Category: Hospital

Canada Should Look to Turkiye for Health Information/Data Systems

Disclosure: I have a business relationship with Medicte, a firm that provides high quality medical tourism services for Canadians. They provided me with some information for this blog. If you are on a prohibitively long waiting list for medical or surgical services, and are willing to consider travelling out of country to have treatment, contact Dr. Abdullah Erdogan at: medical.developer@mestassistance.com

I’ve written previously about Health Data Systems and what a poor job Ontario (and indeed all of Canada) does at using information technology (IT) to help with health care. Let’s look at country that does things the right way, Turkiye (formerly Turkey). I appreciate this choice may come as a surprise to many, but Turkiye has a very modern, highly efficient health care system, and had to go through their own period of transformation from a fragmented system to a more integrated one.

The long version of how Turkiye evolved their health systems can be found here. The short version is that in 2003, the Turkish government came up with the political will to introduce the Health Transformation Program. Over the next ten years this act, and unyielding political will, transformed the Turkish health care into a fully integrated system. In many ways, it’s a model for what Canada needs to do.

I had the honour of being invited to do a talk for the Canadian Turkish Business Council on the Canadian health system (along with my smarter and more esteemed colleagues Drs. Nadia Alam and Silvy Mathew). In preparation, I studied up on how Turkiye handles health data (with the help of Medicte). I cannot tell you how impressed I was with their system.

Drs. Nadia Alam, Silvy Mathew and yours truly speaking at a meeting sponsored by the Canadian Turkish Business Council

In Turkiye, the federal government has mandated that all hospitals in Turkiye use the Hospital Information Management System (HIMS). Now to be clear, different hospitals in Turkiye still use some different modules of software, but they are all compatible with HIMS. The data for all citizens of Turkiye is then backed up securely.

Then, every citizen of Turkiye is offered a patient portal called e-Nabiz.

Official logo of Turkiye’s patient portal.

What does this portal allow patients in Turkiye to do? According to Medicte:

“When people enter their E-Nabız profile, they can make appointments at all public hospitals and access the records of these appointments. They can review all of their examination, diagnosis and treatment data in the health facilities they visit and access the details of all the tests performed during this process. This includes all data related to the process, such as all laboratory tests and radiology images with their reports, prescriptions, diagnoses and drug usage details.” 

Further more, the app can be used to allow other health care providers access to patients health information (with consent). Let’s say a resident of Istanbul happens to travel to Antalya (a truly lovely tourist destination about an 8 hour drive away). If that person gets ill, they can use the E-Nabiz portal to allow doctors in Antalya to see their previous health information to help guide their care. Not only that, information about their visit in Antalya will automatically be available to their family doctor in Istanbul, including lab work, diagnosis, and prescriptions. I can’t even get health information on patients of mine that go to a walk in clinic in Barrie, and that’s only 30 minutes away from my office.

Not only does this system allow for much better communication between health care professionals of all kinds (physicians, nurses, pharmacists, home care and so on), but having knowledge of a patient’s previous health history significantly reduces duplication of tests. And leads to more optimal outcomes.

For people who are not citizens of Turkiye, but go there for medical tourism (Turkiye is one of the top medical tourist destinations in the world), their travel companies can offer them similar access to their health care records. For example, Medicte will soon offer the MestCard app via its parent company MestGroup.

Screenshots of the MestCard Apps

Essentially, a patient of mine, who choses not to wait the 13 months that they currently have to wait for a hip replacement in my area, could go to Turkiye next month, get their hip replaced AND have much better access to all their health records than a patient of mine who got that done in Canada. (And yes, all of these apps/software/portals are compliant with recent security standards).

But that’s not all, this tight integration of IT allows for other benefits. For example, Health Systems Consultant Matthew Lister, who spoke at the same event, informed how this allowed hospitals across Turkiye to manage their supply issues. If one hospital was short on something (tubing, a drug, IV fluid or so on), it can immediately check the inventory of nearby hospitals and request a transfer. No phone calls, no double checking. It’s all online, backed up, and available for hospital management to see. He also emphasized that this has been the case in Turkiye since at least 2011!

