2013-2014 Annual Report

Landlord and Tenant Board

Complaints about the Landlord and Tenant Board have been on the rise since 2010-2011 (when we received 99), and remained steady this year at 138 (down marginally from last year’s 139). Landlords and tenants raised a variety of issues, including poor customer service, clerical errors, and delay.

For example, four landlords complained to us about a “legal loophole” that enabled tenants to avoid paying rent for extended periods of time by making groundless appeals to the Board when they are ordered evicted. These landlords were owed thousands of dollars and could not pursue court claims against the tenants, who had left the province.

In a similar case that did go to court in 2012, Ontario Superior Court Justice Ted Matlow suggested the law be changed to require tenants to obtain a court’s permission before they can appeal eviction orders. He stated:

“[T]here is a growing practice by unscrupulous residential tenants to manipulate the law improperly, and often dishonestly, to enable them to remain in their rented premises for long periods of time without having to pay rent to their landlords. It is [a] practice that imposes an unfair hardship on landlords and reflects badly on the civil justice system in Ontario. It calls for the government, the Landlord and Tenant Board and this court to respond.”

Although the Board has the authority to require tenants to pay rent to it in trust, Board officials told our Office it is generally more expedient for tenants to deliver rent arrears directly to their landlords. Ministry of Municipal Affairs and Housing officials also told us it is not common for tenants to exploit the legislative framework in this way, and that changing the legislation to require tenants to seek leave to appeal would further delay eviction proceedings. Ombudsman staff will continue to monitor similar complaints about the Board.

We also spoke to the Board about complaints that signalled a need for better training of its adjudicators and staff. In one case, a tenant complained that an adjudicator made critical comments at a hearing about her landlord’s conduct and indicated an order would be issued in the tenant’s favour – but the Board’s written decision completely dismissed the tenant’s application. Ombudsman staff suggested the Board use the case in training adjudicators to emphasize that they should reserve their comments until a final decision is issued. In another case, the Board undertook to improve staff training after several landlords complained that the Board had provided them with the wrong forms, resulting in delays in having their issues adjudicated.

Office of the Public Guardian and Trustee

The Office of the Public Guardian and Trustee (OPGT) handles the financial affairs of Ontarians who do not have the capacity to do so themselves. It continues to be a leading source of complaints to the Ombudsman, with 180 complaints in 2013-2014, up from the past two years (162 in 2012-2013; 130 in 2011-2012).

As in previous years, the most common complaints relate to poor customer service, delays and communication failures, as well as disagreement with the OPGT’s decisions. Senior Ombudsman staff continue to meet regularly with OPGT leadership to discuss individual cases and potential systemic concerns.

In one case we raised, a man complained that the OPGT, which paid bills on his behalf, paid his telephone and Internet provider bills multiple times. The man was on a fixed income and was anxious about the unnecessary payments. We discovered this happened inadvertently because the man’s client representative was on an extended leave and the other employees who took over his file paid the bills without noticing they had already been paid. Ombudsman staff flagged this problem to OPGT senior staff. The OPGT assigned a working group of managers to review how files are managed when client representatives are on extended absences.

In another case, a woman and her social worker attempted unsuccessfully for five months to reach her OPGT client representative to obtain a document that would entitle her to see a naturopathic doctor at a reduced cost. After Ombudsman staff intervened, the OPGT apologized for the unreasonable delay.

Many OPGT clients, their family members and social workers are not aware that there is an internal complaint process and they can call management if they have not received a response or are dissatisfied. Our Office has raised this with the OPGT and suggested it make more information available to clients and the public.

Senior OPGT staff are working on several projects to streamline and improve their internal processes and service delivery. We will continue to monitor their progress in implementing these changes.

Services for children with special needs

Complaints about services and treatment for children with special needs remained relatively consistent in 2013-2014 – there were 89, down slightly from 91 the previous year, but considerably more than the 47 received in 2011-2012. Families raised concerns about an overall lack of funding and services available for children with special needs, as well as about policies, procedures and decisions regarding eligibility for such services.

Ombudsman staff worked with community agencies and the Ministry’s regional offices to connect families with available services and funds for their children. The Ministry also reorganized its regional offices and reduced their number, while promising more integrated service delivery for children and adults with special needs.

Ombudsman staff regularly flag urgent cases to senior Ministry officials. In one such case, when the mother of a nine-year-old girl with severe autism and aggressive behaviours told us the child was going to be discharged from a psychiatric unit without any support services in place for the family, we contacted a senior manager who had his staff arrange for short-term emergency support at the family’s home until a long-term plan could be developed. The local hospital then agreed to keep the girl for two more weeks while the necessary services were put into place, and ultimately she was assessed for a residential placement.

In another case, the mother of a nine-year-old boy with serious mental health issues contacted our Office after waiting eight weeks for the Ministry to approve her request for complex special needs funding – twice as long as she was told it would take. Immediately after Ombudsman staff contacted the Ministry, her funding was approved in full.

Family Responsibility Office

The Family Responsibility Office (FRO) is responsible for the enforcement of court-ordered child and spousal support in Ontario, and is consistently a top source of complaints to the Ombudsman. In 2013-2014, complaints were up significantly – to 1,157 complaints, 46% higher than the 794 received in 2012-2013. It is consistently the most complained about provincial organization, exceeded this year only by Hydro One – the subject of a Special Ombudsman Response Team investigation that accounted for 6,961 cases as of March 31, 2014.

