Despite ‘hitting a bureaucratic wall,’ journalists explain the importance of challenging hospital media restrictions
When B.C.-based photojournalist Jimmy Jeong took portraits of frontline health care workers in the spring of 2020, he says it was the ability to show the details in person that conveyed the weight of the situation — like the indents left on ICU nurses’ faces from hours of wearing a mask, or the bandages covering their cuts.
Jeong says he thinks readers were surprised to see health-care workers in that state, and the ability to “hear [their] voices and see their eyes” made more of an impact compared to health authorities’ press conferences at the time. As the months went on and the provinces reported case and death numbers, Jeong says that might be all they became for some people — numbers.
“I think people sometimes just need proof. And a photo can be proof that something bigger is going on.”
“Nothing is going to beat the on-the-ground reporting, right up front inside, where you are able to take viewers (or) readers to places that they don’t have access to,” Jeong says. “That’s what journalists are supposed to do. But it makes it difficult when there’s barriers set up blocking access.”
As journalists across Canada found themselves unable to access pivotal sites of the pandemic, these personal, human images of a health-care system and workforce in crisis independently documented by journalists were few and far between.
By late April 2020, photojournalist Jesse Winter had hit enough roadblocks trying to access health-care sites that he stopped prioritizing pandemic stories altogether.
Like many photojournalists in Canada, Winter works freelance, and he couldn’t justify the unpaid hours spent “pleading” with health authorities over the years. The answer always ended up being “no,” anyway — at COVID-19 test sites, supervised consumption sites, or isolation centres. It was still “no” when Winter offered to come in before opening hours, or photograph frontline workers setting up in empty convention centres. The reason given was almost always privacy.
Before the pandemic, Winter hit the same roadblocks while working on a story about how seniors experiencing homelessness are shuffled between hospitals and the shelter system. When Winter’s source was admitted to a hospital in Surrey, B.C, Winter says he doesn’t remember following the hospital’s authorization process. He had already experienced too many prior instances where his formal requests for journalistic access to the health-care system had been denied.
At that point, Winter had known his source for months and had obtained her informed consent for the project, so he went in with her and her support friend for two of her hospital admissions (he adds that he made no attempt to disguise himself either time.) Winter says that the second time, when he began photographing his source in her hospital bed in a private room, a nurse objected and called security. He says he explained his situation to both the nurse and security guard, and that his source asked for him to be able to stay and “make the pictures in question.” Despite this, Winter says he was told to leave the hospital or the police would be called; the reason cited was that he was risking the privacy of others in the hospital.
“By using the excuse of patient privacy, they’re systematically denying agency to all of their patients and taking away the sources’ ability to choose for themselves whether they want to be part of a news story or not.”
“To do my job, I need to have reasonably unrestricted access, and their policies had created a situation where it was impossible to get,” Winter says. “I was left with no opportunity; no alternative but to force the issue, which is not something that I enjoy doing.”
“By using the excuse of patient privacy, they’re systematically denying agency to all of their patients and taking away the sources’ ability to choose for themselves whether they want to be part of a news story or not.”
Winter and others say these and more seemingly inflexible barriers result in a “frustrating” routine of health-care authorities outright denying public access and information about the public health-care system.
Journalists and health-care workers in Canada describe a piecemeal system of access where key patient and hospital staff voices remain largely absent, and bureaucratic obstacles resulted in untold health-care stories as media workers walked away in frustration — especially those without newsroom or institutional resources to back up often lengthy conversations about authorization.
During the pandemic, some sources say media bans delayed Canadians’ understanding of the severity of COVID-19. It has left the country with a very limited independent record of what happened inside the health-care system during the height of this historic time period. And a system of reactive disclosure which requires journalists to file information requests for key outbreak and death data in public health-care institutions resulted in delays in crucial information for reporters on the ground during COVID-19, as well as under-reported case numbers and deaths.
Sources say pandemic restrictions have further normalized government and public-sector obstruction to public information, buttressing dangerous precedents. The inability to show what’s really going on behind hospital walls also creates missed opportunities and vulnerabilities in resisting conspiracy theories and vaccine hesitancy. Especially as policy makers and the public grapple with variants, re-opening and the impact of not mandating vaccines for hospital workers for years to come, missing chunks of history could mean that Canada is doomed to repeat it.
But collective responses like campaigns from media outlets, as well as some precedents of trust with hospital communications teams, have partially broken down these barriers, and potentially offer lessons for more effective and transparent practices.