Matthew Lister speaking at the Canadian Turkish Business Council event.

In Canada, given the disastrous current state of our health care system, there have been calls for system transformation from multiple sources. Whether from what are viewed as conservative organizations like the Fraser Institute and Postmedia News, or progressive organizations like Canadian Doctors for Medicare and the Torstar Media group, everyone from all sides of the political spectrum agrees that health care is need of a fix.

Here’s thought. Rather than start from scratch, let’s look at countries like Turkiye, that have taken their own fragmented health care systems, unified them and leapfrogged Canada to develop a much more efficient health system. Then just do what they did.

The benefits to the citizens of Canada would be enormous.

Post Script: While it’s true that Turkiye has a modern, high functioning health system, even such a system can be overwhelmed by a disaster like the recent Earthquake that has claimed at least 50,000 lives. To help the victims of the earthquake in both Turkiye and Syria, I encourage you to donate to the IDRF Earthquake Relief Fund.

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Moving Procedures to IHFs is a Step in the Right Direction

Let’s say you are a patient with high blood pressure in Ontario. It’s time for a check up. If you are lucky enough to have a family physician, you will go their office. Your family doctor will check your blood pressure and perform additional physical exams as necessary. If you are due for additional tests, they will order that and renew your medications. They will likely be paid fee code A007, currently set at $36.85. Out of that $36.85, your family doctor will put some aside to pay the staff, some for cleaning, some for rent, some for other expenses. The remainder, the “profit” if you will, your family doctor will keep for themselves.

Additionally, your family doctor will be required to keep their medical equipment in good order, vaccines in a fridge at consistent temperature, sterilize their equipment and so on. Medial charts must be kept legible and comprehensive. Your doctor will be subject to inspections from their governing body, the College of Physicians and Surgeons (CPSO) to ensure they comply with this.

None of this is new, and it’s how health care has worked in Ontario for decades.

It’s therefore amusing to me to see the righteous indignation on social media when the Ontario Government announced that it would allow more procedures to be done outside of hospital, in an attempt to start to catch up on a backlog of health care that some estimates place at 20 million procedures. The frenzied cries of how this is scheming to create two tier health care where you pay with your credit card have come from the usual suspects.

Premier Doug Ford and Health Minister Sylvia Jones announcing the expansion of Independent Health Facilities

Ontario has had Independent Health Facilities (IHFs) for decades. This is not a new concept. Just like your family doctors, these IHFs bill OHIP for services that are insured, and in return perform a procedure/test/examination on you the patient. They are subject to inspection by the CPSO (just like your family doctor) and have to stay up to standards.

As technology has evolved, many procedures that were once done only in hospital can now be done safely outside of hospitals. Cataract surgery for sure. Colonoscopies/Gastroscopies as well. Arthroscopies are safe and even some joint replacements can be done as outpatient surgery now.

And, just like a visit to your family doctor, you would go to the IHF, the physician would get paid for the work they do by OHIP, some of what they get paid would go to cover their overhead, and the remainder, the profit, they would keep for themselves.

Philosophically, there is NO difference between these two scenarios. So it is extremely curious that people are raising such a furious response to this. Essentially they are saying “it’s ok for family doctors to own their own clinic and keep a profit but it’s not okay for a specialist to do so.” Talk about two tier!

Now that’s not to say there aren’t some practical considerations that need to be thought out.

