One Year After the First Secret Ontario Critical Care Triage Protocol Was Sent to Ontario Hospitals, the Threat of Critical Care Discrimination Against Some Patients with Disabilities Remains A Live Worry


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/

One Year After the First Secret Ontario Critical Care Triage Protocol Was Sent to Ontario Hospitals, the Threat of Critical Care Discrimination Against Some Patients with Disabilities Remains A Live Worry

March 29, 2021

            SUMMARY

It was one year ago yesterday that the Ford Government secretly sent Ontario hospitals a deeply-flawed critical care triage protocol, directing how hospitals should decide who will be refused life-saving critical care if hospitals get overloaded by the COVID-19pandemic. It was one year ago next week that the disability community learned of this, and made public the fact that the Government’s critical care triage protocol discriminates against some patients with disabilities.

Where are we one year later? The COVID-19 pandemic is still upon us. Despite the good news of COVID-19 vaccines, waves of new infections continue to push Ontario’s hospitals to the limit. The risk of Ontario having to ration critical care remains a real one.

As well, one year later, the Ford Government wrongly continues to deal with this issue in secret, and without itself consulting the public or making public what it is doing. It continues to deny responsibility in this area, sloughing it off on the medical profession. It continues to sit back while an updated critical care triage protocol is in place, that would continue to discriminate against some patients with disabilities.

Oddly, the health care web page of the AODA Alliance website continues to be the best, if not the only place to go to find public copies of important documents in this area, such as Ontario’s January 13, 2021 Critical Care Triage Protocol, and the September 11, 2020 report of the Government’s Bioethics Table. News reporters continue to tell us that they cannot get straight answers, and at times, cannot get any answers at all, from the Ford Government on this critical care triage issue.

Even though too many news outlets have failed to give this issue the attention it deserves, there have been a few recent and important news reports. Below, we set out:

* The March 29, 29, 2021 Globe and Mail report on the critical care triage issue;

* The February 7, 2021 Globe and Mail report on the critical care triage issue; and

* The February 8, 2021 Lawyer’s Daily report on broader health care barriers facing people with disabilities during COVID-19, which situates the critical care triage discrimination against some patients with disabilities into that broader issue.

We offer four reflections on those reports:

  1. The cruel irony has not been lost on many people with disabilities that at the same time as people with disabilities must battle against the life-threatening dangers facing them if Ontario undertakes critical care triage, disability advocates have also been campaigning against Bill C-7, controversial new federal legislation that substantially liberalizes medical assistance in dying. There has been this increased governmental focus on ending the lives of people with disabilities, without comparable governmental efforts to improve the opportunities for living with a disability.
  1. As the Government itself hides, Dr. James Downar continues in effect to play the role of the Government’s chief defender on this critical care triage issue. He appears indistinguishable from a cabinet minister’s spokesperson. He has been credited with being an author, if not the key author, of the January 13, 2021 Critical Care Triage Protocol which embodies seriously harmful disability discrimination. As a member of the Government’s advisory Bioethics Table, he was a key player during a series of virtual meetings last summer, where the AODA Alliance and certain other disability advocates and experts voiced concerns in this area.

Dr. Downar’s statements in the Government’s defence in the March 29, 2021 article below constitute a seriously erroneous rejection of key points of input we presented to him and his Bioethics Table colleagues on these disability issues. That article states:

“He said using a scoring system, such as the clinical frailty scale, to evaluate patients is meant to limit the scope of a doctor’s subjective judgements or bias, in order to try to ensure everyone is treated equally. The protocol, he said, is focused on a patient’s risk of mortality at 12 months, not whether they have a disability.”

Whether or not the critical care triage protocol was intended as he stated, we and other disability advocates have shown that the protocol has the clear effect of discriminating because of disability. It is the effect of the protocol and not its intent that determines whether it is a violation of the Charter of Rights and/or the Ontario Human Rights Code. Dr. Downar’s defence provides no defence.

  1. Both Globe and Mail articles report on advocacy by some doctors to be given the power to pull the plug on critical care patients over their objection, taking away critical care they are already receiving, and thereby endangering their life. No one has answered our objection that Ontario cannot authorize this without the doctor running up against Canada’s Criminal Code homicide provisions. This piles onto vulnerable people with disabilities yet another danger to their lives, during a pandemic where they have disproportionately been at risk of getting COVID-19and dying from it.
  1. The Globe and Mail’s February 7, 2021 article quotes a bioethicist in defence of the January 13, 2021 Critical Care Triage Protocol, who claims it is designed to protect human rights. The title “bioethicist” implies great expertise in this area. However, there is cause for concern.

There is no public regulation of who can call themselves a bioethicist. There appears to be no self-governing body for bioethicists, and no code of ethics for bioethicists. We have learned through the critical care triage issue that a person does not need to have any training in law or human rights, to call themselves a bioethicist. Indeed, some make statements on basic constitutional and human rights that reflect a demonstrable lack of knowledge in these important areas.

For more background in this area, check out the AODA Alliance’s health care web page. Also, check out the AODA Alliance’s February 25, 2021 report entitled: “A Deeply Troubling Issue of Life and Death — An Independent Report on Ontario’s Seriously-Flawed Plans for Rationing or “Triage” of Critical Medical Care If COVID-19 Overwhelms Ontario Hospitals”.

            MORE DETAILS

Globe and Mail March 29, 2021

Originally posted at https://www.theglobeandmail.com/canada/article-ontario-covid-19-surge-could-force-doctors-to-use-online-calculator-to/

Ontario’s COVID-19 triage plan includes online care calculator

By JEFF GRAY

Staff

If COVID-19’s surging third wave overwhelms Ontario’s hospitals, doctors could soon be forced to use an emergency triage protocol that includes an online calculator to help decide who gets lifesaving care and who does not.

The website, which prompts physicians to key in a critical patient’s diagnosis in order to estimate their chances of survival, is part of an emergency procedure drafted to help doctors make what would normally be unthinkable decisions. The protocol has been distributed to hospitals. But it has never officially been made public.

The province has loosened some pandemic restrictions in recent weeks, even as daily new infections still shoot upward, with more than 2,448 recorded on Sunday and 19 deaths. Ontario counted 390 COVID-19 patients in its intensive-care units, not far from the peak of 420 hit in the second wave of the virus in January.

While the provincial government says it has added hospital capacity, the Ontario Hospital Association warned last Friday that the province’s critical-care system was reaching its “saturation point” and that soon “hospitals will be under extraordinary pressure to try and ensure equitable access to lifesaving critical care.”

To deal with the onslaught, ICUs have been transferring critical patients from packed facilities to those elsewhere that still have space. Patients are being shipped via ambulance helicopter from Toronto to as far away as Kingston. Field hospitals have also sprung up around several health care facilities, including Toronto’s Sunnybrook Health Sciences Centre.

But more than a year into a pandemic that put hospitals in New York and Italy over the brink, the Ontario government has kept almost all planning for such a worst-case scenario out of the public eye.

By contrast, Quebec held open consultations on its emergency triage protocol months ago.

Meanwhile, the Ontario Human Rights Commission and disability rights groups have raised objections for months, warning that leaked drafts of Ontario’s protocol discriminate unfairly against older and disabled people.

Both a January version of the protocol, developed by the group that co-ordinates critical care across the province, and the online calculation tool have only come to light after being obtained by the Accessibility for Ontarians with Disabilities Act Alliance, a disability rights group.

The AODAA has also obtained a “framework document,” prepared by the government’s bioethics table, a committee of experts that has been wrestling with the triage issue for the past year.

The province’s Ministry of Health has said only that the triage protocol, known as an “emergency standard of care,” was drafted by the medical profession and not approved by the ministry.

The notion of an online triage aide may sound strange, but nothing about hospitals swamped by COVID-19 would be normal. The “short-term mortality risk” calculator would allow physicians to type data on the severity of a patient’s conditions – cancer, trauma, stroke and so on – to help come up with an estimated chance of survival after 12 months. Those with a higher chance of survival would be given priority for ICU spots. Decisions would be made by two doctors, not one alone.

David Lepofsky, a lawyer and chairman of the AODAA, said it’s the wrong approach.

“It creates the false impression that this can be an objective [task]. Just type in the data, press the button, the computer will tell you who lives and who dies,” Mr. Lepofsky said in an interview.

He takes issue with the protocol’s reliance on a metric for use on those over 65 known as the clinical frailty scale, which measures a patient’s ability to perform various everyday tasks.

That, he argues, devalues the lives of disabled people.

James Downar, a specialist in critical care at The Ottawa Hospital and a drafter of the triage plan who sits on the province’s bioethics table, said the online calculator is no different than the paper version that doctors can also use under the protocol.

He said using a scoring system, such as the clinical frailty scale, to evaluate patients is meant to limit the scope of a doctor’s subjective judgements or bias, in order to try to ensure everyone is treated equally. The protocol, he said, is focused on a patient’s risk of mortality at 12 months, not whether they have a disability.

“None of us want to be in a triage scenario,” Dr. Downar said.

“The purpose of a triage system is to reduce the number of preventable deaths and reduce the number of people who are denied critical care.”

Dr. Downar said he believed it would be best to make the triage plans public.

A spokeswoman for Ontario Health Minister Christine Elliott referred questions about the protocol to Jennifer Gibson, the cochair of the government’s bioethics table and director of the University of Toronto Joint Centre for Bioethics.

Dr. Gibson said the bioethics table has been in discussions with the Ontario Human Rights Commission on addressing its concerns with the triage protocol.

She also said the table has previously recommended an open public consultation on the triage issue – but that the government had so far not acted on this idea.

“We provide advice. And that advice may be taken or it may not be taken,” Dr. Gibson said.

Even with ICUs at a tipping point, Dr. Gibson said she didn’t think it was too late to start a more open discussion of the issues at stake, to build public trust.

Earlier this month, the chief commissioner of Ontario’s Human Rights Commission, Ena Chadha, wrote to Ms. Elliott to reiterate concerns about the protocol, the potential for discrimination against the disabled and a lack of consultation and transparency around it. Ms. Chadha and other groups have been at odds with the government over the issue since last March.

“We have to develop a framework that is equitable, with human-rights considerations being paramount. Which means it can’t be built on ageist or ableist notions, or assumptions about quality of life,” she said. “This is the problem.”

Michael Warner, the head of critical care at Michael Garron Hospital in Toronto’s east end, said ICU doctors have been familiarized with the emergency triage protocol – even though the government says it remains unapproved – and that committees at hospitals across the province to oversee it have been set up. He held up a paper triage form in a Twitter video on Friday, urging Premier Doug Ford to tighten public-health measures.

He also criticized the government for so far declining to say it would, if needed, issue an order to override Ontario’s health care legislation and allow for the withdrawal of lifesaving care from patients already in the ICU who are unlikely to survive. Under the plan as it stands now, only new patients would face ICU triage.

It’s unclear, Dr. Warner warned, how the plans would roll out in what would be an unprecedented crisis.

“This could be battlefield medicine,” he said. “We may end up having to improvise.”

 The Globe and Mail February 7, 2021

Originally posted at https://www.theglobeandmail.com/canada/article-ontarios-life-and-death-emergency-triage-protocol-remains-a-work-in/

News

Ontario’s life-and-death triage protocol still in progress

By JEFF GRAY

Staff

If a third wave of COVID-19 overwhelms Ontario hospitals, and intensive care units run out of beds, the province’s doctors could be forced to make previously unthinkable decisions about who gets access to life-saving treatment. Precisely how they would do that remains largely under wraps even as concern mounts about the spread of more contagious new variants of the virus.

Ontario has cancelled procedures, added beds and helicoptered patients from hotspots to less-crowded hospitals to avoid the worst. But its contingency planning for how doctors would cope with an uncontainable COVID-19 surge has occurred largely behind closed doors. That has raised alarms with disability rights activists and the Ontario Human Rights Commission, who warn hospital triage protocols must guard against discrimination.