As we have done for several years, senior Ombudsman staff meet regularly with FRO’s senior team to address complaint trends and egregious matters, and FRO managers have been co-operative, responsive and proactive in addressing the issues raised. Senior management at FRO have committed to improving their service and have welcomed the Ombudsman’s involvement, which has helped them not only resolve hundreds of individual cases but address potential systemic problems.

The most common FRO complaints we receive involve inadequate or delayed enforcement of support orders and insufficient communication with clients. For example, we discovered the FRO had not taken aggressive enforcement action against a man who owed $16,000 in child support, because he claimed to have a pending court action to have his support obligations changed. In fact, there was no such action and FRO staff had not verified it. Once they learned this was just a stalling tactic, they took aggressive enforcement action by suspending the man’s driver’s licence.

Ombudsman staff also noted a trend in FRO complaints involving inter-jurisdictional support orders – cases where the FRO works with outside enforcement agencies to collect support payments from payors who do not live in Ontario. We identified several incidents of communication breakdown in these cases.

Delay in registering one family’s case with an agency outside of Canada resulted in a lost opportunity to locate a father who owed more than $18,000 in child support. FRO officials made a series of mistakes in this case, including failing to file the proper paperwork in the father’s country for more than a year, and incorrectly informing the children’s mother that this had been done. By the time the FRO’s errors had been rectified and the file was properly registered in the father’s country for enforcement, he had disappeared.

As a result, FRO management engaged a consultant to review how interjurisdictional cases are processed. Ombudsman staff are monitoring the outcome of this review.

Examples of other FRO cases we have helped resolve can be found the Case Summaries section of this report.

FRO payment “assignments” to the Ontario Disability Support Program

Proactive flagging of FRO complaints also led us to uncover a grave miscommunication between it and the Ontario Disability Support Program (ODSP), that deprived families of hundreds of thousands of dollars over several years. The cases all involved people who were entitled to family support payments collected through the FRO, while they were receiving social assistance from the ODSP.

Under the normal process, these ODSP recipients enter an arrangement called an “assignment,” where the FRO forwards support payments collected from their ex-spouses to the ODSP. What we discovered was a communication breakdown in cases where the families were no longer receiving ODSP assistance. Because the ODSP failed to cancel the assignments, the FRO continued to forward the families’ support payments to the ODSP, and the money sat in an account.

One woman who complained to our Office did not receive 14 years’ worth of support payments – more than $8,000 in total – because FRO sent them to ODSP. She was never made aware that the payments were being collected or that she and her children were entitled to them.

Ombudsman staff raised this issue with the Social Assistance and Municipal Operations Branch of the Ministry of Community and Social Services. We learned that an employee there had manually reviewed ODSP records on her own initiative, and identified at least 350 similar cases.

To date, the Ministry has reimbursed these families more than $845,000, and senior officials have agreed to report back to the Ombudsman on how the Ministry will deal with cancelling “assignment” arrangements with the FRO when clients stop receiving social assistance. The Ministry’s plan includes reviewing its database to identify and reimburse any other former ODSP recipients who are owed money, improving staff training and ensuring that recipients with FRO assignments are regularly informed of the status of their support payments.
 

Thistletown Regional Centre – Adults with special needs

Last year, we reported on the Ministry’s plan to close Thistletown Regional Centre, a mental health facility that offered specialized services to hundreds of children and youths with complex special needs. It also provided residential care for 13 adults, some of whom had been there since early childhood.

Families of six of these adult residents complained to us about the decision to close Thistletown and relocate their relatives. As we reported last year, our review found the families were given inaccurate and inadequate information about the transition process. Ombudsman staff met with senior Ministry officials, who committed to improve communication with the families and confirmed that the residents would not be relocated until appropriate placements were found. The planned closure date was extended a year, to March 31, 2014.

By September 2013, two of the six adults were relocated, but serious concerns were raised about the others. A community agency was given funds by the Ministry to purchase a new group home for them, and met with the families to review the residents’ needs. However, the families complained that the home it purchased did not meet specific requirements, based on assessments of the residents, that it not be close to busy roads, bodies of water, or other residential dwellings with animals and children. An alternative location was found that satisfied the needs of three of the residents, but because it was close to water, the fourth family raised concerns that it would pose a danger for their relative, who had a history of running from caregivers and being obsessed with water.

The Ministry initially would not consider any other placements for the man and suggested he be cared for at home, although his parents were seniors and the man had not lived at home for 15 years. After Ombudsman staff raised concerns about this with senior Ministry officials, they agreed to look into establishing a new group home that would meet the man’s needs and accommodate other residents in future. A temporary placement was found for him in the meantime.

In a letter of thanks to Ombudsman staff, the man’s father wrote:

“He cannot say it himself so I will say it for our family. Thank you. You made no promises and we still have a long journey ahead, but you cared enough to listen.”

Correctional facilities – Complaints from inmates

The province’s correctional facilities have historically been a top source of complaints to the Ombudsman’s office. Combined, they accounted for 3,839 complaints in 2013-2014, down from 4,477 in 2012-2013. A breakdown of the top 10 most complained about correctional facilities can be found in Appendix 1.

Our strategy to ensure complaints from correctional institutions are dealt with quickly and efficiently has been to prioritize serious health and safety issues. These involve inmate concerns about the use of excessive force by correctional staff (the subject of last year’s systemic investigation report, The Code), prolonged or inappropriate segregation, inadequate medical treatment, and inmate-on-inmate assaults.