  1. Where will the support staff (particularly nurses) come from?
    • My feeling on this is that right now we do have a number of nurses who have left hospitals because of the stress of working there. They are never going back. If we build these outpatient surgical centres as part of the hospital bureaucracy, not only will it take longer (hospital bureacrats have never met a committee they didn’t like) but when the hospitals go to hire staff, they will likely want the staff to be able to work in other parts of the hospital and take call. The nurses who left the hospital will NEVER agree to that. Maybe some of these nurses would work in an IHF if they were guaranteed daytime hours. I don’t know how many. But it will be more that the zero that will go back to a hospital owned facility.
  2. Where will the surgeons come from?
    • Fun fact that you may not know. We do have a shortage of doctors. But we also have 150 unemployed orthopaedic surgeons in the province. I’m serious. And I agree with Canadian Medical Association Journal that this is a sign of poor planning. The real problem for most surgeons is lack of operating room time. Having IHFs with operating time will allow them to work and catch up on the health care back log.
  3. Will there be charges outside of OHIP?
    • The reality is that OHIP only covers some things. If you need a Drivers Medical for example, OHIP does not pay for that. Your family doctor will charge you. Same for sick notes, prescription renewals without a visit and more. Philosophically, there is again, no difference between what your family doctor would do, and IHF would do if you wanted something that OHIP didn’t cover (an upgraded cataract lens for example). My father paid for upgraded lenses when he had cataract surgery (in a hospital), and that was something like 15 years ago.
  4. How will we ensure appropriate care?
    • This is a biggie, and the one area that we really need more details on. One example, if I order an MRI of a spine on a patient, I have to fill out an “MRI Appropriateness Form”. This form ensures that clinically, the MRI is required and if the patient doesn’t meet the clinical criteria, the MRI is declined. This is process is only in place at some hospitals. We do need something similar in place if we are to have IHFs do MRIs and other tests.
  5. How do we ensure physician coverage at hospitals?
    • Another biggie. And another area where we really need some more details. What happens if someone has, say, a gall bladder is removed at an IHF and unfortunately the patient has complications? Obviously they will need to go to a hospital. Off the top of my head I would suggest that an IHF only get a licence to do surgical procedures if all of the surgeons have privileges at a nearby hospital so that they can manage their own complications. There may be other ways around this. But there clearly needs to be some work done here as well.

In short, Ontario is finally taking some steps that have the potential to reduce the overwhelming backlog of medical care that patients are experiencing. Instead of throwing up egregious “two tier American style health care tweets” based on ideology alone, we need to work on the practical details of this move to ensure that the roll out is done in the most effective manner possible. Even with that, it will still take years to make a meaningful dent in the backlog of health care.

But I can tell you that if we listen to what the politically motivated folks on Social Media want (have the hospitals run these facilities) it will instead, take decades.

Open Letter to Nadia Surani, Director, Primary Health Care Branch of MOH

Dear Ms. Surani,

On November 21, 2022 you wrote a letter to primary care organizations requesting that they offer seven day a week availability. For those who may not have seen this letter – I’ve attached a copy for upload here.

The response to your memo has been probably not what you expected. You’ve got one Past President of the Ontario Medical Association calling it dumb. Mind you, that guy always was a bit of a boorish loudmouth. But you’ve got another, much more eloquent past President of the Ontario Medical Association also calling you out on this:

You can’t even say you didn’t know the consequences of your letter, because you’ve got the really smart Dr. Premji warning you against blaming family docs FOUR DAYS before sending your letter:

There’s a lot more upset physicians (and other health care professionals) on social media and elsewhere, but you get my drift. This letter was, to put it far too mildly, not well received. In light of all this, might I humbly suggest that I re-write your letter for you.

From: Nadia Surani, Director, Primary Health Care Branch

To: Family Health Teams, Nurse Practitioner Led Clinics, Indigenous Primary Health Care Organizations

Re: Important Ministry Request

First and foremost, on behalf of the Ministry, I want to thank each and every one of our primary care providers for working tirelessly through the pandemic. I know that there are not enough of you to take care of all the health care needs of Ontario’s residents. Despite that, you continue to do your best and have been working at 110% capacity for longer than seems humanly possible. Your efforts have not gone un noticed and are truly appreciated.

Unfortunately, we are now experiencing a difficult and complex fall season, full of the respiratory illnesses that many of you had predicted. The combination of earlier than expected Influenza A, returning RSV infections and ongoing Covid-19 is pressuring our healthcare system like never before. The paediatric sector is particularly hard hit and sadly, we are expecting high volume pressures across our health system throughout the winter months.

