ISSUE UPDATE: Ontario Health Coalition Succeeds in Protecting & Strengthening Ontario’s Ban on Private Hospitals
Posted: February 9, 2018
(February 9, 2018)
We sent out an update in early December, but it appears that many of you did not get it. Here is the final update on our campaign in late November/early December to restore Ontario’s ban on private clinics after the government removed it in their omnibus health care bill that was brought to the legislature last fall.
The government passed the health care omnibus bill — Bill 160 — prior to Christmas and it has been promulgated into law.
The three political parties proposed a total of more than 100 amendments to the Bill. Those amendments went to the Standing Committee to to voted on in early December. (Membership in the Standing Committees follows the make-up of the Legislature so the governing party currently has a majority on all Committees.) The Liberals voted down all amendments proposed by the Opposition Parties. The amended Bill then went to the Legislature and was passed.
Our concerns about paramedic services, long-term care, private clinics and retirement homes were not addressed
The amendments we were seeking in all the other Schedules of the Act were not passed, with the exception of Schedule 9 (the Private Hospitals section) which I will describe below. Thus, our concerns about paramedical services, long-term care, private clinics, private retirement homes etc. still remain. If you want to see what they are, please see our submission on Bill 160 to the Standing Committee on General Government here: http://www.ontariohealthcoalition.ca/wp-content/uploads/submission-to-the-standing-committee-2.pdf
We were, however, able to get Schedule 9 — the section on Private Hospitals — amended to meet every one of our concerns.
This is what happened:
Schedule 9 repealed the Private Hospitals Act. This may sound like a good thing, but in fact, it was quite the opposite. The Private Hospitals Act (1971) was passed to limit private hospitals. It was a short Act, and a good one. Essentially, it banned all future private hospitals (after 1971) and stopped them from expanding, gave the Minister powers to require private hospitals to be licensed annually, to refuse the transfer (sale) of a license in the public interest, and enabled the Minister unfettered powers to revoke a private hospital’s license in the public interest. When the Shouldice Hospital tried to sell out to Centric Health, one of the largest transnational private health companies in the world, we cited the powers in this Act to ask the Minister to stop the sale. We were successful. Thus the Private Hospitals Act has, by and large, protected Ontario’s public non-profit hospital system from incursions by private for-profit hospitals and transnational chain companies for almost two generations.
So when the government introduced Bill 160, we were extremely concerned. We warned that the government was, in Schedule 9, lifting the ban on private hospitals and the powers of the Minister to stop their expansion and control them, without replacing those powers in the new legislation. We wrote an open letter to all MPPs we organized press conferences, asked the NDP to raise questions in Question Period, and we sought high-level meetings with the Premier’s, Government House Leader’s and Health Minister’s offices.
The Premier & the Health Minister agreed and stepped in to direct the bureaucrats to draft amendments
The Premier’s staff agreed with our analysis and facilitated meetings with the Health Minister’s staff and high-level bureaucrats. We brought our lawyers and ultimately key officials from the Premier’s and Health Minister’s offices agreed with our analysis and worked with us to fix it. The government delayed the legislation and agreed to make amendments to Schedule 9. We reviewed the amendments and the Premier’s and Health Minister’s offices agreed to change the language until we were satisfied. All this to say that the amendments, in the end, met all of the requirements we asked of the government regarding the issue of private hospitals.
This is what we achieved:
- The ban on private hospitals was restored. Only the 5 still-existent private hospitals that were grandfathered in under the 1971 Private Hospitals Act are allowed to continue.
- No private hospital can expand its services or its bed capacity. No private hospital may move its location.
- The Minister’s powers to license these facilities is reinstated along with the powers for the Minister to refuse the transfer, suspend, or revoke a private hospital’s license in the public interest.
- Only the grandfathered-in private hospitals may accept a patient for inpatient services and provide treatment. No other entity can do that, and no other entity can hold itself out as providing hospital services.
- We also won an improved definition of private hospital (as a facility that provides overnight accommodation and medical and nursing care). This will help to limit private clinics from turning into private hospitals.
- We also won expanded powers for the Ministry to control transfers of licenses among private clinics, and to revoke or suspend those licenses in the public interest.
In the end, we are satisfied that the government heard us and the amendments to Schedule 9 continue and expand the limits on private hospitals.
But private for-profit clinics (not hospitals) can still expand and take over public hospital services unless we stop them
However, Bill 160 rolled the private clinics providing outpatient diagnostics and procedures (not hospitals) legislation (called the Independent Health Facilities Act) into the new legislation and renamed it, even more euphemistically, the Community Health Facilities Act. The Act remains the same as it was. It allows the expansion of private clinics by the stroke of a pen of a bureaucrat in the Health Ministry. It was always a bad Act and remains so. We have successfully fought back every attempt to expand private clinics in recent years. We will have to continue to do so until we win legislation that rolls the clinics back into public ownership and stops the expansion of private clinics.
