CUPE Health Care

The veteran medical officer of health said the proposal suggests municipalities would pay the same share of the new health units'operation as they do now - 25 per cent - but he argued they could receive "quite a bit less representation."

He said it would also require "a huge commitment from government, which we have not yet seen" and on an "exceedingly tight" deadline.

"At least three major pieces of legislation would have to be changed to accommodate this," said Gemmill.

"I've seen a lot of them ... they don't really save money.

"I don't foresee amalgamations happening," Gemmill said, recalling the mergers of municipalities and school boards.

"I would not see the public health work force jeopardized in any way," he added. "There are very well-trained people who are doing a great job and that needs to be maintained."

Before his 2016 retirement, Schabas said health units could possibly save money by sharing a single medical officer of health and sharing some services. Schabas worked two days per week and was otherwise on call. He was paid $244,317 in 2016.

At the time of Schabas'remarks, Paul Huras, the chief executive officer of the South East Local Health Integration Network, said it was worth considering but sharing services may not work because of health units'distinct mandates. Huras said health units could benefit from better links with other health care providers and, if they could save money, may have more to spend on front-line staff.

Gemmill said health unit staff and Huras will meet Monday.

Board member Egerton Boyce, a Belleville councillor, said he attended a recent AMO panel on the subject. He said he left with the impression the concept is "likely not going to happen for a long time."

Health board members referred the matter to their governance committee and are expected to provide the resulting feedback to the health ministry. "There's merit to looking at the system," Gemmill told reporters. "It's been 50 years since the last time it was restructured in a major way." But he said the changes would be "a mammoth chore" and remain "very unlikely" before the election

"That included Mount Sinai Hospital, the Hospital For Sick Children, Sunnybrook Hospital and McMaster University Centre," said MacDonald.

"All of which were either closed or restricted."

According to the Mount Sinai Hospital website 1,100 babies are admitted to that hospital's Newton Glassman NICU each year.

He pointed out that so far no babies have needed to be sent outside of the province.

Ontario Ministry of Health and Long Term Care officials confirmed that some NICUs are facing an unusual "surge," in critically ill babies, but emphasized the situation is temporary and that they are working with the Local Health Integration Networks and affected hospitals to take immediate action.

"This is a fluctuating situation and hospitals are working closely and in coordination to manage these pressures," said Mark Nesbitt, ministry spokesperson.

"The NICU situation continues to show improvement since last week, this is consistent with the fluctuating nature of patient flow."

Nesbitt says there is no single cause for the sudden increase in babies requiring highly specialized care.

"On Tuesday night of last week (Aug. 22) the possibilities were that the child would have to go to Ottawa or possibly out of province."

"The situation is stabilizing," said Nesbitt on Sept. 1.

"While we know there is always more work to do, investing in health care is a top priority of our government. That's why as part of the 2017 Budget, we are investing an additional $518 million in all public hospitals, a 3.1 per cent overall increase to the hospital sector, to improve patient access to care, reduce wait times, and improve the patient experience for all Ontarians at their local hospital."

He said the ministry is monitoring the situation and will increase NICU capacities as necessary.

While MacDonald said he is optimistic the right people are now listening he pointed out that on Aug. 28 there were still issues at McMaster University Centre because their transport team, which picks up the sick babies from other hospitals did not have enough nurses.

He argues that ultimately this is a government funding issue, which needs to be resolved to expand the capacity of the NICUs at these children's hospitals.

"They have pared down things so much and have gotten away with it in the past and have been able to send babies to other units within the metro area, but for this cycle this wasn't a possibility," said MacDonald.

"There is a need for government funding, not just for beds, but for nurses. Nurses are critical to the running of a NICU. They look after the patients. We of course have to make decisions about how to manage the patients, but the nurses are the ones that deal with the kids from minute to minute. They are with them all the time and if they don't have enough nurses to staff the units then the units will close or the transfer team will close down, like what happened on Monday."

MacDonald also pointed out that while the province is attributing this problem to a "surge" in critically ill babies, the NICU bed shortage has really been happening on a smaller scale for years.

"It is only getting worse with the government cutbacks."

He attributes this reaction to the reality that NICU bed shortages is not a local issue, but a national one with similar problems recently reported in the Maritimes, Alberta, Manitoba and British Columbia.

