights—this may take the form of a patient code of rights—and about what kind of complaints can be escalated to the ombudsman level
  • ensuring that the staff handling complaints at the ombudsman office level are highly trained and experienced in dealing with the very complex landscape of Ontario’s health care sector
  • gaining the trust of all sectors, health-care providers and managers as well as patients and
  • operating with discretion.

Ontario’s Excellent Care for All Act (2010) stipulates that hospitals must establish a patient relations process to address and improve the patient experience. The Long-Term Care Homes Act (2007) also stipulates that all LTC homes in Ontario are required to have written procedures for making complaints, and that these procedures must be posted where people can see them. Most observers agree that, when possible, complaints are best dealt with at a local level.

Settle issues as close to the front line as possible

“It’s a fundamental wisdom to try to settle issues as close to the front line as possible,” says Dr. John Cowell, chief executive officer of the Health Quality Council of Alberta.

Steven Lewis, advisor to The Change Foundation, an Ontario-based health policy think tank, adds that it’s vital that the local level complaints process be “transparently independent and able to do its job despite ruffling some feathers within the organization.”

As well, individuals who handle complaints at the local level must be well trained to ensure their neutrality, says Catherine Regis, director of programs in law and health policy at the Université de Sherbrooke. “But,” she stresses,” it’s also very important to have a second step, to an independent body.”

Judith Wahl, executive director of the Toronto-based Advocacy Centre for the Elderly, says that in her experience some hospital-based patient advocate offices reiterate hospital policy, even when it doesn’t comply with patient rights and the law.

For example, her Toronto-based legal centre has dealt with “many, many” complaints of Ontario hospitals threatening to charge patients hundreds of dollars a day if they refuse to move to a nursing home that has an opening, but that is not on the list of the patient’s preferred homes.

“This is not legal,” says Wahl, and her centre has posted a 2011 memorandum, from the Ministry of Health and Long Term Care that clarifies the issue.

“You’d like to be able to get a bigger remedy”

“When you see a consistent problem like this, you’d like to be able to get a bigger remedy . . . because these are systemic issues,” says Wahl, explaining why she favours giving the ombudsman—or some other independent third party—powers to investigate.

Quebec has long experience with a health ombudsman, a position (reporting to the health minister) that was created in the early 1990s. This position was accompanied by legislation that spelled out patients’ rights, explains Regis. The only other province with similar legislation is Alberta, although the relevant legislation, the Alberta Health Act, has not yet been proclaimed.

The Quebec health ombudsman’s role has since been absorbed into the office of the provincial ombudsman, which answers to Quebec’s National Assembly, and “can do an independent review from a bottom up perspective and make recommendations about systemic issues,” she notes.

However because the ombudsman can only recommend, it’s important that the office also have credibility and trust among health care managers and workers, she says.

Alberta has a different system.  The 26 staff at Alberta’s Patient Concerns Office (PCO) last year dealt with 8,500 complaints and concerns that had not been satisfactorily dealt with at the point of care, says executive director Pat Brooks. The PCO is independent of the individual health care facilities and operates under the Quality Improvement Division of Alberta Health Services.

Only 23 of the 8,500 complaints were escalated to Alberta’s Ombudsman, whose jurisdiction is limited to ruling on the administrative fairness of the resolution process.

Ontario’s Marin would like jurisdiction to step in to investigate individual complaints about hospitals and long-term care facilities that aren’t resolved at the local level and, as well, be able to conduct major investigations into system-level problems.

In Alberta, it’s the Health Quality Council of Alberta (HQCA) that has the power to tackle system-level problems in the public health care system. The council does not receive patient complaints, but conducts independent reviews at the request of the health minister or Alberta Health Services, explains executive director Cowell.

The reviews, which may be triggered by patient complaints, have considered issues such as medication errors and cancer care wait lists. “We’ve had to invent our own methodology,” says Cowell, adding that individuals who give testimony, always on a voluntary basis, are guaranteed anonymity. The reviews “analyze and shine a light on a situation” and make recommendations about specific actions.

