Cut services to elderly, says doctors’ survey… but leave our salaries alone!

“With a guaranteed income and job security, I don’t know one doctor who has suffered in the recession…”

By David South

Today’s Seniors (Canada), January 1993

If the results of a nation-wide survey of doctors are right, Canadian physicians love medicare but abhor government attempts to make them accountable for its costs. It also suggests that doctors are more willing to talk about cutting services to seniors and people with “unhealthy lifestyles” than to discuss cutting their own wages to save money. 

However, according to some doctors, physicians’s anger with the provincial government is founded on ignorance and poor analysis of the larger forces affecting health care. 

The survey, Breaking the Wall of Silence: Doctors’ Voices Heard at Last, was commissioned by The Medical Post, a national newspaper for doctors. It sent questionnaires to 12,000 doctors, receiving 3,087 responses. The Post also conducted in-person interviews to better gauge the mood of doctors. 

The survey’s title is somewhat misleading, considering that doctors have been making noise over a number of issues this year; targets included proposed right-to-treatment legislation, cuts to the Drug Benefit Plan, capping of yearly billings at $450,000, and inquiries into charges of sexual abuse by doctors. And most significantly, the last conference of the Canadian Medical Association passed a resolution calling for a two-tier health system in which those with money can hop the queue. 

Post editor Diana Swift says the poll shows fairly strong support for limiting services to the elderly, although the survey question is short on details: “I feel it is reasonable that access to high-cost services such as transplants should be rationed according to such parameters as the patient’s age and/or unhealthy habits.”

Yet just under 70 per cent of doctors opposed any capping of their salaries, despite 56 per cent of the public supporting this measure according to a 1991 Globe and Mail-CBC poll. 

When questioned, Health Minister Francis Lankin expressed surprise that doctors felt so strongly, and denied the government is considering rationing services to seniors. Lankin feels the volatile mood of doctors is a reaction to the rapid changes taking place in health care. 

Dr. Michael Rachlis, health care critic and author of the book Second Opinion, says the survey’s low response rate means that the answers reflect “redneck physicians, who are more likely to respond.” Swift admits to a high response rate from young male physicians, who since the 1986 doctors’s strike in Ontario, have been considered the profession’s most militant. 

One response which some may find alarming was towards the “Oregon model.” In that American state, medical procedures are rationed to seniors and individuals covered by medicare. Anybody needing uncovered emegency treatment has to pay for it themselves. A disturbing 65 per cent of survey respondents supported such a move. 

Dr. Gerry Gold, associate registrar at the College of Physicians and Surgeons of Ontario, feels that some doctors lack perspective. “The complaints are a reflection of frustration with increasing involvement of government. But if physicians understood the role of the government in the U.S., they would realize they, along with insurance companies, intervene far more.”

Gold says doctors have had the same complaints ever since the beginnings of medicare. “Many front-line doctors lack the information to make informed comment,” he says. “They aren’t being consulted or informed by the government.”

Rachlis says many doctors fail to realize how privileged they are. “Canadian physicians don’t realize medicare has protected their autonomy more than in the U.S.,” he says. “Doctors are always angry because they have large chips on their shoulders from being brutalized in their training. They don’t realize the government has given them a privileged monopoly over health services. With a guaranteed income with job security, I don’t know one doctor who has suffered in this recession.”

Gold doesn’t foresee strikes or job actions by doctors, but predicts further government cuts, and more services being de-insured by OHIP. A recent example involved removing coverage for third-party medical exams such as those requested by employers or insurance companies. As medical procedures end up outside of OHIP, Gold foresees physicians charging whatever they like. 

A perennial idea is the user fee. This is one of the few ideas that gathers support from a majority of doctors and the general population alike. But Rachlis feels these measures are meanspirited and avoid the real problems plaguing health care. “When Saskatchewan introduced user fees for physician and hospital care in 1968,” he says, “health costs remained the same and it discouraged the elderly, the poor and people with large families from seeking service. 

“When providers are allowed to charge users for care, as in the United States, where more than 20 per cent of health care costs are paid our of pocket, overall costs go up.” 

