Disability Coalition Slams Trudeau Government’s Giving Millions to Rick Hansen Foundation’s Seriously Deficient Building Accessibility Certification Training Program


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

August 24, 2021 Toronto: Just before calling a federal election, the Federal Government announced action that wastes public money, creates serious new problems for people with disabilities and lacks important due diligence needed before pouring millions of public dollars into an unaccountable private foundation.

On August 13, 2021, the Federal Government announced up to 7.5 million dollars to the Rick Hansen Foundation (RHF) to help finance its problem-ridden private accessibility certification program for buildings. Entirely unhelpful for six million people with disabilities in Canada, this wasteful federal announcement took a page from Ontario Premier Doug Ford’s troubling playbook, by using a wasteful diversion of public money to the RHF to deflect attention from protracted delays in implementing disability accessibility legislation.

The Federal Government claimed: “With this investment, the Foundation will establish a new standardized profession of “accessibility professionals,” which will increase expertise and information on how to build accessible spaces in a way that includes people of all abilities.”

1. RHF Program Does Not Accurately Measure a Building’s Accessibility

The RHF program provides an unreliable accessibility “certification”. It in reality certifies nothing. A building that the RHF says as accessible” is not assured to be accessible.

a) A BC restaurant agreed to a human rights settlement due to its premises’ lack of accessibility even though the RHF had “certified” it as accessible. See “Human Rights Tribunal to hear disabled customer’s complaint about Pat Quinn’s” and “Disability advocate settles accessibility complaint against Pat Quinn’s Restaurant & Bar”

b) The RHF proudly gave the Vancouver International Airport a gold rating for accessibility, even though it had “hang out steps”, riddled with accessibility problems. See “Who gets to decide what is accessibleand who does that leave behind?”

c) The Ontario Government is building a massive new courthouse in downtown Toronto replete with accessibility problems. Yet the Ontario Government told the AODA Alliance that the RHF program rated the building’s design as accessible. The RHF assessor never contacted the AODA Alliance to investigate the Alliance’s detailed and publicly documented accessibility concerns with that building.

2. Deficient RHF Training Does Not Make a Person an Accessibility Professional

The Federal Government makes the highly misleading claim that the RHF training that the Government is underwriting will create a new standardized profession of accessibility professionals. Yet two years ago, an AODA Alliance report detailed massive problems with the RHF’s seriously deficient training. A person completing that substandard training would mislead others if they claim to thereby be an “accessibility professional.” Even the RHF conceded in an August 19, 2021 report in the Burnaby Beacon:

“‘we agree that the 2-week RHFAC training course is not sufficient to provide students with enough knowledge to consider themselves experts in the application of universal design,’ the foundation said.”

Far from being the gold standard for training accessibility professionals that the Federal Government should underwrite and that others should follow, the very short RHF training program is a model of how such training should not be done.

3. Ford Government Earlier Spending $1.3 Million on RHF Program Yielded No Improvement in Accessibility

In 2015, the Kathleen Wynne Government flirted with buying into the RHF program, but wisely dropped that idea. In 2019, the Ford Government claimed it was improving the accessibility of buildings in Ontario by giving the RHF private accessibility certification program 1.3 million dollars. The AODA Alliance led criticism of that misuse of public money. See the July 24, 2019 Toronto Star: “Advocates slam Ontario plan to rate accessibility of buildings.”

On August 6, 2019, the Toronto Star ran a strong editorial blasting the Ford Government for this use of public money. Over two years after the Ford Government bought into the RHF program, there’s no proof it led to the removal of any disability barriers.

4. Much Needed Federal Government Due Diligence is Strikingly Absent

Before pouring millions of public dollars into the RHF, an unaccountable private foundation, the Federal Government must not have undertaken obvious, rudimentary due diligence. A quick Google or social media search would quickly reveal serious concerns about the RHF program emanating from credible voices in the grass roots disability community that this federal spending supposedly is to benefit. For example, the Federal Government never contacted the AODA Alliance to explore its documented concerns with the RHF training and certification program. Two years ago, the AODA Alliance made public two detailed reports, dated July 3, 2019 and August 15, 2019. Those reports exhaustively proved in exquisite detail, based on RHF documentation, the many serious deficiencies with the RHF program. Since then, the RHF has not disproved these concerns.

5. RHF is not Expert in Training Accessibility Professionals or Assessing Building Accessibility

Mr. Hansen’s name and personal notoriety do not give the RHF the expertise it lacks in this area. In contrast, Canada RCanada has real accessibility professionals, with far more than a couple of weeks of accessibility training, who can competently assess a building’s accessibility and make recommendations where improvements are needed.

“By buying into the Rick Hansen Foundation’s problem-ridden program and misleadingly claiming to create a new profession of accessibility professionals, the Federal Government hurts people with disabilities. It’s substantially lowering the training needed to competently work in this area, and putting it in the hands of an unaccountable private foundation with a record of focusing primarily on some disabilities to the potential exclusion of others,” said David Lepofsky, chair of the non-partisan AODA Alliance that advocates for accessibility for people with all kinds of disabilities. “This public funding would have been far better used to develop a strong, effective, comprehensive, mandatory national standard for accessible design of buildings for all people with disabilities that could be enforced under the Accessible Canada Act.”

In this close election race, the non-partisan AODA Alliance wrote the major political parties on August 4, 2021, seeking specific election commitments to implement the Accessible Canada Act that was passed in 2019. In the 2019 federal election, the Liberal party committed “to the timely and ambitious implementation of the Accessible Canada Act so that it can fully benefit all Canadians.” It also pledged to use a disability lens for all Government decisions.

The Accessible Canada Act requires Canada to become accessible to people with disabilities by 2040, at least within federal jurisdiction. In the two years since the Accessible Canada Act was passed, there has been some progress. However, we have to date not observed any appreciable improvement in accessibility for people with disabilities.

The Federal Government has still not even hired the national Accessibility Commissioner or the Chief Accessibility Officer to lead the Accessible Canada Act’s implementation. No national accessibility standards have yet been enacted to require specific action to remove and prevent disability barriers.

Contact: AODA Alliance Chair David Lepofsky, [email protected] Twitter: @aodaalliance For more background:
1. The AODA Alliance’s July 3, 2019 report on the RHF program..
2. The AODA Alliance’s August 15, 2019 supplemental report on the RHF program certification program.
3. The AODA Alliances widely viewed online video about accessibility problems with the new Ryerson University Student Learning Centre. That building included the very inaccessible “hang out steps” that are also present at the Vancouver International Airport, the latter building being the first to receive an RHF gold rating for accessibility.




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Disability Coalition Slams Trudeau Government’s Giving Millions to Rick Hansen Foundation’s Seriously Deficient Building Accessibility Certification Training Program


ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE

NEWS RELEASE – FOR IMMEDIATE RELEASE

Disability Coalition Slams Trudeau Government’s Giving Millions to Rick Hansen Foundation’s Seriously Deficient Building Accessibility Certification Training Program

August 24, 2021 Toronto: Just before calling a federal election, the Federal Government announced action that wastes public money, creates serious new problems for people with disabilities and lacks important due diligence needed before pouring millions of public dollars into an unaccountable private foundation.

On August 13, 2021, the Federal Government announced up to 7.5 million dollars to the Rick Hansen Foundation (RHF) to help finance its problem-ridden private accessibility certification program for buildings. Entirely unhelpful for six million people with disabilities in Canada, this wasteful federal announcement took a page from Ontario Premier Doug Ford’s troubling playbook, by using a wasteful diversion of public money to the RHF to deflect attention from protracted delays in implementing disability accessibility legislation.

The Federal Government claimed: “With this investment, the Foundation will establish a new standardized profession of “accessibility professionals,” which will increase expertise and information on how to build accessible spaces in a way that includes people of all abilities.”

1. RHF Program Does Not Accurately Measure a Building’s Accessibility

The RHF program provides an unreliable accessibility “certification”. It in reality certifies nothing. A building that the RHF says as accessible” is not assured to be accessible.

  1. a) A BC restaurant agreed to a human rights settlement due to its premises’ lack of accessibility even though the RHF had “certified” it as accessible. See Human Rights Tribunal to hear disabled customer’s complaint about Pat Quinn’sand “Disability advocate settles accessibility complaint against Pat Quinn’s Restaurant & Bar
  1. b) The RHF proudly gave the Vancouver International Airport a gold rating for accessibility, even though it had “hang out steps”, riddled with accessibility problems. See “Who gets to decide what is accessible—and who does that leave behind?”
  1. c) The Ontario Government is building a massive new courthouse in downtown Toronto replete with accessibility problems. Yet the Ontario Government told the AODA Alliance that the RHF program rated the building’s design as accessible. The RHF assessor never contacted the AODA Alliance to investigate the Alliance’s detailed and publicly documented accessibility concerns with that building.