Many inmates complained to us this year about being held too long in segregation – normally, this means they are confined to a cell alone and separated from the general population. Inmates may be placed in segregation because they pose a threat to themselves or others, because of misconduct, or at their own request.

By law, (Ministry of Correctional Services Act, Reg. 778), all segregation placements must be reviewed by the correctional facility every five days, and a special report must be filed if an inmate is kept in segregation for 30 continuous days or more. But inmates complained to us that they were kept in segregation for months on end. Some felt anxious and even suicidal; several had pre-existing mental health issues, making them particularly vulnerable. We also found that in many cases, the facility did not conduct the required reviews – in fact, some senior staff were not even aware of the review and reporting requirements.

We reviewed a number of egregious cases with senior Ministry officials, who provided the Ombudsman with their plan to ensure segregation reports are completed as required at all correctional facilities. Ombudsman staff are closely monitoring complaints received and the Ministry’s implementation of its plan.

Medical treatment accounts for a high volume of inmate complaints – in particular, lack of access to medication or medical staff. Many complaints involve health care staff not communicating with community physicians, institutional doctors refusing to prescribe medications, missed or delayed medication due to lockdowns, and medication being cut off without an alternative. We also received a large number of complaints from inmates with serious mental illnesses who faced long waits to see a psychiatrist, and about a lack of services for female inmates with mental health issues.

One inmate who had painful kidney issues complained that she had to wait seven days after a nurse said she would be sent to hospital for an examination. After Ombudsman staff contacted the facility’s health care manager, the woman was immediately taken to hospital, where doctors recommended she be seen by a specialist.

Another inmate who had been taking morphine by prescription for nine months complained he was abruptly cut off the drug, causing him to go through painful withdrawal with no medical care. Our office confirmed with the Ministry that the man should have been prescribed alternative medication and monitored. They arranged for him to receive the proper medical attention.

While complaints about inmate-on-inmate assault have trended downward in the past year, we have monitored them to ensure Ministry policies are being followed. For example, in one case, we inquired why no internal investigation was done after an inmate was injured so badly by another that he required surgery to his face. We have also identified inconsistencies between correctional facilities in determining when to investigate such incidents.

The Ministry advised us that it has directed all facilities to conduct internal investigations at the local level whenever there are serious injuries in inmate-on-inmate assaults. We continue to track complaints on this issue and to monitor the Ministry’s actions.

Exceptional Access Program

The Ombudsman often receives complaints from people who have asked the province for help in paying for drugs that are not covered by existing programs. We received 34 complaints about the Exceptional Access Program (EAP) and the lack of a process to allow for individual patients’ needs for specific drugs.

For example, the Ministry denied a physician’s request for a specific medication in a granule format for a teenager who has complex developmental disabilities and receives food through a tube, because the drug was not on any of the Ministry’s approved formularies. It also denied two patients who needed an injectable, liquid form of Gravol to manage nausea related to Crohn’s disease, because it only approves the drug for patients in palliative care.

In another case, it denied a physician’s request to fund a drug that was helping a woman with a potentially terminal vascular disease (at a cost of $3,000 per month), on the grounds that there was not enough evidence that the drug was effective.

Although we have succeeded in persuading EAP officials to review decisions in some cases (see “The Right Prescription” in the Case Summaries section of this report), the evidence from these cases has raised the Ombudsman’s concern about whether the EAP truly addresses exceptional cases, where patients’ circumstances may not satisfy rigid eligibility criteria.

At present, there is no mechanism within the Ministry to review a drug funding request based on a patient’s individual circumstances, such as his/her age, multiple medical conditions, ability to tolerate certain medications or his/her physician’s specific recommendations. The Ombudsman is concerned about the lack of a mechanism to address these exceptional circumstances, and our staff have been monitoring the Ministry’s response to his concerns. The Ministry and Ombudsman staff continue to engage in discussions relating to individual circumstances.

At present, the Ombudsman is evaluating whether or not a formal investigation is warranted.

Community Care Access Centres

Ontario’s 14 Community Care Access Centres (CCACs) co-ordinate support services for people who require nursing services or assistance with personal care, such as help with dressing, eating, using the bathroom, etc., at home.

In 2013-2014, the Ombudsman’s Office received 122 complaints about CCACs – most regarding the number of hours of service offered and the service quality – and CCACs across the province have been highly co-operative with our Office in resolving individual complaints, to the benefit of many patients.

In one case, a CCAC reduced personal services for a 12-year-old girl with cerebral palsy, ADHD and a brain injury from 60 hours a month to 30, Ombudsman staff asked the CCAC’s client services supervisor to reassess her situation. The girl’s service hours were increased to 40 hours per month.

Similarly, we intervened after a CCAC informed a mother who was caring for her 21-year-old son (who needed help with dressing, showering and eating) that it was cutting his monthly service hours to 60 from 70 under new budgetary guidelines. The CCAC advised us that these measures were meant to apply to new clients; since the man was not a new client, the CCAC agreed to reinstate his service to 70 hours per month.

Natural Heritage, Lands, and Protected Spaces Branch

In last year’s Annual Report, the Ombudsman reported that the Ministry was looking at ways to address an inequity in the Aggregate Resources Act stemming from a complaint to our Office from an aggregate business operator. Aggregates – gravel, sand, stone, etc. – are used in construction projects, and under the Act, some designated geographic areas are subject to a system of licensing, monitoring, inspection and enforcement, while undesignated areas are not.

The operator’s complaint was that licensed aggregate businesses in designated areas are at a competitive disadvantage when bidding against unlicensed operators in undesignated areas. He argued the rules should be consistent across the province.