Bottom line? The premier and the Health Minister agreed with the protections we were seeking in the public interest. They worked with us to change their own legislation to stop the expansion of private hospitals and expand public control over them. This is a great achievement in the public interest. Now we need to roll the private clinics’ services back into public non-profit hospitals….
Misinformation from MPPs
Some of you have received letters from your local Liberal MPPs containing false information about Bill 160 Schedule 9. These letters mislead, mix up the issues between private hospitals and private clinics, and in some cases contort the truth in order to avoid admitting that the government made mistakes in the original draft version of Bill 160. The way that the Bill was written before the government agreed to work with us to amend it, private hospitals would be able to expand in Ontario. The powers of the Minister to exert the public interest over these hospitals were removed. There was no clear definition of private hospitals. In addition, private clinics would be able to expand with the stroke of a bureaucrat’s pen. Even with the amendments that we have won, private clinics can still expand with the stroke of a bureaucrat’s pen, but they cannot turn into full private hospitals with overnight beds and services.
Further, the government has been stating that the Private Hospitals Act was written in the 1930s. This has sown some confusion. It may well be that there was a private hospitals act passed in the 1930s. But the version that was changed by the Omnibus Bill and Schedule 9 was the version that is listed as the 1971 Private Hospitals Act in the government’s own e-laws. This 1971 version would have been significantly amended from the 1930s version of the Act since there was no public hospital system in the 1930s therefore there would be no ban on private hospitals etc.
While we thank the Premier and Health Minister for their help and for recognizing this issue as a serious one that needed to be addressed, the letters that we have seen from a few local Liberal MPPs are egregiously misleading, and sometimes, outright dishonest about what happened with Bill 160 and the issue of private hospitals. You can see the course of the events in November/December on our website here: http://www.ontariohealthcoalition.ca/index.php/urgent-action-alert-new-bill-allows-private-for-profit-hospitals-more-private-for-profit-clinics/ .
Thank you to the NDP for helping
The NDP kept up the pressure in the Legislature while we were negotiating with the Health Minister and Premier’s office. NDP Leader Andrea Horwath asked key questions in Question Period for several days in a row to make sure that the government was held accountable to come through with the changes we were seeking to protect against the expansion of private hospitals. You can see the videos of those questions in the Legislature and the answers from the Health Minister here:
Question 1 November 28 https://youtu.be/lTvLBxZXVzU
Question 2 November 29 https://youtu.be/eXag3w9_2Sw
Thank you — what an amazing team effort!
Thank you to all of you who contacted your MPPs, came out to the Legislature to help put on the pressure. Thank you to OCHU/CUPE and Unifor for helping to facilitate meetings with the Premier’s and Minister’s staff. Thank you to lawyers Steven Barrett and Ethan Poskanzer for working day and night to help. To all the organizations, from nurses to seniors’ groups, the Council of Canadians, health care unions for writing and presenting submissions to the Standing Committee pushing for amendments. To OPSEU for bringing out your members to help fill the Galleries at Queen’s Park. It was a team effort and everyone made a real difference.
Here is the history of the passage of Bill 160 as it happened:
(December 1, 2017) Success! Working with the Minister and Premier, we are on our way to ensuring the ban on private hospitals remains.
We are pleased to be able to report that the Minister of Health, Dr. Eric Hoskins and Premier Kathleen Wynne agreed with our concerns about private hospitals in Schedule 9 of Bill 160 which is currently going through Ontario’s Legislature. Schedule 9 repeals the Private Hospitals Act. This may sound like a good thing on the surface of it, but in truth this Act banned all future private hospitals after 1973. It gave the Minister unfettered powers to revoke a private hospital’s license and powers to stop the transfer (or sale) of a private hospital, in the public interest. When multinational giant private health corporation Centric tried to buy the Shouldice Hospital in Ontario, we used this legislation to ask the Minister to stop it. The ban in the Private Hospitals Act has worked to stop new private hospitals from opening in this province for an entire generation.
We were extremely concerned about the legislation, which, as written would lift the 44-year ban on private hospitals and enable the existing 1000 private clinics (98% of which are for-profit) in Ontario to turn into private hospitals. The Minister and the Premier agreed with these concerns and have worked to amend the legislation. Proposed changes to the legislation will go to the Standing Committee on General Government early next week. Then the legislation will return to the full Legislature for final Reading and debate before it is passed into law. The Legislature will rise on December 14 so we anticipate the process will be complete by then.
