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Collaboration in Action: Case Summaries

Patient Ombudsman always seeks to resolve complaints informally before they go into formal investigations. Early resolutions are the lion’s share of our work and the most frequent result. Here are some highlights of our collaborative efforts across Ontario’s healthcare system.


Public Hospitals

Experience
The caregiver of a patient requiring frequent out-patient hospital visits complained that the hospital’s patient relations process was unclear and difficult to use.

Resolution
After discussing these concerns with Patient Ombudsman, the hospital agreed to revise its patient relations process and make information more accessible to the public to assist future patients.

Experience
At the time of an involuntary admission to hospital under the Mental Health Act, a patient reported having been assaulted. The patient later complained that the hospital had failed to adequately respond to the reported assault.

Resolution
Patient Ombudsman determined that although the hospital had recorded the patient’s declaration, there was no evidence in the medical records that the hospital had followed its internal policy in responding to the patient’s alleged assault. As a result, the hospital apologized and updated its internal policies to prevent a similar incident from occurring in the future.

Experience
A man had a stroke which resulted in significant physical and medical challenge. Initially, he was taken to one hospital by ambulance for specialized treatment and then, once stable, transferred to his local hospital. Later, because he had long-term care needs that were too complex for a long-term care home, he was transferred again to a complex continuing care hospital – far from his caregiver’s home. His caregiver did not drive and had several chronic conditions herself. The caregiver did not understand why her husband needed to be moved to another hospital, especially one so far from her home.

Resolution
Patient Ombudsman helped facilitate communication between the hospital and the caregiver to help her better understand the reason for the transfer and also helped facilitate the transfer of the patient to another complex continuing care hospital that was more accessible to the caregiver.

Experience
After a medical procedure, a patient with no additional health insurance requested a ward room in a hospital. Because none were available, the patient was put into a semi-private room and advised by hospital employees that the semi-private co-payment would not be charged. Upon discharge, the patient was billed at the semi-private room rate.

Resolution
Patient Ombudsman reviewed the patient’s concerns with the hospital and it was agreed there was a perceived lack of communication. The hospital agreed to review its policy on billing for patient accommodation and more effectively communicate the policy to patients. The hospital also reimbursed the patient for the full amount of the semi-private room.

Experience
A patient with no informal support system was in a lot of pain and required out-patient surgery at a local hospital as soon as possible. The hospital policy required that day surgery patients needed to be accompanied home upon discharge. The patient tried to explain that no one was available to assist. The hospital, based on its policy, cancelled the surgery.

Resolution
Patient Ombudsman worked as a facilitator between the hospital and the patient to achieve a resolution that resulted in the re-scheduling of the surgery and an agreement that the hospital would keep the patient overnight as an in-patient.

Experience
The complainant contacted Patient Ombudsman with concerns about the care provided to his sister, who has a major mental illness and is an in-patient at a hospital. The complainant’s sister had been hospitalized on an involuntary basis several times and has been issued Community Treatment Orders.
His sister was able to challenge the physicians’ assessments of her incapacity and the validity of Community Treatment Orders at the Consent and Capacity Board based on incomplete documentation and a failure to follow requirements under the Mental Health Act. The complainant was deeply concerned that his sister’s mental health was deteriorating, and the failure of physicians and other members of the care team to adhere to the requirements of the Mental Health Act was a contributing factor.

Resolution
Patient Ombudsman reviewed the hospital’s support of physicians and other members of the care team in understanding their responsibilities and the importance of compliance with complex mental health legislation.

Because of this situation, the hospital created new policies, amended practices, conducted multiple training and education sessions, and is actively working to continue to implement improvements to prevent the complainant’s family and future patients from experiencing similar issues. Patient Ombudsman also provided the complainant with a detailed letter summarizing the issues with his sister’s care that he can use is his advocacy efforts for legislative reform.

Experience
A patient contacted Patient Ombudsman to complain about a bill close to $8,000 for a semi-private room during a recent hospital stay.

The patient was referred for in-patient rehabilitation following surgery. The first available rehabilitation bed was in a semi-private room and the patient was transferred there. Shortly afterwards, she was presented with a ‘responsibility for payment’ form even though she had not requested a semi-private room. The patient indicated that she was in no condition to understand what she was being asked to sign. She recalled that she did not sign the form but she may have initialed it.

Resolution
Patient Ombudsman requested a copy of the form from the hospital and confirmed that the patient had not signed it, but there was an ‘X’ and her initials beside a box indicating that, if her insurance declined, she would be responsible for the charges.
In discussion with the hospital, PO raised concerns about:

  • the clarity of the form,

  • the patient’s condition at the time she was asked to sign it, and

  • the fact that she had never requested a semi-private room.    

The hospital agreed to waive the fee and to review their process for obtaining agreement to accept responsibility for payment and make appropriate improvements.

Experience
A patient contacted Patient Ombudsman to complain that not all hospitals are able to complete rape kits. She had attended a small rural hospital following a sexual assault and had requested a forensic examination or “rape kit” to be administered. The hospital responded that it was not able to carry out the examination and arranged for her to be transferred to a second hospital.

Resolution
Because of the trauma of her experience, the complainant did not feel comfortable complaining to the hospital. Given the sensitive nature of this complaint, Patient Ombudsman contacted the hospital directly. Patient Ombudsman spoke with hospital senior leadership. Small hospitals may not have the specialized expertise necessary for forensic examinations. It takes a number of hours to complete the tests, and the evidence collected may be presented in court. To ensure that the evidence stands up in court, it is important that the tests are conducted by experts, not just any physician or nurse available. Small hospitals experience challenges to maintain this expertise given the low volume of sexual assault admissions. 

