Group items tagged

What is especially disturbing, said Amy Ma, co-chair of the central users' committee, is that the above-ground parking lot was constructed 30 years ago, and so there is no justification for charging such a high fee. In contrast, the MUHC is charging the same rate for its new underground parking lot that opened at the superhospital's Glen site in April, arguing that the higher fees are necessary to pay back a $266-million loan for the lot's construction. "Recently, I was talking to a parent who had to bring her child to the newly opened external clinic of the Children's at 5100 de Maisonneuve," Ma said. "In addition to having to pay $25 for an allergy shot, she also had to pay $25 for parking. The $25 for parking ... is just mind-boggling because it's not even a brand-new, multi-storied parking garage.

"It's definitely going to add yet another barrier in terms of access to care," Ma added. In September, Quebec's ombudsman vowed to investigate "excessive" parking fees at the $1.3-billion superhospital following a formal complaint by the users' committee. The MUHC levies patients and visitors $25 after 90 minutes of parking - the highest rate of any hospital in the province. On Aug. 1, the MUHC also "harmonized" its parking rates to $25 after 90 minutes at the Montreal General and Montreal Neurological hospitals. Previously, the rates were $19 after 90 minutes.

Despite this harmonization, the users' committee found that a patient who parked at the Montreal General and the Glen site on the same day was charged $50. The ombudsman warned that such doubledipping is "abusive and shows a lack of inter-hospital coordination." A report by the ombudsman's office on Oct. 27 recommended that the MUHC "revise" its parking rates by Monday so that the fees "do not hinder the right of an individual to access to health care." The ombudsman's delegate, Léa Préfontaine, did not recommend by how much the rates should be lowered.

A week before the report, the MUHC lowered the maximum rate for express parking at the superhospital to $30 from $50 for cars parked between 61 minutes and 24 hours. But the $25 fee for general parking has not been changed. In fact, the hospital network raised the fees for employee parking by $120 a year, going from a monthly rate of $105 to $115. What's unusual about the parking at 5100 de Maisonneuve is that it does not fall under the jurisdiction of the MUHC, since it's a private facility. On Oct. 13, the Brunswick Medical Group opened "The Children's Clinic" at that address. The clinic is staffed by doctors from the Montreal Children's Hospital that is part of the superhospital complex.

Parents who go there must present their children's medicare card before each consultation. If a child is in need of an allergy or blood test, the parent is offered one on the spot for a fee, or can go to the hospital and wait for one that would be covered under medicare. Shortly after the Montreal Gazette reported that children were being charged fees for tests at the private clinic, Health Minister Gaétan Barrette ordered the MUHC to remove its signs from the building. He also demanded that the MUHC cancel as soon as possible a 30-year lease it signed with the Royal Victoria Hospital Foundation regarding the property.

an Popple, a spokesperson for the MUHC, confirmed that the hospital network is managing the parking lot at 5100 de Maisonneuve through a private company. Popple added that the "MUHC plans to announce modifications to its parking policy over the coming week," but declined to provide details. aderfel@montrealgazette.com twitter.com/Aaron_Derfel

DAVE SIDAWAY, MONTREAL GAZETTE / The parking at 5100 de Maisonneuve Blvd. does not fall under the jurisdiction of the MUHC.

He also cited Scotland, which got rid of most hospital parking fees in 2008. The government saw it as a matter of principle, arguing that hospital parking fees went against the idea of free health care, as well as being a source of stress for patients.

Since the crisis, all the hospitals involved have stopped outsourcing gemcitabine and cyclophosphamide mixtures and brought it in-house, mixing their own medications.

Their trust would be further hit. Within two weeks, the Star reported that health-care companies are allowed to mix drugs for hospitals without federal or provincial oversight, prompting top health officials — Ontario health minister Deb Matthews and federal health minister Leona Aglukkaq — to scramble to close that regulatory grey area.

This week Jake Thiessen, the founding director of the University of Waterloo school of pharmacy, submitted a final report of his investigation into the issue. There has been no formal indication when it will be made public. Hospital administrators say they have been told it will be two to three weeks before they or the public see this report.

