On the International Day of Persons with Disabilities, 64 Organizations Call for Immediate Action to ensure all Patients including those with Disabilities will Not be Discriminated Against if COVID Surge Requires Rationing of Critical Medical Care

Accessibility for Ontarians with Disabilities Act Alliance

ARCH Disability Law Centre

 

NEWS RELEASE – FOR IMMEDIATE RELEASE

On the International Day of Persons with Disabilities, 64 Organizations Call for Immediate Action to ensure all Patients including those with Disabilities will Not be Discriminated Against if COVID Surge Requires Rationing of Critical Medical Care

December 3, 2020 Toronto: Today, to mark the International Day of Persons with Disabilities, 64 organizations and groups sent Premier Doug Ford a powerful open letter (below) pressing him to ensure that patients with disabilities face no discrimination in access to life-saving critical medical care if the skyrocketing COVID surge requires rationing or “triage” of critical care. They urge an end to protracted Government secrecy over its triage plans. They ask Ford to release the recommended triage rules that Ford’s Bioethics Table gave the Government in September.

Signatories represent people with vision loss, the Deaf, HIV & AIDS, persons labelled with intellectual disabilities, autism, mental health and psychosocial disabilities, communication disabilities, neuromuscular disabilities, neurological disabilities, and mobility disabilities, as well as respected cross-disability organizations.

“From the outset, this process has been plagued by secrecy and that lack of transparency continues to dominate. Last March, the Government sent Ontario hospitals a discriminatory critical care triage protocol which was never made public,” said Robert Lattanzio, Executive Director of the ARCH Disability Law Centre, a disability rights legal clinic. “If applied, the discriminatory nature of that protocol would have disproportionately impacted persons with disabilities and persons from other equity seeking groups. Following public outcry and over six months of advocacy, the Government finally cancelled that secret triage protocol but more must be done.”

“It’s a good partial step that Ford cancelled his earlier discriminatory March critical care triage protocol, but he’s created a dangerous vacuum if the COVID surge necessitates critical care triage. Doctors could choose whom to deny life-saving critical care based on stereotypes or unconscious bias about disabilities,” said David Lepofsky, chair of the non-partisan AODA Alliance that advocates for accessibility for 2.6 million Ontarians with disabilities. “It’s wrong for the Ford Government to promise openness in its response to COVID, but to keep secret its Bioethics Table’s new recommendations on how to fill this vacuum, especially when the Ontario Human Rights Commission said those recommendations raise human rights concerns.”

When the NDP pressed the Ford Government on November 5 to make public its secret Bioethics Table’s triage recommendations, the Government said it “may” send a new triage framework to health professionals if “conditions deteriorate significantly”. It never committed to let the public see that new triage framework. Since November 5, COVID-19 conditions have deteriorated significantly. New daily infections break records day after day. Government models project horrifying increases. A growing number of communities have been locked down.

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Contact:

AODA Alliance Chair David Lepofsky

Email: aodafeedback@gmail.com

Twitter: @aodaalliance

Robert Lattanzio, Executive Director

ARCH Disability Law Centre

Toll-free: 1-866-482-2724 extension 2233

Email: lattanr@lao.on.ca

For more background on this issue, check out:

  1. The November 5, 2020 exchange in Question Period on the critical care triage issue.
  2. The AODA Alliance’s unanswered September 25, 2020 letter, its November 2, 2020 letter and its November 9, 2020 letter to Health Minister Christine Elliott
  3. The August 30, 2020 AODA Alliance submission to the Ford Government’s Bioethics Table, and a captioned online video of the AODA Alliance’s August 31, 2020 oral presentation to the Bioethics Table on disability discrimination concerns in critical care triage.
  4. The September 1, 2020 submission and July 20, 2020 submission by the ARCH Disability Law Centre to the Bioethics Table.
  5. The November 5, 2020 captioned online speech by AODA Alliance Chair David Lepofsky on the disability rights concerns with Ontario’s critical care triage protocol
  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.
  2. 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.
  3. The ARCH Disability Law Centre website’s COVID-19 page offers more about ARCH’s work on the clinical triage protocol, including a September 15, 2020 published article, visitation ban policies, access to technology and other issues concerning the rights of persons with disabilities during the COVID-19 crisis.