Meanwhile, some doctors say a draft “emergency standard of care” distributed to hospitals last month – but not publicly released – does not go far enough.

They say it lacks a grim but necessary provision: The power to unplug patients who are unlikely to survive from life support without consent to make room for those with a better chance.

Not allowing this kind of triage, some doctors argue, could create a kind of first-come, firstserved system, in which patients who might have lived are denied access to scarce ICU beds because others who have little hope already occupy them. More people, they say, would end up dying.

The problem is a legal one. In Ontario, removing life support without the consent of the patient or their next of kin or designated decision maker has been barred since the Supreme Court of Canada decision ruled in 2013 that the province’s Health Care Consent Act applies to both providing and withdrawing care.

The decision did not affect other provinces.

Quebec’s triage protocol, which has been made public, would allow doctors to apply a set of criteria to remove patients from life support without consent if needed. Other jurisdictions, including New York, have had to invoke triage protocols, formal or informal, to deal with tidal waves of COVID-19 cases.

Ontario’s COVID-19 bioethics table, made up of critical-care doctors and academics, recommended in a September “framework” document that the government issue an emergency order “related to any aspect [of the triage plans] requiring a deviation from the Health Care Consent Act.” It also called for an order to provide liability protection for doctors. The document laid out the principles for triaging patients in a COVID-19 surge.

In response to inquiries from The Globe and Mail, Ontario’s Ministry of Health said in a statement that an emergency order, which would need cabinet approval, “is not currently being considered.” It also said it had not yet officially approved any triage protocol and that the bioethics table would continue to discuss the proposals with “stakeholder groups.”

The draft emergency standard of care distributed to hospitals would classify new patients needing life support based on how likely they are to survive for 12 months. But those already inside the ICU, no matter how small their chance of recovery, would stay put.

Michael Warner, the head of critical care at Michael Garron Hospital in Toronto’s east end, said the government has to issue an emergency order to fix an unfair triage plan that would leave more people dead. But he said he realizes politicians would rather not confront the issue before it is necessary: “I understand that this is a nuclear football for any government.”

Last month, with more than 400 COVID-19 patients in ICUs across the province, hospitals raised frantic alarms. But with the recent slowdown in infections, numbers have declined.

On Friday, the province said it had 325 patients in its ICUs with the virus.

Critics say Ontario is wrong to keep the life-and-death deliberations quiet. Disability rights activists obtained leaked copies of the framework and the proposed standard of care and posted them online. Neither of the cochairs of the bioethics table responded to requests for comment for this article.

“That’s just the way Doug Ford likes to do things, behind closed doors, and in secret,” Opposition NDP Leader Andrea Horwath said. “But on something like this, literally life-and-death decisions … there’s just no excuse to not make these kinds of policy decisions the result of massive engagement with Ontarians.”

Disability rights activists say the current proposal would discriminate against the disabled.

Some hold that doctors should never remove a patient from life support without consent.

“That is a point that we shouldn’t have to get to,” said Mariam Shanouda, a lawyer with the ARCH Disability Law Centre, who argues the government must do more to ensure such drastic measures are never needed.

David Lepofsky, a lawyer and chairman of the Accessibility for Ontarians with Disabilities Act Alliance, said the triage protocol lacks an arm’s-length process to appeal decisions, which doctors say is not compatible with acting quickly in a crisis. He also questions the government’s legal authority to issue an emergency order that would allow doctors to remove a patient from life support without consent.

“Any doctor that would consider doing this, I hope they’ve got a lawyer,” Mr. Lepofsky said.

Andrea Frolic, an ethicist and the director of the medical assistance in dying program at Hamilton Health Sciences, who served on the bioethics table until last September, said no protocol is perfect, but the current draft includes safeguards and is designed to protect human rights.

It focuses on the individual patient’s risk of dying, she said, not any disability.

Dr. Frolic said the government needs to assure ICU doctors that the protocol and an emergency order are in place long before infections begin to spike again, so that doctors – and the public – are prepared: “That’s not necessarily something that can turn on overnight.”

The Lawyer’s Daily February 8, 2021

Originally posted at https://www.thelawyersdaily.ca/articles/24331/research-project-seeks-to-understand-covid-19-justice-barriers-for-people-who-live-with-disabilities

Research project seeks to understand COVID-19 justice barriers for people who live with disabilities

Researchers at a western Canada university have embarked on studies into how measures to combat COVID-19 have impacted access to justice for Ontarians with disabilities living in care centres and people with mental disorders in British Columbia’s prisons and psychiatric facilities.

Thompson Rivers University (TRU) law professor Dr. Ruby Dhand is one of the researchers who in January launched the two projects. Each is being run in collaboration with various legal and advocacy groups. The goal, to use legal and scientific research to promote legislative change.

The Ontario project, Dhand told The Lawyer’s Daily, will also involve a TRU science professor and a law professor from the University of Windsor and will be run in collaboration with the Toronto-based ARCH Disability Law Centre (ARCH).

According to a description on a TRU webpage, the project will examine “COVID-19 barriers to justice for those who live with disabilities in these congregate care settings,” such as long-term care homes, group homes and assisted living facilities.

Dhand said restrictions put in place to combat the health crisis have resulted in a lack of care, community supports and “communication devices,” as well as fallout from visitor bans and reductions in standard services.

“We’ve recognized that people with disabilities, as this pandemic has evolved, who are living in congregate care settings … have really been disproportionately impacted,” said Dhand. “It’s become clear that over 80 per cent of these COVID-19 related deaths have occurred in these long-term care facilities. … They are experiencing complex forms of discrimination.

“[The] purpose of this research to highlight those voices, because this will be a quotative, multidisciplinary research project. … We recognize that, throughout this pandemic, the voices of people with disabilities have really be silenced, and it doesn’t seem like they’ve been prioritized.”

Dhand also talked about the controversial emergency “triage” protocol put together by the province, which would reportedly allow doctors in intensive care units to decide who gets a bed and who doesn’t in the event hospitals become overwhelmed by the health crisis.

“A clear access to justice issue has also been Ontario’s triage protocols,” Dhand said. “As a result of the triage protocols, a person with a disability will be deprioritized. The protocols state that they will be deprioritized for a ventilator [if their] future quality of life is determined to be poor because of their disability. So, disability advocates have raised concerns about the discriminatory impact of the triage protocols on people with disability in congregate care settings. … Access to health care is an access to justice issue.”

In January, ARCH issued a statement about possible temporary suspensions to Ontario health-care legislation that “would effectively permit doctors to withdraw treatment from a patient without the consent of the patient or family” if hospitals end up having “more patients than resources.” This would accompany the province’s triage protocol, ARCH goes on to state.

The Accessibility for Ontarians With Disabilities Act Alliance recently said that such a thing would be like “recklessly tap-dancing in a constitutional minefield.”

Dhand hopes the research she and the others conduct will help prompt legislative change.

“This proposed partnership comes at a critical moment in ARCH’s advocacy efforts, and we want to be able to help; we want to be able to have this research create disability-informed responses to the pandemic and post-pandemic planning.”

Turning to the second research project, Dhand says this B.C.-based initiative is examining COVID-19 transmission risks and barriers to justice for those being detained in the province’s mental health facilities, prisons and detention centres.

It is in collaboration with a number of community organizations, including the West Coast Justice Society and the Elizabeth Fry Society.

“People with mental health and substance use issues who are in mental health facilities and prisons and detention centres have an increased potential of death,” said Dhand. “They experience much higher likelihood of getting COVID-19 because these are congregate care facilities, where people live in crowded and confined spaces with high transmission risk. And there is also a lack of resources [and] a lack of [personal protective equipment]. And people with mental health and substance use issues have already pre-existing health issues and vulnerabilities.”

Dhand said they can also “experience consent and capacity issues” and, in some cases, “may not even understand what the public health measures mean.”

She also cites “a lack of community-based care and diversion options” and an increase in the use of solitary confinement and lockdowns since the start of the pandemic.

Both projects will run for up to two years, Dhand said.



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Come to a March 9, 2021 Virtual Town Hall on Helping Stop Toronto from Allowing Electric Scooters that Endanger People with Disabilities, Seniors, children and Others


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/

Come to a March 9, 2021 Virtual Town Hall on Helping Stop Toronto from Allowing Electric Scooters that Endanger People with Disabilities, Seniors, children and Others

March 5, 2021

            SUMMARY

We’ll have more news to report to you over the coming days about the disability community’s campaign to protect Torontonians with disabilities and indeed all of us from the injuries and accessibility barriers that would be suffered if Toronto wrongly decides to allow electric scooters (e-scooters). Here is just some of the latest news.

  1. On Tuesday, March 9, 2021 at 5 pm EST, CNIB is hosting a virtual public forum to talk about the dangers that e-scooters pose to people with disabilities and others, and to give you ideas on how to help oppose e-scooters. The announcement, set out below, tells you how to take part. Please sign up. While it says it focuses on the dangers to people with vision loss, everyone is welcomed, regardless of their disabilities. We are in it together.
  1. Please encourage everyone to watch our captioned 15 minute video on how to help us get Toronto to reject the idea of allowing e-scooters. The video is available at https://www.youtube.com/watch?v=PDdTJt9NK14&feature=youtu.be We have gotten so much great feedback on it.
  1. It is illegal to ride an e-scooter in Toronto in public spaces like roads, bike paths, and sidewalks. Despite that, some people are buying e-scooters, and then riding them in public. Toronto’s law enforcement need to enforce the law, to protect the public.

The February 24, 2021 Toronto Star included an article reporting on stores that sell e-scooters. It is set out below.

That article quotes AODA Alliance Chair David Lepofsky to the effect that police should enforce the ban on riding e-scooters.

Not addressed in this article, in a breathtaking example of trying to capitalize on illegal use of e-scooters, some e-scooter corporate lobbyists argue that because there are some people buying e-scooters and riding them illegally, the City of Toronto should allow rental of e-scooters. Yet two wrongs don’t make a right. There are assaults going on in our society, contrary to the law. The solution is not to legalize assault.

Stay tuned for more on this issue. For more background, read the AODA Alliance‘s February 22, 2021 brief to the Toronto Accessibility Advisory Committee. Visit the AODA Alliance e-scooters web page.

            MORE DETAILS

CNIB Announcement of March 9, 2021 Virtual Public Forum on How to Fight Against Electric Scooters

The Dangers of Electric Scooters Town Hall

Date: March 9, 2021

Time range: 5:00 pm – 6:00 pm

CNIB has partnered with David Lepofsky of the AODA Alliance (Accessibility for Ontarians with Disabilities Act Alliance) for a special meeting on the issue of e-scooters and their dangers to the low-vision/blind community. Join us as we discuss how we can all take action to ensure Toronto leaves in place the ban on electric scooters.

This meeting runs via Zoom web conference on March 9 from 5 to 6 p.m. Eastern Time. Call in information will be given upon registration.

Please be advised that you must register for all programs. We kindly ask you to RSVP a minimum of 1 full business day before the start of the program.

Registration required. To register for this meeting, please contact Neisha Mitchell, Coordinator Advocacy and Outreach at

[email protected] or call 416- 525-7951

Toronto Star February 24, 2021

Originally posted at https://www.thestar.com/news/gta/2021/02/24/e-scooters-are-selling-fast-in-toronto-retailers-report-the-catch-theyre-illegal-on-city-streets.html

E-scooters are selling fast in Toronto, retailers report. The catch: they’re illegal on city streets |

Barry Nisan, owner of Epic Cycles on Dundas Street West, says e-scooter owners need to respect the law and other road users. “If people are riding on the sidewalk, they shouldn’t be,” he says.

By Ben Spurr

Transportation Reporter

In an article posted to its website last month,

a company called TekTrendy outlined the “key benefits of using e-scooters in Toronto in 2021.”

The electric-powered kick-style scooters “help save time, save money and make travelling more fun,” according to the Toronto-based company, which is just

one of a number of retailers selling e-scooters in the city and whose site lists four models for sale, ranging in price from $699 to $1,099.

