in 2022-23<\/a>.<\/p>\nDesperate measures and a \u2018pain crisis\u2019<\/p>\n
Ontario Health atHome completed its consolidations on Sept. 24, 2024, moving from 65 medical supply contracts to 15, including just two main purchasers.<\/p>\n
Internal memos and health-care workers\u2019 notes show the crisis began almost immediately.<\/p>\n
By early October, an agency memo noted a \u201chigh volume of urgent orders\u201d for antibiotics and symptom response kits (SRKs) \u2014 packs of medication to manage acute end-of-life symptoms like pain, nausea and anxiety.<\/p>\n
Weeks later, the southwest region was seeing \u201clate or only partial deliveries\u201d of SRKs, according to a summary of health-care workers’\u00a0notes at the time.<\/p>\n
\u201cOne resulted in a pain crisis for a palliative client,\u201d the notes read.<\/p>\n
Over the next month, the agency\u2019s system logged 1,562 \u201cincidents,\u201d according to a memo OHaH prepared for the Ministry of Health.<\/p>\n
\u201cA key theme,\u201d the memo read, \u201cwas incomplete supplies and missing doses causing distress prior to succumbing to illness.\u201d<\/p>\n
\u201cIn three known cases, palliative patients died without pain medications and one patient died without nutrition because supplies were delayed,\u201d it said.<\/p>\n
Palliative care is mainly about \u201ckeeping a person comfortable,\u201d said Jane Meadus, a lawyer with the Advocacy Centre for the Elderly (ACE), in an interview with The Trillium.<\/p>\n
Without medication, the end of one\u2019s life can suddenly become filled with \u201ca lot of pain,\u201d and a loss of dignity, she said.<\/p>\n
The crisis wasn\u2019t limited to end-of-life care. As the supply chain fractured, standard medical equipment became scarce, then disappeared, driving nurses and patients to desperate measures, detailed in notes from health workers in every part of the province.<\/p>\n
Soon after the transition, service providers had to raid their community clinics\u2019 stockpiles of supplies, leaving them \u201c[severely] depleted,\u201d according to an OHaH briefing note.<\/p>\n
With little to no supplies left, clinics sent patients to emergency rooms to get IV antibiotics. However, some refused \u201cas they cannot afford [the] ambulance fee\u201d of $45, another issues summary read.<\/p>\n
As the shortage deepened, health-care workers detailed how they were forced to improvise.<\/p>\n
In Toronto, \u201cwreath hangers [were] sent to client homes as [a] substitute for IV poles.\u201d<\/p>\n
In Hamilton\/Niagara, a nursing manager \u201cwent to [redacted] and bartered supplies\u201d so the clinic didn\u2019t have to turn patients away.\u00a0It\u2019s unclear what the nurse traded, and with whom.<\/p>\n
Months after\u00a0shortages began, patients were still being sent \u201cincompatible\u201d or \u201cpoor quality\u201d substitutes that had to be thrown away, health workers wrote.<\/p>\n
Nurses complained of leaky catheter bags and incontinence pads, poor-quality gauze, tape and injection kits, and \u201cexpired supplies,\u201d like the anticoagulant used to flush intravenous lines and prevent blood clots.<\/p>\n
Eventually, critical supplies ran out. Catheter bags and nephrostomy bags, which hold urine drained from the kidneys, were on backorder, and no amount of bartering or creativity could help.<\/p>\n
Some patients were left with only one choice.<\/p>\n
\u201cClients having to reuse supplies as there are not enough appropriate [nephrostomy] bags available,\u201d read\u00a0a note\u00a0from early December 2024.<\/p>\n
Health worker notes from different parts of the province also revealed a lack of co-ordination.<\/p>\n
In the southwest, patients\u2019 orders for nephrostomy supplies were \u201cchanged\u201d to catheter supplies \u2014 while at the same time, in Hamilton\/Niagara, orders for catheter supplies saw nephrostomy supplies delivered instead, according to health worker notes.<\/p>\n
Multiple patients received orders meant for others, which \u201cthen cannot be returned,\u201d according to several health worker notes.<\/p>\n
Sometimes, clients received what they thought were supplies, but turned out to be IOUs.<\/p>\n
\u201cClients are receiving empty boxes with notices indicating that their supplies are on backorder,\u201d wrote Deborah Simon, then the Ontario Community Support Association\u2019s CEO, in a letter to Cynthia Martineau, OHaH\u2019s CEO at the time.<\/p>\n
Other supplies were marked as delivered, but never showed up, Simon wrote \u2014 an issue noted multiple times by health workers.<\/p>\n
One delivery arrived at 2 a.m., causing a patient to think \u201che was being robbed,\u201d according to health worker notes in Hamilton\/Niagara.<\/p>\n
One regional summary\u00a0describes\u00a0the bureaucratic hell health workers had been wading through for weeks. Nurses had \u201cno visibility\u201d into what was in stock, read the\u00a0November 2024 notes.<\/p>\n
