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


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

June 7, 2021

SUMMARY

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

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

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

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

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

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

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

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

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

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

More Details

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

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

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

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

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

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

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

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

1. Mr. Ahluwalia told us that the critical care triage topic is not suited for the format of The Current. Yet Just 13 days later, on January 18, 2021, The Current devoted a segment of its program to the critical care triage issue. Moreover, as David Lepofsky pointed out to Mr. Ahluwalia, TVO’s The Agenda with Steve Paikin, a very similar TV public affairs program, devoted a 30-minute segment on January 13, 2021 to the disability issues in critical care triage. If it is suitable for The Agenda, it is hard to see why it would be unsuitable for The Current.

2. When The Current did discuss the critical care triage issue on its January 18, 2021 program, it did not include any disability experts or advocates. It only included physicians. The host Matt Galloway had a great record covering disability issues earlier when he had been the host of CBC’s Toronto radio program Metro Morning. However, in this edition of The Current, he asked no questions of the physicians he interviewed, that raised any of disability issues.

3. Mr. Ahluwalia wrote on January 5, 2021 that the disability critical care triage issue was not suitable because it was hypothetical i.e. No one had died from a critical care triage decision. Yet that reason did not stop The Current from interviewing physicians about critical care triage just 13 days later on its January 18, 2021 program. Moreover, as David Lepofsky pointed out to Mr. Ahluwalia, The Current has elsewhere covered hypothetical topics.

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

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

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

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

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

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

This is an important issue now. South of the border, NPR has done excellent investigative work revealing terrifying and appalling disability-based discrimination in access to critical care. Check out https://www.npr.org/2020/12/21/946292119/oregon-hospitals-didnt-have-shortages-so-why-were-disabled-people-denied-care People with disabilities are already fearful of going to hospital, even if no critical care triage is now going on, because they fear the danger of being de-prioritized now or in the near future.

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

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

****

ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE
NEWS RELEASE FOR IMMEDIATE RELEASE

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

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

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

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

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

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

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

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

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

Contact: AODA Alliance Chair David Lepofsky, [email protected] For more background on this issue, check out:
1. The Government’s external advisory Bioethics Table’s September 11, 2020 draft critical care triage protocol, finally revealed days ago.
2. The December 3, 2020 open letter to the Ford Government from 64 community organizations, calling for the Government to make public the secret report on critical care triage from the Government-appointed Bioethics Table.
3. The AODA Alliance’s unanswered September 25, 2020 letter, its November 2, 2020 letter, its November 9, 2020 letter, its December 7, 2020 letter, its December 15, 2020 letter and its December 17, 2020 letter to Health Minister Christine Elliott.
4. The August 30, 2020 AODA Alliance submission to the Ford Government’s Bioethics Table, and a captioned online video of the AODA Alliance’s August 31, 2020 oral presentation to the Bioethics Table on disability discrimination concerns in critical care triage.
5. The September 1, 2020 submission and July 20, 2020 submission by the ARCH Disability Law Centre to the Bioethics Table.
6. The November 5, 2020 captioned online speech by AODA Alliance Chair David Lepofsky on the disability rights concerns with Ontario’s critical care triage protocol.
7. The AODA Alliance website’s health care page, detailing its efforts to tear down barriers in the health care system facing patients with disabilities, and our COVID-19 page, detailing our efforts to address the needs of people with disabilities during the COVID-19 crisis.

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

Thanks for bringing it to my attention.

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

Please allow me to explain.

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

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

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

I will, however, keep your suggestions in mind should there be such a case.
4. January 8, 2021 Email from AODA Alliance Chair David Lepofsky to CBC The Current’s Executive Producer Raj Ahluwalia

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

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

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

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

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

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

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

This story is well-suited for your program’s format, with which I, as a listener, am well familiar. Your program does not inflexibly always require an initial interview with a victim before an important issue is addressed. This meaty issue can fill your typical program time allocation with a great deal still left unaddressed. Ontario’s flagship provincial public affairs program, The Agenda with Steve Paikin aired a 26 minute item on the issue (with no disability advocates) back on April 14, 2020 that ran for a full 26minutes https://www.tvo.org/video/deciding-who-lives-ethics-in-a-pandemic
There is much more to say about the subject now, more than 8 months later. As one example, look at the coverage that has just gone online from one local Mississauga online publication, https://thepointer.com/article/2021-01-08/already-in-crisis-mode-ontario-hospitals-have-no-protocol-for-who-gets-priority-treatment-human-rights-advocates-say There are a number of people on different sides of this issue worth speaking to. We would be happy to assist your program in learning about those issues and seeking out people with whom to speak.

We regret that CBC news has, until now, not covered our issues that we have raised for months on this issue, despite numerous news releases, and tweets directed at CBC. As Canada’s public broadcaster, its failure to do so is troubling and puzzling.
We will continue to try to raise this with CBC news, but it remains a story that is extremely well-suited for The Current. Please let me know if you might reconsider, and if we can help.

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

Dear Raj,

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

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

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

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

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

Stay safe.

David Lepofsky CM, O. Ont
Chair Accessibility for Ontarians with Disabilities Act Alliance




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


Accessibility for Ontarians with Disabilities Act Alliance Update

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

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

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

June 7, 2021

            SUMMARY

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

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

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

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

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

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

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

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

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

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

 More Details

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

www.aodaalliance.org/healthcare

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

****

ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE

NEWS RELEASE – FOR IMMEDIATE RELEASE

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

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

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

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

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

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

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

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

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

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

For more background on this issue, check out:

  1. The Government’s external advisory Bioethics Table’s September 11, 2020 draft critical care triage protocol, finally revealed days ago.
  2. The December 3, 2020 open letter to the Ford Government from 64 community organizations, calling for the Government to make public the secret report on critical care triage from the Government-appointed Bioethics Table.
  3. The AODA Alliance’s unanswered September 25, 2020 letter, its November 2, 2020 letter, its November 9, 2020 letter, its December 7, 2020 letter, its December 15, 2020 letter and its December 17, 2020 letter to Health Minister Christine Elliott.
  4. The August 30, 2020 AODA Alliance submission to the Ford Government’s Bioethics Table, and a captioned online video of the AODA Alliance’s August 31, 2020 oral presentation to the Bioethics Table on disability discrimination concerns in critical care triage.
  5. The September 1, 2020 submission and July 20, 2020 submission by the ARCH Disability Law Centre to the Bioethics Table.
  6. The November 5, 2020 captioned online speech by AODA Alliance Chair David Lepofsky on the disability rights concerns with Ontario’s critical care triage protocol.
  7. The AODA Alliance website’s health care page, detailing its efforts to tear down barriers in the health care system facing patients with disabilities, and our COVID-19 page, detailing our efforts to address the needs of people with disabilities during the COVID-19 crisis.

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

Thanks for bringing it to my attention.

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

Please allow me to explain.

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

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

the systems are so different that any comparisons are inaccurate.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dear Raj,

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

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

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

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

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

Stay safe.

David Lepofsky CM, O. Ont

Chair Accessibility for Ontarians with Disabilities Act Alliance



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COVID-19: Toronto woman charged after gatherings reportedly held at Innisfil Airbnb


A Toronto woman has been charged in connection with an Airbnb rental in Innisfil, Ont., after gatherings were reported to be taking place at the address amid the third wave of the COVID-19 pandemic.

Under Ontario’s current emergency orders, short-term rentals are only allowed for people who are in need of housing.

All gatherings are also currently prohibited in order to curb the spread of the novel coronavirus.

South Simcoe Police said they received complaints from the community about gatherings at an address in the 25th Sideroad and 9th Line area.

On Wednesday, the Toronto woman and Airbnb renter was served a provincial offences notice under the Reopening Ontario Act.

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Ontario’s COVID-19 triage protocol ‘discriminates because of disability,’ advocates say


When Tracy Odell experienced bleeding in her stomach last summer during the first wave of the COVID-19 pandemic, she went to hospital but vowed she would not return.

“I don’t feel safe in hospitals and a lot of people with disabilities similar to mine, where you need this much assistance, don’t feel safe in a hospital,” she said.

Odell was born with spinal muscular atrophy and requires assistance to complete many daily tasks.

Now, amid the third wave and with critical care units filling up, Odell said she fears if she ever needed the care, she would not be able to get it.

Read more:
Pushing Ontario’s ICUs to the brink — How some hospitals are preparing for the worst

“I, personally, wouldn’t go to a hospital. I would feel it would be a waste of time and I’d feel very unsafe to go thereIt’s a real indictment, I think, of our system, that people who have disabilities, have severe needs, don’t feel safe in a place where everyone’s supposed to be safe,” she said.

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Odell is most concerned about a “critical care triage protocol” that could be activated in Ontario.

It would essentially allow health-care providers to decide who gets potentially life-saving care and who doesn’t.

Under the guidelines, as set out in a draft protocol circulating among hospitals, patients would be ranked on their likelihood to survive one year after the onset of critical illness.

Read more:
Ontario reports 3,480 new COVID-19 cases, 24 deaths

“Patients who have a high likelihood of dying within twelve months from the onset of their episode of critical illness (based on an evaluation of their clinical presentation at the point of triage) would have a lower priority for critical care resources,” states the document.

Odell says it’s tough to predict who will survive an illness.

“They have to guess who’s going to last a year ... As a child with my disability, my projected life expectancy was like a kid … they didn’t think I’d live to be a teenager and here I am retired, so it’s a very hard thing to judge,” said Odell.

Disability advocates have been raising alarm bells over the triage protocol for months.

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David Lepofsky, of the Accessibility for Ontarians with Disabilities Act Alliance, sent multiple letters to Minister of Health Christine Elliott demanding transparency, arguing “the Ontario government’s pervasive secrecy over its critical care triage plans has made many people with disabilities terrified, angry and distrustful.”

Read more:
‘She deteriorated like she fell off a cliff’ — Vaccinated Ontario senior battles COVID-19 in hospital

“People with disabilities have disproportionately had to suffer for the past year from the most severe aspects of COVID … People with disabilities are disproportionately prone to end up in intensive care units and die from the disease,” said Lepofsky.

“Now we face the double cruelty that we are disproportionately prone to get told, ‘No, you can’t have that life-saving care.’”

Lepofsky said the document that is circulating, while not finalized, is problematic, unethical and discriminatory.

“The rules that have been given to intensive care units for deciding who gets critical care and who doesn’t, if they have to ration, may look fine because they’re full of medical jargon, but they actually explicitly discriminate because of disability,” he said.

“We agree there should be a protocol, but it can’t be one that discriminates because of disability. That’s illegal.”

John Mossa, who is living with muscular dystrophy, has been homebound for more than a year, afraid he would contract COVID-19 if he went outside and not survive it.

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Read more:
COVID-19 — Critical care nurses in high demand in Ontario as 3rd wave puts pressure on hospitals

“COVID is a very serious disease for me … if I do get COVID, I would probably become very ill and pass away because of my poor respiratory condition. I have about 30 per cent lung capacity due to my muscular dystrophy so COVID is very serious. It’s been a very scary time,” he said.

Never more frightening than right now, Mossa said, amid a surging third wave with a record number of patients in Ontario’s critical care units and the potential for triaging life-saving care.

“The people that would be affected the most are the least considered to get care … I’m afraid, I’m totally afraid to go to hospital right now,” he said.

A few weeks ago, Mossa said, he had a hip accident but he has avoided the hospital, even though he is suffering and should seek medical help.

Read more:
‘A lot of suffering’ — Front-line health-care workers describe the moments before death by COVID-19

“I should be considering going to hospital, but I’m not going to go to hospital because I know that I won’t get the care I need and if it gets any worse. I know that I wouldn’t be given an ICU bed,” he said.

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On Wednesday, when asked about the triage protocol, Elliott said it has not yet been activated.

That was echoed by Dr. James Downar, a palliative and critical care physician in Ottawa who co-wrote Ontario’s ICU protocol.

