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

CPSO: transparency in the complaint process

Update, Sept 22, 2015   

As of Sept 22, 2015, still no response from the CPSO.  For further details see end of this entry for Sept 13, 2015.



In June, 2014, I submitted a complaint with the College of Physicians and Surgeons (CPSO) against my family doctor, who had acted unprofessionally, disrespectfully, and administratively insensitively towards me. At this point, September, 2015, I am waiting for the Inquiries, Complaints and Reports Committee to determine whether they think I have a case worth taking any further. Their decision will be based, in part, on what they receive from the Investigator assigned to my case. In the following look at correspondence and methods of seeking the truth of the matter, I will use the situation of the ENT specialist and my ongoing ear problems as an example of the lack of transparency in the process of the CPSO complaints system, and their inadequate methods of seeking answers. The ear/ENT problem is only one of many behaviours and decisions I was concerned about, but here I will focus only on this one.

Letters, Reports, etc

Two weeks ago, on August 31, 2015, I wrote the following brief letter to the CPSO Investigator assigned to deal with matters to do with the complaint I had brought against my family doctor over a year earlier, in June, 2014. There was nothing left to say, I assumed, and this would be going to a committee who would determine whether my complaint was worth looking into further. My concern now is whether the Investigator herself was biased in her approach to the summary, documents and other evidence she was preparing for the Inquiry Committee for the College of Physicians and Surgeons.

Dear [CPSO Investigator],

Thank you for your letter of Aug 21, 2015 informing me that the committee has met and that I can expect to receive their decision in approximately 4 months. 

I am wondering if I could have a copy of the statement they received about the case from you, and a list of any documents they took into account, also sent to them by you. There is very little transparency in this process, and I need to have more information about what the committee gets to see as I read their decision. 

Sincerely,

Sue McPherson (Aug 31, 2015)

I regret now that I did not ask her specifically, had she received my July 14 response to her previous letter of June 26, 2015. That was my last chance to tell my side of the story and to respond to claims made by my family doctor. She neglected to acknowledge receiving that letter. I will reproduce part of that letter here, just the part that applies to this matter of the ENT specialist and my family doctor/gp’s handling of that situation of my ear problems.

I have not yet received a response to my letter of August 31, 2015.

Backing up in time, to February, 2015, I noted that I had asked the same question, about what the committee got to see and base their decision on. I wrote,

“How much information am I able to have on this procedure, for instance, the report you provide for the Committee or just their final report?” (McPherson, Feb 9, 2015).

The Investigator had responded, less than two weeks later,

“As the investigator in this case, it is not my role to accept, deny, or "uphold" a physician's response, or take one person's word over another. It is my role to gather relevant information, but not to provide my opinion on the information gathered. Nor is it my role to elaborate on, or explain [the doctor's ] response. Consideration of the physician's response rests with the Inquiries Complaints and Reports Committee (ICRC), and I do not participate in their discussion or decision-making. Please note that the ICRC is a screening committee; not an adjudicative body that assesses credibility or makes findings of fact” (Investigator, CPSO, Feb 18, 2015).

Skipping a couple of months of letters back and forth, the Investigator wrote on April 13, 2015, documenting in a list the reports, letters and responses she felt were important for the committee to see, saying,

“I am now in the process of preparing the information received for review by the Inquiries Complaints and Reports Committee (ICRC); it will be a review of the documentation gathered and audiotapes, and neither the physician nor the complainant attend” (Investigator, CPSO, Apr 13, 2015).

Despite having claimed earlier that she was objective in her role as Investigator, she wrote, regarding the particular report from the ENT specialist,

“For your interest,  I have learned during the course of this investigation that although you saw [the ENT specialist] in August, 2013; it appears that his report was not sent to [your family doctor] until Mar 5, 2013 (Investigator, CPSO, Apr 15, 2015).