2. Deficient RHF Training Does Not Make a Person an Accessibility Professional

The Federal Government makes the highly misleading claim that the RHF training that the Government is underwriting will create a new standardized profession of accessibility professionals. Yet two years ago, an AODA Alliance report detailed massive problems with the RHF’s seriously deficient training. A person completing that substandard training would mislead others if they claim to thereby be an “accessibility professional.” Even the RHF conceded in an August 19, 2021 report in the Burnaby Beacon:

“‘we agree that the 2-week RHFAC training course is not sufficient to provide students with enough knowledge to consider themselves experts in the application of universal design,’ the foundation said.”

Far from being the gold standard for training accessibility professionals that the Federal Government should underwrite and that others should follow, the very short RHF training program is a model of how such training should not be done.

3. Ford Government Earlier Spending $1.3 Million on RHF Program Yielded No Improvement in Accessibility

In 2015, the Kathleen Wynne Government flirted with buying into the RHF program, but wisely dropped that idea. In 2019, the Ford Government claimed it was improving the accessibility of buildings in Ontario by giving the RHF private accessibility certification program 1.3 million dollars. The AODA Alliance led criticism of that misuse of public money. See the July 24, 2019 Toronto Star: “Advocates slam Ontario plan to rate accessibility of buildings.”

On August 6, 2019, the Toronto Star ran a strong editorial blasting the Ford Government for this use of public money. Over two years after the Ford Government bought into the RHF program, there’s no proof it led to the removal of any disability barriers.

4. Much Needed Federal Government Due Diligence is Strikingly Absent

Before pouring millions of public dollars into the RHF, an unaccountable private foundation, the Federal Government must not have undertaken obvious, rudimentary due diligence. A quick Google or social media search would quickly reveal serious concerns about the RHF program emanating from credible voices in the grass roots disability community that this federal spending supposedly is to benefit. For example, the Federal Government never contacted the AODA Alliance to explore its documented concerns with the RHF training and certification program. Two years ago, the AODA Alliance made public two detailed reports, dated July 3, 2019 and August 15, 2019. Those reports exhaustively proved in exquisite detail, based on RHF documentation, the many serious deficiencies with the RHF program. Since then, the RHF has not disproved these concerns.

5. RHF is not Expert in Training Accessibility Professionals or Assessing Building Accessibility

Mr. Hansen’s name and personal notoriety do not give the RHF the expertise it lacks in this area. In contrast, Canada RCanada has real accessibility professionals, with far more than a couple of weeks of accessibility training, who can competently assess a building’s accessibility and make recommendations where improvements are needed.

“By buying into the Rick Hansen Foundation’s problem-ridden program and misleadingly claiming to create a new profession of accessibility professionals, the Federal Government hurts people with disabilities. It’s substantially lowering the training needed to competently work in this area, and putting it in the hands of an unaccountable private foundation with a record of focusing primarily on some disabilities to the potential exclusion of others,” said David Lepofsky, chair of the non-partisan AODA Alliance that advocates for accessibility for people with all kinds of disabilities. “This public funding would have been far better used to develop a strong, effective, comprehensive, mandatory national standard for accessible design of buildings for all people with disabilities that could be enforced under the Accessible Canada Act.”

In this close election race, the non-partisan AODA Alliance wrote the major political parties on August 4, 2021, seeking specific election commitments to implement the Accessible Canada Act that was passed in 2019. In the 2019 federal election, the Liberal party committed “to the timely and ambitious implementation of the Accessible Canada Act so that it can fully benefit all Canadians.” It also pledged to use a disability lens for all Government decisions.

The Accessible Canada Act requires Canada to become accessible to people with disabilities by 2040, at least within federal jurisdiction. In the two years since the Accessible Canada Act was passed, there has been some progress. However, we have to date not observed any appreciable improvement in accessibility for people with disabilities.

The Federal Government has still not even hired the national Accessibility Commissioner or the Chief Accessibility Officer to lead the Accessible Canada Act’s implementation. No national accessibility standards have yet been enacted to require specific action to remove and prevent disability barriers.

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

For more background:

  1. The AODA Alliance’s July 3, 2019 report on the RHF program..
  2. The AODA Alliance’s August 15, 2019 supplemental report on the RHF program certification program.
  3. The AODA Alliances widely viewed online video about accessibility problems with the new Ryerson University Student Learning Centre. That building included the very inaccessible “hang out steps” that are also present at the Vancouver International Airport, the latter building being the first to receive an RHF gold rating for accessibility.



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Another Media Report on Huge Problems with the Rick Hansen Foundation Private Accessibility “Certification” Program


RHF Concedes Its Training for Its Accessibility Assessors Does Not Make Them Experts in Accessibility

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

August 20, 2021

SUMMARY

An excellent, extensive article in the August 19, 2021 edition of the Burnaby Beacon, set out below, details many serious problems with the Rick Hansen Foundation (RHF) private accessibility “certification” program. For more than two years, this program has been the centrepiece of the Ford Government’s failing efforts to address the many substantial barriers that people with disabilities face in the built environment. What Ontarians with disabilities need instead is for the Ford Government to agree to develop a Built Environment Accessibility Standard under the Accessibility for Ontarians with Disabilities Act.

Over two years ago, the Ford Government announced that it would spend over 1.3 million public dollars on the RHF program over a two-year period. Two years later, there is no evidence that this has resulted in any improvement in the accessibility of the built environment in Ontario.

The AODA Alliance, quoted in this new article, as well as other credible voices, have together brought to public attention many serious failings in the RHF program. For example, the fact that the RHF calls a building “accessible” is no proof at all that it is accessible.

As another example, the very short training course that the RHF provides for those assessing a building’s accessibility is too short and riddled with problems. The RHF calls those who complete that inadequate course an “RHF accessibility professional”. This is an inaccurate and very misleading title. In this new news report, the RHF is quoted as in substance conceding this point. The article states in part:

we agree that the 2-week RHFAC training course is not sufficient to provide students with enough knowledge to consider themselves experts in the application of universal design, the foundation said.

This new article refers to a Toronto Star editorial that blasted the Ford Government for its strategy of using the RHF program. We set that editorial out below. It accords with criticisms of the RHF program that we have made public.

The AODA Alliance’s July 3, 2019 report on the RHF program, entitled “A Problematic Government Strategy on Accessibility for Ontarians with Disabilities and An Inappropriate Use of Public Money
The AODA Alliance Report on the Ontario Government’s Proposal to Spend Public Money on the Rick Hansen Foundation’s Private Accessibility Certification Process” made these findings which have not been disproven in the past two years:

“* Ford’s Government says this plan will remove barriers facing people with disabilities. Yet the report reveals that the plan need not result in any barriers ever being removed.

* Instead of using properly trained Government inspectors, Ford’s plan uses private individuals who may have no prior experience with the highly technical area of building accessibility, and who just took a two-week course and passed a multiple choice exam. To acquire the needed expertise, it takes much more training on accessibility than a 2-week course.

* There are serious concerns with RHF’s private standard or yardstick to assess a building’s accessibility. For example, there is a real risk of leaving out people whose disabilities are not related to mobility, vision or hearing.

* There is a risk of conflict of interest if the RHF inspects an organization that has given or may give the RHF a charitable donation. It would be inexcusable for an organization to give money to a Government inspector.

* These private free-lance accessibility assessors appear to have a troubling incentive to give higher accessibility ratings, in hopes of getting more work. An organization chooses the RHF-trained free-lance assessor who will inspect their building. Assessors are paid by the job.

*Even though the taxpayer will fund these inspections, the public will have no right to know the inspection’s results, unless an organization agrees to make its results public.”

The AODA Alliance’s August 15, 2019 supplemental report on the RHF program reached these 17 additional conclusions:

“1. It was wrong for the Ford Government not to hold an open competitive bidding process before deciding to give $1.3 million to the RHF.

2. There are no measures in place to address serious conflict of interest concerns with the RHFAC.

3. Key and basic aspects of this public funding program have still not yet been worked out months after it was announced.

