Hospital CEO Adendum 2

OPENESS – Patients for Patient Safety and Patient Champions promote open and honest relationships and dialogue between all stakeholders, professional and consumer.

HONESTY – Patients for Patient Safety and Patient Champions promote and expect honesty in dialogue and communication

"It is inevitable that when a number of health professionals are dealing with complicated problems that certain inconsistencies will arise in the recording of events, and these inconsistencies may give rise to concern on the part of family members. It is not the responsibility of the committee to explain each of these inconsistencies to the satisfaction of the complainant,".

Isn't meticulous accuracy necessary to clarify conflicting issues, especially when dealing with life and death matters?

Patient Safety Initiatives in Canada, based on recent experience,

seem to be an exercise in futility rather than progress.

indicated that the openness and honesty process is not very close to being attained.

This is to confirm that our office recently received your complaint. The Mediator who will be dealing with your file .......... will be contacting you to discuss this complaint with you.

The Office of the Information and Privacy Commissioner (IPC) is committed to mediation as the preferred method of dispute resolution.

If the complaint is not resolved through mediation, it will proceed to review. During the Review stage of your complaint, you will be entitled to submit representations on the issues remaining in dispute. The representations you provide to this office will be shared with the other party or parties, unless there is an overriding confidentiality concern.

To avoid delay, it is essential that you provide us with your current address and telephone number if this information is not already indicated in your letter of complaint.

For additional information about the Complaint Process, please try our interactive Complaint Process flow chart located on our Web site at www.ipc.on.ca. You can locate the flow chart by clicking on Search, and typing the words "flow chart" in the Search field.

You might be contacted by our office, as part of our efforts to evaluate the services we provide to the public.

November 8, 2005

The mediation stage of this complaint has now been completed. Enclosed please find a copy of the Mediator's Report setting out any issues that have been resolved and the issues that remain in dispute.

The purpose of the Report is to provide the parties to a complaint with a record of the result of mediation and to provide the Adjudicator with information regarding records and issues that remain to be adjudicated.

Please review the Report and if there are any errors or omissions, please contact me no later than November 21, 2005. I will consider your comments and determine whether the Report should be revised. You need not contact me unless there are errors or omissions.

After November 21, 2005, the complaint will be transferred to an Adjudicator, who will conduct a Review and dispose of the outstanding issues in the complaint.

The Adjudicator will send you more detailed information about the process in advance of the Review.

November 18, 2005

Information and Privacy Commissioner/Ontario
Tribunal Services Department
2 Bloor Street East
Suite 1400
Toronto, Ontario, M4W 1A8

Your letter dated November 8, 2005

Due to illness and the time restraint limit to provide my response I have attached my comments to your “Report”, albeit not to the thoroughness that I would have desired.

PARTIES:
Complainant
Health Information Custodian

REQUEST:

The Hospital received a request dated November 24, 2004, under the Personal Health Information Protection Act, 2004 (the Act) for access to all personal health information records relating to the requester's deceased spouse, with the exception of those records that he had received in 1987. The requester indicated that he was also seeking access to information regarding the disposition of his wife's remains as he would like to visit the site.

I was seeking access to the missing records in order to determine the location of my wife’s remains. The hospital consistently ignored my requests for this information.

The requester included with his request, copies of his letter dated November 9, 2001 addressed to the Hospital in which he detailed his attempts to obtain access to the complete records and his subsequent letter dated April 21, 2004 asking for a response. Also included were copies of letters from the Ministry of Health and Long-Term Care (the Ministry) dated October 17, 2001 and August 20, 2002.

DECISION:

The Hospital responded to the request. It advised that it had reviewed all of its correspondence with the requester as well as the decisions rendered by the College of Physicians and Surgeons, the Health Discipline Board and the Supreme Court of Ontario.

The decisions, if they were reviewed, would have indicated that the process was not dealing with the involvement of the hospital. Even so, pages of the decisions were highly critical of the hospital dealings with procedures/response to procedures pertinent to my current concerns. There has not been any indication of the significance of the Supreme Court of Ontario decision.

Is the above statement included just to have an outsider assume that the hospital was displaying an interest with my concerns? An attempt to mislead?

The Hospital stated that it had confirmed with the Head of the Pathology Department, its earlier advice to the requester that his wife's internal organs would have been returned to her body except for small tissue samples.

