Group items tagged

"It shows that people here really care about the Miramichi and it's too bad that politicians don't care about it as much," Driscoll said. "They want to privatize the nursing homes, they want to cut to the Education Department, their cutting the highway budgets and they're cutting to every service they can think of, so where are we going to go? They don't seem to think that matters." The Liberal government, come the fall, is expected to have a deal in place that will see all hospital food and cleaning services being outsourced to a private firm.

Government officials, including Health Minister Victor Boudreau have maintained that the changes are needed in order to help the province get its finances in order and will save the province millions of dollars through efficiencies that will be brought in under private management. Driscoll says those efficiencies, CUPE fears, are simply going to amount to job cuts at hospitals throughout the Horizon Health Network. The union learned from the province earlier in the summer that food and facilities management giants like Sodexo, Aramark and Compass Group are involved in the bidding process.

"If they privatize these services, then these corporations are going to come in and say 'you don't need all these people' ... we're going to cut because they're going to want to make at least a 20 per cent profit. Driscoll said the hospital is just one example of the trend toward the greater privatization of public services the union is seeing. Nursing home workers at Mount St. Joseph Nursing Home and the Miramichi Senior Citizens Home have been protesting at various points throughout the summer after learning the Department of Social Development would be using a private-public partnership (P3) model in building a new 280-bed nursing home that will replace both of the city's current facilities, which are run by a volunteer board of directors. Workers at both homes will have to reapply for positions at the new nursing home if that's what they choose to do and, with a private company running things, the membership has said it is concerned that those who do catch on at the new place could be subject to reduced pay and benefits.

The government is expected to open up a request for proposals (RFP) in the coming weeks to begin the process of determining which proponent will build and operate what will likely be New Brunswick's largest nursing home by the time it opens. Currently, each of the three privately run nursing homes in the province are owned by Shannex. The unions have also warned that the move to a P3 model would lead to a reduction in the level of community outreach programming offered to local seniors through things like Meals on Wheels and adult daycare. Tourism Minister Bill Fraser, the Liberal Miramichi MLA who advocated heavily for the new nursing home to be built and the man at the centre of much of the unions' ire, has shot down those concerns in previous interviews. Fraser has reiterated that regardless of whichever proponent emerges with the right to build and manage the structure, the initiative represents a major upgrade in terms of nursing home infrastructure.

He said the standards of care are dictated by the province and will remain, at the very least, on par with what has existed at the two current nursing homes over the last several years. Programs like Meals on Wheels, adult daycare and lifeline, would remain in place and potentially even enhanced and in terms of jobs, he said there will be provisions written into the RFP asking that priority be given to local applicants and that with an increase of 26 beds, even more staff will likely be required. As for pay and benefits, he said staff at two of the three Shannex properties have already unionized and the third was in the process of doing that.

Nursing home staff have called on the province to force the boards at the Mount and the senior citizens home to amalgamate together and operate the new facility using a model similar to what was undertaken in Edmundston when two nursing home boards melded into one in order to operate the new $48 million, 180-bed Residence Jodin. Danny Legere, the president of CUPE New Brunswick, was on hand for the vigil and urged the Miramichi workers to keep up the fight. "I want to congratulate the people of the Miramichi for taking a stand - the fight that you have started is a fight for all New Brunswickers," Legere said. "The militancy that you are showing is exemplary and it has to be carried on from one end of the province from one end to the other."

Andy Hardy, a Miramichi native and the president of CUPE 1190, said his sector is used to certain services being contracted out to private interests but when it comes to health and senior care, he said it was "flat out wrong." "You're looking after the most vulnerable people in that building right there," Hardy said. "When you privatize the food services and the cleaning services all it is is for profit - the service goes down and the profit goes up, and for nursing homes as well." Length: 1090 words

Just now in Ontario this arrangement would appear to have hit a wall. Having negotiated a four-year deal offering average annual fee increases of 2.5 per cent, the Ontario Medical Association executive was dismayed to find it rejected by nearly two-thirds of its members, who complain it does not make up for cuts in fees imposed last year. How things should have broken down to this extent need not detain us here. But it does perhaps point to the need to find another way.

Because doctors' fees, as such, are not the issue. To be sure, they are part of the puzzle: at $11.5 billion annually, they are roughly one-fifth of Ontario's health-care budget. But all the hard bargaining in the world isn't going to rescue Canada's health-care system from the fiscal cliff to which it is headed. Much more important than doctors' fees are doctors' decisions, as the gatekeepers dictating how resources are allocated within the system: how many tests are ordered, what procedures are done, and so on.

The problem is that decisions about treatment are too often divorced from decisions about budgets. Governments set a budget constraint at the macro level, which filters down through the various regional health authorities and local health networks the provinces have seen fit to establish. But doctors typically do not: they make whatever they can bill. And the incentives of feefor-service are to perform as many surgeries and other treatments as they can. Absent changes in those incentives, simply capping fees isn't going to change much.

You can see why doctors felt the need to organize. Governments had set themselves up as sole purchasers of medical services. The idea was supposed to be that they could exploit that monopoly power to drive down costs. But it didn't quite work out that way: politicians in need of re-election, it seems, do not make terribly tough negotiators (who knew?). It was always easier to pass the problem on to the next government, or the next generation - or, as federal governments got in on the act, Ottawa. In consequence, health-care spending skyrocketed through much of the 1970s and 1980s.

Traditionally, doctors have been paid per service, while hospitals have been funded on a block grant basis. The key to reform is to turn this around: giving groups of doctors a fixed amount per patient, with which to purchase services from hospitals, clinics and other providers, that is on a per-treatment basis. Paying doctors a lump sum localizes the budget constraint, forcing doctors to take account of costs in decisions on treatment; paying hospitals per service makes it possible for lower-cost competitors to undercut them.

Even in the more recent wave of cuts following the last recession, these have been largely untouched. As documented in a new study by the C. D. Howe Institute

("Hold the Applause: Why Provincial Restraint on Healthcare Spending Might Not Last"), governments have largely resorted to the familiar public-sector strategy of starving the capital account to feed the operating account: while capital spending has been sharply curtailed, physicians' fees have not.

This is not sustainable in the long run - as new doctors enter the profession, and most of all, as the population ages. As it is, provinces are now spending more than 40 per cent of their budgets on health care; by 2030, a recent Fraser Institute paper projects the number will have risen to nearly 50 per cent. Yet wait times continue to mount: at more than 18 weeks, on average, from GP referral to treatment, they are nearly twice what they were 20 years ago.

Clearly the answer does not lie in more money, least of all more federal money: for every additional dollar in federal transfers the Howe study's authors find that provincial health spending increases by 36 cents. But neither is the answer ever stricter doses of austerity - any more than one would improve a car's mileage by putting less gas in the tank. Rather, what's needed is systemic reform, altering the way that public funds flow through the system, and how the different players within it are remunerated.

Only with the onset of the early 1990s recession, and particularly the sharp cut in federal transfers as Ottawa tried to stabilize its finances, was there the first serious effort at retrenchment. But as the fiscal crisis eased, and particularly after the 2004 health-care accord, with its massive 10-year increase in federal transfers, whatever impetus for reform there might have been dissipated. Rather than "buying change," most of the new money went to increases in provider compensation.

In sum, rather than doctors and governments negotiating with each other at one gigantic bargaining table, what we need are lots of little bargaining tables, at which providers can haggle with each other.

Thus the board's justification for putting him on contract to provide advice on projects: "The former CEO has specialized knowledge and experience with partnerships solutions." Still, the Partnerships brass were not oblivious to the conflicts that might arise if Blain were retained as a consultant on a project that was also being vetted by the board.

"In order to mitigate the risks of any conflict of interest arising from this arrangement," the review reported, "the board chair was required to recuse himself from any meetings where his projects or his contract were being discussed." Instead, another member of the board was designated to serve as temporary chair. The designated lead director also oversaw the authorization of Blain's consulting contract. "While this conflict of interest issue appears to have been generally well managed," the finance report went on to say, "there could be the perception by some stakeholders that the contractor role still conflicts with the board chair's role of providing independent oversight." Any such perceptions were history by the time the report was completed in July 2014. Blain had already departed as board chair earlier in the year, replaced by Dana Hayden, a former deputy minister turned private consultant.