As a result of the above I would like to offer you what support I can to help the residents of Ontario get care during these challenging times. You are all on the front lines, and you see the day to day challenges of providing care first hand. You see the inefficiencies and you see where things can be made better. Many of you may have ideas as to how better manage the flow of patients and many of you have some unique solutions that will help us cope, despite the shortage of health care workers.

Knowing there are limited resources, I obviously can’t promise that we can implement everything suggested. But I want you to know that every reasonable suggestion that will increase the ability of your organization to see patients and alleviate pressure on the health care system as a whole will be considered. If you feel that there will be extraordinary costs associated your suggestions, please contact your ministry representative.

Thank you once again for your ongoing commitment and dedication in the fight against the pandemic and other urgent system pressures. I truly appreciate it and I will do my best to support any innovative solutions you may have.

Please connect with your assigned ministry contact with any suggestions you have for enhancing your organization or any other questions.

Nadia Surani, Director, Primary Care Branch, Ministry of Health

There you have it. I hope that was helpful.

Sincerely,

Your humble servant.

Get Your Flu Shot…. AND Your Covid Booster.

I’ve written about the importance of getting flu shots before. I continue to be grateful for people who are being pro-active about their health, even if the phone calls to my office asking when the flu shot is coming get to be bit much.

This year there seem to be two main themes in all the phone calls we are getting.

1) What is the ideal interval between getting the flu shot and a Covid booster?

This one is relatively straightforward. The human immune system is designed to handle multiple threats at a time. We can handle multiple vaccines at a time. When infants get immunized at 2,4 and 6 months, they get Tetanus/Diptheria/Pertussis and Polio (and in many jurisdictions Rotavirus and Haemophilus) vaccines all at the same time. We’ve been doing this for decades and it’s served us well.

So getting the flu shot and Covid vaccine on the same day is not an issue. The Centre for Disease Control (CDC) in the United States has clearly indicated this. What is important however, is that the flu shot really needs to be timed properly for peak effectiveness. Again, I’ve written about this before, but the short version is you should get a flu shot in November, so that the vaccine will have peak efficiency during flu season.

If you happen to be due for your Covid booster in November, that’s ok, get both shots at the same time. On the other hand, if you are not due for your Covid booster for a couple of months, please do not put off getting your flu shot.

2) Do I really need a flu shot?

I am hearing this question more often and it saddens me. It is true that the past two flu seasons were relatively mild. The measures we implemented to prevent us from getting Covid (masks, social distancing, etc) also prevented us from getting ALL respiratory illnesses, including the flu. Perhaps people have forgotten how bad the flu can be.

If you have a cough, or the sniffles or a low grade fever, that’s just a cold. It’s not “a touch of the flu”. If you have the flu, in addition to those three symptoms, you will feel like you got run over by a truck twice. The second time because the flu virus will have wanted to to ensure you really really felt it’s presence. Muscles you never knew existed will hurt for days, and it will be an experience you won’t soon forget.

If you are a senior, or someone who for whatever reason has a weakened immune system, the flu will make you more prone to getting a serious complication like pneumonia. You will wind up in hospital, or worse.

With many of the Covid restrictions easing it is reasonable to anticipate that this coming flu season will be worse than the last two years. Australia, which also lifted many Covid restrictions, just came off their worst flu season in five years and their pattern is often repeated in North America. So yeah, anticipate a much worse flu season this year.

Additionally, the number of boosters we need to protect ourselves from Covid seems to increase every few months, and a certain amount of “vaccine fatigue” does set in. I get it, I really do. It can be tiresome to be told you need yet another shot. But you do.

One issue that I have not been asked about, but we should talk about, is what happens if you do get the flu. Hopefully you will “just” be sick for a few days, and then get over it. But unfortunately, we have to consider the possibility that you may get a severe case, and have complications that require you to go to hospital.

