Health Committee on May 16th, 2019

[The Chair, Liberal, Bill Casey]

Okay. Thanks very much.

Now we'll go to Mr. McKinnon.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you, Chair.

My first question will be to Ms. St-Pierre.

Most of our discussion on violence has involved relationships with patients and people associated with patients, but you indicated that there's also professional violence. I would suspect that means, basically, violence among co-workers.

If we take out of the equation all of the patient-related violence, is the health care environment more dangerous than, say, other working areas in terms of violence among co-workers?

[Isabelle St-Pierre]

I would say that it is. We are seeing an increase everywhere. Part of it is workloads, with the work environment being so stressful and people not being able to help one another or not having time to get to know each other. Attributing ill intent.... Sometimes violence is subjective. You maybe perceive that someone is mean to you when in fact it was something else. Perhaps they were rude, but there wasn't an intent to hurt you.

I think it's complicated. We know that this form of violence, when it's worker to worker, is usually more damaging to the staff. You expect your colleague to have your back. If you have that day after day after day, that's then you go on sick leave and get depressed, and it affects your self-esteem.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

In the health care environment, people tend to be substantially overworked and overloaded in many ways. I believe you're saying that this burden overwhelms the regular sort of workplace or occupational safety rules that apply for everybody.

[Isabelle St-Pierre]

I agree with you. It also goes further than that. For example, if I go for a break, someone will look at me and say, “Oh, you have time for a break? You must not be that busy.” It gets to be that when you take your lunch or break or go to the bathroom, it's almost frowned upon by your colleagues. There are cliques like that and situations like that.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you.

Dr. Gill, you said that the majority of physicians in Ontario—and by extension, I would suspect, across the country—are in private practice. I would think that this means most physicians are better able to control their environment in terms of the working conditions they provide to their staff and so forth.

What can physicians in private practice do to improve the safety of themselves and their staff?

[Dr. Kulvinder Gill]

Over the past several years, physicians in private practice have been trying to ensure the safety of their secretarial staff. They're often the very first people who encounter a violent patient at the time of check-in, for example. Physicians are creating more barriers between the secretarial staff and patients.

Aside from that—as I had mentioned earlier—if the de-escalation attempts fail, often the only avenue that front-line physicians and the secretarial staff have is to call police. That's often after an assault or after the violence has already escalated.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Would the availability of things like panic buttons, as Mr. Hayes has indicated, be a useful tool for such workers?

[Dr. Kulvinder Gill]

What does a panic button trigger? That would be the question. Would it be triggering the local police department? If that's the case, I know that where I practise, the Peel police are extremely overwhelmed. Despite the increased budgeting, they're still struggling to deal with the sheer volume of calls that they have. By the time the call is attended to, often the event has already transpired.

It's a very challenging situation. Aside from putting up signs, creating barriers, installing cameras, etc., there's very little that front-line physicians within the community have available to them in terms of addressing the violence. With legislation such as MP Davies has brought forward, patients would know that there are serious consequences for their actions, and it would help to create a significant deterrence to that type of behaviour.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we go back to Ms. Gladu.

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

Thank you, Chair.

I want to talk a little bit about resourcing and trying to reduce the wait times to get at that part of the frustration.

There's a shortage of doctors and nurses across the country. The most extreme situation I've seen is in Cape Breton, where they're missing 52 emergency room physicians and a vascular surgeon. If you cut an artery, you will either lose a limb or die because they can't get you to Halifax in time. Across the country we're seeing nursing shortages.

I have two questions. The first one is this: What is the correct ratio of nurses to patients that we should be trying to put into place for the various levels of service, knowing that the ICU is different from emergency, etc.? Do you have any ideas on that one?

[Josette Roussel]

What we are using is based more on the needs of the patients, rather than going directly to the ratio. It means looking at the needs of the patients.

I know seniors' care is rising, and we've done a recent report on that. We need to plan for more resources by looking at different models and different categories of nurses. We have to do things differently. We can no longer use the same models that we have. We know things are not getting better and we have to use different services in the community so that individuals will not go to the emergency and will not bottleneck emergency services, so that those services that are needed are used for the patients who need them.

Seniors' care is an area where we're thinking of the population's needs and how to provide the resources they need. Also, rural and remote health care, as you suggested, is an area where we are concentrating our efforts and looking at ways to recruit nurses to move to those areas, as well as looking at ways to provide services in those areas using technology and using different models to enable nurses to work to full capacity. There are problems with some jurisdictional regulations and policies that create barriers.

Those are all solutions that are multipronged. It means having a global sense of the situation and of the needs of the population right now.

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

I see that across the country that day cares have one worker for every eight children. We know that in Alberta's nursing standards for long-term care facilities, for example, it's one nurse for seven patients. We know that in Ontario, the standard for ICUs is three patients to each nurse, but as you said, it can depend on the condition of the patient.

In terms of doctors, did I hear you correctly, Dr. Gill, that one million people in Ontario don't have a family doctor?

[Dr. Kulvinder Gill]

It's now over one million.

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

I'm not surprised at all. In Ottawa, the average wait time for a family doctor is six years, so this is a huge issue.

