Accessibility for Ontarians with Disabilities Act Alliance Update United for a Barrier-Free Society for All People with Disabilities
Web: https://www.aodaalliance.org Email: aodafeedback@gmail.com Twitter: @aodaalliance Facebook: https://www.facebook.com/aodaalliance/
June 8, 2021
SUMMARY
Who watches the watchers? Once again, the AODA Alliance has had to do so, when it comes to monitoring media coverage or lack of coverage of the danger since the start of the COVID-19 pandemic of disability discrimination in access to life-saving critical care in Ontario hospitals.
This is Part 2 of our own coverage on this important question. The June 7, 2021 AODA Alliance Update described how CBC’s flagship national daytime current affairs radio program The Current has failed to cover the dangers of disability discrimination in critical care triage during the COVID-19 pandemic. Today, we look to another network and another storyone with an eventual happy ending.
Back on April 28, 2021, CTV’s nightly national TV news program commendably covered the danger of critical care triage in Ontario. It is good that its report included a reference to disability concerns.
However, CTV’s online news report on this issue (unlike its shorter broadcast TV news item) inaccurately stated as a fact that under Ontario’s critical care triage protocol, people with disabilities are to be treated no differently than others. It stated:
The triage guidelines specify that people with disabilities are not treated any differently than the rest of the population
That statement of fact was absolutely and provably incorrect. We were not contacted by CTV before that story ran.
This story appeared to the AODA Alliance to possibly be one that the physicians at the centre of planning the Ontario critical care triage protocol may have brought to the media. It has the focus and sound of the message that they espoused.
On April 30, 2021, the AODA Alliance reached out by email to CTV news. We showed how that statement was factually wrong. To its credit, after some back-and-forth exchanges, at our request CTV news removed that harmfully inaccurate statement from its online report. We very much appreciate that this story was corrected.
Around May 6, 2021, CTV updated this online story in response to our concerns. However, the change was not an effective solution. The line, quoted above, was revised to read as follows, which was also factually inaccurate:
The triage guidelines specify that people with pre-existing disabilities are not treated any differently than the rest of the population
As well, the following was commendably added later in the story:
Disability advocates, backed by the Ontario Human Rights Commission, have raised human rights and discriminatory concerns about the protocol in letters to the provincial government.
On May 18 and 19, 2021, AODA Alliance Chair David Lepofsky again wrote CTV about this story. While appreciating CTV’s effort to correct it, CTV was told that it was still inaccurate for the story to state as a fact that people with pre-existing disabilities are not to be treated any differently than the rest of the population under Ontario’s critical care triage protocol. Shortly after that, CTV again revised the online story to remove the entire unfactual statement. The following words were removed from it:
The triage guidelines specify that people with disabilities are not treated any differently than the rest of the population
As well the online CTV story now includes a link to the AODA Alliance’s detailed February 25, 2021 report on disability discrimination in Ontario’s critical care triage protocol.
Below you can read the following:
a) the original version of this CTV story as posted online on April 28, 2021.
b) the AODA Alliance’s April 30, 2021 email to CTV news.
c) The revised CTV online story as of May 6, 2021.
d) The May 18 and 19, 2021 emails from the AODA Alliance to CTV, and
e) The final version of the story as it now appears online.
We applaud CTV for correcting this story, and for being open to our feedback on it. We have urged CTV’s national news to do a story specifically focusing on the disability discrimination problems with Ontario’s critical care triage protocol. They have not yet done so. It remains an immediate and important story. Things are better in Ontario, but there has been no public accounting for the disability discrimination now embedded in hospital training across Ontario. As well, Manitoba is facing an immediate danger of possible critical care triage.
In contrast, CBC TV’s The National commendably ran a 7-minute story on that topic on 18, 2021. That was a very lengthy story for a national TV news program.
Who watches the watchers? The AODA Alliance and people with disabilities must do so!
