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The crux of the hospital's argument was that health privacy violations were the sole domain of the privacy commissioner and that the Personal Health Information Protection Act (PHIPA) ousts the jurisdiction of the courts. The Superior Court ruled against the hospital, so it took the fight up to the Court of Appeal, which dismissed the case Wednesday. In its decision, the court said health privacy legislation does not exclude the jurisdiction of the courts. Health privacy laws were tailored to handle "systemic issues rather than individual complaints," the court said. Peterborough Regional Health Centre declined to comment on the decision, saying "this matter remains in litigation before the courts." In a written statement to the Star Wednesday, a Peterborough hospital spokesperson said the centre had a "zero tolerance policy with respect to inappropriate access to medical records."

The hospital has 60 days to appeal the decision to the Supreme Court of Canada. Acting Information and Privacy Commissioner Brian Beamish told the Star he was "very pleased" with the ruling. All patients who are victims of privacy violations should have the option of filing a complaint to the privacy office or taking civil action, Beamish said. Under PHIPA, the privacy commissioner's office acts as a watchdog over health institutions, ensuring they are protecting patient information and abiding by privacy laws.

There is no evidence linking Wensvoort's ex-husband to the inappropriate access of her record, according to Crystal, her lawyer. The court awarded Wensvoort $24,000 for the legal fees associated with the appeal. Crystal, who is the lawyer for all the Peterborough patients, said the court's ruling grants patients "access to justice. "The highest court in Ontario has spoken and said invasion of personal health information is not something that is simply the domain of the privacy commissioner," he said. "Patients do not have to go through the administrative nooks and crannies of PHIPA legislation to achieve access to justice." If the latest decision is not appealed by the hospital, Crystal said the next step would be setting dates for a motion of certification for the Peterborough case.

Privacy commissioners from other parts of Canada told the Star earlier this year that they have noted a rising trend of health-care professionals snooping into private medical records with malicious intent.

Perhaps the Central East Local Health Integration Network should also be questioned, Brady said. "That's their job. To make sure money is being spent properly." Part of the Canadian Health Coalition, the local health coalition aims to preserve Canada's medicare system and promote universal public health care.

Agriculture, Food and Rural Affairs Minister and Peterborough MPP Jeff Leal had just returned to the city late Wednesday afternoon when he learned of the news from the hospital. "It is a re-calibration of their financial statements involving a significant amount of money and the process will be ongoing," Leal said.

The trust's forecasts for the next five years show a continuing deficit of £38m or more each year and a cash shortfall of at least £40m a year.

The Peterborough City Hospital PFI is costing £40m a year and has 31 years left to run but ending the arrangement would trigger a very substantial one-off payment, the CPT report concluded.

The ralliers walked along a section of Hospital Dr. carrying signs and handed out information to vehicles entering and exiting the hospital parking lot. CUPE Ontario division president Fred Hahn and Ontario Council of Hospital Unions president Michael Hurley were on hand to rally the crowd of about three dozen with short, but loud, enthusiastic messages. The message was two-fold, Hurley said.

First, to remind the hospital that it has an "obligation" to ensure those who work there are "treated with dignity and respect" and make enough salary to support their families. Second, to speak out about hospital dietary staff earning $20 an hour or more -twice that of food service workers who do not have benefits. "We want Compass to engage us meaningfully at the bargaining table ... until we receive a collective agreement with dignity," he said. The hospital has to be account-a ble to the community as it spends tax dollars, Hahn said, calling the food service employees' vocations' "precarious work." Half of workers in the province are in that position, he said.

They have no guarantee ... it's absolutely a shame," he said, telling the workers that they have the support of more than 250,000 union members. "This employer needs to understand that they are not dealing with a small group." Hahn asked those on hand to be on "standby" for another rally, something Hurley said earlier there would be more of, if progress is not made. A conciliation meeting is scheduled for early next month.

Canadian Union of Public Employees Ontario president Fred Hahn speaks as CUPE workers and supporters protested outside Peterborough Regional Health Care Centre on Thursday. They called on the hospital's board of directors and food service provider Compass Group Canada to ensure a fair deal with employees of PRHC's cafeteria and Tim Hortons.