The internal auditors didn't let Partnerships entirely off the hook for tolerating the unorthodox arrangement in the first place. "The government should consider reinforcing the conflict of interest guidelines for board members of crown corporations and government agencies and ensure that those guidelines are appropriately followed." In other words, "not guilty, but don't let us catch you doing it again." The audit findings, including recommendations to rectify other questionable procedures at Partnerships BC, were forwarded to a steering committee of government and industry representatives, chaired by deputy finance minister Peter Milburn. The committee reported back to Finance Minister Mike de Jong on Oct. 23 with further recommendations for tightening up procedures at Partnerships.

De Jong released both reports and accepted both sets of recommendations in the course of announcing the change of direction for Partnerships BC on Dec. 16 of last year. That was the same day the Liberals chose to announce they were greenlighting construction of a hydroelectric dam at Site C on the Peace River. Just one of those amazing coincidences, but it goes some way to explaining why there was relatively little reporting of the findings regarding Partnerships BC.

There matters stood until this week, when the New Democrats, drawing on a wealth of material gathered by their research department, challenged the Liberals over Partnerships' dealings with Larry (Two Hats) Blain. The highlights package: The contract with Blain's delightfully named consulting firm, Aardvark Insights, was worth $219,000. During that same four-year span he also collected $188,836 in fees and expenses as chair of the board. All this atop the $264,000 he was paid to serve as a director of three other government-owned corporations, and the almost $4 million he was paid for his eight-year service as CEO.

"There's plenty of Blain to go around," quipped one press gallery wag as the New Democrats built their case against the Liberals during question period Wednesday. Another joke making the rounds rebranded P3s as B3s, for "Blain, Blain and Blain" Responding for the government, de Jong paid tribute to Blain's well documented contributions to the agency and cited the audit findings that "the conflict issue appears to have been generally well managed." But he also said this: "Whilst one can suggest that by recusing and taking (other) steps ... the procurement process is properly followed, the standard that we set and expect of agencies, the leadership within those agencies, goes beyond that. There must not only not be a conflict; there must be no appearance of a conflict." Which is as close as the finance minister came to admitting his sense of relief that when the audit branch blew the whistle on this arrangement, Blain had already left the building at Partnerships BC.

A number of other locals joined in on the demonstration, including representation from CUPE 1277 and 1256 of the Miramichi Senior Citizens Home and Mount St. Joseph Nursing Home, respectively, CUPE 1190, which acts on behalf New Brunswick's highway workers, the New Brunswick Federation of Labour and staff from Hebert's Recycling.

The Liberal government, come the fall, is expected to have a deal in place that will see all hospital food and cleaning services being outsourced to a private firm. Government officials, including Health Minister Victor Boudreau have maintained that the changes are needed in order to help the province get its finances in order and will save the province millions of dollars through efficiencies that will be brought in under private management. Driscoll says those efficiencies, CUPE fears, are simply going to amount to job cuts at hospitals throughout the Horizon Health Network. The union learned from the province earlier in the summer that food and facilities management giants like Sodexo, Aramark and Compass Group are involved in the bidding process.

"If they privatize these services, then these corporations are going to come in and say 'you don't need all these people' ... we're going to cut because they're going to want to make at least a 20 per cent profit. Driscoll said the hospital is just one example of the trend toward the greater privatization of public services the union is seeing. Nursing home workers at Mount St. Joseph Nursing Home and the Miramichi Senior Citizens Home have been protesting at various points throughout the summer after learning the Department of Social Development would be using a private-public partnership (P3) model in building a new 280-bed nursing home that will replace both of the city's current facilities, which are run by a volunteer board of directors. Workers at both homes will have to reapply for positions at the new nursing home if that's what they choose to do and, with a private company running things, the membership has said it is concerned that those who do catch on at the new place could be subject to reduced pay and benefits.

The government is expected to open up a request for proposals (RFP) in the coming weeks to begin the process of determining which proponent will build and operate what will likely be New Brunswick's largest nursing home by the time it opens. Currently, each of the three privately run nursing homes in the province are owned by Shannex. The unions have also warned that the move to a P3 model would lead to a reduction in the level of community outreach programming offered to local seniors through things like Meals on Wheels and adult daycare. Tourism Minister Bill Fraser, the Liberal Miramichi MLA who advocated heavily for the new nursing home to be built and the man at the centre of much of the unions' ire, has shot down those concerns in previous interviews. Fraser has reiterated that regardless of whichever proponent emerges with the right to build and manage the structure, the initiative represents a major upgrade in terms of nursing home infrastructure.

He said the standards of care are dictated by the province and will remain, at the very least, on par with what has existed at the two current nursing homes over the last several years. Programs like Meals on Wheels, adult daycare and lifeline, would remain in place and potentially even enhanced and in terms of jobs, he said there will be provisions written into the RFP asking that priority be given to local applicants and that with an increase of 26 beds, even more staff will likely be required. As for pay and benefits, he said staff at two of the three Shannex properties have already unionized and the third was in the process of doing that.

Nursing home staff have called on the province to force the boards at the Mount and the senior citizens home to amalgamate together and operate the new facility using a model similar to what was undertaken in Edmundston when two nursing home boards melded into one in order to operate the new $48 million, 180-bed Residence Jodin. Danny Legere, the president of CUPE New Brunswick, was on hand for the vigil and urged the Miramichi workers to keep up the fight. "I want to congratulate the people of the Miramichi for taking a stand - the fight that you have started is a fight for all New Brunswickers," Legere said. "The militancy that you are showing is exemplary and it has to be carried on from one end of the province from one end to the other."

Andy Hardy, a Miramichi native and the president of CUPE 1190, said his sector is used to certain services being contracted out to private interests but when it comes to health and senior care, he said it was "flat out wrong." "You're looking after the most vulnerable people in that building right there," Hardy said. "When you privatize the food services and the cleaning services all it is is for profit - the service goes down and the profit goes up, and for nursing homes as well." © 2015 Telegraph-Journal (New Brunswick)

It's not hard to figure out why the Naylor report displeased the government. The panel was given a difficult, bordering on impossible, job: recommend innovations without Ottawa spending any more money. The panel's mandate read that recommendations "must not imply either an increase or a decrease in the overall level of federal funding for current initiatives supporting innovation in health care."

The Naylor panel ignored the mandate, explaining in its report that "although it was not an easy decision, we did not follow this guidance." Later, it warned that "absent federal action and investment, and absent political resolve on the part of provinces and territories, Canada's healthcare systems are headed for continued slow decline in performance relative to peers." To that end, the panel recommends creating a health innovation fund with a $1-billion yearly budget to invest in changes to the health-care system in conjunction with willing provinces and health-care institutions.

Such a fund would be just about the last thing the Harper government desires. This government is running on balancing the budget. Adding $1-billion a year in spending would not be what the government wants. Such an investment fund would have little political profile - nothing as sexy as, say, national pharmacare (which the panel cursorily debunked). It would also run the risk of provoking premiers who screamed in St. John's for more cash transferred from Ottawa to them, without strings attached.

For 2017-18, the federal government has announced it will reduce the increase in Ottawa's annual health-care transfer to the provinces from 6 per cent to something in the range of 3 per cent to 3.5 per cent, depending on economic growth. The provinces would likely not appreciate losing money from Ottawa with one hand, and then getting some, but only some, of it back through the innovation fund. The Harper government was hoping for change-on-the-cheap from the panel: innovation that would cost nothing but improve the system. It certainly has no interest in an expanded, direct federal role in health care, having made it abundantly clear that health care is for the provinces, except for Ottawa's responsibility for aboriginal and veterans' health, public health and drug approvals.

Moreover, provincial health budgets are rising on average now by only 2 per cent a year, compared with 7 per cent a decade ago, far below the 6-per-cent increases in transfers still coming from Ottawa. The premiers would love the transfer to return to 6 per cent, as would the federal New Democrats. That would be the single dumbest move any federal government could make, given the lamentable experience of the 2004-11 period, when money gushed out of Ottawa but bought little improvement in the healthcare system. The Naylor panel noted, as have many observers, that the money improved things for providers, but not for many patients.

