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Health News Briefs
January 1992 to December 1994
This document contains brief summaries of news items relating
to health and health policy in Canada during the period January
1992 to December 1994. All items appeared in Medical Reform,
the newsletter of the Medical Reform Group of Ontario, and
are in the order they appeared, starting January 1992.
Abortion clinic attacked
The Morgentaler abortion clinic in Toronto was subjected to an arson
attack on January 24, 1992. A flammable substance was used to ignite
the front doors. The fire caused $5,000 damage to the clinic and
$2,000 damage to an adjacent building. Three people were forced
to flee their apartment above a neighbouring store.
Genital mutilation banned
The College of Physicians and Surgeons has issued a statement telling
doctors not to perform so-called `female circumcision'. The move
came after some doctors reported being approached by immigrants
from Africa to perform the ritual on their daughters. The College
also called on the federal government to outlaw the practice, which
is a traditional practice is some parts of Africa. Various forms
of the practice can involve removal of the clitoris and the labia,
and sewing shut of the vagina.
Anonymous AIDS testing
The Ontario Ministry of Health has selected eight municipalities
to set up anonymous AIDS testing facilities.
AIDS registry to be set up
The task of setting up the federal government's AIDS information
registry has been turned over to a private company, Price Waterhouse.
The registry was to have been set up under the auspices of the University
of Toronto, but after a series of problems and controversies, the
government took the project away from the university. The registry
is to feature a computerized data base containing the latest information
on AIDS treatments. The data are to be available to doctors and
patients across Canada, and is now scheduled to be in operation
sometime this spring.
Racism charged
The Congress of Black Women of Canada has called for an inquiry
into racism in Ontario's health care system. "This is a huge
problem in health care facilities", said Akura Benjamin of
the Toronto chapter of the Congress. The Ontario Human Rights Commission
is currently conducting an inquiry into allegations of racism in
promotion practices made by nine nurses at Northwestern Hospital
in Toronto.
Secrecy deals under fire
Lawyers representing plaintiffs in suits against breast- implant
manufacturers say they had documents at least eight years ago which
showed that the manufacturers knew that the implants could be dangerous.
However, because of court- approved secrecy agreements, known as
protective orders, they were prevented from making the information
public. Manufacturers in the United States routinely demand secrecy
agreements as a condition of settling lawsuits. As a result of the
secrecy agreements, officials of the U.S. Food and Drug Administration
did not learn about studies which showed the implants might be dangerous.
New Zealand protests
A series of marches and demonstrations took place in New Zealand
last month to protest against the implementation of user fees and
health care cutbacks. With the new measures, New Zealanders will
be charged for hospital treatment for the first time in 50 years.
Those on unemployment or social welfare benefits will have to present
a special card to qualify for free hospital care and reduced charges
for visits to primary care physicians. Low-income people who do
not qualify for free hospital care will receive a partial subsidy.
Those classified as "high-income" have to pay full rates.
The "high-income" category includes almost half the population.
Tsongas rebutted
Democratic presidential candidate Paul Tsongas' swipes at the Canadian
health care system have attracted spirited rebuttals from north
of the border. Tsongas, a bone marrow transplant recipient, stated
that if he had sought treatment in Canada, he might have died, because
"socialized medicine" stifles life-saving research and
technology. Doctors at the Ontario Cancer Institute/Princess Margaret
Hospital have pointed out that the research which made Tsongas'
transplant possible was in fact done in Canada, at the OCI/PMH,
by Drs. Ernest McCulloch and James Till. Dr. Don Carlow, president
of OCI/PMH, was quoted in Ontario Medicine as saying that Tsongas
"was fortunate to be in a position to afford the best treatment
available in the U.S. Many Americans do not have the same privilege."
What the doctor ordered
How does the thrusting hospital maximise its income in the market-style
National Health Service? Simple: it gets patients to give far-off
addresses, sends them to the wrong wards and discharges them before
they are fit. These and other tricks of the trade are disclosed
in the latest issue of The Health Service Journal by an anonymous
health authority director of purchasing, whose job is to scrutinize
and settle hospitals' bills. First, and most important, is to try
to stop the patient giving a local address. Students, temporary
workers, members of the armed forces and other should be inveigled
into giving their "permanent" address, likely to be in
another health district which has not contract with the hospital
and can therefore be billed for extra cash. A patient taken to the
wrong department and left, even if only for a few minutes, can enable
the wily hospital to send two bills. Some provider units have submitted
such claims for admissions lasting less than a minute. If possible,
the director suggests, try to discharge the patient before treatment
is ended: most patients will readily co-operation with a readmission
shortly afterwards. "You can then charge for two admissions
at average specialty costs which were, of course, based on the length
of a normal admission. This will double the value of the patient
at a fraction of the cost."
David Brindle, in the Manchester Guardian Weekly, February 9,
1992
Therapist sues patient
A Toronto therapist has successfully sued a patient for a cancelled
appointment. Dr. Stephen Sibalis, (9 Sultan Street, Toronto, (416)
923-8666 (W), (416) 461-9655 (H)) a member of the Committee of Concerned
Physicians, won in court because he had required his patient to
sign a contract in which she agreed to pay for appointments whether
she used them or not. The contract also stipulated that she would
pay for additional services not covered by OHIP, and that she would
be charged compound interest on any missed bill. The contract stipulated
that she would have to pay for a cancelled appointment no matter
how much in advance it was cancelled, and no matter what the reason
for the cancellation was. Asked to comment, Mimi Divinsky of the
Medical Reform Group of Ontario said that contacts put patients
at a disadvantage because of the obvious power imbalance. "It
isn't a contract between equals"', she said.
New doctors hit
The Ontario government has moved to prevent new physicians from
entering practice in the province's urban centres. Physicians who
set up a practice in an area which is considered to have an over-supply
of doctors will only be paid 25 per cent of the normal fee schedule.
Since overhead costs are nearly always greater than 25 per cent
of billings, this will effectively prevent any new physician from
setting up practice in an urban area. The government says the move
is designed to increase the number of physicians in under-serviced
rural and remote areas of the province, while curbing the over-supply
of doctors in cities. However, the way the government is moving
to achieve these goals have been strongly criticized as unfair and
arbitrary.
Enrollment cut at medical schools
Enrollments at the University of Toronto's medical school are being
cut by 30 per cent. Only 177 new students will be enrolled this
fall, rather than the usual 252. The cuts are part of a national
effort agreed on by provincial ministers of health. Other cuts are
taking place in medical schools in Alberta and Manitoba. Enrollments
in other provinces, and in Ontario's four other medical schools,
are being frozen. According to Michael Decter, Ontario's deputy
minister of health, there are too many doctors in Ontario and in
Canada. "Studies have shown that each new doctor that goes
into practice costs us an average of $500,000 a year, when you consider
what they bill, all the lab tests they order and hospital services
that result." A ministry statement said that the number of
physicians rose by 38 per cent from 1981 to 1991, while the population
rose 12 per cent. Over the same period of time, health insurance
payments to physicians in Canada went up 128 per cent.
Billing limit eased for some
Some doctors in rural and remote parts of Ontario will get a partial
break from the provincial government's billing restrictions. The
government previously imposed a "cap" on physician billings
at $400,000 per year. Billings above that amount are paid at two-thirds
of the regular rate, and at only one-third of the rate for billings
above $450,000. But under a new deal between the government and
the OMA, specialists in under-serviced areas can apply for an exemption
from that limit. The Ministry of Health estimates that between 30
and 50 physicians will qualify for the exemptions. Currently, doctors
who move to such areas are exempt from the billing limit for four
years while they set up their practices. The new deal would give
specialists an additional two year exemption. Speaking for the Medical
Reform Group, Dr. Mimi Divinsky said that the exemption is only
a bandaid solution to the problem of overburdened doctors. She said
the exemption will not solve the problem of overworked doctors and
will reward those who practice "revolving-door medicine".
"Doctors who consistently bill higher than the limit are overworked
and not able to spend the time needed with each patient", she
said.
Cutbacks in Emergency
In an effort to cope with funding restrictions, some hospital emergency
rooms will start sending certain types of patients back home instead
of admitting them, the Ontario Hospital Association has announced.
According to Beth Witney of the OHA, the measures will affect only
those who don't really need to be admitted to hospital, such as
elderly people with arthritis or problems with their medication.
The measures are to be coupled with the use of quick response teams,
usually headed by a nurse, which are supposed to follow up to make
sure that patients' needs are taken care of and that they are able
to cope at home on their own.
Birthing centres
The Ministry of Health has asked for proposals to set up three out-of-hospital
birthing centres to be staffed by midwives. Licenses for the centres
are expected to be issued by the beginning of 1994, and the centres
are expected to be operational by the fall of 1994. Midwives in
the centres are to be salaried. Midwives are expected to be fully
licensed and funded in Ontario by the end of 1993, and three Ontario
universities will be offering midwifery programs.
Province announces cuts
Ontario's NDP government has announced that it intends to implement
a series of austerity measures to reduce government costs, including
the costs of health care. $1 billion is to be cut from the health
care budget, $313 million from the social services budget, and $635
from the education budget. Among the measures being brought forward
are plans to require seniors and the poor to pay more for drugs,
and to restrict medical services to refugee claimants. A proposed
reorganization of the Ontario Drug Benefit Plan will require the
2.4 million Ontarions who now receive free pharmaceuticals to pay
a fee. A total of $195 million is to be cut from the OFBP. The parents
of more than 13,000 children in residential care will be required
to pay some portion of the cost of their accommodation. The Oxford
Regional Centre, which cares for 244 developmentally disabled residents
will be closed. Payments for all non-emergency procedures done outside
the province will be ended, unless they have been approved in advance.
The government has said that it plans to chop $275 million from
the $4 billion annual payment to physicians, but details are to
be negotiated with the Ontario Medical Association. A cut of that
size would translate into an average reduction of $11,000 per year
for the province's 25,000 licensed physicians, if the reductions
were spread out equally. Hospital budgets are to be cut by $160
million.
B.C. doctors want union
The British Columbia Medical Association announced on April 6 that
it is seeking recognition as a union. Dr. Derryck Smith, a member
of the association's executive hoard, said unionizing doctors has
become possible through revisions to the province's labour relations
code covering "dependent contractors". Physicians would
continue to function as self- employed professionals, he said. The
move comes after a year of tough bargaining between the BCMA and
the government, marked by walkouts, large-scale advertising campaigns,
and acrimony.
Hospitals woo U.S. patients
The Toronto Hospital and the Hospital for Sick Children have teamed
up to market medical services and surgical procedures to insurance
companies and employer plans in the United States. "Free trade
means free trade," said Dr. Alan Hudson, president of the Toronto
Hospital. The hospitals maintain the plan will not displace Ontario
patients or lengthen waiting lists.
Private MRI clinics
Alberta doctors and businessmen are setting up two private magnetic
resonance imaging clinics which will charge patients $1,000 per
visit. MRI clinics in the U.S. are among the most profitable businesses
in the health care industry but these are the first private MRI
clinics in Canada. Patients who can afford the fee can bypass the
queue for the province's two hospital-based, medicare-funded MRIs.
The waiting list can be several months for patients not considered
to be emergency cases. "If we don't do this, somebody else
will," said Dr. Chen Fong, director of the newly-opened Western
Canada MRI Centre of Calgary. According the Dr. Fong, U.S. companies
are already exploring the possibility of setting up privately owned
MRI clinics in British Columbia and Ontario. According to Dr. Michael
Rachlis, a health care consultant and member of the Medical Reform
Group, the Alberta government's decision to allow the private
MRI clinics appears to violate the Canada Health Act. "Its
a stake through the heart of medicare, allowing hospitals to make
referrals to private clinics when the only people able to go are
the wealthy who can afford it," he said. The province has already
apparently decided that doctors who bill patients directly for an
MRI scan will not be required to opt out of the provincial medicare
plan, as all other physicians who direct bill have to do. Dr. Rachlis
also criticized letting doctors refer patients to MRI clinics in
which they have a financial interest. "These kinds of self-referrals
are already banned in several states in the U.S.", he said.
Canadian drug prices high
According to a study prepared by the Patented Medicine Prices Review
Board, a federal agency, the prices of brand- name pharmaceuticals
are consistently higher in Canada than in other industrial countries,
and are often the highest in the world. The study of 177 top-selling
prescriptions drugs found that Canada had the highest prices for
42 of them, the second-highest for 35, and was above the median
for a total of 105. Another study prepared by the PMPRB shows that
the price increases of brand-name drugs were significantly higher
than the rate of inflation during the first six months of 1992.
The studies were not released to the public, but copies were obtained
by the Globe and Mail newspaper.
Quebec pays for organ retrieval
The number of organs collected for transplant patients has increased
in Quebec after the government starting offering hospitals financial
incentives. Quebec-Transplant, the non- profit organization that
co-ordinates organ donations, began offering $500 to each hospital
that refers a donor and $4,500 to the hospital that retrieves the
organ, at the beginning of the year. During the first three months
of the program, it collected 87 organs, up from 57 during the same
period the previous year.
Saskatchewan hospitals overused
A provincial health care commission has concluded that Saskatchewan's
hospitals are being used to provide care that would more appropriately
be provided in another setting. The commission found that in some
hospitals, only 36 per cent of acute-care beds were filled by seriously
ill patients. "That doesn't mean that the patients did not
require care -- it means that the care could have been provided
at alternative institutions," said Dr. Stewart McMillan, head
of the commission. Dr. McMillan said that there seems to be a problem
in providing appropriate care for older people, especially in rural
communities. "Older patients get admitted... then they get
better and they appear not to be able to move back into the community
or nursing homes or whatever", he said.
OMA plan flawed, College says
The College of Physicians and Surgeons of Ontario is opposing a
proposal from the Ontario Medical Association that would restrict
the College's power to grant exemptions from licensing requirements
to foreign specialists. At present, the College grants a limited
number of exemptions (34 in 1991) to foreign specialists in specialties
where there is a shortage, allowing them to begin practise immediately.
The OMA's board of directors is proposing the power to grant exemptions
be turned over to the government. According to OMA President Dr.
Michael Thorburn, "there's tens of thousands of unemployed
physicians" around the world, and Canada has to reduce numbers
coming here at a time when medical schools here are having to cut
enrolments. According to CPSO Registrar Dr. Michael Dixon, decision-
making power over licensing requirements must remain exclusively
with the College.
