A senior Australian police official who suggested an app could be used to document sexual consent in an effort to improve conviction rates in sex crime cases was met with a largely negative response Thursday.
New South Wales state Police Commissioner Mick Fuller said that the same dating apps that have brought couples together could also provide clarity on the question of consent.
“Technology doesn’t fix everything, but … it plays such a big role in people meeting at the moment. I’m just suggesting: Is it part of the solution?” Fuller asked.
The commissioner said the number of sexual assaults reported in Australia’s most populous state was increasing while a prosecution success rate of only two per cent stemming from those reports showed the system was failing.
“Consent can’t be implied,” Fuller wrote in News Corp. newspapers. “Consent must be active and ongoing throughout a sexual encounter.”
Responses to the suggestion of a consent app have been largely negative or skeptical, with many saying technology was not the answer.
“It’s good (the NSW police are) acknowledging the need for affirmative consent, but this isn’t a safe way forward,” said Hayley Foster, the chief executive at Women’s Safety NSW, the state’s domestic violence service.
“The abuser can simply coerce the victim to use the app,” she tweeted in response to Fuller’s comments.
“I’m mystified by the ongoing belief that technology must be a good solution in situations where we are dealing with power, nuance and complex human behaviour,” said Annabelle Daniel, head of Women’s Community Shelters, a charity.
Catharine Lumby, a Sydney University specialist in ethics and accountability, described the app as a quick-fix that misunderstood the circumstances of sexual assaults.
“Fundamentally, what we are now having a reckoning with is the fact that there is a very small minority of men in this society who are opportunists, who make the decision to sexually assault women,” Lumby said.
“They don’t care where, how or why they do it. They will take the opportunity and I’m sure they are more than capable of manipulating technology,” Lumby said.
Lesley-Anne Ey, a University of South Australia expert on harmful sexual behaviour involving children, said she didn’t think the app would work.
“I don’t think they’re going to interrupt the romance to put details into an app,” Ey told Australian Broadcasting Corp.
Meanwhile, State Premier Gladys Berejiklian congratulated Fuller on “taking a leadership position on having the conversation” about the sexual assault problem, but declined to share her opinion on the app.
Top Australian officials accused of rape
More than 100,000 women protested in rallies across Australia on Monday demanding justice while calling out misogyny and dangerous workplace cultures.
The public anger erupted after the Australian attorney general denied an allegation that he raped a 16-year-old girl 33 years ago. As well, a former government staffer alleged that she was raped two years ago by a colleague in a minister’s Parliament House office.
Fuller said his app suggestion could gain popularity in time.
“To be honest with you, the app idea could be the worst idea I have in 2021, but the reality is in five years, perhaps it won’t be,” he said. “If you think about dating 10 years ago, this concept of single people swiping left and right was a term that we didn’t even know.”
A consent app similar to Fuller’s proposal was launched in Denmark last month. But the app hasn’t been widely adopted, with fewer than 5,000 downloads, according to mobile intelligence site Sensor Tower.
Facebook said on Tuesday it will lift its ban on Australians sharing news after it struck a deal with Australia’s government on legislation that would make digital giants pay for journalism.
Treasurer Josh Frydenberg and Facebook confirmed that they have agreed on amendments to proposed legislation to require the social network and Google to pay for Australian news that they feature.
Facebook’s co-operation is a major victory in Australian efforts to make the two gateways to the internet pay for the journalism that they use.
Facebook blocked Australian users from accessing and sharing news last week after the House of Representatives passed the draft law late Wednesday.
Initially, the Facebook news blockade cut access — at least temporarily — to government pandemic, public health and emergency services, sparking public outrage.
The Senate will debate amended legislation on Tuesday.
Frydenberg described the agreed upon amendments as “clarifications” of the government’s intent. He said his negotiations with Facebook chief executive Mark Zuckerberg were “difficult.”
Australia in ‘proxy’ battle, says official
“There is no doubt that Australia has been a proxy battle for the world,” Frydenberg said.
“Facebook and Google have not hidden the fact that they know that the eyes of the world are on Australia and that is why they have sought to get a code here that is workable,” he added, referring to the country’s News Media Bargaining Code legislation.
The code would undermine the bargaining dominance of Facebook and Google in their negotiations with Australian news providers by requiring a negotiation safety net in the form of an arbitration panel. The digital giants would not be able to abuse their overwhelming negotiating positions by making take-it-or-leave-it payment offers to news businesses for their journalism. In case of a standoff, the panel would make a binding decision on a winning offer.
WATCH | Facebook blocks Australian users from accessing and sharing news:
Facebook feeds in Australia were stripped of news posts during a fight over government plans to make technology giants pay for sharing news content and there are concerns something similar could happen in Canada. 2:02
Swinburne University senior lecturer on media Belinda Barnet said the proposed amendments guarantee Facebook time to strike deals before the arbitration panel decides on a price for news.
Peter Lewis, director of the Australia Institute’s Center for Responsible Technology, a think tank, said in a statement that the “amendments keep the integrity of the media code intact.”
Google also had threatened to remove its search functions from Australia because it said the proposed law was unworkable. But that threat has faded.
Google has been signing up Australia’s largest media companies in content licensing deals through its News Showcase model.