4. It is troubling that the RHFAC tries to shift responsibility and risk for accessibility ratings and advice onto others.

5. The RHFAC accessibility ratings are clearly left in significant part to each free-lance assessor’s subjective discretion, despite the Government’s claims that these accessibility assessments are consistently applied.

6. It is problematic for the RHFAC to take averages of the accessibility of a building’s features like bathrooms.

7. The RHFAC program emphasizes the problematic idea of getting organizations to go “beyond code”, as if building code compliance is all that is required.

8. The RHFAC adjudication process has serious flaws.

9. There are insufficient safeguards to ensure that an RHF-certified building remains accessible after it is so-certified.

10. The mandatory RHFAC course is even shorter than the two weeks we earlier announced.

11. An instructor in the RHFAC course need not have demonstrated expertise in the accessibility of the built environment.

12. The RHF training course crams far too much curriculum into too short a time.

13. The RHFAC course appears to emphasize barriers facing people with physical disabilities such as people using wheelchairs.

14. It is misleading to suggest at points that building code compliance means that a building is accessible.

15. It is inappropriate and potentially harmful for the RHF to use blindness or vision loss simulations as part of the RHFAC course.

16. It is unhelpful for The RHFAC course to ask students to consider which disability they’d rather have or not have.

17. RHFAC testing of course participants is not shown to be sufficient.”

Fully 932 days ago, the Ford Government received the blistering final report of the David Onley AODA Independent Review. Among other things, that report called for substantial new regulatory action to make the built environment in Ontario accessible to people with disabilities. That report did not make any recommendation for the Ontario Government to use the RHF program. Over two and a half years later, Ontarians with disabilities are still waiting for meaningful provincial action on this front.

MORE DETAILS

Burnaby Beacon August 19, 2021

Originally posted at https://burnabybeacon.com/article/rick-hansen-foundation-parks-accessibility/

Who gets to decide what is accessibleand who does that leave behind?

The City of Burnaby is requiring all bidders on parks projects to have Rick Hansen Foundation certificationbut advocates say standards shouldn’t be put in the hands of private foundations.

By Dustin Godfrey

Disabilities advocates are decrying a move by the City of Burnaby to require architects and other contractors looking to work with the city to have certification with the Rick Hansen Foundation.

Earlier this summer, city staff noted in a report to the parks, recreation, and culture commission that the parks department is working to improve accessibility in parks and trails.

Following the principles of universal design, we strive to make our parks usable to the greatest extent possible, by everyone, director of parks, recreation, and cultural services Dave Ellenwood wrote in the report.

Standards for accessibility at parks facilities, according to the report, are sourced from a combination of provincial and national regulations, including the BC Housing Code and the Canadian Landscape Architecture Associations design standards for accessibility.

The report goes on to note that the city doesnt have a direct relationship with the Rick Hansen Foundation, but an access advisory committee in the city is in touch with the foundation semi-regularly.

Approximately 2 years ago, leadership from the Rick Hansen Foundation met with the mayor to inquire if the City would certify its corporate facilities; however, at the time there was substantial fee associated with the process, and it was not pursued, Ellenwood wrote.

Going forward, however, all new civic projects require Rick Hansen training/certification as criteria in its RFP [request for proposals] process for consultants/architects of new civic facilities, including the current recreation centre projects. This means that the Rick Hansen certification lens is applied to Burnaby civic projects.

But advocates say this wrongly forces architects to patronize a foundation they say relieves pressure on senior levels of government to develop their own stricter rules for accessibility.

It is exceedingly inappropriate and quite troubling, said David Lepofsky, chair of the Accessibility for Ontarians with Disabilities Act Alliance, who described his organization as among the leading voices youll see being quoted publicly as raising concerns about the RHF certification process and certifier training.

And the issue draws questions about how accessibility should be regulatedby market forces, such as certifications drawn up by private foundations, or by public entities.

The City of Burnaby did not respond to requests for comment.

What is the Rick Hansen Foundation?

A statue of Rick Hansen at Rogers Arena in Vancouver before it was moved to the Vancouver General Hospital. (Flickr, Creative Commons)

The foundation was launched in the late 1980s as the Man in Motion World Tour Society by Rick Hansen, a paraplegic wheelchair user following a spinal cord injury at age 15 after he completed his famous 26-month Man in Motion World Tour.

The Paralympians 40,000-km wheelchair marathon, inspired by Terry Foxs Marathon of Hope, covered 34 countries and earned Hansen broad recognition, including the Order of Canada and the Order of BC.

And the momentum of that tour carried into the foundation, whose original aim, according to its website, was to raise money to improve the lives of people with disabilities and to support SCI research.

The Rick Hansen Foundation has been the vessel for a number of accessibility investments, doling out grants on behalf of governments, and in 2017, it launched a certification program to rate buildings for accessibility. Since then, the foundation has sent evaluators to over 1,300 sites to determine an accessibility ratingcertification requires 60% compliance, as well as full compliance with mandatory requirements, while a gold certification requires 80% compliance.

Of the 1,300-plus sites assessed, over 850 have received certification, while just over 70 have received gold certification.

Just last week, the federal governmentahead of an election callannounced a $7.5-million investment into the foundation to establish a new standardized profession of accessibility professionals, which will increase expertise and information on how to build accessible spaces in a way that includes people of all abilities.

Whats the problem?

In recent years, while the foundation has managed to elicit the praise of governments, it has also drawn the ire of many accessibility advocates.

Advocates say various governments have come to rely too heavily on RHFs certification program, effectively privatizing accessibility. And they say the program takes pressure off of governments to develop adequate accessibility legislation with teeth to enforce compliance.

Lepofsky pointed in particular to a move by the Ontario government to give Rick Hansen Foundation $1.3 million to do certification inspections on 250 buildings.

They pointed to this, in multiple statements, when points are made publicly that they are not making progress on accessibility in anywhere near the way we need it, Lepofsky said, adding the certification proves nothing other than a PR gesture.

Its a waste of money, but a lot of money for a photo op smokescreen to make it look like theyre doing something, so they can point to it and hope that that gets some good media.

Gabrielle Peters, a disabled writer and policy analyst in Vancouver, said she has been frustrated with the level of interest RHF has gotten from governments and the private sector, particularly around its certification program.

Accessibility is essentially, and should be, understood in terms of the built environment and the conditions of the built environment, she said. Its sort of akin to a fire code, [or] health policy. So if you dont follow the fire code, you can be shut down. Your business licence can be taken away. Thats my ideal situation.

Filling the gaps

Rick Hansen Foundation bills its certification program as something thats intended to fill the gaps not addressed by legislation, saying it agrees that the government also needs to take a role in the issue.

RHF does not disagree with the position that there should be government regulation, however we do not see this as being mutually exclusive to our program. Both can exist. Its important to have both enabling legislation and harmonized national codes and standards and a complementary national certification program that uses consistent methodology and recognizes industry leadership, the foundation wrote in a statement to Burnaby Beacon.

Legislation alone is not enough, according to a report from the Canadian Disability Policy Alliance (CDPA), public and private collaboration is essential.

The foundation also pointed to a study by HCMA Architecture + Design that showed building to the national and Ontario building codes would get a building 35% and 42% respectively on the RHF certification rating.

RHFAC was developed on national and international standards and research demonstrating best practices in accessibility. The program has been reviewed by a broad scope of stakeholders, the foundation said, listing major disabilities organizations, a technical committee of private and public officials, and an advisory committee made up of city planners and operators of commercial spaces.

“People are always ready to tell us if they disagree with usIve heard absolutely no one come to [RHF?s] defence.”
But Peters said accessibility should be defined by the public, through public institutions, comparing it to a fire code or food safety regulations.

If you could just imagine putting those things into a privatized situation, I think you can imagine the myriad of problems that could occur. You dont have to follow the fire code; you have to follow Dustins privately developed rules of fires, Peters said.

That would be a big problem, because it shouldnt be up to Dustin to decide. It should be up to the fire department and the fire marshal to decide. It should be up to a health authority, which is publicly accountable and publicly run. And the same with accessibility.

Legislation being implemented

BC and Canada have both recently passed accessibility legislation, including the Accessible Canada Act in 2019 and the Accessible BC Act signed in June this year.

The federal legislation only applies to federal agencies and federally regulated institutions in the private sector, such as banks, airlines, broadcasting and cross-provincial transportation.

Meanwhile, its still unclear how BCs law will apply, with implementation taking place over 10 years. Its focuses over the next decade will include culture change, accountability requirements for BC government, monitoring and evaluation, and standards development.