The Ministry’s policy initiatives were put on hold after the Ontario Legislature directed the Standing Committee on General Government to review and develop recommendations to strengthen the Aggregate Resources Act. The committee released its report in October 2013, which included 38 findings and recommendations, including improvements to public information on aggregate operations and the licensing process, as well as an increase in the annual fees.

In February 2014, the Ministry announced it would consult with stakeholders and the public on the recommendations, after which it will propose policy and regulatory changes. The Ministry confirmed to the Ombudsman that the issue of designation will be discussed as part of this process.

Licensing Services Branch – “Ghost Licences”

The Ombudsman first reported in 2011-2012 on the potential public safety implications of the Ministry’s practice of creating “master licence” records in its computer system. The purpose of these records is to store information about drivers for whom no existing licence can be found in the system. They are intended to serve as placeholders in the Ministry’s database, and wherever possible, they are matched with the driver’s official licence and the duplicate “master” is eliminated.

However, as we revealed that year in the case of one convicted drunk driver, if the information on the existing licence and the master licence do not match exactly – that is, if there is an error in the address or the spelling of a name – the duplicate record remains in the system. In the case of the drunk driver, this meant that when he was convicted and banned from driving, the conviction was added to the “master” record, not his existing licence – which he continued to use.

Our inquiries with the Ministry revealed that more than 1.1 million master licence records had been created since 1966 – 235,000 of which related to Ontarians (the rest were created to store information about out-of-province drivers). In 2012-2013, it identified some 13,866 of these as potential duplicates of current Ontario licences – of which 1,039[1] had been flagged for suspension. Of those, 138 were considered “high risk,” i.e., suspended for criminal offences.

Since then, the Ministry has confirmed 552 of the licences flagged for suspension had “master” duplicates in its system – that is, exact matches were found. Of those, 99 related to “high risk” drivers and 274 were “medium risk” (suspended for medical reasons). The Ministry contacted all affected drivers.

While recognizing the Ministry’s progress on this issue, the Ombudsman remained concerned about what he called “ghost licences,” since its manual review process was limited to identifying only those records for which an exact match could be found. It could not detect duplicates that had small variations in the spelling of drivers’ names or addresses. After considerable prompting from our Office on this issue, the Ministry agreed to ask the Ministry of Finance’s Internal Audit Division to conduct an independent audit of the licensing control system.

The audit, completed in March 2014, identified several problems with the Ministry’s legacy computer system and pinpointed areas within the master record process that are inherently prone to error and duplication. It made recommendations to improve the accuracy of Ministry records.

Ministry officials told us they are reviewing the recommended changes and their cost implications, and pledged to provide the Ombudsman with their timelines for addressing them. Once we receive this information, the Ombudsman will review it and determine whether or not a formal investigation is warranted.

Licence suspension letters

In another case with potential systemic implications, a woman complained that the Ministry had arbitrarily cancelled her driver’s licence without notification in August 2010, because she had failed to pay a $150 licence reinstatement fee. She had no knowledge of the cancellation until September 2013, when the Ministry advised her that her licence had now been expired for three years, meaning she would have to be retested and go through the graduated licensing process again if she wished to resume driving in Ontario.

Ombudsman staff reviewed the “Notice of Reinstatement” form that the Ministry sent the woman in 2010, after a temporary suspension of her licence. The form states in its first paragraph that the driver’s “authority to drive has been reinstated.” It is only in the fourth paragraph that the driver is informed there is a $150 fee for licence reinstatement. And the notification that failure to pay the $150 fee will result in immediate invalidation of the licence is on small print on the back of the form.

The woman noted that she continued to drive for three years – she had even been stopped by police and attended court for driving infractions – without anyone advising her that her licence was invalid.

Ombudsman staff spoke with Ministry officials about the confusing form and the lack of any specific notification to drivers whose licences are cancelled because of failure to pay the fee. The Ministry is working on improvements to the form. The Ombudsman will monitor its response and has not ruled out a formal systemic investigation.

Hydro One – Ministry of Energy

In the wake of a sharp spike in complaints about billing and customer service at Hydro One – complaints rose from 232 in fiscal 2011-2012 to more than 600 in the first 10 months of fiscal 2013-2014 – the Ombudsman launched an investigation in February 2014, into the transparency of the utility’s billing practices and the timeliness and effectiveness of its process for responding to customer concerns. By March 31, 2014, it had garnered 6,961 complaints, and the number continues to grow – the most complaints, by far, that our Office has ever received about a single government organization.

Hydro One customers across the province complained about receiving no bills, delayed bills, multiple bills or estimated bills covering prolonged periods – resulting in alarmingly high “catch-up” bills. Some customers who had automatic payment agreements with Hydro One were distressed when it withdrew unexpectedly large sums of money from their bank accounts. Many also found that when they complained to Hydro One – or even sought information on how their bills were calculated – they were met with more frustrating delays and poor customer service.

The response to the investigation announcement from the public, Hydro One and government was immediate. More than 1,500 new complaints poured in during the first four days. Along with the Premier and Minister of Energy, Hydro One’s CEO pledged full co-operation with the investigation. The CEO wrote to all Hydro One customers to acknowledge serious problems with billing and customer service, which he said arose from “unanticipated” issues with the introduction of a new system implemented in May 2013.
 

“I want to assure you of our complete co-operation. I have every confidence in Hydro One and the Ministry of Energy to provide detailed and timely access to any and all information that you require.”