The platform said it has deals with more than 50 Australian titles through Showcase and more than 500 publishers globally using the model which was launched in October.
Facebook said it will now negotiate deals with Australian publishers under its own model, Facebook News.
“We are satisfied that the Australian government has agreed to a number of changes and guarantees that address our core concerns about allowing commercial deals that recognize the value our platform provides to publishers relative to the value we receive from them,” Facebook regional managing director William Easton said.
“As a result of these changes, we can now work to further our investment in public interest journalism and restore news on Facebook for Australians in the coming days, ” Easton added.
Whether you support it or are against it, one thing is for certain — medical assistance in dying, or MAID, is a complex, multilayered and deeply personal issue.
Canada’s Parliament passed Bill C-14 in 2016, legalizing assisted dying. Since then, more than 13,000 people have chosen to end their lives that way.
However, a Quebec Superior Court decision struck down the “reasonably foreseeable death” clause in Bill C-14 as unconstitutional, forcing the government to amend the law earlier this year.
The amended law, known as Bill C-7, was tabled on Feb. 24. The proposed changes address, among other things, concerns around who is eligible for MAID, the role of palliative care, and the role of consent.
A full review was scheduled to begin this summer, but has been delayed due to COVID-19. The pandemic has also had an impact on the delivery of MAID across Canada as some hospitals temporarily restricted services, and personal protective gear (PPE) and physical distancing requirements added a layer of complexity to the procedures.
Canadians across the country still have many questions about who can access medical assistance in dying, and when. After the government tabled Bill C-7 in February, The National co-host Andrew Chang and members of the public put some of those questions and concerns to experts in a CBC town hall as part of an important yet difficult conversation. The expert panellists included:
David Lametti, Minister of Justice and the government’s lead on the MAID file
Madeline Li, former head of MAID at University Health Network
Trudo Lemmens, professor and Scholl Chair in Health Law and Policy in the Faculty of Law at the Dalla Lana School of Public Health, and the Joint Centre for Bioethics at the University of Toronto
Susan Desjardins, Dying With Dignity Canada
The National Conversation on MAID was recorded on March 5, 2020, but due to the pandemic it was delayed and aired on The National on July 16 and on CBC News Network on July 19. These are some highlights from the town hall.
Phyllis Fehr is 60 years old, and a former intensive care nurse. She was diagnosed with Alzheimer’s seven years ago. While the diagnosis was difficult for her to accept initially, she does not let it stop her from living and ending her life her way.
Fehr asks: “How will the medical system ensure that there are enough safety checks in place that I will indeed receive MAID when I am near death, and not too soon before I am ready?”
Madeline Li believes that advanced directives discussed and drawn up with family members, along with guidance from clinicians, can help ensure that patients’ wishes as to the timing of MAID is clear:
Madeline Li discusses safeguards that are in place around medical assistance in dying. (The MAID town hall was recorded March 5, 2020.) 0:52
Minister Lametti added that in addition to current safeguards already in Bill C-14, other safeguards are also under consideration.
“There will have to be safeguards that we look at when we do deal with dementia and Alzheimer’s more specifically … we’re always trying to find the right balance between safeguards and a person’s ability to choose.”
Ron Posno has dementia and is a strong advocate of allowing advance directives for MAID. At present, the law requires a final consent just before MAID is administered — which is a worry for people with dementia, since they lose the ability to do that as their illness worsens.
Posno asks: “Those of us with dementia have so far been left out of the conversation around MAID. Will people with dementia be included in the new amended MAID legislation?”
Minister Lametti says he believes that MAID and dementia is an issue of such complexity that comprehensive further review is needed before a decision of any kind can be made:
Minister of Justice and Attorney General David Lametti explains why dementia and cognitive decline patients are not yet allowed access to medical assistance in dying. (The MAID town hall was recorded March 5, 2020.) 0:56
Trudo Lemmens adds that advanced directives for MAID by dementia patients is globally a hot-button issue. He points out that it is so complicated that, “there is no country in the world except the Netherlands that allows an advanced request for medical aid in dying in the context of severe dementia.”
Power of attorney
Judy Kirby watched her mother die a slow, painful death. She had power of attorney over her mother’s treatment, and although she could have stopped her being given water and oxygen, she says she did not have the legal ability to ask for MAID for her mother.
Kirby asks: “Will or when will MAID be available to a power of attorney to make those decisions?”
Minister Lametti told Kirby that allowing a power of attorney to make decisions around MAID is an “ethically charged issue,” and that the government is going to look at it at a later stage:
Minister of Justice and Attorney General David Lametti explains why someone with a power of attorney can not make a request for medical assistance in dying. (The MAID town hall was recorded March 5, 2020.) 1:00
Susan Desjardins, from Dying With Dignity, shared with Kirby that she had personally gone through a similar experience. She suggests the patient, “identify not necessarily a power of attorney, but an advocate who could speak for them if they can’t speak for themselves at a time at which they would meet certain conditions they had defined, [and] that at which time they would have wanted to have an assisted death.”
Jason LeBlanc posed a question to the panelists on behalf of his girlfriend, Justine Noel, who was too sick to attend the town hall.
