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


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

June 8, 2021

SUMMARY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Below you can read the following:

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

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

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

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

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

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

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

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

For more background on this issue, check out:

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

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

1 MORE DETAILS

CTV News April 28, 2021

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CTV News Online Report Updated by May 6, 2021

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

QUEBEC FAR FROM TRIGGERING’ TRIAGE PROTOCOLS

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

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

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

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

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

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

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

intensive care admissions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CTV News

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

Elizabeth St. Philip, CTV News
Contact @LizTV

Ben Cousins , CTVNews.ca Writer
Contact @cousins_ben

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Correction:
A previous version of this story suggested triage guidelines




Source link

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


Accessibility for Ontarians with Disabilities Act Alliance Update

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

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

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

June 8, 2021

            SUMMARY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Below you can read the following:

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

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

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

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

For more background on this issue, check out:

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

1          MORE DETAILS

 CTV News April 28, 2021

Originally posted at

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

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

Avis Favaro

Medical Correspondent, CTV National News

@ctv_avisfavaro

Elizabeth St. Philip

CTV News

@LizTV

Ben Cousins

CTVNews.ca Writer

@cousins_ben

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

QUEBEC ‘FAR FROM TRIGGERING’ TRIAGE PROTOCOLS

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

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

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

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

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

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

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

intensive care admissions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

David Lepofsky CM, O. Ont

Chair Accessibility for Ontarians with Disabilities Act Alliance

Twitter: @davidlepofsky

CTV News Online Report Updated by May 6, 2021

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

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

Medical Correspondent, CTV National News

Contact @ctv_avisfavaro

Elizabeth St. Philip, CTV News

Contact @LizTV

Ben Cousins, CTVNews.ca Writer

Contact @cousins_ben

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

QUEBEC ‘FAR FROM TRIGGERING’ TRIAGE PROTOCOLS

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

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

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

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

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

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

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

intensive care admissions

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

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

To: CTVNews

From: David Lepofsky

Date: May 18, 2021

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

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

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

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

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

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

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

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

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

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

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

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

David Lepofsky CM, O. Ont

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

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

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

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

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

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

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

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

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

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

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

David Lepofsky CM, O. Ont

Chair Accessibility for Ontarians with Disabilities Act Alliance

Twitter: @davidlepofsky

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

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

CTV News

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

Avis Favaro, Medical Correspondent

Contact @ctv_avisfavaro

Elizabeth St. Philip, CTV News

Contact @LizTV

Ben Cousins , CTVNews.ca Writer

Contact @cousins_ben

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

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

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

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

Related Links

Accessibility for Ontarians with Disabilities Act Alliance on triage protocols

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

QUEBEC ‘FAR FROM TRIGGERING’ TRIAGE PROTOCOLS

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

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

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

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

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

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

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

Correction:

A previous version of this story suggested triage guidelines



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


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

June 7, 2021

SUMMARY

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

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

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

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

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

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

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

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

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

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

More Details

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

****

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

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

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

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

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

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

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

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

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

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

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

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

Thanks for bringing it to my attention.

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

Please allow me to explain.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dear Raj,

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

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

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

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

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

Stay safe.

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




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


Accessibility for Ontarians with Disabilities Act Alliance Update

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

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

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

June 7, 2021

            SUMMARY

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

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

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

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

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

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

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

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

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

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

 More Details

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

www.aodaalliance.org/healthcare

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

****

ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE

NEWS RELEASE – FOR IMMEDIATE RELEASE

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

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

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

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

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

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

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

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

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

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

For more background on this issue, check out:

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

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

Thanks for bringing it to my attention.

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

Please allow me to explain.

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

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

the systems are so different that any comparisons are inaccurate.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dear Raj,

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

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

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

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

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

Stay safe.

David Lepofsky CM, O. Ont

Chair Accessibility for Ontarians with Disabilities Act Alliance



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Disability Rights Advocate Resorts to Freedom of Information Application to Unearth the Ford Government’s Secret Plans for Critical Care Triage if Overcrowded Hospitals Can’t Serve All Critically-Ill Patients


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

May 20, 2021 Toronto: To Mark today, Global Accessibility Awareness Day, the AODA Alliance makes public a Freedom of Information application by its chair, David Lepofsky, filed to finally enable the public to see the Ford Government’s secret plans for critical care triage. Since the pandemic began over 14 months ago, the Ford Government has kept a tight lid on its critical care triage plans. This new Freedom of Information application tries to drag into public light The Government’s plans on this life-and-death issue. (Key excerpt from the Freedom of Information application set out below).

“It’s great that daily infections are dropping and vaccines are reaching more people, but the risk remains that critical care may have to be triaged if this positive trend reverses, if there’s new variants or if there’s a fourth wave,” said David Lepofsky, who leads the non-partisan AODA Alliance, which campaigns for accessibility for people with disabilities, including in the health care system. “The public has a right to know exactly what instructions have been given to ICU hospital staff and ambulance crews on who lives and who dies, if critical care triage becomes necessary. The public also has a right to know who is making these life-and-death decisions for the Government, and that is what my Freedom of Information application aims to unearth.”

This Freedom of Information application is necessary because the Ford Government has refused to answer any of the nine detailed and well-researched letters that the AODA Alliance has sent over the past eight months to Health Minister Christine Elliott, including the AODA Alliance’s September 25, 2020 letter, its November 2, 2020 letter, its November 9, 2020 letter, its December 7, 2020 letter, its December 15, 2020 letter, its December 17, 2020 letter, its January 18, 2021 letter, its February 25, 2021 letter and its April 27, 2021 letter. It has refused to directly consult with the AODA Alliance or other disability advocates on this issue, hiding behind its external Bioethics Table, an advisory body that makes no decisions on this issue.

“If you want to see the January 13, 2021 Critical Care Triage Protocol, you won’t find it on a Government website. You will only find a leaked copy on the AODA Alliance website. We have no idea whether it has been changed since we got a leaked copy back in January,” said Lepofsky. “While critical care triage has not been publicly launched, Ontario hospitals have been doing practice drills behind closed doors using the Government’s secret instructions.”

The AODA Alliance, other disability groups and the Ontario Human Rights Commission have raised serious objections to disability discrimination in those parts of Ontario’s critical care triage plans that have been leaked to the public. When the Government is confronted with these concerns, it deflects inquiries to doctors, rather than publicly owning up to the critical care triage plans that are being readied under the Ford Government’s auspices.

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

For more background on this issue, check out:

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

2. The AODA Alliance’s captioned new online video detailing the disability discrimination in Ontario’s critical care triage protocol.

3. The May 7, 2021 guest column by AODA Alliance Chair David Lepofsky in the Toronto Star and

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

Excerpt from the May 18, 2021 Freedom of Information application by AODA Alliance Chair David Lepofsky

1. A record or records from on or after January 1, 2021 (including draft instructions or directions that have not yet been approved or activated) that directs hospitals and/or physicians in hospitals on how and/or when to conduct triage or rationing of critical care including refusing critical care to a patient needing critical care, including but not limited to any document purporting to set out an “Emergency Standard of Care” in relation to critical care. This includes any protocols or directions, draft or final, in relation to patients age 18 or older as well as any such directions or instructions, draft or otherwise, that relate to patients under the age of 18.

2. A record or records dated on or after March 28, 2020 to ambulance services, ambulance crews, emergency medical technicians or other emergency patient transportation services, that directs (or includes draft directions that have not yet been activated or approved) emergency transportation staff on how or when to conduct triage or rationing of critical care in which critical care may be refused to patients needing critical care, including but not limited to any document purporting to set out an “Emergency Standard of Care” in relation to critical care.

3. Any document or documents that include any or all of the following:

a) Membership of the Critical care COVID Command Centre

b) the Mandate and or assigned responsibilities of the Critical Care COVID Command Centre

c) Any instructions since January 1, 2021 from or on behalf of the Critical care COVID Command Centre, in addition to those documents requested in paragraphs 1 or 2 above, to hospitals/and/or doctors, and/or ambulance crews or emergency medical technicians or emergency patient transportation services and/or any other health care professionals, on how and/or when to conduct any form of critical care triage so as to decline to provide critical care to a patient who needs critical care (including draft directions or instructions that have not yet been activated or approved).