"We are trying to live within the means we have," Pellizzari said, adding she wishes the health unit could offer more. "It's not what they want. It's not as much as they deserve." Bargaining unit president diane Lockman, a public health nurse for the health unit, could not be reached for comment Wednesday. She has said previously that she and her co-workers aren't paid as much as their colleagues in neighbouring communities. "We are asking our employer to acknowledge the important work we do by putting a fair and equitable offer on the table -one that prevents us from falling further behind the other public health and registered nurses in the area," she stated Tuesday.

OnA president Linda haslam-Stroud said the wage disparity is as much as 23%. "While the vast majority of Ontario's Rns have received small wage increases, OnA members with the Peterborough County- City health unit are the lowest-paid in the surrounding four health units," she stated Tuesday.

The health unit is following the direction of a province that is putting austerity measures in place, Pellizzarri said, noting the situation could improve in a couple of years. non-unionized staff have been told to expect 0% wage increases during that time, she said. A strike and resulting service disruptions are not a something anyone hopes for, she added. "We hope we can keep talking ... (a strike) is the last thing we want to see."

"It's another day where we are hearing about hospital budgets being balanced on the backs of nurses. This is several thousand hours of RN care that is being removed from this community."

Of the 53 positions to be eliminated, 28 will be registered nurses.

"We are working to decrease length of stay in that service, since it is significantly out of step with provincial benchmarks," PRHC spokesman Arnel Schiratti stated in an email Wednesday night. "By doing so we can treat the same number of patients with fewer beds. By moving to benchmarks four beds will no longer be needed as we treat the same number of patients."

"At the end of the day, there will be three potential layoffs. As this migrates over time, we see that (number) coming down," he said.

While registered nursing positions take the brunt of the cuts, Tremblay said overall the number of nurses employed at the hospital is actually going up.

There will be a bump in registered practical nurses from 204 in 2012-13 to 222 in 2013-14 and registered nursing positions will go from 711 to 755, the hospital said.

The cutbacks represent a 2.5% staffing decrease. PRHC currently employs about 2,070 people. The 2013-14 operating budget will be balanced, without surplus or deficit.

PRHC full-time employees average 10 sick days per year, costing $3.2 million. The leading Ontario hospitals in that category average only six days per year.

Sick days tend to lead to more overtime costs. In 2012/2013, PRHC paid out more than $1.9 million in overtime and the hospital is aiming for a 30% reduction.

"Hospitals across the Southeast LHIN face a devastating restructuring plan that's all about cuts and centralizing services," said Mehra. Mehra described relocating complex continuing care beds to TMH as nothing more than a smokescreen. Retaining cataract surgery at TMH is also misleading. "The plan is to elimin

ate cataract surgeries at hospitals and move the service to private clinics," she same. The same goes for complex continuing care beds. Mehra said the ultimate plan is to relocate those beds to facilities outside hospitals. "Another kicker is losing half the acute care beds at TMH," said Mehra.

Mehra said other hospital across the province are, and have faced, a similar pattern to what's taking place at TMH. She also noted that hospitals in Ontario are chronically under-funded compared to other provinces. Mehra said hospitals in Welland, Fort Erie, Port Colborne, Niagara on the Lake and Niagara Falls are being gutted and face possible closure. Hospitals in those communities are part of the Niagara Health System.

"The first phase includes removing, diagnostics, surgical services and acute care beds, followed by replacing emergency rooms with urgent care centres," said Mehra. The final phase is closure. Mehra said amalgamated hospital systems have never worked. She used Quinte Health Care and the resulting yearly service cuts at TMH as a prime example.

"The current funding model has never worked. It means those hospitals face deficits every year. Virtually all hospital are under stress because the plan is to reduce the scope of services, resulting in the fact that residents will have to travel a lot further," said Mehra. The end result is that smaller hospitals inside large amalgamations are being "completely" gutted. But the local community, said Mehra, shouldn't give up hope. The Coalition has kept a watchful eye on Quinte West and Brighton, and its community hospital.

"Our TMH has done a fantastic job of generating great ideas that are constructive. They have great integrity and have done a great job of rallying the community," said Mehra. On that front, Mehra said the idea of a one-stop health centre and community operated hospital with inpatient beds has the potential to provide a "robust" range of care to tens of thousands of residents. Mehra said a proposed veteran's care centre is a natural extension of that plan. The idea has received attention from national party leaders during the federal election campaign.

But is that enough to convince the province, and those bureaucrats in charge at the LHIN and QHC? Ultimately, said Mehra, it depends on how hard the community pushes its agenda. De-amalgamating from larger hospital corporations wouldn't be precedent setting.

