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Category "BC Government"

18Jul

Ian Mulgrew: Medicare expert, lawyer spar to end landmark trial

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The B.C. Government’s defence in the landmark three-year-old Medicare constitutional trial in B. C. Supreme Court is ending not with a bang but a testy, two-day courtroom sparring match involving one of its experts.

Dr. Gordon Guyatt gave as good as he got, repulsing a prolonged assault on his objectivity and left the stand Thursday having provided some last-minute fireworks but seemingly little insight on the key issue — wait-lists and the effects of constraints on access to private care in the provincial Medicare Protection Act.

“My perception is that there’s been a fluctuation of concerns with waiting lists and that governments have, to an extent, addressed things,” he said.

“Things can always get better … you have tensions — constant tensions — in every health care system in the world, and problems will never be solved.”

A specialist in internal medicine and, for almost 35 years, a health researcher at McMaster University, the argumentative Guyatt was assailed as more of an ideological warrior than a disinterested expert.

Robert Grant, lawyer for the two clinics and handful of patients behind the legal challenge over barriers to access to private care, portrayed Guyatt as a virulent opponent of the private clinics and Dr. Brian Day, the driving force behind the decade-old litigation.

Noting he had a duty to be impartial, Guyatt bristled at the broadsides aimed at impeaching his credibility.

“Given my, given that commitment, I do not see personally as relevant further pursuit of my opinions about issues beyond the issues that I’ve been asked to comment on in my deposition,” he complained.

“Thank you for that,” Justice John Steeves said. “In the meantime, just answer his questions.”

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Government lawyers vainly tried to halt the brutal cross-examination that battered Guyatt’s neutrality.

A self-described left winger who ran repeatedly as an NDP candidate, Guyatt has been a social activist for 40 years.

In 1979 he co-founded the Ontario-based Medical Reform Group, which disbanded in 2014 and was replaced by the Canadian Doctors for Medicare, which he joined.

He was also a director of the Ontario Health Coalition, an activist network, that along with its sister group the B.C. Health Coalition, is a member of the Canadian Health Coalition.

Doctors for Medicare and the B.C. coalition, under the banner of B.C. Friends of Medicare Society, have intervened in the challenge to support the government case.

Grant accused the groups of wrongly asserting Day seeks “U.S.-style health care for Canada, where people go bankrupt, lose their homes and life savings, or worse, because they can’t afford treatment when they need it.”

The B.C. coalition, he said, incorrectly claimed Day wanted a system where “international private insurance corporations run the show and patients foot the bill.”

Grant said the groups were fearmongering.

“It is an overstatement that this case could bring down single-tier Medicare,” Guyatt agreed, adding he also did not endorse the portrayal of Day and his supporters as “greedy, awful people.”

He maintained he was too busy to keep up with everything the groups did,  and distanced himself from the inflammatory rhetoric.

“The way I would put it is that we were advocates for equitable high-quality health care accessible to people without financial obstacles,” he said.

“So, specifically, as I have said previously, I believe that it is more appropriate to base care on the need — the medical need than on ability to pay — and I would like to work, continue to work, in a system where the patients I treat are treated on the basis of need rather than ability to pay.
”

“I understand,” Grant replied.

“But the point (of the trial) isn’t about what you want to do in your own practice; it’s whether or not increased private health care, and specifically private-pay surgeries, will be permitted or not. And you are opposed to increased private-pay surgeries. Isn’t that right?
”

“Yes,” Guyatt confirmed.

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Grant insisted Guyatt was a vocal opponent of Day within the Canadian Medical Association, seeing him as a “tragic choice” and “a complete disaster” as the organization’s president.

“I don’t recall active involvement in that matter,” Guyatt said, but again added such comments would be “hyperbolic.”

The Ontario specialist attacked the concept of using “benchmarks” to measure surgical waiting times — saying “not much” research has been conducted to establish what is acceptable and he suggested they were undependable tools set by “good old boys sitting around the table.”

But Guyatt has long minimized waiting lists and their ill effects — calling them “a problem that may be much smaller than we imagine” in 2004.

And he acknowledged he was not familiar with the circumstances in B.C.

“Certainly not in detail …. I do not know the details of the extent of waiting lists currently. I am sure that waiting lists remain a problem. … and that they’re not optimal … I do not know well enough to know whether it would be appropriate to characterize them as a serious problem or not.
”

The final witness John Frank, an expert on social determinants of health, took the stand later on July 18 and was to finish July 19 — day 179 of the proceedings.

“When this trial began I thought it would last up to 18 weeks (three times longer than the similar Chaoulli case in Que.),” said Day, founder of the private Cambie Surgery Centre.

“I am happy that — almost 3 years later — the witness phase is over. I am confident that the justice system will eventually grant all Canadians the same rights to protect their health that the Supreme Court of Canada granted to citizens of Que., and that the citizens of every other country in the world enjoy.”

Justice Steeves plans to hear final arguments this fall and begin deliberations in December.

