A downtown Brampton health clinic is reeling after receiving an order from the Ministry of Health to close its doors by the end of March.
A letter to the Wise Elephant Family Health Team (WEFHT) on December 14 instructs the group to prepare a wind-down plan and submit it to the Province within a week. The ministry communication says WEFHT will be shut down by March 31, 2021, under a section of its agreement, which allows the government to cut funding without explanation and with no cause.
“Subject to the terms and conditions herein, either Party may terminate this Agreement at any time without liability, cost or penalty, and without cause for any reason, upon giving at least 90 days written notice of its intention to do so,” section 18.1 of the agreement reads.
It’s a blow for some 11,000 patients in Brampton, where healthcare wait-times are among the worst in Ontario. The COVID-19 pandemic has hit the city particularly hard, compounding an already inequitable healthcare situation.
Since 2005, the Province has been funding groups like WEFHT, a collection of healthcare providers under one family health team (FHT). Such clinics are made up of family physicians, nurses, social workers, dieticians and a variety of other healthcare professionals that provide care to a roster of patients.
The concept is centred on the idea that partnership between providers will make it easier for patients with complex healthcare needs to receive the treatment they require in an efficient and cost-effective setting. For example, a patient with diabetes could see a nurse, dietician and doctor in the same setting, helping with long-term management of their condition.
The decision to close the clinic appears to have its roots in a statement of claim filed last year by the current management of WEFHT against its former directors. Following an initial forensic financial audit in 2019, the current administration alleges to have uncovered more than $2 million in financial irregularities by its predecessors.
The statement of claim, which has not been tested in court, alleges the previous physician-led board, including Dr. Sanjeev Goel and Dr. Lopita Banerjee (a married couple) were behind fraudulent transactions. The statement of claim alleges a conspiracy that purportedly led to the misappropriation of approximately $2.2 million in taxpayers’ money meant for patient care.
“We have never had the chance to speak with the auditor, despite repeated attempts,” Goel told The Pointer, adding the Province required a detailed, third-party audit to be completed annually. “We dispute everything in that audit, there is no fraud that’s occurred.”
There are two sides in the ongoing legal battle, both directly tied to the management of WEFHT and allegations each has leveled against the other. Goel and Banerjee founded the clinic in 2010 and stepped down from the board in early 2019, resulting in a transition from a physician-led board to one now governed by patients and community members. Ernesto Gaskin is the current executive director of the patient-run clinic, and under his leadership WEFHT followed up on previous allegations against Goel, Banerjee and other board members lodged in a lawsuit by a former colleague. The current board filed a statement of claim against the previous board, alleging mismanagement and misappropriation of funds, communicating these concerns to police and the provincial government.
Goel denies all allegations by the current board and the former colleague.
The model of care provided by Wise Elephant is delivered using funds from the Ministry of Health through an agreement that has specific conditions attached. For a family health team (FHT) to function successfully, it must be affiliated with a family health organization (FHO) of physicians.
When the current management of WEFHT filed its statement of claim against the previous board (and affiliated FHO, including Goel) relations soured. In December 2019, the Ministry of Health wrote to the FHT and the FHO, telling them to work together to reconcile their differences and deliver care to patients.
“If the two organizations are not able to resolve these matters in the interests of patients by December 19, 2019, the Ministry may exercise its legal rights under the applicable contracts and legislation,” assistant deputy minister, Lynn Guerriero, wrote.
An extension was granted for the two groups to repair the damage and move on. An agreement could not be reached and, on January 14, Goel wrote to the Province to say he and the FHO could not work with WEFHT.
“As you have acknowledged, the WEFHO is no longer affiliated with the WEFHT since Oct 15, 2019… We believe that based on the WEFHT-MOHLTC [Ministry of Health and Long-Term Care] funding agreement that the WEFHT is in breach of its funding agreement with the MOHLTC as it is no longer affiliated with a FHO,” Goel and Banerjee wrote. “We respectfully ask that you note that a resolution to the dispute between the parties does not seem possible due to the actions of the WEFHT.”
Just over a month prior, on December 1, 2019, Goel and Banerjee wrote to the Province suggesting programs run by WEFHT should be transferred to other clinics and FHTs around Brampton. Goel says the letter was sent because “our attempts to find a solution with the family health team were not bearing fruit and patients were suffering in the meantime.”
