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Our report shows that while demand for seniors' housing in B.C. is outpacing supply as more seniors opt for homes in independent living communities , not enough is being done to understand their longer-term health and housing needs. In the next 25 years, seniors will make up 25 per cent of B.C.'s population. We think it's time for the provincial and municipal governments to sit down with us and come up with a new plan to support the development of more independent housing and assisted living as a cost-effective alternative to residential care.

We also need improved planning and implementation of home health services provided by the Ministry of Health and the health authorities to residents of independent living communities to allow them to remain in the communities for as long as possible. There are approximately 355,700 people in B.C. over the age of 75, of which 8.2 per cent live in seniors' residences. Improved utilization and expansion of B.C.'s independent living and assisted living sectors to accommodate residents with a broader range of health and social needs could reduce reliance on residential care.

In the past, residential care was the primary option for people who needed additional care and support, but increasing costs and a shortage of publicly subsidized residential care facilities led to the development of publicly subsidized assisted living facilities. Since 2004, there has been a dramatic increase in the number of both independent living and assisted living units, which are often located in the same development and provide many benefits for their residents. But the time has come to take a fresh look at the services available to seniors and how we provide them. For example, the Ministry of Health could explore options to allow registered assisted living facilities to offer a more flexible approach to what and how services are provided to residents. Expanding the range of services could allow residents to return from hospital sooner and free up beds for other patients, or delay their admission to residential care facilities .

Not everyone has the resources to look after their own care and housing needs in their senior years, but the public resources to help are not unlimited. That means we have to be smart how we develop and implement policies for our seniors. Carole Holmes is president of the B.C. Seniors Living Association. Elder care in B.C.

Private-pay and publicly subsidized housing and care options for seniors in B.C. include: Independent living: A combination of housing and hospitality services for functionally independent seniors. Assisted living: A semiindependent type of housing regulated under the Community Care and Assisted Living Act and includes housing, hospitality services and at least one, but not more than two prescribed services for people who require regular help with daily activities. Residential care: 24-hour professional supervision and care in a protective, supportive environment for people who have complex care needs and can no longer be cared for in their own homes or in an assisted living residence.

In Alberta, professional paramedics apply to an organization called the College of Paramedics to renew or reinstate their registration each year so they can keep working.

They have all told CBC the college penalized them after they disclosed that they sought professional help for work-related mental health issues like anxiety, acute stress or PTSD.

Private enterprise hasn't made health care more efficient, but rather more sluggish, the longtime Labour Party politician said. Bloated corps of lawyers, accountants and consultants hired by government now fret over tenders and contracts, which must be watertight, he noted. Dobson cited one case in which a woman suffering from a serious hemorrhage bled out during surgery because the private clinic didn't have an emergency blood supply. "The answer from the clinic was the contract didn't say we had to have an emergency blood supply," he said. Dobson is touring Ontario cities with officials from the Ontario Council of Hospital Unions (OCHU) and CUPE to discourage provincial plans from bringing more surgeries and procedures into the private fray.

However, with the shift, the ministry hopes to provide patients with "quicker access to complex surgeries because hospitals will be able to get to more complex procedures sooner." Ontario hospitals have struggled to do more with less in an era of cost-cutting and provincially mandated, balanced budgets. But giving private operators a bigger piece of the pie won't lower wait times nor reduce costs, said Dr. Wayne Taylor, executive director of the public policy think-tank Cameron Institute. "I don't see any value added in having something privately owned or publicly owned if it's still government money. What we need frankly is private-pay health care so that people have a choice." However, firms aren't exactly chomping at the bit to delve into health care, the former McMaster professor added, calling it a low-return investment.

Many MRI operators in Ontario dropped off the map about a decade after they set up shop, he noted. "Half of them are still around. Half of them went out of business." A number of private clinics in Hamilton provide OHIP-insured services, such as the Hamilton Endoscopy Centre on James Street South, Pain Care Clinics - Hamilton West, on Main Street West, and the Hamilton Vein Clinic on Upper Wentworth Street. Dobson argues private-sector imperatives and health-care needs are strange bedfellows, recalling how earlier this year one firm operating a U.K. hospital threw in the towel when its care fell under scrutiny and business looked bad. That was Circle Health, which gave up running Hinchingbrooke Hospital after three years because it was "no longer viable," the BBC reported. "The ultimate discipline in a market is if you can't make a go at it, you go bust, and it closes down. Well, you can't allow it to close down because patients need to be looked after," Dobson said.