Read more:
The complications of getting COVID-19 vaccinations for non-residents in Ontario

“I don’t think that there’s any plan to initiate a triage process in the next couple of days. I think a lot is going to depend on which way our ICU numbers go. They have been climbing at a fairly alarming rate,” he said.

On concerns by advocates that the protocol discriminates against people with disabilities, Downar said, “The only criterion in the triage plan is mortality risk.”

“We absolutely don’t want to make any judgments about whose life is more valuable, certainly nothing based on ability, disability or need for accommodations … If you value all lives equally, that, I think, is the strongest argument for using an approach that would save as many lives as you can,” he said.


Click to play video: 'Ontario to allow hospitals to move patients to long-term care, retirement homes to create room for COVID-19 patients'







Ontario to allow hospitals to move patients to long-term care, retirement homes to create room for COVID-19 patients


Ontario to allow hospitals to move patients to long-term care, retirement homes to create room for COVID-19 patients





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As The Ford Government Back-Pedals and Scrambles to Re-Invent Its Response to the COVID-19 Crisis, Will It Make Public and Fix Its Disability-Discriminatory 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/

April 22, 2021

SUMMARY

The Ford Government appears shell-shocked, as it flip-flops, back-tracks and scrambles to respond to the imminent threat that Ontario will run out of space and staff to deliver life-saving critical care to all patients who need it.
Here are yet more recent developments in the non-partisan campaign to try to ensure that people with disabilities will not face disability discrimination in access to life-saving critical care, if that care is rationed or triaged. Regrettably, the Government has shown no willingness to lift the fog of secrecy over its critical care triage plans, to talk directly to disability advocates and organizations about it, or to fix the serious problems with its critical care triage protocol and plans. 1. The Latest Developments in a Nutshell

1. On Tuesday night, April 20, 2021, a very successful online virtual public forum was held to discuss the critical care triage issue as it affects people with disabilities. Key speakers were AODA Alliance Chair David Lepofsky and ARCH Disability Law Centre Executive Director Robert Lattanzio. We are thrilled that an impressive 280 people took part. They got action tips on how to help with our fight against the danger of disability discrimination in critical care triage, if triage takes place.
We all wish there was more time to take all the questions that so many wanted to ask. A huge thank you goes to all who helped organize this event, and all who took the time to attend it.
2. The disability objections to Ontarios controversial critical care triage protocol and plans were raised on Tuesday, April 20 and Wednesday April 21, 2021 in the Ontario Legislatures Question Period. Below, you can read these exchanges and our reflections on them.

3. On Wednesday, April 21, 2022, Ontario New Democratic Party disabilities critic Joel Harden held a virtual Queens Park news conference, focusing on disability objections to Ontarios critical care triage protocol and plans. The speakers that MPP Harden invited to make remarks included AODA Alliance Chair David Lepofsky, ARCH Disability Law Centre legal counsel Mariam Shanouda, and Disability Justice Network of Ontario co-founder Sarah Jama. The AODA Alliance appreciated the opportunity to contribute to this event. As a non-partisan coalition, we take part in news conferences convened by any of the political parties to which we are invited, where the event provides a helpful platform to raise our issues.
Arising out of this well-attended news conference, the NDP issued a news release on April 21, 2022, set out below. It includes a quotation from AODA Alliance Chair David Lepofsky setting out our position. It includes quotations from the other speakers as well.
4. The influential publication QP Briefing ran a strong article on April 21, 2021, arising from that days news conference. We set it out below.
5. The April 22, 2021 online edition of the Ottawa Citizen includes a guest column on the triage issue by NDP disabilities critic Joel Harden. We also provide it for you in this Update.
2. Yet More Reflections on Ongoing Ford Government Failure to Respond to Our Disability Concerns with Its Critical Care Triage Protocol and Plans

1. We have gotten more and more feedback from people with disabilities about the critical care triage disability objections. We keep hearing that people are frightened and angry. As if the COVID-19 pandemic was not bad enough, this issue makes them feel even more vulnerable and at risk.
At the same time, the message we all hear from the public around Ontario over the past six days has been louder than ever: The Ford Governments response to the COVID-19 pandemic needs a major re-think, and fast. Weve added that this rapid re-think needs to include Ontarios critical care triage protocol and plans.
2. In the Legislatures Question Period this week, the Ford Government offered the public evasions and contradictions on this issue.
On Tuesday, April 20, 2021, Health Minister Christine Elliott made a statement that many understood as denying that there even is an Ontario critical care triage protocol. She stated:
I think one thing is really important, Speaker, and I would say to the member opposite, through you, that the speaker is alleging that there is a triage protocol in place in Ontario. There is not; there is not.
This, of course, would contradict the January 13, 2021 Critical Care Triage Protocol, which has been posted on the AODA Alliance website for three months. It would contradict the January 23, 2021 online webinar provided by Critical Care Services Ontario which tries to convince doctors to ready themselves to use that protocol if it becomes necessary. It would contradict the interview on the April 21, 2021 CBC Ottawa Morning radio program in which Dr. James Downar, the author or co-author of that protocol, defended it.
On Twitter, a number of members of the public angrily denounced the Ministers statement. The next day, April 21, 2021, Health Minister Christine Elliott acknowledged that there is a critical care triage protocol, but said it has not yet gone into operation. She stated:
I can certainly advise the member that no triage protocol has been activated or approved by the government of Ontario.
There have been discussions. I understand that there were a number of disability groups that were concerned with respect to a previous draft that was prepared earlier this year. That was then reviewed with the human rights commission. There have been a number of discussions about modifications to it. But nothing has been activated, nothing has been approved by this government.
3. The Health Minister said that there were objections from disability groups to an earlier draft of the critical care triage protocol. That is true. However, we have repeatedly made public that we also object to the most recent version of it, the one issued to hospitals dated January 13, 2021.
4. Also in the Legislature, the Ford Government refused to answer a clear, simple and direct question on what instructions regarding critical care triage have been given to ambulance crews. In Question Period on April 21, 2021, MPP Joel Harden asked Health Minister Elliott:
Speaker, I want to ask the minister, who is very well versed in these issues: What instructions have been sent out and drafted to emergency medical technicians, ambulance services or health professionals about who will live and who will die in our ICUs?
The Ministers response did not answer this important question. The AODA Alliance asked the Health Minister the same thing two months ago in our February 25, 2021 letter to her. The Government has never answered that question or that letter.
In Health Minister Elliotts April 21, 2021 answer in Question Period, an impression may be created that the Government has been consulting on the critical care triage protocol. No one has consulted us on the January 13, 2021 Critical Care Triage Protocol.
5. In its defence, the Ford Government said it is now reaching out to others outside Ontario, to see if they can bring more doctors, nurses and other needed health professionals to help out in Ontarios intensive care units. This is a much-needed measure. It could avert the need for any critical care triage.
However, we must ask why the Ford Government was not doing this weeks and months ago, when it was given ample early warning that Ontario was at risk of critical care overload. Had it done so, we would not be facing the imminent danger we now are confronting. The Ford Government could have had in place detailed emergency plans to shuttle health care professionals to Ontario, with prior clearances from the relevant licensing bodies so they can work here in this emergency. This further illustrates Ontarios failure to properly prepare.
For more information on these issues, visit the AODA Alliance websites health care page. MORE DETAILS

Ontario Hansard April 20, 2021
Question Period
COVID-19 RESPONSE
Ms. Sara Singh:My question is for the Premier. For months, experts including members of the Premiers own science table have been sounding the alarm about dangerously high ICU levels, and today we learned that there are over 760 people fighting for their lives in Ontario ICUs, Speaker.

But the Premier failed to act. They failed to implement paid sick days. They failed to vaccinate workers in hot spots, and now ICUs in communities like Brampton are overflowing. Pediatric hospitals are sacrificing their beds. Patients are being transferred to hospitals around the province outside of their communities, and doctors and nurses are being put in the horrific position of having to make decisions on who will receive life-saving supports and who will not.
Speaker, whywith all of the evidence in front of this government; all of the warnings from their own science tables and medical expertsdoes this government continue to ignore the crisis in our ICUs? The Speaker (Hon. Ted Arnott):Minister of Health.
Hon. Christine Elliott:We have been listening to the experts all along. We have been listening to their evidence. I think one thing is really important, Speaker, and I would say to the member opposite, through you, that the speaker is alleging that there is a triage protocol in place in Ontario. There is not; there is not.
What we are doing is building capacity in our hospitals. We are making sure there are two aspects to what we need to deal with here. We need to blunt the transmission of COVID-19 in communities, as well as, right now, we need to build capacity in our hospitals, which are we are doing.
We are in contact with the CEOs of the hospitals on virtually a daily basis. They are working very hard to create spaces.
We are creating capacity so that everyone in Ontario who needs to be admitted to hospital and needs to be in an intensive care bed will have a bed available for them.

The Speaker (Hon. Ted Arnott):Supplementary?
Ms. Sara Singh:Mr. Speaker, with all due respect to the Minister of Health, that response shows us how out of touch with reality this minister is. Doctors are sounding the alarm bells and this government continues to ignore their pleas for help. The government is following a pattern of denying the problem and acting too late.
Now the government is begging other provinces for help, but refusing the federal governments assistance and the assistance of the Red Cross. Speaker, health care systems in other provinces are also fighting COVID-19. They need their health care workers just as much as we do. It was this Premiers responsibility and this Minister of Healths responsibility to help protect people here in Ontario, and they failed to do that at every step of the pandemic.
This is a national and global failure and it is upsetting and heartbreaking to know that they could have acted and they chose not to. With months to plan for this crisis, why did this Premier fail to address the issues causing ICU capacity to rise, and why does the government think its another governments responsibility to come and clean up their mess? Interjections.
The Speaker (Hon. Ted Arnott):Ill ask members to please take their seats and allow the Minister of Health to reply.
Hon. Christine Elliott:Again, through you, Mr. Speaker, I would say to the member opposite that what youre suggesting is simply not the case. Since the beginning of this pandemic, we have been working hard to make sure that we have both the health human resources Ms. Sara Singh:Why are people dying?
Hon. Christine Elliott:and the physical capacity in order to deal with whats been happening. We have created Interjection.
Hon. Christine Elliott:I dont know if the member opposite really wants to hear me, shes
The Speaker (Hon. Ted Arnott):Im going to ask the Minister of Health to take her seat. Interjections.
The Speaker (Hon. Ted Arnott):Im going to ask the member for Brampton Centre to come to order. Im going to ask the government House leader to come to order. Interjection.
The Speaker (Hon. Ted Arnott):Always innocent.
Im going to recognize the Minister of Health to conclude her response.
Hon. Christine Elliott:Thank you, Speaker. To continue, since the beginning of this pandemic, we have created over 3,100 new hospital beds, which is the equivalent of six new community hospitals. We have also added 14% to intensive care capacity, which is significant in the context of this pandemic.
We have also added resources in order to be able to deal with the health human resources that we need. We have allowed for the deployment of people from one sector to another.
Finally, I would say with respect to whats happening with other provinces and other organizations coming in to help us, were very grateful for the help thats being offered by the other provinces and were very grateful to the federal government for their offer of assistance from the Red Cross as well. We know that we need help right now. We have the physical capacity. We need some more health human resources and we are using those resources to make sure everyone who needs help will get help in our hospitals. Ontario Hansard April 21, 2021
Question Period
COVID-19 RESPONSE
Mr. Joel Harden:My question is to the Minister of Health. As many people have already raised this morning, our ICUs are near the breaking point. Were getting close to 100 patients now being treated in our ICUs, but despite this fact, the government has refused to make public its plans for critical care triage in those ICUs. We dont know. People with disabilities and their loved ones and advocacy organizations still dont know what has been negotiated in secret and what actually will happen when those life-and-death decisions take place but, at home, Dr. David Neilipovitz, the ICU director at the Ottawa Hospital told CBC News, It would be naïve for us to think that triage or changes in the standard of care have not already come about. Lets think about that.
Yesterday, the minister rose in this House and said there is no clinical triage protocol, but we know that hospitals received one on January 13. We also know that a training was done for medical professionals on YouTube on the 23rd of January.
Speaker, I want to ask the minister, who is very well versed in these issues: What instructions have been sent out and drafted to emergency medical technicians, ambulance services or health professionals about who will live and who will die in our ICUs? The Speaker (Hon. Ted Arnott):Minister of health.
Hon. Christine Elliott:I can certainly advise the member that no triage protocol has been activated or approved by the government of Ontario.
There have been discussions. I understand that there were a number of disability groups that were concerned with respect to a previous draft that was prepared earlier this year. That was then reviewed with the human rights commission. There have been a number of discussions about modifications to it. But nothing has been activated, nothing has been approved by this government.
What we are doing instead is to create the capacity so that we can care for all the patients that come into our hospital, whether theyre COVID patients or emergency patients that come in otherwise. We have created over 3,100 beds since this pandemic began, increased our intensive care capacity by 14%.
We are looking at bringing in other health professionals from other provinces and other countries so that, notwithstanding having the creation of those spaces, we will also have the health human resources in order to be able to operate them safely, carefully and professionally. The Speaker (Hon. Ted Arnott):The supplementary question.
Mr. Joel Harden:Earlier today, I was joined by disability rights leaders for a media conference, all of whom are calling upon this government to make public its plans for critical care triage. Speaker, I know this minister served as Patient Ombudsperson for this province for years and knows full well that every patient, physiotypical, neurotypical or not, has a right to their care at the point of service. But the minister also should know that hospitals got a critical triage protocol on January 13, that a training has been conducted. So I must admit my extreme frustration that today, when our ICUs are nearing capacity, we are still hearing, There are no plans.
Speaker, let me say very clearly for this House, I didnt know, at this point: not an acceptable answer. I was just following orders, at this point: not an acceptable answer. Please forgive me to disabled patients and their loved ones: not an acceptable answer.
Will you make sure that people with disabilities are not discriminated against in the ICUs: yes or no?
The Speaker (Hon. Ted Arnott):Again, Ill ask the members to make their comments through the Chair. The Minister of Health to respond.
Hon. Christine Elliott:The rights of people with disabilities has been one of my strongest passions since I got to this place 15 years ago, and I dont need to take any instructions from anybody Ms. Andrea Horwath:Ha!
Hon. Christine Elliott:including the leader of the official opposition, about this issue. I have always stood up for the rights of people with disabilities Interjections.
The Speaker (Hon. Ted Arnott):Order. Opposition, come to order. The member for NorthumberlandPeterborough South, come to order. The Minister of Health, please reply.