No truth to this statement. On the contrary I had been informed that none of her organs had been returned to her body. The previous information that I had been given had even gone so far as to say that they had been incinerated with the garbage. The hospital never gave any indication that this was incorrect. The Hospital letter dated May 27 1992 is hardly credible.

The Hospital noted that a copy of its protocol dated July 6, 1989 for the disposition of organs had been previously provided to the requester. The protocol indicated that any tissue or organs which were not retained for further evaluation were returned to the body and organs or tissues not returned to the body were either kept or incinerated.

This statement is extremely misleading. The protocol had been provided to the CPSO, not me. The CPSO’s protocol, in effect at this time, would have assured the hospital that I would never see the letter/document. It was never intended that I would see it. I attached a copy of the protocol to support my letter of June 1 1992 to the hospital. A copy of the protocol was provided to me by the Health Disciplines Board.

The Hospital stated that it had confirmed with the Head of Pathology that while some of the requester's late wife's tissue was retained, some of it may have been incinerated. The Hospital then provided the requester with the name and address of the company that the Hospital contracted at the time for incineration.

Prior to this, the Regional Coroner after consulting with the Head of Pathology, I was advised that all her organs had been incinerated “with used surgical sponges and other medical waste” in a facility near Gananoque. This was not disputed by the hospital and the hospital has made no attempt to clarify the location of the garbage site with their statement that they contracted with a Quebec based facility for incineration. Who is providing the sadistic misinformation?

The coroner also went on to explain that because the brain required a two week preparation in a formaldehyde solution it was unreasonable to believe that her brain had been returned to her body. He further emphasised that none of her organs were returned to her body.

COMPLAINT:

The requester (now the complainant) filed a complaint of the Hospital's decision.

The complainant indicated his belief that additional records existed based on the Ministry's letter dated October 17, 2001 which stated that "these investigations confirmed that there is no evidence that your wife's internal organs were retained by the hospital. On the contrary, the records indicated that only cells from some of your wife's organs were retained." The complainant indicated that he was seeking access to records regarding the disposal of his wife's organs after the autopsy was conducted. The complainant referred to the Hospital's decision letter which indicated that his wife's organs were returned to her body in accordance with the protocols of the time. The complainant stated that he had not received any records to substantiate this information and therefore believed that further Hospital records must exist.

Was this untruth relayed to me, by the Ministry a result of hospital ministry collusion or hospital misinformation to a gullible ineffective ministry bureaucrat. It should be noted that the Ministry sent a copy of the letter in question to the hospital. The hospital obviously agreed with the statement. These records, pertinent to my concerns, must have been in existence if honesty and truthfulness was an element of the Ministry’s ethics principals.

The complainant indicated that in January, 1987, the Hospital provided him with a package purported to be a complete copy of his wife's hospital records. The Hospital also provided a complete set of records to the College of Physicians and Surgeons (the College) for the purpose of a hearing before the Health Disciplines Board. The complainant stated that the set of records provided to the College by the Hospital was different from the one provided to him.

If you take another look at my initial letter of complaint, it was the counsel for the Health Disciplines Board that determined that the two sets of records were different. At the subsequent hearing the College agreed and the Board declared its previous decision to be null and void because of all the discrepancies, a previously unheard of result. I offered to provide the IPC copies of these further documents if more clarification was desired. While I considered, at the time, the discrepancies to be serious I attributed it to normal human error and evidence that I had been provided a copy of the record that was falsely or at best incorrectly attested as being complete. The hospital providing a copy of the hospital record for the above stated purpose, without believable explanation, gives the appearance of the possibility of serious wrong doing on the part of the College and the hospital.

Both copies of the record refer to other, in-house, records that were used in making the initial diagnosis. These records have never been provided.

The complainant stated that he wished to have access to all of the records that had not been provided to him in 1987.

RESULTS OF MEDIATION:

Initially, the Mediator had telephone discussions with both parties. Upon the filing of the complaint, the Hospital provided this office with a copy of its protocol dated July 6, 1989 which had previously been provided to the complainant. The protocol related to the disposition of tissue obtained at autopsy. In summary, it stated that any tissue which was further evaluation was returned to the body. Retained organs were kept until the report of the post-mortem examination was complete (about 3 4 months) after which time these organs would be incinerated. Small representative tissue sections of each organ were kept for a period of one year and then incinerated. The protocol also stated that in rare circumstances, organs which demonstrated unusual or particularly striking pathology were kept for the long terms within the department for teaching purposes.