The Naylor report covers all the ground about the manifold weaknesses and sturdy strengths of the Canadian system compared with other countries. It hails, quite rightly, some aspects of the U.S. system, especially the coordinated care of the best health organizations such as Kaiser Permanente.

Its broad recommendations, however, are dead on arrival in Mr. Harper's Ottawa, which is why the report slid into the public domain with such little notice.

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.

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.

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.

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.

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."

But ask about the issues that dominate this election, such as the military or fighting terrorists such as ISIS, and Canadians put those in 19th and 20th place - the very bottom! The disconnect between what Canadians prioritize and what politicians emphasize is huge. Simply put, it's syringes, not Syria, that matters most to Canadians. That Canadians put health on top, trumping even defence and terrorism concerns, is no aberration. The pattern consistently holds true in EKOS polls dating back two decades. Any politician clever enough to change gears and campaign on health stands to reap a giant windfall.

Of course, campaigning on health is easier for some parties than others. Ask Canadians who they trust most on health, and they answer the NDP, Liberals and Conservatives in that order - but with each doing a scandalously poor job of articulating their vision for health, the question is somewhat like asking which of Snow White's seven dwarves is the tallest. Only diehard Conservative voters, loyal as always, say that Stephen Harper has improved health care since taking office more than nine years ago. But probe under these knee-jerk, partisan answers by asking about specific actions of the Harper government on health, and a radically different truth emerges.

Canadians of all political stripes - including a majority of Conservatives - disagree with the Harper government's health decisions. Ask Canadians how they feel about the prime minister's refusal to meet with the provincial ministers of health for the last nine years, and they oppose that by a whopping seven-to-one margin. Ask them about cutting funding for the Public Health Agency of Canada, and again the opponents outnumber backers by seven-to-one. Or ask about the Harper government's decision to cut federally funded health research, which is less emotive, and still Canadians deplore this by six-to-one.

These are staggering margins, the sort that pollsters almost never see. That they exist proves the Conservatives have more to lose than gain in a campaign waged on health. Because Conservative voters tend to be older (read: are sicker), a campaign attack that frames the Harper government's actions as the "Death of Medicare" could seismically undermine their base - especially if those long-spurned provincial health ministers piled on.

And Canadians do believe in Medicare, almost as faith. More than three-quarters of those we polled opposed privatization, or letting those with money buy better or faster care. Huge majorities support expanding Medicare to home and community care (81 per cent), psychiatric care (79 per cent) and prescription drugs (77 per cent). The political parties have not wholly ignored these issues, but neither have they dwelled on them.

There are strong electoral lessons here. Certainly any opposition party that wages a negative campaign against the Conservatives' health record has unparalleled room to grow; it is surprising this has not happened already. But the most intriguing result of our poll? By a hair's breadth, most Canadians (50.1 per cent) prefer a coalition to any one party, with a "traffic light coalition" of Reds, Oranges and Greens being the most popular. Astonishingly, those voters feel more comfortable with a coalition running health care than just their preferred party. Could it be ironically true that health is both the most neglected campaign opportunity for each opposition party, and the glue that could bind them in a coalition if none wins? Amir Attaran is a professor in the University of Ottawa's Faculties of Law and Medicine. Frank Graves is a pollster and founder and president of EKOS Research Associates.

"We've been managing our budgetary costs for years," she said, "but this is the first year we've considered staffing restructuring as a practice to balance the budget's bottom line." Since PSWs are trained for a smaller scope of work than RPNs, they are compensated at a lower rate. Wilson-Trider said it should be made clear that there will still be RPNs on the hospital's team. Though there will be fewer RPNs, the team of PSWs will work to lighten their workload by taking care of certain tasks. The restructuring of the care model for the hospital's Rosamond Unit is just one aspect of the changes made to the AGH's budget this year. During the winter months, AGH conducted an internal comprehensive review of the hospital's revenues and expenditures, looking for efficiencies and asking for suggestions from staff.

The review, Wilson-Trider said, had a target figure of a five per cent change to the budget's bottom line, either in increased revenue or decreased expenditures. The cuts to RPN positions will account for some of that five per cent change, but the review also found other areas to cut costs, such as supply cost savings and energy management practices. Also, the hospital reviewed their service costs and found that they were charging below the average for private rooms, something they've adjusted for 2015. "These changes are a way of living within our means from a budget standpoint while providing the least impact to current patient care and the patient experience," Wilson-Trider said.

Protest Anita Comfort, one of the RPNs whose job is being eliminated, has been working at AGH for 21 years. She's among one of many soon-to-be-laidoff RPNs who have been at the hospital for decades, and she says that level of dedication can't be replaced. "We know our hospital, we know our patients and we know how to care for them," she said. "There's simply not going to be the same level of care without us." Comfort was one of more than 30 demonstrators who marched the street in front of AGH on March 16, asking for honks of support from passing cars.

Affected RPNs, friends, family, union representatives and even patients came out to show their support, holding signs boasting messages such as "Cuts hurt everybody," and "My skills are vital to patient care." Linda Melbrew, president of the local chapter of the Canadian Union of Public Employees (CUPE), which represents the RPNs, was present for the demonstration, showing the union's support for saving their jobs. "We're asking the hospital to reconsider their decision," she said, "and we're also asking for the province to provide better funding for our hospitals so something like this doesn't have to happen at all." Representatives from the Ontario Nurses Association also showed their support during the demonstration, holding signs and marching among the affected RPNs.

Cathy Porteous, another of the RPNs who will lose her job because of the cuts, also mentioned the hospital's appearance on the Sunshine List: a list of employees whose annual salary rates are $100,000 or more. She said she heard there are 10 such employees with the AGH. "Why can't they make cuts in that area," that's what we want to know," she said. "Instead of cutting from the front lines of patient care, maybe they should take a look at their own salaries." When asked about the Sunshine List later in an interview, Wilson-Trider said the hospital doesn't have 10 employees being paid more than $100,000 annually - instead, they have nine.

Those employees, she explained, are all high-level employees and not all of them are paid by AGH itself. Among those on the Sunshine List are the director of care for the hospital's Fairview Manor (FVM) and the manager for Lanark County Ambulance Services. "These managers are already stretched," she said. "Between managing the hospital and their accountability to the LHIN (Local Health Integration Network) and the ministry, they're stretched." Many of the demonstrators voiced another concern as well: that patients will not receive the same level of care with a team of PSWs than they would with RPNs. "The don't call it complex care for nothing," said Debbie Tipping, whose husband, like Marie Campbell's, receives care in the Rosamond Unit, also called the Complex Continuing Care Unit.

Since PSWs don't go through the same level of training as RPNs and therefore are not qualified to perform certain tasks, Tipping said she is concerned her husband's care could suffer. "We don't want to lose the nurses we've come to know and love," Campbell said. Patient care While Wilson-Trider said the AGH is appreciative of the work the affected RPNs have put in over the years, she also said that she thinks the new care model will benefit patient care. "I actually think that this will be good for patient care," she said. "The new PSWs will be there to support the RPNs, who will be working at their full scope of practice."

"Patient care," she added, "is of the utmost importance here, and we have taken every measure to ensure that that level of care is maintained." Over the next few months, as the new model of care is phased in and positions are jostled around, Wilson-Trider said that the AGH will be following the union's collective agreement and working with the union the whole way through. "We appreciate the commitment and high quality of care that all of our staff has demonstrated and continues to demonstrate," she said, "and we're also very appreciative of the care they've given to our patients." Illustration: • Kelly Kent, Metroland / On Monday, March 16, more than 30 demonstrators took to the street outside Almonte General Hospital (AGH) to protest the hospital's new model of care that will cut 10 registered practical nurse (RPN) positions from its team of sta . AGH's new model of care comes in light of budget challenges passed down from the province's freeze on funding. Some of the a ected RPNs, above, held signs reading "My skills are vital to patient care."