The Ontario College of Pharmacists has passed legislation that allows it to inspect any premises where a pharmacist works — not just licensed pharmacies.

All of the changes taken together would have seen Marchese Hospital Solutions still able to supply drugs as it did but subject to inspection by the college.

The federal government has new rules defining who can be a drug producer, adding that any facility supervised by a licensed pharmacist can do the job. The province has said that hospitals can only purchase drugs from accredited suppliers.

There is very little clinical evidence to indicate what might happen to a cancer patient who receives an underdose of chemotherapy.

At the same time, many of the more recent advances in chemotherapy have been in drugs that alleviate side effects like nausea.

In an oncology pharmacy, strange is not good. And on March 20, one week before Marley’s last cyclophosphamide treatment, Craig Woudsma, a 28-year-old pharmacy assistant, and a colleague at the Peterborough Regional Health Centre, had a bad feeling.

In this case, it was a shipment of new gemcitabine chemotherapy bags that required refrigeration, according to the label. Previous batches, from a different supplier, had not.

Woudsma noticed more differences. The bags from Marchese only had a total volume and concentration on the label — 4 grams of gemcitabine in 100 mL of saline — instead of the specific concentration, the amount of drug per single mL of saline, as the old bags indicated.

The new bag’s label did not contain enough information for him to accurately mix the patient’s dose. He needed to know the specific concentration.

When preparing the solution, staff at Marchese Hospital Solutions, in Mississauga, Ont., dissolved the medication into a pre-filled 100 mL bag of saline. These bags typically contain between 3 to 20 per cent more solution than 100 mL,

“I told the pharmacist in the area. And then it kind of went above me at that point ... They came to me saying, this is kind of a big deal; teleconferencing with the minister of health, that kind of stuff,” said recently, sitting on the front steps of his red-brick, semi-detached home in the village of Millbrook, Ont. “It’s kind of a foreign concept, to think that what we do, in our corner of the hospital, is going to get that kind of exposure.”

This means that the bag Woudsma was holding contained 4 grams of gemcitabine in more than 100 mL of solution. The concentration of the medication wasn’t what the label would have made him think. It was weaker than advertised.

People have asked Woudsma why he was able to catch a problem that went undetected at other hospitals for more than a year. Simple, he says. He had something to compare it to.

The company’s pharmacy workers did not remove the known overfill when mixing the medication because they thought each bag was going to a single patient

referred to in the industry as overfill, included to account for possible evaporation.

The hospital had switched that very day to a new supplier — Marchese Hospital Solutions. A bag of the old supply from Baxter CIVA was still on site.

Medbuy, a group purchasing company for hospitals, starting in 2008, had a contract with Baxter Central Intravenous Admixtures to provide drug-mixing services. The two drugs in question, cyclophosphamide and gemcitabine, were outsourced because they come in powder form and are tricky to mix. It takes about four hours to reconstitute them in liquid, and in that time they must be shaken every 20 minutes.

As that contract was about to expire, Medbuy issued a request for proposals for drug-mixing services: Baxter CIVA, which wanted its contract renewed, Quebec-based Gentes & Bolduc and Marchese all stepped forward.

The details of the new arrangement remain known only to Medbuy. It was founded in 1989 to get better deals for hospitals buying products like scalpels, bed pans and even some medications in bulk. The company’s 28 member hospital organizations in Ontario, New Brunswick and Prince Edward Island spent a combined $626-million on contract purchases in 2012.

Marita Zaffiro, president of Marchese, testified at Queen’s Park that the Medbuy contract did not indicate the hospitals wanted the labels on these drugs to cite a specific concentration. The reason she included it that way in the RFP was simply to show what could be done.

Sobel ran the calculations in his office. For a single patient to require a 4,000 mg dose of cyclophosphamide, on a common breast cancer treatment regime, that patient would need to be about 7 feet tall and weigh 2,200 lbs.

“The chance of 1,200 patients getting 4,000 mg exactly — it’s just impossible.”

Four Marchese pharmacists who played a role in the new contract work revealed to the Queen's Park committee in June that they had either limited or no background in oncology.