The HQCA’s most recent review, sparked by concerns about dangerous levels of emergency ward overcrowding, resulted in 21 recommendations, all of which were accepted by the government, Cowell notes.

Ombudsman “should be careful what he wishes for”

He suggests that the Ontario Ombudsman should be careful what he wishes for. “For starters, the ombudsman will have to ramp up expertise to understand the complex, messy world of health care. We have 30 people on staff, all very seasoned with extensive experience and it is still a challenge to get into these issues and get out sensible, trustworthy findings that are actionable.”

Colleen Flood is a University of Toronto law professor and former scientific director of the Institute of Health Services and Policy Research of the Canadian Institutes for Health Research. Ontario should have an independent, arm’s length agency to which patients can complain if they’re not satisfied with how they are dealt with by a provider or institution, or if they are reluctant to bring their issue up at that level, she says.  “This is a huge access to justice issue,” she argues.

If such an agency (the Ombudman or another office) “works well, it will likely be a win win for patients and providers. If the ombudsman does their job properly . . . they will resolve the complaints, and this means there will be fewer formal complaints to bodies like the CPSO [College of Physicians and Surgeons of Ontario] and fewer court cases.”

New Zealand, for example, experienced a significant drop in such complaints after it introduced a patient’s code of rights and an ombudsman position, she says.

But Flood says other provisions should be in place, including a clear expectation for patients about the basis on which the ombudsman will hear complaints. While she says it’s not absolutely necessary, she favours legislation for a  patients’ code or bill of rights (Ontario doesn’t have one) that articulates what patients should expect of providers and what providers should expect of patients.

The mantra of alternative dispute resolution

A provincial ombudsman should be committed to resolving disputes. “They have to take on the mantra of alternative dispute resolution. They are not there to punish the provider or institution, or to shock the system into performance. . . . The ombudsman has to garner the trust not just of the patient, but of providers and system managers.”

When the office of the ombudsman identifies system-level problems, as a result of the nature of complaints that are reviewed, these larger issues can be highlighted in the annual reports, she says.

Ombudsman Marin, whose office does have jurisdiction over provincial ministries and agencies, has investigated health care related issues, such as newborn screening and funding of the drug Avastin, and he notes the government has accepted his recommendations. “I have no reason to think we could not have the same constructive relationship with hospitals,” he wrote in an email response to questions.

Health care institutions are steadily being required to become more accountable and it seems likely that, sooner or later, the Ontario Ombudsman—or some other independent agency—will be given the power to adjudicate unresolved patient complaints. It would therefore seem advisable, in advance, to prepare a comprehensive evaluation of how that role has best been played out in other provinces and what other system changes best support the role.

Read the Toronto Star’s coverage of stakeholder views of the Ombudsman’s bid and the experiences of one family with the current hospital complaints system.

The comments section is closed.

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  • Adrienne Shannon says:

    It is extremely important an independent body be put in place to investigate issues related to health care in Ontario. As Canadians, we can feel fortunate to have access to world-class health care but the system has become overburdened and terribly flawed. People are dying and suffering needlessly due to errors, wait times and negligence. I am 65 years old and can name a dozen close friends who have lost a family member, or watched a loved one go through long term suffering because the team of specialists do not have time, do not care, or are focused on the paperwork instead of the patient. In my own experience, my mother died in a nursing home from a small infection in her leg that became systemic, a dear (young) friend with cystic fibrosis who caught a cold in the hospital and died of pneumonia, and a colleague who has suffered debilitating GI pain for 10 years and cannot get a diagnosis or help.
    We cannot have the investigative body be part of the system that includes doctors and administrators. People cannot be brushed off by arrogance and intimidation. We need intelligence, sensitivity, open ears and compassion. Doctors, please look up from your paperwork, test results and HEAR what the patients are saying! Put yourselves in the shoes of s/he who is suffering and do what you were trained to do and your to your oath. These experts need time and space to do their jobs! Though we are an impressive health care system, a lot can be learned from other global health care systems.