Taylor, however, who calls the National Health Service a "disaster," says the private-public operating debate is a "red herring." He has heard of some "quality issues" at privately run colonoscopy clinics. If a doctor punctures a colon at a hospital, there's backup, Taylor said, but, in private clinics, "I don't know." Success depends on proper regulation, Taylor said. The Liberal government has come under scrutiny for not providing adequate oversight of private clinics, notably after a bacterial outbreak at a Toronto pain clinic in 2012 went unpublicized as it infected nine patients there.

"When we looked across the for-profit insurers in Canada over the past 20 years, for the plans that are typically bought by individuals and small- or medium-sized employers, there was a pretty dramatic change in the gap between the premiums people paid in and the benefits that got paid back to them," Law said in an interview. "Whereas Canadians were paying in a dollar and getting 92 cents back in 1991, they were paying a dollar and getting 74 cents in 2011."

In the U.S., when a greater share of premium revenues goes toward administration and profits, under the Affordable Care Act, known as Obamacare, the excess has to be rebated to plan members to the tune of $1.1 billion in 2012.

t follows that humanity’s very provision for the universal human life necessities that have evolved over millennia are blinkered out by the life-blind value measures of what is miscalled ‘the economy’. Everything that makes a society civilised or liveable is excluded from view – life-protective laws including sufficient minimum wages and environmental regulations, common water and sewage systems for all, free movement pathways and life spaces without cost to use, non-profit healthcare and disease-prevention by public institution

public income security from disemployment, old age and disability, primary to higher education without multiplying debts, family housing, food and life means assistance for children without sufficient parental money, and public libraries and arts facilities with accessible books, films and works of art and art creation. This is more or less a complete index of the collective life capital bases modern society has evolved, but all are dismantled by the global corporate disorder to maximally profit from.

Private project managers also tend to charge higher legal and management fees. As well, they must return profits to their owners. Aficionados of public-private partnerships insist that while all of this may be true, privately managed projects are far more likely to come in on time and under budget. That is the argument used by Infrastructure Ontario, the body charged with handling public-private deals. It says that if the 74 projects had been handled by the public sector, delays and overruns would have cost taxpayers - in net terms - about $6 billion more. It also says that publicly managed projects are five times more likely to come in over budget than privately managed ones. Is any of this true? Lysyk is not convinced. She points out that Infrastructure Ontario has no empirical evidence to back up its claims and instead bases them on the judgment of outside advisers who, her report says, make their case "anecdotally" and tend to cast publicly managed projects "in a negative light." She also notes that Infrastructure Ontario's initial cost estimates for public-private partnerships are systematically inflated. One result (which she is too polite to mention) is that private-public schemes usually appear to come in under budget. That makes everyone look good.

The Liberals may be the grand priests of private-public partnerships. But they are not the only ones to embrace this particular theology. In the 1990s, Bob Rae's New Democratic Party government famously arranged for a private consortium to finance, build and operate Highway 407, largely to avoid saddling the province with $1 billion more in debt. Yet in the end, the Rae government had to borrow the $1 billion itself - and then pass it on to the consortium. The private-sector partners just couldn't raise the cash as cheaply. Little has changed since then. On the face of it, public-private partnerships seem a good way to save money. In reality, as Lysyk has confirmed, they usually cost taxpayers more. Thomas Walkom is a news services columnist.

Do they? Lysyk looked at 74 public-private projects started since 2005 to answer that question. She found that, in total, they cost $8 billion more than if they had been built and managed by the government alone. In one telling example, she looked at the construction of two near-identical buildings for an unnamed Mississauga college. The first, handled by the public sector, was completed on time and on-budget. Over the objection of the both the college and then mayor Hazel McCallion, the government decreed that the second building be funded and handled by a private project manager. When the figures are adjusted for inflation and other variables, that second building is expected to cost taxpayers 10 per cent more per square foot. The reason is straightforward. Big projects are always built with borrowed money. And governments can borrow far more cheaply than private firms.