Elect Peace

By David South

The Canadian Peace Report, Summer 1993

More than 80,000 people swarmed Parliament Hill on May 15 at an Action Canada Network and Canadian Labour Congress rally against free trade and other federal policies. In a paper issued just before, the Canadian Centre for Policy Alternatives criticizes Canadian military spending as “carried over from a cold war that no longer exists. At the same time, our assistance to poor nations is actually falling.” 

When a federal election is called, peace groups across Canada plan to be heard. They see the defence department’s $11.3-billion yearly budget - amidst cuts to social programs and calls for even more restraint - as ripe for a hot election battle over government priorities. 

A recent Gallup poll conducted for the Canadian Peace Alliance found broad support across all political allegiances for cutbacks to military spending. The CPA also wants daily life demilitarized, with duties like search and rescue turned over to civilian agencies. 

Local groups are mostly awaiting a date for the election, expected about late October, but national groups are already planning. Some groups will fight the Conservative Party’s backing of the North American Free Trade Agreement (NAFTA), which they fear will lead to further military integration of Canada and the United States. 

The Peace Alliance is working on action and information kits targetting military spending versus social needs, and is developing an election logo. It’s also building up to a national action day. 

The idea is to stimulate local and regional activity, coordinator Gideon Forman says. “Kits will help member groups organize actions during the election campaign. They will have information on, among other things, the plan to buy deluxe helicopters, military spending in general and the cost of social needs. 

“We will give local groups suggestions for local events and assist with media work.”

Project Ploughshares has produced a short booklet of questions to ask candidates, “but not a repeat of the Election Priorities Project” of the 1988 election, says researcher Bill Robinson. The booklet suggests calling for cuts in military spending, cancelling the EH-101, limiting Canada’s participation in military operations, and abolishing nuclear weapons. 

Also nationally, the Action Canada Network (to which the Peace Alliance belongs) met with groups from across the country in Winnipeg in mid-June to finalize election plans, which may include a radio ad campaign. National chair Tony Clarke would like local activists to dog the party leaders across the country, as progressive groups did to Ontario’s Liberals during the province’s 1990 election. 

“We will definitely make the link between a range of issues and the (Canada-U.S.) Free Trade Agreement and NAFTA, which we have to get rid of,” says Clarke. “We will be working very hard on jobs and arguing for a job strategy.”

Responding to the Gulf War two years ago (Action Canada Dossier #30), Clarke warned that Canada is “tied in closer than we have ever been before to the permanent war economy” of the U.S.. With a quarter of its output related to the military, the U.S. used militaristic diplomacy to justify maintaining defence budgets, he says. The trade agreements’ guarantees of U.S. access to Canadian energy resources confirm that “we are locking ourselves into what can only be described as Fortress North America.”

Maude Barlow of the Council of Canadians, a network ally, denounced the helicopter purchase during the Peace Alliance’s March 8 lobby of Parliament. Soon after, then defence minister Kim Campbell appeared to waver on the number of helicopters to be bought, but succeeded in winning the Tory leadership without it becoming a major issue. However, Liberal leader Jean Chretien promises to cancel the contract.

At CUSO’s national office, Marc Allain says the development agency will work with the CPA around military spending and the ‘copter purchase. 

To Peter Davison of the Halifax Peace Action Network, the stakes are clear and the passion to fight the issues simply awaits a polling date. 

“Never has the guns-or-butter issue been more prominent in our society,” says Davison. “Conservative economic policies have been collapsing around the globe. We’re seeing desperate restraint and universal trusts being violated - health care, education, pensions.

“It’s bizarre that we can still conceptualize $6 billion for helicopters to fight submarines - an absurd twist away from meeting human needs.”

Terry Gardner says Science for Peace’s mandate bars entering the election fray, but says the group is planning a high-level panel in the fall on NAFTA and militarization of Canadian culture. 

“We’re going to be asking candidates in our area for conversion and reduction in military spending,” says J.J. Verigin of the Doukhobour peace and disarmament committe in British Columbia. He says his MP has been supportive of chopping the choppers. 