Text of the December 3, 2020 Open Letter to the Ontario Government

OPEN LETTER: Ontario’s COVID-19 Clinical Triage Protocol

December 3, 2020

To: Hon. Doug Ford, Premier of Ontario

Legislative Building

Queen’s Park

Toronto, ON M7A 1A1

Via email: premier@ontario.ca

Hon. Christine Elliott, Deputy Premier and Minister of Health of Ontario

College Park 5th Floor,

777 Bay Street, Toronto, ON M7A 2J3

Via email: Christine.elliott@ontario.ca

Hon. Raymond Sung Joon Cho, Minister of Seniors and Accessibility of Ontario

Ministry for Seniors and Accessibility

College Park, 5th Floor

777 Bay Street, Toronto, ON M5G 2C8

Via email: Raymond.cho@ontario.ca

Dear Hon. Premier Ford, Hon. Deputy Premier and Minister Elliott, and Hon. Minister Cho:

Re:     Ontario’s COVID-19 Clinical Triage Protocol

We write about a life-and-death issue now facing Ontarians over which the Ontario Government has key responsibility. COVID-19 continues to surge, repeatedly breaking prior records for daily new infections. Expert projections show that this surge will continue to get worse, reaching new record infection rates. Our hospitals are being strained to the limit. The risk grows that hospitals may get overwhelmed, with more demand for critical medical care than there are critical care beds, staff and services to meet that demand. If that happens, it would be necessary for there to be “triage” or rationing of critical care. Some patients, needing life-saving critical care, may be refused that care – a publicly-insured medical service covered by OHIP.

Last spring, the Ontario Government sent a March 28, 2020 critical care protocol to all Ontario hospitals, directing how hospitals should decide whom to refuse critical care they need, if triage becomes necessary. The Government did not make public its March 28, 2020 critical care triage protocol, or the fact that it had been sent to Ontario hospitals.

When word of that protocol leaked, an April 8, 2020 open letter to the Ontario Government was sent by over 200 disability organizations and groups, and over 4,800 individuals. It expressed the serious concern that the Government’s March 28, 2020 critical care triage protocol would discriminate against some patients with disabilities. It called for that protocol to be cancelled, and for the Government to consult people with disabilities on this issue.

In response to an opposition question during Question Period in the Legislature on November 5, 2020, the Government revealed that it had cancelled the March 28, 2020 critical care triage protocol. We commend the Government for cancelling it.

However, to our knowledge, the Government has not put in place a replacement for the March 28, 2020 protocol. If critical care triage becomes necessary, decisions over who gets refused life-saving critical care would be wrongly left to individual hospitals and doctors, without safeguards against the serious danger of arbitrary and discriminatory decisions made because of disability.

Last winter, the Ontario Government appointed a “Bioethics Table”, including doctors and bioethicists, to give advice in this area. That Table wrote the March 28, 2020 critical care triage protocol, now cancelled. Last summer, the Bioethics Table held meetings and consultations on this issue, including meetings with some disability advocates and experts.

In mid-September 2020, The Bioethics Table submitted a report to the Ontario Government Ministry of Health, to Ontario Health (part of the Government) and to the Ontario Human Rights Commission. That report made recommendations on how critical care triage should be conducted, to replace the March 28, 2020 triage protocol. The Government has refused to make that report public.

The Bioethics Table itself and the Ontario Human Rights Commission have called on the Government to make public the Bioethics Table’s report and recommendations. The Ontario Human Rights Commission has expressed that the human rights concerns persist with the Bioethics Table’s recommendations.