Justine is 29 years old and has fibromyalgia. She has submitted three MAID requests and has been denied twice. She’s awaiting official assessment on her third request. LeBlanc says Noel is worried she will be denied access to MAID once again, due to a lack of medical expertise available to assess her specific condition.
Leblanc asks: “Justine’s question is, what do you intend to do when there is no available MAID assessor with expertise in the applicant’s condition?”
According to Minister Lametti, the expert assessment for MAID no longer requires a specialist, but rather a practitioner with “some level of expertise in the condition.” He adds:
Minister of Justice and Attorney General David Lametti explains who can perform an expert assessment for medical assistance in dying. (The MAID town hall was recorded March 5, 2020.) 0:49
Ernest Frederiksen is a 27-year-old who has lived in constant pain for more than 11 years, due to fibromyalgia and arthritis.
He applied for access to MAID in 2016 and was denied, as his death was not considered “reasonably foreseeable.” He plans to apply again in a few months.
Frederiksen asks: ” Why should I, or those like me whose deaths are not reasonably foreseeable, have to continue enduring physical or psychological suffering that is intolerable and that cannot be relieved, through a 90-day waiting period instead of a waiting period of 30 days?”
Susan Desjardins from Dying with Dignity, also questions the rationale behind a 90-day waiting period before MAID can be given. “Do we really need a 90 day period, or is some of your length of period [not] reasonable to achieve the goals that we’re trying to here in terms of balancing things?”
Minister Lametti pointed out that there were waiting periods under the old act. However, in Bill C-7, waiting periods have been eliminated “because we found that they don’t work.” He adds that the 90 days is a “period of assessment”:
Minister of Justice and Attorney General David Lametti explains why the 90-day period mandated by the government for MAID is one of assessment, and not a period of waiting. (The MAID town hall was recorded March 5, 2020.) 0:55
MAID and the marginalized
Sarah Jama is the founder of the Disability Justice Network of Ontario. She’s worried that once the requirement for “foreseeable death” is removed, MAID will be accessed by a disproportionate number of disabled and racialized people, as a result of a failure of the system to help them live full, sustained lives.
Jama asks: “How are we going to make sure that marginalized communities like the Indigenous, racialized people, and those with disabilities, don’t feel pressured to access MAID because they feel like a burden on the state?”
Trudeau Lemmons shares Jama’s concerns. “People with disabilities are now confronted with the choice when they enter the hospital. You can have MAID in 90 days, or you can go through administrative difficulties of applying for a new system of disability support … that’s actually not available.”
Minister Lametti admitted that the government needs to do more for marginalized people and communities. He stressed that the decision for MAID should never be one of compulsion, but rather always be an informed choice:
Minister of Justice and Attorney General David Lametti on the government’s role in building a system of sustainable care for marginalized communities. (The MAID town hall was recorded March 5, 2020.) 0:47
Bob Davies is a pastor at Kanata Baptist Church. As a person of faith, his biggest concern is the impact of MAID on those caregivers, organizations and people whose moral code does not permit it.
Davies asks: “What is being done to protect organizations, health care workers, caregivers and others from facing the emotional and psychological consequences of participating in or being near a medically assisted death that is against their conscience?”
Minister Lametti assured Davies that no clause in Bill C-14 will compel anyone to participate in MAID if they choose not too:
Minister of Justice and Attorney General David Lametti discusses the support available for those providing medical assistance in dying services. (The MAID town hall was recorded March 5, 2020.) 0:34
MAID and mental health
Glenn Johnson has been living with PTSD and chronic depression for many years. He also suffers chronic pain from degenerative disc disease. He knows that he will want MAID when conditions for him worsen, and he wants MAID extended to those with mental health issues.
Johnson asks: “Pain is pain. Suffering is suffering. And there is no foreseeable end to either my chronic pain or my mental health issues. I want to know why people like myself, with mental illness,are not able to access MAID?”
Trudo Lemmens admits that MAID and mental health illness is one of the most complex issues to tackle. Determining who will and will not get better is close to impossible, he says:
Trudo Lemmens on why the law excludes those with mental illness from access to MAID. (The MAID town hall was recorded March 5, 2020.) 0:56
Minister Lametti added that, “it is an ongoing challenge to better understand the various kinds of mental health issues that might become the basis for a MAID request down the road. We just kept hearing again and again that we weren’t ready to make it part of the MAID package.”
Palliative care vs. MAID
Dr. Naheed Dosani is a Toronto palliative care physician who works at hospitals and within the community to care for people with life-limiting disease at a variety of stages of illness.
In his view, priority needs to be given to better access and options around palliative care, rather than MAID.
Dr. Dosani asks:“How are we working to build up our health care and social care systems, not just in hospitals but in the community too, so that all Canadians from all walks of life have equitable access to quality of life-based palliative care?”
Minister Lametti agreed that access to quality palliative care is crucial. “As a government we have identified palliative care as critically important, and we’re developing an action plan. We’ll obviously work with our provincial partners and territorial partners to try to make sure that it happens.”
Susan Desjardins adds that she believes that both MAID and palliative care focus on the same thing — the quality of dying:
Susan Desjardins shares her personal experience with family members accessing palliative care and MAID. (The MAID town hall was recorded March 5, 2020.) 1:06
It looks like Prince Edward Island will lead the way in Canada’s return to soccer, with the Canadian Premier League looking to possibly kick off its pandemic-delayed season in Charlottetown.