Marchese Hospital Solutions began as Marchese Pharmacy, a Hamilton-area community drugstore that expanded beginning in 1998 when Zaffiro became president. In 1999 the company obtained a contract to supply the Hamilton Niagara Haldimand Brant Community Care Access Centres, business they did until the contract expired in 2011, shortly before it was awarded the Medbuy contract.

It lost the CCAC contract in 2011, shortly before the Medbuy deal, and shed employees. Fifty-seven were either laid off or left the company during this troubled time, according to internal newsletters. But then things started looking up.

Zaffiro attempted to get accreditation for the site, according to her Queen’s Park testimony, approaching both the Ontario College of Pharmacists and Health Canada, neither of which took steps to regulate the fledgling business because each thought the other had jurisdiction.

Medbuy, Marchese and Jake Thiessen have maintained that cost was not a factor in the error. Marchese’s bid on the request for proposal came in at about a quarter of the cost of previous supplier Baxter Corporation. Bags from Marchese cost from $5.60 to $6.60; Baxter charged $21 to $34.

CEO David Musyj thinks about what went wrong. The problems, he says, go far beyond Marchese and Medbuy. “All of us are culpable,” he says. “We could have done some things internally that could have prevented this. We could have weighed the bags when they came in.”

One year after Dr. Parks’s letter was leaked, the government claims the ER wait times issue is under control.

Should we believe the hype?

In October 2010, local media published a leaked letter from the province’s chief emergency room doctor to Health & Wellness Minister Gene Zwozdesky and other government officials warning of “catastrophic collapse” if immediate action wasn’t taken. The letter was written by Dr. Paul Parks, president of the Alberta Medical Association Section of Emergency Medicine

Dr. Parks started to collect examples of substandard care and “adverse events” caused by overcrowding in the ER

When the letters and reports were eventually leaked to the media in 2010, they launched a firestorm.

It’s common to have five-plus EMS units and their medics tied up for hours while they wait for an ER stretcher to be freed up so that they can download their patient and get back on the streets

The situation has gotten so out of hand that we now have patients calling 9-1-1 from the ER

ER was overcrowded because hospitals were overcrowded

A study in the British Medical Journal found that patients whose ER wait times were six hours or longer were more likely to suffer an “adverse event,” such as the need for hospital admission, or even death.

Dr. Parks estimates that Alberta’s large-volume hospitals are still hovering at around 30 per cent of beds occupied by patients waiting to be admitted—meaning that those hospitals are still operating at well over capacity.

Dr. Parks, ER doctors were clear from the beginning of this crisis that the issue of overcrowding in emergency was due to downstream capacity problems, mostly a lack of long-term-care beds in nursing homes.

despite our vast wealth, Alberta has fewer hospital beds than the Canadian average.

The same situation exists for long-term care, where Alberta’s number of beds per capita falls below the national average. But don’t think the province makes up for this by supporting those folks in their homes. Alberta also sits close to the bottom of provinces for home-care spending.

the government opened 360 new hospital beds in Edmonton and Calgary in 2011. It announced plans to open 5,300 new long-term care beds by 2015 (1,174 of them were ready by April 2011), to make additional investments in home care (800 new clients in Edmonton and Calgary) and to improve patient discharge planning. It also announced a five-year plan that includes a primary-care focus

But there’s no plan to increase full long-term care, nursing homes and auxiliary hospitals. This is the category of care that is most needed to take pressure off our hospitals

He also says that even if beds are created, they may not match the needs of hospitalized patients, because of the lower levels of nursing support and the high personal cost for the patient and his family. “Indications are that the private, for-profit care model may actually create barriers to moving patients out of hospital beds,” he says.

Mehra said the rally will show hospital executives and politicians at Queen's Park the community's strength and commitment to public health care. Beleaguered Trenton Memorial and other small, rural hospitals including Northumberland Hills Hospital were the focus of attention during the rally cut short Friday by blustery winds and falling temperatures.