Note again:   This is completely misleading. The hospital did not provide me with that protocol and had every reason to believe that I would never see it.

The Hospital confirmed that this was the general protocol in place at the time of the death of the complainant's wife. The Hospital confirmed that a specific record of inventory listing what was returned to the body was not kept. The Mediator conveyed this information to the complainant. During this discussion, the complainant raised questions as to what happened to his wife's internal organs, and in particular, her brain, after the autopsy was conducted. The Mediator relayed these questions to the Hospital and asked them to clarify in writing and in detail as to what happened to the internal organs after the autopsy.

What is the significance of, “The Hospital confirmed that a specific record of inventory listing what was returned to the body was not kept.”? An attempt to disparage my concerns? Refer to my letter of June 1 1992 to the hospital.

The Hospital responded with a letter to the complainant on July 5, 2005. The Hospital explained that they were informed by the Head of the Pathology Department that the practice in teaching hospitals in 1986, was to return the internal organs to the body following autopsy (except for small samples of tissue). The brain would be retained and fixed in formalin for at least a week prior to its examination. The Hospital explained that the reason for handling the brain this way was to optimize its preservation prior to examination.

The Hospital stated further that small samples of tissue would be encased in slides for microscopic analysis and these samples would be retained for the long term. Small samples would also be kept in formalin in case more extensive microscopic analysis was necessary and these fixed samples would subsequently be incinerated. The Hospital confirmed that slides of the complainant's wife's tissue, including brain tissue, were still in the Pathology Department. The Hospital again confirmed that it was not standard practice to maintain an inventory or record of what was returned to the body.

I interpreted this, along with the statement below, “The Hospital reiterated, in detail, its standard practice regarding returning internal organs to the body, except for small tissue samples...” as referring to “3. Small representative tissue sections of each organ are kept for a period of one year. The tissue is subsequently incinerated.”, in the often referred to hospital autopsy protocol. After discussing this with the mediator and the Director of Risk Management I arranged for a respectful internment of these remains. I was subsequently mocked for this conclusion, with the apparent assistance of the mediator, during the teleconference on September 14. Again, refer to my letter of June 1 1992 re “inventory”.

The complainant advised the Mediator that he wanted all of his wife's remains, even if it was tissue on slides and he would arrange for a funeral home pick them up. The Hospital agreed and the tissue slides were provided to the complainant.

With respect to the records provided to the College, the complainant continued to believe that the records provided to the College by the Hospital was different from the set that he had received. The Hospital advised the Mediator that they were unable to respond to the complainant's concern because these records were not retained and no longer existed. Therefore, the two sets could not be compared. The Mediator explained this to the complainant.

Again - it was the Health Disciplines Board and the College that came to this conclusion, not me. If the hospital is suggesting that they kept records, records that are no longer available, of this process, then this would tend to confirm that this act was a deliberate process and not an act attributable to innocent human error. I don’t know how that it could possibly be believably explained that the copies could no longer be compared because they no longer exist.

With respect to the complainant's issue that he wished to have access to all the records that had not been provided to him in 1987, the Hospital confirmed to the Mediator that it had already provided the complainant with all the records that they had relating to his wife but agreed to put this in writing.

The record that the hospital provided me clearly in themselves demonstrate that they are incomplete. This is a matter of fact not suspicion.

On July 15, 2005 the Hospital responded to this office in writing and provided details of further searches that were conducted in attempts to obtain information on records that may exist but that have not been provided to the complainant. The Hospital's searches included contacting ten named employees from various departments for records relating to the complainant's wife and particularly to the disposition of her remains following the autopsy in 1987. The Hospital confirmed that no additional records existed. The Hospital confirmed that at the time in question, the usual protocol was followed and that no records were kept regarding the specific disposition of any patient's remains at autopsy.

How meaningful is that absolute statement that no additional records exist when they also do not appear to have any reliable knowledge of what actual records had previously been provided.

The Hospital reiterated, in detail, its standard practice regarding returning internal organs to the body, except for small tissue samples and specifically, the treatment and retention of the brain.

In the same letter, the Hospital stated that in reviewing its correspondence with the complainant over the years, the complainant had been correctly advised that aside from small tissue samples, his wife's internal organs would have been returned to her body. The Hospital noted that it was only recently that the complainant was given information about the specific process for dealing with the brain and the likelihood that some retained tissue from the brain and other organs would have been incinerated. The Hospital expressed its deep regret over this breakdown in communication.