Private project managers also tend to charge higher legal and management fees. As well, they must return profits to their owners. Aficionados of public-private partnerships insist that while all of this may be true, privately managed projects are far more likely to come in on time and under budget. That is the argument used by Infrastructure Ontario, the body charged with handling public-private deals. It says that if the 74 projects had been handled by the public sector, delays and overruns would have cost taxpayers - in net terms - about $6 billion more. It also says that publicly managed projects are five times more likely to come in over budget than privately managed ones.

Thomas Walkom's column appears Wednesday, Thursday and Saturday.

In a ruling released this morning Dorsey assigned both health-care workers and clerical staff to the Nova Scotia Government and General Employees Union (NSGEU).

Nurses and support staff  would have waited for a decision at a later date.

In the case of nurses and support staff, where there is no clear majority, Dorsey reserved judgment until a later date, and kept the door open for a bargaining association solution.

Glavine told reporters that new legislation soon to be introduced will assign health-care workers to the NSGEU, and assign the remaining three bargaining units to the other health-care unions.

It appears that never before an entire mediation and arbitration process was rejected in such an offhand manner.

Dorsey sees a recent supreme court decision that endorses the right to form unions as being relevant. The Liberal government vehemently argued that it had no bearing whatsoever on the Nova Scotia situation.

Dorsey rejects the validity of a regulation that government issued consolidating the IWK with the new Health Authority, just to give the Nova Scotia Nurses Union (NSNU) a majority in the Nursing Bargaining Unit.

It appears government took these words to heart, and decided it is better off without Dorsey.

The 2012 government of Ontario-commissioned Drummond report projected that the cost of the province's health-care system, which already devours almost half of provincial spending, will rise to 80 per cent over the next two decades. The report states, "We challenge the government to open the door more widely for private sector involvement, not only to improve efficiencies, but also to capitalize on the huge economic potential in building a vibrant health care sector in Ontario".

The role of government is mainly funding and regulatory. The lesson here is that, as in virtually all other sectors, governments that try to be the deliverer and the regulator fail to do either well. That systems featuring competing private sector providers would prove superior to a bureaucratic government monopoly should come as no surprise. But that monopoly is also financially unsustainable. Ontario is the poster boy for this stark reality.

Recent Fraser Institute reports on the German and Dutch health-care systems found that just five per cent suffered elective surgery wait times longer than four months, compared with 25 per cent in Canada. Those assessments also pinpoint the key reasons for this superior performance. Germany provides universal access to high quality, timely health care through statutory social health insurance, along with an option to buy supplemental insurance. Since Germany's government monopoly health-care system was replaced in 1991, the proportion of care delivered by private hospitals and clinics has risen to 70 per cent. The result has been higher quality care and shorter wait times at a lower cost. Private hospitals and clinics also play a dominant role in the Netherlands. The Dutch system offers universal coverage while allowing the public to select providers competing on the basis of quality and timelines of care.

So what is that "economic potential"? A 2013 report commissioned by the Royal College of Physicians and Surgeons found that one out of six new medical specialists can't find work, while many others accept roles far below their qualifications. Even long-established specialists are only working part time because of severe shortages of operating room access. Allowing these highly qualified professionals to fill those empty hours treating paying patients in private facilities would not only reduce public system waiting lists and costs, but also foster the establishment of Canada as a "go-to" country for fee-paying international patients. This represents a huge opportunity to enhance the sustainability of our public health-care system, while creating a thriving private health care industry.

One would think such a compelling picture would have funding-stressed governments eager for change. But with the exception of Quebec, provinces have tried to stamp out the fragile green shoots of private patient care. The fate of private health care will soon rest with the Justices on the Supreme Court of British Columbia.

After the British Columbia Medical Services Commission ordered him to stop collecting fees at his Vancouver private clinics, Dr. Brian Day launched a lawsuit on behalf of four of his patients claiming a constitutional right to access timely private care. These patients had faced long waiting times that would have proven permanently debilitating or even fatal.