“Many of our customers happily use their scooter to commute to the nearest TTC (stop),” the company reported.

There’s just one catch: in Toronto in 2021, it’s illegal to ride e-scooters on city streets, sidewalks, bike lanes, trails, or virtually any other public place. (TekTrendy’s website does advise customers to check the regulations in their area).

The devices are allowed on private property, however, and it’s not illegal to sell them. That grey area has helped foster a growing retail trade that’s troubling to critics who warn e-scooters pose a safety risk. “It is a loophole that needs to be investigated,” said Councillor Kristyn Wong-Tam (Ward 13, Toronto Centre).

She chairs the Toronto Accessibility Advisory Committee, which opposes legalizing e-scooters on the grounds the near-silent vehicles can harm blind people and others with accessibility challenges if they’re ridden or parked on sidewalks. “Unless somebody has a very large backyard that’s paved over that they plan to exclusively use that e-scooter in, there’s a very good chance that they’re going to take it out” on public streets or sidewalks after they buy it, “and none of that is permitted,” she said.

She acknowledged that outright banning their sale in Toronto may not be the best solution, because a prohibition could easily be circumvented through online retailers. The committee is set to debate e-scooters Thursday.

TekTrendy didn’t return requests for comment. It’s far from the only company selling e-scooters in Toronto, however. A handful of independent retailers offer them, and Canadian Tire lists at least six models available at its Toronto locations.

Barry Nisan, owner of Epic Cycles, said demand for e-scooters is growing fast. He recently opened a new location in Toronto’s Junction neighbourhood, in addition to his flagship store in Vaughan (where officials say e-scooters are also barred from public roads). His shops primarily sell electric bicycles,

but he said sales of e-scooters have quadrupled every year since he started stocking them about four years ago. He estimates Epic sold close to 500 of them last year.

Nisan said he informs customers e-scooters aren’t permitted in on Toronto roads. Asked whether it’s responsible to sell vehicles that aren’t allowed on public rights-of-way, he said e-scooter owners need to respect the law and other road users. “If people are riding on the sidewalk, they shouldn’t be. The same as you shouldn’t be riding bicycles on the sidewalk,” he said.

He predicted authorities will soon allow e-scooter use more widely. “We’re excited about it. We think it’s a great solution to commute and travel, and for getting out and having fun,” he said.

Last year the Ontario government took a step toward legalization by launching a five-year e-scooter pilot project. To take part, municipalities have to pass bylaws setting out where the vehicles are permitted. Ottawa has opted in and is reporting positive results so far, but Toronto has yet to take part

despite a flurry of lobbying from e-scooter companies at city hall.

Last June, a city staff report said e-scooters had the potential to be a convenient, low-cost transportation alternative, but it also flagged concerns about safety, lack of enforcement resources, and legal liability.

According to the city, research from Europe shows scooter riders are four times more likely than bicyclists to injure others. Because e-scooters aren’t covered by insurance providers, staff warned accident victims will sue the city if they get hurt.

E-scooter companies dispute research that says the vehicles, which under provincial rules must top out at 24 km/h, are unsafe, and argue they’re no more dangerous than bikes.

The city report recommended Toronto consider joining the provincial pilot if staff concerns could be addressed, and set a tentative date of May 2021 for opting in. But last July council members voted to refer the matter back to staff for more study. They’re expected to report back in April.

In the meantime, it’s not clear to what extent the city is enforcing the current ban on e-scooters in public places. A spokesperson for the Toronto Police

said she couldn’t immediately provide details of e-scooter enforcement.

David Lepofsky, chair of the Accessibility for Ontarians with Disabilities Act Alliance, said “the police need to vigorously enforce the ban on (e-scooters) now.”

City spokesperson Diane Morrison said city staff are aware “some residents (are) using e-scooters illegally” and “we are monitoring those uses.” She said

the city recommends retailers “properly inform their customers of the status of the use of e-scooters on public roads.”

Ben Spurr is a Toronto-based reporter covering transportation. Reach him by email at

[email protected]



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CBC Program Reveals Disturbing Fact that, Far From Objective Scientific Decisions, Ontario Critical Care Triage Could Involve Doctors Guesstimating and Improvising When Deciding Which Patients Should be Refused Life-Saving Critical Medical Care They Need – And Other News on The Triage Issue


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/

CBC Program Reveals Disturbing Fact that, Far From Objective Scientific Decisions, Ontario Critical Care Triage Could Involve Doctors Guesstimating and Improvising When Deciding Which Patients Should be Refused Life-Saving Critical Medical Care They Need – And Other News on The Triage Issue

January 25, 2021

            SUMMARY

The controversy keeps swirling around the Doug Ford Government’s secretive handling of the life-and-death question of who will be refused life-saving critical medical care if those services must be triaged or rationed, and the danger of disability discrimination, because the Government did not ensure sufficient hospital services for all who need them. Here are the three newest developments on this front.

  1. The Friday, January 22, 2021 edition of CBC Radio’s health program, “White Coat Black Art” was devoted to the topic of how decisions will be made over who lives and who dies if the COVID-19 pandemic leads hospitals to have to ration or triage life-saving critical medical care. In his introduction, typically written after interviews were recorded, Dr. Goldman described how hospital case loads are growing, and stated:

“Last week, hospitals in Ontario were given ICU (i.e. Intensive Care Unit) triage protocols from the Ministry of Health. A similar document was given to hospitals in Quebec earlier this month. These documents, which are backed by science, tell doctors how likely patients are to live or die, if they are admitted to the ICU.”

Yet there is ample room from our own investigations and from Dr. Goldman’s interview that followed to question how much the Ontario triage protocol is “backed by science”, as opposed to a dangerous mirage of science that disguises the palpable danger of disability discrimination. Far from objective science, this program shows that triage decisions over who lives and who dies can be potentially expected to include doctors guestimating and improvising. Doctors and medicine do not have provably objective and reliable tools for predicting whether a critical care patient is likely to live beyond the next year.

This is proven by Dr. Goldman’s first guest on his program, Dr. Michael Warner, the Medical Director of Critical Care at Toronto’s Michael Garron Hospital. Describing how the January 13, 2021 triage protocol would work, he stated in part:

“What’s different now is we have to essentially guesstimate what would happen a year from now.” He explained that this is not how treatment decisions are now made, and that doing this would be “very difficult to do…” because doctors will be very busy caring for patients, and not all patients will have this protocol. This head of a Toronto hospital’s ICU said candidly that he is not sure how they would action this in real life “because it’s a policy on paper…”

Dr. Goldman asked Dr. Warner how confident he is that emergency doctors can use these new rules accurate in a chaotic and stressful environment like an emergency room. Dr. Warner responded in part:

“…so it’s hard to know how we would be able to effectively use a tool that’s written on a piece of paper, where two doctors have to verify someone’s mortality risk and then decide on what to do, if there are patients everywhere, you know, potentially dying. You know, I think we need something written down on paper, so that all these stakeholders can review it and provide their input, but at the end of the day, if we ever have to use it, we may have to improvise..”

It is very good that this program addressed this topic. However, this program’s content was utterly lacking in desperately-needed and fundamental journalistic balance. The program’s host, Dr. Brian Goldman, only interviewed doctors, but no one from the disability community who have been raising serious concerns about disability discrimination.

That flew in the face of the program’s weekly opening line, which proclaims “Welcome to White Coat Black Art, the show about medicine from all sides of the gurney.” Contrary to its stated prime directive, this edition of that program took a selective look at this important issue from only one side of the gurney, that of the doctors. We have been reaching out to Dr. Goldman for months to cover the disability discrimination concerns with Ontario’s critical care triage protocol. The need for such was even flagged for the program by one of its two guests, Dr. Warner. In the only brief reference to disability perspectives on this entire program, Dr. Warner commendably stated on his own initiative:

“…I think that disability and other advocates should definitely educate us on how this policy may not meet the needs of all patients so that it could be fair and equitable…”

CBC knows well about disability community advocacy on the triage issue. This is even more troubling given the difficulty we and the disability community have had for months in getting the media to cover this issue, which has been looming throughout the pandemic.

  1. Today, Ontario’s New Democratic Party commendably made public a letter sent by NDP Leader Andrea Horwath and NDP Disabilities Critic Joel Harden to Ontario Health Minister Christine Elliott. Set out below, that letter asks the Government to answer vital questions on this life-and-death issue which the Government has not answered to date. We thank the NDP for publicly asking these questions, and for endorsing the concerns on this issue that the AODA Alliance has been raising from the perspective of people with disabilities. We urge the Ford Government to end its protracted secrecy on this topic, and provide full and prompt answers.
  1. The January 23, 2021 edition of the National Post included an extensive article on this issue, also below. It quoted AODA Alliance Chair David Lepofsky on some of our many concerns with the Government’s January 13, 2021 triage protocol.

We spelled those concerns out in the AODA Alliance’s January 18, 2021 letter to Health Minister Christine Elliott within days of receiving a leaked copy of that previously secret critical care triage protocol.

There have now been 725 days, or over 23 months, since the Ford Government received the ground-breaking final report of the Independent Review of the implementation of the Accessibility for Ontarians with Disabilities Act by former Ontario Lieutenant Governor David Onley. The Government has announced no comprehensive plan of new action to implement that report. That makes still worse the serious problems facing Ontarians with disabilities during the COVID-19 crisis, that we have been trying to address over the past eleven months.

For more background on this issue, check out:

  1. The new January 13, 2021 triage protocol which the AODA Alliance received, is now making public, and has asked the Ford Government to verify. We have only acquired this in PDF format, which lacks proper accessibility. We gather some others in the community now have this document as well.
  1. The AODA Alliance’s January 18, 2021 news release on the January 13, 2021 triage protocol.
  1. The panel on critical care triage, including AODA Alliance Chair David Lepofsky, on the January 13, 2021 edition of TVO’s The Agenda with Steve Paikin.
  1. The Government’s earlier external advisory Bioethics Table’s September 11, 2020 draft critical care triage protocol, finally revealed last month.
  1. The AODA Alliance website’s health care web 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.

            MORE DETAILS

 January 22, 2021 Letter to Ontario Health Minister from Ontario New Democratic Party

Ministry of Health

5th Floor

777 Bay St.

Toronto, ON M7A 2J3

January 22, 2021

Dear Minister Elliott,

We are writing to you regarding the critical care triage protocol for Ontario hospitals in case of a major COVID-19 surge. With the latest modelling showing that ICUs may be full by early February, the prospect that doctors will have to make life and death decisions about who receives critical care and who doesn’t is not just hypothetical, it could become a reality.

On January 18, we obtained and made public a document dated January 13 written by the COVID-19 Critical Care Command Centre and issued to hospitals. It provides guidance on how hospitals should triage ICU patients in the awful event that emergency rooms are overwhelmed by COVID cases.

Disability rights organizations, including the AODA Alliance, have raised important concerns with the document. Firstly, that it was drafted in secret without the government consulting directly with disability organizations. Second, that it opens the door to discrimination on the basis of disability in the allocation of life-saving care. Finally, it does not offer patients a right of appeal outside the healthcare system, either to an independent tribunal or a court.

Instead of addressing these substantive concerns, we were puzzled by a Ministry of Health spokesperson distancing your government from the document altogether. The Ministry maintains that it is not a triage protocol, despite the fact that it lays out how hospitals should triage critical care patients. Your spokesperson also claimed that the document was “not approved or endorsed by the Ministry of Health”, even though it was authored by the Critical Care Command Centre your government created.

To this end, we would like you to answer the following questions: Your government says it has not approved the January 13 triage protocol, but it is in doctors’ hands right now. Will you rein in any bodies claiming to instruct hospitals on triage, and revoke the January 13 protocol?