Is the IPC acting as the Hospital’s agent in relaying, “The Hospital expressed its deep regret over this breakdown in communication.”, the hospital has never tendered any similar regrets to me? Indeed they only appeared to express satisfaction that their response to my concerns resulted in my interpreting it to be a threat to my life.

The Mediator then had further discussions with the Hospital relating to the July 15, 2005 letter and the searches that were conducted. The Hospital advised the Mediator that the Public Hospitals Act required all medical records to be maintained for a period of 10 years after the date of discharge or death. Therefore, since more than ten years had elapsed since the complainant's wife's death, records might have existed but may have been destroyed.

The key point of interest would be the qualified “may have been destroyed”.

In an effort to resolve the complaint, the Mediator asked the Hospital to provide the complainant with a complete copy of any and all records in its possession. The Hospital agreed, stating that these would comprise the records in its Patient Records department, which were on microfilm. The Mediator conveyed this information to the complainant and explained the details of the Hospital's retention schedule. On August 31 , 2005 the Hospital provided a copy of these records to the complainant.

The Hospital was extremely specific that the above records were from the “Patient Records Department”, records in other possible areas were not included. IPC was a cc to this action.

The complainant advised the Mediator that he was still not satisfied with the searches conducted by the hospital and believed that further records existed.

In further efforts to resolve this complaint, the Mediator suggested a teleconference where the parties would have an opportunity to speak with one another and attempt to clarify any outstanding issues. The complainant and the Hospital agreed to participate and a mediation, via teleconference, was scheduled for September 14, 2005. The complainant was present. The Hospital was represented by its Director of Risk Management, the Head of the Pathology Department and the Medical Director.

During mediation, the parties had an opportunity to state their positions and the complainant questioned the whereabouts of further records. The Hospital reiterated the results of their various searches and confirmed that no additional records were found. The Hospital explained its policy regarding medical record retention and destruction. The Hospital confirmed that medical records for patients who had died at the Hospital were retained according to the Public Hospitals Act (10 years after death), after which time they would be purged for pertinent information, logged and irrelevant information shredded.

The Hospital agreed to send a copy of this policy to the complainant. No further mediation was possible. The complainant advised the Mediator that he would review this policy and then decide whether he wished to proceed with this complaint.

The copy that I received was a description of the protocol for destruction by the hospital. The apparent protocol was consistent with the procedures that I was familiar with and also appeared to be consistent to The Provincial regulations. I referred you to the specific Act on September 14. The hospital’s responses in providing information is not, and was not, consistent with the outlined protocol provided by the hospital.

Subsequently, the complainant advised the Mediator that he was not satisfied and wished to proceed with his complaint. The Mediator advised the Hospital of the complainant's decision.

ISSUES REMAINING IN DISPUTE:

ISSUE:    Reasonable Search

SECTION(s):    56(1) of the Act

November 8.2005

May 21, 1992

Attention: President and Chief Executive Officer

Sir:

Considering the passage of time since my wife's death, will the hospital reconsider and advise me of the location of her remains?

My wife died Sunday February 9, 1986. Because of the circumstances and lack of credible information I am not aware of the true time or cause of her death. Following her attempt to leave the ICU, after being declared dead and abandoned at 10:00 a.m., she was restrained and forcibly subjected to dubious pharmacologic treatment. Apparently, to ensure that she complied with the, newly repeated, medical advice that she was dead, she was subjected to a procedure euphemistically called an "autopsy". This was the procedure, I am led to believe, that all her internal organs, including her brains, were removed and subsequently incinerated.

In the spirit of human compassion would you, at least, provide me with enough information so that I might pay a symbolic visit to the general location of her incinerated remains?

1992 May 27

Thank you for your letter of May 21, 1992,

The Hospital does not have an incinerator, and does not incinerate body parts. Normally, after an autopsy is done, the remains except for small microscopic samples, are returned to the body for release to the family.

I trust that this information is useful to you.

Sincerely,
Executive Assistant to the Vice President (Medical)

June 1, 1992

Attention: President and Chief Executive Officer

Sir:

Reference: My letter to you dated May 21, 1992
            Letter dated May 22, 1992 and
            Letter dated May 27, 1992.

As I was attempting to determine the location of my wife's remains, the information contained in the May 27 letter is of no value to me. While the Hospital's normal procedures are of general interest, I obviously wish to obtain specific information on the actual disposition of my wife's remains.

