Support for Patients and Healthcare Workers with Mental Health Challenges


The COVID-19 pandemic shows us how important healthcare is for every person in Ontario and around the world. In addition, the pandemic has emphasized the many barriers that already exist in the Ontario healthcare system for patients with disabilities. AODA healthcare standards could prevent and remove these barriers, and ensure that all Ontarians access the care they need. For instance, support for patients and healthcare workers with mental health challenges could prevent or remove some of the barriers Ontario patients face.

Support for Patients and Healthcare Workers with Mental Health Challenges

As a result of COVID-19, more people may develop physical disabilities, such as:

Therefore, more guidelines governing the healthcare system would better support the growing number of patients with these disabilities. Likewise, many people may develop Mental health disabilities as a result of the pandemic. For instance, some mental health challenges people experience happen after upsetting life events, or constant stress. As the pandemic progresses, more people may experience increased stress because they:

  • Worry about contracting COVID-19
  • Are isolated from family, friends, neighbours, or colleagues
  • Feel constantly saddened by news about the pandemic
  • Have difficulty coping with changes, such as:
    • Safety protocols for every-day tasks, such as shopping
    • Supervising children during online learning
    • Adapting to remote work
    • Caring for older or immunocompromised loved ones, in person or at a distance
    • Mourning loved ones who have passed away, while distanced from other loved ones

Constant stress from all these factors may lead to mental health challenges. For example, some of the mental illnesses people may experience are:

Anxiety Disorders:

Conditions in which people’s experience of anxiety becomes overwhelming and often affects other aspects of their lives.

Persistent feelings of sadness that can impact people’s:

  • Thoughts
  • Moods
  • Behaviour
  • Energy levels
  • Activities
  • Physical health

Posttraumatic Stress Disorder (PTSD):

A condition in which some people who have experienced a traumatic event, such as an accident, assault, military combat or natural disaster, may have repeated, involuntary memories or flashbacks of the event, sometimes triggered by sights, sounds or smells that recall the event.

Furthermore, some healthcare workers may also develop mental health challenges, after treating patients with COVID-19 under intensely stressful conditions. As a result, the healthcare system must be prepared to meet the needs of many more people with these conditions.

More Support for Patients and Healthcare Workers with Mental Health Challenges

AODA healthcare standards could require healthcare providers to make information about mental health supports available to patients. Healthcare workers could post contact information about services such as:

  • Help lines, by:
    • Phone
    • Text
    • Live web chat
    • Email
  • Mental health community resources
  • Programs providing supports such as cognitive behavioural therapy (CBT)
  • Peer support programs

In addition, healthcare providers could post pamphlets explaining the process for:

  • Referral to a professional counsellor, such as a psychologist or psychiatrist
  • Finding mental health support at school or work

 Furthermore, healthcare providers could post notifications in different places and formats. Healthcare providers could post signs outside their doors and in other prominent places. In addition, healthcare providers could train all staff so that they can offer patients information in person. Staff can take better advantage of these services if they are fully aware of them. Finally, healthcare providers could also post notifications on their websites and on phone-answering services, such as answering machines or automated answering systems.

Moreover, AODA healthcare standards could also include requirements to remedy the shortage of mental health professionals. Government could partner with other sectors to develop more training programs for psychologists, psychiatrists, and other professional mental health counsellors. Campaigns could increase public awareness about the need for these professionals, so that more people would follow these career paths. Likewise, standards could mandate more training on mental health for family doctors and nurse practitioners. Thorough training could help these healthcare workers interact with patients who have mental health challenges, and refer them to specialists when needed.

Finally, all these improvements to the healthcare system would also benefit healthcare workers with disabilities, including mental health challenges. It is vital that Ontario should develop a healthcare system equipped to support patients and healthcare workers who have mental health challenges.




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Support for Patients and Healthcare Workers with Brain Injuries


The COVID-19 pandemic shows us how important healthcare is for every person in Ontario and around the world. In addition, the pandemic has emphasized the many barriers that already exist in the Ontario healthcare system for patients with disabilities. AODA healthcare standards could prevent and remove these barriers, and ensure that all Ontarians access the care they need. For instance, support for patients and healthcare workers with brain injuries could prevent or remove some of the barriers Ontario patients face.

Support for Patients and Healthcare Workers with Brain Injuries

More people may develop disabilities as a result of COVID-19, including Brain injuries. For instance, people may acquire brain injuries that impact different skills and abilities, such as:

  • Mobility
  • Information processing, such as textual or verbal information
  • Speech
  • Focus
  • Memory, organization, and time management
  • Behavioural regulation and stress management

Therefore, more AODA guidelines governing the healthcare system would better support the growing number of patients with these disabilities.

For instance, people with some forms of brain injury need training in which they learn tools to maintain and regulate emotions or behaviours impacted by changes in brain function, such as:

  • Responsibility
  • Self-awareness
  • Personal and social boundaries
  • Safety

AODA healthcare standards could include requirements to increase the number of professionals qualified to teach patients about these tools and techniques. Government could partner with other sectors to develop more training programs for neuropsychologists and mental health counsellors. Campaigns could increase public awareness about the need for these professionals, so that more people would follow these career paths.

Similarly, more patients with brain injuries may also need more professionals who can support them in learning new forms of mobility, information processing, and other daily living skills. For example, some of these professionals include:

  • Physiotherapists
  • Occupational therapists
  • Speech therapists

Likewise, people who have newly acquired brain injuries could also benefit from peer support programs. These programs could connect newly diagnosed patients with other people living with similar injuries, for practical and emotional support.

More Support for Patients and Healthcare Workers with Brain Injuries

In addition, AODA healthcare standards could require more training about brain injuries for healthcare workers, such as:

  • Family doctors
  • Nurses
  • Staff of walk-in clinics
  • Lab technicians
  • Pharmacists

This basic training would prepare these workers to interact with and support patients with different types of brain injuries. For instance, workers could become familiar with different ways that people may:

  • Communicate
  • Process information
  • Move
  • Behave

Detailed training on how to interact with patients who have a variety of abilities could help healthcare workers meet these patients’ needs.

Furthermore, more accessible healthcare spaces would better serve patients who have gained physical disabilities as a result of their brain injuries.

Finally, all these improvements to the healthcare system would also benefit healthcare workers with disabilities, including brain injuries. It is vital that Ontario should develop a healthcare system equipped to support both patients and healthcare workers who have brain injuries.




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Support for Patients and Healthcare Workers with Breathing Disorders


The COVID-19 pandemic shows us how important healthcare is for every person in Ontario and around the world. In addition, the pandemic has emphasized the many barriers that already exist in the Ontario healthcare system for patients with disabilities. AODA healthcare standards could prevent and remove these barriers, and ensure that all Ontarians access the care they need. For instance, support for patients and healthcare workers with breathing disorders could prevent or remove some of the barriers Ontario patients face.

Support for Patients and Healthcare Workers with Breathing Disorders

More people may develop disabilities as a result of COVID-19, including breathing disorders. Therefore, more AODA guidelines governing the healthcare system would better support the growing number of patients with these disabilities.

For instance, AODA healthcare standards could include requirements to increase the number of professionals qualified to support patients in managing their conditions. For example, some of these professionals include:

  • Respiratory therapists
  • Physiotherapists
  • Occupational therapists
  • Nutritionists
  • Psychologists
  • Nurses
  • Technologists

Government could partner with other sectors to develop more training programs in these fields. Campaigns could increase public awareness about the need for these professionals, so that more people would follow these career paths.

Likewise, people who have newly acquired breathing disorders could also benefit from peer support programs. These programs could connect newly diagnosed patients with other people living with similar disorders, for practical and emotional support.

More Support for Patients and Healthcare Workers with Breathing Disorders

In addition, AODA healthcare standards could require more training about breathing disorders for healthcare workers, such as:

  • Family doctors
  • Nurses
  • Staff of walk-in clinics
  • Lab technicians
  • Pharmacists

This basic training would prepare these workers to interact with a variety of patients and meet their needs. For example, some patients with breathing disorders may use assistive devices, such as oxygen tanks or wheelchairs. Alternatively, other patients may not use any assistive devices, but have difficulty walking long distances. In other words, these patients’ disabilities are invisible. Moreover, training could prepare staff to make oxygen available throughout the hospital for patients who need it.

Furthermore, more accessible healthcare spaces would better serve patients who have gained physical disabilities, including breathing disorders. For instance, accessible parking spaces should be as close as possible to hospital entrances. In this way, people who cannot walk long distances can easily enter hospitals. Likewise, wards treating out-patients with these disorders should also be near entrances. As a result, patients could access their treatments without fatigue or breathlessness. Similarly, smoking areas should be farther away from these entrances, so that patients will not breathe in smoke.

Finally, all these improvements to the healthcare system would also benefit healthcare workers with disabilities, including breathing disorders. It is vital that Ontario should develop a healthcare system equipped to support both patients and healthcare workers who have breathing disorders.




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


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

August 5, 2021

SUMMARY

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

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

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

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

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

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

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

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

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

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

MORE DETAILS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

#17 The standard should require that:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

c) A health care facility’s discharge instructions.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

a) Attendant care.

b) Assistance with meals.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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




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


Accessibility for Ontarians with Disabilities Act Alliance Update

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

Web: www.aodaalliance.org

Email: [email protected]

Twitter: @aodaalliance

Facebook: www.facebook.com/aodaalliance/

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

August 5, 2021

         SUMMARY

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

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

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

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

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

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

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

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

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

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

         MORE DETAILS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

#17 The standard should require that:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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Ensuring Access to Support Persons in Healthcare


Currently, there are still no AODA healthcare standards. However, an AODA standards development committee drafted recommendations of guidelines that AODA healthcare standards should include. These guidelines include ensuring access to support persons in healthcare.

The committee’s mandate from the Ontario government requires recommendations focused on the hospital setting. However, patients and healthcare workers with disabilities also face barriers in other parts of the healthcare system, including:

  • Doctors’ offices
  • Walk-in clinics
  • Wellness centres
  • Pharmacies
  • Labs
  • Nursing homes
  • Outpatient rehabilitation centres
  • Health regulatory colleges

Therefore, all these settings should ensure access to support persons.

Ensuring Access to Support Persons in Healthcare

Some patients may need support persons while in hospital, to accomplish non-medical tasks, such as:

  • Communication
  • Making decisions
  • Travelling to or within the hospital
  • Transferring from assistive devices to medical equipment, such as examination tables
  • Activities of daily living

A support person can be a paid personal support worker (PSW), a volunteer, a family member, or a friend. PSWs are trained professionals. Family or friends usually do not have formal training, but they often have years of experience. People often have different support persons at different times. While some patients need support for brief hospital visits, others need ongoing support for longer stays.

Policies for Access to Support Persons

The committee recommends policies and procedures to ensure that patients always have access to the non-medical supports they need. Moreover, these policies should recognize that patients with disabilities make independent decisions about how and when they should receive support, and direct their support persons.

Staff should ask all patients whether they require any support, and document this accommodation need on patients’ care plans. As a result, staff will know how any needed support should be provided, and implement support according to the plan.

Implementing Access to Support Persons

For instance, some patients may use support services daily in their every-day lives, such as attendant care. Patients may wish to receive support from the same person or agency during a hospital stay. As a result, these patients’ care plans should state that they receive support from a third-party service, or from a loved one. Alternatively, patients may receive support from a different person or agency while in hospital. In either case, hospital staff must always allow patients to access their support persons. Moreover, patients’ support persons must follow hospital rules about patient confidentiality.

In contrast, some patients may not receive support in their daily lives, but may require support during a hospital stay. For instance, a patient who is blind may travel independently, but may need some sighted guide from hospital staff. These patients’ care plans should note that they require this support. Furthermore, hospital staff should have training that prepares them to guide patients.

Each patient with a disability should decide whether or not to share confidential information with their support person. For instance, one patient may allow their support person in the room while their doctor gives their diagnosis. On the other hand, another patient may prefer to have the support person wait outside. Hospital policies and practices should recognize that each patient can make their own choices about how they receive support.

These policies and procedures allow healthcare providers and non-medical support persons to work together in providing safe and confidential care.




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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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Please Write to the City of Toronto to Support the AODA Alliance’s New, Comprehensive Brief on Why Toronto Should Not Lift the Ban on Electric Scooters


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/

March 30, 2021

SUMMARY

The AODA Alliance has just submitted a comprehensive brief to the City of Toronto showing why it must not lift the ban on electric scooters (e-scooters). This brief, set out below, brings together and supplements all the work we have done on this e-scooters issue over the past 19 months. We set the brief out below.

The brief begins with a pithy 3-page summary, for those who dont have time to read it all. We encourage you or any community organization with which you are connected to email Toronto Mayor John Tory, any City Council member you think appropriate, and Toronto City staff. Tell them you support the AODA Alliances March 30, 2021 brief opposing e-scooters in Toronto. Mayor Tory: [email protected] and you can email City staff by writing City staff: [email protected]
For an easy-to-use online tool to email Mayor Tory and any City Council members you wish, provided courtesy of the March of Dimes of Canada, visit https://www.marchofdimes.ca/en-ca/aboutus/govtrelations/elections/Pages/escooters.aspx Please quickly write Toronto. It is anticipated that this issue will come up again at the City of Toronto Infrastructure and Environment Committee on April 28, 2021. We will have more information for you in the coming days.

For more background on this issue, visit the AODA Alliances e-scooters web page.

Riding Electric Scooters in Toronto is Dangerous and Must Remain Banned For Toronto To Allow E-scooters Would be to Knowingly Create New Disability Accessibility Barriers Against People with Disabilities

AODA Alliance brief to the City of Toronto
March 30, 2021

Mayor Tory and Toronto City Council must not unleash dangerous electric scooters in Toronto. Riding e-scooters in public places in Toronto is now banned. It remains banned unless Council legalizes them. The pressure to allow e-scooters is relentlessly being advanced by corporate lobbyists for the wealthy and well-financed e-scooter rental industry. Torontonians, including Torontonians with disabilities, need Mayor Tory and City Council to stand up to the corporate lobbyists, and to stand up for vulnerable people with disabilities, seniors, children and others whom e-scooters endanger.

The AODA Alliance submits this brief to the City of Toronto in opposition to the proposal to lift the ban on riding e-scooters in public places in Toronto. It should remain illegal for e-scooters to be ridden in public, whether on a rental e-scooter or a privately-owned e-scooter.

The non-partisan AODA Alliance has played a leading role in raising serious disability safety and accessibility concerns with e-scooters. To learn more about the AODA Alliances advocacy efforts to protect people with disabilities and others from the dangers that e-scooters pose, visit its e-scooters web page.

This issue will likely be on the agenda at the April 28, 2021 meeting of the Toronto Infrastructure and Environment committee. We ask City staff to incorporate this briefs findings and recommendations in its forthcoming report to The Toronto Infrastructure and Environment Committee and the Toronto City Council as a whole.

1. Summary of this Brief – Dont Allow E-scooters in Toronto

Toronto should not lift the current ban on riding e-scooters in public places, whether permanently or for a pilot project. For Toronto to allow people to ride e-scooters, whether ones they own or rent, would knowingly and seriously endanger the safety of people with disabilities, seniors, children and others. It would knowingly create new accessibility barriers against people with disabilities. This would fly in the face of the Accessibility for Ontarians with Disabilities Act and the guarantees to people with disabilities in the Canadian Charter of Rights and Freedoms and the Ontario Human Rights Code. Here are key incontrovertible facts overwhelmingly established by objective City staff reports and by public feedback:

1. Having been forewarned, for the City of Toronto to lift the ban on e-scooters in light of the dangers they pose, as documented in this brief, would expose the City to major claims for knowingly endangering Torontos residents and knowingly creating new accessibility barriers against persons with disabilities. For the City of Toronto to do so knowingly is the same as doing so intentionally.

2. E-scooters will cause an increase in personal injuries, including serious personal injuries to innocent pedestrians and e-scooter riders, burdening Torontos overburdened hospital emergency rooms. E-scooters are a silent menace, ridden by unhelmetted, untrained, unlicensed and uninsured riders.

3. If Toronto allows e-scooters, but bans them from sidewalks, experience in other cities shows for certain that e-scooters will nevertheless regularly be ridden on Toronto sidewalks. This endangers innocent pedestrians. Toronto lacks the law enforcement capacity to effectively police new rules regarding e-scooters, such as a ban on riding or parking them on sidewalks.

4. If Toronto permits e-scooters, this will create new serious accessibility barriers impeding people with disabilities. This will happen especially in public places like sidewalks where they will be left strewn about, as in other cities that permit e-scooters. They will be a tripping hazard for blind people. They will block accessible paths of travel for people using wheelchairs. Toronto already has far too many accessibility barriers in public places such as sidewalks. E-scooters would make this even worse.

5. Toronto City staff found no other city that has found an effective way to permit and regulate e-scooters and to effectively enforce those regulations.

6. To lift the ban on e-scooters will invariably place new financial burdens on the taxpayer. The maximum amount cannot be quantified in advance. This will include added health care costs due to e-scooter injuries, cost of added infrastructure to accommodate e-scooters, added law enforcement costs, added regulatory and monitoring costs, and other liabilities triggered by e-scooters.

7. Torontos mayor and City Council have received strong united opposition to e-scooters from the disability community, reflecting the needs of vulnerable people with disabilities ,seniors and children. This includes two successive compelling unanimous resolutions against e-scooters by the Toronto Accessibility Advisory Committee, strong opposition by many respected disability community organizations, passionate deputations against e-scooters by every person with a disability presenting to City Council committees that have invited deputations on this topic, and emails and phone calls to the mayor and City Council members from many people with disabilities and their supporters.

8. On July 28, 2020, City Council directed City staff to research disability community concerns with e-scooters. City staffs research further validated and documented disability community concerns with e-scooters. City staff explored options for addressing these concerns and found that there are no workable solutions that are safe and that avoid the creation of new accessibility barriers. The e-scooter rental industrys proposed solutions would impose significant cost burdens on the public. They would not effectively solve these public safety and disability accessibility concerns.

9. It is disturbing that on July 28, 2020, almost half of City Council voted to oppose City Staff conducting research on disability concerns with e-scooters. Had those dissenting Council members succeeded, the important new information that City staff has revealed would never have come to light, to the serious detriment of people with disabilities.

10. In disregard of these serious dangers, a relentless push for e-scooters in Toronto is mounted by corporate lobbyists for the Canadian arm of international e-scooter rental companies such as Lime and Bird. They unleashed an extensive, well-financed and well-connected lobbying feeding frenzy at City Hall. Some City Council members told the AODA Alliance that this is one of the biggest, if not the biggest corporate lobbying blitz now underway at City Hall. An AODA Alliance report documented that between June 2018 and October 2020, the e-scooter corporate lobbyists had fully 1,384 contacts at City Hall, including 94 with the mayors office.

11. Substantially eviscerating their credibility on this issue, this brief documents that the e-scooter corporate lobbyists have made a number of false, exaggerated, misleading and/or transparently meritless claims to support their pressure for Toronto to lift the ban on e-scooters and let them expand their market. If Toronto allows e-scooters, the e-scooter rental companies will be laughing all the way to the bank, while members of the public, including vulnerable people with disabilities, seniors and children, will be sobbing all the way to the hospital.

12. The e-scooter corporate lobbyists entire campaign is based on the erroneous assertion that rental e-scooters will significantly reduce traffic and pollution, because instead of driving, people will take public transit, and then rent an e-scooter to ride the last mile to their destinations. Yet data from City staff and from the corporate lobbyists themselves shows that the vast majority of e-scooter rides are NOT taken to connect to public transit. They thus wont reduce traffic or pollution. Indeed a proportion of e-scooter renters use an e-scooter instead of walking or taking public transit. Moreover, for e-scooters to be effective for this last mile, Toronto must be inundated with thousands of e-scooters, so one is available whenever a rider wants one. This exacerbates city clutter and disability barriers.

13. The public use of e-scooters in Toronto should remain banned in any form, whether privately owned the by the rider, or rented e.g. through a shared e-scooter program. The AODA Alliance opposes any e-scooter rental program, whether run by the e-scooter rental companies directly or by the City of Toronto e.g. through its Bike Share program.

14. The AODA Alliance agrees with the Toronto Accessibility Advisory Committee, which called on City law enforcement to enforce the current ban on e-scooters. If someone now illegally rides an e-scooter, City Council should mandate law enforcement to confiscate that e-scooter.

15. The fact that Toronto earlier approved some other shared economy activities, like Uber ride sharing, should not mean the e-scooter corporate lobbyists get a free pass here. Any prior approval of ride-sharing, for example, did not take into account the dangers that e-scooters pose. Each shared economy proposal should be assessed on its own strengths and dangers. Rejecting e-scooters does not preclude City Council from approving other shared economic activities, where it adjudges them safe and appropriate.

16. We seek the leadership of Toronto Mayor John Tory. We need him and all City Council to stand up for people with disabilities, seniors, children and others endangered by e-scooters. We need Mayor Tory and City Council to stand up to the e-scooter corporate lobbyists.

2. The Proof is Overwhelming – E-Scooters Endanger Personal Safety and Accessibility for People with Disabilities, Seniors, Children and Others.

Overwhelming evidence shows that allowing e-scooters in Toronto will endanger the safety of the public, including vulnerable people with disabilities, seniors, children and others. They will also create new accessibility barriers in a city that is already full of too many disability barriers.

a)Two Strong Resolutions of the Toronto Accessibility Advisory Committee

These concerns are strongly supported by two unanimous motions of the Toronto Accessibility Advisory Committee. Those resolutions were passed on February 3, 2020 and February 25, 2021. The latter reads:

The Toronto Accessibility Advisory Committee communicate to the Infrastructure and Environment Committee and City Council, for consideration with the next staff report on electric kick scooters, that:
1. The Committee does not support the use of any electric kick-scooters (e-scooters) in the City of Toronto; and request that a ban prohibiting their use in all public space remain in place without any exceptions, as they: a. create a general safety hazard in the public realm for all Toronto residents; b. add further barriers for the elderly and persons living with disabilities;
c. are poorly enforced when illegally used due to insufficient enforcement resources; d. further encumber pre-existing inadequate infrastructure.
2. The Committee recommends that City Council request the Toronto Police Services Board, the General Manager, Transportation Services, and the Executive Director, Municipal Licensing and Standards to consult with accessibility stakeholders to:
a. develop a public education campaign to effectively convey the existing by-laws on the prohibition of e-scooters use in all public spaces;
b. actively scale up city-wide enforcement of the by-law prohibiting use of e-scooters in all public spaces.

