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Speaking before his appearance at the Health Select Committee, he conceded that urgent care services were “getting closer to the cliff edge,” with A&E admission increasing by 51 per cent over the past 10 years

The letter from the 20 A&E leaders talks of the “institutional exhaustion” of the nursing, medical and even clerical staff who being pushed ever harder by the growing volume of work with little outside support

. It also describes how doctors and nurses are being forced to work in what are verging on dangerous environments

They further warn that overcrowding is likely to lead to more deaths in hospitals and reveal that standards of care are deteriorating as serious clinical incidents and delays are rising.

The letter states: “The aforementioned issues have led to us routinely substituting quality care with merely safe care; while this is not acceptable to us, what is entirely unacceptable is the delivery of unsafe care; but this is now the prospect we find ourselves facing on too frequent a basis

Recent developments such as the introduction of 111 and financial penalties for holding ambulance crews in ED are touted as solutions to the crisis: however we as ED physicians recognise that these measures will actually make the problem worse instead of better, and evidence is already emerging to support our opinions.

Furthermore, we firmly believe and strongly recommend that ED leads should be intimately involved with and consulted on the commissioning of Emergency services in the region, as well as other related emergency care changes-such as 111.

There is toxic ED overcrowding, the likes of which we have never seen before.

In the 1980s, Bayer sold Factor VIII concentrate, a blood-clotting medicine acquired from Cutter Laboratories in 1978. Though Factor VIII carried a high risk of transmitting AIDS and Bayer knew, Bayer continued to sell the drug in Asia and Latin America while selling a new, safer product in the West.

takeover would dilute Bayer’s core drug business currently flush with sales of its blood-thinner Xarelto and Eylea, a drug to treat blindness.

Coalition Against Bayer Dangers

Bayer, a history of unsafe drugs

Monsanto’s first entry into Big Pharma.

Blood clotting drug spread AIDS

all three proposed mergers face antitrust reviews by agencies in the U.S., Europe and China,

In Hong Kong and Taiwan alone, more than 100 hemophiliacs got H.I.V. and “many have since died,” reported the New York Times. 

Statin Baycol recalled

In 2001, Bayer withdrew its lucrative new statin drug Baycol because more than 50 people had died and more than six million patients were at risk from the deadly side effects of rapidly dissolving of muscle tissue.

Yaz birth control pill causes deaths

Xarelto, shady approval of a dangerous drug

underreported bright side: Industries that are doing well generally spin off; industries that are performing poorly generally merge and consolidate.

Millions Against Monsanto movement,

Not a chance, On October 14-16, merged or not with Bayer, the OCA and the global grassroots will expose Monsanto’s crimes against humanity and the environment at the Monsanto Tribunal, a citizens’ tribunal which will take place in The Hague, Netherlands.

He wants the OMA to return to the negotiating table and discuss lowering some of the 7,300 fees on the physicians’ pay schedule. He said the province has made no less than 80 offers since talks broke down two years ago — close to one a week — to no avail. If they don’t, he said he’s prepared to make another unilateral cut (even though the cuts imposed in 2015 have already sparked the second Charter challenge from the OMA this decade). “If necessary we will be forced to make those changes,” he said. Hoskins doesn’t want to cut back on all doctors’ pay, but create a more equal system that doesn’t go over budget every single years, as has historically been the case.

“The top biller, an ophthalmologist, billed more than $6.6 million last year. The top diagnostic radiologist billed more than $5.1 million and the top anesthesiologist billed more than $3.8 million,” a government fact-sheet states. That’s far above the average doctor’s gross payment of $368,000 a year. And though the OMA argues that often doesn’t account for overhead and staffing costs, the province also subsidizes pay in many indirect and direct ways, including allowing doctors to incorporate, which reduces tax and liability burdens. Ontario, unlike many provinces, covers 80 per cent of doctors’ liability insurance. Hoskins said the ministry even sometimes covers hardware costs like computers.

Hoskins says his goal is to make things more equal and better distribute the money going to certain specialists whose work has gotten easier. MRIs and CT scans used to take an hour, now they take 20 minutes. Same with cataract surgery — that’s why diagnostic radiologists and eye surgeons are so disproportionally represented on the list.

