Defend Public Healthcare

From time to time there are rumors that EMS (ambulance services) and municipal public health services may move over to the tender mercies of the Local Health Integration Networks (LHINs), which fund hospitals, home care, long term care, and other health services. Fortunately-- for these services -- that has not happened yet.   The government is starving the LHINs.  According to the recently released Budget Estimates , the LHINs are going to get $300 million less than what they got two years ago. In contrast, public health services (provided by municipalities but funded to a considerable extent by the province) are  budgeted to get about a 6.4% increase from the provincial coffers this year.   Over the last two years the increase is 12.2%.  Not too bad. "Emergency Health Services" (aka EMS) are also largely provided by municipalities but funded almost 50% by the province.  And EMS has also done okay, with a 3.8% increase this year according to the

ORNGE providing a vital service.   Photo: Jason Edward Scott Bain The Globe and Mail kindly lobbed a few questions for the disgraced, former boss of ORNGE, Chris Mazza to swat away.  His responses, published in this weekend's edition , suggest the government was fully onside with his vision -- until the fur hit the fan. He said he could not grasp why he suddenly became a pariah. “Until November, 2011, I was being incentivized, told I was doing grand things. Not just by my board and by investors, but by deputy and assistant deputy ministers. They cheered me on, constantly. My premier cheered me on.” As evidence, he proffered a handwritten letter from Premier Dalton McGuinty written in March of 2009, congratulating him on, as Mr. McGuinty wrote, “the success at Ornge. You are doing a lot of good for a lot of people. Proud of ya!” “So in November, 2011, I’m great,” Dr. Mazza concluded, “and in December, pardon me, I’m a piece of shit. What changed?” Mazza may have been a

The new Ontario Municipal Benchmarking Initiative public report  indicates that ambulances (and by extension paramedics) are spending more and more time in hospitals.  For the thirteen (mostly large) Ontario communities included, the median percentage of time ambulances spend in hospitals has increased from 15.5% in 2009, to 17.8% in 2010, to 18.7% in 2011. That's an increase by more than one-fifth in the amount of time spent in hospitals. As the report notes "the more time paramedics spend in the hospital process equates to less time that they are available on the road."  Ambulance hospital off-load delays are a major part of the problem, as hospitals with too few beds lead to clogged emergency rooms that are unable to deal with newly arriving patients. There is also some more positive news about improving EMS capacity: The number of hours of ambulance service per thousand population has increased from 343 hours in 2009 to 350 hours in 2011, a 2% increase. The

Health Minister Deb Matthews sticks to her guns alright, spinning a tale at yesterday's legislative committee  hearing suggesting she was unable to control ORNGE.  The ORNGE boss stonewalled and manipulated the numbers, she claimed. The shenanigans at ORNGE are shocking, but it takes some believing that the government could not have reined them in if they had wanted to.  The government was funding the outfit after all.  And in fact, when the stench got real bad, the government pulled them up pronto: getting rid of the CEO, the board, and all the private businesses they had set up. A letter  (unveiled yesterday by Frank Klees) from Emergency Health Services at the Ministry of Health and LTC in 2011 suggests government officials knew something was up, reportedly flagging some of the issues that later became headlines, including a lack of transparency. But there is no sign anybody did anything much about it within government. Moreover,even while the Minister suggests she was n

ORNGE and its associated companies employ more than 400 people, including paramedics, pilots and aviation specialists.   ORNGE has its own aircraft and land ambulances, stationed at 12 bases across Ontario.   It also contracts with private service providers throughout the province to transport patients. Until about six years ago, the Ministry of Health and Long-Term Care (MOHLTC) contracted with private operators to provide its air ambulance program.  In 2005, the Ministry appointed a not-for-profit corporation called the Ontario Air Ambulance Corporation to become responsible for all air ambulance operations.  Subsequently, this corporation became Ornge. Initially, Ornge focused on air ambulance services.  But in 2007, the government amended the legislation to allow Ornge to provide land ambulance services.  The following year, the Ministry contracted with Ornge to transfer critically ill patients by land ambulance between health-care facilities.  The government provided Ornge

The disgraced former CEO of ORNGE, the province's air ambulance service, refused to accept any responsibility for the failings of the outfit when he appeared before a legislative committee on Wednesday. Indeed he indicated that the Ministry of Health and Long Term Care was apprised of what was going on. In turn, Deb Matthews, the health minister, pointed her finger back at him and suggested she was not kept informed. This is a hardly surprising exchange. In the union business, it becomes apparent pretty quickly that, for the bosses, water (and other things) flow downhill. One of the outfits on the lower slopes is the Emergency Health Services (EHS) of the Ministry of Health and Long Term Care. Mazza said he kept them in the loop. No doubt, the top bosses at the Ministry are highly impressed with the way EHS stayed on top of the air ambulance file. While some in the media have bought the government line about the 'rogue' nature of ORNGE, the more likely story i