I was dismayed at this. She wasn’t saying that the ENT specialist “claimed” or “explained” that the report did not go out in good time, but says instead in her letter that “it appears that” it was not sent until 7 months after the appointment, implying that was what the situation was.  One of the issues I had, that I referred to before, was that I was never permitted to see the report sent by that specialist, when I asked my gp what the report had said, though he did say he had it there, just not for my eyes to view.

I wrote a response on April 26, 2105 (see excerpt here) to the investigator, but have no idea if that letter got included in the documents sent to the Committee (ICRC), as the list of documents she sent to me was in the letter dated April 13.

Over time, I have expressed many thoughts on the bad treatment I received at the hands of my family doctor, and in this letter, I tried to make clearer what happened in that entire incident of the “ear” problem with the ENT specialist. While the investigator relies on documents and so-called facts, my approach, however, is to look at the circumstances of the incident itself - circumstantial evidence, I believe would bewhat it is called.

The Investigator wrote again on April 30, 2015,

“[The ENT specialist’s] report documented the date Aug 20, 2013, as the date of the appointment. [His] report does not document the date that he wrote the report, however there was only one report written which was faxed to [the family Dr] on March 5, 2014. There is no evidence that [the family Dr] had a report prior to that date” (Investigator, CPSO, April 30, 2015).

This sounds very much as though the investigator is taking the ENT specialist’s word for it - he said he only wrote one report (7 months after the appointment) so that must be way it happened.  What chance do I have at receiving justice if physicians’ words are taken as truth and mine are not?  My family doctor said to me that he had received the report, early on in September or August of 2013, but wouldn’t let hear what was in it. I attempted to find out what the report said on more than one occasion, from my gp, but eventually gave it up as a lost cause.  Now, however, the entire incident has become one more example of the ill-treatment I received at the hands of my gp.

One question I have now is, was my letter of April 26, 2015 (see excerpt) added to the list of documents that I first saw in the letter of April 13, 2015, or was it ignored because it wasn’t an official document or report?  The letter would explain some of the problems over the ENT specialist’s appointment and report - the misunderstandings, the thoughtless choice of ENT specialist in a particular setting which did not apply to me, the two ultrasound reports even though one was redundant, and my family doctor/gp not wanting to allow me to read the report, leading to further confusion in the doctor’s office as I requested another appointment with an ENT specialist, which happened to be for 18 months in the future. Experiencing much pain at the time, I requested that I see an ENT specialist sooner than that, which resulted in another appointment being set up, and confusion overall.

Another question I have is whether the response I wrote on July 14, 2015 (see Ear/ENT excerpt), was added to the list of documents intended for the ICRC, since I received no acknowledgment of it in the Investigator’s letter of August 21, 2015. As I stated in that letter,

“The main problem with the appointment on March 4, 2014 that [my gp] refers to in his letter, in “Audiotape of March 4 Meeting” is not that he raised his voice but that I made it [the appointment] for the purpose of discussing the administration of my ear problem; in fact, I made a point of telling the receptionist that when I made the appointment.  However, at the appointment, as the tape recording indicates, [my gp] immediately moved away from discussing the problems of the 3 ENT referrals to asking once more about my ear and examining it. Strangely, he never once mentioned the non-existent report from [the ENT specialist], even though that ENT appointment had been more than 6 months earlier. At the beginning of that appointment on March 4 I did not mention the report from [the ENT specialist] as on other occasions he had told me it was for his eyes only, saying it was private, not for the patient to read. I had hoped we could move past that” (McPherson, July 14, 2015).

At the end of that office visit about Ear/ENT matters I handed him a letter requesting a copy of the report (see transcript of excerpt of Mar 4, 2014 appointment). And now, there is complete denial on his part, and of the ENT specialist, and of the Investigator, that I asked for the report soon after the original ENT appointment, but did not receive it from my family Dr until very recently, via the Investigator, who seemed to be claiming it was the original – the first and only – report.

Furthermore, my letter expands again on the issues to do with the referral to the ENT specialist and that appointment – see 2nd paragraph from Ear/ENT excerpt from my unacknowledged letter to the CPSO Investigator,  July 14, 2015.