\u201cIf supplies are ordered by [a] nurse and they are out of stock, OHaH will just remove them from the nurse’s order with no notification to [the] nurse or client. The supplies are just not delivered and no substitute is provided,\u201d the notes read.<\/p>\n
The ordering system caused false hope for some patients, as supplies were sent to clinics with patients\u2019 names on them, when they were meant for the clinic itself, the summary reads.<\/p>\n
\u201cClients are being called to pick up their orders when it’s a nurse’s replenishment order,\u201d the notes read.<\/p>\n
An \u201cescalation line\u201d set up by OHaH the month after the crisis began was supposed to provide answers for patients and care providers.\u00a0<\/p>\n
It was quickly overwhelmed.<\/p>\n
Health workers wrote that there was \u201coften no answer\u201d from the line, and when someone did pick up, it could take 45 minutes or more to get through. When they did, those staffing the line sometimes evaded questions or refused to give out information without patients\u2019 billing reference number, a bureaucratic signifier \u201cwhich patients often don’t know,\u201d the notes read.<\/p>\n
Meadus said organizations and governments have to take a hard look at what they could lose when they change from small, \u201cnimble\u201d contracts to much larger ones.<\/p>\n
\u201cHealth care isn\u2019t just about the dollars we spend,\u201d she said. \u201cIt\u2019s about quality.\u201d<\/p>\n
Notes and memos can\u2019t fully capture the human cost of the crisis, added Meadus.<\/p>\n
\u201c(You have) increased pain, you’re not getting wound care, so does that mean that the wound is getting infected? Is it staying longer?\u201d she said.<\/p>\n
\u201cIt just wears on the psyche of people,\u201d she said. \u201cYou’re already sick, you already have issues, and now you’re having to try to battle a bureaucracy, and I think that many people just don’t have the wherewithal or the ability to do that.\u201d<\/p>\n
Children’s medical supplies missing<\/p>\n
The crisis appears to have affected not just seniors but pediatric patients as well.<\/p>\n
Several regional formularies, or approved lists of medical supplies, were combined into one under the new system \u2014 but evidently, important items for children were left off, forcing the agency to ask Toronto\u2019s Hospital for Sick Children (SickKids) for help.<\/p>\n
An OHaH memo written two weeks after the changeover said the agency was \u201cworking with our suppliers and vendors\u201d to add supplies to its formulary.<\/p>\n
\u201cIn the meantime,\u201d OHaH asked SickKids to supply the missing items from its own stockpile \u201cto avoid delays in discharge and support health system flow.\u201d<\/p>\n
The agency worked with SickKids and other pediatric hospitals \u201cto review and identify gaps in the formulary for hospital-based pediatric supplies as well as create a pediatric urgent care kit,\u201d according to an OHaH memo.<\/p>\n
The formulary was finally updated on Dec. 17, 2024, nearly three months after the crisis began. A type of catheter, insulin syringes and blood thinners were added, the memo reads.<\/p>\n
In a statement, SickKids said it \u201cregularly collaborates with Ontario Health atHome on initiatives related to home care for children and youth being discharged home from the hospital.\u201d It did not answer questions about how pediatric patients were affected by the shortages.<\/p>\n
SickKids and OHaH did not say what was in the pediatric urgent care kit, or why the agency scrambled to create one.<\/p>\n
No turning back<\/p>\n
Signs of trouble appeared months before the new system launched.<\/p>\n
It was supposed to go live in June of 2024, not September. But the date was pushed back after vendors requested \u201cadditional time to get ready,\u201d according to a November 2024 memo from Martineau, the then-OHaH CEO.\u00a0<\/p>\n
Medical supply providers (MSPs) \u2014 the vendors that buy items directly from manufacturers \u2014 got a two-month extension, to Aug. 12, 2024.<\/p>\n
Fulfillment and infusion service providers, which buy the medical supplies from the MSPs and deliver them to patients\u2019 homes, were given until Sept. 24, 2024.<\/p>\n
Vendors were told the date was \u201cfirm and there would be no further extensions,\u201d Martineau wrote.<\/p>\n
But by then, it was too late to change course.<\/p>\n
\u201cMaking a go\/no-go implementation decision immediately prior to implementation was not feasible,\u201d Martineau wrote.<\/p>\n
The previous suppliers had a 30-day termination clause and had already “prepared to stand-down,” she wrote, leaving the province with no safety net.<\/p>\n
