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« Resignation of the OMA Executive-What Now? | Main | B.C. Courts will bring into Focus the Hard Questions about Canada’s Health Care System »
Tuesday
Nov152016

Ontarians Should Be Very Wary of Bill 41- "The Patients First Act"

If ever there was a piece of legislation inappropriately named, it is Ontario Bill 41. If the Ontario Liberal government had more accurately named its legislation, “The Grow Bureaucracy and Invade Patient Privacy Act”, it would have garnered a lot more public and media attention. Even the Ontario Medical Association might have been forced to deal with it earlier instead of waiting until the legislation was under fire from front-line physicians.

Bill 41, cloaked in the reassuring sounding title of “The Patients First Act”, has passed second reading and is before a legislative committee. Premier Kathleen Wynne and Health Minister Eric Hoskins want to see it passed in the next four weeks.

Three things you should know about Bill 41:

1. Bill 41 gives the right to government to access your private medical records. The privacy of an individual’s medical record has traditionally been a source of reassurance and trust for patients during the medical process. For government to give itself the power to invade your privacy is as an affront to an individual’s right to have a confidential relationship with their doctor. Today, providers work in teams and more people do have access to a patient’s record now than ever before. But for government to insert itself between providers and patients has potential for negative consequences including further rationing of care and denial of government funded care-which is undoubtedly the rationale for this invasion of privacy.

2. Bill 41 will grow the bureaucracy adding more layers to the fourteen Local Health Integration Networks creating an additional eighty sub-LHINs to be filled with various personnel. Piling on more bureaucracy to the already inefficient LHINs is not the way to stretch our tax dollars to deliver more needed care. Since 2004, the growth in bureaucracy under the Ontario Liberal regime is staggering.  We have seen many layers of managers created to measure quality and wait times, while front line funding is being cut to offset the Ontario Liberals’ waste and mismanagement elsewhere.  The efficiency of the bureaucracy is not even measured. Ontarians will be paying for more managers, not more care.

3. Bill 41 empowers the Ontario Minister of Health with extraordinary levels of autonomy. This dictatorial positioning is of serious concern and raises many red flags. The legislation gives the government more power over patients and providers and it gives one individual, the Minister of Health, the power to do whatever is considered “in the public interest”. This is extraordinary power. Without ever consulting the public about its “interests”, doctors’ offices may be closed, providers may be limited in their ability to work based on geography, and various groups that exist to deliver care will cease to have a voice. Doctors and health care providers will be forced to comply with government decisions and those decisions will not require engaging the public or the medical profession in the process.

Make no mistake. The Ontario Liberals’ Bill 41, "The Patients First Act", is not about putting patients first. It is about the invasion of patient privacy, injecting the government into health care at every turn with a bulging middle management bureaucracy, and expanding the power of the Minister of Health to limit access to care and to treatments.

The public should be very wary of Bill 41. The rights and power seized with this legislation should remain with the people and not be snatched by a government to grow its bureaucracy while rationing our care. Bill 41 entrenches a heavy-handed, top down health system that no longer guarantees the trust and privacy of the doctor-patient relationship. It is truly unconscionable--even for this Wynne Government and Health Minister Hoskins. 

Reader Comments (671)

The OMA has died.
February 6, 2017 | Unregistered CommenterMovingforwardOntario
Why do government employees cost so much?
Charles Lammam and Ben Eisen, Special to Financial Post, National Post February 6, 2017 – 5:08 pm ET


"The reason is twofold. In the government sector, political factors largely determine the wage-setting process, while economic realities — productivity concerns, market forces, hard budget constraints — guide the process in the private sector. Moreover, the monopoly environment of the government sector amplifies these differences, compared to the competitive environment of the private sector."
February 6, 2017 | Unregistered Commentereklimek
Sorry CUPE, you supported the wrong party. Running serial deficits and scandals costing taxpayers billions has left zero wiggle room but you were more interested in protecting your own interests than electing prudent fiscal managers. They are 100% correct that Ontario hospitals are severely underfunded but the cookie jar is empty and there is nothing left. Hard to feel sorry for CUPE or RNAO but I do feel sorry for the nurses and other workers.

CUPE would be the first to fight a parallel private system even if patient care and options (for patients and workers) improved.
February 6, 2017 | Unregistered CommenterERDOC
I don't believe it---it's a stratagem of some kind---we need oak stakes, a wooden mallet, vials of holy water and garlic necklaces to do the job properly.
February 6, 2017 | Unregistered CommenterAndris
From the Toronto Star:

<<The OMA won’t restart negotiations unless the government agrees in advance to go to binding arbitration in the event of an impasse.

But the government has refused because it doesn’t want to hand over control of an $11-billion-plus budget to an arbitrator.>>

Do others see this as a particularly strong rationale? In the past, they have handed control of about 60 to 70% of the hospital budgets arbitrators during staff labour negotiations.