Hon. Christine Elliott:The rights of people with disabilities have been one of the issues that we have cared about and dealt with as part of this entire pandemic. The rights of people with disabilities are equally as important as the rights of anybody else. That is something that Ive always stood by, that
I always will stand by. I can assure the member opposite that no triage protocol has been approved. A draft was circulated in January. That was not approved by this government. It was something that had been discussed. But I understand that the rights of people with disabilities have been brought forward. I asked them Interjections.
The Speaker (Hon. Ted Arnott):The member for Ottawa Centre, come to order. The member for Hamilton WestAncasterDundas, come to order. The minister, please conclude her response.
Hon. Christine Elliott:I asked that this issue be dealt with, with the people with disabilities groups, as well as with the Ontario Human Rights Commission. There have been numerous discussions, but nothing has been activated yet, and I can assure you nothing has been approved at this point. We are working to make sure The Speaker (Hon. Ted Arnott):Thank you. The next question.

QP Briefing April 21, 2021

Originally posted at https://www.qpbriefing.com/2021/04/21/solicitor-general-brushes-off-disability-advocate-concerns-about-triage-protocol/ SOLICITOR GENERAL BRUSHES OFF DISABILITY ADVOCATE CONCERNS ABOUT TRIAGE PROTOCOL
Home Health And COVID-19 Solicitor General Brushes Off Disability Advocate Concerns About Triage Protocol Solicitor general brushes off disability advocate concerns about triage protocol
Asked about concerns raised by disability advocates for months that the provincial triage guidelines discriminate against them, Ontario’s solicitor general got upset.

“There is no triage protocol being used,” Sylvia Jones said, cutting off the question from QP Briefing. “I am very frustrated that you continue to suggest that there is a triage protocol in place in the province of Ontario in our hospitals. Talk to the hospital CEOs, talk to the minister of health. It is not accurate.”

Jones and Health Minister Christine Elliott said the government has not approved a plan for deciding who lives and who dies should Ontario intensive care units run out of life-saving equipment.

But while it has not been officially triggered, the preparation for the nightmare scenario is real.

Hospitals received training on draft guidelines, which leaked in January, and are preparing to use them.

Doctors and nurses have told reporters that due to rising case counts in the third wave of COVID-19, triage decisions could be days away. Some say that while the protocol has not been implemented, decisions to ration or triage care are already happening, including the cancellation of scheduled surgeries.

And advocates for people with disabilities say they worry that if and when the time comes, they will be seen as less deserving of care than someone without disabilities, because of two key parts of the protocol.

One is the inclusion of the “clinical frailty scale,” which outlines how dependent people are on others to live their lives.

It “asks questions like, can you get dressed yourself, without assistance? Can you go grocery shopping without assistance? Can you use a telephone without assistance?” said Mariam Shanouda, a lawyer with Toronto’s ARCH Disability Law Centre. “And if you answer no, I can’t do any of these things without assistance, then you are less likely to access critical care. This is disability discrimination in a nutshell.”

The other major issue is that doctors are asked to estimate patients’ likelihood of surviving the next 12 months. That timeline is too long, advocates say, and could force medical staff to “guesstimate”

“Guessing is not science,” said David Lepofsky, chair of the AODA Alliance. “And it doesn’t become science because the person doing it, or who’s being mandated to do it, has a white coat on and a stethoscope.”

Another issue is that advocates don’t know whether the protocol from January is unchanged, or whether a new version is being prepared. Lepofsky said the government refuses to answer any of his calls.

“The solution is for the government to immediately make public their step-by-step plan for rolling this out, which they obviously have, so we can know what they’re planning to do,” he said.

The Ministry of Health should speak directly to disability advocacy groups like his, “so we can have input into this, rather than having to communicate with the human shields behind whom they’re hiding, such as the Bioethics Table,” he said.

And each hospital that’s done a triaging drill should make the results of that drill public, “so the public can know how much these simulations for triage might vary, depending on which hospital you happen to go to,” Lepofsky said.

Opposition leaders also called for transparency.

Green Leader Mike Schreiner said he shares the concerns of disability advocates, and argued the government should release the guidelines publicly.

He also noted that ODSP payments have not gone up recently, despite the fact that “Ontarians with disabilities have borne a disproportionate burden in this pandemic.”

Liberal health critic John Fraser said Ontario is “dangerously close to asking clinicians to decide who gets care and who doesn’t. The government needs to be open and transparent about the status of the triage protocol. I think the disability advocates have a legitimate concern. The government should have been listening from the start and needs to engage with them now.”

In question period on Wednesday, Joel Harden, the NDP critic for accessibility and persons with disabilities, quoted Dr. David Neilipovitz, the ICU director at the Ottawa Hospital, who told CBC: “‘It would be naive for us to think that triage or changes in the standard of care have not already come about.’ Lets think about that,” he said.

“Yesterday, the minister rose in this house and said there is no clinical triage protocol, but we know that hospitals received one on January 13. We also know that a training was done for medical professionals on YouTube on the 23rd of January. Speaker, I want to ask the minister, who is very well versed in these issues: what instructions have been sent out and drafted to emergency medical technicians, ambulance services or health professionals about who will live and who will die in our ICUs?”

Elliott repeated that there is no official triage protocol yet.

“There have been discussions,” she said. “I understand that there were a number of disability groups that were concerned with respect to a previous draft that was prepared earlier this year. That was then reviewed with the human rights commission. There have been a number of discussions about modifications to it. But nothing has been activated, nothing has been approved by this government.”

It was indeed reviewed with the Ontario Human Rights Commission in December, but the organization still disapproves. Chief Commissioner Ena Chadha sent a letter to Elliott in March outlining concerns with the draft protocol and called on the government to publicly release it.

Harden said “there are no plans” is “not an acceptable answer.”

Elliott disagreed.

“The rights of people with disabilities has been one of my strongest passions since I got to this place 15 years ago,” she said, “and I dont need to take any instructions from anybody”

NDP Leader Andrea Horwath interjected, “Ha!”

“including the leader of the Official Opposition, about this issue,” Elliott finished.

Ottawa Citizen Online April 22, 2021

Originally posted at https://ottawacitizen.com/opinion/harden-ontarios-covid-triage-protocol-must-respect-rights-of-the-disabled Opinion Columnists

Harden: Ontarios COVID triage protocol must respect rights of the disabled

Just over a year ago, 200+ community organizations urged the Ford government to remove disability discrimination from the triage guidance. The response so far: silence.

Joel Harden

The Children’s Hospital of Eastern Ontario is accepting adult critical care patients due to the growing severity of the COVID-19 crisis. PHOTO BY ERROL MCGIHON /Errol McGihon
These are perilous times in Ontario. On April 16, 2021, a record-breaking 4,812 new COVID-19 cases were recorded.

At the moment, more than 750 patients are being treated in Ontarios ICUs. For the first time in its 47-year history, the Childrens Hospital of Eastern Ontario is accepting adult COVID-19 patients who require critical care.

There is a real possibility that by the end of the month, hospitals will have to ration or triage critical care due to surging COVID case counts. Triage refers to how hospitals will decide who gets life-saving care if ICUs are overwhelmed with COVID patients and they run out of beds.

Along with disability and human rights leaders, I am deeply concerned that the Doug Ford governments current clinical triage protocol includes disability discrimination, and hasnt been developed with adequate consultation.

Whats wrong with the triage protocol that was circulated to hospitals on Jan. 13, 2021? Firstly, it includes a clinical frailty scale, meaning that a patient over the age of 65 with a progressive disease (Alzheimers, Muscular Dystrophy etc.) will be evaluated based on how they can perform 11 different activities of daily living without assistance. This is blatantly discriminatory against people with disabilities, millions of whom require varying degrees of assistance to live their fullest lives.

Secondly, it includes criteria that assess the patients likelihood of mortality one year from their admission to hospital. Even ICU doctors have conceded that such assessments are guesstimates rather than an exact science. This leaves the door open to subjective judgments about a persons quality of life that could discriminate against people with disabilities, as opposed to a shorter-term assessment of mortality.

No one is suggesting that Ontario shouldnt have a triage protocol in place if ICUs are filled to maximum capacity. What we are saying is that the protocol must respect human rights and the rule of law. It also needs to be discussed openly and transparently, but this government has taken the opposite approach.

Members of the governments own bioethics table have criticized the secrecy with which the government has been handling its approach to clinical triage. Noting that the process must be informed, transparent, inclusive, reasonable and subject to revision in light of new information or legitimate concerns or claims, they believe that Ontario has failed to meet these requirements.

News media have also reported that the Ford government is considering suspending parts of the Health Care Consent Act (HCCA), which requires doctors to obtain consent from a patient or their substitute decision maker before they withdraw critical care.

It is unacceptable for the government to make life-and-death decisions by a secret memo. If they are considering suspending the HCCA, they must make the details public and have a proper debate in the legislature.

Just over a year ago, 200+ community organizations wrote to the Ford government urging it to remove disability discrimination from the provinces triage protocol. For more than a year, the government has been aware of these concerns and had ample time to consult with disability and human rights leaders in developing its clinical triage protocol.

How has the Ford government responded? With complete silence. It has ignored direct appeals from disability groups, the Ontario Human Rights Commission and the opposition, all of whom have expressed concerns with the Jan. 13 emergency standard of care triage protocol.

