Divisional Court Declines to Rule on Argument that Ontario’s Accessibility Minister Violated Ontario’s Disabilities Act — AODA Alliance Urges Accessibility Minister to Obey the Law He’s Mandated to Spearhead


Accessibility for Ontarians with Disabilities Act Alliance Update

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

Web: www.aodaalliance.org

Email: [email protected]

Twitter: @aodaalliance

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Divisional Court Declines to Rule on Argument that Ontario’s Accessibility Minister Violated Ontario’s Disabilities Act — AODA Alliance Urges Accessibility Minister to Obey the Law He’s Mandated to Spearhead

October 8, 2021

Summary

Here are two major updates in our campaign to get the Ontario Government to effectively implement the Accessibility for Ontarians with Disabilities Act.

1. Ontario’s Divisional Court Dismisses David Lepofsky’s Court Application, Without Ruling On Whether Accessibility Minister Raymond Cho Violated the AODA

On Friday, October 1, 2021, the Ontario Divisional Court released its ruling in Lepofsky v. Cho. We set the 2-page ruling out below.

The Court dismissed the application by AODA Alliance Chair David Lepofsky, without ruling on his contention that Accessibility Minister Raymond Cho violated s. 10(1) of the AODA. That section requires the minister to publicly post a Standards Development Committee’s initial report upon his receiving it. Minister Cho did not post the health care Standards Development Committee’s initial report until over four months after he received it. He did not post the Post-Secondary Education Standards Development Committee’s initial report until 3.5 months after he received it. He did not post the K-12 Education Standards Development Committees initial report until 2.5 months after he received it.

The Court decided not to rule on the merits of David Lepofsky’s claim, concluding that the application had become moot after the Government eventually publicly posted all three reports. The Court had the authority to rule on the case, even though it was moot, but decided not to, for the reasons set out below. Minister Cho had urged the Court not to rule on the question whether he had violated the AODA. David Lepofsky urged the Court to rule on the case even if it was moot.

This ruling does not vindicate the Ford Government’s conduct. There are at least two important developments arising from this case.

First, Minister Cho, through his lawyer, conceded in court for the first time that he must post a Standards Development Committees initial report after taking the steps that are reasonably necessary to prepare the report for public posting. See the ruling, below. Second, the evidence in the case showed that the Government had created bureaucratic barriers that delayed the public posting of these reports. For example, the Government requires Cabinet Office to give permission to post something online, in accordance with Government marketing priorities. Yet, the AODA gives Cabinet Office no right to veto or delay the public posting of these reports.

2. AODA Alliance Writes Accessibility Minister Cho to Call on Him to Fulfil His Unmet Statutory Duties

On October 8, 2021, the AODA Alliance sent a detailed letter to Accessibility Minister Raymond Cho, set out below. It gives some specific examples of how the Ford Government has violated the AODA. It asks the Government to give these three commitments:

“1. Will you commit to now appoint Standards Development Committees to review the Customer Service Accessibility Standard and the Design of Public Spaces Accessibility Standard, after advertising for people to apply to serve on those Committees? Will you give the latter Committee a mandate to make recommendations generally addressing measures needed to make the built environment accessible?”

“2. Will you commit to strengthen the insufficient Transportation Accessibility Standard, Employment Accessibility Standard and Information and Communication Accessibility Standard in the next four months, after you consult us on the revisions needed to strengthen them?”

“3. Will you commit that you will now put in place effective procedures to ensure that the final reports of the Health Care Standards Development Committee, the K-12 Education Standards Development Committee and the Post-Secondary Education Standards Development Committee will each be made public within a few days of your receiving a final report, at the latest? To do this will you commit as follows:

  1. a) Will you agree that under the AODA, you as Minister are required to publicly post a Standards Development Committee’s final report “upon receiving” it?
  1. b) When a Standards Development Committee submits its initial or final report to you, will you immediately let the AODA Alliance and the public know that it has been received?
  1. c) Since your Ministry officials work closely with a Standards Development Committee as it prepares and votes to approve an initial or final report, will you direct your officials to take all the steps that are reasonably necessary to publicly post the report as quickly as possible, and wherever possible, even before the report is formally transmitted to you? For example, most if not all of this work can be started and even completed after a Standards Development Committee formally votes to approve its report, and before that report is formally transmitted to you.
  1. d) Once you receive a Standards Development Committee’s initial or final report, will you have it immediately posted online as soon as it is translated into French and the minimum steps are taken that are needed to code the document for posting, e.g., as a downloadable file?
  1. e) Once you receive an initial or final report from a Standards Development Committee, will you agree not to delay its public posting in order for the Government to take steps that are not necessary for its public posting? For example, will you agree not to delay the report’s public posting until there are briefings of the minister, deputy minister or other public officials on it, and/or to prepare a public survey on it, and/or to prepare other web pages or communication web pages, or other strategies regarding it, and/or to seek permission of Cabinet Office for it to be publicly posted, and/or to edit it to conform to any Government style or writing standards for publicly posted documents, and/or to align the timing of its public posting with the Government’s political, marketing or other strategies or priorities?”

3. Getting Close to 1,000 Days of Ford Government Inaction on the David Onley Report

There have now been a breathtaking 981 days since the Ford Government received the final report of the Independent Review of the implementation and enforcement of the Accessibility for Ontarians with Disabilities Act undertaken by former Lieutenant Governor David Onley. That report found that Ontario is well behind schedule for becoming accessible to people with disabilities by 2025, the AODA’s mandatory deadline. It found that Ontario is full of “soul-crushing barriers” impeding people with disabilities. The Ford Government still has no comprehensive plan in place for implementing the Onley Report.

Send us your feedback. Write the AODA Alliance at [email protected]

        MORE DETAILS

October 1, 2021 Divisional Court Ruling in Lepofsky v. Cho

CITATION: Lepofsky v. Cho, 2021 ONSC 6466

DIVISIONAL COURT FILE NO.: 364/21 DATE: 2021/10/01

SUPERIOR COURT OF JUSTICE – ONTARIO DIVISIONAL COURT

RE: DAVID LEPOFSKY, Applicant

AND:

RAYMOND CHO, THE MINISTER FOR SENIORS AND ACCESSIBILITY, Respondent

BEFORE: Sachs, R. D. Gordon and Kristjanson JJ.

COUNSEL: David Lepofsky, on his own behalf

Michael J. Sims and Wan Yao Chen, for the Respondent

Dianne Wintermute, for the Intervenor, Citizens with Disabilities, Ontario

HEARD at Toronto by videoconference: September 27, 2021

ENDORSEMENT

The Applicant initially sought an order in the nature of mandamus compelling the Respondent to make public proposed accessibility standards the Minister had received from three committees (the “Reports”). The Reports have now been made available. The Applicant amended his application to seek a declaration that the Respondent breached his duty to make the Reports public upon receipt, as is required by s. 10(1) of the Accessibility for Ontarians with Disabilities Act, 2005 (the “Act”).

We agree with the Respondent that the Application’s application is moot. The live controversy between the parties, namely, the failure to make the Reports available to the public, has now disappeared.

The Applicant argues that even if we find that the application is moot, we should proceed to hear it as to do so would provide guidance to the parties for future cases. We agree with the Applicant that accessibility for Ontarians with disabilities is an urgent issue and that the deadline provided for in the Act for achieving the purpose of the Act is fast approaching. Thus, anything that can be done to eliminate delay in achieving the goal of accessibility should be done. We disagree that issuing a declaration in this case to the effect that the Respondent breached its duty to make the Reports public upon receipt would meaningfully advance this goal.

Page: 2

Issuing a declaration that would have a meaningful effect in the future requires adopting an interpretation of the term “upon receipt” used in the English version of s. 10(1) of the Act (the term does not appear in the French version) that is not dependent on the analysis of a particular set of circumstances. Yet, neither the Applicant nor the Respondent is advocating such an interpretation. Both agree that the Reports are required to be released only after the Respondent has taken the reasonable steps necessary to prepare the Reports for public release. Where they disagree is on the question of which steps were reasonably necessary in this particular case and how much time was reasonably required to take those steps. For example, the Respondent asserts that it was necessary to brief the government about the content of the Reports and to make sure that the Reports did not exceed the mandate of the committees who issued them and that the language in the reports is appropriate. The Applicant counters by stating that these steps were not necessary since in this case the Respondent had representatives on the committees that prepared the Reports, which should have obviated the necessity for any more review. Both parties agree that before the Reports could be released they had to be “coded” and translated into French. Where they disagree is on the question of how long this process should have taken.

The Respondent states that part of the delay in this case was due to COVID 19. The Applicant disputes this explanation. Determining whether the requested declaration should be issued would require this Court to assess the evidence about the circumstances in this particular case. If we were to conclude that in this case the Respondent breached its duty, this would say nothing about what a subsequent court might decide in a different case. The analysis is an individual and contextual one and will necessarily vary in each case. For the court to engage in this exercise when the desired objective (the release of the Reports) has been achieved would not be an appropriate use of its resources.

The Applicant argues that failing to hear his application would be deny him a remedy in the face of the Respondent’s breach of its statutory obligation. Again, we disagree. The Applicant’s remedy in this situation was to seek an order requiring the Respondent to comply with its obligation and make the Reports available. Due to the fact that the Reports have now been made available, there is no further need for court intervention.

For these reasons the application is dismissed. The parties agree that there should be no order as to costs.

Sachs J.

I agree

  1. D. Gordon J.

I agree

Kristjanson J.

Date: October 1, 2021

October 8, 2021 Letter from AODA Alliance Chair David Lepofsky to Ontario Accessibility Minister Raymond Cho

Accessibility for Ontarians with Disabilities Act Alliance

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

Web: www.aodaalliance.org Email: [email protected] Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

October 8, 2021

To: The Hon Raymond Cho, Minister for Seniors and Accessibility

Via email: [email protected]

College Park 5th Floor

777 Bay St

Toronto, ON M7A 1S5

Dear Minister,

Re: Your Statutory Duties Under the Accessibility for Ontarians with Disabilities Act

We ask you to take specific overdue actions, required of you as Ontario’s cabinet minister responsible for the implementation and enforcement of the Accessibility for Ontarians with Disabilities Act. These actions would help you fulfil your duty under section 7 of the AODA to oversee the development and implement all the accessibility standards necessary to achieving the AODA’s purpose.

The AODA’s purpose is to lead Ontario to become accessible to Ontarians with disabilities by 2025. That looming deadline is only a little more than three years away. It is beyond dispute that Ontario is not on schedule for becoming accessible by 2025. A failure to swiftly take the actions we identify in this letter would push Ontario further behind in reaching that deadline.

The Duty to Appoint Standards Development Committees to Review the Sufficiency of an Accessibility Standard Enacted Under the AODA Within Five Years After It is Enacted

Within five years after an accessibility standard is enacted under the AODA, section 9 of the AODA requires the minister, responsible for the AODA, to appoint a Standards Development Committee to review the sufficiency of that accessibility standard. You are in clear violation of that requirement in the following two instances.

  1. a) The Design of Public Spaces Accessibility Standard was enacted in December 2012. The AODA required that a Standards Development Committee be appointed to review it no later than December 2017. Yet in the almost four years since then, no Standards Development Committee has been appointed for that purpose.

The previous Kathleen Wynne Government is responsible for not taking this action over the last six months of its term in office, from December 2017 to June 2018. You and your Government have been in violation of that mandatory requirement for your entire term in office to date, well over three years.

We have brought this unfulfilled requirement to your Government’s attention. We and others have urged your Government on several occasions to develop a Built Environment Accessibility Standard, in order to fulfil the AODA’s requirement that buildings become accessible to people with disabilities by 2025. Your Government has never agreed to do so. To the contrary, during debates on this idea in the Legislature on May 30, 2019, during National Access Awareness Week, you inaccurately and hurtfully condemned this idea as creating “red tape.”

  1. b) In 2007, the previous Ontario Government enacted the Customer Service Accessibility Standard, the first accessibility standard to be enacted under the AODA. In June 2016, the previous Government enacted revisions to the Customer Service Accessibility Standard. You were therefore required to appoint a Standards Development Committee no later than June 2021, to review the sufficiency of the Customer Service Accessibility Standard. You have not done so. As far as we have seen, you have announced no plans to do so.

People with disabilities in Ontario continue to face recurring disability barriers in many areas, such as in the built environment and in access to customer service. In important areas, the COVID-19 pandemic has made this situation even worse for people with disabilities. Moreover, your own Ministry enforcement data has revealed over the years that there have been rampant AODA violations in the context of the Customer Service Accessibility Standard.

  1. Will you commit to now appoint Standards Development Committees to review the Customer Service Accessibility Standard and the Design of Public Spaces Accessibility Standard, after advertising for people to apply to serve on those Committees? Will you give the latter Committee a mandate to make recommendations generally addressing measures needed to make the built environment accessible?

 The Pressing Need to Strengthen the Transportation Accessibility Standard, the Employment Accessibility Standard and the Information and Communication Accessibility Standard

In 2011, the Ontario Government enacted three important accessibility standards under the AODA, the Transportation Accessibility Standard, the Employment Accessibility Standard and the Information and Communication Accessibility Standard. These three standards are enacted together in one regulation, the Integrated Accessibility Standards Regulation 2011.

The AODA required the previous Government to appoint Standards Development Committees by 2016 to review the sufficiency of each of those three accessibility standards. It therefore appointed the Transportation Standards Development Committee, the Employment Standards Development Committee, and the Information and Communication Standards Development Committee.

Quite some time ago, each of those advisory committees fully completed their reviews and submitted their final reports to the Ontario Government. The Transportation Standards Development Committee’s final report was made public in the spring of 2018, before the June 2018 Ontario election. The Employment Standards Development Committee submitted its final report to you over two and a half years ago, on January 22, 2019. The Information and Communication Standards Development Committee submitted its final report to you over one and a half years ago, on February 23, 2020.

According to the AODA, once the Government receives a Standards Development Committee’s final report, the Government can amend the accessibility standard that it reviewed. It can enact some, all or none of the changes that the Standards Development Committee recommended, and/or can make other reforms to the standard that the Government thinks helpful.

Despite all this work having been done, and all the recurring barriers that people with disabilities continue to face in transportation, employment and information and communication, your Government has enacted no revisions to the Transportation Accessibility Standard the Employment Accessibility Standard or the Information and Communication Accessibility Standard. In fact, your Government has not enacted or strengthened any accessibility standards at all in its entire term in office.

You have failed to do so, even though over two and a half years ago, you received the final report of David Onley’s Independent Review of the AODA. He found that Ontario is well behind schedule for becoming accessible by 2025, and is full of “soul-crushing barriers” that hurt people with disabilities. In the Legislature, you said that Mr. Onley did a “marvelous job” in preparing his report.

  1. Will you commit to strengthen the insufficient Transportation Accessibility Standard, Employment Accessibility Standard and Information and Communication Accessibility Standard in the next four months, after you consult us on the revisions needed to strengthen them?

Ensuring that the Forthcoming Final Reports of the Health Care Standards Development Committee, the K-12 Education Standards Development Committee and the Post-Secondary Education Standards Development Committee Are Made Public Upon Your Receiving Them, Without Delay

Three Standards Development Committees, appointed under the AODA, are to resume their work this fall. They are required to review public feedback on their respective initial reports received over the summer and fall. They must then come up with their final reports and submit them to you. They will address disability barriers facing people with disabilities in the health care system, in the K-12 education system, and the post-secondary education system.

It is very important that you make public each of those Committees’ final reports upon receiving each of them, and that you not continue the Government’s practice of delaying for months the public posting of initial and final reports of Standards Development Committees appointed under the AODA.

These three forthcoming reports will, taken together, address serious disability barriers in the important areas of health care and education. The initial reports of these three Government-appointed advisory Standards Development Committees already documented that Students with disabilities face far too many disability barriers in Ontario’s schools, colleges and universities. Their initial reports also reaffirm how patients with disabilities face far too many disability barriers in Ontario’s health care system.

The AODA requires the minister responsible for the AODA to make public the initial or final report of a Standards Development Committee “upon receiving” the report. Regarding a Standards Development Committee’s initial report, s. 10(1) of the AODA provides:

  1. (1) Upon receiving a proposed accessibility standard from a standards development committee under subsection 9 (5) or clause 9 (9) (c), the Minister shall make it available to the public by posting it on a government internet site and by such other means as the Minister considers advisable.

As for any progress report that a Standards Development Committee submits to you, including the Committee’s final report, s. 11(2) of the AODA provides:

Progress reports

  1. (1) Each standards development committee shall provide the Minister with periodic reports on the progress of the preparation of the proposed standard as specified in the committee’s terms of reference or as may be required by the Minister from time to time.

Progress reports made public

(2) Upon receiving a report under subsection (1), the Minister shall make it available to the public by posting it on a government internet site and by such other means as the Minister considers advisable.

The Government has a troubling track record of withholding the initial or final reports of Standards Development Committees from the public for months or even years after receiving them, despite the minister’s statutory duty to post these reports upon receiving them. One troubling example of these was your Government’s withholding the final report of the Employment Standards Development Committee for over two years, from the time you received it in January 2019 to the time you publicly posted it in February 2021. You did so while people with disabilities continued to languish, facing troubling barriers in access to employment.

Another troubling illustration of this pattern was your withholding the initial report of the Health Care Standards Development Committee from the public for over four months after you received it. You did this during some of the worst of the COVID-19 pandemic, when you knew that people with disabilities were facing added barriers and hardships during that pandemic, and that the initial report you withheld from the public called for strong action on health care barriers, including those which are COVID-19-related.

In the recent case of David Lepofsky v. Raymond Cho, a senior Ministry official took the incorrect and harmful position that the AODA does not even require you to ever make public a Standards Development Committees final report. The Government had never before claimed that it had no statutory duty to make a Standards Development Committee’s final report public upon receiving it. That official’s affidavit, filed on your behalf, stated:

While posting of Initial Recommendations Reports is required by the Act and follows the process as outlined above, the Act does not require that the Minister post Final Recommendations Reports. In practice, the Ministry has posted these final reports as well.

In Lepofsky v Cho, I had filed a court application for judicial review on May 7, 2021, seeking a court order to force you to fulfil your duty to make public the initial reports that you had already received from the Health Care Standards Development Committee, the K-12 Education Standards Development Committee and the Post-Secondary Education Standards Development Committee. You had withheld those reports from the public much longer than necessary to post them online. It remains my position that you were in violation of your duty under s. 10(1) of the AODA to post each of those initial reports upon receiving them.

Although the court dismissed my application, it did not conclude that you complied with your legal obligations. Instead, at your request and over my objection, the Divisional Court declined to rule on my application, based on the fact that you had subsequently made all those initial reports public.

Your delay in posting those three initial reports was inexcusable. The Health Care Committee’s initial report was posted over four months after you received it. The K-12 Committee’s initial report was posted two-and-a-half months after you received it. The Post-Secondary Committee’s initial report was posted three-and-a-half months after you received it.

You made public the Health Care Standards Development Committee’s initial report just moments after I filed my court application on May 7, 2021, and no doubt before you had learned of my court application. You made public the K-12 Education Standards Development Committee’s initial report on June 1, 2021, over three weeks after I filed my court application. You made public the Post-Secondary Education Standards Development Committee’s initial report on June 25, 2021, over six weeks after I filed my court application.

During the September 27, 2021 oral argument on my court application, your counsel conceded that section 10(1) of the AODA requires you to post an initial report that you have received after taking the steps that are reasonably necessary to prepare the report for public posting. The evidence that you placed before the Court showed that in the case of each of those three initial reports, your Ministry delayed its public posting well beyond the time it took to translate the report into French and to code it for online posting. (Even if it were assumed that your Ministry needed as much time as it actually took for French translation and coding.

According to your Ministry’s own evidence, you and your Government injected additional bureaucratic steps that delayed their posting. This included time taken to brief you or your office, and/or other Government officials. It included time taken to get Cabinet Office’s approval for their public posting in according with the Government marketing priorities, even though s. 10(1) gives Cabinet Office no authority to veto or delay their public posting. It included time taken to develop an online survey about each initial report, even though this is unnecessary to ready a report for public posting. It included time taken for the Government to develop a communication strategy (even though this too is unnecessary before a report is publicly posted). Finally, included time taken to edit the report for conformity with the Government’s standard for online posts, even though the Government has no authority to alter a Standards Development Committees report before publicly posting it.

It is extremely significant that your lawyer conceded in the face of the Court’s questions that the time needed to translate a report into French and to code it for public posting was a small part of the time which the Government actually took before it publicly posted an initial report. There was no evidence that your Government tried to speed up the reports’ translation or coding as a priority, or that most if not all of this work could not be done during the days or weeks before each report was formally submitted to you. Your staff were intimately involved with the work of each Standards Development Committee from beginning to end.

Your delays in publicly posting those three initial reports has further delayed Ontario’s progress toward reaching the AODA’s mandatory goal of becoming accessible to people with disabilities by 2025. As noted earlier, Ontario is already well behind in reaching that goal, as the David Onley Independent Review of the AODA amply documented over two years ago. Moreover, you withheld those reports from the public at an especially harmful time, during pivotal months of the COVID-19 pandemic. It was especially urgent to let hospitals, other health care providers, schools, colleges, and universities know as soon as possible about their disability barriers, and about initial recommendations of what they should do to remove and prevent them. Instead, you stalled that process.

