In Martyna Majok’s 2018 Pulitzer Prize-winning play Cost of Living, John is smart, arrogant and wealthy; he is also confined to a wheelchair by his cerebral palsy. Ani is angry and caustic; she too is confined to a wheelchair, having been made a quadriplegic in a car accident. Both are portrayed by actors who share certain aspects of their conditions.
Not all of them, however.
“The way I can not relate to John is that he is very, very rich,” said Christopher Imbrosciano. “I have yet to experience the wealth that John has.”
Imbrosciano also has cerebral palsy, though not as severely as his character — it mostly affects the actor’s gait. Teal Sherer, who plays Ani, is a paraplegic. In the play, the focus is as much on their caregivers as it is on John and Ani. Rounding out the cast are Bahareh Yaraghi and Ashley Wright, as respective caregivers Jess and Eddie.
The different financial circumstances between the characters adds another layer to Cost of Living, Imbrosciano notes. “Hiring caregivers is not something John has to think about. Whereas Ani struggles to get the assistance she needs.”
While Imbrosciano and Sherer bring a certain amount of lived experience to their roles, neither has had to hire a caregiver.
“That’s something we’ve had to discover,” Sherer said. “I think that’s one thing that drew me to the play.”
Cost of Living is about privilege in its many forms, says director Ashlie Corcoran.
“The play explores the privileges of those who are able-bodied, but at the same time it’s looking at privilege through the lens of socioeconomic status,” she said.
Homelessness, gender, and what it means to be a first-generation American (in the case of Jess) are other themes that come up.
“In prepping for the play, I put different lenses on and tried to say, ‘Well who is more privileged at this moment, and what are they doing with it?’ It keeps shifting. John says, ‘I can do anything I want, except for the things that I can’t.’ And I think you could say that for all of the characters.”
The Vancouver run marks the play’s Canadian premiere. A co-production with Citadel Theatre, Cost of Living will move on to Edmonton in the new year.
Whether identity politics, the #metoo movement, or the environment, theatre is often at the forefront of cultural issues. Recognizing this, the Arts Club has created a role, that of creative cultural consultant, that lets the organization call in experts. For Cost of Living, they’ve consulted with James Sanders, founding artistic director of Real Wheel Theatre. The company is dedicated to inclusion, integration, and understanding of disability.
“Because they (the actors) have their own lived experience, his role has been more about working with the Arts Club as a whole to make sure our spaces and attitudes are as accessible as possible,” Corcoran said. “We’ve learned a lot and made lots of changes. What excites me the most is when we’re in meetings and people bring up these topics.”
Sanders is also collaborating with the Arts Club, in partnership with Bard on the Beach, on an upcoming symposium, Theatre and Accessibility in a Digital World (Oct 20-22 at the BMO). “We’re looking at how we can use technology to make theatre, our spaces, our experiences, our stories, more accessible for artists and audiences alike,” Corcoran said.
Cost of Living is a step in this direction.
“Society usually tells us to turn away when you see a person with a disability,” Sherer said. “With this play, we’re saying, ‘No, look at us. Look at our bodies, look at our experiences.’ And that’s really powerful.”
Nearly a year before two young man died of fentanyl overdoses in houses operated by the Step by Step Recovery Home Society, the B.C. Health Ministry had investigated and substantiated complaints that it was failing to meet the most basic standards.
Within nine days of each other in December 2018, 21-one-year-old Zachary Plett and an unnamed,35-year-old died in different houses operated by the non-profit society that has a total of five houses in Surrey.
A month earlier, inspectors had substantiated complaints at all five houses. According to the ministry’s assisted living registry website, none met the most basic standard of providing residents with safe and nutritious food.
None had staff and volunteers with the skills or qualifications needed to do their jobs. There was no counselling support for residents at any of the houses or any transitional help for those who were leaving.
Late last week, Step by Step closed its house at 132nd Street where Zach died. In a brief conversation Thursday, director Deborah Johnson said it was done “voluntarily.” She promised to call back after speaking to the other directors and staff. But that call didn’t come.
Late Thursday, a spokesperson for the Addictions Ministry said the assisted living registrar was aware that two Step by Step houses had been voluntarily closed, but was still attempting to confirm the closures.
Up until May, Step by Step had taken action on only one of the 65 substantiated complaints. It got rid of the mice at its house at 8058-138A Street in November. But it took 18 days from the time the inspectors were there before the exterminators arrived.
Despite all that, all five houses have maintained their spots on the government’s registry.
What that means is that the social development ministry has continued paying $30.90 a day for each of the 45 residents who are on welfare.
It also means that anyone ordered by the court to go to an addictions recovery house as part of their probation can be sent there.