What message does this send to the 2.6 million people with disabilities who live in Ontario? People with disabilities are more likely to get COVID-19, and to be seriously impacted by the virus. This government must assure them that they wont face any discrimination in the awful event that triage becomes necessary.

Its time to stop the secrecy surrounding critical care triage. Its time for the Ford government to remove disability discrimination from its clinical triage protocol.

Joel Harden is the NDP MPP for Ottawa Centre and opposition critic, accessibility and persons with disabilities.

New Democratic Party April 21, 2021 News Release

NDP MPP Joel Harden, disability rights advocates call on Ford to remove disability discrimination from triage protocol
QUEENS PARK MPP Joel Harden (Ottawa Centre), the NDPs critic for Accessibility and Persons with Disabilities, called on the Ford government to withdraw disability discrimination from Ontarios clinical triage protocol and immediately hold a public consultation on how care will be triaged if ICUs become too overwhelmed to fully treat everyone.
Harden was joined at a Wednesday morning press conference by David Lepofsky, Chair of the AODA Alliance, Sarah Jama, Co-founder of the Disability Justice Network of Ontario, and Mariam Shanouda, Staff Lawyer at ARCH Disability Law Centre, all of whom are expressing deep concerns about the protocol and the secrecy surrounding it.
We should never have gotten to the point where critical care triage became a possibility, but the Ford governments choice to put money and politics ahead of public health has brought ICUs to the breaking point, said Harden. The government must remove disability discrimination from its triage protocol, and assure people with disabilities that they wont be deprioritized for life-saving critical care.
The Ford government continues to ignore human rights concerns raised by disability rights leaders, and the Ontario Human Rights Commission about its approach to clinical triage. They have not held open consultations, and it was disability organizations and the opposition, not the government, that made public the January 13, 2021 triage protocol which was sent to hospitals.
This entire process has been cloaked in secrecy, said Harden. Thats wrong, and its time for the government to stop making life-and-death decisions behind closed doors. Quotes:
David Lepofsky, Chair, AODA Alliance
“Our non-partisan grassroots coalition agrees that Ontario must be prepared for the possibility of critical care triage, but Ontarios plan must include a triage protocol, mandated by the Legislature, that does not violate the Charter of Rights or the Ontario Human Rights Code by discriminating against people with disabilities or denying them due process. They have already disproportionately suffered the hardships of the COVID-19 pandemic.

Sarah Jama, Co-founder, Disability Justice Network of Ontario
We are in a time of deep crisis, and need to offer paid sick days and increase social assistance rates for community members without work from home jobs, or a safety net. But rather than make these preventative policy decisions, our government has created conditions where doctors must rank who gets to live and who gets to die.

Mariam Shanouda, Staff Lawyer, ARCH Disability Law Centre
“Health care, including critical care during a pandemic, must be available free from unlawful discrimination. This is a life and death non-partisan issue. The choice must not be whether we have no triage plan or one that discriminates. And lets be clear, the current plan is discriminatory and will disproportionately impact persons with disabilities who have already disproportionately experienced devastating consequences from this pandemic.”




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As The Ford Government Back-Pedals and Scrambles to Re-Invent Its Response to the COVID-19 Crisis, Will It Make Public and Fix Its Disability-Discriminatory 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/

As The Ford Government Back-Pedals and Scrambles to Re-Invent Its Response to the COVID-19 Crisis, Will It Make Public and Fix Its Disability-Discriminatory Critical Care Triage Plans?

April 22, 2021

            SUMMARY

The Ford Government appears shell-shocked, as it flip-flops, back-tracks and scrambles to respond to the imminent threat that Ontario will run out of space and staff to deliver life-saving critical care to all patients who need it.

Here are yet more recent developments in the non-partisan campaign to try to ensure that people with disabilities will not face disability discrimination in access to life-saving critical care, if that care is rationed or “triaged.” Regrettably, the Government has shown no willingness to lift the fog of secrecy over its critical care triage plans, to talk directly to disability advocates and organizations about it, or to fix the serious problems with its critical care triage protocol and plans.

1. The Latest Developments in a Nutshell

  1. On Tuesday night, April 20, 2021, a very successful online virtual public forum was held to discuss the critical care triage issue as it affects people with disabilities. Key speakers were AODA Alliance Chair David Lepofsky and ARCH Disability Law Centre Executive Director Robert Lattanzio. We are thrilled that an impressive 280 people took part. They got action tips on how to help with our fight against the danger of disability discrimination in critical care triage, if triage takes place.

We all wish there was more time to take all the questions that so many wanted to ask. A huge thank you goes to all who helped organize this event, and all who took the time to attend it.

  1. The disability objections to Ontario’s controversial critical care triage protocol and plans were raised on Tuesday, April 20 and Wednesday April 21, 2021 in the Ontario Legislature’s Question Period. Below, you can read these exchanges and our reflections on them.
  1. On Wednesday, April 21, 2022, Ontario New Democratic Party disabilities critic Joel Harden held a virtual Queen’s Park news conference, focusing on disability objections to Ontario’s critical care triage protocol and plans. The speakers that MPP Harden invited to make remarks included AODA Alliance Chair David Lepofsky, ARCH Disability Law Centre legal counsel Mariam Shanouda, and Disability Justice Network of Ontario co-founder Sarah Jama. The AODA Alliance appreciated the opportunity to contribute to this event. As a non-partisan coalition, we take part in news conferences convened by any of the political parties to which we are invited, where the event provides a helpful platform to raise our issues.

Arising out of this well-attended news conference, the NDP issued a news release on April 21, 2022, set out below. It includes a quotation from AODA Alliance Chair David Lepofsky setting out our position. It includes quotations from the other speakers as well.

  1. The influential publication QP Briefing ran a strong article on April 21, 2021, arising from that day’s news conference. We set it out below.
  2. The April 22, 2021 online edition of the Ottawa Citizen includes a guest column on the triage issue by NDP disabilities critic Joel Harden. We also provide it for you in this Update.

2. Yet More Reflections on Ongoing Ford Government Failure to Respond to Our Disability Concerns with Its Critical Care Triage Protocol and Plans

  1. We have gotten more and more feedback from people with disabilities about the critical care triage disability objections. We keep hearing that people are frightened and angry. As if the COVID-19 pandemic was not bad enough, this issue makes them feel even more vulnerable and at risk.

At the same time, the message we all hear from the public around Ontario over the past six days has been louder than ever: The Ford Government’s response to the COVID-19 pandemic needs a major re-think, and fast. We’ve added that this rapid re-think needs to include Ontario’s critical care triage protocol and plans.

  1. In the Legislature’s Question Period this week, the Ford Government offered the public evasions and contradictions on this issue.

On Tuesday, April 20, 2021, Health Minister Christine Elliott made a statement that many understood as denying that there even is an Ontario critical care triage protocol.  She stated:

“I think one thing is really important, Speaker, and I would say to the member opposite, through you, that the speaker is alleging that there is a triage protocol in place in Ontario. There is not; there is not.”

This, of course, would contradict the January 13, 2021 Critical Care Triage Protocol, which has been posted on the AODA Alliance website for three months. It would contradict the January 23, 2021 online webinar provided by Critical Care Services Ontario which tries to convince doctors to ready themselves to use that protocol if it becomes necessary. It would contradict the interview on the April 21, 2021 CBC Ottawa Morning radio program in which Dr. James Downar, the author or co-author of that protocol, defended it.

On Twitter, a number of members of the public angrily denounced the Minister’s statement. The next day, April 21, 2021, Health Minister Christine Elliott acknowledged that there is a critical care triage protocol, but said it has not yet gone into operation. She stated:

“I can certainly advise the member that no triage protocol has been activated or approved by the government of Ontario.

There have been discussions. I understand that there were a number of disability groups that were concerned with respect to a previous draft that was prepared earlier this year. That was then reviewed with the human rights commission. There have been a number of discussions about modifications to it. But nothing has been activated, nothing has been approved by this government.”

  1. The Health Minister said that there were objections from disability groups to an earlier draft of the critical care triage protocol. That is true. However, we have repeatedly made public that we also object to the most recent version of it, the one issued to hospitals dated January 13, 2021.
  2. Also in the Legislature, the Ford Government refused to answer a clear, simple and direct question on what instructions regarding critical care triage have been given to ambulance crews. In Question Period on April 21, 2021, MPP Joel Harden asked Health Minister Elliott:

“Speaker, I want to ask the minister, who is very well versed in these issues: What instructions have been sent out and drafted to emergency medical technicians, ambulance services or health professionals about who will live and who will die in our ICUs?”

The Minister’s response did not answer this important question. The AODA Alliance asked the Health Minister the same thing two months ago in our February 25, 2021 letter to her. The Government has never answered that question or that letter.

In Health Minister Elliott’s April 21, 2021 answer in Question Period, an impression may be created that the Government has been consulting on the critical care triage protocol. No one has consulted us on the January 13, 2021 Critical Care Triage Protocol.

  1. In its defence, the Ford Government said it is now reaching out to others outside Ontario, to see if they can bring more doctors, nurses and other needed health professionals to help out in Ontario’s intensive care units. This is a much-needed measure. It could avert the need for any critical care triage.

However, we must ask why the Ford Government was not doing this weeks and months ago, when it was given ample early warning that Ontario was at risk of critical care overload. Had it done so, we would not be facing the imminent danger we now are confronting. The Ford Government could have had in place detailed emergency plans to shuttle health care professionals to Ontario, with prior clearances from the relevant licensing bodies so they can work here in this emergency. This further illustrates Ontario’s failure to properly prepare.

For more information on these issues, visit the AODA Alliance website’s health care page.

            MORE DETAILS

Ontario Hansard April 20, 2021

Question Period

COVID-19 RESPONSE

Ms. Sara Singh: My question is for the Premier. For months, experts including members of the Premier’s own science table have been sounding the alarm about dangerously high ICU levels, and today we learned that there are over 760 people fighting for their lives in Ontario ICUs, Speaker.

But the Premier failed to act. They failed to implement paid sick days. They failed to vaccinate workers in hot spots, and now ICUs in communities like Brampton are overflowing. Pediatric hospitals are sacrificing their beds. Patients are being transferred to hospitals around the province outside of their communities, and doctors and nurses are being put in the horrific position of having to make decisions on who will receive life-saving supports and who will not.

Speaker, why—with all of the evidence in front of this government; all of the warnings from their own science tables and medical experts—does this government continue to ignore the crisis in our ICUs?

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

Hon. Christine Elliott: We have been listening to the experts all along. We have been listening to their evidence. I think one thing is really important, Speaker, and I would say to the member opposite, through you, that the speaker is alleging that there is a triage protocol in place in Ontario. There is not; there is not.

What we are doing is building capacity in our hospitals. We are making sure there are two aspects to what we need to deal with here. We need to blunt the transmission of COVID-19 in communities, as well as, right now, we need to build capacity in our hospitals, which are we are doing.

We are in contact with the CEOs of the hospitals on virtually a daily basis. They are working very hard to create spaces.

We are creating capacity so that everyone in Ontario who needs to be admitted to hospital and needs to be in an intensive care bed will have a bed available for them.

The Speaker (Hon. Ted Arnott): Supplementary?

Ms. Sara Singh: Mr. Speaker, with all due respect to the Minister of Health, that response shows us how out of touch with reality this minister is. Doctors are sounding the alarm bells and this government continues to ignore their pleas for help. The government is following a pattern of denying the problem and acting too late.

Now the government is begging other provinces for help, but refusing the federal government’s assistance and the assistance of the Red Cross. Speaker, health care systems in other provinces are also fighting COVID-19. They need their health care workers just as much as we do. It was this Premier’s responsibility and this Minister of Health’s responsibility to help protect people here in Ontario, and they failed to do that at every step of the pandemic.