4. Any correspondence between the Ministry of Health and/or Ontario health and/or the Critical Care COVID Command Centre on the one hand, and the College of Physicians and Surgeons of Ontario (CPSO) on the other, dated September 11, 2020 or afterwards, on the topic of critical care triage and how and/or when critical care triage is to be conducted.

5. Any document from September 11, 2020 and afterwards setting out plans or options or draft plans (whether or not they have been activated, approved or implemented) for legalizing, permitting or directing hospitals and/or physicians to withdraw critical care from a patient who needs critical care and does not consent to the withdrawal of critical care.




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Disability Rights Advocate Resorts to Freedom of Information Application to Unearth the Ford Government’s Secret Plans for Critical Care Triage if Overcrowded Hospitals Can’t Serve All Critically-Ill Patients


ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE

NEWS RELEASE – FOR IMMEDIATE RELEASE

Disability Rights Advocate Resorts to Freedom of Information Application to Unearth the Ford Government’s Secret Plans for Critical Care Triage if Overcrowded Hospitals Can’t Serve All Critically-Ill Patients

May 20, 2021 Toronto: To Mark today, Global Accessibility Awareness Day, the AODA Alliance makes public a Freedom of Information application by its chair, David Lepofsky, filed to finally enable the public to see the Ford Government’s secret plans for critical care triage. Since the pandemic began over 14 months ago, the Ford Government has kept a tight lid on its critical care triage plans. This new Freedom of Information application tries to drag into public light The Government’s plans on this life-and-death issue. (Key excerpt from the Freedom of Information application set out below).

“It’s great that daily infections are dropping and vaccines are reaching more people, but the risk remains that critical care may have to be triaged if this positive trend reverses, if there’s new variants or if there’s a fourth wave,” said David Lepofsky, who leads the non-partisan AODA Alliance, which campaigns for accessibility for people with disabilities, including in the health care system. “The public has a right to know exactly what instructions have been given to ICU hospital staff and ambulance crews on who lives and who dies, if critical care triage becomes necessary. The public also has a right to know who is making these life-and-death decisions for the Government, and that is what my Freedom of Information application aims to unearth.”

This Freedom of Information application is necessary because the Ford Government has refused to answer any of the nine detailed and well-researched letters that the AODA Alliance has sent over the past eight months to Health Minister Christine Elliott, including the AODA Alliance‘s September 25, 2020 letter, its November 2, 2020 letter, its November 9, 2020 letter, its December 7, 2020 letter, its December 15, 2020 letter, its December 17, 2020 letter, its January 18, 2021 letter, its February 25, 2021 letter and its April 27, 2021 letter. It has refused to directly consult with the AODA Alliance or other disability advocates on this issue, hiding behind its external Bioethics Table, an advisory body that makes no decisions on this issue.

“If you want to see the January 13, 2021 Critical Care Triage Protocol, you won’t find it on a Government website. You will only find a leaked copy on the AODA Alliance website. We have no idea whether it has been changed since we got a leaked copy back in January,” said Lepofsky. “While critical care triage has not been publicly launched, Ontario hospitals have been doing practice drills behind closed doors using the Government’s secret instructions.”

The AODA Alliance, other disability groups and the Ontario Human Rights Commission have raised serious objections to disability discrimination in those parts of Ontario’s critical care triage plans that have been leaked to the public. When the Government is confronted with these concerns, it deflects inquiries to doctors, rather than publicly owning up to the critical care triage plans that are being readied under the Ford Government’s auspices.

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

For more background on this issue, check out:

  1. The AODA Alliance’s February 25, 2021 independent report on Ontario’s plans for critical care triage if hospitals are overwhelmed by patients needing critical care,
  1. The AODA Alliance’s captioned new online video detailing the disability discrimination in Ontario’s critical care triage protocol.
  1. The May 7, 2021 guest column by AODA Alliance Chair David Lepofsky in the Toronto Star and
  1. The AODA Alliance website’s health care page, detailing its efforts to tear down barriers in the health care system facing patients with disabilities, and its COVID-19 page, detailing its efforts to address the needs of people with disabilities during the COVID pandemic

Excerpt from the May 18, 2021 Freedom of Information application by AODA Alliance Chair David Lepofsky

  1. A record or records from on or after January 1, 2021 (including draft instructions or directions that have not yet been approved or activated) that directs hospitals and/or physicians in hospitals on how and/or when to conduct triage or rationing of critical care including refusing critical care to a patient needing critical care, including but not limited to any document purporting to set out an “Emergency Standard of Care” in relation to critical care. This includes any protocols or directions, draft or final, in relation to patients age 18 or older as well as any such directions or instructions, draft or otherwise, that relate to patients under the age of 18.
  1. A record or records dated on or after March 28, 2020 to ambulance services, ambulance crews, emergency medical technicians or other emergency patient transportation services, that directs (or includes draft directions that have not yet been activated or approved) emergency transportation staff on how or when to conduct triage or rationing of critical care in which critical care may be refused to patients needing critical care, including but not limited to any document purporting to set out an “Emergency Standard of Care” in relation to critical care.
  1. Any document or documents that include any or all of the following:
  1. a) Membership of the Critical care COVID Command Centre
  1. b) the Mandate and or assigned responsibilities of the Critical Care COVID Command Centre
  1. c) Any instructions since January 1, 2021 from or on behalf of the Critical care COVID Command Centre, in addition to those documents requested in paragraphs 1 or 2 above, to hospitals/and/or doctors, and/or ambulance crews or emergency medical technicians or emergency patient transportation services and/or any other health care professionals, on how and/or when to conduct any form of critical care triage so as to decline to provide critical care to a patient who needs critical care (including draft directions or instructions that have not yet been activated or approved).
  1. Any correspondence between the Ministry of Health and/or Ontario health and/or the Critical Care COVID Command Centre on the one hand, and the College of Physicians and Surgeons of Ontario (CPSO) on the other, dated September 11, 2020 or afterwards, on the topic of critical care triage and how and/or when critical care triage is to be conducted.
  1. Any document from September 11, 2020 and afterwards setting out plans or options or draft plans (whether or not they have been activated, approved or implemented) for legalizing, permitting or directing hospitals and/or physicians to withdraw critical care from a patient who needs critical care and does not consent to the withdrawal of critical care.



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Ontario is Not Out of the Woods When It Comes to the Danger of Disability Discrimination in Critical Care Triage – AODA Alliance


Accessibility for Ontarians with Disabilities Act Alliance Update

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

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

Ontario is Not Out of the Woods When It Comes to the Danger of Disability Discrimination in Critical Care Triage

May 19, 2021

            SUMMARY

It is very good that new daily COVID-19 infection rates are dropping and that more and more people are getting vaccinated. This makes it less likely that Ontario must resort to critical care triage in the immediate future.

However, disability discrimination in critical care triage remains a critical issue (pun intended). We have learned that things can take a turn for the worse very rapidly. With new COVID-19 variants, there is a risk of a later fourth surge. As well, emergency and ambulance crews may well be engaging in critical care triage right now, with no public accountability for it.

We know that behind closed doors, Ontario hospitals have been training their staffs to make critical care triage decisions. They are using the disability-discriminatory January 13, 2021 Critical Care Triage Protocol in that training. As such, disability discrimination is getting more and more embedded in our health care system, all publicly financed.

We will continue bringing these issues to the public’s and media’s attention. Here is the latest news on this issue.

 1. Urge Doctors, Nurses, Ambulance Crews and Hospital Administrators You Know to Watch the AODA Alliance’s Informative New Captioned Video on Disability Discrimination Problems with Ontario’s Critical care Triage Protocol

Do you know any doctors, nurses or others who work in hospital emergency rooms or intensive care units (ICUs)? Do you know any hospital administrators or people who work as part of ambulance crews?

Please encourage them all to watch the AODA Alliance’s new captioned video that explains the serious disability discrimination problems with Ontario’s critical care triage protocol. Those health care staff may have gotten some training on that protocol. We fear they are getting no training on the disability discrimination that permeates it.

We also recommend that you ask your family doctor to watch this video. If you end up in hospital, and if critical care triage is going on, you will want your doctor to help advocate for you in the face of the critical care triage protocol’s disability discrimination.

