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Ontario Hansard - 18-October2017

Ms. Peggy Sattler: I am pleased to rise today to participate in this debate on Bill 160, the Strengthening Quality and Accountability for Patients Act. In particular, I wanted to focus my comments on a couple of the key schedules of the bill, specifically schedule 1, the amendments to the Ambulance Act.

Speaker, some of my colleagues in this Legislature may recall that on numerous occasions throughout the spring, I raised a concern about lack of government approval for a pilot project which my community of London had been working on for a number of months—well over a year, in fact. That pilot project was a partnership between the emergency services and it was a partnership with the London Health Sciences Centre and also with CMHA. CMHA in my community operates a 24/7 crisis centre. When people go to that 24/7 crisis centre, they can usually access counselling within about 20 minutes.

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By contrast, when people experiencing mental health crises call 911 and get picked up by an ambulance, they are taken to the hospital emergency room. That is, as has been pointed out, because of the legislative requirements of the Ambulance Act. Unfortunately, when they are taken to the hospital emergency room, they often have to wait hours and hours and hours before they are even triaged and an assessment is made about their condition. All the while, the ambulance and the paramedics have to wait at the hospital until they know what is going to be happening to this patient.

This is quite costly. In my community, it was determined that if the ambulances could go straight to the crisis centre instead of to the hospital for patients who are experiencing non-acute mental health issues, then there could be savings of about $2.5 million a year, which is significant. This is a significant savings that could then be reinvested into our health care services in the community.

Last March 20, I shared the story of a constituent of mine, Angela Jolly, who had been waiting almost a week on a stretcher at London Health Sciences Centre for access to a mental health bed. At that time, on March 20, 2017, the emergency room was operating at 130% capacity. As we have been hearing over this last little while, that’s actually pretty good. We are hearing of the emergency room operating at 140% or 150% capacity. On that particular week, it was at 130% capacity with 22 patients waiting for beds. Some of those patients had been there for more than a week, in fact, when I first learned the story of my constituent’s experience.

I raised this issue in the Legislature and I called on the Minister of Health to take action to address the mental health crisis in London, which was not a new issue that suddenly materialized in March 2017. This was an issue that we had been facing in London for years.

On March 23, three days later, the hospital ER was, on that day, operating at 152% capacity. There were 26 mental health patients waiting for beds. At that point, I called on the Minister of Health to approve London’s pilot project, to approve this single partnership between the London Health Sciences Centre, CMHA Middlesex and Middlesex-London EMS and allow that to proceed in my community of London. At the time, the Minister of Health was unequivocal: No, it could not happen.

On March 27, I once again called on the government to sign off on this pilot project and allow it to proceed in my community.

Then, on March 30, more crises were erupting all over the place in London. I called on the government once again to stop dragging its feet and do something to look at how to facilitate this pilot project going ahead in London and make sure that this kind of helpful intervention could be put in place.

On April 3, I again asked the government to work with my community, work with those community partners and find a way to allow the pilot project to proceed.

On April 24, which was almost a month since the first time I had raised the issue, I once again asked the minister in question period about the pilot project. At that time, the capacity of the ER was 146% and there were 18 patients waiting for beds. Still the government refused to offer any kind of solution to my community in order to move the project ahead.

The following month, on May 31, I raised the issue for the seventh time in this Legislature and shared the story of another constituent, David Warren, whose wife had been waiting more than three days in the hospital ER. She had been taken to the hospital ER under a Form 1. She was involuntarily taken to the ER and she had to wait—actually, she had to be transferred to St. Thomas because, after more than three days of waiting at London Health Sciences Centre, they told her that there was still no bed and she would have to go out of our community to get the treatment she needed.

So, Speaker, after these seven attempts to get the government to work with my community and get this pilot project in place, I was cautiously optimistic, on June 5, when I read the news release from the government indicating that there would be amendments to the Ambulance Act to allow paramedics to transport patients to non-hospital facilities. Certainly there were concerns about what exactly this would mean, but it appeared that this might provide the vehicle for the pilot project to move ahead.

At the time, however, along with my cautious optimism, there was also great concern because the government’s press release announcing these amendments also indicated that the full rollout of any changes to the Ambulance Act would take approximately 24 months to complete. So two years after the passage of this legislation there would be the possibility that London’s pilot project could finally be in place. That would represent a period of about four years since my community first came together to work out a business case and put plans in place for this pilot to move forward.

You can imagine, Speaker, my concern when I finally saw Bill 160, the Strengthening Quality and Accountability for Patients Act, which includes, as one of 10 schedules, amendments to the Ambulance Act to enable the diversion of patients by paramedics to non-hospital sites. I am concerned because instead of moving forward with enabling legislation to allow the pilot project to go ahead—although I have to say that I really do question whether the government couldn’t have found a way to just allow the pilot project in London to move forward. However, instead of moving cleanly with some simple legislation, the government packaged these amendments to the Ambulance Act within omnibus legislation that includes many, many other very contentious changes to health care legislation.