This is a national and global failure and it is upsetting and heartbreaking to know that they could have acted and they chose not to. With months to plan for this crisis, why did this Premier fail to address the issues causing ICU capacity to rise, and why does the government think it’s another government’s responsibility to come and clean up their mess?

Interjections.

The Speaker (Hon. Ted Arnott): I’ll ask members to please take their seats and allow the Minister of Health to reply.

Hon. Christine Elliott: Again, through you, Mr. Speaker, I would say to the member opposite that what you’re suggesting is simply not the case. Since the beginning of this pandemic, we have been working hard to make sure that we have both the health human resources—

Ms. Sara Singh: Why are people dying?

Hon. Christine Elliott: —and the physical capacity in order to deal with what’s been happening. We have created—

Interjection.

Hon. Christine Elliott: I don’t know if the member opposite really wants to hear me, she’s—

The Speaker (Hon. Ted Arnott): I’m going to ask the Minister of Health to take her seat.

Interjections.

The Speaker (Hon. Ted Arnott): I’m going to ask the member for Brampton Centre to come to order. I’m going to ask the government House leader to come to order.

Interjection.

The Speaker (Hon. Ted Arnott): Always innocent.

I’m going to recognize the Minister of Health to conclude her response.

Hon. Christine Elliott: Thank you, Speaker. To continue, since the beginning of this pandemic, we have created over 3,100 new hospital beds, which is the equivalent of six new community hospitals. We have also added 14% to intensive care capacity, which is significant in the context of this pandemic.

We have also added resources in order to be able to deal with the health human resources that we need. We have allowed for the deployment of people from one sector to another.

Finally, I would say with respect to what’s happening with other provinces and other organizations coming in to help us, we’re very grateful for the help that’s being offered by the other provinces and we’re very grateful to the federal government for their offer of assistance from the Red Cross as well. We know that we need help right now. We have the physical capacity. We need some more health human resources and we are using those resources to make sure everyone who needs help will get help in our hospitals.

Ontario Hansard April 21, 2021

Question Period

COVID-19 RESPONSE

Mr. Joel Harden: My question is to the Minister of Health. As many people have already raised this morning, our ICUs are near the breaking point. We’re getting close to 100 patients now being treated in our ICUs, but despite this fact, the government has refused to make public its plans for critical care triage in those ICUs. We don’t know. People with disabilities and their loved ones and advocacy organizations still don’t know what has been negotiated in secret and what actually will happen when those life-and-death decisions take place but, at home, Dr. David Neilipovitz, the ICU director at the Ottawa Hospital told CBC News, “It would be naïve for us to think that triage or changes in the standard of care have not already come about.” Let’s think about that.

Yesterday, the minister rose in this House and said there is no clinical triage protocol, but we know that hospitals received one on January 13. We also know that a training was done for medical professionals on YouTube on the 23rd of January.

Speaker, I want to ask the minister, who is very well versed in these issues: What instructions have been sent out and drafted to emergency medical technicians, ambulance services or health professionals about who will live and who will die in our ICUs?

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

Hon. Christine Elliott: I can certainly advise the member that no triage protocol has been activated or approved by the government of Ontario.

There have been discussions. I understand that there were a number of disability groups that were concerned with respect to a previous draft that was prepared earlier this year. That was then reviewed with the human rights commission. There have been a number of discussions about modifications to it. But nothing has been activated, nothing has been approved by this government.

What we are doing instead is to create the capacity so that we can care for all the patients that come into our hospital, whether they’re COVID patients or emergency patients that come in otherwise. We have created over 3,100 beds since this pandemic began, increased our intensive care capacity by 14%.

We are looking at bringing in other health professionals from other provinces and other countries so that, notwithstanding having the creation of those spaces, we will also have the health human resources in order to be able to operate them safely, carefully and professionally.

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

Mr. Joel Harden: Earlier today, I was joined by disability rights leaders for a media conference, all of whom are calling upon this government to make public its plans for critical care triage. Speaker, I know this minister served as Patient Ombudsperson for this province for years and knows full well that every patient, physiotypical, neurotypical or not, has a right to their care at the point of service. But the minister also should know that hospitals got a critical triage protocol on January 13, that a training has been conducted. So I must admit my extreme frustration that today, when our ICUs are nearing capacity, we are still hearing, “There are no plans.”

Speaker, let me say very clearly for this House, “I didn’t know,” at this point: not an acceptable answer. “I was just following orders,” at this point: not an acceptable answer. “Please forgive me” to disabled patients and their loved ones: not an acceptable answer.

Will you make sure that people with disabilities are not discriminated against in the ICUs: yes or no?

The Speaker (Hon. Ted Arnott): Again, I’ll ask the members to make their comments through the Chair. The Minister of Health to respond.

Hon. Christine Elliott: The rights of people with disabilities has been one of my strongest passions since I got to this place 15 years ago, and I don’t need to take any instructions from anybody—

Ms. Andrea Horwath: Ha!

Hon. Christine Elliott: —including the leader of the official opposition, about this issue. I have always stood up for the rights of people with disabilities—

Interjections.

The Speaker (Hon. Ted Arnott): Order. Opposition, come to order. The member for Northumberland–Peterborough South, come to order.

The Minister of Health, please reply.

Hon. Christine Elliott: The rights of people with disabilities have been one of the issues that we have cared about and dealt with as part of this entire pandemic. The rights of people with disabilities are equally as important as the rights of anybody else. That is something that I’ve always stood by, that

I always will stand by. I can assure the member opposite that no triage protocol has been approved. A draft was circulated in January. That was not approved by this government. It was something that had been discussed. But I understand that the rights of people with disabilities have been brought forward. I asked them—

Interjections.

The Speaker (Hon. Ted Arnott): The member for Ottawa Centre, come to order. The member for Hamilton West–Ancaster–Dundas, come to order.

The minister, please conclude her response.

Hon. Christine Elliott: I asked that this issue be dealt with, with the people with disabilities groups, as well as with the Ontario Human Rights Commission. There have been numerous discussions, but nothing has been activated yet, and I can assure you nothing has been approved at this point. We are working to make sure—

The Speaker (Hon. Ted Arnott): Thank you. The next question.

QP Briefing April 21, 2021

Originally posted at https://www.qpbriefing.com/2021/04/21/solicitor-general-brushes-off-disability-advocate-concerns-about-triage-protocol/

SOLICITOR GENERAL BRUSHES OFF DISABILITY ADVOCATE CONCERNS ABOUT TRIAGE PROTOCOL

Home Health And COVID-19 Solicitor General Brushes Off Disability Advocate Concerns About Triage Protocol

Solicitor general brushes off disability advocate concerns about triage protocol

Asked about concerns raised by disability advocates for months that the provincial triage guidelines discriminate against them, Ontario’s solicitor general got upset.

“There is no triage protocol being used,” Sylvia Jones said, cutting off the question from QP Briefing. “I am very frustrated that you continue to suggest that there is a triage protocol in place in the province of Ontario in our hospitals. Talk to the hospital CEOs, talk to the minister of health. It is not accurate.”

Jones and Health Minister Christine Elliott said the government has not approved a plan for deciding who lives and who dies should Ontario intensive care units run out of life-saving equipment.

But while it has not been officially triggered, the preparation for the nightmare scenario is real.

Hospitals received training on draft guidelines, which leaked in January, and are preparing to use them.

Doctors and nurses have told reporters that due to rising case counts in the third wave of COVID-19, triage decisions could be days away. Some say that while the protocol has not been implemented, decisions to ration or triage care are already happening, including the cancellation of scheduled surgeries.

And advocates for people with disabilities say they worry that if and when the time comes, they will be seen as less deserving of care than someone without disabilities, because of two key parts of the protocol.

One is the inclusion of the “clinical frailty scale,” which outlines how dependent people are on others to live their lives.

It “asks questions like, can you get dressed yourself, without assistance? Can you go grocery shopping without assistance? Can you use a telephone without assistance?” said Mariam Shanouda, a lawyer with Toronto’s ARCH Disability Law Centre. “And if you answer no, I can’t do any of these things without assistance, then you are less likely to access critical care. This is disability discrimination in a nutshell.”

The other major issue is that doctors are asked to estimate patients’ likelihood of surviving the next 12 months. That timeline is too long, advocates say, and could force medical staff to “guesstimate”

“Guessing is not science,” said David Lepofsky, chair of the AODA Alliance. “And it doesn’t become science because the person doing it, or who’s being mandated to do it, has a white coat on and a stethoscope.”

Another issue is that advocates don’t know whether the protocol from January is unchanged, or whether a new version is being prepared. Lepofsky said the government refuses to answer any of his calls.

“The solution is for the government to immediately make public their step-by-step plan for rolling this out, which they obviously have, so we can know what they’re planning to do,” he said.

The Ministry of Health should speak directly to disability advocacy groups like his, “so we can have input into this, rather than having to communicate with the human shields behind whom they’re hiding, such as the Bioethics Table,” he said.

And each hospital that’s done a triaging drill should make the results of that drill public, “so the public can know how much these simulations for triage might vary, depending on which hospital you happen to go to,” Lepofsky said.

Opposition leaders also called for transparency.

Green Leader Mike Schreiner said he shares the concerns of disability advocates, and argued the government should release the guidelines publicly.

He also noted that ODSP payments have not gone up recently, despite the fact that “Ontarians with disabilities have borne a disproportionate burden in this pandemic.”

Liberal health critic John Fraser said Ontario is “dangerously close to asking clinicians to decide who gets care and who doesn’t. The government needs to be open and transparent about the status of the triage protocol. I think the disability advocates have a legitimate concern. The government should have been listening from the start and needs to engage with them now.”

In question period on Wednesday, Joel Harden, the NDP critic for accessibility and persons with disabilities, quoted Dr. David Neilipovitz, the ICU director at the Ottawa Hospital, who told CBC: “‘It would be naive for us to think that triage or changes in the standard of care have not already come about.’ Let’s think about that,” he said.

“Yesterday, the minister rose in this house and said there is no clinical triage protocol, but we know that hospitals received one on January 13. We also know that a training was done for medical professionals on YouTube on the 23rd of January. Speaker, I want to ask the minister, who is very well versed in these issues: what instructions have been sent out and drafted to emergency medical technicians, ambulance services or health professionals about who will live and who will die in our ICUs?”

Elliott repeated that there is no official triage protocol yet.

“There have been discussions,” she said. “I understand that there were a number of disability groups that were concerned with respect to a previous draft that was prepared earlier this year. That was then reviewed with the human rights commission. There have been a number of discussions about modifications to it. But nothing has been activated, nothing has been approved by this government.”

It was indeed reviewed with the Ontario Human Rights Commission in December, but the organization still disapproves. Chief Commissioner Ena Chadha sent a letter to Elliott in March outlining concerns with the draft protocol and called on the government to publicly release it.

Harden said “there are no plans” is “not an acceptable answer.”

Elliott disagreed.

“The rights of people with disabilities has been one of my strongest passions since I got to this place 15 years ago,” she said, “and I don’t need to take any instructions from anybody—”

NDP Leader Andrea Horwath interjected, “Ha!”

“—including the leader of the Official Opposition, about this issue,” Elliott finished.

Ottawa Citizen Online April 22, 2021

Originally posted at https://ottawacitizen.com/opinion/harden-ontarios-covid-triage-protocol-must-respect-rights-of-the-disabled

Opinion Columnists

Harden: Ontario’s COVID triage protocol must respect rights of the disabled

Just over a year ago, 200+ community organizations urged the Ford government to remove disability discrimination from the triage guidance. The response so far: silence.

Joel Harden

The Children’s Hospital of Eastern Ontario is accepting adult critical care patients due to the growing severity of the COVID-19 crisis. PHOTO BY ERROL MCGIHON /Errol McGihon

These are perilous times in Ontario. On April 16, 2021, a record-breaking 4,812 new COVID-19 cases were recorded.