Computers to track prescriptions
The Ontario Ministry of Health has announced a computer network
which will track patients' prescriptions. The stated purpose of
the system is to prevent over-medication and drug interactions by
giving pharmacists information on what drugs their customers are
taking. The Ontario Drug System will connect about 2,500 pharmacists'
computers to the health ministry. Green Shield Canada has been awarded
the contract to set up and oversee the network in partnership with
the Ministry of Health. Pharmacists are supposed to contact a patient's
physician if the network identifies a problem. The Ministry of Health
suggests that the network could be expanded to include other health
care providers, including hospitals, private health insurers, and
individual physicians. The plan drew support from Seniors'' groups,
but was criticized by John Raufoy, a registered nurse who ran as
an NDP candidate in the last provincial election. "This is
an amazing invasion of privacy," he said. Raufoy said the computers
will give too many pharmacists and doctors access to sensitive medical
information. "The only reason for this is to save money, not
lives," he said. "I can't believe my party is doing this.
It's just one more example of Big Brother."
14 May 1993
Two-tier system advocated
The Fraser Institute, a right-wing think-tank with close ties to
the Progressive Conservative government, is advocating that wealthy
Canadians should be able to queue- jump if they pay the full cost
of their medical treatment. According to Michael Walker, the executive
director of the Fraser Institute, such an approach would help everyone
because it would put more money into the system.
20 May 1993
Abortion bans don't work
Abortions are more common in countries that ban or restrict the
procedure than in those where it is widely permitted, according
to a report published by the International Planned Parenthood Federation.
"It is a popular myth that abortion figures are highest in
countries where abortion is most easily available," said Frances
Perrow, a federation spokeswoman. According to the report, countries
in Latin America which ban or restrict abortions have abortion rates
of 30 to 60 for every 1,000 women, while in western Europe, the
rate is about 14 abortions for every 1,000 women. The report suggested
that countries with tough abortion laws also have few sex-education
programs and generally limit the availability of contraceptives
-- increasing the number of unwanted pregnancies.
29 May, 1993
Setback for blood plant
A proposal by the Canadian Red Cross to build a blood fractionation
plant in Canada received a setback after the Canadian Blood Agency
rejected it. Currently Canadian plasma, collected from volunteer
donors, is shipped to U.S. plants for fractionation. The Red Cross
said that the $100- million Canadian plant would save taxpayers
$400 million over a ten-year period and ensure self-sufficiency
and safety of blood products. The Red Cross manages to collect only
about 75 per cent of the plasma required to meet the needs of Canadian
hospitals. The rest is bought in the United States and Europe. Canada's
tainted-blood scandal, which saw more than 1,000 hemophiliacs and
blood-transfusion patients infected with the AIDS virus, resulted
in part because products made with contaminated blood from the United
States were imported into Canada to meet shortages.
2 June 1993
New Thalidomide victims
Thalidomide, the sedative which was banned worldwide in 1962 after
thousands of infants whose mothers had taken it were born without
arms and legs, is producing a new group of deformed infants in Brazil.
After being banned, Thalidomide was re-introduced in Brazil in 1966
as a treatment for leprosy only. Brazil's health ministry says that
use of thalidomide is strictly monitored, but investigators have
presented evidence that hundreds of deformed infants have been born
and that medical officials have deliberately destroyed evidence
to cover up many of the cases. Investigators found that drugstores
were selling thalidomide without a prescription, and that many illiterate
women taking it were unaware of the risks..
2 June 1993
Depo-Provera
The manufacturer of Depo Provera is appealing the federal health
department's decision not to allow the drug to be marketed as a
long-term contraceptive in Canada. Depo Provera, which is licensed
as a cancer treatment in Canada, was given final approval as a contraceptive
by the World Health Organization in June. Opponents of Depo Provera
have repeatedly raised concerns about its long-term effects on women.
3 June 1993
HIV+ blood donors liable
The Supreme Court of Canada has ruled that people who knowingly
donate HIV-infected blood can be prosecuted under existing laws.
The court upheld the 1989 conviction of an Ottawa man who donated
his blood to the Red Cross even though he knew he had tested positive
for HIV and had been told not to donate blood. He began serving
a 15-month jail sentence after the Supreme Court ruling.
5 June 1993
Hospitals advocate competition
The Canadian Hospital Association is calling for dramatic changes
to the delivery of health care, including the introduction of market-style
competition for hospital patients and the elimination of public
financing for non- essential services. The association's Vision
Project Report, released in June at the annual convention of the
CHA, proposes that hospitals be forced to compete against each other
for patients and public money. "We're talking about emulating
the market system" said CHA president Carol Clemenhagen. "If
some institutions are not as efficient as other institutions, they
shouldn't be receiving public funds for that facility." The
proposal is modelled in large part on reforms introduced in the
British National Health Service by Margaret Thatcher's Conservative
government several years ago. The CHA report calls for a fixed level
of health care funding based on providing a core list of services.
Services not on the core list would no longer be available unless
patients paid privately, along the lines of the system adopted in
the U.S. state of Oregon.
10 June 1993
Smoker denied surgery
Physicians in the United Kingdom triggered a public debate about
medical ethics after the death of a patient who had been denied
non-urgent heart bypass surgery because he was a smoker. Dr. Christopher
Ward, a Manchester cardiologist, said that "we're not penalizing
smokers and not discriminating. The fact of the matter is the benefits
they might get from having coronary bypass surgery are negated by
the fact they continue to smoke." According to Dr. Ward, the
evidence shows that non-smokers have a significantly greater chance
of benefiting from bypass surgery. Others disagreed with the policy,.
"My view is that once we accept an absolute bar to surgery
for smokers, we... may well be on the slippery slope to withholding
treatment for the unmotivated and unfit," wrote Dr. Matthew
Shiu in the British Medical Journal. A smokers' rights group said
that many others, including people infected with AIDS by drug use
or sexual activity, alcoholics with liver disease, and athletes
with sports injuries, are not denied treatment for conditions resulting
from lifestyle choices. Dr. John Bailey, who opposes non-urgent
surgery for smokers, said that likely clinical outcomes will have
to be weighed more carefully as waiting lists for coronary surgery
grow longer.
11 June 1993
Minister quits over "social contract"
Karen Haslam, Minister Without Portfolio for Health in the Ontario
NDP government, resigned from the cabinet on June 14 in protest
against the "social contract" legislation. "I firmly
believe in the rights of free collective bargaining," Haslam
said. "Any time you legislate an override on a collective agreement,
I can't support that and I will vote against it," she said.
14 June 1993
Corporations want tax cuts
A group of 15 major corporations is proposing that companies should
receive a rebate on their employer health tax if they offer health
and fitness programs to their employees. The idea received endorsement
from Ontario's deputy minister of health Michael Decter, who said
"there is huge yardage to be gained, both for employers and
for the society as a whole, in finding ways to contribute to employee
health".
15 June 1993
Community care changes and fears
Patients' advocates are expressing concern that the Ontario government
is rushing into a plan to shift psychiatric patients out of institutions
before the services needed for community-based care are in place.
The government announced in June that the number of psychiatric
beds in Ontario are to be cut in half over the next 10 years. "We
have to transform services that are fragmented so that we have a
co- ordinated system," Health Minister Ruth Grier said. "Many
of the people who have been occupying psychiatric beds for many
years have not been getting treated and in fact can be more effectively
treated in other ways." "I applaud this but I'm scared,"
said June Beeby of the Ontario Friends of Schizophrenics. "You've
got to have transitional money, and there isn't any. You've got
to have the support services up and running. This will mean a gap
of a few years, and they have already taken $45 million out of the
mental-health envelope." She cited lengthy waiting lists for
community-based therapy. "It sounds great in theory and God
knows I'd like it to work, but I think it will be a disaster,"
she said. "If there are fewer beds for the very ill and no
more money for mental health services over-all, it doesn't take
a rocket scientist to figure out that this will mean more people
living on the streets." There are 370 community mental health
programs in the province, providing case management, social rehabilitation,
housing, vocational aid, psychogeriatric care, crisis intervention,
day treatment and counselling. But studies show that there is a
wide variation in services. "You can have 370 programs, but
the vast majority of them wouldn't let a schizophrenic in the door,"
Ms Beeby said. Ms Grier said in her announcement that she will not
eliminate beds until community care is established, but Martha Gandier,
co-ordinator of Toronto Psychiatric Survivors, a self-help group,
is skeptical. She says that when the previous Progressive Conservative
and Liberal governments closed institutions in the 1970s and 1980s,
they made the same promises, but patients found themselves on the
streets, isolated, without human contact, living in rooming houses
in an endless cycle of poverty.
17 June 1993
Hospitals to close
Some Metro Toronto hospitals will have to close and others merge
as the government tries to reform health care, Health Minister Ruth
Grier has said. Grier says that she wants a plan for the closings
by the end of the year.
17 June 1993
Non-profit homemakers planned
Health Minister Ruth Grier has announced that the province wants
to replace private agencies supplying homemakers for the aged and
handicapped under Ontario-funded programs with non-profit operations.
"In these times of restraint, the government prefers to see
tax dollars directed toward services for consumers, and workers'
wages, rather than profit," Ms Grier said. The Ontario government
estimates its funding supports about 15,000 homemakers, who provide
the elderly and handicapped with help in shopping and household
chores. The service makes it possible for people to remain in their
homes rather than be placed in institutions. The province spends
about $190 million annually on homemaker services. Private agencies
provide nearly half of the publicly funded home care in the province.
26 June 1993
Tories eye user fees
The federal Progressive Conservative government is leaving the door
open to the introduction of user fees for health care. Both Kim
Campbell and Jean Charest suggested that user fees should be looked
at as an option during their runs for the leadership of the party.
Campbell later said that she personally didn't think user fees for
"medically necessary" treatments were the best way to
go, but didn't say she would lift a finger to stop provinces from
introducing them. She also said that charging patients who go to
a hospital for what is deemed to be a non-emergency condition that
could have been handled by a clinic would not be a "user fee",
since the hospital visit would not be considered a "medically
necessary" service. This would not be a "user fee"
said Campbell, "it's to discourage people from getting their
services in an expensive place as opposed to a more cost-effective
place." In Tory code, "Never" and "Sacred Promise"
mean "Not until after the election", while "Maybe"
and "Wouldn't rule out" mean "Not until after the
election".
26 June, 27 August 1993
Rural MDs form group
A group of rural MDs has formed the Society of Rural Physicians.
Dr. David Fletcher was elected the first president of the organization,
which is based in Mount Forest, Ontario. Among the issues to be
addressed by the group are a shortage of physicians in rural communities
and the closing of small-town hospitals.
3 July 1993
Refugees to lose coverage
Ontario's NDP government is moving to remove OHIP coverage from
refugee claimants, temporary workers, and foreign students. As many
as 167,000 people could be affected, according to figures compiled
by the Ontario Ministry of Health. At present, temporary Ontario
residents are covered by OHIP in the same way that permanent residents
are. Under the new legislation, they would lose that coverage and
have to pay their own medical bills. Health Minister Ruth Grier
said that it is the government's intention to restrict coverage
to those who are considered permanent residents. The government
has been pressing the federal government to pay for the health care
of refugees.
3 July 1993
Drug money
The brand-name drug companies who benefited from the Progressive
Conservative government's drug patent legislation made substantial
contributions to the Progressive Conservative Party. Figures released
by Elections Canada show that in 1992, the PC Party received contributions
from the Pharmaceutical Manufacturers Association of Canada and
from many of the individual multi- national drug companies. However,
in keeping with the corporate custom of hedging bets by supporting
both of the main pro-business parties, many of the drug manufacturers
also made smaller contributions to the Liberal Party
21 July 1993
Pay equity deal
The Ontario Hospital Association has agreed to give about 40,000
nurses a one-time payment of $4,100 in a pay equity deal. The payment
will raise the maximum annual salary of full-time nurses from $52,000
to $54,210 by January 1996. The hospital association represents
171 hospitals. Another 53 hospitals in Ontario are not covered by
the deal. Hospital association president Dennis Timbrell said the
agreement will cost hospitals about $123 million in retroactive
pay and an additional $66 million in annual costs by 1996. Pay equity
adjustments, which compensate for past pay inequities, are not affected
by the province's "social contract" legislation.
22 July 1993
AZT court case
A U.S. federal judge has ruled that the U.S. pharmaceutical company
Burroughs-Wellcome is the sole inventor of the anti- AIDS drug AZT.
Burroughs-Wellcome sued Novopharm Ltd. of Toronto, Barr Laboratories
of Pomona, New York, and the U.S. National Institute of Health,
after the two companies applied for permission to produce a generic
version of AZT. Novopharm and Barr argued that the AZT patent was
invalid because the drug was developed by public money, and that
two scientists at the U.S. National Institute of Health were co-
inventors of the drug. In a case which observers characterized as
"bizarre", Judge Malcolm Howard allowed Burroughs-Wellcome
to present its case and then ended the case and handed down his
ruling without allowing the other side to present its case. Novopharm
and Barr are asking that a mistrial be declared, but in the meantime
are prevented from marketing the drug.
23 July 1993
Charities lose under "social contract"
Ontario charities in the health care field are having to turn money
over to the province under the NDP government's "social contract"
law. The charities are being made to turn over 5 per cent of their
payroll costs for the next three years. Charities fall under the
"social contract" if they receive any of their funding
from the provincial government. The clawback applies even if agencies'
payrolls exceed the total amount they receive from the government
in the first place.
28 July 1993
Restrictions on out-of-province MDs
The Ontario government has put a moratorium on the right of new
doctors coming into the province to bill OHIP. Effective immediately,
doctors entering Ontario with degrees from medical schools outside
the province will be able to practice medicine only if they go on
salary or accept some other form of alternative payment. They will
not be allowed to bill OHIP under the fee-for-service system. The
moratorium is to last until March 31, 1996, when the government's
"social contract" program expires. However, the moratorium
may be challenged under Canada's Charter or Rights and Freedoms.
Constitutional lawyers said that the government's new rules appear
to violate Section 6 of the Charter, which states every citizen
has the right to pursue a livelihood in any province.
6 August 1993
Private sector bureaucracy
A new study has found that 24.8 per cent of all U.S. hospital costs
go for administrative expenses, about twice the proportion spent
in Canada. The study, based on federally-mandated cost reports from
each of the nation's 6,400 hospitals in 1990 and published in the
New England Journal of Medicine in August, estimates the U.S. could
save $50 billion a year on hospital administration costs by shifting
to a Canadian-style health system. A second study, by Steffie Woolhandler
of Harvard Medical School and Sidney Wolfe of Public Citizen's Health
Research Group, estimated that under a single-payer system, the
U.S.'s total health system (not just hospitals) could save about
$117 billion a year on administrative costs, including the $50 billion
on hospitals.
