Rosaria Giovanniello says when she was referred to a private clinic for cataract surgery, no one told her that the procedure was covered by OHIP, the government-run public health insurance plan for Ontario.
So when the 85-year-old grandmother was given a price tag of $8,000 for the “best” lenses by the private clinic she was referred to in September 2022, she paid it even if it meant taking a big financial hit.
“They said it was the top of the line, you don’t have to wear glasses,” she recalled. “And I figured, well, that’s what I want. I don’t want to wear glasses.”
Despite the high cost and lofty assurances, Giovanniello wasn’t satisfied with the outcome. She said it took more than a year-and-a-half for post-operative blurriness in her left eye to clear up, and that her eyes are now so sensitive to light that she has to wear sunglasses indoors on bright days.
Giovanniello’s daughter, Filomena Collia, said she was shocked to learn what her mother had paid for her cataract surgery, especially since her father had paid much less for upgraded lenses when he had his cataract surgery done through OHIP a few years earlier.
“(My parents) listen to the professionals. So if the doctor says something, they do it, they don’t question,” Collia said. “They don’t want to bother my brother and I to ask us questions all the time, but after the fact when I heard this, I said, ‘What’s going on?’ ”
Collia said she is now considering filing a complaint with the office of Ontario’s Patient Ombudsman, an agency set up by the province to help resolve concerns from citizens about their experiences in the public health system. In just the last fiscal year, the Patient Ombudsman’s jurisdiction was expanded to include the approximately 900 community surgical and diagnostic centres in the province, including ultrasound and X-ray clinics, and private eye surgery clinics of the kind Giovanniello went to.
According to the Patient Ombudsman’s latest annual report, the officer received some 4,429 complaints in the 2023-24 fiscal year — the most since it opened in 2016. This includes 76 complaints about community surgical and diagnostic centres, which are mostly operated on a private, for-profit basis.
The majority of the complaints about these centres were about clinics providing ultrasounds, X-rays and sleep studies, the annual report said, and concerns about these clinics’ communication when it came to responding to patient complaints and delays, as well as “insensitive, disrespectful care.”
Patient Ombudsman Craig Thompson told the Star in an interview that many of the complaints around these clinics had to do with delays in reporting test results.
“That is something we see in this particular sector and that is maybe unique because of the nature of the work they do. It’s very transactional,” Thompson said, noting that these clinics may not be used to a new accountability framework, such as the one overseen by his office, and therefore “sometimes their responses to complaints is uneven.”
Thompson’s report detailed a complaint concerning a patient who went to a clinic for an ultrasound and was told their doctor would receive the results within 10 days. After a few weeks, the patient’s doctor still had not received the results, and after following up with the clinic, the patient learned their results were sent to a different doctor. The clinic assured the patient that their results would be sent immediately to the correct physician. But the patient never heard back, and after beginning to experience symptoms again, the patient contacted their doctor, who reported that the results were never received.
As part of its response, the Patient Ombudsman reported the privacy breach to the Information and Privacy Commissioner of Ontario and reached out to the clinic to provide an opportunity to address the patient’s concerns.
Thompson said these clinics “run the gamut” in terms of size, from “very small operations to some multinational conglomerate-type operations.”
“So every one of them comes with a different type of rigour to the complaints process prior to our coming on the scene,” he said.
In early 2023, the provincial government announced an expansion of the use of private clinics to provide publicly funded procedures, such as cataract surgeries and joint replacements, in an effort to reduce backlogs brought on by the COVID-19 pandemic. This was in addition to the already 26,000 OHIP-insured procedures, such as endoscopies and CT scans, performed every year in what were known as “integrated community health services centres,” now community surgical and diagnostic centres.
In a statement to the Star, the Ministry of Health said 32,000 people received publicly funded cataract surgery at community surgical and diagnostic centres. The ministry added that the province has legislative provisions that prohibit patients being charged for an OHIP-covered service, and that if someone has been charged for such a service, they can contact the Commitment to the Future of Medicare Act program to open a review.
“Those who have been charged for an insured service will be reimbursed in full,” the ministry said, adding that the government will ensure that “people are accessing the health care they need with their OHIP card, never their credit card.”
Natalie Mehra, executive director of the Ontario Health Coalition, an advocacy group working to protect public health care, said that more than 70 complaints about community surgical and diagnostic centres heard by the ombudsman “is a lot given that the vast majority of patients don’t know they can make a complaint.”
She noted that complaints received by the ombudsman about poor quality of care, poor communication and patient records in the private clinics also reflects what her organization hears from Ontarians.
“In addition, we hear a lot of complaints about manipulative upselling, proliferating user charges and illegal extra-billing,” Mehra said. “The private clinics are owned by profit-seeking corporations and the evidence is that the corners cut to take profit out of our health system result in poorer quality.”
Giovanniello hopes that by speaking out, others won’t fall into the same trap. She said had she known that cataract surgeries in Ontario are covered by OHIP, she would have asked her doctor for the publicly covered lenses.
“That’s why I’m talking about it all the time,” she said. “I’m going to talk to everybody that needs a cataract removed.”
