It’s not every day that a major Ontario psychiatric hospital is placed on trial, much less two.
Health care workers across the province will be closely watching the outcome of an ongoing trial following charges against the Royal Ottawa Mental Health Centre under the Ontario Occupational Health and Safety Act.
The Royal unsuccessfully sought a stay of proceedings, arguing that testimony could be tainted by recent media coverage. The Ottawa Citizen reports that Justice of the Peace John Doran rejected the hospital’s arguments, noting that witness statements obtained before the trial would serve as a “baseline” of evidence.
As the trial got underway in December new charges were laid against the Royal Ottawa following an alleged stabbing of a nurse by a patient in October at the hospital’s Brockville site. The stabbing narrowly missed her carotid artery.
Following the attack, the Ontario Nurses’ Association applied to the Ontario Labour Relations Board for an Interim Order to place trained security guards on the unit where the alleged assault took place. ONA represents registered nurses at the Royal. The OLRB responded November 26 issuing an order to provide 24/7 security on the unit – an order the hospital has yet to comply with.
Representing two bargaining units at the Royal Ottawa’s Brockville site, OPSEU is seeking intervener status on this new case despite opposition from the hospital’s legal counsel.
The Centre for Addiction and Mental Health was also charged under the same Act in December — about a week after OPSEU and ONA issued a joint press release calling for action following an alleged January 2014 assault that left a registered practical nurse beaten beyond recognition. Both the OPSEU RPN and the ONA nurse who came to her assistance have been off work since the incident.
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.
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.
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.
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.
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.
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.
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.
Above: Arthur Gallant — one of the more inspired choices for the Mental Health and Addictions Leadership Advisory Council.
Ontario Health Minister Dr. Eric Hoskins has been doing a lot of tweeting this week about the second phase of Ontario’s 10-year Mental Health plan. You may recall that the 10-year plan really was a three-year plan in 2011, which is being followed by another three-year plan now. We presume they’ll just continue making it up as they go along.
First the good news: The government is investing $16 million to create 1,000 more supportive housing spaces, opening a 12-bed paediatric residential treatment unit at Ontario Shores Centre for Mental Health Services, and spending $2.75 million to improve access to mental health and reduce wait times at four of the big psychiatric hospitals – The Centre for Addiction and Mental Health (Toronto), Waypoint Centre for Mental Health (Penetanguishene), The Royal Ottawa (Ottawa and Brockville), and the aforementioned Ontario Shores (Whitby). He is also creating a Mental Health and Addictions Leadership Advisory Council and is “partnering” with the province’s public health units to increase awareness, fight stigma, and promote mental health in schools and in the workplace. The largest chunk of cash — $138 million over three years — will go to community service agencies to increase access to peer support groups, treatment programs, and crisis and early intervention initiatives.
Now the bad news: It’s called perspective.
$2.75 million added to those four hospitals amounts to less than half a percentage point on the nearly $650 million a year they presently spend.
The $16 million in supportive housing will be over three years, or a little more than $5 million per year. There are 8,000 people presently waiting for supportive housing – just in Toronto alone.
Dr. Eric Hoskin, Ontario’s Health Minister, speaks about his top four priorities at HealthAchieve November 5.
Dr. Eric Hoskins may be signing his name, but the latest Toronto Star letter-to-the-editor from the Health Minister sounds as tired and exasperated as those served up by his predecessor. Given Ministers seldom pen their own letters, we conclude it must be hard to get good help these days.
Hoskins (or his ghost writer) insists that Star columnist Bob Hepburn is wrong – that in fact no cuts are taking place in home care. Never mind Erie St. Clair CCAC’s new executive director sent out a memo announcing a 33 per cent cut in daily nursing visits or that Care Coordinators at the Champlain CCAC are beside themselves having to recommend out-of-pocket paid alternatives to long-term patients who suddenly find themselves without a caregiver. Both CCACs are staring down millions in debt and are in freefall. But hey, aren’t we glad that no cuts are taking place?
It’s the same old song and dance coming out of the Minister’s office. Hoskins insists that Windsor got $3 million more in funding this year and that overall $270 million has been added for home care. Demand is far outstripping this funding due to a planned multi-year freeze to the base budget of Ontario’s public hospitals. Care Coordinators are telling us that not only is this placing the CCACs under great pressure, but it is changing the very nature of the work they are doing. It’s all about post-hospital care, not about longer-term chronic care management and support.