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


Accessibility for Ontarians with Disabilities Act Alliance Update

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

Web: www.aodaalliance.org

Email: [email protected]

Twitter: @aodaalliance

Facebook: www.facebook.com/aodaalliance/

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

August 18, 2021

        SUMMARY

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

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

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

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

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

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

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

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

 2. What Comes Next

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

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

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

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

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

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

 3. Helpful Resources

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

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

b) On Disability Barriers in Ontario Colleges and Universities

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

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

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

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

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

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

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

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

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

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

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

        MORE DETAILS

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

Dear all,

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

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

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

 

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

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

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

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

Sincerely,

Accessibility for Ontarians with Disabilities Division

Ministry for Seniors and Accessibility



Source link

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


Accessibility for Ontarians with Disabilities Act Alliance Update United for a Barrier-Free Society for All People with Disabilities Web: https://www.aodaalliance.org
Email: [email protected]
Twitter: @aodaalliance
Facebook: https://www.facebook.com/aodaalliance/

August 18, 2021

SUMMARY

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

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

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

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

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

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

1. You have up to September 13, 2021 to give feedback on the initial report of the Health Care Standards Development Committee. It recommends what should be included in the promised Health Care Accessibility Standard to tear down the disability barriers facing people with disabilities in Ontario’s health care system.

2. You have up to September 29, 2021 to give the Government feedback on the initial report of the Post-Secondary Education Standards Development Committee. It recommends what should be included in the Education Accessibility Standard to tear down the disability barriers impeding students with disabilities in Ontario’s colleges and universities.

3. You have up to September 30, 2021 to give feedback on the initial report of the K-12 Education Standards Development Committee. It recommends what should be included in the promised Education Accessibility Standard to tear down the disability barriers facing students with disabilities in Ontario’s education system.

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

* Send your feedback on disability barriers in the health care system to [email protected]
* Send your feedback on disability barriers in the K-12 school system to: [email protected]
* Send your feedback on disability barriers in Ontario’s colleges and universities to: [email protected]

2. What Comes Next

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

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

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

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

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

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

3. Helpful Resources

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

1. The entire 185-page K-12 Education Standards Development Committee initial report and initial recommendations on what the promised Education Accessibility Standard should include to make education in Ontario schools barrier-free for all students with disabilities.

2. The AODA Alliance’s 55-page condensed and annotated version of the K-12 Education Standards Development Committee initial report and recommendations.

3. The AODA Alliance’s 15-page summary of the K-12 Education Standards Development Committee initial report and recommendations.

4. The AODA Alliance’s action kit on how to give public feedback on the K-12 Education Standards Development Committee initial report and recommendations.

5. A captioned video by AODA Alliance Chair David Lepofsky explaining what is in the K-12 Education Standards Development Committee initial report.

6. A captioned video of tips for parents of students with disabilities on how to advocate at school for their child’s needs.

7. For general background, the AODA Alliance website Education page.

b) On Disability Barriers in Ontario Colleges and Universities

1. The initial report of the Post-Secondary Education Standards Development Committee is available at https://www.aodaalliance.org/wp-content/uploads/2021/06/PSE-SDC-Initial-Recommendations-Report_June-25-2021.docx

2. The draft framework for the Post-Secondary Education Accessibility Standard that the AODA Alliance sent to the Post-Secondary Education Standards Development Committee in March, 2020.

3. You can learn more about our years of advocacy to make all parts of Ontario’s education system accessible for students with disabilities by visiting the AODA Alliance website’s education page.

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

1. The initial report of the Health Care Standards Development Committee is available at https://www.aodaalliance.org/wp-content/uploads/2021/05/Health-Care-SDC-Initial-Report-As-Submitted.doc

2. The AODA Alliance’s August 3, 2021 brief to the Health Care Standards Development Committee giving feedback on its initial report is available at https://www.aodaalliance.org/wp-content/uploads/2021/08/August-3-2021-finalized-AODA-Alliance-Brief-to-Health-Care-Standards-Development-Committee.docx

3. The AODA Alliance’s February 25, 2020 Framework that it submitted to the Health Care Standards Development Committee on what the promised Health Care Accessibility Standard should include.