Verigin found fact sheets helpful and says the CPA does a good job of getting out beyond the urban areas. But he would like the Alliance “to propose something that engages the electorate’s intellect as the gut.”

“We have a general intent to intervene in the election, but we’re not quite clear exactly how,” says North Bay Peace Alliance organizer Brennain Lloyd. “We’re considering a regional information package, something like the Election Priorities Project, that our groups could use.”

Being armed with the facts helps reach the public and pins down candidates, Lloyd says. She applauds the CPA’s idea of producing action kits that her group could integrate into its own. 

Toronto’s ACT for Disarmament won’t be working specifically on the election, but may participate in actions, says organizer Maggie Helwig. “Groups have certain things they focus on, and certain ways of operating. Other people do better at elections.”

In Montreal, Judith Berlyn of Westmount Initiative for Peace says, “We will be doing locally what has been developed by the Canadian Peace Alliance as a whole - go to all-candidates meetings, get the mike and ask the questions. We will be raising issues. Last time our candidate had never heard of low-level flying.”

Berlyn feels many people, including activists, often think they don’t know enough to speak publicly. But with information kits, “we know more than the candidates do.”

While approving the CPA’s focus on military spending, Berlyn says it would be a mistake to over-emphasize the helicopters. “Everybody has [already] picked up on that; it’s a good concrete example of insane military spending.”

She also finds the public receptive to informative and succinct pamphlets advocating alternatives to a militarized economy. A Coalition to Oppose the Arms Trade pamphlet is a good model, she says. 

“It has four concrete proposals of what the government can do to convert military industries - money that now goes to subsidizing the manufacturing of weapons can be turned into conversion subsidies.”

Feds call for AIDS, blood system inquiry: Some seniors infected

By David South

Today’s Seniors (Canada), July 1993

HIV-tainted blood transfusions given in the early 1980s have left some seniors with AIDS, but it is feared many are unaware of their HIV-positive status. 

Between 1979 and 1985 - before testing of blood products for HIV became mandatory - 266 transfusion recipients and over 677 hemophiliacs are known to have been infected in Canada, according to the Centre for AIDS Statistics. 

But the final numbers are unkown - estimates range from 400 to 1,000 cases of HIV transmission among the 1.5 million Canadians given blood products during this time. 

This uncertainty is fueling public concern. With such a serious public health danger, many are shocked by the confusing messages being sent by governments, the Canadian Red Cross Society and hospitals. 

But it took the report of an all-party Parliamentary subcommittee on health, released at the end of May, to shock the federal government into calling for a public inquiry into the blood system. The report is highly critical of the decision-making process involved in blood collection and distribution. 

“We have members of our group who are seniors,” says Jerry Freise, spokesperson for advocacy organization HIV-BT (Blood Transfusion) Group, whose wife was infected with HIV due to a blood transfusion. “And many of them went for years being misdiagnosed and treated for something other than HIV. Others have gotten sick, and one died without knowing it because nobody told him. 

“A classic case is Kenneth Pittman who was infected in 1984. The Red Cross found out in 1985 and they allegedly took two years to tell The Toronto Hospital. The hospital took two years to tell his doctor, and his doctor decided not to tell anybody. 

Infected

“Another couple, a lady of 59 and a man of 64, called us April 1. She found she was infected, and the reason she took a test is because her husband turned out to be HIV-positive three weeks before a transfusion in 1983. He had gone for years without a diagnosis from doctors.” 

This runs counter to the Red Cross’s story. 

“Whenever a blood donor tests positive for HIV antibodies, we go back and trace the prior donations,” says spokesperson Angela Prokoptak at the Society’s national office. “The Red Cross supplies blood to hospitals, so we know which units went to which hospital. But the hospital must go through their records to find who they transfused. 

“After identifying the recipient, the hospital contacts the recipient’s physician, and then they have them tested. There are of course limitations.

“Since 1987, the Red Cross has been advising people who may be concerned to consult their physician for counselling and advice.”

