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My story is relatively brief. Six years ago, shortly after completing my residency in Rochester, N.Y., I opened a solo family medicine practice in what had become my adopted hometown. I had a vision of cultivating a practice where patients felt heard and cared for, and where I could provide a full-spectrum of family medicine care, including obstetrics. My practice embraced the principles of patient-centred collaborative care. It employed the latest in 21st-century technology. After five years of constant fighting with multiple private insurance companies in order to get paid, I ultimately made the heart-wrenching decision to close my practice. The emotional stress too great. My spirit was being crushed. It broke my heart to have to pressure my patients to pay the bills their insurance companies said they owed. Private insurance never covers the whole bill and doesn't kick in until patients have first paid down the deductible. For some this means paying thousands of dollars out-of-pocket before insurance ever pays a penny. But because I had my own business to keep solvent, I was forced to pursue the balance owed.

Doctors deal with this conundrum in different ways. A recent New York Times story described how an increasing number of doctors are turning away from independent practice to join large employer groups (often owned by hospital systems) in order to be shielded from this side of our system. About 60 per cent of family GPs are now salaried employees rather than independent practitioners. That was a temptation for me, too. But too often I've seen in these large, corporate physician practices that the personal relationship between doctor and patient gets lost. So I looked for alternatives. I spoke with other physicians, both inside and outside my specialty. We invariably ended up talking about the tumultuous time that the U.S. health care system is in - and the challenges physicians face in trying to achieve the twin goals of improved medical outcomes and reduced cost.

I knew Canada had largely resolved the problem of delivering affordable, universal care with a publicly-financed single-payer system. I also knew Canada's system operates more efficiently than the U.S. system, as outlined in a landmark paper in The New England Journal of Medicine. So I decided to look at Canadian health care more closely. I liked what I saw. I realized I did not have to sacrifice my family medicine career because of the dysfunctional system on our side of the border. In conversations with my husband, we decided we'd be willing to relocate our family so I could pursue the career in medicine that I love. I'll be starting and growing my own practice in Penetanguishene on the tip of Georgian Bay this autumn. I'm excited about resuming my practice, this time in a context that is not subject to the vagaries of backroom deals between monied, vested interests. I'm looking forward to being part of a larger system that values caring for the health of individuals, families and communities as a common good - where health care is valued as a human right.

I hope the U.S. will get there some day. I believe so. Perhaps Canada will help us find our way. Emily S. Queenan, MD, resides in Rochester, N.Y. She is an adviser with EvidenceNetwork.ca.

On Feb. 10, Valeant Pharmaceuticals International Inc. bought the rights to a pair of life-saving heart drugs. The same day, their list prices rose by 525% and 212%. Neither of the drugs, Nitropress or Isuprel, was improved as a result of costly investment in lab work and human testing, Valeant said. Nor was manufacture of the medicines shifted to an expensive new plant. The big change: the drugs’ ownership.

The policies he has unveiled - a shift in the tax burden from the middle class to the richest 1 per cent of the population; a child benefit targeted at families that need financial support; a non-partisan Senate; open, transparent government; a rebuilding of trust between Ottawa and First Nations; and a federal-provincial plan to shift to clean energy - stand up to scrutiny. But they don't add up to a plan to govern. He has said nothing substantive about health care, affordable housing, early learning, immigration, human rights or poverty reduction. He has not unveiled his urban agenda. He has not told voters how he would align their tax dollars with their priorities.

It is not that Trudeau lacks policies. One of his first actions as party leader was to assign his shadow cabinet and talented Liberal outsiders to draft policy papers setting out what a Liberal government would do in all these areas. Two years later, they are all in hand. He announced a spate of policies between May 1 and June 16 for which he won generally positive reviews. But at the end of June, he turned off the spigot. He has spent the summer - with a single exception - condemning Stephen Harper's record, repeating his pledge to cut middle-class taxes and launching the odd broadside at Mulcair.