As it stands, theres little recourse for anyone with a disability in BC who cant access services or even basics like curb cutsramps at the corners of sidewalks to allow wheelchairs and others to easily get onto the roadbeyond going to the BC Human Rights Tribunal.

But advocates issues with RHFs certification program arent just about who should be responsible for standardizing accessibilitythey have concerns about the methodology and scope of the program.

Weve been very public about this

Peters said Rick Hansen Foundation has gained a particularly strong foothold in BC, where its based, often acting as a vessel for government grant money.

But that hasnt been the case everywhereLepofsky said RHF doesnt have the same standing in Ontario.

When Doug Fords government gave $1.3 million to RHF, Lepofskys coalition listed 17 concerns they have with RHFAC and with the Ontario governments funding announcement. And his organization wasnt the only one that pushed back on the funding announcement.

The Toronto Stars editorial board penned a condemnation of the move, citing a number of similar qualms to Lepofskys concerns.

People are always ready to tell us if they disagree with usIve heard absolutely no one come to [RFH?s] defence, Lepofsky said.

Our positions are informed by feedback we get on an ongoing basis. Weve been very public about this, and Ive had nobody from within the disability community pushing back and saying, Youre wrong; this is a great thing.

Lepofskys concerns about RHF certification range from conflict of interest concerns to the short training period involved to the methodology around its ratings.

If the Hansen folks go in and say somethings accessible, all youve got to do is move a garbage can in the path of travel, and thats over. They get the label, they get the sign up [on the] front of their building, but it doesnt mean anything, Lepofsky said.

Lepofsky further took issue with the suggestion that RHF certification pushes building design beyond the bare minimum, with the implication that the building code is the minimum.

The minimum is the human rights code of the Charter of Rights. So what Mr. Hansen and the foundation talk about is encouraging people to go beyond the minimum, grossly understating what the minimum is, and then applauding people for doing better than that substandard requirement, Lepofsky said.

Human rights complaint

In fact, Lepofsky and Peters both pointed to a couple of notable shortcomings by Rick Hansen Foundation.

Last year, Pat Quinns Restaurant & Bar in Tsawwassen settled a human rights complaint filed against it by a wheelchair user, despite the buildingand restauranthaving accessibility certification from the Rick Hansen Foundation.

And in 2018, the foundation awarded YVR Airport a gold certification. The problem, they said, is where they held the photo opat a set of hangout steps or stepped seating, a feature that is loved by architects but derided by accessibility advocates.

The very picture where theyre portraying it had a barrier in the picture, Lepofsky said. This is a design, a thing that should never take place. And here, [RHF is] not only giving them a gold, but theyre giving them a gold [with hangout steps] in the picture. This is just proof positive of a complete bungle. So thats a huge problem.

RHF did not address a question about the YVR approval directly but said in an email statement that ratings provide a snapshot of the overall accessibility of their facilities.

Certification does not equal perfection. Using their scorecards, organizations are able to identify which areas have scored well and which areas require improvements in a simple and easily understood format, the foundation said.

Rick Hansen Foundation awards YVR Airport a gold certification, with a photo op at hangout stairs in the airport.
And that gets to another point of contention many within the disability community have with the RHF certification program: a sense that it may offer a photo op and a plaque for the sake of PR without actually being adequately accessible.

For Peters, a big part of the issue is transparency around how the certification process is done. The foundation has a public checklist on its website, indicating the different factors that are considered in its accessibility certification test, and how theyre weighted. But when a business says its RHF certified, its not clear what that means.

The word certification is a misnomer, according to Lepofsky.

They dont certify anything. Its not like you get a certificate that is now a defence to a human rights complaint. Its not, Lepofsky said.

Who certifies the certifiers?

Part of the issue, according to Thea Kurdi, an Ontario-based accessibility and universal design consultant with DesignAble who has been involved in writing accessibility standards, is how much training RHF certifiers getjust 10 days.

If youre doing an audit, none of my staff members are allowed to go out and do that independently for 2 years. We take 2 years to train people to make sure that they really understand what theyre doing, Kurdi said.

That can pose a problem when many parts of the checklist are discretionaryeach point is ranked on a scalerather than simple yes or no questions.

In its written statement, RHF noted that its certification process does have prerequisites for its training, including a diploma in architecture, engineering, or urban planning, or a minimum of 5 years experience related to accessibility in buildings.

Furthermore, RHFAC ratings are reviewed by an independent adjudication process, the foundation said. Despite this, we agree that the 2-week RHFAC training course is not sufficient to provide students with enough knowledge to consider themselves experts in the application of universal design, the foundation said.

However, it does change the way industry professionals see the built environment, help them to see barriers they didnt see before, and to challenge the assumption that meeting code is equal to providing real access for people with disabilities.

A focus on spinal cord injuries

One issue Kurdi, Lepofsky and Peters all noted were around where Rick Hansen Foundations focus has been for much of its existence. The foundation was originally created to raise money for spinal cord research, which is a really important endeavour, Kurdi said.

But all 3 said the foundations focus skews toward a specific type of disabilitywheelchair users.

While [the certification program] does talk about other types of disabilities, we have noticedbecause weve been asked to review it for several clients to see, does that make sense for them to useI find its still wheelchair-centric, Kurdi said.

Peters noted one particular RHF point that suggested facilities use aromatic plants as a form of wayfinding assistance for people who are blind or have low vision. This, she said, ignores the existence of winter and the fact that accessibility includes accommodating people with scent sensitivities and allergies.

RHFAC uses them as an example of an olfactory wayfinding clue for a building entrance but does not suggest their use in parks, the foundation said in response to a question about the suggestion.

We continue to value ongoing input from the community, and will discuss the feedback regarding aromatic plants with our Technical Advisory Committee during the development of RHFAC v4.0.

Kurdi said: I love it when people are trying to bring attention to accessibility and when theyre trying to move things going down the whole line. But I think people really need to understand the difference between a certification program and, for example, a building audit.

A certification program can be a fun way to celebrate accessibility and then raise awareness as a central improvement, Kurdi said, but she noted some limitations.

I dont think that this really captures whats required under the human rights code, and it certainly doesnt encompass what were recommending in the accessible built environment industry.

The foundation said its goal has, for 33 years, been to remove barriers for people with disabilities and to increase awareness of accessibility, along with its focus on spinal cord injury research.

One of the most fundamental barriers that people with disabilities face is the lack of physical accessibility in the places we live, work, learn, and play. A key priority for RHF is to improve accessibility for people with physical disabilities affecting their mobility, vision, and hearing, RHF said.

Laws with teeth

A person in a wheelchair uses a curb cut at a crosswalk.

Curb cuts are one basic area of accessibility that Gabrielle Peters says is woefully lacking in Metro Vancouver. (phaustov, Shutterstock)

Peters highlighted the Americans with Disabilities Act south of the border as an example of doing accessibility better than in Canada.

While Canadas and BCs laws have just been passed in the last couple of years, the ADA has been in place for 3 decades now. And while Peters said it isnt perfect by any means, its still much stronger than existing legislation in Canada.

And a key issue, she noted, is how effective it is as a lawif something isnt ADA compliant, a person can sue. This is what happened south of the border with curb cutsand that bears results.

The City of Portland recently settled a class-action lawsuit filed against it by committing to creating 1,500 curb cuts per year.

In Vancouver, Peters said the city has 8,000 corners without curb cuts, and when she sat on that citys transportation council, the projected completion date was 200 years out.

Here in Burnaby, meanwhile, many residential roads dont have sidewalks, and the city even cancelled a sidewalks project at the behest of local families.

Free resources

Peters said one of her main issues with the Rick Hansen Foundations certification program is the pricedescribed by the city in its own report as substantialand the barriers that adds.

This, she said, makes the process inaccessible to people who could consult on disabilities, drawing from lived experience and community consultations but who dont have RHF training.

It makes me very sad that this is being turned into a money-making opportunity that seems to be replicating some of the [existing] oppressions and hierarchy, Peters said.

All the while, she said, there are free resources the city could draw from for its parks facilities.

Because its publicly regulated, the ADAs guidelines are freely available, including standards specific to parks. Peters said the guidelines arent comprehensive but still are more so than those from RHF, also pointing to more guidelines freely available from the City of Malibu in California.

Watch for our companion piece to this article coming on Friday, August 20, where a local resident offers some challenges aroundand solutions foraccessibility in Burnabys parks facilities.