The National Post has reported that the government’s Bioethics Table recommended temporarily suspending the law which requires patient or family consent before life-sustaining treatment is withdrawn from a critical care patient. Is your government considering this and if so, will you immediately publicize any regulations or legislation under consideration for public discussion about this life and death matter?

The Premier promised “complete transparency” at the start of this pandemic but Minster, your government’s approach to clinical triage has been anything but transparent. The public has a right to know what hospitals are being told to do in the event of a major COVID surge, who is telling them to do so, and to be consulted so that any protocol respects the human rights of all Ontarians, particularly those with disabilities.

We look forward to your response.

Sincerely,

Andrea Horwath                                                                                Joel Harden

Leader of the Official Opposition                                                      MPP, Ottawa Centre

 National Post January 23, 2021

A plan of last resort: Choosing who lives and dies if ICUs are overrun; Random selection

Graphic: Nathan Denette, The Canadian Press / If hospitals become overwhelmed, doctors will be asked to make impossible decisions that in normal times would be anathema to their training.

It’s not quite drawing names from a hat.

But if COVID-19 pushes hospitals to crisis levels, Ontario hospitals have been instructed that, when faced with tiebreaking situations – one empty bed in the ICU, and two, four or more critically sick people with more or less equal chances of surviving competing for it – random selection should be applied.

Each person would be assigned a number. The administrator on call would enter the numbers in a random number generator like random.org, and then click the “generate” button.

“Randomization is efficient when decisions need to be made rapidly,” reads a critical care rationing plan prepared for Ontario hospitals designed to help doctors decide who should get access to beds, intensive care or ventilators in the event of a catastrophic COVID-19 surge. Randomization avoids power struggles between doctors, the document continues. It eliminates explicit or unconscious bias and, critically, reduces the moral and psychological burden of deciding whom, ultimately, wins the bed. Who gets a chance at living.

It may sound dystopian and dehumanized. But far worse than a random number generator would be a human being having to choose, said Dr. Judy Illes, a professor of neurology at the University of British Columbia. “Because the people who have to administer those decisions are hugely at risk for moral distress and trauma.”

Doctors in Canada have never faced critical care rationing. There is no historical precedent. If hospitals become overwhelmed, doctors will be asked to make impossible decisions that in normal times would be anathema to their training.

And while thousands of people aren’t getting the timely care they need – knee surgeries, hip replacements, the start of new experimental drug regimes, because of backlogs when hospitals shut down to all but urgent care – most people in Canada have never had to worry about getting rationed for life-saving care.

Critical care triage protocols, like those now being distributed to Ontario and Quebec hospitals, are formed from lessons learned in battle fields and natural disasters. “But it will be no less heart-wrenching in this situation, and maybe even more so,” because the decisions will be taken in urban hospitals, Illes said, not in fields with grenades going off.

“It’s not a question of will the public cooperate? The public will have no choice,” said Illes, who warns that our autonomy will be eroded if we don’t take better control of the situation.

Nothing is fair about COVID-19, Illes and UBC political science professor Max Cameron wrote in April, and now, nine months out, aggressive mutations are spreading. Hospitalizations and deaths are increasing. An average of 878 people were being treated in ICUs each day during the past seven days. Healthcare workers are frightened, anxious, exhausted. Social distancing is slipping, Peter Loewen reported this week in Public Policy Forum; and most Canadians won’t be vaccinated until the end of September. Ten months into the pandemic, “and there are 10 months to go,” wrote Loewen, a political science professor at the University of Toronto. “This is halftime.”

Meanwhile, Ontario surpassed 250,000 confirmed infections, Quebec a breath away from the same grim mark, and while Quebec’s health ministry told the National Post Friday the province is still a long way from triggering its ICU prioritization protocol, doctors are nervously looking at the U.K, where a new variant is turning some hospitals into “war zones.”

“We want to avoid being patients,” Illes said. “We want to exercise our autonomy to help everyone get through this viral war that we’re in and that we’re not winning right now.”

If people don’t double down on distancing and masking and other precautions, choice will no longer be relevant, she said. “Procedures will take over; protocols will supersede choice. And the focus will be on this public-centred approach, maximizing the most good for the most number of people.”

The Ontario ICU triage protocol, used as a model for triage protocols adopted in Quebec, prioritizes those with the greatest likelihood of survival. (It applies to adults only, not children). People who have a high likelihood of dying within 12 months of the onset of their critical illness would be assigned lower priority for critical care. Doctors would score each person on a “short-term mortality risk assessment,” and across a whole range of different conditions – cancer, heart failure, organ failure, trauma, stroke or severe COVID-19 – ideally before they are intubated, connected to a ventilator. It aims to reduce “preventable deaths to the degree possible” under major surge conditions, with the “least infringement of human rights.” Consultant doctors would be available 24/7 to provide a timely (within the hour) estimate of a person’s survival, “recognizing that such estimates may not be perfect,” but likely more accurate than non-expert judgment. In the final “summary and care plan,” one of two boxes would be checked: the patient will, or will not be offered critical care. Those who don’t meet “prioritization criteria” won’t be abandoned. They’ll receive appropriate medical therapy and/or comfort care.

Most controversially is what is not included in the current plan – a recommendation before the Ontario government that life-support be withdrawn from people already in the ICU whose chances of survival are low, if someone with better prospects is waiting behind them.

The Post reported this week that Ontario Premier Doug Ford’s government is being asked by its external advisory COVID-19 Bioethics Table to pass an “executive order” that would permit doctors, without the consent of patients or families, to remove breathing tubes, switch off ventilators and withdraw other life-saving care from people who are deteriorating, and where further treatment seems futile, so that someone who otherwise might live can take their place.

Withdrawing treatment from someone who hasn’t consented to it could be argued to be culpable homicide, said disability rights advocate David Lepofsky. “There are huge legal questions here, and they need to be discussed in the open, because we’re talking about possibly taking an active action that could accelerate someone’s death,” he said.

“The government can’t decide on who lives and who dies by a memo, written in secret, with no debate in the legislature.”

Under normal conditions, withdrawing treatment without consent would be an “illegitimate choice,” Annette Dufner, of the University of Bonn, wrote in the journal Bioethics. Even in a pandemic, doctors might risk legal charges.

“At the same time, it is by no mean obvious that patients already under treatment in a setting of scarcity have the same moral claim on the respective medical resources they would normally have,” Dufner wrote. When scarce, “the use of resources can, after all, come at the cost of other patients’ lives.”

Any suspension of the consent act would be temporary, said Dr. James Downar, a member of Ontario’s Bioethics Table “And, to be super clear: if there are enough resources for everybody, this never happens.”

Outside the horror of having to choose, even the practicalities of deciding who gets an ICU bed and who should be “discharged” – the dispassionate euphemism for stopping intensive care – “these kinds of equitable, distributive justice kinds of decisions are very, very complicated,” said Dr. Peter Goldberg, head of critical care at Montreal’s McGill University Health Centre.

And how will patients, and families, be told that, “by virtue of this decree” you will, or will not, receive life-saving care? “I don’t know how it’s going to be done,” Goldberg said. “No one has ever done this.”

“Families will presumably have heard about this, from the press. But they may not. They may think this is science fiction. They may go to the courts, and I don’t know what the courts are even going to say in this case.”

Goldberg has never had to take community needs, values or resources into consideration when caring for the critically ill. “Never. Zero. When I have discussions with patients and families, my perspective is always deontological,” what’s best for the person lying in that hospital bed. That “duty to the patient” is now being supplanted by a utilitarian view that says we need to rescue the most lives, he said.

“I understand it, intellectually. But from a physician point of view that I was taught all these years, and from my own personal perspective, it’s just anathema.”

He takes comfort that admissions to his hospitals are coming down. He’s hoping it’s a trend. “The kids went back to school in Quebec yesterday, the high schoolers. The epidemiologists are telling us we may see a blip in 10 days or two weeks if schools really are a reservoir.”

“We’re waiting. We’re not putting our cards away. But we can’t get far enough away from this.”

Triage protocols, medically-guided protocols that are blind to disability, socio-economic status, cultural origin, are the only way to manage and mitigate the moral distress facing the people who will have to enact them, Illes said. “At the end of the day, it is physicians on the front line in the ICU with blood flowing on the floor who will bear the burden of decision-making.”

“How do we protect families from moral distress? I don’t know. No protocol is going to help anyone to understand that the people who cared for their loved person weren’t able to take the last-mile possible saving procedure,” she said.

“Let’s try to avoid ever going there.”

National Post

Sharon Kirkey



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Even More Reason to Worry About Secret Ontario Plans Regarding Rationing or Triage of Life-Saving Critical Medical Care Is Revealed in Two Newspaper Articles and a Letter Secretly Sent to Ontario Hospitals


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/

Even More Reason to Worry About Secret Ontario Plans Regarding Rationing or Triage of Life-Saving Critical Medical Care Is Revealed in Two Newspaper Articles and a Letter Secretly Sent to Ontario Hospitals

January 22, 2021

            SUMMARY

We today share more media coverage on the Ford Government’s frightening plans for deciding who will be refused life-saving critical medical care they need, if the out-of-control COVID-19 pandemic forces the rationing or triage of critical care. More revelations give rise to more serious dangers facing Ontarians with disabilities and others if that eventuality arises – an eventuality that a key Government medical advisor Dr. James Downar described as being “close”, on the January 13, 2021 edition of TVO’s The Agenda with Steve Paikin.

We here set out two disturbing new news reports on this issue, and a letter addressed to Ontario hospitals by a member of the Ford Government’s Ontario Critical Care COVID Command Centre, Dr. Andrew Baker. Below you will find:

  1. A January 21, 2021 article in the National Post, which quotes AODA Alliance concerns, among others.
  1. A January 20, 2021 article in the Globe and Mail and, which also quotes AODA Alliance concerns, among others.
  1. An undated letter from Dr. Andrew Baker to Ontario hospitals, giving directions regarding the administration of critical care triage if it becomes necessary.

Before we set out those items below, we first explain the serious new concerns revealed here. These supplement our amply-documented major concerns with the Government’s plans and secretive planning that we have been making public over the past days, weeks and months.

For more background on this issue, check out the following:

  1. The new January 13, 2021 triage protocol which the AODA Alliance received, is now making public, and has asked the Ford Government to verify. We have only acquired this in PDF format, which lacks proper accessibility. We gather some others in the community now have this document as well.
  1. The AODA Alliance’s January 18, 2021 news release on the January 13, 2021 triage protocol.
  1. The panel on critical care triage, including AODA Alliance Chair David Lepofsky, on the January 13, 2021 edition of TVO’s The Agenda with Steve Paikin.
  1. The Government’s earlier external advisory Bioethics Table’s September 11, 2020 draft critical care triage protocol, finally revealed last month.
  1. The AODA Alliance website’s health care page, detailing its efforts to tear down barriers in the health care system facing patients with disabilities, and our COVID-19 page, detailing our efforts to address the needs of people with disabilities during the COVID-19 crisis.

            MORE DETAILS

More Terrifying News Hidden Behind a Fog of Unjustified Ford Government Secrecy

According to the January 21, 2021 National Post report set out below, the Ford Government’s external advisory Bioethics Table has recommended to the Health Ministry that the Ford Government pass an “executive order” that permits doctors to cut off life-saving critical care they have already started to administer to a patient, and which the patient needs, if critical care has to be rationed or triaged. By this, doctors would not just be told they can decide which patients in a line-up outside the intensive care ward will be allowed in, if there are too few beds for all patients in the lineup. More drastically, the doctors would also have the power to evict some patients from the intensive care unit, who were previously admitted, and give their beds and ventilators over to a patient or patients who are outside the unit, and waiting in the lineup to get in.

It is not clear to us that the Ontario Government can authorize this at all, much less by acting in secret to pass an “executive order”. On the January 13, 2021 edition of The Agenda with Steve Paikin, AODA Alliance Chair David Lepofsky raised the serious concern that for a doctor to do this could raise possible issues under the Criminal Code. We earlier raised a concern about this in the AODA Alliance’s December 17, 2020 letter to the Minister of Health Christine Elliott and in our December 21, 2020 news release. As with all our other letters to the Government on this issue, that letter has never been answered. No Ministry of Health officials ever discussed this with us.

