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"We are committed to the health and well-being of Ontarians living in long-term care homes and firmly believe in public accountability and transparency," said ministry spokesman David Jensen. Today, the Star profiles the story of former nursing home residents Fatemeh Hajimoradi, who has a serious pressure ulcer on her buttock, and Dorothy Benson, who died from problems related to gaping bedsores on her leg and foot.

Hajimoradi is now in Credit Valley Hospital, thanks to her family's advocacy. But the complaint filed by her granddaughter, Trinos, with the ministry got no results. Trinos emailed those photographs, with a complaint, to the ministry last spring. The ministry inspector didn't visit the home until Aug. 25 - two months after Hajimoradi was permanently moved to the hospital. Without interviewing the family, the investigator discounted the complaint and told Trinos the photos were not accepted because they could be edited or photo-shopped.

"I feel like I'm helpless now," Trinos said, after ending her call with the ministry. "They aren't going to send anyone else in there. They just go in, close the book and that's it." Jensen, the ministry spokesman, said inspectors do accept photos and must interview families in their investigation. Asked why that didn't happen in this case, he said the inspector used notes and photos from Trinos' original complaint with an intake worker. Now Trinos and her mother, Mehdizadeh, want their story made public as a warning to other families: watch closely, speak up and remember that a bedsore isn't a benign skin condition - it's a toxic threat that requires the most vigilant care.

In January 2013, Mehdizadeh entrusted her mother, Hajimoradi, to the Erin Mills Lodge. Hajimoradi has Parkinson's disease and dementia. She isn't able to move on her own and - like a growing number of long-term care residents - requires help with regular repositioning so that pressure from sitting or lying in the same spot does not create bedsores. Mehdizadeh said she understood skin breakdown was a risk but expected the staff to provide intensive care - including proper nutrition and hydration - so as to prevent the agony of serious infections and open wounds.

"My mother is suffering, suffering. We are all suffering," Mehdizadeh said. "I'm speaking out about this for all people in the older generation. Nursing homes are supposed to give them a safe journey home. But where are their rights to proper care?" Two years later, in May 2015, Trinos' notes said a worker at Erin Mills Lodge privately told the family about a serious and smelly bedsore on Hajimoradi's bottom.

Trinos and her mother said they didn't recognize the significance of the sore, nor did they see it, because the dressings that covered it were changed before their visits. "Come at a different time than you usually do, come and surprise (staff)," they recalled the worker telling them. The next day, Trinos' mother, Mehdizadeh, visited in the morning instead of the late afternoon. She told the nurse to open the dressing on her mother's bottom. The pressure ulcer was partially black and smelled like rotting flesh. Horrified, she took the first of many pictures. Several days later, her mother wasn't eating and was shaking with fever and nausea. Mehdizadeh demanded that the home call 911 and took her mother to hospital.

Mehdizadeh said her mother was admitted to hospital with two infections: sepsis, from the bedsore, and a urinary tract infection. In the hospital, Mehdizadeh and Trinos watched as nurses treated the pressure wound with sanitary cleaning kits. They were impressed. When Hajimoradi returned to the nursing home 10 days later, Trinos took photos and notes to document the difference in wound care. She said staff didn't follow the specific instructions sent by the hospital and didn't have the same cleaning kits. She said staff didn't offer pain medication before using undiluted iodine on the open wound "while my grandma was crying and screaming." Unlike the careful cleaning process used in the hospital, where nurses changed their gloves twice, Trinos photographed a worker cleaning the infected sore with one gloved and one bare hand.

On June 21, Trinos and her mother noticed that the dressing for a pressure wound on her hand was missing and the air mattress to help with the bedsore on her grandmother's buttocks was deflated. Eventually, Trinos called 911 and Hajimoradi was returned to Credit Valley Hospital, where she remains. This time, she was admitted with a dark red early-stage ulcer on her tailbone and a deeper ulcer on her buttock.

Erin Mills Lodge was sold by Sifton Properties to Schlegel Villages on July 10 - after Hajimoradi left. Schlegel spokeswoman Rose Lamb said the former operators tried to work with Hajimoradi's family but said the family insisted on taking her to the hospital. Lamb also said a subsequent meeting between Erin Mills workers and hospital staff concluded there had been no neglect. Lamb said the home's current internal monthly data shows that four out of 86 residents have "worsening" pressure ulcers.

