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Landmark Toronto Star Guest Column by the Authors of the Three Successive Government-Appointed Independent Reviews of Ontario’s Disabilities Act Demands Immediate Strong New Government Action on Serious Hardships Facing People with Disabilities

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

Landmark Toronto Star Guest Column by the Authors of the Three Successive Government-Appointed Independent Reviews of Ontario’s Disabilities Act Demands Immediate Strong New Government Action on Serious Hardships Facing People with Disabilities

September 16, 2020

          SUMMARY

The Ontario Government has failed to effectively implement the Accessibility for Ontarians with Disabilities Act, and must now show the much-needed missing leadership that Ontarians with disabilities need. That was the message of a powerful guest column appearing in today’s online Toronto Star, set out below. This column is an amazing and unprecedented combined effort by the three people who have conducted ground-breaking Government-appointed Independent Reviews over the past decade into the AODA’s implementation and enforcement:

  1. In 2009-10, Charles Beer, a former provincial Cabinet minister, conducted the first AODA Independent Review. The Beer report was made public on May 31, 2010.
  1. In 2013-2014, Mayo Moran, then the dean of the University of Toronto’s Faculty of Law, conducted the second AODA Independent Review. The Moran report was made public on February 13, 2015.
  1. In 2018-2019, David Onley, former Ontario Lieutenant Governor, conducted the third AODA Independent Review. The Government made the Onley Report public on March 7, 2019.

In 2005, the Ontario Legislature unanimously passed the Accessibility for Ontarians with Disabilities Act (AODA). It requires the Ontario Government to lead Ontario to become disability-accessible by 2025 by enacting and enforcing regulations (called accessibility standards) that spell out what employers and the providers of goods and services must do to tear down and prevent disability barriers. Among other things, the AODA requires the Ontario Government to appoint a mandatory Independent Review of the AODA’s implementation and enforcement approximately every three years, and to recommend any reforms needed to ensure that Ontario becomes accessible by 2025, based on a public consultation that the Independent Review must undertake.

Over the past decade, all three AODA Independent Reviews concluded that Ontarians with disabilities have needed the Ontario Government to take prompt strong new action to tear down the many disability barriers they still face when trying to get a job or education, or use public transit or shop for goods or services. In today’s Toronto Star guest column, the authors of all three Government-appointed AODA Independent Reviews together reached these powerful conclusions:

“Key recommendations from the three legislated reviews carried out over the past decade have either been ignored or only partially implemented by both Liberal and Progressive Conservative governments. We asked the Ontario government to show stronger leadership on accessibility, to strengthen existing accessibility standards, to substantially increase enforcement of the AODA, and to create strong new accessibility standards in priority areas like the built environment, education and health.

A clear updated plan is now required to get Ontario back on track to ensure the province is accessible for people with disabilities by 2025.”

The conclusions in this new guest column echo key earlier findings in the three AODA Independent Reviews. As the most recent example, the 2019 Onley Report, which the Ford Government received fully 594 days ago, found that the pace of change since 2005 for people with disabilities has been “glacial.” Back then it also found that by January 2019 “…the promised accessible Ontario is nowhere in sight.” Progress on accessibility under this law has been “highly selective and barely detectable.”

The earlier Onley Report also concluded that: “…this province is mostly inaccessible.” It found:

“For most disabled persons, Ontario is not a place of opportunity but one of countless, dispiriting, soul-crushing barriers.”

Today’s guest column shows how this protracted Government failure has hurt people with disabilities even more during the COVID-19 pandemic. For example, Onley, Moran and Beer unite to conclude such things as:

  1. “COVID-19 is having a disproportionate and devastating impact on Canadians with disabilities.”
  1. “They have disproportionately borne the brunt of this disease. Yet there is no overarching or comprehensive plan to address the needs of people with disabilities as a result of COVID-19. There is no targeted plan to ensure the thousands of students with disabilities are fully and safely included when schools reopen.”

These are major concerns which the AODA Alliance has been raising time and again with the Government. In the 594 days since the Government received the Onley Report, it has still not announced a comprehensive plan to implement it, even though it has inaccurately claimed to be “leading by example” on accessibility and inclusion for Ontarians with disabilities.

Please email Premier Doug Ford today. Write him at premier@ontario.ca Urge him to immediately act on the recommendations in this guest column. Tell him that Ontario desperately needs his Government to announce and implement an effective plan to meet the needs of people with disabilities during the COVID-19 pandemic.

Use social media and contact your local conventional media to let the public know how the Government’s failures in this area have affected you, especially during the COVID-19 pandemic. To learn more about our advocacy efforts for people with disabilities during the COVID-19 pandemic, visit the AODA Alliance’s COVID-19 web page.

We commend David Onley, Mayo Moran and Charles Beer for their extraordinary public statement, and for offering both the Ontario and Federal Government concrete recommendations. We welcome your feedback. Write us at aodafeedback@gmail.com be

          MORE DETAILS

Toronto Star Online September 15, 2020

Originally posted at https://www.thestar.com/opinion/contributors/2020/09/15/strengthening-canadas-disability-community-in-a-post-pandemic-world.html

Strengthening Canada’s disability community in a post-pandemic world

By David Onley Contributors Mayo Moran, Charles Beer

The past six months have been among the most challenging in our history. All Canadians have seen their lives altered on a daily basis. Fortunately, our governments at every level have worked together and have responded positively and effectively to mitigate many of the worst impacts of the COVID-19 pandemic. But we face some fundamental challenges if we are to emerge as a stronger and more compassionate society.

Over the past decade each of us was asked to carry out the first legislated reviews of Ontario’s ground-breaking Accessibility for Ontarians with Disabilities Act (AODA). During the course of our work, we had the opportunity to meet with a number of extraordinary people, all living with disability. Their insights, personal stories, and ideas for a more inclusive future remained with us long after our work was done.

The pandemic has brought us back together with a new sense of purpose. COVID-19 is having a disproportionate and devastating impact on Canadians with disabilities. This crisis deserves the attention of all Canadians and urgent action is required.

The disability community is often invisible or ignored. But in fact almost 25 per cent of Canadians live with some kind of disability. According to Statistics Canada, that population is more likely to be single, female, un-or-underemployed, and living in poverty with more than one type of disability. As our population ages, that percentage will continue to go up.

Since COVID-19 hit our shores, meaningful support has been extended to various parts of our society, including the unemployed, small and medium sized business, students, renters, and the health and social services sectors. These steps have been critical and necessary. But one key population has not received the focused support it needs: our fellow citizens who live with physical, mental and developmental disabilities.

They have disproportionately borne the brunt of this disease. Yet there is no overarching or comprehensive plan to address the needs of people with disabilities as a result of COVID-19. There is no targeted plan to ensure the thousands of students with disabilities are fully and safely included when schools reopen. Many with disabilities who qualify for disability benefits did not qualify for the more generous COVID-19 benefits such as the Canada Emergency Response Benefit (CERB). Throughout the disability community, credit card debt is up; savings, if any exist, have been depleted.

Statistics Canada released a new report in late August that surveyed some 13,000 Canadians with disabilities. The fallout from the pandemic has negatively impacted their employment, income, housing payments, basic utilities and prescription medication. Simply put, the disabled face grave economic hardship.

Even a passing glance at social media reveals the deep despair and anger of many in the disability community.

Stories of near starvation on the Ontario Disability Support Program (ODSP) are matched by increased militancy to the point of one group planning a mass, simultaneous wheelchair blockade of key downtown intersections in Toronto. On Twitter alone there are myriad examples of people going to bed hungry or forced to choose between paying the rent or buying food.

Others have flat given up on life, discussing how they are now seeking medical assistance in dying. Postings on the precise steps to get MAID are easily accessible.

This is simply unacceptable in 2020. We can and must do better. We need to fully implement the AODA by 2025 as originally promised; we need the broader public and private sectors to commit to hire more people with disabilities; and we need to bring in a national basic annual income for those with disabilities.

Over the past number of years, some key advances have been made in Canada to enhance the lives of those with disabilities but it is critical to accelerate the pace of change. Ontario’s Accessibility for Ontarians with Disabilities Act (AODA) was passed unanimously in 2005 to support social inclusion. To date, Ontario, Manitoba and Nova Scotia as well as the federal government are implementing accessibility standards for the broader public sector (e.g., provincial and municipal governments, educational and health facilities), the private sector and the non-profit sector.

When the AODA was passed there was great hope among the disability community that significant steps forward would be made within a short period of time. But the pace of change has been far too slow.

Key recommendations from the three legislated reviews carried out over the past decade have either been ignored or only partially implemented by both Liberal and Progressive Conservative governments. We asked the Ontario government to show stronger leadership on accessibility, to strengthen existing accessibility standards, to substantially increase enforcement of the AODA, and to create strong new accessibility standards in priority areas like the built environment, education and health.

A clear updated plan is now required to get Ontario back on track to ensure the province is accessible for people with disabilities by 2025.

Second, while there have been some advances by the broader public and private sectors over the past decade to hire more Canadians with disabilities, much more can and needs to be done. Numerous reports underline the positive economic impact that employing persons with disabilities can have not only for the individuals themselves but also for the companies and institutions that hire them. We need all governments (federal, provincial and local) to set out meaningful and measurable hiring objectives.

The national and provincial Chambers of Commerce should equally call upon all their members to set out clear plans to increase the number of disabled persons in their organizations. We need initiatives from the private sector to promote and increase the hiring of disabled Canadians, similar to what Bell Canada has done to raise awareness around mental health issues.

Third, while the AODA has been critical to help level the playing field in Ontario for those with disabilities, it was not intended to resolve the persistent financial disadvantages faced by this community. The glaring hole in Canada’s treatment of its disabled population is the paucity of meaningful and appropriate financial support. Across all sectors, we need to raise our game by improving financial supports, focusing on hiring persons with disabilities, and ensuring timely and effective service provision.

Prime Minister Justin Trudeau has informed the country that our federal government will present a Throne Speech on Sept. 23. He underlined that the COVID-19 pandemic now required the government to set out new directions for the country to restore the economy and deal with the broad impacts that the virus has left in its wake.

Finance Minister Chrystia Freeland has said we need to “build back better.” Better must include strong financial supports for the most disadvantaged in our society through a national basic income program for Canadians with disabilities.

Our suggested approach is that the federal government implement, after consultation with representatives from the disability community, a national basic income program for those with disabilities that would provide an income floor under which no one could fall. As a starting point, the eligibility criteria could follow that currently used for the federal disability tax credit.

Income supports as we know them today are meagre at best and Dickensian at worse. Single adults receiving support through ODSP can receive up to $1,169 per month. In Toronto, the average market rent for a one-bedroom apartment is $1,374. A single person receiving ODSP starts the month $205 behind.

In the 1960s, Canada introduced the Canada Pension Plan and medicare. These initiatives lifted thousands out of poverty and ensured that all Canadians regardless of socio-economic standing could access quality health care. In the 1970s, Ontario introduced the Guaranteed Annual Income Supplement in response to a 35 per cent poverty rate for seniors. The more recent Canada Child Benefit has protected thousands of children from poverty.

Indeed, the CERB is only the most recent example of governments of all political stripes acting to provide income support when people need it. We believe the implementation of a national basic income regime for those with disabilities will have a similar and immediate impact on the lives of the disabled.

COVID-19 has had a seismic impact on our society, comparable to that of the Second World War and the population explosion of the 1960s. Following those historic events, Canada responded with ambitious and innovative social legislation designed to meet the needs of a changing world. Those innovations gave birth to the broad social, health and education supports that Canadians enjoy today. The current crisis demands similarly bold solutions.

Let us fully implement the AODA. Let us set out clear goals to hire more people with disabilities. Let us implement a national basic income regime for those with disabilities. These steps will rival CPP, Medicare, the CERB, and other innovations with immediate impact on the lives of millions of people. Just as previous generations built these important programs, let us dedicate ourselves to “building back better” by improving the lives of one of our most vulnerable populations. The time to act is now.

David Onley is the former Lieutenant Governor of Ontario, Mayo Moran is the provost and vice chancellor of Trinity College and University of Toronto and Charles Beer, former Minister of Community and Social Services.

Action Kit: Protect Torontonians with Disabilities from the Dangers of Electric Scooters

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

Action Kit: Protect Torontonians with Disabilities from the Dangers of Electric Scooters

September 10, 2020

How to Help – In a Nutshell

Please take five minutes to help us stop Toronto from allowing electric scooters (e-scooters), a serious new danger to the safety and accessibility of people with disabilities, seniors and the public. If you live in or visit Toronto, please email Toronto Mayor John Tory at mayor_tory@toronto.ca You can also call Mayor Tory’s office at 416-397-2489 and talk to whoever answers the phone.

All eyes are on Mayor John Tory. If he comes out against e-scooters, then Toronto likely won’t unleash them on us.

We invite you to use this key message in your email or phone message to Mayor Tory. You can cut and paste it, or use your own words.

Mayor Tory, Don’t allow electric scooters in Toronto! Please don’t expose Canada’s largest city to the serious Dangers, Personal Injuries and New Disability Barriers that e-scooters would cause. Don’t do an experiment or “pilot” with e-scooters in Toronto, because that would threaten our safety and would create barriers to accessibility in our community. Toronto already has too many accessibility barriers. Please make Toronto easier and not harder for seniors and people with disabilities to get around.

What You Need to Know About the E-Scooters Issue?

The City of Toronto is considering allowing people to ride e-scooters in public places). They would be made available near curbsides to rent. Right now they are banned, unless City Council votes to allow them.

An e-scooter is a silent motor vehicle. A person with no license can race around on an e-scooter at speeds of 20 kilometers an hour or faster.

A report by Toronto City Staff shows that e-scooters pose a real danger to public safety in places that allow them. E-scooter riders and innocent pedestrians can and do get seriously injured or killed. Check out a recent CBC report on e-scooter injuries suffered in Calgary.

E-scooters especially endanger seniors and people with disabilities, such as people who are blind or have low vision or balance issues, or whose disability makes them slower to scramble out of the way. A blind pedestrian can’t know when a silent e-scooter rockets toward them at over 20 KPH, driven by a fun-seeking unlicensed, untrained, uninsured, unhelmetted rider. Sighted pedestrians cannot hear silent e-scooters racing towards them from behind.

In cities where e-scooters are allowed, rental e-scooters, left strewn around public places, become mobility barriers to accessibility for people with disabilities. For people who are blind, deafblind or have low vision, those e-scooters become a serious, unexpected tripping hazard. E-scooters left on sidewalks create serious new accessibility barriers for people using a wheelchair, walker or other mobility device. An e-scooter can block them from continuing along an otherwise-accessible sidewalk. People with disabilities using a mobility device may not be able to safely go up on the grass or down onto the road, to get around an e-scooter.

It won’t solve these dangers for Toronto to allow e-scooters on roads but ban them from sidewalks. Cities that allow e-scooters on roads but ban them from sidewalks find that e-scooters are nevertheless ridden on sidewalks. We’d need police on every street corner to effectively police e-scooters. On July 9, Toronto law enforcement told the City’s Infrastructure Committee that they have no capacity to take on enforcement of new e-scooter rules. City Staff said that there’s no city anywhere that allows e-scooters and that gets enforcement right.

For Mayor Tory to allow e-scooters will cost taxpayers money. There’s new law enforcement costs. There’s OHIP costs for treating those injured in our already-overcrowded hospital emergency rooms. The City could also be sued by people injured by e-scooters. We have more pressing priorities for spending public money.

If Toronto allows e-scooters, the e-scooter rental companies will be laughing all the way to the bank. their corporate lobbyists have been relentlessly turning up the heat on Mayor Tory and City Councilors to allow e-scooters.

Mayor Tory should not allow a pilot with e-scooters in Toronto. A pilot to study what? How many of us will be injured by this silent menace? We already know they do, from cities that allowed them. Don’t subject us to an unnecessary human experiment where we can get hurt.

If we allow bikes, why not e-scooters? A person who has never before ridden an e-scooter (or bike) can hop on an e-scooter and instantly throttle up to over 20 KPH, silently endangering us. In contrast, you can’t instantly pedal a bike that fast, and especially if you’ve never before ridden a bike. In any event, we’ve already got bikes. We don’t need the dangers of e-scooters.

The Toronto’s City-appointed Disability Accessibility Advisory Committee and several leading disability organizations unanimously called on Toronto not to allow e-scooters. Tell Mayor Tory that the safety and accessibility of the public, including seniors and people with disabilities, should prevail over the e-scooter rental corporate lobbyists.

With COVID-19, Torontonians are in crisis, facing unprecedented threats to our health and economy. City Council has more important things to do than debating e-scooters. Montreal tried an e-scooter pilot and called it off. So should Toronto.

Five Ways to Help

On July 28, 2020, Toronto City Council directed City staff to investigate the concerns of people with disabilities regarding e-scooters. Here are five ways to have your say. Email us at  aodafeedback@gmail.com to tell us what you tried and what you heard back.

  1. Please call and email Mayor Tory’s office. Tell him not to allow e-scooters in Toronto.

mayor_tory@toronto.ca 416-397-2489

  1. Email or call Toronto’s General Manager of Transportation Services Barbara Gray. Give her the same message. You can reach her at:

Phone 416-392-8670

Email: Barbara.Gray@toronto.ca

  1. Get your friends and family members to call or email Mayor Tory’s office to tell him not to allow e-scooters in Toronto.
  1. If you are a member of a church, synagogue, mosque, or other religious or community organization, get your organization or its leaders to email and phone Mayor Tory to oppose allowing e-scooters in Toronto.
  1. Widely circulate and post this Action Kit. Use social media like Twitter to tell MayorTory not to allow e-scooters. Mayor Tory’s Twitter handle is: @JohnTory

Here is a sample of a tweet you might send on Twitter:

@JohnTory Don’t allow electric scooters in Toronto! Please don’t expose Canada’s largest city to the Dangers, serious Injuries and New Disability Barriers that e-scooters inflict https://acorta.me/2fe #accessibility #ToPoli

For more background:

Read the AODA Alliance’s July 8, 2020 brief to the City of Toronto Infrastructure and Environment Committee, already endorsed by Spinal Cord Injury Ontario and the March of Dimes of Canada

Read the February 6, 2020 letter from the AODA Alliance to Toronto Mayor John Tory which he has not answered.

Read the open letter to all Ontario municipal councils from 11 major disability organizations, opposing e-scooters in Ontario, and

Read the AODA Alliance’s July 10, 2020 news release explaining what happened at the July 9, 2020 meeting of Toronto’s Infrastructure and Environment Committee where the AODA Alliance and others presented on this issue.

Visit the AODA Alliance e-scooters web page.

More Media Coverage of the Stress and Uncertainty facing Parents of Students with Disabilities on the Eve of the Labour Day Weekend

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

More Media Coverage of the Stress and Uncertainty facing Parents of Students with Disabilities on the Eve of the Labour Day Weekend

September 4, 2020

          SUMMARY

On the eve of the Labour Day weekend, parents of a third of a million students with disabilities in Ontario remain very anxious about what their children will face as schools re-open in Ontario over the next days. The Ford Government has still announced no comprehensive plans to ensure that students with disabilities are fully and safely included in school re-openings, even though it has been repeatedly advised that such a plan is needed. School boards, teachers and principals are all scrambling in the absence of that plan. This scrambling is made all the more hectic as the Ford Government made more announcements on school re-opening late in the summer which should have been made weeks ago.

Even days before schools re-open, some parents of students with disabilities still do not even know who their child’s teacher will be. How can a teacher properly plan to meet the needs of students with disabilities during school re-opening, including safe social distancing, if they don’t even know who their students will be and what their needs will be?

We and other disability rights advocates have succeeded in securing media coverage of these concerns. For example, yesterday, we were included in good reports on this issue on CBC national radio news, and in the flagship CBC national news program “The National

”. Below we set out a sample of some other recent reports on CTV national news, on CBC and in the Toronto Star and St. Catharines Standard, which either include the AODA Alliance or other disability advocates with whom we collaborate.

Here are a few reflections. First, from what we have seen, the Ford Government has not denied to the media or to us that it has no comprehensive plan to ensure that students with disabilities are fully and safely included in school re-opening. It has not denied that it has left it to each of 72 school boards to themselves figure out what to do, as they scramble to cope with the COVID-19 pandemic.

For yet more proof that the Ford Government is largely leaving it to school boards to figure this out, we set out below an excerpt from the Government’s August 27, 2020 “Operational guidance: COVID-19 management in schools.“

Second, when the media asked the Ford Government over the past days about the fact that it has no plan to ensure the full and safe inclusion of students with disabilities in schools, the Government repeatedly answered that it has allocated 10 million dollars to special education as new funding. This, in reality, is a tacit admission that it has no plan. If it had a plan, it would have answered reporters by saying it has a plan.

Moreover, as we have earlier emphasized, that 10 million dollars boils down to a paltry $34 for each student with disabilities. What can that tiny sum procure for students with disabilities?

The absence of a comprehensive provincial plan for fully and safely including students with disabilities in school re-opening means that 72 school boards will have to waste time and money duplicating efforts as they try to figure out how to solve the same problems.

Third, in the absence of a much-needed provincial plan of action, the Ford Government has a plan in place to advertise about its efforts on school re-opening. Below we set out an article from the August 26, 2020 Toronto Star covering this, and the criticisms of this use of public money.

Fourth, we must correct the $4 per student allocation that we earlier calculated, in light of a new Government funding announcement on August 26, 2020. The Federal Government gave the provinces a total of some 2 billion dollars to help with school re-openings. In the Ford Government’s August 26, 2020 announcement on how it would spend its portion of those funds (set out below), it announced an additional 12.5 million dollars for special education and mental health supports. If we assume that all that money is to be spent on students with disabilities, then the addition of that money to the 10 million dollars that the Ford Government earlier announced would bring the total to $22.5 million. If that is divided among a third of a million students with disabilities, that is $67.3 dollars per student for this fall.

$67.3 per student with disabilities, while larger than $34, is still paltry. There will likely be less than $67.3 per student with disabilities. It is reasonable to expect that a large proportion of Ontario’s 2 million students, and not just students with disabilities, will need mental health supports in light of the COVID-19 pandemic. As such, a portion of the new 12.5 million dollars that the Ford Government allocated from the new funds it received from the Trudeau Government will go to students without disabilities.

So what are parents with disabilities to do in the face of all this stress and uncertainty. We remind you all that you can get helpful tips by watching the archived online video of the 3rd virtual Town Hall on COVID-19 and Disability which the AODA Alliance and the Ontario Autism Coalition hosted on August 21, 2020. It has American Sign Language interpretation. It is also now captioned.

We welcome your feedback. We cannot give parents legal advice on how to handle events as they unfold. However, we want to know what you are experiencing, so we can draw on it to focus our advocacy efforts over the next days and weeks. Email us at aodafeedback@gmail.com

For more background on these issues, visit

* The AODA Alliance’s COVID-19 web page and our education accessibility web page.

* The July 24, 2020 report on meeting the needs of students with disabilities during school re-opening by the COVID-19 subcommittee of the K-12 Education Standards Development Committee.

* The AODA Alliance‘s July 23, 2020 report on the need to rein in the power of school principals to refuse to admit a student to school.

* The AODA Alliance’s June 18, 2020 brief to the Ford Government on how to meet the needs of students with disabilities during school re-opening.

* The widely viewed online video of the May 4, 2020 virtual Town Hall on meeting the needs of students with disabilities during the COVID-19 crisis, co-organized by the Ontario Autism Coalition and the AODA Alliance.

          MORE DETAILS

 Toronto Star August 26, 2020

Originally posted at https://www.thestar.com/news/gta/2020/08/26/parents-fear-pandemic-will-lead-to-more-exclusion-of-special-needs-students.html

Is Ontario’s plan ‘a formula for failure?’

Parents of children with disabilities fear their kids are being treated as an afterthought

Brendan Kennedy Toronto Star

After nearly six months of not being able to see her friends in person, Sumayyah Ahmed is even more excited about this school year than usual. She figures it might be “pretty weird” with all her classmates wearing masks and social distancing, but she’s going into Grade 8 so she and her friends will finally be the oldest kids in the school. “I’ve heard it’s the most fun year.”

Sumayyah’s mother, Lindsay Ahmed, is a little more anxious about what lies ahead.

“I’m feeling probably similar to everyone else,” she says. “I have no idea what the right decision is.”

Sumayyah, who has quadriplegic cerebral palsy and is also visually and hearing impaired, is among the estimated one-in-six Ontario students with special needs. Ahmed loves her daughter’s school – Robert Munsch Public School in Whitby – and she’s confident they will “do the best they can with what they’re given.”

But like many other parents, she still has so many questions and she’s frustrated with the lack of information. How will physical distancing requirements affect her daughter’s support person? What happens if there’s another shutdown and Sumayyah is forced to return to online learning, which, if it’s run as it was in the spring, will be mostly inaccessible to her?

Ahmed says it feels like students with disabilities are being treated as an afterthought, “which is usually the case.”

Ahmed isn’t alone. Parents and advocates of students with special needs say Ontario’s back-to-school plan doesn’t address their concerns ahead of this unprecedented school year.

“There was no systematic effort to figure out how to meet the needs of people with disabilities during COVID,” says David Lepofsky, chair of the Accessibility for Ontarians with Disabilities Act Alliance.

Lepofsky says he sympathized with the province back in March when they had to scramble to move classes online. He doesn’t fault them for their missteps then, but he says it’s unacceptable there is still no comprehensive strategy for supporting students with disabilities.

“We said to them in the spring: ‘You need a plan. You need to come up with ways to ensure that your distance learning meets the needs of those one-out-of-six students,’ and they didn’t. I’m not saying they did absolutely nothing, but there was no systematic strategy to deal with it. They basically left it to 72 school boards to each figure it out themselves. That is a formula for failure.”

Last month, the province announced $10 million of its school reopening budget would be used specifically to support special needs students in the classroom. The Ministry of Education has also encouraged boards to support whatever attendance option works best for special needs students.

In an emailed statement, a spokesperson for Education Minister Stephen Lecce said the province is spending “more money than any other province on special education.”

The ministry also pointed out that they have increased funding for special education grants available to every school board, while creating the Supports for Students Fund, which can be used for “additional critical staffing needs,” including hiring more educational assistants.

Even with the additional funding, Lepofsky and other advocates fear the extra health-and-safety burdens on schools, coupled with the lack of a comprehensive plan for special needs students will lead to more students being excluded.

“What we’re worried about right now is with the return to school and principals scrambling there’s a real risk that some of them are going to decide, ‘I don’t know what to do with this kid. I don’t know if we can manage their social distancing. Mom, keep your kid home,'” he says.

“This is a festering problem that predated COVID and we are really worried that this fall it’s going to get worse as a way of coping with the failure of the provincial government to properly plan and resource the return to school.”

A provision of Ontario’s Education Act allows individual principals to prohibit a student from attending school if they believe their presence is “detrimental to the physical and mental well-being” of the other students.

Disability advocates have argued the provision is disproportionately used to exclude students with special needs, particularly those with autism. Last year, the Ontario government said it would look into the issue, but there is currently no provincewide policy and individual principals have broad discretion.

“There’s wild variations from board to board,” Lepofsky says. “Depending on where you live your kid gets a lot of due process, or none.”

Laura Kirby-McIntosh, president of the Ontario Autism Coalition, says she has already heard from parents of autistic children whose schools have asked them to attend for less than a full day or only a few days per week.

“The message there is, ‘Gee, your kid is an awful lot of extra work, so let us get all the normal kids settled and then we’ll worry about you.’ That’s problematic,” she says.

The social impact of being excluded can be “devastating” for a student with special needs, Kirby-McIntosh says. “Especially in that first week.”

Kirby-McIntosh says she’s worried the pandemic will be used as a pretext for more exclusions.

“I’m very nervous about how this is going to unfold,” she says. “I think there’s going to be a lot of lawyers and education advocates who are going to be very busy this fall, and a lot of exhausted and exacerbated parents – and a lot of sad kids.”

The ministry did not respond to questions about the potential for more exclusions this year.

Angela Nardi-Addesa, superintendent of special education and inclusion for the Toronto District School Board, says the board has instructed its schools that pandemic protocols cannot be used as a reason to exclude a student.

“I want to make sure that all our staff know that nothing of what we do should act as a barrier for students with disabilities.” If a student is unable to wear a mask or to distance themselves from other students, she says, accommodations will be made.

“It is up to us as a staff, as a board, to figure out how to best support that student to keep them safe, as well as the staff.”

On top of her uncertainty and anxiety around her daughter’s return to school, Ahmed is also worried about what will happen if schools are forced to close again at some point this fall. Sumayyah, whose disabilities made learning by video nearly impossible, really struggled to keep up during the spring shutdown.

The video connection didn’t always work, and she had trouble seeing and hearing things properly.

“It was annoying and frustrating,” Sumayyah says.

“There was no plan for anyone, so of course the students with special needs were the ones who suffered the most,” Ahmed says. She hasn’t heard what, if anything, has been done to improve virtual learning for students with disabilities. “I’m going to assume there’s probably not a better plan.”

St. Catharines Standard August 23, 2020

Originally posted at https://www.stcatharinesstandard.ca/news/niagara-region/2020/08/23/transition-back-to-school-is-going-to-be-awful-for-special-needs-kids-advocacy-group-warns.html

Transition back to school is ‘going to be awful’ for special needs kids, advocacy group warns

By Allan Benner

Sun., Aug. 23, 2020

Christine Levesque won’t be sending her son back to school in September.

Considering the challenges her 10-year-old boy with autism faced when he was in class prior to the COVID-19 pandemic being declared, Levesque does not feel comfortable sending him back immediately when schools reopen.

She isn’t alone.

The Niagara Falls resident, who leads a group called Autism Advocacy Ontario, said the organization has been in contact with families daily, listening to their concerns about sending their children back to school.

Levesque said she was forced to pull her son, Larz, out of school last October after he slipped away from his teachers three times in one day when the school could not provide the support he needed.

She said school administration informed her in February a new support person had been brought in for Larz, but 10 days after he returned to class labour actions began to disrupt classes, followed by the COVID-19 shutdown.

Like most kids, Larz has been home ever since.

“If his needs weren’t being met before, how are they going to be met now with teachers who are under so much more stress?” Levesque wonders.

She also worries about worse-case scenarios that could arise, possibly leading to bullying related to the virus if children show symptoms.

Although parents of autistic children are typically advised to allow their kids to socialize as much as possible, Levesque said she is no longer concerned that her son may be too isolated at home.

She said Larz been thriving in the months he’s been home, and she’s heard similar stories from other parents through the advocacy group.

“As soon as these kids got out of schools and started spending time with their families, things started happening. Some kids started to communicate better,” she said. “In the last six months, I think the calm-down of everything has helped these kids tremendously.”

But she is concerned about autistic children returning to classrooms too quickly and finding a routine that’s different than before with “all these new expectations and hand washing.”

Levesque said she has been advising parents who contact the advocacy group: “Do not panic, and take your time.”

She said she reminds them that if they have a special needs child, they are in control of their child’s individual education plan, or IEP.

“It’s been this long, the transition is going to be awful. Let’s do it slowly,” she said.

She suggested sending children with autism back to the classroom for a half-day to start, and a full day a few weeks later, “and then we’ll see how it goes in October.”

Levesque said Autism Advocacy Ontario is developing a survey to ask families to discuss concerns they have that are yet to be addressed by school boards or any other advocacy group.

The Ontario Autism Coalition, too, has been working to advise families of special needs children concerned about a lack of guidance.

“The provincial government has announced no comprehensive plan to ensure students with disabilities are fully and safely included in their return to school, or to ensure that any distance learning that occurs this fall will be barrier-free,” said Ontario Autism Coalition president Laura Kirby-McIntosh, who works as a teacher at a Peel high school.

“As always, we have to take things into our own hands,” she said.

The organization teamed up with retired lawyer and Accessibility for Ontarians with Disabilities Act Alliance chair David Lepofsky and ARCH Disability Law Centre executive director Robert Lattanzio.

Lepofsky advised parents to remain in contact with schools to ensure the needs of students are met — whether it’s assistance with wearing personal protective equipment or identifying any needs that may have changed as a result of the pandemic.

 CBC News August 27, 2020

Originally posted at https://www.cbc.ca/news/canada/toronto/parents-special-needs-back-to-school-1.5702709?ref=mobilerss&cmp=newsletter_CBC%20Toronto_1642_106268

Why some parents of kids with disabilities are making the ‘heart-breaking’ choice of at-home learning

Students with disabilities an afterthought in province’s plan, parent Lisa Thornbury says

Julia Knope

CBC News, Aug. 27, 2020

For months, Avery Thornbury, 14, has been looking forward to starting Grade 9 at a new school. In fact, she’s been so excited that she’s had her backpack ready by her front door since June.

“I just want the virus to be done,” she said.

“I just want to go to my school.”

But now — at least for the foreseeable future — that’s not going to happen.

Avery has epilepsy, so she has to be monitored for seizures. And with her cognitive delays, her mom Lisa Thornbury, says she’s working at a Grade 2 level.

Because her daughter has to be constantly monitored, Thornbury has decided to opt for Ontario’s online learning option come fall. She says there are holes in the province’s back-to-school plan for students with disabilities.

It’s a choice she calls “heart-breaking,” but ultimately necessary.

“We just thought that the risks outweighed the benefits,” Thornbury said.

Survey studies impact of COVID-19 on kids with disabilities

Thornbury says she’s spoken to other parents in the same situation who say “they’re really nervous, they’re afraid and they just don’t see that they have any other option.”

Parents of children with disabilities have cited issues such as the wearing of masks, questions about transportation for kids who require aid on school buses and the availability of educational assistants to help their kids when their in the classroom.

On Thursday, Statistics Canada released the results of a survey done in June looking at parents’ concerns since the onset of the COVID-19 pandemic.

Those who have kids with disabilities expressed higher levels of concern in all areas, particularly when it came to the school year and academic success for their children.

And what has made that even worse, Thornbury says, is what she calls “confusion” and “frustration” around the province’s back-to-school plans for children like Avery.

The plan, which was released on July 31, includes a combination of in-class and at-home learning for high school students, but the province has left room for each school board to tweak its own rules.

The Toronto District School Board (TDSB) is still finalizing plans for children with disabilities, both for online and in class learning, according to

Angela Nardi-Addesa, a system superintendent for special education.

Nardi-Addesa says the TDSB is collaborating with other boards to ensure students with disabilities “will not be discriminated against,” while remaining aware that some may have trouble with wearing masks and physical distancing.

Thornbury says transportation is one of the questions that remains for parents of children with disabilities, given that they often require extra aid on a bus. (Evan Mitsui/CBC)

Thornbury says the Halton District School Board, which oversees Avery’s Oakville school, is also still finalizing its plans, leaving “many questions” around

transportation, educational assistants, and wearing masks for students with disabilities.

“My daughter can’t wear a mask for longer than 15 minutes without being completely frustrated,” she said.

But the alternative — sending her to a school where some students aren’t required to wear masks — felt too risky, leading her to choose online learning,

despite the fact that her daughter thrives at school.

“It’s kind of like a lose-lose situation.”

The province has promised more than $22 million for special needs and mental health, some of which is coming from the federal government.

But despite that funding, Laura Kirby-McIntosh, a mother, teacher and autism advocate, says the Ford government should have released its back-to-school

plans earlier.

“Students like my daughter here, who has an exceptionality, they’re one in six,” Kirby-McIntosh told CBC Toronto Thursday.

“So you have to be planning with these kids in mind from day one — you can’t leave it to the last minute.”

Her daughter will also be learning online, as her husband is immuno-compromised and is therefore particularly vulnerable to the novel coronavirus.

Kirby-McIntosh is now pushing for more clarity.

“I specifically called the minister of education today to discuss children with special needs,” she said.

“We’re going to make sure they’re able to get in the classroom safely, [and that] they have the same rights as any other child.”

Meanwhile, Thornbury is now preparing to have Avery at home for longer than originally anticipated, which means “basically home-schooling” and sitting

side-by-side with her during her virtual lessons.

In an effort to recreate the classroom setting, the pair also stick to a rigorous schedule, which includes singing O Canada every day, as well as morning announcements, field trips and recess.

“She thrives in a classroom,” Thornbury said.

And with the added challenge of also fitting her own work into her schedule, Thornbury said it’s going to be hard.

“It’s going to be challenging for sure.”

 CTV National News August 22, 2020

Originally posted at https://www.ctvnews.ca/canada/parents-advocates-for-children-with-disabilities-share-concerns-over-school-reopening-plans-1.5075783

Parents, advocates for children with disabilities share concerns over school reopening plans

Molly Thomas

Ottawa Bureau Correspondent, CTV National News

TORONTO — As Canada prepares to reopen most of its schools, some parents and advocates across the country are voicing safety concerns for children with disabilities returning to the classroom.

Dartmouth, N.S. resident Meredith Tasiopoulos says her five-year-old son Eli, who has special needs, is excited to return to school. However, she still isn’t sure what returning to school will look like for him.

Eli has cerebral palsy and is unable to speak or walk on his own. Before the pandemic, school was the only place he received therapy and when he stopped attending school, Tasiopoulos noticed that the progress he made started to decline.

“We certainly see Eli’s progression slow down as school stopped and he stopped receiving these supports,” Tasiopoulos told CTV News.

Since Eli is more vulnerable to COVID-19, Tasiopoulos said she is still waiting on detailed instructions for what her son’s school year will entail post-pandemic lockdown.

“We don’t want him to be excluded and we’ve worked so hard for our kids to be included and that would be a major step back,” she said. “He loves school, Eli loves school so much.”

In Ontario, a town hall meeting was held on Friday to demand a province-wide plan that will focus on the one in six students who live with a disability.

David Lepofsky, a chair member of the Accessibility for Ontarians with Disabilities Act Alliance said during the meeting that students should be given assurances that they will not only be safe at school but also fully included with the curriculum and activities.

“They have the right to be fully and safely included in the return to school this fall, that won’t happen by accident,” Lepofsky said.

Some parents across Canada are also raising concerns, protesting their provincial governments to implement more staffing and rigorous safety measures to prevent the spread of COVID-19 in schools.

Teachers and parents in Calgary and Edmonton are urging the Alberta government to hire more staff to make class sizes smaller.

“Last year, my younger daughter’s class had 36 to 38 kids in it over the course of a year. There’s no room in the classroom to spread out,” Kyla Stack, a concerned mother protesting in Calgary, told CTV News.

Some child psychologists say if parents are anxious about the return to school, so will their kids. Experts suggest parents practice physical distancing and wear masks around the house now so it won’t seem strange in schools.

Some health professionals are encouraging the return to classes all while the correct precautions are taken into account.

While parents may feel anxious about sending their children back to school, infectious disease specialist Sumon Chakrabtri said it is time for kids to return to the classroom.

“The time has come that we need to move forward with this step and it’s going to be a bit nerve racking but, in the end, it’ll be successful,” he said.

Toronto Star August 26, 2020

Bus drivers left guessing over safety protocols

Salmaan Farooqui The Canadian Press

School bus drivers in Ontario say they need guidance from the province and school boards on COVID-19 safety protocols including social distancing, use of face masks and sanitizing routines.

With just a few weeks until the start of the new school year, the drivers, many of whom are retirees, say they still have many questions about what they’re supposed to do when a child on the bus is sick.

“We know how important it is to get kids to school, but we don’t want to be that weak link, don’t want to be responsible for an outbreak or something in our broader based community,” said Debbie Montgomery, president of Unifor Local 4268, which represents the bus drivers.

“We want to get this right and we want to mitigate as many risks as possible.”

Montgomery said provincial regulations don’t allow for Plexiglas to protect drivers, who are being asked to take on more responsibilities such as taking attendance or ensuring that kids keep their masks on.

She said some drivers have already received manifests with more than 70 students for September.

“How do I ensure, in rush-hour traffic all by myself with 72 kids on that bus, that Johnny is keeping his mask on, Sally isn’t hitting the kid next to her,” said Montgomery, who said in an earlier news release that the drivers “feel like sitting ducks.”

In some locations, Unifor said that bus drivers have been told they don’t have the right to refuse a ride to a child, even if the student is visibly ill.

With the added risk and responsibility, Montgomery said compensation will be a sticking point moving forward.

She pinned the blame on the Ministry of Education and school boards for not responding to demands that the union put out earlier in the summer.

Education Minister Stephen Lecce’s office did not immediately provide comment.

 Toronto Star August 26, 2020

Premier touts back-to-school ad campaign

Ford government mum on cost as critics say spending could have gone toward reopening

Kristin Rushowy Queen’s Park Bureau

Premier Doug Ford says a new ad campaign about the reopening of schools this fall amid the COVID-19 pandemic is needed to keep parents informed – but he won’t yet say how much the government is spending.

Critics slammed the government for the expense, saying the province should be using those funds to hire more teachers to reduce class sizes or to purchase personal protective equipment for staff.

“Everything is going to be transparent, the accountability office is going to have all these numbers,” Ford said at an event Tuesday afternoon at a Catholic school in Etobicoke. “It’s critical that the parents know, you know, it’s not about playing politics like the other ones are doing, I believe in communicating to the parents, the teachers and as well, to the students.”

The public awareness ads, about the safe reopening of public schools, include radio spots that say, in part: “that’s why the Ontario government asked doctors, health officials, school boards and educators to help build a comprehensive plan to keep our kids safe. Working together, our plan includes physical distancing, putting more nurses in schools, masking, enhanced cleaning and hand sanitization and other measures to ensure the well-being of students and school staff.”

Green Party Leader Mike Schreiner said “instead of spending taxpayer money telling the public that kids will be physically distanced in schools, the premier should be spending taxpayer money providing funding to school boards so that they will actually be able to implement physical distancing.”

He said “this government is notorious for wasting money on ad blitzes that promote their own agenda … The bottom line is, if the premier is serious about providing comfort to parents, he should immediately redirect spending taxpayer money on vague ads and instead give it directly to school boards who need it.”

But Caitlin Clark, a spokesperson for Education Minister Stephen Lecce, said “since the beginning of COVID-19, our government’s public awareness campaign has been a critical tool in helping change public behaviour and stopping the spread of COVID-19. We will continue to inform the public about the health protocols that are in place” such as improved hand hygiene and mandatory masks starting in Grade 4.

The government says the ads were approved by the auditor general, and meet provincial treasury board guidelines.

“We inform the people, we inform the parents,” Ford said. “I think it’s a no-brainer … Running ads is the right thing to do, we’re going to continue running ads.”

In London, NDP Leader Andrea Horwath called it “appalling that Doug Ford refuses to invest in smaller, safer classes but is doling out a secret amount of public money on wasteful propaganda to promote his crowded classrooms scheme … Every dime spent on these partisan defensive ads should be spent on a safe September, instead.”

Ontario Liberal Leader Steven Del Duca said “Ford needs to come clean and tell Ontarians how much his vanity ads cost. This is money that could be funding teachers, special education professionals and caretakers.”

He said “for every $1 million Doug Ford spends on ads he could be funding 11 teachers, or 13 special education professionals, or 20 caretakers,” or technology, or masks for students.

Meanwhile, Ontario’s four big teacher unions said they met with Labour Minister Monte McNaughton on Monday and left with “no clear commitment from the minister to address the specific serious health and safety concerns raised there surrounding the reopening of the province’s schools next month,” including class size and physical distancing, as well as busing.

“The unions raised the urgent concern that there are no clear health and safety standards being set out or ordered by the ministry so that its inspectorate and workers can apply known and commonly accepted precautions as schools reopen. The ministry confirmed that no such standards have yet been set.”

They said “in light of the shortcomings” in the back-to-school plan, they’ve asked the labour ministry to limit class sizes to 15 to 20 students and only allowing cohorts of a maximum of 50 people for staff and students.

The province has made about $900 million in funding available to school boards to hire teachers and custodians and purchase personal protective gear for staff. About $500 million of that money is from boards’ own reserves.

 Excerpt from the August 26, 2020 Ontario Government School Re-Opening Guideline

Originally posted at https://www.ontario.ca/page/operational-guidance-covid-19-management-schools

Operational guidance: COVID-19 management in schools

Find out what will happen if there is a coronavirus (COVID-19) outbreak at a school.

… Special education

In order to ensure that students with special education needs are supported as schools reopen, school boards will need to consider additional planning and transition time for students with special education needs to support a smooth transition.

School boards should support attendance options including offering daily attendance to students with special education needs for whom adapted timetables or remote learning may be challenging based on the student’s special education needs.

School boards should work with partners to develop local protocols for school access by regulated health professionals, regulated social service professionals and paraprofessionals for the purpose of delivering school-based supports and services. Protocols should include support for remote delivery where in-school delivery is not possible.

Scenario: Student with special education needs in a special education class (congregated or integrated class) has needs that conflict with COVID-19 safety protocols

Recommended action by teacher

The teacher should:

Meet pro-actively (face to face or virtually) with parent/guardian and special education staff to anticipate and discuss possible changes to accommodations in the Individual Education Plan (IEP)

Consider additional transition time to support smooth transitions

Recommended action by principal, the principal should:

Ensure coordination of staff and supports for student needs as necessary, for example, support staff and PPE

Ensure and coordinate environmental cleaning and/or disinfection of the space and items used by the individual(s)

Support planning for possible online learning

Inform transportation of accommodations as needed

Inform special education superintendent or designate of accommodations as requested

Engage and support in updating the IEP as necessary

Recommended action by school board, the school board should:

With partners, ensure consistent practices across the system regarding students with special education needs (that is, access by regulated health professionals and service providers and paraprofessionals)

Ensure continued access to assistive technology

Recommended action by parent and student, the parent and student should:

Work pro-actively with the school to anticipate and discuss possible accommodations to support the needs of the student

Continue to adhere to current infection prevention and control practices

Communicate regularly with the school to inform daily routines

 August 26, 2020 Ontario Government News Release

Ontario Newsroom

Ontario Newsroom

News Release

Additional Funds Enhance Ontario’s Robust Back-to-School Plan

August 26, 2020

Funding will be used to complement provincial health and safety measures already in place

TORONTO — The Ontario government’s back-to-school plan, developed in consultation with the Chief Medical Officer of Health and public health officials, is being further enhanced by additional federal investments and resources to support the return to class in the fall. Today’s federal announcement provides $381 million to Ontario, on top of the nearly $900 million provided by the province to support provincial back-to-school plans.

“Ontario’s investments lead the nation in supporting priorities like more cleaning, physical distancing, testing, and hiring of staff to ensure a safe reopening of our schools this September,” said Stephen Lecce, Minister of Education. “Today’s investment by the Federal government complements the already landmark investments made by our government in support of safe and healthy schools in Ontario.”

The federal funding will support several priority provincial initiatives:

Reopening Plan Implementation – $200 million

  • $100 million to complement the health and safety components of school reopening plans, in consultation with local public health units, including the

hiring of custodians, HVAC, improvements, internet connectivity for students and other local needs.

  • $30 million to support additional PPE for schools.
  • $70 million for the temporary hiring of educators as required.

Student Transportation – $70 million

  • $44.5 million in support of the Driver Retention Program (DRP).
  • $25.5 million for route protection and to help reduce the number of students on buses.

Special Education and Mental Health Supports Enhancement – $12.5 million

  • Will allow boards to hire and train additional staff and provide more mental health supports for students.

Additional Public Health Nurses – $12.5 million

  • Supports up to 125 additional nursing positions in public health units across the province to help schools manage potential COVID-19 cases.

Remote Learning – $36 million

  • Ensures that every school board offering virtual learning has a dedicated principal and administrative support for both its secondary and elementary virtual schools.

The province is also setting aside $50 million for any future pandemic learning needs, to ensure that Ontario is prepared for every scenario this Fall. Pending federal approvals in December, the Ministry of Education will announce the second half of the payment later this year for the remainder of the school year.

QUICK FACTS

  • Ontario’s COVID-19 website includes resources to help stop the spread, sector specific resources, including helpful posters, mental health resources, and other information.
  • On July 30, 2020 the government released the Guide to Reopening Ontario’s Schools,

which was developed in consultation with leading medical experts and approved by the Office of the Chief Medical Officer of Health. This plan committed over $300 million in funding to support the safe reopening of Ontario’s schools, which is part of the evolving layers of protection the government is providing to students, parents, staff, and the communities they live and work in.

  • The provincial guidelines provide a baseline and school boards are encouraged to adapt them to meet local needs and support students and families. They include:
  • In-person classes for elementary school students five days per week for the 2020-2021 school year.
  • Masking for students in Grades 4-12.
  • Focus on cohorting and limiting student contacts.
  • Adapted secondary school delivery for designated boards.
  • On August 13, the government announced more than half a billion dollars in supports to school boards to ensure schools across the province will reopen safely in September and to protect students and staff.

August 26, 2020 Memo from Ontario Education Minister to School Boards on New Funding for School Re-Openings

Memorandum To: Chairs of District School Boards

Directors of Education

Secretary-Treasurers of School Authorities

 

From: Stephen Lecce

Minister

Nancy Naylor

Deputy Minister     

Earlier today, the Federal Government announced the Safe Return to Class Fund providing the Province of Ontario with first phase funding supports equal to $381 million.

This investment complements the already landmark resources of more than $900 million provided by the province to support provincial back-to-school plans.

The purpose of this memo is to provide information on this first phase of federal funding.

Additional Teaching Staff

Funding of $70 million will be allocated to school boards reflecting a base funding amount of $125,000 per panel as well as projected total 2020-21 Average Daily Enrolment (ADE). This one-time funding is for non-permanent teachers and supply teachers. The funding should be used for time-limited positions. See Appendix A for board-by-board allocations.

School Reopening Emerging Issues

In recognition of the meetings we have had with each school board to discuss the safe reopening of schools, funding of $100 million will be allocated to school boards to augment the health and safety of school reopening plans. This funding is designed to be responsive to varying local issues and may be used to support a broad range of activities such as additional hiring of staff (such as custodians and other school-based staff), leasing of community-based spaces, improving air quality and additional technology and broadband supports. This funding will be allocated to school boards reflecting a base funding amount of $125,000 per panel as well as projected total 2020-21 ADE. See Appendix A for board-by-board allocations.

Additional Personal Protective Equipment (PPE)

As the safety of students and staff continues to be a key priority in the reopening of Ontario schools, the ministry is investing a further $30 million in funding for masks and PPE. This funding will continue to be supported through the centralized supply chain to secure these critical supplies.

Transportation

The ministry recognizes that school boards are facing unique student transportation challenges for the upcoming school year as a result of COVID-19. To support school boards in ensuring enhanced health and safety measures, $25.5 million will be provided to assist in reducing the number of students on school buses to support physical distancing, as well as addressing other pressures school boards may face in transporting students as a result of COVID-19.

This $25.5 million in funding will be allocated to school boards proportional to school boards’ 2020-21 Transportation Grant allocation. See Appendix A for board-by-board allocations.

The ministry recognizes that the student transportation sector may be facing a greater driver shortage this year. As such, $44.5 million will be set aside to support ongoing efforts in school bus driver recruitment and retention for the 2020-21 school year. Further details on the driver recruitment and retention funding will be shared shortly.

A total amount of $70 million will be provided for student transportation to enhance health and safety measures for school buses and to ensure service stability for students and families as schools reopen.

Remote Learning

As parent surveys are indicating more families may be choosing remote learning for part of or all of the upcoming school year, the ministry will be supplementing the $18 million investment announced on August 13, 2020 by a further $36 million. This additional funding will ensure that where school boards choose to provide remote learning, dedicated funding supports will be provided to hire more principals and school administration supports.

In addition, where it is projected that a school board will have more than 1,500 pupils attending virtual schools in 2020-21, by panel, they will now also generate vice-principal funding to ensure appropriate school leadership is available. Furthermore, the five per cent virtual school attendance funding assumption used to calculate the original $18 million investment has been updated to ten per cent to reflect higher than expected enrolment in the remote program.

Where school boards have a need greater than what is provided through the total remote learning funding amount of $54 million, they may access funding provided under School Reopening Emerging Issues. See Appendix A for board-by-board allocations.

 

Additional Special Education and Mental Health Supports

To further support students with special education needs and support the mental health needs of students, the ministry is providing school boards with an additional $12.5 million in funding investments. This is flexible funding to address local needs including the purposes as outlined in memorandum 2020: B11. Each district school board’s projected allocation for this funding is set out in Appendix A. The allocation reflects base funding of $100,000 per board and a top up based on ADE. This formula provides both smaller and larger boards with the ability to implement meaningful special education and mental health supports.

 

Additional Public Health Nurses

As announced on July 30, the ministry continues to work with colleagues in the Ministry of Health to ensure public health capacity is expanded to support school reopening, including 500 new public health nurses through an initial investment of $50 million. Additional funding of $12.5 million is also being provided to support up to 125 additional nursing full-time equivalents (FTEs) in public health units across the province, including a combination of Registered Practical Nurses (RPN), Registered Nurses (RN), and Nurse Practitioners (NP).

The additional FTEs in public health units focus on supporting the school and child care restart plans, with a focus on meeting the demand of schools, school boards, child care centres, and parents/teachers for information, guidance, case and contact management, infection prevention and control, and outbreak management and response.

 

Future Pandemic Response Fund

Given the continued uncertainty surrounding the COVID-19 virus and wanting to ensure there is prudence in our plan, the ministry will be holding back $50 million to address future pandemic education needs. Details on this will be provided at a later date.

In the coming weeks, school boards will receive a Transfer Payment Agreement (TPA) for the new Priorities and Partnerships Fund (PPF) investments reflecting the allocations noted within.

Pending federal approvals in December, the Ministry of Education will announce the second phase of the federal funding in the coming months for the remainder of the school year.

We appreciate all that school boards are doing to reopen schools, and we will continue to work together to support the health and safety of students and staff.

Thank you for your ongoing partnership.

Sincerely,

Stephen Lecce                    Nancy Naylor

Minister                         Deputy Minister

Attachment

c:    President, Association des conseils scolaires des écoles publiques de l’ontario (ACÉPO)

Executive Director, Association des conseils scolaires des écoles publiques de l’ontario (ACÉPO)

President, Association franco-ontarienne des conseils scolaires catholiques (AFOCSC)

Executive Director, Association franco-ontarienne des conseils scolaires catholiques (AFOCSC)

President, Ontario Catholic School Trustees’ Association (OCSTA)

Executive Director, Ontario Catholic School Trustees’ Association (OCSTA)

President, Ontario Public School Boards’ Association (OPSBA)

Executive Director, Ontario Public School Boards’ Association (OPSBA)

Executive Director, Council of Ontario Directors of Education (CODE)

President, Association des enseignantes et des enseignants franco-ontariens (AEFO)

Executive Director and Secretary-Treasurer, Association des enseignantes et des enseignants franco-ontariens (AEFO)

President, Ontario English Catholic Teachers’ Association (OECTA)

General Secretary, Ontario English Catholic Teachers’ Association (OECTA)

President, Elementary Teachers’ Federation of Ontario (ETFO)

General Secretary, Elementary Teachers’ Federation of Ontario (ETFO)

President, Ontario Secondary School Teachers’ Federation (OSSTF)

General Secretary, Ontario Secondary School Teachers’ Federation (OSSTF)

Chair, Ontario Council of Educational Workers (OCEW)

Chair, Education Workers’ Alliance of Ontario (EWAO)

President of OSBCU, Canadian Union of Public Employees – Ontario (CUPE-ON)

Co-ordinator, Canadian Union of Public Employees – Ontario (CUPE-ON)

ARCH Disability Law Centre Identifies Even More Problems with the Revised Draft Protocol for Deciding which COVID-19 Patients, Needing Critical Medical Care, Would Not Get That Care If there Is a Future Shortage of Critical Care Beds

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

ARCH Disability Law Centre Identifies Even More Problems with the Revised Draft Protocol for Deciding which COVID-19 Patients, Needing Critical Medical Care, Would Not Get That Care If there Is a Future Shortage of Critical Care Beds

September 1, 2020

Summary

If this fall or winter sees a surge of COVID-19 that is so severe that hospitals don’t have enough critical care beds and services for all patients who need that medical care, will patients with disabilities face discrimination because of their disability in the “medical triage” decisions over who will be refused critical medical care that they need? Here is another important salvo in the ongoing important campaign to protect people with disabilities from such discrimination.

Today, the ARCH Disability Law Centre made public a very compelling, well-written submission to the Ford Government’s Bioethics Table. The Ford Government appointed the Bioethics Table, physicians and bioethicists, to advise it on how critical care should be rationed among patients if there is a shortage during the COVID-19 pandemic.

We set out the ARCH submission below. The AODA Alliance heartily endorses ARCH’s submission.

For our part, yesterday, the AODA Alliance made public its August 30, 2020 written submission to the Bioethics Table on the same topic. We have closely coordinated our efforts with ARCH and with a team of other disability advocates and experts who are working together on this issue.

We now wait for the Bioethics Table to write its report and submit it to the Ford Government. We strongly urge that that report be made public immediately upon its being submitted to the Ford Government.

Thankfully there is no shortage now of critical care beds for COVID-19 patients who need one. If there were a shortage, how would a decision be made over which patients get those scarce medical services and who would be denied them. At present, the direction to hospitals from Ontario Health, part of the Ford Government, is set out in the March 28, 2020 medical triage protocol    that the Bioethics Table wrote last winter and that The Government did not make public. The Ford Government claims it is only a draft, but has never rescinded it. the AODA Alliance, ARCH, the Ontario Human Rights Commission and others have told the Government to rescind it.

The Bioethics Table sought input on a revised draft to replace that protocol. Both the original March 28, 2020 triage protocol and the revised draft protocol that could replace it each direct doctors to use the “Clinical Frailty Scale” (CFS) to assess patients. The Bioethics Table prepared a simplified description of the CFS for the disability advocates and experts whom it was consulting. We set that simplified description out below.

Put simply, a patient would be assessed using the CFS if:

  1. a) they need critical care.
  1. b) They are not expected to die within six months.
  1. c) they have a progressive disease and
  1. d) they are at least 18 years old.

According to the CFS, a patient is assessed to see how many of the following activities of daily living they can do without assistance: dressing, bathing, eating, walking, getting in and out of bed, using the telephone, going shopping, preparing meals, doing housework, taking medication, or handling their own finances. This is done to rate how frail the patient is, in order to predict their likely mortality as a critical care patient.

All the disability advocates and experts whom the Bioethics Table consulted voiced the serious concern that as a medical triage assessment tool, the CFS discriminates based on a patient’s disability in access to life-saving critical medical care. The ARCH submission set out below and the earlier August 30, 2020 AODA Alliance submission each explains why this is so.

We will let you know when we get any further news on this issue. You can always send us your feedback by emailing us at aodafeedback@gmail.com

For more background on this issue, check out:

  1. The August 30, 2020 AODA Alliance final written submission to the Ford Government’s Bioethics Table.
  1. The April 8, 2020 open letter to the Ford Government on the medical triage protocol spearheaded by the ARCH Disability Law Centre, of which the AODA Alliances one of many co-signatories
  1. The April 14, 2020 AODA Alliance Discussion Paper on Ensuring that Medical Triage or Rationing of Health Care Services During the COVID-19 Crisis Does Not Discriminate Against Patients with Disabilities
  1. The May 13, 2020 ARCH Disability Law Centre’s Analysis of the March 28, 2020 Triage Protocol, which the AODA Alliance endorses.
  1. The July 16, 2020 AODA Alliance Update that lists additional concerns with the revised draft triage protocol. That Update also sets out the Ford Government Bioethics Table’s revised draft triage protocol itself.
  1. the ARCH Disability law Centre’s July 20, 2020 brief to the Bioethics Table on the revised draft triage protocol, which the AODA Alliance endorsed.
  1. The AODA Alliance website’s health care page, detailing our efforts to tear down barriers in the health care system facing patients with disabilities, and our COVID-19 page, detailing our efforts to address the needs of people with disabilities during the COVID-19 crisis.

MORE DETAILS

Simplified Decision Tree for the Clinical Frailty Scale Provided by the Ford Government’s Bioethics Table

Simplified CFS Decision Tree (DRAFT- ADAPTED):

  1. Does this person have a terminal illness with an expected mortality in <6 months?
  1. How many Basic Activities of Daily Living (BADLs) can this person perform without assistance?
  • Dress
  • Bathe
  • Eat
  • Walk
  • Get in/out of bed
  1. How many Instrumental Activities of Daily Living (IADLs) can this person perform without assistance?
  • Use telephone
  • Go shopping
  • Prepare meals
  • Do housework
  • Take medication
  • Handle own finances

September 1, 2020 ARCH Disability  Law Centre Submission on Medical Triage Protocol to the Ford Government’s Bioethics Table

Sent via email to COVIDUpdates@ontariohealth.ca

September 1, 2020

Joint Centre for Bioethics
University of Toronto
155 College Street, Suite 754
Toronto, ON M5T 1P8
Canada

Dear Members of the Bioethics Table:

Re:             ARCH Disability Law Centre’s Submissions Regarding Ontario’s Triage Protocol Draft dated July 7, 2020 Following Meetings with Bioethics Table

The within document is the written submission of ARCH Disability Law Centre (ARCH)[1]   flowing from several meetings[2] between the Bioethics Table and a select number of persons and organizations representing persons with disabilities (the Bioethics Table Meetings).[3] We provide these submissions in addition to our previous submissions dated

May 13, 2020[4] and July 20, 2020[5] and not in substitute of them.

Much of the discussion at these meetings has focused on the Clinical Frailty Scale (CFS) and other discriminatory exclusionary criteria in the first draft of the Triage Protocol[6] and the continued reliance on the CFS and other discriminatory exclusionary criteria in the second draft of the Triage Protocol, [7] in the face of opposition from disability communities and human rights experts.[8] Accordingly, these submissions will solely focus on the concerns arising from the Triage Protocol’s use of the CFS and discriminatory exclusionary criteria. To be clear, this does not imply that the outstanding concerns raised by ARCH in the May and July submissions and that remain unaddressed are no longer in issue. Rather, we trust that the Bioethics Table will consider the culmination of all of ARCH’s submissions and give each concern and corresponding recommendation due weight.

Purpose of ARCH’s Involvement

Prior to turning to our submissions, it is important to clarify ARCH’s involvement and role at the Bioethics Table Meetings: ARCH advances the interests of persons with disabilities across Ontario. Accordingly, our role in these meetings has been to defend the rights of persons with disabilities, given the resources and time permitted. Our role in these meetings was to provide the perspective of persons with disabilities for the authors of the Triage Protocol to consider. We provide the following submissions in furtherance of this role.

  1. The Clinical Frailty Scale is Prima Facie Discriminatory

Any triage protocol that the Government chooses to implement in response to the pandemic, must comply with the Charter[9] and the Ontario Human Rights Code.[10] The development of the Triage Protocol, and the tools and metrics on which it proposes to rely to determine a patient’s prioritization or access in receiving critical care, must be considered through this lens.[11]

One metric employed in this assessment is the Clinical Frailty Scale (CFS). It is our position that the CFS cannot be employed in the manner in which it is proposed, or in any manner, for the purposes of triage as it discriminates against persons with disabilities.

ARCH has previously demonstrated how the CFS will have a disproportionate adverse impact on persons with disabilities if it is applied to them during triage. For example, persons with disabilities are more likely to score higher on the CFS score, because of their general disability-related care needs and reduced activity.[12] If they score higher, then they are more likely to be deprioritized from receiving critical care.[13] The CFS also deems some persons with disabilities as “severely frail” on the basis of their use of a mobility device and having a support person assisting them with activities of daily living.[14]

Unfortunately, these concerns have not been assuaged following meetings with the Bioethics Table. Rather, they have been amplified. Case in point: the simplified CFS decision tree.[15] The stated purpose of which was to assist doctors in applying the CFS during triage. As such, it provides valuable insight into how the CFS will operate in practice.

The simplified CFS asks two especially problematic questions.[16] Namely, question 2 asks if the patient being assessed can perform Basic Activities of Daily Living (BADLs) without assistance; question 3 similarly asks whether the patient can perform Instrumental Activities of Daily Living (IADLs) without assistance.

These questions are prima facie discriminatory and exemplify the very shortcomings of the CFS from a disability rights lens. Many persons with disabilities require assistance with BADLs and IADLs. This assistance is referred to as a disability-related accommodation.

Elementarily, the purpose of accommodation is to ensure that all persons have access to equal opportunities, access and benefits.[17] As the Ontario Human Rights Commission explains:

The duty to accommodate stems, in part, from recognition that the “normal ways of doing things” in organizations and society are often not “neutral” but rather may inadvertently disadvantage, privilege or better meet the needs of some groups relative to others. Instead of giving special privileges or advantages, accommodations help to “level the playing field” by ensuring that all Ontarians are equally included and accommodated.[18]

The questions posed by the simplified CFS reflect an ableist perspective of disability, specifically that disability is an “anomaly to normalcy.”[19] This perspective has historically been used to rationalize the marginalization and exclusion of persons with disabilities from their ability to access services on an equal basis.[20] The CFS, as demonstrated by the simplified CFS, asks questions based on a normative way of doings things, neglecting the fact that some persons can complete the tasks in question with accommodations in place.

Accommodations in place for BADLs and IADLs further the right of persons with disabilities’ to live independently in the community.[21] To note, living independently is not to be interpreted solely as the ability to carry out daily activities by oneself.[22] Rather, it contemplates assistance as a tool for independent living.[23] Persons with disabilities using accommodations to complete tasks to facilitate their ability to live independently are treated as less-than by the simplified CFS. The fact that they can complete these tasks with accommodations in place is of no significance to the CFS – it will score them higher on the scale as they cannot complete these tasks unaided.[24]

The discrimination flowing from the application of the CFS is well exemplified when considering a case scenario provided by the Bioethics Table. The case scenario contemplated a 74 year old woman, who among other characteristics, received assistance with her finances. This need, however, was contextualized during the discussion as follows: she may not require assistance to do her finances because of a disability-related need, but rather because of her socio-economic status whereby she never learned how to do her finances. As such, the conversation continued, she chose to have someone assist her, rather than required for someone to assist her.

Based on this distinction, the Bioethics Table explained, the 74-year-old patient would be marked lower on the CFS in the first instance (choice) and less likely to be deprioritized for critical care, but higher on the second instance (need) and more likely to be deprioritized for critical care. This is exceptionally problematic because both patients require assistance, but only one is deprioritized for receiving critical care. This, of course, is discriminatory.

Notably, the Triage Protocol cites the Disability Rights Education & Defense Fund’s (DREDF) guiding principles for Avoiding Disability Discrimination in Treatment Rationing[25] to demonstrate that “there is published guidance on how triage systems can minimize risk of discrimination based on factors unrelated to a patient’s clinical needs and mitigate discriminatory application of such frameworks in practice.”[26] We direct the Bioethics Table’s attention to the third guiding principle which advises: “The fact that an individual with a disability requires support (minimal or extensive) to perform certain activities of daily living is not relevant to a medical analysis of whether that individual can respond to treatment.”[27]

  1. Discriminatory Exclusionary Criteria

It was suggested by some members of the Bioethics Table that perhaps the adoption of the wording employed by the National Institute for Health and Care Excellence (NICE) in its COVID-19 rapid guideline: critical care in adults[28] may address the issue of discrimination. In particular, NICE explicitly states that the CFS should not be applied to persons with stable long-term disabilities.[29]

Unfortunately, adopting NICE’s wording does not cure the Triage Protocol of all of its discriminatory effects. The assurance that the CFS will not apply to persons with long-term, stable disabilities still leaves a group of persons with disabilities vulnerable to the discriminatory impacts of the CFS – namely, persons with progressive disabilities.

Drawing a distinction between “stable” disabilities and “progressive” disabilities still constitutes discrimination.[30] It is unsatisfactory, from a legal perspective, to defend the discriminatory application of the CFS to one group of persons with disabilities by pointing to another group of persons with disabilities not being discriminated against.[31] The Triage Protocol cannot exclude a particular group of persons with disabilities from access to critical care if those disabilities may not prevent them from benefitting from treatment of the very condition (COVID-19) that the Protocol seeks to treat.[32]

The foregoing is of especial significance when the exclusion of persons with progressive disabilities is not justified and overbroad. In effect, persons with disabilities, and in this specific context persons with progressive disabilities, have a higher threshold to meet in order to be able to access critical care. They will always find themselves deprioritized to those patients who do not have disabilities – which is in direct contravention of human rights law.[33]

In effect, the Triage Protocol adopts the absence of a pre-existing disability as a qualification for prioritization in accessing critical care.[34] The way in which the Triage Protocol currently operates, a person with a disability is much less likely, if ever, to be prioritized above a person without a disability. This concern is further exacerbated by the fact that a broad categorization of disabilities – progressive disabilities – is a criteria upon which a patient will be denied access to critical care.

Accordingly, it is our position that even if NICE’s wording is adopted and the CFS is not applied to persons with long-term stable disabilities, this change does not render the Triage Protocol non-discriminatory. The CFS is a discriminatory standard when applied to persons with disabilities – progressive or otherwise.

  1. Questioning the Available Data on CFS

Some members of the Bioethics Table provided a number of studies[35] in support of the position that the CFS is an accurate predictor of mortality and, as such, is the most appropriate tool for the purposes of the Triage Protocol. We have reviewed these studies and, with respect, question the conclusions of the Bioethics Table.

What is clear, overall from the studies, is that formal assessment of frailty is a newly developing area in critical care[36] with studies as recent as 2019 questioning the reliability of frailty assessments in the ICU.[37] It is clear from the literature that the studies in this

area have neither been broad nor inclusive; with studies raising more questions than providing answers. While it is understood and appreciated that the purpose of medical studies is to raise further issues to investigate, it is our submission that the current and available data on the application and use of the CFS is too unresolved to deem it the most appropriate or reliable tool for the purposes of the Triage Protocol.

  1. The CFS has not been Tested in a Pandemic

We question the broad proposition that the CFS is an appropriate tool for triage decisions. None of the studies provided[38] contemplate the use of the CFS within a pandemic setting, for the purposes of a Triage Protocol, or as a tool by which to exclude a wide range of patients from accessing critical care.[39] Rather, a number of studies, either explicitly or implicitly, state that should the CFS be applied it would be for the purposes of providing better, more tailored care. [40]

For example, one study suggested the diagnosis of frailty could improve prognostication and identify a population that might benefit from follow-up and intervention,[41] while another study advised of the importance of clinicians’ awareness of frailty in order to inform prognosis, aid with counselling, attend to special needs, and plan for appropriate discharge planning.[42] One of the larger studies speculated that by using the CFS, doctors can improve upon their dialogue with the patient on the expected course of recovery and/or survivorship expectations that would lead to a clear person-centered high-value treatment plan.[43]

Of note, there is currently very little data focused on how clinicians should use information gathered from applying the CFS to guide their decision-making prior to getting critical care.[44] This absence of evidence is  concerning as the very purpose of including the CFS in the Triage Protocol is as a determining factor in whether a patient is provided or denied critical care.[45]

  1. The Application of the CFS in Patient Groups Under 65

The proposition that the CFS should or could accurately apply to all patients over the age of 18 is also not supported by the data. Notably, guidance by the Dalhousie Geriatric Medicine Research department on the CFS explicitly states that “The CFS is not validated in people under 65 years of age.”[46] The cohorts comprising the studies provided support this position, with at least 12 of the studies having a mean or median age of 65 or over.[47] Further, one of the larger studies advised that while the CFS may be appropriate for the use of persons aged 80 and above, different tools should be used in the triaging of younger patients.[48]

In light of the evidence, it is clear that the CFS has only been tested on a very small subset of the population – namely, the very demographic for which it was designed. While some studies have explored the potential for applying the CFS for populations younger than 65, this exploration hardly justifies generalizing its application to all adults. One of the studies with a younger population of a mean age of 58.5 called for “further rigorous research in larger cohorts” to confirm its findings.[49]  It is clear studies on the CFS are limited in scope; to use these studies as a basis for widespread application across all ages is a far leap and completely inappropriate. Indeed, members of the Bioethics Table shared that the CFS would not apply to pediatric patients. They later conceded that it was open to narrowing the CFS’ application to an older cohort.[50]

Lastly, in a document that holds as much weight as the Triage Protocol and from which will flow serious, dire and devastating consequences, arbitrariness should be avoided at all costs. The suggestion that the CFS should apply to all patients over 18 is arbitrary. The suggestion that the CFS should apply to all patients over 50 is also arbitrary. Excluding persons over 65 from being able to access critical care during a pandemic is equally arbitrary.[51] However, the metric chosen by the authors of the Triage Protocol stipulates an age cut-off of 65 and over. The authors cannot choose a metric that has been designed for a specific (age) demographic and transpose it into a Triage Protocol to be applied to a completely arbitrary, different and varied demographic.

To be clear, we are not suggesting that triage decisions should be based on age. However, the metric chosen by the authors of the Triage Protocol stipulates an age cut-off of 65 and over. The emphasis on age in discussions surrounding the Triage Protocol arises from the fact that the very metric embedded in the Protocol is only validated for a specific age group. ARCH is allied with advocates for the elderly and believes in the equal protection of elderly patients and patients with disabilities. Anything less amounts to discrimination.

  • The Inherent Subjectivity and the Reliability of the CFS

Several of the studies available acknowledge the subjective nature of the CFS,[52] with one study noting that the CFS may have a higher inter-rater variability than more objective measures of frailty,[53] while another study explicitly describes it as a “nine-point scale based on subjective assessment of functional status”[54] and yet another describes it as a “subjective judgment-based screening tool for frailty.”[55]

In their search for an objective clinical tool, the authors of the Triage Protocol have instead chosen one that is inherently subjective. From a human rights perspective this is extremely problematic.

Bias against persons with disabilities exists within the medical profession.[56] Implementing a metric that is inherently subjective invites these biases to inform the decisions of medical professionals when assessing patients with disabilities. The devaluing of the lives of persons with disabilities directly contributes to health care inequities experienced by the disability communities.[57] The medical community cannot seek to rely upon a subjective tool, especially when stigma and inaccurate assumptions about the quality of life of persons with disabilities[58] continue unaddressed within the profession.

Even arguably objective criteria are prone to an assessors’ subjective notions of the quality of life of persons with disabilities.[59] Scoring systems that aim to be objective have been described as not necessarily ethically-neutral nor free of bias.[60] If objective clinical criteria are susceptible to subjective judgments concerning the quality of life of persons with disabilities, then the risk of persons with disabilities being inappropriately and incorrectly excluded from care on the basis of a subjective tool is increased markedly.

Notably, and with regards to the reliability of the CFS, up until 2017 research pertaining to the reliability of the CFS was virtually absent from critical care literature.[61] Another study in 2018 acknowledged that there had never been a formal evaluation of the reliability of the CFS in an ICU setting for clinical or research purposes.[62] The CFS’ reliability remains unproven,[63] with a review in 2018 finding little evidence of reliability of frailty assessments of critically ill patients.[64] It is evident that more research is needed regarding the reliability of frailty assessment tools – including the CFS – before frailty assessments are used to inform clinical decision-making,[65] and before any recommendations are made concerning its widespread application.[66]

Of interest are the studies focused on inter-rater reliability between health care workers and a family (or surrogates) of a patient.[67] In Hope et al, surrogates tended to rate their family member (the patient) significantly lower on the CFS scale than the researchers. One inference drawn by the Bioethics table from this finding is that the family’s rating is less accurate in predicting mortality which, it is posited, is the more concern pressing concern for the purposes of the Triage Protocol.[68] With respect, this inference is an oversimplification of a much larger problem with the medical community and how it may assess patients with disabilities.

A person with a disability or their close family member may deem themselves less frail than a subjective tool applied to them in a hospital setting by a healthcare worker. The issue then is not whether or not a medical professional is accurate in their assessment of frailty – especially if that assessment is coloured by ableism. Rather, the issue is whether the medical professional is undermining a person with a disability’s own self-assessment that is directly based on their lived experience.

It is well-documented that healthcare workers consistently underestimate the self-reported quality of life of persons with disabilities.[69] This misperception, it has been found, “has negatively influenced physicians’ medical futility decisions and resulted in the withdrawal of necessary medical care from people with disabilities.”[70] This may also be in part to the paternalism present within the medical community; where there is an absence of understanding and respect for the fact that persons with disabilities are better judges of the quality of their own life than those (including doctors) without disabilities.[71]

If, as the Triage Protocol suggests, the CFS is to be applied to a much broader demographic than for whom it was designed, then these issues must be, at the very least, explored further. This is especially considering the fact that none of the studies provided contemplate how, and if, persons with disabilities are assessed differently than patients without disabilities to ensure that they are assessed with their accommodations.

  1. Learning from Past Mistakes

The questionable reliability of the CFS echoes Ontario’s past pandemic errors. In 2006, Ontario released a Triage Protocol in anticipation of the Influenza Pandemic.[72] The Sequential Organ Failure Assessment (SOFA) was the metric identified by the working group as the most appropriate for the purposes of triage in OHPIP at that time.[73] Since then, however, the accuracy of SOFA, especially for the purposes of triage, has been questioned.[74] And yet, at the time, the scientific data available to deem SOFA valid for the purposes of triage in 2006 was arguably more comprehensive and tested than what is currently available for the CFS.

For example, the SOFA was widely tested on a range of patients.[75] The same cannot be said about the CFS. The SOFA was also lauded as an accurate predictor of mortality and, as such, appropriate for the purposes of pandemic triage.[76] Further, even though SOFA had not been previously employed for the purposes of allocating scarce resources, it was designed for that very purpose.[77] The CFS, of course, was not designed for this purpose.

And yet, subsequent studies demonstrate that the predictive value ascribed to the SOFA outside of a pandemic, may not be directly transferrable to a pandemic/triage context.[78] For example, a study out of the UK implemented the triage criteria set out in the OHPIP and found that it failed to adequately prioritize patients who would have benefitted from intensive care.[79] In fact, alarmingly, the study found that of the 46% of patients who would have been withdrawn from critical care, or denied critical care at all based on SOFA scores, 61% actually survived hospital discharge.[80] It was further found that despite some studies claiming an association between a SOFA score of greater than 11 with a mortality predictability at 90%, Guest’s study only reported a mortality predictability of 29%.[81] Another study focused on the admission of H1N1 patients to the ICU.[82] That study concluded that the inclusion of the SOFA score in triage could lead to withdrawal from life support in critically ill patients who could have otherwise survived.[83]

Reflecting on the questionable applicability of SOFA begs the question whether future studies will draw similar conclusions on the application of the CFS. In light of the limited data on the CFS, the Bioethics Table should proceed more cautiously by keeping in mind that whatever harm flows from the application of the CFS will disproportionately impact persons with disabilities. The issues Guest’s study identified in the Ontario’s 2006 protocol as problematic equally apply to the current Triage Protocol. This includes Guest’s finding that using SOFA as a tool creates a method by which “patients are assessed not by individual clinical examination and judgment, but according to a rigid binary method (i.e. certain signs or criteria are present or absent.).”[84]

It is important to note that some have argued against the use of SOFA in COVID-19 protocols because it has not been validated within that context.[85] With respect, the same rationale must apply to the CFS which has also not been validated for the purposes of triaging during COVID-19. Another criticism equally applicable to the CFS is that while such scoring systems can be alluring, their seemingly objective criteria creates the risk of “false precision,” meaning that doctors will look to this criteria to claim that two patients have a different risk of mortality where the reality is that they are clinically indistinguishable.[86]

As at least one critic has warned, it may be time to consider “profound conceptual changes to the triage guidelines.”[87] This is especially pertinent considering the current protocol commits serious human rights violations, to which we have explored in sections # above and to which we now return.

  1. The Standard Is Not Justified

In effect, and in its application, the CFS creates a barrier for persons with disabilities from accessing healthcare services, and specifically accessing critical care, largely based on the fact that they have a disability.[88] This barrier is not justified.[89]

We have raised questions about the strength of the data supporting the use of the CFS in the preceding section. To be clear, our position is that the evidence on which the authors of the Triage Protocol rely fails to demonstrate how the inclusion of the CFS is an appropriate tool for triage decisions.

However, and in the alternative, it is well-established in law that even if a standard, scientific or otherwise, is deemed valid it does not automatically render the discriminatory impact as justifiable.[90] Rather, once prima facie discrimination is established, which has been done with regards to the CFS, then the party proposing the use of the discriminatory standard must demonstrate a bona fide reasonable justification for its use – namely that it is minimally impairing and proportional.[91]  One need only look to the multitude of studies recommending further study on the CFS coupled with the disparate impact on persons with disabilities to find that no justification exists for the inclusion of the CFS as an triage tool.

  1. A Brief Note on Utilitarianism

ARCH has made extensive submissions on the issues arising from the utilitarian framework within which Triage Protocol is developed and applied.[92] We do not aim to repeat these submissions here, but rather provide a brief note specifically regarding the operation of exclusion criteria and the Clinical Frailty Scale within this very framework.

Protocols that emphasize the derivation of maximum benefit from scarce critical care resources have attracted criticism for their employment of simple categorical exclusions to promote the maximization[93] of the “good.”[94] This is because the implementation of categorical exclusions can often disadvantage persons from specific communities, including persons with disabilities,[95] and can lead to the definitive exclusion of persons with specific disabilities despite the absence of evidence going to same.[96]

A utilitarian framework also neglects to consider socio-economic and other inequities that may make some groups more susceptible to contracting the virus, and therefore more likely to require medical attention, than others. The Triage Protocol expressly recognizes that “critical care triage may have a differential impact on some patient populations who may be disadvantaged due to pre-existing health and social inequities or conscious or unconscious bias in clinical settings.”[97] While this acknowledgment is important, it is not appropriately addressed by the inclusion of exclusion criteria and a metric that will have an adverse discriminatory impact on marginalized communities. In short, the Triage Protocol embeds[98] and perpetuates the discrimination, rather than addresses it.

Accordingly, and as others have similarly suggested,[99] we urge the Bioethics Table to turn its mind to conceptualizing a new framework for triage protocols that rejects tools that disproportionately impact persons with disabilities – as well as persons from other marginalized communities.

 

Conclusion

We acknowledge and appreciate that there is a pressing objective central to the Triage Protocol. However, the authors of the protocol are urged to rethink the inclusion of the proposed metric of the CFS for a multitude of reasons, not least that it prima facie discriminates against persons with disabilities by drawing distinctions based on disability. The CFS invites ableist and normative assessments of a person’s abilities, a concern that is exacerbated by the fact that the CFS is inherently subjective. The questions raised about the CFS data coupled with the clear and inevitable disproportionate impact on persons with disabilities that will flow from its application support the position that this is not an appropriate or reasonable tool whose inclusion or application can be justified within a human rights framework.

Sincerely,

 

ARCH DISABILITY LAW CENTRE

_____________________                                                                                                               ______________________

Mariam Shanouda                                                                                                                             Jessica De Marinis

Staff Lawyer                                                                                                                                        Staff Lawyer

Tel: 416 482 8255 ext. 2224                                                                                                             Tel: 416 482 8255 ext. 2232

Email: shanoum@lao.on.ca                                                                                            Email: demarij@lao.on.ca

[1] ARCH would like to especially and sincerely thank members of its Advisory Committee for engaging in extensive discussion and providing thoughtful guidance and expertise on the important issues raised by the Triage Protocol. ARCH’s Advisory Committee, in alphabetical order, includes:  Chris Beesley, Executive Director at Community Living Ontario, Laura LaChance, Interim Executive Director at Canadian Down Syndrome Society, Trudo Lemmens Professor, Scholl Chair in Health Law and Policy at University of Toronto Law School, David Lepofsky, Chair of the AODA Alliance, Leanne Mielczarek, Executive Director of Lupus Canada, Elizabeth Mohler, Board Member at Citizens With Disabilities – Ontario, Roxanne Mykitiuk, Disability Law, Health Law, Bioethics and Family Law Professor at Osgoode Hall Law School, Tracy Odell, Executive Director of Citizens with Disabilities – Ontario, Dr. Homira Osman, Director of Knowledge Translation & External Engagement at Muscular Dystrophy Canada, and Wendy Porch, Executive Director at the Centre for Independent Living Toronto.