Dustin Godfrey
Reporter at Burnaby Beacon

The Toronto Star August 6, 2019

Originally posted at: https://www.thestar.com/opinion/editorials/2019/08/06/ontario-should-move-faster-on-tearing-down-barriers.html Ontario should move faster on tearing down barriers

Editorial

Buildings must be for everyone

As accessibility advocates constantly warn, we’re all just one illness or accident away from becoming disabled.

And with 1,000 Ontario baby boomers turning 65 every day, more of us will be dealing with aging vision, hearing, hips and knees that will affect our quality of life and make our physical environment more difficult to navigate.

So it’s disappointing that six months after former lieutenant governor David Onley delivered a scathing report on the “soul crushing” barriers that 2.6 million Ontarians with disabilities face on a daily basis, the Ford government has yet to develop a clear way forward.

In March, Raymond Cho, Ontario’s minister for seniors and accessibility, finally authorized work to resume on three committees developing accessibility standards in the education and health-care systems.

But, so far, none of the committees have met and no dates have been set.

When NDP MPP Joe Harden introduced a motion in the legislature in May urging the government to implement Onley’s report, starting with the development of new accessibility standards for the built environment, Cho dismissed the idea as “red tape.”

Instead, Cho and the Ford government are trumpeting a two-year $1.3-million investment in a new accessibility certification program developed by the Rick Hansen Foundation.

By certifying 250 public and private buildings, the government says it will raise awareness and encourage the development industry to make accessibility a priority.

We have no quarrel with the foundation’s quest to make the world more accessible for people with disabilities and to fund research into spinal cord injury and care.

But we are concerned about a program that relies on building professionals who have completed just two weeks of accessibility training to conduct the certifications.

And we question why certifications will be given to entire buildings at a time when most accessibility advocates and seasoned consultants say few buildings are fully accessible.

For example, the foundation was recently criticized for awarding a “gold” rating to the Vancouver airport in 2018, even though the building includes so-called “hangout steps” for socializing, which are inaccessible to people using wheelchairs and are difficult to navigate for those with vision loss or difficulty with balance.

Far better for the foundation to give its stamp of approval on accessible design elements that are truly remarkable and worth highlighting as examples for others to follow.

But, for the province to be financially backing such a scheme – particularly when it was not among Onley’s 15 recommendations – is questionable.

Shouldn’t scarce public funds be spent on implementing Onley’s detailed blueprint to ensure that Ontario meets its 2025 deadline for becoming fully accessible under the Accessibility for Ontarians with Disabilities Act?

As Onley rightly recommends, the province should be developing better provincial accessibility standards for public and private buildings and boosting enforcement of the few rules that currently exist.

And it should make accessibility courses mandatory in colleges and universities to ensure future architects and other design professionals get the training they need.

Just as physicians are trained to “do no harm,” architects and design professionals should be educated to create no barriers.

It’s hard to believe that during one of the biggest building booms in the history of Ontario, there are so few accessibility requirements in the Ontario Building Code.

Nothing prevents a developer from building acres of single family homes inaccessible to people with disabilities.

And just 15 per cent of units in multiresidential buildings – condominiums and apartments – are required to be accessible.

Ottawa’s national housing strategy aims to ensure 20 per cent of homes created under the plan are accessible. And yet, according to the latest 2017 federal statistics, 22 per cent of Canadians report having a disability, a percentage that will only grow as the population ages.

Clearly, we are not addressing current need, let alone future demand. The Ford government must do better.




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Another Media Report on Huge Problems with the Rick Hansen Foundation Private Accessibility “Certification” Program – RHF Concedes Its Training for Its Accessibility Assessors Does Not Make Them Experts in Accessibility


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/

Another Media Report on Huge Problems with the Rick Hansen Foundation Private Accessibility “Certification” Program – RHF Concedes Its Training for Its Accessibility Assessors Does Not Make Them Experts in Accessibility

August 20, 2021

        SUMMARY

An excellent, extensive article in the August 19, 2021 edition of the Burnaby Beacon, set out below, details many serious problems with the Rick Hansen Foundation (RHF) private accessibility “certification” program. For more than two years, this program has been the centrepiece of the Ford Government’s failing efforts to address the many substantial barriers that people with disabilities face in the built environment. What Ontarians with disabilities need instead is for the Ford Government to agree to develop a Built Environment Accessibility Standard under the Accessibility for Ontarians with Disabilities Act.

Over two years ago, the Ford Government announced that it would spend over 1.3 million public dollars on the RHF program over a two-year period. Two years later, there is no evidence that this has resulted in any improvement in the accessibility of the built environment in Ontario.

The AODA Alliance, quoted in this new article, as well as other credible voices, have together brought to public attention many serious failings in the RHF program. For example, the fact that the RHF calls a building “accessible” is no proof at all that it is accessible.

As another example, the very short training course that the RHF provides for those assessing a building’s accessibility is too short and riddled with problems. The RHF calls those who complete that inadequate course an “RHF accessibility professional”. This is an inaccurate and very misleading title. In this new news report, the RHF is quoted as in substance conceding this point. The article states in part:

“‘we agree that the 2-week RHFAC training course is not sufficient to provide students with enough knowledge to consider themselves experts in the application of universal design,’ the foundation said.”

This new article refers to a Toronto Star editorial that blasted the Ford Government for its strategy of using the RHF program. We set that editorial out below. It accords with criticisms of the RHF program that we have made public.

The AODA Alliance’s July 3, 2019 report on the RHF program, entitled “A Problematic Government Strategy on Accessibility for Ontarians with Disabilities and An Inappropriate Use of Public Money

The AODA Alliance Report on the Ontario Government’s Proposal to Spend Public Money on the Rick Hansen Foundation’s Private Accessibility Certification Process” made these findings which have not been disproven in the past two years:

“* Ford’s Government says this plan will remove barriers facing people with disabilities. Yet the report reveals that the plan need not result in any barriers ever being removed.

* Instead of using properly trained Government inspectors, Ford’s plan uses private individuals who may have no prior experience with the highly technical area of building accessibility, and who just took a two-week course and passed a multiple choice exam. To acquire the needed expertise, it takes much more training on accessibility than a 2-week course.

* There are serious concerns with RHF’s private standard or yardstick to assess a building’s accessibility. For example, there is a real risk of leaving out people whose disabilities are not related to mobility, vision or hearing.

* There is a risk of conflict of interest if the RHF inspects an organization that has given or may give the RHF a charitable donation. It would be inexcusable for an organization to give money to a Government inspector.

* These private free-lance accessibility assessors appear to have a troubling incentive to give higher accessibility ratings, in hopes of getting more work. An organization chooses the RHF-trained free-lance assessor who will inspect their building. Assessors are paid by the job.

*Even though the taxpayer will fund these inspections, the public will have no right to know the inspection’s results, unless an organization agrees to make its results public.”

The AODA Alliance’s August 15, 2019 supplemental report on the RHF program reached these 17 additional conclusions:

“1. It was wrong for the Ford Government not to hold an open competitive bidding process before deciding to give $1.3 million to the RHF.

  1. There are no measures in place to address serious conflict of interest concerns with the RHFAC.
  1. Key and basic aspects of this public funding program have still not yet been worked out months after it was announced.
  1. It is troubling that the RHFAC tries to shift responsibility and risk for accessibility ratings and advice onto others.
  1. The RHFAC accessibility ratings are clearly left in significant part to each free-lance assessor’s subjective discretion, despite the Government’s claims that these accessibility assessments are consistently applied.
  1. It is problematic for the RHFAC to take averages of the accessibility of a building’s features like bathrooms.
  1. The RHFAC program emphasizes the problematic idea of getting organizations to go “beyond code”, as if building code compliance is all that is required.
  1. The RHFAC adjudication process has serious flaws.
  1. There are insufficient safeguards to ensure that an RHF-certified building remains accessible after it is so-certified.
  1. The mandatory RHFAC course is even shorter than the two weeks we earlier announced.
  1. An instructor in the RHFAC course need not have demonstrated expertise in the accessibility of the built environment.
  1. The RHF training course crams far too much curriculum into too short a time.
  1. The RHFAC course appears to emphasize barriers facing people with physical disabilities such as people using wheelchairs.
  1. It is misleading to suggest at points that building code compliance means that a building is accessible.
  1. It is inappropriate and potentially harmful for the RHF to use blindness or vision loss simulations as part of the RHFAC course.
  1. It is unhelpful for The RHFAC course to ask students to consider which disability they’d rather have or not have.
  1. RHFAC testing of course participants is not shown to be sufficient.”

