Health Committee on May 16th, 2019

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we'll go to Dr. Eyolfson for seven minutes.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Mr. Chair.

Thank you all for coming.

I'll start with you, Dr. Gill. We have something in common. I'm an emergency physician. I worked in emergency departments in Winnipeg for 20 years. Much of what you were describing about the challenges of emergency departments resonated a lot with me. We find that when they cut front-line services, people come to the emergency department to fill the gaps. When they cut in-hospital services and you can't admit them, they basically can't go anywhere. I've always called the emergency department the only place that can never say no.

We often find directives, particularly from administration, to increase the flow. They'll have all sorts of spreadsheets to show the flow isn't the way it should be, but then we're told not to make excuses when we tell them we don't have the resources to increase the flow.

What would you tell administration of hospitals about this? Do you think this attitude of leaving it for the emergency department to figure out is making the problem worse?

[Dr. Kulvinder Gill]

I've had the experience of working in many different provinces. I'm actually originally from Manitoba and I did my medical school training out in Winnipeg, so I'm very familiar with the hospitals there as well.

Regarding flow, I think it's very important for administrators to understand that patient care requires time. Quality assessments and plans require time. We have burnout rates here in Ontario of 63%. I cannot stress enough how much of a serious public health care crisis this is. We have been advocating for this for three years, but no level of government has taken us seriously.

Physicians have the highest rate of suicide compared to any profession. The mandatory reporting is cruel. It's cruel and it needs to change. There is no reason that in every other profession, mental health and physical health are considered to be equal, except for physicians.

Regulatory bodies need to adapt and change. Again, the Australian model is an amazing model to follow. In 2017, their governments passed legislation to support physicians who were suffering from mental illness instead of punishing them. Their governments have taken this issue very seriously. They have even created a front-line ombudsman, which is one of the other recommendations that we had. That allows front-line doctors, nurses and health care workers to actually bring their concerns to an independent body that can then address them. It also allows for confidential reporting of the actual incidents.

Those are part of our key recommendations. We would strongly urge the committee to look into many of the models that currently exist in Sweden and Australia. They are decades ahead of Canada in terms of addressing these issues.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

That also resonates a lot with me.

I was hoping things would have changed since the nineties, when I was in residency at the University of Manitoba medical school. In our residency programs, across the various programs, we had three residents die by suicide in a 15-month period, and not a lot changed. I actually discovered the body of a resident who had committed suicide and I was not offered any mental health services. Actually, no one thought it was unusual that I showed up for work the next day. It didn't occur to anyone to tell me, “Maybe a couple days off would be really good for you.”

I didn't see any changes over the next few years and I was hoping that in the intervening 20 years we would see more changes.

[Dr. Kulvinder Gill]

We've actually seen the opposite happen.

Sadly, in 2017 the Ontario government passed legislation giving the regulatory college access to physicians' private medical records.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Wow.

[Dr. Kulvinder Gill]

Not only is it now mandatory to disclose mental health issues, but the regulatory college in Ontario also has access to physicians' private personal health records. This has created even further barriers to physicians' access to care.

These are serious issues. For some reason, the Ontario government does not see physicians as human and has completely dehumanized the profession. We need to start thinking of doctors as being human and to start treating them as we would treat patients.

There are significant issues within the Ontario regulatory college. Just yesterday we became the first jurisdiction in the entire world to lose our freedom of conscience. No such legislation exists anywhere else in Canada and no such legislation exists anywhere else in the world.

We have also lost our freedom of due process through the regulatory college and our presumption of innocence, which also came with the passage of Bill 87 in 2017.

There are significant issues and challenges for front-line doctors, not only in terms of trying to deliver front-line patient care with limited resources and with an increased escalation of violence and sexual harassment on the front lines, but also in terms of roadblocks and barriers being put up by the regulatory college and by the government that actually impede access to essential mental health and physical health care, which is crucially needed.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you. I did not know about the mandatory reporting of mental health. That is, quite frankly, horrendous.

I don't know if Manitoba's doing that. It's something I will look into.

[Dr. Kulvinder Gill]

It is.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

You're saying it is. That is actually quite horrendous, but I'm glad I know that now. I think this situation needs to be looked into.