It is essential that the Health Care, K-12 and Post-Secondary Standards Development Committees are able to complete their work and submit their final reports to you as soon as possible. Your Ministry should take every step it can to facilitate this.

Once any of those Committees submit their final report to you, you should make public the fact that you have received it. You should publicly post it upon receiving it, without any delay. You should not hold up the public posting for such things as briefing ministers or other Government officials, for getting Cabinet Office approval, for formatting the report to meet Ontario Government posting standards, or for developing communication strategies or survey instruments.

The next Ontario election is only eight months away. We want to ask each party to make commitments to implement those final reports. For you to delay the public posting of any of those reports would impede and frustrate that effort.

  1. Will you commit that you will now put in place effective procedures to ensure that the final reports of the Health Care Standards Development Committee, the K-12 Education Standards Development Committee and the Post-Secondary Education Standards Development Committee will each be made public within a few days of your receiving a final report, at the latest? To do this will you commit as follows:
  1. a) Will you agree that under the AODA, you as Minister are required to publicly post a Standards Development Committee’s final report “upon receiving” it?
  1. b) When a Standards Development Committee submits its initial or final report to you, will you immediately let the AODA Alliance and the public know that it has been received?
  1. c) Since your Ministry officials work closely with a Standards Development Committee as it prepares and votes to approve an initial or final report, will you direct your officials to take all the steps that are reasonably necessary to publicly post the report as quickly as possible, and wherever possible, even before the report is formally transmitted to you? For example, most if not all of this work can be started and even completed after a Standards Development Committee formally votes to approve its report, and before that report is formally transmitted to you.
  1. d) Once you receive a Standards Development Committee’s initial or final report, will you have it immediately posted online as soon as it is translated into French and the minimum steps are taken that are needed to code the document for posting, e.g., as a downloadable file?
  1. e) Once you receive an initial or final report from a Standards Development Committee, will you agree not to delay its public posting in order for the Government to take steps that are not necessary for its public posting? For example, will you agree not to delay the report’s public posting until there are briefings of the minister, deputy minister or other public officials on it, and/or to prepare a public survey on it, and/or to prepare other web pages or communication web pages, or other strategies regarding it, and/or to seek permission of Cabinet Office for it to be publicly posted, and/or to edit it to conform to any Government style or writing standards for publicly posted documents, and/or to align the timing of its public posting with the Government’s political, marketing or other strategies or priorities?

As always, we remain ready, willing and able to assist the Government on the effective implementation and enforcement of the AODA. May we ask for your prompt reply to this letter, including the three commitments that we seek.

Sincerely,

David Lepofsky CM, O. Ont

Chair Accessibility for Ontarians with Disabilities Act Alliance

Twitter: @davidlepofsky

CC: The Hon. Premier Doug Ford [email protected]

Denise Cole, Deputy Minister of Accessibility, [email protected]

Alison Drumming, Acting Assistant Deputy Minister for the Accessibility Directorate, [email protected]



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Ford Government Must Ensure the New Vaccine Passport System Does Not Create New Barriers for People with Disabilities – AODA 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: [email protected]

Twitter: @aodaalliance

Facebook: www.facebook.com/aodaalliance/

Ford Government Must Ensure the New Vaccine Passport System Does Not Create New Barriers for People with Disabilities

September 3, 2021

        SUMMARY

The Ford Government’s plan to require vaccination passports starting September 22, 2021 to access certain places is an important step to get as many people as possible to get fully vaccinated. However, it is very important that this new vaccination passport requirement and system not create any new barriers for people with disabilities in Ontario. This can be achieved if the Ford Government shows strong leadership, and takes the steps outlined here as a swift and clear priority.

As it is, people with disabilities face far too many disability barriers when seeking goods, services facilities and jobs. It is good that the Government’s introductory announcement plans for an exemption for people who cannot get vaccinated for medical reasons. The Ford Government’s September 1, 2021 news release included:

Individuals who cannot receive the vaccine due to medical exemptions will be permitted entry with a doctor’s note until recognized medical exemptions can be integrated as part of a digital vaccine certificate. Children who are 11 years of age and younger and unable to be vaccinated will also be exempted from these requirements.

This general statement, while helpful, does not protect people with disabilities from the creation of new barriers. Before this vaccination passport requirement goes into effect, the Ontario Government must immediately put in place several important measures to ensure that the Government creates no new disability barriers. While this requires further exploration, we know that the following is absolutely necessary:

  1. Any mobile app for vaccine passports must be designed and tested to ensure it is fully accessible to adaptive technology for smart phone users with disabilities, such as screen readers. The Federal Government did not do so for its COVID-19-related smart phone ArriveCan app for entering Canada.
  1. The Ontario Government must make available an easily-accessed alternative hard copy document to a smart phone app for vaccine passports. Too many people cannot afford smart phones, including many people with disabilities (who disproportionately live in poverty).
  1. It is not sufficient for the Government to impose the burden on those individuals with disabilities, who cannot take the vaccine for medical reasons, to get a letter from their physician. This is especially a hardship if it needs to be accomplished in under three weeks.

As it is, well before the COVID-19 pandemic arrived, people with disabilities have faced far too many disability barriers in Ontario’s health care system. The initial report of the Government-appointed Health Care Standards Development Committee documents this in detail. The AODA Alliance’s August 3, 2021 brief to that Standards Development Committee amplifies its concerns. Disability barriers in the health care system got considerably worse during the pandemic. See generally, the AODA Alliance website’s health care page and COVID-19 page.

Some people with disabilities have no doctor to give them an exemption letter. For those who do have a doctor, getting to a doctor can involve disability barriers. The Government has not announced that it is going to pay doctors to provide those letters. We fear that doctors will be even harder to reach if flooded with requests for vaccine exemption letters.

As a result, the Ford Government should immediately provide a vaccine exemption passport for people with disabilities who are medically unable to get the vaccine. The process for obtaining these passports should be ensured to be free of disability barriers. The Ford Government’s related record is not good. To apply for a replacement for one’s expired health care card, one can use a Government website and avoid going to a Service Ontario office, but only if one has a driver’s license. This is an obvious barrier for people with disabilities who cannot qualify for a driver’s license, such as blind people.

  1. The Ontario Government’s problematic roll-out of the COVID-19 vaccine over the past months included real problems facing some people with disabilities who wanted to get vaccinated. The Government did not include in its roll-out plans for the start a comprehensive plan to ensure that there was a barrier-free way for people with disabilities to get vaccinated.

While more vaccination opportunities now exist, the Government needs to now put in place a swift, pro-active, accessible and comprehensive strategy for people with disabilities needing and wanting the vaccine, to get swift, barrier-free and ready access to vaccination

  1. Public protections need to be put in place for any vulnerable people with disabilities for whom a substitute decision-maker is in place, to address situations where the substitute decision-maker has refused to let a person with a disability for whom they are responsible get vaccinated, in circumstances where there is no medical justification for that refusal.

People with disabilities have disproportionally suffered the worst hardships of the pandemic. It is essential that this understandable new passport requirement not make things worse for any people with disabilities.

As our AODA Alliance Updates have documented, time and again the Ford Government has failed to effectively accommodate the urgent needs of people with disabilities during the pandemic. Time and again, we and others from the disability community have come forward with constructive proposals to fix this.

Overall, the Ford Government has a poor track record, when it comes to achieving accessibility for people with disabilities by 2025, the deadline that the Accessibility for Ontarians with Disabilities Act requires. We commend CTV news for focusing on this vaccine passport disability this issue, and for including it in a news report on August 31, 2021, set out below.

        MORE DETAILS

CTV News August 31, 2021

Originally posted at: https://toronto.ctvnews.ca/how-will-vaccine-passport-system-work-in-ontario-for-people-without-cellphones-1.5568573

How will vaccine passport system work in Ontario for people without cellphones?

Jon Woodward

CTV News Toronto Video Journalist

@CTV_Jon

TORONTO — Advocates are cautioning a headlong rush into implementing a vaccine passport using only smartphone apps — warning it could leave the elderly, the poor or the homeless out in the cold.

Angie Peters of the Yonge St. Mission said designing a vaccine passport to work for disadvantaged people has to be as creative and motivated as the push to get those people vaccines was.

“They may have a cellphone but need to print it because technology is fleeting for them. They have a cellphone this month, but not next month,” she said.

And the solution of a printed out code may also not solve all the problems, Peters said.

“If they have a printer, they may not be able to afford the ink. There are people that we work with that lose their ID, they get rolled on the street regularly. If they’re keeping a printed card, it’s going to get lost and it’s going to have to get replaced, just like other ID on a regular basis,” she said.

It all could add up to a barrier that could result in properly vaccinated people denied entry for factors other than just vaccination, she said.

The Ontario government is expected to introduce some form of vaccine passport this week after calls from the medical community that checking vaccine status at the door could prevent the spread of COVID-19 inside any non-essential venues.

The business community has pushed for a vaccine passport, reasoning that it would lead to more business to be done if capacity limits could be raised safely.

But for those without cellphones, with older cellphones, or those who would have a more difficult time navigating the steps to prove that they are vaccinated, this could be a major headache, said David Lepofsky of the AODA Alliance.

If there’s any reason why someone with a disability couldn’t get the passport, they would need an alternative passport, he said, pointing to people for whom there could be medical exemptions from vaccination.

“We don’t want this to become a long-term thing that could be used against people when the health situation has changed so it should be very time-limited and circumstance-dependent,” he said.

In Manitoba, an immunization card alternative has proved so popular that the government ran out of plastic to print it on.

In Quebec and in B.C.’s planned card, printing the code onto paper is an option as the readers can read the QR codes just as well from paper as from a screen.



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Ford Government Belatedly Extended to September 13, 2021 the Deadline for Sending Feedback on Recommendations to Remove Disability Barriers from Ontario’s Health Care System


Accessibility for Ontarians with Disabilities Act Alliance Update

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

Web: www.aodaalliance.org

Email: [email protected]

Twitter: @aodaalliance

Facebook: www.facebook.com/aodaalliance/

Ford Government Belatedly Extended to September 13, 2021 the Deadline for Sending Feedback on Recommendations to Remove Disability Barriers from Ontario’s Health Care System

August 18, 2021

        SUMMARY

1. Summary of All Deadlines for Sending Feedback to the Ford Government on What is Needed in New Education and Health Care Accessibility Standards

Last week, after the Ford Government’s deadline had already expired for submitting feedback on the barriers that people with disabilities face in the health care system, the Government extended that deadline. The Government never told us about that extension. After we heard a rumour about it, we asked the Government if there was an extension. The Government then put us on a list of people being notified about this extension. We do not know who else has been alerted to it.

You may understandably be very confused about when you can give the Ford Government this feedback, as well as your input on two other proposals that are out for public feedback, under the Accessibility for Ontarians with Disabilities Act. We here try to clarify things for you.

The bottom line is this: The Ford Government now has the initial reports of three different AODA Standards Development Committees publicly posted for your feedback and input. The Government has now extended two of the three deadlines it earlier announced for giving your feedback.

The AODA Alliance is taking part in all three consultations. We urge you to do so as well. We have submitted our detailed August 3, 2021 brief to the Health Care Standards Development Committee on its initial report. Please email that Committee to endorse the AODA Alliance brief. We know that the March of dimes of Canada and the Ontario Autism Coalition have already done so. Send them your endorsement of our brief by writing [email protected]

The deadlines for sending the Government your feedback are now as follows:

  1. You have up to September 13, 2021 to give feedback on the initial report of the Health Care Standards Development Committee. It recommends what should be included in the promised Health Care Accessibility Standard to tear down the disability barriers facing people with disabilities in Ontario’s health care system.
  1. You have up to September 29, 2021 to give the Government feedback on the initial report of the Post-Secondary Education Standards Development Committee. It recommends what should be included in the Education Accessibility Standard to tear down the disability barriers impeding students with disabilities in Ontario’s colleges and universities.
  1. You have up to September 30, 2021 to give feedback on the initial report of the K-12 Education Standards Development Committee. It recommends what should be included in the promised Education Accessibility Standard to tear down the disability barriers facing students with disabilities in Ontario’s education system.

Where do you send your feedback? Here are the email addresses to use:

 2. What Comes Next

What happens after all this feedback is gathered? After these feedback periods expire, three Government-appointed Standards Development Committees are to go back to work. They are supposed to review all the public feedback they received, and make any changes to their recommendations to the Government. They then submit their finalized report to the Ford Government on what they think the Government should include in the AODA accessibility standard on which they are working.

Section 10(2) of the AODA requires the Government to publicly post each final report from a Standards Development Committee upon receiving it. After the Government receives a Standards Development Committees final report, it can enact the accessibility standard that the Committee recommended as is, or with any changes it wishes. The Government can also do nothing at all.

At the very lethargic and sluggish rate that the Ford Government has been acting on implementing the AODA, it is extremely unlikely that it will enact a Health Care Accessibility Standard or Education Accessibility Standard before next June’s provincial election. It has enacted no accessibility standards and made no revisions to any accessibility standards since it took office over three years ago.

Making this worse, the Ford Government has not made any changes to strengthen the 2011 Transportation Accessibility Standard, even though the Government received a final report from the Transportation Accessibility Standard in the spring of 2018. It has not made any revisions to strengthen the Employment Accessibility Standard, even though it received the final report of the Employment Standards Development Committee over two years ago. It has not enacted any revisions to strengthen the Information and Communication Accessibility Standard, even though it received the Information and Communication Standards Development Committees final report almost one and a half years ago.

The AODA Alliance campaigned for over half a decade to get the Ontario Government to agree to develop and enact accessibility standards under the Accessibility for Ontarians with Disabilities Act in health care and education. The door is open for your input. These opportunities don’t often come along.

In next June’s provincial election, we plan to ask the major parties to commit to action to make Ontario’s education system and health care system fully accessible to people with disabilities. The current public consultations can help with that effort.

 3. Helpful Resources

a) On Disability Barriers in the K-12 Ontario School system

  1. The entire 185-page K-12 Education Standards Development Committee initial report and initial recommendations on what the promised Education Accessibility Standard should include to make education in Ontario schools barrier-free for all students with disabilities.
  1. The AODA Alliance’s 55-page condensed and annotated version of the K-12 Education Standards Development Committee initial report and recommendations.
  1. The AODA Alliance’s 15-page summary of the K-12 Education Standards Development Committee initial report and recommendations.
  1. The AODA Alliance‘s action kit on how to give public feedback on the K-12 Education Standards Development Committee initial report and recommendations.
  1. A captioned video by AODA Alliance Chair David Lepofsky explaining what is in the K-12 Education Standards Development Committee initial report.
  1. A captioned video of tips for parents of students with disabilities on how to advocate at school for their child’s needs.
  1. For general background, the AODA Alliance website Education page.

b) On Disability Barriers in Ontario Colleges and Universities

  1. The initial report of the Post-Secondary Education Standards Development Committee is available at https://www.aodaalliance.org/wp-content/uploads/2021/06/PSE-SDC-Initial-Recommendations-Report_June-25-2021.docx
  1. The draft framework for the Post-Secondary Education Accessibility Standard that the AODA Alliance sent to the Post-Secondary Education Standards Development Committee in March, 2020.
  1. You can learn more about our years of advocacy to make all parts of Ontario’s education system accessible for students with disabilities by visiting the AODA Alliance website’s education page.

c) On Disability Barriers in Ontario’s Health Care System

  1. The initial report of the Health Care Standards Development Committee is available at https://www.aodaalliance.org/wp-content/uploads/2021/05/Health-Care-SDC-Initial-Report-As-Submitted.doc
  1. The AODA Alliance’s August 3, 2021 brief to the Health Care Standards Development Committee giving feedback on its initial report is available at https://www.aodaalliance.org/wp-content/uploads/2021/08/August-3-2021-finalized-AODA-Alliance-Brief-to-Health-Care-Standards-Development-Committee.docx
  1. The AODA Alliance’s February 25, 2020 Framework that it submitted to the Health Care Standards Development Committee on what the promised Health Care Accessibility Standard should include.
  1. A comprehensive captioned video by AODA Alliance Chair David Lepofsky on the barriers facing people with disabilities in the health care system.
  1. A detailed captioned video by AODA Alliance Chair David Lepofsky on the dangers of disability discrimination in Ontario’s controversial critical care triage protocol during the COVID-19 pandemic.
  1. Background on the AODA Alliance’s campaign for barrier-free health care services for people with disabilities is available on the AODA Alliance website’s health care page.

 4. The Ford Government’s Confused and Confusing Handling of the current Public Consultations on AODA Accessibility Standards

So far, the Ford Government has shown poor leadership in how it has handled the current public consultations. For example:

  • It withheld publicly posting these three initial reports for a long time, even though the AODA s. 10(1) requires the Government to post each upon receiving the report. It delayed publicly posting the health Care Standards Development Committee initial report for over 5 months after receiving it. It delayed publicly posting the Post-Secondary Education Standards Development Committee’s initial report for 3.5 months after receiving it. It delayed publicly posting the K-12 Education Standards Development Committee initial report for 2.5 months after receiving it. In the case of the Health Care Standards Development Committee, that Committee voted to approve its initial report back in September 2020, almost a full year ago.
  • The Government’s delay in publicly posting the Health Care Standards Development Committee’s typifies how this governmental lethargy hurts people with disabilities. That initial report includes recommendations for action needed as a result of the COVID-19 pandemic. For example, it raises concerns about the Government’s critical care triage protocol that endangers some patients with disabilities in Ontario hospitals. The Government kept that report secret from the public over critical months when the danger to people with disabilities was especially high. During that same time, the Minister of Health refused to answer any of the AODA Alliance’s detailed letters raising serious human rights concerns about the Government’s critical care triage protocol and plans.
  • The Government did not announce the extension of the original August 11, 2021 deadline for submitting public feedback on the ‘Health Care Standards Development Committees initial report until August 13, 2021, after that feedback period had already expired. Organizations like the AODA Alliance therefore unnecessarily were forced to rush in the midst of the summer vacation period to submit their feedback before the August 11, 2021 period.
  • Rather than properly informing the entire public, the Ford Government appears to have only let some people know about the extension of the deadline for feedback on the Health Care Standards Development Committees initial report. As noted above, when we heard a rumour about this late last week, we wrote the Government to ask about it. It was only after that that the Government sent out an email to us announcing its extension.
  • The Government initially scheduled the public feedback period on the K-12 Education Standards Development Committee’s initial report to end on September 2, 2021, before the school year begins. This created hardships for giving feedback in connection with the school system. The Government only belatedly agreed to lengthen that feedback period.

 5. Will the Ford Government’s Delays on Accessibility for Ontarians with Disabilities Ever End?

For over three years, we have pressed the Ford Government to develop a detailed plan on accessibility, to lay out how it will get Ontario to the AODA’s mandatory goal of becoming accessible to people with disabilities by 2025. It has never done so.

On January 31, 2019, the Government received the blistering final report of the David Onley Independent Review of the AODA’s implementation. Minister for Accessibility Raymond Cho publicly said on April 10, 2019, that David Onley did a “marvelous job.”

The Onley report found that Ontario is full of “soul-crushing” barriers impeding people with disabilities. It concluded that progress on accessibility has taken place at a “glacial pace.” It determined that that the goal of accessibility by 2025 is nowhere in sight, and that specific new Government actions, spelled out in the report, are needed.

In the 931 days since receiving the Onley Report, the Ford Government has not made public a comprehensive plan to implement that report’s findings and recommendations. The Government has staged some media events with the Accessibility Minister to make announcements, but little if anything new was ever announced.

        MORE DETAILS

August 13, 2021 Broadcast Email from the Accessibility Directorate of Ontario

Dear all,

We are pleased to share that the public feedback period for the Health Care SDC Initial Recommendations has been extended for an additional month, to September 13, 2021. The additional time is intended to recognize that organizations across the health sector and the disability community may require more time to review and respond given the ongoing COVID-19 pandemic.

As a reminder, the Initial Recommendations Report of the Health Care Standards Development Committee is available online here for public comment:

https://www.ontario.ca/page/consultation-initial-recommendations-development-health-care-accessibility-standards

 

As these recommendations may impact you or your community, we would encourage you to participate in this process. We would also encourage you to share this information broadly with your networks.

A survey has been developed to seek public feedback and is linked from the consultation page together with the report itself.

Written submissions can also be sent by email to [email protected]. Members of the public or interested organizations can also reach out to the Accessibility for Ontarians with Disabilities Division by email at [email protected] for any questions.

All feedback received will be considered by the Committee before finalizing their recommendations to the Minister. Identifying information will remain confidential as per the Government of Ontario’s Privacy Policy, and all survey responses will remain anonymous.