The hospital offered to contact the complainant directly to discuss her concerns and the patient agreed. 

Experience
A daughter contacted Patient Ombudsman to complain about her father’s care in a hospital emergency department. The daughter described bringing her father to the hospital. Because of respiratory distress and weakness, he was unable to walk safely from the car to the emergency department. When she requested a wheelchair, she was told to find one herself. Her father waited alone in the car while she found one.

After being admitted to the hospital he was placed on a chair in the hallway for several days because of overcrowding. While her father waited for a bed, the family was told that he was actively dying. During this time, both his intravenous bag and his oxygen tank ran dry. Another relative, who is a physician, found the father was in acute distress.

Resolution
Following Patient Ombudsman’s review, the hospital issued a formal apology to the complainant and her family.

The hospital has since purchased 50 additional wheelchairs for the emergency department. Now, both volunteers and non-clinical staff retrieve wheelchairs to ensure that there are always wheelchairs available in the emergency department.

The hospital revised their procedure so that patients needing continuous oxygen support will not be placed in the hallway to wait for a bed.
The hospital will be opening a new and enlarged emergency department that it hopes will address privacy issues identified by the family.

Patient Ombudsman also helped the family refer a complaint to the College of Nurses of Ontario to address and review why the nursing team did not notice the patient’s state of physical distress.


Long-Term Care Homes

Experience
A resident of a long-term care home complained that new staff needed more orientation and training in order to facilitate better continuity of care for residents. She also requested more courtesy, specifically that new staff introduce themselves before starting care.

Resolution
Patient Ombudsman mediated a discussion between the resident and the long-term care home administration. The home agreed to review their onboarding policy and confirmed that every new staff member must complete an orientation and that all current staff receive mandatory on-line training. The administration also agreed to consider initiating the “Hello my name is” campaign to encourage and remind staff about the importance of introducing themselves before starting care.

Experience
A resident of a long-term care home changed her power of attorney. Due to the complex nature of the resident’s care plan and the circumstances, the long-term care homes administration was concerned about recognizing the new power of attorney. This response eroded the trust between family members and the long-term care home. The family, worried about reprisal because the resident was still living under the care of the home’s employees, felt obligated not to force the issue further.

Resolution
Patient Ombudsman facilitated communication between the family and the long-term care home. Eventually, the new power of attorney was recognized. The discussion also resulted in a revised care plan and clarification as to how care decisions should be communicated in the future.

Experience
A long-term care home (LTC) resident with dementia was transitioned to a hospital because of agitation and anxiety. Although the resident wasn’t hurting anyone, staff at the home found meeting the resident’s needs very challenging. In the hospital, the patient’s behaviour improved, resulting in discharge. However, the LTC home wouldn’t accept the patient back.

Resolution
Patient Ombudsman facilitated discussions that resulted in the return of the resident to the LTC home and connected the caregiver to the Ministry of Health and Long-Term Care’s Action Line to raise additional issues of compliance with the Long-Term Care Homes Act.

 

Home and Community Care Services

Experience
A woman who lived independently at home with dementia was no longer able to shop for herself or prepare her own meals. She was receiving some home and community care services, such as Meals on Wheels and personal support services to help her take medication correctly. Increasingly, she refused to allow people into her home and, as a result, didn’t seem to be receiving enough help with her care needs. Her caregiver was concerned about her overall nutrition and noticed she had lost a significant amount of weight.

Resolution
Patient Ombudsman worked with the health sector organization to schedule times when the caregiver and the service providers were in the patient’s home at the same time to ensure they could meet the woman’s care needs together.

Experience
After moving to a retirement home, a resident became concerned about the lack of consistency in home and community service delivery since the relocation.

Resolution
Patient Ombudsman facilitated communication between the resident and the providers of home and community care services in her region. As a result of this discussion, the resident’s service schedule became more consistent and better aligned with the retirement home’s schedule, enabling the resident to participate more fully in activities, including regular meals.

Experience
The complainant is the primary caregiver for her husband, who has very complex care needs. She receives home care and brief periods of in-home respite services coordinated by the Local Health Integration Network (LHIN), but is unable to access out-of-home respite care that would allow her to take a vacation and get a break from her caregiving responsibilities.

If her husband’s care needs could be managed in a long-term care home, the caregiver would be able to access up to 90 days of out-of-home respite care each year in accordance with the Long-Term Care Homes Act, 2007. However, her husband’s care needs are too complex for a long-term care home and most chronic care hospital respite programs, and he requires specialized hospital-based care.  As such, there are no out-of-home respite options available. The complainant felt it was unfair that caregivers with the heaviest burden of care do not have access to services that would provide them with a period of relief.

Resolution
Patient Ombudsman contacted the LHIN to determine what options were available to address the complainant’s respite needs. Over the last ten years, the LHIN (formerly the Community Care Access Centre) has regularly canvassed hospitals that provide complex care to seek out-of-home respite for this patient. One facility provided respite care for a few years, but later discontinued providing a respite option.

The LHIN confirmed to Patient Ombudsman that there were no dedicated respite beds for patients needing the level of care that this patient needed, but agreed to continue to work with  complex care hospitals to pursue the opportunity for a respite admission.

The LHIN also agreed to conduct a scan to identify respite placement options on an annual basis. Patient Ombudsman also raised the issue with the Ministry of Health and Long-Term Care to identify out-of-home respite for complex patients as a gap in the continuum of care.

 

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