David Malleau awoke in hospital with a gaping hole in his skull.

The 44-year-old Hamilton truck driver had suffered a devastating car accident in 2004 that forced doctors at Hamilton General Hospital to remove a fist-sized piece of bone from his skull to relieve pressure on his brain.

Once the swelling subsided and he was ready for surgery in March 2005, Malleau was sent home and placed on a waiting list.

Three months passed. Then six. He waited at home, a prisoner unable to leave the house for fear something would hit the exposed side of his brain – for him a potentially fatal incident. In the end, it took nearly a year before he could get skull replacement surgery.

If Malleau lived anywhere else but Ontario, the provincial ombudsman's office could have investigated why he had to wait so long for neurosurgery.

When patients or their families feel their complaints about the hospital system are falling on deaf ears, there is no independent body in Ontario with the power to conduct an independent investigation. All other Canadian provinces give their ombudsmen power to scrutinize hospitals. In Ontario, successive ombudsmen have sought that oversight power for more than three decades without success.

"The position of hospitals continues to be, `Let's keep our dirty laundry to ourselves,'" says Ontario Ombudsman André Marin. "There's tens of billions of dollars signed away in the form of a blank cheque to run health care. (Independent oversight) is a complete no-brainer ... It's frankly embarrassing."

With nowhere to turn, Pat Malleau, who quit her job in order to care for her house-bound husband, called New Democratic Party MPP Andrea Horwath (Hamilton East) for help.

Horwath called the hospital several times on their behalf. She says she never got a satisfactory reason for the lengthy delay and was shocked by the lack of response from hospital officials.

"It was the most disgusting display of lack of responsiveness of a hospital that I've seen in a long time," she told the Star. "His life was on hold for a year because they couldn't find the time to put his skull together. It was Humpty-Dumpty gone wrong."

Malleau was reluctant to try another hospital because he wanted the same neurosurgeon who had performed his initial, post-accident surgery. But, although he remained on the waiting list, he was repeatedly bumped as other, emergency surgeries took precedence.

Horwath's experience trying to help Malleau led her to introduce a private member's bill in order to give the ombudsman power to investigate hospitals and long-term care facilities. Horwath doubts her bill will get a second reading before the Legislature rises for the summer. A bill must be read three times in the House before becoming law.

"This case urged me on this issue," she says. "Why should it take me and our local media to get on the bandwagon and embarrass the hospital and government into doing what anybody would expect as a required procedure? It was horrifying."

Horwath isn't the only one pressing for change.

A lack of hospital accountability has outraged Ontarians like John Balatinecz in Toronto.

The retired university professor began lobbying MPPs over the issue after a recent Star investigation. Now the member of a community organization called Humber River Health Coalition is spearheading an effort to get hospital-focused citizen groups together to press for greater hospital transparency during the election campaign.

One goal of the new Ontario Alliance for Accountability of Hospital Boards is expanding the provincial ombudsman's role to include hospitals. "The ombudsman's office is independent of political influence and political considerations," says Balatinecz. "It is really there to represent the citizenry."

If Ontario's ombudsman were given oversight powers into hospitals, his office would have no shortage of complaints. Marin said last year alone his office had 237 complaints about hospitals and long-term care facilities he could do nothing about.

Officially, the role of the ombudsman is not to prosecute or investigate individuals, but to investigate decisions and processes to make sure they are "just, reasonable, fair and right," says Marin. He would look at hiring practices and staff qualifications, follow up on patient complaints and make sure communications between hospitals and patients are clear.

"I'll go in, take a complaint, apply reasonable common sense, use the resources of my offices and make recommendations."

The Ontario Hospital Association disagrees there is no meaningful oversight of hospitals. It has argued Ontario hospitals rank among the most intensely scrutinized institutions in Canada, reporting to the health ministry and local health integration networks.

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As a result of a recent Star series, the governing Liberals are introducing mandatory regulations requiring hospitals to "inform patients when errors occur" and compel hospitals to report critical patient safety measures to the public. The government is also close to passing Bill 171, legislation that will introduce new disclosure rules and end secrecy around malpractice records, criminal convictions and limits on the licences of all health-care professionals.

But the Liberal government has said opening hospitals to investigations by the ombudsman's office is not a priority.

Across Canada, provincial ombudsmen play a vital role in looking out for those without a voice in the health sector.

In Quebec, Le Protecteur du citoyen investigated complaints of abuse at a Montreal adult hospital for the developmentally challenged. The Saint-Charles-Borromée hospital was effectively placed in trusteeship after the revelations of abuse.

Manitoba Ombudsman Irene Hamilton says her office routinely follows up on inquest recommendations related to hospital care issues to determine what actions have been taken.

"I think having an oversight function over hospitals is important. There's a significant expenditure of money and people need an avenue by which they can ask for the opportunity to have actions addressed."

Alberta Ombudsman Gordon Button says that after 10 years of discussion, his office was given the power to investigate complaints last year.

"There needs to be an independent body to provide assurance – that last door to knock on (for patients)," he says from his Edmonton office. "We've pushed long and hard for that. There is no downside to openness and transparency and that is what the ombudsman brings."

Alberta businessman Michael Broadhurst became an outspoken public advocate for making the hospital system more accountable after his 10-year-old daughter died in 1997.

Maren Burkhart was misdiagnosed with flu-like symptoms in a southern Alberta children's hospital and sent home. She returned to hospital and soon after died of septic shock.

Broadhurst became a thorn in the health system's side, demanding explanations. "All of us, we screw up. If no one can look in from the outside, it's going to get worse."

Malleau, after finally getting his skull replacement surgery in January of last year, is paralyzed on his right side and his speech is only now beginning to return.

"I've pretty much had to fight for everything," says his wife Pat, a former bookkeeper.

"We were taxpayers. Owned our own home. We went from having our jobs, being in the middle class, to nothing."

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