Barriers to the frontlines
After 14 months of the pandemic and hundreds of phone conversations with health-care workers, Toronto Star health reporter Megan Ogilvie knew some of the things she was going to see when she entered the hallways of Brampton Civic Hospital in May 2021.
But it was something else to experience it firsthand; to watch workers wheel iPads into patients’ rooms so families at home could say a remote goodbye to their loved ones. She talked to staff about the compounded grief that they were struggling to cope with. She watched a granddaughter say goodbye to her grandfather, and heard from an orderly who had volunteered in the ER every single weekend since December and put “her hospital family ahead of her real family.”
“That’s a voice I don’t know if we’ve heard,” Ogilvie says. “I was really grateful that I could speak to those who I think have done crucial work but don’t often get quoted in the media.”
Ogilvie says after months of speaking to unit leaders and hospital higher-ups in her own reporting, those stories were the ones that she had been waiting to tell firsthand. She had asked roughly six hospitals and hospital systems in the Toronto area for access throughout the pandemic, before an “impassioned argument” she made to Brampton Civic Hospital in April 2021 allowed her and staff photographer Steve Russell to visit the following month.
But visitor restrictions were the most common reason for denying access to Ogilvie and others at various points of different lockdowns.
“If you’re trying to get people to follow the rules, show them how bad it can be.”
Gillian Howard, vice-president of public affairs at University Health Network, a multiple-hospital network that includes Toronto General and Princess Margaret Cancer Centre, says Ontario’s many-months-long provincial lockdown directives were the primary reason for media and other restrictions at UHN.
“We haven’t had people in the hospital, largely because it seemed very insensitive to have media (inside) and families couldn’t come in,” says Howard. “I never heard that from a family member. But I think if we had been letting other people in the building, we certainly would have heard about it.”
While Toronto-based freelance photojournalist Carlos Osorio says he partially understood this reasoning when he heard it from hospitals, it was difficult to accept given that he was trying to gain access to show the severity of COVID-19 and “help people from being in the ICU in the first place.”
“If you’re trying to get people to follow the rules, show them how bad it can be,” he says.
Osorio, who says his own mother’s sacrifices as a personal support worker in a long-term care home inspired him to stick to public health guidelines as much as humanly possible, estimates he emailed almost every health network in the Greater Toronto Area at least twice asking for access, as well as ones in cities outside the GTA, like his hometown of Windsor, Ont.
“Sometimes it felt like screaming into the void,” he says. “‘We ask, and they say no. That’s not a system — that’s just them dictating the policy.”
Osorio adds that coverage is especially important for racialized communities in Canada, who have felt a disproportionate burden during the pandemic and whose experiences in the health-care system are important to document to educate future generations.
But the lack of racial diversity and representation in journalism in Canada — and photojournalism in particular — can contribute to potential gaps in stories about communities that are hardest hit but underrepresented in pandemic coverage.
And Canada’s frontline health-care workforce is overwhelmingly racialized and feminized — 91 per cent of nurses are female, according to 2019 statistics from the Nursing Association of Canada. In Ontario, research shows that racialized women make up 13 per cent of the total workforce, but 25 per cent of workers in nursing and residential care facilities.
For Canadian journalists, the consistent lack of access to health-care facilities was juxtaposed with news images and footage coming from inside hospitals internationally in place like Brazil or in the United States as early as April 2020, some of which Osorio says he and his colleagues attached to access requests to try and show hospital PR teams the kind of work they were looking to do, to no avail.
Some say the disparity between images coming out of Canada in comparison to Italy or New York contributed to public perception that Canada was not as impacted by COVID-19.
It was that disparity that media outlets in Quebec addressed in a Jan. 26 open letter titled “Quebec media must be allowed to show the ravages of COVID-19,” which called for more open access to health-care institutions. It garnered 19 signatures from editors, news directors and managers across the province.
“Government and public-health authorities have chosen to shut the doors of the province’s health institutions to the media, a restriction with little precedent in the rest of the world,” the letter reads, adding that government restrictions “are all the more astonishing” because hospital managers and caregivers expressed interest in media visits.
Luce Julien, executive director of news and current affairs at Radio-Canada, says the letter was born of frustration that she had been hearing from journalists throughout the pandemic, in addition to the fact that CBC correspondents in other countries weren’t facing the same barriers.
On Jan. 22, Julien called Francois Cardinal, deputy editor of La Presse, who said that the newspaper was experiencing the same restrictions. Cardinal wrote the letter, and he and Julien sent it to news directors across the province shortly after. It was signed and ready to publish by the following Monday.
“It was so easy because everyone was just fed up, exhausted with [the] situation,” Julien says. “I couldn’t believe it, I thought it was going to take a week, but it took two or three days.”