Vancouver Island is also in the running to host the Canadian pro league.
“Both are very excited about the Canadian Premier League,” said CPL commissioner David Clanachan.
The Canadian Soccer Association announced Friday that the sport can resume in P.E.I. and B.C., providing clubs compete the final phase of its “Return to Soccer Guidelines” which includes completing a “self-assessment tool.”
A Canada Soccer spokesman said amateur teams could resume training in P.E.I. as soon as this weekend with clubs in B.C. perhaps following next week.
The CPL, meanwhile, said Friday that its owners, clubs and player leadership had unanimously agreed on “the structure and concept of a proposed strategy on the possibility of a 2020 CPL season.”
WATCH | Is it too early for a return to sports?:
CBC Sports’ Jamie Strashin details the various return to play scenarios unfolding across the professional sports landscape. 2:52
Now they just need to nail down a venue, with P.E.I. and Vancouver Island the two leading candidates. That involves getting the approval of local health authorities.
“We feel very confident that our health and safety protocols are very stringent,” Clanachan said in an interview. “And I can say our players are pleased with what they’ve seen. it’s answered all their questions and more.”
‘Charlottetown is open for business’
Charlottetown raised its hand via a statement Friday.
“Charlottetown is open for business,” Mayor Philip Brown said in a statement. “I’m excited to be able to extend an invitation to the Canadian Premier League and its eight member teams to play their modified single-city season in the birthplace of Confederation — it doesn’t get any more Canadian than right here in Charlottetown
The P.E.I. government confirmed last month it had been approached by HFX Wanderers FC about having the CPL resume its season in the province.
Vancouver Island and Langford, B.C., home to the league’s Pacific FC, have also expressed interest.
Lisa Beare, B.C.’s minister of tourism, arts and culture, said she has been in contact with the CPL about hosting a shortened season in Langford.
“We are currently reviewing their proposal,” Beare said in a statement. “It would be great to see Canadian soccer being played on Vancouver Island this summer in a way that is safe for everyone.”
Like Major League Soccer, the CPL is looking at staging a round-robin tournament in one location. The hope is both leagues may be able to resume play in their own host cities at a later date.
“The problem with the world we live in today is everything is changing so quickly every day,” said Clanachan. “That could be very good news for us a few months from now or it could be bad news.
“I’m holding out hope that that [playing in home cities] could be the case. I think everybody is kind of hoping for that.”
League targets July resumption
The league was slated to kick off its second season on April 11 but has been on hiatus due to the global pandemic.
As of Friday, P.E.I. had 27 confirmed cases of COVID-19 and no deaths. Vancouver Island had 130 cases including five deaths.
The league is looking at starting mid- or late July with play going into September. Clanachan says it will be up to the local health authorities if teams would have to self-quarantine upon arrival.
The league has some experience in transporting its teams en masse, having taken them to the Dominican Republic for pre-season training prior to the 2019 inaugural campaign.
Canada Soccer says another two to four provinces could follow P.E.I. and B.C. in returning to play.
“Starting with the suspension of sanctioned soccer in March, countless hours of thoughtful and measured discussion and planning have gotten us to a place where we are confident we can once again provide a safe sport environment in areas of the country where the provincial and local governments have permitted a return to physical activities,” Canada Soccer general secretary Peter Montopoli said in a statement.
Different regions may opt for different rules in resuming the sport. Ontario, for example, could choose to return to play depending on region.
Pro teams are governed by their league’s return to play protocols, as well as local health and government authorities.
Hundreds of protesters, some armed, gathered at Michigan’s state Capitol in Lansing on Thursday objecting to Gov. Gretchen Whitmer’s request to extend emergency powers to combat COVID-19, an appeal Republican lawmakers ignored.
The protest appeared to be the largest in the state since April 15, when supporters of U.S. President Donald Trump organized thousands of people for “Operation Gridlock,” jamming the streets of Lansing with their cars to call out what they said was the overreach of Whitmer’s strict stay-at-home order.
The slow reopening of state economies around the United States has taken on political overtones, as Republican politicians and individuals affiliated with Trump’s re-election promoted such protests in electoral swing states, such as Michigan.
Many people at Thursday’s “American Patriot Rally,” including militia group members carrying firearms and people with pro-Trump signs, appeared to be ignoring state physical-distancing guidelines as they clustered together within 1.8 metres (six feet) of each other.
‘Open this state’
“Gov. Whitmer, and our state legislature, it’s over with. Open this state,” Mike Detmer, a Republican U.S. congressional candidate running for the state’s 8th District spot held by Democrat Elissa Slotkin, told the crowd. “Let’s get businesses back open again. Let’s make sure there are jobs to go back to.”
Police allowed more than 100 protesters to peacefully enter the Capitol building around 1 p.m. ET, where they crammed shoulder-to-shoulder and sought access to legislative chambers, some carrying long guns and few wearing face masks.
People had their temperature taken by police as they entered. Inside, they sang the national anthem and chanted: “Let us work.”
