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With the exception of Prince Edward Island, no province or territory guarantees a minimum number of paid sick days for employees. Across the country, young people, seniors and low-wage workers are the hardest hit

San Francisco, a city many associate with high-tech start-ups and the innovation economy, has been a leader on using paid sick days to keep its residents healthy.

Danyaal RazaRyan Meili March 18, 2016 

In Ontario, the provincial government has commissioned a review of the Employment Standards Act, legislation that has seen no major revisions since the end of the Second World War. There, a coalition of doctors, nurses, researchers and workers, have launched a campaign for change along the lines of the San Francisco model.

and has been estimated to cost Canadian businesses $15-25 billion per year.

The phenomenon of presenteeism (people coming to work despite being sick) is endemic in our work culture

It’s high time we had policies guaranteeing sick time for Canadian workers.

Other non-RHPA occupations have less oversight. Personal support workers, who provide services including assisting with bathing, helping patients adhere to their medications and other tasks in the home, don’t have any provincial body to monitor their training or to ensure they’re practising appropriately, explains Miranda Ferrier, president of the Ontario Personal Support Worker Association (OPSWA).

these doctors tend to err on the side of under-delegation, knowing that if something goes wrong, they’ll be held accountable.

A personal support worker could be fired because of an accusation of abuse or neglect and they can literally get up and walk down the street and get hired by another agency and they wouldn’t know anything about it,” says Ferrier.

The OPSWA conducts a national criminal record and credential check for the 16,000 PSWs registered with them, but registration is voluntary. There are over 80,000 PSWs in the province who haven’t registered with OPSWA, Ferrier explains. “We would like to see one curriculum for all PSWs,” she says. “There should be expectations upon them for retraining and we should have the ability to blacklist ones that get charged with abuse.”

however. Chinese medicine practitioners were granted self regulating status in 2013 and naturopaths in 2015 – but not without controversy.

The problem is that not just in Ontario but broadly, in Canada, we’ve defined regulation in health care as self regulation and other countries don’t do that.”

UK and Australia

government oversight

New legislation should also allow smaller professions that can’t afford to maintain an RHPA-defined College to have title protection, says Grosso. And the voluntary oversight the professions currently do recognized legally, she adds. “When it comes to public protection, size should not matter,” says Grosso. 

Alberta’s government has overseen the development of a College of Paramedics,

Stakeholders throughout the province's health-care system have been lobbying successive provincial governments for at least a decade, urging them to lift restrictions that force the province's roughly 35 advanced-care paramedics to work below their full scope of practice. In February, the provincial government announced it had set aside $580,000 for a new pilot project, which will help New Brunswick figure out how best to make use of these valued health-care providers.

Health Minister Victor Boudreau said two committees have been formed to complete the behind-the-scenes work that is needed to introduce them to the existing ambulance service. So far, he said, things are going well, though he's not sure when advanced-care paramedics will be ready to use their skills on the streets. "We're still trying to put a pilot project together, making sure that we're respecting all the different moving parts to this," he said. "The money is still in the budget for this year. It's just sometimes these things prove to be a little more difficult than you'd like to put together. But it's certainly still on the table."

Chris Hood, executive director of the Paramedic Association of New Brunswick and a participating member of the committee tasked with sorting out the clinical issues around such a change, said that work is progressing nicely and he expects to see advanced-care paramedics in use within the provincial ambulance service soon. "I know the meetings have been happening and, by all indications, we're getting close," he said.

"The committees are still meeting. I've missed the last two meetings, but we had a representative there. They're getting into discussions about the protocols for practitioners, what they'll be following. From what we hear, it sounds like full-steam ahead. They accelerated the meeting times and it seems like everything is on the right track ... All of the prep-work that is necessary is, I would say, probably 80 per cent done, 85 per cent done." Ambulance New Brunswick is also completing some preparatory work, said Hood.

"They're looking at curriculum - refresher programs and things like that. From the clinical side of the business, which is what we're concerned with, that stuff is almost complete," he said. "If form follows function, we should be moving forward rather quickly."

