2012 Annual Report Office of the Auditor General of Ontario Office of the Auditor General of Ontario To the Honourable Speaker of the Legislative Assembly In my capacity as the Auditor General, I am pleased to submit to you the 2012 Annual Report of the Office of the Auditor General of Ontario to lay before the Assembly in accordance with the provi- sions of section 12 of the Auditor General Act. Jim McCarter, FCA Auditor General Fall 2012 Copies of this report are available for $9.00 from Publications Ontario: (416) 326-5300 or toll-free long distance 1-800-668-9938. An electronic version of this report is available on the Internet at www.auditor.on.ca © 2012, Queen’s Printer for Ontario Ce document est également disponible en français. Cover photograph credits: ISSN 1719-2609 (Print) top right: Dick Hemingway Photographs ISBN 978-1-4606-0348-2 (Print, 2012 ed.) middle left: © Tetra Images/INMAGINE.com middle centre: © iStockphoto.com/ssuaphoto ISSN 1911-7078 (Online) bottom left: Office of the Auditor General of Ontario/Mariana Green ISBN 978-1-4606-0349-9 (PDF, 2012 ed.) bottom centre: © iStockphoto.com/mevens, HooRoo Graphics Table of Contents Chapter 1 Overview and Summaries of Value-for-money Audits and Reviews 5 Chapter 2 Public Accounts of the Province 27 Chapter 3 Reports on Value-for-money Audits and Reviews 45 Section 3.01 Cancer Screening Programs 46 Section 3.02 Criminal Prosecutions 65 Section 3.03 Diabetes Management Strategy 82 Section 3.04 Drive Clean Program 107 Section 3.05 Education of Aboriginal Students 129 Section 3.06 Independent Health Facilities 149 Section 3.07 Legislative Estimates Review Process 171 Section 3.08 Long-term-care Home Placement Process 185 Section 3.09 Metrolinx—Regional Transportation Planning 205 Section 3.10 Ontario Provincial Police 230 Section 3.11 Tax Collection 258 Section 3.12 University Undergraduate Teaching Quality 273 Section 3.13 Youth Justice Services Program 292 Chapter 4 Follow-up on 2010 Value-for-money Audits 318 Section 4.01 Casino Gaming Regulation 319 Section 4.02 Discharge of Hospital Patients 325 Section 4.03 Family Responsibility Office 333 Section 4.04 Home Care Services 343 Section 4.05 Hospital Emergency Departments 349 Section 4.06 Infrastructure Asset Management at Colleges 358 Section 4.07 Infrastructure Stimulus Spending 365 Section 4.08 Municipal Property Assessment Corporation 372 Section 4.09 Non-hazardous Waste Disposal and Diversion 382 Section 4.10 Organ and Tissue Donation and Transplantation 392 Section 4.11 School Safety 400 Chapter 5 Review of Government Advertising 407 Chapter 6 The Standing Committee on Public Accounts 420 Chapter 7 The Office of the Auditor General of Ontario 423 4 2012 Annual Report of the Office of the Auditor General of Ontario Exhibit 1 Agencies of the Crown 449 Exhibit 2 Crown-controlled Corporations 450 Exhibit 3 Treasury Board Orders 452 Chapter 1 Overview and Summaries of Value-for-money Audits and Reviews than doubled over the last two decades, even Overview though the number of criminal charges disposed of each year has remained relatively constant. Chapter 1 Factoring in the increasing complexity of today’s MAKING TOUGH FISCAL CHOICES legal environment, the Division needs to determine Ontario is not alone in facing some tough chal- how many Crown attorneys there should be at each lenges to get its fiscal house in order. One of the local office and should make much better use of the impacts of the recent global recession is that information it has on the relative workloads, effi- Ontario, like many other jurisdictions, has been ciency and effectiveness of its Crown attorneys. spending far more than it has been collecting in revenues. And just like a household that spends sig- Diabetes Management Strategy nificantly more than it earns by borrowing the extra money, this practice can only be continued for so The number of people with diabetes in Ontario long. The Ontario government recognizes this, and, has more than doubled from 546,000 in 2000 as the Minister of Finance said in the 2011 Budget, to 1.2 million in 2010 and is projected to grow “To overcome this challenge, the government must to 1.9 million by 2020. Type 1 diabetes, which renew its focus on deficit reduction.” accounts for 10% of diabetes cases, is not prevent- Given the challenging fiscal times, making able; however, Type 2 diabetes, which accounts for significant inroads in reducing the deficit will be no the other 90%, is largely preventable with lifestyle easy matter. Consequently, in many of this year’s changes that include healthier eating and exercise. value-for-money audits, we paid particular atten- In 2008, the Ministry of Health and Long-Term Care tion to looking for efficiencies and cost savings. Our implemented a four-year, $741-million diabetes observations in this regard are summarized in the strategy. We found that, to date, the results have following