"Small and rural hospitals like TMH can not survive another two more years of cuts. Hospitals in small towns are teetering on the brink of disaster," said Mehra. That drew an angry response from the crowd of "no more cuts." Despite the weather conditions, the crowd was upbeat as one speaker after the other slammed the provincial Liberal government. Louis Rodrigues, president of the Ontario Council of Hospital Unions, said funding cuts are shredding services. "All of us are here today demand the restoration of services, and services that have been shuttered in small communities. We're also here to demand that full service be restored at Trenton Memorial," said Rodrigues.

Again the crowd broke into the "not more cuts" chant. "We are all united in pushing back against a provincial Liberal government that is attacking our hospitals in our communities. We are here today to demand an end to the funding freeze that is choking the life out of our hospitals," said Rodrigues. Vicki McKenna, provincial vice-president of the Ontario Nurses Association, kept the crowd riled up.

"Health care in this province is under attack. We will have to fight for it in order for it to stay. It seems to be the easy thing to do -to slowly cut bits and pieces out of the health care system so that our hospitals are left as skeletons. It's not acceptable to me as a registered nurse and it's not acceptable to communities. Our communities need to be strong and continue to stand up and do anything they can because if they don't health care will not be there for you," said McKenna. Northumberland-Quinte West MPP Lou Rinaldi was singled out for not being at the rally. "He likely didn't have the guts," said a protester standing in the crowd. But neighbouring Conservative MPP Todd Smith had plenty to say.

Smith said the No. 1 priority he hears from people across the region is they want good access to health care and they want it close to home. "They don't want to have to travel to Kingston or Ottawa for services," said Smith. Smith slammed Liberals for misspending public money on gas plant scandals, payouts to teacher unions and the sell off of Hydro One. "It's not good news for health care that priorities are not being placed in the right place," said Smith.

ER wait times could be significantly reduced by revamping provincial and municipal housing policies, rewriting provincial and federal taxation codes, initiating programs for middle-class families (and corporations) that encourage universal design retrofits and by rewriting bylaws that alter traffic and parking arrangements for disabled permit holders.

Chloe Atkins is an associate professor and interim director of graduate programs in the department of communications and culture at the University of Calgary.

Last year, amid rising health care expenses nationally, C.P.I. helped cut Seattle Children’s costs per patient by 3.7 percent, for a total savings of $23 million

the hospital avoided spending $180 million on capital projects by using its facilities more efficiently

It served 38,000 patients last year, up from 27,000 in 2004, without expansion or adding beds.

Similar methods are now in place at other hospitals and health systems, including Beth Israel Deaconess Medical Center in Boston, Park Nicollet Health Services in Minneapolis and Virginia Mason Medical Center, also in Seattle.

To increase the number of surgeries the hospital could perform, Dr. Chand’s team spent about $20,000 overhauling the process to sterilize instruments, avoiding a $3.5 million expenditure to expand that department. More efficient scheduling in the M.R.I. department reduced the average waiting time for non-emergency M.R.I.’s from 25 days to 1 to 2.

Eugene Litvak, president and chief executive of the Institute for Healthcare Optimization and an adjunct professor of operations management at the Harvard School of Public Health.

“The health care industry could be on the verge of an efficiency revolution, because it is currently so far behind in applying operations management methodologies,” says Professor Litvak.

not everyone believes that factory-floor methods belong in a hospital ward.

Nellie Munn, a registered nurse at the Minneapolis campus of Children’s Hospitals and Clinics of Minnesota, thinks that many of the changes instituted by her hospital are inappropriate. She says that in an effort to reduce waste, consultants observed her and her colleagues and tried to determine the amount of time each of their tasks should take. But procedure times can’t always be standardized, she says. For example, some children need to be calmed before IV’s are inserted into their arms, or parents may need more information. “The essence of nursing,” she says, “is much more than a sum of the parts you can observe and write down on a wall full of sticky notes.”

These patients aren't just Calgarians. They come from across the south. Then they're shuffled about like pieces in a medical chess game. Edmonton, meanwhile, has long had the superb Cross Cancer Institute, which is close to both the University of Alberta Hospital and the U of A campus itself. That kind of integration is essential for research, teaching and many kinds of secondary medical services that cancer patients need. The PCs promised Calgary the same, recognizing that only the Foothills site can meet all those requirements. Then they promised it again, and again. Just when the project was at last approved, ex-premier Jim Prentice strolled in and canned it, promising instead to build a smaller, cheaper centre at the South Health Campus.