But subcommitte member Chris Axworthy, an NDP MP, found that hospitals and the Red Cross hesitated to notify former patients for fear of lawsuits. He says the federal government should show some leadership and stop passing the buck to other agencies and departments. 

Only two hospitals in Ontario - Toronto’s Hospital for Sick Children and Princess Margaret Hospital - have tried systematically to contact former patients. 

Ontario health ministry spokesperson Layne Verbeek says it is a laborious and costly task for hospitals to notify former patients. “We’ve always informed people if they are thought to be at risk, but many hospitals aren’t in the position to trace. If people are at risk or have doubts, they should be tested.”

Verbeek says recent media coverage has caused an increase in the number of people seeking HIV blood tests - requests for the test doubled after the Sick Kids hospital went public. The provincial government’s lab went from 700 tests per day to 1,300, but Verbeek says that has started to taper off. 

The ministry of health is happy with the number of people coming forward to be tested, says Verbeek. 

But Friese says the different players are more concerned about lawsuits than informing the public. He is especially upset at the Red Cross for not taking a leadership role in disseminating information. 

“The Red Cross and the medical system have failed miserably to contact people. Even today they are reticent to tell people they were part of a risk group and should get treated.” Friese feels the various governments and the Red Cross are leaving the job of informing the public to his group and the Canadian Hemophiliacs Society. 

Beat the drums

“It’s my job to beat the drums for the media while I’m dealing with my wife being infected? That’s my job, when these are the ministers of health?”, Friese says with anger.

The effect of AIDS on seniors isn’t new to US-based National Institute on Aging researcher Marcia Ory. She and colleagues helped sound the alarm back in 1989 with the book “AIDS In An Aging Society: What We Need To Know.” In the US, over 10 per cent of AIDS cases have occurred in people over 50. 

“Surprisingly, people have ignored older people and the AIDS issue,” says Ory. “You had older people in hospitals who might have complained about fatigue which was thought to be age-related. Older people aren’t as likely to be diagnosed as early because of the assumption that they are not at risk from AIDS.

“We don’t want older people in general to be overly fearful, but we want them to acknowledge the possibility, and to engage in good preventative practices if they are at risk.” 

Ron deBurger, director of AIDS prevention for the Canadian Public Health Association, would like assurances that the security of the blood supply has improved. 

“The subcommittee came to the right conclusion asking for a public inquiry,” says deBurger. “I would hope the terms of reference are broad enough to take a look at the whole issue of the safety of the blood supply, not only in terms of what happened in the past, but, more importantly, what’s happening today.”

Other than hemophiliacs, who require large quantities of blood, deBurger believes anybody who received one transfusion has a small risk. “If you had blood once, I think the odds are pretty long that you are going to end up with tainted blood. But AIDS does take eight to 10 years to manifest itself, and we might still be picking up pieces for the next four to five years that we don’t know about yet.” 

Friese recommends that anybody who received blood or blood products between 1979 and 1985 get an HIV test. If their doctor says it isn’t necessary, they should call the AIDS Hotline about anonymous testing. 

Anybody who has tested positive for HIV and would like support and counselling can call Robert St-Pierre of the Canadian Hemophilia Society at 1-800-668-2686.

For information on anonymous testing call the Ontario government’s AIDS Hotline in Toronto at 416-392-2437. For support write HIV-BT Group, 257 Eglinton Avenue W., Suite 206, Toronto, Ont., M4R 1B1. 

The Ethics of Soup: Grading Supermarket Shelves – For Profit

By David South

This Magazine (Canada), March-April, 1993

Where social activists have tried and failed to get Canadian corporations to change their behaviour towards the environment, labour, women and minorities, EthicScan Canada – a for-profit consulting and research firm – steps in.

Toronto-based EthicScan acts as a consultant on ethical issues to both government and private businesses and produces a guide for investors. Its latest project hit the bookstores last fall. The Ethical Shopper’s Guide to Supermarket Products rates products according to companies’ ethical performance. “EthicScan is the only company in Canada doing this,” says senior writer Joan Helsen. “Companies respond to us differently because we are – like them – a business. We have a very good reputation for doing strong research and presenting the facts.”