Sincerely,

Accessibility for Ontarians with Disabilities Division

Ministry for Seniors and Accessibility



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Tell the Health Care Standards Development Committee If You Support the AODA Alliance’s Recommendations on What the Promised Health Care Accessibility Standard Should Include, Spelled Out in the AODA Alliance’s Finalized Brief


Accessibility for Ontarians with Disabilities Act Alliance Update

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

Web: www.aodaalliance.org

Email: [email protected]

Twitter: @aodaalliance

Facebook: www.facebook.com/aodaalliance/

Tell the Health Care Standards Development Committee If You Support the AODA Alliance’s Recommendations on What the Promised Health Care Accessibility Standard Should Include, Spelled Out in the AODA Alliance’s Finalized Brief

August 5, 2021

         SUMMARY

On August 3, 2021, the AODA Alliance submitted its final brief to the Health Care Standards Development Committee. It gives our feedback on its initial or draft recommendations on what should be included in the promised Health Care Accessibility Standard. The Health Care Accessibility Standard is needed to tear down the many barriers that impede people with disabilities in Ontario’s health care system.

We want the Health Care Standards Development Committee to incorporate our recommendations into its final report to the Ontario Government. Our finalized brief includes all the recommendations and other content that was in our draft brief that we circulated for public comment on July 23, 2021. There has only been very minor editing and fine-tuning.

Below we set out the 67 recommendations that our brief makes. To download and read the entire brief that explains these recommendations, visit https://www.aodaalliance.org/wp-content/uploads/2021/08/August-3-2021-finalized-AODA-Alliance-Brief-to-Health-Care-Standards-Development-Committee.docx

Help us build support for our cause. Please email the Health Care Standards Development Committee. Tell the Committee if you support our recommendations. You can write them at: [email protected]

If you or an organization with which you are connected is writing a submission to the Health Care Standards Development Committee it would be great if your submission could state that you endorse the AODA Alliance ‘s recommendations in its August 3, 2021 brief to the Health Care Standards Development Committee. As well, any individual or organization can simply write that Standards Development Committee at the email address listed above, and just say something like:

“I support the recommendations that the AODA Alliance sent the Health Care Standards Development Committee in its August 3, 2021 Brief.”

The deadline for submitting feedback to the Committee is August 11, 2021. Even if you miss that deadline, it can always help to send in an email any time that supports our recommendations.

Do you want more background on this issue? Explore the time line of our efforts to get a strong Health Care Accessibility Standard by visiting the AODA Alliance website’s health care page.

Now 917 days have passed since the Ford Government received the blistering final report of the Independent Review of the AODA’s implementation and enforcement, conducted by former Lieutenant Governor David Onley. The Ford Government has announced no plan to implement that report.

We always welcome your feedback. Write us at [email protected].

         MORE DETAILS

List of the AODA Alliance August 3, 2021 Brief’s Recommendations

Where the following recommendations by the AODA Alliance refer to the “Initial Report”, that is the Health Care Standards Development Committee’s Initial Report in which that Committee sets out draft proposals for what the promised Health Care Accessibility Standard should include.

#1 Throughout the Initial Report, action recommendations should be revised to go beyond providing disability accommodations to patients with disabilities, and making plans for barrier-removal and prevention, so as to also spell out specific measures that must be undertaken to remove and prevent recurring disability barriers to health care services.

#2 The Health Care Accessibility Standard’s primary focus should be on specifying detailed actions to remove and prevent barriers, not by overloading people with disabilities with redundant separate consultations with one hospital after the next across Ontario.

#3 The Standards Development Committee should explicitly and comprehensively make recommendations for the entire health care system, and not merely for the small fraction of the health care system that hospitals comprise. At a minimum, the Standards Development Committee should make a strong recommendation that the Health Care Accessibility Standard must address disability barriers in the entire health care system, and not merely in the hospital sector. It should specify that all health care providers should be required to remove and prevent the same barriers, in terms at least as strong as the Ontario Human Rights Code and the Canadian Charter of Rights and Freedoms

#4 The Health Care Accessibility Standard should cover and apply to all public and private health care programs, services and products available in Ontario, whether or not OHIP covers them. It should cover all health care providers and professions, whether or not Ontario recognizes, regulates or licenses them. It should cover ambulances and other vehicles which can transport patients in connection with health care services. It should cover all parts of Ontario. It should address accessibility barriers that are distinctive to the north, to remote communities, as well as the distinctive barriers facing different racialized, ethnic or other communities within Ontario.

#5 The Health Care Accessibility Standard should address the accessibility needs of patients with any kind of disability, and the accessibility needs of any patients’ support people with any kind of disability. The term “disability” should be defined broadly to include any permanent or episodic disability within the meaning of the AODA or the Ontario Human Rights Code.

#6 The Committee’s final report should clearly state that to make hospitals accessible to people with disabilities, much more is needed than addressing training, accountability and sensitivity within hospitals.

#7 The Initial Report should not recommend that smaller obligated organizations always or presumptively get more time to comply with the Health Care Accessibility Standard than do larger obligated organizations. This especially should not take place in circumstances where smaller organizations can comply more quickly than larger organizations.

#8 The Initial Report should be revised to describe the Standards Development Committee’s mandate as achieving the removal and prevention of disability barriers, the accessibility of health care services, and inclusion of people with disabilities in the health care system. It should not describe the goal as merely making the health care system more accessible or more inclusive, or merely reducing barriers.

#9 The long term objective of the Health Care Accessibility Standard should be to ensure that Ontario’s health care system and the services, facilities and products offered in it, become fully accessible to all patients with any kind of permanent or episodic disabilities and to any support people with disabilities for any patient, by 2025, the AODA’s deadline, by requiring the removal and prevention of the accessibility barriers that impede people with disabilities, and by providing a prompt, accessible, fair, effective and user-friendly process to learn about and seek disability-related accommodations tailored to a person’s individual disability-related needs. It should aim to ensure that patients with disabilities can fully benefit from and be fully included in the health care services and products offered in Ontario’s health care system on a footing of equality. It should aim to eliminate the need for patients with disabilities and any support people with disabilities to have to contend with and fight against health care accessibility barriers, one at a time, and the need for health care providers to have to re-invent the accessibility wheel one health care facility or one health care provider at a time. It should aim for health care services, facilities and products in Ontario to be designed and operated based on accessibility principles of universal design.

#10 The Initial Report’s vision of an accessible health care system should be expanded to include the following:

  1. a) The health care system will be designed and operated from top to bottom for all its patients, including patients with all kinds of permanent or episodic disabilities, as disability is defined in the Ontario Human Rights Code and the Canadian Charter of Rights and Freedoms. The health care system will no longer be designed and operated from an implicit starting point of aiming predominantly to serve the fictional “average” patient, who is too often assumed to have no disabilities.
  1. b) Patients with disabilities, and where needed, any patients’ support people with disabilities, will be able to effectively communicate with health care providers and health care staff in connection with requesting or receiving health care services and products throughout each stage of the healthcare process. This will include face-to-face interactions, telephone or alternates to telephone use, accessible information and forms as well as alternate arrangements for providing one’s signature. For example, health care facilities and ambulances will be equipped with needed equipment to ensure effective communication with people with communication-related disabilities.
  1. c) Patients with disabilities, and where needed, any patients’ support people with disabilities will be able to get and receive information relevant to their health care needs in private, e.g., when giving information at a health care provider’s office or when seeking or receiving information about their medication at a pharmacy, rather than in a public place where others can overhear. Effective procedures will protect the confidentiality of private information relating to patients with disabilities who rely on others to assist them with communication.
  1. d) Information technology and applications which patients can use at home, or at a health care facility in connection with seeking and receiving health care services, will be designed based on principals of universal design and will be accessible to and usable by patients with disabilities, and where needed, to patients’ support people with disabilities. Where needed for effective communication, health care facilities will also provide alternatives to telephone use including email, text, video and authorized human assistance.
  1. e) Health care products, and any instructions for their use, will be designed and available based on principles of universal design so that people with disabilities and not just people with no disability can use and benefit from them.
  1. f) Support services such as sighted guides for visually impaired patients and attendant care will be available to patients with disabilities who need them while going to or at a facility to receive health care services.
  1. g) Publicly funded appointments for receiving health care services will be sufficiently long to enable those patients with a disability, who need more time, to be able to receive the health care services they need. If a patient with disabilities cannot attend a health care provider’s premises due to their disability, there will be in place measures whenever therapeutically possible for remote appointments or home visits.
  1. h) Patients will be free to use their own accommodation supports, such as service animals, when seeking or obtaining health care services and products.
  1. i) New Government strategies, services and facilities in Ontario’s health care system will be proactively designed from the start and operated to fully include the needs of patients with disabilities. Those responsible at the provincial and local levels for leading, overseeing and operating Ontario’s health care system will have strong and specific requirements to address disability accessibility and inclusion in their mandates and will be accountable for their work on this issue. Ontario’s disability community will have effective input into public decisions on the design and operation of Ontario’s health care system to ensure that existing disability accessibility barriers are removed and no new ones are created.
  1. j) An accessible health care system is one where people with disabilities can work in a barrier-free workplace.

#11 The Initial Report should not merely recommend that an obligated organization “consider accessibility.” It should instead require specific actions that will achieve accessibility.

#12 The Health Care Accessibility Standard should require each health care facility and health care provider to create a welcoming environment for patients with disabilities and any patients’ support people with disabilities to seek accommodations for their disabilities when receiving health care services.

#13 Each major health care facility such as each hospital should be required to establish a permanent committee of its board to be called the “Accessibility Committee.” This Accessibility Committee should have responsibility for overseeing the facility’s compliance with the AODA, and with the requirements of the Ontario Human Rights Code and the Canadian Charter of Rights and Freedoms in so far as they guarantee the right of people with disabilities to fully participate in and fully benefit from the health care services that the facility provides. It should endeavour to reflect the spectrum of disability needs.

#14 Each major health care facility such as each hospital should be required to establish or designate the position of Chief Accessibility/Accommodation Officer, reporting to the Chief Executive Officer. Their mandate, responsibility and authority should be to ensure proper leadership on the facility’s accessibility and accommodation obligations under the Ontario Human Rights Code, the Canadian Charter of Rights and Freedoms and the AODA, including the requirements of this accessibility standard. This responsibility may be assigned to an existing senior management official.

#15 Beyond the specific measures to remove and prevent barriers set out in the Health Care Accessibility Standard and in other accessibility standards enacted under the AODA, each health care facility and health care provider should be required to periodically and systematically review its health care services, facilities, equipment and products to identify recurring accessibility barriers that can impede the provision of health care services to patients with disabilities. A comprehensive plan for removing and preventing these accessibility barriers should be developed, implemented and made public with clear timelines, with clear assignment of responsibilities for action, monitoring for progress, and reporting to the facility’s accessibility committee. This plan should aim at all accessibility barriers that can impede patients with disabilities from fully benefiting from the facility’s health care services, whether or not they are specifically identified in the Health Care Accessibility Standard or in any other AODA accessibility standards.

#16 The Initial Report should be expanded to recommend specific, detailed accessibility requirements in the built environment of hospitals and other health care facilities such as those recommended in Appendix 1 to this brief. The goal of these should be that the built environment in the health care system, such as hospitals and any other places where health care services are provided, including the furniture there, will all be fully accessible to people with disabilities, and will be designed based on the principle of universal design. For example:

  1. a) The front area or drop-off areas for a hospital or other health care facility should be accessible, with automatic power doors that do not require a button to be found and pressed, and with tactile walking surface indicators both to warn when a person is walking into a driving area and to guide a person to the facility’s entrance. All other entrances and exits should be fully accessible, with automatic power door operators and an accessible path of travel to the door. This includes entrances from indoor or underground parking to the health care facility.
  1. b) Inside the health care facility, major public areas such as emergency room doors should always be fully accessible and have automatic power door openers.
  1. c) For the benefit of patients and others with learning and cognitive disabilities, vision loss or other disabilities that can affect mobility or way-finding, hospitals and other health care facilities should have way-finding markings in important areas such as the main lobby from the front door to the help desk and other major routes such as to main elevators, including colour contrasted markings such as a carpeted path or tactile walking surface indicators.
  1. d) Hospitals and other health care facilities with elevators should have accessible elevators that can accommodate people using mobility devices. They should also have accessible elevator buttons (with braille and large print on or beside each button), braille and large print floor numbers just outside elevator doors, and audible floor announcements on elevators. Elevator button panels should be consistent in layout from one elevator to the next.
  1. e) Health care facilities, including hospitals, should never install “destination elevators” which require a person to pre-select the floor to which they are going before entering the elevators. These present unfixable accessibility problems.
  1. f) Hospitals and other health care facilities should have accessible signage throughout, including braille and large print, for key locations. For example, public bathrooms should have accessible braille and large print signs on them. These signs should be placed in consistent and predictable locations.
  1. g) Where a health care facility has power doors that require a button to be pushed (i.e., they don’t open automatically), the button should always be located throughout the health care facility in a consistent place to make it easier to find. The button should be located near the door, so that a slow-moving individual can make it through the open door after pressing the button before the door closes. The button should always be located on the wall, and not on a free-standing post or bollard.
  1. h) Despite weaker requirements in other AODA accessibility standards, the Health Care Accessibility Standard should set out specific and strong requirements for the accessibility of any electronic kiosks in hospitals and other health care facilities, such as:
  1. i) specifying their required end-user functionality that effectively address recurring known needs arising from specific disabilities, and,
  1. ii) ensuring that they are at an accessible height e.g., for those using a wheelchair or other mobility device.

As a starting point, see the US Access Board’s standard for accessible electronic kiosks.

  1. i) Patient consultation or treatment rooms should have enough space to enable people using mobility devices to navigate in them and reach any treatment or consultation area. They should have enough space to enable a Sign Language interpreter to be positioned in the room to interpret for a deaf patient or support person.
  1. j) Movable furniture such as desks, tables or chairs should not obstruct accessible paths of travel around a facility where health care services are delivered, such as a doctor’s office, e.g., in their hallways or treatment rooms.
  1. k) Major health care facilities should provide accessible waiting areas for accessible transit pickup and drop-off, close to the pickup/drop-off point, with clear sight lines.
  1. l) Major health care facilities such as hospitals should be designed to avoid major sensory overstimulation or acoustic overloads, such as bright lights, loud music, large atrium areas, or frequent loud announcements. This is especially important in treatment areas or hospital rooms.
  1. m) Throughout a health care facility, proper colour contrasting should be required to assist people with low vision and cognitive disabilities, such as around elevator opening, doorways, and on the edge of stairs and handrails.
  1. n) Health care facilities should be required to have accessible bathrooms so that all patients can use the facilities, including adult change tables, sufficient transfer space and maneuvering room for mobility devices.
  1. o) Major health care facilities should include sensory rooms for people with sensory overload issues, such as in hospital emergency rooms.
  1. p) In a health care facility, all stairs and staircases, including “feature staircases” (included as aesthetic design enhancements) should be accessible, e.g., with tactile warnings at the top and bottom of each set of stairs, no open risers and with proper colour contrast on railings and step edges. There should never be curving staircases.
  1. q) Health care facilities should provide charging areas for electric mobility devices.
  1. r) Hospital rooms should be able to accommodate a patient’s mobility device so they can keep theirs with them and readily available when admitted to hospital.
  1. s) In a health care facility, waiting areas, isolation areas, breastfeeding rooms, staff areas and volunteer areas should be designed to be accessible.
  1. t) Accessible and bariatric paths of travel should be provided in health care facilities.
  1. u) Despite the more limited provisions regarding the provision of accessible parking spaces in other AODA accessibility standards, the Health Care Accessibility Standard should set higher and more specific requirements for accessible parking spaces for health care facilities, such as:
  1. i) requiring a greater number of accessible parking spots for the facility, where possible.
  1. ii) requiring that the accessible parking spots be located as close as possible to the doors of the health care facility.

iii) requiring that at least some of the accessible parking spots have larger dimensions to accommodate larger accessible vans, so that a passenger with a disability can park in that spot and have sufficient room to exit the vehicle, and

  1. iv) requiring that there be accessible curb cuts and an accessible path of travel from the accessible parking spots to the health care facilities’ entrances.
  1. v) Health Care facilities should have designated snow-piling areas outside, to prevent snow from being shoveled onto accessible paths of travel.
  1. w) Major health care facilities such as hospitals should provide service animal relief areas close to the facility’s door, covered wherever possible, with an accessible path of travel to them.
  1. x) When a major new health care facility like a hospital is being designed, or a major new wing or renovation is being planned, especially if public money is helping fund it, a properly trained and qualified accessibility consultant should be required to be engaged on the project from the very beginning. Their accessible design advice should be transmitted unedited to the Government or other organization for whom the project is being built and should be made public. Direct consultation with end-users with disabilities should be part of the design process from the beginning.

#17 The standard should require that:

  1. a) Each hospital patient’s bed should have an accessible means for a patient with disabilities to notify the nursing station of a health care need, not just a button or pull-string that they may not be able to reach and operate.
  1. b) Furniture such as seating in health care facilities should be designed with accessibility features and positioned in a manner that does not block accessible paths of travel.
  1. c) A Help Desk should be positioned immediately inside the main entrance of any major health care facility, including hospitals, to assist patients, including patients with disabilities, to get directions or help to their destination within the facility, or to request other accommodation supports.
  1. d) In any discrete department or area where health care services are provided, (such as an area for day surgery), the check-in desk should be located immediately adjacent to the entrance to that area, so that patients and support people with disabilities can easily reach it after entering the room or area.
  1. e) Accessible public service counters should be installed, even in existing health care facilities, with a specified height requirement, no glass barrier creating barriers for people with hearing loss and knee space for people using a mobility device.
  1. f) A large health care facility like a hospital should have rest areas along routes through the building so that people with fatiguing conditions can stop and rest along their route to get health care services.
  1. g) Health care facilities such as hospitals should have emergency areas of refuge with separate ventilation in case of fire, so that people with disabilities who cannot escape the building have safe areas to wait, while being protected from life-threatening smoke.
  1. h) The Ontario Government should make available to health care facilities and providers: guides on accessible procurement including procurement of accessible furniture, lists of vendors of accessible furniture. The Ontario Government should provide a hub for procuring accessible furniture to help health care facilities and providers reduce the cost of their acquisition.

#18 the Ministry of Health should within one year survey all offices of physicians, chiropractors, occupational and physiotherapists and other like health care providers where they provide direct health care services to patients, on the extent to which their premises are accessible for patients with disabilities. The Ministry should make public a report on the results of this survey (anonymized).

#19 The Health Care Accessibility Standard should set specific technical requirements for the accessibility of diagnostic and treatment equipment. As a starting point, the Health Care Standards Development Committee should consider the accessible medical diagnostic equipment standards that the US Access Board has formulated. The needs of patients with all kinds of disabilities, and not only those with mobility disabilities, should be met by the technical requirements that the Health Care Accessibility Standard sets.

#20 The Ontario Government should impose a strict funding condition on the purchase or rental of any new health care diagnostic or treatment equipment anywhere in the health care system requiring that it must be accessible to patients with disabilities and designed based on principles of universal design, in compliance with the technical standards to be included in the Health Care Accessibility Standard.

#21 The Ontario Government should be required to make readily available to health care providers and facilities, and to the public, an up-to-date list of accessible health care diagnostic and treatment equipment and venders, so that each health care provider and facility does not have to re-invent the wheel by re-investigating these same issues.

#22 To save money, the Ontario Government should be required to attempt to negotiate bulk purchasing of accessible diagnostic and treatment equipment so that health care facilities and providers can obtain them at lower prices.

#23 When health care facilities and providers purchase, rent or otherwise acquire new or replacement diagnostic or treatment equipment, these should be required to be accessible to patients with disabilities and to be designed based on principles of universal design.

#24 Health care facilities and providers should survey their existing diagnostic or treatment equipment, and take the following steps to address any accessibility problems they have, if that equipment is not now being replaced:

  1. a) Identify where the nearest place is where a patient can get diagnosis or treatment services where there is accessible diagnostic and treatment equipment, and to help facilitate the access of the patient with disabilities to health care services from that provider or facility.
  1. b) Adopt and implement an interim plan to make any readily achievable accessibility improvements to the health care facility’s or provider’s existing diagnostic or treatment equipment.
  1. c) Develop plans to purchase, rent or otherwise acquire accessible diagnostic or treatment equipment over a period of up to five years.

#25 These accessibility/universal design requirements should also apply to consumer health care products, such as for example, pill bottles.

#26 Because Ontario’s system for electronic health care records has been centrally created, the Health Care Accessibility Standard should require the Ontario Government and any provincial agency that is responsible for overseeing the design, procurement or operation of the system for electronic health care records to ensure that these records will be kept and available in accessible formats for patients and support people with disabilities, and, as a related benefit, to health care providers and their staff with disabilities, except where technically impossible. PDF format should not be treated as being an accessible format.

#27 Individual health care organizations or facilities, including laboratories, that create their own health care records in electronic form should also be required to ensure that they are readily available in accessible formats for patients with disabilities and any patients’ support people with disabilities, and, as a side benefit, for health care providers and their staff with disabilities, except where technically impossible.

#28 All the Initial Report’s recommendations on training on accessibility laws should be revised to explicitly include training on the accessibility requirements regarding people with disabilities in the Ontario Human Rights Code and the Canadian Charter of Rights and Freedoms.