In late May, Plett’s mother and others filed more complaints about Step by Step that have yet to be posted. But a spokesperson for the mental health and addictions ministry confirmed that they are being investigated.
Plett is incredulous. “My son died there and nothing’s been done,” she said this week.
In an email, the ministry spokesperson confirmed that no enforcement action has been taken and that there is no specific timeline for the investigation to be completed.
“The review of complaints is a complex issue that can often involve a number of agencies conducting their own investigations (which can also require a staged process),” she wrote.
“Each case is different and requires appropriate due diligence. Throughout the process of addressing non-compliance, as operators shift and improve the way they provide service, new assessments are conducted and status is updated online within 30 days.”
A senseless death
Two days after Zach Plett arrived at 9310-132nd Street in Surrey, he was dead. According to the coroner, he died between 9 a.m. and noon on Dec. 15, 2018. But his body wasn’t discovered until 4 p.m.
Plett described what she saw when went to collect Zach’s belongings.
“The house was horrible. The walls were dirty. The ceiling was stained. My son’s bed sheets were mouldy.
“His body was already taken. But the bed was soaking wet with his bodily fluids. There was graffiti on the furniture. The drape was just a hanging blanket. It was filthy.”
To add insult to grief and despair, Plett noticed that his roommate was wearing Zach’s shoes.
Worse than the state of house is the fact that Zach died in the daytime and it was at least four hours before anybody noticed.
Plett wants to know why nobody had checked on Zach? Were there no structured programs where his absence would have been noticed? Didn’t anyone wonder why he missed breakfast and lunch?
“I had no idea what it was like or I would never have sent him,” said Plett.
After battling addiction for seven years, Zach had spent the previous three months in Gimli, Man. and what Plett describes as an excellent facility that cost $40,000.
But Zach wanted to come home, despite Plett’s concerns about omnipresent fentanyl in Metro Vancouver. They agreed that he couldn’t live with her.
A trusted friend gave Plett the name of a recovery house and within a week of returning to British Columbia, Zach went to Into Action’s house in Surrey. It is a government-registered facility that has never had a substantiated complaint against it.
Because he wasn’t on welfare, his mother E-transferred $950 to Into Action to cover his first month’s stay. She was told that the staff would help Zach do the paperwork to get him on the welfare roll.
Later that day, Zach called his mother, asking her to bring him a clean blanket and pillow because the house was dirty.
Because family members aren’t allowed into the house, Plett met him at the end of the driveway to hand over the bedding. It was the last time she saw Zach.
The next day, Dec. 13, he called to say that he had been “kicked out” for “causing problems.” He told Plett that it was because he’d complained about the house and asked to see the consent form that he’d signed.
Later that day, someone from Into Action drove Zach to Step by Step’s house on 132nd Street. Two days later, he was dead.
Because of the confidentiality clause in the informed consent forms signed by all residents, Into Action executive director Chris Burwash would not even confirm that Zach had been a resident.
But he said before signing those forms, residents are given “a clear outline of the expectations of them” and “a clear description of what the rules are.”
They are told that there are no second chances if they break the rules.
“If they outright refuse to participate or outright breach our zero tolerance policies — violence or threats of violence, using illicit substances, intentional damage to facility, etc. — we are put in a position where it is impossible for us to allow them to stay. We have to ask them to leave,” he said.
Staff provide them with a list of other government-registered recovery houses and sit with them while they make their choice without any advice or interference, Burwash said. Once a place is found, Into Action staff will take them there.
Burwash emphasized that only registered recovery houses are on the list, which speaks to the importance of the governments registry. But he said it’s frustrating that operators don’t comply with registry standards since their failures reflects badly on all recovery houses.
“We absolutely support the media shining a light on the facilities that are operating below the standards that they agreed to abide by,” he said. “We are certainly not one of them.”
He invited me to visit any time.
On Dec. 14, Zach and his roommate went to an evening Narcotics Anonymous meeting. Plett found the sign-in sheet from the meeting when she collecting his belongings the following day.
“What he and Billy (his roommate) did between then and early morning, I don’t know,” she said. But another resident told her that she thought they were “using” until around 5 a.m.
The toxicology report from the coroner indicated that the amount of fentanyl found in his system was no more than what is given cancer patients for pain control. But because Zach hadn’t taken opioids for six months, his tolerance for fentanyl was minimal.
“Had he died in the middle of the night, I would never have gone public with his story. But he died in the daytime. If they’d woken him up for breakfast or tried … ” said Plett, leaving the rest unspoken.
“He wasn’t monitored. He wasn’t watched … If I had known I would never have sent him there.”