  • AffectedAndPatientlyWaitingForChange says:

    I believe that the role of the Ombudsman needs to be elevated in Ontario – as far as the medical system is concerned. I have had a direct concern that I did bring to the Ombudsman only to hear that they have no jurisdiction to affect anything in hospitals. I was heartbroken because I seek change so that what happened to me NEVER happens to anyone ever again. I will continue to follow this action until I see a resolve as this weighs quite heavy on my heart. As I look at the number of complaints the Ombudsman receives each year regarding hospitals .. I definately believe that Ontario needs to revisit the idea of giving the Ombudsman oversight over hospitals.

  • Lynda Whelan says:

    Mr. Closson,

    I am a victim of the medical malpractice and the system doesn’t work the you portray it.

    My problem started at the Montreal Neurological Institute where I put my trust in the medical profession. This hospital is an internationally renowned institution in brain research. From personal experience, one of their favourite surgeries is called an “Neuro-Amygdala-Hippocampectomy.

    From my perspective, the problem lies in the ambiguity of the ‘Consent Form.’ The surgery happened in 1991 and it was only in 2006 that I learned of the neurosurgeon’s favourite surgical procedure. The neurosurgeon in question was being paid by a third party to perform these procedures. The epileptic focus is still located on Axis III of my brain. I’m missing my amygdala and hippocampus. There’s been coverup after coverup!

    I’ve followed up with the ‘Protecteur du Citoyen’ and the ‘Ombudsman’s Office’ of the Montreal Neurological Institute. Both denied any wrongdoing despite having all the information available to them. Both of these organizations were supposed to be set up to protect the patient. I have all the documents to prove otherwise and still lost. I have the surgical report indicating that the hippocampus was removed. The term the neurosurgeon used when he was removing the hippocampus was ‘piecemeal.’

    The letter writing campaigns needs to stop. We should be able to have access to these organizations. Otherwise, nothing is going to change.

    The optics look good, but the corruption runs deep.

  • erichbuecker says:

