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At the same time, nurses who call in sick aren't being replaced, so there are fewer people to deal with aggressive patients, said Linda Clayborne, a forensic psychiatric nurse in Hamilton.

'When you have a patient holding onto your clothes and punching you, 54 seconds is a long time.'

In the last two months, violent incidents in Hamilton included attacks on two nurses who sustained concussions, Clayborne said.

Clayborne witnessed an incident last week and pressed her personal alarm to call for immediate help.

In another incident, a female RPN had hot coffee thrown in her face by a patient. Last week, a male co-worker sustained a black eye and swelling to his cheek and eye, Clayborne said. Now his children fear for him.

In long-term care, the majority of patients are over the age of 85 with Alzheimer's, dementia and other cognitive impairments that require a higher standard of care, Fetterly said. "Cutting back on staff is recipe for disaster," Fetterly said, because when a nurse is slow to answer a call bell, she's the "recipient of displeasure." The Ontario groups are also calling for legislation to protect health-care workers from violence.

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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.

Meanwhile, Philpott has promised to spend $3 billion extra on home care and palliative care over the next four years, helping provinces with those costs as the population ages. Hoskins said the provinces and territories, on average, now cover 80 per cent of costs in the health-care system.

Dr. Brian Day's court challenge is underway in Vancouver. The main issue is whether Canadians should be permitted to pay privately for "medically necessary services" already covered by their provincial health plan. Is there a need for increased private health care in Canada? If so, can it be implemented without jeopardizing the public system?

Philpott admits "innovation" is required. Yet governments are constrained by blindly adhering to certain parts of the CHA, while ignoring others. As Ben Eisen of the Fraser Institute has emphasized, provinces have been forbidden to experiment with user-fees, copayments, etc. that would encourage individuals to use health services more responsibly. A "two-tier" system has always existed. Federal prisoners, Workplace Safety and Insurance Board patients, members of the military and RCMP, politicians and professional athletes usually obtain more timely care - often at private facilities. For those not near an inter-provincial border and not a member of a "special group," the main option for timely care may be to go to the United States. This provides employment to American doctors and nurses and profits to U.S. hospitals. Wouldn't it make more sense to allow all Canadians to spend their after-tax discretionary income on health in their own province? Frozen hospital budgets have caused excessive wait times for knee and hip replacements as operating rooms often don't function at full capacity. According to a 2013 survey, 15 per cent of Canadian surgeons considered themselves underemployed and 64 per cent cited poor access to ORs. About 25 per cent of nurses in Newfoundland and Labrador work only part of the year.

If orthopedic surgeons had access to additional "private" OR time, wait times could be shortened for all Canadians and new employment would be created for health-care professionals. If hospitals were permitted to operate electively on Americans and other foreign patients, this would bring in extra revenue and relieve the strain on provincial health ministries. So that MDs did not abandon the public system, they could be required to work 25 to 30 hours per week in the public system in order to receive government reimbursement for malpractice insurance. Most MDs would confine their practice to the public system. They deserve fair treatment. Philpott should amend the Canada Health Act to mandate binding arbitration when provincial negotiations fail, as they have in Ontario. Since 1984, the population has grown and aged, new diseases have been recognized, and new drugs and technologies have developed. Some 32 years ago, it was understood that Ottawa would pay half of health costs. Now it covers less than a quarter. We need to amend and modernize the Canada Health Act. Where wait times are excessive, certain diagnostic services and surgical procedures should allow for private access for all Canadians - not just a select few. This would maximally utilize expensive equipment and provide new employment for nurses, technicians and surgeons. It would provide extra revenue that would help to keep universal public health care sustainable and accessible for all Canadians. Ottawa should then enforce all sections of the Canada Health Act on all provinces and territories. Dr. Charles Shaver Ottawa

Federal Health Minister Jane Philpott, who co-chaired Tuesday's talks, tried to steer the conversation away from money and toward system improvement, innovation and accountability. She repeatedly pointed out that Canada spends more on health care than many other developed countries that have superior health systems. She expressed disappointment that planned system improvements that Ottawa funded in the 2004 health accord did not materialize. Philpott indicated that she wants new funds to be targeted to such areas as mental health and system innovation. She also reiterated an earlier commitment to provide $3 billion for home care, including palliative care.

