Friday, July 4, 2014

Accountability: Platitudes are Poor Substitutes for Making a Wrong Right

One of the flaws of our healthcare system, is a lack of true accountability for when it fails to meet the needs of patients. The best most patients can hope for when they suffer a lack of access to timely care in Canada is often nothing more than platitudes. It is about the extent of what I got after I complained to the Patient Care Quality Office after the birth of my daughter. I then discovered that to hold the system "accountable" in a meaningful way by pursuing litigation was not viable: the damages I suffered simply could not justify the cost and risk of pursuing litigation. For myself, pursuing litigation wasn't about recovering money, it was about affecting change. It was about working to help other women to avoid having the same experience. It was about the other part of meaningful accountability - the part that comes after "I'm sorry" - the part where the wrong that was done is "righted" to the degree possible.

And it is that second part that for many victims of the health system that never comes. The wrongs that are done are not righted to the degree possible. Most patients are left with the cold-comfort of platitudes and are asked to bear the cost of the harm and moving on from the harm on their own. It is not right, but it is the way things are, in Canada, in 2014.

It is the way things are for Kate Austin-Rivas and her family. Kate Austin-Rivas was happily expecting her second daughter in October 2013 and went to the Royal Columbian Hospital in New Westminster, BC to deliver her child. Due to lapses in care and ultimately lack of timely access to a Cesarean, Kate suffered a uterine rupture and her baby, Ireland was born severly Oxygen deprived and irreverseably brain damaged. Unfortunately, Ireland died three weeks after her birth, leaving behind a void in the Austin-Rivas family. The Austin-Rivas family complained about the care they recieved to the Patient Care Quality Office and ultimately got an apology, however, have discovered (like many patients) that recovery of the damages for the harmed caused is not possible.

If the health system was truly accountable, it would have to do more than merely apologize to the Austin-Rivas family of Port Coquitlam, BC. It would cover the costs associated with righting the wrong (to the degree possible) that was done to them - the costs of therapy for PTSD and the costs associated with a surrogacy or adoption so that the Austin-Rivas family could complete their family in the wake of the loss of their baby. That would be the reasonable and right thing to do: however, the system isn't set up for that kind of accountability. Meaningful accountability. Rather the Austin-Rivas family has been asked to be satisfied with platitudes from the system and are doing what they can, on their own and with help from outside of the system that caused them harm, to move on from the tragic loss of their daughter.

The Canadian health system may not be burdoned by the high costs of malpractice claims, but there's a good chance that those costs are unfairly placed squarely on the shoulders of the patients who have been harmed by the system. Further, by not bearing the costs of poor-performance, what incentives does the health system have to ensure timely access to quality care?

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