Non-profit groups have produced similar guides. In the US, perhaps the best known is the American Council on Economic Priorities’ Shopping for a Better World. Here in Canada, both Pollution Probe’s Green Consumer Guide and the Ontario Public Interest Research Group’s The Supermarket Tour offer educational information.

But The Ethical Shopper’s Guide is the first guide in Canada to give a product-by-product breakdown, and to detail the web of corporate ownership. It lists more than 1,200 brand-name products from baby food to soft drinks, with the manufacturer’s “grade” for each ethical category. The guide also profiles 87 companies, with an “honour roll” of 37 corporations.

All of this can be confusing. Oxo gets an F for “women’s issues” and F+ for “environmental management,” but scores A+ on “progressive staff policies” and “environmental performance.” (Apparently. “environmental management” has to do with company structures for dealing with environmental issues while “environmental performance” measures how much it actually pollutes.) What aspect of Oxo’s ethical behaviour do you reward or punish?

EthicScan’s approach fits current advertising trends. Nissan tells us it is just trying to build cars we can live with. Loblaws puts “Green” on everything from plastic garbage bags to tubes of shampoo. But once idea-starved ad copywriters move on to the next gimmick, EthicScan may find that the relationship between ethics and profit isn’t as straightforward as its grading system suggests.

EthicScan's senior writer Joan Helsen.

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Counter accusations split Bathurst Quay complex: Issues of sexual assault, racism at centre of local dispute

By David South

Now Magazine (Toronto, Canada), August 26-September 1, 1993

At the foot of Bathurst where the street disappears into the blue shimmer of Lake Ontario, a complex of apartment dwellers is bitterly divided over issues of public safety in a contest fraught with the tensions of race, class and gender.

Here in the seven-year-old neighbourhood of four co-ops and two municipally funded Cityhome buildings, activist opinion has hardened into factions with widely divergent views on one question – how safe is the Bathurst Quay community?

One group, an ad hoc collection of residents and concerned others is calling for an inquiry to investigate a list of alleged instances of sexual assault and harassment against women going back more than three years. Some of these say they cannot speak publicly for fear of retaliation by a coterie of violence-prone youth in the area.

And they say that they will not release the names of the alleged victims until confidentiality is assured by an independent inquiry.

But neighbourhood youth workers and some residents say this group hasn’t come forward with enough evidence to back their allegations, and that they are playing judge and jury. This collection of individuals, they say, are at best insensitive to the problems of Cityhome youth – many of whom are black – and at worst racist.

Forgotten youth

A year ago, Cityhome management commissioned a consultants report after residents reported the alleged gang rape of an 11-year-old girl, the presence of youth gangs with guns and drugs, and the sexual assault of young girls in the community centre.

The document, concluded in February, argued that the gang had disappeared, but admitted that it couldn’t come to any conclusion as to the validity of the accusations.

Some argue that the list of allegations is an over-reaction to the energies of under-class youth, and that what is essential is keeping communications with them open. Calling the police every time there is a problem, they say, only exacerbates tensions.

“My analysis of the situation is that there are a bunch of adults who have forgotten what it’s like to be youth,” says a community leader who prefers to remain nameless.

“There are youth who are angry, have done stuff, I see a lot of threatening happening, and it’s not by young black youth. It’s by articulate, middle-class white women. It’s sexist, ageist and racist.”

But members of the pro-inquiry group – many of whom belong to the safety committee of the Bathurst Quay Neighbourhood Association (BQNA) – say this point of view, which looks so politically correct, in reality favours young men over young women.

One resident who has been monitoring the situation and who fears physical assault if identified, says it’s important to link racial discrimination and sexual harassment, but women’s fears, she says, shouldn’t be sacrificed to make links with troubled youth.

“Community workers have made choices to privilege male youth,” the resident says. “Racial oppression and sexual oppression are bumping heads, but when young males engage in acts of crime they have to account for their actions. The safety group went many times to the community centre board about abuse in the neighbourhood, but the discussion was repressed. The racism charge is a silencing tool, preventing people from speaking out.”