For more background on this issue, check out:
1. The online captioned video talk on this issue by AODA Alliance Chair David Lepofsky, seen over 1,000 times, and
2. The AODA Alliance website’s health care page.
1 MORE DETAILS
CTV News April 28, 2021
Originally posted at
https://www.ctvnews.ca/health/coronavirus/ontario-hospitals-on-the-verge-of-enacting-last-resort-triage-protocols-1.5406746
Ontario hospitals on the verge of enacting ‘last resort’ triage protocols Avis Favaro
Medical Correspondent, CTV National News
@ctv_avisfavaro
Elizabeth St. Philip
CTV News
@LizTV
Ben Cousins
CTVNews.ca Writer
@cousins_ben
Published Wednesday, April 28, 2021 10:00PM EDT
TORONTO As intensive care admissions climb to dangerously high levels in Ontario, health-care workers in the province worry they might soon be forced into the worst-case scenario of choosing who gets the best care and who doesn’t.
On Wednesday, Ontario reported 3,480 new COVID-19 cases. Although a third wave in the province appears to be levelling off, the number of COVID-19 patients in the intensive care units (ICUs) is steadily climbing, to the point where the province is getting assistance from Newfoundland and Labrador and the Canadian military.
The province also reported on Wednesday that 2,281 patients are currently hospitalized, with 877 patients in intensive care.
It’s believed the province could be forced to enact triage protocols if ICU admissions related to COVID-19 exceed 900.
I just can’t say strongly enough just what a horrible position we’re in the health-care sector right now and why it’s so important that we really drive these numbers to the ground, Dr. Chris Simpson, a cardiologist and executive vice-president of Ontario Health, told CTV News.
We simply have to get COVID under control if we’re going to have our health-care system back in a functional state again.
Ontario’s triage protocols, developed in January, are meant as a last resort to determine who should be given intensive care when the demand for critical care exceeds the supply.
It’s going to be extremely emotionally difficult for staff to have to make these decisions to tell family members that we’re not able to offer ICU-level treatments that we would have been able to offer in the past, said Dr. Erin O’Connor, the deputy medical director of the University Health Network emergency departments.
The situation is already dire in the Toronto area, where health officials have been forced to transport patients to other districts as ICU beds in the city fill up. Ontario’s COVID-19 modelling numbers from April 16 suggest the province could see nearly 10,000 new COVID-19 cases per day by the end of May, even under strong public health restrictions.
There is a wall that’s going to be hit at some point, Simpson said. We don’t know where that is yet. We do believe we can build about 200 new ICU beds per week for the next three weeks or so. It gets increasingly tougher, but we think that that will take us into mid-May and we can only hope that things will be cresting by that point.
Under the triage protocols, all patients are assigned four colours — red, purple, yellow and green — depending on how doctors perceive a patient’s likelihood of surviving for another 12 months. Patients deemed red are predicted to have a 20-per-cent chance of surviving for the year, while patients deemed in the green have more than a 70-per-cent chance of surviving.
Under this system, ICU beds would be given to the green patients first, followed by yellow, purple and red.
That doesn’t mean we’re not going to care for people, O’Connor said. We’re going to offer as much medical care as we possibly can, but some people won’t be able to be on a ventilator —
people that we would have put on a ventilator in the past — simply because we’re in a situation where we’re dealing with scarce resources.
The triage system puts doctors and other health-care workers in the unenviable position of deciding who does not receive the best possible care. It would even require doctors to decide who to withdraw from ICU care if they’re unlikely to survive for another year.
For O’Connor, the prospect having to tell a patient and their family that the province cannot provide them with the best care could have long-term consequences on the entire health-care system in Ontario.
The hardest part really is going to be making these decisions, she said. This is going to take a really large emotional toll and I worry about my staff and I worry about people — after this — leaving medicine because they’re not going to be able to recover.
This is not what we’re trained to do. It’s not what we thought we would ever have to do in our careers.
The triage guidelines are also terrifying for people with disabilities, advanced age or pre-existing conditions.
There’s also this very real concern that I may be denied care based on protocols that say that I have a less likely chance of surviving, said Jeff Preston, who has a neuromuscular disorder and works as an assistant professor of disability studies at King’s University College, an affiliate of Western University in London, Ont.
It’s one thing to get COVID and die, it’s a whole other thing to say, as a Canadian citizen, I might not actually have the same access to health care that other Canadians are going to receive and that hurts in a different way.