I recognize some will accuse me of fear mongering, but in that scenario, you really need to consider the possibility that the care you need (and paid tax dollars for) may not be available. This past summer, media was littered with headlines about this hospitals closing beds, having trouble finding staff and even shutting down ERs. Heck the Chelsey hospital ER is being shut down for months! Do you really think that trend is going to magically end when flu season comes around?

The sad reality is that if you do get a complication from the flu, you may wind up with no one to provide you with the care you need going forward.

What’s the best thing you can do?

First, just about everybody over the age of six months should get a flu shot to protect themselves and their loved ones. The number of people who truly, truly have adverse reactions to the flu shot is very low. Talk to your doctor if you have concerns.

Second, for people who are in nursing homes and retirement homes, it probably is worthwhile getting the shot the last week of October. These patients are truly truly high risk, and it may take them longer to develop immunity.

Third, for most other people in the community, wait till November to get your flu shot. This will ensure that we all have a reasonable amount of immunity until the end of the flu season.

Yours truly getting a gentle flu shot from a gentle nurse…

Finally, get the new bivalent Covid booster as soon as you are eligible (for most people it’s three months after their last booster or a Covid infection). Once again, the chance of a true reaction to the Covid Vaccine is exceedingly low. Much lower than your risk of complications from Covid.

Immunizations continue to represent one of our strongest tools to stay healthy. Outside of clean water/sanitation, they are arguably the most successful public health measure in the history of humanity. Let’s all do our part to stay healthy and protect those around us.

Disclaimer: The opinion above is not individualized medical advice. It’s meant for the population as a whole. If you have specific questions or concerns, speak to your doctor.

Most Health Care in Canada is Publicly Funded, Privately Delivered

NB: My thanks to Dr. Hemant Shah, who inspired the title of this blog with his statements on health care delivery in Canada.

Well, here we go again. Yet another kerfuffle caused by absolutist ideologues who are so hell bent on forcing their immovable views on the rest of us that they are resorting to fear tactics.

“Ontario Health Minister Won’t Rule out Privatization as Option to Help ER Crisis” – screams the headline in the Toronto Star (a newspaper known for its extremely biased reporting on health care). The article comes after Ontario Health Minister Sylvia Jones had a press scrum. The only problem is that’s not quite what she said.

Here’s the tweet from Mark McAllister, who embarrassingly reached a similar conclusion in his summary:

At no point does the Minister say she is going to privatize Emergency Rooms. Her quote is:

“Look, we’ve always had a public health system in the province of Ontario and we will continue to do so.”

Exactly what part of this screams “privatization”? Even the snippet after where she refers to looking at “options” she clearly mentions other jurisdictions in Canada, where, you know, you have public health care.

The reality is that public health care is for the most part, privately delivered in Canada. Take your family doctor for example (assuming you are lucky enough to have a family doctor). Supposing you go to your doctor to get assessed. In Ontario, your family doctor will likely get paid $36.85 (see page A5 on the Schedule of Benefits). Out of that $36.85, your doctor will allot some of it for the receptionist, the nurse, the cleaners, the rent, the computers and so on. The remainder is the profit, which you family doctor will keep for themselves.

Your family doctor is a private business.

The infuriating thing about this kerfuffle is that this kind of absolutist, hyperbolic nonsense has prevented real advances in health care over the past twenty years. Every time there is a new proposal on how to look at health care differently, some nitwit politician screams out that we are opening the door to two tier American style health care. The new idea gets shut down without taking a thorough look at its merits.

It’s the rigid, inflexible thinking by geniuses like Jagmeet Singh that prevent any such exploration of new ideas. Just have a look at our hospitals. We currently have a crisis with our hospitals over capacity and many waiting in ERs for beds. Yet we still do procedures in hospitals that could be done elsewhere, and free up hospital capacity.

For example, there is ample evidence that independently operating cataract surgery clinics are more efficient and can cut cataract surgery waiting lists. In Canada, these clinics would have to be funded by public health insurance. All absolutists like Singh see is that procedures will be done in a “private” clinic, and are therefore un-Canadian and Tommy Douglas must be rolling in his grave to hear of such a possibility.