15 August 1993
BC NDP limits payments
British Columbia's NDP government has introduced new guidelines
as part of an agreement with the province's doctors under which
the provincial health care plan will no longer pay for services
that are not considered medically necessary. If a patient wants
a service which is not considered medically necessary, he or she
will have to pay for it. Prime examples of such services would be
tests for which there is no medical indication. The guidelines to
be applied are to be developed by the province's new Medical Services
Commission, a tripartite body including government, physician and
public representation. David Naylor of Ontario's Institute for Clinical
Evaluative Sciences, said that the guidelines represented a step
forward because "in the past, we have concentrated on the service
itself, and whether it should be funded. Now we are seeing an attempt
to define when and where a service is useful and to stop paying
for it if it is used inappropriately." However, he added, there
is also a danger that physicians will be tempted to subscribe more
and more of their services to private billings once these are allowed.
"They may define what is medically necessary in ways that compromise
the patient's interest. Is this also a step on the slippery slope
towards privatization of our medical-care system?"
25 August 1993
Private sector growing
A steadily increasing share of Canada's health care system is being
financed by the private sector, according to a report prepared by
the Canadian Medical Association. "A process of privatization
is going on," said Dr. Hugh Scully, chairman of the committee
that presented the report to the CMA's annual meeting. The CMA study
stated that the private share of total spending on health care amounted
to nearly 28 per cent in 1991, up significantly from 25.3 per cent
in 1985. The growth in private spending is largely attributed to
increasing use of private insurance for services not covered by
medicare, the lack of fiscal controls on private charges, and a
rapid growth in drug costs. The report points out that more money
is now spent each year in Canada on drugs than on physicians. Drug
costs, including prescriptions, hospital-dispensed drugs, and over-the-
counter drugs, amounted to $11.2 billion, or 16.8 per cent of all
health care spending, while physicians amounted to 15.2 per cent.
Drug plans, eye plans, and the cost of nursing homes are some examples
of where private health care dollars are being spent.
26 August 1993
User fees slammed
User fees are an obstacle to meaningful reform of Canada's health
care system -- and they don't work, according to a report prepared
by health economists Greg Stoddart and Robert Evans. Neither of
the main reasons for user fees -- deterring patient abuse of the
system or reducing the cost of medicare -- stand up to scrutiny,
according to Stoddart. "Costs will increasingly fall on those
who need and use care," he said. The report estimates that
less than one per cent of total health care spending is due to patients
seeking unnecessary services. Meanwhile, estimates of inappropriate
use of the system generated by physicians range as high as 30 to
40 per cent, according to the report. "That is a much larger
problem, and one which user charges will not address." There
is no evidence that user fees deter patient abusers of the system,
according to Stoddart, but there is clear evidence that they deter
low-income individuals from seeking necessary medical care. Stoddart
also said that it is wrong to expect patients "to diagnose
themselves" before deciding whether they need to see a doctor.
"How are they going to know in advance what medical services
are necessary? Trying to do that may do them harm." Introducing
user fees would mean that "the healthy rich stand to gain the
most and the sick poor stand to lose the most."
10 September 1993
Drugs trimmed from ODBP
The Ontario government has removed 134 drugs from the list of those
provided to seniors and welfare recipients. The changes are expected
to save $40 million a year from the $1.2 billion cost of the Plan.
Among the drugs removed from the list are calcium supplements, antacids,
and digestive enzyme supplements. 36 other drugs were added to the
Plan.
13 September 1993
Abuse by nurses found
A survey of 1,608 nurses by the Ontario College of Nurses found
that nearly half those polled had witnessed at least one incident
of physical or verbal abuse of a patient by another nurse. Half
of those said they had witnessed "numerous" incidents.
Two-thirds of the reported incidents involved elderly patients.
Ten per cent of the reported incidents involved hitting or shoving,
31% "roughness", 28% yelling and swearing, and 28% embarrassing
comments. Respondents said patient actions precipitated about 70%
of the incidents. The survey did not specify a time period, so there
was no indication of how many of the incidents occurred in a given
period of time. The College is moving to develop a public awareness
program and professional guidelines.
25 September 1993
New Brunswick to privatize administration of health care system
New Brunswick Premier Frank McKenna has announced that New Brunswick's
Liberal government will turn over administration of the province's
medicare plan to the private sector. Premier McKenna claimed that
by handing the administration to a consortium of private companies,
the province will save between $12 and $60 million a year. Apparently
unconcerned with the government's bargaining position in negotiations
with the private consortium, McKenna made the announcement before
the government had even received a firm proposal from the consortium.
About 80 government employees will lose their jobs. Some will be
hired by the private consortium at undetermined wages. The government
also announced that it will introduce a personal health card which
will be used to feed information into a centralized computer system
run by the private consortium. The new system is supposed to help
the province track down abusers of the system. The cards will also
allow instant printouts of the cost of medical services. The intent
is to give each patient a statement showing them the cost of their
health care.
29 September 1993
Non-profits to be favoured
Ontario Health Minister Ruth Grier has announced that the government
will move to diminish the role of for-profit operators in the provision
of long-term care. "The role of for-profit organizations will
diminish to 10 per cent of the amount of service that is provided
over the next two or three years," Grier said in commenting
on a report offering a blueprint for long-term care in the province.
Grier said that the aim of the new system is to co-ordinate the
1,200 agencies that provide services for the chronically ill into
a new system that will aim at keeping people in their home longer,
with one-stop access to services. The agencies will be umbrella
organizations working under the guidance of Ontario's 32 district
health councils. The agencies will combine home-care and placement
co-ordination with the existing services of community groups, such
as personal care nursing, home-making, physiotherapy, telephone
support and transportation. Grier said some of the new agencies
will be operating by 1994, with the remainder coming on stream in
1995.
30 September 1993
"Administrative fees" may go
Ontario doctors could be barred from charging patients yearly so-called
"administrative fees" by the end of the year. The Ministry
of Health has announced that it intends to move against the charges,
which are supposed to be for services not paid for by OHIP, such
as renewing prescriptions by phone or writing letters on behalf
of patients. However, Dr. Michael Dixon of the College of Physicians
and Surgeons of Ontario, warned that the move could actually result
in some patients having to pay more, since MDs will still have the
option of billing individually for each uninsured service.
16 October 1993
Liberal platform
According to statements made by Jean Chretien during the election
campaign, his newly elected Liberal government will not allow the
introduction of user fees in Canada's health care system. The Liberal
policy document also stated that "a comprehensive re-examination
of Canada's health-care spending is required." The Liberals
have said nothing about whether they intend to maintain, or change,
the existing Progressive Conservative legislation which is aimed
at the elimination of all transfer payments to the provinces for
health care by about 2002.
Morgentaler wins in Nova Scotia
The Supreme Court of Canada has ruled 9-0 that the Nova Scotia government's
ban on free-standing abortion clinics is unconstitutional. The ban
was in essence a criminal law, although the government sought to
present it as a health policy, the court ruled.
1 October, 1993
Cross-border MDs rate Canadian system superior
A survey published in the November issue of the American Journal
of Public Health found that doctors who have practised in both Canada
and the United States rate Canada's health care system as superior
to that of the U.S. The three main complaints of doctors practising
in the United States were the lack of universal access to health
care, the greater amounts of paperwork and bureaucracy, and the
higher fees charged for malpractice insurance. Higher pay was the
main advantage of practising in the U.S., and nearly half of the
doctors who left Canada for the U.S. did so because of the pay.
9 November, 1993
Hospital abandons epidurals
McKellar General Hospital in Thunder Bay has abandoned the use in
epidural anesthesia during childbirth because of a shortage of staff.
The hospital's anesthesia unit made the decision citing under-staffing
as the problem. "We're overtaxed," said James Middleton,
head of anesthesia at the hospital." "We've had to close
one of the operating rooms in the hospital over the last six weeks.
I would say at least 120 people have had their surgery delayed in
that time. So epidurals are one aspect of the problem, but not the
only aspect." Dr. Middleton estimated that McKellar administers
between 300 and 400 epidurals a year. The other major birthing hospital
in the city rarely administers epidurals, and few of the smaller
hospitals across Northern Ontario provide them.
9 November, 1993
Welfare dental cuts cause pain
Metro Toronto's tough measure to reduce dental costs are "causing
tremendous pain and suffering" among welfare recipients, according
to a report by the West Central Community Health Centre. Metro chopped
the dental services budget for welfare recipients to $12 million
from $23 million in 1992. But even this lower budget wasn't spent,
as welfare workers stopped telling people they were eligible. The
result is that only half of the budget was spent. "Not only
has the program been stripped to bare bones, recipients haven't
even been told they're eligible for crucial emergency treatments,"
said Dr. Joel Rosenblum, a dentist who works out of the WCCHC.
10 November, 1993
Shortage of radiation oncologists
Bernard Cummings, the chairman of the department of radiation oncology
at the University of Toronto, has warned there will be a serious
shortage of radiation oncologists in Ontario by the end of the decade.
According to Cummings, the number of cancer cases in the province
is increasing by 3.5 per cent a year with the result that "we
are facing... great difficulty treating the number of patients who
would benefit from radiation, and governments are very slow to implement
corrective measures. There is a slowness in the process, and during
that interval patients cannot be treated." He said 87 radiation
oncologists currently are practicing in the province, with another
64 in training at Ontario universities. By the end of the decade,
there will be a shortage of 55 oncologists if nothing is done, Cummings
said.
11 November, 1993
Staying in bed not that bad
Forcing chronic care patients to stay in bed two days a week "isn't
necessarily" compromising their quality of care, according
to Lin Grist, a spokeswoman for Ontario Health Minister Ruth Grier.
It's understandable that patients at West Park Hospital may be "feeling
badly" because social contract cuts means there's not enough
staff to help them get dressed and out of bed two days each week,
Ms Grist said. "I'm not saying it's a brilliant suggestion
but it sounds to me like it was, for them, the least disruptive
way of meeting their (social contract) target," she said. Officials
at the 398-bed chronic care facility in the City of York are meeting
their target of $1.3 million in salary cuts by keeping some patients
in bed two days a week.
15 November, 1993
Province backtracks on user fees for drugs
In the face of criticism, the Ontario government backed away from
its plan to make seniors pay user fees for prescription drugs. The
Ontario Drug Benefit Program pays for prescription drugs for 2.4
million people, including those over 65 and those on welfare. The
NDP government announced in June that it wanted to charge user fees
to seniors with higher incomes, provoking an angry reaction from
seniors' groups and others.
17 November, 1993
Berger chief of family medicine
Dr. Philip Berger, a long-time member of the Medical Reform Group,
is now the chief of the department of family and community medicine
at the Wellesley Hospital, Toronto. As well as his MRG activities,
Berger is chair of the Toronto HIV Primary Care Physicians Group,
and a founding member of the Canadian Centre for Victims of Torture.
22 November, 1993
Tenant law broadened
Ontario is extending tenant protection legislation to cover people
living in unregulated care homes. About 47,000 people are affected,
mainly seniors, former psychiatric patients and people with disabilities.
Under the new legislation, tenants in care homes will be covered
by the provisions of the Landlord and Tenant Act, which would give
residents security of tenure, and the Rent Control Act, which will
apply to the portion of the monthly charge that is for rent. Operators
of the 2,000 to 2,500 homes affected by the legislation would also
be required to register their charges for care and other services
with the province's rent registry, and to provide residents with
90 days notice of increases in care service charges. Ernie Lightman,
a social work professor at the University of Toronto who wrote a
recent report on conditions in unregulated care homes, told reporters
that tenant protection was the most important of his report's 148
recommendations.
24 November, 1993
Alberta's user fees
Federal Health Minister Diane Marleau has said that she intends
to review the Alberta government's decision to allow private medical
clinics to charge patients large sums for operations which are available
at no cost in the province's hospitals. The Canada Health Act prohibits
doctors from charging more for a service covered by medicare than
the amount set out in their provincial fee schedule. Some privately
operated eye clinics in Alberta charge as much as $1,000 per patient
as a "facility fee" for cataract surgery. The eye surgeon's
fee for the operation, about $550, is paid by medicare, but the
"facility fee" is not. Richard Plain, a health economist,
said this is a clear violation of the Canada Health Act. "This
is condoning extra-billing by ophthalmologists rendered under the
euphemism of a facility fee. If a service is medically required,
such fees are not supposed to be imposed without facing a dollar-by-dollar
penalty. "What's happening is that if you go to a hospital
for the operation, you face a long waiting list. If you step outside
to a clinic across the street, and you've got a thousand bucks,
they'll take care of you immediately." Mr. Plain said he is
equally concerned about the recent opening of two private clinics
in Alberta offering magnetic resonance imaging at $1,000 per scan.
"Once again, if you can pay, you get right in," he said.
"But any other Canadian, if it's a low-priority matter, will
spend months on a waiting list." "The point is that medicare
is supposed to ensure there are no financial barriers for access
to insured services," he said. "They have no right to
impose out-of-pocket expenses on the sick." John Sproule, a
spokesman for the Alberta Health Ministry, said the payment of a
"facility fee" at eye clinics is no different from the
extra fees charged by Alberta's free- standing private abortion
clinic. "We pay the physicians for their services and the patients
pay the facility fee."
24 November, 1993
Reproductive technologies
The Royal Commission on New Reproductive Technologies released its
long-awaited report on November 30. Among its major recommendations,
the report recommends restricting in vitro fertilization to women
with flocked fallopian tubes; ensuring that all women, including
those who are single or lesbian, have equal access to medical procedures,
specifically donor insemination; outlawing the selling of babies,
embryos, fetal tissue, and sperm, for profit; making it illegal
to arrange surrogate births; prohibiting pre- natal testing to determine
the sex of a child unless the testing is medically necessary.
1 December, 1993
Millions owed in back payments
The Ontario government is owed millions of dollars in back payments
by doctors and not enough is being done to collect, according to
the provincial auditor's report. Physicians must repay some of their
fees once billings top $425,000. In the past three years, physicians
were ordered to repay the province $6.8 million because of overbillings
but the province collected only $3.1 million. The auditor's report
also complains that MDs face no fine for repeatedly overbilling
the province, being forced only to repay the excess money. It also
says far too few physicians are referred to the committee that reviews
overbilling.
8 December, 1993
Province offers salaries
The Ministry of Health is offering several hundred university physicians
a deal that would pay them a basic salary plus extra compensation
for such things as overtime or surgery. The Alternative Funding
Plan, which has already been agreed to between Queen's University
and the province, is also being offered to physicians at universities
in Toronto, Hamilton, Ottawa and London. The new faculty payment
plan is anticipated to work far better for academic physicians than
the current fee-for-service "treadmill," said George McLauchlin
of the faculty of health sciences at McMaster University.
