THE WEST BLOCK
Episode 7, Season 12
Sunday, October 30, 2022
Host: Mercedes Stephenson
Dr. Rod Lim, Pediatric Emergency Physician, Canadian Association of Emergency
Dr. David Carr, Emergency Physician, University Health Network
Erin O’Toole, Conservative—Durham
Bruce Moncur, Afghanistan Veterans Association of Canada
Debbie Lowther – VETS Canada
Location: Ottawa, ON
Mercedes Stephenson: Are we heading for another health care emergency as wait times in ERs across the country soar?
And veterans in crisis: The urgent call for Ottawa to do more.
I’m Mercedes Stephenson. Welcome to The West Block.
Children’s hospitals have joined the ranks of ERs overwhelmed by surging cases, putting more strain on an already stressed out system. What’s the solution? We’ll ask the doctors.
Canadian veterans are waiting months for benefits as they struggle and feeling angry over the government’s response to a veteran who was offered medical assistance in dying (MAiD) as an alternative to treatment. Is the government failing our vets?
Long wait times and overflowing emergency wards are a problem all across this country. Even children’s hospitals are sounding the alarm, saying a bad situation is being made worse by cold and flu season which is now upon us.
The premiers have launched a new ad campaign aimed at getting the federal government to increase health funding. So, where are the problems and what are the solutions?
Joining me to talk about the health care crisis are pediatric emergency physician Dr. Rod Lim and emergency physician Dr. David Carr.
Doctors, thank you both so much for taking time out of your very busy schedule treating patients, to chat with me and our viewers about what’s going on.
Dr. Lim, I’d like to start with you because I think the situation in children’s hospitals is particularly concerning and shocking to people. What is happening in your emergency room right now?
Dr. Rod Lim, Pediatric Emergency Physician, Canadian Association of Emergency: Well it’s a tough situation. The fall/winter, always traditionally a time of high viral activity as the weather cools and the viruses spread easily within indoors from schools. We are seeing quite a surge in RSV earlier than we traditionally see it and in fact, since the pandemic, the virus has really kind of broken all the normal timelines. We’ve had RSV actually over the summer as well, which is unheard of. So at the current time, there’s a tremendous strain on both the emergency department, in-patient wards and ICU capacity, across the country.
Mercedes Stephenson: Now how long would the average pediatric patient, do you think be waiting on a bad day?
Dr. Rod Lim, Pediatric Emergency Physician, Canadian Association of Emergency: It really varies across the country, but I think, you know, anywhere from two to seven hours, depending on which emergency department you’re going to. And currently, I’ve seen wait times across the country even approaching 18 to 20 hours.
Mercedes Stephenson: Wow, 18 to 20 hours. It’s an incredibly long time and I know the situation is not better for adults either, Dr. Carr. You’re with the University Health Network. That’s a lot of big hospitals in Toronto for folks from outside the GTA area. What is the situation in the emergency rooms in the hospitals that you’re involved with?
Dr. David Carr, Emergency Physician, University Health Network: We’re seeing tremendous difficulties and really the main difficulties stem from the fact that we’ve had significant shortages of nursing, coupled with a tremendous change in respiratory viruses and then poor access to people to get into their primary care practitioners. So it’s almost a perfect storm so to think in terms of getting people the appropriate care in timely fashions. And I think emergency departments are the barometer of the health care system, and right now in Ontario and across the country, there are some alarming signals.
Mercedes Stephenson: Dr. Lim, why do you think this is happening? Is this sort of COVID pushed an already stressed system to the brink and it started to fray and now we’re seeing the consequences of that. Is it longstanding systemic problems and that’s why we’re seeing it across the country and not just in one province, but not another? What do you attribute this crisis to?
Dr. Rod Lim, Pediatric Emergency Physician, Canadian Association of Emergency: Yeah, I mean it’s all of the above. We know that prior to the pandemic, we were already sounding the alarm in emergency medicine of hallway medicine, bed lock, really having a hard time flowing patients through the emergency departments. The pandemic has been a tough experience for the entire community and the public, and we’re no exception. So we had a very exhausted health care group that was really giving it their all for two and a half years now, but after the pandemic has slowly waned, at least within the public’s, you know life, it has not been anywhere close to normal in the health care systems. And as a result of that, a lot of people who were considering retirement have left. A lot of nurses—the experienced nurses that we have—have had to decide to change locations, or change professions, or do travel nursing, or leave the country and it’s left us in a quite a difficult situation where we’re already exhausted, we’re short-staffed and now we have additional stresses with the viral acuity, sometimes access to timely access to their primary care because they’re overwhelmed as well. It’s—it is the perfect storm right now.