The triage guidelines specify that people with disabilities are not treated any differently than the rest of the population, but Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.
When I was first diagnosed as a baby, they did not believe I was going to survive more than a couple of years, he said. They predicted that I would probably die before four or five years old. Now here I am, almost 40 years old, many years later and that prognosis didn’t turn out to be true.
QUEBEC FAR FROM TRIGGERING’ TRIAGE PROTOCOLS
Other provinces have also developed similar triage protocols in the event ICU admissions exceed the available beds.
In Quebec for example, prioritization protocols are similar to Ontario’s and those who do not receive ICU admission will not be abandoned; they will continue to receive other care, the most appropriate for their condition and possible in the context, according to a statement from Quebec’s Ministry of Health and Social Services.
The department added that it is far from triggering the prioritization protocols and has not done so since the start of the pandemic. It has also expanded ICU capacity for COVID-19 patients to hopefully make sure it doesn’t happen.
This scenario is one of last resort that we want to avoid at all costs, the statement read. That is why we are asking Quebecers for their contribution by reducing their contact as much as possible and by rigorously applying the recommended health measures.
In Saskatchewan, triage protocols will consider a patient’s chance at survival, but also the length of time a patient may require the most care.
These assessments must be based on the best available scientific evidence, the Saskatchewan Health Authority wrote in a statement.
Patients who are not going to receive ICU level of care will receive compassionate care. The sick and dying would not be abandoned. If a patient is not expected to survive, palliative or comfort care would be provided to reduce pain and suffering.
intensive care admissions
As intensive care admissions climb to dangerously high levels in Ontario, health-care workers in the province worry they might soon be forced into the worst-case scenario of choosing who gets the best care and who doesn’t.
April 30, 2021 Email from AODA Alliance Chair David Lepofsky to CTV News
CTV’s online April 28, 2021 online news report on the issue of critical care triage in Ontario, entitled Ontario hospitals on the verge of enacting ‘last resort’ triage protocols, includes a seriously inaccurate and deeply disturbing statement that needs to be rectified. It states:
The triage guidelines specify that people with disabilities are not treated any differently than the rest of the population
In fact, and contrary to what CTV reports, the January 13, 2021 Critical Care Triage Protocol explicitly directs that a patient’s disability IS a factor that in some cases is to be weighed AGAINST their getting access to the life-saving critical care they need, if Ontario has more patients needing critical care than it has critical care beds and supports.
For example, if a cancer patient needs critical care, they will be deprioritized if a patient is Completely disabled and cannot carry out any self-care; totally confined to bed or chair. As another example, if a patient needing critical care is over 65 and has a progressive disease (like MS, arthritis or Parkinson’s), their access to critical care is reduced depending on how few of eleven activities of daily living they can perform without assistance. This includes dressing, bathing, eating, walking, getting in and out of bed, using the telephone, going shopping, preparing meals, doing housework, taking medication, or handling their finances. In both examples, this is disability discrimination, pure and simple.
This is not open to factual debate. The secret January 13, 2021 Critical Care Triage Protocol has been posted on the AODA Alliance website for over three months. No one has disputed that those two features are in the protocol. They can also be found in the terrifying online calculator that we made public, and that critical care doctors are being told to use if critical care triage takes place.
The presence of disability discrimination in the January 13, 2021 Critical Care Triage Protocol has led leading disability organizations to publicly demand that this disability discrimination be removed from it. See our efforts on this at www.aodaalliance.org/healthcare It has led the Ontario Human Rights Commission to raise serious concerns. As well, fully six members of the Ontario Government’s own advisory Bioethics Table have been publicly critical of the January 13, 2021 Critical Care Triage Protocol. This is all documented in detail at www.aodaalliance.org/healthcare
It is good that your story quotes Prof. Jeff Preston as being concerned about the triage protocol. The entire passage, excerpted above, states:
The triage guidelines are also terrifying for people with disabilities, advanced age or pre-existing conditions.
There’s also this very real concern that I may be denied care based on protocols that say that I have a less likely chance of surviving, said Jeff Preston, who has a neuromuscular disorder and works as an assistant professor of disability studies at King’s University College, an affiliate of Western University in London, Ont.
