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

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

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

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

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

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

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

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

The problem is so pervasive that a new non-profit organization has sprung up in the U.S. to help hospitals outsmart their internal thieves. It’s called the International Health Facility Diversion Association (IHFDA) and its inaugural international conference will take place in Cincinnati, Ohio in September.

The overdose death of a care aide at Vancouver General Hospital proves the need for better methods to detect and prevent theft and abuse of hospital medications, coroner Timothy Wiles said in his report Wednesday.

Wiles said Kerri O’Keefe, 36, who had worked in the emergency room for about 15 years, died in her Surrey condo last summer from respiratory failure after injecting a stolen hospital anesthesia drug.

As well, nurses and doctors will be expected to squirt leftover medications into a slush pail that’s a mixture of all drug residuals instead of using sharps containers. “We are looking to make these (remaining) drugs un-usable,” she said. Drug wasting is the term used in health care for discarding partly used medications. Some medical centres squirt leftovers into a bin filled with Kitty Litter to deter anyone from stealing the contents.

To do so he’s launched a petition and is organizing a rally aimed at bringing attention to the health-care crisis in western Newfoundland.

Closing clinics, doctors leaving and no replacements and long waits in emergency rooms are things he feels need to be addressed.

“The fact that 10 hours has become the expected normal is very concerning to me,” he said of the average emergency room wait.

The petition he launched on March 24 on change.org under the heading “Western Newfoundland Needs Doctors” has just over 800 signatures. He’s also printed off copies — which others can also do — and placed them at his workplace.

He’d like to get a couple thousand signatures before the end of the month, for the rally he’s planning. The rally is set for April 30 at Sir Thomas Roddick Hospital at 1 p.m.

There’s not yet even an application to open a pay-for-plasma clinic in Alberta, but the issue already appears to be reaching crisis levels.

Never mind the fact that this practice has been ongoing for decades in Manitoba and for several years in other countries, Alberta’s health minister is being urged to take swift action to put a stop to it — and she appears willing to do so. 

In February, a company called Canadian Plasma Resources opened a clinic in Saskatoon. Plasma collected is used to make pharmaceutical products and other medical therapies, and donors are compensated to the tune of a $25 pre-loaded credit card. They’re now looking to open a clinic in British Columbia and possibly in Alberta and Manitoba in the coming years.

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

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

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

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

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

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

UK and Australia

government oversight

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

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

Department of Economics, Laurentian University

This paper uses a new (Hartwig-Colombier) method to decompose the growth rate of provincial per capita health-care spending in Canada over the period 1982–2011 into the contributions of the cost disease, traditional observable variables, and technological progress. Based on extensive robustness analysis across a variety of specifications, estimation methods, and two separate data sets, we find that the cost disease (rent extracting) is a relatively minor contributor, while technical progress in health care and growth in per capita incomes are by far the biggest contributors to the secular growth in health-care spending in Canada.

were meeting the guideline, while 33 facilities were exceeding it. (Information is missing on another 10 for a variety of reasons. For example, some were new.) The directory's data shows that a quarter of seniors in the homes have a diagnosis of depression and nearly one-third are being given anti-psychotic medication without a diagnosis of psychosis.

A recent Vancouver Sun series on violence in nursing homes found more than 1,000 physical assaults by seniors in long-term care facilities last year. And in the past four years in B.C., 16 seniors in care have been killed by other seniors suffering from dementia. "There's simply not enough time for them (care aides) to do their job and provide the care seniors need. When we establish what the level of care needed is, it needs to be mandatory. Clearly, there needs to be more strenuous accountability in this system for seniors - many of whom are frail," said Whiteside. Nor was she surprised to find 74 per cent of the privately owned and operated businesses failed to meet ministry guidelines. "The system is set up so Health Authorities are contracting with private providers and some of those private providers are subcontracting out some of the care to other contractors and at each phase there needs to be a profit made. It's not the kind of system to have for frail seniors. It's quite shocking to think this is the system we have for them," said Whiteside.

"Anecdotally, everyone was saying hours (for staff) were being cut, but now you have quantitive evidence. For policy shifts (in government), they want to know the magnitude of the issue. Let's have a discussion on how we can fix this. Before you can deal with what homes are not providing recreational therapy and OT (occupational therapy), for instance, you have to fix the hours of care first," said Mackenzie. Whiteside said the figures showing the vast majority of government-funded homes are below ministry staffing guidelines prove what HEU members have been saying for years - that they are rushed in trying to care for seniors in nursing homes and concerned that seniors are suffering and workers are placed in dangerous situations when a senior acts out violently.