PSWs have a role standard  which says “personal support workers do for a person the things that the person would do for themselves, if they were physically or cognitively able”.

There is a great deal of variation around the kind of care PSW’s provide, with some PSWs providing medical care such as changing wound dressings and administering medication, and others providing  ‘only’ personal care such as bathing, transfers from bed and housework. What PSWs can and cannot do varies based on their training, supervision and employer policies.

An estimated 57,000 PSWs in Ontario work in the long-term care sector, 26,000 work for agencies that provide community and home care, and about 7,000 provide care in hospitals.

Changes to the Long-Term Care Act in 2010 outlined a minimum standard of education for PSWs working in that sector specifically.

PSWs working in long-term care homes are required to work under the supervision of a registered nurse or registered practical nurse

Some have suggested that rather than standardizing education for PSWs, more standards should be put in place around PSW supervision, scope of practice and work environment in long-term care and community agencies.

92% of PSWs are women, and many work at multiple part time jobs, involving a great deal of shift work.  PSWs are often paid minimum wages with few benefits.

Community colleges, continuing education programs and private career colleges offer courses or programs of varying durations, with no standardized core curriculum across the programs. There is no single body in Ontario that monitors the quality of these programs.

a PSW Registry to collect information about the training and employment status of the nearly 100,000 PSWs in Ontario

Long-Term Care Task Force on Resident Care and Safety

“a registry is a mechanism of counting and it doesn’t ensure anything about quality, preparation or standards.”

in the past two months there have been stakeholder consultations around educational standards for PSWs

Catherine Richards, Cause for Concern: Ontario’s Long Term Care Homes (Facebook group)

“PSWs have high expectations put on them but very little support to do their jobs.”

In my opinion, what we need most is a ministry (MOHLTC) that will demonstrate leadership by clarifying the role of the PSW in long-term care, nursing homes, hospitals and yes, home care, and to consistently enforce high standards of care

PSWs should feel able to rely on consistent supervision and clear guidance from registered nursing staff and management, yet from my observation there is a lack of communication between PSWs and RPNs/RNs in a long term care home setting, and rarely in my experience is honest communication encouraged to include patients/residents and families. In home care, PSWs have even less support or supervision which should concern people.

PSWs are rarely afforded the time to properly perform the necessary tasks assigned to them and they often bear the brunt of complaints

it is the leadership that must accept the bulk of responsibility when PSW care standards are low

Ombudsman oversight would provide an immediate and direct incentive to elevate care standards

In Nova Scotia, a registry was put in place for Continuing Care Assistants (the provinces’ equivalent to PSWs) in 2010 which has been used to communicate directly with CCAs as well as keep track of where they work. In addition, the registry provides resources and the development of a personalized learning plan to help care givers who do not have the provincial CCA obtain further training. British Columbia has also recently introduced a registry for Care Aids and Community Support Workers.

CUPE addresses these issues in Our Vision For Better Seniors’ Care: http://cupe.ca/privatization-watch-february-2010/our-vision-research-paper

having someone help you bathe, dress, eat and even wash your hair is as important as the medical care

I have worked in a Long-Term Care Facility for four years and have many concerns

it doesn’t take a rocket scientist to figure out that some point of care is being neglected

need to have more PSW staff on the front line

“it is like an assembly line here in the morning”

I don’t think these people are getting the dignity and respect they deserve.

We want to stop responsive behaviours, we need to know what triggers are. what is the root cause

We can’t do this with having less than 15 mins per resident for care.

I also believe that registering PSW’s will eliminate those who are in the career for just the money.

I have been a PSW for 8 years

Every year they talk more and more about residents rights, dignity ect ect … and yet every year, residents have been given less one on one time, poorer quality of meals, cut backs on activities and more than anything else, a lessened quality of care provided by over worked PSW’s.

Residents have floor mat sensors, wheelchair sensors, wander guard door alarm sensors, bed alarm sensors and add that to the endless stream of call bells and psw’s pagers sounding, it sounding like you are living inside a firestation with non-stop fire

they do not provide the staff to PREVENT the resident from falling

bell fatigue

This registry is just another cash grab

Now, it will be that much easier to put the blame on us.