#29 The Health Care Accessibility Standard should require training on disability accessibility, disability human rights and disability Charter obligations for existing health care professionals as a condition of continuing in practice.

#30 The Ontario Government should be required to impose a condition of its funding for post-secondary education programs to train anyone in a health care discipline, profession or field, that the college or university that offers that degree or course must include a sufficient designated and mandatory curriculum on meeting the needs of patients with disabilities.

#31 Wherever possible, any new health care facility or provider receiving public funds that is setting up a new location should be required to locate at or near an accessible public transit stop on an accessible public transit route, with an accessible path of travel from the public transit stop to the health care facility or provider. Similarly, where an existing health care facility or provider is going to move to another location, it should be required to attempt to relocate to a location that is on an accessible public transit route.

#32 Where it is medically possible for a patient to take part in a health care service without physically attending at the health care facility or provider, an option should be provided for taking part remotely, e.g., via Facetime or other remote video conferencing. The Health Care Accessibility Standard should also require the removal of the OHIP barrier to funded physicians house calls.

#33 Where OHIP or a health care facility or provider has a policy or practice of permitting only one health issue per visit, an exception should be created for patients with disabilities for whom transportation to the health care facility is impeded by accessibility barriers.

#34 A health care facility or provider should not be permitted to charge a late fee or a missed appointment fee where a patient with a disability has in good faith attempted to attend on time but was made late or precluded from attending by transportation barriers (such as being made late for the appointment by the community’s para-transit service).

#35 When the Ontario Government is undertaking planning for new health care services, or for improvements to health care services, it should be required to include in those plans, and to make public, requirements to ensure that wherever possible, health care services and facilities are provided in locations on accessible public transit routes, with an accessible path of travel from the accessible public transit stop to the facility or provider.

#36 The 2011 Transportation Accessibility Standard should be amended to set accessibility requirements for public transit stations and stops, as the joint July 31, 2017 AODA Alliance/ARCH brief to the Transportation Standards Development Committee recommended.

#37 The Health Care Accessibility Standard should set technical specifications to ensure the full accessibility of ambulances and other vehicles that transport patients, including patients with disabilities, to or from health care services. See also below re: the need to include equipment in those vehicles for communication with patients with communication-related disabilities.

#38 Any health care facility or provider, including such places as doctors’ offices and pharmacies, should be required to designate an accessible private area where patients with disabilities can give and receive private information in connection with their health care services or products without others being able to overhear this.

#39 Health care facilities and providers should be required to notify all patients, including patients with disabilities, of their right to have their health care needs and issues discussed and information exchanged in a private location, and should instruct their staff, including any who deal with patients or the public, of their duty to fully respect this right.

#40 Without limiting the information and communications to which this part of the Health Care Accessibility Standard should apply, it should address:

  1. a) Information or communications needed to provide a health care provider with the patient’s history, needs, symptoms or other health problems.
  1. b) Information and communications regarding the patient’s diagnosis, prognosis or treatment, including any risks, follow-up or other health care services to secure.
  1. c) A health care facility’s discharge instructions.

#41 Health Care facilities should be equipped with assistive listening devices to enable patients with hearing loss and support people with hearing loss to be able to effectively communicate e.g., at nursing stations, help desks, and when dealing directly with health care providers.

#42 Health care-related products such as prescription and non-prescription medications should be provided when needed with accessible labels, instructions or users’ manuals, available in accessible formats. Those who sell or rent these to the public should be required to regularly notify the public, including their customers, that accessible labels, instructions, and users’ manuals are available on request. See e.g. work on developing standards and practices for accessible prescription drug container labels by the US Access Board. See also the February 6, 2020 news release announcing that the Empire chain of stores, including all Sobeys Stores, will provide accessible prescription labels to customers with disabilities free of charge on request. If they can, so can all other drug stores.

#43 Where a health care facility or health care provider provides information about their services or facilities in print or via the internet, they should be required to ensure that their website meets current international accessibility requirements along prompt time lines, even if the Information and Communication Accessibility Standard does not now require this. Currently, the Information and Communication Accessibility Information and Communication Accessibility Standard has too many exemptions, leaves out too many providers of goods and services, and has timelines that are too long. Whether or not those exemptions, exclusions and long timelines are justified for other sectors, they are unjustified for a sector as important as the health care sector.

#44 Ambulances and other vehicles that transport patients should include equipment to facilitate communication with patients with communication disabilities, such as remotely-accessed sign language interpretation and other communication supports.

#45 The Ontario Government should be required to set up hubs or centralized services to enable health care facilities and providers, including small providers, to quickly and easily access communication supports needed for patients with communication-related disabilities (for example Sign Language interpreters and real time captioning). The Ontario Government should fund these services as part of its funding of the health care system, in furtherance of the Supreme Court of Canada’s Eldridge decision.

#46 Any prepared information on health care conditions, treatment instructions, prognoses, risks, laboratory or other test results and the like which a health care facility or provider makes available to patients, whether in print or electronic form, should be made available at the same time on request in an accessible format. The standard should direct that PDF format is not sufficient to be accessible, and that if information is available in a PDF document, it should also be posted in an accessible format such as HTML or MS Word. Health care facilities and providers should be required to notify patients, including patients and their support people with disabilities, that any hard copy or electronic documents provided to them can be requested and obtained in an accessible format on request.

#47 Where a health care facility or provider asks patients or their support people to use information technology hardware or software in connection with the delivery of health care services (such as asking them to fill out their medical history on a portable computer or tablet device), the facility or provider shall:

  1. a) In the case of new or updated information technology or equipment to be acquired, ensure that it is accessible to people with disabilities and is designed based on principles of universal design;
  1. b) In the case of existing information technology now being used, retrofit to be accessible except where this would pose an undue hardship and,
  1. c) For those people who prefer this option, ensure that patients with disabilities or their support people with disabilities are assisted to use that technology, in private, at the same time as others would use it, where this would not reduce their access to the health care services to which it pertains.

#48 The Ontario Government should be required to develop and make public a strategy for ensuring that health care promotion initiatives in Ontario are accessible to people with disabilities. For example, it should require that:

  1. a) All advertisements for health care promotion should have captioning and audio description.
  1. b) All mail-out, printed and online materials focusing on health promotion should be required to be in accessible formats, regardless of any exemptions in the Information and Communication Accessibility Standard.

#49 Hospitals and other major health care facilities should be required to provide support services for patients with disabilities when needed to ensure that those patients can fully access and benefit from the health care services that the facility offers, to let patients know about the availability of these services, and to annually publicly report on the number of staff available to provide this support, such as:

  1. a) Attendant care.
  1. b) Assistance with meals.
  1. c) Assistance with being guided to and getting around the health care facility e.g., for patients with vision loss or cognitive disabilities.

#50 In a hospital or other major health care facility, there should be one nurse at each nursing station designated to receive training and to be responsible for addressing the needs of patients with complex needs due to their disability.

#51 Each health care provider and facility should be required to put in place a system and designate a person to solicit and receive requests from patients or their support people for disability accommodations in connection with health care services or products.

#52 Each health care provider or facility should be required to make readily-available to the public, including to their patients, in an accessible format, information about how to identify themselves in advance to the health care provider as having disability-related accessibility or accommodation needs, and to ask to arrange for these needs to be met.

#53 Each hospital and larger health care facility should be required to collect anonymized information on disability-related accessibility and accommodation requests received from or on behalf of patients with disabilities, to assist that health care provider or facility in planning for future disability accessibility and accommodation. This anonymized information should be available for study by the Government or other health policy planners.

#54 The Chief Executive Officer of any hospital or large health care facility should be required to annually review the information that the facility has collected on the requests for disability accessibility and accommodation that the facility has received and report to the board of directors on measures that could improve the facility’s capacity to meet these needs.

#55 Each health care profession’s self-governing college should be required to:

  1. a) Review its public complaints process to identify any barriers at any stage in that process that could adversely affect people with disabilities filing a complaint, or about whom a complaint is filed.
  1. b) Develop a plan for removing and preventing any accessibility barriers identified, whether or not those barriers are specified in any current AODA accessibility standards.
  1. c) Publicly report to its governing board of directors and the public on these barriers and the college’s plans to remove and prevent such barriers, in order to achieve a barrier-free complaints process.
  1. d) Establish and maintain a standing committee of its governing board of directors responsible for the accessibility of the services that the college offers the public, including, but not limited to its public complaints process.
  1. e) Consult with the public, including people with disabilities, on barriers that people with disabilities experience when seeking the services of the health care professionals that that profession regulates, to be shared with the board’s Accessibility Committee. To avoid duplication of efforts and burdens on the disability community, several regulatory colleges can jointly undertake this consultation.

#56 The Ministry of Health should be required to designate a senior official at the “Assistant Deputy Minister” level as the leading public official who is responsible for ensuring accessibility, accommodation and inclusion for patients with disabilities in Ontario’s health care system. They should be responsible for ensuring that any policies, plans or proposals regarding the health care system are screened to ensure that they will not create any new barriers for patients with disabilities, and will instead remove barriers.

#57 The Ministry of Health should be required to conduct a system-wide review of the health care system for any systemic barriers, in consultation with the public including people with disabilities. It should identify and make public a plan to remove and prevent systemic or system-wide barriers that impede patients with disabilities from receiving accessible health care, along time lines that the Health Care Accessibility Standard will set.

#58 Each hospital and other major health care facility should be required to establish and regularly publicize a dedicated disability accessibility/accommodation complaints hotline, to trigger prompt action when problems are raised.

#59 The Ministry of Health should be required to establish and regularly publicize a hotline to receive complaints about accessibility problems facing patients and support people with disabilities in Ontario’s health care system. The Ministry should be required to annually publish a report with an anonymized summary of the substance of complaints received and action taken to prevent their recurrence.

#60 The Health Care Accessibility Standard should require the creation of authoritative, well-trained system navigators to assist patients with disabilities and their support people to navigate Ontario’s health care system.

#61 The OHIP fee schedule should be revised to provide for added time to serve the needs of patients with disabilities who need more time for assessment, diagnosis and treatment, to eliminate the harmful financial incentive that the Ontario Government now creates for physicians to avoid treating taking on those patients.

#62 Each hospital and major health care facility should be required to establish a committee of those employees and volunteers with disabilities who wish to voluntarily join it, to give the facility’s senior management feedback on the barriers in the health care facility that could impede patients with disabilities or any patients’ support people with disabilities, and/or employees/volunteers with disabilities.

#63 The Health Care Standards Development Committee should endorse the recommendations regarding health care services in the Initial Report of the K-12 Education Standards Development Committee on barriers facing students with disabilities in Ontario schools.

#64 The Initial Report’s Recommendation 15 regarding the conduct of an after-the fact review of the problems facing people with disabilities in accessing health care during the COVID-19 pandemic should be revised so that this review is an Independent Review conducted by trusted and respected persons who are independent of the Government and of the health care system.

#65 The Initial Report should recommend that the Health Care Accessibility Standard

  1. a) Require the Government to immediately rescind the January 13, 2021 critical care triage protocol and all directions and training materials relating to it, and should direct that these are not to be followed or considered appropriate under any situation.
  1. b) Require the Ontario Government to immediately make public all versions of the critical care triage protocol that have been in force in Ontario, or distributed to hospitals, as well as any critical care triage protocol or directions to ambulances or other emergency services, and any reports that the government received from the Government-appointed Bioethics Table.
  1. c) Require that if critical care triage is directed to occur during this or other emergencies, the Government shall make public on a daily basis the number of patients who are refused or denied critical care that they need and want, due to critical care triage.
  1. e) Require that the Clinical Frailty Scale shall not be used as a tool to decide who is to ever be refused critical care they need and want.
  1. f) Forbid the use or distribution of the “Short Term Mortality Risk Calculator” that was made available under the auspices of Critical Care Services Ontario to all Ontario hospitals.

#66 the Health Care Accessibility Standard should require the Government to ensure the availability of remote or distance delivery of health care services where medically feasible, and where patients with disabilities face barriers attending at a health care office or facility to receive such services.

#67 The Initial Report should be expanded to list a full range of disability barriers reported to the Standards Development Committee in access to health care during the pandemic.



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Please Send Us Your Feedback on the AODA Alliance’s Draft Brief to the Health Care Standards Development Committee on the Disability Barriers in Ontario’s Health Care System


Accessibility for Ontarians with Disabilities Act Alliance Update

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

Web: www.aodaalliance.org Email: [email protected] Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

Please Send Us Your Feedback on the AODA Alliance’s Draft Brief to the Health Care Standards Development Committee on the Disability Barriers in Ontario’s Health Care System

July 23, 2021

            SUMMARY

Did we get it right? Let us know!

We’ve been busy as can be, writing a brief that we plan to submit by August 11, 2021 to the Health Care Standards Development Committee. The Ontario Government appointed that Committee back in 2017 to come up with recommendations on what the promised Health Care Accessibility Standard should include. The Health Care Accessibility Standard is a law that is to be enacted under the Accessibility for Ontarians with Disabilities Act to tear down the barriers that obstruct people with disabilities in Ontario’s health care system.

We’ve come up with a draft brief. We want your feedback on it to help us finalize it.

Back on May 7, 2021, the Ford Government made public the initial report of the Health Care Standards Development Committee. That initial report makes a series of recommendations on what the promised Health Care Accessibility Standard should include. The Government is inviting public feedback on that initial report up to August 11, 2021. The Health Care Standards Development Committee will be given all that public feedback. It can use that feedback to finalize its recommendations to the Government. We want our brief to give as much help as possible to the Health Care Standards Development Committee.

Below we set out a summary of what our draft brief to the Health Care Standards Development Committee recommends. We applaud and agree with most of what the Health Care Standards Development Committee wrote. However, we make a number of recommendations on how it can improve its report.

Our draft brief builds upon all the feedback we have received over the years about disability barriers in the health care system. You can download our draft brief by visiting https://www.aodaalliance.org/wp-content/uploads/2021/07/July-23-2021-Draft-AODA-Alliance-brief-on-health-Care-Standards-Development-Committee-initial-report.docx

Please send us your suggestions on our draft brief by August 1, 2021. We will then have to rush to turn our draft brief into a finished product.

Here are resources that you might find helpful:

  1. The Health Care Standards Development Committee’s initial report, recommending what the promise Health Care Accessibility Standard should include.
  1. A captioned talk by AODA Alliance Chair David Lepofsky two years ago about disability barriers in the health care system.
  1. A captioned talk earlier this year by AODA Alliance Chair David Lepofsky about the disability discrimination in Ontario’s critical care triage protocol that is now embedded in Ontario hospitals.
  1. The AODA Alliance website’s health care page, which documents our advocacy efforts over the past decade to make health care services accessible to people with disabilities.

A long 904 days ago, the Ford Government received the blistering final report of the Independent Review of the AODA’s implementation by former Lieutenant Governor David Onley. It called for urgent action to speed up and strengthen the AODA’s implementation and enforcement. Since then, the Ford Government has announced no comprehensive plan of action to implement that report.

            MORE DETAILS

Summary of the July 23, 2021 Draft AODA Alliance Brief to the Health Care Standards Development Committee

  1. a) The Health Care Standards Development Committee should recommend more concrete actions to ensure that disability barriers are removed and prevented, rather than instead giving primary emphasis to individually accommodating patients with disabilities and having hospitals plan for accessibility.
  1. b) The Health Care Standards Development Committee should more forcefully address all barriers in the hospital sector and the broader health care system.
  1. c) The Health Care Accessibility Standard should ensure that all disability barriers are removed and prevented in hospitals, not just those the Accessibility Minister asked the Standards Development Committee to focus on.
  1. d) The Health Care Accessibility Standard should not assume that smaller hospitals always need more time to comply.
  1. e) The initial report incorrectly understates the role of the Health Care Standards Development Committee.
  1. f) The proposed long-term objective of the Health Care Accessibility Standard should be strengthened.
  1. g) The initial report’s vision of a barrier-free health care system should be strengthened.
  1. h) Additional recommendations are needed to ensure accountability for accessibility within a hospital or other health care provider’s organization.
  1. i) Specific requirements for accessibility of health care facilities’ built environment are needed.
  1. j) Specific actions should be recommended to ensure that diagnostic and treatment equipment are accessible.
  1. k) Specific actions are needed to ensure the accessibility of health records.
  1. l) The initial report’s recommendations on training of health care providers should be strengthened.
  1. m) Detailed recommendations are needed to protect the right of patients with disabilities and of any patients’ support people with disabilities to physically get to health care services.
  1. n) Action is needed to guarantee the right of patients with disabilities to the privacy of their health care information.
  1. o) Additional recommendations are needed to help ensure the rights of patients with disabilities and of patients’ support people with disabilities to accessible information and communication in connection with health care.
  1. p) The initial report’s recommendations should be strengthened to effectively protect the right of patients with disabilities to the support services they need to access health care services.
  1. q) Additional measures should be recommended to ensure right of patients with disabilities to identify their disability-related accessibility needs in advance and to request accessibility/accommodation from a health care provider or facility.
  1. r) Patients with disabilities and support people with disabilities should be assured accessible complaint processes at health care providers’ self-governing colleges, and to have those colleges ensure that the profession they regulate are trained to meet the needs of patients with disabilities.
  1. s) Systemic accessibility safeguards should be built into the health care system from top to bottom.
  1. t) The experience and expertise of people with disabilities working in the health care system should be harnessed to expedite the removal and prevention of barriers facing patients, and those facing their support people with disabilities.
  1. u) The Health Care Standards Development Committee should endorse the K-12 Education Standards Development Committee initial report’s health care recommendations.
  1. v) Further steps should be recommended to supplement the initial report’s recommendations arising from the covid-19 pandemic.
  1. w) The initial report’s recommendations on strengthening AODA enforcement are heartily applauded.t



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Canadians with long COVID: Sick and, increasingly, worried they’ll go broke – National | Globalnews.ca


Adriana Patino, 36, has been battling COVID-19 since December 2020.

First, the virus made her very sick, prompting several trips to the ER when her blood-oxygen levels had dropped dangerously low. Then the long-term symptoms set in: palpitations, difficulty breathing, overwhelming fatigue, and concussion-like cognitive issues.

“I have memory issues, it takes me a while to retain information or follow up conversation or I misspell words constantly,” says the North Vancouver-based consultant.

Patino, once a competitive swimmer who represented Canada at the FINA World Aquatics Championship, says she’s been housebound for more than six months. Minor physical or mental exertions lead to debilitating exhaustion or violent headaches. Carrying out her job, she says, is impossible.

Read more:
‘I’ve progressed very, very slowly’: B.C. COVID-19 ‘long-hauler’ shares recovery story

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But while Patino says her employer has been very supportive, getting her long-term disability (LTD) insurance claim approved is taking longer than expected. Patino, who has exhausted her short-term Employment Insurance (EI) sickness benefits, says she was hoping her LTD coverage would kick in around a month after she filed the claim in early April. Instead, the insurance company keeps coming back with new requests for medical records, she says.

In the meantime, Patino says her financial situation is rapidly deteriorating. After raiding her personal savings, she had to borrow from her mother. Her friends raised funds through a GoFundMe account.

But if her workplace benefits don’t come in soon, she says she’ll have to start selling some of her possessions to make ends meet.

“We don’t have anything else to rely on,” she says.


Click to play video: 'Millions continue relying on COVID-19 benefits'







Millions continue relying on COVID-19 benefits


Millions continue relying on COVID-19 benefits – Mar 15, 2021

More than half of COVID-19 patients might be suffering from long-term symptoms more than 12 weeks after testing positive, according to a new review by the Public Health Agency of Canada. To date, 1.39 million Canadians have contracted the virus and survived, according to official statistics.

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But many of the country’s COVID long-haulers say they’re falling through the cracks of both private workplace insurance benefits and government income supports.


Workplace disability benefits often denied

Only 12 million Canadians have disability insurance, according to the Canadian Life and Health Insurance Association. But even those who, like Patino, have coverage, aren’t necessarily able to access the benefits when they suffer from long-term COVID symptoms, also known as long COVID.

The lingering effects of the virus manifest as a bewildering array of symptoms. The common ones include fatigue, difficulty breathing, cognitive problems often described as “brain fog,” cough, muscle pain or headache, sleep problems, cardiac issues and trouble sleeping.

Read more:
Canadians with lifelong disabilities can lose disability tax credit

The pandemic is leaving millions of COVID-19 survivors chronically ill, creating what science magazine Scientific American recently called a “tsunami of disability.”
But long COVID has all the hallmarks of an illness for which it’s difficult to claim workplace disability benefits. What’s causing those often debilitating symptoms doesn’t always show up in diagnostic testing. Patino, for example, says she has undergone a barrage of tests, most of which came back normal. Only a few tests revealed issues with her lungs, blood and heart, she says.

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Click to play video: 'COVID-19 ‘long-haulers’ describe shakes, trouble breathing weeks after testing positive'







COVID-19 ‘long-haulers’ describe shakes, trouble breathing weeks after testing positive


COVID-19 ‘long-haulers’ describe shakes, trouble breathing weeks after testing positive – Feb 19, 2021

Also, researchers still have a limited understanding of COVID’s long-term effects and family doctors often don’t recognize the condition. A recent study in the British Journal of General Practice, for example, suggested that general practitioners in England may be grossly under-diagnosing long COVID. Researches found less than 24,000 records of formal diagnoses of long COVID, a number that is nearly 100 times smaller than the two million adults thought to have had long COVID in England.