Fun fact: Tommy Douglas supported user fees for health care.

Singh and his absolutists would rather you go blind on 2 year wait lists than have publicly funded health care done in a way they don’t approve.

To be completely fair, there are some legitimate concerns about doing procedures in independent clinics. For example, there was concern that colonoscopies in outpatient settings were suboptimal. However, those concerns were addressed by some needed changes made by the College of Physicians and Surgeons of Ontario, with the setting of minimum standards and inspections. As a result of that, there was a strong feeling that colonoscopies could be done safely and efficiently outside of hospitals.

And let’s face it, it’s not as if public institutions are without issues either. Remember the time there was concern the Niagara hospital mishandled a c.difficile outbreak? Or the public nursing home that has been shut to new admissions for over a year? In fact there’s a suggestion that harm to patients in public hospitals costs $1 Billion a year.

No matter if public or private, so long as human beings are involved, mistakes will get made. What’s really needed is a way to do appropriate inspection and review of facilities that are funded by the public purse, so that mistakes are minimized. Then let them get on with their jobs.

What I don’t get is how these folk don’t recognize the hypocrisy of their views. In their mind, it is okay for a family doctor to bill OHIP for a blood pressure check, then use that money to pay for their clinic and keep the profit. But it’s not okay for a gastroenterologist to bill OHIP for a colonoscopy in a health facility (which is safe to do), and use that money to pay for their clinic and keep the profit. Or for an ophthalmologist to bill OHIP for a cataract removal out of hospital (also safe to do) pay for their clinic and keep the profit. And they accuse Sylvia Jones of promoting two tiered approach to medicine???

What about the fact that these private clinics charge patients for some things? Um…..have you ever gone to your family doctor for a Driver’s Medical? You know it’s not covered by public health insurance right? And you have to pay your family doctor for it? How about a sick note? An employment form? The reality is that ALL clinics will charge you for things that public health insurance won’t cover.

As our health care system continues to collapse all around us, we need to take a thoughtful, intelligent and open minded look at how we deliver health care. Yes it should be paid for by the public purse. But we need to recognize the reality that appropriately funding private clinics (with levers to ensure high quality care) is the most effective way start clearing the immense backlog of health care cases.

As for absolutists who snarl at the mere mention of the phrase “private”. While everyone with a modicum of intelligence recognizes that Star Trek is a much better franchise, let me leave them with this from the other, weaker franchise:

What is Going on at Sunset Manor?

Full Disclosure: Sunset Manor is a public, long term care facility in Collingwood, Ontario. I don’t have patients at Sunset Manor. The only interaction I have with Sunset Manor is when I am on call. My personal experience is that the nature of those calls from them has been no different than those from other long term care homes. All the information in my blog is based on what has been publicly reported in the media (with links attached as appropriate).

In June of 2021, the Ministry of Long Term Care issued an order to stop admissions immediately, to Sunset Manor in Collingwood. According to the CTV News Barrie report:

  • The Ministry stopped admissions because of a belief “that there is a risk of harm to the health or well-being of residents in the home or persons who might be admitted as residents.”
  • Sunset Manor received “several written notifications and compliance orders” for not following requirements highlighted after inspections between July 2018 and April 2021.
  • What shocked me the most – the Ministry stated “There are reasonable grounds to believe that the licensee cannot or will not properly manage the long-term care home or cannot do so without assistance.”

Bureaucrats generally tend to use bland, inoffensive language to avoid controversy. That last sentence jarred me. I’ve lived through some pretty bad health care facility situations in my time and have never seen a sentence that strong.

As I write this blog, Simcoe County’s website lists Jane Sinclair as the General Manager of Health and Emergency Services for Sunset Manor, which would make her the admin person in charge of the place.

The CTV News report stated:

  • Jane Sinclair called the ministry’s report “excessive,” adding,  “We don’t agree with the level of severity of these ministry findings.”

