This Senate has already sent a report back to the Commons, saying the Liberal bill should be amended to allow advance directives from those who wish assistance in dying and are still able to let their wishes be known.When the bill comes back to the Senate, independent Liberal James Cowan will push for an amendment broadening restrictions on eligibility.

The B.C. Civil Liberties Association says every provincial medical regulator has issued “detailed, comprehensive” guidelines for doctors under the high court ruling. Doctors’ conscientious objection rights are protected and, under provincial guidelines, two doctors are required to confirm the patient’s eligibility and consent.The real danger may lie in future court challenges — if assisted deaths are allowed under the Supreme Court wording that would be denied under the federal legislation, the government will have a problem.We shouldn’t be here after 16 months. Canadians deserved better. They deserve a better law.

Brown said there were 33 beds in hallways when he visited Brampton Civic Hospital recently and the ER has 50,000 more visits than they can handle. In Timmins, he was told the 1% funding increase the hospital got barely covers the increased cost of electricity, let alone the collective bargaining increases and the inflationary healthcare costs. Cuts are a reason why doctors and nurses are at loggerheads with the government, he said.

An injection of $10 million from the health ministry has been helpful, he said, noting the latest financial statements show a year-end deficit of about $35.7 million, which could have been as high as $48 million. “It’s a deep, deep worry of the administration, of the organization, of the board; we can’t continue to run deficits. We’ve got to be able to bring our budget into balance,” Florizone said. The health region is implementing a sustainability plan, which in the short term has focused on reducing paid hours, the largest driver of the deficit. Florizone said he hopes job losses can be avoided as much as possible. Board chair Mike Stensrud said the more waste that can be eliminated, the fewer jobs that will be cut. Despite the financial crunch, the health region will never fail to make its payroll, he said.

Health Canada’s annual reports show that Quebec has sometimes complied with its concerns. But in its 2003-2004 report, the agency observed that the Quebec government was “not at liberty to reveal the status of the province’s investigation” into user charges imposed by a private surgical clinic. A year earlier, Health Canada expressed concern “about private surgical clinics that allow individuals to privately pay for medically insured services and thus jump the queue. … Health Canada asked Quebec to confirm that the matter had been resolved.” A long-standing complaint of Quebec by Health Canada is that it allows patients to be charged for MRIs and CT scans if they are done in private clinics. In its 2004-2005 report, Health Canada held discussions with British Columbia, Alberta and Nova Scotia about charging for medical imaging in private clinics, but Quebec refused to participate. 

Health Canada officials did not respond to requests for an interview since last Thursday. Reacting to the Quebec lawsuit last week, federal Health Minister Jane Philpott said she’s a strong supporter of the CHA, and did not rule out reducing transfer payments to provinces that flout the law.

Parti Québécois MNA Diane Lamarre said Barrette’s “about-face” is the result of relentless criticisms by her and the PQ. “When we started studying Bill 20, we were fighting the fact that the minister introduced an amendment that authorized accessory fees,” Lamarre said. “It was a new opportunity to charge, legally, new medical fees. … We asked the minister many times to (scrap) his amendment and he refused. “(It) was a way to introduce accessory fees and make some patients with no money unable to have access to medical services, which is completely against the law. Now we’re proud that he changed his mind,” she said. Both Lamarre and Coalition Avenir Québec MNA François Paradis said they are concerned Barrette will not be able to convince doctors’ associations to include the fees in their remuneration. If doctors’ salaries are boosted by an additional $50 million in the next contract agreement, for example, it will mean that collectively we will all be paying the fees indirectly, Paradis said.

She says she had greater success at Ryerson University, where she was hired to overhaul the food service from 2013 to 2015. “Ryerson was tremendous. We created a beautiful model and the students responded to it,” she says.Under her direction, staff stopped reheating soup from a bag and learned to cook from scratch with raw ingredients. “Soup easily became one of the most popular things on the campus,” she says. “Because it was good and made with thoughtfulness and not that much more work.”The big take-away for Maharaj was learning to negotiate with the companies that provide the food. “Working with a third-party operator is the undeniable piece you have to address when you’re talking about institutional food,” she says. “And these operators are the people we need to start talking to when we want change.”