Last week, Plett had an hour-long meeting with Addictions Minister Judy Darcy and the mother of the other young man who overdosed. He died Christmas Eve at another Step by Step. His body was only discovered on Dec. 26 after other residents kicked in the door of the bathroom where he was locked inside.
“She (Darcy) was very genuine and sympathetic,” Plett said. “I don’t think she realized how bad the situation is.”
Problems left unresolved
Step by Step’s first non-compliance reports date back to an inspection done Jan. 23, 2018 at its house at 11854-97A Street in Surrey.
Inspectors found that meals were neither safely prepared nor nutritious. Staffing didn’t meet the residents’ needs. Staff and volunteers weren’t qualified, capable or knowledgeable.
On Nov. 2, they returned. Nothing had changed and more problems were found.
The house didn’t safely accommodate the needs of residents and staff. Site management wasn’t adequate. There was no support for people transitioning out of the residence.
Critically, there were no psychosocial supports to assist individuals to work toward long-term recovery, maximized self-sufficiency, enhanced quality of life and reintegration into the community. Those supports include things like counselling, education, group therapy and individual sessions with psychologists, social workers, peer-support counsellors or others with specialized training.
On Feb. 4 and March 27, inspectors went back again because of a fresh set of complaints. As of May 8, none of the substantiated complaints had been addressed.
On the same day in November that inspectors were at the 97A Street house, they also went to Step by Step’s other four houses in Surrey — 132nd Street where Zach Plett died, 78A Avenue where the other man died, 13210-89th Avenue and 8058 138A Street. Step by Step doesn’t own any of the houses, but one of it directors, Deborah Johnson, is listed as the owner of 138A Street.
Not every house had the same complaints. But all of the complaints were substantiated and there were commonalities.
None had provided properly prepared nutritious food. None had adequate, knowledgeable or capable staff. Not one house was suitable for its use.
None supported residents’ transition to other accommodation or provided psychosocial support.
Since then, there have been repeated inspectors’ visits but the last posted reports indicate that nothing has change.
The first of five guiding principles for the province’s assisted living registry is protecting the health and safety of residents. Promoting client-centred services is also on the list. But then it gets a bit fuzzy.
Others are to “investigate complaints using an incremental, remedial approach” and to “value the perspectives of stakeholders — i.e. residents and their families/caregivers, community advocates for seniors and people with mental health and substance use problems, residents, operators, health authorities and other agencies.”
But as a result of this incremental, remedial approach and seeking of stakeholders’ perspectives, there were two preventable deaths.
What more do inspectors need before the registration for these five houses is cancelled? How much more time will the province give Step by Step to bring them into compliance?
And, how much longer will the ministry of social development continue writing cheques of close to $42,000 each month to an organization that can’t even comply with the most basic standards?
British Columbia is four years into a public health emergencies that has cost 4,483 lives since a public health emergency was declared in 2016.
More than a year ago, a coroner’s death review urged better regulation, evaluation and monitoring of both public and private treatment facilities following the 2016 overdose death of a 20-year-old in a Powell River recovery house.
It’s unconscionable that the government continues to waste precious resources on substandard recovery houses, while doing so little to force bad operators into compliance. At a time when good quality services are more desperately needed than ever, the registry ought to be the place that vulnerable addicts and their loved ones can find those.
Until this is fixed, Maggie Plett is likely right to believe that Zach would have been better off homeless. At least on the street, someone might have noticed him and done something to help.
When Peggy Mahoney discovered she had a rare liver condition and required a transplant, it came as a shock.
“No one saw it coming because I was a granola-eating, exercising, healthy person,” said Mahoney, of Victoria.
Thankfully, her son was a match for the life-saving transplant.
But Mahoney said she was shocked again to learn how much money she would need to set aside to follow through on her treatment.
All transplants in B.C. are done in Vancouver, where the medical expertise required to assemble transplant teams is available.
The cost of the medical care and the travel to Vancouver is covered by the province.
But transplant patients then have to spend several months living near the hospital after their procedure for follow-up care. They also need to have a caregiver with them to provide support.
Those extra costs fall to the patient and can be as much as $20,000, Mahoney said.
“At that point, almost three years on disability, a lot of my liquid assets were gone,” she said.
“You want to scream at that point: ‘sick person here’. I was not very healthy, to try and come up with that kind of money.”
Mahoney managed to make her finances work, and had a successful liver transplant in 2012. As a counsellor, she now helps other critically ill patients navigate the medical system.
And she worries the rising cost of living in Vancouver has exacerbated the financial burden for transplant patients.
“A lot of these systems were developed in the 1980s where that wasn’t the same kind of financial hardship as it is today.”
