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Patient ombudsman: a sign of increased accountability

The Ontario government’s decision to create its first patient ombudsman position to handle complaints against hospitals and long-term care facilities is another indication of the increased demand for accountability and transparency in the health-care sector, says Toronto health lawyer Lonny Rosen

“While health professionals have been subject to regulatory scrutiny for many years, hospitals, long-term care homes and community care access centres will now also be subject to external accountability with the implementation of a new patient ombudsman,” he tells AdvocateDaily.com

“There is greater accountability now for health-sector organizations because there is an external body, a patient ombudsman, whose sole responsibility will be to receive and respond to complaints about health-sector organizations and to undertake investigations of these complaints."

The patient ombudsman will assist patients and their caregivers who have not had their concerns resolved through existing processes already in place at hospitals, long-term care homes or community care access centres, says the Ministry of Health and Long-term Care.

Key functions of the patient ombudsman will include: addressing unresolved complaints from current and former hospital patients, long-term care facility residents, community care access centre clients and their caregivers; investigating health-sector organizations in response to unresolved complaints, as necessary; and making recommendations to health-sector organizations following investigations.

Rosen, partner at Rosen Sunshine LLP, notes that currently there is a robust system that deals with complaints about health-care professionals.

“Every regulated health professional is a member of a college, and colleges are mandated to govern the profession in the public interest. To that end, they receive complaints about members and undertake investigations,” he says. “With the exception of the minister of health and long-term care and supervisors appointed by the minister (a rare occurrence indeed), there is now a similar regulatory body dealing with hospitals or long-term care homes. As a result, people who have complaints about hospitals, rather than about a particular health-care practitioner within a hospital, would up until now have to raise their concerns with the hospital itself and wouldn’t necessarily have any recourse beyond that.

“Now there will be a patient ombudsman who will receive complaints about hospitals, long-term care homes and community care access centres. These organizations were previously not under regulatory authority.”

Health Minister Dr. Eric Hoskins says in a Toronto Star article that the purpose of the ombudsman is to “give a voice to patients who feel the system could have done better.”

The province is creating the new position following recommendations released last December by the Quality of Care Information Protection Act review committee, says the newspaper. The review committee called on the province to create a mechanism to investigate critical health-care incidents, says the article. 

The move for a patient ombudsman also follows a decision last year for the province to expand the jurisdiction of the Ontario Ombudsman’s office’s mandate into the “MUSH sector” — the vast, provincially funded broader public sector comprising municipalities, universities, school boards and hospitals, as well as long-term care homes, children’s aid societies and police.

While many hospitals already have patient relations departments and processes, as of Sept. 1, all hospitals will be required to have a staff member responsible for overseeing the patient relations process as well as other measures to improve patient relations, says the ministry.

Rosen says the first duty of the patient ombudsman will be to attempt to ensure that the complainant has first attempted to resolve the complaint directly with the health service organization.

“In other words, if someone has an issue and goes to the patient ombudsman, the ombudsman will first say to the person, ‘did you discuss this with the hospital in an attempt to resolve your concerns there?’” he says. “And if not, the patient ombudsman will have the discretion to dismiss the complaint, directing the complainant to take their issue up with the facility first.”

“If the complaint relates to a person who is under the jurisdiction of another body, such as a health professional college, then the ombudsman will likely refer the complainant to that body rather than considering and investigating the complaint himself. For example, if a person’s complaint about a hospital is in fact related to the conduct of a nurse or a social worker within the hospital, then the appropriate body to consider that complaint would be the college that governs those professionals.”

Rosen says the investigative powers of the ombudsman are quite broad and include authority to interview the complainant and other people involved, including by issuing a summons and examining people under oath, to enter premises of a health-sector organization and inspect them, as well as to disclose information obtained during an investigation to another person or body if the information relates to a matter before that body or individual.

“For example, if the complaint is about a hospital and the ombudsman identifies concerns about a particular practitioner, the ombudsman would then have authority to disclose information to that professional’s governing body,” he says. “Generally, an ombudsman doesn’t have authority to issue sanctions, so the findings of an ombudsman are typically not binding, but they will likely be viewed as persuasive and significant by everyone in the health-care system.

"The ombudsman’s authority to disclose information obtained in the course of his investigation may result in the initiation of disciplinary proceedings and the imposition of sanctions by those bodies that do have jurisdiction over health-care professionals and the authority to impose sanctions, and in those bodies having increased means by which to obtain information, which may lead to those steps."

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