    I am from BC in 2006 had 45% percent of my heart function gone from chiroprctic adjustment while having heart attack .Went to emergency and told them what happened and told them pain in both arms.they did not take blood pressure and told me I had 3 hour wait.after half hour got up and told them I need to see a doctor and I later would find out 4 out of 5 on triage assessment.Having been severely visually impaired for years with duplopia and walking up to 10 klms a day I was use to walking every where for method of transportation. I told nurse and she said still long wait why not try care clinic.Walked 3.8 klms and arrived at care clinic in over 4 hours and sweating like crazy and totally exhausted could barely stand up.Doctor gave me nitro glycerin and thought I might have had heart attack and sent me to HOSPITAL lab where they did ecg test .Was told to go home after test and daughter kept asking are you sure to tech and explained what happened during day.She said yes again and few hours later my life will hang in the balance when phone rings telling daughter that I had indeed had a heart attack and get back to hospital.We would arrive and daughter went straight to nurse treating some one with sore foot and explained they phoned and I had said I had had a heart attack.Years later I would find out I was a 2 out 5 on triage scale and nurse would tell daughter you need to sit down and no one was ready for me and worst of all no one wrote down I went to chiropractor ./at care clinic they wrote pain in both arms in morning they wrote muscle pain at hospital .they did blood pressure test at clinic blood pressure 100/80 .I would finally get ambulance to do angi plasti at royal Colombian.several days later sent home and pain unreal back to hospital with severe pain with tear in heart .They said stent collapsed but it was at chiropractor you felt the tearing inside chest and I would have septic heart .Three weeks in come and was suposed to die at royal Colombian hospital and survived then taken out of coma with little chance to survive and arrive at st pauls hospital where they take all fluids out of my body .Family is called to hospital again and told I am going to die.I wake up to tons of nurses injecting syringes of fluid which they hope will save my life.I will survive thanks to dr Hayden and the fantastic nurses at all hospitals.The tear in my heart was severe and three years on transplant list to recover and I am okay now with eye and energy problems with 6+ stigmatism in left eye. I am happy now and no longer have duplopia problem which was caused by drugs I was taking .This a story of learning and having been a first aid man I will never ever be able to figure out why this happened.I took no legal action and wanted to find a advocate to help me with out writing any thing just telling the story so the system will learn from a story that just should not happen.The hospital could not even tell who phoned and did not even interview my daughter who was by my side and answered the phone on a call I would not wish on anyone to be told your father has had a heart attack. The unreal part is the policy at the care clinic has changed where the doctor MUST phone the emergency. The hospital did not tell me this information which I think is really sad because this story is far more bizarre than the phone call in the emergency I believe in Alberta . If your wondering why I do not want to write to the collage of physicians it because it is the system story not a blame a doctor story or anyone for that matter. I also had severe anxiety for years due to being legally blind while working in sawmill.The pain was unreal with chronic back trouble and severe migraines due to kertkonis eye disease which was undiagnosed for years and had to go to emergency regularly for Pain. I would go through four corneal transplants two laser surgeries and two cataract surgeries.I stopped driving for well over a decade and found out I had 100€% and 70% blockages in my heart.I use to vomit all the time and went to emergency regularly with pain in all muscles .I will never understand why I have re read my files because we have system that expects the patient to ask the questions despite going through a ordeal like no other .The anesthetist who put me under to remove my teeth read the chart for over 20 mins and said I had no idea any one could survive what you went through.I phoned nurses ,doctors, chiropractors ,mla mps sent stories and they told me to go through process.eventually I will get it done because I know I am the luckiest man alive and I now help out at Terry Fox high school in basketball program and have for over 4 years with little I am capable.The reason I put story hear is I believe Ombudsman should review cases that could help the system improve and my story shows there has to be someone in the system other than me to say my story is ridiculous and can not be repeated.

  • Brenda Tan says:

    In 2010 the Excellent Care for All Act (ECFAA) provided confirmation of the long-existing and successful role of patient relations through legislation requiring Ontario hospitals to establish a patient relations process to address and improve the patient experience.
    The Ontario Patient Relations Association (OPRA) was pleased to input into the development of hospital guidelines for the patient relations process. Patient Relations is much broader than simply apologizing for a hospital. Skills and expertise include conflict resolution, mediation, quality improvement, and system advocacy.

    We are witness daily to the compassionate and responsive care provided by heath professionals on a daily basis and are proud to relay the many compliments we receive regarding our staff and physicians. Despite the best intentions of staff, there are situations where patients and families are challenged or dissatisfied by the limitations of the health care system, or the approach or skill of the healthcare professional. The ideal situation is that a patient or family’s concern be addressed on the spot by hospital staff or physicians. To this end, we provide education to staff on how to effectively address concerns, always keeping the patient’s best interests in mind.

    There are times when that process is not successful or desired by the patient/family. In those situations, Patient Relations staff help facilitate resolution with the primary goal of meeting the needs of the patient or family and re-establishing the therapeutic relationship between patient and provider. We have found that our immediate availability and knowledge of the inner workings of the hospital leads to timely resolution within a fair and compassionate process. The vast majority of staff and physicians, but most importantly our patients and families, are satisfied with the resolution outcome.

    Patient Relations also serve a key role by feeding into quality improvement within the healthcare system. We are able to identify trends within the hospital or at the system level by bringing forward the patient’s voice. Indeed, many of us facilitate having our patients and families at the table to bring the patient experience into quality improvement

    Redundant reviews and investigations by the Ombudsman risks additional delays to the resolution process and duplication of resources to address individual concerns. It may however be beneficial for the Ombudsman to be the avenue of “last resort”, affirming that resolution processes that are in place and assist in following up on systemic issues that are trended as a result of concerns expressed.