Still worse, we are entirely unsatisfied that any such “executive order” (an American legal term) would be constitutional under the Charter of Rights and would be permissible under the Ontario Human Rights Code, especially in light of the serious disability discrimination at the core of the Ontario Critical Care COVID Command Centre’s January 13, 2021 triage protocol (addressed in detail in our unanswered January 18, 2021 letter to the Minister of Health). This shows with even greater clarity why it is wrong for the Government to leave the planning and execution of directions on this issue solely to physicians and bioethicist, who have no expertise in these important legal issues. The Ford Government should be leading a public debate on its plans, rather than cloaking it in secrecy and claiming it is all left to experts (i.e. doctors) talking to other experts (also referring to doctors). We doubt that the medical profession wishes to have the Government slough this all off on them.

This gives us serious grounds to fear that the Government may try to continue to hide from any public discussion of this issue until the last minute. It may be thinking about then secretly rushing through some sort of “executive order” or regulation behind close doors at the last minute, if it becomes necessary due to hospital overloads. We strongly urge that the Government not take such an approach. The consequences for Ontarians including Ontarians with disabilities are literally life-and-death. This requires any Government action to now be discussed and debated publicly.

Amidst this frightening news, it is noteworthy that the Bioethics Table’s September 11, 2020 report to the Ford Government said that doctors involved in triage decisions should be protected from liability. The opposite is the case. Anyone making such a life-and-death decision should not be immunized from responsibility and accountability for their conduct. No one is above the law.

Compounding this bad news is the erroneous claim in the January 20, 2021 Globe and Mail article, below, by Dr. James Downar, that says in substance that the Ontario triage protocol does not discriminate against patients with disabilities. The article, which describes Dr. Downar as the one who drafted the Ontario protocol, includes:

“Dr. Downar said the protocols “will not exclude people on the basis of disability. No iteration of the protocol would do that, and our protocols explicitly exclude it.””

The AODA Alliance, the ARCH Disability Law Centre and other disability advocates and experts last summer amply showed the Government-appointed Bioethics Table (of which Dr. Downar is a prominent member) that it would seriously discriminate against patients with disabilities for doctors to in any way use the “Clinical Frailty Scale’ when assessing any patient for possibly being triaged out of critical care services. Under the Clinical Frailty Scale as mandated in the January 13, 2021 triage protocol, in the case of a critical care patient age at least 65 with a progressive disease but who has more than six months to live, their likely mortality would be assessed in part by the number of activities of daily living that they can perform without assistance, having regard to each of these specific activities: dressing, bathing, eating, walking, getting in and out of bed, using the telephone, going shopping, preparing meals, doing housework, taking medication, or handling their own finances. The CFS is a clear illustration on its face of direct disability discrimination.

You can read what the AODA Alliance said in great detail on this in its August 30, 2020 written submission to the Bioethics Table. You can watch AODA Alliance Chair David Lepofsky explaining this to the Bioethics Table in his August 31, 2020 concluding presentation to that Table, which is available online as a captioned video. You can also read how the ARCH Disability Law Centre documented this disability discrimination in ARCH’s September 1, 2020 written submission to the bioethics Table.

Yet despite all of this advice, the Bioethics Table recommended use of the disability discriminatory Clinical Frailty Scale in some triage decisions. The January 13, 2021 triage protocol directs doctors to use it in some triage decisions. The fact that the January 13, 2021 triage protocol generally professes the need to respect the human rights of people with disabilities among others does not reduce that discrimination one iota.

It is clear from these two newspaper articles and from the January 13, 2021 edition of Agenda with Steve Paikin that Dr. Downar is now serving in effect as the key public defender if not its spokesperson of the Ford Government on this issue. It is important for the Government to make clear who is making decisions on this issue. We wrote and tweeted to Dr. Downar over a week ago to ask what involvement, if any, he has in the Ontario Critical Care COVID Command Centre.

He has not answered. We emphasized that our concern is not with any one doctor. We are concerned that the Ford Government open up and make public its secret internal actions and deliberations on this triage issue. We all have the right to know what is being planned, and who is doing all the planning and decision-making.

Finally, we are deeply troubled by the secret letter to Ontario hospitals from the Ontario Critical Care COVID Command Centre’s Dr. Andrew Baker, set out below. It shows that the Ford Government had sent an earlier secret draft critical care triage protocol to Ontario hospitals back on November 13, 2020. We were never shown that document. It was sent a mere 8 days after the Ford Government stated in the Legislature during Question Period on November 5, 2020 that it thought it unlikely that such a document would have to be sent to health professionals.

It is also clear from the letter below that the November secret 13, 2020 triage document had recommended that the triage protocol include some due process appeal opportunities for a patient who is to be denied life-saving critical care. We now know that that has subsequently been harmfully ripped right out of the January 13, 2021 triage protocol, to the serious detriment of patients fighting for their lives.

As we stated in the January 21, 2021 AODA Alliance Update, the Government is claiming that it has not approved any of these triage plans. If so, why is Dr. Baker or any other doctor or committee sending such instructions or directions to hospitals? Who is taking responsibility for this life-and-death issue?

The National Post January 21, 2021

Originally posted at https://nationalpost.com/news/canada/ontario-wrestles-with-who-gets-icu-treatment-in-event-hospitals-overwhelmed-with-covid-patients

Ontario urged to suspend need for consent before withdrawing life support when COVID crushes hospitals

Ontario is being asked to temporarily suspend the law requiring doctors get patient or family consent before withdrawing treatment from people facing a grim prognosis

Author of the article: Sharon Kirkey

The COVID-19 vaccine has started to be administered in Canada, but Ontario, Quebec and other provinces still need to prepare protocols to determine who should get critical care — and who should be left behind — in the event that hospitals become flooded with COVID patients. PHOTO BY CARLOS OSORIO/POOL/AFP VIA GETTY IMAGES

Canada’s Supreme Court ruled in 2013 that a major Toronto Hospital could not withdraw life-support from a minimally conscious and severely brain-damaged man without his family’s consent.

Now, in another sign of these extraordinary times, the Ontario government is being asked to temporarily suspend the law requiring doctors get consent of patients or families before withdrawing a ventilator or other life-sustaining treatment from people facing a grim prognosis, should COVID-19 crush hospitals.

The recommendation for an Executive Order to suspend the province’s Health Care Consent Act for withdrawal of treatment in the ICU, should the situation become so dire, comes as Ontario, Quebec and other provinces prepare protocols to determine who should get critical care — and who should be left behind — if hospitals are flooded with COVID patients.

The request, deeply disturbing to disability advocacy groups, comes from Ontario’s COVID-19 Bioethics Table, which is recommending that the province ensure “liability protection for all those who would be involved in implementing the Proposed Framework … including an Emergency Order related to any aspect requiring a deviation for the Health Care Consent Act.” The act requires doctors obtain agreement from patients, or their substitute decision makers, with disputes resolved by the Consent and Capacity Board, an independent tribunal.

This week, the Ontario Critical Care Covid Command Centre issued an “emergency standard of care” to prepare hospitals for the worst-case scenario, an Italy-like surge in demand for critical care. The over-arching objective, the document states, is to “save the most lives in the most ethical manner possible.”

A critical care triage should be considered an option of last resort, invoked only after all reasonable attempts have been made to move people to other hospitals where there is space and staff to care for them, and only for as long as the surge lasts, the document says.

The goal is to minimize deaths, minimize the risk of discrimination and “unconscious bias” against people with disabilities, racialized communities and other vulnerable groups, and minimize “moral injury and burnout” among staff forced to decide who may live and who may die.

According to the document, prepared on behalf of Ontario’s critical care COVID command centre, priority should be given to people with the greatest likelihood of surviving whatever it is that brought them to hospital — COVID-19, heart attack, liver disease, a bleed in the brain or other life-threatening illness. Those with a high likelihood of dying within 12 months from that critical sickness would receive lower priority for an ICU bed.

“It’s really important to be clear here — this is not about how long you’re likely to live, it’s not a life span question,” said Dr. James Downar, head of the division of palliative care at the University of Ottawa and a member of the Bioethics Table. “It’s your probability of being alive 12 months after developing critical illness.”

The protocol is meant to be applied to new patients, or people already in hospital whose condition is worsening. “We’re suggesting, out of a principle of fairness, the same approach should apply to people inside the ICU,” Downar said. “It would be unfair to treat people differently depending on the timing that they presented.”

“Nobody likes the idea of ever withdrawing life-support on somebody without their permission, without their consent,” Downar said. “But in a triage scenario, we’re talking about a scenario where the focus is no longer on the individual himself, but now on our population as a whole, and trying to maximize the number of people who will survive an overwhelming surge.”

Dr. James Downar: “We’re talking about a scenario where the focus is no longer on the individual himself, but now on our population as a whole.” PHOTO BY OTTAWA HOSPITAL RESEARCH INSTITUTE VIA CP

The document now being circulated to Ontario hospitals doesn’t include a provision for withdrawal of potentially life-sustaining treatment without consent. Instead, it says that ICU doctors should regularly reassess people admitted to ICU, and consider withdrawal of life support “through a shared decision-making process with SDMs (substitute decision-makers) if a patient does not appear to be improving.”

But Downar and other doctors said it’s not possible to operate a triage model in which all decisions are made with the consent and permission of people involved, because many people would simply opt out.

“We are going to say, ‘by the way, we are taking your family member off the ventilator in lieu of another patient who we feel has a better prognosis, given this pandemic condition. Do you agree?’ I think that if we did that we would not get consent. Nobody is going to give us consent,” said Dr. Peter Goldberg, head of critical care at Montreal’s McGill University Health Centre.

The Bioethics Table’s request is now before the Ontario Health Ministry. “We are hopeful that, as part of the state of emergency, should we need it, that there will be an executive order allowing us to withdraw,” Downar said

With an Executive Order in place, doctors could put off escalating triage and continue to offer intensive care to every person who might benefit, including borderline cases — “right up to the point that the critical care beds are literally full,” he said. ICUs could run at full capacity. Only then, as new patients come in who meet the triage criteria — a lower risk of death — and who need beds would ICU care slowly start to be withdrawn from people who aren’t responding and are least likely to, Downar said.

Without the Executive Order, triage would have to be started sooner, in order to reserve beds for people with a high likelihood of survival. Fewer people would be offered intensive care, and more people would die, Downar said.

“It’s difficult to imagine how troubling that would be, that we would actually have to suspend the consent act,” said Dr. Andrea Frolic, director of the Program for Ethics and Care Ecologies at Hamilton Health Sciences and a consultant to Ontario’s COVID critical care command centre.

“It would be a rare circumstance that we would have to resort to implementing a care plan that would not have the consent of the patient or substitute decision-maker,” Frolic said.

It’s not a life span question. It’s your probability of being alive 12 months after developing critical illness

But should hospitals become maxed out, with a massive surge of people coming through the doors who have a very high chance of survival, and people in the ICU who aren’t benefitting from critical care and who are highly likely to die — “if we don’t have the tool to provide equitable access to care, that will create a lot of distress on the system,” Frolic said.

It becomes a first-come, first-served system, she said — a car crash victim who needs surgery and a short ICU stay to save his life can’t get into the ICU, because he arrived after a person with end-stage cancer and COVID-related pneumonia who may not be likely to survive their critical illness, or weeks later. “That is a situation of inequity caused by fate, really, or chance. One person happened to get critically ill before another person.”

Withdrawing treatment without consent would be very rare, happen only after every effort to reach consensus with the patient and family has been exhausted, and only as a last resort, Frolic added.