In August 1987, my GP advised me that he had discussed the "autopsy" and the disposition of Jean's remains with the Vice President (Medical). He told me that he did not obtain any information relating to the discrepancies between the provisional and final autopsy diagnosis. He also said he was unable to determine the reason for the discrepancies between these reports and the hospital record. He advised me, that the best information that he could obtain from the Vice President (Medical), was that her organs were handled in the same manner as any organs or tissue removed from a patient during a surgical procedure. When pressed, he confirmed my worst suspicion, incineration.

My GP’s, the College's and the Board's comments, lead me to believe that my wife's remains did not receive the "normal" disposition referred to in letter of May 27. This belief is re-enforced by her not definitively stating that my wife received the "normal" treatment. There is not any reference, as to the disposition of my wife's remains, in the hospital records provided to me, by her, in January 1987. The protocol, outlined in the attached letter, certainly could not be practical unless a record of organ and tissue retention is maintained.

If my wife's body organs were returned to her body, following the procedure euphemistically referred to as an" autopsy", why was I led to believe that they were incinerated? Is this, a sadistic perverse game, routinely played by the hospital's senior medical staff?

Based on the circumstances, the letter appears to be patronizing and incomplete. Considering the availability of commercial incinerators in Canada and the U.S.A., the possession of an incinerator has little bearing on whether or not the hospital disposes of human remains by incineration.

There was no response to my concerns

December 19, 2005

On December 31, 2004 you wrote to this office asking for "assistance to obtain hospital records that [you] had been unable to obtain" from the Hospital. You had requested personal health records of your deceased wife under the Personal Health Information Protection Act~ 2004 (the Act).

In response, this office opened a complaint file and assigned the matter to a mediator, who investigated your complaint and sought to find a resolution. At the end of the mediation process, you continued to believe that additional information should exist, and you requested that the matter proceed to adjudication. Under the Act, the adjudication part of the complaint process is called a review.

Under section 57(4), the Commissioner "...may decide not to review the subject-matter of the complaint for whatever reason the Commissioner considers proper...." Under section 57(4)(a), a review is not necessary if the Commissioner is satisfied that the Hospital has responded adequately to the complaint. We have decided not to proceed with a review. This letter explains our reasons for this decision, as required by section 57(5).

Your complaint focuses on whether the Hospital had made sufficient efforts to locate the records you had asked for. Section 53(3) of the Act requires individuals making a request for personal health information to provide "sufficient detail to enable the [Hospital] to identify and locate the record with reasonable efforts" (my emphasis). In attempting to locate the information you seek, the Hospital must make "reasonable efforts." This standard is relevant in assessing whether the Hospital responded adequately to the complaint.
In assessing the Hospital's efforts, the background to your request under the Act provides relevant context. Your attempts to obtain information have spanned nearly two decades since your wife's death in February, 1986. We understand that:

        ●    before your recent request under the Act, you made an access request under the Freedom of Information and Protection of Privacy Act, which led to your appeal to us on March 2, 2004;

        ●    this was one of a number of repeated attempts to obtain health records for your wife which you believed existed;

        ●    those attempts included verbal and written contact with the Hospital, and complaints to the College of Physicians and Surgeons of Ontario;

    the Hospital provided you with a copy of your wife's file in 1987.

As a result of the mediation process that you participated in with this office, the Hospital searched for additional records, and located tissue slides in their Pathology department which were then provided to you. The Hospital also provided you with another copy of all of the relevant records in their possession. In addition, the Hospital explained that, in attempting to locate additional records during the processing of your complaint, they contacted 10 Hospital employees, three of whom were retired. In our view, these represent reasonable efforts to locate the records you are seeking.

In addition, during mediation, the Hospital provided you with a copy of their policy for medical record retention and destruction. This policy indicates that under the Public Hospitals Act, "...all medical records (are) maintained for a period of 10 years after the date of discharge or death", and that the "original inpatient component of the medical record will be maintained on paper for 5 years after which time the record will be photographed and the paper copy destroyed. The microfilmed copy will be retained indefinitely." Due to the passage of time in your case, your wife's paper records would have been destroyed pursuant to the policy, and the only possible location for records would be on microfilm; the Hospital had searched its microfilm records. Therefore, we do not believe that any further search would provide you with additional information.