22 December, 1993
Midwives join the system
Regulations governing the practice of midwifery in Ontario came
into effect on January 1, making midwives a recognized profession
under the Regulated Health Professions Act. Publicly funded licensed
midwives will now be available for both home and hospital births.
Initially about 60 midwives will be eligible to practice. They will
be paid a base salary of about $55,000 a year, which can go higher
or lower depending on the number of clients and experience. Most
registered midwives will not be permitted to take on more than 80
patients a year or fewer than 20. The Toronto Hospital has announced
that it will now allow midwives to admit, manage and discharge patients.
The hospital plans to appoint four or six staff midwives working
in pairs.
1 January, 20 January, 1994
Hospitals propose merging services
Four downtown Toronto hospitals are proposing to form a consortium
by merging some services to save money. Under the proposal, Mount
Sinai, The Toronto Hospital, Princess Margaret Hospital, and the
Hospital for Sick Children would share one biochemistry laboratory,
security staff, grounds staff, pharmacy and food units. According
to Dr. Alan Hudson, the CEO of the Toronto Hospital, tens of millions
of dollars in annual savings are possible.
13 January, 1994
Rural physicians set goals
The Society of Rural Physicians of Canada held its first national
executive meeting -- via telephone -- on January 19. "We're
discovering that rural physicians across the country have more in
common with their rural colleagues than with their urban counterparts
who may come from their own province," society president Dr.
David Fletcher of Mount Forest said. "Rural is rural regardless
of where you live in this country." Goals identified by the
group include: (1) The need to respond quickly to rural health care
issues from a national perspective; (2) The expansion to a monthly
publication of the group's newsletter; (3) The creation of a national
electronic mail network to allow continuous communication between
members on issues such as hospital closures, physician shortages,
and staffing of rural emergency departments. There was a consensus
from members across the country that governments are moving from
central to regional planning of health care, at the cost of rural
medicine. "It means the largest urban centre in your region
makes all the rules and sucks the resources out of the surrounding
rural area," Fletcher said. "They promise the rural area
`outreach programs' in exchange, but the programs last no more than
12 to 18 months. Meanwhile the rural budgets are never returned
to the rural area." For more information about the Society
of Rural Physicians of Canada, contact Dr. David Fletcher, (519)
323-1951, fax: (519)323-3881.
January, 1994
Dialysis wait called critical
The president of the Toronto Dialysis Committee, Dr. Janet Roscoe,
says that a critical shortage of resources for dialysis patients
has confined some to hospital and others to severe pain while waiting
for treatment. Dr. Roscoe also expressed fears that older patients
may not even be getting referred for dialysis because of the huge
backlog. The number of dialysis patients in Metro Toronto increased
from 504 in 1981 to 1,422 in 1992 and is forecast to keep rising.
The increase is attributed to an aging population and an increased
incidence of diabetes. Meryl Hodnett, director of patient services
for the Kidney Foundation of Canada, said some patients wait so
long that they are in a "very poor state" by the time
they get dialysis. "People are suffering with symptoms of renal
failure and dying as a result of not getting the treatment,"
she said. In October, the health ministry provided emergency funding
to place more people on dialysis as outpatients at two Toronto hospitals.
The ministry has ordered a review of dialysis treatment, which is
expected to be completed this summer.
22 January, 1994
OHIP curbs
Ontario's NDP government has acted to exclude temporary residents
from OHIP coverage. Among those who are no longer covered are about
22,000 foreign workers and their families living in Ontario, and
about 19,000 international students. New residents will be subject
to a three-month wait before coverage begins, and Ontario residents
who have been out of the province for more than 183 days will also
have to wait before coverage resumes unless they made prior arrangements
with OHIP. People arriving in Ontario who don't plan to live in
the province permanently are no longer to be covered. The province
is also continuing to press the federal government to pay the health
care costs of refugee claimants, but has agreed to reinstate the
coverage of refugee claimants whose time-dated health cards expired
July 1. Ontario becomes the sixth province to adopt similar measures.
Critics have questioned the legality of some of the measures, as
well as the practical difficulties of enforcing them. Howard Greenberg,
chairman of the immigration section of the Canadian Bar Association,
said that he objects to the changes because the workers involved
pay taxes in Canada. The Ministry subsequently announced that pregnant
women who arrived in Canada before April 1 would be exempted from
the policy.
April 2, 1994
Workers compensation reforms
Reforms to the Workers' Compensation Board remain controversial
with both labour and employer organizations. The reforms were agreed
to by a special labour-management committee created by Ontario Premier
Bob Rae to sort out the WCB's problems. The changes, which are supposed
to reduce the Board's long-term deficit, were supported by Gord
Wilson, head of the Ontario Federation of Labour, a member of the
committee, and by Ontario Labour Minister Bob Mackenzie, as well
as by employer representatives on the committee. The effect of the
reforms, according to the committee members, would be that injured
workers will lose money to inflation, but will gain a better chance
of returning to their jobs. Under the formula that is at the heart
of the changes, workers' benefit gains would lag 25 per cent behind
the cost of living, and in addition would be docked 1 percentage
point of the inflation rate. Stopping the full indexing of benefits
was a key goal of employers in the negotiations. Wilson said that
workers gain because the agreement contains a strong commitment
to rehiring injured workers. The fully disabled and some workers
with the lowest pension incomes are to keep their indexed benefits.
The WCB provides about $2.4 billion in benefits and services to
more than 200,000 injured people yearly. Some business leaders were
critical of the provisions requiring employers to take back injured
workers. Buzz Hargrove of the Canadian Auto Workers Union criticized
the accord's rewriting of the WCB's purpose. "They're shifting
the emphasis away from a program to benefit workers and they're
emphasizing the financial end of it," he said. Injured workers'
organizations were critical of both the terms of the agreement and
the process used to arrive at it. "I don't want somebody else
speaking for me. I want a representative of mine at the table,"
said Don Comi, head of the Niagara District Injured Workers' Organization.
"We want to be part of the process".
Mandatory reviews
Alberta doctors will become the first in Canada to undergo regular
mandatory evaluations. "It seems pretty clear we're being too
reactive instead of being proactive in terms of stopping potential
problems," said Larry Ohlhauser, registrar of the Alberta College
of Physicians and Surgeons. "The goal here is to fix things
before there's a complaint... There's no point looking at a pilot's
performance after a crash." The College has yet to determine
how it will conduct the evaluations, which each physician will undergo
every seven to 10 years. Evaluations will not begin until 1996 at
the earliest. Other provinces such as Ontario conduct random peer
reviews. Ontario evaluates about 400 doctors each year.
April 6, 1994
Cancer strategy announced
The Ontario Ministry of Health has announced a cancer strategy to
combat waiting lists for treatment and to establish plans for cancer
prevention. The cancer strategy, called Life to Gain, includes provisions
for an additional $8 million for 100 more bone marrow transplants
each year, which is expected to eliminate the existing backlog.
Additional operating funds will be made available to regional cancer
centres to operate radiation equipment. A task force to recommend
"appropriate next steps" for cancer prevention is to be
set up. A provincial cancer network which will include health care
providers, hospitals, agencies, community groups, and patients,
is being set up to link services. Ontario Cancer Treatment and Research
Foundation president Dr. Charles Hollenberg said he was "very
pleased" with the new strategy, calling it "very imaginative
and very badly needed."
April 9, 1994
Law could free criminally insane
An Ontario court is being asked to force Ottawa to proclaim a law
that would limit the length of time a person can be held in a psychiatric
hospital after being found not guilty of a crime because of mental
illness. If successful, the constitutional challenge could lead
to the release of mental patients who have spent more time in hospital
than the maximum sentence for the crimes they were accused of. Advocates
for the mentally ill say the law is long overdue, calling the current
system of indeterminate incarceration discriminatory. However, Peter
Insley, a lawyer representing the British Columbia government, which
has been asking the federal government not to proclaim the law,
said that "whether a mentally disordered accused should be
on the streets boils down to a medical decision. To adopt a legal
model undermines that." The case is being brought on behalf
of Denis LePage, who has been in the Oak Ridge facility for the
criminally insane since 1977.
April 11, 1994
Out-of-country coverage cut
The Ontario government has reduced its coverage of out-of- country
hospital stays from $400 a day to $100 a day, saying it needs to
save the money. The $400 figure was based on the estimated cost
of a one-day stay in an Ontario hospital. "I think that anybody
would be very foolish to leave Canada without health insurance,"
said Ontario Health Minister Ruth Grier in announcing the move.
Ontario's action, which violates the Canada Health Act, is being
challenged in court by a "snowbird" group, and federal
health minister Diane Marleau has said she will takes steps to enforce
the Act. Grier said the reduced coverage is in line with coverage
provided by Alberta and Saskatchewan, and higher than B.C.'s $75
a day. She said that 140,000 Ontarians received out-of- country
hospital care last year. Eric Izzard of the Canadian Snowbird Association
said that "The Canada Health Act has a portability clause that
says a province must pay the same for health care outside of Canada
as they do inside Canada.... "Right now, we feel betrayed by
the NDP government."
April, 1994
Pay at the door
A report by the Toronto Star indicates that some Toronto hospitals
are increasingly asking patients for cash up front. In several hospitals,
patients arriving without a health card are asked to pay $25 on
the spot -- the payment being refundable if you show your card to
hospital officials within 24 hours. Patients arriving by ambulance
are hit with an immediate $45 charge rather than being mailed a
bill. Non-residents are also being charged a hefty up front fee
for the emergency room. Hospitals charging the fees included Toronto
East General, North York General, and Scarborough Centenary Debra
Bloomfield, spokeswoman for North York General, said "This
is not a revenue-generating thing. We don't even like to process
the $25. What we really want is the health card number." East
General's controller, Al Kramer, said that each year, about $70,000
worth of admission, emergency and ambulance services at East General
are never paid by patients, which means the hospital has to absorb
the loss. Non-residents at East General now have to pay a flat $200
fee for the emergency room, which doesn't include doctors' fees,
diagnostic tests or anything else associated with the visit. Scarborough
Grace charges out-of- country patients $110 up front for an emergency
room visit; North York General asks $225.
April 13, 1994
Marleau to enforce Canada Health Act
Federal Health Minister Diane Marleau has cut British Columbia's
federal transfer payments because the B.C. government is allowing
a groups of doctors in the province to extra-bill, and is looking
at similarly penalizing Alberta and Ontario for violations of the
Canada Health Act. Extra billing is not allowed under the provisions
of the Canada Health Act. Marleau said that B.C.'s transfer payments
are being cut by an amount equal to the extra- billing taking place.
She is also pressing the Alberta government to account for violations
of the Canada Health Act taking place in that province. Alberta
has private eye clinics which charge large "facility fees"
of $1,000 or more cataract surgery, and has allowed the establishment
of private MRI clinics. "Services have to be given to people
based on need, and not on the size of their pocket-books,"
Marleau said. "I am adamant there will be no extra-billing."
Ironically, however, Ms Marleau's get-tough approach is being rapidly
undermined by her government's failure to reverse cutbacks in federal
transfer payments brought in by the previous Progressive Conservative
government. The result of these cutbacks will be to eliminate all
federal transfer payments for health care within a few years, thereby
removing the federal government's enforcement mechanism to ensure
adherence to the Canada Health Act.
April 23, 1994
HIV tests for immigrants
Immigration Minister Sergio Marchi says that the government is considering
whether to test all potential immigrants for HIV and then deny entry
to those who have the virus. At present, people with serious medical
conditions like cancer or advanced AIDS may be denied entry to Canada
on the grounds that their condition would put a burden on the health-care
system.
April 26, 1994
Manning defends extra-billing, user fees
Reform Party Leader Preston Manning has said that he supports the
right of provinces to establish private clinics without interference
from the federal government. He said provinces should have more
flexibility to raise money from private sources. "There is
a two-tier system already, not just in Alberta but all across the
country. People with money are going to these high-powered clinics
in the United States. We're losing them anyway. We're saying, `improve
it, by allowing them to do it in Canada instead of somewhere else.'"
April 28, 1994
Drug legislation at issue
Generic drug companies are pressing the federal Liberal government
to make good on its promises to reverse or amend the drug patent
legislation (Bill C-91) passed by the former Progressive Conservative
government in 1992. The generic industry is engaged in a media and
lobbying campaign to show that the legislation is costing Canadians
hundreds of millions of dollars in additional drug costs. Among
the provisions they particularly want revoked is one that made the
terms of the legislation retroactive to December 1991, two years
before it came into effect. That provision alone cost consumers
and provincial governments as much as $2 billion, according to the
Canadian Drug Manufacturers Association. Industry Minister John
Manley says that the government is looking at the effects of the
legislation on prices, and to see if the industry has lived up to
its investment promises. For their part, the multi-national brand-name
drug manufacturers are once again threatening to pull investment
out of Canada if the legislation is changed. However, the new investment
promised at the time the legislation was being discussed is proving
to be less than a sure thing. In April, Eli Lilly Canada Inc. said
it would not be proceeding with the $170 million expansion it announced
when Bill C-91 was being passed. John Pye of the Pharmaceutical
Manufacturers Association of Canada, which speaks for the brand-name
multinationals, said that "forces in the marketplace"
are responsible for the fact that the promised investments are not
materializing. Bloc Quebecois House Leader Michel Gauthier condemned
the Liberal government for even discussing the legislation. He said
that just the suggestion of a review of the legislation has caused
some companies to put investment plans on hold.
April 28, 1994
Safety inspections called inadequate
A decline in enforcement of workplace safety by the Ontario government
is resulting in more injuries and deaths, a union leader has charged.
Fred Upshaw, president of the Ontario Public Service Employees Union,
says that by significantly reducing the number of inspectors and
the number of inspections, the NDP government "comes close
to giving employers a license to kill". Government safety inspection
staff have been reduced by 25 per cent since 1989, and the number
of inspections in the same period has dropped by 40 per cent. The
number of directives against employers and stop work orders has
dropped significantly, and financial penalties against employers
and supervisors declined 69 and 33 per cent respectively. Two figures
showed an increase: the number of fines against workers jumped more
than 400 per cent over the last four years, while the number of
workers killed on the job rose from 232 in 1992 to 292 in 1993.
Business leaders immediately lashed out at Upshaw, saying his comments
were "irresponsible" and didn't make sense since it is
in the interests of companies to reduce job accidents. "I'm
offended," said Ian Howcroft of the Canadian Manufacturers'
Association.
April 29, 1994
Benefits ruling reversed
Ontario's Divisional court has overturned a decision and ruled that
the Ontario Blue Cross does not have to provide family benefits
to the lesbian partner of a Toronto nurse. A human rights board
of inquiry had ruled last year that Blue Cross had to offer the
benefits.