[2] Specifically, these meetings have taken place on the four following occasions: July 27, 2020, July 29, 2020, August 17, 2020 and August 24, 2020.

[3] As ARCH has made it clear in its submissions dated April 2020, May 2020 and July 2020, these meetings have been narrow and under-inclusive. We continue to call upon the Bioethics Table to meet and consult with a broad base of communities that are being disproportionately impacted by COVID-19 and will be disproportionately impacted by the Triage Protocol. This includes holding broader consultations with members from the disability community, the Black community, Indigenous community, and persons from other racialized communities.

[4] ARCH submissions, dated May 13, 2020 [ARCH May Submissions].

[5] ARCH Submissions, dated July 20, 2020 [“ARCH July Submissions”]

[6] Critical Care Triage for Major Surge in the COVID-19 Pandemic, dated March 28, 2020 [“Triage Protocol 1”].

[7] Critical Care Triage for Major Surge in the COVID-19 Pandemic: Updated Recommendations, delivered and dated July 7, 2020 [“Triage Protocol 2”].

[8] See ARCH May Submissions, supra note 4 and ARCH July Submissions, supra note 5 addressing other problematic aspects of the Triage Protocol.

[9] Canadian Charter of Rights and Freedoms, Part 1 of the Constitution Act, 1982, being Schedule B to the Canada Act 1982 (UK), 1982, c 11 [Charter]; Canadian Doctors for Refugee Care v Canada (Attorney General), 2014 FC 651 para 506; see also generally, Eldridge v British Columbia (Attorney General), 1997 CanLII 327 (SCC) [Eldridge].

[10] RSO 1990, c H19.

[11] ARCH May Submission, supra note 4.

[12] ARCH May submissions, supra note 4.

[13] Ibid.

[14] Ibid.

[15] Simplified CFS Decisions Tree provided by the Bioethics Table on July 29, 2020. [“Simplified CFS”].

[16] It was made clear at a Bioethics Table meeting that the assessor would ask both questions of the patient regardless of whether the first question – does this person have a terminal illness with an expected mortality in <6 months – was answered in the negative or in the affirmative.

[17] This comment is in relation to preventing discrimination based on creed, but applies equally to discrimination based on disability. Ontario Human Rights Commission, Policy on preventing discrimination based on creed, (2015) at 54, online: http://www3.ohrc.on.ca/sites/default/files/Policy%20on%20preventing%20discrimination%20based%20on%20creed_accessible_0.pdf

[18] Ibid.

[19] Ontario Human Rights Commission, Policy on ableism and discrimination based on disability (2016) at 10, citing Marcia H Rioux & Fraser Valentine, “Does Theory Matter? Exploring the Nexus Between Disability, Human Rights, and Public Policy,” in Critical Disability Theory: Essays in Philosophy, Politics, Policy, and Law, (Vancouver: UBC Press), 2006, 47 at 51-52. The authors write that the “human rights approach to disability…identifies wide variations in cognitive, sensory, and motor ability as inherent to the human condition and, consequently, recognizes the variations as expected events and not as rationales for limiting the potential of persons with disabilities to contribute to society.” This approach recognizes “the condition of disability as inherent to society, not some kind of anomaly to normalcy.”

[20] Eldridge, supra note 9 at para 56.

[21] Convention on the Rights of Persons with Disabilities, art 19, GA Res 51/106, 76th plen Mtg, UN Doc A/Res/61/106 [adopted by consensus at the UN on Dec 13 2006] [Convention].

[22] Committee on the Rights of Persons with Disabilities, General comment No. 5 (2017) on living independently and being included in the community, 27 October 2017, online: http://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=6QkG1d%2fPPRiCAqhKb7yhsnbHatvuFkZ%2bt93Y3D%2baa2q6qfzOy0vc9Qie3KjjeH3GA0srJgyP8IRbCjW%2fiSqmYQHwGkfikC7stLHM9Yx54L8veT5tSkEU6ZD3ZYxFwEgh.

[23] Ibid, at para 16(d).

[24] The application of the CFS further violates the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability, Convention, supra note 21, art 25, and the right to life, Convention, supra note 21, art 10.

[25] Disability Rights Education & Defense Fund, Applying HHS’s Guidance for States and Health Care Providers on Avoiding Disability-Based Discrimination in Treatment Rationing, April 3, 2020, online: https://dredf.org/avoiding-disability-based-discrimination-in-treatment-rationing/ [DREDF]; See also: Evaluation Framework for Crisis Standard of Care Plans, April 8, 2020, online:  http://www.bazelon.org/wp-content/uploads/2020/04/4-9-20-Evaluation-framework-for-crisis-standards-of-care-plans_final.pdf.

[26] Triage Protocol 2, supra note 7 at 2.

[27] DREDF, supra note 25.

[28] NICE, Covid-19 rapid guideline: critical care in adults, 20 March 2020, online: https://www.nice.org.uk/guidance/ng159/resources/covid19-rapid-guideline-critical-care-in-adults-pdf-66141848681413 [NICE Guidelines].

[29] NICE Guidelines, ibid.

[30] Charter, supra note 9, s 15.

[31] Samuel R Bagenstos, “May Hospitals Withhold Ventilators from COVID-19 Patients with Pre-Existing Disabilities? Notes on the Law and Ethics of Disability-Based Medical Rationing” (2020) 130 Yale Law Journal Forum forthcoming, online: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3559926#.

[32] Ibid.

[33] Ibid.

[34] Ibid.

[35] Eighteen studies were provided to ARCH including, Abraham et al, “Validation of the clinical frailty score (CFS) in French language,” (2019) 19 BMC Geriatrics 322; Sean M Bagshaw et al, “Association between frailty and short- and long-term outcomes among critically ill patients: a multicenter prospective, cohort study.” (2014) 186:2 CMAJ E95 [Bagshaw et al, “Association”]; Nathan E Brummel et al, “Frailty and Subsequent Disability and Mortality among Patients with Critical Illness” (2017) 196 American Journal of Respiratory and Critical Care Medicine 64; Shannon M Fernando et al, “Frailty and associated outcomes and resource utilization following in-hospital cardiac arrest” (2019) 146 Resuscitation 138 [Fernando, “Frailty and Cardiac Arrest”]); Shannon M Fernando et al, “Frailty and Associated Outcomes and Resource Utilization Among Older ICU Patients with Suspected Infection” (2019) 47 Critical Care Medicine E669 [Fernando, “Frailty and ICU Patients”]; Hans Flaatten et al, “The impact of frailty on ICU and 30-day mortality level of care in very elderly patients (> 80 years)” (2017) 43 Intensive Care Med 1820; Bertrand Guidet et al, “The contribution of frailty, cognition, activity of daily life and comorbidities on outcome in acutely admitted patients over 80 years in European ICUs: the VIP2 study” (2020) 46 Intensive Care Med 57; David Hewitt & Malcom G Booth, “The FRAIL-FIT study: Frailty’s relationship with adverse-event incidence in the longer-term, at one year following intensive care unit treatment – A retrospective observational cohort study” (2020) 21 Journal of Intensive Care Society 124; Aluko A Hope et al, “Surrogates’ and Researchers’ Assessments of Prehospital Frailty in Critically Ill Older Adults” (2019) 28:2 American Journal of Critical Care 117; Carmel L Montgomery et al, “Implementation of population-level screening for frailty among patients admitted to adult intensive care in Alberta, Canada” (2019) 66 Canadian Journal of Anesthisia; John Muscedere et al, “The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis” (2017) 43 Intensive Care Med 1105; Richard J Pugh, Chris M Thorpe & Christian P Subbe, “A critical age: can we reliably measure frailty in critical care?” (2017) 21 Critical Care 121; Richard J Pugh et al, “Reliability of frailty assessment in the critically ill: a multicenter prospective observational study” (2019) 74:6 Anesthsia 758 [Pugh et al, “Frailty observational study”]; Melissa Shears et al, “Assessing frailty in the intensive care unit: a reliability and validity study” (2018) 45 Journal of Critical Care 197; Ralph KL So et al, “The association of clinical frailty with outcomes of patients reviewed by rapid response teams: an international prospective observational cohort study” (2018) 22 Critical Care 227; Gary Tse et al, “Frailty and mortality outcomes after percutaneous coronary intervention: a systematic review and meta-analysis” (2017) 18:12 The Journal of Post-Acute and Long-Term Care Medicine 1097; and, Chris Wharton, Elizabeth King & Andrew MacDuff, “Frailty is associated with adverse outcome from in-hospital cardiopulmonary resuscitation” (2019) 143 Resuscitation 208.

[36] Pugh et al, “Frailty observational study”, supra note 35 at 759.

[37] Ibid.

[38] We note that Dr. James Downar, who kindly provided the set of 18 studies, indicated that there are currently more than 1000 published studies involving CFS. However, for the purposes and scope of this document, we focus on these 18 studies (with a few more that we introduce into these submissions ourselves) as Dr. Downar has indicated their findings are likely to reflect current standards of care.

[39] One study does contemplate how frailty should factor into deciding whether “very old intensive care patients” (VIPs) should be admitted into the ICU based on their chances of survival. This study, however, was limited to 5021 patients with a median age of 84. See: Flaatten et al, supra note 35 at 1821. Another study found that the CFS was “feasible” in circumstances of rapid processing of the decision making to admit or refuse a patient in ICU. However, again, this study was limited to patients with a median age of 84 years old with a cohort of 3920 patients. See: Guidet et al, supra note 35 at 67.

[40] Sean M Bagshaw et al, “A prospective multicenter cohort study of frailty in younger critically ill patients” (2016) 20:175 Critical Care at 8 [Bagshaw et al, “Prospective multicenter”]; Shears et al, supra note 35; So et al, supra note 35.

[41] Bagshaw et al, ibid.

[42] Shears et al, supra note 35 at 198.

[43] So et al, supra note 35 at 8.

[44] Montgomery et al, supra note 35 at 1318.

[45] Triage Protocol 1 supra note 6 and Triage Protocol 2 supra note 7.

[46] Geriatric Medicine Research, Dalhousie University, CFS Guidance & Training, online: University of Dalhousie <https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale/cfs-guidance.html>. See also, the NICE Guidelines, supra note 28 at 6 which, after revisions, explicitly states that the CFS should not be used in younger people, people with stable long-term disabilities, learning disabilities or autism.

[47] See Bagshaw et al, “Association”, supra note 35 (mean age of 67); Fernando, “Frailty and Cardiac Arrest”, supra note 35 (median age of 65.7); Fernando, “Frailty and ICU Patients”, supra note 35 (1, 510 cohorts aged 65 and over);  Flaatten et al, supra note 35 (median age of 84); Guidet et al, supra note 35 (median age of 84); Hope et al, supra note 35 (median age of 67.2); Pugh, Thorpe & Subbe, supra note 35 (median age of 70.5); Pugh et al, “Frailty observational study”, supra note 35 (median age of 69); Smith study (median age of 72); So et al, supra note 35 (age of 67); Tse et al, supra note 35 (mean age of 69); and Wharton, King & MacDuff, supra note 35 (median age of 74). We understand and appreciate that median/mean age represented in these studies indicates that persons younger than 65 were a part of these studies. However, none of these studies were solely focused on the validation of the CFS in persons younger than 65. And most, if not all, of the studies call for further studies. Moreover, at least 5 of the studies had cohorts with a mean or median age ranging between 58.5 to 63.8. See Bagshaw et al, “Prospective multicenter”, supra note 40 (mean age of 58.5); Brummel, supra note 35 (mean age of 62); Hewitt & Booth, supra note 35 (median age of patients diagnosed as frail was 62); Montgomery et al, supra note 35 (mean age of 63); and, Shears et al, supra note 35 (mean age of 63.8).

[48] Flaatten et al, supra note 35 at 1826.

[49] Bagshaw et al, “Prospective multicenter”, supra note 40.

[50] See discussion above at page 6.

[51] It should be noted here that the Supreme Court of Canada has confirmed that arbitrariness is not a stand-alone test that must be demonstrated by the applicant to established prima facie discrimination (See Stewart v Elk Valley Coal Corp, 2017 SCC 30 at para 45). However, the existence of arbitrariness is an indicia supporting a finding that a policy violates substantive equality. See: Al-Turki v Ontario (Transportation), 2020 HRTO 392 at para 85 citing Hay v Ontario (Human Rights Tribunal)2014 ONSC 2858 at paras 88 – 90.

[52] Flaatten et al, supra note 35 at 1826.

[53] Ibid. Muscedere et al, supra note 35 at 1112.

[54] Muscedere et al, ibid.

[55] Bagshaw et al, “Prospective multicenter”, supra note 40 at 2.

[56] Ryan H Nelson, Bharath Ram & Mary Anderlik Majumder, “Disability and Contingency Care” (2020) 20:7 The American Journal of Bioethics 190.

[57] Catherine L Auriemma et al, “Eliminating Categorical Exclusion Criteria in Crisis Standards of Care Frameworks” (2020) 20:7 The American Journal of Bioethics 28, online: https://www.tandfonline.com/doi/pdf/10.1080/15265161.2020.1764141?needAccess=true.

[58] National Council on Disability, Medical Futility and Disability Bias: Part of the Bioethics and Disability Series, November 20, 2019, online: https://ncd.gov/sites/default/files/NCD_Medical_Futility_Report_508.pdf

[59] Bagenstos, supra note 31.

[60] Amy L McGuire et al, “Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force” (2020) 20:7 The American Journal of Bioethics 15.

[61] Pugh, Thorpe & Subbe, supra note 35.

[62] Shears et al, supra note 35 at 198.

[63] Richard J Pugh et al, “Feasibility and reliability of frailty assessment in the critically ill: a systematic review” (2018) 22 Critical Care 49 [“Pugh et al, “Frailty systematic review”].

[64] Ibid.

[65] Ibid.

[66] With regards to recommendations concerning widespread application in routine critical care practice. We would submit, however, that this cautious approach applies equally, if not more, to the widespread use of the CFS in a pandemic setting. See ibid.

[67] Hope et al, supra note 35.

[68] Email from Dr. James Downar, Member of the Bioethics Committee, to the ARCH among others, dated July 31, 2020.

[69] Nelson, Ram & Anderlik Majumder, supra note 56.

[70] Ibid.

[71] Bagenstos, supra note 31.

[72] Critical Care During a Pandemic: Final Report of the Ontario Health Plan for an Influenza Pandemic (OHPIP) Working Group on Adult Critical Care Admission, Discharge and Triage Criteria. April 2006. [OHPIP] online: https://www.researchgate.net/publication/273203603_Critical_Care_During_a_Pandemic_Final_report_of_the_Ontario_Health_Plan_for_an_Influenza_Pandemic_OHPIP_Working_Group_on_Adult_Critical_Care_Admission_Discharge_and_Triage_Criteria. To note, OHPIP was never triggered by a surge in Ontario and, as such, was not implemented during the Influenza Pandemic.

[73] Ibid at 8.

[74] Sheri Fink, “Ethical Dilemmas in COVID-19 Medical Care: Is a Problematic Triage Protocol Better or Worse than No Protocol at All? (2020) 20:7 The American Journal of Bioethics 1 [Fink, “Ethical Dilemmas”]; T Guest et al, “An observational cohort study of triage for critical care provision during pandemic influenza: ‘clipboard physicians’ or ‘evidenced based medicine’?” (2009) 64 Anaesthesia 1199; Khan Z, J Hulme & N Sherwood, “An assessment of the validity of SOFA score based triage in H1N1 critically ill patients during an influenza pandemic” (2009) 64:12 Anaesthesia 1283; McGuire et al, supra note 60.

[75] OHPIP, supra note 72 at 8.

[76] Ibid at 9; the Triage Protocol reported that patients with a SOFA score of greater than 11 had a mortality rate of 90% even with full critical care during a normal period.

[77] Ibid at 8, citing FL Ferreira et al, “Serial evaluation of the SOFA score to predict outcome in critically ill patients.” (2001) 286:14 JAMA 1754. Despite the assertion by the authors of OHPIP and Ferreira et al. that SOFA was designed for this purpose, others have argued the opposite, i.e. that it was designed for purposes unrelated to triage, see: Matthew K Wynia & Peter D Sottile, “Ethical Triage Demands a Better Triage Survivability Score” (2020) 20:7 The American Journal of Bioethics 75.

[78] Fink, “Ethical Dilemmas”, supra note 74 at 5. See also: Sheri L Fink, Worst case: rethinking tertiary triage protocols in pandemics and other health emergencies” (2010) 14:1 Critical Care 103.

[79] Guest et al, supra note 74.

[80] Ibid at 1204.

[81] Ibid at 1205.

[82] Khan, Hulme & Sherwood, supra note 74.

[83] Fink, “Ethical Dilemmas”, supra note 74 citing Khan, Hulme & Sherwood, ibid.

[84] Guest et al, supra note 74 at 1205.

[85] McGuire et al, supra note 60.

[86] Ibid.

[87] Fink, “Ethical Dilemmas”, supra note 74 at 5.

[88] This is in violation of section 15 of the Charter of Rights and Freedoms which prohibits discrimination based on protected grounds, including disability, Charter, supra note 9, s 15.

[89] British Columbia (Public Service Employee Relations Commission) v. BCGSEU, [1999] 3 SCR 3 (“Meiorin”).

[90] British Columbia (Superintendent of Motor Vehicles) v British Columbia (Council of Human Rights), [1999] 3 SCR 868.

[91] Meiorin, supra note 89.

[92] See ARCH May Submissions, supra note 4 and ARCH July Submissions, supra note 5.

[93] See, for example Auriemma et al, supra note 57.

[94] Medical Utility in the second draft of the Triage Protocol is defined as creating the maximum good for the maximum number of people.

[95] Auriemma et al, supra note 5793.

[96] Ibid.

[97] Triage Protocol 1, supra note 6 at 2.

[98] Teneille R Brown, Leslie P Francis & James Tabery, “Embedding the Problems Doesn’t Make Them Go Away” (2020) 20:7 The American Journal of Bioethics 109, online: https://www.tandfonline.com/doi/pdf/10.1080/15265161.2020.1779864?needAccess=true.

[99] See for example, Fink, “Ethical Dilemmas”, supra note 7478.

Ensuring that Patients with Disabilities Don’t Face Discrimination in Access to Critical Medical Care If There is a Second Wave of COVID-19 that Overwhelms Ontario Hospitals – A new Brief by the AODA Alliance Is Made Public Today

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

Ensuring that Patients with Disabilities Don’t Face Discrimination in Access to Critical Medical Care If There is a Second Wave of COVID-19 that Overwhelms Ontario Hospitals – A new Brief by the AODA Alliance Is Made Public Today

August 31, 2020

        SUMMARY

If there is a second wave of COVID-19 that is so severe that hospitals don’t have enough critical care beds and services for all patients who need that medical care, who will decide which patients get critical care and which ones will get refused? How will they decide? What fair process will be in place for patients who are told that they won’t get the life-saving critical care they need? It is no exaggeration to call this a life and death issue.

The AODA Alliance today makes public a detailed written submission, set out below, on this important issue that we presented earlier today. We hope that there will never be a new surge of COVID-19 that overloads the capacities of our hospitals. However, from experience with COVID-19 elsewhere in the world, we know Ontario must be ready. The AODA Alliance is doing our part, in close collaboration with other disability advocates, in an effort to try to ensure that people with disabilities do not face discrimination in any critical care triage.

This issue is especially vital for Ontarians with disabilities. Earlier this year, with the COVID-19 pandemic raging, it was revealed that the Ford Government had in place a deeply troubling protocol for making these critical care triage decisions, a protocol that was dated March 28, 2020. That protocol would discriminate against some patients with disabilities.

That protocol had been written by or under a “Bioethics Table”, a Government-appointed group of physicians and bioethicists. To our knowledge, the disability community was never consulted in the development of that deeply flawed triage protocol. The Ford Government later called that March 28, 2020 triage protocol a “draft”, even if it was never marked as a draft before it was publicly exposed.

Many within the disability community vehemently and publicly objected to that critical care triage protocol. This past spring, in response to public criticism of its critical care triage protocol, the Ford Government committed to consult with human rights and community experts on its reform.

Early this summer, the Government’s Bioethics Table, together with the Ontario Human Rights Commission, commendably reached out to a group of disability organizations and experts to get input into the critical care triage protocol from the disability perspective. The AODA Alliance and the ARCH Disability Law Centre are among the group that was invited to take part.

The Bioethics Table gave the disability advocates and experts a revised draft critical care triage protocol that the Bioethics Table had written, and on which it sought input. The AODA Alliance made this revised draft critical triage protocol public in the July 16, 2020 AODA Alliance Update. It was helpful for this to be available for the public. In contrast, the earlier March 28, 2020 critical triage protocol had not been made public.

The disability advocates and experts to whom the Bioethics Table reached out spent many hours this summer very constructively working together. Over the past weeks, this group held several extensive virtual meetings with a delegation from the Bioethics Table. This culminated in a one hour virtual meeting on Monday, August 31, 2020. At that meeting, key concerns from the disability sector were summed up. These had been explored in earlier meetings with the Bioethics Table. Below we set out the AODA Alliance‘s written submission. A written submission from the ARCH Disability Law Centre is expected to be forthcoming shortly.

Our written submission summarizes our position as follows:

“The revised draft critical care triage protocol which was shared by The Ontario Government’s “Bioethics Table” for input is substantially deficient. It is substantially lacking in essential due process protections for patients with disabilities and their families/support people. As well, the standard or assessment tool that it proposes to guide or govern such medical triage decisions is seriously flawed and should not be used for triage purposes. In the case of a critical care patient with a progressive disease but who has more than six months to live, their likely mortality should not be assessed by the number of activities of daily living that they can perform without assistance, having regard to each of these specific activities: dressing, bathing, eating, walking, getting in and out of bed, using the telephone, going shopping, preparing meals, doing housework, taking medication, or handling their own finances. We share the concerns with the triage protocol that we anticipate to be set out in a forthcoming written submission by the ARCH Disability Law Centre.”

We appreciate the time that the Bioethics Table took to meet with the disability advocates and experts that were invited to be part of this process. We now await the Bioethics Table’s final report and recommendations to the Ford Government. We hope it will be immediately made public. We also urge the Ford Government to be very open and consultative in responding to the Bioethics Table’s final report and recommendations.

The AODA Alliance thanks all the disability advocates and experts that worked together on this issue. A special thank-you is extended to the ARCH Disability Law Centre for its excellent work in this area. We also thank the excellent team of Osgoode Hall Law School and University of Ottawa law students who volunteered to help the AODA Alliance in the preparation of our submissions to the Bioethics Table.

Because of the rushed time lines for preparing the AODA Alliance’s written submissions set out below, we were not able to post a draft of this document for your input, before we finalized this submission. Nevertheless, we always welcome your feedback. It can help with our future efforts on this important issue. You can always write us at aodafeedback@gmail.com

For more background on this issue, check out:s

  1. The April 8, 2020 open letter to the Ford Government on the medical triage protocol spearheaded by the ARCH Disability Law Centre, of which the AODA Alliances one of many co-signatories
  1. The April 14, 2020 AODA Alliance Discussion Paper on Ensuring that Medical Triage or Rationing of Health Care Services During the COVID-19 Crisis Does Not Discriminate Against Patients with Disabilities
  1. The May 13, 2020 ARCH Disability Law Centre’s Analysis of the March 28, 2020 Triage Protocol
  1. The July 16, 2020 AODA Alliance Update that lists additional concerns with the revised draft triage protocol. That Update also sets out the Ford Government Bioethics Table’s revised draft triage protocol itself.
  1. the ARCH Disability law Centre’s July 20, 2020 brief to the Bioethics Table on the revised draft triage protocol, which the AODA Alliance endorsed.
  1. The AODA Alliance website’s health care page, detailing our efforts to tear down barriers in the health care system facing patients with disabilities, and our COVID-19 page, detailing our efforts to address the needs of people with disabilities during the COVID-19 crisis.

        MORE DETAILS

Accessibility for Ontarians with Disabilities Act Alliance

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

The Ford Government’s Bioethics Table Must Fix the Serious Problems with Its Revised Draft Critical Care Medical Triage Protocol

 

A Submission by the AODA Alliance to the Ford Government’s Bioethics Table

August 30, 2020

 A. Introduction

1. What Is the Critical Care Triage Issue that This Submission Addresses?

A large future surge in COVID-19 cases may require triage of critical medical care. There could end up being more patients needing critical care than there is critical care available. In that situation, which patients needing critical care will get that critical care and which patients who need that care will be denied it?

Last winter with the arrival of COVID-19 to Canada, the Ontario Government decided to create a written protocol to tell doctors and hospitals who would decide and how to decide which patients would be denied critical care in a pandemic triage situation (the triage protocol). The Ontario Government appointed a “Bioethics Table” to make recommendations on what the triage protocol should say. This was not then made public, nor was the public’s input then sought.

As a result, a triage protocol dated March 28, 2020 was sent to Ontario hospitals but was not made public. Within days, its existence and contents became known to some within Ontario’s disability community. As a result, the March 28, 2020 triage protocol was strongly and publicly criticized as discriminating against some patients because of their disability, contrary to the Ontario Human Rights Code and the Canadian Charter of Rights and Freedoms.

In the face of that public criticism, the Government stated that the March 28, 2020 triage protocol was only a draft. However, it had not been marked “draft”. Last spring, also in the face of public criticism of that triage protocol, the Government announced that there would be consultations on it with human rights and community experts.

The Ontario Human Rights Commission and several organizations from the disability community have called on the Ontario Government to rescind the March 28, 2020 triage protocol. However, to date, The Government has not rescinded the March 28, 2020 triage protocol.

At some point after March 28, 2020, the Bioethics Table wrote a revised draft critical care triage protocol. The Bioethics Table is now consulting on that revised draft before recommending to the Ontario Government any possible changes to that triage protocol. The Bioethics Table invited certain disability organizations for input, including the AODA Alliance. We were all given a copy of the revised draft triage protocol, and were free to make it public. On July 16, 2020, the AODA Alliance posted the revised draft triage protocol on our website.

In this submission, the AODA Alliance gives the Bioethics Table its culminating input on its revised draft triage protocol. This submission is supplementary to and builds upon the input earlier provided from the disability perspective by the ARCH Disability Law Centre and the AODA Alliance. Our prior public statements on this issue are posted on our website’s COVID-19 page. We especially emphasize the following prior AODA Alliance and ARCH public statements:

  1. The April 14, 2020 AODA Alliance Discussion Paper on Ensuring that Medical Triage or Rationing of Health Care Services During the COVID-19 Crisis Does Not Discriminate Against Patients with Disabilities
  1. The July 16, 2020 AODA Alliance Update that lists additional concerns with the revised draft triage protocol.
  1. The April 8, 2020 open letter to the Ford Government on the medical triage protocol spearheaded by the ARCH Disability Law Centre, of which the AODA Alliances one of many co-signatories
  1. The May 13, 2020 ARCH Disability Law Centre’s Analysis of the March 28, 2020 Triage Protocol
  1. the ARCH Disability law Centre’s July 20, 2020 brief to the Bioethics Table on the revised draft triage protocol, which the AODA Alliance endorsed.

The rush to give our input to the Bioethics Table did not allow us time to first post a draft of these written submissions in order to get input and feedback on them from our supporters. We recognize that the Bioethics Table is operating under significant time pressures because of the possibility of a second surge of COVID-19 infections this fall. After presenting these submissions to the Bioethics Table, we will welcome feedback from our supporters in case we later need to elaborate on these issues.

 2. Who is the AODA Alliance?

The AODA Alliance is a voluntary non-partisan grassroots coalition of individuals and organizations. Our mission is:

“To contribute to the achievement of a barrier-free Ontario for all persons with disabilities, by promoting and supporting the timely, effective, and comprehensive implementation of the Accessibility for Ontarians with Disabilities Act.”

To learn about us, visit: https://www.aodaalliance.org.

Our coalition is the successor to the Ontarians with Disabilities Act Committee. The ODA Committee successfully advocated from 1994 to 2005 for the enactment of strong, effective disability accessibility legislation, including the Accessibility for Ontarians with Disabilities Act. Our coalition builds on the ODA Committee’s work. We draw our membership from the ODA Committee’s broad, grassroots base. To learn about the ODA Committee’s history, visit: http://www.odacommittee.net.

We have been widely recognized by the Ontario Government, by all political parties in the Legislature, within the disability community and by the media, as a key voice leading the non-partisan campaign for accessibility in Ontario. In every provincial election since 2005, parties that made election commitments on accessibility did so in letters to the AODA Alliance.

Among our many activities, we led a multi-year campaign to get the Ontario Government to agree to develop a Health Care Accessibility Standard under the AODA, to tear down the many barriers that impede patients with disabilities in Ontario’s health care system. That promised regulation is still under development. Our years of efforts to advocate for accessibility for patients with disabilities are documented on our website’s health care page.

Our efforts and expertise on accessibility for people with disabilities have been recognized in the media, in MPPs’ speeches in the Ontario Legislature, and beyond. Our website and Twitter feed are widely consulted as helpful sources of information on accessibility efforts in Ontario and elsewhere. We have achieved this as an unfunded volunteer community coalition.

3. Summary of This Submission

The revised draft critical care triage protocol which was shared by The Ontario Government’s “Bioethics Table” for input is substantially deficient. It is substantially lacking in essential due process protections for patients with disabilities and their families/support people. As well, the standard or assessment tool that it proposes to guide or govern such medical triage decisions is seriously flawed and should not be used for triage purposes. In the case of a critical care patient with a progressive disease but who has more than six months to live, their likely mortality should not be assessed by the number of activities of daily living that they can perform without assistance, having regard to each of these specific activities: dressing, bathing, eating, walking, getting in and out of bed, using the telephone, going shopping, preparing meals, doing housework, taking medication, or handling their own finances. We share the concerns with the triage protocol that we anticipate to be set out in a forthcoming written submission by the ARCH Disability Law Centre.

We hope that the entire Bioethics Table agrees with our concerns and recommendations, and that it incorporates them into the recommendations that it makes to the Ontario Government. If a majority of the Bioethics Table does not agree to do so, we urge any members of the Bioethics Table who agree with any or all of our concerns and recommendations to prepare and submit a minority report to the Government.

It is important for the Government to receive the most informative feedback from the Bioethics Table that the Table can provide. The Bioethics Table has been asked to advise the Government on very challenging issues. Where there are differing views at that Table, the Government and the public are best served if the spectrum of competing views are expressed in majority and minority reports to the Government. That would let the Government and the public review both a majority report and a minority report as they consider the full range of options when making decisions on how critical care triage should be conducted, if a need for it arises.

B. The First Issue: The Revised Draft Triage Protocol is Seriously Lacking in Due Process for All Patients

 1. The Bottom Line

The critical medical triage protocol needs to be revised to provide strong, mandatory, reliable due process protections that ensure fair and accurate decisions in triage cases. This is especially important since the decision of whether a patient will be given critical care is a life and death decision. The Canadian Charter of Rights and Freedoms guarantees in section 7 the right to life, and the right not to be deprived of one’s life except in accordance with the principles of fundamental justice. Due process must be the most rigourous when the right to life is at stake.

 2. The Rule of Law and the Need for Any Triage Protocol to Be Enacted in Law

As a vital starting point, any critical care triage protocol, including the due process safeguards in it, should be enacted in a law. Such a protocol is specifically aimed at a situation where a patient could be denied critical medical care that they need, despite the fact that they need it. It is a basic aspect of the rule of law that a person’s fundamental rights, such as the right to life, cannot be taken away without the clear authority of law.

Given this issue’s importance, any critical care triage protocol and any legislation that would enact or mandate it should be carefully screened in advance of its enactment by Government’s lawyers to ensure that it is fully lawful and constitutional. The Government has known of the COVID-19 pandemic for over five months. It has had ample time to take these steps. Moreover, The Government has shown that it is prepared to act very swiftly to enact other significant emergency measures to deal with the COVID-19 pandemic. The Government should be capable of doing so in this medical critical care triage context as well.

Any law enacted in this context must fully comply with the Charter of Rights and the Ontario Human Rights Code. Among other things, the standard that it mandates for making a decision over who will be denied life-saving critical care that they medically need must be sufficiently clear and not vague.

 3. Right to Early Notice

As part of due process, a patient and their family should be given notice as early as possible in advance that they may be subjected to triage for critical care. This should include a full explanation of such things as what critical care is, what medical triage is, what the steps of the triage process include, what rights the patient has to input into the process, what appeals are available from an adverse triage decision, and whom the patient and their family could consult for assistance in this process. This rights advice and information should be readily available in a wide range of languages.

 4. Right to Disability Accommodation in the Triage Process

If a person with disabilities, either a patient or a member of their family/support people, needs an accommodation to enable them to fully participate in this due process, it is important to ensure that their accommodation needs are promptly and fully met. For example, relevant printed material should be readily available in accessible alternate formats. Electronic documents should be provided in an accessible format where needed, such as an accessible html or MS Word document. PDF does not fulfil this need. Sign Language and other communication supports should be available for those needing them to take part in this process. Patients and their families should be told as soon as possible that these accommodations and supports are available on request.

 5. Who Should Make the Triage Decision

The triage protocol assumes that this decision over who, among those who need it, should get critical care is a medical decision, and as such, it should automatically be made by physicians. However, that should not be assumed.

It can be argued instead that the decision is not a medical decision, or an exclusively medical decision, even though it relates to medical services. It is a decision over how to ration publicly funded critical medical care in circumstances where there is not enough to go around. It is a decision that should be made by those who are publicly accountable for their decision on how to allocate a scarce life-saving public service or resource.

However, if, despite this serious concern, it were decided to proceed with a medical model for this triage, the following due process is proposed. This due process is proposed without accepting that such a decision should be left at all or exclusively to physicians or other health care professionals.

The hospital team that makes the triage decision should include more than one or two doctors. The Government or Bioethics Table should present a range of options for the Government to consider adopting, listing the advantages and disadvantages of each option, on which public input can be obtained. One option to consider is a committee created by the institution comprised of doctors with expertise in relevant areas such as intensive care or palliative care, nurses, social workers, and ethicists (Sprung, Charles L, et al. “Adult ICU Triage During the Coronavirus Disease 2019 Pandemic: Who Will Live and Who Will Die? Recommendations to Improve Survival.” US National Library of Medicine National Institutes of Health, NCBI, 6 May 2020).

Sufficient safeguards must be in place and monitored to ensure that the persons on the triage team taking part in the triage assessment and decision have no actual or perceived conflict of interest. For example, they should have no personal relationship with the patient or with any of the other patients who are subject to a triage decision. Those making the decision should have personally met the patient, and not simply been briefed by other members of the triage team.

The members of the team taking part in the triage assessment and decision should be required to have recently completed sufficient designated training in the use of the assessment tool, in the assessment due process requirements, and in applicable human rights principles and the requirement to conduct bias-free and barrier-free assessments that do not discriminate against patients with disabilities. This should not be purely passive online training (where a participant simply reads text or watches lectures and then clicks that they did so).

6. Right to Input Into Triage Decision

As part of the critical care triage assessment process, the patient and their family/support people should be given a full and fair opportunity to give the assessment team information on the patient as it relates to the triage assessment criteria, before any critical care triage decision is made. This should include, among other things, the opportunity to present input from others, such as the patient’s personal physician or other support people.

If a patient that is to be considered for possible critical care triage appears to have no substitute decision-maker on the scene with them, and appears to be incapable of managing their health care decisions, the hospital should immediately notify the Public Guardian and Trustee’s office so that that office can consider taking part in the medical triage process on the patient’s behalf, if needed.

 7. Right to Appeal a Denial of Needed Critical Care

If a triage decision is made to refuse critical care to a patient who needs critical care, the senior member of the triage team should tell the patient about the decision and the reasons for it, immediately or as quickly as possible. The patient and their family/support people should be given “rights advice” about the ways for the patient or their family to appeal or dispute the decision. This “rights advice” should also be quickly provided to the patient and their family in writing, written in plain language, in documents provided in an accessible format where needed.

Where a patient is denied needed critical care due to a triage decision, that decision should be re-assessed each 24 hours after this denial (Sprung, Charles L, et al. “Adult ICU Triage During the Coronavirus Disease 2019 Pandemic: Who Will Live and Who Will Die? Recommendations to Improve Survival.” US National Library of Medicine National Institutes of Health, NCBI, 6 May 2020).

If any Ontario emergency orders now suspend due process protections for hospital patients such as opportunities to seek appeals or reviews of refusals of treatment, any such suspension of due process should be lifted. Where a patient who needs critical care is denied it due to a triage decision, the patient and their family should have a right to a swift appeal process within the health care system, with an ultimate option of an appeal to court or an appropriate independent tribunal with the needed expertise and expeditious procedures. This appeal process must be swift due to the fact that the patient needs critical care for a life-threatening condition, and because the health care facility is under incredible work pressure due to the pandemic crisis.

The AODA Alliance has not had the time and capacity to obtain and compare a wide range of hospital appeal protocols. We propose that the appeal process should include these features:

  1. a) Information about the availability of an appeal and how to launch an appeal should be widely available and well publicized, within a hospital.
  1. b) The appeal process must be very fast.
  1. c) The appeal process should rapidly get right to the substantive critical care issues, without being distracted by extraneous considerations. This is needed to minimize the time that the process takes and the need to enable medical staff to spend their time treating patients.
  1. d) A patient or their family/support people should be able to quickly and easily launch an appeal by sending in an email, placing a phone call, or verbally advising a person in charge e.g. a charge nurse in an emergency room. Whoever receives the written or oral notification that the appeal is being launched should be required to immediately communicate it to a central hub at the hospital.
  1. e) To speed up this process, to the extent possible, virtual meetings should be used to conduct the parts of the appeal that do not require in-person contact.
  1. f) On an appeal being launched, a hospital staff person who had no involvement in the triage decision should immediately be assigned to manage the appeal process, and to be the patient/family’s/support people’s primary contact.
  1. g) Immediately upon launching an appeal, an independent person either within the hospital or on stand-by at Ontario Health should review the initial triage team’s documentation of their triage decision. If the documentation reveals any possible errors, the triage team that made the decision should be required to reconsider its decision afresh.
  1. h) If, after that review, the triage team sticks by its decision to deny critical care to the patient, a second triage team, either in the hospital or elsewhere, should be appointed to immediately perform an independent clinical care triage assessment of the patient’s case. The second triage team should have the same required qualifications and training on the triage process as did the first triage team. The second triage team should, of course, include no members from the first triage team.
  1. i) The second triage team should start the assessment from scratch, and should not be provided any of the assessment decision ratings or deliberations of the first triage team. The members of the second triage team should not communicate about this case with members of the first triage team before or while making their assessment.
  1. j) The patient should get the benefit of the most favourable assessment, as between the first and second triage teams. If, after this second team’s assessment, the patient is still denied critical care, they should have an opportunity to have a rapid appeal/review by an independent court or tribunal. New legislation or regulations may be needed to spell this out. We do not have time to specify to whom this appeal should go. One option worth considering is the Consent and Capacity Board (CCB). Another option to consider is a judge of the Superior Court of Justice. A short list of judges from that court could be designated to be on stand-by for cases coming to them, if it is decided that a judge should hear these cases.
  1. k) Whether this final appeal is to a judge or to the CCB or some other body, to expedite this process, a panel of qualified lawyer-mediators should be designated to be on stand by to assist that judge or tribunal e.g. to quickly gather, organize and disclose to the parties and the appeal judge or tribunal all the relevant information from the hospital and the two triage teams that had reviewed the case. Because such appeals must happen extremely quickly, it would be important for the patient, family/support people and hospital to have that emergency assistance.
  1. l) To ensure that the playing field is level for all patients, the Government should direct that Legal Aid Ontario is required to provide free legal representation to any patient invoking this appeal process after being denied critical care. A panel of Legal Aid-funded lawyers should be available on stand-by for emergency engagement if needed.

 8. Accountability for Triage Decisions

At each stage of the medical triage process, the triage team should be required to keep detailed contemporaneous records of their entire triage process including any triage assessments. These cases should be reported weekly for review by the hospital’s senior management and ethics committee, and should be reported weekly to the Ministry of Health. These should also be made public on a weekly basis as aggregated information that does not disclose patient identities. This is all needed to ensure that hospital administration and the Government are kept up-to-date on how the clinical care triage process is operating on the front lines, so that corrective action can be quickly ordered where needed.

For proper public accountability, during any period when a critical care triage protocol is in effect, The Ministry of Health should make public, on a weekly basis, information on a province-wide, municipality and hospital-by-hospital basis, about cases where critical care has been denied due to triage decisions, such as:

  1. a) the number of cases and related medical decisions;
  1. b) key demographic data such as racialized and disability status; and
  1. c) number of decisions appealed and whether the appeal resulted in a refusal or offer of critical care.

C. The Second Issue: Serious Problems with The Triage Protocol Using the Clinical Frailty Scale As A Triage Assessment Tool

 1. The Bottom Line

Up to now, this submission has focused on the process for critical care triage decisions. We now turn to consider the yardstick or assessment tool to be used to make decisions over who will be given critical care and who will be refused it, among all the patients who need critical care, should there be a shortage of critical care beds, equipment or services.

Both the March 28, 2020 triage protocol and the subsequent revised draft protocol, created by the Bioethics Table, use the “Clinical Frailty Scale” (CFS) as the tool that doctors are to use to assess whether a patient should be denied critical care. We oppose the use of the CFS as a critical care triage assessment tool in either protocol. The following are key reasons why use of the CFS is highly objectionable from the perspective of patients with disabilities who need critical care. We also endorse the concerns with the CFS that are outlined in the written submission to be provided to the Bioethics Table by the ARCH Disability Law Centre.

 2. The Burden of Proof to Justify the Use of the CFS in Critical Care Triage

Critical triage decisions decide whether a patient will receive life-saving medical care they need. Before it can be used, a critical care triage assessment tool must be affirmatively proven to be consistently and reliably valid and consistently and reliably applied, based on rigourous peer-reviewed scrutiny. Such an assessment tool, if adopted, would carry with it a strong aura of objective scientific legitimacy and fairness, clothed in the mantle of science.

Accordingly, a substantial burden of proof rests on those who propose a specific assessment tool, to justify its use. Its validity is not presumed, until or unless someone proves that there is a better assessment tool.

 3. CFS Has Not Been Shown to Meet That Burden of Proof

The March 28, 2020 triage protocol and the revised draft triage protocol each use the CFS as the tool for assessing the likely mortality of a patient who needs critical care. During our virtual meetings with some members of the Bioethics Table, members of the Table stated that scientific data shows that the CFS is reliably predictive of a critical care patient’s likely mortality, and that it is more reliable than other assessment tools. However, the Bioethics Table has not provided sufficiently compelling proof that the CFS is a consistent and reliable tool for predicting a critical care patient’s likely mortality, for the entire patient population who would be subjected to the CFS under either triage protocol. The ARCH Disability Law Centre will be making a submission that addresses the studies which members of the Bioethics Table have identified in support of the CFS. The AODA Alliance‘s submission supplements ARCH’s submissions.

Members of the Bioethics Table acknowledged that the CFS was not created or designed for the purpose of making critical care triage decisions. Therefore, we propose that the Bioethics Table must demonstrate that even though the CFS was not designed for the purpose to which the Bioethics Table wishes to deploy it, it coincidentally does consistently and reliably serve that unintended, unplanned purpose.

The Bioethics Table was asked for any studies that show that the CFS is an accurate predictor of a critical care patient’s likely mortality. The AODA Alliance has not had sufficient time to fully review all the information provided in response. Despite that, the following appears evident, in addition to points to be made in the forthcoming ARCH written submission:

  1. a) It is our understanding that the peer-reviewed studies provided to us by the Bioethics Table do not appear to have been undertaken for the purpose of assessing if the CFS is a consistent and reliable predictor of a critical care patient’s likely mortality, when it is used in a critical care triage context.
  1. b) It does not appear that the studies provided assessed the CFS’s application across a full spectrum of patients of all ages to which the triage protocol would apply it. During discussions with some members of the Bioethics Table, we were told that the data provided in those studies address patients at or over the age of 65. They also may provide some data for patients over the age of 50. Yet the revised draft triage protocol does not limit the use of the CFS to those populations that the peer-reviewed studies actually studied. The triage protocols under discussion here draw an age line of 18. They would apply the CFS to any and all patients over the age of 18.
  1. c) During our discussions with some members of the Bioethics Table, we were told that Dr. James Downar, a member of that Table, is currently conducting research on the possible connection of CFS scores to a critical care patient’s likely mortality. Any such unpublished data should not be used as a proper basis for the current life and death policy decision, especially when there has been no public scrutiny of it or of its use. For it to be used when designing a protocol for critical care triage, that data should first have been published in a peer-reviewed medical journal, and exposed to further critical exploration by other studies to see if the conclusions are verified or should be qualified.
  1. d) To rely on any of the CFS rating data in any of the published or unpublished studies or analysis of this issue, it would also be necessary to affirmatively establish that the CFS was properly and consistently applied to all patients who were assessed in those studies or data. Otherwise, the ratings may not consistently correlate to the patients’ actual status. Sufficient proof has not been provided that convincingly establishes this.
  1. e) It would be important to know to what extent the CFS scoring in the studies on point varies depending on whether the professional, doing the rating, has had training on CFS rating. Similarly, it would be important to know if any studies on point were assessing the consistency of CFS ratings when undertaken in a critical care triage context. It would be necessary to rule out the possibility that a doctor’s CFS rating in a critical care triage context is different than their CFS rating when they know it is for a different purpose. It would be important to know if the person doing the CFS scoring knew that their scoring could determine whether the patient would be thereby denied needed life-saving critical care.

The foregoing amply warrants a rejection of the CFS as the critical care triage assessment tool. However, each of the following additional reasons, on their own, also compel its rejection. Each of these points would have to be convincingly disproven before the CFS could properly be deployed in Ontario.

For the CFS to be used as the critical care triage assessment tool, it would also be necessary to establish with convincing proof that different doctors and other hospital staff, applying the CFS to the same patient, will consistently and reliably get the same results, or extremely similar results, and that there is no room for subjectivity in its application. If this is not shown to be the case, then a patient may well get triaged out of critical care due to arbitrary differences in how the CFS is applied by different doctors, and not because of the patients’ likely mortality. The risk must be disproven that two doctors or other health care professionals would assess the same patient differently. This consistency of application cannot simply be assumed.

In discussions with some members of the Bioethics Table, Dr. James Downar candidly acknowledged that there is subjectivity in how the CFS would be applied to a specific patient. That is fatal to its use for critical care triage.

This serious concern is reinforced by feedback we received from the Bioethics Table on the conduct of doctors who assess a patient for admission to palliative care. As we understand it, a doctor is required to give a prognosis of the patient’s likely mortality within a specified period (such as 3 months), to qualify for admission to palliative care. We were candidly told at a meeting with some members of the Bioethics Table that doctors routinely give result-oriented assessments that serve the purpose of getting the patient into palliative care, rather than purporting to accurately assess the patient’s likely mortality. There is a comparable risk that the CFS’s implicit subjectivity will lead to result-oriented decisions by triage doctors or teams, clothed in the image of objective science. As further explored later, this has enormous risks from a disability human rights perspective.

Making this an even greater concern, the fact that a person has an MD does not mean they have expertise in assessing a patient’s ability to undertake activities of daily living. During our meetings, we were told that most physicians are not trained in medical school on how to use the CFS. Some geriatricians have training or experience in its use. In contrast, we noted for the Bioethics Table that the health care professionals whose expertise more specifically focuses on a patient’s ability to undertake activities of daily living (a central part of the CFS) are occupational therapists, not physicians.

 4. CFS Impermissibly Discriminates Against Some Patients with Disabilities

The foregoing warrants a rejection of the CFS for critical care triage purposes, without any resort to human rights principles. However, even if it were assumed that there is no merit to any of the preceding serious concerns with the CFS as a critical care assessment tool, the following human rights concerns also warrant a rejection of the CFS as a critical care assessment tool.

As more fully documented in earlier submissions by the ARCH Disability Law Centre and the AODA Alliance, the use of the CFS for critical care triage purposes would discriminate against some patients with disabilities, implicating the Ontario Human Rights Code and the Canadian Charter of Rights and Freedoms. It is no answer to this that the CFS was not intended to be discriminatory or to be unfair to any patients with disabilities, or that it is equally applied to all patients in the same way, or that its use is supported by mortality data (addressed earlier).

The CFS and even the drawings accompanying it are clear illustrations on their face of direct disability discrimination. As such, there is no need to resort to the additional fact that it also has clear disproportionate impact on patients with disabilities. To now cosmetically edit out the CFS’s accompanying drawings would not retroactively erase this.

It is a core feature of the CFS that it calls for an assessment of a patient’s ability to undertake certain activities of daily living independently or without assistance. At the core of equality and human rights protections for people with disabilities in Canada is their right to disability accommodations where needed, and their right to have their abilities assessed with needed disability accommodations, not without needed disability accommodations. The CFS embodies a deeply entrenched, blistering violation of human rights on that basis alone.

For the triage protocol to invite doctors or other health care professionals to assess the abilities of a patient with disabilities to undertake certain activities of daily living independently or without assistance is to reinforce and build upon deeply injurious stereotypes about people with disabilities. To do so in a protocol that invokes bioethical commitments to “fairness” is especially indefensible.

It would be wrong to assess a doctor’s ability to practice medicine by first requiring them not to wear their eyeglasses. In a decision over life or death, it is all the more wrong to take that erroneous kind of approach to assessing a patient’s abilities to undertake the CFS-listed activities of daily living without considering their needed disability accommodations.

Making the CFS still worse, such an assessment by doctors or other health professionals of people with disabilities risks triggering a covert assessment of the social worth or “quality of life” of patients with disabilities. That deliberative process must be strictly and proactively prevented, and not directly or indirectly tolerated or encouraged.

Amplifying its arbitrariness and unfairness, the CFS’s core focus on a patient’s ability to perform certain activities of daily living can bias against patients based on their socio-economic status, or the timing of their disability. Poor people with disabilities can have less access to rehabilitation training and supports compared to the more affluent. Someone who acquired their disability long ago can have had much more opportunities to learn to perform such tasks of independent living, as compared to those who more recently acquired a disability. When reviewing the CFS with some members of the Bioethics Table, it was not disputed that the CFS measures can have such adverse affects depending on a patient’s socio-economic status or when they acquired a disability.

At one meeting, Dr. James Downar of the Bioethics Table commendably made it clear in response to our question that he would not support using a patient’s race or gender to make triage decisions, even if the data had scientifically showed that a critical care patient’s race or gender correlated to their likely mortality. We emphasize that in our raising this, there was no suggestion that the data had shown such a nexus. We respond that if race or sex should not be used here, even if the data had supported its use, the same should go for a patient’s disability. Race, sex and disability are all forbidden grounds of discrimination.

 5. CFS Deficiencies Are Not Fixable

It would not eliminate or materially reduce these concerns if the protocol allowed a triage doctor or team to use the CFS rating of a patient as “a factor” in the triage decision, without it being mandated as the sole or determinative factor. This is because:

  1. a) To the extent that a triage doctor or team uses the CFS at all for triage, it has all the serious problems here identified.
  1. b) If the triage protocol gave a triage doctor or team a discretion to weigh a patient’s CFS score as a factor in their triage decision, there would be no assured consistency in how much weight each triage doctor or team gives that CFS score. Some could give it a lot of weight. Others could give it much less weight. Some or all doctors or triage teams could give a patient’s CFS score different weight from patient to patient.
  1. c) For a triage doctor or team to be given a discretion to decide how much weight to give a patient’s CFS score in making a triage decision is in effective to give that doctor or team a carte blanche to apply whatever triage criteria they wish. After using whatever triage criteria they wish, they could thereafter assign to the patient’s CFS score that amount of weight that will support the outcome that the triage doctor or team had preferred.
  1. d) This opens the door to discriminatory or stereotype-based decisions. It also opens the door to a triage doctor or team in effect making their decisions on the patient’s perceived quality of life or social utility.

Beyond the foregoing, there is a practical risk that this triage protocol will not govern actual triage decisions, regardless of its contents. In a specific hospital, in the midst of a pandemic surge, there is a real risk that a triage doctor or team, called upon to make a critical care triage decision, will look at the four patients who need critical care and the two available critical care beds, and will size them up based on the doctor’s or team’s own personal assessment or views of who is the most “deserving”. Here again, the risk of stereotypes and of assessing perceived quality of life or social utility of each of the patients is palpable. The CFS’s focus on a patient’s ability to undertake certain activities of daily living independently or without assistance risks triggering such stereotype-based thinking.

The Bioethics Table has asked if the problem is not with the CFS as a critical care triage assessment tool, but simply with its application. By this it might be thought that the CFS is fine as an assessment tool, but that steps need to be taken to ensure that it is applied properly.

This is incorrect. For the reasons set out above, the CFS is fatally flawed as the tool for making such life and death decisions. Those fatal flaws are not fixed by focusing on its application. To illustrate this, had the triage protocol authorized a doctor to take into account a patient’s race when making a critical care triage decision, such impermissible racism could not be cured by simply setting out cautions in the protocol regarding its application, such as a direction to not discriminate because of race.

The Bioethics Table raised with us a suggestion that if physicians were to assess a critical care patient’s likely mortality without using the CFS, there is a risk that in the case of some seemingly frail patients with disabilities, physicians would be more likely to assess them as more likely to die than would be the case if those patients were assessed using their CFS score. To even begin to entertain such a justification for the CFS, it would be essential as a first step to have reliable studies showing that this risk is the case, and to explore what the causes are for the differential in physicians’ assessment of those critical care patients. If it were true that physicians who do not use the CFS are so prone to overestimate the mortality of seemingly frail patients or of some patients with certain disabilities, this would call into question the entire enterprise of having physicians making these triage decisions.

At bottom, after extensive and thorough meetings with some members of the Bioethics Table, we were not given a clear and convincing explanation why in the case of a critical care patient with a progressive disease but who has more than six months to live, how soon that patient will die is correctly measured by the number of activities of daily living that they can perform without assistance, having regard to each of these specific activities: dressing, bathing, eating, walking, getting in and out of bed, using the telephone, going shopping, preparing meals, doing housework, taking medication, or handling their own finances. What is it about those specific activities of daily living that the CFS measures that is supposedly so clearly and causally predictive of the patient’s likely mortality? We asked for this several times.

 6. No Matter What, the Triage Protocol Should Include Certain Specific Directions

Whatever be the assessment tool, if any, that is mandated in the triage protocol, the protocol should give the following directions. These derive from the he April 14, 2020 AODA Alliance Discussion Paper on Ensuring that Medical Triage or Rationing of Health Care Services During the COVID-19 Crisis Does Not Discriminate Against Patients with Disabilities, on which the AODA Alliance has received no negative feedback in the four months since it was made public:

  1. A hospital or physician should never take into account or hold against a patient with a disability the hospital’s or physician’s beliefs or assessment of a patient’s future quality of life living with a disability, when deciding if that patient will get critical care that they need. A patient’s disability must not be used as a factor weighing against that patient receiving needed medical services.
  1. The hospital, physician or other official deciding who will get critical care they need must never weigh or hold against a patient with a disability the fact of their disability or the hospital’s or doctor’s belief about the cost to the public that the patient’s needs in future will pose if they survive the COVID-19 virus.
  1. The personal ventilator of a person with a disability who comes to hospital with COVID-19 symptoms and who brings their personal ventilator with them must not have the hospital try to re-allocate their ventilator to another patient.
  1. Decisions over which patients needing critical care will get critical care should not be based on the physician’s predictions, whether accurate or stereotype-based, about the eventual long-term lifespan of that patient unrelated to the COVID-19 diagnosis. The hospital, physician or other official deciding who will get the critical care must not weigh or hold against that patient with a disability the fact of their disability or its perceived impact on their long-term lifespan.
  1. The hospital, physician or other official who is deciding who will get critical care they need must never use a patient’s need for disability-related accommodations as a factor or reason for refusing them critical care they need.
  1. If a patient, needing a COVID-19 test, has difficulties being tested due to their disability, the hospital or other testing facility should not refuse to administer the test. Instead, the patient should be offered an accommodation to their disability, such as voluntarily taking sedation to enable the test to be administered.
  1. A long term care facility’s decisions over whether or not to send a COVID-19 patient to the hospital should not be made on the basis of the resident’s age, disability or both, nor on the belief that the health system is overtaxed and therefore this person should not be offered treatment. This is apart from any question of whether a long-term care home should even make this decision on their own, without contacting the resident’s physician, and without discussing the situation with the resident’s substitute decision-maker.
  1. When an emergency call e.g. for an ambulance is made, emergency medical technicians EMTs should never use the patient’s disability or their predictions about whether that might lead a doctor to refuse to treat them as a reason or factor to refuse to bring them to the hospital if they otherwise have symptoms warranting a trip to the hospital.
  1. No nurse or other hospital staff should ever de-prioritize a hospital patient with disabilities or decline to immediately notify the attending doctor on the request of the patient or their family, on the grounds that the nurse thinks the overloaded doctors may not assign scarce critical care to that patient even though they need critical care.

In recommending these directions, we emphasize that their inclusion in the triage protocol, while essential, would not rectify the serious problems with the CFS from the disability perspective.

 D. Concluding Considerations

In summary, the Bioethics Table needs to go back to the drawing board to identify an assessment tool that is properly justified and that does not enshrine and promote disability-based discrimination in relation to life and death decisions. The middle of a pandemic would not be the place to try out the CFS and see how well it works.

The March 28, 2020 triage protocol must be clearly and categorically rescinded now. The longer the Government delays in doing this, the more it festers, further embedding harmful ideas and practices that discriminate against patients with disabilities.

The AODA Alliance very much appreciates the opportunity to offer its input to the Bioethics Table on this vital issue. We regret that we were not included in the consultation process in February and March of this year leading to the development of the March 28, 2020 triage protocol. Had we been included in this process much earlier, we would have been able to raise these concerns in fuller detail much earlier.

We remain eager to do what we can to assist the Bioethics Table and the Ontario Government as they grapple with this issue.

Watch the Archived Online video of the 3rd COVID-19 Town Hall by the AODA Alliance and the Ontario Autism Coalition Entitled: “Preparing for School Re-Opening — Action Tips for Parents of Students with Disabilities” – And Check Out the Media Coverage It Got

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

Watch the Archived Online video of the 3rd COVID-19 Town Hall by the AODA Alliance and the Ontario Autism Coalition Entitled:   “Preparing for School Re-Opening — Action Tips for Parents of Students with Disabilities” – And Check Out the Media Coverage It Got

August 24, 2020

          SUMMARY

 1. Now Available to Watch Online at Any Time! The 3rd AODA Alliance/Ontario Autism Coalition COVID-19 Virtual Town Hall “Preparing for School Re-Opening — Action Tips for Parents of Students with Disabilities”

It is online, archived and ready to watch any time you want! Check out “Preparing for School Re-Opening — Action Tips for Parents of Students with Disabilities.” This is the latest COVID-19 Virtual Town Hall by the AODA Alliance and the Ontario Autism Coalition. If you want to copy and paste the link to the video, it is https://youtu.be/ZB78Wt9TJGk

This online video already includes American Sign Language interpretation. We deeply regret that due to an extremely frustrating technical error that we have not been able to track down, the real time captioning did not stream with the event. We are working on getting captioning embedded into the Youtube video as soon as we can. In the meantime, the less reliable Youtube automated captioning is available.

We and the Ontario Autism Coalition again thank the ARCH Disability Law Centre for arranging and providing the ASL and captioning. ARCH was not in any way responsible for the unfortunate technical failure.

 2. Help Encourage Parents of Students with Disabilities to Watch the Helpful 3rd COVID-19 Virtual Town Hall

In a one hour event, our third Virtual Town Hall crams a ton of helpful practical tips that every parent or guardian of a student with disabilities would like to know. Although it focuses on Ontario, our tips will be helpful to parents of students with disabilities outside Ontario as well.

Here are ways you can help, using just a few moments of your time:

  1. Encourage others who could benefit from it to watch our 3rd Virtual Town Hall. Send the link to anyone you know who might benefit from watching it. This includes parents or guardians of students with disabilities teachers, principals and other school board staff, members of the Ontario legislature and school board trustees, and any education professionals.
  1. Ask your school board to publicize to all parents the link to our 3rd Virtual Town Hall and to post a link to it prominently on its website.
  1. Post the link to our 3rd Virtual Town Hall on your Facebook page, Twitter feed, or other social media. If you are a member of any Facebook groups, you can also help by posting this to those Facebook groups.

For example, you might post this on Facebook:

Are you a parent of a student with disabilities? Do you know parents of any students with disabilities ? Want practical tips for navigating the stressful return to school this fall? Check out the virtual public forum for practical tips by the AODA Alliance and the Ontario Autism Coalition, and please share this with others who might benefit from it. https://youtu.be/ZB78Wt9TJGk

  1. Bring this issue and our 3rd Virtual Town Hall to your local media. Ask them to cover the serious challenges facing parents of students with disabilities as they face the uncertainties of school re-opening. Give them examples of the challenges you know these parents and students now face. Forward this AODA Alliance Update to them. Also encourage them to visit the AODA Alliance’s COVID-19 page where they can see our efforts to get the Ford Government to address the needs of students with disabilities .

 3. Helpful Media Coverage Once Again

With so much going on in the world, the 3rd COVID-19 Virtual Town Hall organized by the AODA Alliance and Ontario Autism Coalition has really struck a note with the media. It has gotten coverage on TV, radio and in print.

The day after the event, it was covered on the August 22, 2020 CTV National News. An excellent Canadian press story on this event was posted on the websites of several major news organizations. The Toronto Star also included a somewhat shortened version of that story in its August 23, 2020 hard copy edition. We set the full article out below as it appeared on the CBC News website.

 4. The Ford Government Gives a Deeply Troubling Response to the Media to Justify Its Failure to Announce a Comprehensive Plan to Ensure that Students with Disabilities are Fully and Safely Included in School Re-Opening

What has the Ford Government said to justify the fact that it still has announced no comprehensive plan for ensuring that one third of a million students with disabilities in Ontario are fully and safely included in the fast-approaching re-opening of schools? Here is what is reported in the Canadian Press article, set out below:

“A spokeswoman for Education Minister Stephen Lecce said the government has allocated $10 million in additional funding specifically dedicated to supporting students with special education needs.

“We are spending more money than any other province on special education,” Caitlin Clark said.”

We wish to respond. First, the ten million dollars that the Ford Government announced this summer for students with disabilities boils down to a meager $34 per student. That paltry amount cannot buy much for a student in the way of additional help or support.

Second, Ontario will always need to spend more than any other province on special education . Ontario has the largest population of any province. It therefore will have the largest number of students with disabilities of any province.

Third, the Ford Government’s answer provides no excuse for its failure to bring forward a comprehensive plan for meeting the needs of students with disabilities during school re-opening. By leaving each of 72 school boards to figure it out, the Ford Government is causing wasteful duplication of effort and tremendous inefficiency in the middle of a pandemic. The Government has been advised of the need for it to create a plan of action for students with disabilities by the AODA Alliance and by many others. Among those giving this advice is the COVID-19 subcommittee of the Government-appointed K-12 Education Standards Development Committee.

Send us your feedback. Let us know how you can help get others to watch our 3rd Virtual Town Hall. Email us at aodafeedback@gmail.com

          MORE DETAILS

 CBC News Online August 22, 2020

Originally posted at https://www.cbc.ca/news/canada/toronto/advocates-caution-students-disabilities-more-obstacles-1.5696390

Students with disability face more obstacles amid coronavirus: advocates

Osobe Waberi The Canadian Press

Advocacy groups in Ontario say students with disabilities will face additional obstacles returning to class following the pandemic, leaving parents unsure if their children will be fully and safely included in school reopening plans.

The Ontario Autism Coalition and the Accessibility for Ontarians with Disabilities Act Alliance held an online town hall meeting Friday to discuss what they say is the provincial government’s “failure” to put parents at ease with the school year looming.

OAC president Laura Kirby-McIntosh said when it comes to welcoming children with disabilities back to school, the province is doing the bare minimum at best.

“The Ministry of Education’s guide to reopening Ontario schools is not really a plan,” she said in an interview. “What we get is some very nice words.”

Kirby-McIntosh said the province’s school system is designed primarily with non-disabled children in mind, and while children with disabilities are treated as an afterthought.

“One thing that COVID has done very effectively is it has exposed systemic issues across our society — of racism, medical infrastructure — and now we are getting to school infrastructure.”

A spokeswoman for Education Minister Stephen Lecce said the government has allocated $10 million in additional funding specifically dedicated to supporting students with special education needs.

“We are spending more money than any other province on special education,” Caitlin Clark said.

However, Kirby-McIntosh said schools run on more than just money.

“They run on good planning,” she said. “Yes, they are spending more money on schools, but why wait until the third week of August to announce that? I don’t feel that we are ready, it is not good enough.”

AODA Alliance chair David Lepofsky said both his group and the Autism Coalition have offered plenty of proposals and advice to the government, before and during the pandemic, in relation to students with special needs.

“Not one public official at the Ministry of Education picked up the phone to ask for more information, and they have done nothing about it,” he said.

Lepofsky said students with disabilities risk not being fully supported during the pandemic and through their education. Even worse, he said, is the looming fear of being told they can not attend in-person learning come the fall school year.

Toronto District School Board spokesman Ryan Bird assured parents that when it comes to students with special needs, the board has a number of congregate sites available for them in the fall.

“These schools specialize in supporting these students and that will continue,” he said, noting the TDSB is trying to get as much information as possible to parents in the upcoming days and weeks.

“We get the frustration from parents, and we understand that there are important decisions to be made in sending your child back to school in September,” he said.

“We realize the time is ticking.”

11am Eastern Today, Grassroots Virtual Town Hall Will Give Anxious Parents of One Third of a Million Ontario Students with Disabilities Practical Tips to Prepare for School Re-Openings

ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE

ONTARIO AUTISM COALITION

 

News Release  For Immediate Release

11am Eastern Today, Grassroots Virtual Town Hall Will Give Anxious Parents of One Third of a Million Ontario Students with Disabilities Practical Tips to Prepare for School Re-Openings

August 21, 2020 Toronto: Today at 11am Eastern, a grassroots Virtual Town Hall will be held online to give deeply worried parents of one third of a million students with disabilities practical tips on what to do to prepare for and cope with the impending re-opening of Ontario schools, in the absence of a much-needed comprehensive provincial plan to ensure that students with disabilities are fully and safely included in re-opened schools. This event will have simultaneous captioning and American Sign Language interpretation.

COVID-19 hardships disproportionately fell on students with disabilities and their families while schools were closed last spring. What can parents of students with disabilities do now to prepare for the fast-approaching school re-opening? What should they be asking their school boards? What should they be telling their school boards? What can they do if their child is not being fully and safely included in school programming, whether in-person in the classroom or distance learning?

We’ll tackle these questions today from 11 am to noon. Log in to https://www.youtube.com/c/OntarioAutismCoalition and wait for the event’s live link to appear. The media is free to broadcast any clips from this town hall.

Speaking will be three experts with extensive experience advocating for students with disabilities :

  1. Laura Kirby-McIntosh, high school teacher and president of the Ontario Autism Coalition. Among her many advocacy activities, last year she sat on the Ontario Government’s panel giving advice on reforming the Ontario Autism Program.
  1. David Lepofsky, retired lawyer, part-time visiting professor at the Osgoode Hall Law School, and chair of the AODA Alliance. He is also a member and past chair of the Special Education Advisory Committee of the Toronto District School Board. He is a member of the Government-appointed K-12 Education Standards Development Committee, and a member of its COVID-19 subcommittee.
  1. Robert Lattanzio, lawyer and executive director of the ARCH Disability Law Centre. He and ARCH have done extensive work providing legal advice and representation to students with disabilities and their families.

“All parents are worried about school re-opening, but parents of students with disabilities are especially anxious about whether their children’s needs will get lost in the chaos that we’re expecting,” Said Laura Kirby-McIntosh.

“The Ford Government has announced no comprehensive plan for ensuring that one third of a million students with disabilities one out of every six students, will be fully and safely included in school this fall, even though we’ve been asking the Government for months to come up with a plan and have been offering constructive suggestions. The Ford Government can’t once again just leave it to each school board to try to figure this out, while scrambling in the midst of a global pandemic,” said David Lepofsky.

This is the third OAC/ AODA Alliance virtual town hall to address the needs of people with disabilities during the COVID-19 crisis. Taken together, the first two virtual town halls have been viewed thousands of times.

For further information, please contact:

David Lepofsky, Chair, AODA Alliance, aodafeedback@gmail.com Twitter: @aodaalliance

Laura Kirby-McIntosh President Ontario Autism Coalition laura.kirbymcintosh@gmail.com

416-315-7939 www.ontarioautismcoalition.com Twitter @OntAutism

For more background check out:

The first OAC/ AODA Alliance virtual town hall, held on April 7, 2020 surveying the major issues facing people with disabilities during the COVID-19 crisis.

The second OAC/AODA Alliance virtual town hall, held on May 4, 2020, exploring strategies for teaching students with disabilities during distance learning.

The Ontario Autism Coalition web page, setting out its advocacy efforts for people with autism.

The AODA Alliance’s COVID-19 web page, describing its advocacy efforts during the COVID-19 pandemic.

The ARCH Disability Law Centre’s website.

The Ford Government’s Announced Measures for Students with Disabilities Largely Leaves it to Each of 72 School Boards to Figure Out What to Do to Fully and Safely Include Them in School Re-opening

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

The Ford Government’s Announced Measures for Students with Disabilities Largely Leaves it to Each of 72 School Boards to Figure Out What to Do to Fully and Safely Include Them in School Re-opening

August 20, 2020

          SUMMARY

Earlier this week, we asked this important question: What is the Ford Government’s plan to ensure that over 340,000 students with disabilities are fully and safely included in Ontario’s schools when they open next month? It is now clear that the Ford Government has no comprehensive plan.

At the start of this week, the August 17, 2020 AODA Alliance Update made public the fact that back on August 4, 2020 we had emailed the Ontario Ministry of Education to ask what measures the Government had announced for students with disabilities in connection with school re-opening, and that we had received no answer. Two days later, on August 19, the Ministry responded.

The list of measures that the Government provided is set out below. These include no comprehensive plan of action to ensure that students with disabilities are fully and safely included in school re-opening. These measures do not ensure that the barriers that faced students with disabilities last spring during distance learning are removed and that no new ones are created. The Government has once again left it to each of Ontario’s 72 school boards to figure out what to do for students with disabilities , floundering as they scramble to deal with the COVID-19 pandemic.

A month ago, on July 24, 2020, the Government received a strong report identifying key actions the Government needs to take to ensure that the needs of students with disabilities are met during the ongoing COVID-19 pandemic. These came from the COVID-19 subcommittee of the Government-appointed K-12 Education Standards Development Committee. Among other things, that report recommended the following, which the Government has not included in its list of actions for students with disabilities :

”1)  The Ministry of Education should establish a Central Education Leadership Command Table with responsibilities for ensuring that students with disabilities have access to all accommodations and supports they require during the present COVID-19 pandemic. The responsibilities of the Command Table shall include:

  1. a) immediately develop a comprehensive plan to meet the urgent learning needs of students with disabilities during COVID-19 pandemic quickly and resolve issues for students with disabilities as they arise. The comprehensive plan should be shared for implementation by school boards. This plan should include and incorporate the three options for education:
  • normal school day routine with enhanced public health protocols
  • modified school day routine based on smaller class sizes, cohorting and alternative day or week delivery, and,
  • at-home learning with ongoing enhanced remote delivery
  1. b) collect and share data on existing and emerging issues as a result of COVID-19, the effective responses of other jurisdictions in supporting students with disabilities during the current emergency, using evidence-based data collection methods for people with disabilities
  2. c) establish a fully accessible centralized hub, and share and publicize the hub, for sharing of effective practices about supporting students with disabilities
  3. d) develop a rapid response team to receive feedback from school boards on recurring issues facing students with disabilities and to help find solutions to share with school boards
  4. e) provide clear communication and guidance on school opening, health service delivery, etc. based on data collected.”

On August 19, 2020, the Ontario New Democratic Party wrote Ontario Education Minister Stephen Lecce about this subject. We set that letter out below. That letter calls on the Government to take action now to plan for the needs of students with disabilities during school re-opening.

What are parents of students with disabilities to do now, in this situation? Tune in to the Ontario Autism Coalition‘s Youtube channel tomorrow, Friday at 11 am for the new virtual Town Hall to be convened by the AODA Alliance and the Ontario Autism Coalition, which will be entitled: “Preparing for School Re-Opening — Action Tips for Parents of Students with Disabilities.” This event will have American Sign Language interpretation and captioning. Check out the AODA Alliance’s announcement of this event for more details. Encourage others to log on to this event.

We always welcome your feedback. Write us at aodafeedback@gmail.com

          MORE DETAILS

August 19, 2020 Information Provided to the AODA Alliance from the Ontario Ministry of Education

School Re-Opening Initiatives for Students with Disabilities and Students with Special Education Needs

  • As announced July 30, based on the best medical advice available, the province is implementing additional public health protocols to keep students and staff safe when they return to school in September. To support the implementation of these protocols, the government is providing over $300 million in targeted, immediate, and evidence-informed investments, including:
  • $10 million to support special needs students in the classroom; and
  • $10 million to support student mental health.

This funding is in addition to a $25 million investment in mental health and technology, which will see an additional $10 million dedicated to mental health staff, resources, and programs, as well as $15 million in technology funding to support the procurement of over 35,000 devices for Ontario’s students to support their synchronous learning in-school and beyond.

  • As part of the plan the government is providing additional supports to enable a successful return to school. For students with a high-level of special education needs, the government is directing school boards to facilitate full-time in-school instruction, regardless of whether a secondary school begins the instructional year using an adapted model. The Ministry of Education will work with designated school boards to achieve this goal and will review and approve requests by designated school boards to open small or specialized secondary schools or programs with full-time attendance. Additionally, the government is directing boards to consider changing the school environment and remote learning needs in reviewing and updating Individualized Education Programs (IEPs) to best-serve students.

 

  • In addition to doubling the mental health funding in the Ministry of Education, the government has also worked with School Mental Health Ontario and will provide school boards with a professional learning framework and toolkit to support the mental health of all students. This can be tailored at the board and school levels for different audiences. The professional learning will have a strong focus on building students’ social-emotional learning skills so that they can respond to what they are facing in the COVID-19 outbreak, manage their stress and build positive relationships. Professional learning will be provided for system leaders, educators and mental health professionals to support the approach to school re-entry, as well as throughout the school year.

The re-opening plan builds the summer learning plan for Ontario students to ensure students have every opportunity to continue their learning through the summer months that included focused programming for students with special education or mental health needs, including dedicated learning supports such as access to educational assistants and existing after-school programs that could be delivered through summer school and summer programming in Provincial and Demonstration Schools to focus on continued learning for our students with specialized learning needs.

  • On August 12, the ministry communicated its expectations for three Professional Activity days be implemented prior to the start of the 2020-21 school year that will focus on topics for restarting the school year, to ensure the safety of staff, students and the broader community, and delivery of high-quality education for all learners. The ministry expects that professional learning will consider and incorporate the implications for teaching students with special education needs.
  • Where appropriate, educators should provide more opportunities than the minimum requirements for synchronous learning for students with special education needs, based on their individual strengths and needs, and provide differentiated support and instruction.
  • Educators should continue to provide accommodations, modified expectations, and alternative programming to students with special education needs, as detailed in their IEPs. If it is not possible to meet a student’s needs through synchronous learning, educators and families will work together to find solutions.
  • School boards are encouraged to provide continued access to assistive technology, including Special Equipment Amount (SEA) equipment, where possible, to support students with special education needs as they participate in remote learning. In situations where access to assistive technology is not feasible, educators are expected to work with students and parents to determine workable solutions on an individual basis.

August 19, 2020 letter from the Ontario New Democratic Party to the Ford Government

Hon. Stephen Lecce

Ministry of Education

5th Floor

438 University Ave.

Toronto, ON M5G 2K8

August 19, 2020

Dear Minister Lecce,

We are writing to insist that your government adopts a comprehensive COVID-19 plan for students with disabilities, ensuring that they have the tools they need to thrive during this pandemic.

On July 8, you stated in the legislature that you’ve been in touch with disability rights leaders, but there is still no plan to support the learning requirements of 340,000 students with special education needs.

Firstly, we are concerned about the lack of any uniform guidance on the issue of school exclusions. The AODA Alliance has reported that a majority of Ontario’s 72 school boards do not even have a policy guiding the use of exclusions.

This could set the stage for exclusions to be applied by administrators when schools lack the resources to accommodate students with disabilities.

Your Ministry should issue guidelines to school boards on the use of exclusions without delay, so that no student with a disability is unfairly denied the right to learn with their peers.

Another area where some students with disabilities have been denied equal learning opportunities relates to the discrepancies in how online learning has been implemented. Depending on the school board, different platforms with wildly varying levels of accessibility are being used. It is important for the Ministry to be supporting boards to ensure their online learning systems are equitable and accessible to all students.

Finally, your government has committed only $10 million in additional funding for students with special education needs to date. This amounts to a paltry investment of $34 per disabled student. How could anyone believe that is sufficient to meet the challenges before us? Significant investment in hiring additional educational assistants

and reducing class sizes is crucial to ensuring that all students’ learning needs are supported.

Minister, people with disabilities have been among those hit the hardest by this pandemic. This includes education, where many students with special education needs have struggled with the transition to distance learning.

In order to ensure that students with disabilities can thrive in the classroom or remotely, it is crucial that your Ministry develops a plan in consultation with the disability community, and puts real resources behind it.

We look forward to hearing from you.

Sincerely,

Joel Harden

Official Opposition Critic for Accessibility & People with Disabilities

MPP for Ottawa Centre

Marit Stiles

Official Opposition Critic for Education

MPP for Davenport

Monique Taylor

Official Opposition Critic for Children & Youth Services

MPP for Hamilton Mountain

On Friday, August 21, 2020 at 11 AM Eastern Time, Watch “Preparing for School Re-Opening — Action Tips for Parents of Students with Disabilities” – A Virtual Town Hall Organized by the Ontario Autism Coalition and the Accessibility for Ontarians with Disabilities Act Alliance

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

On Friday, August 21, 2020 at 11 AM Eastern Time, Watch “Preparing for School Re-Opening — Action Tips for Parents of Students with Disabilities” — A Virtual Town Hall Organized by the Ontario Autism Coalition and the Accessibility for Ontarians with Disabilities Act Alliance

August 19, 2020

Like all parents, parents of a third of a million students with disabilities in Ontario are very anxious about the re-opening of schools next month. Will their children be safe? Will their disability-related needs be accommodated?

So much remains uncertain and worrisome about school re-opening during the COVID-19 pandemic. In the face of that, the AODA Alliance and the Ontario Autism Coalition would like to offer parents some practical action tips on how to get ready for school re-opening. We don’t have all the answers, but we want to offer what we can.

On Friday, August 21, at 11 AM Eastern time, log onto the Ontario Autism Coalition’s Youtube channel at https://www.youtube.com/c/OntarioAutismCoalition/. The link to watch this one-hour virtual town hall will appear at or just before 11 AM.

This event will feature a conversation between three speakers, all experts in advocacy for students with disabilities:

  1. Laura Kirby-McIntosh. She is a high school teacher and president of the Ontario Autism Coalition. Among her many advocacy activities, last year she sat on the Ontario Government’s panel giving advice on reforming the Ontario Autism Program.
  1. David Lepofsky. He is a retired lawyer, a part-time visiting professor at the Osgoode Hall Law School, and chair of the AODA Alliance. He is also a member and past chair of the Special Education Advisory Committee of the Toronto District School Board. He is also a member of the Government-appointed K-12 Education Standards Development Committee, and a member of its COVID-19 subcommittee.
  1. Robert Lattanzio. He is a lawyer and executive director of the ARCH Disability Law Centre. He and ARCH have done extensive work providing legal advice and representation to students with disabilities and their families.

Thanks is extended to the ARCH Disability Law Centre, which is providing American Sign Language interpretation and real time captioning for this event. After the event is concluded, it will be permanently available for viewing on Youtube.

This is the third in a series of virtual town halls that the Ontario Autism Coalition and the AODA Alliance have provided to address the needs of people with disabilities during the COVID-19 crisis. Taken together, the first two virtual town halls have been viewed thousands of times.

Please spread the word about this event. Post this announcement on your social media feeds. Encourage as many as possible to log on to this virtual Town Hall.

For more background check out:

* The first OAC/ AODA Alliance virtual town hall, held on April 7, 2020 surveying the major issues facing people with disabilities during the COVID-19 crisis.

* The second OAC/AODA Alliance virtual town hall, held on May 4, 2020, exploring strategies for teaching students with disabilities during distance learning.

* The Ontario Autism Coalition web page, setting out its advocacy efforts for people with autism.

* The AODA Alliance’s COVID-19 web page, describing its advocacy efforts during the COVID-19 pandemic.

* The ARCH Disability Law Centre’s website.

If you have questions that you would like the panel to address, send them in advance to Forum@ontarioautismcoalition.com

What are the Ford Government’s Plans for Ensuring that One Third of a Million Students with Disabilities are Fully and Safely Included During School Re-Opening Next Month?

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

What are the Ford Government’s Plans for Ensuring that One Third of a Million Students with Disabilities are Fully and Safely Included During School Re-Opening Next Month?

August 17, 2020

          SUMMARY

With just two weeks left in August, what are the Ford Government’s plans to ensure that one third of a million students with disabilities will be fully and safely included in Ontario schools when they re-open next month? The Ford Government has received excellent advice on what it needs to do. We are still waiting for it to unveil a comprehensive plan of action, so that 72 school boards are not left to flounder, reinventing the wheel, with the serious risk that they may get it wrong. The Ford Government has had five months to plan for this issue.

On August 4, 2020, we asked senior Ministry of Education officials in writing for any announcements on this topic. The Government has not provided anything in response.

This issue bears on the needs of at least one out of every six students in Ontario-funded schools. The Ford Government’s recently announced plan for school re-opening allocated an additional $10 million to school boards for meeting the needs of students with special education needs. This boils down to a total of $34 for each such student. That will fund very little for each student.

Over three weeks ago, on July 24, 2020, the Ford Government received a comprehensive and excellent set of recommendations on what the Ontario Government and school boards need to do to fully and safely include students with disabilities during school re-opening. That report came from the COVID-19 subcommittee of the Government-appointed K-12 Education Standards Development Committee. The Government knew that this report was coming and had seen earlier drafts.

