Mental health centres must reduce risk to staff and patients

Local 500 President Nancy Pridham during a 2008 press conference addressing assaults at the Toronto hospital. Six years later the same problems persist with the union calling on the Ministry of Labour to charge the employer under the Occupational Health and Safety Act.

Local 500 President Nancy Pridham during an October 2008 press conference addressing assaults at the Centre for Addiction and Mental Health. Six years later the same problems persist with the union calling on the Ministry of Labour to charge the employer under the Occupational Health and Safety Act.

Client Empowerment Council at Ottawa’s psychiatric hospital say they became advocates for the safety of the care team because a “safe place for staff members increased patient safety as well.”

In a statement issued by The Royal November 26, mental health advocate Claude Lurette spoke about his own regret at lashing out at others while a patient at the hospital. “It wasn’t until I became solid in my own recovery of living with bi-polar disorder that I came to understand that the best thing I can do is to own my behaviour and learn what I need to learn in order to minimize the chances of it happening again,” he writes. “It is hard to find the words to express how much I appreciate the nurses and other staff who took care of me even when my behaviour was unpredictable.”

The Royal was publicly responding to the court proceedings following charges laid against the hospital under the Occupational Health and Safety Act. In the alleged incident a patient choked and assaulted two nurses and a support worker in the Royal’s Recovery Unit.

The Royal faces numerous charges around failing to take reasonable precautions to protect worker safety.

Their woes may not be entirely over with these court proceedings. In October, a nurse at the Royal’s Brockville site was allegedly stabbed multiple times in the neck, narrowly missing her carotid artery. She survived the encounter, but the hospital has received an extraordinary interim order by the Ontario Labour Relations Board to provide formal security in the nurse’s unit 24-7.

Stories about patient assaults are always very difficult because of the risk of further stigmatizing persons with mental illness. The truth is that a person with mental illness is more likely to be the victim of violence than the perpetrator of it. With so few beds left in Ontario’s psychiatric hospitals, there is a filtering process that takes place so that patients finding their way into one of these beds are more likely to be a risk to themselves or to others. That should be a call to administrators to step up their efforts to keep everyone safe.

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Transformation or austerity? Hospitals lose further capacity in new round of cuts

Photograph of large Kathleen Wynne puppet at the November rally against privatization of hospital services.

Protest last month over plans to contract hospital services to private clinics. Competitions have not been announced, but hospitals are cutting diagnostic and lab jobs, suggesting the government may be trying to achieve the same aim by stealth.

In October a Whitby nursing home experienced a major fire displacing more than 250 residents.

About 80 of those residents found temporary accommodation in area hospitals. Many are still there for lack of available alternative long term care spaces in the community. It’s remarkable the public hospitals were able to accommodate this many residents given the limited availability of beds.

Hospitals are presently in the third year of a base funding freeze. The Ontario government has maintained that the freeze is part of their overall health care transformation plan, but the Whitby experience would suggest that there is increasingly less flexibility due to funding shortfalls across the entire system. In another year or two how many beds will be available under a similar emergency?

The previous Auditor General of Ontario warned in 2011 that restraining annual health care funding increases to a proposed 3.6 per cent would lead to either service cuts or rising deficits. Instead we have seen health care funding increases limited even further to roughly 2 per cent.

In recent weeks a number of hospitals have been meeting with their respective unions to give notice of layoffs in the coming year. This is starting to become an annual holiday season tradition worthy of a Charles Dickens novel.

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Wynne and Clark cling to discredited P3s despite damning report

Photograph of ballot counting during the 2013 Ontario Health Coalition plebiscite on P3s in Kingston.

In 2013 Kingston residents voted overwhelmingly against a proposed P3 hospital in their city. Despite the results, the Province signed a contract to use expensive private financing to build a new facility to replace Providence Care Mental Health.

Infrastructure Ontario CEO Bert Clark says the $8 billion premium the government spent to build public infrastructure under the public-private partnership model doesn’t tell the whole story.

He’s right, but likely not in the way he’s suggesting.

Remarkably Tuesday night Clark clung to the $14 billion in savings Infrastructure Ontario says is made possible through the privatized model of infrastructure development even though the Auditor General made it clear that figure is based on flawed comparisons and a lack of empirical data to support it. In today’s Toronto Star he downgraded it to $6 billion.

Infrastructure Ontario was not so brazen in its initial response to Auditor General Bonnie Lysyk’s recommendations. Most of their responses in the AG’s report make minor admissions and rely on “third party experts” to justify the rest.

As we stated Tuesday afternoon, just two errors in cost allocation identified by the AG is enough to suddenly swing 18 privatized projects into the public column, saving the public treasury $350 million. Did their “third party experts” notice these errors?

In yesterday’s Star Clark highlights the Union Station renovation and the subway extension to York University as counter examples of public procurement projects that have experienced cost overruns and delays.

By contrast Lysyk points out there were in fact eight P3 projects that were delayed longer than 60 days – the longest more than a year off schedule. For six of those projects the contractor did face financial consequences, but in two they did not. That’s eight out of 38.

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Eight billion reasons why we were right about P3s

2006 photo of P3 protest.

P3 protest in 2006. Pity the government didn’t listen then. In 2014 the Auditor General of Ontario says P3s have cost us $8 billion more.

If there is any trace of self-respect left within the Ontario government, Premier Kathleen Wynne should do the right thing and pull the plug on Infrastructure Ontario’s public-private partnership (P3) program now.