The New Brunswick branch of the Canadian Union of Public Employees accused the government of fear-mongering by releasing the wish list, while the president of the New Brunswick Union said generating revenue should be at the top of the list for the provincial government. "We are always open to looking at ways to improve the quality of public services, so long as there are no job losses among public sector workers who are already stretched to the max," Susie Proulx-Daigle said in a statement. "We also believe public services need to stay public." Education

In schools, the government may cut additional teachers on top of the 249 teaching positions slashed in the 2015-16 budget. Enrolment has declined by 30 per cent over the past 23 years, but the number of teachers hasn't seen a significant decline. Cutting one teacher for every 20 students who leave New Brunswick's school system could save $10 million to $12 million, the government estimated. "What was done in the first budget was done," said Health Minister Victor Boudreau, who is responsible for overseeing the program review. "What we're saying is we could continue doing the same on an annual basis." Other options include increasing the maximum class size by four students per class, which could save $50 million to $70 million, and reducing the number of educational assistants to meet enrolment, a move that could save $3 million to $6 million. They may also privatize all custodial services within the education system, estimating savings of $5 million to $7 million, and convert pensions for school bus drivers, nursing home workers and custodians to the shared risk model ($7.5 million to $9 million in estimated savings).

The New Brunswick Teachers' Association was not available to comment on the possible cuts on Friday afternoon. Bennett believes the government could find savings and have little impact on classrooms by cutting the number of teachers and increasing class sizes.

He said research shows that class size reductions only have an impact on student performance up to Grade 3. After that, he said they don't have much impact and can be expensive. The New Brunswick government decreased class sizes about a decade ago and officials say that has cost taxpayers $50 million per year. But he is "extremely nervous" about basing cuts of educational assistants on financial considerations alone, arguing it could add tremendous pressure to teachers.

I think they need to re-think that." He's also disappointed the government isn't considering suggestions from a paper he co-wrote in January, which suggests the New Brunswick government could find savings by contracting out bus services in some of its school districts, which would produce competition. Health care

The provincial government is considering closing rural hospitals, trimming the number of full-service emergency rooms or centralizing specialized services in one location, like the New Brunswick heart centre in Saint John. The government estimates that could save between $50 million to $80 million. Gilles Lanteigne, president and CEO of Vitalité Health Network, said there isn't enough detail in the report to give him a sense yet of how it might affect service delivery in the francophone health authority. The health network is rolling out a plan to reduce 99 acute care beds in order to save $10 million.

The president of CUPE Local 1252, the union representing hospital workers, is concerned about "significant job losses" that could come from closing rural hospitals. But Norma Robinson is also concerned about the impact on people who live in rural New Brunswick and will have to drive up to an hour to get to an emergency room or to a major urban centre for specialized services. The government estimates 90 per cent of New Brunswickers live within an hour's drive of an emergency room. Universities

The province is also considering changing the funding model for universities, moving toward a performance-based formula that focuses on criteria like graduation rates and limiting duplication. The possible changes could save between $15 million and $45 million, the government says.

On Tuesday he said whether Switzer collects the entire amount is unknown at this point, because the LHIN recently learned that Switzer was hired at the Alzheimer Society but hasn't learned how much he'll be paid. According to Switzer's contract, if he lands a job during the 23 months that pays at least 75 per cent of his former pay, the LHIN will pay out 50 per cent of the balance owed. If he makes less than 75 per cent, the LHIN owes him a lump sum equivalent to the balance owed, less statutory deductions. "So the amount he's going to get in terms of severance isn't determined yet," said Girash, who described the 22-month provision as "generous." But he explained it was part of Switzer's original contract from 10 years ago. Last year, when the LHIN board was negotiating a new contract for Switzer, members really wanted to get rid of some costly provisions, particularly a 14 per cent performance bonus. "We wanted to eliminate that, which we were successful in doing," said Girash.

He said to get that bonus provision eliminated, the board felt it had to agree to continue with the 22-month severance clause. "It looks big but it was, I think, a good stewardship of what we were dealing with from 10 years ago and moving to make it better," said Girash. "The 22 months is really almost a safety net if the individual can't get anything else, but obviously he has." The board agreed to the one-time $16,150 payment in 2015 during negotiations in order to eliminate the 14 per cent bonus clause, he said. Switzer started working at the Alzheimer Society on Aug. 15. Attempts to reach him Tuesday - to ask what he makes - were not successful. He was replaced at the LHIN on an interim basis by the second in command, Ralph Ganter, who remains the acting CEO. The LHIN is a planning agency that co-ordinates health care in the Windsor/Essex, Chatham-Kent and Sarnia-Lambton region. It's responsible for almost 100 different agencies - including hospitals - doling out more than $1 billion annually in Ministry of Health funding. Girash wouldn't say what Ganter makes but indicated it's less than what Switzer made, and because Ganter's old job hasn't been filled, the actual cost of Switzer's termination amounts to the topup Ganter receives. Ganter made $201,920.69 in 2015 when he was senior director at the LHIN. Girash said the board isn't going to decide on a permanent CEO at this time because the LHIN is in the midst of planning for big changes expected when the Ontario government passes its Patients First legislation. Patients First would see LHINs take on big new roles, including co-ordinating primary care (family doctors) and home care.

It's very, very demanding and takes a lot of stafftime, a lot of board time," said Girash. "So it wouldn't be fair to lay on top of everyone a recruiting process." bcross@postmedia.com twitter.com/winstarcross © 2016 Postmedia Network Inc. All rights reserved. Illustration: • Nick Brancaccio, Files / Former LHIN CEO Gary Switzer, right, sits on a panel with David Musyj, Dave Cooke and Janice Kaffer at a hospital town hall meeting in November 2015. Switzer was terminated in May. His severance of more than $500,000 is being described as "one hell of a golden parachute."

What if the Prime Minister linked a climate deal to a health deal? That could be politically explosive. But McGill economist Chris Ragan thinks it's a good idea. One reason is that Mr. Ragan thinks the federal government will end transferring more money to the provinces anyway. Although the growth in provincial health spending has actually slowed in recent years, there are forecasts that it will grow by 3 per cent of GDP - by 2040. Mr. Ragan figures Ottawa will eventually give in, and might one day pay a third, that would be about $30-billion in 2027. The feds might as well admit it now and get a climate-change deal out of it, he argues. In other words, mix talks on health and climate together. "The more things you choose to put on the table, of course it becomes more complicated, but it also becomes a lot easier," Mr. Ragan said. "Because one of the things you bring to the table is a bunch of money."

There are a few problems. One is that Mr. Trudeau's government already wants something else from the provinces, a deal on home care. Ottawa is offering $3-billion and wants provinces to agree to meet targets for home-care services. Another is that Ottawa might not be ready to concede that it's going to have to transfer more to provinces. The recent years of slower growth in provincial health-care costs is an argument that the provinces don't really need the extra money. But that doesn't mean it will stay that way: Many economists believe those costs will rise sharply again in the near future. Then there is politics. Health transfers are to help the sick. Linking it to something else is likely to be seen as crass. But in the end, health-care transfers are dollars, and no one can really identify which dollar is spent on what. Mr. Ragan suggests they could be spent both on health and a climate deal.

Mr. Ragan is also chair of the Ecofiscal Commission, an organization of economists studying climate policy, which argues pricing carbon is the most efficient way of reducing greenhouse-gas emissions, because it will cost the economy less. The Ecofiscal Commission's models indicate that as long as the revenues are pumped back into the economy in the right ways, the costs of carbon pricing will be modest. In other words, if you are going to reduce emissions, a carbon price is the least costly way. In fact, the premiers, including Mr. Wall, agreed last spring to work on carbon-pricing options. Ms. McKenna is now brandishing a federal carbon tax as a stick to demand they seal a deal. But money is the traditional carrot. Mr. Trudeau might find it too politically dangerous to link health transfers to a climate deal. But it would allow him to offer what it usually takes to make a deal: money.

She says she had greater success at Ryerson University, where she was hired to overhaul the food service from 2013 to 2015. “Ryerson was tremendous. We created a beautiful model and the students responded to it,” she says.Under her direction, staff stopped reheating soup from a bag and learned to cook from scratch with raw ingredients. “Soup easily became one of the most popular things on the campus,” she says. “Because it was good and made with thoughtfulness and not that much more work.”The big take-away for Maharaj was learning to negotiate with the companies that provide the food. “Working with a third-party operator is the undeniable piece you have to address when you’re talking about institutional food,” she says. “And these operators are the people we need to start talking to when we want change.”