Moreover, in June, the Government received detailed recommendations on this important subject from the public, including the 19 recommendations in the AODA Alliance’s June 19, 2020 brief on school re-opening. The AODA Alliance ‘s brief was endorsed by several important disability community organizations and by the Ontario Secondary School Teachers Federation. The July 24, 2020 recommendations to The Government from the K-12 Education Standards Development Committee’s COVID-19 Subcommittee commendably include, expand upon and add to the 19 recommendations in the AODA Alliance’s June 19, 2020 brief to The Government.

The Government knows what happens when it does not announce a timely plan of action to meet the needs of students with disabilities during this COVID-19 pandemic. Last spring, the Ford Government announced no comprehensive plan of action to ensure that the learning needs of students with disabilities were met during distance learning while schools were closed due to COVID-19.

Throughout the spring, each school board, each teacher and parent were all left struggling as they tried to figure out what to do to meet the needs of students with disabilities during distance learning. Last spring, we and many others urged the Government to announce such a plan of action and offered our help and advice.

Here are several illustrations of this issue as school re-opening rapidly approaches. As a first illustration, back on July 8, 2020, Ontario’s Education Minister Stephen Lecce commendably stated in the Ontario legislature that on the AODA Alliance’s advice, he is directing all school boards as follows regarding parents of students with disabilities:

“We’ve asked for a check-in of every parent by the school board to ensure that they’ve got the tools they will need to succeed. “

However, we have not yet seen that direction being given to school boards. We have not heard that all school boards have been following this direction in the weeks leading up to school re-opening. We set out below the relevant excerpt from the transcript of that day’s Question Period proceeding in the Legislature.

As a second illustration, we have still seen no plan of action from the Ontario Government or its public education TV network, TVO, to make the Government’s and TVO’s online educational content and teaching tools accessible for students, parents and teachers with disabilities. Over three months ago, at the May 4, 2020 online town hall on teaching students with disabilities, which was organized by the AODA Alliance and the Ontario Autism Coalition, we made public the fact that there are serious accessibility problems with the Ministry of Education’s online materials for teachers, parents and students during distance learning and with the distance learning resources on TVO’s website. The Ford Government had repeatedly proclaimed that TVO was its major partner during the COVID-19 pandemic for delivering online courses to students while schools were closed.

On May 21, 2020, the AODA Alliance wrote TVO’s vice president of digital content. We reiterated these concerns and called for TVO to adopt and implement a plan of action to fix this. Our letter confirmed the content of an earlier phone call between the TVO vice president and AODA Alliance Chair David Lepofsky. Since then, we have not heard a word from TVO and have not seen any plan of action from TVO or the Ford Government to solve this. This fall, when school re-opens, Ontario’s education program will still need to deliver online education. This will be needed for students who opt not to attend school in person, for students whose in-class programs will be delivered in part through distance learning, and for all students if a second COVID-19 wave requires schools to again close.

The Ministry of Education and TVO have now had ample time to address this problem – one that should never have occurred in the first place. The Ministry’s and TVO’s duties to ensure the accessibility of their online content has existed for years. The Ford Government claims to be “leading by example” on accessibility for people with disabilities. These are illustrations of their leading by a very poor example.

As a third example, the Ford Government has not announced any concrete measures to prevent a rash of school principals sending some students with disabilities home when schools re-open, using their arbitrary power to refuse to admit some students or others to school at all. On July 23, 2020, the AODA Alliance made public its extensive and detailed report that shows that for much of Ontario, school principals are a law unto themselves when it comes to their sweeping power under section 265(1)(m) of the Education Act to refuse to admit a student or others to school. The AODA Alliance ‘s concerns about this have been covered several times in the media. For example, we set out below the excellent August 10, 2020 article on the AODA Alliance‘s report in “QP Briefing” a very influential publication about important events at Queen’s Park.

Among its many compelling July 24, 2020 recommendations, the K-12 Education Standards Development Committee’s COVID-19 Subcommittee urged the Government to take action on this issue. That report recommends:

“11) To promote transparency, accountability and identify trends, the Ministry of Education should immediately issue a policy direction for boards to create an exclusion policy, that imposes restrictions on when and how a principal may exclude a student from school, including directions that:

  1. a) Does not impede, create barrier, or disproportionally increase burdens for students with disabilities the right to attend school for the entire day as do students without disabilities. The power to refuse to admit a student to school for all or part of the school day should not be used in a way that disproportionately burdens students with disabilities or that creates a barrier to their right to attend school.
  1. b) Tracks exclusions and provides a transparent procedure and practice to parents/guardians, by requiring a principal who refuses to admit a student to school during the school re-opening process to immediately give the student and their parent/guardian written notice of their decision to do so, including written reasons for the refusal to admit, the duration of the refusal to admit and notice of the parent/guardian’s right to appeal this refusal to admit to the school board.
  1. c) Tracks exclusions, increases accountability and informs policies by requiring a principal who refuses to admit a student to school for all or part of the school day to immediately report this in writing to their school board’s senior management, including the reasons for the exclusion, its duration and whether the student has a disability. Each school board should be required to compile this information and to report it on a regular basis to the board of trustees, the public and the Ministry of Education (with individual information totally anonymized).”

In the weeks since the AODA Alliance made public its detailed July 23, 2020 report on principals’ power to refuse to admit a student to school, the Government has issued no detailed policy direction to school boards to rein in the power to refuse to admit a student to school. no public servants from Ontario’s Ministry of Education have contacted the AODA Alliance to discuss its report or to seek any further information about our research and revelations on this important topic.

The final illustration reflects a broader difficulty with the Ford Government’s overall approach to accessibility for people with disabilities, including in Ontario’s education system. Earlier this summer, the Ford Government announced that it was spending over a half billion dollars on building new schools and expanding existing ones. Yet it announced no new measures to ensure that those new building projects will be accessible to students, parents and school staff with disabilities. Since we made this concern public, we have seen no Government announcement fixing this problem.

For more background on these issues, visit

* The AODA Alliance’s COVID-19 web page and our education accessibility web page.

* The July 24, 2020 report on meeting the needs of students with disabilities during school re-opening by the COVID-19 subcommittee of the K-12 Education Standards Development Committee.

* The AODA Alliance‘s July 23, 2020 report on the need to rein in the power of school principals to refuse to admit a student to school.

* The AODA Alliance’s June 19, 2020 brief to the Ford Government on how to meet the needs of students with disabilities during school re-opening.

* The widely viewed online video of the May 4, 2020 virtual Town Hall on meeting the needs of students with disabilities during the COVID-19 crisis, co-organized by the Ontario Autism Coalition and the AODA Alliance.

          MORE DETAILS

Ontario Hansard July 8, 2020

 

Question Period

 

Mr. Joel Harden: My question is for the Premier. Speaker, students with disabilities and their families are wondering when this government will announce something—anything—to make sure that their learning needs are going to be supported this fall. COVID-19 has hit people with disabilities particularly hard in many ways, including the move to distanced learning. Online platforms are not always accessible for all students, and in-class resources are more difficult or even impossible to access from home.

Without new supports, Speaker, there’s a real risk that students who were already struggling before COVID and during COVID will continue to struggle this fall when schools reopen, in whatever form the government decides they can. Premier, will you release a plan to ensure that all learners, particularly those with disabilities, will be supported?

The Speaker (Hon. Ted Arnott): The Minister of Education.

 

Hon. Stephen Lecce: I want to thank the member opposite for the question. We do agree that these particular children will need continued support and heightened levels of support, given the challenges that they would have faced over the past months while being at home.

What I’ve directed school boards to do for this summer is to continue to provide a continuity of access to special education and mental health supports that normally would end at the end of school in June. We’ve asked them to continue funding those to create continuity. We’ve asked them, for September, for their IEPs and IPRCs to continue unimpeded. We’ve asked for a check-in of every parent by the school board to ensure that they’ve got the tools they will need to succeed. We’ve added additional funding in special education this year in the GSN—the highest contribution ever made. We’ve also added an additional $10 million to hire more psychologists and more psychotherapists, as well as other important social workers to assist these students.

We know that there is more to do in this respect. We’ve added additional funding in the Support for Students Fund. There’s more support specifically tailored for spec ed educators because we know they’re going to be important to the restart and to the success of these young people in September.

 

The Speaker (Hon. Ted Arnott): The supplementary question?

 

Mr. Joel Harden: I heard earlier the minister talking about a four-year math plan. I have a simple proposition to the government: Given this phone that the people of Ontario have given to me—they pay for it—why not a four-minute phone plan, Minister? Why not pick up the phone and call David Lepofsky from the Accessibility for Ontarians with Disabilities Act Alliance, which has given your government a brief to which they’ve heard no response yet about how they can help students with disabilities this fall? They’ve made appeals to this government, Speaker; their appeals have not been answered. Their brief is supported by 10 disability rights organizations and a major teachers’ union.

Speaker, there is no need to reinvent the wheel. All this government and all this minister needs to do is answer the voice mails, answer the multiple emails, answer the appeals.

In all sincerity, Speaker, after the break of question period, I’m happy to sanitize my phone, walk across the aisle, and give the minister—

 

The Speaker (Hon. Ted Arnott): I overlooked it the first time, but you can’t use props during question period or in the House.

Response?

 

Hon. Stephen Lecce: You know, Speaker, I actually speak to Mr. Lepofsky quite often. I spoke to him just two weeks ago in advance of our reopening plan. I’ve spoken to the AODA Alliance, and likewise I’ve spoken to the Minister’s Advisory Council on Special Education on a biweekly basis throughout this pandemic. So you don’t need to share your phone; I am in contact with him, and I care deeply about it.

In fact, it was his opinion and his recommendation to me that there be a check-in of every student by the school boards before September. We adopted that recommendation; I thought that was prudent.

Speaker, in addition, what he has also called for is additional access to support and funding. What we’ve done is increased the GSN, the largest investment in special education, because we recognize, most especially with those families, that they face challenges. We’re going to continue to invest in them.

We’re going to continue to provide mandatory professional development for all educators in the area of mental health, and we’re going to continue to ensure that there is staffing in place to help these kids succeed in September.

QP Briefing August 10, 2020

ADVOCATES FEAR ‘RASH OF EXCLUSIONS’ OF SPECIAL NEEDS STUDENTS WHEN SCHOOLS REOPEN

10.08.2020 By Sneh Duggal, Queen’s Park Briefing

Disability and autism advocates are concerned that the COVID-19 pandemic could result in principals keeping more students with disabilities out of classrooms this fall and are calling on the government to create a “consistent exclusion policy” for the province.

“We’re concerned about the real risk of a rash of exclusions and part of the problem is that principals aren’t getting enough direction and support from the province for COVID for working for students with disabilities,” said David Lepofsky, chair of the AODA Alliance advocacy group. “We are worried because we know that this power has been arbitrarily used before COVID, there’s nothing about COVID that will make that risk reduce.”

The power Lepofsky said school administrators have is outlined in the Ontario Education Act, which gives principals the right “to refuse to admit to the school or classroom a person whose presence in the school or classroom would in the principal’s judgment be detrimental to the physical or mental well-being of the pupils.”

The issue, Lepofsky said, is that there isn’t one single policy across the province, with research from his group showing that while some school boards have policies around exclusions, others don’t. With increased pressure and uncertainty around the reopening of schools during a global pandemic, Lepofsky fears “some principals could well use their power to tell some of those students with disabilities to just stay home, to refuse to admit them to school.”

Laura Kirby-McIntosh, president of the Ontario Autism Coalition and a high school teacher, noted that exclusions, which she described as the removal of a student from school for an indefinite period of time, can take different forms. Kirby-McIntosh, who raised the issue of exclusions with Lepofsky at Queen’s Park in early 2019, has previously spoken of her autistic son who she said had “one meltdown” and was kept out of school for six months.

While some exclusions might be more formalized with a letter being sent to the parent, others might be less so, she said.

“It’s that phone call you get at 10 o’clock in the morning saying ‘Johnny’s got here, but he’s not coping well, can you come and pick him up?’ It’s the call you get from the principal saying, ‘you know what, we need to start Suzy on half days, I’m not sure we’ve got enough to support her for a full day, so we’re just going to bring her in for half a day, or an hour a day.’

“Those are soft exclusions and they happen all of the time, and our kids lose hundreds of hours of instructional time to soft exclusions,” she said. “It’s a very arbitrary power; where suspensions and expulsions have very strict rules around them, exclusions are still very fuzzy and very much up to the individual discretion of the principal, and therein lies the problem.”

There is particular concern within the autism community about what could happen this fall, she noted. Thousands of children with autism have been out of routine and therapy for months, meaning some might have lost certain skills, Kirby-McIntosh said.

Returning to school in the middle of a global pandemic is a “very unusual school experience,” she said, noting that people will be wearing masks and be distanced.

“It’s a very tumultuous situation and transitions for kids with autism are hard at the best of times, but the type of transition that we’re asking them to prepare for now is a really unusual one,” she said. “You could have a kid go who experiences sensory overload, is scared by the masks, has been at home for six months and is not used to being around this many people and is overwhelmed by the smells and the sounds and the sights of all of it and as a result has a meltdown and acts out.”

“My fear is that the temptation for the principal is going to be to just use exclusion and to just say, ‘Sorry, it’s a global pandemic, we can’t keep you safe so you have to go home,'” she said.

Lepofsky said while not all students with disabilities are excluded from school, anecdotal feedback from parents over the years has suggested it is “disproportionately used on those kids.”

The AODA Alliance released a report in July detailing the results of a survey to school boards about exclusion policies. Lepofsky said half didn’t respond, but the group found that just 33 of 72 boards had any sort of policy on exclusions. He said they were “wild variations” from one board to the next, with the Toronto District School Board, for example, outlining that an exclusion can last five days and then be extended, while others set no time limit.

“These are entirely arbitrary and unfair differences,” said Lepofsky. “Before COVID and even more so in light of COVID, we need the province to step up to the plate now and to issue detailed directions setting firm practices across the province on when and how a refusal to admit can take place.” Some of the requirements he outlined included setting maximum time limits for exclusions or requiring that boards have a meeting with the family before a “refusal to admit is imposed.”

The Ministry of Education and Education Minister Stephen Lecce’s office did not directly respond to questions about whether the government would be issuing any guidance on the use of exclusions, develop a provincewide set of requirements for exclusions or support tracking the use of them.

Ministry spokesperson Ingrid Anderson stated in an email that for students with high special education needs, the government is “directing school boards to facilitate full-time in-school instruction, regardless of whether a secondary school begins the instructional year using an adapted model.”

Anderson then pointed to the $309 million the government has announced to help with the reopening of schools during COVID-19, including $10 million to support special needs students and $30 million for additional staffing for smaller classes or “other safety-related measures.”

Lepofsky said special needs funding envelopes were “underfunded before,” but that his asks aren’t about money. Identifying a provincewide attendance code that schools can use to indicate an exclusion, for example, doesn’t come at a cost, he said.

Cathy Abraham, president of the Ontario Public School Boards’ Association, said the organization is “aware of concerns about the practice of exclusions from our member school boards, as well as members of the public, and have requested that education stakeholders, including trustees, be part of any future consultation in this area.”

“The changes to suspensions, as a result of the recent passing of Bill 197, offers an opportunity for the government to consult with education partners to ensure that the term ‘exclusions’ be clearly defined. Should the government seek to consult on this, our association will be ready to provide expert advice based on feedback from trustees and senior school board staff,” Abraham said.

Ann Pace, president of the Ontario Principals’ Council (OPC), said in an email that exclusions aren’t used to discipline students, but rather “when there are serious safety concerns, such as when a student’s actions or presence is detrimental to the physical or mental well-being of other students.”

“While it is always the goal of all educators that students attend school, there are, unfortunately, some instances in which the needs of a student cannot be met due to a lack of human or financial resources,” Pace said. “When necessary, these decisions are made by a principal, but only after consulting with board officials and supervisory officers.”

She stressed that principals should be part of any conversations related to boards implementing requirements for exclusions and that consideration should be given to things like the safety and well-being of the student, their classmates, and staff, the ability of the school

to provide the needed resources and support the student and the capacity of the parent to do the same.

The OPC did say it’s open to tracking the use of exclusions.

“As long as this is not a labour-intensive process, it could be done by school principals. Indeed, it may reveal how rarely they occur,” Pace said.

As part of plans to reopen schools, one focus is on supports for students with disabilities and special needs, she added.

“School boards have implemented a transition plan for high needs students prior to the official start of the 2020-2021 school year to mitigate the issues that would create a barrier for a successful return for those students who we believe have been most impacted by a six-month withdrawal from the structure and routine of school,” said Pace. “We recognize the stress that the closure has placed on families, and we have advocated for additional supports to promote a successful transition back to school.”

An Important New Report to the Ontario Government Calls on the Government and School Boards to Take Action Now to Ensure that One Third of a Million Students with Disabilities are Able to Fully Participate in Ontario Schools as They Re-Open This Fall

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

An Important New Report to the Ontario Government Calls on the Government and School Boards to Take Action Now to Ensure that One Third of a Million Students with Disabilities are Able to Fully Participate in Ontario Schools as They Re-Open This Fall

August 14, 2020

          SUMMARY

We today share with you a very important new report that bears on the needs of a third of a million students with disabilities in Ontario-funded schools, as the COVID-19 pandemic continues. Three weeks ago, the Ford Government received a detailed report on the steps it needs to take to meet the needs of students with disabilities now and into the fall, in the face of the ongoing COVID-19 crisis. This thorough report, which we set out in full below, was written by a subcommittee of the Government-appointed K-12 Education Standards Development Committee. AODA Alliance Chair David Lepofsky serves on that Standards Development Committee and was one of the members of the subcommittee that collectively developed this report. The subcommittee included representation from the disability sector and the school board community.

We are delighted that this report includes the substance of all the recommendations that the AODA Alliance put forward in its June 19, 2020 brief to the Ontario Government on how to meet the needs of students with disabilities during school re-opening. It expands and enhances on the recommendations in the AODA Alliance‘s June 19, 2020 brief to the Ontario Government. This report also goes further, adding other important recommendations.

With school re-opening fast approaching, it is important for the Ford Government to now announce a plan to implement these recommendations. Until the Ford Government does so, we call on all Ontario school boards to review this report and implement its recommendations in their plans for school re-opening.

We encourage one and all to send this report to your member of the Ontario legislature, your school board trustee, and your local media. Email Premier Doug Ford and Education Minister Stephen Lecce. Emphasize to all of them that this report needs immediate action.

The AODA Alliance has been spearheading a campaign for over a decade to tear down the barriers facing students with disabilities in Ontario’s education system. We led the multi-year campaign to get the Ontario Government to agree to create an Education Accessibility Standard under the Accessibility for Ontarians with Disabilities Act .

For more background on these issues, please visit the AODA Alliances COVID-19 web page and our education web page. Check out the widely-viewed online video of the May 4, 2020 virtual Town Hall on meeting the needs of students with disabilities during the COVID-19 crisis, co-organized by the Ontario Autism Coalition and the AODA Alliance.

Stay safe, and let us know what you do to help us press for these reforms. Email us at aodafeedback@gmail.com

          MORE DETAILS

July 24, 2020 Letter to the Ontario Minister of Education and Minister for Accessibility from the Chair of the K-12 Education Standards Development Committee

Date: Friday, July 24, 2020

The Honourable Stephen Lecce

Minister of Education

5th Floor, 438 University Avenue,

Toronto, Ontario M7A 2A5

The Honourable Raymond Cho
Minister for Seniors and Accessibility
5th Floor, 777 Bay Street,

Toronto, Ontario M7A 1S5

Dear Minister Lecce and Minister Cho,

Re: K-12 Education Standards Development Committee: Planning for Emergencies and Safety Small Group Report

On behalf of the members of the Planning for Emergencies and Safety small group (the small group), I am pleased to submit the small group’s advice and recommendations on emergency planning and safety for students with disabilities in K-12 education during the COVID-19 pandemic.

The K-12 Education Standards Development Committee (The Committee) formed the small group when the Ministry of Education was seeking feedback from the Committee on the barriers and issues identified through the COVID-19 pandemic. The small group’s mandate includes using experiential learning from the COVID-19 pandemic to:

  • identify new and reoccurring accessibility barriers to learning for students with disabilities in the context of remote learning; and
  • develop an emergency plan framework (that covers the phases of preparing, planning, response and recovery) for a systematic response to an emergency.

The small group members have put incredible effort, time and passion to complete this report that includes valuable advice and recommendations for government consideration. The report addresses the following 9 barriers for students with disabilities as a result of COVID-19:

  1. organizational, policy and procedural barriers
  2. mental health and well being
  3. academic (learning inequities for students with disabilities)
  4. support for secondary school students with disabilities
  5. transitions between in school and virtual learning
  6. accessible communication and technology
  7. training on the integration of digital technology into learning
  8. transportation
  9. recommendations addressing barriers for the Government and School Boards in emergency planning and safety

Thank you for your shared commitment to ensuring accessibility and inclusion for students with disabilities in Ontario. We have appreciated the discussions with Minister Lecce on Grants for Students Needs funding and the school board memos that address the current work being done to support students. The barriers in our report reflect what we have heard from various educational partners, families of student with disabilities and students within Ontario. I would be happy to meet with you to discuss these additional recommendations. The work and passion of the Committee continues, and we look forward to more opportunities to share our advice and feedback with you.

Together we can create an accessible and inclusive education system for students with disabilities during this unprecedented time.

Sincerely,

(Original signed by)

 

 

Lynn Ziraldo,
Chair, K-12 Education Standards Development Committee

Attachments:

  1. Small group report

July 24, 2020 Report to the Ontario Government from the Planning for Emergencies and Safety Subcommittee of the K-12 Education Standards Development Committee

July 24, 2020


Introduction

The COVID-19 Pandemic has tested emergency plans for all levels of government, businesses, agencies, education systems, communities, families, and citizens in the province of Ontario. Many risks have been identified and challenges have arisen because of the pandemic and more continue to be identified as we move through the stages of the emergency. Emergency plans, response and procedures need to be reviewed to address these risks and barriers immediately and to improve responses to emergencies in the future.

As the Ministry of Education was seeking feedback on barriers and emerging issues identified during the COVID-19 Pandemic, the K-12 Standards Development Committee formed the Planning for Emergency and Safety Working Group with a focus on students with disabilities with the following mandate:

Using experiential learning from the COVID-19 pandemic:

  • Identify new and reoccurring accessibility barriers to learning for students with disabilities in the context of remote learning
  • Develop an emergency plan framework (that covers the phases of preparing, planning, response and recovery) for a systematic response to an emergency.

Methodology

The Planning for Emergencies & Safety Working Group gathered resources from experts including the Framework for Reopening Schools developed by UNICEF, SickKids recommendations to Reopening Schools, Letters to Minister Lecce from the Ontario Human Rights Commission of July 14, 2020; and various other resources and articles from educational partners within Ontario, other provinces and countries (See Resource Section). While reviewing the documents, the Working Group identified barriers and subsequently developed recommendations to address said barriers.

Organizational Challenges and Barriers during COVID-19

Through a review of resources, feedback from parents and guardians, agencies, health professionals and educational stakeholders’ opinions expressed, the Working Group found that students with disabilities have faced challenges compounded by COVID-19.  Their needs have been inconsistently addressed or not at all. These are some organizational, policy and procedural barriers identified:

  • Inconsistent or unclear messaging from varying levels of government, health agencies and school boards
  • Lack of or unable to access consistent data from all regions and school boards to support data driven decisions and implement actions quickly and effectively.
  • Policies and procedures outdated, non-existent, or inflexible to accommodate this type of emergency – COVID-19 pandemic.
  • Emergency response teams not reflecting the different subject knowledge needed to support decision making and development of a plan that reflects the needs of students with disabilities.
  • Inter-governmental, health service, service agencies and school board service agreements did not reflect the ability to provide services in a virtual learning environment
  • Service delivery models used by government, health services, service agencies and school boards not conducive to virtual service delivery.
  • The extent to which Board’s utilized or sought feedback from its SEACs in developing response or action plans to the COVID-19 pandemic varied from none to fully participated.
  • Not all school boards have an Accessibility Standards Committee or for those school boards that do have members of the community or people with disabilities who have lived experience that can help plan and implement the Public Health Guidelines to mitigate risks of COVID-19 in schools for students with disabilities
  • School board Accessibility Standards Committee can be helpful in helping to plan and implement the Public Health Guidelines to mitigate risks of COVID-19 in schools for students with disabilities. However, not all school boards have such committees, or committee membership that includes members of the community or people with disabilities who have lived experience that can inform planning and implementation.

Key Recommendations for Planning for Emergencies

It is important in planning for return to school, the opportunity is taken to review and create structures, policy and procedures that can adapt and be more flexible for a 2nd wave or future emergencies.

By learning from innovations and emergency processes, systems can adapt and scale up the more effective solutions. In doing so, they could become more effective, more agile, and more resilient” – (quoted from THE COVID-19 PANDEMIC: SHOCKS TO EDUCATION AND POLICY RESPONSES, World Bank).

There are 5 known steps to Emergency Planning and Preparedness: 1) Know your risk, 2) Build your Team, 3) Make critical information accessible quickly, 4) Update alert and response procedure, 5) Test the plan and revise.

To eliminate barriers identified, that a return to school plan has input from end users, be designed through an inclusive process and not by one team or group. A team of subject expertise from across the organization is critical for developing a strong plan.

Recommendations – Government

For the above reasons, it is recommended that

  • The Ministry of Education should establish a Central Education Leadership Command Table with responsibilities for ensuring that students with disabilities have access to all accommodations and supports they require during the present COVID-19 pandemic. The responsibilities of the Command Table shall include:
    1. immediately develop a comprehensive plan to meet the urgent learning needs of students with disabilities during COVID-19 pandemic quickly and resolve issues for students with disabilities as they arise. The comprehensive plan should be shared for implementation by school boards. This plan should include and incorporate the three options for education:
  • normal school day routine with enhanced public health protocols
  • modified school day routine based on smaller class sizes, cohorting and alternative day or week delivery, and,
  • at-home learning with ongoing enhanced remote delivery
    1. collect and share data on existing and emerging issues as a result of COVID-19, the effective responses of other jurisdictions in supporting students with disabilities during the current emergency, using evidence base data collection method for people with disabilities
    2. establish a fully accessible centralized hub, and share and publicize the hub, for sharing of effective practices about supporting students with disabilities
    3. develop a rapid response team to receive feedback from school boards on recurring issues facing students with disabilities and to help find solutions to share with school boards
    4. provide clear communication and guidance on school opening, health service delivery, etc. based on data collected.
  • The government/Ministry of Education shall establish a cross sectorial Partnership Table at provincial and regional levels with the responsibility to integrate, coordinate and foster cross sector planning and response to emergencies. Responsibilities of this table are to:
    1. enhance an interlinked, coordinated and inter-ministerial approach in providing a seamless service delivery model to provide services and supports to students with disabilities (Psychology, Physical Therapy, Speech Therapy, Mental Health, etc.).
    2. collect data now, from respective sectors, health services, education, service agencies, etc. to identify existing and emerging barriers, know exactly which students with disabilities and how they are impacted, their needs, and how to better direct resources to support them
    3. provide clear communication and guidance on school opening, health service delivery, etc. based on data collected to ensure accessibility for students with disabilities.
  • The Ministry of Education provincial and regional partnership tables should include advisors that can provide insight on the needs and challenges of students with disabilities from lived experience and the collective experience of disability support groups, as well as students with disabilities.
  • The Ministry of Education should assign staff to assist the Central Educational Command Table by serving as a central rapid response team to receive feedback from school boards on recurring issues facing students with disabilities and to help find solutions to share with school boards.
  • The Ministry of Education should direct that each school board shall establish a similar Board Command table. (See recommendation 12 for School Boards).
  • The provincial government continue and enhance an interlinked, coordinated and inter-ministerial approach in providing a seamless service delivery model to provide services and supports to students with disabilities (Psychology, Physical Therapy, Speech Therapy, Mental Health, etc.).
  • The Ministry of Education should collect and aggregate International data, resources and information from other countries experiences for use in planning transitions between in-school and distance education, including continuation of virtual learning at home.
  • The Ministry of Education should developed comprehensive plans for students with disabilities that addresses the surge in demand and increase capacity to provide specialized disability supports, including enhanced staffing, for the return to in-class and distance learning (increase in in-class supports, social workers, psychologists, guidance counsellors)
  • The Ministry of Education should develop guidelines that provide for alternate or enhanced childcare opportunities to be made available to families of students with a disability, for students required to stay home due to adapted model classroom scheduling. (Excludes childcare needs that are related to quarantine self-isolation for child or family due to exposure or a local outbreak of the virus.)
  • To get the most from the volunteer work of SEACs around Ontario, the Ministry of Education should:
  1. a) Create and maintain a listserv or other virtual network of all Ontario SEACs, to enable them to share their efforts with all other SEACs around Ontario, and
  2. b) Frequently gather input from SEACs around Ontario about the experiences of students with disabilities during the COVID-19 crisis to inform future policies and regulations and directions for school boards.
  • To promote transparency, accountability and identify trends, the Ministry of Education should immediately issue a policy direction for boards to create an exclusion policy, that imposes restrictions on when and how a principal may exclude a student from school, including directions that:
  1. a) Does not impede, create barrier, or disproportionally increase burdens for students with disabilities the right to attend school for the entire day as do students without disabilities. The power to refuse to admit a student to school for all or part of the school day should not be used in a way that disproportionately burdens students with disabilities or that creates a barrier to their right to attend school.
  2. b) Tracks exclusions and provide a transparent procedure and practice to parents/guardians, by requiring a principal who refuses to admit a student to school during the school re-opening process to immediately give the student and their parent/guardian written notice of their decision to do so, including written reasons for the refusal to admit, the duration of the refusal to admit and notice of the parent/guardian’s right to appeal this refusal to admit to the school board.
  3. c) Tracks exclusions, increases accountability and informs policies by requiring a principal who refuses to admit a student to school for all or part of the school day to immediately report this in writing to their school board’s senior management, including the reasons for the exclusion, its duration and whether the student has a disability. Each school board should be required to compile this information and to report it on a regular basis to the board of trustees, the public and the Ministry of Education (with individual information totally anonymized).
  • The Ministry of Education should provide clear guidelines and expectations to school boards on the implementation of Public Health Guidelines to mitigate risks of COVID-19 to ensure that school buildings and grounds be fully accessible for students with disabilities.

Recommendations – School Boards

  • School Boards should establish a similar Board Command/Central table as the Ministry of Education’s Central Education Command/Central Table, to receive and act on feedback from teachers, principals and families about problems they are encountering serving students with disabilities during the COVID-19 period. The Table will quickly network with similar offices/Tables at other school boards and can report recurring issues to the Ministry’s command table.
  • School Boards should utilize the expertise of the Special Education Advisory Committee members by directly involving members in the planning for the delivery of remote learning, other emergency plans, through regular meetings and frequent communications.
  • School Boards should enhance its hub of resources with successful practices, lesson plans, resources specific to students with disabilities in a virtual learning environment for ease of access and support teachers and students in their learning.
  • School Boards should involve their Accessibility Committee, or if there is no committee to establish an Accessibility Advisory Committee which will review all plans at the school board and school level for mitigating risk of COVID-19 meet the accessibility requirements of all students or people with disabilities.
  • School Boards should assign a leadership staff member responsible for ensuring that all changes at schools in response to COVID-19 maintain accessibility for all students with disabilities.

Mental Health & Well Being

As found through the review of resources, student and family mental health & wellbeing needs have soared to due to the traumatic effects of COVID-19. Students wellbeing has suffered for a variety of barriers: effects of isolation from social distancing, increased rise in domestic violence, lack of access to school breakfast programs, lack of access to mental health & therapeutic services, and negative financial impact to family’s income to name a few.

Barriers

  • Agencies, different levels of government and school boards developing plans and working on solutions to barriers with little or no coordination
  • Support for parents with students with complex needs are insufficient
  • Health services and supports not consistently or sufficiently prepared to provide health and mental health services in a virtual setting
  • There is a flood of information and resources being presented to teachers, parents and students
  • More inter-ministerial leadership and collaboration between Ministries of Education (MOE), Community, Children & Social Services (MCCSS) and Health (MOH) is required
  • School Boards and staff must be equipped with appropriate PPE for their own health and wellbeing
  • Need to safely deliver additional supports such and as breakfast & nutrition programs provided by community agencies
  • Plans for the next phase include a return to in-class and virtual instruction, including adapted models whereby some students will be scheduled at home on an alternate day or alternate week basis. Having students at home for short or long periods (alternate day to full semester) will be a significant challenge for families and may prevent the return to work for many parents. Some parents of children with disabilities face barriers to employment, and many others are overburdened with providing 24-hour care to students with complex care needs.

Recommendations – Government

  • The government should enhance the central hub of mental health & wellbeing information resources at provincial and regional levels with key messages and links to other resources. Ensure all resources are in an accessible digital format (as per Integrated Accessibility Standards Regulation), well publicised and shared with school boards.
  • Ministries should review and increase capacity of Ontario Telehealth Network (OTN) and other privacy protected health platforms to allow for boards to use (even in non-emergency times) and deliver services by regulated health care professionals that protect the privacy of the health services and IPRCs.
  • Ministries of Education, Health and Children, Community & Social Services should remove any cross-jurisdictional barriers related to the provision of health and education services to ensure students with disabilities can be provided with the mental health & wellbeing services they require to be delivered remotely. (For example, under Policy/Program Memorandum (PPM) 149, Protocol for Partnerships with External Agencies for Provision of Services by Regulated Health Professionals, Regulated Social Service Professionals, and Paraprofessionals permit electric consent for services and virtual access to services for students with disabilities).
  • The Ministry of Education should provide funding and clear guidelines on use of Personal Protective Equipment (PPE) and protocols for detection and containment of COVID-19 for boards, staff and all students, including those with disabilities. Public health authorities should establish clear protocols for the detection and containment of COVID-19 (and other infectious diseases) for school boards. The guidelines and protocols should be flexible for school boards to react to local situations to mitigate risks.
  • The Ministry of Education’s plan for school re-openings must include detailed directions on required measures to mitigate risk for students with disabilities from COVID-19 to maintain their health and wellbeing during any return to school. This requires additional planning in advance by school boards and additional funding to school boards to hire and train the additional Special Needs Assistants (SNA) and Educational Assistants (EA) they will need to ensure the safety of students with disabilities. It also requires safeguards to ensure that EAs or SNAs do not work at multiple sites and risk transmitting the COVID-19 virus from one location to another.
  • Ministries should review policies and regulations to continue to permit the virtual provision of therapy supports and services that have transitioned successfully to a virtual learning environment and where possible, permit and foster increased access to therapies and services to areas in province where a lack of services exists.

Recommendations – School Boards

  • Many students with disabilities volunteer at school events, in school daycares, kindergarten classes as part of their learning plan, IEP or fulfilling the 40 hours volunteer requirement. School Boards should develop/review guidelines for students with disabilities who volunteer in school to limits risk to health and safety but does not stop this valuable learning experience for students with disabilities.
  • Many adults with disabilities volunteer in schools and school daycares for the opportunity to exist as a valued contributing member within their community. School Boards should develop guidelines for people with disabilities who volunteer within the school that limits risk to the health and safety but continues to have the opportunity to be a contributing member of the school community.
  • School Board should provide virtual learning opportunities for volunteering and co-op courses for students with disabilities. Resources and guidelines should be developed to create the opportunity for the student to complete volunteering hours or cooperative credits successfully.
  • School Boards should develop and/or review guidelines for transitions plans for students with disabilities to outline supports and accommodations that may be offered in a virtual learning environment or enhanced by online tools and resources to support the physical and emotions wellbeing of student with disabilities when transitioning back to school. Accommodations or strategies should be reviewed and adapted to the virtual learning environment to support transitions. (An example would be for students with disabilities have access to audio described (DV) and closed-captioned (CC) virtual tours of the school facilities, so students could familiarize themselves with the school prior to the start of school. (See also Transition section).
  • In consultation with community agencies, School Boards should develop/revise procedures and protocols for volunteers and community agencies that support the health and wellbeing of students with disabilities continue to operate in the school (Example, Food nutrition programs, clothing exchanges, etc.)
  • In consultation with Public Health Regional Health, School Boards must develop clear protocols and procedures with accommodations for students with disabilities for the detection, isolation, tracing and follow up those students who develop symptoms for the virus, flu, respiratory infection, etc. For example: Ensure dedicated space to isolate students with disabilities who may need to return home is accessible and provides the accommodations required to meets the needs of any students with disabilities.

Academic

The pandemic has had profound impacts to student’s learning and staff’s ability to provide a learning environment that promotes student success and achievement. Learning inequities for students with disabilities have increased throughout the pandemic due to barriers faced. Some of the barriers identified were:

Barriers

  • Ongoing accessibility issues with online and virtual learning resources provided for learning at home
  • Wealth of resources, tools, etc. being developed by Boards, Agencies and Associations with limited sharing of resources. Resources developed may not be accessible.
  • Virtual learning is not working for many students with disabilities
  • Many students with disabilities were not effectively engaged in virtual learning for a variety of reasons, including accessibility challenges with the internet, computer software and hardware, nature of resources provided, individual challenges related to format, capacity of family, or behaviour.
  • Closure of schools for 3 months has resulted in significant loss of learning for many students
  • Special Education Advisory Committees meetings have been cancelled and some the skills and knowledge of SEAC members has not been fully utilized.
  • Teachers, students and parents were not prepared for the sudden transition from in-class instruction to the virtual learning environment and planning for future interruptions of schools would benefit from proactive planning for education in a virtual instruction and learning environment.

Recommendations – Government

  • The Ministry of Education should develop curriculum for students from Kindergarten to Grade 12 to enable students to develop the skills and knowledge they need for learning in a virtual learning environment. In the interim, the Ministry should share existing, accessible resources on this topic to teachers and School Boards (Please see Training for additional recommendations)
  • The Ministry of Education should collect and make readily available resources/information on practices, effective strategies in learning environment, and alternate approaches for students struggling with online learning, etc. from School Boards, agencies and disability specific associations.
  • Ministry of Education should provide clear expectations for teacher led instruction, synchronous learning, and weekly teacher student-teacher connections for students who are participating in virtual instruction and learning. Expectations should include monitoring if students with disabilities are fully participating, learning and benefiting from these activities; and if not, action to address barriers or issues identified.

Recommendations – School Board

  • School Boards should assess and document accommodations, modifications, resources and supports for all students with disabilities to plan for transition back to school and continuation of virtual instruction and learning. (Please see Transitions Recommendations for details)
  • School Boards should develop and provide all resources for instruction and assessment materials, homework assignments in an accessible digital format (See Communications & Technology section for recommendation on accessible digital format).

Secondary School

The secondary school experience is different from elementary school. It is where students develop, time management, organizational, advocacy skills, networking and social skills, become more aware of community and identify career paths. It is for this reason, the Working Group felt it was important to identify barriers and make recommendations specific to secondary students. Many of these recommendations can benefit the entire secondary school student population.

Barriers

  • Students with disabilities have experienced little to no personal contact with their school community social network supports (classroom teachers, Educational Assistants, custodians, administrative assistants, etc.), who rely on this contact to maintain their engagement within the school community and preserve their mental health.
  • At any time, students with disabilities have very limited opportunity to fulfill the 40 hours of volunteering required for graduation and rely heavily on volunteering at their high school or local elementary school events. All opportunities for volunteering were eliminated during the pandemic.
  • Many students with disabilities take optional specialized courses such as Specialized High School Major (SHSM), cooperative credits, etc. which provide hands on and participation within the community. Hands on learning, skills in applicable to trades and life skills were significantly diminished during COVID-19.
  • Clubs, councils, sports teams and extracurricular activities are a formative and important part of the high school experience. Often these extracurricular activities are the only opportunity students with disabilities has to socialize with their peers. Not having access to extracurricular activities has impacted their mental health and well-being.
  • Many students with disabilities rely on in class instruction be it due to learning disability, anxiety, learning style, ADHD, or simply due to preference in the way they individually learn, among others. The loss of in-class instruction has significantly impacted their learning and future for success.
  • Learning at home during school closure has been challenging for students in terms of academic achievement, mental health and wellbeing
  • All four years of high school are an integral part of a young person’s development and a multitude of students require and rely on in class instruction be it for specialized courses That require specialized equipment, trained staff;
  • The experience of four years of high school are incredibly formative of a young person’s social, emotional, mental and physical relationship with society, the world around them and indeed the values they will build their life around;
  • Return to school planning must consider the impacts on minority & racialized students, students in abusive households, students with limited access to technology or broadband, students with disabilities and students with other complex learning needs;
  • Many students rely on in class instruction be it due to learning disability, anxiety, learning style, ADHD, or simply due to preference in the way they individually learn, among others;

Recommendations – Ministry

  • The Ministry of Education should allow high school in-class instruction to operate for the 2020-2021 school year, if authorized by Ontario’s Chief Medical Officer of Health.
  • The Minister should direct School Boards to continue courses which require specialized forms of equipment, classrooms, teaching staff and/or resources (science labs, shops, media classrooms) continue to operate, in accordance with local public health advice.
  • As per the Canadian Mental Health Association, 70% of mental health challenges have their onset in childhood or youth and the Kids Help Phone Line has seen a increase in demand, The Ministries of Education and Health should increase capacity of mental health professionals and supports for School Boards, to ensure there is no waitlist for any secondary student requiring support.
  • The Ministry of Education should include student voice through student trustees’ association or other student leaders, when developing a plan for return to school.
  • The Ministry of Education should waive the compulsory credit in Health & Physical Education for students who have entered secondary school in the 2020-21 school or whose timetable will be negatively impacted, should Physical Education classes not operate in the conventional manner.
  • If required by Public Health, the Ministry of Education should fund PPE for students and staff to mitigate risks of infection.
  • The Ministry should direct School Boards to develop a prioritization and execution plan for conducting clinical assessments (e.g., psycho–educational assessments) that students with disabilities require in order to access necessary supports and services as they transition from secondary to post-secondary destinations.

Recommendations – School Board

  • School Boards and Schools should include student voice, including students with disabilities in developing the Board return to school plan, as well as, individual school return plans respectively.
  • School Boards and Schools should provide clear instruction on proper personal protection equipment (PPE) and safety measures to students, parents, and staff.
  • School Boards should follow or mirror Public Health protocols prescribed by the local Public Health. If PPE is not required by the local Public Health, student have the choice to wear PPE. If PPE is required, that school boards are funded appropriately to provide PPE for all students and staff.
  • Where local public health advice can be adhered to, Schools should continue to offer extracurricular activities such as clubs, councils, teams using proper social distancing and general safety protocols.
  • Where applicable, School Boards should waive parking fees for students to reduce financial burdens and help mitigate health risks for students by not riding on a crowded public transit bus.
  • School Boards should make decisions pertaining to cancellation of extracurricular activities in school mirror that of activities outside of school. (Example: If soccer clubs operate locally, then soccer clubs in schools should continue to operate).
  • School Boards should develop and offer online programming for students who cannot or wish not to attend school in person, but not be considered a long-term alternative to in class instruction.
  • School Boards and schools seek out the voice of students, including voices of students with disabilities, when they develop return to school plan options.
  • School Board should develop guidelines for clubs or programs that supplement or enhance education for students with disabilities so they can continue to operate upon return to school.
  • School Boards should continue to offer where possible, alternate classrooms, quiet workspaces, and other special education requirements prescribed in a student’s Individual Education Plan (IEP).
  • School Boards should research and investigate potential online coop placements that may be available for all students; including students with disabilities.
  • When permitted under local health advice, the School Board should review new health and safety protocols with student and the coop placement provider.

Transitions

An impact of the pandemic for students with disabilities is that learning has been lost or stagnant. Learning recovery will be important when returning to school. This will mean targeted measures to reversing learning loss or closing gaps. There will be a need for clear system wide guidance for in-class and central assessments to inform and plan for curriculum delivery, supports and service upon return to school.

Transition planning will occur at the provincial, local and student level. The Ministry of Education will need to identify barriers and gaps from all educational stakeholders to develop an informed return to school plan. School boards will need identify barriers and gaps at a system and individual student level to create an informed back to school plan as well as address the needs for students with disabilities.

The Individual Education Plan (IEP) is a tool for documenting student strengths and needs and the accommodations, programs and services they require to be successful. IEPs are a valuable tool in documenting the student’s current level of achievement and transition plans for planned changes in grades, schools, and life after secondary school. The IEP can also be used to plan for return to school, full time or in an adapted model, or for continued virtual learning.

Barriers

  • During the school closure gaps in student skills and knowledge related to on-line and distance learning has been evident
  • Planning for school year 2020-2021 will include in school and distance learning
  • School staff will need to assess student’s with disabilities to determine their accessibility and learning needs
  • Students with disabilities individual IEPs and transitions plans need to be reviewed to address barriers and gaps to allow for student success.
  • Student voice often forgotten in the planning process
  • Students and prospective students cannot visit the physical environments of schools during the COVID-19 pandemic and do not have the opportunity to check for physical accessibility and familiarize themselves with environment

Recommendations – Government

  • The Ministry of Education should direct School Boards to develop a prioritization and execution plan for conducting clinical assessments (e.g., psycho–educational assessments) that students with disabilities require, in order to access necessary supports and services as they transition from secondary to post-secondary destinations.
  • The Ministry of Education, in partnership with MCCSS should work with school boards to identify their cohorts of students with intellectual and other disabilities who completed their school careers in June 2020 and identify and assess if barriers faced during COVID-19 did not allow for successful student transitions to their chosen pathway (Examples: to work, volunteer work, recreation/leisure programs, and post-secondary education) as outlined in their transition plans. Jointly, the Ministries and School Boards should develop plans to help this cohort of students with disabilities achieve their individual transition goals.

Recommendations – School Boards

  • School Boards should be independently collecting board wide data on gaps, barriers, emerging issues, transition challenges, technology challenges, additional students’ needs and supports arising or as a result of COVID-19 through assessment, student and parent feedback to address and plan for system wide supports and services required by students with disabilities upon return to school.
  • To help with successful transitions for student with disabilities in returning to school, School Boards shall contact parent/guardians, as soon as possible, to discuss and identify learning gaps, individual needs arising from school shutdown and distance learning, transition challenges, social and emotional needs to inform and revise/or create individualized transition plans for students with disabilities.
  • To help reduce stress and anxiety and prepare themselves for return to school, students with disabilities should be involved with discussions and decision made in developing their Transition Plan.
  • School Boards and Administrators shall ensure Individual Education Plans for students with disabilities are revised/created to reflect specific goals and activities to address the individual needs identified in Recommendation #3 to help increase academic and transition success for each student with a disability upon returning to school.
  • School Boards shall include the student when developing their individualized Transition and IEP. All
  • When School Boards develop the Individualized Transition Plans for each student, it should be:
    1. flexible to accommodate the stop and start of in class learning. All methods of instruction should be considered for learning to ensure students have access to an education (virtual instruction, in home instruction, etc.)
    2. include a flexible and hybrid model for entry needs to accommodate the varying student needs. Any model developed for return to school shall be developed in consultation with parent/guardians and student
    3. include strategies for students around social/physical distancing. Social distancing guidelines should be developed in consultation with parents/guardians and student.
    4. Include steps for follow up and checking in with the student
    5. All documentation or information be provided to the parent/guardian and student before the meeting with enough time to review. Documents should be provided in an accessible format.
  • School Boards should take more interactive approaches to collect on-going feedback from parents, students and staff (i.e. “Thought exchange”) to guide and inform changes to policies and procedures impacted by COVID-19.
  • School Boards should develop a clear system wide plan to address increased classroom and school supports and services (Educational Assistants, Education Works, social workers, psychologists, guidance councillors) identified through assessments to help mitigate issues and support learning for students with disabilities.
  • School Boards should create audio described (DV) and closed-captioned (CC) virtual tours of their school. The virtual tour must be fully accessible and thoroughly provide information on accessibility and locations at the schools. Virtual tours should be made permanently available; not just during the pandemic.

Communications & Technology

For our purpose, communication includes technologies, systems, protocols and procedures that enable an organization to effectively communicate to its employees, partners and community. During an emergency, communication is essential and should ensure all relevant personnel can quickly and effectively communicate with each other during such crises, sharing information that will allow the organization to quickly rectify the situation, protect employees and assets, and allows the business to continue.

To relate this to Education – government, school boards, agencies, staff, students, parent/caregivers, should have the ability to communicate effectively during a crisis, while the business of providing learning continues.

Barriers

  • Ongoing accessibility issues with virtual learning environment or platform (Examples: no closed captions, compatibility issues with screen readers, lack of support or knowledge of accessibility features, no ASL interpretation)
  • Ongoing accessibility issue with information and resources provided
  • Conflicting guidelines provided by different ministries and level of government.

Recommendations – Government

  • That a designated communication lead should be assigned at the provincial and regional level for consistent messaging.
  • For efficiency and elimination of duplication of effort for School Boards, The Ministry of Education should immediately engage an arms-length digital accessibility consultant to evaluate the comparative accessibility of different digital learning and virtual learning environments or platforms available for use in Ontario schools. This should involve end-user testing. The Ministry should immediately send the resulting report and comparison to all school boards and make it public. This should be revisited as the fall approaches, in case there have been changes to the relative accessibility of different virtual instruction environments or platforms.
  • The Ministry of Education should provide a list of acceptable accessible, cross platform virtual learning environments and synchronous teaching systems to be used by school boards.
  • The Ministry of Education should make public a plan of action to swiftly make its own online learning content accessible for people with disabilities, setting out milestones and timelines, and should report to the public on its progress.
  • The Ministry of Education should immediately direct TVO/TFO to make its online learning content accessible to people with disabilities, and to promptly make public a plan of action to achieve this goal, with specific milestones and timelines. The implementation of this recommendation has become urgent since Royal Assent was given to Bill 197, COVID-19 Economic Recovery Act, 2020 as amends to the Ontario Educational Communications Authority Act broaden the mandates of both TVO and TFO to position them to provide centralized support for online learning in the English-language and French-language publicly-funded education systems, respectively.
  • The Ministry of Education should direct its entire staff and all School Boards that whenever making information public in a Portable Document Format (PDF), it must at the same time, make available a textual format such as an accessible Microsoft Word (MSWord) or accessible HTML document. Videos must be audio described (DV) and closed captioned (CC). Templates and technical guides should be developed and provided to school boards.

Recommendations – School Boards

  • For consistent messaging, that the School board should designate a communication lead for COVID-19 related issues.
  • School Boards should develop protocols and procedures to mitigate security risks for online and virtual learning platforms to help protect privacy of students with disabilities and staff. Online and virtual learning platforms should also be accessible for all students with disabilities.
  • That School Boards should provide clear communication around protocols and return to school plans. Boards should make written communications readily available and accessible by everyone in the community, parents and students.
  • School Boards should review and revise instructional videos for parents around virtual learning tools used in the school board. Videos must be clear and accessible.
  • School Boards should provide solely dedicated or designated staff, who are available to support technology including accessibility needs to parents who are supporting the learning needs of students with disabilities at home.

Training

The COVID-19 Pandemic has changed the way in which education is delivered. Students, parents/guardians, teachers, staff, school boards and government had to change the way they access, support or deliver education. The pandemic highlighted gaps in digital skills, adaptation of technology to teaching and learning. It has also increased demand for technology and the need to integrate technology effectively into teaching and learning. With this increased demand in the use of technology and the gaps in digital skills identified, it is imperative to train students, parent/guardians and staff in the use and integration of technology in teaching and learning.

Barriers

  • Teachers, students and parent/guardians unprepared for learning at home and use of virtual platforms such as google classroom, Microsoft teams, Zoom for individual and synchronous learning
  • Teachers, ECEs, Staff need training in virtual online learning platforms
  • Teachers, ECEs, Staff need training in strategies to support students with disabilities around transitions between education models, including preparation for changing environments and self regulation
  • Teachers, ECEs lack training in strategies to support Public Health directed precautions, such as social distancing, sanitizing procedures and use of PPE when required to support students
  • School closures have had a significant impact on the mental health and well being of students with disabilities and teachers, ECEs, staff will require training on child development and trauma informed practice to assist them in supporting students in transitioning back to school or continuation of virtual education.
  • The expectation on parent/guardians to support students with learning at home were significant and parents need supports and training in virtual learning software and how they can effectively support their child’s learning.

Recommendations – Government

  • That Ministry of Education should model leadership to School Boards and provide accessible virtual learning webinars, templates for learning, etc. to be utilized in training administrators and teachers.
  • The Ministry of Education should direct School Boards to provide all staff training in child development, mental health and wellbeing to support the wellbeing and learning of students with disabilities.
  • The Government should provide direction to School Boards and Public Service agencies to develop a coordinated training delivery model to support parents of students with rehabilitation needs, mental health concerns or who have complex or significant medically needs, with the delivery of virtual care, including privacy protected health platforms such as OTN, ADcare.

Recommendations – School Boards

  • School Boards should provide focused, practical training for administrators and teachers to support students with disabilities’ health, wellbeing and learning in a mixed or virtual environment.
  • School Boards should provide administrators training and guidelines on supporting students with disabilities through transitioning and change.
  • School Boards should develop parent training modules and resources to enable parent/guardians to develop the skills and knowledge required to support online and virtual learning at home for students with disabilities.
  • School Boards should provide training for teachers and staff on specific tips and solutions, successful and evidence based promising practices by disability to support teachers and students with disabilities learning. These should be made available as soon as possible or at the latest, during the first days of PD before school instruction begins.

Transportation

School Bus operation and delivery of bus services is regulated and governed both federally and provincially. Transport Canada has consulted with the Public Health Agency of Canada to provide guidelines around bus operations during the pandemic. The National Association for Pupil Transportation (NAPT) has also provided general guidelines for the provision of student (pupil) transportation services.

The Ministry of Education’s Return to School Framework directs School Boards to follow these federal guidelines.

To accommodate Federal Transportation and Public health guideline that require social and physical distancing, School Boards will have to revise transportation services delivery that will impact bus routes, increase the number of buses and drivers required, increase ridership time, etc. to mitigate risks to students with disabilities while transporting to and from school.

Barriers

  • Lack of or reduced public transportation available for students with disabilities, particularly for secondary students who take public transit. Municipal governments eliminated routes or reduced schedules during COVID-19. Municipalities have not made public transportation plans for when students return to school.
  • As School Boards and Consortiums plan transportation services to meet the Transport Canada guidelines, current challenges of inadequate buses, shortage of drivers and increasing fuel costs will be a barrier to boards.
  • Changes to routine can have a significant impact to a student with disabilities’ mental health, success for the start of school day and learning. Predictable changes to transportation for students with disabilities can include, increased ridership time, bus route, bus type (72-passenger, small bus), supports or accommodations required for a successful ride, etc. while maintaining safety and mitigating risks for infection.
  • Many School Boards currently overspend the transportation grant, while still achieving a high efficiency rating from the Ministry of Education. The additional requirements defined under the Transport Canada Guidelines will increase cost pressures to provide transportation services to students with disabilities while maintaining safety and mitigating risk of infection.
  • As students with disabilities require may require specific transportation accommodations such as a safety harness, seat belt, wheelchair accessible which cannot be accommodated in all vehicle types.

Recommendations – School Boards

  • As many School Boards overspend its transportation grant while maintaining a high efficiency rating, the Ministry of Education should provide school boards with additional COVID-19 specific funding to follow the guidelines as provided by Transport Canada around:
    • Measures to mitigate risk of exposure
    • Procedures to be taken before a trip, during a trip and at the end of the trip
    • PPE guidelines
    • Physical Distancing
    • Shield and Enclosure system guidelines (if bus operators choose to do so)
  • School Boards should review transportation accommodations and requirements, in consultation with parents and student, IEPs of students with disabilities who require transportation services to identify any change/modifications to accommodations required. The student’s IEP shall be modified to reflect additional requirements to transport the student safely on the bus. The review for medically fragile students should include professionals, such as nurses, occupational therapists, as well as parents. All transportation requirements shall be relayed to the Bus Consortia and administrator of the school for implementation.
  • School Boards must create/revise a protocol for the safe gathering of all students and parent/guardians at bus stops and safety on the bus. It is important that student with disabilities be included and familiarized with these protocols with their peers.
  • School Boards and Bus Consortia should provide bus drivers with training on new health and safety protocols for students with disabilities on a regular bus, small bus and wheelchair accessible bus.
  • Bus Consortia should minimize changes to routes, vehicle type, and schedules for students with disabilities while developing changes to routes, to limit increased anxiety or behaviours as a result of the changes. When changes are considered, parents and student should be consulted about changes.
  • School Boards and Bus Consortia should review procedures and protocols for persons responsible for putting a student with disability’s harness on/off or supporting a student on the school bus to mitigate health risks for the student, bus driver and support person.
  • School Boards and Bus Consortia should revise/develop, implement and disseminate bus safety protocol Information for parents needs to help mitigate health and safety risks and assuage parent’s fears. This includes protocols around harnesses. All communications should be clear and made readily available on the Board and Bus Consortia website in an accessible digital format.
  • Students with disabilities should be included in any training that is provide for all students on enhanced safety rules on the bus.
  • As students with disabilities are statistically proven to be at a higher risk of infection, School Boards and Bus Consortia should implement enhanced student bus ridership attendance procedures to aid in tracing of COVID-19 and mitigating health risks.
  • Traffic volume, student and road safety is always a concern around schools. It is expected for vehicle traffic to increase when school returns, as parent/caregiver or a secondary student chooses to drive to school. School Boards should work collaboratively with Municipalities to develop safe arrival and departure awareness campaigns for students, parents/caregivers and buses. These campaigns could include guidelines for kiss & ride, audio described (DV) and closed captioned (CC) virtual or diagrams of vehicle traffic flows for entering and exiting school property from the street, identifying school bus only access areas, promote other methods of transportation, etc.

Conclusion

The Planning for Emergencies are please to provide its draft recommendations related to the COVID-19 pandemic. The Working Group will continue to review resources and information on barriers and issues arising from COVID-19 and as students return to school. It will start work on its mandate to develop an emergency plan framework focused on students with disabilities (that covers the phases of preparing, planning, response and recovery) for a systematic response to an emergency.

Thank you to all the members of the Planning for Emergencies Working Group for their dedication in developing this draft set of recommendations. Working Group members are:

  • Donna Edwards (Chair – Working Group)
  • Stephan Andrews
  • David Lepofsky
  • Dr. Ashleigh Malloy
  • Alison Morse
  • Rana Nasrazadani
  • Ben Smith
  • Angelo Tocco
  • Dr. Lindy Zaretsky
  • Lynn Ziraldo (Chair K-12 SDC)

Glossary

Accessibility: a general term for the degree of ease that something (e.g., device, service, physical environment and information) can be accessed, used and enjoyed by persons with disabilities. The term implies conscious planning, design and/or effort to make sure something is barrier-free to persons with disabilities. Accessibility also benefits the general population, by making things more usable and practical for everyone, including older people and families with small children.

Accessible: does not have obstacles for people with disabilities – something that can be easily reached or obtained; facility that can be easily entered; information that is easy to access.

Accessible digital format: Information that is provided in digital form that is accessible such as HTML and MS Word.

Synchronous learning: is the kind of learning that happens in real time. This means that you, your classmates, and your instructor interact in a specific virtual place, through a specific online medium, at a specific time. In other words, it’s not exactly anywhere, anyhow, anytime. Methods of synchronous online learning include video conferencing, teleconferencing, live chatting, and live-streaming lectures.

Asynchronous learning: happens on your schedule. While your course of study, instructor or degree program will provide materials for reading, lectures for viewing, assignments for completing, and exams for evaluation, you have the ability to access and satisfy these requirements within a flexible time frame. Methods of asynchronous online learning include self-guided lesson modules, streaming video content, virtual libraries, posted lecture notes, and exchanges across discussion boards or social media platforms.

Distance Education Program: Programs to provide courses of study online, through correspondence, or by other means that do not require the physical attendance by the student at a school. (From Bill 197)

Special Education Services – As defined in the Education Act, “facilities and resources, including support personnel and equipment, necessary for developing and implementing a special education program”.

Virtual learning: is defined as learning that can functionally and effectively occur in the absence of traditional classroom environments (Simonson & Schlosser, 2006).

Virtual education: refers to instruction in a learning environment where teacher and student are separated by time or space, or both, and the teacher provides course content through course management applications, multimedia resources, the Internet, videoconferencing, etc. Students receive the content and communicate with the teacher via the same technologies.

Virtual learning environment: refers to a system that offers educators digitally-based solutions aimed at creating interactive, active learning environments. VLEs can help educators create, store and disseminate content, plan courses and lessons and foster communication between student and educator. Virtual learning environments are often part of an education institution’s wider learning management system (LMS).

Virtual instruction: is a method of teaching that is taught either entirely online or when elements of face-to-face courses are taught online through learning management systems and other educational tools and platforms. Virtual instruction also includes digitally transmitting course materials to student.

Resources

Mental Health

Public Health Guidance and Safety

 

Tools/Best Practices

Stakeholder Reports and Information

Additional Reading

Ford Government to Spend Over a Half Billion Dollars on New Schools and Major School Additions, Without Announcing Effective Measures to Ensure that These Schools Will be Fully Accessible to Students, Parents and School Staff with Disabilities

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

Ford Government to Spend Over a Half Billion Dollars on New Schools and Major School Additions, Without Announcing Effective Measures to Ensure that These Schools Will be Fully Accessible to Students, Parents and School Staff with Disabilities

July 30, 2020

          SUMMARY

Last week, the Ford Government announced that it is investing over half a billion dollars into building new schools and expanding existing ones, without announcing any effective measures to ensure that those schools will be designed to be accessible to students, parents, teachers, or other school staff with disabilities. Public money should never be used to create new barriers against people with disabilities. If new barriers are created, it costs much more to later renovate to remove them.

For years, Ontario’s Ministry of Education has largely left it to each school board to decide what, if anything, to include in the design of a new school building to ensure it is disability-accessible. Each school board is left to decide on its own whether it will include anything in the building’s design for accessibility, beyond the inadequate accessibility requirements in the Ontario Building Code, in standards enacted under the Accessibility for Ontarians with Disabilities Act, and under a patchwork of local municipal bylaws. The Ontario Government does not have a standard or model design for a new school or for an addition to a school, to ensure its accessibility to students, parents and school staff with disabilities.

On July 23, 2020, the Ford Government announced a major plan to build 30 new schools and to construct additions to another 15 schools, to provide both learning venues and more day care locations for students across Ontario (announcement set out below). The Ford Government has not announced any requirement that this new construction must be disability-accessible. It is wasteful, duplicative and counter-productive for the Ontario Government to leave it to 72 school boards to each re-invent the wheel when it comes to the design of a school building to ensure that it is accessible. Moreover, school boards are not assured to have the requisite expertise in accessible building design. Making this worse, too often architects are not properly trained in accessible design.

This is not a situation where each school board is best situated to assess the unique local needs of its community. A student, parent or school staff member with a disability has the very same accessibility needs, when it comes to getting into and around a school building, whether that school is in Kenora or Cornwall.

It has been well established for years that compliance with the insufficient accessibility requirements in the Ontario Building Code, the Accessibility for Ontarians with Disabilities Act accessibility standards and local municipal bylaws do not ensure that a new building is in fact accessible and barrier-free for people with disabilities. To the contrary, the AODA Alliance has shown how new buildings and major renovations in major public projects can end up having serious accessibility problems. This is illustrated in three online videos, produced by the AODA Alliance, that have gotten thousands of views and extensive media coverage. Those videos focus on:

* the new Ryerson University Student Learning Centre;

* the new Centennial College Culinary Arts Centre and

* several new and recently renovated Toronto area public transit stations.

Over a year and a half ago, the third Government-appointed Independent Review of the implementation of the AODA, conducted by former Lieutenant Governor David Onley, found that progress in Ontario on accessibility has proceeded at a “glacial” pace. Among other things, it recommended that the Ontario Government should treat as a major priority the recurring barriers facing people with disabilities in the built environment. The Onley Report emphasized as an illustration the AODA Alliance’s video depicting serious accessibility problems at Ryerson’s new Student Learning Centre.

Strong, effective and enforceable provincial accessibility standards for the built environment are long overdue. Yet the Government has announced no plans to develop and enact a Built Environment Accessibility Standard under the AODA. Beyond this, for over two and a half years, the Ontario Government has been in direct violation of the AODA. This is because the Government has still not appointed a mandatory Standards Development Committee to review the palpably inadequate “Design of Public Spaces” Accessibility Standard, enacted under the AODA in December 2012. Under section 9(9) of the AODA, the Ontario Government was required to appoint a mandatory Standards Development Committee to review that accessibility standard by December 2017. The former Kathleen Wynne Government is on the hook for failing to appoint that Standards Development Committee for the seven months from December 2017 up to the Wynne Government being defeated in the June 2018 provincial election. The Ford Government is on the hook for violating the AODA for the subsequent two years, from the time it took office up to today.

The Ford Government should now direct all school boards receiving any of the public money that the Government announced on July 23, 2020 that all those new projects must be fully accessible. This must go further than simply meeting the inadequate accessibility requirements in the Ontario Building Code, in AODA accessibility standards enacted to date, and in local bylaws. The Ford Government should set specific accessibility requirements that must be met. A good template for this is set out in the AODA Alliance’s draft Framework for the Post-Secondary Education Accessibility Standard.

There have now been 546 days, or over a full year and a half, since the Ford Government received the ground-breaking final report of the Independent Review of the implementation of the Accessibility for Ontarians with Disabilities Act by former Ontario Lieutenant Governor David Onley. The Government has not announced any comprehensive plan of new action to implement that report. That makes even worse the serious problems facing Ontarians with disabilities during the COVID-19 crisis.

For more background, check out:

* The AODA Alliance website’s Built Environment page, that documents our efforts to get the Ontario Government to enact strong accessibility standards for the built environment.

* The AODA Alliance website’s Education page, documenting the AODA Alliance’s efforts to tear down the many barriers in Ontario’s education system facing students with disabilities.

          MORE DETAILS

 July 23, 2020 Ontario Government News Release

Originally posted at https://news.ontario.ca/opo/en/2020/07/ontario-building-and-expanding-schools-across-the-province-1.html

Ontario Newsroom

News Release

Ontario Building and Expanding Schools across the Province

July 23, 2020

Modern Facilities Will Strengthen Student Learning and Increase Access to Child Care

BRAMPTON — The Ontario government is investing over $500 million to build 30 new schools and make permanent additions to 15 existing facilities, supporting over 25,000 student spaces across the province. These new, modern schools will create the foundation for a 21st century learning environment for thousands of students across the province. This investment will also generate nearly 900 new licensed child care spaces to ensure families across the province are able to access child care in their communities.

Details were provided today by Premier Doug Ford and Stephen Lecce, Minister of Education.

“Our government is making a significant capital investment in our school system,” said Premier Ford. “By making these smart investments today, we will ensure our students and teachers have access to modern facilities to learn with features like high-speed Internet, accessible ramps and elevators, and air conditioning, while providing parents with access to more licensed child care spaces.”

The government is investing over $12 billion in capital grants over 10 years, including over $500 million invested in this year alone to build critical new school capital projects and permanent additions. Today’s announcement continues to build upon the government’s commitment to invest up to $1 billion over five years to create up to 30,000 licensed child care spaces in schools, including 10,000 spaces in new schools. These new projects will also result in the creation of new jobs in the skilled trades as over $500 million of major infrastructure projects break ground in short order.

“It is unacceptable that too many schools in our province continue to lack the investment that our students deserve,” said Minister Lecce. “That is why this government is making a significant investment to build new schools, to extensively renovate existing schools, and expand access to licensed child care spaces in our province. Our government is modernizing our schools, our curriculum, and the delivery of learning, to ensure students are set up to succeed in an increasingly changing world.”

QUICK FACTS

list of 4 items

  • The Ministry of Education reviews all Capital Priorities submissions for eligibility and merit prior to announcing successful projects.
  • The Ministry is working in partnership with school boards to deliver high-speed Internet to all schools in Ontario, with all high schools having access to broadband by September 2020, and all elementary schools having access by September 2021. As of March 31, 2020, broadband modernization has been completed at 1,983 schools, including 403 Northern schools. Installation is currently in progress at 2,954 schools, including 99 northern schools.
  • The Ministry is investing $1.4 billion in renewal funding, which continues to meet the recommended funding level by the Auditor General of Ontario to preserve the condition of Ontario’s school facilities.
  • To find out more about projects in your community, visit the Ontario Builds map.

list end

ADDITIONAL RESOURCES

list of 1 items

  • Learn more about Ontario’s commitment to modernizing schools and child care spaces.

list end

CONTACTS

Ivana Yelich

Premier’s Office

Ivana.Yelich@ontario.ca

Alexandra Adamo

Minister Lecce’s Office

Alexandra.Adamo@ontario.ca

Ingrid Anderson

Communications Branch

437 225-0321

Ingrid.E.Anderson@ontario.ca

Office of the Premier

http://www.ontario.ca/premier

An Interim Victory for Disability Advocates — Toronto City Council Directs City Staff to Investigate Dangers to People with Disabilities If Electric Scooters are Allowed

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

An Interim Victory for Disability Advocates — Toronto City Council Directs City Staff to Investigate Dangers to People with Disabilities If Electric Scooters are Allowed

July 29, 2020

          SUMMARY

Yesterday disability advocates won an important interim victory in Toronto, Canada’s largest city, in the campaign to protect the public, including people with disabilities, from the proven dangers to public safety and disability accessibility that are posed by electric scooters (e-scooters).

At the July 28, 2020 meeting of Toronto City Council, the issue of e-scooters came up on the agenda. A City Staff Report had identified serious problems that e-scooters pose. Despite this, the Staff Report recommended that the City take some preliminary and preparatory steps towards running a pilot with e-scooters next year. However, yesterday Toronto City Council voted instead to direct staff to do more research on the disability accessibility concerns that have been raised regarding e-scooters.

The AODA Alliance has been in the lead in showing that e-scooters pose a serious danger to people with disabilities and others. On February 3, 2020, the City of Toronto’s Accessibility Advisory Committee unanimously voted to recommend to Toronto City Council that e-scooters should not be allowed at all. The City Staff Report had mentioned this important unanimous recommendation, but had given no reasons why the Report did not follow that Accessibility Advisory Committee’s recommendation.

It is our understanding that as a result, nothing moves forward in Toronto until the City staff complete the new research that Toronto City Council has directed. The Toronto City Council motion that passed on a vote of 12 to 11 on July 28, 2020, with 2 Councillors not present, was as follows:

“3 – Motion to Refer Item moved by Councillor Paula Fletcher (Carried)

That City Council refer the Item to the General Manager, Transportation Services and direct the General Manager to report back with any changes needed to address the issues identified by the City’s Accessibility Committee, including issues related to insurance.”

“The AODA Alliance commends Toronto City Council for taking this step, in the face of its being heavily pressured by the corporate lobbyists for e-scooter rental companies to ignore the public safety and accessibility dangers that their product inflicts,” said AODA Alliance Chair David Lepofsky. “In the face of overwhelming evidence that e-scooters in Toronto would endanger public safety, inflict serious personal injuries, create new accessibility barriers for people with disabilities and expose the City to law suits, it is a relief that City Council is slowing down to take a serious look at the problems that e-scooters would cause for all Torontonians, and especially for people with disabilities. With the COVID-19 pandemic raging, City Council should stop debating e-scooters, and should instead focus all its attention on the community’s urgent needs during the COVID-19 crisis.”

This is only an interim victory. We still have a great deal of work ahead of us, and cannot let down our guard. The corporate lobbyists for the e-scooter rental companies are no doubt re-doubling their pressure on members of Toronto City Council.

It is deeply troubling that fully 11 members of Toronto City Council voted against having City Staff conduct further research into the dangers that e-scooters pose to people with disabilities. The members of Toronto City Council that commendably voted in favour of this motion were Mayor John Tory and Councillors Bradford, Carroll, Fletcher, Matlow, Minnan-Wong, Nunziata, Pasternak, Perks, Perruzza, Thompson, Tory and Wong-Tam. The members of City Council who voted against having additional research done on the harms that e-scooters inflict on people with disabilities include Councillors Ainslie, Bailao, Colle, Crawford, Filion, Ford, Grimes, Holyday, Lai, Layton and McKelvie.

On July 28, 2020, AODA Alliance Chair David Lepofsky was interviewed on News Radio 1310 in Ottawa, on the problems with e-scooters that have already emerged shortly after Ottawa began its ill-considered pilot with e-scooters. We will have more to say on the e-scooters issue over the coming weeks. Below is set out an excerpt from an article on this in the July 29, 2020 Toronto Star. The history of this item at Toronto City Council is set out on its website at http://app.toronto.ca/tmmis/viewAgendaItemHistory.do?item=2020.IE14.10

For more background:

Read the AODA Alliance’s July 8, 2020 brief to the City of Toronto Infrastructure and Environment Committee, already endorsed by Spinal Cord Injury Ontario and the March of Dimes of Canada

Read the open letter to all Ontario municipal councils from 11 major disability organizations, opposing e-scooters in Ontario, and

Read a sampling of news reports on the serious injuries that e-scooters have caused in communities that permit them.

Read the AODA Alliance’s July 10, 2020 news release explaining what happened at the July 9, 2020 meeting of Toronto’s Infrastructure and Environment Committee where the AODA Alliance and others presented on this issue.

Visit the AODA Alliance e-scooters web page.

          MORE DETAILS

 Toronto Star July 29, 2020

E-scooters remain stalled in Toronto

Council wants answers on safety, insurance before considering pilot project

David Rider and Francine Kopun Toronto Star

Electric scooter services will remain parked for now.

Toronto city council on Tuesday never voted on a city staff proposal that would have laid the groundwork for e-scooter rental services to start operating in Toronto for a trial period starting next spring.

That proposal, which would have seen council decide this fall whether to green-light the controversial pilot project, was rendered moot when a competing motion from Coun. Paula Fletcher passed 12-11.

City staff will now look solely at concerns the short-term rental of e-scooters by companies such as Bird Canada pose to the safety of disabled Torontonians, as well as issues around insurance liability for riders and anyone they might hit.

Council won’t get those answers before fall, almost certainly meaning further delay in a possible start date for the scooter services that have aggressively lobbied city officials, originally in hopes of having riders whizzing around Toronto last spring…

More Overwhelming Proof that Electric Scooters Endanger Public Safety

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

More Overwhelming Proof that Electric Scooters Endanger Public Safety

July 27, 2020

          SUMMARY

On the eve of Toronto City Council considering the question of whether to allow electric scooters in Canada’s largest city, here is yet more overwhelming proof that electric scooters pose a danger to the safety of the public. We set out a sampling of four news articles below. A CBC News July 21, 2020 report showed a troubling increase in serious personal injuries in Calgary, resulting in hospital emergency room visits, due to e-scooters. A January 11, 2020 report in MarketWatch documented is entitled “Electric scooter injuries jumped 222% over the past four years.” The Berlin Spectator June 18, 2020 reported on serious injuries in Berlin, Germany, leading police to sound the alarm. A July 26, 2020 report in the Singapore Press is entitled “E-scooter rider who knocked down woman refuses to pay over $445,000 in damages as he can’t afford it, says lawyer.”

If it is so well established that e-scooters endanger public safety, not to mention accessibility for people with disabilities, why is Toronto City Council even talking about the possibility of conducting a “pilot” with e-scooters? What is the purpose of a pilot? To see if Torontonians will get injured? We know they will. There is no need to subject them to e-scooters to find that out. Should Toronto conduct a “pilot” to find out if it will cost the public money to allow e-scooters? We know it will. Do we need a “pilot” to find out that Toronto’s law enforcement officers don’t have the time and resources to enforce proper conduct by those silently racing around on e-scooters? The City knows that they lack sufficient law enforcement capacity right now, without piling e-scooters onto their responsibilities.

The lead proponents of a “pilot” are the corporate lobbyists for the e-scooter rental companies. They stand to make piles of money from a new market, without bearing the costs. They no doubt want a “pilot” to try to get a foothold on a new market for their product, hoping that if e-scooters are allowed, it would be harder to get them banned.

An e-scooter is a motor vehicle, pure and simple. Yet the corporate lobbyists for the e-scooter rental companies want them treated as if they were not. That would leave public safety less protected.

We will all be watching Toronto City Council tomorrow, July 28, 2020, starting at 9:30 a.m., where its meeting is streamed live at https://www.youtube.com/watch?v=FIKd97OqGeM

It is quite an irony that Toronto City Council has decided to now discuss the possibility of creating this new danger to the public including people with disabilities. On Sunday, July 26, 2020, the US celebrated the 30th anniversary of the Americans with Disabilities Act. Americans with disabilities focused on the progress they’ve made and the barriers yet to be removed for people with disabilities. The US is years ahead of Toronto, of Ontario and of Canada on inclusion and accessibility for people with disabilities.

The fight for the Americans with Disabilities Act inspired a generation of disability advocates around the world, including right here in Ontario, to fight for new disability rights laws. Yet here we are, in the midst of the COVID-19 crisis, having to battle to avoid the silent menace that e-scooters present to all innocent pedestrians, including those with disabilities.

Let’s learn from the experience of Montreal, which called off its e-scooter pilot. Let’s learn from the experience of places like Calgary, Berlin, Singapore and several US cities, which have subjected so many of their residents to undue danger from e-scooters. Let’s learn from their mistakes, rather than repeating them.

Tell Toronto City Council to protect public safety rather than corporate lobbyists’ profits. City Councillors’ contact information is available at https://www.toronto.ca/city-government/council/members-of-council/

          MORE DETAILS

 CBC News July 21, 2020

Originally posted at https://www.cbc.ca/news/canada/calgary/injuries-rise-with-popularity-escooters-calgary-streets-1.5657159

Injuries rise with popularity of e-scooters on Calgary streets

Rider says he looked back and saw his girlfriend on the ground

Elissa Carpenter · CBC News · Posted: Jul 21, 2020 10:58 AM MT | Last Updated: July 21

A Calgary emergency room doctor says rider injuries led to almost 700 emergency-room and urgent-care visits last summer in Calgary. (CBC)

A Calgary couple is telling a cautionary tale involving an ambulance ride, a broken jaw and surgery.

Paul Fox and his girlfriend rented electric scooters Sunday evening. Both had used the ride-share scooters before, but this time something went wrong.

“We were driving the scooters and then I look back and she is just laying there” Fox told CBC News.

His girlfriend was rushed to hospital and underwent surgery for a broken jaw.

Fox was shocked when the surgeon told him he had seen six of the same kind of injury in recent days.

“It’s been the same mechanics of the injury. All jaw injuries … within the last week ” Fox said.

2019  Calgarians wheel into hospitals by the dozen with injuries from new e-scooters

2019 | Calgary e-scooters used nearly 10,000 times per day in August

The department head for emergency medicine in the city isn’t surprised.

Dr. Eddy Lang studied scooter-related injuries last fall after Calgary’s first season of the ride-share program.

“We saw almost 700 emergency-room and urgent-care visits of adults and children with scooter-related injuries last year,” Lang said.

By comparison, about 2,000 people a year are injured while cycling.

“You also have to keep the denominator in mind, if you will ” Lang said. “The number of Calgarians who use bicycles on a regular basis probably far exceeds the number of scooter users.”

Injuries to head, neck and face most common

Lang says the most common injuries were head, neck and face.

“Last year, we studied this in detail and looked at about 30 cases that were transported to hospital by ambulance. The common denominator was speed.”

Lang says the scooters are a great way to see the city or commute quickly to work, but points out they are a motorized vehicle and should be treated as such. He recommends helmet use, staying away from large crowds and riding sober.

With a third company joining the program this year, there are now about 2,500 scooters on the streets.

A second injury study is coming in the fall.

 MarketWatch January 11, 2020

Originally posted at https://www.marketwatch.com/story/your-first-e-scooter-ride-will-probably-land-you-in-the-hospital-2019-05-03

Electric scooter injuries jumped 222% over the past four years

And your first e-scooter ride will probably land you in the hospital, research suggests

Published: Jan. 11, 2020 at 9:36 a.m. ET

By Nicole Lyn Pesce

Many e-scooter riders suffered broken arms and head traumas. XTREKX/ISTOCK

More Americans are taking electric scooters for a spin — and it’s been a bumpy ride.

In fact, the number of e-scooter-related injuries jumped 222% between 2014 and 2018, according to a new study published in JAMA Surgery, adding up to almost 40,000 broken bones, head injuries, cuts and bruises being treated in emergency rooms across the country.

And those injuries spiked over that last year, in particular, jumping 83% from 8,016 in 2017 to 14,651 in 2018.

Researchers at the University of California, San Francisco analyzed U.S. government data on nonfatal injuries treated in ERs, and reported a “dramatic increase” in injuries and admissions associated with e-scooter use, which has become a popular form of alternative transportation across the U.S.

And the number of hospital admissions jumped 365% to almost 3,300 cases between 2014 and 2018, although most injured riders overall weren’t hospitalized. E-scooter riders aged 18 to 34 were also the most likely to be injured.

This study was limited in that it didn’t have details about collision scenarios, alcohol use or helmet use for each injury report, but two studies published last year reported that between 95% and 98% of injured e-scooter riders weren’t wearing helmets.

“We hope to raise awareness that riders should wear helmets and ride safely,” lead author Dr. Benjamin Breyer from the University of California, San Francisco told the Associated Press.

(Related: Famous British YouTuber dies in electric scooter accident)

This is the latest report to raise concerns about the rising number of e-scooter riders hitting the roads and sidewalks, in some cases before the riders have been properly trained to use the vehicle safely. In fact, one in three people injured on e-scooters gets hurt during their very first ride, according to a government safety report released last May.

The CDC and the Austin Public Health department analyzed emergency department data from nine Austin hospitals between September and November 2018.

The city’s almost 1 million people had access to about 14,000 dockless electric scooters, and the study counted 192 e-scooter-related injuries during those three months alone. Two were non-riders (a pedestrian and a cyclist), and the remaining 190 were navigating the motorized scooter at the time. But this report probably underestimated the true number of injuries, the authors noted, because it didn’t include urgent care centers or primary care physicians’ offices.

And one in three of those injured was riding an e-scooter for the first time. In fact, most of those who landed in the hospital were novices; about 63% had ridden just nine times or less before getting hurt.

Almost half of the accidents resulted in head injuries, as only one of the riders was wearing a helmet. The other most common injuries were to the upper limbs, including the arms, shoulders, wrists and hands (70%); the lower limbs, including the legs, knees, ankles and feet (55%); as well as the chest and abdomen (18%).

Many injured e-scooter riders were speeding and/or not wearing helmets.

Most of the accidents actually didn’t involve cars; only 10% of injured riders were hit by motor vehicles. Rather, half (50%) reported their accidents resulted from road conditions such as potholes and cracks. More than a third admitted they crashed while going too fast, and 10% said they hit a curb. Just under one in five (19%) claimed that their scooter malfunctioned. And more than half (55%) were injured in the street, while one-third were hurt on the sidewalk.

The report pushed for more training and education about e-scooter operation and safety to prevent injuries, advising that, “These educational messages should emphasize both wearing a helmet and maintaining a safe speed while riding an e-scooter.” And these PSAs should target riders ages 18 to 29, in particular, as nearly half of all injuries were reported in young adults, and more than one in four (29%) victims had consumed alcohol within 12 hours of crashing. As it stands, many of the scooter companies offer instructional videos on their apps — such as Lime’s “How to Lime” clip — but riders aren’t required to watch them before taking a spin.