There were many cries of outrage, but the most powerful came from John Osler, whose family has deep ties to the Progressive Conservatives. His father, Jock Osler, was former prime minister Joe Clark's media boss more than 30 years ago. Osler said the PCs had flat-out broken their promise. The South Campus would not only be a "strip mall" hospital, it wouldn't even be cheaper. All the problems of the Foothills site - including traffic and parking - had been considered and solved, Osler said. On Wednesday, he sat beside the new NDP minister, looking like he'd just won the Foothills Hospital Home Lottery. Osler said Hoffman had called in several stakeholders on Monday. She and officials actually listened - a new experience for him. Dan Holinda, the Alberta executive director for the Canadian Cancer Society, had the same experience. "We've been fighting for this for 10 years, but we had to pound on the doors to get government to listen to us. We had to lobby and write letters and mobilize the community," Holinda said.

But in this situation the minister (Hoffman) reached out to us. She brought us into a meeting this week. And it's the first time where I've had the experience that the government sat and listened." In one way, this was an easy win for the NDP. All they had to do was reverse a colossal PC mistake that symbolized how the old government had come to take Calgary for granted. But now, the real test for the New Democrats is in the doing. Surprisingly, they're still deciding where the new building will be - on the site of parking lot No. 1, which is directly in front of the Foothills entrance, or at parking lot No. 7, in the angle of 16th Avenue N.W. and 29th Street. The Tom Baker will stay in business for elements of cancer care. Some surgeries could be done in the Foothills itself. The new cancer hospital - as yet unnamed - won't be fully onestop, but somewhat scattered around the Foothills campus.

But it's the best option and it's out of the starting gate. We should hope the New Democrats get this hospital finished quickly, before they feel the slightest urge to mimic the government they replaced. Don Braid's column appears regularly in the Herald. dbraid@calgaryherald.com TIMELINE: TWISTS AND TURNS OF THE CANCER CENTRE December 2005: PC health minister Iris Evans announces Calgary could get $600 million to replace the Tom Baker Centre. March 2006: Premier Ralph Klein's government establishes a $500-million fund for screening and research. April 2007: Experts warn of a looming crisis after the proposed $900-million cancer facility left out of provincial budget. September 2007: Alberta Cancer Board expands operations at old Holy Cross Hospital due to a space shortage at Tom Baker. May 2008: Alberta Cancer Board explores private financing to build a proposed $1.1-billion facility.

April 2009: Budget constraints mean there's no money to replace the aging cancer facilities, says the province. March 2010: Premier Ed Stelmach says a new Calgary cancer centre is a priority after AHS says it's not on the government's capital projects list. March 2013: Premier Alison Redford announces plans to build a $1.3-billion cancer centre on the site of the Foothills Medical Centre. December 2014: In light of low oil prices, Premier Jim Prentice confirms construction of the cancer centre will be delayed. February 2015: The PC government explores different options for the centre, and consider South Health Campus as a new location. March 2015: The government announces the centre will move forward, but it may be located on two sites. July 2015: The NDP government announces the new cancer treatment centre will be built at the Foothills Medical Centre campus. Source: Herald archives

Dozens of people have lost some of their sight after undergoing botched operations provided by a private healthcare firm at an NHS hospital.The hospital in Somerset is facing a string of claims for compensation after half the 60 patients who underwent the procedure suffered complications.

Dozens of people have been left with impaired vision, pain and discomfort after undergoing operations provided by a private healthcare firm at an NHS hospital.

The son of the 84-year-old patient, who asked not to be named, said his father was referred for the cataract surgery by his GP. The retired salesman, from the Somerset Levels, did not consider he needed the operation but agreed to the treatment.

The routine cataract operations were carried out by the private provider in May to help to reduce a backlog at Musgrove Park hospital in Taunton. But the hospital's contract with Vanguard Healthcare was terminated only four days after 30 patients, most elderly and some frail, reported complications, including blurred vision, pain and swelling.