May 3, 1994
Photo ID cards coming
Ontario's Ministry of Health is introducing new OHIP cards that
will bear the card-holder's photograph, signature, birth date, sex,
name, and address. A magnetic strip will carry the same information
in machine-readable form. The new cards are intended to help prevent
fraud and misuse. Health Minister Ruth Grier said that the cost
of the new cards will be $30 million annually for three years, and
then $19 million a year.
May 4, 1994
Payroll tax cut
The Ontario government gave companies a break on employer health
taxes in its spring budget. Employers will not have to pay an increase
in the health tax if wages are raised or workers added. Instead,
a company's tax will be limited to last year's total. The saving
will amount to about $600 for a worker being paid $30,000. Finance
Ministry officials estimate that the tax break will be worth about
$200 million a year, and express hope that the money will be used
to create new jobs.
May 6, 1994
Private firms eye medicare gaps
The move by governments across the country to cut back on publicly
financed health care is leading private insurance companies to move
back into the field of providing health care coverage. Blue Cross
launched its campaign in May with full-page ads showing a picture
of an Ontario health card with a caption below it reading "This
card is full of holes." The ads suggest that costs not covered
by OHIP can amount to thousands of dollars a year. Ontario Health
Minister Ruth Grier said she welcomed the Blue Cross campaign. "I
welcome this debate. It's important for people to have all the information
about how much health care should be paid for by taxes and how much
paid for by individuals." "There's a buzz out there. There's
a lot more interest," said Robin Ingle, president of John Ingle
Insurance, in announcing that his company will be offering a comprehensive
plan to Canadians providing extended health-care benefits not covered
by medicare. "As the gap widens between what the government
pays for and what the patient pays for, there's more room for private
insurers, and we want to be there with a product. This will be our
first such package in 30 years." Mr. Ingle said he believes
Canada is headed for a two-tier health-care system, and that he
has noticed more and more physicians offering services not covered
by medicare. "I've never seen so many entrepreneurial doctors
in Ontario before," Mr. Ingle said. "They're opening rehabilitation
clinics... providing special cosmetic surgery and other specialized
treatments, even penis-lengthening. And they've got people willing
to pay."
May 7, 1994
Poor dying younger
Life expectancy for some groups in Britain has worsened for the
first time in 50 years, research published in the British Medical
Journal shows. The study says there is clear evidence that poverty
rather than personal behaviour is the greatest risk to health. The
study shows that mortality rates in the most deprived areas of the
North are now as bad for some age groups as in the 1940s, and are
four times higher than in the most affluent areas. In the poorest
areas, mortality rates have risen in absolute terms in men under
45 and women aged 65 to 75, reversing previous improvements.
May 8, 1994
Nova Scotia restructures
Nova Scotia's Health Minister Ronald Stewart has announced a restructuring
of the province's health care system. Three hospitals will be closed
and services will be cut at 29 others. Some hospitals will lose
departments and have to close beds, while others will be converted
into community health centres. Hospital workers, like other public
sector workers, are being hit with a three per cent rollback in
wages and a suspension of collective bargaining.
May 13, 1994
Nurses win racism case
Toronto's Northwestern General Hospital has agreed to pay seven
nurses a total of $320,000 and overhaul its management practices
to ensure the institution is free of racism, in a settlement reached
with the Ontario Human Rights Commission after nurses alleged that
assignments, disciplinary actions and promotions were based on racial
factors, with white nurses receiving preferential treatment. The
hospital did not admit guilt or issue an apology, but agreed to
pay the settlement, establish an internal human-rights committee,
and give race relations training to its nearly 1,000 staff and volunteers.
May 13, 1994
Hospitals suing gas firms
Hospitals in Ontario and British Columbia are suing five foreign-owned
gas firms which were convicted of conspiring to rig prices for compressed
gases in Canada. The five companies, Union Carbide Canada Ltd.,
Air Products Canada Ltd., Liquid Carbonic Inc., Canadian Oxygen
Ltd. and Canadian Liquid Air Ltd., paid fines totalling $6 million
after they were convicted. Federal competition branch investigators
found evidence that the compressed-gas conspiracy existed as far
back as 1954, but after plea- bargaining, the companies each pleaded
guilty to operating it for one year. The companies admitted to conspiring
to adopt a common price schedule; raising prices for existing customers
to the agreed-upon level; always quoting prices for prospective
customers from the price schedule; refusing to give prices below
those on the price list; adopting common transportation prices,
and offering no volume discounts. 53 B.C. hospitals and eleven Ontario
hospitals have so far launched damages suits against the companies.
An industry analyst quoted in the Globe and Mail estimated that
the over-charging amounted to $80 million a year across Canada.
May 14, 1994
Drug tab triples
The cost of prescription drugs used by Ontario seniors more than
tripled between 1985 and 1993, according to a report, Patterns of
Health Care in Ontario, released by the Ministry of Health. Prescription
costs for seniors paid for the province's Ontario Drug Benefit Plan
(ODBP) rose from $212 million in 1985-86 to $646 in 1992-93. Among
the factors responsible for the increase were increased drug use,
increased prices, and the replacement of older drugs by newer more
expensive medications. Drugs not available in 1985 accounted for
almost two-thirds of total expenditures in 1992-93. According to
the author of the report's chapter on drug use, Geoffrey Anderson,
some of the new drugs, especially those used for cardiovascular
conditions, may be less effective and more expensive than those
they replaced. "There's some real breakthroughs but there is
also a push to use more expensive medications," Anderson said.
The report cover prescriptions but not drugs administered in acute-care
hospitals. The ODBP now accounts for about six per cent of Ontario's
health-care budget, double the share 10 years ago. Other provinces
have seen similar increases in the costs of their drug plans. Saskatchewan,
the only province whose plan covers its entire population, recently
introduced graduated user fees. MRG member Dr. Joel Lexchin
said that "asking people to pay more or just not covering their
drugs any more are pretty crude methods." "Rather, governments
should put their resources into rational prescribing habits. There
has to be some mechanism to do this. Newer drugs should only be
used when they have clear, demonstrated benefits, and not because
they're new."
May 26, 1994
Air ambulance reforms recommended
A panel reviewing Ontario's air ambulance system has said that the
system is basically safe, but recommended changes in the way air
ambulances are dispatched, in the training and deployment of attendants,
and in the availability of aircraft for emergency flights. The panel
found that the way paramedics are recruited and trained has led
to chronic staff shortages.
May 27, 1994
Unemployment drives health costs
Stress-related illnesses suffered by Canada's unemployed cost the
government $1 billion in extra health-care costs last year, according
to a study by Dr. Chandrakant Shah of the University of Toronto's
preventive medicine and biostatistics department. Shah, who presented
his paper at a meeting of the Ontario Medical Association, said
that the unemployed are more likely than those with jobs to suffer
from heart disease, hypertension, suicidal tendencies, depression,
insomnia and other problems. Increased health- care costs come from
increases in prescription drugs, such as tranquillizers, hospital
visits and trips to the doctor's office, he said. Spouses of unemployed
people often have similar health problems and children may show
their distress through behavioural problems like hyperactivity or
depression, said Shah.
May 28, 1994
Ambulance system said mismanaged
Toronto ambulance workers say that poor management, budget cutbacks,
and the effects of the province's social contract are creating serious
problems in the ambulance system. Appearing before a Metro Toronto
committee, the workers said that response times are increasing and
that staff shortages are resulting in attendants and paramedics
being required to work longer hours, leading to physical and emotional
burnout. Ambulance commissioner John Dean acknowledged that his
department is "getting close to crisis" and that many
of the workers' complaints are justified. "We have less staff
to do the job. We have less cars on the road," he said. But
Dean insisted that the system still works and that the public is
not in jeopardy.
June 1, 1994
Third-party billing criticized
The Ontario government's decision to require those who request third-party
services that are not medically necessary -- specifically sick notes
for absences from work -- to pay for them is being criticized by
both employers and union leaders. The Human Resources Professionals
Association of Ontario says that "transferring responsibility
for third- party medical services to employers -- at an estimated
annual cost of $75 million -- would seriously impair the ability
of Ontario business to regain its pre-recession vitality and create
jobs." The association says that if employers are required
to pay, they will want the right to choose their employees' doctors
and to received a detailed report from the physicians so they will
know that an employee's absence is justified. "Physicians who
issue certificates paid for by employers should be required, when
requested by employers, to provide more detailed information, and
employees should be deemed to consent to release of such information."
Labour leaders say that employees now often end up paying for sick
notes demanded by their employers. Julie Davis, secretary-treasurer
of the Ontario Federation of Labour, said that many employers routinely
demand sick notes after three-day absences, forcing employees suffering
from colds or flu to make unnecessary visits to the doctor, and
then to pay for them.
June 8, 1994
Controversy over incorporation
The NDP government's promise, made at the time of its social contract
agreement with the Ontario Medical Association, that it will introduce
legislation to allow doctors to incorporate is coming under attack
from a number of directions. The Health Professions Regulatory Advisory
Council has released a report strongly opposing incorporation. The
report concludes that incorporation of any regulated health profession
is not demonstrably in the public interest, and is in fact potentially
contrary to the public interest on a number of grounds. The OMA
is insisting that a deal is a deal and that the government is obligated
to proceed. Financial analyses have suggested that physicians earning
more than $200,000 are the ones who will benefit from the tax breaks
associated with incorporation, and that the province stands to lose
upwards of $80 million a year in lost income tax revenue. The figure
would be likely to increase rapidly since the government would be
forced to extend the same privilege to other professionals such
as dentists. At present, doctors in Alberta and British Columbia
are allowed to incorporate. The Medical Reform Group issued
a statement opposing incorporation.
June 16, 1994
AIDS reporting contentious
Physicians who treat AIDS patients have said they will not comply
with a controversial new policy of the College of Physicians and
Surgeons of Ontario which requires them to report physicians infected
with the HIV virus. Under the new policy, doctors treating physicians
infected with HIV or Hepatitis B must provide a report to the College,
stating whether the infected physician's medical practice should
be modified. According to the College's director of policy, Janet
Ecker, the College council formed the policy because it feels it
needs to "assess whether action needs to be taken to protect
the public." Dr. Philip Berger, an MRG member who is
on the executive of the Toronto HIV Primary Care Physicians group,
said "I won't comply; this is totally unjustifiable."
According to Dr. Berger, there have been no documented cases of
a physician transmitting HIV to a patient. "They've singled
out HIV alone for this type of monitoring," he said. "We
don't have to report doctors who have seizure problems, diabetes,
untreated mental illness. All of those things can fiercely impinge
on how a physician practises medicine, yet none of them have to
be reported." Dr. Berger said that "it will drive physicians
who may be at risk for HIV underground." Physicians who discover
that they have the AIDS virus will forgo treatment, he said. Dr.
Berger also noted that nurses and other health care professionals
are not subjected to this policy.
June 17, 1994
Consent Act called flawed
The College of Physicians and Surgeons of Ontario is calling on
the provincial government to amend certain provisions of the new
Consent to Treatment Act which require a "rights adviser"
to be called in whenever a patient is deemed incapable of consenting
to treatment. College registrar Dr. Michael Dixon said that, while
the College supports the principle of the act, its legislative flaws
will work against patients. The College wants the act amended so
physicians can immediately seek the consent of a family member or
substitute decision maker if the patient is incapacitated and the
patient doesn't object. As presently drafted, the legislation requires
that a rights adviser must be called in first. The College says
that it doubts that rights advisers will be available around the
clock in hospitals, nursing homes, and clinics, and suggests that
the legislation will result in a cumbersome expensive bureaucracy
and lengthy delays in treatment.
June 20, 1994
TB on rise in Eastern Europe
After nearly forty years of steady decline, the death toll from
tuberculosis is increasing dramatically in most countries of the
former Communist bloc. The World Health Organization warns of an
impending epidemic, estimating that more than two million Eastern
Europeans were infected with TB bacteria in the past five years,
and that 29,000 people died from TB last year in Eastern Europe
and the former Soviet Union. In Moscow, the incidence of TB has
almost doubled in the last two years alone. "This is clear
evidence of the failure of TB control programs, which is a real
tragedy because TB is so curable," said Kathryn Wilkins, a
senior analyst with Statistics Canada who has been monitoring international
TB developments.
June 22, 1994
Hospital plans to bill patients for beds
Toronto East General and Orthopaedic Hospital says it intends to
begin charging patients who are occupying acute care beds while
they wait for a space to open up in a nursing home or a chronic
care facility. Patients who don't belong in an acute-care hospital
will have to pay $149 a day after they have been in the hospital
21 days. After 29 days, the rate goes to $298 a day, and after 37
days the rate will go to $447, according to hospital spokesperson
Sheila McEachen. The hospital says the charges are necessary because
the provincial funding formula does not cover the costs of patients'
stays. "We have been trying to work with the Ministry of Health
on this issue for over a year," hospital president Gail Paech
said. "The ministry's response has been silence." Because
the government has allowed long- term facilities to increase the
number of semi-private and private beds, those who can't afford
them end up staying in hospital until a funded bed opens up, Paech
said. The Ministry of Health has told the hospital that its planned
course of action is illegal. There was outrage among those who would
be affected by the proposed policy. "It could take up to six
months to get my 85-year-old mother into a nursing home," said
Heikki Nihtila, whose mother Marta recently had her right hip replaced
at the hospital. "We'll refuse to pay the bill. What are they
going to do? Throw her in jail? Make her do community work?"
The hospital subsequently issued a statement saying that the policy
would be applied to elderly patients who refuse to go to a nursing
home that has accepted them. "As soon as someone refuses, the
charges go into effect," Paech said.
June 22, 1994
Drug stores fight tobacco ban
Ontario drug store owners are planning to take the province to court
to overturn a new law which would bar them from selling tobacco.
The legislation introduced by the NDP government would make it illegal
to sell cigarettes to anyone under 19, or to sell them in drug stores
or in vending machines, as of December 31, 1994. Health Minister
Ruth Grier said that her Ministry is banning tobacco from all health-care
facilities. Drug stores are considered to be health care facilities
because they earn 40 per cent of their profits from the Ontario
Drug Benefit Plan, Grier said. Larry Rosen, co-owner of five drug
stores, said that "we feel the provincial government doesn't
have the right to criminalize the sale of a legal good in only one
portion of the retail sector". He said that the bill is discriminatory
because 120,000 other outlets will continue to sell tobacco. Rosen
said tobacco sales account for 10 to 15 per cent of drug stores'
over-all sales, but without cigarettes, spinoff sales will also
be lost. He said sales losses could force 140 pharmacies to close
and layoffs at many more. About half on Ontario's 2,500 drug stores
sell tobacco. An estimated 23 per cent of tobacco sold in the country
is distributed through drug stores. "Here we have pharmacists
going to court to protect the right to sell the Number 1 cause of
disease and death in this country. We think this is nothing short
of pathetic," said Michael Perly of the Campaign for Action
on Tobacco. Gar Mahood of the Non-Smokers' Rights Association argued
the challenge is essentially driven by Shoppers Drug Mart, a subsidiary
of Imasco Ltd., a major tobacco manufacturer.
