More people have come forward with concerns about a lack of communication from the Appletree chain of clinics in Ottawa when patients became attached to family doctors with little notice or no follow-up.
CBC News recently published a story about a woman who said she was kicked off Health Care Connect — Ontario’s family doctor wait-list — after visiting an Appletree clinic as a walk-in patient.
The Ontario Ministry of Health told CBC at the time it was aware of two occasions over the past two years where Appletree rostered patients without those individuals being made aware.
CBC has since heard from nearly a dozen people who said they, too, were confused and surprised when they learned they had been assigned a family doctor at Appletree, which offers both family medicine and walk-in services.
Seven of those individuals agreed to speak on the record, sharing detailed information about their experiences.
“It’s kind of frustrating that we’re in the middle of a health-care crisis and they’re, in my opinion, trying to take advantage of people,” said Emmanuel Yoko, a student at the University of Ottawa.
In a written statement, Mahila Kanesananthakuru, vice-president with Appletree Medical Group, said it “has played a crucial role in supporting medical care in Ottawa,” and its terms are all explained on the company website.
“Our website serves as a comprehensive resource, providing detailed information to ensure our patients are well-informed about our offerings,” wrote Kanesananthakuru, who reiterated the point that registering with the Appletree family practice group “will result in their removal” from Health Care Connect.
Kanesananthakuru did not answer CBC’s question about the possible cause of confusion.
In a statement, a spokesperson with the Ministry of Health said it “follows up on patient complaints it receives, including those related to enrolment.”
“If it turns out that the patients are being listed as enrolled without having signed the ministry form, the ministry will follow up with Appletree,” the statement said.
Military family thought form was for walk-in
Heather Tyler moved to Ottawa with her family in September on a military posting.
Tyler’s husband receives health care through his job in the military but she and their six year-old son left their entire primary care team in British Columbia.
Tyler, who suffers from various chronic health issues including diabetes, said she filled out a form on Appletree’s website in order to book an appointment at one of its clinics in Ottawa.
“I was under the assumption that I was rostering to get a walk-in clinic appointment, not rostering to be a permanent client,” she said.
The “family health group registration” form on the website is, in fact, a contract to become a patient with Appletree.
At the top of the form, the website informs clients they “cannot be rostered to different groups simultaneously in Ontario.” It goes on to say, “If you registered to Health Care Connect, you will be removed from their list as you roster to our group.”
Tyler, however, said the repercussions of what she was signing were unclear.
“Once you fill out that form for rostering, you don’t get any confirmation email, you don’t get any further feedback. So you don’t really know what you’re rostering for at the end,” she said.
After reading the CBC article, Tyler said she phoned Health Care Connect to see if she and her son were still on the list and discovered they had both been assigned to a family doctor with Appletree.
“I didn’t think we’d actually be able to see this doctor very easily, and then I saw that the doctor had some warnings and some really poor reviews,” Tyler said.
She is now trying to de-roster with Appletree to get back on the Health Care Connect list.
“I feel pretty desperate actually, for appropriate health care,” she said. “That was actually the scariest part of our posting.”
‘This was a doozy’
Krystal Ebertowski said her husband was also assigned a family doctor with Appletree without his knowledge.
In his case, Ebertowski said he only signed in at the walk-in kiosk at the Montreal Road location in the fall of 2022. After months of searching for a family doctor, she said they finally found an opening at a clinic of their choosing.
Her husband now has to first de-roster from the Appletree doctor he was assigned to.
“Sometimes there’s mix-ups, but this was a doozy and when we were talking to the Health Care Connect agent, she had said to us at the time that it was quite common,” Ebertowski said.
Yoko, who said the company needs to improve its communication, actually intended to sign up for a family doctor to help with a hip condition that requires continuous treatment.
He said no one contacted him after he filled out Appletree’s online form in January 2022 and he assumed nobody was available.
Four months later, he said Appletree asked him to confirm his email, but didn’t tell him about a new doctor. He only learned he was assigned a doctor in the fall of 2022 when he contacted Health Care Connect.
In his subsequent correspondence with Appletree, the company told him outright in an email “we do not inform patients when they have been rostered.”
“When you complete a form, you can expect to be assigned to a doctor within a few weeks,” the email said.
Regular Appletree patient also confused
New patients aren’t the only ones left confused by their status with Appletree.
Unlike the other complainants, Geoff Paquet had been going to the Preston Street location for about four years for primary care services.
When his family doctor retired in 2019, Paquet said he was frustrated by the lack of notice from the clinic. He said he only found out about the departure when he tried to make an appointment.
WATCH | Concerns, confusion around Appletree clinics and family doctors:
At the time, Paquet said Appletree informed him no doctors were able to take on the orphaned patients. He tried to register with Health Care Connect and told the province to remove the retired doctor’s name from his file.
Then last month, Paquet was surprised yet again when he went to sign onto Health Care Connect, but couldn’t access the system because it said he was still assigned to a family doctor.
Shortly after he received mail from the province informing him his new doctor was also with Appletree.
“On paper, I have a family doctor, but I don’t know who it is,” he said.
Paquet said his new doctor prefers to only take drop-in patients, which he only discovered when he tried to seek care.
“I don’t know how long he’s been my doctor and I can’t make an appointment to see him, so it feels like I don’t have a family doctor,” Paquet said.
Appletree stands by its model
In all her correspondences with CBC, Kanesananthakuru has maintained Appletree’s flexibility and versatility set the group apart from other doctors’ offices.
“We value individual choices and have embraced the community for three decades,” she said.
While provincial payments to individual clinics are calculated in part by the number of rostered patients, Appletree said its team of approximately 200 doctors across Ontario earn their income primarily through the provision of services to patients.
Bonuses tied to factors such as patient head count only account for 10 per cent of Appletree’s doctors’ income, said Kanesananthakuru.
The Ontario College of Family Physicians said across the province nearly 2.3 million people are without a family doctor, which is up from 1.8 million in March 2020.
The organization said the latest forecast shows about one in four Ontarians, or 4.4 million people, will be without a family doctor by 2026.
The Ministry of Health said a patient who suspects they were enrolled without their consent can report the issue by calling Service Ontario at 1-866-532-3161 or report suspected OHIP fraud to the ministry by calling 1-888-781-5556.