Many within the system believe allowing private, for-profit options is a potential solution. Government has always relied on private facilities such as walk-in clinics, X-ray clinics and laboratories to provide insured services within the public system. Perhaps it’s time to allow Canadians to purchase medical services on the open market.

Although a province may have an oversupply of surgeons, it has a shortage of the other disciplines. The hours nurses and anesthesiologists work in the private system would come at the expense of the hours they can devote to the public system.This is a key caveat on the argument in favour of allowing more private, for-profit health care options: it is difficult to create a private tier that does not ultimately weaken the public tier. In fact, it is tough to find examples where increased private options relieve pressure on the public system and reduce wait times.

There is some evidence of this in Saskatchewan, where the government has been allowing private, for-profit MRIs for about 10 months. To date, Saskatchewan claims it has taken 2,200 patients off public wait lists for MRIs. And yet, its wait times in the public system have not gone down.

In fact, during the first six months Saskatchewan allowed residents to purchase their own MRI tests, the government’s own website shows wait times went up.

As of Sept. 25, 2,859 patients had waited longer than three months for surgery — failing to meet the target of less than 1,934 waiting longer than three months. Based on the “current mismatch” between funded volumes and increasing demand, the region projects a minimum of 3,500 patients will wait longer than three months for surgery by the end of the fiscal year.

As of September, the region had a $6.6-million deficit. The overall deficit is projected to grow to around $13 million, but Dewar said the region continues to work hard to reduce that projection. The issues: In September, staff on the adult mental health unit at the General Hospital received layoff notices to align staffing with the needs of the unit. There will be more layoffs in the future, Dewar said.   Other measures to reduce the deficit include reducing sick time and overtime. That is hard to do if there continues to be overcapacity issues — when there are more patients waiting to be admitted than there

Hospitals have fixed budgets and must not run over them the way the mega-hospital has been doing, Gaétan Barrette warned. You can't just keep accepting patients and treating them once the money has run out. It won't be tolerated.

Barrette, who is a doctor himself, might not be the canniest of politicians. Usually, Canada's elected leaders at least publicly play along with the fiction that every Canadian receives proper treatment, free of charge, in a timely manner.

First, there is no "Canadian health-care system." There are a bunch of health-care systems, one per province, with all the inherent inefficiencies that suggests, partially funded by the federal government, which is supposed to oversee things, but gave up ages ago.

The Conference Board of Canada says that if you live in Ontario, you get better health care than you do if you live in Quebec, where you will pay far higher taxes.

Second, the system is somewhat corrupt; if you have influence or an elite education or some "in," you'll get better care than a fellow who doesn't.

None of that, of course, is to mention all the Canadians who head to an American city (or somewhere like India) and pay, in order to circumvent Canadian waiting lists for other procedures.

Third, the idea we'll be cared for in our dotage is aspirational, not anchored in law.

The oldest boomers are now 70, and it's at age 75 that people really start to soak up medical care. So will the system expand to accommodate the surge in need that's coming?

Livio Di Matteo, a health-care economist at Lakehead University

Canadian law actually forbids the private purchase of medically necessary care.

But everyone knows you can pay for a private MRI scan in many parts of the country if you don't want to wait nine or 10 months or longer for one in a hospital.

And if you don't want to languish in unbearable pain, there are places in Canada where you can buy a private hip replacement or orthopedic surgery. By and large, the federal government just pretends it doesn't see.

The federal government, which has been increasing its health-care transfers to the provinces by six per cent a year, wants to cut back, claiming the provinces haven't been spending it all on health care anyway.

As Di Matteo puts it: "If you are willing to let people cross the border and do it, why not give them the option in Canada, where they live" and save them the trip?

Doctors remove a cyst from a male patient's knee at the Cambie Surgery Centre, a private clinic in Vancouver that's at the centre of a landmark case before the B.C. Supreme Court. (Darryl Dyck/The Canadian Press)

While the findings and recommendations are not binding, Smith said they highlight the challenges faced by African Canadians for the international community and hopefully put more pressure on Ottawa to rectify the inequities. "The situation is only going to get worse," Smith said. "We have families in the community torn apart at an alarming rate. "The future looks pretty bleak for our young people."

The UN delegation was in Toronto, Ottawa, Montreal and Halifax to meet with government officials, community members and rights groups to identify good practices and gaps in protecting the rights of black people. "We had been trying to secure a visit to Canada for a long time. It's a great joy that we were officially invited here," the working group's chair Ricardo Sunga told the Star in a phone interview Tuesday. "We look at Canada as a model in many ways when it comes to human rights protection.

