(April 11, 2025) By: Serena Austin, The Toronto Star<\/p>\n
It was a shock to thousands of Dr. Esther Park\u2019s current and former patients to receive a letter from Toronto Public Health urging them to get tested for HIV, hepatitis B or hepatitis C due to improperly cleaned equipment used at the gynecologist\u2019s office.<\/p>\n
The letters said TPH\u2019s investigation had to do with the \u201creprocessing\u201d of some medical instruments used in procedures such as cervical growth removal, uterine biopsies and IUD insertion and removals between Oct. 10, 2020, and Oct. 10, 2024.<\/p>\n
So far, TPH says it has not received notice of anyone testing positive for any of the viruses it was concerned about, but the news left questions about what the cleaning process looks like, how patients can tell it\u2019s been done properly and what to do if they feel it hasn\u2019t. (Park didn\u2019t respond to previous attempts by the Star to contact her.)<\/p>\n
Here\u2019s what you need to know.<\/p>\n
What is reprocessing?<\/strong><\/p>\n The term reprocessing refers to the \u201ccleaning, disinfection and sterilization of reusable medical equipment\/devices in health care and personal service settings,\u201d which contributes to reducing the spread of bacterial infections, according to Public Health Ontario.<\/p>\n There are six steps in the process, including precleaning; disassembly and soaking; cleaning; rinsing and drying; high-level disinfection or steam sterilization; and storage. Disinfection or sterilization must be documented once complete.<\/p>\n In the case of Park\u2019s clinic, Dr. Herveen Sachdeva, TPH\u2019s associate medical officer of health, told the Star the agency\u2019s main concern was that \u201cmedical instruments (like speculums) were not disassembled prior to cleaning and disinfection.\u201d There was also \u201csignificant overdiluting of the disinfecting solution the instruments were soaked in,\u201d she said. Elisabeth Boulanger is a midwife practising out of a clinic in Hamilton who has taken a reprocessing techniques course offered by the Medical Device Reprocessing Association of Ontario.<\/p>\n She recognizes the challenge for the average person in identifying signs that medical instruments have or have not been properly reprocessed. But she said patients should feel comfortable asking their doctors about what their cleaning process looks like, who in the office is involved and where it\u2019s done.<\/p>\n Medical instruments get repackaged before being sterilized, so seeing a doctor opening up the packaging before a procedure can be a reassuring sign, said Boulanger. For some instruments, like speculums, it\u2019s not uncommon to use plastic, disposable versions, to save time by avoiding having to reprocess them multiple times a day.<\/p>\n Public Health Ontario\u2019s best practices for cleaning, disinfection and sterilization of medical equipment\/devices in all health-care settings say there must be \u201cclear separations\u201d between \u201cclean\u201d work areas and areas where dirty equipment will be cleaned and decontaminated.<\/p>\n After Boulanger took the reprocessing course, her clinic began reprocessing instruments in a room with a \u201cone-way work flow, meaning dirty stuff comes in at one end, gets processed and then it\u2019s all clean at the other end of the room,\u201d she explained. \u201cYou don\u2019t want to be going back and forth between clean and dirty.\u201d The College of Physicians and Surgeons of Ontario deals with complaints regarding inadequate clinical care or treatment, poor or unprofessional conduct and sexual abuse and inappropriate conduct. Complaint forms are available on the college\u2019s webpage. And while the college works with public health agencies when it comes to infection and prevention control, it does not handle complaints regarding that subject or other public health measures.<\/p>\n Instead, complaints of that nature should be made directly to the local public health department. It was a complaint from a member of the public that sparked TPH to launch its investigation at Park\u2019s clinic last fall.<\/p>\n \u201cPeople are reticent to make complaints about doctors,\u201d said Natalie Mehra, executive director of the Ontario Health Coalition, an advocacy group focused on protecting public health care. \u201cIt\u2019s a problem and the power imbalance is huge.<\/p>\n \u201cBut this is your health and it\u2019s everyone else\u2019s health. It\u2019s good to speak up.\u201d<\/p>\n If you have a public health concern about infection prevention and control in Toronto, you can file a complaint by calling TPH at 416-338-7600, or by emailing publichealth@toronto.ca.<\/p>\n
\nWhat are the signs to look for?<\/p>\n
\nHow can I file a complaint?<\/p>\n