More Advocacy Action, More Media, and More Ford Government Secrecy on Ontario’s Disability-Discriminatory Plans for Critical Care Triage If Hospital ICUs Run Out of Space for All Patients Needing Life-Saving Care

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 Advocacy Action, More Media, and More Ford Government Secrecy on Ontario’s Disability-Discriminatory Plans for Critical Care Triage If Hospital ICUs Run Out of Space for All Patients Needing Life-Saving Care

April 14, 2021

            SUMMARY

Disability advocacy keeps up the pressure on the critical care triage issue while the Ford Government keeps up the secrecy.

  1. a) On April 13, 2021, the ARCH Disability Law Centre wrote the College of Physicians and Surgeons of Ontario. Its excellent letter is set out below. CPSO regulates Ontario physicians. ARCH echoed the AODA Alliance’s serious objections to the position on critical care triage that the CPSO sent to all Ontario doctors last week. The AODA Alliance ‘s objections are set out in our April 9, 2021 letter and our April 13, 2021 letter to the CPSO, all of which we have made public.

ARCH’s letter amplified our disability concerns. We thank ARCH for its letter, and for working so closely together with the AODA Alliance and other disability advocates on this issue.

  1. b) On April 13, 2021 Andrea Horwath, Ontario’s Leader of the Official Opposition, and Joel Harden, the Ontario NDP disability critic, released a strong statement on the critical care triage issue, also set out below. It blasts the Ford Government for its secret critical care triage protocol that wrongly discriminates based on disability. We thank the NDP for this action, and urge it to give this urgent issue as much public attention as possible.
  1. c) On April 12, 2021, the Thunder Bay Family Network held a Zoom public forum to rally disability rights organizers and advocates in northern Ontario on the disability discrimination concerns with the Ontario critical care triage protocol and plan. AODA Alliance Chair David Lepofsky spoke at that event. A video of that event is posted on TBFN’s Facebook page. We congratulate TBFN and all those who attended and who made this such a success. We urge other organizations to hold similar events. We’d be delighted to help. Email the AODA Alliance at aodafeedback@gmail.com.
  1. d) There continues to be some media attention on the critical care triage issue, but we need more of it!

We congratulate the fiery Dahlia Kurtz for her new national program on Sirius-XM Radio Channel 167, and applaud her for including AODA Alliance Chair David Lepofsky on that show’s third day on the air on April 14, 2021. That should be available later today at https://soundcloud.com/canadatalks

Below we set out the April 8, 2021 Toronto Star report on where the Ford Government stands on the idea of it agreeing in advance to pay all doctors’ claims for deaths due to critical care triage under the disability-discriminatory Ontario critical care triage protocol. We regret that the Toronto Star did not identify or address the disability issues here, as the Star last did several months ago.

We also set out below a column in the April 2, 2021 London Free Press. It identified AODA Alliance concerns with the Ford Government’s mishandling of the critical care triage issue.

  1. e) The Ford Government’s delays on disability accessibility seem interminable. There have now been 804 days, or over 2 and a quarter years, 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. The Ontario Government only has 1,358 days left until 2025, the deadline by which the Government must have led Ontario to become fully accessible to people with disabilities.

For More on these issues, check out

  1. The AODA Alliance’s new February 25, 2021 independent report on Ontario’s plans for critical care triage if hospitals are overwhelmed by patients needing critical care.
  1. Ontario’s January 13, 2021 triage protocol.
  1. The eight unanswered letters from the AODA Alliance to the Ford Government on its critical care triage plan, including the AODA Alliance‘s September 25, 2020 letter, its November 2, 2020 letter, its November 9, 2020 letter, its December 7, 2020 letter, its December 15, 2020 letter, its December 17, 2020 letter, its January 18, 2021 letter and its February 25, 2021 letter to Health Minister Christine Elliott.
  1. The Government’s earlier external advisory Bioethics Table’s September 11, 2020 draft critical care triage protocol, finally revealed in December 2020.
  1. The AODA Alliance website’s health care page, detailing its 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.
  1. You can also 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

April 13, 2021 ARCH Disability Law Centre Letter to the College of Physicians and Surgeons of Ontario

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 at nwhitmore@cpso.on.ca and feedback@cpso.on.ca

April 13, 2021

Dr. Nancy Whitmore, Registrar and CEO

College of Physicians and Surgeons of Ontario

80 College Street

Toronto, Ontario M5G 2E2

Dear Dr. Whitmore:

Re: Triaging of Critical Care in Ontario

I am writing on behalf of ARCH Disability Law Centre in response to your email correspondence to members of the College of Physicians and Surgeons of Ontario on April 8, 2021, and the College’s subsequent response to the AODA Alliance dated April 12, 2021. ARCH shares the concerns raised by the AODA Alliance in its April 9th and April 13th letters.