Fully 932 days ago, the Ford Government received the blistering final report of the David Onley AODA Independent Review. Among other things, that report called for substantial new regulatory action to make the built environment in Ontario accessible to people with disabilities. That report did not make any recommendation for the Ontario Government to use the RHF program. Over two and a half years later, Ontarians with disabilities are still waiting for meaningful provincial action on this front.

        MORE DETAILS

Burnaby Beacon August 19, 2021

Originally posted at https://burnabybeacon.com/article/rick-hansen-foundation-parks-accessibility/

Who gets to decide what is accessible—and who does that leave behind?

The City of Burnaby is requiring all bidders on parks projects to have Rick Hansen Foundation certification—but advocates say standards shouldn’t be put in the hands of private foundations.

By Dustin Godfrey

Disabilities advocates are decrying a move by the City of Burnaby to require architects and other contractors looking to work with the city to have certification with the Rick Hansen Foundation.

Earlier this summer, city staff noted in a report to the parks, recreation, and culture commission that the parks department is working to improve accessibility in parks and trails.

“Following the principles of universal design, we strive to make our parks usable to the greatest extent possible, by everyone,” director of parks, recreation, and cultural services Dave Ellenwood wrote in the report.

Standards for accessibility at parks facilities, according to the report, are sourced from a combination of provincial and national regulations, including the BC Housing Code and the Canadian Landscape Architecture Association’s design standards for accessibility.

The report goes on to note that the city doesn’t have a direct relationship with the Rick Hansen Foundation, but an access advisory committee in the city is in touch with the foundation “semi-regularly.”

“Approximately 2 years ago, leadership from the Rick Hansen Foundation met with the mayor to inquire if the City would certify its corporate facilities; however, at the time there was substantial fee associated with the process, and it was not pursued,” Ellenwood wrote.

“Going forward, however, all new civic projects require Rick Hansen training/certification as criteria in its RFP [request for proposals] process for consultants/architects of new civic facilities, including the current recreation centre projects. This means that the Rick Hansen certification lens is applied to Burnaby civic projects.”

But advocates say this wrongly forces architects to patronize a foundation they say relieves pressure on senior levels of government to develop their own stricter rules for accessibility.

“It is exceedingly inappropriate and quite troubling,” said David Lepofsky, chair of the Accessibility for Ontarians with Disabilities Act Alliance, who described his organization as “among the leading voices you’ll see being quoted publicly as raising concerns about the RHF certification process and certifier training.”

And the issue draws questions about how accessibility should be regulated—by market forces, such as certifications drawn up by private foundations, or by public entities.

The City of Burnaby did not respond to requests for comment.

What is the Rick Hansen Foundation?

A statue of Rick Hansen at Rogers Arena in Vancouver before it was moved to the Vancouver General Hospital. (Flickr, Creative Commons)

The foundation was launched in the late 1980s as the Man in Motion World Tour Society by Rick Hansen, a paraplegic wheelchair user following a spinal cord injury at age 15 after he completed his famous 26-month Man in Motion World Tour.

The Paralympian’s 40,000-km wheelchair marathon, inspired by Terry Fox’s Marathon of Hope, covered 34 countries and earned Hansen broad recognition, including the Order of Canada and the Order of BC.

And the momentum of that tour carried into the foundation, whose original aim, according to its website, was “to raise money to improve the lives of people with disabilities and to support SCI research.”

The Rick Hansen Foundation has been the vessel for a number of accessibility investments, doling out grants on behalf of governments, and in 2017, it launched a certification program to rate buildings for accessibility. Since then, the foundation has sent evaluators to over 1,300 sites to determine an accessibility rating—certification requires 60% compliance, as well as full compliance with mandatory requirements, while a gold certification requires 80% compliance.

Of the 1,300-plus sites assessed, over 850 have received certification, while just over 70 have received gold certification.

Just last week, the federal government—ahead of an election call—announced a $7.5-million investment into the foundation to “establish a new standardized profession of ‘accessibility professionals,’ which will increase expertise and information on how to build accessible spaces in a way that includes people of all abilities.”

What’s the problem?

In recent years, while the foundation has managed to elicit the praise of governments, it has also drawn the ire of many accessibility advocates.

Advocates say various governments have come to rely too heavily on RHF’s certification program, effectively privatizing accessibility. And they say the program takes pressure off of governments to develop adequate accessibility legislation with teeth to enforce compliance.

Lepofsky pointed in particular to a move by the Ontario government to give Rick Hansen Foundation $1.3 million to do certification inspections on 250 buildings.

“They pointed to this, in multiple statements, when points are made publicly that they are not making progress on accessibility in anywhere near the way we need it,” Lepofsky said, adding the certification “proves nothing other than a PR gesture.”

“It’s a waste of money, but a lot of money for a photo op smokescreen to make it look like they’re doing something, so they can point to it and hope that that gets some good media.”

Gabrielle Peters, a disabled writer and policy analyst in Vancouver, said she has been frustrated with the level of interest RHF has gotten from governments and the private sector, particularly around its certification program.

“Accessibility is essentially, and should be, understood in terms of the built environment and the conditions of the built environment,” she said. “It’s sort of akin to a fire code, [or] health policy. So if you don’t follow the fire code, you can be shut down. Your business licence can be taken away. That’s my ideal situation.”

Filling the gaps

 

Rick Hansen Foundation bills its certification program as something that’s intended to fill the gaps not addressed by legislation, saying it agrees that the government also needs to take a role in the issue.

“RHF does not disagree with the position that there should be government regulation, however we do not see this as being mutually exclusive to our program. Both can exist. It’s important to have both enabling legislation and harmonized national codes and standards and a complementary national certification program that uses consistent methodology and recognizes industry leadership,” the foundation wrote in a statement to Burnaby Beacon.

“Legislation alone is not enough, according to a report from the Canadian Disability Policy Alliance (CDPA), public and private collaboration is essential.”

The foundation also pointed to a study by HCMA Architecture + Design that showed building to the national and Ontario building codes would get a building 35% and 42% respectively on the RHF certification rating.

“RHFAC was developed on national and international standards and research demonstrating best practices in accessibility. The program has been reviewed by a broad scope of stakeholders,” the foundation said, listing major disabilities organizations, a technical committee of private and public officials, and an advisory committee made up of city planners and operators of commercial spaces.

“People are always ready to tell us if they disagree with us—I’ve heard absolutely no one come to [RHF’s] defence.”

But Peters said accessibility should be defined by the public, through public institutions, comparing it to a fire code or food safety regulations.

“If you could just imagine putting those things into a privatized situation, I think you can imagine the myriad of problems that could occur. You don’t have to follow the fire code; you have to follow Dustin’s privately developed rules of fires,” Peters said.

“That would be a big problem, because it shouldn’t be up to Dustin to decide. It should be up to the fire department and the fire marshal to decide. It should be up to a health authority, which is publicly accountable and publicly run. And the same with accessibility.”

 

Legislation being implemented

 

BC and Canada have both recently passed accessibility legislation, including the Accessible Canada Act in 2019 and the Accessible BC Act signed in June this year.

The federal legislation only applies to federal agencies and federally regulated institutions in the private sector, such as banks, airlines, broadcasting and cross-provincial transportation.

Meanwhile, it’s still unclear how BC’s law will apply, with implementation taking place over 10 years. Its focuses over the next decade will include culture change, accountability requirements for BC government, monitoring and evaluation, and standards development.

As it stands, there’s little recourse for anyone with a disability in BC who can’t access services or even basics like curb cuts—ramps at the corners of sidewalks to allow wheelchairs and others to easily get onto the road—beyond going to the BC Human Rights Tribunal.

But advocates’ issues with RHF’s certification program aren’t just about who should be responsible for standardizing accessibility—they have concerns about the methodology and scope of the program.

 

‘We’ve been very public about this’

 

Peters said Rick Hansen Foundation has gained a particularly strong foothold in BC, where it’s based, often acting as a vessel for government grant money.

But that hasn’t been the case everywhere—Lepofsky said RHF doesn’t have the same standing in Ontario.

When Doug Ford’s government gave $1.3 million to RHF, Lepofsky’s coalition listed 17 concerns they have with RHFAC and with the Ontario government’s funding announcement. And his organization wasn’t the only one that pushed back on the funding announcement.