Last week in his only campaign commitment to date, he said a Liberal government would invest $2.6 billion in aboriginal education over four years (an elaboration of his earlier promise to close the inequality gap between First Nations and non-aboriginal Canadians). Why hold back the rest of his platform? Why create the impression he has no plans to tackle poverty, fix Canada's broken employment insurance system or simplify the nation's loophole-ridden tax system? Why leave voters wondering if the Liberals know how to get Canadians working or keep medicare sustainable? Why offer no alternative to Ottawa's callous, discriminatory treatment of refugees? Why say nothing about military spending? Why withhold the blueprint for strong vibrant cities that former Toronto councillor and star recruit Adam Vaughan submitted to him months ago?

Not only does this slow-release tactic contradict Trudeau's vow of openness, it detracts from what he has accomplished. In two years he has rebuilt a shattered, demoralized party, filled its coffers and attracted impressive candidates. He has withstood a barrage of Tory attack ads. He has developed a clear focus and consistent message. Initially Trudeau's advisers said he was keeping his platform under wraps so rivals couldn't pick off his ideas. But there is little danger of that now. Harper's record indicates where he stands on most issues. Mulcair released his platform months ago.

He might be saving the rest of his platform until more voters are paying attention. But the longer Trudeau waits, the more openings he gives his adversaries to portray him as a lightweight. Even an incautious phrase - "we can grow the economy from the heart outwards" - exposes him to mockery.

A more troubling possibility is that Trudeau thinks an incomplete platform will suffice, that he can rely on his charm, energy and progressive instincts to carry him to victory. That might have worked before the NDP "orange wave" swept across the land. It is the wrong strategy now.

"She was there for a month before she caught the flu and died. Staff never returned our many phone calls or responded to our e-mails. "This system has to change. It's a disgrace on all levels, both home care and facility care. "Julie Cameron, Vancouver "When the Ontario government cut acute-care beds in the 1990s, adequate home care was not put in place first, reflecting the headin-the-sand approach of successive governments to an aging society. "Home care has long been the Cinderella of the health-care system, underfunded and undervalued, yet it is of increasing importance. "Preventative support to keep seniors independent in the community has markedly decreased, because resources are concentrated on the acute needs of patients discharged from hospitals. This leads to unnecessary early institutionalization. "The burden is increasingly born by patients and their informal caregivers. These caregivers are often frail and vulnerable themselves or, if they are the patient's children, there is the economic impact of taking them away from their work. "Inevitably, there is a two-tier system, where the wealthy are able to obtain necessary support, while the rest are on waiting lists, receiving less than adequate care.

"With an aging society, the problem will become worse. "It is time to review the whole community care system and, learning from other jurisdictions, put in place a comprehensive, transparent and properly funded home-care system. "Rory Fisher, professor emeritus, medicine, University of Toronto

"My wife has advanced multiple sclerosis. Two years ago, she got a cut on her foot, which became infected. She was seen at a local hospital, where it was determined she would need intravenous antibiotic every eight hours. With the first treatment at 1 p.m., every third treatment was at 5 a.m. "After the fourth visit, a nurse at the hospital asked why we were not getting these treatments through home care. We did not know it was an option. "She picked up the phone and by the time we returned home, we had a message from the Champlain CCAC to schedule a nursing visit for the treatment.

"Within 48 hours, my wife was assessed and services assigned that exceeded our expectations in quality and oversight of her condition. Over a two-year period, she has received regular reassessment, with treatment plans adjusted according to her needs. "There is no doubt in my mind that home care is not only more cost-effective, but allows treatment to be delivered in a more comfortable setting without travel and waiting room purgatory. "There is also no doubt that the government planning process has failed this system miserably. "We are an hour from Ottawa, which may have something to do with it, but I cannot believe we are the only people in Ontario who have been this fortunate. "Ken Duff, Vankleek Hill, Ont.