It is especially important for Toronto Mayor John Tory and City Council to pay heed to these unanimous strong resolutions. This is because the Accessibility for Ontarians with Disabilities Act (AODA) requires cities like Toronto to create such municipal accessibility advisory committees. They exist in order to alert municipal governments to important areas where priority action is needed on accessibility for people with disabilities. This includes, among other things, action needed to prevent the creation of new accessibility barriers. If a municipal government creates a new accessibility barrier after it was warned not to do so by its accessibility advisory committee, that government will be acting in a deliberate, intentional and harmful way, contrary to the AODAs goal.

b) Media Coverage Objectively Documents Serious Harms Caused by E-scooters

Here is a sampling of media coverage objectively documenting the harms and injuries that e-scooters can cause.

*E-scooter hit-and-run crash leaves pedestrian, 65, seriously injured in hospital in Greater Manchester, UK

*Woman left with brain injury after being hit by e-scooter when getting off bus in Auckland court hears

*Six e-scooter riders before courts for intoxicated riding – UK pilots

*According to the Edmonton Journal, in Edmonton 94 percent said they saw e-scooters used on sidewalks, 68% said more enforcement needed.

*The Washington Post reported on January 11, 2019 that a 75-year-old man in San Diego tripped over an e-scooter. He was taken to hospital, “where X-rays revealed his knee was shattered in four places”. The article quotes Wally Ghurabi, medical director of the Nethercutt Emergency Center at the UCLA Medical Center in Santa Monica. Ghurabi said, “I’ve seen pedestrians injured by scooters with broken hips, multiple bone fractures, broken ribs and joint injuries and soft tissue injuries like lacerations and deep abrasions.” The article also reports incidents involving pedestrians in Dallas, where a 32-year-old man was “left with scrapes on his knee and face, as well as a deep gash above his right eye that required seven stitches”, and Cincinnati, where a 44-year-old woman incurred approximately $1000 in medical expenses after being “throw [n]…to the ground” both following collisions with e-scooters.

*Euronews reported on June 18, 2019, that Paris intended to implement speed limits and parking restrictions for e-scooters following its first death on an electric scooter. The French transport minister also announced a nationwide ban on e-scooters on sidewalks, effective September. A week prior to the announcements, a 25-year-old man riding an e-scooter had died after being hit by a truck. The report details other incidents, involving both riders and bystanders. In Sweden, a 27-year-old man died in a crash while riding one of the electric vehicles in May. In Barcelona, a 92-year-old woman died in August 2018 after she was run over by an e-scooter making it the first case of a pedestrian being killed by the electric vehicle.

*On July 26, 2019, CBC News reported that since e-scooters became available in Calgary, Calgary emergency rooms have seen 60 patients with e-scooter-related injuries. The report added that [a] bout a third of them were fractures and roughly 10 per cent were injuries to the face and head. These figures have triggered a study by the University of Calgary.

*The Guardian reported on August 11, 2019 that Paris had experienced its third e-scooter-related death in four months: A 30-year-old man has been killed after being hit by a motorbike while riding his e-scooter on a French motorway. The report went on to state that [t] he scooter rider was not wearing a helmet and was reportedly travelling in the fast lane when the motorbike hit him from behind, despite the fact that [u] sing scooters on motorways is banned in France. Moreover, The day before the accident, a 27-year-old woman suffered serious head injuries after falling from an e-scooter she was using in a cycle lane in Lyon. A few days earlier a 41-year-old man had been seriously injured after falling from his e-scooter in Lille. Finally, the report provided details on another, earlier e-scooter-related death in France: An 81-year-old man died after he was reportedly knocked over by an e-scooter in Levallois-Perret, a Parisian suburb, in April.

*CityNews reported on August 13, 2019, as part of a short survey of European regulations, that German police say seven people have been seriously injured and 27 suffered minor injuries in scooter accidents since mid-June, saying most were due to riders behaving carelessly.
*In Austin, an article from 2019 states that almost half of the 190 e-scooter injuries in a three-month period were injuries to the head and 15 percent were traumatic brain injuries. Less than 1 percent of injured riders were wearing helmets.

*In San Antonio, wheelchair users complain of e-scooters being left on sidewalks and ramps; these present a danger to individuals who rely on wheelchairs for mobility. The article notes that the e-scooters create profound obstacles for disabled people who are simply trying to get to work or run daily errands.

*An article entitled “Sharing the sidewalk: A case of E-scooter related pedestrian injury” published in the American Journal of Emergency Medicine in June 2019 cites multiple studies corroborating the occurrence of pedestrian injuries: one from Israel found that, while pedestrians were 8.4% of the patients admitted for e-bike- and e-scooter-related injuries, they “were more severely injured; compared to electric scooter riders and electric bike riders, pedestrians have higher rates of head, face, and neck injuries; traumatic brain injuries; and hospital stays lasting more than a week”.

c) Major Disability Organizations Unite in Opposition to Allowing E-Scooters

An impressive number of respected community organizations have voiced the same safety and accessibility concerns especially for people with disabilities and seniors. They have called for e-scooters not to be allowed. A January 22, 2020 Open letter in opposition to e-scooters in Ontario cities like Toronto has been co-signed or endorsed by the Accessibility for Ontarians with Disabilities Act Alliance, March of Dimes of Canada, the Canadian National Institute for the Blind, the ARCH Disability Law Centre, Spinal Cord Injury Ontario, the Ontario Autism Coalition, the Older Womens Network, the Alliance for Equality of Blind Canadians, Guide Dog Users of Canada, Views for the Visually Impaired, Citizens With Disabilities Ontario and Canadians with Disabilities of Bnai Brith Canada.

d) All deputants with Disabilities Addressing City of Toronto Committees on E-scooters Raise Serious Safety and Accessibility Objections

Safety and accessibility concerns led every deputant with disabilities and their supporters, speaking at City of Toronto Committee meetings on this issue, to insist that e-scooters must not be allowed in Toronto. This was the unanimous message from all people with disabilities and their supporters who have addressed the Toronto Accessibility Advisory Committee on February 3, 2020 or February 25, 2021, and who addressed the Toronto Infrastructure and Environment Committee on July 9, 2020.

For example, at the February 25, 2021 Toronto Accessibility Advisory Committee meeting, a very long meeting for that Committee, Disability presenters at the meeting were unanimous in voicing total opposition to e-scooters in any form or on any basis in Toronto. John Rae, a blind person over the age of 70, spoke for the Alliance for Equality of Blind Canadians. He described e-scooters as an e-menace to people with disabilities and seniors. He said that any deployment or testing of e-scooters would be a new disability barrier, flying in the face of the Accessibility for Ontarians with Disabilities Act. He said Toronto, including its sidewalks, have been becoming less accessible to persons with vision loss. E-scooters will make this worse. This is an issue of pedestrian safety.

Edward Rice, speaking for Bnai Brith Canada, showed disturbing pictures from Fort Lauderdale Florida, where from a year before, when in a two block area, there were fully 25 e-scooters strewn about the sidewalk. He uses a mobility device. He had to ask strangers to move these out of the way so he could travel on the sidewalk. He called this embarrassing and humiliating.

John Mosa, Melanie Marsden and Andrea Hatala together spoke for the GTA Disability Coalition, a network of different disability organizations. They, like Mr. Rice, cited a study of increased emergency room visits in Calgary due to e-scooter use. In Toronto this would compound the discrimination which people with disabilities risk in hospital during COVID-19 due to the Ontario Governments critical care triage protocol. They identified the barriers to people with disabilities that e-scooters pose, because they are silent and can be difficult to avoid, and because they can be a tripping hazard and mobility barrier on sidewalks. They endorsed the AODA Alliances call for e-scooters to be banned, for there to be no e-scooter pilot, and for police to enforce the ban on e-scooters against those now riding them.

Jennifer Griffith, a blind woman who uses a guide dog, described Toronto as an increasingly dangerous and inaccessible city. Her example of dangers are construction sites in the city that she has to try to safely navigate through or around. She described the fear she would face each time she goes out in public if she faces the danger of silent e-scooters injuring her. She would not have heard of a proposal for an e-scooter pilot, had it not been for the AODA Alliance.

Ron Redham is a 60 year old person with a disability who lives in Etobicoke and walks with canes. Having gradually learned how to use canes after having to use a wheelchair, He asked Toronto not to send him and others back on the rehabilitation burdens that he had to go through. He doesnt want to end up in a wheelchair again. He said in Montreal, 80% of scooters were parked illegally, resulting in them littering the downtown. This led to an early cancellation of their pilot project.

Paul Michaels is from Bnai Brith Canada, a national human rights organization. He has two family members with cerebral palsy. They asked him to share with the Committee their fear that they could not readily maneuver out of the path of an oncoming e-scooter or around a group of e-scooters.

Adam Cahoon said he gets hateful looks when he uses his power wheelchair at full speed, around 8 KPH or so. He said e-scooter scan go over double his speed, making him feel especially vulnerable.

On February 25, 2021, several members of the Toronto Accessibility Advisory Committee also described serious safety and accessibility dangers that e-scooters pose for people with disabilities. For example, a member of Toronto Accessibility Advisory Committee said that deafblind persons would be especially vulnerable.

e) Toronto City Staff Confirm the Safety Dangers and New Accessibility Barriers that E-Scooters Would Create in Toronto

Two written City staff reports confirm that e-scooters endanger public safety, including safety for vulnerable people with disabilities, seniors, children and others. They will also create new disability accessibility barriers, even if banned on sidewalks. This is confirmed in the City staffs June 24, 2020 report to the Toronto Infrastructure and Environment Committee, and the City staffs February 25, 2021 presentation to the Toronto Accessibility Advisory Committee.

The City staffs June 24, 2020 report to the Citys Infrastructure and Environment Committee included these findings:

* E-scooters pose a risk to people with disabilities due to their faster speeds and lack of noise. Cities that have allowed e-scooters have observed a high incidence of sidewalk riding by riders, whether permitted or not on sidewalks. Parked e-scooters, especially when part of a dockless sharing system, can pose trip hazards and obstacles. Seniors, people with disabilities, and those with socio-economic challenges could face negative outcomes if injured in a collision or fall. Solutions to enforcement and compliance are still in their infancy.

* Vision Zero Road Safety Risks with E-scooters
The City has a Vision Zero commitment to eliminate serious injuries and fatalities resulting from roadway crashes, particularly around six emphasis areas including pedestrians, school children, and older adults. Replacing car trips with e-scooter trips presents an opportunity to address some road safety issues if e-scooters produce a net safety benefit, especially for these groups. A 2020 International Transport Forum study notes that the risk of hospital admission may be higher for e-scooter riders than for cyclists, but that there are too few studies to draw firm conclusions. While not comprehensive, the emerging evidence of the health impacts associated with e-scooter use warrants a cautious approach to mitigate risks to e-scooter riders, pedestrians, and the City. Some of the findings are below.

New e-scooters users are most likely to be injured with 63 per cent of injuries occurring within the first nine times using an e-scooter. (CDC and City of Austin).

A comparison of serious injury rates between Calgary’s 2019 shared e-scooter pilot and Bike Share Toronto suggests riding a shared e-scooter is potentially about 350 times more likely to result in a serious injury than riding a shared bike on a per km basis, and about 100 times more likely on a per trip basis. This includes a limited sample size, differing definitions for serious injuries, different city contexts (e.g., Calgary allowed e-scooter riding on sidewalks, whereas bicycle riding is not allowed on sidewalks in Toronto) and serious injuries may decline over time as people gain experience riding e-scooters. (Montréal reported few e-scooter injuries for its 2019 pilot, however, it is unclear whether and how data for serious injuries was gathered.) Calculations are based on: 33 ER visits requiring ambulance transport over three months (Jul to Sep 2019) in Calgary for e-scooter-related injuries with a reported 750,000 trips, and average trip length of 0.9km; and 2,439,000 trips for Bike Share Toronto, with 3km average trip length, over 12 months in 2019, and no serious injuries (e.g., broken bones, head trauma, hospitalization) but attributing one for comparison purposes. Further data collection and studies of injuries are needed on a per km basis, by type of trip (i.e., recreational versus commuting, facility type), and by injury type.

The fatality rate for shared e-scooter users is potentially nine to 18 times the rate of bike share-related deaths in the U.S., based on a news report in the Chicagoreader.

Head trauma was reported in nearly one third of all e-scooter-related injuries in the U.S. from 2014 to 2018 more than twice the rate of head injuries to bicyclists. In a City of Austin study in 2018 over three months, 48 per cent of e-scooter riders who were hurt had head injuries (91 out of 190), with 15 per cent (28 riders) experiencing more serious traumatic brain injuries.

Falling off e-scooters was the cause of 80 per cent of injuries (183 riders); 20 per cent (45 riders) had collided with a vehicle or an object, according to a 2019 UCLA study of two hospital ERs in one year. Just over eight per cent of the injuries were to pedestrians injured as a result of e-scooters (11 hit by an e-scooter, 5 tripped over a parked e-scooter, and 5 were attempting to move an e-scooter not in use).

Hospital data will be key to track injuries and fatalities by type and severity, especially for incidents where no motor vehicle has been involved (e.g., losing control) or for a trip and fall involving improperly parked e-scooters. As an ICD-10 code (international standard injury reporting code) specific to e-scooters will not be implemented in Canada until at least spring 2021, a reliable method to track serious e-scooter related injuries and fatalities presenting at hospitals is currently not available.

* Other cities have suspended e-scooter sharing services until after COVID-19 (e.g., Windsor approved a shared e-scooter pilot in April 2020, but has now deferred its pilot until after COVID-19). Prior to the pandemic, a number of jurisdictions (e.g., Boulder, Honolulu, and Houston) had refused to allow or banned the use of e-scooters due to public safety concerns. Key cities with similar population, urban form, and/or climate have not yet piloted e-scooters such as New York City (Manhattan/New York County ban), Philadelphia, and Sydney, Australia.

* While staff have considered a potential e-scooter pilot on ActiveTO major road closures, it would pose risks to vulnerable road users and leave the City open to considerable liability and risk due to lack of resources for oversight, education and enforcement at this time. A key purpose of ActiveTO is to provide a mixed use space for physical activity for people of all ages for walking, jogging and human-powered cycling. Piloting a new vehicle type that is throttle-powered and can potentially exceed speeds of 24km/hr poses risks to vulnerable road users in such conditions. It could also lead to confusion about which infrastructure or facilities under ActiveTO are permissible, and this would pose public safety risks that the City does not have resources to manage at this time.

* Finally, the risk of injury for new users is high, and could put additional burden on local hospitals and paramedics at this time. For the reasons above, City staff do not recommend permitting e-scooters in ActiveTO facilities in 2020.

* If Council were to permit e-scooters to be operated on City streets – without the commensurate resources to provide oversight, education, outreach and enforcement, there would be considerable risks to public safety for e-scooter riders and other vulnerable road users; additional burden on hospitals and paramedics; impacts on accessibility, community nuisance and complaints; impacts on current initiatives to enhance the public realm for COVID-19 recovery efforts, such as CurbTO and CaféTO; and liability and costs to the City. For the reasons above, staff recommend that personal use of e-scooters not be considered until 2021.

* Accessibility for Ontarians with Disabilities Act (AODA)

Persons with disabilities and seniors have considerable concerns about sidewalk and crosswalk interactions with e-scooter users, as well as concerns regarding trip hazards and obstructions from poorly parked or excessive amounts of e-scooters. The Toronto Accessibility Advisory Committee, a body required under the AODA, recommends that City Council prohibit the use of e-scooters in public spaces, including sidewalks and roads. In other jurisdictions outside of Ontario, some legal action has been undertaken against municipalities by persons injured as a result of e-scooter sidewalk obstructions, as well as by persons with disabilities.

After City Council directed City staff on July 28, 2020 to do further research on the disability concerns regarding e-scooters, City staff did further research. This further research reinforced the public safety and accessibility concerns addressed above. None of the City staffs new information refuted or reduced the concerns about the dangers that e-scooters present as raised by disability advocates and others. The City staffs further research did not support a conclusion that these concerns have been or could be effectively eliminated.

The City staffs February 25, 2021 presentation to the Toronto Accessibility Advisory Committee included
* According to the UDV (German Insurers Accident Research) in January 2021, e-scooter riders are 4 times more (or 400% more) likely than bicyclists to injure others, due to e-scooters being illegally ridden on sidewalks.
In 21% of e-scooter incidents with personal injury, the victim is not the rider, but another road user. This is due in part to e-scooters being ridden on sidewalks 60% of the time when they should be on the road or bike lane.

According to Austrias Kuratorium für Verkehrssicherheit (KFV) in October 2020, 34% of 573 e-scooter riders observed at several Vienna locations illegally rode on the sidewalk.
Even if there was a bike path, 23 percent preferred the sidewalk. If there was only one cycle or multi-purpose lane, 46 percent rode on the sidewalk. If there was no cycling infrastructure, 49 percent rolled illegally on the sidewalk.

* Canadian context City of Calgary
No bike share. Only rental e-scooters allowed in Alberta. Allows e-scooter riding on sidewalks.
43% of 311 requests about bad behaviour or conflicts with pedestrians; 42% parking concerns. (total of 769 requests over the pilot period)
Now allowing e-scooter use on some roads to reduce sidewalk riding issues. Added slow speed zones and 30 parking zones (2.5% of riders ended trips in parking zones; 10% of the e-scooter fleet was deployed to the parking zones).
E-scooters to return via the procurement process. Lowered fleet cap from 2,800 (2020) to 1,500 (2021). Will require licence plates for enforcement.
Likely that e-scooters have the highest rate of injury per transportation mode but less severe. 43% of EMS e-scooter injuries required surgery (double that of EMS bicycles at 21%). 37% of severe e-scooter injuries had suspected intoxication.
1,300 e-Scooter-related ER visits during the pilot period but may be over-inclusive of other devices referred to as scooters. 75 required ambulance transport, 5% were pedestrians injured.

Canadian context City of Ottawa
No bike share. Personal use and rental e-scooters allowed on roads with max 50km/h limit, bike lanes, and trails/paths that are not National Capital Commission multi-use paths.
Lowered max. speed to 20km/hr for e-scooters from the permitted 24km/hr under the provincial pilot. 8km/hr for slow zones, e.g., transit malls/stations.
Piloted a fleet of 600 e-scooters with 3 vendors in 2020. Will increase the fleet cap to between 1,200 and 1,500 for 2021 and expand outside the Greenbelt (suburban area).
76% of e-scooter riders surveyed used e-scooters for recreation; 2% to connect to transit (COVID-19 context)
Will pilot in 2021 via procurement process. Staff labour costs not included in cost-recovery. Considering designated parking areas. 69% of all survey respondents reported encountering improperly parked e-scooters.
No injury data collection with hospitals and not likely for 2021 given the pandemic.
Accessibility stakeholders were consulted and raised concerns about sidewalk riding and improper parking, especially barriers for persons with low vision or no vision.
Despite all the overwhelming evidence that demonstrates e-scooters ‘dangers, the two lead e-scooter rental companies, Bird and Lime, together have campaigned for e-scooters in Toronto in effect as if none of that evidence is true. For example, Bird tried to convey an impression that e-scooters pose no additional danger to public safety, if allowed, and are simply the same as bikes. This defies logic. Unlike bikes, an e-scooter, ridden for the very first time by an utterly inexperienced rider, can silently race faster than 20 kph in seconds, powered by an onboard motor. The faster a vehicles speed on impact with an innocent pedestrian, the greater the force applied, and the risk of consequential injury.

Lime has made even more exaggerated claims. It repeatedly told the February 25, 2021 Toronto Accessibility Advisory Committee meeting that rental e-scooters, if allowed, will improve public safety, stating:
The OECD says in their widely, the most extensive report in the world on micro-mobility that road users will be safer, all road users, if e-scooter and bicycle trips replace travel by car or motorcycle.

Lime would thus have Toronto believe that the public is at greater danger now, because e-scooters are not allowed. To support this extreme claim, Lime in substance argued that cars are more dangerous to pedestrians than are e-scooters. Is it just a coincidence that this claim serves the economic interests of the e-scooter corporate lobbyists in getting as many e-scooters on the road as possible, claiming in effect that the more e-scooters that are deployed, the safer we all will be?

Of course, cars are much bigger and heavier than e-scooters. They can go much faster than e-scooters. As such, a car can cause greater injuries when it hits a pedestrian.

Limes claim rests on fatally flawed premises. First, no one is contemplating banning cars from the road, and replacing them with e-scooters. Second, cars, unlike e-scooters, are not routinely driven on sidewalks, where pedestrians expect and deserve to be able to walk in safety, unthreatened by any motor vehicles. Third, as addressed further below, in cities where e-scooters are allowed, they have not been proven to materially reduce the amount of car traffic on the road.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, the City got a unique opportunity to assess the clash between City staff who say that e-scooters create new safety dangers on the one hand, and e-scooter corporate lobbyists who claim that e-scooters will improve public safety, on the other. Committee members asked both e-scooter corporate lobbyists and City staff to address the clash in the data that each relied upon.

When the answers of City staff and the e-scooter corporate lobbyists are assessed together, the only plausible conclusion is to reject the corporate lobbyists claims that e-scooters improve public safety, rather than endangering public safety. City Council is strongly encouraged to prefer the City staff findings. This is so in light of the fact that City staff, acting in the tradition of professional public servants, have provided unimpeachable objective data. In sharp contrast, the e-scooter corporate lobbyistss have a strong economic motive to exaggerate their claims. As is further documented later in this brief, they also have a disturbing track record of false, exaggerated and misleading claims that brings their credibility into question.

