Opinion

Sorry Not Sorry: How a hospital complaint system perpetuates harm after medical error

You know that feeling you get from an insincere apology? Your stomach flip-flops. Your heart pounds. You feel irritated, disgusted even. A vague dissonance nags at you. It’s the same disorienting feeling you get from an insult wrapped in a compliment. Or from realizing you’ve been scammed, and the perpetrator got away. That feeling.

Non-apology apologies are easy to identify. They’re the I’m sorry but, the sorry you feel that, the sorry if statements and their many variations. They minimize wrongdoing, victim blame and twist the narrative to avoid accountability under the guise of remorse. In other words, smoke and mirrors. If these tactics seem dehumanizing and manipulative, it’s because they are. Psychologists identify fake apologies as a form of emotional abuse. They’re also a tactic commonly used by politicians, public relations professionals and those trying to avoid litigation, like health-care institutions after incidents of medical harm.

That was then, this is now

A decade ago, Ontario’s Ombudsman described his growing frustration with hospital complaints processes in a section of his report titled “Losing patience with patient relations.” The report describes the lack of objectivity, transparency and credibility of hospital patient relations departments. Hospital officials, he wrote, “work for hospitals, not patients. They have no independent authority or formal powers of investigation … At best, they operate as internal customer relations departments – clearinghouses for complaints … at worst, they may be unresponsive, insensitive and/or apologists for hospital interests.”

Not much has changed since this report was issued. The ombudsman’s sentiment is echoed by the Center for Patient Protection and countless others who have experienced medical harm, including my own family. In 2015, Kathleen Finlay, CEO of the Center for Patient Protection, called for a “shakeup in our health-care complaints system.” She described the hospital complaint mechanism as “a rigged game that rarely offers satisfaction and often produces still more waves of emotional harm.”

Riding the waves of harm

My family and I experienced precisely such ongoing harm while coping with the multiple medical errors my late father endured as a prostate cancer patient at Canada’s largest hospital research network. Among them was a missed diagnosis of cancer recurrence resulting in a two-year treatment delay. I discovered this while reviewing my father’s online patient record in 2018, after his passing. Neither my father nor my family were informed of this appalling mistake, despite a note in his file, and contrary to the Public Hospitals Act’s Regulation 965 and the College of Physicians and Surgeons of Ontario’s policy, which obligate disclosure of harm.

After this discovery, in June 2019, I requested access to my father’s complete medical record only to encounter an obstructive and harrying chain of events. In response to my appeal of an exorbitant access fee, hospital administrators updated their online fee policy and backdated it to a day before my request, while proceeding to inactivate my access to my father’s online record.

After much effort and hardship, including a complaint to Ontario’s Information and Privacy Commissioner, the hospital lowered its fee and I obtained the complete record. What I discovered shook me to my core – my father’s care was mishandled for far longer than was previously evident. A clinical directive was recorded in his chart when he was diagnosed with aggressive prostate cancer in 2011, necessitating ongoing scans to track recurrence after treatment. Yet, these instructions were ignored by his medical team even when, seven years later, my father experienced new symptoms, his bloodwork was suspicious for recurrence and he repeatedly requested follow-up imaging.

In November 2019, I submitted a complaint to the hospital requesting an investigation into the lapses in my father’s care. Ontario’s Patient Ombudsman’s Office, the province’s office of last resort for hospital complaints, acted as an impartial mediator. Its best efforts at mediating a resolution became a painful, drawn-out succession of hospital administrators’ tactics of deny, defend and delay, designed to frustrate in the interest of self-protection. Responses from patient relations, when they did trickle in, were invalidating, insensitive, evasive and inadequate. A Sorry Not Sorry opus – the mother of all scams in which the perpetrator gets away.

The extensive delays were particularly incomprehensible given that hospital administrators, clinical staff and a lawyer had quietly convened in January 2019 to discuss my father’s case, long before I requested the complete medical record or submitted a complaint via the Patient Ombudsman’s Office.

Limits of moral suasion

Two years have elapsed, yet the complaint remains unresolved. The hospital denied requests by the Patient Ombudsman’s Office for an external independent investigation, and discussions with the hospital’s CEO to address deficits in internal processes have been ineffective. Despite effusive public narratives of patient-centred care, hospital-patient relations remain an intermediary between at-fault staff and the hospital’s legal counsel. An insult wrapped in a compliment.

