Ontario's patient ombudsman received record number of complaints in 2022-23

Ontario's health-system watchdog received more complaints last year than any since it opened, many of which don't fall under the office's mandate, according to its annual report.

The ombudsman received 4,388 total complaints in 2022-23, according to the report, a 33 per cent year over year increase.

The patient ombudsman, which opened its doors in 2016, provided CBC Toronto with an advance copy of the report, which covers April 2022 through March 2023.  

But 785 of those complaints were about primary care. Primary care, which includes family doctors, is often people's first point of contact with the health care system but it doesn't fall under the ombudsman's purview.

"The fact that we are now seeing [primary care] in our complaints, I think just reinforces that there are challenges," ombudsman Craig Thompson told CBC Toronto. 

He said for many primary health care complaints, there is no similar oversight agency that people can turn to.

"That's really troubling," Thompson said. 

As for those complaints that did fall under his mandate, there were 2,264 complaints made about hospitals, 334 about long-term care homes and 272 about home and community care.

Complaints about primary care expected: NDP

France Gélinas, the New Democratic Party's health critic, said she expected primary care complaints to feature heavily in the report based on the number of calls she gets to her office. She says having access to primary care can take the burden off other parts of the healthcare system that may be under strain. 

"Give people access to primary care and the number of ER visits goes way down, the number of people needing to be admitted into the hospital goes way down," Gélinas said. 

Hannah Jensen, a spokesperson for the minister of health, said it will review the report and look for ways to improve. She says the province has spent $30 million this year to expand primary care teams in communities that "need it most." 

Jensen also pointed to the introduction of an act earlier this year that will allow more private clinics to offer certain publicly funded surgeries, which drew criticism from healthcare workers who said the province should invest in hospitals to perform those procedures.

Some complained about ambulance bills

Another area of complaints highlighted in the ombudsman's report are complaints about bills for ambulances and medical transportation. The ombudsman received 14 complaints involving concerns about the fairness of fees for ambulances or other medical transportation.

OHIP-insured patients have to pay $45 when they receive medically necessary ambulance services, according to the report. If the trip isn't deemed necessary, the patient is charged $240. 

"Many people are not aware that ambulance services are not fully funded by OHIP," the report said. 

The report notes that medical necessity is determined by the patient's doctor, not legislation, policy or regulations. Thompson says policy is needed to define what is medically necessary. 

"If you haven't got clear policies, it's impossible to have a fair and transparent system," he said. 

Thompson says the lack of a clear policy can cause decisions to appear arbitrary or create inequities across the province. 

The ministry of health did not directly respond to a question asking if it would consider creating the policy Thompson is calling for.

New long-term care legislation apparently well implemented

The report also includes a section about the implementation of the More Beds, Better Care Act, which came into effect in September 2022 and was much critiqued by opposition parties fearing it would lead to people being far from their loved ones.

The act changed rules so hospital patients awaiting spots in long-term care in southern Ontario could be moved to nursing homes up to 70 kilometres away, while for those in northern Ontario, the distance is up to 150 kilometres. A spokesperson for the ministry of long-term care stressed that the act does not authorize the physical transfer of a patient without their consent

Thompson says his office was concerned when they heard about the changes and proactively prepared advice and guidance for the sector to ensure people weren't placed in homes that are far away from their support networks. 

While the office received some complaints from people worried about the possible impact of the legislation, Thompson said it was surprised to receive no complaints from people who had been moved far away without their consent. 

"The organizations … obviously did a good job of trying to mitigate those potential complaints," he said.