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.