4. A comprehensive captioned video by AODA Alliance Chair David Lepofsky on the barriers facing people with disabilities in the health care system.

5. A detailed captioned video by AODA Alliance Chair David Lepofsky on the dangers of disability discrimination in Ontario’s controversial critical care triage protocol during the COVID-19 pandemic.

6. Background on the AODA Alliance’s campaign for barrier-free health care services for people with disabilities is available on the AODA Alliance website’s health care page.

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

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

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

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

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

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

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

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

MORE DETAILS

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

Dear all,

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

As a reminder, the Initial Recommendations Report of the Health Care Standards Development Committee is available online here for public comment:
https://www.ontario.ca/page/consultation-initial-recommendations-development-health-care-accessibility-standards

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

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

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

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

Sincerely,

Accessibility for Ontarians with Disabilities Division
Ministry for Seniors and Accessibility




Source link

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


Accessibility for Ontarians with Disabilities Act Alliance Update United for a Barrier-Free Society for All People with Disabilities Web: https://www.aodaalliance.org
Email: [email protected]
Twitter: @aodaalliance
Facebook: https://www.facebook.com/aodaalliance/

August 5, 2021

SUMMARY

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

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

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

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

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

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

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

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

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

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

MORE DETAILS

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

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

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

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

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

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

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

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

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

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

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

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

a) The health care system will be designed and operated from top to bottom for all its patients, including patients with all kinds of permanent or episodic disabilities, as disability is defined in the Ontario Human Rights Code and the Canadian Charter of Rights and Freedoms. The health care system will no longer be designed and operated from an implicit starting point of aiming predominantly to serve the fictional “average” patient, who is too often assumed to have no disabilities.

b) Patients with disabilities, and where needed, any patients’ support people with disabilities, will be able to effectively communicate with health care providers and health care staff in connection with requesting or receiving health care services and products throughout each stage of the healthcare process. This will include face-to-face interactions, telephone or alternates to telephone use, accessible information and forms as well as alternate arrangements for providing one’s signature. For example, health care facilities and ambulances will be equipped with needed equipment to ensure effective communication with people with communication-related disabilities.

c) Patients with disabilities, and where needed, any patients’ support people with disabilities will be able to get and receive information relevant to their health care needs in private, e.g., when giving information at a health care provider’s office or when seeking or receiving information about their medication at a pharmacy, rather than in a public place where others can overhear. Effective procedures will protect the confidentiality of private information relating to patients with disabilities who rely on others to assist them with communication.

d) Information technology and applications which patients can use at home, or at a health care facility in connection with seeking and receiving health care services, will be designed based on principals of universal design and will be accessible to and usable by patients with disabilities, and where needed, to patients’ support people with disabilities. Where needed for effective communication, health care facilities will also provide alternatives to telephone use including email, text, video and authorized human assistance.

e) Health care products, and any instructions for their use, will be designed and available based on principles of universal design so that people with disabilities and not just people with no disability can use and benefit from them.

f) Support services such as sighted guides for visually impaired patients and attendant care will be available to patients with disabilities who need them while going to or at a facility to receive health care services.

g) Publicly funded appointments for receiving health care services will be sufficiently long to enable those patients with a disability, who need more time, to be able to receive the health care services they need. If a patient with disabilities cannot attend a health care provider’s premises due to their disability, there will be in place measures whenever therapeutically possible for remote appointments or home visits.

h) Patients will be free to use their own accommodation supports, such as service animals, when seeking or obtaining health care services and products.

i) New Government strategies, services and facilities in Ontario’s health care system will be proactively designed from the start and operated to fully include the needs of patients with disabilities. Those responsible at the provincial and local levels for leading, overseeing and operating Ontario’s health care system will have strong and specific requirements to address disability accessibility and inclusion in their mandates and will be accountable for their work on this issue. Ontario’s disability community will have effective input into public decisions on the design and operation of Ontario’s health care system to ensure that existing disability accessibility barriers are removed and no new ones are created.

j) An accessible health care system is one where people with disabilities can work in a barrier-free workplace.