Mercedes Stephenson: It’s tough to get into emerge. It’s also often tough to get in to see your family physician, if you’re even lucky enough to have one. A lot of people don’t. What are the consequences Dr. Carr for both staff, nurses, and doctors like yourself, and patients when we find ourselves in this kind of a scenario?
Dr. David Carr, Emergency Physician, University Health Network: And I’m not trying to pin blame here, but I think people have to realize the importance that nurses are in terms of the glue in the health care system. And I think people don’t realize that when I come to an emergency department shift, and let’s say there are seven or eight nurses down on the internal medicine floors or the surgical floors, that means those patients in the emerge department can’t get access to a bed upstairs because those beds are closed because nowhere and no one is to look after them. And then the externalities of that lead to emergency department overcrowding. EMS, our ambulance system, our offload, they’re delayed and then people can’t get to the emergency department. And then once they get here, they can’t be seen. And once they’re seen, they can’t go upstairs for admission. So it’s a real cascade and it negatively affects patients and health care providers. We used to talk as Dr. Lim mentioned about waiting room medicine and hallway medicine, prior. I think we’ve now really shifted to just seeing patients in waiting room and in some cases, outside of the waiting room because there’s just no physical space.
Mercedes Stephenson: It’s frustrating. It’s scary. I mean, we’re all very proud of our health care system in Canada, but if you can’t get access, or when you’re waiting in pain, or very sick and sometimes with life-threatening conditions. We heard a report of one death in Quebec in the emergency room because the patient wasn’t seen in time. What’s a reasonable amount of time that we should be trying to strive to get to, Dr. Lim, for a patient to be seen when they come into the emergency room?
Dr. Rod Lim, Pediatric Emergency Physician, Canadian Association of Emergency: Yeah, I think it’s—there’s a difference between convenience and medical necessity in terms of a timely assessment. And there are guidelines in terms of—depending on triage code—when a patient should be able to be assessed by a physician, and they’re there for safety reasons. Certain complaints can be very hard to pick up and if they are having to sit in a waiting room, to no one’s fault, but far longer than any of us would like, there’s real harm. And there have been studies out of England looking at the effect of the health care system on overall morbidity, mortality of the population and it is a measurable impact when patients are unable to flow through the system. And that’s everyone’s worst nightmare. We want to do the best for our patients. It kills us to not be able to do that. And the thought of anyone waiting longer than they have to in a waiting room and something happening to them because of that is every health care workers nightmare.
Mercedes Stephenson: I guess I’m wondering who is able to fix this. I mean the feds point fingers at the province. They say it’s a provincial responsibility. The provinces say the federal government hasn’t upped health care transfers. We’ve been begging them for years. Yes, they gave us money for COVID, but the system was stretched before COVID. Just funding COVID doesn’t fix the underlying issues in the system. Others say it has to do with accreditation for doctors. It’s too hard for people who immigrate to this country to work as a doctor. It’s creating more and more of a shortage. We’re losing doctors to the United States. Where do you see the solutions to this, starting with you Dr. Carr?
Dr. David Carr, Emergency Physician, University Health Network: So I think it’s important to characterize appropriately the situation, which is no province is doing that great. Our country’s not doing that great. And internationally, there’s a global crisis in terms of emergency department wait times—this is not just a Toronto, an Ottawa, a Vancouver—we’re seeing emergency departments close, and we’re seeing wait times reach dangerous levels across the country. So neither Dr. Lim nor I are politicians, but what clear is to both of us, is that this is a nationwide problem and bigger than that. These are not simple fixes. This is a much bigger macro problem than micro fixes. Clearly, things like repealing Bill-124 which freezing nursing pay. Clearly, making it easier to increase our pool of physicians and nurse, recognizing foreign trained graduates and increasing class sizes for health care professionals will help, but let’s recall, this is not going to help this winter. And this winter, is frightening both of us, considerably.
