Provincial and territorial health department officials held cross-country meetings and agreed to a "national decision" to deny a CBC request for information about individual hospitals, CBC News has learned.
Documents obtained by CBC's the fifth estate via freedom-of-information requests show that health ministries across Canada kept in regular contact with each other over the course of a month to craft similar responses.
Fred Vallance-Jones, who teaches investigative and data journalism at University of King's College, said that the cross-country denials raise questions about health-care accountability to the public.
"They still owe a duty to the public, an absolutely fundamental duty to the public to be accountable for the operation of publicly funded health-care institutions," said Vallance-Jones. "And they can't hide behind a wall of co-operation."
Some health ministries also instructed hospitals under their purview not to respond to a separate request that CBC sent directly to hospital CEOs.
Documents also show that a Manitoba government communications employee created a communications strategy that was distributed to health ministry officials across the country in mid-January by a federal Public Health Agency of Canada communications worker.
On Dec. 19, 2012, CBC asked all provinces and territories to allow the Canadian Institute of Health Information (CIHI) — an organization that collects hospital and health-care data — to release information submitted by the hospitals. Provincial and territorial permission is required as part of CIHI's data release policy.
CBC's the fifth estate planned to use the data for Rate My Hospital, a special investigation that presents Canada's first-ever hospital report card and profiles more than 600 hospitals across the country on its website.
Aggregate data requested by the CBC involved eight measures recorded in hospitals, including hospital-acquired infection rates, the number of "foreign objects," such as sponges, left in during surgery, and weekend mortality rates for several medical issues, a figure that would give patients an idea of whether they were at greater risk on Saturdays and Sundays.
Some provinces denied the request saying the data release could have privacy implications for small facilities and expressed concerns about comparing data between jurisdictions.
"Given New Brunswick's small population, the department has concerns that hospital-level reporting of the information could potentially be identifying to the patient, even if it is anonymized," wrote Tracey Burkhardt, director of communications for the N.B. Health Department.
CIHI has policies in place to prevent the release of data that involve low numbers and could pose privacy concerns.
Nova Scotia changes mind
In New Brunswick, on Jan. 8, officials decided as their "first step" in the process to consult with colleagues across the country "to determine how other jurisdictions are responding."
"P.E.I. has shared their approach however are open to an Atlantic approach," said an email written on Jan. 9 by Trish Fanjoy, a policy adviser for New Brunswick's Department of Health in the federal, provincial and territorial relations section.
More than a month after the CBC request, a "national decision" had been made that "CIHI should only be providing publicly available data," wrote New Brunswick's Burkhardt in a Jan. 21 email.
Days later, Nova Scotia's intergovernmental affairs director for the Health Department told colleagues that "our tag line across the country is only release publicly available data."
Nova Scotia's deputy health minister, Kevin McNamara, initially approved the release of its hospital data with a letter to CIHI dated Jan. 18, but six days later revoked the approval.
In those six days, freedom-of-information documents show that a federal Public Health Agency of Canada employee sent out an email to a network of health ministry officials and experts through the Pan-Canadian Public Health Network with a compiled list of all the provinces and territories' planned responses to the CBC request.
Province holds the 'chequebook'
Days after Nova Scotia revoked its initial approval letter, the province's Health Department then alerted communications directors in all nine of its district health authorities suggesting they, too, refuse a separate request CBC sent to the hospitals.
CBC had emailed a survey to more than 600 hospital CEOs across Canada asking for a range of information, including how often staff members wash their hands, whether they use a checklist during surgery to reduce errors and how much they charge patients for parking.
A Jan. 22 email by Carla Grant, a Nova Scotia health department communications employee, expressed the ministry's concerns with the survey and the "significant" time it would take to compile and raised issues about comparability between provinces.
"In chatting with our deputy minister," wrote Grant, "it has been decided that the [district health authorities] in N.S. will be asked to direct the fifth estate to CIHI. I am hoping you can do this."
Grant warned the regions that declining to fill out the survey could be construed as "hiding" information but assured them that "clearly we are not doing" that.
Yukon's Health Department emailed the director of policy and planning at the Yukon Hospital Corporation to ask if they'd received a CBC survey about their three hospitals.
"Nationally, provincial health departments are stating that they will not provide additional information," wrote Patricia Living. "Several of the smaller provinces are advising their hospitals and health authorities to not participate because of privacy and confidentiality issues."
Living told the CBC in an email that the Yukon Hospital Corporation had been advised to make its own decision.
Vallance-Jones said there can be issues with a provincial ministry even suggesting that regional health authorities not release information.
"[The province] holds the chequebook," said University of King's College professor. "What are you going to do? So that could put a lot of pressure on them to not release the information.
"Now what you're doing is, essentially, you're actively trying to undermine and to squelch the release of information that you don't directly control."
Direction sought from CIHI
Initially, Nova Scotia sought direction from the Canadian Institute for Health Information and asked it to oversee a "national approach," according to an email sent by Susan Logue, executive director of business intelligence, analytics and privacy with Nova Scotia's government.
CIHI directed Nova Scotia to seek other venues for connecting with other provinces, such as intergovernmental affairs.
"It looks like CIHI is going to leave us hanging," wrote Logue.
In January, CIHI sent out a briefing note outlining the various initiatives undertaken by the fifth estate: a poll sent to nurses, a survey sent to the CEOs of more than 600 hospitals, a survey for patients and its data requests to ministries.
No provinces to date have granted permission to access the hospital data, the briefing note stated.
Prince Edward Island, New Brunswick and Nunavut eventually provided sets of different data requested by CBC News after the public broadcaster filed a request through the health ministries' privacy and information co-ordinators.
On the survey sent to hospitals, the note said, "it appears that hospitals, health regions and facilities across Canada are all weighing decisions about whether to respond to the CBC survey."
Of the individual hospitals that were sent the survey, 132 ended up filling it out, most of them from Ontario.
In the east, Newfoundland and Labrador was the only Atlantic province that participated with three of the four authorities filling it out.
Manitoba's Churchill Health Centre, a tiny facility on the remote Hudson Bay shore with 19 acute-care beds, was the sole hospital in Western Canada to fill out the survey.
In regards to the data request to ministries, CIHI recommended that they "consider the potential positive impact of this increased transparency about health system performance" but noted the risks involved in such "endeavours."
"In additional, ministries should consider the potential negative impact of declining to provide the information," the briefing note said.
CIHI also suggested that intergovernmental affairs departments could be used to monitor "evolving pan-Canadian responses to the requests from the CBC."
Canada trails on performance data
Toronto-based health policy analyst Michael Rachlis says Canada has much less data available to measure hospital performance than in other countries.
"We are quite far behind," Rachlis told the fifth estate. "I've just been to the U.K. where much data is published on a regular basis."
The wealth of data available in the United Kingdom has allowed authorities to collect performance data to publish on a quarterly basis and has led to major drops in infection rates.
Rachlis said one of the major barriers to finding out more about Canada's health-care system and its quality of care is that "it is a government-paid-for system, [and] governments tend to be secret about what they do."
"They are concerned about measurements and comparisons in case they look bad," he said.
To contact the Rate My Hospital team with tips or information related to the series, please email ratemyhospital@cbc.ca.
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