Nick Shapiro, Lime’s vice president and Head of Trust and Safety, told MarketWatch in an emailed statement that, “Lime’s highest priority is the safety of our riders, and we advance this through rider education, community engagement, product innovation and policy development.” He added that, “we appreciate UCSF’s attention on this important topic and remain committed to ensuring safe rides for all users.” Reps for Bird were not immediately available for comment.

Motorized scooters from companies such as Bird, Lime and the Ford-owned Spin have been appearing all over the country, generally charging users anywhere from 15 cents to $1 a minute to rent e-scooters docked throughout an urban area, which can zip around as fast as 15 miles an hour. (The average speed of most city bicycle riders is about the same, although one can hit 20 miles an hour when speeding down a hill.)

The global e-scooter market is expected to hit $41.98 billion by 2030, according to Grand View Research, Inc. And that’s spurring ride-share heavyweights like Lyft and Uber to get in on the action. Uber and Alphabet invested $335 million in Lime in 2018, and Lyft has rolled out its own motorized scooters in cities including Austin, Los Angeles, Miami and Washington, D.C.

But the rapid expansion of e-scooters is also revving up safety concerns. The Consumer Product Safety Commission reported 3,300 scooter-related injuries in 2016, and 25% of them occurred to the head and face. After the Bird scooter landed in Memphis, local doctors reported an increase in emergency department visits for head and face injuries, which were related to e-scooters. Again, many riders were not wearing helmets. After a 26-year-old Nashville resident died in a e-scooter accident in May 2019, the city’s mayor David Briley said he would recommend banning them. Chattanooga, Tenn. went ahead and enacted a six-month ban on dockless electric scooters and bikes.

A handful of e-scooter riders have also died in the U.S. after colliding with cars in Austin and Washington, D.C., while a Dallas man was killed after falling off his scooter while riding home from work. Last July, British YouTube star Emily Hartridge, who presented the online series “10 Reasons Why,” was killed in a collision with a truck, becoming the U.K.’s first death involving an e-scooter. She was 35.

But a Portland, Ore., study published in January 2019 also found that scooter safety risks were no worse than those found in other modes of city transportation. In fact, scooter-related injuries (including injuries from non-motorized scooters) only accounted for about 5% of the estimated 3,220 of total traffic crash injury visits to emergency rooms and urgent care centers. And while scooters were involved in 176 ER visits, that was less than half of the 429 visits for bicycle-related mishaps.

 The Berlin Spectator June 18, 2020

Originally posted at https://berlinspectator.com/2020/06/18/berlin-police-log-high-number-of-e-scooter-accidents/

Berlin Police Log High Number of E-Scooter Accidents

By Imanuel Marcus

Berlin’s Police Department is sounding the alarm. Too many e-scooter users cause accidents. Serious injuries and even one death were reported. Besides, people do not seem to know the rules.

A year ago, on June 15th, 2019, the use of e-scooters on the streets of Berlin was approved. Since, several rental companies have popped up. They place e-scooters on the streets. Their customers locate them in apps, rent them and get going.

Flip Side

The positive side of the coin is obvious: Individuals, including tourists, can move around in Berlin easily. Taking e-scooter rides is fun indeed. But there is a flip side. The Berlin Police Department just released numbers that show there is a problem.

From June 15th, 2019 to March 31st, 2020, there were 354 accidents that involved e-scooters. One person died, 38 individuals were injured severely, while 182 persons sustained light injuries, according to those statistics mentioned by German-language media.

E-Scooter Rules

In the same time period, police in the German capital distributed as many as 3,340 tickets to e-scooter riders because of infractions they were responsible for. As it turns out, many e-scooter enthusiasts do not know there are rules. And those who know do not seem to care much.

These are some of the rules:

Riding e-scooters on sidewalks is prohibited. More than 1,000 persons were caught doing so anyway.

E-scooters need to be parked in an orderly manner where they do not obstruct pedestrians. Nine hundred people got tickets for choosing bad spots.

E-scooters are vehicles the use of which is not allowed under the influence of alcohol or drugs. Police gave out 280 tickets to drunk individuals who rode those vehicles anyway.

All general traffic rules need to be adhered to. Too many people did not. For instance, red lights were taken, cell phones were used while riding, people rode through pedestrian zones.

E-scooters may not be used by more than one person.

Head Injuries

Making people aware of the fact that e-scooters are not toys, but vehicles propelled by electric motors is the responsibility of the companies that rent them out. Adding clear instructions to the apps is one way of doing it. The thing is that riding those e-scooters is more difficult and requires more attention that some people seem to believe.

In January, Berlin’s Charité university hospital came up with statistics regarding e-scooter accidents for July of 2019. More than half of all accident victims sustained head injuries. Many wounds on feet needed to be treated. The same applied to broken legs, arms and hands.

Foregone Conclusion

During the first three months of the ongoing Corona crisis, most rental e-scooters disappeared from the streets of Berlin. Now they are back. Renting them is rather expensive. An 8-kilometer trip (5 miles) can cost 12 Euro (13.50 U.S. Dollars or 10.75 Pounds Sterling).

The Berlin Police Department said its officers would continue monitoring e-scooter users. It is a foregone conclusion that more tickets will be distributed to those who do not behave.

Singapore Press July 26, 2020

Originally posted at https://www.straitstimes.com/singapore/courts-crime/e-scooter-rider-who-knocked-down-woman-ordered-to-pay-damages-lawyer-says-he

E-scooter rider who knocked down woman refuses to pay over $445,000 in damages as he can’t afford it, says lawyer

Nicholas Ting Nai Jie caused Madam Ang Liu Kiow to suffer severe brain injuries after he hit her while riding his electric scooter in 2016.

Nicholas Ting Nai Jie caused Madam Ang Liu Kiow to suffer severe brain injuries after he hit her while riding his electric scooter in 2016.PHOTOS: ST FILE

Published Jul 26, 2020, 8:19 pm SGT

Selina Lum

Law Correspondent

SINGAPORE – A man who caused a female pedestrian to suffer severe brain injuries after he hit her while riding his electric scooter in 2016 has been ordered to pay her damages of over $445,000.

Madam Ang Liu Kiow, a 57-year-old mother of three, is still unable to speak, read or write nearly four years after the accident and needs help in daily activities such as dressing, using the toilet and eating.

For more background:

Read the AODA Alliance’s July 8, 2020 brief to the City of Toronto Infrastructure and Environment Committee, already endorsed by Spinal Cord Injury Ontario and the March of Dimes of Canada

Read the open letter to all Ontario municipal councils from 11 major disability organizations, opposing e-scooters in Ontario, and

Read the AODA Alliance’s July 10, 2020 news release explaining what happened at the July 9, 2020 meeting of Toronto’s Infrastructure and Environment Committee where the AODA Alliance and others presented on this issue.

Visit the AODA Alliance e-scooters web page.

AODA Alliance Endorses ARCH Disability Law Centre’s Brief that Shows in Even More Detail How the Ford Government’s Revised Draft Medical Triage Protocol, Now Undergoing Consultation, Would Discriminate Against COVID-19 Patients with Disabilities If There Were Not Enough Ventilators for All Patients Needing Them

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

 AODA Alliance Endorses ARCH Disability Law Centre’s Brief that Shows in Even More Detail How the Ford Government’s Revised Draft Medical Triage Protocol, Now Undergoing Consultation, Would Discriminate Against COVID-19 Patients with Disabilities If There Were Not Enough Ventilators for All Patients Needing Them

July 24, 2020

          SUMMARY

The ARCH Disability Law Centre has made public a superb new brief to the Ford Government on the serious disability human rights problems with the revised draft medical triage protocol on which the Ford Government is now holding a consultation. The AODA Alliance strongly endorses ARCH’s brief and congratulates ARCH on excellent work. ARCH’s brief is set out below.

The Ford Government has still not rooted out the danger to people with disabilities that was created by the deeply flawed March 28, 2020 “medical triage protocol” that Ontario Health sent to all hospitals last spring. That protocol lets hospitals violate basic human rights of COVID-19 patients with disabilities if a surge in COVID-19 cases means there are not enough ventilators for all critical patients needing them. A number of disability organizations including the AODA Alliance have been pressing the Ford Government for over three months to fix the mess it thereby created.

The July 16, 2020 AODA Alliance Update made public a revised draft of the Government’s medical triage protocol, on which a consultation is now being held. We announced at that time that this revised draft medical triage protocol still has serious human rights problems from the disability perspective. We submitted that Update to the Ford Government’s advisory committee that is consulting on possible changes to that medical triage protocol.

Since then, on July 20, 2020, the ARCH Disability Law Centre submitted its new brief, set out below, to the Government’s advisory committee. The ARCH Disability Law Centre had a committee of human rights experts giving it input as it formulated this brief, including the AODA Alliance. The ARCH brief echoes and builds upon concerns that we have raised, and adds additional concerns, with which we entirely agree.

More Background

Check out:

* The July 16, 2020 AODA Alliance Update, that sets out serious disability human rights problems with the revised draft medical triage protocol.

* The text of the revised draft medical triage protocol.

* The April 7, 2020 virtual public forum on the impact of COVID-19 on people with disabilities, jointly organized by the AODA Alliance and the Ontario Autism Coalition. During this event, ARCH Disability Law Centre executive director Robert Lattanzio first made public the existence of the original March 28, 2020 medical triage protocol, and the disability human rights problems that it creates.

* The April 8, 2020 open letter, spearheaded by ARCH, identifying the serious disability human rights violations in the original March 28, 2020 medical triage protocol.

* The AODA Alliance’s April 14, 2020 Discussion Paper on what the medical triage protocol should include. In the three months since this was made public, no negative feedback was received about its recommendations.

* The Ford Government’s April 21, 2020 announcement that it would consult community and human rights experts on the medical triage protocol. It claimed that the March 28, 2020 protocol was only a “draft” even though it was never marked “draft”.

* The ARCH Disability Law Centre’s detailed May 13, 2020 analysis of the serious disability human rights violations created by the medical triage protocol, which the AODA Alliance endorses.

* To learn more about the many barriers that impede patients with disabilities in Ontario’s health care system, read the AODA Alliance’s February 25, 2020 Framework on what the promised Health Care Accessibility Standard should include, to be enacted under the Accessibility for Ontarians with Disabilities Act.

* The AODA Alliance’s health care web page, to learn more about the advocacy efforts to tear down the barriers facing people with disabilities in Ontario’s health care system.

* The AODA Alliance’s COVID-19 web page details the coalition’s efforts to advocate for the needs of people with disabilities during the COVID-19 pandemic.

          MORE DETAILS

Text of the ARCH Disability Law Centre’s July 20, 2020 Brief on the Ford Government’s Revised Draft Medical Triage Protocol

Originally posted at http://archdisabilitylaw.ca/resource/submissions-and-recommendations-regarding-ontarios-triage-protocol-draft/

55 University Avenue, 15th Floor

Toronto, Ontario M5J 2H7

www.archdisabilitylaw.ca

(416) 482-8255 (Main) 1 (866) 482-ARCH (2724) (Toll Free)

(416) 482-1254 (TTY) 1 (866) 482-ARCT (2728) (Toll Free)

(416) 482-2981 (FAX) 1 (866) 881-ARCF (2723) (Toll Free)

 

Sent via email to COVIDUpdates@ontariohealth.ca

July 20, 2020

Joint Centre for Bioethics
University of Toronto
155 College Street, Suite 754
Toronto, ON M5T 1P8
Canada

Dear Ms. Gibson and Mr. Smith:

Re: ARCH Disability Law Centre Submissions and Recommendations Regarding Ontario’s Triage Protocol Draft dated July 7, 2020

The within document is the written submission of ARCH Disability Law Centre (ARCH) in response to a review of the draft Triage Protocol dated and delivered July 7, 2020[1] and from the discussion held at the July 15, 2020 Roundtable, co-convened by the Bioethics Table and the Ontario Human Rights Commission.[2] We provide these submissions in addition to our previous submissions dated May 13, 2020,[3] and not in substitute of them.

Background

While Triage Protocol 2 demonstrates some improvement over the first version,[4] there continues to be alarming issues that must be rectified to ensure that any response to a surge in COVID-19 cases does not adversely and disproportionately impact persons from marginalized communities including but not limited to persons with disabilities, elderly persons, Indigenous persons, Black persons and persons from other racialized communities. Representatives from various disability communities and organizations have made clear their concerns with both iterations of the Triage Protocol.

For ease of reference, the submissions that follow are divided into three sections. First, these submissions address the framework of Triage Protocol 2 – this captures the issues related to the overall structure and guiding principles of the document. The second section addresses procedural issues – this includes issues with the process of the development of the Triage Protocol and the lack of transparency. The third section addresses substantive issues, which includes the use of Clinical Frailty Scale as a metric to assess patients, the suggestion to use random selection as a method of fairness, and the importance of ensuring that a dispute resolution mechanism is in place.

ARCH submits the following recommendations to ensure that Triage Protocol 2 does not have an adverse impact on persons with disabilities:

  1. Non-discrimination must be a guiding principle in its own right to ensure appropriate weight is given to human rights in triage decisions.
  2. The Triage Protocol must not rely on medical utility as its primary guiding principle, as it leads to adverse consequences for persons with disabilities, and fails to consider systemic health discrepancies.
  3. The framework must shift from a focus on the intention not to discriminate to whether adverse impact (discrimination) flows from the approaches embodied in Triage Protocol 2.
  4. Ontario Health must communicate to every hospital and medical association/organization that the Triage Protocol dated March 28, 2020 is not be relied upon or implemented.
  5. Clear language and plain language versions of all drafts and the final version of the Triage Protocol are to be produced and distributed widely so that all relevant stakeholders are able to understand the information and provide feedback.
  6. Wider consultations are to be undertaken by the Bioethics Tables to ensure that the perspectives of persons with lived experience from marginalized and disproportionately impacted communities are heard and inform the drafting of the Triage Protocol.
  7. The Triage Protocol must not rely on the Clinical Frailty Scale in any capacity.
  8. The Triage Protocol must eliminate eligibility criteria that considers survivability beyond the acute COVID-related event.
  9. The Triage Protocol must provide clear and specific guidance and direction as to how random selection should be carried
  10. The Triage Protocol must include an individual dispute resolution process to ensure fairness, accountability, and due process.
  11. The Triage Protocol must include a section dedicated to providing guidance and direction on the duty to accommodate.

ARCH’s Recommendations are reproduced below following a discussion and rationale for each at the conclusion of each section.

Concerns with the overall Framework and Structure of the Triage Protocol

As noted at the July 15 Roundtable by members of the Bioethics Table, while it is not necessarily contemplated or envisioned that this Triage Protocol will be used beyond the COVID-19 pandemic, it will most likely inform responses to future pandemics.[5] It is beyond a doubt the Triage Protocol is an important document that will have long and consequential effects, some of which may be devastating and detrimental. Accordingly, it is imperative that such a document, despite its primary purpose being to provide direction to medical professionals, must not be framed solely within the medical model,[6] but also within a human rights framework. This is to ensure that the benefits of any emergency response are also afforded to marginalized communities, rather than at their expense.

In its current version, the Triage Protocol lists a number of ethical principles to guide and inform allocation of scarce critical care resources. These principles are to be considered the starting point, the foundation of any decisions made about critical care in the context of a major surge of COVID-19. These guiding principles, accordingly, seep into and colour all aspects of decisions about scarce resources, which are admittedly difficult decisions with grave significance and great public importance. As such, it is imperative that the principles that guide these decisions are strong, principled, and align with a human rights framework.

In short, the framework within which this Triage Protocol is being drafted must be reformed and reshaped. Without this necessary reformation, discrimination will continue to plague the Triage Protocol. As such, it is recommended that in drafting the Triage Protocol, the authors view the issues from a human rights lens, and in particular from a disability rights and intersectionality lens.

The Right to be Free from Discrimination

The Triage Protocol must be guided by non-discrimination in its own right. The right to be free from discrimination is a quasi-constitutional right afforded to every Ontarian and Canadian,[7] including when receiving health care services and medical attention.[8] It is a right that is elevated above other legal rights and restrictions.[9]

A patient’s right to be free from discrimination is not given its due weight in Triage Protocol 2. Guiding Principle 4, “Equity and Respect for Human Rights”, where a mention of a patient’s human rights is briefly made, is problematic for two reasons. First, it places the right to be free from discrimination on the same pedestal as other guiding principles, including beneficence and accountability. This is inappropriate, namely for the aforementioned reason that the right to be free from discrimination is a quasi-constitutional right, whereas beneficence, for example, is not. Second, Guiding Principle 4 is problematic because it collapses Equity and Human Rights and treats them as the same, or interchangeable, concepts which they are not.

Reframing the Triage Protocol 2 to reflect that the right to be free from discrimination is separate from, and superior to, the guiding principles will more accurately signal how fundamental and integral human rights law must be to the decision-making process. Moreover, this reframing will also account for, and acknowledge, intersectionality and how individuals who identify with multiple protected grounds by human rights law are impacted by the Triage Protocol.

Intersectionality[10] is a term used to refer to instances where persons may experience discrimination on more than one human rights protected ground simultaneously. The importance of an intersectional lens has been emphasized by the Human Rights Tribunal of Ontario which has stated that an awareness of compound discrimination is necessary in order to avoid a narrow and one-dimensional perspective.[11]

In the context of the Triage Protocol, it must be recognized that in treating patients who contract COVID-19 and require critical care within a surge, doctors must be cognizant of the compound discrimination that for example, a Black woman with a disability may experience. Accordingly, this section in the Triage Protocol should include a concrete explanation of what non-discrimination means and how it should be applied in a triage setting, such as “disability, age, race, or any other protected ground cannot factor, even 1%, into triage decisions.” [12]

In sum, the Triage Protocol must be framed within a human rights approach and place the principle of non-discrimination at the forefront, in order to set the proper foundation for triage decisions regarding the allocation of scarce resources and to give effect to the quasi-constitutional status of these rights.

Medical Utility is not a Proper Guiding Principle

 

Medical utility as a guiding ethical principle in the Triage Protocol is problematic. As set out in Triage Protocol 2, medical utility strives to create the maximum good for the maximum number of people.[13] While appearing facially neutral, utilitarianism actually often leads to adverse impacts for persons with disabilities.[14] By virtue of this principle, those that are not able-bodied are less likely to be part of the group that receives the “good” in question.

Utilitarian frameworks do not consider existing systemic health disparities.[15] Many persons with disabilities do not have equitable access to health care or health care outcomes. Many require additional resources to achieve equal health outcomes due to the need for disability-related accommodations, or due to systemic social inequities and/or intersectionality. But where a person’s health outcomes may be influenced by these factors, utility has the unintended consequence of disregarding individual needs.[16] A purely medical utility model has been criticized as “ruthless”[17] and at odds with societal values of defending and advancing the rights of marginalized communities.[18]

The problems with medical utility being a guiding factor are compounded when one considers that Triage Protocol 2 has attempted to distance itself from the pre-existing health and social inequities experienced by persons with disabilities and other marginalized groups in Ontario. At page 4 of Triage Protocol 2, it states that the pre-existing health and social inequities that have been revealed by the COVID pandemic will not be resolved by a triage approach.

Instead Triage Protocol 2 suggests that proactive measures must be taken in other sectors in order to prevent vulnerable groups from disproportionately contracting COVID. In effect, Triage Protocol 2 is offloading responsibility for these disproportionate impacts and distances itself from the systemic and pervasive barriers to health care in our society. This distancing is troubling, given that the very guiding principles that the triage approach is based on are likely to perpetuate and compound adverse health outcomes.

While the Triage Protocol cannot be expected to right all the systemic barriers experienced by marginalized communities, it cannot be permitted to perpetuate and compound these same inequities. Recognition of those pre-existing inequities is an important contextual factor that must be incorporated into and compensated for in the triage approach. This is an objective that is difficult to reconcile with pure medical utility being a primary guiding principle.

Focus on Impact

The Triage Protocol as a whole is written from a lens of intention without any focus on the impact that decisions made will have on patients from marginalized communities. It is well-established in human rights law that the intention to, or not to, discriminate is inconsequential and not a governing factor in determining whether or not a person has experienced discrimination.[19] Rather, it is the effect or impact experienced by the person alleging discrimination that is the focus of any human rights analysis.[20]

It is clear that neither the first version of the Triage Protocol nor Triage Protocol 2 contemplate the adverse impact that will be experienced by persons from marginalized communities, including persons with disabilities, flowing from decisions made pursuant to said Protocol. The inclusion of guiding ethical principles like medical utility[21] and (formalistic) fairness[22] demonstrate that the Triage Protocol inappropriately emphasizes the doctor’s intention, without turning its mind to the adverse impact that will be experienced by the person with a disability.[23] The result is a Triage Protocol with an approach that is problematic and discriminatory in nature.

Accordingly, a shift in the drafting framework must occur. The important question is not, whether the triage approach appears to be neutral and well-intentioned, but rather, whether marginalized communities could be adversely impacted. This shift in focus should lead to a shift in perspective when contemplating the guiding ethical principles; for example, when the focus is impact and not intention then substantive fairness, rather than formalistic fairness, becomes the objective.

Framework and Structural Recommendations:

 

  1. Non-discrimination must be a guiding principle in its own right to ensure appropriate weight is given to human rights in triage decisions.
  2. The Triage Protocol must not rely on medical utility as its primary guiding principle, as it leads to adverse consequences for persons with disabilities, and fails to consider systemic health discrepancies.
  3. The framework must shift from a focus on the intention not to discriminate to whether adverse impact (discrimination) flows from the approaches embodied in Triage Protocol 2.

 

Concerns regarding the process of Triage Protocol development

 

Follow-Up Communication to March Triage Protocol

It is imperative that Ontario Health notify the recipients of the first draft that it is not to be operationalized or applied.

In the cover letter to Triage Protocol 2, the Bioethics Table states that the March 28, 2020 Triage Protocol was sent out to hospitals by Ontario Health. In particular, it states that “[t]he draft recommendations were shared by Ontario Health with hospitals on March 28, 2020 to help hospitals prepare for the possibility of a major surge in critical care demand and to prevent catastrophic health outcomes as have been seen in other jurisdictions.”[24]

We are deeply concerned that, at the time it was delivered and distributed to hospitals and medical associations at least, it was not made clear to the recipients that these recommendations and the Triage Protocol in which they are housed were a draft.[25] The potential harm of this oversight cannot be overstated. Given the highly problematic and discriminatory nature of the first draft, the concern is that should hospitals hit surge prior to the approval or authorization of an improved version, then doctors will rely on the previous version, which may lead to devastating and disproportionate impacts on persons from marginalized communities.

Case in point: in or around May 2020 it was brought to ARCH’s attention that at least three different medical organizations had published the draft Triage Protocol on their websites as a resource for its members – including doctors, nurses and other health professionals – as if this was a finalized document.

Around the middle of May 2020, ARCH reached out to these three organizations, namely the Nurse Practitioners’ Association of Ontario (NPAO), CorHealth Ontario, and Canadian Association of Emergency Physicians (CAEP), and requested that they immediately remove the draft Triage Protocol from their websites in light of the Provincial Government’s statement that this was a draft and not a finalized document. Each organization complied.

It is beyond ARCH’s reach, however, to contact every single hospital and medical association to which the Triage Protocol was delivered on March 28, 2020 or soon thereafter. Frankly, it is also beyond ARCH’s responsibility to do same. Rather, it is incumbent upon Ontario Health to discharge this responsibility.

Accordingly, it is imperative that Ontario Health immediately contact every recipient of the original Triage Protocol to (a) ensure that the hospital/medical association is aware that the March 28, 2020 version is a draft that is not to be relied upon nor implemented, and (b) to ensure that no hospital staff or medical organization members are referring to or relying on that version of the Triage Protocol.

Clear and Plain Language Versions of the Triage Protocol

It is understood that the primary purpose of the Triage Protocol is to provide guidance to medical professionals and healthcare workers in the event that Ontario hits surge conditions. Simultaneously, however, it must be recognized that it is members of the public who will be subject to and impacted by decisions made pursuant to this Triage Protocol. Consequently, the public is entitled to know how doctors are expected to make these decisions and the basis upon which these decisions are made.

For clarification, clear language and plain language are two distinct concepts and are not to be used interchangeably. Clear language refers to the use of straightforward, direct language to convey ideas in a simple manner making the document accessible to everyone. Plain language is the use of techniques, like providing concrete examples and using clear language, to ensure that people with intellectual and/or developmental disabilities are able to access the information.

Accordingly, it is recommended that both clear language and plain language versions of the Triage Protocol be developed and made available to the public to disseminate this information in an accessible manner to as wide an audience as possible. It is imperative that any and all versions of the Triage Protocol be made accessible. This means that not only should the final version of the Triage Protocol also be produced in clear and plain language versions, but any drafts developed along the way as well.[26]

Wider Consultations Needed

Wider consultations on a document such as Triage Protocol 2, which will have wide and varying effects, including consequences that may be detrimental in nature, is imperative. These consultations, however, cannot be formalistic nor performative.

Consultations are imperative in order to ensure that the perspectives of persons who are being disproportionately impacted by COVID-19 and who are, in turn, disproportionately impacted by the Triage Protocol are considered and incorporated. This, of course, includes the perspective of persons with disabilities, Indigenous persons and persons from racialized communities including Black persons and persons from other racialized communities. Moreover, wider consultations ensure that a multi-dimensional lens, including one that emphasizes intersectionality, is applied when drafting any Triage Protocol.

It is important to note, however, that in order to have these consultations be truly accessible and receive feedback from relevant stakeholders, including persons with disabilities, a clear language and plain language versions of the Triage Protocol must be made available to said stakeholders (as stated above). The absence of an accessible version dilutes the purpose of these consultations, namely, to receive feedback from persons from disability communities.

 

Process-related Recommendations:

  1. Ontario Health must communicate to every hospital and medical association/organization that the Triage Protocol dated March 28, 2020 is not be relied upon or implemented.
  2. Clear language and plain language versions of all drafts and the final version of the Triage Protocol are to be produced and distributed widely so that all relevant stakeholders are able to understand the information and provide feedback.
  3. Wider consultations are to be undertaken by the Bioethics Tables to ensure that the perspectives of persons with lived experience from marginalized and disproportionately impacted communities are heard and inform the drafting of the Triage Protocol.

 

Substantive Concerns regarding the Triage Protocol

 

The Continued Inclusion of the Clinical Frailty Scale

The Clinical Frailty Scale (CFS) must be entirely removed from Triage Protocol 2.[27] While Triage Protocol 2 removes the visual chart of the CFS, it is still referred to in the exclusion criteria chart[28], albeit more infrequently than in the previous draft, and is included in Appendix C as a Triage Criteria Tool.[29]

As already submitted in ARCH’s Brief dated May 13 2020, the CFS is included in the Triage Protocol to serve a purpose for which it was neither designed nor developed. The application of the CFS to persons with disabilities without the context of a pandemic is inappropriate. The application of the CFS to persons with disabilities within the context of a pandemic is catastrophic and devastating.

It is understood that the goal and intention of the CFS is to create a situation where all patients are treated fairly by applying the same metric across the board in a non-discriminatory manner,[30] this belief, however, is not only misguided, but a deductive and logical fallacy. In applying the CFS as it is, to all patients, the able-bodied will always score lower (for example, a 1 on the CFS) and persons with disabilities will always score higher deeming them frail.[31] In a pandemic setting this means that the able-bodied person will always be prioritized for care over persons with disabilities. This is not fairness nor is it treatment on an equitable basis.

Several jurisdictions have already recognized the error in initially including the CFS in their Triage Protocols and have remedied their error by removing the CFS from any COVID-19 protocols and committing to an individualized assessment of each patient. For example, in the United Kingdom,[32] the use of the CFS was challenged and the government conceded the problematic nature of the CFS for the purposes of allocating critical care resources.[33] Despite this, reliance on this problematic scale persists in Triage Protocol 2.

Recalling that intention is of no consequence – it is irrelevant whether, with the application of the CFS, a doctor, healthcare worker, hospital, medical organization or government department intended to discriminate against a specific demographic of patients or not. Rather, of importance is the adverse impact experienced by a person with a disability by being subject to a seemingly neutral metric that will disproportionately place them at a disadvantage

The inclusion of the CFS in the Triage Protocol may not have been accompanied by an intention to discriminate, and yet the adverse impact experienced by persons with disabilities is real and tangible. In short, the adverse impact that flows from the inclusion and application of the Triage Protocol renders it discriminatory, regardless of the initial intention.

Survivability Beyond COVID-19

It is inappropriate to rely on ineligibility criteria that extends beyond the recovery of the acute COVID-related event.[34] It is arbitrary and invites a higher risk of ableist value assumptions about the quality of a person’s life, which will inevitably cause a disproportionate adverse impact on persons with disabilities.[35]

Triage Protocol 2 states that a person would be ineligible for critical care where they have a low probability of surviving “more than a few months” beyond recovering from COVID. Triage Protocol 2 further explains that a person would be ineligible if they were “very likely to die in the near future if they recovered from their critical illness.”[36]

First, “more than a few months” is a speculative and subjective assessment, which could mean a number of different things to different doctors making these decisions. Second, this criteria goes beyond an assessment of the person’s chance of survival of the acute COVID-19-related event, and invites ableist presumptions about chances of survival or quality of life after Intensive Care Unit (ICU) treatment to seep into clinical evaluations.[37] These types of assessments tend to disproportionately affect people with disabilities.[38]

As stated by Profs. Trudo Lemmens and Roxanne Mykitiuk:

While the protocol does not clarify the time frame used to determine the risk of ‘mortality’ (i.e. mortality by when?), it goes beyond survival in the ICU, and includes the likelihood of survival months after ICU treatment. As mentioned above, the further one moves beyond ICU discharge, the more a policy will disproportionately impact on the elderly and people with disabilities.[39]

It is clear that survivability beyond the acute COVID-related incident is subjective, arbitrary, and risks discriminating against persons with disabilities. As such, it must not be relied on as a criteria of ineligibility.

 

Random Selection

Safeguards must be put into place to ensure that random selection is not polluted by unconscious biases and prejudices. In an effort to uphold the principle of fairness, Triage Protocol 2 suggests applying the method of random selection in situations where it is not possible to rely on medical utility to make clinical decisions.[40] The aim, according to Triage Protocol 2, is to mitigate against the potential of explicit or unconscious bias in decision-making.[41]

The concern is how random selection will be carried out in practice as any decision-making is always subject to human and inherent bias. Triage Protocol 2 is vague as to how random selection will translate into practice, only noting that “a record of the outcome of the process of randomization should be documented.”[42]

In order to remedy against the influence of inherent bias, safeguards must be put in place to ensure a truly random selection process. It is also important to ensure that accountability and transparency are pillars in any random selection process implemented pursuant to the Triage Protocol. It is of utmost importance that the Triage Protocol be specific and thorough in how the random selection process is to be applied. As it stands at the moment, there is very little guidance and direction on this point which will lead to different practices of random selection across hospitals.[43]

Dispute Resolution Mechanisms

It is imperative that Triage Protocol 2 includes a dispute resolution mechanism. An appeals procedure is an essential procedural aspect of due process, which cannot be set aside in pandemic conditions.

In addressing the possibility of a dispute resolution process for patients/families who disagree with the outcome of a triage decision, Triage Protocol 2 suggests that a formal appeal process “may not be feasible or appropriate.”[44] Instead, it offers to patients who have been subject to triage decisions that the hospital “[c]ommunicat[e] the rationale” to the patient/family and “respond […] compassionately to patient or family concerns.”[45] It also suggests that it will conduct a retrospective, global review by monitoring triage data, and reviewing and revising the approach to ensure it is not leading to adverse consequences.[46] With respect, while these elements are important parts of a triage approach, this is not an acceptable substitute for individual due process.

To the contrary, it is possible and necessary to include an individual dispute resolution mechanism in Triage Protocol 2. A real-time review of individual complaints is vital for ensuring that no individual has been treated unjustly by the decision-makers and so that a new decision can be implemented before irreparable harm is done. This would allow the patient or family member to seek a remedy before a potentially discriminatory and irreversible decision is carried out.

Other jurisdictions recognize the importance of an appeal framework within a triage approach.[47] The University of Virginia Health System Ethics Committee, for example, recommends that triage decisions be supported by an appeal process in order “[t]o promote the ethical principles of trustworthiness, equity, fairness, and justice.”[48]

It has been noted that while global review of the triage approach is important for accountability and on-going improvement of the triage process, it “does not protect vulnerable patients, because it does not allow for timely intervention in individual triage decisions.”[49] As the Indiana State Department of Health noted in its Crisis Standards of Patient Care Guidance, “while meticulous record keeping is desirable, in such cases, it is ethically important to prioritize energies spent in the direct saving of lives over those spent keeping records and in post‐hoc analyses.”[50]

 

Duty to Accommodate

It is imperative that Triage Protocol 2 includes a section that focuses on providing specific guidance and directions about the duty to accommodate. Triage Protocol 2 makes only brief references to the provision of accommodations for persons with disabilities accessing the Triage Protocol and decisions about critical care resources. These references are not specific nor directive.[51]

Disability-related accommodations for the purposes of accessing health care services are a basic tenet of human rights law.[52] Disability-related accommodations ensure that persons with disabilities have equal opportunity to receive, understand, and benefit from critical care.

Other jurisdictions have acknowledged the importance of providing disability-related accommodations to persons to ensure they have equal access to health care during the COVID-19 pandemic. The British Medical Association’s guidance for COVID-19 reiterates that hospitals have a positive obligation to ensure that persons with disabilities are able to access and take advantage of public services in a manner as closely as reasonably possible to someone without disabilities.[53] Similar directives can be found in other ICU decision-making guidance in jurisdictions like Tennessee.[54]

Accommodations may include interpretation, alternative and augmentative communication, support persons, or other supports that allow a person to gain equal access to medical services.[55] These must be provided to the patient during the application of the Triage Protocol and the duration of the patient’s time at the hospital.

Triage Protocol 2 should include detailed directives regarding how accommodations are provided in the context of a pandemic. Disability-related needs vary depending on the person with a disability and may fluctuate throughout a period of time. Accordingly, and as discussed in the preceding paragraph, it is highly recommended that best practices be included such as asking each patient in the emergency room and/or upon admission to the hospital if they require disability-related accommodation and, if they do, what those accommodations are. These patient-specific accommodations should be recorded in the chart and applied by every healthcare worker that comes into contact with the patient. Practices such as these that are in line with human rights obligations will also assist in ensuring that all appropriate accommodations are in place when any assessments are made pursuant to the Triage Protocol.

Substantive Recommendations:

 

  1. The Triage Protocol must not rely on the Clinical Frailty Scale in any capacity.
  2. The Triage Protocol must eliminate eligibility criteria that considers survivability beyond the acute COVID related event.
  3. Triage Protocol 2 should provide clear and specific guidance and direction as to how random selection should be carried out.
  4. The Triage Protocol must include an individual dispute resolution process to ensure fairness, accountability, and due process.
  5. The Triage Protocol must include a section dedicated to providing guidance and direction on the duty to accommodate.

 

Conclusion:

In sum, there continue to be concerns with Triage Protocol 2 that must be rectified to ensure that any response to a surge in COVID-19 cases does not adversely and disproportionately impact persons from marginalized communities including but not limited to persons from disability communities, elderly persons, Indigenous persons, Black persons and persons from other racialized communities.

The above submissions address a number of those concerns and provide Recommendations for reform. The Recommendations herein aim to align the Triage Protocol with human rights law and ensure that marginalized communities are not disproportionately impacted. The Recommendations impact the overall structure and guiding principles of the document, those related to the process within which the Triage Protocol has been developed, and those related to the substantive concerns, such as the use of the Clinical Frailty Scale or survivability beyond the acute event as metrics to assess patients, the use of random selection, the lack of a dispute resolution mechanism, and the importance of upholding the duty to accommodate.

Please do not hesitate to contact us should you wish to discuss any of these Recommendations in further and greater detail.

Sincerely,

 

ARCH DISABILITY LAW CENTRE

 

Robert Lattanzio

Executive Director

Mariam Shanouda

Staff Lawyer

Jessica De Marinis

Staff Lawyer

[1] Critical Care Triage for Major Surge in the COVID-19 Pandemic: Updated Recommendations, delivered and dated July 7, 2020 [“Triage Protocol 2”].

[2] ARCH would like to especially and sincerely thank members of its Advisory Committee for engaging in extensive discussion and providing thoughtful guidance and expertise on the important issues raised by the Triage Protocol. ARCH’s Advisory Committee, in alphabetical order, includes: Chris Beesley, Executive Director at Community Living Ontario, Laura LaChance, Interim Executive Director at Canadian Down Syndrome Society, Trudo Lemmens Professor, Scholl Chair in Health Law and Policy at University of Toronto Law School, David Lepofsky, Chair of the AODA Alliance, Leanne Mielczarek, Executive Director of Lupus Canada, Elizabeth Mohler, Board Member at Citizens With Disabilities – Ontario, Roxanne Mykitiuk, Disability Law, Health Law, Bioethics and Family Law Professor at Osgoode Hall Law School, Tracy Odell, Executive Director of Citizens with Disabilities – Ontario, Dr. Homira Osman, Director of Knowledge Translation & External Engagement at Muscular Dystrophy Canada, and Wendy Porch, Executive Director at the Centre for Independent Living Toronto.

[3] ARCH submissions, dated May 13, 2020 [“ARCH May Submissions”] available online here: https://archdisabilitylaw.ca/wp-content/uploads/2020/05/ARCH-Lttr-re-Clinical-Triage-Protocol-May-13-2020-PDF.pdf

[4] Critical Care Triage for Major Surge in the COVID-19 Pandemic dated March 28, 2020.

[5] This point was succinctly made by Ms. Jennifer Gibson in her introduction providing background and context on the drafting of the Triage Protocol.

[6] Law Commission of Ontario, The Law As It Affects Persons With Disabilities. Preliminary Consultation Paper: Approaches to Defining Disability [2009], online: Law Commission of Ontario www.lco-cdo.org

[7] Ont Human Rights Comm v Simpson-Sears, [1985] 2 SCR 536 [“Simpson-Sears”].

[8] Eldridge v British Columbia (Attorney General), [1997] 3 SCR 624 [“Eldridge”].

[9] Simpson-Sears, supra note 7.

[10] Professor Kimberlé Crenshaw introduced the term intersectionality in 1989 to address the marginalization of Black women within not only antidiscrimination law but also in feminist and antiracist theory and politics. The term was elaborated upon by Professor Crenshaw in 1991 and has been adopted by human rights law.

[11] Baylis-Flannery v. DeWilde (No. 2), (2003) 48 CHRR D/197 (Ont HRT) at para 144.

[12] AODA Alliance, A Discussion Paper on Ensuring that Medical Triage or Rationing of Health Care Services During the COVID-19 Crisis does not Discriminate Against Patients with Disabilities, April 14 2020, online: https://www.aodaalliance.org/whats-new/a-discussion-paper-on-ensuring-that-medical-triage-or-rationing-of-health-care-services-during-the-covid-19-crisis-does-not-discriminate-against-patients-with-disabilities/ [“AODA Alliance April Discussion Paper”]. See also, AODA Alliance, In a Second COVID-19 Wave, if there aren’t enough Ventilators for all Patients Needing them, a new Draft Ontario Protocol Would Continue to Discriminate Against COVID-19 Patients with Disabilities, July 16 2020, online: https://www.aodaalliance.org/whats-new/in-a-second-covid-19-wave-if-there-arent-enough-ventilators-for-all-patients-needing-them-a-new-draft-ontario-medical-triage-protocol-would-continue-to-discriminate-against-covid-19patients-with-d/

[13] Triage Protocol 2, supra note 1 at 2.

[14] Şerife Tekin, Health Disparities in COVID-19 Triage Protocols, April 8, 2020, Impact Ethics, online: https://impactethics.ca/2020/04/08/health-disparities-in-covid-19-triage-protocols/

[15] Tekin, ibid.

[16] Tekin, ibid.

[17] See HHS Office for Civil Rights in Action, Bulletin: Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19), march 28, 2020, online: https://www.hhs.gov/sites/default/files/ocr-bulletin-3-28-20.pdf . See also Peterson, Andrew, Emily A Largent, Emanuel Hart & Jason Karlawish, “Ethics of reallocating ventilators in the covid-19 pandemic” BMJ 2020;369:m1828, online: https://www.bmj.com/content/369/bmj.m1828

[18] New York State Task Force on Life and the Law, New York State Department of Health, Ventilator Allocation Guidelines, November 2015 at 41, online: https://www.health.ny.gov/regulations/task_force/reports_publications/docs/ventilator_guidelines.pdf

[19] Simpson-Sears, supra note 7 at paras 12-13.

[20] Ibid.

[21] Triage Protocol 2, supra note 1 at 2.

[22] Ibid at 3.

[23] An apt example of this, of course, is the inclusion of the Clinical Frailty Scale in the Triage Protocol 2. This is further explored below.

[24] Correspondence from Ontario COVID-19 Bioethics Table to Roundtable Participants dated July 7, 2020 at 1.

[25] This is the second time ARCH raises this concern. It was first raised in ARCH’s May 13, 2020 submissions where we stated: A further concern is that, despite stating that the current version of the Triage Protocol is a draft, the Government has taken no action to clearly withdraw the draft to ensure that it is not implemented should the medical system become overburdened whilst Ontario Health conducts consultations. See ARCH May Submission, supra note 3.

[26] At the July 15, 2020 Round-table discussion co-convened by the Bioethics Table and the Ontario Human Rights Commission, Ms. Jennifer Gibson clarified that she had been advised that there is currently a clear language version of the Triage Protocol being developed.

[27] These submissions are made in addition to ARCH’s previous objections to the inclusion of the Clinical Frailty Scale. See ARCH May Submissions, supra note 3.

[28] Triage Protocol 2, supra note 1 at 7.

[29] Ibid at 20.

[30] Lastly, the July Triage Protocol provides an explanatory note following the exclusion criteria chart noting the purpose for which the CFS is to be used. This qualifier does provide some clarification; however, in saying that, the Bioethics Table still has not demonstrated why the inclusion of the CFS is of necessity in the first place. Secondly, the explanatory note focuses on the intention of the CFS rather than the impact.

[31] A salient point here, of course, is that frailty and disability are two distinct issues – a distinction that the CFS and the Triage Protocol both fail to acknowledge.

[32] Hodge, Jones & Allen, News Release, NICE Amends COVID-19 Critical Care Guideline After Judicial Review Challenge, March 31, 2020 available: https://www.hja.net/press-releases/nice-amends-covid-19-critical-care-guideline-after-judicial-review-challenge/

[33] The Bioethics Table’s attention is also directed to the states of Alabama, Tennessee and Washington in the United States for similar legal challenges to the identification of specific disabilities to be excluded or deprioritized from receiving critical care. Available: https://adap.ua.edu/uploads/5/7/8/9/57892141/al-ocr-complaint_3.24.20.pdf and http://thearc.org/wp-content/uploads/2020/03/2020-03-27-TN-OCR-Complaint-re-Healthcare-Rationing-Guidelines.pdf

[34] A helpful and concrete example of this can be found in the AODA Alliance April Discussion Paper, supra note 12. The example is as follows:

A patient with a history of cancer contracts serious COVID-19 symptoms and goes to hospital for emergency treatment. They need a ventilator. The hospital has too few ventilators to meet the needs of all its COVID-19 patients who need ventilators.

A physician is considering which patients will get a ventilator. The physician decides that the cancer patient’s long-term future lifespan may be shorter due to their cancer than other patients who have no disability. That physician thinks that this should be a factor weighing against that cancer patient getting the use of a ventilator.

Such decisions should not be based on the physician’s predictions, whether accurate or stereotype-based, about the eventual long-term lifespan of that patient unrelated to the COVID-19 diagnosis. The hospital or physician deciding who will get the ventilator must not weigh or hold against that patient with a disability the fact of their disability or its perceived impact on their long-term lifespan.

[35] Trudo Lemmens, Quebec’s clinical triage protocol opens door to discrimination, June 15, 2020, online: https://policyoptions.irpp.org/magazines/june-2020/quebecs-clinical-triage-protocol-opens-door-to-discrimination/

[36] Triage Protocol 2, supra note 1 at 5.

[37] Roxanne Mykitiuk & Trudo Lemmens, Assessing the value of a life : COVID-19 triage orders mustn’t work against those with disabilities, April 9, 2020, CBC online: https://www.cbc.ca/news/opinion/opinion-disabled-covid-19-triage-orders-1.5532137;

[38] Trudo Lemmens & Roxanne Mykitiuk, “Disability Rights Concerns and Clinical Triage Protocol Development During the COVID-19 Pandemic” 2020 HLCJ 40:4 at 107.

[39] Lemmens & Mykitiuk, ibid.

[40] Triage Protocol 2, supra note 1 at 8.

[41] Ibid.

[42] Ibid.

[43] It was noted at the July 15 Round-table by Ms. Jennifer Gibson that the aim of the Triage Protocol is to ensure that the same treatment and approach are taken across all hospitals. With respect, random selection as it is currently set out in Triage Protocol 2 fails to satisfy this objective as it is too vague and lacks direction to hospitals and healthcare workers.

[44] Triage Protocol 2, supra note 1 at 12.

[45] Triage Protocol 2, ibid.

[46] Triage Protocol 2, ibid.

[47] University of Virginia Health System Ethics Committee, “Ethical Framework and Recommendations for COVID-19 Resources Allocation When Scarcity is Anticipated” March 26, 2020 online: https://med.virginia.edu/biomedical-ethics/wp-content/uploads/sites/129/2020/03/Ethical-Framework-for-Co-vid-19-Resources-Allocation-3.26.20.pdf

[48] Ibid at 7

[49] Ibid at 233.

[50] Indiana State Dep’t of Health, Crisis Standards of Care Community Advisory Group, Crisis Standards of Patient Care Guidance with an Emphasis on Pandemic Influenza: Triage and Ventilator Allocation Guidelines, 13 (2014) http://www.phe.gov/coi/Documents/Indiana%20Crisis%20Standards%20of%20Care%202014.pdf

[51] Triage Protocol 2, supra note 1 at 3, 4 and 11.

[52] Eldridge, supra note 8.

[53] British Medical Association, “COVID-19 – ethical issues. A guidance note” (2020) at 7, online (pdf): BMA https://www.bma.org.uk/media/2360/bma-covid-19-ethics-guidance-april-2020.pdf .

[54] Tennessee, Tennessee Altered Standards of Care Workgroup, Guidance for the Ethical Allocation of Scarce Resources during a Community-Wide Public Health Emergency as Declared by the Governor of Tennessee (Version 1.6) (2020) online: Tennessee State Government

https://www.tn.gov/content/dam/tn/health/documents/cedep/ep/Guidance_for_the_Ethical_Allocation_of_Scarce_Resources.pdf .

[55] See AODA Alliance April Discussion Paper, supra note 12:

More than one hospital patient needs a ventilator. There are not enough ventilators for all the patients who need one at that hospital. At least one of the patients who needs a ventilator has disabilities. Some of the patients who need a ventilator have no apparent disabilities.

One of the patients with disabilities who needs the ventilator will need disability-related accommodations in hospital in order to receive health care services, such as a deaf patient who needs Sign Language interpreters to effectively communicate with hospital staff. The emergency room doctor, deciding who will get the ventilator, is concerned that the patient with disabilities who needs such accommodations in the hospital setting will pose a greater demand on the hospital’s services and resources, if they survive, than would other patients who need the ventilator.

The hospital or physician who is deciding who will get to use the ventilator must never use a patient’s need for disability-related accommodations as a factor or reason for refusing them the ventilator.

Tell Toronto City Council Not to Subject Canada’s Largest City to the Dangers, Personal Injuries and New Disability Barriers that Electric Scooters Cause

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

Tell Toronto City Council Not to Subject Canada’s Largest City to the Dangers, Personal Injuries and New Disability Barriers that Electric Scooters Cause

July 24, 2020

          SUMMARY

At its meeting on Tuesday, July 28, 2020, Toronto City Council has on its agenda the question whether to unleash electric scooters (e-scooters) on the people of Canada’s largest city. The AODA Alliance calls on Toronto’s Mayor John Tory and City Council to resoundingly reject e-scooters. They are a proven danger to the safety of the public including people with disabilities. They will create new accessibility barriers for people with disabilities in a city that already has too many disability barriers and that has done too little to remove those barriers.

During the COVID-19 crisis, Toronto’s City Council should be spending all its time on far more important things than the agenda of corporate lobbyists for e-scooter rental companies. Those companies would stand to profit while Torontonians bear the financial costs and suffer the serious personal injuries.

Below we set out a statement to Toronto City Council on this issue by AODA Alliance Chair David Lepofsky. We encourage you to:

* Contact members of Toronto City Council. Their contact information is available at this link https://www.toronto.ca/city-government/council/members-of-council/

Urge them to reject e-scooters for Toronto. At the very least, they should set this issue aside while the COVID-19 pandemic engulfs our society, and spend all their time on issues that are important to the people of Toronto, including people with disabilities.

* circulate this statement to your local media and urge them to print this statement and cover this issue.

* Post this statement on your social media. Spread the word to your family and friends. Ask them to support our cause.

Send us your feedback. Let us know what you can do to help our cause. Email us at aodafeedback@gmail.com

For more background:

Read the AODA Alliance’s July 8, 2020 brief to the City of Toronto Infrastructure and Environment Committee, already endorsed by Spinal Cord Injury Ontario and the March of Dimes of Canada

Read the open letter to all Ontario municipal councils from 11 major disability organizations, opposing e-scooters in Ontario, and

Read the AODA Alliance’s July 10, 2020 news release explaining what happened at the July 9, 2020 meeting of Toronto’s Infrastructure and Environment Committee where the AODA Alliance and others presented on this issue.

Visit the AODA Alliance e-scooters web page.

Statement on Electric Scooters by AODA Alliance Chair David Lepofsky

Toronto Should Not Allow Electric Scooters Which Endanger Us All

City Council must not unleash dangerous electric scooters in Toronto! They are banned, unless Council votes to allow them.

With the COVID-19 crisis raging, why is Toronto’s City Council even discussing whether to allow electric scooters? Why are they doing this in the middle of the summer when the public isn’t looking?

A new City Staff Report amply documents that e-scooters pose a real danger to public safety in places that have allowed them. Riders and innocent pedestrians will get seriously injured or killed.

They are especially a danger to seniors and people with disabilities. A blind pedestrian like me can’t know when a silent e-scooter is rocketing at me at over 20 KPH, driven by a fun-seeking unlicensed, untrained, uninsured, unhelmetted rider. When left strewn on sidewalks, they are a tripping hazard for me and an accessibility barrier for people in wheelchairs.

Don’t think that banning e-scooters from sidewalks solves these problems. The City Staff Report shows that e-scooters are ridden on sidewalks in cities that ban them from sidewalks.

We’d need cops on every street corner to effectively police e-scooters. Yet on July 9, Toronto law enforcement told the City’s Infrastructure Committee that they have no capacity to take on enforcement of new e-scooter rules. City Staff told that meeting that there’s no city anywhere that allows e-scooters and that got enforcement right.

Does the City have budget available to hire more law enforcement? One City Council member last week accurately said “the cupboard is bare.” No Councilor disagreed.

For City Council to allow e-scooters will cost taxpayers more money. There’s new law enforcement costs. There’s OHIP costs for treating those injured in our already-overcrowded hospital emergency rooms. The Staff Report rightly warns that the City could also be sued by those injured by e-scooters. Don’t we have more pressing priorities for spending public money?

If e-scooters are allowed, the ones who will be laughing all the way to the bank are the e-scooter rental companies, whose corporate lobbyists are turning up blazing heat on City Councilors to allow e-scooters. That those corporate lobbyists will go to any length was revealed when they tried exploiting the COVID-19 crisis as a pretext to speed up approval and introduction of e-scooters.

The City Staff Report shows that e-scooters don’t significantly reduce road traffic. Typically, those using e-scooters would otherwise walk the short distance to their destination. E-scooters don’t benefit the environment. Instead e-scooters and their toxic batteries eventually become landfill.

The City Staff Report’s findings all show that e-scooters should remain banned. Since the silent menace of e-scooters endanger our safety and create new accessibility barriers for people with disabilities, since they will costs us all more money and won’t really reduce road traffic, as the City Staff Report all documents, why on earth does City Staff propose taking steps towards allowing a pilot with e-scooters in Toronto?

City Council should not vote to conduct a Toronto e-scooter pilot. A pilot to study what? How many of us will be injured by this silent menace? We already know they do, from cities that allowed them. Don’t subject us to an unnecessary human experiment where we can get hurt. You need a person’s consent before subjecting them to an experiment that could endanger their safety.

Since we allow bikes, why not e-scooters? A person who has never before ridden an e-scooter (or a bike) can hop on an e-scooter and instantly throttle up to silently race over 20 KPH, endangering us all. In contrast, you can’t instantly pedal a bike that fast, and especially if you’ve never before ridden a bike. In any event, we’ve already got bikes. We don’t need to add the dangers of e-scooters.

Toronto’s City-appointed Disability Accessibility Advisory Committee and several leading disability organizations unanimously called on Toronto not to allow e-scooters. Mayor Tory and City Council should listen to them. Please make Toronto easier and not harder for those of us with disabilities to get around.

With COVID-19, Torontonians are in crisis, facing unprecedented threats to our health and economy. City Council has more important things to do than debating e-scooters, especially now. Montreal tried an e-scooter pilot and called it off. So should Toronto. Vote to protect those of us who need safe, accessible streets and sidewalks, and not the interests of corporate lobbyists.

David Lepofsky is chair, Accessibility for Ontarians with Disabilities Act Alliance and visiting professor, Osgoode Hall Law School.

New Report Reveals that At Majority of Ontario’s School Boards, Each School Principal Is a Law Unto Themselves, With Arbitrary Power to Exclude a Student From School – Real Risk of a Rash of Exclusion of Some Students with Disabilities When Schools Re-Open

ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE

NEWS RELEASE – FOR IMMEDIATE RELEASE

New Report Reveals that At Majority of Ontario’s School Boards, Each School Principal Is a Law Unto Themselves, With Arbitrary Power to Exclude a Student From School – Real Risk of a Rash of Exclusion of Some Students with Disabilities When Schools Re-Open

July 23, 2020 Toronto: Parents of a third of a million Ontario K-12 students with disabilities have much to fear when schools re-open. A ground-breaking report by the non-partisan AODA Alliance (unveiled today, summary below) shows that for much of Ontario, each school principal is a law unto themselves, armed with a sweeping, arbitrary power to refuse to allow a student to come to school. If schools re-open this fall, there is a real risk of a rash of principals excluding some students with disabilities from school, because well-intentioned, overburdened principals won’t know how to accommodate them during COVID-19.

The Education Act gives each school principal the drastic power to refuse to admit to school any “person whose presence in the school or classroom would in the principal’s judgment be detrimental to the physical or mental well-being of the pupils…”. A survey of Ontario’s 72 school boards, unveiled today, shows that a majority of school boards have no policy reining in their principals’ sweeping power. Ontario’s Ministry of Education gives principals precious little direction. Principals need not keep track of how many students they exclude, or for how long, or for what reason, nor need they report this information to anyone. School Boards are left largely free to do as little as they wish to monitor for and prevent abuse of this power.

This is especially worrisome for students with disabilities. Disproportionately, it’s students with disabilities who are at risk of being excluded from school.

Today’s report details how the most vulnerable students can unjustifiably be treated very differently from one part of Ontario to the next. Of Ontario’s 72 School Boards, only 33 Boards have been found to have any policy on this. Only 36 School Boards even responded to the AODA Alliance survey. Only 11 Boards gave the AODA Alliance a policy. A web search revealed that another 22 Boards have a policy on this.

As for the minority of 33 boards that have any policy on point, this report documented wild and arbitrary differences from Board to Board. Some Board policies have commendable and helpful ingredients that all boards should have. Some Board policies contain unfair and inappropriate ingredients that should be forbidden. For example, no Board should impose on a student or their family an arbitrary time limit for presenting an appeal from their exclusion to school.

“Every student facing the trauma of an exclusion from school deserves full and equally fair procedures and safeguards,” said AODA Alliance Chair David Lepofsky. “The current arbitrary pattern of patchwork injustice cries out for new leadership now by the Ford Government.”

COVID-19 escalates this issue’s urgency. The Ministry of Education should head off a rash of new exclusions from school this fall before it happens, by immediately directing School Boards to implement common sense restrictions on a principal, outlined in the report, on when and how a principal may exclude a student from school.

Contact: AODA Alliance Chair David Lepofsky, aodafeedback@gmail.com Twitter: @aodaalliance

Download the entire AODA Alliance report on Refusals to Admit A Student to School by visiting https://www.aodaalliance.org/wp-content/uploads/2020/07/july-23-2020-AODA-Alliance-finalized-refusals-to-admit-brief.docx

The AODA Alliance’s COVID-19 web page details its efforts to ensure that the urgent needs of people with disabilities are met during the COVID-19 crisis.

The AODA Alliance‘s Education web page details its ongoing efforts over the past decade to tear down the many barriers impeding students with disabilities in Ontario’s education system.

Introduction and Summary of the AODA Alliance’s Report on the Power of Ontario School Principals to Refuse to Admit a Student to School

I. Introduction and Summary

(a) What’s the Problem?

For years, Ontario’s Education Act has given every Ontario school principal the drastic power to refuse to admit to school any “person whose presence in the school or classroom would in the principal’s judgment be detrimental to the physical or mental well-being of the pupils…”. A student can be excluded from school for part or all of the school day. This report uses the terms “refusal to admit” and “exclusion from school” or simply “exclusion” to mean the same thing.

When a principal refuses to admit a student to school, that violates that student’s right to go to school to get an education. Under the Education Act as interpreted or applied by the Ontario Government and school boards, a student can be excluded from school for days, weeks or even months.

Ontario’s Ministry of Education has given School Boards and principals very little direction on how this sweeping power may be used. School Boards are therefore left largely free to do as much or as little as they wish to ensure that this power is not abused by an individual school principal.

A School Board can develop a policy on how a principal can use the power to refuse to admit a student to school; however, a School Board does not have to do so. If it does adopt a policy, it does not have to be a good policy.

(b) Taking Stock – The AODA Alliance Surveys Ontario School Boards

The AODA Alliance therefore conducted a survey of Ontario’s major School Boards to find out what their policies and practices are regarding the exclusion of students from school. The non-partisan grassroots AODA Alliance advocates for accessibility for people with disabilities, including for students with disabilities. See its website’s Education page.

This report makes public the results of the AODA Alliance‘s survey and investigation. It reveals an arbitrary patchwork of different policies around Ontario, unjustifiably treating the most vulnerable students differently from one part of Ontario to the next. There is a pressing need for the Ontario Government to step into the gap, to protect students, and especially students with disabilities.

In an error which the AODA Alliance regrets, the survey was inadvertently not earlier sent to one board, the Dufferin Peel Catholic District School Board, before this report was written. It has just done so, and will make public an addendum to this report if a response is received that alters the results expressed in this report. This error does not diminish this report’s findings or recommendations.

School Boards were asked (i) if it has a policy on when-and-how its school principals can refuse to admit a student to school, (ii) whether the Board tracks its principal’s use of this power, and (iii) how many students have been excluded from school. The AODA Alliance sent its survey to School Boards twice, once in 2019, and once in 2020. The Council of Directors of Education retained private legal counsel to get legal advice before responding to this survey.

(c) The Survey Revealed an Arbitrary Patchwork of Wildly Varying Local Requirements

Of Ontario’s 72 School Boards, only 33 Boards have been found to have a written policy or procedure on refusals to admit a student to school. Only 36 School Boards responded to the AODA Alliance’s survey. Of those, only 11 Boards gave the AODA Alliance their policy or procedure on refusals to admit.

Six School Boards told the AODA Alliance that they have no policy on refusals to admit. An extensive web search by the AODA Alliance revealed that another 22 School Boards have a written policy or procedure on this topic. In a number of cases, these were not easy to find. Taken together, a large number of Ontario School Boards revealed a troubling lack of openness and accountability on this subject.

This report’s analysis of the 33 policies or procedures on refusals to admit, as obtained by the AODA Alliance, revealed that there are wild variations between the written policies of School Boards across Ontario on excluding a student from school. Some are very short and say very little. Others are far more extensive and detailed.

As for safeguards for vulnerable students and their parents in the face of an exclusion from school, there are arbitrary and unjustified differences from Board to Board. Some Board policies have commendable and helpful ingredients that should be required of all School Boards. Some Board policies contain unfair and inappropriate ingredients that should be forbidden. For example, no Board should use a refusal to admit to facilitate a police investigation, or set an arbitrary time limit in advance for an appeal hearing from a refusal to admit, or give a student or their family an arbitrary time limit for presenting such an appeal.

There is no justification for such wild variations from Board to Board, from no policy, to policies that say very little, to substantially better policies. Every student facing an exclusion from school deserves fair procedures and effective safeguards. Every School Board should meet basic requirements of transparency and accountability in their use of this drastic power. No compelling policy objective is served by leaving each School Board to reinvent the wheel here.

(d) The Urgently Needed Solution: Action Now by the Ontario Government

This situation cries out for leadership on this issue by Ontario’s Ministry of Education. The failure of so many School Boards to even have a policy in this area, the unwillingness of so many School Boards to even answer questions about their policy on this issue, and the fact that policies are so hard to find on line combine to create a disturbing picture. For too much of Ontario, well-intentioned school principals are left to be a law unto themselves. The AODA Alliance expects that these hard-working and dedicated principals neither asked for this nor would like this situation to remain as is.

This issue has serious implications for students with disabilities. Refusals to admit a student to school disproportionately burden some students with disabilities.

The COVID-19 crisis escalates the urgency of this issue. When schools re-open this fall, there is a real risk that there could be a rash of more refusals to admit some students with disabilities to school. This threatens to be the way some overwhelmed and overburdened principals will cope with the stressful uncertainties surrounding the COVID-19 pandemic.

The Ministry of Education should head off this problem before it happens, by immediately directing School Boards to implement some basic and overdue requirements for refusals to admit a student to school. The Ministry should then develop a comprehensive and broader set of mandatory requirements for all School Boards when exercising the power to refuse to admit a student to school.

Examples of helpful requirements that the Ministry of Education should require, and that this report documents as now in place in one or more School Boards include the following:

  1. Refusals to admit should be recognized as an infringement of the student’s right to go to school to get an education, and as raising potential human rights issues, especially for students with disabilities. The Ontario Human Rights Code has primacy over the Education Act and the power to refuse to admit a student to school.
  2. A refusal to admit should only be imposed for a proper safety purpose. A student cannot be refused admission to school for purposes of discipline.
  3. Maximum time limits should be set for a refusal to admit, with a process for considering how to extend it if necessary and justified.
  4. A refusal to admit a student to school should only be permitted in very rare, extreme cases, as a last resort, after considering or trying all less intrusive alternatives. A principal should be required to take a step-by-step tiered approach to deciding whether to refuse to admit a student to school, first exhausting all less restrictive alternatives, and first ensuring that the student’s disability-related needs have been accommodated as required under the Ontario Human Rights Code.
  5. It should not be left to an individual principal to unilaterally decide on their own to refuse to admit a student to school. Prior approval of a higher authority with the School Board should be required, supported by sufficient documentation of the deliberations.
  6. A principal should be required to work with a student and their family on issues well before it degenerates to the point of considering a refusal to admit. The School Board should be required to have a mandatory meeting with the family before a refusal to admit is imposed.
  7. A principal should be required to immediately send a letter to the parents of a student whom they are refusing to admit to school, setting out the facts and specifics that are the reasons for the exclusion from school. A senior Board supervisor that approved the decision should be required to co-sign the letter. The letter should also be signed by the Director of Education if the student is to be excluded from all schools in the Board.
  8. A School Board that excludes a student from school should be required to put in place a plan for delivering an effective educational program to that student while excluded from school, including the option of face-to-face engagement with a teacher off of school property. This plan should be monitored to ensure it is sufficient.
  9. If a student is excluded from school, the School Board should be under a strong duty to work with the student and family to get them back to school as soon as possible.
  10. A School Board that excludes a student from school should be required to hold a re-entry meeting with the student and family to transition to the return to school.
  11. Any appeals to the Board of Trustees for the School Board from a refusal to admit should assure fair procedures to the student and their family. An excluded student should at least have all the safeguards in the appeal process as does a student who is subjected to discipline.
  12. The appeal should be heard by the entire Board of Trustees, and not just a sub-committee of some trustees. An appeal hearing should be held and decided quickly, since the student is languishing at home.
  13. A Board of Trustees, hearing an appeal from a refusal to admit, should consider whether the School Board has justified the student’s initial exclusion from school and its continuation. The burden should be on the School Board to justify the exclusion from school, and not on the student trying to go back to school. At an appeal hearing, the principal should first present why the exclusion from school is justified and should continue, before the student or parents are asked to show why the student should be allowed to return to school.
  14. When an appeal is launched, the School Board should be required to first try to resolve the issue short of a full appeal hearing.
  15. A student’s record of a refusal to admit to school should not stain the student’s official school record.
  16. If a School Board directs that a student can only come to school for part of the school day), the same safeguards for the student should be required as for a student who is excluded for the entire day.
  17. Any policy in this area should be periodically reviewed and updated.

In A Second COVID-19 Wave, If There Aren’t Enough Ventilators for All Patients Needing Them, A new Draft Ontario Medical Triage Protocol Would Continue to Discriminate Against COVID-19Patients with Disabilities

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

In A Second COVID-19 Wave, If There Aren’t Enough Ventilators for All Patients Needing Them, A new Draft Ontario Medical Triage Protocol Would Continue to Discriminate Against COVID-19Patients with Disabilities

July 16, 2020

          SUMMARY

 1. What’s the Serious Issue?

Despite having four months to fix this serious problem, in the COVID-19 crisis the Ford Government has still not rooted out the current danger to people with disabilities, induced by a protocol that Ontario Health sent to all hospitals last spring. That protocol lets hospitals violate basic human rights of COVID-19 patients with disabilities if a surge in COVID-19 cases meant there’s not enough ventilators for all critical patients needing them. Despite months of efforts by disability advocates, a new draft “medical triage protocol” which the Government has under consideration, and which we reveal to the public here while it is open for input, leaves the danger of disability discrimination in place.

Thankfully, Ontario now has no ventilator shortage. However a second wave of COVID-19 cases later this year could create a surge in demand for ventilators. To date, the Ford Government’s troubling handling of what to do if there are too few ventilators for COVID-19 patients has been improperly shrouded in secrecy.

Early in the COVID-19 crisis, Ontario Health, part of the Ontario Government, sent a very troubling March 28, 2020 medical triage protocol to Ontario hospitals. It spelled out what to do if there is more demand for life-saving ventilators than there are ventilators to go around. The Government did not make that protocol public. After it was leaked early last April to some within the disability community, disability advocates slammed it and called for it to be rescinded and replaced.

 2. What’s New on This Issue?

Here is the late-breaking news on this issue, backed by Government documents that we are making public in this Update.

  1. We now confirm that the Government sent the original March 28, 2020 medical triage protocol to Ontario hospitals. A July 7, 2020 letter from Ontario Health’s team drafting the triage protocol, set out below, states:

“The draft recommendations were shared by Ontario Health with hospitals on March 28, 2020 to help hospitals to prepare for the possibility of a major surge in critical care demand and to prevent catastrophic health outcomes as have been seen in other jurisdictions.”

  1. It is now clear and beyond dispute that the Government has still not rescinded that original March 28, 2020 medical triage protocol. Disability advocates including the AODA Alliance, as well as the Ontario Human Rights Commission, have called on the Government to rescind that original medical triage protocol, because it violates the human rights of patients with disabilities. Ontario Health’s June 15, 2020 letter to the Ontario Human Rights Commission, set out below, states the following regarding the medical triage protocol:

“Our goal is to have a final document by the end of July, or to rescind it. “

  1. A Government-appointed committee of physicians and bioethicists that have been assigned to lead the work in this area have written a new revised draft of the medical triage protocol. We among others have received it. We are here making it public, setting it out below, along with related correspondence between the Ontario Human Rights Commission and Ontario Health.
  1. On July 15, 2020, a number of members of Ontario Health’s committee of physicians and bioethicists, assigned to lead this protocol’s development, held a two-hour virtual consultation with several disability community representatives, including the AODA Alliance. This is the first time the AODA Alliance had an opportunity to speak with those leading this issue for the Ford Government. We were not named on that Committee’s list of organizations it had consulted, or to be consulted. This virtual meeting came some three months after a senior official involved in the development of the initial protocol announced on province-wide television that it was a top priority for the Government to consult on this protocol.

As detailed further below, the disability advocates consulted at that meeting unanimously showed that the revised draft medical triage protocol still creates a real and serious danger of discrimination against patients with disabilities.

  1. Ontario Health’s team developing this new draft medical triage protocol aims to submit to the Ford Government its recommendation for a revised medical triage protocol by July 31, 2020. Written submissions can be sent to that team by writing jcb.director@utoronto.ca up to July 20, 2020.
  1. The ARCH Disability Law Centre, which has played a tremendous leadership role on this issue, will be making a written submission by July 20, 2020 in which the AODA Alliance will contribute our input. We will make it public as quickly as we can.

 3. What’s Wrong With the New Revised Draft Medical Triage Protocol?

Here is a summary of just some of the many serious problems with the revised draft medical triage protocol that is set out below.

  1. This new revised draft medical triage protocol does not effectively undo the damage that the March 28, 2020 protocol caused for people with disabilities. The Government had spread that harmful earlier protocol across Ontario’s health care system. Any revised protocol must fully and effectively undo that damage.
  1. The draft revised protocol continues to discriminate against patients with disabilities. It includes some vague references to human rights. Those references are entirely insufficient to eliminate the discrimination that the original protocol and this revised draft protocol each cause. As but one example, the revised draft protocol, like the original one, continues to use the Clinical Frailty Scale, which itself presents real and serious disability human rights concerns. Its prominence in the protocol has been reduced but its use has not been eliminated. Whether or not there are any studies on that scale does not detract from the fact that that scale should not be used.
  1. On April 14, 2020, the AODA Alliance made public a Discussion Paper on this issue. It set out clear illustrations of things that need to be spelled out in the medical triage protocol to address the risk of discrimination against patients with disabilities. The committee drafting the protocol has seen that Discussion Paper. However, the revised medical triage protocol does not include any of the Discussion Paper’s proposals, nor does it cure any of the harms to patients with disabilities that the Discussion Paper illustrates. The protocol should be amended to include all the specific directions and recommendations in the AODA Alliance’s Discussion Paper.
  1. The revised draft medical triage protocol uses vague criteria that any two doctors might interpret very differently. It speaks of patients with “a low probability of surviving more than a few months”. One doctor might think that means 2 to 3 months. Another doctor might think that means 6 to 8 months. Its directions must be far clearer and less open to arbitrarily different applications from one doctor to the next.
  1. The revised medical triage protocol uses lofty and vague language such as its references to ethics, equity, human rights, and fairness. However, those lofty terms will do nothing to stop a well-intentioned doctor or hospital from taking action that discriminates against patients with disabilities. Indeed, as is the case here, many if not most of the barriers facing people with disabilities are created without any intent to harm people with disabilities.

For example, the revised draft medical triage protocol states:

“Triage decisions should treat similar cases similarly based on clinical criteria, i.e., those with similar prognoses should be treated similarly.”

The medical triage protocol might thereby be meant to implement the authors’ notions of fairness and equality. However, this flies in the face of the Supreme Court of Canada’s important ruling in its landmark decision on the meaning of equality rights, Andrews v. Law Society of British Columbia [1989] 1 SCR 143, where the Court proclaimed:

“Thus, mere equality of application to similarly situated groups or individuals does not afford a realistic test for a violation of equality rights.”

  1. If there is a shortage of ventilators during a second wave of COVID-19, this revised draft medical triage protocol in effect creates a “death panel” of two doctors who will decide in an individual case in an individual hospital who gets the ventilators and who does not, among all the patients who need them. It requires no prior training on this issue for the doctors chosen to play that role. It provides no fair procedures or due process to the very patient whose life hangs in the balance. The patient and their family have no right to be heard by those deciding the patient’s fate. There is no assurance that the family can get their family doctor to chime in and add their voice to the discussion. There is no right of appeal to anyone else in the hospital.

There is no duty on the doctors or hospitals to give the patient or their family basic rights advice. This is so even though the revised draft medical triage protocol gives superficial and inadequate lip service to due process concerns, stating:

“Due process considerations (e.g., transparency about reasons for triage decisions) are especially important in this context. Hospitals should plan for how they might proactively prepare patients and families for possible outcomes of the triage process as well as how they would respond transparently and compassionately to patient or family concerns should these arise.”

Appendix E to the revised draft protocol sets out a sample of what a doctor might tell a patient and their family if it has been decided to refuse them a needed ventilator due to a ventilator shortage. That seriously deficient text gives the patient and family no rights advice or other basic information of what they can do if they wish to dispute the decision and to have it reconsidered.

The revised draft Medical triage protocol in substance wrongly and summarily rejects the idea of any appeal, stating:

“critically ill patients must be assessed rapidly in a dynamic and over-taxed environment, a formal process for patients and families to appeal triage decisions may not be feasible or appropriate (e.g., if critical care is contrary to the patient’s wishes).”

 4. For More Background

* The April 7, 2020 virtual public forum on the impact of COVID-19on people with disabilities, jointly organized by the AODA Alliance and the Ontario Autism Coalition. During this event, ARCH Disability Law Centre executive director Robert Lattanzio first made public the existence of the original March 28, 2020 medical triage protocol, and the disability human rights problems that it creates.

* The April 8, 2020 open letter, spearheaded by ARCH, identifying the serious disability human rights violations in the original March 28, 2020 medical triage protocol.

* The AODA Alliance’s April 14, 2020 Discussion Paper on what the medical triage protocol should include. In the three months since this was made public, no negative feedback was received about its recommendations.

* The Ford Government’s April 21, 2020 announcement that it would consult community and human rights experts on the medical triage protocol. It claimed that the March 28, 2020 protocol was only a “draft” even though it was never marked “draft.

* The ARCH Disability Law Centre’s detailed May 13, 2020 analysis of the serious disability human rights violations, which the AODA Alliance endorses.

* To learn more about the many barriers that impede patients with disabilities in Ontario’s health care system, read the AODA Alliance’s February 25, 2020 Framework on what the promised Health Care Accessibility Standard should include, to be enacted under the Accessibility for Ontarians with Disabilities Act.

* The AODA Alliance’s health care web page, to learn more about the advocacy efforts to tear down the barriers facing people with disabilities in Ontario’s health care system.

* The AODA Alliance’s COVID-19 web page details the coalition’s efforts to advocate for the needs of people with disabilities during the COVID-19 pandemic.

Below we set out:

 

* The second draft Critical Care Medical Triage Protocol.

 

* the July 7, 2020 letter from the Ontario COVID-19 Bioethics Table of Ontario Health to organizations taking part in the July 15, 2020 roundtable on the triage protocol and people with disabilities.

* the June 15, 2020 letter from Ontario Health to the Ontario Human Rights Commission

* the June 4, 2020 letter from the Ontario Human Rights Commission to Ontario Health

* the June 4, 2020 Ontario Human Rights Commission letter to the Ontario Minister of Health

We always invite your feedback. Write us as aodafeedback@gmail.com

          MORE DETAILS

 

 Text of the Revised Draft Ontario Medical Triage Protocol

 

 

Critical Care Triage for Major Surge in the COVID-19 Pandemic:

Updated Recommendations

 

Note: This document offers recommendations developed by provincial experts in bioethics in consultation with clinical experts and informed by stakeholder feedback. It reflects best knowledge and advice at the time of writing and is subject to revision based on changing conditions and new evidence in the COVID pandemic.[1]

 

Overview:

During the COVID-19 pandemic, a major surge in demand for critical care may exceed available health system capacity. Difficult decisions would need to be made about how critical care resources should be allocated to meet patient needs. Although advanced health systems have experience with and are well-prepared to manage minor and moderate surges in demand for critical care, there is limited clinical and ethical guidance for how a major surge in demand for critical care should be managed. In Ontario, major surge is defined as: “an unusually high increase in demand that overwhelms the health care resources of individual hospitals and regions for an extended period of time, where an organized response at the provincial or national level is required.”[2] The purpose of this document is to propose a critical care triage approach for major surge in the COVID-19 pandemic, to raise key ethical and clinical considerations for critical care triage in this context, and to offer suggestions for implementation of the critical care triage approach in the Ontario health system if needed.[3]

Critical care triage in the COVID-19 pandemic should aim to maximize the survival and recovery of as many critically ill patients[4] as possible and as equitably as possible within available critical care resources. In a pandemic, critical care triage for major surge will inevitably involve an alternative standard of care. For this reason, critical care triage for major surge should be considered an option of last resort – to be invoked only when all existing local or regional critical care resources have been used, all reasonable attempts have been made to move patients to or resources from areas with greater critical resource availability, and only for as long as the major surge lasts – and would require an emergency order in order to be implemented in Ontario. When not all patient needs can be met within resource constraints, triage is the systematic and consistent process of determining priorities for treatment based on objective and explicit clinical criteria. This is especially important in the context of a major surge, when the number of patients with critical illness exceeds critical care capacity. In the absence of explicit triage criteria and a systematic and consistent process of triage, inconsistencies in clinical practice may result in increased mortality and morbidity.

Critical care triage for a major surge should be predictable and apply to an entire region rather than to individual hospitals alone. In the current COVID-19 pandemic context, the decision to initiate triage falls under the authority of, and would be made by, the Ontario Health Critical Care Command Centre with full situational awareness of the existing critical care resources and demand for critical care. In a major surge, a proportionate response to increasing and decreasing levels of demand on scarce critical care resources is essential. The degree of triage should be calibrated to the degree of demand in order to limit the possibility that a patient will be denied critical care resources unnecessarily. As critical care demand increases in a major surge, triage criteria should become proportionately more stringent; similarly, as critical care demand decreases in a major surge, triage criteria should become proportionately less stringent. Triage criteria and their application should be evaluated at regular intervals to ensure that the overarching goal of maximizing survival and recovery of critically ill patients within available critical care resources is met.

Critical care triage for major surge in the COVID-19 pandemic should be guided by ethical principles. Relevant ethical principles include medical utility, proportionality, fairness, equity, beneficence (including non-abandonment), respect for autonomy, and accountability. Respect for human rights and solidarity with all community members are key values of an ethical triage approach. In a major surge in demand for critical care resources, the necessity of critical care triage does not change the fact that the lives of all Ontarians are of equal moral worth and that all patients must be cared for and receive appropriate symptom management. Those who do not receive critical care resources due to triage should continue to receive other appropriate treatments and supports, including palliative care if needed. Importantly, critical care triage may have a differential impact on some patient populations who may be disadvantaged due to pre-existing health and social inequities or conscious or unconscious bias in clinical settings. Evidence of systemic bias against specific groups should be considered as reason to review and potentially revise these triage recommendations and their application.

Guiding Ethical Principles:

The overall purpose of a triage system in a pandemic is to minimize mortality and morbidity for a population overall as opposed to an individual mortality and morbidity risk. There are published frameworks outlining ethical principles to guide triage systems.1-4 Recent studies of Canadian perspectives on priority setting of critical care resources in a pandemic indicate a preference for maximizing the number of lives saved,5,[5] followed by the application of a fair procedure for prioritization of people with similar likelihood of benefit.1,[6] In addition, there is published guidance on how triage systems can minimize risk of discrimination based on factors unrelated to a patient’s clinical needs and mitigate discriminatory application of such frameworks in practice.6-8 This body of work informs the ethical underpinnings of the proposed triage approach.

In the context of a major surge in demand for critical care in a pandemic, the following ethical principles are foremost:

  1. Medical Utility – Aim to derive the maximum benefit from critical care resources by prioritizing those patients who are most likely to survive their critical illness. When resources are scarce in a pandemic, patients who are very likely to die from their critical illness or who are very likely to die in the near future[7] even if they recovered from their critical illness would have a lower priority for critical care resources.
  2. Proportionality – Ensure that the number of individuals who are negatively affected by the use of critical care triage criteria in a pandemic does not exceed what would be required to accommodate the surge in demand. Given that critical care capacity and demand can be dynamic, access to critical care should be restricted only to the extent necessary to achieve maximum benefit within resource constraints and should become less restrictive as resources become available or the surge abates.
  3. Fairness – Ensure all patients have a fair chance to benefit from critical care by allocating critical care resources on the basis of clinical criteria relevant to predicting the patient’s likelihood of survival. Triage decisions should treat similar cases similarly based on clinical criteria, i.e., those with similar prognoses should be treated similarly. In the event that clinical criteria are not sufficient to prioritize one patient over another, a fair procedure should be used.
  4. Equity and Respect for Human Rights – Affirm and safeguard the equal moral worth of all people in Ontario by implementing measures to minimize the risk of perpetuating or exacerbating the effects of systemic discrimination or marginalization on access to health care[8] and to uphold individual human rights to the extent possible in a pandemic emergency.[9] This includes ensuring triage decisions: i) are based on objective clinical criteria grounded in best available evidence and not any particular demographic,[10] disease, or disability independent of an individual patient’s prognosis,[11] ii) involve an individual assessment of a patient’s clinical condition in relation to the triage criteria and not to a judgment of the individual’s social value, quality of life or long-term survival, and iii) are supported by accommodations as appropriate for an individual patient to the extent possible in an infection control context (see Respect for Autonomy below).
  5. Beneficence – Act in a way that promotes patients’ well-being to the greatest extent possible given resource constraints by clarifying patient goals of care (i.e., patient wishes, beliefs, and values regarding their treatment) in relation to their critical care needs, providing continuity of care for all patients appropriate to their clinical circumstances, including those whose critical care needs cannot be met, and ensuring no patient is left without care. Although resource scarcity in a pandemic may limit the ability to meet all patient needs, maintaining a caring relationship with all patients is essential.
  6. Respect for Autonomy – Ensure all patients have a chance to make their goals and wishes known and to have treatment provided in alignment with these goals and wishes wherever possible. Patients (or their substitute decision-makers) may need support to make free and informed decisions about their care. To ensure effective communication and informed decision-making, individual patients may require accommodations (e.g., plain language, use of communication devices, interpretation services) and/or participation of attendant care worker or other support person to the extent possible in an infection control context.
  7. Accountability – Remain answerable for decisions made in the context of triage. This means communicating triage decisions, including the criteria used to make those decisions, in an open and honest manner to patients or their substitute decision-makers and to the broader community served. It also involves monitoring the implementation of the triage approach to ensure decisions are based in best clinical evidence and expertise supported by ethical reasoning. Triage decisions, criteria, and processes should be evaluated at regular intervals at local, regional and provincial levels to assess the extent to which they are clinically and ethically justified.

 

In a pandemic context, there is an intrinsic tension between some of the ethical principles outlined above. On the one hand, a criteria-based triage approach that focuses on an individual clinical assessment of predicted mortality and not on any other factors (demographic, quality of life, social standing, etc.) offers a defensible way to reconcile some of the tensions between the principle of medical utility (saving the most lives possible) and the principle of equity (mitigating systemic discrimination or implicit bias in health care). On the other hand, for patients who might wish but who are found ineligible for critical care in a major surge, the pandemic context creates a tension between the principles of medical utility and respect for autonomy, and underscores the importance of the principle of beneficence to ensure all patients receive care even if critical care treatment is not available. The evolving COVID pandemic context in Ontario reveals pre-existing health and social inequities in health care, which a triage approach by itself will be unable to resolve. However, the potential adverse consequences of a triage approach for vulnerable groups can be mitigated in a few ways, including: i) the systematic collection of data on triage outcomes to monitor the effect of the triage approach on vulnerable groups, and ii) proactive measures taken ‘upstream’ in the community and across the health system to prevent members of vulnerable groups from exposure to COVID-19 in the first place. Some of these tensions may not be fully resolved in a pandemic. For this reason, the principles of proportionality and accountability are essential bulwarks for an ethical triage approach under difficult pandemic circumstances.