We appreciate Canada's effort in addressing discrimination in various forms, but no country is exempt from racism and racial discrimination." Despite the wealth of information on socio-economic indicators in Canada, the investigators criticized the "serious" lack of race-based data and research that could inform prevention, intervention and treatment strategies. "The working group is concerned that the category 'visible minorities' obscures the realities and specific concerns of African Canadians," its report said. "There is clear evidence that racial profiling is endemic in the strategies and practices used by law enforcement. Arbitrary use of 'carding' or street checks disproportionately affects people of African descent."

The overrepresentation of black people in the criminal justice system was of particular concern for the group, who found African Canadians make up only 3 per cent of the population but account for 10 per cent of the prison population. In the last decade, the number of black detainees in federal correctional facilities has grown by 71.1 per cent, it warned. Among other findings by the UN experts: Across Canada, African Canadian children are being taken into child welfare on "dubious" grounds. Forty-one per cent of children in Children's Aid Society of Toronto's care were black when only 8 per cent of children are of African descent. The unemployment rate for black women is 11 per cent, 4 per cent higher than the general population, and they earn 37 per cent less than white males and 15 per cent less than white women.

A quarter of African Canadian women live below the poverty line compared to 6 per cent for their white counterparts. One-third of Canadian children of Caribbean heritage and almost half of continental African children live in poverty, compared to 18 per cent of white Canadian children. Chris Ramsaroop, an advocate with Justicia for Migrant Workers, hopes the report will raise awareness of the plight of African Canadians. "We need every opportunity to hold the feet of the federal and provincial governments to the fire," he said. The UN experts recommend a national department of African-Canadian affairs to develop policies to address issues facing black people and implement a nationwide mandatory disaggregated data collection policy based on race, colour, ethnic background and national origin.

Odion Fayalo, of Justice is Not Color Blind Campaign, protests racial profiling before a Toronto Police board meeting. • René Johnston/TORONTO STAR file photo

Neighbors held a fundraising drive, gathering nearly $10,000, but by then the bills were so great that the money was gone within a week.

Scott D. Ramsey, MD, is the director of the Hutchinson Institute for Cancer Outcomes Research7 in Seattle. Health economist Veena Shankaran, MD, is a medical oncologist and an associate member of the Hutchinson Institute for Cancer Outcomes Research.

"We are in frequent contact and continue to co-operate" with U.S. authorities, Valeant said in a written statement. "We do not comment on rumours about investigations, and cannot comment on or speculate about the possible course of any ongoing investigation. Valeant takes these matters seriously and intends to uphold the highest standards of ethical conduct." A Pearson lawyer, Bruce Yannett, declined to comment. Dan K. Webb, a lawyer for Schiller, didn't immediately comment. Spokespeople for the FBI and Preet Bharara, the U.S. attorney in Manhattan, declined to comment. Jonathan Rosen, a lawyer for Philidor, didn't respond to requests for comment.

No charging decisions have been made and the case remains fluid, the people said. The U.S. Justice Department could settle with the company and later take action against individuals, one person said. Valeant shares dropped more than 12 per cent to $17.84 in New York, the lowest closing pricing since June 2010. The company's most actively traded debt, $3.25 billion of 6.125-per-cent notes due in 2025, dropped 2 cents to 77 cents at 4:09 p.m. in New York according to Trace, the bond price reporting system of the Financial Industry Regulatory Authority. Prosecution of top corporate executives over accounting fraud allegations is a rare step, and the complexity of such cases can make them hard to bring. More recently, enforcement efforts shifted toward Wall Street in the wake of the financial crisis. Top officials at the U.S. Securities and Exchange Commission (SEC), where many accounting fraud investigations begin, have called for a renewed focus on corporate accounting improprieties over the past few years, but so far few cases involving companies as large as Valeant have emerged. Laval, Quebec-based Valeant, once a darling of Wall Street, has drawn scrutiny in recent years for its practice of acquiring drugs and dramatically increasing their prices.

While the precise contours of the government's case against Valeant aren't clear, allegations of questionable company practices have emerged in the past year as lawsuits and government investigations mounted. Pearson, the former CEO, was a key architect of Valeant's growth over the years. He stepped down from his role last spring and continues to work as a consultant to the company from a Valeant office near his home, according to the people familiar with the matter. Schiller was blamed by Valeant for "improper conduct" that led the company to restate its earnings for 2014 and 2015, an assertion disputed by Schiller. He stepped down as CFO in 2015 and left the company board this year.