    Brenda Tan
    President, OPRA

    • J. Wright says:

      Unfortunately your title precludes you from being objective. Being the Patient Relations spokesperson says it all.

      Families and patients are always referred to the Patient Relations office to resolve patient care issues. This really is unconscionable! Patient advocates do not have the required skill set or education to deal with serious problems. They have absolutely no authority to make critical decisions about patient care. They are not acting on behalf of the patient because they are employees of the hospitals and report only to the hospital. They are not overseen by a college or any independent third party.
      They engage in self-promotion and self-accreditation created by their own associations.

      Patients and families deserve immediate action by an individual that will truly work on their behalf. There is no time for back and forth letter writing with a department that just reiterates the hospital’s policy or position.

      You talk about delays. I guarantee you that an independent investigator will have finished the job and be on vacation before a hospital resolves the problem. Families are still fighting years and years after their loved one has been abused or died!

      I am happy that you recognize that there is a serious problem and that you believe that Ombudsman oversight would be “beneficial”. In a recent poll 92% said YES to Ombudsman oversight. Possibly a patient advocate can be part of the solution but they obviously are not the answer

      Read today’s story on how our Veterans are being abused at Sunnybrook Health Sciences. The Patient Relations representative pleads ignorance!

    • Aaron says:

      Patient Relations departments I have dealt with are a complete joke! They are not impartial and the staff are poorly trained in conflict resolution. Plus, they do little to help patients problem solve and navigate the massive bureaucracy of many hospitals and improve transparency and accountability processes. You are in no position to provide an impartial perspective.

  • E. Watson says:

    Earlier this year another headline appeared proclaiming changes are coming to fix the mess in nursing homes, and the public just shakes their collective heads – here we go again. Promises made by health ministers that residents in long-term care institutions will be kept safe offers no assurances, government vows to protect seniors has been an ultimate failure, legislation keeps changing without rigourous meaningful enforcement; there are councils, a bill of rights for residents, investigations and more committees organized and now we’re told sweeping changes are coming because the health minister determined solutions to the problems could be found by a nursing home industry task force when the nursing home leaders came to her meeting last November with a ‘new attitude.’

    The job of oversight over nursing homes and protection of the residents is supposed to be that of the health minister and health ministry. Instead, those directly involved with the systemic issues of abuse and neglect were incredulously given the position of making recommendations on how to fix the problems.

    Clearly there has been ongoing failure of proper oversight by health ministers and the ministry to protect those in nursing homes. Countless numbers of Ontarians have repeatedly made requests and many hundreds petitioned the Legislative Assembly a year ago to grant oversight authority over nursing homes to the Office of the Ombudsman of Ontario.

    Ludicrous examples were given by Liberal members to quash passing of the bill that was brought forward to assign oversight authority to the ombudsman for health care and other sectors. Two of the most egregious reasons given: it would over burden taxpayer funds — this coming from a government that has cost the public billions of dollars through various poorly hatched and badly executed schemes — and, the ombudsman is not needed because the MOHLTC and the Coroner’s Office are the protectors of vulnerable citizens in long term institutions.

    Ombudsman Andre Marin has the ‘attitude’ needed to ‘fix’ this mess and if the government was really concerned about improving resident care, nursing home residents and their families would have access to the independent unbiased investigative services of the ombudsman’s office.

    Interesting to read the premier was “open to the idea of extending the ombudsman’s jurisdiction.” One wonders exactly what extension that might be considering members of the Liberal party have blatantly shown their strenuous objection to allowing the ombudsman to have oversight over nursing homes, hospitals and certain other institutions, time and time again.

    The constancy of media stories, disturbing ministry reports, and years of heartbreaking accounts by families, leaves no doubt that dependent institutionalized residents will continue to be at risk under the watch of their so-called protectors. Residents and their families will never have access to unbiased, wholly independent investigations and the public will never have open and transparent insight into the plethora of systemic problems plaguing nursing homes under a government that has demonstrated such arrogant determination to keep the ombudsman out.