Thank you so much to the thousands of individual concerned citizens who called or emailed your own MPP, or the Minister’s office, or the Premier. We know that your efforts made a huge difference. Thank you also to all of those who came out to the Legislature on Wednesday to watch Question Period from the Galleries. The group was greeted by the Health Minister who said that he was working with us to get the language right and make sure the ban on private hospitals is “crystal clear”. The group was also greeted by Ontario NDP Leader Andrea Horwath who asked tough questions about this issue both on Tuesday and Wednesday in the Legislature. Thank you also to Andrea Horwath for keeping up the pressure in the public interest. We will send the video of the Question Period exchanges out to you as soon as we can get the clips.
Many thanks are also due to the lawyers Steven Barrett and Ethan Poskanzer who worked night and day to help with this, to the staff in the Minister’s and Premier’s offices who also worked night and day to help, and to OCHU/CUPE for providing for the legal team, to UNIFOR who contacted the Premier’s office and asked for help to resolve this, to the OHC Board and all our affiliates — from the nurses’ organizations, ONA and the RNAO, to the Health Professionals at OPSEU and NUPGE, to seniors’ groups like OCSCO and the Older Canadians Network, and so many many more, who put extra effort in to raise this issue in Hearings, with MPPs, among your memberships, and so on. This was a team effort. Thank you all for making it successful!
We will keep you apprised as the amendments go through Committee to be voted upon and the legislation goes back to the Legislature for final reading.
Private Clinics Still A Significant Problem
While we are really pleased that the Minister and Premier recognized the gravity of the issue regarding private hospitals and acted to stop them, we are still left with 1,000+ private clinics, the vast majority of which are for-profit and many of them chains. Many of these private clinics charge extra user fees to patients for medical services in violation of the Canada Health Act. Cataract surgery clinics are particularly bad. Other clinics sell a bunch of add-ons using manipulative tactics to push patients to pay hundreds or even thousands of dollars for care. This should never happen. Public Medicare in Canada provides that we pay ahead of time through our taxes for care and we share that money across income classes and generations, so that care is there for everyone when they need it. Extra user-fees violate the cornerstone principles of public medicare in our country. They drive up costs. They cause hardship, particularly to seniors and persons with chronic illness who are often patients most in need. The clinics have also shown serious breaches of safety and quality. One private endoscopy clinic in Ottawa failed to properly sterilize its equipment. Public Health had to contact 6,800 patients and advise them to be tested for HIV as a result. Studies have shown that the private colonoscopy clinics in Toronto have a high rate of tests that do not breach the colon, therefore do not tell the patient accurately whether they have cancer or not, for example. A patient died on the operating room table in a Toronto clinic where she was being given liposuction.
Privatization of hospital services into private clinics is not in the public interest. For patients, it is not easier having to travel from a public hospital emergency or specialist, to a private lab, to a private MRI clinic somewhere else, to a private diagnostic clinic of another sort somewhere else, and so on. For many people this actually requires travel from town-to-town as services have been entirely cut from their local hospitals. The privatization of these hospital services has fragmented care, forcing patients to travel to multiple different locations on multiple different days. This is particularly hard on seniors, the poor, those who cannot drive and those who work and have to take time off repeatedly to deal with the fragmented system. It is time to stop the cuts to and privatization of our hospital system and re-integrate services in quality public, non-profit hospitals and community health centres that are run for the public good not for private gain.
Unfortunately, Bill 160 does not do this. It leaves the field wide open for a bureaucrat in the Ministry of Health to vastly expand the private clinics. This is unchanged from the previous legislation that exists now and until the new Act is passed. It remains a significant problem.
Other Parts of Bill 160 Remain
Bill 160 is an omnibus bill that enacts or repeals 7 entire Acts, and amends another 30+ Acts. It was moved through the Legislature very quickly and there were only 4 part days of hearings in Toronto for the public to give input. There remain significant parts of the legislation with which we have concerns.
(November 23, 2017) URGENT ACTION ALERT: New Bill Allows Private For-Profit Hospitals & More Private For-Profit Clinics
The Ontario government is moving forward with legislation that lifts the ban on private hospitals, rolls private hospitals in with private clinics and renames them, offensively, Community Health Facilities, and makes it easier for private hospitals and clinics to expand and more difficult for the Minister to stop them.