Auditor General Bonnie Lysyk delivered a devastating blow to a program that obscured its shortcomings for years in an overflowing super-sized container of gobbledygook.

For all the assurances Infrastructure Ontario could manufacture, it turns out that value for money came down to the “professional judgment and experience” of third-party private sector “advisors.” As Lysyk states in her report, “the probabilities and cost impacts are not based on any empirical data that supports the valuation of risk.”

For a government that has been hammering public sector workers, shuttering hospital clinics, and denying patients access to home care in the name of fiscal restraint, the Auditor General made clear they were more than willing to spend $8 billion more than necessary on private consortiums to build infrastructure in this province – the majority of it in health care. About $6.5 billion of that amount is represented by higher financing costs borne by the private sector – a general point the previous Auditor General made in the evaluation of the William Osler P3 deal in 2008.

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Drugs: “Medicare’s unfinished chapter”

Picture of prescription drugs.

Momentum is building for universal coverage for prescription drugs. (www.canstockphoto.com)

Prepare for a wave of misinformation about the costs of providing universal pharmaceutical coverage in Canada, especially now that momentum appears to be building towards the idea.

The most recent endorsement comes in the form of an editorial in the Globe and Mail Sunday which strongly supports universal access. “It makes no sense to divorce pharmaceutical treatment from the principal of universality,” the Globe states. “More and more health care is pharmaceutical care and Canada is the only developed country with universal health insurance that doesn’t provide full coverage for medications.”

The Toronto Star made its own endorsement in an editorial November 28, calling pharmacare “medicare’s unfinished chapter.”

An endorsement by the Globe is likely a stand-in for approval from Bay Street – not entirely a surprise given the obvious advantages to employers. Drugs are the largest benefit cost they face and the premiums have been escalating faster than inflation. The overall savings of a universal public plan – estimated to be as much as $10.7 billion annually – would easily offset any tax adjustments (if any) necessary to cover such a plan. Those savings represent about five per cent of all health spending – both public and private.

The Globe is endorsing the idea of universality, but has so far reserved comment on a publicly administered system suggesting more study is needed.

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Relationship building with the LHINs

Health care providers have found religion when it comes to involving patients in the planning and decision-making process. At this year’s OHA HealthAchieve every administrator was quick to extol the virtues of soliciting community participation.

In a meeting in Belleville yesterday, Paul Huras, CEO of the South East Local Health Integration Network, told us they constantly review new proposals from a patient perspective.

That, after all, is what this is all about.

LHINs are also subject to a parade of presentations by health care administrators that tend to gloss over the problems and highlight the progress, unless the problems are leading to a specific ask. Let’s face it, who wouldn’t want to look as competent as possible before the funding body they report to? That does mean, however, the LHINs are not always seeing the complete picture, especially the many realities not captured by scorecard data.

Contrary to former Ontario PC Leader Tim Hudak’s wild assertions about the LHINs being some huge bureaucracy, the reality is they are tasked with a big job and very little in the way of resources. We all want accountability, transparency, community consultation and responsive regional planning — the question is, how much are we willing to pay to get it? Last year Huras’ LHIN transferred a little more than $1 billion to provide health services in his region – about two-thirds of that going to hospitals. The amount Huras has to run his own administrative shop? In 2012-13 it was about $4.6 million – a drop of about $200,000 from the previous year. The LHINs have not been immune to government austerity.

Our meeting with Huras was the second around a proposed redesign of mental health services within the SE LHIN. In addition to OPSEU staff, there were front line representatives from Providence Care, Hotel Dieu Hospital and Frontenac Community Mental Health and Addiction Services.

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Tories unlikely to stop Bill prohibiting paid plasma, but why are they even trying?

Picture of protest against the closure of the CBS Thunder Bay plasma clinic in 2012.

2012 protest in Thunder Bay against the closure of CBS’ plasma clinic. Health Canada claims — without any evidence — that self sustainability in blood products in impossible under a volunteer system, but we’ll never know if CBS continues to downsize its operations.

The Ontario Tories recently have appeared to be distancing themselves from some of the more unpopular positions adopted by the party under Tim Hudak.

Voting for second reading of an Act intended to close the door on paid collection of blood and blood components by the private sector, the Tories n one-the-less seem incapable of parking their ideology at the door as Bill 21 finds its way into committee.

For two days the committee is conducting hearings into the legislation, seeing a parade of mostly private sector lobbyists lined up on one side and mostly family and survivors of Canada’s last tainted blood scandal on the other. Each presentation was limited to five minutes, followed by three minutes for each party to ask questions. In the case of the Tories, that three minutes was frequently used to make their own case that somehow we can’t do anything in this province without the involvement of private corporations.

David Harvey, a lawyer who represented patient groups at the 1990s Krever Inquiry, made the point the legislative committee was trying to come to a decision in just two days of public hearings over an issue that took Justice Horace Krever four years to resolve. By contrast, the Krever Inquiry included 247 days of public hearings by 474 witnesses, testimony and submissions filling 50,000 pages and another 100,000 pages of exhibits. Even former Premier Mike Harris admitted the Krever report was “detailed, it was exhaustive and it was complete.”

Yet the Tories appear to be siding with the private lobbyists as they toy with the idea of reversing one of Krever’s key recommendations – that paid collection of blood and blood components be banned except in rare circumstances.

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