  • Sandra Hubbard says:

    Provincial Ombudsman oversight is long overdue! It is shameful and embarrassing that the province of Ontario lags behind every other Canadian provincial jurisdiction in this regard. The public quite literally has no available avenue to be legitimately heard. The avenues listed by the government to table complaints are meaningless, as these bodies provide lip service only. The health minister, during a House debate in the Legislature, had the audacity to go as far as naming the “Corner” as someone the public could go to when unsatisfied with healthcare service. When a loved one is already dead and on an autopsy table, the initial complaint about the hospital is by far too late Minister! In-hospital patient advocates and hospital ombudsman positions are on hospital payrolls and as such will never bite the hand that feeds them. The public needs and demands an independent body… that of the Provincial Ombudsman! Both the public and the Provincial Ombudsman have been asking for this for several years, only to be stonewalled by the government. I believe that the government is completely terrified of Provincial Ombudsman oversight, especially oversight of the present Ombudsman, Andre Marin. WHY? Because Mr. Marin DOES his job with the highest level of integrity and professionalism and does not cow-tow to any political pressure. This is EXACTLY what the public wants, needs, keeps asking for, and deserves to have in place in return for its tax dollars!

  • Tom Closson says:

    Maximum efforts should be given to resolving patient complaints as close to the point of care as possible. As pointed out in the above article by Silversides and Ferguson-Pare, the experience with doing this in Alberta demonstrates that very few complaints ( only 23 of 8,500) needed to be escalated to Alberta’s Ombudsman for resolution as they could not be resolved locally. I worked in BC as the CEO of a health region where the the Provincial Ombudsman would not get involved in a patient complaint until all attempts by both parties were exhausted at the local level. My experience was that almost all complaints were resolved locally and satisfactorily between the patient and the care givers. This approach is essential to enable continuous quality improvement.

    • Neil Haskett says:

      Well Tom, that’s not the way it works here and as we’ve seen, leaves the door wide open to abuse. the steps required is actually a loop that will require maximum effort by the complainant until they are literally exhausted from spending years fighting. It doesn’t take a genius to see that Hospital administration, lobby groups as well as their Insurance companies dread oversight as we’ve seen. This is really a black and white issue to the people who know what’s going on in this debate, the people who can’t wait for an issue to be resolved that only external oversight will bring and the people are responsible for protecting people who cause the complaints. I live in Ontario, you guys had a long run… now it’s about the patients and take offence to people selling this province short of what it needs.

    • Maria K. Daskalos says:

      Second Response to Tom Closson

      Unfortunately “maximum efforts” are not being made in Ontario Hospitals and problems are not being addressed “until all attempts by both parties are exhausted”. This is not happening because of self-serving Hospital Policies and lack of oversight. Hospital staff, including the President, Directors, Managers of Depts., will tell you that it is their “Hospital Policy ” to send you to the Patient Advocate/Patient Relations Department. They conveniently use this dept. as a buffer zone when they do not want to deal with a minor or critical Patient Care matter. The Patient Relations department has the reputation of being nothing more than a “suggestion box”. They are NOT trained or have the expertise to deal with critical situations. Lawyers, Doctors, Nurses, Advocates, Patients and anyone that has had to deal with this ineffective dept. will agree with this description. Doctors and Nurses just want to do their job and what is right for their Patient. Administrators are so unafraid of repercussion that they often take the liberty in putting pressure on Doctors and Nurses. Medical front-line professionals welcome Ombudsman Oversight. The systemic abuse of power and desensitized approach in dealing with serious Patient Care issues is commonplace in Hospitals. Ontario Hospitals and Long Term Care facilities do not make the required effort to resolve problems with the patient/family because they DO NOT HAVE TO. They also know that it is next to impossible to sue them so please don’t undermine our intelligence by saying the Hospitals “want to avoid litigation”. This is why we need Ombudsman Oversight and THIS is the only approach that will prove to be “essential to enable continuous quality improvement.” Hospitals must finally be made ACCOUNTABLE for the care that they provide!