“The vegetables are almost non-existent. They’ll throw a couple on the plate. You’ll have a spoonful of some nasty peas. And they’re not even green no more. They’re grey,” says Tom, who also says powdered mashed potatoes are served multiple times a week (“Both dehydrated and fresh potatoes are used in both the cook-chill and institutional kitchens,” Ross says.)Tom avoided eating chicken entirely when he was in jail. Another woman I spoke with, who spent a year at Vanier from 2010 to 2011, says the poultry was routinely served undercooked and pink. She says she relied on food purchased at the canteen, mostly ramen noodles. When dinner was “fish slop” – a dish she describes as “garbage with fish parts in it” – inmates would run to their stashes, softening the noodles with hot water from the sink over the toilet.

In 2012, Paulette Padanyi, a now-retired faculty member of the University of Guelph, co-wrote a research paper called Food Provision in Ontario Hospitals and Long Term Care Facilities. Of the 55 hospitals studied, 19 hospital administrators agreed to discuss their food budgets. All of them outsourced the food production. Most told Padanyi that they took their cue from long-term-care facilities, which have a prescribed Ministry of Health and Long Term Care rate of $8.03 per day per patient to spend on food.In 2012, the average amount spent per patient in the hospitals Padanyi looked at was $7.91 a day. “They say to the contractors, ‘You’ve got x number of dollars, eight bucks a day per patient or whatever,’ effectively downloading the responsibility of meeting that budget,” she says.Often, these contracts are not just for patient meals, but the staffing and operation of food franchises within the hospital, plus housekeeping and custodial. The main conclusion of Padyani’s report was that food service is considered unimportant relative to the entire hospital.

Tom, a former prisoner introduced to me through the John Howard Society (which asked that I not use his last name), has served time at various correctional facilities around Ontario and suffers from diabetes and Crohn’s disease. He challenges Ross’s statement. “They don’t follow diets,” says Tom, who is in his 30s, was first locked up at the age of 12 and has spent more than 10 years behind bars. “Any jail food, you’re going to be on the toilet six times a day because what they’re giving you is running though you.”

Compass employs half a million people around the world (including 30,000 in Canada), and supplies food to schools, offices, stadiums, museums, mining camps and offshore drilling platforms, as well as hospitals and correctional centres. Of the company’s many customers, patients and inmates have two things in common: First, they are unable to go buy themselves something more healthy, or at least more tasty; and second, we, the taxpayer, are responsible for feeding them.Last November, Compass took over food services at the Regina Correctional Centre, a move that saved the Saskatchewan government $2.4-million a year. Lacking a Yelp page, inmates went on a hunger strike in January to protest against the quality of the food. “If you don’t like the prison food, don’t go to prison,” Premier Brad Wall responded. In March, inmates refused food again, in part because Compass had raised prices at the canteen.Ontario spends $14.54 a day per inmate to feed about 8,000 prisoners in 26 correctional facilities, for a total of $41.3-million a year, including labour and transportation. The food cost is $9.17 for three meals. Perhaps inmates should not, per our punitive view of criminal justice, be dining on lamb racks and truffles. But it’s hard to imagine eating healthy on $9.17 a day.

May 10, 2016

For my entire life, my doctors, my parents and my government have sent me one clear message about food: Nutrition is a key component of physical and mental health. So I had assumed (and hoped) that if MDs or MPPs were choosing menus for those in their care, the result would be a 3-D version of the Canada’s Food Guide chart I coloured in elementary school.

Shepter's story illustrates a problem that extends far beyond a single California nursing home. ProPublica and PBS "Frontline" have identified more than three-dozen cases in which the alleged neglect, abuse or even murder of seniors eluded authorities.

For more than a year, ProPublica, in concert with other news organizations, has scrutinized the nation's coroner and medical examiner offices [1], which are responsible for probing sudden and unusual fatalities. We found that these agencies -- hampered by chronic underfunding, a shortage of trained doctors and a lack of national standards -- have sometimes helped to send innocent people to prison and allowed killers to walk free.

If a senior like Shepter dies under suspicious circumstances, there's no guarantee anyone will ever investigate.

"a hidden national scandal."

Because of gaps in government data, it's impossible to say how many suspicious cases have been written off as natural fatalities.

In one 2008 study, nearly half the doctors surveyed failed to identify the correct cause of death for an elderly patient with a brain injury caused by a fall.

Autopsies of seniors have become increasingly rare even as the population age 65 or older has grown. Between 1972 and 2007, a government analysis [2] found, the share of U.S. autopsies performed on seniors dropped from 37 percent to 17 percent.

"father was lying in a hospital bed essentially dying of thirst, unable to express himself -- so people could have a nice, quiet cup of tea."

"We're where child abuse was 30 years ago," said Dr. Kathryn Locatell, a geriatrician who specializes in diagnosing elder abuse. "I think it's ageism -- I think it boils down to that one word. We don't value old people. We don't want to think about ourselves getting old."

A study published last year in The American Journal of Forensic Medicine and Pathology found that nearly half of 371 Florida death certificates surveyed had errors in them.

Doctors without training in forensics often have trouble determining which cases should be referred to a coroner or medical examiner.

State officials in Washington and Maryland routinely check the veracity of death certificates, but most states rarely do so

there has to be a professional, independent review process

a public, 74-bed facility

Some counties have formed elder death review teams that bring special expertise to cases of possible abuse or neglect. In Arkansas, thanks to one crusading coroner, state law requires the review of all nursing-home fatalities, including those blamed on natural causes.

Of the 1.8 million seniors who died in 2008, post-mortem exams were performed on just 2 percent. The rate is even lower -- less than 1 percent -- for elders who passed away in nursing homes or care facilities.

As the chief medical examiner for King County, Harruff launched a program in 2008 to double-check fatalities listed as natural on county death certificates. By 2010, the program had caught 347 serious misdiagnoses.

Thogmartin said "95 percent" of the elder abuse allegations he comes across "are completely false," and that many of the claims originate with personal injury attorneys.

Decubitus ulcers, better known as pressure sores or bed sores, are a possible indication of abuse or neglect. If a person remains in one position for too long, pressure on the skin can cause it to break down. Left untreated, the sores will expand, causing surrounding flesh to die and spreading infection throughout the body.

Federal data show that more than 7 percent of long-term nursing-home residents have pressure ulcers.

"Very often, that is the way these folks die," he said. "It is a preventable mechanism of death that we're missing."

"Occasionally, there are elderly people who are being assaulted. But this issue of pressure ulcers is a far, far bigger issue, and really nationwide."

a new state law requiring nursing homes to report all deaths, including those believed to be natural, to the local coroner. The law, enacted in 1999, authorizes coroners to probe all nursing-home deaths, and requires them to alert law enforcement and state regulators if they think maltreatment may have contributed to a death.

"It was a horrible place,"

A 2004 review of Malcolm's efforts by the U.S. Government Accountability Office concluded that the "serious, undetected care problems identified by the Pulaski County coroner are likely a national problem not limited to Arkansas."

prompted Medicare inspectors to start citing nursing homes for care-related deaths and to undergo additional elder-abuse training.

Still, nursing homes inspections are not designed to identify problem deaths. The federal government relies on state death-reporting laws and local coroners and medical examiners to root out suspicious cases

They found such problems repeatedly at Riley's Oak Hill Manor North in North Little Rock.

investigations led state regulators to shut down the facility, in part because of the home's failure to prevent and treat pressure sores

staffing in homes is a constant challenge. Being a caregiver is a low-paying, thankless kind of job. (at one time you could make more money flipping burgers than caring for our elderly- priorities anyone??) With all the new Medicare cuts, pharmacy companies who continue to overcharge facilities for services, insurance companies who won’t be regulated, our long-term facilities are in for a world of hurt- which will affect the loved ones we care for. Medicare cuts mean staffing cuts- there are no nurse/patient ratios here- meaning you may have one nurse for up to 50 residents. Scary? You bet it is!!  Better staffing, better care, everyone wins.

Lets not just blame the caregivers. Healthcare and business do not mix. When a business is trying to make money, they will not put the needs of patients and people first. To provide actual staffing (good-competant care with proper patient to caregiver ratios) the facilities would not make money.