Other speakers at the event, which had different organizers than the mid-April protest, questioned the deadliness of COVID-19, the respiratory illness caused by the novel coronavirus.
They also said Whitmer’s stay-at-home order violated constitutional rights, and urged people to open their businesses on May 1 in disregard of her order.
Exercising right to freedom of speech
State authorities have warned that protesters could be ticketed for violating physical distancing rules. The mayor of Lansing, Andy Schor, said in a statement on Wednesday that he was “disappointed” protesters would put themselves and others at risk, but recognized that Whitmer’s order still allowed people to “exercise their First Amendment right to freedom of speech.”
State legislative approval of Whitmer’s state of emergency declaration, which gives her special executive powers, is set to expire after Thursday.
WATCH | Angry mob storms Michigan capitol:
Hundreds of demonstrators pushed their way in, protesting the governor’s COVID-19 emergency measures 0:38
She had asked for a 28-day extension, though Republican lawmakers in control of the statehouse instead voted on bills to replace the state of emergency and her executive orders with “a normal democratic process,” according to a statement from Republican House Speaker Lee Chatfield.
Whitmer is likely to veto moves to limit her authority, and state Democrats denounced the Republican efforts as political theatre.
Whitmer contends that her emergency powers will remain in place regardless under other state laws. The stay-at-home order is set to continue through May 15, though she has said she could loosen restrictions as health experts determine new cases of COVID-19 are being successfully controlled.
Whitmer has acknowledged that her order was the strictest in the country, but she defended it as necessary as Michigan became one of the states hardest hit by the virus, having already claimed 3,789 lives there.
Protesters, many from more rural, Trump-leaning parts of Michigan, have argued it has crippled the economy statewide even as the majority of deaths from the virus are centred on the southeastern Detroit metro area.
Many states, including Georgia, Oklahoma, South Carolina and Ohio, have already moved to restart parts of their economies following weeks of mandatory lockdowns that have thrown nearly one in six American workers out of their jobs.
In the southeast corner of Saskatchewan is a town called Wawota. The town, known for its colourful collection of fire hydrants painted to resemble cartoon characters like Garfield, is home to nearly 550 residents, according to the 2011 census.
“It’s a good community and good people around here. Everyone helps one another out,” said 84-year-old Clarence Lamontagne, a resident of the town and a former building contractor.
But one of the struggles of rural life — in this, and in multiple other communities across the prairies — is limited access to health care.
Wawota has a local medical clinic, but physicians from Arcola, Sask., are only on site on Mondays and Fridays, and see patients by appointment only.
“These doctors come in two days a week and they’re gone. So if you’re sick at night, you can’t go to your health clinic,” Lamontagne said. “You must go 30 miles away.”
It wasn’t always so challenging in Wawota. In the early 1990s, Wawota had its own hospital with doctors who lived and worked in the community.
“When we got all these cuts, our town was going lower and lower,” Lamontagne said. “Of course, when you lose a hospital, then you also lose your drug store, and you lose this and that.
“Then people start going to bigger communities for health reasons. It hurts your area.”
Doctor Matthew McIsaac, who has practiced in various rural communities across Alberta and currently works out of Banff and Canmore, was born in Wawota.
He said cuts to rural health implemented by Janice MacKinnon in 1993, then Saskatchewan’s finance minister for the NDP government, led to a “brain drain” in Wawota.
“It killed rural areas, including [Wawota]. We had lost our [family] practitioner to illness. His replacements came and did not stick around due to the pay cuts,” he said. “They couldn’t find anybody to provide any long-term coverage, and eventually we lost our hospital.”
Since that time, McIsaac said the population of the town has dwindled by about 200 people.
“There is evidence, historically, that things like this kill small-town medicine,” he said.
This year, MacKinnon was tapped by the Alberta government to lead a six-person panel evaluating the province’s finances. In the report emerging from that panel, various recommendations were made to help Alberta to balance its budget, including proposing pay cuts for physicians.
A move to Alberta
Eventually, McIsaac also left Wawota, but kept working in rural communities throughout rural Alberta, including in Coronation, Beaverlodge and Milk River.
Due to higher funding, McIsaac said his time practicing in Alberta was always more fulfilling compared to working in Saskatchewan, as he could take time to help a patient fully and provide complete care.
There are challenges associated with being a rural doctor, McIsaac said — it can be lonely and it can be high-pressure, given the responsibility laid on a limited number of physicians.
So when McIsaac heard about changes proposed by the Alberta government — that would affect how doctors schedule, bill, and interact with their patients, he said it “blew [his] mind.”
“It seems like the government is completely non-thinking and quite hubristic with their approach here, in believing that they’ve found an answer,” McIsaac said. “Or, there’s this cynical view that they actually want to sacrifice rural care.”
Changes proposed by the Alberta government were communicated to the Alberta Medical Association (AMA) on Nov. 14. Rural doctors say those changes, among others, would disproportionately affect their practices.
Earlier this year, Alberta Health Services reduced the amount it pays doctors to be on call after funding was reduced to its specialist-on-call program by $ 10 million per year.
“They cut that without warning quite recently and already the family physicians were quite up in arms, because that’s a big part of their livelihood,” McIsaac said. “But the second thing that’s come now is this proposal that the complex modifier fees get cut.”
