What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Sunday, March 12, 2006

Conscription in Canada

If one is to believe the news media and our public health experts, a pandemic of some sort is not a matter of “if” but rather a matter of “when”. If one is to believe various government sources, Canada is among the nations of the world that are best prepared to deal with a pandemic. We hear about vaccines and biological approaches to such a pandemic, but have heard very little about our human resource and facility capacity to deal with such an event. Perhaps there are reasons for this lack of information; perhaps we don’t have the necessary capacity and any moves so far by governments are non-existent, inadequate or so draconian that the public relations people would rather keep the publics eye diverted elsewhere.
Take Bill 56, for example. This bill was introduced by the Ontario Government on Dec./15/05, the last day before the Ontario Parliament shut down for Christmas break. The bill provides for a $100,000.oo fine and one year in prison if qualified medical and possibly other qualified personnel refuse service in the event of a pandemic. Apparently the bill does not make provisions for, and mandate the government’s responsibilities to, the people who are conscripted.
During the SARS outbreak in Toronto, my understanding is that the majority of the morbidity and mortality occurred in the “caregiver” population---physicians, nurses and their families. In a pandemic, one would assume the same scenario. In effect, caregivers will be the “canaries” in the “mine” of a pandemic. Considering that in Canada we already have a shortage of caregivers (physicians and nurses) is this approach wise? Even worse is the fact that there are no assurances in Bill56 that the necessary supplies and resources to protect caregivers will be in place (such as caregivers and their families given priority to immunization, appropriate masks, gowns supplied, etc.).). Further, no compensation (disability insurance, life insurance, family support provision in the event of sickness or death) is stipulated. My understanding is there are no exemptions specified. Can you imagine how a family physician who is the mother of three small children and whose husband is also a family physician feels about this Bill? Strongly enough to leave Ontario?
The response of the Ontario Government so far is that such things will be negotiated as the need arises. Unbelievable! Who is going to want to discuss these issues when all hell is breaking loose? Were these things determined before health care providers became exposed during the SARS outbreak? For that matter has there been any resolution of these issues for the victims and the families of the victims of the SARS outbreak? Probably not.
So far the Ontario Medical Association and the Canadian Medical Association have “voiced their concerns”. We will see what good it does. The Ontario government intends to have final reading on this Bill by June/06. Does anyone know what other provincial governments are doing in this regard? Although we are repeatedly reassured of our preparedness, I suspect there is very little in terms of a concrete plan. After all, if caregiver and facility shortages have been getting worse over the past fifteen years with no end in sight or solutions on the horizon, what is the likelihood of governments having solutions to the incredible increase in demand and complexities of a pandemic? They certainly haven’t shown brilliance in health care planning to date. Certainly, Ontario’s Bill 56 is a shining example of a very bad start.

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