Hospital emergency room.iStockphoto/Getty Images/iStockphoto
Sick and injured Ontarians are forced to wait far too long to be admitted to intensive-care beds and to undergo emergency surgery, the province's Auditor-General says in a new report slamming the government and hospital bosses for overcrowding at big community hospitals.
The excessive waits have harmed some patients, the report found.
In one case, a patient who suffered a traumatic brain injury waited 21.5 hours for emergency surgery while two elective surgeries were allowed to proceed as scheduled. The patient slipped into a coma during the waiting period, and died four days later.
In another, a patient with abdominal pain suffered a burst appendix while waiting 25 hours for emergency surgery. The patient spent twice as long as expected in hospital because of a surgical complication.
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Auditor-General Bonnie Lysyk uncovered the incidents as part of an investigation into the province's 57 large community hospitals, three of which the A-G's team reviewed in depth.
Those hospitals were Trillium Health Partners and Rouge Valley Health System, both located in the Greater Toronto Area, and Windsor Regional Hospital. The audit didn't reveal where the brain-injury death or the burst appendix case occurred.
The audit found that although the Ontario Ministry of Health and Long-Term Care's target is that 90 per cent of patients who need intensive care should be transferred to the ICU within eight hours, the actual time at the three hospitals was 23 hours. Patients who needed a regular in-patient bed languished in the emergency room for 37 hours.
Lengthy waits in the emergency room are caused primarily by bursting-at-the-seams hospital wards and beds blocked by patients who no longer need acute care, but cannot find a place in a more appropriate setting, usually a nursing home.
The hospital investigation was one of four audits of the health-care system that Ms. Lysyk released Wednesday in her annual report.
Ms. Lysyk found that the government's attempt to create electronic health records for all Ontarians had cost $8-billion over 14 years and was still incomplete. "The initiative has certainly advanced since our last audit in 2009," she said. "However, it is still not possible to say if it is on budget because the government never set an overall budget for it. In effect, we cannot say if $8-billion is a reasonable figure."
In a bid to mitigate the political fallout of the eHealth audit, Health Minister Eric Hoskins last week unveiled a review of the program's assets by former TD chief executive Ed Clark, the government's business guru, that valued the province's eHealth assets at "significantly" more than $5.7-billion since 2007.
In another health-related audit, Ms. Lysyk criticized the government for its lax oversight of physician billing. For example, the ministry failed to go after nine specialists who claimed to have worked more than 360 days in 2015-2016. Six of those doctors billed for the full 366 days.
The audit also found that the government is not getting its money's worth for all the new cash it has poured into primary care across the province. In 2015-2016, 57 per cent of Ontarians reported having to wait two or more days to see their family doctor, up from 51 per cent a decade earlier.
During that period, many family physicians joined group practices with payment models that compensated them for enrolling patients, rather than paying them solely through the traditional fee-for-service arrangements.
The government's goal was to convince more medical students to choose family medicine, and to take pressure off emergency departments and walk-in clinics.
The Auditor-General found that in 2014-2015 alone, the province paid doctors in the most popular group practice model – known as a Family Health Organization – about $522-million more than it would have under the old fee-for-service model.
But that extra money didn't keep 40 per cent of enrolled patients from visiting walk-in clinics or doctors other than their own – leading to duplicate payment of $76.3-million over the five years leading up to 2014-2015.
The audit found that physicians in most group practices worked an average of between 3.4 and four days per week; many did not work the number of nights and weekends required by the ministry.
"Payment models should be designed to ensure patients are receiving the best level of health care when they need it most," Ms. Lysyk said.
The Auditor-General also concluded, in a separate audit, that the province lacked comprehensive standards to treat people with mental illness. While the number of mentally disturbed people visiting emergency rooms increased by 21 per cent in the past five years, the province cut 134 beds in that same period for people with the most severe forms of mental illness.
Kelly Grant