We understand and appreciate the context of your correspondence, and the need to respond to the challenging circumstances that this pandemic continues to thrust on our health care service providers including physicians and surgeons. We also understand the need for a plan as this third wave of the pandemic overwhelms hospitals and critical care resources.

Your email correspondence addresses physicians’ obligations regarding the withholding and withdrawing of critical care. You state that the College supports deviation from its policies in following triage frameworks as developed by the command table.

Respectfully, your stated intention to ensure public trust in decision-making is eroded by supporting a critical care triage protocol that has been kept secret, on which there has been no proper public consultation, and which has been subject to serious disability discrimination objections. Disability advocates, and other marginalized communities, have been outspoken for over a year since the first Triage Protocol draft was leaked, identifying serious unlawful discriminatory implications that have persisted and have not yet been remedied. In addition, your correspondence does not clarify that all actions by your members must be taken free from any discrimination. Human rights protections under Ontario’s Human Rights Code and the Canadian Charter of Rights and Freedoms continue to fully apply during a pandemic. It is precisely during times such as these that our human rights protections are most critical. We are concerned that the College’s messaging disregards and dispenses entirely with such human rights concerns, to the serious detriment of Ontario physicians and patients.

Moreover, in considering public interest and protecting the rights of our most vulnerable patients, any messaging by the College that supports a potentially discriminatory framework and contemplates limitations on patients’ rights such as the making of complaints to the College is troubling and inappropriate.

The public looks to the College to objectively and impartially decide any individual complaints against member physicians. It must not pre-decide issues on which it will have to rule. The public must be given confidence that its complaints process is a fair one. The College’s April 8, 2021 email to its members is inconsistent with that obligation, on a topic where the public needs a strong assurance, rather than a cause for concern.

We urge the College to rescind and clarify its message and ensure that its members understand their paramount human rights obligations during this pandemic, and their continued human rights obligations regardless of what triage frameworks are ultimately approved.

Sincerely,

ARCH Disability Law Centre

Robert Lattanzio

Executive Director

cc:

Premier Doug Ford premier@ontario.ca

Christine Elliott, Minister of Health Christine.Elliott@ontario.ca

Helen Angus, Deputy Minister of Health  Helen.Angus@ontario.ca

Raymond Cho, Minister of Seniors and Accessibility  Raymond.Cho@ontario.ca

Denise Cole, Deputy Minister for Seniors and Accessibility  Denise.Cole@ontario.ca

Mary Bartolomucci, Assistant Deputy Minister for the Accessibility Directorate Mary.Bartolomucci@ontario.ca

Todd Smith, Minister of Children, Community and Social Services Todd.Smithco@pc.ola.org

Janet Menard, Deputy Minister of Children, Community and Social Services Janet.Menard@ontario.ca

Ena Chadha, Chief Commissioner, Ontario Human Rights Commission  cco@ohrc.on.ca

David Lepofsky, Accessibility for Ontarians with Disabilities Act Alliance aodafeedback@gmail.com

April 13, 2021 Statement by New Democratic Party on Critical Care Triage

April 13, 2021

Ford’s triage protocol needs public consultation and must respect disability rights

QUEEN’S PARK – NDP Leader Andrea Horwath and MPP Joel Harden (Ottawa Centre), the NDP’s critic for Accessibility and Persons with Disabilities, said that as ICUs struggle to provide care for a rising number of people in critical condition, the provincial government must hold open consultations on the triage protocol and remove disability discrimination from it.

“We all desperately hope the triage protocol will never have to be triggered, and there is more the provincial government can do to prevent that horrific scenario from playing out in Ontario. But preparing for life-and-death decisions about the lives of people, including people with disabilities, should not be done by the Ford government in secret,” said Horwath. “ It’s time for this government to do the work it should have done months ago, and consult with disability and human rights groups, as well as Ontario families — who will bear the consequences of these decisions.”

Horwath and Harden said Doug Ford must stop ignoring human rights leaders and over 200 community organizations that wrote to the Ford government over a year ago exposing and denouncing its directions to Ontario hospitals on life-saving critical care that discriminates against people with disabilities. According to the Toronto Star, the Ford government is considering indemnifying critical care physicians from lawsuits — which means the government is planning for doctors to have to make life-and-death decisions about allocating care, but is doing so behind closed doors.