Under the proposals, doctors would be paid the same for a 25-minute visit as they are for a 15-minute visit, and funding would be cut for complex care plans.
“These physicians working in rural centres are looking to face between, at the low end, a 10 per cent cut up to a 40 per cent cut for some of them in their billing, almost immediately, because of this,” McIsaac said. “So you’ve just been cut in terms of your night call, and now you’ll see [complex modifier fees cut]. Then, you’re suddenly on par with places like British Columbia, or Ontario, or Saskatchewan, which is the goal of the government.
“Well, to live in a place that is remote and rural, or to move to a place like Penticton or Kelowna or Victoria seems like a no-brainer when the pay is equal and when the cost of living is not much different.”
Some say advanced skills also threatened
Michael Beach is a family physician with training in anesthesia who practices in Drumheller, Alta., and said those working in rural settings with advanced skills would be “very disproportionately impacted” by the changes.
“It impacts us the same way as a lot of the urban doctors, but there are a few things that impact us even more so and threaten those advanced skills in the rural setting,” Beach said.
The reduction of call stipends would make a big impact, Beach said, calling them a “huge incentive” to work in rural Alberta.
Steve Buick, a spokesperson for Health Minister Tyler Shandro, wrote in a statement that those incentives were left over from former regions that competed for doctors by paying them extra.
“A decade ago we had an overall shortage, today we don’t,” he wrote. “We don’t need to pay much higher rates than other provinces when we don’t have a shortage anymore. We can make some modest reductions.”
But Beach said that while he understood what’s being argued — that doctors are working full-time during their call shift, and should not get a stipend on top of being paid continually — he said that only applies in urban settings.
“That’s not true in the rural setting at all. When we’re on these call shifts, we’re not continually providing fee for service work throughout,” he said. “For the duration of time this whole week that I’ve been on my call shift, I can’t leave Drumheller, I can’t go for a walk with my wife that’s a half-hour away from my home and my car, because I could get called at any moment to go do [anesthesia].”
Right now, we’re going to wait and see, but our minds are very open to leaving [Alberta].– Michael Beach, Drumheller family physician
Plus, according to Beach, the whole reason doctors take positions in rural Alberta is because of call stipends.
“If you lose those, in my opinion you’re going to lose a lot of people who say, ‘It’s just no longer worth the effect on my personal life and family life and lifestyle to continue to provide this service for no compensation whatsoever,'” he said. “You’re looking at a potentially large reduction in some of those services in a lot of these smaller centres.”
The spending question
Alberta today spends the second-most on healthcare, behind only Newfoundland. In his statement, Buick said government would listen to proposals offered by the AMA related to getting costs in line to other provinces.
“Some people are overreacting to our proposals and saying doctors won’t be able to do good primary care. The proposals are common sense and aligned with other provinces,” Buick wrote. “They don’t limit physicians’ ability to provide high-quality care, they just reduce the excess amounts we’ve been paying.”
The proposals are common sense and aligned with other provinces.– Steve Buick, spokesperson for Health Minister Tyler Shandro, in a statement
In a joint statement attributed to AMA president Christine Molnar and AMA rural medicine president Edward Aasman, cuts proposed by government to rural medicine could be “immense.”
“The effect would be absolutely devastating on those practices,” the statement reads. “Rural practices are already struggling to remain stable, including attracting and retaining physicians. If implemented, these proposals could severely threaten the viability of those practices.”
With all the proposed changes considered, Beach estimated he would be looking at at least a 30 per cent reduction in his salary.
“My wife and I have actually sat down and looked at it and said, ‘If all of these things come to fruition, would we stay in Alberta?'” Beach said. “Right now, we’re going to wait and see, but our minds are very open to leaving if [these changes go through].”
Addressing potential rural shortages
Even if AMA negotiations don’t go as planned, the Alberta government may have a card up its sleeve to address any shortage of rural doctors that would result from funding changes.
Bill 21, otherwise known as the Ensuring Fiscal Sustainability Act, allows the province to tell new doctors where they must practise medicine in Alberta, based on the recommendations of an expert panel.
Beach said he found that move counterintuitive, given the possible impact of changes being proposed.
“The reason why a lot of things were put in place over the last 20, 30 years, is because we had such a shortage of rural doctors. We had to find ways to incentivize people to come,” he said. “That started to work, and now we’re taking steps back. Forcing peoples’ hands on where they’re going to go simply isn’t going to work.
“All that’s going to happen is, trainees will just finish off their medical education and say, ‘if I don’t want to work in rural Alberta, I’ll just go to another province.'”
The AMA is currently developing its response to the proposed changes, and plans to submit its feedback prior to the Dec. 20 deadline.
The “severity” of proposed provincial changes to the way doctors schedule, bill, and interact with their patients has prompted outcry from some Alberta physicians.
The changes would alter rates at which doctors can bill, fees for what are known as complex care plans, and changes to mandatory drivers’ medicals for those aged 74 or older.
The Alberta Medical Association (AMA) was informed of the changes on Nov. 14, and given until Dec. 20 to provide a response to the government. In a letter sent to AMA members, president Christine Molnar said the board had “deep concerns” about the changes.