Mercedes Stephenson: Dr. Lim, a final word to you.
Dr. Rod Lim, Pediatric Emergency Physician, Canadian Association of Emergency: Yeah, you know I’ll appeal to any parent out there. Two kids are blaming each other and pointing their finger and you know the problem is big enough for all of us to accept responsibility for it. At the end of the day, this is a complex problem, and far beyond this winter, we’re going to have to really have a serious conversation about health care and the amount of resources that are required and the amount of planning that’s required, whether it’s health human resources or whatnot. The sooner we can have an intelligent, a comprehensive conversation around it, the better the solution will be. And right now, we have an immediate problem that needs and immediate solution as well.
Mercedes Stephenson: And hopefully we find that. I know there’s many, many Canadians watching this, worried about the winter ahead. Thank you both for the time and care you give your patients, and for taking the time to speak to us and educate us this morning.
Dr. David Carr, Emergency Physician, University Health Network: All the best.
Dr. Rod Lim, Pediatric Emergency Physician, Canadian Association of Emergency: Thank you.
Mercedes Stephenson: Up next, they fought for Canada but now many say they are struggling for support. Why do so many veterans feel forgotten? And is the system failing them? We’ll find out after the break.
Mercedes Stephenson: Canada’s veterans risked life, limb and their mental health to serve in Afghanistan, Iraq and more.
Over the last decade, more Canadian veterans have died by suicide than were killed in Afghanistan.
Veterans say they are struggling to access disability benefits and a new report by the Veterans Ombudsman backs up that claim, saying vets still wait, on average, 43 weeks for decisions regarding their disability claims. The report comes at the same time as employees at Veterans Affairs Canada are actually calling for the minister to resign.
Joining me now to talk about this is Conservative MP and former Veterans Affairs Minister Erin O’Toole; Bruce Moncur, the founder of Afghanistan Veterans Association; and Debbie Lowther, who is the co-founder and CEO of VETS Canada, a charity that helps veterans in crisis. So our viewers know, we have also repeatedly reached out to the Minister of Veterans Affairs Lawrence MacAulay and he wasn’t available, but we will keep trying. This is a conversation that we’re going to have anyhow because we think it’s very important. Thank you all for joining us.
You know, Bruce I want to start with you. I’ve talked to a lot of friends and contacts and sources who are veterans in recent weeks and heard of a number of deaths by suicides. It is very painful and very difficult for the community, always and there’s a real sense of despair and concern about vets issues not getting attention. What are you seeing as an advocate right now in the veteran’s community?
Bruce Moncur, Afghanistan Veterans Association of Canada: I’m seeing that, you know, that the current government has failed to understand the problems, or even frankly, care, and the triple D policy: delay, deny, die is alive and well.
Mercedes Stephenson: Debbie, I know that you work with veterans who are in extraordinary crisis. I’ve been out of the walks that you do through downtowns, looking for vets who are on the streets, trying to help them. What are you seeing in your position right now with Canadian veterans?
Debbie Lowther, VETS Canada: We’re seeing veterans who are very disheartened. You know, a lot of them have expressed that they don’t feel valued. They don’t feel important. And, you know, to be quite honest, those—we’re hearing those complaints more and more often, especially with, you know, as you mentioned earlier, the wait times and, you know, the increasing rising prices of things, veterans are becoming more and more in crisis like other Canadians. But, you know, these are men and women who put their lives on the line for our country, so I think we owe them a lot more than what we’re providing.
Mercedes Stephenson: Debbie, what’s the consequence for some of these veterans if they have to wait 43 weeks for a disability payment?
Debbie Lowther, VETS Canada: It’s not good. You know, we’ve had to support some veterans for a lot longer than we normally would, to kind of bridge them over that time period. We’ve mentioned to many case managers about having files red zoned and what we keep hearing is that that doesn’t make a difference anymore. So in the past, a file could be red zoned and it would, you know, it would be a little bit quicker. But what we’re hearing now is that’s not effective anymore. So veterans are waiting, they’re struggling and they’re getting further and further behind and it’s having a greater impact on their mental health.