Bob Chiarelli, Minister of Energy, letter to Ombudsman, February 12, 2014

“I was pleased to hear that you are launching an investigation into Hydro One’s billing and customer service practices. Hydro One complaints are among the most frequent cases that I receive in my constituency office…. I look forward to your final report, and I hope that your investigation will bring accountability and transparency to Hydro One.”

PC MPP Randy Pettapiece, email to Ombudsman, February 5, 2014

“This investigation, I hope, will help get to the bottom of why these bills are so out of whack.”

NDP Leader Andrea Horwath, quoted in the Toronto Sun, February 5, 2014

Since the launch of the Ombudsman’s investigation, Hydro One has implemented several short-term measures to alleviate problems. The CEO outlined these in letters to all MPPs and the Ombudsman in early April 2014. They included:

• Waiving late payment charges;

• Providing service charge credits and interest-free payment instalment plans;

• Pledging not to disconnect any customer for billing issues;

• Contacting customers before sending large or unexpected bills;

• Obtaining consent before taking an “abnormally large” sum from a customer’s bank account; and

• Setting a 10-day turnaround time for escalated complaints.

The investigation is progressing on two fronts, as Ombudsman staff deal with the broad systemic issues while helping thousands of people with their individual cases.

Systemic investigation: The Ombudsman set a deadline of nine months to complete the field investigation, after which a report and recommendations will be drafted. The Special Ombudsman Response Team has begun interviews with witnesses, who will include Hydro One staff, customers, stakeholders and utilities in other jurisdictions.

Other investigative steps taken to date include:

• Briefings on Hydro One’s billing and complaint handling processes;

• Site inspections at Hydro One call centres;

• Meetings with stakeholders and the Ontario Energy Board; and

• Obtaining and reviewing more than 19,000 pages of Hydro One documentation, with more to come.

SORT investigators are also reviewing recurring themes and problems arising from individual complaints, including:

• Lack of transparency in billing (how amounts were calculated);

• Lack of communication and delays in dealing with customers;

• Poor training of customer service and billing staff; and

• Inconsistency in how complaints are resolved.

Individual cases: A dedicated team of 10 Early Resolution Officers and Investigators is working with a team set up by Hydro One to resolve thousands of individual complaints as quickly as possible. In the first months of the investigation, staff across our Office worked to triage and respond to the extraordinarily high volume of complaints – identifying some 3,900 to bring forward to Hydro One for action. Examples of some of the cases that have been resolved can be found in the Case Summaries section of this report.
 

"Today I was able to phone the Office of the Ombudsman to inform them that they are able to close my case with Hydro One. Would like to thank all who helped.… It was wonderful to be able to go somewhere when I was unable to get any results myself.”

Complainant via Facebook

De-escalation direction to police – Ministry of Community Safety and Correctional Services

On July 27, 2013, 18-year-old Sammy Yatim was shot and killed – alone on a Toronto streetcar, where he had been seen holding a small knife – by a member of the Toronto Police Service. The incident, captured on video and widely shared via social media, sparked an outpouring of public concern about when, why and how police in Ontario use lethal force.

Among the questions raised: What de-escalation techniques are police across the province trained to use in such cases? After conducting a preliminary assessment, the Ombudsman launched an investigation on August 8, 2013 into the direction provided by the Ministry of Community Safety and Correctional Services to Ontario’s police services for de-escalating situations that could potentially result in the use of force.

As the Ombudsman noted at his news conference announcing the investigation, the issue has been raised repeatedly by juries at coroner’s inquests, but few of their recommendations have been heeded, and police de-escalation policies appear to vary widely across the province.
 

“It seems to be like [the movie] Groundhog Day: Inquest after inquest, police shooting after police shooting. What’s happened to all these recommendations in 20 years? Have they been gathering dust in some bin somewhere?

“Right now, how de-escalation happens in London, Ottawa or Toronto is as diverse as the cities.”

Ontario Ombudsman André Marin, at press conference announcing investigation, August 8, 2013

The Ministry has overall responsibility for policing in Ontario. Although it plays no role in operational decisions, it creates and implements guidelines that provide direction for police services on broad policy issues. For example, after a public outcry over a spate of deaths in police pursuits in the late 1990s, the Ministry introduced a regulation that stipulated how police services should conduct police pursuits, including mandating training for frontline officers and supervisors.

The Ombudsman has received 176 complaints and submissions relating to this investigation, including input from retired chiefs of police, serving officers, psychologists, psychiatrists and academics. The Ombudsman and staff have also met with family members of people who died as a result of police use of lethal force.

To date, SORT investigators have conducted more than 50 interviews, observed de-escalation training sessions at the Ontario Police College and by the Ontario Provincial Police, Durham Regional Police Service and the Peel Regional Police Service, and attended a recent inquest in Toronto into civilian deaths where de-escalation was an issue. They will also examine best practices in other jurisdictions in Canada and elsewhere.

Special advisors and co-operation of police: In November 2013, the Ombudsman appointed two distinguished former police chiefs as special advisors to the investigation, to share their expertise and advice on best practices and potential recommendations. Senator Vern White, former chief of the Ottawa Police Service and Durham Regional Police Service and former Assistant Commissioner of the RCMP, and Mike Boyd, former chief of the Edmonton Police Service and former Deputy Chief and interim Chief of the Toronto Police Service, have both offered their services pro bono.
 

“I welcome the chance to share my experience and that of the thousands of police personnel I’ve worked with at all levels, in an effort to improve how we serve the public.”