In a letter of its own sent to the Ministry in January, the current leadership at WEFHT said Goel’s decision to terminate its relationship was a breach of the agreement and alleged Goel was attempting to end investigations into his allegedly troubling behaviour while he was on the board, and the subsequent litigation launched so the court could determine whether or not Goel and his wife had misused hundreds of thousands of dollars including money they allegedly used for expensive vacations.
“Part of our demands to the FHT if they wished to work with us were that some new health professional board members come onto the board and that Mr. Gaskin resign,” Goel said, referencing an allegation of harassment he has made against the current executive director, which Gaskin denies.
Goel said his actions to have Wise Elephant shut down were not an attempt to terminate the lawsuit the organization filed against him.
“Whether or not the family health team dissolves, the litigation commenced by [the former colleague] is still active. The malicious allegations against us will be vigorously defended against, in that forum,” Goel told The Pointer.
Gaskin acknowledged WEFHT was in breach of its agreement, but said he had reached out to the Ministry multiple times to work out a solution. A communication from WEFHT to Ontario Premier Doug Ford shows more than 90 letters to the Province, many of which were ignored, Gaskin said. The clinic asked if its funding agreement could be amended to work with new physicians, but received no direction from the ministry.
Gaskin says he believed the Province was working on the issue in the background. He was shocked when the wind-down order landed Monday.
Along with his concerns for patients, Gaskin is frustrated that the move will end any investigation or follow-up to the initial forensic audit done by Toronto-based forensic auditing firm P. Macaulay & Associates Inc., which prompted WEFHT’s active lawsuit against former board members, including Goel.
“This is being done without cause, without a reason, there’s no reason for it,” Gaskin said. “Their whole approach is beyond our comprehension. Once you shut it down, all these investigations come to a premature end and the taxpayers are left out in the cold.”
Gaskin says he has made repeated attempts to bring his allegations of corruption to the attention of Queen’s Park. He feels the requests were met with an alarming disinterest.
“This patient and community-led Board had inherited operational, financial and patient-care deficiencies from the former physician-led Board,” a letter sent by the clinic to Ford on December 14 explains. “In particular, the former physician-led Board was composed of physicians who had a direct financial interest and benefit in the WEFHT’s operations. Further to a forensic audit conducted in 2019 and the preliminary report that issued as a result, it was uncovered that the former lead physicians may have misappropriated approximately $2,500,000 during their tenure as directors of the WEFHT (which spanned a decade).”
The forensic audit of the WEFHT’s finances, initiated after the health team’s current board of directors took over following Goel’s departure, found $2,255,125 that was transferred from the WEFHT to companies owned or directed by Goel or Banerjee. Such transactions, according to the lawsuit, are prohibited under the funding agreement between the health team and the Ontario Ministry of Health.
The new directors are seeking $3 million in damages from Goel and Banerjee and others named in the suit, for breach of contract, and $3 million in restitution for unjust enrichment in order to keep the doors of the Wise Elephant clinic open, so badly needed care can be delivered to Brampton residents.
The lawsuit states Goel and Banerjee, along with their subsidiary companies and physicians, “agreed or intended to act together or in concert in a plan or scheme such that the funds of the WEFHT were used or appropriated for the benefit, directly or indirectly, of Defendant Goel, Defendant Banerjee, the Goel Related Parties and the Defendant Goel Physicians with the purpose of harming the WEFHT or to damage the WEFHT.”
Goel denies the allegations.
Overall, the forensic audit discovered $261,000 in Paypal transactions, over $1 million in related-party payments which were in breach of the FHTs funding agreement, and $750,000 in unspecified salary payments.
By closing WEFHT down, Gaskin said the Ministry will effectively end the clinic’s investigations into alleged financial mismanagement, including the previously filed statement of claim. He said it amounts to gagging whistleblowers and is leaving taxpayers worse off.
“We simply do not understand why they would cover up an alleged fraud,” he said. “Why they would shut down the whistleblower and protect $2.5 million in alleged misappropriation of funds. We don’t understand that equation at all.”
In his comments to The Pointer, Goel said that, without physicians, WEFHT simply cannot perform its community function.
“With regard to the relationship between the physicians and the Family Health Team, which basically resulted in the physicians leaving the Family Health Team because services were not being provided to their patients, I believe the reason why the Ministry is closing the Family Health Team down is they have not and are not providing service to the number of patients for which they were funded for,” Goel told The Pointer.