It’s one thing to get COVID and die, it’s a whole other thing to say, as a Canadian citizen, I might not actually have the same access to health care that other Canadians are going to receive and that hurts in a different way.
The triage guidelines specify that people with disabilities are not treated any differently than the rest of the population, but Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.
When I was first diagnosed as a baby, they did not believe I was going to survive more than a couple of years, he said. They predicted that I would probably die before four or five years old. Now here I am, almost 40 years old, many years later and that prognosis didn’t turn out to be true.
It is good that the CTV report notes that people with disabilities are terrified. However, the substantial misstatement of fact to which we here point is not corrected by that aspect of the CTV report. The reader is left with the uncontradicted categorical statement that
The triage guidelines specify that people with disabilities are not treated any differently than the rest of the population
At best, the triage protocol says that people with certain stable disabilities are not thereby to be assessed by the Clinical Frailty Scale that measures their ability to perform the eleven tasks of daily living, listed above, without assistance. However, the protocol goes on to apply that disability-discriminatory Scale to people with progressive disabilities (e.g. MS or arthritis, to name a few).
Especially in a national online news story dealing with a life-and-death issue, and its dangerous implications for society’s most vulnerable, it is essential for CTV to get its facts right. This is all the more so since people with disabilities disproportionately have born the brunt of COVID-19 and disproportionately died from it. It is also especially so since it has been so hard to get the media to cover this story. We’ve been trying for over a year, with success for the most part taking place only very recently.
It would be one thing for your report to include our position and then any defence the Ford Government wishes to offer. CTV did not do so. Instead, it categorically states as objective fact something which is 100% incorrect, and which your reporters on this story did not reach out to us to discuss. Our position on these issues has been widely publicized to the media, including to CTV, via news releases and Twitter.
In marked contrast to the April 28, 2021 CTV online report, on the same day, Global TV News Toronto aired a story commendably bearing the accurate headline: Ontario’s COVID-19 triage protocol discriminates because of disability,’ advocates say.
We know from the January 23, 2021 online webinar that Critical care Services Ontario conducted for hospitals that the Government or its proxies planned to do some sort of public media strategy on the critical care triage protocol. Your story corresponds in large part to the core messages of that strategy. That could very well be a coincidence, and CTV may well have not known about those media relations strategic plans.
We urgently ask you to do a national report on the disability discrimination that is explicitly included in the Ontario critical care triage protocol, the bogus arguments that have been made on the Ontario Government’s behalf to defend it, and the objections to it from the disability community, the Ontario Human Rights Commission and some members of the Government’s own advisory Bioethics Table. We would be please to assist you in any way in such a story.
David Lepofsky CM, O. Ont
Chair Accessibility for Ontarians with Disabilities Act Alliance Twitter: @davidlepofsky
CTV News Online Report Updated by May 6, 2021
Originally posted at https://www.ctvnews.ca/health/coronavirus/ontario-hospitals-on-the-verge-of-enacting-last-resort-triage-protocols-1.5406746 Ontario hospitals on the verge of enacting ‘last resort’ triage protocols Medical Correspondent, CTV National News
Contact @ctv_avisfavaro
Elizabeth St. Philip, CTV News
Contact @LizTV
Ben Cousins, CTVNews.ca Writer
Contact @cousins_ben
Published Wednesday, April 28, 2021 10:00PM EDT
TORONTO — As intensive care admissions climb to dangerously high levels in Ontario, health-care workers in the province worry they might soon be forced into the worst-case scenario of choosing who gets the best care and who doesn’t.
On Wednesday, Ontario reported 3,480 new COVID-19 cases. Although a third wave in the province appears to be levelling off, the number of COVID-19 patients in the intensive care units (ICUs) is steadily climbing, to the point where the province is getting assistance from Newfoundland and Labrador and the Canadian military.
The province also reported on Wednesday that 2,281 patients are currently hospitalized, with 877 patients in intensive care.
It’s believed the province could be forced to enact triage protocols if ICU admissions related to COVID-19 exceed 900.