It's astounding that Day and his patients should be forced to fight an expensive court case aimed at winning Canadians the same freedom of choice that exists in every other country. Governments across Canada had better hope he wins, or they will see their citizens trapped in a downward spiral of ever-longer waiting lists and ravaged social programs. Gwyn Morgan is a retired Canadian business leader who has been a director of five global corporations. (troymedia.com)

"We will work to identify new tools that can help us continue to protect patient safety no matter where (patients) are receiving treatment. Ontarians have my commitment as minister that we will do whatever is necessary to protect the safety of patients," he said. TPH told the Star 11 patients contracted the liver-damaging virus during three outbreaks over the last three years; three were infected at the Downsview Endoscopy Clinic on Dec. 7, 2011, three at the North Scarborough Endoscopy Clinic on Oct. 17, 2012, and five at the Finch Ave. W. site of the Ontario Endoscopy Clinic on March 15, 2013. Nine of the 11 infected patients have gone on to develop chronic hepatitis C, meaning the virus has remained in their bodies, placing them at risk of serious, long-term problems, including cirrhosis of the liver and liver cancer. None of the clinics offered up anyone to be interviewed, but all three provided written statements. They all expressed concern for the health and recovery of the patients, said they co-operated fully with investigations and emphasized that they are committed to ensuring outbreaks never occur again. The Downsview Endoscopy Clinic also said it no longer uses multi-dose vials.

Holt, 79, moved to Italy 12 years ago when he married an Italian concert pianist after his first wife died. The pair split their time between Italy and Argentina - his wife's home country - and made regular visits to Canada to visit his children until last summer, when Holt developed a sore back.

Doctors in Argentina diagnosed a fractured vertebra. Not trusting the care there, Holt came to Ottawa in November and, with the help of his daughter Caroline, applied for Ontario Health Insurance Plan benefits, which require a minimum three-month residency.

He got the bad news from doctors at The Ottawa Hospital. The fracture was the result of cancer that had spread from his lungs to his spine. Doctors began aggressive treatment. He had other tests and eventually a massive dose of radiation just before Christmas that left him partially paralyzed below the waist.

The doctors who treated him in Canada have waived their fees and the Bruyère says it won't begin charging for his care until his OHIP coverage kicks in on Feb. 6. The $61,000 bill he's amassed so far includes the cost of tests, treatment and his bed on the ward in The Ottawa Hospital, where he was admitted as an in-patient in December.

"There is a sense of justice," Holt said. "I did the things I did because of a love for Canada. There was a sense of obligation to my country, but I think the country should have an obligation too."

As a federal retiree, Holt has comprehensive health insurance that would cover him if he were ill outside Canada, but not when he's home and supposedly covered by Canadian medicare.

"It isn't a case of someone who came home because he needed a hip replaced," said Caroline, who acknowledges that some people try to take advantage of the Canadian health-care system. "He's dying. He served his country for 50 years and he's never asked for anything back until now."

Holt grew up in B.C. and joined the RCAF in 1953. He was a member of the air force's Golden Hawks aerobatics team and eventually became squadron leader of the 439 "Tiger" Squadron, flying CF-104 Starfighters at CFB Baden-Soellingen in West Germany. Retiring as a lieutenant-colonel after 28 years in the military, Holt then spent another 20 years as a commerce officer with Foreign Affairs. He says his only other hospital stay occurred when he was 11 and had his tonsils out.

He was admitted to palliative care at the Bruyère Continuing Care Centre on Jan. 24. The three-month OHIP waiting period expires Feb. 6. Holt remains a Canadian citizen and has paid one-quarter of his pension income in Canadian taxes since leaving the country.

The family appealed to Ontario's OHIP Eligibility Review Committee, but was turned down. They are now taking the case to the independent Health Services Appeal and Review Board.

The odds aren't good, says Perry Brodkin, a Toronto lawyer who has taken on their case. Since 2002, the board has heard 219 appeals to waive the three-month eligibility requirement. It has rejected all of them.