subsections. been mixed, in that while the availability of care for people with diabetes has definitely improved, many services were underused and, in some cases, dupli- Criminal Prosecutions cated. As well, we noted that 97% of the funding Crown attorneys in the Criminal Law Division of the was earmarked for treating people who already had Ministry of the Attorney General prosecute criminal diabetes, with only 3% being allocated for preven- charges laid by police forces across Ontario. The tion initiatives. number of Crown attorneys employed has more 5 6 2012 Annual Report of the Office of the Auditor General of Ontario Independent Health Facilities Ontario Provincial Police Ontario has about 800 health facilities that are Over the last two decades, crime rates across Can- independently owned and operated, with about ada have declined by more than 40%, and Ontario 50% being owned or controlled by physicians. has been part of this trend. As well, the number of These facilities provide primarily diagnostic servi- serious motor vehicle accidents has been trending ces, such as x-rays, ultrasounds and CT scans. We down in recent years and calls for service to the suggested the Ministry review facility billings for Ontario Provincial Police (OPP) have remained unusual billing patterns and review whether the stable since our last audit in 2005. However, OPP facility fees being paid are appropriate in relation expenditures (excluding recoveries for police to the actual costs of providing the services. We services provided to municipalities) have increased also noted that in 2009, the Canadian Association 27% over the last five years because more officers of Radiologists observed that as many as 30% of CT have been hired, compensation increases have scans and other imaging procedures across Canada exceeded inflation and cost-savings opportunities contribute no useful information or are inappropri- we previously identified had not been adequately ate. The Ministry of Health and Long-Term Care’s acted upon. We noted that the OPP could reduce its Chapter 1 own estimate was that about 20% of independent operating costs by improving its staff deployment health facility fee billings are likely inappropriate. practices and better controlling overtime. Long-Term-Care Home Placement Process Tax Collection Many people are in hospital longer than medically Most taxes owing to the province are remitted necessary waiting for a long-term-care bed, even voluntarily, but some are not, and the Ministry of though this is detrimental to their health, is more Finance’s Collections Branch is responsible for col- expensive than community-based alternatives such lecting most of these taxes. The Branch estimates as home care or placement in a long-term-care that, as of March 31, 2012, it may need to write off home, and limits the availability of hospital beds about $1.4 billion of the $2.46 billion in outstand- for other patients with more complex health-care ing taxes that it is responsible for collecting. While needs. However, 19% of people waiting in hospital there have been some improvements to the Branch’s for a long-term-care bed had applied to only one collections processes in the last few years, we found long-term-care home, even though their selected that the Branch was often not taking appropriate home may have a long wait list. action on a timely basis and was not using all the strategies at its disposal to maximize the amount of unpaid taxes it collects. Metrolinx—Regional Transportation Planning Youth Justice Services Program Metrolinx is an agency of the Ontario government that is responsible for implementing an integrated The Youth Justice Services program of the Ministry transportation system in the greater Toronto and of Children and Youth Services provides commun- Hamilton area over the next 25 years at an esti- ity and custodial programs and services primarily mated cost of $50 billion. Our review of several to young people aged 12 to 17 who are either significant projects costing hundreds of millions of awaiting trial or have been found guilty by a court dollars indicated that Metrolinx must strengthen of a criminal charge. From the 2005/06 to the its processes relating to infrastructure investment, 2010/11 fiscal years, total program expenditures procurement and cost control. Overview and Summaries of Value-for-money Audits and Reviews 7 increased by 25%–30%, even though the number partly to the Drive Clean program, newer vehicles of youths served increased by only 4%. And in the with improved vehicle-emission-control systems last five years, even though the number of youths and cleaner fuel requirements have had a larger in Ministry-operated secure facilities decreased by impact on reducing overall vehicle emissions. We 37%, the number of ministry youth services officers encouraged the Ministry to ensure that future at these facilities increased by 50%.