“People with disabilities face a higher risk of getting and being severely impacted by COVID-19,” said Harden. “The Ford government must immediately remove disability discrimination from its clinical triage protocol, and respect the human rights of patients with disabilities.”

Toronto Star April 8, 2021

News

Originally posted at https://www.thestar.com/politics/provincial/2021/04/07/premier-doug-ford-instituting-province-wide-stay-at-home-order-expected-to-begin-thursday-sources-say.html

[Premier Doug Ford is vowing to have…]

Rob Ferguson, Robert Benzie and Kristin Rushowy Queen’s Park Bureau

Premier Doug Ford is vowing to have 40 per cent of adults vaccinated against COVID-19 – including essential workers over age 18 in Toronto and Peel Region hot spots – during Ontario’s 28-day stay-at-home order that begins Thursday.

Declaring a third state of emergency in a year, Ford said special education workers across the province and “all education workers in high-risk neighbourhoods in Toronto and Peel” would also begin getting shots during next week’s spring break, with dangerous variants of the virus spreading by the day.

The stay-at-home order, which could be extended, goes to May 6. The premier’s office said Ford’s 40 per cent vaccination target should get enough first doses to hot zones and quell transmission levels there.

“We need to get the vaccines where they will have the greatest impact as quickly as possible,” a sombre Ford said Wednesday, bowing to pressure from health experts and educators for targeted shots in trouble spots where outbreaks have resulted in younger adults being hospitalized at higher rates.

Vaccines will be sent to more hot zones in other municipalities as supplies allow.

“I am pleased with the pivot,” said Dr. Michael Warner, medical director of critical care at Michael Garron Hospital, formerly Toronto East General Hospital. He warned that adults under age 50 in ICUs are now dying at twice the speed of the first and second waves, with one fatality every 2.8 days.

For Toronto and Peel hot spots, Ford said mobile teams and pop-up clinics are being organized to give jabs to anyone over 18 living in highly impacted neighbourhoods.

The trigger for the second stay-at-home order since January was a sudden increase in admissions of critically ill Ontarians to hospital intensive care units above levels that had been predicted in the “worst-case” modelling scenarios, threatening the health-care system, Ford added.

“How we handle the next four weeks, what we do until we start achieving mass immunization, will be the difference between life and death for thousands of people,” he said, brushing aside criticisms that he should have acted sooner on the stay-at-home order given repeated warnings from his science advisers.

“Ford walked us right into this lockdown with eyes wide open,” New Democrat Leader Andrea Horwath told reporters.

“Experts made it clear every step of the way – he was reopening too quickly, taking away public health protections too soon, and implementing half-measures that would not stop the spread.”

With ICU admissions increasing, Health Minister Christine Elliott said the government is trying to boost hospital capacity. It has not yet prepared a cabinet order indemnifying intensive care physicians from liability in making difficult triage decisions as to which patients will get the resources needed to have the best chance to survive, she said.

“We haven’t finalized any of that.”

The province’s science advisers have cautioned the scenario seen last year in New York City and northern Italy, where ICUs were overwhelmed, would become reality in Ontario once patient levels of about 800 are reached in critical care.

The province is at 504 – a record in the pandemic – after a one-third rise in the last week and more admissions expected with the province averaging almost 3,000 new infections a day.

Elliott said many hospitals are at capacity, meaning there is no way for Ontario to vaccinate its way out of the situation and a four-week stay-at-home order is crucial to containing the virus and its highly contagious variants.

“The variants have won this round of the race,” Peel medical officer Dr. Lawrence Loh told a news conference in Brampton. “Close down, vaccinate, and get out of this.”

There were 3,215 new infections reported Wednesday – including 1,095 in Toronto and 596 in Peel – with 17 more deaths bringing the pandemic total to 7,475 fatalities.

The government limited retailers open for in-person shopping mainly to supermarkets, pharmacies, LCBO outlets, and takeout restaurants. Non-essential retailers go back to online sales and curbside pickup. Malls can designate one indoor location for customer pickup of items by appointment.

In a change from a similar order issued to quell the second wave in January, big box stores like Walmart and Costco will be limited to selling essential food, pharmacy, personal and pet care items.

Employees who can are asked to work from home and trips outside the home should be for essential reasons only, such as food shopping, medical appointments and exercise.

Close contact with anyone from another household is discouraged.