We are satisfied that after you filed your complaint, the Hospital took significant and appropriate steps to attempt to locate the materials you seek, and in fact provided you with tissue slides and a further copy of records previously disclosed. In our view, this represents an adequate response to your complaint as referred to in section 57(4)(a). In taking these steps, we are also satisfied that the Hospital expended "reasonable efforts" to locate this material, as contemplated under section 53(3).

Accordingly, while we understand your concerns, we have decided not to proceed with a review of your complaint.

Assistant Commissioner (Access)

December 30, 2005

Information and Privacy Commissioner/Ontario
Tribunal Services Department
2 Bloor Street East
Suite 1400
Toronto, Ontario,    M4W 1A8

Your letter dated December 19, 2005

The timing of your letter was exceedingly effective to deliver the most destructive force to overshadow the normally peaceful atmosphere of this unusual season of joy that had occurred for three major religions. I never believed that the Information and Privacy Commission (IPC) would so blatantly misrepresent my submission, apparently it wasn’t even read, and randomly select mainly untruthful submissions from the hospital. I did believe that I could expect unbiased natural justice, but I do not perceive that I received anything remotely resembling unbiased natural justice.

I have had first hand experience dealing with the handling of documents slated for destruction, both of records where there is no discretion and those whose destruction is discretionary. Procedures were very similar with those apparently in use by the hospital. Logging or recording the destruction is a normal standard operation.

1. The hospital provided the College of Physicians and Surgeons (CPSO) a partial hospital record in 1986 and a partial hospital record to me in 1987. The contents of both packets were not the same, as determined by the CPSO and the Health Disciplines Board (HDB) . This was not my determination it was a determination by the of the CPSO and the HDB. I provided documentation to the IPC with my complaint and offered further if it was desired. Both the CPSO and the HDB advised me that the hospital conduct was not part of their mandate and could not respond to queries relating to the disposition of my wife’s remains. The IPC repeatedly alluding to the hospital record extracts that I received as being a complete record is very biased against my credibility. The IPC’s mediator noting that hospital, at the time, made copies of what was given to both me and the CPSO further corroborates that the packets were not complete records, and that the hospital required these copies to maintain a record of what was provided.

2. Immediately after receiving the partial records from the hospital I made two or three, unsuccessful, verbal enquiries to the Executive Assistant Vice President Medical, who had provided me a packet of hospital records and falsely attested that the packet was complete, about the disposition of my wife’s remains. This was the same individual who later claimed that “....... ...... Hospital does not have an incinerator and does not incinerate body parts.”. This apparently was one of the 10 Hospital employees that was contacted to assist in the processing of the complaint. Credibility?

3. I do not imply that the hospital was guilty of withholding material unethically as the standard of practice at the time gave a significant degree of discretion to withhold records at this time. I do feel that the hospital was unethical to attest that they provided a complete record when it was not a complete record. In 1992 the Supreme Court Of Canada clarified the requirement to provide records. There was now negligible discretion to withhold medical records. Even before the 10 year period that it was permissible to destroy records, I had made numerous requests for the obviously missing records even though I had not been aware of the Court’s decision. The hospital never provided the missing records. Were they then and still do believe them selves to be a law unto themselves? There doesn’t appear to be even superficial compliance with my request under “The Personal Health Information Protection Act”.

4. My past experience with the filing and retention of documents involved documents that had a compulsory set period of retention. These records had to be destroyed and their destruction had to be logged. Other records either had no rules governing whether they were to be retained or destroyed. The largest category of records were subjected to permissive destruction after a fixed period of time but there was a requirement to log the destruction as those slated for compulsory destruction. The rules for retention and destruction of “Hospital Patient Records” are in this category. If as an originator and custodian, I received an appropriate request for a record, a rapid referral to the file registry would rapidly locate the storage location of the document(s), its distribution history and determine its availability. If it had been destroyed, the details of the destruction would be readily available. If the document had been destroyed under rules governing permissible destruction, inquiries to entities on its distribution list could likely retrieve it as others could reasonably have different needs for the document that would not have subjected it to destruction. The Hospital distributed multiple copies of the record. The Hospital is the only legitimate custodian that could request information or copies from these entities. The hospital in limiting its search to a very extremely narrow storage section does not reasonably satisfy the requirement to locate the record. Indeed the material that, you note, was provided to me relating to their policy for medical record retention and destruction are not mutually consistent with one and the another. Here is one of many examples to illustrate my concern;