Mercedes Stephenson: That’s obviously, extremely alarming and concerning that you can be red zoned and still not get a solution. Erin, you know, the Trudeau government’s taken a lot of hits on this because they promised veterans they’d never have to fight in court that they would do better. The same problems seem to exist. You were a minister of Veterans Affairs. The Conservatives had their challenges too, but when you look at the scenario now, what stands out to you as a former minister as one of the biggest problems veterans are facing?
Erin O’Toole, Conservative—Durham: Well two-fold, Mercedes. The first is you always owe veterans and their families the truth. And the Trudeau government started by saying they were going back to the old pension system. They did not do that. They haven’t been clear on lawsuits like the Equitas lawsuit. And they said they would meet the 16-week wait time. And now you said we’re at 43 weeks. So you owe them the truth, first off. Don’t make promises you can’t keep. But second, the department, and really the Canadian Government needs to expand mental health services more, because most of the delayed cases are complex operational stress injuries and Bruce and Debbie know this because they’re on the front lines. If you don’t get that veteran and their family treatment or wellness, it could spiral into addiction, homelessness, and Debbie and her group try and find people who have already fallen through the gaps. So we have to close that wait time down and we need more options in terms of mental health treatment because physical injuries generally have one treatment option. Mental health, it may take two or three before the veteran responds, so we need to ramp up mental health supports dramatically.
Mercedes Stephenson: Bruce, you and I were speaking about mental health before the show. It’s something that we talk about frequently and it’s something that really came to the forefront in part, this summer when we broke the news that a veteran had been offered medical assistance in death, when he wanted treatment for his traumatic brain injury and his PTSD. That had a very real mental health consequence for him and for other veterans. It’s been the subject of parliamentary hearings that the minister appeared before. The department says that this is a one-off kind of accidental case. It’s not supposed to be happening. But I’m curious to hear from you, a lot of veterans felt that that was plausible, and that struck me that they would believe that the government would deliberately advance that policy. There is no evidence that that’s what’s happening. It appears to be this one particular case. But where are veterans at in their perception of how they’re being treated? And how does something like that made offer affect them?
Bruce Moncur, Afghanistan Veterans Association of Canada: Well dead veterans cost no money and I think it would be—it’s not the case manager’s job. They are not qualified to make those assessments in terms of made. And frankly, I mean the fact that it was offered, is disgusting, but the fact that the government had—how they’ve handled it since, is even worse. I asked—myself, I’m the co-chair of the Service Excellence Advisory Committee to the minister and asked for a meeting right after it happened and was denied, and then was told to wait for the meeting that would happen. Unfortunately, the Queen’s passing happened so they decided to cancel that meeting. And then just yesterday, they gave us 24 hours’ notice for a new meeting to happen yesterday and they briefly touched on the MAiD topic and frankly, called your reporting into question with some of their statements.
Mercedes Stephenson: And it’s been very difficult to get answers about this investigation. They say they’ve conducted it, but they also say there are no recordings of the calls, that they’ve reviewed files but they’re not detailing how. They’re saying investigation’s still open. Debbie, I thought it was really interesting that we heard the Union of Veterans Employees calling for the resignation of the minister. That’s pretty drastic. It seemed like he was blaming, at times, the employees during the hearing. He wasn’t necessarily taking responsibility as the minister, which I’m going to put to Erin because he’s the politician, in a moment. But from your perspective, where is the problem here? Is it the department or is it the sort of machinations and bureaucratic red tape behind the scene? Is it the minister and the government? Where does the work need to be done?
Debbie Lowther, VETS Canada: Well I think there’s—it’s a very complex issue, but I think at the core of it, is training for the Veterans Affairs case managers. That’s who we deal with every day. About 80 per cent of the referrals that we receive do come from Veterans Affairs case managers and some are very good and they know what they’re talking about. And then there are others that are just—they’re baffled by their own benefits. They can’t understand them themselves and so they can’t explain them to the veterans. So, you know, there’s a big gap there with training in benefits, I think, and now, clearly, a gap in training for, you know, things like MAiD. As Bruce said, you know, case managers are not qualified to be discussing that, nor are they supposed to be, based on the law. They’re not health care providers, so they should not be discussing it. But I think training is—would be a great first step.