Lime Canada conceded that if a city council saw the information about the impact of e-scooters that City staff presented at the February 25, 2021 Toronto Accessibility Advisory Committee meeting, they would vote against e-scooters. Lime also conceded at that meeting that the highest priority risk areas are parking compliance, compliance with not riding on sidewalks, and riding while intoxicated. We emphasize that all those three areas bear directly on creation of new safety dangers and disability accessibility barriers.
Despite those major admissions, to support its claims that e-scooters will improve public safety rather than endangering it, Lime and Bird referred a report from the International Transport Forum ITF of the OECD at the same Toronto Accessibility Advisory Committee meeting. However, City staff correctly pointed out several critical features of that report that controvert the corporate lobbyists reliance on and claims about it.

First, that report, which the corporate lobbyists called an OECD report, was not in fact endorsed or approved by the OECD. To the contrary, it is labelled as a Corporate Partnership Board Report. City staff explained that the corporate partnership board includes e-scooter manufacturers and e-scooter rental companies. The report includes a pivotal disclaimer that:

“Funding for this work has been provided by the ITF Corporate Partnership Board” and “It has not been subject to the scrutiny of ITF or OECD member countries and does not necessarily reflect their official views or those of the members of the Corporate Partnership Board.”

Second, Bird claimed that the International Transport Forum of the OECD had concluded that a road fatality is not significantly more likely when using a shared standing e-scooter rather than a bicycle, and that the risk of an emergency department visit for an e-scooter rider is similar to that for cyclists. In response, City staff explained that on page 10 and 20 of the report, it says that the hospital rate may be higher for e-scooters, that hospital admissions related to e-scooter incidents may be higher. It is clear that the report does not prove or support the e-scooter corporate lobbyists claims about it. When City staff met with the e-scooter rental industry on January 20, 2021, City staff were very clear in stating that they do not consider, given the research seen, that that the risk profile of e-scooters is merely the same as bikes.

3. E-scooters Wont Materially Reduce Road Traffic, Pollution or Climate Change

E-scooter corporate lobbyists make unsubstantiated claims that to allow e-scooters would materially reduce road traffic and combat pollution and climate change. This lies at the heart of their argument in favour of Toronto permitting e-scooters. For example, Lime told the Toronto Accessibility Advisory Committee on February 25, 2021 that e-scooters can save a ton of car trips. It turns out that these claims are untrue.

The corporate lobbyists argue that e-scooters would reduce traffic on the roads and reduce pollution because instead of taking a car to their destination, they would ride public transit to get near their destination, and then rent an e-scooter to ride the last mile from transit to their destination, or to ride the first mile from their destination back to public transit. Eviscerating this claim is the fact that most e-scooter renters do not use e-scooters to connect to transit. The February 25, 2021 City staff presentation to the Toronto Accessibility Advisory Committee indicated that in the Ottawa fall 2020 e-scooter pilot, a survey revealed that only 2% of e-scooter riders did so to connect to public transit. As well, the City staffs June 24, 2020 report to the Toronto Infrastructure and Environment Committee showed that e-scooters are not mainly used to replace car trips:

While some mode shift from driving to using an e-scooter has occurred in other cities, the majority of e-scooter trips would have been by walking or public transit (around 60% for Calgary and Portland; and 86% in Greater Paris). For example, 55 per cent would have walked instead of using an e-scooter (Calgary). From a Paris area survey, 44 per cent would have walked, 30 per cent would have used public transit, and 12 per cent would have used a bicycle/shared bike; while this study noted that e-scooters had no impact on car equipment reduction, an extrapolation would assume that 14 per cent would have used a car/ridehail/taxi, which still represents a minor shift away from motorized vehicular use.

Even Limes presentation that day only claimed that 20% of their trips are connections to transit. Therefore, fully 80% of e-scooter rides are not for that purpose, even on the most generous statistical claims from the e-scooter industry.

Making this worse, the corporate lobbyists claims supporting e-scooters would require Toronto to be flooded with e-scooters. For e-scooters to serve their supposed benefit as a means to connect to public transit in lieu of car rides, people would have to be assured before they leave home that there will always be an e-scooter waiting for them to rent, conveniently available as soon as they get off public transit, to ride that last mile to their destination. Similarly, When they leave their destination to go back home, theyd need an assurance that there would be a rental -scooter waiting for them right there, available ride the first mile back to transit on their way home.

There would therefore have to be a huge number of e-scooters scattered all over Toronto, just in case someone wants to rent them. Short of that, a person has no assurance that they can rely on this mode of travel. Without that assurance, they wont know if they can get to their destination on time.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, City staff and the e-scooter corporate lobbyists presentations, together, show without contradiction that the e-scooter companies do not prefer having e-scooters parked at fixed docking stations, such as those now allocated for Bike Share bikes. Rather, they prefer for a rider to be able to leave an e-scooter on Torontos sidewalks, tied to a fixed object. City staff told the February 25, 2021 Toronto Accessibility Advisory Committee meeting that docking stations have the advantage of reducing the tripping hazards, sidewalk clutter and accessibility barriers that are created when e-scooters are parked on the sidewalk.

City staff explained that Bike Share corrals are typically 500 meters apart. The e-scooter corporate lobbyists want e-scooters to be within as little as 300 meters to each other. No doubt, this is because the closer be the e-scooter is to a potential renter or market, the more likely the customer is to opt for their product. Of course, the bigger the flood of e-scooters scattered around Toronto, the better it is for the e-scooter industrys profits. However, this also makes the new barriers against people with disabilities and the safety dangers to them even more prolific.

This all means that there must be a massive urban blight of e-scooters, akin to that seen in some other cities, for this supposed benefit of reduced traffic and pollution to work. So speculative a benefit is hardly worth the proven harms e-scooters cause.

4. Allowing E-scooters Would Impose Significant New Financial Burdens on the Taxpayer

City staff reports amply support the inevitable conclusion that to lift the ban on e-scooters in Toronto would impose significant but as-yet unquantifiable financial burdens on the taxpayer. This includes among other things, health care and litigation costs arising from personal injuries caused by e-scooters, the cost of creating and maintaining infrastructure to accommodate e-scooters, the cost of enforcing the laws regulating e-scooters if enacted, the cost of City regulating e-scooters, collecting data and monitoring e-scooter use and e-scooter companies. At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, City staff reported that The Citys insurance and risk management people believe that there would be significant costs to the City if a pilot were to be held. The costs to the City of allowing e-scooters would include costs of claims, cost of police enforcement, cost of City Transportation staff dealing with litter issues enforcement, the cost of City data collection and the cost of staff monitoring and providing oversight. Insurance and risk management is finding it difficult to come up with a specific dollar amount for these costs. This resoundingly disproves the e-scooter corporate lobbyists false claims at the July 9, 2020 Toronto Infrastructure and Environment Committee that there would be no additional costs to the City.

COVID-19 has already imposed massive new costs on Toronto, and on Ontario. Toronto is in no position to suffer these added new additional e-scooter costs. If Toronto can afford to spend more now on Torontos infrastructure and environment, it should be spent to reduce the many accessibility barriers facing people with disabilities. It should not be spent to create new disability barriers, as e-scooters would cause.

The June 24, 2020 City staff report to the Infrastructure and Environment Committee found:

There is a significant risk that the City may be held partially or fully liable for damages if e-scooter riders or other parties are injured. Transportation Services staff consulted with the City’s Insurance and Risk Management office (I&RM) to understand the magnitude of the City’s liability if allowing e-scooters. At this time, loss data is lacking on e-scooters due to generally lengthy settlement times for bodily injury claims. The City has significant liability exposure, however, due to joint and several liability, as the City may have to pay an entire judgement or claim even if only found to be 1 per cent at fault for an incident. The City has a $5M deductible per occurrence, which means the City will be responsible for all costs below that amount. In terms of costs, Transportation Services staff will also be required to investigate and serve in the discovery process for claims.

E-scooter sharing/rental companies typically require a rider to sign a waiver, placing the onus of compensating injured parties on the rider. Riders are left financially exposed due to a lack of insurance coverage and if unable to pay, municipalities will be looked to for compensation (e.g., in settlements and courts). Claims related to e-scooter malfunction have been reported by the media (such as in Atlanta, Auckland, New Zealand and Brisbane, Australia). In 2019, a Grand Jury faulted the City of San Diego for inadequate regulation and enforcement of e-scooter sharing companies. By opting in to the Pilot, the City will be exposed to claims associated with improperly parked e-scooters as evidenced by lawsuits filed by persons with disabilities and those injured by e-scooter obstructions (such as in Minneapolis and Santa Monica, California).

Beyond the foregoing, the City of Toronto could expose itself to major damages claims if people get injured by e-scooters. As amply documented throughout this brief and on the AODA Alliances e-scooters web page, Toronto has ample basis to know that e-scooters present proven safety and disability accessibility dangers. For Toronto to expose Torontonians to e-scooters once it has been alerted to these dangers, injured parties can be expected to claim greater damages. This is because Toronto thereby knowingly endangered its residents and knowingly created new disability accessibility barriers. The City could not credibly defend itself by claiming that it had no idea that it was creating these dangers by allowing e-scooters at the behest of the e-scooter corporate lobbyists.

5. No Effective Insurance Solutions Are Now Available

It has been a fundamental requirement of public policy for decades that the public should be assured that there is sufficient insurance in place to cover those who are injured by motor vehicles. That is why driving a car without proper insurance is an offence.

This is an issue which has not been solved for e-scooters, a form of motor vehicle. The City staffs June 24,2020 report included:

This report also recommends the need for improved industry standards at the provincial and federal levels for greater consumer protection in the purchase and/or use of e-scooters. While staff are aware that e-scooters are being considered as an open-air transportation option, the absence of improved standards and available insurance for e-scooter riders, coupled with lack of enforcement resources, would risk the safety of riders and the public on the City’s streets and sidewalks, especially for people with disabilities.

The City staffs February 25, 2021 presentation to the Toronto Accessibility Advisory Committee said that there would be a need for insurance to cover injuries both to the e-scooter rider and an injured pedestrian. We would add that there would also be a need for insurance to cover damage to property due to e-scooter use, and injuries and property loss due to motor vehicle accidents caused by e-scooter use e.g. if a car needs to swerve to avoid an e-scooter, and ends up in a collision causing personal injuries, death and/or property loss.

The City staff February 25, 2021 presentation concluded in substance that no acceptable insurance solutions for the needs that the City staff identified are now established. Solutions that the industry proposed are not sufficient. For example, the industry proposed that a fund be established to cover losses due to e-scooters. City staff were not satisfied that revenues from a fee to be imposed on each e-scooter ride could cover the funds needed for claims and for the infrastructure that would have to be set up to administer such a new claims fund.

We add that whatever be worked out regarding insurance, the e-scooter rental companies should be assigned first and primary liability for any injuries or losses that are caused to anyone by the use of their vehicles. If they want to make their product available in Toronto, in order to make profits, they should shoulder the costs that are caused to others by the use of their product.

In Ontario, a cars owner is primarily liable for injuries or losses caused by the car, and not just the driver. There is no reason to exempt the e-scooter rental companies from that wise approach. Otherwise, it gives a massive undeserved financial windfall for the e-scooter rental companies.

In the end, insurance, even if properly available, does not eliminate or reduce the dangers to the public including people with disabilities, seniors, children or others. It presupposes that members of the public will be injured by e-scooters. They will have to shoulder the hardships and high costs of bringing law suits to recover damages. Money can help, but cannot eliminate the physical pain, the loss of abilities, and the other hardships that a serious personal injury and civil litigation can inflict. It would be wrong to proceed on the basis that so long as there is sufficient insurance in place, there is no need to worry about the dangers to safety and disability accessibility that e-scooters will create.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, Bird complained that third party e-scooter insurance does not exist in North America, that it is not required anywhere else in North America, and that it is not mandated or provided for Bike Share TO. Yet these provide no reason for dismissing insurance issues addressed here, or the need for there to be proper insurance in place. It just gives another compelling reason why Toronto should not lift the ban on e-scooters.

6. A Pilot with E-Scooters in Toronto Would Endangers Public Safety and Disability Accessibility, and Exposes The City to Major Financial Claims

There are times where it is worthwhile for the City of Toronto to conduct a pilot project with an innovation, to see if it is suitable for wider adoption. However, Toronto should not conduct a pilot project with e-scooters. There are a number of reasons for this. Each, standing alone, is sufficient to reject that idea. Rejecting a pilot here does not mean Toronto is rejecting the idea of ever conducting pilots in other areas of policy that do not present e-scooters dangers.

It is essential to expose why e-scooter corporate lobbyists press so hard for a pilot. They do so purely for tactical marketing reasons. They want their product on the Toronto streets, to build their market. They want to shift the burden to those opposing e-scooters to have to fight an uphill battle to get e-scooters removed, once entrenched. They want the inertia to favour them. They want the City to invest money in their products entrenchment, so it will be easier to secure a permanent foothold in this city. They want to point to Toronto to leverage other cities to follow suit.

First, there is no real need for an e-scooter pilot in Toronto. No one has identified an appropriate purpose for an e-scooter pilot. A pilot is conducted to answer specific questions, identified in advance. If the pilot is to ascertain if some people would like to ride e-scooters, we know from other cities that they do. If it is to find out if e-scooters will ride on sidewalks even if banned from sidewalks, we have ample evidence that they do. Indeed we already have first-hand proof that e-scooters are freely and openly ridden on Toronto sidewalks even when they are entirely illegal in Toronto.

If the question to be considered is weather e-scooters endanger public safety and disability accessibility, we have sufficient proof from other cities that they do. There is nothing about Toronto or Torontonians that make these dangers any less than for other cities that have allowed e-scooters. To the contrary, City staffs June 24, 2020 report shows ways in which Toronto presents added problems, if e-scooters are allowed here. It concluded:

In addition to the experiences in other jurisdictions, several risk factors are unique to the City of Toronto and play a role in informing the recommended approach to e-scooters:

Streetcar tracks: Toronto has an extensive track network (177 linear kilometres) which poses a hazard to e-scooter riders due to the vehicle’s small wheel diameter.

Winter and State-Of-Good-Repair: Toronto experiences freezing and thawing that impacts the state-of-good-repair for roads. A large portion of roads are 40 to 50 years old, with 43 per cent of Major Roads and 24 per cent of Local Roads in poor condition. Coupled with lack of standards for e-scooter wheels (e.g., traction, size), this makes this particular device more sensitive to uneven road surfaces.

High construction activity: In addition to the city’s various infrastructure projects, Toronto has been one of the fastest growing cities with about 120 development construction sites in 2019.

Narrow sidewalks and high pedestrian mode shares in the Downtown Core and City Centres: Most jurisdictions experienced illegal sidewalk riding by e-scooter users, with some business districts saying e-scooters deterred patrons from visiting their previously pedestrian-friendly main streets. This is especially challenging with physical distancing requirements and other COVID-19 recovery programs expanding the use of the City’s sidewalks and boulevards.

Second, it is universally accepted that it is utterly wrong to conduct an experiment on human beings without their consent. This is especially so where it is known in advance that the experiment poses a danger to them. Imagine the liability that a government would risk if it subjected people to a trial COVID-19 vaccine without their consent, to find out if it works and if it has any dangerous side-effects.

An Toronto e-scooter pilot would be a human experiment without the consent of those endangered by it. This is revealed by the City staffs presentation at the February 25, 2021 Toronto Accessibility Advisory Committee meeting. For purposes of gathering data on injuries caused by e-scooters, City staff spoke of collecting data from hospitals before a pilot, during a pilot and after a pilot. City staff explained that the burdens on hospitals during the COVID-19 pandemic precluded their being able to gather the kind of data needed before an e-scooter pilot could begin.

Toronto should not follow Ottawas reckless conduct. Ottawa conducted a pilot project with e-scooters right in the midst of the COVID-19 pandemic, without putting in place effective measures for tracking injuries. The Ottawa mayors office told AODA Alliance Chair David Lepofsky on the night before the pilots approval that if people get injured, they can file complaints. Ottawa unfairly shifted the burden to e-scooter victims to produce evidence of harm they suffered, rather than proactively preventing the harm in advance or ensuring that it is accurately tracked during that pilot.

In these circumstances, if Toronto conducts an e-scooter pilot, it risks facing major financial claims by people injured by e-scooters. As noted earlier, injured victims can be expected to argue, as a factor substantially increasing their right to a large damage award that the City of Toronto decided to subject them to the dangers of an e-scooter human experiment without their consent, having been warned in advance of the safety and accessibility dangers that e-scooters create. That claim for damages would be fortified by the fact that the Toronto Accessibility Advisory Committee twice unanimously recommended against conducting a pilot project with e-scooters, after receiving compelling evidence from multiple sources on the safety and accessibility dangers they pose.

Third, the City staffs June 24, 2020 report shows that in important ways, the proper legal and operational groundwork has not been done at the provincial or federal level, needed for a pilot project. That report concluded:

* Although the HTA sets out some e-scooter standards, such as maximum speed and power wattage, due to the nature of urban and suburban conditions such as Toronto’s, City staff recommend that the Province strengthen the device standards for greater rider safety. Based on an extensive literature review, items recommended for further Provincial exploration include a maximum turning radius, a platform surface grip, wheel characteristics (e.g., minimum size, traction, tire width), braking and suspension.

In addition, the Province has not established set fine amounts for offences under the HTA e-scooter regulations. Without this in place, for the police to lay a charge in respect of a violation, a “Part III Summons” is required, which means the police must attend court for each charge laid regardless of severity, and a trial is required for a conviction and fine to be set. This may make it less likely that charges are laid. Fines outside of ones the City could set (e.g. e-scooter parking violations, illegal sidewalk riding) would create workload challenges for Police and courts.

In spite of the Pilot requirement to collect data, there is currently no vehicle type for e-scooters in the Ministry of Transportation’s (MTO) Motor Vehicle Collision Report (MVCR) template used by all police services to report collisions. Unless the Province specifies e-scooters are motor vehicles for the purposes of collision reporting, and has a field for this in its template, e-scooter collisions may not be reported reliably and meaningful collision data analysis will not be possible. In Fall 2019, City staff requested that the MTO add e-scooters as a separate vehicle type, but MTO has not yet communicated they would make this change.

If Toronto wishes to gather still more information about e-scooters, it should do so without conducting its own pilot experiment on Torontonians, by looking to the personal injuries and disability accessibility barriers that e-scooters created in other cities.

7. E-Scooter Corporate Lobbyists Have Proposed No Effective Solutions that Will Solve the Problems E-scooters Would Create

City Council will want to know if there are compromises i.e. solutions that could allow e-scooters while not making Torontonians suffer from their dangers. The AODA Alliance urges that Toronto should not compromise on the safety of its residents. Especially during COVID-19, our political leaders have emphasized that public safety is their number one priority. That should be the case here as well. Compromising on accessibility for people with disabilities should be out of the question, especially when it comes to the danger of creating new accessibility barriers that would compound the many barriers that people with disabilities now suffer from in Toronto.

That said, the question remains whether there are solutions that would not compromise on public safety or on the impermissible creation of new accessibility barriers. City staff commendably gave the e-scooter corporate lobbyists an ample open opportunity to present practical solutions to the dangers that e-scooters create, if such solutions exist. City staff held a meeting with 29 representatives of the e-scooter rental companies on January 20, 2021. E-scooter corporate lobbyists also had the chance to bring solutions to the Toronto Accessibility Advisory Committee on February 25, 2021.

e-scooter companies have a strong financial incentive to present workable solutions. This would open up the highly-desirable Toronto market to them. They are well positioned to try out effective solutions elsewhere, if there are any. This is because they operate e-scooter rental operations in a number of other cities.

Those companies are well-aware of their need to come up with solutions. The disability community has been raising our disability-related concerns regarding e-scooters for over a year and a half. Such concerns have been raised in other cities.

Despite these opportunities, e-scooter corporate lobbyists presented no solutions that would in fact solve the serious dangers that e-scooters pose. The February 2021 written staff report and the staff oral presentation on February 25, 2021 to the Toronto Accessibility Advisory Committee reviewed key solutions that the e-scooter corporate lobbyists presented to City staff. City staff correctly concluded that none effectively solved the problems that e-scooters present, but impose costs on the taxpayer. The February 25, 2021 City staff presentation stated:

“Potential solutions to address e-scooter sidewalk riding
Protected bike lane/micromobility network and placing e-scooter parking on-street so that trips begin/end off the sidewalk Field staff/ambassadors/patrols and enforcement teams
Visible, unique identifiable plate numbers (licence plates for rental fleets) E-scooter sidewalk riding detection technologies* (*emerging technology)

Other proposals to address e-scooter sidewalk riding
Geofencing pedestrian areas or slow zones
Education and warnings (by companies) and fines for riders (by police) Suspensions/bans on repeat offenders (by companies)
Decals on sidewalks and signage
Audible warnings on the device for the rider and pedestrians

Potential solutions to address improper e-scooter parking
Adequate supply of parking areas (and fleet size caps/reviews) Proper parking verification (photo selfies and/or other technologies)
Field staff/patrols and enforcement teams (1-2 hr service standards or better)
Braille/tactile and unique identifiable numbers on e-scooters (licence plates for rental fleets)
Docked stations* like Bike Share Toronto (*dockless preferred or hybrid by companies)

Other proposals for improper e-scooter parking
Education and incentives (e.g., discounts for proper parking or penalties for repeat offenders by companies; or fines to the companies that are passed onto the repeat offenders) Lock-to parking mechanism (similar to a bicycle lock) Double kick-stand (less likely to topple over); and
Onboard diagnostics indicating the device has toppled over.
Photo of e-scooter being locked to a hand railing at steps to an entrance by a man wearing a bicycle helmet and business casual work clothes.
Photo of e-scooter locked to bicycle parking with a cable. The bike parking is in the shape of a metal loop attached to the sidewalk in San Francisco with a bike lane painted green in the background.”