Treatment and monitoring
Organ transplants are a highly complex procedure and patients must stay near the medical facility to be closely monitored by their transplant team for roughly three months, said Dr. David Landsberg, Transplant B.C.’s provincial medical director for transplant services.
While the need to stay in Vancouver can be a financial challenge, the team works with patients to ensure they have a plan, he said.
Charitable organizations such as Kidney Foundation, Happy Liver Society, Heart Home Society, David Foster Foundation and Ronald McDonald House also help provide affordable places for patients to stay during their treatment.
“We work very carefully with patients to help them find the right support, the right accommodations,” Landsberg said.
While he has heard of patients who decide against being added to the organ transplant list due to the cost and challenges of treatment, Landsberg said no one is turned away over financial need.
“I don’t know of anybody that would ever have been denied a transplant, just on the basis of they didn’t have the funds.”
But Mahoney hopes more can be done to ensure no one ever has to choose whether they can afford to save their own life.
In B.C., a record 502 organ transplants were conducted in 2018. Over 1.35 million British Columbians have registered their wishes to be an organ donor.
On the morning of Aug. 21, 2017, Tyler Hatch put his dogs in their crates and wrote two suicide notes — one to his parents, the other, his wife.
He downed a bottle of sleeping pills with four beers, then fixed a belt around his neck.
After alerting 911 (so his wife wouldn’t have to deal with his dead body when she got home from work), Hatch hung up the phone and waited for death.
Through the fog of asphyxiation he heard the the faraway ring of a phone. It was 911 calling back.
Hatch managed to answer. “I’m glad I did.”
He didn’t want to die, he wanted help.
That awful day was the beginning of a journey toward self-worth that would include facing up to a gambling addiction that cost him a half-million dollars, getting treatment, filing a lawsuit against the B.C. Lottery Corp., and later withdrawing the suit.
Hatch now wants to make two things clear: He takes full responsibility for his actions, and if his story can help others, he’s eager to share it.
In a bright Yaletown office, Hatch, who now specializes in digital forensics, opened up about his path through depression, gambling addiction and recovery.
His game was blackjack, his dealer was online, his hand was $500.
“It was just me against my computer,” said Hatch.
The whole time he was gambling, Hatch, 42, believed he was in control — he even signed up for voluntary self-exclusion periods of three to six months, meant to help gamblers put the habit on hold.
The problem started years before, when the Surrey-born lawyer began to feel stressed by the demands of his career in commercial litigation. He dealt with the pressure by self-medicating — fast food, a few too many beers after work. “I would dread the next day coming, so I would stay up late.”
He spiralled into a depression. In 2010, he had a breakdown.
Eventually, his doctor advised him he should not return to law. Hatch took a permanent disability settlement worth $5,000 a month.
Married with no children, and not working, still coping with depression, Hatch was at loose ends. He began to gamble casually online. There were no indications that gambling would become a problem. He was the guy who called it a day if he lost $100 at a casino.
Online, things were different.
“It’s not real money, it’s not a chip. It’s just a little blue dot on your computer screen. It doesn’t seem real.”
Hatch didn’t know it, but EGMs, or electronic gaming machines and VTLs (Video lottery terminals) are tied to higher rates of gambling addiction. Provinces with a higher proportion of EGMs have greater gambling addiction rates.
“I won all the time, massive amounts of money, ten grand within minutes,” said Hatch. But, like so many gamblers, he found it impossible to walk away with a win. “It wasn’t about winning or losing. It was about the rush of the game.”
Besides, he had something he was good at again. He had a system. Sure, he lost more than he won, but he had a system, he kept spreadsheets, he was sure he could win back what he lost.
Hatch freed up more money by renegotiating his monthly disability for a lump sum settlement. In January 2016, he received a $550,000 payout.
Soon he was gambling $10,000 a week, the max allowed by BCLC online, and losing.
Hatch was also living a double life. No one knew what was happening. He didn’t understand it either. “I felt like I was consciously making a choice, I wasn’t aware of the compulsion.”
“My plan was to either win what I had lost back, or if I lost it all I was going to commit suicide.”
Within months, the money was gone. Hatch had hedged his bets, and lost.
The suicide attempt was a turning point. Friends and family supported his decision to enter a residential treatment centre. While in treatment, Hatch’s doctor noticed that one of the medications he was on, Abilify, was part of a class of dopamine agonists known to amplify compulsive behaviours, like gambling.
Now in recovery Hatch hopes others who recognize themselves in his story will reach out for help.
“There are a lot of free resources available,” says Hatch. “Talk to the people around you who want you to have a healthy, productive life. Talk to your friends, your family, your doctor.”
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