Tuesday January 10, 2012

The following Q&A was put together by The Agenda's student intern, Gillian Wheatley.

On January 1st, 2012, hospitals became subject to the Freedom of Information and Protection of Privacy Act (FIPPA). Natalie Mehra, director of the Ontario Health Coalition, talks to The Agenda about what this means for the health care system, how patients will be affected, and just what information she hopes to find using these new tools.

The Ontario Health Coalition is a network of community organizations in Ontario. They provide information about the health care system and its programs and services to their member organizations and the public.

Hospitals are now subject to Freedom of Information legislation. What does this mean?

It would mean more if the government had left the Public Sector Accountability Act as it was when they initially passed it. Instead, following a lobby effort by the hospital lobby group, the government undid a significant portion of the new access to information. In last spring’s budget the government inserted what we call the “Hospital Secrecy Clause.” It states that hospitals will be allowed to shield from public scrutiny certain quality of care information and information about hospital programs and services. So they granted public access through Freedom of Information, but within the year they took a substantial portion of it away again. The clause should never have been inserted in a budget bill -- it is social policy not a  budget matter, and it runs contrary to the public interest.

Why has it taken so long for these changes to occur?

Opposition from hospitals and a Ministry of Health that has a culture of secrecy and lack of democracy. In general, after a good start in re-establishing democratic practices after they were first elected in 2003, the McGuinty government has become very much what it criticized when it was in opposition. Democratic protections do not rank high on this government’s radar. There is a lot of information that is hidden and will remain hidden. The government has moved forward with dismantling democratic governance and accountability more than the opposite.

How do you see patients being affected by hospitals coming under Freedom of Information legislation?

Because they have now excluded a whole range of quality of care and program/service information from access, it is not clear whether there will be the gains we were hoping for. We are working on testing this now by launching a series of requests for information.  

How will your organization be affected?

Presumably, we should be able to get information that we have sought and been refused. But if hospitals use the enormous loophole granted to them in the Hospital Secrecy Clause, we might not be able to get much more than we already have. For example, we called all hospitals in Ontario and asked for their occupancy rates (i.e., what proportion of hospital beds are full and what proportion are empty). Hospitals played games. They wouldn’t return calls. They said they would send information and then never did. It took months of follow up, and, in the end, more than half did not provide the information. This is basic information that is publicly available in all kinds of other jurisdictions. And we fund these hospitals! Under the extension of access to information legislation to cover hospitals, we should be able to get this. But if hospitals consider this quality of care information on programs and services to be within the hospital secrecy clause, we will continue to be denied this information, and we will have to make a decision about whether we have the resources to go through appeals to try to get it, or just give up. In that case, nothing will have changed.

What kind of information will your organization be requesting from hospitals?

Financial information; information regarding measures of quantity and quality of care, such as numbers of readmissions; information regarding service cuts; information regarding discharges of patients to inappropriate facilities. We are working on the information requests now.

How can the current state of hospital accountability improved?

This is a big question. We need improved democracy and accountability to local communities. There should be controls on the excesses of top executives to restore public confidence. Hospitals are already accountable for all kinds of financial measures and quantitative data (i.e., how many cataract surgeries). But key quality issues such as deaths from superbugs are downplayed and both the hospitals’ and government’s responses are woefully inadequate given the death rates. Similarly, coercion to force patients out of hospital when they are too ill, and when there is no adequate care for them, is a real problem. Requirements that hospitals provide services to people in need must be enforced. In fairness, though, the Ministry of Health also needs to provide the basic planning functions of a public health system – in terms of how many hospital beds are needed, capital planning, appropriate and timely budgets, proper checks and balances when cuts are required, and so forth.