 

Clinical Triage Criteria for Critical Care in a Major Surge:

Explicit criteria-based triage decision-making has been recommended in other published guidance for critical care in a pandemic.[12] Use of explicit criteria fosters consistency, advances medical utility and fairness, and supports accountability. It may also alleviate clinician burden at a time of high stress.[13] Eligibility and ineligibility criteria are specified below based on the best available evidence and expert opinion regarding predicted mortality. A patient should meet one of the eligibility criteria and should not meet any of the ineligibility criteria for access to critical care. Where there is insufficient evidence to support a reasonable clinical judgement regarding whether a patient meets ineligibility criteria, a decision of ineligibility should be avoided. In all cases, an individualized review of each patient’s clinical condition should be performed, ensuring not to assume that any specific diagnosis is determinative of prognosis or near-term survival without an analysis of current and best available evidence and the individual’s ability to respond to treatment. Please note: these criteria apply only to patients aged 18 years and should only be used in the context of a major surge in demand for critical care.

Eligibility criteria were outlined by Christian et al.9 and are repeated here:

Variable Eligibility Criteria for Critical Care Admission
Requirement for invasive ventilator support Refractory hypoxemia (SpO2 <90% on FiO2 0.85) OR

Respiratory acidosis with pH <7.2 OR

Clinical evidence of respiratory failure OR

Inability to protect or maintain airway

Hypotension Low systolic BP (e.g., SBP <90 mm Hg for most adults) OR

relative hypotension with clinical evidence of shock (altered level of consciousness, decreased urine output, end-organ hypoperfusion), refractory to volume resuscitation requiring vasopressor/inotrope support that cannot be managed on a medical ward

SpO2 = oxygen saturation as measured by pulse oximetry

 

Ineligibility criteria for critical care triage in a pandemic have typically fallen under two categories: (1) criteria that indicate a low probability of surviving an acute episode of critical illness, and (2) criteria that indicate a low probability of surviving more than a few months regardless of the acute episode of critical illness.9 These categories are not mutually exclusive, as life-limiting illnesses affect prognosis from acute illness, and acute illness affects the trajectory of chronic illness. The criteria outlined below would limit eligibility for critical care if someone is very likely to die from their critical illness or are very likely to die in the near future even if they recovered from their critical illness. Please note: these criteria are not exhaustive and are meant to reflect known evidence and/or clinical experience-based prognostic indicators for specific conditions. Some medical conditions not listed may also indicate a similarly poor prognosis, and such patients should be triaged accordingly. Conversely, some medical conditions listed may not indicate a poor prognosis in specific situations and such patients should not be found ineligible. Clinicians should use their best clinical judgment informed by these clinical triage criteria as appropriate to determine whether an individual patient’s clinical circumstances would indicate that they should receive critical care resources. The tools listed in the table below can be found in Appendix C.

Criterion Level 1 Triage Scenario (Aiming to exclude people with >~80% predicted mortality) Level 2 Triage Scenario (Aiming to exclude people with >~50% predicted mortality) Level 3 Triage Scenario (Aiming to exclude people with ~>30% predicted mortality)
A Severe Trauma with predicted mortality >80% based on TRISS score Severe Trauma with predicted mortality >50% based on TRISS score Trauma with predicted mortality >30% based on TRISS score
B Severe burns with any 2 of: Age >60, >40% total body surface area affected, inhalation injury Same as Level 1 Same as Level 1
C Cardiac arrest
  • Unwitnessed cardiac arrest
  • Witnessed cardiac arrest with non-shockable rhythm
  • Recurrent cardiac arrest
Same as Level 1 Cardiac arrest
D Progressive, late or end-stage illness marked by severe cognitive impairment, clinically defined as an inability to independently perform basic activities of daily living at baseline (2-4 weeks before admission). This criterion does not refer to all conditions that cause cognitive impairment or all conditions clinically defined by an inability to independently perform basic activities of daily living – see explanatory note at end of table. Same as Level 1 Progressive, end-stage illness marked by moderate or severe cognitive impairment, clinically defined as an inability to independently perform multiple instrumental activities of daily living (IADLs – e.g., finances, medications, transportation) or any of the basic activities of daily living (BADLs – e.g., bathing, dressing, feeding) at baseline (2-4 weeks before admission). This criterion does not refer to all conditions that cause cognitive impairment or all conditions clinically defined by an inability to independently perform instrumental or basic activities of daily living – see explanatory note at end of table.
E Progressive, end-stage neurodegenerative disease Same as Level 1 Progressive neurodegenerative disease
F Metastatic malignant disease with any of the following:

·       ECOG class >=2

·       Disease progressing or stable on treatment

·       Active treatment plan with >80% predicted mortality during or soon after critical illness

·       Unproven (experimental) treatment plan

·       Treatment plan that would only be started if the patient recovers from critical illness

Metastatic malignant disease with any of the following:

·       ECOG class >=2

·       Disease progressing or stable on treatment

·       Active treatment plan with >50% predicted mortality during or soon after critical illness

·       Unproven (experimental) treatment plan

·       Treatment plan that would only be started if the patient recovers from critical illness

Metastatic malignant disease
G Advanced and irreversible immunocompromised Same as Level 1 Same as Level 1
H Severe and irreversible neurologic event with >80% risk of death or poor outcome based on:
  • For Intracerebral Hemorrhage a modified ICH score of 4-7
  • For Subarachnoid Hemorrhage, a WFNS grade 5 (GCS 3-6)
  • For Traumatic Brain Injury, the IMPACT score
  • Acute ischemic stroke alone would not be excluded at this level
Severe and irreversible neurologic event with >50% risk of death or poor outcome based on:
  • For Intracerebral Hemorrhage a modified ICH score of 3-7
  • For Subarachnoid Hemorrhage, a WFNS grade 3-5 (GCS 3-12 OR GCS 13-14 AND focal neurological deficits)
  • For Traumatic Brain Injury, the IMPACT score
  • For acute ischemic stroke, an NIHSS of 22-42.
Irreversible neurologic event/condition with >30% risk of death or poor outcome based on:
  • For Intracerebral Hemorrhage a modified ICH score of 2-7
  • For Subarachnoid Hemorrhage, a WFNS grade 2-5 (GCS <15)
  • For Traumatic Brain Injury, the IMPACT score
  • For acute ischemic stroke, an NIHSS of 14-42.
I End-stage organ failure meeting the following criteria:

Heart

·        Chronic End-stage Heart Failure with NYHA Class 4 symptoms, ineligible for advanced therapies (mechanical support, transplant)

Lung

·        COPD with chronic home O2 >12h per day or breathlessness at rest

·        Cystic Fibrosis with FEV1 <20% predicted when measured at time of clinical stability

·        Pulmonary fibrosis with VC or TLC <60% predicted, baseline PaO2 <55 mmHg, or secondary pulmonary hypertension

·        For pulmonary hypertension, anyone with ESC/ERS high risk criteria (see below)

Liver

·       Chronic Liver Disease with failure of 2 or more organ systems (ACLF Grades 2-3)

·       MELD score >=25

Note that patients who meet these criteria may be eligible for ICU admission if they are currently on an organ donation waiting list and would be given highest priority if admitted to ICU (e.g., status 4/4F for liver transplantation). This does not include people who have been referred to a transplant service but have not yet been listed for a transplantation. This also would not apply if organ donation processes are halted due to triage conditions precluding organ procurement.

End-stage organ failure meeting the following criteria:

Heart

·        Chronic End-stage Heart Failure with NYHA Class 3 or 4 symptoms, ineligible for advanced therapies (mechanical support, transplant) PLUS any of:

o   High/increasing BNP

o   Cardiorenal syndrome

o   Recent discharge (<30d) or multiple admissions for CHF in past 6 months

Lung

·        COPD with

o   Chronic home O2 OR

o   >=1 admission for COPD in past 12 months AND has to stop for shortness of breath when walking at own pace

·        Cystic Fibrosis with FEV1 <20% predicted when measured at time of clinical stability

·        Pulmonary fibrosis with VC or TLC <60% predicted, baseline PaO2 <55 mmHg, or secondary pulmonary hypertension

·        For pulmonary hypertension, anyone with ESC/ERS high risk criteria (see below)

Liver

·       Chronic Liver Disease with failure of 1 or more organ systems (ACLF Grades 1-3)

·       MELD score >=15

Note that patients who meet these criteria may be eligible for ICU admission if they are currently on an organ donation waiting list and would be given highest priority if admitted to ICU (e.g., status 4/4F for liver transplantation). This does not include people who have been referred to a transplant service but have not yet been listed for a transplantation. This also would not apply if organ donation processes are halted due to triage conditions precluding organ procurement.

End-stage organ failure with one-year mortality risk >30% as suggested by an unscheduled admission for an exacerbation or complication of their chronic illness in the past 12 months or previous organ transplant with evidence of chronic rejection or chronic organ dysfunction in the transplanted organ. Note that some admissions (e.g., catheter or access infections) may not suggest an elevated risk of mortality, and for some less common conditions (e.g., CF) unscheduled admissions may not suggest an elevated risk of mortality and specialist input should be sought.
J Anyone with a Clinical Frailty Score of >=7 (on the 9-point tool) at baseline (2-4 weeks before admission) due to a progressive illness or generalized deterioration of health status (see explanatory note at end of table) Anyone with a Clinical Frailty Score of >=5 (on the 9-point tool) at baseline (2-4 weeks before admission) due to a progressive illness or generalized deterioration of health status (see explanatory note at end of table) Same as Level 2
K Elective palliative surgery Same as Level 1 Elective or emergency palliative surgery
L Anyone receiving mechanical ventilation for >=14 days with a ProVent score of 4-5. Anyone receiving mechanical ventilation for >=14 days with a ProVent score of 2-5. Anyone receiving mechanical ventilation for >=14 days who is not improving
M Any other clinical condition that is judged to have a >80% chance of mortality during or soon after critical illness Any other clinical condition that is judged to have a >50% chance of mortality during or soon after critical illness Any other clinical condition that is judged to have a >30% chance of mortality during or soon after critical illness

Explanatory Note:

Criterion D (progressive, end-stage illness marked by severe cognitive impairment) and criterion J (clinical frailty due to a progressive illness or generalized deterioration of health status) would be relevant ineligibility criteria for progressive and life-limiting conditions, such as Alzheimer’s disease or high level of multi-morbidity, which are known to be associated with a higher risk of mortality during or soon after an episode of critical illness.10 By contrast, criterion D and criterion J would not be ineligibility criteria for non-progressive conditions with cognitive impairment, clinical frailty, or dependency, such as developmental disability, spinal cord injury, or traumatic brain injury, because these are not necessarily associated with a higher risk of death during or soon after an episode of critical illness. To be clear, the clinical focus of critical care triage decision in major surge should be on the prognosis (predicted mortality) of the individual in question and not any particular demography, disease or disability. The clinical criteria are not intended to exclude nor to deprioritize all people with clinical frailty, multimorbidity, and cognitive impairment or all individuals with a given diagnosis.

 

Additional Considerations at Level 3:

At Level 3, only patients with the lowest risk of death in the near future would be eligible for critical care. However, if demand for critical care continues to exceed available resources, there may come a point where there may be little clinical evidence to guide triage decisions on the basis of medical utility.[14] As a result, triage decisions must appeal to fairness.

Fairness would suggest that those patients who are already receiving critical care and are benefiting from it should continue to receive it. In other words, demand for critical care from new patients does not justify withdrawing life-sustaining measures from admitted patients with a similar prospect of benefitting from them. Decisions to withdraw life-sustaining measures from someone already admitted to critical care should be driven by clinical considerations. In practice, this would involve a frequent reassessment of admitted patients by the clinical team for any indication that the patient is no longer responding to treatment, or where the patient’s clinical trajectory suggests that their chances of recovery have substantially worsened from when they were admitted. It is important to reiterate that a decision to withdraw critical care should be based solely on clinical considerations, integrating all relevant information, and not on any demography, disease, or disability, or other factors. As with all triage decisions, such patients should be referred for a second opinion to confirm the assessment (i.e., that the person’s chance of survival is poor).

Fairness would also suggest that, when an opportunity emerges to admit a new patient into critical care and a triage decision must be made between multiple patients who cannot be distinguished on the basis of medical utility (i.e., all meet an eligibility criterion and do not meet any ineligibility criteria), then a system of random selection among eligible and not-yet-admitted patients should be implemented. Random selection upholds the principle of fairness in situations where it is not possible to rely on medical utility to make clinical decisions.[15] It mitigates against the potential of explicit or unconscious bias in decision-making and demonstrates the value of humility when uncertainty is high. Random selection also has other advantages as a decision-making strategy in the context of an overwhelming surge of critically ill patients: it is already a well-established practice for making decisions in situations of uncertainty or equipoise in medicine (e.g., randomized controlled trials); it reduces the moral and psychological burden of deciding who receives life-saving treatment, which can lead to moral injury and burnout after repeated cases; it is efficient when decisions need to be made rapidly; and it allows for procedural transparency and accountability. When decisions are made through random selection, this should be done with one or more witnesses, and a record of the outcome of the process of randomization should be documented.

 

Critical Care Triage Approach:

Critical care triage for major surge in a pandemic should be well-coordinated, consistent, predictable, and responsive to an evolving pandemic context.[16] A three-level triage approach is proposed. A proportionate response to increasing levels of demand on scarce resources is essential. As system pressures increase, triage criteria become proportionately more stringent. The degree of triage should be calibrated to the degree of demand in order to limit the possibility that a patient will be denied critical care resources unnecessarily.

In the current COVID-19 pandemic context, the decision to initiate critical care triage for major surge would fall under the authority of, and would be made by, the provincial Critical Care Command Centre with full situational awareness of existing critical care resources and demands. Each hospital should be aware of the precise number of critically ill and mechanically-ventilated patients they can accommodate with their resources (including consumables), staff, and space. The timing and degree of the surge in demand is likely to be variable in different institutions and regions, so as one hospital or region approaches their maximum capacity, significant efforts should be taken to transfer patients to, or resources from, hospitals with lower occupancy to ensure that all resources are maximally used prior to the initiation of critical care triage for major surge. This will also reduce the chances that some patients will be denied critical care resources that they would have received had they been in another hospital. When all hospitals in a region are near their capacity, or when transportation resources are no longer able to move patients to hospitals with lower occupancy, Provincial and Regional Critical Care Command Centres should clearly inform these hospitals that a major surge scenario is impending. Major surge in demand may be intermittent, requiring a regular review (e.g., every 12 hours) of occupancy to determine whether the triage protocol is still required or whether hospitals can decrease the level of triage.

The prospect of a major surge in demand for critical care should prompt discussions with patients or their substitute decision-maker to identify and document patient wishes and values and ensure current treatment plans are up to date. It is also appropriate for physicians and other healthcare providers to engage in advance care planning conversations with patients/SDMs in hospital or in community settings to explore the patient’s wishes and values and to clarity the treatment goals and options available if the patient were to become acutely or critically ill. Regardless of triage decisions at any level, all efforts should be made to treat patients supportively and to ensure all patients receive the right care, in the right place, at the right time to the greatest extent possible during the COVID pandemic.

If a major surge is imminent (but before level 1 triage is initiated), all patients who are currently receiving critical care resources should be reviewed, and those who would be excluded under a level 1 triage scenario should be identified in advance and they (or their substitute decision-makers) should be informed of the situation if possible. When a level 1 triage scenario has been initiated, these patients should begin to have life-sustaining measures withdrawn and be transferred to non-critical care beds, with appropriate palliative measures initiated (or other measures in accordance with the patient’s values, beliefs, and wishes). All patients need not have life-sustaining measures withdrawn at once. Rather, life-sustaining measures should be withdrawn sequentially starting with those patients who meet the greatest number of ineligibility criteria. Withdrawal of life-sustaining measures should be in proportion to demand and operational capacities. Each hospital should communicate the number of patients who would no longer receive critical care in a level 1 scenario to their Regional Critical Care Command Centre to assist with planning and coordination provincially. All new patients who develop critical illness in a level 1 triage scenario should be assessed against the level 1 criteria before receiving critical care resources.

If major surge escalates, all patients in their critical care beds who would be ineligible for critical care under a level 2 triage scenario should be identified and they (or their substitute decision-makers) should be informed that level 2 triage is imminent. The regional critical care command centre should continue to coordinate transportation of patients to optimize the utilization of all critical care resources before initiating a level 2 triage. If a level 2 triage scenario is initiated, hospitals should proceed in a similar manner to the steps described above. All new patients who develop critical illness after a level 2 triage scenario should be assessed against the level 2 criteria before receiving critical care resources. Hospitals should then prepare for a level 3 triage scenario, similar to the previous steps. Based on the principle of proportionality, the number of patients denied access to or withdrawn from critical care should not be more than the incoming demand requires based on the current and expected surge of critically ill patients. This means that triage levels should go up or down in relation to demand and should continue only as long as the major surge persists to minimize mortality and morbidity.

  1. Triage in Hospital: Suggestions for Implementation

The triage approach recommended in this document may be implemented differently depending on the resources available to the hospital and the region in question, which may fluctuate over the course of the pandemic. Appreciating that the implementation of this approach will vary to some degree based on available human resources and other contextual factors at individual institutions, the following suggestions offer a starting point for local and regional planning.

 

  1. Triage Process

In general, the triage process comprises four steps. This process represents an ideal, which may need to be modified to suit specific settings.

Step 1: Clarify Patient Goals of Care and Inform Patient/Family of Change in Standard of Care Due to Major Surge

In general, regardless of whether or not triage has been implemented, when a patient is admitted to hospital or assessed in the Emergency Department, the most responsible physician/most responsible provider (MRP) should explore the patient’s goals and aim to develop a plan of care that reflects those goals and respects the limitations of medical care. If the patient indicates a preference to receive life-sustaining measures in the event of clinical deterioration, but the MRP feels that this is not appropriate given the patient’s medical condition, the MRP should explain this and propose a less aggressive treatment approach. If a person expresses a desire not to receive life-sustaining treatment in the event of clinical deterioration, this should be recorded in the chart and the patient should not be referred for critical care. At this time, the patient or substitute decision-maker should also be informed that the hospital is moving towards triage and that the standard of care may be altered, including strict allocation of critical care based on the approach recommended in this document.

Step 2: Assess Patient Against Triage Criteria

Once the triage approach has been implemented, if an admitted patient meets (or is close to meeting) the eligibility criteria, provided that there is no order to withhold life-sustaining measures, the MRP should assess the patient to determine whether they meet the eligibility criteria and whether they meet any of the ineligibility criteria for the level of triage. A second physician, who would ideally be a member of the critical care team, rapid response team (RRT), or a designated triage physician, should verify whether the patient meets the eligibility and/or ineligibility criteria. Ideally, disagreements about eligibility/ineligibility criteria should be resolved by consensus of the two physicians who assessed the patient if possible. The patient’s triage assessment should be documented in the health record.

Step 3: Referral of Case to Triage Team

Following this assessment, the MRP should communicate the assessment to the hospital or regional triage team, who will review the decision. The triage team may also help to resolve any disagreement about whether the patient meets eligibility/ineligibility criteria. The triage team should confirm that, under the triage approach, admission to critical care will or will not be provided based on current critical care capacity. For clarity, the MRP has the clinical responsibility for determining whether the patient meets the eligibility and ineligibility criteria. The health care system, through the implementation of the triage approach, takes responsibility for determining that they cannot offer admission to critical care. The triage team is ultimately responsible for making decisions regarding the allocation of critical care resources according to the approved criteria for the appropriate level of surge (Level 1, 2, 3).

Step 4: Communication with Patients and Family/Substitute Decision-Maker(s)

The MRP will communicate the outcome of the triage decision (i.e., whether or not the patient will be admitted to critical care) to the patient or substitute decision-maker (see Appendix B for suggested language to disclose a triage decision), with support from other members of the interprofessional team (social work, spiritual care, etc.). The MRP will document the decision in the patient’s medical record. The MRP should continue to offer all other indicated medical treatments and write comfort orders to ensure that the patient receives appropriate palliative care (see Appendix D for suggested comfort medication orders).

Additional suggestions for implementation at the institutional level, including policies, tools, descriptions of roles and responsibilities of triage teams, and communications suggestions, have been developed by Hamilton Health Sciences and can be accessed here: https://macdrop.mcmaster.ca/s/PoGMyw848Wipz88

 

  1. Triage Team

Triage teams have been recommended in other published guidance to support consistent, evidence-based and accountable decisions about the use of critical care resources in the context of a pandemic surge.[17] Triage teams may be institution-based or regional. Suggestions for triage team roles and responsibilities can be found here: https://macdrop.mcmaster.ca/s/PoGMyw848Wipz88.

  1. Patient and Public Communication

In the context of the COVID-19 pandemic, transparency is key to maintaining patient and public trust. This includes being transparent about why critical care triage may be needed in major surge, how triage decisions will be made and by whom, when an institution or region has initiated critical care triage for major surge, and how patients will be supported during this difficult time. Patient and public-facing communication materials (e.g., signage, information sheets) will be essential. Suggestions for how to communicate triage decisions to patients (or their substitute decision-maker) can be found in Appendix E. To ensure effective communication, some patients may require accommodated communication (e.g., plain language, use of communication devices) and access to interpretation services. Attendant care workers or other personal support persons may play essential roles in informing individual treatment plans and advising on an individual patient’s clinical history and functional status. This may require accommodation within institutional visitor policies to the extent possible to comply with infection control guidelines.

 

  1. Clinician Support

Critical care triage in a major surge will entail a significant cognitive, psychological, and moral burden on clinicians and underlines the need to support and prepare critical care clinicians for major surge in advance. Clinical guidance, including explicit triage criteria, institutional supports, such as triage teams, and assurance of legal protection will go some distance to support clinicians. Additional clinician supports identified in stakeholder feedback include: i) education and training about the critical care triage approach for critical care teams, ii) creation of decision support tools, e.g., translating the critical care triage criteria into an accessible format for ease of use in clinical practice, iii) guidelines for emergency department staff and EMS, and iv) general information for clinicians in other clinical areas and settings about the critical care triage approach to foster effective collaboration among clinical teams.

 

  1. Dispute Resolution

Disagreement amongst clinicians may arise regarding the eligibility/ineligibility of a patient for critical care. Although consensus-based decision-making is ideal, a mechanism for resolving disagreement may be needed. Options for dispute resolution may include additional consultation with appropriate medical specialists or discussion with the Triage Team. Where a patient/family disagrees with the outcome of a triage decision, the Triage Team may assist the MRP in communicating the rationale for their resource allocation decision, and the process by which triage decisions are made. Other members of the interprofessional team (e.g., social work, spiritual care, patient experience specialists, bioethicist, etc.) may also assist in supporting patients and families who are distressed by the outcome of the triage process. Given the context of critical care triage in a major surge, where an overwhelming number of critically ill patients must be assessed rapidly in a dynamic and over-taxed environment, a formal process for patients and families to appeal triage decisions may not be feasible or appropriate (e.g., if critical care is contrary to the patient’s wishes). Due process considerations (e.g., transparency about reasons for triage decisions) are especially important in this context. Hospitals should plan for how they might proactively prepare patients and families for possible outcomes of the triage process as well as how they would respond transparently and compassionately to patient or family concerns should these arise.

 

Concluding Recommendations:

The COVID-19 pandemic presents new challenges for the Ontario health system about how health resources will be used to meet patient and population needs. At time of writing, there is limited guidance for health systems about how a major surge in demand for critical care should be managed in a pandemic context. This document offers recommendations to inform the creation of a critical care triage approach in Ontario based on clinical and ethical considerations in the event of a major surge in demand for critical care in the COVID-19 pandemic. Given the novelty of this approach and its broader significance for all Ontarians, we offer two additional recommendations related to next steps for development of this work.

  1. Communicating with the public: Transparency is key to maintaining public trust during a pandemic. Years of risk and outbreak communication science show that the public will support measures when transparency is the “default” setting for governments dealing with public health emergencies and when considerations of fairness have been addressed. In the context of critical care triage in a pandemic, this includes being transparent about: i) the need for these triage criteria and the accompanying legal powers needed to implement them in a public health emergency; ii) the ethical basis for the triage criteria (i.e., minimizing morbidity and mortality); and iii) the process through which the criteria were developed (i.e., based on consultations with a broad array of stakeholders). It is therefore recommended that this document be made public available and that any communication includes the ethical basis and process for the development of these recommendations.
  1. Monitoring and iterative review of the approach: Given limited experience with critical care triage for major surge, it will be important to monitor, review and revise the approach to ensure it is achieving the aim for which it is intended (i.e., to maximize survival and recovery from critical illness of as many patients as possible within critical care resources in a major surge) and is not leading to unintended adverse consequences. This underlines the need for clear and consistent documentation practices across hospitals, the prospective capture of relevant clinical and other data about triage decisions, and a mechanism for mid-course correction that is nimble, transparent and accountable. This aligns closely with other calls for equity-related data collection to understand the impact of pandemic interventions on patients, particularly those who are marginalized in health care and may face systemic disadvantage for other reasons, and to mitigate negative impacts to the extent possible within the pandemic context.

 

 

References <needs updating>

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  14. Christian MD, Toltzis P, Kanter RK, et al. Treatment and triage recommendations for pediatric emergency mass critical care. Pediatr Crit Care Med. 2011;12(6 Suppl):S109-119.
  15. Antommaria AH, Powell T, Miller JE, Christian MD, Task Force for Pediatric Emergency Mass Critical C. Ethical issues in pediatric emergency mass critical care. Pediatr Crit Care Med. 2011;12(6 Suppl):S163-168.
  16. Gall C, Wetzel R, Kolker A, Kanter RK, Toltzis P. Pediatric Triage in a Severe Pandemic: Maximizing Survival by Establishing Triage Thresholds. Crit Care Med. 2016;44(9):1762-1768.
  17. Christian MD, Toltzis P, Kanter RK, Burkle FM, Jr., Vernon DD, Kissoon N. Treatment and triage recommendations for pediatric emergency mass critical care. Pediatr Crit Care Med. 2011;12(6 Suppl):S109-119.
  18. Christian MD, Hawryluck L, Wax RS, et al. Development of a triage protocol for critical care during an influenza pandemic. CMAJ. 2006;175(11):1377-1381.
  19. Azoulay E, Soares M, Darmon M, Benoit D, Pastores S, Afessa B. Intensive care of the cancer patient: recent achievements and remaining challenges. Ann Intensive Care. 2011;1(1):5.
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  22. Kylhammar D, Kjellstrom B, Hjalmarsson C, et al. A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension. Eur Heart J. 2018;39(47):4175-4181.
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  31. Steiner T, Juvela S, Unterberg A, et al. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013;35(2):93-112.
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Truog RD, Mitchell C, Daley GQ. The toughest triage—allocating ventilators in a pandemic. NEJM 2020; 23 March. Available at: https://www.nejm.org/doi/full/10.1056/NEJMp2005689?query=recirc_curatedRelated_article

Christian MD, Sprung CL, King MA, Dichter JR, Kissoon N, Devereaux AV, Gomersall CD. Triage: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2014; 146(4): e-e74S.

Biddison D, Berkowitz KA, Courtney B, De Jong MJ, Devereaux AV, Kissoon N, Roxland BE, Sprung CL, Dichter JR, Christian MD, Powell T. Ethical considerations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2014; 146(4): e145S-e155S.

Savin K, Guidry-Grimes L. Confronting disability discrimination during the pandemic. Hastings Center Report 2020; Apr 2. Available at: https://www.thehastingscenter.org/confronting-disability-discrimination-during-the-pandemic/

Appendix A. Backgrounder: Development of the Recommendations <to be updated>

 

This document was developed by the Bioethics Table based on a review of the literature on critical care triage in a pandemic, consultation with clinical experts, and feedback from health system stakeholders. Feedback has been addressed to the greatest extent possible in this current version where appropriate. This recommendations document is a green document within the overall 2020 COVID pandemic response in Ontario. It is acknowledged that the process for developing an approach to critical care triage in the context of a major surge in demand should remain sensitive and responsive to changing conditions and emerging evidence, and as such, should be on-going.

Development of Critical Care Triage Criteria

Early work on pandemic critical care triage was led by researchers in Ontario following the SARS outbreak and in developing provincial and national pandemic plans in the years leading up to the H1N1 pandemic. 9 At that time, critical care triage criteria using sequential organ failure assessment (SOFA) scores, which help to predict clinical outcomes (acuity and morality risk) of critically ill patients, was proposed. Over the last decade, a number of clinical developments, including novel therapies and new research evidence, have precipitated the need for an updated approach to critical care triage criteria in a pandemic context.

Below we outline the key considerations contributing to the updated critical care triage criteria outlined in this document:

  • With greater experience, most experts no longer recommend the use of SOFA scores to prioritize patients in a pandemic context because the correlation with outcomes is not as strong as was previously believed. Many young patients are admitted with severe illness but ultimately survive, and the severity of acute illness does not imply greater or lower utility of treatment.
  • Advances in clinical management of cancer mean that some individuals with metastatic cancer, who previously would have not benefited from intensive care support, have a reasonable expectation of surviving an ICU admission and living for years.19,20
  • Critical care medicine is better able to prognosticate for patients with some types of chronic organ disease who develop critical illness, such as people with chronic liver disease using the Acute on Chronic Liver Failure (ACLF) grading system.21
  • Organ donation has become more common and may offer substantial life prolongation for people with organ failure. Selected patients who are admitted to the ICU and assigned the highest priority for organ transplantation have a reasonably high expectation of receiving an organ and surviving to discharge. This would mean that anyone who is immediately postoperative from an organ transplant should not be denied ICU admission. However, patients who are being referred for ICU admission while awaiting an organ should only be admitted if organ transplantation is still proceeding (and this may not be the case if people who would be eligible for organ donation after neurological or circulatory death are not being admitted to the ICU) and they are assigned the highest priority for an organ transplant
  • Critical care medicine has better prognostication tools for neurological injury, including:
    • For subarachnoid hemorrhage, the WFNS system.22
    • For intracerebral hemorrhage, the ICH score.23
    • For acute ischemic stroke, the NIH Stroke Scale.24
    • For moderate or severe traumatic brain injury, the IMPACT score.25
  • Clinical research indicates that age may be less relevant to predicting mortality than frailty, multimorbidity, or neurodegenerative disease.10,26,27 The Clinical Frailty Score is currently in widespread use throughout the healthcare system.
  • There is also a greater appreciation of the concept of chronic critical illness, and the ability to identify ICU patients who have survived their acute illness but who are still requiring mechanical ventilation after 2 weeks and very unlikely to survive to a year using predictive tools such as the ProVent score.28-30

 

The critical care triage criteria were developed iteratively in consultation with Canadian medical experts representing specialties including critical care, emergency medicine, neurology, geriatrics, oncology, cardiology, nephrology, respirology, neurosurgery, hepatology, palliative care, and internal medicine in March and April 2020.

 

 

Appendix B: The Ontario Human Rights Code Prohibited Grounds of Discrimination

 

The Ontario Human Rights Code recognizes that discrimination occurs most often because of a person’s membership in a particular group in society. None of the grounds below should influence the allocation of critical care or medical resources; triage decisions should be based solely on the criteria included in this document.

The Code prohibits actions that discriminate against people based on a protected ground in a protected social area. Protected grounds relevant to the health care context include:

  • Age
  • Ancestry, colour, race
  • Citizenship
  • Ethnic origin
  • Place of origin
  • Creed
  • Disability
  • Family status
  • Marital status (including single status)
  • Gender identity, gender expression
  • Sex
  • Sexual orientation

 

 

 

 

 

 

Appendix C. Triage Criteria Tools

TRISS Score Calculator

https://www.mdapp.co/trauma-injury-severity-score-triss-calculator-277/

 

Clinical Frailty Scale (Rockwood et al)

The CFS is only considered relevant in this triage approach when used to evaluate predicted mortality due to progressive illness or generalized deterioration in health status. (Adapted from: Leonardi, Bueno, Ahrens et al. (2018). Optimised care of elderly patients with acute coronary syndrome. European Heart Journal: Acute Cardiovascular Care. 7. 204887261876162. 10.1177/2048872618761621.) For a training module on the use of CFS, go to: https://rise.articulate.com/share/deb4rT02lvONbq4AfcMNRUudcd6QMts3#/

ProVent Score- calculated at 14 days:

One point for each of Age >50, platelet count <150, requiring hemodialysis, and requiring vasopressors. An additional point is given for age >=65, for a maximum score of 5. Scores of 4-5 at 14 days suggest a mortality rate of ~90% at 1 year. Scores of 2-3 at 14 days suggest a mortality rate of 56-80% at 1 year30.

Modified ICH Score23:

One point each for age >80, infratentorial origin, volume >30mL, intraventricular extension, use of oral anticoagulants, and Glasgow Coma Score of 5-12. Two points for a GCS of 3-4. Scores of 4-7 suggest a 30-day mortality rate of >80%. Scores of 3-7 suggest a mortality rate of >60%.

The World Federation of Neurological Surgeons grading system:

A combination of Glasgow Coma Score (GCS) and the presence or absence of focal neurological deficits31. A WFNS grade 5 (GCS 3-6) is associated with a >90% probability of a poor outcome. Grades 3-4 (GCS 7-12 or GCS 13-14 AND focal neurological deficits) are associated with a >50% probability of a poor outcome. Grade 2 (GCS 14 with no neurological deficits) is associated with a ~30% probability of a poor outcome.

National Institute of Health Stroke Scale (NIHSS): score 0-7 is associated with a 30-day mortality of 4.2%; 8-13 with a 30d mortality of 13.9%; 14-21 with a 30d mortality of 31.6%; and 22-42 with a 30d mortality of 53.5%24:.

The IMPACT Score25 predicts outcome at 6-months based on multiple demographic, clinical and radiographical factors using the calculator found at http://www.tbi-impact.org/?p=impact/calc

The ACLF grading system is based on the number of organ systems failing at the time of admission in a patient with chronic liver disease. Patients with more than 2 organ systems failing on presentation (ACLF Grades 2 and 3) have an >=80% risk of mortality at 6 months32. Those with ACLF Grade 1 have an approximately 50% mortality at 6 months32; ACLF grade 1 is defined as having chronic liver failure plus ONE of the following:

  • Creatinine >177 umol/L (2.0 mg/dL)
  • Creatinine >132 umol/L (1.5 mg/dL) AND Hepatic encephalopathy grade 3-4
  • Creatinine >132 umol/L (1.5 mg/dL) OR Hepatic encephalopathy grade 1-2 AND ONE OF:
    • Bilirbin >200umol/L (12mg/dL)
    • INR >2.5
    • pressor support required
    • PaO2/FiO2 <200

For pulmonary hypertension, the ECS/ERS High Risk Criteria are22:

  • WHO Class 4 symptoms
  • 6MWT <165m
  • NT pro-BNP >1400 ng/L
  • RA area >26 cm2
  • RAP >14 mmHg
  • CI <2.0 L/min/m2
  • SvO2 <60%

 

 

Appendix D. Suggested order set for symptom management for COVID-19 patients (adapted with permission from Champlain Palliative Symptom Management Medication Order Form – Long Term Care)

Symptom Medications Recommended starting dose
Pain/Dyspnea Hydromorphone 2mg/ml 0.5-1.0 mg SC q30min PRN*
Nausea/Delirium Haloperidol 5mg/ml 1 mg subcut q2hourly

PRN **

Sedation Midazolam 5 mg/ml 1-2 mg subcut q15 minutes PRN ***
Secretions Scopolamine 0.4 mg/ml 0.4 mg subcut q4hourly PRN
Fever Acetaminophen 650 mg suppositories Administer q6hourly PR PRN
Urinary retention Foley catheter 16 Fr Insert catheter PRN
Dry mouth Mouth swabs Mouth care QID and PRN

Please call MD if patient receives more than 2 PRN of hydromorphone in 4 hours.

* may start at 0.25mg in a patient who is opioid naive, frail, or elderly

** relative contraindication in Parkinson’s disease

*** can use higher doses for refractory dyspnea

 

 

 

Appendix E. Suggested language for clinicians providing support to a patient or family member who is denied critical care in the context of a major surge in demand for critical care resources    

Template 1.

Normally, when somebody develops critical illness, the medical team would offer them intensive care (a combination of medications and machines to support their vital organs), provided that the medical team feels that they had a reasonable chance of survival. However, because of the COVID outbreak, we are currently unable to offer intensive care to everyone who is critically ill. As a result, our hospital is working under triage guidelines, which means that we are only offering intensive care to those who are most likely to be able to survive and recover from their critical illness. You probably have heard about this in the news – all hospitals in the region are working under these guidelines.

I regret to inform you that we are unable to offer you intensive care treatments at this time, as a result of the triage guidelines. Because of your medical condition, the likelihood that you would survive even with intensive care is considered to be too low for us to offer intensive care. The team has made this decision based on the following information:__________________.

I have also asked for a second opinion from a colleague, Dr. ___________, who has concurred with my assessment. You may speak with him/her if you wish.

I am deeply sorry about this situation. This is not the way we ordinarily make these decisions, and I can only imagine how you must feel right now. I want you to know that even though we cannot offer intensive care, we will do everything else that could conceivably give you a chance of recovering, including: _________.

And I promise you that, no matter what, we will also use medication to treat any discomfort, such as pain or shortness of breath. We know that when we treat discomfort appropriately, this is not harmful and may actually help improve your condition.

 

Template 2.

As you know, you/your loved one has been receiving treatment in our Intensive Care Unit. Normally, when somebody is admitted to our Intensive Care Unit, the medical team continues to offer them intensive care until they recover, or it becomes apparent that there is no reasonable chance that they could recover even with continued intensive care. However, because of the COVID outbreak, we are currently unable to offer intensive care to everyone who is critically ill. As a result, our hospital is working under triage guidelines, which means that we are only offering to provide or continue intensive care for those who are most likely to be able to survive and recover from their critical illness. You probably have heard about this in the news – all hospitals in the region are working under these guidelines.

I regret to inform you that we are unable to continue giving you/your loved one intensive care treatments at this time, as a result of the triage guidelines. Because of your medical condition, the likelihood that you would survive and recover even with continued intensive care is too low for us to offer intensive care. I have made this decision based on the following information:

[Either document the specific ineligibility criterion met by the patient, or a brief explanation for concluding that this person’s chances of survival fall below the threshold indicated in the triage document]

I have also asked for a second opinion from a colleague, Dr. ___________, who has concurred with my assessment. You may speak with him/her if you wish.

I am deeply sorry about this situation. This is not the way we ordinarily make these decisions, and I can only imagine how you must feel right now. I want you to know that even though we cannot continue intensive care, we will continue other therapies, including:

And I promise you that, no matter what, we will also use medication to treat any discomfort, such as pain or shortness of breath. We know that when we treat discomfort appropriately, this is not harmful and may actually help improve your condition. We have guidelines for how to keep people comfortable when we discontinue life-sustaining measures, and we will use those guidelines.

 Text of July 7, 2020 Letter from Ontario Health’s Medical Triage Protocol Committee to Disability Community Roundtable Participants

To:       Roundtable Participants

From: Ontario COVID-19 Bioethics Table

Date:   July 7, 2020

Re:       Input on DRAFT / updated recommendations for critical care triage in the COVID-19 pandemic

Thank you for agreeing to meet with us. Attached please find updated draft recommendations for critical care triage in the COVID-19 pandemic for your review and feedback.

In March 2020, the COVID-19 Bioethics Table worked with health system clinical leaders and front-line health service providers to propose a critical care triage approach in the event of a major demand for critical care services in the COVID-19 pandemic. The draft recommendations were shared by Ontario Health with hospitals on March 28, 2020 to help hospitals to prepare for the possibility of a major surge in critical care demand and to prevent catastrophic health outcomes as have been seen in other jurisdictions. Fortunately, a major surge in demand for critical care has so far been averted.

Following the release of the March 28th version, the COVID-19 Bioethics Table sought or received stakeholder and expert feedback. Much of this feedback has been incorporated where appropriate into the revised document. We are now sharing the updated recommendations with key stakeholders to ensure the issues and concerns that have been raised have been properly addressed, to hear any additional concerns or issues that ought to be addressed, and to inform our final recommendations to Ontario Health by July 31st.

We are grateful to the Ontario Human Rights Commission for its support in co-convening this Roundtable consultation with you. Our aim is to hear your perspectives on critical care triage in a pandemic context, to gain insight into the issues and concerns relevant to the communities you represent, and to invite your input on the overall triage approach. Some questions that we hope will help frame our discussion include:

  1. In the context of a major surge for critical care, the revised recommendations articulate an ethical imperative to use available resources in a manner that saves as many lives as possible, with constraints to ensure that individuals are not excluded on the basis of any particular demographic, disease, or disability independent of an individual patient’s prognosis. Do you agree with this approach? If not, why not, and what might you suggest as an alternative?
  2. Critical care triage has the potential to perpetuate or exacerbate pre-existing health and social inequities. The proposed approach seeks to mitigate the potential impact of implicit bias and systemic discrimination on vulnerable groups to the extent possible in a pandemic. To what extent are the proposed safeguards sufficient? What additional safeguards, if any, would you recommend be put in place to prevent or mitigate this outcome?
  3. What key changes, if any, to the document or overall approach would you recommend? What would you not like to see changed?
  4. Are there any other comments/feedback on the critical care triage recommendations you would like to share?
  5. Looking forward, are there any other issues/concerns relevant to the pandemic response that you think the Bioethics Table should be aware of as it contributes to planning for potential Wave 2 of the COVID-19 pandemic in Fall and beyond?

The Bioethics Table is happy to receive additional thoughts or input you would like to share following the Roundtable. Please send your comments to us via email (jcb.director@utoronto.ca) by Monday, July 20 so that they can be considered in the recommendations we will be making to Ontario Health.

We look forward to next week’s conversation.

Sincerely,

Jennifer Gibson and Max Smith

Co-Chairs, Bioethics Table

 Text of June 15, 2020 Letter from Ontario Health to the Ontario Human Rights Commission

Ontario Health

525 University Avenue, 5th Floor, Toronto ON, M5G 2L3

June 15, 2020

Raj Dhir
Executive Director
Ontario Human Rights Commission 180 Dundas Street West, 9th Floor Toronto, ON
M7A 2G5

Dear Mr. Dhir:

RE: COVID-19 triage protocol, data collection and essential support persons

Thank-you for your letter dated June 4, 2020 written on behalf of the Ontario Human Rights Commission (OHRC). We extend the same wishes for safety and good health to you and your team on this journey through the COVID-19 pandemic.

Ontario Health welcomes your letter and is pleased to have this opportunity to share our views on the issues you raised both at this time during the pandemic, but also at this time in Ontario Health’s evolution in the health sector. Specifically, on behalf of Ontario Health, I want to confirm our commitment to recognizing the human rights of all Ontarians and to ensure that as much as possible, the principles of inclusion, diversity and equity are reflected in all of what Ontario Health does. This means both internally at Ontario Health as it matures and integrates the business of numerous former crown agencies, but also externally in how it exercises its mandate in the health system.

As you may know, we have a very important role to play supporting the Ministry of Health as part of their broader health system strategies through the mandate that has been established for us under the Connecting Care Act, 2019. COVID-19 elevated the importance of this role by shining a light on the importance of ensuring there is coordinated communication, collaboration and commitment to patients, residents, health outcomes and front-line workers from the many different health system providers.

From this vantage point, we view Ontario Health as having a very important and ongoing role to play to demonstrate its commitment to observing fundamental human rights for all Ontarians including those in racialized communities, people experiencing poverty, people with disabilities, older people and other Code-protected groups.

While I will defer to the Minister of Health to respond to you on behalf of the Government and the health system more broadly, it is important for Ontario Health to outline our perspective in the four areas you have written about:

  1. Immediately and publicly rescind Ontario Health’s March 2020 Clinical Triage Protocol for Major Surge in COVID-19 Pandemic and undertake meaningful consultation on a new protocol.

Working with health system clinical leaders and front-line health service providers, a draft Clinical Triage Protocol for Major Surge in COVID-19 (Triage Protocol) was shared by the COVID-19 Bioethics Table in March 2020 as a clinical response to avert catastrophic health outcomes from COVID-19. Given the complexity of issues it presented at the time, the unprecedented reallocation and shift of resources in the health system to respond to COVID-19 and the uncertainties surrounding the virus itself, the Triage Protocol remains in draft. That said, it is a product of much consultation by the COVID-19 Bioethics Table (that works with the Critical Care Table) and with clinical and ethical leaders, following best practices in those areas from other jurisdictions who bravely fought COVID-19 before Ontario. While COVID-19 has unfortunately taken a tragic toll in certain parts of our health system, we are thankful that the need to apply the Triage Protocol has so far been averted as a result of our health system response. To my knowledge, the triage recommendations in the Triage Protocol have not yet been applied in Ontario.

At this time in the pandemic with our numbers of confirmed COVID cases decreasing, we have the opportunity to reflect on all aspects of the response, including the draft Triage Protocol. The intent of the COVID-19 Bioethics Table is to continue to seek feedback, which so far, has generated very helpful comments from stakeholders, including the ones you mention. The Bioethics Table is taking the thoughtful input received so far and including it in an updated draft which they are intending to share with the stakeholders they have consulted with – to ensure the issues and concerns that have been raised are properly addressed and before any further steps are taken on it (see Appendix with list of stakeholders). If there is a stakeholder group that has reached out to your office that is not on this list, please let us know, we would be happy to connect the Bioethics Table with them. It is our understanding that the Ministry is supportive of this direction. Our goal is to have a final document by the end of July, or to rescind it.

  1. Quickly develop and release a plan for collecting disaggregated sociodemographic data on the response to COVID-19.

Early in the pandemic, Ontario Health consulted with experts in health equity and the collection of sociodemographic data to gather their advice on how best to understand the impact of COVID-19 on vulnerable populations. These experts included leaders from the Wellesley Institute, the Alliance for Healthier Communities, the University of Toronto, the Health Commons Solutions Lab, and the Upstream Lab. The advice we received had three components: (1) use existing Ontario data at the neighbourhood level to track and report on disparities between communities; (2) begin collection of individual sociodemographic data through the public health information system; (3) begin a longer-term solution to collect sociodemographic information through the OHIP registration form.

The data we routinely report to the Health Command Table on COVID-19 on incidence and prevalence includes information on disparities between neighbourhoods in Ontario using data from the Ontario Marginalization Index (i.e. educational attainment, income, unemployment, quality of housing and family structure characteristics, recent immigration, visible minority resident). This information is also available publicly at howsmyflattening.ca.

We understand from the Ministry of Health that the collection of race and ethnicity-based data at the individual level for COVID-19 is expected to begin within the next few
weeks. Public health case investigators will ask individuals newly diagnosed with COVID for race-based information as part of follow up and case management. The Ministry has worked with many stakeholder organizations and communities to advance this effort and is working with Public Health Ontario and the public health units to facilitate roll out of this important information.

To ensure that sociodemographic data collection at the individual level is sustainable and extends beyond this pandemic to other health issues and conditions, Ontario Health fully supports the feasibility of collecting this information through the OHIP registration form and we will await additional guidance from the Ministry.

  1. Provide clear provincial direction on the duty to accommodate people with disabilities who need to access essential support persons(s) while receiving health services during the pandemic.

As you know, Ontario Health does not provide direct, front-line healthcare to patients. Ontario Health, however, is fully committed to accommodating people with disabilities and is able to support health service providers in fulfilling their important duties on the frontlines. While Ontario Health does not have the power or authority to direct health service providers in how they discharge their duties, we can play an active and supporting role to the Minister of Health in any directions to the broader health system. We will do our best to convey this message informally to our health system partners subject to any further formal advice or directions from the Ministry.

  1. Consult and involve representatives of vulnerable groups and other human rights experts.

As mentioned earlier, Ontario Health continues to be in its formative days, having assumed six (6) existing corporations through Minister Transfer Orders since December 2019. While I have comfort that all of these former entities and their business practices were committed to protecting the human rights of vulnerable persons, the integration of these businesses presents Ontario Health with the opportunity to consider how we can build on their success and be the leader in this area both with our employees and the health system as a whole.

To this end, Ontario Health is already in the process of retaining a human rights expert who can provide meaningful guidance to our operations, policies and the way we interact and engage with stakeholders to observe our commitment to the Code and actively reflect the principles of diversity, equity and inclusion. We are grateful that the OHRC has offered to provide support as we embark on this process.

Once again, we thank the OHRC for reaching out at this time for the important reasons in your letter and for providing Ontario Health with the opportunity to express our shared commitment to protecting the human rights of all vulnerable populations and all Ontarians both through COVID-19 and afterwards. We look forward to hearing from the Ministry of Health in the areas noted above so we can collectively work together to achieve broadly accepted outcomes.

Regards,

ORIGINAL SIGNED BY

Matthew Anderson

President & CEO, Ontario Health

cc: Hon. Christine Elliot, Minister of Health

Hon. Merrilee Fullerton, Minister of Long-Term Care Hon. Doug Downey, Attorney General

Dr. David Williams, Chief Medical Office of Health Violetta Igneski, OHRC Commissioner

Randall Arsenault, OHRC Commissioner

Appendix

Input was sought from individuals at:

  • The Ontario Human Rights Commission
  • ARCH Disability Law Centre
  • Muscular Dystrophy Canada
  • The Ontario Health COVID-19 Critical Care Planning Table
  • Ontario critical care leads and other critical care physicians
  • The COVID-19 Bioethics Community of Practice (based at the Joint Centre for 
Bioethics and comprising all practicing bioethicists across the province working in 
health care settings)
  • Affiliated health institutions of Bioethics Table members (e.g., Health Sciences 
North, Hamilton Health Sciences, London Health Sciences, The Ottawa Hospital, 
Trillium Health Partners, etc.)
  • The Wellesley Institute
  • Canadian Frailty Network
  • CorHealth

Also, input was received via letters (directed to Ontario Health or the Ministry of Health) from:

  • Ontario Hospital Association
  • Ontario Medical Association
  • Canadian Medical Protective Association
  • College of Physicians and Surgeons of Ontario
  • College of Nurses of Ontario
  • Healthcare Insurance Reciprocal of Canada
  • ARCH Disability Law Centre
  • Other disability rights organizations

 Text of June 4, 2020 Letter from the Ontario Human Rights Code to Ontario Health

9th Floor                                      9e étage
180 Dundas Street West            180, rue Dundas Ouest
Toronto, ON M7A 2G5               Toronto (Ontario) M7A 2G5

Postal Code (Courier): M5G 1Z8        Code postal «courier»: M5G 1Z8

Executive Director and          Directeur général et

Chief Legal Counsel    avocat en chef

Ph: (416) 314-4562     Fax: (416) 325-2004

June 4, 2020

Mr. Matthew Anderson

President and CEO

Ontario Health

1075 Bay Street,

Toronto, ON M5S 2B1

Dear Mr. Anderson:

RE: COVID-19 triage protocol, data collection and essential support persons

I am writing on behalf of the Ontario Human Rights Commission (OHRC).

We hope this letter finds you and your team safe and healthy, and thank you for your ongoing efforts to address the COVID-19 pandemic.

On April 2, the OHRC released a policy statement and identified actions consistent with a human rights-based approach to managing the COVID-19 pandemic. The OHRC highlighted the need for government to:

  • Provide all healthcare services related to COVID-19, including testing, triaging, treatment and possible vaccination, without stigma or discrimination
  • Collect health and other human rights data on the response to the COVID-19 pandemic, disaggregated by the grounds of Indigenous ancestry, race, ethnic origin, place of origin, citizenship status, age, disability, sexual orientation, gender identity, social condition, etc.
  • Recognize that any restrictive measures that deprive persons of their right to liberty must be carried out in accordance with the law and respect for fundamental human rights. This includes measures related to people in health and other care institutions
  • Consult with human rights institutions and experts, Indigenous leaders and knowledge-keepers, vulnerable groups, as well as persons and communities affected by COVID-19, when making decisions, taking actions and allocating resources.

Over the last two months, the OHRC has met with a range of stakeholders representing racialized communities, people experiencing poverty, people with disabilities, older people and other Code-protected groups. These groups are concerned that certain aspects in the management of the COVID-19 pandemic are having a negative impact on their human rights, and have raised four immediate concerns:

  1. Ontario Health’s March 2020 Clinical Triage Protocol for Major Surge in COVID-19 Pandemic violates the human rights of people with disabilities, older persons and other vulnerable groups, and has created fear in their communities
  2. Lack of disaggregated data collection during the COVID-19 pandemic is putting the health and well-being of Code-protected groups at heightened risk
  3. Rigid visitor restrictions in care settings are resulting in unequal access to health services and a failure to accommodate people who require essential support person(s) such as a family member, friend, or support worker to communicate or meet other disability-related needs
  4. Lack of meaningful consultation and involvement is negatively affecting Code-protected and other vulnerable groups during the COVID-19 pandemic.

As you may know, the OHRC has previously written to Ontario about its concerns about the Clinical Triage Protocol and the lack of disaggregated data collection. We were advised that Ontario Health would be consulting with us.

As set out below, we are aware that there may be an intention to address some of these concerns. However, to ensure full compliance with the Ontario Human Rights Code, the OHRC urges the following actions:

  1. Immediately and publicly rescind Ontario Health’s March 2020 Clinical Triage Protocol for Major Surge in COVID-19 Pandemic and undertake meaningful consultation on a new protocol.

Ontario Health released a Clinical Triage Protocol for Major Surge in COVID-19 Pandemic, dated March 28, 2020, to guide the use of emergency resources, such as ventilators, if Ontario’s health system is overwhelmed and there is a shortage of these resources. There was no announcement to accompany the Protocol, and notwithstanding an undated letter from Ministers Elliot, Smith and Cho, which referred to it as a “draft” document, the OHRC has heard that health care practitioners continue to recognize the Protocol.

Stakeholders from disability rights organizations, such as ARCH Disability Law Centre, and older persons’ advocacy groups have voiced significant concerns that the Protocol creates stigma and fear, perpetuates historical disadvantage, and gives the impression that people with disabilities and elderly people are expendable and less worthy of protection. These groups were not consulted in the development of the Protocol. At the same time, they recognize that if the protocol is developed properly, it can serve to protect their communities. They are committed to the success of a protocol, but they need to be involved in developing it. The OHRC was able to quickly convene a consultation with these groups so we see no reason why Ontario Health cannot do the same.

The OHRC urges Ontario Health to:

  1. Immediately and publicly rescind the version of the Clinical Triage Protocol for Major Surge in COVID-19 Pandemic released in March, and call on medical organizations to remove the document from their websites and not promote it as valid guidance
  2. Share the revised draft version of the Protocol and commit to a public consultation with disability rights organizations, older person’s advocacy groups, Indigenous, Black, racialized and other vulnerable groups.
  1. Quickly develop and release a plan for collecting disaggregated socio-demographic data on the response to COVID-19.

The OHRC welcomes the Chief Medical Officer of Health’s recent remarks, which were confirmed by the Minister of Health in the Legislature, that the government plans to collect socio-demographic data during the pandemic. However, the lack of a formal announcement and details on how and when data collection will roll out has created confusion.

As the OHRC said in its April 30 public statement, health and human rights experts agree that Ontario needs demographic data to effectively fight COVID-19. Strong data allows health care leaders to identify populations at heightened risk of infection or transmission, to efficiently deploy scarce health resources, and to ensure equal access to public health protections for all Ontarians.

The OHRC urges Ontario Health to:

  1. Take immediate steps to clearly outline the nature and scope of the proposed collection of disaggregated socio-demographic data
  2. Provide specific information on who Ontario/Ontario Health is consulting on the collection of disaggregated socio-demographic data, including, but not limited to Indigenous, Black, racialized and other vulnerable groups
  3. Release a detailed and comprehensive data collection plan that includes collection mechanisms and timelines for the pandemic
  4. Provide specific information on how Ontario/Ontario Health will report publicly on the data collected during the pandemic
  5. Publicly commit to collecting disaggregated socio-demographic data in the health sector in a sustainable manner beyond the pandemic. This would be responsive to longstanding OHRC and stakeholder recommendations.
  1. Provide clear provincial direction on the duty to accommodate people with disabilities who need to access essential support person(s) while receiving health services during the pandemic.

The government has provided guidance to care institutions about visitor access as a virus prevention measure during the COVID-19 pandemic. In its guidance, the government recommends that only “essential visitors” be permitted to enter facilities and provides examples of essential visitors as including, “…those who have a patient who is dying or very ill or a parent/guardian of an ill child or youth, a visitor of a patient undergoing surgery or a woman giving birth.”

Many groups have raised concerns that care institutions are using this guidance to exclude support persons, attendants and communication assistants who provide essential disability-related accommodations. Without their essential support person, some people with disabilities cannot communicate effectively with health care providers about health concerns, make informed decisions about treatment or give or refuse consent to treatment.

The OHRC recognizes that everyone’s right to health includes a government’s obligation to take the steps necessary for preventing, treating and controlling COVID-19. At the same time, under the Code, hospitals and other care institutions have a duty to accommodate a person’s disability-related needs, unless doing so would cause undue hardship based on cost or health and safety.

The OHRC urges Ontario Health to:

  1. Provide direction to health facilities that their interpretation of “essential visitor” should be broad enough to include paid and unpaid support persons, attendants and communication assistants authorized by the patient who provide supports that are essential to enable a patient with a disability to access health care services and communicate effectively with health care providers.
  1. Consult and involve representatives of vulnerable groups and other human rights experts.

 

A human rights-based approach to managing the COVID-19 pandemic requires that government, institutions and other responsible organizations consult with, and involve, Code-protected groups. Lack of meaningful consultation is negatively impacting the human rights of vulnerable groups during the COVID-19 pandemic.

The OHRC urges Ontario Health to:

  1. Consult with human rights experts, representatives of vulnerable groups, and persons and communities affected by COVID-19, when developing protocols, making recommendations or decisions and taking action on managing the COVID-19 pandemic including clinical triage, data collection, restrictions on visitors to care settings and other matters. When consulting groups or needing quick advice, the OHRC is available to help facilitate discussions in a timely manner.

The OHRC appreciates the ever-evolving circumstances surrounding COVID-19, and understands that the government is working to address issues on many fronts. However, is it crucial that vulnerable people’s human rights are upheld, systematically accounted for and properly accommodated while accessing health services during the pandemic. Applying a human rights-based approach and taking these actions as soon as possible, can help limit the spread of the virus while continuing to meet Ontario’s human rights obligations.

Sincerely,

Original signed by

Raj Dhir

Executive Director

cc:        Hon. Christine Elliot, Minister of Health

Hon. Merrilee Fullerton, Minister of Long-Term Care

Hon. Doug Downey, Attorney General

Dr. David Williams, Chief Medical Officer of Health

Violetta Igneski, OHRC Commissioner

Randall Arsenault, OHRC Commissioner

 Text of the June 4, 2020 Letter from the Ontario Human Rights Commission to the Ontario Minister of Health

9th Floor                                               9e étage
180 Dundas Street West                     180, rue Dundas Ouest
Toronto, ON M7A 2G5                        Toronto (Ontario) M7A 2G5

Postal Code (Courier): M5G 1Z8        Code postal «courier»: M5G 1Z8

Executive Director and          Directeur général et

Chief Legal Counsel                 avocat en chef

Ph: (416) 314-4562                  Fax: (416) 325-2004

June 4, 2020

Hon. Christine Elliot
Minister of Health
College Park 5th Floor, 777 Bay Street

Toronto, ON M7A 2J3

Christine.Elliott@ontario.ca

Hon. Todd Smith

Minister of Children, Community and Social Services

Macdonald Block Room M2B-88,

77 Wellesley Street West

Toronto, ON M7A 1N3

MinisterMCCSS@ontario.ca

Dear Minister Elliot and Minister Smith:

RE: COVID-19 Action Plan for Vulnerable People

I am writing on behalf of the Ontario Human Rights Commission (OHRC).

We hope this letter finds you and your team safe and healthy, and thank you for your ongoing efforts to address the COVID-19 pandemic.

The OHRC welcomes the April 23 release of the government’s COVID-19 Action Plan for Vulnerable People (the Plan) as a first step toward addressing the disproportionate impact that the pandemic is having on Ontario’s most vulnerable people. However, to ensure that the human rights of vulnerable people are protected in a way that is consistent with Ontario’s Human Rights Code, the Plan requires expanded scope and detail, which must be done in consultation with vulnerable groups and human rights experts.

Over the past few months, the OHRC has met with stakeholders from various sectors on human rights related to the COVID-19 pandemic. We heard significant concerns about the lack of consultation with affected groups. We also heard that while the Plan mentions certain vulnerable groups, it does not capture other vulnerable communities. The Plan also lacks clarity around how prevention, treatment and control initiatives are being designed to protect and benefit the most vulnerable groups in those communities.

In our April 2 policy statement and actions for a human rights-based approach to managing the COVID-19 pandemic, the OHRC called on the government to uphold the human rights of vulnerable groups by taking the following actions:

  • Anticipate, assess and address the disproportionate impact of COVID-19 and related restrictions on vulnerable groups that already disproportionately experience human rights violations
  • Make sure vulnerable groups have equitable access to health care and other measures to address COVID-19, including financial and other assistance
  • Consult with human rights institutions and experts, Indigenous leaders and knowledge-keepers, vulnerable groups, as well as persons and communities affected by COVID-19, when making decisions, taking actions and allocating resources.

Despite our early advice, the OHRC has not yet been invited to COVID-19 planning forums and tables. Nor have we been able to gain access to specific and timely information to better understand the human rights implications of the government’s COVID-19 initiatives.

The OHRC’s specific requests for more details on the implementation of the Plan and its effect on vulnerable groups have gone unanswered.

In our April 30 submission on Ontario’s next Poverty Reduction Strategy, the OHRC highlighted that social and economic crises, especially a health pandemic like COVID-19, exacerbate the existing inequalities vulnerable populations already experience, such as poorer health and poverty. An inadequate response to the needs of vulnerable groups also undermines the effectiveness of Ontario’s overall response to COVID-19, placing at risk everyone’s well-being and potentially exacerbating an anticipated “second wave” of the pandemic.

To effectively protect the rights of Ontario’s most vulnerable people, Ontario must take immediate action to expand and implement its Plan for vulnerable groups. The OHRC urges the government to make clear, detailed and public commitments in the following areas:

  1. Expand the scope of the Plan to ensure the needs of other vulnerable communities are properly addressed. Examples of communities that are currently excluded include:
  • People experiencing homelessness who are not currently using the shelter system (for example, hidden homeless people and people living in encampments)
  • Highly mobile populations of people who use drugs
  • People experiencing poverty and living in multi-generational and sometimes crowded housing while also working in high-risk settings, such as long-term care, food processing facilities and the service sector
  • In-patients in mental health facilities, including in addictions and withdrawal programs and in residential treatment programs for children and youth
  • Frail seniors in assisted living
  • Indigenous people living in urban and rural communities, and not in congregate care
  • Seasonal migrant workers living in shared housing facilities.
  1. Provide detailed, public information on how the roll-out of expanded testing, screening, tracking and surveillance will reach and benefit high-risk and vulnerable populations. Information should include a plan for:
  • How many tests will be done for vulnerable groups each day
  • How mobile populations will be reached
  • How asymptomatic people from high risk and vulnerable groups will be tested, tracked and monitored.
  1. Consult and work with vulnerable groups that will be affected by the Plan by including Indigenous partners, stakeholder/advocacy groups representing vulnerable people and human rights experts, and involve them in provincial planning tables and committees.
  1. Provide specific and detailed guidance to law enforcement to ensure that COVID-19 prevention measures are not implemented in a way that disproportionately targets or penalizes people who have difficulty or are unable to follow physical distancing restrictions and other requirements, such as people experiencing homelessness and people with certain types of disabilities. Guidance should also include appropriate ways to promote education and awareness.
  1. Identify indicators and collect data to measure whether the Plan, including these additional actions, is benefiting high-risk and vulnerable populations.
  1. Report publicly and regularly on the implementation status of the Plan, including these additional actions, in detail, including the results of the data collected to measure whether the plan is benefiting high-risk and vulnerable populations.

 

The OHRC appreciates the ever-evolving circumstances surrounding COVID-19, and understands that the government is working to address issues on many fronts. However, as many experts note, the spread of COVID-19 among Ontario’s most vulnerable populations could prove catastrophic. Taking the recommended actions as soon as possible can help limit the spread of the virus while continuing to uphold Ontario’s human rights obligations.

Sincerely,

Original signed by

Raj Dhir

Executive Director

cc:        Hon. Merrilee Fullerton, Minister of Long-Term Care

Dr. David Williams, Chief Medical Officer of Health

Matthew Anderson, President and CEO of Ontario Health

Hon. Doug Downey, Attorney General

Violetta Igneski, OHRC Commissioner

Randall Arsenault, OHRC Commissioner

[1] Further details regarding the process by which this document was developed can be found in Appendix A.

[2] Critical Care Services Ontario. Ontario’s Critical Care Surge Capacity Management Plan: Moderate Surge Response Guide Version 2.3. Government of Ontario, September 2019, p. 6.

[3] An earlier version of this document was distributed to Ontario hospitals on March 28, 2020. The current document provides updated recommendations based on additional consultation and stakeholder feedback to clarify the scope and limits of critical care triage in the COVID-19 pandemic, the ethical underpinnings of the approach (including significance of human rights), the nature and purpose of the critical care triage criteria, and key considerations for implementation. It also includes recommendations for continuing consultation and stakeholder engagement.

[4] “Critical care services meet the needs of patients facing an immediate life-threatening health condition—specifically, that in which vital system organs are at risk of failing. Using advanced therapeutic, monitoring and diagnostic technology, the objective of critical care is to maintain organ system functioning and improve the patient’s condition such that his or her underlying injury or illness can then be treated.” (https://www.criticalcareontario.ca/EN/AboutUs/Pages/What-is-Critical-Care.aspx)

[5] Silva DS, Gibson JL, Robertson A, et al. Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public’s perspectives. BMC Public Health 2012; 12:241. https://doi.org/10.1186/1471-2458-12-241

[6] Add missing refs.

[7] Determining the timeframe in which death is likely to occur is challenging. Prognostication requires clinical judgement based on each patient’s unique clinical circumstances. To enhance prognostic certainty, the involvement of clinical judgement of more than one physician is common medical practice.

[8] Skye C. Colonialism of The Curve: Indigenous Communities & Bad COVID Data. Toronto: Yellowhead Institute, Ryerson University, 2020. https://yellowheadinstitute.org/2020/05/12/colonialism-of-the-curve-indigenous-communities-and-bad-covid-data/; Nestel S. Colour-coded health care: the impact of race and racisms on Canadian’s health. Toronto: Wellesley Institute, 2012. http://www.wellesleyinstitute.com/wp-content/uploads/2012/02/Colour-Coded-Health-Care-Sheryl-Nestel.pdf; <additional references to be added>

[9] Ontario Human Rights Commission. Policy statement on a human rights-based approach to managing the COVID-19 pandemic. 02 April 2020. Available at: http://www.ohrc.on.ca/en/policy-statement-human-rights-based-approach-managing-covid-19-pandemic.

[10] Such as: age, sex, socioeconomic status, Indigenous status, race, ethnicity, sex, gender identity and expression, sexual orientation, creed, family status, marital status, geography, and home setting (including homelessness). See also Appendix B: Prohibited grounds of discrimination for a list of prohibited grounds). http://www.ohrc.on.ca/en/ontario-human-rights-code

[11] Savin K, Guidry-Grimes L. Confronting disability discrimination during the pandemic. Hastings Center Report 2020; Apr 2. Available at: https://www.thehastingscenter.org/confronting-disability-discrimination-during-the-pandemic/; Applying HHS’s Guidance for States and Health Care Providers on Avoiding Disability-Based Discrimination in Treatment Rationing. https://dredf.org/avoiding-disability-based-discrimination-in-treatment-rationing/. Accessed April 12, 2020; Biddison D, Berkowitz KA, Courtney B, De Jong MJ, Devereaux AV, Kissoon N, Roxland BE, Sprung CL, Dichter JR, Christian MD, Powell T. Ethical considerations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2014; 146(4): e145S-e155S.

[13] Truog RD, Mitchell C, Daley GQ. The toughest triage—allocating ventilators in a pandemic. NEJM 2020; 23 March. Available at: https://www.nejm.org/doi/full/10.1056/NEJMp2005689?query=recirc_curatedRelated_article

cThe use of an acute illness score (e.g., sequential organ failure assessment (SOFA) score) would be difficult to justify given that even people with high SOFA scores may have a ~50% chance of surviving an acute viral respiratory illness.11 And if one only looks at those who do not meet any of the ineligibility criteria at levels 1-3, the survival rate would likely be even higher. It is currently unknown whether the prognosis of COVID-19 illness is similar to other viral illnesses. Early data suggests that the admission SOFA scores for non-survivors was low, and thus unhelpful for distinguishing them from survivors. 12-13 Moreover, mortality risk from acute illness does not easily translate into medical utility. It is not clear whether the greatest benefit would be seen in those with mild, moderate, or severe illness.

[15] Biddison D, Berkowitz KA, Courtney B, De Jong MJ, Devereaux AV, Kissoon N, Roxland BE, Sprung CL, Dichter JR, Christian MD, Powell T. Ethical considerations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2014; 146(4): e145S-e155S.

[16] Christian MD, Sprung CL, King MA, et al. Triage: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014;146(4 Suppl):e61S-74S.

[17] Christian MD, Sprung CL, King MA, Dichter JR, Kissoon N, Devereaux AV, Gomersall CD. Triage: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2014; 146(4): e61S-e74S; US Veterans Health Administration National Center for Healthcare Ethics. Meeting the challenge of pandemic influenza: ethical guidance for leaders and health care professionals in the Veterans Health Administration, July 2010. Available at: https://www.ethics.va.gov/docs/pandemicflu/Meeting_the_Challenge_of_Pan_Flu-Ethical_Guidance_VHA_20100701.pdf; Emanuel EJ et al. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med 2020 Mar 23; Truog RD, Mitchell C, Daley GQ. The toughest triage—allocating ventilators in a pandemic. NEJM 2020; 23 March. Available at: https://www.nejm.org/doi/full/10.1056/NEJMp2005689?query=recirc_curatedRelated_article

Toronto City Council Infrastructure Committee Is Warned that to Allow Electric Scooters Would Pose Dangers to Public Safety and to Accessibility for People with Disabilities While the City’s Officers Have No Real Capacity to Enforce New E-Scooter Regulations if Adopted

ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE

NEWS RELEASE – FOR IMMEDIATE RELEASE

Toronto City Council Infrastructure Committee Is Warned that to Allow Electric Scooters Would Pose Dangers to Public Safety and to Accessibility for People with Disabilities While the City’s Officers Have No Real Capacity to Enforce New E-Scooter Regulations if Adopted

July 10, 2020 Toronto: Yesterday, the City of Toronto’s Infrastructure and Environment Committee heard compelling uncontradicted evidence that to allow electric scooters (e-scooters) in Toronto would endanger the safety of the public, including people with disabilities. Lifelong Toronto resident, John Rae, himself blind, told City Councilors that e-scooters are a “silent menace” that would make it even harder to safely walk around outside in Toronto, which already has too many barriers in his path. Toronto resident Peter Athanasopoulos, who uses a wheelchair and who spoke for Spinal Cord Injury Ontario, similarly described e-scooters for the Committee as a danger for people like him.

Several City Councilors acknowledged concern over the fact that e-scooters can present safety dangers. Head injuries are among the serious injuries they can cause. Where e-scooters are allowed, the Committee was told that only 4% of e-scooter riders wear a helmet. Provincial regulations don’t require a helmet for e-scooter riders age 18 or older.

One place where e-scooters would especially endanger public safety for innocent pedestrians and accessibility for people with disabilities is on sidewalks. The Infrastructure Committee received a City Staff Report showing that in cities where e-scooters are allowed but banned on sidewalks, they are nevertheless ridden on sidewalks. City law enforcement officials told City Councilors that their overburdened officers do not have the capacity to handle the added burden of enforcing new e-scooter regulations if Toronto enacts them. One Councilor remarked that City law enforcement officials don’t now even enforce restrictions on riding a bicycle on sidewalks.

The Committee asked City Staff if any city had developed a good effective approach to enforcement. City Staff answered the Committee in the negative.

Corporate lobbyists for e-scooter rental companies who stand to profit from Toronto as a new market are pressuring hard for fast adoption of e-scooters. One of them, speaking for the Bird e-scooter rental company, said that e-scooters would not cause the City any “direct” costs. AODA Alliance Chair David Lepofsky showed the Committee that that claim ignores their significant indirect costs. The City Staff Report demonstrated that to allow e-scooters will impose new as-yet uncalculated financial burdens on the taxpayer, such as enforcement costs and possible City liability for injuries suffered (not to mention added health care costs for people injured by e-scooters).

As for allocating new budget to such costs, one City Council member stated that the cupboard is bare. No City Councilors or City staff disagreed with that assessment.

AODA Alliance Chair David Lepofsky told the Committee that with the COVID-19 crisis overwhelming everyone in society, City Councillors have far more important priorities to address than e-scooters. The City Staff Report showed that e-scooters should not be adopted during the COVID-19 pandemic. In troubling contrast, the e-scooter rental companies’ corporate lobbyists tried to exploit the COVID-19 pandemic, actually claiming it is a good reason for adopting e-scooters.

Despite these serious dangers, a majority of the Infrastructure Committee voted to direct City Staff to further research the implications of e-scooters and to take some preparatory steps towards Toronto holding a future pilot trial period, with the topic to come back to the Committee in November. No final decision to allow e-scooters was made, either permanently or as a pilot.

Deputy Mayor Denzil Minnan-Wong voted against taking any further action that could lead to later approving e-scooters for Toronto because they endanger the public. No Councillor who voted for further action mentioned that adoption of e-scooters was strongly opposed by a unanimous recommendation of the City-appointed Toronto Accessibility Advisory Committee and an open letter to all Ontario municipal councils from 11 major disability organizations.

It is a cruel irony that the City uses WebEx for such public meetings, despite the fact that that virtual platform has serious accessibility problems for people with disabilities. AODA Alliance Chair David Lepofsky, who consequently had to use a telephone to speak to the Committee, was almost denied the chance to speak to the Infrastructure Committee at all because Committee Staff erroneously thought he was not on the line, when he had in fact been waiting for 90 minutes to speak.

The non-partisan AODA Alliance, which has been spearheading advocacy against e-scooters due to their dangers for people with disabilities, is redoubling efforts with partners in the disability community to press City Council members not to proceed with e-scooters. They have a battle on their hands, since the corporate lobbyists for e-scooter rental companies have obviously devoted ample resources to work the back rooms at City Hall. Disability advocates are undeterred, having many times waged challenging campaigns for accessibility.

Contact: AODA Alliance Chair David Lepofsky, aodafeedback@gmail.com Twitter: @aodaalliance

For more background:

Read the AODA Alliance’s July 8, 2020 brief to the City of Toronto Infrastructure and Environment Committee, already endorsed by Spinal Cord Injury Ontario and the March of Dimes of Canada

Read the open letter www.aodaalliance.org/e to all Ontario municipal councils from 11 major disability organizations, opposing e-scooters in Ontario, and

Visit the AODA Alliance e-scooters web page.

AODA Alliance to Present Tomorrow at Virtual Meeting of Toronto’s Infrastructure Committee to Oppose Allowing Electric Scooters – Submits Detailed Brief that Shows A City Staff Report Proves E-Scooters Endanger Public Safety and Accessibility for People with Disabilities

ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE

NEWS RELEASE – FOR IMMEDIATE RELEASE

AODA Alliance to Present Tomorrow at Virtual Meeting of Toronto’s Infrastructure Committee to Oppose Allowing Electric Scooters – Submits Detailed Brief that Shows A City Staff Report Proves E-Scooters Endanger Public Safety and Accessibility for People with Disabilities

July 8, 2020

Tomorrow, July 9, 2020 starting at 9:30 am, the City of Toronto’s Infrastructure and Environment Committee will consider if the City should take steps to allow electric scooters (e-scooters) in Toronto. The AODA Alliance is scheduled to make a deputation to the Committee. The Committee meeting will be live-streamed at this link: http://www.youtube.com/torontocitycouncillive

The AODA Alliance has just filed a detailed brief with the City’s Infrastructure and Environment Committee, set out below. It documents in exquisite and exhaustive detail that the City of Toronto’s June 24, 2020 E-Scooters Staff Report amply proves that e-scooters would endanger public safety, lead to injuries and even deaths, create barriers to accessibility for people with disabilities, and force the taxpayer to shoulder new financial burdens. That Staff Report also shows that the supposed social benefits of e-scooters reducing road traffic and pollution are in effect unproven.

“If this gets approved, the taxpayer will get stuck paying the expenses while e-scooter rental companies, who are pushing for their product to get into Toronto, will earn the profits and try to dodge liability for injuries they cause,” said David Lepofsky, Chair of the non-partisan AODA Alliance that has spearheaded advocacy to protect people with disabilities from the dangers that e-scooters pose. “In the middle of this COVID-19 crisis, don’t our City Council members have more important priorities to deal with?”

The only proper conclusion that flows from this City Staff Report is that Toronto should continue to ban e-scooters. Yet the Staff Report instead wrongly proposes that the City of Toronto take steps towards allowing e-scooters. It does not explain why this should be done in the face of the known dangers that the Staff Report shows e-scooters create. We anticipate that the City has been the subject of relentless pressure behind closed doors by corporate lobbyists for the e-scooter rental companies that have been trying to dominate this debate.

The City Staff Report proposes working towards a pilot project in Toronto with e-scooters. The AODA Alliance brief shows that this would be nothing less than a human experiment on the public and would endanger the public, including people with disabilities, without their consent. Human experimentation on non-consenting people is universally condemned.

Contact: AODA Alliance Chair David Lepofsky, aodafeedback@gmail.com Twitter: @aodaalliance

For more background, visit the AODA Alliance e-scooters web page.

Don’t Introduce Electric Scooters to Toronto, Since A City Staff Report Shows They Create Dangers to Public Safety and Accessibility for People with Disabilities

Accessibility for Ontarians with Disabilities Act Alliance Brief to the City of Toronto Infrastructure and Environment Committee on Proposal to Allow Electric Scooters in Toronto

www.aodaalliance.org aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

July 8, 2020

Via email: iec@toronto.ca

1. Introduction and Summary

The AODA Alliance calls on the City of Toronto and its Infrastructure Committee to categorically reject the proposal before its July 9, 2020 meeting to take steps towards permitting electric scooters (e-scooters) in Toronto. The City of Toronto and its Infrastructure and Environment Committee should instead focus 100% of their time on the horrific COVID-19 crisis that now engulfs us all. If the Committee feels it must do something short of an outright rejection of e-scooters, it should simply direct City staff to do more research on the harms that e-scooters have caused in places where they are allowed.

The non-partisan AODA Alliance has played a leading role in raising serious disability safety and accessibility concerns with e-scooters. To learn more about the AODA Alliance’s advocacy efforts to protect people with disabilities and others from the dangers that e-scooters pose, visit its e-scooters web page.

The detailed and well-researched June 24, 2020 City of Toronto Staff Report on e-scooters shows that to allow e-scooters in Toronto will endanger public safety, send both e-scooter riders and innocent pedestrians to our hospital emergency rooms, require significant new law enforcement efforts and impose new financial burdens on the taxpayer to cover added costs that e-scooters will trigger. The Staff Report also shows that e-scooters do not bring the great benefits for reduced car traffic and pollution that the corporate lobbyists for e-scooter rental companies claim.

The Staff Report’s detailed analysis supports only one conclusion, namely that e-scooters should not be allowed. Yet despite all e-scooters harms and dubious benefits, the Staff Report proposes instead (without convincing explanation) that the City take steps towards conducting a pilot with e-scooters, deferring a decision to early 2021. This may be because the City has been subjected to relentless pressure from corporate lobbyists for e-scooter rental companies, who are the driving force behind this issue.

In the face of the dangers from e-scooters that the Staff Report reveals, the Report only says that the action it recommends “…reduces the likelihood of e-scooter risks to riders, impacts on people with accessibility needs, community nuisance, and liability to the City…” The Staff Report does not claim that these dangers would be eliminated, or even that they would be substantially reduced. It only says that those risks would be “reduced.” That could be a mere microscopic reduction. Torontonians–especially those with disabilities–deserve better protection.

The City of Toronto should not conduct a “pilot project” with e-scooters to find out how they will work out. The Staff Report shows from the experience with e-scooters elsewhere that the problems that e-scooters present have already been borne out in practice. Moreover, to run a “pilot project” on Torontonians is to conduct a human experiment on them, without their consent, knowing that e-scooters present dangers to public safety and accessibility for people with disabilities. It is wrong to experiment on non-consenting human beings, and especially those who are vulnerable.

It is good that the Staff Report does not recommend actually unleashing e-scooters on Toronto now, with the COVID-19 crisis nearing the end of its fourth month, with no end in sight. With the COVID-19 pandemic working such havoc on our society, Toronto and its residents have far greater priorities to contend with than meeting the needs of those who want to race around this city on e-scooters.

It is unfair for the City of Toronto and its Infrastructure Committee to be bringing this issue forward in the middle of the COVID-19 crisis. City Council and Committee meetings are not open to the public to physically attend. Members of the public are struggling to cope with the multiple pressures that they face, compounding over the past 16 weeks. At the start of July, many are trying to just get something of a holiday, if possible. For its part, the AODA Alliance is overloaded with issues on which to advocate for people with disabilities during the COVID-19 crisis. For the City of Toronto to force us to divert our volunteer advocacy efforts to this e-scooter issue now is just one more unfair hardship.

If the City of Toronto Infrastructure and Environment Committee is looking for a new and important priority agenda item to address, it should work comprehensively on making Toronto’s infrastructure fully accessible to people with disabilities. The Accessibility for Ontarians with Disabilities Act requires Toronto, including its infrastructure, to become accessible to people with disabilities by 2025, under 4.5 years from now. Toronto is not anywhere close to being on schedule to reach that goal.

2. E-Scooters Endanger Public Safety Causing Injuries and Deaths

Even before the COVID-19 pandemic, our hospitals and emergency rooms were backlogged, resulting in the scourge of hallway medicine. The COVID-19 pandemic has imposed unprecedented added demands and pressures on our health care system, including our hospitals.

The Staff Report’s analysis amply shows that if e-scooters are allowed, this will lead to an increase in personal injuries, both to e-scooter riders and innocent pedestrians. Of course, this will create additional demands and pressures on over-burdened hospital emergency rooms. The Staff Report states:

“The City has a Vision Zero commitment to eliminate serious injuries and fatalities resulting from roadway crashes, particularly around six emphasis areas including pedestrians, school children, and older adults. Replacing car trips with e-scooter trips presents an opportunity to address some road safety issues if e-scooters produce a net safety benefit, especially for these groups. A 2020 International Transport Forum study notes that the risk of hospital admission may be higher for e-scooter riders than for cyclists, but that there are too few studies to draw firm conclusions. While not comprehensive, the emerging evidence of the health impacts associated with e-scooter use warrants a cautious approach to mitigate risks to e-scooter riders, pedestrians, and the City. Some of the findings are below.