When asked if the province's advanced-care paramedics are excited they'll finally be able to put all of their training to use in this province, Hood said many are still frustrated from the long struggle to lift these restrictions on their scope of practice. "I think many ACPs are still a bit, 'I'll believe it when I see it.' But some are very excited about it. We've had a couple of people enquire about attending ACP school and I know that the requests for enrolments in ACP classes both in New Brunswick and in the state of Maine are increasing," he said.

People are starting to feel more comfortable in spending the money to upgrade their skills, to take the education they need. But with the existing practitioners, I think, it's a wait-and-see mentality." Judy Astle, president of paramedics' union CUPE Local 4848, said she's anxious to learn what the pilot project may look like and how advanced-care paramedics will be used alongside primary-care paramedics across the province.

It's going to be a positive," she said. "But we're still waiting to find out the details."

Seattle, Los Angeles and San Francisco

Portland, Ore.

If there are costs as a result of the higher wages, the question is how they compare with the benefits, said Ben Zipperer, an expert on the minimum wage at the Washington Center for Equitable Growth. “Both [costs and benefits] may arise,” he said. “How people feel about the trade-off is more complicated.”

"The priority of the Medical Services Commission and the Ministry of Health is to uphold the Medicare Protection Act and the benefits it safeguards for patients in this province," B.C. Health Minister Terry Lake said in a statement on Tuesday. "We expect and require these clinics to come into full compliance with the law, and we remain fully committed to seeing out this case to its resolution." The ministry said it could not comment further because the case is before the courts. But the federal government is also watching the proceedings closely and has sought intervenor status in the case. In a statement from Ottawa, Health Canada said many provisions of the B.C. legislation mirror those of the Canada Health Act, "making this case of significant importance not only to British Columbians, but to all Canadians."

Given that Canadians "overwhelmingly" support universally accessible health care, "any challenge to a principle so fundamental to our health-care system is of significant concern to the Government of Canada." During a federal Liberal caucus retreat in Saguenay, Que., last week, Health Minister Jane Philpott said the case and the prospect of health-care privatization are a cause of "concern" for her. "I think I have made it very clear on repeated occasions that our government is committed to firmly upholding the Canada Health Act. The Cambie case deals specifically with that, with the provision of services," she told reporters. "It's fundamentally important to the health-care system in the entire country, not just in British Columbia, that we make sure that medically necessary services are universally insured and there are no barriers to access of those services." Ms. Philpott acknowledged that some health-care services in Canada are delivered privately, citing physiotherapy, which is largely carried out in private clinics because it is not included under the Canada Health Act.

But she said anything similar to a user fee is a barrier to people being able to receive medically necessary care. Ultimately, Dr. Day said, the law, facts and evidence are on the side of his argument that Canadians would best be served by a "hybrid" health-care system. "I kind of hope the judge doesn't hear that, and our lawyers would be nervous to hear that, but that's what I believe," he said. Within that system, public hospitals would offer private services and private hospitals would offer public services. He said he also wants to see competition between and within the systems. "Competition breeds excellence," Dr. Day said. © 2016 The Globe and Mail Inc. All Rights Reserved.

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."

The law prevents physicians from operating both inside and outside of the provincial Medical Services Plan. The restriction on so-called dual or blended practices violates Section 7 of the Charter of Rights and Freedoms guaranteeing “right to life, liberty and security of the person,” Gall said.

The strains on the public system, such as waiting lists to see specialists and for surgeries, are “indisputable facts,” Penner told Justice John Steeves. But the remedy proposed by the plaintiffs — a hybrid system where doctors can deliver private and medicare services and patients can buy insurance for services already covered by medicare — will not solve the problem. In fact, said Penner, it could make things worse by disrupting the public system and diverting resources from it.

