Monthly Archives: February 2010

This week in the legislature: PCs compare record on creating new long term care beds

PC Health Critic Christine Elliott compared the PC record on creating long term care beds with the McGuinty record. She said between 1995 and 2003 the PC government had created 20,000 new long term care beds and refurbished 16,000 more. Health Minister Deb Matthews said the McGuinty government has opened almost 8,000 new long term care beds, and is committed to adding another 2,000 beds in 10 communities this year. Matthews said they were building 35,000 beds over the next 10 years.

Party Donations and LHIN appointments

Liberal MPP Charles Sousa rose in defense of LHIN appointees, pointing out that Barry Monaghan, who had come under fire last week for earning two LHIN paycheques in a single year, had previously donated to a Conservative MPP. Tory Leader Tim Hudak had accused the government of stacking the LHINs with Liberal party donors.

Palliative Care

NDP leader Andrea Horwath asked questions about shortages of palliative care in the Ottawa region. “We’ve been reminded … that it’s not just dollars and cents that our health care system needs; it’s common sense and innovation. Building palliative care capacity improves the system and save money.” Minister Deb Matthew highlighted past funding for palliative care and said the government was investing $29 million for “an end-of-life-care strategy.” The question was in response to Dr. José Pereira’s call for more palliative care a the Champlain LHIN. (See story on BLOG)

Children’s Mental Health

PC MPP Peter Shurman said he met with representatives from York Region’s children’s mental health agencies, who said their situation was desperate. Current funding allowed them to accommodate 16 per cent of identified need. Shurman said York Region only received $127 per child compared to $221 in the rest of the GTA. NDP Leader Andrea Horwath said Hamilton and Niagara families faced the longest waits for children’s mental health – 68 days on average compared to 17 days in the rest of the province. Minister Laurel Broten spoke broadly about past government investments in children’s mental health, stating they were the first to give a base increase in over a decade – in 2004/05. They added another $24.5 million in 2007/08. Broten said “we are not scared of these issues.”

Home Care

NDP Leader Andrea Horwath asked the government why they are not ending competitive bidding once and for all. “Since competitive bidding was introduced more than a decade ago, the quality of home care has suffered, working conditions have diminished and costs have increased. Ontario is the only province in the entire country with a full competitive bidding system for home care, and even within Ontario no other part of the health system uses competitive bidding.”  Health Minister Deb Matthews said the province was committed to providing stability for health care workers. Beyond increasing the minimum wage for personal support workers at a cost of $30 million, Matthews never indicated how the government would provide that stability.

Diagnostic Imaging

Liberal MPP Yasir Naqvi gave the health minister an opportunity to speak about investing in MRI access in the Ottawa area. Ottawa had one of the longest wait times for MRI access in the province. The Ottawa Hospital, while shedding jobs this week, did get a new MRI machine in January. Meanwhile NDP Health Critic France Gelinas introduced a petition calling for a PET scan to be made available through the Sudbury Regional Hospital.

Hospital Funding

NDP Leader Andrea Horwath accused the government of announcing $14 million in new funding to “plug a hole in the Niagara Health System’s budget” to divert attention from closing emergency rooms in Fort Erie and Port Colborne. She also raised the byelection bailout in Toronto of the Grace Hospital. “Will this minister continue to play cynical politics with Ontario hospital funding?” The Minister said they were working with the LHINs to determine where additional funding was needed.

Rural incentives

 PC MPP John O’Toole introduced a petition asking that the McGuinty government not reduce or eliminate financial incentives rural communities and small towns need to attract and retain doctors.

 Quote of the Week

Quote of the Week: Accusing the McGuinty Liberals of playing politics with hospital funding in Niagara and Toronto, NDP Leader Andrea Horwath quipped: “If this was an Olympic event, they’d call it freestyle hospital funding.”

In Brief: More hospital positions being eliminated / Retirement homes to be regulated / More