“It’s an invisible illness, it’s much like … chronic fatigue syndrome, (that is) myalgic encephalomyelitis,” says Susie Goulding, a floral designer based in Oakville, Ont. She’s a COVID long-hauler who founded COVID Long-Haulers Support Group Canada, which has almost 14,000 members.

Read more:
These Canadians say they suffered COVID-19 symptoms for months

Many COVID long-haulers in the group have been denied long-term disability benefits, she says.

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“People are being turned away because they just can’t prove it in black and white on paper that they are as ill as they are saying that they are,” she says.

Because there is still little research around long COVID, it’s easy for insurance companies to dismiss disability claims due to “insufficient medical evidence,” says Nainesh Kotak, a Mississauga, Ont.-based disability and personal injury lawyer, who has recently been retained for a long COVID case.

Read more:
‘We were counting pennies’: When disability insurance won’t pay because doctors can’t tell what’s wrong

“It’s no different than dealing with a chronic fatigue case or even a chronic pain case. What is more difficult, though, is certainly the newness of the impairments,” he says.

It’s important for long COVID sufferers to build medical evidence by relying on their family physician to record their symptoms and provide referrals to specialists as needed, Kotak says.

“The important thing, of course, is to have your physicians as an ally,” he notes.

But that’s often a challenge for long-haulers in Canada, where not everyone has access to a family physician. The head of the Canadian Medical Association recently called on the federal government to boost access to family doctors for long-haulers.


Click to play video: 'The struggles of COVID-19 ‘long-haulers’'







The struggles of COVID-19 ‘long-haulers’


The struggles of COVID-19 ‘long-haulers’ – Oct 20, 2020

In the absence of that, long-haulers should consistently use the same walk-in clinic for appointments, which makes it easier to gather evidence, Kotak says.

But besides providing a full picture of long COVID patient’s symptoms, it’s key that doctors identify how the condition limits the patients’ ability to function in their jobs, he adds.

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Still, it doesn’t help that, unlike the U.K., Canada has yet to establish a clinical definition of long COVID.

And some long-haulers face yet another mystifying obstacle: they can’t prove they ever had COVID-19.

Read more:
Cancer patient was cut off from work disability benefits for 10 months — his story has warning for everyone

Many long-haulers who caught the virus in the first wave, when Canada was rationing a limited number of available tests, don’t have a positive COVID-19 test result to show for it, Goulding says. For example, many COVID-19 symptomatic patients weren’t given tests if a family member had already tested positive, she adds.

“They were assumed to have a positive case as well, but then they didn’t get a positive … test, so then they’re left trying to prove themselves,” she says.

In a recent survey of more than 1,000 COVID long-haulers in Canada by Goulding’s COVID Long-Haulers Support Group Canada, Viral Neuro Exploration and Neurological Health Charities Canada, less than 60 per cent of participants said they had received a positive test.


COVID government-benefits safety net not enough for long-haulers

For those who don’t have or can’t access long-term disability benefits, there’s little in the way of a social safety net.

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Chantal Renaud says she began suffering from crippling symptoms, including severe difficulty breathing, tachycardia and profound fatigue in April 2020. When her LTD insurance claim was rejected, she says she accessed EI sickness benefits. But after exhausting the 15-week maximum eligibility period for the program, she says she found herself without any income.

In the end, Renauld says she was forced to sell her house to survive financially.

“I have financially contributed to this country for more than 32 years and I should never have lost my house because I fell ill,” Renaud recently told the House of Commons’ Human Resources committee. “No Canadian should ever have to experience that.”

Read more:
On East Coast, exhausted COVID-19 ‘long haulers’ hope specialized clinics will emerge

Renaud had been called to testify about Bill C-265, a private member’s bill sponsored by Bloc Quebecois MP Claude DeBellefeuille proposing to extend the maximum period for receiving benefits to 50 weeks.

Federal budget legislation recently extended the maximum number of weeks for receiving EI sickness from 15 to 26, but the changes are expected to take effect only in the summer of 2022.

The office of Human Resources Minister Carla Qualtrough did not respond to a question about whether the federal government is considering a further extension of the maximum benefits period.

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“The Government of Canada recognizes that this continues to be a difficult time for many workers in Canada. We will continue to monitor how the labour market rebounds and the needs of Canadians as we move forward on the path to recovery,” Employment and Social Development Canada said via email.

Patino, for her part, says she’s hoping her story helps people and policymakers appreciate the impact of long COVID.

“I want people to take this seriously and I want the government to take us seriously.”




© 2021 Global News, a division of Corus Entertainment Inc.





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ArriveCAN app for cross-border travel includes hurdle for blind Canadians: advocate – National | Globalnews.ca


The federal government’s new ArriveCAN travel app is inaccessible to some Canadians with disabilities, raising questions of fair treatment and practical border-crossing concerns.

Robert Fenton, a board member of the CNIB — formerly known as the Canadian National Institute for the Blind — says he found a major bug when using the Apple VoiceOver screen reader on his iPhone as he tried to access the app, which is playing a pivotal role for those wishing to enter Canada by land, sea or air.

The obstacle arises when would-be users try to add the verification code sent to their email address after starting to set up their account.

“There’s no way to add the number without sighted help,” Fenton said in an interview.

“As people who are blind, we run into this problem frequently with all levels of government when trying to access public services.”

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Read more:
Canada’s new border rules have kicked in. Here’s what to know

Travellers to Canada must use the ArriveCAN app or online portal to submit their vaccine information and the results of a negative COVID-19 test taken no more than three days before departure.

Trouble accessing an app essential to international travel in the pandemic era could pose a real barrier to entry for Canadians with disabilities.

The federal law enforcement agency responsible for border control acknowledged the problem.

“The Canada Border Services Agency (CBSA) is aware that there is a gap between the addition of new features to the ArriveCAN app and when it is fully accessible, and we apologize for any inconvenience this may be causing for users. We are working hard to resolve this issue as quickly as possible,” agency spokeswoman Jacqueline Callin said in an email.


Click to play video: 'Minister Bill Blair outlines updated requirements for fully vaccinated Canadian travellers at the border'







Minister Bill Blair outlines updated requirements for fully vaccinated Canadian travellers at the border


Minister Bill Blair outlines updated requirements for fully vaccinated Canadian travellers at the border – Jun 21, 2021

Unlike the app, the web-based version of ArriveCAN does meet federal accessibility requirements and can be used via desktop, smartphone and other devices, the agency said. It is encouraging travellers who rely on text-to-voice technology to use the online portal until the app store versions are updated.

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The Accessible Canada Act, passed in 2019, aims to remove barriers in areas under federal jurisdiction, such as transportation and telecommunications as well as federally run programs.

“It’s time now for the federal government at least to live up to its obligations in that legislation, and that includes making their websites and apps and other services they offer to Canadians fully accessible,” Fenton said.

The Canadian Press has confirmed the glitch in the app.

Read more:
COVID Alert app cost feds $20M but results ‘did not meet expectations’: new data

Fenton says it follows another problem that prevented blind and partially sighted Canadians from moving beyond the privacy screen that pops up when the app is opened, and which he said the Canada Border Services Agency recently fixed.

“We couldn’t get past the first screen,” he said, “so none of us would know about the second problem.”

The latest problem is particularly urgent as athletes gear up to travel to Tokyo for the Paralympic Games this summer.

Fenton is asking the Canada Border Services Agency to make the app accessible by July 23.





© 2021 The Canadian Press





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At the AODA Alliance’s Request, CTV Commendably Corrects an Inaccurate Online News Report About Ontario’s Critical Care Triage Plans


Accessibility for Ontarians with Disabilities Act Alliance Update

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

Web: www.aodaalliance.org Email: [email protected] Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

At the AODA Alliance’s Request, CTV Commendably Corrects an Inaccurate Online News Report About Ontario’s Critical Care Triage Plans

June 8, 2021

            SUMMARY

Who watches the watchers? Once again, the AODA Alliance has had to do so, when it comes to monitoring media coverage or lack of coverage of the danger since the start of the COVID-19 pandemic of disability discrimination in access to life-saving critical care in Ontario hospitals.

This is Part 2 of our own coverage on this important question. The June 7, 2021 AODA Alliance Update described how CBC’s flagship national daytime current affairs radio program “The Current” has failed to cover the dangers of disability discrimination in critical care triage during the COVID-19 pandemic. Today, we look to another network and another story—one with an eventual  happy ending.

Back on April 28, 2021, CTV’s nightly national TV news program commendably covered the danger of critical care triage in Ontario. It is good that its report included a reference to disability concerns.

However, CTV’s online news report on this issue (unlike its shorter broadcast TV news item) inaccurately stated as a fact that under Ontario’s critical care triage protocol, people with disabilities are to be treated no differently than others. It stated:

“The triage guidelines specify that people with disabilities are not treated any differently than the rest of the population…”

That statement of fact was absolutely and provably incorrect. We were not contacted by CTV before that story ran.

This story appeared to the AODA Alliance to possibly be one that the physicians at the centre of planning the Ontario critical care triage protocol may have brought to the media. It has the focus and sound of the message that they espoused.

On April 30, 2021, the AODA Alliance reached out by email to CTV news. We showed how that statement was factually wrong. To its credit, after some back-and-forth exchanges, at our request CTV news removed that harmfully inaccurate statement from its online report. We very much appreciate that this story was corrected.

Around May 6, 2021, CTV updated this online story in response to our concerns. However, the change was not an effective solution. The line, quoted above, was revised to read as follows, which was also factually inaccurate:

“The triage guidelines specify that people with pre-existing disabilities are not treated any differently than the rest of the population…”

As well, the following was commendably added later in the story:

“Disability advocates, backed by the Ontario Human Rights Commission, have raised human rights and discriminatory concerns about the protocol in letters to the provincial government.”

On May 18 and 19, 2021, AODA Alliance Chair David Lepofsky again wrote CTV about this story. While appreciating CTV’s effort to correct it, CTV was told that it was still inaccurate for the story to state as a fact that people with pre-existing disabilities are not to be treated any differently than the rest of the population under Ontario’s critical care triage protocol. Shortly after that, CTV again revised the online story to remove the entire unfactual statement. The following words were removed from it:

“The triage guidelines specify that people with disabilities are not treated any differently than the rest of the population…”

As well the online CTV story now includes a link to the AODA Alliance’s detailed February 25, 2021 report on disability discrimination in Ontario’s critical care triage protocol.

Below you can read the following:

  1. a) the original version of this CTV story as posted online on April 28, 2021.
  1. b) the AODA Alliance’s April 30, 2021 email to CTV news.
  1. c) The revised CTV online story as of May 6, 2021.
  1. d) The May 18 and 19, 2021 emails from the AODA Alliance to CTV, and
  1. e) The final version of the story as it now appears online.

We applaud CTV for correcting this story, and for being open to our feedback on it. We have urged CTV’s national news to do a story specifically focusing on the disability discrimination problems with Ontario’s critical care triage protocol. They have not yet done so. It remains an immediate and important story. Things are better in Ontario, but there has been no public accounting for the disability discrimination now embedded in hospital training across Ontario. As well, Manitoba is facing an immediate danger of possible critical care triage.

In contrast, CBC TV’s The National commendably ran a 7-minute story on that topic on 18, 2021. That was a very lengthy story for a national TV news program.

Who watches the watchers? The AODA Alliance and people with disabilities must do so!

For more background on this issue, check out:

  1. The online captioned video talk on this issue by AODA Alliance Chair David Lepofsky, seen over 1,000 times, and
  1. The AODA Alliance website’s health care page.

1          MORE DETAILS

 CTV News April 28, 2021

Originally posted at

https://www.ctvnews.ca/health/coronavirus/ontario-hospitals-on-the-verge-of-enacting-last-resort-triage-protocols-1.5406746

Ontario hospitals on the verge of enacting ‘last resort’ triage protocols

Avis Favaro

Medical Correspondent, CTV National News

@ctv_avisfavaro

Elizabeth St. Philip

CTV News

@LizTV

Ben Cousins

CTVNews.ca Writer

@cousins_ben

Published Wednesday, April 28, 2021 10:00PM EDT

TORONTO — As intensive care admissions climb to dangerously high levels in Ontario, health-care workers in the province worry they might soon be forced into the worst-case scenario of choosing who gets the best care and who doesn’t.

On Wednesday, Ontario reported 3,480 new COVID-19 cases. Although a third wave in the province appears to be levelling off, the number of COVID-19 patients in the intensive care units (ICUs) is steadily climbing, to the point where the province is getting assistance from Newfoundland and Labrador and the Canadian military.

The province also reported on Wednesday that 2,281 patients are currently hospitalized, with 877 patients in intensive care.

It’s believed the province could be forced to enact triage protocols if ICU admissions related to COVID-19 exceed 900.

“I just can’t say strongly enough just what a horrible position we’re in the health-care sector right now and why it’s so important that we really drive these numbers to the ground,” Dr. Chris Simpson, a cardiologist and executive vice-president of Ontario Health, told CTV News.

“We simply have to get COVID under control if we’re going to have our health-care system back in a functional state again.”

Ontario’s triage protocols, developed in January, are meant as a last resort to determine who should be given intensive care when the demand for critical care exceeds the supply.

“It’s going to be extremely emotionally difficult for staff to have to make these decisions to tell family members that we’re not able to offer ICU-level treatments that we would have been able to offer in the past,” said Dr. Erin O’Connor, the deputy medical director of the University Health Network emergency departments.

The situation is already dire in the Toronto area, where health officials have been forced to transport patients to other districts as ICU beds in the city fill up. Ontario’s COVID-19 modelling numbers from April 16 suggest the province could see nearly 10,000 new COVID-19 cases per day by the end of May, even under strong public health restrictions.

“There is a wall that’s going to be hit at some point,” Simpson said. “We don’t know where that is yet. We do believe we can build about 200 new ICU beds per week for the next three weeks or so. It gets increasingly tougher, but we think that that will take us into mid-May and we can only hope that things will be cresting by that point.”

Under the triage protocols, all patients are assigned four colours — red, purple, yellow and green — depending on how doctors perceive a patient’s likelihood of surviving for another 12 months. Patients deemed red are predicted to have a 20-per-cent chance of surviving for the year, while patients deemed in the green have more than a 70-per-cent chance of surviving.

Under this system, ICU beds would be given to the green patients first, followed by yellow, purple and red.

“That doesn’t mean we’re not going to care for people,” O’Connor said. “We’re going to offer as much medical care as we possibly can, but some people won’t be able to be on a ventilator — people that we would have put on a ventilator in the past — simply because we’re in a situation where we’re dealing with scarce resources.”

The triage system puts doctors and other health-care workers in the unenviable position of deciding who does not receive the best possible care. It would even require doctors to decide who to withdraw from ICU care if they’re unlikely to survive for another year.

For O’Connor, the prospect having to tell a patient and their family that the province cannot provide them with the best care could have long-term consequences on the entire health-care system in Ontario.

“The hardest part really is going to be making these decisions,” she said. “This is going to take a really large emotional toll and I worry about my staff and I worry about people — after this — leaving medicine because they’re not going to be able to recover.”

“This is not what we’re trained to do. It’s not what we thought we would ever have to do in our careers.”

The triage guidelines are also terrifying for people with disabilities, advanced age or pre-existing conditions.

“There’s also this very real concern that I may be denied care based on protocols that say that I have a less likely chance of surviving,” said Jeff Preston, who has a neuromuscular disorder and works as an assistant professor of disability studies at King’s University College, an affiliate of Western University in London, Ont.

“It’s one thing to get COVID and die, it’s a whole other thing to say, as a Canadian citizen, I might not actually have the same access to health care that other Canadians are going to receive and that hurts in a different way.”

The triage guidelines specify that people with disabilities are not treated any differently than the rest of the population, but Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.

“When I was first diagnosed as a baby, they did not believe I was going to survive more than a couple of years,” he said. “They predicted that I would probably die before four or five years old. Now here I am, almost 40 years old, many years later and that prognosis didn’t turn out to be true.”

QUEBEC ‘FAR FROM TRIGGERING’ TRIAGE PROTOCOLS

Other provinces have also developed similar triage protocols in the event ICU admissions exceed the available beds.

In Quebec for example, prioritization protocols are similar to Ontario’s and those who do not receive ICU admission “will not be abandoned; they will continue to receive other care, the most appropriate for their condition and possible in the context,” according to a statement from Quebec’s Ministry of Health and Social Services.

The department added that it is “far from triggering” the prioritization protocols and has not done so since the start of the pandemic. It has also expanded ICU capacity for COVID-19 patients to hopefully make sure it doesn’t happen.

“This scenario is one of last resort that we want to avoid at all costs,” the statement read. “That is why we are asking Quebecers for their contribution by reducing their contact as much as possible and by rigorously applying the recommended health measures.”

In Saskatchewan, triage protocols will consider a patient’s chance at survival, but also the length of time a patient may require the most care.

“These assessments must be based on the best available scientific evidence,” the Saskatchewan Health Authority wrote in a statement.

“Patients who are not going to receive ICU level of care will receive compassionate care. The sick and dying would not be abandoned. If a patient is not expected to survive, palliative or comfort care would be provided to reduce pain and suffering.”

intensive care admissions

As intensive care admissions climb to dangerously high levels in Ontario, health-care workers in the province worry they might soon be forced into the worst-case scenario of choosing who gets the best care and who doesn’t.

April 30, 2021 Email from AODA Alliance Chair David Lepofsky to CTV News

CTV’s online April 28, 2021 online news report on the issue of critical care triage in Ontario, entitled “Ontario hospitals on the verge of enacting ‘last resort’ triage protocols”, includes a seriously inaccurate and deeply disturbing statement that needs to be rectified. It states:

“The triage guidelines specify that people with disabilities are not treated any differently than the rest of the population…”

In fact, and contrary to what CTV reports, the January 13, 2021 Critical Care Triage Protocol explicitly directs that a patient’s disability IS a factor that in some cases is to be weighed AGAINST their getting access to the life-saving critical care they need, if Ontario has more patients needing critical care than it has critical care beds and supports.

For example, if a cancer patient needs critical care, they will be deprioritized if a patient is “Completely disabled and cannot carry out any self-care; totally confined to bed or chair”. As another example, if a patient needing critical care is over 65 and has a progressive disease (like MS, arthritis or Parkinson’s), their access to critical care is reduced depending on how few of eleven activities of daily living they can perform without assistance. This includes dressing, bathing, eating, walking, getting in and out of bed, using the telephone, going shopping, preparing meals, doing housework, taking medication, or handling their finances. In both examples, this is disability discrimination, pure and simple.

This is not open to factual debate. The secret January 13, 2021 Critical Care Triage Protocol has been posted on the AODA Alliance website for over three months. No one has disputed that those two features are in the protocol. They can also be found in the terrifying online calculator that we made public, and that critical care doctors are being told to use if critical care triage takes place.

The presence of disability discrimination in the January 13, 2021 Critical Care Triage Protocol has led leading disability organizations to publicly demand that this disability discrimination be removed from it. See our efforts on this at www.aodaalliance.org/healthcare It has led the Ontario Human Rights Commission to raise serious concerns. As well, fully six members of the Ontario Government’s own advisory Bioethics Table have been publicly critical of the January 13, 2021 Critical Care Triage Protocol. This is all documented in detail at www.aodaalliance.org/healthcare

It is good that your story quotes Prof. Jeff Preston as being concerned about the triage protocol. The entire passage, excerpted above, states:

“The triage guidelines are also terrifying for people with disabilities, advanced age or pre-existing conditions.

“There’s also this very real concern that I may be denied care based on protocols that say that I have a less likely chance of surviving,” said Jeff Preston, who has a neuromuscular disorder and works as an assistant professor of disability studies at King’s University College, an affiliate of Western University in London, Ont.

“It’s one thing to get COVID and die, it’s a whole other thing to say, as a Canadian citizen, I might not actually have the same access to health care that other Canadians are going to receive and that hurts in a different way.”

The triage guidelines specify that people with disabilities are not treated any differently than the rest of the population, but Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.

“When I was first diagnosed as a baby, they did not believe I was going to survive more than a couple of years,” he said. “They predicted that I would probably die before four or five years old. Now here I am, almost 40 years old, many years later and that prognosis didn’t turn out to be true.”

It is good that the CTV report notes that people with disabilities are terrified. However, the substantial misstatement of fact to which we here point is not corrected by that aspect of the CTV report. The reader is left with the uncontradicted categorical statement that

“The triage guidelines specify that people with disabilities are not treated any differently than the rest of the population…”

At best, the triage protocol says that people with certain stable disabilities are not thereby to be assessed by the Clinical Frailty Scale that measures their ability to perform the eleven tasks of daily living, listed above, without assistance. However, the protocol goes on to apply that disability-discriminatory Scale to people with progressive disabilities (e.g. MS or arthritis, to name a few).