At the moment, more than 750 patients are being treated in Ontario’s ICUs. For the first time in its 47-year history, the Children’s Hospital of Eastern Ontario is accepting adult COVID-19 patients who require critical care.

There is a real possibility that by the end of the month, hospitals will have to ration or “triage” critical care due to surging COVID case counts. Triage refers to how hospitals will decide who gets life-saving care if ICUs are overwhelmed with COVID patients and they run out of beds.

Along with disability and human rights leaders, I am deeply concerned that the Doug Ford government’s current clinical triage protocol includes disability discrimination, and hasn’t been developed with adequate consultation.

What’s wrong with the triage protocol that was circulated to hospitals on Jan. 13, 2021? Firstly, it includes a “clinical frailty scale,” meaning that a patient over the age of 65 with a progressive disease (Alzheimers, Muscular Dystrophy etc.) will be evaluated based on how they can perform 11 different activities of daily living without assistance. This is blatantly discriminatory against people with disabilities, millions of whom require varying degrees of assistance to live their fullest lives.

Secondly, it includes criteria that assess the patient’s likelihood of mortality one year from their admission to hospital. Even ICU doctors have conceded that such assessments are “guesstimates” rather than an exact science. This leaves the door open to subjective judgments about a person’s quality of life that could discriminate against people with disabilities, as opposed to a shorter-term assessment of mortality.

No one is suggesting that Ontario shouldn’t have a triage protocol in place if ICUs are filled to maximum capacity. What we are saying is that the protocol must respect human rights and the rule of law. It also needs to be discussed openly and transparently, but this government has taken the opposite approach.

Members of the government’s own bioethics table have criticized the secrecy with which the government has been handling its approach to clinical triage. Noting that the process must be “informed, transparent, inclusive, reasonable and subject to revision in light of new information or legitimate concerns or claims,” they believe that Ontario has failed to meet these requirements.

News media have also reported that the Ford government is considering suspending parts of the Health Care Consent Act (HCCA), which requires doctors to obtain consent from a patient or their substitute decision maker before they withdraw critical care.

It is unacceptable for the government to make life-and-death decisions by a secret memo. If they are considering suspending the HCCA, they must make the details public and have a proper debate in the legislature.

Just over a year ago, 200+ community organizations wrote to the Ford government urging it to remove disability discrimination from the province’s triage protocol. For more than a year, the government has been aware of these concerns and had ample time to consult with disability and human rights leaders in developing its clinical triage protocol.

How has the Ford government responded? With complete silence. It has ignored direct appeals from disability groups, the Ontario Human Rights Commission and the opposition, all of whom have expressed concerns with the Jan. 13 “emergency standard of care” triage protocol.

What message does this send to the 2.6 million people with disabilities who live in Ontario? People with disabilities are more likely to get COVID-19, and to be seriously impacted by the virus. This government must assure them that they won’t face any discrimination in the awful event that triage becomes necessary.

It’s time to stop the secrecy surrounding critical care triage. It’s time for the Ford government to remove disability discrimination from its clinical triage protocol.

Joel Harden is the NDP MPP for Ottawa Centre and opposition critic, accessibility and persons with disabilities.

New Democratic Party April 21, 2021 News Release

NDP MPP Joel Harden, disability rights advocates call on Ford to remove disability discrimination from triage protocol

QUEENS PARK — MPP Joel Harden (Ottawa Centre), the NDP’s critic for Accessibility and Persons with Disabilities, called on the Ford government to withdraw disability discrimination from Ontario’s clinical triage protocol and immediately hold a public consultation on how care will be triaged if ICUs become too overwhelmed to fully treat everyone.

Harden was joined at a Wednesday morning press conference by David Lepofsky, Chair of the AODA Alliance, Sarah Jama, Co-founder of the Disability Justice Network of Ontario, and Mariam Shanouda, Staff Lawyer at ARCH Disability Law Centre, all of whom are expressing deep concerns about the protocol and the secrecy surrounding it.

“We should never have gotten to the point where critical care triage became a possibility, but the Ford government’s choice to put money and politics ahead of public health has brought ICUs to the breaking point,” said Harden. “The government must remove disability discrimination from its triage protocol, and assure people with disabilities that they won’t be deprioritized for life-saving critical care.”

The Ford government continues to ignore human rights concerns raised by disability rights leaders, and the Ontario Human Rights Commission about its approach to clinical triage. They have not held open consultations, and it was disability organizations and the opposition, not the government, that made public the January 13, 2021 triage protocol which was sent to hospitals.

“This entire process has been cloaked in secrecy,” said Harden. “That’s wrong, and it’s time for the government to stop making life-and-death decisions behind closed doors.”

Quotes:

David Lepofsky, Chair, AODA Alliance
“Our non-partisan grassroots coalition agrees that Ontario must be prepared for the possibility of critical care triage, but Ontario’s plan must include a triage protocol, mandated by the Legislature, that does not violate the Charter of Rights or the Ontario Human Rights Code by discriminating against people with disabilities or denying them due process. They have already disproportionately suffered the hardships of the COVID-19 pandemic.”

 

Sarah Jama, Co-founder, Disability Justice Network of Ontario
“We are in a time of deep crisis, and need to offer paid sick days and increase social assistance rates for community members without work from home jobs, or a safety net. But rather than make these preventative policy decisions, our government has created conditions where doctors must rank who gets to live and who gets to die.”

 

Mariam Shanouda, Staff Lawyer, ARCH Disability Law Centre
“Health care, including critical care during a pandemic, must be available free from unlawful discrimination. This is a life and death non-partisan issue. The choice must not be whether we have no triage plan or one that discriminates. And let’s be clear, the current plan is discriminatory and will disproportionately impact persons with disabilities who have already disproportionately experienced devastating consequences from this pandemic.”



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As COVID-19 Infections Hit Record Highs and Hospital ICUs Reach the Brink, Six Bioethicists on The Ford Government’s Bioethics Table Release a Public Statement Revealing Major Concerns with Ontario’s Plans for Triage of Critical Care, that Echo Disability Community Objections


ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE

NEWS RELEASE – FOR IMMEDIATE RELEASE

As COVID-19 Infections Hit Record Highs and Hospital ICUs Reach the Brink, Six Bioethicists on The Ford Government’s Bioethics Table Release a Public Statement Revealing Major Concerns with Ontario’s Plans for Triage of Critical Care, that Echo Disability Community Objections

April 15, 2021 Toronto: A body blow has just been delivered to the Ford Government’s controversial plans for deciding which patients would be refused life-saving critical care, if the crisis overload in Ontario hospital intensive care units requires that life-saving critical care must be rationed or “triaged”. Six members of the Ford Government’s own advisory “Bioethics Table” have today published an online statement, set out below, that strongly criticizes Ontario’s critical care triage plans. Their concerns reflect serious objections to Ontario’s triage plans from the disability community, including from the AODA Alliance.

The six bioethicists (who don’t claim to speak for the entire Bioethics Table) urge that the Government should now reveal its secret critical care triage plans to the public, should consult the public, and should hold and open discussion of how critical care should be triaged, if rationing becomes necessary, without treating this as a purely clinical issue or one for bioethicists to monopolize. (Key excerpts also set out below)

These six authors make it clear that Ontario needs a better approach to critical care triage. This is a direct blast at the Ford Government’s persistent secrecy on this issue and its refusal to speak directly to key stakeholders like those from the disability community. We offer the example that the Government has refused to even answer eight detailed letters from the AODA Alliance since last September which identify well-researched objections.

The six bioethicists explain that decisions over who should get life-saving critical care and who should be refused it during critical care triage is not simply a clinical question (i.e. one of medical science alone). Ontario’s secret critical care triage protocol treats this triage as purely a clinical question. The six authors humbly emphasize that bioethicists themselves have no monopoly on wisdom in the area of how critical care triage should be conducted.

These authors urge that it is important to respect the human rights of disadvantaged groups in society. We add that the AODA Alliance and others have been showing for months that Ontario’s plans are replete with disability discrimination, contrary to the Ontario Human Rights Code.

We expect that the Ford Government will answer that the Bioethics Table, of whom these six authors are a part, held consultations with a number of disability advocates, including the AODA Alliance. That would be no answer. Those discussions ended months ago. The external Bioethics Table only gives advice to The Government. The Bioethics Table makes no decisions on how critical care triage should be conducted, and rejected some of our major concerns without giving reasons for doing so. Those in the Government who do make the decisions have steadfastly refused to talk to us. The Government has hidden behind them for months, like human shields.

The secret January 13, 2021 Critical Care Triage Protocol is not available on any Government website, but is available on the AODA Alliance website.

In light of this important statement by several of The Government’s own external advisors, the AODA Alliance calls on the Ford Government to take these four urgent steps:

  1. Now make public the current version of the critical care triage protocol, all reports and recommendations by its external Bioethics Table since September 11, 2021, The Government’s plan of action for rolling out critical care triage if needed, and the results of drills or simulations of critical care triage held at any Ontario hospitals.
  2. Remove disability discrimination from the January 13, 2021 Critical Care Triage Protocol, and
  3. Immediately hold a public consultation on how critical care triage should be conducted.
  4. Introduce legislation on critical care triage for debate in the Legislature, rather than dealing with it by an internal memo to hospitals.

Key statements to this effect by the six bioethicists on the Ford Government’s external Bioethics Table in this article include:

“As bioethicists involved in developing an ethical framework for ICU triage at the Ontario COVID-19 Bioethics Table, we have serious concerns about the lack of transparency and public engagement around the constraints the Table works under.”

“We are beholden to the public as bioethicists helping to develop guidance for the ethical use of public resources – especially to the people most likely to be impacted by intensive care triage decisions – as well as to the physicians who will be forced to make these fraught decisions. This requires that the process be informed, transparent, inclusive, reasonable and subject to revision in light of new information or legitimate concerns or claims.

To date, these requirements have not been met in several provinces, including Ontario, and we entreat governments to make available their triage frameworks and protocols for public deliberation.”

“Science alone cannot tell us how to allocate ICU beds.”

“Whose lives we save is not just a matter of how we apply clinical criteria. It is a matter of redressing unfair inequalities in health and a matter of protecting fundamental human rights.

And while utility is one worthwhile objective of health policy, it must be balanced with due consideration of the human rights of people who might be disproportionately, unjustifiably or morally harmed by clinically based triage decisions. Relying on clinical criteria like judgments about mortality risk in the short or long term, functional status or clinical frailty scores compounds health inequities by failing to help distribute health benefits fairly across society through explicit consideration of social disadvantage.

Human rights advocates, disability rights advocates, Indigenous health partners and members of the Black community have voiced concerns about the potential for discrimination when triage does not take stock of societal factors and when they are not involved in the process of developing triage criteria. Meaningful inclusion of these communities and their perspectives is essential for the ethical legitimacy of ICU triage frameworks to balance utility with equity.

The public needs to join the conversation on an ethical approach to triage”

“Bioethicists are not moral authorities, and governments ought not decide on an approach to intensive care triage without engaging in broader moral deliberation with the public and with those who will be most affected.”

“It is a distinctly political obligation to ensure that the triage protocol is grounded in an ethical, democratic process and that it is based on values that have been justified through stated public reasons.

“We join the COVID-19 Bioethics Table, the Ontario Human Rights Commission and disability rights advocates in calling for transparency and public deliberation on the unfinished work of developing Ontario’s approach to critical care triage in a major surge during the COVID-19 pandemic.”

“The protection of fundamental legal and human rights during an emergency is a litmus test for society, and we need to do everything in our power to avoid overriding rights unjustifiably. Without public discussion, the vulnerability of already marginalized groups is intensified and trust eroded.”