The Ottawa Hospital is the latest to announce positions are being cut to balance its budget. Assuming a two per cent funding increase for this coming year, the Ottawa Hospital has to trim its budget by almost $19 million. More than 100 positions are being eliminated at the hospital, including 4.35 FTEs from among OPSEU represented positions. … The Sudbury Regional Hospital is cutting 41,000 cleaning hours at the hospital and expanding contracting out. The affected members belong to CUPE. …  The Ontario government is launching a probe into two mistaken mastectomies performed at the Windsor Hotel-Dieu Hospital dating back to 2003. The actions of two doctors is also under investigation by the College of Physicians and Surgeons of Ontario. The Toronto Star reports that “seven serious cases of concern” have been the subject of a pathology review. … Dr. José Pereira, medical chief of palliative care services at Bruyère Contining Care and The Ottawa Hospital, has told the LHIN that Eastern Ontario needs more palliative care services to allow people to spend their final days in a more humane and less costly settings, such as hospices and nursing homes. Reported in the Ottawa Citizen, Pereira said on any given day between 10 and 16 terminally ill patients at The Ottawa Hospital wait for transfer to a hospice or nursing home. … Seniors Minister Gerry Phillips says he’ll introduce legislation later this spring that will ensure all retirement homes are regulated. The bill will require retirement homes to assess new residents and tell them what services they will be getting. The homes will also be made to meet standards in infection control, safety, staff training and resident services. In Ontario there are about 750 retirement homes serving 41,000 residents.

Private health administration costs almost triple public sector

The Canadian Institute for Health Information (CIHI) reports that health care administration declined in Canada’s public sector while it rose dramatically in the private sector. In the report “National Health Expenditure Trends, 1975-2009” CIHI states that in 1975 administration accounted for 2.9 per cent of total public-sector expenditure and 2.5 per cent of total private-sector expenditure. While the share gradually declined in the public sector to 2.3 per cent in 2007, the private sector share rose to 6.2 per cent. Food for thought as health care faces increasing pressure to privatize.

Ontario Shores eliminates 55 positions to balance budget

WHITBY – Ontario Shores is eliminating 55 positions at the former Whitby Mental Health Centre in order to cope with underfunding from the Ministry of Health.

Forty of the positions will receive layoff notices, while 15 workers will be redeployed following contracting-out of their work.

“Given the priority the province is placing on mental health, these layoffs come as a surprise,” says Warren (Smokey) Thomas, president of the 130,000 member Ontario Public Service Employees Union (OPSEU). “The ministry of health should talk to the ministry of finance – one is trying to create jobs by stimulating the economy, the other is eliminating jobs at an astonishing rate across the province.”

Ontario Shores is eliminating front line workers from nine different classifications covering all three bargaining units. These job losses will impact patient care.

Under the terms of their collective agreement with OPSEU, Ontario Shores is obliged to find positions for members who lose their jobs due to contracting out, however, the union is concerned the 15 workers may only have a temporary landing.

“There have been so many programs cut at Ontario Shores that patients are left on the wards with nothing to do,” says Thomas.

The union is also upset that patients have been targeted with an increase to the cost of food at the canteen and the lack of transportation to and from appointments in the community.

With cuts to transportation, OPSEU questions how forensic patients will get to court appearances and to off-site medical appointments.

In addition to eliminating 55 positions, Ontario Shores has announced that it is closing one of two Beacon House sites. The Oshawa site will now be closed permanently. Beacon House is a residential treatment program serving individuals with complex personality problems that have resulted in psychiatric hospitalizations and frequent involvement with community services.

Ontario Shores has also closed Challenging Directions Enterprises, a Whitby-based outpatient workshop that provides work experience to 75-80 clients each day. The sheltered workshop closed its doors February 23rd.

OPSEU believe the layoffs are a partial response to a growing legion of managers being employed at Ontario Shores. This expanding list of managers is beginning to displace programming space for clients as Ontario Shores seeks to find new office space to accommodate them.

Departing Toronto LHIN CEO candid in Mt. Sinai forum

The departing CEO of the Central Toronto Local Health Integration Network says he is not one hundred per cent sure if the LHIN model is going to work, but defended the work the crown agency was doing.

Matt Anderson addressed a Longwood’s “Breakfast with the Chiefs” forum February 11th at Mt. Sinai Hospital in Toronto prior to being appointed the new CEO of William Osler Healthcare in Brampton.

In his hour-long session, Anderson said the priorities of the government were the priorities of the Central Toronto LHIN – a frank admission that contradicts the government’s insistence that the LHINs meant local people would determine their health service needs and priorities.

“If they (elected officials) say these are the priorities that the people of Ontario wish for, these are the priorities,” he said.

Anderson said the lack of a functioning e-Health system was a major obstacle to integration.

If it was at all unclear who was calling the shots, Anderson even prefaced his data slides by saying he “was allowed by the province to bring the data to you.” In fact, Anderson touted the transparency the LHINs brought to health service planning as one of the major levers at his disposal.

Despite having $4.2 billion to allocate to the 180 health service providers within his LHIN, Anderson admitted the discretionary funding the LHIN could decide upon was very small – about $10-$12 million.