The initial forensic audit, completed in July 2019, was shared by WEFHT with the Ministry of Health and the Peel Regional Police. The clinic was under the impression law enforcement and government would take action. A message on December 15 (Tuesday) from the Ontario Provincial Police (OPP) stated no investigation had been started and said the force was waiting on the green light from the government to get the pending investigation going.
“Due to not receiving a referral regarding suspicion of offences from the Ministry of Health, the OPP is unable to commence an investigation,” acting detective sergeant, Ted Schendera, told the clinic in an email. “Until we have confirmation from the Ministry, our status will not be entering the investigation stage.”
In a response provided to The Pointer, the Ministry of Health did not address the investigation or why it failed to forward the request to the OPP so it could start a probe.
With a formal police investigation stalled, and an order to cease operations from the Ministry of Health, Gaskin is now questioning the motivations of some provincial staff. After receiving no help in its mission to recover taxpayer dollars, he alleges WEFHT is now being punished.
“It became obvious that the same bureaucrats who oversaw the physician led board for about 10 years, who knew about the alleged fraud, are now looking to silence the alleged fraud by shutting down the family health team,” he alleged. “That is blatant self interest against the taxpayer and against all ethics and morality. They had the power to shut them down the same way they’re shutting us down now, but they didn’t.”
The Ministry of Health did not address Gaskin’s allegations, or share its formal reason for shuttering WEFHT, in its statement to The Pointer.
In Brampton, the poster child for hallway healthcare in Ontario, FHTs like Wise Elephant play an important role. Recently, WEFHT completed a flu vaccination campaign that included City Hall staff and Brampton Transit employees.
The clinic had also been planning to roll out COVID-19 testing.
Its ongoing work includes diabetes consulting, especially important for Brampton’s large South Asian-Canadian population, mental health services, palliative care and a gender transition program.
With hospitals full even before COVID-19 and now forced to transfer out patients and cancel surgeries, preventative care and the ongoing work of clinics like WEFHT are at the heart of healthcare delivery. In its letter of termination, the Ministry of Health said patients at WEFHT would be transferred elsewhere in Brampton, along with its funding.
Assuming a smooth transition for patients, space will still be lost and access to healthcare will be reduced, potentially making it harder for thousands of patients to get the attention they need.
“The Ministry is committed to working with other local Family Health Teams and Ontario Health to identify alternative providers in Brampton in order to ensure continued access to interdisciplinary health services, such as chronic disease management and mental health supports offered by nurses, dietitians and social workers, which were offered through the Wise Elephant Family Health Team,” the Ministry of Health said in a statement. “There will be no reduction of funding for interprofessional primary care in Brampton. Access to primary care will continue as usual... During the transition, the Wise Elephant FHT is expected to continue the delivery of FHT programs and services to patients.”
In the fiscal year ending in March 2019, 6,532 patient visits took place at WEFHT, according to the clinic’s letter to Ford. In the run-up to the COVID-19 pandemic, that number increased to 6,965 (ending in March 2020.) The clinic says it serves “the needs of approximately 11,000 rostered patients in ... Brampton”.
Throughout its efforts to get assistance from the Ministry of Health, the current board has received help from the local PC MPPs. Amarjot Sandhu, whose riding includes the clinic, and Prabmeet Sarkaria have acted as intermediaries between the Ministry and WEFHT, advocating to keep the space open and continue its work.
But when the order came down to turn the lights off, Gaskin says the pair knew about the decision and even supported it. Neither gave the healthcare provider any warning before the official letter of termination was sent.
“That was the biggest gut punch of this whole thing,” Gaskin said. “We learnt the MPPs not only knew about this, that they were shutting us down, but they supported it… I am completely devastated by this betrayal. That’s what it is: a betrayal of trust from publicly elected officials who swear an oath.”
Neither Sandhu nor Sarkaria responded to a request for comment.
Goel said the FHT in its current form can’t effectively serve patients without willing physicians, while Gaskin alleges both the Ministry and the old board of directors want to see WEFHT wound up to end investigations and court challenges that would reveal the truth about allegations of widespread fraud and mismanagement.
At the height of a second wave of COVID-19, the people of Brampton just want access to healthcare, Gaskin said.
“Notwithstanding threats from the Ministry to cut my funding if I don’t comply, I will continue to provide care to my patients,” Gaskin said. “That’s my job, that’s my responsibility and I take it seriously. And we’re going to do this with the moral courage others in higher office appear to lack. We will do what’s right — our moral compass is true.”
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