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Closing the QCIPA loopholes

Closing the QCIPA loopholes

On July 1st, Dr. Eric Hoskins, the Minister of Health and Long Term Care made an announcement that the Ministry would begin to work on implementing each and every recommendation put forth by an expert panel charged with reviewing the Quality of Care Information Protection Act (QCIPA).

Under the legislation, which came into force in 2004, “information provided to hospital quality of care committees and other designated quality of care committees that deal with quality improvement would be shielded from disclosure in legal proceedings.”[i] Designed to promote the sharing of information between health professionals, thereby improving patient care and safety, QCIPA has been under fire over the last few years, as numerous patients and/or their family members have reported that the legislation has only served as a secret veil for the healthcare system following an adverse medical event.

The topic of medical errors continues to receive attention across Canada and around the world. For instance, University Health Network’s new President and CEO, Dr. Peter Pisters, recently launched a campaign, on behalf of his organization, with the release of a new video. The video provides statistics on medical errors, from objects left in patients during surgery, to falls, acquired infections, and preventable deaths – I encourage you to watch it.

The statistics in the video are a reminder that more could be done to prevent harm in hospitals. Yet, it is important to note that, even with its loopholes, QCIPA has served a purpose. Had there not been a mechanism to allow health professionals to disclose medical errors in a protected environment, we would have a harder time identifying the scope of the issue, and we might have not made as much progress as we have on preventable incidents. That said, the introduction of the legislation was merely a critical first step and the time has come to resolve its shortcomings.

Of the twelve changes to QCIPA that will be implemented, five recommendations stand out:

  1. Develop clear guidance on when and how hospitals should use QCIPA to avoid the large variation in how the act is currently used.
  2. Amend the act to ensure appropriate disclosure to patients and families following a critical care incident so they are fully informed about the results of a hospital investigation, including what happened and what measures would be taken to prevent future incidents.
  3. Establish an appeal mechanism for the investigation of critical incidents so in circumstances where patients or families are not satisfied with a hospital review, they can request an investigation from an independent body, possibly the Office of the Patient Ombudsman.
  4. Establish a publicly available database or registry that contains information about all of the critical incidents investigated in Ontario hospitals, including the type of incident, the causes and the recommendations to prevent future incidents.
  5. Patients and families must be interviewed as part of the process of investigating critical incidents and then be fully informed of the results.[ii]

The full set of recommendations can be found here.

The implementation of the recommendations won’t affect every hospital in Ontario, as many are already practicing this model of investigation and disclosure. However, it is critical that we are consistent in our approach across the province – our patients and their families deserve that.

I welcome your thoughts on the changes to the legislation and invite you to discuss the issue of medical errors in Canada in the comments below. Better yet, please drop by the Macklem House – my door is always open.

Richard

I would like to acknowledge Emma Woodman for her help in the creation of this post.

 

[i]http://www.health.gov.on.ca/english/providers/project/priv_legislation/quality_info.html

[ii] http://linkis.com/www.thestar.com/life/Y9Lto

Wayne Rosen

Wed, 06/28/2017 - 09:37

Richard, thank you for a very interesting post. I think the ethical issues associated with QCIPA are very challenging and very interesting. With regard to the video about physician error, however, I am not so impressed. It is really the worst sort of statistical nonsense. It is a misleading and manipulative way to present the issue, on par with Nancy Grace or other tabloid journalism. For example, the statistic on objects left in patients is 485 over 20 years. Assuming there are 1 million procedures a year, the actual rate of left objects is 0.0024% or 2.4/100,000. This provides a very different perspective on the issue. In fact, I’m quite sure that the number of objects left in patients is actually much higher. But that does not really help us understand the problem. Of course it is important to address the issue of medical error. All of us know it occurs and all of us know it should be improved upon. Indeed, I’ve yet to meet someone who is actually a supporter of medical error. But the phenomenon of medical error is much too complicated to be boiled down to a few simplistic statistics in order to generate fear. To do so makes the public think that it is a simple problem with a simple solution.

Wayne Rosen

Dear Wayne,

Thanks for your thoughtful comment. I agree that the issue is very complex and reducing it to statistics can be construed as sensationalism. The main point of the blog was to outline how changes in Qcipa may influence our approach to medical error. Thanks again for pointing out your important perspective.

reznickr

Wayne Rosen

Wed, 06/28/2017 - 09:38

In reply to by student

Point taken. I think it’s a fascinating ethical dilemma to provide an environment which enhances reporting and acknowledgment of medical error, but also balances the rights and needs of individual families to know.

Wayne Rosen

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