New e-scooters users are most likely to be injured with 63 percent of injuries occurring within the first nine times using an e-scooter. (CDC and City of Austin)

A comparison of serious injury rates between Calgary’s 2019 shared e-scooter pilot and Bike Share Toronto suggests riding a shared e-scooter is potentially about 350 times more likely to result in a serious injury than riding a shared bike on a per km basis, and about 100 times more likely on a per trip basis. This includes a limited sample size, differing definitions for serious injuries, different city contexts (e.g., Calgary allowed e-scooter riding on sidewalks, whereas bicycle riding is not allowed on sidewalks in Toronto) and serious injuries may decline over time as people gain experience riding e-scooters. (Montréal reported few e-scooter injuries for its 2019 pilot, however, it is unclear whether and how data for serious injuries was gathered.) Calculations are based on: 33 ER visits requiring ambulance transport over three months (Jul to Sep 2019) in Calgary for e-scooter-related injuries with a reported 750,000 trips, and average trip length of 0.9km; and 2,439,000 trips for Bike Share Toronto, with 3km average trip length, over 12 months in 2019, and no serious injuries (e.g., broken bones, head trauma, hospitalization) but attributing one for comparison purposes. Further data collection and studies of injuries are needed on a per km basis, by type of trip (i.e., recreational versus commuting, facility type), and by injury type.

The fatality rate for shared e-scooter users is potentially nine to 18 times the rate of bike share-related deaths in the U.S., based on a news report in the Chicago reader.

Head trauma was reported in nearly one third of all e-scooter-related injuries in the U.S. from 2014 to 2018 – more than twice the rate of head injuries to bicyclists. In a City of Austin study in 2018 over three months, 48 per cent of e-scooter riders who were hurt had head injuries (91 out of 190), with 15 per cent (28 riders) experiencing more serious traumatic brain injuries.

Falling off e-scooters was the cause of 80 percent of injuries (183 riders); 20 percent (45 riders) had collided with a vehicle or an object, according to a 2019 UCLA study of two hospital ERs in one year. Just over eight per cent of the injuries were to pedestrians injured as a result of e-scooters (11 hit by an e-scooter, 5 tripped over a parked e-scooter, and 5 were attempting to move an e-scooter not in use).

Hospital data will be key to track injuries and fatalities by type and severity, especially for incidents where no motor vehicle has been involved (e.g., losing control) or for a trip and fall involving improperly parked e-scooters. As an ICD-10 code (international standard injury reporting code) specific to e-scooters will not be implemented in Canada until at least spring 2021, a reliable method to track serious e-scooter related injuries and fatalities presenting at hospitals is currently not available.”

“Finally, the risk of injury for new users is high, and could put additional burden on local hospitals and paramedics at this time. For the reasons above, City staff do not recommend permitting e-scooters in ActiveTO facilities in 2020.”

“Cities that initially allowed e-scooters on sidewalks have since banned them due to safety issues (pedestrian deaths and injuries), e.g., France, Spain, Singapore and San Diego; and other jurisdictions such Ottawa’s National Capital Commission have banned e-scooters on mixed use trails/paths.

E-scooters have been prohibited also from mixed use paths or in parks because of the intermixing with people and children on foot, who are slower, and also making unpredictable movements when using public space for leisure and recreational purposes. In cities such as Berlin, Paris and Tel Aviv, where e-scooters are permitted for operation on roads or bike lanes, and not sidewalks, there have been compliance and enforcement issues with these rules. Some cities (such as Atlanta) and countries (such as the UK) have accelerated bicycle infrastructure projects after e-scooter fatalities, and in anticipation of expanding micro mobility. In May 2020, the UK announced a £250 million emergency active travel fund – the first stage of a £2 billion investment supporting cycling, walking and bus-only infrastructure.”

“Paris and Singapore banned e-scooters from being used on sidewalks. This ban occurred as a result of pedestrian deaths from e-scooter collisions on sidewalks.”

“In the City of Austin, 63% of injuries occurred within the first nine rides of using an e-scooter. About 50% are head injuries and 35% are fractures. Less than 1% wore helmets. (Centers for Disease Control & Prevention and City of Austin)”

“In Chicago, 10 pedestrians were sent to the emergency room after being hit by e-scooter users in their 4 month pilot project. There were a total of 192 emergency room visits related to e-scooters in these 4 months.”

As well, the PowerPoint that City staff presented at the February 3, 2020 meeting of the City of Toronto’s Accessibility Advisory Committee noted these statistics from Calgary:

“Calgary mid-pilot report for period approx. July to mid-October 2019:

  • 33 ER visits requiring ambulance rides, one of these was a pedestrian; 677 ER visits total”

3. E-Scooters Endanger Safety and Accessibility for People with Disabilities

The Staff Report also shows that e-scooters endanger safety and accessibility for people with disabilities. It states:

“E-scooters pose a risk to people with disabilities due to their faster speeds and lack of noise. Cities that have allowed e-scooters have observed a high incidence of sidewalk riding by riders, whether permitted or not on sidewalks. Parked e-scooters, especially when part of a dockless sharing system, can pose trip hazards and obstacles. Seniors, people with disabilities, and those with socio-economic challenges could face negative outcomes if injured in a collision or fall. Solutions to enforcement and compliance are still in their infancy.””

“Accessibility for Ontarians with Disabilities Act (AODA)

Persons with disabilities and seniors have considerable concerns about sidewalk and crosswalk interactions with e-scooter users, as well as concerns regarding trip hazards and obstructions from poorly parked or excessive amounts of e-scooters. The Toronto Accessibility Advisory Committee, a body required under the AODA, recommends that City Council prohibit the use of e-scooters in public spaces, including sidewalks and roads. In other jurisdictions outside of Ontario, some legal action has been undertaken against municipalities by persons injured as a result of e-scooter sidewalk obstructions, as well as by persons with disabilities.”

The Staff Report’s recommendations to take steps towards allowing e-scooters in Toronto are directly contrary to the strong, unanimous recommendation to the City of Toronto by the statutorily-mandated Toronto Accessibility Advisory Committee. As the Staff Report notes, that Committee recommended that e-scooters not be allowed in Toronto. The Staff Report states:

“On February 3, 2020, the Toronto Accessibility Advisory Committee recommended City Council prohibit e-scooters for use in public spaces including sidewalks and roads, and directed that any City permission granted to e-scooter companies be guided by public safety, in robust consultation with people living with disabilities, and related organizations serving this population.””

The City staff’s PowerPoint, presented to the February 3, 2020 meeting of the City of Toronto Accessibility Advisory Committee also identified this feedback that the City had received:

“Key Stakeholder Feedback So Far

  • Accessibility / persons with disabilities groups
  • Visually-impaired/blind cannot hear or see e-scooter riders, trip hazards with e-scooters, collisions and near collisions/friction on sidewalks and serious injuries from losing balance and falling, no insurance, challenges with enforcement / claims
  • Pedestrian-related – walkability, friction on sidewalks, trip hazards, collisions”

The Staff Report’s recommendations to take steps towards allowing e-scooters in Toronto are also totally contrary to the strong recommendations of 11 disability organizations in the January 22, 2020 open letter sent by the AODA Alliance to the mayors and councils of all Ontario municipalities, set out in this brief’s appendix.

4. If E-Scooters Are Allowed in Toronto, They Will Be Ridden on Sidewalks Even If That is Forbidden

Any consideration of e-scooters must operate on the premise that e-scooter riders will ride e-scooters on sidewalks, even if this is strictly banned. This contributes to the dangers to the public including people with disabilities. The Staff Report states:

  • “Cities that have allowed e-scooters have observed a high incidence of sidewalk riding by riders, whether permitted or not on sidewalks.”
  • “Most jurisdictions experienced illegal sidewalk riding by e-scooter users…”
  • “E-scooter riders will also likely ride on sidewalks, even if not allowed.”

(from feedback from a focus group of Toronto cyclists)

5. E-Scooters Will Saddle the Taxpayer With Financial Burdens While the E-Scooter Rental Companies Make the Profits

The Staff Report demonstrates that to allow e-scooters will inflict new costs and financial burdens on the taxpayer. The AODA Alliance takes the position that these burdens should not be inflicted on the public, especially after our society has had to suffer the crushing financial impact of the COVID-19 crisis, an impact that is continuing with no end in sight. If more public money were now to be spent, it should not be on the costs that the City of Toronto would have to shoulder due to the introduction of e-scooters.

The Staff Report states:

* “There is a significant risk that the City may be held partially or fully liable for damages if e-scooter riders or other parties are injured. Transportation Services staff consulted with the City’s Insurance and Risk Management office (I&RM) to understand the magnitude of the City’s liability if allowing e-scooters. At this time, loss data is lacking on e-scooters due to generally lengthy settlement times for bodily injury claims. The City has significant liability exposure, however, due to joint and several liability, as the City may have to pay an entire judgement or claim even if only found to be 1 percent at fault for an incident. The City has a $5M deductible per occurrence, which means the City will be responsible for all costs below that amount. In terms of costs, Transportation Services staff will also be required to investigate and serve in the discovery process for claims.”

“If Council were to permit e-scooters to be operated on City streets – without the commensurate resources to provide oversight, education, outreach and enforcement, there would be considerable risks to public safety for e-scooter riders and other vulnerable road users; additional burdens on hospitals and paramedics; impacts on accessibility, community nuisance and complaints; impacts on current initiatives to enhance the public realm for COVID-19 recovery efforts, such as CurbTO and CaféTO; and liability and costs to the City. For the reasons above, staff recommend that personal use of e-scooters not be considered until 2021.”

“FINANCIAL IMPACT:

Funding and resources required in various programs for the following will be included as part of future budget submissions for consideration during the budget process to address the financial and additional staff resources required to: manage implementation, operational, and enforcement issues of e-scooters in Toronto; and the resolution of e-scooter issues, including, but not limited to, injury/fatality and collision investigations and data collection and tracking (e.g., in consultation with health agencies and/or academic partners, Toronto Police Services, and others), further standards development for e-scooter device design, and consultations on proposed by-law changes with accessibility and other stakeholders.”

The key proponents of e-scooters are the e-scooter rental companies that stand to profit from their use. The Staff Report shows that e-scooter rental companies take active steps to dodge any liability for the damage that their e-scooters cause. The Staff Report also shows that the insurance industry does not have the insurance products needed in this area. City staff explored the possibility of injury claims being covered by The Motor Vehicle Accident Claims Fund. That fund is financed by the taxpayer. That option would again let e-scooter rental companies reap the profits while the taxpayer covers the consequent costs.

The Staff Report states:

“E-scooter sharing/rental companies typically require a rider to sign a waiver, placing the onus of compensating injured parties on the rider. Riders are left financially exposed due to a lack of insurance coverage and if unable to pay, municipalities will be looked to for compensation (e.g., in settlements and courts). Claims related to e-scooter malfunction have been reported by the media (such as in Atlanta, Auckland, New Zealand and Brisbane, Australia). In 2019, a Grand Jury faulted the City of San Diego for inadequate regulation and enforcement of e-scooter sharing companies. By opting in to the Pilot, the City will be exposed to claims associated with improperly parked e-scooters as evidenced by lawsuits filed by persons with disabilities and those injured by e-scooter obstructions (such as in Minneapolis and Santa Monica, California).

The insurance industry does not currently have insurance products available for e-scooter riders. In Fall 2019, City staff explored whether the Motor Vehicle Accident Claims Fund could be expanded or if a similar kind of fund in principle could be created to address claims where e-scooter riders or non-users are injured and their expenses are not covered by OHIP, nor by other insurance policies (e.g., homeowner’s or personal auto). Further research and consultation would be needed to look into these considerations.

It will be critical to ensure that insurance evidenced by e-scooter sharing companies will cover their operations for all jurisdictions operated in (e.g., all cities nationally or internationally). Further, there needs to be full indemnification for the municipality by e-scooter sharing companies, and not limitations in their indemnification contracts.”

6. Stronger Provincial Regulations Needed Before Even Starting with E-Scooters

Even if the City Council were to consider moving forward at all with e-scooters, the Staff Report’s analysis shows that any municipal consideration of this should be deferred until key missing action by the Ontario Government has been taken. The Staff Report shows the need for stronger provincial regulations on e-scooters safety to be enacted as an important precursor to introducing e-scooters. The Staff Report states:

“Although the HTA sets out some e-scooter standards, such as maximum speed and power wattage, due to the nature of urban and suburban conditions such as Toronto’s, City staff recommend that the Province strengthen the device standards for greater rider safety. Based on an extensive literature review, items recommended for further Provincial exploration include a maximum turning radius, a platform surface grip, wheel characteristics (e.g., minimum size, traction, tire width), braking and suspension.

In addition, the Province has not established set fine amounts for offences under the HTA e-scooter regulations. Without this in place, for the police to lay a charge in respect of a violation, a “Part III Summons” is required, which means the police must attend court for each charge laid regardless of severity, and a trial is required for a conviction and fine to be set. This may make it less likely that charges are laid. Fines outside of ones the City could set (e.g. e-scooter parking violations, illegal sidewalk riding) would create workload challenges for Police and courts.”

“In spite of the Pilot requirement to collect data, there is currently no vehicle type for e-scooters in the Ministry of Transportation’s (MTO) Motor Vehicle Collision Report (MVCR) template used by all police services to report collisions. Unless the Province specifies e-scooters are motor vehicles for the purposes of collision reporting, and has a field for this in its template, e-scooter collisions may not be reported reliably and meaningful collision data analysis will not be possible. In Fall 2019, City staff requested that the MTO add e-scooters as a separate vehicle type, but MTO has not yet communicated they would make this change.”

“This report also recommends the need for improved industry standards at the provincial and federal levels for greater consumer protection in the purchase and/or use of e-scooters. While staff are aware that e-scooters are being considered as an open-air transportation option, the absence of improved standards and available insurance for e-scooter riders, coupled with lack of enforcement resources, would risk the safety of riders and the public on the City’s streets and sidewalks, especially for people with disabilities.”

(Among the Staff Report’s recommendations)

“3. City Council requests that the Ontario Ministry of Transportation amend the Motor Vehicle Collision Report to add electric kick-scooters as a vehicle type and to treat e-scooters as a motor vehicle for reporting purposes….

  1. City Council requests that the Ontario Ministry of Transportation and the Ontario Ministry of the Attorney General establish set fines for violations of O. Reg. 389/19, Pilot Project – Electric Kick-Scooters, and communicate these set fines to Toronto Police Services through an All Chiefs Bulletin.

  1. City Council requests that the Ontario Ministry of Transportation strengthen its standards and specifications for e-scooters in O. Reg. 389/19, Pilot Project – Electric Kick-Scooters based on the latest best practice research.”

7. Substantial Effective Enforcement Would Be Needed But Has Not Been Planned For

The Staff Report repeatedly recognizes the importance of rule enforcement regarding the use of e-scooters. The AODA Alliance adds that it is deeply troubling that the City of Ottawa allocated no additional funds for enforcement during its current pilot with e-scooter and appears to have imposed no fine for law-breakers.

The Toronto Staff Report does not spell out how many enforcement officers would be needed to effectively enforce e-scooter rules if allowed in Toronto, or what this would cost the taxpayer to enforce (including court resources). As noted above, certain key standards are missing which would be important for effective enforcement. The Staff Report states:

“Solutions to enforcement and compliance are still in their infancy.”

“Other key issues raised in the consultations include lack of enforcement and adequate infrastructure; and questions about environmental sustainability, public space and the potential for clutter and safety hazards particularly for people with disabilities.”

“In general, jurisdictions do not have the capacity to enforce compliance. For example, Tel Aviv has a unit of 22 inspectors dedicated to enforcing that e-scooters do not ride on sidewalks. These inspectors are able to issue tickets for sidewalk violations, but only the police have the authority to issue tickets to riders not wearing helmets, as required by law. 21,000 tickets for sidewalk offenses were issued in 2019.”

8. Toronto Is Especially Ill-Suited For E-Scooters

The Staff Report’s contents give additional reasons why Toronto is in reality especially ill-suited for allowing e-scooters. The Staff Report states:

“In addition to the experiences in other jurisdictions, several risk factors are unique to the City of Toronto and play a role in informing the recommended approach to e-scooters:

Streetcar tracks: Toronto has an extensive track network (177 linear kilometres) which poses a hazard to e-scooter riders due to the vehicle’s small wheel diameter.

Winter and State-Of-Good-Repair: Toronto experiences freezing and thawing that impacts the state-of-good-repair for roads. A large portion of roads are 40 to 50 years old, with 43 percent of Major Roads and 24 percent of Local Roads in poor condition. Coupled with lack of standards for e-scooter wheels (e.g., traction, size), this makes this particular device more sensitive to uneven road surfaces.

High construction activity: In addition to the city’s various infrastructure projects, Toronto has been one of the fastest growing cities with about 120 development construction sites in 2019.

Narrow sidewalks and high pedestrian mode shares in the Downtown Core and City Centres: Most jurisdictions experienced illegal sidewalk riding by e-scooter users, with some business districts saying e-scooters deterred patrons from visiting their previously pedestrian-friendly main streets. This is especially challenging with physical distancing requirements and other COVID-19 recovery programs expanding the use of the City’s sidewalks and boulevards.”

9. Toronto Should At Least Defer Discussion of E-Scooters Until After the COVID-19 Pandemic Is Over

The Staff Report’s analysis supports the conclusion that any actual introduction of e-scooters in Toronto should not take place during the COVID-19 pandemic. The Staff Report states:

“Other cities have suspended e-scooter sharing services until after COVID-19 (e.g., Windsor approved a shared e-scooter pilot in April 2020, but has now deferred its pilot until after COVID-19). Prior to the pandemic, a number of jurisdictions (e.g., Boulder, Honolulu, and Houston) had refused to allow or banned the use of e-scooters due to public safety concerns. Key cities with similar population, urban form, and/or climate have not yet piloted e-scooters such as New York City (Manhattan/New York County ban), Philadelphia, and Sydney, Australia.”

“While staff have considered a potential e-scooter pilot on ActiveTO major road closures, it would pose risks to vulnerable road users and leave the City open to considerable liability and risk due to lack of resources for oversight, education and enforcement at this time. A key purpose of ActiveTO is to provide a mixed use space for physical activity for people of all ages for walking, jogging and human-powered cycling. Piloting a new vehicle type that is throttle-powered and can potentially exceed speeds of 24km/hr poses risks to vulnerable road users in such conditions. It could also lead to confusion about which infrastructure or facilities under ActiveTO are permissible, and this would pose public safety risks that the City does not have resources to manage at this time.”

“If Council were to permit e-scooters to be operated on City streets – without the commensurate resources to provide oversight, education, outreach and enforcement, there would be considerable risks to public safety for e-scooter riders and other vulnerable road users; additional burden on hospitals and paramedics; impacts on accessibility, community nuisance and complaints; impacts on current initiatives to enhance the public realm for COVID-19 recovery efforts, such as CurbTO and CaféTO; and liability and costs to the City. For the reasons above, staff recommend that personal use of e-scooters not be considered until 2021.”

10. E-Scooters Not Shown to Significantly Reduce Road Traffic or Pollution

The corporate lobbyists for e-scooter rental companies claim that if e-scooters are allowed, this will reduce road traffic. The Staff Report shows that e-scooters do not bring the major benefits that the corporate lobbyists claim. The Staff Report states:

“While some mode shift from driving to using an e-scooter has occurred in other cities, the majority of e-scooter trips would have been by walking or public transit (around 60% for Calgary and Portland; and 86% in Greater Paris). For example, 55 per cent would have walked instead of using an e-scooter (Calgary). From a Paris area survey, 44 per cent would have walked, 30 percent would have used public transit, and 12 per cent would have used a bicycle/shared bike; while this study noted that e-scooters had no impact on car equipment reduction, an extrapolation would assume that 14 per cent would have used a car/ride hail/taxi, which still represents a minor shift away from motorized vehicular use.”

“Transportation accounts for about 38% of greenhouse gas (GHG) emissions in Toronto (2017). E-scooters are promoted as a near-zero local GHG transportation option as the electricity grid in Ontario is very low-carbon. A 2019 study based on life-cycle analysis suggests that average greenhouse gas (GHG) emissions per e-scooter mile travelled were half the amount associated with a car, but 20 times than that of a personal bicycle. Suggesting that reliance on e-scooters alone to shift people out of cars and to reduce GHGs and environmental impacts may not be entirely effective. Environmental impacts of e-scooters include disused e-scooters arising from the device’s short lifespan, toxic materials from battery waste, and emissions from the manufacturing, shipping, and maintenance of sharing fleets. In May 2020, Jump reportedly scrapped thousands (possibly 20,000) still functional e-bikes, and in June 2020, an estimated 8,000 to 10,000 Circ e-scooters were scrapped in the Middle East.”

The main reason for allowing e-scooters (beyond the profits of e-scooter rental companies) would be that they are fun to ride. The AODA Alliance proposes that this is hardly a reason to incur the dangers to safety, to accessibility for people with disabilities and the greater financial burdens on the taxpayer. The Staff Report states:

“The key appeal and popularity of e-scooters is that they are fun and convenient, particularly to people under the age of 35. They are often used for recreation and touring, but can also be used as a method of commuting or for taking short utilitarian trips. They reduce effort and sweat from exertion compared to human-powered kick-scooters and bicycles. They also enable people to go farther distances than on foot. A large part of the convenience is that there is no need to search for parking as there is with a car; adding to that e-scooters are easy to access, if folded and carried with the user, or if available through a dockless sharing system where the devices are widely available on the street.”

11. Steps that Must Be Taken If the City of Toronto Nevertheless Allows E-Scooters Despite Their Dangers

If e-scooters are to be allowed, over the many objections and despite all the evidence showing their dangers and lack of proven benefits, these requirements should be mandatory:

  1. a) Riding an e-scooter on any sidewalk should be strictly prohibited with a very substantial law enforcement presence and with very steep penalties, including a lifetime ban on using e-scooters. A mere fine is insufficient for such dangerous conduct.
  1. b) The rental of e-scooters should be prohibited with steep penalties for renting an e-scooter.
  1. c) There should be a strict ban on leaving an e-scooter in a public sidewalk or like public location, except in a municipally-approved rack that is located far out of the path of pedestrian travel. If an e-scooter is left on a sidewalk or other public place that is not such a rack, it should be subject to immediate confiscation and forfeiture, as well as a strict penalty.
  1. d) If e-scooter rentals are allowed, e-scooter rental companies should be liable for loss or injuries caused by any renter of the company’s e-scooter, with no waiver of this liability being permitted.
  1. e) There should be a ban on parking an e-scooter within 250 meters of a public establishment serving alcohol.
  1. f) If e-scooters are permitted, they should be required to make an ongoing clearly audible beeping sound when powered on, to warn others of their approach.
  1. g) The speed limit for e-scooters should be set much lower than 24 KPH, such as 15 KPH.
  1. h) An e-scooter driver should be required to successfully complete training on its safe operation and on the rules of the road, and to get a license. This should not be simply done through a smartphone, where a person can simply click that they read the training materials, even if they did not.
  1. i) Each e-scooter should be required to have a vehicle license whose number is visibly displayed.
  1. j) An e-scooter’s owner and driver should be required to carry sufficient liability insurance for injuries or damages that the e-scooter causes to others.
  1. k) E-scooter drivers of any age should be required to wear a helmet, and not just those under 18.
  1. l) A very small number of e-scooters should be permitted in any pilot, such as 250.
  1. m) If e-scooter rentals are to be permitted, a rider must be required to register their own name for each ride, and not merely rely on an app which could be signed up under a friend’s name. It should be made easy to identify a rented e-scooter–rider. The identity of the renter should be mandatorily disclosed on request to any person alleging that they were injured by the e-scooter.
  1. n) If e-scooter rentals are to be allowed via a “BikeShare” regime, the law should require that the e-scooter parking stations be located in a place that cannot block accessibility for people with disabilities. (Note: the draft bylaw included in the Staff Report imposes no such requirement)
  1. o) If the City is to take any further steps, it should convene an actual (not virtual) town hall meeting on e-scooters once the COVID-19 pandemic has subsided, to bring together both people with disabilities and the e-scooter rental companies for a joint public meeting to discuss all issues, at which the City’s leadership should be present.

Appendix – January 22, 2020 Open Letter from Major Disability Organizations

Open Letter

January 22, 2020

To: Hon. Premier Doug Ford

Via Email: premier@ontario.ca Doug.ford@Pc.ola.org

Room 281, Legislative Building

Queen’s Park

Toronto, Ontario

M7A 1A1

And to: All Members of the Ontario Legislature

And to: The Mayors and Councils of All Municipalities in Ontario

Copy to: The Hon. Raymond Cho, Minister for Accessibility and Seniors

Via email: Raymond.cho@ontario.ca

College Park 5th Floor

777 Bay St

Toronto, ON M7A 1S5

And copied to:

The Hon. Caroline Mulroney, Minister of Transportation

Via email: caroline.mulroney@pc.ola.org

5th Floor

777 Bay St.

Toronto, ON M7A 1Z8

I. Introduction

The undersigned community organizations and groups ask the Ontario Government and Ontario municipalities to take the actions listed below to protect the public, and especially Ontarians with disabilities, from the danger to public safety and the accessibility of their communities that is created by the Ontario Government’s new regulation on electric scooters (e-scooters). This regulation lets municipalities choose to permit people to use e-scooters in public.

On November 27, 2019, the Ontario Government announced a new regulation. It lets Ontario municipalities allow the use of e-scooters for a pilot of up to five years. An e-scooter is a motor vehicle that a person rides standing up. It can be very quickly throttled up to fast speeds of at least 24 KPH. It is silent even when ridden at fast speeds.

This Ontario regulation lets e-scooters be ridden on roads as well as sidewalks. It does not require a rider to have a driver’s license, or to have training in the e-scooter’s safe use or in the rules of the road. It does not require the e-scooter’s driver or owner to have insurance.

The e-scooter model does not have to be certified as safe by the Canada Safety Association or other recognized certifying body. The e-scooter need not have a vehicle license, or display a license number, that could help identify the vehicle in the case of an injury.

The Ontario Government said that this pilot is to study use of e-scooters. However, the regulation has not required a municipality that permits e-scooters to study their impact, or to report any study to the public. There has been no showing why five years is needed.

II. E-Scooters Endanger Public Safety, Especially for People with Disabilities

Unlicensed, untrained, uninsured people racing on silent e-scooters in public places, including sidewalks, endanger the public, and especially people with disabilities. Ontarians with disabilities and others will be exposed to the danger of serious personal injuries or worse. Pedestrians cannot hear silent e-scooters racing towards them. This is especially dangerous for people who are blind or have low vision or balance issues, or whose disability makes them slower to move out of the way.

In jurisdictions where they are allowed, e-scooters present these dangers. Ontario does not need a pilot to prove this. In an August 30, 2019 CityTV report, the Ontario Government stated that it had compromised between protecting public safety on the one hand, and advancing business opportunities and consumer choice on the other, when it first designed its proposal for a five-year e-scooter pilot.

III. E-Scooters Will Create New Accessibility Barriers for People with Disabilities

The new Ontario e-scooter regulation will also lead to the creation of serious new accessibility barriers against accessibility for Ontarians with disabilities. In jurisdictions where e-scooters are allowed, e-scooters are frequently left lying in public, strewed around sidewalks and other public places.

Leaving e-scooters on sidewalks is central to the plans of at least some businesses who want to rent e-scooters in Ontario, according to a September 10, 2019 Toronto Star article. The companies that rent e-scooters to the public provide a mobile app. Using that app, anyone can pick up an e-scooter, rent it, ride it to their destination, and then leave it in a random place on the sidewalk or other public place for another person to later pick it up and rent it.

For people who are blind, deafblind or have low vision, e-scooters can be a serious and unexpected tripping hazard. There is no way to plan a walking route to avoid them. They should not have to face the new prospect of e-scooters potentially lying in their path at any time.

Leaving e-scooters randomly on sidewalks also creates a serious, unpredictable new accessibility barrier for people using a wheelchair, walker or other mobility device. An e-scooter can block them from continuing along an otherwise-accessible sidewalk. People with disabilities using a mobility device may not be able to go up on the grass or down onto the road, to get around an e-scooter blocking the sidewalk. Sidewalks or other public spaces should not be made available to private e-scooter rental companies as free publicly-funded parking spaces.

Under the Charter of Rights, the Ontario Human Rights Code and the Accessibility for Ontarians with Disabilities Act, the Ontario Government and municipalities are required to prevent the creation of new accessibility barriers against Ontarians with disabilities. As the 2019 final report of the most recent Independent Review of the AODA’s implementation, by former Lieutenant Governor David Onley revealed, Ontario is behind schedule for becoming accessible by 2025. The Onley report found that Ontario remains a province full of “soul-crushing barriers”. The introduction of e-scooters will create new barriers and make this worse.

IV. Measures In Place Don’t Effectively Remove These Serious Dangers to Public Safety and Disability Accessibility

The Ontario Government’s November 27, 2019 announcement of its new e-scooter regulation did not refer to any disability concerns. The Government announced some restrictions on use of e-scooters. However, those measures do not effectively address the serious concerns raised here.

The Government lists some optional recommended “best practices” for municipalities. Those don’t remove the dangers to public safety or accessibility for people with disabilities. In any event, no municipality is required to implement them.

The regulation permits the use of e-scooters on sidewalks if a municipality wishes. It has restrictions on the speed for riding an e-scooter on sidewalks, and on the rider leaving an e-scooter on the ground, blocking pedestrian travel. However, these are extremely difficult, if not impossible, to enforce. Municipalities don’t have enforcement officers on every sidewalk to catch offenders. When a pedestrian, including a person with a disability, is blocked by an e-scooter abandoned on the sidewalk, there is no way to identify the rider who left it there. A pedestrian who is the victim of a hit and run, will find it extremely difficult if not impossible to identify who hit them. E-scooter rental companies are not made responsible for their e-scooters endangering public safety or accessibility.

E-scooters will increase costs for the taxpayer, including hospital and ambulance costs and law enforcement costs. The Ontario Government has not announced any new funding for municipalities for these costs.

The new Ontario regulation leaves it to each municipality to decide whether to allow e-scooters, and if so, on what terms. This requires Ontarians with disabilities to advocate to hundreds of municipalities, one at a time, to protect their safety and accessibility in public places. Ontarians with disabilities don’t have the resources and capacity for this.

It would not be sufficient for e-scooter rental companies to launch a campaign to urge renters not to leave e-scooters on sidewalks, or for e-scooter rental companies to make it a condition on their mobile app that the user will not leave a rented e-scooter on a sidewalk. People routinely agree to mobile app conditions without reading them. This does not excuse e-scooter rental companies from e-scooters’ known dangers.

V. Actions We Ask the Ontario Government and Ontario Municipalities To Take

(i) Actions We Ask The Ontario Government To Take
  1. E-scooters should not be allowed in public places in Ontario. There should be no pilot project in Ontario because it would endanger public safety and disability accessibility. If the Ontario Government wants to study e-scooters, it should study their impact on public safety and disability accessibility in other jurisdictions that have allowed them.
  1. If, despite these concerns, the Ontario Government wants to hold a trial period with e-scooters, it should suspend its new Ontario e-scooters regulation until it has implemented measures to ensure that they do not endanger the public’s safety or accessibility for people with disabilities.
  1. If Ontario holds an e-scooter pilot, it should be for much less than five years, e.g. six months. The Ontario Government should retain a trusted independent organization with expertise in public safety and disability accessibility to study e-scooters’ impact. It should make public the study’s findings.
  1. If despite these dangers, Ontario allows the use of e-scooters in public in Ontario, the Ontario Government should first enact and effectively enforce the following strong province-wide mandatory legal requirements for their use. Ontarians with disabilities should not have to advocate to each of the hundreds of Ontario municipalities to set these requirements:
  1. a) Riding an e-scooter on any sidewalk should be strictly prohibited with strong penalties.
  1. b) The rental of e-scooters should be prohibited, because the rental business model is based on e-scooters being left strewn about in public places like sidewalks.
  1. c) There should be a strict ban on leaving an e-scooter in a public sidewalk or like public location, except in a municipally-approved rack that is located well out of the path of pedestrian travel. If an e-scooter is left on a sidewalk or other public place that is not such a rack, it should be subject to immediate confiscation and forfeiture, as well as a strict penalty.
  1. d) If e-scooter rentals are allowed, rental companies should be required to obtain a license. They should be liable for loss or injuries caused by any renter of the company’s e-scooter.
  1. e) There should be a ban on parking an e-scooter within 250 meters of a public establishment serving alcohol.
  1. f) If e-scooters are permitted, they should be required to make an ongoing clearly audible beeping sound when powered on, to warn others of their approach.
  1. g) The speed limit for e-scooters should be set much lower than 24 KPH, such as 15 KPH.
  1. h) An e-scooter driver should be required to successfully complete training on its safe operation and on the rules of the road, and to get a license.
  1. i) Each e-scooter should be required to have a vehicle license whose number is visibly displayed.
  1. j) An e-scooter’s owner and driver should be required to carry sufficient liability insurance for injuries or damages that the e-scooter causes to others.
  1. k) E-scooter drivers of any age should be required to wear a helmet, and not just those under 18.
  1. If the Ontario Government does not impose all the safety and accessibility requirements in Recommendation 4 above, then it should pass legislation that empowers each municipality to impose all the preceding requirements.
(ii) Actions We Ask Each Municipality in Ontario To Take
  1. To protect the safety of the public, including people with disabilities, and to avoid creating new barriers to accessibility impeding people with disabilities, no municipality should allow e-scooters in their community.
  1. If a municipality nevertheless decides to allow e-scooters, it should impose all the requirements in Recommendation 4 above. It should not allow e-scooters for more than six months as a pilot project, while undertaking the study on their impact on public safety and accessibility for people with disabilities.

In proposing these seven measures, we emphasize that nothing should be done to reduce or restrict the availability or use of powered mobility devices used by people with disabilities, which travel at much slower speeds and which are a vital form of accessibility technology.

Signed,

  1. Accessibility for Ontarians with Disabilities Act Alliance
  2. March of Dimes of Canada
  3. Canadian National Institute for the Blind
  4. ARCH Disability Law Centre
  5. Spinal Cord Injury Ontario
  6. Ontario Autism Coalition
  7. Older Women’s Network
  8. Alliance for Equality of Blind Canadians
  9. Guide Dog Users of Canada
  10. Views for the Visually Impaired
  11. Citizens With Disabilities – Ontario

With the COVID-19 Crisis Creating a Nightmare for Us All, Why Does the City of Toronto’s Infrastructure Committee Think It’s More Important to Meet to Discuss Allowing Electric Scooters in Toronto?

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

With the COVID-19 Crisis Creating a Nightmare for Us All, Why Does the City of Toronto’s Infrastructure Committee Think It’s More Important to Meet to Discuss Allowing Electric Scooters in Toronto?

July 3, 2020

          SUMMARY

The COVID-19 crisis now is into its fourth month with no end in sight. We need our politicians and public servants working 100% on alleviating the horrible burdens that COVID-19 has inflicted on us all. Yet the politicians on the City of Toronto’s Infrastructure Committee think it is more important to now debate allowing electric scooters (e-scooters) on Toronto street. This is so even though e-scooters are known to present a real danger to safety and accessibility for people with disabilities and others.

On July 2, 2020, the City of Toronto announced at its meeting on Thursday, July 9, 2020 meeting that the City of Toronto Infrastructure Committee will consider a proposal to eventually allow e-scooters in Toronto. The AODA Alliance quickly wrote the City of Toronto’s Infrastructure Committee to request an opportunity to address the Committee at its July 9, 2020 meeting. We set out that request, below.

We have not yet received an acknowledgement of our request to present, or an acceptance of our request. The AODA Alliance has played a major role raising serious safety and accessibility concerns for people with disabilities and others.

On July 2, 2020, the City of Toronto made public a detailed June 24, 2020 staff report on e-scooters submitted to the Infrastructure Committee by the City’s General Manager, Transportation Services. Below we set out key excerpts from that report from a disability perspective. We then set out the entire report, which is about 49 pages long.

We will have more to say about the staff report in the coming days. However, here’s the AODA Alliance‘s initial take on the report:

  1. The City of Toronto Staff Report shows that to introduce e-scooters to Toronto will create real dangers to safety and accessibility for people with disabilities. The Staff Report says that it is an aim to reduce those dangers. However nothing in the report’s plan of action would substantially reduce those dangers, much less eliminate them.
  1. The Staff Report demonstrates that to introduce e-scooters to new costs and financial burdens will be imposed on the City of Toronto. The AODA takes the position that these burdens should not be inflicted on the public, especially after our society has had to suffer the crushing financial impact of the COVID-19 crisis, an impact that is continuing with no end in sight. If more public money were now to be spent, it should not be on the costs that the City of Toronto would have to shoulder due to the introduction of e-scooters.
  1. The Staff Report shows that the supposed social benefits of e-scooters (reducing car traffic on the streets and better for the environment) are actually not proven by experience with e-scooters.
  1. Despite all the demonstrated harms and burdens that e-scooters will inflict, and their dubious benefits, the Staff Report proposes that the City work towards conducting a pilot with e-scooters, deferring a decision to early in 2021. The Staff Report does not justify its conclusion, which is amply and overwhelmingly contradicted by the report’s thorough analysis and findings.
  1. The Staff Report’s recommendations are directly contrary to the strong, unanimous recommendation to the City of Toronto by the statutorily-mandated Toronto Accessibility Advisory Committee. As the Staff Report notes, that Committee recommended that e-scooters not be allowed in Toronto. The Staff Report’s recommendations are also contrary to the strong recommendations of 11 disability organizations in the January 22, 2020 open letter sent by the AODA Alliance to the mayors and councils of all Ontario municipalities.
  1. Those who stand to profit from this proposal are the e-scooter rental companies that would open up this new rental market, without bearing the costs that our community would suffer. There is no doubt that their corporate lobbyists have been hard at work behind closed doors, trying to influence the members of Toronto City Council.
  1. The AODA Alliance calls on the City of Toronto and its Infrastructure Committee to quickly reject this proposal. We call on the City of Toronto and its Infrastructure Committee to focus 100% of their time and effort to the horrific crisis that is now engulfing us at all, namely the COVID-19 crisis.
  1. If the City of Toronto Infrastructure Committee is looking for a new priority agenda item to address, it should work comprehensively on making Toronto’s infrastructure fully accessible to people with disabilities. The Accessibility for Ontarians with Disabilities Act requires Toronto, including its infrastructure, to become accessible to people with disabilities by 2025, under 4.5 years from now. Toronto is not on schedule to reach that goal.
  1. It is especially unfair for the City of Toronto and its Infrastructure Committee to be bringing this issue forward now, in the middle of the COVID-19 crisis. City Council and Committee meetings are not open to the public to physically attend. Members of the public are struggling to cope with the multiple pressures that they face, that have been accumulating over the past 16 weeks. At the start of July, many are trying to just get something of a holiday, if possible. For its part, the AODA Alliance is overloaded with issues on which to advocate for people with disabilities during the COVID-19 crisis. For the City of Toronto to force us to also have to divert our volunteer advocacy efforts to this e-scooter issue now is just one more hardship that should not have had to be shouldered.

To learn more about the AODA Alliance’s advocacy efforts to protect people with disabilities and others from the dangers that e-scooters pose, visit our e-scooters web page.

We welcome your feedback. Write us at aodafeedback@gmail.com

          MORE DETAILS

 July 2, 2020 Email from AODA Alliance Chair David Lepofsky to the Clerk of the City of Toronto Infrastructure Committee

To: Clerk, City of Toronto Infrastructure Committee

Via email: iec@toronto.ca

CC: Mayor John Tory

Via email: mayor_tory@toronto.ca

From: David Lepofsky, chair, Accessibility for Ontarians with Disabilities Act Alliance

Date: July 2, 2020

Re: July 9, 2020 Meeting of the City of Toronto Infrastructure Committee

I write to request a chance to present a deputation to the July 9, 2020 meeting of the Infrastructure Committee on the issue of electric scooters. The AODA Alliance, of which I am Chair, has played a leading role in raising serious disability safety and accessibility concerns with e-scooters.

I ask that we be permitted to present for more than the typical 5 minutes. Even a 10-minute time slot would be preferable to 5 minutes. We have very serous concerns to present, backed by extensive work on this issue. We have also played a leading role in advocating for the needs of people with disabilities during COVID-19, which will bear on the e-scooter issue. Five minutes will not allow us to effectively identify our key safety and accessibility concerns.

We are certain that many if not most of the counsellors will have had ample opportunities to individually hear from the corporate lobbyists for the e-scooter rental companies, before the July 9, 2020 meeting. It is important for the voices of people with disabilities to be given a fair chance to be heard. This is especially important since due to COVID-19, we are not able to attend the Committee meeting in person and in public.

We would be happy to do whatever we can to assist the Committee in its deliberations and to use our time efficiently.

Our advocacy work on the e-scooters issue is available at https://www.aodaalliance.org/e-scooters/

Our advocacy efforts on COVID-19 issues for people with disabilities are documented at www.aodaalliance.org/covid

We also ask that a fully accessible platform be used for the Committee meeting. Your office can contact me if we can assist with that issue.

Please confirm that you received this letter.

Sincerely,

David Lepofsky CM, O. Ont

Chair Accessibility for Ontarians with Disabilities Act Alliance

 Key Excerpts from the June 24, 2020 City of Toronto Staff Report on E-Scooters

* “…this report recommends an approach that reduces the likelihood of e-scooter risks to riders, impacts on people with accessibility needs, community nuisance, and liability to the City, as well as enhancing the public benefits.”

* “City staff recommend that the Toronto Parking Authority (TPA) be authorized to serve as the provider of shared micromobility services to allow for the implementation of more safeguards and better coordination with other municipal services, especially Bike Share. This approach would result in a competitive procurement process for shared e-scooters that complements Bike Share Toronto. The use and parking of e-scooters would continue to be prohibited in Toronto until such time that the TPA service has been contracted and City resources for enforcement are in place.

This report also recommends the need for improved industry standards at the provincial and federal levels for greater consumer protection in the purchase and/or use of e-scooters. While staff are aware that e-scooters are being considered as an open-air transportation option, the absence of improved standards and available insurance for e-scooter riders, coupled with lack of enforcement resources, would risk the safety of riders and the public on the City’s streets and sidewalks, especially for people with disabilities.

Next steps are to commence development of an RFP by the TPA, with support by Transportation Services, and for City staff to report back in the first quarter of 2021 with an update on progress on opting into the pilot and proposed pilot by-law changes applicable to e-scooters (personal and shared) for an e-scooter pilot recommended for May 2021.”

* “RECOMMENDATIONS

The General Manager, Transportation Services recommends that:

  1. City Council request that the General Manager, Transportation Services, report back in the first quarter of 2021 with progress on opting into the pilot and the recommendations below, including, but not limited to, injury, fatality and collision investigations and data collection and tracking, further standards development for e-scooter device design, as well as consultations on proposed by-law changes with the accessibility community and other external and internal stakeholders (e.g., Toronto Police Services, Toronto Parking Authority, and Toronto Public Health), prior to, or in conjunction with, proposed by-law changes required to opt in to the Provincial e-scooter pilot for May 2021, subject to budget approvals and COVID-19 status.
  1. City Council amend Municipal Code Chapter 179 – Parking Authority by adding the term, “micromobility”, in section 179-7.1 to expand the Toronto Parking Authority’s authority over the bike share system to add micromobility share system as shown in the amended section in Attachment 1.
  1. City Council request that the Ontario Ministry of Transportation amend the Motor Vehicle Collision Report to add electric kick-scooters as a vehicle type and to treat e-scooters as a motor vehicle for reporting purposes.
  1. City Council request that the Ontario Ministry of Transportation and the Ontario Ministry of the Attorney General establish set fines for violations of O. Reg. 389/19, Pilot Project – Electric Kick-Scooters, and communicate these set fines to Toronto Police Services through an All Chiefs Bulletin.
  1. City Council request that the General Manager, Transportation Services, consult with internal and external stakeholders regarding the lack of available medical coverage for e-scooter users and non-users when injured, and explore options with other government and industry stakeholders on creating a solution for automatic no-fault benefits for medical and rehabilitation expenses not provided through the Ontario Health Insurance Plan (OHIP) for those injured in incidents involving e-scooters and other micromobility devices.
  1. City Council request that the Ontario Ministry of Transportation strengthen its standards and specifications for e-scooters in O. Reg. 389/19, Pilot Project – Electric Kick-Scooters based on the latest best practice research.
  1. City Council request that the General Manager of Transportation, in consultation with health agencies and/or academic partners, to explore options and methods for studying the health impacts of e-scooter use, including, but not limited to, tracking the number and types of injuries and fatalities related to e-scooters.
  1. City Council request that the General Manager, Transportation Services, report back through the 2021 budget process, and in consultation with the Toronto Parking Authority, Toronto Police Services, the Chief Financial Officer and Treasurer, and other Divisions as necessary, on the financial and additional staff resources required to manage the implementation, operation, and enforcement of e-scooters in Toronto.
  1. City Council authorize the City Solicitor to introduce the necessary bills to give effect to City Council’s decision and City Council authorize the City Solicitor to make any necessary clarifications, refinements, minor modifications, technical amendments, or by-law amendments as may be identified by the City Solicitor in order to give effect to the recommendations in this report dated June 24, 2020, titled “E-Scooters – A Vision Zero Road Safety Approach”, in consultation with the General Manager, Transportation Services and the President, Toronto Parking Authority.”

* “While e-scooters have potential to serve areas with less access to mobility, the experience of other cities has shown that this has not always been realized. The privately operated e-scooter business model is centred around serving areas with higher pedestrian density and more disposable income.

E-scooters pose a risk to people with disabilities due to their faster speeds and lack of noise. Cities that have allowed e-scooters have observed a high incidence of sidewalk riding by riders, whether permitted or not on sidewalks. Parked e-scooters, especially when part of a dockless sharing system, can pose trip hazards and obstacles. Seniors, people with disabilities, and those with socio-economic challenges could face negative outcomes if injured in a collision or fall. Solutions to enforcement and compliance are still in their infancy.”

* “On February 3, 2020, the Toronto Accessibility Advisory Committee recommended City Council prohibit e-scooters for use in public spaces including sidewalks and roads, and directed that any City permission granted to e-scooter companies be guided by public safety, in robust consultation with people living with disabilities, and related organizations serving this population.”

* “The key appeal and popularity of e-scooters is that they are fun and convenient, particularly to people under the age of 35. They are often used for recreation and touring, but can also be used as a method of commuting or for taking short utilitarian trips. They reduce effort and sweat from exertion compared to human-powered kick-scooters and bicycles. They also enable people to go farther distances than on foot. A large part of the convenience is that there is no need to search for parking as there is with a car; adding to that e-scooters are easy to access, if folded and carried with the user, or if available through a dockless sharing system where the devices are widely available on the street.”

* “Vision Zero Road Safety – Risks with E-scooters

The City has a Vision Zero commitment to eliminate serious injuries and fatalities resulting from roadway crashes, particularly around six emphasis areas including pedestrians, school children, and older adults. Replacing car trips with e-scooter trips presents an opportunity to address some road safety issues if e-scooters produce a net safety benefit, especially for these groups. A 2020 International Transport Forum study notes that the risk of hospital admission may be higher for e-scooter riders than for cyclists, but that there are too few studies to draw firm conclusions. While not comprehensive, the emerging evidence of the health impacts associated with e-scooter use warrants a cautious approach to mitigate risks to e-scooter riders, pedestrians, and the City. Some of the findings are below.

New e-scooters users are most likely to be injured with 63 per cent of injuries occurring within the first nine times using an e-scooter. (CDC and City of Austin).

A comparison of serious injury rates between Calgary’s 2019 shared e-scooter pilot and Bike Share Toronto suggests riding a shared e-scooter is potentially about 350 times more likely to result in a serious injury than riding a shared bike on a per km basis, and about 100 times more likely on a per trip basis. This includes a limited sample size, differing definitions for serious injuries, different city contexts (e.g., Calgary allowed e-scooter riding on sidewalks, whereas bicycle riding is not allowed on sidewalks in Toronto) and serious injuries may decline over time as people gain experience riding e-scooters. (Montréal reported few e-scooter injuries for its 2019 pilot, however, it is unclear whether and how data for serious injuries was gathered.) Calculations are based on: 33 ER visits requiring ambulance transport over three months (Jul to Sep 2019) in Calgary for e-scooter-related injuries with a reported 750,000 trips, and average trip length of 0.9km; and 2,439,000 trips for Bike Share Toronto, with 3km average trip length, over 12 months in 2019, and no serious injuries (e.g., broken bones, head trauma, hospitalization) but attributing one for comparison purposes. Further data collection and studies of injuries are needed on a per km basis, by type of trip (i.e., recreational versus commuting, facility type), and by injury type.

The fatality rate for shared e-scooter users is potentially nine to 18 times the rate of bike share-related deaths in the U.S., based on a news report in the Chicagoreader.

Head trauma was reported in nearly one third of all e-scooter-related injuries in the U.S. from 2014 to 2018 – more than twice the rate of head injuries to bicyclists. In a City of Austin study in 2018 over three months, 48 per cent of e-scooter riders who were hurt had head injuries (91 out of 190), with 15 per cent (28 riders) experiencing more serious traumatic brain injuries.

Falling off e-scooters was the cause of 80 per cent of injuries (183 riders); 20 per cent (45 riders) had collided with a vehicle or an object, according to a 2019 UCLA study of two hospital ERs in one year. Just over eight per cent of the injuries were to pedestrians injured as a result of e-scooters (11 hit by an e-scooter, 5 tripped over a parked e-scooter, and 5 were attempting to move an e-scooter not in use).

Hospital data will be key to track injuries and fatalities by type and severity, especially for incidents where no motor vehicle has been involved (e.g., losing control) or for a trip and fall involving improperly parked e-scooters. As an ICD-10 code (international standard injury reporting code) specific to e-scooters will not be implemented in Canada until at least spring 2021, a reliable method to track serious e-scooter related injuries and fatalities presenting at hospitals is currently not available.”

* “Although the HTA sets out some e-scooter standards, such as maximum speed and power wattage, due to the nature of urban and suburban conditions such as Toronto’s, City staff recommend that the Province strengthen the device standards for greater rider safety. Based on an extensive literature review, items recommended for further Provincial exploration include a maximum turning radius, a platform surface grip, wheel characteristics (e.g., minimum size, traction, tire width), braking and suspension.

In addition, the Province has not established set fine amounts for offences under the HTA e-scooter regulations. Without this in place, for the police to lay a charge in respect of a violation, a “Part III Summons” is required, which means the police must attend court for each charge laid regardless of severity, and a trial is required for a conviction and fine to be set. This may make it less likely that charges are laid. Fines outside of ones the City could set (e.g. e-scooter parking violations, illegal sidewalk riding) would create workload challenges for Police and courts.

In spite of the Pilot requirement to collect data, there is currently no vehicle type for e-scooters in the Ministry of Transportation’s (MTO) Motor Vehicle Collision Report (MVCR) template used by all police services to report collisions. Unless the Province specifies e-scooters are motor vehicles for the purposes of collision reporting, and has a field for this in its template, e-scooter collisions may not be reported reliably and meaningful collision data analysis will not be possible. In Fall 2019, City staff requested that the MTO add e-scooters as a separate vehicle type, but MTO has not yet communicated they would make this change.”

* “Accessibility for Ontarians with Disabilities Act (AODA)

Persons with disabilities and seniors have considerable concerns about sidewalk and crosswalk interactions with e-scooter users, as well as concerns regarding trip hazards and obstructions from poorly parked or excessive amounts of e-scooters. The Toronto Accessibility Advisory Committee, a body required under the AODA, recommends that City Council prohibit the use of e-scooters in public spaces, including sidewalks and roads. In other jurisdictions outside of Ontario, some legal action has been undertaken against municipalities by persons injured as a result of e-scooter sidewalk obstructions, as well as by persons with disabilities.“

* “There is a significant risk that the City may be held partially or fully liable for damages if e-scooter riders or other parties are injured. Transportation Services staff consulted with the City’s Insurance and Risk Management office (I&RM) to understand the magnitude of the City’s liability if allowing e-scooters. At this time, loss data is lacking on e-scooters due to generally lengthy settlement times for bodily injury claims. The City has significant liability exposure, however, due to joint and several liability, as the City may have to pay an entire judgement or claim even if only found to be 1 per cent at fault for an incident. The City has a $5M deductible per occurrence, which means the City will be responsible for all costs below that amount. In terms of costs, Transportation Services staff will also be required to investigate and serve in the discovery process for claims.

E-scooter sharing/rental companies typically require a rider to sign a waiver, placing the onus of compensating injured parties on the rider. Riders are left financially exposed due to a lack of insurance coverage and if unable to pay, municipalities will be looked to for compensation (e.g., in settlements and courts). Claims related to e-scooter malfunction have been reported by the media (such as in Atlanta, Auckland, New Zealand and Brisbane, Australia). In 2019, a Grand Jury faulted the City of San Diego for inadequate regulation and enforcement of e-scooter sharing companies. By opting in to the Pilot, the City will be exposed to claims associated with improperly parked e-scooters as evidenced by lawsuits filed by persons with disabilities and those injured by e-scooter obstructions (such as in Minneapolis and Santa Monica, California).

The insurance industry does not currently have insurance products available for e-scooter riders. In Fall 2019, City staff explored whether the Motor Vehicle Accident Claims Fund could be expanded or if a similar kind of fund in principle could be created to address claims where e-scooter riders or non-users are injured and their expenses are not covered by OHIP, nor by other insurance policies (e.g., homeowner’s or personal auto). Further research and consultation would be needed to look into these considerations.

It will be critical to ensure that insurance evidenced by e-scooter sharing companies will cover their operations for all jurisdictions operated in (e.g., all cities nationally or internationally). Further, there needs to be full indemnification for the municipality by e-scooter sharing companies, and not limitations in their indemnification contracts.

In addition to the experiences in other jurisdictions, several risk factors are unique to the City of Toronto and play a role in informing the recommended approach to e-scooters:

Streetcar tracks: Toronto has an extensive track network (177 linear kilometres) which poses a hazard to e-scooter riders due to the vehicle’s small wheel diameter.

Winter and State-Of-Good-Repair: Toronto experiences freezing and thawing that impacts the state-of-good-repair for roads. A large portion of roads are 40 to 50 years old, with 43 per cent of Major Roads and 24 per cent of Local Roads in poor condition. Coupled with lack of standards for e-scooter wheels (e.g., traction, size), this makes this particular device more sensitive to uneven road surfaces.

High construction activity: In addition to the city’s various infrastructure projects, Toronto has been one of the fastest growing cities with about 120 development construction sites in 2019.

Narrow sidewalks and high pedestrian mode shares in the Downtown Core and City Centres: Most jurisdictions experienced illegal sidewalk riding by e-scooter users, with some business districts saying e-scooters deterred patrons from visiting their previously pedestrian-friendly main streets. This is especially challenging with physical distancing requirements and other COVID-19 recovery programs expanding the use of the City’s sidewalks and boulevards.”

* “Residents gave the highest intensity of support for e-scooter riders having to wear helmets (mean score of 8.8 out of ten).”

* “Other key issues raised in the consultations include lack of enforcement and adequate infrastructure; and questions about environmental sustainability, public space and the potential for clutter and safety hazards particularly for people with disabilities.”

* “Other cities have suspended e-scooter sharing services until after COVID-19 (e.g., Windsor approved a shared e-scooter pilot in April 2020, but has now deferred its pilot until after COVID-19). Prior to the pandemic, a number of jurisdictions (e.g., Boulder, Honolulu, and Houston) had refused to allow or banned the use of e-scooters due to public safety concerns. Key cities with similar population, urban form, and/or climate have not yet piloted e-scooters such as New York City (Manhattan/New York County ban), Philadelphia, and Sydney, Australia.”

* “While staff have considered a potential e-scooter pilot on ActiveTO major road closures, it would pose risks to vulnerable road users and leave the City open to considerable liability and risk due to lack of resources for oversight, education and enforcement at this time. A key purpose of ActiveTO is to provide a mixed use space for physical activity for people of all ages for walking, jogging and human-powered cycling. Piloting a new vehicle type that is throttle-powered and can potentially exceed speeds of 24km/hr poses risks to vulnerable road users in such conditions. It could also lead to confusion about which infrastructure or facilities under ActiveTO are permissible, and this would pose public safety risks that the City does not have resources to manage at this time.”

* “Finally, the risk of injury for new users is high, and could put additional burden on local hospitals and paramedics at this time. For the reasons above, City staff do not recommend permitting e-scooters in ActiveTO facilities in 2020.”

* “If Council were to permit e-scooters to be operated on City streets – without the commensurate resources to provide oversight, education, outreach and enforcement, there would be considerable risks to public safety for e-scooter riders and other vulnerable road users; additional burden on hospitals and paramedics; impacts on accessibility, community nuisance and complaints; impacts on current initiatives to enhance the public realm for COVID-19 recovery efforts, such as CurbTO and CaféTO; and liability and costs to the City. For the reasons above, staff recommend that personal use of e-scooters not be considered until 2021.”

* “Recommended Approach

Staff recommend an approach that minimizes risk by seeking enhancements to the Provincial pilot project regulations and supports, as well as building from the improvements made to e-scooter programs in other cities. The conclusion is to propose a municipal service model under the TPA that is competitively procured, and that is coordinated with, and complements Bike Share Toronto. This will ensure shared micromobility continues as a public transportation option with oversight. This approach reduces impacts on sidewalk users and public space by managing shared micromobility parking. This approach requires an amendment to the authority granted to the TPA under Chapter 179, Parking Authority of the Municipal Code to add shared micromobility including e-scooters. (see Attachment 1)

Staff recommend continuing the current prohibitions of e-scooter use and parking as outlined in Chapter 950, Traffic and Parking, and Chapter 886, Footpaths, Pedestrian Ways, Bicycle Paths, Bicycle Lanes and Cycle Tracks, until the system for oversight is in place for public safety, and given the requests for amendments to Provincial regulations. While a number of e-scooter sharing companies are looking for permission from the City to allow e-scooters in 2020, staff do not recommend this as it would pre-empt the recommended approach for competitive procurement, require diversion of staff resources to manage opting in to the Provincial pilot, and lead to considerable risks and costs to the City. A pilot involving e-scooter use in ActiveTO facilities would not provide useful assessment of e-scooters as ActiveTO (e.g., major road closures) are not representative of typical real life conditions and interactions with other road users, and would present immediate liability exposure and costs to the City.”

* “Next steps are to commence development of an RFP by the TPA, with support by Transportation Services, and for City staff to report back in the first quarter of 2021 with an update on proposed pilot by-law changes applicable to e-scooters (personal and shared) and budget requirements for an e-scooter pilot recommended for May 2021.

The report back for 2021 can include any progress on consultations with the Province and other key stakeholders to:

Strengthen the e-scooter standards and specifications to foster greater safety for privately owned e-scooters and for e-scooter sharing;

Update the MVCR template and treat e-scooters as a motor vehicle for reporting purposes to enable effective, consistent data collection;

Establish set fines for offences made under the HTA Pilot Project regulations and communicate this to the Toronto Police; and

Research and explore issues and opportunities to create a fund for claims by e-scooter users and non-users who are injured as a result of e-scooter incidents and have medical/rehabilitation expenses not provided through OHIP or existing homeowner’s or auto insurance.”

 June 24, 2020 Report to Toronto City Council by General Manager Transportation Services for the City of Toronto

REPORT FOR ACTION

E-Scooters – A Vision Zero Road Safety Approach

Date: June 24, 2020

To: Infrastructure and Environment Committee

From: General Manager, Transportation Services

Wards: All

SUMMARY

E-scooters, or electric kick-scooters, are a new vehicle type suited for short urban trips. Since 2017, they have emerged in many cities across North America and Europe as they provide convenient, low-cost solutions for short trips and can provide connections to other modes of travel such as transit.

On January 1, 2020, new Provincial regulations came into effect that allow Ontario municipalities to opt in to a five-year e-scooter pilot project subject to conditions. This requires revising municipal by-laws to identify where e-scooters would be allowed to be used. Key pilot rules for e-scooter riders include a minimum operation age of 16, maximum travel speed of 24 km/hr, mandatory riding in bike lanes where available, and helmets required if the rider is under 18 years old.

This report is informed by a Vision Zero approach to road safety, particularly for vulnerable road users, while also considering the potential benefits of e-scooters such as convenience and alternatives to automobile use for short trips. Based on extensive research and consultations, this report recommends an approach that reduces the likelihood of e-scooter risks to riders, impacts on people with accessibility needs, community nuisance, and liability to the City, as well as enhancing the public benefits.

City staff recommend that the Toronto Parking Authority (TPA) be authorized to serve as the provider of shared micromobility services to allow for the implementation of more safeguards and better coordination with other municipal services, especially Bike Share. This approach would result in a competitive procurement process for shared e-scooters that complements Bike Share Toronto. The use and parking of e-scooters would continue to be prohibited in Toronto until such time that the TPA service has been contracted and City resources for enforcement are in place.

This report also recommends the need for improved industry standards at the provincial and federal levels for greater consumer protection in the purchase and/or use of e-scooters. While staff are aware that e-scooters are being considered as an open-air transportation option, the absence of improved standards and available insurance for e-scooter riders, coupled with lack of enforcement resources, would risk the safety of riders and the public on the City’s streets and sidewalks, especially for people with disabilities.

Next steps are to commence development of an RFP by the TPA, with support by Transportation Services, and for City staff to report back in the first quarter of 2021 with an update on progress on opting into the pilot and proposed pilot by-law changes applicable to e-scooters (personal and shared) for an e-scooter pilot recommended for May 2021.

RECOMMENDATIONS

The General Manager, Transportation Services recommends that:

  1. City Council request that the General Manager, Transportation Services, report back in the first quarter of 2021 with progress on opting into the pilot and the recommendations below, including, but not limited to, injury, fatality and collision investigations and data collection and tracking, further standards development for e-scooter device design, as well as consultations on proposed by-law changes with the accessibility community and other external and internal stakeholders (e.g., Toronto Police Services, Toronto Parking Authority, and Toronto Public Health), prior to, or in conjunction with, proposed by-law changes required to opt in to the Provincial e-scooter pilot for May 2021, subject to budget approvals and COVID-19 status.
  1. City Council amend Municipal Code Chapter 179 – Parking Authority by adding the term, “micromobility”, in section 179-7.1 to expand the Toronto Parking Authority’s authority over the bike share system to add micromobility share system as shown in the amended section in Attachment 1.
  1. City Council request that the Ontario Ministry of Transportation amend the Motor Vehicle Collision Report to add electric kick-scooters as a vehicle type and to treat e-scooters as a motor vehicle for reporting purposes.
  1. City Council request that the Ontario Ministry of Transportation and the Ontario Ministry of the Attorney General establish set fines for violations of O. Reg. 389/19, Pilot Project – Electric Kick-Scooters, and communicate these set fines to Toronto Police Services through an All Chiefs Bulletin.
  1. City Council request that the General Manager, Transportation Services, consult with internal and external stakeholders regarding the lack of available medical coverage for e-scooter users and non-users when injured, and explore options with other government and industry stakeholders on creating a solution for automatic no-fault benefits for medical and rehabilitation expenses not provided through the Ontario Health Insurance Plan (OHIP) for those injured in incidents involving e-scooters and other micromobility devices.
  1. City Council request that the Ontario Ministry of Transportation strengthen its standards and specifications for e-scooters in O. Reg. 389/19, Pilot Project – Electric Kick-Scooters based on the latest best practice research.
  1. City Council request that the General Manager of Transportation, in consultation with health agencies and/or academic partners, to explore options and methods for studying the health impacts of e-scooter use, including, but not limited to, tracking the number and types of injuries and fatalities related to e-scooters.
  1. City Council request that the General Manager, Transportation Services, report back through the 2021 budget process, and in consultation with the Toronto Parking Authority, Toronto Police Services, the Chief Financial Officer and Treasurer, and other Divisions as necessary, on the financial and additional staff resources required to manage the implementation, operation, and enforcement of e-scooters in Toronto.
  1. City Council authorize the City Solicitor to introduce the necessary bills to give effect to City Council’s decision and City Council authorize the City Solicitor to make any necessary clarifications, refinements, minor modifications, technical amendments, or by-law amendments as may be identified by the City Solicitor in order to give effect to the recommendations in this report dated June 24, 2020, titled “E-Scooters – A Vision Zero Road Safety Approach”, in consultation with the General Manager, Transportation Services and the President, Toronto Parking Authority.

FINANCIAL IMPACT

Funding and resources required in various programs for the following will be included as part of future budget submissions for consideration during the budget process to address the financial and additional staff resources required to: manage implementation, operational, and enforcement issues of e-scooters in Toronto; and the resolution of e-scooter issues, including, but not limited to, injury/fatality and collision investigations and data collection and tracking (e.g., in consultation with health agencies and/or academic partners, Toronto Police Services, and others), further standards development for e-scooter device design, and consultations on proposed by-law changes with accessibility and other stakeholders.

The Chief Financial Officer and Treasurer has reviewed this report and agrees with the financial impact information.

EQUITY STATEMENT

While e-scooters have potential to serve areas with less access to mobility, the experience of other cities has shown that this has not always been realized. The privately operated e-scooter business model is centred around serving areas with higher pedestrian density and more disposable income.

E-scooters pose a risk to people with disabilities due to their faster speeds and lack of noise. Cities that have allowed e-scooters have observed a high incidence of sidewalk riding by riders, whether permitted or not on sidewalks. Parked e-scooters, especially when part of a dockless sharing system, can pose trip hazards and obstacles. Seniors, people with disabilities, and those with socio-economic challenges could face negative outcomes if injured in a collision or fall. Solutions to enforcement and compliance are still in their infancy.

DECISION HISTORY

On February 3, 2020, the Toronto Accessibility Advisory Committee recommended City Council prohibit e-scooters for use in public spaces including sidewalks and roads, and directed that any City permission granted to e-scooter companies be guided by public safety, in robust consultation with people living with disabilities, and related organizations serving this population.

http://app.toronto.ca/tmmis/viewAgendaItemHistory.do?item=2020.DI7.3

On October 2-3, 2019 City Council, directed the General Manager, Transportation Services, to report on a program for the oversight and management of e-scooters on City roadways, including possibly adding e-scooters to the bike share fleet as a way of managing e-scooters in the public right-of-way, to ensure a safe and accessible transportation network for all users during the proposed five-year Provincial pilot project. City Council also prohibited e-scooter use on City sidewalks and pedestrian ways, and parking, storing or leaving an e-scooter on any street, sidewalk and pedestrian way.

http://app.toronto.ca/tmmis/viewAgendaItemHistory.do?item=2019.IE7.13

On April 25, 2019, the Infrastructure and Environment Committee requested a report back on a proposed regulatory framework, safe road design and intersection requirements for low-speed wheeled modes under 25 km, including but not limited to electric wheelchairs, scooters, cargo cycles, and e-assist cycles in Toronto.

http://app.toronto.ca/tmmis/viewAgendaItemHistory.do?item=2019.IE4.5

COMMENTS

Background

E-scooters are a two-wheeled battery-powered device, with a narrow board that the rider stands on and steers using a handle stick, and a throttle for acceleration (see Figure 1 which is a photo of this device and a hand holding a smart phone). They are a form of micromobility, a general concept for shorter distance travel using light-weight vehicles such as bicycles, e-bikes, and e-scooters. They may be privately owned or are often rented by the minute through mobile apps.

On January 1, 2020, Ontario Regulation 389/19 Pilot Project – Electric Kick-Scooters under the Highway Traffic Act (HTA) came into force, outlining broad conditions for a five-year e-scooter pilot period. Municipalities may opt in to the pilot by revising their by-laws on where e-scooters would be allowed to operate such as roads, bike lanes, and trails within its jurisdiction. A few of the City of Toronto’s requested standards for e-scooters were included in the Province’s regulations. Key parameters in the HTA for the vehicle and rules are:

  • Two wheels (one at the front of the kick-scooter and one at the rear);
  • No seat, no pedals, no enclosure, no basket;
  • No carrying goods/items/cargo, no towing;
  • Maximum 500 watts, and maximum 24 km/hr speed;
  • Must have lights and bell or horn;
  • Maximum wheel diameter of 17 inches;
  • Maximum weight of 45 kilograms;
  • No provincial vehicle permit or driver’s license required;
  • Minimum age of 16 to operate an e-scooter; helmets required for those under 18;
  • Must be used in bicycle lanes where they exist; and
  • Must be stopped for pedestrians at crosswalks and pedestrian crossovers.

In the absence of federal or provincial industry standards for e-scooter manufacturing and retailing, buyers are able to purchase e-scooters that do not meet provincial regulations.

Benefits of E-scooters

The key appeal and popularity of e-scooters is that they are fun and convenient, particularly to people under the age of 35. They are often used for recreation and touring, but can also be used as a method of commuting or for taking short utilitarian trips. They reduce effort and sweat from exertion compared to human-powered kick-scooters and bicycles. They also enable people to go farther distances than on foot. A large part of the convenience is that there is no need to search for parking as there is with a car; adding to that e-scooters are easy to access, if folded and carried with the user, or if available through a dockless sharing system where the devices are widely available on the street.

E-scooters also take up little space in the roadway and offer the potential to replace automobile trips with some reports of 30 per cent of riders choosing the e-scooter over taking a car/ridehail/taxi (Portland, Calgary), thereby helping to reduce traffic congestion. Some e-scooter rider surveys indicate e-scooters are used to address first mile/last mile issues to get to and from transit. For example, in the Paris area, about 23 per cent of trips were combined with another mode like public transit, and in Montreal, about 27 per cent of e-scooter trips originated or ended at a subway or train station. E-scooters are also attracting interest from individuals during the COVID-19 pandemic as they offer an individual, socially distanced, and open-air transportation option that is a potential alternative to public transit or car use.

Micromobility

Micromobility is a general concept for light weight, human- or electric-powered modes of travel such as walking, cycling, e-biking, and e-scootering used for shorter trips than by driving a car and for first and last mile to transit. Some cities (Montreal, Paris) and industry thinkers (Deloitte TMT Predictions 2020) anticipate that the future of e-micromobility will be realized with pedal assist e-bikes which can be used more comfortably for longer distances than e-scooters or human-powered bicycles, and allow for carrying cargo.

Recent reports by Metrolinx suggests that 40 per cent of trips (4.35 million trips in 2016) within the Greater Toronto and Hamilton Area (GTHA) can be considered bikeable (i.e. less than five kilometres in length). Distances in the Downtown and City Centres in Toronto have great potential for micromobility. From a City Planning 2016 survey of those who live and work in the Downtown, 57 per cent reported walking to work, over 30 per cent taking public transit to work, and 13 per cent cycling to work.

Recognizing the importance of micromobility options, especially as part of COVID-19 emergency response and recovery, the City of Toronto and its agencies are already advancing active transportation as follows:

Implementation of ActiveTO, CurbTO, and CaféTO to reallocate space for walking, cycling, and support of local businesses and their patrons;

Implementation of TransformTO and ResilientTO with a target by 2050 that 75 per cent of trips under 5km will be by walking or cycling, and 100 per cent of transportation will use zero carbon energy;

Accelerated expansion of 40km of active transportation infrastructure in the City Council-adopted Cycling Network Plan;

Expansion of Bike Share Toronto in 2020 to 20 of the 25 wards in the City, adding 1,850 new bicycles, 160 stations and 3,615 docking points to the network. The system will grow to a total of 6,850 bikes, 625 stations, and 12,000 docking points.

Completion of e-bike feasibility testing and the addition of 300 e-bikes to the Bike Share fleet for 2020;

Implementation of the Electric Vehicle Strategy’s action to pilot electric micro-mobility programs (e.g., e-bikes, etc.) that expand electric mobility alternatives to driving; and

Implementation of the Walking Strategy (2009-2019) resulting in a majority of Torontonians saying their neighbourhood is “very walkable” (64 per cent citywide and 75 per cent in Toronto and East York, The Strategic Counsel’s 2018 survey).

Vision Zero Road Safety – Risks with E-scooters

The City has a Vision Zero commitment to eliminate serious injuries and fatalities resulting from roadway crashes, particularly around six emphasis areas including pedestrians, school children, and older adults. Replacing car trips with e-scooter trips presents an opportunity to address some road safety issues if e-scooters produce a net safety benefit, especially for these groups. A 2020 International Transport Forum study notes that the risk of hospital admission may be higher for e-scooter riders than for cyclists, but that there are too few studies to draw firm conclusions. While not comprehensive, the emerging evidence of the health impacts associated with e-scooter use warrants a cautious approach to mitigate risks to e-scooter riders, pedestrians, and the City. Some of the findings are below.

New e-scooters users are most likely to be injured with 63 per cent of injuries occurring within the first nine times using an e-scooter. (CDC and City of Austin).

A comparison of serious injury rates between Calgary’s 2019 shared e-scooter pilot and Bike Share Toronto suggests riding a shared e-scooter is potentially about 350 times more likely to result in a serious injury than riding a shared bike on a per km basis, and about 100 times more likely on a per trip basis. This includes a limited sample size, differing definitions for serious injuries, different city contexts (e.g., Calgary allowed e-scooter riding on sidewalks, whereas bicycle riding is not allowed on sidewalks in Toronto) and serious injuries may decline over time as people gain experience riding e-scooters. (Montréal reported few e-scooter injuries for its 2019 pilot, however, it is unclear whether and how data for serious injuries was gathered.) Calculations are based on: 33 ER visits requiring ambulance transport over three months (Jul to Sep 2019) in Calgary for e-scooter-related injuries with a reported 750,000 trips, and average trip length of 0.9km; and 2,439,000 trips for Bike Share Toronto, with 3km average trip length, over 12 months in 2019, and no serious injuries (e.g., broken bones, head trauma, hospitalization) but attributing one for comparison purposes. Further data collection and studies of injuries are needed on a per km basis, by type of trip (i.e., recreational versus commuting, facility type), and by injury type.

The fatality rate for shared e-scooter users is potentially nine to 18 times the rate of bike share-related deaths in the U.S., based on a news report in the Chicagoreader.

Head trauma was reported in nearly one third of all e-scooter-related injuries in the U.S. from 2014 to 2018 – more than twice the rate of head injuries to bicyclists. In a City of Austin study in 2018 over three months, 48 per cent of e-scooter riders who were hurt had head injuries (91 out of 190), with 15 per cent (28 riders) experiencing more serious traumatic brain injuries.

Falling off e-scooters was the cause of 80 per cent of injuries (183 riders); 20 per cent (45 riders) had collided with a vehicle or an object, according to a 2019 UCLA study of two hospital ERs in one year. Just over eight per cent of the injuries were to pedestrians injured as a result of e-scooters (11 hit by an e-scooter, 5 tripped over a parked e-scooter, and 5 were attempting to move an e-scooter not in use).

Hospital data will be key to track injuries and fatalities by type and severity, especially for incidents where no motor vehicle has been involved (e.g., losing control) or for a trip and fall involving improperly parked e-scooters. As an ICD-10 code (international standard injury reporting code) specific to e-scooters will not be implemented in Canada until at least spring 2021, a reliable method to track serious e-scooter related injuries and fatalities presenting at hospitals is currently not available.

Enhancing Vision Zero Road Safety with the Provincial Pilot Project

Although the HTA sets out some e-scooter standards, such as maximum speed and power wattage, due to the nature of urban and suburban conditions such as Toronto’s, City staff recommend that the Province strengthen the device standards for greater rider safety. Based on an extensive literature review, items recommended for further Provincial exploration include a maximum turning radius, a platform surface grip, wheel characteristics (e.g., minimum size, traction, tire width), braking and suspension.

In addition, the Province has not established set fine amounts for offences under the HTA e-scooter regulations. Without this in place, for the police to lay a charge in respect of a violation, a “Part III Summons” is required, which means the police must attend court for each charge laid regardless of severity, and a trial is required for a conviction and fine to be set. This may make it less likely that charges are laid. Fines outside of ones the City could set (e.g. e-scooter parking violations, illegal sidewalk riding) would create workload challenges for Police and courts.

In spite of the Pilot requirement to collect data, there is currently no vehicle type for e-scooters in the Ministry of Transportation’s (MTO) Motor Vehicle Collision Report (MVCR) template used by all police services to report collisions. Unless the Province specifies e-scooters are motor vehicles for the purposes of collision reporting, and has a field for this in its template, e-scooter collisions may not be reported reliably and meaningful collision data analysis will not be possible. In Fall 2019, City staff requested that the MTO add e-scooters as a separate vehicle type, but MTO has not yet communicated they would make this change.

Accessibility for Ontarians with Disabilities Act (AODA)

Persons with disabilities and seniors have considerable concerns about sidewalk and crosswalk interactions with e-scooter users, as well as concerns regarding trip hazards and obstructions from poorly parked or excessive amounts of e-scooters. The Toronto Accessibility Advisory Committee, a body required under the AODA, recommends that City Council prohibit the use of e-scooters in public spaces, including sidewalks and roads. In other jurisdictions outside of Ontario, some legal action has been undertaken against municipalities by persons injured as a result of e-scooter sidewalk obstructions, as well as by persons with disabilities.

Risk and Liability Issues

There is a significant risk that the City may be held partially or fully liable for damages if e-scooter riders or other parties are injured. Transportation Services staff consulted with the City’s Insurance and Risk Management office (I&RM) to understand the magnitude of the City’s liability if allowing e-scooters. At this time, loss data is lacking on e-scooters due to generally lengthy settlement times for bodily injury claims. The City has significant liability exposure, however, due to joint and several liability, as the City may have to pay an entire judgement or claim even if only found to be 1 per cent at fault for an incident. The City has a $5M deductible per occurrence, which means the City will be responsible for all costs below that amount. In terms of costs, Transportation Services staff will also be required to investigate and serve in the discovery process for claims.

E-scooter sharing/rental companies typically require a rider to sign a waiver, placing the onus of compensating injured parties on the rider. Riders are left financially exposed due to a lack of insurance coverage and if unable to pay, municipalities will be looked to for compensation (e.g., in settlements and courts). Claims related to e-scooter malfunction have been reported by the media (such as in Atlanta, Auckland, New Zealand and Brisbane, Australia). In 2019, a Grand Jury faulted the City of San Diego for inadequate regulation and enforcement of e-scooter sharing companies. By opting in to the Pilot, the City will be exposed to claims associated with improperly parked e-scooters as evidenced by lawsuits filed by persons with disabilities and those injured by e-scooter obstructions (such as in Minneapolis and Santa Monica, California).

The insurance industry does not currently have insurance products available for e-scooter riders. In Fall 2019, City staff explored whether the Motor Vehicle Accident Claims Fund could be expanded or if a similar kind of fund in principle could be created to address claims where e-scooter riders or non-users are injured and their expenses are not covered by OHIP, nor by other insurance policies (e.g., homeowner’s or personal auto). Further research and consultation would be needed to look into these considerations.

It will be critical to ensure that insurance evidenced by e-scooter sharing companies will cover their operations for all jurisdictions operated in (e.g., all cities nationally or internationally). Further, there needs to be full indemnification for the municipality by e-scooter sharing companies, and not limitations in their indemnification contracts.

In addition to the experiences in other jurisdictions, several risk factors are unique to the City of Toronto and play a role in informing the recommended approach to e-scooters:

Streetcar tracks: Toronto has an extensive track network (177 linear kilometres) which poses a hazard to e-scooter riders due to the vehicle’s small wheel diameter.

Winter and State-Of-Good-Repair: Toronto experiences freezing and thawing that impacts the state-of-good-repair for roads. A large portion of roads are 40 to 50 years old, with 43 per cent of Major Roads and 24 per cent of Local Roads in poor condition. Coupled with lack of standards for e-scooter wheels (e.g., traction, size), this makes this particular device more sensitive to uneven road surfaces.

High construction activity: In addition to the city’s various infrastructure projects, Toronto has been one of the fastest growing cities with about 120 development construction sites in 2019.

Narrow sidewalks and high pedestrian mode shares in the Downtown Core and City Centres: Most jurisdictions experienced illegal sidewalk riding by e-scooter users, with some business districts saying e-scooters deterred patrons from visiting their previously pedestrian-friendly main streets. This is especially challenging with physical distancing requirements and other COVID-19 recovery programs expanding the use of the City’s sidewalks and boulevards.

Environmental Impacts of E-scooters

While some mode shift from driving to using an e-scooter has occurred in other cities, the majority of e-scooter trips would have been by walking or public transit (around 60% for Calgary and Portland; and 86% in Greater Paris). For example, 55 per cent would have walked instead of using an e-scooter (Calgary). From a Paris area survey, 44 per cent would have walked, 30 per cent would have used public transit, and 12 per cent would have used a bicycle/shared bike; while this study noted that e-scooters had no impact on car equipment reduction, an extrapolation would assume that 14 per cent would have used a car/ridehail/taxi, which still represents a minor shift away from motorized vehicular use.

Transportation accounts for about 38% of greenhouse gas (GHG) emissions in Toronto (2017). E-scooters are promoted as a near-zero local GHG transportation option as the electricity grid in Ontario is very low-carbon. A 2019 study based on life-cycle analysis suggests that average greenhouse gas (GHG) emissions per e-scooter mile travelled were half the amount associated with a car, but 20 times than that of a personal bicycle. Suggesting that reliance on e-scooters alone to shift people out of cars and to reduce GHGs and environmental impacts may not be entirely effective. Environmental impacts of e-scooters include disused e-scooters arising from the device’s short lifespan, toxic materials from battery waste, and emissions from the manufacturing, shipping, and maintenance of sharing fleets. In May 2020, Jump reportedly scrapped thousands (possibly 20,000) still functional e-bikes, and in June 2020, an estimated 8,000 to 10,000 Circ e-scooters were scrapped in the Middle East.

Transportation Services staff consulted with Energy and Environment, and Solid Waste Management Services Divisions, who are involved in researching and monitoring issues related to e-waste in the Electric Vehicle Strategy, such as potential battery recycling and second life applications for batteries; impacts to the waste stream where end-of-life batteries from these devices may require special disposal as hazardous waste; and also management of discarded or abandoned e-scooters as litter.

Public and Stakeholder Feedback

Various consultation was undertaken in late 2019 to early 2020 (pre-pandemic), including direct staff contact, written submissions, in-person meetings, industry meetings, an online panel survey of 1,010 residents, and focus groups. City staff also consulted a municipal e-scooter coordinating committee across Ontario, and contacts across Canada, the U.S, as well as Paris and Transport for London, UK.

Results are fairly polarized among all those consulted with just over half supporting, and just under half not supporting, the use of e-scooters in Toronto. Most stakeholders and a majority of Toronto residents surveyed (69 per cent) support a coordinated approach to shared e-scooter services managed by Bike Share Toronto. Responses highlighted the potential of e-scooters to provide first mile/last mile connections, however concerns related to safety were also noted. Highlights from the online survey panel:

Fifty-five per cent of residents said they would be comfortable (19%) or somewhat comfortable (36%) recommending that a loved one use an e-scooter, while 18% said somewhat not comfortable, and 21% said not comfortable, and 6% were unsure.