The Toronto Star’s editorial board penned a condemnation of the move, citing a number of similar qualms to Lepofsky’s concerns.

“People are always ready to tell us if they disagree with us—I’ve heard absolutely no one come to [RFH’s] defence,” Lepofsky said.

“Our positions are informed by feedback we get on an ongoing basis. … We’ve been very public about this, and I’ve had nobody from within the disability community pushing back and saying, ‘You’re wrong; this is a great thing.’”

Lepofsky’s concerns about RHF certification range from conflict of interest concerns to the short training period involved to the methodology around its ratings.

“If the Hansen folks go in and say something’s accessible, all you’ve got to do is move a garbage can in the path of travel, and that’s over. They get the label, they get the sign up [on the] front of their building, but it doesn’t mean anything,” Lepofsky said.

Lepofsky further took issue with the suggestion that RHF certification pushes building design beyond the bare minimum, with the implication that the building code is the minimum.

“The minimum is the human rights code of the Charter of Rights. So what Mr. Hansen and the foundation talk about is encouraging people to go beyond the minimum, grossly understating what the minimum is, and then applauding people for doing better than that substandard requirement,” Lepofsky said.

Human rights complaint

 

In fact, Lepofsky and Peters both pointed to a couple of notable shortcomings by Rick Hansen Foundation.

Last year, Pat Quinn’s Restaurant & Bar in Tsawwassen settled a human rights complaint filed against it by a wheelchair user, despite the building—and restaurant—having accessibility certification from the Rick Hansen Foundation.

And in 2018, the foundation awarded YVR Airport a gold certification. The problem, they said, is where they held the photo op—at a set of “hangout steps” or stepped seating, a feature that is loved by architects but derided by accessibility advocates.

“The very picture where they’re portraying it had a barrier in the picture,” Lepofsky said. “This is a design, a thing that should never take place. And here, [RHF is] not only giving them a gold, … but they’re giving them a gold [with hangout steps] in the picture. This is just proof positive of a complete bungle. So that’s a huge problem.”

RHF did not address a question about the YVR approval directly but said in an email statement that ratings provide “a ‘snapshot’ of the overall accessibility of their facilities.”

“Certification does not equal perfection. Using their scorecards, organizations are able to identify which areas have scored well and which areas require improvements in a simple and easily understood format,” the foundation said.

Rick Hansen Foundation awards YVR Airport a gold certification, with a photo op at hangout stairs in the airport.

And that gets to another point of contention many within the disability community have with the RHF certification program: a sense that it may offer a photo op and a plaque for the sake of PR without actually being adequately accessible.

For Peters, a big part of the issue is transparency around how the certification process is done. The foundation has a public checklist on its website, indicating the different factors that are considered in its accessibility certification test, and how they’re weighted. But when a business says it’s RHF certified, it’s not clear what that means.

The word “certification” is a misnomer, according to Lepofsky.

“They don’t certify anything. It’s not like you get a certificate that is now a defence to a human rights complaint. It’s not,” Lepofsky said.

 

Who certifies the certifiers?

 

Part of the issue, according to Thea Kurdi, an Ontario-based accessibility and universal design consultant with DesignAble who has been involved in writing accessibility standards, is how much training RHF certifiers get—just 10 days.

“If you’re doing an audit, none of my staff members are allowed to go out and do that independently for 2 years. We take 2 years to train people to make sure that they really understand what they’re doing,” Kurdi said.

That can pose a problem when many parts of the checklist are discretionary—each point is ranked on a scale—rather than simple yes or no questions.

In its written statement, RHF noted that its certification process does have prerequisites for its training, including a diploma in architecture, engineering, or urban planning, or a minimum of 5 years’ experience related to accessibility in buildings.

“Furthermore, RHFAC ratings are reviewed by an independent adjudication process,” the foundation said. Despite this, we agree that the 2-week RHFAC training course is not sufficient to provide students with enough knowledge to consider themselves experts in the application of universal design,” the foundation said.

“However, it does change the way industry professionals see the built environment, help them to see barriers they didn’t see before, and to challenge the assumption that meeting code is equal to providing real access for people with disabilities.”

A focus on spinal cord injuries

 

One issue Kurdi, Lepofsky and Peters all noted were around where Rick Hansen Foundation’s focus has been for much of its existence. The foundation was originally created to raise money for spinal cord research, “which is a really important endeavour,” Kurdi said.

But all 3 said the foundation’s focus skews toward a specific type of disability—wheelchair users.

“While [the certification program] does talk about other types of disabilities, we have noticed—because we’ve been asked to review it for several clients to see, does that make sense for them to use—I find it’s still wheelchair-centric,” Kurdi said.

Peters noted one particular RHF point that suggested facilities use aromatic plants as a form of wayfinding assistance for people who are blind or have low vision. This, she said, ignores the existence of winter and the fact that accessibility includes accommodating people with scent sensitivities and allergies.

“RHFAC uses them as an example of an olfactory wayfinding clue for a building entrance but does not suggest their use in parks,” the foundation said in response to a question about the suggestion.

“We continue to value ongoing input from the community, and will discuss the feedback regarding aromatic plants with our Technical Advisory Committee during the development of RHFAC v4.0.”

Kurdi said: “I love it when people are trying to bring attention to accessibility and when they’re trying to move things going down the whole line. But I think people really need to understand the difference between a certification program and, for example, a building audit.”

A certification program can be a “fun way to celebrate accessibility and then raise awareness as a central improvement,” Kurdi said, but she noted some limitations.

“I don’t think that this really captures what’s required under the human rights code, and it certainly doesn’t encompass what we’re recommending in the accessible built environment industry.”

The foundation said its goal has, for 33 years, been to remove barriers for people with disabilities and to increase awareness of accessibility, along with its focus on spinal cord injury research.

“One of the most fundamental barriers that people with disabilities face is the lack of physical accessibility in the places we live, work, learn, and play. A key priority for RHF is to improve accessibility for people with physical disabilities affecting their mobility, vision, and hearing,” RHF said.

Laws with teeth

 

A person in a wheelchair uses a curb cut at a crosswalk.

Curb cuts are one basic area of accessibility that Gabrielle Peters says is woefully lacking in Metro Vancouver. (phaustov, Shutterstock)

Peters highlighted the Americans with Disabilities Act south of the border as an example of doing accessibility better than in Canada.

While Canada’s and BC’s laws have just been passed in the last couple of years, the ADA has been in place for 3 decades now. And while Peters said it isn’t perfect by any means, it’s still much stronger than existing legislation in Canada.

And a key issue, she noted, is how effective it is as a law—if something isn’t ADA compliant, a person can sue. This is what happened south of the border with curb cuts—and that bears results.

The City of Portland recently settled a class-action lawsuit filed against it by committing to creating 1,500 curb cuts per year.

In Vancouver, Peters said the city has 8,000 corners without curb cuts, and when she sat on that city’s transportation council, the projected completion date was 200 years out.

Here in Burnaby, meanwhile, many residential roads don’t have sidewalks, and the city even cancelled a sidewalks project at the behest of local families.

Free resources

Peters said one of her main issues with the Rick Hansen Foundation’s certification program is the price—described by the city in its own report as “substantial”—and the barriers that adds.

This, she said, makes the process inaccessible to people who could consult on disabilities, drawing from lived experience and community consultations but who don’t have RHF training.

“It makes me very sad that this is being turned into a money-making opportunity that seems to be replicating some of the [existing] oppressions and hierarchy,” Peters said.

All the while, she said, there are free resources the city could draw from for its parks facilities.

Because it’s publicly regulated, the ADA’s guidelines are freely available, including standards specific to parks. Peters said the guidelines aren’t comprehensive but still are more so than those from RHF, also pointing to more guidelines freely available from the City of Malibu in California.

Watch for our companion piece to this article coming on Friday, August 20, where a local resident offers some challenges around—and solutions for—accessibility in Burnaby’s parks facilities.

Dustin Godfrey

Reporter at Burnaby Beacon

The Toronto Star August 6, 2019

Originally posted at: https://www.thestar.com/opinion/editorials/2019/08/06/ontario-should-move-faster-on-tearing-down-barriers.html

Ontario should move faster on tearing down barriers

Editorial

Buildings must be for everyone

As accessibility advocates constantly warn, we’re all just one illness or accident away from becoming disabled.

And with 1,000 Ontario baby boomers turning 65 every day, more of us will be dealing with aging vision, hearing, hips and knees that will affect our quality of life and make our physical environment more difficult to navigate.