She also cited the most recent report from the Canadian Institute for Health Information, which shows the incidence of worsening pressure ulcers at the home declined in 2013-14. That year, Erin Mills' incidence rates dropped to 1.1 per cent from 3.9 per cent the prior year. The Ontario average for 2013-14 was 3.9 per cent. Hajimoradi developed problems with ulcers in the spring of 2015, a period that is not included in the report.

Clayden said any delay in reinstating surgeries beyond the end of the year would jeopardize the facility's future. A local family physician who performed anesthesia when Clayden operated there said he would need to upgrade his training if his skills are allowed to lapse. He's not prepared to give up his thriving practice for a couple of months to do that. Paulette Goossen, an official with Southern Health, the area's regional health authority, said while the plan was to reopen the Altona OR this month, she couldn't guarantee that will happen. "We are actively recruiting nursing staff to support that service," she said.

Goossen challenged the surgeon's description of the OR as state-of-the-art, saying it is not brand-new, like other sites in the region. The hospital opened in 1994. Only about 150 surgeries a year were performed there, she said. "It is more difficult in rural Manitoba, certainly in smaller communities, to attract nursing staff," she said. Goossen dismissed the idea of hiring private nurses to fill in so surgeries could be performed, saying it would be cost-prohibitive. Such a move would also lead to problems with continuity of care, she added. "It's more difficult to just bring people in who don't know the facility."

Clayden said the Altona OR was already vastly underused. His weekly surgical trips accounted for most of the operations done there, although dental surgery was performed there occasionally. When Progressive Conservative MLA Cliff Graydon raised the matter in the legislature in May, Health Minister Sharon Blady assured him the situation would be rectified "by the fall or sooner."

On Tuesday, Blady said there were challenges in filling nursing vacancies in the community. "I know that they are working on it. I would like it to have been resolved long ago," she said. The province has found it challenging to maintain adequate staffing of doctors and nurses in many rural communities. Blady said one answer may be to build "rural health teams," rather than to focus on shortages of one type of professional or another.

"Maybe the model needs to change," she said. "Maybe we need to see what it is that needs to be done differently so there is a stronger ability to recruit and retain folks." larry.kusch@freepress.mb.ca

But Dr. Alexander Simpson, CAMH's chief of forensic psychiatry, said the numbers aren't "comparing apples to apples." "First of all, we have the largest mental health facility by a long shot," he said. "We look after way more people with mental health problems than any other facility in the city."

The hospital also faces particular challenges when it comes to patients going missing, he noted. "CAMH, of course, has people here in recovery for quite a long time, and we're right in the middle of the city," Simpson said. "It's easy to walk out the front door and right onto the TTC."

The facility made headlines for a potentially dangerous missing patient earlier this week when an Ontario Review Board client absconded on the way to an off-site medical appointment in the Jane St. and Bloor St. W. area on Thursday afternoon. He was with a CAMH staff member at the time.

After a tip from a community member, police found Thomas Brailsford, 55, in Sunnyside Park on Friday morning, said Const. Victor Kwong. Police considered Brailsford a "danger to himself and others." In 2010, he was charged with first-degree murder after his mother was found beheaded in her Scarlett Rd. apartment. He was later found not criminally responsible.

CAMH said the hospital is "reviewing the specifics of what happened in this case to look for potential areas for improving our protocols." "We're also going to consult with CAMH and have a debriefing, if anything can be done better," Kwong noted. Brailsford previously went missing once before in 2014 on an unaccompanied community pass and he failed to return, according to Simpson. "He had more freedom at that point," Simpson said.

The decision for Brailsford to go out with the amount of supervision he had on Thursday seemed appropriate, Simpson said, based on a thorough review of his security level, clinical progress and co-operation. Within the forensics division of CAMH's Complex Mental Illness Program - which provides care and services for people like Brailsford who have serious mental illness and have come into contact with the law - Simpson said CAMH was concerned with rates of absconding and made major changes several years ago.

The hospital tightened the division's processes around assessing risk, followed international best practices and set up new standards and guidelines, he said. "Anyone who has breached a path, even 15 minutes later we notify the police," Simpson added. "That doesn't mean a rise in the number of AWOLs, but more reporting."

This led to a 40-per-cent drop in absconding rates within the forensics division after 2012, he said. But in regards to the overall missing person numbers reported by CAMH to the Toronto police, Mehra said she hopes the hospital "takes steps to better measure and protect patients under their care." "The hospital has a duty, absolutely, to protect them - and the public," she said.