Especially in a national online news story dealing with a life-and-death issue, and its dangerous implications for society’s most vulnerable, it is essential for CTV to get its facts right. This is all the more so since people with disabilities disproportionately have born the brunt of COVID-19 and disproportionately died from it. It is also especially so since it has been so hard to get the media to cover this story. We’ve been trying for over a year, with success for the most part taking place only very recently.

It would be one thing for your report to include our position and then any defence the Ford Government wishes to offer. CTV did not do so. Instead, it categorically states as objective fact something which is 100% incorrect, and which your reporters on this story did not reach out to us to discuss. Our position on these issues has been widely publicized to the media, including to CTV, via news releases and Twitter.

In marked contrast to the April 28, 2021 CTV online report, on the same day, Global TV News Toronto aired a story commendably bearing the accurate headline: “Ontario’s COVID-19 triage protocol ‘discriminates because of disability,’ advocates say”.

We know from the January 23, 2021 online webinar that Critical care Services Ontario conducted for hospitals that the Government or its proxies planned to do some sort of public media strategy on the critical care triage protocol. Your story corresponds in large part to the core messages of that strategy. That could very well be a coincidence, and CTV may well have not known about those media relations strategic plans.

We urgently ask you to do a national report on the disability discrimination that is explicitly included in the Ontario critical care triage protocol, the bogus arguments that have been made on the Ontario Government’s behalf to defend it, and the objections to it from the disability community, the Ontario Human Rights Commission and some members of the Government’s own advisory Bioethics Table. We would be please to assist you in any way in such a story.

David Lepofsky CM, O. Ont

Chair Accessibility for Ontarians with Disabilities Act Alliance

Twitter: @davidlepofsky

CTV News Online Report Updated by May 6, 2021

Originally posted at https://www.ctvnews.ca/health/coronavirus/ontario-hospitals-on-the-verge-of-enacting-last-resort-triage-protocols-1.5406746

Ontario hospitals on the verge of enacting ‘last resort’ triage protocols

Medical Correspondent, CTV National News

Contact @ctv_avisfavaro

Elizabeth St. Philip, CTV News

Contact @LizTV

Ben Cousins, CTVNews.ca Writer

Contact @cousins_ben

Published Wednesday, April 28, 2021 10:00PM EDT

TORONTO — As intensive care admissions climb to dangerously high levels in Ontario, health-care workers in the province worry they might soon be forced into the worst-case scenario of choosing who gets the best care and who doesn’t.

On Wednesday, Ontario reported 3,480 new COVID-19 cases. Although a third wave in the province appears to be levelling off, the number of COVID-19 patients in the intensive care units (ICUs) is steadily climbing, to the point where the province is getting assistance from Newfoundland and Labrador and the Canadian military.

The province also reported on Wednesday that 2,281 patients are currently hospitalized, with 877 patients in intensive care.

It’s believed the province could be forced to enact triage protocols if ICU admissions related to COVID-19 exceed 900.

“I just can’t say strongly enough just what a horrible position we’re in the health-care sector right now and why it’s so important that we really drive these numbers to the ground,” Dr. Chris Simpson, a cardiologist and executive vice-president of Ontario Health, told CTV News.

“We simply have to get COVID under control if we’re going to have our health-care system back in a functional state again.”

Ontario’s triage protocols, developed in January, are meant as a last resort to determine who should be given intensive care when the demand for critical care exceeds the supply.

“It’s going to be extremely emotionally difficult for staff to have to make these decisions to tell family members that we’re not able to offer ICU-level treatments that we would have been able to offer in the past,” said Dr. Erin O’Connor, the deputy medical director of the University Health Networkemergency departments.

The situation is already dire in the Toronto area, where health officials have been forced to transport patients to other districts as ICU beds in the city fill up. Ontario’s COVID-19 modelling numbers from April 16 suggest the province could see nearly 10,000 new COVID-19 cases per dayby the end of May, even under strong public health restrictions.

“There is a wall that’s going to be hit at some point,” Simpson said. “We don’t know where that is yet. We do believe we can build about 200 new ICU beds per week for the next three weeks or so. It gets increasingly tougher, but we think that that will take us into mid-May and we can only hope that things will be cresting by that point.”

Under the triage protocols, all patients are assigned four colours — red, purple, yellow and green — depending on how doctors perceive a patient’s likelihood of surviving for another 12 months. Patients deemed red are predicted to have a 20-per-cent chance of surviving for the year, while patients deemed in the green have more than a 70-per-cent chance of surviving.

Under this system, ICU beds would be given to the green patients first, followed by yellow, purple and red.

“That doesn’t mean we’re not going to care for people,” O’Connor said. “We’re going to offer as much medical care as we possibly can, but some people won’t be able to be on a ventilator — people that we would have put on a ventilator in the past — simply because we’re in a situation where we’re dealing with scarce resources.”

The triage system puts doctors and other health-care workers in the unenviable position of deciding who does not receive the best possible care. It would even require doctors to decide who to withdraw from ICU care if they’re unlikely to survive for another year.

For O’Connor, the prospect having to tell a patient and their family that the province cannot provide them with the best care could have long-term consequences on the entire health-care system in Ontario.

“The hardest part really is going to be making these decisions,” she said. “This is going to take a really large emotional toll and I worry about my staff and I worry about people — after this — leaving medicine because they’re not going to be able to recover.”

“This is not what we’re trained to do. It’s not what we thought we would ever have to do in our careers.”

The triage guidelines are also terrifying for people with disabilities, advanced age or pre-existing conditions.

“There’s also this very real concern that I may be denied care based on protocols that say that I have a less likely chance of surviving,” said Jeff Preston, who has a neuromuscular disorder and works as an assistant professor of disability studies at King’s University College, an affiliate of Western University in London, Ont.

“It’s one thing to get COVID and die, it’s a whole other thing to say, as a Canadian citizen, I might not actually have the same access to health care that other Canadians are going to receive and that hurts in a different way.”

The triage guidelines specify that people with pre-existing disabilities are not treated any differently than the rest of the population, but Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.

“When I was first diagnosed as a baby, they did not believe I was going to survive more than a couple of years,” he said. “They predicted that I would probably die before four or five years old. Now here I am, almost 40 years old, many years later and that prognosis didn’t turn out to be true.”

Disability advocates, backed by the Ontario Human Rights Commission, have raised human rights and discriminatory concerns about the protocol in letters to the provincial government.

QUEBEC ‘FAR FROM TRIGGERING’ TRIAGE PROTOCOLS

Other provinces have also developed similar triage protocols in the event ICU admissions exceed the available beds.

In Quebec for example, prioritization protocols are similar to Ontario’s and those who do not receive ICU admission “will not be abandoned; they will continue to receive other care, the most appropriate for their condition and possible in the context,” according to a statement from Quebec’s Ministry of Health and Social Services.

The department added that it is “far from triggering” the prioritization protocols and has not done so since the start of the pandemic. It has also expanded ICU capacity for COVID-19 patients to hopefully make sure it doesn’t happen.

“This scenario is one of last resort that we want to avoid at all costs,” the statement read. “That is why we are asking Quebecers for their contribution by reducing their contact as much as possible and by rigorously applying the recommended health measures.”

In Saskatchewan, triage protocols will consider a patient’s chance at survival, but also the length of time a patient may require the most care.

“These assessments must be based on the best available scientific evidence,” the Saskatchewan Health Authority wrote in a statement.

“Patients who are not going to receive ICU level of care will receive compassionate care. The sick and dying would not be abandoned. If a patient is not expected to survive, palliative or comfort care would be provided to reduce pain and suffering.”

intensive care admissions

As intensive care admissions climb to dangerously high levels in Ontario, health-care workers in the province worry they might soon be forced into the worst-case scenario of choosing who gets the best care and who doesn’t.

May 18, 2021 Email from AODA Alliance Chair David Lepofsky to CTV News

To: CTVNews

From: David Lepofsky

Date: May 18, 2021

I regret that I must write to again raised concerns about the factual inaccuracy of CTV News’ online April 28, 2021 news report regarding Ontario’s critical care triage protocol. On April 30, 2021, I wrote to alert you to the fact that there was a serious factual error in that report, where it stated the following:

“The triage guidelines specify that people with disabilities are not treated any differently than the rest of the population, but Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.“

In my April 30, 2021 email to CTV news, I explained that contrary to what CTV reported, the January 13, 2021 Critical Care Triage Protocol explicitly directs that a patient’s disability IS a factor that in some cases is to be weighed AGAINST their getting access to the life-saving critical care they need, if Ontario has more patients needing critical care than it has critical care beds and supports. That is disability discrimination.

I very much appreciate that as a result, CTV reporter Avis Favaro spoke to me about this issue and that CTV news looked into our objection.

As a result, CTV News made two changes to the online CTV News report, on or around May 6, 2021. I regret that the first of those changes included a serious factual inaccuracy. The first change was simply to add the word “pre-existing” before the word “disabilities” in the inaccurate statement in the original April 28, 2021 CTV news report. Report’s The revised statement now reads:

“The triage guidelines specify that people with pre-existing disabilities are not treated any differently than the rest of the population, but Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.”

Second, the May 6, 2021 version later adds this accurate sentence:

“Disability advocates, backed by the Ontario Human Rights Commission, have raised human rights and discriminatory concerns about the protocol in letters to the provincial government.”

It is good that CTV attempted to correct it’s inaccurate April 28, 2021 news report. However, CTV has replaced one serious inaccuracy with another serious inaccuracy. The January 13, 2021 Critical Care Triage Protocol does not specify that “people with disabilities” are not treated any differently than the rest of the population (as the inaccurate April 28, 2021 report originally claimed) or that people with pre-existing disabilities are not treated any differently than others (as the May 6, 2021 revision to that article claims. To the contrary, under that critical care triage protocol, if a cancer patient with pre-existing cancer needs critical care, they will be deprioritized if a patient is “Completely disabled and cannot carry out any self-care; totally confined to bed or chair”. That is disability discrimination, up front. Under that protocol, if a patient needing critical care is over 65 and has a progressive pre-existing disease (like MS, arthritis or Parkinson’s), their access to critical care is reduced depending on how few of eleven activities of daily living they can perform without assistance. This includes dressing, bathing, eating, walking, getting in and out of bed, using the telephone, going shopping, preparing meals, doing housework, taking medication, or handling their finances. That too is disability discrimination, pure and simple, including disability discrimination based on a pre-existing disability. CTV’s insertion of the word “pre-existing” into the inaccurate statement did not reduce or correct its complete and demonstrable inaccuracy.

I would add that unless I am mistaken or missed something, nothing on the CTV web page displaying this report acknowledges that there previously was a factual inaccuracy in it. In contrast, newspapers regularly print corrections to earlier stories, that are entitled “correction”, to ensure that the reader is aware that an earlier report had been inaccurate. No one reading the original April 28, 2021 story would know that it was erroneous. No one reading the same report, as revised on or around May 6, 2021, would know that CTV had attempted to correct it. Of course, no one would know from that report that it is inaccurate where it states as a fact that under the protocol, people with pre-existing disabilities are to be treated like everyone else.

We would very much appreciate this story being corrected so that it is accurate. We also would again encourage CTV to run a story that reports specifically on this disability discrimination issue that is anchored in the very wording of the January 13, 2021 Critical Care Triage Protocol. Ontario is not out of the woods, even though ICU cases and overall new COVID-19 cases are reducing. This remains a live issue for your viewers and readers, including the many with disabilities. The newsworthiness of this disability discrimination standing alone is important. The inaccuracy on the CTV website makes the case for a further report even more compelling.

We would be delighted to assist in any way we can. Please stay safe.

David Lepofsky CM, O. Ont

Chair Accessibility for Ontarians with Disabilities Act Alliance Twitter: @davidlepofsky

May 19, 2021 Email from AODA Alliance Chair David Lepofsky to CTV News

Thank you for asking what correction or clarification to the April 28, 2021 CTV News story we would recommend. We respectfully propose that the sentence that requires a change is this:

“The triage guidelines specify that people with pre-existing disabilities are not treated any differently than the rest of the population, but Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.”

May we propose two alternatives. The first and preferable alternative would read:

“The triage guidelines do not ensure that people with pre-existing disabilities are not treated any differently than the rest of the population. Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.”

The second and less desirable alternative would be to simply delete the inaccurate words “The triage guidelines specify that people with pre-existing disabilities are not treated any differently than the rest of the population, but”. The paragraph would therefore read

“Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.”

You asked for a link to the AODA Alliance website. We again offer two alternatives. The more specific link to our report that exhaustively details the disability discrimination in the Ontario critical care triage protocol is https://www.aodaalliance.org/whats-new/a-deeply-troubling-issue-of-life-and-death-an-independent-report-on-ontarios-seriously-flawed-plans-for-rationing-or-triage-of-critical-medical-care-if-covid-19-overwhelms-ontario-hospitals/

The more general link to all our posts on this issue is www.aodaalliance.org/healthcare

We Hope this helps. If a phone call would assist, let me know.

David Lepofsky CM, O. Ont

Chair Accessibility for Ontarians with Disabilities Act Alliance

Twitter: @davidlepofsky

CTV News Online Report As Revised Again on May 19, 2021

Originally posted at: jhttps://www.ctvnews.ca/health/coronavirus/ontario-hospitals-on-the-verge-of-enacting-last-resort-triage-protocols-1.5406746

CTV News

Ontario hospitals on the verge of enacting ‘last resort’ triage protocols

Avis Favaro, Medical Correspondent

Contact @ctv_avisfavaro

Elizabeth St. Philip, CTV News

Contact @LizTV

Ben Cousins , CTVNews.ca Writer

Contact @cousins_ben

Published Wednesday, April 28, 2021 10:00PM EDT

Last Updated Wednesday, May 19, 2021 9:14AM EDT

TORONTO — As intensive care admissions climb to dangerously high levels in Ontario, health-care workers in the province worry they might soon be forced into the worst-case scenario of choosing who gets the best care and who doesn’t.

On Wednesday, Ontario reported 3,480 new COVID-19 cases. Although a third wave in the province appears to be levelling off, the number of COVID-19 patients in the intensive care units (ICUs) is steadily climbing, to the point where the province is getting assistance from Newfoundland and Labrador and the Canadian military.

Related Links

Accessibility for Ontarians with Disabilities Act Alliance on triage protocols

The province also reported on Wednesday that 2,281 patients are currently hospitalized, with 877 patients in intensive care.

It’s believed the province could be forced to enact triage protocols if ICU admissions related to COVID-19 exceed 900.

“I just can’t say strongly enough just what a horrible position we’re in the health-care sector right now and why it’s so important that we really drive these numbers to the ground,” Dr. Chris Simpson, a cardiologist and executive vice-president of Ontario Health, told CTV News.

“We simply have to get COVID under control if we’re going to have our health-care system back in a functional state again.”

Ontario’s triage protocols, developed in January, are meant as a last resort to determine who should be given intensive care when the demand for critical care exceeds the supply.

“It’s going to be extremely emotionally difficult for staff to have to make these decisions to tell family members that we’re not able to offer ICU-level treatments that we would have been able to offer in the past,” said Dr. Erin O’Connor, the deputy medical director of the University Health Network emergency departments.

The situation is already dire in the Toronto area, where health officials have been forced to transport patients to other districts as ICU beds in the city fill up. Ontario’s COVID-19 modelling numbers from April 16 suggest the province could see nearly 10,000 new COVID-19 cases per day by the end of May, even under strong public health restrictions.

“There is a wall that’s going to be hit at some point,” Simpson said. “We don’t know where that is yet. We do believe we can build about 200 new ICU beds per week for the next three weeks or so. It gets increasingly tougher, but we think that that will take us into mid-May and we can only hope that things will be cresting by that point.”

Under the triage protocols, all patients are assigned four colours — red, purple, yellow and green — depending on how doctors perceive a patient’s likelihood of surviving for another 12 months. Patients deemed red are predicted to have a 20-per-cent chance of surviving for the year, while patients deemed in the green have more than a 70-per-cent chance of surviving.

Under this system, ICU beds would be given to the green patients first, followed by yellow, purple and red.

“That doesn’t mean we’re not going to care for people,” O’Connor said. “We’re going to offer as much medical care as we possibly can, but some people won’t be able to be on a ventilator — people that we would have put on a ventilator in the past — simply because we’re in a situation where we’re dealing with scarce resources.”

The triage system puts doctors and other health-care workers in the unenviable position of deciding who does not receive the best possible care. It would even require doctors to decide who to withdraw from ICU care if they’re unlikely to survive for another year.

For O’Connor, the prospect having to tell a patient and their family that the province cannot provide them with the best care could have long-term consequences on the entire health-care system in Ontario.

“The hardest part really is going to be making these decisions,” she said. “This is going to take a really large emotional toll and I worry about my staff and I worry about people — after this — leaving medicine because they’re not going to be able to recover.”

“This is not what we’re trained to do. It’s not what we thought we would ever have to do in our careers.”

The triage guidelines are also terrifying for people with disabilities, advanced age or pre-existing conditions.

“There’s also this very real concern that I may be denied care based on protocols that say that I have a less likely chance of surviving,” said Jeff Preston, who has a neuromuscular disorder and works as an assistant professor of disability studies at King’s University College, an affiliate of Western University in London, Ont.

“It’s one thing to get COVID and die, it’s a whole other thing to say, as a Canadian citizen, I might not actually have the same access to health care that other Canadians are going to receive and that hurts in a different way.”

Preston is skeptical of the triage guidelines in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.

“When I was first diagnosed as a baby, they did not believe I was going to survive more than a couple of years,” he said. “They predicted that I would probably die before four or five years old. Now here I am, almost 40 years old, many years later and that prognosis didn’t turn out to be true.”

Disability advocates, backed by the Ontario Human Rights Commission, have raised human rights and discriminatory concerns about the protocol in letters to the provincial government.

QUEBEC ‘FAR FROM TRIGGERING’ TRIAGE PROTOCOLS

Other provinces have also developed similar triage protocols in the event ICU admissions exceed the available beds.

In Quebec for example, prioritization protocols are similar to Ontario’s and those who do not receive ICU admission “will not be abandoned; they will continue to receive other care, the most appropriate for their condition and possible in the context,” according to a statement from Quebec’s Ministry of Health and Social Services.

The department added that it is “far from triggering” the prioritization protocols and has not done so since the start of the pandemic. It has also expanded ICU capacity for COVID-19 patients to hopefully make sure it doesn’t happen.

“This scenario is one of last resort that we want to avoid at all costs,” the statement read. “That is why we are asking Quebecers for their contribution by reducing their contact as much as possible and by rigorously applying the recommended health measures.”

In Saskatchewan, triage protocols will consider a patient’s chance at survival, but also the length of time a patient may require the most care.

“These assessments must be based on the best available scientific evidence,” the Saskatchewan Health Authority wrote in a statement.

“Patients who are not going to receive ICU level of care will receive compassionate care. The sick and dying would not be abandoned. If a patient is not expected to survive, palliative or comfort care would be provided to reduce pain and suffering.”

Correction:

A previous version of this story suggested triage guidelines



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With CBC’s Strong Commitment to Diversity and Equity in Its Programming, Why Won’t Its Flagship National Radio Program “The Current” Cover Disability Discrimination Dangers in Critical Care Triage Plans 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: [email protected] Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

With CBC’s Strong Commitment to Diversity and Equity in Its Programming, Why Won’t Its Flagship National Radio Program “The Current” Cover Disability Discrimination Dangers in Critical Care Triage Plans During the COVID-19 Pandemic?

June 7, 2021

            SUMMARY

Who watches the watchers? The AODA Alliance has had to do so, when it comes to monitoring media coverage or lack of coverage of the danger since the start of the COVID-19pandemic of disability discrimination in access to life-saving critical care in Ontario hospitals.

Since this danger was first revealed by disability advocates in early April 2020, we and others have been trying hard to get the media to cover this story. From the start, it has had all the hallmarks of a compelling news and public affairs story that is immediate, important and interesting. It has serious ramifications for millions of vulnerable people.

It is a life-and-death topic. It deals with secret Government policies and plans. It raises important human rights issues. Media scrutiny is an important way to hold public officials accountable.

For over a year, it has been an extremely uphill battle to get the media to cover this story. After months of effort, we managed to get some good local and national coverage in recent weeks. That shows how newsworthy it is. Yet the difficulties in even belatedly getting that coverage is itself worthy of attention and scrutiny.

The media often portrays itself as the public’s watchdog, but who watches the watchers? We offer an important illustration in this update.

As a powerful example, CBC’s flagship current affairs radio program “The Current” has refused to cover this story. That program has a great track record on diversity issues, such as those relating to women, Indigenous Peoples, racialized communities, and LGBT issues. It has chronically had a far worse record on covering disability issues. Its stated reasons for refusing to cover this story, documented below in an email from its executive producer to AODA Alliance Chair David Lepofsky, are transparently unpersuasive. One is left wondering what is really going on there. Read on.

In pointing to this example, we acknowledge with thanks that a number of news organizations have covered the issue of disability discrimination in Ontario’s critical care triage plans. Moreover, a number of journalists have tried to get their own media organizations to cover this issue, only to run into disturbing resistance. Moreover, some other CBC programs later did cover this story, though some gave it lesser or no examination.

