Province plans tighter regulations for clinics

Health minister unveils changes in wake of Star investigation

Thestar.com
May 6, 2016
By Theresa Boyle

The province plans to improve oversight of more than 1,200 community medical clinics in response to a Star investigation about serious infection outbreaks at pain and colonoscopy clinics.

Health Minister Eric Hoskins said Thursday he plans to implement 12 recommendations to bolster accountability, regulation, quality and safety in the increasing number of non-hospital medical clinics in Ontario.

The recommendations were made at Hoskins’ behest by Health Quality Ontario (HQO), an agency that advises the province on quality care, following a series of stories in the Star in 2014 about patients who developed life-threatening infections after being treated in clinics.

“As the system evolves and patients increasingly receive care outside of hospitals in more accessible community settings, it is important that its oversight and regulation evolve to ensure that patients are protected,” Hoskins said. “Patients deserve a high and consistent level of oversight, transparency and quality, regardless of where they receive care.”

The long-awaited report released this week by Hoskins recommends, among other things, that Ontario:

• Develop a single system of oversight for all clinics, including 273 “out-of-hospital premises” such as pain, colonoscopy and plastic surgery clinics and 935 “independent health facilities” such as diagnostic testing facilities.
• Introduce quality oversight legislation, which, among other things, would establish the role of an independent executive officer to helm the sector.
• Require clinics to pass inspections, with plain-language summaries of inspection reports to be posted in waiting rooms and online.
• Mandate clinics to report on quality and performance measures to the executive officer.
• Create a transparent complaints process for patients and care providers.

“Changing technology and people’s very reasonable expectations to get care close to home mean more advanced and potentially risky procedures are being conducted outside of traditional settings. However, new settings should not mean any lower quality of care,” said HQO president Dr. Joshua Tepper.

Currently, the College of Physicians and Surgeons of Ontario (CPSO) has oversight of premises operating out of a hospital, while the Independent Health Facilities Act sets out an oversight regimen for the other group of clinics.

Having two separate groups of clinics adds unnecessary complexity and risk, the report says, adding that the dual oversight systems have not kept up with the ongoing movement of services out of hospitals and into the community.

The 46-page document, titled Building an Integrated System for Quality Oversight in Ontario’s Non-Hospital Medical Clinics, acknowledges that infection control and lack of transparency have been problems under the current setup and have contributed to a lack of confidence in the health system.

The Star investigation revealed that patients had developed serious - and in some cases life-threatening - infections at a pain clinic and at three colonoscopy clinics in Toronto in 2011 and 2012. The most recent tally shows a total of 30 people were made ill.

Toronto Public Health investigated the outbreaks but did not make its investigation reports public until Hoskins ordered it to, following publication of the stories.

Some affected patients were never even informed of outbreaks by the health unit. Michael Glass, 69, of Scarborough, learned there had been an infection outbreak at the Rothbart Centre for Pain Care only after reading about it in the Star.

The retired postal worker almost died after getting an epidural steroid injection for back pain at the clinic. He and 12 other patients were infected with Staphylococcus aureus bacteria by anesthesiologist Dr. Stephen James and developed meningitis and spinal abscesses.

James had his medical licence suspended for 10 months after a disciplinary hearing was told he worked in unsterile conditions and tried to thwart an CPSO investigation into the outbreak.
Glass said he’s pleased the government is taking steps to prevent similar outbreaks from happening again.

“It’s too late for people like myself, but hopefully it will prevent anyone else from needlessly suffering in the future,” said the retired postal worker, who continues to suffer numbness, pain and cognitive impairments as a result of the infection.

Other patients of the clinic were left relying on canes and walkers, and permanently lost control of their bladders and bowels.

The Star investigation also found that patients of the three colonoscopy clinics contracted hepatitis C during outbreaks and that Toronto Public Health and the CPSO kept the problem secret.

Medical malpractice lawyer Paul Harte, who represents many of the injured patients, said he is not surprised by the shortcomings identified in the report but is hopeful they will be addressed.

“This report confirms what we already know: the existing regulatory structure puts patients at risk. The report has identified significant gaps and makes reasonable recommendations. It remains to be seen how quickly these Minister Hoskins will move forward, but this is a good start.”