After the appointment, the two waited forlornly in the lobby for more than an hour for an adaptedtransport vehicle. Perron, who is not disabled, sat in a wheelchair because there were no seats in the lobby. As she wheeled Vaillancourt to a waiting taxi van, his wheelchair got stuck in several decorative grooves in the pavement outside the entrance to the new Royal Vic. "That's terrible," Perron said of the pavement for those who must use wheelchairs. "It's a beautiful building, but they are not yet ready to receive patients," Vaillancourt said. However, another patient, 76-year-old Shirley Ann Wood of LaSalle, praised the ultra-modern facilities of the superhospital, especially its "fast" elevators. Wood had just seen her cardiologist for a checkup and was sitting on a wooden bench outside waiting for her daughter to pick her up.

Wood said she was initially skeptical about the superhospital - having gone for years to the Royal Vic on Pine Ave., first for her mother, then herself - but was won over. "Everything is clearly marked and it's easy to get around," Wood said. "It's really nice." But Daniel Andrade, a representative of the MUHC Employees Union affiliated with the CSN, noted that some people found it difficult navigating the many corridors of the superhospital. "It would be nice to have more people standing around directing people to where they need to go," Andrade said.

He identified a number of what he called "hiccups," such as the phone system not working properly, some employees not having phones or computers, printers that were not yet attached and the access cards malfunctioning. Ironically, Andrade added, his card gave him access to every restricted department at the Glen site, and that's not supposed to be the case. Those problems should be ironed out, but Andrade expressed concern that the superhospital won't have enough support staffto function smoothly. Two years ago, the Quebec government imposed $50 million in cuts to the MUHC's operating budget. The $1.3-billion superhospital was built as a public-private partnership to avoid cost overruns. However, design-build contractor SNC-Lavalin is demanding an extra $172 million for what it argues were unforeseen expenses.

SNC-Lavalin delayed handing over the keys to the superhospital by five weeks, which caused delays for the MUHC in "activating" equipment. On Monday, construction workers walked past the new entrance even as patients filed out. As of 4 p.m. Monday, the number of in-patients at the superhospital stood at 125, down from the 154 transferred on Sunday. The volume of outpatient visits was 25 per cent of the normal rate but is expected to rise gradually this week. On Sunday night, the superhospital performed its first operation, an appendectomy, followed by a Cesarean section on Monday. Dr. Ewa Sidorowicz, the MUHC's associate director general of medical affairs, has said that the hospital network will concentrate first on emergency operations and then ramp up the volume of elective surgeries. aderfel@montrealgazette.com twitter.com/Aaron_Derfel

However, an examination of court documents by the Montreal Gazette suggests that most of the missing funds - $4 million - was likely transferred to the country where Porter was arrested by Interpol agents two years ago and where he died: Panama. Indeed, in the days after Porter's death, the Unité permanante anticorruption dispatched two investigators to Panama not only to identify his body but to search for the missing funds, according to La Presse. "I want to assure Quebecers that we are continuing to deploy the resources and energy to recover for Quebec large sums of money that was defrauded," UPAC commissioner Robert Lafrenière said in a July 7 statement.

Anne-Frédérick Laurence, a UPAC spokesperson, would respond only to one question from the Gazette: "The only question I can answer concerns the money that has been blocked: close to $18 million. The judicial process is underway in this file, and that's why we can't respond to any other questions." Lawyers for some of the accused, including Riadh Ben Aïssa, a former SNC-Lavalin vice-president in charge of its international construction division, petitioned a Quebec Court judge last year to impose a publication ban on all but one of the police affidavits in support of the asset freezes. But that one affidavit provides strong hints of where most of the missing $5 million might have been transferred. Even much of that affidavit is still sealed, but what isn't is an annexed diagram in fine print at the end of the document. (None of the allegations in the affidavit have been tested in court.)

The diagram alleges an intricate web of money-laundering transfers by Porter, his wife, Pamela Mattock Porter, and the Elbaz brothers. In December, Pamela Porter pleaded guilty to money-laundering and was sentenced to two years in jail. The diagram alleges that Ben Aïssa made $22.5 million in unauthorized payments on behalf of SNC-Lavalin in 2010 and 2011 to Sierra Asset Management, a shell company controlled by Porter in the Bahamas. Half of that money was wired to Pan Global Holdings, another Bahamian shell company, allegedly controlled by the Elbaz brothers. Pan Global, in turn, wired millions of dollars to a number of bank accounts held by Porter and the Elbaz brothers, according to the diagram. The company also wired $4 million to an obscure company called Dallano Holdings Inc., which the diagram alleges was controlled by Yanaï Elbaz. A $2-million payment to Dallano was allegedly made on June 4, 2010, just two months after the superhospital contract was awarded to SNCLavalin. A second $2-million payment was allegedly made on Dec. 22, 2010, more than two weeks after Porter abruptly quit the MUHC, as scrutiny by the MUHC's board of directors intensified about his private business activities.

Over time, the Porter-Panamanian connection would grow stronger - and more mysterious. On June 4 last year, while Porter was still in La Joya jail fighting extradition to Quebec, he set up a company in Panama with the help of his lawyer, Ricardo Bilonick Paredes.

• Jeff Todd, The Canadian Press Files / Since Arthur Porter's death in Panama on June 30, Quebec investigators have been unable to explain what happened to $5 million that is alleged to have been paid in secret commissions for contracts for a new Montreal hospital. One court document suggests the missing money may have been sent to Panama.

"Management keeps bringing in the plumbers to snake the drains, but the problem keeps coming back again and again. This is very, very disruptive for patients and staff." The superhospital was built as a public-private partnership, with SNC-Lavalin winning the contract in 2010 after a competition with a Spanish-led consortium.

Former SNC-Lavalin executives now face criminal charges alleging they made $22.5 million in bribes to former MUHC officials to win the contract. One of those was former CEO Arthur Porter, who died on June 30 in Panama. Quebec authorities last year obtained court orders to freeze Porter's luxury properties in the Caribbean, along with bank accounts around the world. They also froze assets belonging to Porter's one-time right-hand man, Yanaï Elbaz, and his brother, Yohann. But those seized properties were, collectively, worth about $17.5 million, leaving $5 million outstanding. Documents seen by the Montreal Gazette suggest $4 million of that was somewhere in Panama.

The MUHC has been at loggerheads with SNC-Lavalin over a wide range of "deficiencies" -- from faulty wiring to leaking ceilings -- since before the superhospital opened in the spring. The MUHC has, to date, spent more than $1.5 million in legal fees haggling with SNC-Lavalin. The sewer water backup problem appears to be confined to the new Montreal Children's part of the complex, which opened on May 24. On Tuesday afternoon, a reporter entered a public bathroom in the lobby of the Montreal Children's next to a bank of elevators and was immediately overcome by a noxious stench. The fumes were so overpowering that one could not stay in the bathroom for longer than a few seconds, enough time to take a picture of a central floor drain that was taped over with masking tape.

The door was not locked and no sign was posted warning people of the smell. "I know that a drain has overflowed in the (intensive-care unit) at the Children's at least once," the source said. "It has happened on the eighth floor at least five times in several different rooms. I have never seen black water come up from the drains in the old building." MUHC official Ian Popple acknowledged problems with the drains, but was unable to go into detail. Louis-Antoine Paquin, a spokesman for SNC-Lavalin, blamed the problem on patients or visitors stuffing too much paper or other objects into toilets, rather than something inherently wrong with the drains. "It really has to do with the use of the toilets themselves -- in other words, what people put in the toilets," Paquin said.

David Kellner, a master plumber, disputed SNC-Lavalin's explanation. "There's definitely a blockage further down in the main drain where the water is coming up and it's coming up into the floor drains," said Kellner, who has not worked at the superhospital. "One hundred per cent, it's a deeper problem." In April, MUHC officials said they had identified 3,000 deficiencies with the superhospital ranging from minor issues such as the wrong height of counters to more serious problems such as faulty wiring in operating rooms. The Montreal Gazette has since learned that other insider estimates put the total number at 14,000. The MUHC's health and safety department has instructed staff to document every medical accident that could be attributed, in part, to problems with the new facilities.

Illustration: • Montreal Gazette • A taped-over drain is pictured in the men's bathroom of the new Montreal Children's Hospital. The bathroom is one of several locations in the hospital where sewer water has backed up. The plumbing issues are just one of an estimated 14,000 issues at the new hospital.

