Short takes: The “Savvy State”, accreditation of border nurses, and parking as health care

This winter we noted the constantly shifting terminology around cuts to clinical services at The Ottawa Hospital. At first the public was told by the Health Minister and Premier that cuts to thousands of endoscopies at The Ottawa Hospital were part of health care restructuring. We asked why it was therefore not being treated as an integration decision by the Champlain Local Health Integration Network? The LHIN replied that because the “cuts” (not restructuring) were actions taken as part of the hospital’s accountability agreement, no integration decision was required. For the public, no integration decision means no consultation and no transparency. Despite multiple protests around the cuts and profile given to the issue during the Ottawa South by-election (in which the Tories oddly said jobs were being cut at the hospital because of too much spending on health care) the Champlain LHIN refused to consider intervening. Given its lack of interest in a massive transfer of diagnostic services in the Ottawa area, it is remarkable to note what the LHIN is now deciding upon: parking. While the Ottawa hospital could cut clinical services at will, it sought the approval of the LHIN to build a new $12.5 million parking garage that will be paid for over four years by drivers shelling out $13 a day. Evidently parking is important to health planners. Endoscopies? Not so much.

Last week we noted that Hamilton Health Sciences was caught off guard by a Freedom of Information (FOI) request issued by the Hamilton Spectator. The newspaper had requested executive and board expenses going back to 2007 at the hospital. HHS initially told the newspaper that it would pass on costs of more than $17,000 to retrieve thousands of invoices from an off-site storage facility. The hospital also said it would take staff until the end of the year to sift through the invoices to fulfill the request. Upon appeal, the hospital has now agreed to supply the information by the end of September and fees have been reduced by the adjudicator to $1,228. The fact that a hospital with an annual budget of $1.2 billion could not access these records electronically was astonishing to us, although CEO Murray Martin told the newspaper that in the past year they have implemented a fully electronic financial software system. When Diablogue used the same FOI process last year to track staff-management changes at 20 Ontario hospitals, many claimed to have to resort to manual processes to fulfill our request. It cost us more than $1600 to get the answers demonstrating the freedom of information is far from free.

It is not unusual for Canadian nurses to be working in the U.S., especially those who live close to the border in places like Windsor, Sarnia or Niagara. With few full-time jobs available, particularly as hospitals experience a freeze on base funding, it is not surprising nurses are looking for opportunities across the border. According to the Windsor Star, the College of Nurses of Ontario (CNO) are telling these nurses they cannot keep their provincial accreditation status unless they actually work here on this side of the border. Letters sent out from the CNO are telling these working nurses they can change their status to non-practicing or resign their Ontario accreditation altogether. Ironically in 2015 Ontario nurses will start using the U.S. version of the nursing accreditation exam – the same one these cross-border nurses would have already written. The College claims the changes are intended to help them better conduct health human resources planning, but any perceived obstacle in returning to Ontario may just keep these nurses away permanently. That may pose an even greater challenge to Ontario’s health human resources planning.

One of the surprise guests at the July Shadow Summit in Niagara-on-the-Lake was Wendell Potter, the former U.S. health insurance executive who quit his job and spoke out about how corporations were deceiving Americans about their public health care choices. In his former job Potter was among those who waged a counter campaign to deflate the impact of Michael Moore’s film Sicko on the U.S. health care reform debate – something for which Potter later apologized. Moore not only accepted the apology, but called Potter a hero. In his book Deadly Spin, Potter notes how the tobacco industry had hired British philosophy professor Roger Scruton to come up with non-health related arguments in favour of big tobacco. Scruton attacked public health care advocates seeking to limit tobacco consumption and warned about the coming “Nanny State.” Writing as an independent academic, Scruton’s connection to big tobacco was later revealed when the professor demanded a pay raise on the roughly $6,300 U.S. a month he was earning for such efforts paid for by Japan Tobacco Incorporated. (Later Scruton admitted that perhaps he should have declared his interest in the issue – ya think?) As discredited as Scruton was by the disclosure, this concept of the “Nanny State” has been effectively used by corporations and the right to challenge almost every intervention by government to protect public health. Now two American MDs have coined a new phrase to counter the “Nanny State” spin. Writing in the Journal of the American Medical Association, Doctors Dave Chokshi and Nicholas Stine suggest we start speaking about the “Savvy State.” Whereas detractors of public health initiatives believe unhealthy behaviors are nobody’s business but the individual’s, the two doctors say everyone pays for the health care costs associated with chronic diseases. They note in the Journal that “Public health regulation is often falsely portrayed as a choice between responsibility (of individuals) vs restriction (of freedom) and rarely are the public health consequences of inaction presented as a regulatory choice.” As an example, they suggest that not having a workplace smoking ban should be portrayed as “an active policy decision engendering greater employee exposure to carcinogens and an increased risk of acute myocardial infarction.”

Scruton is not the only high-profile individual to have shilled big tobacco’s line in the media. You may recall that Joe Jackson once sang “(Everything Gives You) Cancer.” Given the song’s message, it is not entirely surprising the musician is now a fervent member of FOREST (Freedom Organization for the Right to Enjoy Smoking Tobacco) — a high-profile UK pro-smoking astroturf group heavily funded by big tobacco.  Jackson uses Scruton’s “Nanny State” spin in penning his own ridiculous 2007 19-page rant that is still posted on his website. Jackson claims his essay was the product of years of research. He writes the “junk” science about the health effects of smoking is comparable to the belief that masturbation will make you blind. For good measure he also tosses in that Adolf Hitler was among those who wanted us to give up smoking. Really Joe? Years of research and this is what you offer us?

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