Cardinal spoke to the premier’s office about the letter the day before it was released. In an email to J-Source, he says that government officials “were convinced that the public was on their side and not ours,” and added that the province’s tone changed in a press conference the following day where Health Minister Christian Dubé said more journalistic access to the health-care system would be beneficial to society.
Cardinal says that a few days later, “as if by magic,” the doors to health-care institutions opened. Julien says Radio-Canada’s coverage inside of hospitals in Montreal in early February was made possible because of pressure that resulted from the letter.
Re-examining the impact of privacy practices on transparency
Restrictive public information policies have been an issue in Canada for decades, according to journalism professor and freedom of information researcher Sean Holman. During his 10 years as an investigative reporter covering provincial politics in British Columbia, Holman second guessed pursuing stories related to the public health-care system because barriers to access made it “more trouble than it was often worth.”
“You just couldn’t get good access to what was going on within that system, to the point that it just wasn’t reported,” he says. “It’s one of those situations where it’s difficult to prove a negative, because it was really in the absence of my reporting on that particular system that demonstrated how difficult it was to report on that particular system.”
Holman says these policies emerged out of an accelerated expansion of the public relations state that started in the 1960s, but absence of information has become especially dangerous during a public health crisis like the pandemic, which “creates a breeding ground for misinformation and disinformation, as people seek faux forms of control and certainty.”
In October 2021, CBC Edmonton footage intended to demonstrate how an ICU functions that included a mannequin was touted as supposed evidence that the pandemic was fake after being reused in COVID-19 segments.
Holman, who is now the Wayne Crookes Professor of Environmental and Climate Journalism at the University of Victoria, saw these difficulties when his former students at Mount Royal University in Calgary were unable to speak to nurses about COVID-19 contact tracing because it would require clearance from Alberta Health Services, the top health authority in the province.
While covering COVID-19 in Peel region near Toronto, journalist Fatima Syed found her health-care sources expressing concern that information could be traced back to them. Having sources with vital tips that would otherwise be willing to speak was frustrating and “a little bit maddening,” says Syed.
“It’s also isolating to you as a journalist. You’re just sitting on all this important information that you can’t put out,” she says, adding that decision making is hindered when vital public information is delayed.
Syed says that for her sources, many of these fears were manifested with the termination of Brooks Fallis, a Toronto-area critical care physician who says members of the William Osler Health Network removed him from his position as interim medical director for criticizing the province’s pandemic response and potentially jeopardizing government funding.
These experiences highlight the limits to conversations about journalistic access to health-care institutions when sources, especially those who’ve seen the impacts of the pandemic firsthand, are not able to speak candidly about their experiences.
Nurses, for example, require direct permission from top health authorities to speak to any media, often due to communication policies that require permission if an employee is speaking in a role on behalf of an organization.
Whistleblowing experts say reporting mechanisms within the health-care system are insufficient for frontline workers, for whom it’s important to have clearer channels of access while dealing with the continued trauma and exhaustion of working throughout the pandemic
Unlike physicians, who are typically contracted by health-care organizations independently and can potentially use other titles to maintain distance from their employers, roles like nurses or respiratory therapists are often direct employees. This means speaking publicly about any of their work in these frontline roles could technically be considered speaking for an organization by the health-care networks, hospitals or other health-care institutions that they work for.
But even for doctors, a contractual distinction is not a guarantee. Dr. Joe Vipond, an emergency physician in Calgary, says he received pushback for his advocacy from Alberta Health Services.
“AHS tried to muzzle me,” Vipond says, “but … I was able to have full freedom once they and I understood that I was not violating any agreement.” He says health authorities withdrew their criticism once they reviewed the “appropriate policies” and after he defended his work with resources for physician advocacy that were developed out of evidence of physician intimidation in the province in the early 2010s.
Sources say establishing clearer channels of access will also be important to support frontline workers dealing with the continued trauma and exhaustion of working throughout the pandemic. Research from May 2021 shows high rates of PTSD for health-care providers working during COVID-19 — especially for nurses, women and people who are married.
‘We basically let the whole thing happen without any independent witnesses’
Journalists say that pandemic issues of access, compounded with privacy policies and sometimes many-week delays in responses from public health authorities, mean that key details remain absent from public health reporting.
One of these practices is standards for patient privacy in hospitals which go “far beyond what people realize,” according to Globe and Mail national health reporter Kelly Grant.
Grant describes a time when she interviewed a physician while a communications staff member was also present on the line, which she and other sources say is becoming more of a regular occurrence.