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9Jul

Taxi borders won’t change under B.C.’s new ride-hailing regulations

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Taxi cabs will keep their municipal boundaries even when ride-hailing is introduced in B.C. later this year.


Gerry Kahrmann / PNG

VICTORIA — Existing boundaries for taxis in most of B.C. won’t change with the introduction of ride-hailing later this year, according to the independent tribunal charged with making the decision.

The Passenger Transportation Board, which will set boundaries and fares for ride-hailing and taxis by next month, is not considering any large-scale changes to current taxi areas that are often based on regional or municipal borders.

“As an administrative tribunal we’d have to discuss changes of boundaries and that would be very contentious and time-consuming and yet another delay in implementing ride-hailing,” board chair Catharine Reid said Tuesday. “And we don’t want a delay in implementing ride-hailing.

“The second reason is we don’t have good origin destination information. So if we try to change taxi boundaries, we don’t know if we’ll make things better or worse.”

Ride-hailing companies like Uber and Lyft can begin applying for licences in B.C. on Sept. 3, after the B.C. government announced Monday it has set the licensing and insurance regulations. Premier John Horgan has said ride-hailing could be in operation by the end of the year.

Drivers must have a class four commercial licence, and companies will be required to pay a $5,000 fee as well as a 30-cent-per-trip levy to improve accessibility services, under the government rules.

But the exact details on fares and boundaries are to be set by the Passenger Transportation Board, which is an independent tribunal.


The Uber app is displayed on an iPhone as taxi drivers wait for passengers at Vancouver International Airport, in Richmond, B.C., on Tuesday, March 7, 2017.

THE CANADIAN PRESS/Darryl Dyck

Reid and the board began public discussions on those issues with taxi companies in Prince Rupert on Tuesday. She said the rest of the taxi sector, as well as ride-hailing companies like Uber and Lyft will be consulted by the end of next week.

“The policy will be up sometime in August that will provide policy on boundaries, fleet size and rates,” she said.

Uber and Lyft have said they want to operate free of borders, to give their drivers flexibility on responding to demand for a ride anywhere.

The taxi sector is divided on the issue. Eliminating borders could solve problems like “deadheading” — where taxis from Vancouver, for example, take a passenger to Surrey but can’t pick up anyone on the return trip due to licensing restrictions. But removing borders could also devalue taxi licenses that hold value based on their scarcity in a certain area, causing significant financial losses for companies, drivers and those who’ve borrowed money to purchase or lease part shares in vehicle licenses.

The board has released two public discussion papers that lay out its options.

For the rest of the province outside of Metro Vancouver, it offers no options to change taxi boundaries. The report says ride-hailing companies could either follow the same borders, or be given larger regional or provincial areas in which to operate, depending on industry feedback.

In Metro Vancouver, three of the four options proposed would keep the existing municipal taxi boundaries for Vancouver, Surrey and elsewhere.

However, one option does propose opening up the Metro Vancouver region as a single area in which both ride-hailing vehicles and the traditional taxi sector could operate equally.

“It is not clear that taxis would want this approach as they are free to launch their own (ride-hailing) service and could also maintain the advantages of taxis that each has within their current operating area,” read the board report.

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An open metro region would give the public “faster and more reliable service, including at peak times,” reduce the numbers of trips refused and tackle the problem of deadheading, according to the report.

However, it would also result in “taxi service likely reduced for suburban areas,” wrote the board.

Taxi licenses would see a “large reduction” in value if ride-hailing was region-wide or provincewide, especially in the City of Vancouver, according to the report.

The B.C. Taxi Association, which attended consultations in Prince Rupert on Tuesday, said all boundaries should be removed for everyone.

“There’s no need for boundaries,” said president Mohan Kang. “If they have the ability to move around Metro Vancouver, so should we.”

The Vancouver Taxi Association, where taxi licenses hold the most value and its operators face the largest risk, could not be reached for comment.

The Passenger Transportation Board is also considering whether to limit the size of ride-hailing fleets, but its discussion papers note that no other governments do so and it would be impossible to set a defensible limit.

Fares are also up for consideration. The board notes no other governments impose maximum price limits on ride-hailing, despite concerns about surge pricing during peak demand. One option up for consideration is setting the minimum fare for an Uber or Lyft ride at the same rate as a taxi, or setting no minimum rate at all.

Uber and Lyft declined to comment. Both oppose B.C.’s class four commercial licence requirement and neither company so far has committed to opening in the province later this year.

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18Jun

B.C. measles immunization program off to good start, figures likely to increase

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A province-wide program designed to help individuals catch-up on their measles immunizations is off to a good start.


Eric Risberg/AP / ASSOCIATED PRESS

A provincewide program designed to help individuals catch-up on their measles immunizations is off to a good start.

According to B.C. Health Minister Adrian Dix, the program has offered 15,796 doses of measles-containing vaccine since its launch April 1 until May 30 to kids in kindergarten up to Grade 12.

A news release noted that figure was a preliminary total and is expected to increase when all records are collected from community pharmacists and care-providers.