"I used to "warn" my patients' families that the first thing CCAC tries to do is to get the family to take over care, even though they "promise" home care while in hospital (to get them out of the hospital). Then, CCAC cuts back on the hours until they "decide" that they must not need home care, because they are only getting four or five hours per week (instead of the 15 or 20 they were originally promised!). It is not the doctors and nurses trying to "get rid of patients," it is administration because of bed times (days in hospital). "Linda Steele, Grand Bend, Ont. "Government needs to put this on speed dial. "April Nairne, Vancouver

"Let's not paint the home-care system with one brush. My husband had excellent, timely and compassionate care through the last weeks of his life which allowed him to die at home, as was our wish. Nurses, personal support workers and supervisors were kind and empathetic. We could never thank them enough. "Ann A. Estill, Guelph, Ont. "Caregivers are frustrated and burning out. One in five Ontarians is a caregiver and they are not receiving the support they need to keep their loved ones at home - be it aging and/or ill parents, spouses or children. "Ontario has acknowledged the need for caregiver supports and more home care. That is great - but where is the change, instead of just lip service?

"In the meantime, families increasingly abandon their loved ones at hospital emergency departments, more caregivers fall into depression, and care recipients end up in hospital or longterm care when they could have stayed home. "We are ready for improvements to home care - any time now. "Lisa Levin, chair, Ontario Caregiver Coalition "Anyone wondering why we baby boomers are demanding the right to assisted suicide should read Kelly Grant and Elizabeth Church's excellent coverage of the Ontario home-care situation to learn the reasons. "Brian Caines, Ottawa " "Associated Graphic "'Care recipients end up in hospital or long-term care when they could have stayed home.'

"ADAM BERRY/GETTY IMAGES

"Rotund, funny and occasionally pompous, Dr. Porter was everyone's friend and nobody's confidante, the life of the party and an agile dancer, both in political circles and around a ballroom floor. A member of Air Canada's board of directors, he travelled the world free. His former friend Prime Minister Stephen Harper had him sworn in as a member of the Privy Council so he could serve as chairman of the Security Intelligence Review Committee, or SIRC, the country's spy watchdog agency. "And he was close to Quebec Premier Philippe Couillard, a relationship that began in 2004 when the politician, a neurosurgeon by training, was provincial health minister. Like many of Dr. Porter's friendships, theirs ended with the news of the hospital's megacost overrun and a $22.5-million fraud inquiry connected to the MUHC's decision to award the construction contract to a consortium led by the Montreal-based engineering firm SNC-Lavalin Group Inc.

""In a way, Arthur was like Icarus, who came crashing down to earth when his wax wings melted because he flew too close to the sun," Jeff Todd, an Ottawabased journalist who first met Dr. Porter in the Bahamas and co-authored the memoir, said. ""He told me that if he did anything wrong, it was to go way too fast," Mr. Todd continued. "There was never a peak he didn't want to climb and if there was a huge challenge, he always thought he would simply fly over it. But he couldn't always do that." "The first indication was in November, 2011, when the National Post revealed he had signed a commercial agreement the year before with Ari BenMenashe, a Montreal-based Israeli security consultant and arms dealer, all while he was head of both the MUHC and Canada's spy watchdog. Mr. BenMenashe was to secure a $120million grant from Russia for "infrastructure development" in Sierra Leone. In return, a company called the Africa Infrastructure Group, which was controlled by Dr. Porter's family, would manage what he wrote were "bridges, dams, ferries and other infrastructure projects" built with the Russian money.

"Dr. Porter was 59 when he died in a Panamanian hospital on June 30, an ignominious, sad and lonely end for a man who had found success far from his birthplace in Sierra Leone. At Cambridge, he was a star medical student. In the United States, where he ran a major medical centre in Detroit, he was a self-declared Republican who in 2001 refused an offer from then-president George W. "Bush to become the next surgeon-general. In his 2014 memoir, The Man Behind the Bow Tie, Dr. Porter recalled getting a phone call soon after. ""Is that your final answer?" Mr. Bush reportedly asked him, lifting a line from Who Wants to be a Millionaire, at the time a popular TV game show.