Mehra said smaller hospitals in Georgetown and St. Joe's Island (near Sault Ste. Marie) have successfully divorced from larger corporations. "But it's up to the community to raise a huge stink with the province and present a good plan," said Mehra. Mehra suggested Trenton Memorial, if it were locally owned and operated, form a coalition with other independently run hospitals such as Napanee, Campbellford or Northumberland.

"The bottom line is people have to fight for what they want. They have to stand up and be heard," said Mehra. Local organizers want that fight to continue in Trenton on Nov. 13. -The Trentonian

5. Most physio clinics are now fee-for-service. The two local clinics which accept patients under OHIP coverage have waiting lists of up to nine months. 6. Patients are denied day surgery unless they have (or can hire) someone to spend the first night post-surgery with them. 7. Costs of equipment and supports have skyrocketed and the government no longer funds a local lending cupboard where people used to be able to pay a refundable deposit for the loan of a walker, cane, wheelchair, bath seat etc. Crutches are now $40 and the cost of an air cast is a minimum of $140 plus tax.

Back in 2014 the health minister urged us to report any indications of creeping two-tier coverage. Over the past two years letters and e-mails to his office have not earned the courtesy of a reply. But one recent letter, forwarded to the minister by our local MPP, did elicit a prompt response. After salutations the minister's assistant courteously and concisely advised that "the ministry receives correspondence from people all over Ontario who offer advice and insights on various issues. Hearing those views is essential to help shape a province that reflects the needs and concerns of all Ontarians. Thank you for writing."

In bureaucratese this can be interpreted as meaning "The ministry has received your correspondence and appropriately filed your letter in the colossal, specially designated parliamentary shredder." Christmas is approaching. It appears that, unless the Health Minister is visited by Three Spirits, we may soon have many more Tiny Tims in our neighbourhoods --people who could have been fit, healthy and often employable had they been able to afford prosthetics or medications or therapies to strengthen and heal their traumatized bodies.

And the priceless legacy of free universal health care, so courageously fought for and won for all of us by the incomparable champion of the disadvantaged Tommy Douglas, will be lost forever. Carol Winter McDonnel St.

Canada has catching up to do compared to other OECD countries. Canadians have difficulty accessing primary care, particularly after hours and on weekends, and are more likely to use emergency rooms.

only 32 per cent of Canadians had access to more than one primary health care provider

In Peterborough, Ontario, for example, a region-wide shift to team-based care dropped emergency department visits by 15,000 patients annually and gave 17,000 more access to primary health care.

We believe that jurisdictions are now turning the corner on primary health care

Sustained federal funding and strong jurisdictional direction will be critical to ensuring that we can accelerate the update of electronic health records across the country.

The creation of a national pharmaceutical strategy was a critical part of the 10-year plan. In 2011, today, unfortunately, progress is slow.

Your committee has produced landmark reports on the importance of determinants of health and whole-of- government approaches. Likewise, the Health Council of Canada recently issued a report on taking a whole-of- government approach to health promotion.

there have also been improvements on our capacity to collect, interpret and use health information

Leading up to the next review, governments need to focus on health human resources planning, expanding and integrating home care, improved public reporting, and a continued focus on quality across the entire system.

John Wright, President and CEO, Canadian Institute for Health Information

the Canada Health Act

Since 2008, rather than repeat annual reporting on the whole, the Health Council has delved into specific topic areas under the 2003 accord and the 10-year plan to provide a more thorough analysis and reporting.

We have looked at issues around pharmaceuticals, primary health care and wait times. Currently, we are looking at the issues around home care.

John Abbott, Chief Executive Officer, Health Council of Canada

I have been a practicing physician for 23 years and a CEO for 10 years, and I would say, probably since 2005, people have been starting to get their heads around the fact that this is not sustainable and it is not good quality.

Much of the data you hear today is probably 18 months to two years old. It is aggregate data and it is looking at high levels. We need to get down to the health service provider level.

The strength of our ability to report is on the data that CIHI and Stats Canada has available, what the research community has completed and what the provinces, territories and Health Canada can provide to us.

We have a very good working relationship with the jurisdictions, and that has improved over time.

One of the strengths in the country is that at the provincial level we are seeing these quality councils taking on significant roles in their jurisdictions.

