A Superior Court justice has refused to grant an injunction that would force Group Health Centre in Sault Ste. Marie to take back 6,798 patients who were de-rostered. However, Madam Justice K.E. Cullin allowed one cause of action (breach of contract claim by the original subscribers, not non-subscribers) to proceed and gave 60 days to amend the claim if they wished to do so. The suit was launched by United Steelworkers Local 2251 president Michael Da Prat, who said the decision to de-roster the patients was due to financial mismanagement, not a shortage of primary care physicians. Cullin’s decision traces the history of the GHC, which was formed as part of the Sault Ste. Marie and District Group Health Association (GHA) in 1962, in the days before OHIP coverage. “Local branches of the United Steelworkers of America provided start-up funding to establish the Group Health Centre Sault Ste. Marie and District, a not-for-profit community health-care centre,” the court decision said. Premiums ended with OHIP “Individuals, most of whom were union members, paid premiums to receive health-care services at the GHC.” When OHIP was implemented in the 1970s, services continued to be delivered by GHC, but were now funded by OHIP and available to the public, not just participating union members and their families. “The health-care services at the GHC are delivered by a combination of staff employed by the GHA and physicians who practise independently as members of the Algoma District Medical Group,” the court said. Since 2012, patients have not been rostered to the GHA, but to individual physicians with the Algoma District Medical Group (ADMG). “Under the 2012 agreement, rostering decisions are solely within the purview of the physicians of the ADMG,” the court said. “Historically, the ADMG has been able to respond to physician resignations and retirements by transferring rostered patients to new or existing physicians. Over time, this has become more challenging as physician replacements have not kept pace with resignations and retirements.” National physician shortage The shortage of doctors is not just a local issue, Cullin said, it “is a systemic issue which plagues the health-care sector across Canada.” In January 2024, the ADMG announced it was de-rostering 10,176 patients as of May 31, 2024. That number was eventually reduced to 6,798. And on May 29, the centre received funding to operate an interim care clinic to offer “episodic” care for de-rostered patients. The centre is led by nurse practitioners. “The GHA acknowledges that this is an imperfect solution and that not every patient seeking a same-day appointment is able to access services,” Cullin’s decision said. Da Prat’s lawsuit argued that the GHA and GHC have an obligation to provide health care to subscribers, “in particular the Steelworkers who spearheaded their development.” “He submits that the Steelworkers were integral to the creation of the GHC and that they have always occupied a distinct role in its governance in recognition of their status as one of its founders,” the court decision said. “He argues that it has always been understood that the GHC was created to provide health care first and foremost to its founders.” However, the court ruled that granting an injunction to force GHC to take back the de-rostered patients would either mean forcing existing physicians to take on even more patients or forcing them to de-roster other patients to make room. “The defendants no longer had physicians to provide primary care to the plaintiff and the other de-rostered patients as of May 31, 2024,” the court said. “As such, an injunction ordered in this case at any time would require the defendants to take positive steps to create a health-care pathway for them.” The court said there was no evidence that the de-rostering was caused by financial issues. “It is a human resources issue that will not be resolved until more physicians enter the health-care system and/or elect to establish practices in Sault Ste. Marie,” Cullin wrote in her decision. Agreeing to an injunction would “effectively require existing ADMG physicians to take on more patients than they can reasonably manage or by removing health-care services from rostered patients who are not parties to this litigation.” Read the full decision here.
