Accessibility for Ontarians with Disabilities Act Alliance Update
United for a Barrier-Free Society for All People with Disabilities
Yesterday, Disability Concerns About the Risk of Disability Discrimination if Critical Medical Care Must be Rationed Was Raised In the Ontario Legislature, the Media and Premier Ford’s News Conference
December 4, 2020
Yesterday’s strong open letter to the Ford Government by 64 organizations and groups, spearheaded by the AODA Alliance and the ARCH Disability Law Centre, has increased public attention to our concerns about the Ford Government’s plans if a continuing surge in COVID-19 cases requires rationing or “triage” of hospital critical medical care. We have called on the Ford Government to at last release the secret report and recommendations of the Government’s Bioethics Table on this issue. This is especially important since the Ontario Human Rights Commission has publicly stated that it has human rights concerns with those recommendations.
What Happened Yesterday
Here is a summary of important developments on this issue yesterday, the International Day for Persons with Disabilities:
- In the Legislature during Question Period, Opposition disabilities critic NDP MPP Joel Harden pointed to this new open letter to The Government from the disability community. He asked the Government to make public the report and recommendations of the Government’s Bioethics Table (which the Government has kept secret for almost three months).
Conservative MPP Robin Martin, the Health Minister’s Parliamentary Assistant, responded, but very obviously did not answer the question. Below is the Hansard (formal transcript) of the exchange.
- Yesterday’s Toronto Star included an excellent report on our community’s open letter, written by reporter Brendan Kennedy, set out below.
As well, this issue was picked up by Ottawa Radio 1310’s Rob Snow program, which interviewed AODA Alliance Chair David Lepofsky. Global News also included a story on this issue in yesterday’s evening TV news program.
- During the Premier’s midday December 3, 2020 news conference, Global News asked Premier Ford about our open letter and about making the Government’s plans public. In an answer which we transcribed and set out below, Health Minister Christine Elliott stated that discussions are now ongoing with the Ontario Human Rights Commission about the proper critical care triage protocol to put in place that is fair to everyone. She said she is not sure how long those discussions would be going on, “but that would come forward at the appropriate time.”
Reflections on What Happened Yesterday
The Government said nothing yesterday or previously to the Legislature or the media that explains, much less justifies its keeping secret the Bioethics Table’s report. Both the Ontario Human Rights Commission and the Bioethics Table have called on The Government to make that report public.
We need the Bioethics Table’s report and recommendations to be made public now, and not at some unspecified future “appropriate time.” If such discussions are going on now that have a bearing on human rights for people with disabilities, we should not be shut out of them. We need to know what they are discussing, and we need to be part of those secret discussions.
You will see in the Toronto Star article, set out below, and to the Government’s statement in the Legislature in Question Period, also set out below, some references to the Government’s having increased the number of hospital beds. Not every hospital bed is a critical care bed, with all the services that a critical care patient needs to survive. We have seen no assurance that along with an increased number of beds, the Government has provided all the supports and services needed to ensure that they can provide effective critical medical care to all patients who will need critical care as the COVID-19 pandemic continues to surge, whether they need critical care due to COVID-19 or due to heart attacks, strokes, car accidents, or numerous other causes. Along with the hospital bed, there needs to be a sufficient number of intensive care doctors, nurses and other specialists, as well as ventilators and other equipment and supplies, and the required ventilator technicians. These critical care beds must be located in facilities that are equipped with the safety features needed to make sure that COVID-19 does not spread among patients and staff.
What You Can Do to Help
We strongly encourage one and all to write the Government. If you are concerned about the need for a non-discriminatory clinical triage protocol and the need for transparency in the process of developing it, you can write to your MPP to request the Ontario Government draft a non-discriminatory clinical triage protocol that ensures persons with disabilities have equal access to critical care resources during the pandemic. ARCH has launched a letter writing campaign. You can use this link to learn more: https://archdisabilitylaw.ca/write-to-your-mpp-about-ontarios-triage-protocol/
Please check out 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, explaining our efforts to address the needs of people with disabilities during the COVID-19 crisis.
Watch the AODA Alliance’s new captioned video explaining the entire critical care triage issue, and our new captioned video describing the broader campaign over the past eight months to overcome the serious new barriers that people with disabilities have had to face during the COVID-19 pandemic.
Delays and Delays and Delays
There have now been 673 days, or over 22 months, 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 still 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, addressed in the new online video we unveiled last week.
Ontario Hansard December 3, 2020
PERSONS WITH DISABILITIES
Mr. Joel Harden: Today is the International Day of Persons with Disabilities, and 60 disability organizations sent the Premier a letter today. My question is for him. In September, the government’s bioethics table for the COVID-19 response recommended which patients should be refused critical medical care if overwhelmed hospitals ration it, but to date, the government is keeping those recommendations secret. People with disabilities have a right to know what the government is going to be thinking of doing in this life and death area. We hope that triage never becomes necessary, but Ontario has to be prepared.
Will the Premier keep his promise to be transparent to people with disabilities, publicize the COVID-19 plans of critical triage protocol and do what is the proper thing: make these bioethics table recommendations public?
The Speaker (Hon. Ted Arnott): The member for Eglinton–Lawrence to reply.
Mrs. Robin Martin: Thank you to the member opposite for the question.
The health and well-being of Ontarians is our government’s top priority. In response to COVID-19, we’ve taken action to build more capacity in our health care system and effectively managed surges and future waves of COVID-19. That’s why we invested an additional $2.5 billion, or an increase of 13% from last year, to support our hospitals throughout the pandemic and build capacity, including 3,100 new beds across health facilities.