The NDP plan to hike corporate taxes could be a flashpoint in the debate as both the Conservatives and Liberals oppose it, saying it would be bad for the economy. The Conservatives are campaigning on their April budget, which cut taxes and promised balanced budgets and more infrastructure spending over the coming years. The NDP say they would balance the books as well, but would fund new programs with roughly $7-billion a year in tax increases, including raising the corporate tax rate to 17 per cent from 15 per cent.

On taxation, an NDP government led by Mr. Mulcair says it expects $3.7-billion a year from the corporate tax increase, making it the single biggest source of new revenue in the party's costing plan. "The NDP's fiscal plan that we have announced today is balanced and it is progressive," Andrew Thomson, a former Saskatchewan finance minister who is running for the NDP against Conservative candidate Joe Oliver in the Toronto riding of Eglinton-Lawrence, told reporters at an afternoon news conference. Mr. Oliver is the Finance Minister in the Tory government. But questions quickly emerged Wednesday as to whether the corporate-tax estimate may prove optimistic, given that corporations could shift profit to countries with lower rates.

The Liberals are planning to run deficits for three years to fund major investments in infrastructure, but have not released specific spending and revenue figures for each year. The New Democrats are locked in a tight three-way battle with both the Conservatives and the Liberals as the election campaign enters its final month.

In the document, the NDP says it will rely heavily on a twopoint increase to the corporate tax rate on Jan. 1 as a key source of revenue to pay for billions in new spending on health transfers, daycare spaces and new infrastructure. The party says it can do all of this while planning for surpluses of at least $3-billion a year in each year of a fouryear mandate. The NDP says the document is not the party's full platform, as it still plans to make more detailed announcements throughout the campaign. Critics questioned the New Democrats' reliance on the April budget numbers to project surpluses given that forecasts for economic growth have since been lowered substantially, which will lead to less federal revenue.

With the economy at the top of the list of issues on the minds of voters, NDP Leader Thomas Mulcair hopes to persuade Canadians that he is a prudent fiscal manager, and someone who can chart a course to prosperity without driving up debt. The seven-page document released Wednesday in Ottawa includes a chart titled "A balanced plan," but total new spending and total new revenue are not in balance. The chart lists seven sources of new revenue, which add up to $7.2-billion in 2016-17 and increase to $7.5-billion in 2019-20. The chart also lists eight categories of new spending, which add up to $5.8billion in the first year and rise to $11.3-billion in the fourth year.

Over all, the lack of detailed information provided by the New Democrats made it difficult to determine whether their numbers add up. But, it was clear that some of the promises being made by the NDP Leader have had to be modified to meet his commitment of a balanced budget. Since late 2011, NDP politicians have accused the Conservative government of planning to cut $36-billion over 10 years from health care, starting in 2017-18, by replacing the annual 6-percent increases in health transfers to the provinces with increases based on the growth in nominal gross domestic product.

The New Democrats have said they would reverse that decision. And Peggy Nash, the party's industry critic, told reporters on Wednesday that the 6-percent increases to transfers would be restored. But, she said, they would be used to pay for the slate of new health-care initiatives included in the NDP campaign platform such as a mental-health innovation fund, a half-billion dollars over four years for new clinics and to hire doctors and nurses, an Alzheimer's strategy, a seniors-care strategy and whatever other health announcements Mr. Mulcair has yet to make. Ontario Health Minister Eric Hoskins said the Conservative decision to slash the Canada Health Transfer would result in $8-billion less for health care for Ontario over 10 years and accused the New Democrats of making health-care decisions without provincial input. Absent from the NDP document is a major pledge to increase foreign aid. Mr. Mulcair had promised in May to set a multiyear target to increase foreign aid to 0.7 per cent of GDP, a pledge that could cost more than $8-billion a year if fully implemented. The party confirmed Wednesday that the foreign-aid target will not be met during the first mandate of an NDP government.

Canada's federal corporate tax rate had declined to 21 per cent between 2000 and 2007 from 30 per cent in 1980. It has since declined gradually under the Conservatives to 15 per cent as of 2012.

Mr. Georgiou, 51, is a long-time senior public servant. Between 2006 and 2012, he held various executive positions at Infrastructure Ontario, the procurement agency that was set up to administer the McGuinty government's ambitious plans to restore the province's outdated infrastructure through public-private partnerships. He was a project manager on the construction of several major projects, including some of the facilities for this summer's Pan Am and Parapan Games, eventually rising to the role of chief administrative officer. How he ended up admitting he issued false invoices - and why that information was not passed on by at least one of his former colleagues at Infrastructure Ontario - dates back to 2009, after a whistleblower complained to management at York about questionable invoices.

Court records show the scheme required Mr. Georgiou to invoice the university, through two family-owned companies, for work that those companies never performed. After cashing York's cheques, he passed on about $40,000 of the total $65,000 paid by York to an intermediary who was connected to a facilities official at the university. Mr. Georgiou said he kept $25,000 to declare for income tax purposes. "Once these events came to light, I fully co-operated with the authorities and counsel for York University, and I assisted them with their investigation. In addition, I ensured that the party who requested the invoices, repaid the entire amount to York University," he said in the statement. He did not address questions about what he told St. Michael's, if anything, about his role in the scheme.

St. Michael's and Infrastructure Ontario have ordered forensic audits. "These swift and prudent actions have been taken by the Board of Directors and Management to preserve and protect the public trust invested in St. Michael's Hospital," a statement from St. Michael's said. In its own statement, Infrastructure Ontario said it was "very troubled" by some of the facts The Globe presented to four of its officials in an interview. "The activity in question goes against everything [Infrastructure Ontario] stands for," said Bert Clark, the agency's chief executive, and Linda Robinson, vice-chair of Infrastructure Ontario's board. Mr. Georgiou, who has been placed on a leave of absence from the hospital, said in an e-mail that The Globe had not provided him enough time to give proper answers to about 40 questions it e-mailed to him last Wednesday. In a statement, he said he never profited from the "exercise" at York and stressed that he was never charged criminally for his role in the false invoice scheme.

York investigated and concluded it had been the victim of a $1.2-million kickback scheme involving false invoices for nonexistent construction and maintenance work. A forensic audit determined that between 2007 and 2010, the university cut cheques to eight different companies for services that were never rendered. The York investigation found that two of those companies, Arsenal Facilities Consultants Inc. and Toronto Engineering Company, were connected to Mr. Georgiou. (He was the listed officer and director of AFC, and the other company was owned by his wife and her parents.) Mr. Georgiou and his lawyer, Gary Clewley, agreed to meet with auditors in February of 2011, and Mr. Georgiou admitted writing three false invoices totalling $64,800 between the two companies. The Globe has obtained a transcript of this meeting, which was marked "confidential" but included in court filings. Mr. Georgiou created paperwork showing that AFC did $22,000 worth of door lock repairs in November, 2007. In February, and then again in April, 2008, he drew up documents claiming that TECO completed a total of $42,800 worth of watermain work.

He wrote these invoices, he told investigators, at the request of a friend who had nothing to do with the university, a parking industry executive named Luigi Lato. According to Mr. Georgiou, Mr. Lato told him maintenance work had been performed and he was hoping Mr. Georgiou could create invoices for that work. But for reasons Mr. Lato never explained, Mr. Georgiou said, whoever did the work did not issue their own invoices. Mr. Georgiou said he believed Mr. Lato was doing a "favour" for a friend at York who needed to pay for the work. A lawyer and an auditor for York pressed Mr. Georgiou on why the companies that actually did this work would not, or could not, issue invoices, and Mr. Georgiou said he did not know.

"There were no details provided to me," he explained at one point. Pressed further, he said, "I didn't ask any questions." York paid AFC and TECO, but Mr. Georgiou told investigators he did not keep the money. He withheld about $25,000 to declare as income tax for both companies, which he said he paid. As for the rest of the money, he made two trips to see Mr. Lato in which he paid him a total of about $40,000 in cash. Mr. Lato could not be reached for comment.

