A version of this commentary appeared in the CBC News, Guelph Mercury Tribune and Hamilton Spectator

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We have all been there: it is 3am and your partner, child, sibling or parent becomes ill suddenly and needs medical care. Will they be safe?

The on-going Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System is shedding new light on the employment history of an Ontario nurse whose career in long-term care resulted in the murders of eight patients and attempted murder and/or assault of six more. While the Elizabeth Wettlaufer case is an extreme example of what can go wrong in health care, it should also serve as a warning to all of us about the issue of patient safety.

The inquiry, which began last week, has already revealed new aspects of the case.  One such detail is that Wettlaufer had a history of medical errors that went largely ignored. This is an important fact not just in this case, but in understanding patient safety more generally.

Canadians have a high level of trust in their medical system. A 2011 EKOS research study found 81 per cent of respondents believed they would receive the appropriate care if they were to become seriously ill.

While these findings suggest the highest level of public confidence in over a decade, research also suggests that medical errors are a common phenomenon in Canadian medical systems.

A 2016 report from the Canadian Institute for Health Information concludes that for every 18 hospitalizations, one patient will experience harm that was preventable. Yet the true number of errors is difficult to track because most studies rely on medical records or critical incident reports. Many errors are not captured with this methodology since records are often incomplete or errors are not recognized as official critical incidents.

In other words, the rates of medical harm may be much higher.  While disturbing, there are positive signs of change.

One important shift involves apology legislation that is now in place in most jurisdictions throughout Canada and allows medical professionals the opportunity to apologize for a medical error or mistreatment. Apology legislation allows for the issuing of an apology while still allowing patients the opportunity to pursue a lawsuit if they so choose. What apology legislation prevents, however, is the ability to use the apology as evidence of fault in a legal proceeding.

Reception of the legislation has been mixed, but it has been heavily advocated by numerous patient safety groups.

With funding from the University of Manitoba and the BC Law Foundation, we are conducting interviews with patients who have experienced medical errors or mistreatment to explore the impact medical apologies may have for those involved.  Our research shows that medical errors are not unusual and that patients often hit a wall of denial when trying to hold clinicians accountable.

Many patients we have interviewed are now personally committed to promoting safe, high quality health care. Some work with patient safety and quality organizations, some filed complaints with the College of Physicians and Surgeons, some wrote lengthy letters to administrators and others personally met with clinicians and administrators to demand changes.

The Wettlaufer case demonstrates a complete breakdown in accountability that resulted in senseless and tragic loss. Records from the inquiry show Wettlaufer was disciplined multiple times for harassment, failure to complete assigned duties, failure to meet the needs of patients and medication errors. Yet, she continued to work in the field.

Patients we interviewed often spoke of feeling dehumanized in current health care culture. They also emphasized the need to recognize the humanity of clinicians to allow for more open interactions and transparency.

If we want to find some meaning in these tragic events, we must remember that we are not different from the patients victimized in this case. Patients are not a small special interest group and we would benefit from remembering that everyone is, in some ways, a patient in waiting.


Fiona MacDonald is Associate Professor, Department of Political Science, University of the Fraser Valley.

Karine Levasseur is Associate Professor, Department of Political Studies, University of Manitoba. They are expert advisors with EvidenceNetwork.ca, based at the University of Winnipeg.

June 2018

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