20 September 2015

Human Rights Tribunals: privacy and transparency

Added Nov 15, 2015: An Interim Decision was made on October 8, 2015.  See more in the note below, at the end.

The purpose of this is to explain part of the process of the Human Rights Tribunal, using one aspect of my own experience and how that relates to privacy laws in health care, and accountability of physicians and other health care workers, and the accountability and transparency of those organizations meant to resolve problems that occur. The example I am using is of my own Application to the Human Rights Tribunal, April 14, 2015, of discrimination on the grounds of my sex, family and marital status, and age (for more details, see Health care among single, older women – a case of discrimination for OHRT).

On Aug 26, 2015, I made a Disclosure to the lawyer of the Respondent. The Disclosure was required according to the Rules of Procedure, providing him with copies of the documents I would be relying on at the hearing, as “arguably relevant” documents.

I received nothing from the other side by the deadline (September 1, 2015) given by the HRT, in the Rules as being three weeks after they notified us (on August 11) of the dates of the hearing (February 10 & 11, 2016). September 1st  was the date by which both sides were to have sent to the other a list and copies of documents they thought may be relevant to the issues raised in the case.

Backing up for a moment, I must say here that only one item had been listed in the Important Documents section of the Respondent’s Response to my Application (received July 27, 2015).  That one item was my Medical Chart, for all the time I was with the doctor in question, from September 2012 until spring of 2014. I submitted my Form 3 reply to the new points raised in the Response on Aug 12 (having had an extension, due to the original due date, August 7, being less than 2 weeks away from when I received the Response) though not responding to the idea of having his entire Medical Chart about me being available for him to pick and choose from at the hearing, or for it to possibly influence the adjudicator. Since no items – appointment dates, specialist reports, etc – were listed, I had no idea whether what was included was a complete set, or whether what would be sent to me, finally, was complete. And at the same time, more or less, received the notice from the HRT about the dates of the hearing, requiring me to then send a Disclosure to the Respondent by Sept 1, which I did, as noted in the previous paragraph.

But now, having not received a Disclosure of arguably relevant documents from the Respondent by September 1, and not agreeing anyway with the idea of my privacy into my medical records being made available in that manner, I discovered that I could complete a request for an Order on a Form 10 and submit it to the HRT, using the Production of Documents part to request a copy of the document - my Medical Chart. To me, the chart wasn’t “arguably relevant,” at least not in its entirety, but I decided to submit Form 10 anyway, requesting that the Dr itemize the Medical Chart and send only those items he was planning on using at the hearing in February. Also, I requested under ‘Other’ that for privacy reasons, the entire chart not be produced at the hearing, thus, not sent to the HRT’s adjudicator (see excerpt from PHIPA, Personal Health Information Protection Act, 2004). Formally, these were the requests I made in writing, and sent to the lawyer for the Respondent and to the HRT:

Request for an Order for the Production of Documents
I am requesting, first, with conditions, that the Respondent, the Dr, produce relevant sections of the document he named in his Response (July, 2015).  I also request that he particularize those sections of the Medical Chart that he plans to use at the hearing.  

Other Request: that the Medical Chart of Ms McPherson not be used in its entirety
I am requesting that the Respondent not rely on the Medical Chart of Ms McPherson in its entirety, for this Application at the hearing, as that would be an invasion of privacy under the law, such as under PHIPA, the Personal Health Information Protection Act, 2004. I request that he selects only those items he plans to use, explains why each is important, and provides a copy of them for the Applicant. (Question 3, Form 10, September 9, 2015)

I wrote out a detailed explanation of my reasons for making these requests in Form 10, Question 4, and sent a copy of the Form 10 to both the Respondent’s lawyer and to the Human Rights Tribunal Registrar/caseworker.

About two weeks later (September 17th) I received a copy of the Medical Chart from the lawyer, obviously not itemized as there was no list, and no explanation of why the Respondent thought each entry in it was important, or arguably relevant, or whether it was complete at all, and of course, reaching me well after the due date for a Disclosure.