With long line-ups at hospital Emergency Rooms, people are beginning to call ambulances to take them to the ER, hoping the ambulance and paramedics will speed them through the ER.   "We call them beat-the-queue calls," John Prno, regional director of emergency medical services reported. Paramedics have to stay with the patient until they are seen by hospital staff, which reduces  ambulance   availability, the Waterloo Record reports, creating offload delays where paramedics must wait in the hospital rather than save other patients in the community.   Offload delays at Waterloo hospitals increased by 20 per cent in 2011 for a total of 6,990 hours, the equivalent of an  ambulance  parked 24 hours a day for 291 days. The good news?  The number of Code Reds, where no local  ambulances  are available for an emergency call, dropped to 12 per month from an average of one a day in 2010. The EMS director noted that the hiring of  five paramedics last year and another five

The overload on hospital beds is catching up with Windsor/Essex Emergency Medical Services (ambulance services). The Windsor Star reports that the time spent by EMS paramedics waiting in hospital emergency rooms has increased 350% since 2009, increasing from 2,653 hours in '09 to 9,557 hours in 2011. EMS paramedics can't leave a patient at a hospital until the hospital takes over care, but sometimes hospitals are so backed up they have no room for new patients. The dramatic increase in "off-load delays" has driven up EMS costs, the Star reports. But, aside from driving a cost explosion, the off-load problems are also delaying EMS response time. "We have a limited amount of ambulances in the county," EMS Chief Randy Mellow told the Star . "There are times when we delay non-emergency calls sometimes up to an hour if we don't have an ambulance." The off-load delays stem from a bed shortage in Windsor that spiked after a "public private pa

Paramedics are spending 10 minutes longer on emergency calls in 2011 compared to 2010 in Hamilton.  EMS Director Brent Bowett told the Hamilton Spectator that time is mostly spent off-loading patients at hospitals. Hospital bed overloads ultimately back up in emergency rooms, forcing paramedics to wait until hospital staff can assume care for ambulance patients.   Hospital restructuring and a growing demand for EMS are also cited as reasons for the growing strain on the EMS system.  Mario Posteraro, the head of OPSEU local that represents paramedics in Hamilton, told the Spectator , “Clearly there’s a need for additional front-line services. I think we’ll be back before council asking for additional resources". Hamilton city councillors want the province to provide an additional $585,000 for an extra ambulance crew to be on call 12 hours a day, seven days a week.  That would cover 100% of the extra costs.  (Typically the province pays 50% of approved costs only.) Th

A shortage of hospital beds led to 32 Code Reds in February 2011 in Waterloo Region, The Record reports. "Code Reds" occur when no ambulances are available to take 911 calls. One Code Red lasted four hours on Feb. 14. A shortage of hospital beds is forcing paramedics to wait in emergency rooms to hand over patients to hospital staff, the Record reports. Regional politicians are being asked to hire five more paramedics to improve EMS  response times. In effect, hospital shortages are driving up municipal costs. Waterloo Region ambulances reach 90 per cent of emergencies within 12 minutes and 32 seconds, up 33 seconds over 2010. The legislated response time is 10 minutes and 30 seconds. The Director of the Waterloo EMS told the Record that off load delays fell in October and November after the service started taking patients to a less-busy hospital even if the hospital was not designated for the patient’s symptoms. “It was safer for a patient to be in the wrong hospit

New research from St, Michael's Hospita l in Toronto suggests that more than two-thirds of paramedics have experienced verbal, physical or sexual abuse on the job. "EMS providers can experience violence in the workplace as they perform their jobs in unpredictable environments and near people in crisis," said Blair Bigham, the lead investigator. "Anecdotal reports and workplace safety records have highlighted cases of verbal, physical and sexual abuse, yet until now, there has been little scientific research. More research is needed to understand the impact of this workplace violence." The study found: Verbal abuse was reported by 67.4 per cent of EMS workers surveyed.  Intimidation was reported by 41.5 per cent.  Physical abuse was reported by 26.1 per cent.  Sexual harassment was reported by 13.6 per cent.  Sexual assault was reported by 2.7 per cent. Patients, or patient family and friends were the most common perpetrator. The study was based

The Toronto Star ran a top of the front page news report yesterday on how the publicly-operated Ornge air ambulance service stopped reporting the salaries of four of its top bosses a few years back.  The excuse the organization is peddling, apparently, is that it has set up some for-profit companies legally separate from Ornge and so does not have to report the salaries under the law. Today, the Star editorialists got in quite a lather about this concluding, "it's up to (Health Minister Deb) Matthews to bring greater transparency to a company that provides a vital public health service and spends quite a lot of taxpayer dollars doing it." This over four unreported salaries?  Wow, call the Mounties. I suppose this does qualify as news, however.  Public providers should report publicly -- and not skirt the rules. But, step back, and the real scandal isn't that the salaries of four public sector bosses aren't reported. Rather it's that the multitude