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

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

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

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

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

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

a) The front area or drop-off areas for a hospital or other health care facility should be accessible, with automatic power doors that do not require a button to be found and pressed, and with tactile walking surface indicators both to warn when a person is walking into a driving area and to guide a person to the facility’s entrance. All other entrances and exits should be fully accessible, with automatic power door operators and an accessible path of travel to the door. This includes entrances from indoor or underground parking to the health care facility.

b) Inside the health care facility, major public areas such as emergency room doors should always be fully accessible and have automatic power door openers.

c) For the benefit of patients and others with learning and cognitive disabilities, vision loss or other disabilities that can affect mobility or way-finding, hospitals and other health care facilities should have way-finding markings in important areas such as the main lobby from the front door to the help desk and other major routes such as to main elevators, including colour contrasted markings such as a carpeted path or tactile walking surface indicators.

d) Hospitals and other health care facilities with elevators should have accessible elevators that can accommodate people using mobility devices. They should also have accessible elevator buttons (with braille and large print on or beside each button), braille and large print floor numbers just outside elevator doors, and audible floor announcements on elevators. Elevator button panels should be consistent in layout from one elevator to the next.

e) Health care facilities, including hospitals, should never install “destination elevators” which require a person to pre-select the floor to which they are going before entering the elevators. These present unfixable accessibility problems.

f) Hospitals and other health care facilities should have accessible signage throughout, including braille and large print, for key locations. For example, public bathrooms should have accessible braille and large print signs on them. These signs should be placed in consistent and predictable locations.

g) Where a health care facility has power doors that require a button to be pushed (i.e., they don’t open automatically), the button should always be located throughout the health care facility in a consistent place to make it easier to find. The button should be located near the door, so that a slow-moving individual can make it through the open door after pressing the button before the door closes. The button should always be located on the wall, and not on a free-standing post or bollard.

h) Despite weaker requirements in other AODA accessibility standards, the Health Care Accessibility Standard should set out specific and strong requirements for the accessibility of any electronic kiosks in hospitals and other health care facilities, such as:

i) specifying their required end-user functionality that effectively address recurring known needs arising from specific disabilities, and,

ii) ensuring that they are at an accessible height e.g., for those using a wheelchair or other mobility device.

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

i) Patient consultation or treatment rooms should have enough space to enable people using mobility devices to navigate in them and reach any treatment or consultation area. They should have enough space to enable a Sign Language interpreter to be positioned in the room to interpret for a deaf patient or support person.

j) Movable furniture such as desks, tables or chairs should not obstruct accessible paths of travel around a facility where health care services are delivered, such as a doctor’s office, e.g., in their hallways or treatment rooms.

k) Major health care facilities should provide accessible waiting areas for accessible transit pickup and drop-off, close to the pickup/drop-off point, with clear sight lines.

l) Major health care facilities such as hospitals should be designed to avoid major sensory overstimulation or acoustic overloads, such as bright lights, loud music, large atrium areas, or frequent loud announcements. This is especially important in treatment areas or hospital rooms.

m) Throughout a health care facility, proper colour contrasting should be required to assist people with low vision and cognitive disabilities, such as around elevator opening, doorways, and on the edge of stairs and handrails.

n) Health care facilities should be required to have accessible bathrooms so that all patients can use the facilities, including adult change tables, sufficient transfer space and maneuvering room for mobility devices.

o) Major health care facilities should include sensory rooms for people with sensory overload issues, such as in hospital emergency rooms.

p) In a health care facility, all stairs and staircases, including “feature staircases” (included as aesthetic design enhancements) should be accessible, e.g., with tactile warnings at the top and bottom of each set of stairs, no open risers and with proper colour contrast on railings and step edges. There should never be curving staircases.

q) Health care facilities should provide charging areas for electric mobility devices.

r) Hospital rooms should be able to accommodate a patient’s mobility device so they can keep theirs with them and readily available when admitted to hospital.

s) In a health care facility, waiting areas, isolation areas, breastfeeding rooms, staff areas and volunteer areas should be designed to be accessible.

t) Accessible and bariatric paths of travel should be provided in health care facilities.

u) Despite the more limited provisions regarding the provision of accessible parking spaces in other AODA accessibility standards, the Health Care Accessibility Standard should set higher and more specific requirements for accessible parking spaces for health care facilities, such as:

i) requiring a greater number of accessible parking spots for the facility, where possible.

ii) requiring that the accessible parking spots be located as close as possible to the doors of the health care facility.