Your questions show we have some work to do here," she said. "I will specifically be writing to each Health Authority and the government on this issue. We have a target of care hours and here's how many of your facilities are at that or under that." Mackenzie said her office will also analyze the Residential Care Facilities Quick Fact directory data to determine whether facilities with low staffing levels may also have more seniors who are depressed or who are prescribed antipsychotics medication. She also wants to study whether these homes offer fewer amenities to boost quality of life such as recreational and occupational therapy. Mackenzie said the Quick Facts Directory, available online, provides numbers to back anecdotal evidence that quality of care has declined in many B.C. seniors homes. The directory will be updated annually, but does not include data on private nursing homes that receive no government funding.

A Vancouver Sun request to interview Health Minister Terry Lake was not granted. However, the ministry sent an email stating there are no plans to introduce mandatory staffing levels. The recommended 3.36 direct care hours is a number used "as a starting point for planning decisions," the email said. "The standard that we want care providers to meet is high quality care at whatever level is most appropriate for an individual patient," the ministry email states. "Direct care hours are dependent on the individual's needs and are determined through a comprehensive assessment process involving the client, their family and staff. Experts all agree that having a legislated or policy requirement for staffing ratios and staffing hours is not appropriate, because of the complexity of patient needs." Daniel Fontaine, the CEO of the B.C. Care Providers Association, whose members represent approximately 60 per cent of the government's contracted-out beds, said home operators would be happy to provide 3.36 direct care hours, but the government funding isn't enough to reach this level.

We can only do what we are funded to do," said Fontaine. "While the government and health authorities are trying to bring those on the lower (staffing) levels up, it's been a slow process." One of the solutions could be to take some of the money spent in the acute care system and shift it into continuing care so seniors in long-term care facilities benefit, Fontaine said. Lorri Chmilar, who retired from nursing last year after working mainly for the Interior Health Authority, said the most stressful place she worked during her career was nine months spent in geriatric care. "Anyone who has worked in public care facilities has seen a decrease in staffing, decrease in activities, and decrease in quality of meals. What has increased is the amount of time in recording statistics, and basically CYA (cover your ass)," she said. "Understaffing is also a result of the poor mix of residents. It only takes one or two residents with severe dementia or severe physical impairments to increase the workload significantly to the detriment of the rest. To increase staffat this point, or to transfer a resident to a different care area is a major undertaking that requires much justifying and time. Nurses are derided for asking for extra assistance, if there is any to be had, and roadblocks to transfers are numerous. I fear for my family, and others, and the grey wave of us to come."

THE NUMBERS DRUGS WITHOUT DIAGNOSIS In B.C. facilities, an average of 31 per cent of residents were given antipsychotics without a diagnosis of psychosis. 133 facilities were above this average. 11 were at the average.

136 were below the average, but just one reported zero cases of providing antipsychotics without a diagnosis of psychosis. DAILY PHYSICAL RESTRAINTS In B.C. facilities, an average of 11 per cent of residents have daily physical restraints placed upon them. 116 facilities are above the average.

9 are at the average. 155 are below the average, of which 27 made no use of physical restraints. Source: Office of the Seniors Advocate, Province of B.C. © 2016 Postmedia Network Inc. All rights reserved.

But McKenna argued nurses in the long-term sector have gone into rooms where a homicide has occurred, and those in emergency rooms constantly deal with victims of violence and horrible accidents.

"You shouldn't exclude particular workers because they might not be the first one to step their foot into a vehicle accident setting," she said. The legislation would mean first responders could access Workplace Safety and Insurance Board (WSIB) benefits far more easily than they can now.

The presumptive legislation, if it passes third reading as expected, is slated to be proclaimed into law Wednesday. It had been long sought and has now been widely lauded by first responders.

In a statement issued on behalf of 8,000 Ontario paramedics, the Canadian Union of Public Employees (CUPE) said the bill will help lessen the stigma associated with PTSD and help first responders get treatment "before it's too late."

"Research shows that because of frequent exposure to traumatic situations, paramedics and other first responders are at least twice as likely to suffer PTSD than the general population," the CUPE statement says.

Craig MacBride, spokesman for Labour Minister Kevin Flynn, said the government is committed to workplace safety for nurses, creating a leadership table on violence in health care and also amending the Occupational Health and Safety Act to help prevent workplace violence and harassment.

It's also important to remember that nurses, like all Ontario workers, are covered for PTSD through the WSIB. Bill 163 simply creates a more responsive process for those who are most likely to face traumatic experiences on a regular basis," MacBride said.

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

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

Despite being eligible for five or nine paid sick days per year, the typical employee used only three, and a quarter used none.

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

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

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

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