The waiting period is set out in Ontario's Health Insurance Act and there are few exceptions, notably for newborns, refugees, adoptees and patients transferring from another province into long-term care in Ontario.

"There are no provisions in the regulation that allow OHIP coverage to be granted on compassionate grounds or for any other discretionary reason," said David Jensen of the Ontario Ministry of Health and Long-term Care in an email to the Citizen.

Brodkin wonders why there is an appeal process at all if the committee and review board have no power to overturn the law. He calls it a "scheme" to deflect complaints from the government.

OHIP says, 'We give them their appeals. We give them their reviews.' And then they'll lose anyway, a long time from now," Brodkin said. Time is not something her father has a lot of, says Caroline, who said the worries about how to pay for his medical bills have been exhausting. "We don't have years to wait," she said. "He'll be dead long before then."

Meanwhile, Jim Holt keeps busy at the Bruyère, dictating his memoirs into a digital recorder. If OHIP or his private insurance don't cover the bills, the money will come out of his estate he has willed to his wife. "For the want of a few months they're taking life savings from people," he said.

"How can a medicine be too dangerous to import but safe enough to consume? This makes no sense," said Amir Attaran, a law professor and health policy expert at the University of Ottawa. By not ordering a recall, he said, "Health Canada is knowingly leaving adulterated medicines on the pharmacy shelves."

Health Canada said it has restricted imports from the Indian plant as a "temporary precautionary measure," and, so far, a recall is unwarranted. "At this time, no specific safety issues have been identified with these products currently on the market," a government spokesman said in an email.

"If at any time health or safety issues are detected, the department takes immediate action, including a recall, if necessary." Spokespeople for Shoppers, Rexall, Walmart and Costco emphasized that no recall has been made and the regulator has deemed the drugs safe to stay on their shelves. "We will continue to monitor this situation closely," Rexall said in a statement. "If a patient has any concerns or questions about any medications they are taking, we would encourage them to speak with their Rexall pharmacist."

In all the packages the Star purchased in January and early February, the drugs were labelled under the store's own brand, with the name of the tablets' Canadian manufacturer - Pharmascience - in small print. No store had any disclaimer stating products from the company are now under quarantine. Pharmascience, which voluntarily agreed to the government's quarantine, said it retests all of the ingredients it imports and is confident the allergy tablets are safe.

"Safety is our priority. The desloratadine products that have been released on the Canadian market have passed strict quality control tests and have also been deemed safe by Health Canada," company spokeswoman Maria Angelini said. The company said it has secured a new supplier of the chemical ingredients used to make the allergy medication. The problems at the India facility, Dr. Reddy's Laboratories in Srikakulam District, were troubling and numerous, according to an inspection report obtained by the Star.

During a November inspection, agents from the U.S. Food and Drug Administration (FDA) found Dr. Reddy staff repeatedly retested raw materials found to have unacceptable levels of impurities and did not document or report the undesirable results. These problems date back to January 2012. The name of the specific products that failed purity tests are redacted by the FDA from the inspection report, making it impossible to tell which specific drugs are affected.

The inspectors' review of one company hard drive "uncovered evidence that analytical raw data had been collected throughout the month of November 2014 and had been deleted," according to FDA inspectors. "The identity of the product(s) analyzed could not be determined." The first day of the inspection, agents found more data and test results sitting in the trash room, tucked in bags listed as waste material.

The U.S. agents also raised concerns about the water used to manufacture the drug ingredients. A probe of the microbiology lab found "significant growth of both bacteria and mould, and appeared to be TNTC (too numerous to count)." The company's data used for detecting worrisome trends did not mention the problem, inspectors found. Meanwhile, the facility failed "to have adequate toilet and clean washing facilities supplied with hot water, soap or detergent," inspectors found.

A spokesman for Dr. Reddy's said the company agreed to a quarantine and no drug ingredients are currently being exported to Canada. Nick Cappuccino said the firm has conducted its own internal review and has "no reason to question the safety of the products involved. "We are now working collaboratively with (Health Canada) to address their concerns with the goal of lifting the voluntary quarantine as quickly as possible," Cappuccino said.

