Health News Briefs
January 1992 to December 1994

Compiled by Ulli Diemer

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

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.

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