This wasn’t what I had hoped for. After all that explaining, the lawyer had simply sent off what appeared to be an unsorted file of my medical records, not particularized, and with no acknowledgement in the cover letter that I had sent to her a completed Form 10 with pages of info and explanations. There was a brief email discussion between the lawyer and myself, which also went to the caseworker.  But in the end, the caseworker said that the Form 10 Orders would go to a ‘decision maker’ to resolve.  Already, I can picture another person getting involved in this situation who knows nothing about the Application, and would have to start from scratch reading up on it, and being pressured to make a fair decision on whether my Medical Chart should be allowed to be taken into consideration and whether it needs to be particularized.  What’s more, the lawyer now has the opportunity to respond to my Form 10 request before the decision maker considers it, and the decision maker gets to see what she says about it, including the fact that she has sent me a copy of the Medical Chart already, by that point.

One might ask, at this point, why did the lawyer quickly send me a copy of the Medical Chart, when it was overdue by practically two weeks, and when it was not what I asked for?

I feel that her sending the ‘document’ to me – the Medical Chart – altered the dynamics of the situation, whereby a ‘decision maker’ might just as easily say, Well, it’s been sent to the Applicant now, so leave it at that. And the Applicant did make out a Form 10 request for Production of Documents . . . . .

The Rules of Procedure say the Respondent must send their ‘arguably relevant’ documents by a certain date, but don’t say what happens if they are not sent by that date, except that I can request them if I choose to, through submitting a Form 10, in this case for Production of Documents.

I don’t want this to end up being a matter later interpreted by the Respondent as me being the one to request the Medical Chart. Details are so easy to skim over, and if the fact is that I submitted a Form 10 for the Production of Documents, which I did, the assumption could well be that I considered them ‘arguably relevant’.

This Application to the Human Rights Tribunal is supposed to be about the actions and behaviour of the Respondent, not about me having to defend myself against false accusations and distortions of the truth made by the Respondent and his colleagues in documents in my Medical Chart. My response to Question 4 of the Form 10 goes into more detail about the idea of truth, and who gets to be believed in this world and who doesn’t. It also brings in the matter of the longer transcript of the April 28, 2014 office appointment, and the accusations made against me by the Respondent in his Response to my Application, that I shouted at his staff after the appointment ended.

I have presented in my Application only 2 examples of discrimination, both of which I believe I have the evidence to uphold. I could write at length, too, about the behaviours of the Respondent, but I have no proof of much of it. But when the Dr says something, and writes it down, it seeme from what I have seen elsewhere that it is taken as truth.

I might not have known about Form 10 and the right to request a production of documents and the right to request privacy of medical information, had not the Respondent failed to make a Disclosure of the ‘document’ named in the Response – the Medical Chart.  I have no access to a lawyer who can foresee such issues arising and be able to advise me. Of course, the other side of that is that no mention of the reason for the importance of the Medical Chart was mentioned in the Response, and its relevance might have been difficult to explain. I have never said the doctor did not provide some good health care towards me. If he hadn’t done something worthwhile, it wouldn’t have taken me so long to acknowledge the unprofessionalism and poor judgement in his treatment of me, and he would have been seen, at least by me, as not worthy of being a physician. Rarely is someone totally one or the other – all bad or all good.

A physician is someone who is subject to certain standards in his profession. Too many errors of judgement, incidents of rudeness, trivializing the patient’s concerns, and judging me on the basis of my sex, and family and marital status, and age is what can lead to the realization that he is discriminating against me. Saying, “The report is back. You’re fine,” isn’t serious on its own, but amongst so many other incidents, it becomes relevant, an indication that he doesn’t care, and isn’t doing his job.  When I go to him about ankle pain, or a swollen knee, and the first question he asks is How does that affect your driving,” one has to wonder. And when medications I have been taking for a number of years are questioned, and changed, for no good reason or without informing me when I go to him to have prescriptions renewed, it made me wonder. And why was I treated like a walk-in patient, having to have my prescriptions renewed by hand, with the risk of mistakes being made, and being denied having access to Tylenol 2 with codeine, 2 per day, as though that was a large amount and I might abuse the privilege of having relief from pain. Read in my blog, Health care among single, older women – a case of discrimination for OHRT, for details about that and the unnecessary pelvic renal ultrasound he sent me for. He wasn’t behaving like a family doctor should.