If you have not seen it, we invite you to also watch this video. This video is available for one and all at https://youtu.be/Ju8cyH7TbQo Hundreds have watched it in the two weeks since it was publicly posted. We’ve gotten very positive feedback about it. Please help us reach those on the front lines of Ontario’s health care system.. We believe that they won’t want to be engaging in any disability discrimination, and will wanted to be forewarned about it.

 2. Media Shines Much-Needed Spotlight on the Ford Government’s Relentless Secrecy over Its Critical Care Triage Plans

The Ford Government’s relentless secrecy still persists when it comes to its critical care triage protocol and plans. No doubt, senior Government officials think that the recent drop in new daily COVID infections and ICU occupancy means this whole issue may go away without them having to face public scrutiny for their disability discriminatory critical care triage plans. If so, we beg to differ.

Below we set out an excellent report in the May 6, 2021 edition of the online publication Press Progress. It reports on this protracted Government secrecy, and on criticism of it from the disability community and the Ontario Human Rights Commission.

This article reports on the fact that we and some others from the disability community have had a chance, months ago, to speak to the Ontario Government-appointed advisory Bioethics Table. We emphasize that that Table does not make any decisions in this area. It only gives advice. We don’t know what happens with that advice once the Bioethics Table gives it.

We don’t know what the Bioethics Table has advised the Government at any time after September 11, 2020. We don’t have any proof that the Bioethics Table ever reviewed and advised on the January 13, 2021 Critical Care Triage Protocol itself, or if it did, whether the Government accepted and implemented that advice. It is all shielded behind the Government-created fog of secrecy.

In this article, the argument is made that among other things, we need clarity on the Government’s critical care triage plans. We add that people with disabilities need much, much more than clarity about those plans. We have utter clarity that these plans are replete with disability discrimination. We need that disability discrimination removed.

In sharp contrast to Ontario’s paternalistic secrecy over its critical care triage protocol and plans, the media has reported that Alberta has made public its critical care triage protocol. We set out below an Edmonton Journal news report on this. We have not had an opportunity to review the Alberta critical care triage protocol and cannot comment on its contents.

 3. A Unique Chance to Read the Ford Government’s Talking Points For Defending Its Disability Discriminatory Critical Care Triage Protocol

The Ford Government’s strategy for several months has been to avoid saying anything about Ontario’s critical care triage protocol and plans wherever possible. When the media asks the Ford Government questions in this area, and if the Government responds at all, it typically deflects media questions to doctors. The doctor who seems to be very often the person to whom the Ford Government points, and who is in effect serving as the Government’s spokesperson, is Dr. James Downar. Dr. Downar has often been identified as the author or co-author of the January 13, 2021 Critical Care Triage Protocol. He is also a member of the Government-appointed advisory Bioethics Table.

Below we set out a statement which Dr. Downar has sent to a media outlet in response to a media inquiry. We offer these reflections on it:

  1. a) Dr. Downar’s response is similar to or the same as other quotations attributed to him that we have seen in other media reports. It reads like it is a set response.
  1. b) This statement reads like it could have been carefully written or vetted by someone within Ford Government. It has the flavour of a Government-drafted or Government-approved communications document.
  1. c) Dr. Downar’s statement is demonstrably inaccurate and misleading on important points. It is misleading where it talks about consultations being ongoing. We have repeatedly sought chances to get the Government to consult us on this issue. We have been very public about the fact that the Government has refused to do so.

This statement is also inaccurate and misleading where it seeks to claim that disability discrimination plays no part in the Ontario critical care triage protocol. Contrary to what this statement claims, the January 13, 2021 Critical Care Triage Protocol explicitly directs that a patient’s disability IS a factor that in some cases is to be weighed AGAINST their getting access to the life-saving critical care they need, if Ontario has more patients needing critical care than it has critical care beds and supports.

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

This statement tries to defend Ontario’s critical care triage protocol by arguing that it does not make the Clinical Frailty Scale (which we have shown to be disability-discriminatory) because, among other things it does not apply that tool to assessing patients with a stable disability. As we have publicly emphasized, this is no defence. You cannot justify discriminating against some people with disabilities, e.g. those with progressive disabilities, by pleading that you don’t also discriminate against those with stable non-progressive disabilities. In the same way, you cannot defend discrimination against Muslims by pleading that you don’t also discriminate against Catholics.

It is deeply troubling that the Government’s defender keeps repeating these bogus arguments long after we have shown them to be so obviously incorrect. The Government has certainly not disavowed these statements that are made in its defence.

 4. The Call for the Ontario Government to Remove the Disability Discrimination from Its Critical Care Triage Protocol Has Come From the Trade Union Sector

Below we set out a recent public statement by the Canadian Union of Public Employees CUPE Ontario echoing our concerns about Ontario’s critical care triage protocol and plans. We welcome support from any and all parts of our society.

 5. Delay and Delay and Delay

There have now been 839 days, or over 2 and a third years, since the Ford Government received the ground-breaking final report of the Independent Review of the implementation of the Accessibility for Ontarians with Disabilities Act by former Ontario Lieutenant Governor David Onley. The Government has announced no effective plan of new action to implement that report. That makes even worse the serious problems facing Ontarians with disabilities during the COVID-19 crisis. The Ontario Government only has 1,323 days left until 2025, the deadline by which the Government must have led Ontario to become fully accessible to people with disabilities.

            MORE DETAILS

 Press Progress May 6, 2021

Originally posted at https://pressprogress.ca/disability-groups-say-ontario-government-did-not-consult-them-on-life-and-death-covid-19-triage-decisions/

Disability Groups Say Ontario Government Did Not Consult Them on Life and Death COVID-19 ‘Triage’ Decisions

Ontario Human Rights Commission Chief Commissioner says vulnerable groups deserve certainty on ’life and death triage decisions’

by PressProgress

May 6, 2021

Ontario Health Minister Christine Elliott promised to involve disability advocates in the drafting of possible “triage protocols” to decide who may be health denied care should hospitals be overwhelmed.

But the province’s major disability advocacy groups say they haven’t been consulted by the Ministry on the current drafts. They worry those drafts could be discriminatory and that they could be implemented on short notice.

According to The Globe and Mail, hospitals across Toronto were practicing triage protocols to reserve Intensive Care Unit (ICU) beds for those most likely to survive, through last week.

Draft triage protocols, which were sent to hospitals on January 13, have not been finalized according to Ontario’s Health Minister. But the drafts’ emphasis on testing patients’ abilities to live “without assistance” — to weigh whether care should be allocated — has many advocates for people with disabilities worried.

On April 21, Ontario Health Minister Christine Elliott told the legislative assembly:

“I asked that this issue be dealt with—with the people with disabilities groups as well as with the Ontario Human Rights Commission. There have been numerous discussions, but nothing has been activated yet, and I can assure you that nothing has been approved at this point.”

Lawyer and AODA alliance chair David Lepofsky says the January 13 draft protocols discriminate against certain disabled people by ranking patients based on their ability to conduct Instrumental Activities Of Daily Living.

“For a person with cancer they look explicitly at whether a person is disabled and can’t get out of bed or less,” Lepofsky told PressProgress. “If it’s a person over 65 with a progressive disease it asks if they can do 11 Activities of Daily Living — getting up, shopping, eating, using the phone, doing your finances — without assistance. If not, you rank lower.”

“That’s disability.”

Yet, Lepofsky said he hasn’t been able to discuss the organization’s concerns with the minister or ministry representatives. “The only consulting that’s gone on at all is a body external to the government called the Bioethics Table. Our consultations with them were last summer — ending August 31 — and then one meeting virtually on December 17. Many of us said we needed more time and needed to prepare.”

Since the draft was leaked, on January 13, Lepofsky said the group has received no further contact.

Ontario Human Rights Commission Chief Commissioner Ena Chadha told PressProgress the OHRC has been telling the government for over a year it needs to consult with concerned advocates for people with disabilities on any triage protocol. Chadha said that wasn’t done.

While an advisory body, the Bioethics Table, consulted some affected groups ahead of the January 13 drafts, since December 2020, Chadha said no other notable consultations appear to have followed. “Since then human rights experts, and vulnerable groups disproportionately impacted by the COVID-19 pandemic, including people with disabilities, older persons, Indigenous peoples and racialized communities, have not been consulted on these latest protocols.”