During the first two months of the program:
• A total of 858 in-school clinics and 2,388 public health clinics were hosted throughout B.C.
• Immunization records for 566,106 students were reviewed.

Still another 230 in-school immunization clinics and more than 900 public health clinics are scheduled through the end of June.

The B.C. government expects to share details in the fall about how it will require students to report their immunization status.


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4Jun

B.C. Ferries’ new ship a nightmare reno of surprises and expenses

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VICTORIA — When B.C. Ferries’ newest ship, the Northern Sea Wolf, left the dock at Bella Coola for the first time Monday, there was little sign amid the bright new paint and spaciously redecorated interior that the public was sailing on one of the most problem-plagued renovation projects in the ferry corporation’s history.

But the 35-car, 150-passenger, vessel was a renovation nightmare for B.C. Ferries.

The Northern Sea Wolf was purchased used in 2017 from a Greek shipyard. It’s retrofit finished a year late and with a $76 million price tag that was more than 36 per cent over budget.

In short, the little Greek boat turned out to be a big fat Greek lemon for B.C. taxpayers.

“I think it’s fair to say that we were, at various times, shocked and surprised at the issues we were running in to,” B.C. Ferries CEO Mark Collins told Postmedia Tuesday.

“I liken it to a house reno. You survey a house and inspect it and all the rest. It looks pretty good for a reno, and then when you start taking off the drywall and you get a few surprises. That’s exactly what happened to us.”

B.C. Ferries had retained a broker and the ship was certified “in class” under marine standards by a third party independent group. There were only three or four ships in the world that met the size, ocean-readiness, and closed deck specifications B.C. Ferries wanted for the Port Hardy-Bella Coola route, and the Greek vessel was “not perfect, but as close as we are going to get,” said Collins.

B.C. Ferries sent staff to survey the ship — originally called the Aqua Spirit — in addition to the third-party inspection. “She needs work, but she’s good enough,” was the opinion at the time, Collins said.

But when the Aqua Spirit arrived in Victoria in December 2017, B.C. Ferries engineers were aghast. There was no fire protection insulation, a key safety measure. “We’d take off the panelling and find no insulation there, I mean literally just missing,” said Collins. “There’s no way a ship should have been approved with that missing.”


The Northern Sea Wolf. Photo: B.C. Ferries

B.C. FERRIES /

PNG

Under the ceiling tiles were sprinklers that didn’t work. “We found some of the sprinklers were not even connected,” he said.

The propeller shafts were “worn beyond allowable specifications.” Some metal was corroded below acceptable minimum steel thickness.

The heating, venting and air conditioning system didn’t work. The elevator didn’t meet code. And the stern door was a problem.

B.C. Ferries had budgeted to overhaul the main engines, install new generators, upgrade the navigational equipment and improve overall safety — but the scope of problems far exceeded the original plan.

“This is what started to put pressure on the budget,” said Collins. The original price tag of $55.7 million grew to $63.4 million in early 2018, and finally $76 million in 2019.

“We were very disappointed in some of the condition of the ship that shouldn’t have been there because a ship being in class should not have had these faults,” said Collins.

“We continue to make claims against the class society for compensation for the things that should not have been there but in fact were.”

B.C. Ferries also had a tight timeline. The direct Port Hardy-Bella Coola route had been cancelled by the Liberal government in 2013 due to financial losses at BC Ferries. Then Transportation Minister Todd Stone said the route was losing $7 million a year, with a taxpayer subsidy of $2,500 per vehicle.

B.C. Ferries sold the ship on the route, the Queen of Chilliwack, which had just undergone a $15 million upgrade. A former B.C. Ferries engineer in Fiji bought it for $2 million for his private ferry operation.

Tourism operators on the coast, Cariboo Chilcotin and Interior were outraged at the lack of consultation and said they’d lose millions in business and international tourism.


Mark Collins, president and CEO of B.C. Ferries, discusses operations in the control tower at the corporation’s Swartz Bay terminal.

Adrian Lam /

Victoria Times Colonist

Then Premier Christy Clark relented on the eve of the 2017 provincial election, announcing the route would be restored by spring 2018. B.C. Ferries was not consulted.

“We informed the government of the day that it was a very ambitious time frame and could only be met with a used vessel,” said Collins.

As problems mounted, B,C, Ferries missed the spring 2018 deadline, and then the fall window as well.

“It was very frustrating for the tourism industry,” said Amy Thacker, chief executive of the Cariboo Chilcotin Coast Tourism Association. “Our international visitors who very much enjoy that route are making plans and booking 12 to 18 months in advance.”

Collins apologized directly to the communities and businesses for the lack of communication.

The final version of the Northern Sea Wolf is basically a totally renovated ship, said Collins. There’s a new galley, dining area, lounge seating, outdoor viewing areas, paint, washrooms, chair lifts, elevators and First Nations art. It’s twice as fast as the Queen of Chilliwack.

It was money well spent, said Collins, even if it was far more than budgeted.

“Instead of being 30 per cent renovated for $55 million, we got a ship that’s 95 per cent renovated for $76 million. So, in that sense, the value is not lost.”