In the last 30 seconds, one of my frustrations in the emergency department was that because so many services are cut outside, there are a lot of initiatives that people bring to the department, saying that the emergency department is perfectly positioned to do this. They're not emergency things, but no one feels good saying no. For example, it's “Let's offer flu shots to everyone who comes in, because we can catch them here”, or other things, such as “Let's offer smoking cessation programs to any smoker who comes in.” These additional things make us busier.

Is it time for the emergency medicine community to start pushing back and saying, “We're already overloaded in what we're doing. Don't make us do more things that aren't in our mandate”?

[Dr. Kulvinder Gill]

We certainly don't have emergency rooms in Ontario giving flu shots. There are now more and more urgent care facilities that are being positioned close to emergency rooms. Oftentimes the triage nurse has the ability to redirect patients away from the emergency room to the urgent care facility, which is sometimes attached to or neighbouring the ER department. That allows for appropriate care to be delivered in an appropriate setting.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you very much.

[The Chair, Liberal, Bill Casey]

Thank you very much.

That completes our seven-minute round. Now we go to a five-minute round, and we start with Ms. Gladu.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thank you, Chair.

I'm going to start with Thomas Hayes. You are heralded as being the “best practice” guy. What is your annual budget for your department?

[Thomas Hayes]

First of all, my department is complicated, because it includes safety, security, parking and staff health. I'll set the parking aside and just talk about safety, security and staff health. If I look at that, I would say our annual budget for those groups is in the range of about $2 million. Part of that would include the budgets we have for the training of staff across the hospital—that falls under my purview as well—as well as budgets for supporting people in their return to work.

If I were to put that in a more concrete type of format, I would say I have a staff of roughly 60 protection agents who are members of the Ottawa Hospital. We also have about another 60 security guards who are contracted out so that we can raise or lower our staffing complement. I have a safety and staff health team of about 35 people, which includes safety officers, nurses, physiotherapists and other health individuals who are involved in either taking proactive work supporting joint health and safety committees or supporting staff in whatever their health needs are.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

They service the 19 locations that you have.

[Thomas Hayes]

Correct.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Very good.

I also want to talk about whether there's acceptable treatment in terms of mental health assistance or PTSD coverage once violence has occurred. What exists for nurses, doctors and health care providers?

Anybody can answer.

I'll start with Josette.

[Josette Roussel]

In the hospital sector, there's WSIB. There's a workers compensation board. Depending on the injury, there's a reporting mechanism, and if you need medical assistance, there's time off. You're covered under that type of insurance in hospitals.

In other sectors, depending which group you're part of, there are some insurance services, but I'm not sure exactly what they are. There are some differences in jurisdictions. Having been a nurse in Ontario, I'm just speaking now of Ontario.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Dr. Gill, would you comment?

[Dr. Kulvinder Gill]

The majority of Ontario's front-line physicians are actually in a private practice and have no benefits. If they do take time off work, not only are they still covering the overhead for their staff but they are also still covering the overhead for their clinic. Once they do come back, all the patients they had cancelled need to be rescheduled. Oftentimes, physicians have an increased burden once they return to work.

We also previously had OPIP, the OMA priority insurance program, which was very minimal coverage through the Ontario government. However, due to escalating cuts, the Ontario government has not only cut mental health coverage, but now it's only a few hundred dollars a year for each physician. There are new graduates coming into the program every single year, but the government hasn't increased funding accordingly, so there's a smaller pool being split among a greater number of people.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Now I'll turn to the Fédération interprofessionnelle de la santé du Québec.

Are there enough services in Quebec for people who've experienced violence?

[Linda Lapointe]

There's a good service for that. Support is offered and all female health care professionals have group insurance that enables them to access it. However, they have to go get the psychological support they need themselves.

One of the federation's pet issues is the ratio projects designed to reduce the number of patients per nurse, per nursing assistant and per respiratory therapist to prevent these forms of violence. You'll be hearing about this in the next few years.

Generally speaking, there is good support, except that all this prevention unfortunately isn't a priority for the organizations. There is really a lot of work to do on the outreach plan before we can say enough is enough.

We have policies on violence, harassment and discourteous behaviour. All health facilities have one, but it's nevertheless a burdensome process. We claim that underreporting is really a problem precisely because of the burdensome reporting process. There's a mediation process for verbal violence and discourteous behaviour between colleagues, but it's quite complicated. Since people feel it won't help in any case, they don't engage in the process.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thank you.