“Given the severity of many of the proposals, it was thought best to bring matters into the light of day for all members,” Molnar wrote.
“These activities by government are troubling and potentially divisive for the profession,” Molnar wrote.
Steve Buick, a spokesperson for Health Minister Tyler Shandro, wrote in a statement that the proposed changes would help to get costs in line.
“Alberta is a great place for doctors to work and nothing in our proposals will change that,” he wrote. “We spend $ 5.4 billion a year on physicians. Our spending is out of line with other provinces and we need to make some modest reductions.”
The Alberta government has proposed changes that will see doctors paid the same for a 25-minute visit as they are for a 15-minute visit. It is not yet clear what doctors would be paid for sessions lasting more than 25 minutes.
Dr. Kathleen Moncrieff, a family physician who works in northeast Calgary, said this will affect doctor-patient interactions.
“Right now, the way we bill in this province, there’s a set amount for a family physician visit that’s 15 minutes or less,” she said. “But if it’s longer than 15 minutes, you essentially bill more for each additional 10 minutes.”
This isn’t just cutting our salaries. This is cutting what we need to do to run our clinic.– Kathleen Moncrieff, Calgary family physician
Visits that last 15 minutes or less are fine for addressing straightforward needs, such as diagnosing a urinary tract infection or refilling a birth control prescription, Moncrieff said.
But many of Moncrieff’s patients have multiple health complaints or illnesses, requiring a longer time slot.
“It doesn’t make sense for me to say, I have 15 minutes to talk to you about your diabetes, and I have 15 minutes in two weeks to talk to you about your blood pressure or your asthma,” she said. “Because you are a person, you’re not a collection of illnesses or a collection of body systems.”
As doctors at community medical practices are not employees of the government, they essentially function like independent contractors or business owners, Moncrieff said. Doctors have to cover the cost of running a clinic: from paying office assistants and nurses, to rent, supplies and other overhead.
“This isn’t just cutting our salaries. This is cutting what we need to do to run our clinic. The government doesn’t pay for these things,” Moncrieff said. “So the fact that we have had these billing codes that let us bill for the amount of time we take with a patient is what allows us to bring in the income that keeps our clinic running.”
The province is also proposing cutting funding for complex care plans, a billing system that supports patients with complex or chronic conditions.
A person with diagnoses of diabetes, high blood pressure, and chronic pulmonary disease – and who is potentially quitting smoking and dealing with depression and anxiety – is a typical example of a patient who would fall under this designation, Moncrieff said.
Moncrieff said such visits allow for doctors to schedule long, involved visits with patients, family members and nurses to develop a plan to improve and maintain health.
“We’ll sit together, go through all of their illnesses, go through all of their medications, go through all of their goals and really come up with a plan collaboratively,” she said.
Without specific funding for such relationships, Moncrieff said she is concerned patients’ needs will not be met.
“As physicians, we’ll try to do our best … but my concern is, economically, we won’t be able to take the time that we have been taking because we need to bill enough to keep our clinics open,” she said. “People’s concerns will be missed, people’s conditions won’t be managed as well as they can be.
“Ultimately, it will lead to more complications from illnesses, more emergency visits, more hospital stays, which leads to worse health outcomes and also doesn’t lead to any cost savings.”
Mandatory drivers’ medicals
Under Alberta Transportation guidelines, a driver must pass a medical exam to keep their licence at age 75, age 80, and every two years after age 80.
Those evaluations test vision, hearing, cognitive ability and overall health of these individuals.
Currently, doctors in Alberta are allowed to bill the government for those exams, but that would change under proposed regulation.
“The government is proposing cutting funding for that entirely, so that senior citizens would have to pay out-of-pocket for those drivers’ medicals, which is very concerning to me,” Moncrieff said.
Buick said the proposals would apply to all doctors, not just family practitioners.
“Nothing in our proposals will harm the ability of family doctors to give comprehensive primary care,” Buick wrote. “The minister looks foward to working through the issues with the AMA at the bargaining table. We’re not going to negotiate in the media.”
Moncrieff said that, though she typically doesn’t engage in politics on social media, she made an exception in this case out of concern for her patients.
“I think my biggest fear is people falling through the cracks and getting sicker because they aren’t getting the care they need,” she said.
Patients in British Columbia could soon know about every single action taken by professional colleges in response to complaints about health-care workers, rather than just a select few.
That’s just one in a substantial list of proposals for reforming B.C.’s system for regulating health professionals, released by a cross-party government committee on Wednesday morning.
The committee is recommending reducing the number of regulatory colleges in B.C. from 20 to five, revamping the makeup of college boards and creating a new oversight body that would perform routine audits and systemic reviews of the colleges.
“These changes will help ensure health professions are regulated more thoroughly and transparently, so that they are providing British Columbians the best care when they need it most,” Health Minister Adrian Dix said.
He revealed the proposals alongside Liberal health critic Norm Letnick and Green Party health critic Sonia Furstenau, who described the proposals as non-partisan.
The news comes seven months after a critical report from international professional regulation expert Harry Cayton that recommended a complete overhaul of B.C.’s system, charging that the current system lacks transparency and consistency.
“There is a lack of relentless focus on the safety of patients in many but not all of the current colleges. Their governance is insufficiently independent, lacking a competency framework, a way of managing skill mix or clear accountability to the public they serve,” Cayton wrote.