“They have a right to clarity and certainty on how life and death triage decisions would affect them. Health care practitioners who would be compelled to make these difficult decisions deserve the same clarity and certainty,” Chadha said.

“Human rights groups are concerned that, despite the Minister’s expressed comments, the reality on the ground will be that the Emergency Standard of Care document circulated to hospitals in January will be used anyway out of necessity.”

On April 28, the Ontario Medical Association hosted a panel featuring Peel Region Medical Officer Lawrence Loh and OMA head Samantha Hill titled Making Difficult Decisions During the Pandemic. Included on the agenda was “Who should be ventilated if resources are limited?”

A spokesperson for the OMA confirmed the discussion was “focusing on existing guidelines” as per the January 13 proposals from Critical Care Services.

“We were sent notice that the triage protocol could be initiated within days,” a doctor at Markham Stouffville hospital told PressProgress. “They’ve been talking about this for sometime. I can’t believe I and my colleagues will be asked to make life and death decisions for people.”

Further, an early May memo obtained by the Globe from Ontario’s “critical care command centre”signalled the health system had plans to utilize the existing drafts. The memo noted, cautiously, that recent increases in capacity may mean “we will not need to activate the Emergency Standard of Care or recommend the use of the triage protocol.”

Community Living CEO Chris Beesley said his organization has been frustrated by a lack of communication from Ontario’s Ministry of Health.

“Since last Spring, we’ve been working with a coalition of disability focused organizations, to try and get some transparency on the triage protocol,” Beesley told PressProgress.

However, Beesley said, “Neither Minister Elliott nor anyone from her staff had communicated with us since last July.”

Arch Disability Law Centre lawyer Mariam Shanouda also told PressProgress “We have never been consulted by the Ministry of Health.”

“We have met several times now with the Bioethics Table which is a Table that was struck by the Ministry to advise them on the Triage Protocol. The last time we were invited to meet with the Bioethics Table was in December 2020, which is especially concerning since the latest version of the Triage Protocol is dated January 13, 2021,” Shanouda said. The organization said it has not been consulted since.

Six members of Ontario’s Bioethics Table additionally warned April 15 that “without public discussion, the vulnerability of already marginalized groups is intensified and trust eroded.”

PressProgress contacted Critical Care Services to respond to concerns advocates had that the consultations were insufficient and the draft it sent out could be discriminatory. CCSO referred PressProgress to Bioethics table member Dr. James Downar, who, CBC News reports, wrote the January 13 drafts.

Dr. Downar told PressProgress:

“The Emergency Standard of Care is a contingency plan to be used as an option of last resort. It was based on recommendations that were developed by the Ontario COVID-19 Bioethics table, which conducted extensive consultations with multiple stakeholders including disability advocates and the Ontario Human Rights Commission. The consultations are continuing, and the process of generating, reviewing and updating any triage plan should always be an ongoing process, responding to changing conditions, emerging evidence and an evolving understanding of the ethical, social and legal implications.”

Ontario’s Ministry of Health did not respond to requests for comment from PressProgress.

On April 27, the Ministry called for special medical assistance from Canada’s armed forces as hospitals face a surge in COVID-19 ICU patients.”

PressProgress

PressProgress is an award-winning non-profit news organization focused on uncovering and unpacking the news through original investigative and explanatory journalism.

@pressprogress

PressProgress is a news division of the Broadbent Institute

 Written Statement in April 2021 to News Outlet by Dr. James Downar in Response to Media Inquiry Regarding Critical Care Triage Protocol

  1. Critical care triage has not yet been initiated anywhere in Ontario. The focus of the critical care community is on building capacity to see us through this surge.
  2. The Emergency Standard of Care is a contingency plan to be used as an option of last resort. It was based on recommendations that were developed by the Ontario COVID-19 Bioethics table, which conducted extensive consultations with multiple stakeholders including disability advocates and the Ontario Human Rights Commission. The consultations are continuing, and the process of generating, reviewing and updating any triage plan should always be an ongoing process, responding to changing conditions, emerging evidence and an evolving understanding of the ethical, social and legal implications.
  3. The only criterion used to prioritize critical care would be short-term mortality risk. This is always based on an individualized assessment, and clinical guidance is provided to help assess risk in people depending on their medical condition. But assessment tools should only be used in situations where they help indicate mortality risk, and with respect to disabilities, there are clear and explicit instructions not to use the Clinical Frailty Scale for people under the age of 65, or for anyone with chronic, stable disabilities or other conditions where it would not indicate mortality risk. For other conditions, mortality risk can be determined without any assessment of function. In other words, people with identical disabilities would be prioritized very differently if their mortality risks were different, and people with no disabilities at all receive a lower priority if their mortality risk is high. The focus is squarely on mortality risk, not ability or function. This is very important.”

 Edmonton Journal April 30, 2021

Originally posted at https://edmontonjournal.com/news/local-news/ahs-releases-triage-protocol-outlining-which-patients-would-receive-care-if-icus-become-overwhelmed-by-covid-19

AHS releases triage protocol outlining which patients would receive care if ICUs become overwhelmed by COVID-19

Author of the article: Anna Junker

The Royal Alexandra Hospital is pictured in Edmonton. The hospital’s ICU unit has seen COVID-19 surges during the pandemic. PHOTO BY SHAUGHN BUTTS /Postmedia, file

Alberta Health Services has released a triage plan for determining who will receive critical care in the event that COVID-19 patients outnumber available ICU beds in the province.

The 50-page Critical Care Triage plan, unveiled Friday, would not be activated until the health authority has exhausted all other options, such as transferring patients, health-care staff, equipment and medication between different hospitals in the same health zone or across the province. It would be implemented based on direction from the AHS CEO, in consultation with the executive leadership team.

“When activated the triage protocol will be utilized in all health-care facilities and critical care units in Alberta to prioritize patients who have the greatest likelihood of overall survival,” the report states.

The plan lays out four “pandemic or disaster” stages, which would determine whether triaging is necessary.

In a “minor surge,” the number of patients requiring critical care would exceed resources. As a result, staff may be pulled from other critical care units to help with care and patients may be moved into recovery rooms.

A “moderate surge” would see staff brought in from other areas of hospitals and patients moved to recovery rooms or subspecialty ICUs. Transfers for patients in emergency departments would be delayed.

Triaging may be required in a “major surge,” which would occur when 90 per cent or more of available ICU beds in the province are occupied. The first phase of triaging would only allow patients who are predicted to have more than 20 per cent likelihood of surviving one year to enter the ICU.

A “large-scale surge” would see 95 per cent or more of available ICUs in the province occupied and could see the second phase of triaging activated. Under that scenario, those with a 50 per cent chance of surviving one year would be admitted to the ICU. Pediatric triaging will be considered.

“Information about a patient’s underlying illness, disease, or disability will not be taken into consideration unless they directly impact a patient’s likelihood of surviving the next year,” the report states.

Decisions for critical care eligibility will not include a person’s age, sex, socioeconomic status, race, disability, employment status, or the cost of future care. Once a decision has been made on who gets care, it cannot be appealed by the patient or family.

Alberta has the capacity to fully staff 425 ICU beds for COVID-19 and non-COVID-19 patients. As of Friday, there are 152 COVID-19 patients in the ICU – the highest since the beginning of the pandemic.

Kerry Williamson, spokesman for AHS, said in a statement the Edmonton Zone currently has 102 ICU beds open — a base of 72 general adult beds and an additional 30 spaces.

This week, the Edmonton Zone was between 86 and 88 per cent capacity for all ICU beds.

‘I just can’t imagine’

Dr. Noel Gibney, co-chair of the Strategic COVID-19 Pandemic Committee for the Edmonton Zone, said the triage plan is well-developed, but it is not a situation to ever want to be in.

“I just can’t imagine, explaining to the patients or their families why these individuals are not going to get the care that they need,” Gibney said. “I can’t imagine doing that day after day after day, or multiple times in the day. I mean that the moral distress associated with that would be extreme.”

He said the postponement of surgeries and release of the triage protocol suggests AHS is extremely worried about a “disaster-type situation.”

Gibney said the public health restrictions that are currently in place are “absolutely not” enough, and warned that the protocol could need to be activated this month.

“I get the sense that the government has some notion that they may be able to just vaccinate the province out of trouble this time. But we’re not going to do that,” Gibney said.