The City staffs February 25, 2021 presentation also stated:

Accessibility Feedback on Proposed Solutions
Technologies are still emerging and not adequate yet:
Geofencing and other technologies to prevent sidewalk riding are not sophisticated enough and would only apply to rental e-scooters.
Docking stations for e-scooters has potential but is still in development.
Lock-to cables on e-scooters mean they could be locked anywhere (e.g., café fence/railing) including in spots blocking entrance access and paths of travel.
There is already a lack of bike parking so this would worsen the number of sidewalk obstructions on narrow and cluttered sidewalks.
If Bike Share Toronto were dockless, there would not be enough bike rings to lock the rental fleet same for dockless rental e-scooter fleets.

Accessibility Feedback on Proposed Solutions
Not enough city resources for enforcement and infrastructure priorities
Oversight is very labour- and resource-intensive and depends on enforcement, which is already stretched or non-existent in parts of the City.
* Licence plates on rental e-scooter fleets could help, but this is a reactive tool and would be a drain on city resources to monitor and enforce. Bigger priorities for limited city resources.
Inadequate infrastructure is a bigger priority not enough sidewalk space or accessible infrastructure; not enough bike lanes/bike lane space; and not enough public transit.
Importance of other city priorities before allowing something which poses a hazard and a nuisance for pedestrians and persons with disabilities.

Accessibility Feedback on Proposed Solutions
Impacts on seniors and persons with disabilities on sidewalks
COVID-19 has resulted in challenges for persons with disabilities, their caregivers and pedestrians who use sidewalks as a necessity and not for recreation.
Allowing e-scooters will pose hazards that affect persons with disabilities, seniors, their caregivers and pedestrians.
Risk of severe injury for seniors or persons with disabilities if tripping and falling or struck by an e-scooter.
Inability to identify e-scooter rider because of their speed, and that the persons credit card on the app may not be the person riding the e-scooter.

The e-scooter corporate lobbyists presented no information that refuted the City staff assessment of these solutions. None of the information presented by City staff either in its February 2021 report or their February 25, 2021 oral presentation to the Toronto Accessibility Advisory Committee demonstrated any need to subject Torontonians to these dangers in a pilot project to see if they would materialize in Toronto. No information was presented to suggest that Toronto would somehow be exempt from these dangers, if it allows e-scooters.

We add the following, which reinforces the City staffs presentation. Toronto has bike lanes, but it is not a contained network. Moreover, extensive law enforcement would be needed to ensure compliance. Both creating the network and such law enforcement imposes substantial costs on the public. The public should not be required to build massive new infrastructure to let the e-scooter corporate lobbyists make their profits.

At most such bike paths are described as helpful as encouraging e-scooter riders not to ride on sidewalks. Yet such encouragement is no assurance that they will comply.

City staff reported that a proposed solution was to use technology such as geo-fencing to prevent e-scooters from riding on sidewalks. Using GPS or other technology, the e-scooter itself would supposedly electronically detect when it is going somewhere where it is not allowed to go. City staff correctly concluded that the technology to do this accurately and reliably simply does not exist. We agree. We add that anyone who uses a GPS for directions know that they are not accurate enough to pinpoint whether an e-scooter is on the sidewalk, or mere inches away on the road.

Even if geo-fencing did work, it would only restrict rented e-scooters and not privately owned e-scooters. Yet both rented and privately-owned e-scooters create dangers to people with disabilities.

Lime said that such sidewalk detection technology could help with reminding riders afterwards. The e-scooter rental company could call the offending rider afterwards. Including those with multiple cases of it. This wrongly relies on e-scooter companies with a conflict of interest to lead this activity. It only addresses the problem after the danger has been created, rather than preventing barriers from being created in the first place. Waiting for multiple infractions does not protect the public from one-time riders. This all presumes without proof that the e-scooter companies can effectively track this.

Another proposal from the industry was to have staff educate e-scooter riders. If these staff are to be provided by the City, that would be an unwarranted cost burden on the taxpayer. Even if these staff were to be provided by the e-scooter companies, there would be no realistic possibility of them being situated all over the city to ensure that they reach all or even most e-scooter riders. E-scooter riders would have no obligation to spend time listening to them. There is no assurance that this education would reach many e-scooter riders, or that it would change their behaviour.

The industrys proposal to require a visible identifiable number to be located on each e-scooter can be partially helpful. However that alone will not materially reduce the problems we have identified.

If an e-scooter rider violates the law, it is not conclusive proof of the riders identity to identify the number on the e-scooter, even if a victim can accurately identify that number. The e-scooter companies would have to make available to the public their internal records of rentals, account holders and vehicle numbers. Moreover, the e-scooter rider may not be the same person as the name on the account charged for the e-scooter. This alone would not be sufficient assured proof in court to establish the riders identity.

This is also no solution for pedestrians who see a law-breaking e-scooter from the side or from behind, or where the e-scooter is racing too quickly for the pedestrian to read the identification number. Moreover, offending e-scooter riders will quickly learn to cover up the identification number. This solution also depends on the public financing enough law enforcement to catch and successfully prosecute offenders.

Another measure proposed was to add braille and tactile letters to an e-scooter, to enable a person with vision loss to identify it. This presupposes that a person with vision loss trips over an improperly parked e-scooter, and then gropes all over it to find an accessible braille or raised letter identifier. That in turn presupposes that the victim knows that such labels are available, and is prepared to try this groping. This is, far fetched. It also leaves people with vision loss exposed to the e-scooter tripping hazard in the first place.

Lime Canada proposed to the Toronto Accessibility Advisory Committee on February 25, 2021 that E-scooter rental companies could require renters to photograph how they park an e-scooter, and send the photo to the rental company for monitoring. This provides no real public protection. The renter could move the e-scooter right after sending in that photograph.

Similarly, it would be problematic to rely on rental companies to impose or collect fines. This would lack needed law enforcement public accountability and safeguards. The public would have to trust the e-scooter companies. Law enforcement should never be parcelled out to a private for-profit company that has such an obvious conflict of interest. Moreover, if the fine is retained by the e-scooter company, that would simply add to their profits.

The industry proposed that they could suspend multiple violators from being able to rent an e-scooter. However, this requires the many serious impediments to proving a violation and a violators identity to first be overcome, e.g. the need for massive increases in law enforcement to detect violators. Moreover, a suspended person could simply use a new credit card to create a new account and then resume riding e-scooters.

The industrys proposal to increase law enforcement would shift more financial burdens to the taxpayer. It also presupposes that if Toronto were to increase its law enforcement spending, e-scooters should be a top priority. We would suggest that there are now other law enforcement priorities that would compete for attention, e.g. ensuring that the public obeys public social distancing requirements during the pandemic.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, Lime conceded that drunk e-scooter riding will require an enforcement component. It said there are some tech tools that some of the companies would come up with to help identify an impaired e-scooter driver. The industry could then deny the intoxicated rider a ride. There is no suggestion that this intoxication technology exists, or that it has been effectively deployed anywhere

The industry proposed that it could message riders regarding restrictions on e-scooter use. This assumes that voluntary compliance would be sufficient. There is no indication that this has been tried and worked in other cities. We would not dispense with drivers licenses and the related training in exchange for car companies messaging their customers on where they are permitted to drive their cars.

The industry proposed that sidewalks could be marked with notifications not to ride e-scooters there. City staff correctly noted that this would create visual clutter. There are many kilometers of sidewalks that would require this. We add that here again, the e-scooter corporate lobbyists once again propose shifting major costs to the taxpayer to enable them to make their profits. It also presupposes that those who illegally would ride e-scooters on sidewalks only do so because they didnt know it is forbidden, rather than because they dont have to fear effective law enforcement.

City staff rejected a proposal that e-scooters emit an audible sound. We note that this measure may help somewhat in overcoming the dangers of e-scooters due to their now being silent. However, this would not overcome the dangers when e-scooters are lying on the sidewalk, blocking pedestrians, nor would this prevent injuries when collisions occur. Moreover, these sounds would have to be loud enough to alert a pedestrian well in advance, so that they can try to evade a fast-moving e-scooter racing towards them.

City staff noted that the industry proposed that e-scooter parking be located on the street, to reduce the chances of them being ridden on the sidewalk. We note that with street parking now at a premium, especially in downtown Toronto where the traffic is often congested, there are harms that would flow from further reducing street parking. From a disability perspective, if any new street parking were to be re-allocated, it should be for more disability parking spots, and not for e-scooters.

Moreover, by having e-scooters parked on the street, this would not in any real way reduce the danger of e-scooters being ridden on the sidewalk. An e-scooter rider could simply continue to ride on the sidewalk and then at the end of their ride, park on the street, if permitted.

To address the problems of parking e-scooters, the industry proposed, among other things, providing them with more e-scooter parking locations. This impinges on limited parking spaces already available in Toronto, as noted above. It also shifts yet another cost to the taxpayer, who would be providing free parking for the corporate lobbyists to make their profit.

The option of providing docking stations was discussed. It burdens the taxpayer with providing the space and paying for the docking stations. It adds to urban clutter.

The industry proposed technology to ensure that e-scooters are parked properly. Yet unless there is a huge supply of staff to monitor this, it will not prevent danger to people with disabilities and others before injuries and accessibility barriers impede people with disabilities.

The industry proposed having a patrol team from e-scooter companies to explore and remedy complaints. City staff said that where tried, the minimum service standard has been one to two hours after a violation is reported by the public, especially during a pilot project. We respond that that leaves the danger to pedestrians in place, and only rectifies it after the fact. It also unfairly burdens pedestrians with having to call in complaints, and indeed, with having to know how to do so and at what number. That depends on a chain of events that is not reliable.

Consideration was given for e-scooter companies to provide rate incentives for those who park properly, such as discounts, or rate penalties for those who do not park them properly. That requires someone to effectively police where each e-scooter is parked. The option of fining the e-scooter company directly for improperly parking the e-scooter raised the concern that the e-scooter company could just pass this cost on to the users, rather than it serving to ensure proper parking of e-scooters. Here again, this presupposes that there is the deployment of ample law enforcement deployed all over the city that has time to conduct all the needed enforcement for e-scooters.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, industry representatives gave major priority to the solution of lock-to. A cable is attached to the e-scooter so that when parked, it can be locked to a pole or other object. However, this is no solution at all. It still exposes people with disabilities to e-scooters being left all over the place in unpredictable public locations, as new accessibility barriers and tripping hazards. It wrongly converts our sidewalks and other public places into free parking for the e-scooter industry, with the public substantially subsidizing their profits.

Bird claimed at that meeting that the problem of e-scooters being ridden on sidewalks would be dramatically reduced if riders could lock up a rental e-scooter on the sidewalk, using the lock to option. It defies logic to argue that this solves the problem of riding e-scooters on sidewalks. A person would ride an e-scooter on a sidewalk, rather than the road, to avoid cars or the many potholes in our roads. Where one can park the e-scooter at the end of the ride does not dictate whether one chooses to ride on the sidewalk rather than the adjacent road en route to ones destination.

The industry proposed having each e-scooter equipped with a double kickstand to reduce the risk of them falling over when parked. That suffers from the same problems as the lock-to proposal.

Similarly, the industrys proposal that each e-scooter have an onboard diagnostic mechanism to indicate if the e-scooter has toppled over also has the same deficiencies. It also assumes that the e-scooter companies will flood the city with enough people to immediately remove such an e-scooter before someone trips over it.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, Lime proposed that the industry could share big data with city officials e.g. if there are locations where there are repeat problems with e-scooters. If this is shown the City might wish to protect the public by creating new infrastructure. By this, it appears to mean that if there is a route where e-scooter riders repeatedly ride on the sidewalk, the City might wish to build a separate path.

By this, the industry concedes the risk of repeat violators. It shifts to the public the financial burden of building new infrastructure to avoid people being injured by e-scooters. It provides no assurance that riders who repeatedly use those sidewalks will stop doing so once a separate bike path is built.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, Lime Canada also says that in the shorter term, this could help focus enforcement on those corridors. That too exposes pedestrians to the dangers of e-scooters, and shifts to the public the cost of additional law enforcement.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, Lime claimed that education of riders along with enforcement are very good tools. Yet enforcement is a major public cost burden. It starts from the premise that the e-scooter has already caused harm.

We add that Toronto cannot rely on education of riders, since a rider can rent an e-scooter without having to ever speak to a human being from the e-scooter rental company, from whom they could receive that education. Moreover, Lime Canada conceded that education alone is not enough to solve the admitted problem of people riding e-scooters on sidewalks. It conceded as well and that there must be a degree of enforcement (though it did not specify how much enforcement it conceded to be necessary).

As explained earlier, an e-scooter is a motor vehicle. Nevertheless, Limes solution for the problem of bikes creating accessibility barriers when left on sidewalks is to regulate them as if they were non-motorized bikes. Yet that would simply add to sidewalk barriers. In effect, the industry sought the lowest and most permissive degree of regulation possible, with the least accountability.

For decades, our society has regulated motor vehicles far more extensively than bikes. We require the vehicle and driver to each be licensed and insured. We require the driver to complete sufficient training, including safety training under proper supervision, before being allowed to drive in public. Licenses are gradually graduated for drivers as their experience grows. Vehicles must meet rigorous safety standards. In contrast, the e-scooter rental industry seeks to evade all of those regulations, as if an e-scooter were not a motorized vehicle.

8. E-scooter Corporate Lobbyists Numerous False, Misleading and Exaggerated Claims Further Show Why Toronto Should Reject Their Dangerous E-scooter Proposals

The e-scooter corporate lobbyists misleading false and claims, flights of extreme exaggerations and flights of illogic are breathtaking. Toronto Mayor John Tory, City Council and City staff should take their claims with at least a grain ton of salt. They should insist on strong corroboration before accepting any of their claims.

The AODA Alliances October 30, 2020 report revealed that these corporate lobbyists have been inundating Toronto City Hall with a huge, well-financed relentless, feeding frenzy of lobbying in the back rooms. Some Councillors have told us that this is one of the biggest, if not the biggest corporate lobbying effort now at City Hall. The AODA Alliance ‘s October 30, 2020 report on this lobbying feeding frenzy gives insight into why in the midst of the COVID-19 pandemic when other pressing issues should be a priority, Torontos municipal politicians are so seriously considering unleashing e-scooters in Toronto, despite their amply-documented dangers to people with disabilities, seniors and others.

That report shows that entries in Torontos official Lobbyist Registry, filling fully 73 pages, reveal that in just the two years from June 2018 to the present, eight e-scooter rental companies and three lobbying firms have documented fully 1,384 contacts with City Hall in person, by phone, by virtual meeting or by email. Among these were at least 112 meetings with City officials and 1,153 emails. These figures only include contacts which corporate lobbyists opted to record in the Toronto Lobbyist Registry during that period.

Amidst this onslaught of corporate lobbyists approaches were a dizzying 94 contacts with the Mayors Office, including 10 with Mayor Tory himself, 58 with the Mayors Senior Advisor, Legislative Affairs Daniela Magisano, 15 with Mayor Torys Director of Legislative Affairs Edward Birnbaum, 10 with his Chief of Staff Luke Robertson, and 1 with Mayor Torys Deputy Chief of Staff Courtney Glen. As well, among these documented contacts are 368 contacts with members of City Council, 479 contacts with staff of members of council, as well as 352 contacts with other City staff, among others (We surmise that the corporate lobbyists may not have reached a few janitors).

Beyond those address earlier in this brief, corporate lobbyists public presentations in support of e-scooters at the February 25, 2021 Toronto Accessibility Advisory Committee meeting and the earlier July 9, 2020 Toronto Infrastructure and Environment Committee meeting, are replete with the following ten additional falsehoods, exaggerations, and transparently bogus arguments. That they must resort to such meritless arguments to offer further shows that their proposals lack real merit.

As a first example, Bird told the February 25, 2021 Toronto Accessibility Advisory Committee meeting that an important question is whether City Hall continues to ignore the number of e-scooter riders on city streets today, despite the current ban on them, or whether Toronto chooses to regulate this space with sensible regulations? It argued that Toronto should lift the ban on e-scooters because some people are now illegally riding privately-owned e-scooters in Toronto.

This falsely suggests that the proper solution to dangerous lawlessness is not to enforce the law, but instead to legalize the dangerous illegal activity. By that reasoning, Canada should lift the ban on unlawful assaults, and regulate assaults instead, since some people illegally assault others. Canada should now lift the ban on heroin and crack cocaine, because some people now illegally use those dangerous drugs.

Instead, the fact that some people are now flouting the law by illegally riding privately-owned e-scooters in Toronto is strong proof that we can expect more flouting of the law by rental e-scooter riders if their use is legalized but banned on sidewalks.

Similarly, Lime relied heavily on the false dilemma that either people will buy their own e-scooters without speed controls, or we can allow rental e-scooters with speed controls. Yet Toronto has the further option of enforcing the law against riding any e-scooters and confiscating any e-scooter ridden illegally in public. That would resolve the whole problem without a necessity of legalizing either owned or rental e-scooters.

Second, at the February 25, 2021 Toronto Accessibility Advisory Committee meeting, Bird misleadingly described the ban on e-scooters as a temporary ban. In fact, the legal ban on e-scooters in Toronto is permanent, unless City Council votes to lift it. Moreover, at present, it can only be lifted for under four years. After that the provincial ban on e-scooters goes back into effect.

Third, Bird told the Toronto Accessibility Advisory Committee on February 25, 2021 that Ottawas pilot with e-scooters is the gold standard by which Toronto should be guided, as if Ottawas experience provides an effective answer to public safety and disability accessibility concerns. Yet Toronto City staff presented earlier at that meeting that Ottawa City staff had not even collected e-scooter injury data. Later at that meeting, CNIB deputed that during the Ottawa pilot, e-scooters were operated unsafely and left in pedestrian clearways throughout the downtown. This caused accessibility barriers and safety hazards. Despite all this, Ottawa is expanding their e-scooter fleet. That means that a key purpose of the pilot, to see their impact on injuries, was disregarded by Ottawa.

CNIB held a public meeting to get feedback from people with vision loss about their experience during the Ottawa e-scooter pilot. It heard alarming stories of safety hazards posed to people with vision loss by e-scooters. There was unsafe operating of e-scooters, regular illegal sidewalk riding of e-scooters and improperly parking e-scooters. 1On a survey about the pilot, 69% of respondents encountered wrongly parked e-scooters. 72% of survey respondents encountered sidewalk riding.

Ottawa City Council nevertheless approved e-scooters for a second pilot despite the staggering data the City itself collected. CNIB warned Toronto not to follow the Ottawa experience. That a leading, e-scooter corporate lobby could point to Ottawa as the goal standard shows how dramatically antithetical they are to the vulnerability of people with disabilities.

Lime claimed that in Ottawa, the votes to continue the e-scooter program were nearly unanimous. That only shows the devastating reach of the e-scooter corporate lobbyists.

Fourth, Bird tried to portray e-scooters as an important mobility aid for people with disabilities. The industry tried to appear as if it were advocating in favour of expanded accessibility for people with disabilities when its core business in fact endangers accessibility for people with disabilities.

Lime claimed at the February 25, 2021 Toronto Accessibility Advisory Committee meeting that they embrace the goal of accessibility for people with disabilities. It told that meeting that 8% of their riders have physical disabilities and use e-scooters as a liberating tool to explore the city. Yet e-scooters are not viewed as adaptive disability mobility devices in the disability community.

Lime provided no independently-verified objective evidence to support the claim that 8% of e-scooter riders have physical disabilities. They would seem to have no way to verify this, since their rental customers do not interact with Lime staff when renting an e-scooter. Moreover, even if some e-scooter riders have some sort of physical disability, there is no proof of how many, if any, need the e-scooter to meet a disability mobility need. It is important not to confuse a bona fide disability power scooter, in which a person with a disability is seated, and one of Limes very different rental e-scooters on which a rider must stand and balance themselves, while travelling much faster than a disability scooter can.

Fifth, Lime made the over-inflated if not bogus claimed at the February 25, 2021 Toronto Accessibility Advisory Committee meeting that allowing e-scooter rentals will help with recovery from the COVID-19 pandemic. This is because people will use an e-scooter to go to stores to shop.

Yet e-scooters are not supposed to be used to transport anything other than the person riding it, such as goods bought in stores. It presumes that e-scooter renters can leave their e-scooter scattered anywhere near any store they wish to visit. This threatens the sidewalk litter, accessibility barriers and tripping hazards that e-scooters have presented in other cities like Ottawa. It presumes that those same shoppers would not go shopping, helping out our economy, had it not been for renting an e-scooter. There is no proof that there has been any such surge in economic activity provably linked to e-scooters.

Sixth, an example of misleading use of statistics was Limes claim at the February 25, 2021 Toronto Accessibility Advisory Committee meeting that in Calgary, city data shows e-scooter injuries were far, far less than bike injuries. Even if there is such a statistic, it can easily be explained by the fact that there are far fewer e-scooters being ridden compared to the total number of bikes being ridden. Instead, the relevant statistic to use is the number of injuries per kilometer ridden. At that Toronto Accessibility Advisory Committee meeting, Lime and Bird did not use that relevant measure for injuries, when comparing different modes of travel, whether cars, bikes or e-scooters. They therefore did not account for how many of each kind of vehicle is on the road, or how far they are driven before causing an injury, or the severity of the injury they cause.

Seventh, Lime argued that rental e-scooters have the added protection of in-built speed limits and geo-fencing capabilities, which are not included in e-scooters that people privately buy. As well, as noted earlier, City staff correctly concluded that geo-fencing is not now a reliable technology. As well, to allow rental e-scooters does not assure that people wont also ride privately-owned e-scooters. Lime advanced the false dilemma that either people will buy their own e-scooters without speed controls, or Toronto can allow rental e-scooters with speed controls. Yet there is the further and preferred option of effectively enforcing the ban on riding any and all e-scooters, and confiscating any illegally-ridden e-scooters.