When we do our 1.5hrs worth of charting every night they tell us to lie and say we have done restorative care and other tasks which had no time to do so they can provide funding which never seems to result in more staff.

for the Cupe reps reading this. You make me sick. Your union doesn’t back us up in the slightest and you have allowed for MANY additional tasks to be put onto psw’s without any increase in pay.

In the past year alone our charting has become computerized and went from 25mins to 1.5hrs. We now provide restorative care like rehab workers and now are officially responsible for applying and charting for medicated creams, not to mention the additional time spent now that prn behavior meds were discontinued and restraints removed created chaos

when your union reps come into meeting with us to “support” us, they side with our managers

about this registry

my sister works for 12 dollars H in Retirenment home

she has over 40 Residents

you should work in Long Term Care then, you will make a few buck more, still have 30-40 residents but at least you have a partner. On the other hand though, unlike retirement homes, for those 30-40 people, you will be dealing with aggressive behaviors, resistive residents, dementia, 75% of your residents will require a mechanical lift, you will have 1-2hrs worth of charting to do on top of your already hectic work load which they will not provide you more time to complete it, so only expect to get one 15min break in an 8 hr shift and often stay late to finish your charting.

As long as retirement homes are privily own they will always be run under the landlord and tenant act. That’s why they can work you like a dog and get away with it.

My 95 year old Dad is in LTC.

PSW’s simply do NOT have time to maintain, let alone enhance seniors’ quality of life.

there are NO rules or regulations about what the ratio of PSW staff to residents “should be”

quality is more than assistance with daily hygene, feeding, dressing, providing meds, getting people up in the morning, putting them to bed in the evening

psw’s are not only caregivers/ nurses we r also sometimes ONLY friend

The solution to our problem begins at the top, and this all seems very backwards to me.

Personal support workers are one of the back bones of the health care system.

Eleven years later, and nothing has changed? Something’s wrong here!

But I will not let this discourage me from taking the course, because no other job I’ve had has even come close to being as rewarding or fulfilling

is to many P.S.W in Ontario,and is not respect for them

Too many PSW’s are working as a Casual Employee

The pay is better in Long Term care as we know but PSW’s work for that extra few dollars more an hour

Most of us enjoy the field but more work has to be done to take care of your PSW’s and a pat on the back is just not going to do it.

administration has to stop being greedy with their big wages and start finding more money to invest in your front line, the PSW

Of the 49 million Medicare beneficiaries, one-fourth already receive comprehensive care through H.M.O.s and other private plans run by companies like UnitedHealth, WellPoint and Humana. The number could rise significantly under Mr. Romney’s proposals.

The type of competition Mr. Romney wants to see in Medicare is strikingly similar to the competition that is supposed to drive down commercial insurance prices under Mr. Obama’s health care law. Under the law, people under 65 could choose among competing health plans offered through an insurance exchange in each state, and the government would subsidize premiums for lower- and middle-income people.

1. Bans insurance companies from dropping women when they get sick or become pregnant

2. Bans insurance companies from requiring women to obtain a pre-authorization or referral for access to ob-gyn care3. Improves the care of millions of older women with chronic conditions4. For women in new private plans, provides free coverage of mammograms and colonoscopies, one or more of which 20 million women have already received5. Beginning this summer, provides that free coverage will also include additional, comprehensive women's preventive services, including contraception in new plans6. Bans insurance companies from denying coverage for "pre-existing conditions," beginning in 2014. Currently, many women are denied coverage or charged more for such "pre-existing conditions" as breast or cervical cancer, pregnancy, having had a C-section, or having been a victim of domestic violence7. Ends the common practice of "gender rating," charging women substantially higher premiums than men for the same coverage, beginning in 20148. Provides greater access to affordable health coverage for women, with the establishment of new Health Insurance Exchanges for the millions who do not have health insurance through an employer, beginning in 2014. Currently, less than half of America's women can obtain affordable insurance through a job

After all is said and done, it appears that the relentless war on the Affordable Care Act by those who call it socialism has actually been, in large part, a war on women

35 buyouts of hospitals or chains of facilities in the last two and a half years by private equity firms

Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the cost of its medical staff

HCA decided not to treat patients who came in with nonurgent conditions, like a cold or the flu or even a sprained wrist, unless those patients paid in advance.