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

iv) requiring that there be accessible curb cuts and an accessible path of travel from the accessible parking spots to the health care facilities’ entrances.

v) Health Care facilities should have designated snow-piling areas outside, to prevent snow from being shoveled onto accessible paths of travel.

w) Major health care facilities such as hospitals should provide service animal relief areas close to the facility’s door, covered wherever possible, with an accessible path of travel to them.

x) When a major new health care facility like a hospital is being designed, or a major new wing or renovation is being planned, especially if public money is helping fund it, a properly trained and qualified accessibility consultant should be required to be engaged on the project from the very beginning. Their accessible design advice should be transmitted unedited to the Government or other organization for whom the project is being built and should be made public. Direct consultation with end-users with disabilities should be part of the design process from the beginning.

#17 The standard should require that:

a) Each hospital patient’s bed should have an accessible means for a patient with disabilities to notify the nursing station of a health care need, not just a button or pull-string that they may not be able to reach and operate.

b) Furniture such as seating in health care facilities should be designed with accessibility features and positioned in a manner that does not block accessible paths of travel.

c) A Help Desk should be positioned immediately inside the main entrance of any major health care facility, including hospitals, to assist patients, including patients with disabilities, to get directions or help to their destination within the facility, or to request other accommodation supports.

d) In any discrete department or area where health care services are provided, (such as an area for day surgery), the check-in desk should be located immediately adjacent to the entrance to that area, so that patients and support people with disabilities can easily reach it after entering the room or area.

e) Accessible public service counters should be installed, even in existing health care facilities, with a specified height requirement, no glass barrier creating barriers for people with hearing loss and knee space for people using a mobility device.

f) A large health care facility like a hospital should have rest areas along routes through the building so that people with fatiguing conditions can stop and rest along their route to get health care services.

g) Health care facilities such as hospitals should have emergency areas of refuge with separate ventilation in case of fire, so that people with disabilities who cannot escape the building have safe areas to wait, while being protected from life-threatening smoke.

h) The Ontario Government should make available to health care facilities and providers: guides on accessible procurement including procurement of accessible furniture, lists of vendors of accessible furniture. The Ontario Government should provide a hub for procuring accessible furniture to help health care facilities and providers reduce the cost of their acquisition.

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

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

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

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

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

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

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

a) Identify where the nearest place is where a patient can get diagnosis or treatment services where there is accessible diagnostic and treatment equipment, and to help facilitate the access of the patient with disabilities to health care services from that provider or facility.

b) Adopt and implement an interim plan to make any readily achievable accessibility improvements to the health care facility’s or provider’s existing diagnostic or treatment equipment.

c) Develop plans to purchase, rent or otherwise acquire accessible diagnostic or treatment equipment over a period of up to five years.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

a) Information or communications needed to provide a health care provider with the patient’s history, needs, symptoms or other health problems.

b) Information and communications regarding the patient’s diagnosis, prognosis or treatment, including any risks, follow-up or other health care services to secure.

c) A health care facility’s discharge instructions.

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

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

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

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

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

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

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

a) In the case of new or updated information technology or equipment to be acquired, ensure that it is accessible to people with disabilities and is designed based on principles of universal design;

b) In the case of existing information technology now being used, retrofit to be accessible except where this would pose an undue hardship and,

c) For those people who prefer this option, ensure that patients with disabilities or their support people with disabilities are assisted to use that technology, in private, at the same time as others would use it, where this would not reduce their access to the health care services to which it pertains.

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

a) All advertisements for health care promotion should have captioning and audio description.

b) All mail-out, printed and online materials focusing on health promotion should be required to be in accessible formats, regardless of any exemptions in the Information and Communication Accessibility Standard.

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

a) Attendant care.

b) Assistance with meals.