Maybe I should just go back from where I came from and continue to recharge?
February 6, 2017 | Unregistered CommenterExecutive Lead Blogger
"The OMA will change nothing" Mfo 28/1/16

With all due respect it was pretty clear that after the rejected tPSA in the summer and the 55% non-confidence vote it was only a short matter of time until the executive fell on its sword. It only took a week, but they did the right and honourable thing by resigning and putting the interests of the profession ahead of their own interests.

Oh the delicious irony that Hoskin's legacy will be that he provided the infusion of calcium necessary to refortify the OMA's failing osteoporotic spine such that the profession will hopefully become unified once again, and have the gonads to take on this authoritarian arrogant health minister. We are going to make his life very difficult from here on in until June 2018.

To all those on this blog who have fought for this day for the last decade thank you so much as it has been a long time coming. And Realist a special thank you to you for allowing us to use this blog to express often controversial views from those on the front line who have tirelessly advocated to maintain a traditional doctor patient relationship without heavy-handed government interference.

We have a long way to go yet but this is the first major step toward putting this government back into the corner where it belings in order to restore our professional independence and self-respect.

Next step is to make OMA membership voluntary. Carry on!
February 7, 2017 | Unregistered CommenterCanary in a Coal Mine
"Dr. Kulvinder Gill, president of Concerned Ontario Doctors, said she hopes the resignation of the executive committee marks the first of many steps the OMA could take towards “renewal.”

“If it’s truly meant genuinely to be for OMA renewal, to gain the trust of frontline physicians again, then OMA leadership must listen to voices from the frontline doctors who are demanding that their president be elected by general membership, that are demanding transparency and that are demanding accountability,” Gill said.

She added the resignations were a goal for her organization for the past six months.

“We’ve been advocating for this for the past six months, since the failed historic contract of the summer,” Gill said. “It’s certainly news that is welcomed by Ontario’s doctors.”"

http://www.torontosun.com/2017/02/06/oma-leadership-resigns-amid-controversy



"In announcing the departure of its executive, the OMA board urged members to maintain “a strong and united front against a government that is intransigent in its approach to health care and disrespectful of physicians.”"

http://www.theglobeandmail.com/news/national/ontario-medical-association-head-resigns-following-no-confidence-vote/article33920497/
February 7, 2017 | Unregistered CommenterCanary in a Coal Mine
Walley claimed the association council had “affirmed their confidence in the elected leaders of the Ontario Medical Association.”

However, a counter statement from the Coalition of Ontario Doctors said the vote “further erodes an already abysmal level of confidence that doctors have in the credibility of the OMA’s current leaders, who have repeatedly refused to step down.”

http://ottawacitizen.com/news/local-news/ontario-medical-associations-embattled-leadership-steps-down
February 7, 2017 | Unregistered CommenterCanary in a Coal Mine
With Bill 41 done, 87 about to pass, look for the Health Care Professional Allocation bill, defining the number of funded positions permitted per LHIN, and how to affect redistribution by funding flows to LHINs.
February 7, 2017 | Unregistered CommenterMovingforwardOntario
The resignations one week delayed do nothing more than document the sullen imperious nature of the OMA. Note the board remains. Same deck of cards will be shuffled and no surprises expected.

The next key step is spring council. At that venue the temperment will emerge.

The key vote will be over special action levy. Will the membership, now rattling the swords, actually support and man the barricades? To be continued ....
February 7, 2017 | Unregistered Commentereklimek
Great to see these insightful comments this morning.
And thanks for your kind comments CICM. I believe in listening to diverse views. One of the reasons I departed from OMA efforts was because the change in governance and Council "efforts" had become about optics.
Diverse views were given limited "airing" and then the Board and the Exec did mostly what they wanted supported by the rationale of "fiduciary duty" and that alignment with government was the way to $$. Sad to observe. I believe that higher level staff was also a driver of this approach.

In any case, here we are. The resignation of the Exec down to Board level is to placate in my opinion. I believe it is an effort to buy some time for the former executive members and the OMA to have its message heard. It will draw on the empathy of OMA members and ask for a second chance. Elections will be held. It will be like mixing your peas with your mashed potatoes.
February 7, 2017 | Unregistered CommenterMerrilee Fullerton
"But the government has refused because it doesn’t want to hand over control of an $11-billion-plus budget to an arbitrator.>>

Do others see this as a particularly strong rationale? In the past, they have handed control of about 60 to 70% of the hospital budgets arbitrators during staff labour negotiations."-ELB

How about a few million for negotiations errrr "pizza money"! Gotta speak to Liz Sandals to see how to arrange! Apparently it's quite possible for government to negotiate with some groups by providing them with financial support for their negotiations with government. But government is afraid to have an arbitrator for MDs.. too weird.
February 7, 2017 | Unregistered CommenterMerrilee Fullerton
R

The power imbalance is noteworthy. The faithful are rewarded.

If I were the Prince, the plan will be

- revoke the OMA representation rights and elminate the organizations ability to assemble a war chest. Fragmenting the doctors remains a priority.