In the future, B.C. Ferries will demand a second independent inspection of ships, beyond whether the international maritime certification says a vessel is “in class,” said Collins. Had there been more time, B.C. Ferries would also have considered building new in B.C., but that likely would have cost as much as $110 to $140 million, he said.

The purchase of the Northern Sea Wolf in 2017 straddled the end of the Liberal government and beginning of the NDP.

Transportation Minister Claire Trevena blamed the Liberals for “making terrible financial decisions.”

“They backed B.C. Ferries into a corner with an incredibly tight timeline, leading to the purchase of a used ship which was well below Transport Canada safety standards,” she said. “The upgrades ran well over budget and cost people $76 million that shouldn’t have been spent in the first place.”

Former minister Stone said the cuts only occurred because B.C. Ferries was losing money and facing fare hikes.

“The cancellation was a very difficult decision,” he said. “It was always our intention to put back a direct link between Bella Coola and Port Hardy.”

Stone said “it’s a really good day” to see the link, though the cost overruns and delays are “very disappointing.”

Meanwhile, actual users appear pleased it’s all finally over.

“We’re just incredibly happy to actually have her out there and sailing,” said Thacker. “Now that service is here, I think there’s a lot of consumer confidence restored.”

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The history of the Northern Sea Wolf

2013: The B.C. Liberal government announces cutbacks to ferry routes, including direct service between Port Hardy to Bella Coola, due to B.C. Ferries financial losses. It says the route lost $7.35 million. Tourism operators are outraged at the lack of consultation.

2014: B.C. Ferries sells the Queen of Chilliwack (which had just undergone a $15 million retrofit) for a reported $1.8 million to a private Fiji ferry company.

2015: The new two-vessel journey from Port Hardy to Bella Bella to Bella Coola includes a nine-hour trip on the MV Nimpkish, a small 16-vehicle ferry with one washroom that government touts as having “potable water” and snacks. Tourist reviews are negative.

2016: Premier Christy Clark announces a plan to restore direct ferry service from Port Hardy to Bella Coola by the summer of 2018. B.C. Ferries is not consulted about the timeline, and scrambles.

2017: B.C. Ferries hires brokers to try to find a “rare” small ferry that can deal with ocean conditions, fit 35 cars and has a closed deck. Only three or four candidates exist. A Denmark ship looks promising by the buyer withdraws. The corporation pays $12.6 million for the 246-foot-long Aqua Spirit from Greek firm Seajet. It was built in 2000 and is certified by third-party maritime groups as being “in class” for sea use.

December 2017: The Aqua Spirit arrives in Victoria after a 10,097 nautical mile journey from Greece.

2018: B.C. Ferries starts stripping the ship down and discovers technical problems, sprinklers that do not work, missing insulation, corroded metal, elevator errors, heat and air conditioning that is non-functional, unusable propeller shafts, and more.

Spring 2018: B.C. Ferries misses its government deadline to be back in service. The budget rises from $55.7 million to $63.4 million.

Summer 2018: Technical problems continue to grow. The budget increases to $76 million.

September 2018: The Northern Sea Wolf, as it is now called, still isn’t ready. B.C. Ferries puts the Northern Adventure on the Port Hardy-Bella Coola run for one month.

May 2019: The ship starts trials. Operates the final two weeks of winter connector service.

June 3, 2019: The Northern Sea Wolf takes its first run from Bella Coola to Port Hardy. It is more than 36 per cent over budget and almost a year late.




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28May

Daphne Bramham: More needed to redress the tragic fact that Indigenous people are disproportionately victims of opioid crisis

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Overdose deaths linked to illicit fentanyl-laced drugs rose 21 per cent last year among First Nations people in B.C. even as there was a glimmer of hope that the crisis may have peaked among the general population.

Since the crisis began four years ago, B.C. Indigenous people have been overrepresented in the deadly count. Last year, they accounted for 13 per cent of the deaths, while making up 3.4 per cent of the provincial population.

Put another way, First Nations people were 4.2 times more likely to suffer a fatal overdose and six times more likely to suffer a non-fatal overdose than other British Columbians.

No one is suffering more than First Nations women and girls, who already have the worst health outcomes in Canada because of violence, exploitation and poverty.

They are unique in this epidemic where 80 per cent of the victims in the general population are men. Women, by contrast, account for 39 per cent of First Nations’ overdose fatalities last year and 46 per cent of the non-fatal ones.

They are bearing the brunt of marginalization, says Dr. Evan Adams, chief medical health officer at the First Nations Health Authority. Another measure of that is expected to come next week in the report of the murdered and missing women’s inquiry.

Among the reasons that he suggests for the widening gap between First Nations’ and the general population’s statistics are the effects of colonization including residential schools, the lack of social supports, childhood experiences and limited access to safe spaces and services.

The litany of dreadful statistics compiled by the provincial coroner’s office was read out Monday against the backdrop of a quilt with the names of some of the hundreds who have died. Among those names was Max, the son of the health authority’s knowledge keeper, Syexwaliya. Max died 12 days before his 41st birthday in March 2018.