Over a year later, Sunset Manor still isn’t allowed to accept new patients, and an exclusive article on Collingwood Today suggests why. You can read the whole article for more details but briefly, Sunset Manor is alleging that the investigations were tainted because an ex-employee of Sunset Manor, Katy Harrison, was part of Ministry Inspection team. Jane Sinclair swore out an affidavit that she told the Ministry the termination of the ex-employee was “not amicable”. Sinclair further states she complained to the Ministry in 2019 about having an ex-employee do an inspection of the home stating she “could not conduct a fair and impartial inspection of the home.”

However, the Ministry elected to have her continue inspecting Sunset Manor as a “junior” member of the team. They state the allegations of bias are “spurious and unsupported by evidence” and that multiple officials inspected Sunset Manor, not just Harrison.

There’s a whole set of details about the inspection process in the Collingwood Today article that I won’t bore you with. But I will note that the article points out there have been four further inspections of Sunset Manor since last June, none by Harrison, and the facility remains closed to new admissions.

Generally speaking, the admin person at an LTC would report to the representative of the owners (in this case the County of Simcoe) to inform them how things are going. As I write this blog, the County of Simcoe’s website indicates that person is one Mark Aitken, the CAO. The website further states one of his responsibilities is overall management for Long Term Care and Seniors Services. Yet another wrinkle thrown into this mess is that Mark Aitken is married to Jane Sinclair. (Yes I know it was a letter to the editor, but it has gone un-retracted which the press would do if it was challenged).

In summary, Sunset Manor has been repeatedly investigated by the Ministry of health over the past four years. One of the investigators was an ex employee whom the Manor feels was biased. As a result of investigations, Sunset Manor has not been allowed to admit new residents to the facility for over a year. The Administrator answers to the owner (or in this case, the owners representative) who happens to be her husband. The response of the owners is to sue the ministry alleging the inspections were biased and unfair.

Here’s my take.

1) I think it was wrong of the ministry to allow ex-employee to investigate Sunset Manor. I’m in no way suggesting that Miss Harrison acted inappropriately. The reality however, is that optics matter. If you’re going to level the most serious punishment possible to a long-term care facility you need to make sure that there’s absolutely no margin for people to think that that punishment is anything other than completely justified.

2) Similarly the administrator of Sunset Manor should not be reporting to her husband. The Administrator may have handled the situation perfectly, but again optics matter. The public needs to be reassured that if the Administrator made a mistake, appropriate action would be taken, and people won’t believe that if your spouse is your boss. (ADDENDUM: While the Simcoe County Website continues to list Mr. Aitken as the person responsible for LTC – please see the first comment below from Mr. Manary – who wrote the initial letter stating Mr. Aitken and Ms. Sinclair were married. At this time I’m simply putting the information out there, but if there is a factual correction to be made by someone in authority at County of Simcoe – I will do so).

3) You know how there are people like Dr. Samir Sinha who write articles that we must stop private nursing homes? Or that tweet the incessantly that public long term care facilities are better? Sunset Manor is public.

This situation has been allowed to drag on for over a year to the point where according to Collingwood today there are now 43 empty beds at Sunset Manor. While four compliance orders have been lifted, the home was fined another $5,500 for failing to comply with medication management.

The frustrating thing is it it should never have come to this. It’s a travesty when we have so many people waiting for long-term care beds. I recently had a patient wait over 90 days in hospital for one. Getting Sunset Manor open again would really help our community.

I don’t know who’s right and who’s wrong here, but hopefully whatever needs to be done there gets done, and our seniors can once again get the care they deserve, in the location they need.

Crisis at Trillium Health Partners Demands an Intervention

Over 20 years ago, I and a number of other physicians were involved in a significant dispute with our local hospital administration. The specifics don’t really matter now (it’s ancient history). But in general terms physicians like myself felt strongly that we were fighting for patient care against an administration that didn’t value our input or opinion. Administration at the time undoubtedly felt differently. Eventually, both sides became entrenched and the Ministry of Health had to send in a team to sort this out, after we went public with our concerns. The MOH bureaucrat even fashioned a new phrase, referring to their team as “Interveners”.