[Dr. Kulvinder Gill]

The wait times for some specialists have actually ballooned to even beyond three years now, so it's extremely dramatic. Canada has one of the lowest doctors per capita rates among OECD countries. Rather than trying to recruit and rather than trying to train more physicians, we've done the opposite.

In Ontario the government cut 50 residency positions, and over the last three years we've actually trained 150 fewer physicians. The toxic climate created by the regulatory body, along with the escalating cuts, has actually driven physicians away from the the province.

Not only are new grads not staying in Ontario, but doctors closer to the end of their careers are actually retiring earlier. We're seeing more and more physicians starting to work outside of OHIP, simply because it's become so toxic through the CPSO and the Ontario government that doctors are now actually leaving the profession of medicine.

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

We see different situations across the country, but anecdotally I'm hearing that there are enough Canadian people trained as doctors that we could put a lot more doctors into the system. There are a lot of Canadian-trained doctors who are not actually able to successfully get a match or get a placement.

In B.C. specifically, they have an issue because of the financial incentives they've put in place provincially: It makes more sense to be an ER doctor than it does to be a family physician, because you have no overhead as an ER doctor for basically the same salary.

Are there a number of solutions that you would recommend in order to address the doctor shortage?

[Dr. Kulvinder Gill]

As I said, the government really needs to start to see physicians as humans. If there's one message I can bring to this committee, it's that doctors are humans. Start treating doctors as humans, and that means taking away a lot of these toxic policies that exist. There is no reason physicians should not have a fair due process. There is no reason physicians should not have the presumption of innocence. There is no reason physicians should not have protection for the freedom of conscience. There is no reason physicians should not have protection of free speech. There is no reason that physicians should not be treated like every other Canadian citizen.

Right now in Ontario, physicians are literally second-class citizens. Let that sink in. Physicians are second-class citizens in Ontario. The very people who are dealing with life-and-death situations, who have spent over 10 and for some nearly 20 years of formal education to be able to provide you with the care that you need at your most vulnerable time, are being treated as though they are subhuman. We have a serious problem.

If we don't start treating front-line physicians as humans, we are going to have a serious problem, because there will be no front-line physicians left, especially after the appalling Ontario court ruling that happened yesterday. It's unprecedented anywhere in the world for freedom of conscience of physicians to be removed. Doctors no longer have freedom of thought. Once that happens, there is a serious problem.

The court made it seem as though there was a dichotomy in terms of trying to pit physicians' rights against patients' rights, but that was a false dichotomy. Every other jurisdiction in Canada figured it out. Every other jurisdiction in the entire world figured it out, so clearly solutions exist. When governments become hostile towards front-line doctors, they leave the profession.

[The Chair, Liberal, Bill Casey]

Okay. Thanks very much.

Now we go to Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair. Thank you all for being here.

Dr. Gill, I represent Brampton South. Thank you for serving Bramptonians. I know we have approximately 900,000 residents but just one hospital.

We heard last week about crowded hospitals, lack of physicians, and cyber- bullying. You also mentioned that. Can you explain to me how we can prevent physicians or health care professionals from cyber-bullying?

[Dr. Kulvinder Gill]

That's extremely challenging, especially because the Internet affords individuals with anonymity. When someone can remain anonymous, there's no accountability for their actions.

There is also something known as RateMDs, which has become a very toxic environment. It's actually owned by the Toronto Star corporation. They even write negative reports and then solicit physicians to have those negative reports.... According to one National Post article, those reports are possibly even being written by the very company itself. Things like this are extremely toxic. Not only are physicians then dealing with toxicity on the front lines—a toxic college, a toxic government—but it's now a toxic Internet as well.

I think that's where government can come in and play a positive role. When businesses are profiting off of the misfortunes of others by creating false reviews and then trying to target physicians to subscribe, at an enormous amount monthly to have those reviews removed, we have a serious issue.

One successful libel suit came forward here in Ontario just this past week against RateMDs. Hopefully there will be more, so that the toxicity ends.

[Sonia Sidhu, Liberal, Brampton South, ON]

Cybersecurity is one main priority for our government. If you have any solutions, you can email us.

If any of you has a suggestion on how the federal government can address that issue, please send it to us or email it to us, and we will look into it.

How can we defuse the situation of training for health care professionals? Can you talk about that?

[Dr. Kulvinder Gill]

Medical students start experiencing sexism and racism from patients—for example, sexual harassment—when they are in their early clerkship years, even before they have gone into their formal residency training.

From the time I trained to even now, there has been no formal training in how to deal with a patient who becomes violent or uses racial slurs.

There was an event in Mississauga about two years ago that made national and international headlines. A patient went into a walk-in clinic and was demanding to be seen by a white physician, and a lot of derogatory language was being used. At that time, the health minister and the premier were denouncing it. The college had indicated that physicians are afforded protection under the Ontario Human Rights Code, but also indicated that the college has absolutely no policy to actually deal with it.

That was one of our 11 recommendations: not only having mandatory training during medical school and in the residency training curricula, but also ensuring that provincial and territorial regulatory bodies develop policies to ensure that basic human rights codes are actually protected and there are policies to deal with harassment issues.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.