June 22, 1994
Money for community care
The Ontario government has announced that it is diverting $29 million
from institutional care for people with developmental disabilities
to community care and local support services. At present, the government
operates nine institutions for the developmentally disabled, serving
2,571 people at a cost of $286 million. 30,000 people with developmental
disabilities and their families use government-funded services provided
by more than 380 non- profit agencies, at a cost to the government
of $609 million. "This is not going to solve the problem, but
it will help," said Ken Haggerty, director of an advocacy agency
for the developmentally disabled. "The most significant part
of the announcement is that money saved from the shutdown of institutions
will stay in the sector."
June 22, 1994
Call for assisted suicides
The AIDS Committee of Toronto (ACT) is calling on the federal government
to amend the Criminal Code to allow for assisted suicides. ACT board
member Alan Stewart said that only a small proportion of the AIDS
sufferers he has known choose suicide, but the availability of the
option provides solace that they can end the pain and indignity
if it gets too severe.
July 6, 1994
Hospital cuts called haphazard
Cuts to hospital operating budgets have been haphazard and have
resulted in longer waiting lists, elderly people being stuck in
acute care beads while waiting for chronic care beds to become available,
and families being burdened with sick parents at home, according
to a review by the Metropolitan Toronto District Health Council,
which reviewed the operating plans of 43 hospitals. The review said
that many administrators did well at making cuts to their institutions,
but since no one was co-ordinating the cuts over-all, hospital administrators
unwittingly left gaps in services, often affecting the most vulnerable.
According to Lorne Zon, executive director of the Council, the result
has been growing waiting lists for those seeking help in mental
health and addiction services; major problems with access to radiotherapy,
chemotherapy, palliative care for the dying and bone marrow transplants;
insufficient paediatric and adolescent services; and extensive waiting
lists for dialysis. Patients are being discharged from hospital
sooner, leaving parents looking after sick parents and children
in their own homes. A growing number of elderly patients are being
housed in acute care hospitals while waiting for spots in chronic
care facilities.
July 7, 1994
Morgentaler in court again
Dr. Henry Morgentaler is going to court to challenge the New Brunswick
government's ban on free-standing abortion clinics. Dr. Morgentaler
performed five abortions at his new Fredericton clinic at the beginning
of July in defiance of the law. The New Brunswick College of Physicians
and Surgeons then restricted his license after being requested to
do so by Health Minister Russ King and called a board of inquiry
to determine whether Dr. Morgentaler committed professional misconduct.
Under New Brunswick law, abortions are permitted only in three accredited
hospitals and only with the approval of two physicians. "I
blame the government for this absolutely useless fight and waste
of taxpayers' money", Morgentaler said.
July 14, 1994
Plain packaging
Tobacco companies are mounting a vigorous campaign to derail proposed
plain packaging regulations. Federal Health Minister Diane Marleau
announced in April that she planned to introduce legislation requiring
plain packaging for cigarettes. The move was seen by anti-smoking
activists as an attempt by the Liberal government to regain some
of the credibility it lost with public health groups after it lowered
cigarette taxes earlier this year. They caution, however, that Marleau
will need to line up other cabinet members behind her initiative
if legislation is to be introduced. Tobacco industry executives
like Michel Descoteaux of Imperial Tobacco Ltd. insist that plain
packaging is a futile measure that "will have no impact on
our sales", but are simultaneously lobbying furiously to stop
the plan dead in its tracks. The industry argues that a plain-packaging
law would violate "corporate freedom of speech" and would
amount to a state-sponsored seizure of a company's trademark. Proponents
of the legislation say that such a law would be a reasonable limit
on tobacco companies, given that an estimated 40,000 people in Canada
die prematurely each year from illnesses caused by tobacco.
Iraqi drugs shortages
Severe shortages of drugs in Iraq are being reported by the medical
charity Medical Aid for Iraq. According to MAI, supplies of drugs
are now at far lower levels than after the Gulf War, and hospitals
are struggling to manage without antiseptics, incubators, anaesthetics,
needles, antibiotics and drugs of all kinds. Medical aid is supposed
to be exempt from the sanctions imposed by the United Nations after
the Gulf War, but aid agencies have complained of considerable practical
difficulties in ensuring supplies. MAI reported shortages for medicines
for children with chronic diseases such as diabetes, asthma and
epilepsy. Intravenous drugs are especially scarce, and antibiotics
are being given in half measures.
July 24, 1994
Kickbacks alleged
The Ontario Ministry of Health is investigating allegations that
a private medical laboratory is paying kickbacks to doctors. The
Toronto-based lab is alleged to have paid individual doctors in
five communities up to $3,000 a month each in exchange for routing
patients to the lab for testing.
July 24, 1994
Healthy newborns
The federal government is setting up a program to help low- income
women get the proper nutrition and prenatal care needed to give
their babies a healthier start in life. The government will spend
$85 million over the next four years providing counselling, education,
and food supplements in an effort to reduce the number of low-birth-weight
babies born in Canada. It is estimated that about one-third of low-
birth-weight babies owe their condition to preventable, poverty-related
factors. About 21,000 babies weighing 2,500 grams or less are born
each year in Canada. The program is to be community based, with
groups able to apply for funding under the program.
July 27, 1994
Fewer MDs bill over $400,000
The number of physicians billing OHIP for more than $400,000 a year
has dropped sharply. This year, 581 physicians billed OHIP more
than $400,000, compared to 827 in the 1992-93 fiscal year. 130 billed
more than $454,500, compared with 199 in the previous year. Under
an agreement between the government and the Ontario Medical Association,
physicians earn 66 cents on the dollar once their billings exceed
$404,000. Once they reach $454,500, they earn only 33 cents on the
dollar.
August 4, 1994
Anti-abortion terrorist kills two
A Florida physician and his escort were killed by an anti- abortion
fanatic, and a third person was wounded, in the latest episode in
the terrorist campaign against abortion clinics in the U.S. Paul
Hill, a leader of the anti-abortion group Defensive Action, has
been charged with murder after he fired a shotgun at point-blank
range at John Bayard Britton, 69, a physician who worked at the
Ladies Center for Abortion in Pensacola, and at Britton's escort,
James Barrett, 74, a retired Air Force lieutenant colonel. Barrett's
wife, June, 68, a retired nurse who works as a volunteer at the
clinic, was wounded. Hill had publicly advocated "justifiable
homicide" against doctors who perform abortions and had led
demonstrations at the clinic every Friday for more than a year.
The use of terrorism to stop abortions has become a prominent feature
of the anti- abortion movement in the U.S., with more than 1,000
incidents of violence directed at abortion clinics recorded since
1977. Another physician, Dr. David Gunn, was shot dead outside another
Pensacola abortion clinic in March 1993.
August 5, 1994
Less hospital use called for
An interprovincial government report says that patients should be
admitted to hospitals only on an acute-care basis if the health
care system is to provide the most cost- effective care. The report,
When Less is Better, was commissioned for the conference of federal,
provincial, and territorial deputy health ministers. It says that
"hospitals have often been, but should not be, the health-care
facilities of first resort... [They] should serve the severely ill
who require the labour and technology-intensive services which can
only be delivered in that setting." Acute-care hospitals are
the greatest single consumer of health-care resources, annually
costing $30-billion -- 40 per cent of the money spent on health
care in Canada, the report says. The report says a significant number
of patient admissions by acute-care hospitals are not warranted,
referring to a number of previous studies. The report says that
studies have shown that physicians who do not work under a fee-for-service
system tend to order fewer patient- days in acute-care hospitals.
Carol Clemenhagen, president of the Canadian Hospitals Association,
said that the report "has forgotten that hospitals are community-based
agencies" and that different communities have different needs.
"If you're in an urban centre, this kind of narrow role for
hospitals is fine, but it has really missed the point as far a rural
communities' needs."
August 12, 1994
Sick Kids MDs go on fixed fees
Doctors at the Hospital for Sick Children in Toronto have signed
an agreement to go on a fixed fee system, abandoning the fee-for-service
system of remuneration. Payments for the 68 full-time and 66 part-time
physicians are based on what they billed OHIP in 1993-94. The hospital's
surgeon-in-chief, Dr. Robert Filler, said that the fee-for-service
system made it difficult to recruit and retain specialists. "Although
our physicians made life and career decisions to work in the academic
environment that Sick Kids provides, they increasingly have been
attracted to centres in the United States that promised a stable
income with protected time for teaching and research," he said.
The physicians remain self-employed and are allowed to treat adult
patients in other hospitals under the fee-for-service method. The
fee is not considered a salary because the doctors are not considered
employees of the hospital and do not receive benefits such as pension
plans. A similar compensation plan has been in effect at three teaching
hospitals in Kingston since July 1, covering more than 200 physicians
with the faculty of medicine at Queen's University, and alternative
payments plans are being negotiated in a number of other teaching
hospitals. Although the agreement was signed by the Ontario Medical
Association, OMA president Michael Wyman emphasized that "this
is not the death knell for the fee-for-service system. Fee-for-service
is still for most physicians the preferable method of payment,"
he said. The OMA won a victory in the negotiations by getting the
government to agree to commit $2 million to the Sick Kids doctors'
payment fund. The OMA has been stone-walling the government on alternate
payment plans, refusing to allow any money for such plans to be
taken from the fee-for-service pool. Under the agreement which the
NDP government signed with the OMA in 1991, the OMA has a veto over
OHIP's $3.85 billion fee-for-service pool.
August 12, 1994
Student benefit cuts criticized
The Canadian Union of Public Employees is calling the decision to
deprive foreign students in Ontario of OHIP benefits "hasty"
and "ill-advised". CUPE's Ontario president, Sid Ryan,
said that it is discriminatory and shortsighted for Queen's Park
to cut the benefits of foreign students, many of whom work as teaching
assistants and researchers. They pay income tax and contribute to
unemployment insurance and the Canada Pension Plan, Ryan said. Vanessa
Kelly, head of the Canadian Union of Educational Workers, said that
an attack by the province on powerless and disenfranchised foreign
students "is an attack on the universality of the health-care
system." "If you can attack one groups of works, who's
next?" Kelly said. About 19,000 to 22,000 international students
and about 22,000 foreign workers and their families are affected
by the cuts. The province has reversed several of the cutbacks in
originally announced. The families of foreign workers who have contracts
proving they are in Canada for at least three years will now be
covered, as well refugee claimants awaiting appeal.
August 12, 1994
Video commercials in doctors' offices
Video terminals blaring commercials are coming to some doctors'
waiting rooms this fall. The Health and Lifestyles Network will
be distributing programs to be shown on TV monitors in the offices
of 400 pediatricians across the country starting November 1. Video
Corporate Reports hopes to strike a similar agreement with an initial
2,400 family physicians. The programs will feature health "information"
on topics such as colds, and nutrition, interspersed with ads from
drug companies, toy makers, and other corporate sponsors. "There's
nothing else like it in Canada," said Emilio Tacconelli of
Health and Lifestyles Network. "In the waiting room you have
a captive audience in a very controlled environment," said
Tacconelli. Physicians signing a contract with the marketing firm
have to agree to show the programs all day on the television monitors
that are provided to them at no cost.
August 14, 1994
Follow conscience on euthanasia
The Canadian Medical Association decided not to take a position
on euthanasia at its August annual meeting. "The question of
legalizing physician-assisted death is a matter of conscience for
physicians, and therefore it does not intend to advocate a particular
position on this matter," said the CMA's policy statement.
August 16, 1994
Hospital accused of racism
A group of current and former employees on North York's Branson
Hospital has filed complaints of discrimination and systemic racism
against the hospital. Seven nurses and two supports workers are
complaining of wrongful dismissals, indiscriminate cancelling of
duties and the assigning of demeaning jobs to qualified women --
all based on the colour of their skin.
August 16, 1994
Man wins discrimination case
The Ontario Ministry of Health may not discriminate because of age
when administering assistive devices for the visually impaired,
the Ontario Court of Appeal has ruled. The court was ruling on a
case involving Edwin Roberts, a 71-year-old man who was turned down
by the Health Ministry for help under the Assistive Devices Program
to buy a closed-circuit television magnifier. The Ministry decided
he was too old to be eligible. The Ministry argued in court that
removal of the age discrimination in the vision-aids category of
the Assistive Devices Program could lead to dismantling of the program.
The court said in its ruling that the Ministry had introduced no
evidence to support this contention. The program, under which the
government pays 75 per cent of the approved cost of the devices,
provides financial assistance to persons with long-term disabilities.
In 1992-93, it cost $93 million and provided 144,183 devices for
123,500 people.
August 18, 1994
Ambulance cuts called dangerous
A task force looking at problems with Metro Toronto's ambulance
service has been told by ambulance workers than ambulance attendants
and paramedics are suffering from overwork, high stress levels and
a poor relationship with management. The ambulance service has seen
dramatic cuts in funding and a consequent increase in worker complaints
and dissatisfaction. The service had about 730 paramedics and attendants
in 1991. That number has now been reduced to 670, with the result
that response times have increased. Workers' claims were supported
by Tom Alston, director of field operations, who told the task force
that "because we cannot provide the kind of coverage in advanced
life support we need, there are people out there that are suffering.
There's no way around that."
August 20, 1994
Infant formula code violations
New claims have been made that Nestle and other infant formula manufacturers
are breaking an international marketing code. According to the International
Baby Food Action Network (IBFAN), Nestle and its competitors are
still giving away free supplies in hospitals to hook poor mothers
on their products. The marketing code was established by the World
Health Organization in 1981. Monitors for IBFAN reported 107 instances
of free infant formula supplies in hospitals in 28 countries, including
Bolivia, Brazil, Chile, Indonesia, Pakistan, South Africa, and Thailand.
Poverty and dirty water make expensive powdered substitutes for
breast milk inappropriate and the code forbids free supplies to
hospitals and direct promotion to parents. Babies can die from bottle
feeding because poor mothers over-dilute the powdered milk and mix
it with dirty water, causing malnourished children to contract diarrhoea,
one of the biggest killers of infants in developing countries.