"He was smart, perhaps too smart for his own good, and affable, with an ability to zero in on the most powerful person in the room with laser-like focus. His long-time friend and former teacher Karol Sikora, who partnered with Dr. Porter in a Bahamian medical clinic and is also the medical director of their joint private health-care company, Cancer Partners UK, said he was uncannily good at getting people together everywhere he touched down, even if they had opposing views. ""People like that are rare and they are very good at running big institutions," Dr. Sikora said. ""Arthur reached the peak of his career in 2010, when he was all glowing and bigger than sliced bread. Then it all went wrong." "Although Dr. Porter claimed the money from SNC was payment for other consulting work he'd done for them, his friend opined that the truth will probably never come out now. ""I'd like to think Arthur was never part of this monkey business, but we'll never know," he said.

"Others were not so kind. Responding to news of his death, the MUHC issued a terse statement that extended condolences to his family and offered no further comment, while Mr. Harper suspended the protocol that would have seen the Peace Tower flag fly at half-mast to mark the death of a Privy Council member. "In prison, living in unsanitary surroundings and denied proper treatment in a hospital for the cancer that many doubted he had, Dr. Porter, who leaves his father, sister, wife and four daughters, was outwardly still full of bravado until near the end. ""I just have to survive and make do," he told CBC reporter Dave Seglins in a phone interview in March that revolved around his treatment at the prison and his successful complaint to the United Nations torture watchdog that his human rights were being trampled on. ""[The] water, food, bedding and the fact that one has to urinate in a bucket shared by about 50 to 100 people ... for someone who has an illness and needs treatment, it was pretty obvious, I presume, the UN clearly found in my favour." "In addition, Dr. Porter continued, his raspy voice rising, he had not had a single court hearing in 22 months.

"I've never left here to go into the city. I have no idea what the inside of a courtroom looks like, not in Panama, Canada, the Bahamas or anywhere," he cried. "I've never been to court in my life." "In the end, though, he seemed to be aware that the stain on his reputation would not be erased, not even in death. ""My entire life has been devoted to climbing, winning and succeeding," he wrote in his memoir. "But with the end drawing near, it is inevitable that I, like anyone else, wonder if what I have accomplished truly matters. I wonder how I will be remembered." "To submit an I Remember: obit@globeandmail.com Send us a memory of someone we have recently profiled on the Obituaries page. Please include I Remember in the subject field.

"In his memoir, Dr. Porter said his life was 'devoted to ... winning.' " "Arthur Porter, left, chats with Stephen Harper at Montreal General Hospital in 2006. The Prime Minister had Dr. Porter sworn in as a member of the Privy Council.

In 2004, the Health Accord was established as an agreement between the government and each province and territory. It provided all regions with stable funding to deliver adequate medical care that met national standards. The $41-billion pact was a response to deep cuts throughout the 1990s and aimed to address issues around wait times, pharmaceuticals and term care. For much of the past 10 years, federal support hovered around 23 per cent.

The accord rightly placed the government in a position of leadership on health care, one from which it could co-ordinate medical delivery and uphold common principles for all Canadians. Under the Harper government, however, the agreement began to erode. In 2011, three years before its expiry, the Conservatives announced major cuts to the Canada Health Transfer of $36 billion over a decade beginning in 2017. Instead of the traditional annual rise of six per cent, funding would now be based on the rate of growth of Canada's GDP.

Then, in 2012, after agreeing to extend monopoly drug patents to European countries in a far-reaching trade agreement, the government increased pharmaceutical costs to Canadians by an estimated $1 billion. Two years later, the Health Accord was not renewed; every province and territory was left on its own to determine how it will fund growing and aging populations into the uncertain future.

The retreat of the federal government from its position of authority on national health care is a troubling trend, one made all the more distressing in light of recent projections outlined in a report compiled by the Canadian Federation of Nurses Unions. In the document, The Canada Health Transfer Disconnect, economist Hugh Mackenzie argues lower GDP growth estimates mean federal support for medicare will drop from 23 to 19 per cent by 2025. This represents a shortfall of $44 billion.

Based solely on GDP and distributed by population, the platform is "insensitive to the differences in the drivers of the costs of health care," Mackenzie writes. Most importantly, this includes an aging population. Within the next 25 years, the number of Canadians aged 65 and older will double, reaching a staggering 10 million.