“My son was just too lost,” she said. “I couldn’t do anything for him. I had to love and accept him as he was.”

Still, Syexwaliya takes heart from the statistics.

“The statistics make me feel that Indigenous people aren’t invisible and what’s brought out in the statistics and in the reports means that work is being done,” she said.

Addiction is a disease of pain — physical, emotional, mental and spiritual. Addiction piles tragedy on tragedy.

“It’s a journey of pain, a journey of suffering and a journey of seeking health services that couldn’t be found,” said the chair of the health authority, Grand Chief Doug Kelly.

Too many Canadians, too many British Columbians and too many First Nations people have already died, but Kelly said that for Indigenous people, things are not getting better. They’re getting worse, especially for those living in cities and most especially for women.

Overdose hot spots include the usual ones: Vancouver’s Downtown Eastside, the Fraser Valley, Chilliwack, Nanaimo, Victoria and Prince George. But for First Nations people, there’s also Campbell River and Kamloops.

Those stark differences mean distinct and targeted solutions are required. As Canada’s first Indigenous health authority, the First Nations authority (with its unofficial motto of “no decisions about us, without us”) is well positioned to do that.

With a goal of addressing causes of addiction, it has its own four pillars approach: preventing people from dying, reducing the harm of those who are using, creating a range of accessible treatments and supporting people on their healing journey.

The authority also strongly supports the call from B.C.’s chief medical health officer to decriminalize possession of all drugs for personal use as has been done in Portugal. (The suggestion was quickly shot down by the B.C. government, which says that could only be accomplished with federal legislation.)

Among the reasons Kelly cites are yet more terrible statistics.

Of Canada’s female offenders in federal prisons, Public Safety Canada reported last summer that 43 per cent are Indigenous. In youth detention, Indigenous kids account for 46 per cent of all admissions — a jump of 25 per cent in a decade.

Addiction is often contributing factor in the crimes committed, as is fetal alcohol spectrum disorder (although the report said there is no evidence that FASD is more prevalent among First Nations than other populations).

Because so many First Nations women are incarcerated, it means their children often end up in government care or with relatives, which only exacerbates the cycle of childhood trauma, loss and addiction.

So far, the First Nations Health Authority has spent $2.4 million on harm-reduction programs. It’s trained more than 2,430 people in 180 communities how to use naloxone to reverse fentanyl overdoses, has 180 “harm-reduction champions” and peer coordinators in all five regions.

But the biggest barrier is the one that led to Max’s death — lack of accessible treatment.

Last week, FNHA and the B.C. government committed $20 million each to  build treatment centres in Vancouver and Surrey and promised to upgrade six existing ones. Kelly says that’s great. But it’s not enough. They’re still waiting for another $20 million from the federal government for construction.

Still, where will the operating money come from? That’s the next multi-million-dollar question. But it must be found.

Now that there is evidence that First Nations communities — and women in particularly — are suffering so disproportionately, ignoring them is unconscionable.

[email protected]

Twitter: @bramham_daphne


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27May

B.C. Greens introduce bill to restrict conversion therapy

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B.C. Green leader Andrew Weaver announces a bill to ban so-called conversion therapies that seek to change gay sexual orientations in minors.


Rob Shaw / Postmedia

VICTORIA — B.C.’s Green party has introduced a bill in the legislature to ban so-called conversion therapies that seek to change gay sexual orientations in minors.

Green Leader Andrew Weaver said the legislation, if passed, would ban any medical professional from using conversion therapy techniques on anyone under age 19.

For adults, it would forbid any counselling, behaviour modification techniques or prescription medication designed to change a person’s sexual identity or gender identity from being billed to the government for MSP or other reimbursement.

The legislation doesn’t seek an outright ban on conversion therapy for adults, with Weaver noting that it becomes a more complicated matter of consent and free choice among adults.

“This bill will bring an end to the abhorrent practice of so-called conversion therapy,” said Weaver.

Banning the practice among minors and restricting its use on adults will “protect the health and safety of LGBTQ rights,” said Weaver.

Conversion therapy is the practice of trying to change a person’s sexual orientation or gender identity using counselling, psychiatry, psychology, behaviour modification or medication. It’s widely discredited, though not explicitly illegal in Canada.

In B.C., the government doesn’t fund or permit the practice of conversion therapy, said NDP MLA Spencer Chandra-Herbert.

“This legislation would put our current practice into law,” he said.

Chandra-Herbert described it as a “symbol” of not just LGBTQ2S+ rights, but also basic human rights.

Nova Scotia, Manitoba and Ontario already have legislation that restricts the practice.

Alberta had a working group tasked with banning gay conversion therapy, but it was cancelled by the new United Conservative Government.

“The direction Alberta is going in is the wrong direction for Canadian society,” said Weaver. “It’s so regressive.”