Language - wording of CPSO Complaint Form and in the Investigator’s letters

It’s also regrettable that there was confusion about the wording of the terms on the original CPSO complaint form  - mentioning “other physicians who provided medical care” interpreted by the Investigator to mean “physician witnesses” (not involved in medical care but who had something to add)  whereas I would have been more interested in having “health care witnesses,” such as receptionists and nursing assistants who witnessed or played a part in the incidents themselves.  Left to the CPSO, however, the aim would appear to be (there’s that word again, demonstrating bias) to have only physicians being granted the right to speak, and only physicians the right to be believed, from all appearances.

I have given examples from letters written by the Investigator of how she views the words of a physician more truthful than the words of the patient. I can only hope she didn’t display this attitude in her submission to the Inquiries Complaints and Reports Committee. Lack of transparency isn’t the only problem with the CPSO and the health care system’s ways of dealing with problems, but without transparency -  at the very least sharing with the complainant what the Committee is seeing, what we have is a complaints system in which the Investigator holds the power to influence the Committee if s/he chooses to do so, or even if due to unrecognized biases.

Transparency

Last year, the subject of transparency within the CPSO was introduced by MPP Steven Clark in a private member’s bill – Bill 29 – in Parliament. His concerns were focused on transparency in notifying the public of complaints, and of the investigation results, rather than about the process itself. And his concern was mainly for the families of people who had lost loved ones unecessarily, through carelessness or negligence.  But those aren’t the only kinds of situations that are harmful to patients and their families. And while I would not agree that a physician’s future has always to be dampened or lost completely by being publicly disgraced, through making errors of administration or judgement, there surely are times when the public should have the right to know more details than they are currently allowed to know. My concern, however, is the lack of transparency in the process of making a complaint and having it addressed.

Having to rely on one person – an Investigator – assigned to a deal with a complaint, is less than ideal. If the CPSO Investigator chooses to withold information from letters written, that are not in the format of a ‘report’ made by a physician, she can do so, leaving the complainant virtually helpless to have their voice heard.

Update, Sept 22, 2015. 

I have not yet received a response from the Investigator of my complaint to my letter of August 31, 2015. Today I wrote to Ms Sandy McCulloch, CPSO Director of Investigations and Resolutions (copy to Ms Katja Lutte, Manager of Investigations and Resolutions), explaining the situation and my concern that my complaint may not have been dealt with fairly. Specifically, I mentioned my last two letters (August 31 and July 14, 2015) to the Investigator assigned to my case, to which I have received no response.

List of resources

Bill 29, Medicine Amendment Act, 2014
http://www.ontla.on.ca/web/bills/bills_detail.do?locale=en&BillID=3055&detailPage=bills_detail_status

Bill would require doctor cautions, complaints to be public
By Marco Chown
The Star
Oct 20 2014
http://www.thestar.com/life/health_wellness/2014/10/20/bill_would_require_doctor_cautions_complaints_to_be_public.html

Doctors’ Blame and Shame – Ontario Bill 29
By Shawn Whatley
Oct 25, 2014
http://shawnwhatley.com/doctors-blame-shame-ontario-bill-29/

See also, list of topics on the right of blog screen, for more on this subject.

Mediation and the Human Rights Tribunal of Ontario - will it work for everyone?

Following is my email response to a suggestion that I  might like to try mediation to resolve the problem I had with my previous family doctor. See email below mine for copy of that email from the Human Rights Tribunal, received today, July 29, 2015.

In April, 2015, I submitted an application to have the case heard by the tribunal. I had already had a taste of the kind of response I was likely to get from the doctor in question, from having laid a complaint about him with the CPSO (College of Physicians and Surgeons of Ontario). I am concerned that no one is actually looking at the Application I submitted, or taking time to compare that with the Response the doctor sent to that. As with emails sent to the Registrar of the HRT, it is more likely that a customer service rep reads my response and decides what to do with it – file it or toss it, or hand it to someone else to deal with, than it actually gets into the hands of the individual whose name is on it .