“We’re in a situation where modelling shows that in about three weeks, so that by May 22, we will be at a point where we may reach Phase 1 of the pandemic triage protocol.”

He said the province needs to implement a strict lockdown and use the same health measures that were in place last April – moving all schooling online, limiting retail to essential-only, closing non health-related personal services like hair and nail salons, severely limiting or close places of worship, and closing patios.

Adequate sick pay also needs to be implemented, he said.

“Some of the components of what the government has been doing with targeted vaccinations, I think that’s great, but it simply isn’t going to be enough in time to get us out of that danger that we’re in,” Gibney said.

[email protected]

Twitter.com/JunkerAnna

 Financial Post May 12, 2021

f

Originally posted at https://financialpost.com/pmn/press-releases-pmn/business-wire-news-releases-pmn/theres-no-room-for-discrimination-against-people-with-disabilities-cupe-ontario-and-joel-harden-call-for-consultation-and-revision-of-triage-protocol

Press Releases Business Wire News Releases

“There’s No Room for Discrimination Against People With Disabilities”: CUPE Ontario and Joel Harden Call for Consultation and Revision of Triage Protocol

Author of the article: Business Wire

Business Wire

Publishing date: May 12, 2021 • 23 hours ago • 2 minute read • Join the conversation

TORONTO — The Ontario Government’s draft plan to ration access to at-capacity critical-care is discriminatory and must be revised immediately, said the Canadian Union of Public Employees (CUPE) Ontario and Joel Harden, NDP MPP for Ottawa Centre and the Critic for Accessibility & Persons with Disabilities.

“The fact that the draft plan says that doctors will look at your short-term mortality risk or your capacity for self-care to decide if you get access to limited intensive care units is nothing more than blatant discrimination against people with disabilities,” said Fred Hahn, President of CUPE Ontario. “This dangerously violates the foundational rights of Ontarians our members care for and the rights of many of our members themselves.”

While Health Minister Christine Elliott recently said that Ontario may not need to resort to rationing, due to reduced demand for ICUs, concerns raised by CUPE Ontario, the Ontario Human Rights Commission (OHRC), disability organizations, and the six bioethicists on the government’s advisory Bioethics Table remain.

“I’m not reassured by that at all,” said Michele Gardner, member of CUPE Ontario’s Workers with Disabilities Committee. “This discriminatory triage protocol can still be used at any time. It makes it clear that people with disabilities are at risk of not getting the critical-care they need because of explicitly biased criteria.”

“The protocol must be revised to remove any discrimination and we must be consulted moving forward,” added Gardner. “The OHRC has raised the problem of lack of consultation, and so have the six members of the bioethics table, who rightly said that without it this government is only intensifying the vulnerability of people with disabilities.”

“More than a year has passed since over 200 community organizations wrote to the Ford government urging it to remove disability discrimination from its triage protocol. The response so far has been silence,” said Harden. “It’s time to stop the secrecy surrounding critical care triage and for the Ford government to remove disability discrimination from its protocol.”

Contacts

Daniel Tseghay

Communications Representative, CUPE

[email protected]





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Ontario is Not Out of the Woods When It Comes to the Danger of Disability Discrimination in Critical Care Triage


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/

May 19, 2021

SUMMARY

It is very good that new daily COVID-19 infection rates are dropping and that more and more people are getting vaccinated. This makes it less likely that Ontario must resort to critical care triage in the immediate future.

However, disability discrimination in critical care triage remains a critical issue (pun intended). We have learned that things can take a turn for the worse very rapidly. With new COVID-19 variants, there is a risk of a later fourth surge. As well, emergency and ambulance crews may well be engaging in critical care triage right now, with no public accountability for it.

We know that behind closed doors, Ontario hospitals have been training their staffs to make critical care triage decisions. They are using the disability-discriminatory January 13, 2021 Critical Care Triage Protocol in that training. As such, disability discrimination is getting more and more embedded in our health care system, all publicly financed.

We will continue bringing these issues to the publics and medias attention. Here is the latest news on this issue.

1. Urge Doctors, Nurses, Ambulance Crews and Hospital Administrators You Know to Watch the AODA Alliances Informative New Captioned Video on Disability Discrimination Problems with Ontarios Critical care Triage Protocol

Do you know any doctors, nurses or others who work in hospital emergency rooms or intensive care units (ICUs)? Do you know any hospital administrators or people who work as part of ambulance crews?

Please encourage them all to watch the AODA Alliances new captioned video that explains the serious disability discrimination problems with Ontarios critical care triage protocol. Those health care staff may have gotten some training on that protocol. We fear they are getting no training on the disability discrimination that permeates it.

We also recommend that you ask your family doctor to watch this video. If you end up in hospital, and if critical care triage is going on, you will want your doctor to help advocate for you in the face of the critical care triage protocols disability discrimination.

If you have not seen it, we invite you to also watch this video. This video is available for one and all at https://youtu.be/Ju8cyH7TbQo Hundreds have watched it in the two weeks since it was publicly posted. Weve gotten very positive feedback about it. Please help us reach those on the front lines of Ontarios health care system.. We believe that they wont want to be engaging in any disability discrimination, and will wanted to be forewarned about it.

2. Media Shines Much-Needed Spotlight on the Ford Governments Relentless Secrecy over Its Critical Care Triage Plans

The Ford Governments relentless secrecy still persists when it comes to its critical care triage protocol and plans. No doubt, senior Government officials think that the recent drop in new daily COVID infections and ICU occupancy means this whole issue may go away without them having to face public scrutiny for their disability discriminatory critical care triage plans. If so, we beg to differ.

Below we set out an excellent report in the May 6, 2021 edition of the online publication Press Progress. It reports on this protracted Government secrecy, and on criticism of it from the disability community and the Ontario Human Rights Commission.

This article reports on the fact that we and some others from the disability community have had a chance, months ago, to speak to the Ontario Government-appointed advisory Bioethics Table. We emphasize that that Table does not make any decisions in this area. It only gives advice. We dont know what happens with that advice once the Bioethics Table gives it.

We dont know what the Bioethics Table has advised the Government at any time after September 11, 2020. We dont have any proof that the Bioethics Table ever reviewed and advised on the January 13, 2021 Critical Care Triage Protocol itself, or if it did, whether the Government accepted and implemented that advice. It is all shielded behind the Government-created fog of secrecy.

In this article, the argument is made that among other things, we need clarity on the Governments critical care triage plans. We add that people with disabilities need much, much more than clarity about those plans. We have utter clarity that these plans are replete with disability discrimination. We need that disability discrimination removed.

In sharp contrast to Ontarios paternalistic secrecy over its critical care triage protocol and plans, the media has reported that Alberta has made public its critical care triage protocol. We set out below an Edmonton Journal news report on this. We have not had an opportunity to review the Alberta critical care triage protocol and cannot comment on its contents.

3. A Unique Chance to Read the Ford Governments Talking Points For Defending Its Disability Discriminatory Critical Care Triage Protocol

The Ford Governments strategy for several months has been to avoid saying anything about Ontarios critical care triage protocol and plans wherever possible. When the media asks the Ford Government questions in this area, and if the Government responds at all, it typically deflects media questions to doctors. The doctor who seems to be very often the person to whom the Ford Government points, and who is in effect serving as the Governments spokesperson, is Dr. James Downar. Dr. Downar has often been identified as the author or co-author of the January 13, 2021 Critical Care Triage Protocol. He is also a member of the Government-appointed advisory Bioethics Table.

Below we set out a statement which Dr. Downar has sent to a media outlet in response to a media inquiry. We offer these reflections on it:

a) Dr. Downars response is similar to or the same as other quotations attributed to him that we have seen in other media reports. It reads like it is a set response.

b) This statement reads like it could have been carefully written or vetted by someone within Ford Government. It has the flavour of a Government-drafted or Government-approved communications document.

c) Dr. Downars statement is demonstrably inaccurate and misleading on important points. It is misleading where it talks about consultations being ongoing. We have repeatedly sought chances to get the Government to consult us on this issue. We have been very public about the fact that the Government has refused to do so.