Michael J. Boyd

“The Ombudsman’s invitation to police chiefs to provide input in this investigation has significant potential to benefit all police as well as the public. I am glad to contribute my expertise toward this crucial issue as a way of giving back to the Ontario public.”

Hon. Vern White

As part of the investigation, the Ombudsman has also written to every police chief, police association and police services board across the province to invite their co-operation with and input into the investigation.

As of the end of March 2014, some 23 responses had been received from police chiefs, 11 from police services boards, and one from a police association. While some chiefs and police services boards have provided helpful information so far on their training and practices relating to de-escalation, most of those who responded declined, stating only that the responsibility for oversight of policing in the province lies with the Ministry. The nature of the responses received will be included in the Ombudsman’s final report.
 

“We are grateful that this investigation will further public dialogue on police procedures and acceptable de-escalation tactics, and that this inquiry will hopefully, finally, lead to the implementation, not just recommendation, of safe conflict resolution procedures.”

Statement by family of Sammy Yatim, August 8, 2013

Unlicensed daycares – Ministry of Education

When two-year-old Eva Ravikovich died in an unlicensed home daycare facility in Vaughan on July 8, 2013, police found there were 27 children in the provider’s care – far more than the allowed number of five.

After conducting a case assessment and receiving a complaint from NDP MPP Monique Taylor, the Ombudsman launched an investigation on July 15, 2013 into how the Ministry of Education (which is responsible for child care facilities) responds to complaints and concerns relating to unlicensed daycares.

In Ontario, about 78% of children are cared for in unlicensed child care arrangements. Often, these involve parents or relatives, but many are informal arrangements with unlicensed daycare operators, which are not monitored by the Ministry. For unlicensed child care, there is currently only one rule: There cannot be more than five unrelated children under age 10 in care, in addition to the provider’s own children. The Ministry is supposed to follow up on complaints about violations of this rule.

The Ombudsman’s assessment of what happened in Eva’s case determined that the Ministry had received complaints about the daycare, but it did not follow up on them.

The evidence-gathering phase of this investigation is now complete. It included interviews with more than 25 Ministry of Education staff, as well as numerous stakeholders, and a review of all complaints the Ministry received about unlicensed daycares with more than five children between January 1, 2012 and July 2013.

The Ministry has co-operated fully with the investigation, and in December 2013, the government tabled Bill 143, the Child Care Modernization Act, which aimed to strengthen oversight of unlicensed daycares through increased enforcement and penalties. However, like all other pending bills, it died on the order paper when the Legislature was dissolved on May 2, 2014.

The Ombudsman expects to release his report on this investigation this summer.

Adults with developmental disabilities in crisis – Ministry of Community and Social Services

The Ombudsman has received well over 1,100 complaints in connection with this investigation, launched in November 2012, into the complex issues relating to services for adults with developmental disabilities who are in crisis situations.

Because of the high volume of complaints and the urgent nature of many of them, Ombudsman staff deal with these cases on two levels: The broad, systemic issues continue to be handled by the Special Ombudsman Response Team, while Early Resolution Officers and Investigators work with individual families and public officials to resolve their situations wherever possible.

A key theme among the complaints is the apparent lack of planning or continuity of resources and programs for children with special needs when they become adults. Families complain of long waiting lists for appropriate placements for their loved ones, particularly when they are in crisis situations – such as when young adults’ behaviour becomes violent or requires specialized care that families cannot manage at home. In some cases, group homes are also unable to care for them because of a lack of resources, skills or training.

Several cases we have resolved in the past year have involved people in such situations being arrested by police and held in hospitals – often in psychiatric units – because there is nowhere else for them to go.
 

“You can imagine, if you are a parent, your child turns 18, and you can’t care for your child – you can’t provide the support for this child you’ve loved all their life. What do you do then? It’s extremely difficult for these parents to cope.”

Ombudsman André Marin, interview with Corus radio network, February 20, 2013

“Housing these people in hospitals and nursing homes doesn’t make sense. Many report that there is too much bureaucracy and not enough service. They feel like they are facing endless waiting lists.”

Deputy Ombudsman Barbara Finlay, interview with The National, CBC News, March 10, 2014

Families have also complained that the bureaucratic processes which must be navigated to access supports and services do not appear to be well equipped to deal with situations where health and safety are at issue. Many say they have experienced poor communication with developmental services organizations and assessment agencies.

The SORT investigation is focused on whether the Ministry of Community and Social Services is adequately responding to these families’ situations and whether it is doing enough to co-ordinate, monitor and facilitate access to services for their loved ones.

Systemic Investigation: To date, SORT investigators have conducted more than 220 interviews across the province, with adults who have developmental disabilities, their families, officials from the Ministry and Developmental Services Ontario, and other stakeholders. Tens of thousands of pages of documentation have also been obtained and reviewed.

In other developments, the government’s Select Committee on Developmental Services heard from families across the province about their problems in obtaining services, and issued an interim report in March 2014. The committee’s final report was delayed by the dissolution of the Legislature on May 2, 2014. Similarly, the government’s announcement of $810 million in new funding to assist people with developmental disabilities over the next three years was included in the May 1, 2014 budget; however, the budget – like all other pending legislation – died on the order paper when the Legislature was dissolved the next day.

The Ombudsman has begun the process of drafting his report and recommendations and hopes to release a final report in late 2014.