As I indicated in my remarks, dispute avoidance activity occurs all the time. That is the daily activity of the Canada Health Act division. We are constantly in communication with provinces and territories on issues that come to our attention. They may be raised by the province or territory, they may be raised in the form of a letter to the minister and they may be raised through the media. There are all kinds of occasions where issues come to our attention. As per our normal practice, that leads to a quite extensive interaction with the province or territory concerned. The dispute avoidance part is basically our daily work. There has never actually been a formal panel convened that has led to a report.

each year in the Canada Health Act annual report, is a report on deductions that have been made from the Canada Health Transfer payments to provinces in respect of the conditions, particularly those conditions related to extra billing and user fees set out in the act. That is an ongoing activity.

there has been progress. In some cases, there has been much more than in others.

How many government programs have been created as a result of the accord?

The other data set is on bypass surgery that is collected differently in Quebec. We have made great strides collectively, including Quebec, in developing the databases, but it takes longer because of the nature and the way in which they administer their systems.

I am a director of the foundation of St. Michael's Hospital in Toronto

Not everyone needs to have a family doctor; they need access to a family health team.

The family doctors in our hospital feel like second-class citizens, and they should not. Unfortunately, although 25 years ago the family doctor was everything to everybody, today family doctors are being pushed into more of a triage role, and they are losing their ability.

The problem is that the family doctor is doing everything for everybody, and probably most of their work is on the social end as opposed to diagnostics.

At a time when all our emergency departments are facing 15,000 increases annually, Peterborough has gone down 15,000, so people can learn from that experience.

I have to be able to reach my doctor by phone.

They are busy doing all of the other things that, in my mind, can be done well by a team.

That is right.

if we are to move the yardsticks on improvement, sustainability and quality, we need that alignment right from the federal government to the provincial government to the front line providers and to the health service providers to say, "We will do this."

We want to share best practices.

it is not likely to happen without strong direction from above

Excellent Care for All Act

quality plans

with actual strategies, investments, tactics, targets and outcomes around a number of things

Canadian Hospital Reporting Project

by March of next year we hope to make it public

performance, outcomes, quality and financials

With respect to physicians, it is a different story

We do not collect data on outcomes associated with treatments.

which may not always be the most cost effective and have the better outcome.

We are looking at developing quality indicators that are not old data so that we can turn the results around within a month.

Senator Eaton

There are different types of benchmarks. For example, there is an evidence-based benchmark, which is a research of the academic literature where evidence prevails and a benchmark is established.

The provinces and territories reported on that in December 2005. They could not find one for MRIs or CT scans. Another type of benchmark coming from the medical community might be a consensus-based benchmark.

universal screening

A year and a half later, we did an evaluation based on the data. Increased costs were $400 per patient — $1 million in my hospital. There was no reduction in outbreaks and no measurable effect.

A thorough research of the literature simply found that there are no evidence-based benchmarks for CT scans, MRIs or PET scans.

The evidence is pretty clear for the high acuity; however, for the lower acuity, I do not think we know what a reasonable wait time is

If you are told by an orthopaedic surgeon that there is a 99.5 per cent chance that that lump is not cancer, and the only way you will know for sure is through an MRI, how long will you wait for that?

colorectal screening

the next time they do the statistics, there will be a tremendous improvement, because there is a federal-provincial cancer care and front-line provider

adverse drug effects

over-prescribing

There are no drugs without a risk, but the benefits far outweigh the risks in most cases.

catastrophic drug coverage

a patchwork across the country

with respect to wait times

The interesting thing about Saskatchewan is that, on a three-year trending basis, it is showing positive improvement in each of the areas. It would be fair to say that Saskatchewan was a bit behind some of the other jurisdictions around 2004, but the trending data — and this will come out later this month — shows Saskatchewan making strides in all the areas.

In terms of the accord itself, the additional funds that were part of the accord for wait-times reduction were welcomed by all jurisdictions and resulted in improvements in wait times, certainly within the five areas that were identified as well as in other surgical areas.

We are working with the First Nations, Statistics Canada, and others to see what we can do in the future about identifiers.

Have we made progress?