I just can’t say strongly enough just what a horrible position we’re in the health-care sector right now and why it’s so important that we really drive these numbers to the ground, Dr. Chris Simpson, a cardiologist and executive vice-president of Ontario Health, told CTV News.
We simply have to get COVID under control if we’re going to have our health-care system back in a functional state again.
Ontario’s triage protocols, developed in January, are meant as a last resort to determine who should be given intensive care when the demand for critical care exceeds the supply.
It’s going to be extremely emotionally difficult for staff to have to make these decisions to tell family members that we’re not able to offer ICU-level treatments that we would have been able to offer in the past, said Dr. Erin O’Connor, the deputy medical director of the University Health Networkemergency departments.
The situation is already dire in the Toronto area, where health officials have been forced to transport patients to other districts as ICU beds in the city fill up. Ontario’s COVID-19 modelling numbers from April 16 suggest the province could see nearly 10,000 new COVID-19 cases per dayby the end of May, even under strong public health restrictions.
There is a wall that’s going to be hit at some point, Simpson said. We don’t know where that is yet. We do believe we can build about 200 new ICU beds per week for the next three weeks or so. It gets increasingly tougher, but we think that that will take us into mid-May and we can only hope that things will be cresting by that point.
Under the triage protocols, all patients are assigned four colours — red, purple, yellow and green — depending on how doctors perceive a patient’s likelihood of surviving for another 12 months. Patients deemed red are predicted to have a 20-per-cent chance of surviving for the year, while patients deemed in the green have more than a 70-per-cent chance of surviving.
Under this system, ICU beds would be given to the green patients first, followed by yellow, purple and red.
That doesn’t mean we’re not going to care for people, O’Connor said. We’re going to offer as much medical care as we possibly can, but some people won’t be able to be on a ventilator —
people that we would have put on a ventilator in the past — simply because we’re in a situation where we’re dealing with scarce resources.
The triage system puts doctors and other health-care workers in the unenviable position of deciding who does not receive the best possible care. It would even require doctors to decide who to withdraw from ICU care if they’re unlikely to survive for another year.
For O’Connor, the prospect having to tell a patient and their family that the province cannot provide them with the best care could have long-term consequences on the entire health-care system in Ontario.
The hardest part really is going to be making these decisions, she said. This is going to take a really large emotional toll and I worry about my staff and I worry about people — after this — leaving medicine because they’re not going to be able to recover.
This is not what we’re trained to do. It’s not what we thought we would ever have to do in our careers.
The triage guidelines are also terrifying for people with disabilities, advanced age or pre-existing conditions.
There’s also this very real concern that I may be denied care based on protocols that say that I have a less likely chance of surviving, said Jeff Preston, who has a neuromuscular disorder and works as an assistant professor of disability studies at King’s University College, an affiliate of Western University in London, Ont.
It’s one thing to get COVID and die, it’s a whole other thing to say, as a Canadian citizen, I might not actually have the same access to health care that other Canadians are going to receive and that hurts in a different way.
The triage guidelines specify that people with pre-existing disabilities are not treated any differently than the rest of the population, but Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.
When I was first diagnosed as a baby, they did not believe I was going to survive more than a couple of years, he said. They predicted that I would probably die before four or five years old. Now here I am, almost 40 years old, many years later and that prognosis didn’t turn out to be true.
Disability advocates, backed by the Ontario Human Rights Commission, have raised human rights and discriminatory concerns about the protocol in letters to the provincial government.
QUEBEC FAR FROM TRIGGERING’ TRIAGE PROTOCOLS
Other provinces have also developed similar triage protocols in the event ICU admissions exceed the available beds.
In Quebec for example, prioritization protocols are similar to Ontario’s and those who do not receive ICU admission will not be abandoned; they will continue to receive other care, the most appropriate for their condition and possible in the context, according to a statement from Quebec’s Ministry of Health and Social Services.
The department added that it is far from triggering the prioritization protocols and has not done so since the start of the pandemic. It has also expanded ICU capacity for COVID-19 patients to hopefully make sure it doesn’t happen.
