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Maplehurst Correctional Complex December 2023 incident

Media release, "Ombudsman to investigate Ontario’s response to incident at Maplehurst Correctional Complex" (June 9, 2025) Investigation into the Ministry of the Solicitor General’s response to a December 2023 incident at Maplehurst Correctional Complex. Announced June 9, 2025. Case update …
/en/our-work/investigations/ongoing-investigations/maplehurst-correctional-complex-december-2023-incident

Adults with developmental disabilities inappropriately housed in hospitals

Media release, "Ombudsman to investigate cases of people with developmental disabilities who are inappropriately housed in hospitals " (March 27, 2023) Investigation into the plight of adults with developmental disabilities who are inappropriately housed in hospital due to a lack of supports and …
/en/our-work/investigations/ongoing-investigations/adults-developmental-disabilities-inappropriately-housed-hospitals

Get me to the court on time

An inmate reached out to us to complain about a rapidly approaching court date. He was scheduled to appear in court in person, but the courthouse was a 15-hour drive away, and facility staff had not made travel arrangements to get him to court. Result: We made immediate inquiries with senior staff …
An inmate reached out to us to complain about a rapidly approaching court date.
/en/our-work/case-stories/get-me-court-time

A timely response

An individual who sent a complaint letter to the Special Investigations Unit (SIU) came to us for help, saying they had been told the SIU had no formal complaint process or timeline for receiving a response. As a fairness best practice, we generally recommend that public bodies establish a clear …
An individual who sent a complaint letter to the Special Investigations Unit (SIU) came to us for help, saying they had been told the SIU had no formal complaint process or timeline for receiving a response.
/en/our-work/case-stories/timely-response

A history of violence

An inmate reached out to us after getting in a fight with another inmate. Both had previously been involved in physical altercations with each other, and should have been placed in separate units within the facility to prevent further ones. Result: Our Office spoke with senior staff at the …
An inmate reached out to us after getting in a fight with another inmate.
/en/our-work/case-stories/history-violence

Urgency overlooked

An injured inmate sought our help with complications related to his eye socket, which had become seriously swollen. He told us he had raised this multiple times with health care staff, who had dismissed his concerns, suggesting it was just swelling and not a cause for alarm. Result: We immediately …
An injured inmate sought our help with complications related to his eye socket, which had become seriously swollen.
/en/our-work/case-stories/urgency-overlooked

Language bridge

A Russian-speaking woman came to us for help in dealing with her daughter’s care through Ontario Health at Home. Since this matter falls under the mandate of the Patient Ombudsman, we referred her to them. However, she struggled to navigate the automated phone system and could not reach a live …
A Russian-speaking woman came to us for help in dealing with her daughter’s care through Ontario Health at Home.
/en/our-work/case-stories/language-bridge

Decades later

A man who was born in Portugal but has been a Canadian citizen for more than 50 years sought our help in renewing his health card. He did not have his original citizenship documents, and the Ontario Health Insurance Plan had extended his coverage to allow him time to get replacements. However, he …
A man who was born in Portugal but has been a Canadian citizen for more than 50 years sought our help in renewing his health card.
/en/our-work/case-stories/decades-later

Fiscal fumble

A woman complained to us that the Trillium Drug Program made a mistake in calculating her out-of-pocket costs because they used an income tax return from the wrong year. Result: After speaking with program staff, we confirmed they were required to use information from the previous tax year, but …
A woman complained to us that the Trillium Drug Program made a mistake in calculating her out-of-pocket costs because they used an income tax return from the wrong year.
/en/our-work/case-stories/fiscal-fumble

Resolved with gratitude

A woman came to us after trying for nine months to get an error corrected on her mother’s death certificate. Her mother’s birthplace was incorrect on the document, and this was causing issues in managing her estate. Result: We raised the issue with officials at the Registrar General, who agreed to …
A woman came to us after trying for nine months to get an error corrected on her mother’s death certificate.
/en/our-work/case-stories/resolved-gratitude

Payment found

After four years of trying to change her legal last name, including a trip to India to get an affidavit verifying her name change from a previous marriage, a woman came to us for help. Result: We discovered the woman’s file was stalled because her payment to the Registrar General for the name …
After four years of trying to change her legal last name, including a trip to India to get an affidavit verifying her name change from a previous marriage, a woman came to us for help.
/en/our-work/case-stories/payment-found