- Ensure the cooperation of the CPSO durng any job action "to protect the public"
February 7, 2017 | Unregistered Commentereklimek
Of note:

February 7, 2017
The Coalition of Ontario Doctors and Concerned Ontario Doctors (COD) called yesterday’s partial resignation of the OMA Executive members a positive first step in the rehabilitation of the OMA’s governance structure and its duty to represent all Ontario doctors fairly. The resignation is partial because the same individuals remain on the OMA Board for the time being leaving many unanswered questions.
The Coalition and Concerned Ontario Doctors (COD) were joined by thousands of doctors who called for the resignation of the OMA Executive Committee members over the past six months due to the OMA’s decision to unsuccessfully force through a deeply flawed Physician Services Agreement that was rejected by 63% of voting physicians.
The removal of the OMA Executive is only the first of many renewal initiatives that Ontario doctors have identified as being essential. Other measures include the negotiation of a Binding Arbitration framework with government as a pre-condition to resume negotiations as well as a new and more professional approach to negotiations to ensure patient care is not rationed further by this Liberal government. The OMA continues to require significant internal governance reform to ensure that the entire physician community elects the OMA Board and Executive leaders to permit transparency, accountability, equity and fairness for all Ontario doctors. Ontario’s patients and doctors need a member-driven organization that is able to passionately advocate for Ontario’s doctors, patients and healthcare system.
Doctors are now going into their fourth year without a contract and have been subjected to an unprecedented period of government hostility directed towards the profession and an unwillingness to bargain in good faith. The Ontario Liberal government has repeatedly bullied and vilified physicians while it has unilaterally cut nearly $2 Billion from the patient services Ontario’s doctors provide. This has led to unprecedented patient wait times for medically necessary care. The recent passing of Bill 41 is a further threat to patients’ access to care and patient privacy rights. The OMA’s longstanding failure to effectively challenge this government’s abuse has served to galvanise thousands of grassroots doctors to be active and to demand change through organisations like the Coalition and COD.
Even though accountability for their actions comes at a very late date, it is an important first sign that doctors can begin to take back their organisation and commence the difficult task of demanding the same fairness and equity from the Ontario Liberal government.
The Coalition and COD will soon be communicating new and disturbing developments we have just learned that OMA has purposely hidden from its members. These alarming issues will be addressed in more detail soon. It includes OMA having advance knowledge of plans by the Ontario Liberals to unilaterally cut even more from the patient services Ontario’s doctors provide. The OMA Executive failed to notify the profession about these dramatic cuts and had planned to do nothing to protect Ontario’s patients and doctors against their devastating impacts.
February 7, 2017 | Unregistered CommenterMerrilee Fullerton
"The Coalition and COD will soon be communicating new and disturbing developments we have just learned that OMA has purposely hidden from its members. These alarming issues will be addressed in more detail soon."

Hmmm.
February 7, 2017 | Unregistered CommenterMerrilee Fullerton
R

Most likely the "news" is no more than foreknowledge of further cuts in the SOB.

Airing the laundry is to be expected. The xtent of the insider information may suggest collusion, but really, its not likely. The OMA was probably privy to such discussion even during last years "negotiation".

The issue is will the rabble coalesce, will a war chest be assembled, and will a widespread "Wynnfluenza" emerge? New leadership is nominally important, but without buy in is meaningless.
February 7, 2017 | Unregistered Commentereklimek
eklimek,
It is my belief that many MDs still think the money will flow. They seem to believe that with a few protests, and some spine at the OMA and the money will flow somehow. Even after 4 years of no contract, an aging population, a sluggish economy, media promotion of any public disapproval of high income earners, and a Liberal spin machine that has proven itself to be empty and unhelpful, I continue to meet MDs who still believe in the Ontario Liberal approach. It is concerning. Why is this?

Is it because these MDs have been paid "physician leaders" and hope the gravy train payments for their "leadership" won't end?
OR
Is it that they are afraid to support a political party that is not currently in power? Hard to say.
Or
Is it that they are selected in medical school for their leanings?
Or
Is it that they don't know any other way to make a living than by government and have been told that this is the noble way?

In all cases, there is serious concern.
February 7, 2017 | Unregistered CommenterMerrilee Fullerton
" Wynnfluenza"....might just catch on.
February 7, 2017 | Unregistered CommenterAndris
R

Concur. Status quo is leading to inadequate and diminishing care. As the "margin" expands there will be pain. When government is faced with the electrate insisting on unavailable services, the solution will be unavoidable.
February 7, 2017 | Unregistered Commentereklimek
"Bureaucracy defends the status quo long past the time when the quo has lost its status." -- Laurence J. Peter
February 7, 2017 | Unregistered CommenterMerrilee Fullerton
Laurence J. Peter of the Peter Principle

"Democracy is a process by which people are free to choose the man who will get the blame." -Laurence J. Peter

Also worth noting from Mr Peter:

"Expert: a man who makes three correct guesses consecutively."
February 7, 2017 | Unregistered CommenterMerrilee Fullerton

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