This scenario is one of last resort that we want to avoid at all costs, the statement read. That is why we are asking Quebecers for their contribution by reducing their contact as much as possible and by rigorously applying the recommended health measures.
In Saskatchewan, triage protocols will consider a patient’s chance at survival, but also the length of time a patient may require the most care.
These assessments must be based on the best available scientific evidence, the Saskatchewan Health Authority wrote in a statement.
Patients who are not going to receive ICU level of care will receive compassionate care. The sick and dying would not be abandoned. If a patient is not expected to survive, palliative or comfort care would be provided to reduce pain and suffering.
intensive care admissions
As intensive care admissions climb to dangerously high levels in Ontario, health-care workers in the province worry they might soon be forced into the worst-case scenario of choosing who gets the best care and who doesn’t.
May 18, 2021 Email from AODA Alliance Chair David Lepofsky to CTV News
To: CTVNews
From: David Lepofsky
Date: May 18, 2021
I regret that I must write to again raised concerns about the factual inaccuracy of CTV News’ online April 28, 2021 news report regarding Ontario’s critical care triage protocol. On April 30, 2021, I wrote to alert you to the fact that there was a serious factual error in that report, where it stated the following:
The triage guidelines specify that people with disabilities are not treated any differently than the rest of the population, but Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.
In my April 30, 2021 email to CTV news, I explained that contrary to what CTV reported, the January 13, 2021 Critical Care Triage Protocol explicitly directs that a patient’s disability IS a factor that in some cases is to be weighed AGAINST their getting access to the life-saving critical care they need, if Ontario has more patients needing critical care than it has critical care beds and supports. That is disability discrimination.
I very much appreciate that as a result, CTV reporter Avis Favaro spoke to me about this issue and that CTV news looked into our objection.
As a result, CTV News made two changes to the online CTV News report, on or around May 6, 2021. I regret that the first of those changes included a serious factual inaccuracy. The first change was simply to add the word pre-existing before the word disabilities in the inaccurate statement in the original April 28, 2021 CTV news report. Report’s The revised statement now reads:
The triage guidelines specify that people with pre-existing disabilities are not treated any differently than the rest of the population, but Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.
Second, the May 6, 2021 version later adds this accurate sentence:
Disability advocates, backed by the Ontario Human Rights Commission, have raised human rights and discriminatory concerns about the protocol in letters to the provincial government.
It is good that CTV attempted to correct it’s inaccurate April 28, 2021 news report. However, CTV has replaced one serious inaccuracy with another serious inaccuracy. The January 13, 2021 Critical Care Triage Protocol does not specify that people with disabilities are not treated any differently than the rest of the population (as the inaccurate April 28, 2021 report originally claimed) or that people with pre-existing disabilities are not treated any differently than others (as the May 6, 2021 revision to that article claims. To the contrary, under that critical care triage protocol, if a cancer patient with pre-existing cancer needs critical care, they will be deprioritized if a patient is Completely disabled and cannot carry out any self-care; totally confined to bed or chair. That is disability discrimination, up front. Under that protocol, if a patient needing critical care is over 65 and has a progressive pre-existing disease (like MS, arthritis or Parkinson’s), their access to critical care is reduced depending on how few of eleven activities of daily living they can perform without assistance. This includes dressing, bathing, eating, walking, getting in and out of bed, using the telephone, going shopping, preparing meals, doing housework, taking medication, or handling their finances. That too is disability discrimination, pure and simple, including disability discrimination based on a pre-existing disability. CTV’s insertion of the word pre-existing into the inaccurate statement did not reduce or correct its complete and demonstrable inaccuracy.
I would add that unless I am mistaken or missed something, nothing on the CTV web page displaying this report acknowledges that there previously was a factual inaccuracy in it. In contrast, newspapers regularly print corrections to earlier stories, that are entitled correction, to ensure that the reader is aware that an earlier report had been inaccurate. No one reading the original April 28, 2021 story would know that it was erroneous. No one reading the same report, as revised on or around May 6, 2021, would know that CTV had attempted to correct it. Of course, no one would know from that report that it is inaccurate where it states as a fact that under the protocol, people with pre-existing disabilities are to be treated like everyone else.