Peter Gajdics, a Vancouver gay rights activist who was subject to conversion therapy from a licensed psychiatrist in Victoria almost 30 years ago, said he believes conversion therapy is still occurring in some B.C. offices under the guise of treatment for depression and other disorders.

Gajdics pointed to religious websites that also promote and advocate for such therapies.

Weaver said he hopes to gain the support of the governing NDP and Opposition Liberals to pass the legislation unanimously this fall.

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26May

Daphne Bramham: Tougher new regulations promise more agony for chronic pain-sufferers

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One in five Canadians lives with chronic pain, but the cries of an estimated 800,000 British Columbians are not only being ignored, their suffering is being exacerbated by regulators limiting their access to both drugs and treatment.

First, in a move unprecedented in North America, the B.C. College of Physicians and Surgeons imposed mandatory opioid and narcotic prescription limits on doctors in 2016 in an attempt to avoid creating additional addicts and having more prescription drugs sold on the street.

Physicians who don’t comply can be fined up to $100,000 or have their licences revoked.

Now, the college is setting tough regulations for physicians administering pain-management injections.

“I’m enraged,” says Kate Mills, a 33-year-old, palliative care nurse who has been on disability leave for the past 18 months. “People like me are living in chronic, intractable pain and being ignored by doctors who are either too scared or too callous to care.”

She has an uncommon, congenital condition that causes chronic inflammation near her sacroiliac joint and in her lower back, which pushes down on her nerves causing “exquisite pain” down her leg.

Her first doctor essentially fired her, refusing to treat the pain. The next one prescribed Oxycodone to help Mills through until she was able to receive a steroid injection at a clinic, which kept the pain in check for several months.

But by the time the injection’s effects were wearing off, her GP went on extended medical leave. The locum assigned to Mills refused to prescribe her any medication and told her to go to an emergency room where she was given a prescription.

After numerous ER visits, Mills finally found a doctor two weeks ago who is willing to provide medication for her between injections. But he agreed only after Mills signed a contract agreeing that she won’t sell the drugs, will only go to one pharmacy and take the drugs only as prescribed.

She is lucky, though. Her pain management clinic will likely meet the college’s new standards that were developed by an advisory panel over the past three years out of concern about patient safety.

“Increasingly,” the college says on its website, “Procedural pain management is being provided in private clinics and physician offices, but without much guidance on appropriate credentials, settings, techniques and equipment.”

The new regulations would require physicians’ offices or clinics to become accredited facilities with standards on par with ambulatory surgery centres.

That means having tens of thousands of dollars’ worth of equipment including resuscitation carts, high-resolution ultrasound, automated external defibrillators and electronic cardiograms with printout capability.

The college acknowledges that “patients do not require continuous ECG monitoring. However, the cardiac monitoring equipment must be available in the event a patient has an unintended reaction to the procedure.”

The disruption for patients will be huge, according to Dr. Helene Bertrand, a general practitioner, pain researcher and clinical instructor at UBC’s medical school.

She estimates that up to 80 per cent of the offices and clinics where the injections are currently being done won’t measure up and already wait times are up to 18 months.

When the new requirements come into force, Bertrand predicts patients will be waiting anywhere from four to seven years for treatment.

Bertrand herself will have to quit doing prolotherapy, which she has done for the past 18 years on everything from shoulders to necks to spine to ankles. That’s despite the fact she’s never been sued, never had a complaint filed with the college and has published, peer-reviewed research that revealed an 89 per cent success rate among 211 patients in her study group.

(Prolotherapy involves injecting a sugar solution close to injured or painful joints causing inflammation. That inflammation increases the blood supply and deposits collagen on tendons and ligaments helping to repair them.)

The college will not grandfather general practitioners already doing injection therapies. Instead it will restrict general practitioners to knees, ankles and shoulders. All other joint injections must be done by anesthetists or pain specialists.

For Joan Bellamy, that’s a huge step backward.

She’s suffered from chronic pain since 1983 and “undergone the gamut of medical approaches, often with excessive waits: hospital OP (outpatient), pharmacology, neurology, orthopedics, spinal, physiatry and private.”

Since 2000, she’s had multiple injections that have made a difference. But her doctor doesn’t meet the new qualifications.

“I am afraid that without her expertise … that pain will become an intolerable burden, and any search for treatment will result in inconceivable wait times and will debilitate me,” Bellamy wrote in a letter to the college and copied to me.

The near future for pain-sufferers looks grim with most physicians able to offer them little more than over-the-counter painkillers.

Ironically at a time when the provincial medical health officer and others are lobbying hard to have all drugs legalized so that addicts have access to a safe supply, chronic pain-sufferers are being marginalized. For them, it’s more difficult than ever to get what they need.

It’s forcing many of them facing a lifetime of exquisite and unbearable pain to at least contemplate one of two deadly choices: Buy potentially fentanyl-laced street drugs; or worse, ask for medically assisted dying.

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8May

MRI wait times fall sharply after government boosts scans

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B.C. Health Minister Adrian Dix says MRI wait times have dropped significantly since the number of scans was ramped up.