I have made it clear to them that we would love, for instance, to invest in innovation," she said. "I want to know how they want to use those investments in innovation. I have told them that I am very interested in mental-health care." Hoskins said his provincial and federal counterparts are on board with that, but that they need a boost in the annual increase in health funding as well just to maintain the status quo. "You can transform and we have to transform, but you have to do that in a way which respects and understands that you need to sustain the existing system," he said. Hoskins cited a Conference Board of Canada report that found that a spending increase of 4.4 per cent is needed "just to keep the lights on, just to keep the existing services working" because of pressures from a growing and aging population. Quebec Health Minister Gaétan Barrette said Ottawa's current plans for health spending will amount to $60 billion less over the next decade for the provinces and territories.

"It says to Canadians, 'We will not provide up to the level of $60 billion.' That's what's at stake," he said. The 2004 health accord - which includes annual funding hikes of 6 per cent - expires next spring. The former Conservative government decided unilaterally that annual health spending will increase at a lower rate of 3 per cent after that. The provincial and territorial ministers are hoping Prime Minister Justin Trudeau will reconsider that when the first ministers meet later this year. Hoskins said a 50-per-cent cut in the annual funding increase will translate to $1 billion less for the provinces and territories next year. Ontario alone stands to lose $400 million. Philpott apologized about confusion over comments she made earlier on accountability for funds. Some provincial and territorial ministers expressed anger over an insinuation that health transfers were not being spent on health. Philpott said that was not what she meant.

I apologize if people misunderstood," she said. "There is certainly no intention to make accusations." Philpott said the Canada Health Transfer, which stands at $36 billion, will increase by about $19 billion over the next five years. "It's really important for Canadians to know that we are going to continue to contribute to the Canada Heath Transfer," the federal minister said. Philpott said that over the last five years, $9 of every new $10 spent on health in Canada came from the Canada Health Transfer. "We are contributing he largest part to spending." In addition to the Canada Health Transfer, extra funds will be provided for targeted priorities with strings attached to ensure transformation goals are met, she said.

This is Canadians' money ... We want to find a way that we can work together so that as we agree to make new investments, that we have already got a sense of plan," Philpott said. In elaborating on why Ottawa should fund new, more efficient ways of providing health care while at the same time provide sufficient funding for the current health system, Hoskins offered the example of dialysis for kidney failure. The ministers discussed how it would make more sense to monitor blood pressure to prevent kidney failure and thereby lessen the need for dialysis, he noted. "That's great and we are all working toward that end, but you still have to provide dialysis today because that individual who needs it will be dead in three weeks without it," Hoskins said.

Ms. Banerji said Inuit may also have a genetic predisposition to these types of infections. But until those environmental conditions are addressed, a medicine called palivizumab is effective against such infections. In 2010, the Canadian Pediatric Society recommended that "consideration should be given" to administering a preventative drug to all fullterm Inuit infants younger than six months of age in areas with high rates of hospital admissions for respiratory infections. The territory currently gives palivizumab only to children born prematurely or who have chronic heart or lung conditions. The region of Nunavik has recently changed its policy and will administer the drug to all newborns. Palivizumab costs about $6,500 an infant. Ms. Banerji said the cost of treatment, including flying sick kids south, is so high that it would be cheaper to give it to all babies born in the worst areas. She says that policy would save $36,000 for each hospital admission avoided. It would also save wear and tear on families. "A mother has to either come with her two-month-old baby to the hospital in Ottawa and leave all the rest of the kids behind, or the baby's there all alone. It has a huge societal impact." The government of Nunavut has received a copy of the paper. The territory's chief medical officer of health was travelling Tuesday and not immediately available to react to its findings. © 2016 The Globe and Mail Inc. All Rights Reserved.