Eighth, Lime claimed at the February 25, 2021 Toronto Accessibility Advisory Committee meeting that there have been no deaths due to rental scooters because they have speed controls. This claim is dubious. It requires proof that a pedestrian, hit by an oncoming e-scooter at 22 KPH, cannot be killed, but one colliding at 30 or 40 KPH can be killed. No proof of such a medical improbability has been provided.

Ninth, Lime made the unsubstantiated claim at the February 25, 2021 Toronto Accessibility Advisory Committee meeting that e-scooters have a much higher parking compliance rate than do cars. Even if this were assumed to be true, the question is not whether to ban cars. It is whether to allow e-scooters which will create new safety dangers and new disability accessibility barriers. Moreover, cars, even when improperly parked, are not typically left strewn about sidewalks as a tripping hazard and accessibility barrier.

Tenth, at the February 25, 2021 Toronto Accessibility Advisory Committee meeting, Lime made the quite exaggerated claim that most major cities outside Toronto had embraced e-scooters, and that unlike Toronto, e-scooters have met with virtually universal acclaim in cities that tried them. This is shown to be misleading, in light of the following information included in the City staffs presentation to the February 25, 2021 Toronto Accessibility Advisory Committee meeting:

Large Urban Peer Cities
Peer cities have banned rental/shared e-scooters from downtowns in Chicago and New York City. No rental/shared e-scooters yet in places such as:
Montréal (not for 2021) or Vancouver
Massachusetts (e.g., City of Boston)
Pennsylvania (e.g., City of Philadelphia)
New South Wales (e.g., City of Sydney, Australia)
Scotland (e.g., City of Edinburgh), The Netherlands (e.g., Amsterdam), and
Others have banned or since banned them, e.g., Copenhagen (city centre), Houston, San Diego (boardwalk ban), etc.
NYC (outside of Manhattan only) and Transport for London (UK) pilots not yet underway.

City staff noted that Montreal, which earlier did a pilot with e-scooters, will not have e-scooters in 2021. Vancouver does not have e-scooters. Hamilton and Mississauga allow privately owned e-scooters. We add that the City of Mississauga Accessibility Advisory Committee recommended that e-scooters not be allowed. We have seen no reason given for Mississauga rejecting that important accessibility recommendation.

City staff noted that London, Waterloo and Windsor are involved in some sort of public consultations on e-scooters which is slowed due to COVID-19. Calgary only allows e-scooter rentals, as is the case for all Alberta. Calgary allows e-scooters on sidewalks, and has no bike share program. Calgary will now allow some use of e-scooters on roads, to reduce sidewalk use.

Calgary staff advised their Council that it is likely that e-scooters have the highest injury rate per transportation mode. 43% of e-scooter injuries that were transported to hospital required surgery, which is twice the rate for bicycle injuries. In Calgary, 37% of e-scooter injuries had suspected intoxication.

City staff also reported that looking at large cities with similar large populations, similar urban densities and similar climate, Chicago and New York City ban rental e-scooters from their downtown areas. There are no rental e-scooters in Montreal, Vancouver, Massachusetts (e.g. Boston), Pennsylvania (such as Philadelphia), New South Wales (such as Sydney). Melbourne requires an e-scooter to have a maximum power of 200 watts. Most e-scooters require a higher wattage than that. There are no e-scooters in Scotland or the Netherlands. They have been banned in the city centre of Copenhagen, Houston, and San Diegos boardwalk.




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Please Write to the City of Toronto to Support the AODA Alliance‘s New, Comprehensive Brief on Why Toronto Should Not Lift the Ban on Electric Scooters


Accessibility for Ontarians with Disabilities Act Alliance Update

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

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

Please Write to the City of Toronto to Support the AODA Alliance‘s New, Comprehensive Brief on Why Toronto Should Not Lift the Ban on Electric Scooters

March 30, 2021

            SUMMARY

The AODA Alliance has just submitted a comprehensive brief to the City of Toronto showing why it must not lift the ban on electric scooters (e-scooters). This brief, set out below, brings together and supplements all the work we have done on this e-scooters issue over the past 19 months. We set the brief out below.

The brief begins with a pithy 3-page summary, for those who don’t have time to read it all. We encourage you or any community organization with which you are connected to email Toronto Mayor John Tory, any City Council member you think appropriate, and Toronto City staff. Tell them you support the AODA Alliance’s March 30, 2021 brief opposing e-scooters in Toronto.

Mayor Tory: [email protected] and you can email City staff by writing

City staff: [email protected]

For an easy-to-use online tool to email Mayor Tory and any City Council members you wish, provided courtesy of the March of Dimes of Canada, visit https://www.marchofdimes.ca/en-ca/aboutus/govtrelations/elections/Pages/escooters.aspx

Please quickly write Toronto. It is anticipated that this issue will come up again at the City of Toronto Infrastructure and Environment Committee on April 28, 2021. We will have more information for you in the coming days.

For more background on this issue, visit the AODA Alliance’s e-scooters web page.

Riding Electric Scooters in Toronto is Dangerous and Must Remain Banned – For Toronto To Allow E-scooters Would be to Knowingly Create New Disability Accessibility Barriers Against People with Disabilities

AODA Alliance brief to the City of Toronto

March 30, 2021

Mayor Tory and Toronto City Council must not unleash dangerous electric scooters in Toronto. Riding e-scooters in public places in Toronto is now banned. It remains banned unless Council legalizes them. The pressure to allow e-scooters is relentlessly being advanced by corporate lobbyists for the wealthy and well-financed e-scooter rental industry. Torontonians, including Torontonians with disabilities, need Mayor Tory and City Council to stand up to the corporate lobbyists, and to stand up for vulnerable people with disabilities, seniors, children and others whom e-scooters endanger.

The AODA Alliance submits this brief to the City of Toronto in opposition to the proposal to lift the ban on riding e-scooters in public places in Toronto. It should remain illegal for e-scooters to be ridden in public, whether on a rental e-scooter or a privately-owned e-scooter.

The non-partisan AODA Alliance has played a leading role in raising serious disability safety and accessibility concerns with e-scooters. To learn more about the AODA Alliance’s advocacy efforts to protect people with disabilities and others from the dangers that e-scooters pose, visit its e-scooters web page.

This issue will likely be on the agenda at the April 28, 2021 meeting of the Toronto Infrastructure and Environment committee. We ask City staff to incorporate this brief’s findings and recommendations in its forthcoming report to The Toronto Infrastructure and Environment Committee and the Toronto City Council as a whole.

 1. Summary of this Brief – Don’t Allow E-scooters in Toronto

Toronto should not lift the current ban on riding e-scooters in public places, whether permanently or for a pilot project. For Toronto to allow people to ride e-scooters, whether ones they own or rent, would knowingly and seriously endanger the safety of people with disabilities, seniors, children and others. It would knowingly create new accessibility barriers against people with disabilities. This would fly in the face of the Accessibility for Ontarians with Disabilities Act and the guarantees to people with disabilities in the Canadian Charter of Rights and Freedoms and the Ontario Human Rights Code. Here are key incontrovertible facts overwhelmingly established by objective City staff reports and by public feedback:

  1. Having been forewarned, for the City of Toronto to lift the ban on e-scooters in light of the dangers they pose, as documented in this brief, would expose the City to major claims for knowingly endangering Toronto’s residents and knowingly creating new accessibility barriers against persons with disabilities. For the City of Toronto to do so knowingly is the same as doing so intentionally.
  1. E-scooters will cause an increase in personal injuries, including serious personal injuries to innocent pedestrians and e-scooter riders, burdening Toronto’s overburdened hospital emergency rooms. E-scooters are a silent menace, ridden by unhelmetted, untrained, unlicensed and uninsured riders.
  1. If Toronto allows e-scooters, but bans them from sidewalks, experience in other cities shows for certain that e-scooters will nevertheless regularly be ridden on Toronto sidewalks. This endangers innocent pedestrians. Toronto lacks the law enforcement capacity to effectively police new rules regarding e-scooters, such as a ban on riding or parking them on sidewalks.
  1. If Toronto permits e-scooters, this will create new serious accessibility barriers impeding people with disabilities. This will happen especially in public places like sidewalks where they will be left strewn about, as in other cities that permit e-scooters. They will be a tripping hazard for blind people. They will block accessible paths of travel for people using wheelchairs. Toronto already has far too many accessibility barriers in public places such as sidewalks. E-scooters would make this even worse.
  1. Toronto City staff found no other city that has found an effective way to permit and regulate e-scooters and to effectively enforce those regulations.
  1. To lift the ban on e-scooters will invariably place new financial burdens on the taxpayer. The maximum amount cannot be quantified in advance. This will include added health care costs due to e-scooter injuries, cost of added infrastructure to accommodate e-scooters, added law enforcement costs, added regulatory and monitoring costs, and other liabilities triggered by e-scooters.
  1. Toronto’s mayor and City Council have received strong united opposition to e-scooters from the disability community, reflecting the needs of vulnerable people with disabilities ,seniors and children. This includes two successive compelling unanimous resolutions against e-scooters by the Toronto Accessibility Advisory Committee, strong opposition by many respected disability community organizations, passionate deputations against e-scooters by every person with a disability presenting to City Council committees that have invited deputations on this topic, and emails and phone calls to the mayor and City Council members from many people with disabilities and their supporters.
  1. On July 28, 2020, City Council directed City staff to research disability community concerns with e-scooters. City staff’s research further validated and documented disability community concerns with e-scooters. City staff explored options for addressing these concerns and found that there are no workable solutions that are safe and that avoid the creation of new accessibility barriers. The e-scooter rental industry’s proposed solutions would impose significant cost burdens on the public. They would not effectively solve these public safety and disability accessibility concerns.
  1. It is disturbing that on July 28, 2020, almost half of City Council voted to oppose City Staff conducting research on disability concerns with e-scooters. Had those dissenting Council members succeeded, the important new information that City staff has revealed would never have come to light, to the serious detriment of people with disabilities.
  1. In disregard of these serious dangers, a relentless push for e-scooters in Toronto is mounted by corporate lobbyists for the Canadian arm of international e-scooter rental companies such as Lime and Bird. They unleashed an extensive, well-financed and well-connected lobbying feeding frenzy at City Hall. Some City Council members told the AODA Alliance that this is one of the biggest, if not the biggest corporate lobbying blitz now underway at City Hall. An AODA Alliance report documented that between June 2018 and October 2020, the e-scooter corporate lobbyists had fully 1,384 contacts at City Hall, including 94 with the mayor’s office.
  1. Substantially eviscerating their credibility on this issue, this brief documents that the e-scooter corporate lobbyists have made a number of false, exaggerated, misleading and/or transparently meritless claims to support their pressure for Toronto to lift the ban on e-scooters and let them expand their market. If Toronto allows e-scooters, the e-scooter rental companies will be laughing all the way to the bank, while members of the public, including vulnerable people with disabilities, seniors and children, will be sobbing all the way to the hospital.
  1. The e-scooter corporate lobbyists’ entire campaign is based on the erroneous assertion that rental e-scooters will significantly reduce traffic and pollution, because instead of driving, people will take public transit, and then rent an e-scooter to ride the last mile to their destinations. Yet data from City staff and from the corporate lobbyists themselves shows that the vast majority of e-scooter rides are NOT taken to connect to public transit. They thus won’t reduce traffic or pollution. Indeed a proportion of e-scooter renters use an e-scooter instead of walking or taking public transit. Moreover, for e-scooters to be effective for this “last mile”, Toronto must be inundated with thousands of e-scooters, so one is available whenever a rider wants one. This exacerbates city clutter and disability barriers.
  1. The public use of e-scooters in Toronto should remain banned in any form, whether privately owned the by the rider, or rented e.g. through a shared e-scooter program. The AODA Alliance opposes any e-scooter rental program, whether run by the e-scooter rental companies directly or by the City of Toronto e.g. through its Bike Share program.
  1. The AODA Alliance agrees with the Toronto Accessibility Advisory Committee, which called on City law enforcement to enforce the current ban on e-scooters. If someone now illegally rides an e-scooter, City Council should mandate law enforcement to confiscate that e-scooter.
  1. The fact that Toronto earlier approved some other shared economy activities, like Uber ride sharing, should not mean the e-scooter corporate lobbyists get a free pass here. Any prior approval of ride-sharing, for example, did not take into account the dangers that e-scooters pose. Each shared economy proposal should be assessed on its own strengths and dangers. Rejecting e-scooters does not preclude City Council from approving other shared economic activities, where it adjudges them safe and appropriate.
  1. We seek the leadership of Toronto Mayor John Tory. We need him and all City Council to stand up for people with disabilities, seniors, children and others endangered by e-scooters. We need Mayor Tory and City Council to stand up to the e-scooter corporate lobbyists.

 2. The Proof is Overwhelming – E-Scooters Endanger Personal Safety and Accessibility for People with Disabilities, Seniors, Children and Others.

Overwhelming evidence shows that allowing e-scooters in Toronto will endanger the safety of the public, including vulnerable people with disabilities, seniors, children and others. They will also create new accessibility barriers in a city that is already full of too many disability barriers.

 a)Two Strong Resolutions of the Toronto Accessibility Advisory Committee

These concerns are strongly supported by two unanimous motions of the Toronto Accessibility Advisory Committee. Those resolutions were passed on February 3, 2020 and February 25, 2021. The latter reads:

“The Toronto Accessibility Advisory Committee communicate to the Infrastructure and Environment Committee and City Council, for consideration with the next staff report on electric kick scooters, that:

  1. The Committee does not support the use of any electric kick-scooters (e-scooters) in the City of Toronto; and request that a ban prohibiting their use in all public space remain in place without any exceptions, as they:
  2. create a general safety hazard in the public realm for all Toronto residents;
  3. add further barriers for the elderly and persons living with disabilities;
  4. are poorly enforced when illegally used due to insufficient enforcement resources;
  5. further encumber pre-existing inadequate infrastructure.
  6. The Committee recommends that City Council request the Toronto Police Services Board, the General Manager, Transportation Services, and the Executive Director, Municipal Licensing and Standards to consult with accessibility stakeholders to:
  7. develop a public education campaign to effectively convey the existing by-laws on the prohibition of e-scooters use in all public spaces;
  8. actively scale up city-wide enforcement of the by-law prohibiting use of e-scooters in all public spaces.”

It is especially important for Toronto Mayor John Tory and City Council to pay heed to these unanimous strong resolutions. This is because the Accessibility for Ontarians with Disabilities Act (AODA) requires cities like Toronto to create such municipal accessibility advisory committees. They exist in order to alert municipal governments to important areas where priority action is needed on accessibility for people with disabilities. This includes, among other things, action needed to prevent the creation of new accessibility barriers. If a municipal government creates a new accessibility barrier after it was warned not to do so by its accessibility advisory committee, that government will be acting in a deliberate, intentional and harmful way, contrary to the AODA’s goal.

 b) Media Coverage Objectively Documents Serious Harms Caused by E-scooters

Here is a sampling of media coverage objectively documenting the harms and injuries that e-scooters can cause.

*E-scooter hit-and-run crash leaves pedestrian, 65, seriously injured in hospital in Greater Manchester, UK

*Woman left with brain injury after being hit by e-scooter when getting off bus in Auckland court hears

*Six e-scooter riders before courts for intoxicated riding – UK pilots

*According to the Edmonton Journal, in Edmonton 94 percent said they saw e-scooters used on sidewalks, 68% said more enforcement needed.

*The Washington Post reported on January 11, 2019 that a 75-year-old man in San Diego tripped over an e-scooter. He was taken to hospital, “where X-rays revealed his knee was shattered in four places”. The article quotes Wally Ghurabi, medical director of the Nethercutt Emergency Center at the UCLA Medical Center in Santa Monica. Ghurabi said, “I’ve seen pedestrians injured by scooters with broken hips, multiple bone fractures, broken ribs and joint injuries and soft tissue injuries like lacerations and deep abrasions.” The article also reports incidents involving pedestrians in Dallas, where a 32-year-old man was “left with scrapes on his knee and face, as well as a deep gash above his right eye that required seven stitches”, and Cincinnati, where a 44-year-old woman incurred approximately $1000 in medical expenses after being “throw [n]…to the ground” — both following collisions with e-scooters.

*Euronews reported on June 18, 2019, that Paris intended to implement speed limits and parking restrictions for e-scooters following its “first death on an electric scooter”. The French transport minister also announced a nationwide ban on e-scooters on sidewalks, effective September. A week prior to the announcements, a 25-year-old man riding an e-scooter had died after being hit by a truck. The report details other incidents, involving both riders and bystanders. In Sweden, “a 27-year-old man died in a crash while riding one of the electric vehicles in May”. In Barcelona, “a 92-year-old woman died in August 2018 after she was run over by an e-scooter — making it the first case of a pedestrian being killed by the electric vehicle”.

*On July 26, 2019, CBC News reported that since e-scooters became available in Calgary, “Calgary emergency rooms have seen 60 patients with e-scooter-related injuries”. The report added that “[a] bout a third of them were fractures and roughly 10 per cent were injuries to the face and head”. These figures have triggered a study by the University of Calgary.

*The Guardian reported on August 11, 2019 that Paris had experienced its third e-scooter-related death in four months: “A 30-year-old man has been killed after being hit by a motorbike while riding his e-scooter on a French motorway.” The report went on to state that “ [t] he scooter rider was not wearing a helmet and was reportedly travelling in the fast lane when the motorbike hit him from behind”, despite the fact that “[u] sing scooters on motorways is banned in France”. Moreover, “The day before the accident, a 27-year-old woman suffered serious head injuries after falling from an e-scooter she was using in a cycle lane in Lyon. A few days earlier a 41-year-old man had been seriously injured after falling from his e-scooter in Lille.” Finally, the report provided details on another, earlier e-scooter-related death in France: “An 81-year-old man died after he was reportedly knocked over by an e-scooter in Levallois-Perret, a Parisian suburb, in April.”

*CityNews reported on August 13, 2019, as part of a short survey of European regulations, that “German police say seven people have been seriously injured and 27 suffered minor injuries in scooter accidents since mid-June, saying most were due to riders behaving carelessly.”

*In Austin, an article from 2019 states that almost half of the 190 e-scooter injuries in a three-month period were injuries to the head and 15 percent were traumatic brain injuries. Less than 1 percent of injured riders were wearing helmets.

*In San Antonio, wheelchair users complain of e-scooters being left on sidewalks and ramps; these present a danger to individuals who rely on wheelchairs for mobility. The article notes that the e-scooters create profound obstacles for disabled people who are simply trying to get to work or run daily errands.

 

*An article entitled “Sharing the sidewalk: A case of E-scooter related pedestrian injury” published in the American Journal of Emergency Medicine in June 2019 cites multiple studies corroborating the occurrence of pedestrian injuries: one from Israel found that, while pedestrians were 8.4% of the patients admitted for e-bike- and e-scooter-related injuries, they “were more severely injured; compared to electric scooter riders and electric bike riders, pedestrians have higher rates of head, face, and neck injuries; traumatic brain injuries; and hospital stays lasting more than a week”.

 c) Major Disability Organizations Unite in Opposition to Allowing E-Scooters

An impressive number of respected community organizations have voiced the same safety and accessibility concerns especially for people with disabilities and seniors. They have called for e-scooters not to be allowed. A January 22, 2020 Open letter in opposition to e-scooters in Ontario cities like Toronto has been co-signed or endorsed by the Accessibility for Ontarians with Disabilities Act Alliance, March of Dimes of Canada, the Canadian National Institute for the Blind, the ARCH Disability Law Centre, Spinal Cord Injury Ontario, the Ontario Autism Coalition, the Older Women’s Network, the Alliance for Equality of Blind Canadians, Guide Dog Users of Canada, Views for the Visually Impaired, Citizens With Disabilities – Ontario and Canadians with Disabilities of B’nai Brith Canada.

 d) All deputants with Disabilities Addressing City of Toronto Committees on E-scooters Raise Serious Safety and Accessibility Objections

Safety and accessibility concerns led every deputant with disabilities and their supporters, speaking at City of Toronto Committee meetings on this issue, to insist that e-scooters must not be allowed in Toronto. This was the unanimous message from all people with disabilities and their supporters who have addressed the Toronto Accessibility Advisory Committee on February 3, 2020 or February 25, 2021, and who addressed the Toronto Infrastructure and Environment Committee on July 9, 2020.

For example, at the February 25, 2021 Toronto Accessibility Advisory Committee meeting, a very long meeting for that Committee, Disability presenters at the meeting were unanimous in voicing total opposition to e-scooters in any form or on any basis in Toronto. John Rae, a blind person over the age of 70, spoke for the Alliance for Equality of Blind Canadians. He described e-scooters as an e-menace to people with disabilities and seniors. He said that any deployment or testing of e-scooters would be a new disability barrier, flying in the face of the Accessibility for Ontarians with Disabilities Act. He said Toronto, including its sidewalks, have been becoming less accessible to persons with vision loss. E-scooters will make this worse. This is an issue of pedestrian safety.

Edward Rice, speaking for B’nai Brith Canada, showed disturbing pictures from Fort Lauderdale Florida, where from a year before, when in a two block area, there were fully 25 e-scooters strewn about the sidewalk. He uses a mobility device. He had to ask strangers to move these out of the way so he could travel on the sidewalk. He called this “embarrassing and humiliating”.

John Mosa, Melanie Marsden and Andrea Hatala together spoke for the GTA Disability Coalition, a network of different disability organizations. They, like Mr. Rice, cited a study of increased emergency room visits in Calgary due to e-scooter use. In Toronto this would compound the discrimination which people with disabilities risk in hospital during COVID-19 due to the Ontario Government’s critical care triage protocol. They identified the barriers to people with disabilities that e-scooters pose, because they are silent and can be difficult to avoid, and because they can be a tripping hazard and mobility barrier on sidewalks. They endorsed the AODA Alliance’s call for e-scooters to be banned, for there to be no e-scooter pilot, and for police to enforce the ban on e-scooters against those now riding them.