Francis Georgian / Postmedia News Files

VICTORIA — Wait times for MRIs across the province have fallen sharply during the past year after government boosted the number of scans, according to provincial data.

The median wait time for an MRI scan in the Northern Health Authority fell 66 per cent between April 2018 and March 2019, with a patient waiting roughly 24 days compared to the prior 71 days.

Vancouver Coastal Health saw wait times drop from 36 to 21 days, a 42-per-cent reduction, and Fraser Health saw a reduction to 48 days from 89 days, a 46-per-cent cut.

“I’m happy with the direction,” said Health Minister Adrian Dix. “This is what we intended to do.”

The data reflects elective or scheduled MRIs. Emergency scans are done immediately.

MRI scan reduction times released May 8, 2019


B.C.’s wait times for elective or scheduled MRIs fell after government expanded exams, according to data released by the Ministry of Health on May 8, 2019.

Ministry of Health/submitted

Last year, B.C. began running 10 of the province’s 33 MRI machines 24 hours a day, seven days a week and bought two privately owned MRI clinics  in the Fraser Valley to expand capacity, at a cost of $11 million (plus an undisclosed amount for the clinics).

Dix announced last week a further expansion of MRI scans in the coming year, but did not have the data to prove wait times had reduced. He said the ministry was compiling the final figures and provided the data publicly Wednesday.

The longest wait times for certain patients — known as the 90th percentile measure — also dropped. Some MRI scans in Fraser Health had taken 346 days last year, but fell to 224 days once government expanded capacity, a reduction of 35 per cent, said Dix.

But that is still not good enough, he said.

“I obviously like the direction, I think we’re getting there,” he said. “We wanted to see everything under 26 weeks, and everything is under 26 weeks, except this.”

The longest wait times in Vancouver Coastal Health fell from 114 days to 99 days, a reduction of 13 per cent, and in Northern Health from 257 days to 55 days, a reduction of 79 per cent.

“The huge difference in the north is obviously significant,” said Dix.

Government is adding another $5.25 million to the MRI budget next year, which Dix said will fund 15,000 additional MRI scans. Dix said the wait times should drop even further.

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2May

B.C. touts success of new MRI strategy but lacks wait time proof

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VICTORIA — B.C.’s health minister is touting the success of his strategy to expand the number of MRI scans done in the province, but can’t definitively show that it has reduced waiting times for the diagnostic procedure.

Adrian Dix said Thursday that the number of MRIs done in the past year has risen by 43,993 scans, or an increase of 23 per cent. In some regions, the increase has been more dramatic. In Northern Health, which had the worst rate of MRI scans in Canada, the number of MRIs jumped almost 87 per cent.

“It is an extraordinary achievement for the public health care system in British Columbia to do this in one year,” said Dix.

Last year B.C. began running 10 of the province’s 33 MRI machines 24 hours a day, seven days a week and bought two privately owned MRI clinics  in the Fraser Valley to expand capacity, said Dix.

Increasing the use of public machines cost $11 million. The cost of buying the private clinics has not been released. Government is adding another $5.25 million to the MRI budget next year, which Dix said will fund 15,000 additional MRI scans.

But Dix was unable to back up the detailed MRI stats with similarly detailed figures that show chronically long waiting times are decreasing across the province. He said his ministry is still trying to compile those figures.

A Health Ministry document obtained by Postmedia News in 2018 that showed waiting times as long as 364 days for MRIs in some locations.

Dix insisted waits have dropped. “We obviously get numbers throughout the year and they show wait times improving in all the health authorities in particular Northern Health and Fraser Health where wait times were longest,” he said.

A technician operates an MRI machine. Four more scanners will be bought for installation in B.C. hospitals in 2018, the health ministry announced Thursday.


A technician operates an MRI machine.

JEFF MCINTOSH /

THE CANADIAN PRESS

The government provided partial data, including how waits for MRIs in Northern Health decreased to 29 days from 57 days for average patients as a result of the increased scanning hours.

At St. Paul’s Hospital, where MRIs are running 24 hours daily, waiting times have dropped to two days from 40 days for patients in the middle of the waiting list and to 38 days from 98 days for people at the upper end of the waiting list.

At Burnaby Hospital, where MRIs also run 24 hours, waiting times dropped to 30 days from 90 days for patients in the middle of the waiting list, and to 154 days from 249 days for people at the upper end of the waiting list.

At University Hospital of Northern B.C. in Prince George, where the machines don’t run 24/7, waiting times dropped to 17 days from 42 days for patients in the middle of the waiting list and to 44 days from 266 days for people at the upper end of the waiting list.

Dix said the success of purchasing the two private MRI clinics and putting them in the public system may lead to similar purchases of private surgical centres to reduce surgical waiting times.

“I think we have to be entrepreneurial about this question,” he said.

“There are a lot of things (that are) good, I think some times, about community and smaller surgical centres. They take less time to build than to increase surgical capacity in a hospital,” he said. “We have to look at that absolutely to increase the capacity of the system to perform surgeries.”

