Thirteen per cent of health clinics in Ontario that do procedures such as cosmetic surgery, colonoscopies and pain injections have not met inspection standards since they began in 2011, an analysis by the Star has found.
This includes the 3.6 per cent of clinics that have failed inspections because of public safety concerns.
Critics say the numbers are too high and raise serious questions about the quality of care at these clinics.
“A rate of one in seven clinics failing or passing with conditions is just deplorable. That is a failing grade no matter how you look at it,” charged medical negligence lawyer Amani Oakley.
“I seriously question whether the inability to do Job 1 — that is, protect the public — can be rectified by something less than a complete overhaul of the system we have,” she said.
Of the 330 clinics the College of Physicians and Surgeons of Ontario has inspected since 2011, 44 have fallen short of meeting standards.
Twelve failed inspections and 33 were given conditional passes — some of them, two or even three times. (One clinic received both a fail and a conditional pass. An additional 22 clinics — not counted in the 13 per cent — were given conditional passes because they were either new or offering new procedures, not because they had not met standards.)
“The percentage of clinics that did not pass inspection without conditions should be setting off alarm bells. Imagine an airline industry where one in 10 planes does not pass scrutiny. The frequency and intensity of inspections needs to be immediately stepped up,” said medical negligence lawyer Paul Harte.
CPSO spokesperson Kathryn Clarke said the public should take comfort in the fact the college is providing oversight of the clinics, something not done until recently.
Prior to 2010, no organization had the authority to regulate the clinics, known as out-of-hospital premises, she said, adding the college had “advanced the idea” of doing the job to protect the public.
“This means a significant improvement in public safety has occurred since the establishment of the program because a number of premises that were not meeting the standards are no longer providing (invasive procedures requiring anesthesia) to patients,” she said.
Queen’s Park gave regulatory oversight of the clinics to the college following a Star investigation into the regulatory black hole surrounding Ontario’s cosmetic industry.
Its move came a year after the 2007 death of Krista Stryland, a young mother who underwent liposuction at a Toronto cosmetic clinic.
A total of 440 inspections have been carried out on out-of-hospital clinics to date, the Star’s analysis has found. Three have had the results of inspections pending for more than a year.
Harte said Toronto restaurants fare better in inspections than health-care facilities do. A 2012 analysis by the now-defunct Grid newspaper showed 8.6 per cent of inspections carried out by Toronto Public Health resulted in either conditional passes or closure notices, and only 0.14 per cent resulted in a closure notices outright.
Another source of comparison to out-of-hospital premises is hospitals. Since 2011, none of Ontario’s 150 hospitals has failed an accreditation review with Accreditation Canada, an organization that measures quality standards.
Harte said the clinic inspection results are of great concern, especially because the province is moving services out of hospitals and into clinics. In 2010, there were 209 clinics in Ontario. Today, 264 are operating and a further 10 are in the process of being set up. That’s a 31 per cent increase, and the provincial government wants the sector to expand even more.
Clinics do not have the same degree of checks and balances as hospitals, and critics say this needs to change.
Harte called on Health Minister Eric Hoskins to establish quality targets for the clinics, as well as a timeline for meeting them.
Earlier this month, Hoskins announced measures to improve transparency in the health system and to improve oversight of these clinics. He asked Health Quality Ontario to lead an evaluation of current oversight programs in such clinics and to make recommendations on improvements.
Hoskins’ announcement followed a Star investigation into infection outbreaks at clinics.
Since the Star reported in 2012 that nine clinics had failed inspections, three more have failed theirs. They include two hair-transplant clinics in Toronto and a pain clinic in Burlington.
Reasons for the recent failures include not having medical directors, not properly cleaning equipment and not being set up to provide IV resuscitation drugs in an emergency.
When clinics fail inspections, doctors working there are prohibited from performing invasive procedures requiring anesthesia.
Progressive Conservative MPP (Leeds-Grenville) Steve Clark said he was “shocked” that so many clinics did not receive full passes.
“I have a real feeling that there needs to be some systemic changes at the CPSO,” said Clark, who recently tabled a private member’s bill, calling for more transparency from the organization.
The Star undertook the clinic analysis after the CPSO twice refused in recent weeks to reveal how many clinics had failed inspections, how many had passed and how many had passed with conditions.
Clarke said the CPSO did not gather information that way and directed the Star to the organization’s online register, which requires users to look up each clinic individually. She warned that there were chances of making errors when doing manual counts.
When the Star asked a third time for a breakdown of inspection results, Clarke provided the current status of clinics. There are 223 clinics registered with full passes, 16 with conditional passes, 25 awaiting inspection results and 66 that have withdrawn from the program, meaning they are no longer offering invasive procedures requiring anesthesia. Those that have withdrawn include clinics that failed their inspections.
Harte agrees with critics such as Oakley who are calling for an overhaul to the inspection system. He said the province should set up a separate body to inspect clinics, one with more teeth and subject to freedom-of-information searches to ensure transparency.
“Public confidence in the CPSO as an effective regulator of these clinics is sorely lacking. The problems relating to clinic inspections ultimately stem from the CPSO’s failure to regulate these clinics adequately,” he said.