One 84-year-old man claimed he has lost his sight and his family is calling for a full independent inquiry after it emerged that half of the 60 patients who underwent surgery suffered complications.

But, when the problems surfaced, a senior member of staff at Musgrove Park appeared to concede that the hospital would be liable for any payments.

The trust refused to talk in detail about what happened pending the conclusion of its own investigation. It also refused to discuss who would pick up any bill for compensation or details of its contract with Vanguard.

The son said the procedure took 15 minutes and his father felt it was "very rushed".

"My father is traumatised and depressed with the loss of his eyesight. Previous pleasures of gardening and watching sport on the TV have been taken away from him.

Among the questions the family want addressed in an independent inquiry is whether Vanguard was brought in to save the trust from paying a financial penalty because of the backlog.

Laurence Vick, a medical negligence lawyer, who has been approached by some of the victims, said the case highlighted the "uneasy relationship" between the NHS and the private sector.

He said the question of who paid when outsourced NHS treatment failed was of growing importance as more services were handed over to the private sector.

For decades, the Ontario health-care system has been planned, operated and overseen by doctors, hospital administrators, health ministry bureaucrats and executives in agencies such as the Local Health Integration Networks and Community Care Access Centres (CCACs) responsible for home care. What's been missing is the voice of patients and caregivers. That's inexcusable, given that some 400,000 people are employed in the Ontario health system and several million patients are treated in hospitals, at home and in community settings each year.

Until now, those patients have had few places to turn when they ran into roadblocks in the system, or have been frustrated trying to find their way through the layers of bureaucracy and in getting anyone in authority to deal with their issues. As health ombudsman, Elliott is to work with patients and caregivers to resolve complaints about their health-care experience. She will also investigate health-sector organizations on her own initiative, make recommendations for improvements and make annual reports to the minister.

Although her five-year appointment doesn't come into effect officially until July 1, 2016, she will start preliminary work on recruiting a staff of 12-15 people early next year. She will earn about $220,000 a year. Elliott quit provincial politics in August, three months after losing the Tory leadership race to Patrick Brown. Hoskins said Elliott was chosen from more than 400 candidates. Her "advocacy for vulnerable people, extensive knowledge of the health-care system and commitment to the betterment of this province make her the perfect choice for Ontario's first patient ombudsman," he said. While some people question the ombudsman's independence because the post reports to the minister, patient advocate groups are delighted with Elliott's appointment, suggesting she will be taken seriously at Queen's Park. As an MPP, she fought for better treatment for stroke victims and people with disabilities, and was a driving force behind a legislative committee's push for the auditor general to review the operations of the troubled CCACs.

There is much to be done in alerting the public and the minister to where patients fall through the cracks and get bad outcomes," says Michael Decter, a former Ontario deputy health minister and chair of Patients Canada, a national advocacy group. "For example, transitions from hospital to home are a major area of problems for patients." As encouraging as this move is, there is still more the government can do to give patients a true voice in health care. One suggestion circulating in the upper levels of the health ministry is to appoint an assistant deputy minister for patient experience. The proposal was first revealed in a blog by Steve Paikin, host of The Agenda on TVO.

The health ministry now has 16 assistant deputy ministers or their equivalents. Their areas of responsibilities range from provider agencies to doctors and pharmaceuticals. Although they may not realize, such bureaucrats can sometimes get captured by and become advocates for those interests over time. None of them, however, have prime responsibility for patients. That means there is no voice for patients or caregivers around the table when the top bureaucrats meet to formulate future policies and procedures or to assess how existing programs are working. It's a stunning absence, given that many universities, such as the University of Toronto, have created positions in recent years to deal specifically with student experiences.

Also, some hospitals have established jobs to deal with patient experience and many private companies have executives assigned to customer care. Naming a health ombudsman is a positive first step in giving patients a voice. Appointing such an assistant deputy minister, though, could be exactly what's needed to shake up the health ministry and focus its attention laser-like on where it should be - the patients and caregivers of Ontario. Bob Hepburn's column appears Sunday. bhepburn@thestar.ca

Christine Elliott is a good choice for the position of patient ombudsman, but there is more that Queen's Park can do to ensure that patients' concerns and needs are put first, Bob Hepburn writes.