This statement is also inaccurate and misleading where it seeks to claim that disability discrimination plays no part in the Ontario critical care triage protocol. Contrary to what this statement claims, the January 13, 2021 Critical Care Triage Protocol explicitly directs that a patients disability IS a factor that in some cases is to be weighed AGAINST their getting access to the life-saving critical care they need, if Ontario has more patients needing critical care than it has critical care beds and supports.

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

This statement tries to defend Ontarios critical care triage protocol by arguing that it does not make the Clinical Frailty Scale (which we have shown to be disability-discriminatory) because, among other things it does not apply that tool to assessing patients with a stable disability. As we have publicly emphasized, this is no defence. You cannot justify discriminating against some people with disabilities, e.g. those with progressive disabilities, by pleading that you dont also discriminate against those with stable non-progressive disabilities. In the same way, you cannot defend discrimination against Muslims by pleading that you dont also discriminate against Catholics.

It is deeply troubling that the Governments defender keeps repeating these bogus arguments long after we have shown them to be so obviously incorrect. The Government has certainly not disavowed these statements that are made in its defence.

4. The Call for the Ontario Government to Remove the Disability Discrimination from Its Critical Care Triage Protocol Has Come From the Trade Union Sector

Below we set out a recent public statement by the Canadian Union of Public Employees CUPE Ontario echoing our concerns about Ontarios critical care triage protocol and plans. We welcome support from any and all parts of our society.

5. Delay and Delay and Delay

There have now been 839 days, or over 2 and a third years, since the Ford Government received the ground-breaking final report of the Independent Review of the implementation of the Accessibility for Ontarians with Disabilities Act by former Ontario Lieutenant Governor David Onley. The Government has announced no effective plan of new action to implement that report. That makes even worse the serious problems facing Ontarians with disabilities during the COVID-19 crisis. The Ontario Government only has 1,323 days left until 2025, the deadline by which the Government must have led Ontario to become fully accessible to people with disabilities.

MORE DETAILS

Press Progress May 6, 2021

Originally posted at https://pressprogress.ca/disability-groups-say-ontario-government-did-not-consult-them-on-life-and-death-covid-19-triage-decisions/ Disability Groups Say Ontario Government Did Not Consult Them on Life and Death COVID-19 Triage Decisions
Ontario Human Rights Commission Chief Commissioner says vulnerable groups deserve certainty on life and death triage decisions

by PressProgress
May 6, 2021
Ontario Health Minister Christine Elliott promised to involve disability advocates in the drafting of possible triage protocols to decide who may be health denied care should hospitals be overwhelmed.

But the provinces major disability advocacy groups say they havent been consulted by the Ministry on the current drafts. They worry those drafts could be discriminatory and that they could be implemented on short notice.

According to The Globe and Mail, hospitals across Toronto were practicing triage protocols to reserve Intensive Care Unit (ICU) beds for those most likely to survive, through last week.

Draft triage protocols, which were sent to hospitals on January 13, have not been finalized according to Ontarios Health Minister. But the drafts emphasis on testing patients abilities to live without assistance to weigh whether care should be allocated has many advocates for people with disabilities worried.

On April 21, Ontario Health Minister Christine Elliott told the legislative assembly:

I asked that this issue be dealt withwith the people with disabilities groups as well as with the Ontario Human Rights Commission. There have been numerous discussions, but nothing has been activated yet, and I can assure you that nothing has been approved at this point.

Lawyer and AODA alliance chair David Lepofsky says the January 13 draft protocols discriminate against certain disabled people by ranking patients based on their ability to conduct Instrumental Activities Of Daily Living.

For a person with cancer they look explicitly at whether a person is disabled and cant get out of bed or less, Lepofsky told PressProgress. If its a person over 65 with a progressive disease it asks if they can do 11 Activities of Daily Living getting up, shopping, eating, using the phone, doing your finances without assistance. If not, you rank lower.

Thats disability.

Yet, Lepofsky said he hasnt been able to discuss the organizations concerns with the minister or ministry representatives. The only consulting thats gone on at all is a body external to the government called the Bioethics Table. Our consultations with them were last summer ending August 31 and then one meeting virtually on December 17. Many of us said we needed more time and needed to prepare.

Since the draft was leaked, on January 13, Lepofsky said the group has received no further contact.

Ontario Human Rights Commission Chief Commissioner Ena Chadha told PressProgress the OHRC has been telling the government for over a year it needs to consult with concerned advocates for people with disabilities on any triage protocol. Chadha said that wasnt done.

While an advisory body, the Bioethics Table, consulted some affected groups ahead of the January 13 drafts, since December 2020, Chadha said no other notable consultations appear to have followed. Since then human rights experts, and vulnerable groups disproportionately impacted by the COVID-19 pandemic, including people with disabilities, older persons, Indigenous peoples and racialized communities, have not been consulted on these latest protocols.

They have a right to clarity and certainty on how life and death triage decisions would affect them. Health care practitioners who would be compelled to make these difficult decisions deserve the same clarity and certainty, Chadha said.

Human rights groups are concerned that, despite the Ministers expressed comments, the reality on the ground will be that the Emergency Standard of Care document circulated to hospitals in January will be used anyway out of necessity.

On April 28, the Ontario Medical Association hosted a panel featuring Peel Region Medical Officer Lawrence Loh and OMA head Samantha Hill titled Making Difficult Decisions During the Pandemic. Included on the agenda was Who should be ventilated if resources are limited?

A spokesperson for the OMA confirmed the discussion was focusing on existing guidelines as per the January 13 proposals from Critical Care Services.

We were sent notice that the triage protocol could be initiated within days, a doctor at Markham Stouffville hospital told PressProgress. Theyve been talking about this for sometime. I cant believe I and my colleagues will be asked to make life and death decisions for people.

Further, an early May memo obtained by the Globe from Ontarios critical care command centresignalled the health system had plans to utilize the existing drafts. The memo noted, cautiously, that recent increases in capacity may mean we will not need to activate the Emergency Standard of Care or recommend the use of the triage protocol.

Community Living CEO Chris Beesley said his organization has been frustrated by a lack of communication from Ontarios Ministry of Health.

Since last Spring, weve been working with a coalition of disability focused organizations, to try and get some transparency on the triage protocol, Beesley told PressProgress.

However, Beesley said, Neither Minister Elliott nor anyone from her staff had communicated with us since last July.

Arch Disability Law Centre lawyer Mariam Shanouda also told PressProgress We have never been consulted by the Ministry of Health.

We have met several times now with the Bioethics Table which is a Table that was struck by the Ministry to advise them on the Triage Protocol. The last time we were invited to meet with the Bioethics Table was in December 2020, which is especially concerning since the latest version of the Triage Protocol is dated January 13, 2021, Shanouda said. The organization said it has not been consulted since.

Six members of Ontarios Bioethics Table additionally warned April 15 that without public discussion, the vulnerability of already marginalized groups is intensified and trust eroded.

PressProgress contacted Critical Care Services to respond to concerns advocates had that the consultations were insufficient and the draft it sent out could be discriminatory. CCSO referred PressProgress to Bioethics table member Dr. James Downar, who, CBC News reports, wrote the January 13 drafts.

Dr. Downar told PressProgress:

The Emergency Standard of Care is a contingency plan to be used as an option of last resort. It was based on recommendations that were developed by the Ontario COVID-19 Bioethics table, which conducted extensive consultations with multiple stakeholders including disability advocates and the Ontario Human Rights Commission. The consultations are continuing, and the process of generating, reviewing and updating any triage plan should always be an ongoing process, responding to changing conditions, emerging evidence and an evolving understanding of the ethical, social and legal implications.

Ontarios Ministry of Health did not respond to requests for comment from PressProgress.

On April 27, the Ministry called for special medical assistance from Canadas armed forces as hospitals face a surge in COVID-19 ICU patients.