So it’s disappointing that six months after former lieutenant governor David Onley delivered a scathing report on the “soul crushing” barriers that 2.6 million Ontarians with disabilities face on a daily basis, the Ford government has yet to develop a clear way forward.

In March, Raymond Cho, Ontario’s minister for seniors and accessibility, finally authorized work to resume on three committees developing accessibility standards in the education and health-care systems.

But, so far, none of the committees have met and no dates have been set.

When NDP MPP Joe Harden introduced a motion in the legislature in May urging the government to implement Onley’s report, starting with the development of new accessibility standards for the built environment, Cho dismissed the idea as “red tape.”

Instead, Cho and the Ford government are trumpeting a two-year $1.3-million investment in a new accessibility certification program developed by the Rick Hansen Foundation.

By certifying 250 public and private buildings, the government says it will raise awareness and encourage the development industry to make accessibility a priority.

We have no quarrel with the foundation’s quest to make the world more accessible for people with disabilities and to fund research into spinal cord injury and care.

But we are concerned about a program that relies on building professionals who have completed just two weeks of accessibility training to conduct the certifications.

And we question why certifications will be given to entire buildings at a time when most accessibility advocates and seasoned consultants say few buildings are fully accessible.

For example, the foundation was recently criticized for awarding a “gold” rating to the Vancouver airport in 2018, even though the building includes so-called “hangout steps” for socializing, which are inaccessible to people using wheelchairs and are difficult to navigate for those with vision loss or difficulty with balance.

Far better for the foundation to give its stamp of approval on accessible design elements that are truly remarkable and worth highlighting as examples for others to follow.

But, for the province to be financially backing such a scheme – particularly when it was not among Onley’s 15 recommendations – is questionable.

Shouldn’t scarce public funds be spent on implementing Onley’s detailed blueprint to ensure that Ontario meets its 2025 deadline for becoming fully accessible

under the Accessibility for Ontarians with Disabilities Act?

As Onley rightly recommends, the province should be developing better provincial accessibility standards for public and private buildings and boosting enforcement of the few rules that currently exist.

And it should make accessibility courses mandatory in colleges and universities to ensure future architects and other design professionals get the training they need.

Just as physicians are trained to “do no harm,” architects and design professionals should be educated to create no barriers.

It’s hard to believe that during one of the biggest building booms in the history of Ontario, there are so few accessibility requirements in the Ontario Building Code.

Nothing prevents a developer from building acres of single family homes inaccessible to people with disabilities.

And just 15 per cent of units in multiresidential buildings – condominiums and apartments – are required to be accessible.

Ottawa’s national housing strategy aims to ensure 20 per cent of homes created under the plan are accessible. And yet, according to the latest 2017 federal statistics, 22 per cent of Canadians report having a disability, a percentage that will only grow as the population ages.

Clearly, we are not addressing current need, let alone future demand. The Ford government must do better.



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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: 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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Legislation introduced to provide income support program for Manitobans with severe disabilities


The province is introducing legislation to provide an income support program for Manitobans with severe and prolonged disabilities.

Current legislation puts Manitobans with severe and prolonged disabilities in the same category as those experiencing temporary losses of employment due to shorter-term or less severe disabilities.

The province says Bill 72 would create a program separate from Employment and Income Assistance (EIA) and include disability support payments and shelter assistance tailored to the specific needs of those who apply.

RELATED: Manitoba advocate releases systemic review of services for children with disabilities

Families minister Rochelle Squires says about 10,000 people will be moved into the new category.

“It will make life easier for them. They will not have to go back and prove on a regular basis that they still are impacted by their disability,” Squires said. “We believe this will be a great reduction in unnecessary regulatory requirements and paperwork and inconvenience for them.”

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“We’re also going to be moving forward with a better income for these individuals.”

NDP critic for persons with disabilities Danielle Adams claims “Bill 72 would propose sweeping changes to Manitoba’s income assistance programs, including how Manitobans are eligible for programs and what level of support they can receive.”

 




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





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Ontario looking to introduce digital ID program, seeking public input


The Ontario government says it is looking for the public’s input on a possible digital ID program that would allow for people to prove who they are online much easier.

The hope is that the program will be introduced by the end of 2021.

The program will allow for people to “securely and conveniently prove their identity online,” according to the Ford government. It will also help people to be able to access things online rather than have to travel to do things in-person, the government said, such as a small business applying for a license or a parent looking for information on their child’s immunization records.

Read more:
Vehicle sticker or driver’s licence expired in 2020? Both still legal in Ontario for now

“We want to assure people that a digital ID will not only offer simpler and easier access to services, but it will be safe and secure, encrypted and harnessing the latest technology to protect your information and credentials,” said Peter Bethlenfalvy, minister responsible for Digital and Data Transformation.

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The government said it will also help with COVID-19 safety protocols, as it limits in-person contact.

The public can weigh in online through surveys provided by the government here from now until Feb. 26.

The government said the program will also help to combat identity fraud and protect Ontarians data. They also said it has the potential to add $4.5 billion of value to the “small-and-medium-size enterprises sector nationally.”

Read more:
Questions raised about new support staff hiring for Ontario schools reopening amid COVID-19 pandemic

“By using this innovative technology, users will be in full control of what identity information is shared and with whom,” the statement read.

The digital ID program will be voluntary and for those who do not wish to participate, they can still use physical documents to prove identity.

“As we develop this initiative, we want to hear directly from the people to ensure their priorities are reflected in this innovative, digital approach,” Bethlenfalvy continued. “No one has a monopoly on good ideas and we are prepared to listen.”




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





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


And Other News on The Triage Issue

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

January 25, 2021

SUMMARY

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

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

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

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

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

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

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

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

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

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

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

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

2. Today, Ontario’s New Democratic Party commendably made public a letter sent by NDP Leader Andrea Horwath and NDP Disabilities Critic Joel Harden to Ontario Health Minister Christine Elliott. Set out below, that letter asks the Government to answer vital questions on this life-and-death issue which the Government has not answered to date. We thank the NDP for publicly asking these questions, and for endorsing the concerns on this issue that the AODA Alliance has been raising from the perspective of people with disabilities. We urge the Ford Government to end its protracted secrecy on this topic, and provide full and prompt answers.

3. The January 23, 2021 edition of the National Post included an extensive article on this issue, also below. It quoted AODA Alliance Chair David Lepofsky on some of our many concerns with the Government’s January 13, 2021 triage protocol.
We spelled those concerns out in the AODA Alliance’s January 18, 2021 letter to Health Minister Christine Elliott within days of receiving a leaked copy of that previously secret critical care triage protocol.

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

For more background on this issue, check out:

1. The new January 13, 2021 triage protocol which the AODA Alliance received, is now making public, and has asked the Ford Government to verify. We have only acquired this in PDF format, which lacks proper accessibility. We gather some others in the community now have this document as well.

2. The AODA Alliance’s January 18, 2021 news release on the January 13, 2021 triage protocol.

3. The panel on critical care triage, including AODA Alliance Chair David Lepofsky, on the January 13, 2021 edition of TVO’s The Agenda with Steve Paikin.

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

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

MORE DETAILS

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

Ministry of Health
5th Floor
777 Bay St.
Toronto, ON M7A 2J3

January 22, 2021

Dear Minister Elliott,

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

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

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

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

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

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

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

We look forward to your response.

Sincerely,

Andrea Horwath Joel Harden
Leader of the Official Opposition MPP, Ottawa Centre

National Post January 23, 2021

A plan of last resort: Choosing who lives and dies if ICUs are overrun; Random selection
Graphic: Nathan Denette, The Canadian Press / If hospitals become overwhelmed, doctors will be asked to make impossible decisions that in normal times would be anathema to their training.

It’s not quite drawing names from a hat.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

National Post

Sharon Kirkey




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


Accessibility for Ontarians with Disabilities Act Alliance Update

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

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

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

January 25, 2021

            SUMMARY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For more background on this issue, check out:

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

            MORE DETAILS

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

Ministry of Health

5th Floor

777 Bay St.

Toronto, ON M7A 2J3

January 22, 2021

Dear Minister Elliott,

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

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

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

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

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

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

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

We look forward to your response.

Sincerely,

Andrea Horwath                                                                                Joel Harden

Leader of the Official Opposition                                                      MPP, Ottawa Centre

 National Post January 23, 2021

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

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

It’s not quite drawing names from a hat.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

National Post

Sharon Kirkey



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