The University of Ottawa's Attaran, however, said the inspectors' findings should be treated more seriously. "The cheapest greasy spoon in Toronto would be shut down if it had these conditions, but the pharmaceutical company sending stuff to Canada is allowed?" he said. He questions why the government is allowing products originating from the facility to remain on pharmacy shelves, considering Canada's Food and Drugs Act prohibits the sale of any drug manufactured under unsanitary conditions. "The law is very clear on this," he said. "We have evidence here that the product was manufactured under unsanitary conditions, and they're selling it. What more does Health Canada want?"

The government said its decisions about regulatory actions are made on a case-by-case basis and can be "deployed in a graduated and proportional fashion, and tailored to the specifics of individual circumstances." Since a Star investigation in September revealed drug products banned from the U.S. market have been allowed by Health Canada into Canadian pharmacies, the government has banned or quarantined imports from at least nine Indian drug manufacturing facilities. The facilities make more than 100 drugs and drug ingredients imported into Canada. © 2015 Torstar Corporation

The penalties are assessed on a dollar-for-dollar basis, meaning they are equal to the amounts patients complained about paying for procedures. B.C. and Newfoundland were the only provinces assessed penalties for the last three years. When the 2013-14 annual report comes out soon, B.C. will once again be penalized, this time $224,000, said provincial Health Ministry spokesman Ryan Jabs.

Since 1994, the federal government has docked B.C. $3.2 million, slightly lower than the record-holder Alberta ($3.6 million). Since 1994, provinces have been assessed nearly $10 million in penalties for extra billing charges. A Health Canada spokesman could not explain why Quebec has never been penalized, even though it reportedly has a thriving private medicine sector. Ontario has also not faced any penalties.

The penalty to B.C. is paltry in relation to the province's $20-billion health budget announced Tuesday. It is also insignificant relative to the federal transfer payments B.C. will collect this year ($4.4 billion) and next ($4.7 billion). In 2006, the then-deputy health minister of B.C., Penny Ballem (now Vancouver city manager) questioned whether B.C. was really the only province where extra billing and private sector queue jumping was taking place. Jabs said Wednesday he can't comment on what happens elsewhere.

In 2005, the B.C. government did not submit a dollar value to the federal government for such extra billing, so Health Canada bureaucrats based the penalty sum on news releases from anti-privatization unions and newspaper clippings about patients who accessed the private system. The Sun learned about that through a Freedom of Information request. The story detailed how discretionary the penalties appear to be and that they are based on "guesstimates" of user fees. Provincial Health Ministry officials often base their reports submitted to the federal government on complaints from patients who go to private clinics for expedited care and then try to collect the fees paid from government. One such patient is Mariel Schoof, who had sinus surgery at a private clinic in 2003. She paid $6,150 for the "facility fee" and then tried to recover the fee from the provincial government or the clinic. She is now one of the interveners in a private versus public medicine trial starting March 2 between Dr. Brian Day and the provincial government. Timeline of Canada Health transfer compliance in B.C.

Early 1990s: As a result of a dispute between the British Columbia Medical Association and the B.C. government over compensation, several doctors opt out of the provincial health insurance plan and began billing their patients directly, some at a rate greater than the amount the patients could recover from the provincial health insurance plan. May 1994: Canada Health deductions began and continue until extra-billing by physicians is banned when changes to B.C.'s Medicare Protection Act come into effect in September 1995. In total, $2,025,000 was deducted from B.C.'s cash contribution for extra billing that occurred in the province between 1992-1993 and 1995-1996. These deductions were non-refundable, as were all subsequent deductions. January 2003: B.C. provides a financial statement in accordance with the Canada Health Act Extra-billing and User Charges Information Regulations, indicating aggregate amounts charged with respect to extra billing and user charges during fiscal 2000-2001 totalling $4,610.