The premiers want the Health Transfer increased to at least 25 per cent of all health-care spending. Without it, the provinces and territories will face insurmountable financial pressure. In real terms, this means fewer nurses, home care visits, primary care centres and long-term beds. Since the election of a Conservative majority government, taxes are at their lowest levels in more than half a century. In its myopic vision of deficit reduction and austerity, Ottawa now collects $45 billion less in revenue. It is no wonder the Canadian public is being told it cannot "afford" adequate levels of health-care funding.

Without negotiations in place to renew the Health Accord, Canada's most cherished public institution is at risk of crumbling at an inopportune historical moment of generational change. At worst, these changes signal the advent of a for-profit, two-tier system that favours the wealthy while driving up costs and delivering poorer outcomes for the rest. From the perspective of the private sector, after all, access to essential care is not based on need, but the ability to pay.

Hyper-partisanship is a symptom of an ailing democracy and should not be responsible for the erosion of an institution that protects basic human rights. It is therefore the responsibility of all Canadians to recall our shared history and uphold a just standard of public morality. Together we may continue to see our nation as Tommy Douglas envisaged it, "like a little jewel sitting at the top of the continent."

Harrison Samphir is an editor at Canadian Dimension Magazine and a graduate student preparing to study International Relations at the University of Sussex, Brighton, UK. hsamphir@gmail.com.

North Bay -Hospital cutbacks have been made worse in Northern Ontario by socio-economic conditions that have led to more prevalent chronic medical conditions and lower life expectancies, says the president of the Ontario Council of Hospital Unions. According to Michael Hurley, large aboriginal and senior populations in the North, coupled with issues such as geography and underemployment, should be the basis for increased services. But he says Northern hospitals have instead suffered devastating cuts. Hurley suggests North Bay has been even harder hit as a result of the province's $1-billion deal with the private sector to build, finance and maintain the North Bay Regional Health Centre.

Although the local hospital has indicated resources are being transferred to the community, Hurley suggested such transfers do not commensurate with the cutbacks and often come at the expense of acute care services. "With the cuts that are happening across Northern Ontario, this is only going to get worse," said Richer, who share some the anecdotal experiences of patients included in the report. One account was that of an elderly man who had suffered a stroke and whose family believed he had been discharged too soon from hospital and did not receive adequate physiotherapy. Although the family struggled to pay for some private therapy, but the man never regained the ability to walk and died within two years of his stroke.

Hurley said hospitals have been forced to make cuts because they are now in the fourth year of a five-year freeze on their budgets. And he said estimates cited by the auditor general calculate that hospitals need a 5.8% increase annually to meet their basic costs. The report calls for the reopening of chronic and alternate level of care beds, a halt to the closure of acute care beds, adequate hospital funding, hospital reinvestment, the elimination of fees for home care, therapies and services and a move away from private for-profit home care, long-term care and pharmaceuticals. Hurley said the OCHU is also preparing to file a complaint to the Ontario Human Rights Commission of discrimination in the health care system against the elderly when it comes to acute care services.

The gestures stem not only from the country's growing diversity, but a generally more patient-focused system - and a recognition treating solely physical ailments is not always enough. "If we don't engage in the (cultural) discussion, we won't fully understand their health needs and they won't get met," says Marie Serdynska, who heads a pioneering project in the field, the Montreal Children's Hospital's socio-cultural consultation and interpretation services.

So ultimately they will get sicker and be a greater cost to the health-care system." But with the topic being featured at national pediatric and bioethics conferences recently, medical professionals are debating a difficult question: is there is a point at which catering to cultural preferences crosses a moral - or even legal - line? While a physician in the neonatal intensive care unit at Toronto's SickKids hospital, Dr. Jonathan Hellman was sometimes asked by fathers from "patriarchal" cultures not to discuss a child's condition with the mother unless the husband was also present.

