COMMENT: In aftermath of Stittsville ‘lapse’, maybe it’s time to start inspecting clinics

Photo: Brown’s Independent, which contains the Main Street Family Medical Centre. Via Google Maps.

After news that 4,600 people (possibly including myself) may have been exposed to infection because of dirty equipment at a Stittsville clinic, I’m sure I wasn’t alone in wondering when it had last been inspected.

And I’m sure I wasn’t the only one who was surprised to learn that Ottawa Public Health (OPH) doesn’t regularly inspect medical clinics. (If you’re just learning this now: Surprise!)

“OPH investigates clinics on a complaint-basis and does not routinely inspect medical clinics,” said OPH spokesperson Donna Casey in an email. “Medical doctors are a self-regulated profession. They are responsible for upholding infection prevention and control (IPAC) standards in their own practice.”

That self-regulation didn’t help too much in this situation.

For 15 years, from December 2003 to April 25, 2018, there were numerous failures at this clinic in the cleansing of reusable equipment, medication storage (someone was even caught storing food in a medicine fridge), specimen handling, occupational health and safety and indeed general hygiene. Such “lapses” in hygiene common sense might be reasonable for a university dorm, but for a medical clinic they are truly astonishing.

You can read the full OPH report for yourself on their website.

It’s not clear who is responsible for the lapses, either. The OPH report only says that they involved at least one member of the College of Physicians and Surgeons of Ontario, which has now launched its own investigation.

How often do these lapses occur? There have been a handful of instances in Ottawa in the past two years — OPH has all the case reports on their website. These don’t only concern medical clinics, but also involve other settings such as dentist’s offices, labs and even nail salons; all places where services provided could transit infections.

One other lapse that stood out to me happened in 2016, at the Algonquin College Health Services clinic. The lapses there involved inadequate hygiene and reuse of tourniquets. There was not much accountability in that situation either; while it did involve members of a regulatory college, the issue was not referred to one because a specific member couldn’t be identified.

For 15 years patients in Stittsville were at risk of being infected with hepatitis C and B as well as HIV. How many more years would these lapses have continued if it were not for a sharp patient reporting their concerns to OPH?

Physicians in Ontario enjoy the privilege of self-regulation because we trust them to have our best interests at front of mind. This is a good system, but it could it be made better by more oversight in the form of inspections, either by public health agencies or a regulatory college on behalf of the public.

The College of Physicians and Surgeons of Ontario does have a clinic inspection program, but that applies to clinics performing more substantive work that involves anesthesia. Why not expand this to all clinics?

The only safeguard if a clinic or doctor is doing something improperly is if a patient complains to either the college or a public health agency. To their credit, both responded quickly and effectively to the problems at the Stittsville clinic.

The college is now conducting its own investigation into the clinic. In a general statement issued in the context of the Stittsville investigation, the college said it “may play an active role in ensuring the competence of physicians practicing there.”

So the public may be assured that the problems there won’t happen again. But this is reactive enforcement — couldn’t there be a more proactive approach? This could happen again at any clinic, anywhere.

Relying on patients to know when their family provider is doing something wrong is not a workable system. Regular inspections of clinics is a far better solution.


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10 thoughts on “COMMENT: In aftermath of Stittsville ‘lapse’, maybe it’s time to start inspecting clinics”

  1. As a Stittsville resident I visited this clinic a couple of times in the past and I was not impressed with the quality of service, particularly of one doctor that came across as totally incompetent. Now, this news shows how ineffective the city health bureaucracy actually is. If doctors are a self regulated body, those related to that clinic should be held fully responsible, and their License to practice should be taken away. It is simply unacceptable that this clinic remains operating.

    1. Completely agreed. There is not ONE competent individual at that clinic. My self as well as my son were misdiagnosed at the clinic previously and the level of rudeness of the staff speaks to how the patients are treated from the moment they walk in to the minute they leave. The clinic should have been shut down years ago.

      1. I disagree. The doctors have good bedside manner, they’re much faster than the AppleTree clinics, and I’ve never had a problem.

        I’ve always been friendly and courteous to them, and they’ve always been friendly and courteous to me.

        I’m guessing this story is making a mountain out of a molehill. I’m sure there were some cleanliness issues, and of course they must be addressed. But it sure looks like they’ve taken the maximum and correct precaution to ensure everyone is ok. Is everyone panicking over nothing? I’d love to know if anyone was actually infected with something as a result of these cleanliness issues. It’s been weeks and I haven’t heard anything yet.

  2. Ottawa public health is short staffed as it is even with that being a big issue public health is limited on what they can do 90% of the blame goes to Ontario.

  3. In my opinion the most concerning issue is that of reuse of single use items which I believe is also why one of my sons got a letter. I will say that I have full confidence in the competence of the doctors there.

  4. We all know that Ontario’s health care system in some areas is in a bad state. It is unfortunate that something like this can happen over such a long period with no-one complaining previously or monitoring the situation. One concern I would have is if our Councillor, Shad Qadri, as Chair of Ottawa Public Health, would have known that the complaint was tabled in April and the next day action was taken that he should have acted immediately and informed the public right away or in a more timely fashion. Especially as the clinic is located in his constituency and affecting ‘his’ residents. There is no excuse for allowing this to take so long before informing the public – April to July – come on! I have empathy for the Browns as they have nothing to do with it and their business name is always mentioned – unfortunate. Let there be a lesson in this.

    Auzzy

    1. Here’s the full statement the College gave us:
      “The College of Physicians and Surgeons of Ontario works closely with Public Health Units (PHUs) across the province to ensure that Ontarians are cared for safely. It is the College’s expectation that physicians practice in a professional manner, respecting all relevant laws and legislative requirements. Any time there are complaints about the cleanliness of a facility, the local PHU would review the concern and inspect the premises when appropriate. The College works closely with PHUs in these investigations and, depending on the individual situation, may play an active role in ensuring the competence of physicians practicing there.”

  5. These clinics should be regularly inspected since these are serious health risks. Presumably some of these infractions would have been caught if there were inspections.
    I just wonder how an inspection would catch the medical staff doing some of the things that are listed. Even for the patient to observe a mistake is dicey. Most of us wouldn’t know the proper procedures so how can we watch to see if they’re being followed.
    How would I know if equipment had been properly sterilized unless I saw the medical staff remove it from sterile packaging? I don’t know what is single-use and which things can be re-used. Once the nurse leaves the room with a blood or urine specimen, I have no idea what she’s doing with it. Does she wash her hands between putting the specimen down and getting my shot ready?
    A lot goes on out of the sight of the patient and we have no way of knowing if shortcuts are being taken. Does the health unit require that clinic staff are regularly retrained in health and safety practices? Is there even a guarantee that they had any training in the first place?
    I don’t know how a patient can evaluate the competence or carefulness of a doctor or other medical staff. In most cases, we have to take it on faith that the appropriate bodies, whether the health unit or the regulatory colleges for nurses and doctors, are overseeing the medical profession. Some people are going to get away with things and, as we see here, it can have a serious impact on your life if you encounter those individuals.

    1. People that are calling for them to be regularly inspected just keep in mind it will come and a step cost public health would have to hire 1500-2000 the avg salary is $45,000 so people better not complain about increase in taxes.

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