Filing a complaint against a private clinic in Ontario could cause headaches
Ontarians dissatisfied with private service can complain to the Ministry of Health, but not to the Patient Ombudsman.
A medical procedure gone wrong, a patient feeling the pressure to pay out of pocket for certain care: what are the remedies for Ontarians who are treated in private clinics? As the province prepares to give a greater role to these independent health centers, voices are being raised for the protection mechanisms to be strengthened.
The Ford government unveiled a plan last week to increase the number and range of medical procedures offered at private health facilities. These interventions would be publicly funded.
But what are the protective mechanisms for patients who visit these clinics? In Ontario, complaints about the health care system fall under the jurisdiction of the Patient Ombudsman, an independent body. However, private hospitals and autonomous health establishments do not come under its jurisdiction. These complaints must therefore be forwarded to the Ministry of Health.
Patient Ombudsman Craig Thompson is well aware of these limitations.
We know that some of these healthcare facilities do not have a robust complaints process or a place to escalate complaints beyond the organization itself, his office told Radio-Canada.
“Any healthcare facility that receives public funding must provide care fairly, which includes a rigorous complaints process if patients are dissatisfied with the care they receive.
— Office of the Patient Ombudsman of Ontario
France Gélinas, NDP Health Critic, believes that the system should be centralized and fall under the office of the Ontario Ombudsman, Paul Dubé.
I would say that we don't need duplication. We don't need a Patient Ombudsman. Give the Ombudsman the right to receive complaints from the health system as a whole. Period, she believes.
The MP for Nickel Belt had proposed this change in a private member's bill last fall, which was defeated. .
The Department of Health did not respond to a request from Radio-Canada about the number of complaints it receives about private hospitals and independent health centers.
The Patient Ombudsman, for its part, received 54 in 2021-2022; complaints he was unable to address and had to redirect.
The Ford government's privatization plans have also raised concerns about possible upselling techniques: fees extras that customers might be offered, and pay out of pocket.
While the Ford government assures that all private clinics will continue to provide services covered by OHIP, it has not closed the door to them also offering non-reimbursed options. For example, in the case of cataract surgery: a basic lens covered by the province, or a premium lens paid for by the patient.
If there is a scenario where someone is not offered the option of a service covered by OHIP, and only an enhanced plan, then that person has the ability right now to apply for investigation through the Ministry of Health. And we do it regularly in Ontario, assured the Minister of Health Sylvia Jones in a press briefing.
We are investigating and, if necessary, we will reimburse the person or patient who received treatment that should have been paid for by Medicare.
Health Minister Sylvia Jones and Premier Doug Ford say proposed changes to the health care system will not have no impact on patients' rights.
But this approach is not easy and finding the information can be an obstacle course, underlines France Gélinas.
“People don't dare to complain, and when they dare to complain, it's next to impossible to find where to do it.” .
—France Gélinas, NDP Health Critic
In a report on outpatient surgeries in 2021 (day surgeries performed in public hospitals, but also in the private sector), the Auditor General of Ontario had noted shortcomings on this side- there, and a lack of public knowledge about optional add-ons and patient rights.
There is no provincial oversight of surgical service providers for protect patients and prevent them from being misled about their right to undergo standard publicly funded surgery without having to pay out-of-pocket costs, writes Bonnie Lysyk.
We reviewed Ministry policies and agreements and found that surgeons or organizations are not required to maintain or disclose any mandatory documentation confirming that they informed a patient of their right to publicly funded surgery without having to pay fees.
What about inspection mechanisms in private health centers? Provisions are included in the Independent Health Facilities Act.
All of these facilities are subject to a mandatory quality assurance program administered by the College of Physicians and Surgeons of Ontario and the College of Midwives of Ontario . Each establishment is inspected on a five-year cycle. They may be subject to more frequent proactive inspections, if determined by the director of independent health facilities, details a Department of Health spokesperson via email.
The inspectors thus come under the professional orders.
For France Gélinas, this system is insufficient. She draws a parallel with long-term care homes, and the gaps in the inspection process highlighted during the pandemic. Supervision of public health establishments, on the contrary, is particularly rigorous, according to the MP.
The vast majority of doctors are good people, who follow the directives, who do not break the laws, which want to offer you quality care. But they are human beings like all human beings. There is a portion who will use their position of privilege and power to enrich themselves, to do things that are illegal, she argues.
The Prime Minister Doug Ford, for his part, wanted to be reassuring last week. I have confidence in this process. I have confidence in the regulations and the doctors who will perform these surgeries, he concludes.