Agreeing to such a request not only raises ethical and practical questions, he says, but might even violate Ontario's Health-Care Consent Act - unless the mother explicitly agreed to the arrangement. "It's challenging to the caregivers in that situation, when the mother is at the bedside and the father is able to visit only in the evenings," says Hellman. "And we believe that both equally have decision-making power, both should have information." Even hospitals that try to be sensitive to specific cultural groups, like Ontario's Hamilton Health Sciences Centre, with its aboriginal patient "navigator," can face vexing dilemmas. When two First Nations girls with leukemia decided to withdraw from chemotherapy at the facility and try native remedies, an emotional courtroom battle followed.

And it recently emerged that a Vancouver-area intensive-care unit was asked to keep a braindead patient on life support for days until he could be flown to his country of origin, the family's culture rejecting the concept of neurological death. Still, for every demanding request, there are dozens of positive incidents - even if they involve once-unheard-of accommodation, say ethicists, doctors and patient advocates.

Some Halifax hospitals have convinced the fire marshal to allow smudging, aboriginal purification rituals in which sweetgrass is burned. Sometimes, this means adjusting the smoke detector in a patient's room temporarily so it doesn't set off an alarm, says Christy Simpson, a bioethicist at Dalhousie University in Halifax. Randi Zlotnik Shaul, director of bioethics at SickKids, said she's aware of a request for a drumming circle in a neonatal intensive care unit, a normally very quiet environment. Steps were taken to comply with the proposal - and not interfere with other tiny patients - but the need for an open fire eventually made it impossible, she said.

Yet fulfilling such appeals, often made for dying patients, can be a question simply of innovation and compromise, like when someone asks that a patient's bed face Mecca, she says. "Some might respond very categorically, 'Nope, in this place all beds face the same way,' "she says. "Someone oriented another way might say, 'Yeah, they are all faced that way, but maybe if we got an extension cord, there is actually something we can do.' " Serdynska says she knows of hospitals providing "mementos" of births to new mothers whose cultures traditionally require them to bury their placenta. Dr. Tara Kiran, a Toronto family physician, was taken aback when she first encountered patients from Bangladesh and Pakistan at an inner-city clinic who insisted on fasting between sunrise and sunset during Ramadan, despite health issues like diabetes that normally require strict regulation of diet and medication.

Her patients, however, happily embraced what they saw as the experience's beneficial, spiritual benefits. "It was an interesting challenge to my assumptions," says Kiran. "My gut reaction was that fasting has negative impacts on health." In London, Ont., St. Joseph's Health Centre runs a special clinic during Ramadan to help the city's estimated 3,000 diabetic Muslims. Muslim needs, including heightened privacy for female hospital patients instead of the usual, unannounced arrival of staff at the bedside, were once given short shrift, says Khadija Haffajee, spokeswoman for the National Council of Canadian Muslims. But the system has generally made great strides, adds Haffajee, who has addressed classes of nursing students on her faith's practices. "It's about reasonable accommodation and understanding," she says. "When people are ill, you're dealing with very vulnerable people, so empathy goes a long way."

Accommodation can sometimes simply be a case of bridging the cultural divide, says Montreal's Serdynska. Medical teams at her hospital once saw Vietnamese patients with unexplained bruising and immediately suspected child abuse. Further inquiry revealed the marks were the result of "capping," or "coining," a traditional southeast Asian treatment that involves scraping a smooth edge across the body in the belief it releases unhealthy elements. Her service now has cultural interpreters who will talk to immigrant parents when, for instance, drug treatment is not working. Sometimes, it relates to the side effects and contraindications spelled out on unfamiliar packaging, she says. "For some cultures who do not generally take pharmaceutical medication, this is very frightening." The institutional, impersonal nature of a hospital alone makes it a daunting place for aboriginal people, especially if they attended residential schools, says Margo Greenwood, academic leader at the National Collaborating Centre for Aboriginal Health in Prince George, B.C. Hanging indigenous art, providing culturally appropriate prayer space and consulting local native communities all help alleviate that anxiety, as does being open to other forms of treatment.

