COMMENT: Stittsville clinic mistakes were more than a 'lapse'

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?

Got a letter today.

My 4-year-old son needs a fucking HIV test. Let that sink in. https://t.co/PyX7basFXQ

— Craig Medaglia (@craigmedaglia) July 19, 2018

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.

This article was originally published on our sister site StittsvilleCentral.ca.