“The vegetables are almost non-existent. They’ll throw a couple on the plate. You’ll have a spoonful of some nasty peas. And they’re not even green no more. They’re grey,” says Tom, who also says powdered mashed potatoes are served multiple times a week (“Both dehydrated and fresh potatoes are used in both the cook-chill and institutional kitchens,” Ross says.)Tom avoided eating chicken entirely when he was in jail. Another woman I spoke with, who spent a year at Vanier from 2010 to 2011, says the poultry was routinely served undercooked and pink. She says she relied on food purchased at the canteen, mostly ramen noodles. When dinner was “fish slop” – a dish she describes as “garbage with fish parts in it” – inmates would run to their stashes, softening the noodles with hot water from the sink over the toilet.

In 2012, Paulette Padanyi, a now-retired faculty member of the University of Guelph, co-wrote a research paper called Food Provision in Ontario Hospitals and Long Term Care Facilities. Of the 55 hospitals studied, 19 hospital administrators agreed to discuss their food budgets. All of them outsourced the food production. Most told Padanyi that they took their cue from long-term-care facilities, which have a prescribed Ministry of Health and Long Term Care rate of $8.03 per day per patient to spend on food.In 2012, the average amount spent per patient in the hospitals Padanyi looked at was $7.91 a day. “They say to the contractors, ‘You’ve got x number of dollars, eight bucks a day per patient or whatever,’ effectively downloading the responsibility of meeting that budget,” she says.Often, these contracts are not just for patient meals, but the staffing and operation of food franchises within the hospital, plus housekeeping and custodial. The main conclusion of Padyani’s report was that food service is considered unimportant relative to the entire hospital.

Tom, a former prisoner introduced to me through the John Howard Society (which asked that I not use his last name), has served time at various correctional facilities around Ontario and suffers from diabetes and Crohn’s disease. He challenges Ross’s statement. “They don’t follow diets,” says Tom, who is in his 30s, was first locked up at the age of 12 and has spent more than 10 years behind bars. “Any jail food, you’re going to be on the toilet six times a day because what they’re giving you is running though you.”

Compass employs half a million people around the world (including 30,000 in Canada), and supplies food to schools, offices, stadiums, museums, mining camps and offshore drilling platforms, as well as hospitals and correctional centres. Of the company’s many customers, patients and inmates have two things in common: First, they are unable to go buy themselves something more healthy, or at least more tasty; and second, we, the taxpayer, are responsible for feeding them.Last November, Compass took over food services at the Regina Correctional Centre, a move that saved the Saskatchewan government $2.4-million a year. Lacking a Yelp page, inmates went on a hunger strike in January to protest against the quality of the food. “If you don’t like the prison food, don’t go to prison,” Premier Brad Wall responded. In March, inmates refused food again, in part because Compass had raised prices at the canteen.Ontario spends $14.54 a day per inmate to feed about 8,000 prisoners in 26 correctional facilities, for a total of $41.3-million a year, including labour and transportation. The food cost is $9.17 for three meals. Perhaps inmates should not, per our punitive view of criminal justice, be dining on lamb racks and truffles. But it’s hard to imagine eating healthy on $9.17 a day.

Regardless of source, it’s important to ensure the safety and security of supply for patients who need blood and blood products. Currently, CBS collects about 200,000 litres of plasma annually. That is enough to produce only about 22 per cent of blood products such as intravenous immunoglobulin, which is used to treat a growing number of immune disorders. That product is purchased from the United States and Switzerland.

Currently, there are no manufacturers of blood products in Canada. However, both Green Cross Biotherapeutics and Therapure Biopharma are getting into the business. Within five years, CBS hopes to increase collection markedly to about 500,000 litres a year, with the use of dedicated plasma collection centres. But CBS has no plans to pay donors, other than the traditional cookies and juice. Nor does it plan to buy plasma from other providers, such as Canadian Plasma Resources.In fact, what Canadian Plasma Resources plans to do with the plasma it has collected is unclear as it does not have license from the U.S. Food and Drug Administration, which means it essentially can’t sell its plasma in the United States. What is clear, however, is that there is a lot of action in the blood business; as opportunities arise, we must be careful to not repeat the errors at the root of the tainted-blood debacle. What policy makers need to do now is come up with a clear, coherent position on issues such as paying for plasma and domestic production of blood products rather than grasping at every shiny bauble that comes along.