Jennifer Griffith, a blind woman who uses a guide dog, described Toronto as an increasingly dangerous and inaccessible city. Her example of dangers are construction sites in the city that she has to try to safely navigate through or around. She described the fear she would face each time she goes out in public if she faces the danger of silent e-scooters injuring her. She would not have heard of a proposal for an e-scooter pilot, had it not been for the AODA Alliance.

Ron Redham is a 60 year old person with a disability who lives in Etobicoke and walks with canes. Having gradually learned how to use canes after having to use a wheelchair, He asked Toronto not to send him and others back on the rehabilitation burdens that he had to go through. He doesn’t want to end up in a wheelchair again. He said in Montreal, 80% of scooters were parked illegally, resulting in them littering the downtown. This led to an early cancellation of their pilot project.

Paul Michaels is from B’nai Brith Canada, a national human rights organization. He has two family members with cerebral palsy. They asked him to share with the Committee their fear that they could not readily maneuver out of the path of an oncoming e-scooter or around a group of e-scooters.

Adam Cahoon said he gets hateful looks when he uses his power wheelchair at full speed, around 8 KPH or so. He said e-scooter scan go over double his speed, making him feel especially vulnerable.

On February 25, 2021, several members of the Toronto Accessibility Advisory Committee also described serious safety and accessibility dangers that e-scooters pose for people with disabilities. For example, a member of Toronto Accessibility Advisory Committee said that deafblind persons would be especially vulnerable.

 e) Toronto City Staff Confirm the Safety Dangers and New Accessibility Barriers that E-Scooters Would Create in Toronto

Two written City staff reports confirm that e-scooters endanger public safety, including safety for vulnerable people with disabilities, seniors, children and others. They will also create new disability accessibility barriers, even if banned on sidewalks. This is confirmed in the City staff’s June 24, 2020 report to the Toronto Infrastructure and Environment Committee, and the City staff’s February 25, 2021 presentation to the Toronto Accessibility Advisory Committee.

The City staff’s June 24, 2020 report to the City’s Infrastructure and Environment Committee included these findings:

* “E-scooters pose a risk to people with disabilities due to their faster speeds and lack of noise. Cities that have allowed e-scooters have observed a high incidence of sidewalk riding by riders, whether permitted or not on sidewalks. Parked e-scooters, especially when part of a dockless sharing system, can pose trip hazards and obstacles. Seniors, people with disabilities, and those with socio-economic challenges could face negative outcomes if injured in a collision or fall. Solutions to enforcement and compliance are still in their infancy.”

* “Vision Zero Road Safety – Risks with E-scooters

The City has a Vision Zero commitment to eliminate serious injuries and fatalities resulting from roadway crashes, particularly around six emphasis areas including pedestrians, school children, and older adults. Replacing car trips with e-scooter trips presents an opportunity to address some road safety issues if e-scooters produce a net safety benefit, especially for these groups. A 2020 International Transport Forum study notes that the risk of hospital admission may be higher for e-scooter riders than for cyclists, but that there are too few studies to draw firm conclusions. While not comprehensive, the emerging evidence of the health impacts associated with e-scooter use warrants a cautious approach to mitigate risks to e-scooter riders, pedestrians, and the City. Some of the findings are below.

New e-scooters users are most likely to be injured with 63 per cent of injuries occurring within the first nine times using an e-scooter. (CDC and City of Austin).

A comparison of serious injury rates between Calgary’s 2019 shared e-scooter pilot and Bike Share Toronto suggests riding a shared e-scooter is potentially about 350 times more likely to result in a serious injury than riding a shared bike on a per km basis, and about 100 times more likely on a per trip basis. This includes a limited sample size, differing definitions for serious injuries, different city contexts (e.g., Calgary allowed e-scooter riding on sidewalks, whereas bicycle riding is not allowed on sidewalks in Toronto) and serious injuries may decline over time as people gain experience riding e-scooters. (Montréal reported few e-scooter injuries for its 2019 pilot, however, it is unclear whether and how data for serious injuries was gathered.) Calculations are based on: 33 ER visits requiring ambulance transport over three months (Jul to Sep 2019) in Calgary for e-scooter-related injuries with a reported 750,000 trips, and average trip length of 0.9km; and 2,439,000 trips for Bike Share Toronto, with 3km average trip length, over 12 months in 2019, and no serious injuries (e.g., broken bones, head trauma, hospitalization) but attributing one for comparison purposes. Further data collection and studies of injuries are needed on a per km basis, by type of trip (i.e., recreational versus commuting, facility type), and by injury type.

The fatality rate for shared e-scooter users is potentially nine to 18 times the rate of bike share-related deaths in the U.S., based on a news report in the Chicagoreader.

Head trauma was reported in nearly one third of all e-scooter-related injuries in the U.S. from 2014 to 2018 – more than twice the rate of head injuries to bicyclists. In a City of Austin study in 2018 over three months, 48 per cent of e-scooter riders who were hurt had head injuries (91 out of 190), with 15 per cent (28 riders) experiencing more serious traumatic brain injuries.

Falling off e-scooters was the cause of 80 per cent of injuries (183 riders); 20 per cent (45 riders) had collided with a vehicle or an object, according to a 2019 UCLA study of two hospital ERs in one year. Just over eight per cent of the injuries were to pedestrians injured as a result of e-scooters (11 hit by an e-scooter, 5 tripped over a parked e-scooter, and 5 were attempting to move an e-scooter not in use).

Hospital data will be key to track injuries and fatalities by type and severity, especially for incidents where no motor vehicle has been involved (e.g., losing control) or for a trip and fall involving improperly parked e-scooters. As an ICD-10 code (international standard injury reporting code) specific to e-scooters will not be implemented in Canada until at least spring 2021, a reliable method to track serious e-scooter related injuries and fatalities presenting at hospitals is currently not available.”

* “Other cities have suspended e-scooter sharing services until after COVID-19 (e.g., Windsor approved a shared e-scooter pilot in April 2020, but has now deferred its pilot until after COVID-19). Prior to the pandemic, a number of jurisdictions (e.g., Boulder, Honolulu, and Houston) had refused to allow or banned the use of e-scooters due to public safety concerns. Key cities with similar population, urban form, and/or climate have not yet piloted e-scooters such as New York City (Manhattan/New York County ban), Philadelphia, and Sydney, Australia.”

* “While staff have considered a potential e-scooter pilot on ActiveTO major road closures, it would pose risks to vulnerable road users and leave the City open to considerable liability and risk due to lack of resources for oversight, education and enforcement at this time. A key purpose of ActiveTO is to provide a mixed use space for physical activity for people of all ages for walking, jogging and human-powered cycling. Piloting a new vehicle type that is throttle-powered and can potentially exceed speeds of 24km/hr poses risks to vulnerable road users in such conditions. It could also lead to confusion about which infrastructure or facilities under ActiveTO are permissible, and this would pose public safety risks that the City does not have resources to manage at this time.”

* “Finally, the risk of injury for new users is high, and could put additional burden on local hospitals and paramedics at this time. For the reasons above, City staff do not recommend permitting e-scooters in ActiveTO facilities in 2020.”

* “If Council were to permit e-scooters to be operated on City streets – without the commensurate resources to provide oversight, education, outreach and enforcement, there would be considerable risks to public safety for e-scooter riders and other vulnerable road users; additional burden on hospitals and paramedics; impacts on accessibility, community nuisance and complaints; impacts on current initiatives to enhance the public realm for COVID-19 recovery efforts, such as CurbTO and CaféTO; and liability and costs to the City. For the reasons above, staff recommend that personal use of e-scooters not be considered until 2021.”

* “Accessibility for Ontarians with Disabilities Act (AODA)

Persons with disabilities and seniors have considerable concerns about sidewalk and crosswalk interactions with e-scooter users, as well as concerns regarding trip hazards and obstructions from poorly parked or excessive amounts of e-scooters. The Toronto Accessibility Advisory Committee, a body required under the AODA, recommends that City Council prohibit the use of e-scooters in public spaces, including sidewalks and roads. In other jurisdictions outside of Ontario, some legal action has been undertaken against municipalities by persons injured as a result of e-scooter sidewalk obstructions, as well as by persons with disabilities.“

After City Council directed City staff on July 28, 2020 to do further research on the disability concerns regarding e-scooters, City staff did further research. This further research reinforced the public safety and accessibility concerns addressed above. None of the City staff’s new information refuted or reduced the concerns about the dangers that e-scooters present as raised by disability advocates and others. The City staff’s further research did not support a conclusion that these concerns have been or could be effectively eliminated.

The City staff’s February 25, 2021 presentation to the Toronto Accessibility Advisory Committee included

* “According to the UDV (German Insurers Accident Research) in January 2021, e-scooter riders are 4 times more (or 400% more) likely than bicyclists to injure others, due to e-scooters being illegally ridden on sidewalks.

–     In 21% of e-scooter incidents with personal injury, the victim is not the rider, but another road user. This is due in part to e-scooters being ridden on sidewalks 60% of the time when they should be on the road or bike lane.

According to Austria’s Kuratorium für Verkehrssicherheit (KFV) in October 2020, 34% of 573 e-scooter riders observed at several Vienna locations illegally rode on the sidewalk.

–     Even if there was a bike path, 23 percent preferred the sidewalk. If there was only one cycle or multi-purpose lane, 46 percent rode on the sidewalk. If there was no cycling infrastructure, 49 percent rolled illegally on the sidewalk.”

* “Canadian context – City of Calgary

  • No bike share. Only rental e-scooters allowed in Alberta.
  • Allows e-scooter riding on sidewalks.
  • 43% of 311 requests about bad behaviour or conflicts with pedestrians; 42% parking concerns. (total of 769 requests over the pilot period)
  • Now allowing e-scooter use on some roads to reduce sidewalk riding issues. Added slow speed zones and 30 parking zones (2.5% of riders ended trips in parking zones; 10% of the e-scooter fleet was deployed to the parking zones).
  • E-scooters to return via the procurement process. Lowered fleet cap from 2,800 (2020) to 1,500 (2021). Will require licence plates for enforcement.
  • “Likely that e-scooters have the highest rate of injury per transportation mode” but less severe. 43% of EMS e-scooter injuries required surgery (double that of EMS bicycles at 21%). 37% of severe e-scooter injuries had suspected intoxication.
  • 1,300 e-Scooter-related ER visits during the pilot period but may be over-inclusive of other devices referred to as scooters. 75 required ambulance transport, 5% were pedestrians injured.

Canadian context – City of Ottawa

  • No bike share. Personal use and rental e-scooters allowed on roads with max 50km/h limit, bike lanes, and trails/paths that are not National Capital Commission multi-use paths.
  • Lowered max. speed to 20km/hr for e-scooters from the permitted 24km/hr under the provincial pilot. 8km/hr for slow zones, e.g., transit malls/stations.
  • Piloted a fleet of 600 e-scooters with 3 vendors in 2020. Will increase the fleet cap to between 1,200 and 1,500 for 2021 and expand outside the Greenbelt (suburban area).
  • 76% of e-scooter riders surveyed used e-scooters for recreation; 2% to connect to transit (COVID-19 context)
  • Will pilot in 2021 via procurement process. Staff labour costs not included in cost-recovery. Considering designated parking areas. 69% of all survey respondents reported encountering improperly parked e-scooters.
  • No injury data collection with hospitals and not likely for 2021 given the pandemic.
  • Accessibility stakeholders were consulted and raised concerns about sidewalk riding and improper parking, especially barriers for persons with low vision or no vision.”

Despite all the overwhelming evidence that demonstrates e-scooters ‘dangers, the two lead e-scooter rental companies, Bird and Lime, together have campaigned for e-scooters in Toronto in effect as if none of that evidence is true. For example, Bird tried to convey an impression that e-scooters pose no additional danger to public safety, if allowed, and are simply the same as bikes. This defies logic. Unlike bikes, an e-scooter, ridden for the very first time by an utterly inexperienced rider, can silently race faster than 20 kph in seconds, powered by an onboard motor. The faster a vehicle’s speed on impact with an innocent pedestrian, the greater the force applied, and the risk of consequential injury.

Lime has made even more exaggerated claims. It repeatedly told the February 25, 2021 Toronto Accessibility Advisory Committee meeting that rental e-scooters, if allowed, will improve public safety, stating:

“The OECD says in their widely, the most extensive report in the world on micro-mobility that road users will be safer, all road users, if e-scooter and bicycle trips replace travel by car or motorcycle.”

Lime would thus have Toronto believe that the public is at greater danger now, because e-scooters are not allowed. To support this extreme claim, Lime in substance argued that cars are more dangerous to pedestrians than are e-scooters. Is it just a coincidence that this claim serves the economic interests of the e-scooter corporate lobbyists in getting as many e-scooters on the road as possible, claiming in effect that the more e-scooters that are deployed, the safer we all will be?

Of course, cars are much bigger and heavier than e-scooters. They can go much faster than e-scooters. As such, a car can cause greater injuries when it hits a pedestrian.

Lime’s claim rests on fatally flawed premises. First, no one is contemplating banning cars from the road, and replacing them with e-scooters. Second, cars, unlike e-scooters, are not routinely driven on sidewalks, where pedestrians expect and deserve to be able to walk in safety, unthreatened by any motor vehicles. Third, as addressed further below, in cities where e-scooters are allowed, they have not been proven to materially reduce the amount of car traffic on the road.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, the City got a unique opportunity to assess the clash between City staff who say that e-scooters create new safety dangers on the one hand, and e-scooter corporate lobbyists who claim that e-scooters will improve public safety, on the other. Committee members asked both e-scooter corporate lobbyists and City staff to address the clash in the data that each relied upon.

When the answers of City staff and the e-scooter corporate lobbyists are assessed together, the only plausible conclusion is to reject the corporate lobbyists’ claims that e-scooters improve public safety, rather than endangering public safety. City Council is strongly encouraged to prefer the City staff findings. This is so in light of the fact that City staff, acting in the tradition of professional public servants, have provided unimpeachable objective data. In sharp contrast, the e-scooter corporate lobbyists’s have a strong economic motive to exaggerate their claims. As is further documented later in this brief, they also have a disturbing track record of false, exaggerated and misleading claims that brings their credibility into question.

Lime Canada conceded that if a city council saw the information about the impact of e-scooters that City staff presented at the February 25, 2021 Toronto Accessibility Advisory Committee meeting, they would vote against e-scooters. Lime also conceded at that meeting that the highest priority risk areas are parking compliance, compliance with not riding on sidewalks, and riding while intoxicated. We emphasize that all those three areas bear directly on creation of new safety dangers and disability accessibility barriers.

Despite those major admissions, to support its claims that e-scooters will improve public safety rather than endangering it, Lime and Bird referred a report from the International Transport Forum ITF of the OECD at the same Toronto Accessibility Advisory Committee meeting. However, City staff correctly pointed out several critical features of that report that controvert the corporate lobbyists’ reliance on and claims about it.

First, that report, which the corporate lobbyists called an “OECD report”, was not in fact endorsed or approved by the OECD. To the contrary, it is labelled as a Corporate Partnership Board Report. City staff explained that the corporate partnership board includes e-scooter manufacturers and e-scooter rental companies. The report includes a pivotal disclaimer that:

“Funding for this work has been provided by the ITF Corporate Partnership Board” and “It has not been subject to the scrutiny of ITF or OECD member countries and does not necessarily reflect their official views or those of the members of the Corporate Partnership Board.”

Second, Bird claimed that the International Transport Forum of the OECD had concluded that a road fatality is not significantly more likely when using a shared standing e-scooter rather than a bicycle, and that the risk of an emergency department visit for an e-scooter rider is similar to that for cyclists. In response, City staff explained that on page 10 and 20 of the report, it says that the hospital rate may be higher for e-scooters, that hospital admissions related to e-scooter incidents may be higher. It is clear that the report does not prove or support the e-scooter corporate lobbyists’ claims about it. When City staff met with the e-scooter rental industry on January 20, 2021, City staff were very clear in stating that they do not consider, given the research seen, that that the risk profile of e-scooters is merely the same as bikes.

 3. E-scooters Won’t Materially Reduce Road Traffic, Pollution or Climate Change

E-scooter corporate lobbyists make unsubstantiated claims that to allow e-scooters would materially reduce road traffic and combat pollution and climate change. This lies at the heart of their argument in favour of Toronto permitting e-scooters. For example, Lime told the Toronto Accessibility Advisory Committee on February 25, 2021 that e-scooters can save “a ton of car trips”. It turns out that these claims are untrue.

The corporate lobbyists argue that e-scooters would reduce traffic on the roads and reduce pollution because instead of taking a car to their destination, they would ride public transit to get near their destination, and then rent an e-scooter to ride the last mile from transit to their destination, or to ride the first mile from their destination back to public transit. Eviscerating this claim is the fact that most e-scooter renters do not use e-scooters to connect to transit. The February 25, 2021 City staff presentation to the Toronto Accessibility Advisory Committee indicated that in the Ottawa fall 2020 e-scooter pilot, a survey revealed that only 2% of e-scooter riders did so to connect to public transit. As well, the City staff’s June 24, 2020 report to the Toronto Infrastructure and Environment Committee showed that e-scooters are not mainly used to replace car trips:

“While some mode shift from driving to using an e-scooter has occurred in other cities, the majority of e-scooter trips would have been by walking or public transit (around 60% for Calgary and Portland; and 86% in Greater Paris). For example, 55 per cent would have walked instead of using an e-scooter (Calgary). From a Paris area survey, 44 per cent would have walked, 30 per cent would have used public transit, and 12 per cent would have used a bicycle/shared bike; while this study noted that e-scooters had no impact on car equipment reduction, an extrapolation would assume that 14 per cent would have used a car/ridehail/taxi, which still represents a minor shift away from motorized vehicular use.”

Even Lime’s presentation that day only claimed that 20% of their trips are connections to transit. Therefore, fully 80% of e-scooter rides are not for that purpose, even on the most generous statistical claims from the e-scooter industry.

Making this worse, the corporate lobbyists’ claims supporting e-scooters would require Toronto to be flooded with e-scooters. For e-scooters to serve their supposed benefit as a means to connect to public transit in lieu of car rides, people would have to be assured before they leave home that there will always be an e-scooter waiting for them to rent, conveniently available as soon as they get off public transit, to ride that last mile to their destination. Similarly, When they leave their destination to go back home, they’d need an assurance that there would be a rental -scooter waiting for them right there, available ride the first mile back to transit on their way home.

There would therefore have to be a huge number of e-scooters scattered all over Toronto, just in case someone wants to rent them. Short of that, a person has no assurance that they can rely on this mode of travel. Without that assurance, they won’t know if they can get to their destination on time.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, City staff and the e-scooter corporate lobbyists’ presentations, together, show without contradiction that the e-scooter companies do not prefer having e-scooters parked at fixed docking stations, such as those now allocated for Bike Share bikes. Rather, they prefer for a rider to be able to leave an e-scooter on Toronto’s sidewalks, tied to a fixed object. City staff told the February 25, 2021 Toronto Accessibility Advisory Committee meeting that docking stations have the advantage of reducing the tripping hazards, sidewalk clutter and accessibility barriers that are created when e-scooters are parked on the sidewalk.

City staff explained that Bike Share corrals are typically 500 meters apart. The e-scooter corporate lobbyists want e-scooters to be within as little as 300 meters to each other. No doubt, this is because the closer be the e-scooter is to a potential renter or market, the more likely the customer is to opt for their product. Of course, the bigger the flood of e-scooters scattered around Toronto, the better it is for the e-scooter industry’s profits. However, this also makes the new barriers against people with disabilities and the safety dangers to them even more prolific.

This all means that there must be a massive urban blight of e-scooters, akin to that seen in some other cities, for this supposed benefit of reduced traffic and pollution to work. So speculative a benefit is hardly worth the proven harms e-scooters cause.

 4. Allowing E-scooters Would Impose Significant New Financial Burdens on the Taxpayer

City staff reports amply support the inevitable conclusion that to lift the ban on e-scooters in Toronto would impose significant but as-yet unquantifiable financial burdens on the taxpayer. This includes among other things, health care and litigation costs arising from personal injuries caused by e-scooters, the cost of creating and maintaining infrastructure to accommodate e-scooters, the cost of enforcing the laws regulating e-scooters if enacted, the cost of City regulating e-scooters, collecting data and monitoring e-scooter use and e-scooter companies. At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, City staff reported that The City’s insurance and risk management people believe that there would be significant costs to the City if a pilot were to be held. The costs to the City of allowing e-scooters would include costs of claims, cost of police enforcement, cost of City Transportation staff dealing with litter issues enforcement, the cost of City data collection and the cost of staff monitoring and providing oversight. Insurance and risk management is finding it difficult to come up with a specific dollar amount for these costs. This resoundingly disproves the e-scooter corporate lobbyists’ false claims at the July 9, 2020 Toronto Infrastructure and Environment Committee that there would be no additional costs to the City.

COVID-19 has already imposed massive new costs on Toronto, and on Ontario. Toronto is in no position to suffer these added new additional e-scooter costs. If Toronto can afford to spend more now on Toronto’s infrastructure and environment, it should be spent to reduce the many accessibility barriers facing people with disabilities. It should not be spent to create new disability barriers, as e-scooters would cause.

The June 24, 2020 City staff report to the Infrastructure and Environment Committee found:

“There is a significant risk that the City may be held partially or fully liable for damages if e-scooter riders or other parties are injured. Transportation Services staff consulted with the City’s Insurance and Risk Management office (I&RM) to understand the magnitude of the City’s liability if allowing e-scooters. At this time, loss data is lacking on e-scooters due to generally lengthy settlement times for bodily injury claims. The City has significant liability exposure, however, due to joint and several liability, as the City may have to pay an entire judgement or claim even if only found to be 1 per cent at fault for an incident. The City has a $5M deductible per occurrence, which means the City will be responsible for all costs below that amount. In terms of costs, Transportation Services staff will also be required to investigate and serve in the discovery process for claims.

