Watchdogs going public on medical mistakes
Health regulatory colleges more proactive in revealing when practitioners receive cautions
Ontario’s health-care watchdogs are lifting the veil of secrecy surrounding cautions given to dentists, nurses, pharmacists and others for mistakes or improper behaviour. Doctors’ cautions became public last year.
Until recently, cautions — such as those issued for drug-dispensing errors or delays in sending patients for crucial followup appointments — were kept secret from the public, including future patients critics say deserved to know the track record of each health professional.
The decision was prompted by a 2013 Toronto Star investigation.
Since the Star stories, Ontario’s health regulatory colleges have been developing measures that would tell the public when their members receive cautions. There are now 26 colleges that regulate the province’s more than 300,000 healthcare professionals.
Most colleges have decided to post cautions publicly on their websites, while three are considering proposals to do so. The College of Physicians and Surgeons of Ontario began making cautions public last year, as reported by the Star.
“Colleges are making more information readily available because the public has the desire and the right to have immediate access to the information it needs about their health-care provider,” said Shenda Tanchak, president of the Federation of Health Regulatory Colleges of Ontario, noting that transparency goes beyond cautions.
“Colleges have increased transparency in their processes, decision-making and information disclosure and will continue to do so. This increase in transparency includes many things, such as improvements to websites, with language that is easy for the public to understand, and having more user-friendly public registers for regulated health-care professionals.”
The Star’s 2013 investigation revealed the regulatory colleges had issued more than 2,000 secret cautions to health-care providers during the previous five years. The Star found many of the secret cautions dealt with very serious issues, such as a failure to review a patient’s medical history before prescribing a drug, violations of patients’ physical boundaries and inappropriate communication with patients.
In one case, the Star found, the College of Chiropractors of Ontario cautioned member David Covey and told him to “refrain from engaging in fear mongering which is designed to induce fear and apprehension.” This was after Covey told a female patient in 2009 that a “reversed curve” in her spine “decreases your lifespan by at least10 years” and that doing nothing would result in a “lower quality of life and a shorter life.”
Under the college’s old rules, this caution was shielded from other patients and the public. Covey told the Star in 2013 he believed it was his professional obligation to do “everything in my power” to ensure the patient was aware of his diagnosis so that treatment could occur.
Colleges had previously argued that the Regulated Health Professions Act, the legislation that governs Ontario’s health-profession regulators, would have to be amended to allow cautions to be made public.
Following publication of the Star’s investigation, however, the provincial health ministry, under thenhealth minister Deb Matthews, said colleges could indeed publish cautions by passing new bylaws and without a change to the legislation.
Then, in 2014, after a series of stories by the Star about infection outbreaks at some Toronto colonoscopy and pain clinics, Health Minister Eric Hoskins, just a few months on the job, sent a letter to all colleges asking them to “share more information and make our system more transparent when it comes to regulating our health professions.”
Hoskins gave the colleges eight weeks to respond about how they intended to do this.
Advisory or remedial in nature, cautions are usually prompted by public complaints and are handed down in cases where a college determines there is a serious issue but not a high risk of harm to the public.
Cautions, while kept permanently on a health-care worker’s record, are not findings of professional misconduct. They can be oral or written, or both, depending on the college. Most colleges have decided to keep cautions on their members’ public profiles for between one and three years.
Others opted for longer time frames or having no time limit at all. “Council rejected this option, primarily because it wasn’t seen to be consistent with the general move towards transparency,” said spokesperson Kathryn Clarke of the College of Physicians and Surgeons.