MacKinnon also challenged two frequent criticisms of private clinics: that they’d cream off the easiest surgeries and steal the best staff. Instead, she says surgeries were assigned by health regions and clinics hired retired nurses and nurse practitioners who liked the better hours and low-hassle atmosphere. She noted that surgeries — which covered only an array of specialties, not a complete list of surgeries — came in 26 per cent cheaper than in hospitals. “I think it was extremely well done.” Only in Canada, she said, would there be any fuss over who owns the clinics providing service in a single-payer system, MacKinnon said.

He wants the OMA to return to the negotiating table and discuss lowering some of the 7,300 fees on the physicians’ pay schedule. He said the province has made no less than 80 offers since talks broke down two years ago — close to one a week — to no avail. If they don’t, he said he’s prepared to make another unilateral cut (even though the cuts imposed in 2015 have already sparked the second Charter challenge from the OMA this decade). “If necessary we will be forced to make those changes,” he said. Hoskins doesn’t want to cut back on all doctors’ pay, but create a more equal system that doesn’t go over budget every single years, as has historically been the case.

“The top biller, an ophthalmologist, billed more than $6.6 million last year. The top diagnostic radiologist billed more than $5.1 million and the top anesthesiologist billed more than $3.8 million,” a government fact-sheet states. That’s far above the average doctor’s gross payment of $368,000 a year. And though the OMA argues that often doesn’t account for overhead and staffing costs, the province also subsidizes pay in many indirect and direct ways, including allowing doctors to incorporate, which reduces tax and liability burdens. Ontario, unlike many provinces, covers 80 per cent of doctors’ liability insurance. Hoskins said the ministry even sometimes covers hardware costs like computers.

Hoskins says his goal is to make things more equal and better distribute the money going to certain specialists whose work has gotten easier. MRIs and CT scans used to take an hour, now they take 20 minutes. Same with cataract surgery — that’s why diagnostic radiologists and eye surgeons are so disproportionally represented on the list.

Davidson also has an idea where to find the money. “We always tell them to look at their executives wages. It’s definitely a top heavy bloated organization.” Indeed, CBS CEO Dr. Graham Sher, earned more than $800 thousand last year. An astounding nine Vice Presidents together made another cool $3.2 million.

It’s one thing to want to keep your workers poor and precarious. Many companies do it. But donors? “These days donors probably have more complaints about scheduling and clinic times than employees do.” That’s what Ron Stockton told us when we first talked to him in January of this year. Stockton is the  NSUPE business agent for the PEI local now on strike. “With CBS it is never about delivering service, it is always about getting the biggest bang for your buck,” Stockton says. A 2015 press release issued by CBS announced the Canada-wide closure of three permanent clinics, the replacement of a permanent clinic with a mobile one, pulling mobile clinics from 16 communities, and “adjusting clinic schedules across the country.” “CBS is being transformed into a business, as opposed to a public service or a humanitarian organization. These days it’s all about automation and squeezing efficiencies out of donors and workers,” Stockton concludes.

“When you walk into the clinic you register by inserting your health card into some kind of ATM machine, then you have your blood taken by an employee who is too rushed to talk to you, then you schedule your next appointment at another machine. “Having  been a donor, I can tell you donors want to see people,” Stockton says. “I am old enough to remember the days when staff taking your blood had time to talk to you. “Doesn’t happen anymore, to CBS you are a piece of meat giving blood, you could be a bag.”

Lately CBS has been in the news because of its endorsement of Canadian Plasma Resources, a private for-profit company that wants to pay for plasma donations.  The Saskatchewan company is eying Nova Scotia and New Brunswick for expansion. Organizations such as Bloodwatch and public healthcare advocates in the Maritimes have strongly opposed the introduction of private for-profit clinics while we have an effective not-for-profit blood service already in place. Paying for donations is asking for trouble, they believe. But concerns around the quality of our blood supply go deeper. “Workers in our locals fear for the safety of this blood system altogether,” Davidson warns. “CBS is more concerned about cost savings than about the safety of the blood supply. They have  pared the organization down so much that all resilience and safety is removed, and we are going right back to 1997,” Davidson says.

“CBS tries to make its operation as lean as possible,” he says. “We cautioned them to make sure that there are no system failures such as the Krever enquiry identified. But they are continually watering it down. It’s all about dollars and cents for them.” When front line CBS workers are concerned about safety, then provincial Health ministers who fund CBS to the tune of $1 billion per year should listen, says Davidson. “We call upon the responsible ministers to step up and pay attention. We need to raise the alarm that things are not good.”