----- Original Message -----
From: Sue McPherson
To: Brennenstuhl, Keith (MAG)
Sent: Wednesday, July 29, 2015 4:58 PM
Subject: Fw: Human rights Application ----------  Susan McPherson v. ----------

Dear Mr Brennenstuhl,

Tell me this: how am I supposed to respond to the lies and distortions of truth he tells in his Response, that he isn't required to show evidence for? Am I just supposed to tell my "interpretation" in my Reply? Am I allowed only to add new facts if I can back them up with evidence? What is this - a game of he says, she shows evidence of? And if he says more than what she has evidence of, he wins?

You would have to convince me that anything could possibly be accomplished through mediation in this situation before I would agree to it. So far, the doctor hasn't admitted to any wrongdoing or poor judgement in my attempts to have this resolved, here or elsewhere, so I just don't see how mediation can help.

When I looked it up online, briefly, I saw that mediation was useful in cases where, for instance, a young person had committed a minor crime against a homeowner, and once found guilty, legally, the process of mediation could begin. That, and cases where married couples are divorcing, and I imagine, for the sake of the children, mediation is offered in order to ease the path for future tolerance of their situation, in which due to the children, their paths might well cross occasionally. Neither of those scenarios fit this one. The doctor has not admitted to anything, and in fact is blaming me for behaviour that he has invented, or must be imagining (and wishing to hold me accountable for), such as shouting at him and his staff.

We have no mutual interests that would require our paths to cross again, since my health and well-being is obviously not one of his, and he appears to have no desire to educate himself in matters of ageing, ageism, and discrimination on the grounds of gender and family status, from the looks of things.

I can see how for the doctor to choose mediation would act in his favour, as he can only benefit from presenting himself as willing and cooperative, for starters, and then, not having admitted to any of the things he has done, he has an advantage right from the start. It could only lead to me having to defend myself against accusations he makes (which he has already started to do) for which he doesn't have to present evidence, as he is a doctor, and I am only an older woman living alone without family beside me to grant me credibility.

No, mediation isn't going to work, unless something really changes in a hurry; for instance, the doctor admits to lying about me and being disrespectful, and to distorting incidents that happened and trivializing my concerns, and agrees to attend courses and programs that hopefully would contribute to making him a better doctor to people in similar circumstances as me.

Sincerely,
Sue McPherson


----- Original Message -----
From: Brennenstuhl, Keith (MAG)
To: s.a.mcpherson@sympatico.ca
Sent: Tuesday, July 28, 2015 12:05 PM
Subject: Human rights Application ------------- Susan McPherson v. ----------

Ms. McPherson,

In reviewing this file I note from the Response that the respondent has agreed to try mediation to resolve your Application. In your Application, you have not indicated a willingness to try mediation. Mediation is one of the ways the Tribunal tries to resolve disputes and it is highly recommended by the Tribunal. It is a less formal process than a hearing. If mediation does not settle all the issues between the parties, a hearing will take place at a later date. Mediation can only happen if both parties agree to it. Please let me know by return email if you are willing to try mediation. Thank-you.

Keith Brennenstuhl

Vice-chair
Human Rights Tribunal of Ontario

Doctors and the CPSO - women growing older

According to the latest letter I have received from the CPSO, my case is now going under review, to see if they think it is worth taking to the committee or will be dismissed.  I have written many letters to them over the last year, responding to questions and letters from them with details about the doctor  - my family doctor, that I laid the complaint about.

Usually, when patients lay a complaint, it is because something of great magnitude has happened – a loved one has died while in their care, or there has been sexual abuse, or outrageous acts of unprofessional or negligent behaviour. I didn’t see my experience as any of those, at least not until the last official appointment with that family doctor, in April, a year ago.

