You know that feeling you get from an insincere apology? Your stomach flip-flops. Your heart pounds. You feel irritated, disgusted even. A vague dissonance nags at you. It’s the same disorienting feeling you get from an insult wrapped in a compliment. Or from realizing you’ve been scammed, and the perpetrator got away. That feeling.

Non-apology apologies are easy to identify. They’re the I’m sorry but, the sorry you feel that, the sorry if statements and their many variations. They minimize wrongdoing, victim blame, and twist the narrative to avoid accountability under the guise of remorse. In other words, smoke and mirrors. If these tactics seem dehumanizing and manipulative, it’s because they are. Psychologists identify fake apologies as a form of emotional abuse. They’re also a tactic commonly used by politicians, public relations professionals, and those trying to avoid litigation, like health care institutions after incidents of medical harm.

That was then; this is now.

A decade ago, Ontario’s Ombudsman described his growing frustration with hospital complaints processes in a section of his report titled “Losing patience with patient relations.” The report describes the lack of objectivity, transparency, and credibility of hospital patient relations departments. Hospital officials, he wrote, “work for hospitals, not patients. They have no independent authority or formal powers of investigation. At best, they operate as internal customer relations departments — clearinghouses for complaints … at worst, they may be unresponsive, insensitive and/or apologists for hospital interests.”

Not much has changed since this report was issued. The ombudsman’s sentiment is echoed by the Center for Patient Protection and countless others who have experienced medical harm, including my own family. In 2015, Kathleen Finlay, CEO of the Center for Patient Protection, called for a “shakeup in our health care complaints system.” She described the hospital complaint mechanism as “a rigged game that rarely offers satisfaction and often produces still more waves of emotional harm.”

Riding the waves of harm

My family and I experienced precisely such ongoing harm while coping with the multiple medical errors my late father endured as a prostate cancer patient at Canada’s largest hospital research network. Among them was a missed diagnosis of cancer recurrence resulting in a two-year treatment delay. I discovered this while reviewing my father’s online patient record in 2018, after his passing. Neither my father nor my family was informed of this appalling mistake, despite a note in his file, and contrary to the Public Hospitals Act’s Regulation 965 and the College of Physicians and Surgeons of Ontario’s policy, which obligate disclosure of harm.

After this discovery, in June 2019, I requested access to my father’s complete medical record only to encounter an obstructive and harrying chain of events. In response to my appeal of an exorbitant access fee, hospital administrators updated their online fee policy and backdated it to a day before my request, while proceeding to inactivate my access to my father’s online record.

After much effort and hardship, including a complaint to Ontario’s Information and Privacy Commissioner, the hospital lowered its fee and I obtained the complete record. What I discovered shook me to my core — my father’s care was mishandled for far longer than was previously evident. A clinical directive was recorded in his chart when he was diagnosed with aggressive prostate cancer in 2011, necessitating ongoing scans to track recurrence after treatment. Yet, these instructions were ignored by his medical team even when, seven years later, my father experienced new symptoms, his bloodwork was suspicious for recurrence, and he repeatedly requested follow-up imaging.

In November 2019, I submitted a complaint to the hospital requesting an investigation into the lapses in my father’s care. Ontario’s Patient Ombudsman’s Office, the province’s office of last resort for hospital complaints, acted as an impartial mediator. Its best efforts at mediating a resolution became a painful, drawn-out succession of hospital administrators’ tactics of deny, defend and delay, designed to frustrate in the interest of self-protection. Responses from patient relations, when they did trickle in, were invalidating, insensitive, evasive and inadequate. A “Sorry Not Sorry” opus — the mother of all scams in which the perpetrator gets away.

The extensive delays were particularly incomprehensible given that hospital administrators, clinical staff and a lawyer had quietly convened in January 2019 to discuss my father’s case, long before I requested the complete medical record or submitted a complaint via the Patient Ombudsman’s Office.

Limits of moral suasion

Two years have elapsed, yet the complaint remains unresolved. The hospital denied requests by the Patient Ombudsman’s Office for an independent external investigation, and discussions with the hospital’s CEO to address deficits in internal processes have been ineffective. Despite effusive public narratives of patient-centered care, hospital-patient relations remain an intermediary between at-fault staff and the hospital’s legal counsel. An insult wrapped in a compliment.

For its part, Ontario’s Patient Ombudsman is committed to fairness and transparency but lacks the authority to enforce binding recommendations, relying instead on moral suasion to influence change. As my family’s experience demonstrates, health care institutions can render the “office of last resort” toothless. In such cases, moral suasion is a poor substitute for an independent investigative authority with the power to enforce systemic improvements for publicly accountable hospitals.

Inadequate legislation and oversight of hospital practices, as well taxpayer-subsidized legal costs for physicians, further enable patient harm. Especially for patients without a support network to advocate on their behalf.

And as long as hospital administrators’ primary concern is to mitigate legal risk, the well-being of patients will not be a priority. Patients and families who experience medical harm will continue to be deterred from seeking accountability and driving systemic improvement.

Iris Kulbatski is a science writer. 

Image credit: Shutterstock.com