Clearly most of the LHIN’s work appears to be around finding ways to measure health care performance and collecting data.

However, Anderson warned that the frequency of integration orders were likely to accelerate – this being the LHIN’s major leverage.

He did caution that integrations were misperceived as mergers, that in fact the description of integrations was so broad that it could represent any number of actions to make the system work as one.

Anderson called the accountability agreements with the health service providers to be “blunt instruments” and that the LHIN was beginning to refine what was in these agreements.

Although the LHINs have had CEOs and Chairs since June 2005, Anderson admits that they are still finding their way. One of the major projects for 2010/11 is for the Toronto Central LHIN to define what health equity actually means – this despite his statement that they were applying an equity filter to “everything we do.”

The LHIN CEO admits that they have much work to do on their own scorecard with the province – there’s “too much red.”

The Central Toronto LHIN is making modest progress on ER wait times, although he admits this is mostly the internal work of the hospitals, not the planning of the LHIN.

He said that progress was more limited on moving alternate level of care patients out of hospital beds – that in fact the situation was flatlined.

Afterwards a participant asked him whether the separation of the two major London Hospitals meant the attempt to integrate the health system was facing difficulties. Anderson admitted that in his own LHIN Sunnybrook and Women’s College Hospitals were going through a de-merger. “It’s not the end of the world,” he said, although the demergers meant there would be another agency with another agenda to negotiate.

He said de-mergers should have some clinical benefit before they take place.

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February 25th Globe columnist Adam Radwanski reflected on the departure of Anderson as being symbolic of the lack of real power the LHINs have. “The fact remains that he is leaving a job where he was theoretically overseeing health care a the centre of the biggest city in the country to run three suburban hospitals,” Radwanski writes. “Mr. Anderson will probably be able to do more good for patients in his new job.”

See: http://www.theglobeandmail.com/news/politics/talented-ceos-move-is-another-nail-in-the-coffin-of-health-networks/article1480596/

In Brief: New surgical protocols follow unnecessary mastectomy / Champlain LHIN admits error / Muskoka-Amalguin communities act to protect health services

Windsor-area hospitals are considering changes to surgical protocols after an experienced Hotel-Dieu Grace Hospital surgeon misread a pathology report and performed an unnecessary mastectomy last year. The changes may include having more than one health care professional look at the patient’s pre-surgery report or ensuring the surgeon reads the pathology report at least one more time before operating. … After coming under fire for issuing a sole-sourced contract to Courtyard Consulting, the Champlain LHIN is now claiming that it wasn’t sole-sourced after all. “It was unfortunately our fault,” Marie Fourtier told the Ottawa Citizen. The chair of the Champlain LHIN said “we declared it as a sole-source contract, but that was our mistake.” The LHIN is now claiming that there was a second competing firm that bid several thousand dollars higher than the $59,000 contract awarded to Courtyard. The contract was to develop a consistent methodology for Eastern Ontario hospitals to track wait times. Courtyard had come under public scrutiny last year during the e-Health scandal, having been awarded millions in untendered contracts from the Crown Agency. Several employees have ties to senior figures at e-Health, including one who was a former advisor to Premier Dalton McGuinty. … MPP Norm Miller and Huntsville and District Councillor Fran Coleman finally got their meeting with the Minister of Health after complaining about access during question period. Miller and Coleman presented the Minister with petitions asking for a one-time five per cent ($3.4 million) increase to Muskoka Algonquin Healthcare’s operating budget. “She didn’t respond,” Miller told Cottage Country Now, “she didn’t respond directly that she would give a definite answer (to look into funding).” Coleman has asked the LHIN to organize a public meeting about the hospital’s $5.8 million shortfall. … Who owns the former Burk’s Falls and District Health Centre? Glenn Miller, reeve of Ryerson Township, told the local media the building may still be under local ownership. “If we got back to the original agreement it looks like either the Village of Burk’s Falls or a group of 13 municipalities still own it.” The ownership of the building may be an important piece in the battle to save the health care facility. Last year Muskoka Algonquin Healthcare closed down the facility with no community consultation or involvement of the LHIN. The Ministry’s plan is to renovate the building as home to a new Family Health Team. Meanwhile, the local communities are upset that equipment purchased with funds donated to the Burk’s Falls hospital are being removed to Huntsville and Bracebridge. … Another outbreak of antibiotic resistant bacteria has occurred at the Owen Sound hospital. The Grey Bruce Health Services has closed a unit to new adminissions and is restricting visitors after an outbreak of VRE (vancomycin resistant enterococcus). The same unit was closed twice last year due to similar outbreaks. … Kevin Smith, president and CEO of Hamilton’s St. Joseph’s Healthcare, has been named chair of the Ontario Hospital Association Board. …. Dr. Denis-Richard Roy began new duties as CEO of Sudbury Regional Hospital January 11. Dr. Roy was formerly CEO of the Centre hospitalier de l’Université de Montreal prior to coming to Sudbury. … The Hamilton Spectator suggests the Premier needs to answer the questions he’s asked in question period. The issue came up after NDP Leader Andrea Horwath asked McGuinty about a 5 per cent cut in surgeries at Hamilton Health Sciences. The Premier answered the question by speaking about family health teams and how they were combating the doctor shortage. “McGuinty does himself no favours by ducking and weaving,” the newspaper’s editorial stated. “That’s not leadership, it’s a pathetic attempt at self-preservation.”