Before then, I had approached a local organization, the London and District Academy of Medicine, LDAM, to help resolve problems I had had with the doctor in question, who had been my family doctor for about a year and a half. I had thought that, as a doctor opening a new practice, that it was stressful and needed time to adjust to, and so thought his attitude and ways of communicating, as well as organizational methods, etc, would improve over time. However, as time went on, I came to realize he wasn’t improving. In fact, his attitude and ways of conducting his practice were getting worse. Moreover, it was obvious he didn’t want me as a patient, in fact, he asked me to find a new doctor, something I was reluctant to do due to the difficulty in finding one in the first place. Surely, a doctor should be able to do his job, treating patients that come to him, without having personal biases interfere.

Recently, I have come to think that he was treating me as a walk-in patient, not as one of his registered patients. Having to go to his office every three months to have prescriptions renewed, by hand, not on the form, at the risk of errors being made, was just one example of that. Although the pharmacy provided a form that had the items on it to be checked off, he required me come in so he could do it by hand, which itself resulted in the occasional mistake and further consultations with the pharmacy, and another trip to the doctor to sort it out.

There came to be an accumulation of instances by him of unprofessionalism, including lack of attention to the details of making referrals, discussing reports, prescribing medications, demeaning comments, trivializing my health concerns and in general, offering a lack of quality time in assessing what treatment I needed - five minutes or so, but not enough. At the end of the my time with the doctor as his patient, however, I felt I had been subjected to more than what I should have had to put up with, and in a manner that was more than disrespectful. It was an attack on me as a human being - as a woman, an older person, and as a single person living in a separate city from other family members.

It was as though he had no time for me. And sometimes, it seemed as though some things that happened that were harmful to my health and sense of wellbeing were done on purpose. Possibly what happened to me was not any worse than how many long-term Canadian doctors are towards their ageing patients, at least the ones they see as being a burden on the system.

It was a year ago that I laid the complaint against my previous family doctor. CPSO stands for College of Physicians and Surgeons of Ontario. For the most part the CPSO seems to be an organization for the benefit of the doctors, so having one’s complaint dealt with in a serious manner is no easy matter. I wrote on my blog almost a year ago about my first encounter with the ‘investigator’ at CPSO. See ‘CPSO complaints against Ontario doctors’. More recently, not having much faith left that the second assigned CPSO investigator was addressing my concerns objectively, and having come to see what happened in terms of discrimination and not only as bullying, abuse and lack of attention to the administrative aspects of his practice I decided to open a case of discrimination against the doctor with the Human Rights Commission of Ontario. See on my blog, ‘Health care among single, older women – a case of discrimination for OHRT’.

A while back I also founded a discussion list on Yahoo - Ageism in Canada's health care system. Anyone wishing to join would be welcome, to discuss issues of concern, whether for the young-old at home, or in hospital, or the old-old, in long term care homes.

The subject of health care among those growing older is so wide I decided to start with my own experience in this blog piece and see where it leads. Twenty-five years ago I studied ageing while at Western University (was UWO), and wrote several essays and research papers as well as conducting interviews with older people – mainly of close to retirement age, about their experiences and thoughts on the subject. Several of these are on my website – the Diversity in Retirement website.

I started my first website with a research essay about my grandmother, Gertrude McPherson, which also was about aging, actually about the life cycle and how women (she was born in 1882) were able to contribute to society and achieve fulfilment over the course of their lives. And of course, for many, that meant marrying and having children. Along the way she became a missionary (in Hong Kong), an artist and art teacher, was married and raised three daughters, and wrote a book, The Grey Cottage, hence the title of my new photo essay, adapted from the original 2001 edition, Gertrude McPherson and the Grey Cottage.

My interest in aging and life cycle development started while at Western University, where I went many years after graduating from high school in Woodstock, Ontario. Taking courses on sex and gender, and aging and the life cycle in Sociology, while I was going through my own midlife changes put me on the path I would take, researching these areas of study and more. No career came of it, though I started the websites and have continued to do research.