Certified win

A man with a winning lottery ticket came to us for help after the Ontario Lottery and Gaming Corporation refused to release the six-figure prize to him because the only identification he had was an old and damaged birth certificate. He told us he had tried for months to get a new one, but the …
A man with a winning lottery ticket came to us for help after the Ontario Lottery and Gaming Corporation refused to release the six-figure prize to him because the only identification he had was an old and damaged birth certificate.
/en/our-work/case-stories/certified-win

Traditional medicines

An Indigenous inmate told us he had not been able to smudge regularly at his facility, and he wasn’t allowed traditional medicines such as cedar, sage, sweetgrass and tobacco. RESULT: After we intervened, he met with a Native Inmate Liaison Officer and was provided with smudge spray, sage medicine, …
An Indigenous inmate told us he had not been able to smudge regularly at his facility, and he wasn’t allowed traditional medicines such as cedar, sage, sweetgrass and tobacco.
/en/our-work/case-stories/traditional-medicines

Indigenous healing lodge

An Indigenous inmate complained of repeated delays in response to her requests to see a social worker, so she could apply to an Indigenous healing lodge. RESULT: We spoke with facility officials, who said staffing shortages had resulted in delays. We kept in touch with the inmate, who confirmed she …
An Indigenous inmate complained of repeated delays in response to her requests to see a social worker, so she could apply to an Indigenous healing lodge.
/en/our-work/case-stories/indigenous-healing-lodge

First Nations birth certificates

We helped a First Nations community experiencing administrative barriers to obtaining birth certificates, which are generally required for people to access government services and programs. We were told that these barriers included an online registration process that was sometimes difficult to …
We helped a First Nations community experiencing administrative barriers to obtaining birth certificates, which are generally required for people to access government services and programs.
/en/our-work/case-stories/first-nations-birth-certificates

Oversight 911

O N TA R I O O N TA R I O ’ S WAT C H D O G OVERSIGHT 911 Investigation into how the Ministry of Health oversees patient complaints and incident reports about ambulance services OMBUDSMAN REPORT n PAUL DUBÉ, OMBUDSMAN OF ONTARIO n MAY 2021 911 OVERSIGHT 911 DIRECTOR, SPECIAL OMBUDSMAN RESPONSE TEAM …
Investigation into how the Ministry of Health oversees patient complaints and incident reports about ambulance services
/en/our-work/investigations/oversight-911

Missed Messages

O N TA R I O Missed Messages Investigation into unilingual out-of-home government advertising regarding health services between April 1, 2020 and March 31, 2023 REPORT OF THE FRENCH LANGUAGE SERVICES COMMISSIONER Carl Bouchard July 2024 O N TA R I O FRENCH LANGUAGE SERVICES UNIT www.ombudsman.on.ca …
During the COVID-19 pandemic, Ontarians turned to the provincial government for important information on protecting their health and that of their families and communities.
/en/our-work/investigations/missed-messages

Married name mishap

A bride whose name was misspelled on her marriage certificate sought our help after waiting in vain for ServiceOntario to send her a form to request a correction. We discovered that the original handwritten marriage certificate had the correct spelling, but her name had been incorrectly typed into …
A bride whose name was misspelled on her marriage certificate sought our help after waiting in vain for ServiceOntario to send her a form to request a correction.
/en/our-work/case-stories/married-name-mishap

At long last

We heard from a man who was waiting for a new long-form birth certificate for his son. He had been told to send the Registrar General some information that was missing from his initial application, but after he did so, he got no confirmation that it arrived. When we checked with Registrar General …
We heard from a man who was waiting for a new long-form birth certificate for his son.
/en/our-work/case-stories/long-last

Writing wrongs

A man came to us for help when a problem with his birth certificate prevented him from applying for federal employment insurance (EI). He was told there were inconsistencies with his parents’ names on his documents – but he couldn’t get further details from ServiceOntario. RESULT: Our inquiries …
A man came to us for help when a problem with his birth certificate prevented him from applying for federal employment insurance (EI).
/en/our-work/case-stories/writing-wrongs