In one measure of adequate staffing — the prevalence of bedsores in patients bedridden for long periods of time — HCA clearly struggled. Some of its hospitals fended off lawsuits over the problem in recent years, and were admonished by regulators over staffing issues more than once.

inadequate staffing in important areas like critical care

Many doctors interviewed at various HCA facilities said they had felt increased pressure to focus on profits under the private equity ownership. “Their profits are going through the roof, but, unfortunately, it’s occurring at the expense of patients,” said Dr. Abraham Awwad, a kidney specialist in St. Petersburg, Fla., whose complaints over the safety of the dialysis programs at two HCA-owned hospitals prompted state investigations.

One facility was fined $8,000 in 2008 and $14,000 last year for delaying the start of dialysis in patients, not administering physician-prescribed drugs and not documenting whether ordered tests had been performed.

Claiming he provided poor care, the other hospital did not renew Dr. Awwad’s privileges. Dr. Awwad is suing to have them reinstated.

“If you were a for-profit hospital with investors and shareholders,” said Paul Levy, a former nonprofit hospital executive in Boston unaffiliated with HCA, “there would be a natural tendency to be more aggressive and to seek more revenues.” Executives at profit-making hospitals are “judged in greater measure by profitability” than the administrators of nonprofit hospitals, he said.

some of HCA’s tactics are now under scrutiny by the Justice Department. Last week, HCA disclosed that the United States attorney’s office in Miami has requested information about cardiac procedures at 10 of its hospitals in Florida and elsewhere.

HCA’s cardiac business is extremely lucrative, and the Justice Department has requested reviews that HCA conducted that indicate some of the heart procedures at some of its hospitals might not have been necessary and resulted in unjustified reimbursements from Medicare and other insurers.

Small and nonprofit hospitals are closing or being gobbled up by medical conglomerates, many of which operate for a profit and therefore try to increase revenue and reduce costs even as they improve patient care. The trend toward consolidation is likely to accelerate under the Obama administration’s health care law as hospitals grapple with what are expected to be lower reimbursements from the federal and state governments and private insurers.

Columbia/HCA became the target of a widespread fraud investigation in the late 1990s, which led to one of the largest Medicare settlements ever.

HCA wanted to attract more patients to its emergency rooms, and it did. Annual visits climbed 20 percent from 2007 to 2011. But while emergency departments are often a critical source of patient admissions, they are frequently money-losers because many patients do not have insurance. HCA found a solution: it figured out how to be paid more for the patients it was seeing.

Nearly overnight, HCA’s patients appeared to be much, much sicker.

No one has accused HCA of up-coding, or billing for more expensive services that were not needed — one of the complaints made against it a decade ago.

The acting head of Medicare is Marilyn B. Tavenner, a former HCA executive who left there in 2005 to become the secretary of Health and Human Resources in Virginia.

Several former emergency department doctors at Lawnwood Regional Medical Center in Fort Pierce, Fla., said they frequently had felt compelled to override the screening system in order to treat patients.

When the doctors failed to meet the hospital’s goals for how many patients should be considered emergencies, “they really started putting pressure on.”

Regulators in several states have taken HCA hospitals to task over screening out patients too aggressively, including situations where the screening missed serious conditions.

“Staffing is critical,” said Courtney H. Lyder, the dean at the UCLA School of Nursing and an expert on wound care. “When you see high levels of wounds, you usually see a high level of dysfunctional staff,” he said.

HCA owned eight of the 15 worst hospitals for bedsores among 545 profit-making hospitals nationwide, each with more than 1,000 patient discharges, tracked by the Sunlight Foundation using Medicare data from October 2008 to June 2010.

an examination of lawsuits shows bedsore problems have been persistent at several HCA facilities

The hospital was cited twice by Florida regulators, in 2008 and 2010, for having inadequate numbers of nurses on its staff to oversee wound care for patients.

One challenge in understanding the extent to which people in health care are injured at work is that injuries tend to be underreported. Generally the data used to measure health care worker injury is through workers’ compensation claims. A study of Canadian health care workers found that of 2,500 health care workers who experienced an injury, less than half filed a workers’ compensation claim.