PressProgress
PressProgress is an award-winning non-profit news organization focused on uncovering and unpacking the news through original investigative and explanatory journalism. @pressprogress
PressProgress is a news division of the Broadbent Institute

Written Statement in April 2021 to News Outlet by Dr. James Downar in Response to Media Inquiry Regarding Critical Care Triage Protocol

1. Critical caretriagehas not yet been initiated anywhere in Ontario. The focus of the critical care community is on building capacity to see us through this surge.
2. The Emergency Standard of Care is a contingency plan to be used as an option of last resort. It was based on recommendations that were developed by the Ontario COVID-19 Bioethics table, which conducted extensive consultations with multiple stakeholders including disability advocates and the Ontario Human Rights Commission. The consultations are continuing, and the process of generating, reviewing and updating anytriageplan should always be an ongoing process, responding to changing conditions, emerging evidence and an evolving understanding of the ethical, social and legal implications.
3. The only criterion used to prioritize critical care would be short-term mortality risk. This is always based on an individualized assessment, and clinical guidance is provided to help assess risk in people depending on their medical condition. But assessment tools should only be used in situations where they help indicate mortality risk, and with respect to disabilities, there are clear and explicit instructions not to use the Clinical Frailty Scale for people under the age of 65, or for anyone with chronic, stable disabilities or other conditions where it would not indicate mortality risk. For other conditions, mortality risk can be determined without any assessment of function. In other words, people with identical disabilities would be prioritized very differently if their mortality risks were different, and people with no disabilities at all receive a lower priority if their mortality risk is high. The focus is squarely on mortality risk, not ability or function. This is very important.”

Edmonton Journal April 30, 2021

Originally posted at https://edmontonjournal.com/news/local-news/ahs-releases-triage-protocol-outlining-which-patients-would-receive-care-if-icus-become-overwhelmed-by-covid-19
AHS releases triage protocol outlining which patients would receive care if ICUs become overwhelmed by COVID-19 Author of the article: Anna Junker
The Royal Alexandra Hospital is pictured in Edmonton. The hospital’s ICU unit has seen COVID-19 surges during the pandemic. PHOTO BY SHAUGHN BUTTS /Postmedia, file
Alberta Health Services has released a triage plan for determining who will receive critical care in the event that COVID-19 patients outnumber available ICU beds in the province.

The 50-page Critical Care Triage plan, unveiled Friday, would not be activated until the health authority has exhausted all other options, such as transferring patients, health-care staff, equipment and medication between different hospitals in the same health zone or across the province. It would be implemented based on direction from the AHS CEO, in consultation with the executive leadership team.

When activated the triage protocol will be utilized in all health-care facilities and critical care units in Alberta to prioritize patients who have the greatest likelihood of overall survival, the report states.

The plan lays out four pandemic or disaster stages, which would determine whether triaging is necessary.

In a minor surge, the number of patients requiring critical care would exceed resources. As a result, staff may be pulled from other critical care units to help with care and patients may be moved into recovery rooms.

A moderate surge would see staff brought in from other areas of hospitals and patients moved to recovery rooms or subspecialty ICUs. Transfers for patients in emergency departments would be delayed.

Triaging may be required in a major surge, which would occur when 90 per cent or more of available ICU beds in the province are occupied. The first phase of triaging would only allow patients who are predicted to have more than 20 per cent likelihood of surviving one year to enter the ICU.

A large-scale surge would see 95 per cent or more of available ICUs in the province occupied and could see the second phase of triaging activated. Under that scenario, those with a 50 per cent chance of surviving one year would be admitted to the ICU. Pediatric triaging will be considered.

Information about a patients underlying illness, disease, or disability will not be taken into consideration unless they directly impact a patients likelihood of surviving the next year, the report states.

Decisions for critical care eligibility will not include a persons age, sex, socioeconomic status, race, disability, employment status, or the cost of future care. Once a decision has been made on who gets care, it cannot be appealed by the patient or family.

Alberta has the capacity to fully staff 425 ICU beds for COVID-19 and non-COVID-19 patients. As of Friday, there are 152 COVID-19 patients in the ICU the highest since the beginning of the pandemic.

Kerry Williamson, spokesman for AHS, said in a statement the Edmonton Zone currently has 102 ICU beds open a base of 72 general adult beds and an additional 30 spaces.

This week, the Edmonton Zone was between 86 and 88 per cent capacity for all ICU beds.

I just cant imagine
Dr. Noel Gibney, co-chair of the Strategic COVID-19 Pandemic Committee for the Edmonton Zone, said the triage plan is well-developed, but it is not a situation to ever want to be in.

I just cant imagine, explaining to the patients or their families why these individuals are not going to get the care that they need, Gibney said. I cant imagine doing that day after day after day, or multiple times in the day. I mean that the moral distress associated with that would be extreme.

He said the postponement of surgeries and release of the triage protocol suggests AHS is extremely worried about a disaster-type situation.

Gibney said the public health restrictions that are currently in place are absolutely not enough, and warned that the protocol could need to be activated this month.

I get the sense that the government has some notion that they may be able to just vaccinate the province out of trouble this time. But were not going to do that, Gibney said.

Were in a situation where modelling shows that in about three weeks, so that by May 22, we will be at a point where we may reach Phase 1 of the pandemic triage protocol.

He said the province needs to implement a strict lockdown and use the same health measures that were in place last April moving all schooling online, limiting retail to essential-only, closing non health-related personal services like hair and nail salons, severely limiting or close places of worship, and closing patios.

Adequate sick pay also needs to be implemented, he said.

Some of the components of what the government has been doing with targeted vaccinations, I think thats great, but it simply isnt going to be enough in time to get us out of that danger that were in, Gibney said.

[email protected]

Twitter.com/JunkerAnna

Financial Post May 12, 2021
f
Originally posted at https://financialpost.com/pmn/press-releases-pmn/business-wire-news-releases-pmn/theres-no-room-for-discrimination-against-people-with-disabilities-cupe-ontario-and-joel-harden-call-for-consultation-and-revision-of-triage-protocol

Press Releases Business Wire News Releases

“There’s No Room for Discrimination Against People With Disabilities”: CUPE Ontario and Joel Harden Call for Consultation and Revision of Triage Protocol Author of the article: Business Wire
Business Wire
Publishing date: May 12, 2021 23 hours ago 2 minute read Join the conversation
TORONTO The Ontario Governments draft plan to ration access to at-capacity critical-care is discriminatory and must be revised immediately, said the Canadian Union of Public Employees (CUPE) Ontario and Joel Harden, NDP MPP for Ottawa Centre and the Critic for Accessibility & Persons with Disabilities.

The fact that the draft plan says that doctors will look at your short-term mortality risk or your capacity for self-care to decide if you get access to limited intensive care units is nothing more than blatant discrimination against people with disabilities, said Fred Hahn, President of CUPE Ontario. This dangerously violates the foundational rights of Ontarians our members care for and the rights of many of our members themselves.

While Health Minister Christine Elliott recently said that Ontario may not need to resort to rationing, due to reduced demand for ICUs, concerns raised by CUPE Ontario, the Ontario Human Rights Commission (OHRC), disability organizations, and the six bioethicists on the governments advisory Bioethics Table remain.

Im not reassured by that at all, said Michele Gardner, member of CUPE Ontarios Workers with Disabilities Committee. This discriminatory triage protocol can still be used at any time. It makes it clear that people with disabilities are at risk of not getting the critical-care they need because of explicitly biased criteria.

The protocol must be revised to remove any discrimination and we must be consulted moving forward, added Gardner. The OHRC has raised the problem of lack of consultation, and so have the six members of the bioethics table, who rightly said that without it this government is only intensifying the vulnerability of people with disabilities.

More than a year has passed since over 200 community organizations wrote to the Ford government urging it to remove disability discrimination from its triage protocol. The response so far has been silence, said Harden. Its time to stop the secrecy surrounding critical care triage and for the Ford government to remove disability discrimination from its protocol.

Contacts

Daniel Tseghay
Communications Representative, CUPE
[email protected]






Source link

New Toronto Star Guest Column Blasts the Ford Government’s Critical Care Triage Plans and the Government’s Harmful Secrecy Surrounding Those Plans


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

May 7, 2021

SUMMARY

Below is an important guest column that ran in the May 7, 2021 Toronto Star in the print newspaper and online, by AODA Alliance Chair David Lepofsky. It summarizes the serious problems with Ontario’s critical care triage protocol and plans. Even if the crisis in Ontario hospitals seems to be levelling off for the moment, it is still very important that the Ford Government address these issues which people with disabilities have been raising for over a year.

We encourage you to:

1. Write a letter to the editor at the Toronto Star with your comments on this guest column. Email the Star at: [email protected]

Encourage the Star to give this topic as much attention as possible.