For its part, Ontario’s Patient Ombudsman is committed to fairness and transparency, but lacks the authority to enforce binding recommendations, relying instead on moral suasion to influence change. As my family’s experience demonstrates, health-care institutions can render the “office of last resort” toothless. In such cases, moral suasion is a poor substitute for an independent investigative authority with the power to enforce systemic improvements for publicly accountable hospitals.

Inadequate legislation and oversight of hospital practices, as well taxpayer-subsidized legal costs for physicians further enable patient harm. Especially for patients without a support network to advocate on their behalf.

And as long as hospital administrators’ primary concern is to mitigate legal risk, the well-being of patients will not be a priority. Patients and families who experience medical harm will continue to be deterred from seeking accountability and driving systemic improvement.

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8 Comments
  • René Andersen says:

    This is another unfortunate story about a system that is NOT health care but rather a “treatment business”.
    Being paid to perform a treatment with limited patient care motivation seems to be endemic in our medical system in Canada – no matter the province or jurisdiction.

  • Peter Nigos says:

    Both Lee and Ryan miss the point of my argument. Lee states that I behave like “hospital administrators…. (who) deflect and deny harm.” Ryan pours scorn on the behaviour of health care organizations “.. after health care harm occurs.”
    I do not deny or accept that “harm occurred” in the example related by Ms Kulbatski. All I pointed out was that it has so far been impossible to prove that, for common aggressive cancers, intensive follow-up prolongs life. Please don’t shoot the messenger.

  • Donna Rubenstein says:

    Thank you for this excellent piece – informative for those unaware of the challenges and an affirmation for those who have had similar experiences and feel alone. Once again we see how system and process take priority .A truly patient centred healthcare system would not allow this to happen. Sadly, it is also tremendous lost opportunity for learning and improvement , Culture change needed from leadership and in medical education .

  • Marie says:

    I have been such and you are dead on. With your write up. Thank you

    Marie B.

  • Lee says:

    Peter, your comment demonstrates exactly what the author describes. It’s a perfect example of the gaslighting & victim blaming that hospital administrators use to deflect & deny harm. Any one of us with lived experience will tell you the same. According to your comment, there’s little reason to treat aggressive cancer or call out a broken & abusive system where doctors don’t disclose their mistakes & hospitals try to cover them up at the expense of grieving families. It’s curious that you choose to defend a line of argument that dismisses & minimizes the damage this causes. You’ve obviously never experienced such harm & I hope you never do.

  • Peter Nigos says:

    As I interpret Ms Kulbatski’s primary complaint, her late father, being followed after treatment of prostate cancer, had a test which later was interpreted as showing recurrent cancer. The failure to identify this test accurately forms the basis of her complaint, with the implicit argument that had the test been interpreted correctly at an earlier stage, some intervention might have prolonged her father’s life, or even cured him of the malignancy so that he would still be alive today.
    With this argument, Ms Kulbatski makes the assumption that intensive follow-up after a primary treatment for an aggressive cancer will result in prolongation of life. In truth, a number of studies in various kinds of aggressive cancers have found it impossible to demonstrate a significant increase in lifespan who comparing intensive follow-up to little or no medical follow-up. This surprising result can be found in summaries prepared for the Cochrane Reviews.
    While Ms Kulbatski appears to have genuine reasons for complaints about her father’s treatment, she should also have the good grace to acknowledge that further intervention at zero time or at two years later would most likely have had little overall effect.

    • Ryan says:

      Respectfully, your interpretation misses the plot, and is kind of a classic example of ‘organizational explanation’ by suggesting ‘he would have died anyway’. The article is about the compounded harm hospitals and healthcare organizations choose to perpetuate on patients and families by obfuscation and inaccessibility in service to legal and reputational risk management after healthcare harm occurs. If healthcare actually spent the time and resources on effectively understanding and learning from healthcare system breakdowns, and sharing those learnings in a compassionate, transparent manner, as they do explaining them away with insincere apologies (when so lucky), we might have made some degree of progress over these last 2 decades. When a PhD in medical science describes the challenges encountered in even obtaining access to information from a system set-up with the discretionary power to largely decide whether they want to or not, we need to pay attention. What hope does that present for people of lesser means/skills/knowledge in the pursuit of understanding and healing from such trauma?

  • Sue Robins says:

    Thank you Iris Kulbatski for writing this poignant piece.

    Health care would be so much better if patients and families were allowed to give feedback at point of care and at the organizational level. Instead, administrators minimize + dismiss concerns. A lost opportunity to improve quality of care that also causes additional patient harm.

Author

Iris Kulbatski

Contributor

Iris Kulbatski holds a PhD in Medical Science from the University of Toronto. She is a science writer.

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