Healthcare check-up: Should the province’s ombudsman have oversight of hospitals?

In partnership with, a website focused on health care in Ontario, edited by health-care professionals and members of the health community, the Star delves into health-care issues facing Ontarians.

At noon today chat with Ontario Ombudsman Andre Marin about whether the Ontario ombudsman’s powers should be extended.

This article was published by The Toronto Star on November 1st, 2012.  To see this article and other related articles on The Toronto Star website and vote on the mini poll, please click here

Every year, the office of Ontario’s Ombudsman receives hundreds of complaints from people who claim they’ve been wronged by hospitals. Here are three of the 383 that came in last year:

• One woman complained about a lengthy emergency room delay that she feels may have contributed to her father’s death.

• The daughter of a woman with dementia claimed she was retaliated against by hospital staff after she made a complaint about her mother’s care.

• A female patient accused male hospital staff of throwing her to the ground, handcuffing her, stripping her naked and putting her in a gown. After complaining to the hospital, the woman said she was told her claim could not be verified because cameras in the room were not working.

The ombudsman did not investigate these complaints because his office does not have jurisdiction over the health sector. At issue is whether he should.

Ontario is the only province whose ombudsman does not have the authority to consider complaints against hospitals and long-term care facilities, which has been the subject of heated debate in the province for years.

Those who argue against extending the provincial watchdog’s oversight say the move would be an unnecessary bulking-up of bureaucracy that would eat up taxpayer funds better spent treating patients. Those on the other side of the debate argue patients and their families have the right to have an independent third party investigate unresolved concerns. Repeated attempts to change the rules have failed, with one private member’s bill after another dying on the order paper.

Earlier this year, it seemed like Ontario ombudsman Andre Marin was closer than ever to having his authority expanded. In April, an opinion piece published in the Canadian Medical Association journal argued that having an independent third party investigator is crucial to the success of resolving problems in the health system. And in June Premier Dalton McGuinty suggested he was open to the idea of extending the ombudsman’s jurisdiction.

Then McGuinty resigned, prorogation killed yet another bill and proponents were once again back to square one. When the Legislature resumes, the argument will begin again.

As part of a six-week series delving into important debates about our health system — launched in partnership with — the Star explored opposing viewpoints on this issue.


Pat Campbell is the president and CEO of the Ontario Hospital Association, an organization that represents many of Ontario’s largest hospitals, including Sunnybrook, St. Michael’s and the University Health Network. Campbell argues hospitals in Ontario operate in a demanding environment for transparency — “probably the most demanding in all of Canada.”

“We feel that in Ontario,” she says, “extending the ombudsman authority to hospitals would duplicate already established mechanisms that foster openness and transparency between the hospitals and their communities.”

Campbell ticks off a list of ways in which hospitals are subject to external independent scrutiny: They publicly report on patient safety measures, quality indicators and wait times; they meet accreditation standards and sign service and accountability agreements; they are subject to freedom of information requests and reviews by the Auditor General.

Critics argue these measures do not add up to an independent third-party investigator and none are means through which individuals who feel they’ve been wronged can seek answers.

“In this constrained funding environment,” Campbell says, “we are very concerned that anything where we are adding cost to the system also generates improvements for patients.”


Dr. Robert Bell is the president and CEO of University Health Network, which includes Toronto General, Toronto Western and Princess Margaret hospitals. He is also chair of the network’s quality council, which means he oversees all complaints that come into UHN’s patient relations office.

All hospitals in Ontario are required to have an internal office or process for addressing patient concerns. Though the job is often given the title of ombudsperson, critics question the legitimacy of a patient advocate who works for the hospital he or she is charged with hearing complaints about.

UHN’s internal ombudsperson reports directly to Bell, which he says has convinced him that the ombudsman role “absolutely” needs to stay within the hospital. He says an external ombudsperson would not have the same impact in resolving issues and improving quality of care.

If the provincial ombudsman were to work with the local hospital patient relations office — rather than replace that role — Bell might be more open to the idea. But he’d still be worried about the duality of roles and costs. “Undoubtedly some patients will be dissatisfied with the answer we provide. The probability is those patients will also be dissatisfied with the answer provided by the provincial ombudsman.”


New Democrat health critic France Gélinas, MPP for Nickel Belt, has introduced two separate private member’s bills calling for the expansion of ombudsman oversight into the health sector. The first died when the Legislature was prorogued in March 2010; the second died two weeks ago. Gélinas plans to table a new bill as soon as the house resumes.

The value of ombudsman oversight, as she sees it, would be twofold. “Not only can he help individuals with their complaints, he can also look at systemic issues. There is no mechanism in Ontario right now to look at systemic issues that are coming up through the complaint system.”


David Baker is a Toronto lawyer who practices health law. Most of the people with legal claims who land at his office have already tried to resolve their issues through hospital patient relations departments and are not happy with the outcome. Baker argues that so-called patient advocates are “apologists for the system that people are grieved with.” He says they don’t fundamentally address problems or adequately deal with patient concerns.

“There aren’t really any mechanisms for addressing hospital issues short of lawsuits, and people risk their homes and their livelihoods if they initiate a legal action against the hospital,” he says.


Andre Marin became Ontario’s sixth ombudsman in 2005. He has been fighting for his powers of oversight to be extended into the health sector since he took office. The ombudsman “would act as an avenue of last resort,” he says, intervening only if “things fall off-track.”

“I’ve never said anywhere that’d we’d be getting rid of hospital ombudsman,” says Marin. “I think they’d be important partners in resolving the issues.”

Marin admits he would need to hire more staff — he envisions a specialized team of about 50 people — but argues the cost would be “piddly” in the grand scheme of things.

This is the first in a six-week series looking at important health-care debates. Visit Friday at noon to chat with Andre Marin about whether his powers should be extended.

Mary Ferguson-Paré, an editor at who recently retired from an executive role at University Health Network, will also be participating.

© The Toronto Star