Individual Cases: As the systemic investigation continues, a dedicated team of Early Resolution Officers and Investigators has helped many families navigate the complex system of assessments and requests for service, placement and funding, as well as to obtain information about waiting lists. Senior Ombudsman staff have also worked closely with regional directors and the Assistant Deputy Minister responsible for community and developmental services to flag urgent cases and recurring issues. For example:

• A developmentally disabled 63-year-old woman, who had previously been sent to a hospital psychiatric unit and specialized treatment centre because of her violent behaviour, was residing in a group home when her family contacted our Office. The group home could not provide her with the supervision she required, so she was left alone in a basement apartment for several hours each day and sent to stay with her elderly, partially blind mother two weekends per month. At one point, she was arrested and handcuffed by police for slapping group home staff. After Ombudsman staff flagged the case to the Assistant Deputy Minister, the Ministry found resources to increase the woman’s supervision at the group home, and her behaviour and well-being improved.

• A young man with autism who could not communicate verbally was taken by police to a hospital after he injured respite workers. He also injured his father and was suspended from school. He was admitted repeatedly to hospital over a nine-month period when his behaviour became unmanageable. When a residential placement became available, the group home agency declined to accept him due to his behaviour. Our staff worked with the Ministry and a community agency that provided in-home support services so his father, a single parent, could continue working. He was later able to move to a specialized residential placement.

Other examples of cases where we have helped people with developmental disabilities can be found in the Case Summaries section of this report.

Better Safe Than Sorry – Ministry of Transportation – Monitoring drivers with uncontrolled hypoglycemia

On April 30, 2014, the Ombudsman released his report on how the Ministry of Transportation administers the process for obtaining and assessing information about drivers who may have uncontrolled hypoglycemia. This investigation stemmed from a tragic 2009 crash caused by a Hamilton driver experiencing severe uncontrolled hypoglycemia, in which three people were killed. Although the driver was immediately arrested and charged with dangerous driving causing death (and convicted in December 2011), the Ministry failed to suspend his driver’s licence until January 2011.

The Ombudsman launched the investigation in March 2012, after family members of the victims asked that he investigate how the Ministry monitors drivers with potentially dangerous medical conditions.

SORT investigators conducted more than 70 interviews, including with Ministry officials, Hamilton Police Service officers, family members of the victims, and medical experts. They contacted such stakeholders as the Canadian Diabetes Association, the Nurse Practitioner Association of Ontario, the Canadian Medical Association, the Canadian Council of Motor Transport Administrators, Diabetes Education Centres and the Canadian Medical Protective Association. As well, they gathered thousands of pages of documentation and reviewed national standards and best practices from other jurisdictions.

Social Media

The Ombudsman’s Twitter account (@Ont_Ombudsman) reached more than 20,000 followers as of March 31, 2014, and continues to grow. The Ombudsman tweets personally on this account unless otherwise noted, and uses Twitter to inform the public, share information about our Office, our work, and news of interest in the oversight field (for example, involving the MUSH sector). Events such as press conferences and speeches are also live-tweeted on the Ombudsman’s account with the hashtag #OOLive.

Our Office’s following on Facebook (2,894 likes) and YouTube (26,100 views) also increased in 2013-2014. The most popular YouTube video was the Ombudsman’s announcement of his Hydro One investigation, which had 950 views as of March 31, 2014. The Ombudsman also began using ScribbleLive to conduct live question-and-answer sessions after the release of the 2012-2013 Annual Report and OMLET Annual Report – these sessions are archived on our website.
 

“Congratulations. Your office’s use of #socialmedia is an example for open and responsive government to follow.”

@BorjeMelin via Twitter

“I like having the Ombudsman on Twitter. One could argue it makes the office more accessible.”

@MikeCBC via Twitter

“I must say, you and your office use Twitter very well. It makes a lot of sense for the Ombudsman to be active on social media.”

@AbdiAidid via Twitter

“Please do continue the great work via social media. The transparency is a great relief.”

@Mediacation1via Twitter

“I never thought about your office until Twitter. Thank you for doing this!”

@dkane_argyle via Twitter

Website and Mobile App

The Ombudsman’s website, www.ombudsman.on.ca, is a one-stop resource for anyone who needs to file a complaint, access the Ombudsman’s reports and videos, find news and information about our Office, or contact us through social media. Unique visitors to the website increased by 25% in 2013-2014, to 125,593. There were 185,758 total visits and 778, 283 pageviews, according to Google Analytics. Visitors came to the site from 179 countries.

There was also a sharp increase in visits to the mobile-optimized version of the Ombudsman’s website, or “mobile app,” which can be accessed via smartphone or tablet. The mobile site had 32,167 unique visitors – an increase of 126% over the previous year. The total visits were 42,756 and there were 94,087 pageviews.

Outreach

The Ombudsman was invited to speak at several events in 2013-2014, including at the 11th International Baku Conference of Ombudsmen in Azerbaijan, and the Financial Management Institute’s Public Sector Management Workshop in Toronto, both in June 2013, and Carleton University Alumni Association’s Ottawa Leadership Luncheon in November 2013.

Our Office was also represented at various outreach and community events involving, among others, the Ontario Bar Association and the law faculties of the University of Ottawa, University of Toronto and York University.

As well, the Ombudsman and staff participated in several charitable events, including the Pride and Remembrance Run in July 2013 and the Run for the Cure in October 2013.

Legal Aid Ontario

Ministry of Community and Social Services

Family Responsibility Office

Ontario Disability Support Program

Ministry of Community Safety and Correctional Services

Hydro One

ServiceOntario

The Right Prescription

A mother contacted the Ombudsman on behalf of her 14-year-old son, who suffers from sytemic-onset juvenile idiopathic arthritis, complicated with macrophage activation syndrome. Her son couldn’t take the drug normally funded and approved for the treatment of the first condition, Tocilizumab, because it can be dangerous to people with the second condition. Because of this, his physician had prescribed another drug, Anakinra.