U.S. prosecutors in Boston and Philadelphia are also said to be conducting separate inquiries of Valeant. Boston's investigation, according to a person familiar with the matter, focuses on Valeant's payments to charities that then helped patients make co-payments for the soaring cost of Valeant drugs, some of the most expensive on the market. The Philadelphia case is examining Valeant's billing of government health-care programs for the company's drugs, another person said. The U.S. Attorney's Office in Boston didn't respond to a request for comment. Michele Mucellin, a spokesperson for the U.S. attorney in Philadelphia, declined to comment. Valeant said in October 2015 that federal prosecutors in New York had issued subpoenas seeking information on the company's drug distribution and pricing decisions. It later disclosed an investigation by the SEC. Judy Burns, an SEC spokesperson, declined to comment. Short-sellers first raised questions about Valeant's accounting practices and relationship with Philidor a year ago. As it turned out, Valeant had offered Philidor executives tens of millions of dollars in incentives to sell its products at a time when the relationship between the companies was still secret, according to hundreds of pages of evidence released by U.S. Senate investigators this year. Though they were nominally separate companies, Valeant was Philidor's only client, a class-action lawsuit in New Jersey alleges. Valeant ultimately acknowledged its financial control of Philidor.

In February, Valeant restated its results for 2014 and 2015, disclosing it recorded $58 million in revenue from Philidor earlier than it should have.

"The plaintiffs state that the negligence of the defendants was the sole cause of Mrs. Scott's death and the losses the plaintiffs suffered as a result of Mrs. Scott's death," the claim states. In the negligence claim, her sons - Bruce Findlay Scott, Glenn Carne Scott, and Thomas Andrew Scott - allege that the retirement home hired incompetent staff, failed to screen staff and failed to properly instruct and supervise its staff. The claim says the retirement home also failed to ensure that staff had the right equipment and did not have a proper program of inspection for the maintenance and use of mechanical lifts. The claim also states that the retirement home "knew that its staff ... were using toileting slings to transfer residents, and that this practice posed a serious threat to the health and safety of its residents, but did not take adequate steps, or any steps at all, to stop this practice." The Scott sons also claim that the retirement home failed to warn their late mother about its "dangerous conditions."

The Ottawa Jewish Home for the Aged has not yet filed a statement of defence but is expected to do so. The Scott brothers' claim, which has not been proven in court, is seeking $225,000 in damages for loss of care, guidance and companionship as a result of their mother's death, plus funeral expenses. The Scott brothers have also named the retirement home's staffing agency in the lawsuit.

5. Most physio clinics are now fee-for-service. The two local clinics which accept patients under OHIP coverage have waiting lists of up to nine months. 6. Patients are denied day surgery unless they have (or can hire) someone to spend the first night post-surgery with them. 7. Costs of equipment and supports have skyrocketed and the government no longer funds a local lending cupboard where people used to be able to pay a refundable deposit for the loan of a walker, cane, wheelchair, bath seat etc. Crutches are now $40 and the cost of an air cast is a minimum of $140 plus tax.

Back in 2014 the health minister urged us to report any indications of creeping two-tier coverage. Over the past two years letters and e-mails to his office have not earned the courtesy of a reply. But one recent letter, forwarded to the minister by our local MPP, did elicit a prompt response. After salutations the minister's assistant courteously and concisely advised that "the ministry receives correspondence from people all over Ontario who offer advice and insights on various issues. Hearing those views is essential to help shape a province that reflects the needs and concerns of all Ontarians. Thank you for writing."

In bureaucratese this can be interpreted as meaning "The ministry has received your correspondence and appropriately filed your letter in the colossal, specially designated parliamentary shredder." Christmas is approaching. It appears that, unless the Health Minister is visited by Three Spirits, we may soon have many more Tiny Tims in our neighbourhoods --people who could have been fit, healthy and often employable had they been able to afford prosthetics or medications or therapies to strengthen and heal their traumatized bodies.

And the priceless legacy of free universal health care, so courageously fought for and won for all of us by the incomparable champion of the disadvantaged Tommy Douglas, will be lost forever. Carol Winter McDonnel St.

