A patient with a traumatic brain injury waited more than 21 hours for emergency surgery at an Ontario hospital – while elective operations proceeded as scheduled – and died four days later.

Road-paving companies cheated on asphalt-quality tests to receive government bonuses, then paved provincial highways with material that cracked within three years.

Contractors made construction mistakes on provincial transit projects, but were still paid and given more contracts.

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These were just three revelations in Auditor-General Bonnie Lysyk's annual report on Wednesday, which spotlighted dysfunction across the provincial government over the past year.

Ms. Lysyk paid special attention to health care, revealing that operating rooms routinely shut down on evenings, weekends and for March break in part because the government is squeezing hospital funding.

She also highlighted how road paving and transit construction contractors routinely do shoddy work but rarely suffer consequences.

Hospitals

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Sick and injured Ontarians wait far too long for intensive-care beds and to undergo emergency surgery at the province's hospitals.

The audit found that although the government's target of transferring 90 per cent of patients who need intensive care to the ICU within eight hours, the actual time at three hospitals she studied was 23 hours. Patients who needed a regular in-patient bed languished in emergency for 37 hours.

Lengthy waits in the ER are primarily because wards are bursting at the seams – a problem exacerbated by a government-mandated four-year freeze on operating budgets – and patients who could be discharged are waiting for places in nursing homes.

Health Minister Eric Hoskins said the province is trying to relieve crowding by increasing base funding to hospitals by nearly 3 per cent this year and pouring a quarter of a billion dollars a year into home and community care.

"By reducing … the number of individuals residing in hospital who don't need to be there, that will open up the opportunity for individuals who come through ER to be admitted more quickly," Dr. Hoskins said.

The Auditor-General also concluded hospitals sometimes do not give emergency surgery priority over scheduled elective operations, resulting in waits such as the 21.5 hours that led to the death of the patient with traumatic brain injury.

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In another case, a patient with abdominal pain suffered a burst appendix while waiting 25 hours for emergency surgery.

Despite the problems, Ms. Lysyk found, the government spent taxpayer dollars on ads touting its health-care spending.

Doctors

Six Ontario specialists claimed to have worked all 366 days in 2015-16 – just one of the apparent billing anomalies the Auditor-General said the government failed to investigate.

The ministry has not "proactively" tried to recover overpayments from doctors since 2013, or probed huge disparities in doctor pay, the report found. Some ophthalmologists, for example, billed for more than $1.2-million in 2014-2015, while others billed closer to $500,000.

Stephen Chris, president-elect of the Ontario Medical Association, which represents the province's 34,000 doctors and medical students, said there is no evidence doctors who billed for every day of the year did anything wrong.

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"It may very well be that they are in communities where the intensity of demand by patients is such that they're working all the time," Dr. Chris said.

Also, many family physicians are in group practices with payment models that compensate them for enrolling patients, rather than paying a fee for every medical service.

The Auditor-General found that in 2014-15, the province paid doctors in the most popular group practice model – known as a family health organization – about $522-million more than it would have under the old fee-for-service model.

eHealth

The government's attempt to create electronic health records for all Ontarians cost $8-billion over 14 years but is still incomplete, Ms. Lysyk found.

The province failed to establish a budget or a strategy for the project, and much of the health-care system remains mired in paper records and antiquated technology that does not allow files to be shared safely.

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"There is no sharing across regions. So if you have your X-ray done in one region and your doctor is in another, you have to carry your file," she said. "The drug system isn't allowing electronic prescribing."

Highways

The asphalt on provincial highways is supposed to last 15 years. But in many cases, the paving begins to crack after less than three – necessitating repaving that costs taxpayers millions.

Ms. Lysyk also found the government pays bonuses to paving companies for using higher-quality asphalt, but some of them provided high-quality samples for testing then used lower-quality asphalt on the road.

Ms. Lysyk found the government developed more tests in 2007 to make sure roads were paved properly, but gave in to pressure from the paving industry not to implement them fully.

She also discovered the province allows contractors to hire their own engineers to certify their work. In one case, the engineer certified that the Nipigon River Bridge on the Trans-Canada Highway was up to snuff even though some steel was 30-per-cent weaker than required, she wrote. The bridge failed last January, just six weeks after it was opened.

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Transportation Minister Steven Del Duca vowed to crack down on shoddy road construction, saying the government will use both asphalt quality tests on all construction starting next year. He also said a new program will ensure the province is in control of all asphalt samples at all times.

Metrolinx

Ms. Lysyk found many construction and design firms building GO stations and other pieces of transit infrastructure made costly mistakes but still received more contracts.

In one instance, she said, a company building a pedestrian bridge to the Pickering GO station installed a truss upside-down and provincial transit agency Metrolinx had to step in to ensure it was done correctly. But it still paid the company and gave it a contract to install a glass cover on the bridge.

Metrolinx CEO Bruce McQuaig disputed Ms. Lysyk's characterization of the Pickering bridge project. He said the contractor actually installed a beam incorrectly. And the mistake happened during the second contract, which was cancelled as a result, he said.

In an e-mail, Ms. Lysyk stood by her report. She said Metrolinx higher-ups did not fully document problems with the contractor, but Metrolinx staff at the construction site confirmed the truss problem to her staff.