  • Diane Blais says:

    I have to completely disagree with the previous comment by Tom Closson. The Ombudsman should be given complete and unfettered oversight of all Ontario hospitals. Mr. Closson is sadly mistaken in thinking that all hospitals have a patient complaint process in place as the truth is they don’t. A patient care representative reporting to the hospital’s “Director of Risk Management” says it all. When there is no resolve or acknowledgement at the hospital level for the complaint being submitted, letters to the LHINs, the MOHLTC and our MPPS are usually the next steps, and yet the roles these entities play are not effecting the change that we so desperately need. Ombudsman oversight of all hospitals in Ontario would therefore be a “unique” mandate in Ontario.

  • Maria K. Daskalos says:

    In response to Tom Closson:

    The Ontario Ombudsman Andre Marin should be given the maximum power to investigate Hospitals and Long Term Care facilities. Accountability in Healthcare is critical and currently does not exist.

    There are absolutely NO “processes in place” to resolve patient care issues. The Patient Relations representatives at the Hospitals do NOT have the capability or power to resolve any serious problems and they are there only to placate families. I will quote Andre Marin, Ontario Ombudsman from his 2012 annual report:

    “The Ombudsman has received numerous complaints about hospital-designed complaints processes over the years. Whether labeled as “hospital ombudsmen” or some variation of “patient relations,” these internal offices have little credibility with those who complain about their lack of independence, transparency, objectivity and investigative abilities.”

    Hospital Administrators consider themselves professionals yet there is no independent college or association, responsible to the public, which makes and enforces rules of professional conduct, which are binding on them. The regulatory gap is obvious. Current Hospital policies favour Healthcare Administrators and Hospital Associations. They are self -serving and do not support accountability or transparency in Healthcare. When something goes terribly wrong there should be someone to turn to. The Ombudsman should be that person. He can step in and investigate.

    You said: “Nevertheless, I do not believe that there is a need for the Ombudsman in Ontario to address systemic quality issues. The Ministry of Health and Long Term Care, the Auditor General and the Ontario Quality Council all have a part to play in this. I do not believe we need to have another agency with this duplicated mandate.” I dispute your comments based on facts. There would be absolutely no duplication in services because patient care in Ontario is not being overseen by the Ministry of Health or the Auditor General. The Auditor may step in to look at financial matters but not issues about patient care. Possibly this quote directly from the Minister of Health Deb Matthews will convince you. She clearly states this in a letter to our family :
    “As we’ve mentioned…my ministry provides funding for public hospitals through Local Health Integration Networks, but the hospitals are independent corporations accountable to their own boards of directors. As set out under the Public Hospitals Act and other legislation, hospitals are responsible for their own day-to-day management. …The hospital administration is responsible for the quality of care its patients receive, and hospital staff can best discuss your concerns.”

    Our Mother Dimitra Daskalos died, as many others have, because there was no accountability or oversight. Patient Relations did absolutely nothing to resolve any of our issues. The actions of the Toronto General Hospital in breaching Infection Control protocols were unacceptable. The actions of Hospital Administrators in demanding that our family find non-existent alternate care facilities and delivering an invoice for $18,238.00 on account of an alleged liability for a co-payment are functionally an attempt to expel a dying patient from the Hospital by Hospital Administrators.

    The actions of the Hospital caused extreme hardship and suffering to our Mother and to our family at a time when compassion and care were required. Our Mother should have been treated with respect for her civil rights and be permitted to die with dignity. I ask you this question: How can you have the offender regulate itself?

    • Aaron says:

      My greatest sympathies are with you. I agree with all your points fully! I commend your courage to go forward with your story and make it public! Thank you!