E-scooter sharing/rental companies typically require a rider to sign a waiver, placing the onus of compensating injured parties on the rider. Riders are left financially exposed due to a lack of insurance coverage and if unable to pay, municipalities will be looked to for compensation (e.g., in settlements and courts). Claims related to e-scooter malfunction have been reported by the media (such as in Atlanta, Auckland, New Zealand and Brisbane, Australia). In 2019, a Grand Jury faulted the City of San Diego for inadequate regulation and enforcement of e-scooter sharing companies. By opting in to the Pilot, the City will be exposed to claims associated with improperly parked e-scooters as evidenced by lawsuits filed by persons with disabilities and those injured by e-scooter obstructions (such as in Minneapolis and Santa Monica, California).”

Beyond the foregoing, the City of Toronto could expose itself to major damages claims if people get injured by e-scooters. As amply documented throughout this brief and on the AODA Alliance’s e-scooters web page, Toronto has ample basis to know that e-scooters present proven safety and disability accessibility dangers. For Toronto to expose Torontonians to e-scooters once it has been alerted to these dangers, injured parties can be expected to claim greater damages. This is because Toronto thereby knowingly endangered its residents and knowingly created new disability accessibility barriers. The City could not credibly defend itself by claiming that it had no idea that it was creating these dangers by allowing e-scooters at the behest of the e-scooter corporate lobbyists.

 5. No Effective Insurance Solutions Are Now Available

It has been a fundamental requirement of public policy for decades that the public should be assured that there is sufficient insurance in place to cover those who are injured by motor vehicles. That is why driving a car without proper insurance is an offence.

This is an issue which has not been solved for e-scooters, a form of motor vehicle. The City staff’s June 24,2020 report included:

“This report also recommends the need for improved industry standards at the provincial and federal levels for greater consumer protection in the purchase and/or use of e-scooters. While staff are aware that e-scooters are being considered as an open-air transportation option, the absence of improved standards and available insurance for e-scooter riders, coupled with lack of enforcement resources, would risk the safety of riders and the public on the City’s streets and sidewalks, especially for people with disabilities.”

The City staff’s February 25, 2021 presentation to the Toronto Accessibility Advisory Committee said that there would be a need for insurance to cover injuries both to the e-scooter rider and an injured pedestrian. We would add that there would also be a need for insurance to cover damage to property due to e-scooter use, and injuries and property loss due to motor vehicle accidents caused by e-scooter use e.g. if a car needs to swerve to avoid an e-scooter, and ends up in a collision causing personal injuries, death and/or property loss.

The City staff February 25, 2021 presentation concluded in substance that no acceptable insurance solutions for the needs that the City staff identified are now established. Solutions that the industry proposed are not sufficient. For example, the industry proposed that a fund be established to cover losses due to e-scooters. City staff were not satisfied that revenues from a fee to be imposed on each e-scooter ride could cover the funds needed for claims and for the infrastructure that would have to be set up to administer such a new claims fund.

We add that whatever be worked out regarding insurance, the e-scooter rental companies should be assigned first and primary liability for any injuries or losses that are caused to anyone by the use of their vehicles. If they want to make their product available in Toronto, in order to make profits, they should shoulder the costs that are caused to others by the use of their product.

In Ontario, a car’s owner is primarily liable for injuries or losses caused by the car, and not just the driver. There is no reason to exempt the e-scooter rental companies from that wise approach. Otherwise, it gives a massive undeserved financial windfall for the e-scooter rental companies.

In the end, insurance, even if properly available, does not eliminate or reduce the dangers to the public including people with disabilities, seniors, children or others. It presupposes that members of the public will be injured by e-scooters. They will have to shoulder the hardships and high costs of bringing law suits to recover damages. Money can help, but cannot eliminate the physical pain, the loss of abilities, and the other hardships that a serious personal injury and civil litigation can inflict. It would be wrong to proceed on the basis that so long as there is sufficient insurance in place, there is no need to worry about the dangers to safety and disability accessibility that e-scooters will create.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, Bird complained that third party e-scooter insurance does not exist in North America, that it is not required anywhere else in North America, and that it is not mandated or provided for Bike Share TO. Yet these provide no reason for dismissing insurance issues addressed here, or the need for there to be proper insurance in place. It just gives another compelling reason why Toronto should not lift the ban on e-scooters.

 6. A Pilot with E-Scooters in Toronto Would Endangers Public Safety and Disability Accessibility, and Exposes The City to Major Financial Claims

There are times where it is worthwhile for the City of Toronto to conduct a pilot project with an innovation, to see if it is suitable for wider adoption. However, Toronto should not conduct a pilot project with e-scooters. There are a number of reasons for this. Each, standing alone, is sufficient to reject that idea. Rejecting a pilot here does not mean Toronto is rejecting the idea of ever conducting pilots in other areas of policy that do not present e-scooters’ dangers.

It is essential to expose why e-scooter corporate lobbyists press so hard for a pilot. They do so purely for tactical marketing reasons. They want their product on the Toronto streets, to build their market. They want to shift the burden to those opposing e-scooters to have to fight an uphill battle to get e-scooters removed, once entrenched. They want the inertia to favour them. They want the City to invest money in their product’s entrenchment, so it will be easier to secure a permanent foothold in this city. They want to point to Toronto to leverage other cities to follow suit.

First, there is no real need for an e-scooter pilot in Toronto. No one has identified an appropriate purpose for an e-scooter pilot. A pilot is conducted to answer specific questions, identified in advance. If the pilot is to ascertain if some people would like to ride e-scooters, we know from other cities that they do. If it is to find out if e-scooters will ride on sidewalks even if banned from sidewalks, we have ample evidence that they do. Indeed we already have first-hand proof that e-scooters are freely and openly ridden on Toronto sidewalks even when they are entirely illegal in Toronto.

If the question to be considered is weather e-scooters endanger public safety and disability accessibility, we have sufficient proof from other cities that they do. There is nothing about Toronto or Torontonians that make these dangers any less than for other cities that have allowed e-scooters. To the contrary, City staff’s June 24, 2020 report shows ways in which Toronto presents added problems, if e-scooters are allowed here. It concluded:

“In addition to the experiences in other jurisdictions, several risk factors are unique to the City of Toronto and play a role in informing the recommended approach to e-scooters:

Streetcar tracks: Toronto has an extensive track network (177 linear kilometres) which poses a hazard to e-scooter riders due to the vehicle’s small wheel diameter.

Winter and State-Of-Good-Repair: Toronto experiences freezing and thawing that impacts the state-of-good-repair for roads. A large portion of roads are 40 to 50 years old, with 43 per cent of Major Roads and 24 per cent of Local Roads in poor condition. Coupled with lack of standards for e-scooter wheels (e.g., traction, size), this makes this particular device more sensitive to uneven road surfaces.

High construction activity: In addition to the city’s various infrastructure projects, Toronto has been one of the fastest growing cities with about 120 development construction sites in 2019.

Narrow sidewalks and high pedestrian mode shares in the Downtown Core and City Centres: Most jurisdictions experienced illegal sidewalk riding by e-scooter users, with some business districts saying e-scooters deterred patrons from visiting their previously pedestrian-friendly main streets. This is especially challenging with physical distancing requirements and other COVID-19 recovery programs expanding the use of the City’s sidewalks and boulevards.”

Second, it is universally accepted that it is utterly wrong to conduct an experiment on human beings without their consent. This is especially so where it is known in advance that the experiment poses a danger to them. Imagine the liability that a government would risk if it subjected people to a trial COVID-19 vaccine without their consent, to find out if it works and if it has any dangerous side-effects.

An Toronto e-scooter pilot would be a human experiment without the consent of those endangered by it. This is revealed by the City staff’s presentation at the February 25, 2021 Toronto Accessibility Advisory Committee meeting. For purposes of gathering data on injuries caused by e-scooters, City staff spoke of collecting data from hospitals before a pilot, during a pilot and after a pilot. City staff explained that the burdens on hospitals during the COVID-19 pandemic precluded their being able to gather the kind of data needed before an e-scooter pilot could begin.

Toronto should not follow Ottawa’s reckless conduct. Ottawa conducted a pilot project with e-scooters right in the midst of the COVID-19 pandemic, without putting in place effective measures for tracking injuries. The Ottawa mayor’s office told AODA Alliance Chair David Lepofsky on the night before the pilot’s approval that if people get injured, they can file complaints. Ottawa unfairly shifted the burden to e-scooter victims to produce evidence of harm they suffered, rather than proactively preventing the harm in advance or ensuring that it is accurately tracked during that pilot.

In these circumstances, if Toronto conducts an e-scooter pilot, it risks facing major financial claims by people injured by e-scooters. As noted earlier, injured victims can be expected to argue, as a factor substantially increasing their right to a large damage award that the City of Toronto decided to subject them to the dangers of an e-scooter human experiment without their consent, having been warned in advance of the safety and accessibility dangers that e-scooters create. That claim for damages would be fortified by the fact that the Toronto Accessibility Advisory Committee twice unanimously recommended against conducting a pilot project with e-scooters, after receiving compelling evidence from multiple sources on the safety and accessibility dangers they pose.

Third, the City staff’s June 24, 2020 report shows that in important ways, the proper legal and operational groundwork has not been done at the provincial or federal level, needed for a pilot project. That report concluded:

* “Although the HTA sets out some e-scooter standards, such as maximum speed and power wattage, due to the nature of urban and suburban conditions such as Toronto’s, City staff recommend that the Province strengthen the device standards for greater rider safety. Based on an extensive literature review, items recommended for further Provincial exploration include a maximum turning radius, a platform surface grip, wheel characteristics (e.g., minimum size, traction, tire width), braking and suspension.

In addition, the Province has not established set fine amounts for offences under the HTA e-scooter regulations. Without this in place, for the police to lay a charge in respect of a violation, a “Part III Summons” is required, which means the police must attend court for each charge laid regardless of severity, and a trial is required for a conviction and fine to be set. This may make it less likely that charges are laid. Fines outside of ones the City could set (e.g. e-scooter parking violations, illegal sidewalk riding) would create workload challenges for Police and courts.

In spite of the Pilot requirement to collect data, there is currently no vehicle type for e-scooters in the Ministry of Transportation’s (MTO) Motor Vehicle Collision Report (MVCR) template used by all police services to report collisions. Unless the Province specifies e-scooters are motor vehicles for the purposes of collision reporting, and has a field for this in its template, e-scooter collisions may not be reported reliably and meaningful collision data analysis will not be possible. In Fall 2019, City staff requested that the MTO add e-scooters as a separate vehicle type, but MTO has not yet communicated they would make this change.”

If Toronto wishes to gather still more information about e-scooters, it should do so without conducting its own pilot experiment on Torontonians, by looking to the personal injuries and disability accessibility barriers that e-scooters created in other cities.

 7. E-Scooter Corporate Lobbyists Have Proposed No Effective Solutions that Will Solve the Problems E-scooters Would Create

City Council will want to know if there are “compromises” i.e. solutions that could allow e-scooters while not making Torontonians suffer from their dangers. The AODA Alliance urges that Toronto should not “compromise” on the safety of its residents. Especially during COVID-19, our political leaders have emphasized that public safety is their number one priority. That should be the case here as well. Compromising on accessibility for people with disabilities should be out of the question, especially when it comes to the danger of creating new accessibility barriers that would compound the many barriers that people with disabilities now suffer from in Toronto.

That said, the question remains whether there are solutions that would not compromise on public safety or on the impermissible creation of new accessibility barriers. City staff commendably gave the e-scooter corporate lobbyists an ample open opportunity to present practical solutions to the dangers that e-scooters create, if such solutions exist. City staff held a meeting with 29 representatives of the e-scooter rental companies on January 20, 2021. E-scooter corporate lobbyists also had the chance to bring solutions to the Toronto Accessibility Advisory Committee on February 25, 2021.

e-scooter companies have a strong financial incentive to present workable solutions. This would open up the highly-desirable Toronto market to them. They are well –positioned to try out effective solutions elsewhere, if there are any. This is because they operate e-scooter rental operations in a number of other cities.

Those companies are well-aware of their need to come up with solutions. The disability community has been raising our disability-related concerns regarding e-scooters for over a year and a half. Such concerns have been raised in other cities.

Despite these opportunities, e-scooter corporate lobbyists presented no solutions that would in fact solve the serious dangers that e-scooters pose. The February 2021 written staff report and the staff oral presentation on February 25, 2021 to the Toronto Accessibility Advisory Committee reviewed key solutions that the e-scooter corporate lobbyists presented to City staff. City staff correctly concluded that none effectively solved the problems that e-scooters present, but impose costs on the taxpayer. The February 25, 2021 City staff presentation stated:

“”Potential solutions to address e-scooter sidewalk riding

  • Protected bike lane/micromobility network and placing e-scooter parking on-street so that trips begin/end off the sidewalk
  • Field staff/ambassadors/patrols and enforcement teams
  • Visible, unique identifiable plate numbers (licence plates for rental fleets)
  • E-scooter sidewalk riding detection technologies* (*emerging technology)

Other proposals to address e-scooter sidewalk riding

  • Geofencing pedestrian areas or slow zones
  • Education and warnings (by companies) and fines for riders (by police)
  • Suspensions/bans on repeat offenders (by companies)
  • Decals on sidewalks and signage
  • Audible warnings on the device for the rider and pedestrians

Potential solutions to address improper e-scooter parking

  • Adequate supply of parking areas (and fleet size caps/reviews)
  • Proper parking verification (photo selfies and/or other technologies)
  • Field staff/patrols and enforcement teams (1-2 hr service standards or better)
  • Braille/tactile and unique identifiable numbers on e-scooters (licence plates for rental fleets)
  • Docked stations* like Bike Share Toronto (*dockless preferred or hybrid by companies)

Other proposals for improper e-scooter parking

  • Education and incentives (e.g., discounts for proper parking or penalties for repeat offenders by companies; or fines to the companies that are passed onto the repeat offenders)
  • “Lock-to” parking mechanism (similar to a bicycle lock)
  • Double kick-stand (less likely to topple over); and
  • Onboard diagnostics indicating the device has toppled over.
  • Photo of e-scooter being locked to a hand railing at steps to an entrance by a man wearing a bicycle helmet and business casual work clothes.
  • Photo of e-scooter locked to bicycle parking with a cable. The bike parking is in the shape of a metal loop attached to the sidewalk in San Francisco with a bike lane painted green in the background.”

The City staff’s February 25, 2021 presentation also stated:

“Accessibility Feedback on Proposed Solutions…

Technologies are still emerging and not adequate yet:

  • Geofencing and other technologies to prevent sidewalk riding are not sophisticated enough and would only apply to rental e-scooters.
  • Docking stations for e-scooters has potential but is still in development.
  • Lock-to cables on e-scooters mean they could be locked anywhere (e.g., café fence/railing) including in spots blocking entrance access and paths of travel.
  • There is already a lack of bike parking so this would worsen the number of sidewalk obstructions on narrow and cluttered sidewalks.
  • If Bike Share Toronto were dockless, there would not be enough bike rings to lock the rental fleet… same for dockless rental e-scooter fleets.

Accessibility Feedback on Proposed Solutions

Not enough city resources for enforcement and infrastructure priorities

  • Oversight is very labour- and resource-intensive and depends on enforcement, which is already stretched or non-existent in parts of the City.
  • Licence plates on rental e-scooter fleets could help, but this is a reactive tool and would be a drain on city resources to monitor and enforce.
  • Bigger priorities for limited city resources.
  • Inadequate infrastructure is a bigger priority – not enough sidewalk space or accessible infrastructure; not enough bike lanes/bike lane space; and not enough public transit.
  • Importance of other city priorities before allowing something which poses a hazard and a nuisance for pedestrians and persons with disabilities.

Accessibility Feedback on Proposed Solutions

Impacts on seniors and persons with disabilities on sidewalks

  • COVID-19 has resulted in challenges for persons with disabilities, their caregivers and pedestrians who use sidewalks as a necessity and not for recreation.
  • Allowing e-scooters will pose hazards that affect persons with disabilities, seniors, their caregivers and pedestrians.
  • Risk of severe injury for seniors or persons with disabilities if tripping and falling or struck by an e-scooter.
  • Inability to identify e-scooter rider because of their speed, and that the person’s credit card on the app may not be the person riding the e-scooter.”

The e-scooter corporate lobbyists presented no information that refuted the City staff assessment of these solutions. None of the information presented by City staff either in its February 2021 report or their February 25, 2021 oral presentation to the Toronto Accessibility Advisory Committee demonstrated any need to subject Torontonians to these dangers in a “pilot project” to see if they would materialize in Toronto. No information was presented to suggest that Toronto would somehow be exempt from these dangers, if it allows e-scooters.

We add the following, which reinforces the City staff’s presentation. Toronto has bike lanes, but it is not a contained network. Moreover, extensive law enforcement would be needed to ensure compliance. Both creating the network and such law enforcement imposes substantial costs on the public. The public should not be required to build massive new infrastructure to let the e-scooter corporate lobbyists make their profits.

At most such bike paths are described as helpful as encouraging e-scooter riders not to ride on sidewalks. Yet such “encouragement” is no assurance that they will comply.

City staff reported that a proposed solution was to use technology such as “geo-fencing” to prevent e-scooters from riding on sidewalks. Using GPS or other technology, the e-scooter itself would supposedly electronically detect when it is going somewhere where it is not allowed to go. City staff correctly concluded that the technology to do this accurately and reliably simply does not exist. We agree. We add that anyone who uses a GPS for directions know that they are not accurate enough to pinpoint whether an e-scooter is on the sidewalk, or mere inches away on the road.

Even if geo-fencing did work, it would only restrict rented e-scooters and not privately owned e-scooters. Yet both rented and privately-owned e-scooters create dangers to people with disabilities.

Lime said that such sidewalk detection technology could help with reminding riders afterwards. The e-scooter rental company could call the offending rider afterwards. Including those with multiple cases of it. This wrongly relies on e-scooter companies with a conflict of interest to lead this activity. It only addresses the problem after the danger has been created, rather than preventing barriers from being created in the first place. Waiting for multiple infractions does not protect the public from one-time riders. This all presumes without proof that the e-scooter companies can effectively track this.

Another proposal from the industry was to have staff educate e-scooter riders. If these staff are to be provided by the City, that would be an unwarranted cost burden on the taxpayer. Even if these staff were to be provided by the e-scooter companies, there would be no realistic possibility of them being situated all over the city to ensure that they reach all or even most e-scooter riders. E-scooter riders would have no obligation to spend time listening to them. There is no assurance that this education would reach many e-scooter riders, or that it would change their behaviour.

The industry’s proposal to require a visible identifiable number to be located on each e-scooter can be partially helpful. However that alone will not materially reduce the problems we have identified.

If an e-scooter rider violates the law, it is not conclusive proof of the rider’s identity to identify the number on the e-scooter, even if a victim can accurately identify that number. The e-scooter companies would have to make available to the public their internal records of rentals, account holders and vehicle numbers. Moreover, the e-scooter rider may not be the same person as the name on the account charged for the e-scooter. This alone would not be sufficient assured proof in court to establish the rider’s identity.

This is also no solution for pedestrians who see a law-breaking e-scooter from the side or from behind, or where the e-scooter is racing too quickly for the pedestrian to read the identification number. Moreover, offending e-scooter riders will quickly learn to cover up the identification number. This solution also depends on the public financing enough law enforcement to catch and successfully prosecute offenders.

Another measure proposed was to add braille and tactile letters to an e-scooter, to enable a person with vision loss to identify it. This presupposes that a person with vision loss trips over an improperly parked e-scooter, and then gropes all over it to find an accessible braille or raised letter identifier. That in turn presupposes that the victim knows that such labels are available, and is prepared to try this groping. This is, far fetched. It also leaves people with vision loss exposed to the e-scooter tripping hazard in the first place.

Lime Canada proposed to the Toronto Accessibility Advisory Committee on February 25, 2021 that E-scooter rental companies could require renters to photograph how they park an e-scooter, and send the photo to the rental company for monitoring. This provides no real public protection. The renter could move the e-scooter right after sending in that photograph.

Similarly, it would be problematic to rely on rental companies to impose or collect fines. This would lack needed law enforcement public accountability and safeguards. The public would have to trust the e-scooter companies. Law enforcement should never be parcelled out to a private for-profit company that has such an obvious conflict of interest. Moreover, if the fine is retained by the e-scooter company, that would simply add to their profits.

The industry proposed that they could suspend multiple violators from being able to rent an e-scooter. However, this requires the many serious impediments to proving a violation and a violator’s identity to first be overcome, e.g. the need for massive increases in law enforcement to detect violators. Moreover, a suspended person could simply use a new credit card to create a new account and then resume riding e-scooters.

The industry’s proposal to increase law enforcement would shift more financial burdens to the taxpayer. It also presupposes that if Toronto were to increase its law enforcement spending, e-scooters should be a top priority. We would suggest that there are now other law enforcement priorities that would compete for attention, e.g. ensuring that the public obeys public social distancing requirements during the pandemic.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, Lime conceded that drunk e-scooter riding will require an “enforcement component”. It said there are “some tech tools that some of the companies would come up with to help identify an impaired e-scooter driver. The industry could then deny the intoxicated rider a ride. There is no suggestion that this intoxication technology exists, or that it has been effectively deployed anywhere

The industry proposed that it could message riders regarding restrictions on e-scooter use. This assumes that voluntary compliance would be sufficient. There is no indication that this has been tried and worked in other cities. We would not dispense with drivers licenses and the related training in exchange for car companies messaging their customers on where they are permitted to drive their cars.

The industry proposed that sidewalks could be marked with notifications not to ride e-scooters there. City staff correctly noted that this would create visual clutter. There are many kilometers of sidewalks that would require this. We add that here again, the e-scooter corporate lobbyists once again propose shifting major costs to the taxpayer to enable them to make their profits. It also presupposes that those who illegally would ride e-scooters on sidewalks only do so because they didn’t know it is forbidden, rather than because they don’t have to fear effective law enforcement.

