14 September 2019

Introduction to CPSO-HPARB Reconsideration Request


Following is an Introduction, now on my website, Accountability in Health care: ethics in aging, to the Reconsideration Request that I submitted earlier that month (August, 2019) to the HPARB Board, which had declined my Request for another look into how a case I had taken to them was handled by them. The formal Request was not an investigation into the case itself, only into how the appeal and review board – HPARB - handled it. The case originally had been investigated by the CPSO. My Request was declined. The original CPSO-HPARB Reconsideration Request of Aug 13, 2019 is located on my website; please follow links.
   
Introduction to CPSO-HPARB Reconsideration Request
                                                                                        by Sue McPherson August 29, 2019

For the purpose of this introduction and my Request to HPARB that follows, the College of Physicians and Surgeons of Ontario, known as the CPSO, is responsible for setting requirements for standards of practice and professionalism for doctors. The Health Professions Appeal and Review Board, known as the HPARB, closely related to the CPSO, is supposedly responsible for setting requirements for standards of practice and professionalism for doctors, and conducting complaint reviews of complaints that have gone through the CPSO’s complaint system, and also registration reviews of doctors.

The text of a Reconsideration Request – names removed -  that I wrote follows this introduction. I submitted it to HPARB (Health Professions Appeal and Review Board), on Aug 13, 2019. The Request I submitted was a result of their Decision of July 24, 2019 to take no further action on the College of Physicians and Surgeons (CPSO) Committee’s Decision of October 5, 2018. I had laid a Complaint in 2018 against a family doctor I had been going to. I have had difficulty gaining access to a doctor I could depend on, actually every since I came back to London. First one, then the next, treated me badly. It could be for different reasons, not always the same. But I am an older woman, alone here, and am virtually unknown, having graduated from Western but not had a career or relationships that might have granted me some credibility and status in the community.

This family doctor who has been the subject of this complaint with the CPSO, and the Reconsideration Requestion, knew almost from the start that there had been some troubling incidents happen regarding the specialist I had gone to for an appointment in late 2016. The specialist did treat me unfairly, no matter what the final Decision is on the subject, my case with the HRTO (Human Rights Tribunal of Ontario). And when I asked questions of his staff, they turned on me, blaming me for being rude to them and telling me if I wanted health care with the specialist I would have to apologize, otherwise I would have to go to Toronto for treatment. I hadn’t been rude, and didn’t apologize. But it made no difference. The specialist wrote up a report of the appointment repeating what his girls in the office had told him. And then a couple of months later wrote up another one, so now there were two. Reports don’t simply disappear when they are written up for Health Records at the local hospital. So trying to find a reasonable, understanding, family doctor has been a nightmare, and Dr G, the subject of this Complaint to the CPSO, is part of that nightmare. Oh, yes, and soon after that I laid a complaint against the specialist who had treated me so badly, and his staff, and others, with the Human Rights Tribunal of Ontario (HRTO), in November 2017, a year after it happened.  

The situation with Dr G, the family doctor, has evolved, going through the steps, each no better than the last as far as receiving just attention and consideration of my experience with him. I submitted my complaint on June 27, 2017. First – not first but the first main decision on the matter - after a period of lengthy, time-consuming errors and time-wasting on the part of the caseworker/investigator assigned to the case, came the Decision by the CPSO’s Committee on October 5, 2018, which stated, in part:

“the Committee is satified that the Respondent provided excellent care in the circumstances. We commend him for the accuracy and level of detail with which he documented his care of the Complainant. Disposition: For the reasons set out above, the Committee takes no further action on this complaint” (ICRC [Inquiries, Complaints and Reports Committee] Decision, Oct 5, 2018, CPSO. Toronto). Notice how the CPSO emphasizes the “accuracy and level of detail” of his notes, documenting his care of me. That’s because the doctor has credibility and I apparently don’t, in their eyes, or if I do, then they are trying to destroy that.

Credibility has nothing to do with telling the truth. It has everything to do with being believed, or having people take your side whether or not you are believed, which is called loyalty. Instead of saying “loyalty,” say the reason you are supporting what a person does or says is “credibility” and you will be more likely to be believed, and so will the person to whom you may only be being blindly loyal. See Presumed Innocence in politics and health care, on my Blog, Sue’s Views on the News. Feb 6, 2018.   http://suemcpherson.blogspot.ca/2018/02/presumed-innocence.html .

And since I didn’t have a career, I must either have been stupid or a drug addict, in the eyes of some, or perhaps they simply want people to believe that, and not that I was married to a man who didn’t want me to work and insisted that I stay home and had a family. Many of us knew little about the world back then. Some of us didn’t realize the harm that would do, staying home and taking care of the family to avoid family arguments.

After the CPSO ICRC (the Committee) handed down their Decision, I applied to the HPARB for a Review of the CPSO’s Decision. The CPSO was meant to submit all documents I had sent them and which passed between her and myself and the respondent, including one controversial one, submitted to me by the caseworker, Ms V, asking me to sign off on a Summary she had written of my original letter of complaint and return it by private mail (not CPSO envelope) to her. I didn’t as it did not accurately reflect what I saw as a good Summary, and I also thought that if I did, the brief description might be used against me, leaving out important parts. I di, however, waste much sffort in trying to rewrite her Summary, but ending up with a slightly shorter version of my original letter and her Summary combined, that I had been presssured into writing, unecessarily, and which she accepted. More about that later.