The health authority introduced a compulsory “vaccinate or mask” policy in 2012. It came on the heels of a disappointing voluntary campaign in which just 46% of Horizon workers got the flu shot. Now vaccination rates are holding steady near 70% and absenteeism has dropped an average of two hours per employee. “Multiply that by 13 000 employees and it doesn’t take long to start saving some money,” said Babineau.

Minister Boudreau's comments after was, there are 22 hospitals in NB for a population of less and 700,000; do we need 22 hospitals?  The need to look at what is the best model; centers of excellence verses community health centers.  Looking at nursing home beds; could hospitals be converted to nursing homes?  He made comments regarding the average wages in NB was $50,000.00 per year and the attendance management; use of sick time and savings.  He made reference to the wage bills varying across department to department; is there savings there?  There is 4-5 million dollars to be cut and it will be challenging to find it.

I fully believe the decisions on health care have been made; made by the previous government and will be carried out by this government.  I believe they know exactly what they will do; which hospitals will close/convert to health centers/convert to nursing homes.When the Minister stated 22 hospitals for the population of NB; do we need that many, tells me they have been comparing our numbers to other provinces of the same size.   It's obvious to me based on what was said, reading between the lines and what was not said, health care and education will be hammered in this strategic review.   To wrap up, we walked away with a lot of questions; concerns as to what was not said. In Solidarity Norma Robinson,President NBCHU CUPE Local 1252

Why is the media so keen on portraying Big Pharma critics as crazy, uneducated, unscientific and irresponsible people?

Dr Marcia Angell worked for over two decades as editor of The New England Journal of Medicine.  She was fired after criticizing the pharmaceutical industry, which had exerted an overriding and negative influence on the scientific literature. She said: “It is simply no longer possible to believe much of the clinical research that is published.”

China has measles outbreaks but 99% are vaccinated

Mandatory Chickenpox Vaccination Increases Disease Rates, Study Shows

In a 2012 measles outbreak in Quebec (Canada) over half of the cases were in vaccinated teenagers

Seasonal Flu Shots still contain thimerosal.

Kennedy was in Sacramento to attend a screening of the film “Trace Amounts,” a documentary he claims helped halt a forced vaccination measure in Oregon.

Skyrocketing hydro rates are making Ontario less attractive to manufacturers, making it harder to replace the good jobs being lost at Bombardier or Ontario Northland, he said.

"Hydro rates started going up after Mike Harris and the Conservatives started privatizing generation, and they shot up with the Liberals' private energy deals, like the sole-source Samsung contract for wind," he said. "This will get much worse with the sale of Hydro One to private interests. We'll also lose the oversight of public accountability officers like the Auditor General." Hahn was speaking to a crowd of North Bay residents calling on Queen's Park to take action to stop the loss of good jobs and quality public services in their community.

The rally organized by the North Bay and District Labour Council, began at the Ontario Northland building, then made its way to City Hall. Speakers included Canadian Labour Congress President Hassan Yussuff, new Ontario Federation of Labour President Chris Buckley, NDP MP Charlie Angus (Timmins-James Bay), NDP MPP John Vanthof (Temiskaming-Cochrane) and Sharon Richer, vice-president of the Ontario Council of Hospital Unions

"It's Kathleen Wynne listened to Ontarians. Almost 85 percent of the public and 194 municipalities oppose the Hydro One sell-off," said Hahn. "The Liberals need to listen to the people, not to Bay Street. We need quality public services and good jobs in our communities. We need at-cost, not-for-profit electricity. We need profitable corporations to pay their fair share so working-class people don't pay any more for disastrous Liberal austerity and privatization schemes."

CUPE is Ontario's community union, with more than 250,000 members providing quality public services we all rely on, in every part of the province, every day. CUPE Ontario members are proud to work in social services, health care, municipalities, school boards, universities and airlines.

Underlying both reforms is a quiet resignation to the idea that two-tiered health care is inevitable. This sense of resignation is understandable, coming as it does on the heels of a decade-long void in federal leadership on health care. Throughout the Harper government's time in office, the Canada Health Act went substantially unenforced as private clinics popped up across the country. Even in its reduced role as a cheque-writer, the federal government took steps that undermined national unity on health care, switching the Canada Health Transfer to a strict per capita formula, which takes no account of a province's income level or health-care needs. If Canadians hope to reverse this trend, we cannot simply wage a rearguard battle for the enforcement of the Canada Health Act as it was enacted in 1984. Even if properly enforced, the act protects universal access only for medically necessary hospital and physician services. This is not the blueprint of a 21st-century public health-care system.