After the conversation about delayed surgeries due to the pandemic where a doctor had vaguely mentioned an emotional phone call with a patient, the staff member phoned Grant and asked her to remove any details that would enable the patient to identify themself. (Grant says that kind of request has happened more than once due to privacy concerns, and in this case meant that she wound up not using the interview because she had stronger material and “without the evocative details the call wasn’t very useful.”)
Grant says the extent of these practices means that in her reporting both in and out of the hospitals, she was not allowed to report “bare bones” details like patients’ age or the city that they were being transported from.
“It makes it hard to tell stories that have the kinds of specific details that, I think, don’t identify patients to the larger public, but that help to drive home what’s happening in the hospitals,” she says.
UHN’s Howard says duties to protect patient privacy in Ontario come from the Personal Health Information Protection Act, a breach of was underscored in a 2005 Information & Privacy Commissioner decision in Ontario that ruled in favour of a patient who was inadvertently pictured in the background of a photo that the subject themselves had consented to.
Howard says the PHIPA privacy standard the ruling underlined is “if the person themselves can recognize themselves, not (only) if a friend or family member can recognize (them.) It’s pretty restrictive. A lot of people don’t mind, but it means that you have to get consent for what you’re doing.”
These standards are addressed with consent forms for all identifiable patients in photos, like with Osorio, who was able to access Humber River Hospital through connections he made with staff members at a mobile vaccine clinic in early 2021.
“In Alberta, we’ve lost lives. I think people have died because of it.”
Osorio’s process was to note details like room numbers and times and then co-ordinate with the communications team to obtain consent from patients and family members for people who were intubated and couldn’t speak for themselves.
Privacy was the reason Toronto Star staff photographer Russell says he was denied access to vaccination clinics, experiences that he gets “riled up” talking about.
On May 16, Russell says media were not allowed into an East York vaccine clinic that administered a record-breaking 10,000 doses of vaccine in one day. Instead, he says PR staff told him he could photograph people waiting in line, an experience he likened to being told that the best photos of Kawhi Leonard’s historic buzzer-beating playoff shot were the people lined up outside of the arena.
Russell says PR staff also offered to send links of their own photography — images which he says he couldn’t accept because he didn’t know the chain of custody and couldn’t personally verify the content.
Amber Bracken, a photojournalist based in Edmonton, agrees. “When we only accept the photographs that they release to us, even if it’s a great story on its own, it exists in a vacuum of all of the access that we haven’t had.”
In Alberta, the doors didn’t open for her, either. Bracken had spent seven years documenting a source’s healing journey for a long-term documentary project called “Generations” that explores the impact of residential schools on present-day families. As both the source and his partner had previous children taken away by the child welfare system, the birth of the couples’ child was a central moment to their story.
In December 2020, she was denied access to the hospital to photograph the birth. Bracken had outlined these details in her request to hospital staff, as well as the fact that both parents wanted her there and had even discussed bringing Bracken in as the mother’s support person in place of her partner (an offer Brackens adds she declined.)
Bracken suspects she would have been allowed as a second support person under COVID-19 safety protocol at the time if she were not media, but she doesn’t know for sure. The response to her five-paragraph long request was one sentence: “Unfortunately, no media is being given access into hospitals given the current circumstances.”
Bracken is an independent photojournalist, and the lack of institutional backing is one of the reasons she hadn’t tried to push for first-person access to hospitals in the early days of the pandemic. Plus, she had figured, better-resourced legacy media must already be working to document independent images of this historical time period firsthand. But her perspective changed when she received the response to her access request, and was shocked to read that there was what sounded like an absolute, province-wide media ban.
“All at once, I realized that it wasn’t going to happen in Alberta. There was never going to be reportage from the COVID wards. There was never going to be someone’s story of recovery, or the ones that didn’t.”
Bracken says she thinks the lack of firsthand coverage compounded with the province’s spread-out population had dire consequences because people didn’t see the impacts of the disease firsthand. “In Alberta, we’ve lost lives. I think people have died because of it.”
In May, the province had the highest COVID-19 cases per capita in both Canada and the United States, and hospitalizations surged in the province in September, with ICUs 95 per cent full and elective surgeries postponed.
In the months after the email, Bracken was motivated to push for more access and find funding for resources like personal protective equipment and isolation time that would allow her to report safely. She tried to get CBC and Canadian Press “on board,” but despite initial interest, plans fell through due to union and distribution issues, leaving her feeling “demoralized.”
“This is something that will continue to impact public health and policy in the province and around the world for at least a generation,” she says, “And we basically let the whole thing happen without any independent witnesses.”