Recent data from Alberta shows that about 3% of health care workers are at risk of a disabling injury in 2012, compared with 1.45% of workers in the mining and petroleum industry.

A study of health care worker injuries in three British Columbia health regions from 2004 to 2005 found that injury rates are particularly high for those providing direct patient care – and highest among nursing or care aides (known as health care aides in Alberta, and personal support workers in Ontario).

83% of health care worker injuries were musculoskeletal in nature.

However, there have been efforts to mechanize some of the dangerous aspects of health care. Musculoskeletal injuries are the leading category of occupational injury for health care workers.

Evidence suggests that this is the case – a 2009 British study of over 40,000 workplace injury claims found that 89% were made by women, and 11% by men.

Gert Erasmus, senior provincial director of workplace health and safety for Alberta Health Services says that “health care is a people intensive business – combine that with physically demanding jobs and an aging workforce.”

The Canadian Federation of Nurses’ Unions notes nurses retire around the age of 56 – compared to the average Canadian worker at 62.

Experts also point to the changing work environments for many health care workers. There is a worldwide trend towards moving health care services out of hospitals into patients’ homes. Thease are uncharted waters for workplace safety and prevention of injury. Little is known about how often workers in peoples’ homes are injured and the kinds of injuries they are sustaining.

Gert Erasmus notes the tremendous insecurity of providing health care inside patients’ homes. “They [health care workers in homes] work in an environment that is not controlled at all, which is fundamentally different than most industries and workplaces.” In this environment, workers are more likely to be alone, lacking back up from colleagues, and the help of aids such as mechanical lifts.

Miranda Ferrier, President of the Ontario Personal Support Worker Association says that each time a personal support worker enters a new patient’s home – they enter into the unknown. “You are lucky if you know anything about a client when you go into the home” she says.

in British Columbia who contracted H1N1 in the spring and summer of 2009. People who had received a seasonal flu shot the previous autumn were more likely to contract the new pandemic strain.

Still, the finding is reminiscent of something that was observed in people in Canada during the 2009 H1N1 pandemic.

The authors cautioned against drawing a line between what happened to the pigs in the study and what might happen with people.

Her findings, which were initially dismissed by many in the global influenza research community, were later replicated in studies done in other provinces as well, leading some to dub the phenomenon “the Canadian problem.”

“I think . . . what they’re showing is a biological mechanism that warrants further evaluation in terms of its relevance to the use of seasonal vaccines in humans and what that may mean for the next pandemic threat,” Skowronski said.

It’s a frustrating target for flu vaccine designers. There are 17 known hemagglutinins, which give flu viruses the H in their name. (Most don’t currently infect people.) The hemagglutinins on H1 viruses look different than those on H3 viruses, and antibodies to one don’t protect against another.

Even within a subtype — H1, for instance — there are different strains, and a vaccine against one might offer lots, some or no protection against another. And all these hemagglutinins are constantly changing, which is why flu vaccines have to be updated almost every year.

Instead of being protected, the H1N2-vaccinated pigs developed more severe disease than exposed pigs that hadn’t been pre-vaccinated. When the researchers tested the blood of the vaccinated pigs, they found high levels of antibodies that attached to the stalk of the H1N1 hemagglutinin, but not to the head of the protein.

Skowronski and others suggested the work demonstrates the complexity of influenza immunology — the science of how the viruses interact with immune systems. “The problem is everybody wants influenza to be simple and be like other vaccine-preventable diseases. And it’s not,” Skowronski said.

Infectious diseases expert Dr. Michael Osterholm said with influenza, there is always a complicated interplay between the virus and the person the virus infects, one that is influenced by what viruses and vaccines the person’s immune system has previously encountered.

“It really drives home the need to be very cautious about what are we actually accomplishing.”

We also have to move medicare beyond the scope of doctors and hospitals, something that has been on the public agenda since Saskatchewan introduced universal health care in 1961. The divide between public and private health care fragments the entire system and undermines efforts to build a continuum of care at every step along the road between sickness and health.