Silas was one of a number of speakers who called on the government of Premier Kathleen Wynne to increase spending on health care in the province. North Bay, they said, is particularly hard hit because it is a P3 (public-private partnership) hospital - and because it brought three hospitals - two general and one psychiatric - under one roof. "It is time to raise the alarm," said Natalie Mehra, executive director of the Ontario Health Coalition.

"This is devastating to the community, so let's raise the alarm." Mehra said people should not make the mistake of "believing that these hospital services are being replaced in so-called community care. You do not replace medical and surgical beds in community care. It's just not community care. It is acute hospital care services that are being cut. "You do not replace emergency room nurses. You do not replace cleaners in community care. Let's not buy into the nonsense that is just window dressing to cuts, cuts and more cuts to local services that are needed by the community." Michael Taylor, one of the organizers of the rally, said the cuts in North Bay are "the worst and deepest". .. that affect departments throughout the whole hospital.

Jamie Nyman was part of a large contingent from Sudbury to travel to North Bay Monday. "This is a very important issue," he said. "The government is cutting services and patient care is declining." Sudbury, he pointed out, has also seen many cuts.

"It's leaving us with too much workload," he said. "We are seeing a lot of workload issues because of cuts." Debbie McCrank from Kirkland Lake, the local co-ordinator for the Ontario Nurses Association, said the cuts are "going to impact all the North." She is responsible for the area from Kirkland Lake to North Bay, including Mattawa and West Nipissing.

The North Bay Regional Health Centre, she said, is "a major treatment centre," but the province's cuts are putting that designation at risk, and putting extra pressure on all hospitals in the North. "It's just having a huge impact," McCrank said of the health funding cuts.

"It comes down to cheaper care versus quality care," she said. "The province is driven by the budget, not by the concern for quality health care." Another supporter was Mike Labelle, a locked-out employee at Ontario Northland. "I'm here to support all the nurses and everyone on down," he said. "Health care has really deteriorated here, and it's time the government wakes up."

Labelle said the mass of protesters "is the heart of the hospital." About 100 Ontario Northland employees, he said, turned up for the rally. Canadian Union of Public Employees president Mark Hancock said the province's health care cuts amount to an attack on the local hospital and the community.

The funding freeze means hundreds of staffand beds across Northern Ontario," he said, pointing to placards waved by hospital workers from Timmins, New Liskeard and Sudbury pointing out the effects of cuts at those facilities. Hancock said health care needs a 5.8 per cent annual increase just to meet rising costs, but the freeze means hospitals are getting zero per cent. In real terms, he said, that works out to a 20 per cent cut over the life of the spending freeze.

Also speaking was North Bay Mayor Al McDonald, who said the situation at the hospital is a major concern in the city. In addition to proper health care for all members of the community, he said, the jobs being cut at the hospital are good-paying jobs, and "if you want to build the city, you need your hospital to provide the same level of care as they have in southern Ontario." Nearby, Stan Zima was waving a large Canadian flag on a 10-foot flagpole.

"It's obvious the cuts in Northern Ontario have become excessive, and especially in North Bay," he said. "We are taking big hits in this. Hospital cuts hurt everybody. "Wynne has got to get the message. Northern Ontario is suffering more than any other area." Nipissing MPP Vic Fedeli, speaking at Queen's Park, called on the provincial government to address the funding crisis at the North Bay Regional Health Centre.

Health-care professionals and patients alike in my riding are concerned that the quality of care we're getting in Nipissing is in jeopardy. And it's creating turmoil in the community," Fedeli said, asking the government to restore "proper ongoing funding" to the facility.