August 14, 1994
Snowbirds sue
The Canadian Snowbird Association, which represents senior citizens
who travel south for the winter, has filed a suit against the Ontario
government for limiting reimbursement to Ontario residents for out-of-country
hospital stays. Earlier this year, Ontario's Ministry of Health
announced that it was dropping its coverage to $100 a day from $400
a day. Under the Canada Health Act, payments for insured residents
temporarily out of Canada are required to be made on the basis of
the amount paid for similar services in their home provinces. However,
Ontario, Saskatchewan, and Alberta each pay only $100 a day, while
British Columbia pays only $75 a day for hospital stays by residents
who are out of the country. The Snowbird Association says these
rates are far below what these provinces pay for in-province hospitalization,
the national average cost of which is about $550 a day.
August 17, 1994
Quality of care questioned
The quality of care in nursing homes is suffering as demands on
a decreasing workforce escalate, says a survey of nurses carried
out by the Ontario Nurses Association (ONA). The ONA study, "Staffing
as a Quality of Worklife Factor: A Grassroots Approach", examined
the relationship between staffing levels and the quality of worklife
from the point of view of the nurses who work in 171 nursing homes
and homes for the aged in Ontario. According to nurses surveyed,
in some homes residents don't get all their medicines and treatments
because there aren't enough nurses. Even such basic needs as nutrition
are not always met, they said, because there are too few people
to help the residents. Many nurses referred to an increase in dementias
and increased violent behaviour, which they felt could be avoided
if there was better staffing both in terms of numbers and education.
The report offered four conclusions: 1) Participation in policy-making
is not working even though a substantial minority of institutions
have some kind of consultative body in place; 2) Problems are most
severe in larger units where administrators seek to achieve economies
of scale; 3) Nurses are afraid to express their real concerns for
fear of losing their jobs, and are only prepared to speak out under
the protection of anonymity; 4) Quality of nursing worklife and
quality of patient care are inseparable.
Fundraising aimed at patients
Nova Scotia hospitals have been ordered to stop using lists of former
and present patients in their fundraising efforts unless they first
receive the patient's consent. However, the Health Department approved
consent forms containing a clause that states that the patient consents
"to receive information about making a charitable donation"
to the hospital or hospital foundation.
Ontario MDs favour uses fees
A majority of Ontario physicians believe patients should be charged
user fees for medical care, according to a recent survey. The Medical
Reform Group responded by pointing out that "there is clear
evidence that user fees hurt the sick and the poor."
August 17, 1994
Health care not legal right, lawyers conclude
A task force of the Canadian Bar Association has concluded that
there is no legal "right to health care" in Canada. The
law as it presently exists gives Canadians the right to publicly
funded health insurance, but says nothing about what medical services
will be provided under health insurance. Richard Fraser, who chaired
the task force, called on the federal and provincial governments
to draw up legislation that would enshrine a right to health care
and define terms such as "medically necessary".
August 23, 1994
MDs protest tobacco sponsorship
Physicians for a Smoke-Free Canada stepped up its war against smoking
by protesting a tobacco firm's sponsorship of a women's golf tournament.
The group decorated major roads near the Ottawa Hunt and Golf Club,
home of the "du Maurier Classic", with signs declaring
that "Cigarettes Kill Women". The signs were put up on
the same poles as the banners promoting the tournament. The tobacco
company is using the tournament to circumvent a federal ban on tobacco
advertising, said Dr. Andrew Pipe, a physician at the University
of Ottawa Heart Clinic, and a spokesman for the anti-tobacco group.
August 23, 1994
Hospital costs rise
The average per-day cost of caring for a patient in a Canadian hospital
was $553 during the 1992-93 fiscal year, Statistics Canada reports.
This represents a 6.8 per cent increase over the 1991-92 fiscal
year. The figures include medical procedures, operating costs, and
support services. Statistics Canada said the rise is in line with
a steady increase in patient-care costs over the last decade. The
inflation rate in 1992 was 1.5 per cent. Carol Clemenhagen, president
of the Canadian Hospital Association, said patient costs rose because
of increasingly complicated treatments and the requirements of caring
for an aging population. There were 3.5 million admissions during
the year, and the average length of stay was 12.5 days.
August 25, 1994
Blue Cross seeks new owners
Ontario Blue Cross, the largest provider of employee health benefits
to Ontario residents, is searching for new owners. Blue Cross, a
650-employee not-for-profit company, is currently owned by the Ontario
Hospital Association, which represents Ontario's 200 public hospitals.
The company wants to expand and needs an infusion of capital, which
the Hospital Association is not capable of providing. Blue Cross
expects private spending on health care by individuals in Ontario
to jump to $5.6 billion in 1997 from $3.6 billion in 1993, and wants
to be ready to take advantage of the growing market for private
health insurance as anticipated cutbacks to medicare take effect.
August 25, 1994
Anti-abortion harassment limited
The Ontario government has won an interim injunction against anti-abortion
pickets at 18 locations, including doctors' homes and offices in
London, North Bay, Brantford, Kingston, and Toronto. The judgement,
which was less than the government sought, excludes anti-abortion
protesters from picketing within 150 metres of the homes of nine
doctors, within 18 metres of the Scott and Cabbagetown clinics in
Toronto, and within 9 metres of the Choice in Health Clinic, also
in Toronto. The Morgentaler Clinic in Toronto previously applied
for, and was granted, a 150-metre exclusion zone. Abortion clinics
in Ontario have been subjected to arson, chemical attacks, vandalism,
death threats, and continuous harassment of staff and patients.
Pro-choice groups said that the decision was a step in the right
direction, but would not be enough to prevent harassment of patients
and doctors. Anti-abortion activists vowed to find ways around the
judgement.
August 31, 1994
Surrogate mother deals being made
A report by Canadian Press says that surrogate-mother arrangements
are now being set up through several Toronto- area fertility clinics.
In such arrangements, a woman agrees to become pregnant and to hand
the infant over as soon as he or she is born. The going rate, according
to the report, is $15,000 for the mother and $20,000 for the lawyers
who draw up the contract. Such deals are not illegal in any province
except Quebec, but the Royal Commission on New Reproductive Technologies
recommended in its report last year that surrogacy deals should
be outlawed. Dr. Peter Leung of the IVF Canada clinic said that
his clinic has been involved in about half a dozen surrogacy arrangements
so far. Dr. Mike Virro of the Markham Fertility Centre defended
the practice, saying that surrogacy arrangements are not designed
to make money but as a service to the infertile.
August 31, 1994
NB plans to cut workers' compensation
The New Brunswick government plans to cut employer contributions
to its workers' compensation plan by an average of 18 per cent next
year. The reduction in contributions was made possible because benefits
to injured workers have been cut to 80 per cent of net pay for the
first 39 weeks, from the previous 90 per cent.
September 1, 1994
Parents sue over "wrongful life"
The parents of a boy with birth defects are suing their family doctor,
saying the child should never have been born. The parents allege
that a "wrongful life" resulted from a lack of proper
medical disclosure of the mother's risk of giving birth to a defective
baby. Jane and Robert Sanders say their doctor told them the results
of a serum alpha fetal protein test were within the normal range.
They contend that the results were abnormal, and that if they had
been told this, the mother would have had an abortion. The baby
has Down's syndrome and was born with a cardiac abnormality. Arthur
Schafer, director of the University of Manitoba's Centre for Applied
Ethics, called the case "very thought- provoking", adding
that genetic advances that allow prospective parents to determine
whether a fetus has a propensity toward manic depression or early
Alzheimer's disease create a potential moral powder key. "Will
they choose to abort? Will the insurance companies be given this
information?", he asked.
September 7, 1994
Blood shipments restricted
U.S. health officials have stopped some Canadian blood products
from entering the U.S., after inspectors concluded that the way
the Canadian Red Cross handles its blood products does not meet
U.S. standards in certain respects. The shortcomings cited included
computer software problems, sloppy record keeping and labelling,
and substandard screening procedures for donors. It was also revealed
that plasmapheresis collection at four of Canada's 17 blood-collection
centres was suspended briefly earlier this year while procedures
were changed to meet new Canadian requirements. After the reports
were released, Federal Health Minister Diane Marleau ordered a review
of blood collection standards. Dr. Carlos Izaguirre, the assistant
national director of quality and standards for the Red Cross, said
his organization and the FDA have known for some time that the Canadian
Red Cross didn't meet U.S. standards. "Our standards are not
below standard," he said. "This simply reflects a difference
in regulations between Canada and the United States." The decision
stops the Red Cross from sending its plasma to the North Carolina
plant where it is processed. There is no similar plant within Canada.
About one-quarter of the Canadian plasma supply is affected, forcing
the Red Cross to buy plasma from the U.S. to make up the shortfall.
Stephen Vick, assistant national director of manufacturing and development
at the Red Cross, also played down the report. "These are not
safety issues, but differences in regulatory requirements that are
largely technical," he said. "We have long said that we
run a risk by having our products fractionated outside Canada. A
fractionation plant will not only make us self-sufficient in blood
products, but help us avoid the problems created by foreign regulation."
September 7, 1994
Psychiatric hospitals lose $53 million
Ontario's psychiatric hospitals are having $52.6 million chopped
from their budgets during the current budget year and next year.
Cuts announced recently range from 17 per cent at Lakehead Psychiatric
Hospital in Thunder Bay to 10 per cent at the Queen Street Mental
Health Centre and at facilities in North Bay and Whitby. Responding
to expressions of alarm from the hospital and mental patients' advocacy
groups, Health ministry spokeswoman Barbara Selkirk said that "everybody
knew there were going to be cuts. They didn't know what their individual
targets would be." The hospitals say they will have to cut
program. Lakehead Psychiatric has already announced it will eliminate
a program for seniors with dementia and a program for Alzheimer's
patients.
September 7, 1994
Chiropractors battle pediatricians
Chiropractors have launched a counter-offensive against a group
of pediatricians who want to put a stop to chiropractors treating
young children. At a news conference called to respond to the pediatricians'
criticism, Donald Henderson, president of the Canadian Chiropractic
Association, accused the pediatricians of simply trying to create
a monopoly in which only medical doctors can treat children. "This
seriously libelled our profession," Dr. Henderson said, referring
to a joint statement issued in September by the heads of the pediatric
departments at 13 major Canadian hospitals. In that statement, the
pediatricians called on the provincial government to stop funding
chiropractic treatments for infants and children. The pediatricians
said they felt compelled to speak out against those chiropractors
who claim to treat a wide range of childhood ailments including
ear infections, colic, spinal scoliosis, tonsillitis, bed-wetting
and asthma. Dr. Henderson acknowledged that some chiropractors may
be doing things that are inappropriate, but said that they are very
much a minority within the profession.
September 8, 1994
Companies evade WCB dues
Thousands of Ontario companies covered by the province's Workers
Compensation Board are failing to make payments into the insurance
plan by evading its registration requirements, according to a former
WCB official. Alec Farquhar, appearing before an Ontario legislative
committee, said that up to 20,000 companies are failing to make
payments even though they are required to, at an estimated cost
of $60 million a year. He also alleged that some employers are abusing
the WCB's program of giving rebates for low injury rates by falsifying
records. The WCB paid out $295 million in rebates to employers last
year. Another $201 million was lost to employers' bad debts.
TB said to be spreading
Contradicting the statements of public health officials, some front-line
health workers are saying that tuberculosis is spreading rapidly
among homeless people in Toronto. Members of the TB Action Group
(TBAG) said that the city's health department is moving too slowly
in the early stages of what could become an epidemic similar to
what is happening in New York City. Cathy Crowe, a nurse at the
Niagara Health Services clinic, said that the health department
should begin mass TB screening tests at hostels and other places
frequented by the homeless, as well as among other high-risk groups
like nursing home residents and prison inmates. "We've got
all of the conditions that feed into the spread of TB -- growing
homelessness and cutbacks to the health care system," she said.
The health department acknowledges concern over TB, but says that
the number of active cases of the disease is remaining at close
to 25 for every 100,000 persons in downtown Toronto. New York City,
in contrast, reports 750 cases of TB per 100,000 persons. Howard
Nojo of the health department said that mass screening might accomplish
little more than wasting the health department's resources unless
ways can be found to ensure that homeless persons attend follow-up
appointments. However, Monica Avendano, a respirologist at West
Park Hospital, said that contact tracing suggests that a surge in
the spread of TB could be around the corner. "If we're not
careful," she said, "we'll be looking at a potential epidemic
like the one we're seeing in the States."
Planned Parenthood spotlights anti-abortion tactics
The Planned Parenthood Federation of Canada is urging supporters
of abortion rights to be aware of tactics being used by the anti-abortion
movement and to be prepared to counter them. According to Planned
Parenthood, the tactics of the anti-choice groups include infiltrating
feminist or pro-choice organizations; boycotting, picketing, and
harassing companies and organizations which give money to Planned
Parenthood; picketing banks and other financial institutions that
provide loans to abortion clinics; picketing hospitals and family
planning clinics; leafleting schools and door-to-door; forming "life-chains"
at key intersections (people standing with anti-choice signs).
Report attacks fee-for-service
A report commissioned by the Conference of Deputy Ministers of Health
has concluded that the fee-for-service method of paying physicians
works against promoting good health. Paying the Piper and Calling
the Tune, by McMaster University health economist Stephen Birch,
says that fee- for-service penalizes doctors who take time with
patients and doctors who take on people who are sicker and harder
to care for. According to Birch, "Doctors who spend the time
to make patients well can be penalized for that time. They perform
fewer services, and so receive fewer fees. To move forward you've
got to align the rewards to the providers with the objectives of
the medicare system. That's not the case now."
September 25, 1994
Ambulance system criticized
Metro Toronto has wasted millions of dollars on a new ambulance
computer system that has increased response times and places lives
at risk, according to the chairman of a task force looking into
the service. Dennis Fotinos called the new system "totally
unacceptable" and said that Toronto would be better off going
back to the old system. "We've spent millions of dollars on
nothing," he said. The task force's report says that the new
recording system has added as much as five minutes to the response
time by requiring dispatchers to ask a complicated series of questions
before an ambulance can be sent. If a translator is required, response
time can jump to as much as 25 minutes because the service must
be accessed through a system located in California. Dispatchers
reported that the new computer system loses calls for no apparent
reason, and that the system was dispatching "ghost calls"
to locations where ambulances had been sent exactly one year earlier.