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

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

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

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

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

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

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

a) Review its public complaints process to identify any barriers at any stage in that process that could adversely affect people with disabilities filing a complaint, or about whom a complaint is filed.

b) Develop a plan for removing and preventing any accessibility barriers identified, whether or not those barriers are specified in any current AODA accessibility standards.

c) Publicly report to its governing board of directors and the public on these barriers and the college’s plans to remove and prevent such barriers, in order to achieve a barrier-free complaints process.

d) Establish and maintain a standing committee of its governing board of directors responsible for the accessibility of the services that the college offers the public, including, but not limited to its public complaints process.

e) Consult with the public, including people with disabilities, on barriers that people with disabilities experience when seeking the services of the health care professionals that that profession regulates, to be shared with the board’s Accessibility Committee. To avoid duplication of efforts and burdens on the disability community, several regulatory colleges can jointly undertake this consultation.

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

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

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

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

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

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

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

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

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

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

a) Require the Government to immediately rescind the January 13, 2021 critical care triage protocol and all directions and training materials relating to it, and should direct that these are not to be followed or considered appropriate under any situation.

b) Require the Ontario Government to immediately make public all versions of the critical care triage protocol that have been in force in Ontario, or distributed to hospitals, as well as any critical care triage protocol or directions to ambulances or other emergency services, and any reports that the government received from the Government-appointed Bioethics Table.

c) Require that if critical care triage is directed to occur during this or other emergencies, the Government shall make public on a daily basis the number of patients who are refused or denied critical care that they need and want, due to critical care triage.

e) Require that the Clinical Frailty Scale shall not be used as a tool to decide who is to ever be refused critical care they need and want.

f) Forbid the use or distribution of the “Short Term Mortality Risk Calculator” that was made available under the auspices of Critical Care Services Ontario to all Ontario hospitals.

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

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




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


Accessibility for Ontarians with Disabilities Act Alliance Update

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

Web: www.aodaalliance.org

Email: [email protected]

Twitter: @aodaalliance

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

August 5, 2021

         SUMMARY

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

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

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

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

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

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

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

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

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

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

         MORE DETAILS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

#17 The standard should require that:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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


Accessibility for Ontarians with Disabilities Act Alliance Update

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

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

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

July 23, 2021

            SUMMARY

Did we get it right? Let us know!

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

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

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

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

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

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

Here are resources that you might find helpful:

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

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

            MORE DETAILS

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

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



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


Accessibility for Ontarians with Disabilities Act Alliance Update United for a Barrier-Free Society for All People with Disabilities
Web: https://www.aodaalliance.org Email: [email protected] Twitter: @aodaalliance Facebook: https://www.facebook.com/aodaalliance/

July 23, 2021

SUMMARY

Did we get it right? Let us know!

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

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

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

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

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

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

Here are resources that you might find helpful:

1. The Health Care Standards Development Committee’s initial report, recommending what the promise Health Care Accessibility Standard should include.

2. A captioned talk by AODA Alliance Chair David Lepofsky two years ago about disability barriers in the health care system.

3. A captioned talk earlier this year by AODA Alliance Chair David Lepofsky about the disability discrimination in Ontario’s critical care triage protocol that is now embedded in Ontario hospitals.

4. The AODA Alliance website’s health care page, which documents our advocacy efforts over the past decade to make health care services accessible to people with disabilities.

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

MORE DETAILS

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

a) The Health Care Standards Development Committee should recommend more concrete actions to ensure that disability barriers are removed and prevented, rather than instead giving primary emphasis to individually accommodating patients with disabilities and having hospitals plan for accessibility.

b) The Health Care Standards Development Committee should more forcefully address all barriers in the hospital sector and the broader health care system.

c) The Health Care Accessibility Standard should ensure that all disability barriers are removed and prevented in hospitals, not just those the Accessibility Minister asked the Standards Development Committee to focus on.

d) The Health Care Accessibility Standard should not assume that smaller hospitals always need more time to comply.

e) The initial report incorrectly understates the role of the Health Care Standards Development Committee.

f) The proposed long-term objective of the Health Care Accessibility Standard should be strengthened.

g) The initial report’s vision of a barrier-free health care system should be strengthened.

h) Additional recommendations are needed to ensure accountability for accessibility within a hospital or other health care provider’s organization.

i) Specific requirements for accessibility of health care facilities’ built environment are needed.

j) Specific actions should be recommended to ensure that diagnostic and treatment equipment are accessible.

