Ontario Hospitals Need to Adopt a Just Culture

Authored August 11, 2023

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Hospital administrators wield great power over physicians to whom they grant hospital privileges to practice in their public institutions. It thus takes a lot of courage for a doctor to challenge his hospital and allege that he was treated unfairly.

According to a news report, a critical-care physician in London, Ont., is suing the London Health Sciences Centre (LHSC) for $6.25 million. The report claims a “covert and improper investigation” was launched into the end-of-life care the physician provided to patients.

The story states that, in 2022, a former nurse complained about the physician’s practice, dating back to 2014. LHSC’s administration subsequently launched a secretive and extensive investigation into Dr. Scott Anderson's work, the news report claims.

The facts of this case have not been proven in court. According to the news report, the hospital has not yet filed a statement of defence. 

This case raises an important message for public hospitals: that administrators of public hospitals ought to be held accountable for overbroad decision making and heavy-handed tactics.

The wrong way to investigate complaints

First of all, investigating a physician without notifying them is “contrary to hospital policy,” as the story notes. It would also be, arguably, contrary to the principles of procedural fairness and natural justice.

After receiving the alleged complaint, administrators should have disclosed the complaint, in its entirety, to Dr. Anderson. He should have been given a chance to answer the complaint and given an opportunity to address any concerns the hospital may have had. Not every complaint warrants an investigation or remediation. In such a circumstance, the matter should be dismissed.

But instead, according to the news report, hospital administrators covertly launched an investigation without notifying Dr. Anderson. After completing that investigation, it is alleged, the hospital unilaterally conducted a review of 600 other cases.

This kind of conduct, on the part of hospital administrators, undermines physicians and can have real consequences on their professional reputations. It also raises the perception of a witch hunt.

According to the news report, Dr. Anderson is seeking damages for allegations that include $2 million for breach of contract and negligence, $750,000 for intentional infliction of mental suffering and $750,000 for defamation.

Revocation is a scarlet letter

In many small to medium-town environments, abuses can escalate if one hospital board controls all the area hospitals. If a physician has their privileges revoked, they find themselves in jeopardy. A revocation can be scarlet letter in a physician’s credentialling file and it creates the possibility that no hospital would grant them privileges again.

This is where the abuse of power often brews – when physicians are treated unfairly, but they are too afraid to challenge their hospital leadership, for fear of retribution down the road in the form of a suspension or revocation of their privileges. That is why challenging LHSC is such a bold move because there is only one hospital system in London, the LHSC umbrella.

$750,000 for mental suffering

The physician’s $750,000 claim for mental suffering is important. It can be intensely stressful for a physician to be under investigation by their hospital. The hospital knows the physician’s career depends on the outcome. During the COVID pandemic, physicians put their lives on the line to serve the public, yet some hospital boards don't want to give physicians appropriate procedural fairness and protections for their careers.

Cases like this underscore a common thread amongst hospitals in the province: we are lacking a “just culture” in our public hospitals. Hospital administrators need to be held accountable when they abuse or overextend their power. Hiding behind the excuse of “public safety” doesn’t cut it: physicians are also part of the public, and we need them in our hospitals delivering patient care.  


Several years ago I was fortunate enough to have been selected as a Tremayne-Lloyd Fellow here at Western Law. I used the funds to finish a book and to begin work on a new one. It dawned on me far too late that I had never thanked you for that splendid gift. The new book is to be published by Harvard Press in 2010. The TTL Fellowships provided ritual seed capital for this project, which required me to spend a good deal of time and money at The National Archive in Washington. Again, with many thanks.

R. W. Kostal Professor of Law and History

Tracey Tremayne-Lloyd Health Law