September 27, 1994
Book says Rae gave in to drug firms
A new book by Queen's Park columnist Thomas Walkom says that Ontario
Premier Bob Rae threw away millions of dollars in potential savings
by secretly caving in the multinational drug companies seeking to
block cheaper generic drugs. Rae Days, The Rise and Follies
of the NDP, says that letters written over Rae's signature
offering major concessions to the drug multinationals were partly
written by the drug companies themselves. The New Democratic Party
publicly portrayed itself as being adamantly opposed to the Progressive
Conservative government's drug patent legislation, Bill C-91, which
was passed in the House of Commons in 1992. In fact, Walkom says,
the Rae cabinet had secretly capitulated in the hopes of attracting
investment from the multinationals to Ontario. Rae personally promised
the Eli Lilly company a two-year grace period for one of its patented
drugs, Ceclor, to remain on the formulary of drugs approved under
the Ontario Drug Benefit Plan, in return for the company promising
to expand its Scarborough plant and create 150 new jobs. In doing
so, he overruled his own health ministry, which wanted to delist
a number of expensive patent drugs, including Ceclor, and replace
them with cheaper generics. The book details several other instances
where Rae is said to have intervened personally to ensure that brand-name
drugs manufactured by the multinationals were kept on the formulary
rather than be replaced by generics. The book records that the 150
jobs promised by Eli Lilly were never created.
September 28, 1994
Provinces boycott health forum
Provincial governments boycotted the first meeting of the federal
government's National Health Forum. The provinces had asked that
a provincial premier, Roy Romanow of Saskatchewan, be appointed
co-chairman of the Forum with Prime Minister Chretien. The federal
government refused, and the provinces responded by boycotting the
Forum. The provinces say they are concerned that the National Health
Forum is a cover for further cuts, and have said they won't participate
unless they get a key role in directing it. The provinces pay for
about $33.5 billion in health care costs, while the federal government
provides about $15.6 billion through transfer payments. Federal
transfer payments have been reduced year after year as a result
of changes implemented by Brian Mulroney's Progressive Conservative
government. The National Forum on Health is planned as a four-year
consultation on the future of health care.
October 20, 1994
Fact finder to look at rural emergency
Ontario Health Minister Ruth Grier has appointed former deputy health
minister Graham Scott as a fact finder to examine the problems surrounding
service provision in emergency departments in small hospitals in
Ontario. Scott has been asked to submit a final report by February
1995.
October 27, 1994
Radiation experiments were widespread
A panel appointed by the Clinton administration to investigate radiation
experiments sponsored by the U.S. government between 1944 and 1975
has found that the experiments were much more extensive than previously
believed. Experiments were conducted on more than 23,000 Americans
in about 1,400 different projects, according to a study released
by the panel. The panel has fully documented 400 government-backed
biomedical experiments involving human exposure to radiation, and
has received materials describing 1,000 other tests. U.S. researchers
conducted several hundred intentional releases, in which radioactive
substances were emitted into the environment, usually to test human
responses and often without the knowledge of those exposed. The
number of those involved cited in the report does not include those
involved in tests sponsored by the Department of Defense or the
Department of Energy, nor does it include those who happened to
live downwind of the intentional releases but who were not studied
for their reactions.
October 30, 1994
Native health program
The Ministry of Health has announced a new aboriginal health policy
for Ontario. The policy recommends ways to improve the health status
of native people and improve access to health services. Its stated
aim is to focus on "removing structural, cultural and geographic
barriers to health care within the existing health care system,
establishing a comprehensive network of aboriginal-controlled health
services, and building partnerships between aboriginal and non-aboriginal
providers and institutions." Ten new aboriginal health access
centres offering primary care are to be funded under the program,
as well as three hostels to treat aboriginal patients in Kenora,
Timmins, and Toronto, and five new youth/family substance abuse
treatment centres and healing lodges to provide residential and
other forms of treatment. Aboriginal health authorities are to be
established to support the planning processes of aboriginal communities
and their interaction with district health councils. Native people
die 10 years earlier than other Canadians, suffer double the rate
of disability and infant mortality, and have up to five times the
diabetes rates of non-native people in Canada.
November 1, 1994
Cold ads called a bust
The Ontario government's advertising campaign to keep cold and flu
sufferers out of doctors' offices had no discernable results, according
to a study by researchers at the University of Western Ontario.
The $300,000 pilot project, conducted in London last winter, aimed
at educating people to look after themselves at home rather than
run to the doctor when they had a cold or the flu. The project was
conceived after a study covering the first three months of 1991
indicated that 12.6 per cent of visits to doctors were for colds,
at an estimated cost of $200 million a year. However, when the UWO
researchers looked at 1,200 consecutive visits to family physicians
during one week in January, they found that only 6.6 per cent were
for colds, and that the average length of time a patient had waited
before seeing a doctor was 9.8 days. "The majority of people
don't go to a doctor unless their cold has lasted a long time, become
more intense or developed into a secondary problem," said Dr.
Evelyn Vingilis, director of UWO's health intelligence unit and
one of the authors of the study. The study found that patient behaviour
after the education campaign was not measurably different from patient
behaviour before the campaign. Dr. Vingilis thinks that the high
number of visits attributed to colds or flu in the 1991 OHIP study
may be the result of doctors' billing practices. If a patient's
initial visit is for a cold, the billing category is not changed
even if the problem turns out to be pneumonia.
November 3, 1994
Vancouver doctor shot
Dr. Gary Romalis, a Vancouver gynecologist who performs abortions,
was seriously wounded by a sniper hiding in his back yard. Police
think the shooting was the work of an anti-abortion fanatic. Romalis,
like other physicians who perform abortions, has been a target of
frequent harassment and threats of violence. Anti-abortion protests
have been held outside his home and office, nails have been scattered
on his driveway, and the Romalis family received a threatening phone
call the day before the shooting. Kim Zander, a spokeswoman for
the Everywomen's Health Centre, one of three free-standing abortion
clinics in B.C., said the police are often slow in responding to
protests in front on abortion clinics and observed that "it's
not a surprise that what has happened in the United States would
happen here. The anti-choice movement in the United States and Canada
have very strong links." According to Dallas Blanchard, a Florida
sociologist who has studied anti- abortion violence in the U.S.,
the common thread among those who resort to violence to oppose abortion
is that they are all religious fundamentalists, "100 per cent
of them." Some anti-abortionists said that they did not condone
the shooting, but others seized on the occasion to incite further
violence. "This man is a mass murderer," said anti- abortion
activist Christine Hendrix of Dr. Romalis after the shooting. "I
do condone violence," prominent B.C. anti- abortionist Gordon
Watson said. Some suggested that the shooting might have been a
provocation to discredit the "pro-life" movement. "The
pro-abortion movement in B.C. is made up of elements that I would
not want to meet in a dark alley," said Ted Gerk, present of
the Pro-Life Society of British Columbia. "They are angry and
thus capable of almost anything." Ted Hughes, a spokesman for
Campaign Life Coalition, said his group condemns violence, adding
that doctors who perform abortions should expect violence because
"the violence starts in the womb when all these human beings
are killed by abortion."
November 8, 1994
Taxation of health plans opposed
The private health plan industry is mobilizing to oppose suggestions
that company-sponsored health plan benefits should be subject to
taxation. Revenue Canada currently deems premiums paid by employers
to be tax-free benefits, but the federal government has suggested
that it might change the rules and the Commons finance committee
has been looking at the issue. Members of the committee have suggested
that the current system is unfair, since people not covered by a
company plan -- an estimated nine million Canadians -- have to pay
for additional benefits, such as dental plans, out of their own
after-tax dollars if they want to have them and can afford them.
Tax reform advocates like Ontario's Fair Tax Commission have also
advocated that all income and all benefits, from whatever source,
should be equally subject to the same tax treatment. However, health
industry spokespeople say that the result would be that young healthy
workers would opt out of the plans in droves, leaving older workers
saddled with sharply higher premiums, while many employers would
dismantle their plans entirely. "It will result in the disappearance
of health plans as we know them today," Marg French of William
H. Mercer Ltd., a benefits consulting firm, told the finance committee.
"It will be a tax on sickness."
November 9, 1994
Marleau says she'll enforce Canada Health Act
Federal Health Minister Diane Marleau has renewed her threat that
Ottawa will cut transfer payments to Alberta to punish the province
for allowing private medical clinics to operate. "I continue
to be concerned about the impact of private clinics and the ability
of Albertans to receive medical services consistent with the Canada
Health Act, particularly access to medically necessary services
without financial barriers," Ms Marleau said. Ms Marleau said
that the clinics siphon resources from the public system and result
in low-income Albertans subsidizing the care received by the rich.
One of the most prominent clinics, the Gimbel Eye Centre, collects
$500 from medicare to perform cataract surgery on one eye, and then
bills patients an additional $1,275. The Alberta government denies
that this violates the provision in the Canada Health Act which
prohibits doctors from charging more for a service covered by medicare
than the amount set out in their provincial fee schedule, claiming
that the fee is not for the service but a "facility fee".
Ms Marleau previously threatened to take action on the matter in
October of 1993, but appeared to back off when Alberta protested.
The Medical Reform Group issued a statement calling on Marleau
to enforce the Canada Health Act. (See Quicker Care is Better Care,
p. 4)
November 1994
Hospital funds frozen
The Ontario government has frozen funding for Ontario's 221 hospitals
for the 1995-96 fiscal year at the current level of $7.28 billion
a year. Ontario Hospital Association spokesperson Beth Witney said
she was pleased that funding has stabilized rather than being cut,
but expressed concern that the freeze will mean problems for some
hospitals, which will have to meet increases in costs for utilities,
medical supplies, and other basics, without a matching increase
in revenue.
December 7, 1994
Long-term care legislation passed
After a lengthy political battle, Ontario's new long-term care legislation
has been passed into law. The bill will lead to a far-reaching overhaul
of the home-care system. The 1,200 agencies which now provide services
such as home nursing and meals on wheels will be amalgamated into
200 to 300 centralized organizations called multi-service agencies.
The government sees the agencies as a way of streamlining the system,
making it possible for those who require home care to receive them
from one place, rather than having to find their way through the
myriad of different agencies that now provide these services. The
province, which currently spends about $645 million on home care,
hopes that the reforms will lead to significant administrative savings.
Several seniors' organizations supported the legislation, but many
charities were strongly opposed. Lynn Moore, director of home-support
services for the Canadian Red Cross, said that the government should
have instituted pilot projects to test the viability of multi-service
agencies. "The implications of what they are planning to do
are so great," she said. "We need to be sure it works."
District health councils will begin setting up the first multi-
service agencies early next year.
December 8, 1994
Nurse practitioners
Ontario Health Minister Ruth Grier has announced that training programs
for nurse practitioners are to be re- instituted. Nurse practitioners
may practise independently in isolated northern setting, but throughout
most of the province they will practice as part of a health care
team in settings such as community health centres. They will not
bill OHIP on a fee-for-service basis. The Medical Reform Group
issued a statement supporting the initiative as "creating an
opportunity for Nurse Practitioners to enter the health care system,
not in competition to, but in concert with doctors." (See
Support for nurse practitioners as members of health care team,
p. 1).
Agreement on Red Lake Emergency Department
An agreement has been reached between doctors in Red Lake and the
Ontario Ministry of Health over the provision of emergency medical
coverage in the community. Doctors in Red Lake withdrew 24-hour
on-call coverage for the emergency department in Red Lake last spring
in a protest over pay and working conditions. Under the new four-year
agreement, the five Red Lake doctors will have their fee-for-service
earnings converted into a global fund. The steady income will allow
individual doctors to have more flexible office hours and maintain
emergency coverage at the hospital.
December 14, 1994
Rosalie Bertel retiring
Rosalie Bertell, the driving force behind the International Institute
of Concern for Public Health for the past decade, is retiring. The
Institute is in the process of reorganizing and is looking for individuals
with "new vision, fresh energy, and an impetus to push the
community health agenda onto the nation's front burner." Contact
the International Institute of Concern for Public Health at 830
Bathurst Street, Toronto, Ontario M5R 3G1, (416)533-7351, fax: (416)533-7879.
Social programs wrong target
A broad spectrum of organizations, including the Medical Reform
Group, have endorsed a petition campaign sponsored by the Council
of Canadians calling on the federal government to target corporate
tax avoiders rather than social programs in its drive to reduce
the deficit. An advertisement signed by many of the endorsing organizations,
including the MRG, links the attack on social programs to
free trade, which results is intense pressure on all countries to
reduce their social standards to the lowest possible level. The
ad states that large corporations are demanding deep cuts to social
programs, despite the fact that only 2 per cent of the debt has
come from social spending. Massive reductions in corporate taxes
over the past number of years account for about 50% of the federal
debt, while much of the rest is due to payments on the debt, themselves
inflated by artificially high interest rates. For more information
about the petition campaign, contact the Council of Canadians, 251
Laurier Avenue West, #904, Ottawa Ontario K1P 5J6, 1-800-387-7177.
Regulatory Efficiency Act
The Canadian Environmental Law Association (CELA) is seeking to
mobilize opposition to the Regulatory Efficiency Act (Bill C-62),
which received first reading in the House of Commons on December
6, 1994. According to CELA, "The Act will allow businesses
to be exempted from regulations under any federal laws by permitting
them to negotiate private agreements with Ministers. These `compliance
agreements' will allegedly allow businesses to achieve regulatory
goals `through alternatives to designated regulations.' The Act
is sweeping, applying to all federal Ministries and `regulatory
agencies' as well as to all federal Acts which may, together with
regulations, be delegated to `provincial, territorial and other
governments or government agencies' for administration." According
to CELA, the regulatory fields targeted for first action under the
Act are health, food, therapeutic products, biotechnology, mining,
automotive, forest products, and aquaculture. CELA says that the
bill "marks the end of any concept of general legal standards
applicable to all, and puts in question all the public safety and
environmental regulations that Canadians have achieved to date....
It will require that public interest advocates constantly repeat
battles for standards that we have already achieved. Even monitoring
these private `deals' will place an impossibly heavy burden on the
public." CELA notes that the government's stated rationale
for this legislation is to help business get products to market
more quickly, and to remove inefficiencies from outdated regulations.
In reply, it contends that "if we have useless or outdated
regulations on the books, we should revoke or amend them. We should
not keep them in force to apply to some people, and allow others
to make private arrangements to avoid them." CELA is contacting
organizations concerned with environmental and health issues and
asking them to lobby quickly against the bill, which the government
plans to have in effect by the end of March. Contact CELA at 517
College St., #401, Toronto, Ontario M6G 4A2, (416) 960-2284, Fax:
(416)960-9392.
All items appeared in Medical Reform, the newsletter of the Medical Reform Group of Ontario, and were compiled by Ulli Diemer.
Related Links:
Health News Briefs 1987- 1991
Medical Reform Group of Ontario - Connexipedia article
Medical Reform Group newsletter online archive
Medical Reform Group of Ontario new releases 1979 - 1995
Connexions Digest Collected News Briefs 1989-1992
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