Mercedes Stephenson: Erin, when you were watching these hearings on medical assistance and death and, you know, kind of felt like a bit of a shrug on both the department’s part and the ministers as oh, it’s a one-off. Yes, it’s terrible. Let’s move on. What were your thoughts on that?
Erin O’Toole, Conservative—Durham: I found it horrendous. They—they’ve already failed one family because they referred to one case worker, referring a veteran to MAiD and that they’re supporting the family. This needs to be not only the cultural training and the sensitivity training for the case workers, I agree with Bruce and Debbie. We should not be having MAiD for people with treatable mental health conditions. And particularly when a veteran feels like they’re a burden on their family and can’t access supports, they are vulnerable. And the courts going back 20 years have warned that assisted dying for people with mental health condition, if they feel that they’re a burden, they will be forced, or pushed, or pressured into accessing assisted dying, when we should be treating them. So as I said earlier, Mercedes, the—the whole department, and as a former minister, I take blame, I should have moved faster. We needed to move out mental health supports much faster as a country. It’s only been made worse by the pandemic, because we need to get those veterans treatment and wellness, not have a case manager awkwardly referring them to MAiD. That’s going to cause more harm than good. So I really don’t think we should be having MAiD in these circumstances at all, certainly not a department of the government encouraging it.
Mercedes Stephenson: Well and I know like there’s—there’s a debate from people over whether or not folks who have mental health conditions should be able to access if they can’t technically, right now. I think it’s March of 2023 that kicks in. The department can’t offer it, but nonetheless, this case work—it wasn’t even a case worker. She was just like a phone bank employee at Veterans Affairs has this discussion. Bruce what’s—what’s the effect of that kind of a discussion? Some people say well what’s the problem with veterans knowing what their options are? Why are you against that?
Bruce Moncur, Afghanistan Veterans Association of Canada: So I think this is where you’re going to start having copycats. Like suicide begets more—begots more suicides and that’s—that’s a big problem. You remember a couple of Christmas’s ago where it just seemed like there was a new veteran taking their life every day and frankly, I mean we’re having, you know, many take their lives and recently. I think that this is indicative to a department that is not well-placed in Prince Edward Island and it’s the only department that is outside of Ottawa. I think that needs to be addressed and brought back into Ottawa. And I think we’re—we’ve got a minister doing his best Joe Biden impersonation. This isn’t Ronald Reagan’s second term. We need a minister that, you know, the bar wasn’t set very high with his predecessors and he seems to be not even be able to make that. So I think, you know, with the workers calling for his resignation, I think it’s—it’s as well, warranted and frankly, as a member of advisory committee, I would—I would suggest the same.
Mercedes Stephenson: So you think the minister should resign, Bruce?
Bruce Moncur, Afghanistan Veterans Association of Canada: A 100 per cent, yes.
Mercedes Stephenson: A quick final word to you, Erin. Do you think the minister should resign?
Erin O’Toole, Conservative—Durham: This always needs to be a minister who’s very capable, very hands-on and action-oriented and Mr. MacAulay is not like that. So he’s got to either step up or step out.
Mercedes Stephenson: Thank you to the three of you for joining us. This is an issue we are going to continue to follow. It is not just when we look at it near Remembrance Day. But we very much appreciate your time and your thoughts today.
Erin O’Toole, Conservative—Durham: Thank you.
Mercedes Stephenson: Up next, what we’re watching: Finance Minister Chrystia Freeland delivers the fall economic update, and convoy organizers will testify at the Emergencies Act Inquiry. We’ll be right back.
Mercedes Stephenson: As inflation soars and the possibility of a recession looms, many Canadians are worried about what it all means for the economy.
Finance Minister Chrystia Freeland will reveal the government’s outlook when she delivers the fall fiscal update this Thursday.
And key freedom convoy protest organizers are scheduled to testify this week at the Emergencies Act Public Inquiry. We’ll keep an eye on that, too.
That’s our show for today. Thanks for watching. For The West Block, I’m Mercedes Stephenson. I’ll see you right here next Sunday, and I hope you have a great week.