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

For More Background

  1. The AODA Alliance’s new February 25, 2021 independent report on Ontario’s plans for critical care triage if hospitals are overwhelmed by patients needing critical care.
  2. Ontario’s January 13, 2021 triage protocol.
  3. The eight unanswered letters from the AODA Alliance to the Ford Government on its critical care triage plan, including the AODA Alliance‘s September 25, 2020 letter, its November 2, 2020 letter, its November 9, 2020 letter, its December 7, 2020 letter, its December 15, 2020 letter, its December 17, 2020 letter, its January 18, 2021 letter and its February 25, 2021 letter to Health Minister Christine Elliott.
  4. The Government’s earlier external advisory Bioethics Table’s September 11, 2020 draft critical care triage protocol, finally revealed in December 2020.
  5. The AODA Alliance website’s health care page, detailing its efforts to tear down barriers in the health care system facing patients with disabilities, and our COVID-19 page, detailing our efforts to address the needs of people with disabilities during the COVID-19 crisis.

Healthy Debate April 15, 2021

Originally posted at https://healthydebate.ca/opinions/icu-triage/?utm_source=mailpoet&utm_medium=email&utm_campaign=we-need-to-talk-about-triaging-critical-care_12

Opinion

Public conversation on the ethics of intensive care triage during pandemic is overdue

by Alison Thompson, Paula Chidwick, Lisa Jennifer Schwartz, Stephanie Nixon, Lisa Forman, Robert Sibbald

COVID-19 has highlighted the ethical challenges in our health-care system, and nowhere is this more apparent than in an overcrowded intensive care unit. ICUs are where the sickest of the sick receive life-saving treatments and where their crashing bodily functions are taken over by high-tech machines.

Even when there isn’t a pandemic, not everyone can get access to intensive care, and not everyone will benefit from it. It is costly, invasive and requires a highly skilled workforce to make it run.

In the early days of the COVID-19 pandemic, people around the world were shocked by the images of ICU doctors working around the clock in Wuhan, Turin and New York. Their faces were etched with bruises from their tight-fitting face masks. Their eyes were haunted by the sheer number of patients they were treating – and by the sheer number they couldn’t treat.

These early warnings from other countries signaled that Canadian provinces needed to avoid a major surge of patients that would strain intensive care resources. But, preparing for the worst, work on guidance for intensive care triage began very early on in the pandemic, with Saskatchewan and Quebec starting in late winter 2020 and Ontario in the spring of 2020 across several of its COVID-19 advisory tables.

As bioethicists involved in developing an ethical framework for ICU triage at the Ontario COVID-19 Bioethics Table, we have serious concerns about the lack of transparency and public engagement around the constraints the Table works under. To be clear, we do not speak on behalf of the COVID-19 Bioethics Table, but we do speak as scholars in clinical and public health ethics and in human rights law who are also members of that Table.

We are beholden to the public as bioethicists helping to develop guidance for the ethical use of public resources – especially to the people most likely to be impacted by intensive care triage decisions – as well as to the physicians who will be forced to make these fraught decisions. This requires that the process be informed, transparent, inclusive, reasonable and subject to revision in light of new information or legitimate concerns or claims.

To date, these requirements have not been met in several provinces, including Ontario, and we entreat governments to make available their triage frameworks and protocols for public deliberation.

Rationing intensive care beds is fundamentally an ethical endeavour

Science alone cannot tell us how to allocate ICU beds. Should they go to the sickest patients? Should they go to those who are most likely to benefit from treatment? Should we use a lottery system? Should we withdraw treatment from patients if they are not going to have a meaningful recovery to give the bed to someone who will? And what constitutes a meaningful recovery? These are ethical questions requiring value judgements.

Many pandemic response plans focus on maximizing the benefit of scarce resources to save the most lives. Allocating ICU beds to people who are unlikely to benefit from them is often considered unethical and inefficient. Clinicians who work in the ICU often talk about the moral difficulty of providing treatments that sometimes do more harm than good. The moral burden of care in these circumstances weighs heavily on ICU clinicians when left to make these decisions alone and without ethical guidance.

How should health equity be balanced with utility in intensive care triage?

Society’s failure to address upstream causes of ill health and inequities means that the futility or efficacy of ICU care is often determined well before people are brought to the doors of an ICU. To fail to attend to this in triage frameworks and clinical protocols undermines trust. Whose lives we save is not just a matter of how we apply clinical criteria. It is a matter of redressing unfair inequalities in health and a matter of protecting fundamental human rights.

And while utility is one worthwhile objective of health policy, it must be balanced with due consideration of the human rights of people who might be disproportionately, unjustifiably or morally harmed by clinically based triage decisions. Relying on clinical criteria like judgments about mortality risk in the short or long term, functional status or clinical frailty scores compounds health inequities by failing to help distribute health benefits fairly across society through explicit consideration of social disadvantage.

Human rights advocates, disability rights advocates, Indigenous health partners and members of the Black community have voiced concerns about the potential for discrimination when triage does not take stock of societal factors and when they are not involved in the process of developing triage criteria. Meaningful inclusion of these communities and their perspectives is essential for the ethical legitimacy of ICU triage frameworks to balance utility with equity.

The public needs to join the conversation on an ethical approach to triage

Consensus on a proposed ethical framework for pandemic triage, even just among bioethicists, is unrealistic. Nor is it necessarily desirable. In fact, the role of dissensus in bioethics is crucial to avoiding the narrowing of possible policy avenues and avoiding presumptive constructions of various stakeholders.

As bioethicists, our expertise is in sketching the moral landscape, providing options and framing ethical debate. Our job is to propose a possible approach to intensive care triage that the public and stakeholders can then weigh and deliberate. It is also to propose and promote accessible and ethically defensible processes for doing so.

Bioethicists are not moral authorities, and governments ought not decide on an approach to intensive care triage without engaging in broader moral deliberation with the public and with those who will be most affected.

To be sure, public deliberation will not make the decisions about how to prioritize patients for intensive care any easier, nor will it necessarily make it easier to live with the consequences. But it would ensure that all voices have been heard, innovative approaches have been considered, and that new ethical considerations can come to light. It is a distinctly political obligation to ensure that the triage protocol is grounded in an ethical, democratic process and that it is based on values that have been justified through stated public reasons.

We join the COVID-19 Bioethics Table, the Ontario Human Rights Commission and disability rights advocates in calling for transparency and public deliberation on the unfinished work of developing Ontario’s approach to critical care triage in a major surge during the COVID-19 pandemic. Other provinces must also follow suit. Specific attention needs to be paid to partnering with people who have been marginalized by both the process and the products of ICU triage development.

The protection of fundamental legal and human rights during an emergency is a litmus test for society, and we need to do everything in our power to avoid overriding rights unjustifiably. Without public discussion, the vulnerability of already marginalized groups is intensified and trust eroded.

No province in Canada can claim to have a morally legitimate and human rights compliant approach to triage until an accessible and public discussion takes place about how to balance equity with the aim of saving lives in a pandemic.



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As COVID-19 Infections Hit Record Highs and Hospital ICUs Reach the Brink, Five Bioethicists on The Ford Government’s Bioethics Table Release a Public Statement Revealing Major Concerns with Ontario’s Plans for Triage of Critical Care, that Echo Disability Community Objections


ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE
NEWS RELEASE – FOR IMMEDIATE RELEASE

April 15, 2021 Toronto: A body blow has just been delivered to the Ford Government’s controversial plans for deciding which patients would be refused life-saving critical care, if the crisis overload in Ontario hospital intensive care units requires that life-saving critical care must be rationed or “triaged”. Five members of the Ford Government’s own advisory “Bioethics Table” have today published an online statement, set out below, that strongly criticizes Ontario’s critical care triage plans. Their concerns reflect serious objections to Ontario’s triage plans from the disability community, including from the AODA Alliance.

The five bioethicists (who don’t claim to speak for the entire Bioethics Table) urge that the Government should now reveal its secret critical care triage plans to the public, should consult the public, and should hold and open discussion of how critical care should be triaged, if rationing becomes necessary, without treating this as a purely clinical issue or one for bioethicists to monopolize. (Key excerpts also set out below)

These five authors make it clear that Ontario needs a better approach to critical care triage. This is a direct blast at the Ford Government’s persistent secrecy on this issue and its refusal to speak directly to key stakeholders like those from the disability community. We offer the example that the Government has refused to even answer eight detailed letters from the AODA Alliance since last September which identify well-researched objections.

The five bioethicists explain that decisions over who should get life-saving critical care and who should be refused it during critical care triage is not simply a clinical question (i.e. one of medical science alone). Ontario’s secret critical care triage protocol treats this triage as purely a clinical question. The five authors humbly emphasize that bioethicists themselves have no monopoly on wisdom in the area of how critical care triage should be conducted.

These authors urge that it is important to respect the human rights of disadvantaged groups in society. We add that the AODA Alliance and others have been showing for months that Ontario’s plans are replete with disability discrimination, contrary to the Ontario Human Rights Code.

We expect that the Ford Government will answer that the Bioethics Table, of whom these five authors are a part, held consultations with a number of disability advocates, including the AODA Alliance. That would be no answer. Those discussions ended months ago. The external Bioethics Table only gives advice to The Government. The Bioethics Table makes no decisions on how critical care triage should be conducted, and rejected some of our major concerns without giving reasons for doing so. Those in the Government who do make the decisions have steadfastly refused to talk to us. The Government has hidden behind them for months, like human shields.

The secret January 13, 2021 Critical Care Triage Protocol is not available on any Government website, but is available on the AODA Alliance website.

In light of this important statement by several of The Government’s own external advisors, the AODA Alliance calls on the Ford Government to take these four urgent steps:

1. Now make public the current version of the critical care triage protocol, all reports and recommendations by its external Bioethics Table since September 11, 2021, The Government’s plan of action for rolling out critical care triage if needed, and the results of drills or simulations of critical care triage held at any Ontario hospitals.

2. Remove disability discrimination from the January 13, 2021 Critical Care Triage Protocol, and

3. Immediately hold a public consultation on how critical care triage should be conducted.

4. Introduce legislation on critical care triage for debate in the Legislature, rather than dealing with it by an internal memo to hospitals.

Key statements to this effect by the five bioethicists on the Ford Government’s external Bioethics Table in this article include:

“As bioethicists involved in developing an ethical framework for ICU triage at the Ontario COVID-19 Bioethics Table, we have serious concerns about the lack of transparency and public engagement around the constraints the Table works under.”

“We are beholden to the public as bioethicists helping to develop guidance for the ethical use of public resources especially to the people most likely to be impacted by intensive care triage decisions as well as to the physicians who will be forced to make these fraught decisions. This requires that the process be informed, transparent, inclusive, reasonable and subject to revision in light of new information or legitimate concerns or claims.

To date, these requirements have not been met in several provinces, including Ontario, and we entreat governments to make available their triage frameworks and protocols for public deliberation.”

“Science alone cannot tell us how to allocate ICU beds.”

“Whose lives we save is not just a matter of how we apply clinical criteria. It is a matter of redressing unfair inequalities in health and a matter of protecting fundamental human rights.

And while utility is one worthwhile objective of health policy, it must be balanced with due consideration of the human rights of people who might be disproportionately, unjustifiably or morally harmed by clinically based triage decisions. Relying on clinical criteria like judgments about mortality risk in the short or long term, functional status or clinical frailty scores compounds health inequities by failing to help distribute health benefits fairly across society through explicit consideration of social disadvantage.

Human rights advocates, disability rights advocates, Indigenous health partners and members of the Black community have voiced concerns about the potential for discrimination when triage does not take stock of societal factors and when they are not involved in the process of developing triage criteria. Meaningful inclusion of these communities and their perspectives is essential for the ethical legitimacy of ICU triage frameworks to balance utility with equity.

The public needs to join the conversation on an ethical approach to triage”

“Bioethicists are not moral authorities, and governments ought not decide on an approach to intensive care triage without engaging in broader moral deliberation with the public and with those who will be most affected.”

“It is a distinctly political obligation to ensure that the triage protocol is grounded in an ethical, democratic process and that it is based on values that have been justified through stated public reasons.