It’s critical that I remind the member opposite that at the request of health systems stakeholders, Ontario Health and the bioethics table of the provincial command structure drafted a clinical triage protocol for a major surge in the COVID pandemic for a potential worst-case scenario due to the spread of COVID-19. To be clear, this was a draft developed for engagement and consultation and should not be used. We’ve also asked our bioethics table to ensure that concerns and perspectives of Indigenous people, Black and racialized communities, persons with disabilities and others who may be disproportionately affected by critical care triage due to systemic discrimination are meaningfully considered and—
Toronto Star December 3, 2020
Group decries virus triage secrecy
Letter seeks transparency on province’s priority protocols for hospitals
Brendan Kennedy Toronto Star
A coalition of disability rights groups is calling on Doug Ford’s government to make public the directions they plan to give hospitals about how to decide who should be prioritized for life-saving treatment if intensive care units become overwhelmed with COVID-19 patients.
The call comes after the government’s initial COVID-19 triage protocol – which leaked in March but was never officially released – was rescinded after it was criticized for discriminating against people with disabilities. “We write about a life-and-death issue now facing Ontarians,” reads the open letter, signed by more than 60 organizations and sent Thursday to Ford, Health Minister Christine Elliott and Raymond Cho, the minister responsible for seniors and accessibility.
The letter calls on the province to immediately release the latest recommendations from its Bioethics Table – the government-appointed group of physicians and bioethicists advising the ministry on a number of COVID-related issues – and ensure that any new triage guidelines “respect the constitutional and human rights of all patients, including patients with disabilities.”
The purpose of a triage protocol, which would be invoked only if critical care resources needed to be rationed, is to minimize overall mortality by prioritizing patients with the best chance of survival.
Among the concerns raised by disability advocates about the government’s initial protocol was its inclusion of the Clinical Frailty Scale, a nine-point grading tool they said was inherently discriminatory against people with disabilities and could lead to their exclusion from life-saving treatment.
In their letter, the organizations commend the government for rescinding the initial protocol, but the fact that nothing has taken its place also poses a danger. “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,” the letter reads.
Roberto Lattanzio, executive director of the ARCH Disability Law Centre, said the province needs to ensure any new policy protects the rights of people with disabilities. “The pandemic doesn’t give governments a pass on ensuring that human rights and constitutional rights are respected,” he said. “We’ve been advocating for a framework free of discrimination for eight months now, and now we find ourselves in a very similar situation as we did from the outset.”
While the number of active COVID-19 cases in Ontario is nearly three times as high as during the peak of the first wave, hospitalizations and admissions to intensive care units (ICUs) are lower now than they were then. On Wednesday, the province reported that 656 people were hospitalized with COVID-19, including 183 people in ICUs. On May 1, by comparison, there were more than 1,000 patients in hospital, including 225 in ICUs.
The province significantly expanded its critical care capacity in April, increasing the number of ICU beds by nearly 1,500 to a total of 3,504. Roughly half of the province’s ICU beds were occupied as of Dec. 1, according to Critical Care Services Ontario’s daily report.
Last month, in response to a question in the legislature from the NDP, Progressive Conservative MPP Robin Martin confirmed the government had rescinded its initial protocol, which she said was only a draft, and that a “revised framework may be shared… should pandemic conditions deteriorate significantly.” But, Martin said: “We don’t anticipate getting anywhere near having to use such a protocol.”
David Lepofsky, chair of the Accessibility for Ontarians with Disabilities Act Alliance, said cases have steadily increased since Martin’s assurances, and the lack of action by the government is inexcusable. “They can’t wait until the day where they need triage and then say, ‘By the way, here are the rules.'”
The Health Ministry sent a statement saying it asked the Bioethics Table to “ensure that concerns and perspectives of those representing Indigenous people, Black and racialized communities, persons with disabilities, and others who may be disproportionately affected by critical care triage due to systemic discrimination, are meaningfully considered and reflected in a revised protocol.” A spokesperson did not respond when asked whether the government would make the revised protocol public.
Text of an Exchange During Premier Doug Ford’s December 3 2020 NEWS CONFERENCE
Note: This entire news conference is posted on Youtube at https://youtu.be/UTp3yZTSBXA
Your final question comes from Miranda Anthistle with Global News. Please go ahead.
Miranda Anthistle: Hi there, thank you for my question.
Doug Ford: Hi. How are you?
Miranda Anthistle: Ok, so the first one is, the Ontarians With Disabilities Act Alliance has written an open letter to your government about transparency on how decisions will be made when it comes to prioritizing life-saving treatments and who will get them if hospitals become overwhelmed. So will this information be released and how does the government plan on prioritizing life-saving treatments?
Doug Ford: Pass that to the Minister:
Christine Elliott: Well this is a very important issue and one that health care professionals asked us to deal with very early on in the pandemic because they were concerned about Ontario becoming overwhelmed in the same way that Italy was, for example. So a draft protocol was developed that had been sent to hospitals, but this is really only meant for internal purposes
but I know that a number…and is not being acted upon. It was met with a lot of concern by a number of disabilities groups and seniors groups and so we reached out to the table at the Health Command Table reached out to the Ontario Human Rights Commission to obtain their assistance in redrafting a protocol and I understand there is still discussions ongoing with the Ontario Human Rights Commission in order to make sure that we reach a level place where everyone is dealt with fairly in terms of dealing with the triage protocol whether it’s for people with disabilities, for seniors, racialized communities, indigenous communities making sure that it’s there and level for all people.
So those discussions are ongoing. I’m not sure exactly how long they will be continuing but that will come forward at the appropriate time.