TORONTO — Ontario’s patient ombudsman says last fall’s medical supply shortages for palliative and home care patients were not only the fault of a single vendor but also the result of weak planning and oversight by the provincial agency responsible for care in the home.
Craig Thompson’s investigation into Ontario Health atHome revealed heartbreaking stories from patients and families who endured serious delays in receiving critical medical supplies. One man with three forms of Stage 4 cancer went without essential equipment for weeks, and the symptom-relief kit intended to ease his pain in his final hours arrived just 10 minutes before his death. A doctor later remarked that the patient “died choking and in pain” because of the delay.
Another patient battling a severe infection missed IV antibiotic deliveries and was forced into hospital, where doctors warned they risked losing an arm. An elderly patient who required catheters three times a day received children’s equipment instead, along with inadequate supplies, leading to painful urinary tract infections.
The problems began when new supply contracts took effect on September 24, 2024. Forecasting errors meant vendors lacked sufficient supplies, even though Ontario Health and Ontario Health atHome had been warned of risks well in advance. By October, patients were being asked to buy supplies out of pocket, with reimbursements offered later. By February, more than 900 claims worth nearly $600,000 had been paid.
Thompson concluded the agency displayed “an attitude of complacency” and actively chose not to engage patients ahead of the transition. “A more active governance structure, more time for implementation, and transparent communication would have prevented or at least reduced the disruption,” the report stated.
While supply issues eased by December, quality problems persisted, including leaking catheter bags and ineffective wound dressings. The ombudsman made four recommendations, including stronger oversight and advance notice for patients before major service changes.
The fallout has already reshaped leadership. Ontario Health atHome’s former CEO was dismissed, and interim CEO Anna Greenberg, along with board chair Carol Annett, issued a public apology Wednesday. “We deeply regret any distress or suffering endured,” they wrote. The agency says it has since introduced a 24/7 urgent support line, added an external clinical advisory group, and stabilized distribution.
Health Minister Sylvia Jones condemned the failures, saying the agency “failed in its basic responsibility to patients, caregivers and families.” She pledged that with new leadership and stricter mechanisms, Ontario Health atHome will strengthen its delivery of services.
For families who lived through the crisis, the ombudsman’s report underscores the human cost of bureaucratic failures — a warning, Thompson said, of what happens when patient needs are treated as an afterthought.