“We join the COVID-19 Bioethics Table, the Ontario Human Rights Commission and disability rights advocates in calling for transparency and public deliberation on the unfinished work of developing Ontario’s approach to critical care triage in a major surge during the COVID-19 pandemic.”

“The protection of fundamental legal and human rights during an emergency is a litmus test for society, and we need to do everything in our power to avoid overriding rights unjustifiably. Without public discussion, the vulnerability of already marginalized groups is intensified and trust eroded.”

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

For More Background

1. The AODA Alliance’s new February 25, 2021 independent report on Ontario’s plans for critical care triage if hospitals are overwhelmed by patients needing critical care.

2. Ontario’s January 13, 2021 triage protocol.

3. The eight unanswered letters from the AODA Alliance to the Ford Government on its critical care triage plan, including the AODA Alliance’s September 25, 2020 letter, its November 2, 2020 letter, its November 9, 2020 letter, its December 7, 2020 letter, its December 15, 2020 letter, its December 17, 2020 letter, its January 18, 2021 letter and its February 25, 2021 letter to Health Minister Christine Elliott.

4. The Government’s earlier external advisory Bioethics Table’s September 11, 2020 draft critical care triage protocol, finally revealed in December 2020.

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

Healthy Debate April 15, 2021

Originally posted at https://healthydebate.ca/opinions/icu-triage/?utm_source=mailpoet&utm_medium=email&utm_campaign=we-need-to-talk-about-triaging-critical-care_12

Opinion

Public conversation on the ethics of intensive care triage during pandemic is overdue
by Alison Thompson, Paula Chidwick, Lisa Jennifer Schwartz, Stephanie Nixon, Lisa Forman, Robert Sibbald

COVID-19 has highlighted the ethical challenges in our health-care system, and nowhere is this more apparent than in an overcrowded intensive care unit. ICUs are where the sickest of the sick receive life-saving treatments and where their crashing bodily functions are taken over by high-tech machines.

Even when there isn’t a pandemic, not everyone can get access to intensive care, and not everyone will benefit from it. It is costly, invasive and requires a highly skilled workforce to make it run.

In the early days of the COVID-19 pandemic, people around the world were shocked by the images of ICU doctors working around the clock in Wuhan, Turin and New York. Their faces were etched with bruises from their tight-fitting face masks. Their eyes were haunted by the sheer number of patients they were treating and by the sheer number they couldn’t treat.

These early warnings from other countries signaled that Canadian provinces needed to avoid a major surge of patients that would strain intensive care resources. But, preparing for the worst, work on guidance for intensive care triage began very early on in the pandemic, with Saskatchewan and Quebec starting in late winter 2020 and Ontario in the spring of 2020 across several of its COVID-19 advisory tables.

As bioethicists involved in developing an ethical framework for ICU triage at the Ontario COVID-19 Bioethics Table, we have serious concerns about the lack of transparency and public engagement around the constraints the Table works under. To be clear, we do not speak on behalf of the COVID-19 Bioethics Table, but we do speak as scholars in clinical and public health ethics and in human rights law who are also members of that Table.

We are beholden to the public as bioethicists helping to develop guidance for the ethical use of public resources especially to the people most likely to be impacted by intensive care triage decisions as well as to the physicians who will be forced to make these fraught decisions. This requires that the process be informed, transparent, inclusive, reasonable and subject to revision in light of new information or legitimate concerns or claims.

To date, these requirements have not been met in several provinces, including Ontario, and we entreat governments to make available their triage frameworks and protocols for public deliberation.

Rationing intensive care beds is fundamentally an ethical endeavour

Science alone cannot tell us how to allocate ICU beds. Should they go to the sickest patients? Should they go to those who are most likely to benefit from treatment? Should we use a lottery system? Should we withdraw treatment from patients if they are not going to have a meaningful recovery to give the bed to someone who will? And what constitutes a meaningful recovery? These are ethical questions requiring value judgements.

Many pandemic response plans focus on maximizing the benefit of scarce resources to save the most lives. Allocating ICU beds to people who are unlikely to benefit from them is often considered unethical and inefficient. Clinicians who work in the ICU often talk about the moral difficulty of providing treatments that sometimes do more harm than good. The moral burden of care in these circumstances weighs heavily on ICU clinicians when left to make these decisions alone and without ethical guidance.

How should health equity be balanced with utility in intensive care triage?

Society’s failure to address upstream causes of ill health and inequities means that the futility or efficacy of ICU care is often determined well before people are brought to the doors of an ICU. To fail to attend to this in triage frameworks and clinical protocols undermines trust. Whose lives we save is not just a matter of how we apply clinical criteria. It is a matter of redressing unfair inequalities in health and a matter of protecting fundamental human rights.

And while utility is one worthwhile objective of health policy, it must be balanced with due consideration of the human rights of people who might be disproportionately, unjustifiably or morally harmed by clinically based triage decisions. Relying on clinical criteria like judgments about mortality risk in the short or long term, functional status or clinical frailty scores compounds health inequities by failing to help distribute health benefits fairly across society through explicit consideration of social disadvantage.

Human rights advocates, disability rights advocates, Indigenous health partners and members of the Black community have voiced concerns about the potential for discrimination when triage does not take stock of societal factors and when they are not involved in the process of developing triage criteria. Meaningful inclusion of these communities and their perspectives is essential for the ethical legitimacy of ICU triage frameworks to balance utility with equity.

The public needs to join the conversation on an ethical approach to triage

Consensus on a proposed ethical framework for pandemic triage, even just among bioethicists, is unrealistic. Nor is it necessarily desirable. In fact, the role of dissensus in bioethics is crucial to avoiding the narrowing of possible policy avenues and avoiding presumptive constructions of various stakeholders.

As bioethicists, our expertise is in sketching the moral landscape, providing options and framing ethical debate. Our job is to propose a possible approach to intensive care triage that the public and stakeholders can then weigh and deliberate. It is also to propose and promote accessible and ethically defensible processes for doing so.

Bioethicists are not moral authorities, and governments ought not decide on an approach to intensive care triage without engaging in broader moral deliberation with the public and with those who will be most affected.

To be sure, public deliberation will not make the decisions about how to prioritize patients for intensive care any easier, nor will it necessarily make it easier to live with the consequences. But it would ensure that all voices have been heard, innovative approaches have been considered, and that new ethical considerations can come to light. It is a distinctly political obligation to ensure that the triage protocol is grounded in an ethical, democratic process and that it is based on values that have been justified through stated public reasons.

We join the COVID-19 Bioethics Table, the Ontario Human Rights Commission and disability rights advocates in calling for transparency and public deliberation on the unfinished work of developing Ontario’s approach to critical care triage in a major surge during the COVID-19 pandemic. Other provinces must also follow suit. Specific attention needs to be paid to partnering with people who have been marginalized by both the process and the products of ICU triage development.

The protection of fundamental legal and human rights during an emergency is a litmus test for society, and we need to do everything in our power to avoid overriding rights unjustifiably. Without public discussion, the vulnerability of already marginalized groups is intensified and trust eroded.

No province in Canada can claim to have a morally legitimate and human rights compliant approach to triage until an accessible and public discussion takes place about how to balance equity with the aim of saving lives in a pandemic.




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Group urges province to open COVID-19 vaccine pre-registration to all Ontarians


A Toronto city councillor and a group of health-care professionals are calling on the province to open COVID-19 vaccine pre-registration to all Ontarians in a bid to improve the rollout of shots.

Coun. Josh Matlow and health-care professionals from the University Health Network and the University of Toronto, posted an open letter to Premier Doug Ford, Health Minister Christine Elliott, and the co-chairs of the COVID-19 science advisory table on Wednesday.

Read more:
Scarborough hospital forced to cancel 10,000 appointments from lack of COVID-19 vaccine supply

“While the vaccine rollout offers an end in sight to the COVID-19 pandemic, too many Ontarians who have yet to be eligible for the current phase of the vaccination plan are left feeling anxious about when, and how they’ll learn that their turn will finally come,” the letter said.

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“That is why we recommend the province offer a specific category on their call-in and online booking systems that gives Ontarians an opportunity to pre-register for the vaccine.”

The letter said residents should be able to enter their date of birth, postal code, and contact information and get onto a registration list.

“Once eligible, Ontarians could receive an email and/or text message outlining the next steps on how to officially book their vaccine appointment and applicable location(s),” the letter said.

They said this could improve the management of vaccine supply, offer insight into vaccine hesitancy, and give residents the feeling of being closer to overcoming the pandemic.





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





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Ontario hospitals told to ‘ramp down’ all elective, non-emergency surgeries due to COVID-19


The president of the Ontario Hospital Association says hospitals have been directed to “ramp down” all elective surgeries and non-emergency activities starting Monday amid the third wave of the COVID-19 pandemic.

“A major redeployment of staff and resources is required to provide care for a large wave of COVID patients requiring hospitalization,” Anthony Dale tweeted.

In a memo dated on Thursday, Matthew Anderson, Ontario Health’s president and CEO, said effective Monday, April 12 at 12:01 a.m. hospitals are instructed to ramp down on non-urgent activities, including surgeries.

“Given increasing case counts and widespread community transmission across many parts of the province, we are facing mounting and extreme pressure on our critical care capacity,” the memo read.

Read more:
Ontario ICU doctors write letter to Ford government over COVID-19 variants, warn more measures needed

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The memo noted the scale back does not apply to the Northern Ontario Health Region but cautions the region should be prepared to do so in the near future if needed.

Hospitals that specialize in pediatric patients were also advised to not ramp down any capacity and continue with plans to care for children and youth.

“These are very difficult and challenging times for all Ontarians, and we understand that deferring scheduled care will have an impact on patients and their families and caregivers,” the memo read.

As of Friday, there are 541 patients in Ontario’s ICUs with COVID-19 according to Critical Care Services Ontario’s daily report — the highest number seen in the entire pandemic. Patients admitted to ICUs in the province have surged in the last couple weeks.

The province also reported more than 4,200 new COVID-19 cases on Friday, the second highest increase in a case count since the pandemic began.

Read more:
Ontario reports more than 4,200 COVID-19 cases, second highest case count on record

“This situation is extraordinarily serious and we ask for patience and support from the people of Ontario as hospitals grapple with this historic crisis,” Dale said. “Ensuring equitable access to critical care services is our paramount priority.”

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Following the scale back directive, another physician Dr. Naheed Dosani said he has received calls from concerned patients living at home with serious illnesses who are “understandably upset that their surgeries/procedures will be canceled.”

The memo from Ontario Health prompted the College of Physicians and Surgeons of Ontario to issue a statement of support for doctors citing provincial consideration to enact critical care triage protocol.

“We firmly believe physicians need to be supported if they are required to make extraordinary decisions about which of their patients will be offered critical care resources that are in short supply,” Nancy Whitmore, CEO of the college said in her statement.

“Once the critical care triage tool is initiated by the command tables of the province, we are supportive of physicians acting in accordance with this protocol even when doing so requires departing from our policy expectations.”

Whitmore said these are extraordinary times requiring extraordinary decision-making. Despite no official word on triage from the province, the college said it would provide clarity and support to Ontarian physicians if the protocol is enacted.

Read more:
COVID-19: New variants having ‘substantial impact’ on Ontario’s health care system, report says

In an email to Global News, Dr. Mary Grant, a radiologist in Ontario, said the college’s letter about possible critical care triage was upsetting to receive and she is urging the public to do their part in these “unprecedented times.”

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“We all believe that the public needs to be made aware of our reality in the medical world,” Grant wrote. “We need public buy-in for this stay at home order, we need those who are eligible to get vaccinated, and we need folks avoiding activities for the short while that could result in trauma (need for an ICU bed).”

Premier Doug Ford declared a third state of emergency and implemented a stay-at-home order in effect for the next four weeks as the province struggles to bring down rising COVID-19 infection rates and hospitalizations.





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





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