All of which is to say I still get nightmares when I hear of in house disputes at a hospital being made public, most recently at Trillium Health Partners in Mississauga. Not working at that hospital, all I can go on is what CTV News reported. 40 physicians at Trillium Health Partners have hired a lawyer alleging:

  • physicians “are targets of an abusive and unprofessional behaviour of the hospital administration.”
  • “terrified for their livelihoods”
  • “fearful to go work”
  • a physician was called “crazy”
  • “a toxic culture rooted in harassment, intimidation and threats”
  • an environment where “physicians are afraid to practice medicine”

All of this certainly brought back my own PTSD at the events that led myself and my colleagues to take action over two decades ago.

As mentioned, I don’t know the specifics there. But I can say a few things in general from not only my previous experience, but from other institutions where I’m aware of doctors speaking out.

First, doctors in general hate speaking to the media and going public about internal conflicts. It’s one thing to talk about medical issues that pertain to the health care needs of the population as a whole. But to go out and air dirty laundry? It’s not in their nature. For something to reach this point, it usually means that every possible avenue has been exhausted, and there is a real concern for patient care.

Second, every hospital has multiple processes for addressing concerns. There’s a Medical (or Professional) Staff Association that advocates for the needs of their professional staff. There are numerous committee structures and depending on the concern the issues can be brought there. There are internal complaints processes and various Human Resource department protocols. There are chiefs of departments whose role includes addressing concerns fairly. Basically a lot of ways to bring problems to the attention of the higher ups.

Third, doctors in general put up with a lot of bureaucratic non-sense just so they can get the job of looking after patients done. Whether it’s ludicrously difficult hospital IT systems, policies that require us to duplicate our efforts, or any number of roadblocks, physicians complain privately about the working environment, but put up with it because we want patients well looked after.

In that context – to see physicians do what they’ve done, and write to the Minister demanding she appoint a supervisor (essentially someone to take over the administration of the hospital) signals a complete failure of all of the internal processes, and a dramatic escalation. This only happens when the two sides are entrenched.

What next?

What’s Likely to Happen:

Usually, administrations in such a situation tend to circle the wagons and go on the defensive. Attempts are made to minimize the concerns or denigrate the physicians as a small group not representative of the whole. Evidence is produced suggesting the concerns were appropriately reviewed and dealt with.

As an aside, Trillium has already done this by having their own lawyer investigate the complaints and, surprise surprise, the lawyer Trillium pays found Trillium did nothing wrong. I would have thought for issues of this magnitude it would be appropriate to bring in an external person to review. Maybe Trillium didn’t do anything wrong. But surely having an external person say that would carry more weight.

Then, if physicians make enough noise, the issues continue to percolate, the general public expresses concern and politicians get scared. In our area, the issue became so toxic that enough physicians decided to resign their privileges and our Emergency Department was in danger of shutting down part time.

After months of agony, somebody at the MOH (plus/minus political intervention) realizes they have to do something and appoints a third party with the power to actually do something and make some necessary changes.

What Should Happen:

Why go through additional months of grief? There’s clearly a crisis there. The residents of the catchment area of the hospital must surely have concerns about the care they will receive when they read the articles from CTV News. Having doctors who are fearful of the working environment simply cannot contribute to good patient care.

The MOH appointed their “Intervener” in my hospital and the Intervener had the power to tell both Administration and Physicians when they were offside. I personally got told I was going too far offside by him during the process, and I know Admin was also told they had to back down on some things. At least he was fair.

I don’t know who’s right and who’s wrong at Trillium, but patients at Trillium need to know that something is being done to address these concerns and ensure there is safe environment for the caregivers. To that end, the MOH needs to appoint an independent third party to help the situation sooner, rather than later.

For a link to CTV News’ follow up report on the issues that includes comments from yours truly, click here.