(November 13, 2017) URGENT UPDATE: With No Public Consultation Ontario’s Government has Introduced Massive New Legislation that Lifts the Ban on Private Hospitals and Changes the Ambulance Act, Long-Term Care Homes Act and Retirement Homes Act, among others
The government introduced the legislation last month and it has passed second reading. The Standing Committee on General Government is holding only four days of public hearings, only in Toronto. The Ontario Health Coalition will be presenting to the Standing Committee this Thursday. Timelines are extremely tight, but it is still possible to apply to present before the Standing Committee.The deadline is Wednesday (November 15) to apply for standing to make an oral presentation before the Standing Committee and noon on November 23 is the deadline to send in a written submission. Information on how to apply for standing and make a submission is here: http://www.ontla.on.ca/committee-proceedings/committee-hearings-notices/files_html/Ad%20Bill%20160.htm
We have prepared our submission. It is linked below.
BILL 160: Manipulative PR
In reality the Bill a massive piece of legislation, repealing 4 Acts, enacting 3 new Acts and amending more than 30 Acts
Public media messaging about this legislation has focused on the elements of the Bill relating to transparency. However, in actuality Bill 160 is an Omnibus Bill with far-reaching implications. The legislation repeals four existing Acts, enacts three new Acts, and makes significant amendments to seven Acts and other amendments to more than thirty Acts in total. Most of its Bill 160’s key sections have not received any public consultation prior to their introduction in legislation.
No Public Consultation
The process by which this Bill has been introduced is unacceptable. It is a massive piece of legislation impacting dozens of existing laws without proper public consultation and without appropriate time for the public to analyse and respond. There are four days of public hearings in Toronto only, though the Act impacts the liability of municipalities and ambulance services across Ontario, lifts the ban on private hospitals across the province, enables the introduction of an array of private clinics, changes conditions of care and work in all of Ontario’s long-term care homes impacting more than 77,000 Ontarians who reside in those homes and their families as well as tens of thousands of care workers, and enables private retirement homes to legally restrain or lock up residents, among many other provisions.
Part of the Act Would Usher in New Private For-Profit Hospitals and Clinics
Health Coalition calls for the urgent repeal of Schedule 9
As a matter of top urgency, we are calling for the repeal of Schedule 9 of this Act. This Schedule repeals the Private Hospitals Act , the Independent Health Facilities Act and the Healing Arts Radiation Act. By repealing the Private Hospitals Act, this Schedule removes the ban on private hospitals. It also dramatically widens the ability for Cabinet or for an appointee of the Minister, without going back to the Legislature, to usher in a whole array of private for-profit hospitals and clinics. There is no preference for non-profit ownership and no prevention of foreign ownership. There is no improvement to the safety regimes in the new Act as it is proposed here. Almost every meaningful item regarding quality of care, safety, monitoring and enforcement is left to regulations that can be decided by cabinet and changed easily with little public notice and input.
Part of the Act Legalizes Confinement of Residents in Retirement Homes
Health Coalition calls for repeal of Schedule 10
Schedule 10 must also be repealed. It enables private for-profit retirement homes to legally confine residents. Retirement homes are overwhelmingly private and for-profit. They are not health care facilities. They are governed under the Tenant Protection Act — the same legislation that covers apartment buildings. They have nowhere near the same regulatory regime and public interest protections as long-term care homes. They are self-regulating. There is nowhere in our society where we allow people to be locked up in private residences with minimal public interest or procedural protections.
Part of the Act Supports Further Cuts to Public Hospitals and Increased Liability for Paramedics Ambulance Operators
Health Coalition calls for amendments to Schedule 1
Schedule 1, which enables the Minister of Health to order all ambulance services in Ontario to transfer patients to non-hospital facilities (including the new array of private hospitals and clinics described above) and to treat patients in ambulances without taking them to public hospitals must be amended.
Part of the Act Improves Transparency and Protections for Long-term Care Residents
We support Schedule 4 which provides the Minister of Health with new powers to obtain information about financial relationships in the health care sector.
We also support Schedule 5 which limits the confining (including use of restraints and locked units) of residents in long-term care homes. However, this Schedule does not recognize in any way that the requirement to minimize confining must be accompanied with a level of care that is adequate to meet the needs of residents. While the acuity of residents (that is, the complexity and care needs) has increased dramatically with the cuts to psychogeriatric and chronic care hospital beds and population aging, the level of care in Ontario’s long-term care homes has lagged far behind the increased need. As a result, the level of violence has increased. Homes are increasingly unsafe for residents, families and staff alike. This Schedule must be amended to include a minimum average care standard of 4 hours of hands-on daily care for residents, proper provisions for specialized care for those with behavioural issues, better monitoring and reporting, a reduction of temporary agency staff, and an increase in hospital beds for patients with care needs that are too heavy for long-term care.