Social Policy in Ontario

Hospital bosses in Ontario are attempting to exert more control over doctors, with new bylaws that would limit what they can say publicly and curtail their decision-making authority over patients.

The Ontario Hospital Association’s move to rein in these professionals has escalated tensions with doctors, who say the bylaws are an attempt to muzzle any criticism of management and give them less say in decisions while increasing the powers of the chief executive officer.

The bylaws prepared by the association, which represents the province’s 155 hospitals, stipulate that doctors cannot engage in any conduct that would adversely affect a hospital’s “reputation or standing in the community,” and must raise any concerns through proper channels, including the chief executive officer or board of directors.

Failure to comply with the new bylaws can be grounds to suspend a doctor’s hospital privileges.

The new bylaws come at a time of enormous pressure on the health-care system that is changing the relationship between hospital bosses and doctors. Many hospitals are in the throes of controversial restructurings as they struggle to reduce operating costs. Health care officials say hospital administrators are seeking to impose strict confidentiality provisions on doctors just as these institutions are facing increasing scrutiny over cuts that affect patient care.

The gag order is not the only point of contention. In a bulletin obtained by The Globe and Mail, the Ontario Medical Association accuses the hospital association of pursuing an agenda to reduce the role doctors play in decision-making.

“The deteriorating relationship between hospital administration and physicians is a prominent concern,” Mark MacLeod, OMA president and an orthopedic surgeon at Victoria Hospital in London, Ont., says in the bulletin sent to members on Tuesday.

Dr. MacLeod says the hospital association is encouraging hospital boards to adopt new bylaws that it drafted without any input from doctors. Until now, the two associations had worked together over the past 60 years to develop bylaws.

“We see that as a breakdown in a collaborative process,” Dr. MacLeod said in an interview on Tuesday.

Tom Closson, president of the hospital association, said the two groups initially set up a task force to draft the new bylaws but talks broke down.

“They felt uncomfortable with the direction the task force discussions were taking and they pulled away,” Mr. Closson said in an interview.

This is the first time the hospital bylaws have been updated since 2003. Mr. Closson said it was important to clarify the relationship between a doctor and a hospital because of all the changes in the health-care system. Many hospitals are now in the process of adopting the new bylaws, he said.

But doctors regard the bylaws as part of a broader shift to reduce their roles while, at the same time, to increase the power and authority of hospital administrators. The medical association outlined its concerns in its written response to the new bylaws.

A doctor’s rights to access hospital resources would be restricted. The bylaws define a doctor’s privileges as the right to admit patients and provide clinical services. But the medical association says there is no mention of giving doctors access to operating rooms, diagnostic equipment and other hospital services.

As well, doctors would have to be part of hospital committees, giving administrators more control over their time and role within the institution, the response says.

As for the gag order, the medical association says it is effectively designed to silence opposition to decisions made by a hospital board. The association asks whether a doctor would violate his duties to a hospital by writing a letter to a local newspaper, arguing against a new strategic plan.

“We’d like physicians to continue to have an opportunity to speak out on issues of quality and patient care within their institution,” Dr. MacLeod said in the interview. “Efforts to minimize that … won’t help the system.”

< http://www.theglobeandmail.com/news/national/doctors-fear-new-hospital-bylaws-will-keep-them-silent/article1565635/ >