  • Neil Haskett says:

    Only in Ontario, does a Government give taxes away to someone and afford them the luxury of investigating themselves regardless of all the bad press and pressure from the General Public. If it’s not a flawed idea, why not grant everyone including criminal organisations the same opportunity to police themselves? Including my wife, we have several family members and friends who are Doctors and Nurses, every single one of them embrace the idea of the Ombudsman and understand it’s long overdue.
    As it stands, not one Ontarian can pick up the phone and call the AG with a complaint so what is the public left with if there is a problem? I’ll tell you the only answer, it’s someone within the corporation (that’s right Hospitals are not owned or operated by the Government) who has everything to lose that controls the outcome of your complaint. Limiting oversight limits quality and value, don’t forget that!

  • Katherine Lembovski says:

    I truly believe that the Ombudsman of Ontario needs to take a greater role to help Investigate complaints and better assist the residence of Ontario in finding answers.

    Our Dear Grandmother, mother and wife of 60 years RISTOSIJA LEMBOVSKI August 14 2011 “Drown in the Detroit River” while in the “Trusted care” of Rose Garden Villa Nursing Home. She was 83 had Dementia and pushed her walker 3 kilometers to her unfornated drowning death alone. The Revera owned Nursing Home failed to supervisor patient care and with staff cut backs and many months of Non compliance Violations by the Ministry of Health and Long Term Care Compliance and Regulations branch they were Ordered Non Compliant. The Home never notified the family and had no idea that she was even missing indicating to her husbands pleas for help that she was just in the bathroom.

    With months of Complaints to the Minister of Health and several govt agencies, A complaint to the Ombudsman’s Office produced no answers as they had no Investigative authority.

    Our family reamins haunted by the need to answers of Why this happended and still have not recieved an acknowledgement by Revera a 7 Billion dollar company controlling the Windsor Long Term Care Market. Our family has Championed behind the Bill C-122 and obtained 1,000 of signatures and supporters.

    Grieving and in shock and Pian we struggle for Answers.

    Lembovski Family
    (561) 703 6903

  • Deepika Ganeshan says:

    I believe that the role of the Ombudsman needs to be elevated in Ontario – as far as the medical system is concerned. The taxpayers in Ontario currently do not have an out other than going to the hospitals with their grievances. The mandates of Ministry of Heatlh and Long Term Care, the Auditor General, and the Ontario Quality Council, and the Ombudsman needs to be revisited – to see how we can have an impartial venue for patients and taxpayers to get answers to issues.

  • Tom Closson says:

    If the Ombudsman is to be given a role in Ontario related to hospitals I believe it should be a limited one. All Ontario hospitals have processes in place to try to resolve patient complaints and they are all motivated to do so to improve patient perceptions of their hospital experience (which is publicly reported) as well as to avoid litigation (which costs a hospital money). As demonstrated by the Alberta experience where their Ombudsman has this limited role, there are a small number of situations where patient complaints are not initially resolved locally and a Provincial Ombudsman could offer some value in assisting to try and achieve resolution. Nevertheless, I do not believe that there is a need for the Ombudsman in Ontario to address systemic quality issues. The Ministry of Health and Long Term Care, the Auditor General and the Ontario Quality Council all have a part to play in this. I do not believe we need to have another agency with this duplicated mandate.

    • Aaron says:

      I don’t agree with you since I have dealt with patient relations departments. They are often under staffed and do a poor job advocating and educating patients and their families of their rights. Often they are staffed with young, inexperienced staff who have little understanding of medicine. Furthermore, the people working in these roles are not impartial enough in their perspectives since their offices are in the hospitals, and they establish personal relationship with staff from other departments. The very same people they are trying hold accountable for their professional actions. ONTARIO needs an impartial 3rd party to deal with patients complaints to allow for greater transparency & accountability. This will greatly improve the quality of health care given at publically run hospitals.


Ann Silversides


Ann is a journalist and specializes in health policy, writing and editing for a variety of health research institutes, associations and labour unions.

Mary Ferguson-Paré


Mary is an editor emeritus at Healthy Debate

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