List of resources

Ageism in Canada's health care system
Yahoo discussion group
founded by Sue McPherson
Feb 25, 2015
https://ca.groups.yahoo.com/group/AgeismHealthCA

Baby boomers, longevity, and health care
Sue’s Views on the News
April 9, 2012
http://suemcpherson.blogspot.ca/2012/04/baby-boomers-longevity-and-health-care.html

CPSO complaints against Ontario doctors
Sue’s Views on the News
July 30, 2014
http://suemcpherson.blogspot.ca/2014/07/cpso-complaints-against-ontario-doctors.html

Diversity in Retirement website
Sue McPherson
since 2004
http://www.DiversityinRetirement.net

Gertrude McPherson and the Grey Cottage
photo essay by Sue McPherson
adapted 2015 from 2001 essay
http://samcpherson.homestead.com/GertrudeMcPhersonandtheGreyCottage.html

Healthcare: Technology is a bigger cost driver than demography
By Julia Belluz
Macleans
February 10, 2012
http://www2.macleans.ca/2012/02/10/healthcare-technology-is-a-bigger-cost-driver-than-demography/

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

Health care among single, older women – a case of discrimination for OHRT

Added April 23, 2015: transcript of short 6 minute excerpt of audio recording of Dr’s appointment April 28, 2014.

This week, on April 10, I submitted an application to the Human Rights Tribunal of Ontario (OHRT), alleging discrimination by my family doctor on the grounds of sex; family and marital status; and age.  The general area of discrimination I filed it under was ‘Goods, Services and Facilities,’ specifically, ‘Medical/health services’.

I had already tried to resolve the matter, or various aspects of it, through LDAM, the London and District Academy of Medicine, with no success, then filed a complaint with the College of Physicians and Surgeons of Ontario (CPSO), in June, 2014. I have received very little feedback on that, except that it is still in progress, I am told. While the CPSO complaint is directed largely towards a lack of professionalism in general in the behaviour, attitude, and practices of the doctor, the application for the HRT is about specific incidents and situations that reflect discriminatory attitudes as well as practices that discriminate on grounds covered by the Code.

The CPSO form was quite vague in the way it asks for information, and even though I included headings under which I thought the behaviour or attitudes would fall, the first investigator immediately changed it to what she saw as the problem. Having the “investigator” be the one who decides what will be told to the Committee is hardly reassuring. While they may claim to be unbiased, even the fact they claim to be suggests they aren’t. If a person cannot acknowledge normal human frailties, but think they are superhuman in their ability to be objective, how can we have faith in their decisions?  I especially did not like the CPSO’s decision to file my complaint under the heading “Communication and termination” as it seemed to minimize what happened, and to clinically sanitize, as it were, what was really going on – the biases the doctor held and the actual incidents of bullying, harassment, and unprofessional behaviour.

I decided to go forward with the application with the Human Rights Tribunal, based on grounds covered by the Human Rights Code. What this means is that, in this case, I have stated in the application that my HRT complaint is on the grounds of sex (meaning male or female); family and marital status; and age. I have focused on two incidents only (and their ramifications), and gone into greater detail on these two incidents than I did in the original CPSO complaint. One incident was an ultrasound test I was sent for, which not only created much discomfort and risk but seemed to be altogether unnecessary. The other event was an appointment with the doctor which turned into a scenario of outright hostility and the outrageous and uncalled for demand that I submit to a urine test for what he called “street drugs” (see excerpt of transcript of 6 min audio recording of April 28, 2014 appointment).

The human rights tribunal application is a more structured form than the CPSO complaints form, although perhaps it also makes a difference that over this last year my thoughts on this period in my life have become clearer, in terms of their significance, so I am better able to express them, and more concisely.

Below are the headings for my responses to the questions on the two incidents and for their effect on me, and why I believe it was discrimination, for the Human Rights Tribunal. To read, follow the links to the pages. The information is the same as what appears in the application itself, though I have not disclosed the name of the doctor who is the subject of the complaint.

The two events are described in terms of what, who, when and where. Following that is an explanation of the effect it had on me.