We desperately need universal coverage for a full array of health-care goods and services -- pharmaceuticals, mental-health services, home care and out-of-hospital diagnostics. Canada is unique among Organization for Economic Co-operation and Development countries in the paucity of what it covers on a universal basis despite falling in the top quartile of countries in levels of per capita health spending. Far from being our saviour, the Canada Health Act in its current incarnation is partly to blame -- not because of its restrictions on queue-jumping and private payment, but because it doesn't protect important modern needs, such as access to prescription drugs.

There are limits on what a public health system can provide, of course -- particularly as many provinces now spend nearly half of their budgets on health care. But fairness requires these limits be drawn on a reasoned basis, targeting public coverage at the most effective treatments. Under the current system, surgical removal of a bunion falls under universal coverage, while self-administered but life-saving insulin shots for diabetics do not. A modernized Canada Health Act would hold the provinces accountable for reasonable rationing decisions across the full spectrum of medically necessary care.

Instead of modernizing medicare, Saskatchewan and Quebec are looking to further privatize it. Experience to date suggests allowing two-tiered care will not alleviate wait times in the public system. Alberta has reversed course on its experiment with private-pay MRIs after the province's wait times surged to some of the longest in the country.

The current wisdom is long wait times are better addressed by reducing unnecessary tests. A 2013 study of two hospitals (one in Alberta, one in Ontario) found more than half of lower-back MRIs ordered were unnecessary. Skirmishes over privatization have to be fought, but they should not distract us from the bigger challenge of creating a modern and publicly accountable health system -- one that provides people the care they need, while avoiding unnecessary care.

Achieving that will make National Medicare Week a true cause for celebration. Bryan Thomas is a research associate and Colleen M. Flood is a professor at the University of Ottawa's Centre for Health Law, Policy and Ethics. Flood is also an adviser with EvidenceNetwork.ca.

The VON was trapped, and ultimately crushed, by that contradiction. It was not the first - the Canadian Red Cross Society's legendary blood transfusion service flamed out in an even more spectacular fashion with the taintedblood scandal in which 20,000 recipients contracted hepatitis C or HIV - and it will not be the last. Canadian Blood Services has taken over the former Red Cross role.

The health-care advocacy group Friends of Medicare said the neardemise of the VON is proof that "experiments in private care must be ceased." But the VON's story is much more complicated than the "public, good; private, bad" and "notfor-profit, good; for-profit, bad" narrative. For a long time, governments funded not-for-profit groups in the health and social services sectors - hospitals, home care, group homes, the Red Cross and so on - in a pretty loosey-goosey fashion. These groups did good, and they were funded relatively well.

But as budgets soared, new accountability measures were put into place. In the home-care sector, for example, competitive bidding was introduced. Stodgy old organizations such as the VON were not ready, and did not adapt. Their market share fell from more than 90 per cent to about 20 per cent. On the surface, this is a good thing. Canadians spend $219-billion a year on health care, including about $10-billion on home care, and, as consumers and taxpayers, they deserve to get value for money.

While we like to preach the gospel of value-for-money, we don't measure it well - the ultimate irony being that expensive bureaucracies have been built to ensure home-care agencies are lean and mean. The VON had many disadvantages in a competitive market.. place - first and foremost that it never provided just home care to its clients. It delivered hot meals, made friendly visits (especially to veterans), ran adult daycare programs, provided respite care to families, visited new mothers and babies, did flu shots at home and did countless other little things that never had a place in the accounting ledger. Some were covered by government payments, but many were not. The VON supplemented its funds from government contracts with charitable donations. It had more volunteers (9,000) than staff (6,000). The VON also paid its workers a decent, living wage. The work force - mostly nurses and therapists - is unionized, salaried and they have benefits, including a pension plan.

In the brave new home-care industry, piecework is the norm, meaning nurses get paid per visit, and few have benefits, pensions or stable employment. It is also in the interest of workers (and employers) to get visits done quickly, and cram as many as possible into a day. While this is a cost-effective business model, anyone with a loved one in home care knows that there is little continuity of care. The relationships that are so important to intimate acts such as health-care delivery to frail seniors living at home are virtually non-existent. When you have a strict business model, when all that matters is the much-vaunted bottom line, none of that gets counted.