Families who feel strongly could use all avenues of advocacy, she said. “The hope is that families will see what’s happening around them. You can imagine if we get to this level of surge, there are patients in hallways; there are patients in gymnasiums. My hope is that families will see their own patient deteriorating but will see the context that we’re in a public health emergency, that it’s not personal, it’s not what we wish to do, it’s a situation caused by the pandemic.”

Mariam Shanouda, a lawyer at ARCH Disability Law Centre in Toronto, said she was “flabbergasted” when told by the National Post about the prospect of an order to allow doctors to operate outside the consent act.

“This is literally life and death and to not only give doctors that power to operate outside (the act) but to insulate them from any liability whatsoever, that is not something to be taken likely,” Shanouda said.

“We don’t know the process by which these decisions will be made, who will be making the decisions to withdraw care. Is there going to be an appeal procedure whereby a family can challenge that decision? Is there going to be accountability?”

“There are huge legal questions here and they need to be discussed in the open because we are talking about possibly taking an active action that could accelerate someone’s death,” said David Lepofsky, chair of the Accessibility for Ontarians with Disabilities Act Alliance (AODA).

“If they were to amend the consent legislation, and if that were valid, and if it were constitutional and if it got around all the criminal law problems, what will that mean? It means if anybody goes to hospital and gets intensive care, they don’t have any confidence they’re going to be able to stay there,” Lepofsky said.

“They’ve got to lie there knowing not only are they fighting for their life, but they are also aware that, at any time, a doctor could decide their chances aren’t so good, somebody coming in has got better chances, ‘sorry, we’re pulling the plug on you.’”

Globe and Mail January 20, 2021

Originally posted at https://www.theglobeandmail.com/canada/article-how-doctors-in-quebec-ontario-will-decide-who-gets-care-if-coronavirus/

How doctors in Quebec, Ontario will decide who gets care if coronavirus hospitalizations continue to surge

LES PERREAUX

If the pandemic gets much worse in Canada’s hardest-hit provinces, grading systems developed by doctors and approved by provinces will help physicians decide who gets potential lifesaving treatment and who does not.

The purpose of the grading systems, filled with scores, scales and categories, is to establish a ranking of patients in need of critical care – including COVID-19 patients – with the aim of determining who will get access to increasingly scarce critical care beds, ventilators and ICU staff. The pandemic critical care triage protocol scores patients on severity of injury or illness, likelihood of immediate survival, and one-year prognosis beyond the intensive care unit.

Another objective, to limit bias and to depersonalize who will receive care, is spelled out at the top of each of the nine pages of the Quebec version of the Intensive Care Access Form. “Do not write the name,” it says.

“Our usual way to work is we treat the patient in front of us, one person at a time. This says we have to start thinking about what’s best for the largest number of people,” said Dr. Paul Warshawsky, chief of critical care at Montreal’s Jewish General Hospital. “It’s to help us select patients in a way that is fair and equitable, not based on how loudly a family is advocating.” Across the country, medical systems are already triaging tens of thousands of patients who need scheduled surgeries but must wait as COVID-19 taxes resources.

Intensive care triage is the next major step for hospital life-and-death decisions.

Critical care triage protocols are circulating in several provinces, including hard-hit Ontario and Alberta. Only Quebec has so far made its final triage form public, along with a 48-page explainer.

Ontario’s full, official protocol, similar to Quebec’s, is expected to be publicly released soon, according to Dr. James Downar, a specialist in critical care at The Ottawa Hospital who drafted Ontario’s protocol. It is not clear if Alberta will make its protocol public.

No Canadian medical system has had to invoke formal critical care triage during the pandemic. New York hospitals invoked “crisis standards of care” in the first wave, but doctors complained the triage guidelines were more theoretical than practical. They often ended up improvising who received care. Los Angeles County put protocols in place this month but has yet to formally start triage.

“If you run out of resources, you have three options: First-come first-serve, which is deeply unfair and brings a lot of extra mortality. A pure lottery random system has lower risk of inequity, but would lead to a lot of preventable death,” Dr. Downar said. “They’re not morally defensible.”

“You are left with option three: Try your very best to come up with criteria that can be applied consistently and explicitly, based on evidence. Avoid criterion that would assign value to a human being, but just assign probability they would live.”

If the protocol is invoked, doctors in Quebec would fill out the ICU access form for every patient in critical care or waiting for it. A team of two doctors and an ethicist for each hospital would receive them, rank patients and make the final calls.

The Quebec form would decide who gets into ICU but also who could be removed from ventilators if patients with a higher probability of survival need them.

It is not clear if Ontario’s final protocol will contain this piece.

In Quebec, the intensive care protocol is supposed to kick in once the province reaches 200 per cent of normal ICU capacity. Most ICUs in Quebec are not full, but some in Montreal are above 100 per cent. Critical patients in Toronto are being moved to hospitals across Southern Ontario.

“It’s scary, we’re not at the doorstep of the protocol but we’re near it,” Dr. Warshawsky said. The Jewish General ICU is “currently running at 130 per cent. I’m not sure we can get to 200 per cent.” Intensive care has two main functions when dealing with an influx of COVID-19 patients. One is constant monitoring – each nurse is in charge of no more than two patients in Quebec. The other is breathing assistance, where ventilators pump oxygen into a patient’s lungs.

Most intensive care triage plans set out three crisis stages. At the first stage, patients with only a 20 per cent chance or less of survival within a year would be denied intensive care. Two other stages with survival rates of 50 per cent and 70 per cent, respectively, kick in if the situation deteriorates.

Then, patients are sorted. In the Quebec form, physicians complete a trauma- and injury-severity score if the patient needs care for a major accident. With cardiac arrest, organ failure and metastatic cancer patients, a number of indicators are used for the first two stages. At stage three, the existence of these afflictions alone would prevent treatment in the ICU.

Patients over 60 years old with burns over 40 per cent or more of their bodies would be denied any ICU care.

The form’s final pages rank conditions that make recovery from assisted breathing less likely, such as dementia and frailty, raising alarm among disability advocates. Weight and muscle loss, diminished ability to walk are among clinical frailty symptoms.

“The tools they use conflate disability with frailty,” said Mariam Shanouda, a lawyer with the Toronto’s ARCH legal clinic, who represents people with disabilities. “We already know there are demographic sectors more affected by COVID-19. Black people, other racialized minorities, Indigenous people, people with disabilities … they will inevitably be most affected by this protocol and they have not been sufficiently consulted.”

The Quebec protocol was reviewed by committees involving dozens of medical professionals, lawyers and ethicists, but a handful of patients. “I don’t know why this wasn’t examined prior to the pandemic as part of pandemic preparedness,” said Vardit Ravitsky, a professor of bioethics at the University of Montreal.

“Public consultation on something involving life-and-death decisions like this should be as inclusive as possible.”

Judging frailty or dementia could discriminate against both the elderly and disabled, said David Lepofsky, chairman of advocacy group Accessibility for Ontarians with Disabilities Act Alliance. He warned the protocol will turn triage doctors “into a law unto themselves.”

Mr. Lepofsky, an adjunct professor at the University of Toronto’s law school, has written to Ontario Health Minister Christine Elliott to demand the protocol be scrapped and a process launched for a full debate and legislation. “They have had 11 months to figure this out,” Mr. Lepofsky said. “And they haven’t.”

Dr. Downar said the protocols “will not exclude people on the basis of disability. No iteration of the protocol would do that, and our protocols explicitly exclude it.”

Dr. Downar added doctors and nurses left with “impromptu triage practices” would create far greater risk of bias. But, he acknowledged, “even a system that controls subjectivity and implicit bias and is purely focused on mortality risk will still affect some groups more than others. Mortality risk is not evenly distributed in society.”

The final page of Quebec’s protocol outlines criteria for resolving ties, putting a priority on younger people and workers in the health care system, elements not part of Ontario’s draft protocol.

In both Ontario and Quebec, if all else is equal, random chance will be used for the final selection of critical care patients.

With a report from Jeff Gray in Toronto.

Undated Letter from A Member of the Ontario Government’s Critical Care COVID Command Centre to Ontario Hospitals

Ontario Critical Care COVID19 Command Centre_ Readiness for Emergency Standard of Care for Critical Care communication January 13 2021.pdf

Dear Colleagues:

Please find attached documents that describe how to implement an emergency standard of care for admission to critical care.

This emergency standard of care does not apply now. This will require a clear, distinct, and specific time of initiation and discontinuation by the Ontario Critical Care COVID19 Command Centre.

Matt Anderson, in his recent memo Further Actions for Optimizing Care, indicated that, “All hospitals are asked to review and standardize their critical care admission criteria in consultation with the Ontario Critical Care COVID-19 Command Centre”. The emergency standard of care (attached) is intended to support this action. It operates within the Health Care Consent Act of Ontario; it does not involve the protocol-driven withdrawal of invasive physiologic support, but does involve the protocol-driven decisions to not offer admission to critical care.

It would be advisable for physicians and your hospital to prepare now to operationalize this emergency standard for when it is initiated. While the forms are included in the document, they are attached here as separate pdfs for ease of printing. Furthermore, here is a site that contains these documents as well as a narrated slide deck for use with knowledge translation. This site can be referenced for updates to these documents and supplementary resources to support implementation.

Along with developing readiness for this change, I recommend concurrently refreshing a commitment to consistent and proactive approaches to goals of care conversations with patients. Some of the tools within this document may be useful in this regard.

Please note that on November 13, 2020, I sent a draft Protocol which does involve protocol-driven withdrawal of invasive physiologic support. This emergency standard of care document supersedes that draft protocol. The substantive differences between this document and the November 13, 2020 draft Protocol are:

  1. Removal of the requirement of a triage team that makes ICU bed allocation decisions; 2. Removal of reference to an external appeals committee; 3. No protocol-driven withdrawal of invasive physiologic support, which would require an executive order from Cabinet to operate outside of the Health Care Consent Act.

However, an updated version of the Protocol may be sent in the near future. Readiness of physicians and hospitals for an updated Protocol will be expedited by preparing to implement this emergency standard of care. The same principles and tools apply to both this Emergency Standard of Care and the forthcoming Protocol. Both approaches benefit from being derived from a Framework developed by the Ontario COVID-19 Bioethics Table. Both approaches emphasize a commitment to human rights, ethical principles, continuous improvement, and fair processes. A system of data collection about the application of this emergency standard of care is being created for the purpose of monitoring and revision of this approach. Information about how to transmit data to this system will be forthcoming soon.

Thank you so much for all you are doing,

Andrew Baker Incident Commander Ontario Critical Care COVID19 Command Centre



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Watch TVO’s “The Agenda with Steve Paikin” Tonight at 8 or 11 PM for a Lively Panel on the Need to Protect Patients with Disabilities from Disability Discrimination if Life-Saving Critical Medical Care Must Be Rationed or Triaged Due to the COVID-19 Pandemic Overloading Hospitals


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/

Watch TVO’s “The Agenda with Steve Paikin” Tonight at 8 or 11 PM for a Lively Panel on the Need to Protect Patients with Disabilities from Disability Discrimination if Life-Saving Critical Medical Care Must Be Rationed or Triaged Due to the COVID-19 Pandemic Overloading Hospitals

January 13, 2021

Watch TVO’s flagship current affairs program “The Agenda with Steve Paikin” tonight at 8 or 11 pm Eastern time for a half-hour panel on what the Ford Government should be doing to ensure that patients with disabilities do not face disability discrimination if life-saving critical medical care must be triaged or rationed. This rationing or triage could be needed soon if the soaring COVID-19 infection rates overload Ontario hospitals.

The four panelists are AODA Alliance Chair David Lepofsky, ARCH Disability Law Centre legal counsel Mariam Shanuda, Dr. James Downar (a member of the Government-appointed external advisory Bioethics Table and an author of the March 28, 2020 critical care triage protocol with which the disability community had strong objections) and Ontario research chair in bioethics Prof. Udo Schuklenk.

This panel will appear on TV. It will also stream tonight at 8 pm on the Twitter feed and Facebook page of The Agenda with Steve Paikin. It will be permanently available on YouTube within a few hours after it airs. We will publicize the Youtube link once we get it.