    A. Jan. 5, 1989 the CPSO requested the senior pathologist provide copies of his office records pertaining to my wife.
    B. Jan 30, 1989 he responded that he had no records or notes or recollection of the autopsy. The CPSO provided me copies of this correspondence. Knowing that my wife’s and my doctor was attempting to provide some answers to my concerns, by both verbal and written contact with him, that he would not discuss with me, I passed this information on to the CPSO.
    C. Feb. 3, 1989 the CPSO queried him on the discrepancy with no response.
    D. Apr. 28, 1989 the CPSO queried him again.
    E. May 16, 1989 he advised them that they had contacted him in his capacity as pathologist. He advised them that the perceived inconsistencies were that his dealings with me and my doctor were in his capacity as Vice-President (Medical) rather than his role as pathologist.

I did relay the details of this to the mediator before and after receiving the few pages of records that specified it was the complete record left in one specific record’s storage location, expressing my concerns that a proper search had not been carried out based on the implied limitations of the search as specified by the hospital.

5. I fail to see what significance there is to the number of persons contacted to assist in the search for documents. One credible researcher is of more value than 100 with doubtful loyalties to ensure the truth. The correspondence that I have received, in 2005, from the Hospital does not instill any confidence in what they have provided. ie;

    A. The Hospital’s letter dated 2004 December 16 stated: “In your previous correspondence with the hospital, you asked about the disposition of your wife’s internal organs following her autopsy. You were advised that they would have been returned to her body except for small tissue samples. My office recently reviewed this with the Head of the Pathology Department and confirmed that your wife’s organs would have been returned to her body, except for some small amount to tissue.” This patently untrue statement was followed by:

    B.   The Hospital’s letter dated 2005 July 5 stated: “The Head of our Pathology Department has informed me that, in 1986, the practice and custom in teaching hospitals was to return the internal organs to the body following autopsy (except for small samples of tissue) and to retain the brain. .............................
    ................... in keeping with the practice and custom at the time, .................. her brain would have been retained. Slides of brain tissue would have been made. The remainder of her brain would have been incinerated.” I still cannot see any truthful consistency between these two statements. No explanation has been provided. This statement though is suggesting that the previous information that none of her organs had been returned has merit.
Indeed, the perceived credibility of at least the five, covered in this letter, of the 10 individuals utilized to locate the additional records are of questionable integrity in matters relating to this search for information.

6. Your paraphrase of Section 53(3) does not seem to bear any significant relevance with that contained in the act.
My request was very simple and uncomplicated, “I do insist that copies of all documents relating to my wife, not included in the packet that I appropriately requested in January 1987, be provided to me without delay. Copies of subsequent pertinent documents should also be included.”. I further elaborated that I wanted these missing documents to enable me to pay a symbolic visit to the area where her internal organs were discarded, information that could have easily been compassionately provided after my first request. IPC correspondence indicates that the Hospital made copies of the excerpt records packets that they provided both to me and the CPSO.. If through some unknown reason either or both these packets were unavailable I could have arranged for replacement copies if I had been requested. I would have fully offered any known required assistance to assist the Hospital to comply with Section 53(3) If the request does not contain sufficient detail to enable the health information custodian to identify and locate the record with reasonable efforts, the custodian shall offer assistance to the person requesting access in reformulating the request to comply with subsection (2).

7. You portray the provision of tissue slides as an act of faith, by the Hospital, showing service above and beyond that what was required rather that the perverse sadistic action that it was. The Hospital stated that slides of tissue, including brain tissue, were still in the Pathology Department. I interpreted this with paragraph 3 of “Small representative tissue sections of each organ are kept for a period of one year. The tissue is subsequently incinerated.”, in the often referred to hospital autopsy protocol. After discussing this with the mediator and in accordance with 54(1)(a) thought that I had confirmed the relevance of the slides with the Director of Risk Management, I arranged for a respectful internment of these remains. There was no ambiguity in what I planned to do. I arranged for a Funeral Home to retrieve these remains and to make arrangements with the cemetery to prepare the grave site so that I could not be accused of committing an indignity to human remains.. I made separate arrangements for the presence of clergy. The Funeral Director contacted me to inform me that the Hospital would not release the remains until I called the Director of Risk Management for reconfirmation. There was absolutely no doubt about the significance that I placed on what the hospital convinced me that they were providing. I was subsequently mocked for coming to the conclusion that any significant quantity of tissue was provided by the Hospital, with the apparent assistance of the mediator, during the teleconference on September 14.