You're dealing with two different systems of knowledge: one is what I learned when I went to university and one is what I learned in my community," she says. "People (are) saying ... 'I want the two to work together.' "But what are health-care providers to do when the request stemming from an ethnic or religious practice appears to breach their own ethical boundaries? Reports in 2013 of doctors in Quebec issuing virginity certificates earned a swift response from the province's medical regulatory body. Physicians must refuse to comply, insisted the College des Médecins, and explain such a service has nothing to do with health care. Less black-and-white, perhaps, is the patient asking for a doctor of a particular sex or, less commonly, of a specific race. On the surface, at least, the idea is a repudiation of fundamental human-rights principles, yet for some patients it could be a religious imperative or a fallout from past abuse.

Some hospitals say they will try as much as possible to provide a female doctor for Muslim women, for instance, when asked. In Montreal, about half the obstetrician-gynecologists are women, so supplying a female one is usually quite feasible, said Togas Tulandi, interim head of the McGill University medical school's obstetrics and gynecology department. More troublesome, say ethicists and physicians, are patients who insist they not be treated by a doctor or nurse of a certain race - typically Caucasians rejecting non-white workers in today's multi-hued medical workforce - or want one of their own colour. Ethicists at Toronto's University Health Network (UHN) published a nine-page paper on how to tackle "discriminatory" requests of this sort, suggesting the affected health-care worker should often have the final say.

"It's ugly, it's unfair," says Linda Wright, a bioethicist at UHN, of the potential impact on medical staff. "To ... have someone say you're not good enough because of the colour of your skin is offensive." How often Canadian hospitals have to deal with the dilemma is unclear. A 2010 U.S. study of emergency doctors, though, concluded the scenario is common, with hospitals frequently accommodating requests for race-specific practitioners. And that is not such a bad thing, argued U.S. law professor Kimani Paul-Emile in a provocative 2012 article. He cited evidence that having a "race-concordant" doctor can bring health benefits, especially for blacks and others who have historically faced prejudice. In the meantime, hospitals here are still more likely to encounter less-contentious culturally based issues, such as whether to loosen age-old restrictions on the number of well-wishers in a patient's room.

"In some cultures ... you have everybody there. You have all the aunts and all the uncles, and all the family members and friends," says Dalhousie's Simpson. "For me, that's been one of the really interesting changes. Why did we say it only had to be two? Why did we limit it so much? Because clearly there's value to having your loved ones around you."

The report, entitled Pushed out of Hospital, Abandoned at Home, chronicled the experiences of hundreds of patients and their families from more than 30 Ontario communities who called a 1-800 patient hotline set up for a year by the OCHU and Ontario Association of Speech-Language Pathologists and Audiologists. The update features additional anecdotal experiences of patients who have been let down by the health-care system as a result of issues such as understaffing, overcrowding, early discharge and insufficient community support or home care. It also focuses specifically on cuts in the North.

The report indicates that cutbacks in North Bay, which is the first stop of the campaign, include the closure of an eight-bed mental health rehabilitation unit and more than 56 positions - representing an estimate of more than 50,000 nursing care hours per year, affecting departments throughout the facility. Although the local hospital has indicated resources are being transferred to the community, Hurley suggested such transfers do not commensurate with the cutbacks and often come at the expense of acute care services. With the cuts that are happening across Northern Ontario, this is only going to get worse," said Richer, who shared some the anecdotal experiences of patients included in the report.

One account was that of an elderly man who had suffered a stroke and whose family believed he had been discharged too soon from hospital and did not receive adequate physiotherapy. Although the family struggled to pay for some private therapy, the man never regained the ability to walk and died within two years of his stroke. Hurley said hospitals have been forced to make cuts because they are now in the fourth year of a five-year freeze on their budgets. And, he said, estimates cited by the auditor general calculate that hospitals need a 5.8% increase annually to meet their basic costs. The report calls for the reopening of chronic and alternate level of care beds, a halt to the closure of acute care beds, adequate hospital funding, hospital reinvestment, the elimination of fees for home care, therapies and services and a move away from private for-profit home care, long-term care and pharmaceuticals. Hurley said the OCHU is preparing to file a complaint to the Ontario Human Rights Commission of discrimination in the health-care system against the elderly when it comes to acute care services.