We once again vigourously applaud The Agenda with Steve Paikin for addressing COVID-19 issues affecting people with disabilities. The Agenda stands in stark and resounding contrast to so many other media outlets that have not covered this life-and-death issue.

Back on April 14, 2020, only one month into the pandemic, The Agenda with Steve Paikin included a panel discussion on how critical care triage should be conducted if COVID-19 overwhelms Ontario hospitals. The three panelists on that program included Dr. Downar, Prof. Schuklenk, and another bioethicist. There was no one speaking from the perspective of the disability community. Those panelists did not themselves voice any disability issues in relation to the entire critical care triage topic. When Steve Paikin raised the fact that concerns had been publicly raised from the disability perspective, Prof. Schuklenk denied that there was a problem of disability discrimination. He had not read the March 28, 2020 critical care triage protocol that the Government had already sent to all Ontario hospitals.

After that program aired, AODA Alliance Chair David Lepofsky wrote The Agenda, urging it to cover the disability perspective on the triage issue as well as other disability issues in the COVID-19 pandemic. To its great credit, The Agenda included AODA Alliance Chair David Lepofsky and Wendy Porch (executive director of the Centre for Independent Living in Toronto CILT) on its May 8, 2020 broadcast. That discussion included the critical care triage issue as well as other disability concerns during the pandemic.

We are delighted that The Agenda is now revisiting the critical care triage issue, given major developments since last spring. To our knowledge, this is the first time that a major media outlet has brought together panelists from the medical, bioethics and disability community perspectives. We need the Ford Government to take part in such discussions, rather than continuing to hide in secret behind its external advisory Bioethics Table that makes no decisions in this area.

Please encourage your friends and family to watch this interview. Promote it on social media like Twitter and Facebook. Urge members of the Ontario Legislature to watch this interview. Call on the media to cover this issue too.

There have been 713 days, over 23 months, since the Ford Government received the final report of the Independent Review of the implementation of the Accessibility for Ontarians with Disabilities Act by former Ontario Lieutenant Governor David Onley. The Government has announced no comprehensive plan of new action to implement that ground-breaking report. That makes even worse the serious problems facing patients with disabilities during the COVID-19 pandemic, addressed in this new episode of The Agenda with Steve Paikin.

For more background on this issue, check out:

  1. The AODA Alliance’s December 21, 2020 news release on the critical care triage issue.
  1. The Government’s external advisory Bioethics Table’s September 11, 2020 draft critical care triage protocol, finally revealed days ago.
  1. 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.
  1. 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.
  1. 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.
  1. The September 1, 2020 submission and July 20, 2020 submission by the ARCH Disability Law Centre to the Bioethics Table.

7.The November 5, 2020 captioned online speech by AODA Alliance Chair David Lepofsky on the disability rights concerns with Ontario’s critical care triage protocol.

  1. The 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.





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Share with Others the Youtube Link to Yesterday’s Important Panel on TV Ontario’s “The Agenda with Steve Paikin” Revealing the Hardships Facing Many Ontario Students with Disabilities During Distance Education and While Attending Re-Opened Schools


Accessibility for Ontarians with Disabilities Act Alliance Update

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

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

Share with Others the Youtube Link to Yesterday’s Important Panel on TV Ontario’s “The Agenda with Steve Paikin” Revealing the Hardships Facing Many Ontario Students with Disabilities During Distance Education and While Attending Re-Opened Schools

December 9, 2020

Did you miss last night’s important panel on Ontario’s flagship public affairs program The Agenda with Steve Paikin on the barriers and hardships facing many Ontario students with disabilities during distance learning or while attending re-opened schools? You can now watch it online any time you want, on your computer, tablet, smart phone or smart TV! If you want to cut and paste the link, here it is!

https://www.youtube.com/watch?v=AO0MDM54gnA&feature=youtu.be

In the past, TVO has upgraded the automated Youtube captioning for its postings from The Agenda with Steve Paikin and has posted a transcript of such panels within a period of days.

On this panel, Steve Paikin interviewed three guests:

  1. AODA Alliance Chair David Lepofsky, who is also a member of the Government-appointed K-12 Education Standards Development Committee, as well as a member and past chair of the Toronto District School Board’s Special Education Advisory Committee.
  2. Ontario Autism Coalition President Laura Kirby-McIntosh, who is also a teacher and mother of two children with autism.
  3. Grand Erie District School Board Special Education Advisory Committee member Paula Boutis, who is also the mother of a child with a disability and the President of Integration Action for Inclusion, a parent association of families with children with disabilities working to improve inclusion in education and community), and a past member of the TDSB Special Education Advisory Committee.

One of the many important points made during this interview is the pressing unmet need for the Ford Government to have developed and implemented a comprehensive province-wide plan on how school boards should meet the needs of a third of a million students with disabilities during distance learning and while attending re-opened schools. It is important to emphasize that the Government was handed just such a plan on a silver platter some five months ago – one it has not implemented. That plan was developed by a sub-committee of the Government-appointed K-12 Education Standards Development Committee and was delivered to the Government on July 24, 2020. That Committee has representation from the disability community and school boards. It sets out a strong consensus position.

At the end of the interview, David Lepofsky stated that Ontario Education Minister Stephen Lecce told the Ontario Legislature on July 8, 2020 that he speaks regularly with Lepofsky. You can read the official Ontario Hansard transcript of that statement! Minister Lecce has not spoken to AODA Alliance Chair David Lepofsky since he made that statement. You can also read the AODA Alliance’s September 23, 2020 letter to Education Minister Lecce, asking for a meeting.

Please encourage as many people as possible, including your member of the Legislature and your local school staff and school board officials to watch the December 8, 2020 panel on The Agenda with Steve Paikin. Forward this Update to them. Publicize it on social media.

We know that so many parents of students with disabilities are struggling more than ever to advocate to their school and school board to meet their children’s learning needs. That’s why we have made available a helpful video that offers parents of students with disabilities a series of very practical tips on how to advocate to school boards for their children. Please encourage parents, teachers, principals and others to watch that video too! Encourage principals to share that video with all the families attending their school.

We again want to acknowledge and thank Steve Paikin, and the staff of The Agenda with Steve Paikin, for shining a bright spotlight on this important disability issue. As AODA Alliance Chair David emphasized in another recent online lecture about advocating for the needs of people with disabilities during the COVID-19 pandemic, it has been inexplicably hard to get media attention on vital disability issues over the past nine months. We are struggling to understand why that is so. Bucking that trend, Mr. Paikin and The Agenda with Steve Paikin stand out as a true and commendable model of receptiveness to our issues and concerns. Steve Paikin noted at the start of this interview that it was an approach from the AODA Alliance that led his program to decide to include this panel, arising out of our concern that an earlier panel on The Agenda did not accurately describe the experience of many students with disabilities during distance education.

Despite the ordeal facing so many Ontarians, including the plight of so many students with disabilities and their families, yesterday, the Ford Government decided yesterday to cancel the rest of the sittings of the Legislature this week. It will not sit again until mid-February of next year.

It is in that context that we remind one and all that there have now been 678 days, over 22 months, since the Ford Government received the final report of the Independent Review of the implementation of the Accessibility for Ontarians with Disabilities Act by former Ontario Lieutenant Governor David Onley. In all this time, the Government has announced no comprehensive plan of new action to implement that ground-breaking report. That makes even worse the serious problems facing students with disabilities during the COVID-19 pandemic, addressed in this new episode of The Agenda with Steve Paikin.

Send us your feedback on this interview on The Agenda with Steve Paikin or on any other accessibility topic. Write us at [email protected]



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Watch TVO’s “The Agenda with Steve Paikin” Tonight at 8 or 11 PM for an Interview on Whether Distance Education and Re-Opened Schools are Meeting the Learning Needs of Students with Disabilities


Accessibility for Ontarians with Disabilities Act Alliance Update

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

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

Watch TVO’s “The Agenda with Steve Paikin” Tonight at 8 or 11 PM for an Interview on Whether Distance Education and Re-Opened Schools are Meeting the Learning Needs of Students with Disabilities

We encourage you to watch TVO’s flagship current affairs program “The Agenda with Steve Paikin” tonight at 8 or 11 pm eastern time for an extensive interview on whether the learning needs of students with disabilities are being met this fall, both those doing distance education and those attending re-opened schools. The guests are AODA Alliance Chair David Lepofsky, Ontario Autism Coalition President Laura Kirby-McIntosh and Grand Erie District School Board Special Education Advisory Committee member Paula Boutis (who is also President of Integration Action for Inclusion, a parent association of families with children with disabilities working to improve inclusion in education and community).

This program will appear on TV (for those who still use it). It will also stream tonight at 8 pm on the Twitter feed and Facebook page of The Agenda with Steve Paikin. It will be permanently available on YouTube. In a future AODA Alliance Update, we will provide the YouTube link.

On November 13, 2020, the Agenda included a panel that explored how effectively distance education is working during COVID-19. Those earlier panelists gave distance education very positive grades, but did not give sufficient consideration to its impact on students with disabilities. Today’s broadcast gives viewers a chance to learn about that important issue with this new panel.

We applaud The Agenda with Steve Paikin for addressing this disability issue on tonight’s broadcast, which is important for a third of a million Ontario students with disabilities in publicly-funded Ontario schools. Back on May 8, 2020, The Agenda included an interview about our campaign to get the Ontario Government to address the barriers that people with disabilities are facing during the COVID-19 pandemic. Today’s new interview provided a good opportunity to bring viewers up to date, with a specific focus on the hardships facing school-age students with disabilities.

Help us use this broadcast to promote real change. Please

* Encourage your friends and family to watch this interview.

* Promote this interview on social media like Twitter and Facebook.

* Press members of the Ontario Legislature to watch this interview.

* Urge your local media to cover this issue too. Bring them stories about barriers facing students with disabilities in Ontario’s schools.

* Follow us on Twitter: @aodaalliance. On Facebook: www.facebook.com/AODAAlliance/

 

* While you’re at it, please encourage parents and guardians of students with disabilities to watch the captioned online video by AODA Alliance Chair David Lepofsky where practical tips are given on how to effectively advocate for the needs of students with disabilities in the school system. We’ve already received very encouraging feedback on that video. Tell your school board to publicize it to all parents.

There have now been 677 days, over 22 months, since the Ford Government received the final report of the Independent Review of the implementation of the Accessibility for Ontarians with Disabilities Act by former Ontario Lieutenant Governor David Onley. The Government has still announced no comprehensive plan of new action to implement that ground-breaking report. That makes even worse the serious problems facing students with disabilities during the COVID-19 pandemic, addressed in this new episode of The Agenda with Steve Paikin.





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Yesterday, Disability Concerns About the Risk of Disability Discrimination if Critical Medical Care Must be Rationed Was Raised In the Ontario Legislature, the Media and Premier Ford’s News Conference


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/

Yesterday, Disability Concerns About the Risk of Disability Discrimination if Critical Medical Care Must be Rationed Was Raised In the Ontario Legislature, the Media and Premier Ford’s News Conference

December 4, 2020

            SUMMARY

Yesterday’s strong open letter to the Ford Government by 64 organizations and groups, spearheaded by the AODA Alliance and the ARCH Disability Law Centre, has increased public attention to our concerns about the Ford Government’s plans if a continuing surge in COVID-19 cases requires rationing or “triage” of hospital critical medical care. We have called on the Ford Government to at last release the secret report and recommendations of the Government’s Bioethics Table on this issue. This is especially important since the Ontario Human Rights Commission has publicly stated that it has human rights concerns with those recommendations.

What Happened Yesterday

Here is a summary of important developments on this issue yesterday, the International Day for Persons with Disabilities:

  1. In the Legislature during Question Period, Opposition disabilities critic NDP MPP Joel Harden pointed to this new open letter to The Government from the disability community. He asked the Government to make public the report and recommendations of the Government’s Bioethics Table (which the Government has kept secret for almost three months).