This critical care triage issue remains a current story (pun intended). The Current should cover it, as should other news and public affairs programs that have not yet looked into it. Even with infection rates dropping in Ontario, there has still been no proper public accounting for the disability discrimination that has been embedded in Ontario hospitals and potentially in emergency ambulance services. With the pandemic’s surge in Manitoba, people with disabilities there now face the same dangers that Ontarians with disabilities have feared for months.

CBC at all levels needs to now carefully investigate and reflect upon its own troubling track record on covering disabilities issues, as it is serious failure to meet CBC’s commendable public commitment to diversity and equity in its coverage. This Update provides one stark and clear illustration of this broader failure. By this we don’t mean that CBC never covers disability issues. Rather, its attention to them pales in comparison to its coverage of other equity and diversity perspectives, as this Update’s example exemplifies.

To learn more about this issue, and to read the media coverage that we have managed to secure, check out the AODA Alliance’s health care page. You can also watch our newest captioned video on the critical care triage issue, which has been seen over 1,000 times in its first four weeks online.

 More Details

 1. The Current Is Certainly Not Current When It Comes to Disability Issues

Some two years ago, when the previous host of CBC’s program The Current was soon to retire, CBC held focus groups to get input into the future of The Current. AODA Alliance Chair David Lepofsky was invited to take part in one of those focus groups, to offer a disability perspective on the program. In preparation for that focus group, Lepofsky conducted a detailed review of months of broadcasts of The Current.

At this focus group (which looked at The Current from a wide range of perspectives), Lepofsky explained that this excellent CBC public affairs program does a great job of fulfilling CBC’s important public commitment to diversity in its coverage when it comes to some equity-seeking groups, such as racialized communities, Indigenous Peoples, women and the LGBTQ+ community. However, it has a poor record of far less attention to disability issues. Equity for some is in reality equity for none. No one disputed the observation that CBC’s The Current program has not given disability issues the kind of attention that it has repeatedly given other equity-seeking groups.

Sadly, nothing has significantly improved at The Current since that focus group two years ago, from the disability perspective. This is so even though we have sent the program any number of story ideas both before and after that focus group session.

The Current’s failure to address the disability issues in critical care triage during the COVID-19pandemic at any time over the past 15 months is a blistering illustration of this systemic failure. That program has commendably covered the pandemic from a multitude of perspectives. AODA Alliance Chair David Lepofsky sent The Current’s executive producer Raj Ahluwalia a detailed email on January 4, 2021, (set out below. It described this story idea, explained its importance, and offered to help the program look into it.

Raj Ahluwalia replied by email on January 5, 2021 (also set out below). He rejected the story as a topic for The Current. That rejection has never changed.

On January 8 and 18, 2021, AODA Alliance Chair David Lepofsky wrote him back (see below). He refuted The Current’s reasons for rejecting the story. Mr. Ahluwalia did not answer those emails. After this email exchange, The Current never reached out to the AODA Alliance to investigate the possibility of covering disability issues in critical care triage.

Raj Ahluwalia’s written reasons for rejecting this story are seriously flawed, both for reasons that David Lepofsky gave at the time, and in light of subsequent events. For example:

  1. Mr. Ahluwalia told us that the critical care triage topic is not suited for the format of The Current. Yet Just 13 days later, on January 18, 2021, The Current devoted a segment of its program to the critical care triage issue. Moreover, as David Lepofsky pointed out to Mr. Ahluwalia, TVO’s The Agenda with Steve Paikin, a very similar TV public affairs program, devoted a 30-minute segment on January 13, 2021 to the disability issues in critical care triage. If it is suitable for The Agenda, it is hard to see why it would be unsuitable for The Current.
  1. When The Current did discuss the critical care triage issue on its January 18, 2021 program, it did not include any disability experts or advocates. It only included physicians. The host Matt Galloway had a great record covering disability issues earlier when he had been the host of CBC’s Toronto radio program Metro Morning. However, in this edition of The Current, he asked no questions of the physicians he interviewed, that raised any of disability issues.
  1. Mr. Ahluwalia wrote on January 5, 2021 that the disability critical care triage issue was not suitable because it was hypothetical i.e. No one had died from a critical care triage decision. Yet that reason did not stop The Current from interviewing physicians about critical care triage just 13 days later on its January 18, 2021 program. Moreover, as David Lepofsky pointed out to Mr. Ahluwalia, The Current has elsewhere covered hypothetical topics.

We point to this example not to single out this one senior, very experienced CBC executive. Rather, we point it out because it is the best, and possibly the only example where a refusal to cover this important disability issue is based on reasons that were put in writing for us. When the reasons given are so transparently unconvincing, one is left to wonder whether there were other reasons at play, even unconsciously.

We urge CBC at the highest levels to look into this, and to consider why it has failed to live up to its commitment to diversity in its coverage in the disability context, especially when it has done so much better at implementing its diversity goals for certain other equity seeking groups. We are encouraged that CBC weeks later gave more coverage on some other programs to the disability-related critical care triage issue. However, that coverage was the product of months and months of efforts by us and others to get CBC to cover it at all.

As stated earlier, equity for some is equity for none. Diversity for some, is diversity for none. Equality for some is equality for none. It merely replaces and old hierarchy with a new one. In the new one, just as in the old one, those left at or near the bottom, like people with disabilities, remain wrongly languishing at the bottom.

 2. January 4, 2021 Email from AODA Alliance Chair David Lepofsky to CBC The Current Executive Producer Raj Ahluwalia

Happy new year Raj! In a nutshell, the story I’m proposing is summarized in the news release set out below. We can supply it to your program based on on-the-record and publicly-posted sources and multiple on-the-record people.

The issue is this: If the surging pandemic exceeds hospital capacity to provide life-saving critical care to all the patients who need it, who will be refused that care, and thus, who will die from a lack of health care? Who will decide who will be denied that care? What rules or standard will govern that life-and-death decision? Will there be any independent check is in place to protect patients, like an independent appeal process? Is there any foundation in law for any of this to take place in Ontario?

This is an important issue now. South of the border, NPR has done excellent investigative work revealing terrifying and appalling disability-based discrimination in access to critical care. Check out https://www.npr.org/2020/12/21/946292119/oregon-hospitals-didnt-have-shortages-so-why-were-disabled-people-denied-care

People with disabilities are already fearful of going to hospital, even if no critical care triage is now going on, because they fear the danger of being de-prioritized now or in the near future.

We and other disability advocates have been waging an incredibly frustrating uphill battle on this issue for months. In the past weeks, it has gotten very little media coverage, including from CBC. We have no idea why. On the rare occasion that an opposition MPP or reporter probes the Ford Government on this issue, the Government scrambles, dodges or prevaricates. The whole record on this is available to you at

www.aodaalliance.org/healthcare

People with disabilities are especially vulnerable here. They are disproportionately bearing the brunt of COVID-19 and are disproportionately dying from it. It would be a cruel irony indeed for them, of all people, to be exposed to the risk of disability-based discriminatory critical care triage. Happy to fill in the details any time. … Please do not leave any voice mails on that number.

****

ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE

NEWS RELEASE – FOR IMMEDIATE RELEASE

Just-Revealed Previously Secret Recommendations for Rationing Critical Medical Care in Ontario that the Ford Government is Considering Are Frightening for People with Disabilities

December 21, 2020 Toronto: Could it soon be that if COVID-19 overwhelms Ontario hospitals, doctors could be told to decide to select some critical care patients to be taken off life-saving critical care that the patients are receiving, still need and want, on the ground that these services must be rationed and given to some other patients? Could a patient who objects to critical care being withdrawn from them be denied a right of appeal to an independent court or tribunal, even though their life is endangered? Could the health professionals making such decisions be insulated from any liability for their actions?

Despite excitement over new vaccines, frightening unreported new details have emerged that would allow all of this to happen, if the record-breaking surge in COVID-19 cases requires hospitals to ration or “triage” life-saving critical care services and beds. The Ford Government is considering a recommendation, made public on the AODA Alliance website, to direct doctors to remove life-saving critical care from some patients already in intensive care who don’t consent to this, if triage becomes necessary. This is even worse than rationing scarce unfilled critical care beds when more patients need them than there are available services.

“Ford’s Government hasn’t shown it has legislative authority to take the drastic, highly-objectionable actions that it is considering,” said David Lepofsky, Chair of the non-partisan AODA Alliance that allies with other disability advocates to protect patients with disabilities against discrimination if triage becomes necessary. “Triage recommendations that Ford’s Government is considering just came to light in the past days, and only because disability advocates campaigned for three months to get the Government to reveal those secret recommendations.”

In those newly revealed September 11, 2020 recommendations, the Government’s external advisory Bioethics Table commendably called on the Government to rescind the Government’s controversial earlier March 28, 2020 critical triage protocol that it had sent Ontario hospitals last spring, because that protocol discriminated against patients based on their disabilities – a concern disability advocates have pressed since April. But last Thursday, at a rushed roundtable that the Ontario Human Rights Commission held with disability, racialized and Indigenous communities’ representatives, those community representatives said the newly revealed triage recommendations, while an improvement, also have numerous human rights problems, even though the recommendations say that human rights should be respected.

These new triage recommendations would give patients, whose lives are in jeopardy, no appeal beyond the health care system (e.g., to an independent tribunal or court). They would insulate health care professionals against liability for refusing or withdrawing life-saving critical care.

On October 29, 2020, the Government, under pressure from people with disabilities and seniors, belatedly rescinded its discriminatory March 28, 2020 triage protocol, but put nothing in place to fill the vacuum. The time when critical care triage may be needed is rapidly getting closer. Health Minister Christine Elliott hasn’t answered any of the six successive AODA Alliance letters to her extensively detailing our concerns.

At last Thursday’s roundtable, a Government representative spoke up for the first time, revealing more disturbing news. A member of the Ford Government’s internal “Critical Care Command Table” responded to feedback at the roundtable, saying that a new approach to triage, addressing human rights concerns raised at the roundtable (with which he seemed to find merit), would have to wait until after this pandemic is over.

“That’s like saying we can be given an umbrella only after the rain has stopped. After months of the Government delaying, refusing to talk to us, and hiding behind its external advisory Bioethics Table for months, we cannot accept that it is now too late to ensure that critical care triage, if necessary, cannot be done without disability discrimination,” said Lepofsky. “We need the Ford Government to speak directly to us, and to obey the Ontario Human Rights Code and Charter of Rights.”

Contact: AODA Alliance Chair David Lepofsky, [email protected]

For more background on this issue, check out:

  1. The Government’s external advisory Bioethics Table’s September 11, 2020 draft critical care triage protocol, finally revealed days ago.
  2. The December 3, 2020 open letter to the Ford Government from 64 community organizations, calling for the Government to make public the secret report on critical care triage from the Government-appointed Bioethics Table.
  3. The AODA Alliance’s unanswered September 25, 2020 letter, its November 2, 2020 letter, its November 9, 2020 letter, its December 7, 2020 letter, its December 15, 2020 letter and its December 17, 2020 letter to Health Minister Christine Elliott.
  4. 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.
  5. The September 1, 2020 submission and July 20, 2020 submission by the ARCH Disability Law Centre to the Bioethics Table.
  6. 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.
  7. 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. January 5, 2021 Email from CBC The Current’s Executive Producer Raj Ahluwalia to AODA Alliance Chair David Lepofsky

Thanks for bringing it to my attention.

I’ve looked through some of what you’ve included here. And while I appreciate and understand your concerns and see that there may be a news story here but it doesn’t work for The Current.

Please allow me to explain.

The situation you describe is hypothetical. Unless there is an actual case of someone, disabled or not, who’s denied care in this manner, I have a hard time “seeing” where a story could editorially go.

I’m also not keen in comparing much from the U. S healthcare system with that of Canada’s. That’s not to say that we’re better than them, it’s just that

the systems are so different that any comparisons are inaccurate.

As you may know our stories run anywhere from 12-to 20-minutues, usually through a series of interviews. And unless there were to be an actual case, as I mentioned, any real discussion of the issues you bring up won’t sustain that length of time on our program.

I will, however, keep your suggestions in mind should there be such a case.

 4. January 8, 2021 Email from AODA Alliance Chair David Lepofsky to CBC The Current’s Executive Producer Raj Ahluwalia

Thank you for taking the time to explain why you do not consider the critical care triage story to be appropriate now for The Current. Exceptional as this may be, may I invite you to reconsider.

You said this story is hypothetical until triage of critical care actually takes place, leading a person to die from a refusal of critical care. Yet this issue is not hypothetical.

The top story on CBC national radio’s January 5, 2021 “The World at 6” (within hours of your writing me) reported that in some Ontario cities, intensive care units are full and tents are being erected. The first line of that newscast reported that the health care system is stretched beyond capacity. It reported that urgent measures are being taken because the system reached the breaking point. Moreover, the US mainstream media is reporting that critical care triage is in fact happening in some US venues.

It is therefore not hypothetical that our society and health care system must ensure that it is ready to administer critical care triage in this pandemic, even if such triage has not taken place. It is not hypothetical that this is a difficult issue and that Ontario has no prior experience triaging life-saving critical care.

It is not hypothetical that the Ontario Government had a secret protocol prepared last spring for this very purpose. It is not hypothetical that the Government was eventually driven to rescind that protocol just weeks ago. It is not hypothetical that it was only rescinded after it was criticized as disability-discriminatory by disability advocates, by the Ontario Human Rights Commission and, eventually, by the very Bioethics Table that initially designed it.

It is not hypothetical that the Government has not announced a new protocol, and that it has been very secretive about this issue. The Government has not answered any of our letters this fall raising such concerns. It is similarly not hypothetical that some people with disabilities are afraid to seek out the health care system, for fear that they could end up being the victims of triage.

In any event, even if it were hypothetical, this should not be a reason to consider this story inappropriate for The Current. The Current has covered issues that are, by your terms, clearly hypothetical. On December 10, 2020, your program aired an item entitled: “Trump Could Push Baseless Election Cheating Claims Well Past Inauguration, Says Journalist.” Of course, that was an important topic to cover. However, by your definition of “hypothetical”, that story should not have run until after inauguration, and until Trump actually repeats his baseless claims at that time.

This story is well-suited for your program’s format, with which I, as a listener, am well familiar. Your program does not inflexibly always require an initial interview with a victim before an important issue is addressed. This meaty issue can fill your typical program time allocation with a great deal still left unaddressed. Ontario’s flagship provincial public affairs program, “The Agenda with Steve Paikin” aired a 26 minute item on the issue (with no disability advocates) back on April 14, 2020 that ran for a full 26minutes https://www.tvo.org/video/deciding-who-lives-ethics-in-a-pandemic

There is much more to say about the subject now, more than 8 months later. As one example, look at the coverage that has just gone online from one local Mississauga online publication, https://thepointer.com/article/2021-01-08/already-in-crisis-mode-ontario-hospitals-have-no-protocol-for-who-gets-priority-treatment-human-rights-advocates-say

There are a number of people on different sides of this issue worth speaking to. We would be happy to assist your program in learning about those issues and seeking out people with whom to speak.

We regret that CBC news has, until now, not covered our issues that we have raised for months on this issue, despite numerous news releases, and tweets directed at CBC. As Canada’s public broadcaster, its failure to do so is troubling and puzzling.

We will continue to try to raise this with CBC news, but it remains a story that is extremely well-suited for The Current. Please let me know if you might reconsider, and if we can help.”

 5. January 18, 2021 Email from AODA Alliance Chair David Lepofsky to CBC The Current’s Executive Producer Raj Ahluwalia

Dear Raj,

It is good that The Current today included a discussion of the COVID-19 critical care triage issue, as this is an immediate and important story. The item included a discussion with two doctors expressing their views and concerns on this issue.

Could your program now consider including a discussion of this issue from the perspective of people with disabilities? That would provide a much-needed balanced look at it, especially since we have identified and documented serious disability human rights concerns with Ontario’s brand new secret triage protocol (one which we have posted on line). It is vital that this issue not be seen or treated as some preserve of doctors and bioethicists. People with disabilities are disproportionately bearing the hardships of COVID-19 and its harshest impact. They are at risk of the cruel irony of facing discriminatory deprioritization if they need critical care, once triage begins.

Two years ago, CBC invited me to take part in a focus group on the future of The Current. At that meeting, I detailed how The Current does an excellent job of addressing a spectrum of important issues on the issue of diversity from the perspective of a number of equality-seeking groups, for which it should be strongly commended. However, it is far weaker at covering important disability issues.

For you to get a good sense of how this story merits the disability perspective, and not just the medical/bioethics perspective, please check out the panel on which I participated last Wednesday on The Agenda with Steve Paikin, available at https://www.youtube.com/watch?v=qkq1NmaXLwk&feature=youtu.be

I’d be happy to do whatever I can to assist your program.

Stay safe.

David Lepofsky CM, O. Ont

Chair Accessibility for Ontarians with Disabilities Act Alliance



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In a Detailed Report Card Delivered During National AccessAbility Week, the Ford Government Gets a Blistering “F” Grade for Its Three Year Record Since Taking Office on Action to Make Ontario Accessible for 2.6 Million Ontarians with Disabilities


ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE

NEWS RELEASE – FOR IMMEDIATE RELEASE

In a Detailed Report Card Delivered During National AccessAbility Week, the Ford Government Gets a Blistering “F” Grade for Its Three Year Record Since Taking Office on Action to Make Ontario Accessible for 2.6 Million Ontarians with Disabilities

May 31, 2021 Toronto: During National AccessAbility Week, the non-partisan grassroots AODA Alliance releases a report card (set out below) on the Ford Government’s record for tearing down the barriers that people with disabilities face, awarding the Government an “F” grade.

When he was campaigning for votes in the 2018 election, Doug Ford said that our issues “are close to the hearts of our Ontario PC Caucus” and that:

“Too many Ontarians with disabilities still face barriers when they try to get a job, ride public transit, get an education, use our healthcare system, buy goods or services, or eat in restaurants.”

Yet three years after taking office, people with disabilities are no better off, and in some important ways, are worse off, according to today’s new report card. Passed unanimously in 2005, the Accessibility for Ontarians with Disabilities Act requires the Ontario Government to lead this province to become accessible to people with disabilities by 2025. Ontario is nowhere near that goal with under four years left. The Ford Government has no effective plan to meet that deadline.

This report card’s key findings include:

  1. The Ford Government has no comprehensive plan of action on accessibility, 851 days after receiving the Report of David Onley’s AODA Independent Review.
  1. The Government has not ensured that public money will never be used to create new accessibility barriers.
  1. The Ford Government has failed to enact or strengthen any accessibility standards under the AODA.

 

  1. The Ford Government has announced no new action to effectively ensure the accessibility of public transportation.

 

  1. The Ford Government imposed substantial and harmful delays in the work of Five important AODA Standards Development Committees that was underway before the Government took office.

 

  1. The Ford Government has repeatedly violated its mandatory duty under the AODA to make public the initial or final recommendations of a Government-appointed Standards Development Committee “upon receiving” those recommendations.

 

  1. The Ford Government has failed for 3 years to fulfil its mandatory duty to appoint a Standards Development Committee to review the Public Spaces Accessibility Standard.

 

  1. The Ford Government has made public no detailed plan for effective AODA enforcement.

 

  1. In a waste of public money, the Ford Government diverted 1.3 million dollars into the Rick Hansen Foundation’s controversial private accessibility certification process. This has resulted in no disability barriers being removed or prevented.

 

  1. The Ford Government unfairly burdened Ontarians with disabilities with having to fight against new safety dangers being created by municipalities allowing electric scooters.

 

  1. The Ford Government’s rhetoric has been harmfully diluting the AODA’s goal of full accessibility.

 

  1. The Ford Government has given public voice to false and troubling stereotypes About disability accessibility.

 

  1. The Ford Government has failed to effectively address the urgent needs of Ontarians with disabilities during the COVID-19 pandemic.

 

  1. The lives of vulnerable Ontarians with disabilities are endangered by the Ford Government’s secret plans for critical care triage during the COVID-19 pandemic, If hospitals cannot serve All critical care Patients.

“We keep offering the Ford Government constructive ideas, but too often, they are disregarded,” said David Lepofsky, chair of the AODA Alliance which campaigns for accessibility for people with disabilities. “Premier Ford hasn’t even met with us, and has turned down every request for a meeting.”

AODA Alliance Chair David Lepofsky has had to resort to a court application (now pending) to get the Ford Government to fulfil one of its important duties under the AODA, and a Freedom of Information application to try to force the Ford Government to release its secret plans for critical care triage if the COVID-19pandemic worsens, requiring rationing of critical care.

Contact: AODA Alliance Chair David Lepofsky, [email protected]

Twitter: @aodaalliance

 A Report Card on the Ford Government’s Record, After Three Years in Office, on Achieving Disability Accessibility

May 31, 2021

Prepared by the AODA Alliance

 Introduction

This year’s National AccessAbility Week takes place when Ontario’s Ford Government is completing its third year of a four year term in office. This is an especially appropriate time to take stock of how well the Ford Government is doing at advancing the goal of making Ontario accessible to people with disabilities by 2025, the deadline which the Accessibility for Ontarians with Disabilities Act enshrines in Ontario law.