About half of Toronto residents said e-scooters are still a new device and should be introduced cautiously, starting with a limited pilot project.

Residents gave the highest intensity of support for e-scooter riders having to wear helmets (mean score of 8.8 out of ten).

Dangerous and fun/adventure are top of mind words. Those 55 years or older are six times more likely to have said, “dangerous” for e-scooters than younger residents.

Eight per cent of residents said they have used or rented an e-scooter. Fun (26%) and convenient (25%) described their experiences, followed by “I would use it but not everyone should use it as it takes some skill” (19%).

Feedback from stakeholder groups surveyed:

Fifty-nine per cent said e-scooters could serve as a first and last mile transportation option to/from public transit.

Sixty-seven per cent said the City’s priority should be road safety, focused on preventing serious injuries and deaths in its approach to e-scooters, rising to 80% for BIA respondents.

Among BIA respondents, 47% said e-scooters are too dangerous to be on city streets and should not be used for transportation, while 40% said e-scooters should be treated the same as power-assisted bicycles.

Other key issues raised in the consultations include lack of enforcement and adequate infrastructure; and questions about environmental sustainability, public space and the potential for clutter and safety hazards particularly for people with disabilities.

Industry Stakeholders

Over 20 e-scooter-, micromobility- and software-related companies have been actively seeking out meetings with City staff, and to varying degrees with City Councillors, TPA Board Members, and senior management at the City to persuade them of the potential benefits of e-scooter sharing products and services. City staff conducted two industry group meetings – one in October 2019 and one in January 2020 – among other individual meetings and communications with industry representatives to understand and share information on e-scooter issues and to develop this report.

E-Scooters and COVID-19

Some cities like San Francisco designated shared mobility as essential during the COVID-19 pandemic, while others have not (e.g., Chicago). Some e-scooter providers provided discounts or incentives like free 30 minute rides for essential frontline or hospital workers. Cleaning was done more frequently (e.g., twice per day or each time the e-scooters were charged/maintained), and users are reminded to wash their hands and not touch their faces. In cities where the service was deemed essential, many private sector providers had reduced or altogether removed their shared bike and e-scooter fleets due to low demand, and in some cases this was contrary to municipal desires to provide transportation options to the public who rely on them (e.g., Portland, San Francisco, and SoBi bike share in Hamilton, Ontario).

While physical distancing requirements and COVID-19 impacts have changed travel patterns, existing options such as independent cycling and use of Toronto Bike Share, in combination with expanded cycling infrastructure, have increased to provide independent mobility. For the first 5 months of 2020, Bike Share Toronto casual ridership has increased 72.6 per cent over the same period in 2019. A Forbes article reported cycling being up 150 per cent in Philadelphia in May 2020.

More recently, with cities in stages of re-opening, e-scooter sharing companies are returning (e.g., Calgary, Edmonton). Other cities have suspended e-scooter sharing services until after COVID-19 (e.g., Windsor approved a shared e-scooter pilot in April 2020, but has now deferred its pilot until after COVID-19). Prior to the pandemic, a number of jurisdictions (e.g., Boulder, Honolulu, and Houston) had refused to allow or banned the use of e-scooters due to public safety concerns. Key cities with similar population, urban form, and/or climate have not yet piloted e-scooters such as New York City (Manhattan/New York County ban), Philadelphia, and Sydney, Australia. A summary of lessons learned from other jurisdictions can be found in Attachment 2.

Consideration of a Potential Pilot for ActiveTO Major Road Closures

While staff have considered a potential e-scooter pilot on ActiveTO major road closures, it would pose risks to vulnerable road users and leave the City open to considerable liability and risk due to lack of resources for oversight, education and enforcement at this time. A key purpose of ActiveTO is to provide a mixed use space for physical activity for people of all ages for walking, jogging and human-powered cycling. Piloting a new vehicle type that is throttle-powered and can potentially exceed speeds of 24km/hr poses risks to vulnerable road users in such conditions. It could also lead to confusion about which infrastructure or facilities under ActiveTO are permissible, and this would pose public safety risks that the City does not have resources to manage at this time.

City staff would also need to address fair process for the 15 or more companies interested in renting out e-scooters for use in a short timeframe (e.g., processing requirements for insurance and indemnification, and appeals for which vendors are allowed or rejected, and creating a permit/legal agreement for the vendors allowed), and this would pre-empt the recommended RFP process. Finally, the risk of injury for new users is high, and could put additional burden on local hospitals and paramedics at this time. For the reasons above, City staff do not recommend permitting e-scooters in ActiveTO facilities in 2020.

Consideration of Allowing Personal E-scooters, Not Shared E-scooters

In theory, there would be a way to only allow personal e-scooters and not shared e-scooters, but this is not the case. By changing the City’s bylaws to allow e-scooters to be operated on the City’s streets – it would be near impossible to prevent shared or rental e-scooters. For example, a number of companies both sell e-scooters for private use and rent them for shared use (e.g., Bird, Razor, and Segway). In addition, while e-scooters present another form of individualized mobility other than cycling or driving, it is limited by the HTA’s e-scooter regulations that do not allow carrying items/goods for safety reasons as this could affect an e-scooter rider’s balance resulting in falls or losing control. Further, e-scooters appear very simple to use, which poses a risk that new riders underestimate the skill and attention required to balance and ride safely.

If Council were to permit e-scooters to be operated on City streets – without the commensurate resources to provide oversight, education, outreach and enforcement, there would be considerable risks to public safety for e-scooter riders and other vulnerable road users; additional burden on hospitals and paramedics; impacts on accessibility, community nuisance and complaints; impacts on current initiatives to enhance the public realm for COVID-19 recovery efforts, such as CurbTO and CaféTO; and liability and costs to the City. For the reasons above, staff recommend that personal use of e-scooters not be considered until 2021.

Recommended Approach

Staff recommend an approach that minimizes risk by seeking enhancements to the Provincial pilot project regulations and supports, as well as building from the improvements made to e-scooter programs in other cities. The conclusion is to propose a municipal service model under the TPA that is competitively procured, and that is coordinated with, and complements Bike Share Toronto. This will ensure shared micromobility continues as a public transportation option with oversight. This approach reduces impacts on sidewalk users and public space by managing shared micromobility parking. This approach requires an amendment to the authority granted to the TPA under Chapter 179, Parking Authority of the Municipal Code to add shared micromobility including e-scooters. (see Attachment 1)

Staff recommend continuing the current prohibitions of e-scooter use and parking as outlined in Chapter 950, Traffic and Parking, and Chapter 886, Footpaths, Pedestrian Ways, Bicycle Paths, Bicycle Lanes and Cycle Tracks, until the system for oversight is in place for public safety, and given the requests for amendments to Provincial regulations. While a number of e-scooter sharing companies are looking for permission from the City to allow e-scooters in 2020, staff do not recommend this as it would pre-empt the recommended approach for competitive procurement, require diversion of staff resources to manage opting in to the Provincial pilot, and lead to considerable risks and costs to the City. A pilot involving e-scooter use in ActiveTO facilities would not provide useful assessment of e-scooters as ActiveTO (e.g., major road closures) are not representative of typical real life conditions and interactions with other road users, and would present immediate liability exposure and costs to the City.

Next Steps

Next steps are to commence development of an RFP by the TPA, with support by Transportation Services, and for City staff to report back in the first quarter of 2021 with an update on proposed pilot by-law changes applicable to e-scooters (personal and shared) and budget requirements for an e-scooter pilot recommended for May 2021.

The report back for 2021 can include any progress on consultations with the Province and other key stakeholders to:

Strengthen the e-scooter standards and specifications to foster greater safety for privately owned e-scooters and for e-scooter sharing;

Update the MVCR template and treat e-scooters as a motor vehicle for reporting purposes to enable effective, consistent data collection;

Establish set fines for offences made under the HTA Pilot Project regulations and communicate this to the Toronto Police; and

Research and explore issues and opportunities to create a fund for claims by e-scooter users and non-users who are injured as a result of e-scooter incidents and have medical/rehabilitation expenses not provided through OHIP or existing homeowner’s or auto insurance.

CONTACT

Elyse Parker, Director, Policy and Innovation, Transportation Services, Tel: 416-338-2432, Email: Elyse.Parker@toronto.ca

Janet Lo, Senior Project Manager, Transportation Services, Tel: 416-397-4853, Email: Janet.Lo@toronto.ca

SIGNATURE Barbara Gray, General Manager, Transportation Services

ATTACHMENTS

Attachment 1: Amendments to Chapter 179 – Parking Authority

Attachment 2: Lessons Learned from Other Jurisdictions

Attachment 3: E-scooter Focus Groups Report

Attachment 4: Views of Toronto Residents on E-Scooters (Summary Report)

Attachment 1: Amendments to Chapter 179 – Parking Authority

Add the following definition:

MICROMOBILITY – a category of vehicles or devices that includes those operated or used by a person that moves the sole person operating or using the vehicle or device, as well as any vehicles or devices that can move or carry up to two people including the person operating the vehicle or device, that are not automobiles, such as – without limitation – electric bicycles, electric kick-scooters, and electric mopeds, and that excludes wheelchairs or unenclosed motorized wheelchairs.

  • 179-7.1 Authority over bike share and micromobility share system

All the powers, rights, authorities and privileges with respect to the ownership, acquisition, management, maintenance and operation of the bike share and micromobility share program assets within the City of Toronto or outside the geographical boundaries of the City of Toronto, including entering into contracts and agreements, undertaking sponsorship, naming, rebranding, partnership, acceptance of donations, approval of sponsorship and third party advertising on the station panels, and all other related ownership, operational, management or revenue generating activities, shall be exercised only by the Parking Authority, subject to the following limitations:

  1. Any operating surplus from the bike share program shall be deposited in the bike share program reserve for the purposes of the reserve, including replenishment of the bike share program capital assets and/or any future operating deficits.
  2. The Parking Authority shall be required to obtain the approval of the appropriate City officials with respect to the location or relocation of the bike share stations and equipment on City property which has not been designated for the Parking Authority’s use by by-law of Council; and shall be required to obtain the approval of the appropriate City officials with respect to the location or relocation of the micromobility stations and equipment on any City property.
  3. (Reserved) 6
  4. Despite anything else in this section, where the annualized cash flow deficit for the bike share program exceeds $750,000, the President of the Parking Authority shall report directly to Council for direction.
  5. The Parking Authority shall not undertake any actions in connection with the bike share and micromobility share system outside the geographic boundaries of the City of Toronto unless the action is in keeping with the purposes of enhancing the long term viability of Bike Share Toronto and the micromobility share system overseen by the Parking Authority, or building and developing the Bike Share Toronto brand or other micromobility system brands overseen by the Parking Authority and not until the Parking Authority obtains the consent of the municipality in which such actions will occur, in accordance with the City of Toronto Act, 2006.

Attachment 2: Lessons Learned from Other Jurisdictions

More recently, e-scooters have received greater interest as a potential open-air transportation alternative that enables physical distancing. While a number of jurisdictions that previously did not allow e-scooters are considering it, such as the UK, it is still early days in terms of how the schemes will be established to address public safety, nuisance and liability issues. Iterative approaches include time limited pilots (e.g., four months or one season) and geographically contained pilots. In June 2020, the UK’s largest urban transport authorities have urged caution in response to the national government’s consultation on allowing e-scooter trials, with respect to speed and the impact on active travel.

Key parameters put forward in their response:

Recommending mandatory helmet use;

Setting e-scooter device standards for features such minimum wheel size, lighting, braking and indicators;

Introducing mandatory training for e-scooter users;

Addressing the risk that e-scooters will replace walking and cycling journeys and associated public health impacts;

Improving cycle infrastructure and streets that place people first; and

Giving municipalities the explicit powers to cap the number of rental e-scooters.

While these UK cities welcome the opportunity for e-scooter trials, they made a joint statement that “it is vitally important that Government recognises the need for e-scooters to be introduced safely and in a way that ensures they help – rather than hinder – the achievement of wider city region objectives for people and places, from a pleasant urban realm to a healthy population.”

Where e-scooters are allowed to operate

Majority of cities treat e-scooters like bicycles and allow them to be operated in bike lanes and on roads (with maximum posted speed limits of 40km/hr to 50km/hr), and prohibit them from sidewalks, trails, paths and parks. Cities that initially allowed e-scooters on sidewalks have since banned them due to safety issues (pedestrian deaths and injuries), e.g., France, Spain, Singapore and San Diego; and other jurisdictions such Ottawa’s National Capital Commission have banned e-scooters on mixed use trails/paths.

E-scooters have been prohibited also from mixed use paths or in parks because of the intermixing with people and children on foot, who are slower, and also making unpredictable movements when using public space for leisure and recreational purposes. In cities such as Berlin, Paris and Tel Aviv, where e-scooters are permitted for operation on roads or bike lanes, and not sidewalks, there have been compliance and enforcement issues with these rules. Some cities (such as Atlanta) and countries (such as the UK) have accelerated bicycle infrastructure projects after e-scooter fatalities, and in anticipation of expanding micromobility. In May 2020, the UK announced a £250 million emergency active travel fund – the first stage of a £2 billion investment supporting cycling, walking and bus-only infrastructure.

Where e-scooters are allowed to park

Dockless or free-floating e-scooters are said to be the most convenient for potential e-scooter customers, as they are left anywhere on sidewalks in a convenient location to be found by an e-scooter customer. E-scooter clutter has resulted in obstacles for pedestrians especially those with disabilities, and in some cases, injury and lawsuits. (Santa Monica, Minneapolis, Paris) More jurisdictions are requiring e-scooters to be parked: in designated areas (Berlin, Calgary, Montreal), at docked stations (Christchurch, New Zealand), or “locked to” a post (e.g., for bike parking) (San Francisco).

In some jurisdictions, e-scooters must be removed overnight or locked (unable to be unlocked and used) to prevent theft, vandalism using e-scooters or vandalism of e-scooters, and intoxicated riding. Companies are developing docked stations that enable charging (e.g., Spin). While some companies operate a dockless approach, there is feedback from some cities that users prefer having the reliability of designated areas or docked stations available to find the e-scooters, bike share or e-bike share.

Personal E-scooter Use, Protections and Regulations

Most jurisdictions do not require individuals to have permits or licenses to operate personal e-scooters; however, some have begun to implement greater oversight to address public safety:

The Netherlands has device standards and testing, and only e-scooters meeting certain conditions are allowed for use on public roads after the RDW (the Vehicle Authority) assesses them.

Germany and The Netherlands have mandatory insurance requirements for individual e-scooter users.

New Zealand has an Accident Compensation Corporation that covers personal injury claims related to e-scooters (for riders and non-riders).

Australia has the Australian Competition and Consumer Commission, which holds e-scooter companies accountable to its legislation (e.g., misrepresentations to consumers about safety when issues known were not disclosed to e-scooter users).

Malta requires that e-scooter users must be in possession of a valid driving licence, third-party insurance coverage and registration plates like a normal vehicle. Breaching these rules could result in being fined thousands of euros, confiscation of the e-scooter, and license suspension.

Singapore requires mandatory training for e-scooter riders, and has high fines and penalties including compensation of damages for injured parties and jail time.

Province of Quebec requires helmets for e-scooter users.

Tel Aviv requires e-scooter riders wear a helmet with a high visibility strip; a driver’s license or training; and license plates affixed to e-scooters. (regulations were implemented in response to fatalities)

Program Management of E-scooter Sharing

In general, jurisdictions have used either a selective permit system or a request for proposals/qualifications for e-scooter sharing companies. Across existing pilot projects, the ideal number of operators ranges from two to four, in order to reduce community nuisance with high amounts of e-scooters on sidewalks, and to reduce the burden of enforcement. More cities are using an RFP (competitive procurement) to have greater oversight over shared mobility as an essential part of public transportation for residents. Cities have also emphasized the importance of taking an incremental approach, and being conservative in setting the initial fleet size and geographic area to mitigate issues related to new rider behaviours and sidewalk clutter, liability and risk, and to evaluate and modify program parameters. Key criteria or conditions in RFP/RFQs and selective permit systems include: strong and clear indemnification agreements, adequate insurance requirements and upfront fees and deposits, minimum service standards,

social equity requirements, data and dashboard requirements including both the MDS and GBFS standards, and a 24 hour/7 day a week customer phone line.

Enforcement

A number of jurisdictions have set higher fines for aberrant behaviour such as discourteous or reckless sidewalk riding, improper parking and intoxicated riding.

Citations have been issued to e-scooter companies and in some cases, permits have been revoked and re-issued after compliance is improved. In general, jurisdictions do not have the capacity to enforce compliance. For example, Tel Aviv has a unit of 22 inspectors dedicated to enforcing that e-scooters do not ride on sidewalks. These inspectors are able to issue tickets for sidewalk violations, but only the police have the authority to issue tickets to riders not wearing helmets, as required by law. 21,000 tickets for sidewalk offenses were issued in 2019.

Earlier on with the introduction of e-scooters, some cities had to deal with issuing injunctions and seizing and impounding e-scooters of companies that launched in these cities without permission from the cities. Some cities have outsourced the enforcement and compliance operations to manage parking issues and other complaints.

E-scooter Focus Groups Report

Prepared for the City of Toronto’s Transportation Services Division

February 2020

Written and compiled for the City of Toronto’s Transportation Services by Swerhun Inc.

Overview and background

This e-scooter Focus Groups Report is an integrated summary of five focus groups commissioned by the City of Toronto to help inform its decision-making about if/how to consider a role for e-scooters in Toronto. It was prepared by Swerhun Inc., third-party facilitation firm retained by the City of Toronto to design, facilitate, and report on the focus groups. The intent of this report is to capture feedback and advice shared by focus group participants and is not intended to imply consensus of opinions. This report should be read in concert with other reports prepared as part of the City’s research / exploration into e-scooters.

As of January 1, 2020, the Government of Ontario has given cities the option to test electric kick-scooters or “e-scooters” on public roads, trails, parks and sidewalks (if they choose to participate through changing their municipal by-laws). An e-scooter is a two-wheeled electric-powered device, where the rider stands on a narrow board holding a handlebar (see picture below).

Staff from the City of Toronto’s Transportation Services are preparing a report for City Council with advice on if/how to proceed with exploring a role for e-scooters in Toronto. To inform the staff report, Transportation Services commissioned five focus groups to better understand the public’s knowledge, attitudes, and perceptions about e-scooters. The focus groups are one of multiple research inputs informing the staff report. Other inputs include an online survey of Toronto residents (~1,000 residents), stakeholder consultation, consultation with representatives of the e-scooter industry, and research by City staff and policy considerations.

Recruitment overview

Recruitment objectives

The City’s recruitment approach was guided by an objective to assemble groups of individuals representing five interest-specific groups: cyclists, drivers, local business owners/managers, local retailers of electric mobility devices, and pedestrians/transit riders. The City’s rationale for choosing these groups was to understand the perspectives of the different road users in Toronto, including their thoughts about e-scooters relationship to public realm, streets, sidewalks, entrances (as related to businesses with a “bricks and mortar” establishments, such as restaurants or stores selling goods/services), and businesses selling or repairing e-scooters and/or similar mobility devices.

The City also wanted to ensure a diverse range of perspectives was represented, including diverse age groups, ethnicities, genders, income levels, geographies, and different levels of first-hand experience with e-scooters (see Appendix B for anonymized demographics of selected participants across all focus groups). The City also wanted to speak with individuals who have not been otherwise consulted or engaged by the City about e-scooters through another mechanism. Finally, the City wanted to speak with individuals over the age of 16 to consult only those that are legally allowed by the Ontario Highway Traffic Act (regulation 389/19) to operate an e-scooter.

Recruitment & selection process

Working closely with the City of Toronto, Swerhun Inc. led the recruitment and selection process of the focus groups. Outlined below is the sequence of events for executing the recruitment process.

  • An independent website was developed for the sole purpose of recruiting focus group participants. The website included background information, purpose of the focus groups, key information about the focus groups (including focus group dates, times, and general location, compensation of $40 for selected participants, eligibility to participate, submission deadline, and contact person), and a webform with questions to collect information about interested participants to determine their eligibility. The recruitment questions were reviewed by City staff. See Appendix A for sample images of the recruitment website.
  • A contact list drawn from publicly available information was developed. Over 750 organizations and businesses with an interest in urban issues and mobility were identified. The organizations and businesses identified represented a range of sectors, including: area-specific and/or interest-specific advocacy groups (residents associations, “friends of” groups, faith-based groups, dog walkers, recreation, environmental advocacy groups, seniors, youth, heritage organizations, economic development organizations, arts organizations, Indigenous organizations, food banks, and many more; community service, shelter, and support (community services and health); accessibility; active transportation and transportation; local businesses and local retailers of electric mobility devices, and; academic organizations.
  • Invitations to participate in the focus groups were emailed to organizations and businesses. They were asked to either fill out the webform attached in the email or share it with others that might be interested. Recipients had the opportunity to opt-out of receiving further emails and request removal from the email distribution list.
  • The initial recruitment website and invitation email required interested individuals to be between the ages of 16 – 70 and to have completed the webform to be eligible to participate in the focus groups. Based on feedback received from email recipients, the maximum age limit was removed, meaning participants were eligible to participate if they were over the age of 16.
  • By the end of the submission deadline, approximately 187 people registered their interest to participate.
  • A three-step screening process was developed to identify who was eligible to participate:
  • Step 1: screen out those who were not available on either evening identified in the website, those affiliated with groups already consulted by the City through other means, and those whose self-identification answers did not qualify them for the target focus group categories.
  • Step 2: ensure the remaining eligible individuals represented a range of demographics, such as age group, gender, ethnicity, income range, geographies and first-hand experience with e-scooters.
  • Step 3: for focus groups that received a high volume of eligible participants (pedestrians/transit riders, cyclists, and drivers), further screening was done to ensure selected individuals represented a range of characteristics (e.g. if they used assistive devices such as a cane/walker/motorized wheelchair to get around, if they had any visual/hearing impairments, if they frequently travelled with baby carriers/strollers, if there were any children below the age of 16 in their household, and if anyone in their household owned a dog).
  • NOTE: The first priority with recruitment was to ensure as much participation as possible from each interest-specific group.
  • After the selected participants were identified and reviewed by the City, they received an email notifying them that they were selected to participate in a particular focus group and requesting their confirmation to attend. Key information participants needed to now before the meeting was also provided (e.g. confirmed date, time, and location).
  • Individuals who were not selected to participate were also notified by email. They were informed that although they were not selected to participate, they could still share their thoughts on e-scooters and what the City should consider as it explores if/how there could be a role for e-scooters in Toronto by emailing Janet Lo, Transportation Services, City staff leading the e-scooter research study.

Focus group process

Between February 12th and February 13th, approximately 27 people participated in the focus groups. The focus groups were organized to represent five interest-specific groups: cyclists, drivers, local business owners/managers, local retailers of electric mobility devices, and pedestrians/transit riders. Each focus group was 55 minutes long and consisted of an overview, introduction, facilitated discussion, and information sharing (see Appendix C for focus group agendas). In each focus group, the discussion was organized into three parts: discussion about participants’ experiences and perceptions of e-scooters; discussion about if/how to pilot e-scooters, and; discussion about changes to perceptions (if any) based on information and statistics shared about e-scooters. The information and statistics shared was provided by City staff and included statistics highlighting potential benefits, potential risks, and neutral information about e-scooters (see Appendix D).

Overall observations

The following points summarize the facilitation team’s observations about which topics emerged consistently across all five focus groups as well as the range of perspectives participants shared within those topics. These observations are drawn from the five individual focus group summaries, also written by the facilitation team, which were subject to participant review prior to being finalized. They should be read in conjunction with the individual meeting summaries that follow and are not intended to imply consensus between participants, either within or across any given focus group(s).

  1. Potential benefits and opportunities of e-scooters. Participants identified a number of potential benefits and opportunities e-scooters could bring to the city, including (but not limited to): a new, convenient mode of transportation; an alternative to driving (that could help address congestion); a first-and-last-mile solution; an opportunity to improve mobility equity across the city (if they are deployed in areas with limited or infrequent connections to transit, like the suburbs), and; transit relief, both generally and as a supplement to shuttle buses during significant delays.
  1. Potential risks of e-scooters. Participants identified a number of potential risks e-scooters could bring to the city, including (but not limited to): safety and injury issues due to a lack of appropriate road infrastructure for e-scooters and potential for pedestrian collisions if e-scooters are ridden on sidewalks; additional “chaos” on Toronto’s streets, especially if there is no increase in enforcement; competition and conflicts with other road users depending where they are allowed (e.g. bike lanes); clutter from lack of designated parking for dockless e-scooters; small tires of e-scooters hitting potholes, debris or snow; concerns about potential criminal behavior (e.g. impaired e-scootering); and risk of losing control because of the minimal effort required by users to operate them (i.e. use of a throttle button).
  1. Key considerations participants said the City should keep in mind as it explores a potential role for e-scooters in Toronto.
  • Public safety. While participants generally agreed safety was important, they shared a range of perspectives on if/how the City should consider safety when exploring a role for e-scooters in Toronto. Some said the City should not consider a new mode of transportation unless/until enforcement and/or infrastructure improves on Toronto’s streets. Others said the City could explore a role for e-scooters in Toronto as long as it considered/developed controls for things like: where e-scooters should and should not go; whether protective gear (e.g. helmets) is required or not; what type of education/training might be required (both for e-scooter riders and for the broader public), and other topics.
  • Participants generally agreed that enforcement of the rules of the road is important whether the City decides to pilot e-scooters or not. Many participants said that existing traffic enforcement is lacking, and they were concerned that the lack of enforcement would be a challenge for e-scooters as well. Enforcement-related topics participants suggested the City consider when exploring a role for e-scooters included e-scooter licensing and/or “identifiers” (with mixed opinions on whether these types of approaches would be effective and/or feasible) and the cost of enforcement (whether paid for by e-scooter companies or the public).
  • What role e-scooters should have in the broader transportation system. Many participants said they saw potential for e-scooters to have a role in Toronto’s transportation system, though some were concerned that City resources dedicated to accommodating e-scooters might draw resources from other transportation modes, like cycling. Among those that supported the City exploring a role for e-scooters, some said the City should be strategic in thinking about what specific role(s) e-scooters should have in the context of the City’s broader transportation objectives and then design the pilot to fulfill that role(s).
  • If/how to use Toronto’s existing street infrastructure. Participants said that, because Toronto’s streets were not designed for vehicles like e-scooters, the City should think carefully about if/how there is room for them. Some participants felt that Toronto’s streets are already struggling to accommodate existing modes and that adding e-scooters to the mix could make matters worse. Others suggested (but did not necessarily agree on) other ways to accommodate e-scooters, including identifying dedicated lanes for e-scooters and other alternative mobility devices and/or re-allocating space from other uses (such as car and/or parking lanes),
  • Protecting public space. Most participants agreed that the City would need to consider and identify ways to protect public space if it allows an e-scooter pilot. Several participants said they perceived e-scooter “clutter” and/or “litter” to be big issues in jurisdictions that have allowed them, while others said some cities have addressed these challenges through strategies like identifying dedicated parking areas, software geo-fencing, and “pick up staff” that collect discarded e-scooters. Several said that the City should consider requiring e-scooter parking in private spaces and/or parking spaces (as opposed to sidewalks and/or parks).
  • A tailored approach to different areas. Among those that were willing to consider a role for e-scooters in Toronto, there were suggestions for the City to consider the influence of different road characteristics in different areas (e.g the fact that sidewalks are wider in the suburbs, the fact that some streets are used for recreation while others are for transportation) when determining if/how to accommodate them.
  • Sustainability and environmental considerations. Participants shared a range of opinions on e-scooters’ potential sustainability and environmental benefits/drawbacks. Some said e-scooters could be a great way to get people out of cars and reduce vehicle emissions; others were skeptical of e-scooters’ purported environmental benefits and said they would like the City to analyze e-scooters’ whole life cycle, including manufacturing, how long they typically last, if/how they’re recycled, and e-scooter companies’ operational impacts (e.g. driving cars to redistribute e-scooters).

Feedback shared in the CYCLISTS focus group

Experiences, understanding, and perceptions

Participants had a range of experiences with e-scooters, including having visited cities where they are in use, seeing them on social media, having friends who own one, and from seeing kids riding them in Toronto’s sidewalks. Participants who saw e-scooters in other cities did not try riding them because they looked unsteady, “made me feel unsafe,” and the rental system would not take their credit card for payment. They used words like “surprisingly fast” and “surprisingly quiet” to describe them. They also saw dockless e-scooters littering sidewalks and in bike lanes.

Potential benefits / opportunities participants identified included: e-scooters could be an alternative to cars; a first-and-last mile solution, and; could help reduce traffic congestion. Potential risks / concerns participants identified included: lack of motor noise makes e-scooters difficult to hear, which could pose a safety risk for cyclists and pedestrians (particularly for the elderly); unpredictable movements, high speeds, and the differential in speed between throttle and human-powered cycling; clutter on streets; safety issues due to challenging road conditions (e.g. snow banks, potholes, debris) and the small wheels of e-scooters being vulnerable to these road conditions, and; riding e-scooters in areas with narrow spaces.

When asked whether they would feel comfortable recommending a loved one use e-scooters, participants mostly said “no” because of the lack of safe and connected infrastructure in Toronto to support e-scooters and lack of training to use e-scooters. One participant said that if e-scooter speed was limited to 10 km/h on multi-use paths like Martin Goodman Trail and e-scooter use was limited to off-peak times when it is not crowded with pedestrians, kids and tourists/busy event times, they would be comfortable recommending them.

Participants also shared thoughts about e-scooters from the perspective of a cyclist:

  • E-scooters could compete with bikes and pedestrians for space. Cyclists already compete with e-bikes in bike lanes — e-scooters would be another vehicle taking space intended for cyclists. E-scooter riders will also likely ride on sidewalks, even if not allowed.
  • Road infrastructure needs to change, regardless of whether e-scooters are introduced. Participants were concerned about the safety of Toronto’s streets for pedestrians and cyclists and said adding a new mode of transportation to Toronto’s streets without improving the infrastructure is risky and would increase already highly stressful conditions on streets. Some said the City should focus first on stronger enforcement to better protect pedestrians and cyclists and on creating a minimum grid of cycling infrastructure rather than finding a way to accommodate e-scooters.

Advice on if/how to accommodate e-scooters

Participants suggested considerations for the City to keep in mind as it explores if/how there is a role for e-scooters in Toronto:

  • The City needs to provide adequately wide, safe, dedicated infrastructure for e-scooters/micro-mobility. The City recently declared a climate emergency. E-scooters could be a great way to get people out of cars and reduce vehicle emissions. However, proper infrastructure is needed for people to feel safe getting around on e-scooters. Road space in Toronto is limited, so if the City decides to create space for e-scooters, something will have to give (e.g. space for cars) — the City cannot “squish” more modes into limited space. Consider giving a tax break or credit to people who use bikes, transit, and other non-car modes.
  • Provide dedicated parking spaces or docking stations to avoid e-scooter clutter on streets and provide more predictability about where they are parked. E-scooter parking should be on streets and car parking spaces, not sidewalks.
  • The City should create a safe space and provide training before piloting e-scooters to avoid accidents or injuries to riders and conflicts with other road users.
  • Tailored approaches for different areas. Instead of taking a blanket approach to accommodating e-scooters, the City should take a tailored approach for different areas that considers factors like pedestrian and vehicle traffic, what a street is commonly used for (e.g. mobility or recreation), width of the street, the speed limit, and driver behaviour.
  • Consider using e-scooters as transit relief vehicles and as a last mile solution. E-scooters could help alleviate congestion on the Yonge subway and supplement shuttle buses during significant delays. Consider providing e-scooter fleets at transit stations and explore integrating payment with the PRESTO system.
  • Consider the acceleration profile of e-scooters versus the average cyclist in safety standards for e-scooters. E-scooters accelerate by throttle, not human power and this affects their interaction with cyclists when starting up at intersections after being stopped at traffic lights, and also the passing behaviour of e-scooter riders in bike lanes.
  • Do not make helmets mandatory, since that could deter use.
  • Rely on e-scooter data from North American cities instead of European cities; North American cities design and transportation patterns are more relevant to Toronto.
  • Consider a role for other mobility devices that would support the growing ageing population, including a fleet of tricycles.
  • Required lighting on e-scooters. The City should require e-scooters’ lights are always on.
  • Consider a role for e-scooters on campuses to help students travel between classes.

How e-scooter statistics influenced participants’ perspectives

After hearing some statistics about e-scooters, some participants reinforced their feedback that the City needs to improve existing infrastructure before introducing e-scooters. Participants also asked questions about the statistics, including questions about: which areas of other cities e-scooters have been deployed; the cause of e-scooter rider injuries (e.g. collisions with cars vs. with other modes); whether there is information on what modes were replaced by the 2/3 of trips that did not replace car trips; the road surface type where accidents happened, and; who is promoting e-scooters as environmentally-friendly modes of transportation (e.g. does this claim come only from e-scooter companies?).

Other feedback

The City should invest resources on concrete infrastructure for plans that are already well-researched and supported (e.g. 10 Year Cycling Plan) before investing those resources on adding micro-mobility devices like e-scooters. Research has shown that 76% of people are too afraid to ride a bike and both Vision Zero and Vision Zero “2.0” are not changing this fear.

Feedback shared in the DRIVERS focus group

Experiences, understanding, and perceptions

Participants had a range of experiences with e-scooters, including having visited cities where they are in use, seeing videos of them on social media, and having learned of them for the first time through the focus group notice. They said they understood e-scooters are used for things like food delivery, entertainment, tourist transportation, and short trips for locals in cities. They used words like “fun,” “erratic,” “tempting,” “fast,” “clutter,” and “scary” to describe them, reflecting attitudes ranging from curiosity and interest to concern.

Potential benefits / opportunities participants identified included: the fact that a rider doesn’t need to worry about parking; speed and convenience, and; the potential to provide more transportation options to help get people out of cars. Potential risks participants identified included: decreased pedestrian safety (due to e-scooters’ speed, quick acceleration, weight, and unpredictable movements); potential for more “chaos” on Toronto’s streets (given the city’s on-going struggles with road safety and the lack of enforcement); competition and conflicts with other road users (since Toronto’s road network is not designed for e-scooters and e-scooter riders may want to use bike lanes and/or sidewalks), and; clutter (especially from dockless e-scooter rental services).

When asked whether they would feel comfortable recommending a loved one use e-scooters, participants responses were mixed. Most said “no,” saying e-scooters are unsafe, especially if the rider isn’t wearing a helmet and/or is riding Downtown or in a busy area. Some said “yes,” saying they would feel comfortable as long as the rider had been properly trained and/or was riding in a designated/restricted safe area.

Participants also shared thoughts about e-scooters from the perspective of a driver:

  • E-scooters could result in increased driver anxiety. It is scary to be a driver in Toronto, especially Downtown. Drivers are already afraid of injuring other, erratic road users, and adding unpredictable e-scooters may make this anxiety worse.
  • There’s potential for more collisions, especially if e-scooters do not handle well in snow and when people have poorer visibility such as when it is raining or dark outside.
  • Risks of an aging population. As baby boomers age, their vision and reaction times decrease. Mixing e-scooters with this demographic seems risky.

Advice on if/how to accommodate e-scooters

  • Participants suggested considerations the City keep in mind as it explores if/how there is a role for e-scooters in Toronto:
  • Public safety and education. If the City decides to allow piloting e-scooters, there would need to be a safety and education campaign reminding everyone to share the road and teaching people to ride e-scooters safely.
  • Enforcement mechanisms. If the City and/or police are not willing to increase enforcement resources, the City either should not allow e-scooters or should require e-scooter companies to subsidize enforcement costs.
  • Public space protections, including preventing clutter from dockless e-scooters and protect older pedestrians (e.g., my grandmother) on narrow sidewalks from e-scooter riders. For e-scooter systems that uses docks, the City should ensure docks are installed in parking spaces or private property, not public spaces (like parks or pedestrian clearways).
  • Learn from the experiences of other cities, like Paris, New York City, and Chicago.
  • Understand what real benefits (if any) e-scooters bring. How many car trips do they displace? E-scooters may actually remove more bicycles and/or transit trips than car trips. Consider piloting/restricting e-scooters to where they might be most effective at removing cars (like university campuses, GO parking lots).
  • Consider different approaches for different areas of the City. Sidewalks in the suburbs are wider and less-used compared to Downtown, so it might be safer to allow people to ride the e-scooters on sidewalks in the suburbs (but not downtown).
  • Pilot outside Downtown to fill a first mile / last mile gap, improve transportation equity, and demonstrate a different kind of approach to e-scooters to the world.
  • Have fewer operators or integration of multiple private operators’ services on one same app so multiple vendors are not competing for and/or cluttering the city.
  • Avoiding legal challenges from e-scooter companies. E-scooter companies have taken municipalities to court to allow their operation, citing the need to allow competition. Any pilot should be designed to prevent this type of legal challenge.
  • Adapting road infrastructure, such as “smart” streetlights that brighten during the darkest and busiest times of the year.
  • Preference for a BikeShare model for a pilot, which gives the City more control.
  • Explore dedicated “alternative transportation” lanes to reduce conflicts.
  • The role for helmets. Some felt helmets for e-scooters should not be mandatory (since they are not mandatory for cyclists and could create a barrier); others thought they should be.

How e-scooter statistics influenced participants’ perspectives

After hearing some statistics about e-scooters, participants reiterated the importance of having dedicated and separated lanes for cyclists and e-scooters, enforcement, penalties, and training if the City decides to identify a role for e-scooters in Toronto. Participants were also concerned about people riding e-scooters while impaired; the City would need to think through ways to prevent this behaviour. Participants reinforced the potential of piloting e-scooters where they have the greatest potential to reduce car trips, especially the suburbs.

Several questioned whether e-scooters are environmentally-friendly, saying the City should engage a third party to review this claim. This review should analyze e-scooters’ whole life cycle, including their manufacturing, how long e-scooters typically last, if/how they’re recycled, and e-scooter companies’ operational impacts (e.g. driving cars to redistribute e-scooters).

Other feedback

Support for the City’s careful approach, including hosting these focus groups. Private e-scooter companies’ business can have a significant public impact, so it is important not to take a knee-jerk reaction one way or the other.

Feedback shared in the LOCAL BUSINESS focus group

Experiences, understanding, and perceptions

Participants had a range of experiences with e-scooters, including having visited cities where they are in use, hearing about them in the media, and seeing people use them in the Beaches. One participant said that it seems cities are “still working out” where e-scooters should be in their mobility system.

Potential benefits / opportunities participants identified included: they are a convenient mode of transportation; an alternative to driving; a “happy medium” between car ownership and bikes; less physically intensive than bikes, and; there is no license requirement to use them. Potential risks / concerns participants identified included: Vision Zero safety and injury issues due to lack of appropriate road infrastructure for e-scooters and risk of sidewalk riding and pedestrian collisions; small tires of e-scooters getting stuck in potholes or snow banks; clutter from lack of designated parking spaces; concerns about potential criminal behavior; reduced user-control because of the minimal effort required to operate them; lack of education about how to use e-scooters, particularly for tourists; potential for accidents during late night use (due to reduced visibility and impaired riding), and; lack of accessibility to people with mobility issues (e.g. people who has difficulty standing for long periods).

When asked whether they would feel comfortable recommending a loved one use e-scooters, participants responses were mixed. Those that said “no” said they would not recommend using them because e-scooters do not have safety features like doors/airbag built into them; the only safety feature is a helmet (if a rider is even wearing one). They also said they wouldn’t recommend using them Downtown, on sidewalks, or in parks. Those that said “yes” would do so if they are used in a designated area and if the users are over a certain age, and that it’s no different than an e-skateboard. Others said they were “unsure,” saying it depends on the person and whether they are able to properly use and control the e-scooter.

Participants also shared thoughts about e-scooters from the perspective of a local business owner/manager:

  • The impact of e-scooters on businesses will depend on the business’ clientele/ audience. E-scooters might help some businesses (e.g. where the customers don’t have to carry lots of bags) but won’t necessarily be either positive or negative for many businesses.
  • E-scooters could help customers get to businesses faster by allowing customers to get around quickly and park anywhere, but this depends on their clientele (e.g. demographic).
  • Avoid impacting existing car parking. If the City is designating parking areas for e-scooters, avoid removing car parking to avoid impacting customers who are drivers.
  • Being located on a street with dedicated infrastructure helps (e.g. bike lanes on Richmond St).

Advice on if/how to accommodate e-scooters

Participants suggested considerations for the City to keep in mind as it explores if/how there is a role for e-scooters in Toronto:

Education for all road users, not just e-scooter riders. It is important for the City to educate all road users on where e-scooters fit in the City’s road infrastructure to reduce conflicts between different road users. Tourists should also be educated to reduce confusion on how the road system works in Toronto. Consider hosting training (like Can-Bike courses) at City Hall/each civic centre to teach proper use of e-scooters to reduce injuries.

Do not allow e-scooters on sidewalks or in parks for pedestrians’ safety, particularly the elderly and children. E-scooters (and other e-mobility devices) should have dedicated lanes.

Explore creating limitations, including limiting maximum speed and restricting night use.

Enforcement should be carefully planned. There should be a place for people to report and have issues addressed. Toronto Police Services is already understaffed and would lack the resources to enforce rules for e-scooters, so the City should consider having a third party enforce e-scooter rules. Los Angeles might be a good model to consider for enforcement.

Designate different zones in the city with different speed limits and have e-scooters automatically regulate the speed when they get into a certain zone (using geo-fencing).

Who is using them? Are they used by younger people, older people, or a range of ages?

Consider how e-scooters impact other modes. For example, if e-scooters are allowed in bike lanes, what is their impact on cyclists? If the City is investing resources into accommodating e-scooters, are there fewer resources allocated to cycling?

Understand the overall benefit and risk to assess if the investment (e.g. cost to taxpayers related to enforcement and policing) is worth the benefit(s) they provide.

Road conditions. Some streets in Toronto are bumpy and have many potholes (e.g. Dufferin St) and need repaving or it could present safety challenges for e-scooter users due to its small wheels.

Deploy e-scooters in the suburbs or less dense areas to provide a first-and-last-mile solution and a convenient way to get around suburban neighbourhoods.

Provide docking stations or designated parking spaces to prevent e-scooters from cluttering streets.

Require the use of helmets. E-scooter riders should be required to wear helmets to protect against head injuries. Some acknowledged that requiring helmets could be difficult given the lack of a place to store them and the likely spontaneous use of e-scooters.

Require e-scooter sharing companies to have insurance coverage for users. For example, Uber covers people who are injured or in an accident while using the service.

Consider requiring registration and insurance for privately owned electric mobility devices (e.g. e-motorcyles, e-bicycles, and e-scooters).

Embrace change. Some participants said e-scooter is like ride-hailing apps (e.g. Uber and Lyft) and the City should embrace change and figure out how it can work for everyone.

How e-scooter statistics influenced participants’ perspectives

After hearing some statistics about e-scooters, several participants said e-scooters could be a good idea in Toronto because they have the potential to replace a good percentage of car use, and could provide another mode of transportation for people who do not like cycling and/or do not own a car. However, some participants were concerned about the high number of head injuries and the possibility for severe trauma. They also said that e-scooters do not seem to replace car or bike use, but rather are another option to get from A to B faster for short trips (i.e. not replacing a 15min drive). Participants said the statistics reinforced their suggestion that education will be important in helping people get over the learning curve in the first few trips and understand the need for helmets.

Feedback shared in the LOCAL RETAILERS OF ELECTRIC MICROMOBILITY DEVICES focus group

Experiences, understanding, and perceptions

Two participants sold e-scooters in their stores (including both kids and adult models as well as e-hoverboards) while one sold bicycles and e-bikes, and provided repair services for bicycles. Participants’ experiences with e-scooters also included seeing them in Prague. The retailers of e-mobility devices said customers ask questions about how long e-scooters’ batteries last and how far they could go, what their warranty period is, whether their tires have tubes, the restrictions around riding them (e.g. minimum age), and how fast they go. They also said customers have typically already heard about e-scooters before they come into the store (usually through advertising or at school); the purpose of customers’ visit is to see one in person. The e-scooters they sell do not have software applications and sell for $499, which has not been an issue for customers. Customers tend to prefer lighter e-scooters and e-scooters that fold up, but do not have any preference for brand or tire type. Customers have been telling retailers that they use them for the first / last mile in their trips, recreation, and entertainment. The retailer whose shop does not sell e-scooters said that customers have not been asking about them.

When asked whether they would feel comfortable recommending anyone use e-scooters, participants were unsure since they do not know what the rules are for using e-scooters. Some said that they would recommend others use them on the condition that e-scooters are not used on the sidewalk (since e-scooters weigh as much as bikes and should be treated like bicycles). Potential benefits / opportunities participants identified included: e-scooters might provide more transportation options; e-scooters might be more theft resistant than bikes (since they fold up), and; e-scooters might be more convenient than a bike (since a rider could more easily fold one up and take it on transit even during rush hours). Participants said it is difficult to comment on the pros & cons of e-scooters in the abstract: the City should instead ask what its transportation objectives are and whether e-scooters help achieve them.

Advice on if/how to accommodate e-scooters

Participants suggested considerations the City keep in mind as it explores if/how there is a role for e-scooters in Toronto:

  • Impacts of regulation on privately-owned e-scooters and local retailers. The City should consider how its approach to regulating big e-scooter sharing companies might impact privately-owned e-scooters and local retailers of e-mobility devices. Participants said it would be unfortunate for private owners of e-scooters and retailers of e-scooters to be impacted by regulations aiming to fix issues from the big e-scooter sharing companies (as has happened in Alberta). Regulations developed based considerations like the size of e-scooter sharing companies’ fleets, the durability of their vehicles, and wear-and-tear on their vehicles might overlook considerations unique to private owners of e-scooters and/or retailers of mobility devices.
  • The same rules should apply to bikes and e-scooters. For example, if the City is going to allow them, e-scooters should be required to use the road and banned from sidewalks and parks because of the risk of collisions with people.
  • Industry standards. Participants had mixed opinions about industry standards. While standards can be a headache for manufacturers, they could be beneficial to create consistency and responsibility. If the City does pursue or advocate for industry standards (e.g. for turning radius, weight, material strength, durability, etc.), there should be different standards for different types of e-scooters (e.g. kids vs. adult e-scooters). There would also need to be a system to enforce standards, such as limiting 750 watt e-scooters (which are not legal).
  • E-scooter warranties and maintenance. Participants said it is up to private individual e-scooter owners to obtain replacement parts and fix the e-scooters themselves. The existing warranty period for some products is two months.
  • Learn from others. For example, the dockless e-scooter and e-bike pilot project has not been working well in other cities (companies did not conform to the City’s requirements). Toronto should learn from that experience to avoid similar challenges.
  • Avoiding “clutter and scooter mayhem.” In many cities, e-scooters end up littering streets, public spaces, and lakes; so there needs to be some control to manage potential nuisances. Recommend that Toronto city staff learn from other cities to consider how to avoid similar negative impacts here.
  • Ways to prevent impaired riding. Impaired riding of e-scooters has been an issue in some cities; Toronto should learn how other cities have approached and prevented this behaviour.
  • Different uses & users. It’s likely there will be two types of uses for e-scooters: commuting and entertainment/recreation. Most people will likely fit into the entertainment/recreation category since the speed and battery life of e-scooters make them less practical over the long distances faced by many commuters. The City should also consider who is using e-scooters (such as students, transit users, etc.).
  • Education will be important, especially in terms of encouraging people to wear helmets and discouraging tourists from going at top speed in pedestrian zones/busy pedestrian areas.
  • Consider the political challenges of building infrastructure for e-scooters and/or bikes. For example, some people may get upset if the City builds more dedicated lanes for bikes and/or e-scooters. However, without dedicated lanes, cyclists and e-scooter riders may be in danger of getting hit by cars.
  • The pros and cons of e-scooters will depend on the City’s goals and objectives. The benefits/risks of e-scooters will depend on the what the City is trying to achieve (e.g. to use along transit or replace transit) and who will use e-scooters (e.g. students, transit users, novice riders).
  • Limit the top speed. Some said the 15 mph (24 km/h) top speed should be maintained.

How e-scooter statistics influenced participants’ perspectives

After hearing some statistics about e-scooters, participants said they were interested in understanding how the statistics compare to e-bikes, especially when it applies to injuries, to help put them in context. Some said the statistics were confusing and seemed to be mixing apples and oranges, such as statistics that compared the percentage of injuries between different municipalities even though each municipality might have different fleet sizes. Some said they would expect head injuries would be higher on e-scooters since people might be more inclined to use an e-scooter spontaneously.

Feedback shared in the PEDESTRIAN / TRANSIT RIDERS focus group

Experiences, understanding, and perceptions

Participants had a range of experiences with e-scooters, including having lived in and visited cities where they are in use (e.g. Tel Aviv, San Diego), seeing them in pop culture, having personally used them, and having no personal experience with them. Some participants saw them being used on either sidewalks or on the streets (depending on the city). Those that had personal experience riding them (all male) and/or lived in cities where they are used said that e-scooters are a wonderful, fast, and convenient way to travel. They said it’s easier (and cheaper) to navigate an unfamiliar city via e-scooter than via public transit (especially where you don’t speak the language and it’s hard to navigate public transit). Participants also said e-scooters work best in cities that do not get snow (or where snow is cleared immediately) and in cities with wide streets or sidewalks. Those that had visited cities where they are in use but did not ride them said they had experienced e-scooters passing them quickly while cycling in bike lanes. Some said they saw e-scooters as “unnerving”, “stealthy”, “litter,” “broken,” and “abandoned” on streets; others said that, in some cities, private companies have developed ways to prevent the litter issue, including app / software updates (requiring e-scooters be left in designated areas), hiring staff to tend to e-scooters overnight, and identifying designated parking areas.

Potential benefits / opportunities participants identified with e-scooters included: they can be a cheaper transportation option when transit is not working or unavailable; they are a convenient and fast way to get around, and; may benefit from being integrated with transit. Potential risks / concerns participants identified included: lack of appropriate infrastructure (such as narrow, unprotected bike lanes); e-scooters are very quiet making them potentially dangerous for pedestrians (if allowed on sidewalks); impaired riding, and; lack of familiarity on how to use/control e-scooters, especially for novice riders.

When asked whether they would feel comfortable recommending a loved one use e-scooters, participants’ responses were mixed. Those who said they would be comfortable said they would only do so if e-scooters were not allowed on sidewalks and were used on streets with safe, well-maintained (“as long as streets are cleaned”) and appropriate infrastructure or in areas with no/little car traffic (such as the suburbs or King Street). Those who said they would not be comfortable cited the lack of infrastructure and having “no safety buffer”, lack of traffic law enforcement on Toronto’s streets, and the dangerous habits of drivers, cyclists, and pedestrians.

Participants also shared thoughts about e-scooters from the perspective of a pedestrian / transit rider:

  • E-scooters could be integrated into the TTC to serve as a last mile solution for pedestrians / transit riders and/or could help distribute the load from the transit system.
  • Carefully consider the impact of e-scooters (using throttle) on people with mobility issues and people with baby strollers.
  • Using e-scooters in the suburbs as a last mile solution is a good idea, but the City needs to identify where e-scooters would fit in the existing infrastructure. If it’s illegal to cycle on sidewalks, it should be the same for e-scooters, but riding on streets in the suburbs is unsafe since cars move faster and take up most of the street.
  • Potential for e-scooter riders to “blow past” open streetcar doors. Enforcement would be needed to discourage this behaviour, which is already a problem with other road users.
  • Advice on if/how to accommodate e-scooters
  • Participants suggested considerations for the City to keep in mind as it explores if/how there is a role for e-scooters in Toronto:
  • E-scooters should not be allowed on sidewalks for pedestrians’ safety, especially kids and the elderly. E-scooters should be restricted to streets and have the same regulation as e-bikes in terms of speed limit.
  • Plan for and provide enough infrastructure space, especially if e-scooters are not allowed on sidewalks, and if more people use e-bikes and e-scooters, consider the threshold where more space is needed for micromobility infrastructure.
  • Provide education and training on e-scooters and promote an awareness campaign about general road safety. Currently, there is a general lack of knowledge about road safety. Adding a new mode of transportation on the streets will require all road users to be properly informed on how to keep the road safe for everyone. Consider closing streets with bike lanes (e.g. Bloor Street) to car traffic in summer to allow people to learn how to properly use e-scooters since some participants said “at first it’s shaky when learning to use e-scooters”.
  • Consider whether there is a role for “identifiers” or license plates on e-scooters. Some felt strongly that an identifier would be important in supporting enforcement of the rules of the road; others said requiring licensing of e-scooters could initiate a move to require licensing for every form of transportation, which has been proven to be impractical.
  • Prevent people from using e-scooters to bypass PRESTO fare machines. A participant was concerned people would use e-scooters for fare evasion, especially in transit stations where the bus bay is easily accessed from the sidewalk (e.g. Bathurst Station).
  • Understand how e-scooters could impact the transportation habits of transit riders, including whether e-scooters are intended to replace or supplement transit and whether e-scooters are suitable for longer distances or inclement weather. Understanding these impacts would help the City understand if e-scooters are replacing driving trips or are only being used instead of walking or short transit trips.

How e-scooter statistics influenced participants’ perspectives

After hearing some statistics about e-scooters, participants generally said the statistics reinforced their thoughts about both the benefits and risks of e-scooters. Some said the statistics made them feel e-scooters are more of a novelty device than a new mode of transportation, while others said the statistics revealed that e-scooters are useful for day-to-day travel and could serve as a new mode of transportation (e.g. if you have a 5km commute or need to get to a transit station and buses are infrequent). Some said they are concerned about impaired or drunk e-scootering. Some said that, if the City allows e-scooters in Toronto, riders should be required to wear a helmet but unsure how helmets would be distributed; others said they would not like helmet use to be required (given cyclists above the age of 18 are not required to wear helmets and requiring helmets for e-scooter use could present logistical and administrative barriers to their use). Participants also asked questions about the e-scooter statistics, including interest in understanding: absolute values (not just percentages); the cause of collisions reported, and; what percentage of the population in the cities surveyed used e-scooters.

Appendices

Appendix A – Recruitment e-mail, website, and questionnaire

Recruitment e-mail

Subject: Seeking Focus Group Participants: City of Toronto E-scooter Research

You’re receiving this email because the City of Toronto and our Swerhun team think your organization or people in your organization’s network may potentially be interested in participating in a focus group about e-scooters in Toronto. Our Swerhun team regularly works on consultations in Toronto and knows organizations and/or businesses like yours pay close attention to urban issues, including issues around mobility. We looked up your contact information online to send you this email — if you would prefer not to receive further emails about this e-scooter focus group research process, please respond and let us know so we can remove you from this email distribution list.

Hello,

We are looking for Toronto residents and representatives of local businesses to participate in one of five one-hour focus groups to help the City of Toronto understand the public’s knowledge, attitudes, and perceptions about electric kick-scooters or “e-scooters.”

Dates and times: One hour in the evening of either February 12 or February 13 (beginning at either 6:00, 7:00, or 8:00 p.m.)

Location of focus groups: Downtown Toronto (Queen and Spadina) – eligible applicants will receive detailed information

Compensation: Participants who attend an entire 1-hour focus group will receive a $40 honorarium

Eligibility: Participants must be between the ages of 16-70 and have completed the web form linked below to be considered eligible to participate. Note that not all eligible participants will be necessarily invited to participate.

How to register your interest: Complete this brief online form no later than Friday, February 7, 2020

More details:

An e-scooter is a two-wheeled electric-powered device, where the rider stands on a narrow board holding a handlebar (see picture below). As of January 1, 2020, the Government of Ontario has given cities the option to test e-scooters on public roads, trails, parks and sidewalks. Staff from the City of Toronto’s Transportation Services are preparing a report for City Council with advice on if/how to proceed with exploring a role for e-scooters in Toronto. The focus groups are one of multiple research inputs informing this report, including staff research, a phone survey, stakeholder consultation, and consultation with the e-scooter industry.

If you are interested in participating in one of the focus groups (or know someone between the ages of 16-70 who might be), please either share or complete the online web form. Click the link below to access the online web form – it only takes 2 minutes to complete. The focus group research team will notify eligible individuals no later than February 7.

www.e-scooterfocusgroup.com

Thank you for your interest. We look forward to your participation.

Khly Lamparero, Swerhun Inc.

Firm retained by the City of Toronto to conduct the e-scooter focus groups

(416) 572-4365

klamparero@swerhun.com

Recruitment website

Recruitment questionnaire

  1. How often do you walk to get to destinations or for recreation?
  • Daily
  • Several times a week
  • Weekly
  • Several times a month
  • Monthly
  • Less than once a month
  • Never
  1. On most days, do you walk or use an assistive device such as a cane/walker/motorized wheelchair to get around?
  • Yes
  • No
  1. How often do you take public transit?
  • Daily
  • Several times a week
  • Weekly
  • Several times a month
  • Monthly
  • Less than once a month
  • Never
  1. Do you travel frequently with baby carriers/strollers?
  • Yes
  • No
  1. How often do you ride a bike to get to destinations or for recreation?
  • Daily
  • Several times a week
  • Weekly
  • Several times a month
  • Monthly
  • Less than once a month
  • Never
  1. How often do you drive?
  • Daily
  • Several times a week
  • Weekly
  • Several times a month
  • Monthly
  • Less than once a month
  • Never
  1. Do you own or run a business establishment in the city of Toronto (e.g. restaurant or store selling goods/services)?
  • Yes
  • No
  1. Do you own or run a business establishment selling bicycles, electric bicycles, kick-style e-scooters and electric motorcycles/e-mopeds?
  • Yes
  • No
  1. Do you have any visual impairments?
  • Yes
  • No
  1. Are there any children 16 or younger living in your household?
  • Yes
  • No
  1. Do you or anyone in your household own a dog?
  • Yes
  • No
  1. Are you a commercially licensed dog walker?
  • Yes
  • No
  1. Among the following, which have you ever tried using? (Select all that apply)
  • BikeShare Toronto
  • Bike share system in another city
  • Pedal assist electric powered-bicycle
  • Electric-powered bicycle (no pedalling required)
  • Kick-style e-scooter
  • None of the above
  1. Have you ever been in a city that allows kick style e-scooters?
  • Yes
  • No
  1. Which of these groups do you identify with the most? (choose up to 3)
  • Pedestrian/transit rider
  • Cyclist
  • Driver
  • Local business owner/manager
  • Local retailer of electric mobility devices (e.g. electric bicycles, kick style e-scooters, electric motorcycles/e-mopeds)
  1. Are you a member of any organization/advocacy group?
  • Yes
  • No
  • Prefer not to say
  1. If you answered yes above, please specify the organization/advocacy group.

______________________

  1. What is your age?
  • 15 and below
  • 16 – 30
  • 31 – 50
  • 51 – 70
  • 71 and over
  1. What gender do you identify as?
  • Male
  • Female
  • Non-binary/third gender
  • Other, please specify
  • Prefer not to say
  1. Which area in the City of Toronto do you live in?
  • Etobicoke York
  • North York
  • Scarborough
  • Toronto and East York
  • I don’t live in the City of Toronto
  1. Please specify your ethnicity.
  • Black (e.g. African, African-Canadian, Caribbean)
  • East Asian (e.g. Chinese, Japanese, Korean)
  • First Nations (status, non-status, treaty or non-treaty) Inuit or Métis
  • Latin American (e.g. Colombian, Cuban, Mexican, Peruvian)
  • Middle Eastern (e.g. Afghan, Iranian, Lebanese, Saudi Arabian, Syrian)
  • South Asian (e.g. Bangladeshi, Indian, Indian-Caribbean such as Guyanese, Pakistani, Sri Lankan)
  • Southeast Asian (e.g. Filipino, Malaysian, Singaporean, Thai, Vietnamese)
  • White (e.g. English, Greek, Italian, Portuguese, Russian, Slovakian)
  • More than one race category or mixed race, please describe below
  • Not listed, please describe below
  • Prefer not to answer
  1. What language(s) do you speak? (Select all that apply)
  • English
  • French
  • Other, please specify
  1. What is your annual household income?
  • Under $20,000
  • $20,000 – $49,999
  • $50,000 – $79,999
  • $80,000 – $124,999
  • More than $125,000
  • Prefer not to say
  1. How many years have you lived in the City of Toronto?
  • Less than 1 year
  • 1 – 2 years
  • 2 – 5 years
  • 5 – 10 years
  • 10 – 20 years
  • Over 20 years
  • Don’t know/Prefer not to say
  1. Please identify which evenings you would be available. Note, eligible individuals are only expected to attend one session.
  • Wednesday, February 12, 2020
  • Thursday, February 13, 2020
  • I am available on both evenings
  • I am NOT available on either evening
  1. Please share your contact information below:

First Name:

Phone Number (optional):

Email:

Please note this information will only be used to follow up with you about additional details if you are identified as being eligible to participate on the focus groups.

Make sure to click “submit” to complete your registration.

This concludes the registration questions. Thank you for taking the time to participate. We will get in touch with you no later than Friday, February 7, 2020 if you have been identified as eligible to participate in a focus group.

Notice of Collection: The personal information is collected under the City of Toronto Act, 2006, s. 136(c) and the Municipal Freedom of Information and Protection of Privacy Act. Any personal information collected by a third party vendor acting as an agent for the City of Toronto will only be used for the purpose of scheduling and organizing focus groups to provide feedback to city staff related to e-scooters. With the exception of personal information, all comments will become part of the public record. For more on the City’s commitment to protect the privacy of individuals, see our Corporate Privacy and Security Statement.

Appendix B – Summary of selected participant demographics

Outlined below is a breakdown of some of the City-identified key demographics of selected participants.

  • Age group. Approximately 21% 16-30 year olds; 45% 31-50 year olds; 24% 51-70 year olds, and; 10% 71 and over.
  • Approximately 48% non-caucasian and 52% Caucasian.
  • Approximately 7% under $20,000; 24% $20,000 – $49,000; 17% $50,000 – $79,000; 24% $80,000 – $124,000; 14% more than $125,000, and; 14% preferred not to say.
  • Approximately 42% female and 58% male.
  • Approximately 79% from Toronto and East York; 14% from Etobicoke York; 3% from North York, and; 3% do not live in Toronto.
  • Experience with e-scooters. Approximately 59% have been in a city that allow e-scooters, and 41% have not.

Appendix C – Focus group agendas

City of Toronto e-Scooter Focus Group

CYCLIST

Alterna Savings Room, CSI Spadina

192 Spadina Avenue, Toronto, ON

Feb 13, 2020

Focus group purpose

To help the City of Toronto understand cyclists’ knowledge, attitudes, and perceptions about e-scooters.

Agenda

6:00 pm           Welcome, introductions, agenda review, quick orientation

Swerhun Inc. and City of Toronto

6:05                 Discussion: your experiences and perceptions

  1. Where and how have you heard about e-scooters? How would you describe them and/or your experience with them?
  2. Based on your experience, would you be comfortable recommending a loved one use them? Why or why not?
  3. Do you have any specific experiences or perceptions to share from the perspective of a cyclist?

6:20                 Discussion: if/how to pilot e-scooters

  1. The Province has given the City the ability to pilot e-scooters. What kinds of things do you think the City should consider when exploring if/how they might have a role in Toronto?
  2. Thinking as a cyclist, what specific issues, opportunities, or concerns do you want the City to consider (if any)?

6:35     Distribution of info and stats around e-scooters

Swerhun Inc.

6:40                 Discussion: changes to perceptions

  1. Did any of the information shared change your opinion or attitude about e-scooters or your thoughts on if/how the City should consider exploring a role for them? If so, how?

6:55                 Adjourn

City of Toronto e-Scooter Focus Group

DRIVERS

Alterna Savings Room, CSI Spadina

192 Spadina Avenue, Toronto, ON

Feb 12, 2020

Focus group purpose

To help the City of Toronto understand driver’s knowledge, attitudes, and perceptions about e-scooters.

Agenda

6:00 pm           Welcome, introductions, agenda review, quick orientation

Swerhun Inc. and City of Toronto

6:05                 Discussion: your experiences and perceptions

  1. Where and how have you heard about e-scooters? How would you describe them and/or your experience with them?
  2. Based on your experience, would you be comfortable recommending a loved one use them? Why or why not?
  3. Do you have any specific experiences or perceptions to share from the perspective of a driver?

6:20                 Discussion: if/how to pilot e-scooters

  1. The Province has given the City the ability to pilot e-scooters. What kinds of things do you think the City should consider when exploring if/how they might have a role in Toronto?
  2. Thinking as a driver, what specific issues, opportunities, or concerns do you want the City to consider (if any)?

6:35     Distribution of info and stats around e-scooters

Swerhun Inc.

6:40                 Discussion: changes to perceptions

  1. Did any of the information shared change your opinion or attitude about e-scooters or your thoughts on if/how the City should consider exploring a role for them? If so, how?

6:55                 Adjourn

City of Toronto e-Scooter Focus Group

LOCAL BUSINESS OWNERS/MANAGERS

Alterna Savings Room, CSI Spadina

192 Spadina Avenue, Toronto, ON

Feb 12, 2020

Focus group purpose

To help the City of Toronto understand local business owners’ knowledge, attitudes, and perceptions about e-scooters.

Agenda

7:00 pm           Welcome, introductions, agenda review, quick orientation

Swerhun Inc. and City of Toronto

7:05                 Discussion: your experiences and perceptions

  1. Where and how have you heard about e-scooters? How would you describe them and/or your experience with them?
  2. Based on your experience, would you be comfortable recommending a loved one use them? Why or why not?
  3. Do you have any specific experiences or perceptions to share from the perspective of a local business owner?

7:20                 Discussion: if/how to pilot e-scooters

  1. The Province has given the City the ability to pilot e-scooters. What kinds of things do you think the City should consider when exploring if/how they might have a role in Toronto?
  2. Thinking as a local business owner, what specific issues, opportunities, or concerns do you want the City to consider (if any)?

7:35     Distribution of info and stats around e-scooters

Swerhun Inc.

7:40                 Discussion: changes to perceptions

  1. Did any of the information shared change your opinion or attitude about e-scooters or your thoughts on if/how the City should consider exploring a role for them? If so, how?

7:55                 Adjourn

City of Toronto e-Scooter Focus Group

LOCAL RETAILERS OF E-MOBILITY DEVICES

Alterna Savings Room, CSI Spadina

192 Spadina Avenue, Toronto, ON

Feb 12, 2020

Focus group purpose

To help the City of Toronto understand local e-mobility device retailers’ knowledge, attitudes, and perceptions about e-scooters.

Agenda

8:00 pm           Welcome, introductions, agenda review, quick orientation

Swerhun Inc. and City of Toronto

8:05                 Discussion: your experiences and perceptions as retailers

  1. Where and how have your customers heard about e-scooters? What kinds of questions do they ask about them?
  2. Based on your experience, would you be comfortable recommending everybody use e-scooters? Why or why not?
  3. Do you have any experiences or perceptions to share from the perspective of a local retailer of e-mobility devices?

8:20                 Discussion: if/how to pilot e-scooters

  1. The Province has given the City the ability to pilot e-scooters. What kinds of things do you think the City should consider when exploring if/how they might have a role in Toronto?
  2. Thinking as a retailer of e-mobility devices, what do you see as the risks/benefits to retailers if municipalities and/or the province decide not to make e-scooters legal? (e.g., decide not to pilot or decide not to continue after the pilot period)

8:35     Distribution of info and stats around e-scooters

Swerhun Inc.

8:40                 Discussion: changes to perceptions

  1. Did any of the information shared change your opinion or attitude about e-scooters or your thoughts on if/how the City should consider exploring a role for them? If so, how?

8:55                 Adjourn

City of Toronto e-Scooter Focus Group

PEDESTRIANS / TRANSIT RIDERS

Alterna Savings Room, CSI Spadina

192 Spadina Avenue, Toronto, ON

Feb 13, 2020

Focus group purpose

To help the City of Toronto understand pedestrian & transit riders’ knowledge, attitudes, and perceptions about e-scooters.

Agenda

7:00 pm           Welcome, introductions, agenda review, quick orientation

Swerhun Inc. and City of Toronto

7:05                 Discussion: your experiences and perceptions

  1. Where and how have you heard about e-scooters? How would you describe them and/or your experience with them?
  2. Based on your experience, would you be comfortable recommending a loved one use them? Why or why not?
  3. Do you have any specific experiences or perceptions to share from the perspective of a pedestrian & transit rider?

7:20                 Discussion: if/how to pilot e-scooters

  1. The Province has given the City the ability to pilot e-scooters. What kinds of things do you think the City should consider when exploring if/how they might have a role in Toronto?
  2. Thinking as a pedestrian & transit rider, what specific issues, opportunities, or concerns do you want the City to consider (if any)?

7:35     Distribution of info and stats around e-scooters

Swerhun Inc.

7:40                 Discussion: changes to perceptions

  1. Did any of the information shared change your opinion or attitude about e-scooters or your thoughts on if/how the City should consider exploring a role for them? If so, how?

7:55                 Adjourn

Appendix D – E-scooter statistics shared in focus groups

E-scooter statistics

  1. In Paris, a survey of e-scooter riders revealed that 7% rented one almost every day and 38% rented one at least once a week. About 68% said it was a pleasant and fun way to travel and saved them time.
  1. Paris and Singapore banned e-scooters from being used on sidewalks. This ban occurred as a result of pedestrian deaths from e-scooter collisions on sidewalks.
  1. In Calgary, 1 in 3 trips by e-scooters replaced a car trip. In Paris, 23% of e-scooter trips were combined with another mode like public transit.
  1. In the City of Austin, 63% of injuries occurred within the first nine rides of using an e-scooter. About 50% are head injuries and 35% are fractures. Less than 1% wore helmets. (Centers for Disease Control & Prevention and City of Austin)
  1. E-scooters are promoted as an environmentally-friendly mode and as a way to reduce car traffic.
  1. In Chicago, 10 pedestrians were sent to the emergency room after being hit by e-scooter users in their 4 month pilot project. There was a total of 192 emergency room visits related to e-scooters in these 4 months.
  1. In Paris, 44% of e-scooters riders used bicycle lanes, 35% used roadways, and 19% used sidewalks. 82% said they wanted to use bicycle lanes for e-scooters.

Attachment 4: Views of Toronto Residents on E-Scooters (Summary Report)

This study was commissioned by the City of Toronto and the research was conducted by Nanos Research. This report summarizes the observations based on an online nonprobability panel survey of 1,010 Toronto residents, 16 years or older, between January 23rd and February 1st, 2020.

Sampling plan: To achieve the best representation, the sample was structured to the natural geographic distribution of Toronto based on the Statistics Canada 2016 Census of Population.

Awareness and Attitudes Towards E-Scooters

While one in two Toronto residents report having seen e-scooters being operated, less than one in ten report having used or rented one. Younger residents were more likely to report having seen e-scooters being operated and were also more likely to report having used an e-scooter than older residents.

  • Dangerous and fun/adventure are top of mind words when Toronto residents think about escooters – Asked what words come to mind when they think of an e-scooter, Toronto residents most frequently say dangerous and fun/adventure (16% each), followed by easy/convenient/ useful (13%), quick/speed (12%), and kid/toy (nine per cent). Toronto residents who are 55 years old or older (27%) are six times more likely to use the word, “dangerous”, to describe e-scooters than younger residents (five per cent of those 16 to 34 years old).
  • Toronto residents most frequently have heard about e-scooters through seeing them being operated or through the News, TV, Twitter or other media – Asked where they have heard about e-scooters, Toronto residents most frequently say they had seen e-scooters being operated (50%) and through News, TV, Twitter and other media (46%), followed by word of mouth (26%), online shopping and retailer websites (19%), and having used or rented one (eight per cent). Fourteen per cent say they had never heard about them until this survey.
  • Older residents are twice as likely to say they have never heard of e-scooters than younger residents – Nearly one in two Toronto residents who are 55 years old or older say they had not heard about e-scooters until this survey (18%) compared to under one in ten (nine per cent) of 16 to 34 year olds. Toronto residents who are 16 to 34 years old are more likely to say they have seen e-scooters being operated than older Toronto residents (55%, compared to 45% of those 55 and older). Younger Toronto residents are also more likely to report having used or rented an escooter (16% of 16-34 year olds, compared to three per cent of those 55 and older).
  • Less than one in ten Toronto residents say they have used and/or rented an e-scooter – Eight per cent of Toronto residents say they have used and/or rented an e-scooter. Of these, Toronto residents who are 16 to 34 years old (16%) are five times more likely to report having used or rented an e-scooter than those age 55 and older (three per cent), and nearly three time more likely than those aged 35 to 54 years old (six per cent).
  • Those who have seen an e-scooter being operated most frequently say that they observed young people operating them – Asked to rank their top three observations when they saw people operating e-scooters, Toronto residents most frequently rank first that they saw mostly young people riding them (29%), followed by people having fun or riding e-scooters for convenience (18%), few people using them (13%), and people riding safely, not speeding, using bike lanes/roadway on e-scooters (13%). Ten per cent first rank that they saw people riding recklessly, speeding, not yielding to pedestrians on e-scooters.
  • Those who have used an e-scooter are marginally more likely to say they used a rented escooter rather than a privately owned e-scooter – Just over one in two Toronto residents (54%) who have ridden an e-scooter say they used a rented e-scooter to do so, while just under one in two (47%) say they used a privately owned e-scooter.
  • Fun and convenience best describe Toronto resident’s experiences when riding an e-scooter – Asked to rank the top three descriptions that best match their experience when riding an escooter, Toronto residents who have used or rented an e-scooter most frequently rank first that it was fun (26%) and that it was convenient (25%), followed by “I would use it but not everyone should use it as it takes some skill” (19%), it was cost effective (16%), it was expensive (seven per cent), and they had a near miss with other e-scooter riders, pedestrians, cyclists or drivers (four per cent).

E-scooter pilot projects

When it comes to how the City of Toronto should participate in the Province’s e-scooter pilot project, Toronto residents most frequently say e-scooters are still a new device and should be introduced cautiously, starting with a limited pilot project. Safety and education are most frequently seen as the priorities the City should consider when developing its approach to e-scooters. Respondents were asked for their views before and after reading a set of statements about e-scooters. Overall, results pre and post-information were consistent.

  • Toronto residents most frequently say that e-scooters are still a new device and should be introduced cautiously, starting with a limited pilot project – Asked how the City of Toronto should participate in the Province’s e-scooter pilot project, if at all, Toronto residents most frequently say that e-scooters are still a new device and should be introduced cautiously, starting with a limited pilot project (44% pre-information, 52% post-information), followed by e-scooters are fun, convenient and should be allowed like bicycles and e-bikes (27% pre-information, 22% post-information), e-scooters are a fad and the City should improve other transportation options (14% pre-information, 11% post-information) and e-scooters are dangerous and should not be piloted at this time (nine per cent pre-information, 10% post-information).
  • Toronto residents most frequently say the most important role e-scooters could fulfil in Toronto’s transportation system is being used for fun or recreation– Asked to rank the top three roles they think e-scooters could fulfil in Toronto’s transportation system, Toronto residents most frequently ranked using them for fun or recreation (20% pre-information, 15% post-information) first, followed by using them instead of walking or short transit trips (18% pre-information, 19% post-information), a way for tourists and others to see the city (13% pre-information, 12% post-information), using them where public transit service is less frequent or not available (12% pre-information, 16% post-information), an alternative to driving (10% pre-information, 11% post-information) and using them to commute to/from work (nine per cent pre-information and post-information). Fourteen per cent say e-scooters do not fulfill a real role in Toronto’s transportation system and five per cent are unsure both pre-information and post-information.
  • Older residents are more likely to say that e-scooters do not fulfill a real role in Toronto’s transportation system compared to younger residents – Just under two in ten (19%) older residents (55 and older) say that e-scooters do not fulfill a real role in Toronto’s transportation system compared to nine per cent of residents aged 16 to 34 years old.

Priorities for the City’s e-scooter approach

  • Residents says safety is the most important priority for the City of Toronto to prioritize when developing its approach to e-scooters – Asked to rank the top three things the City of Toronto should prioritize in developing its approach to e-scooters, Toronto residents rank first focusing on safety to prevent serious injuries and death (28% pre-information, 26% post-information), followed by educating new users of e-scooters to learn how to operate them (20% pre-information and post-information), protecting pedestrians and persons with disabilities from escooters being used on sidewalks (17% pre-information, 22% post-information), restricting the use of e-scooters in Toronto (12% pre-information, nine per cent post information), building more infrastructure for e-scooters and other similar uses (11% pre-information and post-information). Seven per cent rank being open and more permissive to dockless e-scooters first (five per cent post-information), and six per cent say the City should ban/not allow e-scooters both pre-information and post-information.
  • Toronto residents most frequently say the City should prioritize injuries and fatalities compared to other modes when evaluating an e-scooter pilot – Asked what the City of Toronto should prioritize when evaluating an e-scooter pilot if it were to allow e-scooters on public streets, Toronto residents most frequently ranked injuries and fatalities compared with other modes (31%) first, followed by impacts on all road users and the transportation system (25%), costs to the city for enforcement, dealing with litter/complaints, lawsuits, claims and staffing (15%), the environmental impacts like the lifecycle of e-scooters (11%), the number of trips taken and shifts in transportation mode used (10%), and social equity and demographics of users (eight per cent).

Perception of e-scooters

Over half of Toronto residents say they would feel comfortable or somewhat comfortable recommending that a loved on use an e-scooter, with younger residents feeling most comfortable. Toronto residents are more likely to say that using e-scooters is generally safe or somewhat safe than to say it is not safe or somewhat not safe, with younger respondents most likely to say that they are generally safe or somewhat safe. Results pre and post-information were consistent.

  • Over half of Toronto residents say they would be comfortable or somewhat comfortable recommending that a loved one use an e-scooter – Over one in two say they would be comfortable (19% pre-information, 17% post-information) or somewhat comfortable (36% pre-information, 37% post-information) recommending that a loved one use an e-scooter as a mode of transportation in Toronto if the City of Toronto were to allow e-scooters where bikes are allowed on roadways and bike lanes, while four in ten say they would be somewhat not comfortable (18% pre-information, 20% post-information) or not comfortable (21% pre-information and post-information). Six per cent are unsure.
  • Younger Toronto residents are more likely to say they would be comfortable recommending that a loved one use an e-scooter than older residents – Three in ten (30%) Toronto residents 55 years old or older say they would not be comfortable recommending that a loved one use an escooter as a mode of transportation in Toronto, compared to 18 per cent of 35 to 54 year olds and 13 per cent of 16 to 34 year olds.
  • Toronto residents are most likely to say that using e-scooters is generally safe or somewhat safe
    • Over half of Toronto residents say that using e-scooters is generally safe (11% pre-information, 10% post-information) or somewhat safe (44% pre-information, 42% post-information), while just over one in three say that it is generally somewhat not safe (21% pre-information, 24% post-information) or not safe (15% pre-information, 17% post-information). Nine per cent are unsure.
  • Younger Toronto residents and men are more likely to say that using e-scooters is generally safe – Just over seven in ten 16 to 34 year olds say that using e-scooter is generally safe (19%) or somewhat safe (52%), compared to under six in ten 35 to 54 year olds (13% safe, 46% somewhat safe) and just over four in ten 55 year olds and older (five per cent safe, 38% somewhat safe). Men (16% safe, 46% somewhat safe) are more likely to say that using e-scooters is generally safe compared to women (eight per cent safe, 43% somewhat safe).

Support for e-scooter initiatives

Toronto residents gave the highest intensity of support for the initiative that would require e-scooter riders to wear helmets and the lowest intensity of support for the initiative that would ban e-scooters in Toronto.

  • E-scooter riders having to wear helmets received the highest intensity of support from Toronto residents – Asked to rate a series of e-scooter initiatives on a scale from 1 to 10, with 1 being least supportive to 10 being highly supportive, Toronto residents gave the highest mean score to e-scooter riders having to wear helmets (mean of 8.8 out of 10), followed by having e-scooter rentals at Toronto Bike Share stations (mean of 7.0 out of 10) and having e-scooter rentals at public transit stations/stops (mean of 6.9 out of 10). Focusing a pilot downtown or in suburban areas received lower support (mean of 6.2 and 6.3, respectively), while not allowing e-scooters in Toronto like New York city’s Manhattan received the lowest support (mean of 5.4 out of 10).
  • Older Toronto residents were more likely to support initiatives that would ban e-scooters in Toronto; younger Toronto residents were more likely to support having e-scooter rentals at public transit and Bikeshare stations – Older respondents (55 plus) were more likely to support the initiative that would not allow e-scooters in Toronto than younger respondents (mean of 6.0 out of 10 for those 55 plus compared to 4.7 for those 16 to 34 years old), and were also more likely to support the initiative that would require e-scooter riders to wear helmets (mean of 9.3 out of 10 for those 55 plus compared to 8.2 for those 16 to 34 years old). Younger Toronto residents were more likely to support having e-scooter rentals at public transit stations/stops and at Bikeshare stations (mean or 7.3 and 7.4 out of 10 respectively for those 16 to 34 years old, compared to a mean of 6.6 out of 10, each, for those 55 and older).

Nanos conducted an online survey of 1010 residents of Toronto, 16 years of age or older, between January 23rd to February 1st, 2020. The results were statistically checked and weighted by age and gender using the latest Census information and the sample is geographically stratified to be representative of Toronto. Note: Charts may not add up to 100 due to rounding.

More Helpful Media Coverage and More Organizations Endorse the AODA Alliance Brief to the Ford Government on How to Meet the Needs of Students with Disabilities During the COVID-19 Pandemic

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

More Helpful Media Coverage and More Organizations Endorse the AODA Alliance Brief to the Ford Government on How to Meet the Needs of Students with Disabilities During the COVID-19 Pandemic

June 30, 2020

          SUMMARY

With the delight of summer and the ongoing terrible stress of COVID-19 both upon us, here is a grab-bag of latest news in our multi-front campaign for accessibility for people with disabilities. We wish one and all a safe, happy and accessible Canada Day.

1. Support Keeps Growing for the June 18, 2020 AODA Alliance Brief to the Ford Government on Protecting Students with Disabilities During the Transition to School Re-opening

An impressive list of 12 disability-related organizations have now endorsed the 19 recommendations to the Ford Government in the June 18, 2020 AODA Alliance brief on what needs to be done to meet the needs of students with disabilities during the ongoing COVID-19 crisis and the transition to school re-openings. Those organizations now include:

  1. March of Dimes of Canada
  2. Citizens with Disabilities Ontario
  3. Community Living Ontario
  4. Spinal Cord Injury Ontario
  5. The Canadian National Institute for the Blind
  6. the Inclusive Design Research Centre of the Ontario college of Art and Design University
  7. Physicians of Ontario Neurodevelopmental Advocacy
  8. Balance for Blind Adults
  9. The Fetal Alcohol Spectrum Disorder Network – Elgin, London, Middlesex, Oxford
  10. Ontario Parents of Visually Impaired Children (Views for the Visually Impaired)
  11. Ontario Autism Coalition
  12. Integration Action for Inclusion

As we announced on June 26,2020, our brief’s recommendations have also been endorsed by the Ontario Secondary School Teachers Federation. OSSTF is the union that represents thousands of public high school teachers. Thus our recommendations have a broad consensus of support from a diversity of voices within the front lines of the disability community and from teachers who work at the front lines of our education system.