The boy did well on this drug for seven months, thanks to funding from the SickKids Foundation and a limited supply provided by the drug manufacturer. The mother feared that when the supply ran out, the family could not afford the drug, which would cost them up to $20,000 per year. But the Ministry’s Exceptional Access Program denied their physician’s application to have it funded because it was not on its list of approved drugs for children, and an alternative (Tocilizumab), was available.

After Ombudsman staff raised the case with the director of the Ministry’s Drug Programs Branch and explained that the alternative drug was not an option for the boy, its expert advisory board recommended that the criteria for funding Anakinra be changed and posted online. The Ministry also approved funding for the boy’s medication under the new formula.

In the Neighbourhood

A man complained to the Ombudsman on behalf of his father, who was unable to receive rehabilitation services more than eight months after having a stroke in November 2012. Although the father’s doctor, cardiologist, and physiotherapist supported his application for rehabilitation therapy, he was turned away at three different hospitals because he did not live within their geographical catchment area.

When the man contacted the Ombudsman, his father was receiving only 30 minutes of physiotherapy a week, and family members had resorted to researching physiotherapy online so they could assist him with exercises themselves. Ombudsman staff pointed out to Ministry officials that provincial legislation prohibits hospitals from denying patients service based on where they live.

The Ministry escalated the matter to all the chief executive officers of the hospitals in the Local Health Integration Network, to make sure they all understood the legislation. As a result, the man was accepted into a rehabilitation program near his home.

Too Close for Comfort

In early 2012, the Ombudsman was contacted by Nickel Belt MPP France Gélinas on behalf of a constituent in Westree who complained that the Northern Health Travel Grant would not cover the costs of her accommodation in Sudbury, where she had a medical appointment, because she lived too close to qualify. The grant covers accommodation for northern Ontario residents who have to travel 200 kilometres or more for treatment; Westree is 193 kilometres from Sudbury.

Ombudsman staff raised concerns with the Ministry about the need for greater flexibility in the program in cases like the woman’s – who was required to stay overnight in Sudbury so she could take preparatory treatment for a colonoscopy the next day. For two years, Ministry staff assured our Office that they would review the program guidelines and create an internal appeal process, but progress was slow.

In April 2014, senior Ministry officials confirmed that the woman’s November 2011 application was being reassessed and an appeal process was being developed. Ombudsman staff will continue to monitor the Ministry’s review of the case and its progress on setting up an appeal process.

Have Business, Will Travel

An electrical contractor complained to the Ombudsman after the Ministry of Training, Colleges and Universities asked him to repay the $1,269 he received from the Ontario Self-Employment Benefit program. The program provides unemployed people with financial support while they develop and start new businesses.

During the man’s participation in the program, he was paid $423 per week while he set up a new contracting service, providing technical services and energy analysis to various industries. Although his new business was based in Ontario, some work required him to travel out of the country on short notice. The Ministry approved two such travel requests, but denied a third because the man had travelled outside Canada without prior approval. It ended his participation in the program when he refused to repay the funds he received during that time.

The man explained to the Ombudsman that he had responded to a client’s urgent needs and would have lost a valuable contract if he had waited three weeks for the Ministry’s approval. In addition, the job was more complex than anticipated and he was out of the country longer than expected.

Ombudsman staff explained the man’s circumstances to Ministry officials, and asked if there was any flexibility given the nature of the man’s work and the fact he had established a sustainable business, which is the objective of the program. In response, the Ministry agreed that the man didn’t have to repay the money he received while he was outside of Canada.

How do you spell relief?

A student complained to the Ombudsman after the Ontario Student Assistance Program (OSAP) denied his application for a provincial grant that would give him 30% off tuition for the 2012-2013 academic year.

The discount was available as a provincial grant for eligible full-time students attending a public college, university or OSAP-approved private post-secondary school, and any student applying for OSAP funding is automatically considered for the rebate.

OSAP officials told Ombudsman staff the student had been assessed as eligible for the grant, but it could not be approved because they were unable to verify the income of his mother, with whom he lived. It turned out that the student had misspelled his mother’s name on the application, meaning OSAP could not obtain the information it needed. However, the student was never told of the mistake; when he checked his application status online, he was only told it was “to be determined.”

Once the problem was explained, the student immediately provided the correct spelling and information. OSAP agreed to reassess his application and approved him for the 30% tuition grant and a loan, for a total of $1,960 in assistance.

Deadline Driven

A driver who suffered what he believed to be a seizure in April 2013 was diagnosed by a neurologist and, as required by the Ministry of Transportation, had his licence suspended pending a medical review. On October 28, 2013, his doctor faxed documentation to the Ministry to prove that he had been seizure-free for six months, and thus eligible to have his licence reinstated.

However, the Ministry never received the fax. When the doctor learned this and sent it again a month later, the Ministry told the man it would take another 30 business days to process. The man contacted the Ombudsman for help, saying he would lose his job if he did not have his driver’s licence reinstated by mid-December.

Ombudsman staff explained the situation to the Ministry, and the next day, its Driver Licensing Medical Review Section confirmed it had received the medical information and reinstated the man’s licence. The man was delighted, telling Ombudsman staff: “You’ve made my Christmas and you’ve made my job!”