The College of Physicians and Surgeons of Ontario provides limited information on its website about the clinics it inspects, making it difficult to assess the severity of reported problems, critics say.
There is no indication of whether patients have been harmed, and deficiencies aren’t always listed for clinics that have not fully passed inspections.
As well, Inspection-Assessment Summaries prepared for each clinic are not made public. Reasons are sometimes given if clinics fail inspections but are usually not provided if clinics pass with conditions.
Recent Toronto Star investigations have shown the CPSO’s online inspection reports don’t come close to revealing the seriousness of problems at some clinics.
For example, online results for the Rothbart Centre for Pain Care do not reveal that at least nine patients developed serious infections, including meningitis. And they don’t reveal that the clinic had 170 infection-control deficiencies.
The register doesn’t reveal that 11 patients of three colonoscopy clinics acquired hepatitis C, possibly through tainted injections. The clinics in question are the Downsview Endoscopy Clinic, Ontario Endoscopy Clinic (Finch Ave. W. site) and the North Scarborough Endoscopy Clinic.
Despite the serious problems uncovered by the Star, the clinics never actually failed inspections. They passed inspections, passed with conditions, or are still awaiting inspection results.
That means anyone researching these clinics on the CPSO online register would be left with the impression that patient safety was never at risk.
Terrence Sullivan, a health policy professor at the University of Toronto, said there must be more robust public reporting and disclosure on clinics.
Public reporting and disclosure of safety and quality measures in hospitals has driven improvements in hospitals and the same could happen for clinics, he wrote in a recent opinion piece in the online health policy magazine, HealthyDebate.ca.
“It is unclear why the CPSO has so little detailed information on investigations on its public website but happily this may be about to change with Minister Hoskins’ intervention,” wrote Sullivan, who formerly served as chair of Public Health Ontario and president of Cancer Care Ontario.
“In community clinics, we need a standard to post publicly simple indicators for quality, such as infection control and adverse events on each clinic website ... The standard of practice in such clinics should be public reporting on their own or through the college. In association with regular inspection, public reporting is key to keeping everyone honest and on their toes for safety and quality,” he wrote.
CPSO spokesperson Kathryn Clarke said that unless a clinic fails an inspection, there is no public safety concern.
“Where a premise has passed with conditions, it means that a standard has not been met but no public safety concerns have been identified during the inspection. If such concerns are identified, the premise fails the inspection,” she said.
But critics say patients need more information about the track records of clinics so they can judge for themselves whether they are comfortable going there.
It’s difficult to assess the seriousness of problems that caused the clinics not to get a full pass, medical negligence lawyer Paul Harte argues.
Were conditions imposed because patients were harmed, as in the case of the pain and endoscopy clinics? Or are conditions the result of shortcomings identified during the course of an inspection? Do the conditions reflect serious shortcomings or minor ones such as not having paperwork in order?
Clarke said the college’s own bylaws prohibit it from posting any more information that it already does. She said it is evident from the conditions imposed on clinics what the concerns are about.
Until last year, the CPSO didn’t even name clinics that failed inspections. This changed after numerous articles in the Star about the issue.
Health Minister Eric Hoskins recently announced that he wants more transparency from regulatory colleges such as the CPSO.
Among 34 clinics that received conditional passes, some were ordered to stop or refrain from doing certain types of procedures, including surgeries. Some were ordered to beef up infection controls.
Others were required to provide proof of the following:
• That sterilization equipment was working properly and that staff had been trained to use it.
• That a defibrillator had been purchased and a vital-signs monitor repaired.
• That resuscitation and anesthesia drugs had been purchased.
• That nurses were registered with the College of Nurses of Ontario and that staff had certificates of basic and advanced life-saving qualifications.
Other examples of conditions include requirements to post fire-evacuation maps and to update policy-and-procedure manuals.
Some clinics were ordered to meet numerous conditions; others were required to meet only one.
Eleven clinics were twice given conditional passes and two were given them three times.
NDP Health Critic France Gelinas said the CPSO should prepare annual reports on inspection results, with sufficient detail on why clinics fail inspections or pass them with conditions.
“A more friendly approach would be a yearly analysis with a view to protect the public,” she said.