Early Resolution Summaries

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.

Experience
A complainant found their way to Patient Ombudsman after receiving a significant bill from a recent stay in hospital. The police escorted the complainant to the hospital following a sexual assault. As part of the sexual assault, the complainant shared with us they were given substances forcibly and without consent.

The complainant is currently not eligible for OHIP coverage, but had private health insurance coverage.
The complainant’s private insurance provider denied the claim as there was drugs found in the complainant’s blood work despite the explanation the drugs were forcibly and non-consensually given.

The complainant identified as transgendered and recently lost their job due to alleged discrimination and was only receiving government assistance as income. The hospital was seeking several thousand dollars for uninsured care and overnight accommodation.

The payment plan developed by the hospital required payments amounting to nearly half the complainant’s monthly income.

Resolution
Given the circumstances that led to this complainants’ hospitalization, the complainant’s vulnerable status and lack of financial resources, Patient Ombudsman met with the hospital to discuss the fairness of the payment plan. The hospital agreed to waive the fees on compassionate ground and to reimburse the complainant for payments already made.

To help to ensure fair billing for uninsured patients in the future, the hospital revised their billing policy to take a patients’ individual circumstances into consideration.

The hospital also committed to creating a new ‘Patient Concierge’ role to help uninsured patients navigate their options while in hospital.

Experience
A complainant came to Patient Ombudsman after a negative experience at a hospital. 

The patient had spent the entire holiday season as an in-patient and complained about poor care due to a limited skeleton staff during the Christmas and New Year period. After the patient was discharged from the hospital, he received a bill for services that he feels he shouldn’t have to pay for.

Resolution
Patient Ombudsman contacted the hospital and was able to confirm that the bill was not for care, but was related to semi-private accommodation charges that exceeded the amount covered by the patient’s private insurance.

Patient Ombudsman confirmed that the patient had requested semi-private accommodation but discovered that he was charged for two days prior to the date that he signed the agreement to pay.

When Patient Ombudsman shared this with the hospital, they agreed to adjust the bill to cover only the days after the agreement was signed.

Patient Ombudsman explained the bill to patient and confirmed that he was responsible for paying the adjusted amount.

The complainant agreed and appreciated that Patient Ombudsman staff took the time to listen to his concerns.

Experience
Patient Ombudsman received a complaint from a patient following care in their local hospital’s intensive care unit. The patient, who is on a fixed income, awoke to find their winter coat, boots and other clothing items gone.

The patient complained that in their vulnerable state they should not be responsible for lost items.

The hospital informed the patient that it is the patient’s own responsibility to safeguard personal property, including clothing.

Resolution
After Patient Ombudsman’s review of the complaint file, we found the hospital did not follow their own policy and procedure around the placement and tracking of personal belongings.

Patient Ombudsman found that a hospital staff member bagged the clothes in the wrong bag intended for laundry services.

Patient Ombudsman suggested it would be fair that, when a patient does not have capacity, the hospital has a responsibility to safeguard a patient’s personal property.

The hospital accepted responsibility, apologized for the error and is reimbursing the patient over $800.

Experience
Patient Ombudsman received a call from a concerned parent who was very distressed following a recent experience with his community hospital. Her teenage son was recently in the hospital emergency department. The complainant feels that hospital staff was disrespectful of his entire family throughout the situation.

Resolution
Patient Ombudsman did not have consent from the son discuss his care, but shared the complaint with the hospital based on the family’s experience.
After on-going communication with both the complainant and the hospital staff, Patient Ombudsman discovered a long history and a fractured relationship between this family and the hospital.

To repair the relationship between both parties, Patient Ombudsman facilitated a voluntary three-hour mediation so the family and the hospital could each share their perspectives and have their experiences heard.

Experience
A mother came to Patient Ombudsman shortly after her son died from suicide. Her son made a previous suicide attempt and attended the emergency department at a small rural hospital several days before he died.

The mother believes that the hospital discharged her son without a proper assessment and intervention.

The mother was seeking an improved suicide prevention protocol at the hospital to prevent similar tragedies from happening again.

Resolution
The hospital was very receptive and shared that, because of its small size it relied on an outreach team from another hospital to address mental health crises outside of regular business hours. The crisis protocols and assessment tools used by the two hospitals were not the same.

The hospital agreed that there is a need to streamline and align processes with the day staff and the overnight care team. Even though they are two different organizations’, they are still working with the same patients in the community and often, as in this case, in the same building.

It was agreed that significant training with both organizations will occur over the next year.

Additionally, the complainant was asked to participate on two committees to provide crucial caregiver feedback.

One committee is direct quality improvement and the other committee an advocacy group for those living with a mental illness.

Patient Ombudsman provided the complainant support and referral to the College of Physicians and Surgeons concerning elements of her complaint around the attending physician’s clinical skills.

Experience
A patient made a complaint to Patient Ombudsman that each time she accesses services at her local mental health emergency department, she is triggered and has a significant post-traumatic stress disorder (PTSD) episode.

The patient had negative past experiences at the hospital that included voluntary and involuntary stays in the psychiatric unit and she believes this is the root cause of her PTSD.

Resolution
The hospital validated the patient’s past negative experiences and apologized for them. The complainant was not pleased with what they viewed to be a ‘meaningless’ apology.
 
Patient Ombudsman worked with both the hospital and the patient on a personalized protocol that would allow the patient to access services at the hospital with her dog.

The dog is a therapy animal in training and helps her manage her PTSD and anxiety when navigating the physical structure of the hospital.

Experience
A concerned daughter complained on behalf of her mother who was an alternative level of care (ALC) patient at a reactivation centre waiting for a bed in a long-term care home. 

The daughter was concerned because she was restricted with the amount of time she could take her mother off-site to spend time with family and attend other appointments – she felt it was restrictive and did not consider her mother’s health and overall well-being.

The daughter had been informed that she could only take you mother off-site two times a month for a maximum of four hours. In her mother’s case, one of these passes was often applied to dental or other appointments.

After multiple attempts to get an explanation for the restrictions, she was informed there was no formal policy.

Resolution
Patient Ombudsman confirmed that the hospital had no formal policy for patient leaves from the hospital and no clinical rationale offered to the family.

Patient Ombudsman suggested in order to be fair to patients and families, a clear policy concerning off-site visits be developed and shared with patient and families.

Patient Ombudsman also suggested that a clinical ethicist be included as part of the policy development.

The hospital agreed to follow Patient Ombudsman’s suggestions and developed a policy in consultation with their ethicist.

The policy outlines the clinical considerations used in assessing requests for leaves and increased the amount of time for informal off-site visits.

The hospital clarified that absences for appointments would not be factored into time limits.