1. Pelvic renal ultrasound incident   and Effect on me of Pelvic renal ultrasound incident

2. Urine sample, “street drugs” and termination
    Effect on me of Urine sample, “street drugs” and termination

The last part directly addresses the matter of discrimination, and why I believe I was discriminated against.  For this part, the starting point is the type of discrimination. And the three types of discrimination are 1. sex,  2.family and marital status, and 3. age. For each of these, I explained why I believed I was discriminated against, eg., starting with ‘sex,’ I told how I was discriminated against on the basis of being female. For ‘family and marital status’ my focus was on not having family close by, nor a husband, and how that can affect quality of health care.  And finally, age, the one factor that seems to have everyone concerned about the burden older people are presumably putting on the health care system – or some of us, at least.

These are the three areas I wrote about, on the HRT application, explaining why I believe I was discriminated against:

3. Discrimination on the grounds of sex
    Pelvic renal ultrasound test
    Urine sample, “street drugs,” and termination

4.  Discrimination on the grounds of family and marital status
     Pelvic renal ultrasound incident
     Urine sample, “street drugs,” and termination

5.  Discrimination on the grounds of age
     Pelvic renal ultrasound incident
     Urine sample, “street drugs,” and termination

There were other questions asked on the application form. See links following for my responses:

6. Remedy I am asking for

7. Why the other proceeding (LDAM) could not deal with my complaint

8. Other important information the tribunal should know

9. Practices and policies complained about

In my responses, I have quoted from other sources, though I had virtually no advice on how to go about this HRT process and am not sure I did this the way they wanted me to. I can only hope it will be taken seriously. It certainly was serious for me.  Regardless of what happens, I want it to be known that this is what I experienced. Whether it was a unique kind of situation, or one that others have experienced, I do not know, although I do know that discrimination on the grounds of sex, as well as on the grounds of family and marital status, and age, exists in various ways within the healthcare system.


List of References used in the application form questions on discrimination for the HRTO

Ageism: Concepts and Theories, Law Commission of Ontario, 2009. Retr Jan 20, 2015
http://www.lco-cdo.org/en/older-adults-lco-funded-papers-charmaine-spencer-sectionII

Code Definitions (I), Code Protections for Relationships (III), POLICY AND GUIDELINES ON DISCRIMINATION BECAUSE OF FAMILY STATUS, OHRC. March 28,  2007. Retr March 22, 2015.  http://www.ohrc.on.ca

Collaborating with Patients and Others,  Duties: To the Patient. Principles of Practice and Duties of Physicians. CPSO Policies and Publications. Retrieved March 26, 2015.
http://www.cpso.on.ca/Policies-Publications/The-Practice-Guide-Medical-Professionalism-and-Col/Principles-of-Practice-and-Duties-of-Physicians

Defining Discrimination Based on Family Status, OHRC Policies etc on family status. Retr Jan 25, 2015 http://www.ohrc.on.ca/sites/default/files/attachments/Policy_and_guidelines_on_discrimination_because_of_family_status.pdf

Ending the Physician Patient Relationship, CPSO Policies and Publications, Sept 2008.
Retrieved March 26, 2015.
http://www.cpso.on.ca/Policies-Publications/Policy/Ending-the-Physician-Patient-Relationship
http://www.cpso.on.ca/CPSO/media/uploadedfiles/policies/policies/policyitems/ending_rel.pdf?ext=.pdf

Incontinence: The Canadian Perspective, Cameron Institute, Canadian Continence Foundation, Dec 2014. Retr Mar 25/15.

http://www.canadiancontinence.ca/pdfs/en-incontinence-a-canadian-perspective-2014.pdf  

‘Physicians and the Ontario Human Rights Code’, Policy Number:#5-08.  Policy Category: Practice, Publication Date: December 2008, Introduction. Retrieved Feb 22, 2015.
http://www.cpso.on.ca/Policies-Publications/Policy/Physicians-and-the-Ontario-Human-Rights-Code

‘Principles of Practice and Duties of Physicians,’ Policies and Publications, CPSO website. Retr March 24, 2015. http://www.cpso.on.ca/Policies-Publications/The-Practice-Guide-Medical-Professionalism-and-Col/Principles-of-Practice-and-Duties-of-Physicians