We would very much appreciate this story being corrected so that it is accurate. We also would again encourage CTV to run a story that reports specifically on this disability discrimination issue that is anchored in the very wording of the January 13, 2021 Critical Care Triage Protocol. Ontario is not out of the woods, even though ICU cases and overall new COVID-19 cases are reducing. This remains a live issue for your viewers and readers, including the many with disabilities. The newsworthiness of this disability discrimination standing alone is important. The inaccuracy on the CTV website makes the case for a further report even more compelling.
We would be delighted to assist in any way we can. Please stay safe.
David Lepofsky CM, O. Ont
Chair Accessibility for Ontarians with Disabilities Act Alliance Twitter: @davidlepofsky May 19, 2021 Email from AODA Alliance Chair David Lepofsky to CTV News
Thank you for asking what correction or clarification to the April 28, 2021 CTV News story we would recommend. We respectfully propose that the sentence that requires a change is this:
The triage guidelines specify that people with pre-existing disabilities are not treated any differently than the rest of the population, but Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.
May we propose two alternatives. The first and preferable alternative would read:
The triage guidelines do not ensure that people with pre-existing disabilities are not treated any differently than the rest of the population. Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.
The second and less desirable alternative would be to simply delete the inaccurate words The triage guidelines specify that people with pre-existing disabilities are not treated any differently than the rest of the population, but. The paragraph would therefore read
Preston is skeptical in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.
You asked for a link to the AODA Alliance website. We again offer two alternatives. The more specific link to our report that exhaustively details the disability discrimination in the Ontario critical care triage protocol is https://www.aodaalliance.org/whats-new/a-deeply-troubling-issue-of-life-and-death-an-independent-report-on-ontarios-seriously-flawed-plans-for-rationing-or-triage-of-critical-medical-care-if-covid-19-overwhelms-ontario-hospitals/ The more general link to all our posts on this issue is www.aodaalliance.org/healthcare
We Hope this helps. If a phone call would assist, let me know.
David Lepofsky CM, O. Ont
Chair Accessibility for Ontarians with Disabilities Act Alliance Twitter: @davidlepofsky
CTV News Online Report As Revised Again on May 19, 2021
Originally posted at: jhttps://www.ctvnews.ca/health/coronavirus/ontario-hospitals-on-the-verge-of-enacting-last-resort-triage-protocols-1.5406746
CTV News
Ontario hospitals on the verge of enacting ‘last resort’ triage protocols Avis Favaro, Medical Correspondent
Contact @ctv_avisfavaro
Elizabeth St. Philip, CTV News
Contact @LizTV
Ben Cousins , CTVNews.ca Writer
Contact @cousins_ben
Published Wednesday, April 28, 2021 10:00PM EDT
Last Updated Wednesday, May 19, 2021 9:14AM EDT
TORONTO — As intensive care admissions climb to dangerously high levels in Ontario, health-care workers in the province worry they might soon be forced into the worst-case scenario of choosing who gets the best care and who doesn’t.
On Wednesday, Ontario reported 3,480 new COVID-19 cases. Although a third wave in the province appears to be levelling off, the number of COVID-19 patients in the intensive care units (ICUs) is steadily climbing, to the point where the province is getting assistance from Newfoundland and Labrador and the Canadian military.
Related Links
Accessibility for Ontarians with Disabilities Act Alliance on triage protocols
The province also reported on Wednesday that 2,281 patients are currently hospitalized, with 877 patients in intensive care.
It’s believed the province could be forced to enact triage protocols if ICU admissions related to COVID-19 exceed 900.
I just can’t say strongly enough just what a horrible position we’re in the health-care sector right now and why it’s so important that we really drive these numbers to the ground, Dr. Chris Simpson, a cardiologist and executive vice-president of Ontario Health, told CTV News.
We simply have to get COVID under control if we’re going to have our health-care system back in a functional state again.
Ontario’s triage protocols, developed in January, are meant as a last resort to determine who should be given intensive care when the demand for critical care exceeds the supply.
It’s going to be extremely emotionally difficult for staff to have to make these decisions to tell family members that we’re not able to offer ICU-level treatments that we would have been able to offer in the past, said Dr. Erin O’Connor, the deputy medical director of the University Health Network emergency departments.
