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Secrecy in Canadian health system a threat to patients, problem for journalists

January 21, 2014

By ALLISON RIDGWAY

Special to the RJRC

The day before he spoke to a Ryerson University audience on secrecy in the Canadian healthcare system, Robert Cribb received a package from Health Canada. Inside was a CD the Toronto Star investigative reporter hoped would contain information on a popular drug. Cribb says he’d asked for “relatively basic information” – information that he says shouldn’t have taken him more than an hour to access. Instead, it took a year.

To make matters worse, when Cribb examined the documents on the CD, he found they were covered in long bars of black ink. Why these sections were redacted and whose interests they’re protecting are a “mystery,” Cribb told the crowd of more than 100 Ryerson journalism students and faculty attending the Jan. 13 panel, “Medical Secrets: The Code of Silence Surrounding Canada’s Healthcare System.” What he does know is that, after a yearlong struggle with Health Canada over access to information, he’s left empty-handed.

“This is a scandal, by any measure,” Cribb said of Health Canada’s secretive practices. “The only thing that doesn’t make it a scandal is that no one seems to care about it. It seems impossible to inspire much public outrage about this, which stuns me. In Canada, we smile and nod and we say, ‘oh well.’ Too often journalists do that. We don’t appeal and we don’t challenge these ridiculous delays and denials. So, we get the government we deserve.”

The panel was part of a series of presentations on free expression and freedom of the press organized by distinguished visiting professor James Turk and the Ryerson Journalism Research Centre.

Even doctors have trouble accessing information from Health Canada, said fellow panelist Dr. Joel Lexchin, an emergency physician at the University Health Network and professor of health policy at York University. Lexchin, who is currently completing a book on health policy in Canada, recalled a 1996 test he conducted on Canadian doctors’ ability to access information about the drugs they prescribe. He and a colleague submitted an access to information request to Health Canada, asking for all files on the efficacy of drugs used to treat acute diarrhea – drugs the World Health Organization had recently warned against giving to children. They waited 19 months. When information on the drug Imodium finally appeared, it was less than helpful. The five-page packet included a title, table of contents, and two pages of column headings with all the data removed.

If Lexchin had needed this information to decide whether or not to prescribe a patient these drugs, he – and his patient – would have been out of luck.

Lexchin and Cribb painted a portrait of a drug regulatory system that is so overly secretive it puts patients at risk. With limited information on drugs available through Health Canada, doctors have to rely on the potentially biased information they receive from the drug companies themselves, rather than independent researchers.

“The bottom line is that Health Canada, in my view, prioritizes commercial interests of companies over public health,” said Lexchin. “People get sub-optimal treatment and get hurt.”

Health Canada is only one part of Canada’s secrecy problem when it comes to health organizations, said Cribb, who teaches an investigative reporting course at Ryerson’s School of Journalism. He and his colleague, Tanya Talaga, won a Michener Award for their 2006 Toronto Star series, “Medical Secrets.” The series examined the regulatory regime that governs doctors practicing in Ontario and found a lax and secretive medical regulatory system that failed to hold doctors accountable for malpractice. The series pointed to the College of Physicians and Surgeons of Ontario as another example of an organization that withholds information the public needs to know.

From 1996 to 2001, Cribb and Talaga found that the College investigated 13,000 complaints about doctors. Of those, 99 per cent were dismissed outright or handled internally and kept secret from the public.

One case involved Kenneth Bradley, who left his position as chief surgeon at Milton District Hospital in in 1994. Bradley was responsible for two deaths and at least four serious injuries caused by incompetence. He was found guilty in two separate College hearings and told he could no longer practice alone in Ontario. He did not, however, lose his licence.

“So what does a doctor do?” Cribb asked. “Does he work at a golf course, does he sell real-estate? No. He doctors.”

Convinced Bradley was a “clear and present danger” if he continued to practice medicine, Cribb and his colleagues at the Toronto Star searched for him in every province and state. They finally found him in Virginia, where he’d obtained a licence and was working as a surgeon. The College hadn’t warned the Medical Board of Virginia of Bradley’s past because of a “privacy concern.”

Another four patients died and two were medically mistreated under Bradley’s care in Virginia before he was brought before the Ontario College for a third appearance in 2002. He received a “behind-closed-doors” reprimand and his Ontario licence was pulled.

Despite the obstacles, Cribb says journalists can still bring about change. Following the Star’s “Medical Secrets” series, the province announced reforms requiring hospitals to release data on death and infection rates to the public, and also requiring medical regulatory colleges to make public findings, including malpractice, against their members.

In the meantime, Cribb says he is “beginning the long battle” to find out what’s hiding underneath the blacked-out portions of his most recent long-awaited Health Canada documents.

“In the end of the day,” he said, “if you are pursuing these kinds of records and data in the public interest, then you will win, because you are on the side of the angels. But you’ve got to buckle-in. It’s a ride.”

Allison Ridgway is a third-year journalism student at Ryerson University and former intern at The Peterborough Examiner and FoodShare Toronto.