k) Specific actions are needed to ensure the accessibility of health records.

l) The initial report’s recommendations on training of health care providers should be strengthened.

m) Detailed recommendations are needed to protect the right of patients with disabilities and of any patients’ support people with disabilities to physically get to health care services.

n) Action is needed to guarantee the right of patients with disabilities to the privacy of their health care information.

o) Additional recommendations are needed to help ensure the rights of patients with disabilities and of patients’ support people with disabilities to accessible information and communication in connection with health care.

p) The initial report’s recommendations should be strengthened to effectively protect the right of patients with disabilities to the support services they need to access health care services.

q) Additional measures should be recommended to ensure right of patients with disabilities to identify their disability-related accessibility needs in advance and to request accessibility/accommodation from a health care provider or facility.

r) Patients with disabilities and support people with disabilities should be assured accessible complaint processes at health care providers’ self-governing colleges, and to have those colleges ensure that the profession they regulate are trained to meet the needs of patients with disabilities.

s) Systemic accessibility safeguards should be built into the health care system from top to bottom.

t) The experience and expertise of people with disabilities working in the health care system should be harnessed to expedite the removal and prevention of barriers facing patients, and those facing their support people with disabilities.

u) The Health Care Standards Development Committee should endorse the K-12 Education Standards Development Committee initial report’s health care recommendations.

v) Further steps should be recommended to supplement the initial report’s recommendations arising from the covid-19 pandemic.

w) The initial report’s recommendations on strengthening AODA enforcement are heartily applauded.t




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


Accessibility for Ontarians with Disabilities Act Alliance Update United for a Barrier-Free Society for All People with Disabilities
Web: https://www.aodaalliance.org Email: [email protected] Twitter: @aodaalliance Facebook: https://www.facebook.com/aodaalliance/

June 8, 2021

SUMMARY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Below you can read the following:

a) the original version of this CTV story as posted online on April 28, 2021.

b) the AODA Alliance’s April 30, 2021 email to CTV news.

c) The revised CTV online story as of May 6, 2021.

d) The May 18 and 19, 2021 emails from the AODA Alliance to CTV, and

e) The final version of the story as it now appears online.

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

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

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

For more background on this issue, check out:

1. The online captioned video talk on this issue by AODA Alliance Chair David Lepofsky, seen over 1,000 times, and

2. The AODA Alliance website’s health care page.

1 MORE DETAILS

CTV News April 28, 2021

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

Ontario hospitals on the verge of enacting ‘last resort’ triage protocols Avis Favaro
Medical Correspondent, CTV National News
@ctv_avisfavaro

Elizabeth St. Philip
CTV News
@LizTV
Ben Cousins
CTVNews.ca Writer
@cousins_ben

Published Wednesday, April 28, 2021 10:00PM EDT
TORONTO As intensive care admissions climb to dangerously high levels in Ontario, health-care workers in the province worry they might soon be forced into the worst-case scenario of choosing who gets the best care and who doesn’t.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

QUEBEC FAR FROM TRIGGERING’ TRIAGE PROTOCOLS
Other provinces have also developed similar triage protocols in the event ICU admissions exceed the available beds.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It would be one thing for your report to include our position and then any defence the Ford Government wishes to offer. CTV did not do so. Instead, it categorically states as objective fact something which is 100% incorrect, and which your reporters on this story did not reach out to us to discuss. Our position on these issues has been widely publicized to the media, including to CTV, via news releases and Twitter.
In marked contrast to the April 28, 2021 CTV online report, on the same day, Global TV News Toronto aired a story commendably bearing the accurate headline: Ontario’s COVID-19 triage protocol discriminates because of disability,’ advocates say.