Health care flash point during legislature’s first week back

The first week back in the legislature was dominated by questions on the Local Health Integration Networks and hospital cuts.

These included:

  • Why the LHINs were not included in new rules prohibiting sole-source contracting. Tory Leader Tim Hudak raised a sole-sourced $80,000 contract between the Toronto Central LHIN and the Courtyard Group, a Liberal-friendly consulting firm. The contract was to help implement a diabetes strategy. Hudak linked a number of those in the contract with the e-health scandal. Hudak said that after e-health, the same consultants were coming back for “second helpings” from the LHINs.
  • PC health critic Christine Elliott raised questions about  the qualifications of LHIN board members who happened to also be significant financial contributors to the McGuinty Liberals. That list included Juanita Gledhill, Chair of the Hamilton Niagara Haldimand Brant LHIN, the same LHIN that approved closure of the ERs at Port Colborne and Fort Erie.
  • With the LHINs under financial scrutiny, the Premier stated that the Minister of Health brought in tough new rules to increase accountability and transparency at the LHINs.
  • NDP Leader Andrea Horwath asked how the McGuinty government could pass on $4.5 billion in corporate tax cuts while cutting services, including the Toronto St. Joseph’s pain clinic, one of several services recently scheduled for closure by the cash-strapped hospital. “They’ve left hospitals and clinics across the province making random cuts to front-line services while money we cannot spare is being given away to corporate tax cuts.”
  • Both parties contrasted the $15 million bailout of the Toronto Grace Hospital during a by-election with cuts to hospitals in other communities. PC Health Critic Christine Elliott quoted the vice-chair of the Grace Hospital as saying “thank god for by-elections.”
  • PC MPP Norm Miller said the Minister of Health refused to meet with him and Muskoka councillor Fran Coleman because it was “inappropriate for the minister to discuss budget issues,” yet felt no qualms about intervening in the case of the Toronto hospital. Miller also presented a petition calling for an additional 5 per cent in operating funding for Muskoka Algonquin to preserve rehab services under threat. The two were eventually granted the meeting with the Health Minister.
  • NDP MPP Paul Miller raised layoffs at St. Joseph’s Healthcare in Hamilton and at Hamilton Health Sciences, suggesting even more cuts were around the corner.
  • PC MPP Ted Arnott raised the issue of slow ambulance response time in Erin (see story on the BLOG)
  • PC Leader Tim Hudak noted that the number of LHIN positions on the sunshine list (those earning more than $100k per year) had grown by 150 per cent, from 40 to 95 in three years. Executive salaries at the LHIN were also up by 213 per cent. Hudak contrasted the salaries with cuts to front line services, including closure of the Port Colborne and Fort Erie ERs. Hudak also raised the salary of Barry Monaghan, who collected $351,000 in salary from the Toronto Central LHIN while also receiving $104,000 in an untendered consulting contract from the Mississauga Halton LHIN.
  • Premier McGuinty and Health Minister Deb Matthews defended their record, often repeating they increased health funding by 42 per cent since coming to power. They didn’t acknowledge that much of this additional spending came from increased transfers from the Federal government. Matthews described the attack on Barry Monaghan as a “drive-by smear.”
  • NDP Leader Andrea Horwath quoted a release from Hamilton Health Sciences: “Even though we’re recognized as one of the most efficient hospitals in the province, we have been forced to make some changes that will impact patient care… In 2010/11 we will do 1,200 fewer surgical procedures.”
  • Premier Dalton McGuinty on reducing wait times: “angiographies down by 63 per cent, that’s 35 days; angioplasties down by 14 days; cataract surgery wait times reduced by 208 days; hip replacements in Ontario down by 195 days; knee replacements down by 263 days; CT scans down by 39 days; cancer surgery is down by 23 days; MRI scans down by 13 days; general surgeries down by 21 days; MRI scans down by 13 days; general surgeries down by 21 days; pediatric surgery is down by 21 days.”
  • Weird quote of the week: “She (NDP Leader Andrea Horwath) continues to maintain that we have made cuts to our health care system and to hospitals in particular. That is absolutely wrong. It is without foundation in fact.” – Premier Dalton McGuinty in the face of hundreds of layoffs and cuts in hospitals across Ontario. McGuinty went on to reiterate his investments in health care over the last six years.
  • Funny but sad quote of day: “Recent media reports quote members of the Liberal caucus saying that morale over there is lower than a garter snake in a puddle on a backcountry road.” – PC MPP Gerry Martiniuk.