2. Forward this guest column to your member of the Ontario Legislature with your comments.

3. Share this guest column on social media like Facebook and Twitter. Encourage others to read it and to share it with others. The link to post that takes people right to the Toronto Star guest column is https://www.thestar.com/opinion/contributors/2021/05/07/ontarios-triage-protocol-unlawfully-discriminates-against-people-with-disabilities.html

4. Send this guest column to your local media and to any reporters you know. Encourage them to cover this disability issue, which touches the lives of so many Ontarians. Phone in to call-in radio programs to raise this issue. Tell them how you feel about the danger of disability discrimination in Ontario’s critical care triage protocol.

For more background, check out and widely share:

1. The new captioned online video by AODA Alliance Chair David Lepofsky that explains the entire critical care triage protocol issue from a disability perspective, for those who don’t know the ins and outs.

2. The AODA Alliance’s February 25, 2021 report that details serious problems with the Ontario critical care triage protocol.

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

Toronto Star May 7, 2021

Originally posted at: https://www.thestar.com/opinion/contributors/2021/05/07/ontarios-triage-protocol-unlawfully-discriminates-against-people-with-disabilities.html Editorial

Triage protocol unlawfully discriminates against disabilities

David Lepofsky Contributor

People with disabilities are disproportionately prone to get COVID-19, to suffer its worst effects and to die from it. Cruelly compounding this, Ontario’s protocol for triage of critical care would explicitly discriminate against some patients with disabilities who need life-saving critical care. People with disabilities deserve better.

If overloaded ICUs can’t accommodate all patients, rationing or “triage” means some patients will die because doctors will deny them needed critical care. We need a lawful protocol to govern such decisions. Ontario’s protocol isn’t lawful in part because of its disability discrimination.

For example, Ontario’s protocol would rank a cancer patient lower depending on their disability’s severity. That’s blatant disability discrimination. As well, patients over 65 with progressive diseases (e.g., MS, arthritis or Parkinson’s) are ranked lower for each of these activities they can’t do independently: get out of bed, eat, shop, use the phone or do finances.

Ontario’s protocol treats you like a blob on a gurney with no due process and no say. Two doctors rank you and give you the bad news.

With your life at stake, you cannot get the decision reviewed, even on a lightning-fast basis.

No wonder the Ontario Human Rights Commission, disability organizations and six bioethicists on Premier Ford’s advisory Bioethics Table all voiced serious objections. Ford’s approach is dangerously wrong. The protocol was developed and sent to hospitals in secret, with no public consultation by the government’s decision-makers. It isn’t on the government website. (We posted a leaked copy on www.aodaalliance.org.)

Some doctors and others are calling the shots in government back rooms. That is unfair to the public, people with disabilities and triage doctors.

Doctors use this protocol at their peril. Premier Ford is tap-dancing in a constitutional minefield. It’s wrong to direct doctors on who lives or dies by memo. Even worse, Ford may try to suspend the requirement that a patient must consent before needed care is discontinued.

Those defending the protocol argue it doesn’t discriminate because it says a patient’s stable disability, like autism, mustn’t be held against them. Yet the protocol discriminates against others based on progressive disabilities.

Government must remove disability discrimination from Ontario’s critical care triage protocol. It must afford due process to patients whose lives are in jeopardy. Instead of hiding and ducking questions, the premier should hold an open debate and pass legislation governing this, with public input.

The government must commit that if critical care triage occurs, it will daily report the number of people who are refused needed critical care due to triage. If Ford sombrely announces that the pandemic emergency requires critical care triage, remember he’s secretly planned for this possibility for over a year.

David Lepofsky is chair of the Accessibility for Ontarians with Disabilities Act Alliance.




Source link

New Toronto Star Guest Column Blasts the Ford Government’s Critical Care Triage Plans and the Government’s Harmful Secrecy Surrounding Those Plans


Accessibility for Ontarians with Disabilities Act Alliance Update

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

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

New Toronto Star Guest Column Blasts the Ford Government’s Critical Care Triage Plans and the Government’s Harmful Secrecy Surrounding Those Plans

May 7, 2021

            SUMMARY

Below is an important guest column that ran in the May 7, 2021 Toronto Star in the print newspaper and online, by AODA Alliance Chair David Lepofsky. It summarizes the serious problems with Ontario’s critical care triage protocol and plans. Even if the crisis in Ontario hospitals seems to be levelling off for the moment, it is still very important that the Ford Government address these issues which people with disabilities have been raising for over a year.

We encourage you to:

  1. Write a letter to the editor at the Toronto Star with your comments on this guest column. Email the Star at: [email protected]

Encourage the Star to give this topic as much attention as possible.

  1. Forward this guest column to your member of the Ontario Legislature with your comments.
  1. Share this guest column on social media like Facebook and Twitter. Encourage others to read it and to share it with others. The link to post that takes people right to the Toronto Star guest column is https://www.thestar.com/opinion/contributors/2021/05/07/ontarios-triage-protocol-unlawfully-discriminates-against-people-with-disabilities.html
  1. Send this guest column to your local media and to any reporters you know. Encourage them to cover this disability issue, which touches the lives of so many Ontarians. Phone in to call-in radio programs to raise this issue. Tell them how you feel about the danger of disability discrimination in Ontario’s critical care triage protocol.

For more background, check out and widely share:

  1. The new captioned online video by AODA Alliance Chair David Lepofsky that explains the entire critical care triage protocol issue from a disability perspective, for those who don’t know the ins and outs.
  1. The AODA Alliance’s February 25, 2021 report that details serious problems with the Ontario critical care triage protocol.
  1. The AODA Alliance website’s health care page.

Toronto Star May 7, 2021

Originally posted at: https://www.thestar.com/opinion/contributors/2021/05/07/ontarios-triage-protocol-unlawfully-discriminates-against-people-with-disabilities.html

Editorial

Triage protocol unlawfully discriminates against disabilities

David Lepofsky Contributor

People with disabilities are disproportionately prone to get COVID-19, to suffer its worst effects and to die from it. Cruelly compounding this, Ontario’s protocol for triage of critical care would explicitly discriminate against some patients with disabilities who need life-saving critical care. People with disabilities deserve better.

If overloaded ICUs can’t accommodate all patients, rationing or “triage” means some patients will die because doctors will deny them needed critical care. We need a lawful protocol to govern such decisions. Ontario’s protocol isn’t lawful in part because of its disability discrimination.

For example, Ontario’s protocol would rank a cancer patient lower depending on their disability’s severity. That’s blatant disability discrimination. As well, patients over 65 with progressive diseases (e.g., MS, arthritis or Parkinson’s) are ranked lower for each of these activities they can’t do independently: get out of bed, eat, shop, use the phone or do finances.

Ontario’s protocol treats you like a blob on a gurney with no due process and no say. Two doctors rank you and give you the bad news.

With your life at stake, you cannot get the decision reviewed, even on a lightning-fast basis.

No wonder the Ontario Human Rights Commission, disability organizations and six bioethicists on Premier Ford’s advisory Bioethics Table all voiced serious objections. Ford’s approach is dangerously wrong. The protocol was developed and sent to hospitals in secret, with no public consultation by the government’s decision-makers. It isn’t on the government website. (We posted a leaked copy on www.aodaalliance.org.)

Some doctors and others are calling the shots in government back rooms. That is unfair to the public, people with disabilities and triage doctors.

Doctors use this protocol at their peril. Premier Ford is tap-dancing in a constitutional minefield. It’s wrong to direct doctors on who lives or dies by memo. Even worse, Ford may try to suspend the requirement that a patient must consent before needed care is discontinued.

Those defending the protocol argue it doesn’t discriminate because it says a patient’s stable disability, like autism, mustn’t be held against them. Yet the protocol discriminates against others based on progressive disabilities.

Government must remove disability discrimination from Ontario’s critical care triage protocol. It must afford due process to patients whose lives are in jeopardy. Instead of hiding and ducking questions, the premier should hold an open debate and pass legislation governing this, with public input.

The government must commit that if critical care triage occurs, it will daily report the number of people who are refused needed critical care due to triage. If Ford sombrely announces that the pandemic emergency requires critical care triage, remember he’s secretly planned for this possibility for over a year.

David Lepofsky is chair of the Accessibility for Ontarians with Disabilities Act Alliance.



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