“We need 16 to 17 per cent more RNs to catch up with the rest of the country,” he says. “Ontario hospitals are by far the leanest in the country, and the community and long-term care sectors are understaffed as well. More nurses should be going to the community to keep people out of hospitals. I think it’s one of those areas where the healthcare system finds it easier to cut back on nurses than cut back on money going to doctors. Right now family doctors are averaging $300,000 a year.” Full-time RNs make a base of $53,000 in their first year of work and up to $78,000 base if they have many years of experience. Overtime pay is typically one and a half times the hourly rate.

In Alberta, professional paramedics apply to an organization called the College of Paramedics to renew or reinstate their registration each year so they can keep working.

They have all told CBC the college penalized them after they disclosed that they sought professional help for work-related mental health issues like anxiety, acute stress or PTSD.

For nearly 15 years, Beth MacLean has wanted to live in a community. That dream has remained unfulfilled despite the 43-year-old being told she is capable of doing so with support. MacLean has an intellectual disability and lives in a locked unit of Emerald Hall at the Nova Scotia Hospital.

She is one of three Nova Scotians who will bring their complaint to a human rights hearing in the upcoming months. When MacLean was admitted to the Nova Scotia hospital in 2000, she was told she would have supported living in the community within a year. She's been in an institution ever since, despite being told she's ready to leave. 

SNC-Lavalin is a Canadian company with thousands of employees. It would be tragic if a conviction against the company, or even the threat of it, were to result in what could amount to a death sentence for SNC. It is not clear that Riadh Ben Aissa, the former vice-president who is alleged to have been the most active person in corrupt transactions in Libya and other Arab countries, was part of "the directing mind and will" of SNC-Lavalin. That is the necessary element that the law requires to find that a corporation had a criminal intent comparable to that of a flesh-and-blood human being.

Prosecutors and eventually a judge will look at these matters scrupulously. But leaving aside what's before the courts, Diane Finley, the Minister of Public Works, must fix the unintended consequences of the integrity framework. That framework, offering companies no way to set things right or make amends, doesn't fit.

This clearly puts the doctors involved in a conflict of interest. In a health system experiencing a significant shortage of practitioners, medical resources are drained from public hospital-based "free" care and into private purses. It also ties health care quality and accessibility to a patient's wealth - precisely what the Canada Health Act tries to prevent. For example, Montreal Children's Hospital - one of Montreal's two pediatric university hospitals - has decided to stop offering many medically necessary services. Instead, it will direct some patients to a new outpatient clinic. There, parents may be billed for such services as dermatology, endocrinology, general pediatrics and other important specialized care.

This steady disintegration of the principles of health care could soon be irreversible. Premier Philippe Couillard's new Bill 20 will legalize direct patient billing for medically necessary services provided outside of hospitals. The provincial government is confident that Ottawa won't intervene to enforce the Canada Health Act in Quebec (the federal government hasn't intervened in the past decade). Bill 20 makes legal practices that were grey-zone breaches in the universal public health system. This is creates a parallel, legal private health-care system subsidized by public health insurance. This could be the final blow to health care in Quebec. An unhealthy coalition - the Couillard government, private clinic owners, medical federations, private insurers and even some hospital administrators - is irresistibly pushing to decrease the care offered in public institutions and to increase the market share of direct payment and privately insured services. The only chance to save health care in Quebec is direct intervention by the federal government. Prime Minister Justin Trudeau and federal Health Minister Jane Philpott must enforce the Canadian Health Act in Quebec, even cutting federal health transfers until the province conforms.

Doing anything less will mean access to care according to a Quebec patient's wealth, rather than their needs. Astrid Brousselle is a professor in the Community Health Department, and researcher at the Centre de recherche de l'Hopital Charles-LeMoyne, Universite de Sherbrooke and Canada Research Chair in Evaluation and Health System Improvement. Damien Contandriopoulos is a professor in Nursing and a researcher at the Public Health Research Institute at University of Montreal (IRSPUM). CIHR Research Chair in Applied Public Health.