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1May

Daphne Bramham: Alcohol, not opioids, is Canada’s biggest drug problem

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Alcohol is so much a part of our culture that 80 per cent of Canadians drink. But each year, nearly 15,000 people die from alcohol related harms.


Canadian governments are addicted to the revenue from alcohol


DALE DE LA REY / AFP/Getty Images

With so much focus on illicit drugs and overdose deaths, it might seem that opioids are the biggest addictions problem. Far from it.

Alcohol kills many more people each year (14,800 in 2014), results in more hospitalizations annually than heart attacks and is one of the most expensive and intractable health problems.

While cannabis was legalized a year ago and B.C.’s chief medical health officer is pushing hard for decriminalization and ultimately legalization of all illicit drugs, two Canadian addictions research centres want tougher regulations to mitigate the costs and harms of alcohol use and addiction.

The Victoria-based Canadian Institute for Substance Use Research and the Toronto-based Centre for Addiction and Mental Health want a minimum price of $3.50 for a standard drink in a bar or restaurant and $1.75 for off-premise sales. They also want a national minimum drinking age of 19, which is a year higher than national minimum for cannabis. Those are just two of the recommendations in reports they released last month that look at federal, provincial and territorial alcohol policies.

The reports also calling for stricter guidelines for advertising, restrictions on manufacturers’ and retailers’ promotions on digital and social media platforms, and a federal excise tax based on alcohol content that would replace the GST.

Over the past decades, the researchers found an erosion of effective policies and regulations.

“Overall, alcohol policy in Canada has been largely neglected relative to emerging initiatives addressing tobacco control, responses to the opioid overdose crisis, and restrictions imposed on the new legal cannabis market,” their report on the provinces and territories says. In several jurisdictions — Ontario is the worst example — “customer convenience and choice are being given priority over health and safety concerns … the responsibility of governments to warn citizens of potential risks is largely absent.”

British Columbia got a bare pass at 50 per cent based on its potential to reduce alcohol-related harm, which is not good. But it’s still better than the national average of 43 per cent.

Alcohol-related harm was estimated at $14.6 billion in 2014, according the Canadian Centre on Substance Use. Productivity loss due to illness and premature death accounts for $7.1 billion. Direct health care costs add another $3.3 billion and $3.1 billion is spent on enforcement costs for this legal drug.

Related

Tobacco was second at $12 billion followed by opioids at $3.5 billion and cannabis at $2.8 billion. But the data predate the opioid overdose crisis and cannabis legalization.

Alcohol’s costs and harms reflect the fact that 80 per cent of Canadians drink. It’s not surprising. Culturally, we associate drinking with celebrations and good times. It’s We’re bombarded with images in movies, TV and ads of beautiful people drinking and having fun.

Scarcely a week goes by that there isn’t a “good news” story about research showing that a glass of red wine might be good for your heart or that yet another populist politician is campaigning on a promise to slash the price of beer.

Yet less was made of University of Washington’s Global Burden of Diseases Study last summer that found alcohol was the leading factor in 2.8 million premature deaths in 2016 and is so harmful that governments ought to be advising people to abstain completely.

One problem is that Canadian governments are addicted to the revenue from alcohol. Liquor sales and taxes provided $12.15 billion to federal and provincial governments in 2017/18 — $1.6 billion more than five years earlier, according to Statistics Canada.

Last year, liquor consumption rose in British Columbia, which already had the highest drinking rates in Canada. There were also record sales, which meant that in addition to tax revenue, the Liquor Distribution Branch provided $1.12 billion in earned revenue, up from $1.03 billion two years earlier.

Good for taxpayers? Not really. The reports by the substance-abuse centres recommends B.C. “reconsider the treatment of alcohol as an ordinary commodity: Alcohol should not be sold alongside food and other grocery items as this leads to greater harm.”

It’s based on research done last year by Tim Stockwell of the Canadian Institute for Substance Use Research. He and his researchers found that when access to alcohol is easier, more people die.

Between 2003 and 2008, “a conservative estimate is that the rates of alcohol-related deaths increased by 3.25 per cent for each 20 per cent increase in stores density.”

Estimates have to be conservative because alcoholics’ fatalities are mistakenly counted as death from one of more than 200 other kinds of alcohol-related fatalities including car accidents, suicide, liver diseases, cancers, tuberculosis and heart disease.

What’s surprising is that more than a century after legalization, there are no federal or provincial policies aimed specifically at mitigating alcohol’s harms and costs.

The opioid crisis has been the catalyst for governments to finally think about addictions and drug-use policies and, it’s now impossible to ignore the slower moving crisis caused by alcohol abuse and addiction.

In the coming months, the B.C. health officer also plans to release an alcohol addictions report. The B.C. Centre on Substance Use recently developed guidelines for best practices in treating alcohol addiction, but the provincial government has yet to approve or release those.

Prohibition proved a failure. Yet, legalization and regulation are not panaceas either. Because even with more than 100 years of experience, there is still no jurisdiction in Canada or anywhere else that seems to have got it right.

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