Cayton recommended a complete replacement of the Health Professions Act, which sets the framework for regulation, saying it’s inadequate to serve the patients of the future.
The committee’s proposals don’t go that far, suggesting instead extensive amendments to the act.
‘A clear focus on patient safety’
If the proposals become reality, the College of Physicians and Surgeons of British Columbia, the College of Pharmacists of British Columbia and the British Columbia College of Nursing Professionals would be maintained, while the other professions would be grouped under a new college of oral health and another for the remaining health and care professions.
The boards of each college would include equal numbers of public members and college registrants, each appointed by the province rather than elected by registrants. Board members could only be recommended after an independent process to assess their competency.
The new oversight body that would sit above all five colleges would be responsible for holding a single register of all health professionals in B.C., and could develop model bylaws, oversee the appointment of college board members and establish a range of standards of practice.
How the colleges handle complaints is a major focus of the recommended changes, which aim to “provide a clear focus on patient safety, public protection and strengthening public trust in regulation.”
Right now, the colleges only publicize the outcomes of patient complaints when they are deemed to be a “serious matter.”
For instance, when the former vice-chair of the College of Chiropractors of British Columbia was reprimanded and fined after posting an anti-vaccination video online, in clear violation of college policy, there was no public notification of the disciplinary action.
The committee wants to see all of those actions made public, including agreements that are made by consent.
No negotiating agreements
Meanwhile, the committee has suggested that professionals should not be able to negotiate agreements with their colleges late in the complaint investigation process to head off disciplinary proceedings.
That comes on the heels of a CBC News report on the response to numerous complaints against former psychologist Allan Posthuma. After five investigations found serious concerns with his work in child custody disputes, Posthuma negotiated an agreement to give up his registration rather than face a disciplinary hearing.
The proposals also include a new body that would handle any disciplinary decisions, acting independently from the colleges.
P.E.I. could soon have some of the strictest vaping laws in the country.
A private members bill from PC MLA Cory Deagle passed second reading in the P.E.I. Legislature Tuesday night. The bill would restrict where vaping products can be sold, ban certain flavours, and also raise the legal age to buy tobacco and e-cigarettes from 19 to 21.
Deagle said he wants to make vaping products less accessible to young people, especially teenagers.
“These substances, you become addicted to nicotine. In some cases there four or five, 20 times the amount of nicotine in an e-cigarette than there is in a regular cigarette,” said Deagle.
“Teachers, principals have told me it’s an epidemic in schools. And obviously with our youth tobacco rate double the national average and seeing a 74 per cent increase in vaping amongst youth in Canada, I think we have to do something.”
The vote on the second reading was unanimous, with MLAs from all parties speaking in support of it. The discussion included the possibility of new taxes being introduced in the spring budget.
If the bill passes third reading and becomes law, P.E.I. would have the highest age restriction in the country.
Deagle said the bans on flavoured products would not come into effect right away. Those would be done through regulations in cabinet, which he said would likely be a year-long process.
The British Columbia government says any proposed settlement from opioid manufacturer Purdue Pharma needs to include Canadian claims for the devastation created by the overdose crisis.
Purdue, the maker of the pain drug OxyContin, has filed for bankruptcy in the United States and proposed a multibillion-dollar plan to settle with thousands of state and local governments.
B.C. Attorney General David Eby said Monday the province has been monitoring the developments, including a tentative agreement that proposes to resolve the claims with Purdue, which is owned by the Sackler family.
Purdue Pharma Canada says in a statement it is a separate company from the U.S. firm and the actions taken to settle litigation in America don’t directly affect its business in Canada.
Eby said the province remains “ready and willing” to participate in the effort to achieve a resolution but if B.C. is not included in the process then the government will continue its lawsuit, which names Purdue and several other opioid makers as defendants.
“To date there has been no effort on the part of Purdue entities and the Sacklers to involve Canadian jurisdictions in the discussions that have led to the rumoured settlement in the U.S.,” Eby said in a statement.
The province filed a proposed class-action lawsuit a year ago alleging drug manufactures falsely marketed opioids as less addictive than other pain medicines, triggering an overdose crisis that has killed thousands.
None of the allegations have been tested in court.
A statement of defence from Purdue Pharma could not be found on the B.C. Supreme Court website on Monday. Purdue Pharma has previously said that it followed all of Health Canada’s regulations, including those governing marketing, and it’s very concerned about the opioid crisis in B.C. and across Canada.
The pharmaceutical giant filed for bankruptcy late Sunday, step one in a plan it says would provide $ 10-$ 12 billion US to help reimburse state and local governments over overdose deaths.
The plan calls for turning Purdue into a “public benefit trust” that would continue selling opioids but hand its profits over to those who have sued the company. The Sackler family would give up ownership of Purdue and contribute at least $ 3 billion toward the settlement.
It will be up to a federal bankruptcy judge to decide whether to approve or reject the settlement or seek modifications.
Two dozen states plus key lawyers who represent many of the 2,000-plus local governments suing the Connecticut-based company have signed on to the plan.
But other states have come out strongly against it, arguing that it won’t provide as much money as promised.