Adding to the issues were “deficiencies in the initial forecasts\u201d \u2014 ordering patterns “far exceeded forecasted demand” shortly after the new system launched, Ontario Health atHome wrote in an internal memo.<\/p>\n
Meadus wondered how OHaH failed to anticipate the demand for medical supplies.<\/p>\n
\u201cI don’t understand how the demand changed between the change of vendors,\u201d she said.<\/p>\n
Ontario\u2019s patient ombudsman\u2019s report on the shortages found that OHaH was \u201csurprised\u201d by the transition issues and \u201chad no contingency plans in place.\u201d<\/p>\n
He wrote that he \u201cobserved an attitude of complacency\u201d as previous, much smaller contract changes had \u201cgone smoothly.\u201d<\/p>\n
\u201cThere was not enough time to properly implement a model of this scale,\u201d he added, with several of those he spoke to estimating an appropriate timeline of 18 months, instead of the eight initially allotted.<\/p>\n
\u201cThe timing was largely outside of Ontario Health atHome\u2019s control given the funding parameters of the Ontario government and the dates on which the [request for proposals] process was completed,\u201d the patient’s ombudsman\u00a0wrote.<\/p>\n
What the partially redacted documents don\u2019t reveal is whether there was any \u201cpolitical pressure\u201d on Ontario Health atHome to move quickly, Meadus said.<\/p>\n
\u201cThere seemed to be some issues that arose, and then there seemed to be a time when it was like, \u2018No, we\u2019ve got to go ahead now,\u2019\u201d she said.<\/p>\n
\u201cBecause I don’t think it was Ontario Health atHome that came up with this idea,\u201d she said. \u201cIt was the government.\u201d<\/p>\n
Government, OHaH\u00a0point fingers<\/p>\n
Martineau, the Ontario Health atHome CEO during the shortage, was fired in January 2025, four months after the crisis began.<\/p>\n
After the patient ombudsman\u2019s report came out in September 2025, Ontario Health atHome offered \u201ca heartfelt apology to the patients, families and caregivers who were impacted by these changes.\u201d<\/p>\n
The agency said at the time that it had improved its oversight and streamlined processes to \u201cbuild a more responsive and resilient medical equipment and supply system that prioritizes patient care.\u201d<\/p>\n
Ontario Health atHome has implemented all of the patient ombudsman\u2019s recommendations, and the ombudsman \u201cis satisfied with this response,\u201d spokesperson Amber Lepage-Monette said in a statement.<\/p>\n
The agency also reimbursed patients and caregivers who had to purchase supplies out of pocket. As of Feb. 11, 2025, it paid out 932 reimbursement claims totalling $590,125, according to the ombudsman.<\/p>\n
Ontario Health atHome and Jones\u2019 office did not address several detailed questions about the documents. Both parties pointed to someone else as the root cause of the crisis.<\/p>\n
Jones\u2019 spokesperson, Ema Popovic, said OHaH \u201cfailed in its basic responsibility to patients, caregivers, and families.\u201d<\/p>\n
OHaH said the \u201cissue with the vendor that led to the disruption\u201d was \u201cunacceptable.\u201d<\/p>\n
In addition to its escalation line, OHaH spokesperson Faadia Ghani said the agency spoke to clinicians to help revise its formulary, worked with vendors and Supply Ontario to address the shortages, updated service providers, physicians, palliative care, hospitals and vendors throughout the crisis, and has since placed more of an emphasis on \u201cpatient and family engagement.\u201d<\/p>\n
\u201cMany of these actions were closely aligned with the Patient Ombudsman\u2019s recommendations, and the steps we took to resolve the challenges were recognized in the Ombudsman report,\u201d Ghani said.<\/p>\n
\u201cWhile the issue has been resolved for over a year, we continue to apply lessons learned to strengthen the delivery of medical and equipment supplies, ensuring this sort of disruption never happens again,\u201d she said.<\/p>\n","protected":false},"excerpt":{"rendered":"Documents reveal how a cost-cutting merger led to palliative patients dying without medication or nutrition EDITOR\u2019S NOTE: This…\n","protected":false},"author":2,"featured_media":471576,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[49,48,84,392],"class_list":{"0":"post-477827","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-ca","9":"tag-canada","10":"tag-health","11":"tag-healthcare"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/477827","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=477827"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/477827\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/471576"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=477827"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=477827"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=477827"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}