The HRT caseworker had assured me a while back that if the due date were approaching and I hadn’t sent a required document, that he would request it. That was in response to my requesting confirmation when he received documents I sent to him. But he didn’t request from the Respondent the ‘important document’ named by the Respondent in his Response, which surely must have been intended to be sent as an ‘arguably relevant’ document to me as a Disclosure. The caseworker accepted my Form 23, declaring I had sent my own Disclosure to the Respondent, but it didn't jog his memory to ask the Respondent for his list of arguably relevant documents in a Disclosure. And my sending my Disclosure to the Respondent didn’t lead him – or her, the lawyer – to send their own Disclosure to me.

For me to do the requesting of my Medical Chart, through a Form 10, resulting in a conglomeration of largely unexplained and unidentified items quickly being sent to me (although more than two weeks overdue, not the ‘documents’ I asked for, and not mentioning they were in response to my Form 10), would have made it appear that it was me who believed they were ‘arguably relevant,’ unless the decision maker took more time to read what I wrote than the lawyer did. It is possible the lawyer was attempting to cover up a mistake, and was hoping the ‘decision maker’ would overlook it and accept her sending of the documents, though past the deadline, without examining closely what I wrote in Question 4 of Form 10.  But the lawyer wouldn’t have realized her error of omission had I not pointed it out when I sent her the Form 10. And then what?

It’s too easy for the Human Rights Tribunal to take short cuts, to not be transparent in its process, and to simply make important decisions without the Applicant knowing what’s going on, for instance, who the decision maker is in terms of position if not by name, and his expertise, especially in the area of privacy in health care. This situation has now been left in the hands of the Respondent’s lawyer, who gets to write a response to my Form 10, and the decision maker for the HRT, who makes a judgement on the Form 10 I submitted. He could have her send a list of itemized documents from the Medical Chart, and agree with me that the privacy of my medical records is important, or he could just say, Well she has sent it now, so that’s good enough. And then she will send a copy to the HRT in December, the relevance of which the Respondent will not be obliged to explain, even if it gives a false impression of me, while falsely presenting him in a better light.

Note: Added Nov 15, 2015: 


An Interim Decision was made on October 8, 2015, granting the Respondent and lawyer their requests, regarding their Disclosure – my medical chart.  It was declared by Laurie Letheren, an adjudicator with the HRT, that my requests were premature. The material was delivered to me, although not organized properly, some of it not relevant and none of it argued to be relevant, and not itemized, no reason stated for its importance other than it demonstrated the care I received from the doctor, and it was sent a little late. But at least I got them, I think she was saying. 

If the Respondent decides to particularize the documents, s/he may do so when required to send the documents to the Tribunal (deadline December 29th) in preparation for the hearing early in February. But again, s/he may not. There has been no warning given by the adjudicator to the lawyer to itemize the documents. It’s just a collection of undecipherable documents, much of it, with no explanation of why each page of the seemingly random collection is relevant. At least, that much should have been done. Then, by the end of December, s/he would be able to decide, presumably, which documents she is going to use at the hearing. 

Also added to List of Resources, on Nov 15, ‘Health-care system in need of more transparency, report says’ (The Star, Nov 12, 2015).

Resources


Health care among single, older women – a case of discrimination for OHRT
April 12, 2015
http://suemcpherson.blogspot.ca/2015/04/health-care-among-single-older-women.html

Health-care system in need of more transparency, report says [added Nov 15, 2015]
C.D. Howe Institute says there should be more public reporting on patient experience within Canada’s health-care system.
By Theresa Boyle, Health
The Star
Nov 12, 2015
http://www.thestar.com/life/health_wellness/2015/11/12/more-transparency-needed-in-health-system-report.html

New health legislation will improve transparency
By Olivia Carville, Staff Reporter
The Star
Sept 19 2015
http://www.thestar.com/life/health_wellness/2015/09/19/new-health-legislation-will-improve-transparency.html

Personal Health Information Protection Act (PHIPA), 2004, S.O. 2004, c. 3
Government of Ontario
http://www.ontario.ca/laws/statute/04p03#BK1
retr Sept 17, 2015
see excerpt here: http://suemcpherson.blogspot.ca/p/personal-health-information-protection.html






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