The real tragedy in the VON's unravelling is not that another home-care business is biting the dust (after all, there are hundreds more out there), but that the "old-fashioned" way of delivering care - taking the time required to talk and listen to patients and treating them as people, not "units of service" for example, not just changing their dressings, but feeding them and filling the fridge - is falling by the wayside. With the VON's collapse, we have a home-care system that may be more efficient - at least in theory - but one that has less heart.

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.

The CDC is launching a public education campaign for nursing homes aimed at preventing more bacterial and viral infections from starting and stopping others from spreading. A similar effort was rolled out for hospitals last year.

"One way to keep older people safe from these superbugs is to make sure antibiotics are used appropriately all the time and everywhere, particularly in nursing homes," said CDC Director Tom Frieden in announcing the initiative. Studies have estimated antibiotics are prescribed inappropriately 40 per cent to 75 per cent of the time in nursing homes. Here's why that worries the CDC: Every time someone takes antibiotics, sensitive bacteria are killed but resistant bacteria survive and multiply - and they can spread to other people. Repeated use of antibiotics promotes the growth of antibiotic-resistant bacteria. Taking antibiotics for illnesses the drugs weren't made to treat - such as the flu and common colds - contributes to antibiotic resistance.

Antibiotics also wipe out a body's good infection-fighting bacteria along with the bad. When that occurs, infections like Clostridium difficile can get out of control. C. diff. leads to serious diarrhea that each year puts 250,000 people in the hospital and kills 15,000. If precautions aren't taken, it can spread in hospitals and nursing homes. Health-care facilities already have infection-control procedures in place, such as providing private rooms and toilets for infected individuals. But the CDC is pushing them to do more on the prescribing side, advising nursing homes to track how many and what antibiotics they prescribe monthly and what the outcomes were for patients, including any side-effects.

Other recommendations include placing someone, such as a consulting doctor or a pharmacist, in charge of antibiotics policies and training other staff in following them. Some of the CDC's suggestions could challenge nursing homes' culture and how staffs, residents and their families interact. While nursing home residents and staff are among the people most at risk for the flu, annual shots aren't mandatory. Nor do homes always track who gets them.

That's starting to change at Evangelical Lutheran Good Samaritan Society, a nonprofit that provides a spectrum of senior care services in many states. Starting this year, it will collect data on staff vaccinations at one of its 167 nursing homes and share the pilot project's results with other homes, said Victoria Walker, chief medical officer. But better handling of antibiotics in nursing homes may also require tactful communication with residents' families and nursing home doctors accustomed to treating antibiotics as a default remedy.

"There's a real fear of undertreatment and that it is better to err on the safe side, and that means treating with antibiotics but forgetting about all the harms. But giving antibiotics can be just as harmful as not," said Walker. Family members may push for an antibiotic treatment when they visit a loved one in a nursing home who seems sick, even if they don't know precisely what's wrong. Doctors and nurses may go along because they don't know either and it's easier to treat than not. "The family will check in and ask what the doctor did and the nurse will say 'nothing' because they don't see monitoring as doing anything," said David Nace, director of long term care at the University of Pittsburgh, who contributed to the CDC guidelines.

"Practitioners are guilty of saying, 'it's just an antibiotic.' ... We don't appreciate the real threat," he said. Antibiotics are routinely prescribed to treat urinary tract infections, which are common in nursing homes, but too often when a UTI is only suspected, not confirmed, studies have found. The Infectious Disease Society of America is developing guidelines to help institutions implement programs to better manage antibiotics. In addition to fostering antibiotic resistant bacteria and causing C. diff infections, antibiotics also can produce allergic reactions and interfere with other drugs a nursing home resident is taking. Those risks aren't always fully considered, says researcher Christopher Crnich, who has published articles on antibiotic overuse. He is a hospital epidemiologist at William S. Middleton Veterans Hospital in Madison, Wisconsin. "Bad antibiotic effects don't come until weeks or months later, and frankly all we [prescribers] see is the upside when we're dealing with a sick mom or dad," Crnich said.

The Centers for Disease Control in the United States has raised concerns about the use of antibiotics in nursing homes.