It is not too late for you as an individual, or for an organization with which you are connected, to write the Ministry of Education to endorse the AODA Alliance’s June 18, 2020 brief on school re-openings. Email the Ontario Government at EDU.consultation@ontario.ca to support our June 18, 2019 brief. We’d welcome the chance to add more organizations to this list.

 2. What Has TVO Done to Fix Its Website Accessibility Problems?

The Ford Government has repeatedly announced that it has partnered with TVO to deliver online learning content to students during distance learning, while schools are closed due to COVID-19. Back on May 4, 2020, we made public the fact that there are significant accessibility problems with the online learning resources offered on the website of TVO, Ontario’s publicly-owned and operated public education TV network. This was revealed during the May 4, 2020 virtual town hall that was jointly organized by the AODA Alliance and the Ontario Autism Coalition on meeting the needs of students with disabilities during the COVID-19 crisis. We are proud that since then, over 1,600 people have watched that virtual town hall. It is still available online for you to watch, and for you to share with others to watch!

Since we revealed this problem, the AODA Alliance has expressed its concerns in detail to TVO in a 30-minute phone call on May 14, 2020 between AODA Alliance Chair David Lepofsky and the TVO vice president for digital content. The AODA Alliance followed this up with a detailed letter to TVO’s digital content vice president on May 21, 2020. We have also raised this issue at the highest levels within the Ministry of Education. The Ministry oversees TVO.

Since then, we have not heard a word from TVO. TVO has not told us of anything it has done, if it has done anything, to act on the serious accessibility problems we identified and the concrete recommendations for action that we offered.

 3. More Media on the Impact of COVID-19on People with Disabilities

For more than three months, our media has devoted most of its attention to the COVID-19 crisis. Despite that, it has been incredibly hard for the disability community to get sufficient and appropriate media attention on the disproportionate impact that COVID-19 has had on people with disabilities, and on the failure of our governments to effectively address the unmet needs of people with disabilities during this pandemic. We have tried hard and will continue to try hard to get the media to properly cover these issues.

Set out below are three good media reports that have accrued over the past weeks that we’ve wanted to share with you:

  1. An article in the June 23, 2020 Mississauga News on the barriers for people with disabilities that are threatened by Mississauga’s approach to allowing restaurants to open patios to serve the public. For practical suggestions on how to ensure such patios are accessible to people with disabilities, and don’t create barriers to people with disabilities, check out a list of tips from DesignAble Environments, an accessible design consulting firm.
  2. The May 6,2020 Global News report on the impact of COVID-19 on people with disabilities, and
  3. The May 5, 2020 report in QP Briefing on the virtual town hall organized by the AODA Alliance and the Ontario Autism Coalition on meeting the needs of students with disabilities during COVID-19.

 4. Delay and Delay and More Delay from the Ford Government

There have now been 516 days, or a full year and a half, since the Ford Government received the ground-breaking final report of the Independent Review of the implementation of the Accessibility for Ontarians with Disabilities Act by former Ontario Lieutenant Governor David Onley. The Government has announced no comprehensive plan of new action to implement that report. That makes even worse the serious problems facing Ontarians with disabilities during the COVID-19 crisis.

There have been fully 97 days, or over three months, since we wrote Ontario Premier Doug Ford on March 25, 2020 to urge specific action to address the urgent needs of Ontarians with disabilities during the COVID-19 crisis. He has not answered. The Premier’s office has not contacted us. The ordeal facing Ontarians with disabilities during the COVID-19 crisis is worsened by that delay.

Visit the AODA Alliance’s COVID-19 web page to see what we have been up to, trying to ensure that the needs of people with disabilities during the COVID-19 crisis are properly addressed. Send us your feedback! Write us at aodafeedback@gmail.com. Please stay safe!

          MORE DETAILS

 Mississauga News June 23, 2020

Originally posted at https://www.mississauga.com/news-story/10039099–waived-all-the-red-tape-mississauga-to-allow-more-bar-and-restaurant-patios-starting-wednesday/

‘Waived all the red tape’: Mississauga to allow more bar and restaurant patios starting Wednesday

Patios could be ‘navigational nightmare,’ accessibility advocate says

NEWS Jun 23, 2020 By Steve Cornwell Mississauga News

When Ontario allows Mississauga bars and restaurants to serve customers outdoors starting Wednesday, June 24, you may see proliferation of patios in the city.

Mississauga council is moving forward with a temporary bylaw relaxing restrictions and fees on restaurant patios in strip mall parking lots, public streets and on sidewalks.

Prior to the new bylaw, restaurants patios were permitted on private property in Mississauga’s downtown area, Port Credit or where the city has allowed them through a zoning variance.

The new rules apply to the city’s five business improvement areas and wherever restaurants have their own entrances.

Restaurant patios can extend for free once establishments reopen: province

Mississauga Mayor Bonnie Crombie said the move is meant to help restaurants and bars revive revenues impacted by the COIVD-19 pandemic.

“We’ve waived all the red tape,” she said. “We’ve waived all the fees and we’re just telling them to get ready because as soon as they get the green light from the province to open Phase 2 they can start serving.”

Peel Region, including Mississauga, is not yet in the province’s Stage 2 reopening phase, which allows restaurants and bars to host patrons on outdoor patios. The province will allow Peel to move to that stage June 24.

Until then, the city would continue to enforce COVID-19 emergency orders forbidding restaurants and bars from having services beyond takeaway and delivery, according to Mississauga’s planning commissioner, Andrew Whittemore.

Patios on sidewalks and on public streets would still require a temporary permit. Parking lot patios in strip malls would also need to be permitted by property managers.

Crombie also said inspectors will be out ensuring that the patios meet Mississauga’s building standards.

But accessibility advocate David Lepofsky said a sudden surge of new furniture on sidewalks could be a big proplem for individuals that use mobility devices or have low vision.

“For people like me who are blind, those patios that stick out on the sidewalk are just a big navigational nightmare in the best of times,” said Lepofsky, who chairs the Accessibility for Ontarians with Disabilities Act Alliance. “And they can be unpredictable. It’s there one day; it’s not there the next day.”

He said problems for people with accessibility needs could be intensified during the pandemic as there are more concerns around interacting with others for help to get around obstacles.

“Ordinarily if you got something that’s a little uncertain (in your path) you could just ask a stranger,” he said.

“But that means that I take your arm. Well, I don’t want to take your arm and you don’t want me taking your arm because now we’re not two metres apart.”

City council still needs to hold a July 8 planning and development meeting to officially pass the temporary bylaw. However, it voted to relax enforcement on patios that would be allowed under the new rule — after Mississauga enters Stage 2 — in the meantime.

Toronto is moving ahead with a similar program, CaféTO, which aims to streamline the placement of temporary sidewalk and curb lane patios, once permitted.

That program requires a minimum 2.1 metres of clearance for pedestrians and for any patio installation to be cane-detectable, meaning individuals with low or no vision can use their white-cane to navigate around it.

 Global News Online May 6, 2020

Originally posted at https://globalnews.ca/news/6906216/coronavirus-canadians-disabilities/

‘I need help’: Coronavirus highlights disparities among Canadians with disabilities – National

BY EMERALD BENSADOUN- GLOBAL NEWS

Prior to the novel coronavirus pandemic, 27-year-old Marissa Blake was rarely ever home. Now, Blake, who lives in Toronto supportive housing and needs assistance to walk, can only have one visitor a week for three hours and can’t see her friends in-person. An appointment to discuss surgery on her legs was cancelled, and her sleep and care schedule are in flux because her personal support workers keep changing.

“It’s difficult,” she said. “I feel like I’m in jail.” Disability advocates say B.C.’s woman’s death shows need for clearer COVID-19 policy. Her exercise program with March of Dimes Canada, a rehabilitation foundation for disabled persons, was cancelled, and Blake said she’s been less physically active than usual.

“It’s been really making me tight, really making me feel like I’m fighting with my body,” she said. “I can’t just get up and walk. I need help.”

But for Blake, isolation and exclusion are having the largest impact. “The biggest thing for me is support,” she said.

“I miss my friends. I miss interacting with people. Because when you look at a computer, it’s great but it’s not the same as seeing them face-to-face.”

One in four Canadians — about 25 per cent of the population — has a disability, according to the latest data from Statistics Canada. Despite this, advocates say they are often left out of emergency planning.

David Lepofsky, who chairs the Accessibility for Ontarians with Disabilities Act Alliance, likened the situation to a fire raging inside of an apartment building complex, where the people inside are alerted by a fire alarm and loudspeaker that tells them to exit by taking designated stairs illuminated by clearly-indicated markers.

A person who is deaf wouldn’t hear the fire alarm. A person in a wheelchair would be trapped inside. And those designated markers will do nothing for someone who can’t see. Unless they receive support, Lepofsky said anyone with disabilities living in the building will likely not survive. Similarly, he said the government has applied a mostly one-size-fits-all approach to COVID-19 measures that offer little support the country’s disabled.

“It’s because of their disability and it’s because no one planned for them in the emergency,” he said.

Often, Canadians with more severe disabilities will get placed in long-term care facilities, where health officials said over 79 per cent of COVID-19-related deaths occur. Lepofsky said that poses a danger to those with disabilities, as well. He said comparable problems arise in Ontario’s virtual elementary and secondary education system, called Learn At Home. The program isn’t user-friendly for students with disabilities who may be deaf, blind or unable to use a mouse, said Lepofsky. Despite making up upwards of one-in-six of the student population, he said much of the program was made with only able-bodied students in mind. When asked about this, the Ontario Ministry of Education said in a statement to Global News that Education Minister Stephen Lecce had convened two “urgent” discussions with the Minister’s Advisory Council on Special Education where they discussed how best to support students and families during this period and has consulted the K-12 Standards Development Committee struck by the Ministry for Seniors and Accessibility. They said all resources were reviewed for accessibility based on the standards of the Accessibility for Ontarians with Disabilities Act (2005), but that school boards were ultimately responsible for making decisions on the use of digital learning resources and collaboration tools to support students’ learning online.

“The Ministry has provided clear direction to school boards on how to support students with special education and mental health needs during school closures,” they said.

March of Dimes Canada president Len Baker said even before the existence of COVID-19, people with disabilities were facing “significant” challenges every day, including already-existing barriers like attitudinal ones about disability.

“Those historic barriers become exacerbated during a time such as this pandemic, where now not only do they have to address the issues that they need to be able to complete their goals and feel connected to the community, but with social distancing and the isolation that the pandemic brings, it causes us concern that many individuals are going to feel even a greater sense of isolation and loneliness during this time,” he said.

Baker said around 50,000 students with disabilities rely on the organization for opportunities to read, learn skills, get out in the community, to participate and connect with others. But since the pandemic started, he said they’ve had to revamp their services to be available virtually or over the phone.

Marielle Hossack, press secretary to the minister of employment, workforce development and disability inclusion, said in a statement to Global News the federal government has increased human resources for support services for Canadians with disabilities over the phone and online, and is looking into implementing ALS and LSQ into current and future emergency responses.

The federal government has also established the COVID-19 Disability Advisory Group, which is comprised of experts in disability inclusion, that provide advice on “real-time live experiences of persons with disabilities.” Hossack wrote the group discusses disability-specific issues, challenges and systemic gaps as well as strategies, measures and steps to be taken.

But some advocates don’t think that’s enough.

Karine Myrgianie Jean-François, director of operations at DisAbled Women’s Network Canada, told Global News that despite making up such a large percentage of the population, many are not getting support services typically provided by provincial health departments or social services. This is due to a lot of factors, she said — because there’s a lack of protective equipment, because people are getting sick, because it’s too dangerous. For children with disabilities, Jean-François said the pandemic means they’re often relying on their parents for mental and physical support they would have received at school.

“A lot of the measures that have been made to prepare for this pandemic have been done to think about the greatest number of people, which often means that we forget about people who are more marginalized and people who have a disability are included in that,” she said.

Jean-François said that includes the Canadian Emergency Response Benefit (CERB). Currently, 70 per cent of Canadians eligible for the disability tax credit will receive the enhanced GST/HST benefit based on their income levels due to COVID-19, but that may not add up to much for Canadians with disabilities who may also need to hire food deliveries, in-house care, or those that would be deemed ineligible for the aid because they’re unable to work.

The money “doesn’t go as far as it used to,” she said. When factored to include the rising cost of living, Jean-François said most Canadians with disabilities — many of whom are already living at or near the poverty line — end up barely scraping by. “We’re not all equal under COVID-19,” she said. “We need to be looking at… who stands up to make sure that people get what they need, and how to make sure that they’re supported in what they’re doing both financially but also mentally, because it’s it’s really hard work to support people who were left alone.”

 QP Briefing May 5, 2020

Some Ontario e-learning doesn’t work for students with disabilities

Jack Hauen

Some TVO and ministry course content isn’t accessible to people with low vision, said Karen McCall, a professor who teaches about accessible media at Mohawk College and owns an accessible design firm. She was one of several experts who spoke at a virtual town hall hosted on Monday by AODA Alliance Chair David Lepofsky, a member of the province’s K-12 AODA standards committee, and Ontario Autism Coalition President Laura Kirby-McIntosh, who is also a high school teacher.

None of the stories in the “math storytime” section worked for McCall, who has low vision herself and uses a screen reader. She couldn’t find any homework in the “homework zone.”

Teachers did a good job of describing what was going on in the videos she watched, until they didn’t, she said. For instance, one math teacher didn’t read out the main formula students were to use.

“She said this formula equates to one quarter, but if I’m a student who’s trying to learn this, I have no idea what equates to one quarter,” McCall said.

Another gap came during a science class. “Everything was fine, everything was explained, until the teacher said, ‘Watch what happens,’ and then did not describe what was happening,” she said.

But the biggest problems came with the ministry of education’s own course preview site, McCall said, where her screen reader couldn’t make heads or tails of what it said.

“If they’re going to rely on this kind of content, they’ve got to make sure it’s properly accessible,” Lepofsky said of the provincial government.

Kirby-McIntosh noted that Zoom is the most accessible streaming service, but some school boards have banned teachers from using it. More top-down direction is needed to avoid these types of errors, she said.

Other experts during the town hall provided tips for educators and parents such as making sure videos were the highest quality possible, so kids with hearing loss can better lip read; and sticking to routines as much as possible, which helps many kids on the autism spectrum.

Education Minister Stephen Lecce has held two meetings with the Minister’s Advisory Council on Special Education (MACSE) during the pandemic, and is also consulting the K-12 standards development committee that Lepofsky sits on, said ministry of education spokesperson Ingrid Anderson.

Lepofsky confirmed that he’ll be speaking with Lecce on Wednesday.

“TVO has been working to make all their online content and resources accessible and compliant to AODA regulations. The Ministry will continue to work with the Agency to consider ways to enhance accessibility beyond the AODA requirements,” Anderson said in a statement. “School boards remain independently accountable for making decisions on the use of digital learning resources and collaboration tools to support students’ learning online.”

The minister’s advisory committee is “no substitute for consulting extensive grassroots disability community participation that is needed,” the AODA Alliance wrote in an April 29 letter to Lecce. A number of positions on the committee remain vacant, the group said. “Also, MACSE is designed to focus on ‘special education’ which is not addressed to students with all kinds of disabilities, due to the Government’s unduly narrow definition of special education students.”

The town hall’s last guest was Jeff Butler, the acting assistant deputy minister of student support and field services in the ministry of education. He pointed to actions the ministry has taken already, like directing school boards to consult with their special education committees and honour individual education plans; as well as working with boards to distribute assistive technology that usually lives in schools to families.

The ministry has also hosted a series of webinars for teachers to learn about special education during the pandemic. About 500 educators have attended them so far, and more are planned, he said.

Responding to McCall’s feedback about sites not working with screen readers, he said: “I absolutely am listening on that and will take that input back. It is important to us that those resources that are there are accessible for students with disabilities and students with special needs.”

He promised to continue to engage with experts, saying that their input has been “incredibly valuable.”

It’s critical for the government to carry these lessons through to when schools eventually re-open, Lepofsky said.

For instance, some students won’t be able to socially distance or wear masks due to their disabilities, if they require a close by aide or are hypersensitive to touch. “We can’t tell those kids, ‘Oh, sorry kid, you stay home, everybody else is going back to school.’”

A “surge” in education hours will be needed for some kids with disabilities, who will have fallen further behind some of their peers, Lepofsky said, giving the example of kids learning to read braille who require hand-over-hand instruction that’s impossible to conduct online.

“This is really something we can’t leave to every single school board again to try to reinvent the same wheel,” he said, calling for the provincial government to “take on leadership here.”

Kirby-McIntosh ended the stream with a message for Lecce: don’t just assemble a “spiffy webpage with a blizzard of links,” but consult with experts and provide school boards with top-down direction on best practices.

“Please learn from this town hall,” she said, and gather ideas from the front-line people teaching kids with disabilities during the pandemic.

“The premier committed at the beginning of this crisis to protecting those who are most vulnerable,” she said. “Well, surely a third of a million Ontario students with disabilities are among those most vulnerable.”

The Ontario Secondary School Teachers Federation OSSTF and Ten Disability Organizations Have Already Endorsed the AODA Alliance’s 19 Recommendations on What the Ontario Government Must Now Do to Meet the Needs of A Third of A Million Students with Disabilities in Ontario Schools

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

The Ontario Secondary School Teachers Federation OSSTF and Ten Disability Organizations Have Already Endorsed the AODA Alliance’s 19 Recommendations on What the Ontario Government Must Now Do to Meet the Needs of A Third of A Million Students with Disabilities in Ontario Schools

June 26, 2020

          SUMMARY

Last week, the AODA Alliance made public a detailed brief showing the Ontario Government what it must now do to address the needs of a third of a million students with disabilities in Ontario schools during the transition to schools eventually re-opening, hopefully this fall. This brief draws on grassroots feedback we have received from many sources both before and during the COVID-19 crisis.

We are delighted that in just over one week since we submitted it to the Ontario Government, the AODA Alliance’s June 18, 2020 brief on what should be done to meet the needs of students with disabilities during the COVID-19 crisis has already won important endorsements. As an important step forward, our brief’s 19 recommendations, set out below, were just endorsed by the Ontario Secondary School Teachers Federation OSSTF. OSSTF is the union that represents thousands of secondary school teachers who work at the front lines in Ontario’s public schools. OSSTF’s June 26, 2020 public statement, sent to the AODA Alliance, says:

“Supporting students with disabilities – A statement from OSSTF/FEESO

June 26, 2020 – Over the past four months, educators have done their best to work with students in this unprecedented environment of emergency remote learning. The start of the new school year in September will come quickly, and it is critical that the Ontario government prepare a plan for reopening schools that meets the learning needs of all students.

It is essential for the government to ensure that they meet the learning needs of the thousands of students with disabilities in our school system now, and during the transition to school reopening.

OSSTF/FEESO supports the 19 recommendations of the Accessibility for Ontarians with Disabilities Act Alliance as outlined in its June 18, 2020 brief on this topic. These recommendations effectively speak to the needs of students with disabilities, their families, and those of us committed to providing those students and all students with an excellent education.”

Seven years ago, when we were in the midst of our multi-year campaign to get the Ontario Government to agree to create an Education Accessibility Standard under the Accessibility for Ontarians with Disabilities Act to tackle the many barriers that impede students with disabilities  in Ontario’s education system, We were fortified and helped in our efforts when the OSSTF wrote the Ontario Government to support our call for an Education Accessibility Standard. Several other teachers unions supported our efforts back then.

As well, we have been notified that ten key organizations in the disability community have endorsed our brief’s recommendations, including March of Dimes of Canada, Citizens with Disabilities Ontario, Community Living Ontario, Spinal Cord Injury Ontario, The Canadian National Institute for the Blind, the Inclusive Design Research Centre of the Ontario college of Art and Design University, Physicians of Ontario Neurodevelopmental Advocacy, Balance for Blind Adults, the Fetal Alcohol Spectrum Disorder – Elgin, London, Middlesex, Oxford Network), and Ontario Parents of Visually Impaired Children (Views for the Visually Impaired).

We commend all those who have already supported our brief. We urge other organizations and individuals, whether within the disability community or not, to email the Ontario Government at EDU.consultation@ontario.ca to support our June 18, 2019 brief. Both individuals and organizations can write the Ontario Government to voice this support. Please help us get more individuals and organizations to do so.

There have been 512 days since the Ford Government received the ground-breaking final report of the Independent Review of the implementation of the Accessibility for Ontarians with Disabilities Act by former Ontario Lieutenant Governor David Onley. The Government has announced no comprehensive plan of new action to implement that report. That makes even worse the serious problems facing Ontarians with disabilities during the COVID-19 crisis.

There have been 93 days, or over three months, since we wrote Ontario Premier Doug Ford on March 25, 2020 to urge specific action to address the urgent needs of Ontarians with disabilities during the COVID-19 crisis. He has not answered. The Premier’s office has not contacted us. The ordeal facing Ontarians with disabilities during the COVID-19 crisis is worsened by that delay.

Visit the AODA Alliance’s COVID-19 web page to see what we have been up to, trying to ensure that the needs of people with disabilities during the COVID-19 crisis are properly addressed. Send us your feedback! Write us at aodafeedback@gmail.com. Please stay safe!

          MORE DETAILS

List of Recommendations in the AODA Alliance’s June 18, 2020 Brief to the Ontario Government

#1. The Ministry of Education should immediately develop, announce and implement a comprehensive plan for meeting the learning needs of students with disabilities during the COVID-19 crisis. This plan should include during this time of distance learning, during an eventual return to school, and in case of a future COVID-19 wave that requires another round of school closures. To the extent possible, this plan should be an integral part of the Ministry’s overall plan it is developing for school re-opening.

#2. The Ministry of Education should immediately establish a “Students with Disabilities Education Command Table” to oversee the development and implementation of a Government action plan for meeting the urgent learning needs of students with disabilities during the COVID-19 crisis, and to swiftly react to issues for students with disabilities as they arise.

#3. The Ministry of Education should immediately issue a policy direction to all school boards, imposing restrictions on when and how a principal may exclude a student from school, including directions that:

  1. a) During the re-opening at schools, students with disabilities have an equal right to attend schools for the entire school day as do students without disabilities. The power to refuse to admit a student to school for all or part of the school day should not be used in a way that disproportionately burdens students with disabilities or that creates a barrier to their right to attend school.
  1. b) A principal who refuses to admit a student to school during the school re-opening process should be required to immediately give the student and their family written notice of their decision to do so, including written reasons for the refusal to admit, the duration of the refusal to admit and notice of the family’s right to appeal this refusal to admit to the school board.
  1. c) A principal who refuses to admit a student to school for all or part of the school day should be required to immediately report this in writing to their school board’s senior management, including the reasons for the exclusion, its duration and whether the student has a disability. Each school board should be required to compile this information and to report it on a bi-monthly basis to the board of trustees, the public and the Ministry of Education (with individual information totally anonymized). The Ministry should promptly make public on a provincial basis and a school board by school board basis the information it receives on numbers, reasons and durations of refusals to admit during post- COVID-19 school re-opening.

#4. For each student with disabilities, each school board should now:

  1. a) Contact the family of each student with disabilities, preferably by phone rather than email, to discuss and identify the student’s progress during the school shutdown, the student’s specific and individualized disability-related deficits and needs arising from and during distance learning due to the COVID-19 crisis and the student’s needs and challenges related to eventual transition to school (including any vulnerabilities of other family members due to the COVID-19 pandemic), and;
  1. b) Create a COVID-19 IEP to set specific goals and activities to effectively address their disability-related needs during distance learning, and in connection with transition back to school.

#5. The Ministry of Education should assign staff to assist its Students with Disabilities Command Table by serving as a central rapid response team to receive feedback from school boards on recurring issues facing students with disabilities and to help find solutions to share with school boards.

#6. The Ministry should direct that each school board shall establish a similar central rapid response team within the board to receive and act on feedback from teachers, principals and families about problems they are encountering serving students with disabilities during the COVID-19 period, that will quickly network with other similar offices at other school boards, and that can report recurring issues to the Ministry.

#7. The Ministry of Education should plan for, fund and coordinate the provision by school boards of a surge in specialized disability supports to those students with disabilities who will need them when students return to school.

#8. The Ministry of Education’s plan for school re-openings must include detailed directions on required measures for ensuring that students with disabilities are safe from COVID-19 during any return to school. This requires additional planning in advance by school boards and additional funding to school boards to hire and train the additional SNAs and EAs they will need to ensure the safety of students with disabilities. It also requires safeguards to ensure that an EA or SNA does not work at multiple sites and risk transmitting the COVID-19 virus from one location to another.

#9. The Ministry of Education should immediately engage an arms-length digital accessibility consultant to evaluate the comparative accessibility of different digital meeting platforms available for use in Ontario schools. This should involve end-user testing. The Ministry should immediately send the resulting report and comparison to all school boards and make it public. This should be revisited as the fall approaches, in case there have been changes to the relative accessibility of different virtual meeting platforms. The Ministry should direct which platforms may be used and which may not be used for virtual or synchronous classes or parent/school meetings, based on their accessibility.

#10. The Ministry of Education should immediately direct TVO to make its online learning content accessible to people with disabilities, and to promptly make public a plan of action to achieve this goal, with specific milestones and timelines.

#11. The Ministry of Education should make public a plan of action to swiftly make its own online learning content accessible for people with disabilities, setting out milestones and timelines, and should report to the public on its progress.

#12. The Ministry of Education should direct all its staff and all school boards that whenever making digital information public in a PDF format, it must at the same time also be made available in an accessible format such as an accessible MS Word document.

#13. The provincial plans for return to school should include these features:

  1. a) Rather than having all students across Ontario return to school at once, in a one-size-fits-all strategy, the Ontario Government should lead a strategic return to school process, trying out different approaches to see what works most effectively. For example, opening a few schools first to detect recurring problems and plan to prevent them would assist with opening of other schools across Ontario.
  1. b) The COVID-19 IEP of each student with disabilities should tailor their plans for the return to school to meet their individual needs. Students with disabilities who need this accommodation should be afforded a chance to return to the school facility early so they can be oriented to any changes to which they need to adjust in the COVID-19 era.

#14. The Ministry of Education should immediately put in place an effective proactive team to gather teaching strategies for students with disabilities during distance learning from frontline teachers, parents and school boards and make these easily available to the frontlines on an ongoing basis, in formats that are accessible to people with disabilities. These should be supplemented by strategies that the Ministry researches from other jurisdictions that have innovated creative solutions.

#15 The plans for return to school must include measures for ensuring that those who cannot return to school at the same time can secure effective distance learning, including home visits (with social distancing) from teaching staff.

#16. The Ministry of Education should prepare teaching materials for teachers and parents to use, addressing different disability-related learning needs, for preparing students with disabilities for the return to school, to address such changes as social distancing.

#17. The Ministry of Education should create, fund and effectively enforce new standards for safe bussing practices for students with disabilities during any return to school while COVID-19 remains a community threat.

#18. Each school board should ensure that its Special Education Advisory Committee (SEAC) meets at least once per month, and preferably more often, during the COVID-19 crisis, to give its board ongoing input into planning for students with disabilities during the COVID-19 crisis.

#19. To get the most from the volunteer work of SEACs around Ontario, the Ministry of Education should:

  1. a) Create and maintain a listserv or other virtual network of all Ontario SEACs, to enable them to share their efforts with all other SEACs around Ontario, and
  1. b) Frequently gather input from SEACs around Ontario about the experiences of students with disabilities during the COVID-19 crisis.

Please Email the Ontario Government to Support the AODA Alliance’s Finalized Brief on Measures Needed to Meet the Needs of Students with Disabilities Now and During the Transition to Schools Re-Opening

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

Please Email the Ontario Government to Support the AODA Alliance’s Finalized Brief on Measures Needed to Meet the Needs of Students with Disabilities Now and During the Transition to Schools Re-Opening

June 18, 2020

          SUMMARY

Working at warp speed, the AODA Alliance has finalized and submitted its brief to the Ontario Government on what must be done to meet the needs of at least one third of a million students with disabilities in kindergarten to Grade 12 now and during the eventual transition to schools re-opening. We set out that 23-page brief below.

We invite and encourage you to email the Ontario Government right away to support our brief’s 19 recommendations. Those recommendations are set out and described throughout the brief. To make it easier for you, at the end of the brief is an appendix that lists all the recommendations together in one place.

You can support us by emailing the Government at this address: EDU.consultation@ontario.ca If you are part of a disability community organization, please get your organization to write the Government to support our recommendations. Of course, we encourage you to add any thoughts, experiences or recommendations that you wish.

It is good if you can use your own words when you write the Government. If you don’t have time, you might just wish to say something like this:

“I support the recommendations made in the AODA Alliance’s June 18, 2020 brief to the Ontario Government on what needs to be done to meet the needs of students with disabilities now and during the transition to re-opened schools.”

We thank everyone who took the time to read over the draft of this brief that we circulated for comment on June 11, 2020. We got fantastic feedback. We drew heavily on that feedback as we finalized this brief.

This finalized brief makes all the 17 recommendations that were in our draft brief (with some minor improvements) with one exception. Based on feedback we received, we removed our draft recommendation 13(b) in the draft brief. It had recommended that schools re-open for vulnerable students first. Our finalized brief replaced that recommendation with this, in #13(b):

“The COVID-19 IEP of each student with disabilities should tailor their plans for the return to school to meet their individual needs. Students with disabilities who need this accommodation should be afforded a chance to return to the school facility early so they can be oriented to any changes to which they need to adjust in the COVID-19 era.”

This finalized brief adds two new recommendations, 18 and 19. These propose that the Government and school boards across the board make more use during the COVID-19 pandemic of the Special Education Advisory Committee that each Ontario school board is required to have, if they are not doing so now.

In addition to writing the Government to support our recommendations, we encourage you to send this brief to your local school board and school trustees. Encourage them to take the actions we recommend in this brief.

For more background on these issues, please visit the AODA Alliances COVID-19 web page and our education web page.

Stay safe, and let us know what you do to help us press for these reforms. Email us at aodafeedback@gmail.com

          MORE DETAILS

A Brief to the Ontario Government on Key Measures Needed to Address the Learning Needs of Students with Disabilities in Ontario During the COVID-19 Crisis Both During Distance Learning and During The Transition to the Eventual Re-Opening of Schools

Submitted by the Accessibility for Ontarians with Disabilities Act Alliance

www.aodaalliance.org aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

To: The Hon. Stephen Lecce, Minister of Education

Via email EDU.consultation@ontario.ca

June 18, 2020

 Introduction

The AODA Alliance submits this brief to the Minister of Education for Ontario, in response to the Ministry of Education’s public consultation on the transition to school re-opening during the COVID-19 pandemic.

The AODA Alliance is a voluntary non-partisan grassroots coalition of individuals and organizations. Our mission is:

“To contribute to the achievement of a barrier-free Ontario for all persons with disabilities, by promoting and supporting the timely, effective, and comprehensive implementation of the Accessibility for Ontarians with Disabilities Act.”

To learn about us, visit: https://www.aodaalliance.org.

Our coalition is the successor to the Ontarians with Disabilities Act Committee. The ODA Committee advocated more than ten years for the enactment of strong, effective disability accessibility legislation. Our coalition builds on the ODA Committee’s work. We draw our membership from the ODA Committee’s broad, grassroots base. To learn about the ODA Committee’s history, visit: http://www.odacommittee.net.

We have been widely recognized by the Ontario Government, by all political parties in the Ontario Legislature, within the disability community and by the media, as a key voice leading the non-partisan campaign for accessibility in Ontario. In every provincial election since 2005, parties that made election commitments on accessibility did so in letters to the AODA Alliance.

Among our many activities, we led a multi-year campaign to get the Ontario Government to agree to develop an Education Accessibility Standard under the AODA to tear down the many barriers that impede students with disabilities in Ontario’s education system. Our years of efforts to advocate for accessibility for students with disabilities are documented on our website’s education page.

Our efforts and expertise on accessibility for people with disabilities have been recognized in MPPs’ speeches in the Ontario Legislature, and beyond. Our website and Twitter feed are widely consulted as helpful sources of information on accessibility efforts in Ontario and elsewhere. We have achieved this as an unfunded volunteer community coalition.

The Government must pay special heed to the input it receives from the disability community including parents of students with disabilities . Input to the Government from other organizations can fail to effectively address the specific experience and needs of students with disabilities . The recommendations in this brief are gathered together in a list in the appendix appearing at the end of this brief. Our position in this brief is summarized as follows:

  1. a) The COVID-19 crisis has imposed disproportionate added hardships on people with disabilities. As part of this, it has led to disproportionate, serious hardships being inflicted on students with disabilities in Ontario schools. These hardships are exacerbated by no small part by serious pre-existing problems and disability barriers that have faced students with disabilities for years in Ontario’s education system, which have been made even worse for too many students with disabilities during the COVID-19 pandemic.
  1. b) In this brief we address the needs of all students with disabilities, using the inclusive definition of “disability” in the Ontario Human Rights Code and the Accessibility for Ontarians with Disabilities Act . We do not limit our recommendations to the narrower group of students whose disability falls in the narrower definitions of “special education “ or “exceptionality” that the Ministry of Education uses.
  1. c) To date, the provincial response to the problems facing students with disabilities during the COVID-19 pandemic has been substantially insufficient. The AODA Alliance offers 19 recommendations in this brief, to effectively address this, starting now and into the fall. Our fuller recommendations for comprehensive and long term reforms in the form of a strong and effective Education Accessibility Standard are set out in the AODA Alliance’s October 10, 20-19 Framework for the promised Education Accessibility Standard.
  1. d) While students are not able to go to school this spring due to the COVID-19 crisis, students with disabilities are experiencing wildly different learning experiences. Some are making good progress. Some are making much less progress. Some are making no progress or are losing ground. Some are getting extensive educational supports from their school board. Some are getting much less support. Some are getting little if any support. Conditions and supports can vary widely, even within the same school board and by students with the same disability.
  1. e) There is a pressing need for a comprehensive Ministry of Education plan of action to address the needs of students with disabilities during the COVID-19 crisis.
  1. f) There is a need for a provincial “Students with Disabilities Command Table” at the Ministry of Education.
  1. g) The Ministry must prevent a rash of principals refusing to admit some students with disabilities to school when schools re-open.
  1. h) There is a need for specific COVID-19 Individual Education Plans for individual students with disabilities before and during the transition to return to school.
  1. i) There is a need for Provincial and School Board Rapid Response Teams to be established to address recurring urgent needs of students with disabilities.
  1. j) A surge of specialized supports for students with disabilities is needed when schools re-open.
  1. k) School boards must plan for the needs of students with disabilities who cannot themselves ensure social distancing.
  1. l) The Ministry must ensure the full accessibility of digital platforms used for remote classes or “synchronous learning”.
  1. m) The Ontario Government must immediately ensure the digital accessibility of Ontario Government and TVO online learning resources.
  1. n) The Ministry of Education and school boards must stop making some learning resources available only in PDF format as this creates accessibility barriers.
  1. o) One size fits all does not fit for return to school.
  1. p) There is a need for a rapid method to spread the word to teachers and parents about effective teaching strategies for students with disabilities during COVID-19.
  1. q) Distance learning must be effectively provided for students who cannot return to school right away when schools re-open.
  1. r) The Ministry of Education should now create provincial resources for parents to prepare their students for the return to school.
  1. s) New protocols are needed for safe school bussing for students with disabilities.
  1. t) The Ministry should ensure the very active engagement of each school board’s Special Education Advisory Committee.

This brief builds on extensive involvement of the AODA Alliance during the COVID-19 crisis, advocating for the needs of people with disabilities across society. On June 11, 2020, we made public a draft of this brief, and solicited public input on it. We were very gratified by the supportive and helpful feedback we received. We have drawn heavily on that feedback to produce this finalized brief. We are urging one and all to share their own advice and recommendations with the Ontario Government during this important consultation.

 1. Pressing Need for A Comprehensive Ministry of Education Plan of Action to Address Needs of Students with Disabilities During the COVID-19 Crisis

Since the COVID-19 crisis began, the AODA Alliance has repeatedly urged the Ontario Government to develop and announce a comprehensive plan to meet the needs of students with disabilities during the COVID-19 crisis. This has been needed so over 70 school boards don’t have to each re-invent the wheel in deciding what the needs of students with disabilities are and how best to meet them. To date, the Ontario Government has not done what we have urged.

The need for this comprehensive provincial plan remains pressing during the period of distance learning due to school closures. It is also needed to ensure that students with disabilities’ needs are met across Ontario when schools eventually re-open. Ontario needs to also be prepared in the event of the realistic possibility that distance learning will have to continue in the fall, either because school re-opening is further delayed, or because a second wave of COVID-19 would require another round of school closures.

To date, the Ontario Government has primarily focused its education strategy during the COVID-19 pandemic on students without disabilities. Almost as an afterthought, it then reminded school boards that they should also accommodate students with special education needs.

The plan for students with disabilities should, to the extent possible, be included in the Ministry’s overall plan for school re-opening.

We therefore recommend that:

#1. The Ministry of Education should immediately develop, announce and implement a comprehensive plan for meeting the learning needs of students with disabilities during the COVID-19 crisis. This plan should include during this time of distance learning, during an eventual return to school, and in case of a future COVID-19 wave that requires another round of school closures. To the extent possible, this plan should be an integral part of the Ministry’s overall plan it is developing for school re-opening.

 2. Need for a Provincial “Students with Disabilities Command Table”

To deal with the need for rapid planning during the COVID-19 crisis, the Ontario Government has commendably set up its own “command tables” to deal with critical areas, like health care planning and planning for the safe operation of the economy during this crisis. This enables the Government to have critical expertise at the table to make rapid and key decisions.

There is a pressing need for a “students with disabilities command table” within the Government to plan for the learning needs of students with disabilities during the COVID-19 pandemic. No such table or concentrated expertise centre exists now within Ontario’s Ministry of Education. We have been pressing for this for three months. That table needs to be staffed by professionals with focused expertise on providing education to students with disabilities.

This is not meant to be an advisory or consultative table. It needs to be a planning and implementation table that can quickly and nimbly make decisions and effectively connect with the frontlines in the education system, where the action is.

This need is not fulfilled by the Minister of Education having had some consultative meetings with the Minister’s Advisory Committee on Special Education (MACSE), which still has vacancies, or with the AODA K-12 Education Standards Development Committee. Those bodies are only advisory. They do not have the capacity of a Ministry command table. Of course, it is good that they have been consulted.

We therefore recommend that:

#2. The Ministry of Education should immediately establish a “Students with Disabilities Education Command Table” to oversee the development and implementation of a Government action plan for meeting the urgent learning needs of students with disabilities during the COVID-19 crisis, and to swiftly react to issues for students with disabilities as they arise.

 3. Preventing a Rash of Refusals to Admit Students with Disabilities to School When Schools Re-Open

Ontario’s Education Act lets a school principal refuse to admit to school any “person whose presence in the school or classroom would in the principal’s judgment be detrimental to the physical or mental well-being of the pupils…”. Disability advocates have repeatedly criticized this as an excessive, arbitrary and unfair power. The Education Act and the Ministry of Education leave to school boards and individual principals an extremely wide discretion over when, how and why to exclude a student from school under this power. The Education Act does not even require principals to give a parent their reasons for excluding a student from school. It does not cap the duration of the student’s exclusion from school. It does not require a school board or the Ministry to keep track of how often or why students are excluded from school under this power.

Disproportionately, this excessive power has been used against students with disabilities, leading them too often to be excluded from school altogether or allowing them to attend school only for reduced hours. Long before the COVID-19 crisis, parents’ and students’ advocates have called for this power to be reduced and regulated. See for example the January 30, 2019 joint news release by the AODA Alliance and the Ontario Autism Coalition. To date, the Ontario Government has not made any significant reform of this power.

In September 2018, the Ontario Human Rights Commission released an updated policy on accessible education for students with disabilities. Its recommendations to the Ontario Government included, among other things:

“9. Identify and end the practice of exclusion wherein principals ask parents to keep primary and secondary students with disabilities home from school for part or all of the school day (and the role that an improper use of section 265(1)(m) of the Education Act may be playing in this practice).”

There is a serious risk that some principals will feel at liberty to use this power to exclude some students with disabilities from school during school re-openings in the midst of the COVID-19 pandemic, especially before any effective vaccine is invented and widely available. This is especially so if school boards do not now effectively plan for the inclusion and accommodation of students with disabilities at school during the transition to school re-opening. They may do so either because they don’t know how to accommodate some students with disabilities during social distancing, or because the Ontario Government and/or their school board has not given them the staffing, directions and resources they need to be able to effectively include and accommodate those students at school for part or all of the school day. Such exclusions from school raise serious human rights concerns and are contrary to the student’s right to an education.

With all the uncertainties and pressures anticipated during the transition back to school, a principal can be expected to feel a real temptation to use the power to refuse to admit such students to school during a COVID-19 school re-opening. This is so because it would seem to solve the problem of having to plan for those students’ needs at school.

The need to reform practices regarding a school principal’s power to refuse to admit a student to school for part or all of the school day has therefore become even more pressing in light of the COVID-19 pandemic. The AODA Alliance considers this a major priority. It is essential that school re-openings this fall do not lead to a rash of principals’ refusals to admit any number of students with disabilities to school. Such a rash of exclusions would thereby create two classes of students, those allowed to return to school and those who are excluded from school, especially if this disproportionately divides along disability lines.

The Ontario Government has commendably been willing to give directions to a school board about the use of its power to refuse to admit students to school in other contexts. It can and should do so here as well. The Ontario Ministry of Education has very recently given directions to the Peel District School Board to keep and report data on exclusions of students from school by race. In directive number 9, the Ministry stipulated that:

“The Board shall centrally track disaggregated race-based data on suspensions (in-school and out-of-school), expulsions and exclusions, and report publicly through the Annual Equity Accountability Report Card.”

We therefore recommend that:

#3. The Ministry of Education should immediately issue a policy direction to all school boards, imposing restrictions on when and how a principal may exclude a student from school, including directions that:

  1. a) During the re-opening at schools, students with disabilities have an equal right to attend schools for the entire school day as do students without disabilities. The power to refuse to admit a student to school for all or part of the school day should not be used in a way that disproportionately burdens students with disabilities or that creates a barrier to their right to attend school.
  1. b) A principal who refuses to admit a student to school during the school re-opening process should be required to immediately give the student and their family written notice of their decision to do so, including written reasons for the refusal to admit, the duration of the refusal to admit and notice of the family’s right to appeal this refusal to admit to the school board.
  1. c) A principal who refuses to admit a student to school for all or part of the school day should be required to immediately report this in writing to their school board’s senior management, including the reasons for the exclusion, its duration and whether the student has a disability. Each school board should be required to compile this information and to report it on a bi-monthly basis to the board of trustees, the public and the Ministry of Education (with individual information totally anonymized). The Ministry should promptly make public on a provincial basis and a school board by school board basis the information it receives on numbers, reasons and durations of refusals to admit during post- COVID-19 school re-opening.

 4. Need for Specific COVID-19 Individual Education Plans for Individual Students with Disabilities Before and During Transition to Return to School

For each student with disabilities, distance learning during COVID-19 will have created different deficits and challenges. The transition back to school will present challenges and needs that will vary from student to student.

Students’ IEPs were all written earlier this past school year while students were in school. They were written with no contemplation of the COVID-19 crisis or the challenges and hardships of distance learning and then of a later transition back to school. All students with disabilities will need their IEP modified to address these unforeseen needs.

As an immediate measure, students with disabilities each now need a customized COVID-19 –specific IEP to be created and implemented. This should not be limited to students whose disability fits within the narrow and incomplete definition of “exceptionality” in Ontario, which leaves out some disabilities. It should be provided to any student that has a disability within the meaning of the Ontario Human Rights Code. It should not be limited to students whose disability has been formally “identified” at an Identification and Placement Review Committee.

This COVID-19 IEP would not replace the student’s existing IEP. It would not replace the usual IEP development process when school is back in usual operation. This COVID-19 IEP is meant as an immediate, temporary or interim measure to address these hitherto-unanticipated events and related learning needs. IEPs are supported to deal, among other things, with transition needs. Both the transition to distance learning and the later transition to school re-opening fit well within that rubric.

The COVID-19 IEP should be developed now and over the summer, not in the fall when students are already back in school. This may well require new resources to enable this to be developed over the summer.

As noted earlier, there is a real possibility that distance learning will continue in September, or may have to later resume due to a resurgence or a second wave of COVID-19. These COVID-19 IEPs need to now anticipate and effectively address each of these possible eventualities.

The development of each student’s COVID-19 IEP should start with a direct phone conversation as soon as possible between the student’s teacher and the family. They should discuss where the gains and gaps have been, the concerns for the fall that are anticipated and how best to address them. The COVID-19 IEP should be developed in close consultation with the family and, where appropriate, the student.

We therefore recommend that:

#4. For each student with disabilities, each school board should now:

  1. a) Contact the family of each student with disabilities, preferably by phone rather than email, to discuss and identify the student’s progress during the school shutdown, the student’s specific and individualized disability-related deficits and needs arising from and during distance learning due to the COVID-19 crisis and the student’s needs and challenges related to eventual transition to school (including any vulnerabilities of other family members due to the COVID-19 pandemic), and;
  1. b) Create a COVID-19 IEP to set specific goals and activities to effectively address their disability-related needs during distance learning, and in connection with transition back to school.

 5. Need for Provincial and School Board Rapid Response Teams to Be Established to Address Recurring Urgent Needs of Students with Disabilities

During the COVID-19 crisis, Ontario’s education system continues to try to navigate uncharted territory. No matter how much planning for the needs of students with disabilities takes place as we here recommend, unexpected surprises will crop up. School boards and the Ministry of Education each need to be able to quickly detect these, and to nimbly respond to them. Traditionally, large organizations are not always the best at rapid and nimble adaptations in the midst of great uncertainty.

Parents, teachers and principals need a central point in the school board to report difficult challenges. Each school board needs to quickly feed this information to a single point at the Ministry that is staying on top of things, for rapid responses to recurring issues around the province.

We therefore recommend that:

#5. The Ministry of Education should assign staff to assist its Students with Disabilities Command Table by serving as a central rapid response team to receive feedback from school boards on recurring issues facing students with disabilities and to help find solutions to share with school boards.

#6. The Ministry should direct that each school board shall establish a similar central rapid response team within the board to receive and act on feedback from teachers, principals and families about problems they are encountering serving students with disabilities during the COVID-19 period, that will quickly network with other similar offices at other school boards, and that can report recurring issues to the Ministry.

 6. Surge Needed in Specialized Supports for Students with Disabilities

All students will have fallen behind to varying extents during the months when schools were closed. This hardship falls especially on students with disabilities who have additional specialized curriculum to learn, related to their disabilities, or who need specialized supports to learn which are unavailable during distance learning.

When students return to school, students with disabilities who need those supports will need a surge in the hours of support provided to them to help them catch up and adjust to the return to school. School boards cannot simply pull those resources out of the air. School boards will need added funding to hire those staff. They will need provincial help in finding them where there are shortages.

For example, students with vision loss are unable to get the full benefit of teachers of the visually impaired (TVIs) teaching hands-on braille reading when schools are closed. When schools re-open, school boards will need to engage additional TVIs to help ramp up the surge in TVI hours to be provided to students. There is now a shortage of TVIs in Ontario. The Ministry will need to lead a concerted effort to create a surge of TVIs to help school boards fill this gap during the return to school. Comparable needs can similarly be identified for students with other disabilities where such specialized educational support is needed.

We therefore recommend that:

#7. The Ministry of Education should plan for, fund and coordinate the provision by school boards of a surge in specialized disability supports to those students with disabilities who will need them when students return to school.

 7. Planning for Needs of Students with Disabilities Who Cannot Themselves Ensure Social Distancing

As an illustration of the last issue discussed, any return to school while COVID-19 continues to exist in our community will require students to engage in social distancing. If schools re-open, they will be doing so mindful of the fact that many students will not be able to consistently and reliably engage in social distancing, frequent hand washing and other important protective activities. Many are too young to ensure that they can fully understand the need to do so and comply. For some older children, it may seem cool to periodically break the rules. For many, it will be impossible to remain attentive to these precautions all the time.

For any number of students with disabilities, social distancing and related safe practices may pose additional challenges. For some, wearing a mask may not be possible due to such things as sensory integration or behavioural issues.

Some students with disabilities require an education assistant (EA) or special needs assistant (SNA) for all or part of the day to fully take part in school activities. For some of these students, it will not be possible to remain two meters away while providing the support or assistance that the student needs. Some will require close assistance for eating, hand-washing and other personal needs.

Pre-COVID-19 staffing levels for EAs and SNAs were too often inadequate. They did not account for these important additional requirements. EAs and SNAs were not experienced with or trained for this before COVID-19. It is not sufficient to now send them an email with instructions, or a link to a training video, and thereafter to assume that they will be fully equipped to consistently and reliably handle these duties. In addition to new in-person training, they will need to have constant access to good quality personal protective equipment (PPE), like masks.

It is also important to employ enough EAs and SNAs so that they don’t have to split their time among multiple schools or venues, lest they pose a greater risk of transmitting the COVID-19 virus from place to place among vulnerable students.

We therefore recommend that:

#8. The Ministry of Education’s plan for school re-openings must include detailed directions on required measures for ensuring that students with disabilities are safe from COVID-19 during any return to school. This requires additional planning in advance by school boards and additional funding to school boards to hire and train the additional SNAs and EAs they will need to ensure the safety of students with disabilities. It also requires safeguards to ensure that an EA or SNA does not work at multiple sites and risk transmitting the COVID-19 virus from one location to another.

 8. Ensuring Full Accessibility of Digital Platforms Used for Remote Classes or “Synchronous Learning”

We do not here wade into the dispute between the Ford Government and some teachers’ unions about whether or when a teacher should conduct online classes for their students in real time over the internet, sometimes called “synchronous learning”. We insist, however, that whenever an online real time class or synchronous learning takes place, or any other online meeting involving students with disabilities or their parents in connection with their education, it must be conducted via a fully accessible digital meeting platform.

When the Ontario Government moved our education system from the physical classroom to the virtual classroom in late March, it should have ensured from the start that the choice of digital meeting platforms was fully accessible. The Ontario Government did not do so, nor did it monitor school boards to see what platforms they were using. The Ontario Government dropped the ball on this critical accessibility concern, to the detriment of students, teachers and parents with disabilities. The Ministry of Education took the erroneous position that it was up to each school board to decide which online virtual meeting platform to use, based on the board’s assessment of its local needs. Yet these disability accessibility needs do not vary from school board to school board. They are the same across Ontario. The Ministry wastefully leaves it to each school board to investigate the relative accessibility of different virtual meeting platforms.

As a belated partial attempt to address this problem, the Minister of Education wrote school boards on or around May 26, 2020 about several issues regarding distance learning. That memo stated, among other things:

“Boards must ensure that the platforms they use for connecting with students and families are fully accessible for persons with disabilities.”

However, that direction provides no assistance to school boards on which platforms to use or avoid, or how to figure this out. It still leaves it to each school board to investigate this as much or as little as they wish, and then to duplicate the same investigations of this issue over and over across Ontario. We have seen no indication that the Minister’s direction led any school boards to change what they were doing in this regard.

This issue remains a live one and will continue into the fall. It is not clear when schools will re-open. Our education system may still be running on 100% distance learning at the start of the fall school term. Even when schools re-open, there is a real likelihood that some distance learning will continue in some blended model of in-school and distance education. As noted earlier, if a second wave of COVID-19 hits, as has happened elsewhere, requiring another round of school closures, Ontario will have to return to 100% distance learning.

At least one school board has improperly prohibited the use of Zoom, even though it is at least as accessible as, or more accessible than, other platforms. The Ministry of the Attorney General did its own comparison of digital meeting platforms, for use by the courts. The Superior Court of Justice of Ontario has decided to use Zoom as its platform for virtual court proceedings. If Zoom is safe enough for the Superior Court of Justice, there is no reason why a school board should prohibit its use.

Canada’s largest school board, TDSB, has announced that it is using Webex for parent-teacher meetings. This is so even though Webex has real accessibility problems. Such a practice should not be allowed.

We have heard examples of quite inaccurate information on this topic from some in the school board sector. Parents should not have to fight about this, one school board at a time, especially in the middle of a pandemic.

This topic requires ongoing effort and leadership by the Ministry. By August, there could well have been changes to the relative accessibility of different virtual meeting platforms. School boards need to operate based on current information.

We therefore recommend that:

#9. The Ministry of Education should immediately engage an arms-length digital accessibility consultant to evaluate the comparative accessibility of different digital meeting platforms available for use in Ontario schools. This should involve end-user testing. The Ministry should immediately send the resulting report and comparison to all school boards and make it public. This should be revisited as the fall approaches, in case there have been changes to the relative accessibility of different virtual meeting platforms. The Ministry should direct which platforms may be used and which may not be used for virtual or synchronous classes or parent/school meetings, based on their accessibility.

 9. Ensuring Digital Accessibility of Ontario Government and TVO Online Learning Resources

Over three months into the COVID-19 crisis, the Ontario Government has still not ensured that the online content that it provides to school boards, teachers, parents and students meets accessibility requirements for computer-users with disabilities. The AODA Alliance has been raising concerns with the Government about this since early in the pandemic. We have seen no public commitment to the needed corrective action. We have raised our concerns at senior levels within TVO and the Ministry of Education. The Government and TVO were required to comply with these accessibility requirements well before the advent of the COVID-19 pandemic.

We therefore recommend that:

#10. The Ministry of Education should immediately direct TVO to make its online learning content accessible to people with disabilities, and to promptly make public a plan of action to achieve this goal, with specific milestones and timelines.

#11. The Ministry of Education should make public a plan of action to swiftly make its own online learning content accessible for people with disabilities, setting out milestones and timelines, and should report to the public on its progress.

 10. Stop Making Some Learning Resources Available Only in PDF Format

Throughout this pandemic, as well as beforehand, the Ministry of Education and too many school boards have continued to make important digital information available to the public, including to parents, teachers and students, only in pdf format. That format can present accessibility problems for people with disabilities. When a document is made public in PDF format, it should also be made public in an accessible format, such as MS Word. This is an important time to start this long-overdue practice.

We therefore recommend that:

#12. The Ministry of Education should direct all its staff and all school boards that whenever making digital information public in a PDF format, it must at the same time also be made available in an accessible format such as an accessible MS Word document.

 11. One Size Fits All Does Not Fit for Return to School

To avoid chaos, a return to school should not be done all at once using a one-size-fits-all approach. Because we are in uncharted waters, it makes sense to go about this gradually and to try different approaches at different locations to see what works. We must avoid students with disabilities being again treated as after-thoughts who have to try to fit into a chaotic situation that was not designed with their needs in mind.

One suggestion that some have raised is to enable students with disabilities to return to school first, and for teaching staff to ensure their needs are met, before trying to also cope with an onslaught of all other students. Some have raised with us a concern that this might turn out to be a form of segregation, and could be detrimental for some of those students.

We therefore recommend that:

#13. The provincial plans for return to school should include these features:

  1. a) Rather than having all students across Ontario return to school at once, in a one-size-fits-all strategy, the Ontario Government should lead a strategic return to school process, trying out different approaches to see what works most effectively. For example, opening a few schools first to detect recurring problems and plan to prevent them would assist with opening of other schools across Ontario.
  1. b) The COVID-19 IEP of each student with disabilities should tailor their plans for the return to school to meet their individual needs. Students with disabilities who need this accommodation should be afforded a chance to return to the school facility early so they can be oriented to any changes to which they need to adjust in the COVID-19 era.

 12. Need for A Rapid Method to Spread the Word to Teachers and Parents About Effective Teaching Strategies for Students with Disabilities During COVID-19

Teachers and parents of students with disabilities are struggling around Ontario to cope with distance learning and the barriers it can create for many students with disabilities. Teachers and parents are creating novel work-arounds to address this.

Yet the Ontario Government has not been effectively canvassing the frontlines of teachers and parents to gather these up and share them around the province, so all can benefit without having to re-invent the wheel in the midst of a traumatic pandemic. We have called on the Ontario Government for the past three months to do this without success. We modelled one way of doing this by our successful May 4, 2020 online virtual town hall on teaching students with disabilities during the COVID-19 crisis (jointly organized with the Ontario Autism Coalition). As far as we have been able to learn, the Ontario Government has neither taken up that idea nor has it shared with school boards the link to our May 4, 2020 virtual town hall so that they can all benefit from it. We have repeatedly asked the Ministry of Education to share that link with school boards.

In the meantime, to fill this gap, several school boards have commendably been trying to address this need themselves. They have themselves been compiling good ideas and sharing them within their own board.

This is a huge and wasteful duplication of effort. The Ontario Government should be centrally accumulating and compiling all these resources, as well as researching what other jurisdictions have compiled from their own experience. These should be rapidly made available to frontline teachers and parents in a way that is easy to access, not by a blizzard of endless links that few if anyone will have the time to explore.

This effort should have been done weeks ago. Nevertheless, it is still not too late, since distance learning will remain part of our lives in whole or in part until a vaccine for COVID-19 is created and widely administered.

It is important that any such resources be themselves fully accessible to teacher, school staff, students and family members with disabilities. We regret that we have no assurance of this. On June 15, 2020, the Ontario Government announced in a news release that it was now making available new teaching materials during the COVID-19 crisis, under the headline: “Ontario Develops Additional Learning Materials for Students and Teachers”. The AODA Alliance promptly wrote senior officials at the Ministry of Education to ask what steps were taken to ensure that these new educational materials are accessible to people with disabilities, and asking what was done to include tips for teaching students with disabilities. The Ministry has not answered as of the time this brief was submitted.

We therefore recommend that:

#14. The Ministry of Education should immediately put in place an effective proactive team to gather teaching strategies for students with disabilities during distance learning from frontline teachers, parents and school boards and make these easily available to the frontlines on an ongoing basis, in formats that are accessible to people with disabilities. These should be supplemented by strategies that the Ministry researches from other jurisdictions that have innovated creative solutions.

 13. Distance Learning Must Be Effectively Provided for Students Who Cannot Return to School

When schools re-open, each school board will have a duty to accommodate its students with disabilities in school unless the school board can prove that it is impossible to do so without undue hardship. There may be some students who cannot return to school when others do. Their disability may make it impossible to accommodate them in school under the restrictions that apply during the COVID-19 pandemic. Some students may not be able to return to school because their parents or other family members with whom they live are so medically vulnerable or immuno-compromised that the family must take heightened precautions to avoid the risk of contracting COVID-19.

In those cases, even if other students are learning at school, the school board must provide effective and accessible distance learning for those students who must remain at home. This may include home visits from teaching staff. In this, students with disabilities must be more effectively and consistently served during distance learning than was the case in the spring.

We therefore recommend that:

#15 The plans for return to school must include measures for ensuring that those who cannot return to school at the same time can secure effective distance learning, including home visits (with social distancing) from teaching staff.

 14. Creating Provincial Resources for Parents to Prepare Their Students for Return to School

Some students with disabilities will need extensive preparation at home for their eventual return to school, including learning about social distancing and other new school practices due to COVID-19. Some parents will need a great deal of time to deal with this. Each school board or teacher and family should not have to duplicate these efforts by inventing their own curriculum, social stories or other resources.

We therefore recommend that:

#16. The Ministry of Education should prepare teaching materials for teachers and parents to use, addressing different disability-related learning needs, for preparing students with disabilities for the return to school, to address such changes as social distancing.

 15. New Protocols Needed for Safe School Bussing

There were ample problems with bussing of students with disabilities to school before the COVID-19 crisis. In any return to school, heightened safeguards will be needed, including frequent sanitization of busses, ensuring students are seated more than 2 meters from each other and ensuring that the driver has PPE and doesn’t risk spreading COVID-19. It is not realistic to expect that this will all simply happen with private sector bussing companies who employ casual and part time drivers working at low wages.

We therefore recommend that:

#17. The Ministry of Education should create, fund and effectively enforce new standards for safe bussing practices for students with disabilities during any return to school while COVID-19 remains a community threat.

 16. Ensure Very Active Engagement of Each School Board’s Special Education Advisory Committee

Each Ontario school board is required to have a Special Education Advisory Committee to advise it on special education issues. We understand that some have met regularly during the school closures, using conference calls or virtual online meeting platforms. Others have not met regularly, from what we have heard.

SEACs have a great deal to offer in this area. In making our recommendations about SEACs, we note that SEACs are not required to include representation regarding students with all kinds of disabilities. They are instead required only to have members that represent families whose students whose disability falls within the more limited definition of “exceptionality” that the Ministry of Education uses. Of course, it is open to a school board to have its SEAC have a more inclusive membership. It is also open to SEAC members to speak to any needs of any students with disabilities . School boards and the Ontario Government must ensure that they get input regarding students with any and all kinds of disabilities.

It is essential that each school board ensures that its Special Education Advisory Committee (SEAC) is meeting at least once per month, if not more, during the COVID-19pandemic, including during the transition to re-opening. While they usually don’t meet during the summer, they should meet if possible during the 2020 summer. They should be fully engaged in planning for the needs of students with disabilities during the COVID-19 period.

Their volunteer efforts would have more impact if the Ministry of Education took two easy steps. First, the Minister should create a virtual network or listserv to enable SEACs to share their work with each other. No such network now exists. As well, the Ministry should collect input from all Ontario’s SEACs on their concerns and advice given during the COVID-19 era, as this is a readily-available avenue to more front-line experience of students with disabilities.

We therefore recommend that:

#18. Each school board should ensure that its Special Education Advisory Committee (SEAC) meets at least once per month, and preferably more often, during the COVID-19 crisis, to give its board ongoing input into planning for students with disabilities during the COVID-19 crisis.

#19. To get the most from the volunteer work of SEACs around Ontario, the Ministry of Education should:

  1. a) Create and maintain a listserv or other virtual network of all Ontario SEACs, to enable them to share their efforts with all other SEACs around Ontario, and
  1. b) Frequently gather input from SEACs around Ontario about the experiences of students with disabilities during the COVID-19crisis.

Appendix – List of Recommendations

#1. The Ministry of Education should immediately develop, announce and implement a comprehensive plan for meeting the learning needs of students with disabilities during the COVID-19 crisis. This plan should include during this time of distance learning, during an eventual return to school, and in case of a future COVID-19 wave that requires another round of school closures. To the extent possible, this plan should be an integral part of the Ministry’s overall plan it is developing for school re-opening.

#2. The Ministry of Education should immediately establish a “Students with Disabilities Education Command Table” to oversee the development and implementation of a Government action plan for meeting the urgent learning needs of students with disabilities during the COVID-19 crisis, and to swiftly react to issues for students with disabilities as they arise.

#3. The Ministry of Education should immediately issue a policy direction to all school boards, imposing restrictions on when and how a principal may exclude a student from school. including directions that:

#4. For each student with disabilities, each school board should now:

  1. a) Contact the family of each student with disabilities, preferably by phone rather than email, to discuss and identify the student’s progress during the school shutdown, the student’s specific and individualized disability-related deficits and needs arising from and during distance learning due to the COVID-19crisis and the student’s needs and challenges related to eventual transition to school (including any vulnerabilities of other family members due to the COVID-19 pandemic), and;
  1. b) Create a COVID-19 IEP to set specific goals and activities to effectively address their disability-related needs during distance learning, and in connection with transition back to school.

#5. The Ministry of Education should assign staff to assist its Students with Disabilities Command Table by serving as a central rapid response team to receive feedback from school boards on recurring issues facing students with disabilities and to help find solutions to share with school boards.

#6. The Ministry should direct that each school board shall establish a similar central rapid response team within the board to receive and act on feedback from teachers, principals and families about problems they are encountering serving students with disabilities during the COVID-19 period, that will quickly network with other similar offices at other school boards, and that can report recurring issues to the Ministry.

#7. The Ministry of Education should plan for, fund and coordinate the provision by school boards of a surge in specialized disability supports to those students with disabilities who will need them when students return to school.

#8. The Ministry of Education’s plan for school re-openings must include detailed directions on required measures for ensuring that students with disabilities are safe from COVID-19 during any return to school. This requires additional planning in advance by school boards and additional funding to school boards to hire and train the additional SNAs and EAs they will need to ensure the safety of students with disabilities. It also requires safeguards to ensure that an EA or SNA does not work at multiple sites and risk transmitting the COVID-19 virus from one location to another.

#9. The Ministry of Education should immediately engage an arms-length digital accessibility consultant to evaluate the comparative accessibility of different digital meeting platforms available for use in Ontario schools. This should involve end-user testing. The Ministry should immediately send the resulting report and comparison to all school boards and make it public. This should be revisited as the fall approaches, in case there have been changes to the relative accessibility of different virtual meeting platforms. The Ministry should direct which platforms may be used and which may not be used for virtual or synchronous classes or parent/school meetings, based on their accessibility.

#10. The Ministry of Education should immediately direct TVO to make its online learning content accessible to people with disabilities, and to promptly make public a plan of action to achieve this goal, with specific milestones and timelines.

#11. The Ministry of Education should make public a plan of action to swiftly make its own online learning content accessible for people with disabilities, setting out milestones and timelines, and should report to the public on its progress.

#12. The Ministry of Education should direct all its staff and all school boards that whenever making digital information public in a PDF format, it must at the same time also be made available in an accessible format such as an accessible MS Word document.

#13. The provincial plans for return to school should include these features:

  1. a) Rather than having all students across Ontario return to school at once, in a one-size-fits-all strategy, the Ontario Government should lead a strategic return to school process, trying out different approaches to see what works most effectively. For example, opening a few schools first to detect recurring problems and plan to prevent them would assist with opening of other schools across Ontario.
  1. b) The COVID-19 IEP of each student with disabilities should tailor their plans for the return to school to meet their individual needs. Students with disabilities who need this accommodation should be afforded a chance to return to the school facility early so they can be oriented to any changes to which they need to adjust in the COVID-19 era.

#14. The Ministry of Education should immediately put in place an effective proactive team to gather teaching strategies for students with disabilities during distance learning from frontline teachers, parents and school boards and make these easily available to the frontlines on an ongoing basis, in formats that are accessible to people with disabilities. These should be supplemented by strategies that the Ministry researches from other jurisdictions that have innovated creative solutions.

#15 The plans for return to school must include measures for ensuring that those who cannot return to school at the same time can secure effective distance learning, including home visits (with social distancing) from teaching staff.

#16. The Ministry of Education should prepare teaching materials for teachers and parents to use, addressing different disability-related learning needs, for preparing students with disabilities for the return to school, to address such changes as social distancing.

#17. The Ministry of Education should create, fund and effectively enforce new standards for safe bussing practices for students with disabilities during any return to school while COVID-19 remains a community threat.

#18. Each school board should ensure that its Special Education Advisory Committee(SEAC) meets at least once per month, and preferably more often, during the COVID-19 crisis, to give its board ongoing input into planning for students with disabilities during the COVID-19 crisis.

#19. To get the most from the volunteer work of SEACs around Ontario, the Ministry of Education should:

  1. a) Create and maintain a listserv or other virtual network of all Ontario SEACs, to enable them to share their efforts with all other SEACs around Ontario, and
  1. b) Frequently gather input from SEACs around Ontario about the experiences of students with disabilities during the COVID-19crisis.

Send Us Your Feedback Very Quickly on Our Draft Brief to the Ontario Government on the Urgent Needs of K-12 Students with Disabilities During the COVID-19 Crisis

Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

Send Us Your Feedback Very Quickly on Our Draft Brief to the Ontario Government on the Urgent Needs of K-12 Students with Disabilities During the COVID-19 Crisis

June 11, 2020

          SUMMARY

We are rushing to prepare and submit a brief to the Ford Government on what it must do now and as schools eventually re-open to meet the urgent needs of students with disabilities during the COVID-19 crisis. We have assembled a draft brief, which we set out below. We want your feedback and ideas. We need them fast. We want to get this brief submitted to the Government as quickly as we can. We are sorry this is so rushed. Life during COVID-19 feels like an endless blitz for the AODA Alliance!

Send your feedback to us by June 16, 2020 by emailing us at aodafeedback@gmail.com and feel free to share this draft brief with others. We welcome feedback from anyone who wants to offer it to us.

Stay safe!

          MORE DETAILS

A Brief to the Ontario Government on Key Measures Needed to Address the Urgent Learning Needs of Students with Disabilities in Ontario During the COVID-19 Crisis During Distance Learning and in the Eventual Re-Opening of Schools

June 11, 2020

NOTE: This is only a draft. The AODA Alliance seeks input and additional ideas no later than June 16, 2020. Send feedback to aodafeedback@gmail.com

1. Pressing Need for A Comprehensive Ministry of Education Plan of Action to Address Urgent Needs of Students with Disabilities During the COVID-19 Crisis

Since the COVID-19 crisis began, the AODA Alliance has been urging the Ontario Government to develop and announce a comprehensive plan to meet the urgent need of students with disabilities during the COVID-19 crisis. This has been needed so over 70 school boards don’t have to each re-invent the wheel in deciding what the needs of students with disabilities are and how best to meet them. To date, the Ontario Government has not done what we have urged.

The need for this provincial plan remains pressing during the period of distance learning due to school closures. It is also needed to ensure that students with disabilities’ urgent needs are met across Ontario when schools eventually re-open. Ontario needs to also be prepared in case of the realistic possibility that distance learning will have to continue in the fall, either because school re-opening is further delayed, or because a second wave of COVID-19 would require another round of school closures.

To date, the Ontario Government has primarily if not totally focused its education strategy during the COVID-19 pandemic on students without disabilities. Almost as an afterthought, it then reminded school boards that they should also accommodate students with special education needs.

We therefore recommend that:

#1. The Ministry of Education should immediately develop, announce and implement a comprehensive plan for meeting the urgent learning needs of students with disabilities during the COVID-19 crisis. This plan should include during this time of distance learning, during an eventual return to school, and in case of a future COVID-19 wave that requires another round of school closures.

2. Need for a Provincial “Students with Disabilities Command Table”

To deal with the need for rapid planning during the COVID-19 crisis, the Ontario Government has commendably set up its own “command tables” to deal with critical areas, like health care planning and planning for the safe operation of the economy during this crisis. This enables the Government to have critical expertise at the table that makes key decisions.

There is a pressing need for a “students with disabilities command table” within the Government to plan for the urgent learning needs of students with disabilities during the COVID-19 pandemic. No such table or concentrated expertise centre exists now within Ontario’s Ministry of Education. We have been pressing for this for three months without success. That table needs to be staffed by professionals with focused expertise on providing education to students with disabilities.

This is not meant to be an advisory or consultative table. It needs to be a planning and implementation table that can quickly make decisions and effectively connect with the front lines in the education system, where the action is.

This need is not fulfilled by the Minister of Education having had some consultative meetings with the Minister’s Advisory Committee on Special Education (MACSE), which still has vacancies, or with the AODA K-12 Education Standards Development Committee. Those bodies are only advisory. They do not have the capacity of a Ministry command table. Of course, their input should be welcomed and valued.

We therefore recommend that:

#2. The Ministry of Education should immediately establish a “Students with Disabilities Education Command Table” to oversee the development and implementation of a Government action plan for meeting the urgent learning needs of students with disabilities during the COVID-19 crisis, and to swiftly react to issues for students with disabilities as they arise.

3. Preventing a Rash of Refusals to Admit Students with Disabilities to School When Schools Re-Open

Ontario’s Education Act lets a school principal refuse to admit to school any “person whose presence in the school or classroom would in the principal’s judgment be detrimental to the physical or mental well-being of the pupils…”. Disability advocates have repeatedly criticized this as an excessive, arbitrary and unfair power. The Education Act and the Ministry of Education leave to school boards and individual principals an extremely wide discretion over when, how and why to exclude a student from school under this power. The Education Act does not even require principals to give a parent their reasons for excluding a student from school, nor does it cap the duration of the student’s exclusion from school.

Disproportionately, this excessive power has been used against some students with disabilities. School boards have not always tracked when or why or how many students are excluded from school under this power. Long before this COVID-19 crisis, parent advocates have called for this power to be reduced and regulated. See for example the January 30, 2019 joint news release by the AODA Alliance and the Ontario Autism Coalition. To date, the Ontario Government has not agreed to any significant reform of this excessive power.

In September 2018, the Ontario Human Rights Commission released a new policy on accessible education for students with disabilities. Its recommendations to the Ontario Government included, among other things:

“9. Identify and end the practice of exclusion wherein principals ask parents to keep primary and secondary students with disabilities home from school for part or all of the school day (and the role that an improper use of section 265(1)(m) of the Education Act may be playing in this practice).”

There is a serious risk that some principals will feel at liberty to use this power to exclude some students with disabilities from school during school re-openings in the midst of the COVID-19 pandemic, especially before any effective vaccine is invented and widely available. This is especially so if school boards do not effectively plan for the inclusion and accommodation of students with disabilities at school during this school re-opening process. They may do so either because they don’t know how to accommodate some students with disabilities during social distancing, or because the Ontario Government and/or their school board has not given them the directions and resources they need to be able to effectively include and accommodate those students.

The need to reform practices regarding a school principal’s power to refuse to admit a student to school has become even more pressing in light of the COVID-19 pandemic. It is essential that school re-openings this fall do not lead to the creation of two classes of students, those allowed to return to school and those who are excluded from school, especially if this disproportionately divides along disability lines. A principal can feel a real temptation to use the power to refuse to admit such students to school during a COVID-19 school re-opening because it would seem to solve the problem of having to plan for those students’ needs at school.

The Ontario Government has been willing to give directions to a school board about the use of its power to refuse to admit students to school in other contexts. It can do so here as well. The Ontario Ministry of Education has very recently given directions to the Peel District School Board to keep and report data on exclusions of students from school by race. In directive number 9, the Ministry stipulates that:

“The Board shall centrally track disaggregated race-based data on suspensions (in-school and out-of-school), expulsions and exclusions, and report publicly through the Annual Equity Accountability Report Card.”

We therefore recommend that:

#3. The Ministry of Education should immediately issue a policy direction to all school boards, imposing restrictions on when and how a principal may exclude a student from school. including directions that:

  1. a) During the re-opening at schools, students with disabilities have an equal right to attend schools as do students without disabilities. The power to refuse to admit a student to school should not be used in a way that disproportionately burdens students with disabilities or that creates a barrier to their right to attend school.
  1. b) A principal who refuses to admit a student to school during the school re-opening process should be required to immediately give the student and their family written notice of their decision to do so, including written reasons for the refusal to admit, the duration of the refusal to admit and notice of the family’s right to appeal this refusal to admit to the school board.
  1. c) A principal who refuses to admit a student to school for all or part of the school day should be required to report this in writing to their school board’s senior management, including the reasons for the exclusion, its duration and whether the student has a disability. Each school board should be required to compile this information and to report it on a bi-monthly basis to the board of trustees, the public and the Ministry of Education (with individual information totally anonymized). The Ministry should promptly make public on a school board by school board basis the information it receives on numbers, reasons and durations of refusals to admit during post- COVID-19 school re-opening.

4. Need for Specific COVID-19 Individual Education Plans for Individual Students with Disabilities Before and During Transitioning to Return to School

For students with disabilities the distance learning during COVID-19 will have created different deficits and challenges. The transition back to school will present challenges that will vary from student to student.

Students’ IEPs were all written while students were in school, with no contemplation of the COVID-19 crisis or the challenges and hardships of distance learning and then of transition back to school. All students with disabilities will need their IEP modified to address these unforeseen needs.

They each need a COVID-19 –specific IEP. This should be done now and over the summer, not in the fall when students are hopefully already back in school. This will require action now. It may require new resources to enable this to be worked on over the summer.

As noted earlier, there is a real possibility that distance learning will continue in the fall or may have to resume due to a second wave of COVID-19. IEPs need to now anticipate and address these needs.

We therefore recommend that:

#4. For each student with disabilities, each school board should now:

  1. a) Contact the family of each student with disabilities, preferably by phone rather than email, to discuss and identify the student’s progress during the shutdown, the student’s specific and individualized disability-related deficits and needs arising from and during distance learning due to the COVID-19crisis and the student’s needs and challenges related to eventual return to school (including any vulnerabilities of other family members due to the COVID-19 pandemic), and;
  1. b) add to their IEP specific goals and activities to effectively address their disability-related needs during distance learning, and in connection with transition back to school.

5. Need for Provincial and School Board Rapid Response Teams to Address Recurring Urgent Needs of Students with Disabilities

During the COVID-19 crisis, Ontario’s education system continues to try to navigate uncharted territory. No matter how much planning for the needs of students with disabilities takes place as we here recommend, unexpected surprises will crop up. school boards and the Ministry of Education each need to be able to quickly detect these, and to nimbly respond to them.

Parents, teachers and principals need a central point in the school board to report difficult challenges. Each school board needs to feed this information to a single point at the Ministry that is staying on top of things, for rapid responses to recurring issues around the province.

We therefore recommend that:

#5. The Ministry of Education should assign staff to assist its Students with Disabilities Command Table by serving as a central rapid response team to receive feedback from school boards on recurring issues facing students with disabilities and to help find solutions to be shared with school boards.

#6. The Ministry should direct that each school board shall establish a similar central rapid response team within the board to receive feedback from teachers and principals about problems they are encountering serving students with disabilities during the COVID-19 period, that can quickly network with other similar offices at other school boards, and that can report recurring issues to the Ministry.

6. Surge Needed in Specialized Supports for Students with Disabilities

All students will have fallen behind to some extent during the months when schools were closed. This hardship falls especially on students with disabilities who have additional specialized curriculum to learn, related to their disabilities, or who need specialized supports to learn which are unavailable during distance learning.

When students return to school, students with disabilities who need those supports will need a surge in the hours of support provided to them to help them catch up and adjust to the return to school. School boards cannot simply pull those resources out of the air. School boards will need added funding to hire those staff, and provincial help finding them if there are shortages.

For example, students with vision loss are unable to get the full benefit of teachers of the visually impaired (TVIs) teaching hands-on braille reading when schools are closed. School boards will need to engage additional TVIs to help ramp up the surge in TVI hours to be provided to students. There is now a shortage of TVIs in Ontario. The Ministry will need to lead the effort to provide a surge of TVIs to help school boards fill this gap during the return to school. Comparable needs can similarly be identified for students with other disabilities where such specialized educational support is needed.

We therefore recommend that:

#7. The Ministry of Education should plan for, fund and coordinate the provision by school boards of a surge in specialized disability supports to those students with disabilities who will need them when students return to school.

7. Planning for Needs of Students with Disabilities Who Cannot Themselves Ensure Social Distancing

As an illustration of the last issue discussed, any return to school while COVID-19 continues to exist in our community will require students to engage in social distancing. If schools re-open, they will be doing so mindful of the fact that many students will not be able to consistently and reliably engage in social distancing, frequent hand washing and other important protective activities. Many are too young to ensure that they can fully understand the need to do so and comply. For some older children, it may seem cool to periodically break the rules. For many, it will be impossible to remain attentive to these precautions all the time.

For any number of students with disabilities, social distancing and related safe practices may pose additional challenges. For some, wearing a mask may not be possible due to such things as sensory integration or behavioural issues.

Some students with disabilities require an education assistant (EA) or special needs assistant (SNA) for all or part of the day to fully take part in school activities. For some of these students, it will not be possible to remain two meters away while providing the support or assistance that the student needs. Some will require close assistance for eating, hand-washing and other personal needs.

Pre-COVID-19 staffing levels for EAs and SNAs did not account for these additional requirements. EAs and SNAs were not experienced with or trained for this before COVID-19. It is not sufficient to now send them an email with instructions, or a link to a training video, and thereafter to assume that they will be fully equipped to handle these duties. In addition to new in-person training, they will need to have constant access to good quality personal protective equipment (PPE), like masks.

We therefore recommend that:

#8. The Ministry of Education’s plan for school re-openings must include detailed instructions on required measures for ensuring that students with disabilities are safe from COVID-19 during any return to school. This requires additional planning in advance by school boards and additional funding to school boards to hire and train the additional SNAs and EAs they will need to ensure the safety of students with disabilities.

8. Ensuring Full Accessibility of Digital Platforms Used for Remote Classes or “Synchronous Learning”

We do not here wade into the dispute between the Ford Government and some teachers’ unions about whether or when a teacher should conduct online classes for their students in real time over the internet, sometimes called “synchronous learning”. We insist, however, that whenever an online real time class or synchronous learning takes place, or any other online meeting involving students with disabilities or their parents in connection with their education, it must be conducted via a fully accessible digital meeting platform.

When the Ontario Government moved our education system from the physical classroom to the virtual classroom in late March, it should have ensured from the start that the choice of digital classroom platforms was fully accessible. The Ontario Government did not do so, nor did it monitor school boards to see what platforms they were using. Put simply, the Ontario Government entirely dropped the ball on this critical accessibility concern to the detriment of students, teachers and parents with disabilities. It did so based on a transparently erroneous starting point. The Ministry of Education took the position that it was up to each school board to decide which online virtual meeting platform to use based on its assessment of its local needs. Yet these disability accessibility needs do not vary from school board to school board.

As a belated partial attempt to address this problem, the Minister of Education wrote school boards on or around May 26, 2020 about several issues regarding distance learning. That memo stated, among other things:

“Boards must ensure that the platforms they use for connecting with students and families are fully accessible for persons with disabilities.”

However, that direction provides no assistance to school boards on which platforms to use or avoid, or how to figure this out. It still leaves it to each school board to investigate this as much or as little as they wish, and then to duplicate the same investigations of this issue over and over across Ontario.

This issue remains a live one and will continue into the fall. It is not clear when schools will re-open. Our education system may still be running on 100% distance learning at the start of the fall school term. Even when schools re-open, there is a real likelihood that some distance learning will continue in some blended model of in-school and distance education. As noted earlier, if a second wave of COVID-19 hits, as has happened elsewhere, requiring another round of school closures, Ontario will have to return to 100% distance learning.

We therefore recommend that:

#9. The Ministry of Education should immediately engage an arms-length digital accessibility consultant to evaluate the comparative accessibility of different digital meeting platforms available for use in Ontario schools. The Ministry should immediately send the resulting report and comparison to all school boards and make it public. The Ministry should direct which platforms may be used and which may not be used for virtual or synchronous classes or parent/school meetings, based on their accessibility.

9. Ensuring Digital Accessibility of Ontario Government and TVO Online Learning Resources

Over three months into the COVID-19 crisis, the Ontario Government has still not ensured that the online content that it provides to school boards, teachers, parents and students meets accessibility requirements for computer-users with disabilities. The AODA Alliance has been raising concerns with the Government about this since early in the pandemic. We have seen no public commitment to the needed corrective action. We have raised our concerns at senior levels within TVO and the Ministry of Education. The Government and TVO were required to comply with these accessibility requirements well before the advent of the COVID-19 pandemic.

We therefore recommend that:

#10. The Ministry of Education should immediately direct TVO to make its online learning content accessible to people with disabilities, and to promptly make public a plan of action to achieve this goal, with specific milestones and time lines.

#11. The Ministry of Education should make public a plan of action to swiftly make its own online learning content accessible for people with disabilities, setting out milestones and time lines, and should report to the public on its progress.

10. Stop Making Learning Resources Available Only in PDF Format

Throughout this pandemic, as well as beforehand, the Ministry of Education and too many school boards have continued to make important digital information available to the public, including to parents, teachers and students, only in pdf format. That f