Not only that, but the amendments that they have proposed to the Ambulance Act are much broader than what my community was looking for. They are, in fact, so broad that there are numerous and quite justified concerns about what this legislation will mean for the province. There is nothing in the legislation that talks about what these non-hospital sites will be. In my community, we were looking strictly at the CMHA crisis centre. It’s a community service. It’s operated through a non-profit board. However, in this schedule 1, the amendments to the Ambulance Act that are outlined in this legislation are wide open in terms of where paramedics could divert patients instead of taking them straight to the hospital. As I said, this has aroused all kinds of very legitimate questions. For example, will patients be able to decide where they are going to be taken? Will paramedics be protected from additional liability that may arise from this new ability to divert patients away from emergency rooms? Will paramedics be pressured to treat and refer patients inappropriately because of lack of provincial funding for ambulance services? How will the acuity of the patients be determined? How will safeguards be put in place to ensure that patients who are diverted are the patients who should be diverted?

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Speaker, if the government had moved ahead with a pilot project in London—which is what my community has been working on for years, as it happens—we could have done the research from that pilot project. We could have determined what kinds of mechanisms needed to be put in place to ensure patient safety when they are being transferred. However, the government has decided to move ahead with this full provincial rollout of amendments that are so broad that there are a lot of legitimate questions, and that may create all kinds of barriers to the pilot project proceeding in my community.

That’s just one schedule of the act that I wanted to focus on today.

I also want to spend some time talking about schedule 5 and the amendments to the Long-Term Care Homes Act.

I can’t help but be struck by the fact that this debate is taking place on the very day that the public inquiry into the safety and security of residents in the long-term-care system is holding its very first public meeting on the Wettlaufer murders and the circumstances that led to the Wettlaufer murders in Woodstock and London. The inquiry is meeting today in Woodstock and tomorrow in London. As you can appreciate, Speaker, there are many, many people in my community who want to be part of that public inquiry, who want to talk about their personal experiences with loved ones in the long-term-care system, and who are very concerned that the focus on the circumstances of the Wettlaufer murders will restrict the kind of input that they can bring to that public inquiry.

Schedule 5 makes amendments to the Long-Term Care Homes Act. There are some positive changes—making it an offence for a licensee to fail to protect residents from abuse or neglect—but very, very problematically, it also makes amendments to allow for the use of restraints and the confinement of residents. Unless we provide long-term-care homes with the resources that are required to safely use restraints and confinement in dealing with residents, unless we ensure that those staffing ratios and that funding are in place, we could be jeopardizing the lives of some of the most vulnerable people in our province. The proposed amendments are not accompanied by any indication that there will be enhanced funding.

As my colleagues and I in the NDP have reinforced in this Legislature and outside of this Legislature, we need to look at all of the systemic issues within our long-term-care system. In particular, we need to look at staffing ratios; we need to look at quality of care. We have been advocating for a minimum standard of four hours of care per resident per day, adjusted for acuity and case mix. We need to look at those things.

We need to look at regulation, enforcement and inspections. We need to look at capacity—the availability of long-term-care beds. We need to look at the impact of for-profit privatization on the long-term-care system. We also need to look at the accountability of this government for responding to numerous recommendations that have been brought forward by the Auditor General and the coroner about what needs to happen in our long-term-care system.

It is irresponsible of us to move forward and approve an amendment like this, allowing for the use of restraints and confinement of long-term-care residents, without ensuring that all of those other protections are in place: the staffing, the funding, the processes, the procedures, the checks and balances, everything that needs to be addressed from a systemic perspective. Those things have to be dealt with before we should be looking at that.

I hear regularly from constituents in London West about their personal experiences and their concerns about what has happened to their loved ones in the long-term-care system. I don’t know how many constituents I have spoken to, women my age, who have either reduced their employment from full-time to part-time or who have left the labour market altogether because they have a loved one in a long-term-care home. They have gone in there too many times and seen that there is no staff to feed their loved one. There is no staff to move their loved one from the bed to the wheelchair so that they can be taken to watch TV in the common room. They have felt obligated to be there to provide the services for their loved one that staff at our long-term-care facilities are simply not able to provide because there are too few of them. There are not enough people, not enough health care professionals, PSWs or RPNs to provide the kind of care that vulnerable seniors need.

I can’t believe that my time is up and I’ve only been able to address two of these 10 schedules, but it does give you a sense of how problematic it is when you bundle all of these kinds of changes—very significant changes—to our health care system that really need to be dealt with individually so that they can have the kind of comprehensive review and analysis that is necessary to make sure that we actually are strengthening the quality of our health care system and we actually are ensuring accountability for patients in Ontario.

Speaker, I can tell you, as my colleague the very eloquent member for Nickel Belt, the health critic for the NDP, stated in her lead on this legislation, that this is not a bill that the NDP can support. There are simply too many red flags. There are simply too many concerns for us to be able to support this bill.


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