Public Editor: Personal stories give crucial context to Ontario hospital crowding debate

A story earlier this week on elderly patients feeling pushed out of hospitals drew a rebuke from an emergency medicine and occupational medicine physician, Dr. Vimal Scott Kapoor.

The story was about an 88-year-old Ontario widower, Ilias Spanidis, who had been in hospital for almost a month when a doctor decided he was free to be discharged following treatment for a spinal fracture. His son disagreed and the dispute ended, according to the son, with hospital officials warning that if the father was not taken to the home they shared, an ambulance would drop him at a homeless shelter.

This was used as one example to show the overcrowding of hospitals in Ontario and Canada, and the efforts hospitals make to free up beds. But beyond the example used, the meat of the story was the data released through freedom-of-information requests obtained and analyzed by The Globe and Mail. It found that seven Ontario hospitals averaged occupancy rates above 100 per cent between 2012 and the end of last year. The article also included an interview with a lawyer from the Advocacy Centre for the Elderly in Toronto, who said that concerns about how frail seniors are discharged from hospitals are far and away the top reason people contact the community legal clinic.

This is a crucial subject of great public interest.

Dr. Kapoor argued that health care is a very complex subject and there are many factors to consider when a patient is discharged. He noted in an e-mail that hospitals struggle with capacity issues and that they must be able to admit new patients. "Your article … told one family's story, and only from their perspective. It is well-known that hospitals and health-care providers are bound by legislation that protects patient privacy and, as such, can never comment on any specific patient or their circumstances. You chose to proceed with your article knowing that you were only telling one side of the story."

He said that harm is done "to patients really in need, the system and the public, when the threat of going to the media, and unbalanced articles, drives health-care decisions as opposed to consideration of all the variables and the 'truth.'"

His point of view is important in this debate about how we can deal with crowded hospitals.

But I think he is wrong to criticize the article for using the example of Mr. Spanidis, as in Dr. Kapoor's words, "knowing that you were only telling one side of the story."

The hospital declined to comment on the specifics of this case for privacy reasons. In order to understand the privacy laws, I e-mailed the office of the Information and Privacy Commissioner of Ontario about whether a hospital could speak on questions other than personal health. The office responded with a statement that said: "The mere identification of an individual as a patient of a hospital is personal health information. Further, information about the transfer of a patient from the hospital to another facility would be considered personal health information as it relates to the provision of health care to the individual."

But, I wondered, could hospitals speak with the patient's consent to certain details? The privacy commission statement said: "Hospitals are only permitted to disclose personal health information with the consent of the patient or as permitted or required by the [Personal Health Information Protection] Act. Further, unless the disclosure is permitted or required by the Act, hospitals must obtain the express consent of the patient when disclosing personal health information to someone who is not a health-care provider (e.g., the media). While hospitals are not permitted to identify a specific patient or provide information from which an individual patient may be identified, they are certainly free to explain or clarify their policies, procedures and practices … in order to respond to concerns expressed about patient treatment. However, the Act does constrain the ability of a hospital to discuss a patient's treatment and care without their consent."

It is worth noting that Mr. Spanidis's son was willing to provide the consent, although it is the elder Mr. Spanidis who must give consent. The reporter said she offered to hold the story to give the hospital time to seek his consent through a Greek interpreter, but the hospital declined.

It is important that when corroborating evidence is not easily gathered, such personal stories need reporting to back them up. In this case, not only were experts quoted on the issue of overcrowded hospitals and complaints about the pressure put on some residents, but the police were contacted to confirm the details of their meeting with the patient. This from the story: "(A spokesman for York Regional Police confirmed that three officers were dispatched to Mr. Spanidis's room, essentially to 'referee' the discussion. No charges were laid.)" Mr. Spanidis's son also had a detailed timeline of the events around his father's stay, which was backed up by key facts.

In such an important issue in the public interest, it is extremely helpful for readers to see a real example of the struggle to open beds and to hear from the son. And while the hospital said it could not say more about this specific case because of privacy reasons, it was given the opportunity to respond. A spokeswoman for the hospital described the challenge of a near-100-per-cent capacity and said they would "never discharge a patient who was not medically stable or who still required hospitalization."

I was at a talk Wednesday morning at St. Michael's Hospital in Toronto by Globe health-policy columnist André Picard, who was describing another story about patients. "It is important to bring medical stories to life with patients. That is what impacts policy. You are never going to convince anyone with statistics."

He is right. That is what you remember – the very real-life example of the impact of overcrowded hospitals on a fragile senior. The public interest in that story is very high. The story of Mr. Spanidis was described by his son; the larger story is about the incredible pressure on both hospitals and family members , but it would not be well understood and felt without Mr. Spanidis's example. And the alternative, of not allowing patients to speak freely and publicly to the media about their own experiences when hospitals don't comment, is not acceptable.