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

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

David Lepofsky CM, O. Ont
Chair Accessibility for Ontarians with Disabilities Act Alliance Twitter: @davidlepofsky

CTV News Online Report Updated by May 6, 2021

Originally posted at https://www.ctvnews.ca/health/coronavirus/ontario-hospitals-on-the-verge-of-enacting-last-resort-triage-protocols-1.5406746 Ontario hospitals on the verge of enacting ‘last resort’ triage protocols Medical Correspondent, CTV National News
Contact @ctv_avisfavaro
Elizabeth St. Philip, CTV News
Contact @LizTV
Ben Cousins, CTVNews.ca Writer
Contact @cousins_ben
Published Wednesday, April 28, 2021 10:00PM EDT

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

QUEBEC FAR FROM TRIGGERING’ TRIAGE PROTOCOLS

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

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

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

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

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

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

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

intensive care admissions

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

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

To: CTVNews
From: David Lepofsky
Date: May 18, 2021

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

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

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

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

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

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

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

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

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

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

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

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

David Lepofsky CM, O. Ont
Chair Accessibility for Ontarians with Disabilities Act Alliance Twitter: @davidlepofsky May 19, 2021 Email from AODA Alliance Chair David Lepofsky to CTV News

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

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

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

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

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

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

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

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

David Lepofsky CM, O. Ont
Chair Accessibility for Ontarians with Disabilities Act Alliance Twitter: @davidlepofsky

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

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

CTV News

Ontario hospitals on the verge of enacting ‘last resort’ triage protocols Avis Favaro, Medical Correspondent
Contact @ctv_avisfavaro

Elizabeth St. Philip, CTV News
Contact @LizTV

Ben Cousins , CTVNews.ca Writer
Contact @cousins_ben

Published Wednesday, April 28, 2021 10:00PM EDT
Last Updated Wednesday, May 19, 2021 9:14AM EDT
TORONTO — As intensive care admissions climb to dangerously high levels in Ontario, health-care workers in the province worry they might soon be forced into the worst-case scenario of choosing who gets the best care and who doesn’t.

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

Related Links
Accessibility for Ontarians with Disabilities Act Alliance on triage protocols
The province also reported on Wednesday that 2,281 patients are currently hospitalized, with 877 patients in intensive care.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

QUEBEC FAR FROM TRIGGERING’ TRIAGE PROTOCOLS
Other provinces have also developed similar triage protocols in the event ICU admissions exceed the available beds.

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

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

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

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

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

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

Correction:
A previous version of this story suggested triage guidelines




Source link

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


Accessibility for Ontarians with Disabilities Act Alliance Update

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

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

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

June 8, 2021

            SUMMARY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Below you can read the following:

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

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

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

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

For more background on this issue, check out:

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

1          MORE DETAILS

 CTV News April 28, 2021

Originally posted at

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

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

Avis Favaro

Medical Correspondent, CTV National News

@ctv_avisfavaro

Elizabeth St. Philip

CTV News

@LizTV

Ben Cousins

CTVNews.ca Writer

@cousins_ben

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

QUEBEC ‘FAR FROM TRIGGERING’ TRIAGE PROTOCOLS

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

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

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

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

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

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

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

intensive care admissions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

David Lepofsky CM, O. Ont

Chair Accessibility for Ontarians with Disabilities Act Alliance

Twitter: @davidlepofsky

CTV News Online Report Updated by May 6, 2021

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

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

Medical Correspondent, CTV National News

Contact @ctv_avisfavaro

Elizabeth St. Philip, CTV News

Contact @LizTV

Ben Cousins, CTVNews.ca Writer

Contact @cousins_ben

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

QUEBEC ‘FAR FROM TRIGGERING’ TRIAGE PROTOCOLS

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

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

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

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

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

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

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

intensive care admissions

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

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

To: CTVNews

From: David Lepofsky

Date: May 18, 2021

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

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

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

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

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

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

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

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

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

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

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

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

David Lepofsky CM, O. Ont

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

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

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

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

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

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

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

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

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

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

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

David Lepofsky CM, O. Ont

Chair Accessibility for Ontarians with Disabilities Act Alliance

Twitter: @davidlepofsky

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

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

CTV News

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

Avis Favaro, Medical Correspondent

Contact @ctv_avisfavaro

Elizabeth St. Philip, CTV News

Contact @LizTV

Ben Cousins , CTVNews.ca Writer

Contact @cousins_ben

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

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

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

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

Related Links

Accessibility for Ontarians with Disabilities Act Alliance on triage protocols

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

QUEBEC ‘FAR FROM TRIGGERING’ TRIAGE PROTOCOLS

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

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

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

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

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

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

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

Correction:

A previous version of this story suggested triage guidelines



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