I do not think we have the data to accurately answer the question. We can talk about proxies for data and proxies for outcome: Is it high on the government's agenda? Is it a directive? Is there alignment between the provincial government and the local health service providers? Is it a priority? Is it an act of legislation? The best way to answer, in my opinion, is that because of the accord, a lot of attention and focus has been put on trying to achieve it, or at least understanding that we need to achieve it. A lot of building blocks are being put in place. I cannot tell you exactly, but I can give you snippets of where it is happening. The Excellent Care For All Act in Ontario is the ultimate building block. The notion is that everyone, from the federal, to the provincial government, to the health service providers and to the CMA has rallied around a better health system. We are not far from giving you hard data which will show that we have moved yardsticks and that the quality is improving. For the most part, hundreds of thousands more Canadians have had at least one of the big five procedures since the accord. I cannot tell you if the outcomes were all good. However, volumes are up. Over the last six years, everybody has rallied around a focal point.

The transfer money is a huge sum. The provinces and territories are using the funds to roll out their programs and as they best see fit. To what extent are the provinces and territories accountable to not just the federal government but also Canadians in terms of how effectively they are using that money? In the accord, is there an opportunity to strengthen the accountability piece so that we can ensure that the progress is clear?

In health care, the good news is that you do not have to incent people to do anything. I do not know of any professionals more competitive than doctors or executives more competitive than executives of hospitals. Give us the data on how we are performing; make sure it is accurate, reliable, and reflective, and we will move mountains to jump over the next guy.

There have been tremendous developments in data collection. The accord played a key role in that, around wait times and other forms of data such as historic, home care, long term care and drug data that are comparable across the country. Without question, there are gaps. It is CIHI's job to fill in those gaps as resources permit.

The Health Council of Canada will give you the data as we get it from the service providers. There are many building blocks right now and not a lot of substance.

send him or her to the States

Are you including in the data the percentage of people who are getting their work done elsewhere and paying for it?

When we started to collect wait time data years back, we looked at the possibility of getting that number. It is difficult to do that in a survey sampling the population. It is, in fact, quite rare that that happens.

Do we have a leader in charge of this health accord? Do we have a business plan that is reviewed quarterly and weekly so that we are sure that the things we want worked on are being worked on? Is somebody in charge of the coordination of it in a proper fashion?

Dr. Kitts: We are without a leader.

Mr. Abbott: Governments came together and laid out a plan. That was good. Then they identified having a pharmaceutical strategy or a series of commitments to move forward. The system was working together. When the ministers and governments are joined, progress is made. When that starts to dissipate for whatever reason, then we are 14 individual organization systems, moving at our own pace.

You need a business plan to get there. I do not know how you do it any other way. You can have ideas, visions and things in place but how do you get there? You need somebody to manage it. Dr. Kitts: I think you have hit the nail on the head.

The Chair: If we had one company, we would not have needed an accord. However, we have 14 companies.

There was an objective of ensuring that 50 per cent of Canadians have 24/7 access to multidisciplinary teams by 2010. Dr. Kitts, in your submission in 2009, you talked about it being at 32 per cent.

there has been a tremendous focus for Ontario on creating family health teams, which are multidisciplinary primary health care teams. I believe that is the case in the other jurisdictions.

The primary health care teams, family health care teams, and inter-professional practice are all essentially talking about the same thing. We are seeing a lot of progress. Canadian Health Services Research Foundation is doing a lot of work in this area to help the various systems to embrace it and move forward.

The question then came up about whether 50 per cent of the population is the appropriate target

If you see, for instance, what the Ontario government promotes in terms of needing access, they give quite a comprehensive list of points of entry for service. Therefore, in terms of actual service, we are seeing that points of service have increased.

The key thing is how to get alignment from this accord in the jurisdictions, the agencies, the frontline health service providers and the docs. If you get that alignment, amazing things will happen. Right now, every one of those key stakeholders can opt out. They should not be allowed to opt out.

the national pharmaceutical strategy

in your presentation to us today, Dr. Kitts, you said it has stalled. I have read that costing was done and a few minor things have been achieved, but really nothing is coming forward.

The pharmacists' role in health care was good. Procurement and tendering are all good. However, I am not sure if it will positively impact the person on the front line who is paying for their drugs.

The national pharmaceutical strategy had identified costing around drugs and generics as an issue they wanted to tackle. Subsequently, Ontario tackled it and then other provinces followed suit. The question to ask is: Knowing that was an issue up front, why would not they, could not they, should not they have acted together sooner? That was the promise of the national pharmaceutical strategy, or NPS. I would say it was an opportunity lost, but I do not think it is lost forever.