The changes came six days after the premier announced an Ontario-wide “lockdown” widely panned as inadequate since it just closed restaurant patios, indoor dining and personal services such as hair salons and barber shops that were open in areas outside Toronto and Peel, and not already in lockdown.

Toronto’s public and Catholic schools closed to in-person learning Wednesday, following in the footsteps of Peel Region schools the day before.

Ford rejected pressure from health experts and opposition parties to introduce a sick pay policy so that people with COVID-19 symptoms and without benefits can stay home if ill. Ford said a federal program is available.

The stay-at-home order is a dramatic turnaround from recent weeks, in which Ford allowed non-essential retailers in lockdown zones to open to 25 per cent customer capacity, raised indoor dining capacity limits in bars and restaurants outside lockdown areas and permitted sidewalk patios in Toronto and Peel.

There was also the promise that barber shops, hair and nail salons could open April 12 in Toronto, Peel and other regions elevated to lockdowns, but as infection levels grew across the province those hopes were dashed.

Cases of COVID-19 are up more than 70 per cent in the last two weeks.

London Free Press April 2, 2021

Originally posted at https://lfpress.com/opinion/columnists/baranyai-triage-framework-should-be-debated-if-public-is-to-have-confidence-as-third-wave-rises

Baranyai: Triage framework should be debated as COVID’s third wave rises

Author of the article: Robin Baranyai • Special to Postmedia News

A triage nurse waits for patients in the Emergency Department. (File photo)

Under normal circumstances, patient triage is about identifying who should be treated first: who needs resuscitation, and who can wait to have their broken wrist set. It is not a question of whether the patient receives the care they need, but when.

Last March, that assumption was turned on its head. The world watched in horror as Italy’s well-regarded health-care system, with 3.2 hospital beds per 1,000 people (compared to 2.5 in Canada), was overwhelmed.

The case for delaying the second vaccine dose

Faced with too many patients and too few ventilators, doctors were forced to decide on the fly where scant resources should be allocated. All too often, it came down to the patient’s age.

Canadians hope to avoid these unthinkable choices. As they say: Hope for the best, but plan for the worst.

Concerns again were raised this week about Ontario’s emergency standard of care, designed to provide consistent medical guidance on decisions — should they become necessary — about who receives care, by prioritizing resources for the patients most likely to survive. The protocol includes an online risk calculator for short-term mortality.

The protocol has been shared with Ontario hospitals, though not approved by the Ministry of Health, nor officially made public. The ministry has deflected queries to Jennifer Gibson, director of the University of Toronto’s joint centre for bioethics, and co-chair of the government’s bioethics table, which developed the triage framework.

It’s not shocking there is a protocol for making life-or-death care decisions, should hospital resources be overwhelmed. It would be shocking if there were not.

It is concerning, however, that an updated version of the protocol was brought to light by a disability advocacy group, and not by an open process of consultation, as recommended by both the bioethics table and the Ontario Human Rights Commission.

Under the protocol, two physicians would be involved in treatment decisions. The online tool allows doctors to input data on the severity of comorbid conditions, such as cancer, to help estimate patients’ odds of survival. Those with the best chance of surviving 12 months would be given priority for ICU beds.

The use of a clinical frailty scale (CFS) in risk calculations was flagged by the Accessibility for Ontarians with Disabilities Act (AODA) Alliance. It measures the ability to perform everyday tasks in patients older than 65. While a CFS may reduce the subjectivity of assessments, the AODA Alliance rightly points out, difficulty people with disabilities have with everyday tasks may have nothing to do with their odds of survival.

Similar concerns were raised by disability advocates in Quebec. An expert working group developed an emergency protocol last March, and the province held open consultations. The emergency protocol was revised after hearing from advocacy groups, including the Quebec Intellectual Disability Society.

Quebec’s protocol goes further than Ontario’s, establishing criteria by which patients could be removed from life support, if needed, without their consent. As yet, there is no mechanism in Ontario to prioritize treatment of patients with a higher likelihood of survival over those on life support.

This is deeply uncomfortable territory. It forces us to think about choices we’d rather not make, or have made for us. But if we want continued confidence in our health-care system, people need to know how these decisions could be made.

The hard choices of “battlefield medicine” may not be theoretical for long. At the height of the second wave in January, the number of COVID-19 patients in Ontario ICUs peaked at 420. As of Monday, there were 390.

The battle here is not only between patient care and system capacity. It is between communication and opacity; transparency and uncertainty. Transparency builds confidence.

write.robin@baranyai.ca