Ontario Medical Transparency

For the first time, Ontario patients will be able to easily discover if a doctor has been found guilty of medical malpractice, has a criminal conviction and why or what limits have been put on a physician's licence.

Public light will be shone not only on the records of doctors, but those of all regulated health professionals – from nurses to dentists to acupuncturists. All will now be required to report findings against them to their respective professional colleges. And those colleges must release the information to the public. As well, findings against medical professionals will no longer be wiped clean after six years. These changes are all amendments to legislation moving through the Ontario Legislature to improve hospital safety.

In addition, all Ontario hospitals will be required to report safety information such as medical errors – what hospitals call adverse events – to the province, which will make it public on websites. These changes to existing provincial legislation will ensure that secrecy will end.

The changes will put Ontario at the forefront of medical transparency in Canada.

Health ministry officials say the move comes in response to a Toronto Star series on medical secrecy that began last October. The series highlighted the absence of safety information available to patients once they step inside Ontario's hospitals. For instance, patients have no idea how many cases of hospital-borne infections have swept through a hospital or how many have died after a specific surgical procedure.

The Star has pursued the issue of medical secrecy since 1997.

This is all part of improving quality of care, said Health Minister George Smitherman. "If you measure things, you hold yourself to a test," the minister told the Star yesterday. "This is, accordingly, a big step forward. But it's not just about me saying this and you recording it in your newspaper. It is a really complicated and challenging step. We'll have to work really hard with a lot of different players to make it work well."

Those partners are the Ontario Hospital Association, the Ontario Medical Association and all the regulated colleges such as the College of Physicians and Surgeons of Ontario.

"We've had several discussions with government over the last several weeks," said Patrick Nelson, a spokesperson for the OMA, the professional group representing 24,000 doctors.

Nelson said it was important to the OMA that health professionals maintain their right to a fair hearing – they believe doctors' rights would be denied if complaints were publicly posted without due process. "We needed to make sure that action only be taken on transparency if a health professional has been found guilty of misconduct. It's not fair to take action before a hearing or finding."

The changes do not go as far as releasing complication rates of individual doctors or surgeons.

The Star series exposed the plight of women who claim they were victims of medical negligence at the hands of a Scarborough obstetrician and gynecologist. The former patients of Dr. Richard Austin held a press conference on April 19, calling on the province to lift the veil of secrecy over doctors' complication rates, malpractice suits and complaints. More than 50 women have now contacted the Star to allege they were victims of medical errors by Austin. The series revealed a pattern of lawsuits, complication rates and unintended cuts to internal organs by Austin that medical experts call well above average.

At least 15 of the women have filed lawsuits since 1983. In one case, a judge ruled Austin guilty of battery against a patient. Four are before the courts. Six suits were settled out of court, four were dropped, including three in which complainants cited high legal costs as part of the decision to abandon their cases.

Austin and his lawyers have not answered repeated requests for an interview.

Frances Borrow was one of the women at the press conference. She has been living with a plastic bag strapped to her stomach to collect her urine ever since her bladder was accidentally cut during a hysterectomy in 1990. "I'm very pleased to hear this. It would've changed my decision if I'd known that kind of information when I had surgery." Toronto lawyer Amani Oakley is acting on behalf of many of the women. She called the proposed and mandatory changes an amazing first step. "It's an excellent step toward transparency. But it doesn't make sense to stop at the edge. Individual (physician) complication rates are key," she said. "You can still see cases like Austin that would be a problem. We have two rights bumping up against each other – the right of the physician to hide poor complication rates versus the right of patients to know if bad complication rights exist. In this case, it seems overwhelmingly obvious that the public would favour the right of the patient to know."

Settlements made after a claim of medical malpractice is made will not be part of the changes.

Smitherman has maintained he's not sure how best to capture and report complication rates – by health team or specific doctor or nurse. "We have a lot of work to do with our partners."

Some of Ontario's highest-ranking medical officials have been calling for greater transparency. Three weeks ago, Dr. Alan Hudson, head of the Ontario Wait Times Strategy and former president of the University Health Network, announced hospital funding would be tied to disclosure of quality and safety information.

"If you are going to buy a house in Ontario, you check the roof, you check the wiring and plumbing. This is slightly more important," said Hudson. "This is your life."

Dr. Michael Baker, UHN Physician-in-Chief who advises the Ministry of Health on patient safety, said: "Analyzing mortality rates and infections and other issues lead us to analyze what we can do better. The American evidence does suggest that it leads to improvements in safety. We can't look bad if we disclose. We can only look good for sharing what we have."

As many as 23,750 people die each year from in-hospital adverse events, according to the Canadian Institute for Health Information, more than the number who die from breast cancer, car accidents and HIV combined.

The OMA said most adverse events in hospitals are not the fault of one person. "We know the majority of adverse events in hospitals are the result of systemic problems, not the result of an individual," said Nelson. "For this reason, we've maintained that improved patient outcomes require a systemic team-based approach."

Source: Toronto Star