William McDowell, a lawyer acting for York, asked Mr. Georgiou how the teller at his bank reacted when he withdrew $14,500 in cash for Mr. Lato's first instalment: "Doesn't your banker kind of squint when you go in and ask for $14,500 in cash?" Mr. Georgiou replied: "I didn't go into the bank and ask for $14,500 in cash, you know, like in one shot. I had, you know, some cash at home, went to the bank for some cash..." About a year later, on Jan. 26, 2012, York filed a statement of claim against all of the people and companies it believed had defrauded the university, including Mr. Georgiou. The same day, the university's general counsel, Harriet Lewis, met with a senior executive at Infrastructure Ontario, Bill Ralph, who at the time was the procurement agency's chief risk officer, both York and IO said in separate statements. Ms. Lewis informed Mr. Ralph that York had launched a lawsuit against Mr. Georgiou and others because of what the internal investigation uncovered.

Mr. Ralph did not respond to requests for comment. Two weeks after the meeting, Mr. Georgiou suddenly resigned. A few days later, the CEO of Infrastructure Ontario, David Livingston, announced in a company-wide e-mail that Mr. Georgiou was "leaving." The departure e-mail made reference to "various personal and family matters" Mr. Georgiou needed to address. "I know it was a tough decision for him, but I admire him for making it." Mr. Livingston did not respond to repeated requests for comment e-mailed to him and to his lawyer. After leaving IO, Mr. Livingston was appointed chief of staff in May, 2012, to Dalton McGuinty, then premier of Ontario. Mr. Livingston has been accused by Ontario Provincial Police of orchestrating a plan to purge government records after the controversial cancellation of two power plants. He has denied through his lawyer that he did anything wrong.

Employment lawyer Natalie MacDonald said a chief risk officer should give the board of directors any information that could damage the organization's reputation. A risk officer has a "duty to inform the board so it can make an informed decision," Ms. MacDonald said, speaking generally. But according to Infrastructure Ontario's organization chart, the chief risk officer reports directly to the CEO rather than to the board. In an interview last Wednesday, Ms. Robinson, the board vicechair, said the news that Mr. Georgiou had, at one time, been named a defendant in the lawsuit and admitted writing false invoices never made its way to the agency's board.

In April of 2012, Mr. Georgiou and Mr. Lato signed a settlement agreement with York that required them to pay restitution - the amount has not been disclosed in public documents - which Mr. Georgiou said in his statement to The Globe was covered by the "party" who requested the invoices. One of the conditions of the settlement is that York "shall not make any statements to the media" about the agreement or about allegations levelled in York's claim, except to say that Mr. Georgiou co-operated.

Seven months later, St. Michael's board meeting minutes show that it had identified a preferred candidate to replace its chief administrative officer, and in the New Year, Mr. Georgiou officially started his new job. In its statement, St. Michael's said an external search firm was enlisted to identify Mr. Georgiou, and a separate firm conducted reference interviews. The issues at York were "never disclosed by Mr. Georgiou," St. Michael's statement said.

In his statement to The Globe, Mr. Georgiou said he has led the hospital in securing government funding, as well as capital redevelopment funding. "During my tenure at St. Michael's we have achieved tremendous results for the hospital both in the excellence of our hospital's performance as well in the success of our redevelopment project."

Wayne Brown, the president of the New Brunswick Council of Nursing Home Unions, which falls under the Canadian Union of Public Employees umbrella, said the members of the locals representing the two nursing homes don't plan on going away without assurances their issues will be dealt with. "We're getting more and more pressure on him and I know he has to tow the party line but he also has to step up to the plate for those folks who are his constituents," Brown said.

"So we're certainly not done yet - it all hinges on that RFP that is coming out and my feeling is that they are certainly revisiting that RFP, so maybe they're looking at something ... hopefully they will blink on this one because there are ways for them to save face." During a town hall meeting organized by government officials in Miramichi last Thursday, Rogers and Fraser stopped short of guaranteeing the union concerns would be addressed in full.

Fraser said he would like to engage in deeper dialogue with officials from the Senior Citizens Home about how they could partner up to help ensure that programming like Meals on Wheels and adult daycare are enhanced in the transition to the new place. In terms of the labour concerns, Fraser said the government team is "well aware" of them and said high-level discussions have taken place to discuss how to mitigate some of them and potentially work some of them into the RFP.

But on the P3 model, he said the government has to make strategic changes to the way it has traditionally done things in order to trim expenditures and free up efficiencies. The government has made a commitment to building any new nursing homes moving forward using a P3 model and it just so happens that the Miramichi facility is first in line for this new way of doing things. That setup, he stressed, allows the government to dictate the standards of care without adding to its financial burden and it is clear the province doesn't have any current plan to back away from that strategy.

Fraser said people have to "get past the fact that we're going to an RFP" for the new nursing home. "The province is in a fiscal situation that is at the brink - the interest payment on our debt alone is in excess of $650 million a year ... that's not the debt, that's the interest payment," Fraser said.

"Think of the good things we could do if we could get that under control, and this home would not be possible any other way without going through the RFP process to ensure the best economic return on our dollar and for the best care, safety and comfort of our seniors." There are presently three private nursing homes in New Brunswick and all of them are operated by Shannex. Fraser said the main reason the province is committing to this project is to alleviate some of the strain being put on the delivery of front-line health services at the Miramichi Regional Hospital, where many seniors are forced to reside until a new nursing home bed opens up. He said the community "needs to come together" on this.

But both ministers said they were actively listening to what the workers were saying and would attempt to work some of those issues into the request for proposals which will ultimately lead to the proponent that will build and maintain the home. Speaking last Friday, Fraser said once again he understands how staff would be nervous about the situation given that a new entity will be coming in to run the new building.

"Are we going to guarantee everything? Probably not, but are we going to do our best to address as many of the issues as we can? Absolutely we are," he said. "Because at the end of the day we want our residents to be cared for by people they know in an environment they love, and I'm confident that's going to happen." As for the CUPE membership, Brown said they aren't willing to compromise on the issues they've outlined and he hopes the government understands why.

The health care system was in crisis. It took nearly 15 years of incremental increases to bring the federal portion of health funding back to the level is was at before Paul Martin took his axe to it. Going through an exercise like that again would be devastating for the health services that Canadians depend on each and every day.

Adding fuel to the speculation that the Liberals are planning massive cuts to health funding is Trudeau’s September 2nd letter to the Council of the Federation that makes no firm commitments to health care or federal transfers. The only firm commitment was to improve the federal-provincial relationship. That’s pretty thin gruel considering the state of that relationship after 10 years of Stephen Harper!

All Canadians who are concerned with the future of health care in this country need to scratch below Trudeau’s soothing words and take a look at his hard numbers. When you break down their plan, 77 per cent of the value of their “new investments” are tax shifts and benefits (including others not listed under that category), 12 per cent is the catch-all of ‘infrastructure’ spending (though most Canadians don’t think of early learning and cultural facilities as ‘infrastructure’), and five per cent is EI (paid for through EI premiums).

That leaves only six per cent, or a little over two billion a year for everything else. How much of that available funding will go to public home care and long-term care? How much will go to the provinces for new hospital beds after years of cuts? On reading the Liberal plan, we have to conclude: not a penny.

Their plan also targets $6.5 billion in spending reductions from an expenditure review. Will health care be on the table for cuts, if they can’t meet that ambitious target? John McCallum said on Saturday that in the effort to balance their books before the next election, ‘everything was on the table.’ Contrast this with Tom Mulcair’s plan for health care under a federal NDP government, and the stark choice is brought in to focus. 

Mulcair has committed to reversing Harper’s $36 billion in health care transfer cuts to the provinces.  He has committed to investing $5.4 billion into new public health care programs, including a prescription drugs, a plan for 41,000 home care and 5,000 long-term care spots. Over five million more Canadians will have access to primary health care through his plan to build 200 Community Health Clinics. And there are practical policy initiatives on mental health for youth, Alzheimer’s and dementia care.

Canadians cherish their universal Medicare system as one of the things that makes Canada great. They want a federal government that will commit the necessary funding and leadership to build the public health care system of our collective futures, to meet the challenges of an aging population and increasing drug costs. The next party to lead the federal government should be judged by the real dollars and focused policy it has committed to meet Canadians’ health care needs.

On that measure, the Liberal plan is dead on arrival. Paul Moist is national president of the Canadian Union of Public Employees. Representing over 633,000 members, including over 153,000 working in the health care sector, it is Canada’s largest union.