City staff rejected a proposal that e-scooters emit an audible sound. We note that this measure may help somewhat in overcoming the dangers of e-scooters due to their now being silent. However, this would not overcome the dangers when e-scooters are lying on the sidewalk, blocking pedestrians, nor would this prevent injuries when collisions occur. Moreover, these sounds would have to be loud enough to alert a pedestrian well in advance, so that they can try to evade a fast-moving e-scooter racing towards them.

City staff noted that the industry proposed that e-scooter parking be located on the street, to reduce the chances of them being ridden on the sidewalk. We note that with street parking now at a premium, especially in downtown Toronto where the traffic is often congested, there are harms that would flow from further reducing street parking. From a disability perspective, if any new street parking were to be re-allocated, it should be for more disability parking spots, and not for e-scooters.

Moreover, by having e-scooters parked on the street, this would not in any real way reduce the danger of e-scooters being ridden on the sidewalk. An e-scooter rider could simply continue to ride on the sidewalk and then at the end of their ride, park on the street, if permitted.

To address the problems of parking e-scooters, the industry proposed, among other things, providing them with more e-scooter parking locations. This impinges on limited parking spaces already available in Toronto, as noted above. It also shifts yet another cost to the taxpayer, who would be providing free parking for the corporate lobbyists to make their profit.

The option of providing docking stations was discussed. It burdens the taxpayer with providing the space and paying for the docking stations. It adds to urban clutter.

The industry proposed technology to ensure that e-scooters are parked properly. Yet unless there is a huge supply of staff to monitor this, it will not prevent danger to people with disabilities and others before injuries and accessibility barriers impede people with disabilities.

The industry proposed having a patrol team from e-scooter companies to explore and remedy complaints. City staff said that where tried, the minimum service standard has been one to two hours after a violation is reported by the public, especially during a pilot project. We respond that that leaves the danger to pedestrians in place, and only rectifies it after the fact. It also unfairly burdens pedestrians with having to call in complaints, and indeed, with having to know how to do so and at what number. That depends on a chain of events that is not reliable.

Consideration was given for e-scooter companies to provide rate incentives for those who park properly, such as discounts, or rate penalties for those who do not park them properly. That requires someone to effectively police where each e-scooter is parked. The option of fining the e-scooter company directly for improperly parking the e-scooter raised the concern that the e-scooter company could just pass this cost on to the users, rather than it serving to ensure proper parking of e-scooters. Here again, this presupposes that there is the deployment of ample law enforcement deployed all over the city that has time to conduct all the needed enforcement for e-scooters.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, industry representatives gave major priority to the solution of “lock-to”. A cable is attached to the e-scooter so that when parked, it can be locked to a pole or other object. However, this is no solution at all. It still exposes people with disabilities to e-scooters being left all over the place in unpredictable public locations, as new accessibility barriers and tripping hazards. It wrongly converts our sidewalks and other public places into free parking for the e-scooter industry, with the public substantially subsidizing their profits.

Bird claimed at that meeting that the problem of e-scooters being ridden on sidewalks would be dramatically reduced if riders could lock up a rental e-scooter on the sidewalk, using the “lock to” option. It defies logic to argue that this solves the problem of riding e-scooters on sidewalks. A person would ride an e-scooter on a sidewalk, rather than the road, to avoid cars or the many potholes in our roads. Where one can park the e-scooter at the end of the ride does not dictate whether one chooses to ride on the sidewalk rather than the adjacent road en route to one’s destination.

The industry proposed having each e-scooter equipped with a double kickstand to reduce the risk of them falling over when parked. That suffers from the same problems as the lock-to proposal.

Similarly, the industry’s proposal that each e-scooter have an onboard diagnostic mechanism to indicate if the e-scooter has toppled over also has the same deficiencies. It also assumes that the e-scooter companies will flood the city with enough people to immediately remove such an e-scooter before someone trips over it.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, Lime proposed that the industry could share big data with city officials e.g. if there are locations where there are repeat problems with e-scooters. If this is shown the City might wish to protect the public by creating new infrastructure. By this, it appears to mean that if there is a route where e-scooter riders repeatedly ride on the sidewalk, the City might wish to build a separate path.

By this, the industry concedes the risk of repeat violators. It shifts to the public the financial burden of building new infrastructure to avoid people being injured by e-scooters. It provides no assurance that riders who repeatedly use those sidewalks will stop doing so once a separate bike path is built.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, Lime Canada also says that in the shorter term, this could help focus enforcement on those corridors. That too exposes pedestrians to the dangers of e-scooters, and shifts to the public the cost of additional law enforcement.

At the February 25, 2021 Toronto Accessibility Advisory Committee meeting, Lime claimed that education of riders along with enforcement are “very good tools”. Yet enforcement is a major public cost burden. It starts from the premise that the e-scooter has already caused harm.

We add that Toronto cannot rely on education of riders, since a rider can rent an e-scooter without having to ever speak to a human being from the e-scooter rental company, from whom they could receive that education. Moreover, Lime Canada conceded that education alone is “not enough” to solve the admitted problem of people riding e-scooters on sidewalks. It conceded as well and that there must be “a degree of enforcement” (though it did not specify how much enforcement it conceded to be necessary).

As explained earlier, an e-scooter is a motor vehicle. Nevertheless, Lime’s solution for the problem of bikes creating accessibility barriers when left on sidewalks is to regulate them as if they were non-motorized bikes. Yet that would simply add to sidewalk barriers. In effect, the industry sought the lowest and most permissive degree of regulation possible, with the least accountability.

For decades, our society has regulated motor vehicles far more extensively than bikes. We require the vehicle and driver to each be licensed and insured. We require the driver to complete sufficient training, including safety training under proper supervision, before being allowed to drive in public. Licenses are gradually graduated for drivers as their experience grows. Vehicles must meet rigorous safety standards. In contrast, the e-scooter rental industry seeks to evade all of those regulations, as if an e-scooter were not a motorized vehicle.

 8. E-scooter Corporate Lobbyists’ Numerous False, Misleading and Exaggerated Claims Further Show Why Toronto Should Reject Their Dangerous E-scooter Proposals

The e-scooter corporate lobbyists’ misleading false and claims, flights of extreme exaggerations and flights of illogic are breathtaking. Toronto Mayor John Tory, City Council and City staff should take their claims with at least a grain ton of salt. They should insist on strong corroboration before accepting any of their claims.

The AODA Alliance’s October 30, 2020 report revealed that these corporate lobbyists have been inundating Toronto City Hall with a huge, well-financed relentless, feeding frenzy of lobbying in the back rooms. Some Councillors have told us that this is one of the biggest, if not the biggest corporate lobbying effort now at City Hall. The AODA Alliance ‘s October 30, 2020 report on this lobbying feeding frenzy gives insight into why in the midst of the COVID-19 pandemic when other pressing issues should be a priority, Toronto’s municipal politicians are so seriously considering unleashing e-scooters in Toronto, despite their amply-documented dangers to people with disabilities, seniors and others.

That report shows that entries in Toronto’s official Lobbyist Registry, filling fully 73 pages, reveal that in just the two years from June 2018 to the present, eight e-scooter rental companies and three lobbying firms have documented fully 1,384 contacts with City Hall in person, by phone, by virtual meeting or by email. Among these were at least 112 meetings with City officials and 1,153 emails. These figures only include contacts which corporate lobbyists opted to record in the Toronto Lobbyist Registry during that period.

Amidst this onslaught of corporate lobbyists’ approaches were a dizzying 94 contacts with the Mayor’s Office, including 10 with Mayor Tory himself, 58 with the Mayor’s Senior Advisor, Legislative Affairs Daniela Magisano, 15 with Mayor Tory’s Director of Legislative Affairs Edward Birnbaum, 10 with his Chief of Staff Luke Robertson, and 1 with Mayor Tory’s Deputy Chief of Staff Courtney Glen. As well, among these documented contacts are 368 contacts with members of City Council, 479 contacts with staff of members of council, as well as 352 contacts with other City staff, among others (We surmise that the corporate lobbyists may not have reached a few janitors).

Beyond those address earlier in this brief, corporate lobbyists’ public presentations in support of e-scooters at the February 25, 2021 Toronto Accessibility Advisory Committee meeting and the earlier July 9, 2020 Toronto Infrastructure and Environment Committee meeting, are replete with the following ten additional falsehoods, exaggerations, and transparently bogus arguments. That they must resort to such meritless arguments to offer further shows that their proposals lack real merit.

As a first example, Bird told the February 25, 2021 Toronto Accessibility Advisory Committee meeting that an important question is whether City Hall continues to ignore the number of e-scooter riders on city streets today, despite the current ban on them, or whether Toronto chooses to regulate this space with “sensible regulations?” It argued that Toronto should lift the ban on e-scooters because some people are now illegally riding privately-owned e-scooters in Toronto.

This falsely suggests that the proper solution to dangerous lawlessness is not to enforce the law, but instead to legalize the dangerous illegal activity. By that reasoning, Canada should lift the ban on unlawful assaults, and regulate assaults instead, since some people illegally assault others. Canada should now lift the ban on heroin and crack cocaine, because some people now illegally use those dangerous drugs.

Instead, the fact that some people are now flouting the law by illegally riding privately-owned e-scooters in Toronto is strong proof that we can expect more flouting of the law by rental e-scooter riders if their use is legalized but banned on sidewalks.

Similarly, Lime relied heavily on the false dilemma that either people will buy their own e-scooters without speed controls, or we can allow rental e-scooters with speed controls. Yet Toronto has the further option of enforcing the law against riding any e-scooters and confiscating any e-scooter ridden illegally in public. That would resolve the whole problem without a necessity of legalizing either owned or rental e-scooters.

Second, at the February 25, 2021 Toronto Accessibility Advisory Committee meeting, Bird misleadingly described the ban on e-scooters as a “temporary ban”. In fact, the legal ban on e-scooters in Toronto is permanent, unless City Council votes to lift it. Moreover, at present, it can only be lifted for under four years. After that the provincial ban on e-scooters goes back into effect.

Third, Bird told the Toronto Accessibility Advisory Committee on February 25, 2021 that Ottawa’s pilot with e-scooters is the “gold standard” by which Toronto should be guided, as if Ottawa’s experience provides an effective answer to public safety and disability accessibility concerns. Yet Toronto City staff presented earlier at that meeting that Ottawa City staff had not even collected e-scooter injury data. Later at that meeting, CNIB deputed that during the Ottawa pilot, e-scooters were operated unsafely and left in pedestrian clearways throughout the downtown. This caused accessibility barriers and safety hazards. Despite all this, Ottawa is expanding their e-scooter fleet. That means that a key purpose of the pilot, to see their impact on injuries, was disregarded by Ottawa.

CNIB held a public meeting to get feedback from people with vision loss about their experience during the Ottawa e-scooter pilot. It heard alarming stories of safety hazards posed to people with vision loss by e-scooters. There was unsafe operating of e-scooters, regular illegal sidewalk riding of e-scooters and improperly parking e-scooters. 1On a survey about the pilot, 69% of respondents encountered wrongly parked e-scooters. 72% of survey respondents encountered sidewalk riding.

Ottawa City Council nevertheless approved e-scooters for a second pilot despite the staggering data the City itself collected. CNIB warned Toronto not to follow the Ottawa experience. That a leading, e-scooter corporate lobby could point to Ottawa as “the goal standard” shows how dramatically antithetical they are to the vulnerability of people with disabilities.

Lime claimed that in Ottawa, the votes to continue the e-scooter program were nearly unanimous. That only shows the devastating reach of the e-scooter corporate lobbyists.

Fourth, Bird tried to portray e-scooters as an important mobility aid for people with disabilities. The industry tried to appear as if it were advocating in favour of expanded accessibility for people with disabilities when its core business in fact endangers accessibility for people with disabilities.

Lime claimed at the February 25, 2021 Toronto Accessibility Advisory Committee meeting that they embrace the goal of accessibility for people with disabilities. It told that meeting that 8% of their riders have physical disabilities and use e-scooters as “a liberating tool to explore the city”. Yet e-scooters are not viewed as adaptive disability mobility devices in the disability community.

Lime provided no independently-verified objective evidence to support the claim that 8% of e-scooter riders have physical disabilities. They would seem to have no way to verify this, since their rental customers do not interact with Lime staff when renting an e-scooter. Moreover, even if some e-scooter riders have some sort of physical disability, there is no proof of how many, if any, need the e-scooter to meet a disability mobility need. It is important not to confuse a bona fide disability power scooter, in which a person with a disability is seated, and one of Lime’s very different rental e-scooters on which a rider must stand and balance themselves, while travelling much faster than a disability scooter can.

Fifth, Lime made the over-inflated if not bogus claimed at the February 25, 2021 Toronto Accessibility Advisory Committee meeting that allowing e-scooter rentals will help with recovery from the COVID-19 pandemic. This is because people will use an e-scooter to go to stores to shop.

Yet e-scooters are not supposed to be used to transport anything other than the person riding it, such as goods bought in stores. It presumes that e-scooter renters can leave their e-scooter scattered anywhere near any store they wish to visit. This threatens the sidewalk litter, accessibility barriers and tripping hazards that e-scooters have presented in other cities like Ottawa. It presumes that those same shoppers would not go shopping, helping out our economy, had it not been for renting an e-scooter. There is no proof that there has been any such surge in economic activity provably linked to e-scooters.

Sixth, an example of misleading use of statistics was Lime’s claim at the February 25, 2021 Toronto Accessibility Advisory Committee meeting that in Calgary, city data shows e-scooter injuries were far, far less than bike injuries. Even if there is such a statistic, it can easily be explained by the fact that there are far fewer e-scooters being ridden compared to the total number of bikes being ridden. Instead, the relevant statistic to use is the number of injuries per kilometer ridden. At that Toronto Accessibility Advisory Committee meeting, Lime and Bird did not use that relevant measure for injuries, when comparing different modes of travel, whether cars, bikes or e-scooters. They therefore did not account for how many of each kind of vehicle is on the road, or how far they are driven before causing an injury, or the severity of the injury they cause.

Seventh, Lime argued that rental e-scooters have the added protection of in-built speed limits and geo-fencing capabilities, which are not included in e-scooters that people privately buy. As well, as noted earlier, City staff correctly concluded that geo-fencing is not now a reliable technology. As well, to allow rental e-scooters does not assure that people won’t also ride privately-owned e-scooters. Lime advanced the false dilemma that either people will buy their own e-scooters without speed controls, or Toronto can allow rental e-scooters with speed controls. Yet there is the further and preferred option of effectively enforcing the ban on riding any and all e-scooters, and confiscating any illegally-ridden e-scooters.

Eighth, Lime claimed at the February 25, 2021 Toronto Accessibility Advisory Committee meeting that there have been no deaths due to rental scooters because they have speed controls. This claim is dubious. It requires proof that a pedestrian, hit by an oncoming e-scooter at 22 KPH, cannot be killed, but one colliding at 30 or 40 KPH can be killed. No proof of such a medical improbability has been provided.

Ninth, Lime made the unsubstantiated claim at the February 25, 2021 Toronto Accessibility Advisory Committee meeting that e-scooters have a much higher parking compliance rate than do cars. Even if this were assumed to be true, the question is not whether to ban cars. It is whether to allow e-scooters which will create new safety dangers and new disability accessibility barriers. Moreover, cars, even when improperly parked, are not typically left strewn about sidewalks as a tripping hazard and accessibility barrier.

Tenth, at the February 25, 2021 Toronto Accessibility Advisory Committee meeting, Lime made the quite exaggerated claim that most major cities outside Toronto had embraced e-scooters, and that unlike Toronto, e-scooters have met with virtually universal acclaim in cities that tried them. This is shown to be misleading, in light of the following information included in the City staff’s presentation to the February 25, 2021 Toronto Accessibility Advisory Committee meeting:

“Large Urban Peer Cities

  • Peer cities have banned rental/shared e-scooters from downtowns in Chicago and New York City.
  • No rental/shared e-scooters yet in places such as:
  • Montréal (not for 2021) or Vancouver
  • Massachusetts (e.g., City of Boston)
  • Pennsylvania (e.g., City of Philadelphia)
  • New South Wales (e.g., City of Sydney, Australia)
  • Scotland (e.g., City of Edinburgh), The Netherlands (e.g., Amsterdam), and
  • Others have banned or since banned them, e.g., Copenhagen (city centre), Houston, San Diego (boardwalk ban), etc.
  • NYC (outside of Manhattan only) and Transport for London (UK) pilots not yet underway.”

City staff noted that Montreal, which earlier did a pilot with e-scooters, will not have e-scooters in 2021. Vancouver does not have e-scooters. Hamilton and Mississauga allow privately owned e-scooters. We add that the City of Mississauga Accessibility Advisory Committee recommended that e-scooters not be allowed. We have seen no reason given for Mississauga rejecting that important accessibility recommendation.

City staff noted that London, Waterloo and Windsor are involved in some sort of public consultations on e-scooters which is slowed due to COVID-19. Calgary only allows e-scooter rentals, as is the case for all Alberta. Calgary allows e-scooters on sidewalks, and has no bike share program. Calgary will now allow some use of e-scooters on roads, to reduce sidewalk use.

Calgary staff advised their Council that it is likely that e-scooters have the highest injury rate per transportation mode. 43% of e-scooter injuries that were transported to hospital required surgery, which is twice the rate for bicycle injuries. In Calgary, 37% of e-scooter injuries had suspected intoxication.

City staff also reported that looking at large cities with similar large populations, similar urban densities and similar climate, Chicago and New York City ban rental e-scooters from their downtown areas. There are no rental e-scooters in Montreal, Vancouver, Massachusetts (e.g. Boston), Pennsylvania (such as Philadelphia), New South Wales (such as Sydney). Melbourne requires an e-scooter to have a maximum power of 200 watts. Most e-scooters require a higher wattage than that. There are no e-scooters in Scotland or the Netherlands. They have been banned in the city centre of Copenhagen, Houston, and San Diego’s boardwalk.



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Ontario Urged to Suspend Need for Consent Before Withdrawing Life Support When COVID Crushes Hospitals


Sharon Kirkey, Postmedia News ([email protected])
Published: January 21, 2021

Dr. James Downar: Were talking about a scenario where the focus is no longer on the individual himself, but now on our population as a whole.

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

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

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

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

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

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

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

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

Its really important to be clear here this is not about how long youre likely to live, its not a life span question, said Dr. James Downar, head of the division of palliative care at the University of Ottawa and a member of the Bioethics Table. Its your probability of being alive 12 months after developing critical illness.

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

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

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

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

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

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

With an Executive Order in place, doctors could put off escalating triage and continue to offer intensive care to every person who might benefit, including borderline cases right up to the point that the critical care beds are literally full, he said. ICUs could run at full capacity. Only then, as new patients come in who meet the triage criteria a lower risk of death and who need beds would ICU care slowly start to be withdrawn from people who arent responding and are least likely to, Downar said.

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

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

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

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

But should hospitals become maxed out, with a massive surge of people coming through the doors who have a very high chance of survival, and people in the ICU who arent benefitting from critical care and who are highly likely to die if we dont have the tool to provide equitable access to care, that will create a lot of distress on the system, Frolic said.

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

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

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

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

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

We dont know the process by which these decisions will be made, who will be making the decisions to withdraw care. Is there going to be an appeal procedure whereby a family can challenge that decision? Is there going to be accountability?

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

If they were to amend the consent legislation, and if that were valid, and if it were constitutional and if it got around all the criminal law problems, what will that mean? It means if anybody goes to hospital and gets intensive care, they dont have any confidence theyre going to be able to stay there, Lepofsky said.

Theyve got to lie there knowing not only are they fighting for their life, but they are also aware that, at any time, a doctor could decide their chances arent so good, somebody coming in has got better chances, sorry, were pulling the plug on you.’

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hen COVID crushes hospitals

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Sharon Kirkey, Postmedia News ([email protected])

Published: a day ago
Updated: 15 hours ago

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Dr. James Downar: Were talking about a scenario where the focus is no longer on the individual himself, but now on our population as a whole.
Dr. James Downar: Were talking about a scenario where the focus is no longer on the individual himself, but now on our population as a whole.

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

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

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

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

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

Prioritize ICU treatment for patients ‘most likely to survive’ in event of COVID ‘major surge,’ Ontario hospitals told
Jesse Kline: Overreach of COVID measures risks turning Canada into a police state

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

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

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

Its really important to be clear here this is not about how long youre likely to live, its not a life span question, said Dr. James Downar, head of the division of palliative care at the University of Ottawa and a member of the Bioethics Table. Its your probability of being alive 12 months after developing critical illness.

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

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

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

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

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

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

With an Executive Order in place, doctors could put off escalating triage and continue to offer intensive care to every person who might benefit, including borderline cases right up to the point that the critical care beds are literally full, he said. ICUs could run at full capacity. Only then, as new patients come in who meet the triage criteria a lower risk of death and who need beds would ICU care slowly start to be withdrawn from people who arent responding and are least likely to, Downar said.

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

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

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

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

But should hospitals become maxed out, with a massive surge of people coming through the doors who have a very high chance of survival, and people in the ICU who arent benefitting from critical care and who are highly likely to die if we dont have the tool to provide equitable access to care, that will create a lot of distress on the system, Frolic said.

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

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

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

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

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

We dont know the process by which these decisions will be made, who will be making the decisions to withdraw care. Is there going to be an appeal procedure whereby a family can challenge that decision? Is there going to be accountability?

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

If they were to amend the consent legislation, and if that were valid, and if it were constitutional and if it got around all the criminal law problems, what will that mean? It means if anybody goes to hospital and gets intensive care, they dont have any confidence theyre going to be able to stay there, Lepofsky said.

Theyve got to lie there knowing not only are they fighting for their life, but they are also aware that, at any time, a doctor could decide their chances arent so good, somebody coming in has got better chances, sorry, were pulling the plug on you.’

Email: [email protected]




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