The situation is already dire in the Toronto area, where health officials have been forced to transport patients to other districts as ICU beds in the city fill up. Ontario’s COVID-19 modelling numbers from April 16 suggest the province could see nearly 10,000 new COVID-19 cases per day by the end of May, even under strong public health restrictions.
There is a wall that’s going to be hit at some point, Simpson said. We don’t know where that is yet. We do believe we can build about 200 new ICU beds per week for the next three weeks or so. It gets increasingly tougher, but we think that that will take us into mid-May and we can only hope that things will be cresting by that point.
Under the triage protocols, all patients are assigned four colours — red, purple, yellow and green — depending on how doctors perceive a patient’s likelihood of surviving for another 12 months. Patients deemed red are predicted to have a 20-per-cent chance of surviving for the year, while patients deemed in the green have more than a 70-per-cent chance of surviving.
Under this system, ICU beds would be given to the green patients first, followed by yellow, purple and red.
That doesn’t mean we’re not going to care for people, O’Connor said. We’re going to offer as much medical care as we possibly can, but some people won’t be able to be on a ventilator —
people that we would have put on a ventilator in the past — simply because we’re in a situation where we’re dealing with scarce resources.
The triage system puts doctors and other health-care workers in the unenviable position of deciding who does not receive the best possible care. It would even require doctors to decide who to withdraw from ICU care if they’re unlikely to survive for another year.
For O’Connor, the prospect having to tell a patient and their family that the province cannot provide them with the best care could have long-term consequences on the entire health-care system in Ontario.
The hardest part really is going to be making these decisions, she said. This is going to take a really large emotional toll and I worry about my staff and I worry about people — after this — leaving medicine because they’re not going to be able to recover.
This is not what we’re trained to do. It’s not what we thought we would ever have to do in our careers.
The triage guidelines are also terrifying for people with disabilities, advanced age or pre-existing conditions.
There’s also this very real concern that I may be denied care based on protocols that say that I have a less likely chance of surviving, said Jeff Preston, who has a neuromuscular disorder and works as an assistant professor of disability studies at King’s University College, an affiliate of Western University in London, Ont.
It’s one thing to get COVID and die, it’s a whole other thing to say, as a Canadian citizen, I might not actually have the same access to health care that other Canadians are going to receive and that hurts in a different way.
Preston is skeptical of the triage guidelines in part because doctors sometimes incorrectly estimate life expectancy of people with these conditions.
When I was first diagnosed as a baby, they did not believe I was going to survive more than a couple of years, he said. They predicted that I would probably die before four or five years old. Now here I am, almost 40 years old, many years later and that prognosis didn’t turn out to be true.
Disability advocates, backed by the Ontario Human Rights Commission, have raised human rights and discriminatory concerns about the protocol in letters to the provincial government.
QUEBEC FAR FROM TRIGGERING’ TRIAGE PROTOCOLS
Other provinces have also developed similar triage protocols in the event ICU admissions exceed the available beds.
In Quebec for example, prioritization protocols are similar to Ontario’s and those who do not receive ICU admission will not be abandoned; they will continue to receive other care, the most appropriate for their condition and possible in the context, according to a statement from Quebec’s Ministry of Health and Social Services.
The department added that it is far from triggering the prioritization protocols and has not done so since the start of the pandemic. It has also expanded ICU capacity for COVID-19 patients to hopefully make sure it doesn’t happen.
This scenario is one of last resort that we want to avoid at all costs, the statement read. That is why we are asking Quebecers for their contribution by reducing their contact as much as possible and by rigorously applying the recommended health measures.
In Saskatchewan, triage protocols will consider a patient’s chance at survival, but also the length of time a patient may require the most care.
These assessments must be based on the best available scientific evidence, the Saskatchewan Health Authority wrote in a statement.
Patients who are not going to receive ICU level of care will receive compassionate care. The sick and dying would not be abandoned. If a patient is not expected to survive, palliative or comfort care would be provided to reduce pain and suffering.
Correction:
A previous version of this story suggested triage guidelines