It is with a strong sense of frustration that we award the Ford Government a failing “F” grade for its record on this issue.

The Ontario Public Service includes quite a number of public officials who are deeply and profoundly dedicated to the goal of tearing down barriers impeding people with disabilities, and preventing the creation of new disability barriers. They have commendably found quite a number of willing partners within the disability community (both individuals and disability organizations), and among obligated organizations in the public and private sectors. These partners are also committed to the goal of accessibility, and have in their spheres of influenced tried to move things forward. To all these people we and people with disabilities generally are indebted.

For example, several Standards Development Committees have been appointed under the AODA to craft recommendations on what enforceable AODA accessibility standards should include to be strong and effective. They have invested many hours, trying to come up with workable recommendations.

As well, over the past three years, the Ontario Government has continued to operate voluntary programs that have existed for years to contribute to the goal of accessibility. The Ford Government has also, we believe, improved things by freeing its Standards Development Committees from excessive involvement by Public Service staff. This has enabled those staff to support the work of those committees, while leaving them free to do their own work, devising recommendations for the Government.

However, all of that cannot succeed in bringing Ontario to the goal of an accessible province by 2025, without strong leadership by the Ontario Government and those who steer it. This has been the conclusion of three successive Independent Reviews, conducted under the AODA, by Charles Beer in 2010, by Mayo Moran in 2014 and by David Onley in 2018.

Over the past three years, we regret that that leadership has continued to be lacking. The result is that Ontario is falling further and further behind the goal of an accessible province by 2025. Less and less time is available to correct that.

This report details several of the key ways that the Ontario Government has fallen far short of what Ontarians with disabilities need. As the Government’s mandatory annual report on its efforts on accessibility back in 2019 reveals, the Government’s prime focus has been on trying to raise awareness about accessibility. As has been the Ontario Government’s practice for years, that 2019 annual report was belatedly posted on line on the eve of the 2021 National AccessAbility Week, two years after many of the events reported in it.

Decades of experience, leading to the enactment of the AODA in 2005, has proven over and over that such awareness-raising and voluntary measures won’t get Ontario to the goal of accessibility by 2025, or indeed, ever. As always, the AODA Alliance, as a non-partisan coalition, remains ready, willing, able, and eager to work with the Government, and to offer constructive ideas on how it can change course and fulfil the AODA’s dream that the Legislature unanimously endorsed in May 2005.

1. The Ford Government Has No Comprehensive Plan of Action on Accessibility, 851 Days After Receiving the Report of David Onley’s AODA Independent Review

We have been urging the Ford Government to develop a detailed plan on accessibility since shortly after it took office, to lay out how it will get Ontario to the AODA’s mandatory goal of becoming accessible to people with disabilities by 2025. It has never done so.

In December 2018, the Ford Government said it was awaiting the final report of former Lieutenant Governor David Onley’s Independent Review of the AODA’s implementation and enforcement, before deciding what it would do regarding accessibility for people with disabilities. On January 31, 2019, the Government received the final report of the David Onley Independent Review of the AODA’s implementation and enforcement. Minister for Accessibility Raymond Cho publicly said on April 10, 2019 that David Onley did a “marvelous job.”

The Onley report found that Ontario is still full of “soul-crushing” barriers impeding people with disabilities. It concluded that progress on accessibility has taken place at a “glacial pace.” It determined that that the goal of accessibility by 2025 is nowhere in sight, and that specific new Government actions, spelled out in the report, are needed.

However, in the 851 days since receiving the Onley Report, the Ford Government has not made public a detailed plan to implement that report’s findings and recommendations. The Government has staged some media events with the Accessibility Minister to make announcements, but little if anything new was ever announced. The Government repeated pledges to lead by example on accessibility, and to take an all-of-Government approach to accessibility. But these pledges were backed by nothing new to make them mean anything more than when previous governments and ministers engaged in similar rhetorical flourishes.

2. The Government Has Not Ensured that Public Money Will Never Be Used to Create New Accessibility Barriers

In its three years in office, we have seen no effective action by the Ford Government to ensure that public money is never used to create new disability barriers or to perpetuate existing barriers. The Ontario Government spends billions of public dollars on infrastructure and on procuring goods, services and facilities, without ensuring that no new barriers are thereby created, and that no existing barriers are thereby perpetuated.

As but one example, last summer, the Ford Government announced that it would spend a half a billion dollars on the construction of new schools and on additions to existing schools. However, it announced no action to ensure that those new construction projects are fully accessible to students, teachers, school staff and parents with disabilities. The Ontario Ministry of Education has no effective standards or policies in place to ensure this accessibility, and has announced no plans to create any.

3. The Ford Government Has Enacted or Strengthened No Accessibility Standards

In its three years in power, the Ford Government has enacted no new AODA accessibility standards. It has revised no existing accessibility standards to strengthen them. It has not begun the process of developing any new accessibility standards that were not already under development when the Ford Government took office in June 2018.

As one major example, the Ford Government has not committed to develop and enact a Built Environment Accessibility Standard under the AODA, to ensure that the built environment becomes accessible to people with disabilities. No AODA Built Environment Accessibility Standard now exists. None is under development.

This failure to act is especially striking for two reasons. First, the last two AODA Independent Reviews, the 2014 Independent Review by Mayo Moran and the 2019 Independent Review by David Onley, each identified the disability barriers in the built environment as a priority. They both called for new action under the AODA. Second, when he was seeking the public’s votes in the 2018 Ontario election, Doug Ford made specific commitments regarding the disability barriers in the built environment. Doug Ford’s May 15, 2018 letter to the AODA Alliance, setting out his party’s election commitments on disability accessibility, included this:

  1. a) “Your issues are close to the hearts of our Ontario PC Caucus and Candidates, which is why they will play an outstanding role in shaping policy for the Ontario PC Party to assist Ontarians in need.”
  1. b) “Whether addressing standards for public housing, health care, employment or education, our goal when passing the AODA in 2005 was to help remove the barriers that prevent people with disabilities from participating more fully in their communities.”
  1. c) “Making Ontario fully accessible by 2025 is an important goal under the AODA and it’s one that would be taken seriously by an Ontario PC government.”
  1. d) “This is why we’re disappointed the current government has not kept its promise with respect to accessibility standards. An Ontario PC government is committed to working with the AODA Alliance to address implementation and enforcement issues when it comes to these standards.

Ontario needs a clear strategy to address AODA standards and the Ontario Building Code’s accessibility provisions. We need Ontario’s design professionals, such as architects, to receive substantially improved professional training on disability and accessibility.”

4. The Ford Government Has Announced No New Action to Effectively Ensure the Accessibility of Public Transportation

Just before the 2018 Ontario election, the Ontario Government received the final recommendations for reforms to the Transportation Accessibility Standard from the AODA Transportation Standards Development committee. Since then, and over the ensuing three years in office, the Ford Government announced no action on those recommendations. It has not publicly invited any input or consultation on those recommendations. At the same time, the Ford Government has made major announcements about the future of public transit infrastructure in Ontario. As such, barriers in public transportation remained while the risk remains that new ones will continue to be created.

 5. The Ford Government Imposed Substantial and Harmful Delays in the Work of Five Important AODA Standards Development Committees that was Underway Before the Government Took Office

When the Ford Government won the 2018 Ontario election, the work of five AODA Standards Development Committees were all frozen, pending the new Minister for Accessibility getting a briefing. Any delay in the work of those committees would further slow the AODA’s sluggish implementation documented in the Onley Report.

Those Standards Development Committees remained frozen for months, long after the minister needed time to be briefed. We had to campaign for months to get that freeze lifted.

Over four months later, in November 2018, the Ford Government belatedly lifted its freeze on the work of the Employment Standards Development Committee and the Information and Communication Standards Development Committee. However it did not then also lift the freeze on the work of the three other Standards Development Committees, those working on proposals for accessibility standards in health care and education.

We had to keep up the pressure for months. The Ford Government waited until March 7, 2019 before it announced that it was lifting its freeze on the work of the Health Care Standards Development Committee and the two Education Standards Development Committees. It was as long as half a year after that announcement that those three Standards Development Committees finally got back to work.

In the meantime, the many unfair disability barriers in Ontario’s education system and Ontario’s health care system remained in place, while new ones continued to be created. The final enactment of new accessibility standards in the areas of health care and education was delayed commensurately, as was the enactment of revisions to strengthen Ontario’s 2011 Information and Communication Accessibility Standard and Ontario’s 2011 Employment Accessibility Standard.

6. The Ford Government Has Repeatedly Violated Its Mandatory Duty Under the AODA to Make Public the Initial or Final Recommendations of a Government-Appointed Standards Development Committee “Upon Receiving” Those Recommendations

Section 10(1) of the AODA requires the Government to make public the initial or final recommendations that it receives from a Standards Development Committee, appointed under the AODA “upon receiving” those recommendations. The Ontario Government under successive governments and ministers has wrongly taken the approach that it can delay making those recommendations public for months despite the AODA‘s clear, mandatory and unambiguous language.

The Ford Government has certainly taken this troubling approach. It delayed some two years before making public the final recommendations of the Employment Standards Development Committee earlier this year. It delayed some six months before making public the final recommendations of the Information and Communication Standards Development Committee last year. It delayed over five months before making public the initial recommendations of the Health Care Standards Development Committee earlier this month. It has delayed over two months so far in making public the initial recommendations of the K-12 Education Standards Development Committee and Post-Secondary Education Standards Development Committee.

As a result, AODA Alliance Chair David Lepofsky has brought a court application, now pending, to seek an order compelling the Ford Government to obey the AODA. This is especially disturbing, because the Government is leading by such a poor example when it comes to the AODA. Its delay in complying with s. 10 of the AODA slows the already-slow process of developing and enacting or revising accessibility standards under the AODA.

7. The Ford Government Has for 3 Years Failed to Fulfil Its Mandatory Duty to Appoint A Standards Development Committee to Review the Public Spaces Accessibility Standard

The AODA required the Ontario Government to appoint a Standards Development Committee to review the Public Spaces Accessibility Standard by the end of 2017. Neither the previous Wynne Government nor the current Ford Government have fulfilled this legal duty. This is a mandatory AODA requirement.

The Ford Government has had three years in office to learn about this duty and to fulfil it. We flagged it for the Government very soon after it took office in 2018.

8. The Ford Government Has Made Public No Detailed Plan for Effective AODA Enforcement

During its three years in office, the Ford Government has announced no public plan to substantially strengthen the AODA’s weak enforcement. Three years ago, the Ford Government inherited the previous McGuinty Government’s and Wynne Government’s multi-year failure to effectively and vigourously enforce the AODA. What little enforcement that took place fell far short of what people with disabilities needed, as is confirmed in both the 2015 Moran Report and the 2019 Onley Report. The failure to effectively enforce the AODA has contributed to Ontario falling so far behind the goal of becoming accessible to people with disabilities by 2025.

 

9. In a Waste of Public Money, the Ford Government Diverted 1.3 Million Dollars into the Rick Hansen Foundation’s Controversial Private Accessibility Certification Process

The only significant new action that the Ford Government has announced on accessibility over its first three years in office was its announcement over two years ago in the April 11, 2019 Ontario Budget that it would spend 1.3 million public dollars over two years to have the Rick Hansen Foundation’s private accessibility certification process “certify” some 250 buildings, belonging to business or the public sector, for accessibility. In two years, this has not been shown to lead to the removal or prevention of a single barrier against people with disabilities anywhere in the built environment. It has predictably been a waste of public money.

The Ford Government did not consult the AODA Alliance or, to our knowledge, the disability community, before embarking on this wasteful project. It ignored serious concerns with spending public money on such a private accessibility certification process. These concerns have been public for well over five years. The Ford Government gave no public reasons for rejecting these concerns.

A private accessibility certification risks misleading the public, including people with disabilities. It also risks misleading the organization that seeks this so-called certification. It “certifies” nothing.

A private organization might certify a building as accessible, and yet people with disabilities may well find that the building itself, or the services offered in the building, still have serious accessibility problems. Such a certification provides no defence to an accessibility complaint or proceeding under the AODA, under the Ontario Building Code, under a municipal bylaw, under the Ontario Human Rights Code, or under the Canadian Charter of Rights and Freedoms.

If an organization gets a good -level accessibility certification, it may think they have done all they need to do on accessibility. The public, including people with disabilities, and design professionals may be misled to think that this is a model of accessibility to be emulated, and that it is a place that will be easy to fully access. This can turn out not to be the case, especially if the assessor uses the Rick Hansen Foundation’s insufficient standard to assess accessibility, and/or if it does not do an accurate job of assessing the building and/or if the assessor’s only training is the inadequate short training that the Rick Hansen Foundation created.

For example, the Ford Government got the Rick Hansen Foundation to certify as accessible the huge New Toronto Courthouse now under construction. Yet we have shown that its plans are replete with serious accessibility problems. The Rick Hansen Foundation’s assessor never contacted the AODA Alliance to find out about our serious concerns with the courthouse’s design before giving it a rating of “accessible.”

The Rick Hansen Foundation’s private accessibility certification process lacks much-needed public accountability. The public has no way to know if the private accessibility assessor is making accurate assessments. It is not subject to Freedom of Information laws. It operates behind closed doors. It lacks the kind of public accountability that applies to a government audit or inspection or other enforcement. For more details on the problems with private accessibility certification processes, read the AODA Alliance’s February 1, 2016 brief on the problems with publicly funding any private accessibility certification process.

10. The Ford Government Unfairly Burdened Ontarians with Disabilities with Having to Fight Against New Barriers Being Created by Municipalities Allowing Electric Scooters

It is bad enough that the Ford Government did too little in its first three years in office to tear down the many existing barriers that impede people with disabilities. It is even worse that the Government took action that will create new disability barriers, and against which people with disabilities must organize to battle at the municipal level.

When the Ford Government took office in June 2018, it was illegal to ride electric scooters (e-scooters) in public places. In January 2019, over the strenuous objection of Ontario’s disability community, the Ford Government passed a new regulation. It lets each municipality permit the use of e-scooters in public places, if they wish. It did not require municipalities to protect people with disabilities from the dangers that e-scooters pose to them.

Silent, high-speed e-scooters racing towards pedestrians at over 20 KPH, ridden by an unlicensed, untrained, uninsured joy-riders, endanger people with disabilities, seniors, children and others. Leaving e-scooters strewn all over in public places, as happens in other cities that permit them, creates physical barriers to people using wheelchairs and walkers. They create tripping hazards for people with vision loss.

Torontonians with disabilities had to mount a major campaign to convince Toronto City Council to reject the idea of allowing e-scooters. They were up against a feeding-frenzy of well-funded and well-connected corporate lobbyists, the lobbyists who clearly hold sway with the Ontario Premier’s office.

Unlike Toronto, Ottawa and Windsor have allowed e-scooters, disregarding the danger they now pose for people with disabilities. Some other Ontario cities are considering allowing them.

Thanks to the Ford Government, people with disabilities must now campaign against e-scooters, city by city. This is a huge, unfair burden that people with disabilities did not need, especially during the COVID-19 pandemic. It is a cruel irony that the Ford Government unleashed the danger of personal injuries by e-scooters at the same time as it has said it wants to reduce the number of concussions in Ontario.

11. The Ford Government’s Rhetoric Has Been Harmfully Diluting the AODA’s Goal of Full Accessibility

A core feature of the AODA is that it requires Ontario become “accessible” to people with disabilities by 2025. It does not merely say that Ontario should become “more accessible” by that deadline.

Yet, the Ford Government too often only talks about making Ontario more accessible. In fairness, the previous Ontario Liberal Government under Premier Dalton McGuinty and later Premier Kathleen Wynne too often did the same.

This dilutes the goal of the AODA, for which people with disabilities fought so hard for a decade. It hurts people with disabilities. It is no doubt used to try to lower expectations and over-inflate any accomplishments.

 

12. The Ford Government Has Given Public Voice to False Troubling Stereotypes About Disability Accessibility

 

Two years ago, the Ford Government publicly voiced very troubling and harmful stereotypes about the AODA and disability accessibility during National AccessAbility Week.

In 2019, during National AccessAbility Week, NDP MPP Joel Harden proposed a that the Legislature pass a resolution that called for the Government to bring forward a plan in response to the Onley Report. The resolution was worded in benign and non-partisan words, which in key ways tracked Doug Ford’s May 15, 2018 letter to the AODA Alliance. The proposed resolution stated:

“That, in the opinion of this House, the Government of Ontario should release a plan of action on accessibility in response to David Onley’s review of the Accessibility for Ontarians with Disabilities Act that includes, but is not limited to, a commitment to implement new standards for the built environment, stronger enforcement of the Act, accessibility training for design professionals, and an assurance that public money is never again used to create new accessibility barriers.”

Premier Ford had every good reason to support this proposed resolution, as we explained in the June 10, 2019 AODA Alliance Update. Yet, as described in detail in the June 11, 2019 AODA Alliance Update, the Doug Ford Government used its majority in the Legislature to defeat this resolution on May 30, 2019, right in the middle of National Access Abilities Week.

The speeches by Conservative MPPs in the Legislature on the Government’s behalf, in opposition to that motion, voiced false and harmful stereotypes about disability accessibility. Those statements in effect called into serious question the Ford Government’s commitment to the effective implementation and enforcement of the AODA. They denigrated the creation and enforcement of AODA accessibility standards as red tape that threatened to imperil businesses and hurt people with disabilities.

13. The Ford Government Has Failed to Effectively Address the Urgent Needs of Ontarians with Disabilities During the COVID-19 Pandemic

All of the foregoing would be enough in ordinary times to merit the “F” grade which the Ford Government is here awarded. However, its treatment of people with disabilities and their accessibility needs during the COVID-19 pandemic makes that grade all the more deserved.

In the earliest weeks, the Government deserved a great deal of leeway for responding to the pandemic, because it was understandably caught off guard, as was the world, by the enormity of this nightmare. However, even well after the initial shock period when the pandemic hit and for the year or more since then, the Ford Government has systemically failed to effectively address the distinctive and heightened urgent needs of people with disabilities in the pandemic.

People with disabilities were foreseeably exposed to disproportionately contract COVID-19, to suffer its worst hardships and to die from it. Yet too often the Government took a failed “one size fits all” approach to its emergency planning, that failed to address the urgent needs of people with disabilities. This issue has preoccupied the work of the AODA Alliance and many other disability organizations over the past 14 months.

Two of the areas where the Government most obviously failed were in health care and education. This is especially inexcusable since the Government had the benefit of a Health Care Standards Development Committee, a K-12 Education Standards Development Committee and a Post-Secondary Education Standards Development Committee to give the Government ideas and advice throughout the pandemic. The K-12 Education Standards Development Committee delivered a detailed package of recommendations for the pandemic response four months into the pandemic. Yet those recommendations have largely if not totally gone unimplemented.

The Government repeatedly left it to each school board, college, university, and health care provider to each separately figure out what disability barriers had arisen during the pandemic, and how to remove and prevent those barriers. This is a predictable formula for wasteful duplication of effort, for increased costs and workloads, all in the middle of a pandemic.

For example, the Ford Government largely left it to each frontline teacher and principal to figure out how to accommodate the recurring needs of students with different disabilities during distance learning. The Government relied on TVO as a major partner in delivering distance learning to school students, even though TVO’s distance learning offerings have accessibility barriers that are unforgivable at any time, and especially during a pandemic.

As another example, the Ford Government did not properly plan to ensure that the process for booking and arranging a COVID-19 vaccine was disability-accessible. There is no specific accessible booking hotline to help people with disabilities navigate the booking process from beginning to end.

There is no assurance that drug stores or others through whom vaccines can be booked have accessible websites. We have received complaints that the Government’s own online booking portal has accessibility problems. Arranging for a barrier-free vaccination for People with Disabilities is even harder than the public is finding for just booking a vaccination for those with no disabilities.

14. The Lives of Vulnerable People with Disabilities are Endangered by the Ford Government’s Secret Plans for Critical Care Triage During the COVID-19 Pandemic, If Hospitals Cannot Serve All Critical Care Patients

The AODA Alliance, working together with other disability organizations, has also had to devote a great deal of effort to try to combat the danger that vulnerable people with disabilities would face disability discrimination in access to life-saving critical care if the pandemic overloads hospitals, leading to critical care triage. The Ford Government has created new disability barriers by allowing clear disability discrimination to be entrenched in Ontario’s critical care triage protocol. Even though formal critical care triage has not yet been directed, there is a real danger that it has occurred on the front lines without proper public accountability e.g. by ambulance crews declining to offer critical care to some patients at roadside, when called via 911.

The Ford Government has allowed a concerted disinformation campaign to be led by those who designed the Ontario critical care triage protocol, and who are falsely claiming that there is no disability discrimination in that protocol.

Further Background

Further background on all of the issues addressed in this report card can be found on the AODA Alliance’s web site. It has separate pages, linked to its home page, addressing such topics as accessibility issues in transportation, health care, education, information and communication, the built environment, AODA enforcement, and disability issues arising during the COVID-19 pandemic, among others. Follow @aodaalliance



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