It is truly odd to see the Fraser Institute fretting over what the next candidate to represent the U.S. Republican Party might think of Canada’s health care system when we’re in the middle of our own election. Canadians would do well to ask the parties seeking to form the next government what they plan to do about expanding medicare, increasing the role of the federal government in establishing and enforcing high national standards, and developing a more stable and cost-effective (i.e., more public) way to make sure the provinces have sufficient funding to meet them.

The numbers underscore the need for improvements to hospital staff safety measures, something the Ontario Nurses' Association (ONA) has long been calling for to better protect health-care providers. "Violence isn't part of this job. It shouldn't be part of this job," said Andy Summers, vice-president of health and safety with ONA. "Eventually, somebody will get killed."

Summers called the current situation of violence against nurses in Ontario "completely unacceptable." At UHN, which includes Toronto General Hospital and Toronto Western Hospital, there has been a consistent increase in reports of assault in the past three years. The number of reported violent incidents doubled in two years, jumping from 166 incidents in 2012 to 331 in 2014, according to data provided to the Star. In 2014, 11 workers who were injured were unable to return to work for their shift following the assault. Spokeswoman Gillian Howard said changes in reporting standards probably account for the rise. The changes include a Behaviour Safety Alert, implemented at UHN in 2014, which requires staff to put an alert on patient records if the patient has aggressive or violent behaviour. Howard also said increased reporting could be attributed to the fact that unions are encouraging staff to report every incident: "a very good thing," she said.

"We do not want any staff member at risk from a patient, but given the care we provide, the medications used, the fact that some patients have cognitive impairment as a result of injury or aging, the impairment of some patients when they arrive, and the risks associated with some of the treatments, it is not likely that we will see a year with no incidents," said Howard, adding that UHN employs approximately 13,000 staff and has over one million patient visits per year. But ONA lashed out at this explanation, saying employers are trying to downplay the issue.

Erna Bujna, occupational health and safety specialist with ONA, said some employers "absolutely" still discourage staff from reporting incidents, by telling workers that violence is just part of the job. ONA wants to see a violence strategy implemented at hospitals across the province. The strategy would include mandatory reporting of every violent incident reported to the Ministry of Labour - currently, employers are only required to report fatalities and critical incidents to the ministry - mandatory risk assessment of every patient, increased security and more health-care providers hired. They also want the Ministry to charge individual hospital CEOs when workers are not adequately protected from violence.

He added that legislation requires employers to assess the risks of workplace violence, create workplace violence and harassment policies, develop programs to implement those policies, and take every precaution reasonable to protect workers from workplace violence. ONA's call for an updated safety strategy comes on the heels of a decision by the Ministry of Labour to lay charges against Toronto's Centre for Addiction and Mental Health (CAMH) in December 2014. The charges - made under the Occupational Health and Safety Act and relating to failure to protect workers from workplace violence - stem from a violent incident in January 2014 in which a nurse was dragged, kicked and beaten beyond recognition, according to ONA.

Toronto police later charged the patient, who was found guilty of assault causing bodily harm, according to court documents. "We don't want staff ever to feel that aggression is the norm," said Rani Srivastava, chief of nursing and professional practice at CAMH, in response to the comments. "We are committed to a culture of safety and recovery and that means safety for staff and patients." Jean Dobson, a nurse at University Hospital in London, Ont., said she's been strangled with a stethoscope, stabbed with a metal fork and spat at by patients over the course of her 42-year career. "People think that they can hurt a nurse and that's OK," she said. "We have to smile and take it."

In one incident, Dobson had her nose broken when she was kicked in the face by a patient. She was forced off work for weeks and suffered from PTSD, she said. Dobson said she's seen the frequency of patient-on-nurse assaults and the severity of violence increase during her career. At Sunnybrook Hospital, reports of abuse against staff by patients and visitors jumped from 140 in 2012 to 320 in 2013. The hospital attributes the increase mainly to their move to electronic reporting, which makes it easier to record violent incidents, a spokesperson told the Star. According to a 2005 national study from Statistics Canada, 34 per cent of nurses surveyed reported being physically assaulted by a patient in the previous year, and 47 per cent reported experiencing emotional abuse. For those working in psychiatric and mental-health settings, 70 per cent of nurses reported experiencing emotional abuse.