Penner warned that if the Cambie plaintiffs win their challenge, the implications will extend outside British Columbia. Other provinces have similar restrictions on physician practice and private insurance that, like BC, are tied to federal transfer payments under the Canada Health Act. The trial opened Sept. 6 when Peter Gall, acting for Cambie, an affiliated clinic and several patients, argued BC’s Medicare Protection Act handcuffed both doctors and those seeking timely care.

Penner’s argument addressed core questions in the closely watched case: Does the law infringe doctors’ freedom to provide and patients’ right to receive timely medical care and, if it does, are those restrictions reasonable under the Canadian Charter of Rights and Freedoms?

Orthopedic surgeon Dr. Brian Day of Cambie Surgery Centre says provincial laws limiting private care have resulted in rationing and long waiting lists.

The law also keeps residents from using private insurance to pay for treatment for things covered by the public system, despite the fact that some groups, such as those covered under WorkSafe BC injury claims, get expedited private care. That violates the Charter’s equality provisions under Section 15, argued Gall. The arguments echoed long-held positions of orthopedic surgeon Dr. Brian Day, Cambie’s co-founder and the visible face of the case. He contends provincial laws limiting private care have resulted in rationing and long waiting lists.

The alleged Charter violations are far from clear cut, said Penner, as he reviewed previous Charter decisions. A key test, for instance, is whether legislation violates the principles of fundamental justice under Section 7. Past rulings have specifically warned against applying it to social policies, he pointed out. Gall noted that the Supreme Court of Canada’s 2005 decision in the Dr. Jacques Chaoulli challenge affirmed Quebecers’ right to use private medical insurance to pay for publicly insured services when the public system was inadequate.

But Penner said the wording of the Canadian and Quebec charters differ on fundamental freedoms and only three of nine Supreme Court justices found the Quebec law violated the Canadian Charter in Chaoulli. The evidence in the Cambie case is not the same, he added. “It will tell a very different story.” Even if evidence points to Charter violations, he said, such violations are legal under Section 1 of the Charter, which allows “reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society.”

The justification here is government’s ability to ensure universal access based on need, not ability to pay, said Penner, adding courts have deferred to legislatures on social policies such as those covering housing. Granting the plaintiffs’ application would reverse that by putting patients with money or insurance ahead of those without, said Penner.

Penner was expected to take two days to present the government’s defence, with intervenors on both sides of the case presenting separate arguments later in the week. The trial is scheduled to last six months and hear from dozens of witnesses, including experts, historians and patients. Steeves’ decision is expected to end up being reviewed by the Supreme Court.

The veteran medical officer of health said the proposal suggests municipalities would pay the same share of the new health units'operation as they do now - 25 per cent - but he argued they could receive "quite a bit less representation."

He said it would also require "a huge commitment from government, which we have not yet seen" and on an "exceedingly tight" deadline.

"At least three major pieces of legislation would have to be changed to accommodate this," said Gemmill.

"I've seen a lot of them ... they don't really save money.

"I don't foresee amalgamations happening," Gemmill said, recalling the mergers of municipalities and school boards.

"I would not see the public health work force jeopardized in any way," he added. "There are very well-trained people who are doing a great job and that needs to be maintained."

Before his 2016 retirement, Schabas said health units could possibly save money by sharing a single medical officer of health and sharing some services. Schabas worked two days per week and was otherwise on call. He was paid $244,317 in 2016.

At the time of Schabas'remarks, Paul Huras, the chief executive officer of the South East Local Health Integration Network, said it was worth considering but sharing services may not work because of health units'distinct mandates. Huras said health units could benefit from better links with other health care providers and, if they could save money, may have more to spend on front-line staff.

Gemmill said health unit staff and Huras will meet Monday.

Board member Egerton Boyce, a Belleville councillor, said he attended a recent AMO panel on the subject. He said he left with the impression the concept is "likely not going to happen for a long time."

Health board members referred the matter to their governance committee and are expected to provide the resulting feedback to the health ministry. "There's merit to looking at the system," Gemmill told reporters. "It's been 50 years since the last time it was restructured in a major way." But he said the changes would be "a mammoth chore" and remain "very unlikely" before the election