Once the HPARB became involved, I received a phone call stating that the process had been expedited, receiving a package of information on Dec  24, 2018, which apparently was the same information the CPSO had used to make its Decision, now handed over to the HPARB so they could analyze it – and to me, so I could too, for the first time.  I was denied it before, even though I wrote several letters to CPSO officials about it. And of course, it was not complete, and there were errors. And I did not have time to delve into it in great detail at the time. By this time I was dealing with problems with my respirologist and with the HRTO case over Dr A, the specialist, which had  rescheduled their Summary Hearing for Dec 7, 2018, instead of Nov 7, leaving me little time to prepare for each of these events - the case conference with the HPARB on Feb 7, 2019, and the Review also by teleconference with them on April 3. A meeting I had had with my respirologist on Jan 7, 2019 didn’t go well and it was only a matter of time before I decided I could nnot have him as my respirologist any longer. None of this will make much sense to readers; however my point is there was a lot going on and a lack of information as well as obstacles were being placed in my way.

By the time all that was over, I had received a Decision about the complaint I had made about the specialist to the HRTO (on March 5, 2019) to which I responded with a Request for Reconsideration on March 28. In due course, on July 24, 2019, the HPARB responded, on the matter of the Complaint I made against Dr G with the CPSO. I did also receive acknowledgment from the HRTO of the Request for Reconsideration that I had sent them. That HRTO case, against the specialist and his staff, is closely related to the CPSO complaint I made against the family doctor on June 27, 2017, who had sent away for all specialists’ reports on the first day and soon let me know that he believed him – what he had said in his reports of that appointment and about his female staff and others. There was no way this patient-doctor relationship could work out well.     

Returning to the Decision against Dr G, the HPARB Board wrote that the Committee (of the CPSO) had “investigated the Complaint and decided to take no further action” (Item 11, HPARB Decision, July 24, 2019).

It further stated, “Accordingly, the Board (HPARB) finds the Committee’s decision to take no action on this aspect of the Applicant’s complaint to be reasonable” (Item 38, HPARB Decision July 24, 2019. CanLII 67524).

That is when I wrote the Reconsideration Request of the Decision made by HPARB and submitted it on August 13, 2019.

The decision made by adjudicator Bonnie Goldberg, on Aug 19, 2019, on my Reconsideration Request from HPARB was as follows:

11. While the Applicant has provided the reasons as to why she believes the Board failed to properly consider adequacy of the investigation and the reasonableness of the decision, I
am not persuaded that the reasons advanced by the Applicant warrant reconsideration of the Board’s decision.
12. Accordingly, the Board’s decision of July 24, 2019 will not be reconsidered”
(Items 11 and 12. Decision, Aug 19, 2019, HPARB, Toronto).

The Board of the HPARB isn’t required to give a reason why they will not reconsider a Request for Reconsideration, according to Practice guidelines. And although the Rules state that the Board will make corrections of errors and missing documents, none of the ones I mentioned in my Request for Reconsideration were acted upon. It only took adjudicator Bonnie Goldberg 6 days to examine my 19-page Request, and she was new to it, not being present for the Review – not being a member of the original panel of Board members.

In Rule 16.5 of the Rules for the HPARB, it states,

“The Board, on its own motion or at the request of a party to the proceeding, may reconsider any decision made by it and may confirm, amend, or revoke it. The Board may do so if it considers it advisable to do so.” (p. 30, Power to Reconsider a decision of the Board. Consolidated Rules of Practice and Procedure, HPARB and HSARB. http://www.hparb.on.ca/english/docs/directions/2013%20HPARB%20&%20HSARB%20-%20Consolidated%20Rules%20of%20Practice%20and%20Procedure%20-%20EN.pdf ).      

One may wonder why someone who was not part of the original Board was invited in to place judgement on me – on my Reconsideration Request. But there are other rules that cover that kind of situation, described in “Powers of the Board”. See General Rules, Rule 2,  Application of rules; and Powers of the Board, 2.1  -  2.8.  pp 7-8. Consolidated Rules of Practice and Procedure, HPARB and HSARB.  http://www.hparb.on.ca/english/docs/directions/2013%20HPARB%20&%20HSARB%20-%20Consolidated%20Rules%20of%20Practice%20and%20Procedure%20-%20EN.pdf

Moreover, in the HPARB and HSARB Consolidated Rules of Practice and Procedure, under Corrections, it is stated,

“After rendering a decision or order, the Board may at any time correct a typographical error, an error of calculation, an error of omission, or any other similar error in its decision without prior notice to the parties. The Board shall notify the parties of its correction to the decision or order (16.4, p 30-31. Rule 16 – Decisions, Corrections, Consolidated Rules of Practice and Procedure, HPARB and HSARB. http://www.hparb.on.ca/english/docs/directions/2013%20HPARB%20&%20HSARB%20-%20Consolidated%20Rules%20of%20Practice%20and%20Procedure%20-%20EN.pdf
Yet in the Reconsideration Request sent to the HPARB, I included several instances of errors and omissions from material submitted to the CPSO, hence that also went to the HPARB from the caseworker/investigator. And that’s just the minor part of my Request. The legal aspect of it is about the idea of “error of law” based on the matter of Medical Records being seen as legal documents, even though there may be errors.

My next step should be to appeal the case to Divisional Court, but this is another new area for me, and one that would take even more physical effort and energy that is sometimes lacking. The filing of documents and attending the court room sessions is not something I would look forward to or maybe not be able to do well enough, especially when it is obvious justice has not been done if anyone took the time to read what I have written. Why would they believe what I say, or what I show them, when the authorities in this situation have not done that yet themselves? I can write and explain all that happened, but they aren’t listening. And they don’t have to. There’s nothing or no one to make them, and nothing within themselves to enable that to happen.

Click here to go to the CPSO-HPARB Reconsideration Request



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