Conservative MPP Robin Martin, the Health Minister’s Parliamentary Assistant, responded, but very obviously did not answer the question. Below is the Hansard (formal transcript) of the exchange.

  1. Yesterday’s Toronto Star included an excellent report on our community’s open letter, written by reporter Brendan Kennedy, set out below.

As well, this issue was picked up by Ottawa Radio 1310’s Rob Snow program, which interviewed AODA Alliance Chair David Lepofsky. Global News also included a story on this issue in yesterday’s evening TV news program.

  1. During the Premier’s midday December 3, 2020 news conference, Global News asked Premier Ford about our open letter and about making the Government’s plans public. In an answer which we transcribed and set out below, Health Minister Christine Elliott stated that discussions are now ongoing with the Ontario Human Rights Commission about the proper critical care triage protocol to put in place that is fair to everyone. She said she is not sure how long those discussions would be going on, “but that would come forward at the appropriate time.”

Reflections on What Happened Yesterday

The Government said nothing yesterday or previously to the Legislature or the media that explains, much less justifies its keeping secret the Bioethics Table’s report. Both the Ontario Human Rights Commission and the Bioethics Table have called on The Government to make that report public.

We need the Bioethics Table’s report and recommendations to be made public now, and not at some unspecified future “appropriate time.” If such discussions are going on now that have a bearing on human rights for people with disabilities, we should not be shut out of them. We need to know what they are discussing, and we need to be part of those secret discussions.

You will see in the Toronto Star article, set out below, and to the Government’s statement in the Legislature in Question Period, also set out below, some references to the Government’s having increased the number of hospital beds. Not every hospital bed is a critical care bed, with all the services that a critical care patient needs to survive. We have seen no assurance that along with an increased number of beds, the Government has provided all the supports and services needed to ensure that they can provide effective critical medical care to all patients who will need critical care as the COVID-19 pandemic continues to surge, whether they need critical care due to COVID-19 or due to heart attacks, strokes, car accidents, or numerous other causes. Along with the hospital bed, there needs to be a sufficient number of intensive care doctors, nurses and other specialists, as well as ventilators and other equipment and supplies, and the required ventilator technicians. These critical care beds must be located in facilities that are equipped with the safety features needed to make sure that COVID-19 does not spread among patients and staff.

What You Can Do to Help

We strongly encourage one and all to write the Government. If you are concerned about the need for a non-discriminatory clinical triage protocol and the need for transparency in the process of developing it, you can write to your MPP to request the Ontario Government draft a non-discriminatory clinical triage protocol that ensures persons with disabilities have equal access to critical care resources during the pandemic. ARCH has launched a letter writing campaign. You can use this link to learn more: https://archdisabilitylaw.ca/write-to-your-mpp-about-ontarios-triage-protocol/

Please check out the AODA Alliance website’s health care page, detailing its efforts to tear down barriers in the health care system facing patients with disabilities, and our COVID-19 page, explaining our efforts to address the needs of people with disabilities during the COVID-19 crisis.

Watch the AODA Alliance’s new captioned video explaining the entire critical care triage issue, and our new captioned video describing the broader campaign over the past eight months to overcome the serious new barriers that people with disabilities have had to face during the COVID-19 pandemic.

Delays and Delays and Delays

There have now been 673 days, or over 22 months, since the Ford Government received the ground-breaking final report of the Independent Review of the implementation of the Accessibility for Ontarians with Disabilities Act by former Ontario Lieutenant Governor David Onley. The Government has still announced no comprehensive plan of new action to implement that report. That makes even worse the serious problems facing Ontarians with disabilities during the COVID-19 crisis, addressed in the new online video we unveiled last week.

            MORE DETAILS

Ontario Hansard December 3, 2020

Question Period

PERSONS WITH DISABILITIES

Mr. Joel Harden: Today is the International Day of Persons with Disabilities, and 60 disability organizations sent the Premier a letter today. My question is for him. In September, the government’s bioethics table for the COVID-19 response recommended which patients should be refused critical medical care if overwhelmed hospitals ration it, but to date, the government is keeping those recommendations secret. People with disabilities have a right to know what the government is going to be thinking of doing in this life and death area. We hope that triage never becomes necessary, but Ontario has to be prepared.

Will the Premier keep his promise to be transparent to people with disabilities, publicize the COVID-19 plans of critical triage protocol and do what is the proper thing: make these bioethics table recommendations public?

The Speaker (Hon. Ted Arnott): The member for Eglinton–Lawrence to reply.

Mrs. Robin Martin: Thank you to the member opposite for the question.

The health and well-being of Ontarians is our government’s top priority. In response to COVID-19, we’ve taken action to build more capacity in our health care system and effectively managed surges and future waves of COVID-19. That’s why we invested an additional $2.5 billion, or an increase of 13% from last year, to support our hospitals throughout the pandemic and build capacity, including 3,100 new beds across health facilities.

It’s critical that I remind the member opposite that at the request of health systems stakeholders, Ontario Health and the bioethics table of the provincial command structure drafted a clinical triage protocol for a major surge in the COVID pandemic for a potential worst-case scenario due to the spread of COVID-19. To be clear, this was a draft developed for engagement and consultation and should not be used. We’ve also asked our bioethics table to ensure that concerns and perspectives of Indigenous people, Black and racialized communities, persons with disabilities and others who may be disproportionately affected by critical care triage due to systemic discrimination are meaningfully considered and—

Toronto Star December 3, 2020

Originally posted at https://www.thestar.com/news/gta/2020/12/03/disability-rights-groups-decry-ford-government-secrecy-about-covid-19-triage-guidelines.html

Group decries virus triage secrecy

Letter seeks transparency on province’s priority protocols for hospitals

Brendan Kennedy Toronto Star

A coalition of disability rights groups is calling on Doug Ford’s government to make public the directions they plan to give hospitals about how to decide who should be prioritized for life-saving treatment if intensive care units become overwhelmed with COVID-19 patients.

The call comes after the government’s initial COVID-19 triage protocol – which leaked in March but was never officially released – was rescinded after it was criticized for discriminating against people with disabilities. “We write about a life-and-death issue now facing Ontarians,” reads the open letter, signed by more than 60 organizations and sent Thursday to Ford, Health Minister Christine Elliott and Raymond Cho, the minister responsible for seniors and accessibility.

The letter calls on the province to immediately release the latest recommendations from its Bioethics Table – the government-appointed group of physicians and bioethicists advising the ministry on a number of COVID-related issues – and ensure that any new triage guidelines “respect the constitutional and human rights of all patients, including patients with disabilities.”

The purpose of a triage protocol, which would be invoked only if critical care resources needed to be rationed, is to minimize overall mortality by prioritizing patients with the best chance of survival.

Among the concerns raised by disability advocates about the government’s initial protocol was its inclusion of the Clinical Frailty Scale, a nine-point grading tool they said was inherently discriminatory against people with disabilities and could lead to their exclusion from life-saving treatment.

In their letter, the organizations commend the government for rescinding the initial protocol, but the fact that nothing has taken its place also poses a danger. “If critical care triage becomes necessary, decisions over who gets refused life-saving critical care would be wrongly left to individual hospitals and doctors without safeguards against the serious danger of arbitrary and discriminatory decisions made because of disability,” the letter reads.

Roberto Lattanzio, executive director of the ARCH Disability Law Centre, said the province needs to ensure any new policy protects the rights of people with disabilities. “The pandemic doesn’t give governments a pass on ensuring that human rights and constitutional rights are respected,” he said. “We’ve been advocating for a framework free of discrimination for eight months now, and now we find ourselves in a very similar situation as we did from the outset.”

While the number of active COVID-19 cases in Ontario is nearly three times as high as during the peak of the first wave, hospitalizations and admissions to intensive care units (ICUs) are lower now than they were then. On Wednesday, the province reported that 656 people were hospitalized with COVID-19, including 183 people in ICUs. On May 1, by comparison, there were more than 1,000 patients in hospital, including 225 in ICUs.

The province significantly expanded its critical care capacity in April, increasing the number of ICU beds by nearly 1,500 to a total of 3,504. Roughly half of the province’s ICU beds were occupied as of Dec. 1, according to Critical Care Services Ontario’s daily report.

Last month, in response to a question in the legislature from the NDP, Progressive Conservative MPP Robin Martin confirmed the government had rescinded its initial protocol, which she said was only a draft, and that a “revised framework may be shared… should pandemic conditions deteriorate significantly.” But, Martin said: “We don’t anticipate getting anywhere near having to use such a protocol.”

David Lepofsky, chair of the Accessibility for Ontarians with Disabilities Act Alliance, said cases have steadily increased since Martin’s assurances, and the lack of action by the government is inexcusable. “They can’t wait until the day where they need triage and then say, ‘By the way, here are the rules.’”

The Health Ministry sent a statement saying it asked the Bioethics Table to “ensure that concerns and perspectives of those representing Indigenous people, Black and racialized communities, persons with disabilities, and others who may be disproportionately affected by critical care triage due to systemic discrimination, are meaningfully considered and reflected in a revised protocol.” A spokesperson did not respond when asked whether the government would make the revised protocol public.

Text of an Exchange During Premier Doug Ford’s December 3 2020 NEWS CONFERENCE

Note: This entire news conference is posted on Youtube at https://youtu.be/UTp3yZTSBXA

Your final question comes from Miranda Anthistle with Global News. Please go ahead.

Miranda Anthistle: Hi there, thank you for my question.

Doug Ford: Hi. How are you?

Miranda Anthistle: Ok, so the first one is, the Ontarians With Disabilities Act Alliance has written an open letter to your government about transparency on how decisions will be made when it comes to prioritizing life-saving treatments and who will get them if hospitals become overwhelmed. So will this information be released and how does the government plan on prioritizing life-saving treatments?

Doug Ford: Pass that to the Minister:

Christine Elliott: Well this is a very important issue and one that health care professionals asked us to deal with very early on in the pandemic because they were concerned about Ontario becoming overwhelmed in the same way that Italy was, for example. So a draft protocol was developed that had been sent to hospitals, but this is really only meant for internal purposes

but I know that a number…and is not being acted upon. It was met with a lot of concern by a number of disabilities groups and seniors groups and so we reached out to the table at the Health Command Table reached out to the Ontario Human Rights Commission to obtain their assistance in redrafting a protocol and I understand there is still discussions ongoing with the Ontario Human Rights Commission in order to make sure that we reach a level place where everyone is dealt with fairly in terms of dealing with the triage protocol whether it’s for people with disabilities, for seniors, racialized communities, indigenous communities making sure that it’s there and level for all people.

So those discussions are ongoing. I’m not sure exactly how long they will be continuing but that will come forward at the appropriate time.



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“Preparing for School Re-Opening — Action Tips for Parents of Students with Disabilities” – And Check Out the Media Coverage It Got – 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/

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

August 24, 2020

          SUMMARY

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

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

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

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

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

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

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

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

For example, you might post this on Facebook:

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

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

 3. Helpful Media Coverage Once Again

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

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

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

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

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

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

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

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

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

Send us your feedback. Let us know how you can help get others to watch our 3rd Virtual Town Hall. Email us at [email protected]

          MORE DETAILS

 CBC News Online August 22, 2020

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

Students with disability face more obstacles amid coronavirus: advocates

Osobe Waberi The Canadian Press

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“We realize the time is ticking.”



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


Accessibility for Ontarians with Disabilities Act Alliance Update

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

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

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

August 17, 2020

          SUMMARY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For more background on these issues, visit

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

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

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

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

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

          MORE DETAILS

Ontario Hansard July 8, 2020

 

Question Period

 

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

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

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

 

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

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

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

 

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

 

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

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

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

 

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

Response?

 

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

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

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

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

QP Briefing August 10, 2020

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

10.08.2020 By Sneh Duggal, Queen’s Park Briefing

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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