St. Thomas Elgin Hospital cuts diagnostic and lab services

ST. THOMAS – Despite emerging from its financial deficit, St. Thomas Elgin General Hospital (STEGH) is cutting services that will limit access to outpatient lab testing, increase waits for diagnostic imaging, and impact jobs in the community.

Six positions are expected to be eliminated from the lab and diagnostic imaging – this at a time when the Ontario government is spending to stimulate new jobs in the economy.

In a memo to staff and volunteers last month, the hospital said it was trying to find ways to address an expected funding freeze from the Ministry of Health – a freeze the Premier has since said is no longer on the table.

STEGH justified the reduction in outpatient lab service by indicating most lab tests ordered by local physicians could be performed by private community labs.

“Once again we are seeing minor savings to the hospital, reduced hours of access to users, and an increased cost to the Ministry of Health,” said Warren (Smokey) Thomas, president of the 130,000 member Ontario Public Service Employees Union (OPSEU). “This plan just pushes the costs somewhere else – it doesn’t save anything.”

In 2008 the government received a consultant’s report indicating the cost of private laboratory testing was 50 per cent more than those performed in a comparative selection of small public hospitals.

OPSEU is also concerned that those who go to the private labs will discover not all tests formerly processed by the hospital are covered under OHIP.

The cuts to diagnostic imaging come as a surprise given their importance to the government’s wait times strategy.

“The idea that positions in diagnostic imaging could be lost without any effect on patient care is absurd,” says Thomas.

OPSEU is maintaining a web site where the public can express their displeasure to their MPP about the lack of funding for public hospitals. The site can be found at www.avoidingzero.ca

Deputy Fire chief encourages residents to exaggerate medical conditions to get help faster

The Deputy Fire Chief of Erin, a community 30 km northeast of Guelph, told the Guelph Mercury that residents know reporting certain maladies will get the fire department dispatched faster than an ambulance. “We teach people around here to say you’re having trouble breathing … which will trigger us to come,” said Deputy Fire Chief Ken Keeler.

Town officials have complained about slow response times from the Guelph-run ambulance service. Graham Smith, manager of Erin’s community centre, said “If I had someone down here I would definitely say they were having trouble breathing because you just get a better response time.”

Guelph-Wellington EMS has an agreement with the fire fighters over what kinds of calls are appropriate for the fire department to respond to.

The issue gained public attention after a woman waited for more than an hour for ambulance service after falling and injuring her knee outside the Erin Community Centre. Shawn Armstrong, regional director of EMS, told the newspaper “that type of situation happens in the City of Guelph and County of Wellington every day.” He said the delay was a combination of bad weather and prioritizing of calls.

OPSEU represents members at the Guelph-Wellington EMS.

Physio should be accessible to all — association airs ads during Olympics

The Canadian Physiotherapy Association is drawing attention to the profession through its first public advertising campaign in 90 years.  The campaign will including television commercials airing during CTV’s Olympic coverage, a public web site, and print ads in the run up to National Physiotherapy month in May.

“Necessary physiotherapy services should be accessible to all Canadians without delay,” says Alice Aiken, PhD, PT, and President of the Canadian Physiotherapy Association. “Canadians are able to decide for themselves that they want to see a physiotherapist and they should be able to access physiotherapy, free of unwarranted legislative, bureaucratic, or economic constraints. Facilitating timely, direct access to a local physiotherapist is the most important goal of the CPA’s national advertising campaign”, adds Dr. Aiken, “because when patients see a physiotherapist without delay, they get better faster and can return to work sooner.”

The companion web site for the campaign can be found at

www.physiotherapy.ca