On November 5, 2020, the Government stated in the Legislature that it “may” provide a new critical care triage framework to health professionals if conditions deteriorate significantly. To continue waiting creates great risk that any new critical care triage framework that discriminates against patients with disabilities cannot be fixed if it becomes too late, and triage is already taking place. It took the disability community over six months to get the discriminatory March 28, 2020 triage protocol withdrawn. Moreover, the COVID-19 situation is now deteriorating significantly, with modelling projecting that it risks quickly getting much worse.

Accordingly, the organizations and groups that are signatories to this open letter call on the Ontario Government to:

  1. Immediately make public the report and recommendations of the Government-appointed Bioethics Table submitted to the Government in mid-September, which are now secret, on how to choose which patients should be refused critical care if the COVID-19 pandemic overwhelms hospitals, requiring triage or rationing of critical care beds and services.
  2. Now hold an open, accessible and inclusive public consultation on how such critical care triage decisions should be made, and what protections for patients must be in place.
  3. Develop and make public any new directives or protocols regarding critical care triage, and ensure that they are primarily guided by, and respect, the constitutional and human rights of all patients, including patients with disabilities, ensure due process to patients that are exposed to the risk of being denied life-saving critical care due to triage or rationing of that care, and that such directives and protocols are founded on a properly mandated legislative foundation.

We urge the Government to act immediately in response to this call for action.

Sincerely,

Accessibility for Ontarians with Disabilities Act Alliance (AODA Alliance)

Accessible Housing Network

Advocacy Centre for the Elderly (ACE)

Alliance for Equality of Blind Canadians/l’Alliance pour l’Égalité des Personnes Aveugles du Canada

ARCH Disability Law Centre

Barrier-Free Canada/Canada Sans Barrieres (BFC/CSB)

B.C. Aboriginal Network on Disability Society

Bellwoods Centres for Community Living Inc

Breaking Down Barriers Independent Living Resource Centre

Brockville and District Association for Community Involvement

Canadian Autism Spectrum Disorder Alliance

Canadian Down Syndrome Society

Centre for Independent Living in Toronto (CILT)

Chatham-Kent Legal Clinic

Citizens With Disabilities – Ontario (CWDO)

CNIB Foundation

Communication Disabilities Access Canada

Community Living Chatham-Kent

Community Living Ontario

Community Living Prince Edward

Council of Canadians With Disabilities

DeafBlind Ontario Services

DEEN Support Services

Durham Association for Family Resources and Support

Empowered Kids Ontario

Family Network Thames Valley

Family Support Network-York region

Good Things In Life

Guelph Independent Living

Guide Dog Users of Canada

Hamilton Community Legal Clinic/Clinique juridique communautaire de Hamilton

HIV & AIDS Legal Clinic Ontario

HIV Legal Network

Hydrocephalus Canada

Inclusion Canada

Independent Living Canada

Injured Workers Community Legal Clinic

Joyce Scott Non Profit Homes Inc.

Lupus Canada

March of Dimes Canada

MPN Ontario Patient Support Group

Muscular Dystrophy Canada

National Coalition of People who use Guide and Service Dogs

National Network for Mental Health

Network of Women with Disabilities NOW

Ontario Association of the Deaf

Ontario Disability Coalition

Ontario Federation for Cerebral Palsy

Ontario Parents of Visually Impaired Children OPVIC (Also known as Views for the Visually Impaired)

OPTIONS NORTHWEST

Organization of Canadian Tamils with Disabilities

Parents of Adults with Developmental Disabilities

Peterborough Community Legal Centre

PHSS – Medical and Complex Care in Community

PooranLaw Professional Corporation

RISE: Resource Centre for Independent Living

Shannon law office

Spinal Cord Injury Ontario

Sudbury Community Legal Clinic

Susan Morris Consulting Inc

Tangled Art + Disability

The Older Women’s Network

The Ontario Autism Coalition

Working for Change