An important part of the Progressive Conservative platform is privatization .  So it's worth looking at the results of the privatization initiatives they took the last time they were in government.  One notable PC initiative was "patient transfers". The Ontario Progressive Conservative government introduced legislation in 2000 allowing hospitals to use for-profit "patient transfer" companies rather than ambulances to move patients between hospitals or long-term care facilities if the patient was in stable condition. This led to a drastic increase in the number of patients transferred by for-profit companies. Despite assurances prior to the legislative changes from then Minister of Health Elizabeth Witmer and her parliamentary secretary Tim Hudak, now the leader of the Ontario Progressive Conservative Party, minimum standards for staff or equipment were never developed by the ministries of health or transportation (nor have they been developed under the l

A new study in the Journal of the American Medical Association  concludes that diverting patients from overcrowded hospital Emergency Rooms (ERs) is linked to a 3 percent higher risk of death for heart attack patients. The study was based upon 14,000 medicare patients in California. "For every hundred patients there are three avoidable deaths," said Dr. Renee Hsia, an emergency physician at the University of California, San Francisco who led the study.  "Now we actually have empirical evidence to show crowding affects patients in a very real way," Hsia told Reuters . "We know as practitioners it's very unpleasant to work when it's crowded," said Hsia. "You kind of know that you're not able to give patients enough attention because everybody is running around. Now we know we have to pay more attention to this, because patients are dying from it." Steven L Bernstein of Yale University School of Medicine told Reuters that ambulanc

The City of Hamilton has doled out another $833,000 for more ambulances and paramedics to deal with a chronic ambulance shortage on the streets. EMS response times have crept up to almost a minute and a half over the provincial standard.  "Code zeroes" (when there is no ambulance available to respond to a 911 call) are on track to record annual levels, with over 100 so far this year. The ambulance service recorded fewer than 20 Code Zeroes in 2006. Last year, the EMS dealt with more than 90. Mario Posteraro, president of Local 256 of the Ontario Public Services Employees Union, said the additional resources won’t be enough to fix the problem. “I don’t think it will make a significant enough impact,” he said. Since 2007, politicians have been providing nothing more than “band-aid” solutions to a complex problem, he said. Councillor Brad Clark said the city doesn’t have any control over the root causes of Code Zeroes such as hospital ambulance offload delays caused by

The Ontario Ombudsman had some harsh words for the for-profit patient transfer industry Friday.  Ontario residents would be better off taking a taxi to a hospital than one of the privately owned vehicles used to transfer hundreds of thousands of non-critical patients each year, provincial watchdog Andre Marin   told the Canadian Press . The ombudsman said he was "blown away'' by the stories he heard while investigating non-emergency medical transfers, an industry that CP says is regulated in all provinces except Ontario. It's allowed private companies to charge hundreds of dollars per patient for transports in old, beat-up ambulances operated by ``kids'' with no medical training, he said. "They place people's lives in serious jeopardy,'' Marin said. "These vehicles - that for all intents and purposes are ambulances - are completely without any rules,'' Marin said. "It's astounding.'' Most patient transf

Yesterday, the Liberal government proposed to regulate non-emergency patient transfers via legislation. However, as the legislature has stopped sitting and will not sit until after the fall election, the proposal  may be moot.  In recent years, patient transfers have been moved from Emergency Medical Services (EMS) to patient transfer operations.  While EMS is largely provided by not-for-profit public organizations, patient transfer operations are often run by for-profit businesses.  These businesses generally make their trucks looks like ambulances and the public often thinks they are ambulances.  There is little if any regulation of these businesses, and that sparked an unfavorable report from CBC radio on the sub-sector as well as comment from the Ombudsman.  The government is only promising to set ' core standards ' for non-emergency patient transfers between health care facilities, so even if passed, it sounds like the government is limiting expectations regarding how mu

The provincial Budget Estimate s have just come out and, again, we see a significant increase for EMS funding.  The one year increase for “Municipal Ambulance” and “Other Ambulance operations and Related Services” is over $41.7 million – or 7.75%.  Land ambulance funding has done well for quite a few years, and this continues the trend.  Air ambulance was not so fortunate, getting only a very modest increase. The Budget Estimates call for a 12% increase for "Emergency Health Services" overall compared with actual  spending two years previous  in 2009-10. 2010-11 Estimates Transfer payments    Payments for Ambulance and related Emergency Services: Municipal Ambulance 473,466,900     Payments for Ambulance and related Emergency Services: Other Ambulance Operations and Related Emergency Services 63,229,600    Air Ambulance 138,225,800 674,922,300 2011-12 Estimates Transfer

As reported earlier, ambulance off-load delays have surged in London (Middlesex County), with 689 episodes from March 2 to March 29 .   And as the Emergency Medical Services (EMS) Director told Middlesex County "This is caused in most part by back-ups of patients who require admission to an inpatient bed, but for whom an inpatient bed is not available."  This, unfortunately, is becoming a familiar story that hardly needs reporting.   Interestingly, however,  the   Londoner  reports  that  to respond to the problem 20 beds have been opened in the past few months and work is underway to open flex beds for three to five months during next year's flu season.