The impact of pandemic information delays
For Tyee reporter Jen St. Denis and other journalists across the country, delays in releasing COVID-19 data and information have hindered journalists’ ability to provide timely pandemic information to their communities.
St. Denis is a beat reporter who focuses on stories about Vancouver’s Downtown Eastside, a complex community with disproportionately high rates of poverty and substance abuse. While reporting on the pandemic, the barriers to information got to the point where St. Denis gave up trying to contact health-care authorities.
First, in fall of 2020, Vancouver Coastal Health Authority didn’t disclose a COVID-19 exposure in a community pub until after St. Denis published a story in the Tyee based on a tip. Then, in November 2020, after St. Denis had tried to contact health authorities for two months and even extended her deadline to get Downtown Eastside specific COVID-19 case numbers, authorities responded after publication with more detailed data. St. Denis says that information would have provided important context surrounding the severity and risk of COVID-19 for community members.
St. Denis says she gave up trying to contact health authorities after she was told they had Downtown Eastside specific case numbers, but they would not share it with her or “make anyone available for an interview to explain what they were seeing in the data.”
“It’s just frustrating, because I’d really like to provide the most accurate picture,” she says. “It just feels like hitting a bureaucratic wall.”
And the barriers continued into 2021, when St. Denis says she couldn’t get comment from health authorities in regards to her first story about a dual COVID-19 and bacterial infection outbreak in the neighbourhood — which St. Denis says she only learned of when a source sent her pictures of a sign in their building saying their floor was 100 per cent contaminated with COVID-19. (Vancouver Coastal Health provided an email statement for her second story on the topic.) St. Denis says communications staff have told her that they are required to get approval from the provincial ministry of health before they can release any information, a system that she suspects causes some of the delays.
St. Denis says although it was never directly communicated to her, she’s heard privacy concerns have been given as a reason not to release outbreak data in smaller communities in the province. She says she’s not hearing similar concerns about privacy from community members and her sources in the Downtown Eastside.
Addressing the ‘reluctance to engage’
Photojournalist Winter says his frustrations are not with the importance of privacy or informed consent, but the system’s “reluctance to engage” with journalists in the nuances of these conversations.
“I can understand why it’s easy for authorities to deny access on a case-by-case basis, especially when there isn’t a solid precedent of access being granted before,” says Winter. “They see us as being nothing but risk.”
Winter, Bracken and other journalists express concern that the pandemic has normalized public institutions outright denying access, as well as the underlying assumption they feel is at the heart of these restrictions.
“We’ve quietly accepted the government assessment that we’re wild agents and not capable of being careful or respectful,” Bracken says. “Even when this safety question goes away, I am concerned that we’ll still be fighting this assessment of the media as broadly untrustworthy to handle these stories.”
Professor and FOI researcher Holman says that coverage focused on the restrictive nature of media relations policies within the public health-care system, and broader public sector, has been limited, and that journalists have fallen short of reflecting those realities in reporting. Media, says Holman, needs to reassess the premise that this topic is “insider news.”
“I think it’s (a) mistaken notion that the public isn’t interested in stories about how information access is limited in this country,” he says, adding that constrictive policy practices developed without support outside of the public sector bureaucracy. “We need to be writing about it, not simply because it’s in our own self interest to do so, but because it’s ultimately within our audience’s self interest to do so.”
One of the proposed reforms was the legal right of proactive disclosure, which would mean that instead of going through the access to information system, the government would be required to release broad categories of records — like health-care records and scientific reports submitted to health authorities — by default, requiring federal and provincial public bodies to release them without redaction within 15 days of their completion.
Another recommendation is reforming Canadian whistleblower protection laws, which accountability advocate Ian Bron says are currently ineffective, symbolic, and “not serving the public interest” on both a federal and provincial level.
Holman says he doesn’t think any of the group’s recommendations have been implemented, he says there is still an opportunity to challenge restrictive communications policies moving forward, albeit one that is “presenting itself under extremely difficult conditions” due to the sheer exhaustion of reporters.
“We need to sort of get past this notion that the public doesn’t have a right to know information that is in the public interest,” he says. “We confuse what privacy is. What we should be most concerned about is whether or not the powerful can surveil the powerless.”
This story was reported as part of the 2021 J-Source/CWA Canada reporting fellowship, funded at arm’s length by CWA Canada.
Editor’s note: This post was updated on Friday Nov. 5, 2021 at 2:05 p.m. ET to clarify that barriers to health-care sites led Jesse Winter to deprioritize, rather than stop, covering pandemic stories.