Pj Wilson, The Nugget / Natalie Mehra, executive director of the Ontario Health Coalition, addresses a crowd of close to 1,000 people at Lee Park, Monday. Supporters from across the province were in North Bay to pressure the Kathleen Wynne government into providing more funding for hospitals across the province. • Pj Wilson, The Nugget / Close to 1,000 people called for the provincial government to increase funding to Northern Ontario hospitals and, in particular North Bay Regional Health Centre, at a rally at Lee Park, Monday. Busloads of supporters came from as far as Toronto, Hamilton and Stratford to support North Bay.

And that's exactly what is happening now with the pending demise of 14 huge Ontario agencies that oversee the delivery of home care to hundreds of thousands of patients each year and employ tens of thousands of workers. The bosses involved are the chief executive officers of the 14 Community Care Access Centres (CCACs) in Ontario. These government agencies, which have been embroiled in controversy for several years, are responsible for co-ordinating access to home and community care services, such as nursing, physiotherapy and personal support workers.

Even more revealing was the fact that while the CCAC bosses were getting massive pay raises, many of the therapists, personal support workers and nurses who actually provide care to patients were earning less than $25,000 a year and hadn't seen a pay raise in years. Other managers in the CCAC system also earn huge salaries. One vice-president of strategy, communications and engagement earned $193,000 in 2014. In the Toronto Central CCAC, there were 45 employees earning more than $100,000 in 2014. In the Ontario Association of CCACs (OACCAC), there were 37 employees earning more than $100,000 with the executive director earning close to $300,000.

Politicians and bureaucrats at Queen's Park, however, regularly dismissed the complaints and did little to fix the broken system. Indeed, under former health minister Deb Matthews, the CCAC bosses were never really challenged to improve their operations. Some were openly hostile, arrogant and aggressive, operating with a sense of entitlement that saw them run their agencies as they saw fit. But as happened to Oda, the heady days for the CCAC executives came to a sudden halt when their skyrocketing salaries and stunning pay raises were revealed. In some cases, CCAC bosses were paid raises topping $65,000 a year, with salaries over $300,000. Others saw their pay jump by more than 50 per cent over three years.

Worse was the fact that the CCAC executives were also ordering their staff, most of whom cared deeply about and worked hard to deliver good care, to trim patient services such as the number of visits to patients by front-line health workers in order to meet their budgets. Suddenly, politicians at Queen's Park took notice.

n early 2014 an all-party legislative committee asked auditor general Bonnie Lysyk to conduct a wide inquiry into CCAC operations. Lysyk's report, released in September, described in detail a bloated CCAC system that costs too much money, does nothing very well and where barely 62 cents of every dollar goes to actual direct patient care. For Hoskins, that was the final straw. Now he is about to unleash the biggest change in health-care delivery in Ontario in a generation. Through it all, the CCAC executives were often their own worst enemies.

Instead of explaining why they deserved huge salaries, they became aggressive, hiring expensive lobbyists and public relations experts to promote their agencies, denouncing journalists and critics who raised legitimate concerns about the system, and misleading their own staffers on how their operations were faring or what the future might hold for them. When news first surfaced that Hoskins was planning to dismantle the CCACs, the executives denied any real moves were coming and that their futures were in jeopardy. Some CCAC bosses went so far as to tell their staff that the Star's articles about the pending demise of the CCACs were "inaccurate."

In recent days, though, the CCACs have gone silent as they come to grips with the realization that their jobs and agencies are likely doomed. Hoskins is not waiting to start the transformation, but his initial timetable for dismantling the CCACs has proven to be problematic. Hoskins originally wanted the LHINs to start assuming some CCAC roles, such as responsibility for front-line staff, as early as three months from now. But sources say these timelines keep being blown up because the LHINs are not yet ready to take on increased duties.

Still, Hoskins is planning to press ahead. He will get more ammunition on Dec. 2 for the home-care transformation when Lysyk releases the second part of her inquiry into CCACs. For patients waiting for needed treatment and who have tangled with the CCAC bureaucracy and bosses in the past, the changes can't come soon enough. Bob Hepburn's column appears Sunday. bhepburn@thestar.ca

Oh, and here's another issue the provinces have added to the agenda: pension reform. While Flaherty is taking a pass on pensions, the premiers may be rising to the challenge of CPP improvements.