After rereading the IPC letter dated April 29, 2005 I assume that I am expected to understand that the IPC has decided to apply to itself the same standard of truthfulness that it applies to entities such as hospitals.

I do not accept that an honest and just resolution has been obtained.

if the hospital tells you the records have been destroyed
ask them for a letter stating the date and the reason
for the destruction of same

February 28, 2006

Information and Privacy Commissioner/Ontario
2 Bloor Street East
Suite 1400
Toronto, Ontario, M4W 1A8

IPC letter dated December 19, 2005
My letter dated December 30, 2005

Am I correct in assuming that the Commission’s letter of December 19, 2005, and the non response to my letter of December 30, 2005, are a subtle confirmation that a complainants’s concerns may be dismissed without the appearance of natural justice being obtained? If there is a perception that a reasonable standard of truth and respect for the rules and common sense has not been exercised by either the Commission or the Hospital, the Health Information Custodian, justice cannot be obtained. There must at least be a perceived, realistic attempt to address the concerns.

After enrolling in the Armed Forces for over 40 years, as soon as I reached the age requirement, after World War ll, I now feel that I have wasted a greater portion of my life if no explanation is forthcoming on the travesty of justice that I perceive that I have been subjected to with the apparent assistance of the Information and Privacy Commission.

Hopefully, I will be given reason to, again, be proud to call myself a Canadian Citizen.

March 8, 2006

I am writing in response to your letter dated February 28, 2006.

There is no appeal or reconsideration mechanism relating to the closure of health complaints under the Personal Health Information Protection Act, 2004 (the Act). Nevertheless, after reviewing your concerns, and reviewing our file, my decision remains unchanged.

I believe that your complaint has been dealt with properly and in accordance with our procedures. Unfortunately there are no other grounds to revisit this complaint. I believe that you have received the full and complete services of our agency and there is nothing more we can do to assist you. I can only suggest that you might consider seeking legal advice to inquire about other avenues of pursuit. I am sorry that we can do no more.

Current Patient Safety Initiatives in Canada

As I have not had any success up to now with what I perceive to be a system devoid of compassion I do not know if I can be of assistance to you.

The biggest shortcoming, that I think was my downfall, was that all my dealings with the regulatory and other quasi-judicial organizations was on my own with no backup. I would advise that no one is capable of dealing with these organizations on their own. If the matter is significant a competent legal expert in that field would be a great advantage but cost could be prohibitive to most. The next best alternative would be to have one or two intelligent and articulate mentors to provide you with unbiased detached advice and ensure that your arguments do not significantly get diverted.

While you can assume that the ombudsman case worker and/or mediator is unbiased, these individuals are human. Complainant's concerns that reach this point vary from trivial due to misunderstandings and communication breakdowns and serious due to innumerable causes and unethical cover ups.

Complainants acting on their own inevitably view the case worker as their advocate, at least for portions of the investigation. While I do not believe that this is the intent, it probably will occur. Informed mentors will/should minimize this danger by alerting the complainant when it begins to occur.

From my limited experience and observation, I do not believe that appealing any unsatisfactory dealings with a publicly funded non governmental entity is likely to achieve any successful results. Hospitals and other medical oriented groups are extremely loath to admit to any shortcomings on their part and essentially have unlimited funds to thwart any perceived threat. Take a look at this web log post. I am not aware that any significant, effective, attempt has been made to decrease the number of needless deaths caused by the current regulatory system ( look at this post). Canadian common law has evolved from English common law, is this post an indication of Canadian practice?

The entity against which a complaint is made will have a professional to deal with the matter. For example if it is a hospital, a "Risk Manager", previously a position that was facetiously named "Patient Ombudsman", would deal with the nuisance. I assume that similar positions would exist in many major organizations that could be approached by an official government appointed ombudsman. You will not normally be made aware of the substance of all the private conversations and correspondence that occurs between the professionals, the Ombudsman Caseworker and the Risk Manager. Professional courtesies are at play.

The Risk Manager can be expected to be an expert in assessing your vulnerabilities and if you are not careful you will be arguing facts that appear to be initially pertinent to your complaint but are not. This is a ploy to make you appear to be overly critical of everything and to paint the Risk Manager's organization as some one that is going above and beyond their duty to try to satisfy you. You will require support in this ensuing debate.

Click here to see a self explanatory sequence of events that might illustrate the results described above.

I hope that this is of some use to you.

Best wishes and take care.

Information and Privacy Commissioner