Accordingly, a deduction of $4,610 was made to the March 2003 federal transfer payment. 2004: A $126,775 deduction was taken from B.C.'s March 2004 Canada Health Act payment, based on the amount of extra billing estimated to have been charged during the 2001-2002 fiscal year. Since 2005: $786,940 in cash transfer deductions have been taken from B.C.'s federal health transfer payments on the basis of charges reported by the province to Health Canada. January 2011: Vancouver General Hospital begins charging patients a fee when they elect to have robot-assisted surgery versus the conventional surgical alternative for certain medically necessary procedures. 2013: Deductions in the amount of $280,019 are taken from the March 2013 federal transfer payments of B.C. in respect to extra billing and user charges for insured health services at private clinics. Source: Canada Health Act Annual Report 2012-2013

The branch investigates about 30 cases a year of extra billing, usually related to private surgical facilities or expedited visits to specialists. The government is not sure whether it will be penalized in the future for allowing Vancouver General Hospital to charge patients fees for robotic surgery. VGH spokesman Gavin Wilson says since 2012 patients choosing to have surgeons remove their prostates using the robot have been charged on a partialcost-recovery basis. The B.C. government allows the extra billing because robotic surgery is discretionary, not medically necessary, and there are higher costs associated with it. In 2012, however, Health Canada began examining the Canada Health Act implications of patient charges for robotassisted surgeries. The process convinced the health minister that VGH should stop charging for robot-assisted surgeries as of Jan. 1, 2015. Vancouver Coastal Health collected $345,000 a year for the procedures; most recently, the patient fee was $5,700. Sun health issues reporter pfayerman@vancouversun.com

SNC-Lavalin is a Canadian company with thousands of employees. It would be tragic if a conviction against the company, or even the threat of it, were to result in what could amount to a death sentence for SNC. It is not clear that Riadh Ben Aissa, the former vice-president who is alleged to have been the most active person in corrupt transactions in Libya and other Arab countries, was part of "the directing mind and will" of SNC-Lavalin. That is the necessary element that the law requires to find that a corporation had a criminal intent comparable to that of a flesh-and-blood human being.

Prosecutors and eventually a judge will look at these matters scrupulously. But leaving aside what's before the courts, Diane Finley, the Minister of Public Works, must fix the unintended consequences of the integrity framework. That framework, offering companies no way to set things right or make amends, doesn't fit.

If convicted, SNC-Lavalin could be banned from bidding on government contracts for 10 years under Ottawa's so-called integrity framework. The code's regulations deal with companies convicted of crimes in Canada or abroad and the ban extends to subsidiaries and sister companies of convicted companies. Three Canadian companies have been convicted since 2013 under the Corruption of Foreign Public Officials Act. Calgary-based oil and gas company Griffiths Energy International was fined $10.35 million in 2013 for bribing a diplomat's wife to secure oil rights in Chad. Niko Resources of Calgary was fined $9.5 million in 2011 for bribing a Bangladesh cabinet minister for natural gas drilling rights. Hydro-Keen Group of Red Deer was fined $25,000 in 2005 for bribing a U.S. immigration officer at the Calgary airport to get workers into the United States. In October, Card said that the company could be forced to close or sell its operations if it faced criminal charges. A company vice-president later clarified that it would consider all options in deciding what is best for shareholders. SNC-Lavalin's reputation has been tarnished in recent years by charges against former employees in Libya, Algeria, Bangladesh, and in relation to a $1.3 billion Montreal hospital contract.

Several ex-officials, including former CEO Pierre Duhaime and construction vice-president Riadh Ben Aissa, face fraud charges in Canada involving $22.5 million in payments related to the hospital contract. Ben Aissa was charged in Canada after he was extradited from Switzerland where Swiss authorities had sentenced him to the 29 months he'd served in jail on fraudrelated charges relating to SNC-Lavalin's business in Libya. They also ordered him to repay millions of dollars to the company. Ben Aissa acknowledged in court that he bribed Saadi Gadhafi, son of Libya's late dictator, Moammar Gadhafi, so SNC could win contracts. Ben Aissa also admitted to pocketing commissions. SNC-Lavalin had a presence in Libya for decades with annual revenues peaking at more than $400 million. Work included the Great Man-Made River project, a plan to pump water from deep desert wells to the populated cities along the northern coast. It also built an airport in Benghazi and a jail in Tripoli.