If it seems like Big Pharma has escaped accountability for its role in perpetuating the nation's deadly opioid epidemic, those suspicions are not unfounded. According to a former top Drug Enforcement Administration (DEA) official, the industry's influence over Congress has successfully quashed efforts to regulate the pharmaceutical drug market aiding an unprecedented addiction to legal drugs.

Much of the friction at a meeting of federal, provincial and territorial health ministers in Toronto two weeks ago stemmed from the Liberal government's plan to adopt the former Conservative government's decision to slash funding in half as part of a new health accord starting next April.

He said regional "piecemeal innovations" that need to be scaled up include British Columbia's tracking of medications that allow various doctors to electronically check a patient's prescription history.

Ontario has been a leading province using multi-disciplinary teams including physicians, nurse practitioners, counsellors and other professionals as part of a primary-care model, he said.

We know that funding some non-physician-provided community mental-health services is something that Canada ought to move forward on in a more concerted fashion," he said, adding that like doctors, counsellors should be allowed to bill the public system. "That's a new service-provider group and it's threatening in some sense to some of the current service providers."

Ontario Health Minister Eric Hoskins predicted that the reduction in the annual "escalator" to three per cent would result in a "declining partnership." Yet considering Ottawa contributes only 23 per cent of the average provincial health budget, the three per cent difference in the annual "escalator" translates into a reduced rate of increase of only 0.69 per cent! Much of this is mere political bluster! Is it not finally time to revisit the Canada Health Act and fine-tune it?

As Konrad Yakabuski has stated (Globe and Mail, Oct. 19), "As long as the provinces remain bound by the Canada Health Act, which constrains their ability to dramatically alter the way health care is paid for and delivered, any new conditions on the use of federal transfers are only likely to further weigh down an already overly bureaucratic system."

When it was passed in 1984, it was understood that the federal government would pay half of health costs. Now it covers less than a quarter. Thanks to Ottawa's admission of refugees and migrants, overall growth of an aging, sicker population, new diseases, and new technologies, the provinces must shoulder an increasing burden.

Yet as Bacchus Barua (Ottawa Sun, Oct. 21) has stressed, more efficient health care systems in Europe allow a greater role for the private sector, use co-payments and user fees (with exemptions for the poor and elderly) and fund hospitals according to activity, not by global budgets, which have been frozen in many provinces.

MDs could be required to work - perhaps 25 to 30 hours per week - in the public system in order to receive government reimbursement for malpractice insurance. Most MDs would confine their practice to the public system. They deserve fair treatment. Thus Philpott should amend the CHA to mandate binding arbitration when provincial negotiations fail.

For those not a member of a "special group," the main option for timely care may be to go to the United States. This provides employment to American doctors and nurses and profits to U.S. hospitals. Would it not make more sense to allow all Canadians to spend their after-tax discretionary income on their own health in their own province?

Frozen hospital global budgets have caused excessive wait times for knee and hip replacements as operating rooms are often not functioning at full capacity. According to a 2013 survey, 15 per cent of Canadian surgeons considered themselves underemployed and 64 per cent cited poor access to ORs. Hence if orthopedic surgeons had access to additional "private" OR time, wait times could be shortened. If hospitals were permitted to operate electively on Americans and other foreign patients, this would bring in extra revenue for hospitals and relieve the strain on provincial health ministries.

Philpott has vowed to do more than just "open the federal wallet." She admits that "innovation" is required. Yet governments are being constrained by blindly adhering to certain parts of the CHA. Despite denials by politicians, a "two-tier" system has always existed. Federal prisoners, WSIB patients, members of the military and RCMP, politicians and professional athletes usually obtain more timely care - often at private facilities.

When the premiers meet with Prime Minister Justin Trudeau in December, besides discussing funding of the new Health Accord, they need to revisit the CHA and begin putting forth proposals as to how best to amend and modernize it. Where wait times are excessive, certain diagnostic services and surgical procedures should allow for private access for all Canadians - not just a select few.

This would utilize expensive equipment and provide new employment for nurses, technicians and surgeons. It would provide extra revenue - from both inside and outside the country - that would help to keep universal public health care sustainable and accessible for all Canadians. Ottawa should then enforce all sections of the CHA on all provinces and territories.

Ottawa physician Dr. Charles Shaver was born in Montreal. He graduated from Princeton University and Johns Hopkins School of Medicine. He is currently chair of the section on general internal medicine of the Ontario Medical Association.