Three arrested

Another resident of one of the Cityhomes, whose daughter was assaulted in the laundry room over two years ago, says she and other women have to deal constantly with taunting by local youth.

“We are known as the broad squad,” she says. “Three or four of us will defend each other in the courtyard. A lot are afraid to walk at night.”

Three of the youths accused of harassing tenants were arrested Sunday (August 22) for a hat-trick of armed robberies on Bathurst, according to Keith Cowling of 14 Division. Two are residents of Bathurst Quay, while a third, from nearby Maple Leaf Quay, regularly visits the area.

Pro-inquiry forces say they are stung by charges of racial unfairness, and say they want prominent womens’ and black community groups as investigators to ensure, as their pamphlet explains, an “anti-racist, anti-sexist and anti-classist” resolution.

“It seems to me that whenever you say something, you are called a ‘racist’," says Marlene Irwin, chair of BQNA and contact person for the pro-inquiry group.

“I feel we are doing male youth more of a favour (by calling for charges to be laid) than those protecting them for assault, harassment and break and enter,” she says.

Much of the attention of the ad hoc group focuses on the Harbourfront Community Centre (HCC) – a small, portable building, clean, unvandalized and decorated with posters depicting African-Canadian history.

Last month, a former youth worker who left the HCC circulated a hard-hitting document summarizing her experience at the centre. She says in it that there is an “apparent ‘normalizing’ of violence within the youth community that has been supported by various adults living and working in the community.”

She was, she says “physically assaulted at work. There was a general environment of abusiveness that frequently resulted in forceful behaviour.” There was, she says, daily physical, sexual and verbal bullying and manipulation by the young men towards the young women.

Washrooms and the office, she says, were dangerous places for young girls.

But HCC executive director, Leona Rodall, sitting in her office – a small janitor’s closet – with tears rolling down her face, denies that she allowed young women to be abused.

“The BQNA safety committee refused to meet with us,” she says. “We have nothing to hide, but what can we do if we don’t know what the incident is and when? Children’s Aid said there is nothing they can do without names and dates. If safety committee members have information of assaults by minors, they are liable to inform the CAS.”

The problems faced by youth in the community involve racism and poverty, and this means some aren’t Sunday-school types, she says.

Rodall supports an inquiry if it clears the air and investigates the validity of the alleged assaults.

HCC staff believe they are being singled out for blame for the community’s social problems because they are the only service there, and that some residents don’t like the mandate and approach of the HCC, where youth take priority and those charged with criminal acts are not excommunicated.

Youth worker Robin Ulster says some of the residents insult the youth. She argues that the conflict is a two-way street. She says the issue of public safety is being defined much too narrowly by those arguing for an inquiry.

“It should take into consideration the safety of youths who experience racism and poverty,” she says.

“All these incidents of young women being touched, or pushed into the washrooms, I haven’t seen it,” she says.

One black youth worker at the HCC who helps with the girl’s club, Tamara (she prefers not to use her last name), says rather than being harassed, the young women are very independent and confident.

Yuppie attitude

Residents are causing a self-fulfilling prophecy, by backing troubled black male youth against the wall. People who think the easy solution is to rely on police are expressing a “yuppie WASP attitude”, she says.

Black and white youth interviewed at the HCC say they don’t recognize the scenario the complainants paint. One of them, David, a 12-year-old who has lived in the community since its beginning seven years ago, says it is far safer than other Cityhomes he’s lived in, but “Some of them are prejudiced, nosy people.”

Toronto Councillor Liz Amer, who sits on the board of the HCC, says while she has helped women transfer out of the neighbourhood, the numbers have been no worse than in other Cityhomes.

“I know from time to time people do run into problems with neighbours,” says Amer. “The centre is trying to provide recreation services, not police.”

But Francis Gardner, chair of the tenant association at the Bishop Tutu Cityhome says many people are underestimating the menacing impact, particularly for women, of local teenage boys clustered outside the entrance.

“It’s easy to trivialize the loitering. But you have to step over their feet, and this lurking – they give young women the once over.”

"Counter accusations split Bathurst Quay complex": Now Magazine, September 1993.

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